allnurses Magazine - Spring 2019

EMPOWERING. UNITING. ADVANCING.

Spring 2019

allnurses.com

PLUS:

The Future of Nursing: Reflections of a Nurse Educator

Why We Celebrate Nursing:

History Behind Nurses Week

Nurses Make a Difference: Memories of a Lifetime in Nursing Imagine a World Without Nurses

Liability Insurance Tailored For Nurses

$

Click to Visit

0 0 0 , 0 0 0 , 1 of protection only starting at

A program that focuses on what matters to you the most - PROTECTION. Protection you can count on.

1 0 2 per year

$

up to

25% lower than competitors!

Learn More NOW!

allnurses.com/products/3-affordable-medical-malpractice Spring 2019

allnurses

3

EMPOWERING. UNITING. ADVANCING.

Dave Smits

Mary Watts

Content & Community Director mary@allnurses.com

Gregg Knorn

Sales Director gregg@allnurses.com

Brian Sorenson

Marketing Director bsorenson@allnurses.com

Contents

Nursing: The Most Trusted Profession

By Melissa Mills

C.E.O.

30

Julie Bollinger

Business Operations Director admin@allnurses.com

Why We Celebrate Nursing: History Behind Nurses Week

Claudio Rassouli

Recruitment Marketing Director claudio@allnurses.com

Joe Velez

Technology Director joe@allnurses.com

40 By Brenda Johnson

The Future of Nursing: Reflections of a Nurse Educator

EDITORS / CONTRIBUTING WRITERS Mary Watts, BSN, RN Beth Hawkes, MSN, RN-BC Jennifer Collier, RN Joy Eastridge, BSN, RN, FCN Lane Therrell FNP-BC, MSN, RN Melissa Mills, RN, BSN, CCM, MHA Brenda Johnson Lorie Brown, RN, MN, JD Brian Sorenson

allnurses is published quarterly by allnurses.com, Inc., 7900 International Dr., Suite 300, Bloomington, MN 55425 All rights reserved. Reproduction in whole or part without written permission of the publisher is prohibited. The opinions of contributing writers to this publication do not necessarily reflect the views of allnurses.com, Inc. Copyright © 2019 by allnurses.com. All rights reserved.

Learn what it means to do what you love.

34 By Lane Therrell

Nurses Make a Difference: Memories of a Lifetime in Nursing

24 By Joy Eastridge

Imagine a World Without Nurses

Products featured within these pages do not constitute an endorsement by allnurses.com.

Working at Sharp isn’t just a job — it’s about waking up every day knowing you’ll make a difference.

San Diego’s largest and most comprehensive health care system

By Jennifer Collier 7900 International Drive, Suite 300 Bloomington, MN 55425 Phone: 612-816-8773 email: magazine@allnurses.com Website: allnurses.com

20

By Mary Watts

Find your next career at Sharp. https://jobs.allnurses.com/company/sharp-healthcare-0875

4

Spring 2019

allnurses

Most Memorable Moments from Nursing

16

Departments 6 Editor’s Note 9 Nursing News Briefs 12 The Best of...

13 Calendar 14 Career Tips 28 Trending Products 44 Get Social 45 LOL 46 Expert’s Corner

Editor’s Note This issue’s ‘from the editor’ column runs a bit longer than usual but don’t let its length put you off.

It does actually lead somewhere.

Read on as I tell the tale of the past month (or so) and how nurses made a difference…

Brian Sorenson

Editor, allnurses Magazine

Connect

allnursesrock allnursescom

It popped up during a routine exam. It was diagnosed as an irregular heartbeat. The doctor was concerned and scheduled a follow-up appointment with additional tests. During one of those tests the root of the problem was discovered – a hole in the mitral valve. I knew something was wrong because a call in the middle of the afternoon from my mom was out of the ordinary.

She told me the abridged version of everything that had taken place in the previous month which lead to getting me involved.

They were nervous and rightfully so. Having been in basically perfect health for his entire life, my dad is the kind of guy who simply doesn’t

stop. At nearly 80 years old, he starts each day around 5:00 AM by eating a healthy breakfast, catching up on the news as he sits in the dining room and shortly after sunrise heads outside to get the day moving with a mile-long walk. That walk, though, is hard for most people to keep up with. I struggled to keep up with him for the majority of my life and have only been able to keep up for the past ten or so years – and not just when it comes to walking. He’s a workhorse and doesn’t know how to slow down.

When my mom informed me of the upcoming surgical consultation at the rather well-known Mayo Clinic, I knew that her asking me to come along and drive them was her silently panicking. She was concerned. My dad – even at nearly 80 years old – still farms and until about 45 days ago had no intentions of stopping any time soon. That all came to a screeching halt in the afternoon after that surgical consultation. I knew that

allnurses @allnurses allnurses @allnurses

Contact us

We welcome your story ideas.

Reach us at magazine@allnurses.com

6

Spring 2019

allnurses

“Nurses are the heart of healthcare.”

– Donna Wilk Cardillo

they would have to do a considerable amount of driving in the coming month so their vehicle situation was certainly a priority.

With their reluctance to admit that a 20 year-old car and an even older truck had seen better days and at least one needed to be replaced, I nudged them into car shopping. Not exactly the kind of thing that is a top priority after hearing that the blood regurgitation was deemed “severe”, but some things just need to be dealt with. After nearly immediately settling on a car after a test drive, it was on to discuss the farm situation.

I made it known to my parents that my dad’s likelihood of farming in 2019 was slim. What if there were complications? What if recovery took longer than expected? I laid out two options; either I would put this year’s crops in or they talk to a neighbor and have a conversation about renting the farm.

In less than a week they had made their decision. Let’s just say that I won’t need to dust off my farming skills this year.

every day and there’s a reason that leaders from around the globe come to the Mayo Clinic. He was going to be in excellent hands. As the days progressed, I scheduled hotel rooms and helped iron out details and answer questions as best as I could.

Waking up far before sunrise on a rather warm Thursday morning, we walked across the street to the hospital. After being directed to another floor where the surgical unit is, I had my first encounter with the nurses of St. Mary’s Hospital. With them being used to working at such an early hour, they were extremely helpful, cheery and light-hearted. They are professionals both at healthcare and at sensing people’s moods and they were at the top of their games that morning.

The day after the consultation was another appointment. An angiogram confirmed the level of blood regurgitation via the hole in the mitral valve as well as a newly discovered partial blockage in one artery. Surgery would consist of the mitral valve being repaired and a They simply did their thing. They single bypass. After finding this out and placed IVs, did all of the typical tests talking with friends and neighbors in and asked tons of questions. A. LOT. the next couple days, I learned just how OF. QUESTIONS. My dad, being his common bypass surgery is. talkative self, replied to each and every Over the next ten or so days leading one of those questions with long form up to the quickly scheduled surgery, answers. As we sat in the smallish room, I reassured both of my parents that the nurses asked us questions as well. this was indeed a routine surgery. The To them, it’s all in a day’s work and their staff at the Mayo Clinic and St. Mary’s care and professionalism truly showed.

Hospital perform this type of surgery After 90 or so minutes, the team of

nurses wheeled my dad out of that room and down the hall to do more prep for surgery.

My mom, her brother and myself were shown to the waiting room that would be our new home for the day. Between breaks to eat meals, catch up on some work and read a book I had purchased to pass the time on that day; we stayed up to date via the television screen which updated the surgery’s progress.

We were also updated by the nurse communicator (at least I believe that was her title) throughout the day.

By late in the afternoon, my dad had been moved to the ICU. With the information packets handed out by Mayo Clinic staff as well as the discussions with both the surgeon and a few of the nurses, my mom had been briefed on what to expect. She told me that there would be tubes, wires, sensors, and a lot of machines. None of this was a shock to me. I was more impressed than anything when we arrived at his room in the ICU. The nurse who would be taking care of my dad and monitoring his progress – Glen – was amazing. He had worked as a nurse for over 25 years. He talked us through most of what he was doing.

Spring 2019

allnurses

7

Nursing News Briefs Administering various fluids and medicines and talking about an upcoming conference which he was attending. He was a one-man healthcare machine.

When Glen took his break, Jesus was briefed on everything and took over.

Jesus was just as calming, comforting and knowledgeable as Glen. Jesus mentioned that he routinely walked the five minutes to work and that his roommates were nurses as well. After nearly three hours of waiting, my dad’s heart rate was brought up to an acceptable level. After a few false starts, he came out of the anesthesia. Having never had anesthesia in his lifetime, it took over five hours after the conclusion of surgery for him to come to. With my dad awake, Glen informed us that he would be essentially dialing down the work that the ventilator was doing and in fifteen minutes the breathing tube would be coming out.

