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On Call: Leadership in Nursing

Nursing Holds the Heart of America, But…
February 8, 2017 11:24 AM by Martie Moore

Nursing has once again been voted the most trusted profession in America. Merriam-Webster defines trust as the "firm belief in the reliability, truth, ability, or strength of someone or something." We, as nurses, hold the firm belief of the American people in our abilities, reliabilities and, foremost, in our integrity and truth telling. Yet there is a secret among us. A secret that is ignored.

Our secret: We, as nurses, believe what we teach to our patients doesn't always pertain to us. We see ourselves as untouchable from disease-especially heart disease-in addition to other chronic conditions and contributing behaviors. I subscribed to this in my own practice. I experienced symptoms of hypertension but ignored it. Then, at a routine physical, I made my physician take my blood pressure five times before I agreed that maybe, just maybe, I might be hypertensive. I negotiated a 30-day trial to see if I could do something before utilization of medication. Then I did research. I was shocked to learn nurses are some of the worst in taking care of their hearts. I discovered the Nurses' Health Study and how it demonstrated the correlation of post-traumatic stress disorder (PTSD), specifically in women with the associated higher onset of cardiovascular disease. Many nurses suffer from PTSD and do not recognize it within themselves. Many nurses have cardiovascular disease and/or behaviors that contribute to a future diagnosis of heart issues.

Last year, Medline donated more than $60,000 to the American Heart Association (AHA) in its mission to fight heart disease. The company is working with AHA again, along with the American Nurses Association, to touch the hearts of nurses and others. To change their numbers for the better.

Nurses have the opportunity to change the health of America through our individual actions. We are 3.4 million strong, and if each and every one of us adopted one behavior that improves our own individual health, we can improve the health and hearts of this nation.

As the most trusted profession in the country, it is time for a call to action. It is time for us to make a change for ourselves.

Let 2017 be the Year of the Mouth
January 16, 2017 10:04 AM by Martie Moore

In 2014, Shirley Gutkowski wrote an article entitled "The Biggest Wound: Oral Health in Long-Term Care Residents." Her article outlined how oral care is not being done in care settings across the nation. Her call to action was to not only understand the impact that poor oral care has on health, but also rethink the approach of oral care in the elderly. Her article is excellent and well worth your time to review. The one aspect that the article misses is that this is not a long-term care issue only.

Health Affairs devoted their December 2016 journal to "Oral Health and More." Health Affairs is a peer-reviewed journal dedicated to the serious exploration of domestic and international health policy issues. Why would a journal committed to health policy be devoting an entire issue to oral health?

When we look to the research, we now have a greater understanding of why oral health and care have risen to a higher level of importance. The research tells us that poor oral care can contribute to cardiovascular, pneumonia and other infectious diseases. The research also tells us that there are issues of social disparities with oral health. Hispanics, African Americans, American Indians and Alaska Natives generally have the poorest oral health of any ethnic groups in the United States. Experts also share that more than 47 percent of U.S. adults over the age of 30 have some form of periodontal disease. In adults aged 65 and older, 70 percent have periodontal disease.

When I first trained as a registered nurse, oral care was part of my practice. I thought about and attended to assuring that those I cared for had proper oral care administered. Times have changed, and recent studies show that oral care is one of the most forgotten actions in a care setting. So if you're looking to prevent hospital-acquired pneumonia (HAP) or any other hospital-acquired infections (HAI), there is value in getting back to the basics.

Maybe if we think about oral care as more than a basic task, and maybe if we change our perspective to oral care being a fundamental necessity of practice, we can make 2017 the year of the mouth.

Sam's Gift
December 1, 2016 8:41 AM by Martie Moore
As a pediatric intensive care nurse, I dreaded the holidays because tragedies were even more poignant and painful due to the time of the year. This one particular Christmas proved me wrongnot because of the lack of human loss but because of the greatness of the human spirit. 

