DiversityNursing Blog

BY JO, RN

We all have moments in which the stress of our jobs threatens to make our heads spin around 360 degrees. Moments like that are fine, but if there’s a trend toward constant head-spinning, then you, my friend, need an intervention. 

Tip One: Make sure your personal space is as stress-free as possible.
When you come home at night or in the morning, are you faced with stacks of dishes in the sink and cat hair everywhere? You need to start taking care of that stuff on your days off. Your home is a haven. Even with roommates or kids, you can have one space that’s inviolable and neat and clean. That one thing will make such a difference in your mental health, it’s amazing.

Tip Two: Treat your body well.
Fast food is good once in a while, but for tip-top functioning, you really need to pay attention to how you feed your body. Good, clean food will help your body and brain work well and will lessen your stress levels immensely. Batch-cooking things you can stand to eat during and after your shifts will make you so much happier than a burger from Big Bob’s Burger Barn.

Tip Three: Simplify.
I have six of the exact same uniform, four bras that I know fit perfectly and eight pairs of socks that are identical. I have a zippered makeup bag that I got for a buck at Target that holds all my work stuff, from pens to stethoscope to ID. I have set jewelry to wear to work, and a set time in the morning by which certain things have to be accomplished. This makes my life so much easier, I can’t even tell you.

Integral to this plan is a coffeemaker with a timer. If you don’t own one, go get one.

Tip Four: Know which stress relievers are good in the long run.
I’m a big fan of carefully applied general anesthetic in the form of ETOH (as my mother says), but not after every shift. A glass of wine or other Adult Beverage of your choice can be helpful when you’re too wound up to sleep or if your brain simply won’t shut up…but don’t make a habit of it. Exercise is better (and I’ve never found that getting good and sweaty an hour before bed will make me insomniac), venting to a friend is good (especially if she’s not also a nurse), playing catch with your pup or the neighbor’s kids can work. Know what’s healthy (movement, talk, art, music) and what’s not (alcohol, too much food, drugs), and plan accordingly.

Tip Five: Get a massage. Seriously.
Touch is amazing for making you feel better. Find yourself a good massage therapist and get the two-hour rubdown. Don’t plan anything at all for the rest of the day. You’d be amazed at how small niggling problems and constant stressors seem when you can barely walk to the car. If you can afford it, do it once or twice a month: It’ll give you something to look forward to, and you’ll feel amazing for at least a day or so.

Source: Scrubs Mag 

Source: Maryville University 

For nearly a year, the Boston Marathon bombings and their aftermath have haunted Chelsey McGinn, RN, of the Blake 12 Intensive Care Unit (ICU). In December the MGH gave McGinn an opportunity to honor the victims – and begin her own healing process – by running this year’s marathon as part of its Emergency Response Fund team.

“I feel like it’s been almost a year now, and I haven’t really done anything therapeutic since it happened,” McGinn says. “I felt like other people who I worked with found ways to kind of cope with it, but I hadn’t really found that. When this came up, I thought this was a perfect way to celebrate how far the victims have come and recognize my co-workers.” 

McGinn is one of six nurses on her unit who are planning to run the 2014 Boston Marathon – five for charity teams and one as a qualified runner. Most are first-time runners, and all say they are running in honor of the three bombing victims who were treated on the unit.

“I had a really hard time afterward, and it lasted longer than I expected,” says Laura Lux, RN, who is running for the American Red Cross. “I’m running because I don’t want to be defeated. I know if he could, my patient would be running just to prove a point. Because he can’t, I feel like I need to do this for him. After watching what he and his family went through, I feel like it’s the least I could do for them.”

Lux says she felt an immediate connection with her patient and his family. “Despite everything they were just so determined and so strong,” she says. “Everyone was angry, but there was good coming from it too. We got to know each other because of it. I felt like he was a family member. It’s the most personal experience of my career.”

