Home Healthcare Benefits for Nurses and Patients

/in /by

With healthcare workers at the forefront of these challenges, their preferences for their work environments are beginning to shift. The rate of nurses leaving the profession is rapidly increasing. Hospital IQ surveyed 200 nurses and found that 90% are considering leaving the profession — 71% of those nurses reported at least 15 years of experience. Rather than leaving the profession altogether, nurses should consider the benefits of home health care positions compared to working in the hospital environment.

Home Healthcare Benefits for Nurses

The Centers for Medicare & Medicaid Services (CMS) reports that home care expenditures are expected to reach $201B by 2028, a 73% increase from 2020. This increase in funds will allow nurses to easily transition from intense hospital environments to individualized home care settings.

Since the onset of the pandemic, nurse to patient ratios have drastically increased to dangerous levels. This overload is just one of the many new challenges for nurses presented by the pandemic. Nurses shifting to home health care can avoid bureaucratic obstacles common in hospital settings and focus solely on their patients.

Home care allows nurses to provide high-quality, individualized care and have more autonomy in one-on-one settings. Schedules can be more flexible and customized to best fit the needs of the patient as well as the nurse. Physically, home health care is less demanding on nurses which can be a great transition for beleaguered nurses used to working 12-hour shifts with little to no breaks.

Nurses working in the home healthcare can more easily see the fruits of their labor. Patients are able to demonstrate their progress by completing daily, household tasks all thanks to the hard work and dedication of their home health nurse. This adds a uniquely fulfilling experience for nurses which can be not as common in many hospital settings.

Home Healthcare Benefits for Patients

COVID-19 not only changed the hospital environment for nurses — it drastically changed for patients as well as increased fear of hospitals became common. Individuals who were sick or injured during the initial stages of the pandemic were less likely to go hospitals to seek care in fear of contracting the virus.

A research study conducted by NEJM Catalyst showed that during the onset of the pandemic, emergency room visits declined by nearly 50%. This shifting view of hospitals and healthcare at large has resulted in patients, especially elderly ones, preferring to receive care in the comfort of their own homes.

For the elderly, entering the hospital poses several risks including a higher chance of falling and contracting illnesses due to exposure. Approximately 700,000 to a million people fall in hospitals each year in the U.S., according to the Agency for Healthcare Research and Quality. More than one-third of these falls result in serious injuries like fractures and head trauma.

Entering the hospital or a nursing home long-term poses both physical and mental risks. A research study found that approximately 20% of all nursing home residents have major depression (about 350,000 people in the U.S.), and an additional 30% have significant depressive symptoms. Home healthcare can more easily spare them from several these physical and emotional risks. With Medicare and Medicaid reform adding expenditures for home healthcare, nurses can rekindle their love for nursing in a less stressful environment while making an immense impact on the lives of their patients.

Transitioning to Home Healthcare

U.S. Bureau of Labor Statistics reports that home healthcare is one of America’s fastest-growing industries, with a projected compound annual growth rate of 5% for 2014–2024, which equals approximately 760,400 new jobs.

While the pandemic is still presenting unprecedented challenges, the increased awareness of the benefits of home healthcare is a beacon in the healthcare industry during this difficult time. Home healthcare nursing can be the pathway for nurses facing burnout.

Becoming a Home Health Nurse

According to the statistics and projections from the National Bureau of Labor and the Health Resources and Services Administration, the need for nurses skilled at providing care to patients in their homes is growing.  This is a good time to consider a career in home health nursing. This course provides nurses with information about home health nursing practice, so nurses can determine if home health nursing is a good career choice for them. The rewards, challenges, required skills, regulations, and agency types of home health nursing are reviewed.

 

Does Closing Patient Privacy Curtain Breach the Standard of Care

/in /by

I’m sure you are familiar with the importance of adhering to your nursing standard of care for patients.

As I have noted in previous a previous blog, your standard of care in a professional nursing malpractice case is based on applicable standards of practice such as the nurse practice act and position statements from your professional nursing organizations.

In a 2021 Louisiana appellate court case, the court articulated the requirement of proving that a standard of care was indeed breached.

Elements of the Case

In this case, the female patient was admitted to the medical center for treatment of a staph infection connected to her existing medical condition, scleroderma. When treated with antibiotics for the infection, acute renal failure resulted, and the patient required dialysis.

While on dialysis, the patient experienced seizures which required resuscitation. She was admitted to the ICU for further treatment, which included placing her on a ventilator, and her plan of care included “seizure precautions.”

On the patient’s first day off of the ventilator, she “[was] alert, talking, ate breakfast, and participated in a physical therapy session.” When she completed the therapy session, she asked an ICU nurse to close her privacy curtain so she could rest.

When a phlebotomist entered the patient’s room about 20 minutes after the curtain was closed, the patient was found unresponsive on the floor. A code blue was called, and the patient was re-intubated and placed back on the ventilator. Approximately 10 days later, the patient’s ventilator was removed, as she had no brain activity.

The cause of death was determined to be “anoxic brain injury…secondary to cardiac arrest, secondary to renal failure, and secondary to scleroderma.”

Eight months after her death, the patient’s siblings filed a malpractice case against the medical center alleging numerous failures on the part of the medical center’s staff in properly monitoring the patient, both physically and by telemetry, and responding to the late patient’s medical needs.