I first met Sam when the lab called in a panic about her urinalysis. Her urine glucose levels were off the scale. Something was terribly wrong... but it wasn't Sam's urine. It was the apple juice she sent down that was diluted with a touch of her urine. She giggled and giggled about her "trick." Sam was in the hospital for her "treatments," and frankly, she was bored. She could not understand why we examined her urine when her cancer was wrapped around her spine. She asked, "Why does my pee care about my ugly spot?" She called her tumor her ugly spot, because on the scans it looked ugly to her. It was that simple. 

As the months went by and Sam entered and left the hospital, it became clear that the "ugly spot" was growing and Sam's fight was becoming harder. As we entered the holiday season, other team members and I attempted to prepare the family for what we knew was Sam's last Christmas. A couple weeks before that Christmas, I worked nights. I checked in on Sam and saw she was sleeping. I quietly went about my assessment and vital signs. As I finished up, a quiet voice spoke out, "You know I am not afraid." Startled, I apologized for waking her up. She giggled and said, "I thought it was funny how you tiptoed around my bed." 

I sat down in the chair next to her bed and asked, "You're not afraid?" 

She sat up and said, "Nope. I am not afraid, not one iota."

I asked again, "Not afraid?" 

She giggled and said, "To die, you silly goose." 

Wow, what do you say in response? As I was working to find words, she leaned over and opened her bedside drawer. She pulled out several papers and laid them out on her bed. As I turned the light on, I saw sketches of hands. Hands providing care to what I assumed was Sam. One of the pictures had a series of hands around a black object that she explained was her ugly spot. Sam chattered away about how the hands were loving, caring even, when they caused pain. She knew that the hands were always there to help her. 

I've never forgotten the picture of the pair of hands cupped open with a young girl sitting in them staring upward. She called the picture her "I am not afraid to die" picture. What was amazing was she wasn't. Leading up to Christmas Day, we worked hard to get her home, but it wasn't to be. She directed the decorating of her room from her bed. She requested that anyone entering her room must sing her favorite holiday jingles, critiqued by her for tone, execution and delivery. We protested when she compared us against each other, as some of us could sing while others not so much. She just giggled. 

Sam lost her fight two days after Christmas. Several days later, her mother called and asked if I would stay a little bit over as she had something from Sam. She handed me an envelope with my name written on it. Her mom said she had found it in the papers brought home from Sam's room. 

She simply had written "Thank You!" in the middle of a heart.

Nurses touch lives in so many ways every day. This holiday season, ADVANCE for Nurses was able to give away a limited number of copies of "Chicken Soup for the Nurse's Soul" by Nurse and Author LeAnn Thieman. The book serves as a little pick-me-up to remind clinicians about why they became a nurse and the compassionate impact they bring to patients and families. Thanks to all who clicked to receive a copy.

MacGyver Nurses Among Us
November 17, 2016 10:30 AM by Martie Moore

I cannot remember the first time I heard the term "MacGyver Nurse."  For those of you that do not remember watching MacGyver, the show is back. The main character could settle any crisis, it seemed, from world war, invasions of aliens, or out-of-control spaceships with duct tape, his Swiss pocket knife, and gum. 

Okay, I might be stretching it a little, but it always amazed me how he could use his resources to fly through each situation thrown his way by innovating and working around what most would consider unconventional actions. 

My own most memorable MacGyver moment came during a code. The patient was bleeding out from an esophageal varice. I cracked the code cart and found one IV start kit. Someone forgot to restock. I had to get volume in him fast, so catching my breath, I went for the stick. Good karma over me, I got in and started the IV. It was me and one other personhe kept the airway open. If you have ever dealt with esophageal varices, there is a lot of blood and keeping the airway open takes tremendous effort. I was on my own. I hung the IV bag as high as I could get it. Then I took tape and wrapped, wrapped, wrapped the bag as tight as I could get the tape around it. I made a pressure bag before we had them on code carts. 

Florence Nightingale was the "MacGyver Nurse" role model. She used glass milk bottles to collect urine to promote a more hygienic environmentthe root of today's male urinal design. She developed a process to sanitize the gauze that was being reused on wounds of the soldiers. Florence consistently innovated. She also designed and redesigned her workflow, environment, and products used to practice nursing. 

