DiversityNursing Blog

But what about chief nursing officers? They aren't providing direct care at the bedside, but do they still experience moral distress?

The answer, according to a qualitative study published in the Journal of Nursing Administration in February, is yes. It's just taboo to talk about it.

"There's shame and isolation when you do have the experience, so it can make it very difficult for people to feel like they can openly discuss it," says Rose O. Sherman, EdD, RN, NEA-BC, FAAN, professor and director of the Nursing Leadership Institute at Florida Atlantic University.

Sherman is one of the study's authors. "I think that the other piece of it is, CNOs might not always label it as moral distress. But these are uncomfortable situations where they're making decisions against their values systems."

Through oral interviews, Sherman and her co-author, Angela S. Prestia, PhD, RN, NE-BC, discussed chief nursing officers' experiences of moral distress, including its short and long-term effects. Prestia is corporate chief nurse at The GEO Group.

The study's 20 participants described their experiences of moral distress, and several said they experienced it on more than one occasion. It was often related to issues around staff salaries and compensation, financial constraints, hiring limits, increased nurse-to-patient ratios to drive productivity, counterproductive relationships, and authoritative improprieties.

"For example, a physician went to someone over a CNO's head and said, 'I think you should pay a scrub tech more. She is very valuable to me," Prestia says. "And of course he was a high-admitter, high-profile physician."

The CEO approved the special compensation, creating a salary inequity among the other scrub techs.

In another scenario, six participants reported their CEOs had improper sexual relationships with staff members. Prestia points out that the CNOs did not object to these relationships because of religious or moral beliefs, but because they were harming productivity at the organization.

"In their [the CNOs'] mind' of right and wrong, these people had access to things that they should not have had access to and [those relationships] create barriers to getting the work of the organization accomplished."

Lasting Effects 
The study uncovered six significant themes related to CNO moral distress:

1. Lacking psychological safety
2. Feeling a sense of powerlessness
3. Seeking to maintain moral compass
4. Drawing strength from networking
5. Moral residue
6. Living with the consequences

CNOs reported they often felt very isolated during the experience of moral distress.

"If they pushed back on a decision because they felt it was in conflict with their values they were isolated within the organization and they no longer felt safe. They weren't invited to meetings. They weren't included in decision making," Sherman says.

Even though they took steps to do what they felt was right—documenting meeting minutes, reviewing policies and procedures, and referring to The Joint Commission standards—to maintain their moral compass, those efforts were often unsuccessful.

"What happened was when they were in this situation… they were beat down at every turn," Prestia says. "Then the 'flight' started to set in. 'Maybe I need to leave? Maybe I should resign? Maybe I need to start planning my exit strategy?' Or before they could do that, they were terminated."

Moral Residue
Even once they were out of the situation, many CNOs reported the experience left them with a 'moral residue.'

"It is a lingering effect of the moral distress. I liken it to a fine talc that lingers on your skin and it manifests itself either physically or emotionally," Prestia says. "We actually had several participants say, 'When I get a call about staffing now in my new job, all of a sudden I get this feeling of impending doom.'''

Both Sherman and Prestia hope this research will open up a larger conversation about CNOs and moral distress. They will present their findings at the AONE 2017 conference in March.

"What we found in the work that we did was, clearly, collegial support from a strong network is very important in building one's resiliency and being able to deal with these situations," Sherman says.

"I think that having others who've been through it is very important, which is why forums that allow people to talk about this candidly, when a CNO finds him or herself in this situation, become critical."

"No! No! Don't die! You died!"

The shrieks come hurtling down the hallway of the Children's Unit at Grand River Hospital, but don't be alarmed. They are punctuated by laughter — a lot of laughter.

Registered nurse Tommy Sing is playing a video game with 10-year-old patient Conner Quigley, and he's losing badly. 

"I've always liked to play," he says, "I was never good at them, obviously, but I've always enjoyed playing them."

Sing, who has been working on the Children's Unit for almost six years, has been dubbed the unofficial video game guy for the amount of time he spends playing with patients.

"I've played everything from Minecraft – not very well, but I've played Minecraft – all the way to games on the Nintendo Wii, all the way up to playing Call of Duty with some 16 and 17-year-old patients," he said. 

"You know, I'll walk into a patient's room and they'll already have the Xbox or the Nintendo Wii already set up and then we'll start talking video games. Obviously, sometimes, on the floor it's too busy for me to play with them, but if the opportunity presents itself or I finish my shift at 7:00 p.m. I'll stay after work and play a couple of rounds with them."

Although video games often get a bad rap in the health sector, being blamed for everything from poor eating habits to behavioural problems, Sing says they help him build quick rapport with the kids on the unit.

"It gives you one thing definitely that we have in common," he said. "It's so easy to just break the ice by playing the games and it just helps snowball into finding more and more about each other and even having more and more in common with each other."

He says the relationships he's been able to form with the patients makes it easy to crawl out of bed in the morning and come to work, even when his shift starts at 7:00 a.m.

One hospital in Dorset, England has stumbled upon an unusual way of making tiny premature babies in the neonatal intensive care unit (NICU) feel safe and comforted: by giving them a tiny handmade octopus to curl up with.

