Nursing News

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Vicki Milazzo is a nurse, but she’s also a legal nurse consultant and an author and CEO of the Vicki Milazzo Institute. She’s a registered nurse (RN) and also has a master’s degree in nursing (MSN) and then also has a doctorate in law (JD).

She put all of these diverse interests and talents together to pioneer the nurse consultant field. In an interview with Laura Raines of the Atlanta Journal-Constitution, Milazzo says that she was working overtime to pay off her mortgage but was no longer feeling fulfilled in a hospital setting.

“I didn’t want to change professions, but I wanted to practice nursing in my own way,” she said.

If she started her own business, Milazzo decided, she could be her own boss. Interested in the relationship between nursing and the law, Milazzo set out to pitch the value of her nursing expertise to medical malpractice attorneys. Although the term “legal nurse consultant” didn’t exist yet, Milazzo became one and went on to start an educational company that trained other nurses in the specialty.

“I had no business skills, so I followed the nursing process I’d learned — assess, diagnose, plan, perform appropriate action, evaluate and start over. I still use that process every day,” she said.

Milazzo also made herself five promises when she realized that having dreams wasn’t enough to change her life and that it would take commitment to realize them.

1. “I will live and work a passionate life.” She wanted to wake up every day feeling excited and energetic.

2. “I will go for it or reject it outright.” You can’t wait for the right time to start living your dreams.

3. “I will take one action step a day toward my passionate vision.” That’s how she created her business.

4. “I commit to being a success student for life.” The quickest way to learn is through the experience of others.

5. “I believe, as a woman, I really can do anything.” If she could save a life in the middle of the night, she could certainly start a business.

“I still live those five promises every day,” Milazzo said.

She encourages nurses to commit to their own promises and reach for their goals. “Nurses today have an incredible knowledge base that can take them in any direction.”

Image © Alexander Raths via Fotolia

One of the biggest challenges for women seeking to build a career and also have a family is to figure out how to find a balance. Many professions require a level of commitment that is incompatible with raising a family, and it is rare to find a profession that allows you to take a long break and then return to work. Nursing is one of those rare professions.

The story of how one nurse took a long break from nursing, but then was able to return to the profession (and excel) is told in this article on KCCommunityNews.com:

Some nurses break from the bedside and return to their patients with fresh eyes.

“My scope is bigger this time,” said Nan Whalen, RN, MSN.

Whalen stopped nursing for five years to focus on her family. She gradually added PRN shifts and as her children grew older, then flew from the nest, Whalen re-entered the work force full time. She said few professionals can re-enter their field of choice.

“That’s one of the unique benefits of nursing overall,” she said. “There are not a lot of professions that allow you to do that.”

To keep her options open, Whalen never let her nursing license lapse while she stayed home full time to raise children. She also fulfilled 45 hours of continuing education credits every three years required by the state of Iowa, where she lived at the time.

Whalen said it is important to do what is right for you and for your family. Nurses can take a break or scale down their hours, she said if that is what they choose. There is a need for nurses working in a variety of shifts and hours, Whalen said.

“Nurses work everywhere in the community,” she said. “There are so many ways to contribute. I am a firm believer in life balance. It was important to take care of my family and kids.”

Whalen encourages anyone struggling to maintain family and work to take a break or ot scale back, but to keep your eyes on the future.

“You have to be purposeful about it,” she said. “ I need to keep current in it. You‘ve got to take professional accountability.”

Whalen is administrative director of Inpatient Nursing Services at St. Joseph Medical Center, a position she never dreamed she would pursue. As a younger adult in her twenties, she viewed nursing as a means to support herself and her family and did not consider moving into leadership roles, she said. That changed after several decades of motherhood and patient experiences when delivering her children in a hospital. She came back to nursing wanting to make a better experience for patients.

“It was a completely different feeling,” she said. “I definitely viewed patients differently.”

It was tougher than she liked, taking those initial steps back into nursing, Whalen said. Having moved from Iowa, she quickly learned it would be wise to certify on both sides of the state line, she said. There were changes in medications and technology she knew she would face. She spent extra hours in orientation becoming comfortable with electronic record keeping.”

“It’s very scary to leave the field and come back,” she said. “Things change so rapidly in health care.”

Whalen said you cannot take the nurse out of nursing, however. A colleague told her that nurses are hard-wired to do what they need to do and Whalen has come to believe that. In the five years she was gone from the field, she saw equipment like drains, ventilators and computers had changed and grown in hospital settings, but the respiratory and cardiovascular systems remained the same, she said.

