EOC

Physicians have a distinction. They are called MD. Seems like education is needed in what a doctoral degree means. It is quite an accomplishment to achieve. I agree that there is a lot of confusion with say calling someone with education or psychology doctoral degree Dr. Do they tell students when and how to use their degree before they graduate? I don't what triggered this concern now

After two and a half years of dealing with the enormous physical and emotional weight of covid, a light is beginning to show. We have lost many of our experienced nurses throughout the covid pandemic. This created a huge gap in the experience level of nursing today. Nurses who were the go-to for standards of care, policy, and general nursing care experience were leaving. They either retired, found a new opportunity, or changed professions entirely. The bleeding of nurses has now started to become more of a trickle. Now comes the work of rebuilding. Getting nursing back to the "normal" we all knew ... before covid. The problem is we cannot go back. The world has changed, we have changed, and healthcare has changed. Leading bedside nurses encompasses skill, patience, and time and lets us not forget energy. CNOs, Directors, and Managers have the task of directing the paths that lie before us in our new normal of nursing. Clinical leaders such as Assistant Managers, Clinical Supervisors, Clinical Specialists, Clinical Educators, Charge Nurses, and others have the task of leading nurses at the clinical level. Connecting with your staff is more important than ever before in nursing. Cultivating a mindset of care and compassion, not only with patients but with each other. The question now becomes, how can nurse leaders navigate, inspire, and grow staff through this new normal of healthcare? Leadership is now more important than ever to direct and cultivate a new generation of nurses. To do this, we must focus on developing leadership by learning the skills to retain, engage, stimulate, and mentor staff while also maintaining high-quality outcomes. By no means, an easy task. We are not born with directions on how to lead the next generation of nurses. Current and emerging nurse leaders need organizational education to develop and grow their leadership styles. There are several types of leadership models from which to choose. Niinihuhta and Haggman- Laitila1 reviewed the impact a leadership style has on a nurse's work-related well-being or burnout. They found that a relational leadership style such as transformational, authentic, ethical, and servant was more supportive of nurses, thereby improving retention1. Connecting to staff with compassion and purpose and finding and developing a style that fits well with you may take time to develop. To gain and sustain nurse retention in this new normal environment, the continuous engagement and development of staff nurses and nurse leaders should be an essential focal point in every organization. In this new era of rebuilding healthcare nursing numbers, bring your thinking caps out. How do we attract nurses? How do we keep nurses? Many hospitals have programs for loan repayment, pay increases, sign-on bonuses, and career ladders. Do they work? And for how long? It is so important for organizations to support leadership by giving them the tools to be able to grow, support, and retain nurses. These ideas and questions are to stimulate conversations that are taking place in every healthcare setting. What are the best ways to lead and grow nurses who are starting their careers? How clinical leadership is supported will look different in each healthcare facility, according to their individual needs. However, the goal is the same, grow and retain nurses at the bedside. A nurse leader's paramount goal should be to open the door to a nurse's potential, motivation, and compassion. Ideas to Improve Staff Retention Touch Base Meetings are about connecting with staff, building relationships, and learning the needs of staff. Working towards developing their professional goals and helping to guide them there. Shared Governance/ Unit Council Having an organized group that works together to improve quality and patient care. Stimulating and engaging staff to develop projects that improve patient outcomes and develop teamwork and leadership skills. Unit-based councils can be valuable in addressing issues in the day-to-day workings of a unit. Mentoring Filling the gap and improving retention. Mentoring helps nurses build confidence, develop critical thinking and improve retention. It can be social or clinically focused with new or experienced nurses. References/Resources 1A systematic review of the relationships between nurse leaders' leadership styles and nurses' work-related well-being Mentoring the working nurse: a scoping review Magnet Tips and Tricks. Mentoring or Succession Planning: Which is it? Touch Base Meetings: Why and How They Work (+ Template) Nursing Shared Governance How To Support Nurses And Raise Nurse Retention Rates

Look into your state's Board of Nursing's scope of practice. See what they say about verbal orders. Verbal orders are usually for true emergencies only. For example, the MD is in the middle of intubation. Does this hospital have an EMR? If that's the case, then the MD will have access from home to place orders. I have worked in small hospitals where culture plays a role. Changing it takes time. However, you must be mindful of your license too.

I agree. The ICU had many lifting devices available. It only takes a minute to put in place. Other areas that use ICU skills could be a CDS or clinical development specialist. They do a lot of audits and QI monitoring. An ICU clinician or educator would be a great alternative too.

I'm a clinical supervisor. I don't have an assignment usually, only in emergency-type situations. I have a lot of fires to put out as well as audits. I also cover for Rapid response if they are busy and need help. There is too much stress to have a patient assignment, as well. I would then hand over my phone, which never stops ringing, to the manager.

