By Dr. Sanjay Gupta
Annette Tersigni decided at the age of 48 that she wanted to make a difference. She attended nursing school and became a registered nurse three years later. “Having that precious pair of letters – RN – at the end of my name gave me everything I wanted,” she writes on her website. Before long, Tersigni discovered the rewards – as well as the physical and emotional challenges – that come with nursing.
“I was always stressed when I worked, afraid to get sued for making a mistake or medical error,” says Tersigni, who was working in the heart transplant unit of a North Carolina hospital. “Plus, working the night shift caused me to gain weight and stop working out.” Tersigni moved to another hospital, but the long shifts continued. Three years later, she left her job.
Tersigni’s experience isn’t unusual. Three out of four nurses cited the effects of stress and overwork as a top health concern in a 2011 survey by the American Nurses Association. The ANA attributed problems of fatigue and burnout to “a chronic nursing shortage.” A 2012 report in the American Journal of Medical Quality projected a shortage of registered nurses to spread across the country by 2030.
Work schedules and insufficient staffing are among the factors driving many nurses to leave the profession. American nurses often put in 12-hour shifts over the course of a three-day week. Research found nurses who worked shifts longer than eight to nine hours were two-and-a-half times more likely to experience burnout.
“Our results show that nurses are underestimating their own recovery time from long, intense clinical engagement, and that consolidating challenging work into three days may not be a sustainable strategy to attain the work-life balance they seek,” says study author Linda Aiken, PhD, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.
Deborah Burger, RN, co-president of the union and professional association National Nurses United, doesn’t believe that long work shifts tell the whole story. “Most people can work a 10- or 12-hour shift if they’ve got the right support and right level of staffing,” Burger says.
“In order for nurses to feel satisfied and fulfilled with their work, the staffing issues must be seriously addressed from a very high level,” says Eva Francis, MSN, RN, CCRN, a former nursing administrator. “Nurses also need to be able to express themselves professionally about the workload, and be heard without the fear of threat to their jobs or the fear of being singled out.”
A new study suggests that nurses’ burnout risk may be related to what drew them to the profession in the first place. Researchers at the University of Akron in Ohio surveyed more than 700 RNs and found that nurses who are motivated primarily by the desire to help others, rather than by enjoyment of the work, were more likely to burn out.
“We assume that people that go into nursing because they are highly motived by helping others are the best nurses,” says study author Janette Dill, assistant professor of sociology at the University of Akron. “But our findings suggest these nurses may be prone to burnout and other negative physical symptoms.”
RELATED: Managing Job Stress
That finding doesn’t surprise Jill O’Hara, a former nurse from Hamburg, NY, who left nursing more than a decade ago.
“When a person goes into nursing as a profession, it’s either because it’s a career path or a calling,” says O’Hara, 56, who now operates her own holistic health consulting practice. “The career nurse can leave work at the end of the day and let it go, but the nurse who enters the field because she is called to it takes those emotionally charged encounters home with her. They are empathetic, literally connecting emotionally with their patients, and it becomes a part of them energetically.”
Besides driving many nurses out of the profession, burnout can compromise the quality of patient care. A study of Pennsylvania hospitals found a “significant association” between high patient-to-nurse ratios and nurse burnout with increased infections among patients. The authors’ conclusion: A reduction in burnout is good for nurses and patients.
So what can be done? O’Hara thinks the burnout issue should be addressed early on, when future nurses are still in school. “I honestly believe the way to truly help nurses avoid burnout is to begin with a foundation of teaching while in school that stresses the importance of knowing yourself,” she says. “By that I mean your strengths and weaknesses. It should be taught that self-care must come first.”
Burger stresses the importance of taking regular breaks on the job. “If you’re not getting those breaks or they’re interrupted, then you don’t have the ability to refresh your spirit,” she says. “It sounds hokey, but it is true that you do need some brain downtime so that you could actually process the information you’ve been given.”
