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Nurse on the Run

The Problem with PPE (Personal Protective Equipment)
October 15, 2014 9:27 AM by Lorettajo Kapinos

It's impossible to turn on the television, radio or look at the internet without the virus EBOLA staring you in the face.  And now, two health care workers have been infected at the same hospital.

Blaming the nurse was the first reaction . It was assumed the nurse broke protocol. Now, workers are coming forward with reports that the hospital did not provide the right equipment and training. But what if both scenarios share thread of truth?

I am a nurse. I know MRSA, CDIFF, VRE very well. I protect myself everyday from these "superbugs." However, when faced with tuberculosis, measles, mumps and even chicken pox, I have to stop and review the precaution information. Often, I am not confident that I know how fully protect myself or other patients in my ED, but I do the best I can. 

But these infections are still spread, even though we use PPE every day to prevent it.

Why?  Nurses aren't careless. Hospitals aren't wreckless.

I believe it's because many people take PPE for granted.  We work in a high demand environment that forces us to move faster than we should, with less help than we require. We gown and glove mindlessly, like we do with many other nursing tasks. But with Ebola, we can't be mindless. We owe it to ourselves, our patients and our communities to don (dress) and doff (undress) our gear with care.

But do we really know how? Personal Protective Equipment we are unfamiliar with can cause more harm than good. We deserve experts at our side to support and educate us.

It looks like that time has come for that hospital in Dallas. According the the Center for Disease Control's most recent fact sheet:

"The single most important aspect of safe care of Ebola is to have a site manager at all times who oversees the

putting on and taking off of PPE and the care given in the isolation unit. A site manager is now in place and will

be at the hospital 24/7 as long as Ebola patients are receiving care."


 Do you feel this is an appropriate response? Would you feel more comfortable caring for an Ebola patient with an expert from the Center for Disease control by your side? Do you think this will set  a precendent for future outbreaks of illness?

Stay Current With Our Guide to Ebola...

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Ebola Resource Center

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Training for an Ebola Patient
September 15, 2014 9:20 AM by Lorettajo Kapinos

When I was in nursing school, the movie Outbreak (1995) was released. That prompted me to read a book with the same name, Outbreak (1987). Though the story was different, the epidemic concept was the same. I was also taking a microbiology class.

 I freaked out and swore I would never again watch another movie or read another book even remotely related to Ebola.

I stuck by that rule until July of this year, when someone enticed me into watching 28 Days Later (2002) while on vacation. Though it was categorized in the zombie genre, it  made me think of Ebola. I shuddered while remembering my college years and the coincedental fictional stories that paralleled the last Ebola outbreak. In the time that followed, my creative brain hijacked my rational thoughts. Suddenly, I worried Ebola was going to make a resurgence.

And then, it did. 

Thanks to a very proactive Infectious Disease Department, the hospital I work at has already begun training emergency staff in the use of protective equipment.  We have a plan in place, should a patient arrive with symptoms and a potential exposure. Though I am still concerned, I feel prepared and confident we can handle it. The training was performed by our local Fire Department. The planning has been in collaboration with our larger hospital.

 Has your hospital done anything to prepare? Do you think they should? 

The Truth About Suicide
August 12, 2014 10:09 AM by Lorettajo Kapinos

Robin William's death will not alter my every day life. I loved his movies and laughed at his comedy, but I didn't know him personally. His pain and his struggles, however, I do know. I know them all too well.


I know that sometimes the only place of comfort is a dark cavern, where no one can reach you. 

I know that pushing people away is much easier than letting them help.

I know that help isn't what most people think it is.

I know that my insurance company THINKS they know what help is. They don't.

I know that this type of suffering is mocked, ridiculed and belittled on a regular basis not only by society but by the voices that echo through your head.

I know that showing happiness makes others feel better and they will likely leave you alone to feel safe in that comfortable dark cavern. So you fake it.

I know you know suicide is not the answer, but you already feel dead and worthless and don't want to burden those that you love anymore. So you do it.

I know others think you are selfish because you can't share these truths, but really, you don't want to bother people with your nonsense.


