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sirI, MSN, APRN, NP Admin 98,776 Views

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  • Aug 16

    This article is written in response to the query below which was posted in the thread Examining the role of a Parish Nurse. As a long time Faith Community Nurse, I hope to be able to answer this nurse’s questions fully in this article and possibly inform others that may wonder about what a congregational nurse is and what the role entails.

    Hello everyone! I am in progress of obtaining my BSN and right now I am taking a class called Community Health Nursing. One of our assignments is to conduct a short interview a parish nurse. If there is anyone willing to help me with my assignment, I would very much appreciate it!

    -Describe the nurse’s role in the community and give examples of what he/she does on a daily basis. Real-life examples should be included whenever appropriate.

    First of all, what’s with the name? The official designation by the American Nurses Association is Faith Community Nursing (FCN); other titles used include parish nurse and community health nurse. All are correct and can simply be a matter of preference for the nurse and his/her faith community.

    The ANA defines the FCN role as, "...the specialized practice of professional nursing that focuses on the intentional care of the spirit as part of the process of promoting holistic health and preventing or minimizing illness in a faith community." (American Nurses Association, 2012, Faith Community Nursing: Scope and Standards of Practice, Silver Springs, MD: Author, p1).The nurse working in a faith community serves as an advocate, a resource person, a bridge between those who have needs and those who wish to serve them.

    Some examples from the particular congregation that I serve include: home visitation, card ministry, casserole delivery, prayer shawls, free mobile unit health care once a month, grief recovery, support group for caregivers, blood drives, dental clinic, haircutting salon and many others.

    In day-to-day practice, the outreach of a congregational nurse spans everything from welcoming new babies to making hospice-type visits in the home. The FCN provides information, support, encouragement and links the members with any services they might need.

    FCNs work in a variety of partnerships. Some are totally volunteer; others receive a stipend and still others are paid a regular nursing salary. Some are part time and others full time. Hospital systems can be sponsors for FCN programs or they can originate in the church.

    -Identify how and who the nurse(s) would work with for coordination of services to provide a comprehensive health program in the community.

    At my church, I work with a large group of volunteers. They actually implement the outreach efforts—I encourage and coordinate. I also work as a liaison with the medical community, helping people understand their diagnoses, assisting them in finding ways to get to tests and doctors’ appointments. Sometimes when parishioners are in the hospital, I work with the case managers and families to make sure that everyone understands what the plan is, thus avoiding unnecessary repeat hospitalizations.

    -How would the nurse utilize a population-based approach in his or her role?

    A FCN must continually assess the needs of the particular congregation that she/he serves, deciding where to expend energy and time. In my particular situation, I meet with a Congregational Care Team and they help me plan what we will be focusing on each six months.

    -Does this role include assessment and screening of individuals, families, or groups? If yes, please include examples.

    We do routine blood pressure screenings as well as occasional special event screenings, measuring parameters such as BMI, height, weight, waist circumference, body fat composition. When visiting our “at home” members, or our members long term care facilities, I do brief assessments—always noting changes and progression.

    -What health education responsibilities does the nurse have in the community?

    The FCN often serves as an information source as well as a referral person, helping people to connect with the medical community as needed. She can answer questions about services surrounding rehab, home health, hospice, nursing home care, assisted living and a variety of other living arrangements for people with physical needs.

    At times, the nurse coordinates with others to help promote programs that might be of interest, for example: grief support, advance directive preparation sessions, caregiver helps, etc.

    -Does this nurse work with a vulnerable population? If so describe.

    Many congregations have a sizable population of elderly. At our church, I work hard to keep an updated list of our at risk elderly. I try to connect those that have needs with people that want to be of service. In this way, I can serve as a bridge.

    -Describe an ethical dilemma that this nurse has faced and describe how you would have handle that situation.

    The most common ethical dilemma many FCNs face has to do with confidentiality. When working on a church staff there is a need to share information that is helpful but not private. It is important to constantly draw that line at the point of confidentiality.

    -How important would record keeping and documentation, including computerization be for a nurse in this role?

    Different nurses have different strategies for keeping records. Because we are professional nurses, we do keep careful records of encounters and interventions. SOAP notes are helpful and brief. Sometimes simple narrative notes on the computer can be valuable for when another encounter is needed.

    What about you? Have you had any contact with a FCN? Are you familiar with a congregation that has one?

  • Aug 15

    As a pharmacist, I have fourth professional year pharmacy students working with me at my college (APPE stands for Advance Pharmacy Practice Experience) and those that are with me are specifically in an elective Academic rotation. In this rotation, the student learns best practices in teaching to students such that students can then teach to their patients. Part of that teaching is good board work and the gravitas that comes from putting content on the board from memory.

    These videos are Beta version videos, eventually we'll have a professional come shoot the finished products, but with the new semester coming up we thought this would be a valuable share and to see an alternative to flashcards, PowerPoints, and repeated questions.

    Drawing Pharmacology - Gastrointestinal Chapter 1, reviews the major areas of the gastrointestinal system like the videos from Memorizing Pharmacology: A Relaxed Approach also found on but 1) Adds many more medications and 2) is meant to provide a foundation for adding therapeutic pearls. It works in two steps.

