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  1. In times of crisis, sometimes there is a hero, an angel, a person who inspires others to make a difference. In 2020 the world was shaken to the core by a deadly pandemic. There was much loss of life and of hope, but the medical community forged ahead taking care of the gravely ill, holding a hand during someone’s last breath, and developing many versions of the vaccine in record-breaking time that saved many lives. It is these moments in history that can lead to dramatic breakthroughs in medicine and medical treatment. A similar situation arose during the Crimean War. Thousands of soldiers were dying, not due to their injuries, but from infections caused by that plagued them because of the unsanitary conditions they were expected to heal in. It was one woman, who stepped out of the comfort and safety of her own upbringing, who changed nursing and medicine forever. Florence Nightingale came from a wealthy British family and social elitism was an important part of her upbringing. She grew up on one of the family’s two estates in the English countryside of Derbyshire and was educated in the classics in addition to being taught German, Italian and French. Florence's call to nursing came early in life. To her mother’s dismay, Florence attended to the sick and needy in the villages around her home. By the time Florence was 16, she declared her passion for nursing to her parents. They strongly disapproved. Being a nurse was not something a young lady of her status should strive for, but this did not deter Florence. At the age of 24 she enrolled in Lutheran Hospital of Pastor Fliedner in Kaiserwerth, Germany. Florence not only revolutionized the role of the nurse and nursing, she brought esteem and legitimacy to the profession during a time when women who worked were seen as “less than,” lower class, or servants. On her return to London, Florence was employed as a nurse at a Middlesex hospital and was greatly challenged by a cholera outbreak. She quickly understood that the unsanitary conditions, such as dirty linens and lack of hand washing, contributed to the rapid spread of the disease. By focusing on improved hygiene, Florence lowered the death rate significantly at the hospital. She also applied her hygiene practices when she cared for soldiers in the Crimean war and reduced the death rate by two thirds. Florence was also a statistician, and it could be said that she was the first informatics nurse. She helped start a Royal Commission looking into the health and well-being of the British army. Florence created the polar diagram, now known as the “Nightingale Rose Diagram''. The Nightingale Rose Diagram is a circular grid divided into equal parts. Each section expands from the center depending on the magnitude of the value it depicts. Nightingale’s diagram clearly showed how sanitary conditions and focus on hygiene decreased death rates and improved health outcomes during the Crimean War. Florence turned data into best practices and laid the foundation of nursing today. (History, 2020) Florence Nightingale’s original rose diagram (Natarajan, 2019) What would Florence Nightingale say about modern nursing? The Covid-19 pandemic laid bare the shortcomings of nursing and the medical system. I believe that Florence would be heartbroken and outspoken about the many social disparities that impact health outcomes: People unable to afford health care or medications A nursing culture that is riddled with bullying and abuse Unsafe working environments Unachievable expectations of workloads Nurses are taking care of a more acutely ill population of patients. Our readiness to care for these patients needs to be elevated and supported by the nursing profession. I graduated in 2007 with an associate's degree in nursing. At that point in my life I already had earned a BA, had two children, and experienced first hand the patient side of medicine. I thought my maturity and life experience had prepared me for the profession. I was the student keynote speaker at our nursing graduation. I spoke of hope, responsibility, ethics, and self care. Through teamwork my classmates and I survived nursing school. In our bubble of academia, we shared and listened to ideas, studied together, and built our courage and commitment to nursing. But many things changed after that graduation day as we went our separate ways into a profession that expected so much and gave very little in return. I never realized as I stepped onto the hospital floor what challenges awaited me from unsupportive and even bullying colleagues, condescending doctors, unrealistic time management expectations, demanding and even violent patients. I recoiled and moved inward to protect myself as I tried to care for and advocate for my patients as best I could. The nurse who spoke so assuredly on graduation day was gone. We can not tolerate or accept the continued shortcomings and old culture of the nursing profession that has been riddled with exploitation and abuse. Florence Nightingale would have shined her light on these issues and challenged us to do better and to be better. Thankfully things are changing. Nurses are more empowered to stand up and together against social and workplace disparities. There are nursing organizations that advocate for both nurses and patients. The ANA, the American Nursing Association, is a national organization that promotes, “Through our united voice on policy issues, we support nurses to practice to their full potential – and improve health care for all.” (Nursingworld, n.d.) The ANA recently keynoted The National Commission to Address Racism in Nursing. They both commit to addressing racism, and focusing on equality and diversity in nursing. 2020 was also “The Year of The Nurse” and a call to action in response to Covid-19. The ANA article, The National Commission to Address Racism in Nursing Reflects on Nurses’ Vast Contributions During Nurses Month, states, “Nurses developed innovative solutions to deploy lifesaving treatments to COVID-19 patients, participated in clinical trials to contribute to COVID-19 vaccine development, advocated for their patients and social justice issues, and confronted long standing health inequities exacerbated by the pandemic.” (McClendon, 2021) I believe Florence Nightingale would be singing the praises of nursing as a powerful force that can influence and change policies and harmful cultures. She would be impressed by the continued determination to be a fierce patient advocate that she had promoted so many years ago. As nurses, we celebrate our achievements, but we still must work to continue to ensure the health and safety of our patients and ourselves. Florence Nightingale was called the “the Lady with the Lamp' because she brought light to the darkest shadows. She not only dedicated her life to the well-being of others, she revolutionized what nursing could be in a time of crisis. Nurses today have similarly illuminated the gaps revealed in the healthcare system during the Covid pandemic and used this opportunity to bring change to the nursing profession and care of patients. Modern nursing is