BarefootNurse

Live from Las Vegas... EMS World Expo!

2011-09-01T16:55:00.000-04:00

This is the first time I have ever attended a large scale EMS conference (I understand that EMS World Expo is the largest in North America) and it has been incredibly fascinating networking and meeting people from not only the United States but Europe and Canada. As an advanced practice nurse in Emergency & Critical Care I have a different perspective than that of my pre-hospital counterparts, but what I have truly come to appreciate this week is the need for continued focus for the collaborative and integrative approach to care between pre-hospital and hospital personnel and organizations. And not just with direct patient care management, but with quality improvement, patient outcomes and community outreach initiatives.

We as healthcare professionals tend to stay close to our own kind but it is important to branch out and seek knowledge and learning opportunities from other disciplines as we are all working to the same end and have an important role to play. Getting a different perspective on issues or perhaps solutions can improve system processes and ultimately improve patient outcomes. I met some interesting people that share the same challenges and obstacles in their systems of care thousands of miles away and even on different continents; a great reminder that we are all doing the same work and trying to improve care delivery and patient survival. I am a huge proponent of working smarter not necessarily harder; we have a lot to learn to from each other if we just listen.

Check out some helpful links:

EMS World EXPO
EMS 12-Lead Blog

Using technology as a learning and reference tool

2011-08-18T20:14:00.002-04:00

This past spring I made a giant leap in smartphone technology - I reluctantly gave up my Blackberry (TM) and switched to a phone with the Droid OS. I sincerely believed I was going to be sad and unorganized and go through Blackberry DTs but to my surprise I wondered why the heck I waited so long to make the switch to this teeny-tiny super computer! Since acquiring my Droid four months ago I have loaded it with all sorts of very cool apps, most notably nursing and medical calculators, references, and resources that are always available as quickly as my fingertips can slide and tap across the screen. Instead of carrying 4 and 5 pocket-sized reference books in my lab coat pockets I have my smartphone and iTouch ready and waiting.

One of the best things with apps is the portability and the availability to research or study almost anywhere. Which is why I am super excited to share the upcoming release of the 12-Lead Challenge App for novice, intermediate, advanced and expert clinicians both in the pre-hospital and hospital settings. This app will prove both challenging and educational whether you are just brushing up on skills, preparing for licensure or certification exams or just want to have some fun with ECGs. Look for it in the coming weeks where Apple and Droid apps are sold.

For more information click on the icon below:

Learning to write again - the art of writing an abstract

2011-07-31T16:53:00.001-04:00

I have always prided myself with the fact that I was a pretty good writer. And having spent the past 5 years in academia furthering my education, being published and of course the myriad of polices, procedures, clinical guidelines, executive summaries and other miscellaneous clinical reports that I seem to write on a daily basis again confirm that I am fairly good with the written word. Until this summer that is. Perhaps it is not so much the words but the format. I have recently started writing abstracts and speaker submissions for conferences which is new for me. And it is very different. It started earlier this year when a colleague asked me to help her write an abstract for a poster presentation for her professional conference - what a challenge it was having word and character limits not to mention special formatting requirements. Then I attended NTI in Chicago and got inspired...so I submitted two proposals for live speaker sessions at NTI 2012 in Orlando. And I have to say that I wish I could go back and re-do them. Since the AACN deadline in June, I have submitted another proposal and it was so much better...I am starting to get the hang of it. It's like giving a sneak peek of something - like a television show. You want to pique curiosity and sell your idea, but you don't want to give away too much, because then there is nothing left to watch or see and you have to do it in so many minutes or in this case words and characters, but you also have to provide certain key details. So now it is hours away from August and I have submitted a total of 3 or 4 abstracts or speaker submission proposals and I now wait to see if any will be accepted. Even if they are not, it's okay, the experience itself has taught me a great deal and I am sure I will continue to learn and master this new way of writing. Besides there are many more opportunities ahead.

E-learning resources

2011-07-19T18:52:00.000-04:00

I am always looking for internet-based resources that provide medical, nursing, & healthcare news, education, literature and other information that I may find useful in my daily work or studies. That search also includes needed educational contact hours for certifications and licensures. Here is a great blog that has organized some great information for nurse practitioners. Please check it out!

25 Useful Dot-Edu Resources for Nurse Practitioners

Work Life - Balance

2011-07-15T21:50:00.000-04:00

I recently wrote about and shared an article about finding peace and balance in our work and non-work life hours. Here is another article on subject that highlights the importance of achieving balance in our lives.

Nurse Leaders Offer Wisdom on Achieving Work–Life Balance - NurseZone

Big Chill May Save Lives

2011-07-14T18:56:00.000-04:00

Another article supporting the use of Therapeutic Induced Hypothermia psot-cardiac arrest to preserve pre-event baseline neurological functioning:

Medical News: Big Chill May Save Lives - in Cardiovascular, Arrhythmias from MedPage Today

3-2-1 Time-Out

2011-07-08T12:16:00.001-04:00

Today's space shuttle launch of Atlantis is a great opportunity to discuss the Universal Protocol or "Time-Out" process. The launch nicely demonstrated the importance of the time-out process and why it works. Using checklists have long been used in the aviation industry and for good reason, yet healthcare entities, namely surgical and procedural areas remain reluctant to embrace the practice.

