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  1. The nursing profession has evolved over the years which includes working conditions, duties, skills, educational and practice standards, technology, regulations and policies. Many of these changes occurred as the result of research and evidence-based practice. There has always been a focus on patient safety and decreasing and preventing medication errors. Research has shown working 12 hour shifts often effect nurses’ critical thinking, productivity and job satisfaction which impacts patient care and patient safety. This Article will discuss how the Lewin change model can be used to implement changes to the current practice of hospital staff nurses working 12 hour shifts. The primary people effected are hospital staff nurses, patients, nurse managers and nursing supervisors. What are Goals of the Change? Decrease nurse fatigue Optimize the nurse’s critical thinking Increase productivity Increase job satisfaction which will result in reduced rate of medication errors Improve quality of patient care According to Kearney-Nunnery (2016) Kurt Lewin’s change model consisted of three main components: unfreezing, moving, and refreezing. “To achieve change, the restraining forces must be weakened and the driving forces strengthened” (Kearney-Nunnery, 2016, p.183). Restraining forces are forces that resist change. Pertaining to the 12 hour shifts, restraining forces for nurses include ability to “work less hours and days, and potentially have an improved work/life balance” (Rollins, 2015, p.162), (Ball, Dall’Ora & Griffiths, 2015). Restraining forces for hospitals include paying less overtime, less dependency on agency nurses and scheduling coverage for only 2 shifts. Patients and families tend to like having the same nurse for the longer part of the day and “having fewer names and faces to remember” (Rollins, 2015, p. 162). Driving forces promote change and includes “desire for more novel, effective, efficient or merely different activities” (Kearney-Nunnery, 2016, p.183). There are several driving forces indicating the need for change. Nurses often work longer than the 12 hour shift (Scott, Rogers, Hwang & Zhang, 2006). A greater number of nurses working 12 hour shifts report burnout and plans to leave their job compared to nurses working 8 hour shifts (Rollins, 2015) and often work 2 or more 12 hour shifts in a roll. Nurses, especially older nurses-who are more experienced, report physical and emotional exhaustion after working 12 hour shifts, “aches and pains, sleep deprivation” (Rollins, 2015, p. 162). Overtime and working consecutive 12 hour shifts further increases the rate of fatigue and burnout which decreases patient satisfaction with the quality of care received (Stimpfel, 2012). Nurses also report poor quality of care provided, decreased patient safety and more duties left undone when working 12 hours or more (Ball et. al., 2015). According to Stimpfel, Sloane and Aiken (2012) when a greater number of “nurses working more than thirteen hours on their last shift, higher percentages of patients reported that they would not recommend the hospital to friends and family” (p. 2506). Also studies have shown working more than 12 hours increases the risk for medication errors (Scott, 2006), nurse burnout, job dissatisfaction and intention to leave the job (Stimpfel et. al. 2012, page 2504). How to Bring about Change Nurses and hospital administrators must review both research and their hospital’s collected data from patient surveys, circumstances surrounding medication error reports and patient safety and nurse/employee incident reports and complaints related to quality of care filed. Executive administrators must be willing to review the financial impact of the driving forces verses the financial benefits from the restraining forces over the past several years and be open to seeing future trends. This is the unfreezing stage of the Lewin change model. During the moving stage, “change objectives must be selected with consideration of activities for progressive change” (Kearney-Nunnery, 2016, p.185). “Organizations such as the Institute of Medicine and the American Nurses Association have made or supported recommendation to minimize fatigue and improve patient safety” (Rollins, 2015, p. 164). Nurses need food, hydration and proper rest in order to maintain optimal productivity (critical thinking, alertness, and providing quality nursing care and ensuring patient safety) on the job. As people advance in age, energy level and stamina decreases. Viable options for change include limiting overtime requirements, ensuring nurses receive uninterrupted breaks, making meal options available at all times, providing eight hour shifts as well as split shifts for nurses who want to work part-time (Geiger-Brown & Trinkoff, 2010). Nurses can work within organizations, such as the American Nurses Association to lobby for legislation to promote change. Nurses and nursing supervisors can work with hospital administrators in implementing and maintaining the changes. Over a period of time, staff and administrators will adjust to, get in the habit of and maintain (refreezing) the change. This will lead to improvements in nurses’ job performance and patient satisfaction. In summary, nursing has evolved over the years including the scheduling of work hours for the nurse. Twelve hour shifts has become popular with both nurses and hospital administrators but research has shown working 12 or more hours has adverse effects on the quality of nursing care provided, patient safety and patient satisfaction largely as well as nurse fatigue and burnout. The Lewin change model can be used to bring about changes to nurse schedules which positively impacts the nurse’s job performance and job satisfaction which increases patient safety and patient satisfaction. Effect of the 12 hour shift on patient care and the nurse.docx
  2. Nurse Beth

    8 Work From Home Jobs

    In my career advice column, Ask Nurse Beth, I am asked so often about job opportunities away from the bedside, and just as often how to work from home. Why do nurses quit the bedside? There are so many reasons for leaving the bedside. Some nurses face age discrimination. Others have lost their passion and need a new start. With an emphasis on proactively managing health and improving outcomes, more opportunities are being created that use nurse's knowledge and skills. At some point, many of us dream of working from home. Picture yourself coffee cup in hand, slipper or flip flops on your feet, with your dog or cat nearby. Sounds great? Working from home is perfectly suited for the individual who enjoys minimal supervision. Most remote jobs require two to three years of clinical practice experience and MS Office skills such as Word and Excel (easily learned). First, identify your skills and what you're looking for in a job. Do you enjoy detail and digging deep to audit charts? Would you enjoy coaching and talking to patients on the phone, educating and coordinating? Here are some promising jobs for the nurse who wants to work from home. Note: Sometimes "work at home" jobs actually mean "based from home" with travel required. Sometimes work at home is allowed after working on-site for a time, such as a year. Telephonic Nursing/Nurse Hotline/Nurse Advice Line Telephonic nursing includes telephone triage where you'll provide health care guidance, support, and referrals for members. You help members decide if they need to go to an ED, or a provider's office, or manage their concerns at home. Case Manager Case Managers cover a range of jobs and responsibilities that vary from employer to employer. Essentially, Case Managers coordinate and collaborate to provide services across the continuum of care, using available resources to promote quality cost- effective outcomes. There is a ton of good advice on the Case Management forum . Some jobs require certification. Here's how to get Commission for Case Manager Certification (CCMC) Certified. Eligibility requires a minimum of one year of case management experience, but does open more doors. Case Reviewers Case Reviewers review and abstract medical record data. Case reviewers may include Quality Reviewer, Field Nurse Case Workers, and Worker's Comp. Reviewers. Medical Claims Review Medical Claims Reviewers evaluate adults with chronic illness or disability to determine the level of care and eligibility for services. Often these are Medicare related, such as determining eligibility for Medicare Part B. Closely related is Clinical Appeals, where the nurse evaluates documentation used to approve or deny claims. Wellness Coach/Care Coach Wellness Coaches are hired to contact and coach individuals to help them meet their insurance plan's wellness goals. For example, an overweight individual may be called once a month by the coach and in this way held accountable. You assist members in navigating the healthcare system and help them move towards better health and wellness which assists in preventing hospital and ER visits. Clinical Documentation Improvement (CDI) Specialist This is a rapidly growing field. The CDI Specialist is a liaison between providers who enter orders and coders. The CDI Specialist reviews and evaluates clinical records to determine accuracy and integrity of coding outcome versus clinical documentation and compliance with coding regulations and guidelines. You would use your knowledge of clinical documentation to make sure the coding accurately reflects the clinical episode of care and conforms to regulatory requirements. Online Nursing Faculty The distance nurse instructor facilitates online discussions and evaluates student performance. Depending on the program, this may require a graduate degree. Good for the nurse who loves teaching. Prior Authorization RN The Prior Authorization nurse performs medical necessity reviews for services that require prior authorization utilizing specific criteria. She/he collaborates with treating physicians and other healthcare professionals to gather necessary information needed to review the requested services. Use Job Search Engines Register with a job search engine such as Indeed and set your filters for "work at home" Other search keywords are "remote", "telecommute" and "distance online faculty". Start reading the different jobs available to see what's out there and what interests you. Companies That Offer Work at Home Jobs Aside from using job search engines, search companies sites for listings. Here are just a few large companies known to offer work from home jobs: Aetna, Anthem, AxisPoint, Medtronic, Cigna, CVS, Humana, McKesson, UnitedHealth Group Self-Employed Then there are those of us who are self-employed or have side hustles, like the nurse writers. Be sure and check out the Nurse Entrepreneurs/Innovators Hub for our inspiring stories! Here's mine: How I Became a Nurse Author and Wrote a Book! Best wishes on finding your dream job working from home.
  3. NurseJulie31

    15 Minutes in the Life of a Nurse

    It's 10am, I have been here for 3 hours and "all" I have managed to accomplish is making sure everyone has their medications. In the middle of pulling a locked narcotic that a patient needs now, the phone rings informing me that a patient has a critical lab needing called to the doctor. This particular lab can be deadly so I pick up the phone to call the doctor....wait....what are the patient's vital signs? Because we know he will ask that. On my way to get the patient's vitals, I am stopped by therapy letting me know that there is a patient complaining of dizziness and her oxygen is dropping. I go to the therapy room to assess the patient and she is struggling. I am now diverted outside to grab some oxygen and get her vitals. Once she is stable, I remember that I have another patient needing immediate attention based on a lab result so I grab those vitals and pick up the phone to call the doctor. Wait.....what med is this patient on causing this abnormal lab? What disease process could be causing this? I grab her chart to quickly get more background information because I am required to know everything on ALL patients so that the doctor can make informed decisions. As I'm on the phone, I hear a bed alarm go off and my STNA is in a room changing another patient. I can either tell the doctor to wait, or find a patient on the floor, hope they are ok and now do frequent neuro checks. I put the doctor on hold and get this patient to the bathroom reminding him that he must call us before he gets up....he laughs, I laugh and we both know that "education" will go nowhere. I receive new orders from the physician (who is now yelling at me because the poor thing had to wait) and as I'm working on squading this patient out, the original patient who has been in pain reminds me of how I'm not "doing my job." This is only 15 minutes of my day....the prioritizing and re-prioritizing. Worrying that any move you make or don't make could harm another life. Having patients ask you where their breakfast is, what time is their appointment today and do they have a ride, what is the pink pill they are taking, why are they not getting their pain pill on time, etc. I have messages from the social worker and dietician, a patient who is a full feed which takes my STNA away from all other patient care, another doctor who just walked in writing orders for a STAT lab and a patient telling me if they don't get to the bathroom NOW, they are going to poop everywhere. This is all happening and it's up to me to keep it straight. All of this while being reminded from someone who works in an office somewhere that you are not "documenting things in a timely manner as they happen." Being told that more paperwork is required and more thorough documentation needed is maddening because I'm meant to be on the floor, not at a computer. My charting and initialing of everything I do isn't saving lives, my presence on the floor is. Please stop requiring nurses to spend more and more time at a computer and then getting upset when patient quality of care scores go down. You want quality care? Get us some help because we are drowning.
  4. CoMoNurse

