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LindaGracie ADN, BSN

geriatric, psychiatric/mental illness
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LindaGracie has 6 years experience as a ADN, BSN and specializes in geriatric, psychiatric/mental illness.

LindaGracie's Latest Activity

  1. LindaGracie

    COVID Vaccine: False sense of security or green light?

    I can relate to how your parents are feeling a sense of relief after getting the vaccine. I personally have some risk factors and work in home health but one of my client's family doesn't always take the precautions which puts all of us at risk. Also one of the aides had a positive COVID-19 test results which fortunately turned out to be a false positive because no one got COVID-19 and she had very close contact with the client and her agency didn't require her to wear a mask so she didn't wear a mask. I am convinced if she had COVID-19 the client and others in the family and other caregivers would of gotten COVID-19. During the late fall and Winter is when my asthma tends to be worse and yes, I was concerned about getting COVID-19. After getting to about 50% immunity (approximately 2 weeks after the first Pfizer dose) I noticed I wasn't as concerned about catching COVID-19. After getting the second dose I'm no longer concerned. I feel if I do catch it, it won't be a serious life threatening case. I have also worked hard in getting several family members who are in phase 1a scheduled for the vaccine and all but one has had the first dose and by the end of February they will receive the second dose. The one who hasn't had the vaccine yet is scheduled for 2/12 but he is retired and doesn't put himself at risk. So I am feeling better about my family members who have received the vaccine. My father-in-law has not really taken COVID-19 seriously but fortunately he has not caught COVID-19 yet but is physically healthy and active but is a week and a half out from his first dose so has some immunity now. My husband and I do wear masks while out and avoid large crowds and have remained healthy through out the pandemic. Even though yesterday I did wake up "fighting a bug" (sinus and fatigue related from working too much the past few weeks) which is better today but I'm not concerned that it is COVID-19. If I got these symptoms a month ago I would have been very concerned so I definitely feel the vaccine lowers the anxiety of getting COVID-19 so I personally recommend anyone who has concerns of catching COVID to get the vaccine as well as those with risk factors for complications.
  2. LindaGracie

    Depression. Despair. Suicide.

    That would be a HIPAA violation. A major law suit!!
  3. LindaGracie

    Suicidal thoughts every week before first shift

    Psychiatric nursing triggered a major depressive episode for me. It was a toxic work environment. (Yes, as a result I could understand emotionally what a suicidal person was feeling) I ended taking about 3-4 months off. I am coming out of the depression now, working for Bayada part-time and a home care agency as the nurse supervisor. There are small companies where the employer cares about the employees and also Bayada actually cares about their employees as well. You may want to consider other areas of nursing before getting out of nursing completely.
  4. I agree this would be the best solution. That way all nurses would be happy with their work hours. Thanks for sharing.
  5. RNsheal, Thank you so much for sharing this information. I think all nurses should check out what bills are in Congress. I know I plan to check this out.
  6. That was how I felt about Atrium Health when I worked there. That feeling lasted for about a year even after leaving the hospital. One year later when I drive or ride by the hospital I don't have the intense negative emotions stir up. It is sad that a job can be so stressful that it triggers such intense negative emotions. Have you thought about going into another area of nursing?
  7. LindaGracie

    15 Minutes in the Life of a Nurse

    When I worked in the hospital, I had this scenario occurred all the time but was constantly told I had to improve my time management. I would get frustrated because I didn't know how I was suppose to handle all of these things at the same time. Someone was always not happy. The sickle cell patient in sickle cell crisis was wanting her pain medication stat, the lab kept calling with several critical lab values, I had to administer the 8pm meds, complete the assessments, attend to beeping IV pumps, do hourly roundings, had an admission waiting to be admitted to the floor, a confused patient's family requesting to talk to the nurse, as well as my preceptor wanting me to document something or had a question. Still brings back some negative memories. Now I love my job working with one patient and family. True I am giving tube bolus feedings every 30 minutes but this is achievable because that is the only patient I am attending to. Less stress!
  8. LindaGracie

    15 Minutes in the Life of a Nurse

    I really like this idea! Saves the nurse time which can take 5-10 minutes or more of the nurse's time just to check/obtain the patient's VS, review the chart and contact the doctor which may become an issue of phone tag. The doctor can't really get upset with the lab because they are just reporting the lab value. True the doc wouldn't get the whole picture of the patient but he/she can check with the nurse on the floor or better yet, go check on the patient him/herself.
  9. LindaGracie

    RN in Medical School -Should I keep this to myself?

