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.

Saturday, November 21, 2015

Want to write for publication but intimidated by the process?

Want to write for publication but intimidated by the process?

 Anatomy of Writing for Publication for Nurses
“Nurses are involved in every aspect of patient care, so their insights could vastly improve health care. That’s why knowing how to write about their experiences is key to change,” says Cynthia L. (Cindy) Saver, RN, MS, veteran nursing author and editor of a new book, Anatomy of Writing for Publication for Nurses, published by the Honor Society of Nursing, Sigma Theta Tau International (STTI).
Saver brings together 15 of nursing’s top writing experts to answer the most common questions asked by nurses who are interested in writing but intimidated by the publishing process. The 256-page book, which covers topics ranging from peer review and online submission to mind-mapping and social media, includes a foreword by Diana Mason, PhD, RN, FAAN, editor-in-chief emeritus, American Journal of Nursing.
“Communication is defined as a process by which we assign and convey meaning in an attempt to create shared understanding,” Saver says. “By learning how to write clearly and effectively, nurses can share their knowledge with policymakers, journalists, hospital administrators, nursing educators and the general public, which will benefit everyone.”
“If you are looking for a comprehensive text on writing for publication, from A to Z, look no further,” says Tim Porter-O’Grady, DM, EdD, ScD(h), senior partner of Tim Porter-O’Grady Associates Inc. “Anatomy of Writing for Publication is a great contribution to all nurses, from novices to scholars,” observes Pam Cipriano, PhD, RN, NEA-BC, FAAN, editor-in-chief, American Nurse Today.
Cindy Saver
Cindy Saver
Saver, former book acquisitions editor for STTI, is president of CLS Development Inc., an editorial consulting firm. A nurse for more than 30 years, she has spent the last 20 as a writer, editor, speaker and nursing publications executive. Saver has written for Nursing Management, Nursing Spectrum, American Nurse Today, AORN Journal, OR Manager and the American Journal of Nursing, to name a few. Her writing experience includes a 10-part series for the AORN Journal, research reports, case studies, interviews, clinical articles and continuing education modules.
STTI has also just published Take Charge of Your Nursing Career by Lois S. Marshall, PhD, RN, which includes advice on pursuing potential career options. Both books are available at

Saturday, November 14, 2015

Ready, set, write: 5 tips for becoming a better writer

Ready, set, write: 5 tips for becoming a better writer
For this writer, the first step was to start running
By Tiffany M. Montgomery

