RSSRecent Articles

Dealing with secondary trauma for mass-casualty nurses

Many emergency nurses are used to dealing with badly injured patients and sudden death, but when it comes to caring for victims of mass shootings and their families, the healing process can be very different. Lesa Beth Titus, BSN, RN, a trauma coordinator for Mercy Medical Center that treated victims of the mass shooting in Rosburg, Oregon, told Nurse.com that nurses think they are immune to the everyday tragedies of the emergency department, but the aftereffects of a mass casualty incident were very different.

Studies show that repeated exposure to traumatic events can have a similar effect to experiencing trauma directly; this experience of trauma is referred to as secondary trauma. One study found that about one in three emergency nurses experienced anxiety, depression and sleep disorders, while one in 10 showed clinical levels of Post-Traumatic Stress Disorder (PTSD). David Tetrault, PhD, MDiv, who worked as a chaplain at Banner-University Medical Center that treated victims from the Tucson, Arizona shooting, said that a mass shooting adds another layer of complexity, as it calls into question your personal values, which makes coping more difficult.

The public nature of mass casualties can make it more difficult for nurses suffering from secondary trauma as well. The media attention can serve as a constant reminder of the event, delaying the return to normalcy that many seek after a traumatic experience.

What can help nurses suffering from secondary trauma? It’s important to recognize that everyone reacts differently, and it’s important to respect that. Joy A. Lauerer, DNP, RN, PMHCNS-BC, explains: “We know that trauma is long-lasting and that it affects the brain and neurological systems… and some people process trauma more readily than others.” Struggles with trauma can last for years, and the trauma can be retriggered as well.

Basic self-care can have a positive effect on those dealing with trauma; eating well, proper sleep and exercise can all help the healing process. Talking with friends, family and others with similar experience can also help. As a manager, there are variety of stress management tools to help workers, and some hospitals have used protocols developed for first responders for their staff. A staff debriefing can be helpful, but it’s also important to checking in with staff regularly and provide them with voluntary ways to express themselves.

While it might be difficult to consider, having some preparation or training in place for dealing with traumatic experiences can help staff heal. As Lauerer points out, “[Emergency Departments] do a lot of disaster preparation. But I don’t think it ever prepares you for what this is going to feel like.”

To read the “The healer’s journey” article series, click here.

Want to receive articles like this one in your inbox? Subscribe to Nurse Leader Insider!

Rock Your Health: Feeling Out of Balance?

A recent study of more than 50,000 employees from a variety of manufacturing and service organizations found that two out of every five employees are dissatisfied with the balance between their work and their personal lives.  If you are feeling out of balance, what would be the best thing for you right now?

Pay attention to what is happening in your MIND, BODY and SPIRIT and begin moving from DENIAL into AWARENESS. Here is a strategy that might work for you.

  1. Make a list of signs you are experiencing in each of these areas.   Here are some examples
  • BODY – My stomach is tied up in knots and I keep taking antacids all day.
  • MIND – I’ve got too much on my mind of what I have to get done and it gives me headaches
  • SPIRIT – I’m questioning whether I can keep working at this pace the rest of my career.
  1. For each sign, re-write it from a negative point of view into a positive statement
  • BODY – I honor my body by feeding it food that makes it feel good and find I don’t need to take medication because I eat healthy
  • MIND – My mind is free of clutter because I have my priorities in order and know how to say NO
  • SPIRIT – I am at peace with where I am with my work and am looking forward to what is next in my career with renewed energy
  1. What awareness do you now have about how your life could be different?

“What is necessary to change a person is to change his (her) awareness of him (her) self.” Abraham Maslow

Email me at carol@carolebert.com if you need support with getting your life back into balance.

Editor’s Pick: Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, 2e

The American Nurses Association (ANA) has recommended the second edition of Ending Nurse-to-Nurse Hostility: Why Nurses Eat Their Young and Each Other, by Kathleen Bartholomew, RN, MN, in its official position statement on Incivility, Bullying, and Workplace Violence as a resource for nurses. Now in its second edition, the cornerstone work has just been released as an eBook and offers 4 continuing education credits (CEU).

