What is herd immunity?

Influenza season is in full swing and the headlines are troubling. For example, CDC Confirms Widespread and Intense Flu Season All Across the US, CDC official on why the flu is near-epidemic, peaking early this year, and Severe flu brings medicine shortages, packed ERs and a rising death toll in California, are a just a few headlines causing distress for many. According to the Centers for Disease Control and Prevention, the most important method to prevent the flu is getting the flu vaccine every year. Keep in mind, that recommendation is not just made for your own protection.

herd-immunity.pngHerd immunity, or community immunity, makes it less easy for communicable diseases to spread, especially to those for whom vaccination is contraindicated. It’s an indirect way to protect individuals through vaccination of the public. Herd immunity protects everyone, but it is especially important for those who can’t get vaccinated – for example, those with life-threatening allergies to any part of the influenza vaccine.

An example of a disruption in herd immunity occurred in the not-so-distant past. If you recall, back in 2015, a measles outbreak began in California when an unvaccinated child was hospitalized with rash. The child’s travel history included a recent visit to a Disney theme park, and within two months, about 125 additional cases were connected with visits to Disneyland (Gould, 2017).

So, what’s the problem? Of late, vaccine safety is being questioned by many and the controversy is getting more attention than the diseases they are intended to prevent. Also, many of us weren’t alive when certain communicable diseases – those for which vaccinations are currently available and recommended – even existed. Most of us haven’t been affected by the crippling effects of polio or the devastation from diphtheria.

While influenza may not seem like a scary illness to some, it can be devastating for others. According to the Centers for Disease Control and Prevention, 6,486 laboratory-confirmed influenza-associated hospitalizations have been reported since October 1, 2017, and 7% (the epidemic threshold) of deaths for the year (up to and including the week ending December 23, 2017) were attributable to pneumonia and influenza. Twenty influenza-related pediatric deaths have been reported during the 2017-2018 influenza season thus far (Centers for Disease Control and Prevention, 2018).

When it comes to vaccination, remember that by protecting yourself, you are protecting so many others. As nurses, we are in a key position to educate our patients and the public. Use these tools for Staying Healthy This Flu Season and be sure to SHARE the Flu Vaccine Recommendation.
Centers for Disease Control and Prevention. (2018, January 12). Influenza (Flu). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/flu/index.htm

Gould, K. (2017). Vaccine Safety: Evidence-Based Research Must Prevail. Dimensions of Critical Care Nursing, 145-147.

U.S. Department of Health & Human Services. (2017, December). Community Immunity. Retrieved from Vaccines.gov: https://www.vaccines.gov/basics/work/protection/index.html


Posted: 1/18/2018 9:13:56 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions

Nurses and the Business of Caring: An interview with John Bluford [Podcast]

“Nurses work hard and do hard work.”

John-W-Bluford.jpgI recently had the privilege of speaking with John W. Bluford, lll Founder and President of the Bluford Healthcare Leadership Institute and President Emeritus of Truman Medical Centers. Mr. Bluford and I discussed the important work of the Nurses on Boards Coalition and how nurses can be leaders in health care.

Listen in on our conversation and hear specific examples from Mr. Bluford of how he has seen the voice of nursing impact change. Mr. Bluford offers some great advice regarding the need for nurses to understand the financial aspects of health care, since we already know our profession as the “business of caring.” 

Thank you, Mr. Bluford, for joining me in this conversation and all your important work!

Take some time to listen to our full conversation here.


John W. Bluford, III, MBA, FACHE has a distinguished career in hospital and health system administration. Mr. Bluford is President of the Bluford Healthcare Leadership Institute and former President and CEO of Truman Medical Centers. He is also former Chairman of the American Hospital Association, the National Association of Public Hospitals, and the Missouri Hospital Association. He currently serves on the Board of the National Center for Healthcare Leadership. His extensive career began with his role as a Centers for Disease Control and Prevention (CDC)-trained Epidemiologist, later leading Pilot City Health Center in Minneapolis to become the first JCAH-accredited community health center in the county, and then becoming CEO of Hennepin County Medical Center. Mr. Bluford has received numerous awards and achievements and has presented nationally and internationally on topics related to healthcare leadership and change management. His full biography can be read here


Posted: 1/15/2018 1:43:55 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Leadership

Should You Take Laughing More Seriously? 5 Facts To Keep In Mind

Perhaps you should’ve made a New Year’s Resolution to make more time to laugh, in all seriousness.  It comes as no surprise to learn that laughing can positively impact your mood and quality of life. Though hesitations arise from those in the medical field as to whether laughter should be directly credited for making people feel better, here are five things we surely know about laughter:

1. Laughter emulates exercise (to an extent). When we laugh, a domino effect unfolds. We stretch our facial and bodily muscles, stimulate our heart and lungs, and enhance oxygen intake similar to the effects of mild exercise [Bennett & Lengacher, 2006].