Lux’s experience is similar to that of the other nurses who are running, including Emily Erhardt, RN, a trauma ICU nurse and member of the MGH Emergency Response Fund Team, who has stayed in touch with her patient and his family since they left the hospital. “This event affected everyone, so it was one of the few times in my career that I felt like all I could do with the family was cry with them. It’s such a terrible thing that happened that there aren’t words to comfort them. You just have to be there for them,” she says. “A year ago they were strangers to me, but now they’re the most inspiring people in my life. I’m not much of an athlete, but I was really affected by the whole thing, and I wanted to do something more.”

Blake 12 runners receive a boost of support from the Harvard University Employees Credit Union. Included in the photo with members of the ICU are Paul Conners, MGH branch manager; Eugene Foley, president and CEO; and Guillermo Banchiere, MGH director of Environmental Services, who serves as a member of the credit union's board of directors.

Allyson Mendonza, RN, who is running for the Mass General Marathon Team “Fighting Kids Cancer … One Step At a Time,” recalls the moment she knew she too wanted to do something more. Mendonza says her patient had just returned from surgery when she was told President Barack Obama was coming to visit. The woman was excited but was distraught about her appearance, so Mendonza and her colleague soaked her nails and helped shampoo and condition her hair to wash out the cement and clumps of dried blood.

“We just tried our best to make her feel better about herself and feel good for the day ahead. She actually fell asleep. When she awoke, she said, ‘This is the most relaxed I have felt in days.’ It was just so emotional for us and for her,” Mendonza says.

Caring for the marathon victims brought the unit closer together, and staff once again have come together to support and encourage their fellow colleagues.

“The teamwork and the camaraderie were amazing,” saysKatherine Pyrek, RN, who was the charge nurse during the week of the bombing. “Every one of the nurses was affected by what was going on, but they stayed strong and carried on. The bonds the nurses made with the patients and their families were incredible and really went above and beyond.”

Pyrek, who is running for the Mass General Marathon Team, says the Blake 12 runners offer each other advice and encouragement to help in the training process. “We remind why we’re doing this – for our patients and their families,” she says. “I think about the patients when they were in pain and how scared they were. I think that if they get through it then I can get through however many miles I need to run.”

The runners all say they look to Meredith Salony, RN, a veteran marathoner who qualified for the marathon, for guidance. “I’m so proud to be in this unit where there’s so much enthusiasm. Even the people who aren’t running are trying to help out and organize events and find ways for people to contribute,” Salony says.

Each of the nurses says they are overwhelmed when they imagine how they will feel on Marathon Monday.

“I think it’ll be really therapeutic and empowering,” McGinn says. “I’m honored to be a part of it. If I’m ever going to run a marathon, this is the one I want to run. I’ll always remember the way I felt at work that night, and it’s going to be a really nice thing to be able to remember this feeling for the rest of my life too.”

For more information or to support the teams visit www.runformgh.org.

This is the first in a series of articles that MGH Hotline will publish about staff running in this year’s Boston Marathon.

Source: Massachusetts General Hospital

by Danielle Logacho

Let’s say you’re a nurse at a local hospital. For the past several weeks, you’ve been for a young boy who needs a heart transplant.

One day, you learn that a donor organ has become available. You are elated – and you decide to share the news on your Facebook page.

“Great news! A new heart has been found for my five-year-old patient at Children’s. Be brave, Aiden – we’re all rooting for you!”

Good idea? Not really.

That’s because a post like this – while well intentioned – is a breach of confidentiality. There’s enough information here to identify the patient, his condition and the hospital where he is receiving treatment. Put it all together, and you’ve got yourself a HIPAA violation.

The truth is, there can be real consequences to nurses’ irresponsible use of social media. State boards of nursing may investigate reports of inappropriate disclosures on Facebook and other social media sites. If the allegations are found to be true, nurses can face reprimands, sanctions, fines, or temporary or permanent loss of their nursing license.

Many organizations have social media policies that govern employees’ use of social media, even if it’s for personal purposes. If yours is one of them, be sure to read and understand the guidelines.

