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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.

June 27, 2018

By: Roric P. Hawkins MBA, BSN, RN

When most of us entered nursing practice, we recognized that lifting patients is an acceptable part of the job responsibilities, but rarely did we think of it as an occupational hazard. Before we started our professional careers, we understood that our patients would require some physical assistance from time to time, but never imagined that lifting could lead to debilitating career ending injuries.

It often amazes me to what extremes nurses are willing to go in care of a total stranger. There seems to be something in our professional DNA that transforms our mindsets once we’re assigned to the care of another human dressed in a hospital gown. Having been away from the bedside for some time now, when I look back it’s hard to understand why we allow people dressed in hospital inpatient attire to drive us to assume unnecessary injury risks when providing them care. We rarely consider ourselves to be victims of our own circumstances, yet we consistently jeopardize our most important asset, which is needed to competently perform our professional duties, our health.

Recap

As we pick up where we left off last month, the nuclear medicine department within one of my organizations was . . .

June 20, 2018

By: Leon Chen, DNP, AGACNP-BC, CCRN, CEN, FCCP

In 1976, Dallas police officer Robert Wood was shot and killed during a routine traffic violation stop. For 12 years, the killer remained at large while an innocent bystander by the name of Randall Adams was wrongfully convicted for the murder and was at one point sentenced to death. In 1988, a documentary about the case resulted in public outcry for a new trial. Multiple inconsistencies during the process of the trial were noted, and in 1989, the Texas appeals court granted Mr. Adams a new trial. Shortly after, he was released and all charges against him were dropped.

The actual murderer of the police officer was later executed for committing another unrelated murder. In a way, this documentary was the predecessor of later popular true crime documentaries such as “Making a Murderer”, “The Jinx”, and “Evil Genius”. During the initial murder trial against Adams, the prosecutor commented in his closing argument that the police are the “thin blue line” separating society from anarchy. The released documentary therefore took this line as its title. While the prosecutor did not create this phrase, the documentary did popularize it, and it’s now closely associated with the important role our police force . . .

June 12, 2018

By: LaQuana L. Smith, MSN, RN-BC

Communication is an exchange of information between two persons—a sender and a receiver. But it doesn’t end there. Feedback is an essential component because it closes the loop of the communication process: It validates how effective communication is and confirms exactly what is interpreted during the exchange of information.

Effective communication can be challenging, but some simple strategies can boost your chances of success.

Value of communication

Communicating with patients is often complex; each patient usually has multiple healthcare providers involved in his or her care. Effective communication is necessary to provide a positive benefit for patients. Communication with patients can help build a rapport, involve patients in decisions, reduce their anxiety, and increase their adherence, cooperation, and satisfaction. Ineffective communication contributes to poor outcomes, decreased quality of care, medical errors, and psychological stress for patients. It can cause them to feel unsafe and uninformed and to perceive staff as being inexperienced, incompetent, or unknowledgeable.

Effective communication is an important component of quality patient care. In acute care, there are specific communication questions used in reporting quality indicators. For example, there are questions about communication with nurses, communication about medications, communication about pain, and communication between the healthcare . . .

June 5, 2018

By: Eric Keller, BSN, RN

Thoughts crash in my mind, like a storm brewing in an endless sea of desolation fueled by anxiety and fear. It’s my first day on my own as a nurse—a day of reckoning. It’s a day I will remember for the rest of my life, one that I have been looking forward to with excitement and bewilderment. The anticipation leaves an unquenchable emptiness in the bottom of my stomach, causing my thoughts and emotions to take an uncharted journey through hopelessness and helplessness. Each minute of the shift is wrapped up in anticipation like a gift, waiting to be carefully unwrapped and enjoyed. The moments elicit questions not answered during orientation. I feel like a lone wave in the sea brewing into a storm.

I tried to rest on the eve of my first shift, but dreams of potential errors and mistakes kept me awake. As I tossed and turned, I forced my eyes closed, hoping the dreams would pass. Instead, my dreams became more realistic, and the line between fact and fiction slowly blurred until I was clocking-in and taking responsibility for the care of my patients—alone. I fumbled through simple tasks that were . . .