Tersigni, 63, now works part-time at a local hospital, specializing in the health and well-being of other nurses. She founded Yoga Nursing, a stress-management program combining deep breathing, quick stretches, affirmations, and relaxation and meditation techniques. “All of these can be done anytime throughout the day,” Tersigni says. “I even teach nurses to teach these to their patients. So the nurse breathes, stretches, and relaxes, while also teaching it to the patient.”
By Rena Gapasin
If you are a nursing student or new nurse, you are probably wondering what you will need in your work bag. Aside from your personal stuff, what are the things you bring that signifies you are a nurse?
These nursing supplies listed below are a must if you want to do your job efficiently.
The most common supplies nurses have in their bags are:
This is one of the most important tools of the trade. Nurses use this tool to listen to things such as the heart, veins, and intestines to make sure proper function. According to Best Stethoscope Reviews, here are the 6 best stethoscopes to buy. As you surely know, it's one of the most important tools for a patient's assessment.
One of today's leading stethoscope brands is Littmann. You can choose from the classic style to the most advanced kind.
A handy reference listing down common medicines and conditions. MIMS provides information on prescription and generic drugs, clinical guidelines, and patient advice. Nurses can also use Swearingen's Manual of Medical-Surgical Nursing, a complete guide to providing optimal patient care.
- Scissors and Micropore Medical Tape
Bandage scissors are used for cutting medical gauze, dressings, bandages and others. Nurses need to have these in their pockets for emergency use, especially for wound care. Micropore tape is also important and should be readily available, for example, when your patient accidentally pulls his/her IV.
- Lotion and Hand Sanitizer
Nurses never forget to wash their hands several times throughout the day, leaving their skin dry. That's why having lotion in their bags is important to keep the skin in good condition. Meanwhile, the sanitizer helps nurses steer clear of germs, along with other contagious agents.
Six saline flushes
Sanitary items - gauze, sterilized mask and gloves, cotton balls
OTC pharmacy items (cold medicines, ibuprofen and other emergency meds)
Small notebook - for taking notes from doctors and observations of your patients.
Watch with seconds hand
On Nurse Nacole’s website, she shares that she carries a drug handbook, intravenous medications, makeup mirror, tape measure, towel, lotion, wipes, 4 in 1 pen and a homemade cheat sheet for her patients.
Also, in MissDMakeup's What's In My Work Bag Youtube video, she has a box of batteries, tapes, a pack of gum, toothbrush, sanitizer, coupons, snacks, umbrella, stethoscope, pens, folder of her report sheet and information sheet, tampons, charger, name tag, ID, makeup bag, eye drops, lotion, hair clips, highlighter, pen light, and journal.
So, What's in My Bag?
In my bag, I have a 4-in-1 pen, a highlighter, IDs, bandage, journal to write some new information when I surf the net, my phone with medical e-books and medical dictionary in it, and other stuff like alcohol, sanitizer, over-the-counter meds (such as paracetamol, cold medicine, pain killers, multivitamins), eye drops, handkerchiefs, floss, toothbrush, nail file, band aids, and food.
Aside from my knowledge in providing quality patient care, I also bring things that can help me get through my shift. In an effort to make things more compact and easy for a nurse to get access to, most common nursing supplies are available in a portable kit. The size and styles are developing as new ways of making a nurse's shift easier.
These are just few of the essential nursing paraphernalia that a new nurse needs.
What's in your bag that you can’t live without?
Source: nurse together
By Ian Lee
Far from the sea, a man-made coral reef is taking shape -- and it could change medical operations forever.
Step inside the OkCoral lab in Israel's Negev Desert and you'll find row after row of quietly bubbling fish tanks, each containing a precious substance.
It is hoped the coral grown in this surreal "farm," could one day be used in bone operations -- encompassing everything from dental implants to spinal procedures.
Unlike animal and human bones, coral can't be rejected by the body, say medical experts at the company CoreBone, which manufactures bone replacements from coral.
Grown in the lab, this coral is also free from the diseases you might find in the oceanic variety.
