peblevins

Shaniece, If you stick with it, all your skills and knowledge will return. I went from hospital bedside nursing (for 24 years) to a nurse in a mental health practice (for 6 years)-enough time to bury my clinical expertise. Now I work in a nursing home. WoW! After 1 1/2 years there, it's returning. I can totally relate.

LaZarca, This must have been very difficult for you to share. It means a lot. Yes you are invaluable! You are so right in saying that these issues should have been addressed decades ago. Many years ago, I worked on the floor with a nurse who applied for and was given the administrative job of ensuring patient satisfaction, attending to pt. complaints, helping patients with advanced directives etc. I caught up with her after a few meetings with administration and asked how they respond to suggestions/complaints of nurses and she said that the CEO responded "nurses will always complain". I felt totally dejected and realized then there would be no help from them and it was up to me to decide when I had enough.

Recently I was looking for information on the effects of the pandemic on those with mental health disorders. MULTIPLE articles referred to a mental health crisis among nurses leading to an increase in suicides. A short time later, I learned of the suicide of a nurse in California. I was shaken with a jolt in trying to accept this reality. This article contains some of what I learned about nurse suicide. Raising Nurse Suicide Awareness Many nurses would attest that their decision to become a nurse was a calling. In other words, their conscience led them to the profession to be healers and to define success as knowing another life has breathed easier due to their efforts. (Thoreau). With experience, although, Nurses are transitioned from this altruistic mindset to feelings of hopelessness due to suffering from years of burnout. Burnout and being stressed to the brink led to psychological distress and mental health problems such as anxiety disorders, depression, substance abuse and suicidality.1 Then the COVID-19 pandemic hit. What exactly do nurses experience? Moral injury is the name given to the feelings of guilt, shame, betrayal, and loss of trust that nurses develop as a result of working in prolonged stressful conditions. It is derived from the extenuating situations that are repeated in a crisis that cause a sense of powerlessness. Some of these situations might involve deciding who gets triaged first, allocating resources, witnessing death that they feel didn’t need to happen, having to follow unfair policies, and feeling guilty about surviving or potentially infecting others.2 A Tragic Example On January 18, 2022, Michael O'Dell BSN, RN left his shift early. He was working the night shift at Stanford Hospital in San Francisco, California, and told his co-workers he had to get something from his car. He never returned. Two days later his body was found and the suspected cause of death was suicide. In an online article by Stat Health by Andrew Joseph, it was revealed that Michael had made earlier facebook post warnings of “the deleterious effects of the pandemic on all healthcare workers navigating it”. The article mentioned that his GoFundMe page has numerous posts of current and retired nurses who have shared his hopelessness and depression due to their careers.3 What is the Nurse Suicide Rate? It’s reported that the suicide rate of nurses is greater than the general population but finding actual statistics is difficult. An article written in 2018 entitled, “Nurse Suicide Breaking the Silence”, identified that there weren’t any statistics for the death of nurses by suicide although there were easily attainable rates for physicians, educators, police officers, and military officers. Writers of the article learned that there is a lack of standardized reporting of death by suicide. The article explained that the Centers for Disease Control (CDC) maintains a National Violent Death Reporting System which is the most comprehensive death registry by suicide by occupation. This database is available only by application. At the time that the article was written, the authors had submitted an application to gain access.4 What can be done? There can’t be more urgency to develop ways to support nurses and other clinicians who have been on the frontline. Multiple articles point out the deleterious effects of the pandemic on this vulnerable population. Development of a program similar to the World Trade Center Health Program which provides monitoring and treatment for responders and survivors.1 The National Academy of Medicine’s Action Collaborative on Clinician Wellbeing and Resilience offers resources to support well-being-focused programs across sectors.1 Nurse suicide prevention starts with crisis intervention. This gives access to an article by Judy E. Davidson et al that provides an enormous amount of information including why nurses are at risk, identifying symptoms of depression, resources, crisis management, how to communicate, and more. Replicating the Healer Education Assessment and Referral Program (HEAR) program for nurses. It was created to address the suicide of physicians. It has been endorsed by the AMA as best practice.5 Some Good News The U.S. suicide Hotline-988- is set to go live in July 2022. President Biden’s physical year 2023 budget includes $51.7 billion in new mandatory investments over the next ten years to expand access to mental health services References 1Preventing a Parallel Pandemic - A National Strategy to Protect Clinicians’ Well-Being 2U.S Department of Veteran's Affairs: PTSD: National Center for PTSD 3‘I fear the long-term effects’: Before his death, a nurse warned of the pandemic’s toll on health care workers 4National Academy of Medicine: Nurse Suicide Breaking the Silence 5How one program may help prevent suicide in nurses