May 29, 2018

By: Roric P. Hawkins MBA, BSN, RN

As I recall one of my first experiences as a safe patient handling (SPH) consultant, I’m reminded of an unlikely department that introduced me to workplace injury prevention and ergonomic assessments. Although a high-flow patient care area, it’s an area that probably in most circumstances would not make it onto a SPH coordinator’s initial top list of priorities. But as fate would have it, the department manager made it a point to seek me out because she was told that I was being paid to develop solutions and that her department was definitely in need of an injury prevention solution. In her frustration, she also told me that she expected to get her money’s worth and that I needed to “make something happen”.

The problem

Always up for a challenge, I immediately recognized the manager’s frustration and addressed it by inviting her to the hospital café for a cup of coffee. The conversation was casual and non-threatening. Once the manager was comfortable, she began to open-up and provide details that were eye opening. As she began to explain what had been going on in her department, she talked about how for weeks . . .

May 22, 2018

By: Jon Templeman, BSN, RN

Memorial Day is one of those holidays that seem to welcome warm weather, barbecues, and time with family. For me and many others, Memorial Day also brings up memories of those who are no longer with us because they gave their lives in service to our country. We rely on Memorial Day and Labor Day to bookmark our summer seasons, but for my fellow Marines and me, these two holidays will forever be inextricably connected to what happened on September 4, 2000.

That Labor Day morning, I was serving as an airport firefighter in Yuma, Arizona. Hours before millions of Americans would start firing up their grills, and a year before the twin towers of the World Trade Center would fall, changing our country forever, a sudden event that matched the trauma of 9/11 for those of us involved would occur. This event would not only take a life and destroy careers, but it would ultimately shape my nursing practice in ways I am just recently realizing.

I was the junior Marine on my truck, with a crew of four, having arrived from the fire academy about 3 months earlier. We were eager to quickly check out our trucks . . .

May 14, 2018

By: Emily Matheson, DNP, CRNA, ARNP, CCRN

During my 8 years as an RN, I’ve had the opportunity to precept several nurses and student nurses. After the students graduate and start their careers, I continue to connect with them to learn about their experiences. I often hear the same myths about expectations of being a nurse. Usually, new nurses compare their situation to these myths and feel like they are alone. But they need to know that they’re not alone. It’s time to address these myths and prepare nurses to have satisfying careers. Both new nurses and experienced nurses can benefit from understanding the realities behind the myths.

 

Myth 1: I am going to love nursing from day one on the unit. While I hope that this is the case for everyone, it’s not always the reality. Nursing school rigorously prepares us to be competent nurses. However, part of being a nurse is critical thinking and understanding the value of your role, which can take years to develop. I often hear from new nurses that they aren’t as happy as a nurse as they thought that they would be. The bedside is not what they expected. Many consider other careers or . . .

May 4, 2018

By: Joan M. Creed, MN, RN, CCM, University of South Carolina

Even though nurses are part of a caring profession, some of them bully new graduate nurses. About half (48%) of new graduate nurses fear they will be a target of bullying. Bullying and uncivil behaviors negatively affect the new graduate, the organization—and the patient. Here is how bullying affects new graduates and resources they can use to survive the experience.

Bullying burden

The American Nurses Association defines bullying as “repeated, unwanted, harmful actions intended to humiliate, offend and cause distress and includes hostile remarks, verbal attacks, taunts, threats, intimidation, and withholding support.”

New graduate nurses who are bullied experience both psychological and physical symptoms. Common emotions include an increase in anxiety, depression, and stress leading to emotional exhaustion. It’s already known that new graduate nurses have significant emotional exhaustion, with one study reporting 66% as having high levels.

Without their normal emotional equilibrium, new graduate nurses may feel less confident and question their clinical skills and abilities. They can feel undervalued, inadequate, and neglected. Feelings of moral distress may occur where they feel they aren’t able to provide the best care for their patients. Low job satisfaction may result with feelings that professional growth is limited. They . . .

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 . . .

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