“The tools changed but the pathophysiology didn’t change,” she said. “It still provided the same benefit to the patient.”

Image courtesy of serch via Flickr

The Daily Iowan has an article about a nurse practitioner named Mary Shlapkohl, who has worked at the University of Iowa Children’s Hospital for many years. She managed to find a way to bring some much-needed cheer to the kids who are her patients.

Every day, Mary Schlapkohl wears a red I AM LOVED button pinned to the straps of her ID-card, dangling around her neck.

“A teenage girl gave this to me,” the 50-year-old said, clutching it in her hand.

The nurse-practitioner said when she asked the young patient handing them out for one, the child replied, “Ugh, you’re never going to wear it.”

“And so I’ve never not worn it, just to spite her,” Schlapkohl said and smiled.

Working at the University of Iowa Children’s Hospital for the last two decades has allowed her to meet numerous children and families facing cancer.

“I’ve worked here a long time, so everybody knows me, and I’m up here on the floor a lot,” she said.

A UI nursing alumna, Schlapkohl worked for two years as a bone-marrow transplant specialist before becoming an assistant head nurse for the inpatient unit at UIHC. In 1992, she became a nurse-practitioner — beginning her work in the UI’s second-level pediatric hematology oncology unit.

A few years after, Schlapkohl was invited to the first planning meeting for Dance Marathon. From there, she has witnessed its continued growth.

“I think of how [Dance Marathon] has evolved to where it is now, and I can’t believe it,” she said. “It’s not just the amount of money it has raised, but what this has grown to mean to our families has been just incredible and how much the students just embrace our families and become so involved with them.”

For Schlapkohl, Dance Marathon is like a partnership. The volunteers bring joy to distract patients, she said, and the hospital staff members help children get better and provide information to the families.

“So I think it’s a great parallel way of treating our patients and working with them together,” she said.

Children’s Hospital nurse Kristie Febus, who has worked with Schlapkohl for the last seven years, said she has a knack for working with children.

“I can honestly say that I have not seen a kid who doesn’t love Mary,” the 31-year-old said.

Febus said Schlapkohl always maintains a lot of energy around staff and patients.

“She figures out a way to put fun into the hospital,” Febus said. “This isn’t a very fun place, and somehow she is able to make the kids feel comfortable and make them feel like they’re at home. It’s always jokes and laughing with them, and she makes them feel like there’s a little bit of fun to be had here.”

For the last 15 years, the Joint Commission (formerly JCAHO) has been evaluating medical errors and their causes and using this data to improve patient safety standards. What it has found is that hand-off communication has played a role in approximately 80 percent of “serious preventable adverse events,” also known as sentinel events, in healthcare.

In 2006 the Joint Commission initiated National Patient Safety Goals, which changes emphasized goals on a yearly basis. These standards grew out of the recommendations of the Sentinel Event Advisory Group and target issues that most commonly lead to sentinel events. For 2011, Goal 2 focused on improving communication among caregivers since communication errors and breakdowns remain a leading cause of sentinel events.

Hand-off communication can be especially problematic, for several reasons such as one person is often at the end of their shift and wanting to go home, or a patient is being bumped up to a higher level of care and the care provider has already been under stress and strain from the patient’s more serious needs. Important details that are vital to the patient’s current state and treatments may be missed or misunderstood due to the stress of the situation and fatigue of the caregiver.

Image courtesy of Kathryn Weigel via Flickr

One method of improving the odds of giving and receiving a more thorough report has been for the oncoming nurse to perform an immediate baseline assessment to confirm the hand-off report. This method can take time and hold up an outgoing nurse from leaving the facility, which means that she must remain on the clock until the assessment is finished. Most facilities have strict time limits on end-of-shift overage minutes.

Another method that has been gaining ground is the hand-off sheet used in many facilities when transferring patients between units. Although a seasoned nurse knows if she’s is likely to have all the information she needs, a newer nurse may want the security of a completed hand-off sheet. Although nurses offer mixed reviews of the extra paperwork, a benefit is that the communication is documented.

Some nurses prefer the “walking report” where the off- and on-going nurses walk from room to room and give a hallway report outside the patient’s room. This allows a quick review of the nurses’ notes and the chart, and a quick visit with the patient. Other nurses feel this invites interruptions from family members, and patient requests that cannot be handled until after hand-off has been completed.

In school, nurses learn the quick 30-second head to toe assessment. While this method is a goal, in school most students only have one or two patients for their ‘shift.’ In the real world of nursing what works best is often found only through evidence-based practice and a lot of talking to other nurses to find out what works best for them.