J.Adderton BSN, MSN

Like nurses, most physicians learn how to measure blood pressure while they are in medical school. It’s likely they don’t receive refreshers following their initial training over their professional careers. There’s concern that lack of training on this fundamental skill could lead to misdiagnosis of a patient symptoms, especially with high blood pressure being the leading risk factor for heart attacks and strokes. On-line Course Launched On November 18th, the American Medical Association (AMA) and the American Heart Association (AHA) released an on-line course to provide periodic retraining. The aim is to ensure health care professionals measure blood pressure accurately and consistently every time. The 30-minute course is based on the updated 2017 comprehensive clinical guidelines for the prevention, diagnosis and treatment of hypertension in adults. The guidelines were developed by several health organizations, including the AHA and the American College of Cardiology. The course objectives include: Reinforce guideline recommended blood pressure measurement techniques Simulate proper BP measurement using a manual, semi-automatic, or automated device Boost competency and confidence in BP measurement The course also provides 0.5 Continuing Education (CE) credit and costs 25.00 for individual enrollment. The course can be accessed at Achieving Accuracy: BP Measurement. Clear Need for Training The module was developed after the AMA-AHA surveyed over 2,000 healthcare professionals and found they were not receiving ongoing blood pressure training. Specific findings include: Half of physicians and physician assistants reported never receiving BP retraining after school One-third of nurses and a quarter of medical assistants were not retrained As much as 41% of BPs taken across all medical practices were probably less than 100% accurate 50% medical assistants and three-quarters of nurses, physician assistants, primary-care physicians and pharmacists were not required to complete refresher training but felt it should be a regular part of their continuing medical education. Campaigning for Accuracy According to Dr. Michael Rakotz, a family physician and the vice president of health outcomes for the AMA, very few medical professionals, including nurses and doctors, perform the procedure correctly. The AMA sponsors an ongoing campaign to raise awareness around the correct technique for BP measurement. The campaign includes posters that are displayed in exam rooms and anywhere vital signs are taken. The posters also raise awareness among patients and Rakotz states, “once the patients learn how their blood pressure should be measured, they aren’t going to let anybody measure it incorrectly again”. You can read the article Are Blood Pressure Mistakes Making You Chronically Ill. Common Mistakes Regardless if you are a student, nurse, physician or other healthcare provider, there are common mistakes we make when measuring blood pressure. Have you made any of these BP missteps? Incorrect positioning For someone able to maintain a sitting position, both feet should rest on the ground or a stool. The back and arms should be supported, with arms propped at heart level. Activity before a measurement Sitting quietly 5 minutes after activity for five minutes will help relax the body after activity. Placing cuff over clothing It is important to place the cuff on bare skin. Did you know placing a cuff over a sleeve can add up to 50mmHg to a reading depending on the clothing’s thickness? Using the wrong sized cuff Using a cuff that is too small can add between 2mmHg to 10mmHg to a BP reading. Talking during the measurement It is tempting to talk and ask questions while taking a BP, however, even active listening can add 10mmHg. Heavy Consequences Dr. Raymond Townsend, director of the hypertension program at the University of Pennsylvania Hospital points out the consequences of simple errors, “When you label someone as having hypertension you actually have given them a chronic disease label. That can be a downer on our outlook on life so getting it right is important”. Dr. Townsend and Dr. Rakotz worked on a study to look at the accuracy of blood pressure measurement among medical students. During the 2015 annual AMA meeting, early 160 medical students participated in a “blood pressure check challenge”. The students were evaluated on 11 measurement elements and four was the average number performed correctly. Townsend points out correct measurement and treatment of blood pressure is the single most important difference HCPs can make to “ help someone live longer and live free of target organ damage”. Evaluating Effectiveness The AMA and AHA have partnered with Advocate Aurora Health, the University of Pennsylvania, the University of Alabama and CVS Minuteclinic chain to evaluate if the on-line training meets the training needs of their clinical staff. What do you think? Is it important for physicians, as well as other HCPs, to retrain periodically on this fundamental skill?

We have all had the uncomfortable runny nose, congestion and postnasal drip that accompanies rhinitis. In over 25 million Americans, these symptoms become chronic and are experienced long-term. For most, first-line medical treatments work well to relieve symptoms associated with rhinitis. ClariFix is an innovative procedure bringing relief to those who are unable to tolerate or haven’t responded to traditional medical treatment. What is Chronic Rhinitis? Rhinitis is inflammation of the inner lining of the nose and usually lasts a few days or up to four weeks. Chronic rhinitis means the inflammation has lasted beyond 4 consecutive weeks and is long-term. There are two types that are categorized based on the underlying cause, allergic and non-allergic rhinitis Allergic Rhinitis This is the most common type and is also known as hay fever. It is caused by the body’s inflammatory immune response to an allergen, such as pet dander, dust or pollen. Non-allergic Rhinitis This represents about one-fourth of rhinitis cases. Unlike allergic rhinitis, it is does not involve the body’s immune response. It is triggered by irritants, such as air pollution, cigarette smoke, certain foods or changes in the weather. Symptoms Inflammation of the nasal passages may lead to annoying symptoms, including: Water, runny nose Nasal congestion Postnasal drip Morning congestion Frequent throat clearing Medication Management Medications used to treat chronic rhinitis decrease inflammation and mucous in the nasal passages. Include: Nasal saline irrigations Nasal steroids Intranasal antihistamines Nasal decongestants How It Works The ClariFix procedure uses a device to apply cryotherapy, or cold therapy, to the posterior nose. The first use of cryotherapy for nasal conditions was reported decades ago. In 2017, the FDA approved ClariFix and the procedure was initially performed mainly at medical universities. The procedure uses a device to freeze some of the nerve fibers in the back of the nose that have become overactive. The cold temperature interrupts the nerve signals that produce the runny nose and congestion of chronic rhinitis. Where is it Performed? ClariFix Cryotherapy is typically performed in the doctor’s office with only local or topical anesthetic. The Procedure There are several steps to the procedure, including: Application of numbing medication to the nose Placement of the ClariFix device and endoscope to the back of the nose Freezing chemicals (nitrous oxide oxygen) is applied through the device, though a small balloon tip The balloon presses up against the overactive nerves in nasal tissue The cold temperature injures some of the overactive nerves to reduce symptoms Not all of the nerves are damaged during the procedure, as this would lead to excessive nasal dryness. The treatment should not be painful but some report feeling slight pressure, a cooling sensation and some discomfort. Down Time and Side Effects Most patients require minimal downtime, and some are able to return to normal activity the same day. The most common side effect is a temporary increase in nasal congestion and some discomfort that may last up to a week. In a clinical study, side effects usually associated with nasal cryosurgery included: Headache Facial pain Dry nose Bleeding Ear blockage Within 3 months of surgery, these symptoms had either resolved or were rated as mild. When Will it Work and For How Long? Most people see an improvement in their symptoms of chronic rhinitis within 2-4 weeks. The nerve disruption lasts for a different amount of time for each person and additional ClariFix treatments can be performed. A clinical study found 4 out of 5 patients who had the procedure reported long-term results. To discover more about this innovative procedure, check out these resources: FDA Approval Notice ClariFix Website ClariFix Cryoablation Clinical Study