Ending Nurse-to-Nurse Hostility, Second Edition

The first and most respected book showing new and experienced nurses how to build a better workplace by facing and overcoming horizontal hostility is now updated.

Find out why this book is a best-seller and how it’s empowered thousands of nurses to create positive change for themselves and their peers!

Revised to reflect current research on horizontal hostility in the nursing field (also known as lateral violence), Ending Nurse-to-Nurse Hostility, Second Edition, provides staff nurses and their managers with techniques to create a workplace that promotes team relationships and career development while preventing burnout.

Ending Nurse-to-Nurse Hostility provides staff nurses and their managers with the knowledge they need to:

  • Identify verbal abuse, bullying, and other detrimental behaviors
  • Develop responses to defuse or head off such behaviors
  • Create positive alternatives to hostility

These skills support the success of the individual nurse, the unit, and patient care quality at a time when healthcare systems are publicly ranked on patient experience and outcomes.

Horizontal hostility, also known as bullying or lateral violence, is a major factor in nursing attrition rates. Healthcare organizations that don’t proactively create a healthy workplace face the expense of finding, hiring, and training new nurses to replace burned-out staff.

This book provides the following benefits:

  • Skills: Nurses will learn skills for identifying and responding to verbal abuse, bullying, and other detrimental behaviors that undermine individual nurses, the unit, and the quality of patient care.
  • Real-world examples: Gain insightful reflections from individual nurses who have experienced horizontal hostility, presented in their own voices.
  • Author voice: Kathleen Bartholomew is a beloved nursing author who is authoritative yet approachable and always respectful.
  • Scholarship: Extensive references draw on the latest empirical and theoretical literature concerning horizontal hostility.
  • Culture change: Improve nurse retention, nurse productivity, and hospital rankings with an improved environment for patient care.

For more information or to order, visit the HCPro Marketplace.

Join our Nursing Book Review Group!

We would like to thank everyone who responded to our call for authors last month! The response has been fabulous and we’re still going through emails.

We are once again opening up our Nursing Book Review Group!  If you didn’t have a chance to join last year or if you’re new to us, now is your chance to join an ad-hoc group interested in reading and reviewing prepublication drafts of books and training materials in your areas of interest and expertise.

Our editors will send you periodic emails listing upcoming projects available for outside review. If you’re interested, just let us know. We’ll send reviewing guidelines and give you an idea of our timeframe. If it works for you, we’ll send the draft chapters as they’re available, and a printed copy of the book when it’s complete. In addition, you will be recognized as a reviewer inside the printed book.

Please have a minimum of five years of nursing experience and be in an educational, supervisory, or leadership role within your organization.

For more information or to sign up as a reviewer, please fill out our reviewer form.

Newly promoted leaders need support too

Many companies have clear guidelines for onboarding a new hire; they often have formal training, manuals, and extra resources to help them adjust to their new responsibilities. However, many nurse leaders are promoted from within, and their training path is often less clear. As a new study suggests, the training process for internal promotions is often inadequate, and internal hires require just as much support as external ones.

Michael Watkins wrote in the Harvard Business Review about this issue, and coined the term “inboarding” to describe the process of training internal hires for their new position. About two thirds of the new hires in his study were internal; 70% of them said that their transition was as difficult as joining a new company, and 35% found the transition more difficult. This results in unnecessary failures and difficulties for the organization.

Watkins identifies the lack of support given to inboarding as one of the main reasons for this disparity. So how can an organization make inboarding easier? To start, leaders should adopt a common methodology when approaching new hires. This includes using the same framework and tools for all leadership transitions. Watkins also suggests performing a risk assessment for transitions: identify the potential difficulties (such as relocation, new business divisions, or shifts in work culture) and provide additional support for those risks. This might sound simple, but changing an organization’s culture can be difficult and the first step is identifying that internal hires need the same support as external hires.

Did you receive formal training when you got your first leadership position? Did you feel prepared for your new responsibilities? Let us know in the comments, or take our Strategies for Nurse Managers Poll.

Rock Your Health: The FIX is IN!

Ready for a run-on sentence, which is sure to put you on notice?

