×

Before you go!

Sign up for the FREE weekly email newsletter from the publishers of American Nurse Today. You’ll get breaking news features, exclusive investigative stories, and more — delivered to your inbox.

Sign up today!

*By submitting your e-mail, you are opting in to receiving information from Healthcom Media and Affiliates. The details, including your email address/mobile number, may be used to keep you informed about future products and services.

Insights Blog

When you hear your peers tell their own nursing stories, you gain insight into how you may want to handle your professional growth, patient care, self-care, patient advocacy, and more. You may also want to share your own stories by submitting a blog for possible publication.

July 17, 2019

By: Mary Ellen Wurzbach, PhD, MSN, FNP, ANEF

Moral disagreement can be painful and involve deeply held beliefs. This combination may lead to conflict and even more disagreement—as a pebble dropped into a pool of water with ever-expanding effects.

Because moral disagreement is so prevalent in a pluralistic society it deserves serious thought. Consider the following questions: What is moral disagreement? What causes it? What occurs during disagreement? What are the consequences of moral disagreement?

What is moral disagreement?

Moral disagreement is a difference of belief about strongly held convictions. Convictions occur on a continuum—mild, moderate, strong conviction, and moral certainty. Some persons are morally uncertain and others morally certain. This uncertainty and certainty many times (but not always) evolves into moderate conviction. Morally certain persons are more likely to remain absolutely convinced. Person’s beliefs about one issue does not always apply to other issues. One can be morally certain about one issue but uncertain about others. And yet, some persons are morally certain or uncertain about a variety of issues.

What leads to moral disagreement?

In many cases the difference in belief is based on having different information, a difference of opinion about how to interpret information, or strongly held beliefs about others . . .

July 10, 2019

By: Christina McDaniels, BSN, RN

Bullying and incivility remain the norm in nursing today despite efforts to raise awareness. Bullying is cyclical—people who were bullied often perpetuate the cycle by becoming bullies themselves. Experienced nurses bullied early in their career might continue the cycle by trying to “toughen up” the next generation of nurses. The mindset “If you can’t stand the heat, get out of the kitchen” will continue if nurses don’t work together to break the bullying cycle.

During nursing school, my instructor gave us a reading assignment about the prevalence of bullying in nursing. I was shocked reading the facts because I thought most nurses were by nature kind and nurturing. Shortly after graduating from an acute care new graduate program in Los Angeles, I experienced chronic bullying firsthand. At first I didn’t even realize I was being bullied; for months I thought my manager’s continual criticism and steady stream of write-ups were because of my own ineptitude. I beat myself up trying to improve, despite never receiving any type of action plan from my manager. Ultimately, I quit my position after suffering harsh psychological and physical effects from the bullying.

Bullying can include:

A manager mimicking . . .

July 3, 2019

By: Roric P. Hawkins MBA, BSN, RN

In our efforts as leaders to influence new ideas, strategies, change, and/or concepts, often there are countless theories and ideas to choose from. Depending on what you read, who you talk to, or what you listen to, you’re likely to receive myriad suggestions based on any given individual’s past experiences, whether the results were successful outcomes, failures, or perhaps a combination of both. Though there may be value to much of the information received, ultimately the direction you choose will become the sum total of the decisions you ultimately make. Be it good or bad, you must be prepared to live with the outcomes either way or be willing to make the necessary adjustments required to put you back on track towards your stated goals and objectives.

A consultant or program manager implementing safe patient handling (SPH) programs is always tasked with achieving decreased employee injury outcomes and results; hence, this is the intended purpose for pursuing such a challenging undertaking in the first place. Though many of our paths will be different for how we get there, we are all likely to encounter some common terms or “change” language along the way: staff education, training/in . . .

June 26, 2019

By: Eric Keller, BSN, RN

Murphy’s Law says that if something can go wrong, it will. There is nothing to prepare an individual for the chaos that consumes an emergency department (ED). Education, drills, simulations, and experience can’t obviate the necessity to be prepared and ready for anything.

As the patient came in, anxious from chest pain and short of breath, staff methodically prepared her for the cardiac catheterization that would ensue, starting I.V.’s, drawing labs, and giving medications, in an efficiently orchestrated maneuver. It was like a NASCAR pit crew preparing a car to finish a race, except the stakes were higher and the race was unfairly organized and started without her consent. Her first inclination of any problem was a pressure that enveloped her chest, making it hard to breath. Thanks to the first responders, she arrived alive and well ready to undergo catheterization.

