Guest editorial by Debbie Moore-Black, RN, ADN, charge nurse/staff nurse at Pineville Medical, Charlotte, NC, and Devin Black, BA, at the Center for Behavioral Health, North Charleston, SC.
She came rolling into the ICU. Intubated, chest tube, restraints, propofol, fentanyl and Levophed drips infusing through her veins. Her blood pressure is low, we pour normal saline IV into her veins as fast as possible. She's only 28 years old.
She crossed the median of the highway int the oncoming traffic. Barreled into four vehicles, randomly. She sent three people to the ED. One young father is dead. Her hair is filled with shattered glass; her face has lacerations. She has a tension pneumo.
The ED nurses and doctors are on high alert, and she is emergently intubated, a chest tube is inserted. The nurses give her drugs to slow her respirations, restrain her to make sure she doesn't pull out her endo-tracheal tube.
She was a young mother, not ready for the real world. Had minimal support. A boyfriend that drifted in and out of her life. When her little boy was 4, she picked him up when he was crying, he jerked out of her arms, and she pulled a sciatic nerve in her back. Severe back spasms set in.
She moved furniture, hurt her back again, and a period of strange "events" kept happening, where her back "gave out." So she went to her physician. She said her pain was a "10". He wrote her a prescription: hydrocodone. It worked pretty well, but not good enough. Then she graduated to oxycodone. Oxy was good. Drifting off on the couch, pink clouds, angels, rainbows, and the pain was gone, emotionally and physically. It didn't matter that Timmy was in his crib crying because he was hungry, it didn't matter that the sink was piled high to the ceiling, it didn't matter that she missed several days of work. Two tablets every day, grew to three tablets a day. And it was never enough. She needed more. After a year, Jen needed more. But her MD said he was unable to write her any more prescriptions. And so after one year of chewing down her oxycodones, she was without for 18 hours. Her boyfriend would supplement her with drugs being sold on the street, but it was $30 a pill. Jen ran out of money, and she ran out of pills.
Covered in sweat, stomach churning, goose flesh skin, restless legs. She was in withdrawals. She haphazardly roamed the streets and there it was. Magic. Black. Black tar. He said half a gram of heroin is $80. That was cheaper than the $120 it took to get Jen through the day.
She wrapped the belt around her upper arm. The syringe was loaded. He inserted the needle in her arm, and pushed. Suddenly, she was wrapped in a warm hug in the clouds of heaven, suddenly everything was OK. There was no pain, no sadness. Jen was euphoric.
And Jen did this whenever she could. Whenever she had the money, or "found" the money.
But this time, after shooting up, she jumped into her car. Driving, on the highway, her head tilted back as she felt that rush go through her veins. And she drove, unaware of driving ... and she plowed into four cars. Four cars totaled, three people sent to the ED, one man dead. Blue lights, red lights, ambulances, police, fire department, people gawking on the sidelines.
And you wake up in the ICU; several weeks have gone by. You are out of your coma, chest tube pulled, breathing tube gone. And you squeeze my hand, and ask where you are.
How do I tell you that you put three people in the hospital? How do I tell you that Social Services has your little boy? How do I tell you, you no longer have an apartment? How do I tell you that you killed a man? An innocent man, driving home from work to his wife and three children.
Could she even put these pieces back together again? Rock bottom.
With the assistance from her doctors, nurses, counselors, rehab, Jen slowly, painfully pulled her life back together.
Not everyone makes it.
Three months later, Jen came back to the ED. DOA. Body bagged. Famous deaths by heroin: River Phoenix, John Belushi, Janis Joplin, Jim Morrison, Sid Vicious, Cory Monteith, Dee Dee Ramone, Philip Seymour Hoffman, Chris Farley.
Non-famous deaths: Over 8,200 deaths in 2013 per the CDC. Every day, 44 people in the U.S. die from overdose of prescription painkillers, and many more become addicted.
Greatest risk: prescription opiods, painkillers such as codeine, fentanyl, hydrocodone, Demerol, morphine, methadone, oxycodone and dilaudid.
Treatment: Recognize and acknowledge your problem. The WILL to quit. Drug treatment centers. Psycho-therapy. Drug rehab. Methadone clinics. 24/7 hotline: "Narcotics Anonymous: 1.888.827.7180. Educate yourselves, give out this number. If "they" don't quit heroin, the alternative is death.
November is National Hospice and Palliative Care Month, and I would like to share an open letter to all the nurses, social service, home health aides, chaplains, volunteers, and office staff who work every day to make Hospice care a seamless transition at end of life.
To My Dear Hospice and Palliative Care Workers:
- For all the times you answered your phone, thank you
- For all the paperwork and explanations, thank you
- For coordinating beds, supplies and wound care, thank you
- For taking time in your day to ask how my family is, thank you
- For all the meals you missed while working to make "healthcare" happen for us, thank you
- For all the phone calls you've made, agencies you've contacted referrals you completed, thank you
- For all the tender care you provided my loved one, thank you
- For including massage therapy, healing touch and giving me a peaceful presence, thank you
- For sending me memorial cards and hand writing them, thank you
- For remembering my loved on in your ceremonies during the holiday, thank you
- For helping me to organize my life both during and after those final hours, thank you
- For teaching me it's okay to be happy and laugh in times of grief, thank you
- For crying with me, thank you
- For your follow up care and bereavement, thank you
- For including me and my loved one in your prayers, thank you
Some nurses ask, "How can you work in Hospice?"