2. Laughter cultivates open communication. Several researchers have discoursed laughing as a defense mechanism and coping strategy due to its therapeutic nature and euphoric effects. While evidence supporting laughter improving one’s health remains insufficient or weak in scale, using humor has been attributed to moderating a patient’s pain and credited for creating lines of communication between medical professionals and their patients [Bennett, 2003]. Humor has been shown to diminish the formal exchange of communication and allow patients to feel more comfortable in discussing difficult issues [Bennett, 2003].

3. Laughter releases endorphins. Seeking a runner’s high without running? Laughter can provide a similar effect. Laughing with others has been directly linked to triggering the release of endorphins in the brain, leading to a euphoric-feeling [Arponen et al., 2017]. Studies also show that the more opioid receptors in an individual’s brain, the more potent the euphoric effect [Arponen et al., 2017].

4. Laughter enables long-term relationships. Do you consider laughter as a factor in establishing relationships? Research has shown that endorphin release due to social-induced laughter may contribute to our ability in forming and maintaining social bonds [University of Turku, 2017]. Laughter is highly contagious causing the endorphin response to spread throughout large groups [University of Turku, 2017].

5. Laughter can help boost immune function. Stress can unquestionably take a significant toll on a person’s quality of life. However, research has shown in some instances that mirthful laughter can not only be a way to decrease stress, but also be a way to boost the immune system [Bennett, McCann, Rosenberg & Zeller, 2003]. Perhaps the key to minimizing stress in your daily life is adding a dose of laughter to your routine.

Though we might not be able to say with scientific certainty that laughing directly affects your health, there is certainly no downside to a genuine, hearty laugh. It may not have abilities to cure ailing patients, but it has enough power to uplift someone’s day, attitude, and outlook.


Arponen, E., Dunbar, R., Hari, R., Hirvonen, J., Jääskeläinen, I., Karjalainen, T., Manninen, S., Nummenmaa, L., Sams, M., Tuominen, L. (2017, May 23). Social laughter triggers endogenous opioid release in humans. The Journal of Neuroscience. Retrieved from http://www.jneurosci.org/content/jneuro/early/2017/05/23/JNEUROSCI.0688-16.2017.full.pdf
Bennett, H. (2003, December). Humor in Medicine. Southern Medical Journal, 96 (12), 1257-1260. Retrieved from https://www.utmb.edu/gem/pdfs/humor_in_medicine.pdf
Bennett, M., McCann, J., Rosenberg, L., Zeller, J. (2003, April). The effect of mirthful laughter on stress and natural killer cell activity. Alternative therapies in health and medicine 9(2), 38-45. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/12652882
Bennett, M., Lengacher, C. (2006, January). Humor and laughter may influence health. Evidence-Based Complementary and Alternative Medicine, 3(1), 61-63. Retrieved from https://www.hindawi.com/journals/ecam/2006/383090/abs/
University of Turku. (2017, June 1). Social laughter releases endorphins in the brain. ScienceDaily. Retrieved December 19, www.sciencedaily.com/releases/2017/06/170601124121.htm

More Reading and Resources
LAUGHTER: The Best Medicine or Best Measure?
Start a "Laugh Club"
Humor Theories and the Physiological Benefits of Laughter




Posted: 1/5/2018 2:32:26 PM by Lindsey Lynch | with 0 comments

Categories: Blog

Celebrate Nursing in 2018

Happy New Year! Here’s the list of nursing recognition days, weeks, and months for 2018. Have something to add? Please leave a comment or email clinicaleditor@nursingcenter.com.  

Thank you!
2018-calendar.pngJanuary February March April May June September October November Let us know how you will celebrate or what plans you have to recognize your colleagues. Leave a comment or email us at clinicaleditor@nursingcenter.com.

Have a great 2018!  


