Congresswoman Lois Capps of CA is committed to helping people improve their daily lives through better schools, quality health care, and a cleaner environment. During her 20-year tenure as a Nurse and public health advocate, she felt her education and background was needed in Congress to help improve health care in the US and strengthen our Nursing workforce across the country.
Mon, Sep 26, 2016 @ 03:33 PM
Thu, Sep 22, 2016 @ 03:33 PM
Chief Diversity Officers can make a hospital a more welcoming place for employees and the patient's they serve. It takes many steps for a CDO to make that possible. Continue reading to learn more about how CDO's can help your healthcare organization.
Workplace harassment complaints. Recruiting a diverse workforce. Cultural competency training. These are matters that traditionally fall under HR, but healthcare organizations are increasingly relying on professionals with specialized skills to work on these sensitive and important issues.
Enter the chief diversity officer, or CDO.
As the country grows not only more ethnically diverse but more diverse in personal beliefs, regional origin and identification, and disability status, the demand for leaders who specialize in creating dialogues between people with differences will increase, says Oliver B. Tomlin, III, senior partner at search firm Witt/Kieffer and founding member of National Association of Diversity Officers in Higher Education. He has assisted with several CDO searches.
Below are several functions a CDO might play to make a hospital a more welcoming place both to workers and the community they serve:
1. Make Sure Everyone is Heard
Many of us can remember attending a party or other event where we didn't fit in, possibly because of differences between ourselves and others.
A CDO specializes in being the person who makes sure workers don't have to feel uncomfortable about what makes them unique, and that they can bring their "whole selves" to work, says Deborah L. Plummer, PhD, vice chancellor and chief diversity officer at University of Massachusetts Medical School and UMass Memorial Healthcare.
"If everyone feels they can bring their whole self to work and they feel like differences are respected, it can make the workplace richer and stronger," Plummer says.
"Then, we are able to come together and work in diverse teams, and are able to solve challenges with our collective wisdom."
2. Teach Awareness
What's the next step that will lead toward improved patient satisfaction and both clinician and worker retention? Teaching the workforce to be sensitive to and accepting of the differences that are inherent to a diverse organization or in a diverse community.
Sometimes it's not always easy to gain the trust of people when there are differences involved, especially in light of healthcare disparities members of minority groups often experience, says Tomlin, but educating a workforce can help.
Plummer suggests offering regular inclusion events, hosting employee and community research groups, and familiarizing hospital leadership with hot topics in the workforce and within the community.
She also suggests that CDOs organize training sessions around current topics, such as:
- LGBT-related issues
- Sexual harassment
- Building an inclusive workforce
- Cultural competency education
3. Devise and Implement Inclusion Strategies
Diversity and inclusion aren't easy topics to tackle, says Plummer. "There has to be someone who gets up every morning thinking about the complexity of these differences."
A CDO can fit that bill.
Plummer makes it clear that she believes HR is "necessary and great function. [It keeps] the trains running." But appointing a leader to specialize in diversity makes sense.
"I can say that the space of diversity is more about people strategy and management, while HR is about the employee, and their employment relationship to the organization," she says.
A CDO will be able to prioritize diversity matters above all else; these hot topics will have their full attention. Far from being just another C-suiter, the CDO has potential to be a mediator, a teacher, an outreach coordinator, and someone who helps make your hospital a more comfortable place for everyone.
If you have any questions about Chief Diversity Officers, Diversity and Inclusion, or just a general question, please ask one of our Nurse Leaders by clicking below!
Tue, Sep 20, 2016 @ 11:08 AM
We usually associate therapy animals with dogs, but many other animals — horses, cats, rabbits and even chickens — can provide assistance with mental and physical health.
Research shows that sick or injured people benefit from interacting with animals.
Therapets do not judge, they don’t stare and gawk and they don’t ask endless questions about how the patient is doing or what the prognosis is. They are there as a companion that patients can talk to or pet.
“There have been studies linking interaction with animals to lower blood pressure; lower heart rate; lower level of stress hormones like cortisol, epinephrine and norepinephrine; less reliance on pain medication; and higher levels of helpful hormones like serotonin, prolactin and oxytocin,” executive director of Therapet, Carianne Sikes said. “Patients report having less fear and anxiety when they interact with animals.”
“We receive a number of great emails and Facebook posts from former patients saying they were feeling discouraged or depressed and were ready to give up until they received a visit from Therapet,” Sikes said. “Many say their mood changed, but often we hear that their recovery turned around – they started getting better after the visit from Therapet.” Patients recovering from joint replacements or illnesses like strokes often stand longer and walk farther and faster with an animal,” Sikes said. “They relax more during their exercises and seem to be more likely to lose track of time and exercise longer.”
Therapets also go into schools to help calm students before a big exam and to let young children read to them as a way to improve their reading skills.
Canine Companions for Independence is a non-profit organization that enhances the lives of people with disabilities by providing highly trained assistance dogs and ongoing support to ensure quality partnerships.
CCI trains four types of assistance dogs: service dogs, who help disabled people; skilled companion dogs, who help disabled people with the assistance of another adult; facility dogs, who work in clinics or other professional settings with patients; and hearing dogs, who increase people’s environmental awareness.
The dogs have two modes: rest and work. While at rest, the dogs act like any other dog, but the moment their owner commands them, the dogs instantly go to work and don’t stop until told. Passersby are advised to ask the owner before petting an assistance dog and to address the owner first, not the dog.
Studies of dogs and cancer detection are based on the fact that cancerous cells release different metabolic waste products than healthy cells in the human body. The difference of smell is so significant that dogs are able to detect it even in the early stages of cancer. Dogs are able to identify the chemical traces in the range of parts per trillion. Some studies have confirmed the ability of trained dogs to detect skin cancer melanoma by just sniffing the skin lesions. Furthermore, some researchers have proven that dogs can detect prostate cancer by simply smelling patients’ urine. Dogs may also be able to sniff out the presence of cancerous cells through a human’s breath. Not only does their sense of smell make cancer detection possible, but research suggests that dogs can be trained actively to sniff out the cancer.
