Nursing Specialties

Addicted to Helping People

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


joyfnp/ Fotolia

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.”

Getting Political

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


pkchai/ Fotolia

“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.”

Popularity of Nurse-Midwives is Rising Again

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

October 1st, 2012
Jenna Fischer

Dalia Dulia/ Fotolia

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.

The Case of the Upside-Down Woman

Posted in Nursing, Nursing News, Nursing Specialties

SodanieChea/ Flickr

This is a fascinating case study. It opens with a woman being dangled by her feet by a “giant” in the Emergency Room. Various ER personnel are alarmed and try to get the seven-foot-plus man carrying her to put her down already, but both the (very tall) man and the (very small) woman insist that she needs to stay in her inverted position.

Dr. Louis F. Janeira comes on the scene and tries to make sense of things. He eventually learns that a) the large man holding the small woman is named Jason, b) the small woman is his wife, Mary, who the doctor had in fact seen the day before due a slow heartbeat but didn’t recognize, upside-down.

She’d come in to the Emergency Room the day before with a complete heart block, which is caused when the electrical system that connects the atria to the ventricles fails. Her heart rate had been under 40 beats per minute instead of the normal range for her age group, 60-80 beats per minute. Dr. Janeira had called a colleague for urgent implantation of a pacemaker, which generates rhythmic electrical pulses that bring the heartbeat back to normal.

Dr. Janeira discovered that the pacemaker was successfully installed the day before, and Mary had returned home from the hospital that morning. Everything was fine until about half an hour beforehand, when she had coughed and then collapsed.

Her husband Jason explained that she had fallen behind the bed and he’d picked her up by her ankles, and she regained consciousness. When he’d put her down, she fainted again. This process repeated a few times; she’d pass out, he’d pick her up by her ankles, and she’d be back again. So they’d given up on the experimenting and he was just carting her around by her ankles to keep her conscious.

An Urgent Diagnosis

My mind raced through the possibilities. Mary could have something obstructing the blood flow from her heart to her brain that was overcome when her head was down. Or her blood pressure could be so low that blood reached the brain only when she was upside down. Blood pressure that low could have been triggered by an allergic reaction, anaphylactic shock, or severe dehydration.

Another possibility was that Mary was suffering from cardiac tamponade, a compression of the heart caused by a buildup of blood in the sac covering the organ. If her heart had been perforated during the pacemaker implantation and blood had seeped out into the sac around it, it might be that her ventricles were now being squeezed by this accumulating blood, lowering her cardiac output. That condition could improve when she was upside down by increasing blood flow to the brain.

The first thing to do was to check Mary’s vital signs. “Bring her into a room,” I said. “Let’s get her on a monitor.”

I pointed the way, and Jason carried her into the cardiac room, an entourage of curious ER personnel trailing behind us.

Even once in the cardiac room, Jason was unconvinced that he should let go of her ankles and put her on the bed. “When I put her down, she’ll go out on us,” he said.

I paused for a moment. “We’ll do an assessment of the vital signs first while Mary is upside down. Then we’ll put her in bed and see if and how things change, OK?”

Jason nodded. Mary’s long black hair waved back and forth, which I took for agreement from her, too. Ellie then placed heart monitor electrodes on her chest.

“Normal-paced rhythm,” I said, watching the monitor. “The pacemaker is working perfectly fine right now.”

“And I feel perfectly fine,” said Mary. “Well, except that I’m upside down and have been for about 30 minutes now.”

Ellie wrapped a blood pressure cuff around her arm. “It’s 120 over 66,” said Ellie. “Pretty good.”

“OK, slowly get her on her back,” I said. Jason walked closer to the bed and Ellie and I eased Mary down onto it. The only sound came from the heart monitor: beep, beep, beep, steady at 60 times a minute. We all held our breath.

Then the cardiac monitor showed a sudden change. The alarm began screaming.

