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Damion Jenkins MSN, RN

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Hi! I am Damion - a Registered Nurse, Educator, Tutor and Writer! I am the owner and operator of TheNurseSpeak.com - a nursing education consulting company & blog.

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  1. Since nurses are expected to be self-regulated professionals, we are legally and ethically obligated to identify and make a valid attempt to resolve all practice issues as they arise as a means to minimize potential negative impacts they may have on patients, our fellow colleagues, and daily operations. In part one of this three part series, we will focus on how to identify practice issues and how they may negatively affect our patients, as well as our ability to perform and function at an optimal level. Let’s take a look at two strategies we can implement to gain a better understanding of what’s going on, so we can find the best way to resolve a practice issue: Identifying a Practice Issue A practice issue can be defined as any issue or situation that either compromises patient care or services by placing a client at risk for harm, or one that affects a nurse’s ability to provide patient care or services that are consistent with current standards of practice. The first step in addressing a practice issue is being able to identify one. In order to determine if your issue is indeed a practice issue, one must ask the following questions: Does the issue present a risk to patients? Does the issue make it difficult to function according to current standards of practice? Does the issue conflict with your institution’s standards, guidelines, or policies? If you answered “yes” to any of the above questions, then you may have a practice issue that needs to be resolved. If you answered “no”, your issue is not likely a practice issue but still needs to be explored further and resolved if possible. Here are some examples of practice issues: Inappropriate use of social media such as discussing your patient on Facebook. A nurse from a telemetry unit being floated to the intensive care unit and is assigned a ventilated patient without appropriate support. Withholding critical information about a patient from a member of the healthcare team. Consistently working short staffed with unsafe nurse to patient ratios. Chronic workplace bullying and lateral violence. Once you have been able to properly identify a practice issue, you must then explore the issue to determine the severity of the issue so that you may prioritize resolution accordingly. Fully Exploring a Practice Issue Taking the time to fully explore a practice issue will help you to gain additional insight and develop a shared understanding among colleagues and other members of the healthcare team. A better understanding will also help to prevent a quick response that may be influenced by incomplete information, emotions, or assumptions surround the issue. Reflecting on a practice issue before reacting is a great way to look at the situation more objectively and can help you to quickly identify potential causes. Gaining your team's perspective can also provide further clarity about the issue and supports a team approach to resolving the issue. The following questions can assist you in reflecting on and exploring a practice issue in greater detail: How does this issue place patients at risk? How does this issue affect your ability to provide patient care according to current standards of care? Does this issue go against the Nursing Code of Ethics? Does this issue put a strain on your nursing oath to do not harm? How does this issue prevent you from following agency policies and procedures? Do you have the knowledge and skill to address the practice issue? Who is affected by the practice issue and what are their perspectives? Does your organizational policies, procedures, or guidelines contribute to this issue? Is this a recurring practice issue? And if so, why is it recurring? What are some of the anticipated outcomes if the issue goes unresolved? Develop a Description Once you have explored the practice issue in full, you will need to develop a description of the issue, making sure to be as objective as possible. You’ll want to include the date, time, place, people involved and full account of how the issue affects the client, your nursing practice and/or the healthcare team. Be sure to outline all contributing factors. Having this detailed description will be helpful when communicating the issue with your nursing leadership. In many cases, common contributing factors for practice issues include, but are not limited to: Inadequate Skill Mix Lack of Accountability Decreased Resources Lack of Responsibility Ineffective Communication Breaks in Standards of Practice Outdated Policies and Procedures Challenging Legal and Ethical Issues Workplace Bullying and Lateral Violence As you can see, the first two steps in resolving practice issues involve identifying the practice issue, then fully exploring the issue and the anticipated outcomes on the quality of patient care and delivery of high-quality nursing practice. Once you have completed the first two steps, you will move into utilizing available resources and taking action to find resolution. Stay tuned for part two - where we will discuss two more strategies in resolving practice issues for nursing success! Best, Damion
  2. Damion Jenkins