Horses do not see disabilities, said Nancy Tejo, of Merrick, owner of Sky Riding LI at Parkview Stables in Central Islip, NY. They only see people. She works with riders who have conditions ranging from autism to charge syndrome, a rare genetic disorder that causes heart defects and slow physical growth. Occupational therapy is known in horse circles as hippotherapy. Specially trained physical and occupational therapists use this treatment for clients with movement dysfunction. In hippotherapy, the movement of the horse influences the client. The client is positioned on the horse and actively responds to his movement. The therapist directs the movement of the horse; analyzes the client's responses; and adjusts the treatment accordingly. This strategy is used as part of an integrated treatment program to achieve functional outcomes.
Cathy Josephson, of Northport, has a daughter, Erika, with charge syndrome, which has left her deaf and legally blind (she can see only a short distance out of one eye). Erika has trouble sitting up for long periods of time, so her lessons last only 30 minutes. “She’s aware of what’s going on,” Cathy said. “Nancy does a great thing. She sings to her. They play games.” Erika “has gotten so much stronger,” her mother said. “Her upper-body strength has gotten much better.”
While many people view chickens as something to be barbecued, there is evidence that chickens have high intelligence and can easily create personal bonds with humans. Chickens also have their very own means of communication. Each sound means something different in “chicken language” and researchers have identified up to 30 different types of vocalizations.
Mountain House, a Santa Barbara-based adult residential facility, has recently implemented a program that uses chickens to help comfort their patients who have been diagnosed with mental illness and high anxiety.
Ellen Levinson, executive director of Life Care Center of Nashoba Valley said, “We deal with agitation a lot on the dementia unit,” Levinson said. “Having that chicken in my arms and holding it against my body was profoundly soothing. The chicken felt wonderful to hold. Something clicked. If I were agitated or upset, this is what I would want.”
For individuals with an ASD or Asperger's syndrome (a form of autism), chicken therapy may be a surprising but effective breakthrough.
"An autistic or Asperger's individual inherently needs to be assisted away from over fixation on the inner self," explains Pet.org.au, which provides support services for "autistic children and parents to find the 'perfect' companion animal."
"This encouragement to outward awareness and not to fear it can be found in the antics and curious jerky head motions that catch the eye made by all chickens," Pet.org.au says. "It is so captivating and funny…"
"Chickens, as with most pets, will coax a special needs child to innately accept that there is fascinating 'chaos' in life and that unpredictable things will occur with fun result."
Research has found that having a pet confers health benefits on most owners, with or without an illness. Studies have shown that being around pets is associated with lower blood pressure and heart rate, and fewer symptoms of anxiety and depression. Therapists and hospital volunteers take advantage of that by using therapy animals to bring comfort and other psychological benefits when visiting patients. No matter what type of animal it is, they all can help humans in a way other humans can’t. Hopefully in the future more types of animal therapy will be a means of healing for patients.
Mon, Sep 19, 2016 @ 11:44 AM
To be a successful nurse, excellent communication skills are required. The ability to communicate and connect with patients and health care professionals can help build relationships, prevent mistakes and provide a higher level of care.
According to a 2013 study published in the Journal of Patient Safety, as many as 440,000 people die each year from preventable medical errors, representing the third leading cause of death in the U.S. on the list from the Centers for Disease Control and Prevention (CDC). Of deaths due to medical errors, The Joint Commission estimates that 80 percent involve miscommunication. The Joint Commission’s analysis of 2012, 2013 and first-quarter 2014 data revealed that in all three time frames, communication was one of the top three leading causes of sentinel events, a patient safety event unrelated to the patient’s illness or condition that results in death, permanent harm or another qualifying negative outcome.
Increases in nursing communication can lessen medical errors and make a difference in positive patient outcomes. In a 2014 study published by the New England Journal of Medicine, medical error rates in nine children’s hospitals decreased by 23 percent after a handoff program was instituted to enhance and standardize communication. According to Ros Wright, the body of literature in nursing communication points to “increased recovery rates, a sense of safety and protection, improved levels of patient satisfaction and greater adherence to treatment options” as well-documented results of effective communication.
Communication Theories in Nursing
Multiple communication theories are used in nursing to help explain and guide interactions made between nurses and patients, as well as nurses and other health care professionals.
Peplau’s Interpersonal Relations Theory
This theory focuses on the nurse-client relationship and the therapeutic process that takes place. Communication that occurs in this context involves complex factors such as environment, in addition to attitudes, practices and beliefs in the dominant culture. Peplau’s interpersonal relations theory defines four stages of the relationship that achieve a common goal:
- Orientation Phase: The nurse engages the patient in treatment, and the patient is able to ask questions and receive explanations and information. This stage helps the patient develop trust and is where first impressions about the nurse and health care system begin to evolve.
- Identification Phase: The patient and nurse begin to work together. These interactions provide the basis for understanding, trust and acceptance as the patient becomes an active participant in treatment.
- Exploitation Phase: The patient takes advantage of all services offered, exploiting the nurse-patient relationship to address treatment goals.
- Resolution Phase: As a result of effective communication, the patient’s needs are met, and he or she moves toward full independence. The patient no longer needs help, and the relationship ends.
Dyadic Interpersonal Communication Model
The dyadic interpersonal communication model describes the dynamic interactive process that takes place between two people. Based on a sender and recipient — the encoder and decoder — and outside influences such as perception, attitude, content and the emotional and physical elements, the model points to the many factors that can alter the message or the message’s delivery.
As the sender or encoder provides a message, the recipient, or decoder, must process the information. The dyadic interpersonal communication model highlights the importance of clarity and awareness for the many factors that can affect verbal and nonverbal communication.
