DiversityNursing Blog

By Christina Orlovsky Page 

If necessity is the mother of invention and Florence Nightingale is the mother of modern nursing, it’s only fitting that during National Nurses Week--culminating in Nightingale’s birthday, May 12--we take the time to recognize nurses’ inventions and the talented professionals who used their creative energy to improve patient care. Ever hear of the crash cart, for instance? It is just one of the many innovations that nurses have helped devise. 

So here is a salute to just a few nurse inventors, from past and present, who realized a need and turned their ideas into reality.

A Nurse-Turned-Physical Therapist’s Feeding Apparatus for Amputees 

For Bessie Blount, nursing was just one step on her long career path, but it was a step that led to several technological advances in assistive devices for amputees. Working with veterans disabled in World War II, Blount, who trained in nursing and then physical therapy, created an electronic device in the early 1950s that allowed amputees to eat on their own. When Blount didn’t receive support for her invention from the American Veteran’s Association, she donated the rights to the French government, and the rights to another invention--a disposable hospital basin--to Belgium. Blount, who became a pioneer among African American women in the mid-century, ended her career path in forensic science, which she practiced until her death in 2009. 

An ER Nurse Leader’s Profession-Changing Invention and Association  

In the 1960s, emergency department nurse Anita Dorr, RN, recognized the length of time it took to gather the supplies the unit needed in a critical situation. Together with her staff, who created a list of necessities, and her husband, who built a wood prototype, Dorr envisioned a wheeled “crisis cart” in 1968 that has since evolved into the crash cart of today. Dorr’s dedication to emergency nursing eventually led to the establishment of the Emergency Room Nurses Organization in 1970--a group that would later become the Emergency Nurses Association, today a 40,000-member-strong organization devoted to strengthening and supporting the professional specialty. 

A Mother-Daughter Duo’s IV Catheter Shield 

In the early 1990s, mother-daughter duo Betty M. Rozier, an entrepreneur, and Lisa M. Vallino, RN, BSN, a pediatric emergency nurse, teamed up to establish I.V. House, Inc., an intravenous therapy organization based in Chesterfield, Mo. With products designed out of a need Vallino had seen in her clinical years for site protectors that eased patient anxiety and reduced reinsertions, the original I.V. House device was patented in 1993; today, millions of I.V. House site protectors have been provided to hospitals worldwide. 

A Sister Act for IV Safety  

Inventive IV lines took a colorful turn for nurse sisters Terri Barton-Salinas, RN, and Gail Barton-Hay, RN, whose half-century-plus of combined nursing experience provided helped them see the need for increased patient safety surrounding IV lines. Acknowledging the hazards of using clear, indistinguishable lines, the pair assisted with the product development of ColorSafe IV Lines, lines available in red, green, orange, blue and purple, with corresponding colored labels for the IV bags.  

A College’s Nursing-Engineering EHR Collaboration 

Perhaps no place is better for innovation than a university campus, which affords bright minds the opportunity to brainstorm, collaborate and experiment with creativity. One such innovative collaboration came out of the University of Tennessee at Knoxville, where the colleges of nursing and engineering partnered to create the DocuCare EHR, which integrates electronic health records into a simulated learning tool for students, changing the way nursing students learn and preparing them for the increasingly EHR-heavy hospital workforce. Developed by Tami Wyatt, PhD, RN, associate professor of nursing, and Xueping Li, PhD, associate professor of industrial and information engineering--co-directors of the university’s Health Information Technology and Simulation Laboratory--the product was purchased by health care publishing giant Lippincott Williams & Wilkins (LWW) in 2010 and is being utilized in nursing school curricula across the country.

© 2013. AMN Healthcare, Inc. All Rights Reserved. 

Source: Nursezone.com

By Karen Long

While all nurses evaluate the four vital signs of temperature, pulse, blood pressure and respiratory rate, Ellen Cunningham, RN, MSN, is among many RNs who assess a fifth: pain.

"Every patient has the right not to suffer in pain," said Cunningham, nurse manager at the Interventional Pain Center at North Shore-LIJ Health System’s Syosset (N.Y.) Hospital.

But assessing the pain of patients in the critical care setting can be difficult, especially if they have cognitive impairments or can’t speak. 

"Inability to provide a reliable report about pain leaves the patient vulnerable to under-recognition and under- or over-treatment," the American Society for Pain Management Nursing stated in a July 2011 position paper about pain assessments in patients unable to self-report. "Nurses are integral to ensuring assessment and treatment of these vulnerable populations."