    I have learned there tends to be groups who are very supportive and inspired by someone furthering their education, there are groups who tend to be negative towards people pursuing their educational dreams (maybe because of perceived biases or negative experiences pertaining to school) and those who feel they have obtained enough schooling and see further schooling as a waste of time. Either way, stick with those who are encouraging and stay focused on pursuing your dream. Don't give up or let anyone discourage you.
  10. The nursing profession has evolved over the years which includes working conditions, duties, skills, educational and practice standards, technology, regulations and policies. Many of these changes occurred as the result of research and evidence-based practice. There has always been a focus on patient safety and decreasing and preventing medication errors. Research has shown working 12 hour shifts often effect nurses’ critical thinking, productivity and job satisfaction which impacts patient care and patient safety. This Article will discuss how the Lewin change model can be used to implement changes to the current practice of hospital staff nurses working 12 hour shifts. The primary people effected are hospital staff nurses, patients, nurse managers and nursing supervisors. What are Goals of the Change? Decrease nurse fatigue Optimize the nurse’s critical thinking Increase productivity Increase job satisfaction which will result in reduced rate of medication errors Improve quality of patient care According to Kearney-Nunnery (2016) Kurt Lewin’s change model consisted of three main components: unfreezing, moving, and refreezing. “To achieve change, the restraining forces must be weakened and the driving forces strengthened” (Kearney-Nunnery, 2016, p.183). Restraining forces are forces that resist change. Pertaining to the 12 hour shifts, restraining forces for nurses include ability to “work less hours and days, and potentially have an improved work/life balance” (Rollins, 2015, p.162), (Ball, Dall’Ora & Griffiths, 2015). Restraining forces for hospitals include paying less overtime, less dependency on agency nurses and scheduling coverage for only 2 shifts. Patients and families tend to like having the same nurse for the longer part of the day and “having fewer names and faces to remember” (Rollins, 2015, p. 162). Driving forces promote change and includes “desire for more novel, effective, efficient or merely different activities” (Kearney-Nunnery, 2016, p.183). There are several driving forces indicating the need for change. Nurses often work longer than the 12 hour shift (Scott, Rogers, Hwang & Zhang, 2006). A greater number of nurses working 12 hour shifts report burnout and plans to leave their job compared to nurses working 8 hour shifts (Rollins, 2015) and often work 2 or more 12 hour shifts in a roll. Nurses, especially older nurses-who are more experienced, report physical and emotional exhaustion after working 12 hour shifts, “aches and pains, sleep deprivation” (Rollins, 2015, p. 162). Overtime and working consecutive 12 hour shifts further increases the rate of fatigue and burnout which decreases patient satisfaction with the quality of care received (Stimpfel, 2012). Nurses also report poor quality of care provided, decreased patient safety and more duties left undone when working 12 hours or more (Ball et. al., 2015). According to Stimpfel, Sloane and Aiken (2012) when a greater number of “nurses working more than thirteen hours on their last shift, higher percentages of patients reported that they would not recommend the hospital to friends and family” (p. 2506). Also studies have shown working more than 12 hours increases the risk for medication errors (Scott, 2006), nurse burnout, job dissatisfaction and intention to leave the job (Stimpfel et. al. 2012, page 2504). How to Bring about Change Nurses and hospital administrators must review both research and their hospital’s collected data from patient surveys, circumstances surrounding medication error reports and patient safety and nurse/employee incident reports and complaints related to quality of care filed. Executive administrators must be willing to review the financial impact of the driving forces verses the financial benefits from the restraining forces over the past several years and be open to seeing future trends. This is the unfreezing stage of the Lewin change model. During the moving stage, “change objectives must be selected with consideration of activities for progressive change” (Kearney-Nunnery, 2016, p.185). “Organizations such as the Institute of Medicine and the American Nurses Association have made or supported recommendation to minimize fatigue and improve patient safety” (Rollins, 2015, p. 164). Nurses need food, hydration and proper rest in order to maintain optimal productivity (critical thinking, alertness, and providing quality nursing care and ensuring patient safety) on the job. As people advance in age, energy level and stamina decreases. Viable options for change include limiting overtime requirements, ensuring nurses receive uninterrupted breaks, making meal options available at all times, providing eight hour shifts as well as split shifts for nurses who want to work part-time (Geiger-Brown & Trinkoff, 2010). Nurses can work within organizations, such as the American Nurses Association to lobby for legislation to promote change. Nurses and nursing supervisors can work with hospital administrators in implementing and maintaining the changes. Over a period of time, staff and administrators will adjust to, get in the habit of and maintain (refreezing) the change. This will lead to improvements in nurses’ job performance and patient satisfaction. In summary, nursing has evolved over the years including the scheduling of work hours for the nurse. Twelve hour shifts has become popular with both nurses and hospital administrators but research has shown working 12 or more hours has adverse effects on the quality of nursing care provided, patient safety and patient satisfaction largely as well as nurse fatigue and burnout. The Lewin change model can be used to bring about changes to nurse schedules which positively impacts the nurse’s job performance and job satisfaction which increases patient safety and patient satisfaction. Effect of the 12 hour shift on patient care and the nurse.docx
  11. LindaGracie

