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  • Oct 18

    Does going to an online FNP program automatically translate to an easy A? Many believe that online FNP programs are less rigorous than traditional programs, especially when it comes to examination policies. Many falsely assume online students are given carte blanche during examinations, and can always look up answers, but that can be further from the truth.

    Online FNP programs utilize various tactics to ensure students are held accountable during examinations:

    1) Open Book Quizzes

    For quick knowledge checks, programs will sometimes use timed open book quizzes. But please don't make the mistake of equating open book quizzes to being easy. In fact, open book quizzes tend to be harder than closed book quizzes. Why, you ask? Because students have access to resources, the questions are more difficult. To answer appropriately students are required to have a thorough understanding of the material. Simply memorizing and regurgitating information will not cut it, and is a sure fire way to do poorly!

    2) Live Real-time Exam Proctoring by Professor

    Students log in to their school's site at a specific time and must take the exam on camera as the professor monitors. Students must ensure appropriate lighting and noise level. Additionally, students can't take breaks/pause the exam or leave the room and must be alone throughout the examination. So taking the exam at the local bookstore or Starbucks is out of the question.

    3) Automated Exam Proctoring Service

    Students must first download a program from an automated proctor site (schools use various sites). When students are ready to take their exams there will be a link on their exam that will return students to the automated proctoring site. This site will not only confirm your identity and proctor the exam, but it also performs further analysis post examination. Things such as too much eye movement, getting a drink of water, using scrap paper, opening other screens or having notes on the screen will cause the automated proctoring service to close the exam and alert your school.

    4) Proctoring Centers

    Students go in-person to a designated proctoring center to take their examinations.

    In this week's vlog, I go over how I got kicked out of my exam! You read right. This is not a typo! Some highlights include:

    • How Simmons College Online FNP program students take exams
    • Why did I get kicked out of my pharmacology exam? What happened next?
    • Information overload.
    • Finally deciding on a semester project topic.

    I hope you enjoy Follow Me Through Grad School (#FMTGS) Episode 203: I Got Kicked Out of My Exam!!! Let me know below if something like this has ever happened to you. Please like, comment, share and subscribe!

    Until Next Time,

    Bizzy Bee Nursing

    Fuel your passion. Fulfill your purpose.

    Heads up! If you're new here or an old friend of the Follow Me Through Grad School (#FMTGS) series, you can always catch up with my journey from the beginning in the link below:

    Click here to never miss another episode of Follow Me Through Grad School (#FMTGS):
    Bizzy Bee Nursing - YouTube

  • Oct 18

    Fire on the Mountain

    Last Tuesday evening at 6:15 pm, when my smartphone vibrated to announce an incoming text, I broke my personal rule against texting during meetings, and surreptitiously glanced down at the message. It was from my husband. The words, "We have been evacuated" stared up at me. I blinked twice to make sure I was seeing the message correctly.

    I had tracked the wildfires' progress after waking up before dawn the day before (Monday, October 9, 2017) to witness a long line of orange flames marching atop a mountain ridge, approximately eight air-miles west of our home in Napa, CA. The sight was terrifying. I chose to cope with my fear in those initial moments by telling myself that I had seen such sights before.

    Early local news reports indicated that the town of Santa Rosa was under siege. My husband, a former volunteer firefighter, and 30+-year local resident repeatedly assured me that the conditions were not right for the epic fire to become a direct threat to us in our isolated rural community. I trusted his judgment. So much so, that I felt confident about attending a meeting in Sacramento (more than an hour's drive away) on Tuesday evening. But no amount of professional expertise, experience, or local knowledge could have predicted the sudden wind change that caused the uncontained burn to jump a local road and trigger the mandatory evacuation of our neighborhood. How could I have so grossly underestimated the power of Mother Nature?


    As the true meaning of my husband's text message sank in, a patchwork quilt of emotional and spiritual concerns descended over me. Fear, anger, guilt, blame, anxiety, and visions of my own mortality all manifested within me simultaneously. Physically, the sensation was a surreal combination of stomach ache, indigestion, and headache. My first thoughts were, "I can't go home tonight!" and "What if I can't ever go home again?" Then my mind jumped to the realization that I didn't have any toiletries with me. I immediately chastised myself for not doing a better job of preparing and planning, and then I felt even more deeply ashamed because I was worrying about ridiculous things, like my toothbrush, when so many other people nearby were losing far more important things, like their lives.

    Taking Control

    While I didn't have to run out of an actively burning building in the middle of the night to survive, as many others did, I found that the inability to return home carried a unique burden of stress. Our lives had been disrupted due to circumstances beyond our control, and we were being required to hang out and wait. Even if our home and property remained intact, how long would we be displaced?

    Multiple variables including humidity, wind speed and direction, and air quality all contributed to the ambiguousness of the threat we were facing. We decided the best way to achieve peace of mind was to assert control wherever we could to reduce the power of the threat: We would control the things we could, and let go of the possible outcomes of the things we couldn't.