Fifteen minutes later, another amazing team arrived to remove the breathing tube. Mere minutes later, we walked back into the room where my still groggy but now hoarse dad began to look around. The first words out of his

mouth centered around his tractors, if my mom had been taking care of them well and when he could get back behind the wheel and get back to work. The nurse, Glen, had a good laugh about that being that we had explained that my dad had been farming for around 60 years in one way or another.

With plenty of additional information – the biggest being that he would likely be out of the ICU before noon the following day – it was time for me to make my way home. I had two things on my mind – how amazing the nurses had been during what was clearly a trying day for my parents and where I was going to find something decent to eat in what was essentially the middle of nowhere after I had hurriedly made my way out of Rochester, MN. I knew then – after I had reassured my mom that the biggest of her worries should be behind her – that my dad was in an excellent place and would be back to his old self in no time. That was confirmed as I returned a few days later with the family in tow to visit him in the hospital. He was walking (with assistance) and back to his familiar way

of talking and digging into his go-to conversation topics.

I have friends who are nurses. I work with nurses. After the past month, I have a newfound appreciation for nurses. The way that they can calm a situation is impressive. Nurses seem to seemingly have a sixth sense in knowing that the family member and patients alike are often nervous. The way that nurses explain things in a way that nearly everyone can digest is both helpful and reassuring.

No matter where you are at in your life, you’ve likely crossed paths with a nurse who has changed your life in one way or another. I know that my family certainly met many nurses who made a difference in the past month. It may have been something rather small that you didn’t notice or it could have been something as significant as what I recently witnessed. No matter how seemingly insignificant those gestures are, nurses make a difference. So, nurses, take a moment and remember that your work doesn’t go unnoticed.

Kate Middleton Shares a New Connection with Game of Thrones’ Emilia Clarke – for a Special Cause!

So what do Kate Middleton, the Duchess of Cambridge and Emilia Clarke, the Mother of Dragons have in common?

Well, they are both supporters of Britain’s Nursing Now campaign. This is an organized program aimed at developing new models of community-based care and supporting local efforts to promote health and prevent disease. It is based on the Triple Impact study from 2015. Their goal was universal healthcare coverage for the entire world. The Triple Impact encompasses nursing as the center of healthcare, surrounded by improved health, stronger economies, and greater gender equality.

Read more

Thank you, Nurses!

Register for Nurses Week giveaways now at allnurses.com!

8

Spring 2019

allnurses

Spring 2019

allnurses

9

Nursing News Briefs

2019 Top 10 List of Patient Safety Concerns The Top 10 List of Patient Safety Concerns has been published by ECRI (formerly the Emergency Care Research Institute). Not surprisingly, testing and results top the list. Burnout is also addressed as an important safety concern listed by patients. With the increasing size of healthcare systems it is equally important to have transparency and standardized safety protocols across the entire system.

Read more

The future of nursing report: where are we now?

The Future of Nursing Report was released in 2010. In response to this report, the Robert Wood Johnson Foundation, AARP, and the AARP Foundation joined forces to create Future of Nursing: Campaign for Action. One of the goals was to have at least 80% of nurses holding a BSN by 2020. This goal is unlikely but the number has increased. A second goal was to double the number of doctorally prepared nurses by 2020 and this was achieved by 2017. Full practice authority for APRNs was yet another goal that still needs to be achieved.

Read more

Is home genetic testing right for you?

It’s becoming increasingly more popular for people to do home DNA genetic testing. Many reasons account for this with one of the major ones being the discovery of your personal risk for a disease.

Direct to consumer DNA testing

The popularity of direct to consumer or DTC genetic testing is surging, “with the global market valued at more than $70 million in 2015, according to one report; that’s up from roughly $50 million in 2014.

One company, 23andMe, has even gained Food and Drug Administration approval to provide information regarding whether you’re a genetic carrier for some disorders, including sickle cell anemia.”

Should you invest in a DTC genetic test?

Or go to your medical provider?

Curiosity or concern for the possi-

10 Spring 2019

allnurses

bility of a certain disease are two of the most frequently used reasons to pursue DTC genetic testing? However, should you go to your medical provider instead? Medically ordered genetic testing does come with some advantages: • Quality assurance • Medically provided guidance as to your risk factors • Once results are available, you have more medical guidance as to the importance of the results • Privacy regarding results • Some of the advantages of DTC genetic testing: • Cheaper than medically ordered testing • Can be done in your own home • Faster results However, what is done with the results? Medically ordered genetic testing is covered by HIPAA. So, what about DTC testing? “The Genetic Information Nondiscrimination Act

(GINA) was signed into law on May 21, 2008, and became fully effective November 21, 2009. GINA prohibits discrimination by health insurance companies and employers based on “genetic information.” In this case, “genetic information” is defined as: your genetic test results; your relatives’ genetic test results (up to and including fourth-degree relatives); and/ or information about family history of any disease or disorder. Information about your participation in research that includes genetic testing, counseling, or education is also protected.”

What’s in the future?

The future is wide open to developing more DTC genetic testing as more and more companies jump on the wagon of people making their own decisions about genetic testing. Is it right for you?

Read more

Spring 2019

allnurses

11

The Best of allnurses.com

Calendar of Events

Each quarter, hundreds of amazing articles are published on allnurses.com, below are those deemed the best by our readers!

A brief and informative overview of events, conferences and special promotions for the nursing community.

CEO Says More Nurses Won’t Improve Care

Illinois is poised to adopt safe staffing ratios even as a hospital CEO publicly puts profits before patients. Mark Gridley, CEO of FHN Memorial, thinks fewer nurses are better and claims that Illinois already has optimal staffing levels of registered nurses.

Curiosity Killed the Cat and Got 50 Hospital Employees Fired

At Chicago’s Northwestern Hospital, Jussie Smollett, an actor from the TV series “Empire,” was admitted after he was physically attacked. According to reports, he suffered bruises and facial lacerations.

RaDonda Vaught’s Arraignment - Guilty or Not of Reckless Homicide and Patient Abuse?

By now, most nurses have heard about RaDonda Vaught, a former Vanderbilt University Medical Center nurse who was charged with reckless homicide and patient abuse as a result of administering the wrong drug that killed a patient in December 2017. Many nurses showed their support by being present at the arraignment.

Video coverage by Show Me Your Stethoscope founder, Janie Harvey Garner captures some of the day’s activities.

Nurse Charged With Homicide

Should Radonda Vaught, the nurse who gave a lethal dose of Vecuronium to a patient at Vanderbilt University Medical Center, be charged with reckless homicide?

MAY

6

MAY

14

Nurses Week May 6-12, 2019

18

American College of Nurse-Midwives (ACNM) Annual Meeting & Exhibition

Atlanta, GA JUNE

18

MAY

20

National Teaching Institute & Critical Care Exposition

Indianapolis, IN JUNE

23

JUNE

2

American Holistic Nurses Association (AHNA) Conference

2019 Wound, Ostomy and Continence Nurses Society (WOCNext) June 23-26, 2019 Nashville, TN

May 20-23, 2019

Ageism in Nursing

American Association of Nurse Practitioners (AANP) 2019 National Conference June 18-23. 2019

May 18-22, 2019 Washington D.C.

Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) Convention June 8-12, 2019

May 14-17, 2019

Orlando, FL We are so accustomed to ageism in our society that it’s not always recognized for what it is- prejudice and discrimination. Aging is a normal process of living and is experienced differently by everyone. Aging is not a choice, but ageism is.

8

National Conference for Nurse Practitioners Chicago, IL

MAY

JUNE

JULY

11

2019 Primary Care Focus Symposium 18th Annual July 11-14 Naples, FL

June 2-6, 2019 Tulsa, OK

12 Spring 2019

allnurses

Spring 2019

allnurses

13

Career Tips

Click here to Download the

Career Dilemma: Outpatient Setting – Will I like it or not?

by Beth Hawkes MSN, RN-BC, HACP

Beth Hawkes (Nurse Beth) is an accomplished nurse working in Acute Care as a Staff Development Professional Specialist.

She is also an accomplished author, blogger and columnist.

As Nurse Beth, she regularly answers career-related questions at allnurses.com.

Dear Nurse Beth, I have a dilemma regarding a position which I have just been offered. I have been a nurse for 20 years at a hospital setting. However, I was searching for an outpatient setting and finally found one at a nearby facility. My dilemma is I don’t know whether I will like the job or not. It is 5 days a week, no holidays or weekends.

And I was used to 12-hour shifts, and the off days in between, but the hectic bedside work was too much for me. If I don’t like the outpatient setting can I go back to bedside 12-hour shift? Would it be difficult to transition back?

Click here to submit your career-related question to Nurse Beth today or visit https://allnurses.wufoo.com/ forms/z1j8p9o81puszdb/

How long should I wait before I know whether I like my new job or not? Looking for your response. Thanks.

Dear Dilemma, Congrats on your job offer!

It’s natural to have concerns when changing jobs.