Do you ever feel like you are charting on auto pilot? With electronic “point and click” charting it is easy for documentation to become more standardized than individualized. When assessing the GU system, our documentation is often limited to continent or incontinent. It’s easy to forget there are different types of incontinence that impact a person’s life at varying levels. Bladder Health Awareness Month is a great opportunity to learn more about the most common type of incontinence, Stress Urinary Incontinence (SUI). What is SUI? Do you ever experience urine leakage when you exercise, cough, laugh or sneeze? SUI is caused by sudden pressure on the bladder that causes the sphincter muscles to open briefly, allowing urine to leak out. The urine amount may be a few drops or enough to need a change of clothes. In severe cases, simply standing bending or walking can lead to embarrassing leaks. Statistics Approximately 1 in 3 women will experience SUI at some point in their lives. The risk increases with age and About one-third of women age 60 report sometimes leaking urine About 50% of women age 65 and older report sometimes leaking urine Over half of women with SUI also have an Overactive Bladder Men do have SUI, but prevalence rates are for lower than women. Causes of SUI in men are likely due to prostate surgery or pelvic nerve damage. SUI and Menopause Oestrogen is a female hormone that helps the urethra to seal after urinating by maintaining thickness of the urethra’s lining. Unfortunately, production is slowed after menopause, leading to SUI in some women. SUI can occur in younger women and men, although it impacts older women the most. Some young women experience SUI after pregnancy and childbirth, which typically improves over time. Other risk factors include: Obesity Smoking Chronic cough Lower back nerve injuries Pelvic surgery Prostate surgery Impact on Quality of Life The prevalence of SUI is likely under reported due to the embarrassment experienced by people with incontinence. Fear of leaking urine can have a negative impact both emotionally and socially, such as Being reluctant to leave home Stopping you from activity you enjoy, such as exercising Changing the way you live Making you uncomfortable with your body Changed relationships with family and friends Making you avoid sex or changed your sex life It may be easy to feel isolated when the fear of being too far away from a bathroom keeps you from doing things you enjoy. Treatment The treatment plan for SUI will depend on a person’s symptoms and the impact on daily life. Both surgical and nonsurgical options are available to treat SUI. Let’s take a closer look at several treatment options available for women, pelvic floor exercises, vaginal inserts, electrical stimulation and surgery. The goal of all SUI treatments is to strengthen muscles that support the GU system organs and pelvic floor. Lifestyle Changes There are lifestyle changes that can be made to help minimize urine leakage. Pelvic Floor Exercises (Kegel) These self-directed exercises can be done by women anytime and won’t cause any side effects. By squeezing and relaxing the pelvic floor muscles multiple times a day, symptoms of SUI can be greatly reduced. For additional pelvic floor exercises, visit the following websites: Pelvic Floor Exercises for Women Pelvic Floor Exercises for Men Other lifestyle changes that can help with SUI include: Maintain a good bowel pattern to prevent constipation Maintain a healthy weight (losing just 10lbs can help with leaks) Start a smoking cessation program Vaginal Inserts Pessaries are vaginal devices that are inserted into the vagina and press against the vaginal wall and urethra. They help reposition the urethra and/or uterus, leading to fewer leaks. There are different types of pessaries from disposable over-the-counter devices to fitted specifically to a woman’s anatomy. Electrical Stimulation Low-grade electrical currents may be used to stimulate weak pelvic muscles to contract. A tampon-like device is inserted into the vagina and a handheld device is used to adjust the current. Units are available for home sessions and may be covered by insurance. Surgery Surgical interventions are aimed at restoring the normal position of the bladder neck and urethra. However, effective these procedures are is often debated in the medical community. Medications At this time, there are no medications on the market specifically for the treatment of SUI. For more information on SUI and other types of incontinence, check out these resources: Bladder Retraining Stress Incontinence in Women Stress Incontinence in Men How have you seen SUI impact your patient’s emotional and social life?

A dentist, Lawrence Tabak, DDS, PhD, has been appointed interim director of the National Institute of Nursing Research (NINR). The dentist previously served as the National Institutes of Health’s principal deputy director. On October 1st, he will assume the helm of the federal research organization, currently held by Ann Cashion, RN. Tara Schwartz PhD, a biologist, will fill the position of deputy director. Facing backlash from nurses, NIH added a job listing encouraging qualified nurses to apply for the director position the same day Business Insider reported the interim appointment. The job will remain posted until November 18, 2019 and you can check out the details here. The NINR’s Mission The NINR is one of the 27 institutes making up the National Institutes of Health. It is also the country’s largest federal nursing research institute. According to their mission statement, NINR “seeks to extend nursing science by integrating the biological and behavioral sciences, employing new technologies to research questions, improving research methods and developing scientists of the future”. The institute’s research encompasses health promotion and disease prevention, quality of life, health disparities and end-of-life. Failed to Find a Suitable Person? An NIH representative provided Business Insider the following statement: Reporting the inability to identify a qualified doctorate prepared leader in nursing research is a difficult pill to swallow for many. According to the September 13th job posting, the NIH is “looking for applicants with a commitment to scientific excellence and the energy, enthusiasm and innovative thinking necessary to lead a dynamic and diverse organization”. The nursing profession has an abundance of nurses that spent years obtaining doctorate degrees and go on to pursue research that would strengthen and support NINR’s mission. What Message is Being Sent? Nursing organizations across the country argue that a nurse is more qualified than non-nurses to evaluate grants for nursing research. The appointment of a non-nurse has evoked anger among nurses who fear it damages the public’s perception of the profession. Also, the decision may send the message that qualified nurse researchers aren’t valued as educated science professionals. Enforcing Negative Stereotypes The nursing profession is currently plagued by negative stereotypes. This includes the perception of servitude and is reinforced with heavy workloads, poor and stressful working environments and lack of professional gratification. The healthcare environment lacks respect for nurses, often undervaluing their skills and contributions. But, nurses are found in other professional roles, such as administrators, nurse practitioners, educators and researchers. It is worrisome that the appointment of a dentist to lead the NINR reinforces negative stereotypes that are already a burden to the nursing profession. The Truth About Nursing has created a petition asking the NIH to recall the appointments of both Dr. Tabak and Dr. Swartz. You can access the petition here. What are your thoughts? Do you think a nurse should hold the NINR director position? Let us hear from you! Additional Resources Business Insider Article- Nurses Criticize Move to Appoint Dentist to Head NINR

The pressure of the holiday season seems to begin building earlier each year. From holiday anticipation to New Year dread, a full range of emotions hits us before the first leaves fall. We barely make it through the marketing bombardment of all things pumpkin spice when the holiday displays go up in stores. Just think a minute about all the messages telling you how the holidays “should be”. A few that come immediately to my mind is commercials, social media, movies, family and long-standing traditions. It is possible to relieve the pressure and frustration of the holiday season. Here are 10 things to consider not doing this season to keep the focus on what is most important to you. Don’t Suffer From FOMO I have a serious fear of missing out (FOMO) on certain holiday activities. For example, I don’t really want to go shopping on Black Friday. But, a little voice inside my head tells me if I don’t go- I will be missing out on something I am “supposed” to do as part of the holiday “experience”. Escape the trap of FOMO by letting yourself off the hook. You may not have to decorate the perfect tree, bake cookies for your co-workers, host the neighborhood party and send 50 Christmas cards to your closest friends and family. This holiday season try letting go of what you feel you are supposed to do with a revised list of what you truly find meaningful. Don’t Stress Over the Perfect Gift Stores would love for you to believe the perfect gift can be found on their expensive shelves. But thoughtful gifts usually carry more meaning than short-lived fads that result in credit bills to start the new year. Set a budget that doesn’t stretch your resources and stick to it. Try these alternatives Donate to a charity in honor of someone Give homemade gifts Share a memory by giving a photo Give the gift of your time Don’t Eat Every Treat It’s really hard to pass on those sweets, appetizers and goodies that are a part of our holiday celebrations. But, with a little willpower, you can avoid making the annual “lose the holiday weight” resolution on New Year’s Day. Just use moderation and you can still enjoy all the delicious seasonal eats. Don’t Forget Your Rose-Colored Glasses In movies, families often reconcile, undo wrongs and heal old wounds around the Christmas table. Unfortunately, it is not this easy in the real world. We often set our expectations too high for family and friends to meet. Try setting aside grievances during the holidays and address when the timing is more appropriate. Keep in mind that others may be caught in the stress of the season too. Try cutting them a little slack when they do (and they will) fall short of your high expectations. Don’t Drink Too Much There are several reasons why we may drink more alcohol during the holidays Social gatherings and parties Depression and/or loneliness Increased stress levels Merrymaking can easily lead to regretting what you did at last night’s work party. Try keeping a “big picture” of your true alcohol intake to help you keep it in moderation. Overindulgence can lead to increased risk-taking behaviors and worsened depression. Don’t Forget Exercise Exercise is a great way to tackle holiday stress by improving mood and boosting energy levels. Research also shows regular exercise can reduce anger, tension and fatigue. Don’t Try to be Perfect Remember, perfect holidays do not exist. Even when you pour all your time, energy and money into your holiday preparations, everything will not go as expected. Be realistic and expect hiccups in even the best laid plans. Don’t Live Up to the Hype Do you live in a neighborhood where every house goes all out in decorating? If so, you may be feeling the stress of keeping up with the outdoor wreaths, lights and inflatables displayed by your neighbors. Before you spend the time and money on elaborate outdoor decorations, ask yourself “is this important to me?”. If the answer is no, let it go. Don’t Forget What is Most Important Try making a list of the people and traditions that are most important to your holiday celebration. This will help you stay focused on what matters most. Don’t Forget to Ask for Help This may be one of the hardest things to do. We don’t want to put anyone out during this busy time, even when we become overwhelmed. Likely, there are people in your life who want to help and are ready. They are likely just waiting for you to take the step to let them know what you need. If your depression or stress begins to impact your daily life, reach out for professional help. Let us hear from you. What have you found helpful in reducing holiday pressure? For more tips, check out this resourceful handout. Managing Holiday Stress Handout

Great question when you consider the practicality in certain situations. It would be less important to disrobe a person seeking care for flu, follow-up ect. vs. a person with alarming high/low readings, urgent medical condition or any other condition where accurate reading is priority. I have never been to New England, but have always wanted to go. I always hear about the beautiful scenery.