Medical Review Panel’s Finding

Consistent with state law, a medical review panel reviewed the complaint. The medical panel, composed of three expert physicians, “unanimously concluded” that there was no deviation from the standard of care by the medical center.

As to the nursing staff’s conduct, the panel found that the ICU nurses followed protocol regarding side rails and fall precautions. It further found that it was appropriate to honor the patient’s wishes to close the privacy curtain.

The panel’s additional findings indicated that the patient suffered many afflictions, including scleroderma, pulmonary hypertension, and methicillin resistant staph cellulitis.

The medical center filed a Summary Judgment Motion, stating that there was no medical expert testimony to support the siblings’ case. The siblings opposed the Summary Judgment Motion but did not identify a medical expert. Rather, their position was that the negligence against the medical center should be inferred.

They also raised the doctrine of res ipsa loquitur (“the thing speaks for itself”), arguing that the circumstances suggest that the fall would not have occurred but for the medical center’s negligence, that the medical center had control over her care, and that there was no other plausible explanation for her fall and death.

The trial court granted the medical center’s Summary Judgment Motion and dismissed the case with prejudice (meaning that it could not be refiled).

Appellate Court Decision

The late patient’s family’s appeal was based on her suffering and death. They alleged that the closure of the privacy curtain, along with inappropriate telemetry monitoring, was a deviation from the standard of care in an ICU room.

The court supported its decision by citing state law and cases. It began by pointing out that the medical center clearly met its initial burden of proving it was entitled to Summary Judgment as a matter of law due to the medical review panel’s decision.

Because the medical center met its burden of proof, the burden shifted to the siblings to produce facts to support their contention that there was a breach of the standard of care and that breach caused their sister’s death.

The siblings did not present any facts to allow the court to deny the Motion for Summary Judgment. Moreover, they did not present as evidence an expert medical opinion.

The court also held that the doctrine of res ipsa loquitur was not applicable in this case, as it can only be applied when there is factual evidence and “sufficient circumstantial evidence to suggest the only reasonable cause of injury, in the context of a medical malpractice action, is a breach of the standard of care.”

The evidence in the record, the court opined, failed to eliminate other more probable causes of the patient’s death than negligence, including her previous seizure history, the possibility that her telemetry monitor was disconnected as she attempted to get out of bed without assistance, and that her death was from a lack of oxygen.

The court affirmed the lower court’s granting of the Summary Judgment Motion and dismissed the case against the medical center.

How This Standard of Care Case Affects You

There is no question that you have a legal and ethical obligation to protect your patients’ privacy, which includes an individual’s right to get away from the “hustle and bustle” of a busy hospital environment. This is especially so when a patient requests the closure of a privacy curtain or a room door.

But, as this case makes clear, there remains a continuing obligation for nursing staff to assess the patient and provide care consistent with the standard of care in the situation.

The nursing staff’s documentation regarding the care of the patient on the day of her death, both before and after the privacy curtain was closed, was an essential, factual basis for the court’s decision. Be sure to accurately document all aspects of the care you provide to patients, including flowsheets, nursing notes, and communications.

Finally, ensure that you are up to date with all aspects of the monitors you work with and that your skillset regarding them is current.

 

Do You Know What Questions To Ask During a Nursing Interview?

/in /by

When you come home from your first day at a new job, will you be energized by its possibilities or feel slightly sick to your stomach and anxious that you’ve made a big mistake? If it’s option B, you may be able to trace that nauseated feeling back to something you overlooked during a nursing interview.

An organization with a job vacancy spends a lot of money advertising for the right person to fill an open spot while marketing itself as the best workplace in the U.S. So, as you’re headed into your interview and prepared to present yourself as the world’s most fabulous nurse, keep one question in the back of your mind: Do I really want this job?

Whether you’re a new or experienced nurse, you should know something about the job you might take and the organization you’re considering joining. Neither exists in isolation from the other. You might not have time to ask questions about every aspect of the job during a nursing interview, but you might have time during subsequent pre-employment meetings with your prospective boss and staff. You can always research the employer on your own through an Internet search, social media and colleagues with whom you can network. Here are key discussion points to explore during pre-employment meetings and areas to investigate outside of the formal hiring process.

5 Areas to Investigate Before Taking the Job

Staffing — Every unit has a budgeted staffing plan. Does this organization connect budgeted staffing to an acuity system? If so, is the acuity system routinely used? Are budgeted positions filled or left vacant because of a difficult local job market, because the unit is an unpleasant place to work or because the organization is trying to save money by not filling positions?

A well-managed unit will strive to fill positions so scheduling is consistent and projected for weeks in advance, incorporating workers’ vacations and unexpected emergencies.

Scheduling — You should know the basics that come with the job, such as shift rotation, weekend scheduling and call policies. Find out if scheduling is accomplished electronically or by personnel. Is the schedule generated by a centralized office for the whole department or created on the unit, as in self-scheduling? And what does self-scheduling mean on your new unit? Are the self-schedulers a small cadre of staff who have been cranking out the schedule for 10 years, where new hires have little chance of getting any requested time off or counting on a regular schedule that allows time to go back to school?

Management — Never take a job without interviewing your prospective manager, because management styles vary. For example, if you want to work for a maternalistic or paternalistic supervisor, you can find managers who treat their staff as children, doling out rewards and punishments commensurate with behavior. Some nurses want that. Other managers view their staff as vibrant professionals who, like race horses, need room to run and opportunities to win. And if this will be your first job, know that your initial manager may likely influence your socialization and how you view yourself as a nurse for a long time, so choose that person as carefully as you select your job.