Our response, "How can you not provide a beautiful end of life experience?"
Hospice and Palliative care staff work to create the best end of life experience for the patients as they move from this world to the next. We don't choose to work in Hospice, Hospice has called us to work
Happy Hospice and Palliative Care Month!
Karen Gagliardi MSN, CRNP, Holy Redeemer Home Care and Hospice
This guest post is written by Lisa Wolf PhD, RN, CEN, director, Institute for Emergency Nursing Research, Emergency Nurses Association
Moral distress as it is currently understood in nursing has been studied in many settings, but there is a lack of research on the nature and content of moral distress as it manifests in the emergency department (ED).
Moral distress has been described by Corley and colleagues1 as "the painful psychological disequilibrium that results from recognizing the ethically-appropriate action, yet not taking it, because of such obstacles as lack of time, supervisory reluctance, an inhibiting medical power structure, institution policy or legal considerations." Because researchers find a relationship between moral distress and aspects of burnout, nursing retention and job satisfaction, this is an important area of study.
To investigate moral distress among emergency nurses, we conducted a qualitative exploratory study in which 17 nurses participated in two focus groups held at the Emergency Nurses Association's 2014 Annual Conference. The nurses had an an average of 24 years of experience in nursing and 19 years of experience in emergency nursing.
Overall, nurses in the study described a profound feeling of not being able to provide the quality of care they believed patients deserved. They told us about "challenges of the emergency care environment" that included staffing levels, quality and safety of patient care, the use of technology and conflicting expectations of the nursing role. "Being overwhelmed" included categories concerning frequent users, time pressures and patient volume and flow. "Maladaptive/Adaptive/Coping" included categories referring to emotional fallout, physical symptoms and stress management strategies.
What we found was that unlike in the ICU and other care areas, where sources of moral distress were interaction-based (ie, conflicts between particular nurses and patients, or nurses and families, or nurses and physicians), feelings of moral distress in the ED centered on the practice environment itself.
Nurses reported physical manifestations of moral distress that included disturbances in sleep, food intake, and complaints of gastrointestinal (GI) distress, fatigue and high blood pressure. The emotional repercussions of moral distress were reported as helplessness, despair, complacency, burnout, emotional withdrawal, anger, depression/anxiety and desire to leave the job. Nurses reported coping with this distress by using "positive" mechanisms such as training for a triathlon, or unit support groups, but also reported using less positive coping mechanisms such as alcohol and food to mitigate the feelings of moral distress.
There are two really important implications of this study, for both emergency nursing specifically as well as nursing as a discipline: the first is that for emergency nurses, the cause of moral distress is an inability to provide care to the standard they see as a disciplinary obligation, stemming from a lack of resources and support. In short, the factors in moral distress are environmental, and therefore the solutions must also address the work environment.
The second implication is that nurses describe high levels of "moral residue," or lingering moral distress, from what appears to be an almost continuous series of compromising events and lack of external support, or capacity, to remedy the way in which care is provided. This leads to burnout and compassion fatigue, and ultimately patient care suffers.
The issue of moral distress affects both nurses and their patients. Addressing the individual and environmental factors of moral distress may lead to a healthier work environment and better patient care.
1. Corley MC, Elswick RK, Gorman M, Clor T. Development and evaluation of a moral distress scale. J Adv Nurs. 2001;33(2):250-256.
Guest editorial by Matthew F. Powers, MS, BSN, RN, MICP, CEN, president of the Emergency Nurses Association, the leading nursing association serving the emergency nursing profession through research, publications, professional development, and emphasis on quality and patient safety.
A trip to the emergency department can be a stressful event for any patient just given the fact they are sick or injured. As emergency nurses, we are on the front line helping patients to remain calm and get the care they need. But what happens when something avoidable goes wrong and it turns into an even more traumatic situation? For a transgender patient, this is often a reality.
According to a 2011 study (Injustice at Every Turn: A Report of the National Transgender Discrimination Survey, 2011), nearly 30 percent of transgender people report harassment or violence during their medical visits, and 33 percent of transgender people postponing medical care as a result of these implications and dangers.
These statistics are unacceptable. It's crucial for us, as emergency healthcare professionals, to provide care to transgender patients that's proactive, accurate, compassionate and considerate, as we strive to treat all patients the same without judgement
In fact, new research from the Journal of Emergency Nursing highlights the importance of acting appropriately when caring for transgender patients in the ED. The article chronicles the experience of Brandon James, (a pseudonym), in an American ED in 2015. According to the case study, the patient's ED visit was filled with situations that a transgender person might experience with ED personnel who are unfamiliar with treating transgender patients.
For instance, James, a masculine transgender man who transitioned using hormone replacement therapy five years before his ED experience in 2011, describes his check-in process as humiliating. When James presented his driver's license, which identified him as a female, he was met with staff debating his gender aloud and pulling in an additional two to three people to assist him. This occurred despite the fact that his electronic medical records from previous hospital visits included female gender markers. James describes feeling like a "freak show at the circus."
