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Sarah Matacale

Sarah Matacale BSN, RN

Clinical Documentation
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Sarah Matacale has 20 years experience as a BSN, RN and specializes in Clinical Documentation.

Sarah Matacale's Latest Activity

  1. Well Kiss My Grits Flo! Hurricane Florence: A Tale from a nurse in Eastern NC I stole this title from a boarded-up restaurant window that I saw today in our small town in Eastern North Carolina. If any of y'all (see how I did that..y'all) have ever read my articles, you know that I am a nurse and my husband is a doctor. We have 3 young kids and are transplants (over 20 years ago) from the northeast. Yankee's as we are lovingly and no-so-lovingly (at times) referred to down here. Growing up, we both had snow and ice to contend with....lots of it. We are experts at getting to work, school etc in winter conditions. We know how to prepare for such...when to prepare and with what. We both practiced medicine there and know how emergency personnel will get you to work if you can't get yourself there. When you get to the hospital, you better plan on staying...indefinitely. That being said, we have weathered through some serious hurricanes and tornadoes here in North Carolina, however, nothing compares to this baby named Florence. She has set our state and several others in a widespread panic. We have been watching Florence casually for about 10 days, I am guessing, to see what she might amount to. Hurricanes are not unfamiliar here. Anytime you have a "season", such as hurricane season, and the storms get a name, you know it's a pretty regular thing. People down here know their storms. They can track a storm, know the wind patterns, surges and flood zones with more accuracy than the IV team placing an 18 gauge. They know their local weather person by name (good ones and bad). They will smack talk about another person's trusted forecaster like they are college basketball players, and each "storm-watch" day facebook lights up with memes of the local weather celebrities. So, when the locals tell you it's time to worry as they compare the storm statistics of Florence to a catastrophic storm tale from the 1950's, you know you know it's time to get serious. As serious as a post-op patient with decreasing urine output! Oh, and we got the National weather celebrities setting up camp at our coast...cue the memes. Thursday was the day we were told she would hit land as a category 4. We were projected to be hit by the eye of this massive storm bringing catastrophic conditions such as 30 to 40 inches of rain, severe flooding, crazy high wind and storm surges. So, Monday morning we started preparing. The grocery stores were already sold out of bread and much of their canned and boxed food. Water was sparse so I grabbed all that I could. Got batteries, food for pets, and other necessities. We just built a new house in the country that has well water. The power goes out easily here, and we are one of the last to get turned back on as we are the furthest out from the city. No power equals no water...no water also equals no toilets flushing! Yikes. Got as much water as we could by Monday night. Got all medicines refilled and emergency medications on hand for what could potentially be a week or more without power. My in-laws at the coast were on high alert on Monday. They expected to evacuate to us on Wednesday or Thursday. I bought wine....... Tuesday morning was when things got real. We started getting messages from our hospital's Emergency Response Command Center. At this point, they were offering optional time for staff to volunteer to work during the storm. They were offering to pay minimum wage for essential personnel to just stay at the hospital during "off hours". Overtime for those working extra. Our hospital hotel was preparing to house staff. Nutrition, pharmacy, IT, and materials management were working tirelessly to prepare for the influx of staff, families, and patients that would be stranded there as well as managing the communities needs. Transfers from coastal hospitals had started. Still category 4 with increasing strength possible before landfall. We get out all the emergency equipment. Get more water and canned meat! I project by the end of all of this, that we will all have gained 10 pounds yet be malnourished. How can canned meat, veggies, poptarts, and Doritos sustain us? Get a generator. Get the outside living areas ready and moved indoors. Reschedule all later week appointments. Many friends have beach houses. They head for the coast to literally batten down the hatches and move their boats and personal belongings to safety. Evacuations start to become mandatory along the coast by early afternoon. State of emergency is declared to assist with much-needed services and supplies. Both sides of highways leading away from coast get opened as traffic is bumper to bumper. Pets! Get your pets ready. People pleading for anyone inland who can take horses, chickens, goats etc. Bring dogs in. Set up plastic pools with sod in them for safe potty locations for dogs. Farmers are working non-stop to harvest their tobacco, (one of our largest sources of agricultural income here). Preparations for the crops of soybeans and cotton that were planted a few weeks before. Schools make the decision to close early Wednesday and remain closed Thursday and Friday so that families can prepare and/or evacuate as many have chosen to do. My in-laws (hard-of-hearing, judge-whoever-watchin, leave your chewed apple core on the couch arm...) have come......get more wine. Wednesday morning the weather celebrities bring a bit of good news. Overnight the storm has shifted some to the south. We MIGHT not get the eye directly, however, she is expected to stall adding strength and increasing our flood potential. Emergency resources start coming in. Urban search and rescue, medics, ambulance strike teams, swift water rescue and the national guard. Ok...now I am scared. Hospitals along the coast start to evacuate their patients inland. Our hospital is now on high alert. Any persons able and willing to work in any capacity at the hospital are requested. Those scheduled to work must be prepared to stay indefinitely. You will be fed, housed, and paid. The IWarn emergency paging systems are tested over and over. IT is preparing for probable power outages which makes patients medical records unattainable in our paperless charting world. Our ambulance and air transport teams are activated and ready. Facebook lights up with messages of stores that have water and batteries. Check on the elderly people in our lives. Make sure all friends and family are ready. The phone calls from friends and family out of state are increasing...."Where are you in relation to all this?" About 100 miles inland I say but this storm is huge, slow and powerful. "Stay safe...you are welcome here....we are praying for you". Kids are released early. The schools have been sending messages of how to help our children cope with the stress and anxiety of all this. With all of the panicky adults running around preparing for doomsday, with our constant news feed running on our phones, radio, and TV warning us of the damage to come, and the discussions at school and home about how to stay safe or evacuate in case of emergency, it's no wonder they are a mess. We all are. "Will our Nintendo switch work off the generator?"...sigh. Have cards, board games and books onhand...check! State of emergency starts Thursday night at 5p, meaning no unauthorized persons are allowed on the road, and YOU CAN'T GET ANYMORE WINE..... It is now Wednesday night. We are watching the latest on the storm. It looks quite beautiful from the space station. Massive (covering the state) and beautiful. Our sunset was particularly stunning tonight. Stars are out, air is cooler, wind is slight, bugs are less. Would be a great night to sit on our front porch in our rocking chairs....but alas, they are safely stored away. We are as ready as we can be. We now watch, wait and pray....and have a glass of wine.....
  2. Sarah Matacale

    Alene Nitzky, Ph.D., RN, OCN

    I have been blessed to interview many nurse innovators and entrepreneurs over the past several months, but none have had as unique a path that leads them to their current career as Alene Nitzky, Ph.D., RN, OCN. Her journey toward helping cancer patients, families, the healthcare system and community at large is inspiring. Her journey includes caring for and listening to her own needs and will encourage all of us to rethink how we can truly affect our patients and families. Starting the Journey At present Alene is a Registered Nurse certified in Oncology with critical care experience, but she started her career far from bedside care. In fact, she did not start out in healthcare at all but rather in natural resources. She has a Bachelor's Degree in Forestry and a Ph.D. in Natural Resources Recreation. Her doctoral program was in the health benefits of leisure. Arlene studied both the psychosocial and physiologic aspects of recreation behavior and the health benefits of leisure in the outdoor setting. She also taught at the college level in exercise science for a few years, and then started a personal training business to work specifically with older people with chronic health conditions. "While doing that, I was learning so much about their health conditions, medications, and the disease processes that I felt I needed a medical or healthcare background. I ended up going to nursing school!" Carving Her Own Niche Alene has been through the healthcare system as a patient and had a sister diagnosed and treated for breast cancer. Her father also has a chronic form of leukemia that is currently in remission. "As a family member of someone with cancer, it is hard to watch the effects of the gaps in care and information for people with cancer during and after treatment. These experiences were pivotal in making me want to do a better job for patients." With this passion for patients with cancer all along the care spectrum, Alene started her own business where she develops support programs that focus on improving the quality of life and health for cancer survivors in her community. Her work encompasses coaching individuals who are often in the phase between finishing cancer treatments and trying to regroup and regain control over their own lives again. These individuals also struggle with regaining confidence in their bodies once treatment is over. She also works with individuals who are either in the middle of ongoing treatment or have chosen palliative- only interventions. Alene states that "I teach the public about cancer at every opportunity. I write articles on topics related to how different healthcare industry practices impact cancer patients' lives, I teach classes and speak to many different groups about cancer and health concerns." Alene has developed two programs that support her mission in advocating and empowering patients at whatever stage of the cancer journey they are in. The first is called Cancer Harbors which is a six-month coaching program that addresses a comprehensive range of concerns common to many cancer patients after treatment ends. The second is FIERCE, which is a class that encourages movement and physical activity, and introduces cancer survivors to different therapeutic movement and mind-body modalities that help in healing. It provides social support, learning, and community resources. As if this doesn't keep her busy enough, Alene is working on publishing her first book that will go to press this fall called, Navigating the 😄 A Nurse Charts the Course on Cancer Survivorship Care. Her book will showcase the ideas behind the two programs she runs. "I think working nurses' voices need to be heard in the discussions about healthcare policy, legislation, and operations. The nurses who work directly with patients are the ones who need to steer the future of healthcare as much as physicians, administrators, or policymakers. My book talks about values- and living true to those values, no matter what your role in healthcare is." Challenges One of Alene's biggest barriers is getting the time with physicians, and potential patients to have her ideas heard. "But that's why I am writing the book. It gives me the chance to get it all out there and I am not limited to a 10-minute talk or a 2-minute video presentation. I get to showcase my work to the individuals who can benefit from it." Getting the word out about post cancer treatment is imperative to Alene. This is a time of great angst for patients. They have anxiety about recurrence as well as not being as closely followed by their treatment team. She would like to get policy and practice in place where these patients can be taught what reasonable self-expectations are, regarding activity level, fatigue, healing, and goal setting that is realistic for themselves in a year or two after treatment so that they don't get discouraged. This kind of care is innovative and getting health care professionals, administrators and policymakers to think about these patients after their active cancer care is finished is the most challenging part of Alene's entrepreneurial experience. A Word of Advice for Aspiring Innovators "Really examine your own values, and what you really want to get out of the work you do? What is most important to you, makes you happy? Find mentors, people who encourage you. You need to be willing to set a long-term vision for yourself, and not expect things to happen quickly. Money helps, but it isn't everything. Network, talk to as many people as you can, if you are enthusiastic about your work, it will show and people will be drawn to you." Passion Passionate is the single word that comes to my mind as I write about Alene Nitzky. She has evolved herself, her career, and her life around a passionate, caring heart for patients who need it the most. She uses her knowledge accumulated through lifelong learning and experience not only as a nurse but in all of the areas of her formal education. Her ideas have grown through the experiences of others and her willingness to really listen to the patient, family, and caregiver's needs. It takes great passion to bring your ideas to fruition in an innovative market. I can't wait to hear more about how far Alene's passion takes her into the future of healthcare!
  3. Sarah Matacale

