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SafetyNurse1968 ADN, BSN, MSN, PhD

Oncology, Home Health, Patient Safety

If I were in charge of the universe, there would be staffing ratio laws and unions in every state and you'd get written up for NOT taking your breaks.

Content by SafetyNurse1968

  1. If you think you know the correct diagnosis for this Case Study (CSI)... Do not post the answer here. Instead, post your answer in the Admin Help Desk. We don't want to spoil it for others who are late in joining us. In a few days, after the diagnosis is posted, Admins will announce the names of those who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You can ask questions and comments below. Chief Complaint “My son died a month ago. He was stationed in Afghanistan. I think I’m still in shock. For the last few weeks I haven’t slept well. I keep waking up in the middle of the night, my heart pounding, out of breath, and now on top of that I’ve been feeling nauseated. I even threw up yesterday. I wonder if I have the stomach flu. I’m just praying I don’t have another migraine coming on.” History of Present Illness A.W. began to experience shortness of breath and racing heart approximately two weeks ago, primarily at night. Nausea began two days ago with two episodes of emesis yesterday. Admits to burning pain in her throat that she attributes to heartburn. Ms. W. has been depressed and anxious since learning of her youngest son’s death. Ms. W. states she has been feeling more tired than usual, but attributes it to lack of sleep and stress over her son’s death. Most recent migraine was over a month ago. General Appearance Looks anxious. Eyes wide, blinks a lot, shoulders tense, diaphoretic, occasionally rubs stomach just under sternum. Pt appears female, skin is brown in color, appears stated age, looks slightly overweight with weight carried around the middle. Okay super sleuths, what’s going on here? What information do you need? What would you do first? What labs do you want? What other diagnostic tests should we run? Ask me some questions! REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  2. I have asked a fellow faculty member for access to their PowerPoints and exam questions, and they have refused. I'm a new faculty member, teaching pathophysiology for the first time. I've been teaching for almost 25 years, 10 of those in the field of nursing, so I feel pretty confident in how to go about creating materials for the course. There are two other faculty members teaching the course who have been at the school for many years. I approached them, asking if I might see their materials so I would know if I am on the right track - am I teaching at the right level? The faculty keep referring me to the syllabus and the course outcomes, which I am already using to design my test blueprints. Here is an example of why I am nervous: I was prepping to teach acid base (using the syllabus, the course objectives, the textbook and textbook PowerPoints as guidelines for my lecture, while adding my own flavor and flair to it -I like to throw in videos, sample test questions and case studies). While I was prepping for this content, I asked a senior nursing student about her memories from the course and she told me she is still using the tic tac toe method and how great it was that she had been taught how to solve acid base problems in path. I almost had a heart attack - there was nothing in the syllabus, powerpoints or textbooks to suggest that I go to that level in a pre-nursing course. I spent many hours revamping my course to include acid base problem solving. I never had to take path... I don't have a solid idea of what a pre-nursing student needs to get from this course...My insecurity isn't from a lack of understanding of WHAT to cover, it's confusion over how DEEP to go...what level? I've always shared everything I create with anyone who wants it, and I've never had faculty at other institutions refuse requests in the past. I've spoken directly to the faculty member who is the course coordinator and here are the reasons for not sharing: 1. I might copy their stuff 2. I need to create materials to match my own teaching style 3. I might give her stuff to the students and/or the students may share her test questions with each other 4. They don't trust me because they don't know me 5. They've asked other professionals whom they trust and they said that sharing test items and PowerPoints is not best practice. CONUNDRUM: I'm still baffled - I've looked through the literature briefly and can't find anything to suggest that sharing test questions and PowerPoints is not best practice. With the NCLEX as the end game, it seems important that all the students in the program get a similar experience in our course. As a solution, I sent a copy of the most recent test I wrote and asked them to review it for me. I've also suggested that the instructors for the course might get together and write some exams in a collaborative fashion. I'd love to know what you think? Do you share? If so, what? Why or why not? Do you have any research to back up your position on sharing? I've written to the NLN to see if they can direct me to someone who might have an answer. In my doctoral education I recall reading multiple articles and books about the importance of collaboration, but I'm looking for specific research on best practice in nursing education regarding sharing of materials, most specifically, test items and PowerPoints.
  3. SafetyNurse1968

    Case Study(CSI): Stomach flu? Anxiety? What’s Going on Here?

    No lower extremity edema. You'll have to wait till Saturday for the rest :)
  4. SafetyNurse1968

    Case Study(CSI): Stomach flu? Anxiety? What’s Going on Here?