    Failed NCLEX 3 times...HELP

    Hi Dkray, First, let me say that you are NOT alone! I've helped over a hundred students and clients pass the NCLEX - some who have had up to 14 unsuccessful attempts! It's important to remember that the NCLEX is not a measure of your future success as a nurse, nor does it measure your intelligence or skill set. The NCLEX is designed to challenge your ability to critically think, and decipher the information thrown at you in a stressful setting - similar to what nurses face on the job every single day. Since the NCLEX is comprised of integrated questions that pull in several concepts per high-level question, it is easy for test-takers to choose the "distracting" answer choice rather than the correct answer choice. ATI, Kaplan and Hurst are all great resources for content review. I think what you may need is test-taking strategy tutoring. If you'd like more information, please do not hesitate to reach out. Remember this - if you can graduate nursing school, then you can pass the NCLEX! Best, Damion
  3. Damion Jenkins

    Break between graduating and taking NCLEX- RN, advise?

    Hi tmarie4, If you think you need a content review, there are several online options link Hurst, Kaplan, Remar, etc. However, I find that most nurse graduates don't need a full content review, but benefit most from individualized NCLEX test-taking strategy tutoring. There are several online tutors out there, and some (including myself) have a 100% pass rate. Good luck - you got this! -Damion
  4. Hi cicigz16! First, let me assure you that you are not alone in this! Many of my NCLEX clients have come to me feeling anxious after an unsuccessful attempt at passing the NCLEX. As an NCLEX Expert and with my 100% pass rate for two years in a row, I think I can be of assistance. Here are a couple tips to help to ease your anxieties: Focus on mastering your approach to every single question. You must approach each question the same way, every single time. The decision tree is a helpful resource if you know how to correctly apply it, however it is not the only strategy that exists in answering NCLEX style questions. You must be able to understand what the question is asking of you. (can you identify the topic?) Sometimes you cannot, and must look to the answer choices for clues. Focus on the harder, more complex, critical thinking questions that have integrated concepts - these are the ones that give you better chance at passing if you answer them correctly. Many of the test banks have a mixture of content focused questions, as well as integrated - high level questions. The high level questions should get your focus when studying. Try to reduce your stress levels. Get adequate sleep. Do not drink too much caffeine, exercise regularly, eat a healthy diet, and stay hydrated. Good luck, and don't hesitate to reach out if you need additional support! Best, Damion
  5. Damion Jenkins

    Nclex sata

    Hi bound&determined91! The answer to your question is - Yes. It is possible that all of the SATA answer choices can be correct. As an NCLEX Prep Expert, it is essential that I stay up on latest NCLEX trends and test plans. You may find it surprising to know that this is not new to the upcoming update, and has been possible since 2016. The most important thing to do when approaching SATA questions is to carefully consider each and every answer choice independently of the others. If it makes sense and goes along with what you've learned in school, then it should be considered as a correct answer choice. I hope this is helpful. Good luck! -Damion
  6. Damion Jenkins

    ATI & NCLEX-RN

    Hi NurseRedHeart-RN! As an NCLEX Prep Expert - I can assure you that ATI is a valuable resource for NCLEX Prep. With that being said, it is still essential that you focus on test-taking strategy in addition to content review. The NCLEX assumes that you've mastered the nursing content learned in school and will challenge you to answer integrated concept questions that may include obstetrics, medical-surgical nursing, as well as delegation and scope of practice all in the same question. Therefore it is essential that you prepare best by knowing the content as well as practicing answering NCLEX test-questions with a systematic approach. Good luck! -Damion
  7. Damion Jenkins

    Gonna Quit: When Nursing Is Rough...

    THIS!!! Until we nurses (from the bedside to nursing leadership) strive to uplift, support and mentor our own - nursing will always be one of the most undesirable positions in healthcare. The role of the nurse will always be challenging, and therefore requires continual support from our colleagues and leaders.
  8. Damion Jenkins

    Anyone else regret becoming a nurse?