    My First Mammogram - A Comedy

    Somehow, much to my surprise, I turned 40 a few years ago. I don't know how it happened, but I double checked my birth certificate and sure enough...40 years old! Shortly after this shocking realization, came a letter in the mail from my gynecologist office telling me it was time for my annual physical AND a mammogram. Say WHAT??? A mammogram.....I actually laughed out loud. See, there is some history to this, that at my own embarrassing expense I will share with ya'll. First of all you have to know my personality. There is nothing too private or personal for me to not share. I have always been the one to call out the "elephant in the room" so to speak. My husband sees this as a fatal flaw at times, but I have always felt that my stories can not only be really funny, but also help others by putting it out there for the world to hear. You never know who you might help. My first mammogram is one of those stories. As a pre-teen/ teen, I dreamed of the time that I would NEED to wear a bra. As a 40 something year old woman, I still dream of that day. You see, I was not blessed with a voluptuous Victoria's secret set. You ladies know what I mean, the kind that you pay $45 for beautiful, uplifting, supportive bras for. I was given the Walmart sale section kind of tatas....$6 bargain bin. Bra's for me, are not necessary to make me feel beautiful and supported but rather to (with the help of some padding) give me the subtle appearance of breasts. Yup, part of the itty bitty club over here. I spent years not sleeping on my stomach to encourage their growth and avoid stunting them. I followed all the teenage guidelines that should help them to grow...nothin did it, I say, Nothin! When I was a new Mom, these "girls" were supposed to take on a new purpose. Feeding. I wanted desperately to breastfeed my babies. Here is another elephant.....if you have nipple inversion (like the Never EVER come out kind) then it becomes very difficult, and for me impossible, to breast feed. Despite tricks of the trade from every lactation consultant from the hospital to the health department and industrial strength breast pumps, those guys were not coming out. (I still to this day swear that one particular pump would repeat over and over again..."You're a loser, you're a loser" as it would pull a few dribbles of milk from me after hours of trying to get enough to sustain life for my child). Bottle fed it was...and to my surprise all 3 kids are happy, healthy and mostly well adjusted members of society in light of my early worries and "loser status"-per my breast pump. That's the history of my girls. So when the, "It's time for your mammogram letter came", you can understand why I would giggle thinking about what new boobie adventure this would bring. How on earth would the "girls" fit between the x-ray plates. I was thinking the dentist's office oral x-ray plates might be a better fit.....or I offered the tech that maybe a plain chest x-ray might be better suited for my size. I mean, there is nothing to squeeze. No tissue to see past or through. I was actually nervous about how this would work. I told the mammography tech all of my concerns and she informed me that she had been doing this job for over 20 years and I quote, " I can find tissue to squeeze on everyone no matter how small their breast size." Uuuhhhhhh....yikes! First we started with the nipple markers. Talk about funny to me. I have never had nipples. These were like little nipple prosthetics! I asked her if I could try them on with my tee shirt, just to see! I mean come on it was a whole new world!! I told her I wanted to mess with my husband...he would be shocked if he saw those through my tee shirt after almost 20 years of marriage. She gave me a whole package to take home...no kidding! I got a goodie bag from the mammogram! Then came squish time. I couldn't believe it, but do you know that woman did find tissue to squish! I truly believe it came from as far down as my v-hoo-hoo and as far up as my neck, but she got some kinda tissue in between those x-ray plates. I could not breath, because if I did it would ruined all of that woman's hard work in getting them in there. So I was still for what seemed like forever. As I was joking about my tini-tiny- itty-bitties, the mammography tech was telling me about the lady she scanned before me that needed six different films to complete one image due to the size of her larger than large breasts. One breast did not fit on a whole x-ray plate...it took six shots! God gave that woman part of what was supposed to mine...I am sure of it! Anyway.....the tech and I made it thru laughing the whole time at this crazy adventure of turning 40 as a woman. To all who wonder, my scans were clean. Nothing to worry about. Cleared till my next due date. I got one more chuckle as I read the results saying, "dense tissue bilaterally" and thought to myself "of course it's dense tissue...she squeezed my sternum, rib cage and likely part of my spine into that machine!" I encourage all women to go for their screenings, an hour out of your day once a year can save your life. You can laugh through your nerves like I did. These "girls" are our responsibility to care for and monitor whether they are $45 dollar Victoria Secrets or $6 dollar Walmart bargain bins.
  4. I am a critical care trained Registered Nurse turned patient who developed one of those RARE side-effects that can happen when you take any medication. The only medical condition I have is Irritable Bowel Syndrome, (the "C" kind.... constipation). As with all chronic illnesses, you can be doing great, cruising along at a steady state, good symptom management when BAM.....there it is again! In my case, severe left upper quadrant abdominal pain with constipation, crazy bloating ("no I am not 5 months pregnant...it's gas!"), nausea, reflux and eventual diarrhea after you eat, drink and do everything in your power just to poop. There, I said it.....this whole medical mess I found myself in was because of poop, or lack of it! So, my story starts like this......I have been seeing the same gastroenterologist for years. He, very literally, knows me inside and out. He knows what I eat that agrees with me and what blows me up like a balloon. We have worked over the years to get my ever-evolving symptoms under control. With Irritable Bowel Syndrome, it's a matter of managing flares and keeping things moving along as smoothly as possible. I had been "stable" taking a few different medications that control contributing factors of IBS-C for a few years until about six months ago. My stress level went up tenfold in a short time. We decided to build a new home, so we bought land, sold our current home very quickly, (less than 24 hrs), moved into a very small rental and 2 storage units with three kids and two cats, started a new job, adopted a puppy, mother-in-law got very sick postoperatively......all in about 2 months time. Needless to say, the stress affected my IBS and I was in a constant flare. After cleared CT scans, a colonoscopy, and multiple dietary changes we started to adjust medications. With adjusting these medications you go through many unwanted side effects for a few weeks. Fatigue, dry mouth, nausea, dizziness, etc., many of the "typical" side effects mentioned on the TV commercials, magazine ads, and medication information inserts. These side effects are usually temporary resolving over time as your body adjusts. After trying a few "lesser of the evil" medications, no luck, still struggling. So we finally decided to wean off one class of drugs as we introduce and increase another. This is where it starts to go bad. Within the first few weeks on this new medication, I knew it did not agree with me. I was not just moody, but in full meltdown mode if the computer did not boot up fast enough. Crying in the corner on the floor. Every time I had to say no to my kids, (you guess by their ages 11, 9, and 7 how often in a given day that happens), I would convince myself that I was the worst mom ever. Crying so hard like I scarred them for life because they could not have a can of Dr. Pepper at 8 pm! My brain knew what was rational but my emotions told me another story and one that was difficult to forgive myself for. So I made an appointment with the GI specialist to discuss this and work on getting me off this medication. During the day or two before my appointment, I felt palpitations here and there. They were significant enough to take my breath away but did not last long. I mentioned it to my husband and we chalked it up to stress or caffeine. The day of my appointment, I was feeling more frequent palpitations so I asked when my vital signs were being checked what my heart rate was. The nurse very casually said 120 bpm. She said that it had been up as high as 140 but settled in around 120. I was not nervous or anxious at that time but was surprised and concerned. I am a runner and am athletic. My normal resting heart rate in between 50 and 60 bpm. I mentioned this to the physician when I was seen and he agreed with all of the symptoms I was having on this particular drug that gradual weaning off was the answer and tapering up another class of drugs that will hopefully give me and my colon the desired effect of peace and calm. That night I was aware of my more frequent high heart rate. By the next morning, I was about to start a cycling class and I checked my heart rate prior....135. Being a bit stubborn and a lot stupid, I took the class anyway. I went about class as intensely as I would normally. My heart rate went up as high as usual. I did not feel dizzy or severely short of breath. Stress test complete! I passed, except after class, my rate stayed above 140 and I had the shortness of breath and now a sense of someone sitting on my chest. That day my husband and I met to choose the tile for the new house we are building and I felt worse. As far as I could tell my heart rate was never going down. I had more episodes of pressure, shortness of breath and a few dizzy spells. It was now time to go to the hospital. At the hospital, I got the typical cardiac work up. Besides being tachycardic in 150's, I had a negative cardiac profile as well as electrolytes, thyroid, and CBC. I had a positive D-Dimer (who doesn't) which started the workup for pulmonary embolism. After scans, that too was cleared from my differential list. Despite bolus', maintenance intravenous fluids, and antibiotics (incidental finding of urinary tract infection) my heart rate would not budge. So ultimately, I was able to discharge after four days with exactly the same symptoms as I came in with. The only answer was that I was having a reaction to the medication. This particular medication causes irregular tachyarrhythmias and widened QT intervals in a very small percentage of the population.......me. Lucky me! So today is, as I type this, the last day of my wean from this medication. I am still having intermittent bursts of tachycardia, but much less frequent. I am looking forward to being done with this mess. We never know when starting a new medication how our body will respond. With different hormone levels, metabolisms, and system functions even that .001% of medication reaction possibilities can happen to you. Be aware of your body. Know your baseline. Report any changes from that baseline to your prescribing doctor, and definitely go to the hospital for any potentially life threatening symptoms. I am glad that I have maintained an active lifestyle, so that my heart was able to tolerate the sustained high heart rate for so long without damage. All this trouble just because of poop! Who'd have thought!
  5. Sarah Matacale

