DiversityNursing Blog

By Michael McFall

At first, they want to die.

And then forensic nurses such as Monique Turner get to them. She talks to them, asks them about the sexual assault in a safe environment and tends to them — all while collecting the evidence police and attorneys will need to put the perpetrator away. By the time Turner is done, the victims feel like they can face the next day.

"People are ultimately grateful, it’s the greatest thing that we can give them," Turner said.

Forensic nurses have the added expertise to document wounds, collect DNA and look for evidence of neglect or abuse, as well as the ability to comfort a sexual assault victim and ultimately testify in court. And nowhere else are they needed more: Utah ranks 19th in the nation for reported forcible rapes, according to the Utah Department of Health. One in three women in the state will experience some kind of sexual assault in her lifetime, and one in eight will be raped, according to the department.

But as vital as their role is to the criminal justice system, it is one the public is relatively unaware of. November featured National Forensic Nurses Week; you may not have known. You may not have even heard of a forensic nurse before. But their early interactions with victims help define how they deal with their trauma for years to come, and their forensic skills help decide whether the attacker sees the inside of a prison cell.

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"The worst day of their life, forever" » As an emergency room nurse at University Hospital, Turner had never heard of a forensic nurse until a few years ago when she met one. There are several regional teams of forensic nurses around the state, including one that serves the Salt Lake Valley — Salt Lake Sexual Assault Nurse Examiners (SANE). Turner was looking for a little extra money, and with her affinity for "CSI" and familiarity with pelvic exams, she figured it could be a good fit.

Then she got started. Her first case was a woman who had been kidnapped, taken across state lines and been abused the whole way.

"It is really, really hard to see the evil that people do to each other; to listen to how horrible this person was to them," Turner said.

Nationwide, there is a lot of burnout: almost one out of every two forensic nurses will quit within a year. While a whole team of experts, including law enforcement, victims advocates and a Rape Recovery Center representative step in to help, forensic nurses tend to be the first or second people to interact with victims.

But in the three to four hours the exam takes, the nurses see the transformation.

"Our major job is excellent health care and compassionate initial response. It’s that first response a patient gets that has the potential to decide whether they can heal from this traumatic event and whether they stay engaged in the criminal justice system," said Susan Chasson, a forensic nurse on the Salt Lake City team who trains prospective members. "… There’s so much self-blame [after an assault], if we say ‘Oh yeah, it’s your fault,’ we compound that. When someone has a negative response, that keeps them from telling somebody else for a long time."

Victims are not forced to have the exam in the first place, and at any point, they can decline a specific part of the exam. The nurses do that to give back to them that sense of control that a sexual assault robbed from them.

The victims are clearly traumatized, but spending time with them, supporting them and returning "some of that power to them, they walk out … with their head up," said Diane Fuller, who founded the Salt Lake City team. The care does not get rid of their trauma, but it gives them a stronger sense of self, she added.

"I’m sure we can all think back to the many patients who cried and said thank you, and gave us a big hug and said ‘I can’t imagine what I would do if you guys weren’t here,’ " said Beth Weekley, who joined the team about six and a half years ago. That is what keeps Turner and Weekley on the team.

"We help them realize that they can go on, they don’t have to die," Turner said. Few other nursing jobs have such a huge impact on someone, said Turner, who joined the team shortly before Weekley. "… This is usually the worst day of their life, forever. … It’s really, really hard, but the emotional payoff is worth all of the evil nastiness."

And they make sure officers and attorneys have the evidence they need to put that nastiness behind bars.

Salt Lake City police Detective Cody Lougy credits forensic nurses for helping end a high-profile serial date rape investigation he worked several years ago. Azlen Marchet was convicted of sexually assaulting four women in Salt Lake County from 2002 to 2007. He is currently serving 45 years to life in prison.

Forensic nurses also help new officers working their first rape cases — Lougy remembers how nervous he was during his — with their years of expertise, guiding the officer in what to look for based on the evidence they collect.

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Brave new era » As vital as they have become, the nurses are a relatively new addition to the crime scene. The speciality only came about 21 years ago, created by nurses at the University of Minnesota School of Nursing. The Salt Lake City-based forensic nurse team formed about 12 years ago.