    First, a student writes out the information in the video becoming familiar with the medication generic and brand names. While the NCLEX may not test brand names, patients use them often and they are also a key to memorizing the generic. Remembering generic-only makes a person test ready, but less competent to practice. This video shows that step.

    Second, a student would only put the first letters of a drug name then add the therapeutic pearls, e.g. bismuth subsalicylate causes black tongue and stool, is contraindicated in children because of the aspirin component and has the potential for salicylism and so forth. They would practice this much like a student would go through notecards, but this drawing the pictures provides an opportunity to reinforce the material and teach it to others.

    The concept centers surround drug classes. The drug classes I go over are:

    1. Antacids
    These drugs include many of the most popular antacids available over the counter. I placed them in alphabetical order because there isn't much of a distinction in generations. These medication names are unique in that the generic name is the chemical name.

    2. Histamine-2 receptor blockers
    These acid reducers include one medication, cimetidine, which affects the cytochrome P-450 system and is often the focus of many NCLEX questions. The others have that -tidine ending which also looks like "to dine" when many people experience reflux.

    3. Proton Pump Inhibitors
    The PPIs form the foundation for much of acid reducing therapy and also as a part of treating Peptic Ulcer Disease (PUD). The stem -prazole tells us its a PPI, but watch out for -piprazole which means a drug is an antipsychotic. Piprazole is one of the few stems that include another active stem, something the World Health Organization frowns upon.

    3a. Triple therapy for PUD

    3b. Quad therapy for PUD

    4. Gastric protectants
    Some medications protect the stomach from insult especially the damage from NSAIDs. One coats the stomach and the other works against the damaging effects of the NSAIDs themselves.

    5. Motility agents
    These drugs propel acid out of the stomach reducing the insult. They tend to have a number of drug interactions and have mostly fallen out of favor.

    6. Medications for diarrhea and constipation
    By placing these medications that have opposite effects close to each other it becomes more readily memorable.

    7. Medications for nausea and vomiting
    By separating those drugs that prevent nausea and those that treat vomiting as distinct, it makes for an easier visual.

    8. Medications for irritable bowel syndrome and irritable bowel disease
    While this content may not be the highest yield, it's important to understand the difference between the syndrome, a non-autoimmune condition and the disease, an autoimmune condition.

    I welcome your feedback as we work to develop this next book and series of videos to benefit pharmacology students.

  • Aug 15

    "I don't need it, Nurses are never or hardly ever sued". So, does the Nurse actually need Liability insurance? If so, why?

    A couple of questions that should be considered while making this decision would be: "Would my policy provide an attorney to defend me and reimburse me if I incurred costs ... and, "Would my policy include coverage for any disciplinary action taken by the Board of Nursing?"

    What do you think?

    Does the Nurse really need his or her personal liability protection?

    Do you have one? And, if so, what was the main reason you obtained a policy?

    Want more nursing cartoons? Visit Nursing Toons / Memes

    Thanks to cardiacfreak for the caption. Winner of our July 2017 Caption Contest!

  • Aug 13

    I fell in step with my friend Terry, as he walked down the hospital hall carrying big bags of peritoneal dialysis fluid. Arms full, he responded to my question about where he was headed, indicating a room near by. “Just getting that patient all set up.” When he finished up, we talked for a few minutes, and I asked more questions about being a dialysis nurse and what was involved.

    How did you get into the field?

    I started as an aide and worked my way through school. Once I became an RN, I worked in the ICU, the PACU, the ER and even wound care before starting to work the hemodialysis unit in the hospital. I eventually moved to outpatient dialysis where I now supervise and coordinate the hemodialysis center along with the home peritoneal dialysis (PD).

    What do you recommend for someone that might be interested in working with dialysis patients in some capacity?

    Start out by getting some critical care experience—that is sort of a good starting point. It’s really a great field for people who like or need stable hours—especially the dialysis center work. Many places you can start early and finish up early. It requires staying up-to-date with continuing ed. And the pay tends to be good. There are clinical ladders, special certifications and a variety of ways to move up. It’s also an ideal field if you enjoy seeing the same patients repeatedly and getting to know them. With the hemodialysis centers, patients come in three days a week and often you can really get to know them long term.

    What are special challenges for nurses working in the hospital hemodialysis centers?

    In the hospital, you have the patients who are already on dialysis that need to have their treatments while receiving care for whatever their diagnosis is, and you also have patients who have emergent needs related to trauma. These short term dialysis treatments can allow that injured kidney to heal and hopefully, it doesn’t turn into a chronic dialysis situation. As you would expect, when patients are sicker—as they usually are in the hospital—everything is more complicated and requires the nurse to be on top of a more critical situation.

    How long are patients usually on dialysis?