based on the foundation of a woman who stepped out of a life of comfort to help and heal others. Like the nightingale, “Nightingale became a figure of public admiration. Poems, songs and plays were written and dedicated in the heroine’s honor.” (History, 2020) References/Resources Animalia. (2020). Nightingale. History. (2020, April 21). Florence Nightingale. https://www.history.com/topics/womens-history/florence-nightingale-1 McClendon, S. (2021, May 26). The National Commission to Address Racism in Nursing Reflects on Nurses’ Vast Contributions During Nurses Month. Nursingworld. https://www.nursingworld.org/news/news-releases/2021/the-national-commission-to-address-racism-in-nursing-reflects-on--nurses-vast-contributions-during-nurses-month/ Natarajan, S. (2019, July 15). From the Battlefield to Basketball: A Data Visualization Journey with Florence Nightingale. Medium.com. https://medium.com/nightingale/from-the-battlefield-to-basketball-a-data-visualization-journey-with-florence-nightingale-c39571686dfc Nursingworld. (n.d.) Practice-Policy. Retrieved May 30, 2021, from https://www.nursingworld.org/practice-policy/
  2. Understanding Florence Coming from privilege, determined and passionate about helping those in need, she used her influence and intellectual voice to bring about change. At times that voice was pointed and harsh, her will strong. A study of Florence shows so many examples of this (McDonald, 2020b, para. 2-4). One such example can be seen when she circumvented commanding officers to order and obtain much needed medical supplies, The Chief British Officer, John Hall wrote in anger, “Miss Nightingale shows an ambitious struggling after power inimical to the true interests of the medical department” (Hammer, 2020, para. 8). Although Florence Nightingale was a practicing nurse during the Crimean War, who started one of the world’s first nursing schools, the vast majority of her career was devoted to research and hospital reform. She did this through years of collaborative efforts with government and private organizations, associations, and individuals at the top of their field. Working alone and with others, she compiled data and statistics to convince bureaucrats and the medical community of desperately needed change (McDonald, 2020a, para. 2-4). She used her station in life and her connections to help influence decision-makers and fund those changes (McDonald, 2020a, para. 21). Her ideas and observations were not always received well by bureaucrats and superiors. Some were inaccurate, however when shown the evidence she did change her recommendations (McDonald, 2020a, para. 19). Through hard work and relentless drive, she was able to contribute so much to her profession and humanity. Her hope was to improve healthcare for all, not just the elitist class she was born into. Even though her own health was poor she was a tireless staunch advocator, opening the eyes of many who were resistant (Hammer, 2020, para. 16 & 20). The scope of her work regarding Hospital Reform covered multiple topics and subtopics. She was so much more than “The Lady with the Lamp.” She was a forward futuristic thinker, and although not all of her advice proved relevant, much of her work remains the basis of nursing, hospital and healthcare reform today (McDonald, 2020b, para. 23-24). What Would Florence Advocate for Today? Historical writings through publications, correspondence and notes by Florence show us what she fought for. These findings would lead us to believe in modern-day, she would continue to advocate for best practice in: infection prevention disease prevention hospital architectural design to enhance healing and nursing efficiency supportive research and data collection to justify changes remediating patient safety issues to avoid errors questioning hospital expenditures allocating healthcare funds access to healthcare for all stress reduction (both physical and psychological) But besides these broad areas listed she also fought for equality and the protection of not only patients, but nurses as well, inside and outside of hospital walls. Much of today’s terminology, with regards to the treatment of nurses on the job was not commonly used in her time. It was even thought that she alluded to protecting nurses and nursing students from “sexual harassment” and “sexual abuse” when she advised against “holes and corners” with regards to hospital design (McDonald, 2020b, para. 5). Florence also expressed that nurses and student nurses should have a safe environment to work in, and they should have a comfortable work environment (McDonald, 2020b, para. 5-6). What Constitutes a Safe Work Environment? Certainly, a safe work environment includes Physical and Psychological Safety. Physical and Psychological Safety have always been of great concern for Nurses and Healthcare Worker’s and has been unbelievably magnified since the COVID-19 pandemic (Mann, 2020). While Physical Safety must be considered first, Psychological Safety can no longer be ignored. Yes, the lack of Physical Safety can lead to injury, contracting disease of all kinds, short and long-term disability, and even death. The absence of Psychological Safety can and does have the same implications, but many times gets ignored within our healthcare institutions and healthcare culture. Hospital Reform Through Internal Culture Change Now more than ever healthcare organizations need to understand the importance of assuring, to the best of their ability, healthcare workers are psychologically safe on the job. There is no more denying the problem exists. When organizations private and public publish articles and a call to action on Harassment, Bullying, Bystander Effect, and Microaggressions (which stretch beyond gender and racism) we know how pervasive the problem is. Awareness is all around us through peer reviewed articles and books, and leading speakers touring and training on these subjects. Let’s take a look at some of these organizations and what they are publishing: American Nurses Association, (2015, July 22) American Medical Association (AMA), (Murphy, 2020) The Robert Wood Johnson (RWJF), (Fountain, 2014) National Institutes of Health (NIH), (Edmonson & Zelonka, 2019) Occupational Safety and Health Administration (OSHA), (OSHA, 2015) The Joint Commission (The Joint Commission, 2016) With all we know of Florence, today she would be an advocate for Hospital Reform through “Internal Cultural Change” to promote Psychological Safety for nurses and healthcare workers. She would ask, “Given all the attention issues surrounding the lack of Psychological Safety in recent times have had, why is it still so prevalent within healthcare settings”, “Why are we all talk, and despite attempts to mitigate the problems, having little success?” She would undoubtedly let the statistics speak for themselves. Our Modern Day Nightingales: Solutions Offered Researching who Florence Nightingale was and what she stood for reveals an individual that was: always looking; always leading; always problem-solving; never accepting that this is all we have; that this is all we can do; never giving up on finding solutions. She is a