We have MacGyver Nurses in care settings across America every day, figuring out how to care for someone in need of help. Florence made sure that within the DNA of nursing was a quest to do it better. Incredibly brilliant nurses are carrying her legacy forward each day.  

Florence did one other thingshe wrote out her ideas and designed her innovations. Today's complex and fast-paced healthcare world could definitely benefit from a dose of Florence. As part of Medline's commitment to helping healthcare providers perform at their very best, we are always looking for new ways to deliver care more effectively and efficiently. So, if you're a MacGyver Nurse who'd like to submit a new idea or invention, we'd love to hear from you. Learn more at

What's your "MacGyver Nurse" moment and how did it help improve care?

Nurse, Heal Thy Physical Self and the Skin You’re In
October 11, 2016 8:25 AM by Martie Moore

She was one of those nurses that you always wanted to be like when you grew up to be a nurse. She initiatively knew what her patients needed, was compassionate, vigilant, and when she called a doctorthey came running. No questions asked. She was a teacher to the novice, a leader for the unit, and voted Nurse of the Year. As I worked alongside her, she would remind me to wash my hands, every time, every moment. Well before hand hygiene was studied and confirmed as a way to reduce the transmission of infectious disease, she was already promoting this best practice. 

Overtime, however, her hands became dry, then cracked, then infected. She had to leave the bedside due to the condition of her skin. I have never forgotten my last conversation with her. I asked her if washing her hands was worth it. Remember, this was before we fully understood hand hygiene. Glove use was becoming more common due to better understanding of HIV transmission. Her answer to me was clear and her voice strong, "Of course. My hands can heal, but they also can hurt. I needed to assure that they did not hurt through transmission of bacteria." She sacrificed her skin health for her practice. But she was wrong about one thing; her hands did not need to hurt her.

The science has advanced, and we now know that skin health can be maintained even in a tough clinical environment. You have to "feed the skin from within and from without." "Feeding from without" means assuring that skin is moisturized on a regular basis. Every nurse out there uses hand moisturizers to try to combat dryness and cracking, but not every moisturizer is the same. 

I had to learn that the hard way. My hands were becoming cracked and dry. I would brace myself for stinging and pain when I applied alcohol-based gel. I turned to the evidence to guide me on how to heal my skin from the outside. Some evidence pointed to the benefits of moisturizers or emollients, such as dimethicone or other silicones. Botanical extracts such as safflower seed oil, corn oil, and coconut oil can be beneficial. The evidence also suggested the use of sodium hyaluronate, otherwise known as hyaluronic acid, as well as nutritional components such green tea, clove, soy, and blue green algae, along with additional vitamins, proteins, and amino acids. Additionally, what became clear is application of nutrients to skin promotes resilience or the ability for the skin to respond to adverse conditions. Getting into a pattern of slathering the skin even when not in the clinical setting promotes heathier skin. Reading the labels and understanding what you are applying to your skin is the other action to take. 

The second part of taking care of yourself is "feeding the skin from within." Research in the field of wound treatment shows increased protein levels improve healing rates. What we now know is that protein is essential for keeping skin healthy. Yet, as nurses, we do not always have the best nutritional intake, and if we take a moment to eat, we have a tendency to grab low protein foods. A healthy diet supported by protein and Vitamin C intake is essential to keeping you and your skin healthy.

And don't forget hydrationthe often infamous catch 22. I've had nurses tell me they do not have time to urinate. I can remember walking through the door of my home and questioning if I went to the bathroom in the last 12 hours. The bodyespecially skinneeds hydration to be top performing. Not going to the bathroom all day is not a badge of honor for being too busy, it is cheating yourself out of being healthy. 

