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Ashley Hay, BSN, RN

Ashley Hay, BSN, RN BSN, RN

Pediatric & Adult Oncology
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Ashley Hay, BSN, RN has 10 years experience as a BSN, RN and specializes in Pediatric & Adult Oncology.

Over 10 years of nursing experience in several areas of Pediatric & Adult Oncology including clinical research, chemotherapy, transplant, hematology, proton therapy, GI surgery, wound care, post anesthesia recovery, etc. I really enjoy reading, cooking, yoga and the beach during my time off. Becoming a writer has been an aspiration of mine for many years - I'm so glad allnurses was willing to give me my start in a field I am so passionate about. Looking forward to getting to know all of you in this great online community. :: Visit my website at AHayWriting.com ::

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  1. Ashley Hay, BSN, RN

    Are You Doing it Right? Taking Accurate BPs

    In my personal healthcare experiences, I've noticed several healthcare providers (HCPs) taking blood pressures quickly and often inaccurately. I'm sure you have too. This simple task can sometimes be rushed due to the lack of time providers have available to spend with their patients. However, a documented blood pressure reading can determine many aspects of future care for the patient, including potential medication dosing adjustments or changes. Blood pressure readings are a measurement of the circulatory system. It is composed of two numbers, the systolic (top number) and the diastolic (bottom number) blood pressure. A simple explanation (useful for explaining blood pressure readings to patients and caregivers) can be found at WebMD.com, "When your heart beats, it squeezes and pushes blood through your arteries to the rest of your body. This force creates pressure on those blood vessels, and that's your systolic blood pressure. The diastolic reading, or the bottom number, is the pressure in the arteries when the heart rests between beats. This is the time when the heart fills with blood and gets oxygen." Proper blood pressure measurements can be indicative of many medical issues. For example, hypertension (elevated BP) can lead to many life-threatening medical conditions, such as heart attack, stroke or kidney disease. Hypertension can also be due to white coat syndrome or high levels of pain and is greatly influenced by a variety of lifestyle factors including, age, weight, medication, alcohol use, tobacco use, and diet. Equally as important, hypotension (decreased BP) can be a warning sign for many health-related issues. Examples of such include septicemia, anaphylactic reactions, dehydration, blood loss, and body temperature dysregulation. Many medications have the potential to cause an unexpected drop in blood pressure, so be sure to educate patients on getting up slowly and reinforce proper oral hydration guidelines. Symptoms of hypotension include nausea, blurred vision, dizziness and even fainting, Many inaccuracies in assessment of this vital sign are avoidable by following some basic guidelines. How To Ensuring Accurate Blood Pressure Readings STEP 1: Correct Cuff Size Using an incorrectly sized blood pressure cuff is one of the most common reasons for skewed results. Many cuffs now have a range marker that indicates if the cuff is a proper fit. A cuff that is too small can result in a false high reading, so ensure that the bladder length encircles 80-100% of the upper arm and the width is about 40%. (Here's a helpful photo to further explain.) STEP 2: Remove Barriers Bare skin is best, despite many patients wishes to not roll up their (sometimes thick!) sleeves. This technique also allows for assessment of anatomical landmarks, ensuring correct placement of artery marker on cuff over the brachial artery. STEP 3: Uncross Legs This bad habit of many (myself included) can produce false high BP readings. Remind your patient to uncross their legs in order to get an accurate recording. STEP 4: Give Rest Time Taking vital signs is typically one of the first tasks many HCPs aim to complete. In a non-emergent scenario, giving the patient adequate time to sit quietly can bring their blood pressure down to a resting rate after that walk from the lobby. Taking other vital signs first is a useful practice. STEP 5: Don't Talk This can be difficult. Patients want to tell you their reason for the visit and you want to discuss symptoms. However, explaining the rationale behind this quiet method can go a long way. In order to avoid a false increase in BP, try not to chat with the patient and encourage them to try and rest quietly for a few minutes. STEP 6: Proper Positioning To obtain the most accurate reading, have your patient sit up straight with their back supported. Let the patient's forearm rest on yours or use a supportive surface to have the upper arm in the ideal position for a blood pressure reading. (See this quick reference by Welch Allyn for helpful photo.) STEP 7: Check Manually Could the monitor be defective? When in doubt, checking manually is best practice. To begin, follow all same steps above. Place bell of stethoscope lightly over the brachial artery. Quickly Inflate the blood pressure cuff to 180 mmHg. Release the air at a steady and moderate pace. The first "bump" sound you hear is your top number (systolic) and the last sound you hear is your bottom number (diastolic). For more detail, visit this page on clinical skills related to BP measurements. What tips or tricks do you use to ensure accurate BP readings? References Healthline: Everything You Should Know About White Coat Syndrome Mayo Clinic: Hypotension (Low Blood Pressure) Practice Clinical Skills: Blood Pressure Measurement Up To Date: Determining appropriate blood pressure cuff size in children WebMD: Know Your Blood Pressure Numbers Welch Allyn: Taking an Accurate Blood Pressure Reading
  2. Ashley Hay, BSN, RN

