Monday, February 8, 2016

Compassion fatigue: Are you at risk?

compassion fatigue

Compassion fatigue: Are you at risk?

Publication Date: January 2016 Vol. 11 No. 1
Author: Kate Sheppard, PhD, RN, FNP, PMHNP-BC, FAANP

For many of us, nursing isn’t just what we do; it’s who we are. Most of us became nurses because we care about people and want to make a difference in their lives.
Over time, nurses develop a nursing intuition and a working knowledge of disease and trauma. Our intuition, knowledge, and caring don’t automatically shut off when we leave work. For example, have you ever seen a worrisome mole on a complete stranger? Have you felt concern about a friend’s weight or a neighbor’s smoking habits? Have you ever been in a public place when you heard someone coughing—and wondered at what point you might intervene? These experiences are common among nurses. Yet, inability to shut off our knowledge and caring may leave us feeling emotionally saturated and raise our risk for compassion fatigue.

Ideally, as nurses, we should feel satisfied with our work and derive satisfaction from providing excellent care. Compassion fatigue has been defined as loss of satisfaction that comes from doing one’s job well, or job-related distress that outweighs job satisfaction. Sometimes, merely being exposed to another’s traumatic experience leaves us feeling emotionally distraught. Called secondary traumatic stress, this is a part of compassion fatigue. As our sense of job satisfaction decreases, we may feel more burnout. A reaction to our work environment, burnout can stem from such conditions as short-staffing, long work hours, workplace incivility, and feeling dismissed or invalidated. (See Research on compassion fatigue.)
Research on compassion fatigue

Who gets compassion fatigue?

Compassion fatigue can happen to any nurse—and it can be unpredictable. We know that nurses who work in oncology or see more patient deaths may be at greater risk. Also, when we form close, caring relationships with patients (especially if we lose our personal boundaries), we may be putting ourselves at higher risk.
Sometimes a particular patient or a patient’s family member may remind us of someone important in our lives. If that patient or family member has died, we may be triggered emotionally. Many nurses I interviewed in my research described being triggered unexpectedly and profoundly by a smell (caring for a child with second- and third-degree burns over 50% of his body), a sound (a mother screaming with grief when told her 3-year-old child had coded and died), or a sight (a dog on the hospital bed with his head across his master’s chest). Nurses who skip breaks, take extra shifts, or come in on their days off out of a sense of duty may be more at risk for compassion fatigue. One of the greatest risks for compassion fatigue comes when nurses forgo their own self-care.

What does compassion fatigue feel like?

In many cases, the first symptoms are emotional. Nurses talk about feeling bored with their work or feeling detached and distant from patients and colleagues. They may realize they’re irritable and short-tempered. They may feel they’ve failed to relieve a patient’s pain or to help a patient get well, losing their sense of pride in being a nurse.
Frequently, nurses with compassion fatigue talk about sleepless nights as they worry about what they forgot to do at work or replay disturbing events in their minds. They may be forgetful at work, in school, or at home. As compassion fatigue progresses, physical symptoms typically arise. Most nurses describe feeling physically and mentally exhausted, and many report headaches or backaches. Frequently, I hear nurses say they feel queasy just driving to work, and those feelings intensify as they walk in the door.
What happens to nurses who don’t deal with compassion fatigue symptoms? First, their work performance changes; for example, they may be at risk for medication errors. Without realizing why, they may start to call in sick more frequently. They may be short-tempered, sarcastic, or rude to colleagues and even to patients or families. They may appear tired and may become more easily startled.
Unfortunately, they may attempt to reduce their emotional saturation through alcohol or drug use. Ultimately, when emotional saturation becomes too intense, some nurses may view leaving the profession as the only means of escape.

Can you have compassion fatigue but still feel compassion?

Absolutely. In my studies, some nurses volunteered that they felt symptoms of compassion fatigue, yet stated, “But I also still feel compassion.” Clearly, a nurse can have symptoms of compassion fatigue while still feeling compassion. If anything, the more compassion a nurse feels, the greater the risk that she or he will experience emotional saturation or compassion fatigue.

Reducing compassion fatigue

What can you do to reduce or even prevent compassion fatigue? Start by being aware of how you feel physically and emotionally. If you realize, for example, that interactions with a specific colleague often feel uncomfortable or unpleasant, reflect on that a bit. Explore what’s beneath that feeling.
Perhaps you feel overlooked, ignored, invalidated, unfairly treated, or criticized—but instead of accepting those feelings and trying to make a change, you compound your feelings with guilt and shame. When you experience negative emotions, pay attention to how you feel physically. By bringing physical and emotional feelings to the surface, you can more efficiently address the underlying cause.

Establish healthy boundaries.

Establishing healthy boundaries is an important way to reduce the risk of compassion fatigue. Many of us face minor boundary issues frequently without really considering the consequences. Examples might include answering a question you feel uncomfortable with, sharing personal information you’d prefer to keep private, doing a favor for someone not because you want to but because you feel you have to, having someone hug or touch you in a way that makes you uncomfortable, and tolerating a rude or pushy person. By slowing your response and doing some self-reflection, you can address these issues with firm but courteous responses.

Make self-care and self-compassion priorities.

Perhaps the most important way to prevent or reduce compassion fatigue is to take care of yourself. As nurses, we work hard and really need our breaks. We need to eat, and to take time for ourselves without being interrupted by alarms, patients, or colleagues. We also need our time off, for our mental and physical well-being.
Before you were a nursing student and nurse, you probably had hobbies or activities you enjoyed. But later, between working long hours and trying to balance your personal and professional lives, those hobbies and activities were probably the first things you let go of. So try to bring them back into your life. Take the dog for a walk every day, listen to music, read a book for pleasure, go for a hike, call a friend—do something for yourself every day.
Self-compassion is important, but it may be hard to attain. Start noticing how you talk to yourself when frustrated, upset, or angry. Do you berate or criticize yourself? Try replacing that talk with kindness, just as you might talk to a loved one.

Practice self-reflection and mindfulness.

Parts of your job may make you feel frustrated because you feel powerless. As burnout and compassion fatigue build, your emotions may grow so strong that they become an overwhelming blur of anger, resentment, frustration, or helplessness.
Thoughtful and quiet self-reflection away from work may help you slowly separate events, interactions, and experiences. By examining each event or interaction, you can become more aware of your triggers (specific people, situations, or events) and address each one individually. Even if you can’t change your work environment, you can find power within by listening to your emotions with kindness and approaching colleagues and others from a wise and centered perspective.
Mindfulness is an important part of self-compassion. Although mindfulness has its roots in Buddhist meditation, it’s also a secular cognitive practice in the form of mindfulness-based stress reduction.
To practice mindfulness, take note of the present and pay attention with kindness and curiosity. You may notice physical or mental feelings of pain, fatigue, or pleasure. If you feel pain, ask yourself what your body or mind is trying to tell you—and address those concerns. By engaging in mindfulness, you can learn to identify which areas of your body react to your emotions. Mindfulness can reduce stress and anxiety and improve your physical and mental well-being. Through self-reflection and mindfulness, you allow yourself to consider events and triggers, learn from them, forgive yourself, and move forward.

