DNP Translational Research Project

In support of my friend's Doctoral project.

My name is Nicole Bello and I am a Doctoral of Nursing Practice student at Georgia College and State University. I am conducting a translational research project on the effectiveness of home-based blood pressure monitoring in practice and I am in need of 100 blood pressure monitors to implement my research project in May 2016. 

Definition: Home blood pressure monitoring (HBPM) is the act of taking an individuals blood pressure in the comforts of their home and recording results for later evaluation by their health care provider.

Purpose: The purpose of the proposed project is to utilize home-based blood pressure monitoring to improve the management of hypertension and decrease complication of uncontrolled blood pressure.
The goal of the project is to improve blood pressure management in those with hypertension to prevent complications from uncontrolled hypertension.

Innovative Technology: The Omron is a sphygmomanometer that has the ability to transmit data via email and to the patient's provider. This eliminates the need of patients having to keep a written log. The home-based blood pressure monitoring program eliminates the tediousness of writing the results and prevents the misinterpretation of results due to poor writing legibility or lack of memorization. By keeping an electronic record of accurate bp results that can be easily accessed and reviewed, the practitioner will be able to utilize supporting data to institute the best intervention necessary for treatment of the patient’s blood pressure. The Omron BP785 was rated the best blood pressure monitor according to Omron and other validated research studies. Cost is approximately $65 per BP monitor. The uniformity of the monitor is important to minimize variance and error in the interpretation of results for a successful doctoral research project.

Why? HBPM will help health care providers deliver individualized patient care based on accurately reported blood pressure results. Improved blood pressure control will decrease the prevalence of co-morbid conditions and decrease health care costs. The HBPM program decreases cost to the patient and has the potential to increase coverage and reimbursement to the health care practice.

THANKS IN ADVANCE FOR YOUR SUPPORT IN MY ENDEAVORS!

Link to Nicole's Go Fund Me page:
https://www.gofundme.com/hbpm2016

On the shoulders of giants, we can do great things

It is only fitting that I start my next journey during Nurses Week. That on Florence Nightingale's birthday I was in class discussing using research and data to transform nursing practice. That this week that honors and celebrates the amazing work all nurses do, I was stepping out of my comfort zone, going from 'expert' back to a novice of sorts. While many were graduating programs and starting their journey as new clinicians or administrators or educators, I am purchasing books and software and attending immersion week.

Since making the decision to begin this journey I have come up with every reason why I should not pursue this path. I have rationalized every excuse. I have compared this experience with past ones; unfavorably of course. I have almost talked myself out of it...twice. Something I have wanted to do for years, I have almost quite before I have started. Because it will be hard? Because I will be busy (I'm already busy and used to piling on the work!) What is different this time? Is it fear of failure?

In my mind I know how I want to leave my mark on nursing - some of it I am already doing. Some is yet to come; that is part of the journey. This is the next step. I need more tools to accomplish my goals.

As I entered the classroom meeting my classmates for the next 18 months, I realized they were all questioning themselves also. They were also doubting their abilities and wondering "What am I doing here?" But as these past few days have unfolded, we have found out that we bring a variety of skills and experiences with us. We have amazing visions for nursing and what we believe advanced practice nurses can do to improve care for our patients and impact an ailing health care system that is still in need of repair to provide the necessary care for all.

It will be hard. At times we will be tired and frustrated. We will be inspired. We will change practice and do great things. And in December of 2016 we will be Doctors of Nursing Practice.

“How very little can be done under the spirit of fear.” ~Florence Nightingale

Yes, I'm a nurse! Celebrating Nurses Week

Its that time again! To celebrate nurses and all the amazing things we do! Yes, we do amazing things. I don't usually like to brag about it; in fact what we do, whether you are an LPN, RN, CNS, NP, and administrator or educator it is hard work. We have all been there at the bedside doing things no one else would or want to do. We have cried with patients and families. We have gone home and put our uniforms right into the trash. We have cried in the shower, swearing we could not possibly go back and do the job another day. But we do. Again and again.

I told my husband just yesterday that even when I come home after being screamed at by a desperate family member who is watching her mother with progressing Alzheimer's turn into someone she no longer knows, that I still love my job as a hospitalist. Even when I spend over an hour explaining there are no more options to a patient and her husband, that it is time for hospice and watch the hope fade from their eyes, yes, I still love my job.

I love being a dual-boarded APRN. I love teaching future nurses and APRNs this incredible profession. I love using my voice so that one day my state will be 'green' too!

