1. Bruno, Marsha BSN, RN, CMSRN
  2. Herrera, Claudia BSN, RN, CCRN, CDN
  3. Elizondo, Stacie BSN, RNC
  4. Neighbors, Megan BSN, RN

Article Content

Is job shadowing right for nursing students?

I really enjoyed reading the article, "Bringing Clarity to Job Shadowing" by Briyana L. Morrell, MSN, RN, CCRN, and Julie Detty-Gin, BSN, RN (April 2016). As a director of a busy medical-surgical unit for the past 7 years, I've had ample opportunity to see shadowing done in several different capacities. In an effort to hire nurses who are a good fit for our unit and facility, I often offer candidates the opportunity to shadow. I've had great success with nurses returning to the workforce and agreeing to shadow for one or more shifts to get a feel for our unit and decide if our facility is the place for them. I've also had some experience with students shadowing on my unit and I feel these students are often overwhelmed with what they see and hear. I don't feel that this is an appropriate group to include in a shadowing program.


Some disadvantages of job shadowing lie in choosing the nurse to be shadowed. With an inexperienced student shadowing a high-performing nurse, the student may potentially walk away with a false sense of the job. On the other hand, if the student is paired with an incompetent nurse, he or she may learn bad habits and have a difficult time relearning the proper way to perform tasks. Another area of concern is the patient experience factor. Some patients may not respond well to a nonlicensed "observer" in their room during assessments and procedures. Many students are very inexperienced and can find it difficult to feel comfortable and communicate effectively in the healthcare setting. Is it prudent to expose such inexperienced students to nursing in this way?


In the article, the authors didn't reach a clear conclusion due to the limited control group. I would be very interested in seeing results of a study with a larger intervention and control group to determine if shadowing is indeed worthwhile in the recruitment of new nurses.


-Marsha Bruno, BSN, RN, CMSRN


Nurse manager enthusiasm key to project management

The article "Project Management Supports The Change Process" by David Stanley, NursD, MSc HS, BA Ng, Dip HE (Nursing), RN, RM, Gerontic Cert, Grad Cert HPE, MACN; Linda Malone, RN, MHM, FACHSM, MACN, Grad Dip Geront Nurs, Grad Cert E Health, Grad Cert Anaes and Rec Room, Dip App Sci (Nurs); and Linda Shields, MD, PhD, FACN, FAAN, Centaur Fellow, MAICD (June 2016) discussed how "many nurse managers aren't instructed in the formal practice of project management." The authors propose "instruction in the application of project management tools be introduced into nursing education programs, with a specific recommendation to include project management as a fundamental component of nurse manager education." I agree with the overall recommendation, but request for the enthusiasm of the nurse manager responsible for project management to be considered.


I've been an RN for 20 years, including 10 years' experience as a nurse manager of intermediate care and an acute hemodialysis unit in a county hospital. I've experience leading the implementation of new projects and know how the perception of the nurse manager affects the success of the project. One study found that a challenge to successful projects was nurse managers' lack of enthusiasm for project management. Nurse managers should have buy-in before committing to managing a project. They'll need to take into consideration all of their other daily routine responsibilities. Also, nurse managers may not believe that they're capable of project management. In addition, some nurse managers may have a unit that isn't interested in helping with new projects. All of these factors impact the enthusiasm of a nurse manager as a project manager and affect the success of the project.


Therefore, I suggest the development of an assessment tool to evaluate the enthusiasm of the nurse manager before assigning project management. I do agree that projects affecting patient care should have a large amount of nurse manager involvement but other factors, such as the nurse manager's enthusiasm for being a project manager, should be considered.


-Claudia Herrera, BSN, RN, CCRN, CDN


How do we manage nurse cell phone use?