    First, we made sure our basic needs were met. We stayed with friends the first night, then chose to hotel-hop after that instead of going to a community shelter. We did not take an out-of-town vacation this year, so I suggested pretending this was our vacation. While it sounded like a good idea at first, as a way of achieving some semblance of control, the fear of the unknown looming in the background lent an unsettled quality to the occasion that was difficult to deny. At least my husband and I were able to enjoy each others' company as well as the love and support of friends and family.

    The stress and smoke inhalation took a physical toll, causing upset stomachs and wheezy lungs. Our solutions: eating wisely, getting back to exercising regularly, staying properly hydrated, and thinking optimistically.

    Beyond basic needs, we sought the best information we could find about the status of the fires and our immediate neighborhood. We obtained useful information by drips and drops through texts and emails from John's fire department contacts. Through public and private news sources, we learned that our property was secure and that we would likely be able to return after a reasonable amount of time away. The satellite imagery we found online confirmed the other news we were able to gather.

    Looking Within and Looking Ahead

    Facing this type of fear of the unknown gave me an opportunity for introspection. I realized, among other things, that I need to work on my personal priorities. During his time in the fire department, my husband adapted the standard emergency prioritization protocol of people property and environment to advise homeowners facing evacuation to consider saving people, pets, prescriptions, and papers-- in that order. Knowing this recommended order of prioritization will help me rethink how I prepare for adverse circumstances in the future.

    Meanwhile, in introspection mode, I began to see areas of my life where my priorities have been misallocated all along. For example, since attending nursing school, I have tended to prioritize paper over people, and I think that might be worth changing!

    Our six-day mandatory evacuation put me in a holding pattern that forced me to take stock of my life in a way that I'm not sure I would have done otherwise. I realized how unimportant material things are, and how little control we actually have over any external circumstances in our lives. I can't say I won't be caught off guard in the future, but I can say that I will be much more conscious and conscientious about my priorities and preparations moving forward.

    Applications to Nursing Practice

    As a nurse, I can't help thinking how this experience will inform my practice. Disasters affect those who are touched by them in different ways. Remember that those who are marginally affected are still affected. That's because stress is stress in terms of the body's response.

    Many have lost their homes and lives, during the catastrophic California wildfires, and thousands more fall into a middle ground or gray area of being affected. These people have significant needs. And the stresses are ongoing, as the immediate neighborhood and local region is changed forever, and strives to rebuild. No one stays the same after something like this-we all have to get our lives back.

    The secret to getting our lives back is resilience. In a month, when the immediate danger has passed and the national news has moved on to the next high drama, we will still be rebuilding our lives and our communities. There is a profound opportunity for caregivers in communities rebuilding post-disaster, to help those who are non-critically affected. Encourage resilience by listening to their stories, offering support, and steering them toward any and all available resources for physical and psychological health.

    As for that patchwork quilt of emotional and spiritual concerns that initially enveloped me when I learned that my neighborhood was being evacuated, the initial fear, anger, guilt, blame, anxiety and visions of mortality have transformed into strength, acceptance, and resolve. My experience is but a microcosm of all the cataclysmic events that have claimed lives and property and shaped current events over the last few months. Long-lasting consequences including Fear of the unknown, survivor guilt, and the need for resilience will continue to affect our residents and communities here in California Wine Country long after the wildfires have been contained and the imminent dangers are over.

    Questions for Discussion:

    Have you been touched by disaster? What are your priorities? How might building resilience help you or those you know and love who have been affected by disasters?

    Sources and Resources:

    Gift From Within – PTSD Resources for Survivors and Caregivers
    Guilt Following Traumatic Events - Survivor Guilt - PTSD Resources - Gift From Within

    Study: Fear of the Unknown Compounds Many Anxiety Disorders
    Study: Fear of the Unknown Compounds Many Anxiety Disorders | Psychology Today

    What is Resilience?
    What is Resilience? | Psych Central

  • Oct 17

    Sara, thank you so much for sharing your story. You were able to do what many in this nursing community wanted to do but couldn't.......

    I just felt strongly like I needed to go do something.

  • Oct 17

    I work as an RN in Las Vegas and took care of several shooting victims in the ICU. It was several days of tears and team work.

    Thank you to all the hospitals and staff nationally that donated free food and gifts to the affected families and staff.

    Amidst tragedy, there were some happy endings.

  • Oct 17

    Many of us may wonder what it would be like to be faced with a disaster right in our community. Sara D. is an oncology nurse in a large hospital in Vegas and reported to work in the middle of the Las Vegas massacre. She generously agreed to share her experience.

    Sara, what happened that night?