Photo credits: AANP State Practice Acts and Administrative Rules

There are so many amazing things that nurses can do beyond the bedside: clinical education, quality, health policy, academia, informatics, professional organization, special interest groups, leadership, community health and volunteering - I could go on!

So this week, we take a moment and celebrate all that nurses do for patients, their families and each other. We reflect on where nursing has been and what lies ahead. Nurses are leading the way with inspiring nurses leaders like ANA President Pam Cipriano PhD, RN, NEA-BC, FAAN who was recently selected among Top 25 Women in Healthcare and future and past AACN and AANP Presidents. We reflect back on history to influential nurses like Dorothea Dix who is attributed with creating the first mental health system and Mary Eliza Mahoney the first African-America nurse in the United States. And of course our beloved Florence Nightingale who became an advocate for the poor and infirmed, dedicated to improving the conditions for treating patients and used data to improve care. Our first nurse mentor that we still honor on her birthday.

Remember this week and every moment why we became nurses. Celebrate the good and amazing things we do. We have a lot of work to do but we are strong and compassionate professionals. And our patients deserve the best care we can provide to them.

Just following orders? Is it okay to say no?

Recently the American Nurses Association (ANA) has publicly supported a Navy nurse that has refused to force-feed Guantanamo Bay detainees that have refused to eat and are on self-imposed hunger strikes.   Each case is reviewed by a senior medical officer and determined if force-feeding is necessary. If ordered, the detainee is strapped in a 5-point restraint system in a chair and the nurse then proceeds to place a nasogastric feeding tube and administers tube feed consisting of Ensure (according to the cited article: Top nursing group backs Navy nurse who wouldn’t force-feed at Guantánamo) The controversy in this case is whether the nurse was wrongly removed from duty for refusing to carry out the force-feedings. The ANA is supporting the nurse and believes that a nurse should not carry out an out that he or she feels is unethical. 

Reading this story I began thinking of patients in the hospital setting. How often do these type of situations occur? How often are nurses faced with situations that are dancing on the edge of being ethical? Whether it is placing a patient in restraints or feeding a patient that has already refused via an advanced directive or giving a medication for an unapproved use or performing CPR on a DNR patient; how many circumstances come close to being questionable? Maybe the actions are not as violent as restraining a patient to slip a tube through their nose into their gut so that liquid food may be given to them like a drug; however placing wrist or hand restraints on a frightened elderly woman with advanced dementia who keeps shaking the side rails of her bed could be similar.

The point is there are times when nurses can say "No, I cannot do this or that" for ethical reasons. Maybe the more appropriate question is how many times do nurses speak up or question the order? Is this grounds for dismissal or is there any recourse? 

I think that a fundamental question needs to be asked...will these actions either way harm the patient? If withholding care will result in injury or death the nurse has a duty and obligation to ensure the patient is safe and receives the care they need. However if the nurse is being asked to do something that could result in harm that would need to be reported that the order is not being carried out and why to the supervisor. Remember nursing practice should be guided by the ethical principles of nonmaleficence and beneficence - to "do no harm" and to be compassionate and "desire to do good." 

The story of the nurse and detainee is troubling because it makes me wonder the principle of autonomy is in this situation. Has that right been forfeited because he is a prisoner so the other principles are also null and void as well? As a nurse this is confusing and somewhat undermines are core values that guide are practice. I will continue to follow this story as the outcome is important to nurses as clinicians and decision-makers everywhere.

Links:
ANA Short Definitions of Ethical Principles and Theories 

 

Read more here: http://www.miamiherald.com/news/nation-world/world/americas/guantanamo/article4002028.html#storylink=cpy

Can't we all get along? Making true collaboration work

I recently read a Blog posted on the Society of Hospital Medicine regarding relationships between physicians and non-physician providers, namely nurse practitioners. It was interesting as I could not agree more with the points in the blog as barriers to successful hospitalist or other collaborative care models. The author summarized well what I believe are key issues that can create toxic environments for nurse practitioners and physician assistants and ultimately affect patient care. I truly believe that there is a place for all providers and that are many successful   practices both in and out of the hospital setting in which physicians and nurse practitioners work along side of each other to delivery high-quality and cost-effective care.

The big winner in this is the patient. But so are all the providers if we can all get over ourselves and truly work as colleagues, together!

BarefootNurse on list of 30 BEST NURSING BLOGS OF 2014

BarefootNurse Blog named 1 of 30 Best Nursing Blogs
Nurse Practitioner category


Thank you!

