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Joy Who?

The internet was in an uproar. Miss Colorado, Kelley Johnson, delivered a monologue about her experience of being “just a nurse” for the talent portion of the Miss America pageant. I watched it on YouTube the night of the contest. Like many nurses, I felt all the warm, fuzzy, nurse feelings and even got a little misty eyed. By Tuesday morning, the news reached my Facebook nursing groups. Joy Behar and Michelle Collins had mocked Miss Colorado on The View. Ms. Collins thought it would be a good laugh to poke fun at the heartfelt monologue delivered by Nurse Kelley. Ms Behar chimed in with the question, “why does she have a doctor’s stethoscope around her neck?”

A doctor’s stethoscope! Behar poked a sleeping bear with those words. Nurses roared into action as the disparaging remarks reached nurses across the globe. Hashtags like #nursesshareyourstethoscopes, #nursesrock, #nursesmatter, #notacostume, #mytalentisnursing, #nursesunite and #notjustanurse began trending on social media. I wish that Ms. Behar and Ms. Collins had supported Nurse Kelley, not only as a healthcare professional, but as a woman. It was disturbing to watch an all-woman-panel mock another woman for sharing her talent, the art of nursing.

The backlash from three million nurses was swift and strong. Pictures of nurses wearing stethoscopes flooded my news feeds. I spent time retweeting every one of my fellow nurses posts about the scandal. I was caught up in the collective outrage and for a few days I felt united with my sister and brother nurses.

Weeks later, the nurse hashtags have stopped trending and the conversation has changed to other hot topics. All of the nurse empowerment energy has evaporated.

Have we once again become stethescope#justnurses?

Joy Behar’s comment was careless. It was a throw away thing to say to fill up space and to seem like she had something intelligent to add to the conversation. I don’t believe that she meant it maliciously, she was being thoughtless. Her thoughtlessness united nurses in a way that I have not seen since nurses jumped on planes and busses to help in the aftermath of Hurricane Katrina. The energy on social media was exciting. It was gratifying to read supportive comments and see nurses being given positive attention. I loved seeing all the stethoscopes and reading nursing stories about where those stethoscopes have been. For a few days it has felt like nurses were united and a part of a large community. United in their outrage of being publicly mocked.
It is now clear that nurses have the ability to direct national conversations. Where have all the hashtags gone? Why aren’t there trending hashtags like #endhealthdisparity, #decreasepatientratios, #stoplateralviolence, #nurseautonomy, or #APRNsIncreaseAccessToHealthcare? Healthcare policy and laws are influenced by a handful of lobbyists and legislators. These lobbyists and legislators number far fewer than three million nurses, but their decisions affect the entire nation. Can you envision a healthcare system being directed by our modern day Florence Nightingales and Clara Bartons, with the support of the national nursing community?
The best thing that could result from this stethoscope spectacle would be for nurses to finally find their voice.

We have power to influence, educate and advocate for the healthcare changes that we know we need. We can command a national stage whenever we choose to unite behind a cause. Its time to come together to influence issues that affect our friends, neighbors and families. Nurses are never just nurses, it is time to prove it.

To take action start here: American Nurses Association

 

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Giving Thanks for Advanced Practice Nurses


     I am thankful for advanced practice nurses (APRN) A Nurse Practitioner (NP) is one type of advanced practice nurse and one that probably comes most readily to the mind of the public. Certified Nurse Midwives (CNM), Certified Nurses Anesthetists (CRNA), and Clinical Nurse Specialists (CNS) are also APRNs and fill similar, but diverse roles. I have been fortunate to have been cared for and mentored by many APRNs throughout my life and career. T
his November I wanted to share how APRNs have touched my life and express my gratitude.

1.As a young child, my family accessed healthcare through the county public health system. Thanks to public health nurses, and the APRNs that led them, I was vaccinated against diseases and screened for health problems. I grew up healthy despite my parents’ lack of healthcare insurance and money.