Co-workers — They are equally important in influencing your self-perception as a professional nurse are the staff around you. If you spend 40-plus hours per week around enthusiastic coworkers, then you’re surrounding yourself with positivity and your career may benefit from these good examples. If you hang out with Negative Neds and Nellies, your career may not have as good of a chance to prosper. Make sure you interview as many staff from the unit as possible. Some organizations allow for a group interview, and at the very least, you should be able to network via social media with some of the people with whom you will be working. Find out what sort of teamwork goes on, and get a bead on the culture of the unit.

Shared governance — Many organizations have or aspire to Magnet accreditation or Pathways to Excellence status, and you should seek them out. A requirement for these designations is not necessarily something labelled “shared governance” (or shared leadership, decision-making, or whatever combination of sharing is used as a label), but any program that empowers caregivers to make meaningful decisions about their practice and the resources that support it. But shared governance makes this happen.

You need a firm understanding of what shared governance is, so you can evaluate whether it has been successfully implemented in both the unit and organization in which you are considering employment.

If you thoroughly investigate these five areas of human capital, you will be an informed potential consumer for your next nursing interview. You will be ready to prepare for second and third interviews, accept the forthcoming job offer or move on to other prospects. It’s good to know about a job before you take it, but it’s even better to know everything about the organization — the good and the bad — before you join the ranks.

 

Could This School Bullying Tragedy Have Been Prevented?

/in /by

An essential duty of any RN, including a school nurse, is assessing the patient. As I wrote in a previous blog, this duty includes both a physical and emotional assessment of any student who presents in the school nurse’s office.

In the following case, a school nurse’s role should have included assessing a frequently bullied student who ultimately took his own life. The case illustrates the importance of this aspect of school nursing.

Specifics of the Case

A third-grade student at a public school in Cincinnati, Ohio, was the victim of 12 violent, bullying incidents that began when he was a first grader until his death when he was a third grader.

The bullying incidents consisted of students punching, kicking, or hitting him. When he tried to defend himself on one or two of the occasions, he was told “he would be punished if he punched a student in self-defense.”

The physical injuries sustained by the third-grader included the loss of two front teeth, a bloody nose and lip, and a thumb injury.

After experiencing a bloody nose and lip due to a bullying situation, the boy was treated by the school nurse. The school nurse called his mother and told her that two students had punched her son in the face which resulted in the injury.

Although the school stated that they left voice messages with the victim’s mother after the other incidents, she denied ever receiving them.

In addition, when the school did contact her after one of the incidents, the mother asked to see the video of the altercation. Her request was denied.

Another incident occurred two days before the third-grader’s death. A student began attacking male students in the school bathroom. When the boy walked into the bathroom, the “aggressor” grabbed the boy’s hand and yanked him toward the wall, causing his head to “collide with something.” The boy fell to the floor unconscious, with the aggressor “celebrating” his fall.

At least a dozen students passed through the bathroom after his fall, “taunting and kicking” him as they entered and left the bathroom.

When the assistant principal responded to the situation, the boy was still unconscious and lying on the floor. The principal did not check for vital signs or get help. The boy was unconscious for more than seven minutes.

An hour after the incident, the school nurse examined him after he regained consciousness. She did not call 911. Rather, she called his mother and told her that her son had “fainted,” was alert, that his vitals [were] fine, and that he did not require any additional medical attention.”

The boy did not tell his mother about the attack.

At home, he experienced stomach pain, nausea, and vomiting. His mother took him to the hospital, and she told the ED staff he had “passed out” at school. Since she did not know that her son had experienced a head injury, she could not share this.

The boy was diagnosed with the stomach flu, and he was sent home. He did not go to school the next day due to his being ill. When he returned to school, he was attacked once again. He told one of his teachers, but no follow-up took place.

The boy came home after school and took his own life.

Family Files Lawsuit

The third-grader’s parents and the administrator of his estate on their behalf sued the school district and others, including the school nurse, for a violation of his civil rights under Section 1983 of the federal Civil Rights Act of 1871.

Several of the defendants, including the Board of Education, filed a Motion to Dismiss the claims, alleging they were entitled to governmental immunity under state law. The trial court denied the defendants’ motion.

The defendants appealed that decision and argued that they were entitled to immunity because the plaintiffs failed to establish that their conduct was “reckless.” The appellate court’s decision reviewed the facts of the case in detail in their opinion.

It found that, among other things, the defendants:

  1. “Withheld information concerning [the boy’s] safety and wellbeing” as a student in the school.
  2. “Failed to punish the students that attacked [him].”
  3. Failed to contact his parents about the bullying incidents.
  4. Failed to call 911 for more than three minutes after discovering he was unconscious.

The appellate court affirmed the lower court’s denial of the Motion to Dismiss and held the defendants were not entitled to state governmental immunity.

Five months after that decision, the Cincinnati Public School System reached an agreement to pay the family $3 million and to institute reforms to strengthen the bullying reporting system that was currently in place, including including “empowering school nurses to report suspected incidents of bullying.”

