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ICU, trauma, gerontology, wounds
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Teresag_CNS has 34 years experience and specializes in ICU, trauma, gerontology, wounds.

RN since 1982, mostly in critical care. I completed my PhD in 2004. Now I lecture around the U.S. on trauma, critical care, and gerontology. My practice is in hospice, mainly skin and wound care. I have a passion for improving care of older adults in the the ICU. Also passionate about undergraduate nursing education.

Teresag_CNS's Latest Activity

  1. Glad to hear the good news!
  2. Teresag_CNS

    Introducing #SilentNoMore

    While we may never eradicate violence in the health care workplace, that is not a reason to give up. Nurses deserve good security in our workplaces. We deserve the right to prosecute patients and visitors (and coworkers) for assault. We deserve administrators who listen to our concerns. Violence should not be "just part of the job," yet most nurses I speak to have experienced it. What it "looks like" to me is: support from managers to engage in self-care after an assault (no matter how severe the physical injury), a policy to ensure no nurse is ever left alone with a potentially dangerous person, and rapid responses from security personnel when a nurse calls for help.
  3. Teresag_CNS

    "That's a myth about nursing"

    "There is a shortage of nurses willing to work under current bedside nursing conditions." AMEN!
  4. I was interviewed two days ago by NBC news reporter Elizabeth Chuck regarding sexual harassment of nurses. She wants to hear from others. My interview lasted about 15 minutes. We need to tell these stories. Thank you for speaking up, nurses!
  5. Teresag_CNS

    Order that says "Don't call MD for pain meds"?

    Acetaminophen has been shown to be little better than placebo for musculoskeletal pain. Since nurses spend the bulk of the time at the bedside, we deserve a rationale for such an order. Fractures hurt. Several people here have speculated, but you need to know the reason. A past history of addiction does not justify inflicting unnecessary pain.
  6. Teresag_CNS

    Nursing is Just a Job- common myths in nursing

    I think it's important that we nurses not allow employers to define us. Although they may treat us as a necessary evil (and I believe that is true), we don't have to embrace that misrepresentation of our profession. Nursing is a profession. Employers (and policymakers, and often the public and physicians) might choose to treat us as less than a profession, but that does not change my identity.
  7. Teresag_CNS

    Nursing is Just a Job- common myths in nursing

    I may have misunderstood what you meant by "Nightingalish," but it sounds like you're not familiar with her life and career. Florence Nightingale defied her parents as a young woman to study the nursing profession because she felt strongly about devoting herself to something useful in life rather than marrying and settling down to what she considered a life of idleness typical of upper-class women. She revolutionized hospital care and nursing education. She was the first woman inducted into the Royal Statistical Society for her work in the then-new field of epidemiology. She was not doing "a job." She was committed to improving health through nursing.
  8. Teresag_CNS

    HELP! Threats to call BON!

    Speak directly with your board of nursing. Tell them what's happening. He is probably making empty threats, but if you contact the BON first, you're much less likely to appear guilty. Tell them the facts and ask for advice. Also, your state nursing association (if you're a member) may have a service that gives you a short free lawyer consultation. Mine does. Ask them. And best wishes to you. This shouln't happen to anyone.
  9. Teresag_CNS