As the cardiologist and a team of competent nurses transporting her to the cardiac catheterization lab, it started to rain. The drops were few and far between but eventually a proverbial thunderstorm took over, and her rhythm began looking like a lightning strike. The strikes merged together to form ventricular tachycardia and the patient faded . . .

June 19, 2019

By: Julie Mason Jubb, DNP, RN, CNE

Mentorship is an important concept for new nurses, as they work to navigate the profession and learn needed skills for success in their new role. The nurse role can be a challenge to learn without a compass, road map, or guide. Nurses learn most about what being a nurse is and the “how” of nursing when they begin nursing practice. Nursing leadership has an important responsibility to guide the next generation of nurses toward positive outcomes. Whether a novice or seasoned nurse, you can be part of positive change within the profession. The concept of “nurses eating their young” can no longer have a place in the profession.

Mentorship can be defined in many ways. This concept can range in definition from a seasoned nurse sharing knowledge with a new nurse to an “intense relationship” between a new nurse and an expert to create an environment of success for both the individual and the organization. The nurse and mentor can both learn and grow together.

The Robert Wood Johnson Foundation (2014) states that in a survey of newly licensed RNs, nearly one in five new nurses will leave their job in the first year. In the National Healthcare Retention and . . .

June 18, 2019

By: Mary Ellen Wurzbach, PhD, MSN, FNP, ANEF

Some say having patience is a good thing. Ambrose Bierce defined patience as “a minor form of despair disguised as a virtue”. I take the middle ground, believing patience can be either—virtue or despair.

Patience allows one to withstand the vicissitudes of life. It allows one to look the future in the eye and know that one can survive a great deal of stress, ambivalence, abuse, and sorrow.

Patience entails hope, which is in some ways antithetical to despair. For this reason, although one sometimes experiences despair while being patient, I don’t believe patience is a minor form of despair, although it may be strongly associated with despair.

Patience, I believe, is a virtue and not a disguised virtue. It allows for a hopeful resolution to a problem. It allows one to “wait” and maintain hope despite uncertainty. It allows one to make decisions calmly and resolutely despite knowing that the outcome may be months or even years away.

Patience is an important virtue. It provides time to think and plan and implement if necessary. It delays precipitous decisions and makes decisions more robust and realistic. Patience provides the necessary extension of faith for someone else who needs . . .

June 12, 2019

By: Kimberly Dimino, DNP, RN, CCRN

Note: This blog is based on a keynote address that the author gave to the graduating nursing class at William Paterson University.

As much as you feel joy and a great sense of accomplishment as a new graduate nurse, you probably also feel a little anxious about what lies ahead. But don’t fret. If you survived the NCLEX, you can survive anything! Seriously though, take a moment to savor and appreciate what you have accomplished. It has been an intense time of growth for you, and I know it comes as no surprise for me to note that there are intense times of growth ahead.

Some of you are first-generation college graduates. I was also the first in my family to graduate from college, so I understand the pressure and intense growth that comes with being “the first.” But I also know it’s worth it—all of it! I truly believe education is the way up and over any obstacles you may face. I’ve been a student my whole life and I am proud of that.

You might wonder why I, a mom of three teens who loves her job as a pediatric nurse and clinical . . .

June 5, 2019

By: Victoria Rondez Squier, MSN, RN, CNL

Food for thought: Rather than dining on our young, how might we—the next generation of nurse leaders—model positive professional behaviors and help to end the hazing, the bullying, the eye rolling, and all the other covert and overt intimidation that has plagued our profession for decades. A mentor once said to me, “Physicians groom their young and teach them early that they are the leaders of the healthcare team.” I do not for the life of me remember ever being conveyed the message that I was to lead anything but a code blue in the event that I would be asked to do so. However, I do remember being told, “You are the coordinator of care…you are in charge of your patients…and if anything goes wrong, you will be blamed, so cover your behind!” I suppose that was one way of saying to me that I am the captain of my ship.

I made it through nursing school with just a hint of PTSD, unscathed, and ready for action. The bit of confidence I gained from having passed the grueling boards was enough to last me my first week of orientation as a new grad. But . . .