“Here I go,” said Mary. “It’s happeni…” Her words dissolved into nothingness.

“No heart rhythm,” Ellie called out. “Pacemaker failure.”

“Get me epinephrine,” I yelled. Also known as adrenaline, epinephrine is a hormone that can constrict blood vessels and get a stalled heart beating again.

“But we don’t have an iv in yet,” said Ellie.

“Out of my way,” said Jason, pushing us aside to get to Mary’s feet. “I told you this would happen.” The big man grabbed Mary’s ankles and pulled them up in the air. Moments after Mary was upside down again, the heart monitor resumed steadily beeping.

“I’m back,” said Mary.

Something must have gone wrong with her operation yesterday, I thought. Then suddenly it hit me. “The pacemaker lead, the wire going from the pacemaker generator to your right ventricle, must have disconnected. Your coughing spell could have done it,” I said. “Somehow, the lead reconnects when you are upside down and continues to stimulate the heart.”

Pacemakers are made up of two main components, a generator and a lead that carries electrical impulses to the heart. Often the lead tip is screwed directly into the heart muscle, but in rare cases it can dislodge and cease to stimulate the heart. Data from St. Jude Medical, one of the largest pacemaker manufacturers, show that out of about 220,000 implants of the company’s most popular lead attached directly to the heart, only 97 dislodged within 30 days of implantation. Apparently, Mary was one of the rare cases.

Getting The Patient Upright

“How are we going to fix this, doc?” Jason wanted to know.

“You’ll need to go back to surgery to reattach the lead,” I said to Mary. “Let’s page your electrophysiologist stat.” I looked at Jason and sighed. “Meanwhile, keep her upside down.”

We inserted an iv in Mary’s arm and hooked her up to an external pacing device. But pacing her heart through her chest wall gave her severe discomfort and was not a good option, even in the short term. Moreover, it turned out that Mary’s slow beat did not respond at all to medications, including intravenous epinephrine. So she was quickly transported to the electrophysiology laboratory, dangling by her ankles, carried by the only man around with enough strength to do it. And my ER shift continued.

The next day I was back on duty. As I came out of a room after examining a small child with a fever, I heard a familiar voice behind me.

“Dr. Janeira, it’s me, Mary. I’m all fixed up.”

I turned and smiled at Mary and nodded at Jason, who towered massively behind her. “You were right. The pacemaker’s ventricular lead had to be re-screwed in my heart,” she said. “I’ll be having the pacemaker checked in a few days and then every three months.”

“How do you feel now?” I asked.

“Back to normal,” she said. “Thanks for your help!”

And with that, she left my ER walking upright and hand-in-hand with her giant.

The July Effect

Posted in Nursing, Nursing News, Nursing Specialties

MAFord –

July is the month that medical students, fresh from medical school, start learning how to be doctors. That gives rise to the “July Effect,” where medical error rates increase as these new doctors learn on the job.

In this article in the New York Times, Theresa Brown, a nurse, looks at whether the July Effect exists, and how nurses can deal with it if so.

She notes that the medical literature is inconclusive regarding the July Effect, but cites two articles that found evidence of it. The author of one off the articles compared the deployment of new resident so to having rookie football players replace veterans “during a high-stakes game, and in the middle of that final drive.”

Brown’s own conclusion is that the July Effect “is undeniably real in terms of adequacy and quality of care delivery.”

She goes on to describe an experience she had as an oncology nurse, where a patient was dying of cancer and was in unbearable pain. She paged the first-year resident, brand-new to actual doctoring, and explained why the patient needed a much higher dose of pain medication. The doctor refused to up the dose. After trying repeatedly to convince him, as her patient writhed in pain, Brown paged the palliative care physician on call, who she had talked to about the patient day before.

