As I write this, I’m on my flight home from the Clinical Symposium on Advances in Skin & Wound Care 2012 which was held at Caesars Palace in Las Vegas, Nevada. Thank you to the conference chairpersons, Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Richard Salcido, MD. It was an informative, well-organized, and fun conference!

I was particularly drawn to the sessions which addressed skin care and pressure ulcer management at the end of life. Even in the keynote address, Legally Defensible Wound Care, presented by Caroline E. Fife, MD, CWS and Kevin W. Yankowsky, JD, this was a theme. An interactive case presentation was the format and we, the audience, got to share our opinions/votes by holding up a red or green card to questions such as “Was this pressure ulcer a result of negligence?”, “Would you take the case?”, and “Should the hospital be sued?”, among many others. During the presentation, an interesting observation was shared. When a cause of death is identified as ‘heart failure’ or ‘renal failure,’ a response of sympathy often results; however, a cause of death of ‘skin failure’ often leads to more negative responses, such as “that never should have happened” or even a search for somewhere or someone on which to place blame. 

The lesson that I learned, both from this keynote address and from a session titled Skin & Wound Care at Life’s End: Clinical Considerations, presented by Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN, is that the skin is an organ and at the end of life, it will fail just as the heart and kidneys and other organs do. Despite optimal care and evidence-based interventions for skin and wound care, skin failure and pressure ulcers often are unavoidable at the end of life. 

Here are some more highlights from the conference:

• Book signing! Sharon Baranoski, MSN, RN, CWCN, APN, DAPWCA, FAAN and Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN were on hand to sign their book Wound Care Essentials, Third Edition. 

• Exhibit Hall! The exhibitors shared their products in dynamic ways, including wound care karaoke & dressing change races.

• Resources! Here’s a list of resources shared by the presenters – be sure to check them out!
  • Advances in Skin & Wound Care
  • The National Pressure Ulcer Advisory Panel 
  • SCALE Final Consensus Statement
  • Screening for the High Risk Diabetic Foot: A 60-Second Tool
  • Braden Scale for Predicting Pressure Sore Risk

• Quotes! Looking back on my notes, I just have to share these wise words that were shared.
  • “The keys to preventive legal care and effective communication are managing expectations beforehand and answering questions afterward.” Kevin W. Yankowsky, JD
  • “Edema is the real enemy.” Sandra Wainwright, MD (discussing chronic venous hypertension ulcers)
  • “Anytime cartilage is present, you have a stage IV pressure ulcer.” Diane K. Langemo, PhD, RN, FAAN
  • “If there is stable eschar on a heel, leave it alone!” Diane K. Langemo, PhD, RN, FAAN
  • “We all own pressure ulcers, not just nurses.” Elizabeth Ayello, PhD, RN, ACNS-BC, CWON, MAPWCA, FAAN
  • “The Braden scale accounts for most risk factors for pressure ulcers, but we also need to think about perfusion, age, comorbidities, and if the patient has a history of pressure ulcers.” Dr. Janet Cuddigan

You can see some pictures from the conference on our Facebook page. Next year, this conference will be held in Orlando, FL on October 24-27, 2013. It would be great to see you there!

I think that every nurse I know has a story about jumping in to help during an emergency outside of the work setting. I’ve had several over the years, the most recent being this past summer while out with my kids. It was an evening out at the park, close to dinner time, so it wasn’t very crowded. Suddenly a young boy ran from the swings holding his head. His mom (or another caregiver – I’m not certain what the relationship was) was seated at the next bench, not very far from me. She started to scream and cry.

I could see the blood coming down the little boy’s neck and quickly ran over to help. Fortunately I had a towel in my bag since we had just come from the pool. As I approached, the mom/caregiver stepped away crying and fell into the arms of another woman who was there. I quickly assessed his head (it was a pretty big gash) and held pressure with the towel while lowering him to the ground where we sat and waited for emergency medical services (EMS) to arrive.

All the while, my own children were watching in fear. After the EMS team arrived and took over the boy’s care, which included a trip to our local emergency department, we collected our stuff and headed toward the car. I reassured them that the little boy would be okay and that he might just need some stitches. The conversation that ensued with my one son went something like this:

Me: “It’s a good thing there was a nurse around, huh?”

