By Vickie Milazzo
A huge thank-you to everyone who took our survey “Are You Way Too Stressed Out?”
A remarkable 3,312 of you took the time out of your busy day to complete the survey, and this high response rate highlights the seriousness of this issue to the nursing world.
The results of the survey reveal the dangerous levels of stress that RNs pervasively live with, both at work and in their personal lives. Lack of sleep, 12-hour shifts, night shifts, poor diets, unrealistic workloads, lack of authority at the workplace and unsupportive management are just some of the key contributors to the stress being experienced by RNs today.
RNs are neglected by a system that overworks, under-appreciates and marginalizes the experience of individuals who are the most connected to patients.
Respondents had the opportunity to answer the question, “What are some of the things that stress you out the most?” Many of you were brutally candid, and I cringe at what you continue to put up with on a daily basis. These five responses are representative of the thousands received.
“People who have never done your job telling you how to do it. People who have lost sight of the patient — the focus is the $$.”
“Not having the authority to take care of the things that need to be done, but being responsible for it.”
“Long hours (12-hr shifts), working nights, poor pay, poor benefits that are dependent on maintaining hours to prevent losing the benefits, lack of PTO to cover sick/vacation days.”
“Overwork with no relief in sight, working for $3 to $5 dollars less than average city wages …”
“Corporate chaos, lack of support, unrealistic expectations, being put in possible license jeopardy due to corporate greed and mismanagement.”
The system is broken! The very people treating patients are sick and in need of healing themselves. This is crazy.
The stress placed on RNs is eventually going to cause many of them to quit. Our nursing system is already grappling with an aging workforce and an aging general population. While the nation will need an increased number of RNs, we’re likely hurtling toward a nursing shortage. Stress leads to mistakes and errors, and hospital errors are already the third leading cause of death in the U.S. Put it all together, and we may be headed for a national healthcare crisis.
This is a report you will not want to miss. Download the full PDF report below and click through the SlideShare presentation, and share your own experiences with stress as an RN in the Reply section below. I want to hear from you!
Download the Report
View the SlideShare
By S.L. Page
ESFP personality types are very compatible with many areas of nursing. As an ESFP, you’re full of energy and a zest for life. You genuinely enjoy being around people, and you are a true people-person. In fact, some people call your type the “parties,” as you always seem to be looking for a new social event to attend. When there, you can talk for hours and you enjoy being the center of attention. Other personality profiles refer to your type as the “Entertainer” or “Artisan.”
ESFP Overview: What is an ESFP Personality?
An ESFP is one of the main 16 personality types. An ESFP will have scored the following dominant characteristics on a personality assessment: Extroverted (E), Sensing (S), Feeling (F), and Perceiving (P). The breakdown and description of each of these dominant characteristics is listed below:
Extroverted (E): As an extrovert, you enjoy a lot of external stimulation. You love hanging with friends, meeting new people, or engaging in external things that stimulate your mind. When you’re isolated for too long at home, you’ll soon begin saying to yourself, “I’ve got to get out of this house!” In fact, you may say that after only one day alone at home!
You probably have a wide circle of friends, and you love getting together for a meal, hanging out, or just striking up a conversation with a random person. Because extroverts tend to enjoy talking and engaging in social situations, they often get labeled as “social butterflies.” You may have even been called a “people person” or “outgoing.” In fact, introverts sometimes get a bad rap due to extroverted people, as people often quip, “Why does that introvert keep to themselves so much? I wish they were more talkative and outgoing.”
You probably dislike writing or reading too much, and you’d much prefer to pick up the phone and make a call as opposed to writing an email. Some extroverts loath writing, although not all feel this way. Some extroverts make great writers, but most prefer face-to-face communication if given the choice. Some extroverts tend to have difficulty expressing their ideas in written form, as their minds are wired to work while engaging. ESFPs can spend a lot of time text messaging contacts, however, because they love to keep up with their friends and acquaintances.
Being an extrovert doesn’t mean that you dislike alone time, it’s just that it tends to suck the life out of you after a while. You get energized and feel most comfortable around other people, especially many friends or family members.
You think better while talking, as opposed to writing or thinking alone. In fact, some of your best solutions or ideas have probably come to you while talking to others. You also tend to blurt out the answer if asked a question. In contrast, introverts hate being put on the spot, and prefer to mull over a question before replying.
Sensing (S): As a sensing person, your mind tends to think of more rigid “here and now” concepts. You generally tend to think about the “what ifs” only rarely. You tend to notice minor details that other people may overlook. In fact, some people are quite shocked at the fact that you can sometimes make really keen observations. This can be a big benefit in nursing, as you may notice that a patient suddenly doesn’t look so well.