Taking action

We can all reduce our risk of compassion fatigue and emotional saturation by reflecting on our triggers, practicing mindfulness, replacing self-criticism with kind self-talk, and engaging in daily self-care activities. Finally, if you’re suffering from sleeplessness, poor self-care, loss of interest, or other symptoms of distress, reach out for help from an employee assistance program or a mental health provider.

Kate Sheppard is a clinical associate professor and the psychiatric–mental health nurse practitioner specialty coordinator at the University of Arizona College of Nursing in Tucson.

Selected references
Hinderer KA, VonRueden KT, Friedmann E, et al. Burnout, compassion fatigue, compassion satisfaction, and secondary traumatic stress in trauma nurses. J Trauma Nurs. 2014;21(4):160-9.
Maiden J, Georges JM, Connelly CD. Moral distress, compassion fatigue, and perceptions about medication errors in certified critical care nurses. Dimens Crit Care Nurs. 2011;30(6):339-45.
Neville K, Cole DA. The relationships among health promotion behaviors, compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a community medical center. J Nurs Adm. 2013;43(6):348-54.
Sheppard K. Compassion fatigue among registered nurses: connecting theory and research. Appl Nurs Res. 2015;28(1):57-9.

Tuesday, February 2, 2016

Nurse Safety and Workplace Violence

Being safe: Dealing with injuries, violence in the workplace
Chapter from A Nurse’s Step-By-Step Guide to Transitioning to the Professional Nurse Role, an STTI book.
By Cynthia M. Thomas, Constance E. McIntosh, and Jennifer S. Mensik

​In this chapter from A Nurse’s Step-By-Step Guide to Transitioning to the Professional Nurse Role, the authors examine the types of violence nurses face and provide strategies to reduce violent behavior.

As you transition to the registered nurse (RN) role or to a new role within the professional practice, you may encounter some difficult people who exhibit a variety of violent behaviors. Healthcare is not immune to violence. As a nurse you are interacting with many people who are ill, under stress, anxious, under the influence of drugs or alcohol, living with mental health disorders, or fearful of the future. Patients, family members, and even your peers may not handle stress well or may become overwhelmed by the pressures of difficult situations. You may have already experienced or witnessed violent behaviors from a patient, family member, or, sadly, another nurse or physician. Our goal in this chapter is to alert you to the many forms of violence in healthcare and provide strategies to reduce or defuse the behaviors.
Types of Workplace Violence
Violence in the workplace is not new, and nursing is not an exception to violence. In fact, workplace violence occurs in healthcare more often than it does in any other workplace environment (Howard & Gilboy, 2009). In 2013, Speroni, Fith, Dawson, Dugan, and Atherton found that 76% of nurses reported experiencing a verbal or physical attack (2013). The United States Bureau of Labor Statistics (2010) reported healthcare employees were the victims of over 11,370 assaults, a 13% increase since 2009. Violence in the workplace is considered to be acts of physical and verbal assaults and threats aimed toward a person while that person is at work (Howard & Gilboy, 2009). There were at least 2,130 assaults occurring in nursing and residential care facilities, and assaults are most likely a higher number since many assaults are not reported.
The assaults can inflict physical or emotional harm to employees, visitors, and patients (McPhaul & Lipscomb, 2008; Papa & Venella, 2013). Though much of the violence comes from patients, nurse-to-nurse violence is one of the highest forms, followed by physician-to-nurse (Thomas, 2010).
Violence comes in many fashions (see Table 8.1), including threatening behaviors, verbal and written statements, and physical attacks of biting, hitting, kicking, shoving, throwing things, and pushing people (Sullivan, 2013). More violent behaviors might include the use of guns or knives, rape, sexual harassment, or murder (Sullivan, 2013).
There are many names for violence in the workplace, such as lateral violence, horizontal violence, and bullying (Thomas, 2010). Many states are taking a more proactive approach to stopping violence in healthcare facilities by making it a felony to assault or commit battery against emergency department nurses (Trotto, 2014). There is a drive to have Congress pass legislation for increased preparation for, recognition of, and de-escalating of violent behaviors in healthcare organizations (Trotto, 2014).

Table 8.1 Common Types of Workplace Violence 

Yelling in the nursing station, hallway, or patient room
Throwing things at a person or in a room
Kick, a physical act
Not acknowledging a request by simply avoiding or walking
away from the person
Making derogatory remarks toward a
person or to others
Hit, a physical act
Sighing, a covert action (not openly displaying behavior)
Making sexual
comments to a person
or to others
Biting, a physical act
Eye rolling, a covert action (not openly displaying behavior)
Yelling directly or indirectly to the person
Throwing things, a physical act
Gossiping about the person to others
Hanging up on a phone call
Threatening a person directly or indirectly
Making rude comments to a person or to others
Making demeaning remarks directly or indirectly to the person
Using guns, knives, or other weapons directly or indirectly on the person
Threatening someone
Making a person the brunt of jokes directly or indirectly
Calling the person names or referring negatively to gender, sexual orientation, or ethicality
Excluding someone
from the team
Making threatening comments directly to the person

