DiversityNursing Blog

Most of us have heard of macular degeneration, which eventually robs people of their eyesight. But, have you heard about a new procedure done at UC Davis Medical Center that has restored a woman’s eyesight? The patient led a very interesting career for 40+ years and started losing her eyesight shortly after retirement.  Due to a new technology, she can now see her friends and family’s faces, read and enjoy the beautiful sights around her.

Virginia Bane was a trailblazer, both as a female business leader and an early embracer and purveyor of cell phone technology in circa-1980s Silicon Valley.

So when age-related macular degeneration stole her central vision after retirement, naturally she welcomed an innovative solution.

In a first-of-its-kind procedure for Northern California, UC Davis doctors implanted a pea-sized telescope in Bane’s eye, gradually restoring her ability to see faces, colors and print. Today the 92-year-old still enjoys reading, seeing friends and living independently – thanks to both her pioneering spirit and what she fondly calls her “bionic eye.”

“The outcome of this is one of the most wonderful thing I've had and if I didn't have it, I could not appreciate the things I see today,” Bane said at her Pollock Pines home. “I can see my family. I can see people's faces that I could never see before. I can see outside and long distance in my yard that I would not have been able to see without the scope.”

A leading cause of blindness

Bane was familiar with both technology and medicine from her 40-year business career, mostly spent in management during an era of relative gender inequality in the workplace. She started her first management job at 23 and retired 40 years later as the president of several corporations that provided pager and cell phone service, repairs and physicians’ exchanges in the Bay Area and Southern California.

“I had around about 70 employees between the corporations, and dealt with the attorneys and government agencies for licensing, but it was very rewarding,” Bane said. “It was very difficult, but I enjoyed every bit of it.”

It was soon after her retirement to a new painting hobby that Bane’s eyesight began its gradual decline due to age-related macular degeneration, a fairly common disorder among senior citizens and the leading cause of blindness in the U.S. for patients over the age of 60.

 “There is no pain with it, so at first you don't realize that you have it. I noticed it mostly in my reading and then of course, trying to draw,” she said. “Because of the light and the dark, and the shadows, it was very difficult to distinguish if something was in front of me at that time. It got so bad that at 84 I stopped driving my car.”

The disease affects the retina. Bane reached a point where she could no longer see images on an eye chart, and could only detect a doctor’s hand when waved directly in her face.

“This means you can't see the faces of your family members, you can't read a book, you can't watch TV,” said Jennifer Li, an associate professor of ophthalmology who cared for Bane at the UC Davis Eye Center. “There are a lot of things that we take for granted every day that people with this condition are unable to do.

“As you can imagine, patients like Virginia really suffer a lot from their disorder. They lose a lot of sense of independence.”

New treatment option

Bane came to the Eye Center after she reported seeing purple through one eye, a trait that stumped her local physician (“I went to UC Davis because they are advanced in everything about the eye,” Bane said). In 2012 the center was able to offer her a new technology, the implantable miniature telescope.

The pea-sized device is fixed in the eye and has two lenses that help magnify an image to about three times normal size, allowing the user to utilize undamaged parts of the retina.  Users still wear glasses to adjust their focus from reading to distance.

The device, approved by the Food and Drug Administration in 2010, is the only medical/surgical option available that restores a portion of vision lost to the disease. UC Davis Health System's Eye Center, in collaboration with the Society for the Blind, is one of the few in California and the nation to offer the innovative procedure.

Bane would be the first patient in Northern California and among the first 50 individuals in the U.S. to receive the implant. Candidates must be 65 or older with untreatable end-stage, age-related dry-form macular degeneration, with no other ocular diseases such as glaucoma and with adequate peripheral vision in the second eye.

“I've been very fortunate in that some people can go completely blind, and I have been able to still maintain and see things through the eyes,” Bane said. “When I had the opportunity to have the telescope lens implant, I was excited and ready to go.” 