    It can be for a number of years. It really depends on them and how compliant they are with their diet and fluid intake and other metabolic parameters. We see our patients in the center three times a week and our home PD patients two times a month. If they are compliant, they do well. Otherwise, you watch them fade away. But it can be as much as 20+ years. We keep track of their fluid, potassium, phosphorus, calcium, blood chemistry and other co-morbidities such as diabetes or hypertension. The main thing sounds simple but is so true: they have to keep showing up. That is really hard to do long term. A certain chronic fatigue with the whole process can set it. And, of course, we always work toward the ultimate cure for dialysis: the transplant—helping them get where they need to be so that can happen.

    [According to the latest U.S. Renal Data System Annual Data Report, more than 660,000 Americans are being treated for kidney failure, also called end stage renal disease or ESRD. Of these, 468,000 are dialysis patients and more than 193,000 have a functioning kidney transplant.]

    Since Medicare pays for hemodialysis and they are encouraging more people to change to home dialysis. What is that like for patients?

    Patients can do very well. Often it depends on if they have a caregiver or health partner situation that is positive. The more support they have, the better they will do with any type of dialysis. We do CAPD (continuous ambulatory peritoneal dialysis) and CCPD (continuous cyclic peritoneal dialysis) more and more often; we are also moving into home hemodialysis and that has been increasingly popular for patients. Home dialysis can be significantly cheaper—maybe 40% cheaper—and also more convenient for patients. But whether or not they are good candidates for it really depends on many factors.

    With CAPD, sometimes patients can develop a fistula or a membrane failure and will need to take a break from that routine.

    With home hemodialysis, it takes 2.5-3 hours and 45 minutes setup and take down each time. They do it 5x per week instead of 7x for CCPD.

    What would you want to tell a nurse that is considering entering the field of dialysis nursing?

    It’s a little intimidating and technical at first. But as with most nursing jobs, after a while, it becomes familiar and more accessible and less stressful. Working in this field we have special infection control concerns, especially with the amount of body fluid that we are always around: potential exposure is always a risk. The work involves being on your feet a lot and we are always, always teaching. Each visit, whether in the center or at home, we are going over access care, infection control, diet, fluid management.

    Learning more about nursing in the dialysis field brings up questions about others’ experiences in caring for patients with kidney disease. If you work in this field, what is that that you love? What is particularly challenging for you? Would you encourage other nurses to pursue training to become dialysis nurses?

  • Aug 12

    When you make the decision to launch a side hustle, you are buzzing with excitement. When I launched my writing career, I could not contain my joy in anticipation of this amazing business. I imagined myself spending my days playing with my daughter, writing during her naptime, and making more money than I did as a nurse. The amazing thing is, that IS how I spend my days now. It took time to get to this point, but it was worth it.

    The downside is that there is a long murky middle period. You’re still working your full-time job while building up a completely new business, and probably feel like you’re losing your mind most of the time. Self-doubt and overwhelm become your constant companions, and you can’t help but wonder if all of this work and time are going to pay off.

    Over my career transition the past five years, I’ve learned that the secret to creating something new is focus. Keeping a positive focus on your business will help move you forward even when you feel like quitting.

    Commit to a schedule

    The first step to launching a business is taking it seriously, and that means devoting regular time and energy to it. When we decide to work on our business “whenever we have time,” that time never comes. You are busy with work, family, school, and other obligations. If you want to grow a sustainable business, you have to start taking it seriously from the very beginning.

    Every weekend, look at the week ahead and make a plan. Maybe you will decide to wake up 30 minutes earlier every morning or devote your lunch break (what’s that?) to building your business. It doesn’t matter if you only have 15 minutes per day to work on your side business. If you commit to those few minutes and accomplish one task, you will move forward and achieve your goals.

    Ignore the naysayers

    Here’s a little secret that all new business owners face. Your loved ones will probably discourage you from trying. It doesn’t mean that they don’t believe in you or don’t support you. They simply may not see your vision and just don’t want to see you disappointed.
    When I told my husband that I was going to leave nursing to launch a freelance writing career, he was less than thrilled. I knew he believed in me, but he had never seen a nurse writer before and didn’t know if this was possible. He didn’t want me to get my hopes up, only to waste all of my time and energy.

    But here’s the thing. Starting a new business is a gamble. There is no such thing as guaranteed success, but that doesn’t mean it isn’t worth trying. If your family and friends are not on board yet, just don’t talk about your business with them. Talk to people who have done it before, and don’t sweat the people who haven’t.

    Envision your future

    Because building a business can be a long, challenging road, it is crucial to stay focused on what you want and why you want it. Create a clear picture in your mind of what you want. If you can’t stand working every other weekend, imagine the time freedom that your business will bring you. If you are hoping your side hustle will bring a higher income, imagine what that money will mean for you and your family.

    Spend a few minutes each morning visualizing your future. This will keep you focused and motivated, even on the toughest days.

    Look for people who have done it before

    As the motivational speaker Tony Robbins says, “Success leaves clues.” Actively seek out nurse business owners who have successfully done what you’re working towards. You could reach out directly with questions or simply follow their journeys. Pay attention to the kind of content they are putting out. Read interviews with them to learn their success strategies. You don’t actually have to meet someone for her to be your mentor.

