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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.

September 18, 2019

By: Lisa DiBlasi Moorehead, EdD, MSN, RN, CENP

Earlier in my career, my nurse manager told me I was exhibiting signs of burnout. I was offended.

When I was oriented as a new nurse almost 40 years ago, we were socialized to be self-sufficient about everything. Asking for help was frowned upon and work environments weren’t the friendliest.

My manager was forward-thinking in raising the issue of burnout with me at the time. When I thought more about it, I realized I was becoming cynical, which is a classic sign of burnout. I was fortunate enough to be able to change my schedule and add more work-life balance. For me, any activity that makes me lose track of time—like crafting or reading—helps re-charge my batteries.

Every manager should keep burnout on the radar. According to a national nursing engagement report released in April 2019 by PRC, of the more than 2,000 health care partners responding to the survey, 15.6% of nurses self-reported feelings of burnout, with emergency department nurses being at a higher risk.The Joint Commission issued a Quick Safety on developing resilience to combat nurse burnout (jointcommission.org/assets/1/23/Quick_Safety_Nurse_resilience_FINAL_7_16_191.PDF). It lists some . . .

September 11, 2019

By: Pamela Lawson, DNP, RN

Upon graduation, nurses are expected to uphold professional standards, guidelines, and principles from the American Nurses Association (ANA). It’s paramount for nurses to understand how important it is for their safety andthe safety of the patients they are caring for in their working environment. Otherwise, they could face loss of licensure.

The threat of losing a nursing license is a devastating situation. Nurses are accountable for their actions to the patient. They must deliver care safely, know their scope of practice, and address situations beyond their competency. The goal is to provide care that results in best patient outcomes. Nurses can spend a lot of money for schooling and many hours of learning, only to lose their nursing license in an instant.

Nurses are responsible for the care they deliver to their patients, as noted in the ANA Code of Ethics for Nurses with Interpretive Statements. Given this information, why do nurses not follow theCode? Why don’t managers hold nurses accountable for the incorrect actions they perform? Why don’t nurses understand the severity of placing their license in jeopardy?

Nurses are being overworked, including assignments with a high acuity of patients, and some lack experience; this can . . .

September 4, 2019

By: Mary Costello, BSN, RN

Fresh off the boat was a term I’d heard once or twice amongst my former travels, usually referring to an immigrant who had recently arrived in a new country of chosen inhabitance. Fresh off the boat instantly became my joking term to explain my newfound situation to random UK citizens who felt the need to ask where I was from and when I arrived. Here’s a shocker: There aren’t many Americans working in London, or anywhere really outside of the United States.I was commonly asked, “Where is that accent from? Are you Canadian? Why did you come here?”
When asked why I came to London to try nursing, all I could really think to answer is that I came for the experience and to see what it is like living outside of the United States. I had travelled on my own a-plenty, to many countries around the world, so I wanted to know what it was like to live in one of them. London, UK just happened to be the easiest one for me, and lucky for me, I have learned why.
When you have a system of free health care such as in the . . .

August 28, 2019

By: Kimberly Dimino, DNP, RN, CCRN, and Maria Tabago, BSN, RN

“Nursing students have a responsibility to model civility and encourage respectful social discourse. Collaborating with faculty and taking a leadership role in co-creating classroom and clinical norms have a significant and positive impact on providing a safe, open environment to express diverse views.” ~ Cynthia Clark

I have been a nurse educator for 10 years and a clinical nurse for over 20 years. During my career, whether in clinical nursing practice, teaching, or in my research, I keep coming back to one concept: civility.

With my senior nursing students, I emphasize the importance of the “soft skills” when it comes to patient care. Nursing programs prepare them with all the “hard skills” they need; however, unpredictable clinical learning environments, incivility within academic and clinical environments, and the cultural assumption that nurses are supposed to suspend their humanity in order to be professional, can often leave them feeling lost. I see an important part of my job as teaching future nurses coping mechanisms and empowering them to speak up for themselves and for their patients.

I love to hear from former students, especially when they can talk about how they have applied the lessons learned in my class to the real . . .

August 21, 2019

By: Cally Graniero, MSN, RN, and Florence Graniero, RN

Healthcare professionals should know that most, if not all, patients have low health literacy, according to The Joint Commission. The U.S. National Library of Medicine notes that health literacy is the capability of the individual seeking medical care to recognize and comprehend “basic health information” in order to make safe decisions as a partner in care. Health literacy indicates a patient’s knowledge and abilities in arriving at informed healthcare decisions

Nurses need to be sensitive to the fact that many individuals don’t understand even the simplest medical information. In addition, older patients, who are at risk for increased health problems, also are most at risk for poor health literacy. This in turn can lead to poorer health outcomes including death.  The financial hardship of low health literacy as a result of frequent emergency department visits, hospital admissions, as well as delayed recovery and medication errors, is enormous and estimated to be in the trillion-dollar range, according to Scott.

