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herring_RN Guide 65,850 Views

Joined Mar 14, '04 - from 'California, USA'. herring_RN is a retired registered nurse. She has '>40 years' year(s) of experience and specializes in 'Critical care, tele, Medical-Surgical'. Posts: 16,789 (72% Liked) Likes: 32,869

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  • May 16

    I took the 8-week MBSR course last year and it was a game changer in helping me deal with long-standing issues related to anxiety and depression. By the time I took the class my work-related/nurse role-related anxiety (coupled with some significant personal losses and setbacks) had reached an untenable pitch. Mindfulness practice has not made me impervious to stress or discouragement, but it has made me more resilient - able to move back to an okay place far quicker and easier.

    For me, it's about bringing moments of mindfulness into my every-day experience. It's wonderfully simple and really doesn't require you to change anything external in your life. You increase the aggregate of "being okay" moments and over time you find that your set-point has subtlely shifted to a happier place.

    Some hospitals actually offer the course to employees. If it's not offered directly by your hospital/employer, you might be able to use your health plan's Wellness initiative benefit to offset the cost of taking a course from a local college or therapist.

  • May 16

    Mindfulness: A Cure for Auto-Pilot

    Have you ever felt that your automatic pilot just switched on the moment you walked in the door? No matter what setting you are working in, nursing demands a complex skill set. To keep up on any given day, one must have their critical thinking, multi-tasking, speed, and accuracy skills polished and at the ready. It is clear why at the end of a 12-hour shift it seems as if every ounce of physical, emotional and cognitive energy has been consumed, leaving you empty. It makes sense that you would want to protect your energy level, not to mention side-step any metaphorical land mines quietly waiting to explode. Switching on Auto-pilot may seem like a quick fix, a desperate attempt to conserve your valuable energy to get through the day, but this experiential avoidance may be having a paradoxical effect.

    Humans have an inherent natural survival instinct that determines our reaction to unpleasant or uncomfortable events in our environment (e.g., combative or resistant patients, family members or difficult staff). This primitive instinct tries to steer us away from unpleasant things because of their potential for harm. This same instinct affects our internal processes as well, disconnecting us from unpleasant thoughts (e.g., worry or judgement), emotions (e.g., frustration, grief, stress, helplessness), or sensations (e.g., physical fatigue or tension). We protect ourselves by using experiential avoidance and, for some, it looks like switching on the auto-pilot. The irony is that experiential avoidance has been found to actually maintain psychological distress (Hayes et al., 1996).

    No matter how hard you try to escape yourself and all of your internal thoughts, feelings, and experiences, you are stuck with you. Interestingly, struggling with discomfort is what actually maintains this cycle and changing the relationship with the present experience is what helps long-term. It can seem a bit nebulous, but in order to relieve yourself from the struggling, you must open yourself up to experiencing the very thoughts, feelings and sensations that you are trying to avoid. It takes a lot of practice. However, it will serve you well if you can develop a willingness to contact whatever comes up during the work day – even if what comes up creates stress, irritation or sadness.

    Mindfulness-based research purports that although experiential avoidance (i.e., automatic pilot) can alleviate distress in the moment, over time it teaches us to become intolerant of our own internal experience. Jon Kabat-Zinn, a world authority on the use of mindfulness, defines it as: "Paying attention in a particular way: on purpose, in the present moment, and non-judgmentally." Mindfulness is about waking up, connecting with ourselves, and appreciating the fullness of each moment of life. Kabat-Zinn calls it, "The art of conscious living." It is a profound way to enhance psychological and emotional resilience, and increase job satisfaction.

    Accepting your authentic experience in the moment is the complete opposite of avoidance. When we learn to practice mindfulness in our daily lives and apply an open and accepting attitude to all internal and external experiences (including the painful ones), then we free ourselves from suffering. Notice that I did not mention that you would be free from pain? Pain is part of life. Suffering does not have to be. When we sit with unpleasant thoughts, feelings, and sensations (even if only briefly), they lose their power over us. They become just thoughts – just feelings – and just sensations.

    Research shows mindfulness training can help nurses cope more effectively with stress and reduce the risk of professional burnout. A study based on Jon Kabat-Zinn’s 1979 study was conducted on a trial of nurses and found that those who participated in an 8-week Mindfulness-Based Stress Reduction training program (MBSR) had significantly fewer self-reported burnout symptoms, along with increases in relaxation, mindfulness, attention and improved family relations, compared to nurses in a control group.