The tragedy in suicide is that it takes these truths with the people who carry them. Those of us who survive suicidal thoughts figure the rest of  world doesn't want to hear about them anyway. Because, let's face it--you don't. No one wants to hear about the disease that poisons our brains and thoughts. No one believes this could possibly be an illness, similar to heart disease or cancer.

I know suicide is a symptom of a disease that needs attention. I see it every day at work.  I've lived it. 

Please, can we finally start treating it as such? 


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Officially Committed
August 6, 2014 9:20 AM by Lorettajo Kapinos

I have worked per diem for much of my career, by choice. It has nothing to do with my desire to work hard. It had more to do with my ability to commit, or rather my perception of it.  Over the years, I was offered full time and part time jobs.  I was chided, coerced and threatened by leaders. Still, I stood my ground, remained flexible and refused to give in.

Earlier this year, I accepted my first full time job.

A few things changed to make this possible. My family is now older; they don't need me as much. My husband works from home now. And finally, I wasn't being forced into sacrificing weekends and holidays away from my family. But mostly, I have learned that committing isn't nearly as horrible as I imagined.

As a runner, I see commitment in a whole new way. It's not a burden. It's a challenge. And who am I to turn away from that? I also see that it doesn't have to be all or nothing. Committing means giving something attention while blending it in to the rest of your life, in other words--not letting it consume me. Every mile opens my eyes to new destinations, more possibilities. The more miles I run, the better I feel.

So, in addition to committing to full time work, I have just signed up for my first half marathon. It's been on my mind for a long time. I've been loosely training for it since last year. But yesterday, I paid the fee. I am committed.

On October 25th, I will run my first half marathon in Falmouth, MA. And I am committed to training for it.



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Passion: Productive versus Destructive
July 2, 2014 8:47 AM by Lorettajo Kapinos

I have always been an expressive person. There are many adjectives to describe that part of me. Some of them are positive, but not all. When I was younger, I thought my passion was bad. I ignored it, denied it, suppressed it. Ultimately, I made myself feel pretty awful. Eventually, ALL of my thoughts would explode, causing massive destruction. After, I would back down into my silence and the cycle would begin again.

Then, something happened. My daughter was born.  She, too, is expressive. At first, I found myself frustrated and angry. She cried a lot that first year. Then that crying turned into temper tantrums. Just before I was about to lose my mind, I found the greatest word ever: passionate. 

I mulled that concept over. I let the word settle on my tongue and my brain. Soon, I was able to see my daughter as a passionate person who needed guidance to express what I could not. As I taught her, I learned. 

She is  eleven.  I am now in a leadership role at work. 

Over the past ten years, I have struggled to name my passion. I react strongly to many things, but couldn't quite figure out why.  I searched for my foundation on which to stand tall. I needed to grasp exactly what it was I believed in.

What I have found, is that I stand for honesty, fairness and doing the right thing. When a situation makes me angry, I work to discover what is triggering it. When I realize what is upsetting me, I face it with the proper tools--words of evidence. I have found utilizing these tools have made me very effective.

My passion has now become productive versus destructive. This has not been an easy road. I still battle the fears of ridicule and rejection I faced when younger. But in trying, I have found an amazing strength inside of me. I feel more at peace. I feel productive.  Burnout has left me and I feel satisfied working as a nurse once again. 

 Have you ever tried to turn around a perceived weakness and make it your strength? Tell me about it below. 

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Manager's Forum
June 25, 2014 11:45 AM by Lorettajo Kapinos

Last night, I held a Manager's Forum meeting as the Pioneer Valley Chapter President of the Emergency Nurses's Association. Our topics included crucial conversations, sharing difficult conversations with your manager and how to advocate for yourself without whining.   The premise was to offer a safe place for managers and staff to find common ground. As a new leader in nursing, I feel it's important for both sides to share perspectives, otherwise empathy is lost, and ultimately, the patient suffers.

