Nurse leaders + Las Vegas + a Presidential election = a busy conference week! Whew…it certainly was an eventful week as nurse leaders from around the world got together in Las Vegas for Nursing Management Congress 2016!
For two days, preconference workshops were in action. The New Manager Intensive
provided fundamentals for success for those new to the role, including calculations – staffing, supplies, and equipment – to effectively and safely run a unit. In addition, new managers brushed up on relationship and communication skills, as well as handling the pressures of leadership through a period of health care reform. The Experienced Nurse Leader Intensive
covered topics related to the business of health care, such as aligning with organizational goals, team development, and improving performance. Other sessions during these two days included a Certification Prep Course, Creating a World-Class Culture,
and Improving the Patient Experience.
An opening session to remember
This was my first real exposure to Zubin Damania, MD, aka ZDoggMD
, and I am now a big fan! His humor, talent, and passion for improving the patient experience were inspiring. He encouraged us to “reshuffle our deck” and embrace a new era of health care – Health 3.0 – re-personalized medicine with a focus on building relationships. Here’s a brief video clip from his keynote address:
You can find ZDoggMD on YouTube, Facebook
, and twitter
. His “membership-based primary care and wellness ecosystem”, Turntable Health
, is truly breaking down barriers.
So much learning
While I’ve never held a role in nursing management, the knowledge and advice from the experts at NMC are beneficial to all nurses. Here are some of the pearls and tips I learned:
“To be a successful leader, you must be flexible and move quickly in decision making.’”
Jeffrey Doucette, DNP, RN, FACHE, CENP, LNHA
“Until you change people’s minds about their work habits, they’re not going to change their work habits.”
Changing the Culture of Fatigue: A Nurse AND Patient Safety Problem
Mary Lawson Carney, DNP, RN-BC, CCRN, CNE
“Understanding quality across the continuum will lead to improved outcomes across the continuum.”
Reducing Readmissions Across the Care Continuum
Leonard L. Parisi, RN, MA, CPHG, FNAHQ
“Nurses should prepare for the future by keeping their eyes on how nursing care helps patients become and stay healthy and allows the health care system to work smoothly.”
Nursing Workforce Predictions: What’s Really Happening?
Sean Clarke, PhD, RN, FAAN
“It’s the simple solutions that get us where we need to be.”
Getting the Most from People Around You
Andrea Mazzoccoli, MSN, MBA, PhD, FAAN
“The curse of knowledge…We forget what it was like to not know what we know now.”
Talkin’ Bout My Generation: Generations in the Workplace should be Your GREATEST Strength, Not Your Biggest Headache!
As next year’s planning gets underway, we invite you to look at our 2016 NMC photo album
, see social media highlights
, and submit an abstract!
See you next year!
In honor of National Case Management Week,
which takes place October 9th
, we are featuring a stellar Nurse On the Move
, Ann Marie Marks RN, BSN, CCM. Marks has over 36 years of nursing experience. She started in the critical care field and eventually segued into case management at a time when this field was being developed.
Marks helped pave the way for the role of the case manager, including creating content for the first Certified Case Manager (CCM) exam in 1990. She’s helped define what case management entails and continues to serve as an advocate for patients by coordinating care across a large, interdisciplinary health care system.
Today, she serves as an RN case manager consultant and speaker; she presents at the Thomas Jefferson College of Health Population Health Academy, and was the #1 ranked speaker at NAHQ’s 2016 National Quality Summit. She recently served as the Director of Care Coordination at the Delaware Valley Accountable Care Organization where she continues to consult on post-acute services. She was previously Director of Commercial Case Management for Humana, Inc., in Louisville, Ky., and as the National Director of Integrated Care Management for Aetna’s Medicaid division. In 1999, Marks was appointed by the governor of Kentucky to serve as Deputy Secretary of Health, with oversight of Commonwealth’s Primary Care Case Management Program (KenPAC), and programs within the Department of Medicaid Services, CCSHCN, and Office of Aging.
I was fortunate enough to sit down with Marks in our Philadelphia office to discuss what case management is, what it was, and how it’s evolved, including why it’s so important in today’s world of health care.
Read on to discover the vital role that case managers play and for more case management news:
- Subscribe to Professional Case Management , the Official journal of the Case Management Society of America (CMSA). Marks is a CMSA member and a long-time subscriber to the journal and says, “Over the years, this journal has been the source for evidenced-based studies and peer-reviewed literature for case management. It’s the most often cited and is often a source of reading materials for classes on case management. For me, this journal is one of my go-to spots when I’m attesting to the value of case management or saying a program hasn’t proved valuable.”
CMSA Core Curriculum for Case Management
- Check out these books on case management from Wolters Kluwer.
