PositiveEnergy

All good points. So true about life-long learning. When you really begin to practice you realize how much there is to learn, and how little you really know in the big picture. So keep on asking the "whys" and "hows" and not be afraid to say "I don't know, but I'll look it up." Know your resources...so you know right where to go when you need an answer quickly. Always remember to keep in the forefront of your mind - "If that was me (or one of my family), how would I want to be treated." "What would I want that nurse or provider to say to me?" Remember your patients are sick and have their own worries - they don't want to hear the dynamics of the unit, complaints about other staff members, being short-staffed....this can make them fearful about whether or not they are going to receive proper care. Make a room check without focusing on doing a patient care task - instead take a moment to chat with your patient. But most importantly compliment yourself each day on something you did well, or just felt good about. For those things that were challenging, plan how you would improve on them the next time. If you see a colleague do something you think is stellar - compliment them as well. All to often nurses failure to pat each other on the back and say "well done."

The old saying, "a picture is worth a thousands words" came to mind when I read this. Essentially your mental visualization is providing you a wealth of direction/information to guide you through your daily procedural challenges. I cheer you on this practice - definitely an approach that boosts one's confidence before engaging in unsure waters. Sometimes if time allows, this imaging can help one identify their own weak areas and seek direction/answers to these idenified weaknesses before the scenario actually plays out.

Certainly a noninvasive intervention and worth at least trying for those who suffer from cramping.

In general my experience both professionally and with family members who have noctural leg cramping is that finding something that effectively, and most importantly, continuously relieves leg cramping rarely happens. Hence as listed by individuals in these post, there are abundance of suggestions, but how many are truly effective and valid is questionable. But those who experience the excruciating pain are willing to try most anything to obtain relief. Even pickle juice. Unfortunately there does not seem to be that "one fix, that fits all." But, we can't stop investigating potential calming agents because these people's pain and sleep interrupted nights affects their overall well-being. One area I think healthcare providers should check themselves on is how often they immediately assume the person's cramping is from low potassium and/or insufficient Mg. And the next step is to suggest the person either begin to take supplements or increase foods and drinks that will boost their levels of these electrolytes. It seems the appropriate first step would be to have these serum electrolyte levels tested before suggesting the person increase intake of these items. As we know, boosting levels of these electrolytes in individuals can have negative results (even worsening cramps) if the increased intake causes to high serum levels and/or kidney function is an issue.

Well said.

Excellent ideas here. Because students aren't often directed to do some of these needed task they don't even think about them - especially those things patients need upon discharge to assimilate back into their home life. Even some seasoned inpatient nurses have a gap in truly understanding what patients need when going home. If you have ever worked as an RN in both inpatient settings and in home care settings you can appreciate how communication is lacking between the two entities when coordinating home care for patients. Great idea to get those students nurses thinking about these patient discharge concerns. How about having some of those students sit at the bedside with their patients and educate them on their disease process. One would be amazed if they take a pictorial anatomy book in to their patient and show them the part/s of their body involved with the disease process. Often patients have no idea of their internal anatomy and are very appreciate of learning. Students too will gain confidence in patient teaching and reinforce their own A&Ps knowledge.

"The energy is kind of bad on the unit." "My students literally cried about..." I read these statements above and had flashes of all the conferences, papers written, general presentations, and professional dialogue on "Nurses Bullying Nurses" or "Nurses Eating Their Young" and I hear this sentiment here. Honestly, it feels like we talk and talk about this behavior, but it still keeps happening. And here we have novice nursing students learning from the modeling of senior nurses and what are they learning on how nurses treat one another. I only hope they say when I am a "real nurse" one day I am never going to treat students like I was treated. I am going out of my way to show them the ropes.