    To Keep or Ditch Past Certifications?

    So, is it worth it? Benefit Becoming certified in your area of expertise has many benefits to both the nurse and his/her patients. Obtaining certification demonstrates to your peers, management and patients that you are an expert in the field and have taken additional steps to solidify your comprehensive knowledge of this healthcare specialty. An article from workingnurse.com titled, The Power of Nursing Specialty Certifications states, "While specialty certification is voluntary, obtaining it can be a tremendous benefit to almost any registered nurse. Nurses who validate their expertise through specialty certification set the standard for the profession" and adds, "Don't be surprised if your next patient asks if you're certified. A 2002 Harris Poll found that 78 percent of consumers were aware of nursing certification. Seventy-three percent said they'd prefer to receive care in a hospital filled with certified nurses." The article also discusses another important potential benefit to nurses seeking specialty certification - confidence. Workingnurse.com goes into more detail, explaining, "studies show that nurses who are certified in their areas of specialty reported feeling even more confident in their work and more satisfied with their jobs. Even if you know your specialty inside and out, improving your credentials can give your confidence a boost and help you enjoy the work you do even more." With all the given potential benefits of certification - an vast knowledge of the specialty, personal growth, professional confidence, increased patient satisfaction and maybe even improved job satisfaction - you may be asking, why don't we all get certified? It's complicated. Let's dig a little deeper. Relevance One of the awesome benefits of entering the healthcare industry as a nurse is the flexibility this profession can provide. We are able to work in many different settings and in multiple roles. If you (like many) enjoy the freedom of changing your specialty every few years, specialty certifications may not be relevant at your next position. A personal choice - is seeking certification worth my time and money? Will it continue to serve me and my career? These, among others, are important questions to ask yourself when considering pursuing additional certs. Really assessing your current and potential future healthcare setting can help to determine if this path is worth your efforts. Finances Keeping multiple certs can be expensive to maintain, especially if your employer is unwilling to assist financially. Some institutions value the voluntary educational efforts of their nurses and provide partial/full reimbursement upon proof of passing. However, there are many hospital systems that, unfortunately, do not have the funds or desire to assist staff financially with additional certification(s). Let's be real - being a nurse can be expensive. Depending on your area of work, many nurses are required to purchase things like: attire (scrubs, shoes, surgical caps, etc), accessories (stethoscope, pen lights, scissors, clamps, etc), fee to maintain state licensure (sometimes multiple), and also potentially pay for continuing education credits to keep said licensure active (if not offered for free at place of current employment). Fiscally assessing your budget may prove helpful in your decision to seek, maintain or get rid of your specialty certification. How much will the exam cost? What is the estimated cost of required study materials? Will you need to miss a day of work to take the exam? Letting Go If you are/have ever been certified, you know the time, effort and funds required. Weighing out the pros and cons to keeping or obtaining your cert can be more difficult than anticipated. Is it ever worth letting go? If so, isn't there a potential for regret in the future? Yes, there is... After about eight years in oncology I decided it was time to pursue my OCN (Oncology Certified Nurse) certification. I had historically bounced back and forth every few years between adult and pediatric care. I bore very easily, but it was clear to my I would always be in some facet of oncology care, so pursuing certification made sense to me. It required a considerable amount of study time and funds. The exam was definitely not a breeze, but I passed. Years later, I was (again) back in the world of pediatric oncology, so, when my certification was due to renew, I didn't think much of it. To be honest, I was uncharacteristically lazy about it. I felt like it wasn't of value to me anymore and the "hassle" of looking into what was required to renew was not something I thought I had time for. (Oh, if I had a crystal ball.) Fast forward, my OCN lapsed one year ago. Now, working as a freelance writer and consultant, I regret letting this certification go. I had worked quite hard to obtain it and believe those extra letters can convey the wealth of knowledge I possess to others. Lesson learned. You don't have to keep them all, but some are worth it. Do you have any specialty certifications? Have you ever let any go? If so, do you regret your decision to do so? References: Montgomery, S. (n.d.).The Power of Nursing Specialty Certifications.Retrieved December 11th, 2017 from The Power of Nursing Specialty Certifications - Articles Archive - Nursing Jobs, RN Jobs, Career Advice at Working Nurse
