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Melissa Mills BSN


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  1. You enter the exam room to get Jane checked in before she sees the Cardiologist for her annual visit. As you’re reviewing her meds, Jane pulls out a medical marijuana card. She tells you that she takes it for chronic pain caused by Fibromyalgia, but that it hasn’t been working quite as well lately. Jane starts asking you questions about dosages and if you think she can increase what she is currently taking. She also tells you that she is getting ready to go on a trip to Kansas to visit a childhood friend and asks if she can take her marijuana with her there. Jane has lots of general questions about how the drug works. You silently think to yourself that you’re not prepared to answer her questions. Medical Marijuana Overview If you’re not sure what you need to know about medical marijuana and your patients, you’re not alone. As several states continue to develop and pass legislation and others change laws, it can be challenging to stay up-to-date. The National Council of State Boards of Nursing published the National Guidelines for Medical Marijuana. Here are the essentials you need to know when caring for a patient using cannabis or other medical marijuana drugs. Current State of Legalization Marijuana is currently classified as a Schedule I Controlled Substance by the Drug Enforcement Agency (DEA) which prohibits physicians from prescribing cannabis, pharmacies from dispensing it, and limits the amount of research that can be done about the long term effects and benefits. While the federal government doesn’t provide guidelines for use, many state medical marijuana laws do. Currently, thirty-three states and the District of Columbia, Puerto Rico and Guam have comprehensive medical marijuana laws. Another thirteen states allow for the use of low tetrahydrocannabinol (THC), high cannabidiol (CBD) products for medical use. The federal government under the Obama administration discouraged prosecution of people who distribute or use cannabis for medicinal purposes. However, this was rescinded in January of 2018, and federal prosecutors are now encouraged to decide which cases to prosecute. Principles of a Medical Marijuana Program (MMP) States create their own MMP rules for their jurisdiction. These rules vary from one state to the next. However, there are a few general concepts that exist regardless of the state: Health providers do not prescribe the drug Physicians certify that the patient has a qualifying condition under state law Qualifying conditions and the certifying process are described in each MMP, including the type of healthcare provider that can certify a qualifying condition Pharmacies do not dispense medical marijuana products Each state gives provisions for dispensaries that can sell the drug to those with a medical marijuana card Once a patient has a physician who will certify a qualifying condition, they can register with the MMP and then obtain cannabis from an authorized cannabis dispensary. Administration is generally limited to the patient or their designated caregiver. Some states allow employees of a hospice provider, nurse, or home health aide to act as a designated caregiver. Endocannabinoid System Overview Did you know that you have a body system named after cannabis? The endocannabinoid system is made up of a series of cannabinoid receptors that lie deep in cell membranes. You have naturally occurring endocannabinoids in your body that trigger this system. Plant substances like marijuana can trigger it as well. Endocannabinoids stimulate your system, promoting balance or homeostasis. The most well-known cannabinoids are tetrahydrocannabinol (THC), cannabidiol, (CBD), and cannabinol (CBN). Pharmacology of Cannabis Because marijuana remains illegal under federal law, there is a limited amount of research available to help you better understand the use, indication, and dosage of the drug. Placebo-controlled trials that have been done have determined a few conditions that medical marijuana can help. A current list of qualifying conditions include: Nausea and vomiting caused by chemotherapy Body wasting related to some severe chronic illnesses Pain caused by cancer or rheumatoid arthritis Chronic pain associated with fibromyalgia Neuropathies resulting from HIV/AIDS, diabetes, or multiple sclerosis (MS) Muscle spasticity from MS or spinal cord injuries As with all drugs, medical marijuana can cause some side effects. However, it’s important to note that a few of the side effects are desired for some patients. For example, if you have a patient who is experiencing weight loss and body wasting, medical marijuana might be prescribed for its ability to increase the appetite. Potential side effects include: Sleepiness Rapid heart rate Decreased blood pressure Dry mouth and eyes Increased appetite Hallucinations Paranoia Anxiety Decreased urination Safety Considerations for the Patient It’s essential you fully understand your facility policy for patients taking medical marijuana. The only people with the authority to administer the medicine is either the patient or their designated caregiver, so you should not give the drug. As with any other medications, medical marijuana must be kept in a locked area out of reach of children and others in the patient's room. Drug disposal should be done following the DEA Disposal Act. Approaching the Patient Social acceptance of the use of these products is still evolving, and scientific evidence continues to be obtained. Nurses are expected to provide care without personal judgment. Consider your own biases about the use of medical marijuana for pain and other conditions. However, regardless of your personal opinions, you must remain non-judgemental and understanding of the patient’s decision and right to use the drug. Have you had any personal experience caring for those with a medical marijuana card? Share your experiences below to get the conversation started.
