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.

June 11, 2017

By: Jennifer L. Farrell Burns, MJ, BSN, RN-BC

The December 2016 Gallop Poll announced that once again, nurses were rated the highest for honesty and ethics among professions for the 15th straight year! As we graciously accept this honor (again) and receive congratulatory “likes” on our Facebook posts, let’s discuss the Code of Ethics for Nurses (2015), presented by the American Nurses Association.

The Code of Ethics is the nursing professions’ document that expresses “the values, duties and professional ideals” central to the core of nurses’ behaviors (ANA, 2015, p. viii). The Code began as the “Florence Nightingale Pledge”, written by Lystera Gretter in 1893, and remained the informal standard until 1950 when the “Code for Professional Nurses” was adopted by the ANA Delegates. The Nightingale Pledge by Gretter reads;

“I solemnly pledge myself before God and in the presence of this assembly: To pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping, and all family affairs coming to my . . .

May 31, 2017

By: Roric P. Hawkins MBA, BSN, RN

There are two things that I have often thought to be consistent with modern day nursing program’s focus of emphasis: teaching students how to write state boards and preparing students how not to “kill” or injure someone when they first begin nursing practice. I’ve often reminded nurses of this because not only does it merit some truth, but also partly to solicit a laugh to certain truths that applies to most of our nursing experiences. Nevertheless, the reality for most professional nurses throughout our careers is that everything we’ve ever learned about nursing practice and taking care of patients was actually learned by showing up for work every day.

As I reflect on my earlier days as a nurse, not only was I nervous during those days, but recently it occurred to me that there was one other point of emphasis particularly stressful about learning how to take care of patients. It involved learning to time-manage. Being able to manage tasks so that all patients are cared for responsibly and timely require not only learning the task or the skill at hand, but also executing the steps within the process efficiently. As I gave this idea . . .

May 17, 2017


It’s a sunny spring day in Gothenburg, Sweden’s second largest city. It is a city, country I have grown to love and call my second home. I moved here for love nearly seven years ago and while it has not been without tribulation, I have been given a rare glimpse inside the work of a fully functional social democracy and the amazing benefits it has to offer.

I have just left my biennial mammogram offered completely free to every female resident over the age of forty. I received a friendly reminder in the mail that it was time again. I laugh to myself because it coincides with my birthday reminding me that I am in fact getting older. I arrived on time, was taken back by a friendly nurse, and was done within 5 minutes. I tried to pay, but the receptionist smiled and said, “no, it’s free.”

I feel so fortunate. I no longer worry in the way I did back home. I can see my primary doctor the same day with any issues. I sit here with a heavy feeling though-a guilt that wakes me sometimes at night. Sometimes I lie awake and think . . .

April 27, 2017

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

Ok, so let’s be honest, you were injured on your nursing job because you didn’t follow proper procedural techniques right? I mean, you’ve been taught how to lift, move, handle, position, transfer, and turn-and-reposition patients right?

For example, maybe when your new admission arrived in a wheelchair, you discovered he couldn’t bear weight, yet insisted on going to bed. You knew you needed help, but you discovered that not only were you tired because you were at the beginning of your third 12-hour shift, but the unit was short-staffed with no available co-workers to assist—undoubtedly because they were trying to overcome their own complex patient care dilemmas.

When you concluded your only option was yourself, you remembered that not only are you an invincible nurse capable of being prudent in all aspects of patient care, but you were taught proper body mechanics. You recalled that you are skilled, with the track record to prove it, so with minimum help from your patient, you could make it happen. After all, when it’s all on the line, it’s what you do; you are a nurse!

But now you find yourself . . .

March 31, 2017

By: Amanda Walk, RN

As a nurse, opportunities for growth and change are constantly at your fingertips. It’s easy to stay in your comfort zone and work as an expert within your field of nursing, but often times there are great rewards when you step into the unknown. According to a Career Builder Survey conducted in 2014, although 93% percent of nursing professionals are satisfied with being a nurse, 54% of nurses move to a new area of nursing at any point in their career. Most are hoping for a better life balance, increased pay, and different challenges. Whatever the reason, nursing is the perfect career to explore and find your perfect fit.

Many nurses can attest from personal experience or observing their coworkers, that switching departments multiple times is commonplace, sometimes because of changes in the local job market.

I always thought my forever job would be a charge nurse on a post-surgical unit. It didn’t take long to master the environment and the general expectations for each patient’s recovery journey. I enjoyed feeling confident, but I frequently thought about what other opportunities might ignite that fire within me; that same fire I felt after I first graduated nursing . . .

