‘Micro’ and ‘Macro’ Strategies for Nursing to Thrive as a Profession

At last month’s annual convention of the Academy of Medical-Surgical Nurses (AMSN), nurse and health care economist Peter Buerhaus received the Anthony J. Jannetti Award “for extraordinary contributions to health care.” Buerhaus, a professor of nursing at Montana State University College of Nursing, is widely known across health care disciplines for his research on health care costs and value, especially in regard to nurses and nursing. In his keynote talk, Buerhaus shared some of his recent research findings and offered some “micro” and “macro” nursing strategies for thriving amid today’s health care challenges.

Nurses maintain status as highly trusted professionals.

Click to expand. Most trusted professions, Gallup 2017 poll.

He began by reminding the group of some of the reasons that nurses are respected and trusted in America. People believe that nurses ensure quality of care, protect patients and maintain safety standards, and provide advice on personal health issues.

Studies show that we maintain this trusted status even when the media reports on the mistakes of individual nurses. And after good media attention, as when Alex Wubbels protected her patient or when nurses play key roles in disaster relief efforts, our approval ratings soar.

Accomplishments of NPs have reinforced good reputation of nurses.

2017-11-17T10:20:27+00:00 November 15th, 2017|Nursing, nursing research|0 Comments

Sepsis Perfusion Assessment: A Matter of Seeing and Touching

A heightened level of care.

Sepsis is estimated to strike up to 3.1 million people in the United States each year, and in 2014 resulted in over 182,000 deaths. Patients who develop sepsis are subjected to an onslaught of procedures and interventions, from cardiac monitoring and transfer to the ICU to frequent blood sampling and insertion of central lines and urinary catheters. It is a frightening experience and requires attention to the patient’s experience and interventions to mitigate stress.

According to a clinical feature article in our October issue, “Assessing Patients During Septic Shock Resuscitation,” the revised six-hour bundle from the Surviving Sepsis Campaign includes a recommendation that, after initial fluid resuscitation, patients’ perfusion and volume status should be reassessed.

Noninvasive bedside indicators of perfusion and volume status.

click image to expand

This article focuses on measuring capillary refill time (CRT) and the skin mottling score (SMS; see figure at right) and details the evidence underlying the correct way to perform these assessments and how to incorporate findings into the overall plan of care.

One of the key advantages of these two measurements is that they are noninvasive and require no equipment—just the eyes and touch of an astute nurse—yet they are highly valuable in the overall indication of whether resuscitation […]

2017-10-27T10:05:47+00:00 October 27th, 2017|Nursing|0 Comments

Tips for Nurses to Counter Workplace Negativity

“Negativity is a lot like cigarette smoke. If it’s around, you know it.”

The 26th Annual Convention of the Academy of Medical-Surgical Nurses (AMSN) took place October 12-15 in Palm Springs, California. More than 1,100 nurses from across the country as well as Canada, Saudi Arabia, Puerto Rico, and the Bahamas came to network, attend educational sessions, and enjoy stimulating company.

Negativity as a default response to workplace stress.

The opening address by Sharon Cox, “Staying Positive While Working with Pearl and Grumpy,” set an enthusiastically constructive tone for the four-day conference. Cox, a former staff nurse, unit manager, and medical center administrator, shared practical suggestions for managing the “stress, drama, and trauma” of today’s health care workplace.

Cox pointed out how easy it is in the current environment to turn on each other, see ourselves as victims, and create negativity that affects our personal health and working relationships—and also affects patients and their families. Said Cox, “Negativity is a lot like cigarette smoke. If it’s around, you know it.”

Good habits are intentional.

Cox emphasized the value of cultivating our ability to remain positive in the midst of daily challenges. There are options in virtually every situation—and, she emphasized with a smile, we are not talking about options to change the behavior of others and tell them […]

2017-10-25T14:39:45+00:00 October 25th, 2017|Nursing|0 Comments

Workarounds May Work, But They Perpetuate Dysfunction

Photo © Associated Press

A couple of months ago, we posted a query on Facebook asking visitors to the page if they had ever used workarounds—the improvised shortcuts that may not be the standard practice or the policy, but may allow for more efficient work processes. We were amazed at the uniformity of the responses. No one saw a problem with workarounds, and most responded along the lines of “I love my workarounds—couldn’t do my job without them” and “I’ll never tell—keep hands off my workarounds.”

Nothing new.

Workarounds have probably been around since Florence Nightingale’s day—I can imagine one of her nurses at Scutari hiding lamp oil so she’d have enough to make rounds at night. In my early nursing days, we hid sheets so we’d have some in case we needed an extra bed change for a patient. When I worked in the ER of a busy city hospital, we kept a pretty large supply of IV fluids and medications on hand in a closet. It became a well-known secret that the ER had its own stockpile—in fact, there were occasions when the pharmacy would come to us for meds!

Today, the workarounds I hear about tend to revolve around dealing with the electronic health record and scanning medication bar codes.

Some cautions.

In this month’s article, “Workarounds Are Routinely […]

Easy to Judge Patients for their Choices, Harder to See Them as Individuals

This month’s Reflections essay, “Someone’s Son,” is by Jami Carder, now an RN case manager at the Visiting Nurse Association of Cape Cod. In it, she looks back to a formative nursing experience.

I started my nursing career as a floor nurse. Our patients were complex, and though it seemed we never had enough time or staff, it was important to give them the care they needed and deserved…. [I]t was frustrating to feel that any time was being ‘wasted’…. I remember complaining, at such times, about not being able to take care of my other patients who were ‘really sick.’

By Eric Collins/ecol-art.com.

Who ‘deserves’ care?

Wasted here is meant as code for spending valuable patient care time on patients who are sick because of unhealthy behaviors: in this essay, substance abuse. But we might also then include smoking, overeating, lack of exercise, and so on.

The potential list of unhealthy behaviors is long. And the question of choice is slippery, to say the least. It’s always before us in our personal lives, moment to moment—and by extension, for nurses at the bedside, and in how we as a society think about health care and who ‘deserves’ it. […]

2017-10-11T12:17:07+00:00 October 11th, 2017|Nursing|0 Comments