After waiting several hours to be treated, a nurse who listened to James' friend recount the check-in experience apologized and validated their experience. It's critical for all nurses to take actions like this to make sure every patient's dignity is preserved.
James' story identifies new implications for emergency nursing practice when treating a transgender person, as nurses today care for an increasing number of transgender patients. Nurses and their ED colleagues must understand how to give these patients the care and respect they deserve.
Here are a few important takeaways from James' story that emergency nurses should consider when caring for transgender patients in the future. Nurses should take these steps to provide a high-quality and comfortable experience for the transgender patient:
Ask the person how they would like to be addressed. In the case of Brandon James, many insensitivities could have been avoided if the ED staff member asked the patient how he would like to have been addressed.
Use the proper pronoun. When speaking to a transgender patient, use the pronoun that matches the gender to which he or she currently identifies.
Keep conversation clinical. Only ask clinically relevant questions during the examination of a transgender patient as one would with all patients.
Be sensitive to shared spaces. When taking a transgender patient into an area of the ED where he or she might share a space with another patient, keep gender to which he or she identifies, top of mind.
Lead by example. Because nurses are on the front lines of patient care in the ED, they should take a leadership role in showing respect to all patients regardless of how they identify themselves, and step in to help defuse any sensitive situations they observe.
James' story is told in the article, "I Was a Spectacle...A Freak Show at the Circus: A Transgender Person's ED Experience and Implications for Nursing Practice," to prevent similar events from happening in EDs across the country. You can find the full article here.
Guest editorial by Stacy Slater, MSN, BS, RN-BC, Revenue Cycle Coordinator, Munson Healthcare, Traverse City, MI
Pay-for-performance, value-based purchasing, the triple aim of healthcare, HCAHPS, volume to value - Nurses need, at the very least, a rudimentary understanding of these terms and how the care they provide directly affects reimbursement and how reimbursement impacts the care they provide to their patients.
What is this: The two main goals of the Patient Protection and Affordable Care Act of 2010 are reforming health insurance (the Marketplace) and reforming delivery and payment systems (pay-for-performance). Pay-for-performance is the reimbursement model that Medicare is using to drive the triple aim (improved value, improved outcomes, and improved patient experience). Value-based purchasing is just one of the elements of pay-for-performance.
What does it mean and how does it impact nursing: Value-based purchasing (VBP) is a method of payment that involves penalties or incentives. This method allows CMS to "purchase" value when it pays for healthcare versus paying for services based on volume or "fee-for-service." Currently, all healthcare providers that participate with Medicare are transitioning from volume to value. One of the measures of the VBP program is patient experience. The patient satisfaction scores, measured via the Hospital Consumer Assessment of Healthcare Providers and System (HCAPHS), surveys inpatients post discharge and includes questions that are directly related to nursing care. Questions such as nurse-patient communication, how well pain was controlled, quietness and cleanliness of the patient's room, how well discharge orders were understood, responsiveness of staff, and communication about medications. The quality of care that nurses provide can be measured and can be positively reflected in patient outcomes and payments received by the health system. This collaboration between nursing and finance can lead to improved patient outcomes and improved value.
In her blog, Pamela Austin Thompson, chief executive officer of AONE, eloquently states the need for nursing and finance to be on the same team. To prevent patient care from becoming secondary to reimbursement, we need nursing professionals who understand finance and the financial impact of clinical decisions, and financial professionals who understand how cost-reduction measures impact the delivery of patient care.
This is our time to shine and step out front - nurses and the quality of care that we provide can improve the value of care, improve patient outcomes, improve the patient experience and in essence be the drivers of healthcare reimbursement.
Editor's Note: This guest post is written by Veronica Gutchell, DNP ‘13, RN, CNS, CRNP, assistant professor, University of Maryland School of Nursing
On any given night, about 3,000 people in Baltimore experience homelessness. To help with this ongoing problem, University of Maryland School of Nursing (UMSON) faculty members Katherine Fornili, MPH, RN, CARN, assistant professor, and Rosemary Riel, MAA, clinical instructor and associate director, Office of Global Health, and I participated in the Baltimore City Point in Time count last winter. We worked with both sheltered and unsheltered individuals. The data from the count is used to advocate for resources, plan programs, implement policies to address homelessness, and evaluate the use of existing resources and programs.
I came upon this opportunity through the Global Health Certificate program at the University of Maryland School of Nursing. The Global Health Certificate program helped me think about my practice through the lens of social justice. It challenged me to understand my own biases and how they impact my practice as a nurse practitioner. Using the lens of social justice changed the way I work with underserved patients in primary care.
We spent a lot of time in the certificate program focusing on the social determinants of health and then we applied those concepts in a field placement experience. Going abroad for four to six weeks didn't work for my life at the time, so I asked for the opportunity to practice applying the social determinants of health locally.
My assignment addressed the issue of homelessness in Baltimore. Through the faculty's network of contacts, I was introduced to some very talented people at Health Care for the Homeless, a nationally-recognized model for the delivery of health care to those experiencing homelessness. Through Health Care for the Homeless, I was able to work on a project to start up a mobile clinic program. The mobile clinic delivers primary health care to those experiencing homelessness in Baltimore and surrounding areas.