What Causes Violence?
The nurse’s job can at times be stressful. Nurses often work 12-hour shifts in difficult situations. They are working with a variety of people with different personalities and coping mechanisms, and often people have unrealistic expectations of nurses and other healthcare providers. When people are sick, they frequently behave differently. Patients and family members may exhibit a fear of the unknown and lash out in frustration.
Gates, Gillespie, and Succop (2011) believe that working in healthcare increases the risks for violent behaviors, much of it being created by stress. In addition, emergency departments are prone to violent behaviors by nature of psychiatric and confused patients, alcohol and drug abusers, and violent patients such as murderers and gang members (Gates et al., 2011; Wood & Brott, 2013). Psychiatric departments and hospitals, emergency departments, geriatric facilities such as Alzheimer’s facilities, and overcrowded waiting rooms are potential areas for increased violent events (Nachreiner et al., 2007). Additionally, nurses who work alone or with limited staff, who work in areas with longer waiting times, and who spend time in less secure spaces like parking lots and dimly lit areas are at increased risk of violent behaviors (Glacki-Smith et al., 2010; Sullivan, 2013).
Reducing the Risk of Being a Victim of Violence
No one should be subjected to violent behaviors regardless of the magnitude of the behavior. The workplace should be a safe environment that is free from intimidation and fear. Nurses should not hesitate to ask questions and seek help when needed. 
Realistically, policies are effective only if the people working within the organization are willing to enforce them. Be willing to report someone who is bullying or displaying violent behaviors toward you. 
The Joint Commission mandated that all healthcare organizations have a zero-tolerance policy and procedure in place to address and eliminate violence from the work environment (The Joint Commission, 2012). You can review this policy at 2012.pdf. Knowing your organization’s policies and procedures on violence is vital and helps to protect you as a potential victim.
Nurses must know the warning signs of an impending violent event and be able to either defuse it or get help. Consider these great tips to recognize violent warning signs when someone:
  • Stands close or moves aggressively toward you
  • Yells or escalates his or her voice when you attempt to talk to the person
  • Elevates his or her arms in a fighting or striking position
  • Stares blankly or appears disconnected
  • Clenches or hits his or her fists
  • Possesses or brandishes a weapon of any type: pen, knife, gun, heavy object, or even a patient chart
  • Makes angry comments such as “I’m going to kill you” or “I’m going to knock your brains out” or “I’ll be waiting for you in the parking lot”
  • Attempts to prevent you from leaving or moving out of the way by standing in front of you or barring the door or exit
  • Bars you from retreating to a safe place (Sullivan, 2013; Wood & Brott, 2013)
Following are the steps you can take in these situations to protect yourself and others:
  • Do not approach or try to take a weapon from a person.
  • Do not turn your back on the person, but slowly walk backward, keeping your vision on the person at all times.
  • Call Security or 911, or call out for help or for someone else to call 911 or Security.
  • Remain calm and avoid threatening a violent person, slow your breathing, and change the subject, if necessary.
  • Protect other patients, close other patient room doors, lock unit or office doors, and direct people away from the area.
  • Do not allow the violent person to be close to the door if in a room; remain by the door so that you can exit quickly if needed.
  • Move to a safe area. (Sullivan, 2013; Wood & Brott, 2013)
Report abusers immediately, using the appropriate steps in your organization.
The Not-So-Obvious Workplace Violence
The sad fact is that violence is a negative part of healthcare, and nurses must learn how to recognize and protect themselves from falling victim to such behaviors. Most nurses have been subjected to some form of violence during their careers (Speroni et al., 2013; Thomas, 2010). Maybe you have also, but brushed it off as just part of the job. The incident may be as simple as another nurse rolling her eyes when asked a question or reach the level of bearing witness to a physician throwing a chart or personally experiencing sexual harassment.
New nurses are especially vulnerable to violence but may not recognize it as such (Thomas, 2010). Some not-so-obvious violent behaviors are someone giving the silent treatment, sighing, walking away when approached, refusing to help when asked, giving angry looks, and excluding others. Consider the following examples of not-so-obvious bullying incidents.
The Eye Roll
What it is: You may recall as a child rolling your eyes whenever your parents told you to do something you didn’t want to do. It was a subtle covert action that indicated your displeasure with something.
Example: Mary, a new nurse, asks Bill, an experienced nurse, for help to program an IV infusion machine. Bill rolls his eyes so that other nurses can see his objection to the request and pretends that he does not hear Mary.
Ways to deal with it: Mary should confront Bill about the incident. Mary is confronting Bill’s behavior, not Bill personally. Mary might say something like this: “I know I ask for help often, but I am still learning. You are the best nurse to help me because you are so good with problems like troubleshooting the IV machines.” This statement lets Bill know that Mary values his help and expertise and potentially defuses a violent behavior.
What it is: Ignoring happens when you make a request or ask a question to another person who does not acknowledge you or the request.
Example: Rose, an LPN, was floated to the 4South medical unit today. She has never worked on this unit and is unsure of the routines. Rose asks Connie, one of the regular unit nurses, when vital signs are generally taken. Connie responds by simply ignoring Rose. In fact, Connie gets up and walks out of the nursing station without addressing Rose’s question.
Ways to deal with it: One way to deal with ignoring situations is to confront the person about the behavior. You might say something like this: “I have never worked on this unit, and I am willing to do whatever work I am qualified to do, but I need some initial direction about the unit routine. Would you be willing to answer some of my questions?”
The Angry Doctor/Teammate
What it is: Dr. Jackson is well known for his difficult behaviors, and in fact, many nurses simply accept his behaviors and pass along this advice: “Well, that’s just how he is, and you will get used to him.”
Example: Sally, an RN, is assisting Dr. Jackson with a bedside lumbar puncture procedure. Dr. Jackson asks for a medication that is not normally given during the procedure and is not among the medications in the room. Sally informs him that she will have to leave the room or call another nurse to obtain the medication, which will delay the procedure. Dr. Jackson lashes out at Sally, yelling and cursing that she should have been more prepared and he will report her to the nurse manager.
Ways to deal with it: Sally should not accept the abusive behavior that Dr. Jackson is displaying. An appropriate response would be for Sally to calmly state, “Dr. Jackson, I will not accept being cursed at or yelled at by you. If I had been notified prior to the procedure that you might want that particular medication, I would have ensured it was present. If I step out of the room to obtain the medication, it might present a safety issue for the patient; therefore, I will call another nurse to obtain the medication as soon as possible.”
Excluded from the TeamWhat it is: Being excluded from the team is another form of violence. It implies that you are not worthy, that you are not part of us, that we don’t care about you. Being excluded may result in a hostile work environment.
Example: Cheryll was a new registered nurse working the night shift on a busy medical surgical unit. The more experienced nurses had all been working together on the unit for at least 6 years and were friends outside the organization as well. Cheryll had never felt part of the team, because the nurses tended to exclude her from conversations or not invite her to social events outside of work.
Ways to deal with it: The unit was particularly busy one night with several new admissions from the emergency department. Cheryll had completed only two admission assessments on her own and was concerned about her ability to complete the admission assessment on a patient with multiple acute health issues and family members with lots of questions. She decided to seek help from Beth, one of the more experienced nurses, who was sitting at the nursing station.
When Cheryll asked Beth for help completing the admission assessment, Beth pretended she did not hear Cheryll and walked out of the nursing station. Frustrated, Cheryll decided to find Beth and ask her again for help. As she approached a patient room, Cheryll overheard Beth talking about her to another nurse on the unit. “She is so stupid. What did they teach this girl in nursing school, anyway? She can’t do anything for herself. I wish they would have never hired her. She doesn’t fit in.”
Subsequently, Cheryll went back to her patient room and completed the admission assessment on her own. The next evening when she reported to work, the nurse manager asked to meet with her. Cheryll was given a written warning, composed by Beth, for making an error of omission for a routine medication the patient had been taking before the hospital stay. Cheryll was so upset that she resigned her position to evaluate whether she should remain a nurse.
Being excluded from the team can be very difficult. Exclusion is also a form of violence because it sets the person apart and sends the message “You are not one of us.” Cheryll should have confronted the nurse’s actions and explained that she is new to nursing and to the unit and needs help from experienced nurses. If Cheryll believes the nurse’s actions are creating a hostile work environment, she would need to make a formal complaint to the nurse manager. Though it is not required that a nurse is included in personal activities outside of the work environment and it is not necessary that everyone likes everyone else, nurses must be respectful to each other and work as a team or a cohesive group to maintain a safe, quality work environment.
Workplace Injuries
Many injuries are the result of workplace violence and need to be addressed to bring awareness and to support education and prevention programs. Other situations happen in healthcare organizations resulting in workplace injuries that may have been prevented. Nevertheless, nurses must be aware of potential risk factors in healthcare organizations to minimize their risk of injury.
Knowing how to avoid injuries and employ proper safety techniques for yourself and your patients is vital. Not surprisingly, injuries such as in the back and neck occur most often in healthcare environments and are estimated to cost more than $7 billion every year (Nordqvist, 2013). The American Nurses Association (ANA) statement makes it clear that back, neck, and shoulder injuries are preventable with the proper education and equipment (Nordqvist, 2013).
Many types of injuries can happen in healthcare organizations. The Centers for Disease Control and Prevention (CDC) reported that healthcare workplace injuries included needle sticks, latex allergies, back and neck injuries, violence, stress, exposure to chemicals, disease, and illnesses such as blood- borne pathogens (2014a). Nonfatal injuries in healthcare rank among the highest of any industry (CDC, 2014a).