Posted: 12/30/2017 9:03:40 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Inspiration

Inspired Nurses Calendar 2017: Giving Care to "Throwaways"

Lippincott NursingCenter.com is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. Here is December’s nurse story, Giving Care to “Throwaways.”
Giving Care to “Throwaways”
Carol Hodge, Retired
December-2017.jpgWhile working as the Director of Nursing in a Medicaid only nursing home, I had the pleasure of taking care of the many "throw-away" people in the county. These were the homeless, prostitutes, and drug abusers, as well as others who needed long-term care but did not have the resources to pay for it. When a patient, an elderly former prostitute, was admitted to the hospital, I visited her, finding her in a room alone and unresponsive. I sat and talked with her for a while even though I did not get any response or acknowledgement. We weren’t particularly close, so I wasn’t expecting much from our visit. But as I left the room, I heard a weak cry. I turned around, and she was looking straight at me with a tear sliding down her face. It was a moment that confirmed I was on the path that had been chosen for me. I will never forget that day. And now that I am no longer able to work in my chosen career, I know it was truly the hardest job I have ever loved. God Bless our nurses!


Posted: 12/27/2017 7:48:47 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration

Influence with Storytelling

nobc-logo-small.pngThis blog is the third in the series, Nurses on Boards: Building a Healthier America. Wolters Kluwer is a Founding Strategic Partner of the Nurses on Boards Coalition
In September, we attended the American Hospital Association (AHA) Advocacy Day in Washington D. C.. Prior to our attendance on the Hill, we attended a board meeting that consisted of physician and nurse executives. The agenda and conversations concerned practice issues. Participants were expected to be informed to provide evidence around the topics being discussed. We observed one strategy that constantly refocused the group and highlighted ideas –  storytelling. Storytelling is an effective way to manage sensitive issues and influence people’s emotions to redirect the topic and to influence others. 

What are the benefits of telling a brief story on a board?

  1. Storytelling provides context and meaning to the situation or topic.
  2. Storytelling brings out creativity.
  3. Storytelling rekindles the passion for the topic.
  4. Storytelling generates empathy for the agenda item.

How do you create a compelling or powerful story?

  1. Keep it short (about three minutes).
  2. Start with the context.
  3. Use metaphors.
  4. Include an element of surprise.
  5. Appeal to the emotion.
  6. Make it tangible and concrete.
  7. Use a style appropriate for business.
  8. Be culturally aware.
  9. Acknowledge the composition of the board to ensure sensitivity and appropriateness of the story.
According to Mary Ann Fuchs DNP, RN, NEA-BC, FAAN, Vice President of Patient Care, System Chief Nurse Executive, Associate Dean of Clinical Affairs at Duke University, and AONE Board member, “Storytelling is a very effective strategy that helps to build relationships, demonstrate effective communication and engage others in issues important in health care and especially to the health of our country.”.

Call to Action!
Inform and engage others through storytelling to bring relevant perspective and connectedness to board topics, and to bring about good outcomes.
Nurses on Boards Coalition (2017). Board Core Competencies. http://www.nursesonboardscoalition.org

Schawbel, D. (2012, August 13). How to Use Storytelling as a Leadership Tool. Retrieved from Forbes: https://www.forbes.com/sites/danschawbel/2012/08/13/how-to-use-storytelling-as-a-leadership-tool/2/#429048d8789e
M. Lindell Joseph, PhD, RN, AONE Board of Directors and The University of Iowa College of Nursing & Laurie Benson, BSN, Executive Director, Nurses on Boards Coalition

For more information or comments contact us: maria-joseph@uiowa.edu and/or laurie@nursesonboardscoalition.org



Posted: 12/15/2017 6:02:55 AM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Leadership

SHARE the Flu Vaccine Recommendation

The Centers for Disease Control and Prevention offers the SHARE method to approach the conversation on flu vaccination. This is a great way to help patients make informed decisions.