Proper skin care must be part of the fight against HAIs  and caring for patients and ourselves. Join me in giving skin respect and working to make it healthy.  It deserves to be considered just as important as the heart, lungs, and brain. It is what holds us together.
Forgive Others… You Deserve It
September 19, 2016 10:08 AM by Martie Moore
In my previous post, I spoke about one of my learnings for helping the nursing profession grow more resilient and introduced the concept of forgiveness. I can tell you this is not an easy subject matter to discuss in the workplace or beyond. What I can also tell you is that the energy of being angry and judgmental wears on the individual, team and organization. I have watched departments implode between shifts or amongst team members due to these emotions. As I shared in the last post, I have also watched nurses leave the profession, because they felt they could never measure up or meet the required needs. They were exhausted, and tying a knot at the end of their rope with the hopes of hanging on was not a viable action.

In thinking through this subject, I wanted to share insight from someone who is actively working with nurses on self-care. LeAnn Thieman is a nurse and co-author of "Chicken Soup for the Soul." Here, she shares tangible actions you can take to help you in this crazy chaotic world we call healthcare.

Martie: Why is it so important to forgive?

LeAnn: We waste a lot of our energy, our health and even our lives when we fail to forgive. Religious, spiritual and medical leaders have taught the practice of forgiveness. Research shows that it is not only good for our souls but also for our hearts and bodies. Those who fail to forgive have increased cardiovascular disease and lower immune-system function. Forgiving people have lower divorce rates, less clinical depression and better social support.

Organized religion and 12-step programs have long recognized the healing power of forgiveness. It has helped people break through intergenerational cycles of revenge, anger and bitterness and resolve resentment within relationships.

Martie: Starting is the tough part. Especially for those in healthcare.

LeAnn: It is tough but needs to beginstarting today. First of all, we must forgive ourselves. For any past mistakes or indiscretions, we exonerate ourselves. What we did back then was who we were then, based on what we knew then. It has nothing to do with who we choose to be today. And starting today, we must forgive somebody else, no matter how horrific the offense. And I know some are horrific.

It took me too long to realize that when we refuse to forgive someone, it doesn't hurt them; it only hurts us. Why would we give someone who wounded us so deeply the power to continue to harm us with sleepless nights, upset stomachs and headaches?

We must forgive them. Whether they deserve it or not, we do. I know people who are mad at others who don't even know they're mad at them. I know people who are mad at past administrations that are long gone. I know people who are mad at dead people. We must forgive. It is freeing and healing.

Martie: As an author and nurse how often does this topic come up?

LeAnn: I've had the privilege of writing 14 "Chicken Soup for the Soul" books, including three for nurses, the most recent "Chicken Soup for the Soul, Inspiration for Nurses." In every one of my books there are stories, often full chapters, on forgiveness. When I do presentations or launch SelfCare for HealthCare afterward, people consistently come up to me and say, "Thanks for talking about forgiveness." It is one of the most powerful healing tools.

Martie: Tell us how you encourage nurses to start the forgiving process.

LeAnn: There are four basic steps to begin this therapeutic journey. First, realize you have been unjustly treated and have a right to be angry.

Second, decide that forgiveness is an option of choiceand a positive one. Forgiving does not equal forgetting, and sometimes there is no reconciliation. A widely accepted definition of forgiveness is to pardon or release from further punishment. For the offender and you.

Third, reframe the one who hurt you. Acknowledging how they were raised and treated helps reveal how they were probably victims of similar conduct. In this step we are not condoning or excusing their behavior but examining and understanding it from another perspective.

The fourth stage occurs when you begin to develop feelings of empathy or even compassion for the offender; not because of what they did but in spite of it.

Finally, you can forgive, often breaking the cycle and putting to rest feelings of revenge, anger and guilt.

Martie: What other actions can folks put into action to forgive?

LeAnn: Positive visualization is another effective tool. Visualizing a quarrel ended, a relationship restored, the pain and alienation eliminated is amazingly effective.

Sometimes you can confront the offender directly, but sometimes that is not possible or advisable. Then it may help to imagine, vividly, the face of the person who has wronged you and say out loud, "I forgive you." Writing a letter, whether you send it or not, releasing the other personand youcan promote healing.

