After the NCLEX: 48 hours of torture

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After taking my NCLEX in July, I thought I would feel relieved, but to my surprise, I wasn’t. Waiting the 48 hours for the unofficial quick results was absolutely torturous. Falling asleep at night was nearly impossible. My NCLEX results were the only thing I could think about. The anxiety washed away only after I found out that I had passed. No words can express my joy!

Some of my friends reached out to me after they took the test. Most of them thought they failed. Some of them walked out of their test sites hysterically crying. I tried my best to calm their nerves. My advice to them was to take comfort in the fact that they did their best. I told them worrying is fruitless, as there’s no changing the outcome now. I also reminded them the amount of questions they get does not necessarily indicate if they passed or failed. I have friends who passed at 75 questions and friends who passed at 265 questions. But I can proudly say that every single one of them passed.

When I found out that I passed, I couldn’t believe after all the blood, sweat and tears that I was now RN. But soon after the celebration ended, I began thinking, “Now, what do I do?”

The answer, of course, was to find my first nursing position. A mentor once told me it can take up to six months to find your first job. In some cases, it may take even longer, so do not get discouraged.

Keep these tips in mind as you start your job hunt:
• If you have friends or contacts who work in hospitals and may be resources for finding a nursing position, reach out to them via email or give them a call. This is not the time to be shy.
• If you completed a preceptorship at a place at which you enjoyed working and you believe they thought highly of you, send the manager an email and see if any positions are open or are opening soon. Follow up with a phone call if you don’t hear back.
• Make sure you contact your references to let them know you are applying for jobs and that they may be called by prospective employers.
• Call your nursing school’s career center and let them know you have passed your NCLEX. Find out if job openings have been posted.
• Make sure your basic life support certification and resume are up to date and that your resume is polished and error-free.

Good luck to all the new RNs and the students cramming for the NCLEX. Remember: Throughout your careers, you will never stop learning, so keep asking questions and keep studying!

 

A good bedside manner is an invaluable tool

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As we all know, having a good bedside manner helps build a trusting relationship with patients. In class, our professors explain how we should behave at a patient’s bedside. They tell us to be kind, caring and respectful. Hearing this instruction at school is helpful, but being able to practice it face-to-face with patients is an invaluable lesson.

I am in my last clinical rotation at NewYork-Presbyterian, and what I have learned through nursing school and from my mentor is that patients want to know you respect them and genuinely care. They feel vulnerable while in the hospital and sometimes do not understand the terminology used by healthcare professionals. Often, patients’ family members feel a similar sense of vulnerability — and helplessness. Having a good bedside manner can help us ease their feelings of vulnerability and tackle their challenges.

Here are some tips to developing a good bedside manner:

Smile

Patients appreciate when you enter the room with a smile. Recently, a patient told me how much she appreciated how the nurses on the unit always came into her room smiling; it simply made her day better. A patient having a bad day does not need the added stress of having a nurse with a negative attitude. It is not always appropriate to enter a patient’s room with a smile on your face, but we can always present a positive attitude and give off positive energy. This is something that we need to learn and perfect.

Maintain your focus

It is important to leave our personal problems at home in order to provide excellent patient-centered care to the best of our abilities. By starting out the day with patients — not ourselves — as our primary focus, we can give them our undivided attention, and that is exactly what they deserve.

Practice active listening

Active listening requires your full concentration on what a patient is saying and on their body language, so you can thoroughly understand their needs and questions. This practice is extremely important; it gives us the information we need to be effective patient advocates. We also must give our full attention to family members in order to help them cope with a patient’s illness.

Show respect

Respect can be demonstrated in several ways. For instance, if you are not familiar with a patient’s cultural practices, do some research and find out what you need to know in order to respect their wishes and those of family members. Also, if a patient wants to speak to another team member about a procedure, the care plan or anything else, make sure you follow up on that request on your patient’s behalf. When you tell a patient you are going to do something for them, do it. If you are extremely busy and it is a task you can delegate, go that route instead.