Nurses can be leaders in improving health outcomes by identifying those with poor health literacy skills.

Warning signs

According to Smith, 77 million people in the United States lack basic health literacy skills. Warning signs are often subtle . . .

August 14, 2019

By: Marie Smith-East, PhD Candidate, DNP, PMHNP-BC, EMT-B

As nurses, at some point you may have provided discharge instructions or outpatient instructions to a patient that “this medication must be taken with food.” However, does the instruction just stop there? What else is instructed to patients when a medication must be taken with food? Take with a snack or take after dinner? What does this look like for your patient?

Some patients may not have the means to meet this requirement or even the appetite. Are examples provided? Some nurses may not be aware that for some medications the exact caloric requirement may make a difference in whether or not the medication works.

In my clinical practice of psychiatric nursing, there are two antipsychotic medications in particular that require a certain amount of calories in order to be effective. Lurasidone requires 350 calories. Another is Ziprasidone, which for any calories less than 500 results in variable symptoms. In other words, at 500 calories, absorption is increased up to two-fold in the presence of food, which results in less variable responses in patient symptoms. Standard guidelines when prescribing medications to patients can include increasing the dose if the desired effect is not achieved. However, with medications such as . . .

August 7, 2019

By: Fidelindo Lim, DNP, CCRN

Not long ago, I walked down a hospital corridor of a medical-surgical unit and found all the work stations on wheels (WOWs) flush to one side, with nurses sitting in front of a blank computer screen, tethered to their cell phones. The sight reminded me of a bumper-to-bumper traffic jam of single-occupancy cars descending into a tunnel. As I passed by, I saw a nurse maniacally trawling social media. On another cell phone screen, I saw a colorful display of footwear. The nurse was shopping for shoes too uncomfortable for a job that requires miles of walking! Nosy as I am, I asked, “What happened? How come everyone is in front of the WOW?” Someone curtly replied, “The system is down. We’re waiting for it to come back up.” It was 9:30 in the morning.

As I walked along, I thought, What if the system doesn’t come back up for hours? What if, for some apocalyptic reason, the system never comes back up? What would happen to nursing care? These seemingly rhetorical questions are worthy of consideration as the dominance of technology becomes intractable in healthcare. Computer literacy and technological dexterity are now . . .

July 31, 2019

By: Jennifer Chicca, MS, RN

“Wait for me in the breakroom,” Mikki, an ICU nurse of 17 years, said to me. I nodded and headed down the hall. It was my third shift in a row, so I was tired. I sat down in the breakroom and looked through the glass window to see Mikki in room 10 with Robin, the patient we had been passing back and forth over the last 3 days. Mikki tightened Robin’s wrist restraints.

Robin, who had been on our unit for over 2 weeks, was intubated because of respiratory failure. Her course had been complicated by a stomach ulcer that developed after her ulcer prophylaxis had been forgotten for several days. In the previous 2 days, we had tried continuous positive airway pressure (CPAP) trials to see if she was ready to have her breathing tube removed. Each day, she had failed. “Stop it,” Mikki firmly said to Robin. Then, though her wrists were tied to the bed, Robin punched the side rails. Mikki rolled her eyes as she headed my way.

Mikki entered the breakroom wearing her favorite fashion statement—skulls. Yes, skulls. She had skull earrings, a skull necklace, skull scrubs, and skulls on her shoes . . .

July 24, 2019

By: Donna Feinblum, BSN, RNC-LRN

Meaningful recognition is considered a simple form of feedback that may involve providing praise or simply saying “thank you”. This kind of acknowledgment not only encompasses the individual’s behavior, but also the impact that the specific behavior has had on other parties.

Organizations that support and encourage this type of recognition among their staff are considered to be more supportive, and the employees tend to feel more valued. Meaningful recognition is an essential strategy that supports a healthy work environment, engages the nursing staff, and, undoubtedly, impacts the patient experience positively. In attempts to provide a healthy workplace environment, as well as to foster staff engagement, healthcare organizations seek to implement programs and activities designed to nurture recognition and increase job satisfaction.

Implementing the DAISY Award for Extraordinary Nurses is a powerful way to recognize positive nursing experiences identified by patients, family members, and staff. This program, established in 1999 by the Barnes family, provides a straightforward, yet heartwarming, approach to recognizing the direct care nurse. After their son past away from an autoimmune disease, this grieving family wanted to say “thank you” to the amazing nursing staff that went “above and beyond” in caring for their son. The . . .

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 . . .

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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.