The first thing that jumps out at me is not to give the staff the task of writing out your student assignments. You might involve the staff by asking them which patients might benefit/appreciate having a student assigned to them and what nurses are most receptive to having students assigned to them. Remember, you know what your clinical objectives for the day or clinical course are, so you would be the best one to make assignments that best addresses the students needs. Many times staff have a totally different perception of what students should be focusing on. An important piece for you is to be sure the staff understand what the students are focusing on that semester in clinical. Take the time to share this with the staff. You would be surprised how many nurses will then seek out students to participate in something that is occurring at the moment which addresses their objectives. To prevent students from standing around you have to get creative: Some things I always found helpful: 1. Discuss not standing around in groups with the students. Share you would prefer they not hang out in groups even if they are "charting" or working on their client's plan of care. 2. Suggest they volunteer to do some activities they have been passed on that might help the staff - even if they think little of the task they will always take something away from the experience and improve interaction skills. First, though they must be on target with their assigned patient's care. Example: tell staff they will do vital signs on all the patients in the unit at a particular time (including charting of the vitals). Have students volunteer to assist the nurses in little task like re-positioning patients, spending time talking or sitting with patients, answering any of the ringing "call bells" not just their patients....whatever you can think of to give students learning experiences. Some students might gripe but other will be happy the day goes by quickly and they are helping both patients and staff. In time I have found nurses will come to appreciate your students and be glad when they know your students are coming on. 3. If the staff member is agreeable assign students to shadow nurses or other disciplinary members that interact with patients on your particular assigned unit - example med nurse, charge nurse, an IV nurse, a physical therapist, play therapist (great for peds rotation), social worker...There is alot of take away for their own future practices by sharing in such interdisciplinary activities. Their future patients might benefit. 4. Most in-patient facilitates still have physical libraries. If a question comes up or there is an "interesting patient scenario" (even if not one of the students assigned clients) assign 1 or 2 students to go to the library, if reasonable close. If only an e-library is available have them use this. Be sure and have another student/s cover the leaving students patients. Have the students look up related information and plan for them to share what they found in a post conference. 5. Ask students for ideas of how they think they might be able to add to the units functioning. Even if they work in pairs for moral support. 6. Ever think about having students go in the unit's supply closet/shelving area and ask themselves "what might this item, tube, instrument...be used for? Do I know how to use it? Can I explain the use/purpose of everything here. By encouraging students to check these kinds of items out when they have down time imagine how much quicker they might retrieve those tubes or instruments in emergency situations. They would know where it is and what it is. Think about all the wasted time in emergencies because people have no idea how to use or operate a needed item. Just remember - any activity is a teachable moment for students. Even if it isn't obvious to the student at the moment. You might have to remind them of this when you come up with a creative idea that no other instructor has encouraged them to do. Just remember they have to meet their assigned patient's needs first.

So many options of how this evolved. WIll probably take several years to even figure out the truth. What always amazes me is the number of people who jump on the band wagon and go along with such dishonesty.

Very interesting article. The unassuring take away from this information is this is just one of the fraudulent operations that got caught - after much investigation too, and years of pumping out "fake" nurses before they got caught. Hope the take away is policing needs to continue and checks of qualifications/backgrounds tightened.

Reflecting on those patients who have touched my life. I think of those patients who have caused me to pause and recall something special about our encounter. Not what I left them with, but rather what they left me with. Those special stories I have within me - compliments of those special people I have met.

I was glad to see this article. Leaving loved ones and heading off to work is challenging on holidays. But as you pointed out, coming up with creative strategies can help make heading into work a little bit easier on these days. I worked in Obstetrics and Pediatrics for many years. Of course, the approach for children was to try and get them physically better before the Christmas holiday so they could be home for the holiday. So the pediatric census would often dip and the kids left to spend the holiday with us were often very sick. So we tried to make whatever Christmas wonder (dressing up, Santa visiting, elves...) we could for the children. This also lifted our spirits. Obstetrics like anytime was always unpredictable. Heading in you never knew if your holiday shift would seem extra long because few came in laboring and delivering, or if you would never sit down the whole shift and end up having your Christmas potluck dinner on the run. In one unit where I worked they had a tradition that I thought was nice and helped eased some of one's pre-holiday baking. A few days before the Christmas holiday everyone would bring in a predetermined number of baked cookies. Then everyone swapped so at the end of the day everyone headed home with a large batch of different cookies to add to their holiday treats and decrease their baking workload.