March 25, 2017

By: Nargis Abdelmessih, MSN, RN

Clostridium difficile (C. diff) is becoming a common microorganism in the healthcare systems and poses a catastrophic threat to the United States. It costs the healthcare system up to billions of dollars, leading to serious complications and higher mortality rates per Centers for Disease Control and Prevention (CDC). Caring for C. diff patients is becoming burdensome, time consuming, and overwhelming for nursing staff. It doesn’t just negatively impact patients, but also family members and organizations.

I have worked as a nurse for 16 years in hospitals, long-term care facilities, and as a hand hygiene observer in conjunction with the infection prevention department at the Ohio Hospital Association. During that time, I have seen healthcare workers walking out of rooms with C. diff patients without washing their hands. Once an infection prevention physician tried to argue the necessity of clinicians washing their hands, even when they didn’t touch anything in the room. More than once I asked different healthcare workers, why do we have to wash our hands when caring for C. diff patients and they couldn’t answer.

Earlier in my nursing career, I admit to the lack of knowledge on C. diff infection. At one of . . .

March 17, 2017

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

Have you ever been faced with a patient mobility challenge at the point-of-care when your patient had to be moved but moving the patient alone was not within your physical capabilities? In that instance, did you recall from your past experiences the various lifting options you maybe once applied in similar situations but was conflicted because of all the new information related to back injuries from manually lifting patients? The one time you actually considered using the patient-lift device located in the storage room on your unit, could you be confident that it was capable of addressing the mobility needs of your patient? What decision did you eventually make and would you make that same decision if a similar situation were to reoccur?

Choosing the appropriate patient-lift device, as well as having the appropriate equipment available, is necessary when seeking to safely address patient mobility challenges at the point-of-care. Having a preplanned solution before being faced with a patient mobility challenge would not only be ideal, but also beneficial to protecting both the patient and the caregiver’s safety. It would be helpful to include your patient’s mobility limitations as part of your . . .

March 10, 2017

By: Pamela Germinaro, BSN, RN

In 2004 President George W. Bush set forth a goal of all persons having electronic health records (EHR) within 10 years. This goal seemed unachievable at the time, and in fact proved to be so, although 90% of hospitals and 80% of private offices did have some form of EHR by 2014.

In 2014 President Barack Obama furthered the cause by including in the American Recovery and Investment Act that public and private healthcare providers must demonstrate meaningful use of EHR in order to receive Medicare and Medicaid reimbursement.

Now in 2017 President Donald Trump, according to FierceHealthcare, brings new challenges of safety and security regarding individual participation in providing personal details to health care providers. President Trump, by promising to repeal the Affordable Care Act (ACA) and the privacy protections it affords, as well as promises of deportation for immigrants and Muslims, is causing concern amongst healthcare providers that individuals may withhold important medical information for fear of repercussions. Developing concise and extensive EHR can help facilitate the appropriate care of individuals as well as allowing for data collection and research to improve care across the health care continuum. Patients’ rights to privacy regarding the release of demographic and . . .

February 28, 2017

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

On a hot summer evening during my recent post-doctoral dream cruise, I was preparing to relax and enjoy a show in the beautiful, fabulously-appointed lounge when, above the excitement and din, I heard the unmistakable, discordant sound of a human body hitting the marble floor. In fact, the dull thud of a head making contact with an immovable object was one any nurse would recognize. It was immediately followed by the sickening sound the cry of a young child that quickly grew from a whimper into a crescendoed, pitiful scream.

I instinctively jumped from my seat and ran in cartoon-esque fashion to the back of the lounge—my legs seemed to be moving faster than my body. As if in slow motion, however, I noted the bewildered stares of my traveling companions in the seats around me. Before the first “where are you going?” reached my ears, I was already at the back of the lounge and at the side of a very young boy who was now holding his head and staggering to get to his feet. “Please don’t move. I am a registered nurse” I told him and the small group of people standing . . .

February 17, 2017

By: Marcy Hanson, MN, RN

Our foster care system is in dire straits. According to the Department of Health and Human Services, in the United States alone, over 400,000 children are currently in care and over 100,000 of those children are waiting for permanent adoptive homes. While the numbers are staggering, so are the long term and lasting psychiatric and mental health concerns that often follow these children through the system. One of the most common consequences of early trauma and a journey through the foster care system is often misdiagnosed or underdiagnosed posttraumatic stress disorder (PTSD) and anxiety.

Typically we think of PTSD as associated with veterans or those who have lived through war, but we often forget the complex, interpersonal trauma that is often experienced by children within the foster care system. Trauma such as separation and loss, as well as various forms of abuse or witnessing violence, can lead to PTSD. Unfortunately, children who have survived trauma often are left without the appropriate coping mechanism to battle their inner distress. As such, these hurting children often display behaviors that are linked to diagnosis of ADHD, conduct disorder and oppositional defiance disorder as opposed to PTSD or even anxiety.

As a . . .