Lessons for School Nurses

If you are a school nurse, you know that school bullying is not a random occurrence. The Centers for Disease Control and Prevention (CDC) notes that in nearly 12% of public schools bullying takes place once a week. Assessing a student who is the victim of bullying is critical to that student’s wellbeing.

In this case, it appears the school nurse did not take into account the emotional toll the numerous incidents of bullying had on this student. Had she conducted a careful and complete assessment of both the physical and emotional injuries to this student, the outcome may have been radically different.

The importance of reporting a bullying event as your school protocol requires cannot be overlooked. It is not known what the reporting system was in this case. Apparently, though, it was not substantial enough to provide the school nurse with the personal power to report the bullying outside of the school.

Yet, as you know, you must also meet your legal and ethical duties to report suspected child abuse to the proper authorities as required by state law. The duty to report suspected child abuse is not one that you can succumb to pressure from others to not report or rely on a reporting system that does not provide you with the power to do so. The mandatory obligation to report is yours and yours alone.

Furthermore, when contacting a parent about his or her child’s bullying incident, it is essential that you are truthful about what happened. Why the school nurse in this situation did not do so when she contacted the boy’s mother about the bathroom attack is perplexing at best.

It is also puzzling why the school nurse did not seek further medical evaluation, either by telling his mother that he sustained a head injury or by calling 911 when he was in her office.

Remember, too, that your documentation of the care of any student must provide a clear picture of what you assessed, including what treatment and interventions you provided and your call to the student’s parents and what was said.

 

Case Management Fast-Growing Role, Despite Pandemic Difficulties

/in /by

It’s difficult to overstate the critical importance of nurse case managers. They oversee virtually every aspect of a patient’s care from admission to discharge. They are the principal contact for patients and their families when addressing immediate and intermediate needs.

A patient’s short- and long-term treatment options are almost always orchestrated by a dedicated nurse case manager.

And throughout the COVID-19 pandemic, case managers have assumed even greater, more visible roles as hospitals and healthcare facilities have struggled to navigate unfamiliar terrain. They’ve been integral in ensuring that extant procedures function as intended, and new protocols are adhered to and address the needs of large, diverse patient groups.

By now, the hurdles that healthcare workers in virtually every setting faced at the onset of the pandemic are well-documented. Nurse case managers were certainly no exception.

For many case managers, “It was baptism by fire,” said Catherine M. Mullahy, BS, RN, CRRN, CCM, FCM, President of Mullahy & Associates, which provides case management continuing education, certification preparation, training, and support. “Everybody was pressured to do more with less and work in extremely tense environments with so many negatives swirling around every decision,” she added. Mullahy, along with Jeanne Boling, RN, MSN, CRRN, CDMS, CCM, FCM, Vice President of Mullahy & Associates, is also the creator and instructor for Nurse.com’s Best in Class Online Case Management Course.

Though it’s true that many case managers are also nurses, not every component of nurses’ extensive skillsets necessarily translate to the demands that case managers must meet.

This was certainly the case during the height of the pandemic.

Nursing vs. Case Management

According to Mullahy, many case managers new to the role aren’t necessarily aware of the pronounced differences between the responsibilities and challenges entailed and how these differ from day-to-day nursing.

“Some of the skills you need as a case manager transition from nursing, but many of them do not. Many nurses don’t have to do the kind of complex care planning associated with case management. Nurses are at the bedside, and they see that patient while they’re in their unit — and once the patient goes home, that’s it. But case management done correctly should consist of ongoing Involvement with that patient as they transition within the hospital and beyond.”

COVID-19 expanded the need for this kind of continuous attachment to the patient. And more case managers were called for to fill that gap.

Demand for skilled case managers skyrocketed during the height of the pandemic. There were greater numbers of sick patients with disparate needs being discharged into an array of settings.

It was up to case managers to organize and orchestrate these movements — all while keeping patients and their families (not to mention insurance companies) apprised at every turn.

“Many case managers had never done this before — they were used to primarily moving patients to their homes,” Mullahy acknowledged. “But now, there were many ventilator-dependent patients, for example, who had to be placed in facilities that the case managers were unfamiliar with and in many cases didn’t even know where these facilities were located.”

This illustrates the kinds of obstacles unique to case managers, even under the best of circumstances. The burnout and frequent uncertainty regarding patients’ status significantly contributes to attrition within case management, a problem clearly exacerbated by the pandemic.

Unique Stressors

Mullahy admits that turnover among case managers has been an issue for some time, a problem certainly not helped by the myriad stressors brought by the pandemic.

“Many case managers had unmanageable caseloads before the pandemic hit, and they carry a lot of guilt,” she explained. “They’re working 12-hour days and then going home worrying about whether or not the home health agency showed up when they were supposed to or if the infusion antibiotics arrived. Making sure their patients are adhering to their treatment plans, communicating with patients and their families, and keeping other members of the patient’s medical team informed requires a great deal of focus, organizational skills and detailed reporting which can be extremely challenging at times.”

To be sure, all nurses are relentlessly dedicated to their patients’ wellness. But nurses work on teams in which each person is committed to working in tandem to achieve the best outcomes for those in their care.

The circumstances Mullahy lays out illustrate the kind of persistent obligation that case managers feel, without the support of team members to help them with each patient in their charge.

“Nurses working in the unit know that when they leave, there will be someone coming in right behind them to see to their patient,” Mullahy explains. “Case managers on the other hand — when they’re discharging a patient, they’re solely responsible for them, and they’re left wondering what’s happening. ‘How is the family coping? Is someone making sure they’re taking their medication?’ It’s a very different, emotionally challenging role.”