In researching my project proposal, I came across 2013 data from the Mayor's office on the Baltimore City Point in Time Count. After my field placement was completed, and I presented my experience, a colleague talked to me about volunteering for the next Count. I was immediately interested in organizing volunteers from UMSON, so I sent an email to the School's faculty and staff announcing a service opportunity. Nine people responded and three of us ended up being able to participate. The organizers needed most volunteers for the overnight count and it turned out that the three of us were able to volunteer for both nights.
The Count involved conducting a survey to try to better understand who experiences homelessness. For example, from the 2013 Count, 52 percent of respondents reported a history of mental illness, 56 percent a history of substance abuse, and 11 percent indicated they were veterans. This information helps communities determine how to tailor services to those in need.
Questions on the 2015 survey looked at mental illness, substance abuse, Post Traumatic Stress Disorder, and veteran status. Additionally, there were questions about previous experience with trauma and how long an individual had been experiencing homelessness. Almost every person I surveyed agreed to participate. I even had one individual who was sleeping on the street in 27-degree weather say "God bless you."
The experience of homelessness can seem overwhelming. Even so, I feel optimistic about the goal of making homelessness "rare and brief." Journey Home Baltimore, the organizers of this event, estimates over 300 people volunteered to help with the 2015 count. I'm hopeful because there are a lot of people who cared enough to come out in the middle of two cold winter nights to conduct this important survey. The volunteers were a widely diverse group of community members; for me, there's something moving and promising about that. I am inspired by those who dedicate their professional lives and those who volunteer to make homelessness a temporary experience for individuals and families. It's that work and commitment that keeps me encouraged.
Editor's Note: This guest post is written by Lisa Bingham, MSN, RN from Newburg, Oregon. She has been a registered nurse for 18 years and is currently pursuing her FNP from Gonzaga University
I fully support the idea about leveling "the playing field" when it comes to requiring advanced degrees for nurses to practice. I believe that my advanced education has greatly improved my nursing care; however, there is very important aspect related to this debate that is often neglected.
One of the problems with requiring advanced degrees for nurses, is, according to the American Association of Colleges of Nursing (AACN), we not only have a nursing shortage but a faculty shortage as well. As a recent nursing faculty member, I can tell you that I worked in one of at least 700 nursing schools with vacant faculty positions (http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage). Although the average salary of a nursing instructor is slightly over $78,000 per year, I was making a little more than half that amount and working every day of the week to prepare my students for the workforce. When my students graduated and obtained a job, they made more money than I did. A nurse practitioner, who also requires a master's degree, averages over $91,000 per year (http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-faculty-shortage).
Compensation, although important, is not the most important aspect of a career. As I previously stated, I worked every day. I am an organized person by nature, but not only were there papers to grade and research to be done in order to prepare for lectures and clinical experiences, in an academic setting service is a requirement of scholarly research and publication in order to gain promotion. There were often marathon faculty meetings as well as hours of advising of students. Most of the time, it feels like you don't get to spend enough time with working with the students which is the whole reason you started teaching. People say, "Well, you get the summer off." Again, we are doing research, service and preparing for the next academic year. We are volunteering at new student orientations and academic advising for the incoming freshmen and transfer students.
I am not complaining about the job as I loved spending time with students, but I am trying to show that there is much more to being a nursing faculty member than working 12 hours and then going home. (I'm not saying that working a 12 hours shift in a hospital is not difficult). I also have a spouse and four children. I had to stop working as a nursing faculty in order to be present with my family. I now have a part-time nursing position in which I spend 24 hours and make more money per hour than I did as a nursing faculty.
The compensation for the amount of hours that a nursing faculty is required to spend is not adequate. Until this is remedied, requiring advanced degrees for nurses is going to be an uphill climb. It's a wonderful idea and has been shown to improve patient outcomes, but thought needs to be put toward nursing faculty retention and compensation in order to make advanced practice degree requirements work.
Editor's Note: This guest post is written by Kathy Eliscu, BA, RN, who worked more than 30 years as a nurse in maternal/child health, office nursing, school nursing, and psychiatry at a major mental health clinic.
After 30-plus years in nursing, I've accumulated plenty of stories. You get it, if you've been in nursing for a while. Like for at least a week.
In the first decade, nursing experiences floated through my mind like sand pebbles dumped from shoes after an afternoon at the beach. I was aware of them, but didn't put them much into conscious thought, since my brain was already figuring out a grocery list for the way home and wondering if pizza and ice cream for the fourth night in a row was really such a bad thing. Wait. There were a few outstanding memories - some of us who have been nurses for a long time will recall - when being hollered at by a doctor was not uncommon, when working night shift meant cleaning up the floor after a delivery and checking on mom and baby in between swipes of the mop. And, of course, there are the tender recalls of the gift of truly being present with a patient, the basics of helping, which brought most of us into the profession in the first place.
There have been controversies around union issues, the transient, occasional lateral violence between nurses ... there are probably few experienced nurses today who don't have stories to tell.
Then came the big insurance changes - more restrictions on hospital stays, the advent of prior approvals for treatments and certain medications, often shifting the day-to-day focus of nurses. For me, time spent with patients was greatly reduced due to increased time on the phone with insurance companies and an increase in staff meetings largely focused on keeping up with regulations and the changing systems required to do that. At times, it all seemed so ridiculous. BECAUSE IT WAS.