    Sunday was my night off. I am always off on Sunday nights and it's my time to completely relax and re-charge. So I was sitting at home and watching an absolutely terrible movie (laughs). I happened to look at my phone and saw CNN breaking news that there was a huge shooting. I thought there's no way!! This is insane!

    I just felt strongly like I needed to go do something.

    Did you ever think beforehand about what you would do if a disaster happened and you were not at work?

    I always thought, living in Vegas, that something would happen-it was just a matter of when. We're a target. I've been in the hospital when we had an active shooter or bomb threat and I know the drill. Close all the doors, make sure the patients are safe. My hospital had regular disaster drills. But never anything like this.

    What motivated you to go in that night?

    Literally, because they described it as a massacre. I figured it's what you do. I know that I can respond in an emergency situation.

    I thought "They are going to need anyone who knows how to do anything at this point".

    I posted on Facebook, "Does anyone know how nurses can help? Where can nurses go to respond?" So then I called the charge nurse on my floor and at that time she hadn't heard yet what was going on. She called the house supervisor and he said to come in right away.

    I got dressed and went in immediately but I texted my Mom first. "You are going to hear about this soon, Mom. I'm going into the hospital. Don't freak out." She started crying and then said she was proud of me.

    What was your assignment when you got there?

    They put me down in ED hold, which is overflow. I dealt with the non-traumatic patients coming in with chest pain and syncope, and so on.

    Then we had to open up a second overflow unit and move patients over there. The front ED was designated for shooting victims. We had five victims when I got there. I remember looking down the hall towards the bathroom. Near the bathroom was a man with his back to me. He was wearing a plaid shirt, all bloodied and dirty on the back. Standing next to him was a girl on crutches.

    Did your hospital do a good job in an emergency?

    Everything flowed super well. We were able to get everyone taken care of - that was the main point!

    We were on lockdown, which meant putting our victims and victim's family in separate rooms. No one was allowed to leave until they talked to Metro. We had Metro at all of our entrances and inside the facility.

    There really wasn't a lot of confusion like "Are we using this room or that room?" because we had excellent teamwork and we were ready to work in a massive disaster from previous training.

    What inspired you?

    I'm so proud to be from Vegas. Because people don't understand that we're not just strippers who live in hotels and gamble. I was raised here. Educated here. It's not just a transient town, a tourist town; it's my hometown - since I was three years old.

    We're a community.

    The outpouring of love and support was insane. For a week afterward, the staff at every hospital got meals delivered. A local tattoo artist offered Las Vegas Strong tattoos for a $50.00 donation that went directly to the Victim's Fund.

    It's really strange. As awful as it was, I felt the power and goodness of my community.

    How has it affected you emotionally?

    It was an absolutely, incredibly horrible event, we still don't know the motive, there's still so much confusion. It was so much bigger than anything we ever imagined would happen.

    And people are all thanking me for my part, but I feel like I didn't do anything special. It feels weird. What I saw and did wasn't close to what others saw and did, so I feel weird getting credit.

    I was definitely like in a funk for about a week.

    It was surreal. And then I still had to work my normal workweek.

    There was a very weird feeling in the hospital as well. I felt empathetic to everyone's emotions. I had a friend who was at the concert who had people shot and killed right next to her. I have friends from high school who were there and I'm still hearing who was there.

    Ya…., it gives you a weird sense that something really big did happen right here where you live. Driving down the strip, I see shattered windows. It feels heavy driving down strangely quiet streets at 2 am. It makes you more aware of your surroundings but for me personally, I haven't changed my routine. I actually have a concert tomorrow night at Mandalay Bay that I'm going to.

    I don't want to always to be afraid. I'm not going to live in fear because then the bad
    guys win.

    I'm not going to just stay in my house because you know what, I'm going to die eventually anyway.

    Nothing good comes of me not going out and living my life.

    I take care of people dying from cancer. It's what I do. As an oncology nurse you face your mortality sooner anyway, you know, so it's how I deal.

    Is there anything else you'd like to share with your fellow nurses?

    It felt awesome being part of something so much bigger than myself, no matter how horrendous it was. Even if you feel you didn't make a did. Being there to go get a patient a cup of ice was more fulfilling than if I had just sat there and done nothing and watched my fellow co-workers and my hospital go through all this.

    My hospital is my second family. I see more of them than I do my own family. You never want to be in an internal disaster triage or an external disaster triage that affects your hospital and your work family.

    All us nurses have this common bond, a natural need to take care of people. So if you're my co-worker, and you're inundated, I will gladly come behind you and pass ice or start an IV. And that's what I got to do that day.

    I love that we came together.

    Sara, thank you so much. You make us all proud and remind us why we chose this profession.

