Nursing Specialties

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An RN named Kelly Jantz loves being a nurse, and loves making people laugh.

Once a week, she shows up at her hospital in a vintage nursing uniform, wheeling her cart full of supplies. No hypodermic needles here — it’s all the likes of stuffed animals, comic DVDs, and clown noses. These supplies are used for laugh therapy with staff members, patients, and their families.

She’s dubbed her program Positive Hopeful Individuals Laughing, or PHIL. In this article on the KC Community News website, Jantz says, “Humor is so important… It can change your whole day.”

Jantz started being interested in integrating laughter therapy into nursing after attending a conference where she was exposed to the healing properties of laughter during a yoga session. She researched laughter therapy further and then contacted the vice president of nursing at North Kansas City Hospital about starting a program there. After getting the green light, she did more research and then launched PHIL last fall.

Like Mary Shlapkohl, another nurse who has harnessed the power of laughter to help her patients and their families, Jantz appreciates being able to make a hospital stay more comfortable.

Jantz now dedicates her entire Wednesday shift to PHIL. She spends 10 minutes with each patient and family members. Sometimes patients know of her arrival in advance and sometimes they are surprised, she said. She wheels the PHIL cart into patient rooms, outpatient waiting rooms or meets with staff members to tell jokes, present riddles or perform magic tricks. A cackling monkey sends children and adults into fits of laughter every time, she said.

“Everyone laughs at the monkey,” she said.

Jantz’s photograph and pager number are posted in units throughout the hospital. Jantz responds to nurses, managers, charge nurses, transporters, technicians and doctors who recommend their patients. She said the laughter therapy is three-fold. She lightens stressed-out staff members and signals a lighter mood to patients and their families. Research shows that a good guffaw has similar benefits to a cardiovascular work-out, she said.

“It increases heart rate and blood pressure,” Jantz said.

Laughter is also good for the immune and respiratory systems, enhances mental functions, reduces pain, increases endorphins and leaves you thinking more clearly, Jantz said. Jantz’s program includes DVDs of vintage sitcoms such as “I Love Lucy,” “I Dream of Jeannie,” “Kids Say the Darnedest Things” and “Candid Camera.” The comedy shows spark memories among patients and their families, she said, taking their minds off pain and worries. Conversations flow and blood pressures drop, she said.

“Everybody should be laughing,” Jantz said.

The spirit is contagious, too, Jantz said. She once passed a clown nose to a patient in radiology, who then wore it the rest of the day, tripping staff and family members into fits of giggles. Jantz always leaves them laughing, she said. She leaves patients with clown noses, oversized sunglasses or giant combs among her silly exit gifts.

“It reminds them of their laughter moment,” she said. “It brings up conversation with other people. It’s going to bring back that positive moment.”

Jantz said she is naturally humorous and hails from a family of jokesters. She said she always has approached nursing with smiles and a light touch.

“I love to laugh,” Jantz said. “I love talking to people and joking around.”

Jantz said she wants to grow the PHIL program. She is already at work creating online laughter websites for staff members and thinking of ways to spread the program more effectively throughout the hospital. She documents each visit, and results are reviewed for the program’s impact.

“She shows up, she’s just a hoot,” Kathy Riddle, RN and staff nurse in the oncology department at North Kansas City Hospital said. “Everybody’s mood changes.”

Riddle said she is a jokester as well and connected with Jantz’s program.
“I love humor. Patch Adams was my hero,” she said. “This is perfect. I am quite a joker. We just meshed.”

Riddle chooses appropriate patients for Jantz to visit, depending on their stage of cancer and where they sit emotionally. She said her patients love the singing stuffed animals and humorous gifts she leaves behind.

“It takes their mind off what’s going on,” Riddle said. “They can still have fun and laugh. They have a different perspective on life after she leaves.”

Patients talk about Jantz after they leave, Riddle said. They tell their family members about her, keep her photo on the wall and write favorable comment cards, she said.