Every hospital is different and has different heparin protocols. We have to double sign the gtts at the start, bag change, tubing change, and shift change. That's a challenge in itself. If you were so busy, learn to reach out to leadership, charge nurse, or peers on the shift for help. It is very important to keep in mind your high-risk drugs and prioritize what needs to be done. I tell the nurses that handoff is soooo important. That means line reconciliation, gtts, patient condition, etc...If it isn't done you own it. Of course, it was an error if you can't figure out when the heparin was off to turn it back on. I think the preceptor was teaching the nurse what you are supposed to do when you run into these things. I'm curious, don't you have a heparin flow sheet? That should tell you the start and stop times ( unless that wasn't filled out). I know ours do. Yes, you could have handled the conversation better. Turn it into an opportunity for improvement. I would apologize and admit that I should have made sure it was done. Looking for things to improve your and others' workflow is important. This may be something you could bring to your manager and help turn it around for you. Some days at work just suck. We have all had them. Pay it forward to the next person you find who forgets. Nurses need to be supportive of each other too.

Thank you for your reply. I had listed Covid 19 as a condition that places you at risk for PE. Yes, there are studies on vaccines and blood clots. The Johnson and Johnson vaccine, I believe is the one most attached to the blood clot issue. I hope in the next few years we learn a lot more about them and have better treatments for sure. I lost my niece at 38 from Covid. She was a beautiful woman. She was overweight and had asthma. She chose not to get the vaccine. In rehab, I'm sure you see a lot of post covid issues too. I dread the thought of another round of covid.

So glad you listened to your son and went to the ED. I work in the ICU and we see this scenario all too often. Having mild symptoms makes it so much more difficult to decide if you need medical help or not. I tell patients that are having CP, wouldn't it be better to go home with heartburn than not going home again. So glad you're okay!

What Every Nurse Should Know About Pulmonary Embolism What can cause PE The risk for PE Symptoms of PE Treatment of PE Things you can do Our circulatory system is made up of veins and arteries that move blood and plasma throughout our body to deliver oxygen and nutrients. Blood clots can be found anywhere in the body. The blood clot that forms (thrombus) can break off and create an embolism (a blood clot or foreign body) that travels through the body to the lungs. A sudden disruption of blood flow and oxygen can cause damage to the lungs and other organs in the body. In the United States, approximately 1-2 per 1000 individuals develop a Veno thromboembolism (that includes DVT and PE). A pulmonary embolism can be extremely serious and can even cause death. What can cause PE? The blood clotting mechanism is a normal process of our body. There are two parts, blood clotting and breaking down of blood clots. At times, the system may not work as it should. When that happens, bleeding can occur or the formation of clots. A pulmonary embolism most commonly results from thromboembolism. That is where part of the thrombus (clot) becomes dislodged, usually in a lower limb, and makes its way to the lungs. The risk for a PE Conditions that place individuals at risk: Surgery - orthopedic surgery (fat embolism) Pregnancy Cancers Lung diseases (COPD, cancer) Cardiovascular disease (Heart failure) Genetics Immobility (extended periods of bed rest and long trips can place you at higher risk of DVT) Obesity Hormone replacement therapy, birth control (can affect clotting mechanism) Age - increased risk after age 40 Varicose veins Infections, Covid – 19 Cigarette smoking Injury to a vessel or infection can irritate the vessel wall and can create a thrombus. Other causes of pulmonary embolism can be air or amniotic embolism, broken-off pieces of a tumor, or fat emboli from a broken bone. Symptoms of PE If you have any seek medical attention at once. Shortness of breath with or without sudden onset Feeling anxious, impending doom Chest pain (may worsen with breathing) Irregular heart rhythm Coughing up blood Hypotension Treatment of PE Developing a pulmonary embolus can be alarming. Getting medical attention and treatment should be done asap. Diagnosis of PE can be difficult. Having a thorough history and physical is always important in the identification of any condition. Confirmation of a pulmonary embolism can be done by lab work and or various testing. Some of the tests ordered may be; chest x-ray, CT scan, MRI, or V/Q scan Anticoagulation is the usual first-line treatment. They prevent the formation of new clots while your body is breaking down the clots you have. Heparin is the usual drug of choice unless you have an adverse effect. Heparin can be given by IV or subcutaneous routes. Coumadin or Arixtra are some other options that can be used. Consult with your physician on which treatment and the length of treatment will work best for your condition. Thrombolytics are used to dissolve the clots that are already there. Most deaths occur within an hour of symptoms of severe hypotension from PE. Alteplase (tPA) is used most often for severe complications of PE. Streptokinase and urokinase also may be used. Bleeding is a complication in the use of these drugs. Monitoring for 24 hours post-infusion is standard care. Thrombectomy is used for unstable PE. The patient is taken to interventional radiology to extract the clot from the vessel being obstructed. IVC filter (inferior vena cava filter) Is placed to catch most clots that are in your lower extremities from traveling to your lungs. It doesn't stop any new clots from building up. Things you can do: Exercise Eat a balanced diet Don't sit for extended periods of time Wear support stockings Drink fluids to avoid dehydration. Summary: A pulmonary embolism can become a life-threatening condition. Approximately one-third of people undiagnosed with pulmonary emboli have a fatal outcome. Treatment of pulmonary embolisms can be done with blood thinners. Treatment with anticoagulants needs to be checked closely because of the elevated risk for bleeding. When found early most pulmonary embolisms can be treated successfully. Another treatment to remove the clot is a thrombectomy. Be aware of your risk factors. Know your family history. Ask your physician what your risks are and develop a plan to help reduce them. Make prevention your goal. References Pulmonary embolism Hopkins Medicine - Pulmonary embolism: Mayo Clinic American Society of Hematology 2020 guidelines for management of venous thromboembolism Treating and Managing Pulmonary Embolism | American Lung Association Update on Thrombolytic Therapy in Acute Pulmonary Thromboembolism - PMC (nih.gov)

