Nursing CE Central

The question to increase, maintain, or decrease Pitocin is a long-aged question, asked frequently by nurses working in labor and delivery areas. Even though this very question has been asked countless times over a multitude of years, there is still no straightforward answer. Not having a clear answer is heavily related to the controversy surrounding Pitocin management practices between healthcare providers. There are practice guidelines that help guide Pitocin management, but some assessments can come down to provider interpretation. As the nurse, having all of your information is an invaluable resource to apply in your daily practice to help direct patient care. Taking It All In Upon first glance, you see an indication to evaluate your Pitocin infusion. What is your next move? As nurses, we know that our assessment skills are the keys that we use to evaluate the need for additional assessments or set forth any corrective interventions. To capture a complete clinical picture, we need to take it all in. Of course, the decision to perform additional assessment can be altered if there is an emergent response required. When there is not an emergent response required, we need to build up our clinical picture with an array of assessment information. The medical equipment we use is depended upon to capture information for us, which is then used to piece together components of our clinical assessments. We should always ask ourselves if we agree on the equipment information captured in comparison to any physical assessments performed. If there is any disagreeing data, we can start asking ourselves the following: Is there another piece of equipment that would capture more information that is conclusive? If we were using a Doppler, would an external ultrasound or toco give us more information? If we were using external monitoring, would internal monitoring with a fetal scalp electrode or intrauterine pressure catheter, give us more information? Even with equipment availability, it is also important to ensure we are capturing correct information, so we may ask ourselves what we can do to verify our equipment readings. Can we palpate our patient? Can we auscultate our patient? What visual observations of our patient can we make? We also rely on our communication skills to gather data from our patients and their family members to help direct our assessments. These verbal assessments can be used to identify changes from previous assessments or from our baseline assessment. Have we performed a complete pain assessment with our patient? In addition, communication is frequently utilized throughout the healthcare team. Sometimes a set of new eyes brings in a completely new perspective. More experienced co-workers may bring forth valuable knowledge and insight they have acquired. Use these moments to initiate a huddle to walk through the gathered information; this can lead to solutions or alternative ideas that had not been considered previously. Huddles can also provide an excellent opportunity for education among new staff members or solidify changes in evidence-based practice. Using our team members to help us connect patterns, rule out insufficiencies, or confirm any dots in this clinical picture we are building. Considerations Taking in all of the data allows us to build a complete clinical picture that will help guide us in our decision-making. Imagine this scenario: After glancing at our strip, we noted the possibility of tachysystole on the monitor; requiring us to create a complete further assessment. Depending on the results of our complete clinical picture, we should start to consider several different options. This is where we begin to rely on our education and training in fetal monitoring and clinical interventions. Considerations for in-utero fetal resuscitation measures include maternal positioning, supplemental oxygen, IV fluids, and of course our Pitocin management in conjunction with notifying the provider. In order to prepare for safe and effective Pitocin management, you should always stay up to date on not only your facility's policies and procedures, but your fetal monitoring education as well. It will give you the best foundation in caring for your patients! Going to Bat Following the previous scenario, once the initial assessments are complete, the equipment has been checked, the communication avenues have been established, and other interventions are considered, this is when Pitocin would be administered. However, because tachysytole is present on the monitor, the decision to not administer Pitocin was made. And that's it! We established a solid clinical picture and performed an intervention that you can back. Sometimes, this can be a difficult decision as a nurse, especially if it upsets anyone on the healthcare team. Again, please revert to your facility's policies and procedures to help dictate best. Remember being a patient advocate is also in the framework of your role. Written by Hollie Dubroc, RN, BSN for Nursing CE Central