Why we are here

We have this thing, my husband and I. I protest that life is hectic and timing is impossible and that I am not 'feeling' that I am ready for the trip from the east coast. He talks me up and tells me how I will feel once the conference starts and I meet up with nurses from all over the country and begin networking. But my presentation isn't quite perfect. It will be, he coaxes. I have so much to do. You need to recharge your professional batteries he reminds me.

It takes little time to feel the energy of AACN's NTI. From the flight attendants giving a 'shout out' to the nurses on the plane, or the LED sign welcoming AACN Nurses to Denver or walking into the conference center and picking up your materials working out your schedules for the week.

It is day one of NTI2014.

On the phone he reminds me why am I here. And I have to admit he was right. Recharge and renew.

Why are you here? What will you learn? What will you take away?

Today we Step Forward in Denver together for NTI 2014.

Not a physician, not a nurse...what?

APRN Advanced Practice Registered Nurse
ACNPC Acute Care Nurse Practitioner-Certified
CCNS Certified Clinical Nurse Specialist
CEN Certified Emergency Nurse 
Are you following the pattern?  I could go on...
These are examples of just some of the many certifications for nurses in specialized areas of care. And please excuse the underlying snarky tone as I am not feeling so "happy" after this past Certified Nurse Day.

Disclaimer: I am very proud to be a nurse and promote clinical excellence through certification - this is not a swipe at certification  or certified nurses!

So let me set the scene. I primarily work as an ACNP specifically as a Hospitalist and part time as a CNS. I also work as nursing faculty at a local university. During this past certified nurses day a unit clerk asked in general to anyone in earshot is it CNA day? (meaning certified nursing assistants day)  I spoke up and said no, it's certified nurses day - a day to recognize nurses that have obtained specialty certification, I gave him examples of my certifications and the clerk pointed to a list on a wall and said I was not on the list and finished with "well you're a doctor". "Umm, well actually I'm not. I did not go to medical school. Well you're not a nurse anymore," was the reply. Wow! I was not prepared for that. As it turned out this person was not alone in this perception.

Interestingly, I am no longer considered part of the nursing staff but not "part" of the medical staff. I have to abide by the medical staff by laws. I am not allowed to eat meals in the medical staff lounge or get free meals in the cafeteria. I am part of the "Allied Health Staff" which includes NPs, PAs, CNRAs,  & CMWs; we all pay dues. But we have no leadership. No meetings. No organization. No lounge. And we are not welcome at either nursing meetings or medical staff meetings.

So if I'm not physician and not a nurse, what am I? I know that I am not the only nurse practitioner or clinical nurse specialist that has been experienced something similar? Please don't get me wrong, I have a great working relationship with most of the medical and nursing staff members and I love my both of APRN positions. And most of all I LOVE being a nurse.

I continue to educate the staff on my evolving roles (I started out as a staff nurse and worked my way through school and various positions).  And to either our determent or benefit, I think we [nurses] will continue to educate others on what we do at every level as we continue to diversify our roles in healthcare.

I know I am not a physician. I do not pretend to be. I am an acute care NURSE practitioner and clinical NURSE specialist and I believe that I offer my patients something my physician counterparts do not. I am proud of my roots and my education and experience...and most of all my certifications. All of them!

Always a lesson in every situation...

I haven't blogged in some time. I would like to think it's due to the fact that I am so busy with juggling several jobs, raising a teenage daughter, planning a wedding (and getting married!), assisting my new in-laws with their move and other, numerous time-sucking things I have been doing this summer. But perhaps it is laziness in part; not taking time to put my thoughts down on issues that matter to me. Well, today that changed - well at least in part. These are not my words, but those of a friend and fellow blogger. I had to share simply because I was struck by the emotion of the words (the story was not new to me) and the renewal of the call many of us have answered in following a career in healthcare.

I invite you his blog and read about Pip, the flying squirrel.

Because of Pip: Taking Action

Put one foot in front of the other...

I have to admit that is what I first thought of when the President-elect new theme was unveiled. Then I gave it more thought..Dare to Step Forward...nice. The themes fit very well. Of course all of the themes fit well...these are very smart woman and NURSES!

It was a week a firsts for me. My first trip to Boston. My first time sightseeing in a city by myself and see the path of great Patriots. My first time presenting at NTI. A week of stepping out of my comfort zone and into something bigger. I can hear all the past themes running through my head.

We are once again reminded that we, as individuals not to mention as unified group can do great things. Each one of us. We all matter. We deserve to be happy. And we must rest. Wow...powerful stuff.

In the weeks before I left for Boston, I was struggling with whether or not I still wanted to go and if I had it in me to present at NTI in the API track (step forward). Whether I wanted to travel to a city that had suffered a brutal, cowardly attack (together, stronger, bolder). Whether I wanted to go essentially alone, save my colleagues and friends from my AACN Chapter. I was so wrong...I not only wanted to go, I needed to go (dare to).