voice from the past that resonates with us today on current issues. If she were alive today, we know this driving force would continue doing the same, utilizing modern-day research and listening to frontline staff that brings to light problems that need to be addressed. So, what are our modern-day Nightingales doing? Collaboratively, nurses and non-nurses are doing the same, working towards Hospital Reform through creative solutions such as: Training on Harassment and Bullying Training on Microaggression Training on Bystander Effect Training on Psychological Safety Working Around Obstacles to Protect Staff Physically and Psychologically Books and Journal Articles Calling Out Issues Foundations and Professional Organizations Giving Voice and Solution to Issues Promoting Psychological Safety Software and Apps Created to Track Internal Issues Giving Staff Anonymity When Reporting Listing resources for the above list would be exhaustive. A simple Google search opens our eyes to the ubiquity of these problems, and the attempt to bring awareness and solutions to them. However, three individuals worth mentioning here are Amy Edmondson, Toni Howard Lowe, and Pamela M. Tripp. Amy Edmondson is a Harvard Business School professor who coined the term Psychological Safety and defines it as: “a sense of confidence that the team will not embarrass, reject, or punish someone for speaking up with ideas, questions, concerns, or mistakes. It is a shared belief that the team is safe for interpersonal risk-taking.” (Andreatta, 2020). Toni Howard Lowe is, “a global diversity and inclusion strategist and consultant” and founder and CEO of TCT Consultant Group. She consults corporations, engages in speaking tours across the country, and gives trainings on “Microaggression” in the workplace (Lowe, 2021). Those interested in her trainings can view her on LinkedIn free. Pamela M. Tripp is President and Founder of “Corporate Transcendence” and author of “The Culture Cure: Transforming the Modern Healthcare System” (Tripp, n.d.). These three women, non-nurses, are working inside and outside of healthcare. Their aim is to change our toxic cultural workplace practices, from employees on up to CEO’s. Wouldn’t Florence be so proud of these women, wouldn’t she collaborate with them? Conclusion While honoring and acknowledging frontline healthcare workers through media, billboards and such is welcomed and appreciated, it should never take the place of protecting, supporting and compensating those workers both Physically and Psychologically in an effort to “cause no harm.” It takes a village of like minds, working for a common cause to bring about change. It is so important to “Critically Think.” There may not be a best practice in the moment. The best practice at the time may be standing up, speaking out and doing the right thing. Isn’t that what Florence would do? References American Nurses Association (ANA). (2015, July 22). Incivility, bullying, and workplace violence. ANA Position Statement. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/ Andreatta, B. (2020, October 26). Work shouldn’t hurt: Resources for workplace bullying and psychological safety. Retrieved from https://www.brittandreatta.com/about-britt-andreatta/ Edmonson, C., Zelonka, C. (2019, June 4). Our own worst enemies: The nurse bullying epidemic. Nursing Administration Quarterly. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6716575/ Fountain, D. M. (2014, April 27). How to address disparities? End bullying of nurses in the workplace. Culture of Health Blog: Robert Wood Johnson Foundation. Retrieved from https://www.rwjf.org/en/blog/2014/04/how_to_address_dispa2.html Hammer, J. (2020, March). The defiance of florence nightingale. Smithsonian Magazine. Retrieved from https://www.smithsonianmag.com/history/the-worlds-most-famous-nurse-florence-nightingale-180974155/ Lowe, T. (2021). Dealing with microaggression as an employee. LinkedIn Learning. Retrieved from https://www.lynda.com/Toni-Lowe/20544000-1.html Mann, B. (2020, May 2). Nurses left vulnerable to COVID-19: 'We're not martyrs sacrificing our lives'. Retrieved from https://www.npr.org/2020/05/02/848997142/nurses-left-vulnerable-to-covid-19-we-re-not-martyrs-sacrificing-our-live McDonald, L. (2020a, May 4). Florence nightingale: The making of a hospital reformer. HERD: Health Environments Research & Design Journal. doi/full/10.1177/1937586720918239 McDonald, L. (2020b, June 8). Florence nightingale’s influence on hospital design, hospitalism, hospital diseases, and hospital architects. HERD: Health Environments Research & Design Journal. Retrieved from https://journals.sagepub.com/doi/full/10.1177/1937586720931058 Murphy, B. (2020, November 17). Workplace bullying must have absolutely no place in medicine. American Medical Association. Retrieved from https://www.ama-assn.org/practice-management/physician-health/workplace-bullying-must-have-absolutely-no-place-medicine Occupational Safety and Health Administration (OSHA). (2015, December). Caring for our caregivers: Preventing workplace violence: A road map for healthcare facilities. Retrieved from https://www.osha.gov/sites/default/files/OSHA3827.pdf The Joint Commission. (2016, June). Bullying has no place in health care. Quick Safety Issue 24: The Joint Commission. Retrieved from https://www.jointcommission.org/-/media/deprecated-unorganized/imported-assets/tjc/system-folders/joint-commission-online/quick_safety_issue_24_june_2016pdf.pdf?db=web&hash=84E4112AB428AD3CA1D5B9F868A1AD10 Tripp, P. (n.d.). Transformational change in healthcare Speaker profile. Retrieved from http://www.sahalliance.org/files/Pamela Tripp - Speaker Profile.pdf Additional Resources & Reading Duma, Maingi, Tap, Weekes, Thomas Jr. (2019, May). Establishing a mutually respectful environment in the workplace: A toolbox for performance excellence. American Society of Clinical Oncology. Retrieved from https://ascopubs.org/doi/10.1200/EDBK_249529 Edmondson, A. (n.d.). Why is psychological safety so important in health care? Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Amy-Edmondson-Why-Is-Psychological-Safety-So-Important-in-Health-Care.aspx Hughes-Reese, M. (2017, April). Magnet tip: Cultivating psychological safety at the unit level. American Nurses Association. Retrieved from https://www.nursingworld.org/organizational-programs/ana-consultation-services/tips-articles-and-videos/cultivating-psychological-safety-at-the-unit-level/ Institute for Healthcare Improvement. (2021). Why is psychological safety so important in health care? Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/education/IHIOpenSchool/resources/Pages/AudioandVideo/Amy-Edmondson-Why-Is-Psychological-Safety-So-Important-in-Health-Care.aspx Redford, G. (2019, November 12). Amy Edmondson: Psychological safety is critically important in medicine. Association of American Medical Colleges. Retrieved from https://www.aamc.org/news-insights/amy-edmondson-psychological-safety-critically-important-medicine Tripp, P. (n.d.). The fix the healthcare industry yearns for. [Web log post]. Retrieved from https://pamelatripp.com/culture-fix-healthcare/
  3. FOR ALL THE NURSES