Proper training is vital to helping nurses interested in transitioning to nurse case management and preparing them to bear the unique stressors and nuances associated with the role.

Nurse Case Management Training

The Bureau of Labor cites case management as one of the fastest-growing occupations in the U.S., even before the pandemic. With this upward trend, the need for training has grown along with the role itself.

In addition to a solid clinical background and experience, effective training is key to learning the particulars of things not commonly associated with standard nursing responsibilities, like community resources, payer systems, and how to best help patients across the entire spectrum of care.

Mullahy notes that though case management had to adjust to meet the pandemic’s demands, the core components of the role have remained largely unchained, and the training that she champions is specially designed to teach those skills.

“The essential components of case management have not really changed in all the years we’ve been doing this,” she acknowledges. “There are certainly little tweaks here and there, and new healthcare system related developments such as utilizing new technologies, contributing to population health management data capture, as well as changing demographics and rising incidences in certain medical conditions. But things like how you assess planning and coordinating, how you evaluate a plan then demonstrate and measure the outcomes — those things have never changed. And proper training will give you the knowledge and skills you need to do these things well and feel comfortable in an interview and get yourself a job within case management.”

 

Ambulatory Care Nursing: Quickly Evolving and In Demand

/in /by

Ambulatory nursing is really about collaboration and coordination,” said Johnson, a patient navigator, coach, consultant and nurse leader for more than 35 years.

Nurses are pivotal in ambulatory care delivery. They understand plans of care and how to communicate those to patients and families, and they know what to do and who to call if something goes wrong.

Ever-Growing Demand

Care will continue to shift from traditional acute care to ambulatory settings, and the demand for ambulatory care nurses will increase exponentially, according to Susan Paschke, MSN, BA, RN-BC, NEA-BC, a nurse leader, administrator and quality management specialist with 40 years of experience in a variety of healthcare settings.

“Coordination of care and management of the transitions between levels of care are natural roles for ambulatory care nurses,” said Paschke, also a speaker for the Nurse.com Ambulatory Care Nursing Certification Review course.

“Virtual visits and telephonic care also are in the realm of the ambulatory care nurse,” and these duties have ramped up during the pandemic, she said.

Ambulatory care settings include traditional medical clinics, urgent care centers and outpatient surgery centers. Ambulatory care nurses work in infusion clinics, outpatient oncology units, retail centers that have onsite clinics, schools and even in long-term care, where nurse practitioners might do rounding, according to Johnson.

Pharmaceutical companies hire these nurses to educate, coach, monitor and triage patients that use specialty drugs and other treatments for rare diseases. These nurses also deliver care in people’s homes. For instance, these nurses teach parents and children how to use at insulin pumps, cardiac monitors and other equipment in the home, said Johnson.

Ambulatory Nursing’s Distinguishing Factor

The transition from acute care to ambulatory care might not be seamless for many nurses. That’s because telephone triage is a key distinguishing characteristic in ambulatory care. Nurses in acute care usually have their patients in front of them as they’re getting data, educating and more.

“Nurses in critical care have a lot of experience managing crises,” Johnson said. “They have a lot of equipment to help them understand what’s going on.”

Nurses doing telephone triage don’t see patients. They use standard protocols, as well as nursing judgement to effectively do patient interviews, collect data and listen to what patients are saying and what their needs are. It’s a skill, according to Johnson.

Effective telehealth can keep patients out of the clinic and safe, as well as respond in a timely way to patients whose symptoms are worsening.

Why Get Certified?

Certification is, in general, important for nurses in any given specialty, according to Johnson. “Certification is sort of the gift your give yourself and your institution,” she said.

Research has shown nurses who are certified are more competent and confident in what they do.

“When I hired nurses, if I had nurses that were equal in education, skill sets and experience, but one was certified and one was not, I would always hire the certified nurse because I know that nurse has invested in [her or his] career,” Johnson said.

Like in other specialties, nurses have to work 2,000 hours in an ambulatory care setting before sitting for the exam to become certified by the American Academy of Ambulatory Care Nursing.

Certification helps nurses keep up with the constantly changing demands, evidence and complexity.

“Seventy-five percent of all visits in ambulatory care are for chronicity of illness,” Johnson said.

Today’s patients are increasingly using technology to help them and their providers manage chronic healthcare conditions. That means there will be more back-and-forth communications with ambulatory care nurses and doctors as they collect, review, educate and act on the data.

A Big Issue in Ambulatory Care

The Nurse Licensure Compact greatly impacts ambulatory care. Nurses in non-NLC states can’t practice across state lines to use telephone triage for their patients if those patients are in different states when they call. That limits the care nurses can provide.

But that issue seems to be easing as more states have become NLC states or have legislation pending during the COVID-19 pandemic. There were 34 NCL member states as of April, with pending legislation in several others, according to the National Council of State Boards of Nursing.

“The one thing that is probably going to change with this crisis is that every state is going to pass compact licensure,” Johnson said. “And it needs to change because our world is mobile. This is an issue that I really support. That way nurses could triage across state lines.”

Johnson described ambulatory care as the “richest” nursing practice in the U.S. today. “You see patients from birth to death,” Johnson said. “The ability to support, coach families and patients about what they need, I think it’s a gift.”

