Caring for Patients Through our Comfort

With so much fear happening right now as a result of COVID-19, there are many patients that are in fear of dying and asking for prayer.  In some hospitals, many staff will be more concerned with their agenda and not the patient’s thoughts or concerns.  Our own beliefs as a nurse can impact a patient in many ways.  For instance, if you find yourself in a Christian Hospital where praying is okay with a patient and encouraged, and you feel comfortable asking the patient if they would like to pray, then you would do that.  Now in the same situation, if you are a nurse that is not very religious but work in a Christian Hospital and a patient asks you to pray with them, it can be very awkward for the nurse.  The nurse can let the patient know that she will stay there as the patient prays and a warm touch of the nurse’s hand on the patient’s hand can be all the comfort that the patient needed (DeNisco & Barker, 2012).  However, many staff will be fearful to do this because of COVID-19.  But remember even through a mask, gown, gloves, and a face shield, we as nurses and healthcare givers can still provide someone that is afraid that warm and caring support and a smile that will let them know we care.

References

DeNisco, S. M., & Barker, A. M. (2012). Theory-based advanced nursing practice. Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp. 5-18). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Compassion Comes from the Heart

As nurses, we have the ability to use compassion and genuinely want the best for our patients.  We understand our patients and want to help them find the best treatment that will help them.  There are also nurses and doctors who do not exercise cultural competence in what the patient’s beliefs and wishes are.  As nurses, we have to validate our patients’ feelings of fear of not being able to provide for their families.   Many hospitals have case managers who focus on the hospital losing money and allow patients to treat at their facility but if they do not have insurance, they are very quick to send them elsewhere.  Many times when this happens, these case managers that are gatekeepers, are not thinking of the patient’s safety.

Social workers and nurse case managers are the peacemakers in these delicate situations, involving patient advocacy.    A good nurse case manager will identify the problem right away and diffuse it so that the focus is back on the patient.   Sometimes our culture in America imposes our beliefs on others thinking that they have to accept a specific method of treatment, but the reality is patients have a choice.  If a choice is explained well to someone, they will make the right decision.  We as healthcare providers have to explain things to the patient and family to help them understand and make an informed decision.

The skill that the staff needs to learn about caring for patients from other cultures is to remember that we as healthcare providers have to be sensitive to someone’s beliefs or culture.  Just because they do things differently does not mean it is wrong, it is just different.  We as healthcare providers have to be respectful (Barr & Dowding, 2012).

Cultural expectations were seen in my previous job while I was the manager of a team of nurses and social workers.  There was a manager from England and then there was myself,  of Hispanic background.   The majority of my team was from a different culture.   There was a nurse on my team who was great, but she spoke with a thick island accent, however her patients loved her.  The other manager like myself was from England. During a case presentation, the other manager stated how hard it was to understand her and she should not present again.  I stated that was not a fair statement because she presented cases and her skills and case were valid.   The other manager did not reply to my statement verbally but she made herself known by challenging everything I said in the future.  It is instances like this that discourage people from staying in jobs.

References

Barr, J., & Dowding, L. (2012). What makes a leader? Leadership in healthcare (2nd ed., pp. 32-44). [Vital Source Bookshelf]. http://dx.doi.org/ Retrieved from

Leadership Styles and Organizational Changes

In my previous employment, I went through some challenging issues that started at the leadership level.  I was a manager of case managers at the time.  The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose of the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses, we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.

Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced-based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands-on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my workplace to utilize the social workers in conjunction with the nurses to manage the social aspects of the patients, however, the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands-on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in the perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however, they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day.  When the case managers check their emails,  they find deadlines on multiple items due.  These changes affect the staff because they have to work after hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders, we tend to fall into the routine of lecturing due to the pressures that we are under.  However, two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity into the change and use intuition to know how to speak to our group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with staff at different levels and empower them to meet their goals and gain confidence in their strengths.  By being confident, they can focus on themselves as they work on their weaknesses.  In my previous job, the leadership style seemed like a dictatorship; however, for the purpose of the discussion here, it will be stated as coercive.  My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions, 1 second wait time, no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager make it happen.  My manager always reminded me that she did not take lunch or breaks and she had “no life!” For fun,  she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).