    My Life as a Nurse

    Through the Years Forty years, how can that be? Today it hit me on my commute into work, punched me right in the gut...forty years. I started out as a still wet-behind-the-ears nurse ready to take on the world one (or twelve) patients at a time. I would supervise an LPN with her 12 patients and I would have my 12 patients and that was the hallway we took care of. We had an aide to empty drainage bags and to take patients to the bathroom and to ambulate patients, but we did the rest. I hung all the IVs and gave all the IV meds for those 24 patients. I mixed up and gave chemotherapy drugs to patients who I would later care for during their death. I prepared Adriamycin, Cytoxan, 5-FU for use intravenously, without gloves, without a hood, without any sort of protection for me or the patient. I drew the correct amount up out of the vial and we weren’t even required to double-check our doses with another nurse. I even gave chemo through a chest tube, more than once. I prayed a lot during that time that I wouldn’t make a mistake. I gave my patients a night time back rub and sat with some while they struggled to fall asleep. Charting could always wait back then. I took care of patients on blue plastic laminar air flow mattresses and Stryker frames, even some patients who could only get comfortable in a recliner. I turned, I cleaned. I had poop thrown at me and have been thrown up on more than I can remember, I had my bright white nursing cap ripped off my head with the bobby pins still clinging to a few strands of hair. I accidentally filled a shoe with urine from a urine bag that I didn’t get clamped well enough. One of my patients flipped an entire bath basin full of Betadine soap onto my white uniform, for a good reason of course, that she didn’t like to do the soaks her MD had ordered. I have cleaned out bedsores, deep bedsores full of stuff I can’t even identify and have seen white bones shining up from the wound bed. I held many a patient while they died alone, alone except for me. I gave that last dose of pain meds to ease them into their next life. I watched a mother who was my mom’s age die from cancer that had eaten her breast away. A lot of these deaths were painful and hard to see. I was only in my 20s, yet I held so much in my hands. It was 1980, pulse oximetry wasn’t a standard of care, and my COPD patients had a daily ear oximetry spot check if they were really sick. When I started in the NICU in 1982 pulse oximetry still didn’t exist for babies and we evaluated how well our patients were oxygenation by pulling back on their arterial lines to see how bright the blood was. Or if they didn’t have arterial lines we just looked at their color, were they grey or pink or blue? If they were pink we lowered the oxygen by 1%. Those were the days before surfactant was approved in the US in the late 1990s...surfactant really changed the outcome of a lot of preemies. Less time on the ventilator, shorter hospital stays; but we were saving babies very young, which in itself led to a higher morbidity rate. More intraventricular bleeds, more eye problems, more gut problems, more airway issues, more feeding difficulty. The onset of developmental care for preemies came about in the late 1980s while I worked in the NICU as well. We made more developmental appropriate outcomes a possibility by trying to limit the noise, light and tactile sensations for our tiny patients. I attended a national conference to learn how to take care of the most fragile babies developmentally. I got to meet the clinicians who came up with those early protocols to protect the tiniest of brains. I worked in a pretty big NICU, so I was honored to see a lot of anomalies and sad cases...I saw conjoined twins more than once. I took care of babies without a brain, babies with their heart beating away on the outside of their bodies, babies with tails, babies with wonderful parents who were so saddened by their baby requiring intensive care. I watched baby with a newly placed hours old trach cough it right out on to his chest. I immediately slipped it back in without thinking and probably held my breath for 3 minutes as I waited for the baby’s color to change to pink again. I watched a baby as he perforated his bowel on Christmas Eve, regardless of how many times I notified the resident, I feared for this baby’s life. I held moms in my arms as they cried for a baby they would never take home. I cried too for this life that wasn’t meant to be. I have sheltered deformed babies from the prodding and staring of residents and medical students. I have held dying babies in my arms when a parent couldn’t or wasn’t in the same hospital. I have helped moms breast feed and have heard all sorts of stories from all sorts of families. I have had families love me and had some hate me. My own baby was in the NICU where I worked and so I learned why those moms cry when they go home without their babies. And that made me a better baby nurse. I worked during two NICU moves, one to another building close by and one across town. I moved on to adults, saw my first HIV patient in the mid-1980s, I ran peritoneal dialysis, watched as a man farted as a joke and died immediately from a myocardial infarction. I worked nights during a power outage when all the monitors went out. I worked during a hospital fire, evacuating patients. I took care of adults until I suffered a life-altering back condition that I struggle with even today. I worked as an IV nurse, starting IV lines on all sorts of people, I started PICC lines, just feeling for the vein, I also was privileged to use an ultrasound to place PICC lines. I was proud of my abilities to find even the smallest vein. I glued lines back together when they tore and they were desperately needed. During this time I made some good friends in my work and I raised my son while I worked. I worked outpatient pediatric clinics and got to see all sorts of things and again, meet some great people, patients, and their families. I worked with incredible doctors and some who had opportunities for improvement. I moved halfway across the country for a new job. I have been fired from a job, even escorted out of the hospital with an armed guard (not to worry, I had done nothing wrong to warrant that type of an escort). That was my most painful nursing experience ever, but I survived that. I don’t regret any of my nursing experiences; they all are a part of the tapestry that is my career. Now I work in an area where I only say what is scripted, where I cannot offer advice to my patients, I must say only what my script says. I never meet my patients, I only talk to them over the phone...It’s been a difficult adjustment. It’s a business job, but it’s alright and I work with some great people. I think it is a fitting way to end my last two years before retirement. And, I'm Still Not Finished ... This morning I got a text from an associate on Linked In, asking if I was interested in a traveling nurse position in a small rural hospital near Washington DC. I asked some questions, and it sure sounds nice... Not sure what I will do, but it sure sounds nice.
  5. RSouth

    Just a Nurse | Life of a Nurse

    As I am approached by an angry family member of a patient that has been getting increasingly worse, they shout at me to which I reply... "I am just the nurse." After my shift, as I make my way home, I reflected on my response and what I meant in that statement "I am just the nurse...." What exactly did that mean? As a looked back on the major accomplishment of my life, I realized that the response I gave, although only a few words, was worth more than anything I could explain. "Just the nurse" meant that I had mastered the art of assessment and deliberation. Mastered prioritization and communication skills. I had spent more of my recent life with strangers who ended up closer than a family than I had spent with my actual family. I have spent countless hours filling my brain with information that I could only pray to remember the next day once the test began. I had tried on dozens of scrub uniforms until I finally found the perfect brand. And let's not forget about the walking, I have put more miles on my work shoes that most cars are able to reach. I have held more hands and offered more comfort than one person could possibly be capable of. I have dealt with more unexpected outcomes than any individual should be able to adapt to. I have answered more medical questions for my family members and friends than I care to discuss. Yet, here I am. Head held high knowing the power that I possessed to change the trajectory of a life by "just being a nurse." As a nurse, we have the power to hold hands and comfort souls while we wipe the tears away. We have the power to offer protection and be the defenders for our patients and families. We help comfort in the midst of pain and spread courage in the face of fear. We are able to be an advocate for those who are unable to advocate for themselves. We give hope when all hope is lost. We offer a shoulder to cry on and a listening ear in the middle of the night. We pour our soul out to others for long shifts, yet wake up and give more the next day. We are healers of not just the physical but the spiritual. Being "just a nurse" is more than a job choice. It extends beyond a profession. Being a nurse consumes your soul and radiates from within. It is our calling, our destiny. As a nurse, we are proud of the person whom we have grown to become, shaped by what our eyes have seen. We are every-changing in our outlook on life as each day is a precious gift that we see taken far too soon and far too often. It is an understanding that each day will be different and that every day is a chance to touch a life, a life that may have been lost if it were not for you. Once you are a nurse, you soon understand your path of life that is destined for you. You become a visionary not only for yourself, but for those lives that are touched and inspired by you. You become someone's cheerleader in the worst moments of their life, and their biggest fan when success has been achieved. As a nurse, you understand that you are more powerful than most superheroes on the television on any given day. Because being "Just a Nurse" is simply understanding that not all superheroes wear capes, some wear scrubs and stethoscopes......
  6. Sarah Jividen

    Things I Wish I Knew Before I Became A Nurse

    I remember when I first made the decision to go to nursing school. I was 31-years-old and struggling with the idea that I had spent 9 years working in a career that I didn't really like. In fact, I hated my profession. I had spent nearly a decade selling medical equipment to hospital operating rooms, traveling up and down the west coast, schmoozing with doctors and hospital purchasing managers so they would buy my stuff. But even though my heart wasn't passionate about my professional at the time, I was passionate about working hard and performing well. So, each year I met my professional goals and advanced in the profession. Which, in turn, also made it harder for me to leave. But then one day, it hit me. I didn't want to just work in the medical profession. I wanted to be an actual medical professional. I remember thinking how bored I was sitting on the sidelines as a device rep, watching procedures and literally thinking, "this is SO lame, please shoot me!" So (a few mental breakdowns later) I finally did it. I signed up for the 7 prerequisite science classes that I needed to take before I was even able to apply to nursing school (as a prior journalism major, I hadn't taken very many science classes at that point). I took my classes in the evenings after work. And I started studying to take the TEAS. It all took me about a year to complete, and in 2010 I started my journey to become a nurse. 8 Things I Wish I Knew Before Becoming a Nurse ... #1 Nursing school is crazy hard (and expensive) Not only will you have daily classes, labs, weekly exams, and intense competition from classmates, but you will also be working clinical shifts as a student nurse. Many nursing programs also advise against outside work during the program because they warm that you won't be able to keep up with the work. And in California (like many other states), hospitals are no longer hire nurses who don't have a BSN. As a result, many nurses are graduating from nursing school with 50-100K or more in student loan debt. #2 You will probably have to work night shifts, at least in the beginning Nurses are needed 24 hours a day, 365 days a year. Since many nurses don't want to work all night, seniority is often the deciding factor when it comes to assigning nurses to the day shifts. Some hospital units even have a rule that new nurses must work night shifts for at least the first few years of being there. You will want to invest in a great set of blackout shades, at least one pair of blue blocker sunglasses, and a box of ear plugs (so the guy mowing his lawn at 1100 doesn't wake you up). #3 Working three days a week as a nurse isn't as easy as it sounds I remember thinking how awesome it would be to only have to work 3 days a week. I mean come on, its only 3 days! But that also means that the days you do work are incredibly long. Nursing shifts are often advertised as being 12 hours, but they are actually more like 14-16 hours once you factor in oncoming nurse reports, overtime due to short-staffing, and your commute to and from work. #4 You will be afraid that you might kill someone This one is a real fear because, for example, if a nurse makes a medication error or forgets to check vitals or a patient's neuro status's per order, then you actually accidentally could kill someone. But as you grow more tenured in your career, you develop a sixth sense for things that might go wrong and you figure out how to triple check in the most time-crunched circumstances. And you learn how to assess your patients quickly enough that if there are any vital or neuro status changes, that you can get the help you need before things go downhill. #5 You will learn to balance more information then you have ever had to before There really is no such thing as multitasking, because our brains can't actually focus on more then one things at the exact same time. But nurses developed the uncanny ability to juggle multiple ongoing tasks for multiple patients for up to 12 hours a day - such as medical orders, patient requests, vital signs, medications, allergies to medications, lab values, care plans, etc ... We forget too eat and pee all day, but we remember the important medical information we need to know for our patients. Being a nurse stretches your brain further then you even thought it could go. #6 Nurse abuse really does happen Sadly, abuse against nurses isn't uncommon. In fact, nurses are expected to put up with levels of abuse that would NEVER be acceptable in just about any other professional setting. I have been cussed at more times than I can count, in just about every colorful way you could imagine, for just doing my job. Even worse, violence against nurses is prevalent (especially emergency room nurses) and it usually isn’t even routinely tracked. I have been lucky not to find myself the victim of direct physical violence as a nurse as of yet. Many nurses have not been so not lucky. #7 Your whole body will start to hurt There is alarming evidence now that even proper lifting techniques expose nurses’s spines to dangerous forces. If that's not bad enough, chronic back pain in the nursing population is a common ailment. An evidenced-based review at the Texas Women’s University reported that estimates of chronic low back pain among nurses range from 50%-80%. You may not be able to escape some of the wear and tear from being a nurse at the bedside. However, you can pick up healthy habits outside of the hospital like yoga, running or weightlifting to help recuperate on your days off. #8 You will find that there are multiple types of job opportunities away from the bedside One thing that I Iove about being a nurse is that there are so many job opportunities away from the bedside for nurses. So even if you decide that beside nursing isn't for you anymore, there are other nurse occupations to look into. Here are a few examples from some of my nurse peers: aesthetics nursing legal nurse consultant nurse blogger/freelance writer medical/pharmaceutical sales professional nurse coach nurse recruiter Despite the Intensity, I Love Being a Nurse I'm proud of what I do to help humankind, all within a 12-hour shift. I get to help people in some of the worst moments of their lives, and I am surrounded by other co-workers who enjoy being helpful as much as I do. And, I am always being inspired to keep learning more.
  7. Meagan