, COLLABORATE® for Professional Case Management
, Case Management
Q: You’ve been a registered nurse for nearly 40 years and specialized in critical care. What made you decide to become a nurse?
When I was 15 my father was in a horrible auto accident. He was taken to a larger city hospital about 70 miles from our small town. His jaw was wired and he had a chest tube, a feeding tube, and many injuries. He could not be left alone, and my mother needed to return to her position as a teacher. Somehow I was nominated to “stay” with him. I slept on a cot in his room and within a day the nurses and doctors started teaching me to care for him. I learned so well that they allowed me to take him home three weeks earlier than anticipated! Three years later, I was awarded a college scholarship to a college that had a Bachelor's in Nursing and knew I wanted that. But having the experience of living in a hospital for eight weeks and caring for a complex patient, my dad, certainly influenced my choice to be a nurse. It was the confidence those nurses instilled in a teenage girl.
Q: How did you enter into the case management field?
It seemed like years before what I did was called case management. When I entered in the early 1980’s, we were referred to as rehabilitation nurses. It was my encounter of a “rehab nurse” when I was working in ICU that inspired me to explore the field. A nurse arrived in our hospital to discuss a patient who had been in a catastrophic industrial accident. She was very business-like and wore a suit! I found it intriguing that she was a nurse, not providing direct medical care (treatments, medications, etc.,) but was coordinating the care. I came to learn that she was working for a company that provided services to large self-insured employers and insurance carriers. Eventually, I was able to get my foot in the door there. The president, Mary Gambosh, hired me part-time, and challenged me with expanding her business in Kentucky.
But more importantly she trained me about the principles of good case management, and shared everything she knew. Mary assigned me to a large account in the coal fields of eastern Kentucky. That was the beginning of a great career in case management and the expansion of nursing for me and a mentorship under one of the legends in this field, Mary Gambosh, RN.
Q: Can you define what a case manager is and speak to why the name, “case manager,” has changed over time from patient navigators to care coordinators, etc.?
I think the word “case” was always there because the insurance companies would “refer you a case;” I first started to hear the term “case manager” in various states’ Departments of Insurance. As long as I have known about case management, I have associated it with advocacy, care coordination, and resource management. Even when I entered the field as a ‘rehab nurse,’ I knew that the profession of case manager was evolving, and there was a need to distinguish the education and experience of the professional who did this work. In the late 1980’s, talk started to ensue among the rehabilitation nurses, the certifying agencies, and other professions with great debate about who would qualify to sit for an exam to be a ‘case manager.’ Simultaneously to this, we started to see case manager roles expand inside the hospitals, among payers, and self-insured employers themselves. Components of utilization management, hospital bill auditing, and care coordination became requests of those in this field. I have seen the new titles of care coordinators and navigators, and I am pleased when I see the job descriptions that often state, “CCM preferred.” The certification attests that you meet a certain competency and experience level to sit for the exam. We do help patients and families navigate complex systems. We do coordinate care. Case management is about making things happen!
Q: How are case managers patient advocates? What is vital about this role in the health care system?
In addition to their clinical experience, the case managers have training in the benefit systems and reimbursement systems that pay for the services. Helping patients access their benefits and manage those benefits effectively is often critical to the outcome. Advocating for quality care, access to care, and even evidence-based care, is part of the advocacy. Sometimes it’s as simple as getting people involved in the patient’s care to listen—to take a pause and think about what the patient is trying to say or wants. In a world that is stressing value-based care and quality performance measures, the case manager role becomes more vital. We are vital to driving quality health care, helping manage benefits at the right place, right time, etc., and ultimately to the cost management of large populations.
Q: Can you describe an important case you’ve worked on?
One that always stands out in my mind was a victim of a mass shooting known as the Standard Gravure Shooting in Louisville, Ky., in 1989. It’s important to me because gun violence and violence in the work place has become a weekly headline. But this event drew national publicity. Within hours of the shooting, I was being called to be the case manager for some of the victims. One was a gentleman who had worked in the plant over 40 years. This wasn’t just a patient with serious physical wounds, but one with emotional trauma. I remained a part of his case until the day he returned to work, which was his personal goal. I followed him the first year in his new job. But this patient, this case, changed my awareness of the importance of integrating physical and behavioral health into care planning.
Q: What is the biggest challenge related to case management?
Establishing trust with patients. Today we talk about “patient experience” and “patient engagement” and this applies to case managers as well. Many patients or families initially see you as the person who is coming to take something away. It takes skill to help a patient with complex issues to understand that you are there to assess the situation and can actually help. There are also challenges in health reform itself and the demand for quality case managers.
Q: I understand you helped write t sample test questions to become a certified case manager in the 1980’s. How has this specialty evolved since then?