  2. Hi, Juan de la Cruz - I completely agree with you that all patients receiving care have a certain level of vulnerability. Even when my mother who is 100% capable of making her own decisions is in the hospital - a family member is always there to offer an extra level of protection. However, I do believe with experts who consider specific patient populations more vulnerable to harm. Those who can't make their own decisions regardless of age are left at our mercy and when in the wrong hands can be injured not just by a mistake, but by intentional acts. This is when the level of vulnerability is placed on a different plane than those who are cognitively capable of making decisions. Thanks for your thoughts and engagement. Melissa
  3. Melissa Mills

    5 Reasons to Invest in Your Continuing Education

    Susie2310 - You much some excellent points. If nurses take the path of least resistance and complete basic courses to get the CEs, then they certainly won't get much out of the process of completing CE's. As nurses, we must embrace the idea that we are and will always be life-long learners. Thanks for sharing your thoughts. ~Melissa
  4. Continuing education - these two words either excite you or send you into a state of boredom-induced slumber unmatched by pretty much anything else in life. Nurses are required to complete continuing education to maintain their licensure. However, experts tell us that there are more significant benefits to continuing education than just keeping our ability to practice the craft of nursing. Here are a few reasons you should spend your time and money investing in your future. Maintaining Licensure Every state in the U.S. has a different set of expectations for nurse continuing education requirements. Some states mandate a certain number of continuing education. Others have specific courses or topics they require to address issues that happen in the state, such as child abuse, domestic violence, or laws governing your practice. Providers of continuing education courses must meet specific rules to ensure that information is current and meets laws and nursing practice as it changes. This safeguards you from completing materials today that was outdated years ago. Be sure your up to date on what you need to know about nursing licensure. Improving Safety Your patients expect to be safe when in your care. No one wants to be responsible for adverse drug events, falls, or other unsafe patient situations. While it is impossible to eliminate errors altogether, it should still be your goal. When nurses participate in continuing education that focuses on best-practices, patient-centered care, and safety prevention - errors lessen and patient satisfaction increases. Fostering a culture of lifelong learning in nursing is one of the pivotal practices that keep patients safe. In fact, when the 1999 To Err is Human: Building a Safer Healthcare System was published by the Institute of Medicine (IOM), it showcased some scary numbers about patient safety: Up to 98,000 patients die each year due to preventable medical errors Medical errors cost up to $29 billion each year nationwide You might think that the IOM would have been looking for high-tech ways to rectify these numbers. The Robert Wood Johnson Foundation and the IOM joined forces to establish eight recommendations with goals for the next 20 years. Half of the strategies created to fix the issues found were based solidly in education. The four learning strategies included implementing nurse residency programs, increasing the percentage of nurses with a baccalaureate degree, doubling the number of nurses with a doctorate, and engaging nurses in lifelong learning. I believe that this study illustrates the strength of continuing education in nursing. When nurses are empowered to increase their own understanding of the profession, patients are safer and more satisfied with their care. Meeting Certification Requirements Have you considered becoming certified in a nursing specialty? Accrediting bodies often have their own requirements you must meet to maintain your certification. You might need to complete courses on specific topics or areas to achieve the necessary requirements. For example, if you’re like me and have a certification in Case Management, you’ll need to show that you’ve completed 80 hours of approved continuing education specific to being a case manager. Many courses will meet the requirements you need for your certification while also keeping you compliant with your state board of nursing. Gaining New Skills and Meeting Changes Healthcare is becoming more innovative every day. From new drugs and treatments to the use of artificial intelligence and virtual reality, there’s so much to learn. Instead of waiting for hands-on training opportunities to come to you on the job, consider enrolling in a CE course that provides an overview of skills you know you’re going to need. It’s essential to remember that not all new skills are technical. While learning how to use equipment or how to assess for specific diseases is necessary, sometimes the skills you need most are interpersonal. If you’re struggling at work with communication, time management, or you’re considering moving up the career ladder, there are courses to help you gain the knowledge you need. Advancing Your Career Whether you’re considering certification, returning to school, or just want to stay up on the latest research - all of this learning will help to advance your career. Continuing education is an excellent place to start if you’re considering changing your specialty. You can choose a few courses to take to learn the basics of just about any nursing niche out there so that you can find out if it might be right for you. Continuing education might be mandated. However, if you can flip the script on how you approach continuing education requirements you might find that there are many reasons to invest in your professional development. How you do feel about mandated continuing education? Do you enjoy it or do you just complete it because it’s required to maintain your certification?