To illustrate how a sensing person things, consider an example of a large container sitting on the edge of a counter. You would probably look at the large container of fluid and think, “That’s an interesting color. I wonder what this fluid is?” You may also examine the lettering used for the logo, and so forth. You’d probably read the details on the packaging and think about those things.
This type of thinking is in direct contrast with people who have the “intuitive” characteristic. Using this same illustration, an intuitive person may look at the same container you looked at and think thoughts like, “That may fall down. Then it could make a mess. Someone could slip and fall and hurt themselves. We could even be sued.”
That’s not to say that sensing people can’t have moments of intuition, or that people with intuition won’t see more concrete details. But generally speaking, sensing people are very in-tune with details and facts, and tend to not think of the possible scenarios that could happen.
Feeling (F): As a person with the “feeling” characteristic, you have a strong inclination towards considering how things may affect people or society. When considering a decision, you tend to think of how other people may react, or how other people may be impacted by the consequences. As a result, people (or society in general) can be a big part of your decision making process. This can be a good characteristic to have as a nurse dealing with patients whose lives may be greatly affected by your actions.
Feelers have a very deep and empathetic heart to help people, and they genuinely care for others. If someone asks you how their new haircut looks, you’ll likely be very polite and try to focus on the positives to avoid hurting their feelings–even if the haircut looks terrible.
As a feeler, you also tend to have a strong need for happy relationships, both with yourself and people around you. If people aren’t getting along, it will tend bother you quite a bit. You’re a happy-go-lucky person who enjoys keeping in good standing with people. You also tend to have a natural affection for animals or pets.
This characteristic is in contrast to the “thinking” characteristic, in which people tend to make decisions based on logic, facts, or truth.
Perceiving (P): As a person with the “perceiving” characteristic, you generally like to live life in a care-free manner. You usually don’t like to make extensive plans, and you prefer to just “wing-it.” You tend to be very adaptable to any given situation. This adaptability and spontaneity gives you a reputation of being a fun and exciting person to hang around.
You are likely to live a somewhat disorganized life, at least internally. You probably have a relatively messy or unorganized home or office space, although this is not true for all ESFPs. This personality characteristic is in contrast to the “judging” type, in which people tend to live in a more organized and controlled manner.
You also tend to procrastinate with deadlines and tasks, but will get a burst of energy when something has to be done. Some ESFPs have a wild side, and are sometimes referred to as “daredevils.” You may enjoy activities such as skydiving, rollercoasters, surfing, or other similar activities that give you that “thrill.”
Nursing Career Possibilities for ESFPs
You are a fun and entertaining “people-person.” You like to live life in a fun-loving way. This can help you quickly and easily connect with patients. You also have the ability to focus on details, and you can easily empathize with other people’s problems. As you make decisions, you ponder how they may affect other people. This means you are likely to keep your patients best interests at heart.
For this reason, there are many areas of nursing that may appeal to you. Floor nursing, pediatric nursing, ER nursing, and other exciting areas may be of interest. For ESFPs who have a daredevil side, you may also enjoy flight nursing. Being a camp nurse is also a good possibility. If you have a strong faith, Parish Nursing may also be a good fit, as you’d love interacting with people on a spiritual level.
There are a few pitfalls you’ll want to avoid on the job. First, ESFPs tend to dislike having to do routine tasks. You like to be stimulated in your environment, and if you have to do dull tasks, you’ll get bored quickly. You also dislike having to read long documents or write reports.
Another area of frustration for ESFPs is working alone. You enjoy the company of people, and if confined to an empty office all day, you’d probably get very exhausted. You get energized talking and engaging with people. You enjoy team settings.
You dislike organizing things due to your spontaneous nature. You like to experience things in real time, and you don’t like to ponder the “what-ifs” in life. You also may struggle clocking in on time.
Possible Nursing Career Matches for ESFPs
- Home Nursing/Private Duty Nursing
- ER Nurse
- Parish Nurse
- Hospice Nurse
- Travel Nurse
- General Floor Nurse
- Ambulatory Nurse
- Pediatric Nurse
- Flight Nurse
- Camp Nurse
- Oncology Nurse
Are You an ESFP? Share Your Input
What areas do you hope to work as an ESFP? What jobs have you loved? What jobs have you hated? Please consider sharing your experience in the comment section below, as this may help other ESFP nurses in their careers.
