nursing perspective Archives - Page 81 of 158

The ACA and Me: A Dispatch From the Trenches

Argonauta: The Beach at My Back/ oil stick on paper, 2010 by Julianna Paradisi

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

“Reality is the leading cause of stress among those in touch with it.”—Jane Wagner

By 2014, up to 30 million Americans will have gained access to health care insurance under the Affordable Care Act (ACA). As a nurse human being, I support increased access to health care. However, it is naive to believe it can be accomplished without sacrifice.

My job is a casualty of the ACA.

But let’s backtrack:

It’s more accurate (but less dramatic) to say that our country’s need of better health care delivery significantly affects my job. Most hospital nurses are familiar with Medicare tying reimbursement to patient outcomes. Further, built into the ACA is a requirement that hospitals expecting Medicare reimbursement form accountable care organizations (ACOs):

Under the proposed rule, an ACO refers to a group of providers and suppliers of services (e.g., hospitals, physicians, and others involved in patient care) that will work together to coordinate care for the patients they serve […]

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Jacob Molyneux, senior editor/blog editor2016-11-21T13:07:22-05:00June 5th, 2013|nursing perspective|6 Comments

At Least Once in Every Nursing Career: Final ICN Congress Recap

By Maureen Shawn Kennedy, AJN editor-in-chief

from Great Ocean Road in Australia

Here’s a final recap of my trip last week to the 25th quadrennial congress of the International Council of Nurses (ICN). (My previous posts on this year’s ICN events are here and here; there’s also a podcast of my interview with outgoing ICN president Rosemary Bryant.)

My final few days were busy with sessions as well as a meeting with some members of AJN’s International Advisory Board. Here are some highlights:

Nurses and the Nazis. A session on ethics led by Australian nurse Linda Shields examined nursing in Nazi Germany and discussed how nurses might have rationalized participation in Nazi euthanasia and killing programs. She noted that aside from the usual “just following orders” mantra, obedience was tied to housing and livelihood, as well as to the belief that “the health of the volk (community) was more important than the health of the individual.” (The topic brings to mind our 2009 article, “The Third Reich, Nursing, and AJN” [abstract only], which made the case that “in the interest of promoting international cooperation and an image of nursing unity, AJN shirked its duty to hold German […]
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Shawn Kennedy, MA, RN, FAAN, editor-in-chief (emerita)2018-03-28T10:30:55-04:00June 4th, 2013|career, nursing perspective|0 Comments

Using Evidence-Based Practice to Reduce CAUTIs

By Karen Roush, AJN clinical managing editor

Using evidence-based practice to . . .

Fill in the blank. There’s something on your unit that could be improved—the rate of ventilator-associated pneumonia (VAP), the engagement of family in care, the readmission rate of patients with heart failure, patient satisfaction with pain management. Whatever it may be, you have the ability to improve it. This month we have a CE article (link is below) about an evidence-based practice (EBP) project to reduce catheter-associated urinary tract infections (CAUTIs).

Scanning electron micrograph of S. aureus bacteria on the luminal surface of an indwelling catheter with interwoven complex matrix of extracellular polymeric substances known as a biofilm/ CDC

The really interesting thing about this article, and what makes it especially helpful for beginner quality improvers out there, is that it doesn’t just describe an effective project to reduce CAUTIs. It also describes how to do an EBP project, step-by-step. The author, Tina Magers, a novice EBP mentor, followed the seven steps outlined in AJN’s Evidence-Based Practice series and describes the actions involved in each step. It’s a great how-to on applying evidence to practice. Here’s the overview/abstract of this useful June CE article, “Using Evidence-Based Practice to Reduce Catheter-Associated Urinary Tract Infections”:

Overview: In […]

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Guest Author2017-05-27T10:29:02-04:00May 31st, 2013|nursing perspective|0 Comments

On Its Own Terms: An ICU Nurse Considers Human Adaptability

By Marcy Phipps, RN, a regular writer for this blog. Her essay, “The Love Song of Frank,” was published in the May (2012) issue of AJN. Some of the patient’s identifying details in this post have been changed to protect privacy.

by ashraful kadir/ flickr

I caught an airing of The Shawshank Redemption the other day. It’s one of my favorite movies—full of irony and rich with messages of hope and perseverance.

There’s one line from the movie, in particular, that I love:

“Get busy living, or get busy dying.”

It’s one of my favorite movie quotes, and one that plagued me at work recently as I took care of a woman who’d suffered such a high-level fracture to her cervical spine that her injury was compared to an internal decapitation.

Her doctors had talked with her and her family at length about her injuries and prognosis, and although she’d initially indicated that she wanted to withdraw aggressive care, as time passed her directives became inconsistent—she’d tell her husband one thing, her medical team something else. On the day I was her nurse, she looked at me and very clearly mouthed the words “I don’t want to die,” then shut her eyes tight, ending our brief conversation as effectively as if she’d stood and left the room.

I think that most of the time, at least in the ICU where I work, people aren’t “getting […]

Marcy Phipps, BSN, RN, CCRN, CFRN2016-11-21T13:07:26-05:00May 30th, 2013|Nursing, nursing perspective, Patients|3 Comments

The Best Nurses Day Gift: Enough Time With Patients

What’s Left Behind, oil, graphite, and mixed media on wood panel. 18″ by 18.” Copyright J. Paradisi.

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

I can’t remember which handle on Twitter asked nurses last week for their stories about the best or worst Nurses Day gifts from their employers, so I will tell mine here. It began badly, but became the best.

Nurses Day in May is a cute little rhyme. In Oregon, where I live, May also brings hay fever allergy, which is neither cute nor rhymes, but like Nurses Day, is an annual event.

I woke up on the morning of Nurses Day with a headache and my voice hoarse from allergy. Previously, I had traded shifts to work this day in place of another nurse with an acutely hospitalized family member. If she and I were playing Rock, Paper, Scissors, her need was scissors to my paper.

Calling in sick was not an option. It’s part of the unwritten Nurse’s Code, which is really more of a guideline, but don’t test it. Calling in sick after agreeing to work for a coworker will not garner sympathy from your unit.

When I arrived for work, another nurse remarked that my hoarse voice sounded sexy, like actress Kathleen Turner’s. Despite my crankiness from inadequate respiratory gas […]

Julianna Paradisi, RN, OCN2016-11-21T13:07:32-05:00May 22nd, 2013|career, Nursing, nursing perspective, patient experience, Patients|2 Comments