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  1. The #1 digital stethoscope for nurses. 40x sound amplification Reduced ambient noise 7 volume levels for listening comfort Adult & pediatric diaphragms Rechargeable battery with 9 hour life with continuous use Bluetooth connectivity to free mobile app Connecting the CORE to the free Eko App gives clinicians the ability to visualize, record, save, and share heart sounds. These functions are useful for hearing low grade heart murmurs, getting a second opinion on irregular sounds, education, and telemedicine. The Eko CORE is available in two models. $299, the Eko CORE Digital Stethoscope is a complete stethoscope $199, the Eko CORE Digital Attachment can digitize a traditional stethoscope from manufacturers such as 3M Littmann, ADC, and Medline Who uses Eko Stethoscopes? The Eko CORE is used by over 10,000 clinicians at 1,000 institutions around the world. The sound amplification and bluetooth connectivity are helpful for clinicians with hearing loss or patients that are difficult to auscultate. Medical and nursing schools are adopting Eko as an intuitive learning tool. Finally, Eko is expanding telemedicine programs with cardiology-grade live streaming of heart and lung sounds. FLASH SALE This special 30% off offer - only available to allnurses.com readers - expires September 30th, 2018. Use the promo code allnurses to get 30% off your order today! Click Here to Purchase This is a sponsored article brought to you by allnurses.com in conjunction with the advertiser. The views expressed in this article are those of the advertiser and do not necessarily reflect allnurses.com, its parent company, or its staff.
  2. Disposable gloves have long been a mainstay of required equipment for the protection of healthcare workers and patients. In many perioperative areas, surgical tasks require the use of double-gloving. Ansell developed the GAMMEX® PI Glove-in-Glove System™, the world's first pre-donned double-gloving system featuring pre-donned outer and inner gloves allowing quick and easy double gloving with a single don. Features and benefits include: Semi-transparent outer glove over a green under glove allows quick and easy breach detection Ability to don 2 pairs of gloves with one don in half the time of the traditional double gloving with 2 dons Non-latex Saves time Cuts down on waste For more information see the GAMMEX® PI Glove-in-Glove System™ Product Overview in the allnurses Product Directory. If you have used this product, please leave a review in the Directory.
  3. Julie Godby Murray, RN has over 40 years in healthcare and is currently an OR nurse in Michigan. She has been instrumental in developing the Nurse Honor Guard. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, "It's so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. This is a ceremony that takes place to honor a nurse's service to her patients, community, family and friends. As Ms Murray states, " Its so healing for the families. Families know what we go through. The families are very touched." She further explains that the Honor Guard wears a white dress, cap, cape, and they carry a white rose that is placed on the casket to symbolize the caring that a nurse does during her lifetime. Here is an example of a Nurse Honor Guard ceremony. Taking their cue from military honor guards with a tradition of honoring fallen military comrades via a ceremonial tribute, the Nursing Honor Guard provides this tribute for nurses who have died. Julie, who is also the union steward for over 500 nurses in a Michigan hospital system provided some more information about what a Nurse Honor Guard does: Attend all services wearing the traditional white uniforms with cap and cape Stand guard at the nurse's casket or simply provide a presence at the visitation. Recite "A Nurse's Prayer" at the funeral or during a special service Present the Florence Nightingale lamp to the family. Place a white rose on the nurse's casket at the end of the service, which signifies the nurse's devotion to his or her profession. Julie has been a driving force in the further development and spread of the Nurse Honor Guard. From the east coast all the way to the Kenai Peninsula in Alaska, you will find Nurse Honor Guards ready and willing to pay tribute to their fellow nurses. Julie is willing to help and has assembled many tips on her organization's FaceBook page; OPEIU Nurses Honor Guard. Julie was also one of the invited speakers at the 2018 Nurses Take DC. She encourages nurses to legislate for adequate nurse-patient ratios. She stated, "Our hospital has the same staffing ratios that California has and our ancillary personnel are figured into this. We need them too!" She went on, "We have the power, lets do this together." She closed her discussion with this quote from Alice Walker, "The most common way people give up their power is by believing they don't have any." [video=youtube_share;22nbfekuGCE] References: Alice Walker, Author of the Color Purple
  4. NursesTakeDC had one purpose: to support the Federal Legislation for National Nurse-to-Patient Ratios S.1063 & H.R.2392 Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2017. These bills support mandated nurse to patient ratios. Doris Carroll, BSN, RN-BC, CCRC is one of the faces and organizers of NursesTakeDC. She is also the Vice President of the Illinois Nurses Association and she is an administrative nurse at the University of Illinois Hospital and Health Sciences System. At the recent NursesTakeDC rally in April, where nurses gathered in the Nations' Capitol to advocate for safe nurse-patient ratios, Nurse Beth from allnurses. com talked with Doris Carroll who stated, "It's time we do something. We need to take charge of our profession. Some of our nurses have 3 and 4 patients in the ICU... Nurses need to understand that we are so powerful at almost 4 million strong across the country, yet we can't seem to unify around the most dangerous part of our jobs which is unsafe staffing. What we want to do is empower nurses. This movement is comprised of both non-union and union nurses. It doesn't matter where you come from or what kind of nurse you are. What matters is that you do and say something to change things. is not just about nurses, it's about our patients. We must let the public and legislators know that patient acuity ratios affect patient outcomes." Nurse Beth, who is from California stated, "Some of these ICU nurses have 3-4 patients. This is unheard of in California where we've had nurse ratios for 14 years. What would you advise nurses to do?" Doris responded, "Find out who your senators are - talk to them about acuity-based nursing ratios in language they can understand. Relate it to their family - I might not be able to get to their Mother or Father in a timely manner when they need help; when they cry out for pain medication or if they fall on the floor. Encourage your legislators to co-sponsor nurse ratios laws." She went on, "It doesn't matter whether you are union or non-union, we want our patients to be safe. Educate other nurses that acuity-based ratio staffing will help the nurses to remain at the bedside caring for patients." Currently 14 states have staffing ratios: 7 states require hospitals to have staffing committees responsible for plans (nurse-driven ratios) and staffing policy - CT, IL, NV, OH, OR, TX, WA. CA is the only state that stipulates in law and regulations a required minimum nurse to patient ratios to be maintained at all times by unit. MA passed a law specific to ICU requiring a 1:1 or 1:2 nurse to patient ratio depending on stability of the patient. MN requires a CNO or designee develop a core staffing plan with input from others. The requirements are similar to Joint Commission standards. 