Letters to the Editor

Letter to the Editor – Recognizing Heart Failure Symptoms Can Improve Patient Self-Management

Dear Editor:

Authors Sharon Vincent and Karen Mutsch discuss the increased incidence of heart failure in Americans ,and that by improving self management will promote better outcomes. They provide several interventions to assist in enhancing self management of heart failure patients in “Recognizing Heart Failure Symptoms Can Improve Patient Self-Management” in Volume 10, Issue 10. These interventions include identifying the patient’s why for nonadherence to self management, increasing patient knowledge, weight and dietary recommendations, using motivation to help patients adhere to compliance, and encouraging daily activities. Vincent and Mutsch put a lot of emphasises on educating the patient so they can better self manage themselves. When is this teaching and recommendations being provided to these patients? Upon discharge home from the hospital or the visit they make to their provider? Most people do not retain information on the first go round, and need information repeated over and over to truly use the information they are taught. Yet heart failure patients in a time of stress are expected to return home with self management skills, and be knowledgeable enough to know when to alert their nurse or provider of exacerbating symptoms.

Realizing that patients will be overwhelmed with information to assist in self management of heart failure my home health agency received a grant to set patients up with an in home cardiac monitoring device. This telehealth device takes daily weights, heart rate, oxygen saturation level, blood pressure ,and asks pertinent questions regarding patient symptoms at the time. This information is telephonically sent to a monitoring cardiac nurse. This nurse then evaluates the readings. If the results are abnormal they will call the patient’s home health nurse to alert him/her the patient may be potentially exacerbating, or the cardiac nurse may call the physician directly if no home health nurse is involved with this patient. The home health or cardiac nurse will speak with the physician regarding the abnormal symptoms to help provide the patient with interventions to prevent hospitalization. Telehealth device alerts the cardiac nurse of exacerbating symptom, provides daily trend log that assist the nurse and physician to determine the best plan action for the patient, and education. By the telehealth device repeating daily questions such as “Are you short of breath today?”, “ Are your ankles more swollen than usual?”, “Have you taken your medication today?” this helps to enforce the education regarding symptoms that a patient may experience if they heart failure is exacerbating, and provides a medication reminder. During the home health visit or the call from the cardiac nurse the patient will also get another opportunity to receive reinforcement of education on self management skills, and a chance to ask questions regarding their disease process.

By just providing patients with education and recommendations for changes in patients daily lives is not going to be enough to decrease patient readmittance into the hospital. Most of these high risk, heart failure patients live at home, and need some sort of daily assessment to prevent re-admittance into the hospital. With a combination of using cardiac telehealth along with repeated education and recommendations for changes in patients daily lives will help assist patients in improving their self management skills. Thus, hopefully decreasing hospital readmissions.

Sincerely,

Robin C. RN

Letter to the Editor

Consider adoption

    1. You are skilled at the art of patience.
    2. You know you to give excellent care under pressure.
    3. You know how to show care and then say goodbye.
    4. You understand why it’s important to have a great support system.
    5. You are used to working with social workers.
    6. You belief in the importance of showing love.

Does this sound like a nurse? It does. But these are also the qualities of a foster parent.

Since 1894, ChildServ has helped children in the state of Illinois find their way to better lives. In that 118-year history, we’ve learned a lot about what it takes to give kids the best chance possible for success. One of the things we have seen time and again is that nurses, teachers and people in the helping professions make amazing foster parents. Their ability to care, their quickness on their feet and their understanding of the welfare system are all unique gifts.

I write today with a special message to people in the helping professions: Please consider sharing your gift with a child or young adult who seriously needs your help.

To learn more about becoming a foster parent, simply visit www.childserv.org/foster. You can see the criteria for fostering and learn more about what fostering is like. You can also learn more by calling our foster parent recruitment staff at 773.867.7323.

On behalf of ChildServ, thank you for choosing a profession that makes the world healthier, safer, more educated and better for all of us.

James C. Jones
President & CEO
ChildServ

Letters to the Editor – March 2009

Avoiding the dangers of I.V. phenytoin 
As an infusion nurse specialist, I’d like to add some information to and clarify some points in “Phenytoin: Keep patients in the range and out of danger” in the January 2009 issue. The author recommends giving phenytoin through a central venous catheter, a good practice, but she didn’t mention the importance of assessing for a brisk blood return before administration. Certain factors can alter the fluid pathway, causing a retrograde flow and leakage of this vesicant drug into the subcutaneous tissue. Because of this danger, a nurse should also frequently check for blood return during the infusion—even when using an infusion pump. Remember, a pump can keep pumping an extravasated drug without sounding an alarm.
For peripheral administration, many sources recommend a large catheter, such as an 18-gauge catheter. But an infusion nursing standard of practice is to always use the smallest gauge catheter capable of delivering therapy. A large catheter can alter blood flow through the vein, reducing the amount of blood available to dilute the drug. It can also cause mechanical and chemical vein irritation and increase the risk of thrombosis distal to the venipuncture site. All these factors increase the risk of extravasation injury. To avoid this complication, I would use a 22-gauge or 24-gauge catheter, frequently assess for a brisk blood return, and flush the catheter with 10 mL of normal saline solution before and after administration. As the author points out, I.V. administration of phenytoin always requires a 0.22 micron in-line filter. I would add that filters may easily clog with drug precipitate and should be replaced if occlusion occurs.
Lynn Hadaway, MEd, RN, BC, CRNI
Milner, GA

Editor’s comment: Now that generic fosphenytoin is available, the Institute for Safe Medication Practices recommends using it instead of I.V. phenytoin to avoid these complications.