Taking Hold of My Dreams blog
Getting a PhD is unlike anything I’ve ever done. Once my coursework was complete, and it was up to me to continue progressing through the program, I was at a standstill. I was surprised, because writing has never been difficult for me. As a child, I loved to write. I wrote songs, short stories, and poems. I’d even doodle my name for hours on end. But it didn’t take long for me to realize that writing the chapters of my dissertation would be much different than the type of writing I was used to.
Because I had never really taken on a task that I deemed too large to complete, I was unsure of how to move forward. I tried talking to a dissertation coach. She helped me break down the overwhelmingly large chapters I had planned into more doable sections. Meeting with her was helpful, but it didn’t do the trick. I still found myself stuck. I tried writing at different times of the day, a technique that had previously been helpful. This time, it didn’t work.
I began to feel that the only way to conquer this formidable task was to take lessons I had learned from overcoming other obstacles and apply them to my writing. The problem was, I didn’t have a plethora of previously conquered obstacles to choose from. Until then, I had led a pretty safe life, taking on only those things I knew I could achieve. So, as a way to train for writing, I started to think of a new, self-inflicted obstacle I could overcome. It didn’t take long before I decided that running would be that obstacle.
I have never enjoyed running. Never ever. I used to get in trouble during physical education class for refusing to run. I didn’t mind participating in other forms of physical activity, but running was always tough for me. Several asthma attacks had been triggered by running in cold weather, and those experiences made me hate running even more. I used to say, “If you see me running, you had better start running, too, because there’s probably something chasing me.” As I said, I hated running.
I don't remember the day I decided to run, but I remember exactly how I felt. I thought I was going to die! Upon reaching the end of that first section of bike trail, I was proud of myself. I didn’t die. I didn’t even pass out! And I had achieved a goal I once thought unattainable. As I walked the next section of the trail, my breathing slowed, my heart didn’t beat so fast, and I was ready to run again. I continued to alternate between running and walking each new section of trail, and, by the time I made it back home, I was beaming with pride. I did it! Now that I knew the truth of what could be, there was no stopping me.
Every time I went for a jog—more accurately, a jog-walk—I had to mentally prepare myself. “You can do this. You won’t die. Just keep moving. Whatever you do, don’t stop.” And every time I arrived back home, I was proud of myself. Once again, I had accomplished something I was truly scared to do.
I used the lessons I learned while jogging to help me become a better writer. There is an endless list of tips I could give to help any new jogger or writer, but I’ve chosen five to share with you:
1. Go at your own pace.
You don’t have to do what everyone else does. Quite honestly, you shouldn’t want to. This is your race. You aren’t competing with anyone but yourself. Almost every runner on the trail moves at a faster pace than I do. I don’t care. I’m not running in a competition. My only goal is to do better this week than I did last week. That’s it! When I started walking regularly, my pace was 22.5 minutes per mile. Today, I jog at a pace of 15 minutes per mile. My goal is to get below 12 minutes per mile, and it will happen. I just have to keep going. I’m committed to staying in my own lane, no matter how fast others around me are running.
The same is true with writing. Not everyone will write at the same pace. Even if we did, the dissertation chapters, journal articles, and class papers wouldn’t be the same length or word count. Some people have more references than others. Some people’s methods are more complicated than others. Nothing about a PhD program screams “competition.” I completed my dissertation proposal and advanced to candidacy a full year after some of my classmates. It doesn’t matter. In the grand scheme of things, my job was to write and defend my proposal—and I did. As hard as it is, try not to compare yourself to others. It doesn’t help you progress any faster, and, ultimately, it takes your focus away from the task at hand. In most cases, wearing blinders isn’t a good way to approach a situation. In this case, it’s OK.
2. Use the proper tools.
As I have become a more experienced runner—(I use the term “experienced” lightly—I’ve learned to use proper tools, which keep me from having sore ankles or becoming so irritated while running that I stop midstride. Not too long after beginning to run, I bought my first pair of running shoes. I thought it was the only tool I’d need. I was wrong. When I began running, my keys were in my hand, and the sun beat into my eyes. When it was cold, I wore a very thin warm-up jacket that did nothing to keep cold air from getting to my lungs. After running more than enough days feeling like my chest was on fire, I purchased a light, but very warm, running jacket, and I made sure it had zippers so I could safely secure my keys, phone, and ID.
When it rains, I put the hood on. On warmer days, when I don’t wear my jacket, I put all my belongings in my running pouch. If running after sunrise, I wear a baseball cap or sun visor. Finally, I use the Run Keeper app. It tracks the length of my runs and allows me to comment on my friends’ workouts, as well. These and other tools are staples for “real” runners.
As I’ve become somewhat of an experienced writer, I have also found several writing tools I can’t live without. One of these is EndNote, a reference manager. Once I began using EndNote, I was mad at myself for not discovering it earlier. It’s a true writing assistant! I no longer have to manually enter in-text citations or entries to my reference list, and I am able to group my 750-plus references for easy identification. I can attach article PDFs directly to the references, and EndNote saves the highlights and notes I make on the electronic copies of the articles. It’s an amazing tool, indeed! I’m not suggesting that everyone go out and buy EndNote. It’s the reference management software I like to use, but there are plenty of other software programs that can help organize your references.
Another tool I use, though not as regularly as I did when writing my proposal, is my Pomodoro app. The Pomodoro method of writing says that, for every 25 minutes of writing, you should take a five-minute break. Then, for every two hours of writing, including those brief breaks, you should take a longer break of about 15 to 30 minutes. This technique has been shown to increase productivity for many, including me. There’s an entire science behind this method, which I won’t go into now, but it’s worth checking out.
3. Find a group to encourage you.
Running was OK when I was alone, but it became really fun when I started running with a group. Earlier this year, I began to power walk and run with a local Black Girls Run (BGR) group. BGR has running groups all over the country. Members meet at various times and locations to work out together. One of the things I love about this group is their motto “No woman left behind.” Whether you are a walker, jogger, or runner, you will not have to go it alone.
I experienced this the first day my running partner couldn’t make it to our morning running group. I can’t run as fast as some of the ladies, but they promised not to leave me, and they didn’t. They’d run laps around me, run to a tree, then back to me, or just run alongside me at my pace. There’s something special about doing things with a group. Running is no different.
Just as running groups help you run, writing groups help you write and develop healthy habits. During my third year at UCLA, I joined a writing group on campus. We didn’t actually write together, but we met weekly to report our writing experiences during the previous week, give advice to each other, and thus help increase our writing efforts. We set what we thought to be attainable goals each week. Sometimes we met our goals, sometimes we didn’t, but I loved the community that was built among our group, and I remained in the group for the duration of my third year.
In addition to in-person writing groups, there are tons of group-writing websites, such as and the Text and Academic Authors Association. Social media sites, such as Twitter, also encourage group writing through hashtags that include #AcWri (academic writing), #amwriting (early morning writing), and #shutupandwrite. Anytime you can write in the presence—or virtual presence—of another person, you will be encouraged to do your best. If you have become distracted from writing, I urge you to join a writing group. If nothing else, the group members will hold you accountable. You’ll either get with the program, or you’ll leave the group.
4. Do it even when you don’t feel like it.
If I had a dollar for every time I said, “I don’t feel like running today,” I’d be able to buy myself a nice pair of Jimmy Choo pumps. Whether or not I feel like running when I begin, I always feel great after my run is complete. And never have I regretted getting out of bed at 4:30 a.m. to go for a run. That’s right, my running group takes off at 5:15 a.m. I have plenty of excuses to stay in bed, but getting my run in early has yet to negatively affect my plans for the day. So I run, no matter how I feel.
Like running, writing is not something that comes easy for most people. Even among those for whom writing does come fairly easy, we aren’t always in the mood to write. While completing my proposal, I discovered something about writing: You don’t have to be in the mood to write to be a productive writer. The best way to become a great writer is to write as often as possible. Every day you don’t write is a 24-hour period closer to never writing again. That said, write when you want to write and especially when you don’t. I promise, once you get started, it’s not so bad. The first five or 10 minutes of writing are always the most difficult. After that, your ideas become more organized, and the words just begin to flow.
5. Quiet the mind-chatter.
Running is the most physical thing I have ever done. However, I have learned my mind will give up long before my body does. One of my friends who runs gave me the best advice ever. She told me, “Just keep moving your arms.” She was right. As long as I kept moving my arms back and forth, no matter how badly I wanted to quit, I kept running. At this point in my running journey, I don’t even listen to the negative thoughts anymore: “You’re not going to make it.” “You’re going to pass out.” “Your legs can’t take this.” My mind says these things, but my body hasn’t failed me yet.
Just like running, writing is more mental than physical. Your mind will keep you from writing long before you ever sit down to type. You can’t allow yourself to listen to those negative thoughts. You have to sit down at your desk, at the kitchen table, or wherever else you write and think like the Nike slogan: “Just do it!” While it’s important to take mental health breaks, don’t let negative mind-chatter talk you out of writing altogether. Even if it’s for only 15 minutes, write something! If you manage to write for 15 minutes, you can probably write for 15 more. Once you look up, two or three hours will have gone by, and you’ll be done with your writing for the day!
These tips are but a few that may help you become a better writer. I am no expert, by far, but each of the aforementioned tips has been of great help to me. If you are struggling to write—and even if you aren’t—I encourage you to take on a new and challenging activity, and use the lessons you learn to help you become a better writer.
For me, it was running. For you, it may be swimming, knitting, dancing, or hiking. It may also be something like jigsaw puzzles, computer games, or a musical instrument. Whatever you decide to take on, if you stick with it, you won’t be disappointed. Your writing will be much improved, and you’ll find a new hobby along the way. RNL
Tiffany M. Montgomery, MSN, RNC-OB, C-EFM, a women’s health nurse since 2005, initially worked as a labor and delivery nurse before broadening her focus to obstetrics and gynecology. She is now pursuing a PhD in nursing at UCLA.

