Off the Charts

When a Patient Turns Scary, a Nurse’s Options Aren’t Always Clear

I was leaning over my patient, listening to his lung sounds, when his hand tightened around my wrist. “Why don’t you get in the bed with me?” he said.

Illustration by McClain Moore

That’s the arresting opening of “The Squeeze,” the Reflections essay by nurse Danielle Allen in the September issue of AJN. Such scary experiences happen, as many nurses can attest. What behaviors cross the line? Who decides? After all, nurses put up with lots of challenging behavior. What’s unacceptable, and what constitutes a real safety issue?

Complicating these questions may be the responsibility a nurse feels to not let down their equally burdened nursing colleagues. No one, as Allen writes, wants “to be that nurse. You know, the complainer, overly sensitive, not-a-team-player nurse.”

Allen vividly evokes her encounter with the patient, the varied responses of nursing colleagues later, the emotional aftereffects of the event, and the larger question she finds herself asking about what can be done to keep nurses and other health care workers safe. […]

Jacob Molyneux, senior editor/blog editor2017-08-28T08:37:02-04:00August 28th, 2017|Nursing, nursing stories|1 Comment

AJN September Issue: Family Caregivers and Alzheimer’s, Older Adults and Driving, C. Diff. Prevention, More

The September issue of AJN is now live. Here are some articles we’d like to bring to your attention.

CE: Original Research: The Experience of Transitioning to a Caregiving Role for a Family Member with Alzheimer’s Disease or Related Dementia

This qualitative study explores the experiences of people who transitioned to the role of caregiver for a family member with Alzheimer’s disease or a related dementia. Vivid interview excerpts illuminate the inner struggles caregivers may experience as they navigate a radically changed existence as well as the strategies that have helped them find their way.

CE: Can Your Older Patients Drive Safely?

Many older Americans depend on their cars for independence and connection to the outside world. What are the driving risks associated with advanced age? What behaviors and situations put older drivers at greatest risk, and what are the key indicators of an older patient’s ability to drive safely? Nurses are in a position to raise patients’ awareness of these risks and inform them about transportation alternatives.

Six Things You Can Do Today to Prevent Hospital-Onset C. Difficile Tomorrow

What changes can you make in your practice to prevent transmission of this common bacterial infection?

Lessons Learned from Litigation: Legal […]
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Diane Szulecki, editor2017-08-25T09:03:28-04:00August 25th, 2017|Nursing|0 Comments

How I Spent My Summer: Funding the Cost of a Nurse’s Education

Photo by Julianna Paradisi/2017

At a neighborhood grocery store, I picked up a few items for dinner, one of which was a preroasted chicken still warm and juicy from the heat lamp display.

After ringing up the total, the checker began bagging my purchases. Before placing the chicken in a bag, she put a rubber band around the container to prevent it from accidentally opening, and then wrapped it in a separate paper bag as a further precaution against leakage.

I thanked her for the extra care. No one waited behind me, so we exchanged a bit of small talk. It was a weekend, and she asked if I had plans. “No, my husband and I work in health care, and it’s his weekend on,” I said.

“What area of health care?” she asked. I told her I’m a nurse and work with cancer patients. Expecting the cringe I usually get from laypeople when I say this, I quickly added, “It sounds sad, but I really love my work.”

Her face lit up. “I’m a nursing student! I’m taking exams to become a CNA so I can work with patients while I finish my BSN.”

Her news delighted me. I have strong intuition, and I felt sure she would make a terrific nurse. I congratulated […]

Julianna Paradisi, RN, OCN2017-08-22T15:07:48-04:00August 22nd, 2017|Nursing, nursing students|2 Comments

Tuberculosis: Nurses Play Critical Role in Prevention, Diagnosis, Treatment

Mantoux skin test/CDC PHIL

In the U.S., the chances are that tuberculosis isn’t on your mind a lot. Most of us focus on TB only when we have a patient on airborne precautions—or when we’ve been exposed to TB at work.

Globally, TB was one of the top 10 causes of death in 2015. In the U.S., after a spike in cases early in the HIV epidemic, the incidence of TB has fallen to about three cases per 100,000 people. In TB-endemic countries, incidence rates run into hundreds per 100,000. But with TB elimination defined as a rate of less than one case per million people, we are far from eradicating this disease in the U.S. In fact, the number of TB cases in the U.S. rose slightly from 2014 to 2015.

Also, of course, nurses often work with people who are at high risk of acquiring TB—transplant recipients, others who are immunocompromised, people with HIV or certain cancers, those who are refugees or homeless—increasing our own risk for the disease as well. Therefore, the low overall U.S. incidence rate doesn’t reflect the experience (or risk) of most nurses. (And if you are “PPD positive,” click here for some reminders about what that should mean to you as a nurse: “Nurses and Latent TB Infection.”) […]

Betsy Todd, MPH, RN2017-08-18T08:58:20-04:00August 18th, 2017|infectious diseases, Nursing, Public health|2 Comments

Designing Nurses: Make Your Ideas Reality

“At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher…”

Earlier this month, the New York Times published an article, “Design Thinking for Doctors and Nurses.” In it, the author describes a simple solution designed by a nurse to identify who was in charge of a resuscitation team: whoever was wearing the orange vest was the leader.

As a former ED nurse who participated in many codes and trauma emergencies, I could easily picture the chaotic scene that led to this innovative solution. In a large urban teaching hospital, cardiac arrests and trauma calls draw many physicians and medical students, respiratory therapists, and of course, at least two to three nurses. It wasn’t unusual to have conflicting orders shouted out by physicians, residents chiming in with questions and suggestions, and the medication nurse making the decision as to which order she/he would process. At one hospital I worked, nurses used masking tape to outline a box on the floor around the resuscitation stretcher—only the physician in charge and resuscitation team were allowed inside the box. All other onlookers (mostly medical students and residents) had to stay outside the box and be silent. It did wonders for instilling a quiet, organized atmosphere into a highly charged event.