Our discussion went on for an hour and a half. It was lively, friendly and very informative.  Here are a few things I took away:

1) If management wants to take credit for success, then it's only fair they accept responsibility for failure. In other words, I heard staff asking leaders to please stop blaming them when things go wrong. There are many parts to the system, each one needs to carry their own weight. It's difficult to work in an environment when management rarely or never admits to being wrong. It leads to staff hiding their mistakes and a punitive culture.  No one can win, even when things are going well.

2) People don't always know they are unhappy or behaving badly. If people don't know what is expected of them, they will create their own rules. Expectations of behavior must be set and enforced, otherwise accountability is useless. Often, it takes one person's honest observation to curb or cure another's unhappiness. Both leaders and staff have a role in changing a department's culture. Individuals need to own their emotions and move on if they are that unhappy.

3) Transparency is valued by both staff and leaders. Trust and a sense of safety are key to growth and development for both the individual and the group. Each must trust the other. The only way to build trust is to extend it. Often it's the leader who is responsible for demonstrating it first. This comes from being up front with info, updates and data at all times.

4) ED nurses don't feel allowed to complain. When we talked about "whiny" conversation, everyone in the room agreed that ED nurses tend to be more stoic than emotional when it comes to expressing needs.  Often, we feel the stressors are "just a part of the job". Most of asked if this was caused by leadership. We agreed it depended on the situation, but overall, ED nurses tend to compartenalize their issues.  This is great protection, but also the leading cause of burn out, in my opinion.

5) Everyone wants to do a good job, for the most part. Managers don't set out to upset staff. Staff isn't trying to make life difficult for their boss. Everyone has a job to do and strives to do it well. Staff want and need a leader who can make their jobs more fulfilling, not necessarily easier.

6) Staff desires managers who can work clinically with them. We had a nice long debate regarding clinical skills of leaders. Many managers felt they couldn't do as good of a job leading if they are in the trenches. Staff felt they couldn't be evaluated by managers who couldn't do the tasks of the bedside nurse. It seems there must be a happy medium. Maybe a manager can't work the trauma room, but they can triage or take vital signs. A presence during a time of crisis can be invaluable and build respect, even if the leader is a little rusty.  

  What would you say to your manager or leader, if you had the chance? 

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Confidence Based Nursing
June 11, 2014 12:05 PM by Lorettajo Kapinos

I have heard the term "evidenced based nursing" since the day I started nursing school. It's not a new concept, but it's one that is important to everything we do. It's proof that we are providing the most up to date care for our patients based on evidence collected via research and provides a means of improvement for facilities. 

I am all for utilizing research in my practice, but I think it is even more important for nurses is to feel confident in what they do. Research and evidence is great, but it can change quickly. New products come out. Different studies disprove what previous studies swore was the best thing.

Sometimes we even find out we were hurting patients with our evidence based practice.

That is a confidence killer.

As an educator, I often wonder how to build confidence in an ever changing climate. I often utilize three tools. One, I listen. Change is scary. I let my staff verbalize all their thoughts. Then, I empathize. It's important to let people know they are heard.  Finally, I am as honest as I can be. I can't always tell them how I really feel about something, but I can provide a rationale . I try to fall back on evidence based reasons as much as possible. When I can't, I offer up all the reasons I have been given during the discussion leading up to the change.

How do you build confidence in an unsure environment. I'd love to hear thoughts, stories and suggestions.


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Spring in My Step
May 22, 2014 3:19 PM by Lorettajo Kapinos

I know I am not alone is saying the winter of 2014 has felt like the winter that wouldn't end.  And now spring is here. Or is it?   I still feel cold more often than I like.  So, to put a little spring in my step, I figured I needed some new sandals.  But with my history of foot and heel pain, I was worried sandals would aggravate it like last year.

Was I going to be stuck wearing sneakers all summer? Would I have to suck it up and buy ugly but supportive sandals? I bravely told myself I could have the best of both worlds and wouldn't stop until I found both a supportive and pretty sandal.

It didn't take me long. The first place I searched was  the Dansko website.  I was  surprised at the selection, but still feared I'd end up with a pair of old lady type pair of sandals.