Back when case management started, it was very episodic. Up until the early 1990’s, you would take one case, then another, and we thought that receiving a case referral six months after a diagnosis or three months after an injury was “early.” It used to be based on the idea that something had to have already happened. Now, I’m looking out across the population with predictive analytics information on a subset of that people in a community and trying to identify where I could best place a case manager.
An additional change is the growing numbers of certified case managers. The recognition of case managers in the continuum of health care has been part of the evolution. They are valued as key members of the team, in whatever setting. Case managers have started to be identified as part of the preventive services, not just a referral after a catastrophic event.
Q: Why should nurses in other practice areas pay attention to National Case Management Week and what are some ways nurses can celebrate?
National Case Management Week, like other specialty recognition weeks, affords an opportunity to learn about nurses and other professionals who are part of an integrated care team. Gaining insight into the training, the various job roles, and what a case manager can “make happen” could help other nurses collaborate with this key person on the team. It might even help nurses who are interested in the specialty of case management find an open door.
Q: What do you see for the future of nurses and case managers?
I see that the role of nurses in general has really come back to that primary care model. We want to coordinate end-to-end care for the patient, and I think the future holds more case managers taking the lead coordinating for the patient across the entire continuum of care. I see unlimited possibilities, but I certainly see an increased demand not just for nurses, but for case managers. Technology will also continue to play a big role. The skill sets have changed and over the years I’ve hired 2,000 case managers in a variety of settings, and I can tell you that the skill sets to do this work require so much knowledge about the software for the documentation and for the reporting. Plus, many of our case managers are virtual, so the settings will continue to change. A person needs to survive in a virtual workforce.
Posted: 9/23/2016 9:47:00 AM
| with 0 comments
, Nurse On the Move
We’ve all experienced it over the years…the frustration of having some piece of equipment, computer program, patient care process, person, or policy get in the way of getting the job done. Sometimes it’s because the thing or situation that’s standing in our way is broken. Other times it’s because there’s no rule in the playbook that addresses exactly an unusual circumstance. The end result is often the creation of a work-around…
and nurses can be extremely creative!
Work-arounds circumvent established procedures, policies, and processes. In some cases, they truly may be needed to get an essential task accomplished because the current system has not yet caught up to the realities of clinical practice. The work-around may ultimately indeed be the right way, but just continuing to do it informally may be viewed as a much quicker and easier path to travel than the journey to making it a permanent solution. Depending on the nature of the issue and the organizational change process that’s needed, there may be tedious processes to follow, forms to fill out, a chain of command to invoke, a business case to make, committees to form, places to go, and people to see.
In other words, the real solution can appear a far-off, daunting task that requires considerable expenditure of time and energy and quite possibly a measure of stretching way beyond a personal comfort zone into organizational bureaucracy. There’s a very real chance that the proverbial “squeaky wheel” that brings the matter to light could wind up the owner of the issue and be expected to be part of the solution. However, if the work-around makes things look like everything is working just fine, there’s no obvious burning platform as the catalyst for necessary change. The problem may remain invisible to the larger system and go unsolved. If leadership is unaware, there’s no opportunity to submit requests for maintenance or budget for new equipment, system upgrades, or even necessary material or human resources.
Another category encompasses the work-arounds that may simplify the job or allow it to be accomplished faster, but bypass safety measures put into place to reduce risk. Ignoring established safety practices that are perceived as cumbersome is an example. Staff may become so good at these that the work-around escapes detection. These types of work-arounds can evolve to become the usual practice or even the cultural norm. They may be passed along to new staff members as tips or tricks to be more efficient to the point that staff stops seeing the strategy as a work-around at all. Direct observation might be the only way to spot this situation. Nurses who follow the rules can experience considerable moral distress when they discover that co-workers are using such work-arounds inappropriately. They are then placed into the very difficult position of either turning a blind eye (which has significant ethical and even professional regulatory implications), or acting as a whistle blower to management.
My advice is that if a work-around is felt to be necessary, there’s a problem with the current system that must be addressed. That includes those situations where the work-around is done to make the job easier or faster but bypasses safety measures. Perhaps the safety measures could be maintained and risks reduced if the system was re-designed in a way to make it easier to do the right thing while still meeting all of the standards and regulations. Our knee-jerk in healthcare often involves creating a new form to fill-out or coming up with a new tedious process that gives the illusion of a safety improvement, but instead just adds another barrier that people look for ways to overcome. We need to think broadly and be truly innovative. Strategies include researching current best practices, connecting with staff at other organizations to learn how they manage similar issues, and even investigating if there are applicable innovative solutions in industries outside of healthcare.