2. As a teenager, living in a rural community, my primary healthcare provider was a Nurse Practitioner. She practiced in a small healthcare clinic a few minutes from my house. At that time I was covered by insurance, but she had low rates for self-pay patients. I loved the way that she took time to listen to my teenage complaints and helped me navigate my own health for the first time.

3. Then next time I came across an APRN I was a service member’s wife, struggling to raise a growing family during wartime. A Nurse Practitioner screened me for depression and referred me to a support group. That support group helped me to survive and thrive through each of my husband’s deployments.

4. In nursing school a Nurse Practitioner faculty member candidly shared the practice struggles facing APRNs. She mayNurse-Heart have thought she was dissuading me from entering the struggle, but she inspired me to eventually join the cause.

5. I learned about the true mission of public health at the side of a CNM. Her job was to make prenatal and postpartum home visits. She taught me how to meet people wherever they are in life. I can still picture her on a dozen different sofas, rattling off nursing advice in both Spanish and English.

6. My leadership preceptor in nursing school was also a CNM. She was the director at a community hospital labor and delivery department. She ran around that unit with a mug of tea she would intermittently reheat, but never finish. She taught me what is meant to be a visible leader.

7. When my career turned from adult medicine to perinatal nursing, I learned how to be fully present and care for a woman in labor thanks to a group of CNMs. They taught me how to seamlessly involve the partner and other present family members. I can’t express how much of the nurse I am today is directly due to the hours I spent in the sacred spaces that those women created for our patients.

8. When I decided to become an APRN, I was mentored by two amazing CNSs and a wonderful NP. The lessons they taught went far beyond how to dictate a note or prescribe a medication. I am truly grateful for their time and advice. I owe them much of my career success. The greatest gift they gave me was belief in my own ability. They drilled in me to not sell myself short, to not settle and to unabashedly pursue my goals as an equal player in the healthcare arena.

9. The darkest year of my life was attended by another APRN. A CNM helped me through back-to-back perinatal losses. She was the first primary care provider to truly listen to my health complaints and she diagnosed me with hypothyroidism. The diagnosis came too late to affect my pregnancy, but she helped me on the road to health, both physically and mentally.

10. I don’t want to leave out CRNAs! I work with brilliant, funny and energetic CRNAs. They are an important part of the perinatal team. I am thankful that when we are running to the same emergency together, I know our patient can be in the OR within minutes receiving lifesaving care from our team.

      I would not be the person I am today without APRNs. It’s possible I may not even be here without some of them. APRNs fill an increasingly important role in our healthcare system. Despite the amazing, holistic and safe care that APRNs provide patients, they experience many barriers to practice. Our nation continues to face a crisis in healthcare that could be greatly reduced by allowing all APRNs to practice to their full scope, in every state. Currently APRNs are lobbying for independent practice in many states and nationally. Independent practice is evidence based and a safe policy. We need public support to help pass legislation to allow more APRNs to care for patients. To learn more about the APRN regulations in your state and pending legislation click here. If you are grateful for an APRN, please share your story in the comments.

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at http://yourahi.org/blog.

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The Little Blue Button

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A “code” is the term that medical professionals use to describe the orchestrated chaos that surrounds a patient that is on the brink of death.  Depending on the facility a code may be called a Code Blue, Code Red, Code CPR, or sometimes Code 99.  They all mean the same thing.  A person is about to die unless there are medical interventions made immediately.  Sometimes it means that death will come no matter how hard we try to stop it.

 

A few months past graduation I experienced my first code on my own patient.  The man had been verbally abusing me all day.  I had been running around trying to make him happy and also care for my other five patients.  He was bellowing from his bed that he was going to die.  A lot of patients speak in that way, but something about the way he said it terrified me a little.  All his vitals, physical assessment findings and that he was able to yell with so much energy all assured me that he was stable.  I called the physician anyway.  He agreed to assess the patient. I went to check on my suddenly quiet patient.  When I walked into the room I knew something was different.  I will never forget how grey he looked.  I froze in a moment that felt like eternity while I listened and looked for breathing.  It only took a few seconds to confirm.  I reached up above his head and pressed the small blue button.

