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Sister Nurse: The other side of the bed

By Karen L. Madsen, MSN, APRN-BC

Blog admin note: While different from most blog posts on SFNM.com, this is a captivating, inside look at nursing today. It is, at the same time, a look through a professor’s eyes and through a mother’s eyes. The article first appeared on StressedOutNurses.com and was quickly picked up by Comarow on Quality, the U.S. News & World Report blog on medical safety and quality.

I don’t like this side of the bed. No, I take that back. I loathe this side of the bed. It scares me, it makes me angry, it makes me cry. I have no control over this side of the bed, I have little identity, I don’t have much of a voice. All this and more ran through my mind as I sat at the bedside of my 15-year-old daughter recently. It had been a long time since I had been part of the patient equation of the hospital rather than the nurse. It was just as much fun as I remembered.

Our daughter, Grace, is our baby, the youngest of our four children. Grace is a typical teenage girl. She slams doors, she cries at the drop of a hat. She grazes all day rather than sitting down to a meal. She is funny and emotional and dramatic, and she is a world class champion at texting on her cell phone. All of our children have been blessedly healthy, but Grace is our emergency room child. You know, she is THAT child, the one who falls, who hits her head, who goes through a fence on a horse, the one who had more stitches by age 5 than her other three siblings had, combined, by age 20!

A few weekends ago, she came home from a school-sponsored trip on a Saturday afternoon unexpectedly pale and pouty. She can be dramatic, but is rarely pouty. I should have known then something was up or something was wrong. Her group had stopped for lunch at KFC and then she had ridden in the back of a school bus home for about 90 minutes, so I wasn’t overly surprised or alarmed when she complained of feeling nauseated. I checked her forehead with the inside of my right wrist, my trusty mother thermometer. No fever. It was Saturday afternoon and I wanted to spend some time with my husband doing something we liked to do to relax. So, I basically told her to suck it up and quit whining.

We walked around a couple of flea markets and hit the grocery store for supper supplies. Once we were home, she took a nap and woke feeling a little better. Later that night, she had several episodes of vomiting and I began to think food poisoning rather than a virus was affecting my girl. Still, she had no fever, no localized pain, certainly no pain on either side of her abdomen. “Relax,” I thought, “there are a million viruses out there right now. She’ll be better in the morning.”

And she was. Or at least I believed she was. As we had been up late the night before, both she and I slept until around noon. She woke up, ate a bite or two of breakfast, and had another nap.

It was another story when she woke about 5 p.m.

Read the rest of Karen’s two-part column.

Take a survey on the image of nursing

What is your perception of the nursing profession? How would you compare this image to the image five years ago? How about 10 years ago? Have we made any strides? If not, why?

The nurse leader is in a pivotal position that affects the image of nursing. Nurses need to mentor staff, motivating them to advocate for a true representation of nursing. These nurses should be taught the skills to mimic this in their own work environment.

In preparation for an upcoming book on the image of nursing, Shelley Cohen, RN, BS, CEN, is referencing a web link below that will direct you to a quick survey consisting of related questions. Forward it to other managers and staff so they, too, can respond with feedback on the issue. We will report on the results on the blog when they become available.

In the interim, between now and when the book publishes at the end of this year, here are some tips on how you as the manager can influence the image of the nurse:

  • Share results of the survey with your staff and work as a team to develop a specific unit plan to improve the image of your nursing staff
  • Discuss information about the Center for Nursing Advocacy with staff and encourage them to write letters and emails when they see media misrepresenting the nursing profession
  • Get involved in community projects, such as BP screenings, health fairs, and speaking at schools
  • Identify unacceptable behaviors and hold staff accountable for them
  • Dress in a professional manner at all times
  • Encourage staff to validate their nursing expertise through the documentation process

To complete the brief 10 question survey, please click below

Groundbreaking study seeks to uncover truth about new grad nurses

As new generations of nurses enter the workforce, questions abound. What influences a new graduate’s job choice? How long do they expect to stay? Why do some of them want to leave? Professors Christine T. Kovner, PhD, RN, FAAN, and Carol S. Brewer, PhD, RN, are spearheading an in-depth study to find answers to some of these critical questions. And thanks to a recent $4.1 million grant, in addition to $1.9 million in earlier funding, from the Robert Wood Johnson Foundation, the research is now funded into 2015.

“There is a lot of information floating around about new graduates,” says Kovner, who has been at New York University since 1985. “But, in my opinion, there is no solid, systematic research.”

Already, that is changing.