With 31 seconds on the countdown clock of the final Space Shuttle Mission due to a failure of the camera, the clock briefly stopped. The failure prompted the NASA team to ensure the swing-arm had cleared the external hydrogen tank in preparation for take off. Each Mission Control member was heard verbally confirming the arm was clear. After it was determined that it was in fact clear, they all had to verbally agree to proceed followed by a mini-countdown to resume the official countdown clock to lift-off.

I was impressed at the order and efficiency in which the NASA officials identified the issue, determined it was acceptable and resumed the countdown, only after everyone confirmed and agreed it was safe to proceed. Bravo to them - they continue to be light years ahead of medicine!

Finding Peace

2011-07-08T08:15:00.001-04:00

As I sit here on my final full day of vacation looking over the sparkling blue waters of Lake Huron sipping my hot coffee breathing in the crisp air, I realize that I am totally relaxed and at peace. This is a far cry from where I was just one week and a day ago. As a critical care APN and ER nurse (and ACNP student in the ER) my work life is anything but calm. Add to that my flawed over-achieving, have-to-do-it-now-or-the-world-is-going-end & it-has-to-be-pretty-close-to-perfect thinking; it is the perfect set up for disappointment and lots of stress!

Ironically, I found this very timely article today about nurses and stress that I had to share as my vacation comes to an end tomorrow and we began the scenic drive back down towards the city and then take our plane back to our hometown and begin our hectic lifestyle all over again. I hope to heed the advice given - especially the work/life balance! Enjoy (it certainly can be applied to anyone in healthcare)

The Path to Stress Prevention for Nurses: Straight Talk, Simple Tips
http://tinyurl.com/3u3alew

From Standing Tall to being Strong!

2011-05-14T09:46:00.000-04:00

Together. Stronger. Bolder. That's the new theme unveiled at AACN's 2011 NTI conference by incoming president, Mary Stahl just a couple short weeks ago. I can safely say it was received excitedly by the 7,000+ critical care nurses in attendance, as the crowd chanted the mantra. This once again a awesome transition from previous year's themes - Act with Intention & Stand Tall. I commented on Facebook after the supersession that the themes were 'brillantly synergystic' - and they are. These themes build and compliment each other calling on nurses to reach higher, stretch further, & work harder at doing what we do everyday. I am excited to share this theme with my not only my nurse colleagues but all those that impact patient care and incorporate this year's theme into my daily work. What does Together. Stronger. Bolder. mean to you?

NTI Count Down!

2011-04-16T08:39:00.007-04:00

In less than a month, thousands (yes thousands!) of nurses will converge upon Chicago at the annual AACN NTI conference. Besides the fact that I have never been to Chicago (so looking forward to visiting the Windy City) I am looking forward to all the brain food! Other than a couple pre-conference courses, I am still combing through the offerings in attempt to maximize my learning potential and to network with so many nurses and other professionals. I truly had no idea how 'big' NTI was until attending my first one last year in Washington D.C. You can read my story and read the ad by clicking this link: NTI Story. It is an amazing conference and a fantastic (and fun) way to reignite your passion for nursing.

Hope to see you there!

Stand Tall - enjoy what you do!

The Great Debate

2011-03-13T08:33:00.003-04:00

Aside from patient safety and quality scores, I bet the hottest topic in nursing is the entry into practice debate. An interesting article arrived in my e-mailbox this morning about the BSN becoming the required degree for entry into nursing practice. The debate is not new - in fact it has been going on for 47 years! And if you read the many, many comments posted in response to the article, it is clear that nurses have strong and varying opinions about the topic.

The article highlights several well-known studies and publications (see below for links) that support the BSN as entry into practice as well as support better matriculation and progression between colleges and universities. What the article did not address is the issue of continuing education (CE) for renewal of licensure. According to the ANA, a little over half of US states have this requirement. It is my opinion that continued learning and education is an essential part of developing and maintaining professional practice and ensuring safe, quality care by nursing staff. Many nurses do little to enrich their clinical practice or keep current on best-practices, products & technology, medications and other relevant topics. Once nurses have completed their degree (no matter what level), how do we keep them on the path to ongoing learning?

There is no doubt that there are many issues that need to be addressed if states are going to require a minimum of a BSN for entry into nursing including requirements for current non-BSN nurses, costs, scheduling, wages, etc. Nurses need to understand the potential benefits and positive impact of a change such as this on patient care. And hopefully the push is to focus on providing the highest quality care to patients and not for recognition purposes.

Links:

Future of Nursing Report

AACN - The Impact of Nursing Education on Practice

What I'm reading

2011-02-08T19:21:00.006-05:00

I have provided links to a few interesting articles related to various critical care topics. These are of particular interest to me and are currently 'hot topics.'

