DiversityNursing Blog

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.

Dogs

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

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.”

Chickens

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.  

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. 

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Have questions about getting your BSN or have a general question? Ask one of our Nurse Leaders! 

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.

Please SHARE this story with friends and family!

Nurses are always learning. Whether it’s on-the-job with practical experience or continuing your formal education, you are always on a quest to learn more. Perhaps you’re trying to figure out how to do something better, earn your next degree, improve your relationship and listening skills, or how the latest electronic medical records program works. You are determined to move forward and be your best. If you’re looking to advance your formal education, we offer this article as a source of information on Nursing schools and acceptance rates.

You must take the time to read this article! If ever there was a tribute to Nurses, this is it! This story is written by an oncology patient who pays wonderful tribute to many Nurses, but also a particular Nurse who took care of her and helped her get through her surgeries and treatments. I think most patients feel this way about the Nurses that take care of them. They don’t always show their appreciation, but this patient took the time to write about her experience. I hope this will make your day.

RELATIONSHIPS WITH NURSES can stick with patients for the rest of their lives. From nurses, I learned the power of accompaniment. One held my hand as I uncontrollably teared up before port surgery. Another nurse on the oncology floor, when she found out that my husband and I had been married two weeks before I had checked into the hospital, made me a pillow adorned with our wedding pictures. Another shaved my head for me when my hair started falling out at an unsightly pace. A patient-care technician—what used to be called a nursing assistant—held me while I threw up in the bathroom after a two-hour MRI.

Though I don’t like to remember these things, I feel deep gratitude for the nurses who were there with me during painful and sorrowful days. In Siddhartha Mukherjee’s The Emperor of All Maladies: A Biography of Cancer, he quotes journalist and breast-cancer patient advocate Rose Kushner. “Few doctors in this country seem to be involved with the non-life-threatening side effects of cancer therapy,” Kushner notes. “In the United States, baldness, nausea and vomiting, diarrhea, clogged veins, financial problems, broken marriages, disturbed children, loss of libido, loss of self-esteem, and body image are nurses’ turf.”

Although I respected my oncologists for the important role they played in my cancer treatment, I found the wide and varied “turf” that exceptional nurses cover astounding.

A year ago last May, I was checked into Boston’s Beth Israel Deaconess Medical Center (BIDMC) as a 29-year-old non-Hodgkin lymphoma cancer patient just out of spinal surgery and unsure if I’d be able to walk again. A few days post-surgery, two nurses held me next to my hospital bed to see if I could stand. Although I was frightened, I particularly remember Neely Beaulac, R.N., joking with me in her thick Boston accent while I slowly tried to march in place with feet that moved like cinderblocks. Somehow, I broke into a small smile and laughed as Neely cheered me on.

Nearly a year later, I walk the 1.1 miles to the BIDMC from my apartment, stroll into the ’80s-style lobby, and wait in a herd of visitors to ride the elevators to the upper floors. I had planned to meet Neely after her shift. I wanted to interview her about working as an oncology nurse. But when one of her patients had an allergic reaction to a transfusion, she asked if we could meet at the outpatient clinic instead in order to be nearby in case her patient needed her.

While in the elevator, I remember my own allergic reaction to a transfusion, which made my eyes puff up to the size of bouncy balls. Given the complexity of cancer treatment and the series of patient issues that arise moment to moment, the end of an oncology nurse’s shift can be fluid.

“Sorry to make you come here!” Neely says with an incandescent smile. I greet the other staff I know, and the two of us head to a break room to sit and talk. She puts a small bottle of water in front of me, as she has so many times before.

Neely is in her mid-thirties with clear blue eyes and dark hair. She’s attractive in that cool-girl way that makes you want to know her jokes. When she’s doing her job, she can be efficient and quick but also chatty. She makes her nursing tasks look easy yet precise. She’s the kind of nurse who makes a note of when your IV bag is going to run out so you’re not repeatedly awoken by a beeping apparatus. She’s at home barging into a room to restore order. The blue shirt of her scrubs matches her eyes and is adorned with a flowered nametag and a pin a patient gave her, a take on the Superman insignia.

Neely was born for nursing. She tells me her mother would describe her as bossy, organized, particular, “and just that little bit defiant.” Even as a child, she always liked “to be a little helper.” If she thinks she can help by providing information, she wastes no time telling a patient the truth of the matter. She doesn’t sugarcoat.