 

After a Nursing Job Interview, There’s Still More to Do

/in /by

You’ve done it. You submitted your resume and cover letter, and you just made it through a nursing job interview with the manager for a nursing job you really want. Now what? Do you wait for a call? No, you get your ducks in a row, follow up in a timely manner and plan your next move.

Take Stock in What Went Well and Not So Well

After the nursing job interview, there’s still plenty to do. When you walk out of the interview, it’s time to take stock. Ask yourself the following questions:

  1. How did it go?
  2. What went well and what could have been better?
  3. Did you sufficiently highlight your strengths?
  4. Did you assuage any concerns expressed by your interviewer?
  5. Are there unanswered questions on your mind?

Job interviews are research and development for your nursing career. Each experience builds upon the last. Your interview skills and comfort will grow with time. Learn from your experiences; study interview techniques; practice with a friend, family member, colleague or career coach; and use these conversations as a training ground for your career. Make note of what you could have done better and bookmark it for next time.

Follow Up After the Nursing Job Interview

Follow up is crucial. In this fast-paced world, most interviewees will send a thank you by email. This is fine, but if you want to stand out from the crowd, send a typed thank you letter, using the same letterhead, style, and paper as you did with your resume and cover letter. If you were interviewed by more than one person, send a thank you letter to each individual.

Your thank you letters should be concise, reiterating your enthusiasm about the position and the employer and expressing your gratitude for the opportunity to have a substantive conversation.

Briefly — but powerfully — highlight the skills, knowledge and experience that make you the perfect candidate. Always include a copy of your personal business card with your thank you letter.

If you have not received a return call within the time frame you were told to expect a response, call your interviewer and graciously inquire regarding how the hiring process is proceeding. If you are informed that you were not selected for the position, feel free to politely inquire if there is something about your experience or interview skills that they feel you can improve. It never hurts to ask, and it shows a high level of maturity and professionalism.

A Few Extra Tips

If you are waiting to hear back regarding a position for which you’ve gone through the nursing job interview process, here are a few more things you can do — and one you shouldn’t do:
• Find your interviewer or interviewers on LinkedIn; send a personalized invitation to connect. Do not send a generic invitation under any circumstances.
• Enter the interviewer’s email address in your email contacts, so any emails from them do not mistakenly go to your spam folder. Check your spam folder daily, just in case.
• Enter your interviewer’s phone number in your phone’s contacts. This will help you recognize the incoming call if they call you, and be prepared with your best professional voice.
• Conduct further research on your potential employer to prepare for a possible second interview.
• Never send a “friend” request to an interviewer on Facebook.

Always be the consummate professional. Learn to ace your interviews and the all-important follow-up process.

 

5 Tips for New Nurses

/in /by

Congratulations! You’ve completed the hard work of nursing school and passed the NCLEX. You now have a good foundation of the skills that you will need to launch your nursing career. Once the excitement has settled and the diploma is proudly displayed on the wall, you might find yourself wondering, “What’s next?” These tips for new nurses can help center your thinking.

Starting a new career as a nurse is an exciting time but also comes with some stress and worry about being out on your own. Building on the foundation of your skills takes time but is well worth the effort.

Though there are many tips that may be helpful during the beginning of your career, organization, mentorship, confidence, learning, and self-care are especially important tips for new nurses.

Organization

Organizational skills are a must for the new nurse. As you get started on your own, developing a routine and a system that works for you is essential for a successful shift. Though the exact needs may vary based on where you work, organization is a great tip for a new nurse.

For some, showing up early to get a few minutes to review their assignment, getting a cup of coffee, and taking a moment to center themselves can be helpful. Find an organized way to get a report from the previous shift. After report, take a moment to prioritize your day. Review the orders and medications for your patients and come up with a rough schedule of how the day will go. If there is something pressing that needs to be done, take care of that first. A helpful tip for new nurses is to set a schedule for rounding on your patients.

Another way to stay organized is to keep notes throughout the day. Write down things you need to remember to do or questions you need to ask. This can help you keep your thoughts organized and make sure you’re able to accomplish everything.

Mentorship

Finding a good mentor is incredibly beneficial as you start your nursing career. Some employers provide formal mentorship opportunities for new nurses. If your employer doesn’t assign one for you, seek one out as you meet your fellow nurses. If there is someone you’re comfortable with and respect, ask them if they would be willing to mentor you.

Developing this mentor relationship can help continue to build your skills — skills beyond the clinical ones. A mentor can help with skill building in decision making, communication, and organization just to name a few. Mentors can also share their experience and the things they’ve learned over the years that have been helpful or not so helpful. It can be comforting when you’re new to have someone to go to when you have questions or concerns.

Confidence

It’s important to remember that you do actually know what you’re doing! Although many things are still new and unfamiliar, never forget that you are more than capable of doing what needs to be done.

A key tip for new nurses — try not to compare yourself to other nurses. No two nurses are the same and each nurse has something to offer. Comparison sets you up to possibly feel inadequate, which can lead to questioning your ability to do the job. It’s also important to remember that every nurse was new once, and not one of them became an expert overnight.

Becoming confident won’t happen quickly. It takes time as you experience new situations and learn how to grow into your role. Exhibiting confidence in your interactions with patients will help them feel more at ease and confident in your care.