As nurses, we often champion good nutrition for our patients. Unfortunately, we are known to fall short when it comes to our own eating habits. Research shows your risk of being overweight or obese increases by 40% or more if you work night shift. Studies also suggest working the graveyard shift may play a role in the development of certain cancers, type 2 diabetes, heart disease and other illnesses. Night Shift Problems Nurses working night shift face several challenges when it comes to personal well-being. We experience a significant disruption in our natural sleep cycle, which can lead to a sluggish metabolism and weight gain. It is definitely a challenge (if not impossible) to find healthy food choices in a fast food drive thru or vending machine during your 2 AM lunch break. And what about exercise? Good luck finding a safe place to exercise after dark and in the wee hours of the morning. Once you clock out, it usually takes your last bit of energy to drive home, take care of any urgent matters and make it to bed. Meal Planning is Key Eating healthy and even losing weight while working night shift is possible, but it does take effort. Planning is key since your best route to good nutrition on nights is to brown bag meals and snacks from home. Read on for a few good tips to help get you started. Eat Before Your Shift On night shift, your first meal of the day should be your biggest and eaten before you report to work. To keep your energy levels up, start your day with plenty of protein from lean meats, fish or other sources. Eating before your shift will also help you stay in line with your natural circadian rhythm. Be Snack Ready Having snacks readily available is your best defense against the lure of your vending machine’s high calorie and high fat goodies. Examples of good snacks include- fruit with low fat cheese or nuts with low fat yogurt. The Dieticians of Canada Healthy Snacks for Adults factsheet is a great resource for planning your workday snacks. Eat Less More Frequently After eating your first meal, eat small frequent snacks throughout the night. You should alternate a protein with a carbohydrate to keep you alert and satisfied. Sample Eating Plan First Meal 3 to 4 oz of chicken or any lean protein 2-4 cups of frozen or fresh cooked vegetables Snack 1 Apple or other fruit Snack 2 Greek yogurt with handful of nuts Snack 3 1 cup raw veggies with lite dressing as dip Snack 4 3 pieces of string cheese Final Meal 1 oz cereal with skim milk and fruit Eating a large meal during the graveyard shift can cause gas, bloating, heartburn or constipation. Once your shift is over, eating a light meal that includes carbohydrates will help you fall and stay asleep. Pause for Meals Many of us are guilty of mindless snacking as we chart or go about our busy shift. It is important to pause, sit down and take time to eat at a relaxed pace. As nurses, this is not always an easy thing to do, but hopefully, you will be able to carve out a few minutes to recharge. Avoid the “Entertainment” Snack When nurses begin to yawn and eyes grow heavy, It is common practice to visit the vending machine. However, snacking to boost energy levels does not work well and actually contributes to weight gain. Instead, try a ten minute power nap, a short walk or stretching to keep drowsiness at bay. Beware of Caffeine Yes, coffee and other caffeinated drinks can help you stay alert in the wee hours of the morning. But, many of us exceed the recommended daily limit of 400mg of caffeine. Caffeine also hangs out in your system for up to eight hours and can affect your ability to sleep. A good rule of thumb is to switch to decaffeinated drinks (water, juice, herbal tea) at least four hours before going to bed. Outside of Work How you treat your body outside of work will greatly impact your ability to stay healthy on night shift. Practice a healthy lifestyle by exercising, setting regular meal times and adopt good sleep hygiene. Also, don’t forget to step out into the sun to keep your vitamin D levels up. Want to Learn More and Earn CEUs? The National Institute for Occupational Safety and Health has a free on-line 2-part CEU module available on their website: NIOSH Training for Nurses on Shift Work and Long Work Hours. The training provides education about the health and safety risks associated with long hours and shift work and how to reduce these risks. Have any night shift meal tips and tricks worked for you? We would love to read about them!

JUUL Labs CEO, Kevin Burns, issued an apology to parents of teens who are addicted to the company’s vaping products. The apology was made while touring the JUUL plant with CNBC as part of a documentary aired on July 15, 2019, “Vaporized: America’s E-Cigarette Addiction”. Burns was asked how he would defend his company’s product to the parent of a child addicted to vaping. Burns responded, “I hope there was nothing that we did that made it appealing to them.” E-cigarettes are the most commonly used form of tobacco among U.S. youths. In 2018, 3.6 million junior high and high school students used e-cigarettes. During the same year, use among high school students increased by an alarming 78%. What Are E-Cigarettes? JUUL is a battery operated electronic cigarette that produces vaporized nicotine, or flavored non-nicotine solutions. A user inhales the vapor and then exhales providing the sensation of smoking cigarettes. The use of e-cigarettes, or vaping, are marketed as a way to cut down or make it easier to stop smoking. JUUL and the Youth Appeal JUUL, launched in 2015, is the most popular e-cigarette, making up more than 70 percent of the U.S.market. The popularity among teens is related to several factors, including: Easy to hide and use in school Looks like a USB flash drive Small enough to fit in a closed hand Can charge in a computer USB port Flavors that appeal to youth (i.e. mango, creme, mint, fruit) Higher doses of nicotine than other e-cigarettes According to the manufacturer, a single JUUL pod contains as much nicotine as a pack, or 20, cigarettes. A study from Truth Initiation found that 63 percent of 15-24 year old JUUL users did not know the product always contains nicotine. Sleek Advertising In November 2018, JUUL suspended its official social media accounts on Facebook and Instagram to address the widespread use by minors. However, the CDC reports about 69% of middle and high school students have been exposed to e-cigarette marketing. In fact, advertising comes from multiple sources; the internet, stores, magazines, TV and movies.. Exposure to e-cigarette advertisement has played a part in the increased use in youth, even though adults are the intended audience. Not "Just Vaping" Youth are often unaware of the potentially harmful substances contained in e-cigarette vapors. The dangers are further hidden since some e-cigarettes marketed as containing no nicotine have actually been found to contain nicotine. Other potentially harmful substances emitted in the vapor include: Fine particles that can be inhaled deep into the lungs Diacetyl, a flavoring chemical linked to serious lung disease Cancer causing chemicals Heavy metals- tin, nickel and lead Users may also be unaware of other vaping dangers. Youth who use e-cigarettes are at higher risk for smoking cigarettes in the future. Also, the long-term health effects on users and those exposed through second hand vapor is still not known. Nicotine and the Young Brain Adolescence is a critical time for brain development, which continues until about age 25. Nicotine interferes with normal brain development and young users are at a greater risk for harmful effects when compared to adults. This risks include: Quickly become nicotine addicted Develop psychiatric disorders later in life Experience poor impulse control Develop other addictions in life Have altered memory, attention and learning abilities Easily Accessible The 2018 National Youth Tobacco Survey found that 14.8 percent of underage middle and high school e-cigarette users got them from a vape shop, 8.4 percent from a gas station or convenience store and 6.5 percent from the internet. A 2018 survey of JUUL users, age 12-17, found that 50 percent were provided the device through a social source. Taking Action The FDA has taken steps to address the rising use of e-cigarettes among U.S. youth. Plans are in place to expand youth education efforts, such as “The Real Cost” campaign. The FDA is also planning to launch a TV advertisement on the dangers of e-cigarettes at the end of July, 2019. Read the FDA’s July 15, 2019 press release detailing the agency’s actions toward tackling the vaping epidemic here. What are your thoughts on the lure of e-cigarettes to today's youth? Additional Resources: FDA “Real Cost” E-Cigarette Youth Epidemic Campaign Materials CDC- Keep Kids E-Cigarette Free Juul E-Cigarettes: Fueling A Youth Epidemic

