It’s been 2 weeks since I attended Nursing2012 Symposium and I am finally organizing all my notes! My pencil was giving off sparks as I tried to keep track of all that I was learning from the experts during the conference. What a great time I had learning, connecting with nurses (old friends and new!), and answering questions and sharing our ‘goodies’ in the NursingCenter booth in the exhibit hall. Of course, being in Orlando during some glorious weather also added to a wonderful getaway!

The opening address – Livin’, Laughin’, and Learnin’ through the Years – was presented by Barb Bancroft, RN, PNP, MSN. That title sums it up perfectly! The audience was laughing out loud as changes in nursing and medicine from the last 30 years were highlighted. I had forgotten just how many times classifications for diabetes have changed and was reminded of the funny things that patients sometimes say. Ms. Bancroft also shared her 8 ‘best bets’ in nursing. My favorites were “Never stop being a student” and “Work well with others.” 

Steve L. Robbins, PhD., presented the Keynote Address, entitled Unintentional Intolerance. This was powerful! In his presentation, Dr. Robbins used various exercises to demonstrate to the audience how we all have ‘gut reactions,’ and that the important thing is how we handle them. I wish I could demonstrate these exercises here via this blog post (I did use them on my family!). It was incredible – his discussion included topics such as cognitive scripts (how mindlessness and multiple remnant messages lead to this ‘unintentional intolerance’), drive-by greetings (we all do it…say “Hi. How are you?” without actually hearing the response), branding, and mindlessness (think of the things we do without thinking about them, for example, showering and then wondering “Did I wash my hair?”) The best quote that I took away from Dr. Robbins was “Leverage human differences to solve complex problems.”

In Your Patients at Risk: Preventing Complications, I was thrilled to listen to a former colleague of mine present! JoAnne Phillips, MSN, RN, CCRN talked about patient safety and nine adverse events that all hospitals should be working on: falls, ventilator-associated pneumonia, adverse drug events, central line-associated blood stream infections, catheter-associated urinary tract infections, pressure ulcers, obstetrical adverse events, surgical site infections, and venous thromboembolism. Ms. Phillips shared some great resources, namely Partnerships for Patients and the IHI Improvement Map. She also reminded us that “Patient safety is not about decreasing errors, it’s about decreasing harm.”

The next session that I attended was Stop the Revolving Door. Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC discussed the importance of “shifting the healthcare paradigm from a volume-based system to a value based system.”  Ms. Woods stressed 3 things to help reduce the numbers of ICU bounce-backs and hospital readmissions: better care, better communication, and better follow-up. Other points that stayed with me since her presentation include using ‘teach back’ in patient education, scheduling follow-up appointments prior to discharge, and tuning into noncompliance, meaning if a patient is noncompliant, we need to find out why. 

In Faculty-Guided Poster Tour: Ask the Experts, three experts – Frank Myers, MA, CIC; Cheryl Dumont, PhD, RN; and Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC – led an informal tour of the posters being presented at the conference. They pointed out key features of the posters themselves as well as the research being presented. Here are some of the things that I learned and I hope that you find them useful too! 

Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM and Captain Jeffrey R. Evans, BS, NREMT-P shared patient scenarios and the hospital and police responses in Bad Boys, Bad Boys…Whatcha Gonna Do? I learned a lot from these experts including never touching a weapon whether it’s immediately apparent or perhaps falls out when cutting off a trauma patient’s clothes, not using cell phones around suspicious packages (did you know they can detonate bombs?), and the importance of being aware of active gangs in your area. The most important advice I remember was always maintaining "situational awareness."

That’s just a sampling of the many presentations offered this year at Nursing2012 Symposium. All of the presentations were recorded and can be found at Lippincott’s eConference Center.com. If you have the opportunity to attend in the coming years, go for it! Maybe I’ll see you there!

End-of-life (EOL) care has always been a special interest of mine. I know the frustrations that often arise with EOL care in a critical care unit – for example, when a patient can no longer make decisions for himself and his family is unsure of his wishes, or when family members disagree. However, I also know how satisfying it can be when a patient’s death is a positive experience for all involved. Sometimes providing end-of-life care is just as rewarding as seeing a patient ‘turn the corner’ and get better. I imagine that some nurses find that EOL care is even more rewarding. 

