Nurses spend more time with patients than most other types of providers and have unique insight into patient care and the the healthcare system.

Enough Rants: On Fostering Meaningful Dialogue

Karen Roush PhD, RN, is an assistant professor of nursing at Lehman College in the Bronx, New York, and founder of the Scholar’s Voice, which works to strengthen the voice of nursing through writing mentorship for nurses.

Angry woman, Ranting By Amancay Maahs/Flickr

“Patients are never satisfied!” “Only bedside nurses really understand nursing!” “Management always takes advantage of you!”

These are examples of the types of statements I’ve heard recently, whether talking with other nurses or reading blogs or other social media. Often presented as contributions to discussion, in reality they are rants—more interested in eliciting rote agreement than in true dialogue. This has got me thinking about how we create dialogue, especially about topics that stir an emotional response—particularly when anger is front and center. I’m a firm believer that:

  • creating dialogue is necessary and transformative
  • strong emotions are often the impetus for needed change

But we can’t allow emotions to dominate. When they do, our discussion is no longer a dialogue; it’s a rant. And rants are not productive for creating change. They eat up the energy that could otherwise be directed to positive action.

So, how do we do create dialogue about the issues that get our backs up? Here are my thoughts:

So You’re a Nurse With a Story to Tell…

Madeleine Mysko, MA, RN, coordinator of AJN’s monthly Reflections column, is a poet, novelist, and graduate of the Johns Hopkins Writing Seminars who has taught creative writing in Baltimore for many years.

karindalziel/ via Flickr Creative Commons karindalziel/ via Flickr Creative Commons

Whenever I meet someone new who happens to be a nurse—in both clinical and social settings—I wait for the right moment to mention my work at AJN on the Reflections column. It’s not only that I’m proud of the column. It’s also that I’m forever on the lookout for that next submission—for a fresh, compelling story I just know is destined to shine (accompanied by a fabulous professional illustration) on the inside back page of AJN.

“I imagine you have a story or two to tell,” I’ll say to a nurse I’ve just met—which is the same thing I say, whenever I have the chance, to nurses I’ve known for years. I mean it sincerely; given the vantage point on humanity that our profession affords, I actually do believe that every nurse is carrying around material for a terrific story.

The response I usually get (along with a wry smile, the raising of eyebrows, or a short laugh) is, “Oh yes. I have stories.”

But then—even as I’m mentioning the Reflections author guidelines, even […]

AJN in February: Rapid Response Teams, Complications of CHD Repair, Managing Type 2 Diabetes, More

AJN0215 Cover OnlineAJN’s February issue is now available on our Web site. Here’s a selection of what not to miss.

Rapid response teams (RRTs) are teams of expert providers who can be called on in an emergency to treat patients before their condition deteriorates. The success of an RRT depends on whether it is activated properly, a task that often falls to staff nurses. The original research article, “Hospital System Barriers to Rapid Response Team Activation: A Cognitive Work Analysis,” describes the factors affecting nurses’ decisions to activate RRTs. This CE feature offers 3 CE credits to those who take the test that follows the article.

Further explore this topic by listening to a podcast interview with the author (this and other free podcasts are accessible via the Behind the Article podcasts page on our Web site, in our iPad app, or on iTunes).

Long-term complications after congenital heart defect (CHD) repair. Nurses often encounter patients with complications that occurred years after CHD repair. “Long-Term Outcomes After Repair of Congenital Heart Disease: Part 2” reviews four common CHDs, their repairs, common long-term outcomes, and implications for nurses in both cardiac and noncardiac settings. This article offers 2.5 CE credits to those who take the test that follows the article.

Making nurses full partners in reforming health care. The Institute of Medicine’s report, […]

Nursing Perspective: Why I Work in Corrections

By Megen Duffy, BA, BSN, RN. Her blog is Not Nurse Ratched.

Michael Coghlan/Flickr Michael Coghlan/Flickr

When I go to work, I go through a metal detector (did you know Danskos contain metal?), and all my belongings are scanned or gone through. I check out keys and a radio, and then I go through a series of sally ports to get to the medical area. I count every needle and pair of scissors I use. I never see patients without an armed guard nearby, and a good portion of my patients are cuffed and shackled. I’m on camera from the second I get out of my car.

Welcome to prison, nursing style!

“Why?” people ask me. “Couldn’t you get another job? Aren’t you scared? Didn’t you like the ER?” I worked in critical care/emergency nursing for a long time, and yes, I did like it. I brought those skills with me to corrections, where they are a lock-and-key fit. A surprising number of corrections nurses are ex-ER nurses. The same personality types work well in both settings.

Corrections nursing involves phenomenal nursing autonomy and uses many of the skills I honed in the ER:

  • quick triage
  • multitasking
  • sorting out who is lying from who is sick
  • knowing which assessments are the most important for each situation

The atmosphere tends to be quirky to chaotic and requires imagination, flexibility, and an ability to […]

2016-11-21T13:03:08-05:00January 23rd, 2015|career, Nursing, nursing perspective|21 Comments

Cassandra’s Refusal of Chemo: Nurse Ethicist Ponders Ethics of Forcing Treatment

Douglas Olsen is an associate professor at the Michigan State University College of Nursing in East Lansing and a contributing editor of AJN, where he regularly writes about ethical issues in nursing.

scalesThe case of Cassandra, a 17-year-old female in Connecticut being compelled by the court to undergo chemotherapy for Hodgkin’s lymphoma, has aroused interest in the media and among bioethicists, who have offered mixed conclusions. (Here’s a recent update on Cassandra’s legal status.) For example, Ruth Macklin concludes that the actions taken to force the treatment were not justified, while Arthur Caplan concludes that compelling her to have the chemo is justified. Both are scholars of the highest order.

I agree with Caplan that she should be given the chemotherapy, but my purpose here is to illustrate that perspective plays an often unacknowledged role in ethical analysis. When feelings and personal perspective go unacknowledged, the analysis loses credibility and depth.

The principles in conflict in this the case are straightforward for ethicists: respect for autonomy versus beneficence.

As a society, we value control over personal choice, that is, autonomy, which would mean honoring Cassandra’s decision to forgo the chemo. The chief justification for overriding a patient’s autonomy is that the patient lacks decision-making capacity because she is a minor.

However, we also value doing what is […]

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