Forgiveness sometimes feels like a short-term loss for a real, long-term gain. Some confuse it as a weakness, but it demands great moral courage and spiritual strength both in granting and accepting it. When someone apologizes to you for wrongdoing, use the four steps to pardon them, releasing yourself and them from further torment.

Forgiveness is an empowering choice and sometimes one of the greatest gifts you can give yourself.

How can forgiveness help you be better for yourself, colleagues and patients? Share your thoughts below.

Nurse, Heal Thy Spiritual Self
August 19, 2016 8:10 AM by Martie Moore
Last month, I shared with you a very personal story that jump-started my quest to further understand why nurses are emotionally tired. I wanted to understand how today's environment spiritually impacts the practice of nursing. I dove into the research and literature like they were a cool pond on a hot August day. I researched with gusto, hungry for a sense of grand accomplishment. Three key tracks emerged: holistic nursing, self-care for the nurse, and an academic take on how to do a spiritual assessment. A few courageous authors spoke about the spiritual self of the nurse, but most directed it toward self-care. Self-care is important, and we will be exploring self-care in the coming month.

Spiritual resilience is what I wanted to understand: that ability to be present and mindful to those in need of care, even in the face of computers, chaos, and suffering. The American Medical Association has also identified this need for our physician colleagues and has developed learning modules to improve resilience and decrease burnout. So in my quest, I sat down with one of the top leaders working tirelessly in the field of spirituality. I asked her what she thought could be done. She replied, "One cannot be gentle with others, until one is gentle with oneself." I reflected on this comment. Nurses are trained to look for what is wrong as we stand vigilant over those entrusting us with their care. In essence, we have a very critical eye, and we use that same critical eye on ourselves and others.

As a chief nursing officer, I often would do rounding, but my rounding sometimes was in the parking garage. I found the parking garage to be a great place to just talk. I remember coming upon a nurse who looked not only exhausted but also defeated. We started talking, and she shared with me her day. She used terms expressing feelings of being a failure in nearly every other sentence. She missed a medication, she had a family that was upset, and she didn't have a patient ready for radiology. When I asked her what had happened to influence her day that way, her eyes welled up. She reflected on an elderly patient who had just lost her husband and learned that she now had cancer. The woman was alone and afraid. The nurse made the decision to be present to her patient's suffering. By doing this, she took on her own suffering of feeling like a failure for not having tasks done. She felt she let her team down. She felt that she should have been able to do it all. She was in spiritual distress.

Spiritual distress is defined as a disturbance in a person's belief system. It is an approved nursing diagnosis for patients but rarely is it discussed for nurses. Nurses, many times, feel they can do it all, and asking for help is seen as being less than adequate. We spoke about her feelings of failure. I asked her what she was going to do next time. She replied, "Try harder." Try harder would only bring on more frustration and feelings of being overwhelmed. Who knows what would stem from those feelings. The studies show that actions such as leaving the profession of nursing, impairment, disengagement, and job change are consistent with nurses who felt the way she might have felt over time.

I softly asked her if she could forgive herself. Forgiveness of self and others is a first step to being spiritually healthy and resilient. Forgiveness is a tough word and concept to bring forward in a work setting. Yet, in looking to the evidence on developing resilience, two key actions are major influencers on creating spiritual resilience: gratefulness and forgiveness.

 A wise leader taught me to have a virtual tree where, at the end of my day, I could hang all of the things that I felt I did not do right throughout the day. Then the next day, I could decide if I wanted to pick up any of it or leave it there on the tree of forgiveness.

When we seek to understand forgiveness and practice it, we start to understand and appreciate the very essence of humanity before us-our own.

What are you grateful for and how do you use those experiences to fill your cup?
The Cost of Caring
July 19, 2016 8:34 AM by Martie Moore

Suddenly there it wasa lack of compassion. Or was it?