On Friday, September 6, 2019, the Center for Disease Control (CDC) warned Americans on the dangers of e-cigarettes after the fifth death from an illness linked to vaping was reported. The five CDC verified deaths occurred in Minnesota, Illinois, Indiana, Oregon and California. In a briefing, the CDC also reported the number of severe lung illnesses connected to e-cigarette increased to 450, more than doubling from 200 in the previous week. The illnesses have occurred in 33 states across the U.S. and the majority were in between the ages of 18 and 25. Read about the first reported death linked to e-cigarettes here. Narrowing Investigation Public health officials are finding it a challenge to pinpoint the exact cause of the mysterious vaping illness. However, Dana Meaney-Delman, CDC incident manager, made the following statement during Friday’s press conference, “We believe that; a chemical exposure is likely associated with these illnesses, but more information is needed.” In addition to the harmful substances contained in e-cigarettes, there is also concern surrounding vape products brought on the street or that have been altered by consumers. Delivery of Illicit Substances Some e-cigarette products are used to deliver illegal substances and may be obtained from unknown or “street” sources. The products may be modified, increasing the risk of user harm. For example: Single use e-cigarette pods or cartridges can be refilled with illicit or unknown substances. Some e-cigarette products are used for “dripping” or “dabbing”. Dripping: dropping e-cigarette liquid directly into the hot coils of an e-cigarette resulting in high concentrations (i.e. THC and cannabinoid [CBD]). Dabbing: super-heating substances that contain high concentrations of THC and other plant compounds (butane hash oil [BHO], “710” and CBD). The director of the Center for Tobacco Products at the FDA, Mitch Zeller, reports particular concern is also developing around products that have been modified by vaping retailers. Vitamin E Acetate New York health officials have identified vitamin E acetate as a potential link between vaping and the recent severe lung illnesses. Laboratory tests conducted at the Wadsworth Center in Albany, New York, discovered very high levels of the chemical in nearly all cannabis-containing vaping products that were analyzed. Each person in New York who became ill with the lung illness and submitted a product to the state has been linked to at least one vaping product containing vitamin E acetate. Some of the vaping products containing the chemical are candy-flavored vapes. In a statement released by the New York State Health Department, a link was provided to images of some of the products found to contain vitamin E acetate (view images here). Vitamin E acetate is not an approved additive for the state’s Medical Marijuana Program-authorized vape products and was not seen in the nicotine-based products tested. Vitamin E acetate is not known to have adverse effects when ingested as a nutritional supplement or applied to the skin. The chemical is an oil-like substance when inhaled and this is thought to be a contributing factor in the development of lung symptoms. What is Being Done The CDC, FDA and state health departments are continuing to investigate whether the illnesses can be linked to specific devices, ingredients or contaminants associated with e-cigarette product use. States are submitting data to the CDC about lung illnesses associated with vaping, as well as the types of e-cigarettes used. Health providers are being asked to immediately report any possible cases of vaping associated lung illness to their local or state health department for further investigation. Providers should also provide a detailed history of the substances and devices used and when possible, any product devices and liquids should be submitted for testing. What the Public Should Do The CDC recommends people consider not using e-cigarettes while the investigation is continued. People who do use these products should consider the following: Monitor themselves for respiratory symptoms, such as cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain and fever. Promptly seek medical attention for any health concerns Do not buy products off the street and never modify devices or add substances not intended by the manufacturer Products should never be used by youth, young adults, pregnant women or adults who don't currently use tobacco products. If you would like more information regarding the outbreak of severe lung illness linked to vaping, visit this CDC website. Are the lung illnesses caused by a recent change in vaping products or is it an illness that has existed under the radar? What do you think? Additional Resources Vitamin E Suspected in Serious Lung Problems Among People Who Vaped Cannabis Vitamin E Key Focus in Vaping Illness, Health Officials Say

I recently participated in an employee viewpoint survey at my place of employment, which is a hospital setting. Administration “motivated” employees to complete the confidential survey with phrases like, “tell us what we can do to make things better” and “what you say is important”. I was sold and get this... I actually spent time thinking about the feedback I would give. The survey was a typical “rate on a scale of” deal and at the end, space was given to type in suggestions for improvement. I quickly realized the space had a ridiculously low character limit and I was barely able to fit in one short 6-word sentence. The Survey That Left Me Hanging Administration had my buy-in before I started the survey but left me hanging on the idea that my feedback mattered. If felt like winning free tickets to a blockbuster movie advertised during the Super Bowl and the movie was never actually released. Now, I have been a nurse for many years and understand large pay raises and more vacation pay are not survey opinions likely to be adopted by administration. However, reading back through my planned suggestions, I realized it was “easy to implement” things administration could do to show I am a valued employee. I have a hunch that there are others with small ideas that have the potential for a big job satisfaction impact. Therefore, I am going to use this platform to share what I wrote down but could not communicate within the 6-word limit. Implement a “Loop Back Around” I look forward to our bi-annual “Town Hall Meetings” with members of administration meeting with each department to provide an update on quality improvement, customer service and growth outcomes. During the meeting, a member of administrator usually takes “notes” on suggestions, feedback and concerns shared by staff and issues a robust “thanks for sharing this information, I will definitely get back with you all”. To be honest, the promise of looping back around seems empty as no one from administration is likely to follow-up. Any small amount of “loop back around” would make staff feel more valued. The follow-up could be as simple as an e-mail communication, newsletter or face-to-face visit. In fact, the follow up could be framed by administration as “we listened to you and here are a few exciting changes based on your feedback”. Education is Valued Thank you for arranging for vendors to provide in-services for staff on new products. To maximize training, I suggest product educators plan a time that falls outside of shift “high activity times”, such as medication passes. Also, an email or other forms of communication to let nurses know the topic of upcoming in-services and times would be helpful and appreciated for planning purposes. Provide a “Heads Up” on Time Card or Paycheck Changes Recently, I received a paycheck that did not include the paid time off (PTO) amount I was expecting. Having less on my paycheck than I expected was a blow, but I think I was most hurt by my director not calling to tell me my time card had been adjusted. I truly felt like “just another warm body” that was not valued. Giving staff “heads up” of time card or payroll changes, as well as the rationale behind the changes, will convey the message staff are a valuable part of the team. Maintain the Supplies and Equipment We Need I appreciate the high-quality equipment and supplies we have access to when providing patient care. However, over the past 6 months, our department has experienced a shortage of working equipment and patient care supplies. For example: Only 3 of 5 wheeled computer stations functioning after multiple work orders submitted Frequently out of linens (especially wash clothes and towels) and not receiving enough stock to last until next restock. Wound nurses ordering wound care, but supplies not maintained in department inventory. Wound care supplies not available outside work hours of wound nurse for dressing changes. Glucagon not maintained in department stock and nurses must wait on pharmacy to send with critically low blood glucose levels. Having needed supplies in stock will help decrease the amount of time spent “hunting down” what is needed. Last But Certainly Not Least, “Thank You” I also want to take this opportunity to say “thank you” for the recent change in our night shift staffing grid to allow for an additional patient care technician. Our patient wait times have been significantly reduced and our ability to provide good customer service has also improved. What is Your Experience? Do you feel like your voice is heard where you work? What are small changes could your manager(s) make to send the message “you are valued here”? It would be great to read responses from nurses working both within and outside the hospital setting.

When asked to describe a problem drinker, an image of the “stereotypical” alcoholic often comes to mind. Most of us are familiar with alcoholics portrayed in TV shows, movies and in the media. Perhaps an unkempt homeless person, drinking hard liquor from a paper bag and later blacking out somewhere other than a bed. The truth is… stereotypes can be used to justify drinking habits and lead to denial of a potential drinking problem. Someone may brush off warning signs of problem drinking by rationalizing: I am responsible with my bills. I have a good job. I have a family that loves me. I am reliable and in control of my life. Many alcoholics don’t admit to having a problem until their life begins to unravel. However, there are early “subtle” signs that you, or someone you know, may have a drinking problem. The Subtle Signs 1 - Vows To Quit Are A No-Go Drinking alcohol can lead to embarrassing situations or “morning after” sickness. People may get into a fight, cause a public scene, act inappropriately or experience a terrible hangover and vow never to drink again. And, most people learn a valuable lesson and don’t experience a repeat. But, someone who vows to “never do it again” and plays out the same experiences over and over, is most likely a problem drinker. 2 - Corners Are Being Cut When night time drinking starts to interfere with daytime responsibilities, it could be a sign of unhealthy drinking. Maybe a person is late getting kids to school, skips their regular morning routine or is late to work. Having difficulty or being unable to do what needs to be done in a day is another subtle sign of alcoholism. 3 - The Last One Standing Another subtle sign of a problem is regularly drinking a lot of alcohol, but not showing signs of intoxication like other people. If you’re having to drink 4 glasses of wine to feel “buzzed” instead of two, this could mean you are building a tolerance to alcohol. 4 - Make Plans Around Alcohol Making frequent plans and suggestions for socializing around alcohol could be a warning sign. And, not agreeing to plans if alcohol is not involved and questioning “What fun is that?” is also a bright red flag. 5 - A Case of Jekyll and Hyde Problem drinkers often morph into very different personalities when they drink.. Unfortunately, the alter ego can be loud, obnoxious or even violent. In contrast, some people use alcohol to self-medicate depression and anxiety and become withdrawn. Both scenarios point to drinking that has become problematic. 6 - Just Not Looking Good Alcohol can affect how a person feels and looks. A problem drinker may have unhealthy coloring, look exhausted or have changes in weight. The person may also put less effort into self-care and personal appearance. 7 - Memory Gaps or Loss While Drinking It is a common comedy plot. After a night of heavy drinking, someone wakes up not remembering what happened the night before. Everyone laughs as friends recap the night’s shenanigans to the person with memory loss. There is a difference in blacking out and passing out. A person who passes out is not conscious, while a person who blacks out is conscious the entire time they are drinking. A problem drinker may fish around trying to figure out what happened the night before when they were blacked out. 8 - Your Friends and Family Notice Family and friends often pick up on someone’s problem drinking before the person realizes there is a problem. If family or friends voice concern about someone’s drinking, it is likely the person has fallen into unhealthy drinking habits. For more information on the effects of alcohol on health and resources for problem drinking, visit National Institute on Alcohol Abuse and Alcoholism (NIAAA). What other warning signs have you observed in others or ... experienced yourself?

