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  1. AACN offers the premier critical care conference, National Teaching Institute (NTI) annually. Recently allnurses.com’s Content and Community Director Mary Watts, BSN, RN, interviewed Anna Dermenchyan, MSN, RN, CCRN-K. In 2010, she founded the first hospital-based chapter of the American Association of Critical-Care Nurses (AACN). As the first chapter president, she began an annual Leadership Symposium for nurses and nursing students within the hospital and the community. Issues Associated with the Job Anna started her nursing career in a CVICU at UCLA. She relates; “they cared for such critically ill patients and provided such an enriching environment for a new nurse. What I was not prepared for was the issues associated with my job.” She progressed in her nursing career and had many roles including resource nurse, preceptor, and charge nurse. Approximately five years down the road, she wanted to take on a quality role. She went back to school and is currently working on a PhD looking at outcomes for HF patients in primary care. Idealism as a New Nurse allnurses.com asked about the issues surrounding nursing care. Anna discussed the idealism that is felt in nursing school, “you don’t know the expectations of the new job.” She went on to discuss the need for teamwork and that sometimes this isn’t always there and “the patients suffer.” One of the stressors at the start of her career was that the CVICU manager left within six months and the unit felt “lost.” Another issue was that she had numerous preceptors which added to her stress. Healthy Work Environment Anna also commented that AACNs healthy work environments (HWE) initiatives are so important for critical care nurses. The six initiatives are: Skilled communication True collaboration Effective decision making Appropriate staffing Meaningful recognition Authentic leadership The Importance of Networking Next, they talked about networking which is a great way to make connections that will lead to success in your nursing career or any career. Mary asked, but how do you network successfully at a large conference like NTI? Anna replied, “It is a place to learn clinical topics and there are 300 sessions, motivating. It’s also a value-added commodity. You can let your guard down and network and it's an amazing experience. It’s not only about practice education but also a great way to connect and make new members. You can find a mentor.” Don’t take learning for granted. Collaborate with others. Here is the complete interview presented in 2 videos:
  2. Many people have thoughts about how to combat nursing burnout. There have been studies, conversations, symposiums. Speaking to someone who has experienced burnout helps to clarify the issue and a possible solution. allnurses.com’s Content and Community Director, Mary Watts, BSN, RN recently spoke with Anna Rodriguez, BSN, RN, PCCRN, CCRN at the AACN/NTI Conference about her journey through nursing burnout. Anna explained that she went thru an experience approximately 3 to 4 years ago when she was in the right place at the right time and became a unit manager of a 10-bed CVICU. She held this position for two years and during these two years they had many changes including starting a new ECMO program, launched new and different technology and it just was a perfect storm. Anna got to the point where she went back to bedside via travel nursing. Currently, Anna is working in endoscopy. She had started a blog, The Burnout Book to collect her thoughts and to share with others as well as to bolster her spirits. This is based on the original burnout book that was a little journal she started writing during her second year of nursing school. She commented, “It’s important to remember our “why” in nursing. It's the little things that matter. Now I’m a burnout survivor.” Any human being will have bad days. As a nurse its important to develop a skill set to deal with bad days. However, when you have moral residue, it becomes harder to see that perhaps it's just a bad day versus actual burnout. From the ANA, moral distress is defined as: Understanding and Addressing Moral Distress - American Nurses Association Signs and symptoms that can be indicative of moral residue include: Physically, and emotionally exhausted Dreading the job that you used to like Less connection with your job Chronic illness All of this can lead to burnout. Early recognition is the key. Possible solutions: Talk with someone, perhaps a trusted co-worker Acknowledge your feelings Employee assistance program Counseling if your mental health is endangered Changing jobs, shifts or specialties Mary then asked if there are some personality traits that make a person either more prone to burnout or more resilient to this phenomena? Anna answered that in general people that are empathetic can have more issues with less resilience and this describes most nurses. As nurses, we have to find the balance between being compassionate and caring and separating ourselves from these feelings. They also discussed compassion fatigue which is when you take on the feelings of others to the detriment of yourself. Anna’s advice identifies that the goal is to be more resilient. When you feel a burnout moment, you need to get out of it. However, don’t make huge lifestyle changes at the moment. You need to resolve the immediate stressor but once the stress lessens then you can rethink the situation and look at your life to see if you need to make big changes. All nurses experience this to some degree but its how you handle it. Don’t quit nursing, find your spark, there are a lot of different ways to be a nurse!
  3. traumaRUs

