DiversityNursing Blog

Faced with a shift in the healthcare landscape toward outcomes-based practices and quality improvements, the American Association of Colleges of Nursing (AACN) sought to update the scope of nursing practice with a new master's prepared role: the clinical nurse leader (CNL).

The first new nursing role in over 35 years, the CNL grew out of the 1999 Institute of Medicine report "To Err is Human" which challenged care providers to reduce medical errors and focus on patient safety. 

Rising to the challenge, the AACN initiated an investigation into the barriers to improved care delivery and in 2005 introduced the new role as a way to prepare nurses to thrive in the changing healthcare system, according to the AACN website. For many, it couldn't have come at a better moment.

"We are at a pivotal time for the role," said Bob LaPointe, MS, MSN, RN, CNL, president, Clinical Nurse Leader Association (CNLA), and MICU staff nurse at Penn Presbyterian Medical Center, Philadelphia. 

"Healthcare is increasingly complex, and we need leaders who are trained in complexity theory to be able to navigate that and understand it to have better patient outcomes and that's what clinical nurse leaders are uniquely trained to do."

CNL

As defined by the CNLA, the CNL is an advanced clinician who serves at the point of care as the lateral integrator, facilitating, coordinating and overseeing care within the unit while also collaborating across the healthcare continuum.¹ The CNL is trained to facilitate evidence based care at the bedside and ensure positive outcomes for even the most complex patients. Such training, especially these days, is a great option for nurses of all kinds looking for a way to make a difference at the bedside.

"The role really is about improving clinical outcomes-improving the care of the patient as well as improving financial outcomes," said Tracy Lofty, MSA, CAE, director, Commission on Nurse Certification (CNC), an autonomous agency of AACN, Washington, DC. "Regardless of practice setting, the ultimate goal is to improve outcomes, so really everyone benefits from the role."

When Veronica Rankin, MSN, CNL, Carolinas Medical Center, Charlotte, N.C., decided to go back to school, she chose to do so through a CNL program after her facility's assistant vice president introduced the role at a town hall meeting. Since graduating in 2011, she and her fellow CNLs have been making a huge difference for patients, colleagues and the hospital as a whole.

"We bring that continuity of care back to the bedside, so that even though the nurses may change every shift every day, you are still going to have the same clinical nurse leader Monday through Friday taking care of that patient," Rankin said. 

"It has given me the opportunity to stand back and see the big picture of my patients' journey. I can get in there and see, 'OK, out of everyone that is involved in this patient's care, we have all these hands in this pot, what are we missing and where are the bridges I need to help connect?'"

Rankin's ability to streamline care and improve both patient and hospital outcomes comes directly from her training, and nurses and facilities across the nation are starting to see the difference CNLs can make on a unit-by-unit basis.

"When you take a policy and implement it in your unit, in your hospital, in this city, with the resources you have available, it can be the best evidence based practice out there," LaPointe emphasized. "But we have to apply it to our patients and our staff as well, and that's really where the clinical nurse leader's role really comes into play. How does this make sense for us as a unit, and for our patients."

Education

Since the pilot program that tested in the fall of 2006, more than 2,500 nurses have earned CNL certification from CNC. Part of the success, according to LaPointe, is the fact that anyone inspired to become a CNL can do so.

"Nursing has always had multiple points of entry, which leads to lots of people being able to do it, but it also leads to lots of variability about the training and preparation," LaPointe said. "There is so much more to know and healthcare is so much more complex, that to have training in complexity theory, change management and in the science of outcomes, that's going to be good for anybody."

To make the CNL educational track available to nurses already practicing as well as those looking to get into the field, the AACN created five different models so that regardless of educational background, there is an entry into a CNL education program. The five models are:

• Model A - Master's degree program designed for BSN graduates
   
• Model B - Master's degree program for BSN graduates that includes a post-BSN residency that awards master's credit
   
• Model C - Master's degree program designed for individuals with a baccalaureate degree in another discipline
   
• Model D - Master's degree program designed for ADN graduates (RN-MSN)
   
• Model E - Post-master's certificate program designed for individuals with a master's degree in nursing in another area of study²

Following graduation of a CNL education program, licensure as a registered nurse, and successful completion of the CNL Certification Exam, candidates may be awarded the CNL credential.

With the role gaining momentum, the CNC decided to revamp the certification exam in 2012 to make sure it reflected the basic competencies of a CNL.

"The new exam is based on a CNL job analysis study that was completed in 2011, so the exam reflects the knowledge, skills and abilities of a competent CNL," Lofty said. "It's all about application, so you may be in an educational program, but then you need to be able to apply the knowledge, and that is demonstrated on the exam."

Integration

As new CNL graduates start the search for the right clinical setting, they need to keep in mind that some healthcare organizations have yet to fully integrated the clinical nurse leader into their staffing model.