  3. When I began writing from home, I had a sluggish ten year old laptop and my tiny desk was shared with my less than organized husband, the conditions were not ideal. The funny part is, at the start, I didn't even realize what I needed to be more efficient. After taking some time to cultivate my perfect setup, my days and creative process now seem to go a bit smoother. Where to Start It can be hard to imagine all the items you might need to work from home if you've never done it before. While a separate space is key, it may not always be possible. However, if a full office space/room is not available, setting aside a relaxing and comfortable workspace can keep distractions down and create workflow ease. Potential expenses for your first year are also quite difficult to imagine (especially if you're anything like me and unsure of what you might even need to start). Here's a general list to help give you an upfront idea of what you might need... Laptop While my old laptop was technically in working condition, it wasn't very conducive to getting much done. Despite cleaning it up, it was painfully slow and many tasks took twice as long. Time is money, especially when you're paid to create content and expected to be on the computer for most of your workday. Get a current & updated laptop or computer (with virus protection!) The money spent on my new laptop was one of the best investments I could have made. Not only did my new toy inspire me to write more, but it's cool features help me get so much done in half the time. I personally work on a Surface Pro Laptop. The screen in big enough to read/view work, yet easily portable to make my office mobile. My other favorite features include the detachable screen (turns into a tablet - you're allowed to have a little fun too!) and the touchscreen capabilities, including being able to take on-screen notes. I find this feature particularly helpful when researching multiple sites for information to be included in an upcoming article. Keyboard While the keyboard on my laptop is great, typing all day requires a proper, full keyboard (unless you want your wrists to whimper by lunch every day). I use a Logitech K120. Do a little research and see what setup you might prefer - there are many different orientations of keys available. If possible, test drive it at the store before you buy. While there were other keyboards I had my eye on, this one's key placement works best for me and far reduces my rate of typos. Hey now, don't go digging through this article looking for typos... a tired nurse writer can easily defy the rules of any helpful keyboard. Bonus feature of the K120 keyboard - it's quiet and doesn't have that extra loud clackety-clack noise that could drive me to the brink of insanity. Get Comfy Make your setup work for you and as ergonomic as possible - your body will thank you. If working on a laptop, elevate it to eye level (lots of cool setups to choose from online... or a huge med surg book works well, too!) Ensure your chair has great back support, elevate feet if space permits Lower the keyboard so your shoulders don't ride up to your ears (yikes!), keeping a near 90-degree angle in elbows Invest in proper lighting for your workspace (I see you squinting...) Stay Organized I'm definitely an office supply nerd. It's quickly become one of my favorite things to shop for. Aside from the basics (pencils, steno pads, paper clips & post its - among my frequently used items), you may also need: File folders Separate office calendar to plot out due dates for work ahead Small dry erase board (to keep track of potential pitch ideas, to-do list, or business goals) Templates Getting your hands on some pre-formatted templates can save you a ton of time. (You guessed it, I learned this one the hard way.) To find these formats, dig around online, in the Microsoft Office suite, or reach out to other helpful colleagues. Examples of some frequently used templates include: Invoices, expense sheets, time tracking sheets, contracts, pitch formats, etc Employee ID Number (EIN) Obtain an EIN from the IRS While the options of LLC, Inc. and other business structures exist - that's a whole topic for a whole other day. What I can tell you is obtaining an EIN is a great starting point for any new freelancer and the online process is actually quite easy. The benefit to having an EIN is it prevents your social security number from floating around on invoices and other forms exchanged between you and clients. The application form takes less than 10 minutes. The best part? It's free. Ambiance One of the benefits of working from home is being able to tailor your space to your needs... and likes! Include some fun stuff that will keep you happy & motivated. Here are a few examples of things I love to have/frequently use in my office: "Focus & Patience" scented candle, made by Chesapeake Bay (Target.com) Fresh Flowers Essential Oil Diffuser (Amazon.com) *I like to use an energizing citrus scent when working Music Application (Pandora.com) Note cards of encouragement from friends Surrounded by books (inspiration, humor, nursing research, etc) What are your favorite things that make your work-from-home day a little easier or more enjoyable?
  4. Ashley Hay, BSN, RN