The study, which tracks more than 3,000 nurses from 35 states, touches on a variety of topics including workplace experience, relationships with managers, and violence against nurses. Some early highlights from the first few years of the study include:

  • About 66% of newly licensed registered nurses (NLRNs) worked a 12-hour shift
  • Poor management was cited as the top professional reason for leaving a first job
  • About 62% of NLRNs reported at least one incidence of verbal abuse
  • 27.2% of NLRNs who had worked at least 13 months in nursing had already left their first job
  • Nearly 60% of NLRNs reported they were satisfied or very satisfied with their jobs
  • 41% of NLRNs planned to stay in their first jobs for less than three years
  • The median income for NLRNs was $45,000
  • The most important work characteristics to new RNs are “the ability to do the job well” and “being rewarded fairly for the work”

What are your impressions of these early study findings?

For more information on the study, visit http://www.rnworkproject.org or for more of this article, click here.

Create a nurturing nursing environment

By Rosa Belgard, MS, RN, Presbyterian Hospital of Dallas

The challenge of retaining the best nurses at the bedside is universal in the nursing profession, so it is crucial to offer nurses an environment where they can gain new skills, contribute to improving patient care, and feel like their job makes a difference. If you offer such an environment, nurses will not only stay, they will prosper and flourish.

Choosing and developing an environment where bedside nurses are held in high esteem, receive frequent recognition, and are compensated appropriately must be an individual process every healthcare organization, and the biggest challenge is developing an environment that meets your needs.

How are you working on creating this environment for your nurses? What are your biggest challenges in developing, maintaining, and supporting a clinical ladder or career advancement program? How have you addressed these challenges?

Don’t let Dr. Jekyll turn into Mr. Hyde

Is there a physician, possibly your medical director, who has been non-supportive behind your back?

You know who these people are. At a meeting or in front of your boss, they are supportive and, at times, encouraging of your work and efforts. But once the meeting is over and everyone goes their own way, they are completely different. You would think it was a “Jekyll and Hyde” experience!

This is not to take away from all the providers we collaborate with who are ethically strong and committed to being part of a team. This hot topic is not about them; we are grateful for strong collaboratives with many providers we work with.

But believe it or not, some people are unhappy when they see your successes. Now that I spurted that out, think about it. You already knew that, but most people won’t say it. You are that multi-tasking, confident, caring, empowering nurse leader and some folks out there want to burst your bubble.

How do they burst your bubble?

  • Going behind your back and planting seeds among those who look up to you. What are they planting seeds for? They are hoping to grow their own cheerleaders and take your squad away from you.
  • Relaying misinformation about what you said or wrote
  • Discouraging staff from following policy or procedure
  • Verbally defaming your ability to perform your role
  • Identifying staff members vulnerable to getting on their bandwagon

How would you approach this professional? Or, if you have already faced a situation similar to this one, how did it go?

Driving under the influence of drowsiness

It’s no secret that nursing can do a number on your health. Sore backs from lifting patients and poor eating habits because of strange schedules and lack of time, to name a couple examples, can have a detrimental effect on your health. Add driving under the influence of drowsiness to the list.

According to a new study published in the December 1 issue of SLEEP, staff nurses who work extended hours, work at night, struggle to remain awake at work, or obtain less sleep are more likely to experience a drowsy driving episode. The data was compiled during a four-week span and focused on 895 nurses, who reported, on average, one drowsy driving episode out of every four shifts worked. Additionally, 281 accidents or near car accidents were reported during the study.

Sleep restriction and sleep fragmentation are listed as the two main causes of drowsy driving. To combat the problem, the American Academy of Sleep Medicine recommends getting enough sleep, taking breaks while driving, consuming caffeine, avoiding alcohol, and avoid late-night driving.

Here is a link to the full press release with further information: Sleep Study

Every manager’s discrimination fears

Managers are forever grateful for the supportive teams they work with and all have staff they wish could be duplicated on a copy machine. Because we work with a variety of people, challenges will always be present. Our “Hot topics” will look at the reality of these challenges, helping managers by sharing their experiences. We can all benefit from those who have had success in meeting these situations of conflict.

How do you handle the employee who “everyone” knows needs to be shown the door, you have all the necessary documentation, but there is a “discrimination fear”? The employee may be obese, have a physical challenge, be from another country, or be in a recovery program for an addiction. According to the EEOC (US Equal Employment Opportunity Commission), types of discrimination include;

  • Age
  • Disability
  • Equal pay
  • National origin
  • Pregnancy
  • Race
  • Religion
  • Retaliation
  • Sex
  • Sexual harassment

Some employees may verbally threaten their manager by using the term discrimination and others use the weight of the nursing shortage as ammunition. The most recent case I was involved with was an employee who had threatened both the manager and the HR director with racial discrimination as they were walking the employee through the steps of termination.