Assaf Shaham founded the unusual laboratory six years ago at a cost of $2.5 million, with an ambitious vision of tapping into the billion dollar worldwide bone grafting industry.
But first he'll need the approval of authorities in the European Union and U.S., with a decision expected next year.
The father-of-two's dedication to the business is astounding -- if not a little disconcerting.
"In six years of growing corals, I haven't left these four walls for more than 12 hours -- not even once," he said.
"For me, it's 100% learning as I go. I take the mother colony, and I cut off a branch of the coral with a diamond saw. Then I glue it to another base made out of cement."
The delicate ecosystem needs constant care to ensure the water's salinity, temperature, and chemical make-up is perfect -- any variations and the coral could die.
The fish swimming around each tank are essentially the "worker bees" of the artificial reef. They eat the algae growing on the coral, their feces helps feed the coral, and finally, their movements in the water keep the coral strong.
And much like the traditional canary in the coalmine, if the fish die, you know something's not quite right in the water.
Happily for Shaham, his ambitious experiment appears to be thriving, with coral in the lab growing at ten times the normal rate.
Just a small container of the coral costs roughly $5 to $10 to produce, and sells for around $250.
One of the biggest benefits of the business is its environmental sustainability.
"We have a constant supply," says Ohad Schwartz of company CoreBone.
"We don't have to worry that in several years, harvesting from the sea could be forbidden."
It's a concern they'll never have to think about, when harvesting these remarkable fruits of the desert.
With the generous support of the Robert Wood Johnson Foundation and guided by a national advisory committee, a multidisciplinary team based at the University of Pennsylvania seeks to learn from clinicians or clinical leaders who are primarily responsible for transitional care services in health systems and communities throughout the United States. Specifically, the team is conducting a research study designed to better understand how transitional care services are being delivered in diverse organizations. Participation in this research survey is voluntary.
If you are a clinician or clinical leader responsible for transitional care service delivery in your organization, I encourage you to learn more about this study. To access the survey and more information on the study, please visit:
Transitional Care Survey
NAHN is happy to assist Dr. Mary Naylor and the University of Pennsylvania in this 2 year project. Dr. Mary Naylor will be providing NAHN with feedback on the survey results. If you know of others who have such responsibility within your association or work environment, please forward this email to them.
Thank you in advance for your consideration of this request.
By Debra Wood
Modern Healthcare readers selected four nurses in leadership roles to be ranked on this year’s 100 Most Influential People in Healthcare list, based on their effect on the industry.
“It’s great for nursing, because we do this together,” said Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, who made the magazine’s annual list for the first time, ranking 45th.
“I’m honored to be recognized,” she continued, “but I realize this is not about me. It’s about the hundreds and thousands of nurses working together to make the American Nurses Association a powerful force, to make nursing a powerful force, and to help our colleagues in health care and the general public understand the impact of nursing practice. I am the lucky person to be in the CEO role, but there are a lot of people making this happen.”
Other nurses in leadership who made the list included Marilyn Tavenner, agency administrator with the Centers for Medicare & Medicaid Services (CMS), listed fifth; Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association in Washington, D.C., 34th; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI) in Cambridge, Mass., 50th.
“The four nurses on Modern Healthcare’s 100 Most Influential People list this year are transformative and visionary leaders, and some of the brightest lights in the nursing world,” said Susan B. Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. “They are role models.”
Weston was one of 19 new people to join the list, which is dominated by elected and appointed government officials, top executives of health care industry corporations and physicians. Anyone can nominate a candidate. The magazine received 15,000 submissions for 2014. The top 300 nominees, including 10 nurses, were presented to Modern Healthcare readers for voting. Half of the candidates are selected through the reader votes and the other half by the magazine’s editors.
While not a nurse, RoseAnn DeMoro, executive director of National Nurses United (NNU), with 185,000 members, made the list again, at 41st.
“With the disproportionate economic influence of the hospital and insurance giants in particular, it is especially gratifying to see the name of RoseAnn and NNU on this list,” said NNU Co-president Deborah Burger, RN.