Saturday, November 7, 2015

Telling our stories brings healing to our woundedness.​

Telling our stories
Telling our stories brings healing to our woundedness.
By Patrice Rancour

“The stories people tell have a way of taking care of them. If stories come to you, care for them. And learn to give them away where they are needed.”
— Barry Lopez, Crow and Weasel
Patrice Rancour
Is it any wonder that the PBS Masterpiece Theater program “Call the Midwife” has piqued the interest of the public? In these stories, written more than a half-century ago, viewers see their own stories—birth, death, suffering, joy, tragedy, humor, mystery—the gritty pathos of day-to-day life, so often lived in quiet desperation. And they see us—nurses and midwives—right in there with them, living with them, birthing their babies, ministering to their sick and wounded, and helping them, at the end of their lives, to cross the threshold into the unknown.
The series demonstrates in a very real way that the bulk of health care still takes place in homes and communities where people live, work, and play—not merely in doctors’ offices. This is why, except for the tragedy of 9/11, when firefighters rightly took front stage, the public continues to identify, year after year, nurses as the most trusted professionals. And yet, our work typically remains invisible to most people, until they need us. Which brings me to my point.
The healing power of story
When we share our stories—with each other and the public—we accomplish a number of things. The power of writing and telling stories about our work lies in the compelling power of healing they evoke. There is an old proverb: “In the hearing is the learning, but in the telling is the healing.” In the telling of our stories, woundedness—ours and theirs—is distilled, allowed to bubble up from regions of unconsciousness, where, as we shed light upon it, it can be transformed, released, and healed.
Patrice RancourI have written extensively elsewhere about my work with patients, asking them to write narratives about their illness experiences—to write letters to parts of their bodies they struggle with, to people with whom they are in conflict, even to people who have died. This ability to write one’s story is powerful in that it seeks after meaning and coherence and gives people who often feel mute and powerless a voice. James Pennebaker’s work on journaling demonstrates that patients who journal about their health issues require far less treatment—even as much as six months less—than people who don’t write about them. Such people become the heroes of their own stories and define themselves as such, rather than letting someone else define them as victims. This is true not only of patients, but of ourselves as well.
It is an error in judgment to believe that coming into contact with so much suffering does not affect us. We can bear suffering inasmuch as we find meaning in it. Giving voice to our stories helps us preserve our individual and group energies and defends us from the rigors of compassion fatigue and burnout. The act of writing about these experiences elevates our response to illness experiences, moving such descriptions from the merely banal to tales of heroic journeying.
When I listen to nurses share such stories, I often hear them say that they feel privileged or humbled in being allowed entrée into peoples’ sacred spaces. This self-reflection inoculates nurses against the very real occupational hazard of contact trauma. Such stuff leads to peak—rather than bleak—experiences, not only for our patients but also for our selves. And it allows us to come back and work yet again, another day.
Story as teaching tool
Telling our stories to one another and to the lay public becomes a teaching tool. If you are old enough, you probably remember those odious process recordings of yore: assignments demanded by an earlier cohort of fastidious nursing instructors that required us to write down, painfully, entire verbatim conversations between ourselves—as students—and our patients. Columns identifying feelings generated, assessments made, and how these translated into action followed. Voilà, the nursing process (also known as critical thinking).
In these days of bulleting and texting, I fear that such critical thinking is getting lost in the translation. Reliance on technology and pharmacology is eliminating the use of self as therapeutic tool. Writing and telling our stories takes us back to a time of self-empowerment that comes with knowing there is virtually no room I can enter in which suffering cannot be reduced just by virtue of my being intentionally and therapeutically present.
Telling stories about how this is accomplished is crucial to mentoring succeeding generations. All the computer programs in the world cannot help a medical or nursing student who is asked to have an end-of-life discussion with a patient when all that the student wants to know is, “But when she asks if she’s dying, what do I say?”
Telling stories about how these interactions occur is a means for providing such students with not only information but also the self-reflective practice tools that help us all become more self-aware, learn to center, use language as a healing modality, use words to help one another derive meaning—and, therefore, transcendence—especially in the face of fear, uncertainty, or death.
So when I write about my work, I am not necessarily seeking merely after facts, but rather after the truth of the experience. Story telling is what gets to this. As sociologist William Bruce Cameron observed, “Not everything that counts can be counted, and not everything that can be counted counts.” In a world of measurement mania and outcomes obsession, story-telling can get to the truth.
Story as cultural mediator
Lastly, when we share our stories with one another, we create a pool of shared experience in which we develop a culture of values that is passed on from one generation of nurses to the next. When we tell each other our stories, we are pooling and preserving a group culture and collective wisdom that strengthen us and help us resist powerlessness. Sharing our stories creates continuity and ensures that the essence of what we do is captured in self-reflective practice. The stories we tell one another about ourselves lift us up. The stories we share with the public about the work we do give them a voice in telling their own health and illness stories. And, in that respect, such stories evoke healing, not fear, for all of us.
So, tell us and one another your stories. Use words for the purpose of healing, to evoke hope, to help one another and your patients move through grief, make sense of the inexplicable, and make the world whole again. RNL
Patrice Rancour, MS, RN, PMHCNS-BC, clinical assistant professor in the College of Nursing at The Ohio State University (OSU), is a behavioral health and Reiki therapist at The OSU Center for Integrative Medicine. She is the author of Tales from the Pager Chronicles, published by Sigma Theta Tau International.