    Meet Ersilia Pompilio RN,MSN,PNP

    Ersilia Pompilio RN, MSN, PNPStoryteller, Educator, Producer, Nurse, and Super Cool Lady! I can't wait to introduce Ersilia Pompilio to everyone at allnurses! As her subtitle reads, she is a nurse innovator and entrepreneur, that has found a niche using many of her talents, interests and strengths combined with her passion for nursing. Ersilia Pompilio is the Creator and CEO of Rogue Nurse Media 501c3 whose mission is to empower nurses to tell their stories. "I teach and develop innovative educational tools focussed on healthcare that are in alignment with current trends in social media, mainstream media, art and technology. The goal is to abolish fake news in healthcare and change the stigma around how people see nurses and patients in the media. My goal is also to encourage nursing schools to change their curriculum and bring them more into the mainstream technology using social media." Ersilia has several tools and productions that are moving her mission forward: The Well Written Nurse: Writing workshops that teach nurses storytelling, screen/ TV writing, journalistic writing, memoir writing, blogging, and how to get published. Ersilia and her team are set to launch a screen/ TV writing workshop in November of 2017 called Mapping the Story of Genome, A Screenwriting Workshop for Healthcare Professionals. The workshop will focus on the character developement of the healthcare professional...nurses and patients. Nurses and Hypochondriacs Storytelling Show: a storytelling show where real Nurses, Patients, and Hypochondriacs take the stage and tell true, unscripted comedic stories. Nurses and Hypochondriac Podcast: Nurse experts, patients, and hypochondriacs come together to discuss hot topics in healthcare. Since Ersilia has a teaching background, she was able to get her courses approved by the California BRN for CE's! How this all got started!?! Ersilia admits that she loves to tell stories. "When I was working as a Pediatric Nurse Practitioner on a busy pre surgery unit, I often had many nurse friends from around the hospital that I knew stop by to ask: 'Got any new dating stories?' They loved my perils of being single in Los Angeles and dating wacky men. I attracted a certain type of guy in my dating world. My HIPPA attorney friend and fellow writing buddy affirmed in the middle of a story one day: 'You sure do date a lot of hypochondriacs!'" So it was born! Due to "burnout" from teaching nursing and working as a nurse practitioner, in 2008, Ersilia started taking writing classes at a boutique writing school in downtown Los Angeles' Art District. She found writing healing and cathartic, and soon published her first short story, "Our Little Hospital Ghost". This opened a creative portal, and Ersilia started to gather a team of creative writers to help her produce her one woman show The Nurse and the Hypochondriacs. After 3 runs of the show, she "put it to bed", feeling deflated and defeated, until a few audience members told her how much they learned through the show. Ersilia "resurrected" the show in 2015 and made a few changes, turning it into a storytelling show called Nurses and Hypochondriacs. She produced 5 productions for the Hollywood Fringe Festival with 20 storytellers. The show was a slow hit, but once again the audience affirmed how much they learned through the show. At the end of 2015, Ersilia had one of Oprah's "ah-ha moments" and she got to work developing Rogue Nurse Media 501c3. While writing an article for Working Nurse Magazine on Nurses in the media, it all came together, the only way to change the stigma of nursing is to teach and empower nurses to write and change it for themselves! Barriers Moving from the Health Care Nurse Practitioner world into the creative unknown was very intimidating to Ersilia. She learned that she needed to listen to the voice inside and trust that her intuition was leading in the right direction! Her motto (from Field of Dreams) was "Build it and they will come!" So, Ersilia jumped in head first creating websites, working with graphic artists, hiring and firing people, working with ensues for shows, directing and coaching storytellers, and now learning to podcast! Advice to Give Aspiring Nurse Entrepreneurs The best advice that Ersilia would give to aspiring nurse entrepreneurs is "not to listen to your co-workers and the naysayers! Follow your gut and create. Spend lots of time outside of your 'Nurse' box! Do fun stuff like go to museums, take art classes, watch stage shows etc....do something that makes your soul sing and dance! Read books that teach and inspire you! Journal, meditate, and write!". When asked what the best way to prepare and nurture dynamic innovators for the future of healthcare practice, Ersilia offered that nursing schools need to start offering creative classes for innovative nurses. "Your career needs to be malleable to what your personal needs are! Nursing schools need to start teaching that!" Career Role Models and Inspirational Persons "I recently attended a one act play at the Hollywood Fringe Festival 2017 called Mary's Medicine. It was an adaption of Mary Seacole's autobiography. Mary Seacole was a Scottish-Jamaican Nurse who invented ginger beer. She married a Scottish man who was sickly. She too was a hypochondriac magnet. Mary was a great inventor, entrepreneur, nurse, and pioneer. I related with her character and her story in the play. I have faced and currently still do face many of the same challenges she did. Creating something unique and empowering nurses and patients to tell their stories through storytelling and podcasting has brought about much scrutiny from people in the profession who are used to runnings on the same treadmill of life and are afraid of getting off and doing something different!" The Single Most Important Issue For Nurses to Address in the next 2 years Ersilia feels that most important issue that the profession of nursing needs to address is the image of the profession itself. "We have nurses getting their Ph.D.'s and DNP's yet the mass population still sees us as the bedside nurse. Nurses are great innovators and educators. The public needs to understand that...the only way to do that is by telling and educating the public about what we do as nurses through our stories!"
  6. Sarah Matacale

