We see, read, and hear so much about horizontal violence and nurses not being supportive of each other, and also about other healthcare professionals being unsupportive of nurses. Another such case is occurring, but what is striking to me, is that while this one nurse is going through this tough time, nurses on the web are rallying together to support her and encouraging others to do the same.

The case is of Amanda Trujillo, a registered nurse in Arizona. According to a letter she wrote and the posts of many nurse bloggers, Amanda has been fired from her job, her nursing license is in question, and she is undergoing psychiatric evaluation after educating a patient about his illness and options. The patient decided to forgo surgical intervention and explore hospice care. The details of her case can be read on a number of nursing blogs, including vdutton’s posterous (with the transcript of details recorded by her attorney), Those Emergency Blues, and Emergiblog. The Nerdy Nurse also has several posts and an extensive list of resources about the case and ways to show support.

I can think of several instances where patients I’ve cared for had questions that either were not answered by the healthcare team or were answered, but the patient did not fully understand his condition or options. On many  occasions in my nursing career, I provided patient education that helped a family make an  informed decision. I’ve called together family meetings with the healthcare team and requested ethics committee consultations. Advocating and educating patients, within the scope of nursing practice and institution policies, of course, is our responsibility. 

I will be following the case to see what evolves and the response of nursing organizations. Thank you to the nurses who have been sharing Amanda’s story.

Happy New Year everyone! I thought I’d start the year off here on In The Round with some positive energy and pull together nursing recognition days, weeks, and months for the beginning of 2012*. Please feel free to add to this list any that I may have missed by leaving a comment. Wishing everyone a happy and healthy 2012!

National Nurse Anesthetists Week 
January 22-28, 2012

National IV Nurse Day 
January 25, 2012

PeriAnesthesia Nurse Awareness Week 
February 6-12, 2012

GI Nurses and Associates Day 
March 28, 2012

Certified Nurses Day 
March 19, 2012

National Radiology Nurses Day 
April 10, 2012 

National Critical Care Awareness and Recognition Month 
May 2012

Oncology Nursing Month 
May 2012

National Nurses Week 
May 6-12, 2012 (National Nurses Day is May 6)

National Student Nurses Day 
May 8, 2012

National School Nurse Day 
May 9, 2012

International Nurses Day 
May 12, 2012

Neuroscience Nurses Week 
May 13-19, 2012

*Some of the links above may take you to pages from 2011. I will update these when new pages become available. Thanks!

I read a lot about nursing - mostly journal articles, but this year I’ve spent quite a lot of time reading nursing blogs and I love it! Some tell stories of certain patient experiences, some bloggers have written more about the changes our health care system is undergoing, and others use their blogs to teach students and lead newer nurses. Quite a few nurses out there do all that and even more on their blogs. I thought I’d share some of my favorite posts from the past year. These are the blog posts that have inspired me and left me with such a good feeling about nursing. Thank you to nurse bloggers who share their stories and experiences. It is so great learning from you all. 

A Nurse’s Week Reflection: The nurse’s night off
Nurse Story

Humility, Forgetfulness, and Glitter
Nursetopia

Receiving compliments
At Your Cervix

Return of Compassion
New Nurse, In the Hood

The Priceless Clarity of Inexperience
AJN’s Off The Charts

There are such talented nurse writers out there and I’m sure I’ve missed some good posts – please share your favorites as well. I'd love to read more and learn what posts have inspired you this year.

On December 2nd, Dr. Donald M. Berwick will step down as administrator for the Centers for Medicare and Medicaid Services (CMS). Replacing Dr. Berwick will be Marilyn Tavenner, who served as Berwick’s deputy principal administrator since April 2010. The first article I read about this development was last week on Reuters.com. Toward the end of the article, I read “Tavenner is a former Virginia health secretary and hospital chief executive. A nurse by training, she has been with CMS since February 2010, first as acting administrator and currently as principal deputy administrator." A nurse to head CMS? Yes!

Since last week, I’ve read more about the sequence of events leading to Dr. Berwick’s resignation as well as more about Marilyn Tavenner’s background and experience. In this blog post from the Washington Post, Tavenner’s path from ICU nurse to this nomination is chronicled in detail with comments from former colleagues describing her as respectful, quick-thinking, decisive, and hard-working. In an article on HealthLeaders Media, more former colleagues share their thoughts and feelings of Tavenner’s pragmatism, leadership experience, and decision-making skills. 

The American Nurses Association (ANA) has released a statement commending the White House for its decision to nominate Marilyn Tavenner, MHA, BSN, RN, to head CMS.  I’d like to join in on the commendation. Seeing a nurse take on such a prominent leadership role makes me feel proud – how about you?

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. 

There are certain words and phrases that are used frequently in nursing and medicine – sometimes so frequently that we lose our understanding of their true meaning. Or sometimes, we may not have really understood them at all.

For me, “shared governance” was one such phrase. In the past, if someone had asked me what shared governance meant, I would have had some difficulty explaining it in great detail. Sure, I would have answered that it’s a model for nurses to work together and manage themselves, but beyond that, I’d have been at a loss.