Tuesday, October 27, 2015

Scrubs May Carry S. Aureus

Student Nurse Scrubs May Carry S. Aureus

By Rita Buckley

NEW YORK (Reuters Health) - Scrub tops worn by student nurses may harbor methicillin-sensitive Staphylococcus aureus (MSSA) even after laundering, researchers say.
Dr. Elizabeth Scott, from Simmons College in Boston, and colleagues say contaminated student scrubs may carry the pathogen out of the hospital and into the community.
The researchers used two electronic surveys to gather information on 89 students' clinical work settings and laundry habits. Study participants also swabbed their scrub tops after shifts and again after laundering.
The researchers found no evidence of methicillin-resistant S. aureus (MRSA) on any pre- or post-laundry swabs, according to an article online July 2 in the American Journal of Infection Control.
However, 17% of pre-laundry swabs tested positive for MSSA after clinical shifts. Of these, 64.3% were clear of it after laundering and the rest remained positive.
Four scrubs that were negative for MSSA before laundering tested positive afterward. Use of hot water, bleach, ironing, or dryer time did not make a statistically significant difference in the clearance of MSSA. Neither did laundering.
Of the students surveyed, 31.5% lived on campus. Roughly half (51.7%) worked at academic medical centers, with 34.8% on medical surgical units.
Close to 60% of the student nurses spent two days per week on clinical duty. Approximately one-third of the patients they cared for were on contact precautions.
More than 90% of the students wore their scrubs to and from the hospital, and 37% wore them on campus after their shifts.
Close to 70% lived off campus and did not use dormitory laundry facilities.
The nursing students rarely followed safe laundering guidelines that include daily hot water washing with bleach, hot air drying, and ironing.
Nearly half left their scrubs in a hamper for at least two days before cleaning them. Just over 90% washed them with other items, and 46.1% used warm water.
Only 5.6% of the students used bleach. Over 85% tumble-dried their scrubs, but just 3.4% ironed them.
Dr. Scott said it's likely that nursing students around the country have similar laundry habits to the ones observed in the study.
"To help reduce the risk of infection transmission in the hospital setting, it's important to establish good habits during nursing training, including best practices regarding clinical scrubs," she told Reuters Health by email.
All the same, laundry routines may be of little consequence.
"S. aureus is common," said Dr. David Hooper, chief of infection control at Massachusetts General Hospital in Boston, who was not involved in the study. "One-quarter to one-third of the population normally carry it, usually in their noses," he explained.
According to Dr. Hooper, it's impossible to tell where the bacteria in the study came from. "We don't even know if the scrubs were contaminated in the hospital," he said, adding that the report can't be interpreted in any useful way due to problems with its design.
Dr. Pritish Tosh, an infectious disease physician and member of the Mayo Clinic Vaccine Research Group at Mayo Clinic in Rochester, Minnesota, told Reuters Health by phone that the small sample and lack of statistical significance made the findings questionable.
"Hand hygiene is the most important mode of transmission, not scrubs," he said.
Dr. Tosh, who wasn't involved in the study, still thinks it has some value. "It can open the door to further research on ideal laundering techniques as well as actual transmission of bacteria," he said.
Am J Infect Control 2015.

