Archive for October, 2012

Addicted to Helping People

Posted in Nursing, Nursing Jobs, Nursing News, Nursing Specialties


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A new book focusing on American nurses is nominally a book of portraits, intended for coffee tables. But a doctor writing in the New York Times, Abigal Zuker, found the the narrative to be the most affecting part, hitting her “in the solar plexus.”

For example, she appreciated the observation of a hospice nurse named Jason Short in rural Kentucky who has had a number of jobs, including auto mechanic and commercial trucker. He turned to nursing when the economy went under. This pragmatic decision turned into something more, and Mr. Short says he’s a nurse for good. “Once you get a taste for helping people, it’s kind of addictive,” he says in the book, called “The American Nurse.”

The book tells the stories of 75 nurses. Some of them wanted to be nurses from when they were very young, while others took Mr. Short’s more pragmatic approach. All of the nurses profiled exhibit the same “surprised gratitude,” according to Dr. Zuker.

The nurses profiled come from many different health care settings from many different places in America, ranging from large academic institutions like Johns Hopkins to very small places like the Villa Loretto Nursing Home in Mount Calvary, Wisconsin. There are administrators, home health care workers, emergency room nurses, military nurses, and much more.

All describe unique professional paths in short first-person essays culled from video interviews conducted by the photographer Carolyn Jones. Their faces beam out from the book in Ms. Jones’s black-and-white headshots, a few posing with a favorite patient or with their work tools — a medevac helicopter, a stack of prosthetic limbs or a couple of goats.

But even the best photographs are too static to capture people who never stop moving once they get to work. For a real idea of what goes on in their lives, you have to listen to them talk.

Here is Mary Helen Barletti, an intensive care nurse in the Bronx: “My whole life I’ve marched to a the beat of a different drummer. I used to have purple hair, which I’d blow-dry straight up. I wore tight jeans, high heels and — God forgive me — fur (now I am an animal rights activist). My patients loved it. They said I was like sunshine coming into their room.”

Says Judy Ramsay, a pediatric nurse in Chicago: “For twelve years I took care of children who would never get better. People ask how I could do it, but it was the most fulfilling job of my life. We couldn’t cure these kids, but we could give them a better hour or even a better minute of life. All we wanted to do was make their day a little brighter.”

Says Brad Henderson, a nursing student in Wyoming: “I decided to be a nurse because taking care of patients interested me. Once I started, nursing just grabbed me and made me grow up.”

Says Amanda Owen, a wound care nurse at Johns Hopkins: “My nickname here is ‘Pus Princess.’ I don’t talk about my work at cocktail parties.”

John Barbe, a hospice nurse in Florida, sums it up: “When I am out in the community and get asked what I do for a living, I say that I work at Tidewell Hospice, and there’s complete silence. You can hear the crickets chirping. It doesn’t matter because I love what I do; I can’t stay away from this place.”

The Skills of Advocacy

Posted in Nursing, Nursing News


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Nurses are often strong advocates for their patients, but have traditionally been less effective in advocating for their own needs. Advocacy can be defined as supporting a cause — it’s as simple as that. Advocates are people who identify a need or an issue that must be addressed, then work through different channels to achieve a goal. Political lobbyists have perfected advocacy, but nurses have been slower to mobilize and understand that real change in healthcare is possible when nurses become strong advocates for themselves, for their peers, and for the nursing profession.

Identifying a problem and desiring change is not enough — nurses must utilize the skills they learn in advocating for their patients and transfer these skills to a broader arena in advocating for the nursing profession. So what skills are needed? Karen Tomajan (Medscape, 2012) outlines the necessary skills as follows:

Problem solving: As nurses, we problem-solve on a daily basis. Problem solving involves identifying an issue and developing a strategy to solve the issue or problem. While this is easy enough to do in our daily working life, it becomes more difficult when advocating for a broader issue or change. The bigger the arena and the issue, the greater the number of people that must be convinced and the longer it takes to effect change. Doing our homework beforehand thus becomes necessary if we want to be effective advocates. This may involve identifying key stakeholders, researching the issue at hand to ferret out compelling evidence to support the chosen stance, and determining the best time and place to go forward.

Communication: Although we talk about communication a great deal in nursing and communicate on a daily basis, advocacy means effectively delivering your message to the right people in the right way. Communication may be verbal, written or electronic in nature and must fit the target audience’s needs. Using real examples backed up by facts, rather than opinions, can make an argument more compelling. Discussing the positive impact of an issue or change is crucial to winning the approval of those you have identified as key decision-makers.

Influence: Influence refers to one’s ability to alter individual or group thoughts, actions or beliefs. Advocacy requires influence to succeed, and the person or persons delivering the message must be credible, trustworthy and competent in order to successfully sway others to their position. This requires the ability to build a compelling case for change, back up the argument with hard facts and convey the positive impact that the desired change will have on the issue at hand. Influence must be tempered with relatively small amounts of persuasion which, according to Tomajan, can backfire if utilized too heavily.