Hard work

UC Davis cornea specialists Li and Mark Mannis implanted the scope. As expected, Bane did not wake from the hour-long procedure with immediately improved vision. Use of the device involves an extensive yearlong process of “visual rehabilitation” with UC Davis occupational therapists to adjust the brain to the larger image the telescope produces.

“They're going to use the telescope to look for things with the center part of their vision, look at faces, watch TV, try and read – but they still need their other eye to help them move around, to make sure they don't bump into things and to allow them to continue to be mobile,” Li said. “A lot of the training requires them learning how to use their eyes again and learning which to use under what circumstances, so that they’re able to go back and forth easily without thinking.”

The regimen involved twice-weekly appointments and hours of practice at home – trying to “find” the scope, teaching the other eye to resist taking it over (which causes double vision) and learning to move the device from place to place to enable reading.  Several weeks into training, things seemed to gel.

“I was sitting looking at TV, and golf was on,” Bane said. “All of a sudden, I could see the ball go into the little cup. I was thrilled to death because I knew then I’d ‘found’ the scope.”

Bane had high praise for her occupational therapist, Terri Hayward.

“She’s wonderful, she has the patience for everything – and she was learning at the same time I was because I was the first one to have the scope,” Bane said. “She did a marvelous job for me and I know she does for everyone.”

Restored independence

Three years out, Bane has vision ranging from 20/80 to 20/100, which equates to very readable letters on an eye chart.

“I couldn’t see, couldn’t read, couldn’t see the faces of other people, couldn’t see anything on TV unless I was sitting right on top of it,” Bane said. “With the scope, then of course, I can do all these things. Say if I'm watching television, I can tell you what color eyes people have, describe their faces and everything, the things that I could never have done before.”

The improved vision should remain indefinitely, Li said, thanks in no small part to Bane’s enthusiasm and training discipline.

 “She's achieved a lot of her (vision) goals, and hopefully she'll be able to continue doing the things that she enjoys for the rest of her life,” she said.

Here’s an interesting article about how to make the mentor/mentee relationship work through a new American Nephrology Nurses’ Association program called the “Pay It Forward Challenge”. Some excellent points are provided about how to make this important relationship work such as living near each other so you can meet in person for meetings. This seems pretty intuitive, but they have confirmed meeting in person is far better than trying to have meetings over the phone. Read on from some great tips about starting or improving mentor/mentee relationships.

Pairing two nurses in a mutually beneficial mentor-mentee relationship can be a little like Match.com. As part of the mentor matching program for the Organization of Nurse Executives, New Jersey, a nurse manager new to leadership lists what she or he wants out of the relationship and where in the state she or he lives, and the ONE NJ Mentorship Committee finds a mentor with the expertise to meet those needs, said Bettyann Kempin, RN, MSN, NE-BC, NP-C, a member of the committee and assistant vice president of medical/surgical services at The Valley Hospital in Ridgewood, N.J.

The success of well-matched pairs who commit to a year of the program can be an important career boost for the new nurse managers, Kempin said.

“The relationship didn’t end after a year,” she said of her own experience as a mentor.

How each nurse gets involved

To become a part of the American Nephrology Nurses’ Association program, potential mentors and mentees complete an online survey that asks for contact information and a list of goals they have developed, said Cindy Richards, BSN, RN, CNN, the organization’s president and pediatric renal transplant coordinator at Children’s of Alabama in Birmingham.

Any ANNA member can participate in the association’s Pay It Forward Challenge, which Richards announced at her recent induction as president; however, mentors must have at least one year of nephrology experience to give them the “solid background needed to help mentor a newer nephrology nurse.”

The nurses have the benefit of pairing with some of the leading nurses in nephrology, which might not always be possible at the mentees’s own organization, Richards said.

For ONE NJ’s program, which focuses on providing guidance for nurse managers, mentees and mentors attend a once-a-year workshop where nurses who want to participate as mentees share what they need help with. Then the mentorship committee sorts through its selection of mentor nurses “waiting to be called up the ranks,” Kempin said.

