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Melissa Mills BSN

Nurse Case Manager, Professor, Freelance Writer

Hi there! I'm Melissa and I'm a skilled writer, editor, and content manager and I would love to help you with your next project. I specialize in healthcare and women's content

Content by Melissa Mills

  1. Melissa Mills

    Got Stress? Eat These Foods to Lower Your Stress Levels

    OldDude - You are sooooo right! LOL I would need a little whiskey myself! Maybe I should make another list of 10 Things You Should Drink at the End of Your Work Day That No Doctor Would Recommend! LOL.
  2. Social media can penetrate all areas of your life. As a nurse, you understand the importance of professional boundaries, but this unique medium poses a potential threat to your ability to maintain therapeutic relationships with your patients and their families. Understanding Professional Boundaries The National Council of State Boards of Nursing reports that professional boundaries are the spaces between the nurse's power and the patient's vulnerability. Your relationship with your patients is unequal, meaning that you know more personal information about them than they know about you. While you must respect this imbalance of power, you also need to maintain it to keep a healthy distance between you, your patients, and their family or caregivers. Social media can quickly create imbalances in the therapeutic relationship. To better understand social media and patient care, let's explore a few scenarios. The Friend-Request You hop on Facebook and see you have a new potential friend waiting to hear from you. The name sounds familiar, but you can't quite place it. You click on the profile to see the picture, and it hits you - it's the wife of the patient in Room 220. You've been caring for her husband for the past week and have had some great conversations. You go to click "confirm," and a quiet voice tells you that you might need to reconsider. What should you do? How to handle this situation You shouldn't accept this friend request. Allowing the patient's wife to have access to more personal information about you can shake up the balance of the therapeutic relationship. If the patient is still in the hospital, talk to her face-to-face and let her know that while you enjoy talking to her and caring for her husband, you can't accept the friend request. If the patient is no longer in the hospital, decline the friend request and send a personal direct message letting her why you can't accept the friend request. Check with your hospital's social media policy to ensure that this isn't a reportable occurrence. The Insta-Celebrity Patient You walk into the room of Eva Lopez. She's been admitted for acute pneumonia, but rather than lying in bed resting, she's putting on her make-up and setting up a small lighting contraption on her over- bed table. When you ask her how she is doing and inquire into the reason for the light, she tells you that she has an online business and blog. She goes on to say that she has over 50K followers who want to see images of her daily and part of her gig is to be transparent with her life. You talk briefly about your side gig - a lifestyle blog helping fellow nurses. Eva tells you that she can probably get you a few thousand followers just by letting her take a picture of you next to her in bed. She also says that you should follow her on Insta and she will follow you back, which should get you even more followers. You're interested, but not quite sure if it's a good idea. How to handle this situation Taking a quick photo with Eva might be tempting. However, you know without a doubt that she is going to post it and you will likely see some growth in your side gig because of it. Before you do anything, read the facility policy about patients taking pictures of staff. If you read the policy and think that it might be okay, talk to your immediate supervisor about it before you allow Eva to snap that picture. Better safe than sorry because, as you know, once something is out on social media, the chance of getting it back is slim to none. Showing Support to the Patient Maria, a cancer patient you've been seeing in hospice for the last few months posts regularly to a hospital-supported social site. While looking at a recent post, you notice that she mentions how severe her pain has been lately and how she feels a bit depressed. To show your support, you remind her that the new antidepressant and pain medications should be helping soon and that you would discuss a few other things during your next visit tomorrow. Before you go to see Marie, you stop at the grocery store. Mrs. Smith, a local school teacher who is friends with Marie, chats with you in line and asks how Marie is doing. She then inquires what medication they started Marie on because she takes Zoloft and wonders if that's what Marie needs too. At that moment, it hits you - while the people on the site have been invited by Marie, you probably shared information that you shouldn't have shared. How to handle this situation In this scenario, the information has already been released. You need to talk to Marie and let her know what you did. You also need to report this incident to your immediate supervisor as soon as possible. It's important to remember that privacy breaches can still happen on sites such as this one because you've given information without Marie's permission. What other scenarios have you encountered with social media? Or, do you have any other social media advice for nurses? Share in the comments below. Schedule
  3. It seems that there is an app for just about everything these days. I mean, there's even an app that tells you if it's a good time to run to the bathroom during a movie and one that will help you find your car - in a pirate voice! So, it's not surprising that there are hundreds of apps out there made just for nurses. Here are a few of the best for every nurse. Symptomia When you need to check symptoms quickly, access this medical diagnostic tool that was created for medical students and healthcare professionals. Symptomia offers a fast, easy-to-use resource of selected medical information. The next time you're dealing with that one patient that nobody can pinpoint a diagnosis- pop their top symptoms into this resource and receive a list of differential diagnoses with only a few taps of the screen. Medical Spanish You arrive at work and receive report on Mr. Lopez - a Spanish speaking male who seems to be getting more agitated by the day because he can only speak to his care team when the interpreter is on the unit. Well, you're a bright nurse - so, you whip out the Medical Spanish app by Mavro. This app was created for non-Spanish speaking healthcare professionals to obtain vital medical information from Spanish speaking patients quickly. Hola, Amigo - let's get to work! Pocket Lab Values Science continues to discover new ways to diagnose and treat illness through new lab values. This is challenging when you're trying to remember lab value norms. Try downloading Pocket Lab Values. It provides thirteen simple categories that range from electrolytes to immunology, to toxicology. It contains over 200 lab studies and provides reference ranges for each along with a brief description explaining the test in detail Pill Identifier Now, you take the popular medication resource, Drugs.com with you on your phone. Pill Identifier is a searchable database with more than 24,000 prescription and over-the-counter medications at your fingertips. This app comes with a free and a paid version, to make it even more specific to your needs. Calm You run into work with just enough time to take off your jacket, grab your stethoscope, and slide into a seat to receive report. As you look at your colleague, you see their mouth moving, but all you can concentrate on is your busy home life. You think to yourself, "I need to focus and be more mindful." This is where Calm comes to the rescue. Use the new Daily Calm meditation that's uploaded each day, or practice one of the many guided meditations that help with focus, stress, and anxiety - three things you can feel just during report, right? Nurse Tabs When you need med-surg, fundamental, or pharmacology information, you probably need it in a hurry. Nurse Tabs provides these three concepts in an easy-to-use app format that focuses on the data that nurses need to know. Students can also review for the NCLEX exam and sharpen critical thinking skills. Epocrates Over a million healthcare providers use Epocrates when they need support making clinical decisions. This app saves time and helps you keep the focus where it should be - on the patient. You can review evidence-based guidelines, find peer-reviewed content, send texts to other colleagues, and even check for harmful interactions. Nurse's Pocket Guide Nursing diagnoses can stump even the most tenured of nurses. The Nurse's Pocket Guide by unbound, helps you make accurate nursing diagnoses and create patient-specific care plans. With this app, you'll have others on the unit asking for your care plan expertise in no time. Cozi Nurses have lives outside of work - busy ones, at that! That's why you need Cozi, a free app that's won the Mom's Choice Award three times! You can store recipes, plan your meals, and even create and share your grocery list. Cozi will keep your work and home-life schedules organized so that you get to work, the game, and that upcoming ballet recital on time. Med Mnemonics Have you ever used a short rhyme, phrase, or other mental technique to remember complex information? If these quippy mnemonics help you, you're going to love Med Mnemonics. This app gives you almost 2000 clever memory tricks that cover topics from anatomy to surgery. What are you go-to nurse or medical apps? Share in the comments.
  4. Melissa Mills

