DiversityNursing Blog

By JEFF SHARLET

The photograph that Markisha McClenton posted on Instagram is a self-portrait, a close-up that is muted in dim light. She might be on her way to work. She might be coming home. Her workdays begin and end in the dark, and they are dark in between. She’s a lab technician in Jacksonville, Fla. Her specialty is blood. She has worked these dark hours since her son was 7. “Freedom,” she told me over the phone from her lab. That’s why she works these hours: The freedom to work at night and to raise her children during the days. To her, this is good fortune. She is smiling in this photo. But her eyes are midnight eyes, 3 a.m. eyes. Why take a photo at that hour? “People forget about us, the night shift,” she said. The #nightshift. That’s the hashtag she used. It’s how I found her.

I’ve been working at night myself for a long time now. Once it was out of choice, a preference for the quiet hours. More recently it was because I had no choice. Insomnia. One night, I was drinking my third cup of coffee — because when you can’t sleep, you might as well stop trying — and ignoring the deadline looming the next morning. Instead, I stared at the matrix on my phone, my own red eyes scanning a tiny sample of some 670,000 photographs under #nightshift. Most of them were people like me, awake when they didn’t want to be awake. And like me, they were looking at the screen in their hands, held up by the one in mine.

Night Life

This is the ghost world of #graveyardshift (#nightshift’s sister hashtag), whose workers file into Instagram every evening. These pictures may be clever or maudlin, silly or harrowing or sad. “Desperate” is a word that comes to mind, but so does “resigned.” And even “resistance.” Sometimes it’s in the form of a gag, a ridiculous pose; sometimes it’s in the form of a gaze so steady that it seems to warm the fluorescent panels framing so many of these pictures. The hashtag itself is a form of solidarity.

There are the warehouse workers who snap themselves letting a wisp of marijuana smoke slip from between their lips, little Instagram rebellions. There are the soldiers and sailors pulling a night shift for no good reason other than orders, photographing themselves and their comrades on the verge of sleep or already under. Cops in noirish black and white, their pictures framed to show a bit of badge. And nurses. A lot of nurses. Close-up, arm’s length, forced smiles, dead eyes. Scroll through #nightshift, and you’ll see some saints among them and some whose hands you hope will be more alive in an emergency than their ashen faces.

The #nightshift hashtag is especially well populated by the armed professions and the healing ones. Sometimes they are almost one and the same, as in the case of @armedmedic3153, a.k.a. Marcelo Aguirre, a paramedic in Newark and suburban New Jersey. He owns an AR-15, a ­9-millimeter­ and a shotgun, but the only thing he shoots on the night shift is his camera. He works nights so he can study days; he wants to be a doctor. Nights are good preparation for that: You get more serious cases. You learn on the job. A 12-hour course each night you’re on. Twenty-four hours if you take a double. After a while, the adrenaline that juices you when you’re new — when you’re still keeping a tally of the lives you’ve saved — disappears. You just do the job. “High speed and low drag,” Aguirre told me when I called. “Please ignore the siren,” he said. “We’re going to a call.” A stroke. Nothing to get excited about. Coffee sustains him. He stays clean. Some guys, he said, use Provigil, but that’s prescribed. “For shift-work disorder,” he said.

Markisha McClenton, the lab tech, told me that she no longer gets sleepy. “I program myself,” she said. She wouldn’t change her schedule now if she could. She likes working alone. There are nurses at the facility where she works, but they don’t often venture back to the lab. “They think it’s creepy,” she said. “At night.” Maybe it is: The long hours of the night shift are a reckoning with time.

“There’s people still struggling like I struggle,” a miner named Mike Tatum told me, explaining why he posts pictures and why he looks at them. “Working through the night, not sleeping next to your wife, missing your kids because they go to school before you get home.” Tatum likes to post pictures of the heavy machines used to dig coal from Wyoming strip mines. He drives a D-11 bulldozer. “I push dirt,” he said. Other machines dig the coal. Twelve hours of ‘dozing, four nights in a row. He came to this job — a good one, $30 an hour or more for as long as the coal lasts — after construction work dried up in California. “Nobody back home has really seen what we do out here,” he said. It’s a good job, he swears. He’s brought his 6-year-old boy out to see the machines. He’d be proud if his kids grew up to be miners. A good job. Rough on the back. But you’re just sitting. Driving the ‘dozer. Nobody bothers you. Hours without a word. “Pretty easy,” he said. Plenty of time to think. To make plans. Things he can do with his days, when he has days.