    Ways to Unwind

    Self care is certainly not a one-size-fits-all scenario. You may find these are even more effective in a personalized combination effort. Maybe you're well versed in these too, but if not - try something new. My hope is that you are also pleasantly surprised at the results and can achieve a little calmness this holiday season. Massage I know. It seems like just an awesome (expensive) luxury, but the truth is, our bodies may need it more than you think. Nurses put a ton of physical strain & stress on our bodies with bedside care, long shifts & emotionally straining situations. While an hour long massage can work out some of the tightest neck knots and back kinks there are, but it can also be tough to justify spending the money on it and can be difficult to afford, particularly with holiday gift giving around the corner. Here are a few ideas to get you the relaxation you need, without the high price tag: Try Groupon for local spa/independent masseuse deals Talk to your coworkers - Who do they see? Some businesses offer first time customer referral deals. Acupuncture Afraid of needles? Then this next suggestion may not be ideal for you (although a nurse with needle-phobia is somewhat ironic, no?). Despite willingly trying multiple types of Eastern Medicine, I was incredibly hesitant to try this. It wasn't so much the needles as it was the thought of having said needles in me and then having to sit, alone with them left in! What if there's an earthquake? What if I have to pee? What if I sneeze or have an itch?! Luckily, a good friend of mine is very patient and (after hearing all of my laughter producing fears) she suggested we go together for the first time. It was amazing. Soothing music in the background, comfortable recliner chairs, attentive acupuncturists...and all in a community setting. Relaxing, but not alone. Perfect. If nothing else, having a 45 minute acupuncture session forces me to remain still, focus on my breathing and just relax. Limited sessions may be approved by some health insurance companies Look for a place with package deals (buy more, save more) and a comfortable setting you like Enjoy your time to relax & reflect... and not be interrupted. Time with friends Taking time away from family obligations and working to really connect with others you enjoy can be very fulfilling. You may even find that you return to life's responsibilities a little more refreshed. Satisfying conversation and time well spent with others can provide an opportunity to deepen your connections with those who matter most. Take the initiative - don't wait around to be invited. Plan an event for you and your friend(s) to enjoy. It can be anything you like, from dinner out to a night in (sweatpants and wine optional, but also recommended). Meditate Meditation at the start or end of any day can allow a temporary escape from your holiday task list, or at least reframe your thoughts about it. Taking time to mentally assess and clear out your thoughts, while focusing on breathing/stillness, can promote a healthier brain and a happier you! Many find meditation difficult, even after practicing for years. A new app I've been using for a wide variety of guided meditations is called Simple Habit. It even has a great "remind me to meditate" alarm-type feature. Creative Hobby Having a creative outlet can be a great source of stress relief. There's something about making anything with your own two hands that has a way of melting away anxiety and distracting your mind. Here's a few ideas to try: Group hobby: join a book club, host a movie night, etc. Art: take a painting class or simply pick up some cheap art supplies/crafts for home use Cooking: the sounds and scents are cooking can be really enjoyable and therapeutic. If it's something you enjoy, maybe take time to bake/cook your favorite dish. Meal box subscription services are also very popular right now and can help you discover a new recipe. Get Physical Not only is physical activity good for your heart, it's also great for your mind. Getting your blood pumping can provide a great stress release & increase endorphins. You don't have to be an Olympic athlete to enjoy the benefits of a good sweat. Give any of these activities a whirl to wind down: Go for an outdoor walk Join a running club: meet other people in your neighborhood & get a great workout Join a gym: many offer group classes if you're not sure where to start. Bonus- there are lots of deals during the holiday season, some even waiving initial membership fees or offering free trial periods) Try a group sport: another great way to meet others, plus enjoy a little healthy competition What are your favorite ways to unwind from the stresses of work, family, and holiday demands?
  5. Ashley Hay, BSN, RN