Nursing burnout is an ongoing crisis in the U.S. healthcare system and is one of the main contributors to the mass exodus of nurses currently leaving the profession. Those who have stepped up to the plate and continued caring for patients amidst these national staffing shortages are now struggling with combating feelings of burnout. Although it can stem from many factors, burnout is usually a result of emotional and physical exhaustion, depersonalization (or compassion fatigue), and low professional achievement. Not only is this a matter of staffing shortages, but a significant patient safety issue. A 2021 nursing burnout review evaluating the results of over 15 studies and almost 20,000 nurses determined that 34.1% of respondents are emotionally exhausted (one of three major burnout factors). The passion nurses have for their profession is being stretched thin. They are exhausted, overworked, and burnt out at the bedside. With the continuance of the COVID-19 pandemic, it seems as if there is no end in sight to this ongoing burnout crisis. Something must be done, but what? Whether you are a nurse in the field or are simply passionate about the status of our current healthcare system, it is vital that we recognize, address, and develop initiatives that will actively work to decrease the prevalence of nursing burnout. What is the Nursing Burnout Cycle? Although nursing burnout has been around for many years, the COVID-19 pandemic has only exacerbated the situation. The cycle, however, has remained consistent. Let’s break it down. Phase 1: A healthcare facility is understaffed, and those who were planning to head home after their shift are now being asked to stay to cover the next until a replacement can take their spot. This is now a daily occurrence. Phase 2: A couple of weeks go by and a nurse has compiled over 100 working hours in just one pay period (equaling out to 50 hours per week). The other nurses on staff are beginning to argue with each other, and it is evident that the workplace morale is exceptionally low. Although the overtime payout is nice, the nurse is beginning to feel detached from reality and disconnected from her team. She has confided in a colleague that she is struggling mentally. Phase 3: Despite talking to her superior about not wanting to work any more overtime because it is affecting her health, she is told that they are so short-staffed that no one else is able to come in to fill the gaps; she feels compelled to push her feelings aside and continue to work. Lives are on the line. Phase 4: At this point, both physical and emotional exhaustion are in full effect. The workplace morale has only worsened over time, and it seems like no one is able to get along or work together. The nurse is beginning to miss changes in vital signs, and her quality of patient care delivery has plummeted. She is now a risk to patient safety. She discloses with her superior that she is burnt out and that she is putting in her two-weeks' notice, as she feels that she can no longer live under the circumstances that she has been for the past several months. The hospital is now one nurse short and they cannot afford to lose anyone else, as it would detrimental to their continuously rising patient influx. This is just one of many examples of the nursing burnout cycle. If you are a nurse, I am certain that you have experienced something similar during your career. The question is, “how can we stop this?” What You Can Do Unfortunately, there is no tried-and-true way to reduce this never-ending cycle. Everyone is different, and what may work for you, may not work for someone else. However, it cannot hurt to try various methods! The Cleveland Clinic suggests setting boundaries (if possible) or engaging in healthy activities outside of the workplace. From an organizational standpoint, more needs to be done to prevent nursing burnout. Institutions hire providers to care for patients, so they must be able to return the favor when their employees are struggling to stay afloat. If workload demands are going to continue to increase because of staffing shortages, there must be processes or initiatives that are put in place to assist those who are continuing to work, and potentially at their own health’s expense, too. From burnout-specific trainings, mental health and well-being initiatives to various educational resources, there is so much that can be done to help providers who are struggling with burnout that does not solely involve monetary benefits. Hospital administrators and executives must make these initiatives a priority before it is too late. Positive patient outcomes are on the line, and nothing is going to improve if we do not address, recognize, and act on implementing true changes.