I learned so much - not just about clinical practice and being an advanced practice nurse but about myself (act with intention)

There are so many things that left an impression on me. So much that touched me and is pushing me to work harder and to do more (stand tall)

So the big questions is how will you Step Forward this year?

One foot in front of the other

The NTI countdown begins

So we are just days away from undoubtedly the largest gathering of nurses - the AACN's NTI conference in Boston, MA.

I have to admit, I have been slow to get excited for this conference; especially since the bombing occurred. Glued to the TV for days as the events of the attack unfolded, I was shocked and horrified and angry that yet again a senseless tragedy occurred on American soil. Relief poured over me when details emerged and the suspects were caught.

As many of my nursing colleagues have thought about I'm sure, I have prayed for not just the victims but the numerous nurses, paramedics, physicians, and other healthcare providers impacted by this act of terrorism. No doubt we will hear more this week from these frontline providers that worked tireless to save lives.

This is my first time presenting at NTI. Part of me is terrified. But I am starting to feel a tiny bit of excitement build deep within me...I am after all presenting on something I feel very patient about.

Over the past week or so I have given much thought about this trip to Boston...specifically NTI. I was reminded by someone very dear to me that it is a time to recharge my nursing batteries with many strong and powerful nurses. He's right. Nurses are strong and overcome crises and struggles everyday to care for patients and ensure the best possible outcomes. We are passionate and forward moving.

It turns out that Boston is a great place for NTI this year. Nurses and other providers always rise to the occasion and remain strong and resolute. So has Boston.

Yeah, I think I'm ready.

Boston Strong                                 Nurses Strong

Patient safety lessons from Starbuck's

Anyone who knows me, would agree that saying I like coffee is an understatement. In fact, coffee is truly one of my life's pleasures. Right up there with anything chocolate and the beach. A good cup-a-joe, anytime of the day - hot or iced, frappuccino or espresso, I'm guaranteed to love it.

So what does my love of coffee, Starbuck's and healthcare have in common? Probably very little at first glance; besides the fact that coffee is the fuel of healthcare providers and clinicians everywhere...we may be able to learn something from the highly rated java-giants.

A typical shift day for me begins with a trip to the local Starbuck's for my usual special latte for one last jolt of caffeine to get through my unpredictable day. No matter what time I visit, I am always greeted by a friendly voice in the drive-thru that identifies themselves first and says something like "Good morning or welcome, my name is so-and-so, how may I help you today?" WOW! It always impresses me...really. Every day. All the time. No matter the person taking my order. I respond the same...."Good Morning! (It's contagious you know) I'll have...I won't bore you with my special coffee needs" And here's the best part...wait for it.....the friendly barista READs BACK & VERIFIES my ORDER! (RBVO) Ta-Da! Yes, they verify what they heard you say. Amazing. And if it is wrong they correct it on the spot and you get the wrong drink in addition to the corrected order. Now granted, no one is going to die or be injured with the wrong coffee-drink, but that is not the point.

In our clinical practice settings we give and receive orders or diagnostic results or other patient-related communication all the time and it is extremely easy to misinterpret or transcribe them incorrectly. The difference is, we can't take back the wrong treatment, medication or diagnostic result and it can most definitely harm the patient. I give telephones quite frequently and I am surprised at how many times they are not read back & verified. I often ask them to repeat the order back to me or I repeat it myself.

If Starbuck's thinks it is important enough to Read, Back & Verify your Order (RBVO) shouldn't it be important enough to us where the stakes are much higher? Incidentally, those of use that work in the acute care (hospital setting) know that CMS and The Joint Commission already think so...this was a National Patient Safety Goal for many years; it is now part of the Provision of Care Standards and yes a hospital can actually be penalized for not demonstrating evidence that a verbal or telephone order was RBV.

Startbuck's greets their customers with kindness and reads back their orders to maintain a high level of customer service and satisfaction, not because people will die. Clinicians and providers at every level should make reading back and verifying communications a natural part of their practice and a priority for patient safety.

Hard pill to swallow???

For many Americans sweet dreams are not obtainable. They complain of poor sleep everyday - or more appropriately every night. The elderly are much more likely to report sleep problems. Due to a myriad of reasons, most physiologic sleep is altered and they find themselves up at night when they should be getting restorative sleep. For that reason the use of sleep aids has increased...and so have the consequences. Many drugs leave patients with 'hangover' effects impairing judgment and physical mobility long into the daylight hours after taking these prescription sleep aids - especially long-acting formulas. For the elderly this can be especially dangerous leading to increased risk for severe injuries related to falls, mismanagement of medications and other accidents. Some hospitals have reduced the use of such medications in hopes of reducing confusion, falls and other sequelae (especially in the elderly). In the hospital setting, patients often do not recover from untoward events. 