    Tools to Beat Writer's Block

    I love the freedom (and income) of being a freelance healthcare writer. When bedside nursing full time was no longer an option for me, writing healthcare content satisfied my desire to remain working while still using my hard earned knowledge of medicine. Best of all, I'm still able help to help others (patients, nurses, caregivers), just in a different way. But, all the sunshine and rainbows of being a freelance writer has a way of fading quickly if you feel overwhelmed or unable to start and can't complete the task at hand - create content. The irony of my current situation is not lost on me here. It's actually quite comical that I am experiencing a bit of writer's block (and even mild anxiety) for this very article - procrastination at an all time high in addition to a dwindling clock and a fast approaching deadline. Never fear! This article will be completed (eventually) and here's how: Outlines Personally, I find making outlines to be one of the most helpful tools for writer's block. I've used many different types (and kind of shoot from the hip). Use what feels good and works for you. Here's a great website discussing several different outline options: youngwritersproject.org Go Back to Your Pitch When pitching a client via email, I usually include a few brief bullet points that describe major themes of the potential article. If I'm feeling particularly stuck (or even unable to start) writing an article, I like to have the email pulled up in a separate browser tab and use it to structure my piece into a list type - much like how this article is structured. Your original pitch can serve as a handy outline and contains your initial ideas surrounding the topic. Use it and expand out from there. Change of Scenery Some days I love working from my home office. I enjoy my own routine of lighting a scented candle, turning on the radio and tending to some fresh flowers in my personal workspace before starting my day. However, working from home can also be incredibly distracting. I should really organize that closet, clean those dishes, prep dinner, throw in some laundry. When my home becomes more of a hindrance than a help, I make my office mobile. I'm fortunate enough to live in a temperate climate year round, so heading outdoors is usually an option. On days when it's not (or the outdoors is also somehow a source of distraction) I like to work from a quiet, comfortable cafe that's not too far from home. I find switching up your scenery (even if it's just a different space in your home) can sometimes make all the difference in your overall productivity. Take a Break! When other methods fail, take a break. It's probably your brain's way of screaming for a breather anyway. Many recent studies have found multiple benefits from taking regular breaks from doing anything for too long, studying, sitting, working, etc. For example, this article from PsychCentral.com examines how taking a break can actually improve one's attention span; author Rick Nauert PhD writes, "even brief diversions from a task can dramatically improve one's ability to focus on that task for prolonged periods". Get Moving Expanding on the theme of taking breaks, try stretching your legs. Increasing the flow of blood and circulating oxygen, physical exercise has a way of refreshing the mind. I read several articles by fellow freelancers that discuss scheduling regular gym time into their daily routine. Awesome idea, but let me be honest here, I'm definitely not one of those people. However, whether it's a brisk walk, hike, bike ride, swim, weights or yoga - all are beneficial for both mind & body. Read Something, Anything When I can't seem to write, I like to read...anything. Reading has always been a favorite hobby of mine since I was young. The escapism a well-written novel can provide is something I consider to extremely therapeutic. I find reading a great work of fiction, an interesting online blog or in-print magazine frequently provides inspiration, direction, or a fresh perspective for a piece I'm currently working on. Talk with a Colleague Being a nurse, writing for other nurses...you are surrounded by potential future readers of your work. While at my bedside job I like to sometimes pick my coworker's brains. What are they interested to know on the topic? What clinical questions do they have? Use having unlimited access to your target audience to your advantage. What tips/tricks help you beat writer's block? References: Seven Types of Outlines Taking Breaks Found to Improve Attention
  6. Ashley Hay, BSN, RN

    What Are You Thankful For?

    Thanks for reading - glad you enjoyed it. This is not to say I haven't experienced my fair share of frustrations and struggles with nursing - but I find it helps to look at it from all angles and have gratitude for all it has given me, as well. Thanks for sharing & good luck!
  7. Ashley Hay, BSN, RN

    What Are You Thankful For?