5 states require some form of disclosure and / or public reporting - IL, NJ, NY, RI, VT Nurse-patient ratios are an extremely important issue for nurses as well as patients. Improving safety and reducing errors as well as improving job satisfaction are all tenets of nurse-patient ratios. In 2014, the Robert Wood Johnson Foundation cited a statistic that almost one out of five new nurses leave their first job within the first year of gaining licensure as a nurse. If that is not worrisome enough, one out of three leaves the profession within two years of beginning their nursing career. Medical errors are the third leading cause of death in the US. Patient safety is the most important reason to improve and mandate nurse-patient ratios. In order to reduce patient errors, there needs to be more nurses at the bedside. One study found that for every one additional patient added to a hospital staff nurse's workload is associated with a seven percent increase in hospital mortality. A study published in 2014 in the Lancet showed, "An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7%." Doris Carroll concluded, "We are educated and professional and we care about our patients." Thanks to Doris Carroll and Nurse Beth for their informative interview. Now...we all are being tasked to talk to the public and our legislators. [video=youtube_share;5H2LCDSuEPY] References: ANA - Nurse Staffing Nearly One in Five New Nurses Leaves First Job in One Year Nurses Take DC Position Paper Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study Third Leading Cause of Death Doctors
  5. The annual Emergency Nurses Association conference is dedicated to the emergency nursing profession and it will be held in the City of Bridges at the David L. Lawrence Convention Center (Pittsburgh, Pa.), Sept. 26 - 29, 2018. "Emergency Nursing 2018" will bring attendees unique opportunities for hands-on education, access to cutting-edge research and renowned experts in emergency medicine as well as opportunities to network with nurses from around the world. There are numerous ways to take advantage of the education and networking opportunities at the conference this year. Attendees can earn over 29 contact hours and choose from more than 160 sessions ranging from pediatrics and geriatrics, to leadership, trauma, advanced practice and forensics. All attendees have the opportunity to build their own personal agenda by pre-registering for their desired sessions, including hands on cadaver and ultrasound labs. This year, there will be more advanced practice content available too. In partnership with the American Academy of Emergency Nurse Practitioners (AAENP),ENA has created a full day Advanced Practice Procedural Skills Lab that allows attendees to participate in hands-on practice elements, two interactive simulations to promote clinical reasoning skills, a basic suturing workshop and more. This experience can be further enhanced by an advanced practice ten-course track designed to dive deep into common advanced practice emergency nursing skills and address the risks, benefits and possible complications that become considerations practitioners should be versed in. The conference offers several interactive experiences in the Exhibit Hall including: ENA Learning Lab: Discover clinical education sessions on the exhibit floor and earn CERPs - topics include IV infiltration, intubation, obstetrics in the ED and more. Career Wellness Center: Access professional services like headshots, make use of private interview spaces and unwind in the ENA sponsored relaxation station. DisastER: Visit the flight medical helicopter and tent to learn more about transport nursing. Presentation topics will focus on how to become a transport nurse, how to transport intubated patients and more: SIM Wars: 16 teams of four will compete in a two-day emergency simulation competition on two separate stages complete with bracket style playoffs, ending in a championship round. AdvancED: Step into the future of emergency nursing. This fully-equipped, mock, four- bed ED provides nurses at any stage of their career with progressive clinical information allowing groups of six to eight to participate in hands-on clinical simulations. EDTalks/SMACC Talks: Listen while colleagues, ENA representatives and valued partners share short presentations focused on successful ideas, trends, equipment, supplies, services, research studies, practical problem-solving efforts and expertise that are optimizingEDs around the country. Early bird rates are available through July 31, 2018. For more information or to register for the conference, visit Emergency Nursing 2018. Register When: September 26 - 29, 2018 Where: David L. Lawrence Convention Center in Pittsburgh, PA Primary Spokesperson: ENA President Jeff Solheim, MSN, RN, CEN, TCRN, CFRN, FAEN, FAAN Conference Website For additional information regarding ENA, please contact Tim Mucha at tim.mucha@ena.org, 847.460.4022 Rates Registration Type Early Bird Deadline July 31, 2018 Advanced Registration After July 31, 2018 Member - Full Conference $520 $750 Member - Two Day $350 $500 Member - One Day $185 $285 Non-Member - Full Conference $620 $850 Non-member - Two Day $450 $600 Non-member - One Day $285 $385 General Assembly - Full Conference $520 $520 General Assembly - Two Day $350 $350 General Assembly - Thursday Only $185 $185 Student Nurses* - Full Conference $250 $250 Student Nurses* - One Day $100 $100 Faculty Discounted Rate** $250 $250 *Student rate applies to both member and non-member students, based on ENA Student Membership requirements. **Must be approved for discounted rate. Please contact education@ena.org for details. Hotel Information: ENA has negotiated travel discounts and secured a limited number of reduced-rate hotel rooms to make your trip to Pittsburgh affordable. Through the travel experts at onPeak, rooms at the group rate are limited and available on a first come, first served basis. Please login into the registration dashboard to book your hotel. You must have an active Emergency Nursing 2018 registration in order to reserve a hotel room in the official hotel block. Reservations without active registration records will be canceled and a cancellation confirmation will be sent. Please note: You may book up to 3 rooms per registrant. If you require more than three rooms, please email your request to ena@onpeak.com. Official ENA Hotels The Westin Convention Center Pittsburgh - Headquarter Hotel Starting at $209/night Courtyard by Marriott Pittsburgh Downtown Starting at $199/night Doubletree by Hilton & Suites Pittsburgh Downtown Starting at $199/night Embassy Suites by Hilton Pittsburgh Downtown Starting at $189/night Hampton Inn & Suites Pittsburgh Downtown Starting at $184/night Kimpton Hotel Monaco Pittsburgh Starting at $234/night Omni William Penn Hotel Starting at $205/night Renaissance Pittsburgh Hotel Starting at $189/night
  6. Provided by ANCC American Nurses Credentialing Center This year's event in Denver will mark the 16th year ANCC has hosted the Magnet Conference. Join over 10,000 other talented nurses and nursing executives that represent more than 20 countries for the National Magnet Conference. The prestigious Magnet Recognition Program celebrates accomplishments for newly designated Magnet organizations. Attendees return to their hospitals energized to improve their practice and equipped with proven solutions. Over 250 exhibitors will be sharing their expertise so make sure to stop by and pick their brains. The Magnet Conference was organized to recognize healthcare organizations that provide exceptional nursing care and uphold the tenets of professional nursing practice. Lunch and refreshments are provided along with prize drawings and giveaways. Make sure to take time to see the more than 150 posters that fellow nurses have made showing their evidence-based practice. Choose from the 70+ new and innovative concurrent sessions and enjoy the inspirational general sessions with dynamic speakers ... and don't forget to come to the welcome party! Who Attends Magnet? Magnet is the leading source of successful nursing practices and strategies worldwide. A breakdown of the attendees is below. 