    A Letter to my Hospice Patient

    To the Patient I’ll Never Forget When we first met, it was my third year of nursing. I was young and excited to start my new job in the clinic. You were in your 80's, and had been through a lot - Heart Disease, Chronic Kidney Disease, Dialysis, and now CHF. By the time we met, you had been coming to the clinic for several years. I heard nothing but wonderful sentiments about your kindness and resilience from my coworkers. I had only known you for 6 months before you surprised me – you wanted to transition to hospice. I remember that day very clearly. We had been working very hard to keep your CHF under control, but we knew it wasn’t enough. You were more short of breath with minimal activity, had more swelling to your legs, and developed reoccurring ascites for which you required numerous abdominal paracentesis. You went to see the renal specialist and cardiologist – and hadn’t received good news – there was nothing else they could do. You see, at that time, I had been a nurse for about three years and my experience came from a busy Telemetry unit. I had taken care of and helped to transition many hospice patients, but they hadn’t walked out of the hospital to go home. They were usually very ill, and after lengthy conversations with family and physicians, they were transitioned down to the inpatient hospice unit. As a nurse, my experience was actually caring for the hospice patient. What I didn’t have experience doing was initiating the hospice transition. You were my first. And, after you passed away, I realized I had learned some of the most valuable lessons in my nursing career. I learned to slow down. When you work in the hospital, you’re always in “save” mode. You’re on high alert for the slightest change, because if you don’t catch it, it could spell disaster or even death for your patient. You’re ready at the slightest change to race down the hall and put to work those ACLS skills you worked so hard to learn. You’re ready to be the best patient advocate you can be to save their life. But I didn’t work on the unit any more. I worked in a clinic with a patient population consisting of the chronically ill. It dawned on me when you chose hospice that it was okay to slow down. I learned it was okay to use my clinical judgement as a nurse to initiate those difficult conversations with my patients and take a more holistic approach. I learned that hospice does not mean “giving up.” When we talked about hospice and your thoughts on starting the process, you told me with such conviction that you were ready. You had been through “save” mode many times. You had been stuck countless times for IV’s or labs, had numerous abdominal paracentesis’, and had already been through dialysis. By this time, you didn’t want any more doctors office visits, trips to the hospital or any invasive procedures. I remember you telling me that you felt so blessed to have made it this far, and that resonated with me. I learned what dignity truly means. By definition dignity is, “the state or quality of being worthy of honor or respect.” After you passed away, it was hard for me to see that empty chair every week. But, what I realized was that you had given yourself and your family a gift. There are times in our nursing careers when we see patients who can’t make these decisions for themselves. Sometimes they don’t have advanced directives in place, or they have family members that just can’t agree. I respected your family’s commitment to your wishes, as this is something I don’t think we get to experience often enough. Although many years have passed, I will never forget the conversations we had, and the lessons I learned as a new nurse. I think about that day often and I thank you for helping to shape my nursing career. Fellow Nurses, have you had similar experiences that changed your nursing practice? What was your greatest take-away?
  8. Maureen Bonatch MSN

    What Advice Would You Give to Future Nurses?

    The news is often overflowing with articles about nurse burnout, bullying, staff shortages, and questionable compensation. You may have experienced some, or all, of these issues yourself during your nursing career. Maybe enough to make you wonder why you went into nursing in the first place. This may make it difficult to come up with a positive response when someone asks you, “Do you think I should go into nursing?” The issues of inadequate staffing and the significant number of nurses reaching retirement age are a common concern of the nurses today. A continuing influx of nurses into the profession is required to help reduce these staffing issues. Although with a significant number of nurses leaving the profession, it can be helpful to provide advice that is more practical, rather than personal, for someone considering a career in nursing. Don’t Be a Dream Crusher Complaining comes as a natural response to most people, some so much that it’s become a habit. We might not think twice about unburdening all the unsavory things about being a nurse on a willing listener to feel validated. Even if your complaints are justified, this can paint a negative image of the nursing profession. It may potentially deter future nurses before they determine if nursing is a good career choice. Even if it feels like the bad aspects of the job are outweighing the good, consider that the positive benefits of nursing are probably what led you to the profession, and made you stay. Provide Practical Advice The profession of nursing continues to be an attractive, growing, career option. One that’s held in high regard and respect by many who consider it the most honest and ethical profession. With an awareness of the challenges that can accompany a nursing career, explain what you feel might be a few key characteristics of a good nurse. That way they can determine if a nursing career would work well for them based on their career goals, personal strengths, weaknesses and their personal life. What Are Some Characteristics of a Good Nurse? Flexibility: Nurses work holidays, weekends and with varying schedules. Sometimes there may be several different shifts in one week or extended hours during one day. Empathy: Nurses must draw upon empathy when caring for patients at their most vulnerable times, or dealing with the challenges of patients that have different views, beliefs or are just difficult to care for. Compassion- Providing compassionate care is at the heart of nursing, no matter what the specialty. Physical endurance- Long shifts spent on your feet providing physical care for patients can take a physical toll, so recommend that they consider their personal tolerance and physical limitations. Attention to detail- Accurate documentation and having a discerning eye to notice changes in patient conditions is essential to provide quality patient care. Excellent Communicator- Nurses work with an increasing variety of disciplines, cultures, and in diverse environments. This requires strong verbal and nonverbal communication skills. Lifelong learner- Healthcare is continuously changing through the use of technology. This increases demands on nurses to continue learning to keep their skills relevant. Emotional stability- The demands of nursing can be stressful, so positive coping mechanisms, prioritizing self-care, and the ability to recognize and address signs of burnout are important. Organized- Stellar organization skills are helpful to juggle the varied demands of a nurse’s usual day and provide quality patient care. See for Themselves These key characteristics are shared by many nurses, although each specialty, and different nursing environments, can come with their own positive and negative attributes. It may be challenging to adequately describe a day in the life of a nurse to ensure a future nurse is entering the profession without blinders. A deeper look into the reality of nursing could be achieved for someone who is uncertain if nursing is the right career choice. What are Some Ways We Can Encourage a Future Nurse? Take an online course Shadow a nurse to observe a usual day Become a certified nursing assistant (CNA) to experience providing direct patient care Obtain work in an entry-level job in a healthcare environment Share Your Wisdom The nursing profession isn’t for everyone, and ultimately the decision is an individual one, but you can help a potential nurse to make the best decision about their career. Instead of chipping away at the fresh face full of idealistic hopes and dreams, allow their enthusiasm. It just might help you remember why you chose nursing in the first place. What Advice Would You Give to a Future Nurse?
  9. Shawna RN