As a nursing administrator in an acute care setting, I frequently come face-to-face with the issue of cell phone use by nurses. There are reasonable arguments on both sides of this issue, and I find myself shifting from one side of the argument to the other, depending on the situation. In the article "Calling In At Work: Acute Care Nursing Cell Phone Policies" by John Brandt, MA, MILS; Diane Katsma, DNP, MN, RN, FNP; Diane Crayton, DNP, MSN, RN-BC, FNP; and Alleene Pingenot, PhD, MA, MS, RN (July 2016), the authors provide a great discussion about what nurse leaders are facing as we try to navigate through the quagmire of cell phone use and determine what's best for our patients and staff.


The Pew Research Center indicates that 90% of American adults own a cell phone; 67% of these owners report finding themselves checking their phone for messages, alerts, or calls, even when they don't notice their phone ringing or vibrating. This is my main concern: We must have the ability to self-regulate the use of personal cell phones and, frankly, that seems near impossible. I'm equally guilty of mindlessly checking my cell phone when I have a few free moments, and most nurses do the same. When we've succeeded in achieving some degree of compliance with nurses' cell phone use, I'll then inadvertently stumble upon a physician showing pictures at the nurses' station or find out about an incident in which the physician tried to text admission orders to the nurse because he didn't want to have to log on to his computer to enter orders.


We all recognize the importance of leveraging technology to enhance communication between healthcare providers, but we struggle with the professional implications of cell phone use. As the article mentioned, most facilities have general cell phone use policies that focus on staff use of personal cell phones, vary widely in content, and often aren't even enforceable. Most of these policies don't guide the appropriate use of cell phones for enhancing patient care and outcomes. This is likely due to the fact that we, as nurse leaders, don't know how to put into words all that's involved with cell phone use. In addition, there's little research to guide our efforts.


Moving forward, nurse leaders must focus on research to gather the evidence needed to effectively manage the use of cell phones in the healthcare setting. We would be doing a disservice to our patients and staff if we don't actively work to successfully and appropriately integrate this technology into our daily practice.


-Stacie Elizondo, BSN, RNC


Promoting the safe use of forced air warmers

It's discouraging to know that there are minimal institutional policies that relate to the use of forced air warmers (FAWs) and their effect on patient safety. I've been an OR nurse for 5 years and the facility in which I work performs general surgical, endoscopic, obstetric, and gynecologic procedures; it's standard practice to place a warming blanket on any patient who's undergoing general anesthesia. After reading "Forced Air Warmers: Policies For Safe Use" by Amanda D. Deinlein, BSN, RN, PCCN, and Pam Baker DeGuzman, PhD, RN (July 2016) and searching for a workplace instruction at my facility, I was somewhat surprised that we don't have one either. As the article discussed, there's a lack of evidence that FAWs are safe for patient use; however, there's an abundance of literature to support the necessity of use in an operative setting.


The misuse of FAWs has been tied to nurses omitting the use of the warming blanket and just laying the hose directly near the patient's skin, which provides a concentrated amount of heat to one area of the body, resulting in burns ranging from first to third degree. Risks for improper use of warming devices are printed in the operating manuals. The thermoregulatory process is disrupted when a patient undergoes anesthesia and surgery. Anesthesia-related hypothermia occurs when heat is redistributed from the core to the periphery as a result of the vasodilation effect of anesthesia agents. Heat is typically lost through radiation, convection, and conduction; by performing preoperative warming with forced air, the likelihood of hypothermia occurring intraoperatively is decreased by 68%.


Recently, FAWs have been under scrutiny for leading to an increased rate of surgical site infections (SSIs); however, in one study there was no conclusive evidence to prove that FAWs increase SSI rates. There's concern that bacteria may be harbored in the path of air flow inside the warmer, but the evidence wasn't supported and the study confirmed the Association of periOperative Registered Nurses stance that active warming using FAWs is an effective way to prevent hypothermia.


It's important for nurse leaders to be aware of infection control, especially in the OR. To prevent the air hoses and filters from growing bacteria, we need to be proactive about disassembling such devices on a routine schedule and doing a thorough cleaning.


-Megan Neighbors, BSN, RN