65% have a BSN - 2% are under age 25 44% have a RN - 22% are age 25-34 33% have a MSN - 26% are age 35-44 7% have a MS - 27% are age 45-64 8% have a BS - 21% are age 55-64 4% have a PhD 42% are staff nurses 9% are CNO 9% are Directors 6% are Hospital Administrators Attendee to Exhibitor is 32 to 1 Conference Dates Wednesday - October 24, 2018, 12:00 p.m. to 4:00 p.m. Thursday - October 25, 2018, 8:30 a.m. to 12:30 p.m. Friday - October 26, 2018, 8:30 a.m. to 12:30 p.m. Conference Location Colorado Convention Center 700 14 Street Denver, Colorado 80202 Sessions The Year of Rapid Improvement Events Inpatient Flow A Behavioral Emergency Support Team (BEST) on Medicine Developing Future Nurse Manager Empowering Nurses With an Online Roadmap for Evidence Based Practice From Paper to Practice: Getting Your Team on the Same Page Building a Nurse-Led Patient Care Logistics Reducing Unrecognized Clinical Deterioration and MANY MORE. For a full list, go to Concurrent Sessions Poster Subjects Fostering Systems Thinking to Improve Golden Hour Efficiency Elevating Practice with an Electronic Peer Review Tool Contrast Induced Acute Kidney Injury in the Cath Lab Decreasing Staff Injury with Innovative Protective Equipment Rates Early-Bird Registration Ends June 22, 11:59 p.M. EDT Individual rate: $889 before deadline June 22, 2018 - save $490 Group Rate: $879 before deadline June 22, 2018 - save $1050 Retired Nurse, Faculty: $629 before deadline June 22, 2018 - save $240 PreConference Options Research Symposium: October 22, 2018 9am-5pm - $359 Practice Transition Accreditation Program (PTAP) Workshop: October 23, 2018 8am-5pm - $325 Nurse Executive Certification Interactive Review Course: October 23, 2018 8am-12:30 p.m. - $399 Advanced Nurse Executive Certification Interactive Review Course - Workshop: October 23, 2018 1:00 p.m.-5:30 p.m. - $399 International Forum: October 23, 2018 5:30pm-7:30pm - $125 Getting Started Magnet Program: October 22, 2018 8am-4pm - $999 Additional Guest to Welcome Party - $125 The Welcome Party is on October 24, 2018 from 7pm to 9pm. Journey through the seasons and snack on locally grown food and enjoy the beer garden from the Colorado microbrewery. Registration Register online only and pay by check or credit card. Pay by check is only to September 7, 2018. After that date, the only payment accepted is by credit card. Refunds up until September 7 minus $200 administration fee. Contact information ANCC Conference Services, P.O. box 207, Lincoln, RI 02865-0207 ancc@confex.com Hotel/Travel Information Use Connection Housing (the official provider) for special rates and features Email: ANCCHousing@ConnectionsHousing.com Phone: 404-842-0000 Toll free: 1-800-262-9974 Fax: 678-228-1930 Information regarding hotels and prices is available at conference site Airline discounts starting on January 22, 2018, 3-10% discounts available Delta - delta.com/meetings: Code NMRT3 1-800-328-1111 United Airlines - www.united.com: Code ZCODE=ZEZC Agreement code: 119159 (1-800-426-1122) Check out the excitement from the 2017 event [video=youtube;0OI-O-Ml6F4] Conclusion Bring your family or a best friend with you to enjoy the Mile High City. There is a large variety of restaurants, museums, nightlife, and natural wonders for you to explore. While you learn and network, you know that you are with an organization that gives back. They partner with Metro Caring that has been in the Denver community since 1974. Here they have a free Fresh Foods Market in which their aim is to end hunger through access to food and break the cycle of poverty.
  7. If you are reading this article, then likely you have come to the same decision or are thinking about it. We each have a story or background as to how we came to make this life-altering leap into the sexy and emotionally fulfilling field of nursing right? (Teehee, that's a whole nother article!) Books, television shows, and movies like to portray nurses as being born knowing that this was our lifelong goal. While this may be true for some of us, how did the rest of us come to choose a career in nursing? In late August 2017, allnurses.com released a survey that ran through September to determine what factors students consider when selecting a school. One of the questions asked nurses and student nurses, "Why did you choose nursing?". The survey, which is set to release soon, had over 1500 participants. The responses varied greatly; some were light-hearted answers (like the "sexy" comment, wearing scrubs, or liking all things gruesome); some practical, "it's what my parents would pay for"; some well thought out, "hours, schedule and pay", and some people were just plain "born to do this". There were a number of similar and common threads woven through the survey responses. Nursing has ranked #1 as the most trusted profession for at least 15 years in a row in Gallup Polls. Job security, flexibility, and pay were a deciding factor for many choosing nursing as a career. No matter sick or well, people will always be in need of healthcare. Nursing was a popular second career choice as reported in the survey results, either from a non-healthcare profession or from many who were non-nursing healthcare professionals. They reported wanting to have more direct contact and connection with patients, many stating that they feel drawn to care for those in need, not to "sit behind a desk". The career opened up possibilities to work schedules so they could care for aging loved ones or children. For many it was a better, more stable paycheck offering sick and vacation time and better healthcare for themselves and their loved ones. Nursing also offered the ability to advance within the career itself and further their education toward ultimate life goals. The "calling", or desire to care for people in a time of crisis or at their weakest, seems to be a strong pull toward nursing as a career. Several answers reflected "always having known that nursing was a calling", or that their "personality and heart guided them" toward this career. There were many replies that the "science" that nursing encompasses was the appeal. Anatomy, physiology, how the body responds to pharmacologic interventions, the technology of caring for the body systems was another popular response. The ability to think critically and quickly and to work with a team of like-minded professionals was a draw. Some answered that they loved the rush of emergent care, or on the flip side, the pace and attention to dying hospice patients and their loved ones. A large number of participants were inspired by a family member (s). Some had family members that were in the healthcare profession and through watching, listening, or living with someone who is a nurse, they felt compelled to go on to nursing school themselves. Experiencing healthcare from the opposite side of the bed was another influence that a family had on many. For some being the patient and "living through" the healthcare continuum was the guide toward wanting to make a difference in the life of others. As we all have come into the "wonderful world of nursing" for our various reasons, decisions, or life events it is clear that the survey has captured the uniqueness that each of us brings to the care of our patients and the advancement of our profession. Our passions, skills, and differences will ultimately keep nursing innovative and cutting edge while maintaining the very core of our career of care and compassion for others. Keep your eyes open and watch for the complete results from the 2017 Student Survey to be posted soon. You will find out what students think are the most important factors to consider when searching for a nursing school. The interactive images will allow you to customize your view and discover how variables such as age, location, current level of educational standing, and degree program enrolled in can affect one's priorities. More 2017 Student Survey Articles... 2017 Student Survey: Demographics 2017 Student Survey: School Profiles 2017 Student Survey: What Students Really Want From Nursing School
  8. allnurses