Centers for Disease Control and Prevention. (2017, December 11). Make a Strong Flu Vaccine Recommendation. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/flu//professionals/vaccination/flu-vaccine-recommendation.htm


Posted: 12/13/2017 12:46:46 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Diseases & Conditions

Staying Healthy This Flu Season

Here we are in mid-December and influenza season is in full swing. In fact, while flu activity was low during October 2017, activity has been increasing since the start of November, with more cases of influenza A viruses, specifically influenza A(H3N2). In the United States, flu season typically ranges from late fall through early spring and while many who get the flu recover without sequelae, serious illness and death can occur, especially in high risk patients, including:
  • older adults
  • young children
  • pregnant women
  • those with certain chronic medical conditions, such as:
    • chronic lung diseases, such as asthma and chronic obstructive pulmonary disease (COPD)
    • diabetes
    • heart disease
    • neurologic conditions.
get-your-flu-shot.pngSo, how can you stay healthy and keep those around you healthy this flu season?
The best way to avoid getting and/or spreading the flu is to get vaccinated! The CDC recommends that everyone six months and older get an injectable flu vaccine this season. And here’s why…
  1. While there are certain high-risk groups, anyone can get very sick from the flu, including otherwise healthy people.
  2. As a health care provider, you can get sick from coworkers or patients who have the flu.
  3. If you get the flu, but don’t feel sick, you can still spread the virus.
  4. By getting vaccinated and protecting yourself, you are also protecting your family and friends, and your patients. 
Educating Patients: Be ready to answer some of these frequently asked questions
How does flu spread?
Flu viruses spread through droplets when people with the flu cough, sneeze, or talk. The droplets can reach the mouths or noses, or be inhaled into the lungs of others, up to six feet away. A person can also get the flu by touching a surface or object that has flu virus on it and then touching his or her own nose or mouth.

What are the symptoms of the flu?
The flu usually comes on suddenly with a wide range of symptoms:
  • Fever and chills, although not everyone with flu develops a fever
  • Cough and sore throat
  • Runny or stuffy nose
  • Muscle or body aches, headaches, fatigue
  • Vomiting and diarrhea (more common in children).
When is a person with flu contagious?
Most healthy adults are contagious starting one day before symptoms appear and up to five to seven days after feeling sick. So, it is possible to spread the virus before someone feels ill and even if no symptoms are present.

What if someone has an egg allergy?
Often, a question arises regarding ability to get the flu vaccine if a person has an egg allergy. According to the CDC, “People with egg allergies can receive any licensed, recommended age-appropriate influenza vaccine and no longer have to be monitored for 30 minutes after receiving the vaccine. People who have severe egg allergies should be vaccinated in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions.”

Our Role as Health Care Providers
As health care providers, it is our responsibility to keep our knowledge up-to-date and educate patients, so they can make informed decisions about vaccination. How do you stay informed? And how do you approach the conversation on vaccination
Centers for Disease Control and Prevention. (2017, December 11). Influenza (Flu). Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/flu/index.htm

Flannery, B., Reynolds, S., Blanton, L., SAntibanez, T., O'Halloran, A., Lu, P.-J., . . . Fry, A. (2017). Influenza Vaccine Effectiveness Against Pediatric Deaths: 2010–2014. Pediatrics, 1-9.

HealthDay. (2017, December 8). Influenza Picking Up in U.S., Predominantly A(H3N2). Retrieved from Lippincott NursingCenter.com: http://www.nursingcenter.com/healthdayarticle?Article_id=729211


Posted: 12/13/2017 12:29:27 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments


Why Handwashing Makes Us Healthier – and Happier too!

handwashing.jpgAs nurses, we all know the importance of handwashing. We understand that germs can spread disease, and that hand hygiene can help defend against it. But still, 78 percent of all healthcare professionals tested in a recent study presented at a conference of the Association for Professionals in Infection Control and Epidemiology (APIC) didn’t wash up to the standards of the World Health Organization’s guidelines for reducing the risk of spreading infection to patients. So, why so many slackers?

Perhaps sinks or hand sanitizer dispensers aren’t always in the most convenient locations in hospitals. And if they are conveniently located, there might not always be soap or sanitizing gel in those dispensers. Or maybe it’s just that we’re rushing from one emergency or critical situation to the next, and taking time to stop and wash our hands consistently doesn’t get prioritized. Or simply because, given those same circumstances, we merely forget.

It seems so obvious, yet the importance of handwashing wasn’t always known. In 1847, a physician working in a Viennese maternity hospital with two separate clinics, one run by physicians and one run by midwives, discovered that babies delivered by physicians had nearly triple the infant mortality as babies delivered by midwives. The reason was that the doctors coming into the hospital to deliver babies had just finished up duties in the autopsy ward, thereby infecting mother and child with numerous germs acquired from their deceased patients. Once doctors were instructed to wash their hands with an antiseptic solution before delivering babies, the mortality rate plummeted.