    Be kind to yourself

    When you’re working towards a goal, it’s easy to get caught up in everything you don’t know and haven’t accomplished yet. I still constantly find myself comparing myself to more established nurse writers, rather than appreciating how far I have come.
    Make sure to take time to take care of yourself during this process. If you burn out from exhaustion, there will be no business, so prioritize self-care. Take days off. Go for a walk in the sunshine. Write down 10 things you are grateful for. Take exquisite care of yourself so that you can pour that energy into a successful business.

  • Aug 10

    Review done! My college experience was absolutely exceptional! Unfortunately, there are those students who were not prepared or motivated for online learning and as such, did not succeed in the program. It is my strong belief that the complaints of these students contributed somewhat to many of the recent changes that the program has undergone. Not everyone will fit in every situation. But as sure as the sun will rise tomorrow, those program-specific 'unfit' students will cry "FOUL!!", and a method that has been tried-and-true for DECADES will be forced to change its operations.

    Sadly, some of those same folks couldn't handle the changes, either. If 'one' was part of an old program and could not succeed, but then became part of the new program and still could not succeed, then the problem must be within the 'one'. Be careful what you ask for...

    Just my opinion..

  • Aug 10

    Do you remember how difficult it was deciding which nursing school to attend? How difficult it was to find feedback on costs, instructors, and academics?

    There are many who are going through the same thing you did.


    It doesn't take much - just 1 minute of your time can go a long way.

    Your feedback is valuable.

    ↪ Submit Your School Review Today!

    As you grow expectations are different so we recommend you submit separate unique reviews during your journey.

    You can review any school as a Pre-Student, Student, Alumni, Parent, or Employee.

    We know privacy is important so Anonymous reviews are allowed.

    If your school is not listed please leave a request at

  • Aug 9

    Social media

    The use of social media and other electronic communication is expanding exponentially; today’s generation of nurses grew up in a social media milieu.

    Social media provides wonderful online communities for nurses to post and interact. I myself have met amazing colleagues on Twitter I would not have otherwise met. I’ve been on Twitter as @bhawkesrn since 2009 and thankfully never violated HIPAA or posted an over-the-top rant.

    Thankfully because social media is far reaching and nothing can be easily and permanently deleted once posted.

    Poor Judgement

    Lindsay posted a picture of herself on Facebook at a party showing a lot of side boobage.
    It was shocking and hard to reconcile the image of her as a responsible nurse in scrubs with a blatantly sexy picture. Of all the hundreds of images she posted, this may have been most memorable. She took it down, it stayed up only 24 hours, but the damage was done. It’s not that it wasn’t attractive, it’s poor judgment.

    Sheila posted in a large Facebook group that she was looking for a job… because her nurse manager played favorites...unfortunately her nurse manager was tipped off by someone in the same group. It can blur the lines and pose a risk when you friend your boss on Facebook.

    I’ll never forget an ED nurse I knew personally who took a picture of a tattoo located on a patient’s genitalia- what was she thinking? “I’ll never see something like this again, I have to get a picture and show my friends”? To make it even worse, there were four other employees in the group and no one said anything. Until later, when one nurse was bothered by the incident and spoke up. She reported it to the manager, and of course, the nurse was fired.

    My heart goes out to this patient who trusted himself in our care and was taken advantage of.

    Katie Duke, a popular nurselebrity, starred in a medical reality TV show a few years back, ABC’s New York Med. As a nurse in the ED, she dealt with trauma and death every day.

    One day she posted an image on Instagram of a room after a code in a trauma room. A man had been hit by a train and had been treated in this room. If you’ve ever been in a code, you can picture the scene.

    The gurney is gone, leaving a clean floor space in the center of the chaos. The room looks as if a bomb went off, with paper wrappings thrown on the floor, discarded supplies, maybe a bloody get the idea.

    It was an evocative picture but did not reveal any patient information of any sort. Even though she did not violate any HIPAA laws, she was fired that same day from New York Presbyterian Hospital, where she had worked for seven years, being insensitive. Katie claims that the image was taken by a doctor, although shared by her, but that the doctor was not reprimanded.

    I’m sure she suffered a lot afterwards and regretted her choice.

    Other examples include nurses posting X-rays on Facebook, employees taking shots of residents in nursing homes, and posting without consent. Sometimes an employee will only receive a warning at work but typically these violations are not taken lightly, and the current trend is to be terminated.

    Impulse and Anonymous Posts

    Impulsive posts, venting, inappropriate humor...we see it all the time on social media. Remember humor doesn’t always translate well in text and can backfire.

    I have been on social media for many years, but never as anonymous. It was a boundary that kept me in check especially when I wanted to vent, and it prevented me from using bad language or making other poor choices.

    My rule is to only post whatever I’d be OK with my mother reading and seeing. If I hadn’t done that, I could easily have sabotaged my own career down the road. I would not have been able to become a nurse author and write a book, I’m sure.


    As professionals, we must never breach hospital policy or violate the Health Insurance Portability and Accountability Act, a law known as HIPAA, that protects patient privacy.
    Most facilities have social media and patient privacy policies in place- be sure and read yours.