  • Oct 14

    We've all made errors -- some of us are fortunate enough to have caught our own error (or had it caught by others) before there was harm to the patient. I've been in both positions. I have also been involved in a sentinel event -- one of a series of health care team members who overlooked a critical lab value until it was too late. I was the last one in the chain . . . closest to the outcome. Although it was many years ago, I still wake up in the middle of the night, heart pounding and horrified once again. For months after the event -- more like two years, I would wake up in anguish over my failure to catch that lab value and intervene. When the patient's status changed, I attributed it to the reasons outlined by her medical team. Had I noticed that one lab result, I would have known better. Had I noticed it in a timely fashion, I could have changed the outcome. I know that I'm not the ONLY person who should have noticed and could have changed the outcome -- my charge nurse, the intern, the resident, the fellow, the attending and the consulting teams could have and should have noticed as well, but didn't. Nevertheless, I am the one who "took the heat" for it because I was the one at the bedside. And for years I beat myself up over it.

    I kept my job, but it was rough for a long time. There were investigations into the event, investigations into the investigations and investigations of my state of mind, critical thinking skills, knowledge base and fitness for my position. Those endless interviews with risk management, nursing management, the medical team, etc. were difficult to endure but hopefully necessary to the process of ensuring that a thing like that never happens again. After a few years, I didn't think of that incident every time I walked past that patient room but there were whispers in the break room that would suddenly stop when I entered. A few "well-meaning" folks went out of their way to "tell you what people are saying about you behind your back." That still happens from time to time.

    Years after the event, a nurse practitioner who was one in the chain of folks who ALSO should have noticed sought me out because she was leaving the hospital and wanted to talk to me first. She told me that in M & M Rounds, the attendings, the fellows, the residents, the interns and the NPs involved in the patient's care blamed the entire event on *my* failure to notice that lab result. But one nurse practitioner stood up and said "If I was operating in the same conditions as Ruby with the same access to information and the same support as she had, I would not have done anything differently than she did." I needed to hear that. Then she told me that some of those most vociferous in blaming me for the entire chain of failures were also beating themselves up about their part in the failure -- including herself. I needed to hear that, too.

    A few years after the event, researchers came to our unit to discuss their ideas for a study of what would be most helpful to secondary victims of a medical event. It was the first time I'd heard the term. I'm glad that more research is being done, more help is being offered to those who have found themselves involved in medical errors and sentinel events. I wish that there had been something available to me in the time that I most desparately needed it.

  • Oct 12

    We have all heard of the concept bullying. A sometimes over-used word but one that needs to be addressed. AllNurses staff recently attended the 2017 Magnet Conference in Houston. We were fortunate to catch a presentation by Jay Parchment, PhD, RN, NE-BC, Arnold Palmer Medical Center about evidence-based practice as it relates to the workplace bullying.

    Dr. Parchment presented research study results involving over 200 nursing managers. Nursing leaders are often caught in the middle and squeezed from the clinical staff on one hand and THEIR nursing leaders on the other. He presented research study results involving over 200 nursing managers. Here are the demographics of the respondents:

    Many nursing organizations have addressed this in one way or another. In 2015, the American Nurses Association penned a position paper that states:

    • The nursing profession will not tolerate violence of any kind from any source
    • RNs and employers must collaborate to create a culture of respect
    • Evidence-based strategies that prevent and mitigate incivility, bullying, and workplace violence promote RN health, safety, and wellness and optimal outcomes in health care
    • The strategies are listed and categorized by primary, secondary, and tertiary prevention
    • The statement is relevant for all healthcare professionals and stakeholders

    And in 2016, The Joint Commision on Hospitals identified the following categories of workplace violence:

    • Threat to professional status (public humiliation)
    • Threat to personal standing (name calling, insults, teasing) Isolation (withholding information)
    • Overwork (impossible deadlines)
    • Destabilization (failing to give credit where credit is due)

    So, how do we work to prevent bullying or incivility? ANA has also published information in a paper, Breaking the Bullying Cycle:

    • Remember what it was like to be a new nurse. Treat new nurses as you would have wanted to be treated as a "newbie."
    • Make an effort to welcome new nurses and help them feel they're part of the group.
    • If you're being bullied, address the behavior immediately. Bullying might be so ingrained in the workplace culture that bullies may not be aware of their behavior.
    • Use conflict-management strategies when confronting a bully.
    • Identify the problem clearly when it occurs, and raise the issue at staff meetings.
    • Serve as a role model for professional behaviors.

    AllNurses has also addressed bullying. A well-received article from TheCommuter addressed the "why" of bullying in her article Why Do People Bully Me? She also offers suggestions on how to get the bullying to stop.

    In another article, the author offers concrete suggestions about how to stop bullying. Break the Silence, Report Bullying. One of the suggestions in this article is to have exit interviews with staff leaving a unit or hospital and to ask about incivility. Addressing a unit culture can be difficult from within the unit. However, when administration is feeling the financial pinch of repeatedly hiring staff for a unit, staff consistently leaving a unit after a short while, and resulting staff shortages, this issue will rise to their attention.

