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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.

April 20, 2018

By: Eric Keller, BSN, RN

In the Army I learned what it meant to never give up as well as what it meant to succeed. I quickly mastered my mind and body to overcome many challenges. I learned the value of hard work along with the pride of serving my country. My time in Iraq revealed the burdens and difficulties that most people around the world face every day and gave me a deep sense of appreciation for my life. It was a time for personal growth and reflection where I discovered a joy in helping those in need.

Over the years I have learned that my joy comes from helping others and have witnessed the large impact a small gesture has. Caring for patients with compassion and kindness can transcend cultural boundaries and provide a foundation for stronger and more productive relationships. As a new nurse in the emergency department (ED) I am humbled by the opportunity to help people at their most vulnerable and difficult time. It is a very fast-paced environment where time is quite limited, but even small gestures, like a warm smile, can foster a relationship. These small gestures with great compassion can have a large impact; just as . . .

April 13, 2018

By: Roric P. Hawkins MBA, BSN, RN

Although safe patient handling (SPH) programs are designed to reduce employee injuries related to manual patient lifting and repositioning, many programs are limited to being marginally effective at best because of a lack of knowledge for how and why such injury prevention programs work. Unlike many safety practices and protocols in other industries, clinical practice settings are unique, given the many unpredictable variables that exist within the environment. From the actual caregiver, to the patient, to the limited amount of space for performing patient care, these and other factors pose unique challenges when attempting to implement new safety prevention protocols. This is the reason why a unique approach along with a unique perspective is required for SPH programs to be successful in decreasing patient-handling injuries.

Practicing safety

Clinicians who perform duties in patient care environments develop work practices that are centered on how they believe they can most safely and efficiently accomplish tasks despite environmental challenges. This explains why clinicians are hesitant to change patient-practice processes that they consider to have mastered. For example, when considering environmental workspace, clinicians have learned to avert injury risks by eliminating clutter for the purposes of preventing trip hazards all while being . . .

April 6, 2018

By: Jon Templeman, BSN, RN

If you grew up listening to rock music in the 1980s, you might have heard stories about the overly demanding requirements of Van Halen and their infamous brown M&Ms. For those who don’t know, one of the items that had to be present backstage in the green room before a concert was a bowl of M&Ms. This bowl of candies could not have a single brown one among them or havoc would ensue, and the show could be canceled according to the contract. What for decades had been perceived as the diva antics of a rowdy rock band was much more nuanced than that and served a vital purpose.

An interview with lead singer David Lee Roth years later revealed that this demand was an intentional quality control measure that they hid deep within their contract to ensure the massive musical production would be handled safely across all the various venues they toured at. At that time, most bands would arrive with three truckloads of equipment for a concert, but Van Halen was putting on massive shows that required nine truckloads worth of light and sound equipment. They needed to be sure that each venue . . .

March 30, 2018

By: Michelle Perregrini, MSN, RN, CPAN, CAPA

The greatest impact on who we become as nurses evolves from the transition from nursing school to graduate nurse, a stage of intense vulnerability, uncertainty of expectations, and lack of self-confidence. And a stage that cultivates practice and guides our approach to care. During transition, we’re also exposed to professional relationships between nurses, sometimes subjected to lateral violence, or bullying, as it is more commonly known.

Coursey and colleagues note that lateral violence includes many low-level types of hostile behavior including using innuendo, ostracizing, sabotaging, making verbal affronts, and withholding information. Lateral violence causes dissatisfaction because it can result in poor communication, poor patient care, and increased staff turnover. Lateral violence can occur at any level, from nursing student to experienced nurse; however, strategies that support the next generation can mitigate the risk of ongoing harassment throughout a nurse’s career.

Here’s a look at the issue of support from the perspective of nursing students and nurses.

First impressions count for nursing students

As a nursing student on clinical rotations, you maintain the safety net and support of an instructor while performing skills with patients, knowing that at any given moment “a real nurse will jump . . .