Ask questions

One of my mentors once told me that when you enter a patient’s room ask, “How may I help you today?” and “What are your goals and how can I help you to accomplish them?” When you are leaving the room ask, “Is there anything else I can help you with before I leave?” Be sure to mean what you say and maintain eye contact as you speak with a patient, rather than asking the questions as you are just about to leave the room.

These are a few tips I have picked up along my journey through nursing school. I know that in the years to come as a nurse, I will learn many more. Do you have any tips on developing a great bedside manner? Please share them.

 

10 tips for making the most of clinical rotations

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I remember feeling excited, nervous and lost during my very first clinical experience. Those feelings made me wonder if nursing was right for me. But as I gained more hands-on experience and knowledge, I gained more confidence and my critical thinking skill improved. Here are 10 tips for making the most of all of your clinical experiences and building that confidence you need.

Learn the names of your unit staff members so you can greet them properly

This simple gesture makes a huge difference. Staff members are important and remembering their names gives them the respect and recognition they deserve. Names can be hard to remember as the weeks go by, so sometimes I write them in my clinical notebook as a reminder.

Be prepared for anything and everything

It is essential that you prepare for your clinical experience before entering the unit by studying and reviewing the theoretical and clinical knowledge needed for the day. You should know what kind of unit you will be working on and the common disease entities patients present with at admission. Your clinical instructor may provide your patient assignment the day before, so you can review the patient’s medical history, current conditions and related nursing care. Go over clinical skills you may be performing in the skills lab and be sure to look up related evidence-based practices.

Actively participate in pre- and post-conferences

Pre- and post-conferences will help you to reflect on what you have learned during the clinical experience. It will give you the opportunity to discuss with your clinical instructor what you have mastered and what you need more help with to gain a better understanding of nursing interventions and patient care. These conferences provide tremendous support as you grow professionally.

Show interest, eagerness, respect and appreciation in the clinical setting

Your enthusiasm to learn and your willingness to offer a helping hand as a student can make a difference to patients, families and staff. I remember encouraging an elderly woman as she worked with the physical therapist to improve her mobility. Your optimism and support can motivate patients to take that extra step in the recovery process.

Communicate with your preceptor

Take the initiative to convey your thoughts and opinions, in terms of patient care, with your preceptor. Or perhaps you can share with your preceptor whether you are more of an auditory or kinesthetic learner. Ask good questions and welcome constructive feedback. You will encounter preceptors who may not be as interactive or outgoing as you might like, but as we all know, we need to learn how to work with people who have their own personalities and ways of being.

Get involved in other unit activities or help staff members or classmates

The unit works as a team, and even as a student, you are a part of that team. You may be able to offer your help with other patients on the unit, even if they are not part of your assignment. Your classmate might need help with a bed bath, a call light may need to be answered or a nurse may need help with a patient’s vital signs. Your efforts will not go unnoticed, and all of these experiences will help in your professional development.

There is no such thing as downtime

There is always new knowledge and skills to build upon while on your clinical rotation, such as learning more about your patient’s health history, assessment, plan of care and educational needs as well as unit procedures, process of operating and leadership style.

Complete your day’s work

At the end of the clinical day, remember to report off to your preceptor, chart patient information and thank staff for their help and support. And don’t forget to say goodbye to the patients and family members you have taken care of that day.

Know your strengths and weaknesses

While your clinical rotation is ongoing, you will notice that certain skills are developing, while others need improvement. Set a goal each week to work on those areas that need improvement. Perhaps your preceptor or clinical instructor can assist you. I remember needing more help with ventilator care, so I asked my clinical instructor to help me in becoming more proficient. By taking the initiative, I improved my skills and showed my clinical instructor I was eager to learn.

Never do something if you are uncertain of your skills

Be sure to ask questions when you feel uncomfortable and review the steps for clinical skills and procedures prior to performing them. Nursing units usually have reference centers as a resource, and your clinical instructor is there to help you learn.