A number of other theories in communication and specifically in nursing communication have been used in health care. For instance, Jean Ann Seago notes that “Habermas’ critical theory has been used to identify successful nurse-physician collaborative strategies, including a willingness to move beyond basic information exchange and to challenge distortions and assumptions in the relationships.” Also, Seago mentions theories deriving from Foucault, feminism and the aviation industry to understand and enhance communication. In addition to these types of theories, several others could be named, such as those in experiential communication.
Best Practices in Nursing Communication
In order to help patients and work alongside peers, nurses must consider the skills and tools that are involved in effective communication. From being aware of potential barriers blocking effective communication to utilizing integral communication skills, nurses can take steps toward providing better care.
Barriers to Effective Communication
Nurses who are aware of the common barriers to effective communication will be able to anticipate and properly react to any roadblocks. With this focus, nurses can help ensure optimal communication and patient care.
In "Effective Communication Skills in Nursing Practice," Elain Bramhall highlights common barriers to effective communication for the patient and health care providers. Patient barriers include environmental items such as noise, lack of privacy and lack of control over who is present; fear and anxiety related to being judged, becoming emotional or being weak; and other barriers such as an inability in explaining feelings and attempting to appear strong for someone else’s benefit. Health care professional barriers include environmental items such as lack of time or support, staff conflict and high workload; fear and anxiety related to causing the patient to be distressed by talking or responding to questions; and other barriers such as a lack of skills or strategies for coping with difficult emotions, reactions or questions.
Effective Communication Skills
In the Journal of the Academy of Medical Sciences of Bosnia and Herzegovina, Lambrini Kourkouta and Ioanna Papathanasiou highlight three foundational skills in communication:
- Nonverbal Communication: An “ongoing process … characterized by facial expressions, gestures, posture and physical barriers such as distance from the interlocutor,” nonverbal communication must agree with verbal communication. In stressful moments, Kourkouta and Papathanasiou note, changes in these two communication types can be difficult to assess.
- Listening: An important part of communication, listening is a “responsible nursing practice and requires concentration of attention and mobilization of all the senses for the perception of verbal and nonverbal messages emitted by the patient.” By listening, nurses can be attentive to the patient and integrate care according to the patient’s evolving needs.
- Personal Relationships: Marked by kindness, compassion and care, nurses can develop good personal relationships with the ability to “ask questions with kindness and provide information that does not scare, that demonstrates interest, creates feelings of acceptance, trust and a harmonious relationship, especially in modern multicultural society.” This relationship is connected to not only the transmission of information but also the mental and emotional dynamics found in communication.
Further skills can promote effective communication practices in nurses. Bramhall points out that asking open questions, clarification and screening questions can help keep the focus on the patient. For information giving, providing small amounts of information at a time, checking what information the person knows already and pausing before continuing can help. And for listening, summarizing, paraphrasing, empathizing and making educated guesses can demonstrate that the nurse is listening and able to communicate effectively to patients and other health care professionals.
Developing Crucial Communication Skills
It is no secret that communication skills for nurses are essential and difficult to master — and they require proper attention. “Promoting effective communication in health care is demanding, complex and challenging because of the nature of the work environment, which is often stressful and pressurized, providing little time for communication,” Bramhall writes. “If nurses are to meet these challenges in the future, they need to be supported by high-quality, evidence-based training.”
Through education and employment-sponsored training, nurses can advance communication skills that are crucial to improving as effective health care professionals. At Southeastern University, current nursing professionals can enhance their communication skills with an online RN to BSN degree. The program expands on knowledge and skills nurses need to advance into leadership positions.
For nurses, communication comes into play in virtually any context. As nurses cultivate these skills to develop professional relationships with fellow health care professionals, connect to patients and become more well-rounded and effective individuals, education and on-the-job training can maximize the impact improved communication skills will have in the workplace.
Tue, Sep 13, 2016 @ 03:12 PM
As healthcare changes, so do their goals. The latest goal is 80% of the Nurse workforce should have their BSN by 2020. Most hospitals are no longer hiring Nurses with only their Associate’s degree. If they do hire them, the Nurses are expected to sign a contract that they'll get their BSN within a certain time frame.
When explaining why, Luzar proudly reads from what she wrote for school about her return: “There is much I do not know, have not taken into consideration or addressed from nursing school 30 years ago. It is the right time physically and emotionally in my personal life to commit to a program to learn what I do not know.”
Luzar, who received her BSN in 2014 from Ohio University, is one of many nurses taking advantage of RN-to-BSN programs across the region and country that have been cropping up to help registered nurses with diploma or associate degrees take the next step in their education as hospitals increasingly expect higher skill levels.
“The hospitals at least in our area aren't hiring the associate degree prepared nurses, or they would prefer to have a BSN,” said Linda Linc, dean of the Byers School of Nursing at Walsh University in North Canton. “So you're seeing more individuals going right into a BSN program, and there are a lot of them in Northeast Ohio.”
Many Northeast Ohio health systems are looking only to hire nurses with a BSN. Those with an associate's degrees are often asked to sign a contract that they'll get their BSN within a certain timeframe after employment.
Following a 2010 report from the Institute of Medicine, health care providers across the country pushed forward initiatives to get more of their nurses baccalaureate-trained. “The Future of Nursing: Leading Change, Advancing Health” recommended that 80% of the nursing workforce have a BSN by 2020. The report stated that the health care system doesn't provide sufficient incentives for nurses to further their education and get additional training.
“Everyone has taken that very seriously, knowing that health care reform requires nurses to be front and centered and that they need to be well-educated,” said Joan Kavanagh, associate chief nursing officer for the Office of Nursing Education and Professional Development at Cleveland Clinic.
Patricia Sharpnack, dean of the Breen School of Nursing at Ursuline College, said she's seeing an uptick in the number of students looking to complete their BSN
“Initially there wasn't as great of a push by the hospitals or the acute care agencies to really mandate this,” she said.