    UPDATE! I'll repost all the additional data since the ORIGINAL POST (OP). PLUS some extra info you didn't ask for: REMEMBER: DON’T POST THE ANSWER HERE! Ask questions and I’ll give you more information. Past Medical History: Type 2 DM X 5 years Migraine with aura X 25 years Hypertriglyceridemia HTN X 12 years (poorly controlled, poor patient compliance) Family History (no one asked for this!): Mother died from breast cancer at age 79 Father died from myocardial infarction at age 55, had DM Son died in combat at age 24 Daughter age 40 diagnosed with pre-hypertension and pre-diabetes, son age 38 alive and well One sister, age 62 alive and well, one brother age 60 with HTN Grandparents “may have had heart disease” Social History (you asked for alcohol use, but not the rest...): Born in Tulsa, Oklahoma, the youngest of three children. Lives in Santa Monica, California with husband Christian Scientist Runs a non-profit and husband is a writer Drinks “one glass of wine” per day, Smoked half-pack per day for ten years, quit 5 years ago Denies drug use Medications: Amlodipine 5 mg po QPM Glyburide 10 mg po QAM, 5 mg po QPM EC ASA 325 mg po QD Gemfibrozil 600 mg po BID Terazosin 1 mg ph HS Metoclopramide 10 mg PRN nausea related to migraine Imitrex 25 mg PRN migraine pain Allergies: NKA Review of Systems [only abnormal findings are presented]: THIS IS NEW Skin: cool, diaphoretic Slight basilar inspiratory crackles with auscultation Tachycardia with occasional premature beat Soft S4 Distinct bruit over left femoral artery Vital signs: BP 160/98 RA sitting HR 105 RR 18 T 98.2oF HT 5’6” WT 170 lbs BMI 27.4 Laboratory Test Results: Na 133 meg/L K 4.3 meq/L Cl 101 HCO3 BUN 14 mg/dL Cr 0.9 mg/dL Glucose, fasting 264 mg/dL Mg 1.9 PO4 2.3 Cholesterol 213 Triglycerides 174 LDL 143 HDL 34 CPK 99 IU/L CK-MB 6.3 IU/L Troponin I 0.3 ng/mL Hb 12.2 g/dL Hct 40% WBC 4,900/mm3 Plt 267,000/mm3 HbA1c 8.7% Arterial Blood Gas pH 7.42 PaO2 90 mm PaCO2 34 mm SaO2 96.5% UPDATE Ms. W. began to experience burning and choking pain in throat, and her jaw started to hurt with pain 9/10. The patient was transported to the ED with suspected heart attack. En route she was placed on nasal cannulae and IV fluids were started. She received ASA 325 mg po and 2 mg/IV morphine. Pain eased slightly to 8/10. Pain unrelieved by 3 SL nitroglycerin tablets. Electrocardiogram: 4 mm ST segment elevation in leads V2-V6 Imaging: Chest X-ray shows bilateral mild pulmonary edema (<10% lung fields) without pleural disease or widening of mediastinum. Go to the ADMIN HELP DESK and post a specific diagnosis - PLEASE DON'T POST HERE! What you CAN post here is: did anything about the update confirm or refute your initial ideas? Was anything surprising? Was there any data you wish you'd asked for? On Saturday I'll post the FINAL ANSWER!
  5. Surgical smoke is produced by thermal destruction of tissue by use of lasers or electrosurgical devices during procedures like blood vessel cauterization. The CDC states that over 500,000 healthcare workers are exposed to surgical smoke, including surgeons, nurses and surgical techs, not to mention patients. The OR can fill with smoke in as little as 5 minutes after surgery begins.1 Smoking in the OR There are multiple issues with smoke in the OR. It can get so thick that it obstructs the surgeon’s view. It also causes bad odors, irritates the eyes, nose and throat, causes headaches, coughs and asthma.1 After being exposed to surgical smoke all day Brenda Ulmer, a nurse in Georgia who is a proponent of the Bill stated, “my chest felt tight, I felt sick in my stomach and my throat hurt.” Brenda Ulmer says “I had issues with allergies and asthma. I had to go on an inhaler.”2 Acute health effects of exposure include1: Eye, nose and throat irritation Headache Cough Nasal congestion Asthma and asthma-like symptoms Bacteria and Viruses in Smoke? The National Institute for Occupational Safety and Health (NIOSH), a subdivision of the CDC states the surgical smoke plume may contain toxic chemicals such as carbon monoxide, polyaromatic hydrocarbons, benzene, hydrogen cyanide, formaldehyde, viable and non-viable cellular material, viruses and bacteria (NIOSH).1 No research has linked surgical smoke to cancer, but smoke inhalation has been known to induce acute and chronic inflammation (emphysema, asthma, chronic bronchitis) in animal models. It’s frustrating because there’s not a lot of scientific data on humans. In a study on the risk of infection and disease, it was found that Human Papilloma Virus can be transmitted through surgical smoke. Case in point, a laser surgeon developed laryngeal papillomatosis, which was linked to viral particles present in the laser plume.3 It Doesn’t Have to Be This Way What gets me so angry about this topic is that like so many issues in health care, a little prevention could solve the problem. Evacuators or Local Exhaust Ventilation (LEV) devices remove smoke from the room efficiently and inexpensively. I looked up pricing and the Center for Construction Research and Training (CPWR) cites a retail price from $1000 - $3000. Welders use LEVs constantly to prevent inhalation of Mercury and other heavy metals.4 NIOSH recommends using local exhaust ventilation (LEV) for all procedures where surgical smoke is generated as best practice. Training should be provided for employees about the risks of inhalation of surgical smoke, and exposure should be minimized. In addition, they recommend using a properly fitted, filtering facepiece respirator (N95) rather than a surgical or laser mask.1 Who is affected? NIOSH conducted a survey of healthcare workers. To be included in the survey, respondents had to be within five feet of surgical smoke in the seven days prior to the survey. 