So far, this is enough to see him through the nights safely. “Quite a few fatalities the past year,” he observed. He heard about a man at another mine who drove a machine into the pit. “Maybe a suicide.” It didn’t seem like an accident; he had to drive through a couple of berms. “Splat,” Tatum said. “And a couple more like that.” He says other guys have died on the road, Highway 59. It’s a long drive out to the mines, and drug testing never stopped anyone from drinking, especially after the shift is over.

Pan out to take in some fraction of the 670,000 faces. Pay attention to the eyes, drooping or unnaturally wide. Is it fatigue? Or something more? Something less? Stay sane, and the night shift may seem like just another set of hours. Lose yourself to the loneliness, and the daylight leaks out of you. But something else can come in. A kind of calm. The kindness of dark hours.

When I was first drawn into this nighttime Insta­gram grid, I was looking for a distraction, for ­images to displace the thoughts that had agitated me to exhaustion. What I found instead was something that seemed descended from Walt Whitman’s “Democratic Vistas,” his great prose poem of an essay that was really a proposal for a new kind of literature, a way of speaking, a way of seeing. We shouldn’t mistake Instagram’s squares for the public one. But neither should we miss the quiet dig­nity afforded by gathering under this hashtag: the solidarity of recognition, of being seen.

“Nightwalkers,” Pierre Bell calls the men and women who find their peace after-hours. He’s new to the night himself, working as a nurse’s aide on the behavior unit at an assisted-living home in Akron, Ohio. “What’s behavior?” I asked. “Combative,” he said. “Lockdown. Spit, kick, hit, bite.” Sounds terrible, I said. It’s not, he told me, especially at night, when the anger subsides, and when the alarm I can hear beeping in the background is an event rather than a constant song. The other aide will get that one. Bell, a 28-year-old father of a 9-month-old, was sitting with the nightwalkers. The strange ones, the restless ones, the story­tellers. “Some were in wars,” he told me. “Some were teachers.” Sometimes they talk for hours. If they’re up, he’s up. It feels to him like a matter of courtesy. The behavior unit is his patients’ home. He’s only visiting. Trying out the night they live in.

And on his break, he can slip away. Take a snapshot, make a record of himself in this new country of the other hours, post it on Instagram as ­@piebell522.­ He took the one that caught my eye when he was in the bathroom. “I saw the dark behind me,” he said. “I thought it could be a picture.” A lovely one, as was the shot that followed hours later: Bell’s baby boy, the reason he works the night shift. Not for the money but for the days he can spend with his son, a handsome little guy with his father’s gentle eyes, but warmer in the golden sunlight of the morning.

Source: www.nytimes.com

Nurses are an important part of the medical workforce. They provide crucial supplementary services and are primary caregivers in a lot of industries. As such, the demand for nurses is high, though there are variations according to different states. As the country’s population and access to medicine continues to grow, the demand for nurses does as well.

Source: http://online.adu.edu

BY EMMANUELLE SALIBA

After a howling blizzard with hurricane-force winds socked Boston with 21 inches of snow on Tuesday, some nurses and doctors hitched rides with police or put on skis and snowshoes to get to work.

Kelli O'Laughlin, one of the doctor's at Brigham and Women's Hospital who skied to work, found her ride "fun" and "exhilarating." She told NBC's Miguel Almaguer that doctors have to come in to work because"the emergency department is one of those places where 24 hours a day, 7 days a week it's always going."

"Our sincerest thanks to all employees that have gone to extraordinary lengths to get to the hospital during the storm," wrote the hospital in an Instagram post along with a photo of pathology technician Vivian Chan on snowshoes.