My son: “There was?”

Me (shocked): “Yes! Me!”

My son: “Oh yeah…I forgot you’re a nurse. You're more of a ‘typer’ than a nurse though, mom.”

The conversation went on a little longer, but I must say it was as if something just hit me right then. I’d recently been considering getting back to patient care, but hadn’t even begun to look into job opportunities or refresher courses in the area. This brings me to my reason for sharing this story…

I’ve been away from bedside nursing for more than 10 years and have a few questions for anyone else that took a similar “hiatus” and then returned to patient care.

1. What steps did you take to prepare for a return to bedside nursing?
2. Did you return to your prior place of employment or a similar unit, or did you start over in a new area or with a different patient population?
3. How easy or hard was it making the transition?

Please share your story! I look forward to any advice you may have for me!

Thank you J

Nurses must increase vigilance for identifying patients at risk for fungal meningitis following the September 26, 2012 recall of injectable methylprednisolone acetate that was packaged by New England Compounding Facility in Framingham, MA. According to the Centers for Disease Control and Prevention's website, there have been 185 cases and 14 deaths among 12 states and continues to grow (CDC, 2012). The impact is potentially greater because healthcare facilities in 21 states have received the recalled lots of the affected drug. 

Patients who received contaminated injections presented with symptoms from one week to 4 weeks after the injection. It is important for nurses to report patients who are symptomatic of meningitis through the month of October to a physician or licensed advanced practiced nurse. To further assist in the evaluation or referral for meningitis work-up, all health care professionals including those in primary care offices, emergency departments, or retail clinics should go to the CDC website (http://www.cdc.gov/hai/outbreaks/meningitis-facilities-map.html) for a current list of health care providers who administered the recalled lots. The CDC website also provides continually updated information on the meningitis outbreak and educational information for providers and patients.

Reference

Centers for Disease Control & Prevention. (2012). Multistate Meningitis Outbreat Investigation. Retrieved from http://www.cdc.gov/HAI/outbreaks/meningitis.html. Last accessed 10/12/2012.

In the opening address at Nursing Management Congress 2012, Sharon Cox presented ways that managers can “add value in a time of volatility.” While this was a conference geared toward nurse managers and other administrators and executives, her words and ideas are applicable to us all, both as nurses and as human beings.

One thing that she said (it’s on my list of favorite quotes from the conference) was “We teach people how to treat us.” While looking back at my notes, I found these words in all capitals and circled several times. This was a powerful statement!

Think about it. Do you have colleagues who aren’t true “team players?” Any bullying go on in the unit where you work? Are some nurses bullied more that others? Why?

You can ask yourself similar questions about any relationships, not just in the workplace. If we allow ourselves to be treated poorly, people will continue to do so. I agree with this statement by Sharon Cox because by allowing others to treat us with disrespect, it’s as if we are condoning that behavior.

So what is the solution? In my mind, the trick is to be “respectfully assertive,” that is, stand up for ourselves without being aggressive or becoming defensive. This is one of those things that is often “easier said than done,” but by being aware of how we receive and react to certain behaviors and making any necessary changes on our own end, perhaps we can make a difference.

Some wise words were spoken at Nursing Management Congress this year. Here’s my top list of quotes from the conference. Thank you to all of the experts who shared their experience and stories with us!

Without further ado…

1. “Our knowledge of what we do everyday is very limited; based on tradition, not science.”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

2. “Intrapreneurs are ‘dreamers who do.’”
Kathy Russell-Babin, MSN, RN, NEA-BC, ACNS-B, Senior Manager, Institute for Evidence-Based Care, Meridian Health

3. “Prioritization is a fact of life in clinical practice.”
Sean Clarke, RN, PhD, FAAN, Director, McGill Nursing Collaborative for Education and Innovation in Patient and Family Centered Care, McGill University and the McGill Teaching Hospital Network

4. “We teach people how to treat us.”
Sharon Cox, BSN, MSN, Founder and Principal Consultant, Cox and Associates

5. “Shift from ‘busy’ to ‘productive.’”
Sharon Cox, BSN, MSN, Founder and Principal Consultant, Cox and Associates

6. “Don’t forget the patient in the shared decision making model.”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