    Addressing Bullying in the ED

    allnurses.com staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN, Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care. How does bullying in the ED manifest itself? Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care. How does this differ from bullying in other departments? I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions make the emergency department a particularly high-risk area for this dynamic to manifest. What kind of collateral damage results from bullying in the ED? Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs What methods did you find to be the most effective in addressing/decreasing bullying? Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying As a result of your research, what type of training do you recommend? Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying. Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence." ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)." "According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"." ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well. Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?
  9. allnurses

    Urology Nurses Week 2017

    Urology nurses function in multiple environments including hospitals, same-day surgi-centers, private practices and home health. They may care for patients with multiple co-morbidities in addition to urologic needs. The urologic nursing specialty requires its professionals to have a comprehensive knowledge of developmental and aging changes that are essential to understanding acute and chronic urological diseases. Here is an article about urologic nurses. There are several sub-specialties for urologic nurses too: Office nurses that assist with cystoscopies and sedation Nurse Practitioners in urology practices Nurses that administer intravesicular meds for bladder cancer Pediatric urologic nurses Many opportunities exist for urologic nurses and associates. Urologic associates are often unlicensed assistive personnel who help with procedures, assist with patient education and otherwise contribute to overall patient care. Often the nurse will delegate tasks to a urologic associate in order to focus on a nursing-related skillset. Here is a description of a day in a urologist's office. You will see patients with appointments for recurrent UTIs, renal stones, and post-op follow ups. You might also see patients with the complaint of sexual dysfunction related to erectile dysfunction. Urologic nursing can also encompass some aspects of transplant nursing. Renal transplants occur frequently and often are done in coordination with a transplant surgeon as well as urologist. Nurse navigators help to coordinate care and ensures patients are kept up to date regarding their cares, assists with appointments, and facilitates communication. They work with physicians and other medical personnel to help with transitions and follow-up. Nurse navigators bridge the gap between hospital and out-patient care and work as an integral part of the care of the urological patient.
  10. allnurses

