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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.

 

Nurse Blog Carnival

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Nursing is Bigger on the Inside

tardis

 

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. 

doctor-who-its-bigger-on-the-inside

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.

Nurse Blog Carnival

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Private Fears of Healthcare Workers

I saw the tweet shoot across my phone during a meeting.  Someone had walked into Brigham and Women’s Hospital and shot a surgeon.  I did not know the story.  I did not need to read the details to feel the familiar terror creep into my heart.  It is not something that nurses often talk about.  In the privacy of break rooms, during whispered conversations and in our own minds we admit that patients sometimes scare us.

Death, birth, illness, surgery, dementia, sleep deprivation, drug induced psychosis, and alcohol withdrawal are examples of the dangerous landscapes that healthcare workers navigate each day.  I have been a nurse in many different situations and types of patients.  Labor and delivery is one of the most volatile units in a hospital.  Emotions run high when mothers and babies are involved.  Babies do not always go home with their mothers.  When child protective services is taking custody of a newborn, there is a palpable stress on the unit.

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Nurses are an easy target for angry parents.  Nurses are blamed, by parents, for reporting mothers who test positive for illegal drugs.  Threats against nurses and doctors are common in these type of situations.  Threats can lead to actual violence.  I have been physically hurt by angry patients.  I have seen nurses punched in the face, choked and pinned against walls.  In the back of my mind I am always planning my escape route.  My internal alarm goes off when I see a father stomping across the unit.  It makes me uncomfortable to see the poster banning guns from the hospital grounds.  Its a daily reminder that we are defenseless against a shooter that disregards that posted warning.

Hospitals practice disaster drills, one of which is an active shooter drill.  We prepare for the worst.  We hope we never have to face what Dr. Michael Davidson did on January 20th.  The investigation in the Brigham and Women’s shooting is still ongoing.  We do not know the relationship between the doctor and the shooter.  Regardless of the relationship, it will not decrease the worry and fear that healthcare workers live with in order to do their work.  Our mission and passion is to care for patients.  Patient safety is our top concern and what we base all care around.  On days like today, we are reminded that we need to also worry about our own safety.

As I was writing this post I recieved another tweet.  The surgeon has died. Dr. Michael Davidson, your colleagues around the nation are thinking about you tonight and mourning your loss.  Our thoughts and prayers go out to his family in this sad time.

 

 

 

 

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A Call to Labor Nurses: Go to the Bedside

One to One Nursing Care for Actively Laboring Mothers

Not all hospitals are able to, or choose, to staff their labor units according to AWHONN guidelines.  Many hospitals recognize that one to one nursing care for actively laboring mothers is the gold standard and is safer for mom and baby.  I have worked in both types of facilities.  Nurses that are able to care for mothers one to one can give a great gift of time and attention to their patients.  Mothers in labor do better when they have continuous support.  I feel lucky to work at a hospital that strives for one to one staffing.  I am making a call to labor nurses, go back to the bedside.  I love working with you ladies and gents.  You make me laugh.  The nursing station is a fun place to joke around with people whom understand you in a way that even your family can not.  I love swapping war stories and sharing photos of babies with you.  As much as I love this interaction with you at the nursing station, I ask you to go back to the bedside.  The mothers need us.  Laboring mothers need continuous support.  Remember labor sitting?  We need to bring that back!  With continuous support mothers are less likely to need medical interventions.  You will be able to recognize subtle differences in your patient’s status.  You will have more time for observation, assessment, education and supporting the mother and her family.  One to one staffing is a great gift for both the nurse and the mother.  Sometimes a mother will request less of your presence at the bedside.  This is rare.  All mothers should have continuous support during labor, even when they have has an epidural.

Quietly sitting, charting and guiding the mother is reassuring and decreases maternal stress.

It may seem awkward at first.  It will become normal very quickly.

 

nursing station

 

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Nurse Burnout: 12 Ways to get Your New-Grad Happy Back

Nurse burnout happens.  No nurse is immune.  If you are a nurse you are at risk for burnout.

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Remember how it felt to be a brand new nurse?

The only thing more shiny than your new stethoscope was your happy face.

happy dance

 

 

 

 

 

 

 

 

 

 

 

I diagnosed myself with nurse burnout when I started thinking that driving my car off a cliff sounded better than going to work.

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I was able to get back to my nursing happy place and I am in love with nursing again.

Here are some ways to get you back to happy-dancing your way to work.

 

 

1.  BLOG!  I love it and I’m not the only nurse on the interwebs!  If you are not a writer then read nursing blogs.  There are all flavors of nursing blogs, from informative to hysterical.