    Top 10 Nursing Apps You Need to Download Today

    Love Turbo-Scan!!! It's great! And, eliminates the need for a scanner at home or a trip to the local office-store.
  5. Melissa Mills

    Social Media and Patient Care: Understanding the Rules

    JavaJunkie RN - This seems like a very good plan! ~melissa
  6. Melissa Mills

    Top 10 Nursing Apps You Need to Download Today

    Thanks for the suggestion!
  7. According to the Bureau of Labor Statistics, 10.7% of all wage and salary workers in the U.S. were members of a union in 2017. UNIONFACTS.com reports that there are over 170,00 nurses in the country who belong to a labor union. This number has been steadily rising since 2011. The increase in union membership may surprise you. Some nursing and healthcare unions have pushed to increase membership even more over the past few years. The Union Debate at Johns Hopkins Nurses at Johns Hopkins Hospital in Baltimore have been in the midst of the union debate. A recent article in the Baltimore Business Journal reported that many of the supporters of the union had criticized the hospital for high turnover rates, low pay, inadequate staffing, and adverse effects on patient care. There have been reports that the hospital has prevented union supporters from discussing organizing in some hospital settings or unions. This might all seem like typical union banter. However, there's more to the story. The article goes on to report about another group of nurses, known as "Stand With Hopkins." These nurses don't feel that Hopkins is in need of a union. They feel that the union rhetoric could be hurting the reputation of their employer and that they need to be told the positives and negatives of unionizing along with any possible alternatives. One member of the "Stand with Hopkins" said that if the union is the best option, they are okay with it. The group says they only want to ensure that all possibilities are explored so that nurses can make an informed decision. The real question here is this - If you were in this situation, would you know how to vote? Do you understand the pros and cons of joining a nurses union? Here are a few things to consider. What is a Union? A labor union is an organized group of workers who come together to make decisions about factors affecting their work. Unions function to bring economic justice to the workplace by advocating on the workers' behalfs on issues such as benefits, working conditions, hours, and wages. There isn't just one union that represents nurses across the nation. However several unions represent nurses and other healthcare workers. Understanding the Pros of a Nurse Union Job Security If you're not in a union, you're probably an "at-will employee." This just means that you can be fired for any reason at any time. Employers can also make changes to your benefits and wages without notice. However, when you are in a union, the contract is binding, and it protects you from being terminated without cause. Many unions also negotiate guaranteed pay raises with each new contract. Guaranteed Representation Another benefit of being in a union is that if you are given disciplinary action or are in breach of your contract, you won't go to any meetings with supervisors alone. The same is true if you were to ever file a grievance against your employer. Better Pay Unions put forth much effort to fight for higher salaries. This is especially true under circumstances such as being understaffed or working in less than favorable conditions. While it's difficult to say just how much more you might make if you belong to a union, some sources report that union nurses make up to an extra $400 a week. Improved Working Conditions Unions represent the best interest of their members. As a nurse, this might mean improved safety protocols, access to needed equipment, and better nurse-to-patient staffing ratios. Understanding the Cons of a Nurse Union Risks to Your Job Many employers don't like unions and will do anything they can to keep their nurses from joining. While this isn't legal - it is the reality in some places. If a union calls for a strike, you might find yourself without a job, because if another nurse is willing to cross the picket line to work - they might be given your position. Fees to Join Most unions charge a percentage of your annual salary. Dues pay for services such as contract negotiations and representations. However, many nurses don't want to pay for these services and opt out for this reason. Unpaid Strikes Unions strike when they can't come to terms with the employer. During these times, you might go without pay. Seniority is King Unions often promote based on tenure at the job, rather than skills. You could get passed over for a promotion if a coworker has been there longer, even if you are more deserving of the position. Everyone is Equal This might sound more like a pro, but in unions, employers can't terminate nurses who are just not good workers. The employer has to jump through the hoops, which means that you can be stuck with a coworker who doesn't pull their weight. What's the Best Option? This is not an easy question to answer. Quite simply, every nurse needs to consider if being a member of the union is a good fit. This isn't a "one-size-fits-all" scenario. What do you think? Do you belong to a union? If so, would you recommend joining to others? Or, do you run for the hills everytime union membership is offered? We'd love to hear your thoughts.