I described the patient’s sudden lurch toward death, the sharp increase in pain and the resident’s reluctance to medicate the patient enough to give him relief. “Ah,” she said, “I was worried about that,” meaning that the patient might begin actively dying sooner than the medical team had expected. She ordered a morphine pump. I got the drug, loaded and programmed the machine. The patient died fairly soon after. He was conscious to the very end, and I can say he did not meet his death in agonizing pain.

A FEW hours later I ended up in the elevator with the new resident. He and I both started talking at once. Looking stricken, he apologized to me for having been busy, overwhelmed with several new patients. Knowing it is never easy to have someone’s footprint on your head, I apologized for having called in an attending physician. “I don’t usually jump the line,” I started to explain, when he interrupted me. “You did the right thing for the patient,” he said.

Such an exchange is rare. A nurse who goes over a doctor’s head because she finds his care decisions inappropriate risks a charge of insubordination. A resident who doesn’t deliver good care risks the derision of the nurse caring for that patient. Nurses aren’t typically consulted about care decisions, and this expectation of silence may lead them to lash out at doctors they see as inadequate.

The July Effect brings into sharp relief a reality of hospital care: care is becoming more specialized, and nurses, who sometimes have years of experience, often know more than the greenest physicians. We know about medicating dying patients for pain, but we know a lot of other things, too: appropriate dosages for all kinds of drugs, when transfusions and electrolyte replacements are needed, which lab tests to order and how to order them, whether consulting another specialist is a good idea, whether a patient needs to go to intensive care because his vital signs are worryingly unstable.

The problem can be limited by better supervision from senior residents, fellows and attending physicians, as well as by nurses. We need to acknowledge this fact, because admitting that new residents need help, and that nurses can and do help them, is the beginning of owning up to our shared responsibilities in providing care. For the good of our patients, nurses and doctors need to collaborate.

Bugs Be Gone

Posted in Nursing, Nursing News, Nursing Specialties

alexfiodorov –

The “Bugs Be Gone” educational session outlined in this article wasn’t about the things that bite you when you’re out on an evening walk. The bugs in question are the ones that cause infections, a serious issue for hospitals, with about one in every 20 patients developing an infection related to hospital care.

Over 60 healthcare professionals from a variety of disciplines, including many nurses, attended the half-day event to learn how to reduce that number of infections.

A registered nurse named Ellen Rankin said that it was important to gather healthcare professionals from many different disciplines “to show that this is a cross-setting issue and that we all face the same problem.”

One speaker was Janet Phillips, RN, Healthcare Quality Strategies Inc., New Jersey’s federally designated quality improvement organization, who summarized the healthcare-associated infections focus under the Centers for Medicare & Medicaid Services’ nationwide initiatives.

“The event highlighted the problem and encouraged shared improvements that can positively affect us all no matter what area we’re in,” Susan Hermida, RN, MSN, GCNS, CWCN, clinical nurse specialist at RWJ Hamilton, said in the release. “The most important step toward that goal is for everyone to wash their hands. Wash, wash, wash their hands.”

Neha Merchant, RN, of Hamilton Continuing Care, emphasized the importance of hand washing before providing a detailed look at catheter-associated urinary tract infection, central line-associated bloodstream infection and the components of an effective infection prevention program.

Among the attendees was a group of nursing students from The College of New Jersey School of Nursing. “The information presented today was really valuable,” said Corimae Gibson, a Robert Wood Johnson clinical program participant. “I’m a student at TCNJ and I’m about to enter the nursing profession. This information is the first step toward avoiding all the complications and patient loss we heard about today.”

Developing a presentation to take on the road is the collaborative’s next goal. By traveling to educate nurses in Mercer County, the team can help them identify signs and symptoms of infections that may reduce readmissions and improve patient care.

Gaming as Training for Nursing Students

Posted in Nursing, Nursing News, Nursing School, Nursing Specialties

Serguei Kovalev -

Practice makes perfect and nobody is a perfect nurse right away. So it would be nice if nurses could make their rookie mistakes on virtual patients rather than real ones. The University of Minnesota School of Nursing is helping to develop a bunch of computer games that allow that kind of practice for nursing students, the Minnesota Daily reports.