It wasn't long before I began to imagine humorous scenarios beyond the agony. It was either that, or consume large quantities of chocolate at eight in the morning. Sitting through what once seemed largely patient-focused meetings now felt like board meetings, with graphs and charts and outcomes - yes, there were lots of numbers. Big numbers, small numbers, scary numbers. The way of corporate thinking had reached medicine in a big way. I'd look around the room: 20 or 30 professionals crammed into a classroom, eyes glazing over watching a powerpoint presentation filled with statistics. It made me want to run home to take a shower. Soon, I couldn't help myself from looking at nearly everything more critically, and thankfully, with laughter. For now, I was also dealing with my the middle years, complete with aging parents, a child still in college, my inability to say no when someone needed a favor ... and I began to imagine "what if" scenarios. I confess I may have missed a few of the important facts of some of the unending "initiatives" at these meetings. But using humor as a tool for coping with the boredom and get-me-outta-here thoughts each time actually gave me all the more smiles and charity for when I did - finally and blessedly - get to actually interact with a patient.
Not Even Dark Chocolate Can Fix This Mess is fiction. It's the wildly, silly story of a woman who nurses by day and crams her overwhelmed life into the rest. She gets roped into doing a good deed for her niece and in her constantly-overwhelmed state, ends up making a huge, embarrassing mistake. Even though she's tried all that deep breathing stuff. Friends, you will learn nothing from this novel. But it will give you some much-deserved laughs. You've earned it.
Now, pay attention to the powerpoint. And nod slowly up and down. It looks good.
Editor's Note: This guest post is written by by Nancy C. Lee, MD, deputy assistant secretary of health - women's health, and director of the office on women's health at the Department of Health and Human Services and Ana N. Fadich, MPH, CHES, vice president, men's health network.
Each year we ask women and men to take two weeks out of their routines to make their health a priority. In May, we ask women to take small steps to improve their health during National Women's Health Week (NWHW) (May 10-16). In June, Men's Health Week (MHW) encourages men to get regular preventive care (June 15-21). With NWHW behind us and now that we are in the middle of MHW, it's a great time to talk about how we can all team up for better health the other 50 weeks of the year!
We know that the healthiest decisions aren't always the easiest ones to make. But with support and encouragement from the people we love - particularly our partners and families - making smarter choices is easier. Let's make focusing on healthy behaviors and prevention a team effort.
Now's the time to team up with your partner to meet your health goals together. If you are not married, partner with a family member, friend, or coworker! Having someone else who is committed to the same things will make it easier for both of you to stick to a healthier lifestyle. Here are some small changes you can make today:
- Move more - together.Try changing the way you think about exercise. See it as quality time you can spend with your partner, kids, friends, or coworkers. Getting active with others is a lot more fun than slogging through a workout alone, so it's easier to stick with it. Need ideas? Take up a new sport, play tag with your kids at the playground, or take a brisk walk at lunchtime with your coworker. Having someone else to get moving with also makes motivation a little easier. You can hold each other accountable, and celebrate your achievements together.
- Experience the joys of cooking.Interested in saving money and eating healthier? Start cooking at home more often, and have your family help with the shopping, menu planning, and prep work. When you're the chef, you choose how big your portions are and know exactly what goes into your meals - both of which are important to weight management. Spice things up by trying new recipes and flavors at least once a month.
- Sync your annual checkups.Make sure you and you partner both get your annual checkups by scheduling your appointments at the same time, for the same day. If you both aim for a late-morning visit, you can pack a lunch and have a picnic together afterward. Over lunch, talk about how you can help each other reach your health goals.
That last one may feel a little strange at first. After all, we're used to the idea of exercising or eating with other people, but going to the doctor? There are benefits, though! If you're someone who feels anxious around doctors, knowing your partner is doing the same thing can give you much-needed support. If you have a hard time remembering what your doctor told you to do, talking it over with your partner afterward can help you keep track of the information. All women and men - even if they feel fine - need to receive routine care. Your annual checkup is a time to talk with your provider about how you're doing, how you'd like to be doing, and what changes you can make to reach your health goals. It's also a time to get preventive services and screenings. And thanks to the Affordable Care Act, most health plans must cover a set of preventive services at no cost to you, even if you haven't met your yearly deductible. For a complete list of covered services for adults, visit http://www.healthcare.gov/.
When you and your partner take steps for good health, not only are you helping each other stay healthy for the long-haul, but you're setting a positive example for your kids. It shows them that health is important and it's okay to talk about it. In fact, you should talk about it. Build an open line of communication with your kids, and help them feel comfortable coming to you with questions about their health. It's time we made health a family affair this week and every week. When you're healthy and happy, everyone wins!
Editor's Note: This guest post is written by Christine W. Clarke, RN, MS, ONC, educator, Houston Methodist Orthopaedics
When I reflect on the elements which persuaded my decision to become a nurse, I cannot ignore hereditary influence. Between my maternal grandfather's aunt serving with Florence Nightingale during the Crimean War and three of my aunts graduating as diploma nurses after WW II, I would say my genes are pretty entrenched in a passion for nursing!
