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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

    9 Tips for Communicating Under Pressure

    @PotatoRN- Communicating with others is hard! That is why I actually prefer dogs. lol! :). But, seriously......I hear what you are saying. Your story brought back all kinds of memories of similar issues over the years. Telephone conversations, while convenient, can be infuriating. And, a doctor that does not like new staff could be a very dangerous thing to have if a patient is circling the drain. I think the best thing we can do as professionals is to reflect on these situations and do better next time. Thanks for sharing! ~Melissa
  2. Melissa Mills

    9 Tips for Communicating Under Pressure

    Nurses understand stress. Sometimes you can feel it in the air as you walk on to the unit. For nurse leaders, it may hit you like a ton of bricks as you open the door to a meeting room. Once the intensity of your workplace environment changes, communication can become stressful, tenuous, and downright difficult. The Importance of Effective Communication No matter what industry, experts agree that effective communication is needed to make your workplace function at its highest capacity. Of course, in nursing, ineffective communication can create sentinel events, workforce harm, poor patient experiences or wasted resources. One study found that communication failures were a factor in 30% of healthcare malpractice cases, which included 1,744 deaths. Knowing how to communicate under pressure can save lives. Tips to Consider for Effective Communication 1. Control your emotions - This is often easier said than done. We are emotional beings that react under pressure. You are not doing anything wrong by becoming emotional, it just interferes with your ability to see the situation objectively and communicate clearly. Don't be afraid of conflict - Not many people openly embrace the idea of conflict, but avoiding it will not make it go away. When you have to communicate under pressure, remain calm, respectful, and practice direct communication. 2. Consider non-verbal communication - When you are under stress, your body and face likely tell the story before you ever open your mouth. Gregory L. Jantz, Ph.D. suggests learning how to read other people's body language as well as your own. Mastering body language can guide your conversations along with spoken words. 3. Shut up! - The proper use of silence can be an effective strategy during stressful communication. According to mediate.com, creating space for questions through the use of silence is a powerful gift. Silence can be uncomfortable and we tend to fill silence with emotion. When silence happens during stressful conversations, it is noticed. Using silence as an effective communication tool can be difficult. You must not withhold communication as a means to frustrate others, but use it as a way to reflect, consider, and then deliver your thoughts in an effective manner. 4. Maintain clear delivery - Being clear in word choice, tone, and delivery is an important factor in communicating during stressful situations. Be sure to use pauses, vary your tone, and maintain eye contact. 5. Learn to say what you mean with tact. Don't blame the other person and steer clear of criticism and sarcasm. A great way to decrease tension is the use of "I" statements. This shows that you are taking responsibility for your feelings and actions. 6. Soften your responses - When in doubt, request more information. As tensions escalate, you are likely not listening or communicating to your full abilities. Be sure to soften the way you respond in a way that allows the other person to know you need more information. For example, instead of telling someone you flat out disagree or feel they are wrong, try saying something like, "Can you help me understand" or "Maybe I'm missing something". This lets the person know you are listening and trying to understand their side of the story too. 7. Consider Biases - We all have them, even though we don't like to admit it. And, in conflict, you may be working from a place of bias. Consider what your biases are about a situation and learn to set them aside. This will allow you to clear up the current stressful conversation as well as limit future issues over the same topic. 8. Relax - If you feel a stressful conversation coming on, take a walk away from the stress if possible. Sit in a quiet place and take a few deep breaths. A few minutes out of the stress can give you clarity about the stressful conversation that is about to start. 9. End on a Positive Note - If possible, try to end the pressurized conversation with a positive statement or resolution. This is not always possible, but if you can muster up the courage to apologize and accept your part of the conflict, you may be able to walk away knowing you did your best to add a positive spin on the situation. Communicating under pressure is never easy. By using these 9 tips the next time you feel a stressful conversation brewing, you can de-escalate the emotions that come along with stress. Have you had a stressful conversation that ended better than you thought because you used one of the tips above? Is there an important tip missing from the list? Leave your thoughts in the comments below to start the conversation.
  3. You walk on the unit and can cut the tension with a knife. Everyone looks stressed. You ask how the day was to be told of multiple admissions, an unexpected death, and bedside procedures that were added at the last minute. This created stress among the nursing staff and now 2 nurses are currently in the manager's office to resolve a dispute. Conflict in high stress workplaces is inevitable. Nurses are usually strong-willed people and when staff have different goals, ideas, or personal needs, conflict can arise out of just about anything. But, is conflict always bad? Absolutely not! There are some benefits to conflict on the nursing unit. The Benefits of Conflict Conflict Builds Teams: If conflict is resolved effectively, it can create cohesion among staff. Learning how to communicate effectively, listen well, and compromise creates a great nursing team. Conflict Increases Understanding: If you are open to solving the conflict, you must be willing to listen to the all sides of the story. By listening and understanding opposition, you will have a better understanding of the issue as a whole. Conflict Builds Self-Awareness: When you have conflict with another person, it challenges you to review your goals and expectations. Conflict allows you the time to align your actions with your beliefs. Conflict Leads to Solutions: When something simply does not work, it may be time to change the process. Change on nursing units can be hard. Change pushes you outside of our comfort zone. But, if you can allow the conflict to create change that leads to solutions, the whole unit will be better for having gone through the conflict. Conflict can be good. You must understand how to handle it to get the most out of the conflict. Resolving conflict to provide the best solution is not easy. Here are a few tips to help you solve conflict on your nursing unit: 6 Tips for Solving Conflict 1. Treat Others With Respect - No matter how upset you may be about the conflict, show respect to everyone involved. If you are simply not ready to talk, ask for more time. Be courteous and kind when you do speak. 2. Process versus People - Nursing is a high-stress area with lots of processes that will fail as things change. Remember that most problems are actually caused by a process, not the people that carry out the process. That's not to say that you will never have a conflict with another person, it just means that you need to look at the process first. 3. Listen - Communication in nursing is essential for successful patient outcomes and listening in a big portion of communication. It is just as important when dealing with co-workers and conflict. Active listening takes practice and skill. Work hard to hear what the other person is saying and work even harder not to speak until they have fully expressed themselves. 4. Think Before You Speak - One of the best ways to put things into perspective is to talk about the conflict with a trusted colleague or family member. When you can be authentic about your feelings without fear of hurting anyone or creating more conflict, you will likely feel better. A little time, space, and lots of reflection can often provide clarity to the situation. 5. Face-to-Face - Most people do not care for conflict. And, once the heated part of the conflict is over, everyone just wants to forget about it and move on. But, without an open, honest face-to-face conversation, conflict will bubble up again. It is best to plan a face-to-face meeting between all of the parties involved in the conflict. Using an objective mediator, such as the nurse manager or other leader, is always a good idea. They can help guide the conversation and ensure everyone gets their chance to be heard. 6. Apologies Go a Long Way - When you sit down to resolve the conflict, remember that everyone will probably have at least a small part in the bigger problem. When you identify your part in the conflict, simply admit when you were wrong and apologize. You don't have to take blame for everything, just for your own behavior. Learn, Grow, and Move On There will always be conflict at work. Stressful work environments create conflict. Remember that there is always good in conflict, if resolved the right way. At the end of the day, all you can do is learn from it, grow so that you handle it better next time, and put your best foot forward for the future. Have you had a good experience with conflict in nursing? Or, maybe you are in the midst of a struggle that you are not sure how to fix. Share your story below and get the conversation started.
  4. Melissa Mills