    The next time that you experience some aversive, unpleasant, or unwanted experience, use it as an opportunity to choose to respond to the event differently than you normally would. Try to engage with curiosity and openness. Try to notice the unpleasant event, welcome it into your experience, examine it for what it is, accept it completely (which does not mean approve of it), and then allow yourself to let it go.

    Example of a Mindfulness Exercise (practice 10 minutes a day):

    Focus on your breathing. Notice the sensations of the breath as it travels in and out of your body. Don’t try to make the breath happen in any particular way; just notice your breathing as it is happening. Of course, your mind will get caught up in other mental events, such as planning or daydreaming. But mindfulness simply invites your attention back to the breath without criticizing or judging the mind’s wandering. This “awareness of breath” meditation helps slow your mental activity and builds the capacity to stay focused. Taking a few slow, mindful breaths before entering a patient’s room can activate the parasympathetic nervous system, causing the “relaxation response,” which helps you feel more centered and more fully present with the patient.
    Pain is inevitable, suffering is optional ~ Anonymous.
    ADMIN NOTE: You are invited to participate in
    a research study to pilot a new method of mental health training for registered nurses working in emergency departments across the country.

  • May 13

    This is one of the studies that my facility uses as evidence to base their policy on restricting people in direct patient care areas from wearing acrylic nails or gels or having long natural nails: Candida Osteomyelitis and Diskitis after Spinal Surgery: An Outbreak That Implicates Artificial Nail Use | Clinical Infectious Diseases | Oxford Academic

    It's a case study, but still....

    Candida osteomyelitis...blech. I read the title and, though I was fine and understood that acrylics, gels, chipped polish and long nails can harbor gnarly bacteria, that pushed it over the top for me.

    Now, in the real world most people who want to wear polish, gels or acrylics still do, but they are aware of the risk. It may not be the worst risk but it's there, even if the facility doesn't go out of their way to enforce the policy.

  • May 10

    Yes, but I have a pale pink French manicure! Sorry.

    Kidding aside, buff nails look a lot better than I imagined they would.

  • May 10

    @NeatsBSN. Trust me, staff have not had an extra nanosecond to sit around due to staffing guidelines and a lawsuit is the only way it will happen. It took years and a democratic governor to get this signed into law. It all comes down to bean counters, make no mistake, and the last concern on their mind as their account crunches the profit and updates them on their IRA is the patients and the staff. Bob Severe summed it up perfectly in his song ' feel like a number.' I am just a tiny cog in a great big wheel...people do not buy or run SNF because they care...

  • May 10

    Dang auto correct. Bob Seger.

  • May 9

    There are current bills in the House of Representatives and the Senate. H.R. 2392 introduced on 5/4/17, and S. 1063 introduced on the same date. The house bill is sponsored by Janice Schakowsky of IL. The senate bill is sponsored by Sherrod Brown of OH. These have just been introduced so far and referred to committees.

    The House bill is referred to the Ways and Means committee, and the energy and commerce committee. The senate bill is referred to the health,education,labor,and pension committee. You can contact these senators and representatives on the appropriate committees. Also contact Paul Ryan the speaker of the house.

    We need to use our voices to get this heard. We can get legislation passed if we try hard enough.

  • May 8

    I am a Management RN who has worked as management before becoming an RN. I care about patient safety but am able to look at the whole picture and have information available to me that line staff more than likely do not. I have worked in union and non-union environments.
    Developing a staffing model is an art if you will. Most people think only "bean counters" decide how much staff we get.
    When I do develop a staffing model I get input from staff. I have provided schedules (no names on it) and times we need higher coverage than others. I have also provided an empty schedule (no times with the caveat of some must have criteria i.e. there must be coverage 24/7)...this one I get my best results and a very creative schedule that with some tweaking success for staff.