References

Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

Portrait, Dog, Animal, Suit, Business, Woman, Bitch

 

What is Nursing in Today’s World

In the words of Florence Nightingale:

“Nursing is an art: and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of Fine Arts.”

In today’s world, many people do not respect nurses and the work that they do.  There are many types of nurses in different fields.  I personally have had the privilege of working as a nurse in medical-surgical units, labor and delivery, legal nursing,  home care, case management, workman’s comp, and field nursing.  The experiences that I gained in working in all of these different areas of  nursing make me who I am today.

Through out the past month, these same nurses that did not receive any gratitude have now started to receive recognition, some negative and some positive.  Nursing as we know it has changed many lives.  We have had to adapt to the way that we reach out to our patients for their protection and ours through telehealth nursing.  For many patients, this has been a great thing because they can still talk with their nurse and their doctor.  I see clients in their home and doctor’s offices, but during the COVID-19 shelter in, I have had to reach out by telehealth to my clients in order to continue to provide the services that they need.

Many people have been so scared that they are losing sleep and feeling stress due to not working and how are they going to pay their bills.  Then there are the nurses that work frontline in the hospitals and doctor’s offices and the nurses that now have to see patients through telehealth measures.  One would think that those of us that have jobs still amidst this pandemic would be grateful and kind, but instead, for some people, it is causing stress and anxiety as a result of undisclosed fear.

Fear’s acronym that has been shared is false evidence appearing real.  In this case, though it is fear of the unknown.  Will there be work, will I get infected? Will my family be okay?  These are all questions that go through people’s minds.  What can we do as nurses?  Pray and ask God for that peace to be the light in the midst of darkness.  Second, understand that we can’t change the world and those that are in it; but we can change the way we look at it and how we handle circumstances.

A friend paid me the greatest compliment the other day, he said “Rosie Moore you followed The Great Physician! Bringing healing and hope to those in despair.  keep up the good work.  There is a crown waiting for you!”  So today know that every type of nurse is important whether in the frontline or via telehealth.  When COVID-19 is over, never forget what our country went through and the work that nurses and other healthcare workers did.

 

COVID-19 Should I Be Concerned

There is a lot of stress and fear globally regarding the COVID-19 and what we are supposed to be doing to protect ourselves.  The media, friends and family, popular theme parks, businesses including airlines, cruises, and places of attractions, all have something to share about the COVID-19.  This is a household word that gets used in households on a daily basis probably more times than we want it to be.  Should we be concerned? That is an outstanding yes!! Why?  Well, first of all, let’s dissect what is happening, fear ( false evidence appearing real).

There is a lot of things that we are uncertain of and many times people will provide us information that may not be accurate.  They are not telling us to be mean, but they themselves are scared because they do not have all the facts.  Our healthcare professionals are leaning on the Center for Disease Control (CDC) and the World Health Organization ( WHO) to provide them the latest facts.  I am sure there are doctors who specialize in microbiology ( that famous petri dish that I hated in college) to do a battery of tests on this organism.  They learn something new each day.  There is not a specific cure as the virus has not been here long enough to develop a vaccine against it.  This is what causes the fear of not having a cure, not knowing if you contract it what will happen to you, your family, and your job, not to mention your friends.  So now that we dissected what the real issue here is fear, let’s see if we can put your mind at ease while we let the professionals figure out how to eradicate this virus.

“First of all Coronavirus disease 2019 (COVID-19) is a respiratory illness
that can spread from person to person. The virus that causes
COVID-19 is a novel coronavirus that was first identified during
an investigation into an outbreak in Wuhan, China.”

“The virus is thought to spread mainly between people who
are in close contact with one another (within about 6 feet)
through respiratory droplets produced when an infected
person coughs or sneezes. It also may be possible that a person
can get COVID-19 by touching a surface or object that has
the virus on it and then touching their own mouth, nose, or
possibly their eyes, but this is not thought to be the main
way the virus spreads.”

The symptoms are Fever, Cough, and Shortness of breath.  Pretty common symptoms that can be overlooked for many upper respiratory infections.  These symptoms can manifest themselves at any time in the 2-week window after becoming infected.