 

I was the person yelling now.

 

I called above the alarm sound for help. Help came.  Almost before I could lay the patient flat in the bed, a nursing aid, with a football player build, began chest compressions.  Respiratory commanded the head of the bed, bagging and preparing for intubation. A metal crash cart clanked into existence, pushed by my charge nurse.  The emergency room physician and intensive care nurse rushed in together. The ICU nurse asked who the primary nurse was.  All I could think was ‘Oh Crap! That’s me.’  She told me to grab the chart (that’s back when patient’s records were big, clunky, 2-ringed, plastic folders stuffed with a ream of paper printouts and handwritten notes) and call the patient’s physician.

 

I ran to the desk and called the doctor again. He was just getting off the elevator. We met at the patient’s bedside. I calmly answered questions about history, vitals, and labs, all while the resuscitation dance continued.  I was calm only on the outside.  Inside my mind raced, searching for what I might have missed.  This man had been screaming at me all shift.  How could we be coding him now?  I couldn’t think of anything I could have or would have changed.  Even now looking back, with much more experience, I know gave him appropriate care.  I watched the code continue, clutching the hard plastic chart.  I optimistically observed that his color was pink again.  Surely that was a good sign, I told myself.

 

As if someone had flipped a switch, everything stopped.

 

The ER physician called time of death after nearly 40 minutes of trying to coax my patient back to life.  I watched as my patient lost his rosy color while the team waded through the open package wrappers that had been hastily discarded on the floor.  The CNA stayed and helped me to clear the debris and prepare my patient for the morgue.  The aftermath of the code was over quickly.  I think that is what stunned me the most.  The physicians and nurses went on caring for their patients.  Housekeeping came and cleaned the room for my next admission.  I did not have time to cry or sit in disbelief or process what had happened.

 

The shift went on and so did I.

 

I have since been to countless codes.  Sometimes I am doing the compressions.  Sometimes I am the nurse directing the chaos.  Occasionally I am the primary nurse questioning every action I did or didn’t make that shift. Luckily one aspect of patient codes has changed since I was a new nurse.  It is now an expectation in many hospitals that a debrief occurs after a code, regardless of the outcome.

 

A debrief is conducted as soon as possible after the event.  All available team members are expected to attend.  It is a confidential and non-discoverable group discussion of the event.  The purpose is to discuss the facts, problems, barriers, needed improvements and to acknowledge and share feelings.  This is not a time to place blame or try to find fault with one another. This opportunity to discuss the event and acknowledge how we feel about it is a valuable practice.  I never want to feel that losing a patient is business as usual.

 

Debriefing is the pause that we need to take to acknowledge, gain knowledge and make adjustments for the next time we press that little blue button.

 

 


Debriefing Steps 

1. Introduction: The facilitator establishes the group goals and rules and reinforces the need for confidentiality about anything that transpires within the group.

2. Fact gathering: Each staff person describes what happened and facts are gathered.

3. Reaction phase: Led by the facilitator, the group examines its feelings, thoughts, and responses to the event experienced. If the debriefing session happens soon after the event occurred, there might not be any symptoms.

4. Symptom phase: If some time has elapsed since the event, group members may be experiencing symptoms. The facilitator helps the group examine how these reactions have affected personal and work lives.

5. Stress response: The facilitator teaches group members about their stress response.

6. Suggestions: The facilitator offers guidance on how to cope with stress related to the incident.

7. Incident phase: Group members identify positive aspects of the event.

8. Referral phase: The facilitator concludes with this phase, whereby specific individuals who require additional support are referred for individual follow-up.     

