Mild Cognitive Decline or Physical Limitations: What’s a Nurse to Do?

Noticing small changes in what’s possible.

I worked for many years in infection prevention and control, and loved it. Still do. But I loved bedside work too, and it was always in the back of my mind that I might one day return to staff work. That is, until I took care of a family member during the last year of his life.

While I think I provided him with reasonably good care—let’s not get into the emotional connection that made me a less objective caregiver than were his fantastic CNAs—there was no fooling myself any longer. After years away from the bedside, my assessment skills have slipped. I’m not used to working while wearing glasses (without which I can’t read labels or check for reddened skin or cloudy urine). And arthritis in my wrists meant that those bed-to-walker transfers were not optimally safe.

What about multitasking, 12-hour shifts?

My difficulty in providing physical care made me wonder whether my cognitive skills, too, might not be up to managing the pace and pressure of floor work today. I may still be good at supporting and teaching, but can I multitask through 12 hours of nonstop problem-solving and decision-making?

In “When Is It Time to Leave Nursing?” in this month’s AJN, nurse Janet Blake […]

2019-05-21T12:18:44-04:00May 21st, 2019|career, Nursing|0 Comments
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The ECRI Top 10 Patient Safety Concerns of 2019

A list grounded in data and expert opinion.

Atlantic Training/Wikimedia Commons

Each year, ECRI Institute creates a list of top 10 patient safety concerns in order “to support organizations in their efforts to proactively identify and respond to threats to patient safety.”

The list isn’t generated out of thin air. The ECRI Institute relies both on data regarding events and concerns and on expert judgment. Since 2009, ECRI and partner patient safety organizations “have received more than 2.8 million event reports.”

2019 Top 10 Patient Safety Concerns

  1. Diagnostic Stewardship and Test Result Management Using EHRs
  2. Antimicrobial Stewardship in Physician Practices and Aging Services
  3. Burnout and Its Impact on Patient Safety
  4. Patient Safety Concerns Involving Mobile Health
  5. Reducing Discomfort with Behavioral Health
  6. Detecting Changes in a Patient’s Condition
  7. Developing and Maintaining Skills
  8. Early Recognition of Sepsis across the Continuum
  9. Infections from Peripherally Inserted IV Lines
  10. Standardizing Safety Efforts across Large Health System

[…]

2019-04-15T08:16:15-04:00April 15th, 2019|digital health, Nursing, patient safety, Patients|0 Comments
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Are Your PCA Pumps Accurate, and Working?

Device malfunction happens.

After orthopedic surgery several years ago, I awoke in the PACU to find nurses working frantically on one side of my stretcher. Simultaneously, I realized that my leg hurt. A lot. And with another moment’s awareness—awake enough now for my nurse’s brain to begin to kick in—I understood that all of the activity concerned my PCA pump.

neeta lind/flickr creative commons

One of the nurses noticed that I was stirring. “Your pump has malfunctioned. We can’t get the replacement to work. A third pump is on the way. I’m so sorry!”

The scramble for a replacement, and then another, probably lasted less than five minutes, but it was a pretty wild ride. My deep breathing in an attempt to control the pain gave me something to focus on, but it was a pretty weak effort up against bone pain in the immediate post-op period. I’m grateful that my nurses—there were at least three involved at that point—regarded the pump failure as an emergency.

But operator errors are more common.

Needless to say, then, I was particularly interested in a new study that appears in this month’s AJN. In “Errors in Postoperative Administration of Intravenous Patient-Controlled Analgesia: A Retrospective Study,” Yoonyoung Lee and colleagues examined […]

2019-04-10T09:29:43-04:00April 10th, 2019|Nursing, nursing research, patient experience, Patients|0 Comments
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A Call to Address Fatigue to Protect Nurse Health and Patient Safety—from 1919

The evidence on nurse fatigue has been there all along.

During Women’s History Month, which is about to end, I’ve been posting (here and here) on nursing history (and in the process exploring its close confluence with women’s history). For this last post, I’m highlighting an article published in the March 1919 issue of AJN—exactly 100 years ago. The evidence on fatigue from long working hours has been there all along.

“The Movement For Shorter Hours in Nurses’ Training Schools” (free until April 15; click on the pdf version in the upper right), was written by Isabel Stewart, who was professor and then director of the nursing program at Teachers College, Columbia University, and coauthor of the National League for Nursing Education (the forerunner of today’s National League for Nursing) Standard Curriculum for Schools of Nursing.

A call for 8-hour work days for nurses.

In this article, which is in some ways disturbingly relevant today, Isabel Stewart notes that major nursing organizations recently met and were seeking “to enlist the support of a great many influential organizations and the general public in establishing an eight-hour day and a fifty-two hour week for pupil nurses.” (As a reminder, hospital nursing staff at that time were mostly nursing students.)

Fatigue […]

2019-03-29T11:07:06-04:00March 29th, 2019|Nursing, nursing history, patient safety|3 Comments
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The Complex and Illuminating History of Nurse Participation in Bedside Rounds

This week’s offering in homage to Women’s History Month.

We know from research that interdisciplinary bedside rounds improve communication and create a safer care environment. As noted by the author of a new CE article in the April issue, nurse–physician bedside rounding “has been shown to reduce mortality, medication errors, hospital length of stay, and hospital costs; improve staff and patient satisfaction; expand the health care team’s understanding of the patient’s plan of care; and increase both efficiency and perceptions of patient safety.”

Not your grandmother’s rounds.

In her article, “An Historical Review of Nurse–Physician Bedside Rounding,” Genevieve Beaird notes that while nurses rounding with physicians is not new, the nurse’s role today is vastly different from the early days. At that time, the nurse’s main concern was often preparing the stage, so to speak, for the physician’s appearance at the bedside. Here’s a quote from Dorothea Gothson, RN, in a 1913 issue of AJN:

“There is nothing more distressing to either patient or the earnest hardworking nurse than to be surprised by the attending doctors…. Equally annoying is the experience of patients and nurses being ready, waiting for the doctors, and their not appearing for one or two hours after the appointed time—perhaps not at all—thus upsetting […]

2019-03-22T08:39:03-04:00March 22nd, 2019|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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