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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.

January 30, 2019

By: Eric Keller, BSN, RN

This time of the year is a busy time in the gym as most Americans find themselves replete with goals for the new year—mostly recycled from last year’s unsuccessful attempts like weight loss. As the days go by, fewer and fewer people find the personal resolve to take the next step, and the gym becomes less crowded. It’s difficult to realize and appreciate any progress in such a short time frame, and bad habits are hard to break. This creates an environment that often cuts a journey of a thousand miles into just a few misplaced steps, leaving the goal in an abyss and in an unreachable and mysterious state…until next year’s haphazard attempt.

Lao Tzu once said, “The journey of a thousand miles begins with one step.” This quote emphasizes the importance of small and humble beginnings towards accomplishing monumental goals. Whether learning to crawl, walk, or run, an individual must first find personal strength and courage to take the first step, regardless of how small and insignificant it is.

Each year people across the globe take time to celebrate a period of rebirth and exploration, setting goals and attempting to change their life . . .

January 23, 2019

By: Joseph L. Greene, MSN, RN-BC, CEN

I am not a religious man, although I have a system of beliefs. I do not always share my feelings at work, but at one point in my career, had allowed myself to develop an emotional callous in order to block out the negative experiences associated with working in an emergency department (ED). This is an occupational hazard, I suppose, but it enabled me to compartmentalize, adjust, and deal. Certainly, I’m not the only person with this malady, though at one point in my career it led to a cynicism that quickly approached burnout. That is, until I had my Miracle. Let me explain.

The ED in which I have worked for 17 years is very busy, and the population in the area continues to grow. The catchment area is many square miles, and at the edges it can be a 45-minute ETA to the hospital. Designated as a Level II Trauma Center, the ED is also Emergency Department Approved for Pediatrics by the Department of Health Services in Los Angeles County, and as such, we see 12,000 children a year. Very often, they come in quite sick. As any emergency nurse will tell you, when a . . .

December 19, 2018

By: Lisa Miller, BSN, RN, CCRN, CVRN

Have you ever wondered about a patient’s quality of life after receiving an organ transplant? We’ve all heard about the success of kidney transplants, but what do you know about lung transplants? Before I started working in the bronchoscopy unit, I didn’t know anything about these patients. I had never met or cared for a patient who had received a lung transplant in my 20 years as an ICU nurse. Based on my experience in the bronchoscopy unit, I’m able to share my perception of these patients’ quality of life after receiving a transplant.

Part of the postoperative care these patients receive, whether it’s a single or double lung transplant, is a bronchoscopy a few days before being discharged. This initial bronchoscopy is for surveillance purposes—to make sure there are no signs of rejection and to clean out any sloughed tissue at the anastomosis site. Patients usually have six to seven bronchoscopies at various times during their first year after transplant to make sure they don’t have any infections or any signs of rejection. I administered the sedation for their bronchoscopies, so I was able to follow these patients throughout their first year . . .

December 12, 2018

By: Eric Keller, BSN, RN

As the clock slowly pushed toward three o’clock, motionless hands grinding the gears that perpetuate the workday stood as a moribund reminder of each still moment. Like the last grains of sand in an hourglass waiting to fall, time stood completely still. Conversations with coworkers and small talk about life filled the void that time left behind. When the call came from the fire department that a full arrest was a few minutes out, everyone was ready.

Everyone took their place and found an intrinsic comfort in the chaos that swarms a code. Everyone but me, that is. I had not been in a code before and just completed my Advanced Cardiac Life Support (ACLS) training. The emotions crawled into every nook and cranny of my thought process, leaving me with doubt, anxiety, and hopelessness. As I aimlessly circled the room, looking for something to do…something impossible to mess up, I found myself lost in the moment. I tried to collect my thoughts and remember everything that I learned in class. That’s when the attending told his residents that nurses have more experience and training in codes.

In fewer than 5 minutes, I went from a confused . . .