Eight-hour shifts will fly by for you since you’re used to working 12’s. It will take a while to get used to working Monday through Friday,

FREE e-book NOW!

because you may feel you’ve lost some “me” time during the week. Instead of easily making your personal appointments on your days off, you’ll be fitting them in around your 8 hour days. Then again, this is what most working people do.

You’ll be joining the majority of workers who are off on weekends and holidays. You may enjoy actually being in sync with the rest of the world.

Working 12-hour shifts at the bedside has a relatively short life span and much as many of us love it, there’s a time to move on. You are wise to make this transition at the 20-year point, rather than waiting until the point of injury or illness.

It takes time to adjust.

Expect to go through a grieving process when you leave the inpatient setting.

Depending on your new job, you may be giving up some patient contact, challenging practice situations, and skills.

You can always change your mind, but give yourself several months, at least, as you will feel differently as time goes on.

Best wishes, Nurse Beth Author, “Your Last Nursing Class: How to Land Your First Nursing Job”...and your next!

14 Spring 2019

allnurses

10 TIPS

TO HELP YOU LAND THAT COVETED NURSING JOB

Insider Tips Teach You How To: • Nail Your Interview • Write a Compelling Cover Letter • Compose a Remarkable Resume

...all intended to make you a memorable candidate... even if you are a new grad!

Your Credit Card Won’t Be Charged! brought to you by

written by

Nurse Beth

Spring 2019

allnurses

15

e l b a r o m e M

Nursing Career Moments

Whether you are just beginning your nursing career or you have years of experience, all nurses have those moments, good and bad, they will never forget. These moments made an impact on us as they are etched into our memory bank and woven into the colorful tapestry that defines our nursing career.

Nurses are the core of healthcare. We touch so many lives in ways we might never imagine. When we look back over the years, we can see the faces of those whose lives and deaths have touched us. Not only are we the most trusted occupation but I dare say we are among the most compassionate and caring professionals that have the privilege and opportunity to touch many lives in some of life’s most vulnerable moments.

A Beautiful Tapestry of Memories

I saw this quote by Donna Cardillo several years ago that has stuck with me: “When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don’t remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me and those threads make up the beautiful tapestry in my mind that is my career in nursing.”

– Donna Wilk Cardillo “What is one of the most memorable moments in your nursing career?”

The allnurses readers were asked to share their experiences related to the question, “What is one of the most memorable moments in your nursing career?” This could be something you witnessed or that you were directly involved in. How did this event affect you? What changes, if any did you make in your actions or thinking?

Here is a sampling of what our readers shared: Spring 2019

allnurses

17

Memories

Memories

Memories

18 Spring 2019

I remember a patient we had on our Oncology unit. She had breast cancer and was in/out because of complications related to her chemo/radiation treatments. One of those that whatever can go wrong did! We all felt sympathy for her and did our best to care for her when she came in. I happened to be her nurse one day when she was admitted. I knew her entire story (from the beginning of diagnosis until now about 1 year in) because I also did charge and therefore heard most reports even if not my patient. She was in bed and I was starting admission paperwork etc. Then came time to assess her wound (which is the primary reason she was admitted). So after obtaining some info, I asked if I could assess the wound, did she need pain meds first, etc. She gave permission and moved her hands that were placed over her chest on top of the saturated dressings. I removed these dressings to find that her entire chest was one large cavity. Because of the copious drainage, she had placed 2 medium sized baby diapers along with various gauze pads into the chest wound/cavity. I started removing these and of course, they were also foul smelling (because of the malignant wound and infection). I just kept taking these out while asking how she was doing. Next thing I know she raises her hand to my face (hand still dirty with wound drainage) while thanking me and telling me how thoughtful and caring I have always been to her. Instinctively I jerked back a little but then stopped just as fast. In that very moment my humanity and empathy kicked in and I just could not bring myself to offend her in that way. I let her touch my face, thanked her for the compliment and just kept cleaning the wound until completed. I finished my work and did not hurry out, but as soon as I was done I did go wash my face. Even though this happened many years ago it stays with me for different reasons. She was a very strong person who just kept going forward no matter what the situation, not feeling sorry for herself but accepting her fate even while fighting to the best of her ability. And also because it reminds me that people need our humanity and empathy, not just our sympathy. It is always harder for us to put ourselves out there and feel empathy but it can make all the difference to our patients when we are able to do that. That incident, although not planned at the time, has helped me be more mindful in those moments that I am able to make a difference for someone.

Daisy4RN Most memorable moment? Performing a surgical cricothyrotomy in the back of an ambulance in the middle of the desert as a flight nurse. The patient had been joyriding on a motorcycle through the desert in the middle of the night and the passenger on the back did not survive. We flew to the nearest trauma center where the patient eventually walked out the doors from. It reminded me of how fragile life is and how honored I am to be able to do what I do!

Tomsgirl42

One for me was a woman admitted from hospice at home for increasing respiratory distress.

She just could not get enough air. We had her on bipap and respiratory treatments. Family including her daughter were there. The patient was too ill to make any requests, but the daughter was constantly asking for things and changing her mind (more respiratory treatments, repositioning, medications, etc). She was very distressed. Eventually, the patient died and the daughter told me she appreciated the care we were giving her and reminded me that this was the day her mother died.

I know that losing one’s mother is heart-wrenching for many people, but that daughter was able to articulate it very clearly. This situation reminded me of the need for empathy, and truly the reason I chose to become a nurse.

CalicoKitty, BSN, RN allnurses

Worst day

22 patients blown up when their bus hit an IED in Afghanistan. The most critical came through my two trauma bays and a few went directly to the OR (about 20 steps from the trauma area). Two badly injured young children, brother and sister, with head injuries. They were both my patients and I resuscitated them successfully until we could get them out of our tiny facility. I heard later that the receiving Afghan hospital just put them in a corner and let them die. Poor babies. They just didn’t have the means to deal with their head traumas.

Memories

Best moment

Successfully advocating for a patient to get them transferred to an appropriate level of care to diagnose the rather subtle stroke that I knew was happening (stubborn physicians). Finding out I was right and the patient got what was needed for an optimal outcome. Two years later after being gone from that ER for a while, hearing that the patient’s spouse said that I was the only good thing that happened to them that day (a friend took care of the spouse in my old ER when the spouse was rather ill, and she told me this). I realized that we really do leave a mark on some patients’ lives.

Pixie.RN, MSN, RN, EMT-P

As an on-call hospice nurse on 2nd and 3rd shift, I often went to patient’s homes when they were having extreme pain, agitation, or other symptom management issues. One night I was called to the home of a 40-something woman who had fought a hard fight with breast cancer. Her family had filled almost every space in the house and was offering the best care you can imagine. Her mom greeted me at the door to let me know what the concerns were and how she was doing since we spoke on the phone. I went to the bedside to find her two young children lying in bed with her. She was minimally responsive, and at first glance, I knew she was getting close to the end of life.

Memories

I did a thorough assessment to confirm what my gut told me. Then I sat down with the adults in the family to discuss what she wanted and needed at this point. Next, I sat on the floor with her children and talked to them about what their mom was going through.

As a young mom myself at the time, my heart was breaking and aching with every word I told this family.

I stayed with them for many hours and started care that would keep a nurse at her bedside until she passed. I ended up back there for the next 3 days and had the honor to be with her when she took her last breath.

This family welcomed me into one of the hardest moments of their lives. While I was breaking inside, I worked with compassion and cared like never before because I could see my children and me in that bed since the first night.

After her death, I received a letter about how much my care meant to them. What they didn’t understand was how much they blessed my life during one of the most challenging time of theirs.

Melissa Mills, BSN

Tap to read more and share your story Spring 2019

allnurses

19

It takes only a brief reflection to imagine a world without nurses when you consider the profession’s contribution to society. Nurses are a constant in meeting the health needs of individuals from birth to end of life. What a different world it would be without nurses guiding and advocating for us through the always changing healthcare environment.

H

20 Spring 2019

allnurses

Imagine a World Without Nurses...

ave you ever tried to imagine what the modern world would be like without the nursing profession? Nurses play a continuous role in the life of a single patient, a family, a community, a region, nationally and worldwide. How would our most vulnerable populations navigate the always changing and complex healthcare system to receive necessary care? In 2018, the Gallup poll ranked nursing as the most trusted and ethical profession for the sixteenth consecutive year. Nurses are a trusted constant in healthcare. Nursing also has a long history of contributions to the health, social and economic wellbeing of the populations they serve. In order to imagine a world without nurses, it first necessary to recognize just how important many contributions the nursing profession has made to society.