Once when a consult team visited my room to inform me of a drug called Lupron, used to protect ovaries during chemo, they called it a quick shot in the arm. Neely’s eyebrows furrowed. As soon as the doctors left, she told me, “It’s not a quick shot in the arm, it’s actually a pretty large shot in the tush.”

But for all her native bossiness and helpful bluntness, she says nursing has changed her: “I’m definitely still organized, but I’m not as uptight, not as intense.” She has become better at listening rather than convincing. When frustrated and overwhelmed patients say they want to stop cancer treatment, not an infrequent occurrence, Neely now tries to hear them out, helping patients feel they have more control and aren’t being bossed around.

“I’ve come to realize that a lot of times people don’t want to just go home and be left alone and die,” she says. “They want treatment. But they just want to hear they can leave if they want to.”

ACCORDING TO THE Bureau of Labor Statistics’ Occupational Outlook Handbook, important qualities for nurses are attention to detail, critical thinking, communication, compassion, emotional stability, organizational skills, and physical stamina. Nurses spend their days multi-tasking and managing all kinds of people throughout the day, from patients to parents to spouses and doctors. Although they take on many roles throughout a shift, an eye for detail is essential. Oncology nurses administer chemotherapy and other cancer drugs, making sure that “the correct dose and drug are administered by the correct route to the right patient,” as the nursing reference book Cancer Medicine puts it. Too much of the poison can be fatal.

Oncology nurses also take on other more complicated and personal roles. When I was a patient last year, feeling miserable and immobile in a hospital bed, saltine crumbs were scattered all over the bedtable. I had not asked my husband to clean it, because I was tired of asking him to do things, and I figured crumbs were the least of my worries. Neely then came into my room, and before leaving, wiped down my table. It wasn’t part of her job; she just did it. I felt comforted by someone willing to blur the lines between professional nursing responsibilities and basic human-to-human caregiving, as if going out of her way is not out of her way at all.

“I never want anyone to feel like they’re imposing on me or to say sorry I’m keeping you,” she says. “You’re keeping me?” she pretends to ask a patient while talking to me. “I’m going home…I know you’d rather be anywhere but here.”

Not only do nurses do small things to give you dignity, like picking up crumbs or wiping your mouth, they also clean up filthy messes to restore livable conditions for their patients. One night early in my treatment, my husband and I had friends visiting. As I began falling asleep and my husband was saying goodbye to the friends in the hallway, I had a late onset of nausea from the chemo drugs. Before anyone knew what was happening, I was throwing up my dinner without being able to get off my hard neck brace. In what seemed like seconds, nurses rushed in to clean me off, change my sheets, and generally get the room back in order as if the disgrace had never happened.

Those nurses’ NASCAR crew-like handling of my soiled room helped me move past such a gross and miserable situation more quickly. While receiving cancer treatment and undergoing several surgeries, I encountered numerous take-charge, warm, nursing souls who literally ran toward problems rather than away from them.

And oncology nurses don’t just keep things orderly; the great ones boss people around in both clandestine and overt terms to get the best outcomes for their patients. When I was Neely’s patient, she would gently boss around my husband. “Don’t forget to pack her underwear!” she would remind him, when I had to stay in the hospital longer than expected and he’d rush home to bring me more T-shirts and yoga pants. “Husbands always forget underwear. I don’t know why that is,” she tells me during our recent interview.

Good nurses chase down doctors, assert their opinions based on their sometimes superior knowledge of a situation, and appease family members and other caregivers. Once my discharge was postponed for 48 hours by the attending doctor who barely seemed to have read my file and was rarely available. I felt I could not spend one more day in the hospital with its scratchy sheets, bad food, being woken up every few hours for vital signs, no chance of getting outside into the light of day, institutional showers, and daily injections. It was a nurse who listened to my husband’s rising anger throughout the day as he saw how my mental state was deteriorating. The nurse didn’t have the power to discharge me, but sought out answers from the doctor time after time, despite having a list of patients in equal or worse predicaments.

Oncology nurses are masters at balancing the tensions between patients and doctors, family and treatment team, all the while remaining upbeat and encouraging. Of her tireless questioning of doctors, Neely shrugs and laughs. “What’s the worst they’re going to say? No? And I’ll ask again, ask someone different. And sometimes you never get the answer you want, but at least you feel like you tried.”