Kudos to you for doing what you knew was right as the doctor chose to believe a different story. A lot can change in 24 hours! In that setting, with your thorough charting, no one would have faulted you. And as a pulse of 90%=P02 of 60%, there wasn't time to waste. When I worked the floor and had an elderly client who was DNR and declining I would discuss with the patient, as long as she is alert, what were her wishes regarding resuscitation, ventilator etc. Although on night shift, there's usually not enough staff to allow for this depth of conversation and there is some value in waiting until the light of day when fresher heads prevail. Whenever you feel uncertain/anxious about a patient, I always found it helpful to make sure, of course that the charge nurse was aware and even the nurse supervisor. I think you did great!

I've learned that working in community/home health involves greater chance of using nursing judgement. There's situations that would make nursing judgement safer in a particular instance. Time of day of decision is a factor as doctor's offices are usually open only until 5 and of course not on weekends. If a nurse feels it best and safest for the patient to invoke her discretion over doctor's order, first she should chart thoroughly. At the first opportunity, the nurse should notify the doctor. We are on a slippery slope when practicing out of our scope. We must not allow ourselves to practice this way, convenience be-damned. We would be damaging the nursing profession and potentially putting the patient at risk. It seems reasonable that an agency would have protocols/policies addressing this type of situation.

In spite of the gravity of the pandemic, the unvaccinated continue to hold a strong conviction that it is not the right decision for them. As of May 2021, 37% of the US had not received one vaccine despite it being available and accessible1. For them, their belief is as strong and ironclad as those who were first in line to be vaccinated. Factors including their particular unease regarding the vaccine, increased exposure to the disinformation of social media, and sense of distrust in institutions of the United States have swayed their perception. The idea of persuading them with facts and scare tactics has not been successful. Nurses are the ideal source to empathize, utilize communication skills to educate and evoke a person’s awareness that getting the vaccine is the best way to end the pandemic2. Information Sources Are Changing in the United States A large number of Americans are increasingly turning to social media sites for their news despite the criticism of the sites posting disinformation. It is interesting to note that the idea of vaccine hesitancy being fueled by social media began before COVID-19 due to the resurgence of vaccine preventable diseases. According to an article posted in USA Today by Heidi Legg3 on May 4, 2021, there is a lack of trust in mainstream media. She writes that the media which was once considered a pillar of democracy has become elitist, biased, opinionated, and fails to report all the news. She reports that there is no transparency in funding and Americans need to know who is feeding them the news3. Social media is not subject to scientific vetting or journalistic integrity. Social media is characterized by personal opinion and experience. It also has the potential to reach large audiences and disseminate information rapidly4. Studies found that anti-vaccine tweets were 4 –fold more likely to be re-tweeted than neutral tweets. Another study that analyzed 150 Instagram posts found that anti-vaccine posts had a significantly higher number of likes. Another study examined the role of non-human users. “Bots” are accounts that generate automated content and “trolls” misrepresent their identity and attempt to create conflict. Twitter uses a higher amount of bot accounts. The study determined that Twitter accounts ranked at a high likelihood of being automated bots posted significantly more COVID-19 related tweets than non-bot accounts4. In addition, researchers found that within social media use, algorithms feed content based on the input of users. The user is fed with content derived from their browsing history which gradually became further and further from the truth. Information silos are the result. Experts interviewed stated that this