March 28, 2018

By: David Foley, PhD, MSN, RN-BC, MPA

I recently spent one summer working as a clinical instructor in a course that required 12-hour experiences on a very busy inpatient floor. As any clinical instructor, student, or floor nurse knows, clinical days can be long, confusing, and often chaotic. Each day I met many wonderful nurses—some had been in practice for years and others were recent graduates. In either case, it was a pleasure pairing them with students who would benefit from their knowledge, skill, and experience. As we spoke throughout the first few weeks of the clinical experience, we couldn’t help but compare notes on our own experiences during our prelicensure and graduate programs. And as is often the case when a group of nurses come together, the conversation drifted easily from topic to topic, including how much nursing practice, medical equipment, and especially nursing education has changed. One nurse shared several “used to be’s” and was proud that she could still calculate I.V. drip rates with the help of her trusty watch with a second hand and provide medications as accurately as any pump on the market.

While eating lunch with several instructors, students, and faculty one day, I was surprised . . .

March 23, 2018

By: Eric Keller, BSN, RN

As a soldier, I arrived in Iraq in February 2004. The trip was exhausting but ended with the most spectacular sunset. It was absolutely breathtaking. The sky was like an endless pastel canvas for the stars to slowly settle down upon. The unobstructed view across miles of open desert created an astonishing vantage point for me to watch. As the day slowly turned into night, the nostalgia of the sunset was quickly forgotten, as gunfire subdued the night. It was the thrill of a lifetime, but the novelty of fighting faded faster than the sun, and the reality of the situation sank in even quicker. It was war, and it quickly became the most difficult time of my life.

In the Army I learned the value of hard work and what it means to never give up. Despite the challenges and adversities, soldiers are prepared to succeed. This is the foundation of the warrior ethos. It is an innate willingness to succeed at all costs despite the consequences, no matter how grave. Failure is not an option, it must be avoided to accomplish a mission.

Walking into a patient’s room may seem like walking into battle. The list of . . .

March 16, 2018

By: Roric P. Hawkins RN, MBA, BSN

In last month’s blog, I wrote about the importance of equipment procurement from the standpoint of streamlining a purchasing process, understanding the complete value of equipment purchases, and minimizing time spent with equipment vendors. I stressed the significance of these particular considerations because it’s important for safe patient handling coordinators to establish themselves not only as subject matter experts, but also as being fiscally responsible. I highlighted the importance of not becoming captivated by the dazzling features that so many of these patient-lift devices offer, but to focus on the functionality of the product and how it may or may not be transitioned into an organization’s existing patient-care processes.

Of course, patient-lift equipment will always be needed to protect worker’s safety in patient-care settings. This equipment represents the foundation that safe patient handling programs are built upon. A coordinator’s ability to select devices that will influence end-user’s commitment towards using the device will be the major determinant for whether the facility will effectively achieve reductions in employee injuries related to lifting and repositioning patients. In this blog, I’ll discuss important steps to consider in the role of safe . . .

March 9, 2018

By: Randelle I. Sasa

The day after the horrific mass shooting incident at Douglas High School in Parkland, Florida, I began my undergraduate nursing lecture with a piece on mass shootings. I was expecting a lively conversation on the topic, yet my students remained quiet. They were perhaps surprised by the fact that I brought up what’s in the news rather than the subject matter I was supposed to teach, so I attempted to personalize mass shootings by saying, “I do not like the fact that I am getting desensitized to mass shootings in schools. I do not like it because tomorrow, it can be us running for our lives.” My statement got the conversation going, which made me realize that my student must have been desensitized to mass shootings to some extent as well.

Well, who wouldn’t be?

There have already been 17 mass shooting incidents in 2018 at the time of this writing, and a total of 345 last year, according to the Gun Violence Archive, a Washington, DC-based nonprofit that tracks gun-related deaths and injury based on official records. Three of the deadliest mass shootings in US history happened in the past 5 months.

The main reason . . .