This article stresses the need for community education regarding the use of AEDs and early intervention:
Strangers are Unwilling to use AEDs in a Pinch

More reinforcement of treating sepsis as an emergency code:
Early Antibiotics Reduced Mortality in Septic Patients

More trouble for Dopamine?
Steriod-Dopamine Combination May Be Fatal in Septic Shock

Happy reading...

What's in a name?

2011-01-30T08:40:00.008-05:00

One of my favorite bloggers (thanks EMS12Lead) sent me the link to a great article* written by a pediatric NP, about the negative impact the term "mid-level provider" has on nurse practitioners, physician assistants and patients a like. I did a quick search of the term and was surprised at some of the 'definitions' that returned:

A mid-level provider, sometimes referred to simply as a "mid-level", is a clinical medical professional who provides patient care under the supervision of a physician. Mid-levels are referred to as such, because they are somewhat "in between" physicians and less qualified nurses, techs, and allied professionals in the level of health care they are licensed to administer. From: About.com Health Careers
A health care provider–eg, nurse practitioner, physician assistant, etc, whose activities are directed and/or dictated by a supervising physician on whom liability for those activities rests. From: MedicalDictionary

The results are many when you search the term "mid-level providers." Not surprisingly, the term is not supported by professional nursing organizations. In fact, the AANP has published a position paper regarding the use of the term and its consequences. The position taken is that the term is demeaning and confusing for both patients and health care providers; the implication is that NPs provide less than adequate care. This issue is more than semantics, but another facet of how nurse practitioners and other advanced practice nurses (CNS, CRNA, Midwives) impact the delivery of high-quality care in a climate of meeting ever changing quality standards, CMS reimbursement and preventing complications and never events.

No doubt as the health care reform debate continues, with more patients seeking access to the health care system in addition to the shortage of all types of providers, these sort of debates detract from the ever growing problem of ensuring the delivery of safe, quality patient care. At the risk of sounding Kum-By-Yah-ish, should we not be focusing on ensuring that all health care providers work to the full extent of their scope of practice and deliver appropriate, cost-effective care?

See also a previous post on APRN practice

An interesting take written by a physician (be sure to read the comments): The Eroding Physician Brand

*Link to referenced article: I Am a Nurse Practitioner, NOT a Mid-Level Provider!

Systems of Care

2011-01-22T20:15:00.005-05:00

In this month's issue of Critical Care Medicine, there was a fantastic article on systems-based cardiac arrest care. The authors showcase implementation of the "Take Heart America" program in two Minnesota towns. The study objective was to evaluate care before and after implementing the program. The focus of the THA program is to train entire communities from the lay public to providers of emergency services in early recognition and evidence-based intervention of cardiac arrests. Such interventions include:

AEDs widely available in communities

Public education to include CPR & AED training

Early activation of EMS

Quality pre-hospital care to include: advanced airways, intra-osseous drug delivery, ipedence threshold devices and automated CPR devices

Hospital care, centers of excellence to include: accessibility to revascularization, ICDs and EP, therapeutic induced hyptothermia

Data collection and analysis

The goal: to improve survivability after cardiac arrest events by ensuring all stakeholders have the knowledge and resources they need to reach that goal. This is a excellent example of how a system-wide evidence-based and standardized approach to care can greatly impact patient outcomes.

I have provided a link to the abstract below.

Take Heart America: A comprehensive, community-wide, systems-based approach to the treatment of cardiac arrest Lick et al. Critical Care Medicine: January 2011 - Volume 39 - Issue 1 - pp 26-33
doi: 10.1097/CCM.0b013e3181fa7ce4

Making it personal

2011-01-12T18:10:00.003-05:00

I read a great a great article in a recent issue of ADVANCE for Nurse regarding nurses and healthcare providers working in areas of clinical practice that they have personal experience with. Often patients and families are discouraged and frustrated as nurses educate them on making healthy lifestyle changes that seem to take something away from them or require strict adherence to medical regimes. The nurses showcased in this article have taken their struggles and victories with various diseases and illnesses to dedicate their professional practice to caring for those with the same issues. It is more than simply practicing what they preach, but relating to patients on a intimate and human level, applying personal experiences to caring practices.

Many of us have stories of illness and struggle. Choosing to use those stories in professional practice is truly inspiring.

Follow this link to the article:

"Being a Good Role Model: Nurses' health histories - good and bad - influence patients." By Sandy Keefe, MSN, RN

APRN Scope of Practice Issues Revisited

2011-01-11T18:11:00.004-05:00

There has been much discussion in the media and among professional nursing and medical organizations regarding the impact the Affordable Care Act, the health care law that was passed March 2010 on providers of healthcare. It is an understatement to suggest that this law will impact all levels of providers within the healthcare system and it is important that we as providers and caregivers alike understand the impact the Affordable Care Act will have on our current and future roles as nurses and physicians. I encourage you to read this very positive article from the New England Journal of Medicine: Perspective (see link below). I also encourage you to stay informed and involved with your professional organizations and state licensing boards as we embark on certain changes in the way we deliver health care.