Even if your employer does not have a specific policy, the main rule of thumb should be familiar to you: as a nurse, you have the legal and ethical obligation to maintain patient privacy and confidentiality. 

The Health Insurance Portability and Accountability Act (HIPAA) specifically defines “identifiable information” and when and how it can be used. Such identifiable information could cover the past, present or future health of a patient, or it could be something that would lead someone to believe that it could be used to identify a patient.  Brush up on your understanding of HIPAA.

How do you avoid problems? Do you need to stop using Facebook altogether if you’re a nurse? No, but you do need to be careful. Here are a few general guidelines:

- Simply put: Don’t reveal any personal health information about your patients in your posts. (And don’t think that it’s OK if you reveal their details but give them a fake name.)

- Don’t post any photos of your patients, even if they are cute kids. Photos are specifically called out in HIPAA as identifiable information.

- Maintain professional boundaries, even online. Friending your patients or patients’ families is, in most cases, a no-no. The Mayo Clinic’s guidelines for employees say, “Staff in patient care roles generally should not initiate or accept friend requests except in unusual circumstances such as the situation where an in-person friendship pre-dates the treatment relationship.”

- Don’t rely on privacy settings. No matter how meticulous you are about privacy settings, there’s no guarantee that a friend won’t like your post so much that she takes a screenshot and posts your “private” message elsewhere.

- Remember that anything online will be there forever, even if you delete it. Someone may have taken a screenshot before you took your post down. If you are under investigation, your posts can be still found on servers.

For more information, read A Nurse’s Guide to the Use of Social Media from the National Council of State Boards of Nursing.

These guidelines are for informational purposes only and are not legal advice.

References

National Council of State Boards of Nursing. (2011). A Nurse’s Guide to the Use of Social Media [Brochure]. Retrieved from https://www.ncsbn.org/NCSBN_SocialMedia.pdf

Pagana, K. (2014, January 21). Facebook: Know the Policy Before Posting [Webinar]. In Nurse.com Continuing Education series. Retrieved from http://ce.nurse.com/course/ce630/facebook/.

Source: Chamberlain College of Nursing 

A classic “Far Side” cartoon shows a man talking forcefully to his dog. The man says: “Okay, Ginger! I’ve had it! You stay out of the garbage!” But the dog hears only: “Blah blah Ginger blah blah blah blah blah blah blah blah Ginger …”

As a nurse, I often worry that patients’ comprehension of doctors and nurses is equally limited — except what the patient hears from us is: “Blah blah blah Heart Attack blah blah blah Cancer.”

I first witnessed one of these lost-in-translation moments as a nursing student. My patient, a single woman, a flight attendant in her early 30s, had developed chest pain and severe shortness of breath during the final leg of a flight. She thought she was having a heart attack, but it turned out to be a pulmonary embolism: a blood clot in the lungs. Treatment required several days in the hospital. Already far from home and alone, she was very worried that a clotting problem would mean she could no longer fly.

When the medical team came to her room, they discussed her situation in detail: the problem itself, the necessary course of anti-coagulation treatment and the required blood tests that went with it. To me, just at the start of my nursing education, the explanations were clear and easy to follow, and I felt hopeful they would give my patient some comfort.

After the rounding team left, though, she turned a stricken face to me and deadpanned, “Well, that was clear as mud, wasn’t it?”

I sat down and clarified as best I could. But until then, I hadn’t realized what a huge comprehension gap often exists between what we in health care say to patients and what those patients actually understand.

A growing body of literature suggests that these clinical miscommunications matter, because the success of physician-patient interaction has a real effect on patients’ health.

In a 2005 article in the Journal of the American Medical Association, Eric B. Larson and Xin Yao, researchers at the University of Washington, claim that treatment outcomes are better when doctors show more empathy and take the time to make sure patients understand what’s going on.

I saw the importance of caring communication during a friend’s recent heart attack scare. He had a lingering case of bronchitis, and one morning found himself struggling for air. He had pain in his shoulders, back and neck and a feeling of increasing constriction in his chest.