    Alarm Management Practice Alert

    How to manage the many alarms that the bedside nurse must assess? “The Joint Commission has identified alarm management as a national patient safety goal and requires hospitals to take action to reduce unnecessary alarms as a condition of accreditation." allnurses.com’s Community Manager, Mary Watts, BSN, RN had the opportunity to interview Halley Ruppell, PhD, RN and Stacy Jensen, CNS at NTI. Some issues they discussed included: Tailoring the alarm setting to the individual patient and the disease process. For instance some children with congenital heart issues experience a “normal" SpO2 saturation below the standard so setting the parameters lower results in fewer nonactionable alarms Actual alarm management teams including engineers have come together to enact age-appropriate alarm settings that would somewhat standardize parameters. Placement of electrodes, skin prep prior to placement, and the amount of pressure applied to skin are all part of the monitoring process SpO2 sensors being applied correctly and the use of the correct sensor on the correct body part are key to proper management of alarms also Quality improvement activities are very important to the care of the critically ill patient; for both pediatric and adult patients. Nonactionable alarm overload can result in nurses actually not hearing alarms as well as disregarding alarms. With many “false alarms,” this results in less response to the alarm increasing the chance of missing an actionable alarm. The process alarm alert was updated in 2018. Here is the link to the practice alert. During the interview, it was discussed that there is not a lot of research involving the differences between pediatric and adult critical care monitoring. This has resulted in a standardized monitoring system for both adults and pediatrics which isn't always individualized. It is imperative that clinicians order appropriate monitoring for patients and that monitors are not overused. This can also lead to alarm fatigue. Another issue that was discussed was buy-in from the bedside nurses. The feedback received after the initiative was published involved hard data. This provided the bedside nurse with evidence-based information proving the efficacy of the practice alert. Listening to fewer alarms really engaged the nurses and brought awareness of alarm fatigue to the bedside nurse. This is important also for the families bedside and promoted the engagement of both staff and visitors. Change in practice can sometimes become burdensome for the bedside nurses but with evidence-based information, you can obtain more engagement. It was eye-opening for nurses to realize that they didn’t hear all the alarms. Its a sensory overload type of situation. Leadership must also recognize the need for change. Per AACN; “The strategies for nursing leaders include the following: Establish an interprofessional team to gather data and address issues related to alarms Develop unit-specific default parameters and alarm management policies Provide initial and ongoing education on monitoring systems and alarm management for unit staff Develop policies and procedures for monitoring only those patients with clinical indications for monitoring" Yet another piece of this project was a collaboration between the researchers and the industry that makes the monitors. It is very important to involve business leaders and engineers. Here is the entire interview:
  4. Come and join your fellow critical care nurses at NTI 2019 in Orlando, Florida from May 20-23rd. With more than 37.5 hours of CEUs offered, this conference is sure to teach, inspire and impress all high acuity and ICU nurses. Reasons to attend NTI It would be easy for us to tell you the reasons. However, here are a few of the of the comments from recent attendees: "It pumps me up." "Chance of a lifetime." "Makes me motivated to be a better nurse." "Gave me back my enthusiasm to be a bedside nurse." There are many reasons to attend and some of the past attendees have stated some of these reasons. The sessions are also a solid reason to attend NTI. They are divided into pre-conference offerings that include Chapter Leadership for those nurses who want to advance to an AACN leadership role. The pre-conference sessions also cover other topics such as a cadaver lab for APRNs, advanced 12-lead EKG interpretation, certification prep courses, in addition to other critical care exploration options. The pre-conference topics are offered on Sunday and run most of the day so that you have the ability to more fully explore the topic. Concurrent sessions are usually 60-75 minutes in length and cover such topics as: 12-lead EKG Interpretation, Candida: The Fungus Among Us and From the Playground to the Nurses Station: Understanding and Eliminating Workplace Bullying. NTI 101 One of the most interesting topics is NTI 101. This is an introduction to the conference, how to navigate it, how to get the most out of the experience. Here's what AACN says about NTI 101: "Perhaps it’s your first time or you need a refresher; attending the National Teaching Institute and Critical Care Exposition (NTI) can be an adventurous and sometimes, an overwhelming experience. The Program Planning Committee Chairs offer strategies to help you navigate your way through NTI. Please be sure to bring your mobile devices so you can participate fully in this dynamic session. Learn how to plot your educational journey through hands-on use of the NTI Program Guide, Program Schedule, Learning Action Journal and ExpoEd Guide which can be found in your NTI bag. Join the API or NTI Chair in this interactive and engaging session to explore how to develop a personalized education schedule, identify available resources and use My NTI. This session is designed to answer questions about the multitude of diverse opportunities available to every attendee and to help make your NTI an enjoyable and rewarding professional experience." This session will lead you on your way to a satisfying and enjoyable NTI 2019 and its offered several days and times so fitting it in shouldn't be difficult. The Advanced Practice Institute (API) offers some great options for the APRNs; whether you are just beginning your APRN journey or have been around the block several times. The ECMO session is always a highlight, as is the cadaver lab. Some other topics include: Vasoactive Pharmacology for Pediatric Shock, Neuromuscular Blockade in the ICU: A Review of Practice, Top Sepsis Studies 2018-2019 and Acute Decompensated Heart Failure, Management and Prevention of Recurrence. And these are only a few of the selections. The Exposition Hall This is where you learn, see, and experience all the new technology that is currently available or soon to be available for your critical care units. Its also where you can learn about educational opportunities to advance your career and also where the jobs are found. There are over 300,000 square feet of experience and you can truly spend the entire day here and not see everything. The opportunities are endless - pick up a brochure about a new piece of equipment, listen to a seminar about a new process to make patient care more efficient, network with other critical care nurses about the challenges and rewards. Registration Register Now Where to Stay AACN has a very comprehensive list of available hotels with pricing included here. There are a wide variety of options with many hotels located near the convention center. There is also a shuttle that runs between many of the hotels and NTI. We have just briefly touched on what NTI 2019 offers you. AACN has a very comprehensive site with all the details. Several allnurses.com staffers will at NTI 2019. We love to meet our members. Please let us know if you are attending. Also, we do have the opportunity to interview some of the speakers - who would YOU like us to interview? Tell us!
  5. In 2013, the Society of Critical Care Medicine (SCCM) recommended the following as basic to ICU patient care: routinely monitor all intensive care unit (ICU) patients for pain, depth of sedation, and delirium, using valid and reliable PAD assessment tools;(2) assess and treat pain first, before sedating patients; (3) avoid deeply sedating patients; (4) use nonpharmacological delirium management strategies over medications to prevent and treat ICU delirium; and (5) link PAD management to ventilator weaning and early mobility efforts. ABCDEF Bundle - Recommendations of best practices: A - Assess, prevent, and manage pain B - Both spontaneous awakening and spontaneous breathing trials [SATs/SBTs]; C - Choice of analgesic and sedation D - Delirium: assess, prevent, and manage E - Early mobility and exercise F - Family engagement and empowerment; Integrating pain, sedation, and delirium management allnurses.com staff recently interviewed Joanna Stollings, PharmD, a clinical pharmacist in the department of pharmaceutical services at Vanderbilt University Medical Center (VUMC), Nashville, Tennessee. Here is what we discussed: Q: This is a multi-disciplinary assessment. How are institutions initiating this aspect? Daily meetings/huddles or is each discipline responsible for their own part of it? Institutions are using many different methods to implement the ABCDEF Bundle. One of the best has each of the team members to present a separate component of the bundle during interdisciplinary rounds. Another approach is to include documentation of the entire bundle in one area of the medical record. Our group is actively working with Epic and Cerner to help with this documentation process. We want to avoid having practitioners practicing in silos and to promote the interdisciplinary aspects of this bundle to promote the best care of the patient. Q: Regarding family engagement in ICU care of their loved one, does the introduction of a formal palliative care program fit into this objective? Does open (24/7) visitation of family members help to achieve family engagement? In many pediatric ICUs, there is open visitation. Could adult ICUs take this as an example? A formal palliative care program can be part of the objective of family engagement. The Family element of the ABCDEF Bundle promotes involving the family in all decisions about patient care. Adult ICUs definitely could use the open visitation policies that are commonly found in pediatric ICUs. Open visitation by family members definitely helps with family engagement. It allows the family members to be present during interprofessional rounds and to assist in the implementation of other parts of the ABCDEF Bundle such as assistance with physical therapy. Q: Regarding mobility assessment - does implementing early physical therapy referral assist with this goal? Implementing a referral for early physical therapy can help with obtaining appropriate mobility assessments. However, nurses, physicians, advanced practice nurses and physician assistants, etc. also need to be able to do an appropriate mobility assessment to better triage the utilization of physical and occupational therapists to the most complicated patients. Q: With the opioid overuse crisis, utilizing a range for dosing of opioids for pain control is often ordered for ICU patients. Of course, this must be regulated by hospital/facility policy. What educational material would be utilized to provide this education and best practice for the bedside ICU nurse? We would recommend utilizing resources from the Joint Commission and/or the American Pain Society to educate nurses about range dosing of opioids. Q: How do you get "buy-in" from the bedside nurse who can already be overwhelmed with documentation and care of the patient? Seeing their patients have better outcomes and other results from implementing the ABCDEF Bundle help secure buy-in from bedside nurses. While it is important to introduce the concept of the ABCDEF Bundle as a whole when implementing it, the team can focus on the various elements individually over time. This allows the unit to keep the big picture in mind while fine-tuning the details along the way. It always helps the whole team to remember that these elements are interrelated. When ICUs start to use the ABCDEF Bundle, we recommend they start with one letter and to start with only a couple of patients. As nurses start to see the results of each of the different components of the bundle in a few patients, they will want to implement the Bundle in more patients. Resources Utilized by Joanna Stollings: Common Challenges to Effective ABCDEF Bundle Implementation: The ICU Liberation Campaign Experience Implementing the ABCDEF Bundle: Top 8 Questions Asked During the ABCDEF Bundle Improvement Collaboration AACN news release: Practical Advice for Implementing the ABCDEF Bundle Society of Critical Care Medicine