    Bullies make the lives of staff as a whole miserable. Who likes to go to work and listen to negativity all shift? Who likes to dread going to work? Who likes to wonder if you will get help when you need it? Who will have your back? Should you look for another job? Why is the bully so unhappy that they feel they must share their unhappiness with others? And this has all been shown to affect patient care and not for the better! Break the chain - report bullying.

    So, is our culture as a whole becoming ruder, meaner and just overall, less caring? Maybe, maybe not. However, we must all as individuals answer for our own actions. Stop bullying now!

    Its simple - BE NICE! Treat others as YOU would like to be treated.

    How does your facility address bullying? What do YOU do individually to help foster an environment of caring, not only for your patients but your co-workers?

  • Oct 10

    Nationwide Children's Hospital, located in Columbus, Ohio is a nationally ranked pediatric care center which spans 68 facilities caring for the sickest children in the state. While they care for children, they also care for their staff.

    The Agency for Healthcare Research and Quality describes second victims of medical errors: "While the focus of the patient safety field has mostly been on improving systems of care, such systems include real people, and safety events may take an emotional toll. Frequently, clinicians review medical errors and understand what has unfolded, reacting with appropriate sadness and concern. Such errors occasionally result in an intense period of professional and personal anguish, even among the "strongest" caregivers."

    So, how do we care for the second victims?

    AN recently interviewed Jenna Merandi, PharmD, MS who is the Medication Safety Coordinator; Director, at Nationwide Children's Hospital. Her educational credentials include: PharmD, West Virginia University School of Pharmacy and an MS in Health-System Pharmacy Administration, The Ohio State University.

    1. The nursing community has heard of second victims committing suicide. (Kim Hiatt, RN). What happens if an employee is terminated due to an error? Where can they go for support?

    Generally speaking, we do not terminate an employee for one mistake as everyone is human and we can all make errors. Each situation is evaluated on its own merits to determine the appropriate course of action. For any employee who makes an error, they can reach out to their supervisor, peer supporter (one is available in every department), or Matrix services for support. Very difficult situations are also presented through our Schwartz rounds.

    2. What measures are in place to ensure that what is discussed in the peer to peer discussions is not discoverable if a lawsuit ensues?

    We train our peer supporters to focus on providing emotional support to individuals, not discussing the details of an event. No information is recorded or documented that relates to the event itself. The main goal of peer support is to provide one on one assurance to second victims and support them emotionally.

    3. Can a second victim utilize EAP at the same time as this program?

    Yes, EAP is actually a part of our program. We utilize the "Scott Three Tiered Interventional Model of Support" which consists of:

    Tier 1 support – could be provided by a manager, supervisor or colleague to recognize the signs and symptoms of a second victim and provide reassurance to that individual.

    Tier 2 support – consists of trained peer supporter who has been trained with the basic skills of responding to second victims and who provides one on one interventions and potential team debriefings

    Tier 3 support – our professional resources which include Employee Assistance Program (EAP), Clinical Psychologist, Social Work and Pastoral Care

    Second victims who need additional help beyond that of a peer supporter can utilize our EAP.

    4. Has there been culture-wide education? By that I mean, when a nurse/provider/someone else makes a mistake, one of the common phrases heard is "well that could never happen to me because I'm too careful." Its the whole system that needs to change.

    Yes, there has been culture-wide education both related to Zero Hero and our peer support program and as it relates to safety in our organization. The safety culture is incredible at Nationwide Children's as frontline staff feels comfortable reporting adverse events and working to try and prevent harm. We have a "just culture" at our institution which means there is shared accountability and follow up actions match the behaviors regardless of who is involved and what the outcome is.

    5. Are there any additional measures in place in case of the death of a patient due to an error? Is critical incident stress debriefing used at all?

    Yes, we have a Critical Incident Stress Management (CISM) team and debriefings could be conducted for larger group intervention (that beyond the role of peer supporter).

    Second victims are often forgotten in the scheme of an error. Nationwide Children's Hospital is at the forefront of programs designed to decrease the trauma of being a second victim.

    What is your facility doing to help the second victim? Please share.

  • Oct 9

    The difference between your dreams and reality is action. One of the hardest parts of FNP school is finding the balance between schoolwork and life. On one hand you want to be present for friends and family, but on another hand you’re committed to realizing your dream of becoming a FNP! Nothing worth having is easy to come by. The sacrifices made today is what will help to secure your future. However it doesn’t have to be all or nothing. Take reasonable time to enjoy your life while also remaining cognizant that for the time being grad school must take priority! Remember FNP school is only for a few years, not forever. You've got this!

    In this weeks vlog you'll see me juggle keeping up with my FNP School deadlines while also heading out of town for a weekend wedding. Some highlights include:

    - Collaborative practice agreement vs independent practice agreement, why is it important?
    - What is the most important part of the patient assessment?
    - Weekend wedding highlights
    - Deadlines are fast approaching, will I make it?