  5. Nurses care for vulnerable populations each day. Patients might be considered vulnerable because of economic, social, or political standings or because of an illness or disability. Regardless of the reason for the patient's vulnerability, it’s the nurse’s role to care for these patients with sensitivity, skill, and above all us - protection. Breaking Headlines If you’ve watched television in the past week or so, you probably saw a story about a nursing home patient who gave birth to a baby at the end of December. When this story first circulated, there were questions about the patient’s mental capacity and who might be the father. A few days after the initial coverage, a nurse, Nathan Sutherland, was arrested and charged with assault and abuse of a vulnerable adult. Sutherland cared for this patient in the nursing home and willingly took a DNA sample, which is allegedly a match with to the patient’s newborn baby boy. As this story unfolded, questions flooded the minds of people across the country. How does this happen in a facility where care providers are working around the clock? What systems failed to protect this patient? And, how can a patient in a long-term care facility deliver a full-term baby, but no one seems to know that she was even pregnant? The answers to these questions aren’t available yet. However, as nurses, it’s our duty to learn from these situations and consider what patients, family members, or loved ones might be susceptible to the same or similar behaviors at the hand of healthcare providers. Vulnerable Patients 101 Our healthcare culture might have us more concerned about reimbursement models, readmission rates, and patients with comorbid conditions over those who can’t speak up in the face of abuse, neglect, and general misconduct. Definitions of vulnerable patients vary based on organizations, locations, and use of the system. One population might be considered vulnerable in one setting, but doesn’t meet the definition in another. A few populations that are generally considered to be vulnerable include: People 60 years or older with physical, mental, or functional limitations in their ability to care for themselves Adults 18 years of age who: Are unable to make medical decisions and might have a guardian Live in a nursing facility, rehabilitation center, group home, or other facility licensed by a state Have developmental disabilities Receive in-home services such as hospice, home care, or individual providers Children under the age of 18 Making Sense of the Dichotomy At the end of 2018, nursing was selected as the most trusted profession again for the seventeenth consecutive year. Nursing has earned this designation because this is how the general public views nurses - trusted. Why are we so trusted? Nursing staff help bring babies into the world. Often nurses are there when the aged, ill, and injured take their last breaths. Imagine any significant life event in the middle of birth and death, and there is probably a nurse supporting, caring for, or educating patients, family, and other caregivers. Nurses speak up when patients have no voice. They fight for the wounded and underprivileged. Yet, this incident happened in a facility filled with nurses. How does this dichotomy live on the spectrum of nursing? I must admit - this story has been hard to understand. And, while it’s essential we remember that Mr. Sutherland hasn’t been found guilty at this time, this situation can make you lose a little faith in humanity. However, being an optimist (most of the time), I feel that this is an excellent time to review ways to keep vulnerable patients safe. Safeguarding Against Abuse and Neglect There are a few things all nurses caring for patients can do to ensure you’re keeping those entrusted into your care safe at all times. Learn the signs of abuse The symptoms of abuse are different depending on what’s happening. Having stellar assessment skills is one of the best ways to protect against any form of abuse. If you notice new bruises, injuries, burns, or a change in the patient’s reaction to care, this might be a sign that something out of the ordinary is happening. If patients are being neglected, you might notice weight loss or gain, poor dental and physical hygiene, and the presences of new pressure sores. When neglect is happening, patients may wear the same clothes for days at a time, even when they are torn or visibly soiled. You might also notice changes around food, such as begging or scarfing down food as though they haven’t eaten in quite some time. Speak Up If you suspect neglect or abuse of a patient, it’s your responsibility to speak up right away. If you’re in a facility, bring your concerns to your manager or the Director of Nursing. When caring for patients in the community, know your employer’s policies and when you should contact the police or other agencies such as adult protective services or children services. If you’ve ever had to file a report of suspected abuse or neglect, let us know about the situation in the comments below. Do you have other ways nurses can protect vulnerable patients from dangerous situations?
