Nurse Safety

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.

Media Messages about Nursing are Mixed

Posted in Nurse Safety, Nursing, Nursing News

Peter Kim –

How are nurses portrayed in the media? A group of researchers decided to find out, by examining the YouTube database to find the most viewed videos for “nurses” and “nursing” as of July 2010.

According to this article on, out of 96 videos surveyed, about 40% of them presented nurses as smart, educated, and skilled. The rest of them presented nurses as “a sexual plaything and a witless incompetent.”

This was found to be in keeping with other forms of mass media portrayals of nurses. The study indicates that these stereotypes are not merely annoying; they can have a real effect on how patients interact with the nurses who are caring for them. Nurses are highly-trained professionals who play a crucial role in American health care, yet these portrayals trivialize what they do and who they are.

The study authors suggest that the nursing profession harness the power of YouTube to promote a more positive image.

Key findings of the study, which appears in the August issue of the Journal of Advanced Nursing, included:

• The 10 most viewed videos reflected a variety of media, including promotional videos, advertising, excerpts from a TV situation comedy and a cartoon. Some texts dramatized, caricatured and parodied nurse-patient and interprofessional encounters.

• Four of the 10 clips were posted by nurses and presented images of them as educated, smart and technically skilled. They included nurses being interviewed, dancing and performing a rap song, all of which portrayed nursing as a valuable and rewarding career. The nurses were shown as a distinct professional group working in busy clinical hospitals, where their knowledge and skills counted.

• Nurses were portrayed as sexual playthings in media-generated video clips from the sitcom Frasier, a Virgin Mobile commercial set in a hospital, a lingerie advertisement and a “soft news” item on an Internet videocast. All showed the nurses as provocatively dressed objects of male sexual fantasies and willing accomplices in their advances.

• The final two clips were a cartoon that portrayed a nurse in an Alzheimer’s unit as dim and incompetent and a sitcom that showed the nurse as a dumb blonde, expressing bigoted and ignorant views about patients and behaving in a callous and unprofessional way.

“Despite being hailed as a medium of the people, our study showed that YouTube is no different [from] other mass media in the way that it propagates gender-bound, negative and demeaning stereotypes,” Fealy said. “Such stereotypes can influence how people see nurses and behave toward them.

“We feel that professional bodies that regulate and represent nurses need to lobby legislators to protect the profession from undue negative stereotyping and support nurses who are keen to use YouTube to promote their profession in a positive light.”

Nurse Puts Diet Where Her Mouth Is

Posted in Nurse Safety, Nursing, Obesity

Elenathewise –

One thing that comes up sometimes with nurses is the disparity between the talk and the walk — when great advice is being given about how to get and stay fit, but the nurses giving that advice are not fit, themselves.

A Minnesota nurse named Michelle Williams says that she always felt hypocritical when she stressed the importance of being fit to her patients. “I’m telling people to lose weight, watch their diet. And I weighed 270 pounds,” she says in this article in the Star Tribune.

Not anymore, though. After a lot of hard work and dedication, she’s dropped 95 pounds. She has improved her health, changed her outlook, and serves as an inspiration to patients and colleagues.

Her identification badges at the hospital still have photos that were taken before her weight loss — she keeps wearing them, to show patients that she’s putting her diet where her mouth is. She’s been on a strict diet while also exercising regularly.

Long before she decided that her ideal meal was a cup of garden vegetable soup with pesto and a half sandwich at Panera, she pretty much ate whatever she wanted, whenever she wanted. Her parents were overweight. Williams was big as a child. For her, this was normal.

And she’s a good cook.

Obesity brought Williams awkward moments as a child. But when she reached 33, she was in crisis mode. She was diagnosed with hypertension. As a cardiology specialist, she didn’t have to read any health charts to predict what her future might be like unless she drastically changed her lifestyle.

North Memorial offered the Optifast program. Williams, who is single, began 14 months ago. She has lost 34 percent — or one-third — of her total body fat.

It hasn’t been a piece of cake.

“I’d go hours and hours without eating,” she recalled. “And then I’d eat a ton.”