We do need to make processes associated with nursing practice and healthcare in general safer, easier, more efficient, and more effective. The appearance of a work-around is a red flag for an improvement opportunity. Rather than allow it to persist or remain obscure, bring the situation to light and be an advocate for necessary change. Keep in mind the old adage: if you always do what you’ve always done, you will always get what you’ve always got. When confronted with a work-around, take on the challenge and demonstrate individual leadership, advocacy, and the courage to engage in true problem resolution.
Happy Nurses Week!
Linda Laskowski-Jones, APRN, MS, ACNS-BC, CEN, FAWM, FAAN
Vice President: Emergency & Trauma Services
Christiana Care Health System – Wilmington, Delaware
Safety is something we think about constantly in our daily lives. We look both ways when we cross the street, we buckle our seatbelts when we get into the car, and we put on helmets when we participate in outdoor activities, such as biking, skateboarding and skiing. For many, safety is not an all-consuming concern at work. As health care providers, however, we are exposed to a multitude of dangers every day. According to the United States Department of Labor, Occupational Safety & Health Administration (OSHA), a hospital is one of the most hazardous places to work.1
Health care workers experience some of the highest rates of nonfatal illness and injury – surpassing both the construction and manufacturing industries.2
In 2011, U.S. hospitals recorded 253,700 work-related injuries and illnesses, a rate of 6.8 work-related injuries for every 100 full-time employees.1
At work, I regularly lift, turn and transfer patients with limited mobility, strength and balance. I often encounter confused and combative patients who pose a great risk to themselves and the clinical staff. The threat of a needle stick injury and the possible exposure to infectious diseases are two dangers that are perpetually at the forefront of my mind. In nursing school, we were taught basic ergonomic techniques to protect our backs. We were instructed on procedures to prevent unintended exposure to blood borne pathogens. But in the fast-paced world of health care, where patient loads are high, many of these safety strategies fall by the wayside. By nature, nurses often put their own health and safety at risk for the benefit of the patient.3
So, how safe do we really feel at work and what are hospital administrators doing to protect their employees?
In 1979, Congress passed the Occupational Safety and Health Act, which resulted in the creation of the OSHA. OSHA is the government body responsible for ensuring a safe and healthy working environment for employees by setting and enforcing standards and by providing training, outreach, education and assistance.3
When I began working in the intensive care unit many years ago, I remember having to complete my first annual competency checklist, which incorporated mandatory lectures developed by OSHA. Topics included blood borne pathogens, fire hazards, fall prevention and methicillin resistant staphylococcus aureus (MRSA). Today, those topics have expanded to include latex allergy, equipment hazards, workplace violence, and workplace stress.4
These topics are just a subset of the hospital-wide OSHA standards spanning every department from dietary to central supply to housekeeping.
One area of hospital workplace safety that has received great attention in the media in recent years is the use of Personal Protective Equipment (PPE). This issue was highlighted in the news when the first laboratory-confirmed case of Ebola was diagnosed in the U.S. in September 2014.5
Controversy surrounded this story, which began when a man, who arrived from Liberia initially without symptoms, walked into a Texas emergency room complaining of fever and other flu-like symptoms. After being discharged, he was readmitted several days later and diagnosed with the Ebola virus. Personal Protective Equipment was provided to the staff assigned to the infected patient. Despite these safeguards, however, two clinicians were exposed and ultimately contracted the deadly virus. Thankfully, both nurses survived, but fingers pointed to the hospital administrators, placing blame on their inability to properly educate and ensure the safety of their staff. Were they at fault or just inadequately prepared with minimal resources to deal with this seemingly rare occurrence?
Ebola is an extreme example that emphasized the importance of hospital workplace safety and one that forced hospital administrators across the country to evaluate current policies and procedures. All workers, regardless of the industry, have a right to a safe work environment. Have you noticed any areas of your hospital where improvements could be made to increase overall safety? Do you have recommendations or a success story to share? We would love to hear from you – please leave your comments below.
Occupational Safety & Health Administration (OSHA): Worker Safety in Hospitals
Occupational Safety & Health Administration (OSHA): Hospital eTools
Improving Patient and Worker Safety: Opportunities for Synergy, Collaboration and Innovation (Joint Commission)
Myrna B. Schnur, RN, MSN
1. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) Worker Safety in Hospitals: Caring for Our Caregivers. Retrieved from: https://www.osha.gov/dsg/hospitals/index.html
2. The Joint Commission: Improving Patient and Worker Safety. Retrieved from: http://www.jointcommission.org/assets/1/18/tjc-improvingpatientandworkersafety-monograph.pdf
3. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) About OSHA. Retrieved from: https://www.osha.gov/about.html
4. U.S. Department of Labor: Occupational Safety & Health Administration. (2016) Hospital eTools: Intensive Care Units. Https://www.osha.gov/SLTC/etools/hospital/icu/icu.html
5. Centers for Disease Control and Prevention (2016). Cases of Ebola Diagnosed in the United States. http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/united-states-imported-case.html
As health care professionals, there are few things more agonizing than listening to a grief stricken mother describe how her young daughter, bravely fighting cancer, died during a hospital stay as a result of delays and failed communication. Looking at the audience at the Patient Safety Seminar that day, you could see that all of us felt her pain. After all, we got into the medical field to help people, to heal the sick and care for the most vulnerable, but in this case, we failed. Sadly, I have heard versions of that mom’s story many times throughout the years. The specifics change, but the result is the same -- the loss of life or permanent injury as the result of a medical error.