Contribution: Communication

“Nursing encompasses an art, a humanistic orientation, a feeling for the value of the individual, and an intuitive sense of ethics, and of the appropriateness of action taken.” - Myrtle Aydelotte (nurse, professor, and hospital administrator) The nursing process is a scientific method for the implementation of nursing care. However, interpersonal skills and communication is also a vital element of nursing practice. Nurses’ ability to communicate with patients is just as important to successful outcomes as technical ability. Effective communication

is a contribution made by the nursing profession that promotes care ranging from individual care to healthcare policy. Nurses contribute by truly listening to the needs, fears, concerns, thoughts, and feelings of others. Maintaining good personal relationships allow the nurse to ask questions in a way that does not judge or scare, but rather, promote trust and acceptance.

It is a true gift when nurses connect with individuals of all cultural and socioeconomic backgrounds with the same level of sincerity.

Contribution: Collaboration and Coordination

“In proportion as my own discomfort has increased, my conviction of necessity to search into the wants of the friendless and afflicted has deepened. If I am cold, they too are cold; if I am weary, they are distressed; If I am alone, they are abandoned.” - Dorothea Dix (author, teacher, and reformer) The nursing profession is

Jennifer Collier RN

Jennifer Collier is a nurse and earned a master’s degree in rural nurse case management.

In her 24 year nursing degree, Jane has had the privilege in working in diverse areas of nursing ranging from bedside nursing to leadership. After a personal challenge in 2016, Jane began writing as a way to share her story as a way to help other nurses. Writing on nursing topics has been a great next step in her career.

Spring 2019

allnurses

21

safe and effective care. It would be difficult for nurses to contribute to a growing a body of skill and knowledge without the desire for continued professional and educational development.

out the influence of nurses. It is not difficult to identify the unique contribution the nursing profession will bring to these real-time healthcare trends:

Addressing the opioid crisis

Contribution: Empathy

• Importance of the patient experience in a value-based payment system

“As a nurse, we have the opportunity to heal the heart, mind, soul, and body of our patients, their families and ourselves. They may forget your name, but they will never forget how you made them feel”. – Maya Angelou (American poet)

• Changing nursing workforce (generational communication challenges, borderless nursing) • Rising cost of specialty drugs • Technological advances- wearable sensors and biometric garments These trends represent only a small sample of constant change within healthcare. Nurses will consistently advocate for education, access to resources, collaboration and continuous improvement to improve individual health in today’s healthcare environment.

Contribution: Explanation

“Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion” - Florence Nightingale (founder of modern nursing) unique in providing continuity of care from hospital to home and all other settings of healthcare. Nurses are a “constant” in healthcare and participate in care from birth to end of life. The collaboration and coordination of healthcare services is an important contribution of modern nursing. Nurses collaborate and work together with other disciplines to provide the best care to patients. Nursing curriculum incorporates the required education, scope of practice and areas of expertise in other disciplines. Nurses advocate for their patients by using the resources and knowledge provided by disciplines outside of nursing.

Current healthcare trends bring added challenges to care coordination and it is easy to imagine chaos with-

22 Spring 2019

allnurses

Anxiety and fear are common in any setting where someone is receiving healthcare. First, there is the fear of medical assessments, diagnosis, and treatment. Fear and anxiety have negative health consequences as well as negative patient experiences. The “white coat” phenomenon is an example of interaction with a healthcare setting or providers increases a person’s blood pressure above their baseline. Hospitalized patients experience restrictions placed on their personal freedom, mobility, and choice. In a world without nurses, patient fear and discomfort would contribute to negative physical and emotional outcomes. Nurses reduce the “fear of the unknown” through explanation and education. With respect and empathy, nurses are in a unique position to reduce patient fear and discomfort through anticipatory guidance.

Contribution: Education

“Nursing’s story is a magnificent epic of service to mankind. It is about people: how they are born, and live and die; in health and in sickness; in joy and in sorrow.

Its mission is the translation of knowledge into human service. Nursing is a compassionate concern for human beings. It is the heart that understands and the hand that soothes. it is the intellect that synthesizes many learnings into meaningful administrations.” -Professor Martha Rogers Nursing as a profession has a clear pathway for nursing education. There have been many historical nursing figures to contribute to the knowledge and skill of nursing.

In 1874, Linda Richards became the first trained nurse and eventually became the superintendent of Boston Training School. Lavinia Dock (1890) published the first manual of drugs for nursing and in 1978 Bertha Harmer published the first scholarly nursing textbook, Principles and Practice of Nursing. Over the years, nursing education has provided students with standardized programs of study. As a result nursing students enter the profession with the practical knowledge to deliver

Empathy does not always come naturally to all nurses. The ability to put themselves in another’s shoes by seeing situations from another’s perspective is developed with life experience. Nurses play an important role in listening to patients and families and validating their experience. Without nurses modeling empathetic behaviors, the art of connecting those receiving care would be diminished. Nurses also model the ability to relieve suffering through compassion. The ability to show kindness, caring and willingness to help others is one of nursing’s greatest contributions.

Final Thoughts

“Unless we are making progress in our nursing every year, every month, every week, take my word for it- we are going back.” - Florence Nightingale, (founder of modern nursing) This article speaks to only a few of the many invaluable contributions nurses have made and continue to make in healthcare today. Nurses are a constant in the delivery of care from birth through end of life. Nurses have a unique opportunity to advocate for access and equality of healthcare by involvement in the legislative process.

The profession of nursing makes progress every day and without a world of nursing, we would move backward in the health of individuals, communities and the world.

Without nurses at the helm, navigating healthcare would be much like a ship in stormy waters without a lighthouse.

Spring 2019

allnurses

23

“What do you want to be when you grow up?”

The standard question from grown-ups to kids always elicited the same response from me, starting at age 4, “A nurse!” I liked to take care of my younger brother and he cooperated with my schemes in make-believe which meant he sometimes had to drink whatever “medicine” I came up with and submit to a variety of bandages made from scarves or my mother’s sewing scraps.

Nurses Make a Difference:

Memories of a Lifetime in Nursing

by Joy Eastridge BSN, RN, FCN, Certified Lay Minister Parish Nurse United Methodist Church Joy is a Faith Community Nurse who also enjoys writing. Besides nursing articles, she works on Bible Studies and has recently published a children’s book, Bennie Goes Up! Up! Up! as her way to connect with children, especially her young grandchildren. As a long time nurse, Joy has been privileged to work in a variety of settings in nursing including hospice, medical office work and home health.

24 Spring 2019

allnurses

Over time, I became an avid reader and enjoyed adolescent fiction about nurses as well as biographies of Florence Nightingale and Clara Barton. In high school I started reading nursing journals that a nurse friend shared with me and took all the science classes my tiny high school could offer, begging our teacher for independent study so I could learn more about biology.

The idealized version of nursing that made up my early dreams gave way to reality as I launched into the true study of nursing and put in all the long hours to make my goal a reality. It was harder than I had anticipated, and I had to study hard to make it happen and to pass the terror of the boards. While in school, I started working as a nursing assistant in a children’s hospital and as a personal assistant to a handicapped student.

All of this gave me a little taste of what would become a lifelong vocation—helping others and working to provide healing or comfort any way that I could.

My formation as an RN, a Real Nurse, started small, with the little ones in pediatrics and went on from there.

I remember how hard those first few months of night

shifts were. As a charge nurse on a pediatric ward, I struggled to learn and to be a professional, quickly realizing that this job might not have been the best choice for someone just learning the ropes of the profession. I didn’t know how much I didn’t know. I don’t remember doing a lot of great things during that year—in fact, it was really a divine grace that I didn’t make some egregious mistake! The memories of that time flash by in black and white like a dim slide show: the child with asthma who nearly arrested before I could get the resident to come, the toddler who was a “failure to thrive” for whom I bought a small toy, the angry mother that didn’t like my attitude, the commute to the downtown hospital late at night, the wards with 8 kids each…

From peds I found a different calling with adults on a general medical/surgical floor. There I learned to balance time demands and prioritize my work, honing the skills needed to be efficient, and cramming my brain with some of the more practical knowledge that doesn’t always get included in the general nursing curriculum.

The slide show continues, picking up more hues as it moves forward through time: the man bleeding out that I transferred to the ICU in a big hurry (and I ran over someone’s toe with the bed on the way—and no, they didn’t get seriously injured but I was horrified!); my first time doing CPR and feeling the elderly lady’s ribs cracking under the pressure of my wrists and then the tears later in the locker room; being asked to teach a group of peers about acid/base levels in a staff meeting—all of these blend to make a picture of years that added up to a satisfying experience and made me much more compe-

Spring 2019

allnurses

25

tent as the RN I longed to be.