"There are many healthcare institutions specifically recruiting to full clinical nurse leader positions," said Lofty. "For other institutions, it may not be that title, there may be a different title like care coordinator, or they are still looking for someone with the same skill set and they are still hiring individuals with those competencies and perhaps applying them to other positions."

But CNLs need not worry about their job prospects, because their CNL skills are valuable in just about every care setting. According to a 2012 survey conducted by the CNC, 96% of the respondents indicated that they apply their CNL knowledge in their current role, 92% feel they are an important member of their team and 87% said they are valued as an employee because they are a CNL.³ LaPointe knows from personal experience just how useful being a CNL can be regardless of job title.

"I am not functioning in a job that is called 'CNL' right now, and that is true for many people who currently have the certification," LaPointe said, who was confident he would still use his training despite not being hired specifically as a CNL. "I helped write our successful Beacon Gold application, I was very involved in our hospital's first Magnet designation, I am on the evidence based practice committee for the hospital, and the chair of our unit-based council as part of the shared governance structure of the MICU, so I am using this stuff all the time."

Next Steps

No matter where CNLs end up, they are sure to improve care coordination, communication and hospital-wide outcomes.

"You are basically in there improving care for nurses, patients, and physicians," Rankin said. "You are improving care delivery and the receiving of care for the patient population, so you are in there with your hands so much."

"Bring evidence based practice to your unit to show what the worth of the role is," Rankin advised nurses considering the CNL role. "In the end we are also taught that the clinical nurse leader is the guardian of the nursing profession, so we have to get in there and be the guardian. I would say, go for it, go hard, and be a guardian for the nursing profession."

Source: Advance for Nurses 

BY SEAN DENT

There is a lot of advice out there about how you should enter, develop and progress in nursing.

Do you get your feet wet by simply gaining some “field” experience before transferring to a specialty like Emergency, Critical Care, or the Operating Room?

What about pursuing an advanced degree? What are the qualities you should acquire and maintain to stay sharp? How do you avoid burnout? Where is the best place to work? What about workplace bullying? Nurses eat their young, right?

The list is long and the questions are never-ending  And, quite honestly, there is never a simple answer, or a single correct answer.

Over the years, I think I’ve finally figured it out: I found that “one thing” that matters. I found that “one thing” that can ensure you don’t get bogged down with the rhetoric and negativity. What is it?

Honesty.

Being honest is the key to success in this profession. And I’m talking global honesty across every facet of your job.

Be honest with your patients

• If you don’t know something, admit it. It’s okay to share stories with them. It’s okay to be human. It’s nurses’ genuine nature that keeps patients voting us the most trusted profession every year.

Be honest with your coworkers

• Don’t pull a fast one on the very people you’ll be relying on to pull you through that hellish shift. But don’t be a pushover. Be honest. Be genuine. You may be a little more vulnerable, but the reward you get always outweighs the risk.

Be honest with management

• This goes hand-in-hand with coworker honesty. Take care of those who will take care of you. Even if it’s the worst boss in the world, hate and evil just beget more hate and evil. I truly believe that honesty always wins out.

Be honest with your physician partners

• Respect has to be earned, not just expected. I have learned over the years to be honest about your skills, your knowledge and your performance with your physician partners–they will respect your honesty more than any lie you can tell. Don’t try to fool the very professionals who are your biggest supporters.

Be honest with yourself

• Not happy with your job? Change it. Not happy with your position? Change it. Don’t let anyone convince you that your situation is not in your control. We work in the greatest profession I know. You have an unlimited number of opportunities–you just have to be enough of a forward-thinker to go find them.

Be honest. Now, remember, I never said being honest was easy. Just because it’s the right thing to do doesn’t mean it’s popular. Be honest, but be strong. You will find that being honest is tough, so hang in there and don’t succumb to the pressure of dishonesty.

Do you agree?

Source: ScrubsMag

By Leah Thorsen

Margie Long was a 24-year-old nurse when she held the smallest baby she’d ever seen.

It was Jan. 31, 1947. Little Sharon Lynn Kaiser weighed just 1 pound, 14 ounces, measuring 12 inches long.

She had arrived more than two months early and was delivered by Caesarean section.

Doctors didn’t think she’d survive more than a day.

Long had become a nurse to help people. She knew that baby needed help, and she devoted herself to caring for the newborn during her 73-day stay at Suburban Hospital in South Gate, Calif.

“She looked like a rubber doll,” Long said Thursday as she and that grown baby — now a 66-year-old great-grandmother whose married name is Sharon Bolles — sat on the couch of Long’s home in De Soto.

In the decades since Bolles’ birth, the two have shared a bond experienced by few nurses and patients. They have corresponded by letter and phone while separated by thousands of miles, and have enjoyed the occasional face-to-face meeting.