The way to protect yourself and others from catching the COVID-19 is to practice washing your hands for 20 seconds with antibacterial soap before eating, after eating, after using the bathroom, after touching your nose, eyes, or mouth.  You should also wash your hands after coming from the grocery store or any other public place that is not your home.  If you do not have access to soap and water right away uses the antibacterial right away.  If you shake hands with someone, do not be afraid to use your antibacterial.  I know people may frown at that and think you are germophobic, but really it is okay if questioned a simple explanation stating that you want to practice good infection control and want to be certain that you do not compromise them or your family is enough stated.

Always wash your hands after preparing food and serving or taking care of others ( no matter age).  Avoid contact with people that are sick and if you feel sick, stay home.  do not try to go to church, restaurants, activities, school, or any public spaces with multiple crowds and pawn it off on allergies. Everyone knows allergies are not contagious so many people who cannot afford to stay home because they do not get paid for being out, tell everyone that they have allergies.  Yes someone may have allergies but until this is verified by a doctor or nurse practitioner, stay home!

Be sure to clean surfaces with antibacterial wipes or household disinfectants as the virus can live on surfaces and if touched it can cause someone to get the virus.  When you come home from the outside, take your shoes off outside clean the bottom of the shoe and do take a shower at night before bed or if possible as soon as you come home from work.

I know this all may sound excessive, but if you follow good infection control, it will help decrease the stress that the media is causing you by playing the news 24/7.  Limit the times that you watch the news so that you are able to function on a day to day basis.  Have a cup of chamomile tea for bed to allow your mind to relax and get rest.  Start your day with something positive such as a daily devotion, prayer, or if you do not do any of the latter, watch a tv show that brings laughter to you.  Listen to the news midday or afternoon, this will give you at least what happened in the evening and the morning and not bombard you.

Sick Woman Cold

 

I hope that this has brought you some comfort.  For specific updated information go directly to one of these sites:

CDC/Center for disease control

WHO/World Health Organization

OSHA/Occupational and Safety Health Administration

As a nurse, I have to practice above and beyond the CDC, WHO, and OSHA rules so that I can protect myself and my patients.  So I understand and get everyone’s concerns right away.

Be blessed and be safe.

 

Leadership Skills Mentoring and Coaching

When I was a  manager of a team of nurses and social workers, collaboration existed in my direct report team, and as a team, we functioned using critical thinking, interdisciplinary team approach and collaboration on cases together.  But in the big picture of corporate America under the manager that I reported to, this was not acceptable, it was more along the lines of a multidisciplinary team.  In this type of team, you only have individual thinking in the group, meaning their way and no other opinions.  The focus would be on tasks and check off systems regardless if it was feasible to do (Rubenfeld & Scheffer, 2014).

Nurses do have the ability to be leaders, educators and changers of a system, if assertive enough to make that change, but in order to do so, a good team of interprofessional people is needed (Denisco & Barker, 2012). Because at the end of the day, the patient is who counts and why changes are necessary. If more companies were focused on having a management style that was transformational vs transactional, this would alleviate the unnecessary resignation of employees, corrective action plans and disgruntled employees.

In my team, for instance, a good way that we incorporated learning was to have one person do a case study every week.  They would team up with another person on the team to present the case study on a difficult patient.  During this time the team had the ability to comment on the case, make suggestions and also refer to our medical director for review.  This allowed me to mentor the nurses and social workers during our weekly meetings so that we could continue to go over any other cases that may have been difficult or of concern to them.

 

References

Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 547-567). [Vital Source Bookshelf] Retrieved from https://campus.capella.edu/web/library/home

Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 

Leadership Theories and Attributes

I had the opportunity to interview Mary Alice Cullen, a Director of Patient Care Services.  She oversees the Neonatal Intensive Care Unit (NICU), labor and delivery, pediatrics, maternity ward, and the women’s clinic.   Mary graduated in May, 2016 with her Doctorate of Nurse Practice. Mary has always wanted to get her MSN.  As she started to study to get her MSN, it opened her eyes to endless possibilities of what she could do with her degree.  When she graduated with her MSN, the position that she was in opened up for her and she took on the job.  As she went through her role she wanted to make more of an impact on the role and the clients and staff she was supporting.  Mary decided to continue school for her Doctorate in Nurse Practice (DNP) with a concentration on Executive Doctorate in Nurse Practice, and this degree is also approved by the American Nurses Credentialing Center (ANCC). Her attributes are that of a caring leader, one that will work with her staff to encourage and teach them and empower them to be the best that they can be, even when they do not see that they can.