"The community needs simply weren’t being met," Fuller said. When she founded the team in 2001, she started off with eight people pulled from all over the place. Now she has 18, and her team is unique to most of the country: they respond to hospitals across the valley instead of being housed in hospitals, which would require the victims to drive to them.

When the nurses start out, they face a lot of intimidation in knowing how to care for a patient in emotional trauma, when before their jobs were focused on the physical.

"It’s a very different ball game," said Weekley, who joined the team shortly after Turner. "Thank goodness we work closely with [the Rape Recovery Center]. They’re with us on every single case we do. I cannot even imagine doing this without them."

Advocates from the Rape Recovery Center work with the nurse during the exam, talking to the victims as well, helping them with paperwork and understanding what comes next and the resources available to them, said Holly Mullen, executive director of the center. She admires the nurses’ ability, with the help of evolving technology, to collect evidence even days after the event, and even if the perpetrator left behind no bodily fluids. Most victims strongly want to see resolution in their case, built in part by that evidence.

But when it comes to testimony, the advocate is a "confidential communicator" — they cannot testify in a case. Not so with the nurses. They play a big part in not only objectively relating what they observed in the exam, but also in educating the jury about what that means, Fuller explained.

Like the first time approaching a traumatized victim, entering the courtroom can be intimidating for a nurse — at first. But since in their day jobs they spend much of their time educating patients, whether about wound care or healthy living, almost every nurse that Fuller has watched on the stand transitions naturally into that mode within the first couple minutes. They are still educating, but this time it’s the jury, not a patient.

Forensic nurses can potentially play a "very significant role" in trial when their findings corroborate one side or the other, said Blake Nakamura, Salt Lake deputy district attorney. "They can be pretty valuable and influential in making the case."

The quality of the evidence they bring is phenomenal, added Salt Lake District Attorney Sim Gill. "What they do is essential for law enforcement, prosecution, and what the victim is going through."

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Healing the healers » As much comfort as they bring to the victims, even the forensic nurses need someone to do the same for them. The team has a counselor on hand when a case hits a nurse particularly hard. For Turner, it was when she was examining a girl about her daughter’s age. "She had so much in common that it really hit home. The counselor helped me box that up."

Weekley knows just what that is like. Many of the stories they hear are haunting. "It might sound callous," she said, "but you need to have some boundaries to not let it completely affect you and your life."

The team is also in touch with people involved in the case if they need to vent or talk it out — since when Turner goes home to her husband, patient-privacy laws prevent her from discussing what she went through that day.

A lot of nurses burn out before long, either from the emotional burden or the hours; for most, being a forensic nurse is a second job. They sign up for six-hour shifts, which cover every hour of every day, during which they could be called out to anywhere in the valley. Turner goes on three to four calls a month, while others might go on five or six.

The nurses who stick around take hiatuses for a few months at a time — Turner is on one now — to recharge or focus on other areas of their lives.

"We want to make the world a better place and provide care in a field that not everybody can do," Weekley said. "We take pride in that. … It takes a special person to be able to do this job."

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Spreading the word » The team is always looking for new members. They hold biannual, three-day training sessions for prospective nurses, though only two or three people in any given 20-person turnout actually want to join the Salt Lake City team, Turner said. Most are either from other areas in the state, are just there to learn or back out once they realize what the job is like.

Ultimately, Turner would like the team to hire enough nurses to have two on call during each six-hour shift, as opposed to the one per shift they have now.

The next training is scheduled for March, then again next fall in Blanding. There is a big need in that corner of the state, since the nurses there often cannot take the time off to travel to Salt Lake City, Chasson said. Bringing the training to them also gives nurses in tribal communities and in neighboring southwestern Colorado, who are likewise isolated, the same opportunity.

Anyone interested in becoming a team member can find more information at slsane.org or by emailingslsane@comcast.net. The website also connects victims with hospitals and law enforcement in the Salt Lake Valley, with a comprehensive list of phone numbers they can call.

Regardless of whether a victim’s region has a trained forensic nurse at the hospital or on call, Mullen encourages victims to call the police or go to the nearest emergency room and report the rape.

Mullen and Fuller worry about the culture surrounding rape that blames the victim instead of the perpetrator that can keep victims silent. More than 88 percent of rapes are not reported to law enforcement, according to a 2007 health department survey.

