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  • 4 staff recently had the opportunity to interview Lisa Wolf, PhD, RN, CEN, FAEN,
    Director of ENA's Institute for Emergency Nursing Research. She has published research about bullying and how it affects nurses patient care.

    How does bullying in the ED manifest itself?

    Bullying can manifest as the dynamics of aggression, which includes overt hostility, denigrating comments, giving inappropriate assignments for the nurses' experience and expertise, and selective reporting. More difficult to identify and call out, however, are the dynamics of exclusion, which is marked by a withdrawal of help, support, and information. These types of behaviors often result in a nurse being "set up to fail", which has consequences for patient care.

    How does this differ from bullying in other departments?

    I don't know that it is very different in other departments, but the constant flow of patients, the short turnaround times, and the initial lack of knowledge about patient conditions makes the emergency department a particularly high risk area for this dynamic to manifest.

    What kind of collateral damage results from bullying in the ED?

    Workplace bullying is a significant factor in the dynamics of patient care, nursing work culture, and nursing retention. The impact on patient care cannot be overestimated, both in terms of errors, substandard care, and the negative effects of high turnover of experienced RNs who leave, compounded by the inexperience of newly hired RNs

    What methods did you find to be the most effective in addressing / decreasing

    Our respondents report that a "calling it out" strategy by both staff and management is the most effective way to reduce bullying and its consequences. An assessment of hospital work environments should include nurse perceptions of workplace bullying, and interventions should focus on effective managerial processes for handling workplace bullying

    As a result of your research, what type of training do you recommend?

    Given that management is the key role in mitigating bullying behaviors, education in the identification of bullying behaviors (especially those marked by the dynamic of exclusion) and in addressing them with staff is probably the most effective way to reduce workplace bullying.

    Bullying is becoming more pervasive in our culture as a whole. However, as nurses on the forefront of life and death decisions, it is imperative that nurses have a toolkit to deal with bullying at work. The American Nurses Association published a position paper on this in 2015 with a goal; "to create and sustain a culture of respect, free of incivility, bullying and workplace violence."

    ENA has also published guidelines to deal with and curb lateral violence which is defined as; "violence, or bullying, between colleagues (e.g. nurse/nurse, doctor/nurse, etc.)."

    "According to a 2011 study by the Emergency Nurses Association (ENA), 54.5 percent out of 6,504 emergency nurses experienced physical violence and/or verbal abuse from a patient and/or visitor during the past week. The actual rate of incidences of violence is much higher as many incidents go unreported, due in part to the perception that assaults are "part of the job"."

    ENA offers a toolkit with six distinct steps to address workplace violence. The first step is acknowledging that it exists and that nurses have the capability to decrease the incidence. There are many shareholders in this initiative including the front line staff but managers and administrators also have a key role in this. JCAHO, OSHA and other governmental agencies require documentation of a safe workplace and offer recommendations as well.

    Violence should never be tolerated. Do you feel safe from lateral violence in your emergency department? What has your ED done to combat lateral violence?

  • 3

    Urology nurses function in multiple environments including hospitals, same-day surgi-centers, private practices and home health. They may care for patients with multiple co-morbidities in addition to urologic needs. The urologic nursing specialty requires its professionals to have a comprehensive knowledge of developmental and aging changes that are essential to understanding acute and chronic urological diseases. Here is an article about urologic nurses.

    There are several sub-specialties for urologic nurses too:

    • Office nurses that assist with cystoscopies and sedation
    • Nurse Practitioners in urology practices
    • Nurses that administer intravesicular meds for bladder cancer
    • Pediatric urologic nurses

    Many opportunities exist for urologic nurses and associates. Urologic associates are often unlicensed assistive personnel who help with procedures, assist with patient education and otherwise contribute to overall patient care. Often the nurse will delegate tasks to a urologic associate in order to focus on a nursing-related skillset.

    Here is a description of a day in a urologist's office. You will see patients with appointments for recurrent UTIs, renal stones, and post-op follow ups. You might also see patients with the complaint of sexual dysfunction related to erectile dysfunction.

    Urologic nursing can also encompass some aspects of transplant nursing. Renal transplants occur frequently and often are done in coordination with a transplant surgeon as well as urologist.