    Nurses Week | COVIDian Rhapsody

    FOR ALL THE NURSES We hope this nursing parody brings you joy and laughter, especially during this challenging global pandemic! We would like to recognize all the nurses around the world for their continued work and sacrifices!  HAPPY NURSES WEEK!
  4. NurseMelly11

    Tubing COVID Specimens?

    At the beginning of the COVID pandemic, our hospital policy stated we could not transport any specimens for a PUI or confirmed COVID patient through the tube system. Then, restrictions changed to that we could transport blood and urine for these patients through the tube system, but not the actual COVID specimens. Now, over a year later, several hospitals in our state are allowing transport of the double bagged specimens through the tube system. We have asked to change our hospital policy, but continue to be told no by lab, but not given a reason as to why. We would like to stop having to take specimens ourselves to the lab because it is delaying pt time in the ED, it is decreasing patient satisfaction, and it takes an employee off of the unit, which at times is not realistic. I’ve tried finding latest EBP on this topic, but pretty much everything I have found is from early 2020. There is nothing current. Would any of you be willing to share with me what your hospital policies are and if you know why they are the way they are? Thank you.
  5. Thanks to the nurses for these efforts. Found at ABC News 12/4/2020 ICU nurse begs community to help 'save lives’ Three St. Lukes Health System intensive care unit nurses share their experiences working during the COVID-19 pandemic. https://abcnews.go.com/video/embed?id=74540053
  6. I live in Alabama and the pandemic has opened my eyes to how nurses pay in my state trails behind compensation in most other states. This has been the case throughout my 27 years of nursing, but I always thought it was because of our lower cost of living. Currently, Alabama is ranked the 3rd lowest in nursing pay when compared to compensation in other states. The high number of people with chronic illness contributed to the ranking of #10 in states with the highest number of COVID-19 deaths per capita. To better understand the pay gap, I try to learn more about any staffing and pay issues in other states. I’ve compiled information from recent news articles to discover how employers in other states are showing nurse appreciation through pay incentives. Houston Methodist Offers “You Rock” and “Hope” bonuses Houston Methodist hospital is offering a bonus to thank workers for persevering in 2020 and to also to spread hope for the months to come. COVID-19 vaccination is not mandatory for employees, but it is included in the bonus eligibility criteria. In November 2020, Houston Methodist gave a “you rock” bonus to recognize employees for their hard work during the pandemic. The Houston Methodist system consists of 8 hospitals with around 26,000 employees. Vanderbilt Nurses Get Pay Raise Vanderbilt University Health System, in Nashville, announced pay raises for their nurses early in the pandemic. In April 2020, a local new station brought forward a complaint from a nurse frustrated with the dramatically higher pay rates of travel nurses. In a statement released by VUMC, administration announced a pay increase for all nurses and nurse managers involved in direct patient care. Texas Children’s Hospital Receive Special Stipend In January, Houston's Texas Children’s Hospital recognized employees' hard work during the pandemic with a special stipend. Full-time employees received a $500 stipend and part-time employees were given a $250 stipend. These same stipends were distributed in April 2020 before the pandemic’s peak. Wake Forest Baptist Health Increases Pay for 60% of Employees Wake Forest Baptist Health announced plans on March 3rd to pay increases for about 60% of their total employees. CEO, Dr. Julie Ann Freischlag, expressed gratitude in a news release, stating “I have personally witnessed their dedication to our patients and their families and have seen them provide such comfort and assistance, no matter their job”. The initiative will include the following: Increase base pay to $15.00 per hour, or Increase pay by 2%, whichever is greater Increase in minimum nurses pay rate Nurses in professional salary plans to receive a $1.00 increase. Night, evening and weekend shift differentials will be adjusted based on market analysis The health system has more than 20,000 employees and about 12,000 will see pay increases in April 2021. CVS Shows Gratitude In December 2020, CVS gave nearly 200,000 workers a $250.00 bonus for their hard work during the pandemic. In addition, the company adjusted pay for some employees to help off-set loss of income related to the virus. Virginia County Gives Hazard Pay Bonus High risk workers in Virginia’s Fairfax County received a one-time hazard pay bonus of up to $2,000 in February 2021. Eligible employees include those working in the following positions: Medical transport providers Hospital workers Dental staff Medical staff Mortuary services Non Medical support staff Long term care staff Home health workers A Fairfax Board of Supervisors member, Jeff McKay shared the following statement with a local news channel: "Our first responders and other members of our county staff put their lives on the line every day, risking contracting COVID-19 in their work with the community." COVID-19 Vaccination Incentives Some companies are offering incentives to their essential workers who choose to be vaccinated. The incentives are designed to ease any of the work barriers employees have in getting the one or both doses. Here are a few companies offering incentives: Aldi The grocery store will pay hourly employees up to four hours pay if they get vaccinated (two for each dose) and pay the cost of administration. Dollar General Offers a one-time payment equal to 4 hours pay to employees who opt for vaccination. However, it does not make it a requirement. Darden Restaurants Darden Restaurants is offering paid time off for vaccination, two hours pay for each COVID-19 dose. The pay will be based on workers total earning including tips. Darden Restaurants operates chains including Olive Garden and Longhorn Steakhouse. Have You Received An Incentive? Let’s shed more light on what the industry is doing (and not doing) to acknowledge hard work and risks employees are faced with the coronavirus. Let’s share what’s going on in our corner of the country. References Cumulative COVID-19 Cases and Deaths
  7. I am a pre-nursing student wanting to go into nursing school this year or next. I have finished most of my pre-requisites and also have a bachelor's degree in biology. Are there any downsides into going into nursing school right now amidst the COVID pandemic? I would like to start working as a nurse right out of nursing school. Becoming a nurse is my goal but I am just concerned about whether COVID will impact anything. Is nursing school run normally in hospitals now since we have the COVID vaccine or are all classes online? Thank you!
  8. Wonderful vignettes in the Smithsonian Magazine including pictures of female physicians in native dress and scrubs, in how they are using traditional customs, including a "medicine man" and modern medicine to treat COVID patients. Karen How Navajo Physicians Are Battling the Covid-19 Pandemic
  9. Superb communication skills and lifelong infectious disease public health advocacy helped Dr. Fauci win this award. Karen ABC News 2/15/2021 Fauci wins $1 million Israeli prize for 'defending science'
  10. Khalen Dietz