 

3 things I learned by going back to school

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Everyone has a reason for going to nursing school and often different reasons for continuing education beyond that. I am one of the few RNs I know at my age who decided to become a nurse when I was in high school. Living in Washington state at the time, I participated in the Running Start program, which allowed me to take college prerequisite courses at the local community college. The tuition was covered by the high school; I just paid for books. I completed my nursing school prerequisites and applied to the associate’s degree in nursing program my senior year of high school.

As a sophomore in high school, I wanted to be a nurse practitioner. I knew once I was done with my ADN, I would transfer to Washington State University for my BSN. I had even chosen my NP program. I am quite the type A personality and had my life planned in 10th grade! Interestingly, my high school counselor always questioned my decision to go into nursing. And  while progressing through nursing school, I actually did change my mind. Because I have a type A personality, changing my planned path was difficult. It was one that I didn’t fully appreciate at the time, but I am thankful for today. I often reflect and tell others about what I learned along my 12-year journey. Here are the most important pieces of my self-reflection.

Pay attention to what piques your interest

As I started my RN to BSN program, I was still bound and determined to be a nurse practitioner. However, I really didn’t like pathophysiology nor pharmacology. I slugged through the material because I needed to learn it. But then came a leadership course. And as I was reading articles, I fell in love with the content. What I noticed was that many authors, all RNs, had MBAs. This made me pause. This was something I had not considered, primarily because I had never been exposed to it. As I finished my BSN, I decided I was going to get my MBA and not be a nurse practitioner.

Many of us get preconceived ideas of what we want to do based on what we know at the time. And many of us continue down a path because we do not pause to really determine if that is what we should still do. As you think about your next steps and what you want to do, pause and think. What piques your interest? Life is too short to not do what you love.

You get back what you put into it

During my MBA program, I couldn’t afford the time commitment to be on campus at times, so I chose an online education. At the time, many people were weary of online programs, thinking they lacked rigor and quality. This is where you need to make your own decisions. Regardless of the program type, I have seen students do the minimum work and try to sail through courses, checking off boxes, just to get the degree. As a faculty member, it is so disheartening to see. Why are you selling yourself short? It saddens me every time I overhear nurses say they didn’t learn anything when they went back to school. I am very leery of those individuals.

During my online program, I read everything and worked hard on my papers. I knew this would prepare me to be better at whatever I did. Today, I can tell the difference when I speak with someone who put in great effort to learn compared with the one who did not. It’s difficult to fake knowledge. You either know something or you don’t. So do not just treat this as a hoop to jump or check marks on a to do list. Your time is worth more than that, so spend it learning well. The time and money you are spending on education should make you better — a better nurse, a better person and an example for others. Maybe even an example to your children.

The more you learn, the more you realize you don’t know

Once I graduated with a doctoral degree, I proudly used my new initials after my name. What was interesting is that overnight, many people saw me as an expert. The perception was I had a doctoral degree, so I must know what you I’m talking about. In many ways through my dissertation I had become an expert in a particular area. But cue imposter syndrome! I feared I was really a fraud. I had to remind myself that there was no way I would ever know everything. There is so much to learn! You literally could spend every day of your life reading research articles and never know everything. What I learned wasn’t that I knew more than others; what I learned was the more you learn, the more you realize you don’t know.

So, realize that whatever stage you are at in your career or education or years of experience, there is a world out there much bigger than you or I could ever know!  Pause and think — are you happy with what you are doing and where you are going? Are you taking advantage of learning? And realize that no one knows everything. We are all lifelong learners.

 

Why evidence-based practice matters to students

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There was a time when milking chest tubes and bathing children in alcohol were standard practices. Although at the time the nursing interventions may have seemed rational, evidence-based practice has proven otherwise.

EBP continues to change the way nurses care for their patients. For example, during one of my clinical rotations, a seasoned nurse corrected me for not aspirating a syringe during an intramuscular injection. Current evidence-based research suggests that aspirating intramuscularly is no longer a standard of practice since no evidence supports its practice and it can cause trauma to patients.