According to Poole Hospital, where the practice of pairing preemies with crocheted cephalopods has become an ongoing ritual, these cuddly crafts do more than just calm the babies.

The idea originally hails from Denmark where Aarhus University Hospital has suggested that the creatures can actually help smaller babies grow and thrive. A spokesperson for Poole hospital stated that the decision to introduce the crocheted crafts to patients wasn’t based on published scientific research but contact with other hospitals who had found they made a noticeable difference to their little patients.

But it can't be just any toy. It must be an octopus.

So why these sea creatures exactly? The design of the crocheted tentacles gives the babies something to hold and squeeze, and that can be a good thing for regulating everything from oxygen intake to heartbeats. What's more, the tentacles might be helpful at keeping the tiny patients from pulling out their tubes.

A number of babies at Poole Hospital took to their new toys especially well. In a feature that in the Daily Echo last fall, it was revealed that premature twin sisters Jasmine and Amber Smith-Leach both benefited from the comfort of their new toys. Their neonatal nurses said they have no doubt these tiny octopuses have helped the girls.

What's more, in response to the story, the hospital's NICU has received a whole new supply of crocheted octopuses for future patients.

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

“We’ve been overwhelmed by the kind response to our appeal for crochet octopi,” said Daniel Lockyer, matron of neonatal services. “We’ve now received over 200 octopi and have a year’s supply ready and waiting for our little patients! We’re not looking for anymore octopi for a little while so we can use these up.”

Find the Octopus Pattern on our Pinterest!

Medical professionals like doctors, nurses, and paramedics devote much of their time and energy to making sure we are safe and healthy. They don’t get a lot of time to themselves, and many would argue that they don’t get the recognition they deserve.

Ashley Bolling is a stylist and mother of three who is letting it be known that these people, particularly nurses, deserve more than just a thank you. She posted a sweet message for nurses everywhere after one came into her salon, Captivate Salon & Spa, and dozed off in her chair. The woman hadn’t slept all night and was clearly exhausted. Ashley gently rested her head against her stomach, but it was her shoes that grabbed her attention. They weren’t worn down or dirty — she was simply amazed by how much weight they carried, both literally and figuratively.

You can read Ashley Bolling’s sweet and moving tribute to nurses below.

I had one of those “stop-you-in-your-tracks,” extremely humbling moments, while working quietly on the hair of a very exhausted, sleeping nurse.

She’d been at work all night and hadn’t been to bed when she landed in my chair, but not before stopping to buy my breakfast on her way.

As she dozed off, I gently rested her head on my stomach and continued to foil her hair…. then I noticed her shoes.

I wondered how many miles those shoes have walked. I wondered what they’d walked through. Blood? Tears? In & out of the countless rooms of the patients she’s cared for? I wondered how many hours they’ve carried her, and all those like her, while they literally save the lives of those we love and hold the hands of the ones who can no longer fight that fight.

But with those shoes propped up in that chair, phone in her lap, I got the chance to take care of her (even if it was just for a few hours) and I felt extremely honored to take care of such a hard working, inspiring woman I’m so lucky to call my friend.

I’ve always respected and valued these amazing superheroes and am proud to be the sister, daughter, niece, friend and hairstylist of so many. Know you are appreciated, know you are irreplaceable, know you are loved!

The nursing profession is the largest segment of the nation’s healthcare workforce, with more than three million nurses practicing across the U.S., according to the American Association of Colleges of Nursing.  Nurses serve as both the backbone of the healthcare industry and on the front lines of developing health solutions. Although most nurses may still head to work in scrubs and comfortable shoes, for many nurses, the day-to-day reality of their job has changed in dramatic ways over the past ten years.

This evolution has been shaped by a changing U.S. population, new technology and the influential 2010 Institute of Medicine (IOM) report, “The Future of Nursing: Leading Change, Advancing Health.”  The report charged nurses to take a greater leadership role in healthcare, noting that nurses should be full partners, with physicians and other healthcare professionals, in redesigning the U.S. healthcare system.

Below, we’ve detailed just a few significant changes in nursing practice within the last decade.

Growth of Nursing Leadership

The IOM report highlighted the unique patient-centric viewpoint of advanced practice nurses and the important role they can play in addressing the shortage in primary-care healthcare providers across the U.S. Advanced practice registered nurses (APRNs) play a critical role in providing access to affordable, quality care. According to the Robert Wood Johnson Foundation, “consumer demand for APRN-provided care is growing thanks to a shortage of primary care physicians, the soaring cost of healthcare, and a population that is aging and living longer with more acute and chronic conditions.”

“We see patients through the full spectrum, from the newborns on up,” said Steve, a rural family nurse practitioner featured below in the Campaign’s “A Day in the Life” video. “With the shortage of family practice providers, ‘midlevels’ such as myself and physician assistants are becoming a much more important part of the of the healthcare delivery model.”

“Wearable devices that can monitor consumers’ health are changing the way our society thinks about providing care,” said Fratzke.