    Fibromyalgia: How can the nurse help?

    Fibromyalgia is a condition which often effects more females than males however males can get fibromyalgia. In the past fibromyalgia was known as a “catch all” diagnosis since there were no conclusive tests for fibromyalgia. It was once a frustrating diagnosis because many people did not consider it a valid diagnosis and thought it was “all in the head”. This is essentially true among other locations throughout the body but not in the sense “all in your head” was meant to mean. It is not a psychosomatic condition that the person makes up to get sympathy, attention seeking behavior or avoiding dealing with life issues. It is in the head in the sense the brain emits alpha waves in deep sleep, the brain interprets increased level of pain, the brain neurons signals do not travel along the synapses in the “normal” fashion resulting in the neurological and cognitive symptoms. Tender points throughout the various parts of the body receives excess blood supply (in a similar fashion that occur in migraines) resulting in increased pain at the trigger point traveling to other parts of the body. Fibromyalgia can be an emotionally draining and frustrating condition in the sense that the patient may not be able to perform physically and cognitively prior to developing the condition. This can lead to the grieving process and can even lead to depressive symptoms. The patient may become socially isolated due to physical and cognitive limitations as well as due to depressive symptoms. The patient may feel no one understands what she/he is going through. This then can cause tension and stain in social and family relationships. What is Fibromyalgia? Fibromyalgia (FM) is often a disabling condition which causes widespread chronic pain and increased fatigue. Other symptoms include difficulty with memory and concentration and mental cloudiness which is often referred by FM patients as “fibro fog”. The pain is often characterized as generalized aching, widespread tenderness of muscles, areas around tendon insertion sites (tender points), muscle stiffness, poor or unrefreshing sleep (likely due to intrusion of alpha waves in the delta waves) and thought to be triggered by extreme or chronic level of physical and/or psychological stress. Stress including physical or emotional trauma, poor sleep, cold or damp weather and being around chronic negativity from family, friends or coworkers can lead to exacerbations of symptoms. Other common comorbid conditions include irritable bowel syndrome, interstitial cystitis, headaches (tension or migraine) and paresthesias (Biundo). Depression and anxiety have also been linked to FM and the cause of FM is still unknown (Capriotti & Frizzell). Diagnosis Physical examination is unremarkable except that specific, discrete areas of muscle (tender points) often are tender when palpated. The tender areas are not swollen, red, or warm; such findings should suggest an alternative diagnosis. Diagnosis is clinical based on the patient’s medical history and symptoms. Treatment includes gentle exercise such as yoga, local heat, stress management, drugs to improve sleep, and non-opioid analgesics. How can we help? What can the nurse do? The nurse needs to include in the nursing assessment such things as asking the patient regarding rating the level of pain, description of pain, location and how long the pain has been present. The nurse can ask the patient of precipitating factors that causes an increase in pain and other associated symptoms. Trigger points at the base of the skull, around the neck and shoulders, around the side of the elbow, upper outer buttocks, hip and medial side of knees can be palpated for pain (Capriotti & Frizzell, 2016). The nurse will need to assess the quality of sleep, stress level, and coping skills. The nurse needs to be empathetic, not judgmental, in approaching the patient (and even discussing the patient or condition with coworkers). The nurse will greatly benefit from learning about fibromyalgia and current research being done. The nurse should become familiar with local and online support groups so the nurse can provide this information to the patient as a means of increasing emotional support for the patient. References Biundo, J. J., (2018). Fibromyalgia: Myofascial pain syndrome; fibrositis; fibromyositis. Merck Manual Professional Version Capriotti, T. & Frizzell, J. P. (2016). Pain. In Capriotti, T. & Frizzell (Eds.), Pathophysiology: introductory concepts and clinical perspectives (pp. 93-113). Philidelphia, PA: F. A. Davis
