More than 10 years after the passage of the landmark Needlestick Prevention and Safety Act, needlestick injuries still pose a significant hazard for nurses, especially during phlebotomy procedures. In ADVANCE's upcoming webinar, experts will discuss the most recent needlestick injury data and nurses' rights under current laws/regulations, as well as provide a review of available safety-engineered technologies and the benefits and limitations of each class of devices. 

After this webinar, attendees will be able to:
* discuss the leading causes of needlestick injury during phlebotomy
* understand current needlestick injury data and nurses' rights
* articulate available safety-engineered technologies, as well as their benefits and limitations.

This offering will be presented as a live, virtual event on June 13 at 1 p.m., ET. It also will be available in our archive two days after the live presentation.

You may earn 1 contact hour by taking and passing a test following the webinar. The first 125 people can take the test free courtesy of BD.

For more info and to register, click here.

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the 13th and final installment of a weekly blog that enabled readers to join her on the journey.

Entry 13: Facing Forward

December 28, 2011

I’ve been attending a support group for women with breast cancer. I hope it helps me to cope as I’m able to express my feelings and fears in a safe environment, although two of the women are in stage 3, which means their cancers are advanced, metastatic. One woman is a nun in her seventies and the other woman I met many years ago at my old hospital. We were both treated at the same time by the same physicians. 

I feel terribly sad and afraid for them. And I wonder about my fate, too. Maybe that’s selfish but I think it’s normal. 

I’ve now completed two cycles of chemotherapy and survived both so far with the hope that both the steroids and the wonderful anti-emetic continues to keep the nausea at bay. I’m able to eat and maintain an appetite. I am now facing my third infusion in one day. 

In the meantime, my son is coming home from visiting his grandparents in Delaware over the winter break and we will be reunited. I look at him with renewed hope and pray I am able to take care of him for a long time.  Until next time, diary …

Click here to read Entry 12: Hair Loss as a Family Event.

When we published an article on the subject in January, readers posted an avalanche of responses. Many related personal stories of unresolved bullying at work. One stated she is "ashamed to be part of this profession"; another said "I tell anyone I know: Be a teacher, not a nurse!"

Where does it come from? One theory is the stress experienced by nurses is in many ways unique. Inadequate staffing, lack of autonomy, overwhelming responsibilities and constant life-and-death decision-making in numerous settings can make some nurses feel backed into a corner, and they display displaced aggression. While there might be some truth there, it doesn't help the targets of abuse.

The American Nurses Association has added a new resource on the subject with the recent release of the 28-page book Bullying in the Workplace: Reversing a Culture. Although the price of the brief book raises some eyebrows ($19.95 for ANA members, $29.95 for nonmembers) it's significant the nation's most prominent professional nurses association is acknowledging the problem.

The ANA publication outlines zero-tolerance policies against bullying, which is a sensible step to combat such behavior. Bullying exists within organizations because it's allowed to exist. Most everyone can point them out; bullies are seldom subtle and often flaunt their power. If it's a nurse or nurses on a unit creating a hostile environment for co-workers, it's up to their manager to confront them. If the manager is the problem - and have I ever heard those stories - the manager's direct report is responsible for allowing it to continue. And so it goes up the line.

The buck has to stop somewhere, even in the c-suite. Perhaps workplace atmosphere should be a prominent part of Joint Commission or similar appraisals. If accreditation was on the line, it would be gratifying to see how fast the bad apples would be weeded out.

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the 12th installment of a weekly blog that will enable readers to join her on the journey.

Entry 12: Hair Loss as a Family Event

December 3, 2011

My sister-in-law, a very compassionate and caring woman, and also a hairdresser, has taken pity on me once again and agreed to shave my head today. My mother-in-law; Tim’s sister, Peg; his brother, Jim; and my mother showed their support and rallied around me to help cheer me up through this excruciating process.

I would lose my hair in the den. I’d warned my son about what he could expect and what mom would go through with cancer. It was hard for him to swallow, and he was kept outside of the room so I could have some privacy.