Cascade Iatrogenesis is a series of adverse events triggered by an initial medical or nursing intervention initiating a cascade of decline. It often results in a poor outcomes for the patient or inability to return to pre-illness level of functioning and is preventable. Many of these events are precipitated by medications - either a new medication, too many medications (polypharmacy) drug-drug interactions, over-sedation, so on and so on...
As for the use of sleep aids, especially in the acute care setting, it cannot be overstated - we must be vigilant and cautious when utilizing these or any medications in the elderly patient. Having an a lower dose option may be helpful, however we should really be considering alternatives rather than adding one more pill to the the medication soup

See the following:
Wall Street Journal: Citing Dangers, FDA Requires Lower Doses for Certain Insomnia Drugs http://online.wsj.com/article/SB10001424127887324081704578233652166139618.html?mod=dist_smartbrief 
National Sleep Foundation: http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia

Pearls for Practice: Newborn Assessment

What do you know about cyanosis of the hands and feet of the normal newborn?

Another great episode of Insights in Nursing!

Great discussion on the future of nursing, how staffing patterns impact patient outcomes and mobile technology in patient care!

http://insightsinnursing.com/2012/08/happy-nurses-equal-happy-patients/

Enjoy!

History taking getting too personal?

Whether or not you support the constitutional right to bear arms and what you believe the right to free speech covers, there is a definitely a controversy brewing in Florida over the "Gag Law."  A recent ruling states that Florida "cannot enforce a law that prohibits physicians from asking patients whether they own a gun because it infringes on their First Amendment right to free speech." The National Rifle 

Association (NRA) helped lobby for the law believing the second amendment was at risk and stating that the information obtained by healthcare providers would go into individuals' permanent health records. Physician groups argue they are trying to protect children and that assessing whether there is a gun in the home is necessary to provide education on gun safety, similar to bike and car safety. Other groups disagree. But what about adult patients? 

The question then becomes what information is necessary for healthcare providers? How is some of this and other social information used in relation to patients' overall health care? Some argue that some information should not be kept in their permanent medical record and do not understand the relevance. 

Would it be appropriate to assess a person with profound depression risk for suicide? Part of that assessment would include assessing for a plan, access to methods and ability to carry it out.  How about a patient that has substance abuse issues - is it appropriate to ask about the use of drugs and alcohol? Sexual orientation, partners? You get the point...

As an ACNP I understand the concept of history taking but I also understand the need for being respectful of sensitive information. Of course many patient's do not share everything with healthcare providers out of fear, or stereotyping or some sort of recourse. Will this situation in Florida have the effect they are looking for - preventing unintentional firearm accidents? I'm not sure. But I do know that constitutional rights are polarizing topics and it seems that most sit on one side or the other. Regardless of your personal beliefs on firearms or free speech, when it comes to caring for patients, the patient must remain central in order to be a true advocate.

Florida 'Gag Law' on Physician Gun Queries Blocked for Good

Roundup: Doctors entitled to free speech, too

Taking care of everyone but ourselves

It is no secret that a majority of Americans are overweight. Some studies predict that 42% of Americans will be obese by 2030; with obesity defined as weight greater than over 20 - 25% of normal body weight. The most common health consequences of obesity are also well know - hypertension and diabetes. What many lay-persons may not be aware of are the myriad of other health issues that result from obesity: cardiovascular diseases (risk of cardioembolic events such as stroke and myocardial infarction) renal dysfunction, infertility, erectile dysfunction, obstructive sleep apnea, risk of developing various cancers, not to mention decreased quality of life (this list is by no means exhaustive).

Nurses, physicians, respiratory therapists, paramedics and others, on the other hand are all aware of the consequences of poor health such as obesity and chronic hypertension. Yet, there are many healthcare providers and workers that are in extremely poor health, smoke, are very obese. How many of us work with colleagues that can not respond to code situations quickly and you find you are the only that can actually run to the bedside? Everyday tasks are fraught with shortness of breath, fatigue, painful joints and other ailments during the long 12-hour shifts or longer. Add to that lack of sleep and stress of the shift (see Burning Out: Combating compassion fatigue & moral distress) and nurses and other care providers are set up for health problems. Unfortunately, nurses are not necessarily good at caring for themselves on daily basis. I am talking daily renewal and refreshing your body and mind - taking time to clear your head and let go of the stress of the shift. Celebrate the saves and mourn the losses. When it comes to preventive health and wellness, we tend to care for those around us and put ourselves last; waiting to the last minute or too long to seek care. But I regress....

