DiversityNursing Blog

By Roberto Scalese

As ambulances screamed away from the finish line Monday, they carried many of the injured to hospitals operated by Partners HealthCare, including Mass General and Brigham and Women's Hospital. Partner's President and CEO Gary L. Gottlieb told workers today that the company will continue its efforts with a $1 million donation to One Fund Boston. 

Spaulding Rehabilitation in Framingham is part of the Partners Healthcare group. 

"We are making this commitment on behalf of and in honor and recognition of every one of our 60,600 men and women who give every moment of every day to support our mission of caring for our patients and their families," wrote Gottlieb Monday in an email to all Partners employees. "Every one of our employees is a member of this community. So let us take this opportunity to stand together to say we will be there to help."

In the email, Gottlieb thanked the doctors and nurses who have worked tirelessly over the past week.

"We know of the extraordinary and immediate response of our doctors, nurses, care teams and the staffs at our hospitals who provided life saving support to the wounded and who will continue to deliver much needed care in the weeks and months ahead. All of our training and preparation for horrific events like this have been widely praised. Even the President made mention of it on his visit to Boston last week," he wrote.

One Fund Boston was established by Mayor Thomas Menino and Governor Deval Patrick as a fund to help the victims of the Marathon bombings. In it's first day alone, the fund raised over $7 million to help defray medical costs for the injured.

Source: Framingham Patch

In March 2013, Dr. Donna Shalala, the longest-serving secretary of the Department of Health and Human Services, and chair of the Institute of Medicine (IOM) committee that produced the report “The Future of Nursing: Leading Change, Advancing Health”, addressed hundreds of health care leaders at the American College of Health Care Executives (ACHE) Annual Congress. Dr. Shalala provided her reflections on the removal of barriers to practice and care and the future of health care delivery. Dr. Shalala underscored the need for nurses to play a lead role in all aspects of the health care debate, ensuring that patients and families have access to timely, effective care; and outlined specific steps that health care executives should take to fully maximize nurses to meet patient care demands.

Donna Shalala Addresses American College of Healthcare Executives

By: Jacqueline Ingles, WFTS

Nicole Turner is calling her neighbor Aly Smith a miracle and a savior.

Smith, a nurse, came to the rescue of her 2-year-old daughter Ireland after her legs were severed in a tragic lawn mower accident Wednesday night.

"It was horrible," explained Smith.  "It's the scariest thing I have ever seen."

A labor and delivery nurse for nine years, Smith's training kicked in and got her through it.

Smith was sitting at home with her husband when she heard screams coming from outside.  Her husband ran outside first and she followed.  That's when she came face-to-face with a horrific scene.

"He kept saying, 'Her legs are gone, her legs are gone.'  And I said that can't be possible."

Jeremiah Nugent, 47, was swaddling his daughter whose legs were both severed below the ankle.  Just minutes before Nugent accidentally ran over his daughter with his riding lawn mower.

According to Ireland's mother Nicole, Ireland darted from the backyard into the front yard.  Then, when she saw her father, she ran to him and began calling out, 'Daddy, Daddy.'

Nugent never heard his little girl because the lawn mower drowned her out.

Nicole tried to flag her husband down to warn him.  Thinking he was about to hit something moving forward, he put the mower in reverse.

Ireland's mother watched the horrific accident.

"Why couldn't it have been me?" Nicole Nugent asked during a press conference at Tampa General Thursday afternoon.  "Why did it have to be her?"

Smith said she helped wrap the little girl in towels and put pressure on her legs to help stop the bleeding.  Smith was also comforting the little girl.

"She kept saying, 'I want to go to bed. I want my daddy and I want to go to bed,' anything to keep her talking," Smith explained.

Smith said she was surprised at how calm Ireland remained.  She stayed with the little girl while her mother called 911.  Fire crews responded and then Ireland was airlifted to Tampa General.

"It felt like an eternity," Smith said.