Have you ever thought about leaving a job for something better but never put effort into “feeling out” the job market? Most of us have been in a career rut at some point and felt trapped in an unfulfilling job role. We wake up dreading the workday and literally countdown the days and hours until time off. If this describes you, it is possible to become “unstuck” and regain passion for your current job or move forward with finding a future job. The first step is to take a look at what barrier (or barriers) is keeping you trapped and career stuck. You’re Bound By Golden Handcuffs In nursing, recruitment and retention strategies may include pay incentives that keep you pulled in, such as with sign-on bonuses or baylor pay. However, money that is too good to resist can become golden handcuffs that keep you in a job that no longer makes you happy, affecting your overall quality of life. In this case, you can work on an exit plan, a budget and timeline, such as “Over the next year, I will cut back and live on a budget to save money. Then, I will look for a job that will give me a better work-life balance.”. Your Confidence is Wavering Sure, there will always be someone else with flashier skills or with a different talent than your own. But, this doesn’t mean you are less capable or your talents are not as important. Everyone, at some point, has compared themselves to their coworkers. Focus on your strengths while working on weaknesses to build your confidence and keep forward momentum. You’re Just Waiting…. Have you ever found yourself waiting “just until”? Perhaps you are waiting until your next evaluation to see if you receive a raise. Some nurses wait to see if “things get better”, such as a change in management, better staffing or a work culture overhaul. But, the waiting game can lead to significant amounts of time passing with the expectations of change falling flat. Not Sure What You Want In nursing, there are endless career options and job types. However, it is hard to your dream job when you aren’t sure of what you want. In order to move forward, it is important to ask yourself some questions, such as: What do I want from my career? What are my job “deal-breakers”? What am I most passionate about? What are the things I must have in a job? What skills do I have to offer? What skills do I want to improve or learn? What type of work culture and environment do I want? What is my expected salary? You may find the article “9 Questions That Will Help You Find Your Dream Career” helpful, even if you just want to stay in nursing but try something different. Your Job is Familiar and Comfortable A simple Google search will yield an endless amount of motivational quotes about stepping outside of our comfort zones. Although you may be unhappy in your current job, you know what to expect during the workday… you duties and interactions are familiar. Most likely, you have working relationships with co-workers and understand all the nuances specific to your work environment. The fear of the unknown keeps us trapped in unfulfilling work comfort zones. To offset your fear, it is important to determine if your fear is based in reality. For example, you may tell yourself “I will never find another job with hours similar to the job I have now.” and never explore other job openings or career opportunities. You Put Self Care on the Back Burner If you feel trapped at work, there is a chance you are not consistently practicing self-care. Have you lost work-life balance and burning the candle at both ends? It is easy to lose perspective and motivation when we are mentally and physically tired. Try simple acts of self-care, such as meditation, going for walks, taking a class or relax doing something you love to keep yourself centered. You Need to Expand Your Network Talking to nurses working in other settings and environments may shed light on career options you find interesting. There are several ways you can build your professional network. Online networking through LinkedIn or other professional networking sites Reach out to your existing contacts to ask for help, seek advice or look for inspiration. Attend a local nursing association meeting or conference The goal of networking isn’t just expanding your number of professional contacts but to also focus on a vision for yourself. Are you feeling trapped in a job? If so, what is keeping you from moving forward?

I know there are many that relate to your situation, including myself. When I was stuck, I wish I had your insight of my "situation will change".

I love that!

The sprays, wipes and liquids nurses frequently use to prevent infection could be harmful to lung health. A new study, published in JAMA Network Open found workplace exposure to cleaning chemicals significantly increases the risk in COPD among nurses. In the study, researchers used data from an on-going study of more than 116,000 registered female nurses, in 14 states, dating back to 1989. The study focused on women who were still nurses and without lung disease in 2009. The nurses completed questionnaires every other year to track work history and lung health from 2009 to 2015. Occupational Exposures and COPD COPD is not only the third leading cause of death worldwide, but a chronic condition that often can lead to long term disability. Cigarette smoking remains the major risk factor for COPD in the U.S. However, data suggests that 15% to 20% of cases are caused by occupational exposures. Workplace exposures can also contribute to the disease burden of someone with COPD. In the past, studies on occupational exposure and COPD have investigated broad categories of causal agents, such as vapors, dust, gases or fumes and only on a limited number of occupational settings. Significant Increase in Risk According to the study findings, nurses were between 25% and 36% more likely to develop COPD based on exposure to certain cleaning products. The percentages reported in the study were determined after accounting for whether the nurses were smokers or suffered from asthma. Researchers found weekly use of disinfectants to clean hospital surfaces increased COPD risk by 38%, while weekly use of chemical to clean medical instruments increased the risk by 31%. Women at Risk Although gender roles have changed over the past few decades, exposure to cleaning products at home and at work are more common in women. The majority of nurses are female, with males being only 13% of the nursing workforce. A 2014 survey by the US Bureau of Labor and Statistics found that women perform 55-70% of household cleaning, which is about 30% more than men. In the healthcare industry, exposure levels to cleaning products and disinfectants are particularly high. Irritation Causing Chemicals Orianne Dumas, lead study author and researcher with Inserm, states, “We found that exposure to several chemicals were associated with increased risk of developing COPD among nurses.” Glutaraldehyde and hydrogen peroxide, used to disinfect medical instruments were among the chemicals identified by Dumas. Glutaraldehyde exposure can cause throat, nasal and lung irritation, asthma and difficulty breathing, skin irritation, wheezing, burning eyes and conjunctivitis. Nurses were also regularly exposed to fumes from bleach, alcohol and quaternary ammonium compounds, which are used to clean surfaces and floors. All these chemicals are known to cause lung irritation and could lead to the development of COPD. However, Dumas states researchers only found an association in the study, not a cause-and-effect relationship. More Research Needed The study authors found further study is needed to determine how these cleaning products might cause COPD, and if they increase the risk of lung disease for workers in other professions. Findings also suggest the need for further research to determine exposure-reduction strategies that provide adequate infection control for healthcare settings. What Are the Alternatives? Hospitals could continue to protect nurses’ and patients’ health by using safer alternatives, such as ultraviolet light or steam for disinfecting equipment and surfaces. Another option is for hospitals to switch to “green” cleaning products that don’t emit harmful fumes. The key is finding a balance between safeguarding the health of nurses while maintaining the needed level of infection control. Additional Resources CDC Fact Sheet- Glutaraldehyde Cleaning Chemicals: Know the Risks

In hospitals across the country, experienced nurses provide orientation to an ever-revolving door of new hires. The need to retain beside nurses is well known and solutions widely researched. Yet, work conditions in acute care settings are slow to improve and many nurses turn away (or run) from bedside nursing. According to NSI Nursing Solutions, Inc., hospitals saw the highest turnover rates in 2018 when compared to the last 10 years. From 2014-2018, hospitals turned over a staggering average of 87.7% of staff. While most hospitals identify nurse retention in key strategic planning, it is not followed through in operational practice and planning. According to the report, only 43.2% of hospitals have put their strategic plan into formal retention strategies. Do Graduate Programs Play a Role? I recently read an editorial, authored by Maureen Kennedy, MA RN FAAN in the American Journal of Nursing, questioning if the push by colleges for students to attend graduate or doctorate nurse practitioner programs is contributing to the devaluing of bedside nurses. Research has clearly shown hospital working conditions to be the primary reason nurses are leaving the bedside. Most of us have experienced long hours, lack of flexibility and poor leadership while working in acute care at some point in our careers. And, the large need for advanced practice nurses in today’s healthcare environment, as well as the need for qualified nurse faculty, is undisputed. Hospitals typically don’t have work environments that offer nurse autonomy or promote professional practices. Nurses may see an advanced degree as offering job opportunities that are more supportive, with greater autonomy and less stress. The editorial’s author summarized the issue by quoting a colleague: Keeping Nurses at the Bedside Healthleaders magazine recently published an article sharing what three nurse executives did to retain RNs with the right skills and experience needed to deliver high quality care. Here are a few of the ways the executives improved their facility’s retention rates for the long haul. Improve the Organizations Reputation Rush Oak Park Hospital in Illinois was plagued with a negative reputation because of consistently poor quality outcomes. The hospital’s reputation bled into the work environment resulting in nurse dissatisfaction. In addition, there was a “revolving door” of chief nursing officers leading to inconsistent leadership and vision. Karen Mayer, chief nursing officer, knew the work environment needed to change and hospital leadership was up to the challenge. Over a period of years, leadership worked to improve quality indicators to improve patient care and nursing job satisfaction. After many years, turnover rates decreased from 22% to just 8.3%. Entice Nurses Back to the Bedside Press Ganey’s 2017 National Database of Nursing Quality Indicators RN Survey found newly licensed nurses and those who have been in practice 2-4 years at highest risk for attrition. Claire M. Zangerie, chief nursing executive at Allegheny Health Network saw the same trend within her organization. Under her direction, the RetuRN to Practice Program was created to address some of the issues leading to attrition. The program was designed to attract nurses who have stepped away from nursing and want to return to the bedside. As a result, the workload of all nursing staff was successfully lessened. Attract nurses with flexible scheduling RetuRN participants offer managers at least 3 hours availability at any time, on any day, day shift or night or any weekend or holiday. The nurses help ease workload in high need areas and perform “rover-type” duties, such as admissions, discharges, patient education, covering other nurses’ patients for breaks or for continuing education. Extensive on-boarding, remediation, training and support is offered to RetuRN participants to ease the transition back to the bedside. Support Professional Development and Work Environment Kelly Johnson, vice president, patient care services and chief nursing officer at Stanford Children’s Health understands a healthy work environment and professional development programs are critical to retaining nurses. Therefore, Johnson developed and implemented several programs to support nurses in various stages of their career. Nurses have opportunities to continue growing through personal success plans, a succession planning development program, certificate and advanced degree programs. The organization has also committed to creating a healthy work environment and culture. This includes initiatives embracing HeartMath concepts that empower employees to “self regulate emotions and behaviors to reduce stress, increase resilience, and unlock their natural intuitive guidance for making more effective choices”. The goal is to create a work environment that is caring and healing, where nurses care for each other and themselves. What programs or initiatives have you experienced that improved the work environment of bedside nurses? Additional Resources NSI Nursing Solutions 2019 National Healthcare Retention Report Want to Keep Nurses at the Bedside? Here’s How Nurses at the Bedside - Who Will Be Left To Care?

