Nurses are a constant presence at the bedside and regularly interact with physicians, pharmacists, families, and all other members of the health care team but, physicians may spend only 30 to 45 minutes a day with even a critically ill hospitalized patient. This means Nurses have the critical role in ensuring a patient's safety.

Nurses ensure their patient's safety by monitoring them for clinical deterioration, detecting errors, understanding care processes, and performing countless other tasks. There are many ways to help you achieve quality safety for yourself and your patients. Here are a few...

Nurse-to-patient ratios

According to Agency for Healthcare Research and Quality, assigning increasing numbers of patients eventually compromises a Nurses' ability to provide safe care. Several seminal studies have demonstrated the link between Nurse staffing ratios and patient safety, documenting an increased risk of patient safety events, morbidity, and even mortality as the number of patients per Nurse increases. The strength of these data has led several states, beginning with California in 2004, to establish legislatively mandated minimum Nurse-to-patient ratios; in California, acute medical–surgical inpatient units may assign no more than five patients to each registered Nurse.

Safe and healthy workplace

OSHA, which enforces the Occupational and Safety Health Act of 1970, ensures employers are providing a safe and healthy workplace for workers and comply with OSHA’s regulations. Some of the obligations include:

• Complying with your employer’s policies and procedures based on its obligations under OSHA;

• Using personal protective equipment, including masks, when indicated;

• Informing your Nurse manager and others designated in the facility policy of workplace violence (e.g., bullying, intimidation, verbal abuse);

• Using proper body mechanics when lifting, pushing wheelchairs or otherwise working with patients;

• Reducing risks for slips, trips or falls by removing obstacles, wiping up wet walking surfaces and wearing shoes that support your feet and your walking;

• Speaking with your Nurse manager and CNO when policies and procedures governing safety are not being followed.

Overtime and long shifts

It is common for hospitals and clinics to request that their Nursing staff work overtime. While working overtime can be an effective solution to a Nursing shortage, it also can present a number of problems. Nurses risk becoming burned out, tired and/or stressed if they take on too much overtime.

 A study conducted by the Pennsylvania Patient Safety Reporting System showed working a 12-hour shift or working overtime was related to having trouble staying awake during the shift, reduced sleep times and nearly three times the risk of making an error. The most common medication errors identified in the study due to Nurse fatigue were wrong doses, dose omission and extra doses.

Communication

Health care teams that communicate effectively and work togehter reduce the potential for error, resulting in an improved clinical performance. According to the American Hospital Association,  A key aspect in improving teamwork and communication in health care is engaging patients and families. Increasingly, research shows a correlation between increased patient and family engagement and fewer adverse events. Determining how patients and families want to be involved in their care and then engaging them in designing their plan of care increases their understanding of tests, procedures, and anticipated care outcomes, including a successful discharge.

If you have any questions about patient or staff safety, please click below to ask your question and a Nurse Leader will respond.

Workplace conflict is common across all industries especially in a fast paced and stressful field like Nursing. Conflict mediation can be complex and typically Nurse managers step in to help resolve the problem.

Acoording to Nurse.com, conflict is a disagreement between two or more people who differ in attitudes, beliefs, values, feelings or needs. It’s a part of every work environment, including healthcare organizations. The ingredients of conflict include:

Article from www.discovernursing.com

With the many horrific disasters happening across the country, have you considered how you can help? Of course you have. You’re a Nurse and that’s what you do – care for others. This is a terrific interview of a Nurse who retired a year ago and is now volunteering for the Red Cross. Her skills are desperately needed. Perhaps her story will inspire you.

Mary Yoshino, FNP, wore an identification badge for years that told the world who she was and what she represented in the healthcare community. When she retired from being a nurse, Mary wasn’t sure what her next step would be, but she knew she wanted to continue to help people.