Concerned, his wife took him to the emergency room, where his breathing became even more labored. In the triage area he began sweating profusely and then collapsed. A rapid response team rushed in, put him on oxygen, started an IV, got an EKG. His wife thought she was watching, helplessly, as her husband of more than 20 years died in front of her.

Minutes passed and the code team revived him, but no one told her that he’d passed out because of a protective effect of his autonomic nervous system, not because his life was threatened. No one fully explained that to him, either.

At that point his wife called me, and knowing how confusing modern health care can be, I went to the hospital to help. I caught up with them in the cardiac catheterization lab, where the miscommunications continued. The cardiac cath showed that his arteries were clear — but the diagnosis, explained in technical terms, meant nothing to his wife. It took over 12 hours to learn that his echocardiogram revealed all cardiac structures to be normal. (Also, no one told the wife that her husband would stay overnight in the I.C.U. because protocol required it, not because he actually needed intensive care.)

Although my friend received exemplary care, neither he nor his wife felt that they had. Instead, similar to my patient in nursing school, they felt they had been hijacked to a foreign land. The hospital staff members were obviously dedicated to restoring patients’ health, but they and the work itself came across as alien, obtrusive and impossible to understand. Also, my friend’s problem was correctly diagnosed days later when he went to his primary care physician. Acid reflux was causing his pain; the cure was a prescription for Prilosec.

Interestingly, patients in hospitals report more satisfying interactions with physicians when doctors sit down during rounds instead of standing, according to a 2012 article co-written by the researcher Kelli J. Swayden, a nurse practitioner, in the journal Patient Education and Counseling. Sitting gives the message “I have time,” whereas doctors who stand communicate urgency and impatience.

I don’t mean to blame doctors and nurses; it can be very hard to force yourself to slow down and tune in to a patient’s wavelength when you have other patients and countless pressing tasks to get to.

And that’s especially true today, when hospitals are focused, machinelike, on volume and flow. Bedside manner does not increase efficiency, and it certainly can’t be charged for. Still: My friends had gone from blueberry pancakes at breakfast to worrying that the husband might die, and the closest anyone got to assuaging that fear was the doctor who said, “Well, we’ve ruled out everything that will kill you right away.”

And that’s not good enough, because going to the hospital is an exercise in trust. Ill health is frightening, the treatments we offer can be scary, and stress and anxiety make people poor listeners. Our high-tech scans and fast-paced care save lives, but we need to make time for the human issues that pull at every patient’s heart.

Theresa Brown is an oncology nurse and the author of “Critical Care: A New Nurse Faces Death, Life, and Everything in Between.”

By National Institute of Health

Researchers will enroll around 500 African-American children and adults who have asthma in a multi-center clinical trial to assess how they react to therapies and to explore the role of genetics in determining the response to asthma treatment. This new clinical study, which will take place at 30 sites in 14 states, is aimed at understanding the best approach to asthma management in African-Americans, who suffer much higher rates of serious asthma attacks, hospitalizations, and asthma-related deaths than whites.

The Best African American Response to Asthma Drugs (BARD) study is under the auspices of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health.

“This large-scale clinical effort is expected to provide new insights into how health care professionals can better manage asthma in African-Americans to improve outcomes,” said Gary H. Gibbons, M.D., director of the NHLBI.

“BARD reinforces the institute’s commitment to understand, reduce, and ultimately even eliminate the disparities in asthma outcomes observed in the African-American population compared to other Americans with asthma,” added James Kiley, M.D., director of the NHLBI Division of Lung Diseases.

BARD will examine the effectiveness of different doses of inhaled corticosteroids (ICS) used with or without the addition of a long-acting beta agonist (LABA). ICS reduce inflammation and help control asthma in the long term. LABAs relax tight airway muscles. This study will compare multiple combinations of medications and dosing regimens to assess the response to therapy. BARD will track whether children and adults respond similarly to the same treatment, and evaluate how genes may affect treatment response.