March 2, 2018

By: Jon Templeman, BSN, RN

Seneca the Younger, a Roman philosopher from the first century noted, “It’s not that we have little time, but that we waste a good deal of it.” While some nurses would balk at that statement (me included at times), it’s sometimes not about the time we have, but what we do with it that determines how successful a shift is.

A very brief history of time

The concept of time is one that humans have tried to understand and master for millennia. From primitive stone structures hundreds of years ago that marked time by displaying shadows on the ground, to the masterful Swiss engineering that people now spend thousands of dollars for, we have tried to bend time to our will so that we can know how much of it we have left in a day as we rush to accomplish various tasks. Paracelsus, the 16th century Swiss doctor and alchemist said, “Time is a brisk wind, for each hour it brings something new…but who can understand and measure its sharp breath, its mystery and its design?”

Nurse’s foe?

The constant pursuit of mastering time and facing new challenges each hour are concepts that are certainly . . .

February 23, 2018

By: Roric P. Hawkins RN, MBA, BSN

In our efforts to discourage caregivers from manually lifting patients, it would seem logical to assume that the more patient-lift devices made available for staff to use, the more likely staff are to use patient-lift equipment. Although conventional wisdom would seem to support such logic, my experience suggests that it doesn’t work that way. Instead, staff become confused when they have too many devices to choose from.

The impression that an abundance of equipment is needed to address routine patient-lift challenges is an overreach that often leads to a lack of equipment utilization. In most cases, too many devices lead to the law of diminishing returns phenomenon; ultimately staff decide not to use any. A better strategy is to thoughtfully assess what is needed.

Develop a procurement process

Developing a standardized process for procuring patient-lift equipment is important for ensuring that the appropriate patient-lift equipment is purchased, while avoiding wasteful spending (therphawkinsgroup.com/services/procurement-optimization/). The first step in this process should be to understand the immediate patient-handling needs of the clinical environment for which equipment is being purchased. This is best achieved by performing ergonomic assessments in patient care areas. The . . .

February 16, 2018

By: Fidelindo Lim, DNP, CCRN

There is a ritual in medical schools to hold a memorial service to honor those who have donated their bodies or body parts to advance medical education and research. In spite of advances in instructional technologies, the dissection of human cadavers remains a staple teaching strategy in gross anatomy in medical schools. There is no doubt, dissecting cadavers teaches more than just muscle insertions and blood vessels. It invites the future physician to contemplate on our collective humanity, to acknowledge the inescapable reality of disease and death, and to ponder upon the virtue of gratitude.

It’s proper and good to eulogize the people who donated their bodies to medical education. To give thanks to those who continue to give, post-mortem, is a moral obligation. Organ donors, both live and cadaver, evoke similar heartfelt thanksgiving. A donated organ can save a life, but a donated body paves the path to save many more. The gift of the dead, both physical and spiritual, will continue to manifest in the lives restored under the care of a learned and skillful physician.

Nurses don’t dissect cadavers to learn their craft. And the dead do not endure. Before the advent of high . . .

February 10, 2018

By: Chris Hirschler, PhD, MCHES

Trained as a licensed practical nurse in 1948, after being a nurse’s aide in Rochester, New York during World War II, Rita Hirschler has cared for the sick and dying throughout much of her century-long life. She has provided end-of-life care for multiple family members, including her mother, two husbands, a daughter, my mother, and many patients. I might not be alive to write this story had my grandmother not been by my bedside 33 years earlier in the hospital’s intensive care unit and noticed I was bleeding internally.

On January 8, 2018, Rita turned 101. She has spent the last 840 days in this nursing home, enduring a tiny, shared space separated by a thin curtain and the maddening blare of strangers’ television selections. When I visited her two days before Christmas 2017, I asked her how she was doing. A single tear formed, desperate, as if tortured, her voice quivered, “I can’t sleep!” Meanwhile, her roommate screamed gibberish. The woman’s daughter, cognizant of the disturbance, reassured my cousin, “She won’t be here long.” Making light of the mortal implication, my cousin quipped, “They’ll do a Dateline special on my . . .