    Who knew scope of practice wasn't the same in all 50 states? There can be major differences and its important you know what is required in your state.

    Obtaining a history from a patient is usually very detailed and points you in the direction of the primary diagnosis, differential diagnoses and enables you to formulate a plan.

    I hope you enjoy Follow Me Through Grad School (#FMTGS) Episode 202: Juggling FNP School Deadlines + Weekend Wedding. Let me know below, what tips you use to balance schoolwork and life. Please like, comment, share and subscribe!

    Until Next Time,

    Bizzy Bee Nursing

    Fuel your passion. Fulfill you purpose.

    Heads up! If you’re new here or an old friend of the Follow Me Through Grad School (#FMTGS) series, you can always catch up with my journey from the beginning.

  • Oct 8

    Accidental Pill Pusher

    In the early 80’s nursing education about pain management took a turn. Gone were the days of observing the patient for non-verbal signs of pain or of watching the clock to see when the next dose of Demerol and Phenergan were due. In its place came the pain scale that we use today and the altogether new approach, “A patient’s pain is what they say it is.” Unspoken was the undercurrent that pain is the enemy to be removed completely whenever possible.

    At the same time, we began to see the development of long-acting narcotics and a plethora of opioid presentations that seemed to promise to wipe out all physical pain. While helping our patients get through post-operative pain or chronic pain, we saw opioids as our allies in the battle, and actively participated in educating our patients in using them for pain management.

    Then came the problems. They started slow but have snowballed to mammoth proportions in the past few years. We live in a nation that takes pills for everything. The evidence is everywhere: even the evening news slot advertises for pills to help people have a bowel movement when they have narcotic induced constipation—like this is a normal thing that we should all know about!

    The statistics are appalling:

    • Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) quadrupled. From 2000 to 2015 more than half a million people died from drug overdoses. 91 Americans die every day from an opioid overdose. [CDC]

    • Over two million Americans are estimated to be dependent on opioids, and an additional 95 million used prescription painkillers in the past year — more than used tobacco. [NYTimes,6/5/17]
    • Neonatal Abstinence Syndrome (NAS)Among 28 states with publicly available data during 1999–2013, the overall NAS incidence increased 300% (CDC)

    Whether or not we are moved by the statistics, we all know people around us who have been affected by the epidemic: family members, neighbors, co-workers.

    It is important in any discussion of pain management that we differentiate between acute pain, chronic pain and end of life pain. The approaches for treatment of each type vary widely, and our discussion here centers around acute and chronic pain.

    The question for us, as professional nurses becomes one of urgency: what can we do to help stem the tide, to make a difference?

    1. Teach better. We can start now with modifying how we teach our patients about narcotic use for post operative pain and chronic pain. Simply taking time to discuss non-narcotic pain relief legitimatizes it and helps it be the first line of defense when pain begins. NSAIDs, Tylenol, ice, heat, distraction, music, topical analgesics are all part of our arsenal of tools for addressing pain. The simple expectation that narcotics are a second choice can open doors for patients who are looking to manage their pain in ways that don’t promote dependency.
    2. Chronic pain requires chronic help. Chronic pain is in a category of its own. It cannot be overstated how debilitating and life-altering it is to suffer from chronic pain. We don’t ever want to go back to the days of not treating pain or not feeling with someone who is hurting, but we must also adjust our thinking when it comes to using narcotics to address long-standing chronic pain. An attitude of compassionate care, gentle teaching and measured use of narcotics can together add up to a potential plan for addressing long term pain. This together with a call for the development of wholistic measures and new classes of drugs to help.
    3. Give fewer. Encourage providers to write for fewer numbers of narcotics. Studies show that initial dependency often happens after surgery for orthopedic problems, wisdom teeth or other “routine” procedures. Young people end up with too many pills and use them. Sometimes they share them with others which further multiplies the crisis. Additionally, with heroin becoming more readily available, users may transfer from pills to IV drug use when their supply runs out. This transference to heroin has increased dramatically in recent years and adds exponentially to the overdose deaths. Also, teaching family members to monitor the pills themselves and know where to dispose of them once they are finished with the particular surgery or illness, is crucial to keeping the drugs out of the wrong hands and off the street.
    4. Empower your patient. Know where and how to dispose of narcotics in your area. When people ask, be ready to tell them or include that in your teaching. Also, point out how many pills are in the prescription and let the patient know that they don’t have to fill the total amount if they don’t feel they will need that number. These measures, along with emphasizing narcotics as a second choice for pain management, may help prevent an initial addiction.
    5. Study more. Nurses are very often on the forefront of change that improves their patient’s lives. Just as we sought to approach pain differently back in the 1980’s, so now we are faced with the daunting challenge of re-inventing our overall approach to pain management. What we are facing will involve us directly: making us spend more time with actual bedside pain control measures with less reliance on narcotics as the primary answer to a complaint of pain.