BY SCRUBS CONTRIBUTOR
Ah, the dreaded night shift. Every nurse will have to encounter it at some point in his or her career. Some enjoy the more patient-based shift with its lack of administrators and clerical work, while others never can get into the rhythm of being a night owl.
If you’re a nurse on the night shift, chances are you have plenty of non-medical professional friends who won’t keep the same schedule as you. So how do you keep a normal social life while you work the night shift? Check out these five helpful tips:
1. Plan ahead with your non-work friends. If your shift is starting at 7:00 PM, for example, you could realistically have time to meet them for dinner an hour or so ahead of time. The night shift might remove some of the spontaneity of your social life, but it doesn’t have to remove time for fun and socializing.
2. Limit your caffeine intake. It can be tempting to consume cup after cup of coffee to get through those long shifts, but it’ll throw your sleep rhythm off even more and cause you to have to miss out on social functions with friends and family during days off.
3. Treat the switch to normal sleeping hours like jet lag. Take short naps at first to store up some energy and then power through the day until it’s time for bed. This will quicken your transition back to a normal sleep schedule. Try making time for non-work friends the day after you’ve adjusted back to normal sleeping hours.
4. Group your night shift days together. This will assure that you can have longer stretches of days off or daytime shifts. That leaves plenty of time for recreation, fun with friends, errands and time with family, but it’s also better for your overall health!
5. Get to know your coworkers! You’re spending so much time with them at odd hours, so you might as well establish trust, rapport and friendship. Try and bond with them socially and professionally. For example, if you like exercising, invite them to go on an early morning hike or to a workout class with you after the shift ends; if you are a coffee nut, see if they want to grab a cup at a nearby café. You can also bond professionally by trying to coordinate procedural training, or going to conferences and professional development events together.
The night shift doesn’t need to kill your mood, routine or health. Treat it seriously, plan accordingly with your shifts and keep a positive outlook so you can make new friends and keep up with those outside of your professional circle!
By Joan Raymond
Today's expectant moms and their doctors have decided it's not nice to fool Mother Nature. Rather than inducing labor, they're letting nature take its course, with the length of pregnancies in the U.S. on the upswing, according to a new study by the CDC.
The study released Wednesday tracks labor started through surgical or medical means during the years 2006 through 2012. The researchers found that induction rates at 38 weeks — once considered full-term gestation but now called an early-term gestation — declined for 36 states and the District of Columbia during this six-year period. Declines ranged from 5 percent to 48 percent.
Geography didn’t seem to matter. Thirty-one states and the District of Columbia posted declines of at least 10 percent. The researchers did find that trends in induction rates at each week from 35 weeks, considered late pre-term, to 38 weeks, varied by maternal age. At 38 weeks, though, induction rates declined for all maternal age groups under 40, dropping 13 percent to 19 percent for women in their 20s and 30s.
This is a sharp reversal of trends tracked from 1981 through 2006 in which the proportion of babies born at less than 39 weeks gestation increased nearly 60 percent, while births at 39 weeks or more declined more than 20 percent.
“We were surprised that the overall induction rate went down,” says lead researcher Michelle Osterman, a health statistician with the National Center for Health Statistics, which is part of the CDC.
And it is welcome news, too. “For years we were taught that the 37th or 38th week of pregnancy was full term, but we did not appreciate the neonatal outcomes,” says ob/gyn Dr. Nancy Cossler, vice chair for quality and patient safety at University MacDonald Women’s Hospital in Cleveland, Ohio.
“It was an ingrained part of our culture that 37 weeks is OK, but it’s not necessarily OK for the baby,” she says, citing issues such as hypothermia, feeding difficulties and respiratory distress among infants born early.
Historically, MacDonald Women’s Hospital had a rate of about 11 percent for labor induction for non-medical reasons among patients who were 37 to 38 weeks pregnant. Today, it’s nearly zero. In 2013, only one birth among the 37 to 38 week gestational age was done through induction. The patient had metastatic breast cancer, which is not among the usual listed criteria for medical induction, and needed to start chemotherapy and needed an early delivery, says Cossler.
Indeed, there is a big push nationally for longer-term births, such as the large-scale educational program called the 39-Week Initiative, supported by the March of Dimes and other groups. It seeks to end non-medically indicated deliveries prior to 39 weeks. Last year, the American Congress of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine even recommended the label “term” in pregnancy, be replaced with categories based on gestational age. Today, babies born at 39 weeks through 40 weeks and six days of pregnancy are considered “full term.” Babies born at 37 to 38 weeks are now considered “early term.”