When I read Ethics in Critical Care: Twenty Years Since Cruzan and the Patient Self-Determination Act: Opportunities for Improving Care at the End of Life in Critical Care Settings, I was reminded that while challenges continue, we actually have come pretty far with regards to advance care planning (ACP) and EOL care. Resources such as the Center for Practical Bioethics’ Caring Conversations, Respecting Your Choices, and Five Wishes have emerged to help patients and families discuss their wishes with one another. Other highlights of progress include The Joint Commission standards on palliative care, advance care planning, and pain management; National Healthcare Decisions Day (April 16); palliative care consultation services at large numbers of hospitals; and increased numbers of people with advanced directives. I encourage you to read this article in its entirety to see the extensive list of examples provided by the authors. 

What issues remain? 

• Advance care planning – increasing the number of patients with advance directives; living wills & power of attorney issues
• Caring for patients who are in a minimally conscious state vs. persistent vegetative state
• Providing hydration and nutrition
• Communicating a patient's wishes or plan of care during transfer from one care setting to another (for example, from nursing home to hospital)

Take some time to read this article (it’s free to read online while on our Recommended Reading list!). On page 103 (page 5 of the pdf), you’ll find 'Ten Things Critical Care Nurses Can Do To Improve Advance Care Planning.' 

Reference: 

Rushton, C., Kaylor, B., & Christopher, M. (2012). Ethics in Critical Care:Twenty Years Since Cruzan and the Patient Self-Determination Act: Opportunities for Improving Care at the End of Life in Critical Care Settings. AACN Advanced Critical Care, 23(1). 

A while back, I wrote a blog post about using SBAR (Situation-Background-Assessment-Recommendation) as a method to help organize change-of-shift report. First implemented by the U.S. Navy to reduce miscommunications, use of this tool is becoming more widespread in healthcare settings. It has been theorized that the use of a standardized approach such as SBAR creates a “common language” among healthcare professionals and thereby decreases communication errors and may even impact our behavior. A recent study published in Health Care Management Review explored this potential impact of SBAR on the daily activities of nurses.

The researchers interviewed nurses, nurse managers, and doctors in two hospitals where implementation of the SBAR protocol was in its early stages. Analysis of the data revealed two findings: first, that most thought of SBAR as strictly a means of standardizing communication, and second, that SBAR actually had a “more far-reaching effect than just being a communication tool.” 

So what are these “far-reaching effects?”

1. Schema development – SBAR facilitated the development of schemas which help nurses make intuitive decisions.

2. Contribution to the accumulation of social capital – The common language of SBAR serves as a means to integrate nurses into the organization.

3. Providing legitimacy – The common practice also helps individuals gain credibility.

4. Shift in logic – SBAR supports a shift from individual autonomy to standardization and formalization of the nursing profession.

Interesting findings! This fairly simple tool does have far-reaching implications – for our individual practice and our profession. If we communicate more effectively, make decisions more easily, and are integrated into the organization as a credible member of the healthcare team as a nursing professional, won't that ultimately lead to better patient care and outcomes?

Reference: Vardaman, J.M., Cornell, P., Gondo, M.B., Amis, J.M., Towensend-Gervis, M., Thetford, C. (2012). Beyond communication: The role of standardized protocols in a changing health care environment. Health Care Management Review 37(1), 88-97.

I just finished reading Professional Growth: Taking a novice nurse under your wing from the September issue of Nursing2011. In this article, the author, Pamela Woodfine MSN, RN, emphasizes the importance of mentoring and making a new nurse’s first experiences in the “real world” of nursing positive ones. She also stresses the importance of recruitment and retention to the future of our profession. Below, the phases of the mentoring process are listed as presented in this article. Regardless of where you are in your nursing career, whether the new nurse or a new or experienced preceptor, I think you’ll find them interesting and helpful in planning and implementing a successful transition into nursing. 

• Phase 1: introductions, discuss one another’s personal and professional goals 
• Phase 2: set goals and objectives together, establish a time frame
• Phase 3: determine guidelines for implementing plan of action and working relationship (for example, open communication, availability, and constructive criticism) 
• Phase 4: reflection and feedback  (most important phase; fosters critical thinking and increases clinical skills)

I hope you enjoy this article. You can read it free online while it is on our Recommended Reading list.  Also, you can read about A memorable mentor in my career and my thoughts on The makings of a good mentor.

In my last post, I wrote about a challenging case where a patient’s sister, who was a nurse, tried to limit the amount of pain medication we were administering. Now I’d like to share my feelings about being a nurse turned patient/family member. 

Many of you who are members of NursingCenter or who follow this blog already know the story about when my sons were born. It was a surreal time in my life when they were born prematurely and spent several months in the Neonatal Intensive Care Unit (NICU). In minutes, I had switched roles from critical care nurse to new mother of two critically ill babies.  Before this, I had seen family members through illness and surgery and even sat by the bedside of my grandmother when she died in the unit where I worked. However, I think it was my time as a NICU parent that really exposed me to what it was like to be on the “other side.”