Foreign nurses: A question of education
I read “Short-term solution to our shortage” in the November 2008 issue’s Letters to the Editor, and I agree that nursing education is a vital solution to the shortage. But I don’t agree with the suggestion that hiring nurses from other countries puts patients at risk.
Nurses educated outside the United States are subject to the same standards of practice as nurses educated in this country. Plus, many of these nurses undergo difficult training, earn bachelor’s degrees, and pass numerous board and proficiency exams. All nurses are worthy of the respect of the public and other nurses.
Johanna Divinagracia, BSN, RN
New York, NY

Documenting our stories
I enjoyed the thought-provoking Editorial, “Telling our story” in the January issue and would like to share some suggestions. To make our accomplishments known, we must collect and publish value-added outcome data. Our traditional missions include providing patients and family members comfort, realistic hope, and appropriate alternatives. We accomplish these missions daily, but we don’t document an increase in our patients’ comfort or hope. Nor do we document our suggestions for alternative therapies when a patient faces a difficult regimen. And we don’t document whether a patient adopted our suggestion and whether or not it worked.
Nurse administrators should track data about strategies they use to effectively orient, reward, and retain good nurses. These strategies include making staffing decisions based on patient and family needs and creating work schedules based on needs of nurses. Outcome data about such decisions, including attendance, overtime, and retention, must be published to share what works.
Data on patient and management outcomes are more likely to show positive changes if they are based on a shared theory of nursing, in which all healthcare team members are invested. To collect value-added patient data, we need to devise mechanisms for charting. When medical records show positive outcomes and they are publicized, nurses will be telling their stories effectively and credibly.
Dr. Kathy Kolcaba  PhD, RN
Chagrin Falls, OH

Correction: In the January 2009 issue, the table on page 20 called “Interpreting arterial blood gas values” has two incorrect values. The compensation value for metabolic acidosis should be Paco2 < 35 mm Hg, and the compensation value for metabolic alkalosis should be Paco2 > 45 mm Hg. Visit www.AmericanNurseToday.com/journal for a corrected PDF.

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – January 2009

Why not a bachelor’s degree in 10?
I agree that advanced education for RNs should be mandated, as described in “BSN in Ten” in the November issue. I don’t agree, however, with the narrow focus of the mandated degree, the Bachelor of Science in Nursing (BSN). Nursing is an art as well as a science.
I earned a Bachelor of Arts degree before I entered an associate degree RN program. I tried but failed to achieve my BSN. Later, I completed my Masters degree in Public Administration, which allowed me to move into a nurse-manager position and positively affect patient outcomes.
Many roles are available to nurses today, and a science background isn’t the best preparation for all of them. The requirement should be that RNs attain any baccalaureate degree within 10 years. By mandating the BSN, all we are doing is turning out square pegs for holes with an infinite variety of shapes.
Ken Wolski, MPA, RN
Trenton, NJ

From Today’s Forum
www.AmericanNurseToday.com/forum
Yes, Yes, Yes. BSN should have been the entry level years ago. Nurses are essentially the patient-care team leaders, yet other professions require more education and training. Physical therapists, occupational therapists, respiratory therapists, and pharmacists all have increased educational requirements. But nurses continue to be offended by the thought that needing more education means they aren’t good nurses. We need to move past that mindset and progress as a profession or be left behind.
RN
Florida

Inappropriate reflex testing?
In the November issue, the author of “Urinary incontinence: No one should suffer in silence” says the neurologic exam should include checking for anal wink (in response to a light scratch of the perineal skin lateral to the anus) and bulbocavernosus reflex (similar anal contraction in response to a light squeeze of the clitoris or glans penis). Neither I nor my colleagues have ever heard of these reflexes. We don’t see why they are necessary when assessing a patient with urinary incontinence or how their presence or absence would affect patient care. We believe that eliciting these reflexes would be uncomfortable for the patient and nurse and could lead to a sexual harassment lawsuit.
Name withheld by request
St. Louis, MO