    With the fall season in full swing, themes of pumpkin flavored everything, brightly colored foliage and crisp mornings are all around us. While I will not deny my undying love for pumpkin spice lattes, another important thought also comes to mind during this season - gratitude. When reflecting recently on things I'm thankful for, my nursing career and all it has provided seemed to somehow bubble toward the top of the list. Stability & Opportunity Pursuing a career in nursing gave me a stable income, something I hadn't had previously. Over the years, my earned income has allowed me to provide for my family, travel to amazing places, buy a house and continue to pay the ever-growing list of bills that seem to accumulate with age. While I don't think any bedside nurse is swimming in an excess of cash, a nursing career can provide a steady stream of income and having that comfort is not something I take lightly. I'm grateful to have a solid way to provide for myself and loved ones. The field of nursing is filled with opportunity. This is no longer your grandmother's idea of nursing (so to speak) - where working in a hospital or for a physician is the only possible setting for your hard earned skills. After over a decade at the bedside, I realized there was more this career had in store for me. I've been fortunate enough to utilize and expand my skill set from bedside care and use it in several new roles: case management, clinical educator, healthcare content writer, consulting and more. I'm incredibly thankful I chose a career that could stand the test of time while also allowing me to branch out creatively - and get paid to do it all while still helping others in some capacity. Greater Understanding Going into nursing at a young age, I feel I owe a lot of my character development to this career. You quickly realize what matters and what really just doesn't. Being a nurse has a funny way of putting life into perspective, no matter what age you come into the healthcare setting. Seeing life and death, suffering and joy - all in it's purest, most raw form, first hand, changes a person. If being a bedside nurse doesn't give you a greater understanding of life and true empathy, nothing will. And, for this experience, for being able to be a part of a patient's healthcare journey, I am filled with gratitude. All Kinds of Kinds As the years go by, the number of patients and families I've met seems to blur into an incomprehensible number. Yet so many individuals are still clear as day in my mind - their names & faces, their story, their pain, their successes. Being exposed to so many different cultures, personality types, and temperaments has given me a useful tool to carry with me outside of my life at work. Learning to work together despite our differences is a lesson I'll gladly take a refresher course on time and time again. Being a nurse can frequently mean practicing a delicate balancing act between providing comfort and setting boundaries, a valuable tactic that reaches far beyond just nursing. Life Lessons I've been a type-A personality for as long as I can remember. Nursing has been a wonderful way for me to harness this; teaching me the value of being flexible yet allowing room for my love of organization. We all know time management is key to a good day on the floor - but the truth is sometimes the best-laid plans just don't matter in healthcare. I quickly learned that if I couldn't roll with it - I would be flattened and steamrolled by the nursing powers that be. I'm grateful to have a career where I was able to learn it is possible to loosen up and yet still be effective - as a nurse, wife, entrepreneur, friend, and much more. What are you thankful for this season? What has your nursing career given you?
  8. Ashley Hay, BSN, RN

    The Underestimated Benefit of Ancillary Staff

    Couldn't agree more. Thanks for your comment!
  9. Ashley Hay, BSN, RN

    The Underestimated Benefit of Ancillary Staff

    Thanks for bringing this up! I completely forgot to mention volunteers - and I've worked with some pretty amazing ones. They are a huge asset to any unit.
  10. Ashley Hay, BSN, RN

    The Underestimated Benefit of Ancillary Staff

    Hi Missmollie, Thanks for your concern but I have to politely disagree. I've worked in several healthcare settings over the years and this article was based on a collection of different experiences, not just one. I think it's important to openly (and constructively) discuss pressing issues that affect the nursing profession - as that is the only way things can move forward toward change. For example, in recent years more and more media attention has been devoted to sensitive topics in nursing like burnout, safe staffing ratios, etc. I don't feel a need to post this anonymously as the focus of the article speaks to the invaluable benefit ancillary staff brings to any unit. I'm believe that issues in nursing, not matter how delicate the topic, should be tackled with respectful, factual, open & honest dialogue. When all parties come to the table with an open mind, more can be accomplished and changes can be made effectively. Thanks for taking the time to reading this article - and for attempting to protecting a fellow RN 🙂
  11. Ashley Hay, BSN, RN