My first job during college was working as a weekend secretary on an orthopaedic ward at a major medical center hospital in the northeast. It was then that I grew to admire the spirit of the "floor" nurse who wore a starched white uniform, nurse's cap, white stockings, white shoes, and a navy blue cape clasped at the neck worn during cold, snowy weather. I was in awe of how that uniform stayed a pristine white after an eight hour shift! Those nurses worked diligently to nurse adult patients with complicated musculoskeletal conditions. I loved to sit at the bedside with some of the long-term patients to listen to their stories. The head nurse wore many hats. She was the medication nurse who poured meds in the nurse's station from a locked wooden cabinet. She was acutely aware of each patient's condition and was prepared to give a succinct report to every attending MD at 0800. She also oversaw the role of the RN as they performed the patient assessment, dressing changes, and prepared the patient for surgery. The LVN answered to the RN, and there were no patient care assistants. The LVN took vitals, measured I&O's, turned scoliosis patients on Foster frames, monitored patients in restraints, and was expected to bathe every patient, while still having time to autoclave metal bedpans before the end of their eight hour shift. The nurse did it all and I was so excited to be a small part of their team!
Although I was told, "You should have been a nurse" many times during my life, I don't think I seriously considered going into the nursing profession until I experienced a life-changing event which happened to me as a patient at Houston Methodist Hospital. As an adolescent, I developed a chronic hip condition which leads to significant arthritic pain and immobility. The predictable treatment was total hip replacement. I was encouraged to wait as long as possible to receive the most reliable implant which would improve my quality of life, a life without chronic arthritic pain. A nurse from our church recommended a well-known, highly respected orthopaedic surgeon at Methodist. At 40 years old, I underwent hip replacement surgery. I remember waking up in a private room, surrounded by my family; and best of all, I was free from hip pain!
My nurses were experienced orthopaedic nurses who exhibited a kind, and caring passion in the art of nursing. I trusted them with my life. Because of my positive experience from an inpatient perception, I felt a strong urge toward following the Golden Rule, that is, to "give back." Could I be a nurse? My hip was fixed, but I was unsure I could endure the physical demands required of a nurse. My final nudge was from my husband who said, "There is nothing wrong with your brain - go back to school and become a nurse." That gentle push was what I needed to fulfill my need to give back to those who changed my life.
I have since graduated with my Master's degree and have shared my personal story thru pre-operative teaching to hundreds of elective joint replacement patients which have included nurses, pharmacists, physicians, and high-profile individuals.
As I approach the age of retirement along with many of my nurse colleagues, I urge graduate nurses to consider entering the specialty of orthopaedics. There is no question that nursing is a stressful profession. The orthopaedic patient population envelopes many more co morbidities which go hand in hand with chronic and acute musculoskeletal disorders. Arthritis may be accompanied by the challenge of immobility and obesity, drug or alcohol dependency, depression, hypertension, and/or diabetes. Mobilizing ortho patients may be physically exhausting; but the rewards of watching a patient walk straight and tall, with minimal pain, just a day after surgery, allows one to quickly forget how physically demanding ortho nursing can be. I can only hope that sharing my experience has made a difference!
By Corina Wilkin, BSN, RN
The American Organization of Nurse Executives (AONE) and Emergency Nurses Association (ENA) recently held a ‘Day of Dialogue' to discuss how incidents of violence are currently addressed in hospitals. AONE includes lateral violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse) in their definition of workplace violence. According to the Workplace Bullying Institute (WBI) workplace bullying is partially defined as repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators. It is abusive conduct that:
- is threatening, humiliating, or intimidating
- sabotages or interferes with work impacting productivity of the victim
- includes verbal abuse
- is non-physical violence and is sub-lethal (unless the victim commits suicide)
- is driven by perpetrators' need to control the targeted individual(s)
- is initiated by bullies who choose their targets, timing, location, and methods
- includes acts of commission (doing things to others) or omission (withholding resources from others)
- requires consequences for the targeted individual
- escalates to involve others who side with the bully (through peer pressure or coercion)
- undermines legitimate business interests when bullies' personal agendas take precedence over work itself
- is akin to domestic violence
"Being bullied at work most closely resembles the experience of being a battered spouse. The abuser inflicts pain when and where she or he chooses; keeping the target (victim) off balance knowing that [lateral] violence can happen on a whim, but dangling the hope that safety is possible during a period of peace of unknown duration. The target is kept close to the abuser by the nature of the relationship between them -- husband to wife or boss to subordinate or co-worker to co-worker," (WBI website).
The WBI states that the "most easily exploited targets are people with a desire to help, heal, teach, develop, and nurture others. Targets generally do not respond to aggression with aggression. But the price paid for apparent submissiveness is that the bully can act with impunity (as long as the employer also does nothing)." According to the 2007 WBI - Zogby Survey, 45% of targeted individuals suffer stress-related health problems. WBI reports that victims suffer negative consequences to end the abuse as follows:
- 28% quit voluntarily
- 25% were forced out (constructive discharge)
- 25% were terminated
- 11% transferred to other jobs in the same organization
As a victim of workplace bullying, I can relate to other WBI. When I have talked to my direct supervisor about these issues, she has spent time counseling me to improve my response to my bullies. This leads me to question my own behavior when it is not my behavior that is the problem. The most recent bullying incidence involved a coworker popping a latex balloon in my presence and announcing to our entire office that people with latex allergies should not be in the office. Yes, I have a latex allergy. When I complained to my boss she asked what I could have done differently. The ‘dream job' has turned into a living nightmare.