    The American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN®) posted a joint statement on professional responsibility in social media. have mutually endorsed each organization’s guidelines for upholding professional boundaries in a social networking environment.

    According to NCSBN Board of Directors President Myra A. Broadway, JD, MS, RN:
    “Nurses must recognize that it is paramount that they maintain patient privacy and confidentiality at all times, regardless of the mechanism that is being used to transmit the message, be it social networking or a simple conversation. As licensed professionals, they are legally bound to maintain the appropriate boundaries and treat patients with dignity and respect,”


    Inappropriate posts on social media can get you kicked out of nursing school, fired, or not hired at all.

    If you think only your “friends” see your postings, remember that curious hiring managers can simply google your name and check your online presence and postings with little effort.

    Protect your online presence and if you question whether you should post something- you probably shouldn’t.

  • Aug 8

    The day has finally arrived! I am done with my first semester of FNP school! It seems like it was just yesterday that I was excited to start on this journey, and in a blink of an eye my first semester is over! In this weeks vlog I give quick overview of my impressions and experience so far in FNP school.

    Highlights include:
    - Semester highs and lows
    - Semester grades
    - Will there be a semester 2 of Follow Me Through Grad School (#FMTGS)?

    I hope you enjoy Follow Me Through Grad School Episode 113: Semester 1 FNP School Wrap-Up. Thanks so much for watching all semester! Don’t forget to like, comment, share and subscribe!

    Until Next Time,

    Bizzy Bee Nursing

    Fuel you passion. Fulfill your purpose.

    If you want to catch up on previous episodes, just check the link below:

    BizzyBee's Nursing Blog

  • Aug 8

    Quote from sirI
    Hello matthewandrew

    THANK YOU for the suggestion. Great idea.

    The forum now has a new name: Hospice/Palliative Nursing
    You are amazing!!! Thank you for applying my suggestion!

  • Aug 5

    As nurses, we know that nurse burnout pervades the profession. Insufficient staffing, long work hours, phone calls to come in to work on your days off, and a growing nursing shortage all contribute to nurse burnout. Sounds ominus, doesn’t it? So given the cards that are stacked against nurses, is it inevitable for every nurse to suffer from nurse burnout in their career? Below are some tips and tricks to halt nurse burnout in its tracks before it gets a firm hold on you!

    Stop with the Brave Face and Admit There is Something Wrong. When nurses are on the job, we put others’ needs before our own; frequently not even stopping to go to the bathroom. But when we constantly push down our needs for a break or won’t admit to ourselves (or others) that we’re overworked and overstressed, we’re setting ourselves up for failure. Nurses in direct patient care face tough jobs at the bedside. Stretched thin through insufficient staffing, nurse-to-patient ratios that are unsafe, patients with so many co-morbidities that it’s impossible to address them all -- nurses’ stress levels don’t just put nurses’ mental and physical health at risk, they also put the patient at risk.
    The most effective way to deal with burnout before it becomes a problem is to talk to someone. The department manager or nurse supervisor is the first stop. Yes, they have heard complaints about nurse staffing before, but management can’t help a nurse suffering from burnout unless it’s known to them. Every facility handles nurse burnout differently, and some, unfortunately still have no programs in place to help alleviate the burnout problem. The first step in addressing the problem, in any case, is to speak up.

    Second Line of Defense: Relationships with Coworkers. In the event that a facility lacks a program, plan, or resources to alleviate nurse burnout, the relationships that nurses have with their co-workers can often relieve some of the more detrimental effects of nurse burnout. A nurse friend of mine never dreamed she’d ever been a person that fished (yes, I mean with a fishing pole and a tackle box), but after learning that so many of her coworkers got together on off days to go fishing and raved about how much of a stress reliever it was, she decided to give it a try. She said that dark cloud she felt constantly hanging over her head at work was suddenly not so dark after all. All the normal work stressors were still there, short staffing, sicker patients, but she didn’t feel they weighed so heavily on her because she felt closer to her co-workers. She felt there were people who had her back.

    Engage in mindfulness and take a pause. When work and life in general becomes too stressful and nurses know they are burned out, it is time to take a pause and look at the big picture. Quiet time -- when there is no “mind” noise from technology, family, patients, but just time to breathe in and out and be quiet -- creates a space to be able to see problems, possible solutions and even long-held desires for the nursing career you’d dreamed of having. It may take some practice to see what you wanted when you began your nursing career and what you need to do in order to get it back on track. Approach the situation looking for possibilities. The path to get to the goal(s) may be reveal itself in time, or you may know immediately the steps to take to get there.

    Let go of what no longer serves. If you’ve been a night shift nurse your entire career and now you need to transfer to the day shift, ask to be switched. If you’ve had your fill of your nursing specialty and think a change may refresh you, check the job board at your facility. If your normal stress relieving activities are no longer working, try new tactics. Even simply taking up a new hobby or sport can refresh your mind and stop the overwhelm from overtaking you. In the same vein, if you haven’t had made time to engage in your favorite hobbies or activities, schedule them on your calendar like an appointment. And then, keep the appointment. You’d do it if it were a doctor appointment or one with your child’s school, right? Give appointments with yourself the same respect and reverence.