  12. The purpose of this article is to address concerns related to the time frame allowed to administer the medications at skilled nursing facilities and the number of medication errors, especially ‘wrong time’ errors due to the apparently impossible task of being able to administer all of the medications, tube feedings, complete glucose and blood pressure checks and obtaining "missing meds" that have not been restocked on the med cart prior to the start of the shift. What is the discrepancy? There is a discrepancy between how medication administration should be completed and how nurses actually complete the medication administration especially during heavy peak times during the morning and evening medication pass. This article addresses the concern related to the time frame allowed to administer the medications at many skilled nursing facilities (SNFs) and the number of medication errors, especially ‘wrong time’ errors. Typical patient load is 20-22 patients. Most residents receive 10-20 medications and supplements during the morning medication administration time which includes tube feedings, intravenous (IV) antibiotics, breathing treatments, eye drops, and preparing crushed medications ordered to be administered at 8:00 am with a window from 7:00 am to 9:00 am. This seems to be an unrealistic task to complete. The most frequent medication error, research has shown, is wrong-time administration (Stokowski, 2012). The Institute of Medicine (IOM) report “To Err is human: Building a safer health system” (1999) points out the high number of medical errors resulting in death, disability, financial costs, and loss of trust of the healthcare system. The report points out the fact that humans will make unintentional mistakes but most errors are caused by the healthcare “faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them (Institute of Medicine, 1999). The IOM report indicates that the healthcare system needs to change and put in place systems that will reduce risks for errors and promote learning from mistakes to prevent repeats of the same mistake rather than taking disciplinary measures (IOM, 1999). The IOM report outlines several strategies to promote safer health care. As a result of the IOM recommendations, the Center for Patent Safety was created within the Agency for Healthcare Research and Quality (AHRQ) and has created the Patient Safety Network (PSN) website which includes various resources pertaining to patient safety issues. Healthcare educators and management are now promoting the importance of identifying and learning from mistakes. Each state has mandatory reporting systems which holds healthcare organizations and providers responsible for resolving and preventing errors. The mandatory reporting system covers errors resulting in death or serious injury. A voluntary reporting system covers errors that causes minimal or no harm. The IOM report recommends raising performance standards and expectations in safety, and implementing safety systems such as scanning medications (IOM, 1990). Mahmood, Chadhury, and Gaumont (2009) study focused on factors contributing to medication administration errors in long-term care facilities. Mahmood et al. (2009) found limited research on medication errors in nursing home patients but identified several factors contributing to medication administration errors. Dim lighting, excessive noise, poorly designed work space, inadequate supplies, disorganized medication storage, distractions and interruptions, and heavy workloads due to staff shortages and turnover are factors that contribute to increased medication errors during medication passes. One study (Szczepura, Wild, & Nelson, 2011) concluded a high rate of medication administration errors occur in long-term residential care. One study (Roth & Wieck, 2015) concluded that nurses are frequently interrupted while administering medications. Many nurses may claim the ability and mastery of being able to multi-task, humans are not able to focus on multiple things at once and perform accurately (National Research Council, 2010). Quality Improvement Process The Plan-Do-Study-Act (PDSA) methodology is a scientific method for bringing about improvement by testing out changes on a small scale which is for action-oriented learning. Changes and modifications can be easily made in the procedure being tested among the small group of research participants. Key questions of the PDSA includes the following questions. “What are we trying to accomplish? How will we know if the change is an improvement? What changes can we make that will result in improvement?” (Institute for Healthcare Improvement, 2019, para. 1). PDSA involves testing a change “by planning it, trying it, observing the results, and acting on what is learned” (Institute for Healthcare Improvement, 2019, para.1). The nurse will use the PDSA method with the goal of decreasing medication wrong-time error and advocate for improvement in medication administration and decrease medication errors occurring at the skilled nursing facility. Plan The plan involved making observations of how nurses at a SNF administered the morning medications, observing times on