 And then, I found them: The Sophie.  I loved the color selections, the style and the look. I knew they had to be supportive because Dansko wouldn't sell anything less.  But I still worried they'd be ugly in person.

They were NOT UGLY! As a matter of fact, my preteen daughter tried to claim them as her own. However, I needed to believe they would support me, not hurt me, even though Dansko had never let me down before. I chose to wear them for the first time to a weekend conference. I packed a back up pair, but didn't need them,even though I was on my feet constanly for two days. 

But I wanted to be extra sure I liked them before I wrote about them. So I did what I call the ultimate test: I wore them for a walking tour in New York City. And, again, I was very satisfield.  I did have to break in the straps a little bit because they irriated my pinky toe a bit. But overall, I can't complain. They are soft, supportive and comfortable.

So, if you need a pair of sandals that are both supportive and nice looking. Try Dansko. I doubt you'll be disappointed.

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Dansko Shoe Winner Announced
May 19, 2014 11:51 AM by Linda Jones
Posted on behalf of Dansko

Thanks to all who replied to the question "What is the most important thing that has happened in or to the field of nursing?" We hope you enjoyed reading the comments as much as we did.

The winner of the Dansko shoes, chosen at random from all the entries is Karen Farrar, RN, from Indianapolis. Congratulations!

We hope everyone had a wonderful National Nurses Week!

Nurses Week Reflection: I Never Gave Up
May 12, 2014 8:50 AM by Lorettajo Kapinos
I first entered the nursing world 20 years ago. When I think about who I was then, I have trouble believing where I am now. No one in my family was in the medical field. I knew nothing about hospitals, nursing homes or healthcare in general, except what I had seen on TV or read in books. I just knew I wanted to learn everything I could about the human body and help others take care of it.

Passion filled my veins, giving me the push I needed to fight my way through nursing school. It was a long, challenging road, but I never doubted I could do it. Along the way, a few people tried to discourage me. Some even tried to stop me. But, always, just when I needed it, a light would shine through to guide me.

Culture shock is how I describe my birth into healthcare. The real world was so different from what I had imagined. I pictured nurses nurturing each other and doctors providing insight or guidance. We all worked together to meet a common goal - save lives and heal people. Naïve was how people described my innocent hopes and dreams of utopia. I ignored those naysayers and marched on.

At one point, my passion dwindled. Dreams suddenly felt out of reach, silly and immature. I thought I had to grow up. Consequently, I believed that meant I had to give up. I tried. I attempted to conform, but that only lead to more misery. My heart wouldn't stop pumping out passion. My brain couldn't contain its ideas. But I held it all inside, believing it was the right thing to do.

Then one day, the idea of leadership was planted in my head. I first thought I couldn't do it. I rationalized the fear with denying I wanted to do it. Finally, a few people convinced me to try.

My first attempts caused me to stumble. I cowered a few times. I even ran away. But now that I am here, educating and leading other nurses, I know I am right where I belong. Anytime I waiver, I remind myself of what I believe nursing can be. I remember why I became a nurse. And I am thankful I never gave up.

"I have an almost complete disregard of precedent, and a faith in the possibility of something better. It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past."--Clara Barton


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Congratulations from Dansko
May 6, 2014 2:52 PM by Linda Jones
Posted on behalf of Dansko

As a way to recognize the hard work nurses do, we asked you to tell us on the Dakso website why you celebrate Nurses Week.

From the many entries we received, the 5 random winners of the Dansko Appreciation Event are Jasmine from Tennessee, Dorothy from Oregon, Carolyn from New Jersey, Sharon from Texas and Renay from Massachusetts. Each winner and a group of teammates will enjoy a celebratory lunch and a pair of shoes!

Happy National Nurses Week to all!

Win a Pair of Dansko Shoes!
April 28, 2014 12:08 PM by Linda Jones

Posted on behalf of Dansko

As a way to celebrate National Nurses Week, we are giving away a pair of Dansko shoes to one lucky reader.