As anyone who has ever been there can tell you, it is scary! Sure my knowledge and clinical experience were helpful in understanding what was happening, but I remember quickly (even immediately) reaching the point of being completely overwhelmed. While I understood terminology and the pathophysiology, I was used to caring for adults - premature babies were a whole different world. “What about his tachycardia?” I would think. Then, the nurse, without even knowing my question would tell me, “He’s not tachycardic, a heart rate of 140 bpm is normal!” I guess she could just see the panic on my face!

It was very stressful for me to be aware of all the potential complications that could come upon my sons. Sure, I knew that dopamine was necessary to perfuse “Baby A’s” kidneys. I also knew that when the nurses increased the dose, that the goal had changed and now maintaining his blood pressure was necessary. I didn’t want to know the possible consequences if it extravasated or that his high ventilator settings could cause a pneumothorax. 

I know that my knowledge and experience helped me advocate for my sons, be involved with their physical care, and explain what was happening to the rest of our family. I am so grateful for the staff that, while they knew about my background, they also saw me as a new mother who was scared.  So what did I learn from this? Yes, patients and family members, whether they are health care professionals are not, are more informed and educated about their health care than ever. That is a good thing, but it is important to remember that we are all human beings first and in times of crisis, we all need compassionate care and a kind ear. 

Since you are here reading this on our blog, chances are you are pretty familiar with the world of social media. You may even have navigated your way here from Facebook, twitter, or another social media “avenue.”

It’s amazing how social media is infiltrating our lives and changing the world in which we live. We have  several blog posts already about social media (see here, here, and here), but now I’m interested in hearing a little bit about how you are using social media in your job. It is clear that social media is here to stay and will begin to play a more prominent role in health care and nursing. In just the past 3 months, we’ve had several articles in our journals dedicated to social media. For nurses, the use of social media gives us another way to communicate with patients, educate the public, and keep our own knowledge up-to-date. We must be mindful of course, to use social media in a professional manner and without violating privacy.

So here’s my question: What role does social media play where you work?

…and here are those recent articles I mentioned:

How Private Is Your Facebook?
Nurse Educator, May/June 2011

Career Scope: Using a blog to improve communication
Nursing Management, June 2011

Using Social Media as an Institutional Resource: Implications for the Clinical Nurse Specialist
Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, May/June 2011

Practice Points: Social Media Collaboration Checklist
Advances in Skin & Wound Care: The Journal for Prevention and Healing, July 2011

Living wills. Life support. Do-Not-Resuscitate. These are all phrases that I used frequently working in an adult medical intensive care unit. I rarely had trouble using the words death, dying, hospice, or end-of-life with patients and families.

However, outside of the hospital, these words have been a lot harder for me. My parents do have living wills and have expressed their wishes to me, but not because I initiated any discussion with them. In fact, I’ve actually avoided those conversations despite knowing how important they are. 

There is not really a good time to have end-of-life discussions, so people tend to wait for the "right time" which often turns into the "wrong time" or "too late." The conversation might end up taking place in the hallway of the emergency department or in a critical care waiting room. Sometimes, information is conveyed and decisions are even made over the phone.

I am fortunate that my own family members have insisted on preparing for the end of their lives and sharing their plans and wishes with me. As a daughter, I really don’t like to hear about it. As a nurse, I know that this is a very good thing.

Saturday, April 16th is National Healthcare Decisions Day. Make this day the "right time" to talk with your loved ones and encourage the patients you care for to do the same.

Here are some of the latest thoughts from our journal editors ~ enjoy!

• In Forging the future of nursing, Linda Laskowski-Jones MS, RN, ACNS-BC, CEN, FAWM writes: “We're at a historic crossroad as nurses. We must awaken as a profession and grasp the unparalleled opportunity to move forward in the same direction if we want our rightful place at the table. This means committing to ongoing education, actively engaging in dialog and decision making, and finally resolving the debate over entry-level educational requirements.”
• In Taking responsibility for our practice, Elizabeth M. Thompson MSN, RN, CNOR  shares her thoughts on relating the theme of this year’s AORN Congress “Freedom to be” to perioperative nursing practice. She also uses a clinical example to help define the terms responsibility and accountability.
• Kathryn Murphy DNS, APRN comments on The importance of cultural competence in the March/April editorial of Nursing Made Incredibly Easy! She reminds us that to be culturally competent nurses, we must remember knowledge (of cultures in your service area), attitude (avoid making assumptions and be aware of your own prejudices) and skills (learn new communication skills to simplify language).
• In Food for thought about our most frequently used anticoagulants, AnneMarie Palatnik MSN, RN, APN-BC writes about the challenges of caring for patients on warfarin and heparin and reminds us to “Follow the protocols that have been put into place in your organization, and remember that these protocols are there to keep your patients safe.”
• Suzanne K. Powell MBA, RN, CCM, CPHQ writes “…although many consumers are not clear what a "case manager" is and does, a case manager holds the promise of support and help during their experience in a complex, scary, and ever-changing healthcare environment.” Read more about case management professionalism in her editorial A Rose by Any other Name.