May 29, 2019

By: Alex Sargsyan, DNP, CNE, ANP-BC; Jean Hemphill, PhD, FNP-BC; and Lee Ridner, PhD, FNP-BC

Single parents face many challenges when accessing healthcare for their children and themselves, and have health issues that may go unrecognized, particularly for single fathers. The number of single father households has increased dramatically over the past few decades. There were fewer than 300,000 single father households in 1960, but in 2011 that number increased to more than 2.6 million—a 8.6-fold increase from baseline. Despite this jump in numbers, the literature addressing health-related issues of single fathers is rather scant. In this blog, we disseminate the limited number of studies on the subject and make recommendations for nurses to address the health disparities for this unique segment of population.

Lack of recognition

Life in a single-father household can be a challenge for both children and the single parent. While it’s well recognized that single women with children face disparities and inequities in health, healthcare access, and care due to gender and socioeconomic factors, single fathers face the same concerns and also struggle because their unique vulnerabilities often go unrecognized by healthcare providers. Health disparities in men include access barriers to primary care, gender influenced help-seeking, and disproportional rates of suicide and . . .

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

It’s one of a healthcare provider’s worst nightmare—a person within the facility has a weapon. What will you do? Who will you call? What can you expect from the outside agencies who respond? In Fast Facts for the Triage Nurse, 2ndEd., disaster management expert Erik Angle RN, MICN, MEP, covers essential actions to take in the event you find yourself faced with such a horrific event.

INCIDENT RESPONSE

The risk of an active shooter or active violence incident is higher in the community than within the hospital itself.

Attack Occurs in the Community

When an attack happens within the community (not within your facility), you should do the following:

Assume the role as assigned in the hospital’s emergency operations plan (EOP) and prepare for incoming mass casualties.
Recognize that there is the potential that the hospital could be a secondary target.

Attack Occurs Within the Hospital/Healthcare Facility

Active shooter or active violence incidents in a healthcare setting present unique challenges, such as a large vulnerable patient population and hazardous materials. There are special challenges such as with firearms and MRI machines (these machines contain large magnets that can cause accidental discharge of a weapon or . . .

May 22, 2019

By: Paul E. Coyne, DNP, MBA, MS, RN, APRN, AGPCNP-BC

In April of 2019, I had the privilege of attending the ANA Quality and Innovation Conference where Inspiren, the healthcare technology company I co-founded with fellow nurse, Michael Wang, received the inaugural Innovation Award, powered by BD. Since that time, I have received messages from nurses around the country asking me why I felt the need to innovate on this large of a scale and if I had any advice for nurses wishing to innovate as well.

While we greatly appreciate your support, we want you to know that we did at Inspiren isn’t any different than what nurses do each day. Nurses are inherently innovators by our very nature. More importantly, we currently have a unique opportunity to highlight this aspect of our profession to improve our healthcare system at every level. However, in order to truly seize this opportunity, we must embrace fully that which defines our profession.

The most defining and memorable moments of my life were spent recovering from a stroke in a hospital bed with a nurse by my side. Based on that experience, I decided I wanted to be present to others and help them during their most defining and memorable moments . . .

May 15, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

Redness, itchy, fluid filled, crusty, fever or no fever. So many rashes, so many decisions. Do I isolate the patient? Is the condition emergent or can the patient safely wait for care? Knowing how fast to act and when to isolate a patient comes as a challenge for many healthcare providers.

In Fast Facts for the Triage Nurse, 2ndEd., Anna Sivo Montejano DNP, RN, PHN, CEN, and I share insights into some medical conditions requiring patient isolation.

CONDITIONS REQUIRING ISOLATION

Many presentations require isolation to prevent exposure of other patients, visitors, and staff. The following discussion is not all encompassing but provides information that may help the triage nurse understand rash progression, determine when to initiate isolation, and guide triage decision-making. For additional information, see www.cdc.gov.

Chickenpox: Occurs in individuals with a recent exposure to someone with chickenpox; patient may or may not present with a rash since patient is contagious 48 hours before rash erupts and remains contagious until lesions crust over; incubation period is 10 to 21 days after exposure to chickenpox (CDC, 2016); rash appears first on the face, back, or abdomen and then spreads; rash starts as small red bumps (pimples) that develop . . .