    The Underestimated Benefit of Ancillary Staff

    Having worked in multiple healthcare settings, many of us have seen how differently each unit can function. While no two units will be the same naturally, differences can be attributed to many factors, including patient acuity, management style, staffing plan/ratios, and much more. While several issues noted are frequently discussed and improved to better the performance of the unit, there is one topic that is somewhat avoided - the massive benefit of employing ancillary staff. Years ago, I worked on a high acuity, high volume, outpatient Oncology unit. While we frequently treated around 100 patient per day (with limited nursing staff), we certainly didn't do it alone. Yes, it was busy - but always eventually manageable, mainly due to the assistance the nursing staff received from other members of the team. For example, we had a unit assistant to help answer the eternally ringing phone and direct calls to nursing staff only when necessary. They were available to help make phone calls on our behalf to track down patient transport, security, etc. The unit assistant cleaned the patient area after each patient, freeing up valuable time for us to prepare for the next patient. We also were fortunate enough to have a patient care assistant to help with vitals and comfort measures. (While nurses are always happy to get apple juice, magazines and warm blankets, we don't always have the time. Having a patient care assistant was not only a major benefit to nurses, but also to the patient's overall experience and comfort level - crucial.) Having a team of phlebotomists also made the patient volume possible. Without them being the first to lay eyes on the patient (calling nursing when something seems off), drawing labs, taking baseline vitals and weight - we never could have treated that many patients in a day. After leaving that position, I experienced a very different setting on multiple occasions. One where there is very limited, to no staff - other than nursing. This leaves the nurse with so many non-nursing tasks on top of her regular duties that the patient is ultimately the one who pays the price, time for bedside care is extremely limited. Aside from the expected nursing duties (monitoring, medication admin, charting, etc, etc, etc, etc - so many tasks!), without ancillary staff, he/she is now additionally required now to allot time for answering the phone, making charts/copies, sending faxes, cleaning beds, restocking, running to the blood bank and pharmacy, and more. Nurses are expensive. Is their time best spent performing non-nursing tasks? Certainly not when it is taking away from patient care, making it difficult to attend to patient needs and spend much needed time at the bedside. It can take up so much time on a busy unit that it in fact prevents nurses from taking more patients, limiting the unit capacity. This becomes a slippery slope in terms of hospital revenue, as well. When all of the budget is spent on employing only nursing and no ancillary staff - the hospital is not maximizing their return on investment. Units who do not employ any assisting staff members typically will not be able to treat and discharge patients as quickly and efficiently as one with a fully diverse staff could. When beds aren't filled or turned over as quickly, money is ultimately being lost. Nurses are burnt out faster, being asked to perform multiple roles with limited resources and time. Is it possible to have a busy outpatient unit run only by nursing staff and management? Yes, but does it really make the most sense? I don't believe so. The benefits to having a robust and diverse staff are many. This can most certainly improve efficiency but more importantly, it can allow us all, as a team to provide the best possible care to our patients - while still holding on to our own sanity. What are your experiences? What positions have I left out that have been most helpful to you as a nurse? How are your units run? Do you have helpful tips to share?
  12. Ashley Hay, BSN, RN

    Hypernatremia: You are "FRIED"

    So sorry for the confusion. When I write the articles (with students in mind) I always do my best to research topics and write as clearly as possible, my apologies. Thanks for reaching out to clarify.
  13. Ashley Hay, BSN, RN

    Hypernatremia: You are "FRIED"

    Thank you for catching the mistake! While I was excited to learn about hypernatremia more in depth by writing this article, it is not my area of expertise and I apologize for the mistake. Thanks for reading and for your valuable input!
  14. Ashley Hay, BSN, RN

    Hypernatremia: You are "FRIED"