The program has 17 pairs this year, up from fewer than a dozen when it started four years ago, Kempin said.

Ask your mentor anything

One of the important aspects of the programs is the safe arena for the mentee to ask the mentor the “afraid-to-ask questions,” Kempin said. “It’s almost like big brother, big sister.”

The relationship can provide new nurses with clinical skills, problem-solving and critical-thinking skills and a way to discuss issues that arise on the job, Richards said. “As mentors, we need to foster a positive, encouraging environment for younger, newer nurses.”

Many mentors in the ONE NJ program have said they would have appreciated such a relationship when they were new managers, Kempin said.

“I would have loved to have been able to ask questions of other folks rather than research it and speak with other people I might know,” she said, adding that her network would have been wider faster with a mentor.

Nurses also have the opportunity to step out of their organizations and gain perspective. “They’re getting a different view of acute care hospitalization,” Kempin said.

What makes it work

After receiving feedback from its first mentor-mentee pairs, ONE NJ discovered pairing nurses who are geographically close and who can have face-to-face meetings was key to developing successful relationships.

“Telephone conversations don’t cut it,” Kempin said.

The feedback helped ONE NJ develop a 25-page, evidence-based toolkit of resources that describes the phases of a mentor-mentee relationship, explains the responsibilities of each role, has partnership agreements and relationship assessments and includes checklists for goal formation, meeting preparation and progress evaluation, according to the “Developing Leadership Talent: A Statewide Nurse Leader Mentorship Program” article published in the February issue of Journal of Nursing Administration.

“It’s a nice backbone to the program,” Kempin said.

ONE NJ checks in with the pairs every couple of months during the year to ensure they’ve met in person and are using the toolkit. “Having us check in on them helps keep them on track,” Kempin said. Because the workshop that kicks off the mentorship program happens annually, all of the participants are on the same timeline, she added.

For the ANNA’s one-year program, the mentor leads by example and shares her knowledge and the values of being a professional nurse and “the specific value set needed to work with chronically ill nephrology patients on a long-term basis,” Richards said. “The mentor must also be willing to acknowledge the mentee’s progress and explore where the mentee desires to go in ANNA and nephrology nursing.”

As part of Richards’ new Pay It Forward Challenge, the ANNA will recognize at its national symposium one pair in 2016 and one pair in 2017 with the most robust achievements, Richards said.

Without mentorship to expand their networks, “a lot of times, people get stuck,” Kempin said. But mentorship programs help nurses grow.

“We get rave reviews about it,” she added.

As the Nursing shortage continues so does the need for Nurse Educators. We thought you’d enjoy this article where Judy Burckhardt, Ph.D., MAEd, MSN, RN, Professor & Dean, Nursing and Healthcare Programs at American Sentinel University lists the Top 10 Best Things about being a Nurse Educator and why she feels it’s a natural step for many Nurses.

The need for more highly educated nurses and the growing shortage of nurse educators has broadened the career horizon for new nurse educators. The demand offers a high-level of job security and opportunities to advance quickly.

More importantly, nurse educators play a pivotal role in healthcare by strengthening the nursing workforce, serving as role models, and providing the leadership needed to implement evidence-based practice and improve patient outcomes. 

Judy Burckhardt, Ph.D., MAEd, MSN, RN, Professor and Dean, Nursing and Healthcare Programs at American Sentinel University says that teaching is an integral part of nursing and that becoming a nurse educator is a natural step for many nurses.

"Whether they choose to work in the classroom or the practice setting, nurse educators prepare and mentor patient care providers and the future leaders of our profession," she says.

Dr. Burckhardt says that many nurse educators typically express a high degree of satisfaction with their work and that mentoring students and watching them gain confidence and skills are some of the most rewarding aspects of their jobs. She shares her 'Best Things About Being a Nurse Educator' for nurses considering nurse education as their career path.

