In light of Breast Cancer Awareness Month, I have put together a guide for nurses on the latest breast cancer information.
Breast cancer is the second leading cause of cancer death in women (second only to lung cancer). In the US, 1 in 8 women will develop breast cancer during their lifetime, while 1 in 36 women may die from the disease. Currently, there are 2.8 million breast cancer survivors living in the US (American Cancer Society, 2016).
Types of Breast Cancer
Most breast cancers are classified as carcinomas, which is cancer of the epithelial cells that line the tissues in the breast. Ductal carcinoma in situ (DCIS) is non-invasive and is considered pre-cancerous. Invasive ductal carcinoma is the most common type, which starts at the milk duct and spreads to the fatty tissue of the breast. Invasive lobular carcinoma starts in the milk-producing lobules of the breast. Inflammatory breast cancer affects only 1-3% of all breast cancers. It presents itself as red, warm skin that resembles an orange peel instead of a typical lump, which can be mistaken as mastitis. This is caused by cancer cells blocking the lymph nodes in the skin. Triple negative breast cancer occurs in 15% of breast cancers and refers to the absence of estrogen, progesterone, and human epidermal growth factor receptors, which limit treatment options (Turkman, Opong, Harris, and Knobl, 2015).
Risk Factors for Breast Cancer
Uncontrollable risk factors for developing breast cancer include age, race, and gender. The risk increases with age. Caucasian women are at slightly higher risk for breast cancer than African American, Asian, Hispanic, and Native American women. However, African American women are more likely to die from the disease and have higher rates of breast cancer in women younger than 45 years of age. Women are at higher risk than men, although men can also develop the disease. Other factors include a family history (although 8 out of 10 women with breast cancer have no family history). The presence of the BRCA1 or BRCA2 genes and other genetic mutations also increase the risk for breast cancer. Interestingly, the age of menarche less than 12 years of age and the age of menopause greater than 55 years of age also increase the risk for breast cancer.
Controllable risk factors for breast cancer include smoking, consuming alcohol, and obesity. Hormone replacement therapy and hormone contraceptives also increase the risk. Participating in 150 minutes of moderate activity per week and breastfeeding for 1.5-2 years can reduce the risk (American Cancer Society, 2016).
The American Cancer Society (2016) guidelines for breast cancer screening include:
- Women ages 40-44: mammograms, if desired
- Women ages 45-54: mammograms every year
- Women ages 55 & older: mammograms every 2 years
Self-breast exams are no longer recommended due to lack of research evidence of a benefit. Regardless, women should report any changes to the way their breasts look or feel to a healthcare provider. Women who are at high risk for breast cancer due to genetic factors, radiation, or certain syndromes should get yearly mammograms and MRIs.
Treatment for breast cancer may include a combination of surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, and/or clinical trials.
After mastectomy, women may experience altered body image, sexual dissatisfaction, lack of sensation in the reconstructed breasts, and emotional distress. Many of the anxieties can be reduced from pre-operative education, counseling, and support (Suplee, Jerome-D'Emilia, and Boiler, 2016).
Newly diagnosed African American women with breast cancer have lower five-year survival rates (78%) than Caucasian women (90%), which is not explained by biologic differences (Jiang, Sereika, Bender, Brufsky, & Rosenzweig, 2016). Factors that may influence the health disparity include social, economic, and cultural barriers to screening and treatment. African Americans may be disproportionately affected by social injustice, poverty, and general mistrust of the healthcare system (Jiang et al, 2016). Latina Americans are more likely the Caucasian, African American, and Asian Americans to report diagnostic delays for breast cancer. Increasing the timeliness of diagnosis and treatment following abnormal mammogram results improves survival and may reduce the mortality differences between racial and ethnic groups (Oakley-Girvan, Londono, Canchola, and Davis, 2016).
It is imperative that nurses in the acute care, long-term care, and community settings are prepared with the latest information on breast cancer risk factors, etiology, and treatment to provide patients with the education they need to make informed decisions. Nurses have a unique perspective as they treat the whole person and consider the physiologic, social, economic, psychological, and spiritual impact breast cancer has on patients and their families. Nurses can utilize this knowledge to promote health by encouraging breast cancer screenings, teaching women about lifestyle modifications to reduce risk factors, and collaborate with inter-professionals to mitigate health disparities.