May 8, 2019

By: Roric P. Hawkins, MBA, BSN, RN

Over the past couple of years, I’ve written a lot about the various parts and pieces that make up safe patient handling (SPH) programs. If you’ve followed my blogs, you sometimes may have gotten lost in some of the information, especially if you are not familiar with how SPH programs work. From patient-lift technology (equipment) to policies and processes, to buy-in and organizational cultures—all of these discussions were aimed at demonstrating how all are related to achieving one fundamental objective: creating an operational system that designates patient-lift technology as the primary means for how professional caregivers are to go about lifting and moving patients. This operations system is designed to take the place of traditional manual patient lift practices and processes. The implementation goal for SPH programs is to transition patient-lift technology from being thought of as an exceptional available option for when manual lifting practices are not probable to an accepted standard of clinical practice where using patient-lift equipment for all lifts is the hospital organization’s norm.

To make SPH programs work, patient-lift technology must be made consistently and continuously available for employees. This is why you will often . . .

May 1, 2019

By: Lynn Sayre Visser MSN, RN, CEN, CPEN

Five patients arrive simultaneously into the emergency department (ED) waiting room. Who will you see first? Who will go straight to an ED bed? Who can wait for care? The rapid triage assessment in the emergency nursing environment is a quick assessment that helps the triage nurse identify those patients requiring immediate care from those who can safely wait.
In Fast Facts for the Triage Nurse, 2nd Ed., Anna Sivo Montejano DNP, RN, PHN, CEN shares insight into performing the rapid triage assessment.

RAPID TRIAGE ASSESSMENT
A rapid triage assessment begins with an across-the-room survey. Visualizing the patient’s appearance as he or she enters the facility is the beginning of the rapid triage assessment. A great deal of information can be gathered by visualizing the patient as he or she steps into the waiting room (WR):

Does the person use a device to assist with ambulation (e.g., cane, walker)?
Does the facial expression or body language indicate pain?
What is the skin tone and color?
Is the gait slow, rapid, absent, or demonstrating signs of weakness?
Is he or she unresponsive or altered?
Is there limited eye contact? Does the person express fear, anxiety, or agitation . . .

By: Fiorella Martin, RN

In the intensive care unit (ICU), patients and families learn coping mechanisms to deal with stressful events and potential changes in their lives; however, the length of stay and complications can lead to ICU delirium.

As an ICU nurse, I have seen and cared for patients with delirium. They gradually manifest behavioral, cognitive, and emotional disturbances. Fortunately we use assessment tools, implement strategies, administer antipsychotic medications, and involve family members in the management of delirium. However, what do we do if the family member is showing those same signs of delirium? How can we treat him or her? Who do we call? How can we prevent it? I started asking these questions in 2018 while taking care of Mrs. S. in the Tampa hospital where I work.

Mrs. S. was a 70 year-old woman admitted with advanced thyroid cancer. She received a poor prognosis at a local hospital in South Miami where she and her family resided. Mrs. S. and her husband drove to Tampa for a second opinion, hoping to find a specialist who would operate and remove a large neck tumor. Unfortunately, despite multiple tests and non-surgical interventions, Mrs. S. became progressively sicker as the tumor . . .

April 17, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

An unexpected fall from a ladder, a motor vehicle accident, a sudden onset of acute chest pain…these are merely a few of the reasons people find their daily lives disrupted and seeking care in an emergency department (ED). Once in the ED, they are often among many others seeking care. The nurse must then use triage to prioritize patients.

Triage of incoming patients is a complex process that is frequently misunderstood by the layperson. The word triage comes from the French verb “trier” which means “to sort”. In essence, the triage nurse is constantly “sorting” by prioritizing and re-prioritizing the incoming ill or injured patients who require care. The nurse should base his or her decision-making on evidence, not only to ensure patients receive the care they need when they need it, but also because patients often misunderstand the triage process. Explaining that there is a process behind decisions may help ease anxiety.

In Fast Facts for the Triage Nurse: Orientation and Care Guide Second Edition, Deb Jeffries MSN-Ed, RN-BC, CEN, CPEN writes about triage acuity scales used in EDs around the world.

TRIAGE ACUITY: OVERVIEW

Emergency departments (EDs) have historically used triage scales or . . .

April 10, 2019

By: Julie Gardner, BSN, RN, CPN

When I joined the nursing profession, I never imagined sharing my most vulnerable thoughts and emotions as a nurse and a human just a few years into my career, nor how the experiences ahead would change me. I graduated from nursing school in 2015, bright-eyed and 22 years old, ready to take on the known physical and mental fatigue ahead. I wasn’t prepared for how exhausting it is to continually see so much pain, hurt, and suffering. Just a few years later, I now realize how deeply I have been impacted by compassion fatigue.