We aren’t perfect, I tell myself, as I hear those excruciating stories. We are human beings and sometimes, despite our best efforts, we come up short. But inevitably, as I let their brave messages sink in, I use those heartbreaking stories to motivate me -- to dig deeper and try harder and to become a more determined advocate for improving patient safety.
The American Nurses Associations (ANA) theme for National Nurses Week this year is Culture of Safety – It Starts with you
. Since the landmark Institute of Medicine (IOM) report, To Err is Human: Building a Safer Health System
was released in 1999, creating a culture of safety has been a major focus in our profession. The notion that medical errors resulting in patient harm are largely preventable and a result of system failures provided the platform for health care culture reform.
The IOM report provided clear recommendations to address medical errors. The government, professional organizations, and health care organizations have all worked towards reducing preventable medical errors. There is a plethora of information on culture of safety, including webinars, how to guides, frameworks, guidelines, etc. While we have made progress, preventable harm occurs in hospitals every day.
So what is a culture of safety? A culture of safety is an environment in which patient care is safe and effective, and patients are free from preventable harm. The complexity of systems in which health care is provided makes this challenging, but not
So, how can every nurse take a leadership role in creating and sustaining a high reliability culture of safety?
- Actively engage patients and their family as partners in care.
- Approach care delivery with interprofessional collaboration and teamwork.
- Promote a culture of blame-free reporting of adverse events and near misses; analyze and learn from them.
- Implement evidence-based best practices; remove barriers to ongoing sustainment.
- Maximize the use of technology as intended.
- Improve hand-off communication and transitions of care.
- Maintain a high level of situational awareness in your work area to anticipate problems ie., rounding, huddles.
- Speak-up if you witness or identify unsafe behavior or safety hazards and hold each other accountable to safe practices.
- Establish goals, measure outcomes and promote transparency of data.
During Nurses Week
this year, let us all make a commitment to ourselves, our teammates and those we care for, that we will become better patient advocates. Let us learn from those heartbreaking stories of loss and take whatever steps are needed to create and sustain an environment founded in a culture of safety -- every day and in every way.
Susan Mascioli MS, BSN, RN, NEA-BC, CPHQ, LSSBB
Director, Nursing Quality and Safety
Christiana Care Health System
NursingCenter is celebrating Certified Nurses Day
, which happens every year on March 19th. Why March 19th? It happens to be the birthday of the pioneer and inspiration behind nurse certification, Margretta "Gretta" Madden Styles, RN, EdD, FAAN.
While we would have been beyond thrilled and honored to interview this innovator in the nursing profession, sadly, Styles passed in 2005 after a long, successful life and career. We thought we would adjust our ‘Nurse on the Move’ blog to feature one of the top ‘Nurses Who Moved’ and truly shaped the profession.
Life and Education
Styles was born in Pennsylvania in 1930. She was married to her husband for 47 years, Reverend Douglas Styles, and the couple had three children.
Styles attended Juanita College and earned undergraduate degrees in biology and chemistry. She went on to Yale University to earn her master’s degree in nursing and then on to the University of Florida, where she earned her doctorate in education.
Nurse educator, author, and innovator
Styles started teaching as an associate professor in 1967 at Duke University and then moved on to become the dean of nursing at various universities, including University of Texas Health Science Center at San Antonio, Wayne State University in Detroit, and the University of California, San Francisco.
Styles campaigned and advocated for stricter certification requirements and credentialing standards for nurses. She wrote at great length on this topic and later helped to create the American Nurses Credentialing Center (ANCC). Her influence on refining the nursing profession in the U.S., extended internationally, and, for a time, Styles also served as president of the Internal Council of Nurses.
While her legacy will always be tied to her role in the creation of the ANCC, her impact on the nursing profession is still widely prevalent. She is often quoted and referenced in medical publications and has had many awards and grants named in her honor. Styles was also inducted into the American Nurses Association hall of fame.
And, of course, the profession will continue to honor Styles’ work and accomplishments on her birthday every March 19th for Certified Nurses Day.
Happy Birthday, Gretta and Happy Certified Nurses Day! Be sure to check our Certified Nurses Day
page on March 19th for lots of great resources and deals to honor this special day.