If you walked into my old unit almost any day of the week, you would find some sort of processed, junk food in the lounge. I myself have an insatiable sweet-tooth and am known for always having a chocolate stash! But I am also not obese, not even overweight - not even close. I am a vegetarian and I rarely sit still and I drive my family crazy about being healthy because I don't want any of us to suffer from the diseases I treat patients for. My point is this...you never see a plate of veggies and fruit in the nursing unit lounges. When was the last time you saw a big bowl of hummus and cucumbers? You may see salsa, but with corn chips and out of jar! Cookies, brownies, candy, chips and more. Even the cafeterias struggle to cook healthy options. And firehouses...they definitely like their bacon and sausage in the morning and meat and potatoes in the evening! (No disrespect to all my paramedic and firefighter friends!)

On a serious note, it disturbs me that we as educated professionals are teaching and preaching to patients and their families how to stay healthy and prevent further admissions by "reducing dietary sodium," "smoking cessation," "cutting back on alcohol consumption," "increasing fruits and vegetables while reducing sweets and fats," yet the collective we is just as unhealthy as they are. What message are we sending our patients? One news media article cited that 55% of nurses are obese. It is clear we are not following our own advice. Again, what does that do to our credibility? How can we take better care of ourselves and be better role models for our patients?

With healthcare at the forefront of discussion in the media and a focus on prevention and reducing costs, it is important that we are do our part to care for ourselves and each other.

I encourage you go to the Nurses Health Study link. The partners have been studying the health of nurses since 1976 and currently recruiting nurses for their third study.

The Nurses Health Study

Burning out: Combating compassion fatigue & moral distress

Most of know that feeling as being "burned out." When you fell like you cannot do your job another shift let alone the rest of your working days. The irony is that we became healthcare providers (nurses, medics, physicians, etc) because we wanted to care for others. To make a difference. We knew our work was that of service and that some days it would be hard. And although television often portrays healthcare as glamorous and adrenaline-producing every moment of every day, we know the real truth.

Compassion fatigue is defined as a loss of compassion and caring over time. It is a condition that is hallmarked by emotional, physical and spiritual exhaustion that occurs from caring for and internalizing the suffering of others. Compassion fatigue is also referred to as secondary post-traumatic stress disorder. Nurses have a propensity to carry on the burdens and problems of others - their patients, coworkers, families, and friends which may leave them exhausted and feeling empty. (I recommend reading Bertice Berry's Blog, especially Day 145: Seeing Miracles)

Moral distress is another term often used related to burn out, however often there is an ethical component or dilemma associated. Nurses frequently find themselves in the middle of conflicts involving patient care issues, especially related to end-of-life or futility of care. This produces a great deal of stress for the nurse whom often has no outlet.   

We have all seen it - burned out coworkers call out more, are late to work, have no interest in most of what they do, chronic fatigue, decreased productivity, high turnover, workplace injuries, reduced satisfaction in work and home, and even more patient complaints. Not to mention patient safety events; if our head is not in the game so to speak how can we be sure we are not going to make a serious error or failure to rescue or prevent harm to a patient.

There are many reasons that nurses become burned out with their jobs. High patient acuity, staffing issues, conflicting values and expectations for time between work and other life responsibilities and difficult or devastating patient situations.We talk about it. We say, "Oh, I'm so burned out, I just don't care anymore." Yet we do little to nothing about it. At work we barely support each other; often because we are so busy ourselves and consumed with our own tasks and crises. Helping and supporting each other through difficult situations and even the everyday ones has to be a priority. It is wearing us out and creating an undercurrent of distress and hostility and resentment. Having formal systems in place to help us deal with difficult emotions is important not only for the staff member involved but all other staff, and more importantly for the patient. 

At home we do even less. We set no priorities of care for ourselves. Do not allow ourselves to grieve a loss at work or at home. We do not give ourselves permission to really care for ourselves in a healthy way - sleep and eat well, exercise, rest and relax, read a good book, play and so on.

I have posted some very good resources on moral distress, compassion fatigue and burn out. I strongly encourage you to read them and develop resources in your workplace to combat this insidious foe to our job satisfaction and personal happiness.

Addressing Moral Distress: An Important Step toward a Healthy Work Environment

Six Ways to Deal With Compassion Fatigue and Burnout, Kendra Mims, ENA Connection (Mar 2012)

How do I deal with compassion fatigue?