Thank you for sharing this information. As a nurse, as well as a person who has dealt with this issue in a family member, awareness and education is so vital. I think so often nurses do learn about Sundowning at least sometime in their schooling, but thinking something so practical could be "that hard-to-manage" patient's issue gets overlooked. Instead, we have a tendency to think something bigger is the causative variable. I think this is where really stopping to consider the patient, maintaining continuity of care (to recognize changes), and looking for patterns in patients (e.g., personality changes about same time every day).... becomes vital to diagnosing and addressing Sundowning in individuals. If we then utilize some of your interventions and (as you stated) report the Sundowning interventions to the next shift, perhaps the patient will fare better and the shift in general will flow smoother for everyone.

First congrats on passing the NCLEX and becoming a new RN. Nursing school is a challenging major - no easy way through. Your article interested me because I have many nursing years under my belt. So I was curious what you would perceive as a major challenge. I can understand why you say the long shifts and long hours are so disruptive in one's everyday existence and emotionally/physically depleting. In my earlier years the eight hour shift was the norm then the profession moved into twelve hour shifts. When twelve hour shifts were evolving many articles were written related to adverse responses on behalf of those engaging in twelve hour work days....fatigue, increased errors, physical and mental sense of imbalance.... Despite these warnings and due to demands of short-staffing twelve hour shifts became the norm. And now the work day has even extended with doubles and overtimes. So it doesn't seem surprising many nurses of today are expressing some of these same feelings you did in your article. Not just new grads either - hope that helps to know your not alone. I would just add one variable that I have heard many nurses doing twelve hour shifts complain about, particularly during Winter months when it gets darker outside earlier. That is they can go days at a time without seeing light outside - and we all know how lack of sunshine can have both physical and mental effects on us. They "go to work in the dark....and come home in the dark." Doesn't even sound good! So this thought leaves me with one piece of advise I did not see mentioned in your terrific list of recommended self-care measures. So I would add... make sure you leave the building during your shift and go for a walk even if you do so on your lunch or dinner time. Take something you can eat while you walk or sit outside. Don't think your department is going to fall apart if you leave the unit. Don't convince yourself you are better off eating on the go in your department while you continue working or worse yet not even stop for breaks or to eat. Those nurses who do take these short breaks away (and outside) feel somewhat more positive and refreshed when returning. Best wishes - you have some good self-care measures figured out.

This feeling of loss and sense of death is the part of nursing that I believe makes you human. When you develop that connection with a patient that you sense is different from your relationship with your other patients, you will feel a sense of heaviness/loss when he/she does die. If you didn't that doesn't seem normal. Don't be afraid to talk about the person to your colleagues and to think about the good memories or just about the person in general. It seems no matter how many years you will be in practice there will be these extra meaningful patients you will always recall. Likely there will be times some incident/action... will trigger a memory of this person and you will be struck again by that heavy feeling. Could be years later - but it will have a different degree of intensity. Just like any loss - you will always remember - just over time the pain won't aways be in the forefront as it is now. It will find a place in your being and once in awhile surface. Hopefully surfacing as something that made you feel good about the person and brings a smile or sigh of contentment from you. Most of all don't let anyone make you feel your feeling are exaggerated and such feelings should be held in check. Glad you recognized you needed to talk about your feelings and reached out. That in itself is healthy!

Interesting article - like the personal side of the article where you shared what you have learned and what your daughter has taken away from her TikTok experiences. It does seem this is a good target for capturing the interest of teens and young adults - something as you hinted should be realized by healthcare professionals looking to share supported research and offer valid health care tips to TikTok viewers.

You know for quite some time healthcare professionals have been encouraging people to take control of their health, to practice preventative health, and to be proactive in their own care. Consequently people have learned to become active in their own care - developing more personal autonomy. With this mindset, people are looking for their own answers and searching the net for explanations. With such overwhelming mounds of seemingly legitimate information people can easily become schamed into unfounded treatment recommendations, herbal medicines/vitamins and quick-fix options.

No problem - was an enjoyable and informative read.