The step into home health in a backwoods town in Tennessee brought me out of the hospital and into living rooms. Pulling from past experiences, I was able to build higher on that wall of competence, again starting at foundational principles and learning from others as well as from my own interest. The interactions with people in their own settings brought with it the realization that the patients are ultimately in control of their own bodies and their own decisions and it was my job to help them have the tools they needed to maximize their own goals for health. This ability to see the limits of my own interventional care brought a new dimension to nursing and gave me a greater respect for my own limits and the boundaries between medical care and the individual’s choice. In the hospital setting, it was so much murkier as patients submitted (mostly) to what

the doctor prescribed and adopted a more passive role of recipient, blending back into the whiteness of their crisp pillowcases with resignation. At home, even the very ill patients were more likely to express themselves, to be comfortable in their own choices and to challenge the edicts handed down by medical staff. Over the years of traveling through t the hills and hollows of mountain villages, the slide show becomes brighter, clearer but also holds the shadows of difficult days replete with defeat: the elderly man in the overalls, living in a hermit’s cabin, legs swollen with cellulitis, stasis ulcers draining, who proudly proclaimed, “I ain’t movin’” and pointed to a shotgun to emphasize his statement; the bed bound

26 Spring 2019

allnurses

woman whose bed sat smack dab in the middle of the living room as family members rotated sleep so they could keep her turned in a timely fashion; the mouse that ran under my legs while I sat perched on the edge of a dirty couch causing me to leap up in a most unprofessional way; the edentulous woman, mouth stuffed with snuff who unexpectedly sneezed—I had to change uniforms!

The attraction to hospice nursing should have been clear from the beginning but didn’t come into stark relief until a beloved sister-in-law lay dying at a hospice house from the ravages of ovarian cancer. I admired the care, consumed the comfort greedily and promised myself that as soon as I could, I would pursue this new passion. Hospice nursing also took me out and about and again placed me squarely in the center of the patient’s own domain. Clearly, in rounding the bend and heading toward home, the patient and their family were firmly planted in the driver’s seat and I sat behind, offering simple suggestions to help make the way less confusing and to shine a small light on the path ahead. I learned a lot about the blessing of using my skills quietly and respectfully, always trying to be aware of who was really in charge and fitting in without imposing my will.

My knowledge and skill set continued to expand as the dying required creative and caring solutions to all the myriad ways the body can break down at the end of life. Defeat was not an option, and working with the team at hospice, we worked hard to circumvent the impossible and to find a way toward our ultimate goal which often included making the passing as easy and as peaceful as possible.

In this new setting I learned the truth of the maxim: “People don’t care how much you know until they know how much you care.” (attributed to T. Roosevelt). My technical knowledge and nursing skills were all tested and tried and sharpened but the “soft” nursing skills grew even more as I learned to communicate better, to “read” the situation in the room, to help patients and family move to a new place in their view of their situation. In this expanded nursing theater where life and death live intertwined and the distance between them grows smaller, I learned to respect the limits of my skills

and to understand that sometimes the gift of presence was all I could offer. Coming to the end of myself as a nurse gave birth to a more profound respect for my work and my colleagues. The team approach of hospice helped me to broaden my horizons and see up close and personal how the social workers, aides, chaplains and physicians all worked in a fine concert to play the music the patient wanted played, as they directed the symphony from their place on the bed or the couch or the front porch. As nursing butted up against the hard wall of death, I found myself with renewed courage to face the unknown and to help others prepare for that same encounter someday.

The slide show from the years in hospice is bright with the edges tinged dark from the sadness of loss as patients transitioned on from us to their next stop: the elderly couple who held hands and looked with longing into each others’ eyes; the young man surrounded by his boisterous friends who slipped away peacefully right in the middle of their conversation, surprising us all; the humor of knocking on the door of the wrong “yellow house on the left” and announcing that I was the hospice nurse; the occasional families whose motivations and possible drug diversion made our jobs difficult; watching youtube videos in the car to refresh my skills in changing specialized dressings; the long drives following GPS instructions into rutted roads that gave way to dilapidated, thrown-thrown-together houses with a dozen dogs; the sometimes angry family who saw us not as angels of mercy but harbingers of death; the exhaustion of caregivers etched with stark clarity on pale faces that mixed resignation with relief and grief.

Faith Community Nursing was simply a logical next step, blending those carefully practiced assessment, teaching and leadership skills into a position of trust within the staff of my local church. Over the years, things have changed as the moniker Parish Nursing has given way to the more inclusive “Faith Community Nursing” but the work itself has remained unaltered.

Being an FCN is a natural morphing for a nurse who sees the intersection of life and death as not an endpoint but as a transition and as such, a call for us all to do what we can to make the most of every day on this side, living well in the body we have for now. As an FCN, I work to help people maximize health through interpersonal relationships, increased activity, medication management and mobility protection. Assessing, teaching, visiting, planning, coordinating all come together as a lifetime of nursing experience coalesces into work that uses all the collected ingredients to make a work of nursing art, not perfect to be sure, but blended nicely and resulting in a worthwhile final product.

Here, the slideshow glows with the brightness of an updated powerpoint: opening the door of an independent living to see an elderly man with a rapid respiratory rate and probable pneumonia and getting him to the hospital; teaching CPR through fatigue; organizing a group walk/hike; participating in advance care planning by teaching about “5 Wishes;” helping coordinate volunteers to visit the homebound and let me know of any needs; working to organize food delivery to those experiencing times of illness or grief.

The beauty of a career in nursing is the variety that is possible. Every experience, every position, every shift brings new insights and learning. As nurses, we walk through the department store of experiences and fill our buggies with patient encounters that help shape us, with responsibilities that stretch and grow us, and eventually with the wisdom to practice our profession well, becoming a credit to our peers. As we all take stock of our practice and celebrate the nursing profession, let us encourage each other along the way: it won’t all be good, but through perseverance our slideshow of memories can be bright.

Spring 2019

allnurses

27

Hot Products

Simplify Life with these Hot Products Check out these innovative products then click over to allnurses.com/products to learn more...

Picmonic for Nursing

Are you stressed, overwhelmed and tired from struggling to keep up with your assigned reading and then retain the massive amounts of information you are learning? Wouldn’t you rather watch some funny cartoons and start getting A’s? Now you can ace your classes, exams, and the NCLEX® with Picmonic, the most efficient way to remember everything! Picmonic is a picture-based, audiovisual and quiz learning tool that simplifies test prep.

GLOVY™ Patient Safety Device The GLOVY™ Patient Safety Device, invented by a Vascular Surgeon, is a non-restraining device that prevents removal of pulse oximeters, IVs, PICC lines, catheters, dressings, etc., while maintaining patient dignity and freedom of movement.

Click to learn more... https://allnurses.com/products/ medical/glovy-patient-safety/

Click to learn more...https://allnurses.com/products/ tech/picmonic-nursing-r180/

12.00-$­96.00

$

Changing Behavior - Immediately Transform Your Relationships with Easy to Learn, Proven Communication Skills

Changing Behavior - Immediately Transform Your Relationships with Easy to Learn, Proven Communication Skills is the first-ever guide to provide simple, proven strategies to facilitate lasting change and to experience new levels of fulfillment, collaboration or intimacy. It is written for all individuals, from all walks of life, so they may experience more fulfilling, longer lasting relationships. Hospital study tested since 1980 Click to learn more... https://allnurses.com/products/books/changing-behavior-immediately-transform-r176/

6.00-$­11.00

Nurse Coach Track by the National Institute of Whole Health

Are you a certified nurse coach? Frustrated by the limitations of your coaching credentials? You can transform your ability to do the work you love with the National Institute of Whole Health’s (NIWH) Nurse Coach Track that provides you with the additional scope of practice and training to educate and advocate for your clients. This is a post-professional training for secondary provider status as a Patient Health Educator.

Click to learn more... https://allnurses.com/products/ services/nurse-coach-track-national-institute-r175/

4,495.00

$

$

28 Spring 2019

allnurses

Spring 2019

allnurses

29

Nursing: The Most Trusted Profession

Think of one patient who changed your nursing career. Was it a baby who fought their way into this world or an elderly person at the end of life? Maybe it was a child who fought during a battle with cancer or the young mother and father who sat next to their bed night after night. We each have a story of someone who changed our professional lives for the better.

However, many people around the globe would argue that the more important part of this story is how your actions made the patient and their family feel. When they left the hospital or clinic, or you discharged them the agency, they likely never forgot your name or what you looked like. Your compassion and care created a bond in the center of your professional relationship. This bond is known as trust.

For the 17th consecutive year, nursing was named the most trusted profession by the annual Gallup poll. More than 4 of every 5 Americans rated the honesty and ethical standards of nurses as “very high” or “high.” Nursing was added to the poll in 1999 and has been at the top of the list every year except 2001 when firefighters won the vote just after the 9/11 terrorist attacks. While

it might be easy for you to understand why your profession is number one year after year, it’s essential we take a deep dive into the reasons you and your colleagues are thought of so highly by the public.

Understanding the Meaning of Trust

We can’t discuss the reasons nursing has outpaced all other professions unless we know what being trusted means. Trust is a belief in the truth, strength, and ability of others. It is formed during a relationship between two people. You can’t demand or expect it from the other person. It is created by your actions and words. It bubbles up when you tell someone that you will be there, take care of them, educate them, or support them and then follow through on that promise. Ethics and honesty

by Melissa Mills RN, BSN, CCM, MHA

Melissa is a Quality Assurance Nurse, professor, writer, and business owner.