Adapted from: Hanna, D., & Romana, M. (2007). Debriefing After A Crisis. Nursing Management (Springhouse), 38-42,44–45,47.


This post was written as part of the Nurse Blog Carnival.

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Book Review: Your Next Shift by Elizabeth Scala

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Fellow Nursepreneur, Elizabeth Scala, has captured the nursing spirit again with her second book, Your Next Shift.  This is a great read for any nurse, wether you have found your career bliss or are still searching.   

Elizabeth Scala shares her own savvy advice while managing to tie in philosophies from great thinkers from Churchill to Green Day.  Scala gives us a sneak peek into her personal reflections in which we easily can recognize our own struggles and fears.

“When you are OK with where you are currently at, you are able to celebrate everything about you and then exude that energy out into the world.” Elizabeth Scala

Your Next Shift is not a blueprint for becoming someone else. Scala guides her fellow nurses through a journey of self awareness while sharing her steps to success, however you define it.

I recommend this book for every nurse that feels that there must be more to nursing, happy nurses that want to level-up their careers, and nurses that feel the call of a slightly different path.

-Carrie Sue Halsey

 

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13 Fundamentals for Practicing Nursing

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National Nurses Week is a time set aside for the public to recognize the amazing work of nurses.  Nurses will be the topic and focus of hospitals, newspapers and media outlets.  Our accomplishments, character and hard work will be applauded and we will receive all kinds of tokens of appreciation from employers, patients and family.

This year instead of another pen, coffee mug or tote bag, I want to give nurses something that that won’t end up in the summer yard sale.

 

Rosemarie Rizzo Parse’s 13 Fundamentals for Practicing Nursing

 

  • Know and use nursing frameworks and theories.

You can begin with Parse’s theory of Humanbecoming, which is an insightful nursing theory that describes how nurses and patients co-create the health experience.  Parse marries the art and science of nursing in a beautiful and applicable way.

 

  • Be available to others.

Nurses are busy.  Do not let the fast pace of healthcare prevent you from being available.  Remember to be available for the nurses around you. No one understands you quite like a fellow nurse. Take the time to listen, help and care for one another.

 

It is a poor coping mechanism to view patients as diseases, room numbers or annoyances.  Nursing is stressful, people are not always kind, and you may never hear a thank you, but it is important to value everyone as a human presence.

 

  • Respect differences in view.

Whether you are a new graduate or about to retire, you are a nurse with opinions.  Differences in opinions are good!  Respecting differences of view is important too.  Creating a safe and welcoming environment, for everyone to share their view, will allow nursing knowledge to evolve and grow.

 

  • Own what you believe and be accountable for your actions.

If you believe in something or someone, stand up and speak up.  If you turn out to be wrong, admit it and move on.

 

  • Move on to the new and untested.

Change is hard.  No one likes it, but change is necessary and good for us and nursing.  If we did not push forward and try new nursing interventions we would still be sterilizing our own needles and fetching coffee for physicians. Parse’s theory is a paradigm shift away from medical thinking that embraces nursing as a standalone science.

 

  • Connect with others.

Compassion, caring, respect, understanding are all qualities that nurses help nurses to connect with the healthcare team, including the patients.

 

  • Take pride in self.

You are not “just a nurse.” Being a nurse is exceptional.  Don’t shortchange your contributions to healthcare.  You are brilliant, own it!

 

  • Like what you do.

If you hate your job, find one where you can be happy.  There are endless opportunities in nursing.  You owe it to yourself and your patients to like coming to work every day.

 

  • Recognize the moments of joy in the struggles of living.

Life is hard.  Take time to recognize and feel joy when you find it.

 

  • Appreciate mystery and be open to new discoveries.

Nursing is a beautiful work. We are the companions to humanity throughout the life span and in every imaginable condition. We continue to discover what it means to be human day after day.  Be open to the mysteries of life and embrace what you find.