    I agree with what is written here and patient safety but I really do not think a class action lawsuit is the answer. What I think is the ANA, and any other health profession association band together and submit a Problem, Solution and discussion formation to our Nation leadership. Invite your local congress senator, mayor, governor to your facility for the day at a time when they are feeding, passing medication, putting in bed for a afternoon rest... you know the busy times. I know from being in Long Term Care to have staffing ratios and the reimbursement that goes with it would make a difference in so many lives however I would want this to be made in a thoughtful way because be careful what you wish for once we get government input then our administrative costs', documentation, and everything else we do is so much more than what we bargained for to begin with. I want to see staff busy not overloaded in an unsafe way, I do not want to see staff sitting around because there is nothing to do.

    I urge my healthcare profession to carefully think before acting so that any changes are sound and not cost prohibitive.

    Bring a solution that includes higher reimbursement form CMS in writing with thousands of signatures not only from nurses but other healthcare staff and patients would be prudent and may work with public pressure in a coordinated, formal and professional way would be refreshing and certainly remembered in that we directed our own path and hopefully worked.

    Lastly people often think the companies reap the rewards for profit at the expense of staff, although this may seem true at times I can say in the Long Term care setting profit is not more than 3 percent at most so already they are operating bare bones.

  • May 5

    I too lived and worked in Louisiana as a RN for both magnet and non-magnet hospitals. I was tired of being under-paid and over-worked. The worst was when I was a Charge Nurse on a Med-Surg floor that also had to care for six of my own patients during my shift. I've left and come to California, and working here is like Heaven in comparison! Better wages, sensible staffing, assignments with thoughtful acuity. Come to the Best/West Coast as soon as you can!

  • May 4

    Thanks to nurses who never stopped paying attention! I hope Jimmy's son gets a full recovery as he undergoes all other required surgeries. Thanks Jimmy for noticing the diligence of that nurse who did a thorough assessment rather than go through the short cut! BRAVO

  • May 4

    Thank you Jimmy Kimmel for taking such a painful situation and using it to highlight the plight of many people who would be in a tragic position if they were to lose insurance coverage due to not qualifying or a pre-existing condition. I remember having patients that were born prematurely or with congential conditions and had continuing needs. Their parents had health insurance, but the child's pre-existing conditions were excluded. These folks ended up filing for bankruptcy. It cannot be left up to states to determine if insurance companies will provide for pre-exsisting conditions. Already some states have rejected funds offered through ACA for their poor. It would send a real message if doctors and hospitals refused to bill insurance companies for the care provided to politicians and make them pay cash up front. Let them feel the stress that others feel. Then when they vote they can have a reference point. Of course this would be considered unethical, right?

    Jimmy Kimmel also did something that occurs too infrequently. Individual nurses were acknowledged and thanked for their expertise and interventions which made a difference between life and death. We all benefit from this public shout out.

    I pray that the Kimmel's son makes a speedy recovery and enjoys a long and happy life and the family find strength from all of us in the nursing community.

    Nurses must educate themselves about healthcare finance and public health issues. Find out who the payors are, how much care actually costs and how those costs are distributed. How can we help our fellow citizens (not counting volunteer/mission work). What is our role in reducing costs? Then participate in the political process. Whichever side you're on, you can do something positive.

  • May 4

    Quote from NuGuyNurse2b
    Why is there a post such as this on every social media about this video? Preexisting conditions were before the Trump era. And if you're following, preexisting conditions are currently covered under Obamacare, which Trump has yet to repeal. And further, in his attempt to appeal Obamacare, he supports coverage for preexisting conditions.
    Because the preexisting conditions portion of the ACA has been a source of contention recently as certain Congress members (the Freedom Caucus) initially would not vote for the ACA replacement to be pushed forward without the repeal of Title One provisions mandated in the ACA. Among these provisions was the preexisting condition mandate. Regardless of what the ACA currently covers and the promises that have been made to keep the provision in the future, there are a good number of people in powerful positions that would like to see it done away with. It is completely understandable that people are bringing attention to it given current events.

  • May 4

    Someone should send this repeatedly to every Senator and Congress person. I would say Trump as well but unless it's a tweet he probably wouldn't notice it. Make the powers that be think again about eliminating chances for families to save their children by having health insurance even for preexisting conditions.

  • May 4

    I absolutely loved this when I saw it as well. A lot of times, especially with the more well-known cases or celebrities, they automatically thank the doctor by name and then clump everyone else into "the care team" or "the nurses." I loved that he named the nurses by name, some first and last.

  • May 4

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