That is, until, I did some reading. Now I feel better prepared to discuss shared governance and its role in nursing. Here’s what I’d say now:

Shared governance is collaboration, whether in scheduling staff, educating new staff, or implementing evidence-based practice. It involves teamwork, problem-solving, and accountability, with the goals of improved staff satisfaction, productivity, and patient outcomes. It is working together to make decisions that affect nursing practice and patient care. It is working with other disciplines for the good of the patient. It is collaborating to improve nursing practice. 

Allow me to share the following excerpt which I found very enlightening:

The structure is shared governance; the process is professional nursing practice; the outcomes are positive productivity data.¹

Is a shared governance structure in place where you work? Have you been involved with implementing shared governance? I'd love to learn more; it sounds like the ideal working environment, but I'm wondering - does it truly exist?

1. Church, J.A., Baker, P., Berry, D.M. (2008). Shared governance: A journey with continual mile markers. Nursing Management, 39 (8).

Have you ever heard someone say “I used to be a nurse” when asked what they do? Me neither! In fact, when someone asks me what I do, the first thing I say is “I am a nurse.” This is usually followed by questions about where I work, what type of patients I care for, and the like. If the person I’m talking with is truly interested, I’ll explain my background in critical care, my role as a nurse practitioner in women’s health, and now my career in the world of publishing. I am proud of what I’ve done in the past and what I do now, but the biggest sense of pride comes with being able to say “I’m a nurse.”

A recent conversation with my mom went something like this: 

Mom: “Have you heard from your cousin?”

Me: “Yes, he’s been great.” I then went on to fill her in on recent events in his life, as well as what his family and friends have been up to.

Mom: “Wow, why is it that everyone calls you with their latest news?” She then answered her own question with “I think it’s because you are a nurse.” 

That warmed my heart! You can probably relate similar stories, especially when it comes to others, sometimes complete strangers, sharing their healthcare stories and questions.

Nurses – we truly are a special group!

What does it mean to be a leader? In the past, I would think of a nurse leader as any nurse in a management position or an advanced practice nurse. After reading Finding the Leader Within: Thoughts on Leadership in Nursing, my perspective has changed. Let me share the following words of the authors to help you understand why we all can be, and should be, nurse leaders:

…real leadership is less about a title or institutionally granted power, and more about how we “show up” in the myriad of moments that make up our days.

…leadership is an “in the moment experience”

…being a leader is basically about constantly trying to be a better person.

The authors’ work has focused on helping individuals find the “leader within” and developing behaviors to share their leadership with others. To do this, they identified five “skill-cepts”, that is, skills derived from leadership concepts:

1. Know your stuff - have the knowledge and be confident in it
2. Have a goal - know where you are going
3. Stay “in role” - focus on your goals and how to achieve them; avoid taking things personally (you really must read this part of the article in its entirety!)
4. Love the fight - recognize resistance as a sign that you are making an impact
5. Cultivate gratitude - remember there is always something positive to gain, even when you are faced with challenges

I hope you find this article as inspiring as I did. You can read it free online until 7/1/11 as it is from our current featured journal. Let me know what you think!

Reference: Gordin, P.C. & Trey, B. (2011). Finding the Leader Within. Journal of Perinatal and Neonatal Nursing, 25(2), pp. 115-118.

I was on orientation in the Medical Intensive Care Unit and I had the most amazing preceptor. She really did know everything. I still have yet to meet a smarter nurse, or person, for that matter. Her knowledge of physiology, pathophysiology, medications, technology, and random entertaining facts to keep us going during night shift astounded me! Not only that, she was (and is) an amazing nurse --- caring, compassionate, a good listener, excellent at time management, and all things nursing!

And her teaching skills? Amazing.

I was a new graduate fortunate to work with and learn from this nurse every day. I had worked in this MICU as a nursing assistant for over a year, so I knew some of the basics (where to find supplies and knowing which room is which is huge when you are just starting out, right?) I’ll never forget this one time…

Amy (not her real name, of course) would often stand back in the corner of a patient’s room while I did my assessment at the start of a shift. Sometimes I’d forget she was there until she’d start with “the questions.” During this particular shift she said, “Lisa, what if all of a sudden the ventilator alarms for a high peak airway pressure?” I started to go through my list of troubleshooting ventilator alarms: look at the patient - is he in distress, what is his oxygen saturation, how is his color, listen to his breath sounds, is his endotracheal tube in place - and then moved on to the ventilator - any water in the tubing, is everything connected as it should be, etc.

Amy then said “Okay, you don’t find any concerns, but the high pressure alarm is still sounding. Now what?”  I replied, “I would disconnect the patient from the ventilator and bag him.” Amy said “Yes, and what else could you do to search for a reason for the alarm?” I could tell by Amy’s face that I was missing something.

She pretended to take a picture. Huh? I must have looked confused, because she did it again. I thought for a minute and then it hit me --- a chest x-ray!