First the scissors, the shiny, sharp, silver scissors, which shortened the length, thereby making the clippers more efficient. After about 20 long, torturous minutes, the deed was done. I’d been buzzed.

I ran for the mirror to see what G.I. Jane looked like, again. But I knew very well that this wouldn’t be the end of the hair fallout. There was more to come until I was bald as a newborn, with only a few strands of peach-fuzz remaining. I collected hats, wigs and bandannas to disguise my very bare head but each and every head-covering was a rude reminder of my status as “cancer patient."

Tim told me he had to vacuum an enormous amount of hair behind the bed.  He seemed very upset by this.

Click here to read Entry 11: The Dog Wins.

I thoroughly enjoy editing articles. Whether written by a trio of PhDs, a CNO, a staff nurse writing for her first time, a freelance journalist or another ADVANCE editor, I just can't let a sentence be until it sounds right in my head.  A long-time telecommuter, I've often turned away from my computer after a long day to find my house has grown completely dark around me with the setting sun entirely unnoticed.    

Unfortunately, this means I sit - a lot, which apparently can be a very dangerous thing to do. In short, my job, or at least the way I approach it sometimes, may well be killing me.

That's according to a recently released study from a group of Australian researchers, "Sitting Time and All-Cause Mortality Risk in 222,497 Australian Adults," the results from which suggest sitting for 8-11 hours a day combined with other lifestyle choices, e.g., sitting down with a cold beer and a slice of pizza to watch the game after sitting all day at work, can potentially kill a person.  

From more than 222,000 adults ages 45 and older surveyed between 2006 and 2008, the researchers found people who reported sitting for up to 11 hours a day were 40 percent more likely to die sooner than those who sat less than 4 hours daily.  That doesn't necessarily prove sitting alone shortens people's lives, of course, but it certainly is food for thought. 

The survey, the results from which are published in the March issue of the Archives of Internal Medicine, also asked questions about participants' overall health and whether they smoked or used to smoke in addition to how much time they spent sitting and exercising, and if they had any pre-existing medical conditions.  

Thing is though, whether a person smoked or exercised a lot or not at all, or even if they were of normal weight, overweight or obese, made less of a difference to their longevity than did the simple act of sitting for extended hours, a common denominator in those 5,400 original survey participants who actually died during the study.

"When we give people messages about how much physical activity they should be doing, we also need to talk to them about reducing the amount of hours they spend sitting each day," lead author Hidde van der Ploeg of the University of Sydney reportedly said in releasing the results of the study.

Too much sitting may harm blood vessels and slow metabolism by increasing fats in the blood and lowering good cholesterol levels, she says. By contrast, when you are standing or walking, your leg muscles are constantly working which helps to clear blood glucose and blood fats from the blood stream.

So what can a person do?

Well, if you're a nurse who works on any floor of a hospital, sitting is obviously not as much of an issue for you as trying to find time to sit down and get off your feet.  

However, if you are a managerial or administrative type, or a nursing instructor or researcher perhaps who sits a lot while working, here are some tips I've read while searching the web since the results of the survey were announced:

• 1. Make sure your telephone, printer and fax machine are far enough away from your desk that you have to get up from your chair to take or make a call, or to retrieve something.
• 2. Park as far away from your building as time and weather allows, use the stairs once inside, etc.
• 3. Take a walk on your lunch break if you get one.
• 4. Stand up and stretch and say hi to a coworker, preferably one more than a few steps away from your cube.
• 5. At night, do some chores while listening to your favorite TV show. You can always run over to your TV when your favorite Idol contestant comes on, which is actually more exercise.
• 6. Buy a treadmill desk (my personal favorite).

How about you? Do you have any tips for getting out of your chair while working a desk job - and potentially living longer as a result?

This month, a mother in Texas was convicted of child endangerment after a second baby died of SIDS due to co-sleeping.