December 5, 2018

By: Linda Slaven, BSN, BSN

Sometimes in life, when things appear to be going smoothly, in the blink of an eye, everything can change and your world is turned upside down. Security quickly disappears and is replaced with turmoil and anxiety. Reality becomes clouded with doubt and fear and there seems to be no relief in sight.

In 2001, all of this happened to me, when my husband, Bob, was diagnosed with Stage 4 Melanoma and my life changed forever. At the time, I was 35 years old, working full time, and raising my 2 teenage children. Suddenly, my predictable day-to-day routine turned into chaos, and I had no idea how to stop my world from unraveling. All I knew was that my husband was diagnosed with a very aggressive form of cancer, and I had to learn how to win the fight for his life. To stand a chance at defeating this disease, I must learn to behave like a lion, fierce and strong, in front of doctors, when inside, I felt like a lamb in need of protection and guidance. I know that people believe that we are only given what we can handle, but at this time of my life . . .

November 28, 2018

By: Cheryl Resha, EdD, MSN, RN, FNASN

My story began when I was 49 years young and told I had Stage IV colorectal cancer. That was almost 12 years ago, and today I am one of the fortunate ones—not only has it been almost 12 more years of living, but my oncologist has used the word “cured”. Like most cancer patients and survivors, I have endured a lot, but I also have much to be grateful for and have been able to express that gratitude to many throughout my journey. However, there is one group of people who may not know how thankful I am for them. That group is all of the registered nurses throughout my 12-year journey.

Like other significant dates in your life that you always remember, such as birthdays and anniversaries, September 5, 2006, will be forever etched in my brain as the day I was diagnosed with cancer. I had just completed my doctorate degree and was excited to enter a new career track. My primary care provider ran some routine blood tests in anticipation of my upcoming physical and to my surprise I was anemic. The series of tests and scans to follow were a whirlwind and then the . . .

By: Lillee Gelinas, MSN, RN, CPPS, FAAN

I cradled a very sick child with the flu in my arms this week and asked why the mother had insisted on her child NOT being vaccinated with the flu vaccine a month earlier. “It’s my right,” the mother replied.

The Texas (where I live) Department of State Health Services reported nearly 10,000 flu and pneumonia-related deaths duringthe last flu season.This is a spike of nearly 27% above of the previous year. The Centers for Disease Control and Prevention (CDC) reports that 80% of the children who died nationally were unimmunized or under-immunized. Since the flu season in Texas peaks between December through February, those of us in the caring professions are getting ready for the onslaught. How many more deaths do we need in 2019? Does this mother really realize the danger confronting her child?

I am getting tired of the lame tactics, rhetoric and politics aimed at swaying public opinion on the dangers of vaccines, while the innocent get infected and needlessly die from preventable illnesses, like the flu. Although the CDC reports low flu activity so far, the first pediatric death occurred this week. In Texas, the “opt-out” of vaccine policy . . .

November 27, 2018

By: Roric P. Hawkins RN, MBA, BSN

As mentioned in last month’s blog, which discussed importance of equipment selections, I stated a few points to consider before making patient-lift equipment purchases. This month I plan to carry the discussion a step further by focusing on why equipment ease-of-use and the manufacturer’s instructions for use (IFUs) are both relevant considerations for increasing the probability of staff choosing to incorporate patient-lift equipment into their everyday practice. I consider many factors when advising facilities which patient-lift devices will work best, and when it comes to achieving optimal injury prevention results, I focus on recommending changes that cause the fewest disruptions in everyday workflow.

Ease-of-use was mentioned last month in terms of complexity versus simplicity as an important consideration for selecting patient-lift equipment. The concept of ease-of-use encompasses not only how easy staff view the equipment is to operate, but also how it integrates into the clinical workspace. Both views contribute to the likelihood of whether staff will choose to use the equipment. In considering nurses’ approach to patient care, keep in mind that time is always a critical consideration for how caregivers prioritize their workday. Staff will feel . . .