When she started the program in May of last year, she immediately gave up soda, which she loved. She reduced her carbohydrate intake, a difficult task for someone who loves bread. But the hardest part was the exercise.

“I’m not crazy about running or some of the machines,” she said. “But I do what I need to do. At first, I forced myself. Eventually, it became part of my routine.”

Doctors at North Memorial now point to Williams as an example of what can be.

She’s not sure how far her journey will take her. But on Labor Day weekend, she will be in New York, where half of one of those 2-inch-thick deli sandwiches could last the entire three days.

“I’m excited,” she said. “This is a dream come true.”

The trip to New York is just the cherry on the cake. Her greatest reward is what she no longer sees in the mirror.

Developing Healthy Habits

Posted in Nurse Safety, Nursing, Nursing News, Obesity

momcilog - iStock

Physician, heal thyself — and nurse, get thyself fit.

It’s one of the paradoxes of the health care field that often the very people who are dispensing valuable advice about fitness have a hard time following it, themselves. According to several studies, more than half of all nurses are obese, and more than 10% smoke. Many nurses feel they are too busy to take care of themselves, tending to help others first.

Why is there this disconnect between the clinical knowledge about how to be healthier, and actually putting that into practice? How can nurses successfully reach their wellness goals?

One thing they can do is look to the behavior-change concepts they use with patients, such as the Stages of Change and the Health Action Process Approach, according to this article on

Behavior change science is still evolving, but nurses who are involved in wellness and behavior change say that the first step toward health is often finding a strong motivation to change.

It’s also important to set realistic goals, going inch by inch rather than trying to do everything at once (and getting discouraged when that doesn’t work). One nurse in the article started by just walking a mile or two around the neighborhood regularly. Another made sure she built breaks into her schedule — for every 50 minutes of work, she would take 10 minutes to get up to walk around and stretch. She not only made gains in her health but was more energetic and productive when she went back to work.

Planning for change and possible barriers also is important, said Karen Gabel Speroni, RN, BSN, PhD, MHSA, director of nursing research at Inova Loudoun Hospital in Leesburg, Va., and co-creator of a research program called Nurses Living Fit. She suggests nurses start any self-care plan by documenting their lifestyle practices — what they eat, how much water they drink, how much sleep they get — and use that information to work in small changes.

Darlene Trandel, RN, PhD, FNP, PCC, an International Coach Federation-certified professional health coach and consultant for health, wellness, lifestyle and chronic care, has worked with many nurses to create environments to help them succeed. This may mean keeping sweets out of the house, planning an activity program or finding a satisfying substitute for a cigarette. She also helps them plan for things that might sabotage their good intentions, such as treats in the break room or feeling too tired to exercise after work.

Start small, finish big

After nearly a year of neighborhood walking, Cotter’s friend suggested they walk the 2011 Oklahoma City Memorial Marathon. Cotter said she thought she could do the 13.1 mile half-marathon, so they began to increase their walking times and distances, got up early nearly every day, trained with a running group and entered short races.
Although she wasn’t dieting, Cotter started decreasing portion sizes and increasing fruits and vegetables. She didn’t lose weight at first, but she dropped a dress size and began feeling better. People started telling her she looked better, too.

The half-marathon was a success, and the friends agreed they would try for the full marathon in 2012. They finished the 26.2 mile race in 6 hours, 46 minutes. By the start of the April 29 marathon, Cotter had lost 50 pounds and six dress sizes. She was off all but one medication, including the blood pressure medications she’d assumed she would take for the rest of her life. In January, three months before the marathon, Cotter made a resolution to give up fast food, a vow she has kept “with three small lapses,” she said.

Worth the effort

Creating and sustaining a healthy lifestyle is not easy, said nurses who work in behavior change, and the process almost always involves setbacks. Tracking progress, enlisting the support of others and changing strategies to avoid boredom can help people continue with healthy changes. “Don’t hate yourself for doing behaviors that are not what you wanted,” Speroni said. “Forgive yourself and move on.” Support from friends, family and colleagues through the entire change process is crucial, Melnyk said.