Broadening the Scope of Nursing Practice

See also:

National Association of Clinical Nurse Specialists

American College of Nurse Practitioners

Peds Part I

2010-09-07T06:03:00.006-04:00

I read a great blog (510 Medic) about the importance of taking vital signs in pediatric patients. The author cites great research on how often vital signs are not taken, especially blood pressure which puts our patients at risk if we are unable to properly assess and measure vital sign data. This issue cannot be underscored and is applicable to all providers in the emergency services - both pre-hospital and in the hospital. I often get asked about pediatric assessments (including vital signs) from nurses and paramedics alike. My answer is always the same...what does the child look like and do the vital signs match the rest of the clinical picture?

For instance, some years ago I had an ED nurse tell me that an infant had a respiratory rate of 8 - 10 and was in no distress. Apparently I had an alarmed look on my face as she questioned my concern. I asked, "what does the child look like - color, skin temp, capillary refill, respiratory effort, etc.?" She proceeded to tell me the child was comfortably sitting in the mother's lap, skin very warm, flushed cheeks, but taking Pediatlyte from a bottle. Obviously I reassessed the child including vital signs and found that the respiratory rate was in fact almost triple the original rate and the heart rate was quite tachycardic due to fever.

It is important that we synthesize all the patient data and evaluate what we are hearing or seeing. Does it make sense with the clinical picture?

Thanks to 510 Medic for addressing a topic near and dear to my heart! Stay tuned for Part II with a discussing breaking down the numbers and correlating to the pediatric assessment.

Celebrate Clinical Nurse Specialists!

2010-09-04T08:42:00.002-04:00

2nd Annual National CNS Week September 1st - 7th

Clinical Nurse Specialist Facts from NACNS:

Hildegard Peplau, RN, Ed.D. (9/1/1909 – 3/17/1999), is the founding mother of the CNS role. Rutgers University School of Nursing is the birthplace of the CNS role.
Dr. Peplau was a nursing theorist who published a landmark work in 1952 titled, "Interpersonal Relations in Nursing." She emphasized the nurse-client relationship as the foundation for nursing practice, and the important partnership model that focused on shared experience through observation, description, formulation, interpretation, validation and intervention. This theory was considered "revolutionary", since at that time clients or patients typically were passively receiving treatment and nurses were merely acting out doctor’s orders. In 1956, Dr. Peplau established the first nursing Master’s Degree program with a focus exclusively on clinical practice. Graduates of this program were called "clinical specialists."
Health systems across the nation are commemorating this recognition week. Plans include community activities and public lectures, receptions honoring Clinical Nurse Specialists, wellness fairs, community outreach, and fundraisers promoting the spirit of nursing, such as organized walks or golf outings which in turn support underserved communities or particular health concerns.
An estimated 72,521 Clinical Nurse Specialists practice in the U.S. They are licensed registered nurses who hold masters or doctorate degrees in nursing.
CNSs are expert clinicians in a specialized area of nursing practice. The specialty may be identified in terms of a population (i.e. Pediatrics), a setting (ie. Emergency Dept.), a disease or medical subspecialty (i.e. Diabetes), type of care (ie. Psychiatric), or type of problem (i.e. Pain).
CNS practice improves the healthcare environment and outcomes by influencing: direct care of patients/clients, nursing standards and personnel, and care delivery systems. In other words, as leaders CNSs drive innovation in their environments from care at the bedside to system-wide improvements.
Examples of outcomes of CNS practice: reduced medical complications in hospitalized patients, reduced hospital costs and length of stays, improved pain management practices, increased patient satisfaction with nursing care, reduced frequency of emergency room visits.

More proof that STEMI Systems work

2010-08-14T08:19:00.001-04:00

A recent news article showcased the coordination of care between EMS and a hospital in Vancouver for patients having an MI: En-route diagnoses save heart attack victims’ lives. It is unfortunate that despite increasing global evidence that pre-hospital diagnosis is an integral piece of improving patient outcomes with STEMI, there are still barriers and turf wars that prevent the same. So how do we change this?

Putting a sacred cow to pasture - cervical and spinal immobilization

2010-08-08T08:38:00.006-04:00

The American Emergency Physicians News recently published a piece on the use of spinal immobilization and cervical collars. Despite evidence against the use and very little evidence that using immobilization techniques and equipment protects the patient from further injury this practice continues to put patients at risk for injury. There is increasingly more literature that discusses the harms associated with inappropriate cervical and spinal immobilization, which is defined as either incorrectly applied devices or inappropriately placed on patients without signs/symptoms of injury. This practice has been under scrutiny since the 1980s yet both pre-hospital and emergency departments use this practice routinely despite valid and recent evidence recommending otherwise. Disclaimer: this is not to say that there are not situations that spinal and/or cervical immobilization is not appropriate or necessary; and there is literature that supports this practice.