One of the key points we learn in nursing school is about the importance of evidence-based practice. As students we are taught to be a generation that provides high-quality care. This high-quality care is supported by evidence, which took many years to become standards of care through translation from research to clinical practice. Nursing EBP continues to expand and several resources such as journals, models and books are available to help nurses understand the concepts and process. Gaining knowledge of EBP and learning strategies for implementation are critical skills for nurses, no matter the setting.

Expand your knowledge about EBP with these tips:

Know what evidence-based practice means

Evidence-based practice is a clinical decision-making process in which clinicians use theory-derived, research-based knowledge to inform their decisions about care delivery. Consideration of individual needs, preferences and resources are also included. EBP replaces policies and procedures based on other sources of evidence such as tradition or authority. It takes into account three things nursing students should consider at all times: best practice evidence, patient preferences and clinical expertise.

Understand how these practices have changed nursing care

Here are just a few examples of how EBP has changed nursing care. You can find many more examples in the literature.

The BRAT (Bananas, Rice, Applesauce, and Toast) diet is no longer a nutritional recommendation for gastrointestinal upset in children. The American Academy of Pediatrics now recommends that children be return to a well-balanced diet as soon as possible.

  • Nurse-driven protocols now guide nursing practice regarding the best time for removing urinary catheters to prevent urinary tract infections.
  • Aspirin was previously used to control fever in the pediatric population, but it is no longer a standard practice because it increases the risk of Reye’s syndrome.
  • ICU ABCDEF Bundle is a combination of multiple evidence-based interventions that can collectively reduce delirium, improve pain management and reduce long-term consequences for patients in the ICU. (A: Awakening trials for ventilated patients; B: Spontaneous breathing trials; C: Coordinated effort between the RN and respiratory therapist to perform the spontaneous breathing trial when the patient is awakened by reducing or stopping the patient’s sedation; D: A standardized delirium assessment program, including treatment and prevention options; E: Early mobilization and ambulation of critical care patients.)
  •  Turning patients every two hours is no longer a standard of care. The timing for turning patients should be dependent upon their condition and their risk for skin breakdown. For example, one patient may need to be turned every 15 minutes and another patient may need to be turned every hour.

Appreciate how EBP is important to student nurses

The evidence-based interventions we learn can improve patient outcomes, help to provide high quality care, reduce costs and eliminate practices that have become obsolete or are not effective. As nursing students and future nurses, we hold a promise of continuous learning, and it is essential to build evidence-based knowledge over time. As students, it is never too early to start thinking like a nurse who is driven by evidence-based practices.

Learn how to search for EBP

You probably will notice on the units where you work there are specialty populations and patients with similar diseases. To provide a higher level of care, look up evidence-based practices for that particular population. Hospital units or your university library usually have nursing databases to search for specific journal articles.

Discuss it with others

One of my clinical assignments each semester is to find new evidence-based practices that can help nurses on the unit improve care. Not only do we as nursing students have the power to educate staff, but we also can serve as a great resource, helping staff to provide better care and improve patient outcomes.

As a student, you can suggest implementing evidence-based practices as a standard of practice. Embrace its positivity knowing it will help the care of your patients. You can print out evidence-based practices for your unit and perhaps leave it at the nurses’ desk or in the break room. Start a journal club or join one and come together with nurses who are willing to bring change to the units where you work.

Evidence-based practice change starts with you as a student. Be the change agent, and never be afraid to advocate for the care of your patients.

Key points to keep in mind:

  • It’s important for student nurses to learn the value of evidence-based practice, in order to provide high-quality care. It is never too early.
  • EBP is a based on research, evidence on best practices, and the consideration of individual patient’s needs, preferences.
  • During clinicals, do research on the medical conditions your patients have. It will help you provide a higher level of care.
  • Be proactive in suggesting EBP during clinicals or helping to bring more attention to EBP research.