Wednesday, October 7, 2015

Nurses Are Talking About: Why They Go to Work Sick

by Laura A. Stokowski, RN, MS

Sick of Going to Work Sick

Imagine this scenario. You are an experienced, professional registered nurse who works the night shift in the coronary care unit. Every night, the hospital, the physicians, and everyone else depend on your acute assessment skills and your sound professional judgment to monitor very sick patients, detect the status changes that might precede deterioration, and take steps to ensure that your patients do not come to harm. Today, at 4:00 pm, you wake up with a sore throat, fever, and malaise. You call your supervisor and say that you are sick and cannot work tonight. The response? "You will need a doctor's note, or you won't be paid."
Seriously? The health and fate of scores of sick patients are regularly placed in your hands, but you are incapable of determining whether you are too sick to go to work? It would be comical if it wasn't such a serious and frequent problem. Every shift, every day of the year, nurses and physicians are compelled, through fear, guilt, or intimidation, to go to work when they are sick (known as "presenteeism"). And although healthcare employers profess to decry presenteeism, their policies and responses when employees call in sick suggest otherwise.
The news report "Many Docs Come to Work Sick: Survey", described a survey that found that many doctors, nurses, midwives, and physician assistants routinely go to work sick primarily because there is no coverage, and they don't want to abandon their colleagues or patients. More than 95% believed that working while sick puts patients at risk, but 83% still said they had gone to work with such symptoms as diarrhea, fever, and respiratory complaints during the previous year. Doctors were more likely than nurses or physician assistants to work while sick. Many expressed a strong cultural norm to go to work unless extraordinarily ill. This report provoked a swift and strong reaction from Medscape readers, beginning with the nurse (at work, sick) who found the news timely:
I am the first to say "shame on me" for coming to work today. I am so sick that I cannot stop coughing. Why am I here? We have an "attendance management program." If I am sick "too often," I will automatically be enrolled in this program to help "manage my sick time." My horribly inappropriate reasons for being absent earlier this year were chicken pox and whiplash following an accident. I guess I am just another nurse trying to "suck it up" today, and infecting my fellow nurses, to avoid disciplinary measures. My boss can clearly see and hear how sick I am yet has not offered to send me home.

The Guilt Trippers

Commenters overwhelmingly agreed that a strong motivation for going to work sick was the lack of coverage for the unit and the guilt that this engendered. Calling in sick invariably leaves your unit short-staffed. Knowing that you won't be replaced, and that your peers will have to carry the added burden created by your absence, is often enough to prompt clinicians to take acetaminophen or cough and cold preparations and drag their ill bodies into work. It is an age-old problem. "I have been a nurse for 43 years and nothing has changed," wrote a nurse. "There is no one to cover if you call off. Or your absence compels another nurse to work 14 days in a row or a 16- to 24-hour shift." Healthcare employers rarely make contingency plans for illness among the workforce. A Medscape reader wryly commented that nurses don't have the type of job in which we can just say, "No big deal if we don't give the meds today—we can catch up tomorrow."
Physicians and other clinicians who see patients regularly have similar problems when they are sick. An optometrist wrote, "I come to work sick because I feel guilty for cancelling an appointment that someone may have waited 2 months for."
One Medscape reader believes that physicians are victims of their socialization and acculturation, which begin in medical school:
It has been made clear since the onset of their education that only the strong survive, that there are no replacements, everyone is needed every day, and that to need time off for personal or family illness is a sign of personal failure and weakness. Surgeries and clinics cannot be canceled; what can we tell the patients who are depending on us? This is institution-speak for how will we replace the revenue, and how will we deal with the disappointment and inconvenience of the patients? It makes little sense. Who wants a compromised surgeon operating or a sick nurse or physician providing care in the clinic or hospital?
And a nurse added this: "I've caught some nasty viruses from sick doctors who should have been at home—I can appreciate their work ethic, but if I know when I'm not fit to work, why don't they?"
A family medicine physician agreed, saying, "We are too conscientious for our own good, and that of our patients! You can't heal anyone if you don't heal yourself first! And let's never forget: primum non nocere! Stay home when you are sick!"
In a sense, presenteeism is the response to a conflict of interest on the part of the nurse or other healthcare worker—the conflict between taking care of oneself (or family member) and fulfilling one's obligation to the workplace. Is it better to go to work and be "half a nurse," than no nurse at all?
Major nursing associations such as the American Nurses Association (ANA) do not have position statements on the issue of presenteeism, but they do have a code of ethics for nurses, which is particularly relevant to these issues. Thinking through the situation critically, and bearing in mind the nurse's ethical obligations to patients and to themselves, can be helpful. The ANA's newly revised Code of Ethics for Nurses With Interpretive Statements[1] states in part: "The nurse's primary commitment is to the patient." But what about the unit, coworkers, supervisors, and other colleagues who might suffer because of the nurse's absence?
Pertinent to presenteeism, the code of ethics addresses conflicts of interest directly, saying, "Nurses may experience conflicts arising from competing loyalties in the workplace, including conflicting expectations from patients...colleagues, [and] healthcare organizations... Nurses must examine the conflicts arising from their own personal and professional values, [and] the values and interests of others who are also responsible for patient care and healthcare decisions...Nurses address such conflicts in ways that ensure patient safety, and that promote the patient's best interests, while preserving the professional integrity of the nurse..."[1]
If the nurse is sick or otherwise unfit for duty, he or she may appropriately view it as an ethical obligation to not put patients at risk, either by exposing them to contagious illness or threatening their welfare by providing substandard care. The guilt that might accompany such a decision should be outweighed by the satisfaction of doing what is right for patients, not to mention coworkers who might become ill from close working contact with a sick colleague.