    Thank you Florida Sun RN for sharing. Many of us share similar feelings. Regret that I became a nurse is not one of them though. By no means have I sailed through becoming the nurse that I am today. I have too been in the exact same place as you - constantly bullied by seasoned nurses, manipulated by horrible nurse managers, physically assaulted by patients, and forced to take mandatory overtime while caring for 24 patients, and overseeing a house of 8 LPNs and 200 patients when I only had 4 months of nursing experience. There were many points when I considered leaving nursing when I felt powerless to change my workplace experiences, until I went back to school and started teaching and taking agency/travel assignments. I found that the worst part of nursing wasn't necessarily the hard work, but the people who were in control of my workplace experiences: nurse bullies terrible nursing leadership unprofessional coworkers poorly run facilities etc. Rather than letting these things rule my nursing practice and experiences, I removed myself from the role of a staff nurse and focused on becoming a contract nurse - only accepting assignments that were meaningful and fun for me. I understand that not everyone has this opportunity, especially when they have children, etc., but many cities have local travel opportunities or per diem agency options where you can pick and choose when you want to work, which units you want to work in, and you don't have to get all caught up in the overly political or manipulative culture that many nurses find themselves working in. Now admittedly, this is not a permanent solution for the global issues that make nursing an undesirable career, but it worked for me and many of my fellow colleagues. Now I am a Clinical Practice Education Specialist in staff development role, as well as a nurse entrepreneur. I enjoy a nice balance of working for a healthcare facility where I can use my experience and skill set to positively impact the nurses and nursing assistants who are still facing many of the same struggles that you've mentioned above, as well as the autonomous role of running my own consulting and content writing business. I empathize with you. We all do - and I strongly agree that one of the first steps to resolving these global nursing issues is to stick together and support one another. Once nurses (of all experience levels and backgrounds) begin uplifting one another rather than trying to tear each other down, real progress will follow. Good luck, and regardless of what the future holds for you - you are and will always be appreciated for your nursing skills and service. Best, Damion
  9. Identifying Common Collaboration Challenges Major factors that affect collaboration include communication, respect and trust, unequal power, understanding professional roles, and task prioritizing. Let’s take a look at how each one of these factors plays an integral role in the effectiveness of collaboration: Communication Let’s face it, our entire healthcare system is built upon the ability to communicate patients’ needs to the appropriate services and providers. In a system that is already overwhelming, breaks in communication happen often. From in-person communication to telecommunications, there are lots of opportunities for miscommunication to occur between members of the interprofessional team. The bottom line is that when communication is ineffective, the interprofessional team does not work together in harmony, thus collaboration efforts become compromised. Respect and Trust There’s been a long-running issue with mutual respect and trust between the different healthcare providers. According to a recent study, nurses report that some physicians are unwilling to listen to their inputs regarding patient care. Whether the physician has valid reasons for not acknowledging the nurses’ input or not, this is often perceived as disrespectful. Naturally when someone feels disrespected by a person or group of people, then trust for that person(s) becomes diminished. This phenomenon occurs among all members of the interprofessional team, and is not unique to nursing alone. Unequal Power and Autonomy Power and autonomy disparities are often attributed to the different levels of education, status and prestige that is unique to each profession. Additionally, the influence of traditional stereotypes where nurses were often viewed as the handmaidens of physicians and should not question a doctor’s order also plays into this barrier to collaboration. Unfortunately, even in the year 2019, nurses are still not being invited to the table to share their problem-solving skills, offer innovative solutions, or contribute in the decision making processes that ultimately affect them and the work environment around them. Understanding Professional Roles It is not uncommon for healthcare professionals to have a vague understanding of the roles and responsibilities of other healthcare professionals. For example, nurses understand what a physical therapist does for their patients, however, they do not understand