    I'm Just The Nurse | Life of a Nurse

    I’m just the nurse. That was my response when questioned regarding my role. One day, that response felt wrong. I am the nurse that will provide care, advocate, educate, and inform. This thinking “just a nurse” is exactly what is wrong with the world view of nursing. The truth about nursing is unknown by most people. Maybe, that is due in part to the many roles a nurse can have. A nurse can provide direct patient care inpatient or outpatient, research, administration, legal, and the list continue. I am not just a nurse. I am educated and knowledgeable. I am caring and compassionate. I work in private practice and my role changes from minute to minute and day to day. I provide phone triage. I obtain information and give advice to patients over the phone. I may be talking to the parent of a sick child, a prenatal who is in labor, or a patient with chest pain. I must be able to think quickly and provide appropriate advice. If a patient needs to go to the hospital, then I need to be able to tell them that right away. I can’t wait for the physician in the event of an emergency. Take a stroke patient for example, every second is critical, and care cannot be delayed. I room patients, obtain vital signs, and get them ready to see the physician. Depending on the patient and visit type, different information may be needed. I may need to obtain a urine specimen, obtain blood for laboratory testing, administer oxygen, administer medications orally, through injection or IV. They may require a procedure in which case I would set up for the specific procedure they are going to have. In addition to regular office visits, my office does casting for simple fractures, sutures for lacerations, excisions, circumcisions, cryotherapy and IV antibiotics. Our patients range in age from newborn to geriatrics including OB/GYN. I also manage. I do staff scheduling and order supplies. I put out fires and sometimes I’m the fall guy. I manage our state vaccine program. Order imaging for patients and obtain approval from their insurance companies. When the pharmacy tells you that your insurance doesn’t want to cover your medication, and it requires prior authorization, yes, I do that too. I also work with insurance companies to ensure that patients are getting regular preventative care as a care coordinator. I attend meetings and gather information. I am given our office report card so to say and make changes where needed. I’m calling patients to tell them they are past due for their physicals, diabetic eye exams, colonoscopies, and mammograms. I talk to patients about medications, treatments, questions, and concerns. I talk to every drug rep that comes through the door. I hold the hand of a new widow and listen. I sit with a patient that has just been told they have a terminal illness. I continue to work after finding out that a favorite patient has passed away. I hold back my own emotion to maintain a professional image, to continue to meet the needs of other patients, to provide information, and guidance as needed. My car is my safe haven and my ride home is when I can allow my emotions to show. Conversations are not always pleasant because I didn’t do these things fast enough for some. You may not know that I work through lunch most days to ensure every request is done. I forgot to drink enough fluids today, and I didn’t use the bathroom yet. I have worked an hour over and now I must leave to race to my child who awaits me. A forgiving child who is often the last child at aftercare because I could not leave a patient. I am a caregiver. I am an educator. I am a nurse. I am human. I am a mother, and a wife who sometimes comes home empty. Shawna Whitford, RN
  10. Have you ever thought about leaving a job for something better but never put effort into “feeling out” the job market? Most of us have been in a career rut at some point and felt trapped in an unfulfilling job role. We wake up dreading the workday and literally countdown the days and hours until time off. If this describes you, it is possible to become “unstuck” and regain passion for your current job or move forward with finding a future job. The first step is to take a look at what barrier (or barriers) is keeping you trapped and career stuck. You’re Bound By Golden Handcuffs In nursing, recruitment and retention strategies may include pay incentives that keep you pulled in, such as with sign-on bonuses or baylor pay. However, money that is too good to resist can become golden handcuffs that keep you in a job that no longer makes you happy, affecting your overall quality of life. In this case, you can work on an exit plan, a budget and timeline, such as “Over the next year, I will cut back and live on a budget to save money. Then, I will look for a job that will give me a better work-life balance.”. Your Confidence is Wavering Sure, there will always be someone else with flashier skills or with a different talent than your own. But, this doesn’t mean you are less capable or your talents are not as important. Everyone, at some point, has compared themselves to their coworkers. Focus on your strengths while working on weaknesses to build your confidence and keep forward momentum. You’re Just Waiting…. Have you ever found yourself waiting “just until”? Perhaps you are waiting until your next evaluation to see if you receive a raise. Some nurses wait to see if “things get better”, such as a change in management, better staffing or a work culture overhaul. But, the waiting game can lead to significant amounts of time passing with the expectations of change falling flat. Not Sure What You Want In nursing, there are endless career options and job types. However, it is hard to your dream job when you aren’t sure of what you want. In order to move forward, it is important to ask yourself some questions, such as: What do I want from my career? What are my job “deal-breakers”? What am I most passionate about? What are the things I must have in a job? What skills do I have to offer? What skills do I want to improve or learn? What type of work culture and environment do I want? What is my expected salary? You may find the article “9 Questions That Will Help You Find Your Dream Career” helpful, even if you just want to stay in nursing but try something different. Your Job is Familiar and Comfortable A simple Google search will yield an endless amount of motivational quotes about stepping outside of our comfort zones. Although you may be unhappy in your current job, you know what to expect during the workday… you duties and interactions are familiar. Most likely, you have working relationships with co-workers and understand all the nuances specific to your work environment. The fear of the unknown keeps us trapped in unfulfilling work comfort zones. To offset your fear, it is important to determine if your fear is based in reality. For example, you may tell yourself “I will never find another job with hours similar to the job I have now.” and never explore other job openings or career opportunities. You Put Self Care on the Back Burner If you feel trapped at work, there is a chance you are not consistently practicing self-care. Have you lost work-life balance and burning the candle at both ends? It is easy to lose perspective and motivation when we are mentally and physically tired. Try simple acts of self-care, such as meditation, going for walks, taking a class or relax doing something you love to keep yourself centered. You Need to Expand Your Network Talking to nurses working in other settings and environments may shed light on career options you find interesting. There are several ways you can build your professional network. Online networking through LinkedIn or other professional networking sites Reach out to your existing contacts to ask for help, seek advice or look for inspiration. Attend a local nursing association meeting or conference The goal of networking isn’t just expanding your number of professional contacts but to also focus on a vision for yourself. Are you feeling trapped in a job? If so, what is keeping you from moving forward?
  11. Since nurses are expected to be self-regulated professionals, we are legally and ethically obligated to identify and make a valid attempt to resolve all practice issues as they arise as a means to minimize potential negative impacts they may have on patients, our fellow colleagues, and daily operations. In part three of this three-part series, we will focus on how to document and evaluate to improve practice issues within our work settings. Let’s take a look at two strategies we can implement to gain a better understanding of what’s going on, so we can find the best way to resolve practice issues: Document It is important to keep personal records of all steps taken to resolve a practice issue. This ensures there is an accurate account of events and that you can use to demonstrate that you’ve met your professional obligations. It is recommended that all communication with managers and other leaders of your organization be noted in your personal communication log. Additionally, it may prove to be helpful to have any discussions or meetings followed up with a summary email. This provides all parties involved with a detailed record of what was discussed and allows for you to highlight specific details, seek further clarification after you’ve thought about it for a while, and to hold other individuals accountable for their contributions to the discussion and/or meeting. Each board of nursing offers detailed information about the legal and ethical responsibilities relating to reporting and documenting challenging situations within practice. The boards of nursing help to clarify the nurse’s legal and ethical obligation to report incompetent, unethical or impaired practice of a nurse or unethical conduct by any health professional to management, administration and/or the appropriate regulatory body. When documenting any of the above mentioned, be sure to include the following: The practice issue witnessed When the practice issue occurred (specific date and time) Exactly what happened - be sure to remain objective and factual. Describe how the issue has impacted your ability to meet Standards of Practice, Code of Ethics or organizational policies Any other relevant information A request for leadership to follow-up It is essential to note that the client chart is NOT the place to document discussions regarding a practice issue unless the practice issue had a direct impact on the client. You may also be required to document the practice issue in an incident reporting system. Be sure to know your organization’s policies regarding documentation and/or refer to your state’s board of nursing for more information regarding principles of documentation related to practice issues. Evaluate The final step of the nursing process evaluation - and now you must evaluate if the practice issue has been resolved and to determine how your actions may have impacted on the issue itself. If the practice issue was addressed with the support of others, it is important to include them in the evaluation process. Remember that you are never alone in nursing practice - it is always a team effort! Evaluation helps to ensure that the issue has been addressed and serves as a way to examine what you would do or change in the event of another practice issue. Depending on the severity of the issue, it may not be possible to resolve it immediately and this should be considered during the evaluation process. If your organization’s leadership decides that it is best for them to manage the practice issue without your involvement, it is appropriate to ask that you be informed when it has been addressed or resolved. Be aware that because of confidentiality, the leadership may not be able to provide you with detailed information about how they have resolved the issue. They may only be able to inform you that the issue has been addressed. If you see the practice issue reoccur in the future, it is important to let leadership know and follow the same process as before. You’ll find that as you move through your career, and from one facility to another, things fall between the cracks as individuals leave organizations. It is very likely that an issue that you help to resolve one year, may resurface within the next year or so. If you’ve determined that the practice issues have not been resolved, take a step back and consider why. Review the process you used by asking yourself the following: Did you clearly identify the issue? Could you define how and when client care or service was affected? Were the right people involved in the discussions and attempts to resolve the issue? Is there evidence that your leadership team took steps to address the practice issue? What could have been done differently? Once you have reviewed all of the possibilities, you’ll choose your next steps. If the practice issue persists you need to continue to take action until it is addressed. Further action could include: Request a meeting if you have not yet had a meeting with your leadership team. Meet with your direct supervisor again to determine when resolution is likely if you have already met with them and the issue persists. Consider discussing the practice issue with the next level of leadership in your organization if your direct supervisor does not provide the support needed for resolution. Continue to notify the appropriate people until the issue has been resolved. In this three-part series, we’ve discussed the six steps in resolving practice issues within nursing practice. The six steps include: Identifying Practice Issues Fully Exploring the Anticipated Effect and Outcomes of the Practice Issue(s) Identifying Resources Taking Action Documenting Evaluating Does the above list of steps sound familiar? If you guessed - The Nursing Process, you’d be correct! The Nursing Process is always the most important tool that nurses can use to resolve highly complex situations - even major practice issues. To read the first 2 parts of this series, go to: Strategies for Nursing Success: Part 1 of 3 - Identifying Practice Issues Strategies for Nursing Success: Part 2 of 3 - Identifying Resources and Taking Action to Improve Practice Issues If you have any other tips or suggestions you’d like to share regarding resolving practice issues, please feel free to leave your thoughts in the comments section below! Best, Damion
  12. My career has been marked by one main constant - change! Can change really be constant? Read my story and decide for yourself. I started my career as a home health nurse. I was really happy with it for a while because I got to spend one-on-one time with my patient and I made (what I considered at the time) good money. But after about a year, I was looking for something else. Home health nursing was wearing me and my car out. I was putting about 600 miles on my car every week and I was working about 80 hours a day. My poor husband told me, "I feel like I live alone because you are either at work or working at home." And he was right! I had a huge territory, and I saw 7-10 patients a day. I was constantly being asked to pick up extra work because there were not enough RNs. This got old, and besides, I became a nurse to work in a hospital. This led me to my second job: working on a cardiac step-down unit. I loved this too! My job was 10 minutes from home, I didn't have to bring home any paperwork or documentation, and (what a privilege!) I was given health insurance and paid time off. I thought I was in heaven (again). So what happened? I was working with some really snooty nurses who didn't like new people at all, it seemed. This made me feel sort of lonely for 36 hours a week, and my pay actually went down. My husband and I had always wanted to do travel nursing, so I got signed up with an agency and off we went! That was a really fun time in life, filled with so many adventures, good pay and more choices. Travel nursing is full of change: a new hospital every 13 weeks. This was good for me. I guess I'm sort of gypsy at heart. I loved moving around all the time. I loved the change. Every new place was a new start and by the time I started being temperamental about the hospital, it was time to go and start over again. What could possibly go wrong, you ask? Well, living in an RV or a hotel most of the time started feeling cramped. I missed my (grown) kids because I was away from home so much of the time, and about this time I was also feeling really burned out in hospitals. To give myself a new change, I decided to go back to home health. Here is my current problem. Working in home health requires being available 5 days a week to make enough money. I thought it would be a good trade-off for the reduced stress compared to the stress level I was feeling hospitals. But it has been less than 6 months and already I am tired of working 12 hour days 5 days a week. I am tired of having to call doctor's offices on my days off. I am tired of working all day in the field only to come home and have to document, answer emails, call patients to set up my next day, and I'm tired of being tired. I miss having 4 days off every week. Yes, I have applied and been offered another hospital job. Will this make me happy this time? I sure do hope so. Before the comments start - I have considered other types of nursing. I have looked at and applied to many non-hospital and home health jobs. Unfortunately, I have not been able to get an interview for a single one. Additionally, I really do love 3-12s, and I have only seen that in hospitals. I realize that I am going to have to accept the fact that no job is going to be perfect. I think I've done that. I hope I've done that. If I am to be 100% honest here, I know that working for myself is the only answer that is going to make me feel satisfied in the long run... and I am working on it
  13. jeastridge

    Is Nursing Kind?

    Kindness never goes out of style. One of the first lessons we learn in life that relates to how we treat others is often what we call The Golden Rule, “Do unto others as you would have them do unto you.” While this life-theme fits in beautifully in our spiritual lives, how does it apply to being a nurse? Does it? Can it? Is nursing getting harder? We are practicing in a hard time. Nursing is always hard, but for some reason, the last two decades seem to have progressed in ways that make nursing harder. There is a lot of focus on excellence, but not exactly the kind of excellence that leads to kindness. There is a lot of push for efficiency and flexibility, but sometimes we feel our personal lives sacrificed on the altar of corporate interests who often appear to completely disregard the meaning of the word kindness. The cost-cutting measures, pressures to document and concerns about staffing levels often bear down hard on the persons who work closest to the patients—the nursing staff. Whenever an organization goes through a re-alignment or sells out to another entity, it appears that one of the first measures submitted for scrutiny and possible “chopping” are nursing ratios and pay levels. Sometimes, our more service-oriented profession puts us at the bottom of the power structure and we find ourselves in the uncomfortable position of defensiveness, sometimes without adequate representation or voice on the boards that control outcomes. Additionally, years of medical malpractice lawsuits have yielded some unwanted results. While the ability to sue is still sacrosanct, the huge payouts over time have resulted in fearful institutions that carefully guard their territory and work hard to become impervious to lawsuits (an impossible feat, it appears…). The practitioners that find themselves in the crosshairs of this controversy are sometimes the nurses who document and document, using electronic medical records that are built as defense mechanisms instead of patient care tools. How do we keep being kind? Where does all this leave us in our pursuit to be kind to our patients and to truly care? How can we be persons and employees who set a good example that leads others to follow? 1. Stay centered. While our professional life may keep coming at us full force, it is up to us to practice good physical, mental and emotional self-care, practices that enable us to overcome obstacles and push forward with kindness in the face of the opposite. By investing time in daily meditation, exercise, prayer, journaling—whatever feeds your spirit—you maintain the integrity of self that promotes kindness even in oppositional environments. 2. Allow for the benefit of the doubt. People have bad days. They mess up. They are “hangry” (hungry + angry = trouble). They are grieving. They are going through life crisis. Their pet died. We just don’t know what kind of uncomfortable shoes our neighbors are walking in. Yes, they may just be “high and mighty” and mean folks but then again, what good does it do us to go with that assumption? The training on “Trauma-Informed Healing” encourages us to ask not, “What is wrong with you?” But instead ask, “What happened to you?” We can experience a refill of the blessed gift of kindness when we change our questions and look at others with eyes that allow for grace. 3. Be kind even when it is unreasonable. Most of us know that when we are offended, mistreated and stepped on, we want to retaliate. That is human nature. Nurses are human, for sure. We get tired of being at the bottom of the totem pole of consideration. We get tired of being asked to pick up the slack again and again. We get tired of adding thankless jobs to our list, simply because someone higher on the pay grade thinks it is a good idea. We have a choice to make every day: reply with anger or defensiveness or even with the simple truth (which can be harsh sometimes…), or find ways to continue in kindness—all the while seeking true justice. Being consciously kind! Social media is awash with quotes about kindness, some of them helpful and others, not so much. But the one that really sticks with me is by Brian Tracy: In life you can never be too kind or too fair; everyone you meet is carrying a heavy load. When you go through your day expressing kindness and courtesy to all you meet, you leave behind a feeling of warmth and good cheer, and you help alleviate the burdens everyone is struggling with. As nurses, we have a daily choice to make. We can succumb to the pull of unkindness and rail against the unfairness of our professional life or we can continue to pursue excellence all the while seeking true justice and improving conditions for ourselves as professionals and for our patients who depend on us. How do you work to stay kind?
  14. Maureen Bonatch MSN