    Rebounding from The Embarrassment of a Bad Day

    Love this! Sorry can seem like a dirty word sometimes! But, it is not. And, I have found that when I allow myself to become vulnerable and I apologize, I learn so much more about who I am as a person. #lifelessons.
  5. For many of us, we come home from a long day of work to the pitter patter, tail-wagging love of a pet. According to the Handbook on Animal Assisted Therapy, the strength of the human-animal connection allows companion animals to quickly become members of our family. Pets fill a void in the lives of their owners by offering an endless amount of unconditional love. Pets can decrease loneliness, stimulate conversation and physical reactions that are important to your health. In short, pets can increase your quality of life and happiness. But, what happens when a patient is in the hospital or other facility long-term? Does this bond decrease? Is there a missing piece to the pet-lovers overall health? May is National Pet Month and a great time to explore the many benefits of pet therapy. What is Pet Therapy? Dogs and cats come to mind when we think of pet therapy, however, fish, guinea pigs, horses, birds, and other animals that meet the screening criteria can be used. According to Mayo Clinic, pet therapy is a broad term that includes animal-assisted therapy and other animal-assisted activities. Animal-assisted therapy is a growing field. It is a formal, structured program that helps the patient meet goals in their treatment, such as better coping skills or improvement of health problems. Animal-assisted activities is a more generalized concept. This includes using pets in a casual way to provide comfort, enjoyment, and recreation. Benefits of Pet Therapy Physical Benefits - A pet can help motivate your patient to get out of bed. One study found that having a pet increased the physical activity of elderly patients. Your patient can be motivated by the idea of petting, walking, or playing with a cat, dog, or other animals. Emotional Benefits - Have you ever been sad and found that your cat or dog seemed to connect with your emotions? Pets form a very special bond with people quickly. The same study as mentioned above, found significant improvements in the emotional health of patients, including: Less behavioral disturbances in patients with Dementia Improved socialization in Dementia patients Less anxiety and fear in patients with Depression Improved social behaviors in Schizophrenic patients Less loneliness Sense of Purpose - You may find that a patient who suffers from depression, anxiety, or chronic illness struggles with feelings of purpose. They may choose to stay in bed or simply in the confines of their room on days that this feeling is strongest. Pets can change these feelings. You may find that on pet therapy days, patients chose to go to the activity room or allow the pet to visit even when they have chosen to not allow other visitors. This is a testament to the value of pet therapy. Decreased Stress - Animals evoke feelings of happiness. Happiness and other positive feelings are a result of the release of endorphins, which are chemicals produced by the brain. Spending time with animals will increase the secretion of endorphins, decreasing stress and increasing the feeling of happiness. Pets also decrease loneliness, anxiety, and can even decrease the severity of symptoms of some health conditions. Positive Memories - Have you ever seen a new puppy at the park and immediately remembered the day you brought your dog or cat home? Animals evoke memories. They can help patients connect with their past and feelings of happiness and pleasure. Staff Can Benefit Too - Therapy animals will offer love and understanding to staff too! If you are having a bad day and see the therapy dog trotting down the hall, don't be afraid to snag a few kisses. It could be just the thing the doctor ordered on a stressful day as a nurse. Ways to Use Pet Therapy In Your Practice Have you ever considered pet therapy for your patients? Some areas of care are difficult to provide pet therapy due to infection control issues. But, even in these areas exceptions can be made at times, if the benefits outweigh the risks. Below are a few ideas: Nursing Homes or Assisted Living: According to the University of New Hampshire, therapy dogs are commonly used in these settings to increase social activity in patients and lift their spirits. The animal may live in the facility too or just come for regular visits with their owner. Drug and Alcohol Treatment Centers - Pets provide purpose and companionship to people during recovery from addictions. It can give them something to focus on other than the physical symptoms of withdrawal. Home Care or Hospice - Some agencies will have a volunteer dog who makes visits to homebound patients. These patients may be without an animal companion, but find peace in the soft puppy kisses and cuddles. In-patient Hospital Visits - Even in some high acuity settings, animal visits are appropriate. It may be through a volunteer animal or a special visit by the patient's pet that they have been separated from during the hospitalization. Pediatrics - Everyone knows that animals and children go hand-in-hand. If you care for pediatric patients and don't have a pet therapy program, talk to your nurse supervisor or administrator about the positive benefits pediatric patients may have with frequent visits from a therapy pet. Animals can boost the spirits of a hurting patient. They provide love, connection, and purpose. During National Pet Month, thank a therapy dog and their owner for all of the love, compassion, and benefits they give to you and your patients. Do you have a pet therapy story? Ever experienced a fun, emotional, or bizarre pet-patient connection? Place your thoughts in the comments, we love hearing them and connecting with you through your real-life nursing stories.
  6. You finished nursing school and passed the NCLEX. You are ready to land that first job. You sit down in front of the computer to hash out your resume.........crickets! You freeze. Do really have any skills to list? How do you make this look professional and get the attention of the hiring manager without a nursing job history? The American Nurses Association (ANA) recommends creating a well-structured resume no matter how much experience you have. This format may give you an advantage over applicants who don't put the time and effort into their resume, even if they have more work experience. The ANA says that an excellent nursing resume will showcase your education, career progression, professional skills, and significant experiences. Below are 10 tips you can use when creating your first nursing resume. 10 New Grad Nurse Resume Writing Tips 1. Structure and Organization Your resume is the first impression the hiring manager will have about your communication skills. Use proper spelling, grammar, and abbreviations. Consistent formatting throughout the entire resume is a must. 2. List Skills Even as a new grad, you have clinical skills. You probably completed a preceptorship where you were able to perform many clinical skills and procedures. Be sure to include a comprehensive list. You should also include a list of "soft skills". Soft skills are better known as social skills. These skills provide you with the ability to get along with others and be a productive member of the healthcare team. Common soft skills include: Communication Decision Making Time Management Self-Motivation Autonomy Adaptability Leadership 3. Think Like the Hiring Manager Resumes used to be created to list what you were looking for in a job. Today, you must create your resume to stand out to the hiring manager. Look at the job description and be sure to align your skills with those needed to perform the job in which you applied. 