    Watch ants. I don’t mean that you have to literally watch ants, just observe nature. Whether it’s watching ants build an anthill -- something you may have done as a child -- or a spider build a web, or simply noticing the different shapes clouds make. When you’re observing this amazing planet, it’s tough to think about all the stressors at work. Taking a few minutes or hours in nature helps us slow down the world a bit and take a look around. I’ll bet there may be a few places that you used to go and enjoy spending time in that you haven’t seen for a while. Could you schedule a date on your calendar to revisit one? Take a friend or loved one who has never been there and make a new memory. Sometimes in all the stress swirling around us, we forget to notice some things that have been missing for a while. Reconnecting with nature or a favorite place helps us fortify ourselves against burnout and as stated above, helps stop it in its tracks.

    OK, so what did we miss? If you were talking to a nurse who was looking for answers on how to deal with stress what would you tell them? What are some other ways to cope with and shift nurse burnout?

  • Aug 5

    Change is a constant in the nursing profession. However, it can be difficult to maintain professional flexibility in a field with ever changing policies, procedures, and daily routines. Many changes are usually evidence based these days and meant to improve the safety or effectiveness of patient care. With that, most nurses are usually on board and willing to comply despite the discomfort. When leadership demonstrates support and an openness to feedback from staff, it can make or break a new policy change. This is especially true when trying to implement multiple changes in a short time. When staff feel supported and able to voice their difficulty in adjusting to new challenges they are more willing to push through and make it successful. Everyone likes to feel like they are part of a change for good.

    With nurses pulled in so many directions, being asked to do more with less, frustrations can reach an all time high quickly. Nurses are held to incredibly high standards daily. There is no room for error when handling another human's life. It seems despite our best efforts to always do our best we are constantly told what we could do better - and that can be disheartening over time. We are told, “lower infection rates, increase patient satisfaction, eliminate error rates in specimen collection, increase documentation” and more. Can we handle all of this? Yes.
    Yes we can, just not when paired with lack of staff. The virus grows…

    Nurses are resilient. Somehow you find yourself and others banding together, making it work. But now, vacations are being denied. You’re constantly being asked via email, text, phone and facebook if you can cover or pick up shifts - either to help your struggling unit stay afloat or allow your fellow comrade attend an event away from work. Discontent continues to grow. You can see the virus spreading; lunch breaks turn into vent sessions, staff meetings are uncomfortable, your peers look tired and as you walk the halls you overhear complaints at every turn. It’s everywhere. Coworkers begin to talk about finding other work. Some leave. This only increases the issue at hand, especially if the all mighty budget ‘can’t support replacing staff at this time’. Puss is starting to form around this growing wound…

    Desperate for an antidote you look upward to your leadership and administration, hoping for a swift recovery. Have they noticed the rampant spread too? Maybe this virus doesn’t grow past the patient ridden halls and call bells, unable to be seen behind a closed office door. Too weak individually, feeling quarantined and isolated the infected begin to voice their concerns as a whole. Here’s where either the cure comes or death is near...

    There is no doubt that on an unit such as this leadership is feeling the pressure too and may likely have their hands tied from those above them. An unfortunate middle man expected to become a shaman with potentially limited resources. But going back to the principles above, simple acknowledgement of discomfort and support of staff frustrations can go a long way. Morale can be a difficult thing to pick back up if the issues at hand are unable to be fixed in the foreseeable future. Difficult but not impossible, there are a few ways around it:

    • Host a pep talk instead of another meeting (letting staff know leadership is aware and commending staff on their survival skills and hard work thus far)
    • Discuss ideas for how to work together with staff on scheduling/vacation requests (instead of just denying with no remedy - as being denied much needed time off on an increasingly stressful unit only increases burnout more rapidly)
    • Suggest/help staff plan a night out (a way to blow off steam, increase rapport and maybe even have a little fun)
    • Collaborate with staff on the issues causing low morale (otherwise, if this looming virus is left unattended, staff simply become more & more disengaged over time, unable to exert any more energy and will eventually go elsewhere to work in a disease free setting)

    Working on or leading a unit with low morale is trying for all involved. Ultimately it helps to remember that all parties usually just want to be heard, acknowledged and improve current conditions. There is no roadmap to chart this course. No perfect elixir or antibiotic for curing the lingering virus of low morale. When everyone demonstrates open, honest communication with transparency, a more collaborative environment can begin to heal itself.

  • Aug 3

    Let me start by sharing my story about aging. Since I was 30, I have been exercising regularly and living and breathing wellness after transitioning from bedside nursing to working in the preventive health field. That was a turning point in my career and how I viewed what being healthy was all about. This has really paid off for me as I have been aging.