She was only 29-years-old when the phone rang with news no one wants to hear. She didn't believe it at first, and neither did her family. Then it became reality-more doctor appointments and finally surgery scheduled for a double mastectomy. She had ductal carcinoma, highly aggressive, but caught early. The funny part was she felt something was wrong long before others believed her. Her doctors informed her young women her age do not get breast cancer.  She made a joke of it and said, "I guess they were wrong." 

The day she went in for surgery, I and her family were present to hug and love her. She made a request of me: tell her the truth when she came out of anesthesia. Being her aunt and a nurse, I knew the rhythm of the operating room and recovery thereafter. My family and I watched the board to see the colors change and knew where she was in the surgical process. As the clock went around and around again, her holding time in the recovery room became an outlier. My family was worried (and, frankly, so was I) that she was not moving up to her inpatient room. We could not go back and see her and later learned room availability caused the hold-up. When a room freed up hours later, we finally got to see her for the first time. 

As she came through the door, we were waiting. She acknowledged her husband, parents and then turned to me and said, "Did they get it all?" I was the truth teller, and she knew I would hold my promise to her. "Yes, sweetie. They got it all." Heavy emotion hung in the air as her words and my words drifted together. Suddenly a voice, crisp and matter-of-fact said, "Come along folks. We cannot stand here in the hallway forever. I have to get back to my other patients."  

There it was, the moment when a perception of compassion was lost forever, replaced instead with feelings of anger and judgment by me and my family. 

The question I had to answer to myself was the why behind the action of the nurse. It is clear that in today's healthcare environment we move throughout the day in a rhythmic way, addressing the tasks. Was she so deeply connected to the next "to-do" that she failed to see the human suffering before her? Was this the fifth patient today who had a life threatening diagnosis and surgery, and she just couldn't be present to the raw emotions anymore? The nursing profession is doing a better job of trying to understand compassion fatigue. Could self-care be missing and she just didn't have it in her to be empathetic one more time? In essence, her cup was empty? 

I will never know the "why" of the nurse and her actions that day. I don't know if it matters. I do know it propelled me into greater understanding of how emotionally tired nurses are across the country today. In the coming months, I will share with you some of my learnings and what you can do to help yourself be a healthy nurse with the ability to be resilient.

How real is compassion fatigue in your life, and what do you do to fill your cup?

Nursing Is More Than A Stethoscope and Scrubs
May 3, 2016 8:04 AM by Martie Moore

 A stethoscope and a pair of scrubs stimulated a national discussion on nursing several months ago during the Miss America pageant. You may recall Miss Colorado wearing these items while presenting a monologue about what it means to be a nurse. 

Daytime talk show "The View" made commentary about her stethoscope and scrubs.  It ignited dialogue and raised a swell of voices around one common theme -- we love nurses!  Nurses spoke in a single voice about the stethoscope and how the tool is used in their profession to help save lives every day. Some physicians confessed they were less skilled in using the stethoscope than the nurses they worked alongside. Scrubs, and the reason why nurses wear them, also hit social and mainstream media. 

"What is a nurse?" became coffee house musings.  While I too felt emotions as I watched the comments on TV, a conversation with my granddaughter struck the greatest emotional chord.  

My ever-so-observant granddaughter asked, "GMa, why are you a nurse?"  I explained to her my years of schooling, the depth of my experience and skills, and the vast opportunities I experienced as a nurse.  I shared how I have patients to this day I have not forgotten...their story imprinted forever in my memory, who now have become part of my life story. I reflected on saving lives and making a difference to those I served.  I went into how I love using evidence to advance practice.  I love seeing advancement of quality care and excellence.  In my excitement of nursing, I elaborated on how healthcare is the most complex industry and I love being a part of that complexity.  I explained how nursing is the hub of the wheel called healthcare.  I used descriptions to help her understand how incredible - and hard - being a nursing is these days.  I forgot that her world is influenced by Disney's Doc Mcstuffins.  In her six-year-old wisdom, she looked at me and said, "GMa, you are a nurse because you care."