Figley (1995) said it well: “We have not been directly exposed to the trauma scene, but we hear the story told with such intensity, or we hear similar stories so often, or we have the gift and curse of extreme empathy and we suffer. We feel the feelings of our clients. We dream their dreams. Eventually we lose a certain spark of optimism, humor, and hope. We tire. We aren’t sick, but we aren’t quite ourselves.”

I’ll never forget my first day in patient care as a newly licensed nurse. My patient’s mother was loving, kind, and grateful, wanting to . . .

April 3, 2019

By: Lynn Sayre Visser MSN, PHN, RN, CEN, CPEN

Three months out of nursing school I was assigned to orient to the triage nurse role in a fast-paced urban emergency department (ED). Patients and their support systems lined the hallways and overflowed out the door of the small waiting room. A large glass window separated me from the incoming patients standing shoulder to shoulder in the cramped hallway. On one hand, I loved that I could see each person as they entered the facility. I could assess from a distance things like breathing and skin color and whether they could walk unassisted or with the use of a medical device. Sometimes I could quickly identify who needed immediate help, while other times the person’s chief complaint was all a mystery until I had the time to talk to him or her.

My triage orientation consisted of a see one, do one, teach one approach. Watch a triage, perform a triage, and soon precept another new nurse to triage! Almost 25 years have passed, and I’m hopeful that this approach is now a thing of the past in triage orientation.

There is something to say about “ignorance is bliss”. Being a new nurse, green as could be . . .

March 27, 2019

By: Catherine Meliniotis, RN

It always begins innocently, doesn’t it? “I’m just venting,” you think to yourself. But the more it goes on, the more infectious and toxic it becomes. One complaint easily snowballs into an avalanche of dissatisfaction. Before you know it, you can be pegged as the negative one that your coworkers try to avoid. Has this become the reality of today’s workplace? Why do we do it? How do we deal with it? Is there anything healthy to become of it?

If you stop and take a moment to observe, you’ll find that complaining has become an integral part of most people’s daily verbal communication. According to author and Clemson University professor, Robin Kowalski, PhD, there are two basic categories of complaints: instrumental and expressive.

Instrumental complaints are goal-oriented, meaning that we verbalize the problem in hopes of bringing about change. For example, you rant to your coworkers about how messy and disorganized the medication room is, because you are really hoping they’ll offer to help tidy it up. You gripe about how hard it is to keep up with the repositioning of an obese total care patient, in the hopes of a coworker . . .

March 22, 2019

By: Roric P. Hawkins MBA, BSN, RN

As we celebrated patient safety week this month, I couldn’t help but ponder whether safe patient handling (SPH) practices created the type of solutions that would put healthcare facilities along a path to considering themselves high reliability organizations (HROs). As I considered the safety science that supports HROs, which are designed to protect healthcare workers, it certainly reaffirmed what I have always known an SPH program to be—a well-developed care delivery improvement system intended to mitigate unsafe patient care practices with the potential of causing harm to caregivers and patients. As an added bonus, our efforts to address employee injuries through safe SPH programs have enabled us to discover opportunities to improve certain health-related outcomes by applying patient-lift technology innovations to common patient care interventions.

Technology to prevent hospital acquired pressure injuries

Through implementing patient-lift technology to protect both employees and patients, we have seen improvements in quality measures such as hospital acquired pressure injuries (HAPIs) when patient-lift equipment is appropriately applied. Though our initial focus was intended to address the epidemic of musculoskeletal injuries among healthcare professionals, the safety science associated with SPH program implementations has forced organizations to analyze and address . . .

Test Your Nursing Knowledge

Answer this interactive quiz to be entered to win a gift card.

  • This field is for validation purposes and should be left unchanged.

Insights Blog

Today’s News in Nursing

The views and opinions expressed herein are those of the contributors, authors and/or advertisers on this website and do not necessarily reflect the opinions or recommendations of the ANA the Editorial Advisory Board members, or the publisher, editors, and staff of American Nurse Today.

American Nurse Today attempts to select contributors who are knowledgeable in their fields.  However, it does not warrant the expertise of any contributor, nor is it responsible for any statements made by any contributor.  Nurses should not use any procedures, medications, or other courses of diagnosis or treatment discussed or suggested by contributors without evaluating the patient’s conditions and possible contraindications or dangers in use, reviewing any applicable manufacturer’s prescribing or usage information and comparing these with recommendations of other authorities.