 

 

CMS targets antimicrobial resistance and hospital-acquired infection compliance

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Significant bacterial infection can be cured with judicious and expedient use of appropriate antimicrobial agents, notably antibiotics.

However, repetitive short-term exposure to antibiotics and random mutation of bacteria have resulted in resistant bacterial organisms, with few options for cure.

The long-term consequences of bacterial resistance to antibiotics is increased morbidity and mortality and increased healthcare costs. To mitigate these outcomes, the U.S. Centers for Medicare & Medicaid Services has implemented requirements regarding proper antibiotic use. The centers also are scrutinizing healthcare organizations based on new requirements focusing on resistant infections that initially occur in the hospital setting.

Infections due to Clostridium difficile, commonly called “C. diff,” and methicillin-resistant Staphylococcus aureus, known as MRSA, are specifically targeted by the CMS, as they place a large burden on patients and the healthcare system and have a propensity to be acquired during an inpatient stay.

The penalties may result in up to 1% in reduced reimbursements from CMS for some institutions. This could cost them an estimated $430 million in 2016, making reduction of these organisms a major priority of many health systems, according to a Healthcare IT News article.

How can healthcare professionals address these infection issues?

The control of resistant microorganisms is a responsibility of everyone in a healthcare setting. Collaboration and communication among key members is essential to ensure reporting is uniform, and developed policies are appropriately designed and carried out.

First, education is necessary across the board, involving not only healthcare team members but also administrators, staff and patients. With all members having a better understanding of their role and a basic knowledge of the transmission of these organisms, the ability to track and control organisms becomes easier.

A 15% decrease in antibiotic use may be needed to decrease misuse by half, according to a recent CMAJ article, “Antibiotic overprescribing is a growing problem.” Appropriate hand hygiene, facility management and modes of infection transmission must be identified and addressed to reduce the spread of disease within the healthcare setting.

As with many medical issues, preventive measures are key to infection control. Policies and procedures should be developed that consider everything from patient transport to food services, to ensure minimal risk of microbial spread. Hand sanitization, gowning and medicine preparation are practices that should be evaluated and consistently targeted.

Finally, a dedicated means of gathering data, reviewing it and using it to develop and evaluate ways to continuously improve should be put into place.

With everyone better understanding their role in preventing the acquisition of these infections, improved reporting and institutional policies can be designed and implemented.

The overall impact on the healthcare system would be positive as patients are at a reduced risk of acquiring resistant and potentially lethal infections, and hospitals experience reductions in admissions and excessive costs.

 

Nurses experience a wide range of emotions when caring for patients.

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One of the most important tools needed to manage those emotions is empathy.

In this Q&A, we explain how empathy and developing self-compassion have impacted nurses’ career.

Q: Is it easy for healthcare providers to confuse empathy and sympathy?

A: It is, especially in the moment, but I don’t think most do this intentionally. Our typical reaction is to keep some emotional distance because it takes time and investment to truly step into empathy with someone. In a practical sense, we may be very rushed and need to get to the next patient. We simply don’t have the time to go there, so it’s easier to default to feeling bad for someone rather than with them.

Q: What makes empathy so powerful?

A: It’s powerful because it builds connection. People feel heard, supported, cared for and validated when someone is taking the time to truly walk through the steps of empathy with them.

Rarely, if ever, will the perfect words fix the painful situation in which our patients find themselves. We can’t take away the emotional pain with the perfect words, and to think that something we’d say will fix it is … well, unrealistic.

Rather than focus on fixing or making patients and their loved ones feel better, shifting that focus to just feeling with them can be significantly more meaningful.

This includes stopping to take in their unique perspective of the situation, genuinely suspending judgment, attempting to understand another’s feelings and then communicating that understanding. Our patients and their loved ones truly feel cared for when we stop trying to say the perfect thing and embrace simply being there and ensuring people feel heard, understood and validated.