Collaboration: As nurses, we frequently work with a wide variety of other healthcare professionals. Advocacy for a cause may require nurses to move beyond other healthcare workers and seek out groups or individuals that can further the cause, such as people who will be affected by the issue or individuals/groups with their own intersecting agendas (i.e. members of the legal community, government or special interest groups). Collaboration requires mutual respect, trust and credibility, as well as frequent and honest communication. What is the end result of collaboration? When groups with similar concerns or interests work together, they can achieve more than if they were to tackle the issue alone; in other words, there is strength in numbers.

Given the rapid changes occurring in the healthcare system, nurses need to come together to advocate for themselves and the profession. As more and more pressure is placed on nurses to do more with less, advocating for our patients is no longer enough — we must also advocate for ourselves to ensure that the future of healthcare is bright and sustainable. As Tomajan points out, “Despite nursing’s strengths inherent in its size, diversity, and unique relationship with the public, the full potential for influence by the nursing profession has yet to be realized.”

Getting Political

Posted in Nursing, Nursing Jobs, Nursing News, Nursing Specialties


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“Healthcare is political,” says a nurse quoted in this article on The article looks at why some nurses have become politically active.

Pat Barnett was motivated to get involved in the legislative process in 1976, when she was a young nurse working for a state psychiatric hospital. At the time, deinstitutionalization was underway, with attempts by the state to move people from state facilities to the community. Barnett felt that she couldn’t just stand by and watch what she saw as a great injustice, as people were discharged from the state institutions but then had nowhere to go, and were given very little support. “So you would see people end up in the No. 1 institution for the mentally ill,” says Barnett. “Jail.”

She testified along with other nurses and they were able to get more funding for the mental health system, allowing some facilities to remain open.

Barnett points out that nursing is a highly regulated profession, which means that it’s especially important for nurses to be active and engaged politically.

The current state of healthcare and the upcoming presidential election add to that urgency, Barnett says. The points out that the Affordable Care Act alone has a great impact on nurses. If it stands, there will be 900,000 new patients in the state of New Jersey who will have new health coverage. Right now there are 1,400 too few primary care doctors — Barnett sees nurses as possible saviors.

“We have 5,000 advanced practice nurses, 80% of whom actually practice in primary care, and many of those take Medicaid and Medicare patients,” Barnett said. “So I think nurses need to be involved because the Affordable Care Act creates opportunity for nurses, whether or not they are advanced practice nurses. Also, there is money in the Affordable Care Act to create nurse-run clinics — and money for nursing education. That happened only because the American Nurses Association, other nursing associations and individual nurses lobbied the legislature and their individual legislators to make that happen.”

The Institute of Medicine weighed in on the importance of nursing input in its October 2010 report, “The Future of Nursing: Leading Change, Advancing Health.” According to the IOM, nursing is at a pivotal point.

“Nurses’ roles, responsibilities and education should change significantly to meet the increased demand for care that will be created by healthcare reform and to advance improvements in America’s increasingly complex health system,” the IOM announced after releasing its report.

Even as the largest healthcare profession, nursing’s voices often are silent or ignored, according to Vance.

“I believe our values and concerns should be heard to help our patients and our profession,” she said. “We have to decide whether we want to make our voices heard, [and have] input in the decision-making around our practice. Or, they’ll make these decisions without our input.”

Many nurses, like a number of Americans, think politics is a dirty word, according to Linda Parry-Carney, RN-BC, MA, education specialist at Hackensack (N.J.) University Medical Center.

Parry-Carney is a former president of the New Jersey State Nurses Association and the current chairwoman of the board for the New Jersey Collaborating Center for Nursing.

What nurses might not realize, she said, is they already are politicians, whether they’re negotiating with patients at the bedside, with employers, on hospital committees or as members of organizations.

Legislators don’t act alone. They make decisions based on what their constituents want, according to Parry-Carney.

“[As NJSNA president,] when I needed to talk to the Governor’s staff, an assemblyperson, senator or the commissioner of health, it wasn’t just me sitting in front of him,” she said. “He knew I represented the interests of all the people who were members of our organization, and, in fact, all nurses in New Jersey.”

One nurse sharing his or her perspective helps formulate strategies that groups use in an effort to influence policy and make changes.

“Every nurse should be a ‘political’ nurse because we are such a caring, large constituency for people,” Vance said. “We are important to society. We’re important to people. So we have to take our practice beyond the bedside, beyond the school, beyond our research, and set it in a larger way into community involvement, which means being an activist, being a volunteer, being an informed citizen.”