    This is a call to action for us as professional nurses. We can help. Reversing the tide of the drug epidemic can begin with us—as we do our part to continue to relieve pain and suffering, we must also re-double our efforts to combat a growing problem by being effective teachers and by working, within our realm of influence, to make a difference.

    Joy Eastridge, RN, BSN, CHPN

  • Oct 7

    Humor is an often-neglected emotion in nursing. We are all so very busy, rushing here and there and trying to get the impossible done in the shortest time possible. However, here is some comic relief for our hectic lives.

    As nurses, we are exposed to both the best and worst of heath care situations. Few professions have more impact on people who are often experiencing the worst day or hour of their life. We have been entrusted with the responsibility as soon as we passed our licensing exam. We know that having a sense of humor extends our lives. Laughter really is the best medicine. There’s even been research conducted on nursing humor. For instance, a 1997 study published in the International Journal of Nursing Studies wanted to describe the meaning of nurses' use of humor in their nursing practice. Five themes emerged in which humor was found to:

    • Help nurses deal effectively with difficult situations and difficult patients
    • Create a sense of cohesiveness between nurses and their patients and also among the nurses themselves
    • Be an effective therapeutic communication technique that helped to decrease patients' anxiety, depression, and embarrassment
    • Be planned and routine or be unexpected and spontaneous
    • Creates lasting effects beyond the immediate moment for both nurses and patients.

    AN realizes that nurses need humor in their lives. Check out our forum; Nursing Humor. AN staff was recently at the ANA Magnet Conference in Houston and were fortunate to attend a lecture on….humor!

    Johns Hopkins Magazine emphasizes the need for therapeutic humor: “Therapeutic humor doesn't mean laying a string of one-liners on an unsuspecting patient, or teasing her or using sarcasm. It's about tuning in to the ways a patient views her situation and following her lead if she takes a turn toward the lighthearted. Just as a patient and provider might connect over a shared interest in baseball or a favorite movie, humor provides another avenue toward the common ground that generates trust between individuals. It can also offer a step back from a difficult situation, a reminder that life can still be larger than fear and pain alone.”

    Sometimes humor is also a coping mechanism. I have a friend recently diagnosed with cancer who underwent major surgery but faces years of follow up and a 25% chance of recurrence. She is not an ideal patient and copes via the use of humor and sarcasm. For her and many others like her, these coping mechanisms are what gets her thru trying times.
    Humor can work wonders in staff situations also. How many times have we all been involved in very stressful situations and we can engage in humor and even laughter with our co-workers. This shared experience can lead to increased cohesiveness of the relationship as well as increased job satisfaction.

    Humor can be helpful in many situations. However, there must be a set of “rules” or “guidelines” to ensure that humor is well-received:

    • Timing - although humor can be used in very serious situations, it is always important to remember the patient and others that may have different emotions
    • “Gallows humor” - as healthcare workers we are in a position of authority and have a mastery of the situation. Patients are vulnerable and sometimes must be protected from our humor
    • Scope - our work world is so hectic, we all know this, so its important that if humor is deployed, there is enough time for the other person to answer or absorb the humor

    So, humor can be used in the clinical setting, provided you use common sense rules. There are many instances where humor can defuse a potentially flammable situation. Humor can also be used to decrease tension between staff members during a stressful event.

    The ANA agrees via American Nurse Today: “Humor should lift the spirit and make everyone feel more comfortable. In other words, we should laugh with, rather than laugh at, our coworkers. Avoid sarcasm because it can be misunderstood and often targets others in a negative way.”
    Humor is good -

  • Oct 4

    Compression socks… longer just for grandma. Although compression socks look different from the grandma socks of the past, they still perform the same functions, only in a more stylish way.

    Let’s refresh your memories as to why you should wear compression socks and give you great explanations to tell your spouse, significant other etc. why they cost more than a regular pair of socks. If the sight of your edematous feet and ankles and multiplying purple and blue varicose veins are not enough, hopefully, this explanation will help.

    You already know that oxygenated blood flows to the extremities including the muscles of your overworked legs and feet. Once the oxygen is delivered, the blood carries the lactic acid and other waste products that have built up in your muscles from all the walking you do and attempts to carry it back to the heart and lungs. Ideally, this should be a smooth process, but this is an uphill battle as the blood struggles to flow against gravity through tired veins and venous valves. This is when things can start to back-up and the fatigue, pain, and swelling begins as the lactic acid and fluid continues to build up in your feet and leg muscles. It’s important to keep this process moving along effectively. This is where compression socks come to the rescue.

    Compression socks are designed to provide graduated compression, higher compression at the foot and ankle and decreased compression moving up the leg. This type of constant graduated compression works to assist the unoxygenated blood flow up the leg against the force of gravity and back to the heart.

