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!

Every year Nurses Week rolls around and nurses are told “thank you” by their institutions; if you are lucky, you may receive a token of appreciation like a lunch bag, a water bottle, or a beach towel. The research is clear, nurses do make a difference in patient outcomes and nurses are the most trusted profession according to the Gallop poll. This is my 28th year experiencing Nurses Week, but this year I am seeing it a little differently.  

My mother passed away last year on May 25th from small cell lung cancer. From the day she was diagnosed to the day she died was 2 and a half months. She tried chemo but it didn’t work, it often doesn’t. She never regretted trying the chemo because it gave her the time to say good bye to all of her family and friends. Her friends were incredibly supportive of her and the rest of our family. You see, her friends were all nurses. They helped prepare meals, assist with her activities of daily living, and administer her medications. They even stayed overnight when one of the family couldn’t stay. They allowed me to be the “daughter” not always the caregiver. When my mom died, she was surrounded by her children and three of her best friends who were all nurses. These women made all the difference in the world to my mom and our family. They made it possible to keep her where she wanted to be – at home. 

Being a nurse doesn’t end when you retire or take time off to raise your family. It is an innate part of who you are and how you conduct yourself each and every day. So, during this Nurses Week, if you come upon a nurse who is retired or is taking some time off, say “thank you…you make a difference.”

Submitted by:
Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC
Chief Nurse
Wolters Kluwer Health / Lippincott Williams & Wilkins / Ovid Technologies  

My eyes have really been opened over the past year. Since launching the Skin Care Network in collaboration with the Dermatology Nurses’ Association and becoming a member of the editorial board of the Journal of the Dermatology Nurses’ Association, I have learned A LOT about skin cancer, indoor tanning, and prevention. I’ve written about skin cancer before on this blog, not so much about the cancer itself, but my involvement (or lack of) when caring for my dad when he underwent Moh’s surgery (Is Nursing Really For me?) I digress a little, mainly to share that with a family  history of skin cancer, I should and will be more proactive in prevention methods for myself and my family. 

Recent publications demonstrating the increasing incidence of melanoma and its association with tanning bed use include Increasing Incidence of Melanoma Among Young Adults (Mayo Clinic Proceedings), Use of Tanning Beds and Incidence of Skin Cancer (Journal of Clinical Oncology), and Melanoma surveillance in the United States: Overview of Methods (Journal of the American Academy of Dermatology). Many states have enacted or are considering teen tanning bed restrictions (here’s  a nice list) and a Congressional Report revealed “the false and misleading health information provided to teens by the indoor tanning industry.”

I know those are a lot of links to sort through above, however, the number of reports & articles (and there are more) demonstrate what a big issue this is. What is critical here is that there are ways to prevent or minimize skin cancer occurrence, resources to educate our patients and the public, and important information to know to recognize skin cancer so it can be treated early. The following organizations and events are a good place to start! 

Organizations/Programs

National Council on Skin Cancer Prevention 

Children’s Melanoma Prevention Foundation 

SunAWARE 

Outrun the Sun 

Events

Melanoma Monday ~ the first Monday in May; the purpose is to raise melanoma awareness and encourage early detection.

Don’t Fry Day ~ the Friday before Memorial Day; the purpose is to increase sun safety awareness and remind everyone to protect their skin while spending time outdoors.

I was taken aback when I read that “one in five patients admitted to a hospital suffers from alcohol use disorder” in Managing alcohol withdrawal in hospitalized patients in the April issue of Nursing2012 (here’s the pdf for the best view). With numbers like this, it really is critical that we are aware and able to assess all patients for signs and symptoms of alcohol withdrawal. I’d like to bring this article to your attention because there are some great resources included to help assess patients and also care for those experiencing alcohol withdrawal. There is a table on timing of symptoms – when they might occur in relation to the last drink – and also a copy of the Clinical Institute Withdrawal Assessment for Alchohol Scale, Revised (CIWA-Ar), which is the gold standard for assessing for withdrawal. The CIWA-Ar is not copyrighted – so go ahead and print it out, share it, and use it (in accordance with your facility policy, of course.)

April is Alcohol Awareness Month. While those of us in the hospital setting may come in contact with patients at risk for or experiencing alcohol withdrawal, we all know that a critical component of alcohol awareness is prevention. This year’s theme is “Healthy Choices, Healthy Communities: Prevent Underage Drinking."  Won’t you read more about this and help spread the word?

He came in on room air – somewhat dyspneic with a respiratory rate of 28 and shallow breathing. His O2 saturation was 95%. He was a young guy, 32 years old, with no prior medical or surgical history. After settling him into his ICU room, I headed out to the nurses’ station to write my admission assessment. The physicians were at the bedside completing their physical examinations. Suddenly, alarms started ringing like crazy. I ran into the room and immediately started to bag this patient with 100% oxygen. A flurry of activity began --- intubation, heparin bolus and I.V. infusion begun --- before I knew it, someone had started CPR. Wow – what was going on? How had he decompensated so quickly?