She enjoys empowering other nurses to find their passions and create a unique nursing career that fits their passions, desires, and gifts. She is owner of www.makingspace.company, a website dedicated to helping women find their creative passions through writing and co-owner of enursingresources.com, a start-up Nursing CE company that will offer online courses soon.

are pivotal factors in trust.

Why are Nurses the Most Trusted?

As nursing continues to be at the top of the list on the annual poll, experts are starting to wonder why. There are several theories. Here are a few of the reasons why nurses are trusted by people across the country.

Level of Intimacy in the Relationship

Patients stand before their nurses naked (literally and figuratively) day after day. You help with elimination problems, care for them after surgeries or injuries, and listen as they tell you about their fears, failures, and battles. Your empathetic heart gives patients the confidence to tell you things they may have never shared with friends or family before.

According to a 2007 study on clinical intimacy in nursing practice, the connectedness in the nurse-patient relationship must be achieved practically and predictably way within the difficult constraints of the practice environment. It must be distinct from empathy in both concept and practice. The therapeutic nurse-patient relationship must be built on mutual trust, have shared meaning, and a strong sense of understanding.

Female-dominated

A 2010 study published in Time reported that people perceived women to lie less than men. They also think of the type of lies told by the two sexes differently. The interesting thing is that men and women both admit to not telling the truth about 20-35 percent of the time during social interactions. Even though people may feel that women are more honest, there isn’t likely any real statistical significance.

You might be wondering why any of this matters.

Nursing is a female-dominated profession. In fact, less than 10 percent of all nurses are men. This means that when individuals answered the poll about the jobs they trusted, they were thinking primarily of women. Some experts have argued that this could be one reason the profession tops the charts year after year.

While the fact that nursing is a predominantly female

32 Spring 2019

allnurses

profession, it’s essential to point out a few things. First, male nurses are trustworthy. My personal experience has been that most of the men I’ve worked with throughout my career were trustworthy, and when the “you-knowwhat” hit the fan, I was happy they were by my side. The other thing to consider is that the specialties men choose might not be where patients remember the care they provided. Our 2018 Nursing Salary Survey collected information about specialty and found that most men who work as nurses can be found in emergency rooms, med-surg units, and on specialized cardiac care floors.

Often patients are very ill when they are on these units and might not remember those who provided life-saving treatment when they are completing a survey months later.

Code of Ethics

You learned many things in nursing school, from how to do an assessment to inserting IVs to how to teach patients about their diagnoses. However, one critical thing you learned that is probably ingrained into your daily practice is your code of ethics. The American Nurses Association created nine provisions that help nurses conduct their actions by the code. These provisions include practicing with compassion, being committed to the patient, and promoting, advocating for, and protecting the rights and safety of the patient at all times.

When a nurse’s actions align with these provisions, it creates a therapeutic relationship in which trust can grow. Patients and their families can see the nurse acting and working with their best interest at heart and know that their nurse selflessly and tirelessly provides the care they need to restore health. These heartfelt and sincere actions build a trusting relationship that creates the basis for all other care.

Will Nurses Remain the Most Trusted Profession?

There are many reasons that nurses have outpaced any other profession as the “most trusted.” While it’s hard to tell just how long they can hold onto the honors, the trade as a whole has certainly earned it each year. If you had to choose the most trusted profession would you choose nursing or would another job take the top honor?

Spring 2019

allnurses

33

by Lane Therrell FNP-BC, MSN, RN

The Future of Nursing

Lane Therrell is a board-certified family nurse practitioner, nurse educator, healthcare freelance writer, and nurse entrepreneur. She translates her devotion to the art of conversation into practice at www.DailyInspiredHealth.com

B

efore I studied nursing, I studied communications. So, when I think about the technology-driven future of healthcare, I automatically see an increasing demand for more effective interpersonal communication. Now that I’ve become a board-certified family nurse practitioner, worked in primary care, and taught new NPs in both the classroom and the clinic, I’m ready to share my thoughts on the importance of communication to the future of nursing.

Golden thread and soft skills

The future of nursing parallels the future of medicine, which is bright with technological innovations. From robotics, telemedicine, smart sensors, artificial intelligence, gene editing and more, the game-changing technological advances available now and on the horizon promise incredible improvements in healthcare across the board. It’s an exciting time to work in the biosciences. And it’s also a time when clinicians and caregivers must remain vigilant in recalling the reason healthcare exists: To improve the lives of human beings.

Reflections of a Nurse Educator 34 Spring 2019

allnurses

Communication is the golden thread that ties future to present and past, and connects individuals to one another. Communication involving digital screens and online connections creates convenience and leverages time and money but it also changes the nature and dynamics of human connections. I believe technology has created a real and relevant need for genuine human contact, a revival of the art part of nursing.

In recent years other professions including medicine have formally acknowledged the value of “soft skills,” which include interpersonal communication. That’s because interpersonal communication skills really aren’t that “soft” after all. Communication skills are powerful, and mastering them can be just as rigorous, difficult, and demanding as learning other clinical nursing skills can be. There is an academic and technical rigor associated with communication skills that too often remains unrecognized in nursing. Nursing must treat soft skills

as clinical skills that are worthy of development.

My perspective

Before I get too carried away, let me clarify my perspective. I entered nursing at midlife after a successful 20-year career in public relations for agriculture. I hold two master’s degrees in two very different areas of inquiry—rhetoric and nursing—which gives me a truly multidisciplinary academic background. I bring a mature, holistic, mindset to my practice that embraces a full spectrum of thought and ideas. My perspective matches the ideals of advanced practice nursing and offers the kind of outside perspective that exposes insular thinking and promotes innovation. And because I’ve been academically trained to deliver instruction in communication and leadership, I can teach people how to communicate more effectively.

My diverse experience in classrooms and clinics has shown me that better communication translates into better nursing care. It has also brought to light a great opportunity, as I see it, for nurses at all levels of practice to improve their interpersonal communication skills.

The Patient-Centered Illusion

Patient. Centered. Care. Those three words when used together capture the essence of why I became a nurse. Yet, without effective interpersonal communication, patient-centered care is merely an illusion. In nursing we perpetuate the illusion by failing to communicate effectively. Three ways this can happen are: 1) treating numbers instead of patients; 2) using words that separate patients from their health; 3) establishing plans of care for our patients instead of with our patients.

Treating numbers

At its core, patient-centered care is built on individual conversations between patients and providers of care.

These conversations allow us to treat the patient, not the numbers. Too often, though we become so heavily

Spring 2019

allnurses

35

following APA style to the letter when writing a term paper, or composing a persuasive letter to a legislator.

All of this is important, but interpersonal communication skills are worthy of close academic scrutiny.

To break the barrier, nursing must value interpersonal communication as a skill and teach it as one. It’s not that we don’t value interpersonal communication at all in nursing, it’s that we don’t formally recognize it as a skill to be taught. If we did, we’d have communication labs the same way we have health assessment labs.

invested in counting quality measures or improving patient satisfaction scores, that we forget to check in with the actual patient. We even get tempted to use lab results alone to develop care plans, short-circuiting full patient assessment.

Delivering care that is truly patient-centered means addressing the needs of the individual in front of you, not blindly following an algorithm. Ultimately, no matter how advanced the technology becomes, the best way to discover what is going on with our patients is through careful assessments, focused conversations, and critical thinking.

Disempowering words

Consider how we use our medical vocabulary. Indeed, medical terms have a place, and we must communicate accurately and collaborate effectively with our highly educated colleagues. But we also must use words with our patients that are appropriate and easy to understand.

Words that are unfamiliar or unsupportive to our patients can create and perpetuate gaps in understanding, and contribute to feelings of helplessness and lack of control. Any type of disempowering language in a clinical setting leaves patients disconnected from their health and disengaged from their health behaviors.

Planning in a vacuum

Too often we are guilty of establishing plans of care for our patients instead of with our patients. If the plan of care is not relevant to the patient, and they’re not

36 Spring 2019

allnurses

invested in it, they won’t honor it. This goes beyond “teach back” all the way to buy-in. If the patient can’t tell you step by step what he’s going to do to honor the plan between now and when you see him next, he likely won’t.

As an educator, I work hard to make abstract concepts relevant to my students. I tell them why it matters, and relate it to something they already know so they can remember and “own” the information. We must all do the same with our patients if we want them to engage and comply with their plans of care. The teaching aspect of patient education is not about reciting massive amounts of information to patients, it’s about making any new concepts and information relevant to their daily lives so they can own the plan and take appropriate informed action for themselves between visits. But we’ll never know what’s relevant to the patient if we don’t have a meaningful conversation first.