The law mandates, though it may be difficult, that employers provide a safe environment for workers. The nature of healthcare predisposes nurses to viruses, bacteria, and a large number of illnesses. Exposure to needle stick injuries places nurses at risk for the hepatitis B and C viruses as well as for human immunodeficiency virus (HIV) (CDC, 2014b).
We tend to think of sharps primarily as needles, yet nurses work in a variety of places and are exposed to a multitude of sharp items. Among the more common are scalpels, lancets, razor blades, scissors, wire, retractors, clamps, pins, staples, cutters, and glass (Canadian Centre for Occupational Health and Safety [CCOHS], 2014). Some diseases contracted through sharps injuries are brucellosis, diphtheria, cutaneous gonorrhea, herpes, malaria, staphylococcus, syphilis, toxoplasmosis, and tuberculosis (CCOHS, 2014).
Unfortunately, sharps are often easily accessible to someone intent on harming another person. It would not be particularly difficult to pull used syringes from a needle box hanging on a wall, use the foam antiseptic spray to temporarily blind someone, or grab some lancets to stab another person. Heavy or falling equipment, burns, and inhalants can also injure nurses. Therefore, nurses must be diligent in maintaining safety awareness for not only their patients but also themselves.
Musculosketal injuries are among the most frequent physical injuries and are attributed to moving patients from the bed to the chair or stretcher, repositioning, and attempting to prevent a patient from falling (Stokowski, 2014). Additionally, repeated tasks that require bending, pushing, and pulling may also be problematic (Stokowski, 2014).
The impact of the injury may not be fully realized until much later, as it is the cumulative effect that is most troubling to the nurse.
If you have experienced a musculosketal injury, be sure to complete and submit the organization’s incident report. You should also be seen by a physician or another care provider for a physical assessment to determine the extent of the injury.
To prevent further injury, follow the organization’s policies and procedures for proper lifting, transferring, and moving patients. If the organization provides lift equipment, you need to use it. If you do not, get additional help when moving patients or doing any type of heavy lifting. If you have been placed on lifting restrictions, follow them for the stated length of time. Review and implement proper body mechanics for lifting.
Nurses may also be accidentally shocked by equipment and emergency resuscitation paddles, and there is the potential to be burned by using cauterization machines. Cleaning solutions and disinfectants may cause inhalation problems and exacerbate allergies.
Many nurses work in radiation therapy and therefore are at risk for radiation exposure and burns. Because radiation is invisible and odorless, there is no way to be sure of exposure. At the minimum, nurses may experience nausea, vomiting, erythema, dermatitis, and diarrhea; however, long-term exposure may cause cancer, sterilization, bone marrow suppression, congenital defects, and death (Stokowski, 2014).
Nurses working with lasers are potentially at risk for thermal injury to the skin and eyes (Stokowski, 2014). Surgical nurses are in danger of inhalation problems from toxic gases and blood-borne pathogens (Pierce, Lacey, Lippert, & Franke, 2011).
You must use caution when handling urine, stool, blood, and emesis by wearing gloves and a face shield when necessary. The Occupational Safety and Health Administration (OSHA) has developed the simplified document Hazard Communication Standard, providing a more common and understandable approach to categorizing chemicals and communicating hazard information. The updated document is the Employee Right to Understand, at (Stokowski, 2014). Though Stokowski points out that proper education is paramount, avoiding the chemicals when possible is preferred (2014).
Protecting Yourself
No one will protect you like you will. Be in control of your personal well-being. Know the policies on workplace violence where you work, and know how to prevent it from happening or how to report violent behaviors from others. Ensure that you are aware of the organization’s policies and procedures for workplace safety. Know where to locate the information and what to do if you find faulty equipment or if you or a coworker is injured. Follow all isolation procedures and other safety precautions established in your organization. Be aware of your surroundings and of the people who are present when you are working. Most importantly, know how to protect yourself from developing a workplace injury or from being a victim of violence.
The following list gives you some ways to protect yourself:
  • Wear protective gear when appropriate, such as a mask, an eye shield, gloves, shoe covers, and gown.
  • Do not recap needles.
  • Use needleless devices when appropriate.
  • Dispose of used needles immediately into sharps containers.
  • If you are moving across the room to dispose of a used syringe, hold the syringe upright in front of you to avoid sticking yourself or others.
  • Engage in safety continuing education programs.
  • Use adequate lighting.
  • Check instrument trays for sharp spots before picking up.
  • Avoid chemical exposure, wear proper protective clothing when necessary, and avoid exposure when possible.
  • Minimize radiation exposure by wearing protective clothing and avoiding radiation when possible.
  • Properly dispose of contaminated material.
  • Complete and submit an incident report if you sustain an injury, and seek a medical assessment to substantiate the injury.
  • Stop workplace violence, know your organization’s policies, refrain from violent behavior, confront situations whenever possible, and report people who exhibit violent behaviors.
Healthcare organizations are complex, and many people come and go every day. Nurses are caring for patients with a variety of emotional, psychosocial, and physical illnesses. Family members may be stressed and may lack coping skills to deal with complex and emotional decisions.
Violence in healthcare organizations is among the highest in all working environments, and it impacts the safety of not only nurses but also other providers of care and our patients. Violence may come in many forms, from the not-so-obvious eye rolling and sighing to more violent behaviors such as gunshots, stabbings, and physical assaults that may result in physical and emotional injury and even death.
In addition, nurses are working with lots of different equipment, some of it heavy, bulky, and unstable and often in confined spaces. Nurses are also exposed to many different hazards such as inhalants, topical chemicals, blood-borne pathogens, diseases, high-voltage electrical equipment, and instruments that may result in puncture wounds or skin lacerations. Nurses should be aware of the many potential hazards in the workplace and opportunities for people to commit violent behaviors and then learn how to protect themselves from violence and injury.
Chapter Checkup
Key points from this chapter include:
  • As a nurse, you will face violence, in both obvious and non-obvious ways.
  • Recognize the many types of violent behaviors.
  • Reduce the possibility that you become a victim of violence.
  • Avoid workplace injuries.
  • Protect yourself from an injury.
  • Know what to do if you sustain an injury. RNL 
Cynthia M. Thomas, EdD, MS, RNc, is an associate professor at Ball State University School of Nursing. Constance E. McIntosh, EdD, MBA, RN, is an assistant professor at Ball State University School of Nursing. Jennifer S. Mensik, PhD, MBA, RN, NEA-BC, FAAN, is executive director of On Nursing Excellence and the Institute for Staffing Excellence and Innovation.
Information on purchasing A Nurse’s Step-By-Step Guide to Transitioning to the Professional Nurse Role.
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Gates, D. M., Gillespie, G. L., & Succop, P. (2011). Violence against nurses and its impact on stress and productivity. Nursing Economics, 29(2), 59–66.
Glacki-Smith, J., Juarez, A. M., Boyett, L., Homeyer, C., Robinson, L., & Maclean, S. (2010). Violence against nurses working in U.S. emergency departments. Journal of Nursing Administration, 39(7–8), 340–349.
Howard, P. K., & Gilboy, N. (2009). Workplace violence. Advanced Emergency Nursing Journal, 31(2), 94–100.
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Pierce, J. S., Lacey, S. E., Lippert, J. F., & Franke, J. E. (2011). Laser-generated air contaminants from medial laser applications: A state of the science review of exposure characterization, health effects, and control. Journal of Occupational Environment Hygiene, 8, 447–466.
Speroni, K. G., Fitch, T., Dawson, E., Dugan, L., & Atherton, M. (2013). Incidence and cost of nurse workplace violence perpetrated by hospital patients or visitors. Journal of Emergency Nursing, 40(3), 218–228. doi:
Stokowski, L. A. (2014). The risky business of nursing. Medscape Family Medicine, 2–8. Retrieved from
Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed.). Upper Saddle River, NJ: Pearson.
Thomas, C. M. (2010). Teaching nursing students and newly registered nurses strategies to deal with violent behaviors in the professional practice environment. The Journal of Continuing Education in Nursing, 41(7), 299–310.
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Wood, H., & Brott, E. F. (2013). Key considerations: Healthcare workplace violence. Pro Assurance, 6(1), 2–7. Retrieved from b2c147a79265

Tuesday, January 26, 2016

What do you do with a PhD in nursing?