and off the drug cart, and interviewing nurses on drug administration strategies and length of time to complete medication administration during morning and evening medication pass. Researching current literature on medication administration, medication administration errors, and medication errors in SNFs. The plan was to learn what the common medication errors were and ways to complete the medication pass within the allotted time to avoid wrong-time errors. Studies shown that wrong time medication errors is the most common error made (Patient Safety Network, 2019). Medication “errors may be the result of individual-level slips and lapses, but may also result from system-level failures such as understaffing, human factors problems (e.g., poor process or equipment design), and other latent conditions” (Patient Safety Network, 2019, para. 2). Slips results from temporary lapses in memory during a task-oriented job duty, this could be caused by an interruption, stress, fatigue, or just a plain ‘brain glitch’ which everyone experiences on occasion. Latent conditions refer to faulty systems that leads to mistakes such as having various types of infusion pumps which operates differently causing increased likelihood of an error in programing by the nurse since each pump is programed differently. Other literature reviews reported similar findings which were discussed above. Stokowski (2012) found about two-thirds of medication errors are wrong-time administration and nurses tend not to report medication administration errors, especially wrong-time errors that doesn’t result in patient harm. Observations and results of informal interviews revealed similar and interesting results. Common medication errors include medications and/or supplements not being administered but being documented as administered and most nurses reported inability to complete medication administration within the two hour window. One nurse was observed to complete the medication pass within the allotted time frame. The assistant director of nursing claimed she completed the medication pass within the allotted time on a consistent basis taking short cuts such as bringing both patients medications into the room at the same time with each medication cup clearly marked and relying off of memory when pouring meds. Barnsteiner (2017) reported that avoiding reliance on memory and having computer systems that are user-friendly are important in decreasing risk for errors and increasing patient safety. Most nurses took three and a half hours or longer to complete the medication pass which resulted in 90 minutes or longer where medications were administered outside of the time frame. Frequent ‘holes’ in the paper medication administration record (MAR) where nurses did not initial documenting the medication was administered. The SNF had no electronic MAR (e-MAR) system. Patients with no noticeable cognitive deficits have reported not receiving certain medications or supplements. There were missing medication packets not found in the drug cart nor stored in the refrigerator. The financial impact of these issues includes insurance savings of medications that should have been ordered that were not. There are financial costs related to nurses working over-time to complete duties not completed during the shift, such as charting. There may be financial loss related to lawsuits pertaining to adverse effects from medications not being administered or being administered late. There are no budgetary expenses related to this PDSA research. The goal after collecting the data was to complete the medication administration within the allotted time by utilizing strategies learned including decreasing interruptions and bringing both medications to the patients in the same room when possible. Sometimes this was not feasible if one patient receives insulin injections, eye drops, Miralax, inhalers, and approximately 20 medications and supplements during the morning med pass. Nebulizer breathing treatments were started first thing in the morning before certified nursing assistants (CNAs) got these residents up and took them to the dining/activity room for the day. Daily medication packets were marked indicating the time for administration occurring later in the day (ex. Lasix given at 4pm daily). Do These steps have been implemented. Staff were informed not to interrupt nurses during medication administration except for emergencies. Patients were informed and reminded their non-drug related or non-critical needs will be addressed either after the medication pass or by their CNA. Evidence-based practice confirms limiting interruptions during peak times of medication administration decreases medication administration errors (Westbrook, Li, Hooper, Raban, Middleton & Lehnbom, 2017). Daily medications scheduled outside of the morning med pass were marked on the packet with the