With the relatively small showing for nursing on this year’s list, opportunity exists for more nurses to move up to positions of leadership and influence.
“Nurses spend the most direct time with patients and, therefore, offer a vitally important perspective,” Keehan said. “As a nurse myself who moved into leadership, I encourage nurses to lend their voice to management decisions and consider leadership roles in their units or hospitals. It may not feel natural for some nurses to assert themselves, but the future of health care requires that we listen to their ideas and concerns. I hope to see many more nurses bring their passion for patient care and support of staff to the work of making health care better for everyone.”
Weston pointed out that nurses practice throughout the health care system, not only in hospitals but in home health, public health, primary care and long-term care. They observe when the system works and when it doesn’t for patients.
“That gives nurses the capacity to help make the system work for patents and communities and to redesign the system to transform and improve care,” Weston said. “Nurses are stepping forward to be leaders, and people are understanding nurses are not just functional doers of things, but thoughtful strategists.”
Weston expects more nurses will make the list in the years ahead. She encourages nurses to talk more about the work they do and the effect it has on people.
“The more we highlight the impact we are making, the more people will understand the great strategists and decision makers that nurses are,” Weston said. “There are a lots of pockets of innovation being led by nurses that are improving the quality of care, reducing the cost of health care and improving the access. We need to support each other in taking those pockets of innovation and spreading them.”
Weston has forged partnerships with other disciplines when delivering clinical care and when transforming the health care system.
“Health care is a team sport,” Weston said. “The degree we can work together catalyzes the work getting done.”
Increasing the number of nurses in leadership positions is one of the key recommendations of the Institute of Medicine’s groundbreaking Future of Nursing report and a central goal of the Campaign for Action.
“As the largest group of health professionals, and as those who spend the most time with patients, nurses have unique insight into health care,” Hassmiller said. “We need that insight at the highest levels of our health care system--on the boards of health care systems and hospitals; leading federal, state and local agencies; and more.”
Two members of the Campaign for Action’s strategic advisory committee made the 2014 Most Influential People in Healthcare list: Leah Binder, president and CEO of The Leapfrog Group, and Alan Morgan, CEO of the National Rural Health Association. Additionally, several members of organizations on the Champion Nursing Council and Champion Nursing Coalition were recognized.
“Health care transformation is underway in our country,” Hassmiller concluded. “Nurses possess the skills to ensure that the perspectives of people, families and communities remain front and center in any health decisions that get made.”
Meet the ‘Most Influential’ Nurses¹
5. Marilyn Tavenner, agency administrator with the Centers for Medicare and Medicaid Services, began her career as a nurse at Johnson-Willis Hospital in Richmond, Va., and spent 25 years working in various positions for HCA Inc., culminating as group president for outpatient services. Tavenner was one of several people in government to make Modern Healthcare’s annual list of the 100 Most Influential People in Healthcare.
34. Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association, started out as a nurse and served in the 1980s as Providence Hospital's vice president for nursing, ambulatory care, and education and training. She joined the Catholic Health Association in 2005. She told NurseZone that she hopes many more nurses will bring their passion for patient care to make health care better for everyone.
45. Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, has held a variety of nursing roles, including direct patient care in intensive care and medical-surgical units, nurse educator, clinical nurse specialist, director of patient care support and nurse executive. She has served as executive director of the Arizona Nurses Association and deputy chief officer of the Veteran’s Affairs Workforce Management Office. Weston reported that she has had great role models and mentors in her nursing career.
50. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, began as a staff nurse in 1973 at Quincy City Hospital, moved up and became chief operating officer in 1986, before joining IHI. Bisognano is one of many quality improvement leaders on this year’s Most Influential list.
A study in the current issue of Policy, Politics & Nursing Practice estimates 17.5% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a news release. The researchers found that turnover for this group is lower at hospitals than at other healthcare settings.
The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation. The RN Work Project is a 10-year study of newly-licensed RNs that began in 2006. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo.