Ireland remain in the ICU tonight and is in serious condition.  Doctors said she will recover and will walk again.  And while Ireland's parents are thankful to Smith for all she did, she is remaining humble and said she was just doing what she was trained to do.

" I'll never forget it but it could have been a whole lot worse," she said.

Ireland has already undergone two surgeries, one to clean her wounds and a second to put a pin in her thumb.  Doctors initially thought her hand needed to be amputated but only her thumb was broken.

The Nugents say Ireland will undergo several more surgeries in the coming days.  She will also need skin grafts.

Steve Chamberland with 50legs visited Ireland in the hospital Thursday.  He arranged for Ireland to get fitted for prosthetics for free.  He says once doctors close her leg wounds Monday, she'll recover for four to six weeks before heading to Orlando.

He says they will fit her and she will be back on her feet the next day.

"To see a 2-year-old walk again, it's pretty much her first step and life," explained Chamberland.  "Her father was so funny.  He was ready to go.  He was like, 'Can we get legs now?'  He just wants to see her run again and be normal.

Source: WPTV

By: STACIA GLENN

Florence “SeeSee” Rigney brushed off retirement as easily as she does the good-natured jabs from co-workers at Tacoma General Hospital for being the oldest nurse in recent memory.

Rigney, who will turn 88 next month, still bustles around the operating room wing with the energy of a woman half her age. She expects to be working at least another year.

More than 20 years older than the next senior staff nurse, Rigney is respected, revered and relentlessly teased.

“I kinda keep them in line,” joked Rigney, who blushed in embarrassment and dismissively waved her hand at fellow nurses who call her everything from a star to their hero.

Rigney got her nickname as a kid. She kept telling a teacher, “See, see,” to show how well she knew her lessons. The teacher started calling her “SeeSee” and the name stuck.

In 1946, she donned the stiff white uniform of a student nurse. In her home, she has a framed photo of herself as a fresh-faced nursing student, next to an old black-and-white image of what Tacoma General looked like back then.

Her career crisscrosses the map.

She started in Tacoma General’s operating room before going to work for a private doctor. She had stints in operating rooms in Atlanta and San Antonio, Texas, before her husband deployed for the Korean War and Rigney returned to Tacoma General. She spent a spell in Cheyenne, Wyo., but once again came back to Tacoma.

The couple adopted their first child in 1958, and Rigney shifted to working on an as-needed basis to fill shifts when the hospital was short-handed. When her daughter reached college and her son was in high school, Rigney was needed at home less so she worked more.

After her husband died in 1977, Rigney started full-time again, working 10-hour shifts three days a week. She found it kept her mind occupied and surrounded her with a second family. The hospital gave her plaques to mark her long-running career – five years, 10 years, 15 years. She can’t recall getting the 20th-year plaque.

When she was 67, she thought it time to retire.

“I stayed retired for about five months then I came back and here I am,” Rigney said. “I always thought I’d come back and work but I never thought I’d stay this long. I’m really very blessed my health is good and they want me to work.”

Supervisors and co-workers describe Rigney as one of the best.

Julie Christianson, who has worked with Rigney since 1980, said she is a “crack-up” who is full of great tales about what nursing used to be like.

She regales them with times before computers when charts and records were all hand-written, when staff nurses helped out in the emergency room delivering babies, before technology and equipment became so advanced.

Rigney is not an operating room nurse, handing doctors various instruments. She’s the nurse who sets up patient rooms and keeps track of supplies. Fellow nurses insist Rigney will knows half the patients and has a soothing effect on those she interacts with.

It’s difficult sometimes to keep up with the advancements, Rigney said, but she’s always learning.

“She can still run circles around people half her age,” Christianson said. “She’s very inspirational for the rest of us because she’s still working and she’s still sharp.”

BY TAMMIE SMITH Richmond Times-Dispatch

by Jennifer Mensik for ERE

Regardless of the interview style or methodology used, there is one question that everyone should ask of a registered nurse in an interview. This includes all positions, from staff RN to Chief Nursing Officer.