Wow, that is an outcome I had never thought about.

A new study, produced by BPR Medical Gas Control, shows more Americans die in fires associated with home oxygen equipment than previously reported, with a person dying every four days. Results from The Prevalence and Impact of Home Oxygen Fires in the U.S also found the fire impact extended beyond the oxygen users themselves to other people, with 11 third party deaths reported. Third party death included firefighters, family members, and other residents... Police, neighbors and other persons trying to assist or evacuate others are at significant risk for being injured or killed in residential fires. Problem Scope Data information for the study was collected from media reports of U.S. home oxygen fires between December 2017 and August 2019. During the 20 month period, 311 incidents claimed 164 lives, with the majority of victims being home oxygen users. The numbers are in contrast with the National Fire Protection Association (NFPA) reporting in 2017 that up to 70 people are killed each year from home oxygen fires. The BPR study also found: Media coverage included 71 serious injuries with 63 victims being the oxygen user. Emergency departments recorded approximately 1,200 injuries from home oxygen fires yearly. 72% of oxygen fires in the study were most likely caused by patients smoking while on oxygen 40% of oxygen fires in the study destroyed the home or dwelling Comparison to Other Countries The U.S appears to have a higher death rate, 6.7 per 100,000 oxygen patients, when compared to other countries. The U.K. has the best record for safety after the implementation of national measures and mandatory laws in 2006 to reduce the risk of home oxygen fires.. Between 2013 and 2017, only one death caused by home oxygen use was recorded. When compared to the U.K., the risk of dying in a fire caused by home oxygen is 20 times higher in the U.S. Best practices in the U.K. include strong regulation, mandatory reporting and fitting of thermal fuses to oxygen tubing that cut the flow of oxygen in the event of a fire. How Fires Start Most oxygen fires in the study, 51 percent, were judged to be caused by smoking while using oxygen. Some cases specifically identify cigarette ashes that dropped on oxygen tubing as the source of ignition. In other cases, users may have been reluctant to admit smoking while using oxygen because they did not want their oxygen removed. Cylinder Explosion One third (102 out of 311) of the reported cases had at least one oxygen cylinder in the fire. A volunteer firefighter died after being hit by shrapnel from a cylinder explosion. The majority of home oxygen users have concentrators, but cylinders are used for portable oxygen and in-home back-up. The study authors report anecdotal evidence that some oxygen users have stores of up to 20 cylinders in and around the home. Rising temperatures increase gas pressure within the cylinder and weakens the cylinder’s metal in home fires, even with fitted safety valves. Working Smoke Detectors Save Lives Most of the media reports in the study didn’t specify if there was a working smoke detector in use. However, there were quotes from firefighters stressing the importance of smoke alarms. A recent NFPA study found 57% of U.S. home fire deaths did not have a working smoke detector. And, with a working smoke detector, you are 54% more likely to survive. Study Limitations and Recommendations The study method only captured fires linked to home oxygen use that were reported in the media. The results most likely still underestimate the numbers and the problem severity. As other countries have demonstrated, much of fires caused by home oxygen can be prevented with policy change and affordable risk control measures. Since the study is on-going, it is hoped that valuable data will be collected to support the needed change. Have you had a patient injured in a home oxygen fire? Tell us about your experience? New York State Home Oxygen Fire Safety The COPD Foundation: Playing With Fire

Students pursuing a nursing degree are passionate about making a difference in the lives of others. There are also other appealing “pros” drawing an increasing number of applicants to nursing programs. Due to the ongoing nursing shortage, students have access to scholarships and other financial resources to help pay for nursing school. In addition, new nurses are able to enter the workforce quickly and enjoy job security. Today, the ever-growing need for nurses is met with high student interest. However, acceptance into nursing school is a really competitive process and it starts with the application process. Why is it So Competitive? According to the AACN’s report on 2018-2019 Enrollment and Graduation in Baccalaureate and Graduate Programs in Nursing, 75,029 qualified applicants were turned away from undergraduate and graduate programs in 2018. The reason for limiting the number of students entering nursing programs include insufficient resources in the number of faculty, available clinical sites, classroom space and preceptors. Students with great grades and experience in healthcare are being denied entry into programs. Fortunately, there are “do’s and don’ts” you can follow to strengthen your applicant and earn your seat in nursing school Before the Application Process Requirements for nursing school entry varies by school and programs, however, the following criteria is typical: Acceptable high school GPA or equivalent GED score OR Good grades from completed post-secondary education CNA and LPN programs may not have a minimum GPA Many associate’s programs require a minimum 2.5 Bachelor’s and graduate degrees often require 3.0 or higher Your GPA may need to be greater with advanced degrees and more prestigious programs. Other tips include: Be sure to verify what prerequisites are required and make sure you have those completed before you apply. Research multiple schools and find programs that are the right fit for you. Consider these factors: Your favored learning environment Is the commute reasonable Is tuition affordable or financial aid available How are clinical hours scheduled (does the student or faculty arrange?) Apply to multiple schools to increase your chances of acceptance and provide options if multiple applications accepted. Complete volunteer hours and/or get experience in a healthcare related job. Nursing Programs Have “Hard Stop” Applicant Deadlines Be sure to start your application early and don’t miss the deadline. Now, you may be thinking, “surely they will send reminders to interested students” or “I just can’t believe my application would be denied for a missing document”. But, this is a harsh reality of nursing programs and it is easy to understand why. As a nursing student, you will be responsible for details that affect human life and safety. A complete and timely application is your first opportunity to demonstrate you are ready for these responsibilities. Be sure to have at least 2 other people to proofread your application for grammatical errors and to check for completion before you submit. Avoid These Common Application Mistakes Not preparing for the entrance exam Many nursing programs require applicants to take and pass a standardized entrance exam, such as the Test for Essential Academic Skills (TEAS). These tests will assess your math, science and reading abilities. Students make mistakes in preparing for this important exam when they don’t: Research what test (if any) specific to your program is required Give themselves enough time to study and further develop weaker academic areas. Invest in a test specific booklet or practice tests to help you prepare Get enough rest and eating a good breakfast before the exam Not preparing for the application interview First Impressions Matter Most schools have an interview process for applicants and to make a good first impression, you need to nail it. To make make your best impression, do this: Dress professionally and appropriately (i.e. business casual wear). Arrive on time Extend a solid handshake (good posture and direct eye contact) Leave non-essential personal items behind, remembering less is good Actual In-Person Interview The interview is the time to be yourself and let your personality shine through. It is also an opportunity to let the interviewer know the skills you have and why you would make a great nurse. Questions asked will focus on personal and professional goals, objectives and motivations for applying to the program. For example: Why do you want to be a nurse? How much time are you able to devote to studying and clinical hours? Describe a situation you felt challenged? Can you discuss some hot nursing topics? Check out this article for potential interview questions you can practice answering with a friend or family member. Be sure to research the school and program and have a few thoughtful questions ready to show you’re serious about nursing school. And finally, take a deep breathe and be yourself. If You Want to be a Nurse, Don’t Give Up Remember, you can always reapply. Take an honest look at your application for areas you could improve. Do you need volunteer hours or does you GPA need to come up? It may take a few tries or a bit more time to strengthen weak academic areas, but a degree in nursing is worth it. Do you have advice for a future nursing school applicant? Any words of encouragement? Additional Resources: Avoid These Common Nursing School Application Mistakes Common Mistakes on Nursing School Applications