  8. When you graduated nursing school, you may have envisioned working at the bedside for thirty or forty years before hanging up your nursing shoes. But, lately, you're not sure you want to finish 2018 at the bedside, let alone a few more decades. If you're feeling this way, it's important you know that you're not alone. The RN Work Project, a national study of new nurses, reports that 17.9% of new nurses left the profession within 1 year of starting their first job and 60% left within 8 years of starting their first position. Nurses with more tenure leave because of staffing issues, schedules, and overall job dissatisfaction. So, how do you know if it's really time to leave or if you're just in a career slump? Recognizing it's Time If you're wondering if bedside nursing is where you should be, you're probably going through a lot of emotions. You may feel like your stuck or even regret entering the nursing profession all-together. Don't beat yourself up. A degree in nursing is more flexible today than ever before. So, before you worry that you've made the mistake of a lifetime, let's explore a few signs it's time for you think outside the box of a traditional nursing career. You Get Little or No Joy out of Caregiving Caring for others is hard. Whether it's the long shifts, schedule, or stress levels that come with a lifelong nursing career - it can make the job a bit more demanding than what you want. So, if you find yourself dreading going into work and this feeling lasts for weeks, or even months, it's probably a good indicator that you need to start considering something new. Your Passions and Gifts Aren't Being Used at the Bedside Many nurses start realizing that being at the bedside doesn't give you much ability to use other skills, such as writing, marketing, or organization. Yes, you certainly do write, market, and organize as a nurse, but if you find yourself dreaming about utilizing these skills or others on a daily basis, it may be time to look for new opportunities. Using your passions doesn't always mean you need to walk about from your license. It just means you need to consider a niche of nursing that lets you use both your nursing knowledge and our passion. You're ready to throw in the towel on nursing all together Many nurses find themselves in this situation. But, don't act hastily. A degree in nursing doesn't mean you have to work at the bedside. You have options - especially in a healthcare market that is continually looking for new and creative ways to deliver care cost-effectively. You can look into non-traditional nursing positions that let you use your knowledge, without being at the bedside, such as case manager, health coach, or utilization review - just to name a few. What's Next for You Before you take any other steps, you need a plan. Follow these tips to move in the right direction: Write It Out Make a list of your strengths and weaknesses. Another way to think about this is to jot down all the things you like about nursing and those tasks you despise. This will help provide some clarity for your next role. Next, make a list of your passions and start analyzing the two lists side by side. Do a little research on non-traditional roles that incorporate the tasks you like and your passions. Stay Positive It can be easy to slip into a pattern of beating yourself up over this change. But, what will that accomplish? You're right - nothing! So, don't worry about the past. Many people make career changes after a few years - or a few decades. Try Changing Your Mindset If the thought of jumping ship worries you or comes with financial consequences you can't face, try changing your mindset. You might also want to look for a new employer to see if your issues are more with the unit than with your bedside career. Take Your Time As my grandma used to say, "Don't jump out of the frying pan and into the skillet!" Give yourself plenty of time to make sure you're making the change for the right reason. The last thing you want to do is enter another role that isn't right for you. Have you recently left the bedside? Are you happier now or do you miss it? Let us know why you left the bedside and how your new role is working out for you.
  9. You might think that bullying only happens inside the walls of schools. We often hear stories about bullying between younger children and even teenagers. But, if you've been a nurse for any amount of time, you've probably experienced nurse bullying yourself or witnessed it on your unit. In fact, one study reported that 45% of nurses have been verbally harassed or bullied by other nurses. You might be thinking that you've heard so much about bullying in recent years that you no longer need more education. Renee Thompson, DNP, RN, CMSRN, owner of the Healthy Workforce Institute and bullying subject-matter expert, has this to say about continuing the fight against bullying, "It's just like anything else you want to master - you can't just attend one workshop on a particular topic and then check a box...yep, mastered that! If we really want to eradicate bullying and incivility from the healthcare work culture, we must engage in consistent, ongoing education and training related to disruptive behaviors." This is precisely why every October, our nation comes together to recognize bullying across all settings during National Bullying Prevention Month. Organizations such as STOMP Out Bullying and the National Association of People Against Bullying educate others on this community problem in the hope of curing our culture. What is Nurse Bullying? According to stopbullying.gov, bullying is unwanted, aggressive behavior. Renee has described bullying as having three components: it's targeted, meant to cause harm, and it happens over time. Not all unwanted or mean behaviors are considered bullying. Some actions may be classified as incivility. For example, if you've had a particularly bad day at work and get a little testy with a co-worker, this might be incivility. But, if a co-worker continuously yells at you, picks on you, or turns others against you - this could be a classic case of nurse bullying. Recognizing the Behavior Do you remember the playground bullies you dealt with in elementary school? They would pick on you or others only when the teachers weren't around or paying attention. Bullying in nursing isn't much different. There may be times when the bullying is overt, such as another nurse who yells at you, insults you, or lets you know in no uncertain terms that they don't care for you. However, often the bullying is a bit more subtle and may even leave you wondering if you're interpreting the actions by others correctly. A few examples of subtle bullying include: Others not helping you, even to the point of putting patients in unsafe situations to avoid lending you a hand Not giving you all of the information you need to perform your duties in hopes that you make a mistake Spreading rumors about others Excluding certain nurses from activities on the unit What to do if You're Being Bullied If you find yourself in a bullying situation, you need to speak with your nurse manager. Renee offers