“She never, ever missed my birthday or Christmas,” Bolles said of the cards from Long, whom she credits with saving her life. She has cherished those cards and letters. Now, they talk on the phone at least once a week.

Bolles drove from her home in Tulsa, Okla., to visit Long on Thursday. She brought mementos. They looked at old pictures, including one of Long cradling Bolles as her parents beamed, as well as photos of other visits through the years.

Bolles brought newspaper articles too, some from her time in the hospital and after. One headline read, “Tiny babe, given no hope to live, is a big girl now.”

And Long, now 89, told of Bolles’ tenuous first months, when that bond began.

“I got pretty attached to her,” Long said. “I kind of hated to see her go home.”

MEDICINE DROPPER FOR MILK

Long — who grew up in St. Patrick, Mo., and took the job in California while visiting a cousin there — remembers feeding Bolles a teaspoon of breast milk from a medicine dropper every hour.

A newspaper article reported Bolles gained three-quarters of an ounce each day during the first three months.

Long recalled that she cut a cloth diaper so it was small enough for the tiny baby. She constantly worried that Bolles wasn’t warm enough, and hurried to feed, bathe and dress her, keeping her wrapped in a blanket.

Bolles pulled out a newspaper story with the headline “30-ounce baby makes progress in incubator.”

Long remembers that incubator — it was a bassinet with a 5-gallon jar of water beneath it. Two 500-watt bulbs heated the water, and a sheet covered the top of the bassinet to keep Bolles warm. An oxygen tube ran beneath it so she could breathe.

Bolles said Thursday she had never heard that description.

Long remembers the two blood transfusions Bolles received, when she worried the baby wasn’t going to survive.

And she remembers Bolles’ twin sister, Augusta Lee, who died hours after birth.

“Respiratory distress,” Long said. “We couldn’t save her.”

The record for the lowest birth weight of a surviving infant is held by Rumaisa Rahman, who weighed 9.17 ounces — about a third of Bolles’ birth weight — when she was born in 2004, according to Guinness World Records.

Bolles weighed 5 pounds, 11 ounces when she was discharged from the hospital.

She kept the hospital bill from her stay. It was $597 — that included a $3 per-day charge for 73 days, another $256.50 for 19 oxygen tanks, and $55 for blood, plasma and transfusions.

The two reunited for the first time when Bolles was 1 year old.

“She was still on the tiny side,” Long said.

Bolles would never be big — she weighed 33 pounds at 5 years old, and was just 110 pounds when nine months pregnant with her own daughter, she said.

Long moved to De Soto in 1959 after being stationed with her husband, who was in the Navy, around the country and in Panama. She worked as a nurse for the Jefferson County Health Department for 18 years.

The two met again in 1969, when Bolles’ husband was stationed at Scott Air Force Base, and again in 2006 when Long passed through Oklahoma on her way home from a trip to Texas.

Thursday was their fourth get-together. Long told her grandson that “my preemie” was coming to visit. Bolles certainly wasn’t the only premature baby she’d cared for during her nursing career, but Long didn’t need to explain any further.

“He knew who I was talking about,” she said.

Still, neither can quite explain why their connection has endured.

“I know how special she is,” Bolles said. “I’ve always known that.”

Source: STL Today

By Chris Hoenig

When it comes to understanding the needs of diverse communities, including the LGBT community, not all hospitals are the same. Improving patient outcomes by providing culturally competent care is the focus of a DiversityInc healthcare summit this September, including presentations on equitable care and improved outreach to the LGBT community.

The Human Rights Campaign, which will present at the event, released its 2013 Healthcare Equality Index this month, a measurement of equality in care and employment for LGBT patients and practitioners. Seven of DiversityInc’s Top 10 Hospital Systems earned HRC’s highest rating.

To qualify as an HRC “Leader in LGBT Healthcare Equality,” facilities had to be able to provide documentation proving that they meet guidelines in four core criteria: patient nondiscrimination policy, equal visitation rights, employment nondiscrimination policy and training in LGBT-patient-centered care. The core criteria are further broken down into more specific actions, such as making sure that patient and employee nondiscrimination policies include both the term “sexual orientation” and “gender identity,” and that these policies are communicated to patients and visitors in “at least two readily accessible ways.” A hospital had to comply with every guideline to be designated as a Leader.

The DiversityInc Top 10 Hospital Systems

A total of 24 facilities owned and operated by companies in the DiversityInc Top 10 Hospital Systems achieved Leader status.

University Hospitals (No. 1 in the DiversityInc Top 10 Hospital Systems) has 10 facilities on the list. “We have made it a corporate priority and a strategic business process to nurture and strengthen a culture of diversity and inclusion, both within our system and across our community,” CEO Thomas Zenty III says. The system’s Ohio-based Leader facilities include: UH Ahuja Medical Center, UH Bedford Medical Center, UH Case Medical Center, UH Conneaut Medical Center, UH Geauga Medical Center, UH Geneva Medical Center, UH MacDonald Women’s Hospital, UH Rainbow Babies and Children’s Hospital, UH Richmond Medical Center and UH Seidman Cancer Center.