By Kim Fryling-Resare
Posted: 3/14/2016 8:07:11 AM
| with 2 comments
Carolyn Ackerman Ed.D MS RN CHPN, is from Arvada, Colo., and has almost 40 years of experience in home health and hospice. She actually discovered our Nurse On the Move
feature in a recent Home Healthcare Now journal article, Nurse on the Move: Lisa Gorski
, and thought to herself, “Well…why not [me]?”
I had the opportunity to speak to her over the phone to discover why she thought she would make a good candidate, and I am so glad she reached out to us at NursingCenter. Not only is Ackerman a registered nurse, but she is also an assistant professor at Regis University in Denver, and she is very involved in end-of-life interdisciplinary simulation.
Ackerman recently graduated from Creighton University with her Ed.D in interdisciplinary education. She created an end-of-life board game called The Path of Life: The Journey of Living at the End-of-Life © game
, where participants assume the role of the patient as they make decisions related to their terminal disease.
Listen for the whole interview…
For inquiries around Ackerman’s board game and other work, email firstname.lastname@example.org
*Do you know a great candidate to be featured for Nurses On the Move? We want to know about the nurses who are advancing the profession and inspiring others to do the same. Email your submissions to ClinicalEditor@NursingCenter.com
Posted: 3/9/2016 7:51:01 AM
| with 0 comments
Donna J. White, CRNA, MS is an accomplished nurse anesthetist working and living in Rhode Island. She started her nursing career in the 1980’s with a nursing diploma degree from the Shadyside Hospital school of nursing in Pittsburgh, Pa. After testing her skills in a number of settings, White determined she wanted to challenge herself more, both in her professional and personal life.
White earned her bachelor’s degree from the University of Pittsburgh. She also decided to spend six months hiking the Appalachian Trail with her husband, where she went back to basics and discovered what she really needed to survive in the wild and to thrive in her nursing career. On that trip, she decided to earn her degree as a nurse anesthetist from Southern Connecticut State University, and now, she makes her career work with her active and involved lifestyle as a mom.
For January’s Nurse On the Move
, White talks about her experiences as a busy nurse and how she makes time for herself in between her family members’ schedules. Learn what her New Year’s resolution is for 2016 and her number one piece of advice for nurses looking for a balance between work and home.
Q: What made you interested in becoming a nurse and what was it like starting out with a nursing diploma degree?
I was 17 when I graduated high school, and I spent a few years fumbling. I was earning college credits, and my mother kept saying, “You should be a nurse.” I did always love the sciences, so finally, I decided to go into nursing because I knew I would always have a job. My motivation was to get a job right away – I needed to work. I was in a hospital-based diploma program, which was excellent. It was a 24-month program that was year-round. At that time when I got my first job, I was better prepared than the baccalaureate nurses to care for patients. In the 80’s, BSNs went through a period where they were very book oriented and you could tell the difference between us, but I believe that has changed.
Q: Why did you decide to go back to school and earn your bachelor’s degree and eventual master’s degree to become a nurse anesthetist?
As I was working, I found myself moving around a lot. I think it was because I needed more of a challenge. Changing setting brought a challenge, but after six to nine months, I was already getting bored. I knew that the only way I was going to advance was to continue my education. I preferred clinical care rather than management, so I knew I wanted to work with patients and not manage other nurses.
Q: You’ve held a number of different roles, such as staff nurse, advice nurse, home care nurse, and emergency nurse. Which setting did you enjoy working in the most and why?
As part of being a staff nurse, I worked in the ICU. Definitely, working in the ICU or in my position now as a nurse anesthetist in the OR I’ve enjoyed the most. You have more independence and make more critical decisions in a collaborative way. As an anesthetist, it gives me satisfaction to have the patient feel better by easing their pain.
Q: You’ve also accomplished many things in your person life. In 1990, you hiked the Appalachian Trail for six months with your husband. What was that experience like and did your skills as a nurse come in handy?
The experience was phenomenal. I’m not an extreme sports person, but I’ve always enjoyed being outside and hiking. What hit home the most about being out there is it came down to what you need in life to survive. The basic necessities for survival are water, shelter, and food. Being a nurse, I took hygiene seriously. We filtered all of our water; we never drank directly from a stream. We were very healthy. I had been a nurse for about six years at the time and while on that trip, I thought about going to anesthesia school. I worked with my husband on how we could make this work.
Q: You now also hold the role of a busy wife and mother. For other nurses trying to find a balance between work and their home life, what would be your number one piece of advice?
You need to take care of yourself so you can take care of others. For me, sleeping well and exercising every day for at least an hour keeps me sane. If you’re not well, nobody is well.
Q: Nurses are caregivers and many often put the needs of others before their own. With your busy schedule, how do you factor in time for yourself?