scheduled administration time. Medication was poured for both roommates and marked when the amount of medications can be easily carried into the patients’ rooms at the same time. Management was informed about the medications not received from pharmacy and plan to retrain nurses to order the medications per facility policy and will monitor pharmacy issues and address issues caused by pharmacy. Management now is limiting rotation of nurses to two units (two drug carts) to increase consistency and familiarity with only two drug carts. Study According to one study (Jones, Johnstone, & Duke, 2016) nurses reported cutting corners to “manage their time and workload in the presence of resources and time constraints in busy and demanding clinical environments” and was justified due to limited time because “the nurse could not ‘physically get there’ to provide care that was perceived as being ‘ideal’ in the particular circumstances” (p. 2129). Jones, et al. (2016) reported that experienced nurses using critical thinking know which corners can be cut safely but novice nurses do not know due to lack of experience. Jones, et al. (2016) found “examples where nurses omitted steps in established processes for checking and documenting medications because this represented the only way to ‘get things done’ and achieve the goal of timely medication administration” (p. 2131). Experienced nurses were often observed as cutting corners by not ordering or following up on missing medications. The author reduced the time of medication administration but continues to find medications missing requiring time to search for the medication, contact pharmacy/place order, and documenting and obtaining the missing med dose from the emergency kit (E-kit) which kept on another unit. Since most of the patients receive numerous medications, taking both patients’ medications into the room at the same time has not been effective during the morning pass. This has been useful during other med passes where there is less medications to administer per patient. Successful completion of the medication pass, in the opinion of the author, will occur per policy protocol and evidence-based practice within the allotted time frame. The patient will receive all medications ordered including scheduled supplements. Medications ordered will be available on the cart or stored in the refrigerator, if indicated, at all times. All MARs will be properly documented with no ‘holes’. Act Continued research utilizing the PDSA method is still indicated. The time to administer the medications has not been cut down to the two hour window with the strategies discussed, therefore is not advised to expand to other clinical areas. Corporate plan to install e-MAR system by the end of 2019. Management report morning medication administration times will be changed from 8:00am to staggered times between 8:00am to 10:00am. This will expand the administration time to complete the medication pass from two hours to four hours. This will dramatically cut down on the wrong-time medication errors. Conclusion There are concerns if the current nurse-patient ratio, patients’ level of acuity, and number of medications to be administered makes it feasible for nurses to administer medications during peak medication passes within the allotted time. Many nurses take short cuts in order to complete tasks and meet job demands within the acceptable time frame (Jones, et al., 2016). Nursing programs and professional organizations advocate and promote evidenced-based practice, promoting improvement in health care quality, and patient safety (QSEN, 2019). Healthcare is evolving with focused research on patient safety. More research and collaboration among all stakeholders is needed to merge what is taught as the correct way with what is occurring in the ‘real world’ clinical setting. References Barnsteiner, J., (2017) Safety. In G. Sherwood & J. Barnsteiner (Eds.), Quality and Safety in Nursing: A Competency Approach to Improving Outcomes (2nd ed.). (pp.153-171), Hoboken, NJ: John Wiley & Sons, Inc. Institute for Healthcare Improvement. (2019). How to improve. Retrieved from http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementTestingChanges .aspx Institute of Medicine (1999, November). To err is human: Building a safer health system. Retrieved from http://www.nationalacademies.org/hmd/~/media/Files/Report Files/1999/To-Err-is-Human/To%20Err%20is%20Human%201999%20%20report%20brief.pdf Jones, A., Johnstone, M. J., & Duke, M. (2016). Recognising and responding to ‘cutting corners' when providing nursing care: A qualitative study. Journal of Clinical Nursing, 25, 2126-2133. Mahmood, A., Chaudhury, H., & Gaumont, A. (2009). Environmental issues related to medication errors in long-term care: Lessons from the literature. Health Environments Research & Design Journal, 2(2), 42-59.
  13. LindaGracie