Dr. Burckhardt's Top 10 Best Things About Being a Nurse Educator:

1. The opportunity to educate nurses that will care for my loved ones and me

2. The ability to pass on what I have learned from great nurse educators

3. Hearing from previous students that their daughters/sons have gone into nursing because of their parent's experience in nursing school

4. The chance to make an impact on the future generation of nurses

5. Passing on the "tricks of the trade" to do things easier, without breaking protocols

6. Wearing a white lab coat while supervising students in clinical

7. Seeing the difference between how students appeared the first day of nursing school and seeing them function as great professional nurses in the clinical setting

8. Hearing from students that I had a positive effect on their decision to finish nursing school and become nurses

9. Working with a group of individuals that want to make the world a better place

10. Being able to replicate the activities of nurse educators who shaped who I am as a professional nurse 

Dr. Burckhardt says other benefits of being a nurse educator include access to cutting-edge knowledge and research, opportunities to collaborate with health professionals, an intellectually stimulating workplace, and a flexible work environment. 

She points out that The American Association of Colleges of Nursing (AACN) documented that nursing schools nationwide are struggling to find new faculty to accommodate the rising interest in nursing among new students.  

"Given the growing shortage of nurse educators, the outlook is bright for nurses interested in careers in academia," adds Dr. Burckhardt. "At American Sentinel, our Doctor of Nursing Practice (DNP) program with a specialization in educational leadership was designed to provide nurse education leaders with credentials that validate credibility and competence to academic and business leaders. Students will be taught by experienced nurse educators and surrounded by colleagues who share their education-focused goals."

SOURCE American Sentinel University

As Nurses, a big part of your job is empathy for your patients and their families. You’re so good at understanding what your patients are going through because you care and this I think, is primarily why you decided to become a Nurse – to help people and lend a sympathetic ear. You educate, show compassion, love and understanding every day. You are amazing! 

We came upon this touching video which reinforces that every one of us -- whether we’re a Nurse, a patient or patient’s family member -- has a personal life. Some days are better than others. It reminds us to be mindful of the people around us and their struggles. What are your thoughts about this video?

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A Nurse Reflects On The Privilege Of Caring For Dying Patients

Nurse Association 'Zero Tolerance' On Workplace Bullying

According to projections from the Bureau of Labor Statistics by 2022 there will be an increase in the number of Registered Nurses of 526,800. That is over half a million! This means lots of nursing jobs for the near future– definitely a career with good prospects. If you are curious about RN salaries this infographic will be helpful.

Education, education, education… you’ve heard about the importance of a good education all of your life. It’s right up there with buying a house, where location, location, location is the mantra. This article explains what hospitals and health systems are looking for when hiring Nurses and why a BSN degree or higher is important.  DiversityNursing.com understands that not everyone has the financial means to continue their education. That is why we continue (7 years/winners so far) to offer our Annual $5,000 Education Award. Please read this article and then register for our 8^th Annual $5,000 Education Award below.

Megan Goodman was a dean’s list student at Pennsylvania College of Health Sciences who served on two student nursing boards before she earned her associate degree in nursing in May.

Since then, the 30-year-old Downingtown, Pa., resident still is seeking work after applying for more than three dozen hospital jobs. “Truthfully, an associate’s program is not really going to get you anywhere anymore,” she said.

Hundreds of thousands of Americans flocked to nursing schools over the past decade, drawn by the prospect of a well-paying job with a degree that takes as little as two years. But many have graduated only to find the goal posts have shifted, as hospitals seek nurses with more-advanced degrees, partly in response to an increasingly complex health-care system.

The trend in nursing mirrors a wider one unfolding in other sectors such as manufacturing and office administration, which are demanding more education and skills than in the past. As the number of job candidates with bachelor’s degrees rose during the recession, due to layoffs and people returning to school, employers began expecting degrees for positions that previously didn’t require them.