    Medical-Surgical Nurses Week 2017

    The Academy of Medical-Surgical Nurses wants to recognize and identify the contributions of med-surg nurses all year round but especially this week. Med-surge nurses form the basis of almost all nursing care. It is the fundamental practice of nursing encompassing many different diagnoses and levels of care. Even though med-surg nurses have existed for many years it wasn't until 1990 that the AMSN was formed with an objectives to: Improve the image of the medical-surgical nursing Develop standards for medical-surgical nursing practice Create a Core Curriculum for establishing the essence of the medical-surgical nursing practice As med-surg nursing has grown, developed and become even more complex, the Academy works to keep up by developing position papers on patient literacy, certification, political awareness, staffing standards and practice environment. Gone are the days of med-surg nurses just providing back rubs, routine bed baths, supervising patients' smoking, and giving the occasional medication. Nowadays, med-surg nurses are caring for central lines, stable inotrope drips, post-op patients with open wounds, patients with cardiac monitoring, and complex medication regimens. Today, more than ever, patients are not hospitalized for long periods of time. Therefore, it is imperative that nurses from admission to discharge work to provide education to the patient and family members to decrease the chance of readmission. Medical-surgical nurses care for patients with a wide variety of diagnoses such as: Gastrointestinal hemorrhages COPD/Asthma Cellulitis Endocarditis Pnuemonia Other infections requiring hospitalization GYN disorders Documentation is always paramount for all nurses. An article published in 2016 on AN focuses on documentation: Nurses Charting. Another popular article, A Push for the Return of Team Nursing explores staffing on med-surge units and the needs of an increasingly complex medical-surgical patient. Many nurses have traditionally started in med-surg in order to get an introduction to the nursing workplace and also develop time management and critical thinking skills. Med-surg nurses are the generalists of nursing. They care for several patients with multiple medical and/or surgical needs. Thank you to all the Med-Surg Nurses on AN. Here is your forum.
  11. allnurses

    NTI: What's a Scromper, Nurse Blake?

    Nurse Blake has invented a nursing "onesie" called a Scromper. He demonstrated the versatility of the Scromper for the allnurses team at NTI. It is a useful and fun item with plenty of pockets, room to move and breathe and relax in! He has partnered with a US scrub company to produce the product. Made out of an ultra soft scrub material, it is available for men and women in sizes small, medium, large, and X-large. Although this would not meet dress codes for work, you can wear it anywhere else and rock it at parties, conferences, or even for Halloween. Nurse Blake launched a Kickstarter for the Scromper this week so everyone can have a chance at getting their very own Scromper at an affordable price while also helping to raise money for a great cause. Proceeds will go toward starting a nursing scholarship fund, because as Blake states, "I want to take this opportunity to give back to the field of nursing and I believe that helping the next generation of nurses is the best way to do that!" Get your Scromper today!!
  12. allnurses

    NTI: Medical Marijuana

    AllNurses staff recently attended NTI in Houston, Texas. Andrea J Efre, DNP, ARNP, ANP-BC presented on the topic of medical marijuana. Medical marijuana is used to treat many conditions so it is reasonable to assume that many of us will come into contact with patients who use this. It is important to take this into consideration when caring for patients. Currently, 29 states have medical marijuana laws. According to the Pew Research Center, in 2015, 53% of Americans favor legalization while 77% approve of its use for medical reasons. Each state has their own procedure for issuing "pot cards." It is important that if you work with a population that uses medicinal marijuana that you are familiar with the procedure or can provide info to the patient who asks questions. The Center for Cannabis Research at the University of California, San Diego has an interesting site that provides a lot of evidence-based information regarding the efficacy of medical marijuana. They are in the process of several research studies regarding the use of medical marijuana in neuropathic low back pain, and HIV neuropathic pain. There has also been research into what disease processes can be helped with medical marijuana and these are just some diagnoses that have been approved by some states for the use of medical marijuana: AIDS/HIV Arthritis Epilepsy Alzheimers Nausea related to chemotherapy Chronic pain Glaucoma Multiple sclerosis As you can see, this covers a wide range of patients. And as with any substance, you ingest while there positives, nurses have to consider drug interactions too. According to Mayo Clinic: An interesting drug interaction can occur between medical marijuana and birth control pills that contain estrogen. According to the Susan G. Komen Foundation: And then there are the ethical and legal concerns for nurses who might prescribe or administer medical marijuana. From Medscape: As with any drug, there can be side effects which may include: Nausea, vomiting Dizzyness Syncope Fatigue Feelings of intoxication Behavioral or mood changes Anxiety Cognitive impairment Psychosis Paranoia and hallucinations may be exhibited by new users These side effects can increase also due to the original disease process which is being treated by the marijuana. For instance, in multiple sclerosis patients, who already have an increased risk of depression and anxiety, these feelings can be magnified. For patients with a cardiac history, marijuana possibly can cause tachycardia which may lead to an acute coronary syndrome (ACS). Studies that have looked at cardiac events for marijuana users are not definitive though as many also ingested tobacco products thus putting them at higher cardiac risk. There is a difference between the recreational use of marijuana and medical use. It is important to be aware of the uses, drug interactions and side effects of ALL the medication that your patient takes. References: 29 Legal Medical Marijuana States Center For Medicinal Cannabis Research Marijuana: Interactions with Drugs Medical Marijuana: A Primer on Ethics, Evidence and Politics Susan G Komen Foundation Ten Diseases Where Medical Marijuana Could Have Impact Why Americans Support Medical Marijuana
  13. allnurses