the intricate details of the assessments, tools, billing and documentation that physical therapists complete throughout the day. If healthcare professionals knew more about the specific roles and responsibilities of each of their team members, then collaborative efforts would come much easier. Task Prioritizing One of the biggest challenges with effective collaboration is task prioritizing. One example that appears a lot in research is nursing’s lack of attendance and participation in interdisciplinary rounds. From nursing’s perspective, patient care does not cease during rounding and for that reason, many nurses have a difficult time pulling away from providing care long enough to participate in interprofessional collaboration. Similarly, doctors often demonstrate a sense of “urgency” and “lack of time”when communicating with nurses, which makes a nurse feel that the doctor is “bothered or uninterested” in what the nurse has to say. In both examples, task prioritizing is misunderstood among healthcare team members which is a major barrier to collaborative efforts. Negative Impacts of Inadequate Interprofessional Collaboration Efforts Whether interprofessional collaboration efforts are interrupted by poor communication or misunderstandings of roles and responsibilities, patient safety becomes compromised. Breaks in communication, decreased respect and trust, unequal power and autonomy, not understanding professional roles, and interdisciplinary task prioritizing conflicts are all contributing factors to decreased patient safety practices. When patient safety practices, such as initiating the high falls risk protocol, or interviewing the patient for allergies, are not completed for any or all of the above reasons, poor patient outcomes are soon to follow. According to Gobis, Yu & Reardon (2018), patients always suffer the consequences of ineffective interprofessional collaboration. For example, when doctors do not include the nurse in care planning, or spend a limited amount of time explaining findings and expectations to their patients, it can lead to nonadherence and distrust in the doctor’s ability to manage their care. Medication and care plan nonadherence is an important public health consideration, which affects health outcomes and overall healthcare costs. If collaborative efforts among all members of the healthcare team are suboptimal at any point, the patient may not receive the care that they need. Although decreased job satisfaction may be common among all members of the healthcare team due to high levels of stress caused by ineffective interprofessional collaboration efforts, nurses are among the most dissatisfied. According to the 2018 National Health Care Retention & RN Staffing Report, the current United States nurse turnover rate is 16.8% and is projected to increase over the next decade. Evidence suggests that increased nurse turnover directly impacts decreased patient access, patient safety and quality of care which ultimately leads to adverse patient outcomes. If interprofessional collaboration efforts do not improve across all care settings, turnover rates will create catastrophic disparities for our patients and our communities. Current Initiatives to Improve Interprofessional Collaboration, Communication and Streamlined Care Practices There are a lot of recommendations that current researchers are making to improve upon interprofessional collaboration efforts. Let’s take a look at the top five recommendations: Improving Communication Practices Effective communication is key. One of the best ways to enhance communication is by streamlining communication processes to reduce the amount of hand-off. Hand-off can be defined as “an exchange of information from one source to another, or from one person to another.” One of the ways that healthcare facilities addressed this issue many years ago was by eliminating the 8-hour shift option and implementing 12-hour nursing shifts. Not only did the hospitals save money by having one less shift to staff, but they also improved hand-off communication among nurses. Much like the game telephone, when messages are passed from person to person without streamlined efforts to help keep messages clear and accurate, some of the information may get missed, or misunderstood. Additionally, implementation of standardized hand-off reporting tools have also improved communication between shifts. The use of standardized hand-off reporting tools among doctors, nurses, and other members of the interprofessional healthcare team improves communication and decreases miscommunications regarding patient needs and care that is required. Research suggests that healthcare facilities invest in communication streamlining products and processes that will help to enhance interprofessional collaboration. Increasing Mutual Respect and Trust Among All Members of the Healthcare Team Mutual respect and trust among all members of the healthcare team is essential to effective collaborative efforts. Professionalism, collegiality and accountability are some of the suggested