Such “upskilling” in reaction to a slack labor market was particularly intense in nursing, which saw a flood of new entrants over the past decade. The number of programs of all kinds jumped 41% to 2,270 between 2002 and 2012 amid a widely perceived shortage of nurses, according to a 2014 paper in the journal Nursing Economics. In roughly the same period, the ranks of young registered nurses swelled about 80%, while the number of those over 50 doubled to one million, as would-be retirees stayed on the job.

Meanwhile, the Institute of Medicine, an influential independent advisory group, called in 2010 for 80% of the nursing workforce to have bachelor’s degrees by 2020. It based that goal on research dating to the early 2000s showing that hospitals with a higher proportion of nurses with a bachelor’s degree scored higher on important indicators of overall quality of care.

“The hospitals said ‘Where do I get the best value, the highest outcomes for the cost? From a baccalaureate nurse,’” said Peter Buerhaus, a nursing economist at Montana State University.

At the same time, the Affordable Care Act has put more focus on chronic and preventive care, prompting hospitals to seek more coordination and leadership skills from their nurses—skills that aren’t generally taught as part of associate’s-degree curriculum.

A push by hospitals to obtain “Magnet” status, a certification that helps hospitals to recruit and retain nurses, also tilts the field toward bachelor’s-degree holders, since nurses in leadership roles at Magnet hospitals must have a bachelor’s degree.

Diana Mason, president of the American Academy of Nursing and a nursing professor at Hunter College in New York, is concerned that hospitals’ increasing preference for nurses with four-year degrees could block what has been seen as a reliable way into the middle class.

“That’s a beautiful aspect of nursing’s career ladder, is that it enables people to move from maybe a family growing up in poverty, to solidly middle class,” she said. “It provides access to people who can’t afford a baccalaureate education.”

Some hospital systems, such as Main Line Health in Pennsylvania and Cedars-Sinai in Los Angeles, explicitly require bachelor’s degrees or higher for their nursing residency programs. Hospitals that do hire associate-degree nurses are increasingly putting provisions in their contracts that require completion of a bachelor’s degree within a set period, usually three to five years.

Ida Danzey, associate dean of health sciences at Santa Monica College, remembers when the nursing career fair drew local hospitals. Beginning around 2008, their numbers dwindled. Local universities advertising “BSN completion” programs, which allow associate’s-degree graduates to earn their Bachelor of Science in Nursing with additional course work, have taken their place.

The extra 18 months or so of education often includes courses in things like leadership, evaluating research and the history of nursing, prompting complaints about unnecessary costs.

“What we had to pay for was just fluff,” said Rebeka Rivera, a pediatric nurse at Children’s Healthcare of Atlanta who took those courses in the final year of her bachelor’s program. “You’re not taking any science courses at that point.”

Others say the evidence shows that better-educated nurses lead to improved health outcomes, and that the skills taught in a bachelor’s-degree or BSN-completion program are increasingly relevant to the way care is now delivered.

“The health-care industry has changed dramatically as a direct result of the economy and health policies in flux,” said Veronica Feeg, associate dean and director of the Center for Nursing Research and Scholarly Practice at Molloy College in New York. “New roles for nurses emerge every day. The need for educated health workers who care for the most vulnerable people and carry enormous responsibility is not new, but requires more critical thinking than ever before.”

Ms. Goodman, who graduated in May, is already pursuing a bachelor’s degree online through Villanova University as she continues to apply for nursing jobs and works two part-time jobs, as a lifeguard and an emergency medical technician.

“It’s really wearing me down,” she said. “I wish hospitals would look at the person. I have life experience.”

Looking to hire Nurses? We can help!

Are you a leader? Are you someone people look to for advice or to make decisions in a time of crisis? Leaders come in all shapes and sizes. Some are natural leaders, they just know what to do. Others become leaders by observing and learning leadership skills through their mentors or family members. At work, are you someone who leads the way? Do you take a stand when you see something is wrong? We can’t all be leaders, but are there times you just naturally step up to the challenge?

Every profession has members who rise into leadership, and effective leaders can make all the difference. This cannot be more true of healthcare and nursing, arenas that necessitate highly collaborative teams.