4. Choose the Best Headings You may not have much work experience to include and that's okay. Just make sure the headings you do choose tell the story of who you are was a qualified nursing candidate. Consider headings like, "Professional Affiliations" or "Awards" to showcase your experiences, networking skills, and achievements. 5. Describe your Training Include any specialized training you received. If your nursing program provided special training or experiences, be sure to list those. Include the name of the facility, department or unit name and specialty as well as the dates for any special training. 6. List all Awards If you received any awards or were part of an honor society, include this in your resume. Nursing school is hard. The hiring manager knows this too. They will understand the commitment and dedication you had to have in order to finish with any awards or honors. 7. Be Professional Getting your first adult job means you have to start acting like an adult (well, at least while at work). Be sure to have a professional email address. Do not use an email that references hot nurse or other inappropriate terms. Do not include pictures, lists of hobbies or interests on your resume. And, the hiring manager already knows you can provide references, so no need to list this on your resume. 8. Create a New Resume for Every Job You Apply To Even if you are applying to similar types of job, be sure to make your resume to specific to each job. The best way to do this is to create a standard resume. With each job you apply to, create a version that aligns well with the job description or job posting. This will increase the chance of your resume making it through the automated computer system and into the hands of the hiring manager. 9. Be Specific You want to stand out, right? The easiest way to do this is being specific with each skill or experience you list. If you completed a 4-week preceptorship on a med-surg unit, be sure to include details about the number of patients you cared for each day, skills you performed, and any other details that help the hiring manager understand your specific skill set and success. 10. Include Past Work Experience While you do not want this to be the focus of your nursing resume, there is no reason to not include a bit of your past experiences. If you held any jobs that are healthcare related, include this with details of the work you performed. If you have never worked in a healthcare field, include soft skills such as leadership, multi-taking, and communication skills to showcase your diverse skill set. Creating your first resume is exciting and maybe a little scary. Take your time and be yourself. Showcase who you are through the way you craft your resume and skills. Are you struggling with how to create a good resume? Have any specific questions? Or maybe you have some other great tips for new grads creating their first resume. Share in the comments, we would love to hear your thoughts.
  7. Post-Concussion Syndrome is difficult to recognize. Would you know the symptoms? Let's meet Mr. Jones and learn about his symptoms of post-concussion syndrome. Case Study: Mr. Jones is a school teacher. While walking down the hall, he slipped in water on the floor near the water fountain. He fractured his left wrist during the fall and reports that he hit his head. He did not lose consciousness. He was treated in the emergency room on the day of the injury. An MRI of the head showed no acute changes. His wrist was reduced in the ER and he was discharged home with instructions to follow-up with an Occupational Health Clinic and orthopedic clinic. Four weeks go by, Mr. Jones returns to the occupational health clinic where you work. He reports that his wrist is doing better and he has started Physical Therapy for mobility and strength training. During his appointment with the Occupational Health physician, it is noted that he is irritable and has difficulty finding certain words. The doctor asks him if he has any other symptoms. He reports intermittent headaches, dizziness, anxiety, and feeling more irritable than normal. He tells the doctor he is confused by these symptoms because the MRI was normal. The occupational health physician tells him that he has post-concussion syndrome and that his symptoms could last months or even years. He gives him an order for vestibular rehab, some written education on post-concussion syndrome, and sends him on his way. You try to provide education, but Mr. Jones is irritable and says he just wants to leave. As he starts to leave the clinic, he comes back to the desk where you are sitting. He is angry, yet tearful. He does not understand this diagnosis, treatment plan, or why this is happening since he bumped his head a month ago. He asks you to help explain this to him further. Can you help? What is Post-Concussion Syndrome? According to Mayo Clinic, post-concussion syndrome is a complex disorder that can last for weeks, months, or even years after a mild traumatic brain injury. It can be caused by a blow to the head or violent shaking or movement of the head or body. You don't have to lose consciousness to have a concussion or post-concussion syndrome. The severity of the head injury is not an indicator of the risk of developing post-concussion syndrome. What Causes Post-Concussion Syndrome? There are several different theories behind the true cause of post-concussion syndrome. One theory is that the symptoms are caused by structural damage to the brain and/or messaging system within the nerves. Another theory is that these symptoms are related to pre-existing psychological factors, such as a history of the following: Depression Anxiety Post-traumatic stress disorders Life stressors Poor social support system Lack of coping skills Signs and Symptoms of Post-Concussion Syndrome Headache Dizziness Fatigue Irritability Anxiety Insomnia Loss of concentration and memory Ringing in the ears Blurry vision Noise and light sensitivity Changes in taste and smell Treatment Treatment of post-concussion syndrome focuses on symptom control. A treatment plan that includes symptom management coupled by time is the best way to assist the patient to learn to control the symptoms they experience. Medications - The patient may be given medications to treat the headaches, depression, or anxiety felt after a mild concussion. Psychotherapy - The patient may need to speak to a therapist to understand that there is a cause for their symptoms. They will need to learn coping mechanisms that help to control the severity of depression and anxiety related to the injury. Vestibular Rehabilitation - One study defines vestibular rehabilitation as a form of physical therapy that uses specialized exercises that result in gaze and gait stabilization. It is an effective treatment for central balance system issues, such as post-concussion syndrome. The goals of vestibular rehab include improved balance, minimizing falls risks, decreased feelings of dizziness, and decreased anxiety. Nursing Goals and Interventions Our main focus for patients with post-concussion syndrome is education and self-management. Mr. Jones is frightened, frustrated