Author’s response: These tests are used to assess pudendal nerve transmission and sacral reflex (S2-S4) integrity. Certainly, more sophisticated tests such as electromyography are available to assess for neurologic or myopathic damage that may contribute to urinary incontinence. However, eliciting the anal wink and bulbocavernosus reflexes can mean avoiding costly, more invasive tests. The absence of these reflexes, though not diagnostically definitive, may suggest further testing is needed to rule out spinal cord pathology that could contribute to urinary or fecal incontinence, such as lumbar sacral cord lesions or cauda equina syndrome.
Numerous reputable sources discuss the importance of and methods for testing these reflexes during a urologic assessment, including these three:
• DuBeau CE. Clinical presentation and diagnosis of urinary incontinence. www.uptodate.com/patients/content/topic.do?topicKey=~._ll0S6Zr2jf6D. Accessed December 9, 2008.
• Gray M. Assessment and management of urinary incontinence. Nurse Pract. 2005;30(7):32-43.
• Toglia MR. Voiding dysfunction and urinary retention: lower urinary tract disorders. In Weber AM, Brubaker L, Schaffer J, Toglia MR, eds. Office Urogynecology: Practical Therapies in Obstetrics & Gynecology. New York, NY: McGraw Hill Professional; 2004:111-133.
Vicki Y. Johnson, PhD, RN
Assistant Professor
The University of Alabama School of Nursing at Birmingham

Nurse-to-nurse abuse: Learned behavior
I agree with Dr. Durkin’s comments in “Novice nurses: Leading the way against nurse abuse” in the October issue’s Letters to the Editor. I’d like to add that abuse in the workplace is deeply rooted in the way nurses are socialized into nursing under faculty mentors who themselves are abusive to students.
As a nurse educator for more than 3 decades, I have been privileged to work with and be a part of shaping our young nurses. However, I am very aware of and outraged by the way our precious students are disrespected, verbally abused, dismissed, and targeted for failure—all under the guise of curricula and high standards. No wonder nurses are abusive in the workplace; they are simply playing out what they learned from some of our respected colleagues.
Esther Graber Bankert, PhD, RN
Marcy, NY

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

letters editor hope_breast cancer dnp degree night

Letters to the Editor – December 2008

A glimmer of hope after breast cancer
I want to thank Mary K. Hughes for her article “Sex after breast cancer: Helping your patient cope” (October). I was one of the lucky ones: I underwent a mastectomy and lymph node biopsy for stage I invasive breast cancer. I didn’t need chemotherapy and was started on the antineoplastic drug anastrozole (Arimidex)—an aromatase inhibitor that can cause sexual dysfunction. Unfortunately, that’s what has happened in my case. Continue reading »

Letters to the Editor – November 2008

Easy and inexpensive  
Thank you for Susan Fetzer’s excellent article, “Putting a stop to postop nausea and vomiting,” in the August  issue. One treatment that wasn’t mentioned is inhaled 70% isopropyl alcohol. To use it, open a standard alcohol prep pad; place it under the patient’s nose; and tell the patient to inhale deeply. Both research evidence and anecdotal evidence indicate this treatment is effective. And because it’s much cheaper than other rescue antiemetics, it’s certainly worth trying.
Kate Siegler, MSN, RN
Ashland, WI

Short-term solution to our shortage   
I strongly agree with the views expressed in “Headlines from the Hill” in the September issue. For one thing, using immigration instead of education to fix our nursing shortage shows a lack of respect for other countries that have their own shortages. Is the United States going to send our nurses to other countries to help them?
Also, the current approach may put our patients at risk. Some nurses from other countries simply don’t have the skills and education American nurses have. What will happen when these nurses can’t perform on par with American nurses?
I don’t understand why our government is looking for a quick fix to the shortage instead of funding nursing education at home. As a 2007 BSN graduate, I remember how many students were turned away or placed on a waiting list for the nursing program. It’s a shame that we look for outside help when we have potential students who are eager to become the nurses of tomorrow.
Jessica Polar, BSN, RN
Miami, FL

An easy read for busy nurses  
I want you to know how much I enjoy American Nurse Today. I look forward to the new issue every month. The journal is well written at a level that is easy for our busy staff nurses to read, yet it includes all of the recent best-practice guidelines and research. The September issue’s “Community-acquired pneumonia: Follow the guidelines to better outcomes” was excellent. It incorporated not just current best practices but also an explanation about externally reported indicators.
Sandy Gandee, MS, RN, ACNS-BC
Atlanta, GA

Nurses leading the way on HIT  
Kudos to ANA President Patton on her charge to our profession to participate in decisions about the implementation of health information technology (HIT). Her message in the August issue echoes messages we deliver when we visit our community hospital clients to assist with their integrated delivery networks. We’re happy to say that nurses at several of these organizations play key leadership roles, even though the information technology groups may have initiated the installations.
Participating in HIT decision making aligns with the Magnet™ principles of nursing excellence. In fact, many of the structures, innovations, and outcomes can become evidence that organizations use to support their application for Magnet.
Darinda Sutton, MSN, RN
Laurie A. Gehrt, BSN, MBA, RN
Kansas City, MO

Eye-opening editorial   
Let me commend Pamela Cipriano on her clinical and leadership skills and her zeal to propel the nursing profession through and beyond the 21st century. Her editorial, “Senior care: Are we prepared for the impending healthcare crisis?” in the August issue was an eye opener. I was wondering if the Advancing Senior Healthcare Conference, held in Pennsylvania this year, could be held in other states in the country. This would provide the same educational opportunity to all healthcare professionals and hope to family members of the aging population.
Lydia Falade, RN
St. Paul, MN

Editor-in-Chief’s response: Thank you for your letter. We will pass along the suggestion about spreading the “Advancing Senior Healthcare” conferences to other states around the nation. Raising awareness and increasing the engagement of healthcare providers will go a long way toward creating momentum that will create lasting change.