  6. Melissa Mills

    4 Reasons Ghosting an Employer is a Bad Idea

    Ghosting is a term that’s commonly used in online dating to describe “standing up” a date or connection. You just disappear from the person’s life and end all contact without giving any explanation. In June 2018 LinkedIn, a social network of professionals published an article about ‘ghosting’ at work, and why it’s driving companies crazy. Amanda Bradford, CEO, and founder of the League, a dating app told LinkedIn that ghosting has “almost become a new vocabulary” in which “no response is a response” among people in the younger generations. She pointed out that ghosting used to be limited to dating but has moved to the job market in recent years. How Do Employees Ghost an Employer Ghosting at work can happen anywhere along the career journey, from an applicant, job candidate, to employee. Some potential candidates start speaking with a recruiter or hiring manager only to disappear without a trace. However, it’s not just in the early stages of an employee relationship when this happens. Employees have been known to pack up for the night and never show up again. Nurses have been ranked as the most trusted profession again, for the seventeenth year in a row. How can those who wear badges as the most trusted profession just skip out on an employer, co-workers, and patients? Well, it happens. When I was managing a group of case management nurses, I learned first hand what ghosting is all about. I had hired nurse A, who had several years of experience as a case manager. She was doing well in the role. However, she seemed to struggle a bit in the environment and with peers. We talked about how to acclimate to the work environment, and I helped her make a few changes to her work schedule to get her more time with a mentor. With extra support from me and a mentor, she seemed to be doing a bit better. One day, I was sitting at my desk when a fellow manager called to chat. She said, “Hey, what happened to nurse A? I saw her leaving with a box of what looked like personal belongings.” Of course, I had no response because I thought everything was improving. I walked over to Nurse A’s desk to find that all of her belongings were gone. There was no note, no email, and no phone call. The only thing she left was an empty desk and a full queue of clients that had to be transferred to a few already overloaded case managers. I tried calling and emailing to get a better an idea as to what happened and to make sure she was okay, but even my attempts at contact were ghosted. Five Reasons Ghosting is Bad There are a few reasons that ghosting your employer is just a bad decision. Here are four reasons you shouldn’t ghost an employer. Puts Your Reputation at Risk If you walk out without any notice or communication, you need to understand that no one will likely get a warm, fuzzy feeling the next time you see any former co-workers. Nursing is a hard profession, and when you leave your employer and fellow nurses in a lurch, it stings. You won’t be remembered as the employee that was great at patient care, even if you were. You will forever be the nurse that walked out without notice. Shuts Down Networking Opportunities Managers, recruiters, and human resources professionals talk. They network at conferences, meetings, and other events. They will name drop or ask about potential employees. And, if your name and the phrase, “he ghosted us” comes up in a convo, there is a good chance you might not move forward in the hiring process. You might also find that your lateral networking system goes dark after ghosting your employer. Nurses who you thought were your “friends” might decide that they don’t like the way you left and not reach out or respond. This can hurt your future prospects at networking events and jobs Adds Stress to Your Coworkers and Employer Nursing units across the country are faced with staffing issues and high nurse to patient ratios. When you’re name is on the schedule to work 7a-7p, everyone from the hospital administrator to the patient relies on you showing up. Ghosting can increase safety issues on the unit where you were to work and skyrocket the stress levels of everyone there. Burns Bridges Many hospitals and other healthcare facilities are affiliated. So, if you ghost hospital ABC, you are likely to be placed on a do-no-hire list for the entire organization. This could limit your job opportunities at skilled nursing facilities, surgical centers, and home care and hospice agencies. If you live in a rural, small, or even moderate size city, you could find yourself having a difficult time getting hired again. Try This Instead While ghosting isn’t a good practice, accepting a new job or staying in a current position that isn’t a good fit isn’t a good idea either. You have to learn a few good strategies for speaking up for yourself and letting employers know what you’re thinking and what you need. Here are a few simple ways to communicate your needs without ghosting: Learn how to say ”no” gracefully. You can tell a future employer that you don’t think the job is for you in a courteous manner that doesn’t burn bridges. If you are unhappy with your current job and are ready to walk way - give the minimum amount of notice needed. If you don’t think you can handle another two weeks on the job, talk to your manager to see if there is a possibility of being able to step out gracefully before the two weeks are up. If you’re having an issue on the job, talk to your supervisor. If there is a situation that makes talking to your manager tense, request that you have another member of management or human resources present for any discussions. If you do ghost and then feel bad about it, reach out by sending an email and explaining the situation. It probably won’t build any bridges with that employer, but it does show that you are thinking about your reputation for the future. Have you ever ghosted a recruiter or interview? Have you ever left a job without notice? Or, maybe you’re like me, and you were ghosted by an employee. Share your thoughts about the subject below.