and probably a bit confused by his diagnosis. You know that you will be seeing him every week when he comes back for his check-ups with the doctor. You can also stop by while he is receiving vestibular rehab in the clinic's physical therapy department. What should you use for nursing goals and interventions? Below are a few nursing goals and interventions that may appropriate for post-concussion syndrome patients: Goal: Patient will report decreased severity and frequency of headaches. Interventions may include: Education on medication management Education on non-pharmacologic interventions to decrease the severity of headaches such decreased activity, noise and light control, and rest Goal: Patient will be free of intervening injuries, including falls, while experiencing dizziness. Interventions may include: Education on clear pathways in the home Education on use of any ordered durable medical equipment Education on energy conservation Education on the use of slow position changes to decrease the severity of dizziness Education on the importance of compliance with Vestibular Rehab and home exercise program Goal: Patient will report a decrease in symptoms of anxiety and depression. Interventions may include: Education on the importance of attending all psychotherapy appointments Education on the proper use of prescribed medications Post-Concussion Syndrome can be a difficult to treat problem. Patients need support and understanding as they receive treatment. Do you have a story about a post-concussion syndrome patient? Other ideas of nursing goals and interventions? We would love to hear your stories and thoughts. Just comment below and get the conversation started.
  8. For most nurses, landing your first hospital job right out of school is one of the high points in your career. As you become more skilled, you may move around to try new specialties and find your niche in the hospital. Some of you will quickly figure out that hospital nursing is not where you want to spend most of your work days. You may dabble in it for a few years and then begin searching for your place beyond bedside nursing. But, what are some of the jobs outside of the hospital that you can use your nursing brain, without being confined to the halls of the unit? Let's explore! 10 Nursing Jobs Beyond the Bedside 1. Home Health Care Nurse: If you enjoy clinical care, but wish you could have more time with each patient, home health is a great option for you. As a home health nurse, you will work with patients in their homes. Most patients are elderly, however, you may work with mid-life patients who have chronic illnesses or who are recovering after surgery. There are also opportunities to work with chronically ill children. Home health nurses enjoy flexibility in scheduling and lots of autonomy. 2. Certified Coder: If you are looking to start a business and enjoy billing, becoming a certified coder is a great option. Coders are computer savvy and detail oriented. You can do training online that will help develop your skills in coding and then work as an independent coder or for a company. Coders work with doctors to ensure proper codes are applied to the bills prior to going to private insurance, Medicare, or Medicaid. Your clients may be hospitals, medical labs, physician offices, or diagnostic centers. 3. Telehealth: Telehealth is a growing niche in healthcare. It helps patients stay healthy in their homes and decreases the risk of hospitalization. Nurses work telephonically with patients with chronic health concerns. Common patient populations are those with Diabetes, Congestive Heart Failure (CHF) or Chronic Obstructive Pulmonary Disease (COPD). You may choose to work for a telehealth company or start your own telehealth nursing agency. 4. Blogger/Healthcare Writer: If you love to write, you can combine your passion of writing with your love for nursing and healthcare. Bloggers find their niche and then attract traffic to their website through compelling blog posts. As a healthcare writer, you can write articles for other companies and get paid for your work. You can also write ebooks, books, or training courses. The possibilities are endless if you are willing to work hard and explore the many possibilities. 5. Speaker: Do you love to talk to large crowds? Do you have a healthcare or nursing story to share? If so, becoming a public speaker is a great opportunity. You can teach people about disease processes, healthy living, or any number of other niches. You can start using this as a side hustle and increase to a part or full-time job. Public speakers offer their services to hospitals, colleges, universities or civic organizations. Start off by choosing your niche for your speaking business and speak for free to a few community organizations. As you become more comfortable, you can offer your services for a fee. 6. Sales/Marketing: Nurses make great healthcare sales reps. You understand what doctors need and how they work. You know how to get your foot in the door and optimize the 5 minutes of facetime you may get with a busy doctor. Many sales jobs come with flexible hours and high earning potential. 7. Life Care Planner: As a nurse life care planner, you can work for law firms, Health Maintenance Organizations (HMO), insurance companies, or as an independent practitioner. Life care planners work with people who have had catastrophic injuries or those suffering from chronic illnesses who need long-term care. You can find training programs online to become a certified life care planner. The out-of-pocket expense to start an independent practice is relatively low. Hourly rates range from $80-$400 per hour. 8. Coach: Nurses are natural coaches. You can offer many different services as a coach. Common areas of practice are health and wellness, chronic illness, or career help. You can start a coaching business for little out of pocket expense. Some coaches go on to get certifications and further specialize in a niche to meet career goals. 9. Nurse Consultant: The possibilities are endless as a nurse consultant. If you have specialized in one area of nursing, you have invaluable knowledge that others may need. You can work with physician practices, established businesses, or entrepreneurs in multiple industries including technology, manufacturing, and sales. 10. Nurse Recruiter: As a nurse, you understand what other nurses are looking for in career opportunities. Nurse Recruiters work with hospitals and other facilities to find nursing staff during times of need. You may work for a recruiting company or start your own business. You can work from the comfort of your home to collaborate with healthcare facilities around the world. Nurses have skills that go far beyond the bedside. This is just a small sampling of the opportunities that lie ahead of a nurse with a mission to find their niche. If you are a nurse entrepreneur or considering becoming one, check out the National Nurses in Business Association. This organization is a springboard for nurses transitioning from traditional nursing to small business ownership and self-employment. Are you a nurse entrepreneur or considering opening a business? Or, maybe you are just looking for an opportunity away from the bedside, but want to continue working for someone else. We would love to hear what you are looking for and how you see yourself changing the face of nursing in the future. Beyond-the-Bedside-10-Nurse-Opportunities-Outside-of-the-Hospital.pdf
  9. Melissa Mills