“I think this study is very positive since several of us have now provided evidence that babies have better outcomes (with longer term births),” says Dr. Kimberly Noble, assistant professor of pediatrics at Columbia University.
In a study published in the journal Pediatrics of 128,000 New York City public school children, Noble and her colleagues found that compared to children born at 41 weeks, those born at 37 weeks had a 33 percent increased chance of having third-grade reading problems, and a 19 percent increased chance of having moderate math issues.
But doctors do worry that the pendulum could swing too far and patients may be afraid of induced deliveries.
Our study “can’t differentiate between induction done for medical reasons and induction done for convenience, and if your doctor says this baby needs to come out at 37 weeks because of a problem, you need to trust your doctor,” says Noble, citing issues such as maternal or fetal distress as a cause for earlier delivery. What patients and doctors shouldn’t do is schedule an earlier delivery because of a vacation or other issue. “We know that 39 weeks and beyond is good for the baby,” she says.
BY ROSE RUSSELL
Kevin Cischke left a music career after 25 years to pursue a new one in nursing, and it won’t bother him that he’ll be a man in a profession largely dominated by women.
As the face of the nursing profession slowly changes, Mr. Cischke, 45, is among the growing number of men signing up for the job. According to the U.S. Census Bureau, slightly less than 10 percent of the 3.5 million nurses in 2011 were men. That’s up from 1970, when only 2.7 percent of nurses were males.
For Mr. Cischke – who will receive a bachelor’s in nursing next year from Mercy College — nursing is in line with his interests. When introduced to nursing, the former organist and choir master for the Archdiocese of Detroit fell in love with it.
“A couple of my close friends who are nurses said I should look into this profession to see if it would interest me,” he said, during a break from his externship in the emergency room at Mercy St. Vincent Medical Center. “It was a whirlwind love affair that has not ended, and I don’t suspect that it will.”
Craig Albers, chief nursing officer and vice president of patient care services at Mercy St. Charles Hospital, said men in nursing offer an important component in the delivery of public health care.
“In the past, nursing was more of a pink collar profession and more of a career for women. A lot of times it’s seen as a profession for Caucasian women. Now, with large numbers of baby boomers retiring and seeking health care, we need a diverse workforce able to work with a diverse population,” said Mr. Albers.
A nurse himself since 1998, he began his college studies pharmacy. When he decided he needed more patient interaction, a professor suggested he look into nursing.
“I job shadowed an ICU nurse and the role really appealed to me. That’s what led me to the profession,” he said.
While also acknowledging the importance of racial diversity, Mr. Albers added, “Each of those different minorities bring a special perspective and skill set in how they work with and relate to patients.”
It was the patients who also attracted Mr. Cischke.
"I enjoy the patient-care side of things. I wanted hands-on patient care. That's what drives me, and the fact that I can continue to learn and grow fits my personality perfectly," he said.
He also liked contributing to the profession and addressing concerns of his male peers. In fact, when they discovered something missing in their nursing school experience, he led the way to establishing a local chapter of the American Assembly of Men in Nursing. The organization addresses issues that affect men in nursing. About 20 men and five women are members of the group.
"I continued to explore what the assembly had to offer, promote, and to accomplish and I realized that their goals aligned with what we needed to have at Mercy to support our male students," said Mr. Cishke, one of 116 male students in the nursing program.
The organization will also help groom male nurses for retiring baby boomers who increasingly use health care. Health professionals who deliver care to boomers must be on their toes.
"Our baby boomer population will be very informed and knowledgeable and Internet and computer savvy, and people going into the nursing profession will have to be extremely knowledgeable and confident and able to communicate with their patients because the patients are very knowledgeable," said Mr. Albers.
While male nurses' physical strength is also a plus for patient care, Mr. Albers said more men joining the field may pursue advanced fields in nursing, such as management, administration, business, and anesthetics. Those advanced career possibilities attracted Daniel Koehler to the profession.
"One of the great things about nursing is that once you are in it and have a job and have some experience after a few years, you can go into management, get a master's, or PhD," said Mr. Koehler, 32, who is in the nursing residency program at ProMedica Flower Hospital. "There are so many different avenues you can go into, so it was kind of a no-brainer that I picked this."
He received a bachelor's in nursing from Lourdes University in December. Eight years ago, he obtained a bachelor's in human biology from Michigan State University. He then worked in the restaurant and fitness businesses before going to nursing school.
He wasn't intimidated by the predominantly female profession, and in fact received positive responses from others.
"Most guys don't grow up thinking they want to be nurses," as many girls do, said Mr. Koehler, whose mother was a nurse in Germany. "With the guys I've met in the profession, I think less of that stigma now days."