I have a history of childhood bullying. The cumulative effects of a childhood history pockmarked with bullying along with the past 20 months of being victimized in the workplace has led me to withdraw a little more every day. I suffer because of my bullies' behavior. According to the WBI that is generally the case. They wrote that only 11% of perpetrators experience negative consequences (5% terminated, 6% punished) resulting in a ‘no consequence rate' of 89% for bullies."
I have myriad questions. Questions a battered spouse likely asks him- or herself.
- Why me?
- Is it my fault?
- Do I need to change?
- If so, how?
- Am I crazy?
- Am I awful?
- Do I deserve it?
- Am I ‘that' person no one wants around?
- Why don't ‘they' like me?
- Is it true when my boss tells me these are issues I'd have at any other hospital?
- Would another hospital even want me?
- Am I the problem?
Every day it is a little harder for me to come to work. As my family's primary wage earner, I don't have the luxury of removing myself from the situation without making provisions. And the longer I stay the more the harmful effects accumulate and whittle away my professional sense of self as well as my sense of safety in the workplace.
Hell, what am I talking about? I have no sense of safety in the workplace. I know another attack is coming. But I am not ready for it. I will never be ready for it.
American Organization of Nurse Executives, Mitigating Violence in the Workplace, http://www.aone.org/resources/PDFs/Mitigating_Violence_GP_final.pdf 2014
Workplace Bullying Institute, http://www.workplacebullying.org/individuals/problem/being-bullied/, 2014
Editor's note: Guest blogger Samer Koutoubi, MD, PhD, is program director and faculty member, public health at American Public University
The health and well-being of Americans should be the top priority of Congress. So why is Congress considering removing $900 million in public health funding from the Centers for Disease Control (CDC) in FY 2016?
The proposal to repeal the Prevention and Public Health Fund will make public health professionals weak and unable to protect the health of our people and communities. This is unacceptable.
The deep cut in FY2016 will reduce and/or remove existing funding for key preventive services and programs for chronic diseases such as obesity, cardiovascular disease and stroke, diabetes, and cancer. This will be disastrous for our country, especially for low-income Americans, and other who benefit from the Supplemental Nutrition Assistance Program (SNAP).
Dr. George Benjamin, American Public Health Association executive director said, "In the face of fiscal pressures, we look forward to working with the administration and Congress to reverse austerity measures that prevent adequate investment in programs that promote and protect public health."
What we need to do?
Nurses and other health care professionals - as well as patients and others who will be significantly impacted by these cuts--should contact local, state, and federal officials and tell them to invest in the public health system to save lives and money. These funds are needed to keep America healthy.
While the new 2016 proposed budget has deep cuts in key public health programs, new programs have been funded especially in the areas of global health security. For more information, please visit the U.S. Department of Health & Human Services HHS 2016 budget, visit www.hhs.gov/budget.
Editor's Note: Guest blogger Ronda McKay, DNP, CNS, RN is chief nursing officer and vice president of patient care services at Community Hospital, Munster, Ind.
My recent article - Using Technology to Enhance Nurse Safety - generated quite a bit of response from members of the nursing community. The discussion is important, as such discourse helps to move our profession forward. I would like to take this opportunity to emphasize some points that I think should be added to this conversation:
1. Safety is an important concern for all healthcare workers, especially nurses. According to Top 10 Patient Safety Concerns for 2015, a recently released report from ECRI Institute, a non-profit research organization, "managing patient violence" should be a top priority for all healthcare organizations. Our organization, Community Hospital, Munster, Ind., is addressing this important challenge, and others should follow suit. The button on the real-time locating systems (RTLS) badge allows our nurses to summon help immediately when faced with patient violence. The system also helps to improve nursing workflow - patient calls are automatically cancelled when the nurse enters the room, so the nurse focus on the patient rather than the button on the wall.
2. The use of RTLS is just one of a variety of initiatives that we have in place to keep workers safe. It is a single, but important, component of a multi-faceted security program that includes a variety of strategies and technologies designed to keep our staff safe.
3. Healthcare organizations need to create healthy working environments for their workers. Leaders and managers need to communicate freely and openly with staff about workplace practices, policies and procedures. Perhaps more important, though, leaders need to abide by the "actions speak louder than words" rule and make sure their organizations not only talk about but actually nurture environments of trust. Indeed, it's this communication and follow-through that leads to a healthy and happy work environment, not the fact that an organization does or does not use a particular technology - such as RTLS.
4. We fully understand the "big brother" concerns associated with RTLS. That's why we clearly spelled out the expectations and intended purpose for using RTLS before implementing the system. Even more important, organizations then need to actually use RTLS in the expressed manner (i.e. to improve workflow, enhance safety or track assets - not to monitor employee breaks or keep tabs on employee movement). For example, if an organization adopts RTLS in an effort to improve workflow - and then uses the technology to make it possible for clinicians to spend more time at the patient bedside, the RTLS will be warmly embraced. Of course, if an organization does monitor clinicians' break time and uses the information in a punitive manner, clinicians will quickly dismiss RTLS, and the benefits of the system will never be realized. Overall, when RTLS is implemented to accomplish specific goals - and then is only used for this express purpose - concerns about the technology being used to covertly keep tabs on workers quickly dissipate.