    Nurse navigators help to coordinate care and ensures patients are kept up to date regarding their cares, assists with appointments, and facilitates communication. They work with physicians and other medical personnel to help with transitions and follow-up. Nurse navigators bridge the gap between hospital and out-patient care and works as an integral part of the care of the urological patient.

  • 3

    The Academy of Medical-Surgical Nurses wants to recognize and identify the contributions of med-surg nurses all year round but especially this week. Med-surge nurses form the basis of almost all nursing care. It is the fundamental practice of nursing encompassing many different diagnoses and levels of care.

    Even though med-surg nurses have existed for many years it wasn't until 1990 that the AMSN was formed with an objectives to:

    • improve the image of the medical-surgical nursing
    • develop standards for medical-surgical nursing practice
    • create a Core Curriculum for establishing the essence of the medical-surgical nursing practice

    As med-surg nursing has grown, developed and become even more complex, the Academy works to keep up by developing position papers on patient literacy, certification, political awareness, staffing standards and practice environment.

    Gone are the days of med-surg nurses just providing back rubs, routine bed baths, supervising patients' smoking, and giving the occasional medication. Nowadays, med-surg nurses are caring for central lines, stable inotrope drips, post-op patients with open wounds, patients with cardiac monitoring, and complex medication regimens.

    Today, more than ever, patients are not hospitalized for long periods of time. Therefore, it is imperative that nurses from admission to discharge work to provide education to the patient and family members to decrease the chance of readmission. Medical-surgical nurses care for patients with a wide variety of diagnoses such as:

    • Gastrointestinal hemorrhages
    • COPD/Asthma
    • Cellulitis
    • Endocarditis
    • Pnuemonia
    • Other infections requiring hospitalization
    • GYN disorders

    Documentation is always paramount for all nurses. An article published in 2016 on AN focuses on documentation: Nurses Charting. Another popular article, A Push for the Return of Team Nursing explores staffing on med-surge units and the needs of an increasingly complex medical-surgical patient.

    Many nurses have traditionally started in med-surg in order to get an introduction to the nursing workplace and also develop time management and critical thinking skills. Med-surg nurses are the generalists of nursing. They care for several patients with multiple medical and/or surgical needs.

    Thank you to all the Med-Surg Nurses on AN. Here is your forum.

  • 6
    Joe V, DDRN4me, dragonheart, and 3 others like this.

    The American Nurse Project is a documentary about US, nurses in the US. Carolyn Jones, an award-winning cinematographer helps to show what we do in our daily work. She traveled the country for a year collecting stories, pictures, and videos of nurses doing what they do and helping people understand what we do.

    She interviewed hundreds of nurses in many specialties: home health nursing, disaster nursing, prison nursing, hospital nursing - all the places where we do our job. Via her movie, she brings the human element to the public as to what we do and take in stride. She honors nursing thru her journalistic efforts. The interviews are riveting:

    • A nurse from New York anguishes about "what if a patient died on my watch - this wasn't supposed to happen."
    • A home health nurse from rural Kentucky discusses black lung disease as a prevalent issue for her patients
    • A prison nurse in a maximum security facility laments about the spread of Hepatitis C in our prison system
    • A policy analyst nurse from Chicago discusses how public policy influences nursing practice

    AllNurses was fortunate to interview her at NTI recently in Houston. AN's Community Manager, Mary Watts, RN showcased this video and what it means to all nurses...

    Carolyn went on to discuss her upcoming documentary which will showcase five nurses in the US from varied backgrounds and career settings. Defining Hope focuses on a journey of investigating how we can make better end-of-life choices.We look forward to this new movie.

  • 8

    AllNurses recently interviewed Nurse Nacole, a well-known blogger and YouTuber. She is a critical care nurse who makes an impact via social media. She uses Instagram, Twitter, YouTube, Google and other platforms to get her message across. Her informational blog focuses on clinical tips for the new and experienced RN. Her YouTube channel discusses time management, how to work with a preceptor, and how to collaborate with other staff members.