The main thing is whenever you find a gap in your day, use it wisely. Do not wait until you feel like exercising or the day will be done as you fulfill other priorities.
Q: How has nursing changed since you began your career? Do you find the expectations and technologies of today help you or hinder you when trying to manage your time?
Technology has definitely helped in the care of the patients in terms of diagnosing and the speed of treatment. Today, the expectations related to payment, reimbursement, and the expectations from management and the hospital to turn over things quickly can leave room for error at times. They may say you have 15 minutes to turn over, but they want it in five minutes. Patients are still people and they are not going to behave the way the statistics say they should every time. Mistakes happen because of the pressure to produce.
Q: You currently work part-time as a nurse anesthetist at Guardian Brockton PC, Good Samaritan Medical Center, where you are scheduled for a 24-hour shift every Friday. What is the most challenging part of this job and how do you work through it?
I’ve always been a worker bee. If I can go in and continue to work throughout the shift, that’s fine. The challenge becomes when the cases are done, your mind tells you to relax and then suddenly another emergency requires you to be focused and do your best for the patient.
Q: Do you have any New Year’s resolutions for 2016?
I would like to start working more this year. The trick is finding the day that I can do that without affecting my girls. I really enjoy my part-time schedule, and being home in the mornings and the afternoons with them. I do hope to work more as my kids get older. I feel very fortunate for my schedule now.
Posted: 1/21/2016 8:00:35 AM
| with 0 comments
We are excited to share the launch of Lippincott NursingCenter’s YouTube Channel
! Our first nursing videos are compilations of inspiration from nurses at the ANCC National Magnet Conference® this past October. Learn how your nursing colleagues keep up with new research, information and evidence. Also, discover what inspired them at this year's meeting and their plans for sharing this inspiration with their colleagues.
Take a look:
We are looking forward to sharing more nursing videos as we move into the New Year! Stay tuned for Clinical Resources, Training Guides, webinars, and more nursing videos as we delve into this platform. Go ahead and subscribe today
to stay up-to-date and inspired.
Nursing “brought out this side of me that I didn’t know I truly had.” Annie Lewis O’Connor PhD, NP-BC, MPH, FAAN never planned on being a nurse. She didn’t even know if she could handle blood. But, after becoming a single mom at a very young age, one social worker gave her the opportunity to experience a new side of herself. O’Connor was able to shadow nurses, and she saw the “human, caring side of what people did when others were sick. I felt it brought out this side of me that I didn’t know I truly had. I think being a new mom brought out this caring side of me as well.”
Today, O’Connor has expanded that side of herself into an influential career. She holds faculty positions at Harvard Medical School and Boston College and received her master’s degree in nursing from Simmons College in Boston, her master’s degree in public health from Boston University, and her PhD from Boston College. She currently serves as the founder and director of the C.A.R.E Clinic (Coordinated Approach to Recovery and Empowerment)
at Brigham and Women’s Hospital in Boston. Specializing in forensic nursing, maternal-child care, pediatrics, and women’s health, O’Connor cares for victims of domestic and sexual violence, human trafficking, and gender-based violence. She also serves on the editorial board of the Journal of Forensic Nursing,
which makes her the perfect Nurse On the Move
for Forensic Nurses Week
. Read on to discover the vital work O’Connor is doing for these patients and be sure to check our Nursing Deals and Discounts
page for ways to celebrate Forensic Nurses Week.
Q: How has nursing changed since you began your career?
Careers are very much about a journey. I believe back in the day when I ended up in nursing school, it was sort of a calling. Today, it’s a great job, profession, and it’s a business. It didn’t feel like a business when I first started out, and that’s not good or bad. What I hope I bring to it is that people never lose sight of the honor and privilege it is to take care of people at the most vulnerable time in their life, and that’s when they are lying in a hospital bed. I get to do this every day with young nurses in the clinic where I work. I love that I am at the stage in my career where I really am feeling that “pay it forward.” I don’t want anyone to feel that nursing is just a good job. It’s much deeper than that, and I try to model that for the next generation of nurses.
Q: You founded C.A.R.E. (Coordinated Approach Recovery & Empowerment), which assists victims of sexual assault, domestic violence, human trafficking, and gender-related violence. Why is this approach important to you?
Brigham and Women’s Hospital gave me the opportunity to grow and develop this clinic; I couldn’t have done it without the support of that administration. This was done through dialogue and gathering statistics on my concerns around victims of intentional violence. These patients are unique in so many ways. My research, which is published in Journal of Forensic Nursing
, shows a lot of these patients who come into the emergency department (ED) just experienced a traumatic event, and they get handed a packet of information they are expected to navigate through. It’s a mess; they don’t know who to call first.