  6. The 2018 Marguerite Rodgers Kinney Award for a Distinguished Career was awarded to Beth Tamplet Ulrich, EdD, RN, FACHE, FAAN at the 2018 American Association of Critical Care - National Teaching Institute annual conference. While at the NTI conference, Mary Watts, BSN, RN, allnurses.com Community Director interviewed Dr. Ulrich and discussed her career and some of her accomplishments. Dr. Ulrich received her bachelor’s degree from the Medical University of South Carolina, her master’s degree from the University of Texas Health Science Center at Houston, and her doctorate from the University of Houston in a collaborative program with Baylor College of Medicine. When she moved to El Paso, Texas; due to her husband’s job, she started in dialysis and learned from the ground up as dialysis was in infancy. She worked to set standards of care and is a past president of the American Nephrology Nurses Association (ANNA). While earning her doctorate, she worked in hospital administration developing nursing simulations and nurse residency programs. She became interested in the healthy work environment and began her work with the American Association of Critical Care Nurses (AACN). She assisted with development of the first Healthy Work Standards survey in 2005. Dr. Ulrich stated that AACN brought together “an expert panel to create the standards.” In 2006, it was decided to “obtain opinions from those nurses with boots on the ground; the staff nurses who do the doing every day.” She further explained that AACN is “absolutely committed” to obtaining information to help the bedside nurse work in the safest environment possible. The 2005 survey was a snapshot. By the 2008 survey, AACN began to assemble comparisons of data which expanded when the 2013 survey data was added and AACN was able to took at trends. Now in 2018, AACN has received over 8000 responses to their current survey. Every time the survey is done, there are more and more nurses responding. Mary stated, “nurses see the value in these surveys because they want changes” via the published results. Dr. Ulrich continued, “When we first looked at this, we were looking for a baseline. In 2013, we saw the down turn of the economy: nurses were returning to work, they were changing from part time to full time, or for those who were working full time, they were looking for overtime.” In this scenario where the economy dictated how much you needed to work, there were not a lot of changes in the work environment regarding safety as income was the number one reason to work. Mary asked, “What contributes to an unhealthy work environment?” Dr. Ulrich answered that inappropriate staffing - results showed that 39% of the respondents reported they had appropriate staffing. Another more concerning result was that 32% stated that <50% of the time, they had adequate staffing. “This is pretty scary for the patients and the nurses". Dr. Ulrich pointed out that "staffing isn't just about the patients; it's about the nurses too, because when staffing isn't adequate, nurses don’t practice at the top of their license. They get done what they have to get done. They don't get to do the things only nurses can do - the critical thinking things, the discharge planning, comforting, teaching patients and families. They have to do tasks and then nurses aren’t satisfied with their jobs.” This results in decreased job satisfaction. Staffing is more than just about enough nurses to take care of the patients. It reflects on everything in the work environment. “I was surprised at the high number of incidents of discrimination with the 2018 survey.” This included verbal and physical abuse experiences. “We capped it at 200 incidents in the survey.” Nurses aren’t leaving nursing, they are leaving the hospitals - they have many options. They aren’t limited to work in the hospitals. “Once a nurse, always a nurse,” stated both Mary and Dr. Ulrich in unison. The survey results are published in Critical Care Nurse, AACN's clinical practice journal. Link to study Allnurses.com extends their gratitude to Dr. Ulrich and AACN for continued support in disseminating vital information for nurses.
  7. As nurses move into new positions, there are many choices and aspects to consider before saying yes to the job. Mary Watts, BSN, RN and Maureen Bishop, MSN, CNS discussed ICU orientation and how to be a successful ICU nurse. They met at the 2018 NTI Conference in Boston, Massachusetts. They talked about the changing face of nursing employment. Nurses on the Move A recent study found that millennials will change jobs an average of four times in their first decade out of college, compared to about two job changes by Gen Xers their first ten years out of college. Ms. Bishop explained that the expectation of employment at her institution is two years. Essentials of Critical Care Orientation (ECCO) Ms. Bishop has been hiring new grads into the ICU for the past 10 years. "Mostly we look for passion. We do what is called a blended orientation concept. They do online modules, classroom time where they learn basic critical thinking skills and they take an 8-week arrhythmia course." In addition, they are required to take and pass ACLS and "of course the most important part is to spend time bedside." Ms. Bishop attributes her facility's orientation success to utilizing AACN's ICU Essentials of Critical Care Orientation (ECCO). According to the AACN, "ECCO's up-to-date, interactive evidence-based education easily blends into your existing orientation plans. AACN's 24/7 customer support, comprehensive reports, and progress tracking tools make implementation straightforward." The ECCO program has earned accolades for its content: "American Association of Critical-Care Nurses (AACN), a leader in providing standard-setting education and expertise that nurses and healthcare organizations can trust, recently won two prestigious Brandon Hall Group silver awards for excellence in the Best Learning Team and Best Advance in Custom Content categories." Even after the 4-6 month official orientation, there is a mentorship program too; where new grads and seasoned have added support for an extended period of time. They also have follow up with Ms. Bishop as well as the unit manager. Mary asked about whether orientation is customized for the experienced nurse and Ms. Bishop assured her that the orientation must be flexible in order to meet the needs of everyone. Customized orientation is also important to AACN and their ECCO program. Ms. Bishop also emphasized that they welcome nurses who apply from out of state, both new grads and experienced nurses. Evaluation Evaluating the end product of orientation is extremely important. Ms. Bishop states that the criteria she uses to evaluate orientees consists of their ability to grasp the concepts of ECCO and put them into practice. She also emphasizes the need to utilize solid critical thinking skills when confronting complex patient care. Other important aspects of a successful new ICU nurse are that they are able to coordinate all the aspects of care including physical assessment into a solid plan of care. This includes understanding lab results, medications and how they affect the overall care of the patient. She concludes, "so for me, it's really how they are doing on the job. Are they putting that knowledge into practice?" Nurses want to be successful in their chosen career. There are many barriers to a successful orientation but using a known product to facilitate this process will increase the odds of retaining ICU nurses.
  8. The opioid epidemic is a hot topic in today's headlines affecting more than 1 million people across the United States. As part of the multidisciplinary healthcare team, the nurse plays an important role in providing safe pain management using a multimodal approach. Catherine Ewing, BSN, RN shares strategies for optimal outcomes for pain control including safe prescribing and follow-ups as needed. At NTI 2018, allnurses.com's Community Director Mary Watts interviewed Catherine Ewing, BSN, RN who addressed the nurses' role in the opioid epidemic. She discussed the recent changes to the Centers for Disease Control and Prevention's recommendations. She stated, "The purpose of these guidelines is not to deny people pain medications but to prescribe safely and have prescribers practice follow-up." Catherine Ewing holds a BSN from the College of Saint Teresa in Winona, Minnesota. She works in the Department of Anesthesia Inpatient Pain Service at the Mayo Clinic, Rochester. As a member of this consult service, she triages and manages epidural and peripheral nerve catheters for both inpatient and outpatient populations. Catherine and Mary discussed the importance of individual pain assessment relative to several factors: Type of pain Reason for pain - is it due to recent surgery or trauma? Patient's previous experience with narcotics Does the patient have a history of addiction? Patients who have addiction issues need pain control also. The American Pain Society has guidelines to help clinicians provide adequate pain relief for those patients who have opioid addiction issues. Some of the points include: Use of methadone, dosing, initiation and titration Conduct a thorough pre-op pain medication assessment in a non-judgemental manner Use a validated pain management tool Provide close monitoring of respiratory status Surgeons should consider local blocks during surgery utilizing long-acting analgesia Catherine went on to state, Consistent nursing assessment and documentation is key to successful pain management. Nurses should also consider nonpharmacological means of pain management too, for instance, ice, elevation, guided imagery, and massage. This is a national problem and one many nurses face each shift they work. Pain Management and the Opioid Crisis - Conversation with Catherine Ewing Catherine's session was very popular and widely attended. One of the comments from the audience, "this is such an important topic given the current state of our healthcare system! I find this particularly relevant to the Cardiothoracic Surgery patients I typically encounter - in the facility in which I work a major issue is that generalized "pain management" policies do not take in to account the nature of the operation itself and the importance of pain control in preventing complications and improving outcomes. Pulmonary hygiene and early mobilization are paramount, however often difficult to achieve without adequate pain control. Unfortunately, it seems the corporate-minded aspect of many healthcare institutions is becoming a barrier to optimizing patient outcomes. I believe wholeheartedly that bedside critical-care nurses should be included by administrators in the development of methods to manage pain in postoperative recovery given the concerns of the opioid crisis. Great topic, glad to see it being discussed!" Pain control is an important element of patient care and one that deserves all nurses' attention. What is your hospital doing to ensure patients have adequate pain control? Reference: American Pain Society, Guidelines on the Management of Post-Op Pain