Further contributing to increased morbidity is prolonged immobilization once in the emergency department. Delays in being evaluated by an emergency department physician or nurse practitioner leave the patient lying immobilized for a prolonged period of time increasing the risk for extension injuries, skin complications, airway complications, elimination issues and emotional distress. Many nurses are not trained or competencied to adequately care for a patient with cervical collars and/or spinal immobilization let alone application and removal; this is often the case in non-trauma centers or in an academic institution with medical residents. Nurses often lose track of how long their patients are immobilized and a substantial delay occurs before being evaluated and removed from such devices. Once in the emergency department, nurses must advocate for their patients and treat immobilization as a priority of care.

Both paramedics and nurses must be familiar with evidence-based practices and know both the risks and benefits of the care they provide. Performing a skill on the basis of “that’s how we’ve always done it” is dangerous business for the patients we care for and it is incumbent upon us to ensure the care we provide is rooted in evidence and not just another scared cow.

The return of communicable diseases

2010-07-25T08:26:00.003-04:00

There was a story today in the NYT Health section regarding people contracting Dengue fever in the Florida Keys. In recent weeks, there has been much discussion of the alarming rate in which Pertussis (Whooping Cough) has spread in California and other parts of the country. This is concerning for me and should be for all healthcare providers in all settings (prehospital, emergency departments, outpatient clinics, acute care/inpatient, etc). Many communicable diseases have previously been eradicated with vaccinations and have not been an issue for decades. Unfortunately, many of us would be unable to recognize many of these diseases; especially those such as dengue fever with vague, nondescript sympotomolgy.

So what does this all mean? The resurgence of communicable diseases requires education for all healthcare providers that may potentially come in contact with infected individuals. Ensuring vaccination to diseases such as pertussis and measles is also important to protect your own health. Both of these efforts are especially important for both EMS and emergency department staff (paramedics, EMTs, nurses, physicians, NPs, CNSs, patient care techs, etc) that have first contact with patients.

Education is perhaps the single most important step we can take for both ourselves and our patients.

Know what, if any communicable diseases have been reported in your geographic area or region. The CDC, WHO and local health departments have free information for both healthcare providers and the laypublic.
Many state health departments send memos to hospitals and EMS systems to alert providers the status of various diseases in the region. These memos are a great resource, providing information on symptoms, transmission, incubation period, disease course and priorities for treatment.
Look for teachable moments: Encourage high-risk populations to vaccinate their children and themselves, use cough-etiquette and perform good hand-hygiene.
Educate your colleagues: share the information you recieve and promote personal safety practices such as hand-hygiene.

Taking a proactive rather than reactive approach may help to reduce the incidence of these deadly diseases.

Lateral violence among nurses

2010-06-30T19:08:00.002-04:00

There is a great discussion at allnurses.com regarding the age-old issue of "nurses eating their young". It is amazing to me that for all the compassion nurses have for patients and being ranked as the most ethical profession, nurses have no reservations turning on each other. Disclaimer: Not all nurses are guilty of this behavior; but not all nurses will intervene or stop one nurse from harassing another either. And lately it seems that there is a renewed emphasis on lateral violence and healthy work environments by many nursing organizations which aim to raise awareness and empower nurses to not tolerate such behavior (a great effort and much needed topic for discussion). But I have to ask will this ritual ever end?

Tall Stan - Part 1

2010-06-10T19:35:00.009-04:00

The new AACN theme introduced Tall Stan - this is my Stan sporting palm tree scrubs!

Stand Tall means to recognize the unique and indispensable role nurses play. Recognize it, understand it, articulate it, own it, accept responsibility for it, and celebrate it.
Stand Tall — be proud of what you do.
Stand Tall — speak up.
Stand Tall — together we can do more.
Stand Tall — own the outcomes of your work.
Stand Tall — enjoy what you do.

-AACN

Stan working on evidence-based practices!

Nurses, keep talking

2010-06-02T22:23:00.005-04:00

Poor communication between healthcare providers including nurses and physicians has been linked to various types of patient safety events. As a patient advocate it is important that nurses ‘speak up’ for their patients and convey critical information accurately and timely. During a typical patient admission, many different units may care for a patient transferring care from one clinical unit to another. Continuity of care depends on the communication of various medical information, plan of care and response to treatments to ensure safe and appropriate care; providing information in a concise manner is important in reducing the risk of errors. Communication problems frequently lead to serious safety events which makes it a high-risk process.

What is good communication? Clear, accurate communication that conveys the patient’s clinical story and ensures the appropriate treatment and care for that patient.

What is meant by hand-off communication? Hand-off is the process of communicating patient information from one care provider to another. Examples include: nurse to nurse shift report, between levels of care, nurses and physicians, care management staff and other care providers, and care providers to patient/family.

Strategies for good communication:
¬ Use clear language – avoid slang terms
¬ Limit interruptions
¬ Standardize routine reports, such as shift to shift or unit to unit, such as SBAR technique
¬ Use tools and technology as available – standardized report tools such as the trip ticket and
Kardex, electronic charting and portable phones
¬ Provide an opportunity for the receiver to ask questions
¬ Repeat back information such as orders or diagnostic results

Keeping patients safe involves more than keeping patients free from physical or
psychological harm but communicating important information in a way that promotes
optimal outcomes.