Nurses Week is a great time to reflect on your profession. What do you think is the most important thing that has happened in or to the field of nursing? Maybe you believe it’s that nurses now are in leadership roles -- or maybe it’s that they are no longer wearing caps! Tell us what you believe is the most important thing in the comment area below and you’ll be entered to win a pair of Dansko shoes.*

Deadline is May 6; winners will be announced May 12.

*No purchase is necessary to enter. U.S. residents only. One winner will be selected at random from all participants who respond to the question in the comment area. Winners will be notified via email by 5/12/14. The winner will receive a pair of Dansko shoes.

Share Your Nurses Week Celebration Story & Enter to Win!
April 14, 2014 9:46 AM by Linda Jones
Posted on behalf of Dansko

Shift after shift, week after week, we know you work hard and we want to recognize you! Tell us why you celebrate Nurses Week. Share your story for a chance to win a Dansko Appreciation event - shoes and lunch for you and your nursing team! (See rules and regulations on the Dansko site.)

Deadline is April 28; winners will be announced April 30.

Click here to enter.


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Nursing as a Team Sport
April 10, 2014 9:59 AM by Lorettajo Kapinos

I often find myself witnessing different specialties of nursing tear each other apart. The ED nurse curses the home care nurse or the long term care nurse for not recongizing a problem before it became an emergency. Inpatient, ICU and OR nurses grit their teeth in frustration because the ED nurse isn't able to provide details about the patient's history or related health issues. Finally, home care nurses and long term care nurses pull their hair out in frustration at the lack of education a patient receives while in the hospital.

This is not a new phenomenon, but has made me crazy since the day I started nursing school. It's like each group refuses to see care from any perspective other than their own.

I believe nursing works best when it's viewed as a team sport.

Each specialty can be a player, with their own skills, strengths and assets. At every stage of care, something different is spotlighted making an entire patient experience whole.

One wouldn't expect a pitcher to do the job of a catcher with every play, right? A pitcher can catch and often does, just like a catcher can throw but doesn't pitch. Both players have the same basic skills, but once specialized it wouldn't make sense for them to be expected to do it all. That's why there's a team. Teams work together to play the game the way it was designed.

So, why do we as nurses not see our team in the same way? We all have roles that matter during the course of the patient's stay. Nursing can be and should be a team sport. Maybe then we can all get along.

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The Path of Least Resistance
March 27, 2014 9:38 AM by Lorettajo Kapinos

I believe everyone wants to do a good job. Maybe I'm a fool, but I can't imagine ever saying, "Today, I am going to do something terribly wrong, on purpose."  Usually there's a reason people diverge off the path. Maybe they need something they aren't getting. Maybe they are seeking to hide something. Maybe they are desperate or frustrated or overwhelmed.

But most often, I think people stray from doing the right thing, because it's easier and no one is going to call them out on it.

Say for example, you are an ED nurse. You know you should document vital signs every two hours, but to document the results is cumbersome and time consuming. If something goes wrong with the patient, the vitals are stored in the monitor--everyone knows the ED monitors all their patients all the time, right?-- you can enter them later if necessary.

You don't actually NEED to enter vitals. No one audits charts. No one really cares, unless there's a problem. And problems are what ED nurses handle best.

Some people call this behavior lazy or careless.There's all sorts of negative terms we can use to judge this nurse, But in reality, she or he is taking the path of least resistance. Not charting, unless something, is wrong is easier. For a while, that was actually the type of documentation I was taught to do. It had a name: charting by exception. Nurses only documented abnormalities. If it wasn't documented, then it was normal. It left a lot of room for omission errors.

Today's hospital culture has shifted into electronic documentation.  The time saving capabilites and potentials are often proven to be a myth. In fact, many experienced nurses struggle to utilize the tool, ending up overwhelmed and exhausted.  Good nurses cut corners not only because they can, but because they have to, in order to survive.

How do we fix this? I think first, we need to recognize the behavior. Electricity will naturally choose the path of least resistance. Humans, I believe are no different.  

I believe it's the job of nurse leaders to not only esure a job is done well, but to strive to make success as easy as possible. How do we do that? Does anyone have any ideas or things that they have tried that worked?

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