4,533 survey respondents reported exposure to surgical smoke: “4,500 during electrosurgery; 1,392 during laser surgery procedures. Respondents were mainly nurses (56%) and anesthesiologists (21%). Only 14% of those exposed during electrosurgery reported local exhaust ventilation (LEV) was always used during these procedures, while 47% reported use during laser surgery. Those reporting that LEV was always used were also more likely to report training and employer standard procedures addressing the hazards of surgical smoke. Few respondents reported use of respiratory protection.” 1 What about patients? In a study of 1,312 spine surgeries in the OR with and without smoke removed demonstrated no statistically significant in infection rates. However, a study in Poland found a significantly higher level of benzene and toluene in urine after laparoscopic cholecystectomy than before it.3 History Lesson As of November 2019, only two states have enacted laws mandating evacuation of smoke from ORs: Rhode Island and Colorado. Rhode Island was the first state to enact a law requiring LEVs. Julie Greenhalgh, RN, an OR nurse with 42 years of experience in Cranston, RI testified at the hearing for the Bill. She attributed her chronic lung disease to decades of exposure to surgical smoke. “I never smoked cigarettes and now I have constant cough, bronchitis and asthma.” She uses three inhalers a day. The Rhode Island Bill became a law on January 1, 2019.3 Colorado enacted a law on March 28, 2019 to protect CO perioperative nurses and surgical team members from the harmful effects of plume. All ORs must implement the new rules before May 1, 2021.5 In Georgia, like the other 47 states without surgical smoke laws, it’s up to each hospital to decide to use surgical smoke evacuators – it’s not mandatory. 2 The proposed bill in Georgia is to make evacuators mandatory inside every OR in Georgia. The cost to the patient would be $25 per procedure but could save thousands in health care costs down the line. 2 Legal Action? According to a legal site, OSHA has regulations in place that should protect nurses.6 Health care organizations have a duty to address recognized hazards with a feasible means of abatement. Employers could be liable for unabated exposure to surgical smoke. OSHA requires an injury and illness prevention plan in some states like California and Washington. Employers in these states are required to train employees on the hazards in their workplaces. Employees and patients who suffer from cancer or infectious diseases at the workplace could bring worker’s compensation or potentially tort claims.6 In other words, if you’re breathing in surgical smoke day after day and you start to feel sick, you may want to talk with an attorney. I’m not normally litigious, but it often seems that healthcare organizations only change their policies for fiscal reasons. What’s Coming I always advocate for joining an organization with a proven track record of effective lobbying. It’s the only way us nurses will ever see positive change in the workplace. Organizations like the Association of perioperative Registered Nurses (AORN) are working hard to ensure the safety of perioperative nurses. The AORN website lists several states considering LEV mandates7: Oregon is having a smoke-free OR day on Feb 4, 2020. AORN asks nurses to spend the day at the Oregon State Capitol to advocate for surgical smoke evacuation legislation. A New Jersey assemblywoman introduced a surgical smoke Bill in NJ in September of 2019. California is currently reviewing comments on surgical smoke evacuation as they work toward proposed regulations. AORN is lobbying for similar bills in other states, so consider joining the cause. If we all donated $1, think what we could do? $3million dollars is a lot of lobbying money! I’m not an OR nurse, but I know several and they are good people who don’t deserve to be needlessly exposed to toxic chemicals that have the potential to cause lung disease. As a possible future patient, I wouldn’t want to be lying unconscious on the operating table breathing in my own cauterized blood vessels. The impact on my respiratory system could be serious, plus it’s just disgusting. I know, not my usual scientific approach, but this article really got me riled up! I'd love to hear there's progress out there toward protecting healthcare providers from surgical smoke. I hope you'll comment and let me know your thoughts and/or experiences.
  6. SafetyNurse1968