this advice to anyone breaching this difficult conversation, "The first action is to get clear on the specific behaviors of that nurse. Instead of saying to your manager, "she's bullying me," try saying, "she refused to take report from me, yet she takes report from everyone else." This takes the emphasis off of the person and places it firmly on the behaviors. Renee went on to say, "Once you're clear on the behaviors, start a documentation trail. Include date, time, location, an objective account of the incident, and most importantly, link that behavior to a patient safety, quality, or satisfaction concern. If done well, documentation can increase the chance that your manager will take action." The last thing to do if you're being bullied is to confront the person. Renee said that she shares many scripting techniques that work well. "Most importantly," she shared, "is that if you're being bullied, you must do SOMETHING about it." How to be a Positive Influence Even if it's never happened to you, there are things you can do to improve the healthcare culture. Try one of these simple actions that let others know that you support a kind, caring nursing environment: If you witness one nurse bullying another, intervene on the target's behalf. You don't have to get in the middle of the situation, but you can redirect the behavior. Befriend and mentor new nurses on your unit. Notify your supervisor if you witness bullying or incivility. Be kind to others, treating them how you expect to be treated. Be positive. Recognize others for the behaviors you want to see on your unit. Have you ever experienced or witnessed bullying? We invite you to share your story to bring more awareness to this problem by placing your thoughts in a comment below.
  10. Have you ever considered choosing to enter a war as a nurse? For most of us, the answer is likely a resounding, "No." But, for one nurse - Sallie Cory - heading into a war zone in the middle of Vietnam was a dream come true. In 1965, the world was a much different place. President Lyndon B. Johnson began his first full term, Malcolm X was assassinated, and over 3,500 United States Marines were sent to South Vietnam to fight in the war. In Boise, Idaho Sallie Corry graduated from Nursing School and began preparing to serve her country in one of the most controversial battles of all time. Her Story Sallie deplaned in Bien Hoa, Vietnam in March 1967 and was ushered into the mess hall for breakfast. She was stunned by the constant booming of artillery and asked a mess Sergeant if they practiced like that all day. He responded with a droll huff, "This is Viet Nam ma'am... we don't practice". This was when she realized she might be in for a bit of a learning curve. Shortly after arriving she celebrated her 24th birthday and just 5 short weeks later she met the love of her life which would then become her husband. Sallie spent one year of her 52-year nursing career tending to the wounds of soldiers. As I listened to her story, I could see the excitement across her face as she remembered a war she felt was her destiny. Here are three resounding lessons Sallie learned in the middle of war zones, helicopters, and red clay sand. Healing is an Attitude My best friend and I sat across from Sallie and her daughter while we ate lunch. Well, while three of us ate lunch and Sallie re-lived some of the best years of her life. While much of what she said resonated, uplifted, and motivated me, the best sentence of the entire 2-hour conversation was this - "I learned that I was a healer." Sallie told of several young men she cared for in the middle of the war. She remembered stories of teaching a young soldier how to care for a colostomy, stabilizing many men before sending them on to Japan, and giving comfort to a man with severe Napalm burns. When Sallie spoke about herself, she recognized that in the middle of bombings, she learned that she was a healer and that people felt better when she was caring for them. Her healing was not always done with high-tech treatments, but with her hands, heart, and words. She gave her patients her time and devotion. She offered reassurance to men she knew might not live to make it back home. Sallie prided herself on meeting her patients where they were physically, emotionally, and spiritually. God's Protection Was All Around Vietnam was a bloody war. But, when you hear Sallie tell her stories, you would think she was talking about a wonderful place. In fact, to her, it was. After leaving Qui Nhon, Sallie was transferred to the 71st Evac Hospital in Pleiku, which was in the Central Highlands. While there, she became accustomed to frequent daytime artillery fire and all night rocket fire coming towards the military headquarters surrounding the hospital perimeter. She experienced the Tet Offensive at the 71st Eval and for the first time felt that she was closer to death than ever before. There were areas of the war going on that were brutal, but she remembered that every place she served was precisely where she was meant to be at that time. She recognized that while she wanted to be there, she was also young, and believed that God used her where her gifts were best and kept her out of places that she wasn't quite ready to serve. Service Was in Her Blood Sallie comes from a long line of service men and women. And, this tradition certainly didn't stop her. As mentioned above, she married an American soldier who she met in the war and later had three children, one of whom went on to serve our great country too. I remember asking her how she felt when her son told her he had enlisted. Very matter of factly she said, "I understood the good and bad things he would see. But, I was so very proud of him too". A Nurse Comes Home Once back in the states, she had to acclimate to civilian life. Sallie went on to serve as a nurse on hospital med/surg units, homecare. She also became a healing touch provider over the years, which connected her to those healing gifts she discovered thousands of miles away in Vietnam. She eventually went into case management, which is where I met Sallie in 2014. I knew her for nearly two years before we ended up on a road trip together and she shared some of her stories of being in the Vietnam war. Today, she's retired, but nursing still runs deep in her blood. She has recognized that healing is a state of mind, and isn't dependent upon your physical capabilities. Being a healer requires you to think, act, and be a healing presence to ourselves and those around us. So, this Veteran's Day, I want to thank men and women for the heroic efforts they give so freely for our independence and right. But, I want to give a little extra love to nurses, who like Sallie, might choose to serve their country in times of healthcare need. Have you served our country as a nurse? Were you stationed overseas during a war? We would love to hear your stories of war and nursing so that we can celebrate you too.