For more information check out these links:

http://www.nursezone.com/nursing-news-events/more-features/SBAR-Improves-Communication-in-Patient-Handoffs_21756.aspx

http://www.psnet.ahrq.gov/primer.aspx?primerID=9

Lessons Learned from NTI

2010-05-30T09:13:00.002-04:00

As a newbie to AACN’s NTI (American Association of Critical Care Nurses, National Teaching Institute) I did not know what to expect; I certainly did not know how ‘big’ and overwhelming the conference was going to be. And inspiring. I cannot possibly list all the incredible sessions I attended, interesting, intelligent people I met, and information I learned. But I can tell you that being in a room with over 7,000 nurses aspiring to provide the best, safest, quality, evidenced-based care they can was exciting. Sharing success and challenges, heart-wrenching stories and uplifting accomplishments was both invigorating and frustrating. This is what healthcare is supposed to be – nurses committed to caring, compassion and excellence; living it, everyday. Isn’t this why we got into nursing in the first place? Because we care and desire to nurture and heal those who are ill or in need?

One of the highlights of the conference is the AACN president’s message. The current president inspired us and shared how we have “Act[ed] with Intention” as she passed the reigns to the incoming president who unveiled her theme for 2010: “Stand Tall.” So the question is what does it mean to “stand tall” as a nurse and how will I accomplish it? I challenge others as well to think about standing tall: doing the right thing, going the extra mile and striving for excellence. No matter how small the act or the intention, we as individuals can make a difference in each patient’s experience and that alone is cause for standing tall.

Building better care

2010-05-12T06:12:00.003-04:00

Another interesting article (Physicians must become team players) on providing primary care and the steps it will take to ensure patients are cared for and each provider type fills their niche. And although cliche' it really is about teamwork and working collaboratively and complimentary of one another towards the same goal...quality & cost-effecient patient care.

Celebrate a nurse

2010-05-08T08:54:00.006-04:00

Recently there has been a lot of discussion in the mainstream and healthcare media regarding ‘turf and title wars” between healthcare providers, namely physicians and nurses that has resulted in nurses being painted in a negative light. (Fox News Health Blog) Nurses have been characterized to be less intelligent than physicians, only going to nursing school because they were unable to get into medical school, that physicians are the only providers saving the lives of patients and nurses are merely task-masters and have no role in the recovery and outcomes of patients.

During this time of uncertainty within the healthcare delivery system, I find it incredibly demeaning and inappropriate that instead of looking toward common goals (patient care) that we are bickering about who is smarter, who has more education and who can provide care or perform what skill. Interestingly, the myriad of medical-drama television programs portray physicians frequently performing nursing roles with a disproportionately higher number of physicians to nurses.

There is no doubt that nurses are not content with the current system –an increasingly growing number of sicker patients in the acute care setting with less resources resulting in poor patient outcomes. Impending Medicare cuts (for both primary care and hospitals), an ever changing and evolving healthcare landscape and decreasing numbers of all levels and types of providers; this includes physical therapists, pharmacists and respiratory therapists just to name a few. Shouldn’t we be focusing on the current resources and collaborative practice?

Maybe the discussion we should be having is how can physicians, nurses, advanced practice nurses and all other care services provide safe, efficient, and competent care together?

With so many unknowns related to the healthcare reform bill, it is time to seriously look that the global impact that the changes are going to have on all providers and patients. We are all professionals and deserve to be treated with respect no matter education level or title we have.

It is time for nurses to let their voices be heard and re-educate others about the important role they play in providing safe, quality healthcare.

Happy Nurses Week to the 2 million strong and intelligent nurses across the country.

And remember to say thank you - they might just save your life one day!

Would you like fries with that?

2010-04-24T09:31:00.000-04:00

I recently overheard a conversation in which a patient was berating the nurse for the temperature of the food on his tray and that he could not see outside his room from where he was sitting.

Disclaimer: I am huge patient advocate and in most cases will look at a situation from the patient’s point of view as they are most vulnerable and it is our responsibility as nurses to provide competent care, ensure their safety and preserve their dignity and rights in the process…however in this particular case, the patient was treating the nurse more like a waitress than a professional. The part of the conversation I encountered upon was only a small part of the patient-nurse dynamic that had been transpiring. The tone of voice and demanding attitude towards the nurse were inappropriate and belittling. She felt that everything she did was not good enough and was spending an inordinate amount of time trying to please him, meanwhile getting behind in her medications and patient assessments. This nurse handled herself with great poise and patience, yet he continued to be demanding.

Nurses are not waitresses. Nor are they babysitters or activity directors. Yet, much of a nurse’s shift is spent making sure the patients are happy instead of cared for. I understand that the role of the nurse is multifaceted and must care for the whole patient, however there comes a point when fluffing pillows and entertaining patients interferes with real nurses work – taking care of patients. The quest for patient satisfaction has perhaps swung the pendulum too far. I am sure some would argue that is part of a nurse’s job. I would however challenge that if nursing has truly become no more than providing hospitality services, then why do we expect nurses to be educated, make critical decisions, provide complex care and so much more around the clock?