“She is a blessing,” Jantz said. “She is like a breath of fresh air. She just has a great personality. She is always like that.”

Sarah Fields, vice president of nursing at North Kansas City Hospital, said when staff members are having a bad day, Jantz can make them laugh and relieve their stress. One of the games on Jantz’s cart is a guessing game involving physicians.

“It’s fun watching them gathered around Kelly’s cart looking at the pictures of the doctors dressed up in disguises and trying to guess who’s who,” Fields said.
Fields said the hospital frequently receives WOW comment cards about Jantz. Patients and their families write that Jantz brought joy and smiles to their day.

“Her passion and dream have become a reality that ultimately benefits our patients,” Fields said.

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A Minneapolis-based hospital group will require that their employes wear matching uniforms distinguished by colors starting in May, one color per job category. Think Star Trek, but in a more Earth-bound (and medical) setting.

Nurses get navy scrubs. Licensed practical nurses will wear eggplant. Respiratory therapists get olive green.

The idea is to make it easier for patients and family members to identify their care team by the color of their uniform. However, unionized nurses are not happy that the change has been imposed from on high, without any negotiation. Many of them also disagree with the new uniform plan. This article in St. Paul Pioneer Press quotes oncology nurse Cristin Betzold of Blaine as saying that her patients appreciate the variety of bright colors she wears. “I have many patients comment on how at least they see a little bit of color in what they see during the day from my uniform,” she said.

They also question whether the color-coding would actually help patients.

So, amidst the discord, the Minnesota Nurses Association has filed a grievance over the uniform policy. The uniform policy will still go into effect on schedule but may roll back later depending on result of the arbitration process.

A survey of hospitals across the Twin Cities finds that there’s no uniform position on color-coded outfits.

There’s no requirement for matching scrubs at St. Joseph’s Hospital in St. Paul, Methodist Hospital in St. Louis Park or medical centers in the Minneapolis-based Fairview system.

To address concerns that hospital patients sometimes struggle to recognize who’s caring for them, Fairview workers get pointers on introducing themselves. Workers at St. Joseph’s, meanwhile, wear super-sized name tags called “badge buddies” that clearly identify their skill set.

But other medical centers have switched to standardized uniforms.

About five years ago, Woodwinds Health Campus in Woodbury started requiring navy blue scrubs for its RNs. Nurses selected the color in a vote after hearing from an advisory committee that matching outfits would be helpful to patients, said Cindy Bultena, the chief nursing officer at Woodwinds.

Regions Hospital in St. Paul has required workers in the same job category to wear the same color for at least a decade and is in the process of again affirming the policy. Over the past few years, workers have started wearing patterned scrubs within their given color, but solids will be required as of Jan. 1, said Jon Henkel, a hospital official.

At the Mayo Clinic in Rochester, Minn., uniforms are color-coded within work units but not across all clinical areas. That means, for example, that not all nurses wear the same color, but all workers in obstetrics wear teal green scrubs.

“The dress code is always under review and we are currently entertaining administering a patient study which will help identify their needs specific to dress,” said Kelley Luckstein, a clinic representative, in an email.

Allina officials say their hospital in Buffalo first experimented in 2010 with what’s now been dubbed the “uniform initiative.” The medical center saw its patient satisfaction scores improve following the change to standardized uniforms.

The health system started talking with employees last year about the switch, which will apply at the system’s 11 hospitals. In December, about 5,500 employees cast ballots for their favorite colors.

“Some employees networked across the entire Allina system to say, ‘Let’s pick these as the top three choices,’ ” said Sorbel, the United Hospital official. “The larger groups got the colors they wanted.”

Even so, the change has proven divisive.

Patients respond to variety, especially pediatric patients, said Bernadine Engeldorf, a nurse at United who also is first vice president of the Minnesota Nurses Association. She added that nurses like the freedom of being able to choose their outfits.

