DiversityNursing Blog

By Cynthia Howard RN, CNC, Phd

Finding the right nursing job includes finding a manager that will help you grow, develop, and support your career goals.

There is a saying that people leave their managers and not their jobs and to have success in your career may mean you want to circulate your resume in order to find the best fit for you. This means you have to know what you want and need in the area of support.

Here are 10 warning signs you may be working with the wrong manager:

1. You never hear from your manager prior to your performance reviews. Over 75% of performance problems can be improved with proper feedback and less than 33% of the time, feedback is provided.
    
2. You have no idea what they want.  This can be worse than not having feedback at all. When a manager says, “I do not like how you did that,” you really have no way of knowing what they really mean. Make sure to ask for clarification. Review your job description and ask for your manager to specify what parts of your job responsibilities are most important to them. It could be they are focused on patient safety and you have an interest in health literacy. Knowing what they want gives you the advantage of focusing your efforts for the greatest gain.
    
3. It is their way or the highway.  This is a problem for many nurses. Job satisfaction comes with autonomy and the opportunity to solve your own problems as they show up on the job. When a manager consistently tells you what and how to do something, employees quickly turn off their own creativity; more than likely, with an increase in mistakes.
   
   A nurse who is practicing for 7 years shared a story about his experience on a new unit. His Clinical Specialist was a micro-manager. She told him to give this medication immediately because of incoming admissions. She had poured the med. This went against his better judgment but because he knew she would have a fit, he gave it, to the wrong patient. She was extremely apologetic however the “error” was on him. Do not compromise your judgment for the sake of status quo.
    
4. Your manager wants you to figure it out.  The opposite of micro-managing is to not manage at all and letting everyone figure it out for themselves. This happens quite a bit leaving the power position to go to the most domineering individuals on the unit. Everyone needs to know the manager is in charge and when needed will make those tough decisions.
    
5. You could not recognize them if your life depended on it.  If your manager hides behind email or a closed door, having a relationship with your manager will be impossible. Communication and trust is the foundation of a great working relationship.  
   
   Suggestion for managers: Time is an important commodity and getting around to all your staff can be time consuming. Why not use technology and set up a short video. Most iPhones take excellent video. Take 2-3 minutes every week and share what is going on. You may also want to share something personal about yourself; if you just started juicing, kickboxing, celebrated an anniversary or a milestone with your children. Interview them, show images along your morning run, and share something of yourself in order to make the connection with your staff.
   
   Suggestion for staff: Make a short video on your unit of a new initiative, gratitude board in the break room, more efficient way to give report, a snippet of rounds, and just a friendly hello from everyone on the unit. You may even want to say thanks and express appreciation; managers are people too!
    
6. The way out the door is faster than up. If you have a manager that makes any attempt for you to advance your skills difficult, it will be hard to boost your resume. Managers can feel threatened by qualified staff members who want to move up the ladder and may indirectly thwart your efforts to move forward. This is really short sighted on the manager’s part because any manager that turns our qualified leaders actually looks really good to their higher ups given the ongoing need for good talent in any organization.
    
7. Lack of training.  Being able to do a job well requires the right training. Often it takes the manager to assess the need for training based on performance and outcomes. This relates to the lack of feedback. While every employee really should do their own assessment of what they need to do well and then make the request of their manager, the manager should also be on the lookout for staff that need training and set up opportunities to make this happen.
    
8. When the manager has obvious “favorites.”  Everyone has preferences in personality style, but when the manager consistently selects one particular individual for all the initiatives, opportunities for advancement, or other assignments that provide variety, the manager is sending a message to others they do not care about your skills or your future.
    
9. When your manager routinely says, “I’ll think about it.”  Obviously considering all sides of the problem/ situation is important however some managers hide behind this and never make a decision about what is the ideal way to go.  Quickly, this can be frustrating if you are looking for a course of action to solve a problem.
    
10. When your manager over reacts or criticizes you in front of others.  This is a toxic behavior and is an indication you want to find a new place to work. Quickly this will diminish your self-esteem, leading to resentment and stagnation.
    
    Knowing what you want in the way of workplace is key and will help you avoid a poor manager. What type of opportunities are you looking for in the workplace? What are your career goals? Evaluate the workplace, ask questions, find out the management style, review a performance appraisal, ask about turnover, and see if you can build a relationship with your new manager.  