    You Can Smoke in the Operating Room! Surgical Smoke in the News.

    Agree 100%. Thanks for reading and commenting!
  7. The next time you’re at work, look around. How many of your fellow nurses are men? I teach nursing and in a class of forty students, I have only three students who identify as men. None of the forty faculty members at my school of nursing are male. Back in the 1960s, only 2 percent of nurses were male, but now the number has risen to 13 percent.1 Why is nursing so female-centric? HISTORY We were taught in nursing school that the first nurses were male caregivers in Ancient Rome, tending the sick and dying during the Crusades. Male nurses were also found in the Civil War in both the Union and Confederate armies. The shift to an all-female workforce didn’t begin until the Army Nurse Corps (ANC), established in 1901, banned men from serving as nurses. It wasn’t until 1955 that they commissioned the first male officer.2 MEDIA You may have seen a movie called Meet the Parents, in which Ben Stiller plays Greg Focker, a male nurse who perpetuates stereotypes that women are nurses and men are doctors. If you look at Grey’s Anatomy, Scrubs and ER, the stereotypes continue. We might see a female doctor, but never a male nurse. In a survey of male nurses, 70 percent stated that gender stereotypes are the main barrier to entering the field of nursing.1 Male nurse respondents indicated they were influenced by the misperception that the profession of nursing is not “appropriate” for men. CHALLENGING MASCULINITY In an article in American Nurse Today, David Foley shares some of his experiences as a male nurse. “The pressure to create a masculine identity within a historically female profession proves overwhelming and they [male nurses] flee for the operating room, emergency department or intensive care unit.” Male nursing students may face questions from family and friends about choosing nursing and may face challenges to their masculinity because women are traditionally seen as nurturers, while men are in more dominant leadership roles. Foley shared a story about a student who was actively discouraged from going into a less technical discipline in nursing with comments like, “You’ll never be accepted,” “Why would you want to make your life so hard,” and “What’s wrong with critical care? You’ll make more money.”3 Edward Bennett, named 2018 Student Nurse of the Year by the National Black Nurses Association, said, “I’ve definitely gotten pushback for being a black male nurse. Other people look at me like, ‘why would you want to be a nurse when you can be doctor?” Bennett continues to advocate for changing misconceptions by reminding prospective male nurses that, “You work with your hands, you think critically and you advocate for your patients every day.”4 Male nurses face a particularly steep challenge in obstetrics and OB-GYN. Even if they overcome stereotypes about who should pursue this field of nursing, often they cannot obtain access to patients. As an instructor I have seen it happen many times – a woman giving birth or having a pelvic exam doesn’t want a male nursing student to observe or care for her.3 In a survey of 462 undergraduate nursing students in Canada, male students demonstrated significantly lower scores on the efficacy subscale, suggesting that some men experience feelings of marginalization and discrimination.5 SOLUTIONS According to the IOM report, The Future of Nursing: Leading Health, Advancing Change, we must find a solution. Men provide unique perspectives and skills that are crucial to the profession and to society as a whole. We need to place a greater emphasis on recruiting men into the field. We know that patients are more receptive to healthcare providers of similar cultural and ethnic backgrounds.1 Male patients may feel more comfortable discussing certain conditions, especially those related to sexual and reproductive health, with other men, than with women. The World Health Organization identifies the “men’s health gap” – men visit the doctor less frequently and are less likely to ask questions or bring up concerns during appointments. “Having a male nurse could help open them up” says Bryan Smith, president of the American Association for Men in Nursing.6 The nursing shortage is another reason to recruit men. The president of the American Assembly for Men in Nursing, William T. Lecher, states that “The shortage of the future will likely not be solved unless men are part of the equation.”1 Elias Provencio-Vasquez, a Robert Wood Johnson Foundation Executive Nurse Fellow, shares that when he was met with resistance from some female patients in the maternity ward early in his career as a student at the University of Texas, in El Paso, “We overcame that by presenting ourselves as students, and our faculty members were very professional and very supportive."1 Bennett recommends creating pipeline programs for male