In sum, succeeding with RTLS, as with any other technology, takes much more than simply implementing the solution. To truly benefit from any innovation, organizations need to create and nurture a culture that can truly support the use of technology solutions for the greater good.
Editor's Note: This guest post is written by Stephanie Noblit, MLS(ASCP)CM, who blogs for our sister publication ADVANCE for Laboratory.
Earlier this May, at ASCLS-Pennsylvania's state meeting, I attended an educational session entitled, "When Professionals Meet: Bridging the Gap between the Laboratory and Nursing." Like most medical laboratory professionals, my opinion of nurses isn't exactly a positive one. So, I was intrigued to hear what the speaker had to say. The presenter was Lucinda Manning, who works in the immunohematogy reference laboratory at ARUP laboratories. Interestingly, Manning is certified as both an MLS and an RN. Unlike us lab techs hidden away in the basement or the nurses up on the floors, Manning has experienced both sides. Seeing her credentials, I figured that this woman may have the answer to the age old question on why lab professionals and nurses just can't get along.
The humor website Uncyclopedia's page on medical laboratory scientists, describes nurses as, "the med tech's arch nemesis and rival." Although you may wholeheartedly agree with that statement when you are being yelled at by a nurse over the phone, it is statements like these that only further create a divide between the two professions. Manning told us to think of a hospital like a wheel with each spoke being a different category of hospital personnel. Then she told us to imagine how the wheel would work if you took one of the spokes away. It was easy for us to imagine how taking away the lab would affect the hospital: no lab, no results. We soon realized, however, that every other personnel area was equally as important as the lab.
The thing Manning stressed in her presentation was that nurses and lab professionals are very different, but we both have a major thing in common and that is our concern for our patients. Often times, we accuse one other of not caring for the patient, but it is not that either side neglects the wellbeing of the patient; we just show we care in different ways. For example, a lab person will not report out a result until they are confident their instrument is working properly through the use of QC. On the flip side, a nurse wants to quickly determine a care plan for their patient so they can get them on the road to recovery. Our intentions are the same, but the different styles of thinking between nurses and the lab causes things to become lost in translation.
Recently, an article entitled, "13 Things this Lab Scientist Wishes Every Nurse Knew," went viral among lab professionals. While every bullet point in the article has crossed my mind numerous times, the truth is that I have the upmost respect for nurses. I know that they are up there on the front lines dealing with patients every day, and I know I could never do what they do. The bottom line is everyone's main concern is the patient, and the only way our patients can receive the best care is if we all work together and respect each other.
By Jamil King, National Sales Manager, Panasonic
As the role of nurses has evolved throughout the years, so too have the mobile computing tools they depend on in the fast-paced healthcare environment. Being on the front lines of patient care, nurses have often been the early adopters of different technology to aid in delivery of patient care - from beepers to "computers on wheels" to PDAs. As faster information retrieval and better documentation tools have become imperative in the healthcare industry, many are looking to next-generation mobile computing tools to increase productivity, reduce costs, and provide more accurate and efficient patient care.
Despite the excitement around mobile computing in the mHealth arena, 93% of nurses in for-profit facilities stated they do not have computers in each room or hand-held/mobile devices to aid in the EHR requirements, according to the Q3 2014 Black Book EHR Loyalty survey. This lack of IT resources has a dramatic effect on nurse workflow patterns and inevitably leads to time taken away from patient care. In this environment where all staff are driven to operate at the top of their license, every minute of time savings and every improvement in accuracy and efficiency is critical to improving outcomes.
Recent innovations in mobile computing technology are the physical manifestation of the industry's rapid rate of change - from 4K displays to view medical imagery more clearly, to integrated barcode readers to use in medication management, to smaller and lighter tablets that fit in a pocket but offer the same processing power as a desktop computer - every new innovation addresses a genuine concern identified by the preceding group of healthcare professionals. Every move the industry makes toward providing nurses with effective mobile computing solutions translates into better, more efficient patient care.
As mobile computing has evolved over the years, equally so has nursing as a career. Nurses are now not only providing care, but working behind the scenes in IT purchasing and implementation, as well. A 2014 survey of more than 3,000 nurses found that 70 percent of respondents agreed nurses play an important role in medical device integration. With this in mind, a relatively new specialty has evolved - the nursing informatics specialist, a discipline that "integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice," according to HIMSS. It is clear informatics nurses will continue to be instrumental players in the analysis, implementation, and optimization of advanced information systems and emerging technologies that aim to improve the quality of patient care, while reducing costs.
As nursing professionals continue to excel within the healthcare industry at all levels of leadership, their understanding and acceptance of technology will continue to propel the use of digital tools, mobile computing included, into an integrated health experience. Nurses know that mobile, point-of-care computing solutions provide a way to effectively leverage information technology to advance both clinical productivity and patient care quality.
Interested in the growing importance of informatics nurses in the healthcare information technology environment? Check out the 2015 HIMSS Impact of the Informatics Nurse Survey to view the full results and infographic.