concepts to be considered. In addition, having a shared understanding of specific roles and responsibilities across the healthcare team also helps to improve trust and accountability. When roles and responsibilities are clearly defined, all members of the healthcare team can effectively work together in anticipating the needs of their patients. Creating a Culture that Supports Equal Power and Autonomy When members of the interprofessional team support one another by recognizing each member’s unique skill set, strengths, and individual contributions to safe and effective patient care, this helps to build a culture of equal power and autonomy over each specific profession. For instance, when doctors understand that nurses work towards upholding patient safety standards at all times, regardless of time, financial, or other organizational constraints, they are able to better support nurses in achieving this goal. By allowing each healthcare professional to have autonomy over their contributions and skills sets in the delivery and coordination of patient care, collaborative efforts improve. Rather than hospital administrators making decisions over patient care processes and unit flow, each interdisciplinary profession should have an equal voice in making these decisions and doing their part in making the magic of teamwork happen. Incorporating More Resource Personnel to help Cover Patient Needs During Interprofessional Collaboration - such as during Care Plan Meetings and Clinical Rounds One of the biggest challenges in establishing effective interprofessional collaboration efforts has been “lack of time and resource personnel” (Reeves, Xyrichis & Zwarenstein, 2017). Many nurses report that making interprofessional rounds is difficult when there are patient needs that need to be addressed. One recommendation to help alleviate this barrier to effective collaboration would be to establish “coverage” while the healthcare professional is removed from their patient care and coordination tasks so that they can spend quality time focusing on collaborative efforts. Much like nurses rely on the charge nurse, or another staff nurse to cover their patients while they take a break, members of the interprofessional team can have their colleagues cover their pages, phone calls, and patient care needs while they are participating in interprofessional collaborative activities such as clinical rounds. Holding Nurse Leaders and Healthcare Facility Administration Accountable It is important that we communicate our needs to nurse leaders and facility administration when moving towards establishing effective interprofessional collaboration. If administrators are not provided with this essential information, then we cannot hold them accountable for meeting our needs. One way to ensure that your nursing leadership, as well as facility administrators, are receiving the message is by submitting your communications via company email. Communication via email creates a permanent and trackable communication log that is helpful in tracking a discussion, thus reducing the likelihood of the receiver “forgetting” about the conversation. In addition to email communications, scheduled meetings with a recorder - someone who types up summaries of meeting topics, discussion and outcomes, is also a helpful method to bring forth necessary change within facilities. Advocating for scheduled meetings, shared governance, and leadership accountability are great ways to ensure that your voice and ideas for improving interprofessional collaboration efforts are being heard. Begin by asking for an opportunity to meet with your nursing leadership so that you can have a detailed discussion. Be sure to always send a follow-up email that summarizes the discussion you had, and the expectations established. This will create an agreement in writing that will help to hold everyone accountable for doing their part in enhancing interprofessional collaboration. Do you have any tips, recommendations, or strategies to help improve interprofessional collaboration in your healthcare workplace? Have you participated in a committee that focuses on improving interdisciplinary collaboration? If so, please contribute to this discussion by leaving your thoughts in the comments section below! Best Wishes, -Damion References 2018 National Health Care Retention & RN Staffing Report. (n.d.). Retrieved from http://nsinursingsolutions.com/Files/assets/library/retentioninstitute/NationalHealthcareRNRetentionReport2018.pdf Gobis, B., Yu, A., Reardon, J., Nystrom, M., Grindrod, K., & Mccarthy, L. (2018). Prioritizing intraprofessional collaboration for optimal patient care: A call to action. Canadian Pharmacists Journal / Revue Des Pharmaciens Du Canada, 151(3), 170-175. doi:10.1177/1715163518765879 Reeves, S., Perlone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017, June 22). Interprofessional collaboration to improve professional practice and healthcare outcomes. Retrieved July 6, 2018, from http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD
  10. Damion Jenkins