For more experienced nurses without a BSN, there's a ticking clock to get one. Earlier this year, the system dropped its timeframe from the three-year requirement it started with in 2013 to a two-year window for nurses to get their bachelor's, “knowing that the year 2020 is creeping up on us,” said Melissa Kline, vice president and chief nursing officer at MetroHealth.
In the past three years, the number of MetroHealth's nurses who are baccalaureate-trained has increased from 48% to 65%, and at any given time, another 13% to 15% are enrolled in a program.
Although achieving the goal of having 80% of nurses baccalaureate trained by 2020 isn't specifically tied to funding or reimbursement, Kline said, evidence that a higher level of nursing education is connected to better outcomes was encouraging enough for hospitals to head in that direction.
In 2013, the Clinic moved to have all nurses who join the system sign a contract that they will attain their BSN within five years. While Kavanagh emphasizes the Clinic is appreciative of and welcome nurses who graduated from diploma and associate degree programs, the goal is that they will get a bachelor's degree.
The extra training brings additional skills of leadership, strategic thinking and research that simply cannot be covered in shorter programs, she said. Diploma and associate degree programs prepare nurses at the micro level, but further education to understand the big picture of systems and how teams work together is increasingly important as health care changes.
“We live in a day where there's more to be known than can be known,” Kavanagh said. “We're knowledge workers. We're constantly wanting to be able to supply the resources and the support to our nurses so that they can continue to develop, whether that's with a bachelor's or a master's or a doctorate.”
Summa Health also no longer hires nurses without a BSN. (A few exceptions are made, but the nurse has two years upon employment to attain their BSN.)
“I wanted to make sure that I didn't hire non-BSN nurses into Summa who would be competing with those loyal diploma nurses who were at a stage in life, who weren't going to go back and get their BSN,” said Lanie Ward, Summa's senior vice president and chief nursing officer. “I didn't want new nurses to be in the 20% number of non-BSNs in 2020.”
Summa is well on its way to achieving its goal. At present, 77.4% of its nurses at Summa Akron City and St. Thomas hospitals have a BSN, up from 60% when the report came out in 2010.
Putting patients first
“A lot of them choose the (associate's degree in nursing) because it's cheaper and quicker, and that really isn't a good reason when we're looking at patient outcomes,” said Motter.
The RN-to-BSN programs, like the one at Kent State, can be a good fit for those students facing those challenges. She's also seeking grants to help support such students.
Kavanagh of the Clinic emphasized that a bachelor's degree is in no way the end of the line.
“It's really all in the name of increasing quality of care for our patients, increasing the access and the coordination, and all of that requires ongoing and lifelong learning,” she said.
Mon, Sep 12, 2016 @ 04:15 PM
Pediatric Nurse, Meghan Nesom is an inspiration and a true example of strength. She has received heart breaking news that won't stop her from continuing her passion of healing others. Meghan reminds all of us how amazing Nurses are and no matter what they are going through in their personal lives, they will always try their hardest to stay positive and moving forward. Staying positive is something Meghan has clearly passed on to her son and once you see his response to his mother's diagnosis, you'll completely agree.
Nesom is a wife and mother who has been working as a pediatric nurse. She’s helped heal children with cancer, and has also been there to comfort children in the moments they succumb to the disease.
“There is never a ‘woe is me,’ with kids,” she says, “They just are fighters. They’re wonderful.”
And the same could be said of this brave woman, who, in a cruel twist of fate, has also been diagnosed with cancer.
But rather than feeling sorry for herself, her response is one of utter selflessness: she describes the relief of knowing it’s she, and not her child, that’s been diagnosed.
She underwent surgery and radiation three years ago to kill the cancer; now, however, it has returned in the shape of clear cell sarcoma, for which there is no cure. That also means she’s recently been tasked with telling husband Philip and 4-year-old son Colin about the traumatic procedures she’s about to undergo.
So, Meghan told her son that she was going to have to have her leg cut off — and his response truly proves that some children have a wisdom far beyond their years.
“He told me that all of his friends are going to be jealous because his mommy’s going to have a robot leg,” she proudly recounts.
And, despite already beginning oral chemo, she still continues to work as a nurse and help others. Like the retired nurse who spends her days driving cancer patients to their chemo appointments, Meghan has been tireless in her quest to help others.
Her coworkers have been by her side through it all, even raising a whopping $10,000 to help cover medical costs.
To help this fantastic woman who has devoted her life to helping others, visit her GoFundMe page.
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Thu, Sep 08, 2016 @ 01:03 PM
Topics: school nurse
Wed, Sep 07, 2016 @ 02:31 PM
On the hot Saturday night of Labor Day weekend in 2002, Jon Hagen was working his regular evening shift as a flight nurse on a medical helicopter in Wisconsin when a call came through about a rollover accident on a rural highway. Hagen and his partner rushed to the scene and airlifted a critically injured man to the nearest trauma center.
The patient, who looked about the same age as Hagen, died minutes after arriving at the emergency room. But something about the case haunted Hagen, a married father of two.
"For some reason, this one stuck," Hagen said. "Here's a guy that's I don't know how far from home, traveling alone ... You think about that and you wonder if they had family, kids, what they were doing."
Hagen Googled the patient's name a few days later. When he found an online obituary for Tom Procek, a 42-year-old married father of three from Woodridge, he took a few minutes to send the Proceks an online message to let them know their loved one didn't die alone.
Hagen didn't know it at the time, but that small gesture offered Procek's family comfort for years to come. And more than a decade later, Procek's only daughter, Kelly, returned the favor last spring when she Googled Hagen's name and sent him a touching message on Facebook.
"I wanted you to know that you and the work that you do inspired me to go back to school for nursing ...Throughout my school when we are asked why we wanted to go into nursing, I go back to the letter that you wrote our family about being by my Dad's side in his final moments. It meant the world to me that he wasn't alone. My Dad and I were very close and it still upsets me that we never were given the chance to say goodbye but thankful that he was with the people that were trying their hardest to save him. It inspired me to be that person for someone else."