In July 2010, Vanessa and Mark Clark's 2-month old son died while sleeping with his parents. Vanessa Clark had Xanax and Hydrocodone in her system. Less than a year earlier, the couple's 1-month old son died in the parents' bed. No charges were ever filed, as the first baby's death was classified as SIDS.

Clark's defense team said Child Protective Services gave Clark a brochure for safe co-sleeping after the death of her first son, but did not prohibit it.

We're living in an age of constant information streaming and it's hard to believe any parent would be ignorant of the dangers of co-sleeping under the influence of drugs. It's almost unconscionable that a family who has already buried a child would bring an infant into their bed again. That being said, I've also compromised safety by moving a baby to our bed at 3 a.m. in the name of a few hours' shuteye (although never under the influence of Xanax and Hydrocodone).

In Milwaukee, The HOPE Network provides free portable cribs to single mother families with demonstrated financial need. Parents are required to take a safe sleep class to qualify for the crib. While it's impossible to quantify how many little lives this initiative may have saved, it illustrates a growing awareness of SIDS prevention.

In the Clark case, there's no evidence that they didn't have the financial means to provide a crib. How do you pediatric nurses dissuade determined parents from co-sleeping? Has anyone ever encountered a family with two SIDS deaths?

Hopefully, this  tragic case will raise awareness about the dangers of this still too-popular practice.

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the 11th installment of a weekly blog that will enable readers to join her on the journey.

Entry 11: The Dog Wins

November 20, 2011

Day number two following chemotherapy. Definitely feeling that fatigue. I’m dragging, physically and mentally exhausted.

I’m impatient with my son, which I attribute to the steroids I’m required to take for several days around the chemotherapy infusions. I have mouth sores and my eyes feel as though they’ve been rubbed with sandpaper. I force myself to workout but my energy level is way down. I cannot push myself.

I made the mistake of trying to extract a nut from my dog’s mouth. That was the very next day after chemotherapy. Stupid, unthinking me! 

Unfortunately, my thumb became the victim of some sharp incisors. The dog’s teeth penetrated this finger in two places, both the nailbed and the pad. That bought me a trip to an emergency room at the local hospital. 

I went through the “fast track”, that is, evaluated and treated in 2 hours flat. The finger was examined, X-rayed, washed out and I’d been given my first dose of antibiotics.

Click here to read Entry 10: A Port, No Breakfast & Patient Providers.

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the tenth installment of a weekly blog that will enable readers to join her on the journey.

Entry 10: A Port, No Breakfast & Patient Providers

November 15, 2011

The infusaport is in. I was naturally anxious about getting a silicone and metal dome-shaped device implanted in the superficial portion of my upper chest. This was attached to a skinny flexible catheter threaded into my right internal jugular vein that would ultimately be the delivery device for my chemotherapy infusions.

Although I was grumpy from not having had anything to eat or drink since the wee hours of the morning, the nurses were very nice and took their time with me, listening to my long and sordid tale of cancer (yet again).

I hadn’t met the interventional radiologist until that morning. He was very kind, very young and, as I’d expected, a bit hurried, but he took the time to discuss a couple of possible locations for the device implantation. My arms however, were off limits because of the lymphedema risk. So the usual location of chest and neck would have to suffice.

Click here to read Entry 9: Against All Odds.

What motivates you to get up in the morning (or in the evening, afternoon or middle of the night depending on your schedule) and go to work? That's not really a tough question for most people  — money, of course.

As Daniel Pink, former speechwriter to Al Gore and author of books on workplace issues, told attendees of the American Organization of Nurse Executives annual meeting in March in Boston, money is certainly a motivator but it's not enough to engage workers.

"If people are not being paid fairly  — boom  — there goes the motivation," he said. "People will do just enough not to get fired."

Leaders should, he said, hire great people and pay them enough so they don't concentrate on the money but concentrate on the work.

Nurse leaders should also look at three key motivators: autonomy, mastery and purpose, he said.

For autonomy, Pink invited attendees to conduct their own "autonomy audit." He recommends managers take the audit on how they think the employees will rate the workplace, then compare those numbers with how the staff members actually rate it.