I think this situation is a symptom of a bigger problem…entitlement. Everywhere people go, the customer is always right, the service must be outstanding, the product must be perfect and if not the right to complain about it is theirs. Healthcare is different and hospitals are not hotels. There is no room for social admissions anymore; beds are tight and resources are short. If you are well enough to notice the food is cold and want to see into the hallway to people watch you are most likely too well to be in the hospital (this a perfect example of healthcare waste) and would be better off going to Burger King where you can have your way.

It's a new day

2010-04-03T08:26:00.004-04:00

and I am back...or at least I hope to be. I cannot believe it has been nearly a year since I last posted to my blog. So much has changed in these past 11 months, but wasn't hasn't changed are my passions: nursing/patient care and coastal living.

Stay tuned as I find my way back to the blogging world!

the right words

2009-05-17T14:43:00.000-04:00

The five rights of patient medication safety include: the right person, the right drug, the right dose, the right route and the right time. It seems pretty simple enough. The last piece critical to medication safety is the right/write documentation. Not just because of the fact that if it is not documented it is not done, but if it is not documented what is stopping someone from giving the medication again.

I am continually amazed when doing case reviews at the lack of documentation. Besides the obvious legal peril that not documenting may leave someone in, the safety implications are often overlooked. And don’t forget the issue of payment and reimbursement. How can you bill for services that there is no record of? More than once I have I seen charges written off because after reviewing a medical record the “patient’s story” is not clear – there are pieces missing and the care that was provided, however appropriate and safe is brought into question because the proof is not there.

This does not just apply to nurses….physicians, respiratory and physical therapists, social workers, paramedics, and anyone who provides care to patients. A hospital defense attorney’s worse nightmare is to have to defend a hospital or provider using a chart that is missing notes and documentation. Documentation is just as important as performing the five rights.

Connect the dots. Close the loop. Write it down. Take credit for the care or treatment that was provided.

Of course, make sure what is written is both legible and spelled correctly.

Happy Birthday

2009-05-09T08:46:00.012-04:00

May 12th, 1820 - August 13th, 1910

Nursing and healthcare have certainly changed through the years, but what hasn't changed is the impact of examing practice to improve clinical outcomes. Florence Nightingale was on to something all those years ago using science and statistics to effect patient outcomes; she positively impacted the face of nursing.

Thank you Florence.

Times have certainly changed

2009-03-28T20:51:00.001-04:00

Perhaps it is that I can barely remember being 13 or in middle school for that fact, but I do not understand in a world jam packed full of technology such as cell phones, iPods, computers and Wii games why kids feel the need to take cold medicine to get high. Ok so I was not perfect growing up, but I was too busy in middle school going to slumber parties and the mall and the movies to wonder to myself what it would be like to take some random OTC cold remedy.

My favorite part is the attitude that accompanies these pubescent, hormone-intoxicated kids when they present to ER with a chief complaint of an overdose. Seriously? What do they honestly think is going to happen when the nurses and physicians in the ER ask them why and when and how much they took? Of course you are going to be stuck with needles and asked to pee in a cup and drink activated charcoal with Hershey’s syrup over ice! And mom, please do displace your anger towards the staff trying to undo the damage 24 cold and flu tablets with acetaminophen can do.

Then there is the burning question in my mind – What happened to stealing cigarettes and sips of alcohol from your parents’ liquor cabinet? I am not as old as you think – I was just too scared to try anything else, because my mother would have killed me if ever I got caught! But I guess the times have changed and each generation has their own sense of what is cool and the thing to do. This nurse just does not get it; but then again would I want a cranky nurse taking me after I got caught chewing cold tablets like candy or some compassion – hmmm, the jury’s still it out on that one.

Blood, bandages & bedpans

2009-02-28T23:19:00.000-05:00

It seems a little odd that a job that almost broke me is still my most favorite. I had not realized how much I missed working in the emergency room until I pitched in the other day for a couple hours as they were bursting at the seams. Sure the very short shift consisted only of pushing one wheelchair-bound female to her family’s car, cleaning and making numerous stretchers and removing one IV. I did triage from EMS the very pleasant gentleman that was the unfortunate recipient of a head bleed. It was rather uneventful. I have missed the commotion, the noise, the smells…yes, all of them; there really is no other place quite like it.

I returned to my regular job just as quickly as I arrived to help out in the ER. It occurred to me when I was back in my very quite, feng-shui office that you may take the nurse out of the ER but can’t take the ER out of the nurse.