December 6, 2016

By: Jill E. Toledo, MSN, RN, CPON

When a cancer diagnosis is made, we as providers do everything possible to start treatment immediately. Often times we can overlook the value of reproductive health counseling, as we are focusing on providing swift interventions. Under certain circumstances it’s possible to delay starting treatment so the patient can explore fertility options. Under other circumstances treatment initiation can’t be delayed. In those instances we must provide information about fertility after cancer treatment and allow patients to explore fertility options when treatment completes.

As providers we must be mindful that the discussions should begin as close to diagnosis as possible. It’s believed that these discussions should also occur regardless of whether the treatment will affect fertility. Klosky notes that inclusion of fertility topic as part of patients’ treatment plan can alleviate concerns about infertility, encourage safe sex practices during treatment and promote future discussions. In addition, it’s important to realize that when patients lose their fertility it can lead to psychological distress which includes grief, depression, anxiety, anger, frustration and regret.

Some topics of discussion include contraception during treatment, sexuality for both males and females, ethical/legal concerns and even adoption and surrogacy. It’s important to recognize . . .

November 3, 2016

By: Aileen Cassada, MSN, RN, NREMTP

Recently I had the opportunity to assist on a medical mission trip to Honduras. Here I share my experience to help others who might be interested in serving on missions.

About Honduras

Honduras is the second poorest nation next to Haiti in the Western Hemisphere. According to the 2013 statistics over 64% of the population is below the poverty level and 54% of households are in extreme poverty averaging a daily income of less than $1.25. Another horrifying statistic is that 23 out of 1000 children 5 years and younger will die due to sickness and malnutrition.

Obstacles in gaining access to healthcare for the people of Honduras include the great distance people have to travel with too rough of terrain, lack of funds to purchase such items, and limited medical resources throughout the country. The closest hospital in San Pedro Sula is 76.39 kilometers from the nearest city Pena Blanca, which can be more than an hour travel with a vehicle through rough terrain down the mountainside. Over-the-counter medications are almost unattainable for many of people.

Arriving at base

The team from the United States consisted of a physician, nurse practitioner, two RNs, two EMTs . . .

October 19, 2016

By: Jan Vander Luitgaren, RN

What is good health? The absence of disease? What is wellness? The ability to function optimally? These are some of the things I am going to discuss in this blog, as well as give you some simple tips to achieve health and wellness in your life.

I always wanted to be a nurse since a very young age and I was so thankful to get to achieve that goal. I always thought it was a privilege to help others at those times when they really needed someone. It became apparent to me not far into my career that many of my patients didn’t always want to or know how to take good care of themselves. Was this just part of their personality, was it partly due to how they were raised, or was it just a lack of desire?

On my journey to figuring out wellness for patients I decided to start with myself. I wanted to see what brought me good health. At the time I didn’t really understand how good health and wellness of mind, body, and spirit are two different things. So I did the usual. I exercised a lot, ate as healthy as I . . .

October 11, 2016

By: Sara Bell

If you have a mental illness, you may be at greater risk for both substance abuse and addiction. If you have an addiction problem, you may be putting yourself at risk for developing a mental illness. These two conditions all too often go hand in hand, feeding off of each other and endangering those who are struggling with them.

Treatment is the best way to either prevent these co-arising issues or recover from them but, of course, that requires detection and recognition of the problem. Here is a short overview on addiction, mental illness, and how you can recognize an at-risk loved one.

Self-medication is a major perpetrator

In people with mental illness, particularly untreated mental illness, self-medication is a common issue that tends to result in addiction. Self-medication is the abuse of a substance in an attempt to control the symptoms of an illness.

When a person abuses an addictive substance, they may believe that they are reducing their symptoms when in actuality they are making them worse. Substances may dull symptoms for a short time, but when the high has ended, they will come back worsened with each use. These worsening symptoms then . . .

September 22, 2016

By: Jennifer J. Brokaw, RN, WCC, OMS

Nursing is the largest medical profession in the world with nearly 4 million nurses in the United States alone. As such, nurses have the potential to profoundly influence policy and politics on a global scale. In fact, it is the moral and professional obligation of nurses to be engaged in legislation that impacts their patients. When nurses influence the politics that improve the delivery of healthcare, they are ultimately advocating for their patients. Unfortunately, nurses have historically had little involvement in policy that affects healthcare delivery.

There are several reasons for the limited nursing participation in policy and politics. Lack of awareness, inadequate skills, and little opportunity for involvement are just a few factors. Another barrier is the limited formal health care policy education in nursing. Time and resources are further obstacles to the nursing profession’s participation in politics. Additionally, studies show that nurses are not given sufficient support to generate the evidence needed to influence healthcare policy.

Regardless of the multiple factors limiting the nursing profession’s potential impact on politics, the fact remains that nurses are vital to the development and implementation of healthcare policy. As the largest medical profession in the world, nurses should be leading . . .