I now view the question as an opportunity to educate.
By Tiffany Montgomery

Almost weekly, I am asked about my choice to pursue a Doctor of Philosophy in nursing. The frequency of this makes me wonder if the general public only sees nurses as bedside handmaidens who take orders from physicians. The more frustrating thing is when these probing questions come from other PhD students.
I was shocked the first time I was asked by a non-nursing PhD student, “What do you do with a PhD in nursing?” I’ve now grown used to hearing this question from my doctoral colleagues outside the school of nursing. Still, it’s quite bothersome, because the question usually isn’t framed as an inquiry about what area of research I’m interested in or what type of employment I plan to seek upon graduation. It’s more, “Why in the world would a nurse want a PhD?”
Before I became accustomed to the question, I wasn’t sure how to answer it. Oftentimes, it was difficult to decipher whether or not the person asking was trying to be sarcastic (especially if the question came from another PhD student). At one point, I became irritated by the question and started giving a pretty snappy reply: “The same thing you do with a PhD in anything else!”
After completing a year of doctoral studies, however, I now realize that the general public is unaware of all the wonderful avenues available to nurses. So, now I view the question as an opportunity to educate.
What do you do with a PhD in nursing? Whatever you want! There are PhD-prepared nurses who teach, conduct research, evaluate programs, write books, lead health care organizations and work for the government. With a doctoral degree, the sky is the limit. One thing I doubt most nurse PhDs want to do is work full time in direct patient care. At the doctoral level, nursing is less about hands-on patient care and more about the abstract thinking that helps move the profession forward. More than anything else, a nurse with a PhD has the training needed to conduct research and add to the body of available nursing research knowledge. While not all PhD-prepared nurses choose to work as researchers, all have been exposed to great amounts of research and have had to demonstrate their ability to conduct high-quality research on their own.
Three jobs I’ve noticed that most PhD-prepared nurses consider are listed below. The job descriptions provided are based on my observations of nurses employed in these positions, and they may vary from facility to facility:
Nursing faculty member—A nurse educator who works in an AS, BSN, MSN or PhD program as a classroom instructor. Nurse faculty members are also responsible for creating, implementing and evaluating program curricula and mentoring nursing students. Oftentimes, in addition to their teaching responsibilities, they are expected to conduct research. They typically disseminate this research in scholarly journals and at research conferences.
Director of nursing research—a nurse researcher who serves as administrator of the nursing research department of a health care facility or coordinator of the facility’s nursing research program. The director may supervise other nursing research employees, or he or she may be responsible for overseeing all nursing research projects conducted within the facility. The director of nursing research is typically the go-to person within the facility for questions regarding the design and implementation of a desired research study. He or she may or may not be responsible for dissemination of research findings.

Director of clinical services—a clinical administrator who oversees daily operations of patient care departments in a health care facility. He or she is the liaison between upper management and department managers. Although the director is not involved in direct patient care, he or she is aware of the work flows in each department that promote optimal patient care. The director may generate or receive reports addressing the efficiency of departmental work flows, and this information is then given to each department manager in an effort to increase efficiency and patient satisfaction.
Other jobs available to PhD-prepared nurses include research or high-ranking administrative positions in pharmaceutical companies, research institutes, health advocacy organizations, health care information technology corporations and nursing or other health-related publishing companies. A nurse who has attained a PhD can practically work anywhere that research, education, or program evaluation takes place. The important thing to remember is that graduation from a reputable PhD program ensures that a nurse has received proper research training.
If you have any additions to the types of jobs held by nurses with PhDs, please post below. I’d like to learn of new opportunities for nurses with the terminal degree. RNL

Thursday, January 21, 2016

From ‘Dr. ColeMAN NURSE,’ an RNL blog, Push that reset button every day!

Why be content with going nowhere?
By Christopher Lance Coleman

Blog by Christopher Coleman
The new year provides an opportunity for each of us to reflect on lessons learned in the past 12 months and to reset life goals. I sometimes ponder how long it takes to arrive at the point where we avoid making choices that lead us to the same uncomfortable place. They may involve neglecting to take care of ourselves, failing to set and follow through on goals, or responding poorly to situations where people have hurt us. Whatever the case, the result is the same—an endless walk on a “hamster wheel” that goes nowhere.
For me, this past year has brought increased awareness of how quickly time is passing and how easy it is to not make the most of the time we have. I remember my beloved grandmother who firmly believed that taking time for granted is an irreversible mistake. By the time we realize our mistake, we find ourselves on the other side of an event that has disrupted our foundations. Clearly, we cannot stop time or reverse events that have already occurred.
Tragic world events of 2015 remind us all that we cannot take life for granted. Time is a gift we should use for good, not for engaging in unproductive or destructive activities. Perhaps you are among those who pledged at the beginning of 2015 to use your talents and gifts to improve lives around you. Or you made a commitment to exercise more or eat better. If you’re like most, the result has been a mixed bag of successes and failures. The point is, we often find ourselves pivoting away from life-improving goals toward places of familiarity that do not move us forward.

How do we stay engaged in working toward goals that move us forward? We push the reset button every day! Each day, we resolve to be our best, fully committing ourselves to excellence in all we do, whether it’s exercise, work, developing friendships, or nurturing family relationships. Like you, I have learned many lessons over the years. One is, if I don’t take care of myself, I can’t improve the lives of those around me.
As you ponder what you want to accomplish in 2016, remember to invest in yourself so you can be that change agent who positively impacts the lives of others. RNL
Christopher Lance Coleman, PhD, MS, MPH, FAAN, is Fagin Term Associate Professor of Nursing and Multicultural Diversity and associate professor of nursing in psychiatry at the University of Pennsylvania (UPenn) School of Nursing. He is senior fellow in the Center for Public Health Initiatives at UPenn and Institute on Aging Fellows in the Family and Community Health Division, Department of Psychiatry, School of Medicine at UPenn. He is also the author of Man Up! A Practical Guide for Men in Nursing, published by the Honor Society of Nursing, Sigma Theta Tau International.