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – October 2008

Novice nurses: Leading the way against nurse abuse 
In the informative and timely article “No more nurse abuse” (July), John Murray points out that novice nurses are more likely to report abuse or harassment to a supervisor than experienced nurses, who seem to think abusive behavior is unavoidable. As a nurse educator, I believe we must instill the value of mutual respect in students from the start of their nursing education. Perhaps novice nurses can help transform abusive environments by serving as role models for their more seasoned colleagues. After reading this article, I intend to stress to my students that they can play a pivotal role in creating and maintaining positive work environments.
Anne Durkin, PhD, RN
Rocky Hill, CT

Is the senior care “crisis” old news?   
I felt compelled to write this letter after reading Pamela Cipriano’s August editorial “Senior care: Are we prepared for the impending healthcare crisis?” Impending? The senior healthcare “crisis” has been around for decades. As a nurse for more than 30 years, I’m baffled as to why nursing leaders are still making calls to action on a topic that was headline news 3 decades ago. No wonder we don’t have a firm entry-into-practice requirement or that some of us are still writing articles about the nurse’s handmaiden image. It’s time for us to move forward and for national nursing leadership to take a stand and show resolve in supporting the profession. Why not tackle big issues, such as the shoddy way boards of nursing treatment programs deal with addicted nurses, or the reasons why nurses frequently “eat their young”? I’ve been elected to numerous national leadership positions and sat on countless committees and task forces—and I see the same old issues being raised, with no solutions proposed. It’s time to stop talking to ourselves and do what nurses do best—change things.
Richard S. Ferri, PhD, ANP, ACRN, FAAN
Brewster, MA

Dr. Cipriano’s response: Given the findings of the Institute of Medicine report “Retooling for an Aging America: Building the Health Care Workforce,” I believe the country will face a crisis caring for seniors. The nursing profession has been taking action by preparing more and more individuals at varying levels of expertise to care for the elderly, but even those numbers won’t be sufficient to meet the predicted need. Change is required throughout our social and healthcare systems. Nurses alone won’t be able to fill all the gaps in senior care. With health care taking a top spot in the current political agenda, nurses will have many opportunities to take Dr. Ferri’s advice to create change and tackle tough issues.

Looking for Mary Jo   
I recently read the online version of your November 2006 article “Reflections on nursing in Vietnam,” which recounted the military nursing experience of Mary Jo Rice-Mahoney. Ms. Mahoney, now a retired colonel, was a lieutenant in the U.S. Army who worked at the 67th Evacuation Hospital in Qui Nhon, South Vietnam, in 1969. I believe she cared for me there in November 1969. I had taken a direct hit from a rocket-propelled grenade on a mine-sweep ambush. I suffered a head injury with extensive loss of skull, upper mouth, and right hand, and I lost the use of my left hand. Although I don’t remember much of that time, I do recall receiving care from a young lieutenant nurse whose nametag read “Rice.” I’ll never forget what she did for me at a time when nearly everyone else wrote me off for dead. If this is the same Lt. Rice, I would like to thank her for her kindness and caring, which brought me through. If not for her and the Qui Nhon medical team, I wouldn’t be here today.
I was in Walter Reed Hospital for almost 2 years; the medical staff told my family they don’t know how I survived my injuries. I was medically retired with 100% disability. Since then, I’ve gotten a degree from Cleveland State University and worked in medical engineering. My wife and I will celebrate our 40th anniversary this December, and together we’ve raised two sons.
I live a fairly normal life. I hope Mary Jo Rice-Mahoney has been able to live a normal life, too, considering all the horror she lived through as an Army nurse in Vietnam. Wherever you are, Mary Jo, thank you.
Henry (Hank) Vasil,
Sergeant (Ret.), U.S. Army
Brook Park, OH

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – August 2008

Nursing pins, nursing pride  
I read the letter “Nursing school pin: Not for sale at any price” in your June issue with great interest. Like Theresa Stephany, I believe pins shouldn’t be sold to non-alumni. Last year when I toured St. Thomas’ Hospital in London, our guide proudly showed us the display of pins (which they call badges) from graduates of the London nursing school founded by Florence Nightingale in 1860. A “Nightingale nurse” is expected to will her badge back to the school on her death or take other measures to ensure it doesn’t fall into the wrong hands. The hospital’s display includes the name of each nurse. Wouldn’t it be a proud thing if American nursing schools created similar displays to celebrate their deceased alumni?
Sharon Jacques, PhD, RN
Candler, NC

The pin in one of the photos you ran with Theresa Stephany’s letter was from Villanova University. As a Villanova College of Nursing alumna, I’m wondering if our nursing pin was one of those Ms. Stephany found for sale on the Internet. I am very proud of the excellent education I received at Villanova and am disheartened to think a fellow alumna would have so little pride and connection to her nursing heritage as to sell it online. Please tell me it isn’t so!
Sherry Schacke, MSN, RN, FACHE
Commerce, GA

Editor’s response: Not to worry. The pins in both photos belong to American Nurse Today staff members and were photographed to illustrate the letter.