Currently, Mary is on the ground in Houston, Texas, volunteering in the aftermath of Hurricane Harvey, an extremely destructive Category 4 Atlantic hurricane that made landfall in southern Texas in August 2017. We recently had the opportunity to speak with her to learn more about her career and her current role as a volunteer disaster response nurse.

Nursing Notes (NN): Can you share a little bit about your nursing background?

Mary: All my life, I wanted to be a nurse. As a student nurse at Johnston-Willis Hospital School of Nursing in Richmond, Va., I became very active with the American Red Cross by taking and teaching classes. Since graduation, my nursing career has spanned 47 years in all areas of nursing and multiple states. I have worked in intensive care units and emergency rooms, college health services, and the Army Nurse Corps Reserve. I went back to school to become a nurse practitioner in 1990, and then worked as a family nurse practitioner for 26 years before retiring last year at the age of 69. I took this past year to reflect on what I wanted to do in my next phase of life.  

NN: What made you want to volunteer during Hurricane Harvey, and how did you get involved?

Mary: I received a text from my son in Friendswood, Texas, saying that his home was taking on water and that he and his family were evacuating. That morning, I signed up to volunteer with the Red Cross. I was so desperate to help people again and was deployed out of Albany, N.Y., to Houston with a team of four other nurses.

NN: What are your day-to-day responsibilities as a volunteer nurse?

Mary: Currently, I’m a supervisor for a 460-resident shelter facility. We’re responsible for going from cot to cot, making rounds and assessing residents’ health needs daily. We are doing dressing changes, distributing over-the-counter medications, and calling for prescription refills. Some of our patients are very sick; yesterday alone we called 911 four times. We talk to our patients, hear their stories, and hold back our tears as we wipe away theirs. Our day is busy. There’s no time to sit, and very little time to eat because our patients’ needs come first.  

NN: What is the most rewarding aspect of this volunteer role?

Mary: The most rewarding aspect is to see the gratefulness in the eyes of the people we help. They come in feeling dehumanized, as they have lost all that they hold dear. Some cry and some are quiet, but they see that we care and we talk to them about the realness of their situation and ask them quietly how we may help them. Today, I was with a woman who teared up and said, "You really care, don't you?" A kind smile, manners, and showing respect goes a long way.

NN: What did you take away from this experience?

Mary: This experience has inspired me to go back and work in our local Red Cross chapter, to be a spokesperson for the Red Cross and to encourage others to volunteer. Even on a local front, there are so many ways to help.

NN: What do you wish others knew about the impact that Hurricane Harvey has had on citizens and communities?

Mary: My team has seen firsthand the destruction around Houston and realized just how real this hurricane was and how it has changed the lives of so many. As other breaking news has developed, people here are still feeling the effects of Harvey and are coming together in the communities that were hit the hardest. In my son's community, all homes were destroyed, but they went door to door helping each other. It’s about people helping people.

NN: What advice do you have for other nurses who are interested in disaster response nursing?

Mary: Let's do it!!! Be there, hold a hand, wipe a tear, make people feel human and safe again. Think back to why you became a nurse, and let those reasons once again come to the front. Let's go make a difference.

NN: Is there anything else you’d like to share about this experience?

Mary: When I retired from nursing, I broke down emotionally. I did not know who I was besides a nurse practitioner. The Red Cross has given me my life back. I feel like I have found my niche. I came to Houston and realized that I can still make a difference. I will return home in mid-October after having been in Houston for a month. In November, I hope to be deployed somewhere again. This time, I will go in knowing I have the confidence to lead and make a difference for the victims of a disaster.

To learn more about volunteering as a nurse through the Red Cross, visit www.redcross.org.  

Burnout amongst Nurses isn't a new thing. In fact, it could be getting worse. With a combination of Nurses retiring and an influx of aging patients, this can become too much to handle and some will leave their profession.