How to assess a critically ill patient

Determining a nonverbal patient’s pain is "definitely like unpeeling an onion," Cunningham said. Many nurses follow a hierarchy for pain assessment to evaluate the pain of a patient who cannot self-report, said Barbara St. Marie, ANP, PhD, GNP, ACHPN, pain specialist and former member of the American Society for Pain Management Nursing’s board of directors. The ASPMN outlines the steps in its position paper as follows: 

Try to have the patient self-report pain. It often is difficult with critically ill patients, Cunningham said. Obtaining that information "may be hampered by delirium, cognitive and communication limitations, altered level of consciousness, presence of endotrachael tube, sedatives and neuromuscular-blocking agents," according to the position paper. Those patients might not be able to rate pain on a scale of one to 10, but could use a gesture such as grasping the nurse’s hand or blinking their eyes to indicate pain, St. Marie said.

Identify potential causes of pain. That could include surgery, trauma, catheter removals, wound care or constipation, Cunningham said.

Observe patient behavior. Several tools also exist to help nurses assess pain in patients who are unable to speak, said Donna Gorglione, RN, BSN, clinical nurse manager of the ICU and progressive care unit at Hudson Valley Hospital Center in Cortlandt Manor, N.Y. For patients who are aware but not able to voice their pain, nurses can use the Wong-Baker FACES Pain Rating Scale, said Maggie Adler, RN, MSN, WCC, associate director of standards and quality at HVHC. 

The Pain Assessment in Advanced Dementia Scale measures behaviors such as restlessness, agitation, moaning and grimacing that can indicate pain. Nurses observe the patient and score a zero, one or two in five areas — breathing independent of vocalization, negative vocalization, facial expression, body language and consolability — then add up the score. Zero equates to no pain while 10 means severe pain. Nurses then treat the patients based on the pain score, Adler said. For example, a two might indicate the patient’s pain could be eased with Tylenol, while a seven would dictate a more serious intervention, such as narcotics.

The critical care pain observation tool and Face, Legs, Activity, Cry, Consolability tool also are useful, St. Marie said. Changes in blood pressure, heart rate or respiration could be indicators of pain. "I always say that if someone has a physiologic indicator, that’s the point where you start investigating more," she said.

Obtain a proxy report. Parents of young children or caregivers and family members of the elderly can provide vital information about what is causing patients’ pain, Cunningham said. "Credible information can be obtained from family members who know the patient well and may be a very consistent caregiver throughout their illnesses," St. Marie said.

Try an analgesic trial. If the other methods to determine pain yield inconclusive results, a trial could help, St. Marie said. Nurses administer low doses of any number of opioids and look for the patient to settle down, change facial expression or otherwise indicate a decrease in pain. According to Cunningham, any of those would indicate the patient had pain and not distress.

Pain management treatments

After assessing the patients’ pain, level of consciousness and respiratory status, nurses look at other indicators such as comorbidities, kidney and liver function, estimated blood loss from surgery and amount of opioids received in the OR and PACU. Nurses can use a variety of treatments to block pain through multiple receptors and pathways, St. Marie said.

Medications — such as nonsteroidal anti-inflammatory drugs, opioids, acetaminophen, local anesthetic agents and antiepileptics — through various pathways are common ways to treat pain. "Pain mechanisms involve our entire body, so it’s not just one pathway" that pain is transmitted through, St. Marie said. Nurses can now help block pain at many of those pathways.

Not all pain can be eliminated, Gorglione said. In some cases, a patient’s goal is to reduce pain to a tolerable level. "That’s an important piece of pain management," she said. "Sometimes we can’t get your pain to zero. If you can tolerate a level of three or four, we can get your pain there, and you can perform your activities of daily living."

Besides medications, patients can benefit from holistic therapies including music, massage or even hand-holding or warm blankets, Gorglione said.

"The tendency with medicine is to run right to the medicine cabinet," Adler said, noting other therapies can be effective. For some patients at HVHC, music has made a difference. "We’ve had patients and patients’ families thank us for the special attention and how relieved they were and how much it helped," Gorglione said. An integral part of pain management is reassessment after treatment. Nurses should use the same tool they used for assessments to determine whether the patient has a lower level of pain, St. Marie said.

Challenges in treating pain

Along with determining the right treatment, nurses face a variety of challenges in pain management. For example, some patients think pain is a normal part of their illnesses and refuse pain medication, Adler said. Elderly patients often have anxiety about becoming dependent on medications, Gorglione said. In those cases, educating the patient about pain management can help.