In 2010, the U.S. Drug Enforcement Agency launched “National Prescription Drug Take Back Day” to remove unwanted, expired or unused prescription drugs from homes. The DEA has announced on the next Take Back Day, scheduled on October 26, 2019, vaping devices and cartridges will be accepted for the first time. Don’t Be the Dealer During the last Take Back Day in April 2019, the public turned in 469 tons of prescription drugs at more than 6,258 sites. Cleaning out and safe disposal of unused medications is necessary to safeguard our family and homes. Prescription drugs lying around in medicine cabinets, bedside tables and other common areas are at risk for abuse and potential overdose. Think about medications currently in your home and consider the following: Prescription and OTC drugs are the most commonly abused substances by Americans aged 14 and older after alcohol and marijuana Each day, more than 1,600 teens begin abusing prescription drugs Approximately 4 in 10 teens who misused a prescription drug report getting it from their parent’s medicine cabinet. Accidental Ingestion Leftover prescription drugs puts toddlers and children at risk of poisoning and overdose. Between 2001 and 2008, more than 450,000 cases of poisoning in children under 6 years old were reported to U.S. poison control centers. Of these reported cases, 95% involved ingestion of a prescription medication, resulting in 66 deaths. Vaping Products Accepted As of October 15th, the CDC has confirmed 33 deaths among 1,479 lung injuries linked to the use of e-cigarettes. Several states like Oregon, New York, Michigan and Washington have banned flavored e-cigarettes that target teens. A public health emergency has been declared by the governor of Massachusetts with a four month ban on the sale of all vaping products. To help in the fight against this public health threat, vaping devices and cartridges will be accepted on National Drug Prescription Take Back Day. The DEA has provided the following guidelines for submitting vaping products and substances for safe disposal: Vape pens and e-cigarette devices will only be accepted after batteries are removed. The collection sites will not be responsible for removing batteries from devices. If battery cannot be removed, check with large electronic chain stores to ask if they can accept the device for proper disposal. People dropping off vaping devices and liquids to participating sites will help take these products off the streets and away from children and teens. Find a Collection Site On Saturday, October 26th, more than 5,250 collection sites will be open from 10:00 am to 2:00 pm local time for drop-off. You can find a collection site near you by visiting www.DEATakeBack.com or by calling 800-882-9539. Safely Dispose All Year Round If a take-back site is not available in your area and disposal instructions are not provided on prescription drug labeling, the DEA provides guidelines for safe disposal in household trash. Remove the medicine from its original container and mix it with used coffee grounds, kitty litter or other undesirable substances. Place the mixture in a sealable bag, empty bag or container to prevent medicine from leaking or breaking out of a garbage bag. Scratch out all identifying information to protect your identity and privacy. Never share your prescription drugs. If no other disposal method is available, medication may be flushed down a sink or toilet. However, some communities may prohibit flushing out of concern for trace drug residues found in rivers, lakes and community water supplies. Also, only flush if the prescription drug labeling specifically instructs you to do so. For more information on the growing number of illnesses and deaths related to vaping, visit: CDC Information on E-Cigarettes Severe Lung Disease For more information on what you can do to prevent prescription drugs from falling into the wrong hands, visit these websites: United States Drug Enforcement Administration (DEA) Get Smart About Drugs: A DEA Resource For Parents, Educators, & Caregivers ThinkTwice Global Vaccine Unit For more information on safe disposal, visit: Disposal of Unused Medicine: What You Should Know DEA Allows the Return of Unused Medication to Pharmacies

Parents of tweens and teens are being warned about a new social media trend thought to be inspired by young celebrities. The trend of “sadfishing” is when someone makes an exaggerated claim about feeling down or emotional to draw sympathy and attention from others. Digital Awareness UK (DAUK) recently published a new report based on more than 50,000 face-to-face sessions with students ages 11 to 16. The interviews revealed “sadfishing” posts can backfire when someone is looking for genuine sympathy and peers accuse them of attention seeking. Sparked by Celebrities In early 2019, momager Kris Jenner tweeted that her daughter had a “huge” announcement and told followers to “prepare to be moved” by a “most raw story,'' adding #bethechange and #shareyourstory. Kendall Jenner later announced she would be partnering with a large company to promote acne treatment products, with the decision based on her own experience with acne. The Kardashian duo received backlash from Twitter users who viewed the announcement as over-hyped since most people can relate to acne. Even more recently, Justin Bieber shared with his 119 million Instagram followers that “it’s hard to get out of bed in the morning when you are overwhelmed with your life”. Bieber also received backlash and was accused of playing the sympathy card for attention. What are the Harmful Emotional Effects? Social media users frequently use the platform for seeking attention and over-sharing. We all have a social media follower or friend who regularly participates in sadfishing. However, the school environment can magnify the response of teen peers and cause further harm to those with emotional or mental health issues. Social media posts don’t provide us with verbal and nonverbal cues, therefore, it is difficult to know if a person is looking for support or if they are truly in crisis. Shoshana Bennett, PHD, a clinical psychologist in California, suggests thinking about previous posts to help determine if someone should be taking seriously. A sadfishing post that comes out of the blue from someone could be a sign they need help. However, any post that someone threatens to hurt themselves should be taken seriously. Cyber Grooming “Sadfishing” may open the door for cyber grooming and bullying. Cyber grooming is when a person, often an adult, befriends and builds an emotional relationship with a child online. The goal of cyber grooming is to build trust with the victim for later sexual abuse, exploitation or trafficking. Perpetrators may take on the fake identity of a child or teen and find victims on youth friendly websites. The relationship may start with general conversations about school and hobbies, and then progress into sexual conversations. Groomers are savvy. The report cites an example of a teenage girl who shared her experiences with depression online. Afterwards, she was asked by a much older man to send him explicit pictures of herself. How to Respond If you are concerned about someone’s post on social media, reach out in a private message or have a conversation with them. You can start by simply saying “I saw your post and I am concerned”. In the case of children and teens, reach out to a caregiver or school employee. It is also OK to encourage the friend to seek professional help. If you are truly concerned about someone’s safety, you can help them call 911, a suicide prevention line or go to the emergency department. The way NOT to respond is with a statement that minimizes the person’s experience, such as “It’s not so bad, just get over it”. To learn more about the sadfishing trend and available resources for help, visit the following: National Suicide Prevention Hotline- 800-273-8255 SAMHSA’s National Helpline- 800-662-HELP Sadfishing: What Parents Need to Know ChildSafeNet Cyber Grooming What do you think? Is "sadfishing" a true phenomenon or are "teens just being teens"?

Dr. Marty Makary, a surgeon at John Hopkins Hospital, became seriously concerned about widespread predatory billing practices that are eroding the public's trust in healthcare. In response, the best-selling author wrote the new book, “The Price We Pay: What Broke American Health Care- and How to Fix It” and is raising awareness around factors contributing to the problem. Let’s explore a few of the driving forces discussed in the book that are leading to higher healthcare costs and growing personal debt. A Growing Burden of Debt In his book, Makary identified 1 in 5 Americans as having unpaid medical debt. He also refers to a study by the Kaiser Family Foundation that revealed 70 percent of Americans have cut back on basic needs (i.e. food and clothing) in order to pay their medical expenses. The Kaiser study also found an eye-opening 58 percent of Americans take an extra job or work additional hours and 41% borrow money from family or friends to cover medical bills. Makary highlights a local hospital in Carlsbad, New Mexico that had a practice of hiking prices and then suing patients who were unable to pay. A Carlsbad county clerk reported the hospital cases accounted for 95 percent of the town’s lawsuits. And according to the book, this was not an isolated incident. Thirty-seven percent of U.S. hospitals filed over 20,000 lawsuits in 2017, including nonprofit and faith-based hospitals. Detached Hospital Administrators In the book, Makary reveals hospital administrators are often unaware their hospital is suing patients. In an interview with FierceHealthcare, he states, “I found sometimes hospital executives, board members and certainly our research supports doctors not knowing about this practice. And when they find out, the clinicians are outraged. By and large, Board members want it to stop…”. Healthcare experts have argued with Makary that “it was not a problem that was ‘diabolical’, they just weren’t proximate to the issue”. Makary further claims all the revenue generated from suing patients amounts to less than the amount of the CEO’s pay raise for one year, ultimately making the lawsuits unnecessary. Prospecting and Predatory Screening Visit any churches, community center or senior living facility and you will most likely find advertising for an on-site health fair offering a variety of “free screenings”. Makary submits these screenings are not always medical professionals serving the public, but rather, a way to “prospect” patients for further testing and unnecessary treatments. For example, a vascular screening fair is conducted and patients are “nudged” by the sponsoring physicians into further testing and ballooning, stenting and lasering of non threatening plaques in leg arteries. The sponsoring physicians then make large amounts of money from unnecessary tests and procedures while insurance companies and the rest of us are left with the costs. Bill Mark-Ups In the FierceHealthcare interview, Makary expresses concern for the decline of public trust due to hospitals marking up prices as high as 23 times than what is paid by Medicare. Hospitals also use software called “chargemaster” to automatically inflate prices toward a desired profit margin to compensate for charity care. However, according to Makary, the data does not support this assertion. Getting Rich in Healthcare In his book, Makary makes points out price markups in healthcare extend well-beyond the hospital and people are getting rich. For ambulance and helicopter services, markups can result in patients receiving an unexpected surprise bill. With three companies now owning 75 percent of these helicopters, Makray writes “wealthy business people” are taking advantage of Americans “when they are most vulnerable.'' But, there’s more. Based on early 2019 data, U.S. hospitals were on target to reach their highest margin in history while rural hospitals are closing. According to Makary, large hospitals use sophisticated cost-shifting to buy new buildings, pay down debt and increase executive pay with hospital profits. How Can We Fix Our Healthcare? Makary highlights the Free Market Medical Association (FMMA) and making medical costs transparent and fair regardless of who is paying as a move in the right direction. For example, the Surgery Center of Oklahoma is now offering one fair price, regardless of who is paying instead of other complicated pricing methods. What are your thoughts on the motives behind health fairs and free health screenings? Additional Information Free Market Medical Association Broken American Health Care: Good People, Bad System and Health Powers Disruptors