  11. You hang up the phone. You did it! You just landed your first nurse leadership position - now what? You may have literally had this thought running through your mind. Sure, you know you need to tie things up in your current position. But, how do you make a smooth transition from being a staff nurse to a nurse leader? And, not just any leader, but one that you can be proud of being, right? Job transitions are hard and exciting. When moving into nursing leadership, you need to understand the principles of successful leadership and then set yourself up for success from the beginning. Here are a few ways you can make sure you get started on the right foot: STEP 1: Establish New Boundaries If you are going to be the manager of a unit, department, or facility that you've never worked on before, it's a bit easier to set healthy boundaries. But, when you're moving up the ladder in your current place of employment, you might find that some growing pains are coming your way. You may need to change some of your past friendships to fit your new role. No matter the situation, make sure you create boundaries. Before you give every nurse your personal cell phone number to show just how available you - stop and think about the worst case scenario of that decision. Oh, and I'm speaking from experience here! Yes, you have a work phone, and they know they need to use it first and only use the personal phone for emergencies. However, you can trust me when I say that you might find yourself with both phones on at the same time - all the time. Be sure to think through these decisions before you give everyone access to you 24/7, rain or shine. STEP 2: Create Two Lists of Leaders Sit down with a journal and make a list of 5-10 nurse leaders you know that you admire. Under each name, jot down the qualities that made you put them on the "good leaders" list. Then, do the same with leaders that you didn't connect with quite as well. Compare these two lists and meditate over both the positive and negative qualities. By writing this down, you can start making intentional decisions about the type of leader you want to be in your new role. STEP 3: Meet Your New Staff One-on-One You want to take the time to meet privately with each staff member. This might mean you have to show up extra early or even swing by for a few third shift meetings. Create a list of 10 question you want to ask each staff member so that you get similar information from each nurse. Here are a few sample questions that might work for you: What do you love about this job/unit/department? What improvements do you want to see in 6 or 12 months from now? What are your greatest assets? What do you need from a leader? What motivates you? If you were the manager of this department, what would be your top 3 concerns for the future? How can I serve you best as your manager? STEP 4: Set Goals Being the best leader you can be takes skill and planning. Write out 2-5 goals for yourself and then for the unit as a whole. Use the SMART goal system when writing your goals to help you achieve them. You might even develop unit goals at a staff meeting so that everyone gets the opportunity to share their ideas. Once you've crafted your goals, post them in a highly visible area of your office. For department goals, place them in the breakroom or nurse's station. STEP 5: Educate Yourself A title alone doesn't make you a leader. It does make you a manager, but not a leader. You're going to have to put some work into this first leadership job if you want to be here for many years to come. Connect with the American Organization of Nurse Executives or Organization of Nurse Leaders. Attend a local or national meeting to learn more about how to be a successful nurse manager. Go to the library or bookstore and check out some books on leadership skills. Here are a few of my personal favorites: The Fred Factor by Mark Sanborn Who Moved My Cheese by Spencer Johnson and Kenneth Blanchard Emotional Intelligence 2.0 by Travis Bradberry and Jean Greaves The One-Minute Manager by Ken Blanchard and Spencer Johnson STEP 6: Host an All-Staff Meeting It's essential to meet with all of your staff together. Meetings give you the opportunity to ensure that everyone hears the same messaging at the same time. It cuts down on miscommunication and allows you to set clear expectations for yourself and your new team. STEP 7: Create Clear Expectations Speaking of expectations --there is nothing is worse than not knowing what your leader expects from you. Be sure to communicate your expectations through clear verbal and written messaging. Send emails, post minutes after meetings, or create a newsletter to make sure that all shifts are getting the same information. STEP 8: Celebrate With Your Staff Being a nurse is a hard job, so make sure you celebrate the big and small wins with your staff. Have a monthly birthday potluck, celebrate holidays, new babies, graduations, and other life events. It doesn't have to be anything elaborate, but having a small party will mean a lot to your staff. And, one of my favorite ways to celebrate staff is with a small, hand-written note. Buy a box of blank notes and keep them handy in your office. It's amazing what a short note of thanks or encouragement can do to boost your staff's spirits after a rough day. Use these tips to start moving your new leadership career in the right direction. If you're a new leader, did you use any of these tips when you got started? Or, if you're a seasoned nurse leader, what other tips would you give to new leaders who want to be successful from the start? Comment below, we love to hear your thoughts.
  12. Melissa Mills