Never stop learning

Although you just finished school and might not want to think about going back anytime soon, never stop learning. Continually seek out opportunities to continue building your skills and knowledge. This is one of the most important tips for new nurses.

Learning doesn’t always have to take place in a formal classroom setting. There are ways to learn through many avenues, including:

  • Continuing education courses
  • Getting a certification in a specialty
  • Participating in a committee in your workplace
  • Attending nursing conferences
  • Participating in virtual meetings or webinars
  • Reading nursing journals
  • Discussing issues with other healthcare providers

Take care of yourself

This may be one of the most difficult tips to follow but is one of the most important tips for new nurses. Nursing is a rewarding career, but it is hard work. Nursing can be physically difficult and emotionally draining. Knowing how to recover from a tough shift and take care of yourself is an important skill to master. Some tips for new nurses include:

  • Eating a healthy balanced diet and exercising regularly to help manage stress
  • Getting enough sleep
  • Spending time with family or friends
  • Getting a massage
  • Mediating
  • Taking a vacation or weekend away

Tips for New Nurses

These tips for new nurses can help you be successful in your practice. Never hesitate to ask questions and remember to give yourself some grace as you adjust to your new and exciting career. And remember, every nurse has been in your shoes and understands what it’s like to be new. Before long, you’ll be sharing your own tips for new nurses with a new cohort.

 

 

5 Positive Traits of High-Caliber Nurse Leadership

/in /by

Nurse leadership is crucial to the health of any unit, facility, or agency, and we’ve all likely heard or experienced horror stories of nurse managers from Hades.

Still, there are stellar nurse leaders in the healthcare ecosystem, and there are certain ubiquitous traits in those leaders who stand above the rest. Here are five traits that can readily identify progressive nurse leaders who are at the top of their game:

Highly-Developed Communication Skills

There’s a saying that we have two ears and only one mouth for a reason. A stellar nurse leader spends a great deal of time listening to what the nurses on the ground have to say. He or she will actively solicit information, listen deeply and then use that data as part of an ongoing assessment of the organization.

As a thoughtful, conscientious leader, individuals of this caliber use deep listening as a skillful assessment tool, and then consciously employ language that avoids shame and blame. Thus, a style of communication is employed that is an example to all in its fairness and kindness.

Fairness in Action

A high-caliber leader may indeed make difficult decisions, and he or she does so with a conscientious sense of equanimity. Decisions aren’t made from a place of reactivity; rather, they are arrived at through the aforementioned process of deep listening and careful deliberation.

Not every decision may seem fair to every team member, but necessary actions are explained using empathic acknowledgement of the potential discomfort that some may feel regarding the outcome. Even so, many team members still may admit the leader is thoughtful and fair, despite disagreement with the overarching decision.

Self-Knowledge

In order to be an effective leader, the nurse manager demonstrates an affinity for increased self-knowledge. This implies the nurse manager’s willingness to critically review his or her behavior style, openly admit shortcomings and errors in judgment, and continue to learn and grow in this position of power and influence.

Flexibility Is Key

The progressive nurse leader has a flexible nature, avoiding stances and reactions that are inflexible or carved in stone. This type of nurse leader uses deep listening, self-knowledge, and fairness as cornerstones of a flexible management style.

Discipline Without Shame

Steeped in fairness and flexibility, the strong nurse leader disciplines without shame. Team members may commit errors, but the thoughtful nurse leader never stoops to shame as a means of correction.

To lead into the future, the powerful, progressive 21st-century nurse leader is fair and flexible, using deep listening and excellent communication skills to move the nursing team forward. He or she is always willing to admit mistakes and leads by example in every aspect of his or her nurse leadership style.

 

How to Manage the Caregiver Burden

/in /by

A caregiver is defined as someone who cares for the terminally ill patients, look after the elderly, and the disabled. Caregiver burden on the other hand is the strain that the caregiver experience while performing the task. Some caregivers may perceive the objective tasks of caregiving as being rewarding, while others may perceive them to be quite stressful and negative. The accumulation of subjective stressors, such as negative feelings toward their role or feelings of guilt about not meeting the needs of their care receiver, produces subjective burden on the caregiver.

Signs of caregiver stress

As a caregiver, you may be so focused on your loved one that you don’t realize that your own health and well-being are suffering. Watch for these signs of caregiver stress:

  • Feeling overwhelmed or constantly worried
  • Feeling tired often
  • Getting too much sleep or not enough sleep
  • Gaining or losing weight
  • Becoming easily irritated or angry
  • Losing interest in activities you used to enjoy
  • Feeling sad
  • Having frequent headaches, bodily pain or other physical problems
  • Abusing alcohol or drugs, including prescription medications

Too much stress, especially over a long time, can harm your health. As a caregiver, you’re more likely to experience symptoms of depression or anxiety. In addition, you may not get enough sleep or physical activity, or eat a balanced diet — which increases your risk of medical problems, such as heart disease and diabetes.

Caregiver burden has been largely overlooked by clinicians and in interventions. Informal caregivers have been called “the invisible patient” as they are often forgotten; physicians and clinicians may neglect to ask caregivers about their own mental and physical well-being throughout the disease course of the respective partner. The informal caregiver often takes on many duties, such as assisting with basic activities related to illness management like managing medication and treatment regimens, scheduling and accompanying the chronically ill individual to and from medical visits and checkups, and making treatment/management decisions. Depending on the type and severity of chronic illness, caregivers may take on an even more advanced role in assisting their partners by making meals, taking on household chores, running errands, and assisting them financially. Finally, on top of all of these responsibilities, the caregiver is often a primary source of emotional support and comfort for their partners.