    The Challenges of Being a Nurse

    At the beginning of our nursing career, we might’ve thought the biggest challenge to overcome was passing the NCLEX. We may have envisioned passing this test as if it were the biggest, and last, obstacle standing between us and caring for our patients the way we want to. When in reality, it was just the beginning. Much of the time the issues that challenge nursing career plans are out of our control, and the NCLEX is just the first of many tests nurses face most days. Even if challenges are out of our control, building an awareness of the source of frustration, and focusing on ways to address it, are the first steps to feeling more in control to overcome career challenges. Time Isn’t On Our Side Nurses generally go into the profession because they want to care for people, but often much of their time is spent doing paperwork. Patients may not always understand that these additional tasks are a necessity, and it can result in frustration for them, and also for nurses. This, and ongoing staffing shortages can limit the hands-on time nurses get to spend with their patients. The struggles for nurses to accomplish all that they’d like in a workday that might include frequent overtime can lead to a work-life imbalance, stress, and potentially burnout. When time challenges your best intentions for managing all your tasks so that you still have adequate time for your patients, try to organize and prioritize time commitments as well as you’re able to. Understand that some things may be out of your control. Explain to patients that the paperwork is part of your job, and inform them of when you plan to return when you’re leaving their room. Sometimes a little transparency, and helping patients understand what to expect when they’re feeling vulnerable or at a loss of control, may help reduce their frustration. If you continue to feel overwhelmed, and like you’re running yourself thin with no reprieve, be sure to look for, and address, any signs of burnout. Unexpected Injuries and Health Issues Despite the best intentions for a long career on the floor, nurses often suffer from back or other physical injuries. This can result from long hours standing, lifting and transferring patients, and the overall physical nature of providing nursing care. This may be combined with working with staff shortages, which can result in inadequate assistance that may result in an injury. Nurses may also be exposed to violence in the workplace due to working with angry patients, or if illness contributes to violent behaviors. Always keep safety in the forefront of your mind when caring for patients. If your body is starting to protest about long hours working on the floor, consider continuing your education to increase career options, or look into other opportunities to utilize your nursing degree without as much physical strain. Don’t forget to practice self-care. Taking the time to care for yourself and get adequate rest is not an indulgence, but a necessity. You can’t care for others if you don’t take care of yourself. Continuous Changes in Healthcare Striving to never stop learning is especially important for a career in healthcare. With rapid, ongoing changes, working in healthcare is continuously presenting us with new technology. This can affect the way care is provided, improve documentation methods, and offer varied options for scheduling. Some of these changes are beneficial and can make the job easier, but often the trial and error of learning new technology can be difficult or frustrating. The Affordable Care Act (ACA) brought changes to healthcare delivery, including offering more patients access to healthcare than before, an increased focus on preventative care and chronic conditions, and the need to improve cultural awareness. Even if a change is for the better, it can still be stressful when you’re trying to keep up with the new while continuing to provide the personalized patient care that is at the heart of nursing. Nursing usually isn’t a career that allows you to bask in keeping things the same way that we’ve always done for very long. Try to stay relevant by reading healthcare journals, reviewing online educational material, network with peers, and explore other methods to keep your mind sharp. Rise to the Challenge Most of this information isn’t new to us, and there are probably many more nursing challenges that you can identify. We may have been dealing with some of these issues, or have been aware of them for some time, but nurses are known for their resiliency and resourcefulness. The test is determining how we will rise to face these challenges to make the most of our nursing career. Have You Overcome Any Challenges in Your Nursing Career?
  15. I read my email and felt that sinking sensation—change is coming and fast. The memo stated that in 7 days we would be changing over to the new system. Despite months of preparation, the looming deadline was anxiety-provoking. Would it go well? Would I be able to adapt? Would our patient care suffer? These and many other questions repeated in my mind as I clicked my laptop shut for the day, hoping that I would be ok with the changes. Nursing is all about change, isn’t it? Just when we feel we have adjusted to the new technology, system, machine, arrangement, we get the memo from administration, “Be aware that we will be converting to xyz next week.” Adapt accordingly. Some change is good and leads to improvement. Some change is pretty neutral and some is just plain old bad. The fact remains that we all have to learn to cope with changes and to keep our morale and practice intact no matter how much change comes at us and how fast. How do we stay on an even keel when faced with change? Stay centered When change comes, we all hope to be that unflappable nurse that handles everything with grace, quietly, serenely coping with the new skill or information that he/she is required to master. But no. Reality rarely resembles the dream and most of us struggle mightily to keep our composure, to learn the new way and to not allow our patients to experience any adverse effects. I recently attended a memorial service for a Jewish friend. The rabbi spoke eloquently and wisely about life truths. One thing he said really stayed with me, and compelled me to go back later and listen to the recorded service to capture accurately what he said. Here is the quote from Rabbi Wolfe Alterman from Asheville, North Carolina: “If you see what is in need of repair and a way to repair it, then you are seeing what God has called you to do. If you only see what is wrong and ugly in the world then it is you yourself that is in need of repair. And all of us are in need of repair in one way or another. There is so much in need of repair that this task feels overwhelming.” He finished with a quote from the Talmud: “You are not required to complete the task, neither are you free to ignore it.” Whether or not you are religious in any way, it is possible to see the thread of truth in both statements. We live in a broken world where people get sick and often die; where tragedies happen but where goodness also abounds. When we are able to stay centered on who we are, what our skills are, what our goals are, we are better able to identify our role in the change process and help in the repairs the change is attempting to make. The second quote is also freeing because it helps us shake off the guilt when the desired change doesn’t turn out as we had hoped. We have to continue to try; we cannot quit. Not every change is going to go well or produce the desired results. By not ignoring the problem and doing our best to effect change, we may have at least improved some part of the issue by trying. Stay flexible We have all heard the refrains, “That is not the way we do things,” or “The administration doesn’t care about nursing” or “I wish we could go back to the good old days of nursing.” When we read these phrases we hope that we are not the ones speaking them but, truth be told, we all struggle from time to time when asked to do something new or to endorse and support change when it doesn’t seem to be for the better. Staying flexible and seeing new possibilities is hard, especially as we gain age and experience. Becoming more set in our ways can go hand in hand with being around for a while and it can also mean that we run the risk of being the “stick in the mud” when it means adapting to a new EMR or to a new staffing system. In Simon Sinek’s book, Better Together, he encourages, “Don’t complain, contribute.” It is up to each of us to seek out the positive. Complaining can be a bad habit that threatens our well-being and the general feeling on our unit or office. Sometimes we think that venting our concerns helps to release tension and provides us with much needed psychological relief but the opposite may be true. Complaining can be a habit that drags us down and pulls those around us with it. On the other hand, making a contribution, or suggesting a positive change can do a lot for our job satisfaction and help to influence our whole workforce. I remember working with one of the women from housekeeping that was particularly upbeat. No matter how many rooms were switched out, no matter how much extra she had to do, she seemed to find a way to keep her comments positive and to refrain from complaining. And people noticed. We all loved working her hall! As we face repeated change, it may help us to look back and see times when change did turn out for the better; we can take encouragement from those times and be those nurses that smile and say, “Let’s see what we can do with this!”
  16. Dr Georgianna Donadio

