Experienced Bedside Nurses: An Endangered Species?

“The trend toward our hospitals being primarily populated with nurses with less than two years’ experience is worrisome.”

At least three colleagues who’ve recently been patients in hospitals or had family members who were have remarked on the youthful nurses they encountered—and on their lack of experience. In two of the conversations, my colleagues cited instances in which this lack of experience was detrimental to care, one of them dangerous. That “sixth sense,” that level of awareness that comes with lived experience and becomes part of expert clinical knowledge, is important for safe, quality patient care.

In the February editorial, I report on the answers I received when I queried our editorial board members about new nurses’ inclination to work in acute care for only two years to gain experience and then leave to pursue NP careers. Many of the board members have seen a similar trend, one reflected by research on nurse retention, some of it published in AJN (most recently, see Christine Kovner’s February 2014 study on the work patterns of newly licensed RNs, free until February 6). […]

2018-01-29T09:54:37-05:00January 29th, 2018|career, Nursing, nursing roles, patient safety, Patients|28 Comments
Read More

Helping Family Caregivers with Fall Prevention in the Home

“Because mobility in later life results in positive health benefits but increases exposure to falls, many researchers and health care providers in geriatric nursing and medicine have called for ensuring safe mobility while protecting older adults from harm. It’s especially important to identify strategies that can potentially reduce the risk of fall-related injuries in older adults.This increasing focus on fall-injury prevention—in addition to fall prevention—represents a major shift in safety practice.”

(Click image to enlarge)

How can nurses best help family caregivers?

How can nurses help family caregivers identify fall risk in their family members, prevent falls, and respond to them if they occur?

According to the authors of “Preventing Falls and Fall-Related Injuries at Home“—the latest in our ongoing series of articles and videos, Supporting Family Caregivers: No Longer Home Alone—the need for better education and resources on such topics is widespread among family caregivers:

“In a national survey of caregivers who provide unpaid care to a relative or friend, 46% reported they assisted with medical and nursing tasks. Of these, 43% said such help involved the use of assistive mobility devices, such as walkers or canes. Almost half of family caregivers are also known […]

2018-01-25T10:24:11-05:00January 25th, 2018|family caregiving, family caregiving, Nursing, patient safety|0 Comments
Read More

Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had promised […]

2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments
Read More

A Dream of Horses: An Aging Veteran’s Healing Encounter

“Let’s go for a ride,” I said to Joe as he lay expressionless on his bed, covered in blankets and staring at the ceiling. The room was stuffy with hot, stale air. No bigger than a walk-in closet, the space held the lifetime possessions, many of them scattered on the bed, floor, and windowsill, of a 75-year-old veteran residing in an assisted living facility. Joe appeared frail and bored in the silence of the room.

Illustration by Janet Hamlin for AJN.

That’s the start of the Reflections column, “A Dream of Horses,” in the January issue of AJN. Written by a nurse at the Department of Veterans Affairs, the short, moving essay describes a series of healing encounters between a frail older man, who seems to have given up on life, and the horses at a therapeutic equestrian barn.

The here and now.

The story told here reminds us how much we humans can cocoon ourselves against the more elemental forces of the natural world, and how healing it can be to encounter a magnificent animal that asks only that we be present in the here and now. The senses awaken. We look beyond our own habitual ways of thinking […]

2018-01-16T10:00:35-05:00January 16th, 2018|Nursing, nursing stories, Patients|0 Comments
Read More

Simple Intervention Decreases Oral Mucositis from Head and Neck Cancer Treatment

A painful effect of cancer treatment.

Nurse Cindy Dawson provides patient education on oral care kit used in a nurse-led intervention to reduce oral mucositis severity in adults treated for head and neck cancer. Photo courtesy of Kay Klein.

Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.

While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.

Consistent, standardized oral care.

After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with oncology […]

2018-01-12T09:13:13-05:00January 12th, 2018|Nursing, nursing research, patient experience|1 Comment
Read More

Comment ground rules

1. Please be respectful.
2. We moderate all comments.

Content disclaimer

Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
Go to Top