    Depression and Nursing

    It's a shame that nurses "eat their young" and many have little compassion for other nurses who are hurting. Actually I found a company doing private duty nursing who's logo is "Led by Our Hearts". They provide patient care in the patient's home (private duty). I go for orientation tomorrow. They say they are very flexible with scheduling. You can work as much or a little as you want.. They seem to have the compassion for their staff and even have high ratings on indeed and glass door. You may want to check out Bayada. I know I was contemplating applying for SSDI due to the problems I was having with my last 3 jobs since 7/2018.
  14. LindaGracie

    Can We Talk About Nurse Suicide?

    It is sad that nursing (and much of the corporate work culture) has became so demeaning and demanding. The story of Solomon's son who did not take the counsel of the wise advisors but took the advise of the foolish ones and made things worse for Israel to the point the majority of the nation split off from his rule. Too many good nurses seem to be struggling emotionally from the emotionally abusive/high stress jobs. People can only take so much. I think nurses really do need to unite to make positive changes.
  15. LindaGracie

    Depression and Nursing

    Reading the Article by Nurse Beth, "Can We Talk About Nurse Suicide", prompted me to share my own personal experience and perspective on depression's effect on the nurse. I personally believe that the fast paced, high work demands, and nurses' "eating their young", and corporate culture of making more money by requiring employees to do more with less staff, are major contributors to nurse burnout, depression, and other negative emotional and behavioral elements seen in many healthcare facilities and healthcare systems. This also contributes to lower morale among healthcare systems, nurses and other healthcare workers leaving healthcare and shortages within the healthcare system. The Depressed Nurse and Stress Unfortunately, when nurses are depressed their ability to use their executive processing skills decrease significantly under times of stress. This adversely affects nursing and critical thinking as well as processing speed. A newly hired depressed nurse may feel she/he has to "do it all" because otherwise she/he is told you're not utilizing time well or has poor time management. Often nurses do not recognize depression in fellow nurses, especially management, and the depressed nurse doesn't feel comfortable disclosing the depression because "it isn't that bad" and fear of being rejected. This is further enforced by nurses who engage in bullying behaviors such as incivility (talking with an irritated tone of voice-directed to a specific nurse while talking professionally or friendly towards other nurses, criticizing the nurse, making unrealistic demands of the nurse, not communicating needed information, etc.) The depressed nurse may feel "different" because she/he isn't as "successful" as she/he wants to be and lose self-confidence. However, a depressed or tenderhearted nurse tends to be much more empathetic and sensitive to the patients' feelings and needs. Unfortunately, "the corporate world" sees no value in employees with depression or any mental illness because the nurse does not meet the performance requirements of the job. The nurse's ability to work in a fast-paced environment and being able to quickly make the correct decision while multi-tasking is adversely affected. Much research has also shown that high levels of stress and fatigue increases errors in medication administration. Add the effects of depression on top of this, one can understand how the depressed nurse is even more prone to mistakes. Healthcare leaders and policymakers need to understand that most nurses cannot function optimally under the high stress and demands within many healthcare systems. Creativity and employee loyalty are decreased under these conditions. Employers, management, staff nurses and other coworkers need to recognize distress in the nurse (or any staff member) and offer ongoing help and support rather than "getting rid" of the "problem employee". All healthcare providers, leaders, managers and most nurses will agree that being thorough, advocating for the patient, and being there for the patient is the right thing to do. They will agree that having empathy, having a caring heart, and doing things the right way is good however this is considered “the ideal” but not realistic in the fast-paced hospital environment today. These are qualities that a nurse living with depression may often have. The nurse knows what it is like dealing with some type of major emotional loss and can empathize with the patient who may be struggling with a life-altering experience. The nurse with depression is aware of how one’s attitude and actions affect others and also may try to be a “people pleaser”. The nurse with depression often strives to provide the quality and type of care he/she would want to receive following the Golden Rule. This often takes extra time to accomplish, sometimes resulting in delays in completing non-essential tasks which still needs to be completed by the end of the shift. The nurse that is fast, “efficient” and completes the “tasks” on time is the one who is often rewarded. However, the nurse with depression does not have fast information processing speed as a result of the depression or maybe even related to other underlying cognitive challenges. The nurse also takes longer to make decisions and often struggles with criticism and harsh tones often used by people under stressful conditions. Spiraling Depression Management and most coworkers are understanding of temporary “breakdowns” of a nurse as evidenced by crying, nervousness, or having to step off the unit for a few minutes. They may even be understanding if the nurse had a very recent personal loss. However, often times the nurse is expected to “pull it together” within a few days or may even be allowed a week to get back for full capacity. If the nurse is unable to “perform” to the corporate set expectations, management will begin focusing on mistakes made by the nurse, take a disciplinary approach, and likely look for reasons to terminate the nurse’s employment resulting in even increased depression, feelings of betrayal, decreased morale among remaining employees, and leaving the depressed nurse questioning his/her purpose as a nurse. This could even down spiral to a severe depressive episode. This then leads to Nurse Beth’s article "Can We Talk About Nurse Suicide". What are your experiences with fellow nurses struggling with depression? What was the employer's response? 
  16. LindaGracie