There are professional reasons for nurses to take care of themselves, said Speroni, whose report, “Effect of ‘Nurses Living Fit’ Exercise and Nutrition Intervention on Body Mass Index in Nurses,” cites a recent study that concludes patients may not have as much confidence in the wellness advice of nurses who do not appear to have followed it themselves. “Weight-appropriate nurses had more public confidence in their teaching,” her report states.

Nurses who strive for a healthier lifestyle can provide inspiration for their patients to change, Harrington said. They can acknowledge that change is difficult, but also show it can be done. “Health isn’t a goal, health is who we are,” she said. Making healthy changes provides “an opportunity to be excellent role models, educators and advocates.”

Cotter said her new motivation is to be a model for others. When she teaches her students about the need to take care of themselves now, she is passionate. She brings in photos from her marathons and uses her own experiences as an example. She still has some back pain and wants to lose 25 more pounds, but she feels like she can do it. The most important lesson of her wellness journey, she said, was “figuring out that you just make time. Taking the time is hard, but eventually the benefits are worth it.”

K-9 Team Puts Nurses at Ease

Posted in Maryland, Nurse Safety, Nursing, Nursing News

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The emergency department in a hospital can be a very tense place. Injured people want to be tended to immediately, their family members get upset on their behalf, two people from an altercation can both wind up at the same hospital — there are many reasons why emotions can spill over and difficult situations can develop. And such situations can be stressful and dangerous for nurses as well as patients and their families.

At a hospital in Baltimore, a two-member security team is called when things start to get heated. One member of the team is human, but the other is a German Shepherd. Often just the dog’s presence can serve as a calming influence, according to this article on The dogs add “another level of authority,” according to the hospital’s clinical director for the ED, and “They have a nice presence.”

The hospital is in a high-risk crime area, and started using a K-9 unit in 1994 to help curb violence on the campus. Administrators think that the dogs’ presence has had a profound effect.

“Our director goes to downtown meetings in Baltimore [with other hospital administrators] and they share crime statistics,” said Mark Ross, captain of Mercy’s K-9 Unit. “It’s well-known within the city that Mercy has dogs and it’s not a place to go for crime.”

Ross and four other handlers have their dogs with them at work and at home. The dogs are imported from Europe and trained for protection and to hunt human and explosive odors. Ross, who has partnered for two years with Iko, said the dogs can track someone on the campus, find explosive devices and protect hospital personnel. Working in a hospital requires the dogs to be more sociable than other police dogs. The Mercy dogs must have the ability to be friendly one minute and ready for business the next. “It makes it a little more tricky when it comes to selecting a dog for this environment,” Ross said. “The dogs are tempered because they have to be sociable. They also have to have the ability to work or apprehend on command.”

The dogs at Mercy develop friendships with nurses and patients and are able to enjoy some attention.

“The staff loves them,” said Janet Norman, RN, MS, PCCN, nurse manager, progressive care unit. “When they are training a younger dog, a guard may say, ‘You can’t come close to this one.’ The older dogs, you can talk to them and pet them.”

There is time for pleasure, but during most of the 10-hour shifts, the handlers’ and dogs’ time is for work.

“There is an added sense of protection here,” Norman said. “We had a disturbance once and a family had become so angry. I’m not sure it was directed at us, but it was very frightening. Security came up with the dog and everyone quieted down. There was no feeling that there would be any harm to anyone.”

Handlers and dogs also may walk nurses to their cars in the parking lot. “It gives us peace of mind,” Disney said. “It’s interesting the effect when you have a really busy waiting room. The dogs have a tendency to calm everybody down. It’s a distraction as much as anything, (to) watch the dog for a minute. We joke and call them our favorite security officers.”

And like any smart dog, the Mercy K-9 dogs remember where their friends are when making the rounds. “We have a couple nurses who sneak biscuits for them,” Disney said. “They know where those nurses work and go right to them.”

Waiting for Nurses

Posted in Nurse Safety, Nursing, Nursing News

VILevi -

A new poll has found that 34% of patients who were hospitalized for at least one night in the past year said that “nurses weren’t available when needed or didn’t respond quickly to requests for help.”