According to Fierce Healthcare, several stressors lead to high levels of pressure and Nurse burnout.  These include:

• High patient acuity (years ago, these patients would have been in the ICU)
• High nurse-to-patient ratios (not acuity-based)
• Multiple discharges and admissions (many nurses will discharge and admit an entire team of patients during their shift)
• Lack of ancillary support and resources
• Leaders who assume that nurses “can take one more patient”
• Physicians who expect nurses to drop everything and attend to their needs
• Interruptions while on their break
• The expectation that nurses are all-giving.

A survey by travel nursing company RNnetwork, found that almost half of the Nurses they asked were considering leaving the profession. About a quarter said they felt overworked, 46 percent said their workloads had risen and 41 percent said they’d been harassed or bullied by managers or administrators. Making matters worse, with the aging of the baby boom generation, demand for health care is rising at the same time that large numbers of experienced Nurses are retiring.

Ashley Neuman, LPCC-S, one of Blazey’s colleagues in Cleveland Clinic’s Wellness Enterprise, offered advice to caregivers during a 30-minute Wellness Connection presentation entitled “Managing Burnout in the Workplace: How Caregivers Cope.” She began with a definition of burnout, which can have three components:

• Emotional Exhaustion – “Burnout can occur when you’re not just physically tired, but you are emotionally exhausted,” says Neuman. “It’s when you don’t have the motivation to get up, get moving and finish that one last clinical note. That emotional weight becomes heavier every day.”
• Depersonalization – This happens when you have an unfeeling or impersonal response toward recipients of your service, care or instruction. “Nothing sparks passion or you don’t have that intrinsic motivation anymore,” she explains.
• Dissatisfaction in Personal Achievements – Nurses who experience burnout may lack feelings of competence and achievement in their work. Neuman says, “You become a shell of yourself, losing interest in things you normally enjoy doing.” Maybe you dread going into a patient’s room or going home to make yet another dinner for your family.

Here are some tips that may help Nurses dealing with burnout.

1. Identify The best type of Nursing job for you

The field of Nursing is a large and diverse field. People in this profession might work in hospitals, doctors’ offices, nursing homes, office jobs, mobile units, private practices, home care, schools, the military, and even large public venues like amusement parks. And within the profession, there are medical specialties, such as pediatrics, cardiology, ophthalmology, geriatrics, and sports medicine. Spend some time figuring out what you like the most, and then focus your job search in this.

2. Search for workplaces with lower nurse-to-patient ratios

The Journal of the American Medical Association (JAMA) linked hospital Nurse staffing to nurse burnout and job dissatisfaction in their research on the topic of high Nurse turnover. "Nurses in hospitals with the highest patient-to-nurse ratios are more than twice as likely to experience job-related burnout and almost twice as likely to be dissatisfied with their jobs compared with Nurses in the hospitals with the lowest ratios," JAMA reported.  

The more patients Nurses are expected to care for in a given shift, the less time they have per patient. This can make the usually empathetic task of caring for patients feel more robotic, stressful and incomplete.

3. take care of your own body first

Most Nurses are inclined to take care of others first and worry about themselves later. But in order to be an effective nurse with a long career ahead of you, it’s critical that you take care of your own body. Be sure to make time in your life for adequate exercise, good nutrition, and restful sleep. Bring nutritious protein-packed foods during your breaks. And after a long day on your feet, don’t be afraid to just relax!

4.Learn to say “No.”

masmedicalstaffing.com says, For professionals in healthcare, it’s often our natural inclination to jump right in when someone asks for our help.

However, if you already have an overloaded schedule, your first concern should be to keep yourself healthy—otherwise, you won’t be able to take care of your patients properly.

So instead of always extending a helping hand, take a moment to consider whether you really have the time and energy to do so without adding a bunch of new Nurse stress-inducers to your day.

And if you can’t help out, say so firmly yet politely.