Nurses are there for some of the most challenging days in an individual’s life, and we have a unique ability to provide this powerful support frequently. The caveat is that while it can be rewarding to be able to provide this authentic support to others, it can be difficult to continue to do so without taking specific, intentional steps to care for our own emotional well-being.

Q: Is compassion the same as empathy?

A: No, it is not. I like to explain the major difference like this: sympathy is feeling bad for someone, empathy is feel bad with someone, and compassion is the next step of feeling with someone by taking part in alleviating their suffering.

Only when we’ve been authentically empathetic do we know what compassionate act will best serve the individual. So while empathy can be provided while compassion is being practiced, they are not one in the same.

Q: What resources would you recommend to nurses who want to understand empathy?

A: One of my favorite resources for empathy is Dr. Brene Brown. She has published quite a bit of research and authored many books on the subject. She is able to combine the science of the research with the art of caring, which is something nurses can relate to and appreciate.

Q: What is self-compassion, and why is it important for nurses to practice it?

A: Self-compassion differs greatly from being compassionate for others. It is much more than being kind to ourselves, which is the assumption many make. It essentially consists of three elements:

  1. Being kind to ourselves rather than being overly judgmental.
  2. Recognizing that our challenges/experiences make us part of common humanity rather than isolate us from one another.
  3. Approaching negative emotions in a mindful and balanced way rather than over-identifying with them.

Nurses who practice authentic empathy are at much higher risk for burnout and compassion fatigue, which is not a surprise. However, nurses who practice self-compassion are much less likely to burn out and suffer from compassion fatigue.

It’s a very interesting concept and shown to be somewhat of a protective measure for those of us whose every day at work entails experiencing the trauma of others.

 

 

 

Nurses should practice pressure ulcer prevention

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Pressure ulcer or injury prevention remains one of the most common and significant tasks in healthcare for decreasing harm.

Ethically, we want to do no harm. We not only don’t want to cause harm, but we also want to avoid harm by preventing conditions like pressure ulcers in the first place. Benjamin Franklin’s adage, “An ounce of prevention is worth a pound of cure,” resonates in the healthcare community where we see the outcomes of preventable and unpreventable injuries.

We would much rather prevent injury than watch a patient live through preventable pain, wounds or diagnoses. A paradigm shift is in progress toward education efforts in communities to help people maintain or achieve healthy lifestyles so preventable conditions are avoided.

However, in acute, subacute and chronic environments, we care for patients/clients who have one or many healthcare conditions that put them at risk for injury – skin injury in particular.

How you can help prevent pressure ulcers

Is there a way we can involve healthcare teams through interprofessional education and discipline-specific prevention interventions to combat skin and pressure injuries? Yes!

In 2016, the National Pressure Ulcer Advisory Panel described a change in terminology. The NPUAP staging system now refers to pressure ulcers as “pressure injuries.”

The change should help healthcare professionals think of injuries and potential for injury in terms of harm to tissue from pressure regardless of whether the harm has resulted in open injury or nonintact skin. There can be underlying serious tissue injury before the injury progresses to the point of an ulcer or nonintact skin.

Have you ever heard a colleague say, “It’s just a stage 1 pressure injury.” or “If it blanches, it’s OK.” Well, is it really OK? Implementing prevention measures may help keep these areas of pressure stress or injury from becoming worse.

Practicing prevention also can reduce costs

Being prevention-minded can help save money too. Medicare has penalized hospitals with regard to preventable injuries or complications such as pressure injuries as reported in the article “769 hospitals face Medicare penalties due to patient injuries” in Healthcare IT News. Penalties for hospitals for preventable complications may be upward of $400 million.

In addition, pressure ulcers are a frequent topic for litigation, more so than even falls, according to the Agency for Healthcare Research and Quality. A past estimate states that a pressure ulcer can add tens of thousands of dollars in costs to a hospital admission.

There are things we can do to help decrease healthcare injuries. “A number of innovations have been published offering practicing nurses and managers ideas for raising awareness of skin care and preventing pressure ulcers,” states a research article published by the National Institutes of Health. “The majority of these have focused on patients in hospital settings with very little in the literature related to care-home and community initiatives.”