“One of the biggest problems we face in trying to assess the impact of nurse turnover on our healthcare system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”
According to the release, the research team noted that, in some cases, RN turnover can be helpful — as in the case of functional turnover, when a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. The team recommends organizations pay attention to the kind of turnover occurring and point out their data indicate that when most RNs leave their jobs, they go to another healthcare job.
“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” Brewer said in the release. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.”
The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same healthcare organization, according to the release.
By Jeroen Tas
Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Shanghai, based on the medical scan you did in Kenya. This future is far closer that you might think due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in healthcare and personal well-being.
In only a few years, mobile technologies have spawned tremendous innovation of consumer-level health tools. The emerging solutions are focusing on health conditions over a person’s lifetime and on holistic care. They generate constant insights through analytics and algorithms that identify patterns and behaviours. Social technologies enable better collaboration and interconnected digital propositions that reach out to communities of people with similar conditions, engaging them in ways which were never before possible.
We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analysing your personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time it will not be the chronically ill but the healthy people who will invest the most in managing their health.
Digitization and consumerization will rattle the healthcare industry. It is already tearing at the very fabric of the traditional healthcare companies and providers. Innovation is not only about just adding a new channel or connecting a product. It is also a complete redesign of business models, adjustment of systems and processes and, most importantly, it calls for changing the culture in companies to reflect the new opportunities – and challenges – presented by the digital world.
To drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances, which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology, and clinical applications and informatics.
The game will not only be played by the traditional healthcare providers. With consumerization, even companies without healthcare expertise, but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market.
And in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative healthcare – in many cases, limited only by their imaginations. For example, we may see virtual reality technology moving from gaming industry to healthcare for improving patients’ rehabilitation after a stroke. Or we may see facial recognition software become common in monitoring and guiding patients’ daily medical routines.
While these new propositions tackle a number of healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable, open, and the user experience needs to be harmonized.
But perhaps one of the most important challenges is related to people’s behaviour and preferences. Regardless of whether these new and existing companies are analysing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors.
Consumers, patients and professionals alike, will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies that know how to offer us tailored, cutting-edge solutions, combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisers in health.
Source: World Economic Forum
Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.
Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.
Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.
Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip
Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.
Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.
With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!
By SYDNEY LUPKIN
At Boston Children’s Hospital, doctors perform practice surgeries with replicas of their patients’ body parts. Though the hospital has had a simulation program for about a decade, it started 3D-printing children’s body parts about a year ago, said Dr. Peter Weinstock, director of the hospital’s simulator program.
“They perfect what they want to do before ever bringing the child into the operating room or putting them to sleep,” Weinstock said.
The models are also used to help parents understand their children’s surgeries before the operation and to educate students afterward, Weinstock said.
The printer is precise, with a resolution of between 16 and 32 microns per layer. That means each layer is about the width of a “filament of cotton,” Weinstock said. And since the printer can print multiple resins or textures, doctors can work on replicas that model different tissue types, like brain matter and blood vessels.
The printer only takes a few hours to do their work once CT scans and other forms of imaging are collected and rendered into 3D models. A child’s finger might take three hours to print, but a chest replica they made last week took longer, Weinstock said.
The team has already printed about 100 body parts over the last year and demand is growing, Weinstock said, adding that the printer is running around the clock.
Dr. Ed Smith, a pediatric neurosurgeon at Boston Children’s, said he recently used several different 3D models to perform brain surgery on a 15-year-old patient with an abnormal cluster of veins above his optical nerve. One wrong maneuver and the patient could have gone blind.
He even used a see-through replica of the patient’s skull on a light box in the operating room as a reference.
“It’s kind of like being superman with X-ray vision where you can actually hold this up and see right through it,” Smith said.
The surgery, which would have normally taken five or six hours, wound up clocking in at 2 hours and 20 minutes, Smith said.
Though Boston Children’s hasn’t conducted any formal studies of how the models help surgeons, Smith said he’s heard anecdotally that they result in shorter surgeries because doctors know what to expect.