    Options for Nurses in Today's Medicine

    The Way Things Were As a hospital trained nurse, it has been my privilege to experience nursing for over five decades. It was quite different 50 years ago when we wore all white – stockings, uniforms, shoes and caps. Back then, we stood up if seated when a doctor entered the room. At that time, all the doctors were men and all the nurses were women. The culture of medicine at that time had almost a religious aura about it, with the doctor as the deity and the nurses as guardian angels who watched over the patients, comforting them and following doctors’ orders. To illustrate just "how things were", you can listen to a conversation I had with two very senior nurses interviewed for a nurse radio program. It may provide historical context and some fascinating medical lore. Nurses Eileen Keenan and Lynette Juliet were best friends and colleagues from 1935 until their retirement in 2003. Sixty-eight years of nursing service that covers almost 7 decades of change and transformation in nursing. An Change in the Environment While there are still remnants of that culture, to some extent today in various medical facilities or hospitals across the country, the medical environment is quite different now due to technology, higher education and the media. Today’s nursing is perceived as a career, where it was once viewed as a calling or vocation. Going back to the 1980s when caps were still parts of the nursing mystique, the profession was perceived as being in service to patients and required dedication to the welfare and care of others. It has been said that nursing attracts individuals of a highly compassionate nature. With educational requirements as they are today for entering the profession, there is a great emphasis on academic and clinical skills and less emphasis on patient engagement and relationship development skills that there was just a few decades ago. There are more individuals who are entrepreneurial minded entering the field of medicine and nursing, so there are many directions a trained nurse can go in with her/his credentials. Although the need for well trained, caring nurses is constant, today many nurses wish to strike out on their own and offer private practice services rather than work in acute care or in-patient environments. The medical infrastructure depends on nurses as the hands and heart of healing and nursing is today still the fastest growing medical profession in the country. Another attraction to nursing is that it appears to be recession-proof, which was demonstrated during the latest difficult recession which began in 2008. Changes in Nurses and Nursing The average age of nurses today is over 50 years old and many individuals are entering the professional later in life than in years before. The number of males has also significantly increased and continues to grow as salaries for nurses are competitive with other professions and skill sets. The introduction of holistic nursing, Whole Health nursing and nurse coaching has also opened up other areas of work for nurses as well. There are telephonic nurse coaches, insurance company coaches, and HR coaches in various corporations and hospital. For the nurse who wishes to have their own private practice in any of these holistic fields, clarification around the legal and billings regulations for nurses is critical. All nurses can work privately in their state, according to the practice guidelines of that state. The state regulations can vary significantly and each nurse should contact their licensing board to identify what is permitted in their location. There are, however, hard and fast rules that apply to all nurses across all states. No nurse can direct bill for medical services, with the exception of designated APRNs. Below are the chapter and verse references from Medicare regarding nurse billing. Nurse services can be billed under a physician’s license but she/he cannot use their nurse NPI number, which is intended for the physician or institution to use for billing for the service they may provide. There are only four (4) Advanced Practice Nurse credentials that allow for direct billing of insurance: Nurse Practitioners, Nurse Mid-Wives, APR Clinical Nurse Specialist and Nurse Anesthetist. Non-advanced specialty trained nurses cannot direct bill Medicare for any services, and most commercial payers closely follow Medicare. According to Medicare nurses are not a recognized billing provider class. They can only bill "incident to" a physician's service using 99211 for a patient visit if they meet the requirements to do so and only under the physician's NPI number, not their own. There is absolutely no debate about this. Please see below from the Medicare Claims Processing Manual, chapter and verse cited. Medicare Claims Processing Manual Chapter 12 - Physicians/Non-physician Practitioners 30.6.4 - Evaluation and Management (E/M) Services Furnished Incident to Physician’s Service by Non-physician Practitioners (Rev. 1, 10-01-03) When evaluation and management services are furnished incident to a physician’s service by a non-physician practitioner, the physician may bill the CPT code that describes the evaluation and management service furnished. When evaluation and management services are furnished incident to a physician’s service by a non-physician employee of the physician, not as part of a physician service, the physician bills code 99211 for the service. A physician is not precluded from billing under the “incident to” provision for services provided by employees whose services cannot be paid for directly under the Medicare program. Employees of the physician may provide services incident to the physician’s service, but the physician alone is permitted to bill. Services provided by employees as “incident to” are covered when they meet all the requirements for "incident to" and are medically necessary for the individual needs of the patient. More About Private Practice In upcoming articles, we will explore various specialties that nurses can be trained for which will allow them an additional scope of practice, and credentials to be able to bill for services in private practice.
  17. Download allnurses Magazine Reflections from Rosalee Sites, RN, BSN, MA Memories of Early Days Cleaning our own bedpans in the soiled utility room...steaming needles and syringes after checking the needles for burrs...no IV meds...1 nurse and 3 aids on a 52-bed unit...no critical care units...no recovery room after daytime hours...smoking on the wards...doctors smoking!... Growing up in Elkins, West Virginia in the 1940s, Sites remembers wanting to be a doctor. Interested in all things medical, she knew from an early age that medicine was her destiny; but because of financial considerations in her family and some of the limitations of the time, she instead applied for, and received, a nursing scholarship to the Davis Memorial Hospital Program. After 3 years of rigorous studies in the classroom and on the job training which involved staffing the floor, she was awarded the coveted black stripe on her nursing cap along with her pin and headed to work in 1965. Graduating from a degree program during that time, meant that she had to work hard, repeating a good deal of her initial training, to finally get her BSN 8 years later from East Tennessee State University. "Nursing has been a wonderful profession for me, and I would do it all over again if I could." Working the night shifts on the wards meant that she was responsible for as many as 52 patients a night. She remembers making her rounds early in the shift and taking special note of those that might need something right away. One particular night stands out in her mind because it highlighted the importance of her role as a nurse and how the patient perceived her as being someone they could count on. While rounding, she came into one lady's room and the patient said, "You are here. I've been waiting for you." She asked, "Is something wrong?" The woman went on to say that in the daytime she had family around and there were lots of employees working but at night "It is you and me. That is the reason I wanted to meet you." Her statement stamped itself in Sites' mind, helping her clearly understand how important she was to her patients-they trusted her and counted on her honesty and care; she felt a sense of responsibility for their successful treatment and recovery and her role in it. "Nursing assessment skills are the most important tools we have even now. But back in the early days, they were some of the only tools we could employ: skin color, temperature, respiratory rate, nail bed color, clamminess, pupillary response-all of this nursing observation had to take the place of non-existent monitors." Sites says she can remember rolling a patient's bed into the nursing station with her, so that she could watch them while she charted. "There was just so much less that we could do for people during those times. Medications were limited as were tests. We had to do the best with could with limited resources." "Me, God, and the Telephone" Early on, Sites recognized her special skills in administration and after a few years of general nursing began to specialize in administration as house supervisor with coverage of the emergency room, a small 4 bed unit at the time. As house super she had to do bed placement, deliver antibiotics to the floors on her rounds, and cover the ER. "It was me, God, and the telephone," she remembers. Making necessary calls to physicians at home and running the ER which would be considered primitive by our standards today, was all in a days work. "As a nurse, I have been privileged to share very special moments in patients' and families' lives: being with them as their loved one takes their last breath, bringing a smile to a critically ill child, listening to an elderly lady talk about her family, helping a family member get their father who had dementia on his knees as was his nightly custom for prayer..." After getting her Master's in Organizational Management, Sites continued to make important pioneering differences at Holston Valley Hospital in Kingsport, Tennessee where she continues to practice today. She started the first state-of-the-art Emergency Department, beginning with 23 beds. To really understand what was needed and what was available in terms of design and functional capability, she and a team of other employees visited EDs around the country to borrow the best ideas from the all, eventually making the ED at HVH one of the premiers in East Tennessee. She also headed up a group needed to obtain a Trauma Level 1 designation and worked hard to make that hallmark of advanced technology and ultimate care in trauma part of her local hospital. "The Changes Kept Coming" As the years rolled by, intravenous antibiotics became commonplace; roller clamps and marked bottles morphed into bags of fluid which gave way to machines that counted the drops and delivered the necessary medications in the right quantities to patients. Scans, CTs, MRIs, EKGs, ultrasounds, robotic surgery, all become part of the daily routine for a changing profession. "Even though the changes kept coming, I always realized that the role of the nurse remained central in all of the care we provided. Our patients continued to count on us." Sites went on to clarify, "Your patients will remember you giving them medication for pain, for starting their IV, for inserting their NG tube but more importantly, they will remember you for listening to them; we used to have a physician on staff who said, 'If you listen to your patients they will tell you what is wrong with them.'" The advent of CPR and Life Support provided new ways to intervene at the end of life. "The first person I did CPR on was my own dad in 1965. Because he didn't survive, I worried that I had done something wrong, but later I realized that he had a long cardiac history and there was nothing that I could have done." With CPR came ventilation, ICU care and increasingly interventional medical care. "Continued Education is Critical" A lifelong learner, Sites revels in tackling new topics and continues to be a focused student. As a nursing leader at her institution, she took to heart the major importance of encouraging her staff and others to continue learning. She pushed LPNs to get their RNs, made ACLS mandatory for ED nurses (to loud outcries of protest!), prodded along the process of obtaining certifications in ED nursing. Along with all of this, she was visionary in understanding the critical importance of working with and training the EMS staff so that the pre-hospital care maximized the patient's chance of survival. "As professionals, we owe it to our patients to learn all we can and to push ourselves to reach out for more." She objects to ever hearing the phrase, "I'm just a nurse," and emphasizes the unique and special role that we enjoy as nurses who often are the ones seeing the bigger picture, the ones who are able to bring different disciplines together, the ones who translate what is in the EMR to both the physicians and the family. Our role has always been important but never more than now. Nurses as Leaders "Being a nurse has responsibilities and requires leadership." Throughout her career, Sites has taken seriously the role of mentor to other nurses, and finds it deeply disturbing to hear nurses complain about the profession she loves. "Maybe you have not thought o yourself as a leader but that is exactly what you are. You are a professional nurse and you will be a leader in whatever area you may find yourself." As her career progressed, Sites sought out ways to not only improve conditions within her hospital but also in her area. Helping to start a local medical clinic for the working uninsured and serving on a number of boards and committees, Rosalee continues to see part of her role in nursing as someone who takes on community issues as well. She has been known to quote Sir Winston Churchill, "We make a living by what we get, but we make a life by what we give." Evolving Uniforms and Lack of Uniformity In the early days of nursing, compliance with uniform standards was strict and adhered to stringently. Sites remembers, "We polished our shoes, ironed pleats in our aprons and looked forward to the day when we could earn the right to wear the black stripe on our caps." She laughs to think that they were also required to wear girdles so that there would not be any distracting "jiggles!" Sites states, "What we wear can help inspire confidence in our patients, because if we dress well for our role, it can help us and it can help them. Appearances do matter." Nurses in most areas were not allowed to wear pantsuit uniforms until the mid-'70s. Scrubs came out in the mid-'80s and a general loosening of uniform standards continued until recent times when many hospitals have adopted new, more consistent uniforms, including the requirements that all RNs (and other professionals) wear a certain color scrubs so that patients and families can have an easier time distinguishing between providers. Career Changes and New Challenges Most nurses would readily agree that being able to change positions within the nursing profession is one of the great benefits of our training. Sites is no exception. After spending many years in the ED, Sites wrote a grant to the Robert Wood Johnson Foundation and was approved to start a Parish Nurse (also known as Faith Community Nurse) Program in her community. Now, 20+ years later, she continues on as the director of the program, faithfully administering the growth from a start of a handful of nurses and churches to two different programs with almost 50 nurses total. "Our hospital system wanted to find a way to engage with older adults and I saw Parish Nursing as a great way to do this." After receiving the grant and getting the program started, Sites pursued innovations, continuing education for the group, and diligently encouraged all the FCNs under her leadership to meet and exceed expectations. "One of the primary roles of Parish Nurses is advocacy. They need to be informed, knowledgeable and caring. Sometimes, the nurse if the only person who really cares; is there anything more important than that?" she asks. Looking Ahead "We have come from a time when we could do very little for our patients to a technology-heavy environment that threatens to distance us from those we care for." Sites goes on to say that the very technology that improves patient care can also cause us to lose perspective in our personal lives, over-focus us on screen time and diminish the necessary personal interaction. "You must work on being healthy in mind, body and spirit, modeling a healthy lifestyle for others, refueling and renewing your strength so that you can continue to give." When asked about the future of nursing and the ways that we may need to improve, Sites goes back to the basics: education. There she sees systems that are producing new nurses with good textbook knowledge but less practical training; nurses who are equipped to pass the NCLEX but who are less equipped to do basic bedside procedures. "What happens, when we have graduate nurses that are not fully prepared is that they end up leaving the profession. They feel dissatisfied with their jobs and they change jobs, experiencing less support from their peers. "As mentors and nursing educators, we must pursue avenues to do a better job with training so that when nurses hit the floor they are at least able to have some level of proficiency so that they are assets and feel reasonably comfortable in their roles." Parting Words of Wisdom Through a long career in nursing, Sites has seen a lot: evolving from when we could do very little to extend or improve life to an almost hyper-interventional care time, she sees the need for balance, gratitude and grace. She continues to see nursing as one of the most relevant professions in existence, but one that cries out for its nurses to get back to their roots of truly caring for one another, both our patients and our fellow employees.
  18. traumaRUs

    Nursing Career Adventures

    This article is featured in the Winter 2019 issue of our allnurses Magazine. Download allnurses Magazine Karen K. Wiley, MSN, RN, CEN is the immediate past president of the Emergency Nurses Association (ENA). We recently spoke with her about the changes that have occurred in nursing over the years. Ms Wiley introduced herself: “I have been in nursing for 40 years. My first job was on a 55-bed orthopedic floor where I worked for 8 years. I then worked in various positions including the Intensive Care, Coronary Care Unit and Post Intensive Care. In 1993 I transferred to the emergency department where I worked until December of 2017. I consider myself semi-retired. Currently, I am the 2018 Immediate Past President for the Emergency Nurses Association. My master's degree in nursing was in Nursing Administration.” There are many reasons for choosing nursing as a career. “I chose nursing for a career because it is what I always wanted to do. However, I did not go into nursing until after I was married and had 3 children. When I graduated from high school I did not want to go back to school, at least not right away. I worked in an office.” We have all faced hurdles in nursing too. “My biggest hurdle during my nursing career was working in the emergency department and keeping everyone safe. Patients as well as nurses. Often you work short staffed and you are caring for psychiatric patients and medical patient who remain in the emergency room because there are no beds in the hospital or no staffing on the psychiatric floor.” Nursing continues to change and evolve as our patients become more complex. “The biggest changes that I have seen in the nursing scope of practice include standardized nursing protocols for stroke, chest pain, and sepsis, In addition, we now have Nurse Practitioners, and Physician Assistants.” She went on to discuss that team nursing was the approach to care when she first started in 1978. This consisted of her responsibility of 21 patients along with 2 nursing assistants and 1 RN who cared for the more acute post-operative patient. While working in the emergency department, acuity needed to be considered as the usual workload was 4 patients While that number seems desirable, 4 very ill patients (think diabetic ketoacidosis) are quite labor intensive versus 4 relatively stable patients (think sore throat, well baby checks). Ms Wiley has experienced many changes over the past 40 years. “The changes I have seen in my career that have impacted the profession include computers, (order entry, nurse and physician documentation, medication, any surgical and x-ray reports) The benefit is that nurses and physicians can work in the patient chart at the same time. The negative aspect is when entering the information live, patients do not feel you are talking or listening to them, but the computer. Legal issues have occurred when important information is not documented or the supporting documentation is not there. Another change is 12-hour shifts. Patient satisfaction surveys, and violence in the work setting are others.” Media portrayal of nursing has changed over the years too. It was common to see “physicians defibrillating the patient or doing CPR but now we do defibrillation hands-free. The media also portrays nurse and physicians in a steamy love affair. Our international nurses watch American TV programs and they do not have a very honest view of how we truly practice. The physician and nurse practice as partners in providing care for patients.” She experienced nursing care overseas via an exchange program sponsored by ENA. Ms Wiley visited Norway and Poland and made the following observations: In Poland, EMS has more control of care. It is very unusual for patients to come by themselves to seek care in the ED. This only occurs when a physician has called ahead to inform the ED that the patient is coming. EMS is the usual mode of arrival even though the patients are triaged upon arrival and may still sit in a waiting room. In Norway, she noted that care was very physician-driven and nurses lacked autonomy. However, they are starting nurse practitioners and are working to integrate this into practice. We ended our discussion about how to feel valued at your job. Her words echo many of us; “I feel valued in my job when patients tell me thank you. Also when I walk out the door, I know that I did my best.”
  19. angeloublue22

    What are you doing?