Mary does not often do hands-on care she is in an executive role.  However, she does round daily.  She provides support to her managers that manage the staff, in order to provide better care for the patients. Her leadership model is Kouzes and Posner, but if she is scrubbed in for surgery in labor and delivery, her transactional model side comes out.  Meaning this is a time as a transactional manager, where following directions the same way every day is crucial.  Mary most recently participated in a study that involved strategic planning of having single-family NICU rooms for the parents.  These were her visionary plans and the hospital agreed after the research was completed, that having individualized patient rooms in the NICU, would benefit the staff and the parents of the babies.

My leadership style is very similar to Mary’s in that I lead by example and I am not afraid to do the work that my staff does.  This makes a strong leader because the people who follow you will know that although you are in a position of higher authority, you will still be humble enough to do the job your staff does and be able to explain it from their side and understand the position that they are in.  Knowing your staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. There are seven attributes to being a good leader and Mary possesses those in her character, her track record to be given assignments and projects that have been successful and in the skills that she shows handling her staff (Baer, 2012).

References

Baer, J. (2012). Theories of leadership. In Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

 

 

 

Are Healthcare Workers Forgetting Good Patient Care

I remember most recently having a bad reaction to zinc when I took it on an empty stomach (yes learned that lesson) and passing out with blood pressure and blood sugar bottoming out.  I felt better on the ambulance ride to the hospital after some IV fluids.  The paramedics stayed with me until they had a room to take me to for an exam.  But the nurse then said since I was feeling better, I can get up off the stretcher and wait in the regular waiting room.  They sent an orderly to walk me to the waiting room.  I had my purse, winter coat, boots in one hand and my work bag in the other hand.  The orderly did not offer to get a wheelchair to help me considering I had just passed out an hour ago.  I thought to myself at that moment boy he is rude as he walked 20 feet ahead never looking back to see if I was okay and two, never offered to help carry anything.  My husband arrived minutes later and was appalled at the treatment of a patient this way.

Now at this moment, I still have not been seen for any lab work or by a doctor.  When I finally got into a room two hours later, the doctor did not come in for another hour and a half.  When he came in, he was there a whole 2 minutes and said we are going to send you for some chest x-rays, lab work, EKG and put you on a heart monitor and watch you for 23 hours.  I said wait, I had a bad reaction to a medication how do you derive at all this in a 2 minutes checkup? The best part is where they make you wait for 23 hours is an open room with many other patients looking at you from across the hall.   This triage area does not have curtains, it is a holding area.  I grabbed my things and said I will see my regular doctor thank you very much.

I cannot understand legally or ethically how patients can be treated this way.  Is there not a policy in hospitals that they must follow to give better patient-centered care? As in the Colorado model, it states there should be a management leader looking out for the rest of the team to be sure that patients are being informed of things and being involved in their care as opposed to left alone for hours at a time and not a single explanation of care and why it is being ordered (Goode, Fink, Krugman, Oman, & Traditi, 2010).

References

Goode, C. J., Fink, R. M., Krugman, M., Oman, K. S., & Traditi, L. K. (2010, August 10). The Colorado patient-centered interprofessional evidence-based practice model: A framework for transformation. Worldviews on Evidence-Based Nursing, 96-105.

Is There Still a Nursing Shortage

It seems that the nursing shortage has been an issue since I was going to school.  I remember at one point I received a one year full scholarship to go to nursing school my first year; then the 2nd year I received a letter that stated the President decided the nursing shortage was over and cut my full scholarship for the second year, forcing me to get student loans. That is enough to make you mad! But now as I practice as a nurse, I see that there is still a shortage of nurses in many fields (Moore, 2015). For instance in the hospital what I see is that they do not hire too many nurses because if they have too many on the unit and they don’t float them to another unit, they will send them home without pay because there is not sufficient work. When my son was in the Neonatal Intensive Care Unit, I had to walk past high risk antepartum, one day the lights were dim, and there was no one around. I got a bit concerned that something had happened.  There was a sign that said, “unit closed.” When I inquired, someone stated that the unit was closed because the patient census was down.  Of course two days later, it reopened.