    NTI: Post-Procedure Complications

    Most of the time the patient recovers uneventfully. However, what happens when they don't? Would you know how to troubleshoot and care for the patient with complications from these commonly performed procedures? Some of the associated complications are retroperitoneal bleed, lacerated liver, perforated myocardium, and pneumothorax. AllNurses staff recently attended NTI in Houston, Texas. Cheryl D Herrmann, RN, APN, CCRN, CCNS-CSC-CMC facilitated a session about post-procedure complications. Cardiac Catheterization and Pacemaker Insertion Cardiac catheterization can be done for a variety of reasons but is most performed for chest pain evaluation. Pacemaker insertion also involves multiple disease processes from sick sinus syndrome to patients post-myocardial infarction (MI) to patients with congenital heart malformations. Some of the complications that can occur include: Bleeding from the insertion site Hematoma Perforated myocardium Allergic reaction to the contrast medium Death The risk of death is 0.1% per 200,000 procedures per UpToDate. The most common complication is bleeding, either acutely hemorrhagic which usually occurs in the first 12 hours or contained hemorrhage in the femoral region which might not be evident until days to weeks later. The perforated myocardium is one of the rarer complications. The risks are increased with the use of stiff catheters, including transseptal catheterization, endomyocardial biopsy, balloon valvuloplasty, needle pericardiocentesis, and placement of a pacing catheter. Cardiac perforation often results in bradycardia and hypotension due to stimulation of the vagus nerve. If the patient remains stable, an echo can be done. However, as these patients tend to go downhill quickly emergent pericardiocentesis should be performed via the subxiphoid approach. Nursing Care of the Patient with a Perforated Myocardium Most often these patients will be identified mid-procedure as once the myocardium is breached, the patient's blood pressure (BP) will fall and the patient will develop bradycardia. Nurses monitoring patients in the cath lab are on the forefront to note changes in BP and heart rate (HR). These patients will be transferred emergently to the operating room (OR) or if stable, may have echo while still in the cath lab. Nursing care will include: Close monitoring and documentation of baseline vitals, time of sedation, time of procedural start points as well as any concerns or issues during the procedure. Inform the surgeon of any discrepancies or changes in the patient's vitals or status If the patient is to be taken emergently to the OR, have another member of the team notify the family and move them to the appropriate waiting area. Chest Tube Insertion and Thoracentesis A thoracentesis can be either diagnostic - to find out what is causing the excess pleural fluid or diagnostic - to remove the excess pleural fluid. Sometimes a chest tube is inserted to drain the pleural cavity. Chest tube placement and/or thoracentesis can be done bedside, usually in an intensive care unit (ICU) or more commonly it is done in Interventional Radiology (IR) under sono-guided fluoroscopy. These procedures are usually accomplished with local anesthetic and sedation. In the ICU environment, the patient may be on ventilatory support. When doing a thoracentesis for diagnostic purposes, common tests performed on pleural fluid include cell count, protein, lactate dehydrogenase, pH, glucose, amylase, gram stain, culture, and cytology. The pleural fluid should be immediately placed in the appropriate specimen tubes and bottles, and then sent to the laboratory for analysis Common Complications associated with chest tube insertion or thoracentesis include: Pain at the puncture site Bleeding (eg, hematoma, hemothorax, or hemoperitoneum) Pneumothorax Empyema Soft tissue infection Spleen or liver puncture Central Line Removal The most serious complication that can result from central line removal is an air embolus. Key points to avoid air embolism when removing the central line: Place the patient in the supine position (they should not be sitting or upright) Instruct the patient to hold their breath and perform the Valsalva maneuver (forced expiration with the mouth closed) when the catheter is being removed If the patient is unable to cooperate with instructions, the catheter should be removed following inspiration Cover the insertion site immediately with sterile gauze, maintain firm manual pressure until hemostasis is achieved. Then cover the site with an air-occlusive dressing, which should remain in place for 24-72 hours. Procedures are not without risk of complication. It is important to have all the needed emergency equipment readily available to care for your patient during and after a procedure. References: Diagnostic Thoracentesis Myocardial Rupture Treatment and Management UpToDate, Complications of Diagnostic Heart Catheterization
  14. Allnurses staff recently attended AACN's National Teaching Institute 2017 in Houston, Texas. One of the interesting presentations was Mastering the Art of Professional Networking, presented by Alvin Jeffery, MSN, CCNR, RN-BC and Anna Dermenchyan, RN, BSN, CCRN-CSC. Networking is one of the best ways to make connections that will lead to success in your nursing career. Getting to know other nurses on a professional basis often leads to a tip on a new job, insider information about a prospective facility or unit and can expand your circle of friends. Develop a Goal for Your Network Adventure Are you looking for a new job? Do you want to expand your knowledge of your present specialty? Are you returning to school? Do you want to expand your social media network? What is your goal when you talk about networking? Before you go to a networking event, determine your goal and decide what you would consider success? Is it getting an insider view of a particular hospital or unit? Getting the name of a unit manager or recruiter? Making new contacts in general? Benefits of Networking Potential employment and consulting opportunities Identity for oneself Be more effective in your current job Engagement with others Build a support system Networking at a Nursing Conference That said, few of us can walk into a room of strangers and start instantly networking. Here are some tips for your networking success: Be interesting If you want to have interesting conversations you must be an interesting person. You can do this by staying up-to-date on current events, both in and out of nursing, and doing some homework before the occasion. Check the agenda in advance and research the guest speaker, host, sponsor, or award recipients. Knowing these details will empower you to initiate discussions. Step outside your comfort zone Most of us are more at ease conversing with people we know, which means we often end up not meeting anyone new. Summon the confidence to independently work your way around the room. While you're at it, introduce yourself to someone you've never met before and start a dialogue. If you're unsure whom to approach, simply look for a person who is alone. Invite others to join you People naturally gravitate toward those who are warm and welcoming. Display open body language, wear a smile, make eye contact, and always be ready to shake hands and introduce yourself and the others in your group to newcomers. Make every effort to be inclusive of everyone. Refer to people by name When you meet someone new, use his or her name as soon as you can in conversation. If you forget the name of a person you've met before, ask for clarification. A gracious way to do this is to say, "I remember meeting you, but somehow I've forgotten your name. Can you please tell me what it is again?" Have an escape plan Knowing how to exit a conversational cul-de-sac can be your saving grace. If you need to leave a group discussion, simply excuse yourself at an appropriate moment. When someone has you cornered in a one-on-one situation, however, acknowledge that you were listening before you leave. Wait for a natural break, comment on a point they made, say their name, and move on. Try something like this, "It sounds like your research project is fascinating, Jeremy. Best of luck. Enjoy the rest of the conference." And here are some additional networking questions for national conferences: What's your name? Where are you from? What do you do? Is this your first time at NTI? If not, which other ones have you been to? What's been your favorite thing so far? Who inspires you? Which workshops/tracks are you attending at the conference? Social Networking The rules for social networking vary depending on the goal of your networking. Some of the more common tips are: Create a professional networking profile. No matter what social media platform you choose, it is imperative that you develop a professional profile. Include a professional headshot of you. Do not use a selfie or a picture that could be misinterpreted as less than professional. Join professional groups or discussion boards. You already have a common ground and this makes it easier to talk about your commonalities. Volunteer with your professional organization - this is a great way to network and develop relationships. Volunteering doesn't necessarily have to involve a lot of time and effort but volunteers are noticed and that's one of the goals of networking. Pitfalls of Networking As with anything positive, there are also negatives. Avoid the following issues: Always go to a networking event prepared: find out the dress code in advance, bring plenty of business cards and understand your goals. Do your research on the organizer: what is their goal for this event? Don't arrive late. When you arrive with others, it automatically opens up a conversation. If you arrive late, the conversations will have already started and you have missed out on valuable networking time. References: Networking for Medical Professionals Networking Tips for Every Healthcare Professional Can Use 3 Business Networking Pitfalls to Avoid
  15. allnurses