Despite available literature, pressure injuries are still a significant issue, and risk for pressure injury increases in persons with compromised mobility and/or nutrition, according to the NIH article “Pressure ulcer prevention is everyone’s business: the PUPS project.”

Nurse.com by OnCourse Learning has developed a one-hour interprofessional webinar, “It’s Just a Stage 1 Pressure Injury. Or Is It?” The webinar discusses deep tissue injuries, stage 1 pressure injuries, assessment tips for darker skin tones (where initial tissue changes may be harder to recognize), risk assessment and, of course, prevention efforts.

In addition, nurses, nursing assistants, physical therapists, dietitians, pharmacists and occupational therapists can earn continuing education credit through this educational activity.

 

Dismissed nursing student wants to know her rights

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Generally, if you’re a nursing student your rights in a dismissal proceeding depends on, first and foremost, if you are in a public post-secondary nursing education program or in a private nursing education program.

Public education program rights

If you are in a public college or university, your rights are dictated by the U.S. Constitution and case law interpreting your rights under the Constitution. Because you don’t leave the Constitution’s protections at the entryway of your academic campus, your rights follow you throughout the program.

  1. Notice of the reason for the dismissal.
  2. The right to a hearing before the dismissal occurs.
  3. Notice of the time and place of the dismissal hearing.
  4. The right to present witnesses in your favor.
  5. The right to a written decision by the academic program.
  6. In most instances, the right to legal representation at the hearing.

These rights are called due process rights. Because the law sees graduating from an educational program as a “property right” (ending in licensure), certain protections must be provided to the student to ensure a dismissal is not “arbitrary, capricious or discriminatory.”

You might wonder what the terms “arbitrary, capricious or discriminatory” mean.

An example of an arbitrary decision would be if it were illogical, subjective or made by chance. If you were dismissed without a solid, objective or valid reason, and you could prove this, the dismissal would not be upheld by a court.

A capricious decision of dismissal is one that is not predicted, is impulsive and is erratic. A nursing education program that makes fanciful decisions about who remains in the program and does not follow past decisions and its handbook would not be able to defend such a dismissal.

Discriminatory dismissal decisions are ones in which you are treated differently and not in accordance with the student handbook. If you are a male student and more demands are placed on you in your clinical and classroom requirements than female fellow students and you cannot meet these requirements and are dismissed, this can be seen by the courts as a discriminatory dismissal.

In addition, because a dismissal may prevent you from entering another nursing education program and meet your ultimate goal of graduation and licensure, the proceedings governing the dismissal must pass constitutional protections so that your  “liberty interest” in doing so are not violated.

Private education program rights

If, in contrast, you are a student in a private nursing education program, your rights consist of what the academic institution provides you with. As a result, student rights in private programs vary considerably and are spelled out in the student handbook.

Whatever protections surrounding dismissal from the program are granted by the institution must be adhered to. The student handbook becomes the touchstone of how the nursing program handles a dismissal.

The protections accorded by both a public and private post-secondary nursing program apply to you as a student in all nursing education programs at whatever level.

Take advantage of resources

The student who submitted the question asked where she could obtain more information about her rights when dismissed from a program.

The first resource for anyone in this situation would be a nurse attorney or attorney who concentrates his or her practice in education law and who represents students.

Obtaining a consultation as quickly as possible will help determine how to proceed in challenging the dismissal and obtaining legal representation in the dismissal proceedings.

Because the student who submitted her question is in an initial nursing education program, she also could use her membership in the National Student Nurses Association.

Nursing education programs have an obligation to ensure students enrolled in their programs fulfill all requirements of the program, including grade point averages, clinical competencies and adherence to its established student code of conduct.

The programs also have an obligation to adhere to the protections afforded students and to be fair, reasoned and principled when considering a dismissal of a student in its program.