    Can a registered nurse work as a medical assistant

    Hi yourstrulynurse87, I am glad that you got an interview and that the DON "hired you" on the spot. Unfortunately, a verbal statement of hire does not mean you have a job at that facility. You did have a job for the night shift (which is often a very hard shift to fill), however the DON at that facility does not have to bother with calling you back if a day shift opens up. In fact, she will most likely forget you as the weeks go by. In your case, I would have asked if you could start to get the training, and then in a few months transition into a day shift role. It would have given you pay, experience and a chance at negotiating what shift you prefer. So to better answer your questions: 1) No. You should contact the facility HR/Recruiter and/or the DON directly to clarify your prospective employment. 2) Yes. Until its in writing, it is not official. 3) You shouldn't expect anything. It sounds like you denied the position they were looking to fill, so they most likely won't go out of their way to hire you for day shift. 4) I recommend you continue your job search and DO NOT INTERVIEW for positions that you are not really interested in. Its does not leave a good impression with the facility. I hope that everything I said turns out to be untrue and that the DON calls you ASAP offering you a day position. In the case that it does not, you live and your learn. Best of luck you!
  11. Damion Jenkins

    RN with no work experience

    Good evening NJSassyCat - and CONGRATULATIONS! We are so very happy to have you! Firstly, don't be scared. We all need to gain real-world experience once we graduate and pass the NCLEX. Although previous work experience is a plus for any employer, many nurse graduates (especially from BSN programs) do not have any work experience either. Letters of recommendation from your professors and instructors are a HUGE help for your situation. A prospective employer will want to get a good understanding of your strengths, skill set, and personality traits. They are looking for key terms such as: Compassionate Safe and Effective Patient Care Teamwork Takes initiative Seeks Clarification when warranted Perfect Attendance Always Prepared to Complete Assignments Reliable Trustworthy Goes above and beyond daily duties Critical Thinker Innovative Projects/Awards Leadership Qualities Good GPA Volunteer Service Professional Nursing Memberships Having your letters of recommendation and resume cross reference many of the above listed terms would help for your application to get noticed among the hundreds of others. Remember that you must tailor your resume and cover letter to make it past the automatic screening bots that search for key terms such as the ones listed above. If you could have your letters of reference reflect your cover letter and resume, your chances for having a real human review your application will be increased greatly. So don't be scared. I recommend sending your application, cover letter and resume to EVERY SINGLE FACILITY in the area in which you want to work. Nursing Homes, Hospitals, etc. I started in a LTC facility and learned A LOT! Once I got to an acute care hospital three years later, I was running circles around those other nurses! Although I had food and hospitality experience prior to becoming a nurse (which actually helps a great deal), I've worked with plenty AMAZING nurses who started their careers much like you - straight out of school with little to no work history. You can do it! Good luck, and welcome to nursing!
  12. Damion Jenkins

    Should I feel guilty?

    Hi there RNOrtho - welcome to nursing, we are so very lucky to have you. I share the same sentiments as those who have already replied in regards to not feeling guilty. The bottom line is that Healthcare is a business. Those in charge of running healthcare facilities have manipulated nurses for years into feeling guilty about not staying late, picking up additional shifts, or working with sub-optimal resources. I have sat at the same table with executives as they have said, "we cannot go over budget, so lets cancel two nurses - the remaining nurses will find a way to make it work - they always do." A nurse's compassion and commitment to do no harm has always been what gets us to say "yes" even when we really do not want to. Whether its to show support for our colleagues, or whether its because we want our patients to receive the care we know they deserve, new nurses especially - have a history of saying "yes" more often than experienced nurses. When nurses says "yes" countless times and the situation of being short staffed never seems to get any better, and/or when nurses give their supervisor time off requests 6 months in advance for it to only get denied - espcially after they've selflessly picked up extra shifts for the past several months...!?!? Saying "NO" gets that much easier! Advocating for one's own wellness, rest and time away from work is one of the most important things a nurse can do to prevent burnout, illness and compassion fatigue. You asked if you should feel guilty when you don't go into help...? I say no you shouldn't feel guilty at all. Be sure to take care of yourself first - you and your patients depend on it. Good luck, and keep on rocking it!
  13. Damion Jenkins