Source: www.nbcnews.com

Written by James McIntosh

While violence intervention programs have demonstrated that they can be an effective way of preventing violent injury, little has been known about their financial implications. A new study now suggests that these interventions could save various sectors millions of dollars.

Researchers from Drexel University have analyzed the cost-benefit ratio of hospital-based violence intervention programs (HVIPs) and report that - as well as benefiting victims' lives - HVIPs can make costs savings of up to $4 million over a 5-year period in the health care and criminal justice sectors.

"This is the first systematic economic evaluation of a hospital-based violence intervention program, and it's done in a way that can be replicated as new evidence emerges about the programs' impacts across different sectors," states lead author Dr. Jonathan Purtle.

As a major cause of disability, premature mortality and other health problems worldwide, HVIPs have a crucial role to play in helping victims from experiencing further suffering.

The provision of case-management and counseling from combinations of medical professionals and social workers has been associated with not only reducing rates of aggressive behavior and violent re-injury but also improving education, employment and health care utilization for service users.

Many HVIPs still require a sustainable source of funding

Intervention typically begins in the period immediately after a violent injury has been sustained. Not only is this a critical moment in terms of physical health, but it can also be a time when victims may start thinking about retaliation or making changes in their lives.

"The research literature has poetically referred to the time after a traumatic injury as the 'golden hour,'" says study co-author Dr. Ted Corbin.

In 2009, around six programs were in operation and, as word of their success has spread, more and more HVIPs have been initiated.

Calculating the potential financial benefits of HVIPs is crucial, as for many of these programs a stable and sustainable source of funding does not exist. Instead, many rely on a variety of different financial sources such as insurance billing, institutional funding, local government funding and private grants.

For the study, published in the American Journal of Preventive Medicine, the researchers conducted a cost-benefit analysis simulation in order to estimate what savings an HVIP could make over 5 years in a hypothetical population of 180 violently injured patients. Of these, 90 would receive HVIP intervention and 90 would not.

Costs, rates of violent re-injury and violent perpetration incidents that a population would be estimated to experience were calculated by the authors using data from 2012.

The authors made a comparison between the estimated costs of outcomes that would most likely be experienced by the 90 hypothetical patients receiving HVIP intervention - including $350,000 per year costs of the HVIP itself - and the costs of outcomes predicted for 90 patients not receiving any HVIP intervention.

The net benefit of the interventions

A total of four different simulation models were constructed by the researchers to estimate net savings and cost-benefit ratios, and three different estimates of HVIP effect size were used.

Costs that were factored into the simulations included health care costs for re-injury, costs to the criminal justice system if the victims then became perpetrators and societal costs for potential loss of productivity.

Each simulation calculated that HVIPs produced cost savings over the course of 5 years. The simulation model that only included future health costs for the 90 individuals and their potential re-injury produced savings of $82,765. The simulation model including all costs incurred demonstrated savings of over $4 million.

Dr. Purtle acknowledges that estimated lost productivity costs may have been slightly high due to an assumption in their data that all individuals in the simulation were employed. However, he believes that there are also many social benefits to HVIPs that cannot be financially quantifiable:

"Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented."

The authors believe that the findings of their study could be useful in informing public policy decisions. By demonstrating that HVIPs can be financially beneficial, the study suggests that an investment in HVIPs is one that pays off for everyone concerned.

Source: www.medicalnewstoday.com

By AVIANNE TAN

A Minneapolis mom who wanted a natural birth was more than 13 hours into labor when she felt she wasn't going to make it without something to take the edge off the pain. But rather than asking for an epidural or narcotics, she begged for laughing gas.

"It immediately took my fear away and helped calm me down, though I could still feel the pain," Megan Goodoien, who gave birth at the Minnesota Birthing Center this month, told ABC News today. "I didn't laugh because the labor was so intense, but I everything suddenly felt doable just when I thought I couldn't make it anymore. It's definitely a mental thing."

Though nitrous oxide has long been used in European countries and Canada, the gas is now making a resurgence in the U.S., according to medical experts.

The gas, once popular in the U.S., was sidelined after the advent of the epidural in the 1930's, midwife Kerry Dixon told ABC News, noting she believes epidurals took over because they were more profitable. Dixon did not treat Goodoien but works at the Minnesota Birthing Center.