The poll was conducted by NPR, the Robert Wood Johnson Foundation and the Harvard School of Public Health.

NPR was surprised at the findings and decided to find out more, so they put a request on Facebook for nurses to respond to the poll and provide their own stories. They received hundreds of responses, with stories about nurses feeling overworked, not getting enough breaks or even no breaks at all, and even barely enough time to go to the bathroom.

Most of the nurses who responded did not want to be interviewed for a broadcast, because they were worried about their employers’ reaction. Many were willing to be interviewed anonymously, though.

They conveyed a picture of being understaffed and overworked — even though the nursing shortage is considered to be over in most places, each individual nurse still has a whole lot on his or her plate.

“We’re always afraid that something will happen to our patients during the time we’re off the floor,” one nurse says, “and I personally don’t feel comfortable leaving them unless I know that a co-worker is actually looking after them during the time that I’m off the floor.”

This nurse says she rarely stops. Not for 12 hours. She’s an emergency room nurse in a busy urban hospital. The ideal, she says, would be one nurse for every three patients in her ER. But she typically cares for five patients or more — often eight, if she’s covering for a colleague taking a lunch break. She says there are times when she can’t leave patients’ bedsides.

“Maybe I was injecting medication that you have to push slowly over five to 10 minutes so it doesn’t harm them,” she says, “and I can see the call bell going off in the hallway, and there’s no way I could respond to that.”

The only option is to literally yell down the hallway and hope another nurse hears her and responds to the patient call bell. There have been times when she has driven home at the end of her 12-hour shift, white-knuckling the steering wheel and wondering whether she “missed something.”

Another nurse likens her job to “spinning plates,” just “praying,” she says, that one doesn’t fall. “And these are human beings,” she says, “not products on conveyor belts.”

Stories like this suggest there’s a shortage of nurses. But Linda Aiken, a researcher and professor of nursing at the University of Pennsylvania School of Nursing, says that’s not the case. There was a shortage about a decade ago, she says. Today, that has changed. The number of RNs graduating has increased dramatically over the past decade, but many can’t find jobs.

“There’s not an actual nursing shortage,” Aiken says. “There’s a shortage of nursing care in hospitals and other health care facilities.”

Nancy Foster, a vice president with the American Hospital Association, says hospitals are facing big financial challenges.

“In part, it’s because our patients are sicker — coming to us with more intense diseases and disorders than they did 25 years ago,” she says. “In part, it’s because there’s so many more medications and devices and other interventions at our fingertips; we can help many more patients and restore them to health.”

That is terrific, of course, but it’s not cheap. Any reduction in nurse staffing at a time of increasing patient demand jeopardizes patient care, Aiken says.

“Nurses are the surveillance system in hospitals for early detection and intervention [to save patients’ lives],” she says.

According to one nurse, little clues from patients are critical.

“I mean, you might walk into a room, and they are breathing and answering your questions,” the nurse says, “but if you look at their neck and the jugular vein is slightly distended … taking the time to pick up on the small details like that are the early warning signs that somebody is getting sicker fast.”

Horizontal Violence in Nursing

Posted in Nurse Safety, Nursing, Nursing News

Photo Ma -

Nurses can expect the occasional outburst from a patient whether verbally or physically, but when violence or bullying comes from their co-workers, nurses may find themselves unsure of how to react. Horizontal violence is when some sort of violence comes from a peer, rather than a consumer or a supervisor. Victims of horizontal violence can experience psychological distress, and their workplaces can suffer decreased morale and a higher turnover rate. But why and how does the violence start? It is a mere dislike for a co-worker or a culturally imbedded phenomenon?

One theory suggests that in order to assimilate into a group, an individual first observes the behavior, attitudes and emotional reactions that the members of the group display, and the individual then mimics that behavior in order to be accepted. This pattern is also known as reciprocal determinism. In theory then, if the group engages in bullying a co-worker, the individual who wants to join the group will engage in the same behavior. It is not surprising then that at a 15-member meeting on nursing retention, all but one member could relate a first-hand experience of workplace bullying.