    Can We Talk About Nurse Suicide?

    This is so true!!!! I experienced moral distress while finishing up last clinical rotation at a local hospital in my ADN program. My preceptor had entered another RN's initial's as a witness for insulin administration and said "We have to just trust one another". She did not get another RN to witness nor had me to witness. She indicated this as acceptable practice due to limited time frame and high demands of the job. We were taught in nursing school and Davis' Drug Reference book also labeled insulin as requiring 2 RN witnesses. I think nurses (or anyone) who struggle with dysthymia or depression are more prone to PTSD, second victim syndrome, burnout, compassion fatigue as well as anxiety and other emotional struggles. Unfortunately when we are depressed our ability to use our executive thinking skills decrease significantly under times of stress. We feel we have to "do it all" because otherwise we are told we're not utilizing time well or have poor time management. Often nurses do not recognize depression in fellow nurses, especially management, and the depressed nurse doesn't feel comfortable disclosing the depression because "it isn't that bad". We may feel "different" because we aren't as "successful" as we feel we could be and lose self confidence. However a depressed or tenderhearted nurse tends to be much more empathetic and more sensitive to the patients' feelings and needs. Unfortunately "the corporate world" sees no value in employees with depression or any mental illness which slows down the employee's ability to work in a fast pace environment and quickly multi-task while making the correct decision. I can emotionally understand why Kim took her own life. She couldn't live with the emotional pain anymore and did not get the emotional support from her employer but likely lost her job, faced a lawsuit, faced a possible involuntary manslaughter charge and lost her license. She may not of had the emotional support outside of her job due to family and friends not fully feeling comfortable or knowing what to do or say. Kim likely became even more depressed and saw her life as totally ruined and no longer a respectable nurse, women (wife, mother-if she was married or had children). Not all nurses (or anyone) who are depressed commit suicide but may feel they don't care if the Lord takes them home (have no desire to keep on living because of such a strong sense of loss. If employers, management, staff nurses and other coworkers recognized distress in an employee (nurse or any staff member) and offered ongoing help and support rather than "getting rid" of the "problem employee" this would decrease the number of suicides and other workplace violence among employees.