Henry Ford Health System (No. 2) has six Michigan-based Leader facilities. “Our rich diversity makes us a better company and helps us connect with the healthcare needs of our patients and their families,” CEO Nancy Schlichting says. Henry Ford Behavioral Health Services, Henry Ford Hospital, Henry Ford Macomb Hospital, Henry Ford Medical Group, Henry Ford West Bloomfield Hospital and Henry Ford Wyandotte Hospital all received Leader rankings.

Continuum Health Partners (No. 4) has two New York City hospitals on the list: Beth Israel Medical Center and St. Luke’s–Roosevelt Hospital Center. In addition to site diversity councils and subcommittees, Continuum also has an LGBT communities resource group.

North Shore–LIJ Health System (No. 9) is represented by three New York hospitals. On the DiversityInc rankings for the first time, North Shore–LIJ is known for its outreach to the LGBT community, which has also been recognized by the HRC. Lennox Hill Hospital, Southside Hospital and Staten Island University Hospital all achieved Leader designation in the HEI.

Massachusetts General Hospital (No. 7), Rush University Medical Center (No. 8) and University of New Mexico Hospitals (No. 10), all rated as single facilities, also achieved a perfect four-for-four and are therefore recognized as Leader hospitals by the HEI.

Two Cleveland Clinic (No. 3) facilities—its main campus in Ohio and Cleveland Clinic Florida—narrowly missed the HEI Leader list, gaining approved rankings in three of the four core criteria.

While not included in DiversityInc’s Top 10 Hospital Systems, Kaiser Permanente—a larger healthcare provider that ranks No. 3 in the DiversityInc Top 50—is well represented among HEI Leader facilities. Thirty-eight Kaiser properties in three states—California, Hawaii and Oregon—are recognized in the HEI.

More to Learn

A 2010 Lambda Legal study, quoted by the HEI, noted that 29 percent of lesbian, gay and bisexual patients fear they will be treated differently by medical personnel, while that number rose to 73 percent for transgender patients. More than half of transgender patients (and 9 percent of lesbian, gay and bisexual patients) fear they will be refused care because of their sexual orientation or gender identity.

These statistics highlight the need for improved patient experiences in the LGBT community at the times of greatest need. The Supreme Court’s ruling on the Defense of Marriage Act opens up spousal healthcare benefits for federal employees, but while some financial fears are eased, the care LGBT patients get for the money remains a concern.

The Human Rights Campaign and University Hospitals will offer more detail on the HEI and how to develop successful outreach programs for the LGBT community at Culturally Competent Healthcare: How Diversity Creates Better Outcomes , DiversityInc’s event on Sept.24 in Newark, N.J. Guest presenters include Donnie Perkins, Vice President, Diversity & Inclusion, University Hospitals, and Shane Snowdon, Director, Health and Aging Program, Human Rights Campaign.

Source: DiversityInc

by Angela Stevens

I’ve known a few ER nurses over the years, and all of them have told me that, no matter how much training they have had, how their teachers and textbooks tried to prepare them, and even how much experience in other fields of nursing…nothing prepared them for the reality of working in an emergency room. When choosing any nursing specialty, it is important to test drive the environment before making a final decision. This can easily be accomplished by taking a position as a traveling nurse and visiting different areas of the country as well as different nursing environments. In fact, one of the girls I went to high school with did this, and she found her great love was in pediatrics. Janey, the friend who became a pediatric nurse, actually did a stint in an emergency room for several months and told me some of the hardest things she had ever had to do occurred during that time. Don’t get me wrong, she said that the heartbreak in pediatrics could be excruciating, but that – more often than not – it was a happier place to be.

One of the difficulties she faced in the emergency room was not being able to make a personal connection with the patients. She was with them for only a brief period of time, usually a few hours, before they were discharged or sent to another floor of the hospital. She rarely found out what happened to the patients, even those she felt a connection to. Being able to move on to the next patient and distance yourself from previous patients is difficult. Another difficulty of being an emergency room nurse comes when there are more patients than there are people available to help them. At this point, the nurses, usually the first to see and evaluate a patient, have to decide who is in the most critical condition and get them to see a doctor. Making the decision of who gets medical treatment first was overwhelming for many of the nurses I knew, at least initially. One told me that she finally realized that, the more quickly she was able to make her assessment, the faster everyone would receive the care they needed. This is what stopped her from “hemming and hawing,” as she put it, and put on her decision making cap. While it was true she had to leave some patients in the waiting room who were miserable, they were seen as quickly as she could process those with more pressing conditions. Seeing it in this light made perfect sense to me, and it made me realize that, when I visit the emergency room as a patient, it isn’t that the nurses don’t care. Quite the opposite, really; sometimes they may care too much. I now know that if I’m waiting, there is usually someone with a much more serious problem who is receiving care.