A clinical professor at the U of M named Tom Clancy (apparently no relation to the novelist) is working with the software company VitalSims and local hospitals to develop serious educational tools that would take their place alongside similar tools used by the military, for example.

Simulation is not new in health care — many nursing schools have fancy robot “patients” that are getting more and more sophisticated. They can be mighty expensive, though.

Games are more cost-effective and are able to provide an extremely wide variety of practice situations. Users can train for really complex situations or stick to the basics, according to their needs.

Clancy said gaming is not set to replace any of the familiar components of education, but it will supplement book work and lectures.

“Every time you go from one modality to another, you’re doing a different kind of learning,” he said. Clancy said adding gaming to students’ curricula may seem inefficient, but it reduces the time needed in other educational settings. VitalSims’ CEO Chris Duncan cited a 2008 study that showed serious gaming to assist information retention 91 percent more effectively than lecture attendance.

“We’re still trying to tease out exactly how to implement gaming in education.” Serious gaming is, Clancy said, “in its infancy.”

The game

Clancy opened an early version of his program and chose “Myocardial Infarction” (heart attack) from a list of injuries and ailments on the game’s main menu.

“You’ll have to excuse the graphics; they’re kind of old,” Clancy said.

The heart attack mission opens with a cutscene, or non-interactive scripted event, in which two identical nurses banter before entering the emergency room.

Soon after, they enter the ER, and from then on it’s strictly business. The game is played from a first-person perspective, with the player positioned over the patient. Intense music accents the time pressure, as do occasional comments from the assistant nurse.

There is a “toolbox” at the bottom of the screen in which the player selects from an array of instruments divided by category.

Clancy used his magnifying glass by finding it in a sub-menu and dragging it to the patient’s mouth. When he determined she wasn’t breathing, he opened a another menu, equipped an oxygen pump and selected the appropriate rhythm from a list. He then equipped a heart monitor, which brought up a cardiogram on the side of the screen.

“That rhythm,” Clancy explains, “happens to be very deadly.”

Next he demonstrated the scoring system by purposefully administering random drugs and using incorrect instruments. The patient eventually died.

These games will include multiplayer and cover a wide variety of cases, hopefully ensuring that students are given breadth of experience, Duncan said.

He said cultural considerations are also planned, such as settings that account for different languages and religious beliefs, which will help make it more accessible. There will also be leaderboards, which Clancy said he believes will encourage students to improve through competition.

‘The way of the future’

The new games are part of a growing trend of using gaming for professional development.

Linda Olson Keller, another professor of nursing at the University, is supportive of Clancy’s and the MHA’s project. She described a similar initiative by the U.S. Centers for Disease Control and Prevention to use games to promote public health. One game, called HealthBound, challenges players to solve health-related problems and then scores their results and encourages them to get involved in various community programs.

Another, from the Chicago Department of Public Health, is designed to prepare players for a possible anthrax outbreak.

Keller described this method of education as “the way of the future.”

Clancy foresees games becoming commonplace in other fields.

“We’re seeing this continuum of different ways of education, and gaming has its place in here now,” he said. “We’re still learning where exactly that place is.”

Nurse Practitioners No Threat To Doctors

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

History has shown that physicians don’t always appreciate sharing with nurses.

The field of obstetrics, which was once dominated by midwives and lay midwives, has been a battleground for years, with physicians laying claim to the right to attend all deliveries. Physician’s groups in the past went so far as to say that women who were attended by midwives were putting themselves and their babies at risk, although statistically this notion was never proven to be a reality. Midwives fought long and hard and are only now attaining the respect they deserve as non-interventionists who are fully capable of handling low-risk deliveries. Ceding to midwives has been a hard pill to swallow for many physicians.