American Cancer Society. (2016). Cancer facts and figures 2016. Retrieved from: http://www.cancer.org/acs/
Jiang, y., Serieka, S.M., Bender, C.M., Brufsky, A.M., & Rosenzweig, M.Q. (2016). Beliefs in chemotherapy and knowledge of cancer and treatment among African American women with newly diagnosed breast cancer. Oncology Nursing Forum, 43 (2), 180-189.
Oakley-Girvan, I., Canchola, A., Davis, S.W. (2016). Text messaging may improve abnormal mammogram follow-up in latinas. Oncology Nursing Forum, 43(1), 36-43. doi:10.1188/16.ONF.36-43.
Suplee, P.D., Jerome-D'Emilia, B., & Boiler, J.L.K. (2016). Women's educational needs and perceptions about survivorship following bilateral mastectomy. Clinical Journal of Oncology Nursing 20(4), 411-418.
Turkman, Y., Opong, A.S., Harris, L.N., & Knobf, M.T. (2015). Biologic, demographic, and social factors affecting triple negative breast cancer outcomes. Clinical Journal of Oncology Nursing, 19(1), 62-67.
Oncology nurses provide care to cancer patients and their families across the continuum. They are there from the life-changing moment of diagnosis to the frightening, yet hopeful, treatment phase. Such treatments may make patients feel worse than they did before treatment, causing nausea, vomiting, diarrhea, hair loss, fatigue, loss of appetite, and weakness. Nurses provide education and encouragement during every stage of the cancer journey. They celebrate the victories with patients and their loved ones when treatment is completed and remission is declared. Nurses shed tears with them when their side effects are difficult to endure or if there is devastating news of relapse or worsening disease. Nevertheless, we are their cheerleaders, educators, listeners, and advocates.
Unavoidably, nurses witness suffering—we encounter the grandfather with stage IV lung cancer with COPD who struggles to take each breath and can no longer care for himself. We see the young woman with metastatic ovarian cancer whose tumors have obstructed her GI tract, preventing her from eating, and all her husband wants to do is feed her ice cream. We witness the father with acute leukemia who had a bone marrow transplant in hopes of cure but now suffers from graft versus host disease, renal failure, anasarca, constant pain, and steroid myopathy and can no longer turn in bed. The father turns to his nurse shouting, "This is suffering! This is human suffering!"
How can the young nurse possibly respond?
There comes a point when many nurses voice their concerns: "Why are we doing this? This patient is clearly not going to survive. Why hasn't the doctor addressed the code status? Does the family know how sick they really are?"
In my early years as a nurse, I often shared these thoughts. It seemed like senseless suffering. The voice of the father expressing his anguish left a permanent impression on my mind. He had told me if he had known he would have gone through this, he never would have agreed to the treatment. I have spent many hours wondering why people choose such aggressive treatments for the possibility of cure. This life is not infinite, and we all will have to face death at some point. Did he truly consider the risks of morbidity and mortality before he agreed to treatment or was he so shaken by the diagnosis, he was willing to do anything to fight it?
How can I assume that I would not take that same risk that he did? The alternative of refusing treatment is certain suffering and death versus the possibility of suffering and death. When there is suffering, is it truly meaningless? Is a life with pain and dependency not worth living? Perhaps treatments cannot always provide cure but can offer more time. Time that allows a grandmother to see her infant grandson, a father the opportunity to see his daughter get married, a young adult graduate college, or a retiree take a vacation of which he always dreamed.
As nurses, we cannot become so jaded that we lose perspective of what people are fighting for. Life is precious. When it becomes increasingly difficult and of lower quality, life does not become less valuable. We must be careful to advocate for the patient's wishes—not the family's, not the physician's, and not our own. Self-awareness is crucial to avoid projecting what we would want for ourselves onto patients and their loved ones.