November 21, 2018

By: Eric Keller, RN

A few years ago my wife came home and told me her car was stalling. I knew this was impossible, so I decided to drive her car just to prove her wrong. Trouble is, I proved something else. Her car did stall. It stalled on her and it stalled on me, and the only thing I managed to prove was that I wasn’t listening.

So I took the car to the mechanic and explained the story. But this time the roles were reversed—I became the person not believed. He wouldn’t listen to me. He drove the car and guess what happened…nothing! The car drove fine. So I did what any reasonable person would do: fired the mechanic and got a new car. Problem solved.

Can you relate to this story? Have ever been ignored like this? Whether it’s a mechanic, server, spouse, or a child? How did it make you feel? Does it feel good? Does it frustrate you or make you angry?

How can we talk about empathy, or appreciate someone’s experiences, or share their feelings, if we never take the time to listen to them?

Eleven years ago a 24-year-old . . .

November 14, 2018

By: Geraldine Mceachern, MBA, BS, RN

Is it incivility, horizontal violence, bullying, ageism, policy failure or racism? It’s difficult to comprehend the lack of compassion and humanness from one nurse to another. It happened to a nurse with a stellar reputation for over 45 years who was dedicated to her patients, profession, and staff around her.

One day this nurse was staring at the patient census board for longer than a couple of minutes.  Another nurse, who felt the action was “a bit off”, reported it to her nurse manager at the end of the shift. The nurse manager asked the nurse whose behavior was reported to sign for a drug screen. The nurse had no employee representation. Her immediate supervisor was not there, and no one followed the policy of the observation period asking this nurse if she had difficulty sleeping, was not feeling well, or if she was taking cold medications. Instead, she was made to believe if she did not sign the drug screen she would be fired. After signing, the nurse was escorted off the floor by security to an occupational health nurse who tested her for drugs and alcohol, all of which were negative.

Can you imagine the nurse’s . . .

November 7, 2018

By: Susan B. Fowler, PhD, RN, CNRN, FAHA

Imagine being stuck in a hospital room day after day, for as many as 21 days, not seeing or experiencing a change of scenery except for a stretcher ride to the radiology department. This is often the case for individuals suffering a subarachnoid hemorrhage (SAH) from an aneurysm rupture.

At the hospital where I work, we found that this difficult experience can be eased through brief excursions outdoors. I’d like to share our experience with you, so you can consider implementing something similar in your organization.

The challenge

An aneurysm occurs when part of an artery wall weakens, allowing it to widen abnormally or balloon out. When an aneurysm leaks or ruptures blood enters the subarachnoid space, which is the space below the arachnoid and above the pia, or covering of brain tissue. This is diagnosed as an SAH. Degradation products of blood can cause vessel and muscle damage resulting in severe narrowing or blockage of cerebral arteries. This is referred to as vasospasm, which can be benign or devastating.

Vasospasm may be manifested angiographically, clinically, or both. Vasospasm, or narrowing of the blood vessel, occurs 7-10 days after the hemorrhage, and spontaneously resolves after 21 days. Interventions . . .

October 29, 2018

By: Erika Lugo, BSN, RN, PCRN

As nurses we deliver crucial care to patients. We help to support families in times of distress, welcome new life into the world, and help provide care at the end of life. This fast-paced, high-stress environment can adversely affect our health and happiness. Practicing mindfulness can be a powerful tool to help us focus on what is truly important. By being more mindful and compassionate towards ourselves and our health, we can be more present and “in the moment” with our patients. As humans, we often react too quickly to situations, not thinking about the effects our actions and words have on others. Evidence suggests that mindfulness-based interventions and practices can benefit nurses both personally and professionally.

What is mindful speaking?

We all know that communication is the basis of any relationship and is of utmost importance in the nursing profession; however, the concept of mindful speaking is rarely discussed. Mindful speaking implies having the ability to speak to someone with awareness of what you are saying and the tone in which you say it. Mindful communication also involves listening and using nonverbal cues with kindness, compassion, and attention. Before speaking we should all ask ourselves three . . .