Regardless of whether a victim’s region has a trained forensic nurse at the hospital or on call, Mullen encourages victims to call the police or go to the nearest emergency room and report the rape.

Mullen and Fuller worry about the culture surrounding rape that blames the victim instead of the perpetrator that can keep victims silent. More than 88 percent of rapes are not reported to law enforcement, according to a 2007 health department survey.

Still, they are thankful to see a slow and steady shift to placing blame where the blame is deserved — with the rapist. For Fuller, her nurses are seeing that proof firsthand.

Years ago, a typical victim would come in two to three days after the assault, Fuller said. Now they are seeing victims within the first 24 hours. "That’s public opinion changing. There is great care available, people really are believing you."

Source: The Salt Lake Tribune

By Jackie Farwell, BDN Staff

After a routine mammogram in the fall of 2011, Laurie Thornberg learned she had breast cancer. Over the next nine months, as the Oakland woman endured surgery and rounds of chemotherapy, she watched as friends and loved ones attempted to explain her condition to their children.

Some struggled. One person described Thornberg’s cancer to her children “like I had the plague,” she said. Others were more comfortable, including a close friend and neighbor Thornberg ran into while out for a walk.

“[She] told her children in a kind and gentle way,” Thornberg, a registered nurse, wrote in an email.

Thornberg chronicled the encounter with her neighbor in her new children’s book, “Julie’s Dream,” which she hopes families will use as a tool to talk with their children about cancer and its treatment, as well provide hope to cancer victims and their loved ones.

“Children, even young ones, can be very aware of their surroundings and have questions when they notice family members being upset, someone who is sick a lot, or even as simple as a person suddenly has no hair,” Thornberg said.

In the book, Thornberg’s neighbor explains to her children, “See our friend? She wears that bonnet to cover her head because she got sick and had to take a special medicine that made her hair fall out.”

One of the children turns to Thornberg, asking, “Why don’t you take off that bonnet? I’m sure you’re beautiful under there.”

The book goes on to detail the main character’s dream about magically being healed. Thornberg’s friend and the book’s illustrator, Juliana Muzeroll, had that very dream about her, Thornberg said.

“I liked this approach a lot because it gives the reader freedom to interpret the outcome to fit their own personal situation,” she said. “Meaning, that whether the loved one survives or passes away, there is always healing at the end of a cancer journey.”

Thornberg remains in remission 18 months after her last round of chemotherapy. She now realizes that the disease freed her from stressing over the demands of a life as a full-time hospital nurse, mother, and daughter caring for her disabled mother, said Thornberg, who now works in home health care and said she’s able to focus on what’s really important in life.

“Getting cancer took me away from my excessive stress,” she said. “I often say ‘cancer healed my life.’”

“Julie’s Dream” is available in softcover or as an e-book on amazon.com, barnesandnoble.com, and authorhouse.com, by searching the title and author together.

Source: Bangor Daily News

By Debra Anscombe Wood, RN

Some patients are trached and vented. Other patients are on dopamine drips or receiving total parenteral nutrition. This sounds like a critical-care unit, but hundreds of children in New York and New Jersey are receiving this type of intensive care at home from nurses and other healthcare professionals. 

“There are many more children (with complex care needs) going home,” said Ana L. Pacheco, RN, MS, director of patient services at Montefiore Medical Center Home Health Agency in New York City. “There’s more high-tech in the home. It’s incredible. Being in their home is so much better for the children and parents.”

Bringing the child home despite needing complex care reduces the risk of nosocomial infection and often is easier on the family than continued hospitalization, said Kathy Pfeiffer, RN, BSN, director of pediatric clinical operations for BAYADA Home Health Care, headquartered in Mount Laurel, N.J.

“These kids are acute,” Pfeiffer said. “The homes are set up like an ICU.” 

St. Mary’s Home & Community Programs in New York City has experienced an increase in home care volume as medical advances have allowed premature and other medically needy children to survive longer with a better quality of life. 

“We’re getting sicker kids home, and their needs are much greater,” said Lois Long, RN, nurse coordinator at St. Mary’s Home Care. “Our job is a little more challenging because of that.”