Racism has been increasingly present in the news lately. Whether you are behind the cause Black Lives Matter or All Lives Matter, nurses provide compassionate care and save lives of people of all races, religions, socioeconomic backgrounds, and genders. Cancer, heart disease, and diabetes do not discriminate and neither can we. Unfortunately, healthcare in America has not been historically colorblind. Nurses learn in school about the Tuskegee Syphilis Experiment that used unethical research practices, which resulted in impoverished African American males with syphilis suffering and dying from the disease while researchers knowingly withheld treatment from the participants.
If you have not read The Immortal Life of Henrietta Lacks by Rebecca Skloot, I urge you to get a copy. The book details the story of a young African American mother of four who died of cervical cancer whose cells were collected and grown in cell culture. These cells lead to many medical advances that we benefit from today, such as the Polio vaccine, cancer treatments, and genetic mapping. What really struck me in this well-written story was the history of injustices in healthcare with the black community that goes back hundreds of years. This explains the distrust in the community with the healthcare system which results in not seeking care until symptoms are too severe to tolerate. Many studies address this issue, such as later stage breast cancer at diagnosis for African American women compared to Caucasian women.
Health literacy is another factor that stands out in The Immortal Life of Henrietta Lacks. Henrietta's husband and cousins did not understand the seriousness of her diagnosis or what the radiation treatments would entail. Henrietta and her husband both dropped out of grade school to work on the tobacco farm and had low literacy. Now add the complex medical terms and consent "the doctor knows best" forms compounded by the norm in the 1950s. Patients back then had no Internet access to research their diagnosis and treatments. They did not question their doctors' judgment as they often do today. Combine that with rumors in the African American community that hospitals did "experiments" on black people, it is easy to see how frightened she and her family must have been-not knowing what to expect or what was going on. Thankfully, we now have strict guidelines enforced by institutional review boards to ensure ethical research practices and provide informed consent in a literacy- and language-appropriate manner. Nurses at the front lines encounter individuals from all faiths, ethnicities, races, genders, and ages. We are perfectly suited to get to know our patients, identify how they learn best, discover their fears, and provide them with hope, knowledge, and encouragement. Each of us connects with people who are different from us and we grow because of it. I don't know the answers to racism, poverty, and injustice in our country, but I do know that we can be the positive force that lights the way for the future. We must treat each person as the unique individual they are with hopes, dreams, and fears. We must provide them with dignity, respect, and compassion. We need to avoid generalizing groups of people and realize that each family unit differs with their own strengths and challenges. What unites us as a people is the will to live and the desire to have more time with the people we love. That crosses all cultures.
How many of us have returned from maternity leave with aspirations of pumping every 3-4 hours to keep up our milk supply to meet that goal of nursing our babies for the first 12 months of life? How quickly did we come to the realization that it is difficult to leave the floor 3 times in a 12 hour shift to pump? How soon did the guilt begin about asking our peers to watch our patients so we could pump (yes, again)? How many times did we eat our lunch while pumping so we didn't have to leave the unit AGAIN? How much stress and anxiety did we feel while we tried to do the right thing by our patients, colleagues, and babies? How many of us felt that 12 weeks was not enough time off before returning to work when our babies were still nursing every 3 hours around the clock? How many nursing nurses were too busy on their shift to pump as much as they needed to which decreased their supply? How many of us stopped breastfeeding sooner than we wanted because of the guilt, stress, and time constraints of our role?
I consider myself fortunate. My facility had designated nursing mother's rooms that were locked, quiet, and clean for pumping. I still felt the guilt of leaving the unit to pump while leaving my patients with my peers several times a shift. I quickly decreased to pumping only 2 times per shift and eventually went down to only once. I worked part time after taking the full 12 weeks off with my first two babies. I successfully breasted 6 months for the first and 9 months for the second although my goal for both of them was one year. For my third baby, I struggled with balancing the two older kids' activities, work, my professional organization, and nursing after returning to work. I changed my scheduled from full to part time and from day to night shift. That still wasn't working well, so I made the decision to resign until the baby turned one year old. As a result, he is still nursing at 10 months.