  9. As a nurse, you speak with the public daily. You educate patients, support families, and provide information to community resources to get your patients the care they need. When our country experiences disasters, nurses are at the bedsides, providing care, and advocating for their patients. But, when a journalist covers a story about the latest flu epidemic, acute flaccid myelitis, or another violent attack, who do they interview? Do they look for the nurse at the bedside who cared for these patients, or the doctor overseeing the care? We're quite sure you just said "doctor" in your head, right? But, do you know why? A recent study conducted by Diana Mason and Barbara Glickstein replicated the original Woodhull Study that was done in 1997 to explore how often nurses were identified or interviewed in the media for general healthcare stories. The study was reproduced to determine if there have been any advancements of nurses in the media. At a recent AACN-NTI Conference, we sat down with Diana, who is the Senior Policy Service Professor for the Center for Health Policy and Media Engagement at George Washington University School of Nursing during the American Association of Critical Care Nurses meeting. She provided an overview of the original findings, new data, and the future of nurses in the media. You can watch/listen to the full intervew below. The Original Woodhull Study In 1997, the "Woodhull Study on Nursing and Media" was published, and was the first of it's kind to explore the representation of nurses in the media as sources of health-related stories. Dianna explained that the original study found that nurses were sources in quotes less than 4% of the time in newspapers, and about 1% of the time in newsweeklies. During the interview, she explored the notion that even when nurses were at the heart of the story, such as with HIV/AIDS care in the mid-90's, they were nowhere to be found in print publications. Even rarer was to find nurses being interviewed about nursing policy or actually photographed for news stories. Following the release of the original findings, Sigma Theta Tau raised awareness of the need for nurses in the news. Then in 2010, the Institute of Medicine (IOM) released the Future of Nursing Report in which the Robert Wood Johnson Foundation and the IOM conducted a two-year initiative to assess and transform the profession of nursing. The study concluded that nurses played a vital role in the advancements of the healthcare industry, but that barriers existed that prevented them from being well-positioned to lead change and advance health. Have We Progressed? According to the preliminary results released by The George Washington University, the new study examined 365 randomly sampled health news stories published in September 2017. They looked at the type and subject of the article, the profession, and gender of the speakers, and how many times nurses were references without being quoted. The researchers found that nurses were identified as sources in just 2% of the health news coverage and mentioned in 13% of health news coverage overall. While this is a decrease in the representation, Dianna explained that it's not statistically significant, so the conclusion has been made that nothing has changed. She acknowledged that this might not be accurate because nurses might be cited in stories, but not recognized for their role. It's normal to see stories where Dr. Smith is quoted, even if he or she isn't in a hands-on provider. However, when a nurse holds an executive level position, their credentials aren't always given. Other findings included that females are less represented that males in the media, even though the profession is predominately made up of women. There were also preconceptions in the news media about positions of authority and journalists admitted that they weren't sure what nurses do and when nurses would add to a story unless it was explicitly about nursing. How Do We Make Change? Nurses provide more hands-on care than any other healthcare professional. Yet, they aren't equally represented in the media. Is this because nurses are not comfortable with being in the spotlight? Could it be that when journalists request an interview for a story nurses are not the ones provided by healthcare systems? Or, maybe journalists aren't even sure how to access nurses for stories. Actually, all of these were found to be true. So, how do we ensure that this won't be the same 20 years from today? Here are a few things you can do to help progress nursing representation in the media: Support movements like Show Me Your Stethoscope (SMYS) that advocate for positive cultural changes within the nursing profession and the healthcare community. They strive to provide a united voice for nurses on issues facing our communities. SMYS was founded in response to a public attack on the nursing profession and has ultimately led to the #NursesUnite concept. Talk about your credentials. Diana points out that you don't need to include all 7 of the certifications you hold, but identifying yourself as a nurse with a hard-earned degree and license is paramount to the required changes in media. Improve media competence by training journalists and offering media training to nurses. If you want to be a presence in your local community, seek out the media relations department at your facility and request to be trained on how to speak to the media. This training can teach you how to talk with journalists, stay on your message, and just be yourself. Anticipate healthcare happenings and identify nurses who should be at the forefront of stories. This should be accomplished on a local, state, and national level by healthcare facilities, organizations, universities, and government agencies. Our time with Diana was eye-opening and empowering. Have you been in the media as a nurse? Were you well-represented in print? Or, maybe you have ideas on how to empower nurses to be in the press? Whatever your thoughts are about this study, we want to know. Comment below and get the conversation started.
  10. AllNurses.com's Content and Community Director, Mary Watts recently interviewed Karen Kesten, DNP, APRN at NTI 2018 on the subject of nursing certification. Dr. Kesten is the past chair of the national board of directors for the AACN Certification Corporation, as well as an associate professor George Washington University School of Nursing. Many nursing certifications are available from AACN Certification Corp. for both RNs and APRNs. Dr. Kesten recommends certification for all nurses as a "mark of excellence and distinction." She went on to state that this proves credibility of knowledge and leads to higher patient and nurse satisfaction. New Certifications Two new certifications; CCRN-K and PCCN-K are now available. These certifications are for nurses who do not currently deliver direct bedside care but who indirectly affect patient care thru management, instruction or staff development. The "K" stands for "knowledge." This is a way for nurses to continue to use their knowledge even though they are no longer bedside. Other new certifications include palliative care, and forensics nursing. These specialties show patients and colleagues that the nurse has attained a level of expertise in their specialty. Dr Kesten foresees possible future certifications for nurse navigators and nurses who are involved in transitions of care. APRNs and the Consensus Model Advanced Practice Registered Nurses (APRNs) also need to consider the Consensus Model when choosing their educational pathway. The APRN roles are: Nurse Practitioner Clinical Nurse Specialist Certified Nurse Midwife Certified Registered Nurse Anesthetist "To help take APRN practice to the next level, AACN collaborated with over 40 nursing organizations to address the inconsistency in APRN regulatory requirements throughout the United States. The result was the Consensus Model for APRN Regulation: Licensure, Accreditation, Certification, and Education (LACE)." The Consensus Model sought to improve patient access to APRNs, support nurses to work more easily across different states, and enhance the certification process by preserving the highest standards of nursing excellence. Through consistency and clarity of APRN Consensus Model criteria, APRNs were empowered to work together to improve health care for all." LACE also determines what patient population and focus the APRN certifications cover. This is an effort to delineate out each APRN specialty and to develop more consistency. Dr. Kesten encourages nurses to consider a primary care APRN role as nurse practitioners are in great demand especially in underserved and more rural communities. With the current physician shortage, nurse practitioners are filling many provider roles. More and more nurse practitioners are seeking roles in specialty care, which extends the availability of providers. Why Certification is Needed Dr. Kesten encourages nurses to obtain certifications. She emphasized that nurses are in a life-long learning pattern and with certification, they have more options. There are many faces of nurses so there are many certifications and she expects that nurses will have many more opportunities in the future. Dr. Kesten advocates for nurses having a louder voice in order to advocate for their patients. Overall there are many more opportunities available for certified nurses. Consider certification! References: AACN Certification Corporation APRN Consensus Model
  11. tnbutterfly - Mary