Barrier, value, and taking action

The biggest barrier to improving interpersonal communication in nursing is thinking we’ve already mastered it. We talk about effective communication a great deal, and we’re communicating all day every day, so we think we already know how to do it. But are we doing it well? Most of us are blind to the fact that we’re not being effective. And we’re missing an opportunity to teach interpersonal communication as a skill in nursing.

Effective communication is so much more than delivering information to a patient in their native language,

What if nursing did treat interpersonal communication skills with the intellectual and clinical practical heft I think they deserve? I believe nursing would thrive, improve, and facilitate the delivery of true patient-centered care in an age of booming technology.

The bottom line is: Communication skills are as important as clinical nursing skills. Without them, empathy cannot be expressed, ethics cannot be honored, and a true patient-centered environment cannot be created.

What are we doing to support nursing students’ mastery of the skills underlying our target competencies and course objectives? Effective communication is the unnamed skill that supports virtually all the advanced practice competencies. And yet, who is teaching these fundamental skills to nursing students actively and experientially?

Future benefits

Advances in biomedical science are happening faster than the slow-moving wheels of academia and clinical practice can turn. Fortunately, effective interpersonal communication happens in real time, and moves at the patient’s pace. Effective interpersonal communication is the single best mechanism I know for meeting patients where they are on their individual continuum of change.

From that perspective, what could be more patient centered than engaging in interpersonal communication?

The best strategy for keeping healthcare patient-centric in response to technological integration is improving interpersonal communication skills. Communication skills improvement has great potential to improve outcomes in primary, pediatric, and geriatric care, among cancer survivors, and in any situation that

involves patients with multiple chronic comorbidities. It is a topic that nursing scholars and doctoral candidates may wish to tackle.

Nursing is both art and science. While our education and industry may be biased toward the science, it’s the art part that keeps us focused on our purpose and our patients. I infuse this ideal into all my interactions with students, patients, and clients. And I leverage my background in communication to do so. I celebrate nursing for the connections it allows me to create with others.

And as professionals we can strengthen those connections by improving our communication. I challenge my fellow nurses to begin valuing communication more highly for the good of the future of nursing, and for the good of the patients we serve.

No matter what technology emerges in the future, there will always be a need for nurses to connect with patients as they deliver quality care. The future of nursing holds great possibilities and opportunities which we can embrace by integrating effective interpersonal communication into everything we do.

Article Sources: 5 Key Trends for the Future of Healthcare https://www.weforum.org/agenda/2018/01/this-is-what-the-future-ofhealthcare-looks-like/ Communication in Nursing Practice https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990376/ Effective Communication Skills in Nursing Practice https://journals.rcni.com/nursing-standard/effective-communication-skills-in-nursing-practice-ns.29.14.53.e9355 Effective Interpersonal Communication: A Practical Guide to Improve Your Life http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ ANAPeriodicals/OJIN/TableofContents/Vol-19-2014/No3-Sept-2014/ Effective-Interpersonal-Communication.html Integrating the Art and Science of Medical Practice: Innovations in Teaching Medical Communication Skills https://www.researchgate.net/profile/Cynthia_Haq/publication/8694691_Integrating_the_Art_and_Science_of_Medical_Practice_Innovations_in_Teaching_Medical_Communication_Skills/ links/5551e71f08aeaaff3bef3308.pdf Nursing Students’ Perceptions of Soft Skills Training in Ghana http://www.scielo.org.za/pdf/cura/v40n1/16.pdf The Most Important Soft Skills Employers Seek https://www.thebalancecareers.com/top-soft-skills-2063721 The Art and Science of Nursing: Similarities, Differences, and Relations https://journals.sagepub.com/doi/abs/10.1177/089431848800100105 What are the NP Core Competencies? https://www.nursepractitionerschools.com/faq/what-are-the-np-corecompetencies/

Spring 2019

allnurses

37

NURSING STUDENT EXCLUSIVE OFFER!

remember everything. forever.

Ace Your Classes, Exams, and the NCLEX® with Picmonic!

STUDY SMARTER REVIEW FASTER

Penicillin = Pencil-villain

REMEMBER MORE

47 States 74 Hospitals 48 Outpatient Centers 100s of opportunities

38 Spring 2019

Take a good look at jobs.tenethealth.com allnurses

Picmonic is research-proven to increase your test scores by up to 50%

Over 1,000+ Picmonic videos that are unbelievably efficient & ridiculously effective.

Used by over 450,000 students worldwide, Picmonic offers a more efficient way to study thousands of nursing school topics, using Spaced Repetition quizzes and mnemonic customization to boost memory retention.

Comprehensive Coverage

Learn 1 concept a day for FREE forever at picmonic.com!

Pass the NCLEX® Guarantee We’re so confident that Picmonic will help you pass, we’ll give you your money back if you don’t.

picmonic.com/nursing

Get Picmonic Premium for as low as $4 a month: CLICK HERE! Spring 2019

allnurses

39

N

urses have a lot to celebrate in 2019. We are at the bedside, in the home, insurance company, behind the computer, in the lab, supervising, teaching, in any capacity you can imagine, nurses are there. Celebrate Nurses Week this year in a way you never have. Do something new in your department or office for each other, go above and beyond to celebrate our profession.

Why We Celebrate Nursing History Behind Nurses Week

By Brenda Johnson

The evolution of nurses day or nurses week took many years to become official. The first official attempt was in 1953 when Dorothy Sutherland of the U.S. Department of Health, Education and Welfare proposed a “Nurses Day” to President Eisenhower. She wanted it to reflect the 100th Anniversary of Florence Nightingale’s mission to Crimea, but it did not get done. However, the following year in 1954, a National Nurses Week was celebrated from October 11-16 (Gillies, 2003).

In 1955, a bill was introduced to declare a National Nurses Week, but it did not pass. Ten years later, the International Council of Nurses started celebrating “International Nurses Day”. President Nixon is asked in 1972 to acknowledge a “National Registered Nurse Day”, but it did not happen. However, two years later, Nixon proclaims “National Nurses Week”. The same year, the International Council of Nurses proclaims May 12 as “International Nurse Day” (Gillies, 2003).

allnurses

Looking back at how many changes (or not) have taken place in nursing and the medical field, it seems overwhelming. Even so, the nurse’s mission has remained steady throughout this medical metamorphosis. This is evidenced in a book published in 1930, A Textbook of Medicine, by A.S. Blumgarten M.D., F.A.C.P. In the preface, he tells us what his perspective of what a nurse is.

“The function of the nurse in medical diseases is to observe symptoms accurately, to recognize early signs of complications and to carry out the physician’s orders intelligently” (1930).

This description applies today just as much as it did in 1930. Although we have made great strides in chemistry, biology, and electronics, our basic purpose remains as it always has been - to provide care to our There are several milepatients to the best of stones in the years that our ability without doing followed, and in 1982 “The function of the nurse in medical any harm. I love my old the ANA recognized diseases is to observe symptoms medical and nursing May 6 as “National accurately, to recognize early signs of books. I enjoy reading Recognition Day for them and seeing the Nurses”. That same year, complications and to carry out the nursing students’ signaCongress also made a physician’s orders intelligently” tures written crookedly resolution for May 6 to inside the front cover be “National Recogniand maybe some scribtion Day for Nurses”, bled notes of something and then President they thought was important. These books are precious, Ronald Reagan signed a proclamation on March 25 connecting the past with the present. declaring the same (Gillies, 2003).

The ANA made nurses week (May 6-12) official in 1990 (Gillies). May 12 is Florence Nightingale’s birthday, so it is fitting that we end the week of celebration - celebrating her.

40 Spring 2019

After attending nursing school in Germany, Florence went back to London and became superintendent of a hospital for “gentlewomen” (The History, 2016). Her work in public health and during the Crimean War set new standards for healthcare. She decreased mortality by improving sanitary conditions. Not only that, she kept records of the people who died, and how they died.

This allowed her to make the connection between sanitation and disease. Florence actually had some of the first evidence-based research in healthcare.

One of the books in my collection was written in 1917

by George M. Price, M.D. called, Hygiene and Sanitation A Text-Book for Nurses. When I flipped to the dedication page, it read,

Spring 2019

allnurses

41

“To Lillian D. Wald - The pioneer of Public Health Nursing in the United States and the foremost advocate for the extension of the scope of the nurses’ work. This book is dedicated in appreciation and respect” (Price, 1917).

Wow. Makes me wonder if he knew her or just knew of her. This is the perfect segue into talking about Lillian D. Wald and her contributions to the world of sanitation, education, and the improvement of conditions for children in that day and time.

Lillian Wald is known for her work in reforming public health. Not only did she open a “settlement house” (opened in poor urban areas in an attempt to bring the rich and the poor together in proximity and socially) in 1893 called the Henry Street Settlement, she moved into the house along with her friend and fellow nurse Mary Brewster (Lillian, n.d.).