I call it my European maternity leave as some countries allow for up to one year or more for mothers to bond and care for their babies. I want nurses to have the opportunity to nurse their babies as long as they can and desire to. The nature of our profession poses greater challenges than those who work in office settings where there are not life or death decisions to be made in our absence. My advice is put your family first, be mindful of your colleagues who are trying their best to balance it all, and know that kind acts are never forgotten. When you have mercy on your peers they will be there for you when you need them.
My last blog was October 1, 2014. Why the long hiatus? I suppose it was the complexity of life. Jumping in head first into my first real nursing leadership role, I became involved in every quality project that I could find. I spent my time drafting research and grant proposals, applying for graduate school, and leading teams. I rushed from work to pick up the kids, take them to ball games, cook dinner, put everyone to bed, and clean up the day's mess. The alarm went off at 4:00 am and the routine started again with the hour commute back to work. In that period of time, I went to conferences, suffered a miscarriage, took my grandmother to Italy, and gave birth to my third son. On maternity leave I read a novel called "The Two-Income Trap, Why Parents are Choosing to Stay at Home." The title caught my curiosity. After reading the book, I found myself feeling incredibly guilty for allegedly placing my career before my family. I was not a single-mom so did I have to do this?
I returned to work full-time and pumped breastmilk twice a shift so my baby could continue nursing. I realized I was missing his milestones of rolling over for the first time and holding his bottle. I changed my schedule from full-time day shift to part-time weekend night shift to allow more time at home with the kids. Somehow, I did not calculate how to function on little or no sleep and still attend every baseball and soccer game. Furthermore, I did not factor in spending any time with my husband.
I made the difficult decision to resign from my position to stay home with my family at least until the baby reached one year old. From the sound of it, this should have been an easy decision but that was not the case at all. Nursing is so much more than a job to me. It is wrapped up in my identity as it is with many of my friends who are also nurses. I find it hard to have conversations about anything other than children with other stay at home mothers. I miss having the satisfaction of knowing I worked hard but made a difference today. I am eager to have intellectually stimulating conversations with my colleagues again.
In the meantime, I am blessed to slow down and enjoy the world through the eyes of my sons. I love hearing their enthusiasm with new experiences and their innocent way of processing ideas. They have genuine curiosity, excitement, and joy. They love unconditionally and that is all they ask of in return. Perhaps I will never know if my struggle to achieve work-life balance was successful or not. I have learned there is no right or wrong path and that this "balance" may be an unachievable fantasy. What I do know is we all do the best we can with what we have and it is an honor to care for others as a nurse and a mother.
Two of the guiding principles in modern American culture today can have a devastating impact the success of nursing teams and their ability to provide safe, effective care if we overlook them. The two philosophies are individualism and minimalism which lead to the attitudes "What's in it for me?" and "What is the least I have to do to get by?" Realistically, these thoughts are human nature, but we must acknowledge they exist and discover how to reach and motivate nurses to think come outside of themselves, unite under one mission, and work together to achieve great things. Attitudes drive behavior.
Consider your last shift... Did you work with a nurse on your team who you know will pretend not to hear the call lights going off while you chased your tail to prevent your patients from falling? Did you ask for help turning a patient every two hours and find yourself alone when the job needed to be done? Did your patient wait in pain for an hour to receive analgesics while you were in another room admitting a patient when someone else on the team could have assisted? These very real scenarios have dire consequences... nurse burnout, patient suffering, ineffective time management, medication errors, patient falls, nurse turnover, and chronic understaffing. This vicious cycle plagues many inpatient units but it doesn't have to be this way.
Envision the future... Call lights are ringing and whoever is closest to the door enters the room and asks the patient what they need. At the beginning of the shift, every staff member talks about who needs to be turned every two hours and nurses volunteer to help ahead of time. Two nurses buddy up when an admission comes to cover the other patients while the nurse is tied of for extended periods of time. The quality of teamwork not only impacts the success of a unit, it can determine a nurse's job satisfaction and career fulfillment.
This dream can become a reality. It will require paradigm shift from "What's in it for me?" to "How can we work together to make it better for everyone?" and from "What is the least I have to do to get by?" to "What is the most I can do to provide the best care?" Changing the culture of a unit takes time and involves living an authentic example of service. We must treat each other with the same compassion we share with our patients. Not every day will be easy or stress-free, but it takes the commitment of every level of the team (from nursing assistants to nursing leadership) to care for one another in addition to our patients.