January 29, 2018


Having been a registered nurse for almost 10 years, I’ve been fortunate to have only been a patient for the happy occasions of welcoming my children into the world. During those visits at our local hospital, all with surgical births, I was thankful for the kindness, compassion, and understanding of the nursing staff as I asked many questions and stubbornly insisted on doing many of my own care activities. My first two deliveries, both daughters, are nearly a blur in my memory now. The care was excellent, evidence based, and respectful of my preferences and needs. My husband and I received patient centered discharge instructions that were personal and thorough. We felt confident leaving the hospital, and we truly gave all the credit to our amazing nurses.

Only the stay with my son sticks with me now as different than the first two. Like the deliveries before, we’d had a great OR experience, with excellent and evidence-based care. We’d kept our son in our room for the entirety of the stay, and were treated with respect and dignity. We had chosen to keep our son intact, to not circumcise, and had been supported in our choices . . .

January 22, 2018

By: Lynne M. Hutchison, DNP, FNP-BC

Have you thought about what to do in your retirement? Are you sad about giving up the nursing skills you developed over your years of practice? Have you ever thought of using some of your skills and knowledge to work as a volunteer nurse? There is a need for volunteer nurses in both the United States and abroad. Many nurses are volunteering their time to help those in need after going through a traditional retirement from nursing. Many of the activities nurses performed in their regular fulltime careers translate well to a volunteer setting. Here are some common questions about volunteering in retirement.

What’s in it for me?

Working as a volunteer is rewarding all on its own. The feeling of serving other people is something that makes most of us have a sense of self-worth and one of the reasons we entered the nursing profession. In addition, you are providing care in the most urgent need areas, gaining new skills, and making lifelong friendships. When I go to my volunteer job, everyone is happy to be there. If I miss a week, everyone asks where I was and say they missed me. When was the last time . . .

January 12, 2018

By: Roric P. Hawkins RN, MBA, BSN

As we ended 2017, I reflected on some of the feedback I’ve received from the blogs that I wrote during the year. Most people’s comments have been very positive and supportive, but some have raised questions or concerns. As we start the new year, I thought this would be a good opportunity to address some of those questions here.

Why does nursing seem to be the primary focus of all your blogs?

Most hospital organizational missions are written as a commitment for what patients should expect when choosing to receive care within their hospital facility. It would be next to impossible to accomplish these missions without the direct involvement and unwavering support provided by nursing staff. In hospital settings, nurses are the most central figures to patient care, responsible for not only the delivery of consummate quality, but also acting as coordinators of care both within and often outside of hospital settings. Nurses represent the direct link between the patient’s health, physicians, support services, and associated family members and friends.

As it relates to implementing safe patient handling programs, it must be understood that most patient handling injuries in hospital settings are incurred by the nursing staff . . .

January 5, 2018

By: Jon Templeman, BSN, RN


 After a long, arduous winter of work, you have saved up your PTO and fly out to your dream destination for a much-needed vacation. You are miles away from the cacophony of call lights, alarms and demands of your job, and with each passing mile, you feel the stresses shed away and the beckoning call of the ocean strengthen. The plane is cruising along at an altitude of 40,000 feet as you watch a movie and daydream about the coming days, thinking about how you are going to spend them relaxing on the beach.

In an instant, your moment of tranquility is disrupted by a loud banging noise and the intense pressure of frigid air rushing into the cabin. You fumble with the oxygen mask that has dropped down in front of you, trying to put it on, now remembering the words of the flight attendant instructing you to put your own mask on before you help those you are with. You don’t know this, but you have the next 15 to 20 seconds to properly don the oxygen mask before you lose consciousness.

Thankfully this scenario is something that happens very infrequently; however, the necessity . . .