Ever have your body turn on you and give you so much pain that you have no choice but to act on it so you start taking medications to ease the pain which only works temporarily and then the pain comes roaring back and now you are really frustrated because you can’t get relief and the doctors tell you they can’t help you anymore with their tools and you will have to deal with your stress in other ways so you finally resort to alternative methods of healing which of course take more time to work than the quick fix you sought from the drugs and find that after you finally cave in and do all those things like learning to do less, taking more time to relax and play, doing relaxation strategies like meditation and yoga, exercising daily, eating healthy food that your body doesn’t reject, taking only the best vitamins and realizing that all these non-drug alternatives actually start giving you relief from the pain that you become a believer and start adopting a healthy lifestyle that gives you back your health! WHEW!

I continually amaze myself that when I get too stressed out from doing too much or going down the wrong life path, I still crash and burn and then have to crawl out of the hole to start all over again – although I do less of it these days since I have learned a lot from those experiences. I now know that I CAN HEAL MYSELF WITHOUT DRUGS but it does take time and maintaining a regular practice of healthy strategies.

What an empowering feeling to be in charge of your own wellbeing! And you can do it too! My latest strategy is EFT (Emotional Freedom Technique or Tapping) that is a “quick fix” and has led to a feeling of profound relaxation almost immediately. Maybe it will help you as well.  Check out www.eftuniverse.com

Keep in mind, healing practices work – if you work them.  What relaxation strategies are you willing to implement in your life to bring balance back into your day?

Email me at  carol@carolebert.com and let me know what stress-related issues you have healed without drugs. We are all in this together!

Featured Webcast: Millennial Nurse Retention: Bridging the Generation Gap

Wednesday, April 20, 2016

In 2015, the number of millennials in the workplace surpassed baby boomers as the largest segment of workers. This future generation of nurses has very different career expectations than the generations before them. Millennials expect more feedback, greater collaboration, interaction with nurse leaders, an 8-hour workday and better work-life balance. Unlike their parents, they rarely intend to stay with one employer for their entire career—or possibly even more than a few years.

The shift in attitude has many organizations struggling to retain millennials and learning to adjust management strategies to accommodate their unique style. Join Kathy Bonser, Vice President of Nursing and CNO at SSM Health DePaul as she discusses the importance of leveraging the differences to create a win-win environment for staff and frontline leaders.

Take part in this live 60-minute webcast to:

  • Uncover how making changes in leadership behaviors can bridge the generation gap
  • Discover new onboarding processes that support the growing millennial workforce
  • Devise a structured approach to providing regular employee feedback
  • Understand the importance and value of engaging millennials early and often

Agenda:

  • Improving nurse retention, especially in the first year after hire
  • Understand communication preferences
    • Text or call? How to decide
    • Use of social media
  • The importance of strong onboarding and engagement processes
    • Scheduled touchpoints
    • Celebration of milestones
    • The need for performance feedback
  • The need for transparency
    • Explaining the why behind decisions
    • Seeking out nurse feedback and acting on it
    • Shedding light on how their contributions make a difference
  • Live Q&A

HCPro is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. HCPro provides 1.0 nursing contact hours for this educational activity.

For more information or to register for the webcast, click here.

Shared decision making has benefits for minority patients

New evidence suggests that shared decision making (SDM) can improve the patient experience for minority groups, particularly LGBTQ patients of color.

Shared decision making aims to include the patient’s perspective when making care decisions and better educate patients about treatment options. SDM acknowledges that each patient is unique, so creating a dialogue between the provider and patient should increase patient engagement and result in better outcomes. As one researcher describes the shift: “It’s going from ‘I’m the expert, take my recommendation’ to ‘I am going to inform you and respect your wishes.’”

This idea of respecting and listening to a patient is at the heart of caring for all patients, but minority patients particularly benefit from an SDM approach. As we discussed in our post about transgender healthcare, an open dialogue and respect for how the patient would like to be addressed goes a long way to build trust for the patient; the same principle applies across minority groups.