You shared some interesting points under the different categories (financial, educational, community building and equitable access) reflecting what benefits can be gained in healthcare if practitioners embrace digital methods. In reading these cited benefits one can not help but think how these benefits are changing the way we practice. Equally important is how vital it will be for practitioners to stay current on what is out there and how best to apply these digital media methodologies into their everyday practices. Makes you think about how quickly practice approaches are being redesigned!

Though I prefer in-person interviewing, it is always a good alternative to have online interviewing, particularly as you mentioned when distance for the candidate is problematic, as well as for others. If one thinks about it, with an in-person interview the interviewer often does all the organizing and setting up to make the interview happen (getting the room, scheduling, making the environment just right....). So the candidate comes into the perfect interview setting. However, think about all those key points you mentioned (particularly about one's environment, distractors, using other devices...) that can occur on an online interview. If the online candidate is sharp he/she will exhibit during their interview that they are implementing proper etiquette skills. Certainly their behavior tells you something about this person's management skills, organizational skills, commitment... and how they will perform on-the-job.

"You’ve Come a Long Way, Baby" (Virginia Slims, 1968); Truly an applicable slogan some practitioners might use to describe how healthcare has advanced over the span of their careers. Likely they would list developments in technology, digital media and social media as examples of how healthcare has “…Come a Long Way.” Nurses coming down to the home stretch of their 40-45 year careers likely have numerous accounts illustrating how the practice has changed from the pre-technology era to today’s digitally enhanced times. Take, for example, how differently taking the nurse’s state licensure examination must have been for them. There were no “clicking” answers on computer screens as testers do today. Instead, they were given test booklets with pencils for shading in selected answers. Through a reflective and comparative approach, this article imparts several anecdotes exemplifying how technology, digital media and social media have changed nursing methods from approximately forty-five years ago. A “Then” and “Now” approach is used to illustrate how the nursing profession has evolved and embraced technologies such as social and digital media. Lastly, a case scenario is shared, demonstrating the importance of caution when scribing to social and digital media usage. #1 Then: At one time, taking the RN Licensure Examination meant traveling to a centralized location on a date prescribed to you. Testing only occurred twice a year on the same days in all states. Having only two dates meant if you did not pass on your first attempt, you would have to wait six months before retaking the examination. When you arrived at the testing building, you most likely would be seated at a desk or long table amongst hundreds of other testers. All that was allowed on one’s desk/area was an issued test booklet and a #2 lead pencil. Proctors walked up and down aisles from start to finish, monitoring for cheating. Each section of the test was timed, so when the section’s time was up, a resounding command of “Pencils Down”…“Time’s Up” resonated within the room. For many, the worse part of the whole testing process was the waiting and wondering whether or not you passed or failed. Finally, after 6-8 weeks via snail mail, a “nay or yay” letter arrived at your residence. #1 Now: Around 1994 the testing approach changed. The first computerized adaptive nationwide RN licensure examination was launched. Some 28 years later, and with additional refinements in computer methods, we are where we are today. Now every graduate in all 50 states takes the same standardized, computer-based, multiple-choice test. Licensure examinations are offered at computer testing centers, and testing times are not limited to two dates per year. Today’s computerized tests are more interactive. And, based on the tester's performance, the level of difficulty might vary. With new computerized graphic techniques and software programs, the types of questions posed have changed. By integrating these different programs, test designers have improved ways of evaluating the critical thinking aptitudes of testers. Although some testers today judge whether they passed or failed by how many questions they are asked, official results are still mailed. Though wait times seem to vary across states, a wait time of 2 to 4 weeks is typically quoted as the norm. However, there are now some fee-based companies reporting unofficial results to individuals within 48 business hours following testing. #2 Then: So what would have happened if a nurse, while working in a care setting, had a question about how to do a procedure, the pharmacotherapeutics of a medication, and/or an unfamiliar diagnosis? Most likely, he/she would have asked a friend who was working with him/her. Or, called the nursing supervisor or someone in another department, like pharmacy, if the question is related to a medication. A medical dictionary, Physician Desk Reference (PDR), and a Lippincott procedure manual were typical reference books kept at nursing stations. Unfortunately, most of the copies were old editions, “grew feet”, and/or were more medically framed than nursing oriented. Many hospitals had medical libraries, but often, these libraries were limited to physician use. In terms of available procedure manuals, typed guidelines for all key procedures were not always available, and included materials were not always kept updated as applicable. #2 Now: Currently, nurses have many resources at their fingertips for answering questions and educating themselves. For almost instant answers, nurses can use mobile phones and computer devices to consult a plethora of professional websites and healthcare-related apps. A social media app (e.g. LinkedIn) can help to connect professionals with one another for purposes of sharing ideas, consulting with one another, and addressing issues. Now, most healthcare facilities have incorporated digital platforms in their systems for sharing educational materials. Many have also converted brick-and-mortar medical libraries into e-libraries to which all healthcare personnel have access. Additionally, the integration of digital telehealth services now allows healthcare providers to visible consult with professional colleagues across global healthcare systems in a manner of seconds. #3 Then: Classroom Education…no desktop or laptop computers gracing classrooms! Not