Since Procek, 32, sent the message in March, she and Hagen, 57, have gone on to forge an unlikely friendship. The man who cared for her father in his final moments now serves as her nursing mentor. Hagen, who still works full time as a flight nurse in Wisconsin, and his wife drove to Downers Grove in May for Procek's graduation ceremony from the nursing program at College of DuPage, when he pinned her uniform — a long-standing tradition for nursing graduates. He cheered her on from a distance as Procek studied for her nursing certification exam, offering her tips and encouragement.
And when Procek begins work as a full-time pediatric nurse at MacNeal Hospital in Berwyn this month, Hagen will be anxiously awaiting stories from her budding career.
It's a bond that nurses seldom get to experience, despite the number of people they affect on a daily basis, said Mary Jo Assi, director of nursing practice at the American Nurses Association. Nurses may come in contact with hundreds of patients and their families each year, but they are trained to not expect much back in return.
"Typically, I think that nurses understand that when they are caring for people who are ill, people are not at their best," said Assi, who added that Hagen and Procek's story was an important reminder: "Those interactions have ripples ... it just absolutely warms my heart."
Lifetime of service
As a high schooler growing up in Wisconsin, Jon Hagen was inspired to become a paramedic by the 1970s show "Emergency!" Hagen received his emergency medical technician certification in 1976 at the age of 17. He took a job in an ambulance, fulfilling 24-hour shifts — one day on, two days off — treating people in dire need. Hagen loved the exhilaration of helping people while under pressure.
But after 14 years on the job, Hagen sought better pay and more job opportunities. He went back to school at Fox Valley Technical College in Appleton, Wis., for an associate's degree in nursing, followed by a bachelor's in nursing from the University of Wisconsin-Green Bay. He worked for four years as a registered nurse at a hospital intensive care unit, then took a job as a flight nurse in 1994.
"Every call is different," Hagen said of medical helicopter work he still does today. "In a half an hour, you don't know where you're going to be, what you're going to be confronted with."
Such was the case on Aug. 31, 2002, when Hagen and his work partner, Pam Witt-Hillen, then flight nurses for ThedaStar Air Medical in northern Wisconsin, were dispatched to an accident on Interstate 39 in the town of Dewey, a rural community in central Wisconsin. By the time Hagen and Witt-Hillen arrived, the victim was being treated by local paramedics, who were administering CPR. The emergency response team got back a pulse and loaded the man onto the helicopter stretcher to be rushed to a hospital in Marshfield, Wis., 50 miles away.
Through years of experience, Hagen knew the downside of his job: being unable to save patients.
"The way I look at it is you do the best you can and let the chips fall where they may," he said. "You rely on your training to do the right interventions and give them a chance."
On the helicopter flight to the hospital, Procek was unconscious. His heart stopped beating, but Hagen and his partner were able to get a pulse back doing CPR. They were still performing CPR when the flight landed and turned him over to emergency room staff. Minutes later, Procek was pronounced dead at the hospital, Hagen said.
Days later, Hagen couldn't stop thinking about the case. He Googled Procek's name from a work computer, something he did from time to time after losing patients on the job. When he saw the description of Procek as a father and husband, Hagen then did something he had never done before: He signed the online guest book at the funeral home.
"I think it was just real brief ... just something acknowledging their pain, and that we were with him," Hagen recalled of the message he posted. "I think people want to know, no matter how bad it is, that he mattered to somebody, he didn't die alone. That we tried."
Kelly Procek, the spirited, rebellious eldest child of Tom Procek, had always enjoyed a close relationship with her father.
Her dad, a machinist, gave her nicknames like "Smelly Kelly" and purposely swerved when he drove his daughter to dance team practice, trying to mess up the makeup she applied in the car. When he grounded her, he took the tires off her car and left it on cinder blocks in the driveway to ensure she didn't sneak away, she recalled with a laugh.
The weekend before the accident, Tom Procek moved Kelly into her new apartment in Bloomington, Ill., where she was enrolled in classes at Heartland Community College. Kelly returned home for Labor Day seven days later, and was out with friends on the night of Aug. 31 when a police officer called her cellphone to tell her that her father had been in a serious accident. They tracked down her mother, who was spending the long weekend elsewhere in Wisconsin with Kelly's youngest brother.
After several confused phone calls, the family learned that Tom Procek had died.
It was devastating news for the family, who were left with many unanswered questions: Where was he heading? What caused the single-car accident? Did he suffer or feel alone?
As the family scrambled to plan funeral services, the message from Hagen was so appreciated.
"We couldn't be there, but to hear from somebody who was there, somebody who cared, provided me with a tiny bit of closure," Kelly Procek said.
Inspired to help others
In the years after her father died, Kelly Procek struggled to find direction in her life. She graduated with her associate's degree, then moved to California with her boyfriend, Josh, for a fresh start. The couple had two children, and Procek worked for a cousin's event-planning business. But after three years on the West Coast, Procek wanted her children to be around family. She also decided it was time to get onto a career track.
When considering what she wanted to do, Procek remembered Hagen and the solace he offered her family when they needed it most. She also recalled the positive experiences she had with the hospital nurses who helped deliver her children.
Before moving back to the Midwest, she contacted the College of DuPage and inquired about what it would take to earn a degree in nursing. She moved back in 2012 and, for the next four years, spent hours at a time at the Glen Ellyn campus attending classes, or at local coffeehouses studying. Josh, a bartender, watched the children during the day. At night, after a long day of studies, she'd rush home to make dinner, give the children baths and put them to bed.
Procek excelled in her classes, earning the distinction of high honors, and became co-president of the college's Student Nurse Association. As her graduation day neared, she felt it was time to give credit to the man who inspired her path. She sent the message to Hagen on Facebook.
"It touched my heart," Hagen said. "That's kind of why you do what you do."