In 2006, 75,768 individuals filed charges with the EEOC with almost 36% of them related to racial claims. gender discrimination was the next most commonly field charge at a rate of just under 31%. Of all the claims made in 2006, there were 403 suits actually filed. You can read more details about the charges, claims and outcomes of the cases at the Web site www.eeoc.gov.

What experiences have you had with this and how did you handle it? Were you surprised by the outcome? Who was your greatest resource that helped to guide you through the process? Did you find yourself in a situation where the organization was best served by “settling” the case?

Your job is a job–not your life

by Pat Maguire, RN, MN, CNAA

It’s the time of year when everything has a tendency to get chaotic–either the budget year is ending and you are worried about your final numbers, or you are putting the final touches on next year’s financial plan and are concerned that your requests may not be approved. The newly licensed nurses are nearing the end of orientation and some feel they aren’t competent to fly solo. One of your expert nurses is contemplating a transfer to a critical care unit and someone who behaves like “poor pitiful Pearl” most of the time has been in your face one more time about her seniority and expectation that she will be off Christmas and New Year’s Eve and day.

You’ve only held your position for a year or two and the stress of the 24-hour accountability and responsibility is starting to take its toll. Where do you turn for support? How do you manage the daily conflicts that tend to pop up regardless of the effort you put into modeling collaboration and teamwork?

Several years ago, a wise colleague who’d seen it all helped me through a particularly tough time. She asked me if I knew what my trigger points were. What made me vulnerable to a self created “pity party?” What part of the chaos did I own? Was I willing to step up to the plate just as I expected my staff to? Wow, those are pretty intense questions, especially if you are willing and able to do some soul searching before you flip back into high gear and try to solve world hunger.

What was the last novel or mystery book you read? What about your friends and family, when did you do something fun with them? Have you had any “retail therapy” lately? How about professional publications–either clinically focused journals or management texts–do you have a favorite? There are so many that offer a world of insight about your team and more importantly, about you and your style. I have found three publications to be most useful:

  • Michael Henry Cohen’s What You Accept Is What You Teach
  • Jim Collin’s Good To Great
  • Carly Fiorina’s Tough Choices

I pick one up whenever I’m down and learn something new about myself each and every time.

Commit to lifelong learning. And at the end of every day, pause and think about the things you did that made a difference for your patients, your staff, and your colleagues. Keep a journal and for heaven sake, don’t be critical and say, “I didn’t do anything.” You and I both know that isn’t true. Above all, be true to yourself. Don’t compromise your values. Know who and what your resources are so you can seek them out whenever the need presents.

The bottom line is make time for yourself every week–both personally and professionally. And never forget, your position is intended to be your job–not your life.

Text-A-Nurse?

Have you seen this?

Text-A-Nurse Cuts Time and Costs for Healthcare Staffing Professionals.

Do you think it as a realistic way for nurse managers to save some time, energy, and money?

Going back to school

p>by Shelley Cohen, RN, BS, CEN

Welcome to the Nurse Manager blog, “The Leaders’ Lounge!” I am thrilled you made time to log in and stop by to see what everyone is chatting about. I have yet to meet a nurse manager that didn’t have anything to say! But this is more than a blog; it is an opportunity to do exactly what this Web site focuses on. It’s a chance to strategize, plan, and develop an approach for your success in a nurse leadership role.

The ground rules for our blog are no different than any you would set for staff: no blaming others not here to represent themselves, take accountability for what you own, and agree it is okay to disagree. Some of the topics we’ll see will make us want to cry, and others will elevate our blood pressure to places we never thought it could go.

This blog is a sharing of all our journeys and I am here to get the proverbial ball rolling. Along the way, I’ll also be the person to laugh with, and the person to provide the rubber pad when you feel like you need to bang your head against the wall.

With all that said, let’s get started:

As I continue to work with nurse managers, charge nurses, and other healthcare leaders, I reflect on my days as a manager and realize all I continue to learn. Like many of you, I am heading back to school to obtain a degree in nursing with constant affirmation that learning is a lifelong process.

Why now, at the age of 53, am I deciding to go back to school? Two important reasons:

  • the shortage of nursing faculty to continue
  • validating my qualifications to perform in my role as a consultant

Although you may have heard me speak nationally or may be familiar with one of the several books and articles I have authored, I need a master’s level nursing degree to teach as faculty for a school of nursing. The shortage of faculty is directly impacting how many students are accepted into nursing programs.

Have you thought about going back to school? Why or why not? What factors are impacting the type of degree you select? What are you having to change and balance in your life so you can accomplish this?</p