In a study led by Nancy Walrafen, MS, RN, OCN, respondents scored the top five behaviors considered bullying or workplace violence, and as witnessed as being done to others, as follows:

– Backstabbing – complaining to others about one individual (77.0%)
– Failure to respect the privacy of others – gossip or talking about others without their permission (76.0%)
– Nonverbal negative innuendo – raising eyebrows or face-making (72.2%)
– Bickering among peers (72.1%)
– Covert or overt verbal affront – snide remarks, withholding information, abrupt response (66.7%)

The most egregious behavior, undermining clinical activities (not available to help, turning away when asked for help), was witnessed by 50% of the respondents. If half of all nurses witness this behavior, how is it affecting patient outcomes or satisfaction scores?

One-third of the respondents reported that they had engaged in negative behavior because they had gotten caught up in the moment or the culture surrounding them. Some did not realize that the displayed behavior was considered bullying or workplace violence.

Nurse victims of workplace bullying often do not report the incidents. Reasons for this vary, from a desire to avoid making waves on a team that needs to maintain cohesion, to feeling that one more report won’t make a difference to supervisors or administrators who have been actively ignoring a problem.

In the study, respondents were also asked to contribute positive suggestions on possible methods for dealing with workplace violence and bullying in the nursing profession. Cultural awareness and appreciation for the differences and similarities was viewed as a possible solution, especially if hospital-sponsored continuing education credits on cultural awareness could be given. One respondent suggested practicing the golden rule of “do unto others” as no one wants to be treated negatively. One nurse offered that adequate staffing could reduce much of the stress on co-workers, giving them the opportunity to focus more on their own needs. All of the respondents agreed that all levels of management should work to address and solve the problem of horizontal violence in their workplace.

Blame The Nurse, A Time-Honored Tradition

Posted in Nurse Safety, Nursing, Nursing Jobs, Nursing News

Scott Hale -

Theresa Brown, an oncology nurse, describes a situation in which an entire medical team on its morning rounds stands in a patient’s room, waiting for a test result. The patient, a friendly middle-aged guy, jokingly asked his doctor whom he should yell at. The doctor turned and pointed at the patients’ nurse and replied, “If you want to scream at anyone, scream at her.”

In this article on the New York Times’ Well blog, Brown notes that this bullying didn’t happen 30 years ago and it didn’t happen on a TV show like “House” — it happened to her, just a few months ago.

Brown later asked the doctor if she could quote him for the article, and he nonchalantly said “Sure, it’s a time-honored tradition — blame the nurse whenever anything goes wrong.”

While Brown was stunned and insulted, she also was concerned about the problems such attitudes pose to patient health. Nurses are the hospital’s front line, and such attitudes can create a hostile and even dangerous environment in a setting where “close cooperation can make the difference between life and death.” While many hospitals have anti-bullying policies, the seriousness of the issue is too rarely recognized.

While most doctors clearly respect their colleagues on the nursing staff, every nurse knows at least one, if not many, who don’t.

Indeed, every nurse has a story like mine, and most of us have several. A nurse I know, attempting to clarify an order, was told, “When you have ‘M.D.’ after your name, then you can talk to me.” A doctor dismissed another’s complaint by simply saying, “I’m important.”

When a doctor thoughtlessly dresses down a nurse in front of patients or their families, it’s not just a personal affront, it’s an incredible distraction, taking our minds away from our patients, focusing them instead on how powerless we are.

That said, the most damaging bullying is not flagrant and does not fit the stereotype of a surgeon having a tantrum in the operating room. It is passive, like not answering pages or phone calls, and tends toward the subtle: condescension rather than outright abuse, and aggressive or sarcastic remarks rather than straightforward insults.

And because doctors are at the top of the food chain, the bad behavior of even a few of them can set a corrosive tone for the whole organization. Nurses in turn bully other nurses, attending physicians bully doctors-in-training, and experienced nurses sometimes bully the newest doctors.