 

  • Be competent in your chosen area.

            What have you been doing since you graduated nursing school?  Have you been to a conference, read a journal, taken a class?  Choose your nursing niche and keep learning.

 

Taking time for self is vital in order to prevent compassion fatigue and nurse burnout.  Nurses are known for putting themselves last.  Their own health, spirituality, emotion and mental needs are often put aside in order to care for others.  Take care of yourself!  Take a few minutes to meditate, pray or sit quietly during a hectic shift and you will feel the difference, and so will your patients.

 

Thank you to all my nursing colleagues around the world!  This is the week that everyone remembers that nurses are a special kind of awesome. 

Let’s remember this about ourselves the other fifty-one weeks of the year!

 

 

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Bournes, D., & Mitchell, G. (2014). Humanbecoming. In Nursing Theorists and Their Work(8th ed., pp. 464-495). St. Louis: Elsevier Mosby.

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3 Small Ways to Bring Mindfulness to the Bedside

Nurses multitask.  We are expected to be flexible.  We accomplish more than any one person should be capable of achieving in twelve hours. We do it all with a smile on our face, at least most of the time.  Behind the smile, our minds our often far from the bedside.  We are thinking about the patient in another room, when pharmacy will tube up the medication that is late, whether our lunch buddy is back from eating, and the charting that needs to be finished from morning assessments.  It is difficult to be truly present with the people that we provide care.  There are many distractions for our attention and energy.  Nursing is also an emotional career.  Supporting, caring and healing people exposes nurses to intense emotion from patients, family and friends of the patient and the nurses own emotion.  Stress, crazy workloads and intense emotions can be huge barriers to nurses having mindfulness at the bedside.

Three tips to put mindfulness in action at the bedside:meditation-clipart-meditation-clipart-animal

 

  1. It is what it is This is one of my go-to-mantra’s.  This is not a surrender to fate, it is an acceptance of the limits of my power as a nurse.  When I truly have done all the intervening and advocating possible, I accept the outcome.

 

  1. Being present Mindfulness requires us to pull up a stool, sit down and be with our patients.  It is letting go of everything else in the world for a small space of time in order to be present.  It is important to connect with each other human to human.  Being present also allows our attention to focus on this patient’s needs, fears, wants and hopes.  Not being present causes errors and decreases the trust from the patient

 

  1. Suspending judgement Being critical of our patient’s actions, feelings, choices or lifestyle prevents us from being present and having mindfulness. It is important to meet people where they are in life.

 

We will not always be able to be 100% mindful as a nurse.  These three tips can help us be more mindful with our patients for their benefit and ours.

 

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at The Balanced Nurse Blog. Find out how to participate.

 

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Nursing is Bigger on the Inside

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I love Doctor Who.  For anyone that is not familiar with this British television program, the basic premise is as follows.  There is a cool alien that looks human, but regenerates every few season to look like the next actor to play him.  This alien is called the ‘Doctor’ because no one can know his real name.  The Doctor is a time lord from a planet called Gallifrey and he travels in what looks like an old police call box, much like a telephone booth.  This police box, the TARDIS, takes the Doctor anywhere in time and space, but that is not the only amazing thing about the it.  The TARDIS is bigger on the inside.  We don’t know how big, but imagine the Star Trek Enterprise stuffed into a telephone booth and you get close. 

Nursing is like the TARDIS.  

People think they know about nursing.  The public only sees the outside. They see that nurses work 3 days a week and are paid well. They see that nursing is not a glamorous job. They see smiling faces and skilled hands.  

Nursing is bigger on the inside. 

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A lot of nurses look cute in scrubs, but even those scrubs lose their appeal when they are covered in various bodily fluids.  I am frequently told by family, friends and random strangers that they could never be a nurse.  I get it.  Nursing is not for everyone.  