Children may receive home care because they have been diagnosed with pulmonary and cardiac diseases, congenital defects, traumatic injuries and other conditions. They range in age from newborns to young adults. Some may live in shelters or in foster care. 

Certified agencies provide intermittent care and licensed agencies offer hourly or shifts of care, including accompanying the child to school. Some organizations, such as St. Mary’s, offer both types of home services. 

Teaching and doing

Nurses teach parents how to care for the child while still in the hospital, but once discharged, home care nurses reinforce that education, fine tune techniques, perform treatments such as peritoneal dialysis, tube feedings and nebulizer and monitor the patient’s condition and the family’s progress with providing care. “We do a lot of education,” said Anne Calvo, RN, BSN, MPS, assistant vice president at the Winthrop-University Hospital Home Health Agency in Mineola, N.Y. 

Home health nurses collaborate with physicians, parents and a multidisciplinary home team, including rehabilitation therapists, social workers and home health aides. 

“We do a lot of care coordination,” said Eno Onda, RN, MEd, coordinator of care in the Children & Family program at the Visiting Nurse Service of New York. “It is patient-centered, family-centered care, and we have to keep good lines of communication.”

VNSNY focuses on short-term care with extensive education to strengthen families to manage the complex care needs of their patients, Onda said. Nurses draw on scientific knowledge, research and nursing theory as they identify needs and coordinate care. 

“What the nurse does is very challenging,” Onda said. “You have to know your values and emotions, so you can [hear] the stories people are telling you and put everything together.” 

Staying for hours at home, school

Some children require constant care. When their parents go to work or sleep, home care nurses often fill in, even accompanying the child to school to perform necessary treatments and medications, according to physician orders and company protocols. 

“They are fragile (children with complex care needs), but despite that, they are kids,” said Donna McNamara, RN, MPA, assistant vice president of community programs at St. Mary’s. “You want to support their growth and development and cognitive function.”

St. Mary’s nurses try not to intrude on family life but become part of the daily flow of activities. McNamara said it takes a team approach to keep these children at home. At BAYADA, a transitional care manager meets with the family in the hospital. Then a clinical manager makes the initial home assessment, collaborates with physicians and other members of the team, and ensures supplies are in the home and the nurse caring for the child is competent to provide treatments. BAYADA conducts simulation drills to hone responses to emergency situations, such as a trach tube coming out or a seizure lasting longer than expected, and reassesses competencies annually.

“In a hospital, you have a team and can call out if there’s a crisis,” said Lisette Alicea, RN, RRT, clinical manager at BAYADA’s Hackensack, N.J., office. “We have to make sure we have the orders [for various situations] and train our nurses to know what to do.” 

Challenges and rewards

In addition to providing highly technical care employing the latest equipment and products, home care remains highly personalized. Nurses offer support, while watching for stressors or signs of abuse and neglect. 

“It’s difficult for parents to have a sick child, whether born premature or (born) healthy and something happens,” said Alyson Bolton, RN, CPN, BAYADA transitional care manager. “The family dynamics are challenging.”

Nurses help by showing parents they are capable of taking care of the child and identifying what the child can do, added Shawn Carroll, RN, clinical manager at BAYADA in Hackensack. 

Psychosocial issues present some of the greatest challenges for nurses. 
“We work with child protective services when needed and with social work,” Calvo said. “We are totally involved in the care.”

Home-care nurses collaborate with others on the team and community resources, such as homeless shelters, counseling and housing authority officials, to resolve concerns.“You become part of the families from day one and then watch them grow and become more self-sufficient,” Carroll said. “It’s a special type of nursing.”

Jeanette Carter, RN, team coordinator at St. Mary’s Home Care, agreed it is rewarding to care for patients who came into the program as fragile infants and watch them improve as they become young adults. 

Despite poor prognoses, many children experience positive outcomes, walking or talking when experts doubted it possible. 

“The good outcomes are really rewarding,” Calvo said. “You see the children blossom.” 

Source: Nurse.com

By Don Walker of the Journal Sentinel

Rita Higgins was caring for Natalie Engeriser, her 11-year-old patient, when Natalie's mother, Katie, walked into a hospital room on the seventh floor of Children's Hospital of Wisconsin.

There's some kind of disturbance in the hallway, Natalie's mother told Higgins Thursday.