phenomenon has happened to highly educated people5. Examining The State Of Mind Of The Unvaccinated. Heidi Larson of the Vaccine Confidence project is an expert on vaccine hesitancy. She offers that we should no longer focus on misinformation alone but regard it as a symptom of distrust. She offers that the pandemic has brought to the forefront anxieties, anger, and fears that Americans have been harboring. Mandates and mitigation efforts were bringing to life the fears of government control, pharmaceutical mismanagement and greed, scientific misconduct, and the bias of the media as well as feelings of not being heard. She gives the recent recession, opioid crisis, defunct Congress as real events that fed the distrust. She suggests allowing those who refuse to be vaccinated to speak and be heard6. A CBS documentary presented on 9/23/2021 described a phenomenon that occurred in a yoga and wellness community just after the beginning of the pandemic. It connects mindset to social media and vice versa. This community is known to be anti-science, anti-authority and seeks non-traditional treatment methods. Those interviewed were afraid of tyranny suggested by mask wearing which they saw as symbolism for silencing people and as they turned to social media to declare their discontent; anti-vaxers joined the discussions. The documentary pointed out that this community became a hot bed for spreading disinformation5. What can nurses do to change the disinformation on social media? Begin disseminating messages on personal social media platforms Direct consumers to the CDC social media downloadable apps to provide users with access to credible, science-based health information when, where, and how they want it. (CDC facebook, Twitter, Instagram, LinkedIn) Encourage nursing professional organizations to take a stand on combatting disinformation about the virus on social media. Learn to equip society with the skills to discern between evidence-based and reliable and misleading or information. Direct consumers to websites of the CDC, the Immunization Action Coalition, Vaccinate your Family and the Mayo Clinic Consult the CDC Guide to Writing for social media What can nurses do to change the mindset of the unvaccinated? Communication is key. Use gain-framed messages that emphasize the benefits of adopting a recommended behavior. Offer novel information about the disease such as describing the longer-lasting and debilitating health problems Appeal to altruism and prosocial behavior by stating the consumer is also protecting his community When correcting misperception about the virus-first affirm their unease, give an explanation as to why disinformation was presented and give factual information Recognize that one size does not fit all in vaccine promoting. Consider the emotional states of different audiences in communication efforts. Learning the technique of Motivational Interviewing-a communication framework that guides a person to identify their insecurities, be open to information then accept the information on their own terms. Resources Considering Emotion in COVID-19 Vaccine Communication: Addressing Vaccine Hesitancy and Fostering Vaccine Confidence References 1COVID Data Tracker 2Using Best Practices to Address COVID-19 Vaccine Hesitancy: The Case for the Motivational Interviewing Approach 3Have you heard the news? But who owns what you're hearing and reading? We need to know. 4Social media and vaccine hesitancy: new updates for the era of COVID-19 and globalized infectious diseases 5How conspiracy theories "infiltrated" the wellness community 6Trust in Vaccines (includes Heidi Larson)

I agree with all of these tips. When doing clinicals in nursing school, I witnessed the "nurses eat their young" adage. Then I was lucky enough to have clinicals at a small community hospital that was app. 45 minutes from where I lived. The nurses there were supportive and it was a different environment all together. They laughed! I made my decision then and there, despite the drive, that I would apply there. I did and was hired and worked there for 23 years. Wanted to add to idea about approaching your nurse manager. I've learned over and over that you will earn more respect if you attempt to address the problem/person/situation yourself first. And if the problem still exists, yes -report it to your NM but yes-be prepared!