Some of us do work 3 shifts a week.  Those 12 hour shifts stretch into 14 or 15 hour days when you add in lunch, report, extra charting and commute time.  The majority of nurses that I have known work much more than 36 hours a week.  

For the most part nurses can at least fake a good mood and do their best to smile.  Smiling and chatting with patients they perform the technical skills that keep patients safe and comfortable.  

Nurses need to be smart, caring, brave, strong willed, strong stomached and have a sense of humor.  We see the worst and best of humanity in our work.  We are happy when our patients do well and cry when they are not.  Nurses monitor, clean, feed, medicate, assess, educate, entertain, console, listen, advocate for and document about patients day and night.  After doctors, therapists, family, friends and even dietary leave for the night, nurses remain at the bedside.  

Caring for patients is rewarding, gratifying and exhausting.  To be trusted to such a degree by a stranger is an honor.  Helping people meet health goals or guiding them through milestones is an amazing feeling.  Even when our patients pass away, helping the patient and family through the process is fulfilling.  

Nursing is much bigger on the inside.  It is easy to get lost in charting, policy reviews and quality audits and forget the art of nursing.  Nurses need to be reminded of the amazing impact that we have on peoples lives.  Nurses not only impact health at the bedside, but have the power to transform healthcare practice.  

 

Take time to remember how big nursing is and why you do it. Energize and renew your yourself at the Art of Nursing 2.0 event from anywhere in the world.  

 

 

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This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at ElizabethScala.com. Find out how to participate.

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The Secret Awesomeness of Night Shift

The hospital feels different after 5 PM.  

The scheduled surgeries are finished for the day.  The short stays and clinics are emptied and closed.  Administrators, executives and their assistants all begin vanishing like the sun over the horizon.  The last few tired nurses clock out and the hectic cloud of day shift follows them into the elevator.  What is left behind is an alternate hospital universe that only true night shift staff discover and appreciate.

The bright lights are dimmed to signal to patients, visitors and staff that night has arrived.  The coffee and tea come out to greet the healthcare team to another night.  Some nursing units brew their own caffeinated delights,  others take turns making massive runs to Starbucks, Dutch Bros or another favorite coffee spot.  Patient assessments are completed and medications are passed.  Nurses and ancillary staff move quickly to check off all the tasks on their lists.  If they are lucky they will be able to tuck themselves in to the nursing station to chart and chat the hours away until dawn.

Everything is more a little more relaxed.  No topic is taboo by 4 AM.  Night shift staff know each other, the good, the bad and the unmentionables.  If a manager or administrator happens to come in on night shift, the news spreads quickly and the books, smart phones and uncovered cups disappear in an instant.  Those late night visits from administration are rare. Night-shifters learn to depend on each other like family.   

The calm can be misleading.

In the darkened corners of the nursing unit lurk the possibility of chaos.  Disaster can interrupt the laughter at the nursing station, despite the careful observation and care of patients.  When emergencies occur, the night shift team leaps into action.  The juicy conversations and cat videos are abandoned and the only priority is the patient.  An outsider may not see an emergency on a nursing unit as seriously as the team working in it.  It does not usually look like it does on television.  There are a lot of people.  Everyone is in motion.  It is often quiet with one or two people calling out times and actions.  Faces are focused.  Minds are alert and assessing, searching for causes and solutions within milliseconds of coming to the bedside.  They have done this before and settle into their comfortable roles.  The night shift team are a little more earnest and confident.  They know that reinforcements are not coming.  This is night shift.

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When the emergency has passed, for better or worse, the team returns to its tasks.  The work and night continue.  

Despite the craziness and sleep deprivation, night shift is awesome.  Most people dread working at night and do not understand why any sane person would choose to work the late shift.  It is not the frappicinos.  It is not the chance of watching cat videos for hours.  It comes down to the men and women sharing the nursing station with you.  They don’t always get along, but they are always in it together.  They create the secret awesomeness that is night shift.  

Shhhhhh don’t tell the boss! 

 

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