  7. As 2019 begins, the healthcare industry is faced with challenges. Everything from cybersecurity to payment models is listed as possible issues. As a nurse, you likely ponder longer on problems of patient care and experience than any other potential challenge. Patients are demanding better service as out-of-pocket contributions, and cost-sharing percentages continue to rise. This means that nurses must look at ways to improve their practice and increase the credibility and skill they bring to the bedside. The American Board of Nursing Specialties reports that there are almost 750,000 certified registered nurses worldwide in a variety of settings. To publish a complete list of common nursing certifications takes quite a bit of space. Nurses can be certified in critical care, case management, urology, or wounds, just to name a few. Certification can be time-consuming and difficult. However, the benefits for employers, patients, and the nurse are many. Adding Value to Your Employer Nursing requires ongoing learning and mastery of skills. Many employers value nursing certifications in various specialties to demonstrate experience and knowledge in complex areas. Nurses are only required to pass the NCLEX once (thank goodness!) but do have to complete a set number of continuing education courses each year by their state board of nursing. Certification in a specialty provides ongoing validation of experience, skills, and knowledge in your certification specialty. Some employers will support certification through continuing education courses, reimbursement of costs associated with certification, and annual memberships to accrediting bodies. Hospitals and other facilities often publish data on the number of certified nurses to increase the public’s confidence in the nursing care provided within the walls of their organization. Employers who embrace certification might be better positioned to thrive in today’s competitive healthcare marketplace. Increasing Confidence of Patients Patients are sicker today than ever before. As life expectancy increases, more people are living longer with chronic illness and acute exacerbations. The public wants to be assured that nurses are competent and highly skilled in their specialty area before they become patients. A 2002 Harris Poll found that 78% of consumers were aware that nurses could be certified. Awareness of nurse certification was slightly higher for nurses than other professions such as doctors, teachers, and accountants. Many consumers prefer hospitals that employ certified nurses to provide care. Being certified in a specialty brings credibility to your practice and marks your work with a sense of excellence. Boosting Job Satisfaction Certification doesn’t only benefit your employer and patients. It validates your knowledge and skilled judgment in a specialty area. Karen S. Kesten, DNP, RN, APRN, CCRN-K, CCNA, CNE and associate professor at George Washington University School of Nursing spoke with Mary Watts, Community Director of AllNurses in 2018 about the path to certification. As the past chair of the national board of directors for the AACN Certification Corporation, Karen understands the benefits of certification. She encouraged nurses to obtain certifications and emphasized that nursing is a lifelong learning pattern and with certification, you have more options. She advocates for nurses to have a louder voice to advocate for the patients, and one to obtain this voice is through specialty certification. When you become certified, you are the “expert” in your specialty and on your unit. You must meet eligibility requirements in your specialty that demonstrates you’ve been working in the field for a specified period. Once you meet the eligibility requirements, the real fun of studying and learning what you need to know to pass the exam begins. Once certified, you will need to maintain your certification through continuing education courses that meet the requirements set by the accrediting body. All of this ensured continued growth your knowledge and skill of your specialty area. Certification can open up job opportunities. Nurses who are certified possess the knowledge and skill to give employers confidence that you will be a high-performer. A certified nurse might pass up other nurses with the same amount of practical knowledge solely because of the extra initials they write behind their name. Weighing in on Certification Are you certified in a specialty? If so, what has certification done for your credibility with other professionals and patients? Has certification helped boost your confidence in your skill level or opened job opportunities? If you’re not currently certified but are considering becoming certified in a specialty, what do you hope to achieve through certification? Do you have questions about certification that other nurses on AllNurses can help to answer? As a certified nurse case manager, I can help along with so many of the other nurses here on the site. Let us know what excites you about the idea of certification and if there is anything that terrifies you about beginning the journey to certification.
  8. Melissa Mills

    Nursing Uniforms: From Skirts to Scrubs and Beyond

    Love this!
  9. Melissa Mills

    Nurse Leaders: Is Promoting From Within a Disservice?

    Emergent - I agree. I think having support from upper management can make or break a nurse manager in just about any role. Melissa
  10. Susan had been a nurse for ten years. She worked on the same unit for nearly five years as a staff nurse and a floating charge nurse. She was recognized on and off for stellar patient care and leadership skills. When the unit manager position became vacant, Susan applied and was hired. She received on-the-job training and was quickly given the reins to work independently. After a few months, Susan started feeling a bit overwhelmed. She noticed that nurses she was once friends with were no longer showing her the respect she had received from them in the past. Susan often felt ill-prepared to deal with budgetary and human resource issues, but she continued to try her very best. By the time she reached her first anniversary as the manager, Susan had wondered if management was for her. She considered asking for formal training or stepping down because she just wasn’t sure she wanted to continue. A Common Story Most nurses can think of someone who has been in Susan’s shoes. Alternatively, you might be living Susan’s life right now. Many nurses are quickly recognized not only for stellar clinical skills but leadership and administrative abilities that bode well for leaders. Possessing these skills can promptly lead to advancements into management positions. However, without training, could we be doing a disservice to future nurse leaders? Nurses as Leaders According to The Future of Nursing: Leading Change, Advancing Health, the public isn’t used to viewing nurses as leaders. Not all nurses start their careers with the intention of becoming a leader. However, nurses are leaders in every phase of their career in some capacity with patients and co-workers. As nurses transition into formal leadership roles, they must be ready to take on new responsibilities, learn policies, and work on committees. We must remember that leadership isn’t innate. Some nurses can learn on the job and fulfill leadership positions at various levels well. Other nurses need help developing their leadership skills by attending formalized training or going back to school for administrative or business degrees. Does Promoting From Within Work? A 2014 Becker’s Hospital Review article lists the pros and cons of promoting leadership from within the organization. They report that one survey found that two-thirds of respondents felt that promoting from within was a bad idea. The other one-third thought that it was a good idea to promote from within as long as there is a mentorship program to help the candidate be successful. The survey of 400 hospital leaders found the below list of pros and cons: Pros Loyalty and retention grow when you promote from within Morale among staff increases when they see opportunities for growth within the organization A manager promoted from within has relationships with other staff, which can help in their success Cons Transitioning from being a peer to being a manager is difficult An outside perspective may be better able to recognize issues and implement change Possessing good clinical skills does not translate into being a good leader A newly promoted leader might find it challenging to deliver criticism or negative evaluations to those they used to work beside Peers might have a hard time recognizing the person and their new authority Old peer networks can hold animosity toward new bosses Newly promoted leaders may have difficulty remaining objective when dealing with staff whom they consider friends From Great Nurse to Great Nurse Leader No matter if you’ve had good or bad experiences with internal promotions, it happens and we need to understand how to support one another in our roles from the bedside and beyond. Here are a few easy ways organizations and co-workers can help support nurse leaders. Recognize that being a great nurse leader is an entirely different set of skills than being a great nurse. Organizations and new leaders should seek training through an endorsed program such as the American Association of Critical Care Nurses or the American Organization of Nurse Executives. Provide a mentor program where successful nurse leaders train and support other leaders in their new roles. Mentoring could be through formal meetings and workshops or informal support that provides opportunities to share stories and ask questions. If you work with someone who has recently taken a leadership role in the same unit, offer support and understanding. Recognize that everyone will go through a learning curve as one of your own becomes part of the leadership team and learns to bridge the gap between an old peer group and a new one. Be open and honest with the new leader, while keeping in mind that they are now your boss. Do you support promoting nurses into leadership roles within the same unit? Is their success solely based on their skills or the unit and organizational support? Have you made the transition into leadership only to discover it wasn’t for you?