What is your definition of nursing?

This helps you to sort out whether you have a professional-role-based RN or one who might only be there for the paycheck. A professional-role-based RN is a nurse who understands the complexities of the profession and is committed to placing the patient first, as opposed to a tas- based RN who is there to just clock time and take home a paycheck. If your organization prefers behavioral-based questions, take that question to the next level as a two-part question by asking the RN candidate to give you an example of when they exemplified the definition they just gave you.

You might say, “Are not all RNs professionals?” One just needs to understand the components of a profession to know that there are RNs in the profession who are not professional. Let me explain by starting with the sort of definition you are looking for and then I will touch on the difference between a technical and professional RN.

The American Nurses Association defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations.” That is a long definition that many RNs will not be able to give you verbatim. However, the professional RN should be able to talk about and say things that are of a very similar nature. The responses between the professional and technical RN will be very different. Most times when I have asked this question, it has stumped many nurses, or was the one they needed the most time to think about before they were able to give their response.

The type of answers you want from a professional RN are statements or an explanation of caring, kindness, ethical, and wholistic care of the entire patient, an understanding that the RN is a professional who is accountable for themselves, and understands that they have a duty to society to place the patient first.

The technical, less desirable answer is when the RN describes their profession as a set of tasks, like medication administration, bathing, assessments, budgets, staffing, or worse yet, someone who assists the physician. While you might expect your RN candidate to do those things and to be competent in those areas, the professional RN understands that. It is a given that part of the professional responsibilities is to carry out tasks and orders, but it is in the manner in which they do it. The technical RN does not understand how to be professional, or worse yet, may not want to be a professional.

Can you teach a technical RN to be professional? I suppose, but only if they are open to it. This is not a simple task they can learn, but a way of being. A professional RN understands their role as a RN, their accountability to the patient and the family, their coworkers, and the organization, and will hold others to the highest standard of patient care.

This type of RN embodies what we want to see in our nurses, like Florence Nightingale. Florence could easily point out the technical nurse. Those who only work as a RN because it’s a good paying, stable job, and where you only have to work three 12-hour shifts; the one who does the minimum to maintain their employment and the minimum to maintain their own education, skills, and professional standards. It is those who do not say anything when another RN or staff member may be jeopardizing patient safety as it’s “not their responsibility” to hold others accountable. Professional RNs do hold each other accountable for quality and safe patient care.

Your next steps:

Recruiters: Have a discussion with your nurse executive on whether this is a question they would like to you ask. Talk with you nurse executive about their nursing philosophy for the organization and how they would like to see RN candidates answer that question.

Nurse managers: What is your philosophy about nursing? Can you articulate it and share with your recruiters so that the right candidates could be screened early in the process? Even if used in the early stages of recruitment,  still include this question in the onsite interview process with the candidate and yourself or the team. Ensure your team who maybe interviewing the RN candidate understands this question and the type of response you want.

As organizations struggle to improve quality measures and patient satisfaction, which type of RN do you want on your team? The professional RN will help your organization obtain success in these areas. If an RN can give you a professional-based answer for the definition of nursing, you are halfway there in choosing the right candidate for your patients and organization.

 By Robin Farmer for HealthCallings

If Janet Patterson, RN, could go back in time, she would learn the answer to a simple yet overwhelming question: What exactly do nurses do?

For most people, images of bedpans and needles pop into their minds, says Patterson, a nurse for 33 years who now works as a home care nurse at Maxim Healthcare in Santa Rosa, Calif. “We think we know [before going to nursing school] what [nurses] do, but we really don’t. I became a nurse and I couldn’t talk about it with anyone who wasn’t one.”

A realistic job description tops the list of information veteran nurses say they wished they had known before embarking on their careers decades ago. Experienced nurses recommend that new nurses and students talk to people doing the job they want. Ask questions in person, by phone or online in chat groups for nurses.