    New Jersey Hope and Healing

    Hi Everyone! My name is Khalen Dietz and I am with New Jersey's Hope and Healing Program, a Fema Grant through RWJBarnabas Institute for Prevention and Recovery. Currently we are offering free virtual connect together groups for all healthcare workers. We offer Monday morning coffee talk, Thursday's at 4pm Happy Hour, and Thursday's at 6:30 pm a wonderful Evening Stretch group. All of our virtual groups can be found at rwjbh.org/hopeandhealing. We also have a hope line at 833-795-4673. I hope you all have a great day! Khalen Dietz- Khalen.dietz@rwjbh.org
  11. COVID has brought many changes to all nurses and the entire world. Nurses working in hospitals have been stressed to the max due to lack of PPE, increased patient numbers and acuity, shortage of nurses, and more. But let's not forget the School nurses. With schools fluctuating between virtual attendance and in-person classes, school nurses have had to remold their roles to fit the needs of their patients and patience. School staff, administration, and parents have looked to you with many different needs and expectations. What are some of the changes you have had to make? What changes have you seen, for better or worse, as the Pandemic has evolved into what seems to be an everlasting nightmare? Do you feel like your voice is being heard?
  12. I know that many hospitals, including the hospital I am employed by, have moved into “disaster” or “crisis” charting. For my hospital this means charting Q12h on each patient and charting changes in condition (I.e. the patient went into respiratory distress and went from RA to 15 L NRB). Previously we had charted Q4H and charted changes in conditions as well. Additionally we are no longer charting on patient education or ADLs which is something we had previously been expected to chart on at least once a shift. What kind of changes are you all seeing to charting at the hospitals you work? Are you concerned at all that the changes in charting could be putting your license in jeopardy? In nursing school I know we were all taught “if it isn’t charted, it didn’t happen” so I wonder if we really are protected in the event a patient or patient family member decides to pursue legal action. Thoughts?
  13. At our home we currently have 0 COVID cases. But back last Spring, we had lots of cases among staff and residents, lots were dying on oxygen, hypodermoclysis, staffing shortages pretty much a headache all around. I remember working mostly doubles and 2 triple shifts. Lots of staff who were never COVID positive went on a LOA these were full time staff they were gone for 2-5 months, and then came back. Staff who have been their for years and the ones who filled those spots were the new staff. When the old staff came back from their LOA the new staff either became casual, part -time or on - call. I personally do not think its fair. You cannot just go "LOA" during a pandemic. One staff said they were going for "personal" reasons which I think was a load of bull *** because she worked short for 1 day, called in sick the next, and then the next day after that she had her LOA letter at the Director of Care desk. One staff said, "I had pneumonia as I was coughing". I said so how come you worked during a respiratory outbreak, an enteric outbreak, and MRSA outbreak, but when COVID comes you go on LOA? To me it makes no sense. And this person was gone for 4 months which makes no sense. After 4 months the outbreak at our home was already controlled. She had no response. I myself had Covid 19 back in April. I isolated for 14 days plus 2 to be safe, then went back to work in May. I have asthma but always have a puffer. I'm always involved in outbreaks, I feel like its part of the job. I mean as long as they have PPE and what not, and the workplace was offering a hotel at no cost. Even the office job nurses in administration, were called to work in the front lines and they said they did not want too. To me its sounds like patient abandonment. If my grandparents were in a nursing home I would want someone taking care of them 24/hours making sure they are safe and cared for. You can blame management but management has no control of people disappearing. The new staff were mad that they lost their positions due to seniority as they were the ones who worked short long hours while the full time staff just disappeared.
  14. Tabitha871