    How to Successfully Navigate NTI

    The 2018 NTI Conference is Sold Out. Join Us Next Year in Orlando. The conference this year has sold out. Registration is closed. NTI will not be accepting any additional registrations online or on-site in Boston Thrive at NTI: Some Tips for the Best Experience This year, more than 8,500 attendees are expected. The size of the conference alone can challenge NTI newcomers and veteran attendees alike. It is important to plan ahead. Use this checklist to start planning your week for a fulfilling and stress-free conference experience. Look for more tips on the FAQ page at www.aacn.org/nti. Explore My NTI and get connected. Sign in on the AACN website and use My NTI to create your schedule, plan your week and participate in discussions with facilitators and other attendees - a great forum for your questions about planning, sessions, and Boston. Organize your schedule and special events. Create your schedule on My NTI, and be sure to add a Sunrise Session to secure your seat. Reservations are required. Check if a session is offered twice or online after the conference to help you decide which sessions to attend on-site. Look for the icons in your Program Schedule or online to easily identify these sessions. Because of the high attendance, it's important to pick a second or third choice in case your first one is full. Also, pay attention to the room locations of your second and third choices so you can get there quickly. Try to pick alternatives close to your first choice. Arrive early to sessions that are a top priority for your education plan, and allow enough travel time. Please note that adding a session to your schedule is for planning purposes only and does not guarantee a seat, except for the API reception and Sunrise Sessions. All other sessions are open seating (first-come, first-seated). Please arrive early for the best opportunity to attend a session. Get NTI tips from the pros. Join NTI Program Planning Committee chairs at "Navigating NTI 101," Sunday, May 20, at 4:15 p.m. or Monday, May 21, at 8 a.m. They'll walk you through how to make NTI an enjoyable and rewarding professional experience. Take a tour of the convention center. If you arrive early, consider joining members of the NTI and API program planning committees for a tour of the convention center on Sunday beginning at 10 a.m. every 30 minutes. Familiarizing yourself with the convention center layout and key locations will make it much easier to get around quickly once the conference begins. Maximize your conference experience with the Learning Action Journal. Tools to assist you plan, learn and act on your conference education and activities are available at www.aacn.org/nti. The Learning Action Journal is included in your attendee bag. Dress for comfort and temperature shifts. Buy a pair or two of comfy shoes and break them in before the trip. Meeting room temperatures often fluctuate, so wear layers. Allow adequate travel time to Convention Center. If you are at a hotel in the downtown or Back Bay area, allow for a 20- to 30-minute shuttle ride due to traffic congestion in the city. Plan meals and snacks, and drink plenty of water. The Participant Map in your attendee bag highlights food options and hours at the convention center, but bring nutritious snacks such as fruit, granola or nuts and bottled water for your midday energy boost. Food lines in the convention center can become quite long. Explore Boston beyond NTI. The diverse neighborhoods of Boston offer endless opportunities for cultural and outdoor activities. Get started at Boston Guide | Hotels, Restaurants, Meetings & Things to Do in Boston or ask the locals at the Host Chapters Booth on-site. Enjoy a fun-filled Nurses' Night Off at Seaport World Trade Center, Wednesday, May 23, 6:30-9:30 p.m. Unwind at this Boston landmark and dance to the city's premier band, Night Shift. The evening out includes complimentary "taste of Boston" hors-d'oeuvres, coffee and tea. We'll also offer a cash bar serving bottled water, sodas, wine, and beer. Shuttle service will be provided throughout the evening. Stay and make it a vacation. With a mix of colonial charm and urban sophistication, Boston features a wealth of historical and cultural attractions. Don't miss this opportunity to experience a city offering great dining and nightlife, extraordinary shopping, exciting sporting events, and a vibrant arts and cultural community. Safe travels. See you in Boston! Source: AACN Bold Voices, the member publication of the American Association of Critical-Care Nurses.
  12. allnurses

    NTI 2018 - See you in Boston!