Such an uncomfortable workplace can have a chilling effect on communication among staff. A 2004 survey by the Institute for Safe Medication Practices found that workplace bullying posed a critical problem for patient safety: rather than bring their questions about medication orders to a difficult doctor, almost half the health care personnel surveyed said they would rather keep silent. Furthermore, 7 percent of the respondents said that in the past year they had been involved in a medication error in which intimidation was at least partly responsible.

The result, not surprisingly, is a rise in avoidable medical errors, the cause of perhaps 200,000 deaths a year.

Concerned about the role of bullying in medical errors, the Joint Commission, the primary accrediting body for American health care organizations, has warned of a distressing decline in trust among hospital employees and, with it, a decline in the quality of medical outcomes.

What can be done to counter hospital bullying? For one thing, hospitals should adopt standards of professional behavior and apply them uniformly, from the housekeepers to nurses to the president of the hospital. And nurses and other employees need to know they can report incidents confidentially.

Offending parties, whether doctors or nurses, would be required to undergo civility training, and particularly intransigent doctors might even have their hospital privileges — that is, their right to admit patients — revoked.

But to be truly effective, such change can’t be simply imposed bureaucratically. It has to start at the top. Because hospitals tend to be extremely hierarchical, even well-meaning doctors tend to respond much better to suggestions and criticisms from people they consider their equals or superiors. I’ve noticed that doctors otherwise prone to bullying will tend to become models of civility when other doctors are around.

In other words, alongside uniform, well-enforced rules, doctors themselves need to set a new tone in the hospital corridors, policing their colleagues and letting new doctors know what kind of behavior is expected of them.

This shouldn’t be hard: most doctors are kind, well-intentioned professionals, and I rarely have a problem talking openly with them. But unless we can change the overall tone of the workplace, doctors like the one who insulted me in front of my patient will continue to act with impunity.

I wish I could say otherwise, but after being publicly slapped down, I will think twice before speaking up around him again. Whether that was his intention, or whether he was just being thoughtlessly callous, it’s definitely not in my patients’ best interest.

Burnout in Oncology Nurses

Posted in Nurse Safety, Nursing, Nursing Jobs, Nursing News, Nursing Specialties

Geo Martinez -

Nurses working in oncology care suffer from a high degree of burnout and compassion fatigue. The typical oncology nurse will develop a close relationship with patients and patients’ family members over the course of treatment, which can last months or even years.

In a study conducted by Memorial-Sloan Kettering Cancer Center, 153 participants (mostly nurses), responded to a wide variety of questions on their feelings of burnout and compassion fatigue. Forty-four percent of inpatient staff nurses felt they suffered some degree of burnout. Similar studies of oncology nurses found a high incidence of emotional exhaustion (37-44 percent), depersonalization (11-47 percent) and low personal accomplishment (20-55 percent).

In order to anticipate which nurses most likely to develop burnout and fatigue, the Kettering study identified a number of risk factors:

Age. Nurses younger than 40 suffered a greater incidence of burnout, perhaps in correlation to their number of years of experience.

Stage of worklife. Nurses with 6-10 years of oncology experience were more likely to suffer high-risk burnout and low compassion satisfaction than nurses with 11-20 years of experience. Nurses with a bachelor’s degree also experienced less burnout than nurses with a doctorate.

Gender. Females suffered more burnout than men.

Personality characteristics. A resilient attitude helped nurses cope with the stress of oncology nursing, and nurses who were equipped with a wide range of positive coping skills fared better than their coworkers who had fewer coping skills.

Social support and spirituality. Not surprisingly, nurses with religious or social support experienced fewer dips in empathy, depersonalization and emotional exhaustion.

The study also identified signs and symptoms of burnout that nurses should monitor themselves for, which included boredom, depression, fatigue, frustration, gastrointestinal distress, frequent headaches, insomnia, low morale, weight loss, increased absences and deterioration in their relationships with physicians and patients.