Using the scale of 0-10 (0 meaning "almost none" and 10 meaning "a huge amount"), what number would you give to these questions?

• How much autonomy do you have over your tasks at work - your main responsibilities and what you do in a given day?
• How much autonomy do you have over your time at work - when you arrive and leave, and how you allocate your hours daily?
• How much autonomy do you have over your team at work - are you able to choose the people with whom you typically collaborate?
• How much autonomy do you have over your technique at work - how you actually perform the main responsibilities of your job?

With, in Pink's words, "0 being a North Korean prison and 40 being Woodstock," where does your workplace stand? If a number is low in a certain area, look at whether you can give nurses more freedom in those weak spots. More independence generally brings more investment in the work.

As Pink said, "Human beings do not engage by being managed, but with self-direction."

Take the autonomy audit and post your results below. Which areas are lacking independence? Which areas do you feel completely autonomous? 

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the ninth installment of a weekly blog that will enable readers to join her on the journey.

Entry 9: Against All Odds

November 10, 2011

I saw my wonderful medical oncologist. He has a heart of gold.

(Yes, I think highly of him as I do my breast surgeon. The two of them have kept me alive. Again, I don’t blame them for any of this. How could they have predicted? How could they have known I would ever develop this disease again? It was against all statistical odds, really.)

He told me that I actually had the option of choosing to undergo chemotherapy. Because he’s a “numbers man,” he ran the statistics on my potential survival if I took the chemotherapy versus not taking the chemotherapy. It seemed that my survival would be a few percentage points greater if I took the infusions.

Of course I agreed.

Why would I choose otherwise, especially with the BRCA1 gene? Having the gene is like having the sword of Damocles hanging over me for the rest of my life, with one thin hair supporting the sharp, deadly weapon.

Who knew if and when it was going to sever my string of good health again? When will it end?

Will I ever feel as though I’ve conquered the disease once and for all?

Click here to read Entry 8: A Sixth Sense.

One in 88 children: That's how many children the CDC estimates has been identified with an autism spectrum disorder (ASD). It's a 23 percent increase since data was reported in 2009 and a 78 percent increase since 2007.

The number of children identified with ASDs varied widely across the 14 ADDM Network sites, from 1 in 47 (21.2 per 1,000) to 1 in 210 (4.8 per 1,000). ASDs are almost 5 times more common among boys (1 in 54) than among girls (1 in 252). The largest increases over time were among Hispanic children (110 percent) and black children (91 percent).

But something always bothers me when these statistics get published. The media spins the numbers as if autism is spreading like the flu from one child to the next. I read somewhere where autism has reached epidemic proportions. Yes, the numbers are large; but, in reality, I believe the numbers aren't really new or even accurate; these kids have been there all along.

I think the bigger message with these new statistics should be that healthcare providers and parents need to continue to learn more about autism and the risks factors, as well as the importance of early screening. Why aren't all children screened at their 2-year well visit, or at community screenings where their parents are being screened for high blood pressure and diabetes?

The CDC's "Learn the Signs. Act Early." program provides free tools to help parents track their child's development, along with free resources for healthcare professionals and educators.

The CDC also provided leadership in establishing Healthy People 2020 objectives and supporting the American Academy of Pediatrics recommendation that all children be screened by age 2, because early screening and diagnosis improve access to services during a child's most critical developmental period.

Perhaps these numbers are meant as a wake-up call, but I feel they are misleading. Autism screening and education should become the norm, not a statistic.

Our family computer is in the den, and I marvel how long they can endlessly view random videos on YouTube or browse status updates on Facebook.

So when I heard about the "cinnamon challenge," I had to check with them. Sure, they heard of it a year ago. Where have I been?

According to the American Association of Poison Control Centers and a multitude of videos posted online, the challenge involves taking a dare to swallow a spoonful of powdered or ground cinnamon. "This results in the cinnamon coating and drying the mouth and throat, causing gagging, vomiting, coughing, choking and throat irritation," the association states. And hilarity for some, based on online comments.