Some suggestions to get you started: Mine of course!   Adventures of a Labor Nurse   The Nerdy Nurse     Nurse Together     Mighty Nurse     Scrubs     Digital Doorway

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2. Go back to school.  Getting your BSN, MSN or DNP will make you more marketable and open up more options.

Going back to school will reenergize you about nursing.

You will read a LOT about new nursing research, which will get you out of a nursing rut.

You will be so busy making powerpoint presentations and writing discussion posts, you will have no time to think/complain about work.

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3. Get certified in your specialty.  If you are burned out then you probably have been a nurse more than 2 years.  Congrats!

That means that you are qualified to become certified in your specialty.

There is a certification for just about everything nursing related.

Look for your specialty on ANCC or NCC to start.  You will be recognized for your knowledge and add to your credentials.

Maintaining certification means that you will need to keep up continuing education in your speciality, which will prevent you from becoming stagnate.

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4.  Take your vacation days!!  Everyone needs a break.  Nursing is stressful.

If you don’t take vacation for yourself, then take it for your patients.  Being a relaxed and refreshed nurse will benefit them.

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5. Celebrate wins.  We are always focused on what we need to improve and what we are doing wrong.

When you or your team have a win, celebrate!

raise the rooof

 

 

 

 

 

 

 

 

 

 

 

 

6. Take some time for yourself.  Nurses know how important self-care is, but its difficult to find the time. Find it!

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7. Join a committee.  Make changes.  Give your input.  Does your hospital have shared governance or unit representation to make decisions?  If yes, join.  If no, start it! You can change nursing practice.

 

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8.  Be active.  Exercise can help improve mood and is a great outlet for work frustrations.

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9. Go to a Nursing Conference.  

There is nothing better than going to a conference full of nurses.  People think that ComicCon is weird, but they have never been to a nursing conference! We have crazy nurse fun!

It is a great time and it is a place where you are reminded why the heck you became a nurse.

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10.  Spend some time with your work buddies away from the call lights and nurse rounds.

You know you love your team.  An out of work activity can remind you that your work pals are awesome.
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11. Attend a continuing education course or webinar about a topic that interests you.

Will you be inspired by experts talking about the topics that they love.

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12.  Quit.  Not nursing, but quit your job.  Sometimes you really don’t have nurse burnout, but job burnout.

One of the best things about being a nurse is the vast opportunities you have for employment.

If you need a change of pace, location or specialty do it.  Give a proper notice and leave on good terms.

You never know when you may work with those nurses again.  (It will happen.)

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Nursing is a rewarding profession.  If you feel yourself getting disenchanted, actively try to get the magic back.

 

If you are successful you will be back to the new grad feeling which is good for you and your patients.

 

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How do you beat the nurse blues?  Leave your suggestions in comments.

 

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Free PDF: Caring for the Patient with an Eating Disorder

 

 

Perinatal nurses are now caring for patients that are higher acuity and with more comorbidities.  Caring for a mother with an eating disorder is rare, but does happen.  Your hospital should have policies in place for caring for these patients.  Attached is a free, one page, information sheet as a quick guide when a patient with eating disorders is admitted on your unit.  Pregnancy can be a stressful time in which old behaviors can return.  A better understanding of this disorder can help you care for mothers that are struggling with these issues.

This is general information is for all adult patients with eating disorders.  Each patient and care plan will be unique and take into the specific patient’s needs, assessment and input from the entire healthcare team.

CLICK BELOW FOR FREE PDF (with references):

Adult-Eating-Disorder-Patient-Overview-1

 

Adult-Eating-Disorder-Patient-Overview-1-page-001

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23 Ways You Know You Work Nightshift

This was you when you decided to try nightshift.
1. This was you when you decided to try nightshift.
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2. This is how you ask to be low censused after you had to stay up all day.
You avoid the sun.
3. You avoid the sun.
You have become an expert in the art of sarcasm.
4. You have become an expert in the art of sarcasm.
You become like siblings to your nightshift buddies.
5. You become like siblings with your nightshift buddies.
Drinking at 0800 seems perfectly normal.
6. Drinking at 0800 seems perfectly normal.
This is how you greet the dayshift when they are late.
7. This is how you greet the dayshift when they are late.
Your beauty maintenance tends to get behind.
8. Your beauty maintenance tends to get behind.
nowhere
9. This is your response when the charge nurse asks where you would like to float.
This is how you feel when you get the message to come in on call.
10. This is how you feel when you get the message to come in on call.