There in the house, she provided nursing care for the poor. Eventually, there were many nurses who would come and volunteer their time. Soon, the settlement was able to open playgrounds, afterschool programs, kindergarten, mother’s groups and more.

Lillian was able to discern what the community needed and then make sure it happened.

the function of the trained nurse and a great broadening of the scope of her usefulness. No longer are her duties limited to the simple care of the sick. The nurse has become a priestess of prophylaxis. Her work in preventative medicine has become invaluable. She has become an important factor in social, in municipal, and in public health work” (Lillian, n.d).

Getting back to the book, I thought you would enjoy what Dr. Price had to say in his preface.

Blumgarten, A. (1930). A Textbook of Medicine for Students in Schools of Nursing. New York: The MacMillan Company.

Filiacia, A. Lillian Wald - Public Health Progressive. (n.d.). Wordpress.

Retrieved from www.lillianwald.com

Price, G. (1917). Hygiene and Sanitation A Textbook for Nurses. Philadelphia and New York: Lea & Febiger.

The History of Nurses Week. (2016). Ashford University. Retrieved from https://www.ashford.edu/online-degrees/health-care/the-historyof-nurses-week

Gillies, H. Florence Nightingale The History of Nurses Week. (2003).

CountryJoe. Retrieved from www.countryjoe.com/nightengale/nursesweek.htm.

**To all the wonderful male nurses out there, know that we appreciate you and you are the “princes of prophylaxis”. **

While documenting in charts has become obsolete, we now see our faces in the reflections of all of the electronic devices we use. We get lab, and other results in real time and can treat patients sooner. Communication has become easier and faster, decreasing the incidents of delay of care and improving patient outcomes. While all of this is great, let’s not forget to look up and make eye contact with our patients; they need it, and so do we. Just from looking at them we can tell so much. We can see if they are pale, in pain, or nervous, and most of all, it begins the process of building a rapport.

Nurses Week is to celebrate you.

All the times you ignore your back pain and keep going, or brush off the bladder that is about to burst in order to care for your patient. As you bring them their lunch while yours is getting cold, this week is for you.

When a doctor yells at you for something that is no fault of yours, this week is for you. As you walk to your car on feet that are so tired they can’t take any more steps, we celebrate you.

Nurses Week is to celebrate you.

Together, she and other well-known women’s rights activist such as Lavinia Dock and Florence Kelley helped to write textbooks, aiding to the progression of the professional nurse. New York City school children benefited from the many people living in that settlement who helped to improve conditions in the schools. Special educations classes were created, and a program for school nurses was started, along with a lunch program for the students. Lillian’s activism and hard work in her community were boundless, including her work in the political arena to end child labor. Her story is a good example of how one nurse changed a country (Lillian, n.d).

References

The connection we have as nurses over the past decades to now binds us in our journey of serving. The best things about the healthcare system have been created by nurses just like you. Do some creating of your own and don’t forget to get a massage to reward yourself. You never know, decades from now, nurses may be reading about you and all the wonderful things that you were able to accomplish. Tell us about some things you would like to pioneer.

NURSES WEEK COMES EARLY THIS YEAR PRIZES. PRIZES. PRIZES! CHECK EARLY. CHECK OFTEN.

“The last decade has seen a wonderful expansion of 42 Spring 2019

allnurses

Spring 2019

allnurses

43

Get Social

LOL

A glimpse at some of the most popular comments from our various Facebook channels... Be sure to click the headlines to add your comment!

Nurses that “only do it for the money” In California the money is insane. $75 an hour day shift, $84 an hr PMS and 90 plus nocs. That’s just for staff nurse II, If you become staff nurse III it goes up another $5 or more. This is in Med surg hospitals. Skilled nursing or behavioral health pays approximately $40 to $50. Hospital settings are not worth the money to me. Its extremely unsafe and understaffed.

No one cares about no one. If you do care you’re voted off the island. Cold atmosphere. I became an RN because I like helping people and making a difference where I can. Not just sit in front of a computer checking boxes to meet hospitals criteria.

Charting before patients. Profit before patients. I’m sorry but I cant sell my soul to the devil for money.

CEO Says More Nurses Won’t Improve Care This “CEO” is paid to keep staffing down so he gets a nice bonus at the end of the year.....am glad I don’t work anywhere he is in charge of...

Safe Staffing Levels for In-hospital Nursing Units Safe staffing is defiantly a good start but nursing needs to pitch in too. We need to take pride in our units, pitch in when help is needed, and care for our own.

44 Spring 2019

allnurses

Nurses have once again been selected as the most trusted profession in the United States. We feel like that deserves an award. A BIG award!

Spring 2019

allnurses

45

Expert’s Corner

It can happen to you any criminal matter where you are arrested, charged or convicted such as a DUI

2.

by Lorie Brown RN, MN, JD

Lorie A. Brown is a Nurse Attorney representing nurses before the licensing board and founder of EmpoweredNurses. org. Empowering Nurses at the bedside and in business.

46 Spring 2019

allnurses

I’ve represented over 500 nurses in dozens of states (I work with co-counsel in states where I am not licensed) and every one of them has said, “I never thought I would be called before the Board.” Yet, here they are sitting across from me feeling very scared and vulnerable that they will not get to continue in the profession that they love. Anyone can report you (file a complaint) to the Board and once the Board receives a complaint, they are required by statute to investigate the allegation(s).

Here are a few ways in which nurses can be called before the Board and how you can protect yourself.

1.

The first and obvious the Board feels that you are a nurse 24/7 and anything that you do that could look bad on our profession or be a concern for your judgment, they will take action. This means

Do not use controlled substances, illegal substances, marijuana or alcohol. If you take a controlled substance and do not have a valid prescription and you have to take a drug test that shows positive, it does not look good for you.

And don’t take medications without a valid, current prescription or borrow medications from someone else as this would be considered practicing medicine without a license by self-prescribing and it is also called diversion.

In addition, do not give a medication to someone else even if they’ve had a valid prescription for that medication in the past. This also is considered practicing medicine without a license and diversion.

3. Do not cross professional boundaries. Nurses are required to care of patients during the time that they are assigned to the patient’s care. Do not come to visit patients after hours and do not continue a relationship with patients after the nurse/patient relationship is concluded. I’ve seen nurses who subsequently marry patients and then, if they divorce, the ex-spouse then files a complaint against the nurse’s license. I have seen nurses who, trying to be nice, will conduct banking chores for the patient. Taking the patient’s debit card and PIN, they do the transaction only to find that the patient then alleges the nurse stole money. Don’t become

even after surgery. If you do give pain medications, make sure you administer them as soon as they are removed from the Pyxis. Do not carry it in your pocket except to go directBe mindful of HIPAA. Talking ly to the patient’s room. I have seen it argued about a patient outside of their before the Board that by waiting too long to room, even without using names, administer injectable narcotic medication, the can be a HIPAA violation. You never know nurse had an opportunity to take some or all who might be listening. And don’t access patients’ records if you are not providing care for of the medication and replace it with saline.

Also, make sure you waste medications right that patient and have no reason to access the away for the same reason and make sure the patient’s records. One nurse’s adult son was witness actually sees the waste and cosigns in the emergency room. She could not leave it. Going to a coworker after you wasted the her position but looked at his chart to get his medication and asking a coworker to cosign information. She had no business checking the waste without witnessing is in violation the chart which was a violation of HIPAA. Don’t talk about patients except for treatment of your facility’s policies and procedures. So, purposes and only in a secure area and do not make sure you follow all the facility’s policies and procedures. If you do get reported to the access any other patients’ charts unless you are providing care or have a legitimate reason Board, my experience has been that if there are discrepancies with narcotics given, the to do so.

Board will think that you are using them and Make sure you use due care in adif you aren’t using them for your own use then ministering and signing out narcotyou are selling them. They can be very unics. With the opiate crisis these days, forgiving. Protect yourself by following your there is software in the Pyxis machine to see policies and procedures to the letter. who is giving more medications than the othThe above-mentioned tips may seem obers who are on the unit. Don’t be an outlier.

Discuss the medication strategy with your co- vious but you would be surprised how many workers and make sure that everyone is on the nurses are called before the Board for these types of issues. The best protection against a same page. When I went to nursing school, pain was considered the 5th vital signs and we Board Complaint is to be proactive and follow always wanted to stay on top of pain. Howev- the rules. er, things are changing. In fact, sometimes they don’t even give narcotic pain medication, involved with patients after the nurse/patient relationship has ended and only provide activities within the scope of your practice.

4.

5.

Spring 2019

allnurses

47

Whether you’re just beginning your nursing journey...

Or you’re furthering your education...

Finding scholarships just got easier!

48 Spring 2019

allnurses

Scholarships Directory Click to Visit

allnurses.com/scholarships