September 15, 2016

By: Lori Boggan, RN

I learned at an early age to help those in need. I had amazing role models. My parents always welcomed our friends into our home and treated them as their own. They never questioned the friends who came hungry and ate double, sometimes triple portions. They allowed them to stay days, weeks, months if needed. While I had no idea at the time that I would become a nurse, the blueprints were already laid for me.

I moved to Sweden over 6 years ago. In that time, the unrest in Syria has unraveled and destroyed or displaced millions. It was on a sunny summer day in 2013 in the southwestern seaside city of Gothenburg that I witnessed desperation, helplessness, and trauma on a scale I had never before seen. I was interning in a refugee clinic that screens some of the average 50,000-100,000 asylum seekers a year coming to Sweden. Sweden offers housing, food, clothing, and education to asylum seekers entering the country. The interviews were scripted, the tests routine, but there was nothing routine about it.

Our first patient was a young woman from Syria. With a translator at her side, we began the interview. Where . . .

September 7, 2016

By: Jennifer J. Brokaw, RN, WCC, OMS

Mrs. Anderson is a well-spoken, poised black woman with a flawless face. She is surrounded by silk-encased pillows and is wearing a tasteful dressing grown with a coordinating turban on her head. She is not at all what I was expecting when I entered her room to perform a skin assessment for pressure injury risk. She doesn’t even look like she needs to be in the hospital. But I soon discover why she scored so low on the Braden scale when I ask her to reposition herself in bed.

“I’ve had over a dozen operations.” She tells me. “It is very difficult for me to move because of the pain.” And under her dressing gown I see multiple keloid scars crisscrossing her abdomen. She points out each one and recites each procedure that resulted in the hypo-pigmented, raised cords of tissue. I assist her as she slowly turns to her side to allow me to continue the head-to-toe assessment. I find more keloid scars running up and down her spine.

I complete the survey of Mrs. Anderson’s skin without finding any pressure injuries. But I educate her on the importance of frequent . . .

June 15, 2016

By: Barbara Pinchera, DNP, ANP-BC

Do the clothes nurses wear at work define their identity as a professional? Currently, the traditional white uniform is rarely worn in the clinical setting. For the nurses who equate this uniform with part of their professional identity, this is disheartening. There are many contributing factors to this trend, including portrayal by the media of a white uniform as a sex symbol. At a recent pinning ceremony a new graduate nurse was ridiculed by a faculty member for wearing her mother’s nursing cap. She was told that the cap and white dress made her look like a “porn queen.” While this behavior on the part of a faculty member is reprehensible, it highlights the fact that the traditional white uniform, worn proudly by many registered nurses is no longer universally recognized as a symbol of caring, compassion, wisdom, experience and professionalism. It is important to the nursing profession that nurses present a professional appearance and recent evidence suggests that some patients and nurses view the white uniform as a symbol of professionalism. Perhaps it is time to reconsider this concept; the white uniform provides patients with a consistent, easily recognizable visual symbol of the nursing profession.

For some, putting . . .

June 1, 2016

By: Allison Moreno, BSN, RN

Editor’s note: This is an excerpt from the book Nursing Is Caring, by Beverly Wheeler, MSN, RN, ACNS-BC, clinical assistant professor in the school of nursing at the University of Texas Health Science Center in San Antonio. The book contains stories from nursing students; 100% of royalties go to the University of Texas Health Science Center at San Antonio, School of Nursing Scholarship Fund.

I have had many experiences that have solidified for me why I chose nursing, and confirmed for me that I indeed made the right decision. One particular patient stands out in my mind as I reflect. Early in my nursing school career I had a patient who was suffering from a chronic wound that was infected and required packing. She was very nervous about how she was going to take care of her wound at home. She had no way to pay for her hospital stay, and she was being discharged before she really felt ready. I have to admit I was concerned for her to go home as well because her wound was on her coccyx and there was truly no way she could pack it and change the . . .

May 25, 2016

By: Donna Cardillo, RN, CSP

You don’t need a rigid schedule or even a lot of time to get each day off to an energetic and healthy start. Try a few of these quick and easy tips to improve your vitality, your mood, and your well-being. These tips are also great to try any time of the day for an extra boost of energy.

1. Drink a glass of water.

It’s not unusual to wake up dehydrated after not consuming any fluids for eight or more hours during sleep. Drinking eight to 16 ounces of water first thing in the morning rehydrates you, keeps your brain alert and operating at its best, and helps keep your body functions running smoothly.

2. Move your body.

If you don’t already have a morning exercise routine, at least move for a few minutes to get your blood circulating, your muscles and nerves fired up, and oxygen pumping to your brain and lungs. Marching in place while brushing your teeth, dancing to the radio, or going up and down a set of stairs a few times should do it. Play some upbeat music while you move to make it more fun and energizing.

3. Do . . .