Safe staffing requires debriefing time    
I would like to comment on the role of stress in safe staffing. (“Safe staffing saves lives” by Rebecca Patton in the June issue). Members of other helping professions know they need daily debriefings to cope with work-related stress and stay healthy. Yet the nursing profession doesn’t use debriefing to ease the stress that comes with bedside nursing. As nurses, we are privileged to care for patients and families at moments of crisis. We truly make a difference—and I love being a nurse. But I’m not a machine. The caring and the crises cause stress. To retain our nurses, our profession should factor debriefing requirements into safe staffing levels. I’m calling for research on debriefing and for a significant restructuring to allow bedside nurses to become the best they can be.
Linda Cannon, BSN, RN, OCN
Dublin, OH

Lariam controversy  
Regarding “Are you prepared for malaria?” (June): My son, currently serving in the Peace Corps in Mozambique, was prescribed the antimalarial mefloquine (Lariam). A humanitarian traveler urged him to stop taking that drug and use atovaquone and proguanil hydrochloride (Malarone) or doxycycline instead. After doing much research on Lariam and reading e-mails from subscribers on the Lariam support-group website, I was able to convince him to switch to doxycycline. Here’s my message to all military personnel, Peace Corps volunteers, and travelers to areas where antimalarial drugs are recommended: Before taking a prescribed antimalarial, be sure to research the drug thoroughly. As for Lariam, please check out www.lariaminfo.org.
Pamela Maule, RN, CNOR
Iron Mountain, MI

From the editor: Clarification on malaria prophylaxis    
Reader Deborah Riehl, BS, RN of Lynnwood, WA, questions the statement in “Are you prepared for malaria?” (June) that chloroquine is the drug of choice for chemoprophlyaxis of Plasmodium falciparum malaria. Ms. Riehl states that “chloroquine-resistant Plasmodium falciparum is now the norm worldwide, and chloroquine is effective in only a few parts of the world. Doxycycline, mefloquine (Lariam), and atovaquone and proguanil hydrochloride (Malarone) have become the standard worldwide, although mefloquine resistance has developed in some parts of Southeast Asia. Please do not administer chloroquine in areas where P. falciparum is prevalent, or we’ll see more cases of imported malaria.”
In this article, author Barbara Chamberlain advises practitioners to review the patient’s travel destination to select an appropriate prophylaxis. For more information, see www.cdc.gov/malaria/travel/index.htm and wwwn.cdc.gov/travel/yellowBookCh5-MalariaYellowFeverTable.aspx.

Letters to the Editor – July 2008

Sacred cows and road runners

American Nurse Today is one of the few publications I look forward to receiving, and I read it from cover to cover. It keeps me grounded in important practical and academic issues, is easy to read, and doesn’t steer away from controversial issues we need to confront.

I want to commend you on the Editorial in the April 2008 issue, “Sacred cow round-up,” and the article, “Challenging nursing’s sacred cows.” I carry this issue with me as I travel to hospitals across the United States to remind me of your important message: “We can’t afford to let sacred cows graze away our innovative thought and creativity.”

Nurses and nursing leaders must meet the current imperatives regarding care and care delivery. Times may seem tough now, but we’re only in rehearsal. The real show comes soon when demands from payers and consumers for low-cost, high-quality care reach levels we’ve never seen. Sacred cows—doing it the way we’ve always done it, ignoring trends, and thwarting innovation—are showstoppers for developing the new care models needed for highly performing hospitals of the future.

Thank you for highlighting this important issue. I’d like to challenge American Nurse Today readers to send examples of innovation and sacred cows put to pasture, so we can all learn from their experiences!

I see excellence breaking out everywhere and marvel at nurses who are road runners—the exact opposite of slow-moving cows. These nurses are our future…. Let’s champion their ideas, support their efforts, and amplify their successes. Let’s make leading practice our common practice. Our patients deserve nothing less!

Lillee Smith Gelinas, MSN, RN, FAAN
Irving, TX

Editor’s note: We invite you to read “Challenging nursing’s sacred cows” at www.AmericanNurseToday.com/forum and post a comment. The Editorial, “Sacred cow round-up,” is available to all visitors in the Archives of our website.

Latex threat
When I read, “Teaming up to improve the quality of surgical care” in the May issue, I was surprised there was no mention of latex allergy and anaphylaxis prevention in the Surgical Care Improvement Project (SCIP) guidelines. As an advocate for latex-allergic people and a person with a severe latex allergy, I’ve witnessed the challenges that surgery poses for allergic staff members and surgical patients.