"The average cost for a woman opting for nitrous oxide is less than a $100, while an epidural can run up to $3,000 because of extra anesthesia fees," Dixon said.

The U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use in 2011, which could also explain the resurgence, Dixon told ABC News.

"Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor]," Dr. William Camann, director of obstetric anesthetics at Brigham and Women's Hospital, told ABC News. "Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest."

He added the gas popular in dentists' offices has an "extraordinary safety record" in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say.

Laughing gas works differently than an epidural or narcotic in that it targets pain more on a mental level than physical, experts said.

"It's a relatively mild pain reliever that causes immediate feelings of relaxation and helps relieve anxiety," Camman said. "It makes you better able to cope with whatever pain you’re having."

But gas can also change awareness, said Dr. Jennifer Ashton, a senior medical contributor for ABC News and practicing OB/GYN.

"In delivering over 1,500 babies, I had never used it nor has anyone asked for [nitrous oxide]," Ashton told ABC News. "[M]ost moms want to be totally aware when they are in labor."

Mothers who have opted for nitrous oxide like that it's self-administered by the patient, who has total control over if and when it's used.

A Nashville mother said she opted for the gas during labor only after she found herself too tense to push.

"I instantly felt relaxed," Shauna Zurawski told ABC News. "Before, I was so tense. I was fighting against the contractions, which definitely wasn't good. But after the laughing gas, my body was able to do what it was supposed to. It was so neat."

Both Goodoien and Zurawski said they put a nitrous oxide machine's mouthpiece over their mouth and nose and inhaled about 30 seconds before their next contraction to get the maximum effect.

Another advantage is that the chemical gets out of your system shortly after stopping inhalation.

"With my first child, I had an epidural, I was numb for so long after the delivery and it took a while to get back to normal," Zurawski said. "But with the nitrous oxide, I was walking around and taking pictures almost right after."

Both Goodoien and Zurawski said they didn't experience any adverse side effects.

Nitrous oxide's possible side effects are usually just minor nuisances such as nausea, dizziness or drowsiness, medical experts told ABC News.

Patients can also choose to stop or get an epidural at any time if they find they don't want the laughing gas.

It's still early to tell how popular this new option will get, but in countries like New Zealand, about 70 percent of women in labor choose to use laughing gas, Dixon said.

"When I was working in New Zealand, I told one of my patients, [laughing gas] wasn't really used in the U.S. and you know what she said?" Dixon asked. "'I thought they have everything in America!'"

Source: http://abcnews.go.com

By Debra Anscombe Wood, RN

While credentials may seem like an alphabet soup after one’s name, the letters tell the world much about a nurse’s qualifications, including licensure, certifications and fellowships.  

“Credentials are not only a source of pride for the nurse, but communicate to patients, colleagues and hospital leaders the nurse’s commitment to standards of excellence,” said Mary Frances Pate, PhD, RN, CNS, associate professor at the University of Portland School of Nursing in Oregon and chairwoman of the board of directors for AACN Certification Corporation, the certification organization for the American Association of Critical-Care Nurses.

Other academic nurses agree. “Credentials matter to the public,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, Lucy Jo Atkinson Scholar in Perioperative Nursing at Case Western Reserve University in Cleveland, adding that they also demonstrate growth and lifelong learning valuable to the nurse and to nurse managers and administrators.

Depending on the position, “some nursing positions require certification demonstrating expertise, and some do not,” said Robert Hanks, PhD, FNP-C, RNC, assistant professor and clinical/FNP track director at the University of Texas Health Science Center at Houston School of Nursing. 

Marianne Horahan, MBA, MPH, RN, CPHQ, director of certification services at the American Nurses Credentialing Center, reported an increase in certification applications this year, in part because of employers’ promotion of certification. A new “Success Pays” program allows the hospital to directly pay for successful exam completion. 

Employers also seek nurses with degrees, as evidence suggests organizations with a higher percentage of BSN- or MSN-prepared nurses have greater patient outcomes, said Paulette Heitmeyer, MSN/ED, RN, CNO at Marina Del Rey Hospital in California. 