"When she said 'disturbance,' I was thinking one of the kiddos was having a hard time," Higgins said Saturday.

"I stepped into the hallway and I immediately realized something was wrong," Higgins said. "There were two nurses at the nursing station and by the looks on their faces, I knew something was wrong. I heard one of the nurses say, 'Oh my God, they are shooting. Call an active-shooter code.'"

A man police later identified as Ashanti Hendricks was armed and police were trying to arrest him. But Higgins, 37, a registered nurse who started working at Children's last February, didn't really know what was unfolding.

But Higgins, a mother of two just starting her third career, knew what to do, as did the rest of the medical staff.

"I immediately turned back around and I said to Natalie, 'Honey, I'm going to need you to get out of bed and me and your mom are going to help you get into the bathroom.' I was going to need them to go into the bathroom and lock the door behind them," she said.

Higgins wanted to be sure she didn't scare Natalie. The girl is one of Higgins' favorite patients. In fact, when Higgins arrived for work on Thursday, she had been assigned a different floor. Higgins was disappointed because she liked working with Natalie and had made strides in her care.

"A co-worker saw how disappointed I was," Higgins said. "A fellow nurse traded with me, basically. She said, 'Hey, Rita, I know you want to take care of Natalie.'"

Later, as the hospital went into lockdown, she was unsure what was unfolding on the unit. That's when she helped get Natalie out of harm's way.

"We got her and the medical equipment in the bathroom with mom," Higgins said. "I told her to lock the door. I looked them straight in the face and said, 'Don't open the door until I tell you to open the door.' I looked at Natalie and said, 'It's going to be OK.' And I closed the door."

At Children's, doors to the hospital rooms don't lock. But next to the closed door was a small window. As Higgins stood guard, protecting a mother and her little girl, she managed to peer out, trying to make sense of the noise, the chaos.

"Looking back on it, in the period of time when we truly did not know what was going on, we didn't know if someone was just literally shooting, and we didn't know police were involved," Higgins said. "There was that unknown period of time when you think, 'Is this door going to open with a guy with a gun?'"

"For all three of us, that was pretty horrible. All I know is that someone was on the unit with a gun. Shots had been fired," Higgins said.

At some point Higgins saw another nurse in the hallway who was watching a TV monitor where she could see police handcuffing the man elsewhere on the floor.

"That's when I stepped out of the room, looking at the monitor," Higgins said. "Seconds later, I heard more scuffling and the man was suddenly running onto my side down the hall and past me. I went back in the room and closed the door."

Police finally subdued him.

"I knew it was loud and so much stuff was going on," she said. "God knows what (Natalie and her mom) were thinking.

"I told them I was going to stay in here. I told them a bad guy was captured. I told them they were going to hear a lot of stuff."

Natalie and her mother came out of the bathroom. Higgins told Natalie and her mother to turn on the television and turn the volume up loud. Drown out the noise outside.

Two days after the ordeal, Higgins was full of praise for Natalie, her mother and the other nurses on the floor who performed calmly, admirably and courageously.

"I was thinking I was glad I stayed on the floor that day and that I was able to be there for Natalie," Higgins said. "You build up trust and she trusted me."

Later that night, when Higgins was about done for the day, a music therapist came with a guitar to visit Natalie.

The therapist played the Katy Perry hit, "Firework."

"That's the way I ended my shift, rocking out with Natalie with 'Firework,'" Higgins said.

Source: Milwaukee Wisconsin Journal Sentinel

RNs can compare their health, safety and wellness to the overall U.S. population and other nurses within demographic categories, including nursing specialty, by taking the American Nurses Association’s new HealthyNurse Health Risk Appraisal, developed in collaboration with Pfizer, Inc. 

This HIPAA-compliant online survey also allows nurses to assess workplace risks such as patient-lifting injuries and workplace violence, the ANA stated in a news release.

The appraisal is a component of ANA’s HealthyNurse program, which encourages nurses to focus on self-care so they can be at their healthiest — physically, mentally, emotionally and spiritually — to provide the highest quality of care and serve as role models, advocates and educators for their patients. 