students at predominantly African American high schools to diversify the profession in multiple ways.4 THE AAMN To encourage more men to join the profession, the AAMN conducts outreach, challenging local chapters to reach as many male middle and high school students as possible through classroom visits, career fairs and more. The AAMN also offers an award to the best schools for men in nursing to recognize programs that have made efforts in recruiting and retaining male students. Award winners include Nebraska Methodist, Duke, Goldfarb, New York University, Rush, Rutgers, Vanderbilt and West Coast University. In addition, the AAMN enlists members to guest lecture at nursing schools. Only 6 percent of faculty are men. Having a lecture from a male nurse can have a powerful impact on male students who are feeling isolated and alone. “Just seeing a male being successful in nursing, even though it seems like something so small, can really trigger a sense of belonging.” says Smith.4 Nurse educators and preceptors must acknowledge that gender bias exists. We need to refrain from gender-biased language and teaching practices that may discourage male nurses from embracing a career in any of the specialties of nursing. WHAT DO YOU THINK? I’d love to hear from male nurses out there – what has your experience been? Did you find support when you needed it? Do you have ideas for how we can recruit more men into nursing and remove some of the misconceptions that are preventing a diverse workforce? Read Gender Bias in Health Care to learn more about gender bias in health care. REFERENCES Male nurses break through barriers to diversity profession Men in Nursing: History, Stereotypes, and the Gender Pay Gap How to Avoid Gender Bias in Nursing Education Bohanon M. (2019, January 8). Men in nursing: A crucial profession continues to lack gender diversity. Sedgwick, M. G. & Kellett, P. (2015). Exploring masculinity and marginalization of male undergraduate nursing students’ experience of belonging during clinical experiences. Journal of Nursing Education, 54(3):121-129. American Association for Men in Nursing.
  8. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Chief Complaint “Over the last few months I’ve been increasingly exhausted. I thought maybe I just needed some time off, but now that I’m actually taking a break from work, I’ve been feeling worse than ever. This last week I haven’t even been able to walk the dog.” History of Present Illness T.K. is a 51 year old woman of mixed race who presents to her primary care provider with progressive fatigue, loss of appetite and mild nausea for the last 6 days. She has been at home for the last 5 days on leave from work but has been unable to take part in her usual activities including walking the dog and gardening. Her partner has insisted that she make an appointment with her primary care provider. General Appearance Looks fatigued: eyes and shoulders drooping, sighs deeply every few minutes, flat affect, moves slowly and with effort; pt appears female, skin is brown in color, appears stated age Past Medical History Broken clavicle from a fall from her bicycle, treated with surgery 10 years ago Latent TB, Positive PPD 4 years ago, treatment with isoniazid (INH) for 9 months High blood pressure, pre-diabetes and hypercholesterolemia for 2 years controlled with diet and exercise Mild depression diagnosed 4 years ago, treated with Prozac and counseling Family History Mother had Ductal Carcinoma In Situ 15 years ago Father had MI at age 65 One brother died from opioid overdose at age 21 One sister (age 45) with Graves disease Social History Born and raised in Asheville, NC Works in an insurance office doing medical coding, previously had been an RN, but quit R/T latent TB Partner teaches elementary school, no medical issues Drinks 1-2 alcoholic beverages per week, non-smoker, occasional cannabis use, denies other drug use Loves gardening and hiking with partner and dogs Tries to walk daily and follows low carb, low cholesterol, low salt diet Medications Prozac 40 mg PO daily for mild depression Acetaminophen 650 mg PO, every 4 hours PRN pain Loratadine 10 mg PO daily for allergies Benadryl 50 mg PO qhs PRN sleeplessness Multivitamin, Centrum, PO daily Allergies NKA Review of Systems (only abnormal systems are presented) Weight loss of 10 pounds in last month Salt cravings for several weeks until loss of appetite a week ago Several bouts of dizziness, one fainting spell in last 6 months Few aches and pains Very dry skin, subnormal turgor, sparse axillary hair, pigmented skin creases on palms of hand, elbows and backs of knees Breasts have very dark areolae, hyperpigmentation prominent along brassiere lines Moderately weak pedal pulses (1+) Vital Signs BP sitting, RA 96/72 HR 80/min RR 12/min T 98.7oF HT 5 ft. 8 in WT 170 lbs What else do you want to know? Feel free to ask questions and make comments below.
  9. SafetyNurse1968