In other situations, the challenges come from providers. Patients who arrive in the ICU and have addiction issues often are stigmatized or marginalized because providers blame the victim, St. Marie said. But a patient going through withdrawal needs "serious pain control," she said.

Nurses have to overcome the challenges to be able to assess, treat and reassess patients’ pain, Cunningham said.

"No matter how old someone is, no matter how cognitively impaired they might be, it never takes away that they might be in pain," she said.

Source: Nurse.com

 By Morgan Whitaker

As a massive tornado swept through the Oklahoma City area Monday afternoon, Moore Medical Center stood directly in the path of destruction.

The building was pulverized by the 200 mph winds, sending patients and staffers scrambling to safety zones located in the center of the hospital. Miraculously, all the staff, patients and families survived the storm.

That includes nurse Cheryl Stoepker, who used her own body to protect a newborn she’d delivered barely an hour earlier. When she heard news of the approaching twister, she wheeled the newborn and his mother down to the cafeteria, a windowless room on the first floor of the hospital.

“It was dark, that was the first thing that told us something was happening,” she toldPoliticsNation on Tuesday. “We could hear the hail hitting the building even though we were on the first floor and it’s a two-story [building],” she explained.

“So we at that point got down on the floor, patient and myself, took her baby, put him in laps, and we hugged, and we started praying,” she said. “The baby was a little over an hour old, didn’t even have a diaper yet at that point, but mom and I held the baby and prayed and made it through.”

When the storm passed, Stoepker and her patient were forced to climb out in the darkness, navigating around debris as she tried to push the new mother and her child out in a wheelchair. They made their way out alongside one of her colleagues, herself 33-weeks pregnant, and pushing yet another infant and mother who’d just given birth. Eventually the wreckage was impossible to wheel through, and her patient, with only a few minutes of recovery from labor, walked–barefoot–out of the building.

Only 24 hours later, she’s still coming to terms with her experience. “It’s hard to describe and I’m still trying to deal with it and figure out what happened,” she said. As Rev. Sharpton said, this hero who saves lives and cares for people everyday in ordinary circumstances was able to keep a precious patient alive in extraordinary circumstances too.

Source: MSNBC 

By Susie Steckner

By Joyce Pellino Crane

When Diana Walker-Moyer left her Westford home on the morning of April 15 to volunteer at the Boston Marathon, she had no idea that her nursing skills would thrust her into the first known and widespread terrorist attack in this northeast region since 9/11.

According to Walker-Moyer, there were two medical tents set up at the marathon. Medical tent A was located at the finish line, and medical tent B was sited further down the road at Berkley Street near St. James, she said. Inside were emergency room physicians, intensive care unit nurses, and emergency medical technicians.

       Walker-Moyer was asked to oversee a team of 15 health care providers charged with scanning the throngs for light-headed runners as they arrived. Her zone stretched along Boylston Street from a point between Clarendon and Dartmouth Streets toward Berkley.

       The trickle of elite runners moving past her at the beginning of the race, swelled to a sea of bodies, as the slower runners finished the race.

       “It’s like swimming in a sea of lemmings,” she said. “There are so many faces.”

       According to the BAA, 23,336 began the race and 17,580 finished.

       Her role was to keep people moving toward a supply of water bottles, Mylar blankets and the medals for finishers. Some team members stood by with wheelchairs in case a runner fainted.

       “People are running this whole time and their heart is circulating the blood and so are their leg muscles,” Walker-Moyer said. “Then when they stop, that leg action muscle no longer is working the same because they’ve stopped moving and they may not be getting as much blood flow to their head.”

       When the first explosion occurred on Boylston between Exeter and Dartmouth Streets, she was walking with a runner. Everyone turned to look. It sounded like a cannon, she said. “But there was no reason for that to happen right then. It made no sense,” Walker-Moyer said.

       “Then the second one went off,” she said. “We were probably 100 yards away from it. Then you have all these people going from joy-faced to sad-faced because they’re in pain.” The second bomb was detonated 13 seconds later in front of the Forum Restaurant between Exeter and Fairfield Streets.

       Medical tent A quickly became a triage center for the wounded.

       “Thank God those people were there because more people would have died just from blood loss,” said Walker-Moyer. “The response was rapid and appropriate and lives were saved.”

       As three police officers rushed past her toward the finish line, Walker-Moyer stayed at her post moving runners forward, said Collins.