    Psst...New Nurses

    I realize that there are so many articles, blogs, books and inspirational bookmarks, coffee cups, and laminated lanyard tags that tell you how to be a great nurse. You learn throughout nursing school how to calculate BMI, use your posture to leverage a patient, "therapeutically communicate" and to give an orange the proper dose of insulin for the blood sugar you just checked with fake sugary blood. Not surprisingly there are some "real life, hands on, I have been there in the trenches for a few years and lived to tell a tale or two ", pearls that I want to share that work. These few tips will save you time, frustration, tears (yours), and will increase your job satisfaction and patient satisfaction. Before you leave the patient's room, ask if there is anything else they need This one is huge! Listen up people...you will save yourself tons of time and frustration in the long run each day if you do this. I can promise you that when you are rounding with you're 8am meds, if you just go in and hand the patient their meds and leave, the call bell WILL go on as soon as you are 2 doors down! Here's the rest of how this scene plays out..."Susie, your patient in 202 needs fresh water." You bring water and leave again to continue with med rounds..."Susie...your patient in 202 is out of straws"....head to pantry, grab straw, deliver and leave......"Susie, your patient in 202 needs to use the bathroom"......"Susie, 202 would like sheets straightened"..."Susie, 202 has family here and would like to ask you some questions".....AHHHHHHHHHH! Multiply 202 times the 10+ patients you have today. Here is my "go-to" of how to work with 202's. When you go into the room, smile and boldly and cheerily say good morning! Ask about the patient's night as you clean up their bedside table. Check on straws, cups, and tissues. Dump old pitcher of water. Tell patient you will be back in second as you get them a pitcher of fresh water with ice (people love that hospital ice), grab straws, cups etc while you are there. When you come back in and put it all on bedside table, chat with your patient about your crazy kids this morning, your animal's antics , really anything personal to open communication. Tell your patient what pills they are taking and for what. Discuss medical plan for the day, tests, labs, time doctor is expected in etc. Any questions 202? Ask if patient needs to use restroom, if yes, straighten sheets or change them if needed while out of bed. If no, straighten the sheets out. Ask if patient is warm enough or cool enough. Place the bedside table, call bell, and channel changer in reach, ask if patient wants blinds open......and last but not least, "Is there anything else I can do for you? I will be back to do an assessment at (such and such) time." Bam! Five to 10 minutes and the patients will love their attentive nurse and not want to bother you knowing you will be back soon. Bonus is that you visually did a pretty thorough assessment of 202 while you were in there. Know Where To Go When You Don't Know Yet another biggie. You will NEVER know all you need to know. However, if you know where to go to find out then you'll be in good shape. On any unit, you will soon figure out who the seasoned staff are. There are always those with special "skills sets". Some are great with inserting IV's; some foleys; some know a ton about cardiac rhythms. Call pharmacy as a resource for any and all questions related to medications or interactions, allergies etc. Use your drug reference handbooks. There are always a few super awesome easy to talk to physicians, nurse practitioners, or physician assistants that love to share information and answer questions. Be friendly, ask questions about disease processes, medications, patient histories or whatever you may have questions about. Be a sponge with any knowledge you can get your hands on. Never be afraid to ask.....I have always been bold and outgoing with questions and I stick my nose and ears on primary physician and specialist conversations. I butt in on wound care during dressing changes, radiology during procedures etc. Let me share a little story of my own. When I came out of nursing school, I went straight to work as a hospice nurse for 5 years. Nothing more unnerving than coming out inexperienced and working in a location where you are autonomous and have no other nurses with you. So one of my first patients had a colostomy and I was to do her ostomy care and assessment for her during my visit. I never had the ostomy experience in my 4 years of nursing school. I read about it, passed the test doing care on a "torso mannequin", but real life is something different. OK, I can think critically, figure this out somehow, right? What did I do? "Mrs. XYZ, why don't you show me how you care for your ostomy so that I can see that you and your family know how and also it will allow me to do it the same way you do when I come". Yup, Mrs. XYZ unknowingly taught me ostomy care! Education opportunities come from many angles. Be Prepared! As a seasoned nurse and the wife of a physician, I can tell you that no doctor wants you to call them with a question or wanting a new order if you don't have all of the information necessary together, and IN FRONT OF YOU. Let's say your patient is in respiratory distress. When you call, you better know: your patient's lung sounds, respiratory rate, amount of oxygen on, medications given, allergies, changes in the patient's overall condition, pertinent labs, etc. Have your computer up and running, logged on. Have paper to jot orders on. Most importantly be by the phone! Most hospitals now have nurses carrying their own phones. If you do put out a call and have to go care for your patient, tell everyone around that you are waiting on Dr. PQR to return your call. Don't go potty then, do not get on the phone with pharmacy on the number the doc is supposed to call you back on. If your patient is in distress, call in your team to help while you talk with the doctor, after all you know the most about your patient. Another area to be prepared for is talking with patients and families. First of all, know who you can talk with (permission) and what you can share. Be aware of who is in the room with the patient if you are sharing personal information about their care. Know what will be going on with your patient thru the day, including labs, tests etc. Explain in common, non-medical language what is going on with their care or diagnosis. I always consider myself the translator between the doctor and the patient. As nurses we bridge a lot of gaps and the medical jargon is just one of those areas, so be prepared to explain what's going on. It is OK to tell the patient that you are unsure about something and need to look into it further, just make sure you provide an answer before you leave for the day. That builds trust in you and for the nurses coming after you. Remember Why You Are a Nurse Everyday start fresh. On your way to work, remind yourself of the reasons you became a nurse. I like to say, most of us were born nurses. We are caring, compassionate, smart, quick thinkers, adaptable, team players and we want to make a difference in someone's life or death everyday. Some days that happens, some day not, but take the few extra minutes when you are in a patient's room to get to know your patient. Small talk about things unrelated to being in the hospital. I live in the south, so when meals come and I help set up, I ask about grandma's biscuits, or if my patient likes to cook. Food is the universal leveler y'all...everyone can small talk about food. In these small things, you get those moments that you went to school for. These small moments make the day brighter for you and your patient. I can't tell you how many chin hairs I have plucked (Btw...designate a family member to tend to that renegaid if you are in the hospital...they pop up when least expected), hair I have curled, faces shaved etc. All to make a difference to that one patient and watch their family glow when they walk into the room and mom has her famous red lipstick on. In other words, humanize your patient. In the current healthcare world, everything is technology, task, and chart. Nothing touches your heart there. Your patients can feel very lost and scared in that world. Bring it back to the basics of biscuits, small talk and hand holding. I do want to stress that as a good nurse, your skills will be picking up subtle changes in your patient during those times too. Skin changes, bowel and bladder habits, confusion, dyspnea, new onset weakness, etc. To wrap it up, I hope you can tell that I love the art of nursing on so many levels and always have, despite any role I have taken in this field. You make all the difference. Somedays you may leave crying in frustration and failure, but many other days you will leave feeling like you mattered to someone. You gave that patient a piece of you. Hopefully this will help some of you with the down and dirty, tips to survive your shift! Nurse on my colleagues!!
  7. Lemons to Lemonade The phrase, "you never know what someone is going thru until you have walked a mile in their shoes", is perfect for this nurse entrepreneur. May 21st, 2012 was the beginning of a life altering journey for Heather Wright-Renick. She was diagnosed with triple negative breast cancer at the age of 33. "It is now understood that breast cancer is not one form of cancer, but many different subtypes of cancer. These subtypes are based on the presence, or lack of, three "receptors" known to fuel most breast cancers: estrogen receptors, progesterone receptors and human epidural growth factor receptor 2 (HER2). The most successful treatments for breast cancer target these receptors. Women with triple negative breast cancer, none of these receptors are found. In a triple negative breast cancer, diagnosis means that the offending tumor is estrogen receptor- negative, progesterone receptor-negative, and HER2- negative, thus the name "triple negative". This cancer is typically responsive to chemotherapy. Because of the triple negative status, however, tumors generally do not respond to receptor target treatments. Depending on the stage of its diagnosis, triple negative breast cancer can be particularly aggressive and more likely to recur than other types of cancer." Heather was a practicing nurse at the time of her diagnosis, working toward her goal of receiving her BSN from the University of Kansas. She had been working as a bedside nurse for 13 years, truly enjoying what she was doing. Heather had started her career as an LPN in long term care, then went to St. Catherine Hospital where she worked on Medical/Surgical unit 5 years before transferring to Intensive care where she worked for the next 5 years. She was chemotherapy certified and also worked prn as a SANE/SART (Sexual Assault Nurse Examiner) nurse. Her current role was not even on her radar. After taking time off for completion of chemotherapy and having a bilateral mastectomy, Heather returned to work in February 2013. She was approached by leaders of St. Catherine Hospital about becoming a nurse navigator and playing a pivotal role in starting The Breast Center at St. Catherine Hospital which became NAPBC (National Accreditation Program for Breast Centers) accredited within one year. A cancer patient navigator is an individual trained to help identify and resolve real and perceived barriers to care, enabling patients to adhere to care recommendations and thus improve their cancer outcomes. She is now a certified breast cancer navigator as well as the Director of the Breast Program. In Heather's words, "I knew being diagnosed would be life changing, but I wasn't sure of the of the magnitude of the change until I have been able to look back on my life since then. Breast cancer could have been a negatively defining moment both personally and professionally. Instead, it was the catalyst of the next journey in my nursing career." Heather said that when she accepted her current position she was scared, excited, and overwhelmed. She asked her bosses, "now what?", "what do I do?", "where do I start?". They told Heather in short, to build a program that would meet HER needs. "I represented every breast cancer patient in our community. I was a mom of two school aged children. I was married to a farmer in a rural community while working as a nurse in a local hospital." The administration entrusted Heather to build a program that would enable patients to receive comprehensive breast care close to home. "I didn't know how to build a program or what the administrative side of nursing looked like; but I did know how to be a nurse as well as a patient. I seized that opportunity!" Heather has two career role models that she mentions as constant inspirations to her. Cathy Huber, RN, with whom she worked with for many years at St. Catherine Hospital on the Med/Surg floor. "She was twice my age and can still run circles around me. Her work ethic is second to none and she leads by example. She doesn't expect something from her coworkers that she wouldn't do herself. She instilled in me the importance of taking care of the small details and the necessity of being a lifelong learner." Heather also is inspired daily by Carol Bush, RN. "She thinks outside of the box, speaks her mind, and is one of the most resourceful people I have ever met. I never hesitate to pick her mind or ask for help. Her enthusiasm is contagious!" Heather speaks like a true entrepreneur/ intrapreneur when she advises other nurses on nurturing their dynamic innovative spirit. "Start right here, right now, one step at a time, one bite at a time. Allow everyday to be your "Ahh ha" moment. "What one thing do you keep seeing while you're working that you think, 'I could do this better,' or 'I wish someone would invent this', or 'In my spare time I'm going to do this.'" Heather says that some of her greatest joys have come from tackling minor life inconveniences and making the system or workflow better for everyone. Heather Wright-Renick has one of the most inspiring stories that I have heard. As a continuous learner, she has opened herself to new career challenges and opportunities. She has seized the day many times, which has put her in a place where she affects the life of patients and an entire community with her love of life and career. She tackled cancer head on and decided to grab a life changing offer that would challenge her to push her limits and expand her knowledge base. Heather, like her role model, truly leads by example and experience. She made lemonade from the lemons she was given, and made enough for an entire community to share! The Breast Center | St. Catherine Hospital | Garden City, Kansas Understanding Triple Negative Breast Cancer
  8. Sarah Matacale

    Cystic Fibrosis: What Is It?