Counting Calories

2009-02-26T20:11:00.001-05:00

So apparently we need an official research study to tell us that eating less calories will result in less body weight (see “Fewer calories = less weight” posted by theHeart.org). In a society obsessed with outward beauty, it is hard to fathom that over 66% of Americans are obese. Obesity is defined as being 20-25% over the ideal body weight; so why then in a time where fad diets are all the rage are there so many overweight people and even more that are perpetually dieting? There is the Atkins diet, the South Beach diet, the Nutri-system diet, the Jenny Craig diet, the Weight Watchers diet, the Slim-Fast diet, the Acai Berry diet, the Pink Grapefruit diet, the Flat Belly diet and the numerous other diets that claim to give you the stealth body you have always dreamed of. No wonder we need medical research to clarify that consuming less calories combined with exercise is the sensible way to lose or maintain one’s weight.

For me, I will happily stick to my “no meat, low fat, whole, no processed or refined foods diet” - of course until medical research proves I should be eating something else.

The birds and the...alligators?

2009-02-24T09:31:00.006-05:00

Spring is almost here! On warmer days you may catch a glimpse of an alligator venturing out of his den and laying in the warm sun. Another tell-tale sign is the ospreys that are returning busily making their nests.

Check out the Osprey Blog and the web-cam - very cool!

http://www.palmetto.coop/community/osprey/env_osprey.asp

Happy bird-watching!

Science or circus?

2009-02-19T21:33:00.000-05:00

It seems that the American’s always want more no matter the consequences. We as a society tend to be gluttonous and selfish; especially when it comes to food and money. But now we can add babies to the list things we need more of.

Apparently if you have more babies than nature intended new opportunities open to you. Perhaps that is the real motivation behind this mother having so many babies…all at once. This of course is in addition to her other 6 children she had previously. My question is how she paid for the in vitro fertilization (IVF) in the first place at nearly $20,000 per cycle. This is a woman who is in danger of having her house foreclosed upon and is living on food stamps and her phone has been disconnected. She has defaulted on student loans and is planning go further her education with a masters degree. How can she responsibly take care of and provide for these children when her priorities are obviously skewed? Perhaps the TV interviews and rights to the innocent pictures of these fragile babies in isolettes will provide a roof over their heads and food in their bellies.

The expense of care will fall onto the tax payers of California, which incidentally is also financially struggling. Who is going to pay for their well-baby checks and vaccinations and formula and prescriptions? What about the physical and developmental issues they may all come to bear? How can we be sure she is even able to care for these babies? And ultimately be responsible for their character development and becoming productive members of society? Clearly her judgment is impaired and making responsible decisions is not something she is experienced with.
Disclaimer: Obviously the fertility specialist is not free from blame in this situation. Abusing medical technology for personal gain is not only irresponsible, but unethical. Medicine is a science, not a circus.

Common sense, not so common

2009-02-14T10:21:00.000-05:00

It seems with patients continually being admitted and discharged, numerous medications to give, IVs to tend to and the myriad of other tasks to accomplish, nurses have lost the ability to problem solve or think critically and in some cases use common sense. Is this a symptom of the increasingly high census and acuity of patients? Or is it something they are forgetting to teach in nursing school? Perhaps it is a combination of issues. Being a nurse today is harder and more demanding than it was 10 or 15 years ago; but if ever there was a time that prioritizing and problem solving were needed, clearly it is now.

Recently my 90 year old grandmother was admitted for a bowel resection secondary to a tumor in her ascending colon. She was a model patient. Considering her age she did remarkably well. Despite her strong recovery from surgery, she developed a few complications post-op day 2. My concerns were not so much the physiologic responses to surgery, but the way in which the nurses reacted to these changes in her condition. The inability to recognize signs and symptoms of delirium, dehydration and bowel obstruction were worrisome. It was I that assessed the changes in her mental status and realized that she was having a reaction to the Benadryl, which is known to cause acute agitation and hallucinations in the elderly. It was I that assessed her fluid deficit secondary to severe diarrhea and suggested that the physician be called to re-evaluate her labs and repleat fluids and electrolytes. And again it was me that assessed her increasingly rigid abdomen and suggested that a post-op radiological exam be obtained.

There is a paradox in nursing. We as a profession want to be viewed as intellectual and autonomous professionals, but do not want the responsibility of communication and collaboration. There is a difference between ‘bothering’ the physician with a question that can wait until rounds or a change in the patient’s condition that warrants intervention. It has not been my experience that a physician was annoyed to know that the patient’s condition was deteriorating.

Assessment, intervention and evaluation are important concepts of problem solving, not too mention part of basic nursing practice…which of course is just common sense.

If nursing is an art, why can't I draw?

2008-08-16T09:11:00.001-04:00

Helping patients understand what you did for them is always a challenge. Helping them understand what they need to do at home to remain healthy is even more challenging. Often I would draw pictures of the problem in which they sought care for to help them comprehend the illness and treatment.

My intentions are well-served, however my drawings are something out of a stick-figure nightmare. The human heart (nothing like its valentine's counterpart) is complex and amazing, and very challenging to draw. Lines and curves and arrows demonstrate this incredible organ and its intricate extensions of arteries and veins all in an attempt to illustrate the bare basics of various ailments of the heart.

Alas, my attempt to expalin disease processes and their treatments to improve home compliance is good intentioned. And just maybe those scribbled stick figures make sense to someone else besides me.