“Diana was part of the medical sweep teams at the finish line, helping to move runners away from harm’s way after the explosions occurred,” Collins said.

       Next year she’ll do it all over again, Walker-Moyer said.

       “It’s Patriots’ Day. You think of the citizens who went to fight (in 1775) and we have this citizens medical group who are trained to volunteer when there’s a crisis,” she said. “One of the strengths of our nation has to be a prepared citizenry.”

Source: Wicked Local - Westford 

BY ELIZABETH HANINK, RN, BSN, PHN

How do you approach continuing education? Do you seek out courses that will truly enhance your skills as a practitioner? Or do you simply look around a week before the renewal deadline and pick an online course you think you can complete in a short amount of time? Is price a deciding factor for you — getting the most hours for the lowest cost or only considering courses offered for free at the most convenient facility?  

We have all probably fallen into several of the above practices at one time or another. While California’s requirement of 30 CEUs per year can hardly be considered onerous, somehow continuing education falls to the bottom of our lists of priorities. Also, some courses are very expensive. Often, a single day at a seminar that offers 7.5 contact hours will run over $200. With the increase in license fees — now $140 — it is quite possible to spend a hefty chunk of money just keeping your license current. Nonetheless, there is real value in many of the courses offered, and we owe it to ourselves to make the most of our continuing education.  ➲

Research the Providers
Because the Board of Registered Nursing certifies course providers, not individual courses, the key is to look for a good provider, either one you know from past experience or one that comes recommended.
Courses generally need to be related to either direct or indirect client or patient care, like patient education strategies, cultural and ethnic diversity or skills courses like stoma care. Indirect patient care may include courses in nursing administration, quality assurance and nurse retention, as well as instructor courses for CPR, BLS or ALS.

Multiple Formats
You can find good courses in any of several formats:

Online:  There are wonderful online companies that offer excellent material and the advantages of time flexibility and low cost. California is very generous in allowing all 30 required hours to be completed online; not all states are as accommodating. Almost every online course offers the option of a hardcopy text if you want it,  and buying one for a few extra dollars is a good, inexpensive way to build up a reference library.  Many online courses also offer the option of retaking the final test several times over a lengthy period (although I have never come across a continuing education test that was even remotely difficult). Several courses also offer a webinar component that allows for greater participation. Virtually all professional organizations offer online courses to their members.

All-day sessions: Usually taught by an expert in a particular field, these classes do not offer as much flexibility or as low a cost as online courses, but can be much more rewarding. Many all-day courses are very hands-on, with tons of take-home material and opportunities to ask the instructor questions — a luxury rarely afforded by online courses. Many all-day sessions target nurses in a particular practice area and presume a certain amount of basic knowledge of the subject matter. (All continuing education courses require that the information provided be above and beyond that required for licensure.)

Fun classes: Some courses promise entertainment, as well as education. Trips to resorts and cruises come to mind, offering sun, scenery, shows and good food — and learning, to boot. Who wouldn’t like that? This is, of course, the most costly option you can choose, but it might be a good way to combine work with pleasure.

Staying Close to Home
Your employer can be a very good source for a wide variety of continuing education programs. These courses are often free to employees and inexpensive for others. Sometimes sponsored by medical equipment vendors or drug companies, many classes of this type are short-term and highly specific. Very often, supervisors are quite accommodating about scheduling if the class is offered in-house — especially if the class is directly related to the care you give. Cross-disciplinary offerings are frequent in hospital settings, and as long as the class is Category I, you can even take courses directed at the medical staff. 

Nurses often make the mistake of thinking that if an instructor is local, he or she has nothing useful to say. But you might be surprised at the credentials of some of your fellow employees. Both day-long and short lunch-hour seminars can be a boon to your professional development and easy ways to rack up the CE hours.

BRN Requirements
As you look for courses to take, don’t forget these essential BRN requirements:

• You cannot take courses designed for nonprofessionals or that focus primarily on self-improvement, like weight reduction or yoga (although some stress-management courses are allowed).

• Providers cannot allow for partial credit, although it is acceptable to break up multiple-day seminars into separate offerings, each with separate CE hours. Staying for only half the day will not cut it.

• If you take a course in California, it must have a California BRN provider number. If taken out of state, courses offered by the American Nurses Credentialing Center are acceptable, as are out-of-state courses offered by providers approved in another state — as long as the course are taken outside of California.