    Cystic fibrosis is a disease that has always been a medical topic of interest to me. Unfortunately, its for the fact that this progressive and fatal disease is in my family's gene pool. I have a cousin, 10 years younger that me, who was diagnosed as an infant with cystic fibrosis. After her diagnosis, her mother left her with my uncle and headed for the hills. To help their brother and niece, my mother and an Aunt took over much of the "momming". I can still remember so many of the classic symptoms she had. The salty taste when you kissed her head, the foul smelling fatty stools, the breathing difficulties and slow growth. She soon took on the nickname "Peanut" because of how small she was. As she grew, treatments increased, regular scheduled hospital stays became norm for "tune-ups", as we all called them, and the daily routine became very complicated and time consuming. Life certainly did not become easier for her. At 31 years old, Peanut is still alive today thanks to advancements in science, technology and modern medicine. As I got into my childbearing years, Cystic Fibrosis was a constant nagging worry in my mind. Could I have a child with this disease? How about my brothers? It seemed so strange to me (before all my research), the odds that gave my cousin this life long struggle and burden. You see, my mother is one of 12 children. Each of her siblings went on to marry and have 2 to 4 children each and of those numbers only Peanut got the disease. Wow! Not even Peanut's own brother got the disease. My husband and I decided (along with our OB/GYN, Pediatrician, and Geneticists) to have genetic testing done. Our insurance company asked my husband to be tested first. If he was negative on all accounts for the genetic marker than I would not be tested. We were pleased to hear that he is not a carrier. However, not having been tested myself, I still wonder if I am a carrier and could have passed on the defective gene to any of our 3 children, potentially affecting our future grandchildren. Let's get into some of the facts of what Cystic Fibrosis (CF) looks like now, in 2017. Some history, genetics, statistics, advancements in care and treatment, and a daily routine for this population. Cystic Fibrosis Foundation states that "CF is a progressive, genetic disease that causes persistent lung infections and limits the ability to breath over time. The defective gene causes thick buildup of mucus in the lungs, pancreas and other organs." Increased mucus in the lungs clogs airways and creates an environment where bacteria gets trapped easily. This bacteria leads to infection, extensive lung damage, and eventually causes respiratory failure in the CF population. Double lung transplants are often the only end stage option with this disease. 80% of the deaths from CF are due to lung problems. With this disease, the pancreas is another organ that takes a major hit due to the increase of thick mucus. Excessive mucus in the pancreas prevents the release of digestive enzymes that enables the body to breakdown food and absorb nutrients necessary to sustain life. This leads to malnourishment and poor growth and often diabetes. Cystic fibrosis can also cause liver disease by producing thick mucus that blocks the common bile ducts. Symptoms of Cystic Fibrosis include: Salty tasting skin Persistent cough (with or without phlegm) Lung infections with pneumonia and bronchitis Wheezing or Shortness of breath Poor growth, poor weight gain despite great appetite Frequent greasy, bulky stools or difficulty with bowel movements Clubbing of fingers and toes due to poor oxygenation and chronic illness 97% of men suffer with infertility, 20% of women suffer with infertility Cystic Fibrosis is a disease that is most common in persons of Northern European descent. It is least common amongst in African American and Asian populations. There are approximately 30,000 people living with CF today (greater the 70,000 worldwide). There are 1,000 new cases diagnosed each year. About 75% of people are diagnosed by age 2 and more than half of the current population living with disease are over 18 years old. There have been tremendous advances in genetic testing and research which has drastically increased life expectancy of this population. In 1960 the median survival age for a child born with Cystic Fibrosis was 6 months or less. By 2010 the median age jumped to 37 years old for women and 40 years old for men. Today the predicted survival age is approximately 40 years. Perhaps the single most important discovery in Cystic Fibrosis research came in 1989 when the defective CF gene was discovered. This meant that researchers could learn more about the defective gene and work towards curing this disease. It also meant that prospective parents and pregnant women can have testing done to determine the risk of conceiving a child with Cystic Fibrosis. Researchers have found that there are approximately 1700 known mutations within this gene and standard genetic testing includes only the most common forms of the defective gene. Further testing can be done if necessary or indicated. This is the basic genetic breakdown for CF: To have a child born with CF the child must inherit 2 copies of the defective gene- one from each parent Each time 2 CF carriers have a child the chances are: 25% of conceiving a child that has CF disease ( 1 in 4) 50% of conceiving a child that is a carrier without disease (1 in 2) 25% of conceiving a child that is not a carrier or has the disease (1 in 4) [*]Couples with 1 copy of the defective gene (one parent only) are considered carriers. No disease and can pass along the carrier gene to their child Drugs that have been found to target the basic defective Cystic Fibrosis gene were approved for use in 2012. Cystic Fibrosis Transmembrane Conductive Regulator or CFTR modulators are expected to add decades of life to some patients with cystic fibrosis. The research continues on new drugs to target this gene. For many parents this disease comes as a surprise. Just like in my family, we never knew of anyone who had the disease until my cousin was born with it. There have been references made as early as the 1800s to children with "salty tasting skin when forehead kissed being destined to an early death", so it is assumed that the defective gene has been in existence for hundred of years. Many children died without a "known" cause early making it difficult to follow a family history of these types of genetic mutations. If Cystic fibrosis is suspected in a newborn or young child, there are a variety of tests that can be performed to make a definitive diagnosis. - Living with Cystic Fibrosis | Cystic Fibrosis Age of Onset | CF News Today Currently, patients with Cystic Fibrosis manage their disease by following a strict and time consuming treatment routine that is modified as their disease progresses and affects multiple organs. Treatments include a combination of airway clearance, medication, exercise and nutrition therapy. Airway clearance- inflatable vests are utilized that vibrate the chest at high frequency to loosen and thin the mucus. Also chest PT such as cupping aid in loosening the mucus in the lungs. Inhaled medications- used to open airways and thin mucus and also include inhaled antibiotics to fight off or prevent infection from forming in the thick mucus Pancreatic enzymes- used to help the body breakdown and process fats and nutrients consumed High protein, High calorie diet- frequent meals to increase calorie intake to help offset the risk of malnutrition and nutritional deficiencies. Exercise- this can be difficult due to lung function, however research has shown that quality and life expectancy improve with regular exercise. Chronic illness of any type can create so many daily physical and emotional challenges to both the patient and their family. Depression is common. Attempting to keep children's life "as normal as possible" is imperative in preventing depression and social isolation. Open communication with schools, counselors, coaches is just as important as the communication with physicians and dieticians. So many new and current information is being discovered regarding this progressive and terminal disease. Through continued funding for research, new medications, therapies, and genetic modifications will add years of life to patients with Cystic Fibrosis and hopefully eradicate this gene in the future. About Cystic Fibrosis | CF Foundation Cystic fibrosis - Wikipedia Living with Cystic Fibrosis | Cystic Fibrosis Age of Onset | CF News Today
  9. Sarah Matacale