As most of you know, I have spent my entire career in oncology nursing. I have cared for women diagnosed with breast cancer who have undergone mastectomies, chemotherapy and radiation with a variety of outcomes. Some have overcome breast cancer yet later developed leukemia or heart failure as a result of the toxic chemotherapy the received years ago. Others women I have encountered return for surgery after their breast cancer returned to their lung or chest wall. Some women are given a terminal diagnosis when the cancer spreads to their bones, brain or liver. The majority of breast cancer survivors rarely enter inpatient hospital settings due to increasing treatment options in the ambulatory clinics. Those happy endings are rarely seen by inpatient oncology nurses.
What you may not know is my personal experience with breast cancer. My grandmother, Elaine, lost her fight with stage IV breast cancer at the University of Wisconsin Madison Hospital shortly after I was born. As an infant, my parents brought me to the hospital so she could see me before she died. There is a single picture of her holding me in her lymphedema wrapped arms, smiling. She wore a white wig, her frame was thin and frail, and her color was gray. I never knew her, but she made a significant impact on her eight children. The cohesiveness of the family appeared to fall apart in her absence. Growing up, I became intrigued by the frightening word - cancer. I wanted to learn as much as I could so that I could one day help patients and their families cope with such a life-changing diagnosis.
In 2006, my mother was diagnosed with stage II breast cancer. It was found in her left breast, but she elected to have a double mastectomy followed by chemotherapy after witnessing her mother-in-law suffer and lose her battle with the disease. This was the year I graduated from nursing school. I found out her diagnosis after I had accepted my first job as a bone marrow transplant nurse. Fortunately, my manager was extremely accommodating and allowed me to delay my start date by two weeks so I could fly out to California and take care of my mother after surgery. In those two weeks, I saw my mother in a very different light than ever before. She had moments of hope, fear, faith, courage and humility. She who had always taken care of me depended on my help and knowledge. After shaving her head, receiving weeks of chemotherapy, and persevering through nausea and fatigue, she is now 8 years cancer free.
I would like to say that as an oncology nurse I would know what to do if it was my turn to get the frightening diagnosis of breast cancer. The truth is one doesn't know until she is sitting in that chair, hearing those words. I routinely get an annual breast exam and perform my own self-breast exams. Insurance companies will not pay for mammograms for women younger than 40 years old. An article published in The New England Journal of Medicine described the effects of screening mammography over the past 30 years on the incidence of breast cancer (Bleyer & Welch, 2012). They concluded that screening has led to the over-diagnosis of breast cancer in 1.3 million women in the past 30 years and screening has not affected the number of women who presented with distant disease. In 2009, the U.S. Preventive Task Force updated guidelines that recommend mammograms every 2 years from the age of 50 to 74.
Many organizations such as the American Cancer Society have rejected these recommendations. I believe it is a decision between a woman and her physician.
Nurse turnover is a complex phenomenon that directly affects patient outcomes and healthcare costs. When new graduate nurses accept new positions on or before one year of hire, the institution loses a significant amount of money that they invested in their training. This affects the bottom line (which equates to nurse-patient ratios), but I am concerned about the larger impact. I have seen new graduates leave during orientation, after 6 months, and at the year-mark. The reasons they state vary (wanting to be an ICU nurse, OR nurse, EC nurse etc.), but I sense that there is something we are missing. The rumor-mill reveals that nurses are frustrated with having one or more admissions every night, handoffs from other areas that leave out crucial information, and a sense that there is no help (either from their team, the nursing assistants or leadership). Past leaders have replied saying "this is a hard floor" or "this new generation has no loyalty to their employer and they move around." In my perception, these statements equate to the off limits statement "that's the way it is" (these are fighting words to me). If we as leaders refuse to acknowledge what is driving nurses away from the bedside early in their career, we are powerless to resolve the issue. Yes, there are generational needs to consider. If baby boomers and generation X do not relate to generation Y's need for instant messaging, texting, blogging, and positive reinforcement we are essentially disconnected.