7. “As a patient, if a provider comes in with an unkempt appearance, do you want that person to touch you?”
Richard Hader, RN, PhD, FAAN, CHE, CNA, CPHQ, Conference Chairperson, Editor-In-Chief, Nursing Management Journal, Senior Vice President and Chief Nurse Executive, Meridian Health

8. “People can change when they are fighting for a cause bigger than themselves.”
John O’Leary, President, Rising Above

9. “When you know your ‘why’ you can endure any ‘how.’”
Victor Franco, Holocaust Survivor (shared by John O’Leary, President, Rising Above)

10. “One person always makes a difference.”
John O’Leary, President, Rising Above

Please keep in mind that I was not able to attend every session as the breakout sessions occurred concurrently. I'm sure I am missing many great quotes on this list! All of the sessions that I did attend were informative, but even more impressive to me, was how invigorating they were. From the enthusiasm in the audience and some of my conversations in the exhibit hall, I know I was not the only one feeling this way. If you are a nurse leader, consider attending Nursing Management Congress 2013 next year!

I just spent a wonderful long weekend in Nashville, Tennessee at Nursing Management Congress 2012. What a great city, great venue (Gaylord Opryland Resort and Convention Center), and great event! I learned a lot, connected with lots of nurse managers and executives, and enjoyed my surroundings. I have lots to share with you over my next few blog posts, but I’m especially excited to share the following idea which was presented by one of the attendees and then shared by Sharon Cox, BSN, MSN during the opening session, titled “Nurse Managers: Adding Value in a Time of Volatility.”

During one of the preconference workshops, a discussion about staff recognition had begun, when one attendee (I wish I knew her name to give credit where credit is due) shared a means of recognizing staff members that has had positive results. Rather than recognizing a staff member with a pat on the back or a letter of recognition to be filed, this manager asks the staff member (and I’m paraphrasing here), “I’d like to let someone important to you know what a valuable asset you are to us. To whom could I send your letter of recognition?”  She then wrote a personal note to to the person selected. 

This manager said she’s written to parents, spouses, mentors, and children of her staff members and has gotten positive feedback from all involved. She even met one staff member’s parents at a wedding and was thanked in person for the note she had written about their daughter.  

What a great idea!

Last week I had the privilege of speaking with Carole Eldridge, RN, DNP, CNE, NEA-BC, Director of Graduate Programs at Chamberlain College of Nursing. This fall, Chamberlain is launching a new Masters of Science in Nursing Healthcare Policy Track and I was particularly interested in learning more about Dr. Eldridge, as I’ve been following her on twitter for years (@Nerdnurse), and about this new MSN track.

I was more than impressed when I asked Dr. Eldridge to share her nursing background with me. In a nutshell, after about 15 years in acute care (including critical care, post-surgical care, hemodialysis, and transplant), Dr. Eldridge and her husband moved to Africa for about a year to run a health clinic. When she returned to the U.S., she started a Home Health and Hospice Agency which grew into about 50 agencies in 4 states! After selling this business, Dr. Eldridge became interested in education and saw a need for training nurse aides. She started her own publishing company which developed training packets. After selling this company, Dr. Eldridge returned to school herself for her MSN in Leadership and Healthcare Business, and later her DNP. She taught for about 3 years, and since then has held various titles including Director of a Master’s program, Dean, and Campus President. Wow!

In her current role, Dr. Eldridge oversees all of the graduate programs at Chamberlain College of Nursing. As previously stated, this fall, a new Healthcare Policy track is available for MSN students. The development of this track is timely in the wake of the report from the Institute of Medicine – The Future of Nursing: Leading Change, Advancing Health – and as we approach a Presidential election here in the United States. An MSN in Healthcare Policy will prepare nurses to be active in bill and policy writing, foundations, education and training, academia and research, disease investigations, health services, and other positions where one can “Impart the voice of nursing to direct the path of healthcare policies that benefit patients, the community, our nation and the world.”

This particular program involves 6 core courses (foundational concepts, theory, informatics, leadership, research, and basic healthcare policy) and 6 specialty courses (healthcare systems, economics, global health, nurse leadership and healthcare policy, healthcare policy practicum, and a capstone project).  When asked for more details about the capstone project, Dr. Eldridge gave me several examples that students from similar programs have done, such as global health projects, legislative proposals, and oral testimony collaboration. The coursework is flexible, can be completed in 2 years, and is completely online.