In 1992, I suffered an anaphylactic reaction to latex that almost took my life. We’ve learned a lot about the allergy since then, but there’s still room for improvement and education. Misunderstandings about the sources of exposure persist, and the general perception that the allergy has “gone away” puts all of us at risk. Adding latex-allergy prevention and management to the SCIP guidelines would be one more step in improving outcomes and safety for nurses and patients.

Renee Dahring, MSN, RN, CNP
Roseville, MN

When malaria requires apheresis
“Are you prepared for malaria?” in the June issue was excellent, and I’d like to provide some additional information on treatment. In 2005, I was fortunate enough to help save a husband and wife missionary team who had been to Nairobi, Kenya, and were infected with Plasmodium falciparum. After their diagnoses using blood smears, we started treatment with antimalarial drugs, but because of a tumor burden of 40% to 50%, these patients needed more than drugs.

Fortunately, the facility where I work has an apheresis unit, and we were able to perform a red blood cell (RBC) exchange (erythrocytapheresis) on both patients. During apheresis, a patient’s blood is drawn into the machine (usually through a central venous catheter), coagulated, and centrifuged. The patient’s RBCs are replaced by a donor’s RBCs, and the blood is returned to the patient.

After 5 days, the husband had a negative blood smear, and 2 days later, the wife’s blood smear was negative. Both recovered completely—and promised to take quinine sulfate prophylactically before their next trip to Kenya.

Judy J. Sigmon, RN, OCN
Winston-Salem, NC

Correction: “Paget’s disease: A therapy update” (June 2008) mistakenly lists pamidronate (Aredia) instead of risedronate (Actonel) as an oral bisphosphonate. To download a corrected PDF, visit www.AmericanNurseToday.com.

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – June 2008

Choose your battles with physicians wisely  
“Don’t tolerate disruptive physician behavior” (March) really hit home. When I started on a cardiothoracic stepdown unit a year ago, I knew I’d be working with surgeons, who don’t have a reputation for being polite. Nearly every time we have a code, they yell and scream at the nurses. I’ve learned not to take it personally, figuring the job is very stressful and sometimes people take their anger out on others.
I think many nurses tolerate doctors’ disruptive behavior out of fear they might lose their jobs if they complain. Who’s more dispensable to the hospital—an RN with relatively little experience on the unit, or a surgeon whose work brings in millions of dollars a year? No one dares report an attending surgeon, who can make your life a nightmare by scrutinizing everything you do. On the other hand, it might be wise to report an abusive resident before he gets to a point of authority where you can’t say anything. Bottom line: We have to choose our battles wisely—and perhaps grow a thicker skin.
Nadine Innocent, RN
Brooklyn, NY

From Today’s Forum:  www.AmericanNurseToday.com/forum
The article regarding disruptive physician behavior was much needed. However, “telling on” every physician who is slightly disrespectful is idealistic and over the top. It’s reminiscent of a “Big Brother” mentality where everyone is walking on pins and needles so as not to offend anyone… Everyone is guilty of having a bad day. This is not to say that boorish behavior should be accepted, but running to management with every incident shouldn’t be encouraged. Instead, speak frankly with the physician without getting into your feelings… In the real world, you do not gain respect (or further inhibit disruptive behavior) by telling a person who has acted in a contemptible manner how your feelings are hurt and allowing someone else to handle the incident.

Nursing school pin:  Not for sale at any price 
Today, nursing school pins are sold on the Internet to the highest bidder. Knowing what they symbolize, I agonize when I see them being bought and sold so easily. I’m old enough to remember when graduates had to jump through hoops to replace a lost school pin. One had to write the school and ask permission to purchase another pin, and then wait for a letter saying the school had notified the pin manufacturer that you were, indeed, a graduate and therefore eligible to purchase a pin.
My blue-and-gold school pin is about the size of a dime and not particularly beautiful, except to me and every other graduate of “Old Blockley” (the former Philadelphia General Hospital’s nursing school). Nothing I own means more to me than this pin. It’s proof that I’m part of a profession with an enormously rich and meaningful history. I wouldn’t sell it at any price, and I’d be devastated if my daughters even considered selling mine after I’m gone. Happily, there’s little danger of that: We’ve begun a family tradition of my daughters (and hopefully, my granddaughters) wearing my pin on their wedding day, to represent something old, something borrowed, and something (a little bit) blue.
I’ve seen two Blockley pins for sale on eBay. I contacted one set of bidders, asking if they were PGH graduates. They were, so I backed out of the auction, relieved to know the pin would go to one of our own. I bought the second pin, which had belonged to a 1942 graduate. Although few people ever notice, I wear it to work every day in honor of that graduate, knowing how much it must have meant to her—and still means to me.
Theresa Stephany, MSN, RN, CARN
San Diego, CA

Journal makes me proud to be an ANA member
As a returning ANA member, I must tell you how impressed I am with American Nurse Today. Reading your journal makes me proud to be an active ANA member. I was especially struck by Pam Cipriano’s February editorial, “Money can’t buy happiness”; we need to share its wisdom with nursing colleagues of all generations. On behalf of nurses everywhere, thank you for your hard work and effort.
Nelda Godfrey, PhD, CNS-BC
Kansas City, KS

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – May 2008

Dimensions of pain distraction

I read with applause “Assessing the seven dimensions of pain” in the February issue. I work in a large teaching institution in the Midwest, where we have the luxury of an in-house acute pain service. Registered nurses are assigned 24 hours a day, and an anesthesiology fellow is on call.

