NursingCenter’s In the Round

A dialog by nurses, for nurses

Measles Update

clock February 2, 2015 16:34 by author Lisa Bonsall, MSN, RN, CRNP

The current outbreak of measles, which has been linked to a California amusement park, continues to make headlines in the United States. The Centers for Disease Control and Prevention (CDC) is tracking data on the states affected and the number of cases. I encourage you to stay informed so you’ll be able to best educate your patients and answer their questions.

Before I get to the purpose of this post – to review transmission, signs and symptoms, and treatment of measles – I’d like to briefly address why we are seeing this resurgence in cases. In 1998, a study was published in the Lancet which suggested a link between the measles, mumps, and rubella (MMR) vaccine and autism. As a result, increased numbers of parents opted to refuse the MMR vaccine for their children. The researchers later retracted their study, and current evidence concludes that there is no association between vaccines and autism.

As nurses, we have a responsibility to educate patients about the importance of vaccinations and the implications when vaccine-preventable diseases reemerge. Measles is extremely contagious and can have serious complications, especially for certain high risk groups. Please stay informed about the current outbreak and recommendations for vaccinations. 

What is measles?

Measles is an acute viral illness, transmitted by direct contact with infectious droplets or by airborne spread. After exposure (the incubation period can range from seven to 21 days), a prodromal syndrome of high fever, cough, runny nose, and conjunctivitis is characteristic. Koplik spots (white or bluish-white spots on the buccal mucosa) may occur and then the development of the characteristic maculopapular rash, which typically spreads from the head to the trunk to the lower extremities, follows. 

Complications of measles


  • Otitis media
  • Bronchopneumonia
  • Laryngotracheobronchitis
  • Diarrhea


  • Encephalitis
  • Respiratory complications
  • Neurologic complications
  • Subacute sclerosing panencephalitis (SSPE)

Who’s at risk for severe complications?

  • Infants and children younger than five years; adults over 20
  • Pregnant women
  • Immunocompromised patients

Need-to-know information for nurses

  • After appearance of the rash, infected patients should be isolated for four days in a single-patient airborne infection isolation room (AIIR).
  • Measles is a reportable disease and local health departments should be notified within 24 hours of suspected measles cases. 
  • Routine childhood immunization for MMR vaccine starts with the first dose at 12-15 months of age, and the second dose at 4-6 years of age or at least 28 days after the first dose. (More vaccine schedules and information, including contraindications to vaccination, can be found here.)

Finerty, E. (2008). Did you say measles? American Journal of Nursing, 108(12). 
Skehan, J. & Muller, L. (2014). Vaccinations: Eliminating Preventable Illness. Professional Case Management, 19 (6).
Wade, G. (2014). Nurses as Primary Advocates for Immunization Adherence. The American Journal of Maternal/Child Nursing, 39 (6). 
Centers for Disease Control and Prevention. (2015, January 30). Measles (Rubeola): For Healthcare Professionals.

Who are “The Ebola Fighters?”

clock December 10, 2014 07:19 by author Lisa Bonsall, MSN, RN, CRNP

They are nurses. They are physicians. They are caregivers. They are scientists.

And as Time’s Person of the Year 2014, “The Ebola Fighters” are “The ones who answered the call.” These are the people who answer the call every day, putting themselves at risk without always knowing what those risks are. These are the people who feel it is an honor and a privilege to care for others during times of crisis and uncertainty. These are the people who thrive on answering tough questions and making tough decisions. 

It is wonderful to see this group recognized for their work. I am hopeful that this recognition will inspire The Ebola Fighters to continue this battle and will motivate others to join as well. We must all stay informed and follow recommendations to keep ourselves, our patients, and the public safe.

Congratulations to The Ebola Fighters – true heroes, deserving of our utmost respect and gratitude. 

Nursing2013 Symposium

clock March 25, 2013 05:45 by author Lisa Bonsall, MSN, RN, CRNP

As I write this, I’m on my return flight from Nursing2013 Symposium in Las Vegas, Nevada. With each conference I attend, a highlight for me is developing new relationships and strengthening older ones with nursing colleagues from around the country and world. As nurses, we have an incredible amount of knowledge and experiences to share and getting away from our workplaces and joining together to talk and learn is exhilarating! By the nature of my work, so many of my relationships are “virtual” ones – communication via email, text, and social media is more the norm for me than face-to-face conversations, so it thrills me to connect in person with nurses that I’ve only “met” online.

I have quite a bit to share from this conference, but let me start with quotes that inspired & educated me during this event!

“Many times, a patient’s history leads to a diagnosis; the physical examination supports that diagnosis.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“The most accurate way to take a blood pressure is by using the bell of the stethoscope.”
Anne Dabrow Woods, MSN, RN, CRNP
Physical Assessment Skills for Adult Patients

“It doesn’t take a title to be a leader.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“Staff nurses are front-line leaders and often hold the key to resolving turnover drivers.”
Jeff Doucette, MS, RN, CEN, FACHE, NEA-BC
Leading From Where You Are: Creating a Culture That Inspires

“The best leaders are personal leaders.”
Charles Denham, MD
A Lifesaver for Lifesavers: How to Survive the Rough Seas of Patient Safety and Value-Based Purchasing Demands