The University of Chicago and the Agency for Healthcare Research and Quality have developed a new project called Your Voice! Your Health! aimed at researching SDM’s influence on minority healthcare and facilitate healthcare improvements for the LGBTQ racial and ethnic minority community. The researchers note that the confluence of minority statuses make it particularly difficult for LGBTQ patients of color; as Monica Peek MD, MPH, Associate Professor of Medicine at the University of Chicago Medicine told ScienceLife: “Racial/ethnic, sexual orientation, and gender identity minority status are all marginalized social identities, so they act in concert to further marginalize people who are trying to navigate the health care system.”

Because there is little existing research on LGBTQ patients of color, providers may not have the proper framework or tools for addressing their needs. Peek and her team developed a new conceptual model to illustrate how the patient and physician’s social identities effect SDM. As ScienceLife describes the strategy: “In the end, establishing trust boils down to how well a physician acknowledges her own identities in relation to those of her patients.” According to the group’s research, differences in social identity didn’t matter so long as the provider was compassionate and encouraged an educated dialogue, the hallmarks of a SDM approach.

program, Massachusetts General Hospital (MGH) reviewed what made the initiative a success. At first they relied on physicians to order decision aids and educational materials for patients to encourage informed discussion, but they didn’t see immediate results. Once they trained all staff and involved patients directly, the use of decision aids increased substantially. Leigh Simmons, MD, medical director of the MGH Health Decision Sciences Center, said of the initiative: “There now is a big push toward more team-based care in medicine; and once we started to engage the entire team – including front desk staff, medical assistants and most crucially, the patients – we saw the use of decision aids take off.” Once the full staff and patients embraced the program, physicians reported that they had more advanced discussions with patients and they are able to focus on what’s important to their patients.

Do you use shared decision making practices in your facility? Do you find it easier to connect with patients using these techniques? We would love to hear about it in the comments below!

For more information on the Your Voice! Your Health! project and a useful tool for establishing a patient dialogue, check out the full ScienceLife article.

Rock Your Health: Cleaning Up Your Act

As we enter the Spring Season, I feel the need to clean up my act.  Everything now feels better – more light at the end of the day, waking up to a light sky, chirping birds, walking outside again without slipping on the ice or worrying about walking in the dark, seeing sprouts of greenery and color once again.

That good feeling and renewed energy even compelled me to clean up one shelf in my office and now I not only feel better and more organized, but the empty places on the shelf makes me feel like I can even breathe easier.  Interesting how these simple things have powerful rewards.

So what can you clean up that will provide you with more relief and less stress?

Need support with cleaning up your act?  Email me at carol@carolebert.com and I’ll give you a complimentary laser coaching session.

Registered nurses not immune to industry influence

There’s been a concerted effort over the last few years to provide transparency for medical industries interaction with doctors, thanks to the Physicians Payments Sunshine Act instituted by the US Senate in 2010. The Sunshine Act requires medical manufacturers, such as drug and medical supply companies, to report payments and gifts given to physicians and teaching hospitals; the goal is to ensure that doctors are not swayed to make care decisions based on financial gains and prevent conflicts of interest. Last fall, two senators proposed a bill to amend the Sunshine Act that would include nurse practitioners (NPs) and physician assistants (PAs) as well, acknowledging that NPs and PAs wrote 14% of all drug prescriptions in 2014 and require the same transparency as doctors.

A new study released this week suggests that even registered nurses (RNs) without prescribing authority could be subject to these sort of interactions with the medical industry. All of the RNs that participated in the study said they had interacted with industry over the past year, averaging 13 one-on-one meetings over the year. Many also participated in sponsored meals or events, received gift offers and product samples, and some received payments for speaking, consulting, and market research work. Most interactions were with medical device and pharmaceutical companies, but some reported interactions with health technology and infant formula industries as well.

Though RNs don’t have prescribing authority, many nurses are part of purchasing committees for their facility. RNs play an integral role in decision-making throughout their facility, and there are no regulations for transparency between RNs and medical industries. Though the sample size is small (56 RNs participated in the study), the authors of the study think the results warrant additional research and regulation. As the largest and most-trusted healthcare profession in the US, it’s important to make sure RNs maintain their trustworthy reputation with their patients.

You can read the full study here, and an editorial accompanying the study here.

For more information about open payments data, check out CMS’s open payments site.