Exceptions to the Rule
The board also excuses certain licensees from needing to accrue CEUs:

•  Advanced degree candidates: If you are in the process of obtaining a higher degree, you can count some of your academic courses toward your CE requirement using the following equation: one semester unit equals 15 CEUs, one quarter unit equals 10 CEUs. 

• Hardship or disability: You may also be excused from some or all of your continuing education requirement if you can prove a personal hardship, such as a physical disability last more than a year, or if you are solely responsible for a totally disabled family member for more than a year.

•  Practicing outside California: If you are employed by a federal agency or in military service and are practicing outside of California, you can maintain your license without CEUs (although those organizations usually have their own requirements).

Other Considerations
Not working right now, but want to maintain an active license? You will need the CEUs, just like everyone else. But you can also choose inactive status; if you go on inactive status and then resume active status within eight years, you will only need 30 contact hours in total to be reinstated.

Don’t forget: It is not enough to take the course and earn the hours. You must retain proof of completion for at least four years, just in case you are one of the randomly selected ­­­­­­nurses whose CEUs the BRN decides to audit and verify.

Whatever your individual circumstances, don’t waste this opportunity for career growth. Choose your courses wisely and try to avoid having to select your CE hours based on expediency. This is the only post-licensure education some nurses will receive. Get as much as you can.   

Resources: 
The California Board of Registered Nursing website

BY KEITH CARLSON, RN, BSN

In 2005, the New York Times published an editorial by Teri Mills, RN, MS, CNE, president of the National Nursing Network Organization (NNNO), calling for the appointment of a national nurse leader who would promote awareness of public health issues. Since then, the NNNO and its supporters have waged a campaign to bring the matter to the attention of nurses, the general public and members of Congress. Could you be a lobbyist?

The United States Public Health Service has had a chief nurse officer (CNO) for decades, working within the Office of the Surgeon General. However, the CNO has largely remained outside the limelight and is mostly unknown to both the public and the more than 3 million nurses currently licensed in this country. 

On Feb. 4, 2013, with the strong support of Reps. Eddie Bernice Johnson (D-Texas) and Peter King (R-N.Y.), the National Nurse Act of 2013 was officially introduced to the House of Representatives as H.R. 485. 

Johnson, who describes herself as “the first registered nurse in Congress,” explained in an email statement that H.R. 485 would designate the chief nurse officer of the U.S. Public Health Service as the national nurse for public health in order to elevate the visibility of nurses.

A NATIONAL MEGAPHONE

The national nurse, Johnson said, would collaborate with the surgeon general to address national health priorities and would serve as a national spokesperson to engage nurses in leadership opportunities and community prevention efforts. 

Under H.R. 485, the national nurse for public health would continue to serve simultaneously as the CNO. However, in his or her new capacity, the national nurse would be a much more public figure than past CNOs, acting as a resource for public health guidance, promoting media campaigns and outreach and garnering support from both healthcare professionals and the general public for public health initiatives. 

OFFERING INSPIRATION

According to Mills, a major goal of the bill is for the national nurse to serve as a source of encouragement, inspiration and professional direction for nurses.  

At a time when this most trusted of American professions struggles with nursing shortages and other challenges, placing a high-profile nurse in such a leadership role could inspire nurses to make positive career choices, including expanded volunteerism and involvement in community prevention efforts. 

“We want the position to be more visible,” says Mills, “because we really believe that nurses, encouraged by a prominent national nurse for public health, will mobilize to carry messages of prevention forward.” Nurses, she adds, are well positioned to reach everyday Americans with meaningful health messages and in times of public health crises and disasters, nurse expert opinion and commentary in the media would provide a “welcome and trusted authoritative voice.”

LOCAL NURSES ARE ONBOARD 

According to Susan Sullivan, a retired public health nurse living in Southern California and the secretary of NNNO’s board of directors, many California nurses are strongly in favor of establishing a national nurse. She explains, “We see the logic in creating a prominent nurse leader whose national visibility will serve to encourage collaboration and community support for meaningful prevention initiatives.” 

She says the national nurse could also play an important role in encouraging and inspiring California nurses to connect with their community’s diverse populations to promote better health outcomes. The national nurse will be a widely recognized public health advocate, a nurse who will have the backing of Congress to take action. “Having this sort of leadership at the national level will produce results.”

Email Susan Sullivan at susansphn@aol.com to arrange a conference call or a conference speaker.

NO PLAYING POLITICS 

One concern that has arisen about expanding the CNO’s role in this manner is the possibility of turning the position into a political one. Mills maintains that the public health service, like the military, must remain nonpartisan and not take any public stand on legislation or elections. 