    What We Don't Measure

    Nineteen-eighty-two was the year I began nursing, associate's degree proudly in hand, in a community hospital's coronary care unit. My excitement about practicing in critical care was tempered by the fear of inadequacy familiar to many new nurses. Early in my career, a man had a huge myocardial infarction in the coronary care unit, right before my eyes. He was sweating, in pain, panicked, and dyspneic. This was before the thrombolytic era, so the treatment was to use our standing orders for nitroglycerin, valium and morphine. He lived through the night, and the following morning he gratefully told the day shift RN, "The night nurse held my hand." He didn't know I gave him nitroglycerin to dilate his vessels, improving coronary blood flow and reducing preload. He wasn't aware that morphine is both an analgesic and a mild vasodilator. Nor was he aware that the valium tablet was to reduce myocardial oxygen demand, not just to temper his well-justified anxiety. "The night nurse held my hand." This statement reflected the priorities of a man in a changing, unknown and threatening situation, when safety and comfort predominate. No standardized tool measures hand-holding or other intangibles such as projecting an aura of confidence. Giving backrubs, reducing noise, and changing sweaty linens figure only obliquely into patient satisfaction measurements. Yet, when you are the man having the MI, they stand out. Patient satisfaction scores are not synonymous with quality scores for this reason: patients' priorities are not clinical, they are personal. Naturally patients want the best care, but they are not equipped to judge whether the nurse gave medications correctly or made the correct judgment about an abnormal lab test. Nurses spend at least 30% of our time documenting. Electronic health records (EHR) may have increased this. They are designed for documentation from a regulatory, reimbursement, and quality management perspective, not a nursing practice perspective. These administrative purposes matter, of course, but they are not why the patient thinks we're there. The patient believes we are there for them. What we value, we measure. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey tool asks a handful of questions regarding nurses and physicians: if they treated the patient with courtesy and respect, if they listened, and if explanations were clear. Pain management is included, too. HCAHPS is important administratively because patient satisfaction scores influence group purchasing power, reducing costs for high-scoring hospitals. The problem is that courtesy, respect, listening and pain relief are nursing fundamentals, not indicators of excellence. What if we also measured nurses' skill in modifying the environment to enhance rest? What if we measured the many aspects of comfort, such as pillow-fluffing, linen changes, backrubs, and the nurse's ability to convey information with confidence and reassurance? Why not ask if we included the patient's family in our care? What if we simply asked patients if they honestly felt cared for? Excluding this information from our data-gathering efforts sends the message that these things are not valued, which may well hurt our efforts to improve patient satisfaction, and ultimately the financial well-being of our healthcare institutions. Would scores for respect and pain management rise if we captured skills like maintenance of a therapeutic healing environment and holistic family care? Possibly. Patients may not know that the backrub is a pain and anxiety management strategy, or that it promotes restorative sleep, but they do know whether they felt cared for and comforted. Measuring comfort interventions may bolster comfort and satisfaction by emphasizing their importance to clinicians, who might otherwise give them low priority in their busy schedules. However, to measure, we must document, and no nurse has more time for documentation. If we add non-pharmacological nursing measures to our EHRs, then something would have to go. Fortunately, nurse scientists have given us ample candidates for removal from nursing routines. Examples include 2-hour turning for pressure ulcer prevention (Bergstrom, Horn, Rapp, Stern, Barrett & Watkiss, 2013) and auscultation of bowel sounds prior to feeding post-operatively (Noblett, 2010). Enumerating the many candidates for elimination is beyond this article, but every registered nurse should know and have the right to practice up-to-date nursing that will improve outcomes and eliminate pointless practices. As a profession, we must reduce nursing time spent in practices that do little to improve patient outcomes. As we do this, we should reconsider the effective fundamental nursing practices that seem to have lost their place among our routines. Valuing (and measuring) them will benefit our patients, our employers, and our profession. References Bergstrom, N., Horn SD, Rapp MP, Stern A, Barrett R,& Watkiss. (2013). Turning for Ulcer ReductioN: a multisite randomized clinical trial in nursing homes. Journal of the American Geriatric Society, 61, 705-13. Noblett, H. (2010). Bowel Management After Surgery. ADVANCE for Nurse Practitioners, (18), 2, 45.
  10. Teresag_CNS

    I think I will give negative feedback

    Definitely. This is inappropriate. They were speaking above you, as if you weren't there.
  11. Teresag_CNS

    New RN having the worst time

    First, those who say a nursing home gives you no experience are flat-out wrong. Your practice is complex, as your dilemmas illustrate. What is the best way to prevent and treat skin tears and UTIs? How is delirium best managed? How to make decisions about end of life? And so on....These are questions that demand expert knowledge of gerontological nursing. My first suggestion is to join the National Gerontological Nurses' Association - Home - the journal is excellent, and you will have a cohort of other nurses skilled in caring for aging adults to back you up. My second suggestion is to read, read, read about gerontological nursing. It is a growing specialty, and those who have these skills will be in HUGE demand in coming years. We need great gerontological nurses like you. Stick with it! And best of luck.
  12. Teresag_CNS

    Regret becoming a nurse....

    I think you're expressing the same frustrations that many nurses experience. I agree with those who suggest a change of practice area; maybe outside of the hospital? Hospitals pay best, but they also have the least sense of why we became nurses, in my experience. Hospital administrators seem to think that physicians provide all the care and nurses are but a necessary evil. Get away and into a more nurse-friendly environment, such as home care, hospice, or an outpatient clinic setting. I wish you well. You sound dedicated to the profession and we need people like you.
  13. Teresag_CNS

    Why do nurses clean off their shoes at work?

    Doesn't do any harm to clean your shoes more often. And it may reduce the bacterial burden on your shoes, keeping you from tracking it everywhere.
  14. Teresag_CNS

    Communication Advice for Nursing Students

    Thanks for sharing that meaningful story, reg4fun69. I'm sorry you had a bad experience with a nurse, but glad she apologized and it does seem like it was a learning experience for you, which is good, of course. Best wishes in your nursing studies!
  15. Teresag_CNS

    Why the heck do I have to be assertive???

    Assertiveness is a quality required of practicing nurses. We need to speak up about quality problems, workplace harrassment, patient safety problems, and other issues. I think the people telling you to be more assertive have your best interests in mind. The unfortunate truth is that those who do not advocate for themselves and their patients in health care are not heard, and that makes them less effective. You'll also find that being more assertive (which, by the way, means speaking your mind clearly and in such a way to not offend others) makes you more effective in the rest of your life. Even going to the grocery store can be easier if you speak up when something isn't right. Good luck!
  16. Teresag_CNS

    Comparative Effectiveness Research in Nursing Care

    We need CER on turning for pressure ulcer prevention. Has AHRQ considering funding an RCT of 2 versus 3 hour turning intervals in acute care? I know there is a large study by Bergstrom in long-term care on the topic. We need the question answered in acute care, because of the risk to nurses of moving patients, the opportunity cost of nurses' time (i.e. what else nurses could be doing with the time spent turning), the fact that most patients are not actually turned q2h, and the fact that turning is painful for many patients. The workload implications of frequent turning are huge, but it seems nurses' workload is not of much interest to funders. We need this research to use our human resources wisely.