6 Ways Nurses Can Beat Compassion Fatigue

Safe Practices: Preventing Needlestick Injuries

Dr Mary Foley

I recently had the privilege to learn more about the Safe in Common campaign, an exciting healthcare initiative that is promoting safe work environments free from needlestick injuries from one of the leading health worker safety advocates, Dr. Mary Foley. Below is our interview. Please read and consider taking the pledge for preventing needlestick injuries and creating safe work environments.

(Kelly) What has been your experience with the general "culture" or perception by nurses and other healthcare professionals regarding needlestick safety?

(Dr Foley) In my experience, healthcare workers are focused on patient care.  They are aware of needlestick risks, but they keep their worries about occupational injury in the background, so they can focus on giving the best care they can.  That presents some danger to healthcare workers.  Doctors, nurses, aids, lab technicians, housekeeping, and maintenance personnel are all at risk when sharps devices and delivery systems are not designed for maximum protection.

(Kelly) Can you estimate the cost in lost wages or medical care annually related to needlestick injuries?  What is the emotional cost?

(Dr Foley) There is an emotional cost to the ever-present threat of an injury, which is there even if a healthcare worker manages to keep the concerns "controlled", so they can focus on patient care. 

When a worker is exposed to a contaminated device, there is an immediate sense of panic, since this could be an infected device.  In spite of that fear, or maybe because of it, almost half of all injured workers fail to report their injury—which puts them at risk for no coverage if they become ill.

Injured workers talk about the tension in their personal and family lives as they wait for test results which are conducted over 6 or more months to determine if the worker is infected.  Some healthcare personnel are encouraged to take prophylactic medications, some of which are difficult to tolerate.  

The preferred future: reduce accidental injuries with better devices, proper training, and a culture of safety.

(Kelly) Can individual nurses make a difference?

(Dr Foley) Individuals can make a difference. Care for the caregivers begins with self care—being as knowledgeable as possible about protecting patients and oneself.  But many of the improvements in health care settings will require collective action by policy makers, device makers, occupational health specialists, managers, and staff.

(Kelly) What can we all do to offer our support?

(Dr Foley) The Safe in Common campaign was launched in May, and we already have thousands of pledges of support.  Just as importantly, the subject of sharp injury prevention is active again, over 10 years after the passage of the Needlestick Safety and Prevention Act.  There have been some improvements in some rates of injuries, but there are still too many occupational injuries from sharps, and now, many of those occur when staff uses "safety" devices. Clearly, the devices in use are not adequately protecting staff, and more work must be done.

Spread the word (thank you for writing about this), share the pledge, advocate for educational content and conference programming that informs and advocates for better protection.

(Kelly) Can you provide any statistics / facts about the frequency and gravity of needlestick injuries?

(Dr Foley) Virtually all healthcare personnel are at risk of harm from occupational exposures such as needlestick injuries. The Center for Disease Control notes that nurses sustain approximately half of all needlestick injuries, while physicians, housekeeping and maintenance staff, technicians, and administrators are also harmed.

The U.S. Occupational Safety and Health Administration (OSHA) estimates 5.6 million workers in the U.S. healthcare industry are at risk of occupational exposure to bloodborne pathogens via needlestick injuries and other sharps-related injuries. OSHA further reports that each year 385,000 needlestick injuries and other sharps-related injuries are sustained by hospital-based healthcare personnel. This equates to an average of around 1,000 sharps injuries per day in U.S. hospitals.

Including other non-acute healthcare facilities, it is estimated that between 600,000-800,000 healthcare personnel incur a needlestick injury each year in the U.S.

Forty percent of injuries occur after use and before disposal of sharp devices, 41% of injuries occur during the use of sharp devices on patients, and 15% of injuries occur during or after disposal.

(Kelly) How did you get involved advocating for needlestick safety?

(Dr Foley) As a registered nurse for more than 35 years, I was one of the first healthcare workers to combat the emerging HIV-AIDS epidemic during my work at Saint Francis Memorial Hospital in San Francisco during the 1980s. I played a key role in securing the passage in California of the first state-based laws in the U.S. mandating the use of safety medical devices. Afterwards, I joined other nursing colleagues to campaign for the adoption of the Federal Needlestick Safety and Prevention Act. Elected President of the American Nursing Association (ANA) in 2000, I was in the Oval Office of the White House when President Bill Clinton enacted the Act into law. Since, I have continued to work to improve healthcare policy, including improving the workplace, and promoting safe care for workers and patients nationally and internationally. Given my passion and knowledge of the issues, Safe In Common asked me to lead their Needlestick Safety Advocacy Tour.