    Raising the Next Generation of Nurses

    As a mother of a nine year old daughter, and a nurse, I often think of the importance of raising a child in the world today. This task encompases instilling and fostering certain qualities that will ensure her success in the future. My daughter has some natural born qualities that, I feel, will guide her toward a career in healthcare. By fueling her critical thinking, confident, strong minded caring and compassionate nature, I believe she will be part of a generation of nurse innovators that will change how we practice healthcare. As I sit here working on this article, I am looking out the window on this beautiful afternoon. I am thinking, "Holy cow where do I even start?" First and foremost on my list of job titles is my position as a mother of three children, a 10-year-old boy, a 9-year-old girl, a 6-year-old boy, and my 46-year-old husband most days. I could stop right there with the amount of work, stress, pressure, and effort. It is enough to make us all emotionally collapse some days. I am a nurse, not just any nurse, but one that was BORN a nurse. What does it mean to be born a nurse? Nursing is in my heart, soul, and emotional make up. Any of you who have the same natural born nurse psyche understand the emotional investment that comes with this. Here is the heavy part- MY DAUGHTER IS JUST LIKE ME! Not only am I responsible for raising a next generation woman, but one that seems to be headed toward a career in nursing. So, this "Holy cow where do I start?" statement literally means, where and how do I start to raise a confident, strong minded, caring, compassionate, critical thinker who can stand her emotional ground when life throws her curve balls? How can I help create a new environment for next generation nurses while I raise my sweet girl to become one? Confident Nursing has changed so much even over my 20 years in the profession. Gone (mostly) are the days where nurses are just giving baths, bedpans, meds and saying yes sir to any orders given by the doctors. This may be due, in part, to how women have changed over the decades. We are not meek and helpless. We are more comfortable in our skin. We speak openly of our questions and concerns about the world we live in. We take leadership roles in the workforce and do it well (thanks to our multi-tasking brains). We balance more on our day to day plate than ever before. Some lucky people are born with confidence. My oldest son, for example, you can not burst that kid's bubble even when he needs it! I, on the other hand, was not born with confidence. I work at it every day and there are always setbacks. When our daughter popped out with her strawberry blonde hair, green eyes, and freckles, I vowed to help her achieve confidence within herself. I would give her all the tools, pep talks, worst case scenario run-throughs, positive body image discussions, to attempt to aid her to grow up confident. It was easy when she was small. She has always loved her face full of freckles. My husband has them too and has always told her that he sprinkles some of his on her at night when she sleeps. One day at a park I overheard a girl, roughly the same age as my daughter, ask in a snotty tone, "What is all over your face?" My sweet girl deflated; my mamma bear chest inflated waiting to growl out in protection. I waited a minute and watched, my daughter gathered herself and said, "They are freckles and my Dad gives them to me as a special present when I sleep". Ok, I thought, she has got this! Whew! Confidence like this is necessary as a nurse today. We have to be ready to defend and protect our patient's rights and wishes at all times. If we are given an order that may cause harm, or is questionable, we need to stand confident and ask "why" questions and defend our concerns. Strong Minded The famous quote, "You never know how strong you are... until being strong is the only choice you have." Cayla Mills could not be truer. As a nurse, how many of us found ourselves in over our heads? It may include patient load, insufficient staffing, a tough family, first day of a new job, or being floated to an unfamiliar unit. Think about the young patient with a lacerated liver that is too sick to transfer and you are his ICU nurse. Family is a wreck, blood transfusion after blood transfusion, constant labs, hemodynamic monitoring, vasoconstrictors, respiratory distress, decreased urine output, road trips to get scans, AND you have one or two other patients. You have not had a break or lunch. You've had to pee for hours, but the doctors are bedside with you providing constant care.You know what? I made it, and so did my patient. The shift eventually ended and I went home and cried. I was scared all day, but what got me through that day was being strong minded kept me together and thinking clearly all day. When my daughter was In Kindergarten, she started to come home from school with blisters and calluses on her hands every day. I first asked her what she was doing and she explained confidently that she wanted to get all the way across the monkey bars. When I brought her to school the next day, I was speaking with her teacher and she told me that my girl was spending 30 mins every day practicing and practicing those monkey bars until she could get across every time. I love that. We fuel passion and dedication in our house. Strong minded and determined people get things done! As children, they are difficult to parent, however, these qualities are desirable as an adult. They end up being our innovators and our future thinkers that think outside of the box. They do things not just because it is what is needed to get things done but to reinvent or develop a new way to attack a problem head on. Caring and Compassionate Naturally, some people are born more compassionate and caring than others. These traits often carry them into professions such as nursing. I remember as a child watching and interpreting moods on people's faces. The kid at school who is chosen last for dodge ball, or has something said to them about not having the latest styles to wear. Even though I did not understand what that meant at the time, I remember feeling tremendous emotion when friends and family members grieved the loss of a loved one. Our daughter, since ever, looks to me when she sees a child with a disability. She asks questions and then wants to know how she can communicate with them, or play with them. She cries during Disney films. She is the first to come to me when I am crying due to frustration, sadness, anger, or even joy (I am one of those people that cries with all emotion). She reads subtle changes in mood, facial expressions, body language. She notices mild physical disabilities, a slight limp, a communication issue. She has that intuition when something is just not right. She does not give up when someone tells her that they are "fine" when she knows they are not. I developed severe hearing loss about 3 years ago, I wear hearing aids bilaterally, and was having a "Poor me, "I am scared" moment alone in our bedroom. My girl came in with a hug and a portable CD player and headphones with the movie Annie set up because "it's your favorite". She said she thought it would take my mind off my worries. As nurses, we need this type of compassion for others. We need an intuition to know when something is just not right. You need to read your patient and understand their subtle changes from baseline. Like I said, some of us are born with this trait, others are not. Those nurses that are born with it, stand out among the rest. My daughter also knows how to make someone feel noticed and appreciated. She commented on an older ladies earrings at a store one day. To be frank, they were awful. The lady lit up when my daughter commented on them. When we left the store my daughter said, "Mommy is it bad that I did not really like the earrings? The lady looked like she needed to hear something nice." Another area we fuel is caring about the people around you. As a nurse, we need to read and care about our patients, as well as our colleagues. They might be feeling overwhelmed or particularly affected by a patient, physician, or co-worker interaction. This generation must be conscious that technology can interrupt face to face time. Emails, texts, tweets may not convey the emotion or context to which we are speaking. Encouraging our kids to look people in the face, feel for/with them, see past themselves and the screens of technology and reach out to others. This quality will help our children connect with the world around them benefit the future of healthcare. Critical Thinker This is one of my favorite attributes that good nurses share, the ability to critically think. Often, a patient's condition changes without notice. Thinking quickly, clearly, running through options and choosing the best choice of action is imperative to quality care. Now, more than ever, nurses have a greater responsibility to the patient's overall care. We are at the bedside for 8 to 12 hours a day. We have conversed with all of the key players, the patient, family, doctors, PT, pharmacy etc. We hold the most information on the total patient picture. Therefore, when changes occur, we have the best overall view of our patient, mentally, physically and emotionally. My favorite jobs were the ones where the nurse was seen as the head of the care team. We rounded on our patients with the physicians, pharmacy staff, therapists etc to fill in the blanks and critical think along with the team as to the best care plan. This is a quality that I believe has to be fostered. When my daughter is interested in something or we see something interesting, I ask, "why do you think that is this way?" or "How can we fix this problem?" or "What would be the next best thing to do?". Encouraging my children to ask questions, think through the answers, also to work with their siblings to problem solve has been instilling a critical thinking mentality to handle problems they face. They don't expect someone else to tell them what to do, they participate, sometimes even when we are not asking for it. This is the future of nursing Critical thinking is what will move us ahead as innovators and trendsetters, it's what will change the art or nursing, the scope and level of care we can provide to our patients and families. Critical thinking is what keeps our patients safe through catching errors and thinking through the what-if's that may arise with various interventions. This will continue to redefine what nursing is to the healthcare industry and our patients and families. So, I guess I figured out where to start. Raising children is a very challenging task that my husband and I don't take lightly. We are both in healthcare and recognize the value of raising the bar on the future healthcare leaders. Throughout history the innovators in nursing have displayed all of the qualities we just discussed, from strong minded critical thinkers, to caring, confident, and compassionate practitioners. They have paved the path for us all to travel down. I feel a strong sense of responsibility to raise my daughter to not just use these paths but to create new ones for her generation. We as nurses, also need to look beyond our generation and foster, encourage and cultivate our children to advance and innovate the future of healthcare!
  10. Let me introduce you to an amazing woman who took a wealth of nursing knowledge and experience, the love of patient care, and an entrepreneurial mind and spirit and created a one of a kind approach to nursing care for cancer patients. Susan Scherer, RN, BSN, OCN is a nurse who seems to have done it all in the field of nursing. Susan's medical career spans over 25 years. Her experience ranges from working in trauma, diagnostic coding, neurological, medical and surgical intensive care units, neurological-oncology, endocrine cancer and disorders to oncological emergency medicine. Not only did she work in England for the National Health Service at Ipswich Trust Hospital for 2 years, Susan has traveled the globe attending and participating in oncology research and acquiring an extensive oncology education learning the latest cancer treatments, best practices with emphasis in patient education and advocacy. She has served in the United States Air Force and has received countless awards for oncology and business. Susan has served on various committees and speaks nationally about cancer patient advocacy. Susan's ambitions and innovative thinking have led her to the company she founded called RN Cancer Guides (RNCG). Susan states, "I have had family members that were diagnosed with cancer and I used to think, 'how do people do this? I am in the system which allows me to help my family but what about others?' I am one who roots for the underdog and I wanted to make a difference." So in 2013, Susan founded a company called RN Cancer Guides. RNCG is a company that hires experienced Oncology Certified Nurses to help navigate cancer patients and their families through all of the barriers of their care with a unique approach. The nurse meets with the patient and family in their home to determine what knowledge they have about their cancer and their medical plan. They find out what the most important issues are in the patient's life and then go on to try to obtain help for them. By remaining independent of any particular provider, clinic, hospital, or insurance company, RNCG is truly able to support the needs of the patient and family. Nurses with RNCG are able to operate to the fullest extent of their education and scope. The nurse goes with the patient and family to doctors appointments and then disseminates the information given so that the patient can make their own decisions regarding care and treatment paths. The RNCG nurse acts as a liaison for the patient and support network with their own medical team and healthcare provider. RN Care Guides are committed to helping patients have a better understanding of the complexities of cancer treatments. Their knowledge and relationships with physicians, social workers, therapists, billing offices, pharmacies and community support resources helps the patient transition more efficiently and confidently through each phase of treatment. The company has 4 service lines: Working with primary care providers in an ACO or IPA capacity Private patient program that is utilized when patients want to hire them directly Employee Cancer Assistance Program (ECAP) that was trademarked to help employees of companies. These companies hire RNCG to care for them and their family members directly RNCG started a not for profit 501 ©3 called RNCG Angel Foundation in 2014 that allows them to care for patients that don't have the means to pay for service In creating this company and concept, Susan encountered many barriers which she proudly states they have overcome. How do I let patients know that we are here? How do I educate the medical profession about the role we play while integrating with their care team? How do we get paid? Nurses can not bill insurance companies unless working under a doctor. RNCG has been very fortunate to have local and national media and press cover what they do. The company gets invited to speak at professional organization conferences that utilize their service lines. Susan has done some radio shows and has spoken to patient support groups. The company has a very robust sales and marketing plan that allows them to have a national reach. When asked what advice Susan would give to aspiring nurse entrepreneurs and intrapreneurs she said, "being on the frontline of healthcare allows nurses to have the most impact. We are constantly troubleshooting problems and having to come up with solutions which allow us to find business opportunities. I think nursing teaches us to have the same skills in medicine as well as business." Having a passion for what you do and a predisposition to multitasking is imperative in starting one's own business. "You need to have the passion for your idea to take you through the highs and lows of running or starting your own business because you will have them." Susan states that nurses have made great strides in practice, research, and business. As our skill set and knowledge improve, she feels "we must break out of the mold that we are perceived as a 'supportive role profession'. We must take the lead in our own employment and in legislation." Nurses have the the advantage of the trust factor in regards to integrity and honesty which is typically an obstacle for business folks looking to build a business or client relationships. "I believe that nurses need to be aware of what is happening with the health care changes, what drives the market, and how it affects everyone involved. Because of my passion for raising our profession along with changes in healthcare, I created a business model that was not dependent on the traditional healthcare insurance reimbursement. My aspiration is that nurses are recognized and reimbursed for their skill set and knowledge." In order to make changes and have an influential voice, nurses need to recognize their own value in monetary terms, not as an expense but as a revenue generator. Susan Scherer has taken her passion and ideas and created an amazing company that is helping so many patients undergoing cancer care. She also is making a major impact in the role of the nurse as an income source in the ever-evolving healthcare market. She says that her role models have been her patients and industry leaders. She takes bits and pieces of inspiration and advice from colleagues and reference organizations such as the National Nurses in Business Association. Most of all she credits her faith in God. " I feel He is my moral compass when dealing with people and business decisions. It has taken many prayers and lots of faith to have come this far and I feel very blessed to be doing this work."