One of the videos I found boasted more than 6.5 million views. Others had merely dozens. The activity seems to cut a wide swath across various youthful demographic groups. Many of the videos feature kids recording themselves, while others have friends and even their mom operating the camera.

I always ironically proclaim it a badge of honor to have been raised on '70s and '80s trash culture, but this stuff makes reruns of "The Love Boat," "Beverly Hillbillies" and "Star Trek" look like the classics.

But it's not just frivolous fun, say poison control centers officials.

"Although cinnamon is a common flavoring, swallowing a spoonful may result in unpleasant effects that can pose a health risk," said Alvin C. Bronstein, MD, FACEP, managing and medical director for the Rocky Mountain Poison and Drug Center. "The concern with the cinnamon challenge is that the cinnamon quickly dries out the mouth, making swallowing difficult. As a result, teens who engage in this activity often choke and vomit, injuring their mouths, throats and lungs. Teens who unintentionally breathe the cinnamon into their lungs also risk getting pneumonia as a result."

One of my kids related this scenario: Someone posts a status update on Facebook stating he'll take the cinnamon challenge if the status receives a certain number of "likes." Then it's off to gag on a spice.

He says the phenomenon has really taken off this year, and the numbers bear out his observation. Poison centers received 51 calls about teen exposure to cinnamon in all of 2011. But in the first 3 months of 2012, poison centers received 139 calls, with 122 classified as intentional misuse and 30 requiring medical evaluation.

Those figures don't amount to a public health emergency, but should be of some concern to parents. There are a lot of bored kids looking for attention via Internet stunts. The same judgment that leads to gulping cinnamon on a dare could lead to worse decisions and bigger problems in the future.

Nancy Cohen, BSN, RN, has graciously shared her personal journal, in which she writes about doing battle with cancer for the second time in her life. This is the eighth installment of a weekly blog that will enable readers to join her on the journey.

Entry 8: A Sixth Sense

November 7, 2011

Mood swings. Up and down. Up and down. Trying to maintain some balance and composure. Very hard to do right now when you think you’ve been “cured” from a life-threatening illness and then it’s back.

The monster with no conscience, the devil himself in the form of a cluster of malignant cells. And what to do, what to think when my physicians are all scratching their heads in a clueless state of wonderment and shock because they tell you that they’ve never seen this before.

I’ve been taking long walks with my dog, Myla, a rescue dog, part black lab, part border collie. I’ve spoken to neighbors, friends, other parents and sorrowfully described my tale of woe to whomever was willing to listen.

Even I get tired of repeating the same story ad nauseum. Cancer, jobless, finances, bills, health benefits. My head is going to explode with worry. Did I know, did I somehow know it would happen like this, after all the conversations with Tim over the years at the dining room table?

Perhaps I had a sixth sense about the same scenario repeating itself. Hopeless, helpless.

Could have happened to anyone but … it happened to me. It happened to be me while everyone else is going along happily in their own lives oblivious to their own personal fortunes. Damn, I have to face this thing again, again, again.

I have to force myself to trudge along, carried by prayers, supported by my devoted family, close friends, caring co-workers and inspired by my 10-year-old whom I’ve promised to wear a hat over my wig when I drop him off and pick him up at school so the wig won’t fly off my head from a strong breeze. (The least of my problems but I agreed to oblige). I get it. I totally get it.

When I’m wearing a scarf and a hat, I’m well aware of the pity stares. I’m certain that those who view me process the mystery disease immediately. Maybe they’re thinking, “What a shame, she seems too young.” Maybe they’re thinking, “Thank God it’s not me,” or “So-and-so is also being treated for cancer.” Everyone has been affected by cancer in some way, shape or form.

Until next time. Chemotherapy starts on Friday. Though some things are unavoidable like alopecia, Tim is hoping I can be spared the nausea and mouth sores.

Click here to read Entry 7: Worthwhile Adjustments.