Though slightly less than 10 percent of ProMedica's nurses are men and slightly more than 8 percent of the nurses in the Mercy health system are men, the idea that nursing is a woman's job stopped Roberta Pratte's father and grandfather, both medics in the military, from continuing in the profession. As a teenager, Ms. Pratte — a Mercy nursing professor — recalls hearing her grandfather speak fondly about nursing.
"Back then it wasn't something that men talked about or thought about. I sensed that they regretted that they were not allowed to follow their dream," said Ms. Pratte, an instructor at Mercy College. She has been a nurse for 33 years, and her mother was also a nurse.
Large numbers of nurses are expected to retire soon, adding to the already critical nursing shortage. That's why the profession is pushing to attract men and women into nursing. As a matter of fact, the American Assembly for Men in Nursing is campaigning to increase the number of male nurses by 20 percent by the year 2020, said Ms. Pratte. She also said the Institute of Medicine and the Centers for Disease Control and Prevention are reviewing how to fill nursing positions to ensure that the public gets proper care.
By Stacey Burling
George Palo is 90. He's repeating himself quite a bit these days and he's just had to downsize to a retirement community. He really misses his late wife.
Soon, he will also miss his beloved dog, Max.
This last bit of news caused a roomful of nurse educators to moan a sad, sympathetic, "Ohhhh" at a meeting last week at the Independence Blue Cross building in Center City.
George is a fictional character, created along with two others to help nurses in training understand dementia and its traveling companions among the elderly: depression and delirium.
The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.
"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.
The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.
Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.
Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.
Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.
Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.
The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.
The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.
Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.
An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.
The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.
Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.
Wolters Kluwer Health
Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article in the Journal of Christian Nursing by Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN. "This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public," they write. "The battle of pertussis is winnable through education, awareness, and vaccination."
Caused by infection with Bordetella pertussis bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.
Why is pertussis on the rise? "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."
Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.
Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.
"Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines," Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.
The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. "These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations," the authors write. "Faith community nurses are in an ideal role to create and lead these partnerships."
Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime."
By Michael O'Connor
Wet snowflakes fell on that day after Christmas 1973 as she glanced out the window.
Nancy Whittaker just wanted to return a few presents with her boyfriend, but her parents worried about her making the 40-mile trip from Beatrice to Lincoln. Maybe it was best if they made the drive another day, after the weather improved.
I'll be fine, Nancy told them before sliding into the front seat. Nancy, 17 at the time, sat in the middle of the bench seat, with her 19-year-old boyfriend, Paul Cramer, on her right, and his college roommate behind the wheel.
Nancy, a pretty and popular senior at Beatrice High School, planned to attend college and follow her dream of becoming a nurse.
She wanted a career, but her greatest hope — one she had wished for since she was little — was becoming a wife and mother. She wondered if Paul might be the man she would marry someday.
Nancy and the two others set out on their trip that winter day 40 years ago, but they never arrived in Lincoln.
In the years that followed, Nancy would face tough obstacles reaching her dreams. Though she wouldn't fulfill them all, she would reach most, including motherhood. And through her faith, courage and perseverance she would inspire her children to achieve one dream that fell from her grasp.
Before Nancy left on the trip that day, she spoke with her dad about a Christmas present she'd given him.
It was her senior picture in a wooden frame. She reminded him to hang it in his office at work.
There was Nancy, with her blue eyes and long blond hair, smiling in the photo.
Her father promised he'd take it to work, and gave her a hug and kiss.
Nancy and the others stopped to fill the white two-door Dodge with gas before heading north out of Beatrice on U.S. Highway 77 — a two-lane road in those days.
Seven miles north of Beatrice, the Dodge trailed a truck near the tiny town of Pickrell about 2:20 p.m. Newspaper stories and a sheriff's report indicate the car moved into the opposite lane. Paul caught a split-second glimpse of the oncoming sedan. He instinctively braced himself against the dashboard with his right arm and threw the other across Nancy's chest.
The two cars collided head-on, according to news reports. The other car carried a 75-year-old Kansas man and his wife, who both died in the crash.
Nancy's head smashed against the dash, crushing the middle third of her face. She broke a hip, her pelvis and jaw. Paul broke an ankle, nearly severed a finger and suffered a concussion and chest injury. His roommate also was injured.
In an emergency room in Beatrice, Nancy remembers hearing voices and her family doctor exclaim, “Oh, my God.”
Her face throbbed with pain, and she couldn't see.