In contrast to the cheery colors some nurses currently wear, navy blue seems “somewhat muted, dark,” she said.

“People take a lot of pride in what they wear to work,” said Betzold, the nurse from Blaine. “I think people don’t agree (with the change), but obviously nobody wants to be terminated because they chose not to wear navy blue.”

The change is being felt in the pocketbook, too, although there are different estimates of the magnitude.

The average uniform costs $80 to $100, said John Nemo, spokesman for the Minnesota Nurses Association. Full time nurses need five to 10 sets of uniforms, he said, because they can only be worn one day before washing. Replacement occurs every six to 12 months, Nemo added, depending on the quality of garments.

Allina officials, however, quote a range of $20 to $50 for scrubs, adding they have negotiated special discounts for workers who purchase from a preferred vendor. The health system is providing up to $80 in vouchers to workers to help defray costs.

“We do recognize that in making a change, there is a financial burden to our employees,” said Tracy Kirby, the director of nursing at Abbott Northwestern.

As the labor dispute plays out, some wonder why navy seems to have become the new color of nursing.

Sure, it’s a color that doesn’t show spots or evoke strong emotions, said Helen Strike, the chief nursing officer at St. Joseph’s Hospital. But there was a time when all nurses wore uniforms, Strike said, and the color always was white.

“Even today, kids who are 3 or 4 years old have this idea that a nurse wears white,” she said. “There’s something very positive about that historical perspective, and I wonder why we don’t utilize that more in nursing.”

White also has been linked with doctors through their historic use of white coats. The new Allina policy, however, won’t apply to physicians, since many aren’t directly employed by the health system.

Kirby, the nursing director at Abbott Northwestern, added: “Patients tend to really know who their doctors are.”

Shortages of cancer drugs aren’t the only drug shortages making news. The January 2012 issue of Clinical Infectious Diseases reports the nation’s supply of go-to drugs to fight infectious disease is running dangerously low. So low, in fact, that hospitals have had to design contingency plans just in case an emergency arises.

So why is this happening? The answer is complicated. One problem is that often only one drug company manufactures a given. Should an ingredient in the drug become difficult to obtain, the supply runs low. Other drugs can be used instead, but in many cases they are either ineffective on the organism or take longer to eradicate the organism.

Ingredients may also become too expensive, with the result that a manufacturer decides to discontinue production of the drug – although drug companies are required to inform the FDA six months before drug production stops.

Among the drugs considered scarce are antibacterials, antifungals and antivirals. Physicians should be prepared to treat with alternative means if it becomes necessary. Every day, more organisms become resistant to drugs that have been on the market for a while, thus making them less effective to treat common illnesses.

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Given the fact that drug shortages are expected to occur, what can nurses do when a shortage threatens the health of their patients? Many times, the first notice of a drug shortage occurs when the pharmacy fails to supply a drug to a newly admitted patient. The nurse calls the pharmacy; the pharmacist states the drug is not available on-site at the moment. Whether or not a contingency plan is in place to get the drug from another facility, the nurse needs to inform the physician and get an alternate drug order if the physician deems it necessary. Some drugs, especially in the case of anti-infectives, are critical to the patient’s health and need to be started immediately.

The United States Congress is considering a requirement that would compel drug companies to report to the FDA any expected drug shortages. Also under consideration is a bill requiring speedy review of newly proposed drugs that could mitigate the shortages. Currently new drugs in development take years to reach the U.S. market, which is a much longer process than it is for the Canadian and European markets, for example.

Clinical nurse managers can take an active role in developing their facility’s contingency plans for unavailable drugs. By understanding what drugs are expected to be in short supply, discussing workable alternates with physicians and formulating a list of facilities as go-to secondary suppliers, nurse managers can arm their nursing staff, especially the night crew, with an action plan when a shortage occurs. Because hospital pharmacies are often overwhelmed and understaffed, nurses may have to take a more active role in getting their patients the medications they need.