Within the first few exchanges, Hagen agreed to pin Procek at her graduation ceremony in May. Before a crowd of hundreds, Procek, who was chosen as the ceremony's graduation speaker, told the story of her friendship with Hagen.
"No matter where we go in our careers, always remember that our job won't always go smooth or be enjoyable. It won't always be clean or stress-free. But it will always have purpose," Procek told her fellow graduates. "Be that person for someone. Go that extra step."
Since then, the new nurse and her mentor have been in regular contact. Hagen sent her texts wishing her good luck before the nursing exam, then a card in the mail when she passed. She reached out to him excitedly when she landed her first job.
Procek, who hopes someday to transition into emergency room nursing, said she wants to follow her mentor's footsteps in more ways than one.
"I think that ultimately he's an inspiration of an amazing nurse," she said. "Just going into it, I hope I can somehow pay that forward."
Topics: Nurse inspiration
Tue, Aug 30, 2016 @ 02:37 PM
A Nurse Is a Nurse
Are you being asked to float in an area outside your specialty? How about stepping in to help out on the Rapid Response team when necessary? How do you feel about it? Do you see it as an opportunity to learn something new and fill in when needed? Or, do you feel it puts the patients at risk because of lack or training? Please read this article and let us know your thoughts.
A recent Medscape article addressed a reader's question about whether a hospital could require critical care registered nurses (RNs) to cover shifts on their hospital's rapid response (RR) team.
RR teams rely on hospital staff with critical care expertise to provide bedside assessment of non–critical care patients who appear to be deteriorating. RR teams can differ in their makeup and typically consist of a "physician and nurse, intensivist and respiratory therapist, physician assistant alone, critical care nurse and respiratory therapist, or clinical specialist alone."
As many as 84% of patients who have a cardiac arrest demonstrate clinically identifiable signs of deterioration in the 6-8 hours before the event, and identifying changes in a patient's condition early can often be the difference between life and death. Failure to recognize a patient's deteriorating status and intervene is known as failure to rescue, and although it does not necessarily mean that a patient's caregivers have been negligent, it does represent missed opportunities to prevent potentially catastrophic outcomes.
The original question (above) noted that the nurse's manager said nurses needed only a brief orientation to function on the RR team. The reader asked whether the hospital could force nurses to serve on the RR team.
Carolyn Buppert, MSN, JD, author of the article, responded that critical care nurses are a good choice to be RR providers, and hospitals can require them to participate on RR teams. But, she wrote, "Each nurse needs relevant education and supervised experience to feel adequately prepared to provide the care the hospital assigns."
Nurses with RR experience wrote in with their thoughts, and even more commented on "floating" to unfamiliar clinical areas in general. Many said they had inadequate preparation for these situations and voiced concern about their patients' welfare. Time and again, nurses wrote that they were frustrated with the one-size-fits-all idea that "a nurse is a nurse." Read on for more of their thoughts. (Note: Comments may have been edited for clarity or length.)
The RR Role
Several readers commented that they had been thrown into the role of RR with little preparation. One nurse had many years of intensive care unit experience, but when her hospital instituted an RR team she received no formal training. She wrote:
My first experience as an RR nurse was having a bag, a cell phone, and this role thrust upon me. I had a caseload but another nurse would "watch over my patients." Even as an experienced nurse, I was uncomfortable doing the job and felt that I just had to rely on prudent nursing principles. There was no specific job description or protocol except basic ACLS. There were no specific personnel or roles on the team other than a respiratory therapist. There was no primary physician to manage orders. I had to contact the patient's physician during each event, which meant I was working with a different physician each time (when they responded). This process ate up time. My mind always raced to when could I get back to my patients, were there any new orders or changes in condition, were their medications given? I survived the transition to electronic charting, and I believe this was the straw that finally broke the camel's back for me. I changed jobs and I am happier for it!
Another nurse, who worked as an Army civilian nurse in an administrative position "embedded in an outpatient clinic" wrote:
I was suddenly assigned as RN on the rapid response team, 1 hour a week during the lunch hour. I objected but did not refuse, though I was not trained and in fact had pursued an alternate career path in nursing, starting with inpatient psychiatric nursing immediately upon graduation. I never worked on a medical/surgical unit and had no clinical patient care experience. I was told that my BSN degree and current RN license satisfied the training requirement for clinical nursing.
"It is reasonable to ask some nurses to fill in on RR teams, just as it is reasonable to ask an emergency room physician to assist in an in-house emergency," one nurse explained. "However, it is not reasonable to ask all nurses to do the same task. Would you want a pathologist assisting with the birth of your child? Both are physicians."
One nurse said that experienced critical care nurses "should be able to work as RR nurses when needed" and offered this advice: "You will have to obtain the history on the patient, admission reason, and hospital course, if any. My next step would be to treat the patient as if he or she were my patient in the intensive care unit and make the same basic recommendations within my scope as RR nurse, such as administering oxygen, intravenous access, obtaining an electrocardiogram, and notifying the attending, or start cardiopulmonary resuscitation or code blue if needed," she wrote. "However," she added, "never work outside your scope of nursing practice."
In her article, Buppert wrote that in addition to receiving adequate training, RR nurses must use their skills often enough to stay current. "To be assigned to RR once a month or less is not optimal and may not be safe," she wrote.
"An acceptable alternative would be to be put on the RR rotation once a schedule to maintain your comfort level when responding to these situations," one nurse commented.
Another reader had this to say about RR assignments:
Assignment to an RR role does require specific training. At the least, the nurse needs to know what the protocols are and what can be done independently. Nurses need to remember that if they don't know the role and don't have the training specific for that role, they can refuse that role. Yes, there are consequences to refusing, but there are also consequences to taking on something you're not trained or educated to do.
Floating to Unfamiliar Units
The Medscape article was about whether critical care nurses should be required to staff RR teams, but nurses who have been "floated" to unfamiliar units or settings (and who has not?) related to the article as well.