You've been in a car accident, her father told her, but you will be OK.
Why can't I see, she asked.
Doctors are taking good care of you, her dad replied. They will figure that out.
Within hours of the crash, doctors transferred her by ambulance to a Lincoln hospital. A nurse Nancy knew sat in the back with her during the drive. The previous summer Nancy had worked as a nurse's aide and the woman had trained her.
The nurse held her hand, and though Nancy still could not see, she felt peaceful, as if the Lord held her in His arms.
In Lincoln, Nancy underwent the first of what would be nearly a dozen plastic surgeries to reconstruct her face. The surgeon who performed the first eight-hour operation told Nancy's family her facial bones were so shattered that it was like “stringing pearls” together.
As she lay in her hospital bed a day or two after the crash, Nancy had a question for her mother.
It wasn't about her eyes, or her face.
Will I still be able to have babies someday?
Her mother leaned over her bed and gently told her yes.
Nancy was relieved, but soon would learn devastating news.
Within a week of the accident, doctors told her what she had feared: She was permanently and completely blind. Her optic nerves were dead because injuries had cut off their blood supply.
Nancy felt the Lord would take care of her, but she was scared, and her mind raced.
How would she get around? How would she pick out clothes? How would she put on makeup?
Could she still go to college? What would her boyfriend, Paul, say?
He was recovering at a Beatrice hospital, and soon after Nancy learned about her blindness, he phoned.
He told Nancy he had fallen in love with her months before, and her blindness didn't change that.
“I love you,” he told her on the phone that day, “not what you can see.”
Nancy remembers a psychiatrist in the hospital telling her she had two choices: Compare her life now to her life before the accident and feel miserable, or move forward.
After finishing her senior year of high school, she enrolled part time at Nebraska Wesleyan University in Lincoln and moved into a dorm with a friend. Paul was a junior at the school.
She majored in psychology, knowing that without vision, a nursing career simply wouldn't work.
Some textbooks were on reel-to-reel tape, and Nancy listened to them in a study lounge. When she had to write a paper, she dictated sentences to her mom, who typed them. Her professors read test questions to her after class.
Nancy's relationship with Paul grew stronger during their college years, and they married on June 4, 1977.
In May 1981, eight years after she began taking classes half time, Nancy graduated.
When her name was called at the ceremony, she linked arms with Paul and walked across the stage.
The audience rose to its feet and erupted in applause.
In spring 1986, Nancy heard the words she had longed for: You're pregnant.
She had accepted her blindness because she knew the Lord would bless her and Paul in other ways. A baby, she thought, was that grace.
Nearly two years earlier she'd had a miscarriage, and she and Paul prayed that they would be blessed with another baby.
That baby was born two months premature in October 1986. Paul Andrew was small — 4 pounds, 2 ounces — but healthy.
Nancy remembers hearing his loud cries for the first time, as tears streamed down her face.
Her husband described the baby to her: blue eyes, light hair, a long body.
She held her child on her chest, stroking his hair, cheeks, nose and lips, tracing the outline of his face with her fingers.
Caring for a baby challenges any mom, and Nancy faced extra hurdles.
Plus, soon she no longer had just one son.
Two years and two days after the birth of her first son, Nancy delivered a second healthy boy, Daniel Whittaker.
Keeping her boys safe at home was a big test. She vacuumed constantly to make sure there wasn't a coin or paper clip on the floor her boys could put in their mouths.
Organization was the key for other duties.
Changing diapers and cleaning messy bottoms became a snap because Nancy knew just where to reach for a clean diaper and a wipe.
Her husband marked foods with a label in Braille, making it easy for Nancy to find the applesauce or baby cereal in the kitchen of their Lincoln home.
As her boys got older, she reminded them that mommy couldn't see them, so they needed to tell her if they left a room, and she could follow the sound of their voices.
Nancy, who left a phone company job to raise her family, regularly walked with her sons and a guide dog to a park and their school five blocks from home.
Every couple of years, Nancy visited her sons' grade school and talked about life as a blind person.
How do you get dressed, students asked. How do you walk without bumping into things?
Her sons listened proudly. Those talks helped them realize that blindness didn't stop their mom. It was simply part of her life, and she dealt with it.
As they grew, Nancy's sons learned that mom sometimes needed help, and she wasn't too proud to receive it.
She knew her way around the house but sometimes cut her forehead on an open cupboard. Her boys would dab the wound with soap and water and place a bandage on it.
Nancy always put on her own makeup, but if she smudged her mascara, her boys cleared it with a Q-tip.