“When we model the healthiest behaviors ourselves, it becomes easier to help our patients to do the best thing for their health,” ANA President Karen A. Daley, RN, PhD, FAAN, said in the news release. “This appraisal will help nurses to optimize their health and serve as an online check-up on the health risks they face in their personal and work lives.”

The data-gathering tool is combined with an interactive Web Wellness Portal, a website for respondents to obtain information and educational resources based on their interests, workplace conditions and results in areas such as fitness, nutrition, stress management, health screenings, sleep and tobacco and alcohol use. 

The appraisal, which takes 20 to 30 minutes to complete, will become a continually accumulating database that will enhance the nursing profession’s ability to track trends and set policy and advocacy priorities and strategies, according to the news release. The ANA recognizes a lack of data on nurses’ health and work environment, and demographic comparisons to national health benchmarks. The most applicable data, the Nurses’ Health Study from the Harvard School of Public Health, is more limited in topics and focuses on women’s health issues.

The ANA defines a healthy nurse as one who “actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional well-being,” and who “lives life to the fullest capacity, across the wellness/illness continuum, as they become stronger role models, advocates and educators, personally, for their families, their communities and work environments, and ultimately for their patients.”

The ANA’s concept of a healthy nurse includes five aspects that enable nurses to function at their highest potential: calling to care, priority to self-care, opportunity to serve as a role model, responsibility to educate and authority to advocate. 

All RNs and RN nursing students are encouraged to take the appraisal for free and access the Web Wellness Portal at: www.ANAhra.org. 

Source: Nurse.com

By Madison Lozano

Sgt. Angela Hughes was always interested in nursing, but wasn’t up to the role right out of high school.

Instead, she entered the Army as a supply soldier. Though she loved her job, after 15 years, Hughes developed carpal tunnel syndrome and was moved to Fort Hood’s Warrior Transition Brigade to prepare to leave military service.

Hughes is one of several soldiers taking part in a new brigade program to earn nurse’s aide certifications before they transition out of the Army.

The Gateway program runs in coordination with Skillpoint Alliance, an Austin-based nonprofit that provides training and education to job seekers. This is the first time Skillpoint has worked in the Fort Hood area.

On Monday, four brigade soldiers trained at the Hill Country Nursing and Rehab facility in Copperas Cove. The center is where they spent 40 hands-on clinical hours, in addition to the 60 classroom hours needed to earn the certification. The group will graduate from the program on Friday.

“It’s a great opportunity for soldiers who are transitioning ... at no cost to them,” said Anthony Thomas, the brigade transition coordinator. He was contacted by Skillpoint and served as a liaison between the brigade and the nonprofit.

“We try to accommodate soldiers’ career goals through job fairs and workshops,” he said, but this program is the first of its kind for the brigade.

Bethany Paul, Skillpoint’s Gateway program coordinator, worked directly with the students during the four-week training period.

“My job is to get them graduated and employed,” she said. Her organization has an 80 percent employment rate within the first 30 days after students graduate from the program.

Paul’s role required her to select the students and track them throughout the program to ensure successful completion.

“We love being able to serve this population,” she said. “I’m excited to be able to give back.”

Skillpoint also offers mock interviews, resume support and networking opportunities, Paul said.

The brigade soldiers have been pleased with the outcome of the program.

“At the beginning, I was disappointed,” Hughes said of leaving the Army. But now that she’s had time to accept the idea, she is excited to move on and work in nursing.

The patients have been her biggest joy of working at the rehab center.

“The residents are great to be with,” she said. “It’s always something new every day.”

Hughes will exit the Army in May 2014 and is looking forward to spending more time with her three children. “Things slow down a bit when you get out,” she said. She’s glad her post-military life will still require interaction with people on a daily basis.

Resident Eva Xindaris loved working with the brigade soldiers.

“They’re very thorough,” she said. “They’re not rushing.” Though Xindaris is sad to see them go, she knows there will be more in the future.

For Staff Sgt. Jennifer Adams-Ward, working in the facility has been a pleasure.

“It’s a joy to see me put a smile on someone’s face,” she said. She loves to help people, and the residents at the Hill Country Rehab Center have treated her well. “I enjoy learning the story of them and what they’re done in their lives,” she said.