My favorite part of our conversation had to be discussing the upcoming election. Dr. Eldridge reminds us that as nurses, we have a responsibility to be politically engaged in order to best advocate for our patients. In particular, we need to be alert to the following:

• Economics – how will healthcare be funded? 
• Affordable Care Act
• The aging population, including funding their care & medical devices
• “Equitable access”
• Epidemiology
• Vaccines
• Global Healthcare 

Remember, Florence Nightingale was our first political activist. As nurses, let’s remain educated about the issues and share our voice. We are more than 3 million strong – it’s important that we are heard!

Resources:

The Future of Nursing: Leading Change, Advancing Health 

Keeping Health Care Reform Healthy, Patients Informed (American Nurses Association) 

ANA’s Policy and Advocacy page 

ANA's Nurses Strategic Action Team (N-STAT)

Changes in laboratory values often give us clues to what is happening with our patients. I came across the following resource this morning and thought it was worth sharing. Here’s a handy table to help you identify diabetic ketoacidosis (DKA).

The following equation can be used to calculate an anion gap:

Anion gap = Na⁺(mEq/L) – [Cl^-(mEq/L) + HCO₃^-(mEq/L)] 

You have an important role when caring for a patient with DKA.  Thorough physical assessments, careful monitoring of laboratory values, and critical thinking are essential to avoid complications of this complex disorder. Have you cared for a patient with DKA? What are the common presenting signs and symptoms?

Reference
Donahey, E., Folse, S., Weant, K. (2012). Management of Diabetic Ketoacidosis. Advanced Emergency Nursing Journal, 34(3).

More than half of all premature deaths among men are preventable.

We’ll let that sink in for a moment. Pretty shocking, right? The topic of men’s health finds itself front and center during Men’s Health Month every June, but the conversation quickly fades in the months thereafter.

A new infographic from Nursing@Georgetown shines a spotlight on the current state of men’s health in the U.S., aimed at increasing awareness of preventable health problems and encouraging early detection and treatment of disease among men and boys. A few more statistics:

• 60% of men aged 50 or older were not screened for colon cancer in the past year.
• 7 million American men haven’t seen a doctor in more than 10 years.
• 67% of men wouldn’t go to the doctor when experiencing chest pain or shortness of breath — two early warning signs of a heart attack. 

But it doesn’t have to be all doom and gloom. By raising awareness, advancing health education and recognizing culturally influenced behaviors, each of us can help improve men’s health. Check out the infographic below for tips on when and how often men should be tested for certain health issues.

Via Nurse Practitioner Programs and Nursing License Map

This post is written by Erica Moss, who is the community manager for the online masters in nursing program at Georgetown University.

It was my sophomore year of college and we were heading into the hospital for the first time. We had been learning about communication and practicing with one another and now it was time to meet a REAL LIVE patient and use our skills. I was so nervous!

I realize now what this first encounter meant to me. I wanted my first official interaction with a patient to be a positive experience. I had already had some doubts about nursing as a career choice (you can read a little about that in Is Nursing Really For Me?) and thought that this experience would give me some insight if this path was indeed the right one for me.

Another thing that I realize now, was that I wouldn’t be just talking as a friend, daughter, sister, or student – roles that I was familiar with. This was new territory and this patient would look to me for answers and support. My role as a nurse was beginning and this patient would trust me to say and do the right thing. 

Despite my nerves, I remember wondering (and being a little impatient about) why we weren’t doing real nursing things when we went to the hospital. I know now that communicating with patients is real nursing. Making that human connection is a big part of what makes us different from other disciplines in health care. Think about how you communicate with patients, their family members and caregivers, and other healthcare providers. Think about how others communicate with you? Any differences?

I like to think that since becoming a nurse, I’ve become a better communicator. I try to consistently think before speaking. I work hard to really listen to others rather than thinking about what I’ll say next when someone else is talking to me. When a difficult conversation is taking place, I think back to the communication strategies that I learned during those first years of nursing school. I also try to pay attention to my own nonverbal cues and those of others.

Have your communication skills and strategies changes since becoming a nurse? How so?