"You Are the Fourth Call-in"

Speaking of guilt, who hasn't heard this when calling in sick? Translation: "You are the straw that breaks the camel's back." What is the nurse supposed to say in reply? It always seems inadequate, but it's probably best just to whisper or croak, "I'm sorry," and hang up before the appeals to come to work anyway begin. Sympathy? Forget it. And the nurse who goes to work sick, hoping to be sent home, is delusional, according to readers.
One of my colleagues was sick with a stomach bug at work and became so dehydrated from nausea, vomiting, and diarrhea that she required intravenous (IV) fluids. But because she was on the "weekend option" and we were short staffed, she had to stay. They gave her ondansetron to stop her vomiting and made sure her IV catheter was in her nondominant hand so that she could still triage laboring women and check cervixes with her right hand.
Many nurses shared anecdotes about calling in sick and being pressured to reconsider. "I once called the house supervisor at 8:00 am to say that I would be too sick to work the evening shift. She began grilling me about whether I was really too sick to come in. Fortunately, I had a spontaneous episode of vomiting, and that ended the conversation." Another nurse, when the supervisor voiced skepticism about the need to stay home, countered by saying, "if the hospital can trust me to provide top quality care to patients, then they should respect my ability to know when I am too ill to work."
During orientation to the neonatal intensive care unit, a new nurse was concerned that her upper respiratory illness and constant, productive cough exposed her patients to infection but was told, "Everybody comes to work, sick or not. Wear a mask."
A few of the anecdotes describe behaviors bordering on bullying. A nurse who was sick on a holiday and couldn’t find anyone to take her place wrote, "I worked one Christmas with pneumonia and a fever of 104 degrees F. I tried to call in but was told that if I wasn't wearing a toe tag, I needed to come in or risk termination."
Administrators have reportedly been known to respond to sick calls or to nurses who become ill on the job with disbelief, anger, resentment, or coercion, all of which are unacceptable. All nurses, including those in administrative positions, must work hard to create "an ethical environment and culture of civility and kindness, treating colleagues, coworkers, employees...and others with dignity and respect. The standard of conduct includes an affirmative duty to prevent harm."[1] ANA's latest position statement, Incivility, Bullying, and Workplace Violence contains best-practice civility recommendations for registered nurses and employers.

"Sick" Policies (Pun Intended)

One reader objected to the idea that altruism induces doctors and nurses to go to work when they are sick. "They are afraid to call in sick not because of worries about a lack of coverage but owing to fear of incurring infractions and penalties assigned by punitive, draconian attendance policies." In other words, presenteeism is actually encouraged. Using sick time is certainly discouraged, as evidenced by the policies reported by nurse readers:
  • If you call in sick on a weekend shift, you are assigned a makeup weekend.
  • If you call in sick on the last day before or the first day after any vacation time, you forfeit your paid vacation days.
  • If you call in sick X number of times, you are subject to an "attendance review," after which no further sick calls will be allowed for a year.
  • No sick time is offered because it will encourage people to be sick.
  • Used sick days count against you in evaluations and promotion policies and can result in denial of scheduling requests.
  • You are required to use 2 or 3 vacation days before using any sick time.
Nurse after nurse described policies that not only penalize them for calling in sick but reveal a "lack of trust and a belief that employees are all deceitful." Another reader said, "There is no end to the unhealthy stance an institution takes toward its nursing staff. The motto, 'patients first' shoves nurses into last place." Another nurse related the effects of the hospital's policies on use of sick time: "A nurse from our unit developed severe meningitis. She was hospitalized for a week and a half and was out for several days more after discharge before she was cleared to return to work. After she returned, she was written up for 'excessive absenteeism.' Come on, now!"
In spite of declarations that staff should stay home when ill, healthcare employers use covert means to discourage sick calls. One such strategy is combining vacation and short-term illness time into "paid time off" (PTO), a practice that not only encourages but practically guarantees presenteeism. Nurses and other clinicians who must use PTO when they are sick are reluctant to call in because it is viewed as using up vacation time. The benefit that is actually labeled "sick time," can typically only be used after 3 or more days of illness, during which PTO must be used.
Hospital sick call policies place nurses in a no-win situation. Go to work sick, and you incite anger by exposing your patients and your coworkers to your illness or by being unable to work effectively. Stay at home, and you anger your supervisor and suffer the consequences of the attendance policy. "Pick your poison," said a nurse.
A reader described the ramifications for not coming to work sick, even in institutions with policies that threaten disciplinary action for doing do. "With punitive consequences—attendance review (disallowing additional call outs for a year; termination if violated), financial repercussions, termination, negative performance evaluations, and denial of scheduling requests—the institution forces the hand of its frontline staff, leaving an unhealthy and dissatisfied workforce at the bedside. Removing such radical punitive consequences and engaging staff on a professional level may result in higher respect for patient safety and infection prevention/control at those institutions."
Another nurse suggested that sick-call policies are backwards. Instead of thanking "Typhoid Mary" for coming to work and disciplining staff for calling in sick, "coming in ill and putting your patients and coworkers at risk should be the occasion for writing up a nurse for poor clinical judgment."
Punitive sick-call policies are inconsistent with the respect and trust that should be extended to employees. The ANA's 2010 Social Policy Statement[2] emphasizes collaboration in healthcare that "includes mutual safeguarding of the legitimate interests of each party and a commonality of goals...parties base their relationship upon trust."
Speaking as a registered nurse, ANA Policy Associate Holly Carpenter said, "Sick time is there for the health and safety of patients, nurses, and other healthcare workers. Nurses should not incur any punishment for using sick time."