Mandatory Flu Shots for Healthcare Workers

Posted in Nurse Safety, Nursing, Nursing News


Rhode Island has officially become the first state in the United States to mandate flu shots for all healthcare workers, despite objections from unions and the local affiliate of the ACLU (American Civil Liberties Union). This means that all healthcare workers employed by hospitals, nursing homes, home care agencies, or any other healthcare organizations in the state will be forced to roll up their sleeves.

Of course, anyone who has a valid medical reason can be exempted from getting a flu shot. Employees can also refuse to get a flue shot by signing a document; however, these workers must wear a mask at all times when in contact with patients when flu activity is noted in the state.

Arguments Against

– The “Nanny State” argument: Our bodies and anything we put in our bodies should not be controlled by the government. Many people disagree that the government has any right to tell healthcare workers to get a vaccine that is potentially dangerous and could cause dangerous side effects. This argument seems to be the most commonly cited argument against getting an influenza vaccine. Health concerns aside, many people are firmly against the government forcing healthcare workers to get a flu shot, as a matter of principle.

– Ineffectiveness of the vaccine: Many of those against mandatory vaccination state that they do not believe the vaccination is effective in preventing influenza.

– Danger associated with vaccination: Many healthcare workers state that they became ill after receiving a vaccination at some time in the past, and so they have refused to get the vaccine ever since. Although serious reactions are rare, the fact that serious reactions do sometimes occur, even if very rarely, makes many people adamant that they will not get the shot and will not be forced into it by anyone, especially the government.

Arguments For

– Patient protection: We owe it to our patients to get vaccinated. In doing so, we protect those who are vulnerable (i.e., infants, the elderly, immunosuppressed individuals) and could potentially die should they come in contact with the virus.

– Herd immunity: When a large enough portion of the population is immunized against a particular disease, most members of the community will be protected because there is little opportunity for the disease to spread. Herd immunity protects the most vulnerable members of society and, as nurses, it is our duty to protect others.

– Role modeling: Many nurses state that, although they are not against the vaccine per se, they are against the vaccine for themselves. As nurses we are role models for others. When members of the community hear nurses speak out against influenza vaccination, it makes them less likely to get vaccinated, as nurses are respected as being knowledgeable about disease prevention.

– Vaccination reduces sick time: When nurses are immunized, there is less sick time, resulting in lower absenteeism, less overtime and less need to replace ill staff members. This could be an enormous cost-saving measure at a time when many organizations are struggling financially.

There are other arguments, but these arguments cover some of the biggest reasons for and against influenza vaccination. When it comes right down to it, we all have choices. Even the nurses in Rhode Island have a choice — they can get the vaccine or wear a mask when in contact with patients during the height of flu season. Getting the vaccine must be a personal choice for all nurses, one that many nurses struggle with every year.

Popularity of Nurse-Midwives is Rising Again

Posted in Nursing, Nursing Jobs, Nursing News, Nursing Specialties

October 1st, 2012
Jenna Fischer

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This article on the Boston Channel website looks into the increasing popularity of nurse-midwives after a period of decline.

For example, a woman named Carla Tonks decided to switch to a nurse-midwife program when she was pregnant with her first child seven years ago. She hadn’t been impressed with her experience with the ob-gyn, especially the long waits at his office that resulted in actually seeing the ob-gyn for only 10 minutes.

She switched over to a nurse-midwife program and was much happier. She moved away from Massachusetts and became pregnant with her second child, and this time sought out a nurse-midwife in North Carolina, her new location. This experience went well too, and she kept up the trend with her third child after she returned to Massachusetts. In the article she pronounces herself “very happy” with nurse-midwives, and appreciates that they can spend more time with mothers-to-be.

Midwives, which were the rule until the mid-20th Century, are becoming more popular again. According to a report by the American College of Nurse-Midwives, 11.3 percent of vaginal births and 7.6 percent of all births were attended by either certified nurse midwives (CNMs) or certified midwives (CMs) in 2009. The number has risen each year since 1989. Certified midwives are not nurses but have Master’s degrees.

Anna Jaques offers nurse-midwives. Either type provides care to women during pregnancy, labor and birth, as well as during the postpartum period. They typically handle low-risk pregnancies.

“We do all the check-ups, all the prenatal care,” says Walsh, one of five nurse-midwives on staff at Anna Jaques. “If a complication arises, we consult with the physicians. They are always on call. If the patient needs a C-section, the physicians take over. But we are still in the operating room.”

Tonks said she did develop high blood pressure during her most recent pregnancy, but she decided not to transfer to a doctor’s care.

“The nurse-midwives can take on a lot more than you think,” she says.

Another plus was that over the course of her pregnancy, Tonks developed close relationships with all the nurse-midwives at the hospital, so if Walsh, for some reason, was unavailable at the time of delivery, Tonks would still know the person performing the delivery in her stead.