Nursing is intimate

Nancy Brook, MSN, RN, NP, wished she had known that “I would be changed as a human being because of the intimacy of the moments that you share with patients.” New nurses must prepare for this, she says. The impact of witnessing many life-changing experiences such as birth, death and serious diagnoses lingers beyond the workday, says Brook, a nurse practitioner at Stanford Hospitals and Clinics in Redwood City, Calif. After the workday, “It’s not your muscles that are sore, it’s the mental muscles,” Brook says.

It’s important for new nurses to create a routine to unwind, learn healthy habits and stay socially connected, seasoned nurses advise.

Keep learning

When Cynthia Ringling, RN, BSN, started nursing in 1990, she had no idea “that the personal touch of nursing would have changed with the age of computers. It made the RN much more of an administrator and documenter,” says Ringling, a chief clinical officer at Interim Healthcare in Colorado. “A lot of the personal tasks we did have been pushed to unlicensed or trained people.”

Nursing is an evolving profession with changing technology. New nurses must stay open to learning from patients, peers, physicians, professors and other professionals.

Squash conflicts

Another discovery Brook wished she had known before pursuing her career are the challenges of working with colleagues. “It’s not the patients who are hard, it’s the other nurses, managers, physicians — that whole interplay that professionals experience, unless you are working independently,” she says.

Ask for help. Make building a support system a priority, veteran nurses recommend.

Remain flexible

Adjusting to an intense work schedule also topped the wish-I-had-known list for longtime nurses. Meeting the demands of patient care can be exhausting. Add nights, weekends and holidays to the mix and maintaining a social calendar requires patience and flexibility. Brook says she wishes someone had told her in advance she would be late for every party because her shift did not end on time.

Accept that people get sick every day and require care. Imagine patients as your own loved ones who need care, says Sheri Cosme, MSN, RN-BC, a clinical educator at MedStar Georgetown University Hospital.

“Nurses work 365 days a year, 24 hours a day. So to think as a new graduate nurse that you will only work days, Monday through Friday, is not realistic,” advises Cosme.

When this happens, and compassion fatigue occurs, there are some things that nurses can do to help put themselves or their colleagues back on track to serve patients passionately and with renewed energy.

A prevalent issue

Compassion fatigue is prevalent in most every health care profession, noted Jude Bijou, MA, MFT, a psychotherapist, professional educator and workshop leader based in Santa Barbara, Calif. “I believe that it is due to having so many unexpressed emotions about all of the interactions, all of the heartbreak, fear and frustration that is part and parcel of witnessing and serving people at times when they are often at their most vulnerable,” she said.

Kathy Ault, director of pastoral care at Mercy Medical Center in Baltimore, Md., agreed. “I think the prevalence of compassion fatigue is very high among all caregivers,” she said, including nurses, physicians, chaplains and others whose role involves taking care of people who are going through a lot of suffering, pain and loss.

Those working in units with the sickest patients--the ICU, oncology units, emergency departments, for example--may be the most obviously impacted, but Ault noted that compassion fatigue can be found anywhere through the health care system because “you’re constantly caring for multiple people with multiple requests and the intensity and frequency of patient contact seems to be increasing.”

In fact, noted Caryl Eyre, RN, MSN, clinical nurse specialist in medical-surgical nursing at University Hospitals Case Medical Center in Cleveland, and co-author ofCompassion Fatigue: A Nurse’s Primer, along with Barbara Lombardo, RN, MSN, PMHCNS-BC: “I think it is very probable that every nurse will experience compassion fatigue at some point in their career.”

Eyre added that compassion fatigue is becoming more and more prevalent. “It’s really a very important topic in nursing because every year we have to do more and more with less and less. People go into nursing because they are caring, empathic, people, so that’s partly the set-up for compassion fatigue. If people don’t care, and can close themselves off, they don’t experience that. But, that’s not the usual personality of a nurse.”