 

5 ways healthcare teams can improve how they care for skin injuries

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Skin injuries are extremely prevalent. The cost is very hard on a healthcare system. Patients are coming into the hospital much sicker than they were years ago. They’re already at risk for so many things, and most every patient has two or more comorbidities. And to Medicare, pressure injuries are preventable.

Here are five ways to ensure you and your team are delivering the highest quality of patient skin care.

1 — Healthcare is a team sport

This phrase is especially true with pressure injuries and wounds. Every discipline has something unique to add to the care team. The approach of an interdisciplinary team is really the only way a patient can get a holistic approach. As nurses, we look at one picture, and everyone has expertise to look at from their perspective. It takes an overall, multidisciplinary team to look at the whole picture.

Nurses play a key role at the forefront of care. CWONs use their expertise to assess and treat wounds and ostomies.

PTs encourage ambulation and proper positioning of patients, along with promoting optimal function.

Pharmacists have the ability to examine a patient’s in-hospital and home medications for interactions, communicate with physicians and encourage any changes in medications.

OTs assist with patient transfers and re-positioning while providing helpful resources and equipment recommendations.

Registered dietitians and nutritionists assist in wound healing by performing a thorough nutritional assessment, looking for signs of malnutrition or other dietary deficiencies. This assessment determines nutrition needs that can aid in the healing process.

#2 — Look from head to toe

Re-positioning patients every two hours is a high priority to avoid pressure injuries. The need to examine potential problem areas of the body also is a necessity for healthcare clinicians.

Some areas are ones clinicians may not expect or regularly check. Especially in the ICU, we see a lot of places on the back of the head. I would have never thought about that when I first got into wound and ostomy care.

Heels, hips, elbows and tailbone often are concerns. For patients who prefer to lie on their sides, clinicians should monitor shoulders, knees, ankles and ears. For patients on oxygen or who use a CPAP machine, the nose and cheeks — where a mask fits tightly on the face — are common trouble areas.

#3 — Document, document, document

Hospital-acquired pressure injuries are among the conditions considered preventable by the Centers for Medicaid and Medicare Services. Thus, healthcare facilities are not reimbursed for treating these injuries when they are acquired by a patient in the hospital.

A thorough skin assessment “is very important when a patient arrives. This protects a healthcare facility from potential litigation and also serves as a baseline for caring for the patient.

That assessment is critical to the healthcare system and the patient. If the facility doesn’t document these injuries in the first 24 hours, we are legally liable from Medicare.

A full assessment early in a patient’s stay offers other benefits too. Like getting the interdisciplinary team involved immediately. If the hospital doesn’t know the patient was at high risk and they let that go, that’s where they get into legal complications, and the patient suffers, as well.

#4 — Consider where patients are going/coming from

Knowing the path your patients take during their hospital stay can offer helpful clues. For example, a patient who spends hours in surgery or getting tests such as an MRI, x-ray or CT scan all will be lying for long periods on hard surfaces. This leads to a greater risk for pressure injuries.

In addition, patients who are unconscious, anesthetized, paralyzed, sedated or have neuropathy all have an increased pressure injury risk.

This is where OTs are important in the care plan. An OT can come in and assist with transfers, re-positioning and offer good resources for the patient.

#5 — Start with a smile

Learning about a patient begins when entering a room. You can tell a lot just by smiling at them.

A return smile from a patient can be the start of a nurse’s education. Smiling shows a nurse if a patient has dentures, a full set of teeth or very few teeth.

Does a patient have jaundiced, dry or moist skin? Are bags under the eyes present that could signal a patient isn’t getting enough rest?

Noticing these signals right away is the beginning of a good assessment.

Try to put yourself in their situation. Always ask about their day. Your goal with every patient should be to have them smile before you leave the room.

Damron also learns from patients who don’t smile, make eye contact or speak to her. These could be signs of depression, mental challenges or cultural differences.

“If they don’t make eye contact, then I know something’s definitely wrong,” she said.