Leadership can be taught, but it’s also intuitive, and some nurses have this gift. What makes a particular nurse embody the characteristics of true leadership, even when he or she has no official title?

Tuning in

A nurse who cultivates deep awareness of both self and others demonstrates a powerful form of leadership. This type of nurse is tuned in,  alert for others in distress, and leads to collaborate in ways that decrease such distress.

This nurse tunes into both individuals and the collective, leading by example while leaning into situations to positively impact the whole. The shadow for this type of consciousness is hypervigilance and controlling behavior, which a highly developed self-awareness can preclude.

Leadership in action

Some nurses are skilled at taking the reins, even when not in official positions of leadership. These nurses see problems, bring them to the team’s attention and proactively seek ways to alleviate the problem.

We’ve likely all known nurses who respond to problems with a statement like, “It’s been that way a while; it’s not my responsibility to fix.” This common attitude can breed a culture of intellectual laziness and disregard for the bigger picture.

Proactive, thoughtful nurses see problems and involve others in manifesting solutions that truly benefit everyone. This is leadership in action.

Speaking up

Some nurses demonstrate leadership by using their voices. This may involve naming a problem, such as noticing a bully on the unit, or otherwise identifying something that’s amiss.
Our silence can serve as complicity, such as not speaking up or taking action in response to a bully. The empowered nurse who speaks the truth overcomes his or her fear by taking a calculated risk and naming what needs to be named.

Speaking up gives voice to those who are too frightened to speak for themselves. This type of nurse leadership can empower others to also speak out, and can be a powerful way to lead by example.

Conscientious collectivism

Natural nurse leaders intuitively lead the way, sometimes dragging their official leaders with them. We all contain the seeds of leadership, but some more readily demonstrate those characteristics.

Those nurses who skillfully and naturally lead do so from an ability to see beyond themselves. These nurses consider the good of the whole, align their own actions with that ideal and proactively seek change.

Nurses can lead the way in any workplace situation. Tune in, see the 10,000-foot view, consider the good of the whole, use your voice and lead from a balance of intuition, savvy critical thinking and conscientious collectivism.

Your turn

How do you lead in your daily work? Share your experiences with us.

You work with patients in a medical facility, doctor’s office, perhaps even a school. You do everything you can to keep your patients, yourself and everything around you clean and sterile. After all of the precautions you take, is it possible you are spreading germs? Read on to find out how you can change a step or two of what you’re already doing to prevent further germ contamination.

In an alarming study about how germs spread in health-care settings, researchers set up a simulation that involved asking doctors, nurses and other health-care personnel at four hospitals to put on their standard gowns, gloves and masks and smear themselves with a fluorescent lotion that was supposed to be a stand-in for germs or other dangerous matter.

After the participants carefully removed the protective equipment as they usually would the researchers searched their bodies with a black light to see whether any lotion was transferred. Both participants and researchers were surprised to find contamination in a high number — 46 percent — of the 435 simulations.

“Most of the participants appeared to be unaware of the high risk for contamination and many reported receiving minimal or no training in putting on and taking off [personal protective equipment],” senior author Curtis J. Donskey of the Cleveland Veterans Affairs Medical Center told Reuters Health.

Writing in the journal JAMA Internal Medicine on Monday, the researchers said that most of the transfer of the lotion took place as gloves were being removed. As might be expected, the contamination was less when proper procedures were followed (30 percent) vs. when they weren't (70 percent)

The researchers recommended that "educational interventions that include practice with immediate visual feedback on skin and clothing contamination can significantly reduce the risk of contamination."

This story is about a Nurse who worked in oncology and then decided to do palliative care in people’s homes. She finds it an honor to be with the patient and their family during the last few days of the patient’s life. She notes how the patient is much more in control and comfortable at home than they are in the hospital and wonders if there’s a way to do it better in the hospital. She has learned to be honest with the patient’s family if they ask if their loved one is dying. She has found they ask, because they really want to know, to prepare themselves. If you are not a palliative care Nurse, is it something you would consider? This story will give you excellent insight.