I have been in ICU nursing for 40 years. I have seen so many changes. I remember when you had a head nurse. Then nurse manager and then changed to service manager. They thought taking the name nurse out would somehow improve things?? When I was PT and wound care. We used Maalox and heat lamps. OK, I went too far back. But I have also seen some great things. I have seen the transformation of philosophy in health care. Patients and families are at the forefront of what we do. I love the team approach that has developed. Dr's asking what do you think. I have always told our nurses If you are an excellent ICU RN, the doctors and APPs will ask you your opinion. EMR, your charting will be faster they said. Boy, we were suckered. I used to say when I was getting a patient on a freight scale in the morning, that someday I'll just have to push a button on the bed. Well, that happened. I think someday we'll wear headsets and talk in them to record our assessments. That would save time. I supervise now. Charting would take me a while. They wouldn't like my OT. LOL The new thing is wearing tee shirts with scrubs. Which one is the nurse? Who is the oriented? Try to figure that in a code. I asked for badge identifiers. I believe looking more professional makes you think that way too. I also think people respect you more. But it is like any generational thing, what goes around comes around. Yes, there have always been shortages. I went from 8 to 12 hr shifts, which I love. I still believe that nursing is a "calling". You have to really enjoy caring for others. If you just want a check, boy you'll work for it. I feel nursing has made me who I am. I diagnose all the time ( nursing of course). I don't have time to listen to those who blame others for their situation. I'm also good at nodding my head. Our profession is all about observation, communication, and listening.

Well, I'm old school. Over 40 years in ICU and still working. We had SG caths a lot. I never had or seen a balloon rupture. Thank God. Yes, there was a lot of literature that terminated the cath as a frequent monitoring device in the ICU. They are also a high risk for infection. However, I do think that they are useful. As mentioned earlier, the flotrack only measures the art line with algorithms. We do see them from time to time. I personally like them.

I love Impella. We are starting to use it in our ICU. Great info!

Have you approached him with an agency, float pool, cross training, or bonus money for extra shifts? I would reach out to your physicians for help with talking to the administration about concerns. I would say, at this time I can't charge and care for patients without more help. I am concerned for our patients. Until we can get staffing increased I will step back from charge. Be very professional and have a concerning tone. If that doesn't work then look for another department.

Sounds like you are still in orientation? It takes at least 2 years for a nurse to really get their feet wet, so to speak. You need to speak with your clinician about how you feel. They should be able to help you. It is scary to start working on the floor. It also can become very rewarding. Finding your niche may take time. Research may be an option. Don't go home feeling miserable. Talk with your leadership. If you want to leave they should help you find a new position. They want you to be successful and happy.

So glad to hear you're wanting to go into the ICU. We ask questions to try to get to know the nurse. They may ask you, tell me 3 strengths and 3 weaknesses. Where do you see yourself in 5 years? Tell me about a memorable moment you had with a patient and a difficult one. Good luck!

Wow, that is poor management. I suggest you find a more experinced nurse on the floor that you get along with, maybe your preceptor and use as a resource. You could reach out to your educator if you have a relationship and explain what is going on. How many "new" nurses are on your unit? There are alot of variables to take into consideration to figure this out.

You go in. No you go in. Your the RN

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Tough situation. I agree to approach him. I would say I'm sure this is all very stressful for you. I would like to make time with you so we could discuss how best to approach each of these issues. I know you agree with me that our patients come first and I would like to help. This opens the door and places it with him to answer. Trust me if the MD's get frustrated they will roll it upward too.

Looking at your experience you should apply as a clinician. Where I work they are considered part of the leadership team. We also have a CDS position(clinical development specialist). From there you could move to a supervisor or assistant manager. Every hospital is set up differently. Use what you have. We need educators!