Nurses widely agreed that floating nurses should be given assignments that reflect their skills and experience, and in some circumstances they should not be given a patient assignment at all but instead perform such tasks as taking vital signs and administering familiar medications.
"I'm in a very similar situation where decisions are made with the assumption that, as long as I am a nurse, I can cover any area," one nurse wrote. "The decisions are being made by managers with non-nursing backgrounds who are looking to get the most out of nurses without providing adequate orientation. Nursing is the only profession that I know of that would allow its nurses to be placed in such a predicament."
"I have been transferred from an acute setting to a long-term care unit where floating for RNs, licensed vocational nurses, and certified nurse assistants happens routinely," commented another reader. "I'm an experienced nurse of 30 years, hold a masters as a clinical nurse specialist, and still find this practice intolerable and dangerous for all. Although nursing care is not the issue, the assignments are. Nurse-to-patient ratios are 30:1."
Floating to other units is a reality that often cannot be avoided, particularly in the hospital setting. Staffing needs rise and fall, and unexpected events occur, including sick calls and census changes.
In the Medscape article, Buppert said that a nurse can refuse to accept an assignment under certain circumstances, including lack of sufficient orientation, inadequate staffing for patient acuity, inappropriate skill mix, and when the assignment poses a serious threat to the health and safety of the patient. Nurses in this situation should file their institution's patient assignment objection form. Buppert acknowledged that doing so may result in disciplinary action or dismissal but said that repercussions, if any, may differ for those working under a collective bargaining agreement. Buppert cautioned against first accepting an assignment and then refusing it, because this could be considered patient abandonment.
One reader related:
On one occasion, the charge nurse gave me an assignment consisting of four patients clustered near each other down at one end of the hall, and my fifth patient was in the very last room on the other end of the hall. Her rationale was, "I want the nurses to keep the same patients they had yesterday." I refused to accept the fifth patient, stating that her decision was not in the patient's best interest, and I felt that she was compromising his care, my license, and the hospital. Was she mad? Absolutely. But after talking to the house supervisor about my refusal and my reason for it, she changed the assignment.
One nurse wrote about her experience of being expected to perform peritoneal dialysis without proper training:One nurse wrote about her experience being expected to perform peritoneal dialysis without proper training.
The job was thrust upon nurses with absolutely no training. Then they sent someone to train us who had no training skills at all. Peritoneal dialysis is a specialty. I feel that nurses are getting hammered with all sorts of additional duties and being told that it's alright when it isn't. Managers and administrations are causing nurses to treat patients like herds of cattle.
"In this age of specialization," asked another nurse reader, "why is it expected that a nurse can float to any unit at any time? We become specialized in our area of expertise and are more proficient in the performance of our duties because of familiarity. It devalues me as a professional by insinuating that I have no special talents or abilities that I have acquired through years of working on a specific unit in a specific field."
Floating as a Growth Experience
Floating can have positive effects as well, and nurses should try to approach these experiences as opportunities for learning and developing relationships with other hospital staff.
One nurse was advised to be open to floating so that she would become a more well-rounded nurse. "I always spoke up and asked questions, and was received with kindness and patience from the more experienced nurses," she explained. "I was there to help them and they respected me for that. Job descriptions and duties were easily accessible on the units for every shift, so I would know what was expected of me. I find it difficult nowadays to actually find a duties list on any of the facilities that I have been to."
Although many of us have had to float to other units, most of us have also been grateful for extra help when we have needed it. One reader offered, "I worked on a unit where we frequently pulled staff from other units, but I always tried to be careful with the assignment of the substitute staff member, and as charge nurse, I frequently checked on them to make sure they felt supported in every way! Also, I was sure to let them know how grateful we were that they were there with us helping us take care of our patients."
One nurse said, "This article is great because it has provided the resources needed to protect yourself from supervisors who look upon staff as 'anyone who can plug a hole.' It may not prevent poorly made decisions to plug that hole, but as the nurse who is floating, you can be on record as attempting to protect yourself. Document, document, document!"
Floating to Specialty Areas
Nurses working in obstetrics and pediatrics were particularly vocal. If nurses are subjected to the "a nurse is a nurse" concept, obstetric and pediatric nurses may be especially vulnerable. There is a huge difference between caring for an adolescent patient and caring for a newborn, and many nurses accustomed to caring for adults and adolescents are way out of their comfort zone when caring for babies in whom even the smallest mistake can have disastrous consequences.
Although many nurses who work in obstetrics are expected to be proficient in all areas of obstetrics—labor and delivery, newborn nursery, postpartum, and even high-risk antepartum—some nurses have specialty areas within the obstetrics unit in which they are most proficient. Many of these nurses strongly objected to being floated to other areas of the hospital, such as adult medical/surgical and orthopedics, and some were uncomfortable floating to the neonatal intensive care unit (NICU), labor and delivery, and pediatrics.Would you want an adult nurse to care for your preemie baby in the NICU?
One nurse wrote, "I work postpartum, and we don't take laboring patients—only stable women in preterm labor. Or we act as a second pair of hands, helping with patients or assisting with deliveries and cesarean deliveries. In pediatrics, we take the easier patients, usually those who are almost ready to go home."
Another nurse added, "I work on a mother-baby floor where we also take care of high-risk antepartum patients. Not every mother-baby nurse works in the baby admission area on labor and deliver—only those who want to. Why," this reader asked, "is it okay to float to a NICU where all the babies are on cardiac monitors? I feel like a fraud going to NICU. I've been a nurse since 1983, and I don't feel safe going to NICU or pediatrics. Why do hospitals think it's okay to do this? Would you want a pediatrician to see your adult mother? Would you want an adult nurse to care for your preemie baby in the NICU?"
Gratitude and Solutions
Nurses on all sides of the situation may be able to make things easier by being proactive. Critical care nurses, particularly newly hired ones, can ask about RR responsibilities and training. It might also be helpful for RR nurses to request a 1-day or half-day orientation on units to which they might be expected to respond.