Our collaborative practice promotes the inclusion of the many dimensions of pain. We also use several methods of distraction, including massage therapy, an in-house music channel for all patient rooms, an on-call chaplain, tape players with a variety of music patients can choose, and a musician who visits biweekly. Patients are referred to the musician by the acute pain service nurses. I have found these complementary strategies to be beneficial in providing a means of distraction to our patients.

Alice Jebrail, BSN, RNC
Howell, MI

2B or not 2B?

I agree with Kathleen Gaberson’s letter in the November 2007 issue, “Unpopular opinion on nursing credentials.” PhD(c) is a false representation of a person’s academic credentials. For those who simply must use the PhD credential before earning it, we could try this alternative: Change the credentials of candidates to “PhD2B.” Those who have actually completed their degrees can then use “PhD4Real.”

Rana Limbo, PhD, CNS-BC
La Crosse, WI

BusinessSpeak: The need to quantify quality

Kudos to the authors of the research article, “Why making the rounds makes sense” in the February issue. Like many sound nursing practices we’ve used for years, making the rounds is crucial to quality patient care, but to communicate with the business professionals who run healthcare facilities, we need to speak their language. We need to discuss how our outcomes affect the bottom line on their profit and loss statements.

I hope the authors will consider a follow-up study on how nursing rounds affect nursing time and readmissions. Based on my 40 years of nursing experience, I’d hypothesize that the overall time a nurse must spend with a patient will be reduced or the saved time could be used for patient teaching that will decrease patient readmissions. A study on the impact of nursing rounds on nursing errors would also be interesting.

Mattie Tolley, MSN, RN
Davis, OK

Important resource on preeclampsia

Thanks to the authors for all the information on follow-up and long-term care in “Preeclampsia: The little-known truth” (February issue). It stimulated my interest.

One of the authors’ references, The American College of Obstetricians and Gynecologists’ (ACOG) Practice Bulletin No. 33, January 9, 2002, is an unparalleled resource because ACOG collaborated with the National Institutes of Health’s Working Group on Research on Hypertension during Pregnancy to clarify some important guidelines.

Susan Spencer, BSN, RNC
Tyler, TX

Focus on bad behavior, not bad feelings

Disruptive physician behavior still poses a threat and a challenge to nurses, so I was glad to see your article in the March issue, “Don’t tolerate disruptive physician behavior.” The emphasis on reporting incidents of such behavior is important. However, I don’t agree with one piece of advice. The authors say that when discussing disruptive behavior with the disrupter, a nurse should state how the incident made her feel. Making statements about feelings can put a nurse in a vulnerable position and may be culturally inappropriate.

In the past, the responsibility for conflict resolution was always on the nurse. Let’s end that and put it on the offender and the organization. You don’t have to tell anyone how you feel.

Janet R. Katz, PhD, RN
Spokane, WA

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.

Letters to the Editor – April 2008

The importance of sharing cultural knowledge

Daniel Yourk’s article, “Nursing in Afghanistan: A cultural perspective” (February) was excellent. His recommendation that nurses publish their experiences working with different cultural and ethnic groups is extremely practice-oriented and can be used by nurses at all levels of service delivery.

I believe that becoming a culturally competent nurse entails:
• integrating the concepts of cultural awareness by recognizing our own biases and stereotypes regarding other cultures
• having the right attitude (wanting to become culturally competent, as opposed to feeling obligated)
• learning how to perform a culturally sensitive assessment on all patients
• gaining cultural knowledge by learning about the values, beliefs, practices, and biological variations of ethnic and cultural groups
• experiencing cultural encounters by interacting with members of culturally diverse groups.

By sharing his knowledge of the Afghani culture, Mr. Yourk has started us on the journey toward providing culturally competent nursing care.

Josepha Campinha-Bacote, PhD, MAR, APRN, BC, CNS, CTN, FAAN
President, Transcultural C.A.R.E. Associates
Cincinnati, Ohio

 

A journal of relevance

Thanks for a great, relevant journal. I’ve enjoyed many of your articles and have taken several of your continuing education tests. In many other nursing publications, I’m lucky to find even one relevant article. American Nurse Today always has at least several. Keep them coming!

Nancy Rodier, MSN, NP
Denver, Colo.