(Kelly) What does Safe in Common do to protect healthcare personnel?

(Dr Foley) Safe in Common is a movement of healthcare personnel committed to making their working environment safe from the risk of needlestick injury. With the safest equipment, the best practices and the right culture, we believe all needlestick injuries can be prevented. The non-profit organization was established to enhance and save the lives of U.S. healthcare personnel at risk of harm from needlestick injuries.  First established in 2010 as an online community of healthcare professionals and other advocates committed to injection safety, Safe in Common is leading the Needlestick Safety Advocacy Tour across the U.S from March 2012 through March 2013 to engage with healthcare personnel to hear their concerns, raise their hopes and unite them together behind the creation of a workplace environment that is free from the risk of needlestick injury. 

The Tour will visit more U.S. hospitals and attend healthcare conferences across the nation during the first stage of the national campaign. At each location, Safe in Common representatives will advocate for needlestick safety, record real stories from healthcare personnel, and provide demonstrations of the latest safety-engineered medical devices that can help to deliver optimal protection to those at risk of harm.

(Kelly) What is the Safe in Common Pledge?

(Dr Foley) The pledge is the cornerstone of the NSAT: http://www.safeincommon.org/needlestick-safety-pledge.

Our goal is to have at least 100,000 healthcare personnel take the pledge as a show of support that more can be done to reduce needlestick injuries. The pledge, which can be taken online or in person wherever SIC is engaging healthcare personnel, says “A safe working environment is essential if I am to effectively serve the needs of my patients. Needlestick and sharps injuries represent one of the most serious threats to occupational safety within my facility.”

The pain and trauma that these injuries inflict upon healthcare personnel, and their loved ones, is unacceptable. The dollars lost each year in the testing and treatment of reported injuries is unacceptable. The continued use of medical equipment that fails to adequately address the safety and functional needs of healthcare workers and their patients is unacceptable.

Thank you Dr Foley for sharing this important topic with my readers. Patient safety causes often take priority over safety initiatives for ourselves. As nurses, other healthcare providers and ancillary services it is imperative to use caution and advocate for safe and healthy work environments.


Please follow the link and take the Safe in Common Pledge! 

NTI 2012: A conference to remember

The week at NTI was an incredible one. It apparently had more of an impact than I even realized. And that is consciously recognizing that I am intellectually, emotionally and spiritually charged. But when I came home and began sharing my experiences with my significant other, the emotions just poured out of me. From the energizing opening by Sticks of Thunder, to the heartfelt stories of courage from Joplin, MO to the motivational keynote address by Robin Benincasa and all the moments in-between - the excitement and intensity, compassion and fatigue flowed out of me as I manically tried to convey a weeks worth of events in 20 minutes! As I showed him my drumsticks and Together. Stronger. Bolder. t-shirt and other goodies from the conference he remarked that he was so happy that there was an organization and conference that provided that level of professional learning and excitement for me. As I gave it more thought, I realized there is no other place that I can go and get the educational credits I need to maintain my three certifications, the relevant learning I desire, the celebration of nursing and accomplishment, the professional networking and camaraderie, the emotional nurturing, all in a spirit of fun. And oh did I mention, I get to experience all this is with thousands of my closest nurse friends?

Not that I could possibly list every detail or even quantify the conference, but some of my personal highlights of the conference include:

• Opening Supersession on Monday - Sticks of Thunder, Mary Stahl, Pioneering Spirit Awards
• Mastery Session on Break the readmission cycle by integrating Pallitiative care with life-saving therapies
• Bertice Berry's Mastery Session - Becoming the highest version yourself 
• President-elects new theme - Dare to
• Robin Benincasa Keynote Address
• Interactive lecture utilizing technology and the other amazing sessions
• Networking with AACN board members 
• Meeting up with classmates from graduate (CNS) & post-graduate (ACNP) schools
• Nurses Night Out at Sea World
• And so many other incredible moments

Thank you AACN and the numerous sponsors that make NTI possible. Having attended other conferences and professional organizations, NTI is of the highest quality and is very well organized. Not to mention fun!

This conference came for me at a important time as I embark on new path in nursing. Perhaps that is why it resonated so deeply with me. So as the post-conference journey begins how will I take the lessons learned and apply them to my practice, to my self as a leader, a healer, as mother and spouse? I leave you with the challenge Kathryn Roberts did...Dare To

Dare to Dream. Change. Lead. Act.   

What do you DARE TO do?