    Understanding Post-Concussion Syndrome: A Case Study

    Hi debrasimons - Thanks for the comment. Yes, the differential diagnoses seem to clump together, which only makes the symptoms that much harder to treat. Has she tried Vestibular Therapy? Might be worth a shot. Best of luck. Melissa
  10. Melissa Mills

    Am I Still a Nurse?

    Great article! Thanks for sharing your story.
  11. Melissa Mills

    Beyond the Bedside: 10 Nurse Opportunities Outside of the Hospital

    Hi ICUMan! The income potential is good. When I first left the hospital and went to a case management position I did take a bit of a pay cut, mainly because I was no longer getting shift and weekend differentials. But, I gained my weekends and a Monday-Friday schedule, so for me it was fine. Now that I have been in case management for many years, my earning potential is great. I still have a Monday-Friday job and working from home is great. When making these types of changes you must take into account things like, no travel expenses, little extra food and clothing expenses, and time saved when your commute is literally down the hall. For me, it was what I needed for my family. I am just lucky that it ended up being something that I love too.
  12. Melissa Mills

    Get Linked: 6 Reasons Nurses Need a LinkedIn Profile

    Elkpark - Thanks for your comments. I certainly understand your concerns. I share them as well, I guess for me, I see so much value in networking and connecting that I take the risk. But, I do see where you are coming from for sure. Thanks for commenting. Melissa
  13. Melissa Mills

    Understanding Pain Assessment Tools

    Let's talk about pain assessments. Knowing how to assess pain is the first step in effectively treating it. Pain assessments are at the core of good nursing care. All hospitals and other nursing facilities have policies and procedures for pain assessment and management. It's not just your hospital or other facilities that believes patients have the right to pain control. The Joint Commission implemented new and revised standards for pain assessment and management in January of this year. The new standards require established policies and procedures that address comprehensive clinical assessment of pain, treatment or referral for treatment and reassessment for patients who report having pain. Changes made by accrediting bodies like The Joint Commission remind us that pain assessments are an important part of our nursing practice. Whether you work in bedside nursing, a clinic, or even telephonically, you must know and understand a variety of pain assessment tools and when to implement them. Numerical Rating Scale Most nurses and other healthcare staff are familiar with the Numerical Rating Scale (NRS). It can be administered visually or verbally. When using the NRS verbally, you simply ask the patient to rate their pain on a 0-10 pain scale. You must educate the patient that 0 is no pain and 10 represents the worst pain imaginable. When using the NRS visually, the same ratings are used. The patient is shown a picture of the 0 to 10 pain scale. It can be vertically or horizontally placed on the paper. Ask the patient to point to the number that best represents their pain rating. Visual Analogue Scale The Visual Analogue Scale (VAS) is a unidimensional way to measure a patient's pain. VAS can be shown to the patient in several different ways: Scales created on a piece of paper that is around 10cm in length with tick-marks placed across the length of the scale. The patient is then instructed to point to the tick-mark that best represents their pain. This is then converted to a 0-10 pain rating. Box-Scales - Circles are placed equal distances apart from each other and the patient chooses the one best representing their pain. Wong-Baker Faces - The Wong-Baker Faces scale is commonly used with pediatric patients. Created in 2009 by Dr. Donna Wong, the Faces scale provides a picture with 6 faces that are rated from 0 to 10 running left to right. The expressions on the faces illustrate 'no hurt' up to 'hurts worst' and also run left to right, correlating with the numeric ratings. You explain to the patient that each face shows a person who has no pain, some pain, and a lot of pain. You then ask them to choose the face that best represents the pain they are experiencing. Verbal Descriptor Scale The use of verbal descriptions is the main idea behind the Verbal Descriptor Scale (VDS). It can be given verbally or visually. The scale has two endpoints, 'no pain' and 'very severe pain'. In between these two endpoints are 4-6 other ratings that increase in severity. Common VDS descriptions are similar to this pain scale below: No pain Mild pain Moderate pain Severe pain Very severe pain Pain Drawing In the pain drawing assessment, the patient is given an outline of a human figure. You then ask them to mark the areas of pain in their body on the outline. You may ask them to circle the pain or shade the body part that is painful. Some pain drawings also ask the patient to use symbols to describe different types of pain, such as burning, stabbing, shooting, or electrifying. Other Considerations During a Pain Assessment: Along with assessing the patient's severity of pain, you must take into consideration a few other factors contributing to their pain. These factors include: Chronicity: Acute and chronic pain differ immensely. If a patient has lived with pain for many years, their tolerance to pain will be higher and this may affect their pain scale ratings. Description During a pain assessment, you must ask the patient to describe their pain. This could be sharp, shooting, electrical, or dull. These descriptors can help a physician when diagnosing the cause of pain. Try to report the pain descriptions in the patient's own words, even if it does not make sense to you. Frequency Find out if the patient's pain is constant or intermittent. You can also ask if anything makes the pain better or worse. For example, if the patient is suffering from an acute ankle sprain, they may report that ambulation makes the pain worse and rest, elevation, and the use of ice makes it better. Age of the Patient There are many special considerations related to the patient's age. A pediatric patient may be unable to tell you much about their pain. Older adults may have similar issues with describing the pain as well. Objective Signs During your pain assessment, look for any objective signs of pain the patient may be exhibiting. This includes facial grimacing, tachycardia, frowning, guarding, or crying out. A patient who is experiencing pain may be angry, depressed, or irritable. Pain ratings are subjective. You must always trust what the patient is telling you about their pain and document it using their own words when possible. Pain is an important part of your nursing assessment and can help the patient receive the correct treatment. What pain assessment do you use? Are there other ways that you assess pain that are helpful in your nursing practice? Comment below. We would love to hear more about your pain assessment practices.
  14. Melissa Mills