Pate said nurses whose clinical skills and judgment have been validated through certification often make patient care decisions with greater confidence, recognize problems and intervene appropriately.

While many believe credentials lead to better care and patient outcomes, research is limited. The Institute of Medicine recently released a research agenda to help fill this gap. 

Nurses should list the highest degree first, immediately after their name, then licensure, any state designations, national certifications, awards, honors and other recognitions, according to the ANCC. 

“Certification provides a foundation for lifelong learning and professional development,” Horahan said. “The purpose of certification is to assure the public that this individual has mastered the body of knowledge and acquired skills in the specialty.”

Source: http://news.nurse.com

6. …but people still expect them to show up the second they ring the call bell.

7. Sometimes they’re working so hard, they can go entire shifts without eating, drinking water, or sitting.

instagram.com

Lunch break? What’s that?

8. Ditto going to the bathroom.

instagram.com

9. Some patients will incessantly hit on them.

Fox / Via nurseeyeroll.tumblr.com

10. Others will expose themselves for no clear medical reason.

Flickr: eflon / Creative Commons / Via Flickr: eflon

“Your arm is broken… so why is your dick out?”

Source: www.buzzfeed.com

By SYDNEY LUPKIN

Seattle Children's Hospital hallways erupted in cheers and applause this weekend as the Seattle Seahawks played a nail-biter of a game against the Green Bay Packers and officially locked down their spot in Super Bowl XLIX.

And 8-year-old Maria Moore's room was no exception. The recovering leukemia patient watched the game while wearing her Seahawks hat and clutching her signed football. On the table next to her, she propped up a photo of herself with Seahawks quarterback Russell Wilson, who visited her at the hospital in November.

At one point, Maria was so bummed that her team appeared to be losing, she shed a little tear, her dad told ABC News. He told her not to worry, that Wilson and the Seahawks would come back. And they did.

"We were just totally shouting and applauding and hollering and giving high fives to each other," Thomas Moore told ABC News. "It was an amazing gave to watch. She was super excited."

Marie was diagnosed with acute lymphoblastic leukemia in September and initially didn't respond to chemotherapy, but the doctors at Seattle Children's and Fred Hutchinson Cancer Research Center helped get her treatment "recipe" just right, he said. Marie underwent a cord blood transplant on Jan. 2, and is in remission, but should be at the hospital a few more weeks, he said.

"We’ll probably be watching [the Super Bowl] from the hospital, but that's OK," he said. "As long as she's doing well, that’s fine by me."

Nearly every Tuesday, the team's star quarterback, Russell Wilson, visits Seattle Children's Hospital to meet with patients, said hospital spokeswoman Kathryn Bluher. So the team holds an extra special place in the hearts of patients and their families.

Wilson visited Maria the day after flying back from an East Coast game in November, and she was "all smiles," Moore said.

"It makes a bigger fan out of me. I really can't say enough," Moore said. "[Wilson] is a down to earth, really nice guy. He takes time talk to the kids, do pictures, sign some things."

After Sunday's win, patients at Seattle Children's Hospital took photos with "Congratulations" signs from their hospital beds to show their support.

"It takes their mind of things," Moore said. "It gives them something fun to think about."

Source: http://abcnews.go.com

Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat. 

Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."

During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness. 

"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"

Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.

A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.

For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder. 

On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."

Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves. 

"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."

Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed. 

Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.

Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him. 

"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."

Source: www.uchicagokidshospital.org

By Dan Kedmey

General Electric released images on Wednesday from its first clinical trial of a next generation body scanner that captures bones, blood vessels and organs in high-definition.

The patients ride into the chamber of the scanner, dubbed “Revolution CT,” where a fan-shaped beam of x rays passes down their bodies and a computer reconstructs a digital model of the body, slice-by-slice. The scanner can build an image of a heart in the time it takes for a single heartbeat, according to GE.

The snapshots below, provided by GE, may look like an artist’s rendering from an anatomy textbook. In fact, they were taken from living patients at West Kendall Baptist Hospital in south Florida, the first hospital to test the new scanner in the field.

Source: http://time.com