By Melissa Assink, RN, BSN

I was in med/surg for 13 years before moving to hospice, where I have been privileged to work for almost 24 years. At age 5, I was telling people I wanted to be a nurse. I believe it was a vocational passion that God placed in my heart those many years ago. 

A recent loss in my personal life, followed by a visit from a former patient, brought my passion into even clearer focus. 

I had received a phone call from my brother, telling me that moments before our father had suffered a massive heart attack and died. Even though he had been in declining health in recent years, the news felt like it hit me completely out of left field. 

The day of Dad’s memorial service arrived. While the presence of those in attendance was a comfort, it was also overwhelming to greet the many people who joined us to celebrate his life. Some we had not seen for many years, and it seemed they all had stories to share about him. 

One of the first people to approach me after the service was a man who appeared to be maybe 85. He had white hair, was hunched over and used a walker. He came up to me and stood there, staring at me, as if willing me to remember who he was. I drew a blank and asked, "How do I know you?"

His response was amazing: "You were my nurse 30 years ago, when I was in the hospital for five days to have my gall bladder taken out." He said it very matter-of-factly, as though I should remember him out of probably thousands of patients I have cared for over the years. 

Rather flabbergasted, I asked, "Did you know my dad?" He indicated he did not, that he had simply seen the obituary in the paper and wanted to come to the service as a tribute to me, his former nurse.

My mind raced. This dear man had connected me with Dad by recognizing me as a listed survivor in his obituary. It meant that he had to remember my first name and my maiden name from a brief hospital stay more than 30 years ago. 

I wanted to sit down and talk with him about his memories, but he promptly turned, walked out the door and was gone as suddenly as he had appeared. It seemed as if he knew he had accomplished his mission. I was engulfed with people wanting my attention, and it became impossible to follow him.

I have been reflecting on this former patient and his sudden reappearance in my life for several months. It was almost like he was an angel of sorts, sent to remind me how we, as nurses, touch the lives of people in our care at every turn. We sometimes are in good moods, sometimes not so good. We can become distracted by computerized charting, time management and policy and procedure manuals. 

It is easy to sometimes forget that we care for people when they are most vulnerable, sharing in their joys and sorrows in a way we might not always appreciate. We might forget their names by the next day, often as a coping mechanism, allowing us to go forth and care for the next person. We neglect to recognize they often do not forget us so easily. 

This former patient reminded me that we should never take any interaction for granted. We need to be caring and supportive, treating each of our patients with the respect and honor we’d like to experience if we were in their shoes. Our personal issues and circumstances are not important to them. They are watching us at every turn, looking for the light of our knowledge and support to see them through. A hug, a smile, a kind word, a moment of laughter or a shared tear — these are easy to give, but never forgotten. 

I pray I will always remember the responsibility I have to provide love, care and perhaps a moment of joy to the patients and families I interact with every time I put on my name badge. After all, we never know when a white-haired angel with a walker who received our care will cross our path and help us remember why we became nurses in the first place. 

Melissa Assink, RN, BSN, works for Providence Hospice and Home Care of Snohomish County in Everett, Wash. 

Source: Nurse.com

New guidelines from the United States Public Health Service update the recommendations for the management of healthcare personnel with occupational exposure to HIV and the use of postexposure prophylaxis. 

The guidelines, published in the September issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America, emphasize the immediate use of a postexposure prophylaxis regimen containing three or more antiretroviral drugs after any occupational exposure to HIV. 

The PEP regimens recommended in the guidelines encourage the consistent use of a combination of three or more antiretroviral agents, which are said to be better tolerated than those recommended in the previously published guidelines from 2005, for all occupational exposures to HIV. Eligible antiretrovirals are from the following six classes of drugs: nucleoside and nucleotide reverse-transcriptase inhibitors, nonnucleoside reverse-transcriptase inhibitors, protease inhibitors, a fusion inhibitor, an integrase strand transfer inhibitor and a chemokine (C-C motif) receptor 5 antagonist. 

The guidance eliminates the previous recommendation to assess the level of risk associated with individual exposures to help determine the appropriate number of drugs recommended for PEP. 

“Preventing exposures should be the leading strategy to prevent occupational HIV infections,” David Kuhar, MD, an author of the guidelines and a medical epidemiologist with the CDC’s Division of Healthcare Quality Promotion, said in a news release. “However, when exposure occurs, it should be considered an urgent medical concern and a PEP regimen should be started right away, ideally within hours of the potential exposure.”

Expert consultation should be sought, but not at the expense of delaying treatment, according to the guidelines. Exposed healthcare personnel taking HIV PEP should complete a full four-week regimen and undergo follow-up HIV testing, monitoring for drug toxicity and counseling, beginning with follow-up appointments within 72 hours of the exposure. 