    NTI: Pain Management Challenges

    Hospitalized patients often experience pain. In the ICU, most patient experience pain to some degree. As more invasive and painful procedures are performed, pain escalates. Add in intubation, multiple lines and your patient experience a wide variety of painful sensations. How to manage this pain? What is the best pain regimen for the opioid naive and opioid-dependent patient? Principles of Pain Assessment Pain is a subjective complaint based on many factors: Procedures being performed Patient past medical history History of opioid use Perception of care received Just to name a few. Assessing pain can also involve many avenues - for the verbal patient: Wong-Baker Pain Scale Faces Pain Scale Verbalization from the patient It becomes more difficult to assess pain in the unresponsive patient. Patients can be unresponsive for various reasons: intubation, sedation, paralysis, dementia, psychiatric disease. However, here are some tips: Grimacing Tachycardia Irritability Decreased interaction with the environment Opioid-Tolerant Patients There is no exact formula to follow to ensure adequate pain management for your patients that already take opioids. The first task is to obtain information regarding the patient's past/current opioid use. Do they have cancer and take escalating doses? Are they on maintenance suboxone for past opioid addiction? Do they use street drugs? Not always easy questions to ask. If the patient is unresponsive, asking the family in a non-judgemental manner is essential. Emphasize that you want to provide optimal pain relief and in order to do so, you need to know if the patient takes opioid medication/drugs frequently. From the Society of Hospital Medicine: "Patients with chronic pain present a special challenge. When they have pre-existing pain and undergo an operative procedure, it becomes important to differentiate pre-existing chronic pain from new acute postoperative pain. Additionally, patients already on chronic opioid therapy may require a 200 to 400 percent increase in preoperative opioid requirements.24 Thus, it is important to establish preoperative analgesic requirements to create a postoperative pain management plan, not to mention a keen awareness of comorbidities that may preclude the escalation of regimens due to patient safety concerns." The Stepwise Approach is recommended - this involves the use of non-opioid medications such as NSAIDs, Cox-2 Inhibitors and non-pharmacological options also. However, in opioid-tolerant patients, "always start off with an immediate release medication. Long-acting opioids are not appropriate to be used to treat acute pain and for initial dose titration. The route of pain medications also makes a difference in the frequency of administering pain medications. Short-acting oral opioids peak in 45-60 minutes. Intravenous dosing will peak in 10-15 minutes. Knowing these parameters makes it easier to dose medications sooner to achieve adequate pain relief in acute pain. When dosing medications for acute pain, it is appropriate to give an additional dose if the pain is not relieved by the expected peak time. As an example, if a patient in acute pain is given an intravenous dose, then it is appropriate to give the same dose again or double the dose (depending on the clinical situation) if there is no relief in 15 minutes once peak onset of action has been reached." (Society of Hospital Medicine) Opioid Naive Patients Patients that do not take opioids merit consideration also. "When using a patient-controlled analgesic (PCA) in opioid-naïve patients, only patient-controlled dosing should be used initially. Starting a continuous basal dose on an opioid-naïve patient is generally not appropriate. Once steady state is achieved with patient-controlled bolus dosing in 24 hours, then starting a continuous basal rate can be considered if the clinical judgment deems it necessary to use opioids for a longer time period." (Society of Hospital Medicine) Other Considerations Always be mindful of renal function as this can adversely affect pain control. Also, due to many factors, renal function can deteriorate while hospitalized. Dose adjustment must be considered. NSAIDs and Cox-2 Inhibitors are usually precluded for the patient who has decreased renal function. Patients on dialysis or CRRT also pose special pain management issues and it will be important to bring on the care of the nephrologist. References: Getting Out of Your Comfort Zone With Opioid Tolerant Patients Multi-Modal Pain Strategies for the Post-Op Patient - Society of Hospital Medicine
  16. allnurses