Palliative care nurse Theresa Brown is healthy, and so are her loved ones, and yet, she feels keenly connected to death. "I have a deep awareness after working in oncology that fortunes can change on a dime," she tells Fresh Air'sTerry Gross. "Enjoy the good when you have it, because that really is a blessing."

Brown is the author of The Shift, which follows four patients during the course of a 12-hour shift in a hospital cancer ward. A former oncology nurse, Brown now provides patients with in-home, end-of-life care.

Talking — and listening — are both important parts of her job as a palliative care nurse. This is especially true on the night shift. "Night and waking up in the night can bring a clarity," she says. "It can be a clarity of being able to face your fears, it can be a clarity of being overwhelmed by your fears, and either way, I feel like it's really a privilege to be there for people."

Sometimes Brown finds herself bridging the gap between patients who know they are dying and family members who are still expecting a cure. "There can be a lot of secrets kept and silences. ... One thing that palliative care can be really good at is trying to sit with families and have those conversations," she says.

While some might see her job as depressing, Brown says that being with people who are dying is a profound experience. "When you're with people who die ... and being in their homes and seeing their families, it's incredible the love that people evoke. And it makes me realize this is why we're here; this is what we do; this is what we give to each other."

Interview Highlights

On cutting costs and stretching nurses too thin 

There's a sense that you can stretch a nurse just like an elastic band and sort of, "Well, someone called off today." That means a nurse calls in and says that she's sick or her car broke down or he won't be there, and sometimes we're able to get someone onto the floor to take that person's place, but often we're not. Or an aide might not be able to show up for whatever reason, and then the assumption is just, "Well, the nurses will just do all the work that the aide would've done," and the problem is that people do not stretch like rubber bands, and even rubber bands will break if you stretch them too far.

On loved ones wanting to feed their dying family members

Food is so fundamental, and their feeling is "I'm letting my husband starve to death and that's wrong." So I have to talk them through the process of the body slowly going in reverse. All the processes we think of as normal and that are integral to life, they're all slowing down. And so the body just doesn't need food when someone gets very close to the end of their life and, in fact, they found that forcing someone to eat can mean that they just have this food sitting in their stomach, they're not able to digest it, can actually make them more uncomfortable. So I talked to [one family member] about that, but tried to do it as gently as possible, while also acknowledging the incredible love that was motivating her and trying to honor that, but make it clear that she needed to show her love by being close with her husband, by holding his hand, by talking to him, but not by feeding him.

On whether patients ask if they're dying 

No, they don't. ... I think it's because they're afraid. They want to just take things day by day. I did have a wife once ask me. She said, "You know, I'm not new to this, and I want you to just tell me. Is he dying?" And at that point I was a pretty new nurse and I didn't have the experience to know to say, "Yes." Now I would know to say that. ... I got a sense that she really wanted to know and no one else was telling her. ...

Physicians can have a mindset of "we're thinking positively, we're focusing on the good that can come, and we're not going to talk about 'what if it doesn't work out.' " And they will sometimes pull the nurse aside and say, "What's going on?"

On leaving the hospital setting for palliative care 

I love the hospital. I never thought I would leave the hospital, but I left to see patients outside the hospital because in the hospital I feel like we never see people at their best. They feel lousy. We wake them up at night. We give them no privacy. We give them, really, almost no dignity. We tell them what they're going to do when, what they're going to eat when, what pill they're going to take when and no one likes living like that. ... So I wanted to see people in their homes because I thought there's got to be a way we could make the hospital better. Seeing what it's like for patients in their homes I thought would show me that. And I would say overwhelmingly what I've seen is control: People have so much more control when they're in their homes and it should not be that hard to give them back a little bit more control in the hospital.