    With more than 37.5 continuing education (CE) contact hours, the outstanding and diverse learning opportunities and inspirational gatherings promise to reignite your commitment to your practice and our profession. Hundreds of learning activities feature the latest innovations in practice, technology, and healthcare delivery, evidence-based practice and research to meet your clinical and professional practice education needs. Connecting with friends and colleagues at special events throughout the week will round out this inspirational experience. There are more than 275 sessions. There are also 2.5 hour sessions at the mastery level. For advanced practice nurses, the Advanced Practice Institute will allow you to obtain pharmacology contacts and to build on your advanced practice nursing skills. Update your knowledge, refine your skills and learn something new in critical care. This educational conference features the latest innovations in high-acuity and critical care practice, technology, healthcare delivery, evidence-based practices and research. When and Where May 21 through May 24, 2018 Boston Convention and Exhibition Center 415 Summer Street Boston, Massachusetts 02210 (800) 899-AACN (2226) Hotel Westin Boston Waterfront 425 Summer Street Boston, MA 02210 (617) 532-4600 Here are some great memories from 2017: Education and Sessions For attendees that come early, there are pre-conferences that offer opportunities for hands-on experiences with 3- and 6-hour sessions providing deeper coverage on relevant topics. If you are an early morning person, consider the Sunrise Sessions which are funded by unrestricted grants from corporate supporters. Reservations are required. SuperSessions are where you can share the joys and challenges of caring for acutely and critically ill patients and their families with thousands of your colleagues. The keynote presentations from AACN leaders and popular motivational speakers will motivate, inspire and celebrate our profession. At the National Teaching Institute & Critical Care Exposition, there are so many educational opportunities that align with the needs of high-acuity and critical care nurses. Choose from hundreds of sessions covering 30 diverse clinical and professional development topics, and visit over 400 exhibitors at the Critical Care Exposition. Attendees practice in many areas in many diverse roles ranging from staff nurse to manager and APRN. Whether you are a new or experienced nurse, the curriculum offers in-depth content using the most up-to-date evidence-based guidelines and practice standards. The Critical Care Exposition is the largest, most comprehensive trade show for high acuity and critical care nurses. Attendees will experience hands-on interactions with exhibitors. The Critical Care Exposition offers 14 hours of exhibit time over three days, with 10 hours unopposed by clinical sessions. There is more than 300,000 square feet of exhibits including the newest equipment, devices, pharmaceuticals, supplies, and technology. Also, there are hundreds of ExpoEd education sessions where you'll receive continuing education recognition points (CERPs). And don't forget all the product demonstrations. Attendees Come to a conference where there will be over 7,000 critical care nurses. Registration and Pricing Registration is open. Register by April 4, 2018 and save $80.00 Member Pricing Early-bird full conference - $450.00 Regular full conference - $530.00 Pre-Conference - $106.00 - $212.00 Daily registration; Mon/Tue/Wed - $225.00 Daily registration; Thu - $144.00 Non-Member Pricing Early-bird full conference - $580.00 Regular full conference - $660.00 Pre-Conference - $140.00 - $280.00 Daily registration; Mon/Tue/Wed - $280.00 Daily registration; Thu - $196.00 Reservations Book your reservations today at the Boston Convention & Exhibition Center
  13. allnurses