  11. Download allnurses Magazine A sick patient enters the emergency department. Feeling faint, he looks for a nurse. As he scans the room, he notices men and women in colored scrubs. He looks again, trying to find a female in head-to-toe-white. This is his image of nursing. Many years ago, this might have been a logical place to begin when looking for a nursing professional. However, today you might find nurses in solid or patterned scrubs, street clothes, or in a lab coat that looks more like the traditional physician attire. Nursing uniforms don't end with clothing. It used to be understood that nurses had no visible tattoos, piercings only in their ears and that naturally colored hair would be pulled back or kept short. Hospitals have become more lenient on the clothing nurses wear and these other aspects of their attire, too. Have you ever wondered how we made it to this point? Whether you feel that your body is not your resume or that the way you dress as a nurse is linked to professionalism, here is a historical view of nursing uniforms from the past to the present. Florence Nightingale Had a Vision Uniforms from the 1800s looked similar to a nun's habit, consisting of floor-length dresses in drab colors with white aprons over the front. Many of the first people to care for the ill were nuns, which is why the uniforms were similar. In the 19th century, Florence Nightingale revolutionized nursing. She entered the profession against her family's wishes because nursing was not seen as a worthy career choice at that time. Florence is known for molding nursing into a respected discipline, writing multiple books, and establishing the Nightingale Training School at St. Thomas Hospital. Florence had a vision for herself and those she trained. She understood the importance of creating a professional image that also served a purpose. She created uniforms to separate nurses from those still in nursing school, and that protected them from illness, weather elements, and the advances of male patients. The first recognizable nursing uniform included a long dress, apron, and frilly cap. War-Time Changes During World War I the nursing uniform underwent some of the first changes. Working on battlefields become difficult in long dresses. Nurses needed to be efficient and move quickly to assist the wounded. The aprons disappeared, and hemlines shortened. Tippets - short, cape-like garments - were added to the war uniforms. Nurses began displaying badges on their tippets to show rank. Uniform Changes with Popularity As nursing became a popular career choice in the 1950s, attire needed to be easier to clean and produced in large quantities. Skirts and caps remained a staple of the standard dress code. But, the need for more flexibility caused hemlines and shirt sleeve length to shorten. Many nurses wore starched white dresses with white hose and shoes as the standard hospital uniform. Capping it Off It's possible that the most recognizable part of a nurses uniform was the crisp white cap that was worn up until the late twentieth century. An article on Medscape Nurses reports that this change brought about changes from patients who said they could no longer tell the nurse from other hospital staff. Caps were worn to show dignity and pride in the nursing profession. Many nursing schools ended with capping ceremonies to celebrate the induction of new nurses into the trade. However, lacking practicality was likely the main reason for the demise of the nursing cap, which was no longer required by most hospitals by the 1970s. Emergence of Scrubs Scrubs began in the operating room. In the 1940s physicians started wearing white uniforms rather than their own clothing. By the 1960's surgical scrubs changed to the traditional green that you see today to lessen eye strain experienced by surgical staff from white uniforms and bright operating room lights. As nurses became responsible for the cost and care of their uniforms, they also started to request more comfortable options from manufacturers. This prompted the modern day scrub. By the 1980s and 90s, the traditional nursing uniform was replaced with scrubs in most healthcare facilities across the U.S. Scrubs are easy-to-care-for, come in a variety of styles and colors, and offer nurses comfort and mobility during long workdays. You can choose styles with multiple pockets, elastic waistbands, drawstrings, and other options and still meet most hospital policies. Some facilities might require nurses to wear a specific color or pattern to help distinguish them from other clinicians. Other employers such as home care, hospice, or other community health providers may wear a combination of scrubs and street clothes to care for patients in their homes. Men in Uniforms Not only has the appearance of the nursing uniform changed over the years, but the look of the workforce has changed, too. Finding images of men in traditional nursing uniforms is difficult. Many nursing schools provided men with a shirt made of the same dense fabric that women wore, and no caps were required. Some hospitals required men to wear uniforms worn by physicians or dentists because there wasn't a standard male attire. As scrubs became acceptable, men followed suit, choosing scrubs in multiple colors and patterns. Hair Color, Piercings, and Tattoos For years, many nurses have covered tattoos and refrained from coloring their hair in unnatural colors to conform with facility policies across the U.S. A 2015 article in Minority Nurse even reported hospitals and nursing schools banning all nail polish colors, unusual hairstyles, and earlobe gauges. In recent years, many facilities have started to change their policies on nursing dress codes. Indiana University Health, the state's largest health system adopted a relaxed policy on tattoos and hair color in 2018. The hospital reported that the changes were made to reflect "authenticity" of their staff. A Becker's Hospital Review article from December 15, 2017, stated that the Mayo Clinic changed their policy on showing