I was reminded of this patient when I read Acute Pulmonary Embolism in the April/June issue of Critical Care Nursing Quarterly. Pulmonary embolism (PE) has always been one of the scariest diagnoses to me. When a patient came in with a ‘rule out PE’ diagnosis, I was nervous; a ‘road trip’ to Nuclear Medicine made me really nervous!

Fortunately, admissions similar to this were not a regular occurrence. You can imagine that the sudden death of a young patient had a great impact on me and the rest of the team that day. I was a pretty new nurse and the details of the events have faded a bit from my memory. What I do remember clearly is that one minute I was speaking with this new admission and within moments (or so it seemed) he was coding. 

PE occurs when the pulmonary artery or one of its branches is occluded by a thrombus that originates somewhere in the venous system or the right side of the heart. The thrombus essentially breaks free from where it formed and travels to the lungs. In the lungs, it blocks vessels and causes impaired gas exchange, which leads to hypoxia. Symptoms of PE are commonly nonspecific – tachypnea, crackles, tachycardia, cough, chest pain, dizziness, anxiety, and dyspnea. Patients may also present with frothy, pink sputum or hemoptysis. 

I’ve listed several resources below if you’d like to read more about PE. You can also search ‘pulmonary embolism’ on NursingCenter to see all of our journal content on this subject. 

Resources:

Gay, S. (2010). An Inside View of Venous Thromboembolism. The Nurse Practitioner: The American Journal of Primary Health Care, 35(9). 

McLenon, M. (2012). Acute Pulmonary Embolism. Critical Care Nursing Quarterly, 35(2). 

Moz, T. (2008). Pulmonary Embolism: More Than Just Short of Breath. LPN2008, 4(6). 

Have you ever cared for one of those patients who is ‘borderline’ unstable? You know --- kind of stable, but not well enough for you to feel too optimistic that they won’t crash? In the Medical Intensive Care Unit where I worked, I can recall many times where we had this one habit to help us get through the shift and keep a patient stable. Sounds silly, almost superstitious, but sometimes it worked…and I’m wondering if any of you have similar quirks or traditions that you use in your own practice. 

What is it? Here are some examples:

A patient is admitted and we settle him in his room – ECG monitor on, vital signs taken, alarms set, I.V. access established, history taken, and physical assessment completed. He seems fairly stable but when you walk out of the room, his alarm sounds for a systolic blood pressure of 90 mm Hg. His initial blood pressure had been 116/78. Your colleague asks, “Do you want some I.V. fluids?” to which you reply “Yes, let me just keep it in the room.” 

Another patient, who had been on the unit for a few weeks and had resolving ARDS (acute respiratory distress syndrome) was extubated 2 days ago and had been doing well breathing on her own. Throughout the shift, however, her oxygen requirements are increasing and her breathing is becoming more labored. The respiratory therapist asks “Do you think she’ll be reintubated?” and you reply “Please bring a ventilator to her room, just in case.” 

I can think of many patient scenarios similar to these, where we’d bring I.V. catheters, vasopressors or other medications, even urinary catheters, into the room but then didn’t need to use them. I know part of this is being prepared and having a treatment or intervention ‘ready to go’ is something that, as nurses, we do all the time. However, sometimes it seemed that the act of bringing something into the patient’s room was enough to keep him or her stable. Just coincidence? Probably. But if it works…

March 19th is Certified Nurses Day. A large number of nursing certification programs exist (I count 92!). This number alone tells me that this is something important that all nurses should consider. I was proud to use the credential CCRN during my days working in a medical ICU. The exam was tough and maintaining the necessary continuing education requirements was challenging, but my own sense of pride and the respect I received from patients, my colleagues, and my employer made it worth it.   

So what is specialty certification exactly? The American Nurses Credentialing Center (ANCC) defines certification as “a process by which a nongovernmental agency validates, based upon predetermined standards, an individual nurse’s qualifications for practice in a defined functional or clinical area of nursing." Many other definitions exist, depending on where you look or from which organization you are seeking certification. In general, being certified demonstrates that you have advanced knowledge and competence in a given specialty. 

Barriers to certification have been identified as time, cost of preparation and examinations, test anxiety, lack of support from supervisors, and continuing education requirements (Valente, 2010). Overcoming these barriers, both on personal and professional levels, is important because of the value and benefits associated with specialty certification. Kaplow (2011) categorized this value associated with certification into three realms: value to patients, value to employer, and value to self. 

With regard to value to patients, certified nurses demonstrate greater confidence in decision making, increased patient safety (including less falls and decreased pressure ulcers), and higher patient satisfaction. Also, certified nurses have been shown to be more likely to provide care based on evidence-based guidelines (Kaplow, 2011). 