    Wanting to leave bedside nursing

    Good afternoon highhope. First, let me assure you that you are not alone in feeling the way that you do. Many of us nurses go through the same thing around the 6 month mark. Eager to make a difference, yet so tired of not being empowered, supported, or autonomous in our abilities to actually illicit the type of difference we want to make. It is very common for nurses to move to a different department, or specialty altogether within the first year of bedside nursing, so you're actually right on track with the norms. To better assist, let me answer your question: I knew that as a new nurse I had very little authority, leveraging power, or negotiating power to best advocate for myself, as well as my patients. I also knew that no matter how much experience I had in my previous career (15 years of Customer Service and Food and Beverage Industry Management experience), that I would still be viewed as new and "wet behind the ears". When I attempted to negotiate the way I would as a regional store opener for a large multi million dollar causal restaurant chain, focusing on customer service, and now as a nurse - patient safety, I was immediately accused of "stepping out of line", or "shedding a negative light" on the facility. Basically, I was told that if I had a problem with anything, I would have to figure out a way to deal with it, because management was unwilling to change the way they were doing daily business as usual. After about 6 months of the same old tiresome struggles, I decided it was time to shake things up and move towards a different path. I thought long and hard about leaving the profession just as you are now. After a few weeks of contemplating, I decided that I wouldn't give up on nursing... heck, I devoted a LOT of sweat, blood and tears into becoming a nurse, so I wasn't going to give up on nursing, but do something that would put me in a position to make a bigger impact. I knew it was a losing battle as a staff bedside nurse. I knew that if I didn't gain additional experience or additional certification that I'd be "wet behind the ears" for several years to come. Instead of accepting that as my future, I enrolled in a Master's Degree program that focused in nursing education. I knew that if I earned a degree in nursing education that I would be empowered with the insights, and skill set to enhance the nursing profession, by having the appropriate ammunition readily available to advocate for not only patients, but to advocate for the nursing profession as a whole. I enrolled in an online program that afforded me the ability to work my three 12 hour shifts per week, and earn a 4.0 in my program of study. I gained the knowledge and skills to better negotiate my working conditions. I gained the knowledge and skills to better advocate for my patients. I learned how to collect data, and present it to upper level management in a way that they cannot ignore. I became an authority of my nursing practice, and more importantly, I became aware of how to hold others accountable to best practices. I worked the entire three years I was in my MSN program, and I was treated the same throughout my entire program. Senior nurses tried me. Nursing management tried me. I was just another new nurse. However I was gaining the ability to see my way out of undesirable work circumstances. I knew that I had a much brighter future ahead of me. And just like magic... once I graduated and earned the initials MSN behind my name, people started treating me differently. All of a sudden I was a respected resource. I became the "go-to" for nursing excellence. I was able to negotiate a higher salary. I was able to professionally refuse unacceptable assignments, and use my grad school training to leverage resources that we needed to best care for our patients. Since then, I have come to teach for a college, travel the country as an agency nurse, serve as a staff development clinical practice education specialist, and run my very own nursing education and consulting business - all things I may not have had the opportunity to do without my Master's Degree. I fully understand that nursing isn't for everyone. To this very day there are times when I question why I stay within this crazy profession, and at the end of each of those days, I always remember why I became a nurse. It's the same reason why we all become nurses. There is no other healthcare provider role that does as much, knows as much, is as innovative, flexible, intelligent, resilient and is as trusted as much as nurses! For those reasons, I did not leave the profession of nursing. Instead, I found my passion within it, and now I am doing exactly what I love each and every day! Hang in there, and seek out the support from those around you. Let's change the narrative and work towards shaping the nursing profession into what we NURSES want it to be! #nursesmatter Best, Damion