tattoos for both nurses and doctors in January 2018. This came just three years after the hospital ended a rule that required female employees to wear pantyhose. These rules, lodged in societal norms, continue to change and evolve. However, some feel that the uniform is more than just functional attire. It's part of the nurse's expression of self, and it's also one component of the patient experience. Function versus Expression The nursing uniform has long been positioned as a way to keep nurses safe. The functionality of the first long-sleeved and floor-length frocks met the safety standards of the day. As the need to become more mobile emerged, changes began to happen that made the uniform more functional. With the emergence of infection control practices, other equipment was added to the attire that is now considered standard, such as gloves, masks, and even isolation gowns, when needed. As nursing gained popularity, nurses found their voice and demanded respect in many forms. The choice of wearing a uniform, changing their hair color and even showing their ink is a part of self-expression and acceptance that many nurses have welcomed with open arms. The Future of Nursing Uniforms Where do we go from here? Will nurses one day be roaming the halls of hospitals in street clothes while they care for patients? Or, will nursing "whites" come back into style either on their own or at the requirements of employers? It's hard to tell what's next for nursing uniforms. We have come a long way indeed. How do you feel about your current nursing uniform policy? Do you want more leniency or do you think that we've gone too far?
  12. Melissa Mills

    8 Best Apps for Patient Self-Care

    According to a New York University School of Medicine study of 1,604 mobile phone users in the U.S., over half (58%) downloaded at least one health-related mobile phone app. The most popular categories of apps were fitness and nutrition, with users accessing these apps daily for self-care management. What does this mean for your nursing practice? Nurses must be aware of this trend. Your job hinges upon educating patients about important self-care behaviors that will keep them healthy and out of the hospital. An article in Nurse Journal reports that patient education must be comprehensive and easily understood because more than 50% of Americans are health care illiterate, meaning they don’t understand the health care information given to them or what to do with it. This is where the mobile phone app trend can help you and your patients. When you are no longer there to educate, these apps can help your patients remember, search, track, and learn about their illness to better manage at home. Glucose Buddy for Diabetics This app has been ranked the #1 diabetes app for over 9 years and allows the user to track blood sugar, medication management, and Hemoglobin A1C results. Glucose Buddy can also track carb intake through the food database, weight, insulin, blood pressure, and provides daily and long-term trends. It integrates with the Apple Health App and has the option of purchasing premium features. Clinical Trial Seek for Cancer Research Studies If you have a cancer patient seeking to enroll in a clinical trial in the U.S. for their cancer care, Clinical Trial Seek is just the app. It allows them to search by location to find studies in their area and by cancer type, clinical trial phase, study sponsor, and inclusion criteria to see the trial that is right for them. CDC App for Flu Season The Centers for Disease Control and Prevention has several apps that can help just about any patient with self-care activities. A popular one for this time of year is the FluView Interactive app gives the latest flu outbreak data to keep your patients safe during the flu season. Click here for a full list of general public CDC health apps available on iOS and Android. WebMD App for Overall Wellness Just about every patient uses WebMD to check symptoms. But, did you know that you can point your patients in the direction of the WebMD app to help with healthy living including a physician directory, pill identifier, medication reminder, and the ever-popular symptom checker for when they’re on-the-go? This app is highly rated by users and available in the Apple Store, Google Play Store, and on Amazon. What to Expect Pregnancy and Baby Tracker for Future Moms Just like the book, the “What to Expect When You’re Expecting” app is chock full of details about exactly where your patient is in their pregnancy and offers week-by-week videos showing the development of their baby. It also has loads of general pregnancy information including tips for nutrition, exercise, and how to prepare for labor. Mango App for Tracking Self-Care Habits If you’re looking for a general health app to help patients with medication management and creation of health habits, check out Mango Health. Patients can track their weight, medication compliance, and even get regular reminders to help with self-care behaviors. SmartBP App for Healthy Hearts Many patients could benefit from an app that helps with blood pressure management and tracks progress towards healthy heart goals. SmartBP uses an iPhone, iPod Touch, or iPad to record, track, analyze, and share blood pressure readings. It connects with Apple Health to keep all health information at the patient’s fingertips. Saebo VR for Stroke Recovery Many stroke patients need assistance with activities of daily living after having a stroke. The SaeboVR app was designed to engage patients in physical and cognitive rehab to simulate everyday tasks. It uses a virtual assistant to offer guidance when performing self-care activities with the affected extremity like picking up transferring, or picking up and manipulating objects. Sample activities include grocery shopping, preparing breakfast, and putting away clothes. Do you have a go-to patient app that you recommend? Comment below and let us know the name of the app, the population of patients you use the app for, and why you like it.