    6 Places the Community Needs Nurses

    Everyone knows that nurses work at the bedside. But, the community doesn't usually consider the need for nurses in other areas of healthcare and even other industries. Just imagine a world without nursing research, education, or leadership. It's important we recognize that healing happens in many places and by numerous methods. In fact, our communities and society at large need nurses in roles they might not even consider. Here are a few places the community needs nurses and the impact these specific roles have on the health and wellbeing of the community they serve. Healthcare Executive Leadership In today's tenuous healthcare environment, nurses are needed in executive leadership roles more than ever. Nursing executives possess a unique patient and bedside nursing perspective that other executives don't have. They have the opportunity to lead and be the champion for patient care from a place of understanding, empathy, and practicality. Nurse executives work to manage budgets, create and implement policies, and execute human resource rules and regulations. They build a culture of innovation, work collaboratively, and increase access to and use of technology. Community members and even patients might not ever interact with a nursing executive, but without them, receiving competent care would be difficult. Nursing Leadership A bit different than executives, nurse leaders manage units, agencies, and other nursing departments. They work in the vast space between hands-on care and nursing executives. Nurse leaders impact the community by being a voice in the world of middle-management. They are just a few steps removed from patient care, so they continue to know and feel the pulse of patient care, safe staffing ratios, and the needs of the bedside nurse. Our communities and the future of nursing need these nurses to have a voice for advocacy. Research You might use the term evidence-based practice when performing care. But, have you ever thought that nurses had to conduct research studies to find the evidence that's used in patient care? In between research and practice is policy, which takes the evidence obtained and implements into practice. Nurse researchers create theories, hypotheses, and develop and implement studies to learn new ways of achieving better patient outcomes. Without nurses doing research, nursing practice would be disorganized and chaotic guess-work. Entrepreneurship Nurse entrepreneurs use their nursing knowledge to start their own healthcare industries. They develop products, services, devices, or offer patient care and education. Other entrepreneurs write articles, create podcasts, and or deliver keynote speeches. Many of them do this work as a side-hustle while continuing bedside practice, but some leave the bedside to run their own companies. They add value to the nursing community through education, development, and more. Without nurse entrepreneurs, our communities would be void of products and services that complement that continuum of care. Flight Nursing If you've ever been critically injured and needed immediate transport to a healthcare center, you've experienced the importance of flight nurses face-to-face. Flight nurses care for patients as they're transported in helicopters and other aircraft. They are essential staff during rescue operations and air evacuations. They provide advanced critical care and assume responsibility for the patient during transport. These nurses provide critical access to our communities at some of the most difficult and stressful times. They save lives when time is of the essence, and our communities are safer because of these advanced care practitioners. Public Health Nurse The term "population health" has gained much popularity in recent years. Public health nurses focus on the health and well-being of a specific population. They promote health and prevent disease and disability. They use concepts from the fields of nursing, public health, and social services to keep our communities well. These nurses work in clinics, schools, government agencies, and volunteer organizations. They work with at-risk populations and provide education on disease risks. Nurses in public health are also instrumental in the preparation of disaster relief. Without nurses working in public health, our communities would suffer from disease and disaster. Nursing is one of the most diverse professions. You can specialize in many ways or create a new nursing path of your own. Are you considering a different direction in your career path? If so, let us know where you would like to work. Or, if you hold one of those "dream" nursing roles, comment below and let us know what's so great about your career choice.
  13. Nurses rattle off acronyms and big words like it's their job - well, actually it is! But, when those big words get in the way of your patient understanding what's going on with their health, it's a problem. The Patient Protection and Affordable Care Act of 2010 defined health literacy as the degree to which an individual has the capacity to obtain, communicate, process, and understand basic health information and services to make appropriate decisions. You understand the critical position literacy plays in the care of patients. But, when you're up to your eyeballs with your patient assignment, it's probably not the first thing on your mind. Here are 7 quick ways you can meet your patient's unique health literacy needs. Assess Patients Skills and Needs Assessing literacy can be a bit tricky. You can ask the patient about their education levels or even directly ask if they can read. However, some patients might try to hide the fact they can't read for many reasons. It's your job to dig a bit deeper to assess their skills and needs. For example, I had a home care patient that was being labeled as non-compliant. No matter what we did, he wouldn't take his medications and required multiple readmissions to the hospital. My manager at the time gave the directive to figure out the issue or discharge for non-compliance. As the RN on the case, I took the lead and went out to assess the problem again, since nothing was apparent during the start of care visit. During our appointment, I set his meds in front of him and asked him to read each label, tell me when he took the medication, and what condition the pill treated. He sat quietly and looked away. After a few moments - it hit me - he couldn't do this because he couldn't read. His literacy issues were creating barriers that were exhibited as non-compliance. I worked with the LPN who saw him a few times each week to devise a system of color coding for his drugs. After a week or so, he was doing much better, and compliance was no longer an issue. It took a bit of investigation to identify the issue, but it was worth it to be able to discharge this gentleman and know that he was now independent in med and disease management. Make a Human Connection No matter what a patient's disability might be, you have to remember that they are human. Take time to connect with them and create a relationship. Once this connection is set, it should be easier for them to trust you and confide in you if they don't understand. Use Teach-back If you need to assess the patient's understanding, you can use the teach-back method. This method allows you to check the patient's understanding by asking them to state what they need to know or do about their health in their own words. Use an Interpreter According to an August 2017 article in The American Journal of Psychiatry Residents' Journal, communication barriers can lead to a variety of problems, such as lack of informed consent, aggression, and avoidance of the health care system. The use of professional medical interpreters can increase outcomes, improve adherence to care and decrease adverse outcomes. Mix the Modes Do you remember sitting in a lecture and wishing that there were more visuals or hands-on teaching methods used? The same is true for those who may have communication barriers. Here are a few ways to mix the modes of communication: Provide demonstration for care Allow the patient to demonstrate competency Give written instructions for reference Provide an opportunity for questions to be asked before they must be independent Use videos and other technology Be sure all videos have captioning Tap into Tech Have you ever considered the use of technology or apps when teaching self-care? Apps can put critical health information at the patient's fingertips. They can also deliver information using video, text, and images. For newly diagnosed diabetics, try MySugr Diabetes Logbook. Or, if you're looking for a med management app, look into Mango Health. Record Teaching Our society is video recording happy. We record everything from a baby's first steps to crimes happening in our neighborhoods. So, why wouldn't we consider allowing a patient to video record teaching or demonstration of care? Well, there are many legal issues for sure, but there is evidence that it is an effective method for instruction. One study found that 72% of patients listened to recordings, 68% shared them with caregivers, and those with these recordings reported a better understanding and recall of healthcare information. Before you allow a patient to record any teaching, be sure to check with your manager and read your facility's policy on patients recording staff. By using these methods to increase health literacy, you're not only improving understanding, but you are impacting the patient's overall ability to care for themselves. Enhanced self-care behaviors increase well-being and outcomes. Have you ever used any of these methods with success? Let us know in the comments below.
  14. Melissa Mills