Adams-Ward’s path differs from her fellow classmates. She will not be transitioning out of the Army. She is a medic, currently serving as the medical noncommissioned officer of the brigade’s 1st Battalion. Earning her nurse’s aide certification is one step towards becoming a registered nurse and an Army officer.

At this time, the brigade and Skillpoint are offering an electrician apprenticeship program too. Thomas hopes to add more options in the coming year. The Gateway program is also open to spouses and dependents.

“It’s been very successful,” Thomas said. “I appreciate the fact that they’re giving soldiers this (chance).”

Source: Fort Hood Herald

By VI-AN NGUYEN

Nursing is often ranked among America’s most stressful careers, thanks to the job’s notorious long hours, physical exhaustion, and emotional toll. So when a nursing student in South Burlington, Vermont, found a veteran nurse’s touching, anonymous note of encouragement—along with a $10 Starbucks gift card—tucked inside a licensing exam study guide at Barnes and Noble, she felt moved to share it online.

“I’m assuming that if you’re thumbing through an NCLEX book that you’re probably nearing the end of nursing school,” the note, which was posted to social news site Reddit and has gone viral, begins. “I want to start by saying that you should be so proud of yourself! You’ve worked so hard to get here, and I promise you, it’s so worth it. I’ve been a nurse for 12 years and can’t imagine doing anything else.”

The handwritten letter included some thoughtful advice about how to deal with the stresses of a nursing career. “I want to let you know that the first year or two out of school is the hardest. But don’t give up and remember why you decided to become a nurse in the first place,” the note reads. “Be patient, and don’t beat yourself up. Don’t take things personally and when you’ve had a difficult situation, try to leave work at work.”

The note continues: “Two more very important things to remember are 1, be proud to be a nurse, and 2, believe in yourself. Also trust your instincts—they’re usually right!”

The letter ended with a pre-exam pep talk—along with the Starbucks gift card. “So grab some coffee and study for the NCLEX. I’m certain you’ll do fine,” the note says. “You’re going to be a great nurse! Remember, be proud and believe in yourself! You can do it!”

The note is signed: “XOXOXO, another nurse.”

Amazingly, although the moving gesture was anonymous, the letter-writer and the student who found it connected online. “My wife put that letter in the book. South Burlington VT, right?” Reddit user TreeBore posted.

“YES!!! South Burlington VT!!! That’s awesome,” the original poster replied. “It was an amazing find, tell your wife thank you and that it really has inspired a lot of people, including my girlfriend. She takes her test tomorrow!”

“We both wish your girlfriend all the luck in the world!” TreeBore responded. “She will do fantastic.”

Several other nurses chimed online to say how spot-on the letter was. “As a registered nurse, who is working a night shift as I type this, this letter is exactly correct,” one commenter said. “Prioritization and believing in yourself are key when becoming a new nurse. Don’t let intimidation affect you. You will be amazed how much you will grow from your first day on the job compared to a year later.”

Another commenter agreed: “I would never have gotten where I am now if it weren’t for adherence to the things she listed in the note.”

By Patrick Healy and Jonathan Lloyd

Nearly 500 registered nurses from across the country have volunteered to go to the Philippines to help victims on the ground after the devastation of Typhoon Haiyan.

Many of the volunteers are originally from the Philippines, where at least 1,700 are dead and more than 2,500 injured.

"I think our expertise is much-needed over there," said nurse Sussette Nacorda "I think it's my way of giving back to my country, to my town."

The Southern California nurse responded to a call for help from the Registered Nurse Response Network. The agency organizes nurses for disaster responses.

Nurses sign up on the network's website, providing information about when they are available. The RNRN also organized volunteer responses for hurricanes Katrina and Sandy, the 2010 Haiti earthquake and other disasters in the past 10 years.

"It's just in our nature," said Nacorda. "We're very compassionate. We like to take care of people.

"We're familiar with doing this on a different level."

Some nurse volunteers, including Nacorda, are still waiting to hear from family members living in the Philippines. She has pictures of the damage that left her sister's home uninhabitable and gets updates on Facebook about her mother and siblings.

Nacorda grew up and attended nursing school in the Philippines. She has worked in Los Angeles for the last three decades.

RNRN is attempting to get an advance team together to make assessments and arrange for the nurses' deployment.