    NTI: Pain Management Challenges

    Hospitalized patients often experience pain. In the ICU, most patient experience pain to some degree. As more invasive and painful procedures are performed, pain escalates. Add in intubation, multiple lines and your patient experience a wide variety of painful sensations. How to manage this pain? What is the best pain regimen for the opioid naive and opioid-dependent patient? Principles of Pain Assessment Pain is a subjective complaint based on many factors: Procedures being performed Patient past medical history History of opioid use Perception of care received Just to name a few. Assessing pain can also involve many avenues - for the verbal patient: Wong-Baker Pain Scale Faces Pain Scale Verbalization from the patient It becomes more difficult to assess pain in the unresponsive patient. Patients can be unresponsive for various reasons: intubation, sedation, paralysis, dementia, psychiatric disease. However, here are some tips: Grimacing Tachycardia Irritability Decreased interaction with the environment Opioid-Tolerant Patients There is no exact formula to follow to ensure adequate pain management for your patients that already take opioids. The first task is to obtain information regarding the patient's past/current opioid use. Do they have cancer and take escalating doses? Are they on maintenance suboxone for past opioid addiction? Do they use street drugs? Not always easy questions to ask. If the patient is unresponsive, asking the family in a non-judgemental manner is essential. Emphasize that you want to provide optimal pain relief and in order to do so, you need to know if the patient takes opioid medication/drugs frequently. From the Society of Hospital Medicine: "Patients with chronic pain present a special challenge. When they have pre-existing pain and undergo an operative procedure, it becomes important to differentiate pre-existing chronic pain from new acute postoperative pain. Additionally, patients already on chronic opioid therapy may require a 200 to 400 percent increase in preoperative opioid requirements.24 Thus, it is important to establish preoperative analgesic requirements to create a postoperative pain management plan, not to mention a keen awareness of comorbidities that may preclude the escalation of regimens due to patient safety concerns." The Stepwise Approach is recommended - this involves the use of non-opioid medications such as NSAIDs, Cox-2 Inhibitors and non-pharmacological options also. However, in opioid-tolerant patients, "always start off with an immediate release medication. Long-acting opioids are not appropriate to be used to treat acute pain and for initial dose titration. The route of pain medications also makes a difference in the frequency of administering pain medications. Short-acting oral opioids peak in 45-60 minutes. Intravenous dosing will peak in 10-15 minutes. Knowing these parameters makes it easier to dose medications sooner to achieve adequate pain relief in acute pain. When dosing medications for acute pain, it is appropriate to give an additional dose if the pain is not relieved by the expected peak time. As an example, if a patient in acute pain is given an intravenous dose, then it is appropriate to give the same dose again or double the dose (depending on the clinical situation) if there is no relief in 15 minutes once peak onset of action has been reached." (Society of Hospital Medicine) Opioid Naive Patients Patients that do not take opioids merit consideration also. "When using a patient-controlled analgesic (PCA) in opioid-naïve patients, only patient-controlled dosing should be used initially. Starting a continuous basal dose on an opioid-naïve patient is generally not appropriate. Once steady state is achieved with patient-controlled bolus dosing in 24 hours, then starting a continuous basal rate can be considered if the clinical judgment deems it necessary to use opioids for a longer time period." (Society of Hospital Medicine) Other Considerations Always be mindful of renal function as this can adversely affect pain control. Also, due to many factors, renal function can deteriorate while hospitalized. Dose adjustment must be considered. NSAIDs and Cox-2 Inhibitors are usually precluded for the patient who has decreased renal function. Patients on dialysis or CRRT also pose special pain management issues and it will be important to bring on the care of the nephrologist. References: Getting Out of Your Comfort Zone With Opioid Tolerant Patients Multi-Modal Pain Strategies for the Post-Op Patient - Society of Hospital Medicine
  14. NTI in Houston provided AN with so many opportunities to interview leaders in the field of nursing as well as to view demonstrations of new products. Halyard representatives discussed oral care to reduce ventilator-acquired pneumonia (VAP). Why is this so important? From the Society of Critical Care Medicine, "The role of oral hygiene in maintaining the health and well-being of patients in the intensive care unit (ICU) is indisputable. Oral care is a simple and effective strategy to reduce ventilator-associated pneumonia (VAP) in patients requiring mechanical ventilation. Colonization of the aerodigestive tract and aspiration of contaminated secretions into the lower airway are the two primary pathogenic processes of endemic VAP. Dental plaque can be a major reservoir of infection by respiratory pathogens in ICU patients.Pharmacological plaque control with chlorhexidine oral rinse is effective and also decreases oropharyngeal colonization by aerobic pathogens in ventilated patients." Oral care for vented patients is always a concern and can be difficult and time-consuming. However, Halyard recently introduced a product that is specifically for patients with smaller mouths who need oral care. These self-contained kits include a self-cleaning Yankauer, a #8fr suction catheter and a small toothbrush. Here are some of the features: Color-coded packaging, allowing caregivers to easily identify specific component packs and to track oral care compliance Rectangular kit design with wall hanger, making it more conveniently accessible in the patient's room to make compliance easier Individual packs that allow caregivers to choose the right tool at the right time, based on patient need and hospital protocol Color-coded "Order of Use" guide, printed directly on the kit, takes the guess work out of oral care by providing easy identification of component packs and promoting proper continuity of care according to protocol. Available in q2 and q4 Kits Providing oral care to our ventilated patients prevents ventilator-acquired pneumonia (VAP), thus reducing ICU time, hospital length of stay and improves patient outcomes. By using evidence-based practices, we can meet the compliancy standards as well and most importantly, ensure our patients' comfort. .
  15. The American Nurse Project is a documentary about US, nurses in the US. Carolyn Jones, an award-winning cinematographer helps to show what we do in our daily work. She traveled the country for a year collecting stories, pictures, and videos of nurses doing what they do and helping people understand what we do. She interviewed hundreds of nurses in many specialties: home health nursing, disaster nursing, prison nursing, hospital nursing - all the places where we do our job. Via her movie, she brings the human element to the public as to what we do and take in stride. She honors nursing thru her journalistic efforts. The interviews are riveting: A nurse from New York anguishes about "what if a patient died on my watch - this wasn't supposed to happen." A home health nurse from rural Kentucky discusses black lung disease as a prevalent issue for her patients A prison nurse in a maximum security facility laments about the spread of Hepatitis C in our prison system A policy analyst nurse from Chicago discusses how public policy influences nursing practice AllNurses was fortunate to interview her at NTI recently in Houston. AN's Community Manager, Mary Watts, RN showcased this video and what it means to all nurses... Carolyn went on to discuss her upcoming documentary which will showcase five nurses in the US from varied backgrounds and career settings. Defining Hope focuses on a journey of investigating how we can make better end-of-life choices. We look forward to this new movie.
  16. Nurses in Search of Pens and Other Freebies Once again the annual ritual. the countdown to the opening of the NTI convention and a sight that rivals the running of the bulls happened at yesterday morning promptly at 10:30. The team from allnurses was there to witness the event. The nurses came pouring in scurrying the aisles in an almost rabid fashion. One thing is for sure,..you better not get in the way of a nurse in search of nursey treasures. I didn't see any casualties, and I was sure to stay out of the way of the encroaching tide of nurses. Why do nurses love so many freebies, especially pens? The pens are pretty simple. Pens are essential tools for nurses, almost as important as their stethoscope. Pens get borrowed and oftentimes do not get returned. They seem to have legs of their own. At NTI, their is a virtual rainbow of pens..all types and colors and the best part, they are FREE!!! What's not to love about that. In addition, there are so many other cool giveaways that vendors have to entice you to their booths. Chocolate is always good, but most of the time, that is something that does not last not longer than 5 minutes. Nurses need the extra sugar boost to give them energy to continue the hunt. But nurses need things to take home. They can be viewed as NTI souvenirs. This year with NTI being in New Orleans, Mardi Gras beads can be found if you look hard enough. One vendor gave me the beads from around her neck, maybe in self-defense??? They are pretty cool ..bright red hearts. Perfect!!! At the same booth, another one of the exhibitor team thrust a palm-sized Nemo into my hand, telling me it was like a stress ball. What???? Do I look stressed. That glazed look in my eyes is just from being amid so many enticing booths…...and FREEBIES. I admit, I was like a kid in a candy store. Speaking of candy, the Milton S. Hershey Medical Center booth had a HUGE Hershey candy bar that caught my eye and lured me to the booth. I was disappointed to find out that they only had one... and I could not have it unless my name was selected during their drawing. I had to settle on a small Hershey Kiss instead. Every year there are a few giveaways that are a big hit... and make the gotta have list. You have to get them before they are all gone. My hunt for goodies was hampered by having to stop to actually talk to the vendors. But that is why I am there, after all. I need your help. If you have found those extra-special freebies, please post pictures here along with the booth number to help me and others find them. Be proud of the treasures you found and also help your fellow nurses who are also in the hunt. Have a great time at NTI...and be careful out there.
  17. Monitoring the hemodynamics of your critically ill ICU is so important. Use of the Swan-Ganz pulmonary artery catheter is one of the ways to quickly assess the cardiac status of your patient, make interventions and improve their care. However, the monitoring systems for Swan lines aren't that intuitive. Until now, that is. Edwards Lifesciences has a new monitor, the HemoSphere advanced monitoring system, which was just recently approved for use in the US which is both intuitive and user-friendly. As an ICU nurse, your monitors are your pathway to your patient. Having a small, portable, easy to use monitor makes your shift just a little easier. This monitor has an interface similar to a tablet and can continuously assess flow, pressure and the global indicator of oxygen saturation (CCO, RVEF, RVEDV, SVO2). Allnurses staff recently attended NTI 2017 in Houston and spoke with the Edwards staff about the HemoSphere on the exhibition floor and got a demo of how intuitive and easy-to-use the HemoSphere is. Would you recommend this to your hospital?
  18. While at NTI this year, the allnurses team saw many innovative medical products. One piece of equipment that caught our attention was a creative product from the folks at Firefly Medical. The IVEA is a product created by nurses for nurses. Who better than nurses know how hard it is to ambulate patients who have an IV pole, pump, oxygen and other equipment to drag along. It sometimes takes 2 to 3 staff just to get the patient to the bathroom. With background experience as an RN, IVEA creator Stephen Schmutzer, decided to do something about this problem. After receiving input from about 150 nurses over three years, the IVEA was created. The IVEA replaces the traditional IV pole entirely, not only at the bedside but also it allows more freedom and mobility as it accommodates supportive equipment such as IVs, infusion pumps, oxygen tanks, chest tubes, catheters, drainage devices, PCAs and feeding tubes. The IVEA provides stability for patients, allowing them to walk safely in a more natural posture and gate, requiring only one nurse for what previously required multiple staff members. Watch the video to find out more about the functions and benefits of the IVEA: Improved Mobility Improved Safety Increased Efficiency Easy and Compact Storage For more information, go to www.iveamobility.com
  19. tnbutterfly - Mary

    So You Want to Be Published: Just Do It!