    3 Signs it Might be Time to Leave Bedside Nursing

    SobreRN - Yep - this is a great example. I don't think tell them "like it is" was the real reason behind this though - it sounds like your dissatisfaction with the system might have been at play. And, we certainly have all been there a time or two! :) So, you no longer work at the bedside? Thanks for taking time to share your experience! Melissa
  15. Melissa Mills

    3 Signs it Might be Time to Leave Bedside Nursing

    Hey Erindel RN - Thanks for sharing your struggles. That's a big first step. Have you considered non-traditional nursing positions? Before throwing in the towel, try writing creating a pros/cons list about this job and other jobs you've held to find some common things you do like. Then, look for opportunities that use those skills as primary functions of the job. There are so many ways to be a nurse - not just at the bedside. Best of luck to you! Melissa
  16. Melissa Mills

    3 Signs it Might be Time to Leave Bedside Nursing

    Yes, Carrie!! There are many other jobs you can do as a nurse and still use your nurse brain - just not your nurse hands. :).
  17. kbrn2002 - Can't love this enough!!! :) Thanks for your thoughts! Always welcome! Melissa
  18. Empathy Labs - nice idea!! ~Melissa
  19. Melissa Mills

    It's Time to Stop Nurse Bullying in Its Tracks

    Hoosier_RN - I understand where you are coming from. And, yes - unfortunately, as with so many things in our society - some people latch on to things like bullying and cry wolf. This further complicates the issue at hand and decrease the credibility of others. Thanks for your thoughts! Melissa
  20. Melissa Mills