“While national asthma guidelines provide recommendations for all patients with asthma, it is possible that, compared with other groups, African-Americans respond differently to asthma medications,” said Michael Wechsler, M.D., principal investigator for the BARD study and professor of medicine at National Jewish Health in Denver. “Our study is designed to specifically address how asthma should be managed in African-American asthma patients, both adults and children.”

The BARD study is supported by NHLBI’s AsthmaNet clinical trials network. BARD began enrolling patients on Feb. 10.

To schedule an interview with an NHLBI spokesperson, please contact the NHLBI Office of Communications at 301-496-4236 or nhlbi_news@nhlbi.nih.gov.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Written by Elizabeth Swaringen for UNC Health Care 

As a nurse at UNC Hospitals, Paula Brown, RN, knows firsthand the difference family presence makes in a patient’s healing.
She also knows the importance of the care and feeding of family members — especially when home is two or three hours away.

So volunteering to cook dinner for guests at SECU Family House was a no-brainer for Paula and her 16-year-old son, TJ, a sophomore at Carrboro High School.  It just took the inspiration of a like-minded 10-year-old boy to make it a priority in 2014.

“I’ve known about Family House since it was a dream, before the construction even began,” said Paula, recalling a massive yard sale to raise money for the 40-bedroom hospital hospitality house that offers safe and affordable accommodations to seriously ill patients and their families who come to UNC Hospitals for care.  

And once Family House opened in March 2008 minutes from UNC Hospitals, Paula had always planned to volunteer, “but sometimes life gets in the way,” she said.

“Then I learned more about the House and the good that happens there from Family House Diaries, the stories that are included in news for employees,” said Paula, who is in her 20th year as a nurse in the post-surgery acute care unit at UNC Hospitals. “It was the awe-inspiring story in October of a 10-year-old boy who cooks and serves that told us the time is now.”

Paula wasted no time getting on the dinner schedule. She called Allison Worthy, who coordinates volunteers at Family House, and nailed down Sunday, Jan. 19.  Allison put Paula in touch with volunteers Charles and Patsy Harrison who lead a team that cooks dinner for guests twice a month.   

She observed Team Harrison, asked questions and checked out the availability of crock pots and utensils in the community kitchen for the chili and cornbread that she and TJ had already decided would be their debut meal.

“I really enjoy chili that way and wanted to give others the option,” TJ said, surmising correctly that most guests weren’t familiar with it.  The Browns offered both a meat chili and a vegetarian chili, again giving guests choices to best suit their palates.

Mother and son spent the day before in prep:  chopping the onions and browning the meat for the chili, chopping other vegetables for tossed salad, baking the cornbread muffins and the brownies for dessert.  By noon Sunday, four crock pots were hard at work in the Family House kitchen.

“We prepared for about 50, forgetting that it was the MLK Holiday weekend and there would be a slimmer crowd as the hospital clinics were closed on Monday,” said Paula.  “But it didn’t matter.  Although we had fewer guests than we’d planned for, we had plenty of leftovers, and chili is always better the second day.”

Leftovers are always welcome and disappear at Family House because the illness of a loved one does not follow a mealtime schedule, said Allison, the volunteer coordinator.

“Our guests always comment with gratitude and amazement about the volunteers who prepare the home-cooked meals here and the quality of the food,” she said.  “But it’s beyond nourishing their bodies; it’s about the community of support that forms around the shared meals. We’ve steadily added Sunday night meals because Sundays have become a busy check-in day for guests.  Like our guests we are grateful that Paula and TJ know their way our around kitchen, especially on Sunday nights.”  

Paula and TJ saw — and felt — the gratitude firsthand.  A lone female guest showed her appreciation by insisting that Paula accept a cash donation that could be used for the next dinner she and TJ prepare.