As I watched the spread of COVID-19 across Asia and Europe in late 2019, I recall a sense of shock and disbelief but held on to a sense of hope that the effects on the U.S would somehow be less severe. I recalled the twenty-three years that I worked in a hospital and the effects of an airborne isolation patient on the nursing units. I currently work at a community mental health center. Although I am an essential worker, anything I had to contend with during this pandemic has been minor compared to the inpatient world. When I worked in the hospital, we were periodically fitted for N-95 masks to ensure proper seal, equipment was never re-used or shared, hand washing was paramount, and the patient had to be placed in a negative ventilation room. The presence of this type of patient changed the workflow of the entire unit. The workload for this patient was much greater due to maintaining precautions therefore a nurse was usually assigned fewer patients but that made more patient assignments for others. The thought of having multiple critically ill patients on ventilators in airborne isolation was more than I could fathom. I feel deeply for the nurses working on those units during the height of the pandemic and agree wholeheartedly that they are our heroes. It is likely that Florence Nightingale experienced shock, disbelief and despair during her treatment of wounded soldiers during the Crimean War. However, as she has been quoted as saying, "how very little can be done under the spirit of fear," she got to work. Florence Nightingale was a pioneer in nursing who confronted infectious diseases. As her accomplishments were visionary and have been advanced and interwoven into nursing standards, I think she would be disappointed in the public health response to COVID-19. It is clear to see the use of her visionary ideas but they were without the vigor and determination in which she would have practiced them. One of her visionary ideas relevant to the COVID-19 response included the recording data on which future nursing actions would be developed. She used her affluence to obtain buy in from stakeholders and encouraged nurses to take part in legislation. She understood that leadership buy in was essential in meeting needs. She understood the importance of education and that public health required inclusion of the poor. The First Statistician If Florence Nightingale was here at the time COVID-19 began, I suspect there would have been greater preparation. As she was known as the first statistician, she would have demanded infection, morbidity and mortality rates and any and all real time data that had been compiled or compile them on her own. In 1860, she called for a uniform method to collect and present hospital statistics to improve hospital treatment. Due to being informed, and deducing that the virus was airborne and spread from human to human, much of her effort would have been towards obtaining necessary equipment to treat patients and supplies to protect nurses and patients. Used Affluence as a Tool and Identified Stakeholders As Florence Nightingale was known for using her affluence, she would have used this to gain the finances and political buy-in required to meet the needs of the pandemic. She realized that there are often problems due to layout of facilities and administration. She was aware that if leadership isn't engaged and doesn't see the advantages, outcomes are diminished. She was not afraid to be a part of the legislative process. She would have reached out to the WHO, the CDC, the NIH, the president, congress, state governors to educate, collaborate and organize an action plan. An Educator Florence Nightingale was an educator. She took the time to write information at a lower level of reading to ensure all could read her writings. Due to the magnitude of the pandemic, it is likely that one of her actions in response would be to educate the public with all she was learning about the virus. She was aware the education was a strong determinant of healthy practices. Advocate for Minorities and the Poor Due to her view that nursing should exist within a broad social context where poor people matter, she would have anticipated the fact that racial and ethnic minority groups would be disproportionately represented among COVI-19 cases. She professed that healthy environments save lives and when they are weak, people are at risk. She would have addressed these populations in their communities at the beginning of the pandemic. “If only (this was done) … this many lives would have been saved." There are so many suggestions for examples to complete this phrase. One certainty is that we were better prepared through the contributions of Florence Nightingale. She would have been proud that, as a profession, we excelled when called upon. Hospital nurses were steadfast against enormous obstacles to care for and comfort the sick which is exactly what she would have wanted. References/Resources Stanhope, Marcia; Lancaster, Jeanette. Seventh Edition. Public Health Nursing Population-Centered Health Care in the Community. 2008 by Mosby Inc. Nightingale, Florence. "Notes on Nursing: What It Is and What It Is Not." https://www.biography.com/scientist/florence-nightingale Accessed June 1, 2021