    Understanding Pain Assessment Tools

    Cardiacfreak - Thanks for this! I did not see this one in my search, however I did not look specific at hospice scales. Hospice patients are unique and have to be handled in a different way, I think. Thanks again for you comment. ~Melissa
  15. Melissa Mills

    Understanding Pain Assessment Tools

    Hey OldDude! Thanks so much for your comments. I agree with much of what you said. It is difficult to do pain assessments. I experience the same exact thing with adults. As a telephonic case manager for folks who have been hurt at work, I often encounter people who had a lumbar sprain/strain in 2015 and still rate their pain as an 8/10. Do I fully believe this, probably not. But, I also have to try to understand more about them as a patient and a person. It is still a good indicator of their discomfort, I just have to look at context. I am often grateful I am not a physician who has to make prescribing decisions off a pain assessments. :) You make GREAT points. Thanks for commenting! ~Melissa
  16. Melissa Mills

    Beyond the Bedside: 10 Nurse Opportunities Outside of the Hospital

    Thanks for the comment! Yes, case management is a great career. I am in case management as well. I work with folks who have been hurt while at work. It is 100% telephonic and I work from home. There are endless ways to be a case manager. ~Melissa
  17. Melissa Mills

    Beyond the Bedside: 10 Nurse Opportunities Outside of the Hospital

    Thanks Juliezehrn! It is amazing all of the options that are out there. Thanks for sharing!! ~Melissa
  18. Melissa Mills