October 23, 2018

By: Roric P. Hawkins MBA, BSN, RN

It’s common for those who see demonstrations of mechanical patient-lift equipment to praise them as excellent tools.But when it comes to using this equipment in clinical practice, do these praises warrant such accolades?

Rarely have I encountered a patient-lift device incapable of performing to its intended specifications. Seldom have I come across a patient-lift device that I did not like. But as a safe patient handling (SPH) consultant, I’ve discovered that what’s more important than my preferences are the thoughts and perceptions of the staff I’ve asked to use these devices. Staff voices are key.

When implementing SPH programs, the overarching challenge revolves around the idea of inserting mechanical machines into settings that are intended to be nurturing and caring. It’s difficult for caregivers to find common ground between professional compassion and mechanical hoists/technology, especially because this level of innovation hasn’t previously existed in patient-care settings. Therefore, we need to ask ourselves: Are patient-lifts as good as advertised? Understand that if the purpose for patient lifts is to protect caregivers from injuries, then the answer is found within the beliefs and perceptions of the caregiver.

Listed below . . .

October 10, 2018

By: Name withheld by request

Editor’s note: This blog is a supplement to the continuing nurse education program “Suicide among nurses: What we don’t know might hurt us.” It illustrates how our unrealistic self-expectations as nurses can lead us down unfortunate paths. The author’s identity is not shared per request; unfortunately, there is still stigma associated with substance misuse. We thank the author for the courage to share this personal story and urge nurses to seek the help they need.

As one life ends another begins—a spiritual lesson and coping mechanism that I taught myself early on to ensure survival. Making sense of the tragic loss of life had always been challenging for me. I always thought it was quite ironic hearing “Brahms Lullaby” echoing from labor and delivery as my patient would take his or her last breath. Fresh life combined with one ending seemed logical to me. It is neutral, loss mixed with gain.

All nurses deal with life and the loss of life in different ways. My approach was effective. I witnessed and held the hands of many dying patients. I would cry, and I rationalized the loss. I would go home and hug my wife and . . .

By: Name withheld by request

Editor’s note: This blog is a supplement to the continuing nurse education program “Suicide among nurses: What we don’t know might hurt us.” It illustrates how our nurses colleagues too offer suffer in silence, reluctant to seek help. The author’s identity is not shared per request; unfortunately, there is still stigma associated with mental health issues. We thank the author for the courage to share this personal story.

Burnout, compassion fatigue, and lateral violence often coexistwith, or contribute to, depression in nurses. Untreated depression can lead to thoughts of self-harm and in the worst-case scenario, even suicide. This account describes my journey along the downward spiral of depression. It illustrates the barriers nurses face to get the help they need, and system issues that can exacerbate the problem.

I hope that my story helps humanize the issue of depression in nursing, so that we can begin to work as a profession to remove treatment obstacles and create preventive measures to optimize the health of our nursing workforce. When I became a nurse, I finally felt like I was a part of something bigger, better than what I ever was as an individual. I had an . . .

By: Arlene W. Keeling, PhD, RN, FAAN, president of the American Association for the History of Nursing

“ . . . Of all things in the world, the tuberculosis question is a social question and the causes of tuberculosis (outside of the bacillus) are social problems that need the ballot for their changing (such as bad housing, overwork, underpay, neglect of childhood, etc.). Take the present question of the underfed school children in New York. How many of them will have     tuberculosis? If mothers and nurses had votes there might be school lunches for all those children . . .”

— Lavinia L. Dock

 In 1908, Lavinia Lloyd Dock, a progressive era nurse and political activist for women’s suffrage, wrote to the American Journal of Nursing, admonishing the Nurses’ Associated Alumnae for its vote —“by a large majority” in attendance at the convention—against women’s suffrage. Dock went on to express her shock and humiliation that nurses could not be depended upon “to take instinctively the intelligent and above all the sympathetic position on large human questions,” and then used the example above, noting that there were, as we would say today, “social determinants” of disease, and how nurses could use the power of their votes (if they were allowed to vote) to change these conditions.

Lavinia Dock, who graduated from Bellevue in . . .