BEFORE SHE KNEW so much about the packing tendencies of husbands or the best ways to get patients discharged, Neely wanted to be a teacher. In fact, she went to college for teaching. She had considered nursing, but felt teaching sounded “less stressful and more fun.” During her junior year of college, her cousin had a car accident, and she went to San Diego for the summer to help him around the house and take him to medical appointments. She was inspired by the nurses that cared for him and could see the tangible and emotional difference they made. “That intrigued me,” she says.

Six months before graduating with a degree in teaching, while gaining experience in schools, Neely decided working in a school system wasn’t for her. “I love spending time with children,” she says now, but the built-in tension between teachers and parents and the regiment of teaching to tests didn’t appeal to her. “It wasn’t as fun as I thought,” she admits, even though her parents told her to stick with it.

Just six months after graduation, she had her way and got into nursing school at a two-year program at Labouré College in Dorchester, Massachusetts. After a semester of science courses, she could then start working in hospitals as a floating patient-care technician (PCT). First she gained experience as a PCT in Beth Israel Deaconess Hospital’s Needham outpatient center, and then at BIDMC’s main campus in Boston in an oncology inpatient unit, where I met her and where she has been for more than ten years.

Neely says she’s had no doubts about her profession since graduating from nursing school and has found oncology nursing especially intimate. Instead of patients coming in to be “fixed” and then put on their way, in oncology units, patients often stay for days or weeks, or come back repeatedly for treatment or follow-up in an outpatient clinic. Nurses know everyone’s name and usually the names of many family members or friends. “You want to put a lot into it,” she says, “because you know [your work] really affects people.” Getting to know someone as a person instead of “just a body,” in her words, does make a difference. I can testify.

Each day she’s on the inpatient unit, Neely tries to give patients a goal to improve or maintain their mental state. “Every patient needs a goal for the day, whether that’s to get out of bed, or to go home, or to visit with family,” she says. When she starts her inpatient shifts, she tries to check in with each patient to set a goal and ask, “OK, we have 12 hours, we need to get this done, how do you want to do it?” And on the inpatient floor, she’s up front about how few choices there are for patients. “It’s not rainbows and sunshine. Let’s be real,” she says.

On some days, I remember my goal was to have a bowel movement or to get from the bed to the chair. “Hopefully by the end, you’re getting out of your chair and doing a few laps [in the hallway] before you go home,” Neely tells me in our interview.

Another of her daily exercises is to put herself in the shoes of others: “I feel like if this were me, what would I do? If this were my husband, my father, what would I do? That’s what it comes down to.”

SEVERAL STUDIES HAVE SHOWN that workplace stress for an oncology nurse can lead to compassion fatigue and burnout that’s caused by just this kind of effort to help others. One 2010 study on oncology nurses, done by Washington University Medical Center in St. Louis, measured compassion fatigue through surveys that captured data on secondary traumatic stress, burnout, and compassion satisfaction. For the study’s 153 oncology inpatient staff participants, 132 of which were registered nurses, nearly 40 percent were at a high risk for compassion fatigue, while 44 percent of inpatient staff were at high risk for burnout.

But another 2008 study conducted by Beth Perry, a professor at Athabasca University in Canada, found that “exemplary oncology nurses were able to avoid compassion fatigue by creating moments of connection and making those moments matter.” Sometimes small moments are all that’s left.

Neely says that one of the hardest parts of her job “is when you’re giving someone treatment and it’s not benefitting them. When you know you’re prolonging these horrible side effects.” She tells her patients in that situation, “I’ll give you chemo until your last day if that’s what you want, but I just want you to know you’re not gonna get better. So if there’s anything else you wanted to do, get it done. Don’t have me poison you to the very end.”

I ask Neely about how she manages working through life and death situations daily. She admits that other nurses she works with are better at erecting emotional barriers. When one of her patients has a bad outcome, “It still rocks me every time.…I can’t separate myself,” she says. “I’m home praying for these people, I say my prayers every night.”

But even in hopeless times, she still feels she can help. “If you know someone is not going to do well—and ultimately die—because that’s what everyone is afraid of with cancer, the Big C, just give them dignity. If there’s something they want to do, get it done. You want your dog to come in? You want to leave and go wherever? Just help them get that done.” She admits that if she were in that situation, she would most likely want to go home with her husband and dog to die.