Specialty certification sends a message of commitment to a current or potential employer. Nurses who are certified demonstrate a personal responsibility to their education, and in turn, patient care and outcomes. Some studies have even shown an association between certification and turnover, vacancy, staffing, nurse retention, job satisfaction, higher nurse performance, and patient satisfaction (Watts, 2010). 

Finally, the personal benefits that come with certification are numerous. The sense of accomplishment, feeling of empowerment, and validation of knowledge had a great impact on my confidence. Other benefits can include an impact on salary and career advancement, as well as improved marketability (Kaplow, 2011).

If you’re interested in learning more about certification, take a moment to read Your guide to certification. This handy table of specialty certification boards and contact information along with the associated credential and requirements is a good place to start your journey to certification. Good luck!

References: 

American Nurses Credentialing Center. (2012). What is Nurse Certification. Retrieved March 15, 2012, from ANCC website: http://www.aacn.org/wd/certifications/content/consumer-whatiscert.pcms?menu=certification  

Kaplow, R. (2011). The Value of Certification. AACN Advanced Critical Care, 22(1). 

Valente, S.M. (2010). Improving Professional Practice Through Certification. Journal for Nurses in Staff Development, 26 (5). 

Watts, M.D. (2010). Certification and Clinical Ladder as the Impetus for Professional Development. Critical Care Nursing Quarterly , 33(1).

Two scholarships were recently brought to my attention and I remember all too well the stress of paying for my nursing education – I must share the details with you!

BestNursingDegree.com is currently offering three scholarships in the amount of $2,500 each to aspiring and current nurses who are pursuing:
       *A second degree BSN or direct entry MSN degree 
       *An RN to BSN 
       *An MSN, DNP or PhD in nursing
Applications are available on their home page at www.bestnursingdegree.com. Deadline is April 15, 2012.

Loyola University Online is offering a set of five $4,500 scholarships for their online Master of Science in Nursing degree program. Applicants are asked to submit a 200-300 word essay answering the question: “What does nursing mean to you, and how will an MSN with a specialization in Health Care System Management benefit you or help further your career?” For more information and to apply, visit http://scholarship.loyolaneworleansonline.com/msn/. The deadline for entry is fast approaching - March 23rd.

Do you know of any other scholarships currently available? Please share! 

There’s no better place to get excited about nursing than at a nursing conference! I spent four days this month in Denver, Colorado at the Dermatology Nurses’ Association 30th Anniversary Convention. What an amazing group of nurses! From a keynote address by Michael R. Bleich, PhD, RN, FAAN which motivated us to enact the changes recommended in the IOM Future of Nursing Report to informative presentations by experts in the field, my days were filled. The camaraderie and networking among the attendees and interaction with the exhibitors was phenomenal. I left there feeling so good about being a nurse and feeling supported by my peers – thank you DNA nurses!

If you will be attending any upcoming conferences, take a moment or two to read A Closing Word: 10 Tips for Getting the Most From a Professional Conference. Here are the ten tips (but be sure to read the article in it's entirety - there is some good advice!): 

1.   Choose your sessions strategically.
2.   Networking is key.
3.   Dress the part. 
4.   Attend the poster presentations. 
5.   Attend the exhibits.
6.   Comfort is important.
7.   Take care of those who take care of you.
8.   Be respectful to your colleagues and to the speakers.
9.   Stay organized during the conference. 
10. Spread the enthusiasm and share what you learned.

Also, check out our events calendar for a complete list of upcoming nursing conferences.

Next up on my calendar is Nursing2012 Symposium in Orlando this April. Hope to see you there!

Reference: Aldridge, M.D. (2012). A Closing Word: 10 Tips for Getting the Most From a Professional Conference. Dimensions of Critical Care Nursing, 31(2).

It amazes me the amount of content that is available in our nursing journals on the subject of technology and social media. From simulation mannequins and electronic health records (EHRs) to handheld devices and mobile apps to blogs and twitter, the way we learn and communicate is forever changed. For some of us, these changes are overwhelming – there is so much to learn. For others, maintaining confidentiality and professionalism is most concerning. Some of us welcome new technology; even thrive on it, believing that easy access to reliable information will increase productivity and lead to better patient outcomes.  And some of us, myself included, are experiencing all of those feelings – it is overwhelming, we do have a big responsibility to protect our patients and act professionally, and the benefits are numerous. 

So what is a nurse to do? Learn about what's out there! When a new technology is presented, take advantage of the inservices or staff educators on the unit who are there to teach you. If you use a smartphone, search for apps that will help you in your practice and try them out. If you blog or use social media, make sure you're familiar with the American Nurses Association's Principles for Social Networking and the Nurse: Guidance for the Registered Nurse. Also, grow your online network with other nurses, whether on Facebook, twitter, LinkedIn, WordPress, or another platform. I have learned so much about healthcare, nursing, and social media from my fellow nurses all around the world.