On traveling to a patient's home

When I started, I thought, "I can't believe I'm doing this. I can't believe I just drive up to these houses and go inside them." I live in Pittsburgh, but it can get very rural feeling actually pretty quickly, and I remember ... going to [a house] that was already through back-country roads and then down a gravel driveway, and I thought: "What am I doing? Am I insane?" And then I went into this house, and this family was so loving and amazing and wonderful, so it was a great education for me not to judge. And I know that my workplace checks out and makes sure that the places we're going are real, so that's comforting, but it's definitely a giant leap of faith, and you just have to make that leap.

On home care versus hospital care

Often in the hospital they can be more comfortable in terms of we're relieving their pain, we're getting them anti-nausea medications very quickly, but ... they're not as comfortable with themselves, and in their homes they seem much more comfortable with themselves and with the people around them, and I had never thought about those two things as being so distinct, but they are. So the question then is how do we give people care that marries those two things, because they're both so important.

On how patients express appreciation to nurses 

A very popular gift in my hospital was Starbucks [gift] cards. ... Often people bring in cookies and chocolate and that's wonderful, but I remember one nurse saying, "You know, I wish someone would just bring in a lasagna." ... Because we never have time to eat and then you go into the break room and you're hypoglycemic and you see all this chocolate, and so you eat all this chocolate, which doesn't really help you feel that much better in the long run. So to actually drop off a meal is wonderful. 

It is clear that digital technology has a firm grasp on our lives and is advancing daily. We walk around with a computer in our pocket (cellphones) full of endless amounts of information. This technology has changed the way we provide healthcare and with this change there are pros and cons. Specifically, Electronic Health Records (EHRs) or Electronic Medical Records (EMRs). 

An Electronic Health Record according to CMS.gov, is an electronic version of a patient's medical history. It is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person's care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. The EHR automates access to information and has the potential to streamline the clinician's workflow. The EHR also has the ability to support other care-related activities directly or indirectly through various interfaces, including evidence-based decision support, quality management, and outcomes reporting.

Pros

EHRs will save you space and paper. Administrative duties in health systems represent a significant amount of time and costs. Staff can spend a good portion of the workday filling out and processing forms. Because they are paperless, EHRs streamline a number of routine tasks. With less paperwork taking up space there will be less clutter and more room to be efficient.

Patient’s medical files will all be consistent. The medical staff can interact easily with affiliated hospitals, clinics, labs and pharmacies about the patient’s medical history. All of the patient’s files are updated when something is entered or changed in the system. This way the patient’s information is always up to date, leaving less room for errors or miscommunication.

Easy access to all clinical data. Staff can quickly transfer patient data to other departments or providers, while also reducing errors, which yield improved results management. Patients and employees often respond positively to this because it helps keep a health system’s schedule on track.

Cons

Privacy is a major concern when it comes to electronic health records. Using EHR software could put your organization at risk if you don’t follow privacy settings correctly. Paper records also make it easy to violate a patient’s privacy but, electronic records are convenient and timely which makes it easier to violate the patient’s privacy. A common privacy concern is identity theft.

Another disadvantage is data loss. A computer crash could wipe out vital data that you’ve been accumulating over the years. Always have a backup plan. This is imperative.  Many systems backup their data through a cloud program. So if there is an unfortunate event and your system crashes, you will still be able to access the data from the cloud.”

There are high costs involved with implementing an EHR to your system and many smaller health systems might not be able to afford it. The American Action Forum says, “Implementing an EMR system could cost a single physician approximately $163,765. As of May 2015, the Centers for Medicare and Medicaid Services (CMS) had paid more than $30 billion in financial incentives to more than 468,000 Medicare and Medicaid providers for implementing EMR systems. With a majority of Americans now having at least one if not multiple EMRs generated on their behalf, data breaches and security threats are becoming more common and are estimated by the American Action Forum (AAF) to have cost the healthcare industry as much as $50.6 billion since 2009.”

Do you work in a health system that uses Electronic Health Records? If so, how do you feel about them? We want your honest opinion, the good, the bad and the ugly.