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.

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!

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

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