    Do Male Nurses Face Gender Bias in Nursing Education?

    Since it would be illegal for me to verify the existence of male genitalia or to confirm a Y chromosome with my students, I cannot answer your question. The term "identify as male" is used out of respect for transgendered folks who have a different identity than the gender they were born with. I'm curious as to why you want to know?
  10. SafetyNurse1968

    Do Male Nurses Face Gender Bias in Nursing Education?

    Such a strange dichotomy - that you can put in a foley on a med surg floor without a chaperone, but can't on an OB/GYN floor. That'd definitely a conundrum...
  11. SafetyNurse1968

    Do Male Nurses Face Gender Bias in Nursing Education?

    Thanks for bringing up the existence of transgendered nurses. Several readers have commented about my use of the term "identify as male" - I use that terminology out of respect for those who were born with a gender that is different than how they present to the world. When writing this article, I found a lot of information about transgendered nurses, but that's something I wanted to approach in a separate article. I love having male energy at work - I agree it provides more balance and a smoother working day.
  12. SafetyNurse1968

    Do Male Nurses Face Gender Bias in Nursing Education?

    I didn't even think about the rest of the movies - it's been years since I've seen them. Thanks for pointing out Focker's success in later movies. As far as being victims, I hope I didn't paint that picture. I was hoping to start a dialogue about the idea of gender bias, so thank you for reading and commenting! I never even thought about the issue of socializing. Thanks for pointing that out.
  13. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Thanks so much for reading and commenting - here's the solution! This patient has Addison’s disease caused by damage to the adrenal glands as evidenced by the abdominal CT. This primary adrenal insufficiency is confirmed by the Rapid ACTH stimulation test showing minimal elevation in cortisol with high levels of ACTH. The cortex of the adrenal gland has been damaged most likely by the latent tuberculosis the patient experienced. This has led to symptoms that relate to low levels of corticosteroids including glucocorticoids which support the body converting food to energy and help the body respond to stress; mineralcorticoids which maintain sodium and potassium balance and keep blood pressure normal and androgens which maintain secondary sexual characteristics like axillary hair. Symptoms often develop so slowly they are ignored and include extreme fatigue, weight loss and decreased appetite, darkening of the skin, low blood pressure, salt craving, hypoglycemia, N/V/D, abdominal, joint or muscle pain, irritability, depression, body hair loss and sexual dysfunction in women. Untreated Addison’s disease can cause an Addisonian crisis as a result of stress, so people with addison’s (a lifelong disease since the adrenal glands don’t grow back) may carry a glucocorticoid injection kit with them and wear a medical alert bracelet. Patients are typically prescribed Cortef (hydrocortisone), prednisone or methylprednisone to replace cortisol. The hormones are given on a schedule to mimic normal 24 hour fluctuations of levels.
  14. SafetyNurse1968

    Do Male Nurses Face Gender Bias in Nursing Education?

    I'm so grateful when folks read my articles and comment. Disagreement seems to make for a more interesting conversation! I completely appreciate what you said about the "nursing shortage" - I came so close to not including that comment in my article. I agree with you, Jednurse. The day nurses are paid fairly and safe staffing ratios are instituted in all 50 states is the day the "shortage" will end. To address your other concerns, as a person who identifies as female, I really wish nursing were more balanced gender-wise. I would like to experience my profession with more diversity and balance - I think it would be more interesting and more fun to come to work. I hope we can agree that a diverse work-force makes for better patient outcomes, and a more collegial and stimulating workplace. Thanks again for reading and commenting.
  15. SafetyNurse1968

    Is my (50K) BSN worthless?