 

Journal clubs need to follow up on articles

Re “Creating more than just a journal club” (November): I applaud the effort made by Massachusetts General Hospital and its nursing staff in creating its Nursing Research Journal Club. But I’d like to point out one potential drawback of journal clubs in general: lack of follow-up. Too many journal clubs discuss a particular article and then fail to check whether a later correction, disclaimer, or admission of poor research technique was printed. Unless a journal club keeps abreast of research and checks for follow-ups, nurses might end up altering their practice based on erroneous information. Before we jump on a bandwagon, we need to be sure we can drive it.

Deborah Adelman, PhD, RN, CNA,BC, CNS
Springfield, Ill

 

Just how effective is valerian?

I believe the information about valerian in “Herbal facts, herbal fallacies” (December) is misleading. Although valerian is safe and has few adverse effects, it is not an effective sleep aid. Based on our exhaustive review of the research literature, my colleagues and I do not recommend that practitioners advise patients or colleagues to use valerian as a sleep aid. (Reference: Taibi DM, Landis CA, Petry H, Vitiello MV. A systematic review of valerian as a sleep aid: safe but not effective. Sleep Med Rev. 2007;11;209-231.)

Carol Landis, DNSc, RN, FAAN
Professor, University of Washington
School of Nursing
Seattle

 

Author’s response:

As mentioned in the impressive meta-analysis you’ve cited, evaluating valerian as a sleep aid is difficult because studies of this herb have varied in size, design, duration, and specific preparations studied. Indeed, in my article, I emphasized this problem as it pertains to all herbal and nutritionally based therapies. Numerous studies support that improved sleep markers occur with valerian use. Because consumers commonly use valerian as a self-prescribed sleep aid, nurses should be aware of the potential advantages and disadvantages of self-prescribing this psychoactive agent.

Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP

Letters to the Editor – March 2008

A glimpse into what matters  
I wanted to give you an update on Mark, the young man in my article, “The freeing force of laughter” in the August issue. His mother called to tell me he died at the end of January. Before he died, he drove his car to visit friends in California, and he did a fair bit of living.
He was so proud to have his story in print, and so was his mother. Sometimes we get glimpses into how our actions matter to others, in ways we would have never imagined.    
Mary DeLisle-Berry, RN
Ypsilanti, MI 

A question of visibility?
I found ANA’s letter of concern about the proposed Office of National Nurse (ONN) interesting, but I wonder why ANA took so long to register an opinion (“Headlines from the Hill” in the December issue). The ONN proposal has been on the front burner for some time.
Like most nurses I know, I am a strong supporter of public health programs and public health nurses. I work to stay fairly well informed, even in retirement. Yet, I cannot tell you who holds the position of Chief Nurse Officer (CNO) of the U.S. Public Health Service. And no where in the article was this person identified by name. Is it possible that the low visibility of the CNO fed into the need to create an ONN to heighten awareness of the versatility of professional nursing and its ongoing service to the public?
Patricia van Betten, RN
Blue Diamond, NV

Response from ANA:
The ANA has long held concerns about the proposed creation of an ONN. ANA initially shared these concerns in a New York Times Op-Ed just 5 days after the proposal arose. 
Clearly, ONN supporters are well intentioned, and ANA supports strengthening the CNO’s role. However, we do not believe that a title change or added visibility for the CNO would be a panacea for the nursing shortage or our current health care crisis.
More complicated, real answers to these challenges lie in the advancement of legislation, empowerment of nurses to run for office and seek agency appointments, and involvement of all nurses in the legislative and political processes. No individual, regardless of title, could be as powerful a voice for the profession and patients as the millions of RNs who comprise the country’s largest group of health care professionals.
Michelle Artz, MA
Associate Director of ANA’s Department of
Government Affairs

Barriers for nurses with disabilities
As a working APRN with multiple sclerosis, I found “Ready, willing and disabled” in your August issue to be an accurate description of the barriers nurses with disabilities face. In my 13 years of working disabled, I’ve found that when my peers support me but the administrators don’t, the result is a hardship for every nurse involved because of interpersonal conflicts caused by a fractured approach. On the other hand, I’ve had the good fortune to work at a facility where all nurses (disabled or not) were treated extremely well and where I felt recognized for my expertise and received the same opportunity as other nurses. Thank you for tackling this issue.
Julie A. Follett, MSN, CNS, APRN
New Britain, CT

Pertinent and praiseworthy
What a great magazine you have! I have been a nurse for 25 years and have read all the nursing magazines. Yours is by far the best.
I’m a manager on a telemetry floor and encourage my staff to read your articles; so many of them are pertinent to our floor. 
Nikki McConkey, RN
Westmoreland, NY O

We welcome your comments. You may submit letters to the editor electronically at www.AmericanNurseToday.com/letters. Or you may send them by regular mail to: Letters to the Editor, American Nurse Today, c/o HeatlhCom Media, 259 Veterans Lane, 3rd Floor, Doylestown, PA 18901. Please include your full name, credentials, city, state, and daytime phone number or e-mail address. Letters should contain no more than 250 words and will be edited for grammar, length, content, and clarity. All letters are considered American Nurse Today property and therefore unconditionally assigned to American Nurse Today.