    I got the urge to write this after our new nurse just had her first shift and she group-texted us to see if anyone could call her so she could ask questions, and the entire team said they were ready. It warmed my heart that we were all so willing to jump in and help our fellow nurse. We talked about it later and she said how grateful she was to be part of a truly supportive group of nurses because she knows it's not like that in many places. We had a conversation about why it might be a rare occurrence in nursing because isn't she the one that is taking shifts so we don't have to, and don't other nurses want someone competent to do the job? What a concept! In nursing school, we did have some discussion about dealing with the pitfalls of being the newbie nurse on the job, whether experienced and brand spanking new. I never understood why this was an issue. I mean, wouldn't we want to be supportive and train our colleagues well. That newbie could be the one that saves your butt when you are drowning and thanks to you, has the ability to do so. They could be that nurse that takes your shifts when you need a much-deserved vacation, and you don't have worry about the care they will deliver because he/she was trained well and is confident in their skills. They can prevent you from getting burnt out and hating your job. I have 8 years of nursing under my belt. I've been a caregiver, LPN, RN, charge nurse, lead nurse, and nurse supervisor. In all of my jobs, I've ended up being the main preceptor/mentor. Why, because I love it. I love training the new generation of nurses. I've had a couple of wonderful mentors and I wanted to be that for others. You would be amazed at how much even little interactions can affect a new nurse. Give them some easy way to remember something and they may remember it for the rest of their career and pass it onto to others. We are essentially creating those nurses we want to work with while creating a long-lasting supportive nurse culture, which is why I find it so puzzling that bullying is so prevalent in nursing and in medical teams in general. A negative nurse culture can have long-lasting effects on the entire medical system. The way a nurse was trained or exposed to said culture can affect everyone else he/she interacts with. For instance, if a nurse was not supported at first, they can be unduly stressed, leading to burnout and "whoops we just lost another one", they can become negative about nursing and perpetuate the bullying themselves, and pass that onto the next generation of new nurses, going round and round until we have a larger culture of negativity. This can affect not only the entire medical team but can dangerously affect our patients as well. This culture is not conducive to stable, knowledgeable, and supportive nurses. I experienced these issues firsthand from multiple nurses, and it actually took a lot of work on my part not to become a negative person. When I asked for some pointers from my seasoned nurses, I was treated like I was stupid or threatened with "well, you better figure it out or you're not going to make it." There wasn't much training going on, it felt more like a trial by fire. It made me feel unsupported, stressed, and scared to be on my own knowing that I would have no one to turn to. This was on my first-week training. This was also a place where nurses got into screaming matches, no one helped each other, and everyone was in a battle to write each other up. I was treated better when I worked at a pizza restaurant. I finally decided that I wouldn't let it get me down and instead of dwelling on the negativity I had an innate drive to change it for other nurses, even if it's only in my little neck of the woods. I quit that job and others that had the same culture while trying to remain a positive force wherever I worked. Finally, I had an opportunity to start my own nurse team at a brand new facility. I made it my mission to be that positive, supportive, patient nurse that other nurses would want to learn from, and hopefully pass on to those they train. Then, to my not so surprise, I was able to build a great nursing team, full of happy, competent, solid nurses. You know, the nurses you want to work with. We also have great supportive providers and support staff because, just like negativity is contagious, so is positivity. I want to hear from you. Please tell us what you are doing to make the next and current generation of nurses better?
  20. Maureen Bonatch MSN

    Is Your Nursing Career in a Rut?

    After years of nursing school, and then choosing what seemed like the perfect job, sometimes it's hard to consider that your job may have lost its luster and that it might be time for a change. That change could be as drastic as a new job, or perhaps as little as joining a committee, taking a class, or looking for a transfer. We all have days when we're feeling bored or unmotivated, but if you're feeling like this often, and a few days off doesn't alleviate that feeling, perhaps your nursing career is in a rut. Most people find comfort in familiarity, and may hope that something will change, but often we must make a change to put the passion back in our career. Check for Signs of a Rut Does it seem like you're going to the same job, with the same people, doing the same tasks all the time? It might be hard to pinpoint why you feel unhappy. Perhaps it's just a phase, or a work project that has you feeling this way. Reflect on the source of your dissatisfaction or lack of fulfillment. You might be in a rut if: You get a sick feeling Monday morning, or the day before Jealousy stirs when others are excited about their job You've lost your pride in your work When people ask about your job you change the subject You feel angry and as if you're stuck in your job You secretly browse job listings, but have no idea what you're looking for Company events or trainings that you used to look forward to now feel like an obligation If this sounds like you, your work may start to suffer as you become more disengaged. If you're not committing time or energy to tasks and just go through the motions, it can be physically and mentally exhausting. Most of us want to be challenged and learn, but if we're feeling tired and lethargic then we might believe it's not worth the effort. Determine the Source of Dissatisfaction Even if it's a great job, and you're successful with what you do, you might have lost that loving feeling somewhere along your career path. Before jumping at the first available opportunity, examine what is dissatisfying to avoid getting stuck in another position that may quickly become unfulfilling. Identify what you like and dislike about your job such as: Are you happy with your schedule, or do you feel run ragged, or as if you lack time off? What is your favorite part of the day, or the tasks that bring you the most enjoyment? Are there opportunities to learn, or do you feel bored, or unchallenged? Is the work environment, or culture, unsatisfactory? Do you feel like you're suffering from burnout, or compassion fatigue? Do You Have an Itch to Switch Jobs? If you're ready to move on and find a job you're passionate about, begin by taking time to clean up your personal and professional brand. If your unhappiness has leaked onto social media you don't want a potential employer gaining a bad impression if they stumble across your complaints or blatant unhappiness. Then consider what you're looking for in a job and how it aligns with your strengths and weaknesses. Consider if a hobby, or other passion, can be incorporated to create a more satisfying position Update your resume and LinkedIn profile with new accomplishments and have your cover letter ready to go Consider if you need additional education for the role you desire, it may be as little as taking online classes, or listening to Podcasts, to gaining a new certification or degree Attend available networking events Let friends, family, and colleagues know you're looking for opportunities Can You Rediscover Your Love? Maybe you're unhappy in your job, but perhaps there are ways to put excitement back in your position so it doesn't feel like a grind. Challenge the status quo by shifting your mindset. Pretend you're new to your job and ask questions and make suggestions instead of accepting how things have always been done. Other ways to inject passion, and change your role into something you enjoy more, including creating your own opportunities by: Looking for a mentor, or volunteering to be one Getting to know colleagues better Finding a better fit with a position transfer Asking for more responsibility Discovering interests outside of work to stimulate your mind Get Unstuck from Your Rut Most of us spend a large part of our day, and our lives, at work so it's important to find something that doesn't make us miserable. Each of us has different things that bring us joy. Only we can determine what makes us happy, or unhappy, in our job. Sometimes it takes devoting time to consider just what drew us to the position in the first place, and what's driving us away now.
  21. jeastridge

    Nurse Mentors: A Mantra for Life

    While out walking in my neighborhood, a young woman I know who graduated 6 months ago, caught up with me and we started walking together. After catching up with her news of being a new hire at the local hospital, she nearly broke down and said, "I feel so overwhelmed all the time. I don't know if I am going to be able to do this. There is often no one to help and sometimes when I ask, I feel stupid. What do I do?" We all know the importance of getting off to a good start in nursing. Having a good mentor can make all the difference between having a colleague who is a successful professional and having another person drop out of nursing to pursue other lines of work. As long term nurses and dedicated professionals, what can we do to be better mentors to those starting out? While an initial positive experience is critical, good mentors are important throughout our careers. Whenever we start a new position, even within the same unit, we look around for that person who can guide us along the way. I remember with fondness the long-term nurse who guided me through the first few months of working with hospice. She was affirming, competent and available. When I started making home visits on my own, she made sure that I knew who to call, even if I couldn't reach her. She outlined potential problems I might encounter before the visit and outlined possible strategies for tackling complications. So what makes a really good mentor and how can we be that person for others? Be kind - It may seem counterintuitive to put this quality first, but kindness shows respect to others and to ourselves. Kindness undergirds the kind of people we want to be and what we would like to see in others. Sarcasm, belittling, gossiping, cutting remarks, excessive or unnecessary criticism all have no place in our mentoring relationships. As professionals, we must start out by looking inward, checking our own motivations and goals before launching into a mentoring relationship. Regardless of the outcome, when we are kind we can almost always look back without regrets, knowing that we did our best. KIndnesses are long remembered and rarely forgotten. Sometimes it is the small things that make our day and help us to get through our work with a sense of accomplishment. Being kind in mentoring other nurses is key to being the best possible professionals. Be available - This one is hard and made harder by our erratic schedules and low staffing. But it is essential that we find ways to be as available as possible when we are in a formal mentoring relationship. By passing the baton to someone else, we can let our new hire know who he/she needs to look to should questions arise. Also, through the wonders of cell phones, we have the ability to be more available to one another in emergency situations; by making it clear what those are and setting defined limits, we can enter into and maintain healthy mentoring relationships with one another. Just as my mentor tried to think ahead and let me know what to expect and what problems I might encounter, so too, as mentors, we can have some idea of what might happen and guide our new charges along the way. The idea of "Well, I had to learn it the hard way; they will too," is cruel and unnecessary and ultimately not in our patients' best interest. You may be thinking that you would never do that, but we have to examine ourselves closely and make sure that we are erring on the side of support and encouragement instead of defaulting to letting people learn by making their own mistakes. Be enthusiastic and grateful - Recently I read an author that said that accounting for all variables such as age, income, health, etc., that the happiest people were those that exhibited two characteristics: they slept well and had an attitude of gratitude. Have you ever been around a "Debbie Downer" or "Dustin Depressed" nurse? There is nothing quite like it to suck the air out of the room and take the joy out of being in nursing, is there? We all know that nursing is hard-that's a given. We don't need to have the hard parts outlined and underlined every day. Instead, we need people around us that can lift us up, co-workers who are full of respect for their patients, that accept others non-judgmentally, and that do their work with patient professionalism. As we mentor each other, we don't need to ignore the difficult parts, but we also don't need to spend all our time focusing them, pointing to them and taking about them. There ARE good things too. As mentors and great nurses, let us be the ones that highlight the good and show gratitude wherever we can. When we give one another the benefit of the doubt, we allow ourselves the freedom to continue to enjoy our profession. When we are grateful for the good things around us, we open the door to more joy in our work. Be excellent - I recently attended a conference where one of the speakers said, "Always go beyond. Do it with excellence. When you do that, we experience freedom in your work." As nurses we have choices every day-not so much about what we do, but about how we do it. To be great mentors, we want to lead the way in going that second mile for others, putting the needs of our patients before our own and recognizing that in serving others we can find our calling. Nursing is so much more than a job. As my young friend and I finished up our walk, I tried to give her some pointers in how to proceed, encouraging her to persevere and to also seek out other mentors who provided an example of kindness, availability, enthusiasm and excellence. Throughout our professional lives, we are mentors to others, both the newcomers and the long-lived peers. Let's be the kind of nurses that to others want to follow!
  22. gemini_star