    Beyond the Bedside: 10 Nurse Opportunities Outside of the Hospital

    Glad you enjoyed it!! ~Melissa
  19. Midlife and Mid-career can be an exciting time for nurses. You know your skills, values, and worth. You have experience that goes beyond the bedside and you are ready to use it for a new employer. But, do they value the skills you have? Can their budget support the dollar amount you have in your head as you interview for new opportunities? Job search and interviewing can feel a bit different when you are in the midlife years. The hiring manager may be younger than you expected. The company may have a mission, vision, or values that are different than your own. How do you prepare for these situations? Let's explore 8 ways to prepare for interviews for the mid-career nurse: 1. Identify Your Priorities: Before you ever begin the job search, know what you want in a new job opportunity. If weekends and night shifts no longer work for your family, mind, or body, don't entertain jobs with those responsibilities. Know what you are looking for and where your areas of flexibility lie. This will help you communicate honestly during the interview. Create your resume to reflect your skills and priorities for your next nursing adventure. 2. Do Your Homework: Research the company. Understand what they do and how you can fit into their mission, vision, and values. Study the job posting and know the core responsibilities. Consider how your skills will help you meet the job duties. Even if your skills are not an exact fit, show your flexibility and willingness to learn by understanding the business even before they offer you the job. 3. Practice the Hard Questions: Why are you looking for a new opportunity? Do you really want to make this big of a career change? When will you retire? Consider hard questions before you sit down in front of the interviewer. Have an idea of how you will answer these questions to showcase your skills, experience, and goals for the future. 4. Prepare Your Own Questions: Interviews are a great opportunity for you to find out if the company is the right fit for you. Be sure to ask questions. Prepare 2-5 questions to take with you. During the interview, take notes and write down other questions as they come to your mind. Ask some tough questions of the hiring manager. Some possible questions for you to ask are below: Do you feel I am a good fit for this job? How do you think I would fit in with the other people in this department? What is the culture of the company, department, or unit? What career growth and development opportunities will be available to me? 5. Consider the Age of the Hiring Manager: If you are in the mid-career years, you are probably in the mid-life years too! This means, there is a good chance the hiring manager will be younger than you. Younger managers value innovation, technology, and problem-solving. Be ready to answer questions about your computer skills and innovative approaches to workplace problems. 6. Prepare Your Resume: Many people believe that showing up with a resume that shows what you were doing 30 years ago is irrelevant. This is simply not true. While you don't have to put every job ever held on your resume, you also don't want to ignore an entire decade of your work. Write a paragraph to summarize your job experiences that are older than 15 years. Focus on your skills and successes. You have probably been through acquisitions, multiple management styles, and business changes. Capitalize on these experiences and how they have contributed to your success as a nurse. 7. Consider Your Age an Asset: Many people feel that having a little age and experience can be a liability when entering a job interview. Don't place biases on others before you have ever met them. Be sure to discuss your energy and ability to stay current with trends and technologies. Discuss how your experiences add value to your job performance. Age can equate to wisdom and others may appreciate what you bring to the table. 8. SoMe: If this acronym confused you, you may need to do a little research before you start interviewing. Social Media (SoMe) is a huge part of getting hired and being successful at interviews these days. You need to be on LinkedIn and understand the basics of your profile, InMail and messaging. Recruiters and hiring managers love LinkedIn. It can be a valuable place to find new job opportunities too. Understanding the basics of LinkedIn and having a profile shows that you are in touch with the high tech times of today. Age and experience bring wisdom. Be yourself because you are great! Are you a midlife nurse looking for new opportunities? Have you been to a job interview lately and were surprised by the questions, feel of the interview, or how you felt afterwards? Share your story in the comments, we would love to hear about your experiences.