    Paralytic and Sedation

    Quick question for everyone. Generally how long are you waiting to turn down sedation after an IV paralytic had been discontinued and turned off? Specifically Nimbex and Roc? im travel nursing during the pandemic and have ran into a bunch of issues with this. So I’m trying to get some opinions.
  15. I'm curious for everyone's thoughts on this article. The nursing shortage or surplus depending on your region has been discussed many times here but I think this article would be more accurate if it said there's a shortage of experienced nurses willing to tolerate the poor working conditions of the bedside. I can't think of a single peer of mine that doesn't have the goal of either going to a non-clinical position, or becoming a nurse practitioner. I think the pandemic is driving even more people from the bedside making working conditions even worse for those that remain. What's happening in your region? Is it feast or famine? What do you feel this article gets right/wrong? Despite High Demand For Nurses, Colleges Aren't Keeping Up
  16. The dumbest thing I ever bought was a 2020 planner. I was so bored I called Jake from State Farm just to talk to someone. He asked me what I was wearing. 2019: Stay away from negative people. 2020: Stay away from positive people. The world has turned upside down. Old folks are sneaking out of the house & their kids are yelling at them to stay indoors! This morning I saw a neighbor talking to her dog. It was obvious she thought her dog understood her. I came into my house & told my cat. We laughed a lot. Every few days try your jeans on just to make sure they fit. Pajamas will have you believe all is well in the kingdom. Does anyone know if we can take showers yet or should we just keep washing our hands? This virus has done what no woman has been able to do. Cancel sports, shut down all bars & keep men at home! I never thought the comment, “I wouldn’t touch him/her with a 6-foot pole” would become a national policy, but here we are! I need to practice social-distancing from the refrigerator. I hope the weather is good tomorrow for my trip to the Backyard. I’m getting tired of the Living Room. Appropriate analogy. "The curve is flattening so we can start lifting restrictions now” is like saying “The parachute has slowed our rate of descent, so we can take it off now.” Never in a million years could I have imagined I would go up to a bank teller wearing a mask & ask for money. (This was hand-written and given to me by a friend. Original source unknown.)
  17. Penandpaper