Tuesday, December 22, 2015

A great article from

Nurses speak out about gender pay gap

By Lisette Hilton
The Greek philosopher Heraclitus’ doctrine that everything changes and nothing stands still doesn’t seem the case when it comes to equal gender pay in nursing, a profession where men have steadily out-earned women since 1988. In fact, nurse researchers report in the March 24/31 Journal of the American Medical Association that there has been no narrowing of the gender pay gap across settings, specialties and job titles for about a quarter century.
This isn’t the first paper to document higher salaries for male RNs, but it does offer a previously unstudied view of the pay gap, according to lead author Ulrike Muench, PhD, RN, of the University of California, San Francisco. “There have only been a couple of studies that have looked at gender earning differences in nursing,” Muench said. “They were conducted over 10 years ago and didn’t examine data over time. Our study is the first to examine a trend over time, and our goal was to include more [updated]data.”
The study reflects data from nearly 88,000 RNs from the National Sample Survey of Registered Nurses from 1988 to 2008, as well as 205,825 RNs from the 2001-2013 American Community Surveys. Men represented 7% of both data sets. Both samples showed male RNs’ salaries were higher than female RNs’ salaries every year.
While researchers estimated the overall adjusted earnings difference was $5,148, they found larger and smaller gaps in different settings. The salary gap dropped to $3,873 for RNs working in hospitals, but rose to $7,678 in ambulatory care. Pay gaps varied among the seven specialties studied: cardiology, psychiatry, neurology, pediatrics, med/surg, orthopedics and chronic care. The gap was biggest in cardiology, at $6,034.
“It is important to remember that our study didn’t capture all clinical specialties that nurses work in, such as immunology, gynecology or infectious diseases,” Muench said. “This is for two reasons: The surveys didn’t include all specialties in every survey year …. Other specialties, such as gynecology, had too few men to be included as a separate specialty.”

Largest gap

Gender pay gaps also varied by position, with nurse anesthetists standing out with a gender pay gap of $17,290.
The fact that nurse anesthesia is the highest paid nursing specialty and attracts more men than any other area in nursing offers no explanation as to why there is such a significant pay gap between male and female CRNAs, according to Sharon Pearce, CRNA, MSN, president, American Association of Nurse Anesthetists.
“From a practice standpoint, all nurse anesthetists — male and female alike — receive the same education and training, and they all provide the same safe, high-quality patient care for every type of procedure requiring anesthesia,” Pearce said. “The AANA and the profession, as a whole, would like to see this gap eliminated, because there’s no acceptable reason for there to be such imbalance in the pay scales.”
The gender pay gap, while it’s making headlines in nursing, is relatively narrow compared with other professions. For example, women who are financial advisers make only 61% of what their male colleagues make, according to Ariane Hegewisch, a study director at the Institute for Women’s Policy Research, Washington, D.C.
Nurses, on the other hand make 90% of what their male counterparts make, according to IWPR’s calculations based on the U.S. Bureau of Labor Statistics Current Population Survey. IWPR published its fact sheet “The Gender Wage Gap by Occupation 2014 and by Race and Ethnicity” in April 2015. “But it is nevertheless quite shocking that [nursing]does have a gap, given that hospitals often are either in the public sector or are more likely to be unionized,” Hegewisch said. “Typically, there is greater transparency in the way people are appointed and the ways they are paid and promoted.”

What’s causing the gap?

So, why the lag in female nurses’ pay? “Practice pattern differences, career choices and educational differences explain most, if not all, of the gender gap in nursing,” said Linda H. Aiken, PhD, RN, FAAN, FRCN, professor in nursing and sociology and director of the Center for Health Outcomes and Policy Research, University of Pennsylvania in Philadelphia, who has studied the nursing workforce in the U.S. and other countries.
“Men work more hours, which is an important factor since a large share of nurses are paid on an hourly basis,” said Aiken, who was not involved in this study. “They are more likely to practice in geographic areas with higher compensation, including the two coasts and large cities. They are more likely to select highly compensated clinical specialties …. Men are more likely to have a bachelor’s degree or higher, and education is associated with compensation.” Research on male and female nurses suggests that male nurses tend to move up the career ladder faster than female nurses, according to Hegewisch. This phenomenon is referred to as the glass escalator, according to a May 21, 2012, article on Women climb the ladder in a female-dominated profession, like nursing, while men glide to the top on an invisible escalator.
Caren Goldberg, PhD, an assistant professor of management at American University said in the Forbes article that part of that phenomenon occurs because women are more likely to experience career interruptions, including taking time off to care for children or elderly parents.

Closing the gap

Aiken said there are solutions that would help narrow any gender gap in nurse compensation, including realigning Medicare, Medicaid and private insurance payment policies to fairly compensate nursing care across settings and specialties. “Nurse practitioners still get only 85% of the payment that MDs receive for exactly the same services, and primary care providers are compensated less than in rapidly growing clinical specialties such as nurse anesthesia,” Aiken said. “Payment policies for long-term care including mental health services require nurses to sacrifice their incomes to provide much needed care.”
Hegewisch suggests nurses start a discussion about pay — that is, if they can talk about salaries. “Nationally, 60% of private sector workers say they are either prohibited by contract or strongly discouraged by their management from discussing salaries,” Hegewisch said.
Nurses can go to websites, such as or, to share and compare salaries, according to Hegewisch. They also can talk among their peers; then, decide whether to approach management about any gaps in pay. “Be proactive,” she said.
Hegewisch said research has shown men are more likely than women to hustle for pay increases, and when women do negotiate, they may be perceived less positively than when men negotiate.
More research is needed to study possible explanations for gender pay gaps in nursing, Muench said. In the meantime, employers can introduce open-pay policies that increase transparency in compensation. For example, the U.S. Department of Labor offers “An Employer’s Guide to Equal Pay,” which includes useful tips on addressing questions about pay discrepancies.
Pearce said the AANA will be looking closely at the research from various sources and considering strategies for educating its members and their employers to ensure that all CRNAs are being compensated equitably.
“I am hoping that our study can raise awareness on this issue and that nurse employers will use our results to examine their pay data to see if differences in earnings exist in their organizations,” Muench said. “If not, then this is a great outcome; if yes, employers can assess if there are legitimate reasons for paying men more than women.”
Lisette Hilton is a freelance writer.

Saturday, December 5, 2015

10 Ways for Nurses to Get Promoted

10 Ways for Nurses to Get Promoted

Are you stuck in a rut at work? If so, it might be time to consider a promotion. You may not have the authority to make that happen exactly, but you shouldn’t wait around expecting to be noticed either. You can—and should be—your strongest supporter. If you’re ready to take charge, here are 10 proactive ways to help you take that next step in your career.

1. Don’t Wait to Get Started
Don’t put off getting your career going, advises Beverly Malone, PhD, RN, CEO of the National League for Nursing (NLN) in New York City. “A lot of young people in particular will say, ‘I don’t know exactly what I want to do, so I’m going to wait before I make a move,’” she explains. “My advice is get started, even if you have to change directions later.”
For Malone, starting her career moves early made it possible to have a highly varied and distinguished career. The eldest of seven siblings, she was raised by her great-grandmother in rural Kentucky. As a young nurse, she worked in a psychiatric unit. Later, she served as dean and vice-chancellor of a historically black college. Then she became president of the American Nurses Association (ANA). And before taking the helm of the NLN, she lived in London, serving as general secretary of the Royal College of Nursing.
One of the hardest decisions for young nurses is choosing a field of study for a degree. “Don’t be too concerned about what kind of degree you get,” Malone advises. “There will always be something you can do with it later.” For example, she no longer works as a psychiatric nurse, but she says her experiences in the field still serve her well.