  20. Do a google search for any myriad of statements related to nurses, their bosses, coworkers, and conflict and you will be bombarded with stories. These stories are your stories. It may be a nurse manager who challenges everything you do. A coworker who seems to disappear mid-shift allowing others to pick up the slack. Or, another healthcare professional who seems to find joy in belittling you in front of others. Whatever the story may be, this happens all to often in nursing departments and agencies across the U.S. Could it be secondary to a primary female profession? Are some people just wired to be bullies, slackers, liars, and brown nosers? Is it solely due to the stressors associated with caring for sick and dying patients? Or, could it be that our healthcare systems don't provide proper training for nursing leadership? Whatever the case may be, we must learn how to handle some of these work-place conundrums. You have people to care for, you don't have time to deal with a manager who simply has to be right or have the last word. Let's explore and few scenarios and how to handle them. The Micro-Management Manager - I can't think of one nurse that loves being micromanaged! We are taught from day one of nursing school to be independent thinkers. Yet, we get hired at a new job only to find out that the manager doesn't like anyone to sneeze before asking permission. Ugh! What do you do? The solution: Being micromanaged can quickly kill your motivation. Recognize when this is happening. Most people can handle situations better when they simply state the issue. I have even written my feelings down on a piece of paper so that I can organize my thoughts. Find a trusted friend, colleague, family member, or counselor and talk it out. Getting the emotions out helps to clear your mind. Then, create a plan! If you feed confident in your ability to level-headed, talk directly to the manager about your feelings. If you can't come to a solution together, create a system that works for you. This may mean that you deliver certain tasks the manager within their request and then allow yourself some creative and autonomous freedoms with other tasks. Nurse Bully - Bullying in nursing is not a new topic. The notion of "eating our young" has been around for a very long time. Today, it is not only the tenured nurses who like to spread their wings by clipping someone else's. Even newer nurses can be guilty of bullying. Nurse bullying not only affects you as a person, but it can hinder your ability to provide high-quality care. It changes the culture on your unit and leads to turnover in the staff. Bullying is not healthy for anyone involved, including the bully. The solution: Report it. While this can be uncomfortable and you may worry about retaliation, you must report nurse bullying to your supervisor. While you are enduring the bullying, don't succumb to the efforts of the bully. Keep your head high and confront the bully by simply pointing out the behaviors that make you feel uncomfortable and ask them to stop. If you can, walk away from the bully if talking to them is not a successful tactic. Bullies like power. If you can limit your interactions with them, you limit their power. The Boss from Hell - This is a strong image and suggestion about some nurse managers. Unfortunately, it may have conjured up an image of a manager who fit the description. We have all experienced a nurse manager from the pit. I have had managers who yell for no reason, cursed at me, engaged in workplace gossip, and one who handed out insults like tic-tacs. These behaviors from the person who is supposed to rally the troops is defeating, disheartening, and infuriating. It can leave you feeling that nursing is simply not the right career choice for you. The solution - First, don't judge a whole profession on the actions of one bad nurse manager. There are good leaders out there. Second, create a plan for dealing with the hellion the best you can. This may include talking to them about their expectations and your desire to meet them. You may talk to another member of management who can offer some advice for working with your manager. Or, you can confide in a trusted friend or colleague who can offer some advice. Finally, if the culture of the unit and the actions of this nurse manager is simply not providing you with the support you need, look for new opportunities. If you are really looking for a way to help the issues with nurse leadership - become a nurse leader. Yep, solve the problem by vowing to be a nurse leader - not a nurse manager. Go into leadership and offer the understanding, acceptance, and support you looked for in those that failed you. Other Work Conundrums To say that Nursing is a unique profession is probably way to simplistic of a description. Nurses tend to be strong, bold people. When you have a whole unit of independent thinkers, you will have magical or explosive combustion. Hang in there and find your tribe of nurses who offer you the support you need. Have you experienced one of these workplace conundrums? Have you had a different experience you would like to share? Put your story in the comments, we would love to hear about your workplace conundrums too.
  21. Melissa Mills

    My Boss Hates Me and Other Workplace Conundrums

    Thanks for your thoughts Caliotter3.
  22. Melissa Mills

    My Boss Hates Me and Other Workplace Conundrums

    Thanks for your thoughts!

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