Enjoy the opportunity to find a place that truly supports and honors you! 

Source: www.nursetogether.com

By Steven Reinberg

Residents of the southern United States may be at risk for a parasitic infection that can lead to severe heart disease and death, three new studies suggest.

Chagas disease, which is transmitted by "kissing bugs" that feed on the faces of humans at night, was once thought limited to Mexico, Central America and South America.

That's no longer the case, the new research shows.

"We are finding new evidence that locally acquired human transmission is occurring in Texas," said Melissa Nolan Garcia, a research associate at Baylor College of Medicine in Houston and the lead author of two of the three studies.

Garcia is concerned that the number of infected people in the United States is growing and far exceeds the U.S. Centers for Disease Control and Prevention's estimate of 300,000.

In one pilot study, her team looked at 17 blood donors in Texas who tested positive for the parasite that causes Chagas disease.

"We were surprised to find that 36 percent had evidence of being a locally acquired case," she said. "Additionally, 41 percent of this presumably healthy blood donor population had heart abnormalities consistent with Chagas cardiac disease."

The CDC, however, still believes most people with the disease in the United States were infected in Mexico, Central and South America, said Dr. Susan Montgomery, of the agency's parasitic diseases branch.

"There have been a few reports of people becoming infected with these bugs here in the United States," she said. "We don't know how often that is happening because there may be cases that are undiagnosed, since many doctors would not think to test their patients for this disease. However, we believe the risk of infection is very low."

Maybe so, but kissing bugs -- blood-sucking insects called triatomine bugs -- are found across the lower half of the United States, according to the CDC. The insects feed on animals and people at night.

The feces of infected bugs contains the parasite Trypanosoma cruzi, which can enter the body through breaks in the skin. Chagas disease can also be transmitted through blood.

It's a silent killer, Garcia said. People don't feel sick, so they don't seek care, but it causes heart disease in about 30 percent of those who get infected, she said.

In another study, Garcia's team collected 40 insects in 11 Texas counties. They found that 73 percent carried the parasite and half of those had bitten humans as well as other animals, such as dogs, rabbits and raccoons.

A third study found that most people infected with Chagas aren't treated.

For that project, Dr. Jennifer Manne-Goehler, a clinical fellow at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, collected data on nearly 2,000 people whose blood tested positive for Chagas.

Her team found that only 422 doses of medication for the infection were given by the CDC from 2007 to 2013. "This highlights an enormous treatment gap," Manne-Goehler said in a news release.

The findings of all three studies, published recently in the American Journal of Tropical Medicine and Hygiene, were to be presented Tuesday in New Orleans at the annual meeting of the American Society of Tropical Medicine and Hygiene.

Symptoms of Chagas can range from none to severe with fever, fatigue, body aches and serious cardiac and intestinal complications.

"Physicians should consider Chagas when patients have swelling and enlargement of the heart not caused by high blood pressure, diabetes or other causes, even if they do not have a history of travel," Garcia said.

However, the two treatments for this disease are "only available [in the United States] via an investigative drug protocol regulated by the CDC," Garcia said. They are not yet approved by the Food and Drug Administration.

Efforts are under way to develop other treatments for Chagas disease, Montgomery said.

"Several groups have made some exciting progress in drug development," she said, "but none have reached the point where they can be used to treat patients in regular clinical practice."

Source: health.usnews.com

Source: www.rntobsnonlineprogram.com

By Ilene MacDonald

Despite new technology and evidence-based guidelines, medical mistakes happen too frequently and may lead to as many as 400,000 preventable deaths each year.

But two new programs, launched at the University of Virginia Medical Center, offer a new approach to patient safety that may prevent medical errors, WVTF Public Radio reports.

This year the organization introduced a simulation lab in the pediatric intensive care unit. The "Room of Errors" features high-tech infant mannequins attached to monitors. When doctors and nurses enter the lab, they have seven minutes to determine what is wrong.

As part of a recent exercise, a doctor-nurse team worked together to spot 54 problems with the scenario, including the fact the ventilator wasn't plugged into the correct outlet, the heat wasn't turned on and the potassium chloride was programmed at the wrong concentration.

The interpersonal, team-based learning approach helps doctors and nurses improve their ability to make decisions together and communicate with one another, Valentina Brashers, M.D., co-director of the Center for Interprofessional Research and Education, an effort headquartered at UVa's Schools of Nursing and Medicine, told WVTF.

