Will your ‘RN’ Name Tag Protect You from Violence?

When I stepped into the entryway, I was met by a group of men, crouched on the floor over a game of craps and shouting excitedly. One of them stood up when he saw me come through the door . . . He dropped the dice, pulled a gun from his waist, and pointed it at my face.

Workplace violence prevention training has become the latest mandatory education module in many hospitals. But what about nurses who work in non-hospital settings? In this month’s Viewpoint, “Workplace Violence Outside the Hospital Setting,” NP and visiting nurse Joanne Schmidt describes the terrifying situation she walked into one day at the start of her morning home visits.

In many community settings, no cameras or security staff.

Schmidt points out that nurses who work in home care, mobile medical vans, school clinics, and other community-based settings may be considerably less safe every single day than those of us who work in relatively protected hospital environments. At least in acute care there are cameras and security staff! […]

2020-02-20T10:55:11-05:00February 20th, 2020|Nursing, nursing stories|1 Comment
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Can We Ever Overcome Burnout in Nursing?

Reality shock redux.

Flickr / Harshit Sekhon

It seems to me that we’ve been talking about burnout about as long as I’ve been in nursing, and that’s over 40 years. In 1974, Marlene Kramer’s book Reality Shock: Why Nurses Leave Nursing reported on how nurses’ dissatisfaction with their inability to practice as they were taught was a major factor in their leaving the profession. (Here’s AJN’s 1975 review of the book.) In the 1980s, it was the downsizing of staff that caused many to leave (see the February editorial for my own experience). In the last decade, as health system changes and staffing (again) engendered moral distress and burnout among members, nursing organizations sought ways to mitigate distress among nurses.

Burnout’s persistence as an issue.

But the issue persists and arguably has gotten worse, with increasingly alarming reports of high levels of burnout—between 34% and 54% physicians and nurses report symptoms—and suicides.

To address the problem, the National Academies of Science, Engineering, and Medicine (NAM) established a 17-member committee to review the research on the […]

2020-02-18T11:56:44-05:00February 18th, 2020|Nursing|1 Comment
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Polypharmacy in the Elderly: The Risks Often Outweigh the Benefits

“…the single greatest adverse drug event risk factor is the number of medications a patient takes.”

Lessons from speaking to elders about their medications.

Early in my career, I taught groups of seniors about common medications as part of a hospital-based community health program. I traveled around the Chicago area, speaking to groups at senior centers, apartment buildings, and places of worship about their health and medications.

As part of our program’s mandate to educate physicians and nurses as well, we interviewed many elders on film, asking them to tell us about their medications. I will always remember one lady, relating a friend’s problems with adverse drug effects. “He’s dead now,” she stated with finality. She made it clear that she blamed his demise on the drugs his doctor had prescribed.

My experience in the Chicago medication education program influenced my pharmacology lectures to nursing students. Students may remember me most for the many times I repeated this statement: “The first sign of an adverse drug reaction in an older person is often a change in mental function.” This is a central reality of drug effects on the elderly.

Paying attention to unexplained cognitive changes.

Yet even today, the default response of many prescribers […]

2020-02-03T08:54:32-05:00February 3rd, 2020|Nursing|0 Comments
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Putting Down Her Burden: A Patient’s Final Choice

‘goodbye, inhaler!’

Chronic illness as a Sisyphean bargain.

Sisyphus was a legendary king of ancient Greece who was condemned by the gods to eternally roll a rock up a hill, only to have it roll down again each time as it neared the top.

Many people with chronic illness today may be able to relate. Chronic illness can mean years or even decades of worsening symptoms and ever more complex medication and treatment regimens, side effects of treatments, treatments for side effects, monetary pressures, activity limitations, a sense of separateness from the legions of the merely ‘walking worried’ around us, and the subtle pervasive tension and vigilance of never quite knowing what might come next.

The ironies of advanced medicine.

The assumption, of course, is that all the effort is worth it. And it is: many of us benefit from, or know people who benefit from, drugs that keep them alive when 50 or 100 years ago they would have died long ago, or keep them able to walk, or breathe without a struggle, or sleep without excruciating nerve pain or the itching of terrible skin sores, and so on. Life has always been about compromise; these are simply new refinements of a universal equation.

2020-01-23T10:03:01-05:00January 23rd, 2020|Nursing, nursing stories, patient experience|1 Comment
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Dissonance and Harmony: Balancing Nursing and Home Life During the Holidays

Between worlds.

There is nothing quite like the holiday season in a culture obsessed with happiness at all costs to make me feel the complexity of navigating back and forth between work and home life as a pediatric ICU nurse.

Home life as a mother to two young children, wife, friend, and community citizen takes on an intense pace from just before Thanksgiving through the new year. I am coordinating celebrations with family and friends, keeping tabs on the kids’ school holiday programs, addressing Christmas cards, and deftly dodging BOGO promotional emails day and night. Life feels boundless with possibilities for activity and opportunity.

I arrive at work and enter the room of my patient, whose life has been brought to a screeching halt. She lies sedated, restrained by lines and tubes, barely oriented to day versus night. If not for the holiday decorations that we put up around the unit, there may be no indication of what season it is.

What is cheerful for me to anticipate at home during the holidays may be potentially disheartening for my patients and their families to consider. I can leave the hospital at will. They cannot. I am sensitive to this fact, and my demeanor when I talk about the holidays at work becomes sober. […]

2019-12-12T10:47:01-05:00December 11th, 2019|Nursing, nursing perspective, wellness|0 Comments
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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.
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