    Nurse Nacole is an enthusiastic young blogger who is an educated critical care nurse using evidence based practice to spread the word. Nursing is her passion. She relates that NTI is a great conference to network and learn about how other critical care nurses care for patients.

    She is currently furthering her education to provide better care for her critically care ill patients. Nurse Nacole is set to receive her MSN in another year and then plans to pursue her DNP.

    Enthusiasm and up to date info is the hallmark of Nurse Nacole's videos/blogs. Check her out.... AllNurses' Community Manager Mary Watts, RN recently interviewed her.

  • 6
    Joe V, LakeButterfly17, mimi1381, and 3 others like this. staff recently attended the AACN NTI Conference in Houston. We were fortunate to interview several well-respected leaders in critical care nursing. One of our interviews was with Judy Crewell, PhD, RN, CNE who is a leader in spiritual care in critical care nursing. Dr. Crewell facilitated a session titled "Spiritual Care Matters in the Care of Critically Ill Patients and Families" in which she discussed the role of the nurse in providing spiritual care and shared strategies on how to provide interventions at the bedside for patients and families.

    In an allnurses interview with her, Judy stated, "Spiritual care has been with us since the beginning of time. It used to be that physicians were also spiritual leaders." Research shows that patients who have religious or spiritual beliefs have better patient outcomes, especially if their spiritual needs are met. As healthcare professionals, it is mandated that we provide for the physical needs of the patient as well as the spiritual needs. In order to do this, we must include a spiritual assessment along with the physical assessment.

    Dr. Crewell recognizes that not all nurses feel comfortable providing spiritual care, however, lack of comfort is not an acceptable reason to not meet the spiritual needs of the patient. The nurse needs to develop a self-awareness of how they feel about providing spiritual care and look for ways in which spiritual needs can be met, either through that nurse or by utilizing another care provider.

    Prayer is often used in hospitals for both patient and staff support and can be quite comforting if used appropriately. Spiritual care must encompass all aspects of religious and spiritual beliefs. Patients and their families are very vulnerable while hospitalized. This is especially true for those in the critical care areas. It's important that nurses take their cues from the patients and their families in assessing spiritual needs and providing spiritual care. In nursing, it is important to remember that spiritual care is about the patient, not the nurse.

    Nursing education has lacked spiritual care information which we often find as we get out into the nursing workforce. Judy stressed the need for incorporating more spiritual care concepts in nursing curriculums.

    Dr. Crewell shared some tips as to what could be done to improve nurse comfort levels with providing effective spiritual care:

    • Obtain support from the religious staff of the facility
    • Look to evidence based practices
    • Collaborate with other nursing staff
    • Don't confuse spiritual care with cultural competency
    • Be mindful of your own bias

    As nurses are the ones who spend the most time with the patients, it is important that they are equipped to address all of the patient's needs, including physical and spiritual.

  • 4
    pmabraham, tnbutterfly, sirI, and 1 other like this.

    Mary Fran Tracy, PhD, RN, CCNS is the editor of AACN's journal, Advanced Critical Care. She spoke with allnurses Community Manager Mary Watts, RN at the recent NTI conference. The Advanced Critical Care Journal is a quarterly, peer-reviewed publication of in-depth articles intended for experienced critical care and acute care clinicians at the bedside, advanced practice nurses, and clinical and academic educators. Each issue includes a topic-based symposium, feature articles, and columns of interest to critical care and progressive care clinicians. AACN Advanced Critical Care contains concisely written, practical information for immediate use and future reference. Continuing education units are available for selected articles in each issue.

    Have you ever thought of what goes into publishing an article in a nursing journal?

    Mary Fran Tracy provides some tips:

    • Take a university writing course
    • Attend conference panel discussions
    • Contact mentors who have published articles
    • Complete online courses in writing for professional publications
    • Look to the publication itself for guidelines
    • Read the journal that you are targeting for your article - know the style

    And of course, always review and proofread your article prior to submission. Plagiarism is also a major concern for both authors and publishers. Self-plagiarism is also a problem. You can only publish articles once. Some other tips:

    • Set aside time to write
    • Have a conducive environment to write
    • Start small and work up to professional journals
    • Be dedicated and committed
    • Realize that not all of your writing will be successful

  • 6
    Joe V, sassy251, AJJKRN, and 3 others like this.