“That was one of those arguments that you can’t win, so I graciously accepted her gift, assuring her it wasn’t necessary, but much appreciated,” Paula said, noting that she and TJ had already discussed “next time” even before they had served the first bowl of chili.

And neither will forget the guest who slipped back into the kitchen after dinner, slammed his palm on the countertop to get their attention and declared,

“I just want to thank you.  With her treatment my wife hasn’t felt like eating in over a month, but tonight she did. We enjoyed it.”

“I thought we were just feeding people, but it was so much more than that,” said TJ, who enjoys the logistical challenges of cooking, especially for a crowd. “Family House is a haven for people.  The reactions to our meal told us that. I had run by the house many times in better weather when training with my cross-country team, but I really didn’t know what goes on here. Cooking here was fun, and I look forward to coming back.”

Cooking at Family House also allows TJ to work towards earning the 25 community service hours he needs for high school graduation.  But it’s not about that requirement, both TJ and Paula agreed.

“It’s the reaction we got from people,” he said.  “It was emotional and genuine for us all.  The fun of the cooking makes the service requirement easier.”  

"It’s a win-win for all,” Paula said, beaming.  

Will chili be their signature Family House meal?

“We’ll probably branch out, but we’ll keep with comfort foods,” said TJ. “You don’t want to go too exotic.  You gotta eat sometime, and we need to make it easy for people to enjoy it, maybe meatloaf and my grandmother’s macaroni and cheese.”

Just as a 10-year-old boy inspired Paula and TJ to step up and cook a fellow nurse told Paula her unit is going to plan a meal at Family House.  

“I just hope it’s my day off so I can participate,” she said.

By Donna Cardillo 

It is imperative that every nurse – new and experienced – realize the healthcare landscape has completely changed. There will be plenty of opportunities for RNs and APNs who stay current with trends in education, technology, care and personal and professional development. Nurses must be willing to step outside their comfort zone and learn new ways — and places — of working and thinking about their profession. Cynthia Nowicki Hnatiuk, RN, EdD, CAE, FAAN, executive director of the American Academy of Ambulatory Care Nurses and the Academy of Medical Surgical Nurses. stresses that, to stay competitive, nurses also will have to be able to articulate the value that they bring to outcomes, beyond tasks, in any setting. So what does every nurse need to do? Here are four key areas:

1| Skill building

Clinical skills alone won’t see us through in this new paradigm. Self-marketing, computer skills, oral and written communication, conflict management, negotiation, leadership and networking skills must be learned and practiced. Hnatiuk said nurses also need to be more business savvy, with an understanding of finances, staffing, acuity and productivity.

2| Education

Higher education is no longer optional. It is a foundation for practice in any setting and fundamental to professional and personal growth and development. Hnatiuk advises that formal and continuing education, along with clinical certification, will help nurses take their practice and careers to the
next level.

For those considering advanced practice, particularly becoming nurse practitioners, the NNCC’s Hansen-Turton advises: “Don’t think too long; jump in. Opportunities will be increasing for NPs over the next 5-10 years. NPs are and will continue to be a hot commodity.” Certified nurse midwives, clinical nurse specialists and certified registered nurse anesthetists also will see expanded opportunities.

3| Professional association involvement

Our professional associations are where we connect with one another, form communities, share best practices (local and national), stay current with trends and issues, and find support. Hnatiuk added that through association involvement, you learn more than you could by yourself and progressively learn leadership skills

4| Mentoring

Hnatiuk encourages nurses to take advantage of opportunities to be mentored and to mentor others. “We have so much to share. Mentoring will allow us to achieve all we’re capable of doing.”

For personalized career advice

If you have specific career-related questions, send them to Dear Donna at www.Nurse.com/AsktheExperts/DearDonna for a personalized response.

Source: Nurse.com

Question:

Dear Donna,

I'm a recent new graduate and I'm trying to figure out how to setup and update my resume to be more attractive to employers. Are there certain topics or headlines that should be included and what are the rules for putting my clinical experience on
my resume?

Wants a More Attractive Resume