All nurses can ask their employers for additional training, and although it should be provided, when it isn't, nurses can obtain it for themselves. Having additional critical care training, including the care of pediatric and neonatal patients, is a feather in a nurse's cap if and when he or she is looking for employment elsewhere.
One nurse wrote:
Good action points at the end of the article! Let's push our organizations for the training. Say how inappropriate it is and what the barriers are when you assume a position that you don't have any training for. Be specific. Propose a training plan; say what protocols/equipment nurses need to be familiar with. Talk with people who are long-time RR nurses. Identify issues (eg, no one skilled in drawing arterial blood gases when you evaluate a patient on the medical-surgical floor) and make solutions (develop a go-bag with an arterial blood gas puncture kit and analyzer, and all the other gear you would need).
Another nurse added, "We solved this issue by asking for volunteers who would be in a critical care float pool, and float nurses were oriented to a unit similar to their own. We had an RR team. We set up a competency review for the float pool and the RR team that had to be completed yearly. We had a good turnout of nurses who were willing to be oriented and float."
It is helpful to develop collaborations between units with similar types of patients, and nurses who feel comfortable floating to certain units should speak up. For example, a nurse on an obstetrics unit may also have pediatric experience and volunteer to float when nurses are needed there. Postpartum nurses with experience in adult medical-surgical or orthopedics units might volunteer to float there when needed.
Nurses whose units receive help from a floating nurse can also help to make things run smoothly.
A nurse who works in maternal-child health wrote:
Once in a while, we will be bursting at the seams, and so will our other maternal-child health units. When that happens, we are usually able to get a certified nursing assistant or licensed vocational nurse to float to us. Sometimes we will get a registered nurse, and they seem really nervous at first. When we tell them that we would never give them a patient assignment and just ask them to help out with vital signs, basic patient care tasks, and whatever they might feel comfortable with, they relax a bit. At the end of the shifts, they always tell us that they would be happy to come back and help us anytime!
One nurse suggested, "When a nurse from another unit floats to our department, we only give them very stable, easy patients, with our charge nurse being a resource person and the rest of us helping out. We only take 'growers and feeders' when we float to the NICU."
Another nurse stressed, "Nurses want what is best for the patient—no one is shirking their duty. Safety of the patient is the first order of business. But how safe for a patient is it when the unit does not have adequate staffing, and the floating staff member is not familiar with the unit's protocols for patient care?"
Another reader summed it up with, "I love safety, I love competence, but I love stretching my abilities and being the best nurse, too—one that could handle anything. We got this, nurses! Good luck!"
Have questions about floating and rapid response duty or maybe just a general question? Ask one of our Nurse Leaders!
Mon, Aug 29, 2016 @ 03:07 PM
We’ve all experienced or heard about long wait time to receive medical attention in the Emergency Room. It’s tough on everyone involved – the patients, their families and medical staff. Many people put off going to the emergency room for this very reason. If they can avoid it, they do. Here’s an interesting article about a Canadian study where Nurses are helping to alleviate this situation. Seems to make sense. What are your thoughts about it?
Emergency room crowding is a common and complex problem for hospitals all over the world, and anything that can be done to improve patient flow without compromising care is a great help. Now, a new study shows how carefully written nurse-initiated protocols can dramatically reduce time in the emergency room for certain targeted patients.
Implementing procedures where nurses start the diagnosis or treatment before patients are treated by a physician or nurse practitioner have been suggested as a possible way to improve the flow of patients in the emergency room (ER).
The new Canadian study, published in the Annals of Emergency Medicine, describes how nurse-driven protocols cut ER lengths of stay for patients with fever, chest pain, hip fractures, and vaginal bleeding during pregnancy.
Lead author Matthew Douma, clinical nurse educator at Royal Alexandra Hospital in Edmonton, Alberta, says:
"Nurse-driven protocols are not an ideal solution, but a stop-gap measure to deal with the enormous problem of long wait times in emergency departments especially for patients with complex problems."
Protocols cut ER time in busy, inner-city hospital
For their study, Douma and colleagues carried out a controlled evaluation of six nurse-initiated protocols in a busy, crowded, inner-city emergency room.
They measured a number of outcomes, including length of stay in the ER, time to diagnostic test, time to treatment, and time to consultation.
The results showed that nurse-driven protocols:
- Reduced the median time taken to administer acetaminophen to emergency patients with pain or fever by over 3 hours (186 minutes)
- Decreased average time to troponin testing for emergency patients with chest pain suspected to be heart attack by 79 minutes
- Cut average length of stay for patients with suspected hip fractures and patients with vaginal bleeding during pregnancy by nearly 4 hours (224 and 232 minutes, respectively).
"Given the long waits many emergency patients endure prior to treatment of pain," says Douma, "the acetaminophen protocol was a quick win."
Need for 'broad and creative strategies' to cut ER time
The researchers conclude that implementing carefully written nurse-driven protocols targeted at specific patient groups can result in improved time to test or medication, and in some cases, cut length of stay in the ER.
They also note that, "A cooperative and collaborative interdisciplinary group is essential to success."
According to the Centers for Disease Control and Prevention (CDC), around one in five American adults visited the ER one or more times in 2014, the most recent year for which full data is available.
In 2011, there were nearly 136.3 million visits to the ER in the United States, and 27 percent of patients were seen in under 15 minutes.
A number of approaches are being tried and used to improve patient flow through the ER. These include: extending the chain, decreasing and smoothing variation, matching capacity to demand, scheduling the discharge, and pull systems.
An example of a pull system is the "Be a Bed Ahead" scheme of pulling patients from the ER to the inpatient unit.
"Emergency department crowding will continue to require broad and creative strategies to ensure timely care to our patients."
Related Article: Emergency department nurses aren't like the rest of us
Topics: ER protocols