Early detection was identified as key to preventing long-term effects of burnout and compassion fatigue. Simple alterations in lifestyle may best minimize the risk to oncology nurses and empower them to maintain balance in their work and personal lives as they are caring for vulnerable cancer patients. The Kettering study suggested the following lifestyle management tools:

– Monitoring and identifying early symptoms
– Good nutrition
– Spirituality, meditation and time in nature
– Grieving losses
– Reducing the amount of overtime worked
– Exercise or participation in sports
– Keeping a sense of humor
– Consulting with experts if symptoms increase
– Peer support, including discussion of coping strategies

Although originally developed as a coping mechanism for physicians, a technique of identifying and working with emotions may also prove beneficial to oncology nurses. This technique involves identifying the conditions under which the emotion arose, naming and accepting the emotion, identifying its source, stepping back to gain perspective in the situation, identifying behaviors that resulted from the emotion, considering implications and behaviors and then developing patient outcomes in response to different behaviors.

Organizations that expect perfection in nursing care also contribute to a higher degree of burnout, especially when standardized care and efficiency is expected. Institutions that empower the oncology nursing staff through educational interventions, emotional support and improved communication can reduce the burnout and compassion fatigue so common to caregivers of cancer patients and their families.

When a Nurse Should Hire an Attorney

Posted in Nurse Safety, Nursing, Nursing News

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Most nurses can expect to face at least one instance where legal representation becomes necessary in the course of their career. Although most healthcare institutions carry malpractice insurance for nurses and will provide their own in-house counsel or insurance counsel, there may be times when nurses feel they need their own private lawyer to protect their interests.

Generally, the amount of malpractice insurance an institution carries will suffice for protecting a nurse from personal financial loss, but in high liability areas of nursing practice, such as nurse midwifery and surgery, nurses should carry an additional policy. Several companies offer professional liability insurance and the Nursing Service Organization offers several types of insurance policies that are tailor-made for the nursing profession.

Two key instances where a nurse should always seek outside counsel are: 1) any time a complaint has been made with the state Board of Nursing, which includes notice of investigation by the Board of Nursing and, 2) any time a nurse has been given notice of being a named party in a lawsuit.

Patients and family members, upon filing a lawsuit, will name every person that has come into contact with the patient as a party to the action. Parties are discharged as the investigation uncovers which healthcare providers are most likely to have caused the alleged harm to the patient. The process can be upsetting and affect a nurse’s practice, but the investigation is a necessary element in the process of resolving the matter.

Nurses may also wish to retain counsel in matters concerning their employers. This can range from a simple review of a contract before hire, to more serious instances involving action taken by employers, supervisors and physicians. Situations in which a nurse should hire outside representation aren’t always clear however. Consider the following situations and advice from Medscape’s “Ask an Expert” before seeking your own legal counsel:

Forced overtime. Several states prohibit employers from requiring nurses to work overtime, but employers mandate the overtime just the same. Employers may threaten a nurse with patient abandonment, which can cause loss of the nursing license. A nurse should consult an attorney in this situation.

Inadequate staffing. Short staffing can lead to dangerous outcomes for patients, but in this situation, a nurse should first work up through the chain of command and bring the situation to the attention of supervisors and the director of nursing. It’s also good to do some background investigation of state laws for minimum staffing levels, which can add credence to the nurse’s case for proper staffing levels. If the facility is a Magnet hospital, it may also be in violation of the requirements to keep Magnet status.

Derogatory or critical supervisor. Derogatory statements can be actionable if they involve discrimination or harassment. A critical supervisor may focus comments more on the nurse’s job performance; these comments are more disparaging than discriminatory or harassing. In this case, the nurse must first examine the reason for the remarks. Is the nurse performing the job as outlined in the job description? If so, the nurse may wish to seek legal counsel who will determine if a cause of action exists.

Termination of employment. Getting fired is usually an emotional situation, but if a nurse believes that he or she was wrongfully terminated, then consulting legal counsel may help recoup financial loss.

Before hiring an attorney, nurses should investigate whether the attorney has experience in handling employment or malpractice issues. It can also help a lot to do some investigation of the applicable laws and regulations before contacting a lawyer — you may discover that the matter can be handled without legal representation, thereby saving hundreds and maybe thousands of dollars.