    3 Signs it Might be Time to Leave Bedside Nursing

    Thanks Davey Do! I toggled back and forth between bedside care and management for several years. At some point, I started feeling the rustiness of my skills and decided it was time to stick with non-direct care positions. From there, I chased my dreams and writing and - well, here I am! LOL Melissa
  21. I remember the first time I had visible bruises on my arms, neck, and chest. I tried my best to hide them with long sleeves, even in the summer months. I made excuses. I told people I fell or bumped into a doorframe. I came up with any story that would keep people from asking for details. You might be thinking, "But, she's a nurse, she knows better." Well, even as a nurse, I had the normal "victim" dialogue in my head. I worried that I provoked him or maybe even deserve the abuse. I feared that he would take my kids or convince our families and friends that I was the problem. I would have these conversations with myself late at night and know deep down that it wasn't true, but many times it was just easier to take the abuse than to create a plan to leave. Today, almost seven years since I've been in that abusive relationship, I'm healthy and happy. This month is Domestic Violence Awareness Month - a time to talk about this challenging subject and remind others that there are countless victims and survivors around each of us in our personal and professional lives. What is Domestic Violence According to The National Domestic Violence Hotline, domestic violence (also called domestic abuse, relationship abuse, or intimate partner violence) is a pattern of behaviors used by a partner to maintain power and control over another partner in an intimate relationship. These behaviors may cause fear, physical harm, or force the victim to comply with things they don't want to do. It isn't only physical. Domestic violence can be sexual, verbal, emotional, or economic. It might also be any combination of these types of abuse. Why does it happen? Getting into the mind of an abuser is difficult. But, research has shown that domestic violence typically starts with a desire to control an intimate partner. The abuser often feels that they have the right to control their partner and that they need to be in power. They may make their partner feel that they are not worthy of other relationships, aren't valuable, or deserving of respect. It's important to know that abuse is a choice. No matter if it is a learned behavior from other relationships or childhood - abuse is not okay. It's a choice made by the abuser. It's never the victim's fault, even though they may tell themselves that it is. Who Can be a Victim? Domestic violence doesn't discriminate. It can happen to anyone regardless of age, gender, sexual orientation, economic status, education, or any other factor. It can be a confusing time for the victim. They might question if they are doing something to deserve the abuse. They may feel responsible for angering the abuser. It's important to know that abuse is never acceptable, regardless of what the abuser may be going through. Common Warning Signs Nurses have a legal and professional duty to report possible abuse. Here are a few signs that your patient might be a domestic violence victim: Black eyes Symmetrical bruises on upper arms, neck, or wrists Marks, injuries, or bruises that are covered by clothing Bruising in various stages of healing Fractured jaws Ruptured eardrums Rib fractures Cuts around the eyes or lips Unexplained STDs Marks consistent with the size and shape of objects like cigarettes or belts Poor hygiene, skin ulcers, malnutrition Hiding bruises or other injuries with makeup or clothing Because many of these signs can be related to other, legitimate injuries, it's crucial that you ensure you obtain more information from the possible victim. Be aware that when you begin asking questions, they might become defensive. Remain calm and non-judgemental as you discuss your concerns with your patient. Questions to Ask As you begin building a trusting relationship with your patient, it's essential that you start asking questions that can help you gauge what's going on in their personal life. Below are a few questions that you can use. These questions range from broad to direct. How are things at home? - This is a broad question that can help establish what's happening in your patient's personal life. When I see injuries like this, I wonder if someone could have hurt you? - This question is a bit deeper and lets them know that you have concerns. Inquiries such as this enable the victim to understand that you see things that are concerning. This might help them know they no longer need to hide. You seem anxious. Is everything okay at home? - With this question, you are getting more specific and personal into the patient's home life and personal relationships. Are you ever afraid of your partner? - This is a direct question that should only be asked once you've established concerning behavior by a partner. Are you concerned about your safety or the safety of your children? - Questions like this one are personal and can elicit fear or anger from your patient if they aren't ready to talk about the abuse. Speaking to possible victims of intimate partner abuse can be uncomfortable. You might not want to offend them. You may worry that you're wrong. But, not asking could leave your patient in an unsafe situation. You can also provide them the hotline number to call at another time when they are safe and away from the abuser - 1-800-799-7233. Are you a domestic violence survivor? If so, what advice would you give to nurses who might care for someone they feel is in an abusive relationship? Have you ever helped a patient to get out of a bad relationship? Share your experience with domestic violence in the comments below.
  22. kbrn2002 - I consider these questions part of a thorough assessment. Just like you would not pick and choose to listen to someone's lung simply because they are not coughing or complaining about shortness of breath. As a survivor - I didn't look or act like a victim. I'm a pretty strong person and being a nurse I knew what to say and do to keep people at bay. However, if someone had asked me point blank if I felt safe at home and showed some compassion I might have broken down and confided in that person and save myself years of abuse. This is of course my personal experience and thoughts. Melissa
  23. Melissa Mills

    It's Time to Stop Nurse Bullying in Its Tracks

    TriciaJ - Awesome responses!!!! Love this convo going on! Melissa
  24. Luchador - I love this "Take care of the people that take care of the people!!!" That is a very powerful statement! Melissa
  25. Melissa Mills

    It's Time to Stop Nurse Bullying in Its Tracks

    NurseSince2014 - Thanks so much for your thoughts. I agree that every situation must be taken individually. The thing that Renee Thompson, subject matter expert, points out is that the actions must be done repeatedly over time. It's not just a one-time incident. I think this does help differentiate those "learning" experiences you pointed out above and a few of your other examples. If someone is trying to help a nurse learn, this shouldn't be a pattern of behavior. Thoughts? Thanks for your comments. It's great to have conversations about these issues and shed some light! Melissa

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