Caregivers that experience high levels of burden tend to be less likely to engage in self-care, and may experience weight loss, anxiety, and sleep deprivation (particularly in caregivers of partners with dementia). In addition, caregivers often reduce their hours of employment to provide proper caregiving which can lead to further financial strain. Lastly, caregiver burden is a unique predictor of mortality risk and suicide

Tips to Help Nurses Manage Burden

On the off chance that you are moving into a caregiver job, or in the event that you’ve been feeling it for quite a while and you’re starting to feel the pressure, you might need to think about the following, regularly ignored advice. So beneath are tips that will help you adapt to the pressure that accompanies it.

  1. Deal with your own wellbeing.

There’s an explanation air explorers are told to put on their own breathing apparatuses prior to keeping an eye on a child’s: you are better ready to deal with others when your own state of being is secure. Eat well, regardless of whether that implies straightforward, simple to-plan dinners. Put aside an ideal opportunity to work out, maybe when the individual you’re really focusing on is dozing. Get satisfactory rest. Have the suggested screenings, shots, and registration. You’ll be better prepared to deal with pressure in case you’re fit and rested.

  1. Enroll others.

Hardly any individuals can do it single-handedly. Ask relatives and dear companions to share the consideration. Indeed, even individuals who can’t give active consideration might have the option to take on assignments, for example, shopping for food, taking care of tabs, organizing clinical arrangements, or taking care of protection administrative work. In the event that you don’t have a gathering of loved ones to call upon, the site of the National Alliance for Caregiving, can assist you with finding guardian benefits and pick among long haul care alternatives. Interview with a geriatric consideration administrator or social specialist may assist you with recognizing nearby administrations—regardless of whether you need only somebody to assist with family unit tasks or an enlisted attendant to oversee medicine and different treatments.

  1. Break away once in a while.

In case you’re really focusing on somebody who needs steady consideration, there is no doubt that you will require help eventually. Simply saving a couple of moments for a stroll in the recreation center or a visit with a companion can improve things significantly. “We’ve discovered that we can fundamentally diminish pressure by giving the overseers smaller than expected rests—even 30-minute breaks periodically,” Dr. Mahoney says. Government lawmakers have additionally recognized that unpaid parental figures need incidental excursions. In 2006, the Lifespan Respite Care Act was passed to give help administrations to family parental figures. You can discover data on rest administrations accessible close to you.

  1. Make an emotionally supportive system for yourself.

Over the long run, providing care can cause significant damage. Regardless of whether you have help with the genuine providing care, you’re probably going to require passionate help, as well. Numerous emergency clinics, medical care plans, and strict associations offer care groups for guardians. Care groups are a decent spot to vent your sentiments and offer thoughts with individuals who are confronting comparable circumstances. Dr. Mahoney has discovered that online care groups—which don’t expect vis-à-vis cooperation, travel, or organizing a substitute guardian—have been a decent option for certain individuals. In case you’re not happy with a gathering, a geriatric consideration administrator might have the option to offer required help and point of view.

  1. Accept help.Be prepared with a list of ways that others can help you, and let the helper choose what he or she would like to do. For instance, a friend may offer to take the person you care for on a walk a couple of times a week. Or a friend or family member may be able to run an errand, pick up your groceries or cook for you.
  2. Focus on what you are able to provide.It’s normal to feel guilty sometimes, but understand that no one is a “perfect” caregiver. Believe that you are doing the best you can and making the best decisions you can at any given time.
  3. Set realistic goals.Break large tasks into smaller steps that you can do one at a time. Prioritize, make lists and establish a daily routine. Begin to say no to requests that are draining, such as hosting holiday meals.

Interventions to Reduce Caregiver Burden

Reducing the negative effects of stress for caregivers has often been the target of caregiver interventions. The outcome variables of interest in these studies may differ, but the studies usually aim to increase positive affect, quality of life, or health and well-being; or to reduce stress, depression, or caregiver burden. Thus, reducing burden, itself, is not always the main or only goal of caregiver interventions, but burden is often an important component included in evaluations of care-giver programs. Caregivers who are the most at risk for adverse outcomes, and who are thereby most in need of intervention, tend to be older females with little income or education who provide high levels of care, have low levels of social support, and feel they have no choice in taking on their role as a caregiver.

Interventions that aim to reduce burden in caregivers often include one or more of the following components. They may seek to reduce the needs or the behavior problems in the care receiver, or they may introduce respite care for the care receiver, thereby reducing the objective stress on the caregiver. They also may seek to target the caregivers themselves. Some interventions aim to increase caregivers’ knowledge of resources and appropriate care techniques (for example, by providing education about the availability of local services to education on how to bathe an uncooperative care receiver). Other caregiver-targeted interventions aim to provide individual (or group) support or therapy.

Psychotherapy can likewise be important. Giving consideration to a relative may trigger a large group of feelings, including insufficiency, lament, coerce, and even hatred. Guardians are likewise at expanded danger of gloom. An advisor can help you work through such issues and create ways of dealing with stress. On the off chance that you don’t have the foggiest idea where to go, ask your clinician for a reference.