By Erin Tolbert, RN, MSN for MidlevelU.com

While there are plenty of apps out there promising to make my life as a nurse practitioner easier, once downloaded to my phone they go largely unused.  Rarely do I calculate pediatric dosages with special programs, rather I go straight for pen and paper.  I don't check apps streaming medical news- the last thing I want to do after work is be inundated with more information from the world of medicine.  But, this week I stumbled across a true winner in the healthcare app world.  PingMD, an app that facilitates patient-provider texting offers real value to NPs.

When I heard about the new PingMD app, I was thrilled that someone had finally come up with a way to bring patient-provider communication into the 21st century.  The medical world is notoriously behind technologically and I was excited by the prospect of weaving my favorite form of communication, texting, in with my work.  So, I decided to contact the app's creator, neurosurgeon Dr. Gopal Chopra, to get the story behind PingMD.  Here's what he had to say about bringing texting to the patient-provider relationship.

What inspired you to develop a way for providers and patients to text?

Dr. Chopra explains that his wife is a pediatrician who initially sparked his idea for the texting app.  She described what she saw as "spillover".  Office visits with patients are getting shorter and shorter.  When patients don't retain the information they get from visiting their healthcare provider, or are unable to reach them during a time of need, they end up in the emergency department.  If she had known about the patient's problem, Dr. Chopra feels that she could have prevented the patient from going to the emergency room, and probably answered their question or given them direction for their medical problem in just a few seconds.  But, without an easy way to communicate, she is unable to avert unnecessary emergency department visits. 

Dr. Chopra also describes the experience in his own clinic. The nurse practitioner in Dr. Chopra's neurosurgery office takes about 80 percent of patient calls. He describes that it only takes this NP about 30 seconds to decide the best course of action for the patient. The problem with patient-provider communication isn't that providers don't know the best course of action for their patients, it’s the communication system that's broken.  PingMD, Dr. Chopra's new app solves this problem.

We all know HIPAA is a major barrier to streamlining patient-provider communication. Does PingMD comply with HIPAA?

When I ask this question, Dr. Chopra brings up an excellent point.  In order for communication to be secure, it must do so from both the patient and provider's end.  This is why texting between patients and providers can be difficult.  Even if the provider's phone is secure, the patient's phone may not have necessary privacy and security measures in place.  The PingMD app addresses this issue.

PingMD complies with HIPAA regulations through password protection, requiring authentication and encrypting stored information on the end of the patient and provider. 

How much does PingMD cost patients?  Providers?

PingMD creates obvious value for medical practices, so I decide to get to the bottom-line asking Dr. Copra about pricing.  I'm shocked by his reply.  The PingMD app is free!  Both healthcare providers and patients are welcome to create PingMD accounts free of charge and begin texting.

PingMD does charge for one service.  The app has the ability to integrate with electronic medical records recording the text conversation in the patient's personal medical record.  This saves you as a provider from going back to record the conversation later, well worth the expense. 

Most providers don't like taking calls from patients after-hours.  Isn't allowing your patients to text you even more intrusive to your private life?

I think I have thrown Dr. Chopra a zinger here. During my time working as a primary care nurse practitioner, I dreaded hearing my work phone ring. It meant a great deal of work to follow. First, I would talk with the patient, then possibly call a medication in to the pharmacy, followed by opening my laptop to record the interaction...on a Saturday evening.  I imagine that by making communication easier, communicating with patients will require even more of my weekend time. Quickly, I see that I am mistaken.

Dr. Chopra explains that texting patients makes being on-call a more palatable prospect. Rather than interrupting your day to answer the phone, PingMD allows you to answer a patient's questions with a simple text message. If your practice pays for PingMD, this message is then integrated into the patient's health record eliminating the need to record the interaction. Texts from patients using PingMD are confined within the app keeping your personal and work-related texts separate.  Overall, texting is a more efficient, less invasive way to communicate with your patients than phone. 

How have providers seen PingMD improve their practice?

Dr. Chopra says providers of all backgrounds, from primary care to anesthesiology clinics, love to ping.  Not only does it make communication with patients easier on the provider-side, it also increases patient satisfaction.  Sounds like a win-win situation. 

The idea behind PingMD is simple, but seamless patient-provider texting just might revolutionize your practice.