The next two tips are from www.travelnursesource.com

5. Eat Healthy and Stay Hydrated

It’s not a secret that the food that you consume plays a big role in your mood and productivity. Increase your fruits and vegetable intake as well as whole grains and lean meat within your diet for an energy-boosting food palette. To increase productivity, eat food that is rich in fiber and carbohydrates. Stick to food with high levels of omega-3 fatty acids to help reduce depression and lift your mood.

 6. Socialize

Having a support system is an integral part of a healthy mental and emotional state. Take some time from your busy schedule to socialize with your friends and family to take a break from your stressful environment. It’s scientifically proven that when we are more likely be happy when we are surrounded by the people who we love – that is why humans are a social creature.

What are some ways you prevent burnout in your life? Comment your thoughts below!

This article was written by the MODERN NURSE at www.discovernursing.com

Nurses are the largest group of healthcare providers and you have a lot of power. You can help make changes that affect your patients and the environment. With climate change on the rise, you can create awareness of areas within your place of employment that need improvement. The reduction of strong chemicals, plastics and paper items can have a strong impact. Check out this interview regarding the Nursing community and how you can affect environmental change.

Public awareness and interest in all things “green” has created a need for nurses to understand environmental issues and their relationship to health with credible, evidence-based information, as well as provide leadership in making the necessary changes in our policies and practices. Cara Cook, MS, RN, AHN-BC, is working to increase awareness and promote action that addresses climate change as a health imperative among the nursing community through her role as climate change program coordinator for the Alliance of Nurses for Healthy Environments (ANHE). We spoke with Cara, who was recently chosen as a 2017 Johnson & Johnson Global Citizen Young Health Leader, about the connection between environmentalism and nursing, and how her background as a nurse has prepared her for advocacy work.

Nursing Notes (NN): How long have you been a nurse, and what significant changes have you seen in the nursing profession since you began practicing?

Cara: I’ve been a nurse for a little more than eight years, and one major change I’ve noticed is the nursing contribution to environmentally safe practice environments. Nurses have long been advocates for safe nurse-patient ratios and preventing adverse health outcomes, such as falls or healthcare-associated infections. In addition to those important patient safety issues, nurses are realizing the connection between the environments in which we live, work, and play, and how this influences health outcomes.

Nurses are at the forefront of change within practicing settings through advocating for use of safer chemicals in hospital cleaning supplies, by forming green teams or sustainability departments that focus on reducing an institution’s environmental impact, or from working in communities to ensure patients have access to healthy foods and safe areas to exercise.

NN: Why is understanding climate change important for nurses?

Cara: Climate change is one of the biggest global health threats we face today. Nurses are on the frontlines of communities caring for patients impacted by climate change, so it’s important for nurses to understand the connection between climate change and health, and how the health sector can respond.

As the most trusted profession and largest group of healthcare providers, nurses are urgently needed to lead the fight against climate change. Being aware of and advocating for solutions to limit and respond to climate change is within our scope of nursing practice, with our own practice standards stating the “registered nurse practices in an environmentally safe and healthy manner.”

NN: How did you get involved with ANHE?

Cara: As part of my master’s program, I was required to complete a certain number of hours for two semesters with a public health organization. Since my area of interest is in environmental health, I was paired to work with Katie Huffling, the executive director at ANHE. At that time, my work with ANHE involved federal reform of toxic chemical policy and participation in campaigns at the state level focused on advancing health-protective regulations for hydraulic fracturing and antibiotic use in animal agriculture. About a year after I graduated, ANHE received funding to expand their climate change and health program, and I came on board as a full-time employee.

NN: How has your background as a nurse prepared you for your current position?

Cara: Nurses feel very comfortable advocating on behalf of patients in healthcare facilities, so all it took was learning how to translate that skill into the policy arena. Another core part of nursing that has prepared me for my current position is the focus on evidence-based practice. Environmental health or climate change work is similar in that you need to look at the evidence in order to understand the issues and potential solutions, and how to adequately communicate this to the public or legislators.