  14. "We are short again today" - A daily phrase used by nursing staff that summarizes the consistent inadequate nursing staff ratios that healthcare facilities seem to continue to support. Inadequate nursing staffing ratios greatly diminish the likelihood of achieving positive patient health outcomes, as well as significantly decreases nursing staff job satisfaction and retention across our nation. Having an upwards of eight or more patients per Registered Nurse, and 15 or more patients per Nursing Assistant in an acute healthcare setting, such as a hospital, has been the norm for far too long now. As our healthcare marketplace expands and becomes more demanding of nursing staff by offering more treatment options, more medications, more technology, longer working hours, more complex patient illnesses, more computerized documentation, etc., healthcare facility staffing procedures should be reconfigured to include more nursing staff resources, rather than remaining unsafe. According to an article posted in The American Nurse - an official publication of the American Nurses Association, when it comes to achieving high standards of care, optimal patient outcomes and institutional financial growth, adequate nursing staffing ratios should be considered as a necessity. Unfortunately, many healthcare facilities have not set standards for adequate nursing staff ratios. Instead, they continue to base their nursing staff to patient ratios off of a grid that only reflects patient body count - not taking into consideration RN experience levels, patient acuity, or available resources. In a nursing led effort to provide adequate nursing staff ratios across our country, the American Nurses Association, each individual State's Nursing Association, and Nurses Take DC, have introduced Bills to improve staffing in a variety of care settings. The ANA proposed The Safe Staffing for Nurse and Patient Safety Act (S. 2446, H.R. 5052) to the House and Senate for consideration. According to the American Nurses Association (2018), this proposed legislation would require Medicare-participating hospitals to create a committee, composed of at least 55% direct care nurses, to develop nurse staffing plans that are specific to each patient care unit. The idea of having these committees is to utilize the expertise of the direct care nurses, who are best equipped to determine the adequate staffing levels to safely meet the needs of their patients. For example, many charge nurses get report from the bedside nurses regarding how much care their patients need. Someone who is completely bed bound, incontinent, has multiple wounds, IV lines, oxygen, and may be confused, would require the assistance of three nursing staff members. This could be a combination of nurses and nursing assistants. The unfortunate reality is that the charge nurse currently collects this information so that they do not assign five of these high acuity patients to the same nurse. Instead of getting additional nursing staff to help with the increased acuity, they try their best to split up the acuity among the nurses and nursing assistants - which rarely works in regards to maintaining adequate and safe nursing staff ratios. However, if the charge nurse were able to bring on an additional nurse, or nursing assistant to help manage the increased acuity, then patient safety and nursing staff job satisfaction would improve significantly. The ANA states that to date, seven states have enacted nursing staff ratios legislation that closely resembles the American Nurses Association's recommended approach to ensure safe staffing, by utilizing hospital-wide staffing committees, where direct care nurses have a voice in creating appropriate staffing levels. A total of 14 states have implemented laws that address nursing staffing ratios. These states include: CA, CT, IL, MA, MN, NV, NJ, NY, OH, OR, RI, TX, VT and WA. For more information on these efforts, you can visit the Nurse Staffing page on the American Nurses Association website. Nurses Take DC have proposed the RN Ratio Bill S. 1063/HR 2392, which goes further by mandating that each nursing speciality has their own mandated patient to nurse ratio, and places great consideration on other staffing issues such as mandatory overtime, averaging, video monitoring, and keeping nursing administration, such as charge nurses, out of the direct patient care staffing numbers. To see a side by side comparison of the differences among the ANA's Bill and the Nurses Take DC Bill, you can click here. As of this very moment the fight for adequate nursing staff ratios continues. With all of our continued dedication and service to improving nursing care and standards of practice, I am certain that we will prevail in obtaining legislation for adequate nursing staff ratios. Best Wishes, -Damion For other articles in this series, go to: Inadequate Staffing: Patient Safety in Today's Healthcare Marketplace - A Four-Part Series Inadequate Nursing: Patient Safety in Today's Healthcare Marketplace - A Four-Part Series Alarm Fatigue: Patient Safety in Today's Healthcare Marketplace - A Four-Part Series Compassion Fatigue: Patient Safety in Today's Healthcare Marketplace - A Four-Part Series
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