  11. Tim Raderstorf RN, MSN Masters prepared nurse, Chief Innovation Officer at Ohio State University College of Nursing, Speaker, inventor, entrepreneur, consultant........say what???!!! These are just the titles and roles that Tim Raderstorf currently plays in the realm of nursing innovation. I have the privilege to share with you all a bit about how Tim got where he is today, the incredible work that he is doing for nursing and healthcare in general, and where his passions and mindset towards innovation are directing him. His philosophies will make all of us nurses rethink our everyday practice, no matter your field. That's why I titled him the "innovator of innovation". Tim has always had an entrepreneurial spirit. He recalls watching the movie Apollo 13 as a child and unlike other kids his age, he did not want to be an astronaut and travel to space. He wanted to be part of the engineering team who was on the ground working out the details and developing the solution to problems on the shuttle. From that point on he knew his mindset was different, that he wanted to provide tangible solutions to an issue. In the quest to use his interpersonal skills, love of helping people, quick thinking and innovative mind, Tim found himself in nursing school receiving his RN license and eventually achieving his Masters Degree in Nursing. Throughout his nursing career, Tim worked in pediatric hematology/ oncology. He began to notice that nurses are very innovative in their everyday practice. He refers to this as the "working around" workflow. For example, if a nurse is unable to connect a urinary catheter to a leg bag, he/ she is likely to "work around" this problem and develop their own solution. They will often find a new way to attach the bag and make it functional. This nurse will go on to do this same thing each time they have the problem. They just work around it. Another example is opening an IV start kit. Let's say following the protocol of their care area, the nurse inserts the IV and each time is left with one piece of unused gauze per packet. This gauze gets thrown out. These kinds of "workarounds" can cost the hospital/facility a lot of money over time. Most nurses never think to mention these minor issues to their unit director or nursing supervisor for a closer look to alternatives. They just do their work and head home and no one addresses the problem, it just gets hidden in the workflow. Tim encourages that we all look at ourselves as innovators. As nurses and healthcare providers we are natural problem solvers. We just might not know how to find the solution. Sometimes we have ideas to fix the problem, sometimes we just know there is a problem, sometimes we might have an invention that would change healthcare or patient safety and outcomes. Sometimes we may just know that a policy or procedure needs adjusting to fit into the workflow as it exists. Tim knows this through personal experience as an inventor of a care team communication device that promotes patient safety and satisfaction. He recognized a gap in the system and worked with a team to develop a solution. This innovative and entrepreneurial mindset is one of the many steps that have lead Tim down his career path. Tim states, "during my time in healthcare, I've studied and focused on neurosurgical research on Tethered Spinal Cord Syndrome, skilling the healthcare workforce in India, developing Innovation curriculum, designing clinical spaces, improving patient throughput in the pediatric hematology/oncology ambulatory settings, promoting patient safety and satisfaction in one of the nation's largest Emergency Departments, transitioning organizations into new physical locations, and developing novel commercial innovations to enhance patient outcomes." As a speaker, consultant and clinical instructor regarding innovation, his current position seemed to be a natural progression of a life long passion. As the Chief innovation officer at the Innovation Studio, Tim and team members assist medical staff and students at Ohio State University bring their ideas, inventions, or problem solutions to fruition with the help of grants provided to the school. "My passion lies in connecting great thinkers and fostering ideation through the innovation and commercialization process." This team of experts across all of Ohio State's campus' work together to bring ideas through all stages of development. "The Innovation Studio exists to foster interprofessional collaboration in creating healthcare solutions. If you have an idea for a health care product, service, or software and would like help developing it into a commercial reality, we have resources, mentors, and tools to help. Besides housing an array of prototyping tools, the Innovation Studio hosts workshops with topics such as product design, pitch development, interprofessional collaboration and maker skills, and provides project mentors, entrepreneurs-in-residence and daily technical support." Besides housing an array of prototyping tools, the Innovation Studio hosts workshops with topics such as product design, pitch development, interprofessional collaboration and maker skills, and provides project mentors, entrepreneurs-in-residence and daily technical support. Tim is a true entrepreneur. He credits his success and mindset to the support of his father. He says his father has always been behind whatever he wanted to do. "My Dad never batted an eye when I said I wanted to shift my career focus toward nursing". This certainly put Tim on a solid path of free thinking that continues to generate ways to get things done "outside the box". Another individual that helped mold Tim into the professional he is today is Paul Newman. Tim had the privilege of working with the actor and philanthropist through a camp called the Flying Horse Farm (founded by Paul Newman in 1988) to create opportunities for children with serious illness' and their families Tim has volunteered with this organization since 2006 and has learned a lot about how to use what you are given to help others. I am excited to see where Tim Raderstorf's entrepreneur spirit will lead him. Just think of the number of like-minded people that he and his team will impact through the Innovators Studio. Nurses are the hub of the patient care world. Our ideas matter, our thoughts, subtle workflow changes and substitutions matter. Grab hold of your innovative mind and run with it! Your thoughts may change the day to day aspects of patient care, safety, quality or workflow and alter future of healthcare! For more information, see: Office of Innovation and Strategic Partnerships Flying Horse fact sheet
  12. This story is very personal to me and my family. I am certain I will cry my way through writing it, but it is an important story to tell. I believe it will help me heal in some way and help others as it is rare and misunderstood. It is a story of a child who has selective mutism due to emotional trauma and life events. I will refer to the very special little girl in this story as Hope. Hope is what I have always felt for her. I was walking my daughter into class about 2 months into her kindergarten year in school. I will never forget this day for the rest of my life. This sweet, beautiful little girl scurried up to me and my daughter and grabbed her hand and held on all the way into the classroom. As we were walking, I asked her name and various other small talk questions until my daughter finally said, "Mommy Hope doesn't talk". I did not ask anything else that morning but thought about what my daughter said all day. When we got home from school, I asked my daughter to tell me about this little girl. She told me her name, that she was new to the school, and that she never, ever talks to anyone. Not to teachers, principal, kids, lunch people, her grandmother...anyone. My daughter said that Hope is her very best friend and she can tell what she is wanting to say so she helps her out a lot. Over the next few months, I would ask about Hope and whether she is talking yet and my daughter always answered "Nope not yet". As I chaperoned field trips, I saw how inseparable these sweet girls were. Hope was full of hugs, hand holding and need for love, but never smiled....always looked troubled and never spoke a word. It broke my heart. Hope was all I could think about. I started to ask questions of the teachers and school counselors of how I could help. Answers followed like, "we are taking care of her, she's on our radar...etc" but nothing changed. With walking my kids into school every morning, I came to know Hope's ways of communicating a bit better. I also noticed from seeing her dropped off, at school functions, that she was from a broken home. As it turns out she was "cared for" by her father who is in and out of prison, mother who is addicted to drugs and in prison often, grandmother who sees Hope as her son's problem to manage, a maternal great grandmother who is so fragile she can barely care for herself, and a maternal great aunt who fills in the blank and supervises Hope's visits with her mother(who has had parental rights revoked). WOW! No wonder she doesn't speak. She sleeps in a different bed every night, unsure of her safety, eats whatever she can find, has seen more danger and insecurity in her 6 years of life than I have in my 40 years! Someone had to help. As a nurse, a mother, a strong Christian and a "get-er-done" kinda lady, I found a way to make that person me. I introduced myself to all of Hope's family as I met them. I made sure that every day when I walked my daughter in, that I stopped to whisper in Hope's ear "Your voice matters, you matter. What you have to say is important and you are important! I care about you". Hope started to come over for playdates with my daughter. She started to open up, relax, smile, laugh, hug a ton and not want to leave. Eventually, I asked if I could pay for her to attend summer camps with my daughter, swimming lessons, gymnastics. Her father allowed it. She became part of the norm around our house, but still after months, no words. As her family life continued to decline, she started staying with our family. Dad would leave her with us for days without calling us or checking in. At times I had to take Hope to the doctor, and to the dentist for several cavities, etc. Dad assigned me power of attorney to help me care for her and be able to safely take Hope on our family vacations, meet with school counselors, attend and sign school forms and meetings etc. She had kept her clothes, lovey bunny, toys etc with us. Had her own space and became a sister to our 3 kids. Our family carried on like she was one of our children. She got hugs, told we love her, tucked into bed at night, bedtime stories, time-outs when necessary, made to take a courtesy bite of the broccoli etc...just like our 3 kids. Then, one evening, it happened! Five months into Hope's life with us, I was reading to the girls at bedtime, and I heard 2 whispering voices. My daughter's voice and one with a strong southern country accent! I had spent months talking to our kids about not making a big deal out of her first words when she feels comfortable talking. But I have to say I wanted to shout it from the rooftops! (I did not, or course). When Hope went to brush her teeth that evening, I asked my daughter if she was talking. My daughter said, "yeah, she has been talking to me for several days". When she is alone with my daughter at school she speaks to her, but not around anyone else. I'll never forget our daughter saying, "Mama...she is REALLY country sounding!" A few days later during our daughter's piano practice, I was killing time with Hope and she just started talking!! As plain and natural as if she always had! Of course, I cried like a baby and hugged her. Told her how happy that it made me that she trusted us with her words! From that point on, Hope was a chatterbox in our home and to strangers when we went on vacations, but still not at school. I got her to read aloud to me as her teacher sat on the other side of the open door and listened so she could be tested. Eventually, she would read to me in front of her teacher. She called me Mommy and referred to our children as her brothers and sister. I wish I could say that Hope is still with our family. Through many court battles that we did not win, she is now staying with her paternal grandmother who has come to love her. She is in a clean house, fed well and cared for. She is still missing some of the childhood necessities that are important to a child with mutism, such as extracurricular activities, birthday parties with friends, sleepovers with her BFFs, but her primary needs are met. Her family does not allow us contact with her as they feel she was too attached to our family to grow with her own family. We grieve every day; some days worse than others. I have truly felt like I lost a child. I cared for her as if she was my own and love her deeply. She is a beautiful, resilient, strong spirit. I get an occasional note from one of Hope's family members (our kids are no longer in the same school). I live for those notes. The best one I received was this Christmas. Hope had a SPEAKING part in her school play in her new school! I cried for days! I am so proud of her for finding her voice in the world! I thought long and hard after that note came my way. I realized that my family and I made a difference in that one little girl's life that will stay with her forever. She will not forget us. She will remember how a "normal family" functions. She will forever know that her voice matters to the whole world! I have hoped and prayed for this child so much and HOPE is exactly what I have always had for her. I HOPE she stays on a solid path in life, I HOPE that she uses her strong voice to help others, I HOPE that she stays true to herself no matter the circumstances around her, but most of all, I HOPE that we get to see her and have her in our life again someday! What is selective mutism? The Selective Mutism Center says: "Selective Mutism is a complex childhood anxiety disorder characterized by a child's inability to speak and communicate effectively in select social settings, such as school. These children are able to speak and communicate in settings where they are comfortable, secure, and relaxed." Selective mutism effects children for various reasons. What causes Selective mutism? Some causes of selective mutism are severe social anxiety, sensory processing disorders, hearing issues, speech problems, instability in the child's life and sadly some due to witnessing traumatic events. More than 90% of children that suffer from selective mutism have an underlying social anxiety or phobia. Most children are genetically predisposed to anxiety. The human body has a built-in mechanism, the sympathetic nervous system, that is triggered when a fearful situation is faced. Children with selective mutism have an actual fear of speaking, or even communicating in a non-verbal manner. This nervous system response is the body's way of protecting itself from danger. Mutism is a symptom and the emphasis should be on what is causing the mutism. What does selective mutism "look" like? Blank facial expression Never seem to smile Awkward body language Seemingly uncomfortable Appears unhappy Avoids eye contact Withdraws from group What to do with/ for a mute child? First and foremost, a child who is mute should not be forced into speaking. Children are often mistreated by adults or peers because of the thought that the "child is just being stubborn".It is important to understand that some children with Selective Mutism may start out with mutism in school and other social settings. Due to negative reinforcement of their mutism, misunderstandings from those around them, and perhaps heightened stress within their environment, they may develop mutism in all settings. These children have progressive mutism and are mute in/out of the home with all people, including parents and siblings. The earlier the child is seen by a physician and a treatment team is established including, parents/caregivers, teachers, speech therapist,and psychiatrist the easier time a child may have transitioning to speaking. The longer the child stays mute, the more difficult social situations become. The following 9 types of treatment may be used to treat this disorder. Behavioral Therapy using primarily positive reinforcement and desensitization Play Therapy, Psychotherapy, and other psychological approaches which decrease the stress to talk Cognitive Behavioral Therapy by specialists trained to redirect fears Medication which may help decrease anxiety levels using SSRIs Self-esteem boosters emphasising positive attributes the child has Frequent socialization encouraging as much socialization as possible without pushing the child School Involvement which will educate the staff and teachers that the child can truly NOT speak. May need IEP or 504 Plan to accommodate learning needs Family Involvement and Parental acceptance Social Communication Anxiety Therapy (SCAT) which is an individual treatment plan set forth for each individual child When diagnosed and treated as early as possible, the prognosis for mutism is excellent. The child needs to be in a safe home where patience and acceptance of the child is present. Education to those involved with the child's daily life is important to decrease the anxiety and misunderstanding of this disorder. This disorder is very painful for the child, we all need to take part in educating and providing the best care possible to help the child overcome this hurdle. Remember that the child is not being stubborn or disobedient, there are true reasons that the child is not speaking. We can make a world of difference to this one child. There are several excellent websites to learn more about mutism. If you have an experience you would like to share, I would love to hear it. This disorder is rare, so support of those suffering (parents/caregiver and child) is crucial. Reference: Selective Mutism Association |
  13. Sarah Matacale