When her boys were older, she'd ask them to read the labels on her medicine bottles.
Her sons never complained about helping. Nancy realized they carried a tender and caring nature, and that filled her and her husband with pride.
Nancy is now 58 and works as a phone interviewer for a university research office in Lincoln. Paul is 60, and the pair — whose relationship flowed from a teenage romance — will celebrate their 37th wedding anniversary next month.
And their boys are grown now.
Paul Andrew, 27, and Daniel, 25, knew their mom had to give up becoming a nurse, and looking back, they realize she channeled her caregiver instincts into raising them.
Her sons were struck by her ability to raise them despite not just her blindness but also her chronic asthma and other medical problems stemming from her car crash injuries.
They joined their mother on dozens of medical appointments while growing up, and saw how the nurses and doctors helped her. Both sons also liked the satisfaction of helping their mom, and how something as simple as them tending to a cut on her forehead made her feel better.
All of those experiences seeped in over the years and led both sons, even as teens, to begin thinking of health care careers.
Though Nancy never reached her dream of becoming a nurse, her sons followed that path.
Paul Andrew graduated last year from the University of Nebraska Medical Center and is a nurse at Immanuel Medical Center in Omaha.
On Friday, Dan walked across the stage at a Lincoln auditorium and received his nursing degree from UNMC. A smile broke across Nancy's face as they called his name.
Afterward in the lobby, Dan weaved through the crowd and found his mother. The 6-foot-4 Dan leaned down and hugged her, as his brother stood close.
For parents, college graduation signals the step into adulthood, although in a mother's mind, the little child never quite disappears.
That's how it is for Nancy.
As the crowd began breaking up, Dan stepped close and told her he loved her.
She reached up and touched the back of his neck with her hand.
A new "Charting Nursing's Future" brief from the Robert Wood Johnson Foundation details a series of programs designed by and for nurses that have “spurred the creation of work environments that foster healthcare quality and patient safety” 10 years after a landmark Institute of Medicine report.
The November 2003 IOM report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” concluded that “the typical work environment of nurses is characterized by many serious threats to patient safety.” The IOM offered a series of specific recommendations about how hospitals and other institutions needed to change to reduce the number of healthcare errors. Taken together, the recommendations constituted a fundamental transformation of nurses’ work environments.
The IOM report found that hospitals and other healthcare organizations did a poor job of managing the high-risk nature of the healthcare enterprise. Accidents were too common, and management practices did little to create a culture of safety.
“We’ve made important gains in the past decade, but we have a lot more work to do,” Maryjoan D. Ladden, RN, PhD, FAAN, senior program officer at RWJF, said in a news release. “Some of the changes needed are systemic and will require collaboration among nurses, doctors, educators, policymakers, patients and others.
“But nurses also have a critical responsibility to transform their individual workplaces, asserting leadership at the unit level and beyond to help identify and solve problems that affect patient safety.”
Among the initiatives highlighted in the brief, “Ten Years After Keeping Patients Safe: Have Nurses’ Work Environments Been Transformed?”:
• Transforming Care at the Bedside. The RWJF-backed TCAB initiative, developed in collaboration with the Institute for Healthcare Improvement, seeks to empower frontline nurses to address quality and safety issues on their units, in contrast with more common, top-down efforts. Evaluations of the program point to fewer injuries from patient falls, lower readmission rates and net financial gains.
• Quality and Safety Education for Nurses. Also backed by RWJF, QSEN seeks to improve patient safety by helping prepare thousands of nursing school faculty to integrate quality and safety competencies into nursing school curricula at the undergraduate and graduate levels.
• Nurse-patient policies. In some jurisdictions, policymakers have addressed patient safety through nurse staffing policies, focusing both on nurse-patient ratios and on the composition of the nursing workforce. To date, California is the only state to establish a limit on the number of patients a nurse may be assigned to care for in acute care hospitals. Other jurisdictions have policies intended to encourage lower ratios. Research on the impact of such efforts on patient safety has been mixed to date.
In addition, the IOM’s 2010 “Future of Nursing: Leading Change, Advancing Health” report gave new impetus to efforts to increase the share of nurses with baccalaureate degrees or higher, and various institutions have begun to address that recommendation through hiring requirements, tuition-reimbursement policies and more.
• Disruptive behavior on the job. Professional discourtesy and other disruptive behavior in the workplace is another barrier to patient safety, particularly given the growing importance of teamwork and collaboration. Noting the consequences of poor behavior can be “monumental when patients’ lives are at stake,” the brief highlights programs at Vanderbilt University Medical Center in Nashville, Tenn., and Johns Hopkins Hospital in Baltimore designed to deter such problems.