Also, I think being able to work through the unanticipated and creatively solve problems when everything seems to be going wrong, as so often is needed in bedside nursing, has helped with working through some of the challenges in environmental health work.

NN: What do your day-to-day responsibilities look like as a climate change program coordinator?

Cara: My role includes spearheading ANHE’s climate change and health program that aims to increase awareness among the nursing profession on the health impacts posed by climate change. Through this program, I work to engage individual nurses and nursing organizations in prioritizing climate change as a health imperative, emphasizing the urgency for nursing action in frontline communities and in an advocacy role. One of our current initiatives is working to form a Nursing Collaborative on Climate Change and Health, which is an effort to unite national nursing organizations around climate change, with the goals of bringing health to the forefront of discussion and policy-making and ensuring a coordinated nursing response across specialties.

Since our organization has a small staff, I also help with our other environmental health initiatives, currently focused on water and health, air pollution, energy and health, safer chemicals, and food sustainability. ANHE also provides advocacy trainings, which I help organize and run, for nurses to learn how to be successful advocates on environmental health issues.

NN: What is your favorite part of your job?

Cara: My favorite part of my job is working with and meeting such amazing nurses. Working for ANHE allows me to meet and work with a variety of nurses from different specialties and learn more about the work being done to address environmental health issues. I lead ANHE’s Global Nurses Climate Change Committee, which provides an opportunity to connect with nurses across the world and learn about what is being done in other countries around climate change.

Another perk of my job is being able to talk with nurses about climate and health, and help them learn how they can move action forward in their own practice. It’s rewarding to inspire nurses to take action and to see how passionate they become when they learn about how climate change is creating significant challenges for health.

NN: What is the most challenging part of your job?

Cara: With environmental health work, and even policy work in general, it can be challenging not to get discouraged. Working with such a strong group of nurses helps to keep the momentum going when efforts can be disheartening.

NN: Looking forward, what advancements/changes do you expect to see in nursing?

Cara: Our healthcare system is in a fragile state, and there must be some dramatic changes for the system to be sustainable. We are already seeing a shift to prevention and building up the primary care system, with increasing attention to how environmental factors can affect health, and I think nurses and nurse practitioners will have a major role in this shift as our profession branches off into different avenues of care outside of traditional settings.

NN: Is there anything else that you would like to add?

Cara: Many of these environmental health issues, including climate change, can seem so daunting, almost as if there is nothing that can be done to reverse the course of action. However, there are solutions to address these complex issues and we are at a critical point where, as nurses we can make a big impact on the health of our patients and communities. Nurses are so important to moving the health message forward on climate change and, collectively, we have incredible power to drive change.

To learn more about environmental health and how climate change impacts health, or to join ANHE, visit envirn.org. For more information on Health Policy Nursing, visit DiscoverNursing.com. To learn more about the Johnson & Johnson partnership with Global Citizen, visit jnj.com/progress. 

Appreciation – we love to feel appreciated for what we do, but often, it feels like our work sometimes goes unnoticed. Here’s a story we think you’ll enjoy. It’s all about appreciation and the work Nurses do. This is a big Thank You to Labor & Delivery Nurses, Midwives and Doula’s.

Mother of four, Jill Krause, recently saw a photo by Katie Lacer that moved her. She was overcome with memories and gratitude for the Nurses. Jill shared the photo with her thoughts about the labor, delivery, and postpartum Nurses who help new mothers in their most vulnerable moments. The post quickly went viral and mothers everywhere commented their experiences and shared their thanks to all the Nurses out there.  Below is Jill's post, check it out and leave your thoughts in the comment sections!

"I'll never forget the faces of the nurses who followed me into the bathroom after delivering each baby. That moment when I was so vulnerable, so tired, scared, shaky. My swollen belly deflating, and my modesty long gone. They treated me with such kindness and dignity. For me, these have been moments of empowerment and confirmation that I have a real village to help me, even if just for that little bit of time in a bathroom, on a toilet, while a kind nurse shows me how to put an ice pad on my mesh undies. This photo by my friend MommaKT Shoots just takes me right back. Like, I can smell the Dermaplast. Let's hear it for the nurses and the doulas and anyone else who shows us how to make ice pad underwear (or helps with that first shower post c-section!) <3"

Posts came pouring in from moms all over! Below are some of the posts that were shared.