The supporters of H.R. 485 have had constructive discussions on that subject with representatives of the surgeon general’s office, resulting in several revisions to the language of the bill.

A CALL TO ACTION

As of this writing, the bill has received bipartisan support from more than 35 members of Congress and further co-sponsorship is being actively sought. The bill’s sponsors hope it will make its way through the political process and pass during the current session. 

If you are interested in learning more about this initiative and supporting the bill’s passage through Congress, visit the NNNO website, www.nationalnurse.org. 

The website includes links to sign up for the campaign’s newsletter, make financial contributions and contact members of the NNNO, as well as opportunities to join the advocacy team and travel to Washington, D.C., as part of the lobbying effort.

The organization can assist you in contacting your representatives, including providing sample phone scripts or letters to mail or email. For a donation of $20, the advocacy team will also deliver an information packet on H.R. 485 to your congressional representative on your behalf.  

------

“Having a national nurse for public health join with the surgeon general will make it possible to expand health promotion and disease prevention efforts in our communities. That’s why I’m a proud co-sponsor of the National Nurse Act of 2013.”

— Congresswoman Linda T. Sánchez (D-Calif.)

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Nurse Turns Lobbyist

You don’t need to be political to be involved

In early February, Audrey Bayer, RN, BSN, of Lambertville, N.J., learned that her congressional representative, Leonard Lance (R-N.J.), would be holding mobile office hours near her home.  

Although she says she is not “a political person,” Bayer contacted Teri Mills of the National Nursing Network Organization and decided to bring the National Nurse Act (H.R. 485) to Lance’s attention. 

“Of course I was nervous,” says Bayer, “since I had never met a person from Congress before. But I felt that this was my moment! He responded in a positive manner, accepting the information I provided, both written and verbal.”

Bayer, who is now in her sixth year as a nurse, says she became interested in the national nurse for public health campaign during her final BSN class at Pennsylvania’s Immaculata University, from which she graduated in January. “Teri got in touch with me and I joined the advocacy team,” Bayer explains.  

Our new nurse lobbyist plans to follow up with Lance and other lawmakers about H.R. 485 over the course of the current legislative session.   

Source: Working Nurse

By: Shazia Memon

I didn't figure this out until last summer. I was at a friend's place helping her move out some old furniture. Right after I lifted her hardwood coffee table, it broke apart, and the heavier piece dove straight onto my toe. After the initial shock, the pain hit, and then the picture was not pretty. I hopped around the living room erratically, alternating between standing and sitting as I tried to find some position of relief. I kept muttering phrases to my friends like "you guys just need to relax" and "calm down, everyone just calm down." They observed in silence, wide-eyed.

After several laps of limping, I ended up on the couch with my foot propped up. My friends put a frozen bag of peas against my toe and then finally said, "We are calm Shazia. YOU need to calm down."

I looked at their faces, stopped my sighing short, and thought about the situation at hand. They were right. I had kind of lost it.

As a pediatric critical care nurse, I deal with my fair share of screaming toddlers, stressed parents, and anxious kids. We hold the hands of children as they undergo painful procedures (sometimes at the cost of adequate circulation to our own hands). There are always worried parents who need reassurance that we are doing everything possible for their sick child. And during the most unpredictable of emergencies, we maintain a cool composure in hopes that the patient and our colleagues will follow suit.

Basically, calming down panicked people is a huge part of the job description. But when that table hit toe, my role had reversed. In hindsight, of course I see how ridiculous I was acting. And that got me wondering more generally about when nurses become patients. How do they handle being in the bed, as opposed to at the bedside?

Turns out that many do not handle it well. After talking to a few co-workers, I realized that nurses can be some of the worst patients. My personal opinion is that it's a dysfunctional coping mechanism; we don't know how NOT to be calm and in control. So the rare times that we don't feel those ways, we project our anxiety through behaviors that are just as unfamiliar to us.

To put it bluntly, we can be kind of obnoxious.

Take, for example, my coworker who was in the hospital and put on a medication that had possible side effects of nausea and vomiting. The doctor's orders stated to give anti-nausea medication if needed--only for if and when the patient displayed the symptom. But my coworker decided that her orders superseded the doctors---a classic mindset of nurses who become patients. She had no intention of feeling any of the side effects.

"I want that anti-nausea medication around the clock. I don't want to have to call you. I don't want to have to wait for it. I want it every six hours, on the dot," she demanded from her nurses.