2. Be a Team Player
You can’t rise through the ranks without being a team player, argues Kanoe Allen, RN, MSN-CNS, PHN, ONC, executive director of nursing at Hoag Orthopedic Institute in Irvine, California. “Understand the staff you are working with,” she suggests. “The team can make or break you.” She also recommends volunteering for extra duties. “It allows other people to see you,” she says.
Raised in a family of Chinese, Japanese, and Hawaiian descent, Allen rose rapidly as a young nurse. Taking a job at a critical care ED, she was named charge nurse within a year and became interim administrator a year after that. A rapidly rising young nurse might have ruffled a lot of feathers among older nurses, but Allen thinks she “garnered some good will from the staff.”
Allen puts a lot of emphasis on social skills. “You need to understand the interplay between personalities and departments and work in a collaborative manner,” she advises. She still finds these skills invaluable as an administrator. “You have to really listen to your team,” she adds.

3. Find a Mentor
Finding a mentor is important to your career, because mentors know about “the back stairs,” Malone says, referring to the secrets of getting ahead in a large organization like a hospital. As a floor nurse, “you know there’s a door to go up, but you don’t know where the door is until a mentor shows you it.”
Sasha DuBois, RN, MSN, a 29-year-old floor nurse at Brigham and Women’s Hospital in Boston, relies on several mentors to show her the way. She acquired her first mentor in nursing school, when she heard her making a speech. “I walked up to her afterwards and struck up a friendship,” DuBois recalls. “She’s invested in seeing me grow.” They get together at least once a year.
Allen advises young nurses to cultivate people who are very accessible to them and can serve as career coaches. “A coach is someone who can be honest and tactful,” she says. “She can provide supportive feedback and help you with your own critical thinking.”

4. Follow Your Passion
You can’t have a successful career unless you are passionate about your work, argues Maria S. Gomez, RN, MPH, founder of Mary’s Center for Maternal & Child Care in Washington, DC. “If you want to achieve anything, you have to have a passion,” she says. “If you only care about your own job, it’s easy to get burnt out. You just go to work and come home.”
As an immigrant from Colombia at age 13, Gomez did not know any English except “thank you.” When she went to work in a large organization as a young nurse, she was unable to find a mentor. ‘The older nurses I worked with didn’t like their work,” she says. “I couldn’t wait to move on.”
She found her calling working at a public health department. “I saw a lot of injustices, and I wanted to make a difference,” she explains. In 1988, she founded Mary’s Center as a shelter for women immigrants from Latin America. Today, the organization has a budget of $39 million and provides care at six locations for low-income women, children, and men in the DC area.

5. Go Back to School
Going back to school to get a higher degree or certification is really about “creating opportunities for yourself,” says Kerry A. Major, MSN, RN, NE-BC, chief nursing officer for Cleveland Clinic Florida. “A degree can open multiple doors and help you find out what your passion is,” she says. “A lot of young nurses don’t realize all the choices that are out there.”
A degree makes you more competitive, Major says. At many hospitals, a master’s degree is a requirement for entry into management. But apart from spiffing up your resume, a degree is an opportunity to learn new skills. “The literature shows that a degree produces a more rounded nurse,” she explains.
Major notes that school is a great opportunity to mix with nurses from other walks of life who you might never have met within your own institution. “You can get an idea of all the opportunities that are out there,” she says. “You’ll meet someone who works in public health, and someone else is an operative nurse.”

6. Nurture Your Communications Skills
Speaking and communications skills become more important the further you move up the career ladder, says Glenda Totten, RN, MSN, CNS, PHN, director of nursing service at Kaiser Permanente Los Angeles Medical Center.
Totten is constantly honing her skills. She identified a senior manager with a great communication style and started paying attention to what he says and how he says it. “I listen intently,” she says. “He’s very precise. He doesn’t beat around the bush when answering questions. He’s able to give bad news in a realistic way, without sugarcoating it or kowtowing. And he’s open to feedback.”
Totten can practice her communication skills in many ways, including serving on a nursing quality improvement committee. She is also responsible for coming up with tools to quickly inform frontline nurses about changes in the hospital policies.

7. Read Voraciously
Don’t forget to read. It can help you improve your communications skills, find new role models, and get on-the-job training. “Reading increases your written and verbal comprehension, improves your vocabulary, and widens the topics you can talk about,” says Totten.
Through reading, Malone says she discovered a new mentor named Mary Seacole, a Jamaican-born nurse who worked in 19th century Britain. In a parallel career to that of Florence Nightingale, Seacole tended to troops in the Crimean War. “Sometimes having a mentor just means having that person in mind when you’re trying to accomplish something,” Malone explains.
Reading is also a good way to pick up new skills. Consider checking out The Nurse Manager’s Survival Guide: Practical Answers to Everyday Problems by Tina M. Marrelli, which is now in its third edition.
You can also take webinars. The “Nurse Manager Development Series” was designed by Lippincott’s Nursing Management journal and ANA to help new nurse managers develop their skills. Topics include retaining talent, managing disruptive behavior, conflict resolution, budgeting, and finance.

8. Volunteer for Assignments
Volunteering for assignments outside of your department helps broaden your skills and makes you a better candidate for promotion, says Juanita Hall, BSN, RN, a nurse manager for cardiology, outpatient treatment center, and dialysis at Providence Hospital in Washington, DC. “Get experience in different departments,” she advises. “Volunteer to be the float nurse.” For example, Hall volunteered to work in dialysis, where she didn’t have much background.
As a young nurse, Hall didn’t initially seek promotion, but she was always willing to learn new things. “I wanted to know what was going on,” she says, and because she was involved in many activities, “my name would come up to the nurse manager.” Even though Hall didn’t have a master’s degree, she got a job as an assistant nurse manager.
“It’s important for nurses to be willing to absorb,” Hall says. “Take in all you can from others. Ask questions [and] show yourself as very interested in what others have to say, so that people feed the information to you.”

9. Don’t Let Ambition Get Out of Control
Hard work and dedication are always welcome, but sometimes a person’s ambition ends up alienating others. “My position is that good things will come to you,” says Hall. “You don’t have to beat anyone up to get to them.” An associate minister in her church, Hall relies on her spirituality to center herself.
Nurses can also be susceptible to burnout if they take on too many assignments. The prime time for burnout comes when studying for an advanced degree while still holding down a full-time job. When DuBois was studying for her master’s degree, she was working 36 hours a week and taking three classes each semester. “I didn’t get burnt out, but I can see how it could happen,” she says. “Everyone has to figure out how much you can handle. It’s about balance.”
Even with her studies completed, DuBois still maintains a busy schedule, including a morning workout in the gym on off-days. “A lot of my friends look at my calendar and think I’m crazy,” she says. But she also reserves time for fun. “I like going out to a party or birthday. I feed off of that. That’s my time to let my hair down.”