    Kathy Douglas, RN, MHA, was one of two recipients of AACN's Pioneering Spirit Award for 2017. According to the American Association of Critical-Care Nurses, "The recipients are directors of two insightful documentaries about nurses, one offering an insider’s viewpoint, while the other presents an outsider-looking-in perspective. Both films showcase the valuable and varied contributions of nurses to patient care and the healthcare system."

    Kathy, a film-maker and former critical care nurse, was "recognized for her conceptual and directorial work on the documentary 'NURSES, If Florence Could See Us Now,' released in 2013." Through the film, Kathy paid her respect to nurses and her lifelong nursing profession by telling nurses’ stories through their own voices, simply interviewing nurses with a camera to capture authentic, candid conversations.

    Allnurses had the opportunity to interview Kathy at the AACN's 2017 National Teaching Institute conference shortly after receiving the award. Nurses sometimes "lose the connection between why we do what we do," according to Douglas in the recent interview with allnurses' Community Manager, Mary Watts, RN.

    Kathy continued in the interview; "We are the most trusted profession" and we must be vocal about what needs to be changed in healthcare today and be strong patient advocates. Now is the time to bring our voices to the table." These comments serve as the basis of the award which according to AACN is; "Successful applicants exemplify a pioneering spirit, influencing the direction of acute and critical care nursing."

    In Kathy's words, "It's hard to find a life that has not been touched by a nurse."

  • 3
    tnbutterfly, sirI, and traumaRUs like this.

    Managing our patient's pain is a paramount concern for all nurses. AllNurses staff recently attended NTI in Houston and interviewed June Oliver, MSN, CNS from Swedish Covenant Hospital in Chicago. She is an eminent pain management specialist who has authored several articles on pain management for patients with substance abuse disorders. According to the American Society for Pain Management Nursing (ASPMN); "Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders."

    In an article from the ASPMN, Ms Oliver states: "In 2010, an estimated 22.6 million Americans (8.9% of the population) aged 12 or older reported using an illicit substance in the previous month. Approximately 7 million of these individuals met diagnostic criteria for a drug use disorder, and an estimated 5.1 million persons reported they had used prescription pain relievers in a nonmedical or non-prescribed manner. Sixty-six percent of those individuals obtained these medications from a friend or relative, and nearly 80% of those friends or family members had each obtained their medications from a single prescriber."

    Drug abuse is prevalent in our society and we, as concerned nurses must use multiple resources to help our patients. In the interview, Ms Oliver provides some concrete means to achieve this goal.

  • 7
    NRSKarenRN, brandy1017, Kitiger, and 4 others like this.

    Nurse injuries are costly: for the nurse, for the facility, for the career field in general. Linet recently previewed a bed at NTI in Houston and allnurses was there! No one wants to experience an injury associated with patient care. Using an integrative approach, Linet developed a bed that assists the nurse to adequately care for a patient without increased risk of injury. We all know its not always possible to have extra help when turning patients, repositioning them in bed or ambulating them. This can lead to a nurse injuries and some of these injuries can be career-ending. Having intuitive equipment can reduce this risk.

    Pressure injury reduction is also at the forefront of nurses and hospitals, especially critical care units where many patients are not ambulatory. In order to reduce these occurrences, Linet developed the Multicare bed powered by the Hercules Patient Repositioner. This bed has multiple modifications:

    • Lift assist is feature where the bed actually moves the patient up in bed via an easy to use interface. There is no need for nurses to move the patient manually. This greatly reduces pressure points.
    • Turn assist works by tilting the bed so that gravity assists with turning patients and the nurse closely observes the patient with minimal assist being utilized.
    • Mobi-Lift provides for easy mobilization of the patient as the bed has varied height adjustments as well as strategically placed handholds for patient security.
    • There is of course an integrated scale which can be adjusted for accessories or items that must be contained in the bed.

    AllNurses' Community Manager, Mary, interviewed a Linet representative and received a hands-on demonstration with Judi, Assistant Community Manager as the patient.

  • 4
    cathybarnes, tnbutterfly, sirI, and 1 other like this.