How Sick Is Too Sick to Work?

"I don't think that healthcare workers should stay home for a simple sore throat; however, we know when we are really coming down with something. In those cases, workers should stay home or seek medical attention." So, how sick must a healthcare professional be to miss work?
One nurse offered her thoughts on this issue and her own definition of "too sick to work:"
There are many different ways to be sick. Did you stay up until 3 am partying, and this morning you are tired and hung over? Do you have mild cold symptoms? Are you mentally exhausted? Are you vomiting? Are you in the hospital? I have found the standard to be an inability to work at all; in other words, I cannot get out of bed.
Illness in the family poses a dilemma for nurses, who are often the primary caretakers, but staying home to care for a sick husband, child, or mother is typically frowned upon. Consequently, nurses feel that they must lie and say that they are sick, a deceit that doesn't sit well with them. One nurse was told by her supervisor that she had to report to duty as scheduled even though her 2-year-old child had been hospitalized. Another nurse, who occasionally missed work when her children were sick, suggested to the nursing director that some of the sick days be converted to "illness in the family" days, to avoid nurses having to lie when their children were sick. She was told, "We do not employ your family."

Misusers and Abusers

The first and really only justification offered by employers for their punitive sick-call policies is the tired old excuse about people abusing the system and the implication that all nurses would call in sick willy-nilly if it wasn't for the threat of losing their jobs. "Apparently, nurses go to nursing school so they can stay home and pretend to be sick," said a nurse.
No one disputes the fact that some people are sick more often than others or that a few of their colleagues might use sick calls to create a more favorable social schedule. "Sadly," wrote one nurse, "there are those who just call in to have a day off."
But is that a reason to treat all nurses—the great majority—as though they are faking illness whenever they call in? Another person wrote, "Firing people for sick calls is an example of the many being punished for the sins of a few. They don't know how to fix 'dishonest,' so they punish 'honest' instead."
Showing a lack of trust in all nurses simply because a few are believed to be untrustworthy or malingering is common, according to comments posted on Medscape. Such a lack of trust can act like a poison, destroying collaborative relationships in healthcare.
Of interest, not a single administrator or manager contributed any thoughts to this discussion. A former nursing supervisor offered this slightly different perspective:
It is an expectation that nurses come to work, ill or not. The hospitals and clinics are short staffed, and one call-off is devastating. I worked in place of an ill employee many times. Most supervisors do not take that initiative. I believe hospitals and clinics need to provide healthy foods and flex scheduling to assist their employees in maintaining health.
However, these solutions are dismissed as untenable, according to one reader, who wrote:
Most nursing supervisors and administrative that I have known don't have the skills to work on the floor. If they were required to work 1-2 shifts every week, they would be better administrators and supervisors because they would have a realistic idea of what the staff nurses do, they would keep up their nursing skills, and they would be able to substitute when the staff nurses are out sick.

Unhealthy Double Standards

Another theme among the comments was the "mind-boggling hypocrisy" demonstrated by the punitive attendance policies that are nearly universal in American hospitals:
For hospitals to market themselves to the public as centers of care and compassion and treat their own employees as soldiers who must not succumb to common illnesses is totally ridiculous. During my 30 years of doing direct patient care, I was never at my best when compelled to come in sick, and the potential to harm patients was high. There is always a way to staff a hospital if employees are sick. Shame on the hospital industry.
Similar sentiments were expressed by another reader, along with a strong rebuke for administrators:
Healthcare institutions speak out of both sides of their mouths—their ostensible concern for infection control, yet their clear disregard for it when they send vectors of disease in the form of unwell medical personnel into patient rooms daily. Concern for employee welfare? The "best place to work?" Yet they have brutal, punitive regulations governing sick leave out of fear that a few might abuse it. And note that administrators take sick leave with impunity because no one really notices if they are there anyway.
Many agree, suggesting that it is high time for this issue to see the light of day. "I always wonder when the public is going to realize that nurses are the most likely source of many nosocomial infections," wrote a reader.
Why don't healthcare employers put plans into place for sick-call replacements? The suggestion is viewed as ridiculous. "Most hospitals can't even provide extra personnel to relieve staff for breaks," said one nurse. No, as usual, the bottom line is the bottom line—it would cost too much.
Fear of lost revenue, either directly or indirectly when patients are inconvenienced, is thought to be the main driver of presenteeism.
Nurses are notorious for trying to shoulder the burdens of the entire world. When they are sick, they immediately become anxious about leaving the department short-handed. However, nurses are not responsible for inadequate staffing.
"It should come as no surprise to healthcare employers that healthcare workers will sometimes be sick and miss work. It is incumbent on the employers to provide safe, optimal staffing levels and to maintain those safe levels even if some of the staff are sick," said Carpenter. "It is unfortunate that the nurse feels personal responsibility for staffing. His or her responsibility is to provide excellent care to patients."
Many healthcare professionals commented on the irony of working in a hospital, which is supposed to be about helping people become healthy, yet caring little about the health of its staff.
At my hospital, a nurse is as important as a floor polishing machine or an adjustable bed. When one breaks, you throw it out and get another. If you are sick, you had better be hospitalized. Nurses and doctors come to work ill, injured, and sleep-deprived. We are expected to provide care for our patients, yet cannot expect any consideration from our employers. Yes, healthcare workers come to work sick, but they have to because the focus is no longer on care but on profit. Until it is no longer considered a crime for sick healthcare workers to stay home and care for themselves, we will continue to have the ill caring for the ill.
It might be helpful to print out Section 5 of the ANA Code of Ethics, which states: "The same duties that we owe to others, we owe to ourselves." As professionals who promote the health and safety of others, "nurses have a duty to take the same care for their own health and safety." Nurses must seek a work-life balance, including attention to their physical health, and "it is the responsibility of nurse leaders to foster this balance within their organizations."
Treating nurses differently from patients is also in defiance of the ANA Scope and Standards,[2] which states: "All must be mindful of the health and safety of both the healthcare consumer and the healthcare worker in any setting providing healthcare, providing a sense of safety, respect, and empowerment to and for all persons."
Healthcare employers are supposed to protect the health of their nurses (and others), but do they? An employer might argue that it is difficult to tell over the phone that an employee is unable to work. But what about when that employee's unfitness for duty is right before the supervisor's eyes? This article began with a quote from a nurse who said, "My boss can clearly see how sick I am but has not offered to send me home." Typically, the nurse soldiers on, hoping to make it through the shift because what are his or her options if supervisors refuse to release or replace the sick nurse? The nurse cannot just leave because that might constitute patient abandonment.
Trying to resolve this problem when you are already sick is probably not the best approach. Conditions under which presenteeism is expected (or encouraged by PTO systems), nurses are told to just "wear a mask," or nurses are not permitted to leave when they become unfit for duty while at work, can be unsafe for patients, and nurses have an obligation to ensure that unsafe practices are not allowed to persist. The code of ethics states that nurses must follow the policies of their employing organizations but also that when practices threaten the welfare of patients, nurses should express their concerns to the appropriate higher authority. It is possible that the policy itself is sound, but its interpretation is faulty, and it must be clarified to prevent unfair consequences to the nurse who calls in sick.