    Hey OP (original post) - I'm going to comment from the perspective of someone who has been terminated several times. It was devastating. I lost not only a job, but felt like a terrible person. I doubted every move I made and that self doubt made it so hard to do the next job. I ended up taking some time off - best thing I could have done, tried some other jobs to build confidence, but it's taken years to regain self-esteem. None of us know you, or know if you "deserved" to be let go, but I do know this - nurses can be fired for no reason in almost every state. I know just as many nurses who have been fired as those who have not. It's not something we talk about. We hide in shame, even if we are sure we were treated unjustly, because if and when we do share, often we are met with judgment. This thread has been good to you - I read through it all and I am so pleased at the responses you are getting. You are brave for sharing. Thanks. In my research about ADHD I have learned that CBT and neurofeedback can be useful tools - you don't always need to medicate to find more efficient ways to do things. Last but not least - square peg, round hole...You can only force it if you cut it and change its shape. You seem like an interesting, reflective, self-aware person. Please don't let the shape of the jobs you have previously attempted change you. Nursing is a field full of options and possibilities. Did you know nurses can be coroners or medical examiners? What about dialysis nursing? You write well - look for a job as a nurse editor...SO MANY THINGS.
  16. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Awesome! Thanks for playing!
  17. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Hey there fearless CSIs! I have more information for you! Lab and imaging results just came in - check them out and be sure to enter your guess in the private Help Desk! Laboratory Test Results (Fasting, drawn at 9:00 am) [only abnormal or borderline labs are presented]: Na 125 meq/L K 5.3 meq/L Cl 96 meq/L BUN 20 mg/dL Cr 1.2 mg/dL Glucose 54 mg/dL Cortisol 3 ug/dL ACTH 902 pg/mL UA Specific Gravity 1.016 Rapid ACTH Stim test: Pre cosyntropin cortisol 2.0 ug/dL 30 min post cosyntropin cortisol 1.9 ug/dL Imaging: Abdominal CT scan revealed moderate bilateral atrophy of the adrenal glands
  18. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Fantastic! So glad you read and commented.
  19. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    Oh that’s even better! Thank you so much!
  20. SafetyNurse1968

    Case Study: I’m too tired to walk the dog…

    I’ll be posting labs in a few days! Do you recall where you saw the other case? I’ve been working up several cases for my pathophysiology students- trying to be original and interesting!
  21. SafetyNurse1968

    Gender Bias in Health Care

    Thank you for pointing out my error. I appreciate your thorough response.
  22. SafetyNurse1968

    Gender Bias in Health Care

    NOT JUST HURT FEELINGS Back when I was working on a master’s in molecular biology, I compared my exam results with a male student (I was the only female in the class). I discovered that though he and I had given the same answer, I had been given a lesser grade. When I approached the professor, he patted me on the head and told me to stop worrying. After taking my grievance to the department chair, my grade was changed, but I will never forget how it made me feel. Maybe I was wrong? Maybe I was making a big deal out of nothing? It hurt, but I got off easy - now we are discovering that being the victim of gender bias can hurt more than your feelings, it can kill you. “You’re just stressed out. You’re just another anxious, young, type-A female student. Take a deep breath. Maybe you need antidepressants or anxiety medicine.” In an interview with the Today show, Laurie Edwards shared some of the things she was told in her journey to being diagnosed with a chronic and rare lung disease. She had been told for years her symptoms were all in her head.1 In another story, Annalise Mabe went to a male OB-GYN to check on a health issue. After disclosing her symptoms and past history, she said her physician, “was really judgmental and said things like, ‘You are wild and crazy, huh?’” She says the doctor made jokes and assumptions about her sleeping around, despite the fact that she had actually been through a sexual assault. “He discounted my input and suggested that I was getting my information from WebMD.” She told him she had already had a full annual exam and he said, “No, you didn’t” and proceeded to give her one.2 DEFINITION Gender bias is defined as “prejudice in action or treatment against a person on the basis of their sex.”3 Gender bias results in situations where patients are assessed, diagnosed and treated differently and at a lower quality level because of their gender than others with the same complaints. It can also manifest as an assumption that males and females are the same when the sexes have differences that need to be addressed.4 Research shows that health care professionals treat women with the same amount of bias as the general population, despite the healthcare mandate that everyone be treated with dignity and respect. Presumably a doctor should be trying to save a patient’s life regardless of gender.2 EVIDENCE Women are 3 times less likely than men to receive knee arthroplasty despite comparable indications.3 Heart disease is the number 1 killer of women. Women are twice as likely as men to die in the year following an MI. Only 40% of women receive a heart attack risk check as part of routine care.1 In a study of 500,000 heart attack patients from 1991-2010, it was found that women are less likely to survive when treated by male physician. There is no physical reason women should die at higher rates than men. When women receive the same therapies as men, odds for survival are the same.6 During routine visits, young women are more likely to be told to lose weight. Young men who are actually overweight are more likely to be put on preventative therapy.4 Women are 75% more likely to have an adverse drug reaction than men.1 It takes an average of nine years for women to be diagnosed and treated for endometriosis – healthcare providers think patients are exaggerating their pain.5 Women receive less effective pain relief than men, are given less pain medications and more mental health referrals. Medically unexplained conditions like fibromyalgia correlate with professionals being unwilling to believe in women’s pain. When pain is the only reported symptom, women have to work hard to be taken seriously, believed and understood.7 In a study of medical coding, charts describing women were assigned a lower level of service than men in patients with asthma and rheumatoid arthritis.8 Lab studies? Mostly male animals have been used.4 Patients, regardless of gender, fare better under the care of women physicians.2 Other areas of gender bias include: peripheral arterial disease, behavioral health, stroke, chest pain, organ donation and transplantation, trauma patient triage. For a more in-depth analysis, please read the Alspach article in Critical Care Nurse.3 WHY DOES GENDER BIAS EXIST? A wide variety of reasons for gender bias exist3: Underestimation of women’s risk Differences in symptoms between genders Differences in self-perception Willingness to discuss symptoms Style or manner of discussing symptoms Unconscious prejudice or stereotyping Overt discrimination based on gender We don’t really know which of these factors plays a greater role. The answers to solving gender bias quite possibly lie in solutions. SOLUTIONS The Times Up movement announced in February of 2019 the launch of Time’s Up Healthcare. The goal is to tackle discrimination, harassment and inequality across the health care industry. Backers include the American Nurses Association, Mayo Clinic, and multiple medical schools, though the American Medical Association is notably absent.5 Recommendations Recognize the problem: awareness of the existence of implicit biases is an important first step toward minimizing their potential effect. JAMA. We need qualitative and quantitative assessments of our healthcare culture. Conduct more research with women: The NIH now requires female subjects in clinical trials, but research funded by private medical companies is exempt. However, more and more journals will not publish research unless it includes female subjects.9 Educate healthcare professionals: The NIH is doing educational outreach to physicians and pharmacists about gender bias, medical journals are requiring researchers to include females in studies. When male physicians work in hospitals where they have more female colleagues, they are better at treating female patients and the gender disparity drops.6, 9 WHAT CAN WOMEN DO? Ask if the drug you’ve been prescribed has been studied in women Ask how accurate the medical test you’ve been ordered is for women Listen to your gut, get a 2nd or 3rd opinion, and be willing to walk away if you aren’t getting the care you think you need. References Gender bias in health care may be harming women’s health: What you need to know. New paper examines how gender bias in health care can be deadly Is there gender bias in critical care? Exploring gender bias in healthcare Time’s up sets its sights on gender bias and harassment in health care Patient-physician gender concordance and increased mortality among female heart attack patients “Brave Men” and “Emotional Women”: A theory-guided literature review on gender bias in health care and gendered norms towards patients with chronic pain An online experiment to assess bias in professional medical coding A framework for integrating implicit bias recognition into health professions education
  23. SafetyNurse1968