Some of her nurses initially protested, saying the medication wasn't supposed to be given preventatively. Others knew that it was a battle not worth picking. Regardless, she got her way and spent the entire hospital stay without feeling any nausea. Or making any new friends.

In other cases, we see nurses taken out of the hospital environment but not able to let go of hospital policies. One PICU nurse went to her primary doctor after a few days of coughing, congestion, and fever. In our unit, there are a lot of children with multiple underlying health issues. We usually respond to a fever and respiratory distress with a series of tests to pinpoint exactly what the cause of those symptoms are. But when an otherwise healthy person shows a mild presentation of these symptoms, the first line of treatment is usually a round of antibiotics. That is exactly what her doctor prescribed after a thorough assessment. But my coworker had a hard time being 'written' off, albeit as a prescription.

"But ... are you sure you don't want to take a chest X-ray?" she inquired, followed by a strategic cough.

The physician smiled and nodded, explaining to her why he deemed an X-ray unnecessary at this point. She wasn't convinced but let it go. As they parted ways, she made sure to take some purposefully labored breaths. Just for emphasis.

Her case of the common cold was cured within a few days--without any unnecessary exposure to radiation. In the back of her head, she knew her request was unreasonable. She just didn't know how to do anything other than what she was used to. Other nurses also admitted to parallel behaviors in primary care settings--the urge to impose hospital protocols isn't easy to shake.

It's also not unusual to find nurses believing that they are above the rules when the tables turn on them. One rule we reinforce to patients and families is not to touch or handle the pumps and machines around them. When one of my colleagues had still not gone to the bathroom twelve hours after his surgery, his nurse and doctor discussed inserting a foley catheter--that is, a tube through his urethra into his bladder to drain it.

"Give me until 7 am. If I don't go by then, you can put it in," he bargained.

They reluctantly conceded. As soon as he was alone, he reached to the pump that was infusing fluids through his IV. After a fleeting pause of guilt, he cranked up the rate to 3 times what it was set at. His plan to over-hydrate himself was not the right or safe answer, but luckily he woke up at 4 AM with an overwhelming urge to relieve himself. He knew it didn't necessarily happen as a result of his medical manipulation, but was desperate to avoid any discomfort down there.

Nurses also make their caretakers work hard to earn their trust -- harder than they really need to sometimes. One of my coworkers has no shame in interrogating her own doctors on their credibilities, and doesn't take them seriously unless she approves of their medical school, residency, and fellowship (fellowships are a given in her book). Another nurse I work with frequently trains new graduates and employees. When it comes to education and advancing the nursing profession, she is always at the front line.

Except when it was her turn to have a breathing tube placed for a surgery. As she was signing consent for this, she looked suspiciously at the badge of the woman obtaining her signature. The woman was a nurse anesthetist.

"I totally respect your profession. But I would feel more comfortable with a physician intubating me," she said.

The nurse anesthetist was slightly taken aback, but offered to speak to the fellow to see if he could do it.

"Actually I'd like the attending to do it," my co-worker responded.

So much for promoting the nursing profession. Or even encouraging the general endeavors of a teaching hospital -- she dismissed every step on the learning ladder by only trusting the attending.

But in this scenario, she was on the receiving end of care, and totally out of her element. Just as I felt when that coffee table fell on my toe. Our comfort zone is nurturing patients and serving as the foils to their fear. When we step out of it and into a position of fear ourselves, we lose our way. Some a little more than others. And some not at all. But for those who do, their healthcare providers should remember -- nurses are generally good, warm, loving people. They might just have passive-aggressive tendencies when they feel anxious, that's all.

As for me, I'd like to think I learned from their stories. If I am ever in a state of vulnerability again -- or rather, when I am -- I'll do my best to stay calm and cool, to be an easy patient. 

As long as everything goes my way, of course.

Source: The Atlantic

By Georgann Yara

Clad in pajamas and a Diamondbacks cap, the “patient” lay still in the bed as Banner Health registered nurse Stacey Fuller looked on and answered questions from an inquisitive mother worried about her son’s asthma attack.

Fuller determined her “patient” displayed good vital signs — even without a heart, brain and other functioning organs.

A recent nursing school graduate, Fuller was interacting with one of 80 high-tech mannequins at the Banner Simulation Medical Center in Mesa, where some 1,500 registered nurses train a few days annually.