Written by Morgan Curry, BSN, RN for Nursing CE Central Now more than ever, I hear this question asked just about every day. When I entered the nursing profession, people were excited to work and care for patients. Yes, you had some nurses who had been in the game for a while and were tired, but in general, people loved nursing and the impact they had. Today, that's just not the case. Nurses are exhausted. They are burnt out. With the COVID-19 pandemic continuing to worsen the state of our healthcare system, it is causing nurses left and right to leave the profession. From increased workload demands to incredibly low staffing rates, many nurses find themselves asking the question, 'Should I leave my job?' Or 'Maybe I should just change careers altogether.' As a nurse myself, this deeply saddens me. However, I cannot lie and say that I haven’t shared the same thoughts. Burnout is more prevalent now than it has ever been before. It not only applies to the healthcare profession, but to many other career paths as well. Are you feeling guilty for wanting to leave the nursing profession due to feelings of burnout? You are not alone. Increased Workload and Exhaustion We have all seen the news headlines of the continuously growing nursing shortage; there are many contributing factors to this. However, the true question is, what is your contributing factor? Why do you want to leave? I want you to sit back and reflect on that for a second. Is it one factor, or is it ten? Are you tired of the heavy workload or the mental, physical, and emotional exhaustion you feel after every shift? Through this pandemic, have you developed some mental health issues related to your work? Is it carrying over into your personal life? You are not alone. Did you know that 2.7 million nurses and counting in the US reported feeling burnout? Burnout is the number one cause of nurses leaving the profession. It's a never-ending cycle. Let’s break it down. It begins with low staffing, which leads to higher workload demand. As a result of these demands, emotional and physical exhaustion increases which then turns into feelings of burnout and leaving the profession. If you are a nurse who can relate to this cycle but do not want to leave the profession, what other options are there? What Can I Do Away From The Bedside? If you find yourself asking that question, you are burnt out and over it. However, try to remember the core reason why you became a nurse in the first place. Was it to help people? To make a difference? Because you love healthcare? Whatever the case may be, there are so many options that allow you to not only leave the bedside but also to continue to follow the core values of why you became a nurse. For example, you can use your nursing expertise to begin consulting, or even opening your own business! Nursing CE Central is founded by nurses who were burnt out from the bedside but wanted to make a difference – the sky is truly the limit for you! As a nurse, you have so much knowledge, experience, and skill that can be used in so many ways. Reflection You should not feel guilty about wanting to leave. You are human. You have your limits, and you can only do and take so much. Before you leave, try to frame your thinking positively. Ask yourself why you became a nurse. Take those answers, and see if they were fulfilled in your current role? How could you make those answers fulfilled in a different nursing role, perhaps one away from the bedside that doesn't cause as much stress in your personal life? I encourage you to sit back and reflect on all your thoughts and experiences, both positive and negative. Talk to your peers, co-workers, and friends on social media that you have met through previous nursing jobs, school, or life. Your feelings of burnout and overwhelming stress are valid. We hear you. We see you. Do not feel guilty. Working up the courage to leave your current job is a big one to make. Whatever you end up doing, just make sure the decision is made with your best interest in mind.

Written by Morgan Curry, BSN, RN for Nursing CE Central Nurses are people too – overworked, burned out, and exhausted. As a result, their physical and mental health is suffering. Regardless of if you love your job or hate your job, there are things you still must do to maintain a happy and healthier lifestyle. Nursing is hard, and when you are at work, taking care of your patient takes priority over everything else. But when the shift ends, you must remember to take care of yourself because you cannot continue to provide and give your all to your patients if you are not catering to your own needs, too. Of course, that is easier said than done, but to help you begin coping with stress and exhaustion from work or life in general, here is a list of the top three things you should remember when caring for yourself! #1- Food is Fuel Ensuring that you fuel your body with the proper nutrition is so important. Are you filling your body with fried food, sodas, energy drinks, and sweets? As a result, are you feeling sluggish? When you provide your body with the proper nutrients, it will respond positively. It will bring you energy, provide immunity, decrease your blood pressure, and more. I cannot stress this enough, but make sure you eat before your shift! If you can, try to steer away from the fast-food drive-thrus and go for something fresh and wholesome. Now, I know that is not always possible, and life can get busy, so it may be helpful to prep your meals ahead of time, so it is one less thing to worry about on your tight schedule! Packing proper healthy snacks to munch on throughout your shift will help maintain your blood sugar and fight off cravings for sweets or caffeine. Fresh veggies, nuts, granola bars, and Greek yogurt are all great snack options! Last, but most certainly not least, remember to drink water! Water. Water. Water. Drinking coffee and energy drinks cause you to dehydrate. #2- Get the Rest You Deserve According to an article from The American Nurse, "sleeping 7-8 hours per night is linked to a wide range of better health and safety outcomes." I know it can be hard to prioritize yourself when you are used to giving and caring for others. Trust me, I have been there, and it's extremely hard when you get stuck working the night shift. Trying to flip back and forth between day and night hours can make you feel terrible. It has been proven that exhaustion and fatigue lead to decreased immune function, higher rates of depression, heart disease, and mood disturbances. With that being said, get some sleep! Your patients need the best version of you, but more importantly, you deserve it, too! #3- Stay Active Not everyone is into the workout scene, I totally get that. But staying active outside of work is essential for your mental and physical health. It does nothing for your body to work a 14-hour shift, go home and sleep, and then be a couch potato for the next two days. Get outside and take a walk. Go for a hike or a jog. Go to a workout class, a gym, or yoga. Take a bike ride with your kids. Explore the great outdoors. Staying active and exercising are proven methods to relieve stress, increase energy, and control weight. If you do not have the motivation to do it yourself, bring a friend. Maybe you'll find something that you love! We are so busy taking care of others that we don't stop to take care of ourselves. As you go through your career, you learn things from mistakes and experiences. Take these three things as guidance to lay a solid foundation for yourself to create or maintain a healthier lifestyle! We truly believe it will make all the difference. Do you have any health tips? Let us know!