    Last year at the AACN National Teaching Institute and Critical Care Exposition (NTI), I had the opportunity to interview Mary Fran Tracy, Editor of the AACN Advanced Critical Care Journal and a Critical Care Clinical Nurse Specialist at the University of Minnesota Medical Center, Fairview. Mary Fran's association with AACN spans several years beginning as a critical care staff nurse. She benefitted greatly from the resources offered by AACN. She is a former president of AACN and a board member. When her term as president ended, she became a journal editor. AACN has 3 journals. Two are members journals: The American Journal of Critical Care (AJCC) and Critical Care Nurse (CCN). Mary Fran is Editor of AACN Advanced Critical Care which is a subscription journal for the more advanced critical care nurse, critical care educators, and staff nurses who are really experienced in critical care. It is published quarterly. According to Mary Fran, "We are always looking for articles for the journal and ways for people to publish." How do nurses feel about publishing articles for AACN and how do you convince them of the importance of being published? "Each year the 4 editors have a panel discussion at NTI for people who are interested in publishing. They can come to this panel session, hear a little more about the journals, and how to get published in them. The facilitators then ask the questions... Why are you hesitant? What do you want to know about publishing? "What we frequently hear is that people think 'I'm not doing anything innovative. No one wants to hear this. It's just what everyone else is doing. I don't need to do a poster.' Then they come to NTI and 'see people presenting on what I had done, the same topic. I see a publication come out and think well really I could've written that.' So I think people tend to underestimate their knowledge, their skill, they think writing is hard. It is hard but you have to try. If you don't try, then you'll never get published. So I try to convince people they can get a start...get mentors and really they can publish. Their ideas are worthwhile to get out there because we are all struggling with the same problems. Presenting is great, but when you present you do it to a room of 50 or 100 people for one time. When you publish it's in the literature for many years for people to access." After you get them to do the initial article, how many come back and do another one? "After they publish once or twice, people sort of get a feel for it... Then they do come back, maybe not to my journal, but to other journals. People feel if they could just get mentored once or twice, then I feel like they could go mentor the next person to write an article so more people would feel more comfortable. It's the guidance... the how-to... that is overwhelming." "There is research that says the more you write, if you write every day, the more likely you are going to be prolific, and it doesn't matter whether you are a novice or an academic. You have to write, you have to do it and just keep doing it and practice and get in the mode of writing to be successful." What are you waiting for? There are always people who dream about doing things, but they wait too long and then somebody else does it. Then they think "I could've done that." Don't be the one who waits too long. Just Do It! If you are one of those nurses who has been hesitant to follow your dream of being published and would like some help, NTI will be having 2 sessions on publishing. Publishing In AACN Critical Care Journals - Monday, May 22, 12:15 pm - 1:15 pm Writing for Publication: Demystifying the Publishing Process - Tuesday, May 23, 11:45 am - 2:15 pm If you cannot attend NTI this year, feel free to post your questions in our Innovators Hub here on allnurses. Some of our published writers will be glad to assist you.
  20. Mary Fran Tracy, PhD, RN, CCNS is the editor of AACN's journal, Advanced Critical Care. She spoke with allnurses Community Manager Mary Watts, RN at the recent NTI conference. The Advanced Critical Care Journal is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles, and columns of interest to critical care and progressive care clinicians. AACN Advanced Critical Care contains concisely written, practical information for immediate use and future reference. Continuing education units are available for selected articles in each issue. Have you ever thought of what goes into publishing an article in a nursing journal? Mary Fran Tracy provides some tips: Take a university writing course Attend conference panel discussions Contact mentors who have published articles Complete online courses in writing for professional publications Look to the publication itself for guidelines Read the journal that you are targeting for your article - know the style And of course, always review and proofread your article prior to submission. Plagiarism is also a major concern for both authors and publishers. Self-plagiarism is also a problem. You can only publish articles once. Some other tips: Set aside time to write Have a conducive environment to write Start small and work up to professional journals Be dedicated and committed Realize that not all of your writing will be successful
  21. allnurses

    NTI: Resiliency and Burnout

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

    NTI 2016 Moral Courage

    We attended an NTI session this morning about moral courage and ethics for the APRN. This is applicable to many nursing specialties The lecture was Sarah Delgado ACNP Clinical Practice Specialist from San Viejo. She brought up some excellent points regarding "ethical creativity" and the ability to troubleshoot very troubling ethical decisions. Utilizing case studies she provided steps to solve complex ethical issues involving withdrawing care from a pediatric patient, discussing DNR status of an elderly ICU patient with multiple comorbidities and general ethical dilemmas. Critical care is an arena where ethical decisions are often found. As critical care nurses, having a toolbox of skills to add to our arsenal helps to meet our patient care goals She broke down the decision-making process into a path with several different directions. Looking at practical alternatives she provided a clear solution to even very complex issues. She pointed out out common pitfalls as well as potential resolutions. Ms Delgado also brought up a team approach in order to provide a united front. Social workers, risk managers, unit managers, nursing staff, families and providers must all be in agreement in order to provide the best solution. Some of the tips Ms Delgado provided to solve ethical issues Know elements that promote ethical dialogue Advertise and use your ethics resources Utilize interdisciplinary teams Mentor and collaborate as a unit Voice conflicting views in calm voice Open body language These tips are not all inclusive. Ethics issues are by their nature sometimes quite fluid without a definite answer. Instead take a proactive approach... Work toward preventive ethic by being open with staff, patient and families. Work thru the emotion of the situation. Accept your responsibility for resolving the situation before it becomes a problem. Being proactive is better than being reactive. How have you handled an ethical situation recently? Have you used any of these techniques? What resources did you use? Reference AACN Ethical Guidelines Moral-Courage-Sarah-Delgado.pdf
  23. You go into a patient room and find the NGT lying on the bed with the tube feeding spewing a nasty circle of smelly liquid onto the sheets. Oh oh - lets get the patient cleaned up, and then we have to reinsert the NGT. But...whats to keep it from coming out again? How do we better secure the NGT? We've all seen and probably used many tricks to secure an NGT: benzoin, different ways of taping, different types of tape. Ugh! Frustrating and time-consuming. NTI recently attended NTI in Houston and interviewed exhibitors. Halyard has a new product that helps to secure an NGT securely. "CORGRIP is now compatible for use with sump tubes up to 18 FR, providing a more secure connection for decompression, suction and drainage of the stomach. The use of this securement device may reduce the overall costs of patient care by reducing multiple procedures from dislodged tubes." What does your hospital/facility use? What's been your experience with this product?
  24. allnurses

    NTI: What's a Scromper, Nurse Blake?

    Nurse Blake has invented a nursing "onesie" called a Scromper. He demonstrated the versatility of the Scromper for the allnurses team at NTI. It is a useful and fun item with plenty of pockets, room to move and breathe and relax in! He has partnered with a US scrub company to produce the product. Made out of an ultra soft scrub material, it is available for men and women in sizes small, medium, large, and X-large. Although this would not meet dress codes for work, you can wear it anywhere else and rock it at parties, conferences, or even for Halloween. Nurse Blake launched a Kickstarter for the Scromper this week so everyone can have a chance at getting their very own Scromper at an affordable price while also helping to raise money for a great cause. Proceeds will go toward starting a nursing scholarship fund, because as Blake states, "I want to take this opportunity to give back to the field of nursing and I believe that helping the next generation of nurses is the best way to do that!" Get your Scromper today!!
  25. How many times have you gone into a patient's room to give G-tube or OG meds or feedings and....splat, the feeding, meds and who knows what else gets splashed on you? Or you go into your patient's room and find them swimming in their tube feeding? Another total yuck! Well, Dale has developed the ACE Connector (Access Controller for Enteral) that is fairly universal, connecting to the most commonly used feeding tubes and other enteral tubes. Secondly, it has a twist-on access point providing a closed system thus reducing the chance of getting splashed or finding the patient lying in tube feeding. The ACE Connector features In-line feeding, suctioning, irrigation, gastric residuals and medication delivery without the need to disconnect A built in needleless syringe port seal that accepts most catheter tip 60cc syringes A simple ON/OFF handle A long lasting silicone adapter, preassembled in the package Here's a video...
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