    NTI in Houston provided AN with so many opportunities to interview leaders in the field of nursing as well as to view demonstrations of new products. Halyard representatives discussed oral care to reduce ventilator-acquired pneumonia (VAP).

    Why is this so important? From the Society of Critical Care Medicine, "The role of oral hygiene in maintaining the health and well-being of patients in the intensive care unit (ICU) is indisputable. Oral care is a simple and effective strategy to reduce ventilator-associated pneumonia (VAP) in patients requiring mechanical ventilation. Colonization of the aerodigestive tract and aspiration of contaminated secretions into the lower airway are the two primary pathogenic processes of endemic VAP. Dental plaque can be a major reservoir of infection by respiratory pathogens in ICU patients.Pharmacological plaque control with chlorhexidine oral rinse is effective and also decreases oropharyngeal colonization by aerobic pathogens in ventilated patients."

    Oral care for vented patients is always a concern and can be difficult and time-consuming. However, Halyard recently introduced a product that is specifically for patients with smaller mouths who need oral care. These self-contained kits include a self-cleaning Yankauer, a #8fr suction catheter and a small toothbrush. Here are some of the features:

    • Color-coded packaging, allowing caregivers to easily identify specific component packs and to track oral care compliance
    • Rectangular kit design with wall hanger, making it more conveniently accessible in the patient's room to make compliance easier
    • Individual packs that allow caregivers to choose the right tool at the right time, based on patient need and hospital protocol
    • Color-coded "Order of Use" guide, printed directly on the kit, takes the guess work out of oral care by providing easy identification of component packs and promoting proper continuity of care according to protocol. Available in q2 and q4 Kits

    Providing oral care to our ventilated patients prevents ventilator-acquired pneumonia (VAP), thus reducing ICU time, hospital length of stay and improves patient outcomes. By using evidence-based practices, we can meet the compliancy standards as well and most importantly, ensure our patients' comfort.

    Gregg, an allnurses staff member, recently interviewed a Halyard representative about a product to reduce VAP...

  • 6

    Monitoring the hemodynamics of your critically ill ICU is so important. Use of the Swan-Ganz pulmonary artery catheter is one of the ways to quickly assess the cardiac status of your patient, make interventions and improve their care. However, the monitoring systems for Swan lines aren't that intuitive. Until now, that is.

    Edwards Lifesciences has a new monitor, the HemoSphere advanced monitoring system, which was just recently approved for use in the US which is both intuitive and user-friendly. As an ICU nurse, your monitors are your pathway to your patient. Having a small, portable, easy to use monitor makes your shift just a little easier. This monitor has an interface similar to a tablet and can continuously assess flow, pressure and the global indicator of oxygen saturation (CCO, RVEF, RVEDV, SVO2).

    Allnurses staff recently attended NTI 2017 in Houston and spoke with the Edwards staff about the HemoSphere on the exhibition floor and got a demo of how intuitive and easy-to-use the HemoSphere is.

    Would your recommend this to your hospital?

  • 2
    VivaLasViejas and traumaRUs like this.

    You go into a patient room and find the NGT lying on the bed with the tube feeding spewing a nasty circle of smelly liquid onto the sheets. Oh oh - lets get the patient cleaned up, and then we have to reinsert the NGT. But...whats to keep it from coming out again? How do we better secure the NGT? We've all seen and probably used many tricks to secure an NGT: benzoin, different ways of taping, different types of tape. Ugh! Frustrating and time-consuming.

    NTI recently attended NTI in Houston and interviewed exhibitors. Halyard has a new product that helps to secure an NGT securely. "CORGRIP is now compatible for use with sump tubes up to 18 FR, providing a more secure connection for decompression, suction and drainage of the stomach. The use of this securement device may reduce the overall costs of patient care by reducing multiple procedures from dislodged tubes."

    What does your hospital/facility use? Whats been your experience with this product?

  • 3
    traumaRUs, tnbutterfly, and sirI like this.

    Capella University is a fully accredited university that offers RN to BSN and RN to MSN completion programs. Could furthering your education expand your career choices? Yes! More and more hospitals and facilities look to the BSN and MSN prepared nurses for management positions, leadership roles and educator positions.