Why did you, or do you want to, become an ER nurse? How has it changed your perspective?

Source: Sunbelt Staffing 

by Mark Downey

One of the questions that I frequently ask my students is, “Do you need to care to be a great nurse?” It’s always interesting to read the expressions on their faces and imagine what they must be thinking, because for the majority of my students it is the wanting to be a nurse and all that it entails that is a motivating factor in studying for their nursing degree.

From “Is he trying to trick me?” to “My teacher is an idiot!”, I can see the cogs and wheels ticking over in their brains. More often than not, I don’t give them an opportunity to answer. Instead, I tell them, “You don’t have to care about people to be a nurse. I consider myself an excellent nurse, but I’m not paid to care”.

Reactions to this vary. The two most common being dumbstruck, tongue tied and not knowing quite what to say or alternatively the hairs on the back of the neck bristle and I am challenged (often quite vigorously). Rarely, if ever, does anyone agree with me.

Let me explain with an example. If you’re a patient in an Accident and Emergency Room or perhaps lying unconscious in an Intensive care bed or on an operating table, is it really going to matter if the nurse gives two hoots about caring for you? Of course not! What is important is that the nurse is clinically competent and understands your health requirements so that every opportunity is afforded in generating a positive health outcome.

A steam train driver doesn’t have to care about his train to drive it, but he does need to understand how it works. As long as the gauges stay within the safe zones and coal is regularly fed to help generate steam to drive the engine, it doesn’t matter if he cares about the train or not. In fact, regardless of his care factor, the end result will never vary as long as he is good at his job. To be a good and great nurse is to know how to do your job right. I know everyone will agree.

Isn’t a nurse just like the train driver? Health outcomes will always be the same regardless of how much caring the nurse gives. It all boils down to the nurse trainings and the skills they have developed and how they are implemented. Nothing more, nothing less. A Cardiac Nurse needs to know about your heart, how it works, what the ECG squiggles mean and what the drugs that have been prescribed for you are going to do, but they don’t need to know your hearts desires or what’s in your heart. Isn’t that the job of the Chaplain?

Another important point is not to confuse advocating for the patient with caring. Advocacy is mandatory if the nurse’s training and experience lead them to believe that an alternative option may deliver a better health outcome for the patient. But really you don’t have to care to advocate as it’s just part of being a good nurse.

My argument is further proven when you consider the nursing process. Although it comes in many forms and guises, it is essentially:

• Assess the situation.
   
• Planning a course of action.
   
• Implement that action plan.
   
• Review the effectiveness of the plan and when necessary returning to step 1 and repeating. 

Nowhere, I repeat, nowhere, in any of the literature I have read, have I ever seen or mentioned that caring was required as part of the nursing process.

So do nurses care about their patients? Of course they do! Don’t be a goose! For the vast majority it’s an integral part of what makes them who they are. Nurses are looking after people, not machines. So, do I care for the people that I look after? I do and with a passion, but I don’t have to and, if couldn’t care for people, I couldn’t do my job.

Earlier on in this post I made the comment “I consider myself to be a great nurse, but I’m not paid to care.” This, I hold, as an absolute truth. When I am nursing, I am not paid to care.  You cannot pay me to care. I will not accept money to care! I choose to care because I want to care and you get that for free.

Source: NurseTogether

Bad Hospital Food: Coming to a Theater Near You

Whatever the paste-like substance is on the bottom right portion of the plate, the icky gravy coating certainly doesn't make it look any more appealing. The glop of green had better days in a Japanese horror flick.

Bad Hospital Food: Thank Goodness There's Dessert

Umm... at least there's caramel pudding! Even the wilted salad that hangs over the edge of its plate seems keen to escape this sad assembly.

Bad Hospital Food: Save Me From Savoury

Bad Hospital Food: Ham Tartare?

It's hard to mess up ham—but we think this plate deserves a medal for making it appear totally unappetizing. The lack of condensation on or around the food also points to another sad fact—this meal is completely cold and clammy. If you stare at the mashed potatoes(?) long enough you can almost see a face. A sad, sad face. 

Bad Hospital Food: The Dry to Try

Well, there's Remoulade sauce so we're guessing this is breakfast? Talk about a DRY looking meal. We're choking just looking at it. Additionally, we have no idea about those things opposite the slice of bread. Could be calamari, could be dog biscuits.

Bad Hospital Food: To Be Determined

There are just so many mysteries on this plate. It's certainly hard to discern the nutritional value of a meal like this when the four main food groups are Incognito, The Thing, Slime and Tan Unknown. 