    Compression socks come in different grades, depending on the degree of compression (in mmHg) at the narrowest point of the ankle. It is usually recommended to select the highest grad sock you are able to tolerate. Grades include Light Support (12-14 mmHg), Moderate Support (20-30 mmHg), and Therapy Support (30-40 mmHg).

    At the recent Emergency Nurses Association Conference in St. Louis, we had the pleasure of talking to Kelly Krumplitsch, President of ATN Compression Socks. She explained the importance of measuring the ankle and calf circumference to get the proper fit.

    Kelly says that the ATN socks which are all 20-30 mmHg provide the following benefits:

    • Minimize the risk of DVT during air travel
    • Clinically effective in increasing circulation
    • Decrease muscle soreness and fatigue
    • Manage pain associated with varicose veins
    • Clear lactic acid for quicker recovery
    • Help manage edema when you are on your feet for extended periods of time
    • Great for athletes
    • No more achy legs

    Watch this video to hear more about ATN Compression socks and to view the fabulous designs. I bet our grandmas would love these! Might be a great Christmas present for yourself, Grandma, or your favorite athlete. Check out the website for current specials.

  • Oct 4

    Just wanted to add, for anyone reading ... if you or someone you know is struggling with thoughts of suicide, please get help. That National Suicide Prevention Lifeline number is 1-800-273-8255.

  • Oct 4

    I am so, so sorry for the loss of your friend and coworker. I have experienced this too, and I know it's easy to beat ourselves up and wonder what we could have done, how we missed it ... that answer is that it is NOT our fault. Ever. *hugs* This is going to be a tough loss. You know about the stages of grief, and that the way out is through. Lean on your work family and celebrate your memories of this member of your family. We really do bond, and you're right - people don't always understand it. But being in what is often a pressure cooker for 12 hours at a time with these folks, it really changes you together. People who haven't been there won't ever really get it.

    Please, please, please - stop beating yourself up. And please don't keep those feelings inside - if you have an employee assistance program (EAP) at your hospital, make use of it. Use your resources, and help each other through this time.

  • Oct 3

    Well...the title says it all: when do you know its time to move on? There are lots of reasons but here are some of the more common ones:

    • Poor hours
    • Lots of call
    • Low compensation
    • Too much work to do in the time allotted
    • Just don't like it anymore
    • Burnt out

    Sometimes the job isn't what was promised with regards to patient load, hours involved, call or something else. Other times, the practice might be poorly managed. Communication is always a two-way street - very important that administration has good skills in this department so that the APRNs can function in their role.

    Another issue can be collaboration with co-workers, physicians. This can happen for a number of reasons, some fixable, others not so much. If you are the first APRN the practice has hired, the physicians might not be used to working with APRNs and this can cause friction between MD-APRN.

    For experienced APRNs, its usually not one incident but rather a culmination of multiple incidents. The considerations for experienced APRNs wanting to change jobs can involve more thought as there usually is an increased comfort level that comes with years in the same position.

    Usually when you are hired into an APRN position, there is a round of interviews and sometimes a shadowing experience. Even with all of this, there can be situations that are not anticipated:

    • Speciality turns out to not be interesting to you
    • Patient load could increase to the point of being intolerable
    • Disinterest in the actual day to day job
    • Call schedule is not as it was explained pre-employment

    For more experienced APRNs, the decision to leave a long term position is difficult. You are giving up the familiar environment, familiar co-workers, physicians, and sometimes patients. You may be at the top of the totem pole with respect to pay, PTO, and other benefits. However, even for very experienced APRNs, there can be the make or break situations. can just be the culmination of several issues that lead to global unhappiness.

    Is the job salvageable? Hmmm...well if a 10% raise would convince you to stay, its worth asking for it; especially if you can prove you are underpaid. Is the call schedule untenable? Maybe negotiating that aspect of employment would keep you at your current job. Co-worker strife? Again, maybe negotiation, a frank sit down talk is in order.

    However, maybe the job is just not what to do!?'ve now made the decision to leave your position. First, find another job before quitting your current one. This can't be over-emphasized. Nothing raises red flags to HR folks more than a lapse in employment. It can appear that you are flaky, irresponsible and its just plain not smart. Don't burn bridges - it often comes back in the weirdest ways.

    Second, give plenty of notice - being APRN is not a two-week notice job for most of us. Its not unreasonable to give 30,60,90 days. It does take awhile to get someone new hired and oriented. Also, if you have a non-compete or some other type of contract - make sure you read it in its entirety to ensure you are in compliance.

    And last...leave gracefully:
    • Make an in-person appointment with your boss and tell them face to face you are leaving
    • Follow this up with an official letter of resignation; giving the date of your last workday.
    • Most important of all, thank your current employer for the opportunity to work for them and learn. you've done it!

    You've quit your current job AFTER you have obtained a new one and you are off and running and excited for the future.