Patients tend to be baby boomers and up and the majority of bedside nurses these days are Gen Y. I argue that these 20-somethings do not care any less than their predecessors. The demands we place on nurses at the bedside detract from the essential, rewarding act of caring. I have witnessed young nurses who can connect with patients of any age, ethnicity, religion, socioeconomic status or sexual preference. Leaders must treat their staff with the same expectations of caring that they demand from nurses to their patients. My hypothesis is that regardless of how "hard" a floor is, nurses will stay because they feel cared for and supported by their leadership. It is the same concept of patients choosing a hospital because they feel cared for and safe. I argue that when we acknowledge this and act accordingly, our turnover rates will respond.
The effects of nurse turnover on patient outcomes are significant. When nurses who float to another floor which is short due to turnover, patients receive care from someone who is unfamiliar with their history and possibly the specialized needs they require. When nurses leave, the attitude of the team is affected negatively. The vocal "nay-sayers" may influence others to have similar intent to leave. When nurses work with reduced staffing, patients recognize that their call lights are not answered as timely and perceive that the unit is "short-handed," which ultimately affects patient satisfaction. The harsh reality is that when every nurse is in a patient room, family members notice that there is no one on the unit when they walk out of the patient room, which is a frightening concept if something emergent where to occur. Time constraints resulting from fewer staff members result in dissatisfying outcomes: patients who have not had a bath in several days, medications administered late and inadequate discharge teaching (Missed Nursing Care). This reality must be addressed as it appears that new graduate BSN-prepared nurses view their first jobs as a stepping stone to advanced practice nurse. Who will stay at the bedside to ensure that nursing care is the highest quality and patients feel cared for? Clinical nurse leaders are in a position to respond to this need, however the competent, caring bedside nurse cannot be replaced.
Today, my unit secretary called me and said there was someone there to see me. I went out to the nursing station to find a man a woman vaguely familiar yet I could not place who they were. The woman standing there said, "You probably do not remember me but you saved my life 2 years ago." She held a card in her hand and as she handed it to me she told me her name. I immediately remembered the frail woman whose room I ran into 2 years ago as I heard her husband say "Help she's not breathing." I immediately checked and found no pulse, hit the code blue button, jumped on her bed and started CPR. The other nurses ran into the room with the crash cart. We quickly attached the defibrillator pads to her and found her to be in ventricular fibrillation. We defibrillated her without hesitation before the code team arrived and continued CPR. She regained consciousness and was whisked away to ICU.
I have never forgotten her name as she was the first patient I ever performed chest compressions on. The literature reveals the extremely poor survival rate of stem cell transplant patients who have undergone cardiac arrest. Somehow, today I was seeing, hearing and feeling a miracle. I truly believed she would not survive for 2 more years. She looked amazing as she stood before me; she had gained at least 20 pounds, her hair had grown back and she had pink undertones in her cheeks. She revealed she now has no evidence of disease.
After hugging her several times and pushing back my tears I had to pinch myself. It was as if I was staring at a ghost as I have rarely seen the outcome of happy endings working inpatient my whole career. She told me, "Gold had another plan for me than to die of cancer." Somehow God had made me part of that plan and worked through my hands. This is what nursing is about. This is why we work tirelessly to save lives, provide education, advocate for justice and build relationships. After a stressful morning, she was exactly what I needed.
Nurses often think that what they do every day is ordinary. My goal is to capture the small gestures that make an extraordinary impact. Here is a glimpse of the amazing things I see from bedside nurses:
Any given day on the thoracic and cardiovascular surgery unit, this nurse can be seen playing her acoustic guitar and singing songs of inspiration for her patients and their families struggling to cope with poor prognoses. Her exemplary service and compassion was beautifully described by a patient who was alone and frightened about her quality of life and body image after having a new colostomy. She said, "I had been in the room alone crying until my nurse angel entered. She knelt by my bed and sang an Irish prayer that was exactly what I needed. She comforted me, helped me calm down, and made me feel like someone cared about me." This outstanding nurse possesses the gift of caring holistically for her patients as a skilled clinician who anticipates changes in patient acuity while providing emotional and spiritual support that is personalized to each individual's needs.