 

This is the look  you give the  person that asks you to stay 4 more hours after your shift.
11. This is the look you give the person who asks you to stay 4 more hours after your shift.
What you say to every meeting that is scheduled at noon.
12. What you say to every meeting that is scheduled at noon.
Running to codes is a breeze.
13. Running to codes is a breeze.
You have seen so much that in emergencies you are eerily calm.
14. You have seen so much that in emergencies you are eerily calm.
This is how your family feels when someone rings the doorbell during the day.
15. This is how your family feels when someone rings the doorbell during the day.
No topic seems inappropriate after 1 AM.
16. No topic seems inappropriate after 1 AM.
When you hear that one of your best friends is going to dayshift.
17. When you hear that one of your best friends is going to dayshift.
This is how you feel when someone tells you how nice it must be to sleep at work.
18. This is how you feel when someone tells you how nice it must be to sleep at work.
Everything is funny at 4 in the morning!
19. Everything is funny at 4 in the morning!
Your bedroom has black out curtains, blankets, or tinfoil on the windows.
20. Your bedroom has black out curtains, blankets, or tinfoil on the windows.
How you feel when your lunch/nap alarm on your phone wakes you up.  Back to work!
21. How you feel when your lunch/nap alarm on your phone wakes you up. Back to work!
How you feel after working a 6 night stretch.
22. How you feel after working a 6 night stretch.
No matter how crazy working nights can be, you are grateful to work with the best people ever!
23. No matter how crazy working nights can be, you are grateful to work with the best people ever!







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Acknowledgements: All gifs were found on google 🙂
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10 Ways to Bring Back the Magic to Labor and Delivery 

All babies are special, but first babies have the unique gift of changing a woman and man into a mother and father.  There is something extra special when a family is welcoming their first child or grandchild. There is also something special about the first baby of the year. Nurses, all over the world, are betting on which mom will deliver the first baby of the new year.  Each hospital wants to be the first in the area to claim the New Years’s baby.  Newspapers will feature photos of the star newborn. The lucky first-of-the-year babies will be showered in gifts from hospitals and companies.

There is a lot of focus on the first baby of the year and nurses ensure that the birth is special and celebrated.  This is a fun tradition, but that feeling fades quickly as the never ending line of pregnant mothers stream in for delivery. Even the most benevolent and happy nurse can forget that every delivery is someone’s special day. Some days feel like just another ordinary day at work.  Nurses have bad days just like everyone else. The difference is that a labor nurse’s bad day can darken a family’s memory of their birth forever.

When labor nurses begin to lose sight of the magic of birth it is important to recharge, refresh and relearn what makes each birth special.

 

Here are 1o ways to bring magic back to labor and delivery:

 

1. Identify something you like about your patient. This may be difficult with some patients, but everyone has some redeeming quality. Find it.

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2. Smile. If you smile your patient will feel welcome and it can change your attitude as well.  Fake it till you make it.

 

funny ctm

 

3. Acknowledge and speak to all the people in your patient’s room. The mama is not the only one welcoming a baby into the world.  The patient’s family is important and they will appreciate being recognized.  Also they can be recruited to help get ice, hold legs and fan the patient.  The people in the room will be the ones that will be there to support the mom at home when she is tired and needs help. Include the whole family in patient education so that they can help mom and baby transition successfully.

 

CALL THE MIDWIFE - SERIES 3 - EPISODE 8

 

4. Include the partner or coach in conversations with the patient. A mother’s support person needs to understand and give input on the patient’s plan of care. The decisions are the patients to make, but they often look to their partner or labor coach for guidance.

Including the partner in the conversations with the patient establishes trust and is an element of family centered care.

 

lunch

 

5. Take lunch off the unit. This may be impossible at some hospitals.  If at all possible, leave the unit for your break. Go outside and breathe real air. Take a walk in the sunshine and absorb some vitamin D.

 

6. Use your relaxation skills to relax yourself.  You teach these techniques to patients every day, those same relaxation techniques can benefit stressed nurses!

 

7. Use your vacation days. Don’t hoard vacation days. People that take less vacation days have less job satisfaction.

 

vaca

 

8. Join your professional nursing organization. Keeping up to date on new research is exciting and stimulating. Challenge yourself and continue to grow in your specialty.

 

Call the Midwife - Ep 4

 

9. Go out of your way for your patient at least once a shift. They may not thank you, but you will know that you put in extra effort to make your patient’s stay better.

 

lice

 

10. When the baby is born take a few seconds to look away from the IV pump, computer and delivery instruments. Witness a new person take his first breath. Watch as a mother holds her baby’s for the first time. Look at a father’s complete reverence and amazement at the miracle that has just occurred.

 

Doris Aston CTM

 

My New Year’s wish is for all nurses to be reenergized in 2015.

Take the time to make every delivery special for your patients.

For nurses it is just another day at work, but for each mother it’s a day that she will always remember.

 

 

 

 

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