Co-worker conflict can be uncomfortable, casting a dark cloud over the workday. Anyone can have a bad day and it is often played out with irritability, raw emotions and thin patience. But, if a co-worker conflict is affecting your work or causing discontent, it is time to take positive action. Your first reaction may be to avoid the issue or escalate it up to your boss. But, with these 6 tips, you can begin to address the situation yourself. Approaching a co-work may feel awkward at first, but your confidence will build with practice and experience. Tip One: Take time to cool down and reflect. Engaging in conflict resolution with a co-worker when you are angry is the easiest way to shut down open communication. Anger takes away our ability to think and problem solve rationally. Walk away from the situation and take the time needed to cool off and reflect. Tip Two: Think about the problem. The old saying “there are two sides to every story” is true when you begin to reflect on both your own and your co-workers perspective of the problem. To explore your perspective, ask yourself: What is the conflict really about? What is it about the issue that has me upset and angry? Do I have underlying concerns, wants or needs that are not being met? What is needed to improve on my circumstances? To explore the other person's perspective, ask yourself: How might they see the situation? How might they view my actions? What needs might she/he have? What is important to the other person? Keep in mind that assumptions, misperceptions and unmet expectations is at the core of most conflict. Tip Three: Plan out the conversation. One strategy for not allowing your emotions to drive the interaction is to plan out the conversation. Start by removing the relationship you have with your co-worker from the equation and focus on the facts to better deliver the message. Practice describing the problem in a non-blaming and non-personalized way. Be sure to address the problem as mutual (our problem) and use “I” statements to communicate your perspective. Tip Four: Don’t gossip or vent to others. It is tempting to talk to other co-workers and seek validation that you are in the “right”. However, the person you are in conflict with may hear you are talking “behind their back” and escalate the situation. It is best to keep the matter confidential. Tip Four: Choose an appropriate time. Find a time (sooner than later) that is convenient to both you and your co-worker. Also, it is important to have the discussion in a private place with little to no interruptions. Tip Five: Communicate effectively. When you approach your co-worker, make your intentions clear, assuring them you want a good working relationship. Your colleague may initially become defensive and possibly assume you want to continue the disagreement. It helps to describe the problem without blaming, put downs and over-generalizations. Here are a few other tips for effective communication: If you feel you may have had a role in creating the conflict or regret how you handled the situation, sincerely apologize upfront. Ask the person to tell you how they see the situation before you share your grievances. This will help lower their defensiveness. Be ready to listen attentively to the other person’s concerns. You may not realize how you are contributing to the problem or how your behavior is being perceived. Having a face-to-face discussion with effective communication supports conflict resolution in the following ways: Gives the other person a chance to explain themselves Gives the other person a chance to apologize (when appropriate) Gives both of you an opportunity to understand how each views the working relationship Allows negotiation of ways to better work together Tip Six: Work toward a solution together Avoid focusing on who is right and who is wrong. Instead, work with the other person to identify possible solutions that work best, meeting the needs and wants of you both. This may take more than one meeting, so keep working at it. It is worth the effort in the long run. Tip Seven: Ask for help when needed. Sometimes co-workers are unable to resolve workplace conflict between themselves and the working relationship takes a toll on productivity. In this case, you will need to identify the proper channel, such as the supervisor, to further discuss the problem and move forward. Conclusion Working together to solve conflicts within the workplace could lead to a closer and more effective working relationship. Down the road, when you or your co-worker have a bad day, you will find yourselves committed to a better way of handling any conflict situations that arise. Let us hear from you! What do’s or don’ts do you have to share with readers? Want to learn more? Check out these additional resources Seven Steps for Mending Relationships With Colleagues How to Handle Conflict in the Workplace

Foot pain is no stranger to nurses and the pain caused by plantar fasciitis can be intense. In search of relief, we often try different styles and brands of shoes, specialty socks, wraps, tropical agents and more. But once you develop symptoms, it often seems like nothing will help. Fortunately, there are steps you can take to prevent, treat and ease the pain of plantar fasciitis. What is Plantar Fasciitis? The condition, often found in athletes (especially runners), is an overuse injury. It is also one of the most common causes of heel pain. Nurses are susceptible to the condition since they are on their feet much of a shift or workday. The plantar fascia is a thick sheet of connective tissue that runs across the bottom of your foot and connects your heel bone to your toes. Overuse causes small tears in plantar fascia leading to inflammation, pain and tenderness. What are the Symptoms? It is a familiar scene, Nurse Y is seen limping down the hall as she tries to keep weight off her painful heel. Let’s take a closer look at other common symptoms typical of plantar fasciitis: Heel pain and tenderness on the foot’s sole (bottom) Pain and difficulty bearing weight on the affected foot, especially few steps after waking Pain commonly described as burning, sharp and can be severe Warmth, swelling and/or tenderness at the bottom of foot and heel Pain after a few steps walking after sitting for extended periods Symptoms may come on gradually or acutely after activity You May be at Higher Risk In many cases, the reason a person develops plantar fasciitis is unknown. However, the following risk factors can make you more prone acquire the condition: Obesity Diabetes Female Gender Very high arch or flat feet New or increased activity Spending long periods of time on feet High impact activity (running, sports) Increasing age (decreases fascia flexibility and thins heel’s protective fat pad) Also, tight calf muscles, that make it difficult to flex the foot and bring toes up toward the shin, can increase your risk. How is Plantar Fasciitis Diagnosed? A diagnosis is usually made with a review of symptoms, health history and physical examination. Although imaging is not routinely needed for initial diagnosis, it may be used to rule out other heel conditions, such as bone damage or changes. Treatment May Be As Simple As R.I.N.E. There is good news in that 90% of plantar fasciitis cases will improve with conservative treatment, including: Rest This is difficult for nurses because of our job requirements. However, when possible, decrease activities where your feet pound on hard surfaces (i.e. running). Ice Rolling your foot over a cold water bottle or ice for 20 minutes will help ease the discomfort. This can be repeated 3-4 times a day. NSAIDs Medications such as ibuprofen or naproxen will help reduce pain and inflammation. Be sure to notify your primary doctor if NSAIDs are used consistently for more than 2 weeks. Exercise The most effective way to relieve the pain of plantar fasciitis is to stretch your calves and plantar fascia. Check out this link from Washington University Orthopedics for easy exercises to help you beat the pain. **Before beginning any home remedies, be sure to discuss your it with your primary physician. Are There Other Treatment Options? There are actually many other treatment and pain relief options available for plantar fasciitis, such as: Steroid injections Platelet rich plasma injections (PRP) Shock-wave therapy Tenex procedure Surgical interventions Physical therapy Splints Shoe inserts (the firmer, the better) Heel cups What Can Nurses do to Prevent Plantar Fasciitis? It would be unrealistic for nurses to significantly reduce the amount of walking and standing during a day’s work. However, there are a few lifestyle changes that could prevent the pain from returning. If overweight, lose weight to reduce the pressure placed on the bottom of your feet. Choose shoes with good support and replace your work and athletic shoes regularly Learn more from this Husson University article. Avoid going barefoot on hard surfaces Do low impact exercises and stretch out your calves and feet. Keep doing the leg and foot exercises found here. Bottom Line We have all heard the phrase “nurses make the worst patients”. In the case of plantar fasciitis, ignoring or masking the pain may make it worse and add further ligament strain. Podiatrists have proven that more than 90% of cases can be improved with conservative, at-home remedies. And, only in extreme cases will invasive treatment be necessary. So next time you say “oh my aching foot” take early action and avoid the intense pain of plantar fasciitis. Additional Resource American Academy of Orthopaedic Surgeons- Plantar Fasciitis and Bone Spurs

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