Source: ScrubsMag

by Paul Millard

Our brain is divided into left and right hemispheres. The left is the logical, linear and reasoning side while creative, intuitive and artistic operations reside in the right side. We all use both parts daily, but our culture strongly encourages the exercise of the left hemisphere. Nursing profession especially emphasizes this in all our “ology” classes: Pharmacology, Biology, Psychology, Microbiology to name a few. But it's interesting that common myth states men do better in sciences whilst nursing is traditionally a female pursuit though nature has seen fit to give us equal size in each hemisphere.

Non-scientific beliefs occur almost to everyone. Who hasn't worried about a black cat crossing their path, of the number 13 (many tall buildings won't even allow a floor numbered 13! and of course Friday the 13th!) or the effects of a full moon? All these arise from the mythical thinking of the right brain. However, nurses need to be positive thinkers to be able to render the quality care every patient deserves. 

Before the reader concludes that I'm criticizing this, I must confess that I've always had a problem with math teachers. Given a test, I would go through the test assigning the correct answers to the questions (intuitive, right hemi thinking), then go back and try to put enough stuff on the paper to “show your work.” This leads me in an argument with the teacher “how can you mark these questions wrong when I got the right answers?” to which the teacher retorts “but you can't get that answer with the work you put on the paper” (scientific, left hemi thinking).

Most of my years as a nursing professional, it has been in the desert Southwest. Very interesting culture and hemisphere clashes occur here. Smile at how cute a Hispanic baby is and the mother might start yelling “mal ojo, mal ojo” (evil eye) believing that I am stealing the child’s spirit with my eyes. Soon I learned to always touch a child on the shoulder or head when looking at it to prevent “stealing his spirit.” The Native Americans believe that what we call the soul resides in the person’s hair. If forced to shave or cut hair from a Native American, I always carefully return all the hair so that the owner can dispose of it through the proper ritual. A friend working with the Navajo tells of having treated a woman for a heart attack. Afterwards, the woman would return periodically and insist on being hooked up to the 12 lead EKG machine. Asymptomatic, it wasn't even necessary to do an EKG. She believed that the connection had healing powers.          

All of that said, a recent question on a website about “Energy Bracelets” caught my eye. There were some positive responses, and some claiming “it's a scam.” I hope someday we'll find an easy way to quantify the power of belief. There were so many naysayers of the energy bracelet that I doubt they would all be atheists. Belief in a higher power requires a certain amount of faith in the unprovable (right hemi), yet belief in an energy bracelet is criticized.

Having witnessed three exorcisms, I supposed tolerance is a virtue all nurses should nurture. Belief, generically speaking, is far more powerful than credited. Over the years, I have seen many things that defied scientific explanation and have had to remind myself over and over that the patient's belief plays a larger role in their outcome than is credited. Just as we must always tell people to make their own decisions because our own answers might not be right for them, we must also avoid projecting our beliefs upon our patients.

Science or superstition, nursing profession is still an art that uses a magic touch that helps ill patients heals and recover from their illness.

Nurses and nursing students, if you are interested in sharing your nursing knowledge and experiences with our audience, please click here.

Source: NurseTogether

By Liane Clores

I glance at the wall clock as I finish off my breakfast with the last sip of coffee. 6:14 am. Duty is about to start in about 46 minutes. I have to hurry up, I don’t want to be late for the endorsement. I fix my neatly ironed scrub suit and smock gown, pick up my things, which I prepared last night and head out the door with my game face on. Another day of saving lives is about to start.

“It’s like having a taste of both heaven and hell on earth,” Carmel* tells as she describes what it is like being an ICU nurse. “You get to save lives and be of help to patients who are sick, but what’s depressing about being a nurse in the ICU is seeing a life fading from a person’s eyes from time to time,” she adds.

6:30am. I arrive just in time for the nurses’ endorsement. I warm up and whisper to myself, “I can do this” as I get ready to face anything that may happen within my 8-hour duty shift. I grab the kardex first and try to read through my assigned patient’s information. Next, I take hold of the chart and read thoroughly, asking questions now and then from the outgoing nurse-on-duty, checking every sheet on the chart. We then proceed to bedside endorsement. Icheck if the IV site is patent and is not yet infiltrated, the labels and drips of they are on time, the urine catheters if clogged up or not, machines attached to the patient if functioning well.

“You have to be meticulous though, everything can be significant. You must check everything in the chart, from orders to what medications are to be administered and what has been the status of the patient within the previous shift. You must possess good assessment skills and must never be afraid nor shy to ask questions, or else it will only result to you getting confused, making mistakes, and worse taking your patient’s life at stake,” Rachelle shares.