10. Use Your Organization’s Career Ladder
Many organizations offer career-ladder programs, which offer higher pay or more responsibilities to nurses who demonstrate their skills, according to Shawana Burnette, OB-RNC, MSN, CLNC, a nurse manager on High Risk Post Partum and High Risk OB at Carolinas Medical Center in Charlotte, North Carolina.
Burnette’s hospital’s ladder process rates bedside nurses on engagement and certification and rewards them with a higher pay level. Nurses who achieve the next rung of the ladder, RN II, get a 10% raise. At higher levels, nurses may be asked to be a preceptor and orient new hires or a nursing student. “The focus is to encourage professional growth and to reward highly engaged nurses in your facility,” she explains.
The ladder process encourages earning certificates in various fields. Burnette is currently studying for a nurse leadership certificate. She says her hospital strongly encourages certification and even provides tuition reimbursement to take review classes to prepare for the certificate exam.
Enjoy the Journey
Nurses who continuously nurture their careers will reap great benefits as they advance up the ladder, argues Allen. “Your nursing career is a journey,” she says. “It’s an incredible journey. It will involve hard work and reaching something meaningful to you.”

Leigh Page is a Chicago-based freelance writer specializing in health care topics.

Leigh Page

Saturday, November 28, 2015

From stall to start: Don’t let fear stop you from writing

From stall to start: Don’t let fear stop you from writing
By Kathleen T. Heinrich

Stymied when you try to write? Can’t get your thoughts on paper? Break the writing barrier by applying these proven strategies.
Stories? Do nurses have stories! So, with all the writing material we accumulate in a day, why don’t more of us write about the amazing things we do?  We say we lack the time or the credentials (Steefel, 2007), when really what we lack is self-confidence, know-how or support (Heinrich, 2008). Whether you want to write a narrative for clinical advancement, an article for publication or an abstract for a conference presentation, find out what’s slowing your progress.
Kelley, Rhett and Jennifer are three nurses who are seeking ways to move their writing projects from stall to start. In the stories that follow, note how their fondest wishes and their greatest fears unmask specific writing challenges. What helps them overcome roadblocks to writing just might work for you.
KelleyKelley’s been a nurse for 10 years, and her manager is encouraging her to pursue clinical advancement. Kelley’s stumbling block is writing a clinical narrative that showcases her nursing care. She tells her manager: “Every time I think of a story, I get all excited. Then I ask myself, ‘What did I do for that patient and family that any nurse wouldn’t do?’ Poof! My excitement’s gone and I’m back to square one.”
Kelley’s fondest wish: If I could pinpoint what’s special about the care I give, it would be easier to write my clinical narrative. 
Her greatest fear: I know I’m a good nurse, but I’m afraid I won’t be able to find the words to convince reviewers that my practice merits clinical advancement.
Kelley’s writing challenge is lack of confidence in her ability to do verbal justice to the quality of her nursing care.
RhettNursing is a second career for Rhett. After trying his hand at real estate, he returned to school and recently graduated with his BSN. Not only is it a relief for Rhett to have a steady paycheck and regular hours, but he’s also loving his first nursing job. A journalist from the local newspaper asks him to write a short piece about finding a new career in tough economic times. Rhett knows he’s the perfect person to write the article; he’s just not sure where to begin.
Rhett’s fondest wish: If I just had a framework to follow, writing this article could be fun.
His greatest fear: I’ll spin my wheels, and all I’ll have to show for it is a wastebasket full of crummy drafts that never get published.
Rhett’s not lacking self-confidence. His writing challenge is lack of know-how. He doesn’t have a systematic approach to writing.
JenniferJennifer is an energetic school nurse who is passionate about “green cleaning.” She wants to present a poster at her state organization’s upcoming conference to help school nurses educate students about safe environmental practices that keep their carbon footprints small and their health strong. The only hitch is writing the one-page abstract that sells conference planners on her poster idea. Jennifer knows that, if she spoke with them for five minutes, they’d be begging for her poster, but her problem is writing an abstract that’s irresistible. 
Jennifer’s fondest wish: If I could talk my ideas out with someone, I might be able to write an abstract that’s persuasive enough to be accepted.
Her greatest fear: I won’t be able to get the word out about something I really care about, because I can’t write like I speak.
Jennifer’s writing challenge is lack of support from colleagues or friends.
What’s your writing challenge?As you read about these nurses’ writing projects, whose wish sounded the most like yours? Was it Kelley’s search for what makes her nursing care special, Rhett’s desire for a systematic approach or Jennifer’s yearning for someone to listen? What, in other words, is your fondest wish for your writing project?
 What’s your greatest fear? Lack of self-confidence? Lack of know-how? Lack of support? A combination of these? Naming your greatest fear(s) can help you anticipate writing challenges. Now that you’ve identified your writing challenge, let’s find out how these three nurses trounce their challenges.
Strategies for breaking the writing barrierDuring the last 20 years, I’ve developed strategies that help nurses meet writing challenges by allowing their wishes to overcome their fears. Applying these strategies move Kelley, Rhett and Jennifer’s writing projects from stall to start. 
To bolster her self-confidence, Kelley rereads notes and letters from grateful patients and families in search of words or phrases that describe her “something special” (Heinrich, 2008). The phrase “caring for the whole family” pops up everywhere and resonates with Kelley’s sense of what’s special about the care she gives. With this knowledge, she’s prepared to write a clinical narrative that showcases the special kind of care she provides.
Rhett compensates for his lack of know-how by identifying the four essentials common to all writing projects—idea, reader, vehicle and slant. Focusing on a single idea, he writes for a particular group of readers who read a specific vehicle, and he communicates his idea using a slant or angle that his audience can’t resist (Heinrich, 2008). For the article he has been asked to write, Rhett identifies the following:
Single idea: Finding a new career in tough economic times
Particular group of readers: Those who read our local newspaper
Specific vehicle: Our local newspaper
Slant: Retooling tips for the resilient in a rough economy
Identifying these four essentials upfront helps keep Rhett’s writing project on topic.
Jennifer is an extrovert who does her best thinking out loud. Unfortunately, her usual circle of colleagues and friends is not providing the sounding board she needs. To compensate for that lack of support and make writing the abstract a social activity, she seeks out a good listener who asks insightful questions and tape-records their conversation. 
From the recording of that verbal give-and-take, Jennifer crafts an abstract that describes her poster. She refines her draft by soliciting feedback from a colleague known for writing winning conference abstracts. Jennifer enjoys these interactions so much that she decides to turn her poster presentation into an article for her organization’s newsletter—with the help, that is, of a few good listeners and peer editors.
Two important questionsThe next time you want to move a writing project from stall to start, ask yourself two questions: What is my fondest wish for this project? What is my greatest fear? Your responses will tell you whether you’re lacking self-confidence, know-how or support. This lack is your writing challenge.
Refer back to your wish, and you’ll find the clue for compensating for this deficiency. Make up for what’s lacking, and you are well on the way to overcoming your writing challenge. As you do, you’ll catch a glimpse of how writing can open up new career opportunities, touch lives far beyond your workplace and influence the profession in ways that nothing else can.
Don’t let your nursing stories go untold! Allow your wishes to overcome your fears, so you can write about the amazing things you do every day. RNL
 Kathleen Heinrich
Kathleen Heinrich
 Educator, author and speaker Kathleen T. Heinrich, RN, PhD, is principal of K T H Consulting in Guilford, Connecticut, and author of the book A Nurses’ Guide to Presenting and Publishing: Dare to Share.