    According the Cleveland Clinic, "Hypernatremia is defined as a serum sodium concentration greater than 145 mmol/L. It is most commonly caused by the loss of water via the skin, urine, or gastrointestinal (GI) tract. In all cases, loss of access to water or impaired thirst sensation is required to maintain the hypernatremic state". An increase in sodium can cause dehydration. Treatment of this condition includes correcting the high sodium level by replacing fluid volume and treating the underlying cause of the fluid loss (antiemetics for vomiting, etc). Replacing fluids for a hypernatremic patient can be extremely delicate and the rate of IV fluids should be carefully considered and monitored so to avoid cerebral edema and increased intracranial pressure. An imbalanced sodium level affects many body systems on a cellular level leading to a wide range of symptoms, listed below. F - Fever & Flushed Skin Patients with prolonged fever can be more prone to developing hypernatremia, as it can cause excessive sweating and fluid loss. When circulating water becomes decreased for long periods of time, sodium levels can rise from lack of dilution. Treating the cause of the fever (upper respiratory infection or other) can help to correct the imbalance. Frequent monitoring of vital signs, including temperature can provide insight into patient status and should be incorporated into the nursing care plan. A full body assessment can give healthcare providers many clues into the direction in which the patient is headed. Flushed skin can be a major visual cue in determining a diagnosis of hypernatremia. Skin will appear reddened or flushed with poor skin turgor and oral mucosa may appear dry with chapped lips if dehydration is present. R - Restless Sodium is an important mineral needed for proper neurological function; an excess can lead to signs of restlessness, irritability, agitation and overall mood changes. These symptoms should resolve with prompt correction of serum sodium imbalance. Regular monitoring of mental status (including assessment of general emotional tone and level of consciousness) should be incorporated into nursing rounds. I - Increased Fluid Retention "Water movement between body fluid compartments is regulated by the effective osmolality of the solutes within each compartment. Sodium is the main determinant of plasma osmolality, and water moves toward body compartments with higher osmolality and away from those with lower osmolality" states the Cleveland Clinic. Keeping this concept in mind, fluid can shift from the intracellular space (where sodium is increased) to the extracellular space (into surrounding tissues), causing swelling of extremities and a decrease in blood pressure. E - Edema Due to the lopsided shift described above, fluids can leak into tissues, only further exacerbating the dehydration state. Light compression stockings and slight elevation of extremities can help to relieve patient discomfort while still being careful not to overload them. Edema can be monitored by checking patient weight pre & post IVF administration, measuring calf diameter and pressing firmly on bony prominences, such as the ankle, to assess pitting edema. D - Decreased Urinary Output & Dry Mouth Carefully monitoring all intake (both oral and intravenous) and output (emesis, diarrhea & urine) can provide vital clues into the patient status. Decreased urinary output can be both a diagnostic indicator and cause for hypernatremia. When urinary output is decreased it can be due to dehydration. When a significant imbalance is noted between input and output, checking a serum CMP (comprehensive metabolic panel) and other electrolytes (not included in the panel) should be included in the care of the ill patient. As previously mentioned, when fluid shifts into the peripheral tissues (causing edema) the fluid volume intracellularly can decrease - leading to further sodium imbalances. Replacement of fluids, both orally and through an IV should take priority and will correct the issue. Dry mouth and a rough tongue is a typical finding when assessing a dehydrated patient with excess sodium. Nursing care should include moistened oral swabs, ointment for dry lips, ice chips and encouragement of oral hydration if possible. It is important to report oral intake to covering MD/NP so that the IVF rate and volume can be adjusted (as over dilution is also possible, along with increased demand on the circulatory and cardiac systems). Using the acronym FRIED can help you identify your hypernatremic patient. Replacement of fluids is key in correcting this imbalance of vascular osmolality and electrolytes. Nursing care should include close monitoring of patient status through frequent vital signs and full body assessment. Comfort care is also imperative, including mouth care (glycerin swabs & lubricant for lips), documentation of hourly all intake & output and encouragement/availability of oral fluids. Nursing care plans may also include education on sodium content of foods and proper daily oral hydration volume. References: Edema Overview Hypernatremia Signs and Symptoms Hyponatremia and Hypernatremia
  15. Ashley Hay, BSN, RN

    Please don't judge me and my daughter

    I'm so sorry to hear this story and what you endured. Sending much love to you and your daughter - and commending your strength. Thank you for sharing such a personal story and let it serve to a reminder for all HCPs. Our actions and attitudes matter to our patients more than we sometimes realize. While it can be difficult to always be "on", this is what each & every patient we encounter deserves - empathy, caring and compassion, always.
  16. Ashley Hay, BSN, RN

    Both Sides of the Bedrails

    Thank you for reading! Your comments are so appreciated