    Most people I know, as they age, start the deterioration process – a slow decline into what they think should be happening because the numbers are piling up. In my case, I have embraced health practices as a way of life and now at 72, people are amazed that I am actually that old. It just doesn’t show up in my body, mind, and spirit. And in my mind, I still feel like I’m 35!
    So let’s explore what might be going on for you and challenge some of your assertions.

    Mind talk

    I am as old as I feel and I feel very old, worn out, frustrated and negative about my work and my life and don’t think I can do anything about it.

    FALSE: You can change your attitude from negative to positive and extend your life and feel better about yourself when you lengthen your telomeres. Telomeres are segments of DNA at the end of chromosomes (like tails) that keep the chromosomes from fraying or damaging each other. Each time a cell divides, its telomeres get shorter until they become inactive or die. Negative thought patterns effect the length of your telomeres which are an integral part of the aging process.

    Here are the attitudes to watch out for that shorten telomeres and lead to premature aging.Do Thoughts Make You Age Faster? 5 Ways They Could - Dr. Axe

    1. Cynical hostility - often angry, mistrustful of others
    2. Pessimism – glass always half empty
    3. Rumination - rehashing arguments or dwelling on whether what you said was wrong
    4. Suppression – holding back your thoughts and not dealing with a problem.
    5. Mind wandering – not giving full attention and being mindfully engaged

    TIP: Practice Mindfulness and Meditation and consider EFT (Tapping) to shift from negative to positive energy flow.

    Body talk

    Everyone in my family is overweight, has heart disease, has cancer, or fill in the blank for you _______________ so it is my destiny genetically and I can’t do anything about it.

    FALSE: We now know from EPIGENETICS that your environment and lifestyle choices can alter the expression of your genes into over-riding negative health effects and favoring positive health outcomes. We also now know that inflammation is the root cause of most all chronic diseases, and it is due to a growing list of factors.

    • Sugar, refined carbohydrates
    • Trans fats
    • Too much omega-6 fats (soybean and corn oils)
    • Artificial sweeteners
    • Hidden food sensitivities (dairy, gluten)
    • Imbalance in gut bacteria
    • Environmental toxins
    • Chronic stress
    • Sedentary lifestyle
    • Nutritional deficienciesJust ponder this list and decide for yourself if any of these factors have contributed to your perception of your state of health as a nurse. Also note that all these factors that are making us sick are within your control and you can turn things around for the better. Even Metabolic Syndrome and Diabetes has been shown to be reversed by adopting healthy lifestyle choices.

    TIP: Exercise daily at the end of your work day to burn off stress and excess weight. Avoid eating food provided at work and bring your own healthy low-glycemic meals and snacks.

    Spirit talk

    I continue to work in nursing because it is my calling, but I am not feeling fulfilled because of all the turmoil in healthcare and not being able to really do the kind of nursing I originally wanted to do. Things have changed, I’m not happy, my spirit is dying, but I have to stay in this job for the money and the benefits.

    It is your birthright and a spiritual principle to be happy and live a fulfilled life. Living daily with negative thoughts takes its toll on your wellbeing and ages you prematurely. You are in control of your destiny and if you can’t leave your job or re-create a new direction for your nursing career, you can change your focus to why you were put on this planet to administer to the needs of others and be grateful for the opportunity that has been given to you.

    Create a gratitude list at the end of each day to put everything back into focus.

    So creating a youthful mindset to carry you thru your long life really pays off! Those who feel younger than their actual age have reduced mortality.

    Feeling Old vs Being Old | Geriatrics | JAMA Internal Medicine | The JAMA Network

    Who doesn’t want that?

    So how old do you feel? Is it older or younger than your chronological age? And what have you done in your life to alter that? Please share.

  • Aug 2

    Violence in Nursing

    When Ashley became a nurse, she dreamed about helping patients and relieving suffering. She never thought she’d be hurt, much less attacked. Her second day on the job, a patient threw a heavy tray across the room, splashing her with orange juice and bits of scrambled eggs. The tray hit a nearby wall, narrowly missing her ankles.

    The reason? “I told you I don’t like scrambled eggs!!”

    She froze, stunned and speechless. Nothing in her upbringing or training had prepared her for this. She could not understand why a patient who was receiving care (in this case, free care) would be abusive and not appreciative.

    The news has reported several horrific incidents of late. Recently a nurse at Delnor Hospital/Northwestern in Geneva IL was taken hostage in her own hospital on May 13, 2017.

    In another incident, also in Illinois, on June 6th at St. Joseph's in Joliet, an inmate used a makeshift weapon to take a nurse assistant and a guard hostage.

    On June 4th at Amita Medical in Bolingbrook, a nurse in the ED was punched in the face by a patient.

    We all heard of the incident that occurred in a New York hospital June 24th, where the perpetrator was a disgruntled fired physician (resigned due to alleged sexual assault against colleagues) who brought in an assault rifle, killing one physician and wounding 6 others.

    Type II Violence

    Abuse can include yelling, cursing, scratching, spitting, hitting, kicking, and verbal threats. Patients with behavioral health problems, alcohol intoxication, substance abuse, prolonged waiting times in the ED- all can contribute to violent behavior.