"When I was pushing, I'll never forget pulling my face away from my nurse's chest to see her scrub top SOAKED with my sweat and tears. I was like, 'Oh my god I'm so sorry!' And she said, 'Baby, this is life all over my shirt. Nowhere else I'd rather be. Now let's get that baby out.'" —Leigh Kathleen, Facebook

Pictured: Joanie McConnell, CNM at the University of Louisville by Katie Lacer / Via mommaktshoots.com

"I will never forget the nurse that helped me get to the bathroom for the first time after I had my daughter. I was hemorrhaging and when I stood it was so humiliating...but that kind soul didn't flinch. I kept apologizing and she kept reassuring me that it was nothing. I will never forget watching her clean my legs and I just kept thinking that this is what my God means when he says love your neighbor." —Tiffany Barnes

"My husband and I lost our daughter at 23 weeks two years ago, and delivered our rainbow baby boy at the same hospital this May. All the nurses I had knew our history, and when my son was born he wasn't breathing. He was immediately taken away to the NICU and I just could not stop sobbing. My nurses cried with me. They rubbed my hair and my back and did everything they possibly could to get me mobile and up to see my sweet boy in the NICU." —Lauren Self, Facebook

Thank you Nurses!

Pictured: NICU nurse at Norton Women's & Children's Hospital discusses care measures for one of Amanda and Lauren Vinova's preemie triplets. By Katie Lacer / Via mommaktshoots.com

Being Short Staffed

This can bring professional and personal issues. When a hospital is short-staffed, you’re left with no other option but to take on more shifts, cover for your co-nurses’ absences, and miss out on important life occasions. Your social life can suffer, too.

Short staffing is one of the most common reasons why nurses experience burnout. Nursing is already a stressful job and not having enough time to relax and care for yourself can make you feel more frustrated and unsatisfied with your job.

Long Shifts

Nurses are often required to work more long hours. It can be due to the hospital being short-staffed or management cutting costs. Whichever the reason, Nurses, working longer than they're supposed to, is detrimental. It can affect the quality of care they deliver, and it can also put their health at risk.

When Nurses work extended hours, they aren't resting properly and aren't letting their bodies recover. for example, many Nurses who take extended shifts suffer from chronic back, leg and shoulder pain. Some of them even develop long-term medical conditions, like diabetes and cardiovascular issues.

By not being well-rested, you can suffer from daytime sleepiness, fatigue, and impaired mental function. It can affect your ability to make proper decisions, which can compromise your patients’ safety.

Salary

The compensations Nurses receive depend on many factors. Aside from specialty, their place of work tends to affect the salary they get, as well. Having a higher degree counts as well. Salary is a common reason why Nurses leave a hospital.

Discrimination

Nurses eating their young isn’t an entirely new thing. In fact, this has been around for ages.

Being a new Nurse is intimidating and you have to adjust to many new things. Apart from the skills you have to gain, you also have to learn how to cope with how the Nursing system in your hospital works.

Unfortunately, not all veteran Nurses are that welcoming. These attitudes tend to dull the enthusiasm of new Nurses enough to make them question themselves if they made the right career choice. You are all on the same team, strengthen your team by welcoming new Nurses and being a little more patient with them.

Job Hazards

Working in the hospital puts nurses in a lot of work hazards. Take, for example, being exposed to infected body fluids. Apart from that, lifting patients of all sizes can also put your safety at risk. Nurses also have to deal with sharps and needles and running on slippery floors during emergencies.

Nursing can be difficult and we appreciate everything they deal with. If you have anything to add please comment below!