Getting Nurses to Wash Their Hands
Solutions to promote more frequent handwashing can run the gamut for many hospitals. Implementing one of several newfangled, automated hand hygiene monitoring devices such as video-monitored direct observation systems, electronic dispenser counters, and automated hand hygiene monitoring networks can work for some. And while there is empirical proof that these types of monitoring systems work, with the budgetary constraints many hospitals face, adoption can be cost-prohibitive and therefore not an option.

While there is no universal solution, many hospitals have taken steps to further encourage handwashing by investing in alcohol-based hand rub solutions (significantly more efficient in reducing hand contamination than antiseptic soaps), both by installing wall-mounted dispensers and by providing individual containers for each healthcare worker. Changing posted messages around the hospital from, “Wash Your Hands to Protect Yourself” to “Wash Your Hands to Protect Your Patients" can be helpful, along with peer pressure and personal incentives like drawings for free monthly manicures (yes, we all know the toll that constant handwashing can have on our skin and nails).
New incentives
It’s apparent that handwashing keeps us healthier, but what isn’t noticeable is the additional, subtle psychological effect handwashing has on us all as well. The Dalai Lama tells us, “as human beings we all want to be happy and free from misery… and we have learned that the key to happiness is inner peace.” So, what if you could achieve inner peace and happiness through the simplest of daily activities – like handwashing?

A study from the University of Cologne in Germany examined how the act of washing one’s hands can positively affect us after a bad experience or stressful event while also making us feel more optimistic after recent failure. Earlier research from the University of Michigan also found that handwashing can be physically and emotionally cleansing, suggesting that this simple act can make us feel more comfortable about decisions we’ve made or actions we’ve taken.

Personally, when I finish a workout at the gym, the first thing I do is wash my hands. Somehow, this simple ritual of washing my hands afterwards provides a sense of finality and accomplishment. The workout ritual, however, is far more complex (at least for me).

The act of seeking cleanliness has two distinct meanings to us humans. The first is the obvious physical hygiene benefits. The second is more psychological in nature. Psychological studies have shown that the simple act of washing one’s hands can help you feel more optimistic, less doubtful, and even a bit morally superior – as “clean” people have been found to be more judgmental towards other people’s bad behavior. Think Lady Macbeth.

So, maybe now as we endeavor to wash our hands for the hundredth time today, recalling the Nightingale Pledge and our duty to protect our patients’ safety, we can also reflect on our own goals for self-improvement, including eating healthier, trying to exercise more, and being kinder to others and to our planet, knowing that this simple act of handwashing might be a more logical path to happiness and inner peace. Or, at least we can tell ourselves that. 
Brun-Buisson, C., Girou, E., Legrand, P., Loyeau, S., Oppein, F., (2002, August 17). Efficacy of
handrubbing with alcohol based solution versus standard handwashing with antiseptic soap: randomised clinical trial. Retrieved from NCBI, US National Library of Medicine National Institutes of Health  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC117885/
Johnson, N., Niles, M. (2016, June 2). Hawthorne Effect in Hand Hygiene Compliance Rates. American
Journal of Infection Control, Volume 44(Issue 6), S28-S29. Retrieved from AJIS
Kaspar, K. (2012, April 10). Washing One’s Hands After Failure Enhances Optimism but Hampers Future
Performance. Social Psychological and Personality Science, Volume 4(Issue 1), 69-73.
Retrieved from http://journals.sagepub.com/doi/full/10.1177/1948550612443267#articleCitationDownloadContainer
Psyblog (n.d.). 6 Purely Psychological Effects of Washing Your Hands. Retrieved from
Deborah Baldwin
Wolters Kluwer Health


Posted: 12/3/2017 10:52:56 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety

Inspired Nurses Calendar 2017: It’s My Pleasure

Lippincott NursingCenter.com is partnering with Lippincott Solutions to bring you an inspired nurse’s story every month. Here is November’s nurse story, “It’s My Pleasure.”
it-s-my-pleasure-November-2017.jpgIt’s My Pleasure
Katie Fadell-Mann, RN
Ebenezer Lake City Care Center
My Dad was a double lung transplant recipient in 2006. What inspired me to be a nurse was seeing the difference his nurse made in his care. His nurse, Sara literally did not leave his side for the first two days after his surgery. When I asked where I could send a gift to for her to thank her for all she had done, she said, "There's no need, it's my pleasure to take care of your Dad."
I started going to school for nursing a few months later.


Posted: 11/30/2017 9:52:16 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration

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