Small acts of kindness are symbols of the compassion of nurses. This is why we are the most trusted profession by the public. The connection nurses share with their patients provides meaning to the difficult work we do every day. Nurses listen to patient's fears, provide reassurance, ease pain, reduce anxiety, and build relationships without consciously thinking about the impact they have on people. What may seem mundane truly leaves a mark on the lives of others.
Honestly, I am inexperienced in dealing with patients who are on illegal street drugs. I recently had to lead my team of nurses on how to deal with someone coming off of PCP and cocaine. Challenges arose over how to legally confiscate home prescription medications, how to prevent someone with erratic behavior from falling, and how to avoid provoking someone who has been arrested recently for assaulting healthcare professionals.
In the end we achieved all three of those goals; however I am left wondering about what environment have we sent this person back to? How do you reach out and help someone with addiction that does not take responsibility for their actions or ownership of their own body?
I found out that you cannot transfer a patient from the hospital to an inpatient substance abuse rehabilitation program. They have to voluntarily walk in the facility's front door. I understand the concept; rehab won't work if the patient isn't ready to change. Nevertheless, I find myself frustrated.
As nurses we work to promote health through education, building trusting relationships with our patients, and providing them with the tools to live a life to their fullest potential of wellness and quality. In this case I felt like we could not connect, educate, or promote wellness for this person and sent them back into an unsafe environment of crime and drugs.
What is being done in these low income communities to proactively prevent substance abuse, obesity and crime? Are we doing enough to promote healthy nutrition, education, and safe-sex practices? Nurses can turn frustration into action to reduce health disparities in the communities we serve.
When nurses receive report on their patients do they think much about patient and family centered care? I believe that nurses are the closest at achieving this concept but we are not there yet. This model of care delivery implies that the patient and family are treated as one unit according to the patient's definition of family. It means that healthcare professionals consider the unique needs, experiences, and wishes of the family unit and create an alliance to achieve mutually agreed upon goals.
Does this sound easy or does it sound like a fantasy?
Patient and family centered care cannot be accomplished if we continue to work in inter-professional silos. There are three requirements to successfully transform this dream into reality: sincerely listening to patient and family concerns, proactively communicating with everyone involved in the patient's care, and responding appropriately to patient's and family's needs.
When nurses listen to patient's goals but do not relay them to the physician we do not meet their needs. When physicians change rotations and the patient's history must be re-learned the patient feels like a number. When families express concern and are told that it is not an issue errors can occur. If all involved sit at the table with the family to discuss the holistic needs of the patient only positive outcomes can occur.
Don't our patients deserve to have a healthcare system that listens to them and stops to consider their concerns? When families question plans of care should we not stop and second guess ourselves? Is it not appropriate to ask the patient and family what the goals of the day should be rather than paternally dictate the day's events?
Healthcare professionals are extremely educated, experienced, and competent but do we know our patients better than they know themselves? Do they not deserve a seat at the table of decision making when the result impacts the rest of their lives?
Consider yourself as a family member at that table the next time you are annoyed with a "demanding" family member.
It has occurred to me recently that many nurses feel powerless to address daily issues that affect patient safety and nurse satisfaction. I often hear grumblings ranging from difficult nursing assistants who do not give baths to medical teams who do not address end of life issues until the time of an impending code.
The phrase "that's the way it is" implies that nurses are powerless to change behaviors that negatively affect patients and drive nurses away from the bedside. Every time I hear that phrase my passion for patient and nurse advocacy grows stronger. As nurses, we have a choice to: 1) turn our heads and accept the status quo or 2) raise our voices to demand the highest quality healthcare for our units, our families and our country.
Confront teammates who deliver suboptimal care. Create a shared vision on your unit for teamwork, quality outcomes and nurse retention. Start conversations with your patients on their preferences at the end of life and advocate for their wishes. Instead of becoming disheartened with the profession get involved and be a part of the solution.