    Reluctant Heroes: Thoughts On COVID-19

    It’s hard to believe that it’s been seven months since the coronavirus disease was declared a pandemic by the World Health Organization (World Health Organization [WHO], 2020). Working in New York, when I first heard rumblings about COVID-19, I couldn’t foresee the impact that it would have on our nation and healthcare systems. During the early stages of the pandemic, steps were put into place to slow the spread of the disease such as travel health notices and quarantine measures (Schuchat, 2020). Despite these efforts, the disease accelerated with approximately 5000 deaths by March 12 (Jones, 2020, p. 1684). According to Schuchat (2020), mass gatherings, air travel, and crowded settings such as skilled nursing homes, hospitals, and other institutions were responsible for the virus's acceleration (p. 553). COVID-19 and the resulting pandemic required much versatility from everyone as we were forced to adapt to our current reality. This led to various governing local, state, and federal bodies creating policies to try to curb the spread of the virus (Schuchat, 2020). Many schools were dismissed and switched to online learning. For those who weren’t furloughed or laid off, their work became remote. Thoughts For those of us nurses and allied health professionals still working, it was a perilous time fraught with constant changing policies; scarcity of supply; and patient overload. Hospitals were overcapacity; workers were falling ill, and everyone had to do the best they could with the resources and information they had at the time. Patients and even some staff members that were well-enough one day were discharged, only to come back in worse condition. Staffing shortages that existed were compounded and structural and social inequality in our healthcare system was exposed. “Across the country, deaths due to COVID-19 are disproportionately high among African Americans compared with the population overall” (Dorn et al., 2020 p.1243). Minority populations tend to be disproportionately affected by other health complications that can make the COVID-19 virus particularly lethal (Li et al., 2020). It is not surprising then that “although Black people make up 13% of the U.S. population, they [accounted] for 21% of deaths from Covid-19” (Warren et al., 2020, p. 121(1). Residents of long-term-care facilities experienced a higher number of deaths from the coronavirus, “[accounting] for 8% of all coronavirus cases but more than 40% of all COVID-19 deaths” (Chidambaram et al., 2020, p. 1). It was a trial but the generous donations from the community kept us going. We were hailed as heroes and cheered, although at night it was hard to sleep as I thought about the circumstances. It was a difficult time but Summer came along and cases seemed to wane. It seemed promising that maybe this was behind us. That was a hope - not a guarantee. Businesses, schools, and stores began to reopen, occasionally shutting down due to pandemic scares. Nothing was for certain and policies flickered on and off. However, it’s December and things seem bleak, and I, like many people, feel weary of our newfound reality which consists of COVID tests, Zoom events, and the endless news coverage. Cases have risen again and that brings with it its anxieties. Promises of a vaccine loom in the distance and I can’t help but hope for the world to return to normal, or something close to it. In Closing The coronavirus disease will forever remain in the minds of those who lost loved ones and family and those who have recovered, yet face possible long-term complications (Jiang & McCoy, 2020). COVID-19 is not the first pandemic to be realized. Of notable consideration are three pandemics of the 20th century, those being Spanish, Asian, and Hong Kong flu (Kilbourne, 2006, p. 9). However, unlike these past pandemics, technology and scientific advancements can lead to the development of efficacious vaccines in record time. Although the death toll continues to climb and the future remains uncertain, it is cause for optimism. In this optimism though, lest it not be forgotten those whose lives were put on the frontlines to combat this pandemic as well as those who paid its price. References Chidambaram, P., Neuman, T., & Garfield, R. (2020, October 27). Racial and ethnic disparities in COVID-19 cases and deaths in nursing homes. Kaiser Family Foundation. Dorn, A. V., Cooney, R. E., & Sabin, M. L. (2020). COVID-19 exacerbating inequalities in the US. The Lancet, 395(10232), 1243–1244. Jiang, D. H., & McCoy, R. G. (2020). Planning for the Post-COVID syndrome: How payers can mitigate long-term complications of the pandemic. Journal of General Internal Medicine, 35(10), 3036–3039. Jones, D. (2020). History in a crisis - Lessons for Covid-19. The New England Journal of Medicine, 382(18), 1681–1683. Kilbourne, E. D. (2006). Influenza pandemics of the 20th Century. Emerging Infectious Diseases, 12(1), 9-14. Li, Y., Cen, X., Cai, X., & Temkin-Greener, H. (2020). Racial and ethnic disparities in COVID-19 infections and deaths across U.S. nursing homes. Journal of the American Geriatrics Society, 00(00), (1-8). Schuchat, A. (2020). Public health response to the initiation and spread of pandemic COVID-19 in the United States. Morbidity and Mortality Weekly Report, 69(18), 551–556. Warren, F. (2020). Trustworthiness before trust - Covid-19 vaccine trials and the black community. The New England Journal of Medicine, 383(22), p. 121(1)-121(3). World Health Organization. (2020). Naming the coronavirus disease (COVID-19) and the virus that causes it. Retrieved December 3, 2020.
  18. MeganMN

    Covid in Rural America

    The Rewards I am a Critical Care Response RN in a small, rural Critical Access hospital. I proudly serve my fellow co-workers and patients by responding to the ED during busy times, for trauma codes, stroke codes, etc. I assist in the ICU with critical patients and try my best to support the primary RN by offering breaks, moral support, acting as a runner for the isolation rooms, and jumping in when we have a Rapid Response or tough IV start. I head to OB for Emergency c-sections, postpartum hemmorhage, or a 'bad' baby. If a staff member calls in sick, I might have a Med/Surg patient assignment, or get the ICU patient settled until the on-call nurse arrives. My day is extremely varied and extremely rich in experience. I have the ability to care for an inpatient in the Emergency Department, complete their admission, and then assist with their care in the ICU or Medical floor. We had a particular patient that I met in the Emergency Department, answered his call light later when he was on the Medical floor, then helped his son put on PPE and visit him in the ICU later in his admission when he eventually transitioned to comfort cares. Because of my unique position, I get the reward of seeing patients all through their stay at our facility. The Traumatic Experiences and Stories Most of us that work there also live in the communities that we serve. Our patients might be a neighbor, a distant relative, a member of our church, or some other type of acquaintance-once-removed. The connections are everywhere. When we scroll through the obituary on a slow Saturday in the Emergency Department, we find ourselves mourning the passing of familiar faces and spend time telling, "remember when" stories. I remember most of the patient deaths that I have been a part of. They get tucked away in my little memory box and every now and again, something triggers a memory, and I think of them. It has never been super traumatic for me and I have learned how to effectively cope over the years. But this pandemic has been different. I have watched as people that lived at home independently, came in to the ED sick and struggling. I have watched them slowly decline in Med/Surg, or in the ICU. I have been involved in family discussions to support end of life decisions. And I have watched them die. I cannot tell you that my experience has been traumatic in the way that it has been for nurses in New York, or El Paso, or even closer to home Minneapolis. What I can tell you, though, is that each one of these people have a story, a family, a community. I cringe when I hear people talk about the Covid deaths as 'old people who were going to die anyway'. We have celebrated a patients birthday with her as she lay in the ICU struggling to breathe, unable to be with her family. I held a patients hand while he caught his first glimpse of his newborn great-grandbaby through the window. Tomorrow I may hold that hand as he dies. I will see the obituary and have my 'remember when' stories, and it won't be just a number on the daily Covid report. The Optimistic Future The I do not know how the country will emerge from this Pandemic. I worry about the cost to our freedoms, our financial burden, our mental health. I am optimistic for a future when things might be better again; this Pandemic has brought me to my knees. Never did I think that my life would be at risk just for my choice of profession. Never did I think that I would watch so many people die. Hats off to everyone who is a part of this tragedy. From a nurse in small town rural America, I pray that soon enough we will all be telling our own, Pandemic of 2020 'remember when' tale...and this will all be behind us.
  19. Hello! I am considering leaving the hospital until the end of the pandemic. Not necessarily because of the ill patients. Mostly because of the politics. I understand that there is a shortage of staff for COVID units. My issue is, the hospital I work for is constantly creating new COVID units for patients that are asymptomatic. I've learned these hospitals are getting additional funding from the relief programs put in place by the government. The hospitals gain additional funding if the patients are placed on vents as well. I've noticed MDs and rr therapists are forcing us to place them on vents even if they do not meet the criteria..... I am becoming extremely overwhelmed and am sick of what I am seeing. I hate how the system is taking advantage of these extremely difficult and emotional taxing times...I don't want to be a part of this anymore. Am I wrong?
  20. NRSKarenRN