until around 2000 did computers noticeably become part of classroom décors. Prior to the introduction of computers, students typically sat together in brick-and-mortar classrooms listening to educators teach in lecture-style formats, diligently trying to take handwritten lecture notes. Some professors incorporated transparency “overheads” on which key points were recorded with markers. The lecturer used a transparency projector machine to project the scribed information onto a classroom wall. Students often complained of aching hands due to repetitive notetaking. In time, as tape recorders became popular, some educational institutions and professors allowed lectures to be recorded; but many did not. #3 Now: As computer technology advanced and the world-wide-web became a household name, the way healthcare students learned and professors taught changed expediently. Now professors use a variety of digital and social media devices to teach and keep students abreast of the latest trends and practices. Students no longer just learn from one voice but have the opportunity to benefit from the expertise of many. Social media (e.g., YouTube) has made it possible to learn from, interact with, and consult with other professionals and other students on large computer screens in today’s classrooms. Digital media (e.g., digital images and videos, holograms, digital databases, eBooks…) brings greater life to the content being taught, enhances learning, and improves student engagement. Online or virtual learning is now part of every healthcare provider’s education. Back when our now senior colleagues were neophyte students, web-based learning wasn’t even part of academia’s vocabulary. #4 Then: Communicating with non-English speaking patients was challenging. You did have some options for obtaining assistance with translating, but options were limited and not consistently available. Even early on, using family members to interpret was frowned upon. Instead, other alternatives were offered. Some healthcare facilities had available educational booklets and pamphlets written in several different languages. Some maintained a list of in-house individuals who spoke a language other than English and volunteered to translate. Often care providers and patients struggled through encounters because translators were not accessible. Eventually, fee-based telephone interpreting services became available, but only two individuals could talk at a time, and there were no visual images of participants. Translator, patient, and provider could not simultaneously speak together on one phone line. #4 Now: In 2010 an additional section of the Affordable Care Act was added, which mandated organizations receiving federal funding hire qualified language translators. Consequently, some exciting strides were made in providing quality interpreting services when healthcare providers and patients did not speak the same language. Now thanks to digital video interpreting services, healthcare providers, patients, and interpreters can simultaneously see and speak to one another during translation sessions. Today digital healthcare companies offering virtual care visits are collaborating with healthcare systems to bring video remote interpreting services to the patient’s bedside. This means at any time during a virtual visit, with a simple “click” of a button, a healthcare provider can bring a visible language interpreter into patient care encounters. Think Before Clicking As one can see, healthcare practices have Come a Long Way, Baby, as advances in digital and virtual technologies have developed. However, although many positive aspects can be cited, negative outcomes do exist. Mentioned above are the more positive aspects of using digital and social media in healthcare practices. However, an aspect of using any type of digital or social media that should be followed is to stop and think before “clicking”. One needs to always keep in mind what may have taken days in the past to be seen or read can virtually be viewed or read by thousands in a matter of seconds. As a result, healthcare providers can easily implicate themselves because of a lack of thought and discretion in what they post. For Example... Presented is a true account of how some student nurses did not stop and think before they “clicked” and posted on their favorite social media page. As you read this, you likely will ask yourself…..How could these individuals be so foolish to do this… Let alone even think about posting this on social media. But they did, with one “click”….a “click” that did bring them attention…but not in the way they anticipated. Although this account relates to students, such behaviors of not weighing potential consequences, or realizing a posting may be offensive to others, is also a concern amongst seasoned providers. The Account Three student nurses enrolled in a basic skills lab course were in a lab room to practice an assigned skill. A lab facilitator was in the room and had manikins set up in beds behind drawn “patient” curtains to simulate real patient-nurse care encounters. Behind the curtain, when the facilitator wasn’t checking on their group, these student nurses decided to use their mobile phones to take pictures of themselves with their manikins. The three took their fun a step further and decided to pose with their manikins in provocative positions. Assuming their friends would think this was as funny as they did, they immediately posted the pictures on their favorite social media pages. Out it went to all their friends, and who knows how far beyond, as friends shared with friends. Additionally, in the posted pictures, the logo of the college/university where the pictures were taken was discernable. Some of their friends did realize the poor judgement and implications of their peers. Within a short time, the director of the nursing program was sent the postings, the three students were called in, the images were removed, and nursing faculties were called together to address the situation. There was no policy directly related to such a social media infraction. But, there were policies related to causes for dismissal from the nursing program and/or university, as well as disciplinary action for unethical behavior. After much debating and discussion, a vote on the suggested disciplinary action was taken, agreed on, and implemented. What Happened to the Students??? More than likely, you are thinking… So, what happened to the students????? Instead of telling you how faculties handled the actions of these three students, the author would like you to weigh in with your thoughts. Keep in mind though this behavior might seem unlikely, there are other examples of poor social media actions initiated by healthcare providers. So how do we best address such behaviors? How would you have handled these students? Please, share your thoughts.