I challenge you to change "That's the way it is" into "What can I do to improve this?" The next time you find yourself frustrated that medications are not available on time from pharmacy form a group to look at the process for order processing and medication delivery. Identify what slows down the process and help create a more efficient system. Nurses spend too much time chasing down supplies, which takes precious time away from patient care. Form a group to review the supply room par levels and have bedside nurses provide input for what they need on a daily basis.
Today we need a workforce of engaged nurses who accept nothing but excellence. We simply cannot wait for someone else to make things better.
It is simply not enough to accept the status quo and spin your wheels day in and day out? We cannot remain silent when there are broken systems, inefficient processes, and continued patient safety concerns. There is so much to be done and if we are going to be leaders in healthcare of the future, we must move forward together as a profession to effect positive change. Change must begin from the bottom up to be effective. We need bedside nurses who are in the trenches saving lives to come up with ideas to make our jobs easier and our patients safer. Everyone must have a stake in our progress. On the front lines of healthcare, nurses impact individuals and communities not only by administering medications and treatments, but also providing education that leads to healthier lifestyles. We see opportunities for improvement everywhere... from the time it takes to get a unit of blood without an active type and screen, to the variation of providers addressing end of life when patients are already dying.
"That's the way it is" is no longer an acceptable answer. We have the power to speak up to improve the quality of care we deliver. Look at the literature to find out what the best practice is for monitoring obese patients with sleep apnea postoperatively. Identify the latest recommendations to provide safer pain management and bring what you've found to your leadership or shared governance committee.
There are outstanding national nursing organizations in this country that provide you with tools and education that you can bring back to the bedside. Submit an abstract of an initiative you have lead on your unit to a national or regional conference. When we stand up for patient safety, make our work environments more efficient, and share what we've learned, we have advanced the great profession of nursing!
Recognizing nurses for going above and beyond is crucial to promoting a healthy working environment that positively reinforces outstanding performance. Nurses work tirelessly to save lives, proactively anticipate changes in condition, complete an endless number of tasks, review countless physician orders, provide patient education, promote health, administer medications, and document everything that occurred on their shift. We cannot disregard the significance of a nurse's work. We must celebrate the positive impact nursing has on the lives of individuals and the health of communities.
As a staff nurse I was honored to receive an award that transformed my career path. At the time I had recently changed my schedule to per diem and had taken a semester off from graduate school. When I was notified that I was a finalist for the Ethel Fleming Arceneaux Outstanding Oncologist Award, I knew that I would not receive such an honor. I was only working per diem and I was a bedside nurse who hadn't done anything spectacular. I simply loved being a nurse. Actually, I loved everything about it... performing an assessment, getting to know my patients, administering medications, providing education, learning my patient's cancer journey, anticipating what could go wrong and what I would do about it, and above all gaining inspiration from patients who showed great courage, faith, and hope. Convinced I had no chance I did not think much more about the award. Weeks later I was surprised by nursing administration that I was indeed the award recipient. I was overwhelmed with tears and thoughts that I did not deserve such an honor compared to the nurses who taught me everything I knew. When the excitement passed, I spent a lot of time thinking about what the award meant to me. I viewed it as a sign that my career had more potential than I once thought. The potential to impact future nurses the way my mentors had taught and supported me. This was a gift that only a handful of nurses received who became legends at our institution. I was no legend. To have such a gift and only work per diem seemed like I was unappreciative in my mind. I decided to change my status back to full time and return to school full time. In my acceptance speech I vowed to give back. Giving back meant I would nominate outstanding nurses that I encountered throughout my career for nursing awards and so appreciation for great care. It meant that I would become a mentor who showed patience, passion, and inspiration. It meant that I would never forget the people who took the time to write nominations for me and to dedicate the award to the patients I cared for who made me a better person.
Nurses are not recognized enough for the amazing work they do every day. I often wonder why nurses do not stay at the bedside and return to school as soon as possible. Is it because they feel unappreciated? Is it the workload? Do they not get satisfaction from relieving suffering, turning anxiety into laughter, or giving families the tools to take care of their loved ones at home? Would they remember why they wanted to become a nurse if they were recognized by peers and patients? If all of us nominated just one nurse per year would they have better work satisfaction? Would they be inspired to give back to the profession?