    Overcoming Clumsiness

    Commonly Asked Questions How can you become a nurse when you often break the glass? Where is your presence of mind?! Are you sure you can do it without tripping or breaking? Clumsiness, an issue that I have considered as a hindrance in pursuing nursing. Yes, I was once a victim of clumsiness. The most painful part was if the above questions were the same words coming from someone dear to you. With strong desire and confidence, I knew I had to make a major decision. It was not only the glasses, but also the plates, spoon, fork, platter, almost any breakables that I can get hold of consistently get broken. It will accidentally fell on the floor or I would wonderfully trip over. Indeed, it was all act of clumsiness. So I asked myself, how I can truly be a nurse when literally everything falls apart? Up to date, the clumsy person that others knew of is not so clumsy anymore. As nursing school passes by, merely 5 semesters of learning nursing skills, I was not aware that I grew out of clumsiness until for quite sometime now. There are some things that I have learned but not really considered that it would really help me a lot. Hence, I would like to share some tips for those who are in doubt of pursuing or continuing nursing just because of being clumsy. Yes, A Clumsy Person Can Become A Nurse Get a grasp of it. When holding an object, whether a medicine bottle or a thermometer, hold it very well. Take control of what you are holding. Control your thoughts by thinking positive. Clumsiness is all in the mind. If you are receptive of this idea that you are clumsy, then you will. It is all in the thinking process, if you are doing something that involve breakables, think that you will not drop it; think that you will get it done without breaking it and last but not the least think that you are not clumsy. Always think positive! Presence of mind. Look around the environment, the people around you and the path you are walking in to. This is one thing that I was very poor at because I cared less of the people and the things around me which is a bad habit. It may take a while to overcome this and takes a lot of practice. Know what you are doing. In each nursing procedure, every step has a rationale Try practicing before doing it. It will prevent mistakes and lessens the anxiety. Do not skip thoughts or think of more advance thoughts. This is also one bad habit of mine. I usually think of advance steps in the process without paying any attention of what I am actually doing at the moment. For example, while in the act of injecting, do not think of massaging the muscle for this will only distract you. A great deal of attention is important in what you are doing. Think of the next step before finishing or after you have finished a certain step. You can learn thinking in advance when you have overcome clumsiness first. Correcting clumsiness is not a one day process. It will take ample of practice, time, and knowledge of what you are doing and about to do. Organization of thoughts and presence of mind are essential tool. Do not force but give time to learn ways to overcome clumsiness. I believe the tips above may vary from one person to another. You can also add what have worked for you based on your experience.
  23. Would you like to have an advantage going into applying for your first, or next job? Even though a nursing shortages exists, many positions still have competition for those positions. There is a free way to "enhance your resume" that will make you stand out from the others. Did you know that employers are granted certain tax advantages for hiring different groups of people (ie veterans)? I first started in medicine over 40 years ago, as an EMT at a level one Trauma hospital, then transitioning to Nursing (ER for over 30 years) - finding a job was NEVER an issue. Most of the time I was "over-qualified", and as my years of experience grew, I was always a strong candidate for any position for which I applied. However, as HR departments started taking over all aspects of the hiring process, it became less about your capabilities, and more about what you looked like on paper. Another downfall, after a certain point (typically around 15-18 years of experience), one's years of experience were more of a disadvantage for hire, because of the starting pay for a facility for those years of experience. It was less expensive to hire those with less experience, even if the acuity in the position being sought, was extremely high. As I got older, there were several times when I was unable to find the job I desired, and had to "settle" as a result. I learned to never leave a position, unless I had another to take its place - or... many of the years in my tenure as a nurse, I worked agency. As I am transitioning out of active nursing, I have been made aware of the fact that there are Federal Hiring Incentives, or tax credits, given to those employers that hire people with certain qualifications. These credits are part of what is called WOTC, or Workers Opportunity Tax Credit. WOTC is NOT just for nursing, but ANY position or business for which one might be making an application. Often times, employers do not take advantage of these credits, due to lack of knowledge about them, or the paperwork and time constraint placed on the appropriate paperwork. There are multiple companies throughout the country that try to alleviate the complexity of the process. I have stumbled across this particular one that makes it simple for both applicant and employer to facilitate and receive the appropriate credits. This is done via a confidential questionaire given during the hiring process, in which qualifications are determined according to answers to the questions on this questionaire. The level of tax credit varies, for example, any veteran is eligible for a $9600 credit to the employer that hires them ... IF the paperwork is handled properly during the hiring process, and filed with the IRS. It is important to note that due to the personal component of some of these questions, by being performed by an independent third party, confidentiality is maintained on the part of the applicant from the potential employer. *Not every applicant qualifies, but research is done to assist in finding every local, state, and federal incentive for each profile received. So happy hunting! When multiple applicants are applying for the same position, this could truly be YOUR Advantage! Carol Ansley, RN, BSN
  24. So I'm a junior in high school, and it's my dream to become a nurse. I want to pursue this career because I love helping people, I love seeing smiles on people's faces, I want to make a direct impact on patient's lives by being there for them, and as self-entitled as this sounds, I think I would make a really good nurse. There are a huge number of problems though... 1. My family is against me pursuing nursing My dad believes that nursing is for people who can't make it to med school, and he said that nurses are equivalent to mechanics is nursing is an "unskilled job," which is so not true! He said in India (where my parents come from) nursing is not considered an honorable career. He thinks I'd be better off in sales/marketing because I am a social person who can talk to anybody and I am really good at selling stuff. My mom has a friend who is a nurse and my mom said that she has to clean poop, so nursing is not fun. I am aware of the difficulties that nurses have to endure, yet I still want to pursue this. They both say that nurses don't earn enough, especially in the SF Bay Area where we live and everything is so expensive. However, I am a frugal person who does not plan on having kids so I think I can make it work. As long as I am making a decent salary, money is not an issue for me. 2. My dad keeps trying to convince me to go into either medicine, dentistry, or business. I can't do dentistry because I do not have the best teeth and I don't have the best oral hygiene practices myself, (I can't even floss!) so how would I be a dentist? I used to want to be an M.D, but after my internet research, I have decided that I would rather be a nurse because of the direct patient contact and care versus the diagnosing. And quite frankly, I have no interest in economics or business. 3. Nursing school in CA is INSANELY competitive I'm not going to sugarcoat it; I'm just not a good student. I immensely screwed (due to sheer laziness)up my freshman and sophomore year, earning GPA's in the 2.7-3.0 range. However, I shaped up my junior year and received a 3.5. I know that's not extraordinary by any means, however next semester is coming up next week and I plan to obtain a 4.0. I received a C in biology my freshman year because I gave up due to my bad attitude, but I plan to take AP Biology my senior year and obviously study very hard, so that I can be prepared. I also received a B and a C in chemistry last year, due to laziness. However, I plan to take Intro to Chem I at the community college this year, since it's a nursing prereq anyway. I know this sounds conceited, but I know I can get an A if I actually study my hardest. Anatomy and Physiology is much, MUCH harder than both bio and chem at my school, yet due to my decent studying habits I obtained an A. However, I'm worried that I won't get into any colleges for nursing due to the B's and C's in bio and chem. I wouldn't mind community college, but my family thinks that it's not a viable option (I disagree!) 4. My parents think this is just a phase and I'm not serious about nursing My mom thinks I won't make it in nursing school due to my lazy study habits in the past, so she said that I have to go through with it. However, I am scared that I just won't make it into nursing school, and then I will lose my family's financial support for college. My mom specifically said that she won't pay for my college if I don't pursue nursing all the way. 5. My mom's friend who was an RN, ADN and now is a professor at CSUEB does not recommend going into nursing. She thinks I won't make it because I'm not aggressive enough and that I'm too nice. She is going to take me with her students to the floor one day so that I can see what the nurses actually do. She said that although nurses make a decent salary and have a lot of flexibility, she did not like it because of the feces and the night shifts. My mom and dad both think that I'm not "rough and tough enough' to make it, this discourages me However there are some good aspects concerning me... I start volunteering at a nursing home near my house soon! So excited! I did get an A in Anatomy, which is considered almost as hard as AP Biology at my school. I am a very patient and caring person which I believe are 2 very important aspects for a nurse. This is my dream and I am willing to work as hard as it takes. What should I do? How do I convince my parents that I'm serious about nursing? Will I get into any of the colleges as a prenursing/nursing major? What's the stigma behind community college anyway? Thank you, I know this post was extremely long
  25. Grachi

    Why Pursue Nursing As A Career

    Nursing is a noble and altruistic profession, concerned primarily with the aiding of others who cannot fend for themselves. In unpredictable economic times, working in a field which you are needed is critical, nursing is noted as among the fastest growing professions. According to statistics 1.2 million jobs will emerge for registered nurses between 2016 and 2022. By 2025, the shortage is expected to be twice as large as any other nurse shortage experienced, due to high retirement rate which will increase the employment opportunities and higher salaries. Actually, I want to go into nursing because I love medical shows and all things about medical from childhood which I believe helped me determine my calling. Sometimes when I asked nurses "Why do you chose nursing as a career", they would reply like "Nursing pays well". Of course it does, but sometimes you have to look at your inner potentials, your qualities such as; compassion, caring for others, selflessness, love for humanity, like what are you good in. Do you genuinely have interest in improving someone's well being or making someone who is sick as comfortable as possible. However, many individuals fail to recognize that they must be suited for their chosen career. Nursing is an interesting, exciting and challenging career which enables you to make a difference in people lives on a daily basis. As a nurse, one will be able to explore deeper in knowledge, use your profession anywhere in the world. Actually I am going into nursing not just for the money but because I want people to feel God's love when they are under my care. I know I can never love everyone on my own because we are all humans but I will definitely rely on Christ as an example because we are all created in God's Image. Before embarking on a nursing school or taking nurse as your second career, try asking yourself " Do I process the qualities that will make me a successful nursing student" and "How will I make a difference in my patient lives as a nurse". Some people get into nursing profession and starts complaining about the line of fire of stressed doctors, sick people, worried families and when all this starts flashing across your mind, you may even decide to quit. But try to always remind yourself of what motivated you to go into nursing at first, what do you love about the career, are you putting your absolute best in the work. In the end , you will find out that there are still reasons to smile for you being a nurse. There are many reasons why nurses are respected in the society Nursing is a time honored profession of great historical significance. Nursing is respected by friends, families and even respected by other profession. Nursing have opportunities in overseas, they are emotional rewarding. You will always be needed, you cannot be lonely. You will have the ability to comfort the ill and dying. Experience the thrill of helping a baby being born Help your family members when they are sick. Work in a hospital, doctors office, public health clinic, schools. Learn different cultures because you work with different variety of people. Learn interesting things about the human body. Interact with people in other health care professions. Help people fight cancer as an oncology nurse. You can even be a journalist or a writer, by writing nursing books, this will advance your knowledge in the profession. Help people overcome drugs/alcohol problems as an addictions recovery nurse. Help people recover from accidents or strokes as a rehabilitation nurse. Get involved in the political process as a nurse activist. Get involved in a faith community as a parish nurse. How many of you even know that nurses hardly have a broken marriage, that's because of the qualities they process. As a nurse you will be needed 24/7. The true meaning of nurse is making a difference in people lives on a daily basis and standing out in other professions. I LOVE NURSING

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