    America's Pandemic

    While reading the Kaiser Family News report from 10/28, saw an article about this 3-Part documentary in which the Washington Post examines the U.S. response to the COVID-19 pandemic and American history of disease outbreak preparedness since the 1990's. I remember when President Clinton created the U.S. National Strategic Stockpile -- in part due to reading a book The Cobra Effect, describing attempted bioterrorism attack on the United States, thus immediate need for PPE and medical supplies. Son loved the book. When this docuseries was posted online 10/27/2020, 225,000 Americans had died. Today 12/1/2020, just one month later, COVID positive cases increased BY I MILLION on just 6 days over the past week; over 4 million in November. 12/01/2020 John Hopkins U.S. COVID stats : 192,750,000+ COVID tests 13.5 million positive cases 268,500 deaths By February 20201, expect the Biden-Harris COVID-19 Advisory Board pandemic plan will be rolled out... at least I hope with these escalating numbers and Christmas/New Years revelry effect yet to be realized. America's Pandemic ...The Washington Post explores a failed response to the coronavirus pandemic that’s left 225,000 Americans dead, despite decades of preparation in Washington. Part 1: Fair warning Part 2: Guided by the science Part 3: Playing it down COVID News Reports: 11/19/2020 Transcript for CDC Telebriefing on the COVID-19 Outbreak 11/21/2020 Newsweek: U.S. Adds 1 Million New COVID Cases in Just 6 Days, Total Is Now Over 12 Million 11/27/2020 Spectrum1 News, KY: U.S. Surpasses 13 Million COVID-19 Cases As Experts Warn Numbers Could Be Erratic Following Thanksgiving 11/28/2020 Buzzfeednews: 4 Million New COVID Cases In US In November CDC video: How COVID-19 Can Spread in a Community View more videos about coronavirus disease 2019 (COVID-19) on CDC’s Youtube Channel
  21. ICU nurse (Kathryn) is being harassed after posting before/after photos. She is being accused of lying about what is going on. 😲 SHOW HER YOUR SUPPORT! Share your PICS!!
  22. I'm a nurse at a city hospital who has cared for Covid-19 patients since the first wave and have continued to do so. As nurses we usually take care of ourselves, but don't rush to the doctor for every little hangnail. I have rarely had acute visits with my PCP, if an issue arises that can wait I bring it up at my annual physical. I booked my annual check-up for this year a year ago. My PCP is aware that I am a nurse who works in acute care. A day before my appointment I received a call from my. PCPs office telling me they were cancelling my annual check-up, they didn't give a reason, but said someone from the office would call to reschedule. Today I received a call from their office assuming it was to reschedule. Instead they told me the doctor wants to do a telephone consult before allowing the office staff to reschedule my appointment. I have heard from nurse colleagues that they have been told by their gyms and hair salons that they are not welcome at this time due to being a healthcare worker who cares for covid patients, but not primary care provider offices. I'm not sure if that's the reason, but I am highly suspicious. Has anyone had any experiences with this or work in primary care and having this as a policy?
  23. Anonymous666

    Has anyone seen this?

    I'm sure this has been posted here before. I'm too computer illiterate to figure out how to post an article let alone search for one. I'm just wondering if anyone has any input on this systematic review and how you think it affects PPE policy in the hospital. (Don't worry, I'm not a conspiracy theorist. I'm just a little rusty with my meta-analysis versus everything else kinda stuff). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-Personal Protective and Environmental Measures
  24. NursesDontNeedChairstoChart12hrShift

    Why be a floor nurse when they don't care?

    in the last newsletter for our nursing unit it read that they will be removing chairs/terminals per "upper management and the expectation is that RNs should chart in patient rooms or in the "hallways" with very limited dedicated space for charting at a workstation...in a time where nurses are stressed, overworked, and facing so many challenges I am surprised Legacy Health, one of Oregon's largest hospital systems is doing this to their beloved RN heroes.... I guess we are not so respected and beloved...and I guess none of them have worked 12 hours straight running their tail off taking care of sick people and cannot realize the importance of focused charting and some time to rest our feet. Besides the reality that sick patients do not want an RN charting in their patient room for an extended period of time...when a nurse is in the room they expect you to be providing care not typing and disturbing them for over 5 minutes. Is this really true Upper Management? Is this what you want for your RNs and patients?