    NTI: Resiliency and Burnout

    Staff of allnurses recently attended the AACN National Teaching Institute (NTI) in Houston, Texas. One of the sessions was "Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments", presented by Vicki Good, DNP, RN, CENP, CPPS. "I'm fried!" "I just can't do this anymore!" "I'm burnt out!" How many times have we heard our colleagues or even ourselves say or think these thoughts? Nursing is a high-stress environment. Burnout is a state of stress that many high achievers experience. Some of the symptoms are: physical and emotional exhaustion cynicism and detachment feelings of ineffectiveness and lack of accomplishment Exhaustion is generalized fatigue that can be related to devoting excessive time and effort to a task or project that is not perceived to be beneficial. Depersonalization is a distant or indifferent attitude toward work. It manifests as negative, callous, and cynical behaviors or interaction with colleagues or patients in an impersonal manner. Reduced personal accomplishment is the tendency to negatively evaluate the worth of one's work, feeling insufficient regarding the ability to perform one's job, and a generalized poor professional self-esteem. Experts estimate that one out of three critical care nurses is experiencing severe burnout syndrome, which is often referred to as a "silent epidemic" in healthcare. Organizational and individual factors lead to the presence of burnout syndrome and both must be addressed to prevent the negative consequences of the syndrome. Critical care nurses are at high risk for burnout due to the complexity of care as well as the high mortality and morbidity of the patients they care for. Over the years, as patient acuity has increased, so has the immense responsibility of the critical care nurse. The ethical journey that we take also takes it toll. The question is no longer "what can be done?" but rather, "should we do it?" Should we continue full court press for all patients regardless of their quality of life? Should we offer all modalities and treatment options even knowing they come with a high potential for a limited quality of life? These questions and much more lead to stress which in turn leads to burnout. We constantly care for others, yet sometimes we are not kind to ourselves. How many times have we put off going to lunch, break, bathroom because "our patient needs us?" How many times have we said "yes" to overtime that we didn't really want to do just so our co-workers wouldn't work short? Again, all circumstances that lead to added stress and burnout. So...how do we combat burnout? Based on a report from the American Association of Critical-Care Nurses, 6 standards are needed to establish and sustain a healthy work environment: Skilled communication True collaboration Effective decision-making Appropriate staffing Meaningful recognition Authentic leadership. Additional commonly recognized tenets of a healthy ICU environment include "avoiding or managing conflicts" and "improving end-of-life care." Communication, collaboration, and effective decision-making during times when emotions are elevated are critical in engaging the team to decrease stress and BOS. A healthy work environment may be enhanced by utilizing team debriefings, structured communication, and collaborating with team members on critical decisions. From Dr. Good's presentation, here are some environmental or organizational solutions: Acknowledgment of stress and burnout Established wellness program Palliative care consultations Active Ethics Committee As individuals there are steps we can also take to reduce or relieve burnout: Stress reduction training Meditations Work-life balance Ensuring adequate rest, breaks, time with family and outside activities We all realize that we work in a stressful environment. To continue to care for our patients and ourselves we need to recognize ways to minimize and cope with stress. It is important that both our organization and nurses work together to focus attention on this increasingly common issue and work jointly to combat it. In the end, this will provide improved care for both patients and nurses. References: American Association of Critical-Care Nurses. AACN Standards for Establishing and Sustaining Healthy Work Environments: A Journey to Excellence. 2nd ed. Aliso Viejo, CA: American Association of Critical-Care Nurses; 2016. Burnout Syndrome in Critical Care Healthcare Professionals Owning Your Future: Building Personal Resiliency in Times of Burnout and Challenging Environments Tell-tale Symptoms of Burn-Out
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