Written by Morgan Curry, BSN, RN for Nursing CE Central It feels like the nursing shortage has been around for a while, and COVID-19 has only exacerbated the issue. Now that we have made it through what is arguably one of the most difficult seasons in our entire nursing careers, we are feeling the impacts of the nursing shortage now more than ever. So, the question is, ‘when will the nursing shortage be over?’ The U.S. Bureau of Labor Statistics reports that the employment of RNs from 2019 to 2029 is projected to increase faster than any other occupation at 7%; the national average for all occupations is about 4%. Healthcare systems globally have been strained by the influx of patients, lack of resources, and extreme working conditions; but there is one major outlier that we cannot prevent. Time. No matter what we say, do, or believe, there is nothing that can stop it. Our nursing population is aging, and more nurses are beginning to retire each year; although this is a significant problem to the industry, there are many more factors that come into play that we must address. In order to fully understand why the nursing shortage is increasing, let’s break this down some of the most prominent contributing factors. Why the Nursing Shortage is Continuing to Worsen Large Aging Populations and Workforce The American Association of Colleges of Nursing outlines that the average age for an RN is 50 years, which poses significant risks for the next several years. As the Baby Boomer and Generation X populations begin to retire from the workforce and potentially present health complications that require care, the nursing industry may be hit with more than they can handle. Burnout A 2018 JAMA Network Open cross-sectional survey determined that out 50,000 nurses, 31.5% of respondents reported leaving the profession due to burnout. A recent Nurse Burnout study from Nursing CE Central identified that out of over a thousand nurses, 95% of respondents claimed to be burnt-out, while 47.9% are actively searching for a less stressful position. Turnover In the 2020 Nursing Solutions Inc. Health Care Retention Report, nurses have the highest turnover rates of all the allied healthcare professions; and it is continuing to rise. For example, the percentage of national RN turnover in 2019 was 15.9%, and 18.7% in 2020. When Will the Nursing Shortage Be Over? Rather than improving, the nursing shortage is only growing, so, unfortunately, there is no right or wrong answer to this well-deserved question. With increased pressures of the nursing shortage, fatigue, and job dissatisfaction, nurses will only continue to leave the profession. So, what can be done about this issue? Through the pandemic, hospital institutions along with other employers have been incorporating hazard pay as well as retention and sign-on bonuses to serve as monetary incentives. Of course, all of these are not bad options; however, money can only go so far, and it is only a piece to the entire job satisfaction puzzle. Nurses want to feel appreciated and respected; work environment, safety, and work-life balance are major factors that contribute to their job satisfaction. Nursing burnout should be addressed as the leading cause of turnover first and foremost. When this national crisis is addressed by employers and hospital institutions, only then will the shortage begin to improve. When managers and institutional executives address the root cause of the problem by taking the time to investigate shortcomings, it will allow them to strengthen their team, increase retention, and decrease burnout. Nurses, remember why you entered the nursing profession in the first place. Your compassion, strength, and grit for the field are unmatched and appreciated more than you know; do not lose sight of this. I know the past year has been extremely difficult for you but try your best to persevere. Keep your patients and your nursing philosophy at the root of your care and practice.