Fratzke was an early leader in the advancement of a nursing mobile app for patient data documentation into electronic health records (EHR). Hospitals can use nursing apps to help nurses more efficiently capture real-time patient assessment documentation, such as vital signs, medicine distribution and pain scales.

Telemedicine’s Impact on Accessibility

Technology has also led to the increase in telemedicine options. According to an article published in the American Journal of Critical Care (AJCC), telemedicine is changing the way patient care is provided in a growing number of intensive care units (ICUs) across the country. The article notes that “the U.S. has approximately 45 tele-ICUs with monitoring capacity” which impacts care for “an estimated 12 percent of ICU patients in the country.”

Benefits of tele-ICUs for nurses, the article states, include increased efficacy in monitoring trends of vital signs, detecting unstable physiological status, providing medical management, enhancing patient safety, detecting arrhythmias and preventing falls.

“In rural areas, it is also possible for tele-health to help fill a void in care,” said Connie Barden RN, MSN, CCRN-E, CCNS, chief clinical officer of the American Association of Critical-Care Nurses, interviewed in the Nursing Notes article, “Tele-ICUs Help Nurses Care for Patients from Afar.” “These remote consults by a nurse specialist result in getting the right care to the patient in a timely manner. Besides being an efficient way of delivering care it may also help to keep the patient in their local area rather than needing a transfer for care hundreds of miles away. So, it can save money and keep the patient with their family – a win-win solution for everyone.”

New Nursing Specialties and Roles

Telemedicine nursing and nursing informatics are just two nursing  specialties that have grown in the past ten years. According to the Bureau of Labor Statistics’ Employment Projections 2012-2022 – released in December 2013 – the registered nurse (RN) workforce is expected to grow to 3.24 million by 2022, an increase of 526,800 or 19 percent since 2012.

As indicated in the IOM report, the half a million new nurses entering the workforce before 2022 will be responsible for shaping the profession, including advancing in-demand specialties, such as home-health nursing and geriatric nursing, for the increase in “Baby Boomers” who are retiring in the next decade.

In addition to new nursing specialties, nurses are also playing new roles in healthcare, The “Modern Nurse” section of Nursing Notes, outlines emerging nursing roles, such as developing simulation technology, flying into emergency situations or establishing a practice in a local libraryas part of a public health initiative.

New specialties, increased leadership opportunities and the use of telemedicine and mobile health are just a few of the ways that nursing has changed in the past ten years. Is there another innovation or idea you think we missed? Tweet us at @DiversityNurse or share a comment on our Facebook Page.

You don't know what you don't know until you know it.

That's the lesson leaders at ProMedica Toledo Hospital in Ohio learned during the design of its 615,000 square-foot patient tower set to 2019.

As part of the design process, the organization took part in research to identify and refine ways to improve nursing care and efficiencies, including distance traveled during a shift.

Architects from HKS, Inc., the firm designing the building, approached Alison Avendt, OT, MBA, vice president of operations, at ProMedica Toledo Hospital about doing the research.

"We have a building that we opened in 2008, so they wanted to look at how we were using the spaces [there], and get feedback from nursing on how it was working," Avendt says.

"That was really attractive to me because I heard we had issues with the building that we were in and there were many things that we wish we could have done better. I thought if we could do a good design diagnostic and learn something from that, it would really help guide our design work."

An Applesauce Moment
During two days of onsite observation, researchers shadowed ICU nurses and intermediate-level medical-surgical nurses. The researchers assessed the existing floor plan, used a parametric modeling tool, and created heat maps to provide a graphic representation of what a nurse's 12-hour shift looked like in terms of workflow and walking distances.

"One of the big [revelations] was around our whole process of medication passing," says Deana Sievert, RN, MSN, metro regional chief nursing officer and vice president for patient care services at ProMedica.

Observation revealed that a nurse reviewed the patient's medication administration record in the patient's room, walked to the supply room to get the medication from the Pyxis machine, and then often had to stop by the patient refrigerator to get something—like applesauce—to aid in the medication pass before walking back to the patient's room to administer the medication.

"It was something that was just so ingrained in our staff nurses' normal daily activities," Sievert says. "When they did the heat mapping it was like…'Wow. [There's a] big pinch point that we as staff nurses didn't really even realize was there.' "

Avendt says the researcher called this realization "the applesauce moment."

"Nurses are masterful at just making things work. There are a lot of things that the nurses knew were not value-added or were problematic, but they would just make it work," she says.

"It was really good to flesh out what those things were by observing because if you just ask[ed] them, the nurse would often not be able to verbalize what the problem was. But by seeing it, it came to light."

The architects used this information to design a unit that would cut down on walking time. Instead of a long corridor with a common area at one end, the unit was broken up into pods and supplies were located in multiple areas so nurses could get them from the location to which they were closest.

"We were able to take them from a three-mile journey on their shift to 1.5 miles. We cut in half the steps that they were taking," Avendt says.

After the tower opens, more research will be done to see how the design is affecting workflow.

"We've since learned that [field research] is not common for people to do. We paid a little bit of money to do that, but in the scheme of things it was well worth the investment," Avendt says.

"Everybody wants to give the nurse as much time as possible to be with the patient [and] try to take away the things that are not value-added in the nurse's day."