I wanted to create a follow up with these patients through C.A.R.E. that will become a national model. Within 48 hours, a victim, with their consent, will receive a text message from us. We provide phones if they don’t have one. About 98% of the victims we see agree to the follow up, and our numbers around being able to contact patients have gone from 27% up to 91%.
We also do consultations with in-patients. For example, they are admitted for a non-related issue and during their stay disclose violence and trauma. This week alone, I’ve done six in-patient consults. I have two victims of human trafficking who came in for asthma and diabetes, and we are educating the nurses on how to provide trauma informed-care for these other issues they are experiencing.
I would also like to mention that I invited 14 survivors to become my patient advisors and to name our clinic. When suggestions come from the actual survivors, the policies and procedures we develop have much more relevant and significant meaning.
Q: When a patient comes in with suspect injuries, what should nurses keep an eye out for?
People want a domestic violence screening tool, which we’ve had for three decades now. But, this has not transformed well into actual health care. I think we need to have an actual conversation with these patients about their relationships and pay attention. As I’m taking the history, I am looking for the red flags, such as a partner who won’t separate or the young girl who comes in with an older man. You need to educate yourself around what those flags are and then talk to the patient. You don’t want to go in and say off the bat, “Have you been hit, kicked, or punched? Has your partner forced you to have sex when you didn’t want to?” The correct way to ask is after you’ve established a rapport with the patient to say, “What do you like about your partner or your work? What don’t you like about it? Tell me three things you would change if you could.” The next thing you know, they are telling you their whole story. Really recognize that this affects one in four women. People are always surprised by this, but the statistics are pretty solid.
Q: What is the biggest challenge related to caring for these victims and how do you combat it?
The biggest challenge is really when there are mental health issues or substance abuse involved. If you look at homeless women, women with mental health problems or substance abuse, you think of it as an onion. You start peeling that onion back to get to the core, where you find that there’s a lifelong history of exposure to trauma and violence. You may be treating them for this one incident they came into the ED for, but you are really treating their whole history.
Q: Has there been a particular patient whose story has stayed with you?
The real hard one recently was we had a woman whose boyfriend strangled and beat her pretty bad. The neighbors called and the police came and brought her in. He choked her so bad we could see the strangle marks. As we are working her up and getting her ready for discharge, she was calling the boyfriend to come pick her up. She just looked at me and said, “I know you must think I’m crazy. I don’t even know if I love him, but I just don’t want to be alone.” That was a “Wow” moment for me. I told her, “How about we try to work on the loneliness? So, you aren’t alone.” She left and two weeks later he beat the living day lights out of her again. She wound up in a different hospital, but called and asked for us. I was able to get her transferred and care for her and that was it. She finally left him, and now she’s soaring. If we didn’t have this follow up program, she would have walked out of there and never come back.
Q: Why is every nurse a forensic nurse?
When you look at ED nurses, they see themselves as ED nurses. But, when they see an injury, like someone looks like there were whipped with a belt, they don’t see that as forensic science, they see that as the emergency care. I think that forensic nursing is not a term they are familiar with, and the more we define and share what it means, the more nurses will recognize that’s what they are doing. Nurses in all aspects of delivering health care will see that.
Q: Why is Forensic Nurses Week important to you?
We get to recognize our colleagues in forensic nursing and that there’s a body of knowledge and expertise we’ve built. During this week, I also think it’s important for every nurse to reflect on their own practice and see what is in their own job that is forensic nursing. Working with the elderly or children, for example, there’s a lot of forensic nursing that goes on there.
Q: How has serving on the editorial board of the Journal of Forensic Nursing affected your career as a nurse?
It’s been really wonderful. It takes me to a different level, where I can grow and develop. Reading manuscripts, providing feedback, and encouraging others to write has been great. It makes me very proud of our profession, and I’m honored to be on the editiorial board. I know that whatever winds up in print is very good quality. I’m very proud of the high standard we set in this journal. I see this journal as the flagship for forensic nursing.
Q: You are traveling to Haiti in November. What work will you be doing there?
I travel to Haiti frequently, where I have two roles. One is that I work with local Haitian nurse leaders to develop nursing leadership in Haiti along with my organization, EqualHealth.org.
We host a conference there and our work is very interdisciplinary. There teams need to work in harmony, so we focus on that. Second, I’ve done research on gender-related violence in Haiti.
Q: What do you envision for the future of nursing?
Nurses will be allowed to practice in the full extent of their license. I would love to see all nurses continue their education in some way, shape, or form. I also think that nurses need to be at those tables where policies are being made. Nurses can play a vital role in education, practice, research, and policy, and I want nurses to recognize that.
*Do you know an inspiring nurse to be featured for the next Nurse On the Move? Email your submissions to ClinicalEditor@NursingCenter.com
Posted: 11/9/2015 9:53:48 AM
| with 1 comments