December 30, 2017

By: Tracey Long PhD, RN, MS, CDE, CNE, CCRN

Angels are generally thought of as having wings and appear quietly, but on October 1, 2017, hundreds of angels descended on Las Vegas wearing scrubs amidst noisy chaos. After a mass shooting at the Mandalay Bay hotel upon 22,000 country music lovers at the Route 91 concert, angels without wings, known as nurses, went into full action.

The two busy trauma centers of Las Vegas include Sunrise Hospital and UMC Hospital and generally receive and treat approximately 20 traumas each day. After “shots fired” was announced, however, both centers received and treated over 250 patients, hundreds with gunshot wounds and more with surgical needs. The total was 527 wounded and 58 fatalities. That Sunday evening, both hospitals had called in all of their off-duty surgeons, anesthesiologists, and nursing surgical teams and activated all their training and creative thinking to deal with the sheer volume of people flooding into their emergency departments. More than 100 physicians and nurses came in, like angels swooping down into chaos to bring help and healing.

“We get patients like this all the time, but maybe two at a time at most,” said Rhonda Davis, Las Vegas Sunrise trauma nurse. “You do all these . . .

December 22, 2017

By: Mary Ellen Wurzbach, PhD, RN

Suffering is an ephemeral state. Not physical pain exclusively but also the mental state that accompanies pain of all degrees. Pain is what the person says it is and so is suffering.

Pain and suffering, although co-mingled, are very different aspects of the same phenomenon. Pain is one part of suffering but not the whole. Suffering entails many characteristics not found in pain alone. Suffering involves many psychological mechanisms encompassing some attributes common to all and some specific to the individual. Suffering includes the physical aspects of pain for some but not others.

Sometimes there is an existential threat. The person worries about his or her own demise, or possibly not death but dying or disability. There may be a loss of social value for the person because of the suffering. Maybe the person has lost a long-held belief or faith in another person or entity. Suffering may be short lived or long standing and it may be continuous or intermittent. Suffering may become permanent as in PTSD, a prolonged illness, or a painful experience. Suffering takes so many forms that it would be difficult to describe all of them. Every individual experiences suffering in his or her . . .

December 15, 2017

By: Jon Templeman, BSN, RN

It’s likely that every nurse who has accumulated a few years of clinical experience can look back on interactions with various medical providers where he or she has gleaned some nuggets of wisdom while working for, or side by side, these providers. I occasionally collected these nuggets the best I could as I busily performed my duties as a new night shift nurse on a med/surg unit, and after two and half years of this, made the transition to home health care. The home health care environment made interactions with providers infrequent and thus, my gold nuggets were few and far between.

A year and a half later, I once again was ready for a change, and became a hospice nurse. Little did I know that I was not just going to get some nuggets, but was going to be entering the gold mine, in the name of Dr. Benjamin Ranck. Dr. Ranck was in the twilight of his career as a hospice physician, but he was clearly committed and passionate about educating staff, patients, and families alike while providing excellent care. I had the distinct honor of working alongside this wonderful man and learning from him for . . .

December 8, 2017

By: Roric P. Hawkins MBA, BSN, RN

In today’s nursing practice, varying opinions about how to best implement safe patient handling (SPH) programs exist. Some nurses offer suggestions based on personal experiences, which is both common and to be expected. Others are passionate and steadfast regarding the successful strategies they may have created.

Although these contributions are important as we move this injury prevention initiative forward, we must be cautious about our personal successes making us rigid in our thinking so that we begin to believe that our way of doing things is absolute. Nor should we allow our strong opinions to lead us to believe that all SPH processes should be standardized to be successful. Instead, we need to understand that others need the option to choose from our strategies and apply those that best fit with their practice situation. This approach also helps inexperienced SPH coordinators to develop decision-making skills related to implementing SPH programs: The more confident coordinators become, the more they learn to trust their abilities to make sound implementation decisions.

Stay flexible

Though it’s true that SPH programs are built on a foundation of evidence-based research that identifies how to reduce clinical staff injuries related to manually lifting . . .

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