Neely’s husband, Jamie, survived testicular cancer before they met, which gives her additional personal insights, but also makes her feel she shouldn’t discuss emotionally difficult parts of her day with him—it would hit too close to home. On the other hand, their joint experiences with the effects of cancer help crystallize their priorities. “There’s a lot that just doesn’t rock us,” she says. “To me, unless someone’s dying, dead, or suffering from extreme illness, I’m like, how stressed out can you be?”

She knows that life can change in a minute. Neely texted me the day after I met with her to say our discussion had made her reflect more deeply on her nursing career. One thing that kept coming to her mind was something that happened to her in college. While on a jog, a car hit her.

“I don’t remember much from that day,” she wrote in the text, “But I do remember I had this nurse who was with me every moment and kept telling me everything is going to be OK.…He was so comforting, and when I decided to go into nursing, he always stuck with me. I always want to give people the comfort that he offered me that day.”

As for me, I’m grateful that I can sit up, reach my computer to type this, and be able to thank Neely for the part she played, alongside many others, in getting me to where I am today. When I do thank her during our interview, she looks me in the eye and insists, “You did it!” Of course she would. 

Think you need to hire a physician to fill an opening at your hospital, practice, or organization? Not necessarily: A nurse practitioner (NP) may be able to get the job done, says Tay Kopanos, DNP, NP, the Vice President of State Government Affairs for the American Association of Nurse Practitioners. As an added bonus, it typically takes less time to find a locum tenens NP to fill an open position.

So, could bringing on an NP work for you? Use our infographic to find out www.bartonassociates.com:

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If your hospital is experiencing high turnover among your newly licensed Nurses, this article may give you an idea of why they’re leaving and areas where you can improve your work environment.

Some factors influencing low unit-level turnover: first professional degree was a baccalaureate or higher, greater variety and autonomy, and better perceived RN-MD relations

“About 80% of newly licensed nurses find their first work in hospitals,” says New York University Rory Meyers College of Nursing (NYU Meyers) Professor Christine T. Kovner, PhD, RN, FAAN. “Turnovers are one of the costliest expenditures in our profession. In fact, costs are estimated at $62,000 to $67,000 per departure, amounting to $1.4 to 2.1 billion in expenses for new nurses who leave their first jobs within three years of starting.”

Prior research on newly licensed nurses tended to focus on organizational turnover, where a nurse leaves the hospital or organization. However, there is scant literature on internal or unit-level turnover, which occurs when a nurse leaves their current assignment to take up new roles or positions within the organization or hospital.

Recently, Dr. Kovner led a team of researchers at NYU Meyers and the School of Nursing at SUNY Buffalo in conducting a study to fill in the gaps. Published in the International Journal of Nursing Studies, the study of a nationally representative sample of new nurses working in hospitals, sought to better inform unit-level retention strategies by pinpointing factors associated with job retention among newly licensed nurses.

“The internal turnover rate for the one year between the two waves of the survey was nearly 30%,” said Dr. Kovner. “This turnover is in addition to those leaving the organization. This figure is substantially larger than previously reported in other studies, which estimated a 13% one-year internal turnover rate among new nurses.”

The researchers looked to bolster the existing evidence on internal turnover to determine precursors to remaining on the same title and unit-type from the first to the second year of employment.

The nurses (n=1,569) were classified into four categories based their unit and title retention. 1090 nurses (69.5%) remained in the same title and unit-type at wave two, while 129 (8.2%) saw a change in title, but not in unit-type. A similarly small group of 185 (11.8%) had no change in title, but changed unit-types, while 165 (10.5%) had a change in their title and unit-type.

In addition to collecting the new nurses’ demographical data, Dr. Kovner and her team assessed their perceptions of their work environment in both surveys.

“In doing this we were able to examine the changes in work environment perceptions over time between nurses who remained in the same unit and title to those who changed unit and/or title,” said Dr. Kovner.

Upon analysis, the researchers found five factors most strongly associated with retention: holding more than one job for pay (negative), first professional degree was a baccalaureate or higher, negative affectivity, greater variety and autonomy, and better perceived RN-MD relations, all positively related.

“Our results point to the variables on which managers can focus to improve unit-level retention of new nurses,” said Kovner.

Related Article: Fellowship Program Improves New Nurse Retention, Nets Savings

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Funding. Funding for this research was provided by the Robert Wood Johnson Foundation.
www.nyu.edu