I totally agree that nurses should help their patients discern what is evidence based information and reliable, versus information that is haphazard and lacks supportive data. People are vulnerable to misinformation especially when ill. Yes, nurses do play a key role, but the issue I see that affects their effectiveness is so often within our own profession there are so many checks and balances on critiquing proposed ideas/information that the delay time often hampers timely presentation of informative information. So in order to share their thoughts in the moment some end up posting less then professional information. Still another concern I see is different healthcare professionals need to support the voice of their multidisciplinary colleagues instead of each trying to "outshine the other" - patients would likely receive more comprehensive and well-rounded information. We have to remember we too do not have all the answers, but we can work with our colleagues to put out quality social media responses and information.

I think you left the reader with some good points to think about as well as to take away to their clients. So true that people are struggling with healthcare cost, as well as just having funds for deductibles to cover for healthcare services. So to compensate they ask friends for advise, plus scroll the internet for answers. So many times people pop vitamins and herbs not realizing these items really are just "supplements". And these "fixs" if taken as frequently as suggested on internet ads can in turn cause other health issues. One of my concerns is the early morning radio talk shows (2 am, 3 am...) often listened to by older adults because they can't sleep for reasons like pain, so they listen to the radio. These stations host individuals who state their credentials as MD, PhD... who profess to have the answer to so many health issues if one takes their vitamins, drinks, supplement... These guest speakers will profess to have tested and found "reliable" results. But one has to wonder about their research methods, their desire for quick money and how reliable their credentials are. I think too the elderly who listen to these radio programs do so because they don't have the skills to surf the internet, so they get hooked into these remedies the old fashion way. I guess no matter the age.... we all have to teach our patients to be aware of where they are getting their information because social media, is social media, whatever the source. Patients be ware!

If you want to be inspired by what nurses can achieve, and the personal account of one nurse's successes and challenges take time to read the ebook Nursing Shoes. Many nurse-patient encounters are shared. The time is right because on August 28th, August 29th, Sept 5th and Sept 6th there will be free promotional downloads in honor of those student nurses returning to school and for any nurse who loves to hear true nursing stories. Use the following link Nursing Shoes: Brenda Pavill: Amazon.com: Kindle Store Have fun reading -it's light reading - not like a nursing textbook!