After all the assessment and baseline vital signs taking, I proceed to checking the stocks and supplies. Once satisfied that the stocks can last the entire shift, I take the medicine cards from the medicine rack and organize them. I plan out my activities for the shift and prioritize them according to urgency, for today is going to be a long day of turning and lifting patients, administering medications, suctioning, monitoring and catering the patient’s needs.

The ICU is where seriously sick persons are admitted and are cared for by specially trained nurses.  They need a higher level of care compared to those patients admitted in wards. They should be monitored intensively and are closely monitored. Even though the ratio of patients and nurses is 1:1, some still consider it stressful being an ICU nurse. Since nurses are assigned to one patient each, each is expected to render comprehensive care to the clientele.

My patient’s BP has dropped from 180/100mmhg to 150/80mmhg. I call the resident doctor on duty to update him on the latest progress and after examining the patient, he orders to decrease the rate of the AC drip in decrements of 5 until the BP reaches 130-140/80mmhg.I decrease the rate from 10 uggts/min to 5uggts/min and recheck the BP 30 minutes later. The attending physician arrives to conduct his daily rounds and I update him regarding my observations on the patient’s current condition. I show the latest vital signs, laboratory findings and assist him as he examines the patient closely. I suggest plans of care which he acknowledges courteously. After which, I carry out the doctor’s orders and prescribe due medicines and supplies while continuing monitoring the patient closely making sure that the patient remains stable.

ICU nurses are trained nurses who are assigned to critically ill patients. Since these patients have unique needs, nurses must be equipped with proper training to handle them more appropriately such as Intravenous Therapy, Basic Life Support and ACLS trainings. They must have critical thinking skills and make snappy decisions. In the battle of life and death, they must come prepared and have a knowing on what to do since by working every day, they know that they are making life and death decisions and one wrong move can make matters worse.

I step out of the unit feeling tired and relieved. My 8-hour shift is now over as I turned my patient over the next nurse-on-duty. I feel fulfilled to know that today, I saved another life. It really is exhausting being a nurse and even the salary isn’t enough compared to all the sacrifices you have made in a day of duty. But sometimes, small things can make a big difference, like for us, nurses, just hearing a simple “Thank You” from either patients or their folks is enough to wipe the stress away.

Source: NursingCrib

The Healing Power of Dogs

It was a tough case: A five-year-old girl awaiting a bowel and pancreas transplant, who had essentially given up the will to live. She hadn’t spoken a word to anyone in days. But that was before Gracie, all two pounds of her, came to visit. Gracie, a Chihuahua rescue who belongs to Danielle Palmieri, R.N., is a therapy dog in the People Animal Connection Program (PAC) at UCLA. As soon as Gracie entered her room, the five-year-old perked up. A nurse even came in to see what had happened—the patient’s vitals had returned to normal for the first time in days. “She started talking and continued for 20 minutes,” says Palmieri, a high-risk labor and delivery nurse at UCLA. “They had pulled out every toy in that hospital, but nothing worked like Gracie.”

In March, PBS will air an episode of “Shelter Me,” a series looking at the positive impact of adopted shelter pets, that features PAC (see shelterme.com for dates). PAC is one of the largest pet therapy programs in the nation and its dogs make 900 visits a month to critically ill children and adults. It’s a trend that’s growing at healthcare facilities around the country. “There’s a lot of documentation showing that being with pets lowers blood pressure, and normalizes respiration,” says Jack Barron, PAC’s former director. “I’ve even seen people come out of a coma in a dog’s presence. People ask, ‘But how do you know it was the pet?’ and I say, ‘How do you know it wasn’t?’”

Palmieri tours the hospital with Gracie in her off hours, but she’s not the only nurse who supports the program. According to Barron, pet therapy wouldn’t happen without the nurses, who lay the groundwork so that dogs can make the visits. The nurses get some of the benefits, too. PAC dogs are also brought round to visit the nurses, especially those in critical care. “It calms them down and puts smiles on their faces,” says Barron. “It’s rewarding to see the nurses have a few relaxing minutes.”

Sister Act

How many times have you had a brilliant idea, only to shrug it off believing it would be too arduous to pursue? California nurses (and sisters) Terri Barton-Salinas and Gail Barton-Hay also came up with a brilliant idea—only they saw it through to fruition. If things go according to plan, you may be seeing it in your workplace some time soon.

Their patented idea: ColorSafe IV Lines, color-coated tubing designed to prevent medication errors. “When I worked in the ICU, the IV lines were like a big pile of spaghetti,” says Barton-Hay, now an OR nurse at Monterey Peninsula Surgery Center. “We were sitting around telling war stories and Terri said, ‘Wouldn’t it be great if tubing were colored?’ We did some research, went to a lawyer and now here we are.”