The mannequins give nurses the chance to practice their skills in a real-time setting before working at one of Banner’s medical centers because they simulate breathing, bleeding, giving birth and even speaking.

“At first, it’s odd having these pretend conversations. But you get used to it and you get to practice conversations that you would actually have with patients and their parents,” said Fuller, whose specialty is pediatrics. “I like to talk to people and explain things, so I think it’s a lot of fun.”

The 55,000-square-foot facility is among the largest in the world and gives new hires an opportunity to work out the kinks and adjust to any policies and procedures specific to Banner. The Mesa location is one of Banner’s two simulation centers in the Valley. The other is in central Phoenix.

The center has many of the same departments found in an actual hospital, such as an intensive-care unit, operating room, emergency department and pediatrics.

Recently, the simulation program received accreditation from the Society for Simulation in Healthcare in five areas of expertise, becoming one of three organizations in the world to achieve this status. Last year, the program was accredited by the American College of Surgeons.

Being placed in real scenarios has given Fuller a better idea of her strengths, like patient interaction, and areas she needs to work on, like time management.

“I’m practicing getting the timing down,” Fuller said. “What I like is that Banner hones their nurses’ education and is supportive of that. Other places don’t do that.”

As Fuller made her rounds, registered nurse and simulation specialist Vickie Hawkins sat in a control room in the pediatrics department. Here, she can watch nurses interact with patients and evaluate their performance. Nurses have the opportunity to see themselves at work by viewing the videos.

Hawkins also plays multiple roles, depending on the scenario. With Fuller’s asthma patient, she was the voice of the mother. In other situations she can play the patient or physician.

The simulation center gives new graduates the chance to function independently — a luxury that they typically don’t get to experience in training, Hawkins said. It also gives veteran nurses new to Banner exposure to situations that they may not have experienced despite their years in the field.

“We allow them to make decisions and mistakes because, unfortunately, mistakes are how we learn,” said Hawkins, who has worked at the center since it opened in 2009.

However, nurses aren’t the only ones gaining knowledge. Simulation director Karen Josey described a scenario that simulated post-labor hemorrhaging. It required taking a mannequin to Banner Gateway Medical Center in Gilbert and putting everyone involved, including representatives from the local blood bank, through the paces.

A few days later, doctors at Gateway repeated that scenario. But this time, it was for real.

“Everyone knew exactly what they had to do and they could do it quickly because they had just gone through it,” Josey said.

The training center is a far cry from when Josey, as a registered nurse in training years ago, practiced inserting IV’s by using oranges.

“We immerse them in a clinical environment so they get that complexity,” Josey said. “It’s about how realistic we can make it.”

Source: AZ Central

By Elizabeth McNamara

Editor's Note: This article was originally published by our Patch family at Fenway-Kenmore Patch.

After the tragedy in Newtown, Conn., in December, in which a gunman killed 26 people at Sandy Hook Elementary School, Stephanie Zanotti of Charlestown, Mass., was inspired by the suggestion to complete 26 acts of kindness as a response. In the wake of the bombings at the Boston Marathon on Monday, Zanotti decided it was time for Part Two of those 26 acts of kindness.

"I am participating in 26 acts of kindness for the victims at the 26th mile of the Boston Marathon," she wrote on her Facebook page. Using Facebook and Instagram, she is chronicling her acts and hoping to inspire others to do the same.

"It's forcing me to think about how you can make someone's day a little lighter, a little brighter," she said Saturday.

She stresses the acts can be as simple as paying for the person's cup of coffee behind you in line at your favorite coffee shop or dropping off some candy at your local fire department – both things she did during her Newtown acts.

So far, Zanotti has completed two acts in this new cycle: she has promoted the sale of a T-shirt designed by a friend in which all proceeds will go to One Fund Boston. And she signed up her dog Lucy, a rescue dog with only three legs, in a dog therapy program. (The t-shirt and Lucy are pictured, right.)

Zanotti is a nurse at Brigham & Women's Hospital and has seen the power of therapy dogs for patients. Knowing that several of the bombing victims have had limbs amputated, Zanotti realized her dog in particular could provide special inspiration.

She said she's speaking out about her actions to raise awareness and, she hopes, to inspire others to follow suit. The realization that the bombings happened at the 26th mile and the parallel with Newtown's 26 school victims was powerful to Zanotti.

"Unfortunately, the '26' theme again," she said. But at a time when so many people want to dosomething in response to the events of the past several days, Zanotti's found a way to be both creative and kind. 

Source: Woodbury-Middlebury Patch