September 26, 2018

By: Roric P. Hawkins MBA, BSN, RN

As I prepare for my evening workout at the gym today, it’s more than likely that I will use weights greater than 35 pounds when performing various exercises. I’m no stranger to the gym (even though I don’t go as much as I should anymore), so my previous training, coupled with years of experience, has taught me how to use good judgment as well as execute proper body mechanics in effort to avoid and reduce the risk of injuring myself. Repetition has allowed me to feel confident that I’ll achieve the benefits associated with working out with barbells and dumbbells without hurting myself in the process. Besides, having lifted weights for over 25 years, I have been fortunate to not ever have sustained a severe injury.

Many of us approach going to work every day with this same level of confidence. We know that most of our patients will certainly weigh more than 35 pounds. Because we have been formally trained and have many years of experience to rely on, we are confident in our abilities to execute good body mechanics to avoid injuring ourselves. Repetition has allowed us to feel confident in the idea that . . .

September 14, 2018

By: Russell Griffin, LP, FP-C, and Paula Patterson, RN

Editor’s note: Griffin and Patterson share their experience with low-dose, high frequency CPR training.

Paula Patterson: I had been a nurse for more than 40 years when I had—for just the second time in my career—the opportunity to save a patient from sudden cardiac arrest.

It happened fast. After a successful procedure, my team was transferring the patient to post-op. I was finishing up my paperwork and preparing to turn my attention to my next case when one of my colleagues rushed into the room with a crash cart. Within seconds, I found myself on a stool next to my patient’s stretcher, beginning compressions to maintain blood circulation while his heart wasn’t beating effectively. The patient was revived in less than two minutes, confused, but on the road to recovery after his very near-death experience.

While I was thankful for this outcome and proud of the way my team had worked together in an emergency to save the patient’s life, I couldn’t help but compare the experience to the last time I had witnessed a cardiac arrest on the job. That patient had survived, too, thanks to the quick action . . .

September 4, 2018

By: Amil Tan, MSN, MHC, RN

Falls, typical incidents among older adults in the nursing home, are associated with debility, functional impairment, and mortality. Falls resulting in injury and medical complication have proven to be costly, and once the elderly fall, they develop a fear of falling again. This fear reduces movement adding the risk of developing a co-morbid condition such as pressure injury, pneumonia, and depression related to feelings of isolation. Falls thus affect the quality of life among older adults.

State regulation on elderly care mandates institutions to incorporate fall intervention programs into their policies. Nurses have an active role in assessing the risk of falls and implementing an evidence-based intervention to prevent and minimize the impact of falls among vulnerable individuals. Understanding current knowledge about falls in the elderly and evidence-based fall intervention and strategies can help nurses keep patients safe.

Falls in older adults

Falls are associated with multiple risk factors, including biological, behavioral, and environmental.

Biological factors can be older age, chronic diseases, low vitamin D level, urinary incontinence, gait and balance disorder, orthostatic hypotension, chronic pain, and altered sensory perceptions.
Behavioral factors include lack of exercise, fear of falling, feelings of anxiety, symptoms of depression, low self . . .

August 21, 2018

By: Roric P. Hawkins MBA, BSN, RN

Just this past week, I encountered two situations that I found to be interesting. The first has to do with recommendations suggested by a committee member in an organization for which I’ve consulted for some time. The second, similar situation happened in a class I was teaching for new hospital employees. Though different in context, both presented the same great take-home points that I believe are worthy of discussion.

Two scenarios

During a committee meeting to improve a safe patient handling (SPH)-related process, a prospective algorithm presented for consideration was rebutted by a well-respected senior leader committee member. In his refute, he explained how the process could be simplified if we were to consider product “A”for the initial patient transfer. He continued by saying that once the patient had reached their destination, then we could implement product “B”as the patient-handling device of choice, which would effectively conclude the patient-handling process safely. As the committee member was concluding his thought, I couldn’t help but think that what he was saying was not only absolutely correct, but that we both had seen this process work very well in other facilities. I also knew . . .

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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.