  1. American Nurses Association. Code of Ethics With Interpretive Statements. Silver Spring, MD: ANA; 2015.
  2. American Nurses Association. Social Policy Statement. Silver Spring, MD: ANA; 2010.

Wednesday, August 12, 2015

Are you using the ANA tools and resources?

ANA offers tools and guidance to help you be your best

As an RN, you invest much of your time and energy into making sure patients follow their treatment plans and do everything they can to improve their health and wellness. But are you taking the same steps to boost your own physical, mental and spiritual health and well-being? The American Nurses Association (ANA) recommends that you do — for the benefit of both you and your patients.
Now, there’s a way to evaluate your own health and wellness, and compare how you’re doing to other RNs as well as the overall population. Also, you can assess the health and safety of your work environment, including risks such as ergonomic injuries, sharps injuries, and bullying and workplace violence, and measure it against that of your nursing colleagues across the country.
In November, ANA launched the HealthyNurseTM Health Risk Appraisal and Web Wellness Portal in collaboration with Pfizer Inc — online tools for all RNs and RN students to assess their health and wellness. The survey provides valuable data on your individual health risks as well as how you compare against ideal benchmarks.  The website component of the appraisal allows survey-takers to find resources on topics for which  they want more education or want to focus on improvement.
ANA encourages all RNs and nursing students to take the free online Health Risk Appraisal to build a comprehensive database of nurses’ health and their work environments. The survey takes about 20 minutes to complete. You can find the survey at
What is a HealthyNurse?
The HealthyNurse Health Risk Appraisal and Web Wellness Portal is a component of ANA’s HealthyNurse  program.  In October, ANA’s Board of Directors adopted a new  HealthyNurse definition and related constructs to guide the program and associated initiatives.
ANA defines a HealthyNurse as one who actively focuses on creating and maintaining a balance and synergy of physical, intellectual, emotional, social, spiritual, personal and professional well-being. A healthy nurse lives life to the fullest capacity, across the wellness to illness continuum, as they become stronger role models, advocates, and educators, personally, for their families, their communities and work environments, and ultimately for their patients.  The constructs further advise nurses that, adherence to each of these constructs enhances the healthy nurse’s full capacity to care. Nurses whose practice is characterized by the HealthyNurse  constructs can function to their highest potential, personally and professionally.
Five constructs of the HealthyNurse
•  Calling to Care — Caring is the interpersonal, compassionate offering of self by which the healthy nurse builds relationships with patients and their families, while helping them meet their physical, emotional, and spiritual goals, for all ages, in all health care settings, across the care continuum.
•  Priority to Self-Care — Self-care and supportive environments enable the healthy nurse to increase the ability to effectively manage the physical and emotional stressors of the work and home environments.
•  Opportunity to Role Model — The healthy nurse confidently recognizes and identifies personal health challenges in themselves and their patients, thereby enabling them and their patients to overcome the challenge in a collaborative, non-accusatory manner.
•  Responsibility to Educate — Using non-judgmental approaches, considering adult learning patterns and readiness to change, the healthy nurse empowers themselves and others by sharing health, safety, and wellness knowledge, skills, resources and attitudes.
•  Authority to Advocate — The healthy nurse is empowered to advocate on numerous levels, including personally, interpersonally, within the work environment and the community, and at the local, state, and national levels in policy development and advocacy.
Visit for valuable resources and to participate in ANA’s HealthyNurseTM Health Risk Appraisal.
— Adam Sachs is a public relations writer at ANA.