“Human factors that contribute to the complexities of patient handoffs include too few nurses, fatigue, rushed report, memory, nursing turnover, emotion, and information/sensory overload.”
JoAnne Phillips, MSN, RN, CCRN, CCNS, CPPS
Effective Handoff Communication: A Key to Patient Safety

“Every time lactate increases by 2, the risk of death [from sepsis] increases by 20%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“The mortality for sepsis equals that of an acute MI in 1960.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“For every organ system that fails, mortality [from sepsis] increases by 22%.”
Julie Miller, RN, BSN, CCRN
Sepsis: Nurses Implementing the Latest Guidelines

“Falls are an adverse drug reaction.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Angioedema from ACE inhibitors is not dose dependent.”
Anne Dabrow Woods, MSN, RN, CRNP
Recognizing and Treating Adverse Drug Reactions

“Start with what you know best, maybe a case study, and start writing.”
Denise Drummond Hayes, MSN, RN, CRNP
Bylines and Deadlines: Writing for Professional Publication

“Our work is based on science and evidence, but we are best known for our caring side.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

“The person with a strong nursing voice is an expert problem solver who is more proactive than reactive.”
Margaret A. Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC
Finding Your Nursing Voice

As many of the sessions were happening concurrently, I know there is so much that I missed and I look forward to listening to several of the presentations when they are available online. For those of you who attended this conference, please share what you learned and what inspired you too! 

Also, you can view some photos from the conference on our Facebook page!

Nurses call to action

clock December 21, 2012 09:27 by author Lisa Bonsall, MSN, RN, CRNP

I have been trying to limit my watching of the Newtown, Connecticut events on television. I feel guilty about it, as those directly affected by the horrible massacre that occurred December 14th must face the tragedy every minute of every day. Like you, I am experiencing all sorts of feelings of sadness and anxiety and my thoughts and prayers are with the victims, their families, and the first responders.

I have not limited my reading though. I feel that by reading the stories shared by family members, I am getting to know the victims and in some small way, I am honoring them. I am reading the stories shared by the survivors and feeling that in some small way, by doing so I am helping them process the events by “listening.” I am reading the thoughts and feelings of how others are processing what happened, hoping to contribute to the discussion and let our voices be heard so that changes can be made to make our nation a stronger and safer place for ourselves and our children. 

Now I turn to the feelings of “How can I help?” and “What can I do?” I encourage you to see posts from our colleagues at AJN’s Off The Charts and Nursetopia for lists of resources and ways to help. Also, the American Nurses Association has assembled a list of more than 30 nursing organizations joining forces to call for change. 

“The nation’s nurses call on President Obama, Congress, and policymakers at the state and local level to take swift action to address factors that together will help prevent more senseless acts of violence. We call on policymakers to: 

• Restore access to mental health services for individuals and families 

• Increase students’ access to nurses and mental health professionals from the elementary school level through college 

• Ban assault weapons and enact other meaningful gun control reforms to protect society”

Nurses – we are the largest single group of health care professionals. We see the devastation caused by weapons and violence. We care for patients with mental illness and know there is need for improved services and access to treatment. It is time to take action.

To Those Affected By Hurricane Sandy...

clock November 2, 2012 08:29 by author Lisa Bonsall, MSN, RN, CRNP

What to say here? I am still in shock by the devastation caused by this hurricane. 

I grew up on Long Island. My parents, my brother and his family, and many childhood friends still live there. Yes, they experienced loss of ‘things’ and remain without power, but they are all safe. As the stories emerge of lives lost, I know how lucky we are. 

The accounts of hospitals closing and patients being evacuated are amazing. I am in awe of those who’ve worked so hard and continue to work so hard to keep patients safe and provide care to those in the hospital as well as out in the community. The evacuation and transfer of patients, especially of NICU babies from NYU Langone Medical Center, is incredible to me. As a mom of 2 NICU graduates, I remember well the challenges of repositioning a sick premature baby in his isolette; I can’t imagine moving across New York City during a hurricane. What more can I say but THANK YOU to our nurse colleagues and the other healthcare professionals who managed this incredible feat. 

To those dealing with loss, I imagine you will never see this post. If, by chance, you do come across this writing someday, know that at this moment, my thoughts and prayers continue for you. I hope that you have rebuilt your home, whether in the same location or somewhere new, and you’ve been comforted and supported in your grief. 

American Journal of Nursing has created a list of helpful resources (open access) to help us cope now and be ready for future emergencies. 

Wishing everyone safety and good health during recovery efforts. 


clock June 12, 2011 06:54 by author Lisa Bonsall, MSN, RN, CRNP

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!

Patient Safety

clock March 7, 2011 03:37 by author Lisa Bonsall, MSN, RN, CRNP

This week is Patient Safety Awareness Week, an annual education and awareness campaign led by the National Patient Safety Foundation. I did a quick search of articles from our nursing journals to bring you some of the great content we have related to patient safety...

Want to read more? We also have an entire collection of resources devoted to the topic of patient safety. In addition to articles and continuing education opportunities, Focus On: Patient Safety includes a PowerPoint presentation on medication error prevention and a quick reference on pressure ulcer prevention. Have a good week!

Recent Comments

Comment RSS

About your comments

We welcome comments, discussion, curiosity, and debate. Let us know about your nursing lives and personal experiences. We reserve the right to moderate comments that are intended to sell something or that are inappropriate or hostile.


Views expressed on this blog are solely those of the authors or persons quoted. They do not necessarily reflect Lippincott's's views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.

Sign in