If a newer fourth-generation HIV antigen/antibody combination test is used for follow-up testing, an option to conclude HIV testing at four months, rather than the recommended six months after exposure, is provided. Many of the revised recommendations are intended to make the PEP regimen better tolerated, increasing the possibility that healthcare personnel complete the full regimen. 

The guidelines were developed by an interagency Public Health Service working group comprised of representatives from the CDC, National Institutes of Health, FDA and the Health Resources and Services Administration, in consultation with an external expert panel. The updated revisions were based upon expert opinion. 

Many HCP exposures to HIV occur outside of health clinic hours of operation, and initial exposure management often is overseen by emergency physicians or other providers who are not experts in the treatment of HIV infection or the use of antiretroviral medications, according to the news release. As such, the updated guidelines should be distributed and made readily available to emergency physicians and other providers as needed.

Read the guidelines: www.jstor.org/stable/10.1086/672271

Source: Nurse.com

By Jacqueline Lee

Doctors may have led the medical BYOD revolution, but nurses have followed their examples. According to a report from Spyglass Consulting group, 69 percent of nurses bring their own devices to work.

According to another survey from Absolute Software, half of hospital staff members bring mobile devices to work access e-mail and calendar applications. However, 36 percent use their mobile phones and tablets to access patient information.

The winner, in many cases, is the patient. Nurses often use their devices to access clinical reference materials right at the point of care. They also use devices to coordinate care with other clinicians.

Overall, nurses that exercise their BYOD power report a greater sense of autonomy in the workplace. They are more comfortable using their own devices, they feel a sense of control over computing and they report an improvement in work-life balance.

Many analysts predict that mobile devices will spell the end for overhead paging systems in hospitals. They may also replace nurse call systems that don't quite get the job done. To make the change as smooth as possible, however, hospitals and medical clinics will have to take an attitude of, "If you can't beat 'em, join ’em." Intel has made an interesting video on the subject:

For example, if staff members are demanding BYOD in a hospital, then the hospital's CIO and IT department need to develop a BYOD strategy that protects patient information. The BYOD strategy should be integrated hospital-wide so that staff members have a unified method of communicating with one another.

A BYOD-friendly hospital, for example, would not only be able to use smartphones to page nurses and to coordinate care. They could transmit alerts from different areas of the hospital as well as communicate lab results and radiology reports. Nurses and doctors could also use their own devices to place orders for important medical tests and to access patient records.

In a world where HIPAA violations garner heavy government fines, medical facilities have to be savvy about how staff members are using patient information. No personal mobile device, for example, should store patient records.

Hospitals that embrace BYOD can make the work of doctors and nurses much easier. In the end, happy medical staff translates to better patient care.

Source: HealthTech

by Carrie Tian 

“Just Ask!” That’s the slogan for a new campaign by the Massachusetts Nurses Association (MNA). The union is encouraging people to ask how many other patients their nurses will be treating that day. The slogan is meant to draw awareness to what the nurses union sees as a growing disconnect between the profit-driven healthcare industry and the quality care of its patients.

The campaign’s goal is to enact minimum mandatory staffing levels, capping the number of patients per nurse. After a similar measure failed to pass the state legislature in 2008, the MNA wants to take the issue directly to voters through a ballot initiative. The union has submitted the text of the Patient Safety Act to the Attorney General’s Office; the act’s terms include limiting nurses to having up to four patients in surgical units and in emergency rooms. Once approved, the union will need to collect 70,000 signatures by November for the Patient Safety Act to appear on the 2014 ballot.

Currently, California is the only state that has mandated nurse-patient ratios. However, this topic may well seem familiar to Mass. voters: state nurses have sought staffing legislation since 1995, and 2011 saw fraught contract negotiations between Tufts Medical Center and its nurses. CommonHealth analyzed how Tufts’ lower nurse ratio affected patient care.

Lynn Nicholas, president of the Massachusetts Hospital Association, alluded to the idea’s long history by calling the current initiative petition a “repeat of an arcane idea that has no merit” in a statement. She said that patients would be better served by having decisions about their care made on a case-by-case basis. Her reactions echoed those of  Michael Sack, President and CEO of Hallmark Health, who wrote an earlier guest post on CommonHealth. “This cookie-cutter approach would completely take away a hospital’s ability to tailor care to specific patient needs,” Sack wrote.

Source: WBUR CommonHealth

by Crystal Loucel

Because minorities are more likely to receive less and lower-quality health care and suffer higher mortality rates from cancer, heart disease, diabetes, HIV/AIDS and mental health illnesses than their Caucasian counterparts, there have long been calls to increase the number of minority providers to reduce these health disparities. Numerous studies have shown that patients are more likely to receive quality preventive care and treatment when they share race, ethnicity, language and/or religious experience with their providers.