Oh little one, so well said.  We are nurses because we care.  We care about humanity.  In our caring we understand that the simple act of shaving the face of a hospitalized homeless man must be done with respect and dignity.  In our caring, we understand that families and their loved ones are not at their best when faced with a healthcare crisis. We meet them right where they are at and provide support and guidance.  In our caring, we understand the importance of human connection.  We go beyond what is expected to assure a patient can feel the fur of their beloved miniature pony, or another can feel the sun on their face before the last breath is taken.

Nursing has been described as one of the hardest but most rewarding professions.  I would not argue that point at all. Sacrifices are made to be a nurse. Yet I, like many, would not change being a nurse.  Nurses make a difference every day.  Their care and compassion have no boundaries and reaches beyond traditional walls of healthcare settings.  Their vision for betterment of those they serve keeps their spirit alive and touches the heart and soul of many.  Nursing is not about a stethoscope and scrubs.  It is about the people who wear them -genuine, incredible people who are the heart and soul of healthcare.  

In the words of a very wise six year old, "Nurses are awesome!" 

Medline honors and celebrates the contributions of all nurses not only during National Nurses Week but throughout the year. From leadership roles and research, to bedsides and in schools and retail clinics, these vital men and women of the profession are redefining what delivery of care and compassion mean today. 

Organ Health – Brain, Lungs and Heart Hit the Charts, but What About Skin?
April 19, 2016 10:54 AM by Martie Moore
Imagine having this conversation with someone you are caring for, "Let me talk with you about keeping your skin healthy. It is just as important as your brain, lungs and your heart."  Unfortunately, it's not common nursing practice I've witnessed very often across the nation.  Skin in many ways is the forgotten organ of the body.  Utilitarian in its function, until it declares weakness or breakdown and then skin steals the show with open and difficult wounds.  In my own practice, I also did not give much thought to teaching or addressing skin health.  I thought about skin breakdown and worked to prevent issues but did not promote health.

It took a personal experience to change my way of thinking.  Being a chief nursing officer of a Magnet hospital, I and the team worked hard to keep our outcomes or incidences of skin injuries below benchmark.  I always felt that I was chasing the wrong work, but never understood what the right course of action should be until I met a patient I will call Mrs. W. 

Mrs. W was in her later 70s and having surgery for the first time. I was rounding and stopped in to visit her before she went down for surgery.  She was amazing.  Her skin was comparable to mine and there was a 25 year delta between us.  She worked hard to be healthy and she felt her skin was one of the most important tools she had to keep "young."  Step one for her was using a pH balanced cleanser.  She did not use soap and water as she knew that it would dry her skin.  Research now supports her actions that utilization of a pH balanced cleanser reduces potential dryness, erythema and irritation.  Her second step for skin health was to moisturize her skin two to three times a day.  She fed her skin from the outside to assure integrity of the organ. Returning to research on skin health, we now know that moisturizers that contain protectants like silicones, plant oils such as safflower/corn/coconut oils, humectants such as glycerol and hyaluronic acid, as well as nutritional components like vitamins, proteins and amino acids either individually or as plant extracts, are all part of keeping skin at its most optimal level of performance.   

Mrs. W. knew she needed to feed the skin from within as well.  She understood nutrition and hydration.  She worked hard to take in a balanced diet and fluids.  She was almost obsessed with her protein intake and felt that the hospital diet selection was less than desirable.  She also understood her vitamin and mineral needs and assured that she had an adequate ascorbic acid intake.  She was a renaissance woman when it came to skin.  She understood better than many, what needed to be done to care for herself and the skin she was in. I have often questioned our practices within healthcare.  Do we create skin issues by not understanding the role that nutrition and hydration play into the breakdown of the cells?