Thanks for reading!

Okay, so I know the words of this title should be hanging in an elementary school somewhere (and probably are), but think about all the reading you do as a nurse. It’s a lot, isn’t it?

From the big textbooks in nursing school to policies, procedures, and protocols in your area of practice, there is a lot of reading that we do. We read to keep up on health care news, drug information, technological advances, and treatment recommendations. We are constantly reading charts, care plans, laboratory reports, notes from other health care professionals, journal articles, and the latest research studies. The list goes on and on!

Social media has expanded our reading list even more. We are connecting online and reading each other’s stories and experiences through status updates, tweets, and blogs. Whole conversations are taking place without any words being spoken. Pretty amazing, isn’t it? Over the past year (since really diving in to the world of social media), I’ve connected with some amazing nurses whom I would have never “met” had I not read their words. 

You can find the links to some of my favorite blogs here under Nursing Blogs (right column, about halfway down the page.) Do you have a favorite blog or even have your own? Please share the link ~ I’ll be sure to check it out! Thanks

On March 22, 2011, the Editors-in-Chief of the top LWW nursing journals got together for a roundtable discussion about the Institute of Medicine and the Robert Wood Johnson Foundation Report on the Future of Nursing. For those of you who listened in, I hope you enjoyed the conversation about how these nurse leaders interpret and understand the key messages and recommendations from the report. For me, the task at hand is now clearer. It is now up to us nurses to bring our profession and our own careers to the level we deserve. I’d like to share some of what I took away from this discussion.

Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC, Chief Nurse of Wolters Kluwer Health/ Lippincott Williams & Wilkins and Ovid Technologies, moderated the discussion and reminded me that there are 3.1 million nurses (which is the largest group of health care providers) in the United States and we “need a seat at the table” to “make changes happen.” Anne then went on to explain in detail the key messages and recommendations in the report.

Maureen "Shawn" Kennedy, MA, RN, Editor-in-Chief of the American Journal of Nursing, spoke next about what the Report means to “nurses at the point of care” - which includes staff nurses, nurses practicing in home care, nursing homes, and other areas where direct patient care is occurring. She speaks about professional practice and having a voice when it comes to priorities of care.  Later in the webcast, Shawn talks about the education of nurses being for the public good and she includes good points about responsibility for funding.

Rich Hader, PhD, NE-BC, RN, CHE, CPHQ, FAAN, Editor-in-Chief of Nursing Management and Senior Vice-President and Chief Nursing Office of Meridian Health System gave his take on the report and what it means for managers and other nurse leaders. Some of his great words included “forge partnerships with academic colleagues” and “produce lifelong learning.” He commented on the timeliness of the report and brought up the idea of economic incentive for nurses going back to school. Rich also lists some key ideas for leaders and managers.

Jamesetta Newland, PhD, FNP-BC, FAANP, DPNAP, Editor-in-Chief of The Nurse Practitioner and Clinical Associate Professor at New York University shared her views on the report with regards to advanced practice nurses (APNs). She commented about APNs being trained holistically and the push to move the healthcare system to one of wellness, instead of illness.

Janet Fulton, PhD, RN, Editor-in-Chief of Clinical Nurse Specialist and Associate Professor at Indiana University spoke about clinical nurse specialists in acute care. Her comments about all APNs collaborating with each other to provide inpatient and outpatient care were eye-opening, especially her quote “nursing collaborating with itself.” Another good one…for all APNs to “push the boundaries to meet the public’s need.”

Suzanne Smith, EdD, RN, FAAN, Editor-in-Chief of the Journal of Nursing Administration and Nurse Educator spoke about the meaning of the report for educators and students. She suggested that we refer to guiding reports from organizations such as the NLN and the AACN. Specifically, Suzanne refers to the AACN’s “call for imagination” and the need for “dramatic change in Master’s education.” This discussion proceeds to the issue of cost.

The entire webcast has been archived and will be available until March 22, 2012. Take some time to listen in to the words of these nursing leaders!