The CNF brief goes on to cite a series of initiatives by government agencies, professional associations, the public service sector and credentialing organizations, all designed to advance patient safety and transform nurses’ work environments toward that end. It concludes with an “emerging blueprint for change” that urges providers, policymakers, and educators to follow through on:
• Monitoring nurse staffing and ensuring that all healthcare settings are adequately staffed with appropriately educated, licensed and certified personnel;
• Creating institutional cultures that foster professionalism and curb disruptions;
• Harnessing nurse leadership at all levels of administration and governance; and
• Educating the current and future workforce to work in teams and communicate better across the health professions.
The brief also provides policymakers, healthcare organizations, educators and consumers with a listing of available tools to help in their efforts.
This issue of “Charting Nursing’s Future” is a publication of RWJF created in collaboration with the George Washington University School of Nursing in Washington, D.C.
RWJF report: http://bit.ly/1kiMsYX
2003 IOM report: www.iom.edu/Reports/2003/Keeping-Patients-Safe-Transforming-the-Work-Environment-of-Nurses.aspx
To mark National Nurses Week, we asked new RNs about what every nurse needs to succeed. Five nurses from the DC/Maryland/Virginia region, all with two years or less of experience, answered the following question: What qualities or characteristics are most important to possess as a nurse, and why?
Hannah Hanscom, RN, BSN, CPN, clinical nurse, surgical care unit, Children’s National Health System, Washington, D.C.
As a pediatric nurse, I believe there is no one quality or characteristic that is most important to being a nurse. Nurses must be passionate about caring for children and their families and be able to think critically and on their feet. But we also must be able to communicate effectively and efficiently with the family, patient and interdisciplinary team. We must be compassionate and able to stay calm when escalating care is needed. Although there is no one quality or characteristic that is most important for nursing, having a passion for the field, for caring for those in need, for educating others and for continuing your own education ties all the other qualities together. Nursing is not just a job or a career. Being a pediatric nurse is in many ways a calling; it is something that comes from the heart and is a lifestyle you must be passionate about.
Shannon Levin, RN, med/surg unit, Novant Health Haymarket Medical Center, Gainesville, Va.
Nursing is more complex than ever. Nurses are managing new technologies, constant advances in best practices and more and more patients with multiple morbidities. Nurses must be organized multitaskers, with quick critical thinking skills. But a nurse who possesses empathy for his or her patients is the best kind of nurse. Nurses with genuine empathy understand that we often see patients and their families at one of the most difficult times. Most of our patients are experiencing some level of physical and emotional pain and often feel anxious and fearful about their hospitalization. An empathic nurse cares enough to identify and understand his or her patient’s feelings. The nurse listens to his or her patient’s medical history and current symptoms and eases his or her fear by explaining the need for hospitalization, the plan of care and ordered procedures. These actions help build trust and ultimately are the foundation of a successful nurse-patient bond and remarkable care.
It takes many characteristics to be a nurse. I believe the most important characteristics to possess are empathy, compassion, hope, patience and good communication skills. Being empathetic for patients and also for their families shows true compassion. Nurses must give patients a sense of hope when they may be at the lowest point in their lives. Nurses smile, and with that smile, a positive perception is given to patients and their families. Patience with not only yourself, but with patients, family members, doctors and coworkers is a must. Nurses must know when to speak up for themselves or their patients and when to intervene - especially when they suspect something may be wrong. Nurses advocate for their patients when they are in dire need. And, finally, one of the most important parts of communication is that nurses must always be great listeners, even after a long 12 hour shift.
Brooke Schautz, RN, emergency department, MedStar Harbor Hospital, Baltimore
To be successful, flexibility is the single most important attribute a nurse should have. Throughout nursing school you are taught many skills to prepare you. However, there are some things that cannot be taught, yet are essential to becoming a nurse. As with most things in life, having the right balance is equally as important. Being flexible, yet having the ability to stay focused, is critical to ensure you are providing excellent care to your patients.
Mandy Ward, RN, emergency services, Novant Health Prince William Medical Center, Manassas, Va.
There are quite a few qualities that are important to possess as a nurse, but I would have tosay the most important one would be compassion. Compassion is listening to a patient, showing him or her sincere concern, being kind and showing empathy.
Our patients look to us to help them when they are most vulnerable. It is up to us to help them when they need it, and we can start by showing them compassion and that we truly care about them. Compassion alone isn’t enough; but, by showing compassion, it makes a big difference for those that we take care of.