    Capella offers their Flexpath programs which allows you to get your degree on a self-paced track. Shiftwork, family responsibilities, and just life sometimes dictate your educational path. Maybe one semester you CAN take two courses but then you might want to slow down the next semester. Flexpath offers the flexibility to work at your own pace.

    And if you would like to pursue a business degree, Capella offers that too. Combining a nursing degree with a business degree can lead to more opportunities too. It is very important for nurses to be aware of healthcare degree choices.

    allnurses has another great resource for you: Peer Reviews.

    Staff recently attended NTI in Houston and talked with a current student.

  • 8

    It is interesting to see the demographics of nursing changing, including average age, gender, ethnicity etc., and there are several reasons for that. In looking at some of the results from the allnurses 2017 Interactive Salary Survey, we can see a change, but do the results leave us with more questions than answers???

    The 2017 allnurses Salary Survey asked questions about nurse’s age, years as a nurse, and years of experience. It is interesting to compare the current data provided by more than 18,000 respondents to data from the past. Looking back in time, we are able to see from a study conducted in 1980 that 25% of registered nurses were over 50 years old. By 2000 33% were over age 50, and in 2007 the numbers rose to 41% of RNs were over 50 years of age. In the allnurses 2017 interactive study, results show that 30% of nurse respondents are over 50 years old. Why the drop? Are aging Baby Boomers leaving the workforce? Are nurses retiring early? Are they leaving the nursing workforce for other careers? Leaving to care for aging parents?

    Now, let's look at the opposite end of the spectrum. In 1980 25% of nurses were under age 25, but by 2007 that number drastically dropped to only 8% under 30 years old. Our 2017 survey shows that approximately 16% or our respondents were under the age of 30 with 4% under the age of 25. This presents an interesting question? In 2007 there are the least number of nurses under 30 and the greatest number over 50. The largest percentage, 54%, of respondents in the 2017 allnurses survey fall in the 30 - 50 age range. Does the shift have to do with age entering into nursing as a career? In other words, were there more nurses choosing nursing as a second career or career change? What factors may be playing into the drop in nurses entering nursing under the age of 30?

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    Part of the equation seems to be the age of nurses when they graduate nursing school as their INITIAL education. We have some statistics showing that in 1985 the average age of the registered nursing school graduate was 24 years old. By 2004 that number jumps to 31 years old.

    Additionally, many students obtaining an RN license have initially earned a different academic degree before deciding to enter the nursing field. During the years from 2000 to 2008, the percentage of RN candidates having earned previous degrees rose from 13.3 percent to 21.7 percent. The increase in the number of second-career students entering the nursing profession would help account for the increase in age of nurses with fewer years' experience.

    When we compare the years of experience as a nurse from our allnurses 2015 study to the 2017 study we see age does not seem to correlate directly to number of years of experience. In the 2015 results, 62% of nurses had less than 10 years of experience as compared to the 2017 results showing the number has dropped to 56% having less than 10 years experience. As one would expect the numbers have increased in years of experience between 11-20 years (a 3 point increase), 21-35 (2 point increase), and 35+(up 1 point) since the 2015 survey.

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    There are so many variables to factor into these statistics, and it will be interesting to see if the entire 2017 allnurses survey answers or leaves more questions. As we can see, the average age of registered nurses is increasing yet the number of years as a nurse or years of experience does not reflect the age increase. When a younger friend of mine graduated nursing school with her BSN in 1993 their graduating class had a greater number of second career, or mothers that raised children prior to attending nursing school, than those of us coming straight out of high school into college.

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    What have you newer grads been seeing? This year’s survey did not ask how many of you entered nursing as a second career or how old you were when you graduated, but we would love to get your input on that, and any other variables you think contribute to the statistics.

    The results of the 2017 allnurses Salary Survey will be posted soon.


    2015 National Nursing Workforce Study
    2015 allnurses Salary Survey Results
    NLN Biennial Survey of Schools of Nursing, 2014
    Nursing: Tradition Gives Way to Non-Traditional
    Non-Traditional Nursing Students Take Non-Traditional Pathways