Because compassion fatigue is so common--and can affect both the caregiver and the level of care they provide--it’s important for nurses and their managers to be able to recognize the signs.

Spotting the signs of compassion fatigue

Compassion fatigue, said Ault, “looks like what fatigue looks like in your own life.” For nurses, she said, one of the early signs may be starting to wonder if they need to make a job change, or they’re not finding fulfillment, satisfaction or energy in the work that they’re doing. In some cases, over time, compassion fatigue may be exhibited as a sort of “shell” that the nurse puts up “that makes it harder for them to have those intimate connections.”

Many of the signs of compassion fatigue are clear, said Bijou. “Maybe our thoughts go negative, maybe our communications are abrupt, maybe we’re continually fatigued, or maybe we get sick ourselves. These are all signs we need some self-care.”

Eyre agreed and added that she and her colleague, Lombardo, work with managers to help them be alert to the signs so that they can intervene. Managers have an important role to play here, she noted, because those who are affected by compassion fatigue are generally not able to spot the signs in themselves.

There are a number of things that health care organizations, their managers and staff members can do both to minimize the impact of compassion fatigue and to address it when it occurs.

Taking action

The health care organization can and should take a role in helping to address and relieve compassion fatigue, said Ault. In her work at Mercy Medical Center, she starts this process during orientation. “As we’re bringing new nurses into our system, we take an hour at the end of their orientation process to do a reflection in our Chapel of Light.” During that process she takes them through a guided imagery exercise as a means of providing some tools that they might use in their daily living. The medical center also does periodic symposia for nurses throughout the community focused on the concept of mindfulness and the importance of caring for themselves.

Case Medical Center is also focused on providing a variety of resources for staff to help them deal with compassion fatigue, said Eyre, and they encourage staff to think creatively about how to address their own needs and those of their colleagues.

As an example, one of the nurses at Case recommended having a room where nurses could go to decompress. While space was at a premium, a spot was found and converted into a quiet respite for all staff on the floor--from nursing to environmental services. It’s a “no phones allowed” place, designed not to catch up on phone calls or email, but literally to relax with soothing surroundings and music.

Finally, stressed Ault, individuals should draw strength from those around them to help fight off compassion fatigue. “It’s essential that there’s a community where people can talk and express and work through some of the intensity of the demands and losses they experience.”

A national study of transgender people finds peer support, family support and pride in transgender identity, are among the protective factors for the clinical depression and anxiety often experienced by this population.

The national online study shows transgender individuals experience particularly high rates of psychological distress associated with the social stigma attached to their gender nonconformity.

The study is published online in the American Journal of Public Health.

"While peer support has generally been encouraged in clinical work, what has not been demonstrated until now is that it can actually make an important difference by buffering the impact of discrimination on mental health related to being transgender," said Walter O. Bockting, PhD, lead author of the study, and a Professor at Columbia University School of Nursing and the College of Physicians and Surgeons.  

Bockting is also co-director of the newly established LGBT Health Initiative in the Division of Gender, Sexuality, and Health at New York State Psychiatric Institute and the Columbia University Department of Psychiatry.

The study demonstrates individuals' mental health distress was associated with stigma.

Among the 1093 transgender individuals whose data was analyzed:

• 44.1% rated high on depression;
• 33.2% rated high on anxiety; and
• 27.5% on somatization, i.e., physical symptoms with a psychological cause.

The researchers found that, as they had hypothesized, "family support, peer support, and identity pride all were negatively associated with psychological distress, confirming these assets are protective factors."

"This provides the first empirical basis for clinicians to encourage peer support, and for social service and health organizations to provide avenues for peer support, such as offline or online support groups and group therapy," Bockting says. 

"In addition, interventions, advocacy and public policy initiatives are needed to confront social structures, norms and attitudes that produce stress associated with stigma, prejudice and discrimination so that the high rates of psychological distress found among transgender populations can be reduced." 

For more information, visit: www.nursing.columbia.edu.

Source: Advance for Nursing