    Nurse Innovators - Meet Deanna Gillingham RN, CCM

    I love it! So glad to hear from people who she has helped!!!
  14. Sarah Matacale

    Nurse Innovators - Meet Deanna Gillingham RN, CCM

    Thank you! I have come across many nurses that are creating new paths and ideas. I can't wait to share more with readers!
  15. By definition, an innovator is "a person who introduces new methods, ideas, or products". Allnurses.com will be featuring nurses that are innovators as a regular series to encourage other nurses to "think outside the box" and create new ideas for themselves and their colleagues in the healthcare industry. It will also help nurses connect with each other and reach out through the resources that these innovators have paved our path toward. I would like to take this opportunity to introduce Deanna Gillingham RN, CCM, The Stay at Home Nurse. She is a true nurse innovator. She practiced nursing for 17 years at the bedside before an ankle and foot injury forced her to rethink her career focus. She needed a desk job. She quickly found a position with a large insurance company as a case manager, with a condition of employment being to become certified in case management. As she began searching out study materials to prepare for the exam, Deanna found it difficult to find any good resources. She ended up doing the material research on her own. She passed the certification exam and became a Certified Case Manager. After her success, Deanna shared her information with other case managers studying for their exam and voila, they passed as well! Here is where Deanna's innovative mind brought her hard work, dedication, and passion to fruition. She decided to write and publish her own case management study guide called: CCM Certification Made Easy: Your guide to passing the certified case manager exam. Along with this, Deanna developed a workbook to go along with the test prep book. Deanna opted to self-publish her book due to the extent of time it takes to get a book to print through a publisher. She found that if she had gone through a publisher, her book would have been outdated before it was published! Deanna created a website called Case Management Study Guide that offers information and support to fellow case managers as well as an online case management certification review course. She also formed a Facebook page called The Stay at Home Nurse. Amongst her biggest challenges has been learning to write. As she says "after writing nurses notes for over 20 years, writing a complete sentence was difficult, let alone a paragraph or a book!" The technical portion of the career path has been a challenge as well. She ultimately took on a business partner who handles the tech portion so that she can focus on her own strengths. When asked about career role models, Deanna stated, "I have a lot! Laura Mitchell RN, BSN was a role model who took me under her wing and encouraged me to really grow in my profession as a nurse. Her inspiration and leadership inspired me to seek out opportunities before I felt I was ready for them. The second would be Anne Llewellyn, RN-BC,MS, BHSA, CCM, CRRN who has become a role model and mentor. She has a wealth of knowledge and expertise and is dedicated to sharing it in order to promote the practice of case management and case managers". As far as advice that Deanna would give to aspiring nurse entrepreneurs and intrapreneurs, Deanna encourages doing something each day toward reaching your goal. Baby steps so as not to become overwhelmed. Ask a lot of "how and why" questions when a problem is introduced. Thinking of how to solve a problem and delving deeper into the why questions. Deanna believes mentoring the next generation of nurses to elevate the quality of nursing professionals is one of the single most important issues to face over the coming years. Addressing issues such as bullying and staffing ratios will help to ensure that the next generation can properly care for patients without burnout and risk of losing good nurses. For more information regarding case management or materials and support groups for studying for the certification exam see Deanna's facebook page or webpage listed above!
  16. Sarah Matacale

    Peripartum Cardiomyopathy

    What an inspiring story! Thank you for sharing!