For your own nursing practice, think about what you can do to promote skin health.  Educate and promote the use of pH balanced cleansers.  Assure that those who you are caring for understand the need to moisturize their skin.  I have seen slathering rounds done twice a day to assure that skin is being cared for on a consistent basis. While this might seem like more tasks or work, it's beginning to translate into higher satisfaction with care and better skin health.  How is this being done?  You can do it while rounding. Or, consider offering a hand massage when you take vitals then provide moisturizer to the patient or resident and encourage them to apply it to the rest of the body.  A challenge for your practice is to change your thinking from moisturizing just when you assess dryness to never having to assess for dryness.  Promote nutrition and hydration and understand that your practice has to work within restrictions, based on disease and organ function.  Most people, especially the elderly, do not have balanced diets and good hydration.  Protein is one of the building blocks of healthy skin.  Remember for your practice, healthy skin can be achieved when you feed the skin from the inside and out.

Click to check out a video on how to care for geriatric skin. Learn more about Medline's unprecedented and holistic approach to skin health and a comprehensive program called Skintegrity by visiting

How often do you think about skin with your patients and residents and what are you doing to help them achieve healthy skin?

What’s on the Horizon for Nursing in 2016?
March 8, 2016 3:42 PM by Martie Moore

After recently giving a presentation on Florence Nightingale, I mused on the changes nursing has seen through the ages. For example? In 1887, one rule for nurses stated that any nurse who smoked, used liquor in any form, got her hair done at a beauty shop or frequented a dance hall would "give the director of nurses good reason to suspect her worth, intentions, and integrity." I would have been kicked out of nursing based on my hair care alone! While the trends and changes we are seeing for nursing in 2016 have nothing to do with our hair salons, they are still things worthy of notice.

Specialty Shortage

First of all, we are facing an ongoing nursing shortage. In 2012, the RN vacancy rate was at 4.4%; it ticked forward to 4.6% in 2013, and rose again to 5.9% in 2014. Specialty areas are the hardest hit due to high retirement rates and difficulty in recruitment. Those areas include perioperative, critical care, emergency and, in some regions, labor and delivery. These specialized areas take developed skills, making it difficult to take new, inexperienced nurses and plug them in right away. It takes time to fill these roles; meanwhile, the shortage keeps rising. Hospitals are offering signing bonuses, loan forgiveness, and other alluring offers to draw candidates in. However, in some cases, it means nurses are moving from hospital to hospital based on the offered incentives. This isn't solving the problem; it's simply reallocating the current resources.

This shortage isn't a new problem. We may currently be seeing it most in the specialty areas, but be aware that this shortage will trickle down. We need to continue to assure that nurses practice to the full scope of their license and remain hungry for ways to put evidence-based information to practice. This can be done through online courses. Some 40,000 courses are taken by healthcare professionals monthly through Medline University online, for example, which offers free educational opportunities.

We also need to have programs in place to help new nurses who choose specialties to get all the training, experience and exposure they need to become valuable team members.

Supply Chain

Another big trend I am excited to see in 2016 is giving nurses a seat at the supply chain table. You may not be invited to have a seat at the table; you may have to make yourself a seat. Nursing needs to be present, because supply chain decision-making can no longer be just about price: It has to be about performance, too. Products need to be intuitive to practice, and clinicians need to have clear understanding of the benefit of using a particular product. Cost for products is not always found just in the number on the invoice. If the product does not integrate well into the nurse's workflow on the floor, they will develop workarounds. There could be waste and lack of efficiency, both of which lead to increased costs, many times lost in the overall expense of delivering care.

The most important thing to understand in getting nurses involved in supply chain decisions is that this isn't about one side winning or losing. Supply chain product decisions affect both patients and nurses, but at the same time, nurses need to understand the supply chain world too. It's about aligning incentives to the performance of the organization. The future of supply chain involves nurses, with a goal of creating one team for true collaboration.

Now It's Your Turn

I am eager to see what the future brings for nursing in 2016 and beyond. While we are facing some challenges, there is so much promise in the growth of the profession, especially in terms of collaboration outside of our normal practice in the units and on the floors.

Each month, we'll tackle a different issue facing the profession and provide unique insight, perspective and tips about how to face it, head-on. 

What are some of your predictions for the future of nursing in 2016 and how will you as a nurse leader make it happen?  Share your comments below.