I see that nurses are overworked because of the shortage as well.  The shortage is only getting worse as the years go by because the baby boomers are soon going to be retiring and there are no new nurses to take their place (“Focus on Education,” 2010). There are also articles that speak about new nurses graduating, but their minimal level of education required will be the bachelor’s level plus all the clinical involved with that level.  There are entrance exams to some nursing schools, making it difficult for the student to pass.  Of course, education should be taken to the next level due to the more complex illnesses and family dynamics that we have today.

In order to not continuously have a shortage, employers need to realize that yes there is a shortage and hiring more staff to help the current nurses and not over tap them will be more productive in the long run.  The medical cases are getting more complex these days for patients in the hospital, therefore making it important for nurses to have a higher level of education. The colleges have to start sending representatives to the high schools to start recruiting future nurses so that when they graduate, we can add more nurses to the profession.  Recruiters need to present the pros and cons of being a nurse and look for candidates that will be a good fit for the nursing profession.

References

Moore, M. (2015). The nursing shortage and the doctor shortage are two very different things. Retrieved from http://www.washingtonpost.com/news/to-your-health/wp/2015/06/05/the-nursing-shortage-and-the-doctor-shortage-are-two-very-different-things/

The future of nursing: Focus on education. (2010). Retrieved from http://nursejournal.org/articles/the-future-of-nursing-infographic/

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
Follow me on Facebook https://www.facebook.com/rosiesnursecorner/

 

 

The Need for Nurses in Schools

For many families that have children in elementary through high school level with special needs for medications, it has become a question as to whether or not the school that they are zoned for has a school nurse. Many schools in Florida do not have nurses on staff (Florida Association of School Nurses website, n.d.).   In one article by the Orlando Sentinel, it notes that not all Orange County public schools have a nurse, in fact, their ratio out of 182 schools in Orange County, showed only 34 had nurses. One Orange County school mentioned that they have an RN and she helps a lot because it frees up the teacher to focus on her classroom instead of the child that is sick. The article went on to say that some tasks are delegated by the RN to non-clinical personnel, for instance, an assistant principal or secretary when the nurse is not in the school (Roth, 2011).

In my opinion, although parents of children administer injectables like epinephrine for allergic reactions or insulin, they are the parents that have been taught to watch for certain symptoms in their child that they see day in and day out.  They have a working knowledge of the situation should it arise. The school personnel, may be taught when to administer medications like epinephrine or insulin, but if they have never used it, or administered it, how can they safely administer it? Will they know what symptoms to look for if there is a reaction?

In the state of Delaware, every school is required to have a registered nurse.  Some schools that have them receive the funding through the school system grants, or in the community (Roth, 2011).  I most recently went to a school that is private with an estimated tuition rate of $14,000 per year and service preschoolers through high school. The school has a large arts program and a population of about 2000 kids, each child receives an IPad upon admission to use for homework.  They stated that they did not have a school nurse, if a child warranted medical treatment of medications or breathing treatments, this would not be the school for the child.  I found it rather sad to see that value was placed more on the material things of an IPad (which I know can help advance a student) but really the computers work just fine; having a registered nurse to help in times of kids needing treatment, or a school teacher needing treatment is much more valuable to me.

References

Florida Association of School Nurses website. (n.d.). https://fasn.nursingnetwork.com/page/18381-school-nurses-save-money-

Roth, L. (2011, September 26). A nurse in every school? Not in Florida not even close. Orlando Sentinel. Retrieved from http://articles.orlandosentinel.com/2011-09-26/business/os-fewer-school-nurses-florida-20110925_1_school-nurses-practical-nurses-students-with-chronic-illnesses

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
Follow me on Facebook https://www.facebook.com/rosiesnursecorner/