    Called type II violence, there is an epidemic of patient/visitor perpetrated violence towards nurses. Nurses (and nursing assistants in particular) are at highest risk for being injured through workplace violence.

    Hospitals have become hazardous workplaces. The ED setting, in particular, is prone to violence. Cognitive impairment and demanding to leave are documented causes as are situational catalysts such as the use of restraints. There’s extremely high stress, a dynamic workplace, and the violence can come from family members, or patients desperately seeking drugs.

    Increased Incidence

    “B****!” Where’s my pain medication?!!” The vast majority of nurses have been subjected to verbal abuse.

    In 2015, OSHA reported patient handling and workplace violence injury rates were highest in inpatient adult wards; these rates were also elevated in outpatient emergency departments, urgent care, and acute care centers and adult critical care departments.

    Culture of Acceptance

    There’s a culture of dismissing and minimizing violence towards nurses. Nurses believe in “doing no harm” and will put patient safety before their own.

    Teachers are not expected to tolerate violence. If the same patient who yells and hits a nurse acted out similarly in the DMV, in court, or even at a fast-food restaurant, they’d most likely be arrested.

    Culture of Non-Reporting

    There are barriers and attitudes towards reporting. Nurses themselves under-report violence. Nurses fail to report, believing it is just part of the job, and that managers may be non-responsive.

    Staff are not clear on what to report, or how to report it.

    For all these reasons, often traditional industrial injury reporting is bypassed in patient/visitor to worker violence. Organizations do not encourage reporting; they encourage a lack of reporting.

    Support and Safety

    What support is there for a nurse with an abusive patient? Not much. She can wait until the violence has escalated and call security. Security is often not well trained and I’ve seen them at a loss; well-meaning, but at a loss.

    In Ashley’s case, she called security, who responded and alternately tried to pacify the patient (egg and orange juice were still splattered all across the floor) and admonish him. The admonishment was in a “Hey buddy, no more of this naughtiness, OK” in a male-bonding manner.

    What’s Needed

    • More training for staff to recognize impending signs of violence. There are effective methods to mitigate escalating violence but they must be taught. In some states, OSHA requires training for staff working in violence-prone areas such as ED and Labor and Delivery
    • Legislation. Thirty-two states have made it a felony to attack nurses. Nurse need protection and support.
    • A zero tolerance for violence. Nurses are conditioned to accept violence.
    • Workplace violence surveillance to determine where interventions and resources need to be employed. Employers have a duty to provide a safe workplace for staff and patients.
    • Increased security.
    • Staff support and debriefing after a violent incident.
    • Encouragement of reporting. It should be clear that the expectation is to report violence and to clearly define the boundaries of unacceptable behavior.
    • *Public education about the proper use of emergency rooms.

    I believe employers have a responsibility to provide a safe workplace. Not everything can be prevented, but it seems the signs are clear that violence against nurses is escalating. What do you think will help?

    Occupational traumatic injuries among workers in health care facilities—United States, 2012–2014. Health Care, 2012. Retrieved July 24, 2017 Occupational Traumatic Injuries Among Workers in Health Care Facilities — United States, 212–214

  • Jul 28

    Marian Altman RN, MS, CCRN-K, CNS-BC, ANP is a Clinical Practice Specialist at AACN (American Association of Critical-Care Nurses) who works with the AACN Clinical Scene Investigator (CSI) Academy, a 16-month nursing leadership and innovation training program to empower hospital-based staff nurses as clinician leaders and change agents whose initiatives measurably improve patient outcomes and hospital bottom lines. CSI projects have dealt with Behavioral/Psychosocial, Cardiovascular, Infectious Disease, Pulmonary, and Patient Safety Issues.

    Marian facilitated a series of sessions at NTI focused on how to impact change on your unit, particularly as it relates to implementing evidence-based knowledge or best-practices.
    Some of the topics covered were

    • Key concepts of a change project.
    • Team roles and their impact on project outcomes.
    • Social entrepreneurship and how to apply the concepts to a nursing change project.
    • How to apply the steps of Kotter's Change Theory to a nursing change project.
    • Components of an Influence Map and how to apply to a project.
    • The difference between process and outcome measures and how they relate to clinical outcomes and change initiative.
    • How to quantify the fiscal impact of a practice change.
    • How to apply components of a logic model and drill down plan.
    • Redosing strategies that lead to sustaining a change project.
    • How to scale a project to another unit, hospital-wide or system-wide.
    • Methods to disseminate project outcomes.
    • Components of innovative project management.
    • How to develop, plan and implement an innovative project that targets a patient/family or clinical outcome on the unit.
    • Using tools from the CSI Academy to create measurable improvements in patient/family, clinical or organizational outcomes.

    In a recent NTI allnurses interview, Marian Altman answers the following questions:

    • What is a change agent?
    • How can nurses be effective change agents?
    • What are some challenges or obstacles to accepting change?
    • What are some important skills nurses learn in the CSI Academy?
    • How can nurses use innovation to create business opportunities that benefit patients?
    • Define social entrepreneurship and describe how to apply the concepts to a nursing change project.