The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health found that a diverse workforce – and the diverse perspective it provides – contributes to enhanced communication, health care access, patient satisfaction, decreased health disparities, improved problem solving for complex problems and innovation. Moreover, the Health Resources and Services Administration (HRSA) has found that minorities could improve access to care in underserved areas more than nonminority providers (see The Rationale for Diversity in the Health Professions: A Review of the Evidence [HRSA, 2006]).

Yet minorities are still under-represented in the health care workforce generally and in nursing in particular. In 1908, when Israel Zangwill popularized the term melting pot to describe the American population, it was 89 percent white, 10 percent black and less than 1 percent Indian, Chinese, Japanese and “others.” Today’s melting pot is considerably more diverse, composed of more than one-third racial and ethnic minorities; moreover, the United States Census Bureau expects that portion to be more than half by 2050.

“Today the nursing workforce does not adequately reflect the diversity in the population including gender,” says Beverly Malone, CEO of the National League for Nursing. Latinos, African Americans, American Indians and Native Alaskans compose only 7.6 percent of the nursing workforce, a dismal figure compared to the 25 percent in the general population. UCSF’s nursing student population is doing a bit better – in 2009, the latest year for which data are available, these same groups composed 16 percent of the UCSF nursing student body – but there is certainly room for improvement. When Asian Americans are included, a 2008 HRSA report showed that minorities make up 35 percent of the total population but only 17 percent of the nursing population.

UCSF has been trying to respond to the 2004 Sullivan Commission Report, titled Missing Persons: Minorities in the Health Professions, which recommended that health profession schools hire diversity program managers and develop plans to ensure institutional diversity, including providing educational support, commitment, role modeling and dedicated recruitment. Currently, Judy Martin-Holland serves as associate dean for Academic Programs and Diversity Initiatives at UCSF School of Nursing, a role in which she recruits minority students, seeks to integrate more diversity in the curriculum, and offers support programs for minority students. In addition, after years of medical student advocacy, Renee Navarro, vice chancellor Diversity and Outreach, created the School’s first Multicultural Resource Center. Though the center currently has no budget, its director, Mijiza Sanchez, hopes to advocate for the types of programs that the commission has recommended, such as the mentoring that Sanchez herself offers students.

It’s also important to remember that minorities often face barriers to financing their education and would benefit from scholarships, loan forgiveness and tuition reimbursement programs.

In addition, universities should link to minority professional organizations to promote enhanced admissions policies, cultural competency training and enhanced minority student recruitment. For example, as volunteer past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses (NAHN), I am proactively connecting to the UCSF student group Voces Latinas Nursing Student Association (VLNSA) to do just that. VLNSA is open to students of all ethnicities who are interested in working with the Latino community; the ability to speak Spanish is not required. And organizations like NAHN typically offer reduced student membership and benefits such as mentoring, résumé revision, job postings, volunteer opportunities, networking and more for students, without requiring them to be from any particular racial or ethnic background.

That last point is important, because no matter how diverse your workforce, the goal is to create an environment that is inclusive and allows everyone to express themselves. As minorities, we cannot address our specific health issues alone; rather, this is a challenge for all health care providers. Given what we know about diversity and its importance to health care, we must partner to creatively address and embrace an ever more diverse future.

Crystal Loucel is a second-year master’s student at UCSF School of Nursing and past president of the San Francisco Bay Area chapter of the National Association of Hispanic Nurses. She has a master’s in public health, specializing in global health, from Loma Linda University; has served as an AmeriCorps and Peace Corps volunteer in Honduras; was one of eight RNs chosen in 2012 for a General Electric-National Medical Fellowship in primary care; and is a 2012 scholarship recipient from the Deloras Jones Kaiser Foundation. An earlier version of this piece appeared in the UCSF student newspaper, Synapse.

by Kathleen Hoffman

The Navajo Sugar Monster

Long ago the Holy People predicted that a monster would take over the Navajos.

Our mothers and fathers would change…No longer were man and woman together.

One after another this monster ate away their faces.

It gnawed away Navajo identity….Everything turned from light to dark….Words ceased to exist.

The Holy People begin to cry.

The Navajo language meets its end…Mouths would soon close entirely.

X marked the spot….Over the eyes and mouths of the people.

The Navajo were not human anymore.

They were beings who craved only one thing

It was not water or food…Nor prayer or traditions…Nor love or family.

The Holy People were right.

Sugar is our monster.

A killer claiming Navajo lives…With a craving that could never be satisfied

Who are these monsters?

Mom? Dad?  Where are the elders? Where is my family?  Who will save us?