"Knowing that there are others that you can work to think with you and share with you their concerns as you work through difficult problems makes care provision a much more enjoyable and rewarding activity. It reduces staff turnover. It creates an environment where we feel like we're all in it together with the patient," she said.

The pilot proved so successful that the medical center intends to roll it out to the entire hospital.

In its quest to eliminate medical mistakes at the organization, UVa also launched a second patient safety initiative that calls for hospital administrators to meet each morning to talk about any problems that occurred in the previous 24 hours, according to a second WVFT article.

The "Situation Room" features white boards and monitors, where administrators review every new infection and unexpected death and then visit the places where the problems took place.

Sometimes the solutions are easy fixes, such as a receptionist who removed a mat that caused patients to trip at the entrance of an outpatient building. Others, caused by communication problems, are more complicated, Richard  Shannon, M.D., executive vice president for health affairs, told the publication. To address it, Shannon wants to shake up the medical hierarchy where the physician sits at the top.

"The physician may spend 20 minutes at the bedside a day. The nurse is there 24/7 and has about 13 times more direct contact with the patient than does the physician," he told WVFT. "You can't have someone at the head of the pyramid who is absent a lot of the time."

Finally, to encourage better communication among caregivers, patients and families, Shannon now encourages healthcare professionals to make rounds in the afternoon, when visitors are on premises.

Source: fiercehealthcare.com

Despite “measurable progress” in the three years since the release of the Institute of Medicine’s landmark report on the future of nursing, more work remains “to fully realize the potential of qualified nurses to improve health and provide care to people who need it.”

That assessment is part of a commentary by Harvey V. Fineberg, MD, PhD, president of the IOM, and Risa Lavizzo-Mourey, MD, MBA, president and CEO of the Robert Wood Johnson Foundation, on the aftermath of the report.

“The Future of Nursing: Leading Change, Advancing Health” was released Oct. 5, 2010, by the IOM with the support of RWJF. It provided a blueprint for transforming the nursing profession to “respond effectively to rapidly changing healthcare settings and an evolving healthcare system,” according to a report brief.

The key recommendations: allow nurses to practice to the full scope of their education and training, provide opportunities for nurses to serve as healthcare leaders and increase the proportion of nurses with a BSN to 80% by 2020. Following the report, RWJF and AARP formed the Campaign for Action to implement the report’s recommendations at the state level. 

Regarding scope of practice for advanced practice registered nurses, Fineberg and Lavizzo-Mourey wrote that 43 state action coalitions have prioritized initiatives to remove scope-of-practice regulations that prevent APRNs from delivering care to the full extent of their education and training. Iowa, Kentucky, Maryland , Nevada, North Dakota, Oregon and Rhode Island have removed barriers to APRN practice and care, and 15 states introduced bills this year to remove physician supervision requirements that can hinder APRN care.

Regarding education and training, the proportion of employed nurses with a BSN or higher degree was 49% in 2010 and 50% in 2011. “Progress is likely to accelerate in the years to come,” Fineberg and Lavizzo-Mourey wrote, “because between 2011 and 2012 along there was a 22.2% increase in enrollment in RN-to-BSN programs and a 3.5% increase in enrollment in entry-level BSN programs.” The authors also noted a recent increase in the number of students enrolled in nursing doctorate programs. Of the 51 action coalitions, 48 have worked to enable seamless academic progression in nursing.

The authors noted that the influence of the campaign has paid off with a $200 million Medicare initiative to support the training of APRNs at hospital systems in Arizona, Illinois, North Carolina, Pennsylvania and Texas.

Regarding nurse leadership, Fineberg and Lavizzo-Mourey wrote, the “Campaign for Action has tapped established and emerging nurse leaders across the nation and is working to provide them with opportunities for networking, skills development and mentoring. A key strategy is to advocate for more nurses to serve on hospital boards.” 

Full commentary: http://bit.ly/176XyZs

Campaign for Action: http://www.rwjf.org/en/topics/rwjf-topic-areas/nursing/action-coalitions.html

“Future of Nursing” report: www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx

Graduate Nurse Education Demonstration: http://innovation.cms.gov/initiatives/gne/. 

Source: Nurse.com

Source: Maryville University Nursing