    Gender Bias in Health Care

    Thank you so much for reading my article and sharing a personal story. It's stories like these that make the numbers feel a bit more real. What ideas do you have for changing up this reality?
  24. SafetyNurse1968

    Gender Bias in Health Care

    I hear you. It sounds like you are having a frustrating experience with healthcare. The point of the article was to show disparities that exist towards women. These statistics certainly don't negate the individual experience that each person has. Thanks for pointing this out - I will look into it - I keep thinking "we've come so far" and then I read stories like these and I feel a bit overwhelmed. We can't give up though. What ideas do you have for creating positive change?
  25. SafetyNurse1968

    MVA, EMS didn't use a backboard!!

    One of my nursing students just told me that yesterday she was driving home after an exam and saw a body lying in the middle of the highway. She pulled over, blocking traffic with her pickup truck (I shuddered at the thought...so unsafe! but I just listened - it was done and she lived...). She ran to the body and discovered two other students from our school attending to a woman who had been hit by a car. They stayed with her, she was breathing, but unconscious with visible wounds to the head. They comforted the driver of the vehicle as well - she was incredibly upset. EMS arrived first (it took about 10 minutes - the student said, "It seemed like forever" - seems like a long response time to me for one of the larger cities in a southeastern state. Here's where I freak out. She said, "EMS didn't put her on a backboard or stabilize her head." I can't even grasp this. Can anyone explain this behavior? I'm sure I can find out who was on that particular run, but I want to hear from ya'll first. Maybe I'm wrong, but I always thought that stabilizing the head and neck were the number one priority in an unwitnessed accident/victim unconscious. Wondering what you would do? Should I try to track them down and report them? This student said several months ago she had called EMS to attend to her husband who was having chest pains and they hadn't known how to do a blood pressure. I am not typically reactionary and try to see all sides of a story, and of course the student could have misunderstood in the stress of the situation. Would love some input.
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