  13. Hello Melissa!  Glad you are here. What do you think of the new home? 

  14. Melissa Mills

    Recognizing the Red Flags of Sex Trafficking

    You work in the ED. Tina, a young woman in her early 20’s, has just been brought back to Exam Room 8. You go in to introduce yourself and see that she has come with complaints consistent with a UTI. Tina is lying in bed, appears malnourished, and doesn’t make eye contact. She is with another woman who is around the same age and an older woman who Tina calls “ma’am” and introduces as her friend, Miss Rhonda. You notice that the older woman does most of the talking, and reports that Tina lost her driver’s license a few months ago and hadn’t gotten a new one. She also tells you that she will pay in cash today for any treatment Tina might need. As you do your admitting assessment, Tina gives you a sketchy health history and says she just doesn’t know about her health when she was younger. You ask the other two women to step outside while you do your physical exam, but Miss Rhonda refuses and says that Tina has no secrets. Tina just looks away. During your exam, you notice several bruises on Tina’s back, chest, and inner thighs. When you ask how she got the bruises, Tina quietly says that she often falls for no reason. Once you are done with your assessment, you go to leave the room, and Miss Rhonda tells you they don’t have much time and need to be treated quickly. As you walk out of the room, you wonder to yourself just what the real story is with the patient in Room 8. Trafficking by the Numbers Human Trafficking is an umbrella term that includes sex trafficking, forced labor, and domestic servitude. The Department of Homeland Security defines human trafficking as an act that involves the use of force, fraud, or coercion to obtain labor or a commercial sex act. Human trafficking is the fastest growing crime in the world and is often silent, happening in homes and business around the country. Most victims never come forward for fear of the traffickers or the potential for legal consequences. The International Labour Organization estimates that there are nearly 40.3 million victims of human trafficking around the globe with 75% of these victims being women and girls. Trafficking is a $150 billion industry that not many people want to talk about or recognize. Nurses need to know what sex trafficking is and how to recognize the signs of a potential victim. Sex Trafficking Defined Victims of sex trafficking are manipulated or forced to engage in sex acts for money. They might be pushed into sexual acts through the use of manipulation, violence, threats, or even the promise of love and affection. Human Trafficking Search reports that the most common recruitment tactic used is an intimate partner/marriage proposition, followed by familial, posing as a benefactor, job offers, and false promises. Signs of Sex Trafficking Nurses are in a unique position to recognize possible victims of sex trafficking. However, studies have reported that as many of 50% of trafficking victims in the U.S. encountered a healthcare professional while in captivity but were not recognized. This statistic is eye-opening and demonstrates the critical need for every nurse to be trained to have a keen awareness of the signs of sex trafficking, which can include a patient who: Displays signs of physical or sexual abuse Has another person speaking for them during the visit Engaged in sexual activity at an early age Reports having a pregnancy or an abortion at a young age Has trauma to the genitalia Presents with advanced health problems that aren’t treated Has frequent emergency room visits Displays anger, depression, or anxiety Has suspicious tattoos or branding Runs away from home or foster care Inappropriately dresses for the weather or situation Reports a high number of sexual partners Has multiple urinary tract infections Has been diagnosed with multiple sexually transmitted infections It’s vital to remember that not all of these signs alone are indicative of sex trafficking. However, when a patient presents with several of these signs during a visit, you should be considering the possibility that something else could be going on in this patient’s life. Let’s revisit Tina’s story from above. Now that you know the signs of sex trafficking, you can quickly see that Tina is a patient you might want to consider as a potential victim of sexual trafficking. Have you ever encountered a victim of sex trafficking? Did you recognize the signs quickly or did it take awhile? How did you respond? Comment below.
  15. 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.