Some physicians are now uneasy with the expanding role of nurse practitioners. The Institute of Medicine recommended in 2010 that barriers to practicing to their full scope be removed so that nurse practitioners could help to ease the shortage of primary care physicians. To date, 16 states (plus the District of Columbia) have embraced more liberal laws to allow nurse practitioners to practice fully what they have studied and trained for. Other states, such as Nebraska, are currently considering such laws.

vgstudio -

One would think that easing the shortage of primary care physicians would be embraced wholeheartedly by physicians, but this has not been the case. What has been the major concern voiced by primary care physicians? It seems that some physicians are worried that nurse practitioners moving in on their turf will result in lowering of physicians’ incomes. Granted, many primary care physicians earn far below what physician specialists earn, so there may be some justification for their concern.

In the first study to assess the impact of nurse practitioners in states with liberal policies versus states with more restrictive policies, researchers from the George Washington School of Public Health and Health Services found no evidence that using nurse practitioners to their full scope of practice had an adverse effect on earnings of family physicians.

This is good news on two fronts: easing the physician shortage and expanding the roles of nurse practitioners. As of May 30th of this year, the Health Resources and Services Administration stated that there are 5,902 HPSAs (health professional shortage areas) serving 59.9 million people. At a ratio of 2000 patients for every one physician, this means that 16,349 practitioners are needed to meet the primary care needs of the population. Such a vast shortage seems to indicate that there is plenty of room for all, and that nurse practitioners can fill a rather large gap in healthcare services that is not currently being filled.

As with the obstetric field, it will take time before nurse practitioners are recognized for what they alone can offer, a unique set of skills and knowledge that can complement and enhance the skills and knowledge that physicians offer. As health care policy changes in the United States, nurse practitioners are entering into a new era, one in which they will be permitted to practice to the fullest extent possible.

Nurse Celebrates Week With Pride

Posted in Nursing, Nursing Jobs, Nursing Specialties

Monkey Business -

Nurses everywhere are celebrating National Nurses Week May 6th through 12th.

One such nurse, Renee DeRider, says that nursing has been one of the most rewarding experiences she’s ever had.

DeRider has over a decade of experience nursing. She graduated in 2001 and immediately started working in pediatrics, with a concentration in hematology, oncology, and surgery. Now she works in a hemophilia center where she coordinates patient care for both children and adults with bleeding disorders.

This article on the Democrat and Chronicle website looks at DeRider’s experience and why she finds being a nurse so fulfilling.

DeRider said she loves her job as a nurse and her work environment due to the endless possibilities.

“As a nurse, there are numerous paths you can choose for your career,” DeRider said. “The choices are endless, and I think that’s what’s so attractive about becoming a nurse; there’s always a portion of the medical field that you can learn something about and there’s always your portion of the medical field that you become passionate about and an expert of.”

But with the love of work and numerous career paths within the field comes heartfelt stories that impact nurses.

DeRider said the most touching experience as a nurse came in 2004 and 2005 while caring for an 18-month-old girl with terminal cancer.

“To know that you’ve had the opportunity to support a family during their most difficult moments and be part of that experience is an honor,” DeRider said. “I know this sounds very awkward for some, but for a parent to allow a nurse — total stranger — in on your most intimate family moments; hold your hand, laugh with you, cry with and for you, and most importantly, love (their) baby as well … there’s no greater experience than that.”

And for her care, DeRider said she has been rewarded countless times by patients and their families with gifts like a simple thank-you card.

“I actually keep each and every one of them, including pictures colored by kids who, by now, are adults,” DeRider said. “I figure that if you’ve taken the time to say ‘thank you’ and what I meant to you, I can keep that to remember you by as well.”

For DeRider, the time spent being a nurse will never match her love and commitment to the job.

“Nobody goes in to nursing because they love the long hours, weekends, holidays and overnights. It’s not a fallback career and requires much dedication. It’s by far (not) a glamorous career, but we’re the thread that ties together the physician and the patient,” DeRider said.

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.