The sisters (one other sister and their mom are nurses too) found a manufacturer and even began selling the lines until they hit a bump in the road–the FDA asked for paperwork that it had previously waived. They complied and expect approval soon. “As nurses, we care about our patients and want nothing but the best for them so we’ve just kept plugging away,” says Barton-Salinas, a labor and delivery nurse at Kaiser Permanent in Vallejo. “If we prevent just one medical error it will be worth it.” The duo’s advise to other would-be nurse-inventors: Don’t take no for an answer.

How Sweet It Is

Clever cookie-maker Jaclyn Shaffer devised these medical- themed cookies by getting creative with cutters she already had. Check out jaclynscookies.com, and for instructions click here.

It’s a Mad, Mad World

Even if you’ve never been the target of a scalpel-throwing surgeon, no one has to tell you that physicians can behave badly. But did you know it’s so common that accredited hospitals must have a written policy on how to handle doctors’ disruptive behavior? Anger not only makes the workplace uncomfortable, it can compromise care.

Enter Anderson & Anderson, a certified anger management facilitator that frequently works with physicians, many of them surgeons. Stress, dealing with insurance companies that limit treatments and a perfectionistic nature all contribute to doctor rage, says George Anderson, director of training. “Plus, doctors put in a lot of hours to get their degrees, which means they don’t have as much time in life to develop interpersonal relationships.”

Okay, but how’s that going to help you deal with verbal abuse? When you witness bouts of anger, bring it to the attention of the appropriate department or committee at your hospital—and also try a personal approach. “Ask if you can speak to the doctor privately for a minute,” advises Anderson, “then ask if there’s anything you can do to help.”

Emotional Rescue 

Hospitals are well equipped to deal with medical emergencies, but crises of the spirit? Not so much. Enter Code Lavender, which, like a Code Blue, offers a form of resuscitation—but without the chest compressions. Instead, when a Code Lavender is called—whether the person in need is a patient, family member or someone on staff dealing with an emotional or spiritual crisis—the rapid response team comes armed with a bevy of potential therapies. Depending on the extent and nature of the need, they may provide reiki, healing touch therapy, aromatherapy, guided imagery, nutrition therapy and/or pastoral care.

The brainchild of ExperiaHealth, a company devoted to improving the patient and staff experience, Code Lavender addresses everything from a patient’s fear of an upcoming surgery to a family member’s worry or stress about a loved one and a nurse’s despair over having just lost a patient.

The program had its beginnings in a simple act of collective goodwill. “When a patient was in crisis, everyone on the hospital staff was asked to stop and send a healing intention or prayer to his room,” says Bridget Duffy, MD, chief executive officer at ExperiaHealth. “Eventually, Code Lavender morphed into not only sending intentions, but sending a healing services team to anyone in need, be it patient, family member or staff.”  

Several hospitals around the country now have a healing team in place, including the Cleveland Clinic in Ohio and Joe DiMaggio Children’s Hospital in Hollywood, Fla. And it’s been of particular benefit to healthcare workers: At the Cleveland Clinic, 40 percent of all Code Lavender requests were from employees.

What’s On Nurses’ Nightstands?

Four books worth a read.

Get Motivated! Overcome Any Obstacle, Achieve Any Goal, and Accelerate Your Success with Motivational DNA by Tamara Lowe and Rudolph Giuliani. (Doubleday)

I’m fascinated by how to effectively teach/motivate patients (and myself)
to take charge of their own health. This book looks at how different personalities get motivated and has already been valuable in helping me determine care plans for my patients. –Jonathan Steele, RN, holistic nurse in private practice, Scranton, PA

A Fistful of Collars: A Chet and Bernie Mystery by Spencer Quinn

This is number five in a series of
 private eye novels narrated by a mixed-breed German Shepherd who couldn’t quite make the cut for K-9 duty…
but neither could his 
owner. Great romp of a read for stress-busting after a long day at work. –Coleen Kenny, RN, MS, division of geriatrics, Virginia Commonwealth University Hospital
in Richmond

Maestro: A Surprising Story About Leading by Listening by Roger Nierenberg

This is about how a symphony orchestra solved problems. I picked it up because I felt it would be inspirational and, it is. It’s helping me to become a better listener, something I feel we all need to be reminded of from time to time. –Melina Thorpe, RN, director of Cancer Services, Glendale (CA) Adventist Medical Center

House of Sand and Fog by Andre Dubus III

I like it because the story builds up to something melancholy and tragic, while also giving some insight into human behavior and motivation. –Melanie Lukesh, FNP-BC, family nurse practitioner, Canton Potsdam Hospital

How Soccer Explains the World: An Unlikely Theory of Globalization by Franklin Foer

I am fascinated at how sports, in particular soccer (Futball), meld with society and stretch beyond the pitch (field). –Kimberly Bertini, BSN, RN, RNC, Magnet Program Coordinator, Cancer Treatment Centers of America at Midwestern Regional Medical Center, Zion, Illinois