It’s going to claim the next generation if things don’t change…

We must stand and make a change…Stand up and fight against this monster

For you…For your family,

Your mother, Your father, Your children

For your Nation.”

by Chantelle Yazzie (A neo-traditional story published on Wellbound Storytellers.)

Native Peoples have higher rates of death by alcoholism (552%), diabetes (182%) and unintentional injuries (138%) than other Americans.  The story above is a neo-traditional story addressing the impact diabetes is having on the Navajo nation.  Neo-traditional stories are creations of today’s Native Americans; attempts at merging the old ways and addressing today’s problems.

Native American’s believe in the power of the story to heal.  Traditional healing stories are unique to particular nations and certain individuals, specifically elders and healers are the only ones who can tell these stories.

According to Teresa Lamsam, of Wellbound Storytellers, specific individuals have a responsibility for traditional healing stories. “Most of the stories that would be relevant [to healing] are considered to have healing within the telling of them — which is what creates the responsibility for the person who carries the story [the healer].  The person who receives the story [patient] also has responsibility.  Usually, a ceremony must accompany the story.”

Do you have a story to share about your experience with diabetes?  Can you create a healing story?

Source: Medivizor

By Rebecca Maitland

With the aging population and with baby boomers moving into their golden years, retirement communities are opening across the city and surrounding areas.

Plus, many established senior living communities are expanding services and programs for continuum-of-care, known as transitional care.

This is all good news for nurses with experience in geriatrics and the senior population.

"Continuum-of-care is the progression of care from independent living, to assisted living, memory care, and to skilled nursing or long-term acute care, all in the same location. As a person's level of acuity rises, one can advance to the next level of care as needed," said Jeny Knight, executive director, The Abbey at Westminster Plaza, Houston, a senior living community.

Residents who live in retirement or assisted living communities have the convenience to age in place, without having to make an additional move in order to have additional care.

Moving is one of life's high stress points, but for senior citizens, it can be more detrimental. Therefore, retirement communities are providing additional services from either outside sources such as home health, rehab or hospice, or are providing transitional care services on site as part of their community.

For example, Houston's Parkway Place senior living community offers independent-living apartment residences, assisted living, continuum-of-care, memory care, and skilled nursing services, all within the location.

"In our skilled nursing, we also provide care for residents needing a short-term rehab stay that is covered by Medicare and for those residents needing long-term nursing care. We provide physical, occupational and speech rehab. We also work with hospice for those residents needing that special care. For residents needing long-term nursing home care, we provide 24-hour nursing care to meet all of their needs," said Jimmy Johnson, executive director, Parkway Place senior living community.

A skilled nursing facility is required to have a 24-hour licensed nurse on site for those who have a higher level of need.

"At The Abbey at Westminster Plaza, the wellness team includes a licensed nurse as director of health services and a wellness manager. We have two licensed vocational nurses, and a home health agency provides our community with an on-site registered nurse," Knight said.

Openings to fill

Most senior living communities that have openings are recruiting licensed RNs, LPNs or LVNs in good standing with the state licensing authority, who are able to remain calm in stressful situations and have a passion for helping seniors. Moreover, most senior living communities provide ongoing training throughout the year for the specific population.

Parkway Place has registered nurses and licensed vocational nurse on staff that participate in the facility's ongoing training throughout the year. The training, which is geared toward geriatrics, includes training in dementia, Alzheimer's, wound care, IV medications and others.

LVN staff at The Abbey also receives additional in-service hours of training in Alzheimer's care to educate them about special needs of residents with various forms of dementia.

"In addition, all of our staff has in-services monthly as part of their continuing education," Knight said.

"We are always looking for nurses, LVNs and RNs to work PRN, or as needed, and we look for staff who enjoy working with senior citizens," Johnson said.

Knight said there is a demand for nurses in skilled and acute care settings. The growing number of people age 65 and older will only increase this need. Therefore, the demand for LVNs and RNs, as well as certified nursing aides, in senior living facilities will continue to grow.

Source: Chron

One of our fellow nurses needs some help dealing with racism in the workplace. Do you have any advice or experiences that will help her out?:

"How do you deal with racist comments directed toward yourself from patients? I've experienced racist attitudes before, but never verbalized comments in a derogatory manner from a patient until this week. Naturally I felt very down for a few hours afterward and I continue to think about it. It wasn't the negativity toward me per se, it was the thought that there could be more people out there thinking/feeling the same animosity toward me over something I cannot control, my phenotype. I take pride in my cultural heritage and wonder how anyone cannot see the beauty in diversity. I also thought that because they are sick they let their true thoughts out. Could any healthy person walking around be feeling the same thing but be inhibited from making it known? Then I thought of the people who could be dealing with this on a regular basis. How do you deal?"