Every Patient Needs an IV, or Do They?

(This post is by an author of AJN‘s January CE feature, “Evidence-Based Practice for Peripheral Intravenous Catheter Management.”)

Questioning the status quo.

As a former critical care nurse and now a vascular access nurse researcher, I’ve had the good fortune to travel widely and work with nurses from around the globe on multiple projects. As a researcher, part of my role is to question clinical practices we often take for granted and to ask, “Is this the best way? Could there be a better way?” Identifying practice that may not always be evidence-based is how research often begins.

Prior to the Covid-19 pandemic, I undertook a two-month fellowship in the US and visited several hospitals where, time and again, I noticed the majority of hospital patients had a peripheral intravenous catheter (PIVC) in place, but many were not in use. When I asked the nursing and medical staff why patients had a PIVC that was not in use, I was repeatedly told, “Every patient needs an IV, just in case.” When I pointed out that some patients had two or three PIVCs not in use, or a central venous access device as well, it became obvious that this is a common problem.

An ‘idle’ catheter is a PIVC that has […]

2023-01-11T11:41:34-05:00January 11th, 2023|Nursing, patient safety|0 Comments
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One Hospital and Community’s Rock Garden of Hope

In March 2020, Mount Sinai Queens, like many other hospitals, was overrun with patients with COVID-19. Despite layers of PPE, plus anxiety, exhaustion, and communication overload, the will to not only survive but thrive sustained the breath behind every mask. Heroes of all types were saving and soothing lives, and still are.

Outside the big front door of our hospital is a bustling ED ramp. To the left were two 18-wheel refrigeration trucks, the sight of which could take your breath away. To the far right were two 30-foot inflatable enclosed tents propped up to help the ED off-load abundant overcrowding inside. These were constant reminders that we were living through a once-in-100-year-pandemic.

An ER nurse’s creative response to a grim time.

The health care workers at the hospital weren’t the only ones subjected to these grim sights; so were our Astoria neighbors, who lived on the same block facing the ED ramp. We’ve always prided ourselves on the collaborative work we do for and with this community, including health fairs, screenings, and partnering with them on community boards. So one of us, an ED nurse named Fionnuala Quiqley (Nuala), decided to do something about it.

Nuala is a skilled and passionate ED nurse with more than 14 years of experience. She is […]

2022-12-08T10:19:25-05:00December 8th, 2022|COVID-19, Nursing|1 Comment
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A Nurse’s Lessons from Hiking the Appalachian Trail

Burnt-out and realizing it’s time for a change.

I had always been able to juggle family, school, and work life well, including roles as class mom, scout leader, and community volunteer, completing my doctorate in nursing, and working two jobs. But at a certain point, and despite my supportive family’s efforts, I began to burn out. Working as a nurse leader for a behavioral health unit was a dream come true and a nightmare all in one. I found myself caring so much, investing so much of myself, that I lost myself in the process.

In the hope that it would help, I moved back to nursing education. It didn’t. There was a void. I was missing something. I was missing me.

Maybe this is what burnout on the way to compassion fatigue feels like. But whatever we call it, my response was to quit my job and hike the Appalachian Trail for five months from Maine to Georgia with my husband. We’d always lived simply, and once we’d made the decision to go, the pieces fell into place.

Along the way, I made many discoveries. It’s paradoxical that I’d gone hiking to forget about nursing, yet I was reminded about it with each step.

Here are some souvenirs from the […]

2022-11-15T12:02:55-05:00November 15th, 2022|Nursing, nursing stories, wellness|0 Comments
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Primary Nursing of Medically Complex Children in the ICU Increases Parental Trust

Differing views about quality of life.

Photo by Pat Smith/Pexels

As medical care has become increasingly advanced in its ability to prolong life in the face of serious, chronic illness, it has also presented complicated challenges for both the caregivers and care-receivers alike. This holds especially true when we venture into the thorny, subjective realm of “quality of life.”

Sam was a patient with serious chronic illness and severe developmental disability who had been in and out of our pediatric ICU for many years. His most recent nine-month hospitalization had been the most frightening and uncertain thus far, and the gap between the perspectives of the medical team and Sam’s mom had became more apparent. The medical team speculated whether Sam was approaching the end of his life, while his mom asked us to continue doing all we could to maximize Sam’s physical longevity.

Unspoken questions also involved our struggle to measure what exactly comprises “enough” quality of life to justify the continued offering of health care resources. It’s an inevitable struggle with scarce resources and the monetization of quality of life, particularly with a chronically ill, severely disabled child who can feel so “other” to those of us living “normal” lives.

Parents come to our unit seeking care […]

2022-09-14T10:01:23-04:00September 14th, 2022|family experience, nursing roles, pediatrics|1 Comment
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Keeping Current with Cardiac Device Technologies

“If nurses understand the purpose of cardiac devices and the care of patients receiving them, they will be better equipped to teach patients to be confident in their own self-care.”

When I was an RN in the cardiac electrophysiology lab, we frequently performed device implants or procedures for patients with heart failure. When giving report to the telemetry nurses, I often felt I didn’t have enough time to fully explain the background for the procedures we performed.

In my CE feature article in AJN‘s June issue, “Guideline-Directed Cardiac Devices for Patients with Heart Failure,” I share an exemplar of a patient who had one of these procedures—an implanted cardioverter/defibrillator with cardiac resynchronization therapy. If nurses understand the purpose of cardiac devices and the care of patients receiving them, they will be better equipped to teach patients to be confident in their own self-care.

It is challenging to keep up with the advances in health care devices. In the article, I also describe some other recent cardiac technologies. Patients with any these devices may be seen in a variety of inpatient and outpatient settings, and nurses may benefit from a general understanding of their purpose and patient care. […]

2022-07-05T09:28:04-04:00July 5th, 2022|Nursing|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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