Thought this was interesting.....

When You Can't Turn "Off"

nammi, Nurse, General Practice, 09:33AM Jul 24, 2015

Diane M. Goodman

Nursing is an insidious job. It gets into your blood and your heart, and at some point, it becomes you. You begin to meld into the person with no "off" switch, the one who eats, sleeps, and breathes nursing into everything and everyone around you.
I recently became that person, and I needed a family member to set me straight.
None of us are immune. We could become entwined with our careers after a week on the job or forty years. It could occur after a particularly heart-wrenching loss, or after achieving a longstanding goal or award, but the signs and symptoms are irrefutable: we interrupt our peers at lunch to discuss an interesting case we received, in spite of their sighs of frustration. We resolutely discuss "work" talk at baby showers and bridal events, when everyone else clearly wants to focus on the task at hand. Additionally, we see disease &/or disaster at every corner of life (with a teachable moment attached!).
Once we lose our ability to turn "off", we forget to engage in non-nursing events. Sleep? How silly. Our minds are churning over the events of the previous day, wondering where we could have found an extra five minutes for charting or patient contact. TV and movies? Hah!! We have articles and policies bookmarked that need attention. We'll never get caught up if we sit through several episodes of Shark Tank....
Hopefully, a family member or friend recognizes the ailment and nips it in the bud, as mine did. Sitting at a teaching hospital to review films (as a patient, not a nurse practitioner), I was convinced the wheelchair-bound patient in front of us was speaking to me when she asked for assistance. My husband, ever the logical one, knew she was not in distress and was questioning the group at large. He reminded me to turn my nurse switch "off" for two seconds and put a layman's hat ON, nearly impossible to do. He reminded me I can take the invisible ID tag off and be someone other than a nurse, which it seems I had forgotten how to do. I suffered through it, but he was right. Everyone lived! I had been so quick to bounce off that chair before his arm gently stopped me.
As painful as the experience was for me, I would guess that many readers have lost the "off" switch as well. Am I right?

PhD or DNP? How to choose

PhD or DNP? How to choose ​Which sibling are you?​

By Tiffany Montgomery

​ Before looking into doctoral programs, prospective nursing students should decide which route is right for them. Currently, two major nursing degrees are awarded at the doctoral level—the Doctor of Philosophy in nursing and the Doctor of Nursing Practice. In my discussions with BSN- and MSN-prepared nurses, there seems to be a little confusion about the two doctoral degrees. My advice is, do your research and know which degree you want before deciding what school to apply to. Put another way, looking at various schools of nursing and using this information to decide which degree you wish to pursue is not the proper way to make the decision. This is because the two degrees are vastly different and, depending on what you want to do with it, pursuing the wrong degree will be a complete waste of your time.   The PhD is a research-oriented degree. The DNP, on the other hand, is a practice degree, which can be likened to degrees obtained by physicians, dentists, pharmacists and optometrists or ophthalmologists. There are a few major differences between the PhD and the DNP. While everyone may not agree with my explanation, consider the following categorical differences,   Prestige Because of their vast differences, the degrees should not be directly compared but, in general, the PhD is regarded as the more prestigious of the two. Of course, the PhD has been around longer and is more widely recognized. It is also the terminal degree in nursing, meaning that no higher degree is attainable. If you looked at nursing degrees from a step-chart perspective, they would look something like this:   The chart may be slightly misleading because, in pursuing nursing degrees, a person doesn’t have to go from one step to the next. For instance, the point of entry for a person seeking a nursing license can be a diploma, an associate degree, a bachelor’s degree or an entry-level master’s degree. Also, a nurse doesn’t have to obtain a master’s degree before pursuing a doctoral degree. Still, the chart is a good indicator of how each nursing degree is viewed with regard to prestige.   What type of knowledge? While both degrees are designed to produce nurses who will contribute to the knowledge base of the profession, one thing is clear—the PhD-educated nurse is expected to create new knowledge. A PhD dissertation cannot be successfully defended without the generation of new knowledge. As nurses who are more focused on practice than research, those in DNP programs may or may not have generated new knowledge upon completing their capstone projects.   An easy way to differentiate between the two degrees is to see the PhD nurse as a knowledge-creator and the DNP nurse as a knowledge-applier. Where a PhD program focuses on understanding the philosophical and theoretical foundations of nursing and using these foundations to generate new knowledge, a DNP program focuses on taking knowledge available to the profession and transferring it to practical application.   Focus on hands-on-nursing Obtaining a PhD requires no clinical hours at the bedside or direct patient care. Obtaining a DNP, however, typically does require some type of practice hours to prove a student’s competence in his or her specialty area. If you are studying to become a nurse educator, for instance, you may have to work in an academic or clinical education setting. Or, if you are obtaining your DNP to become a nurse practitioner or clinical nurse specialist, you will spend many hours under the preceptorship of an already licensed advanced practice nurse.   PhD students take courses such as philosophy and theory to stimulate abstract thinking about the nursing profession whereas DNP students take courses such as pathophysiology and nursing assessment, knowledge and skills more geared to nursing practice. I have seen PhD nurses work per diem or volunteer in order to maintain their nursing skills, provide community service or supplement their income, but never have I come across a PhD-prepared nurse who works full time providing direct patient care. DNP-prepared nurses, on the other hand, often work in patient-care settings as nurse practitioners, clinical nurse specialists, nurse administrators, nurse educators and nurse researchers. Both PhD and DNP nurses teach in academic settings.   Choose wisely Whichever degree you choose to pursue, make your choice wisely. If you are in a PhD program but want to be a full-time nurse practitioner, you may find yourself miserable. If you are in a DNP program, but want to be a world-renowned neuroscience researcher, you may also be miserable. Although it is OK—and highly encouraged—to compare and contrast the two doctoral degrees in nursing, it is imperative to understand that neither degree is “better” than the other. They are complementary. Both are needed to keep patients safe and to continue advancing the practice of nursing.   I like to joke that the PhD is the attractive, older sister and the DNP the sassy, younger sister, but their momma and daddy love them both the same. I need my DNP “siblings” just as much as they need me. We are one big happy family. 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 the University of California, Los Angeles.

Why write? Nurse stories are about life—its messiness and its truths.

Why write?   Nurse stories are about life—its messiness and its truths.

By Karen Roush

Why write? is a question that often comes up in my work of mentoring nurses in writing. The question doesn’t arise as often with faculty members, who are expected to disseminate research findings and are required to publish to get tenure. Nor does it come up with nurses working in the policy arena, who understand the necessity of writing to create change and promote a health care agenda. But nurses working as clinicians don’t see writing as integral to what they do.   While it’s true that you can provide excellent clinical care without ever publishing an article, writing will enrich your practice, enhance your experience, and create more positive outcomes for your patients. If writing isn’t part of your nursing life, I encourage you to start. And if it is, I encourage you to expand your writing, try a different genre, reach a new audience, or consider a new purpose.   Write to improve patient care. Nurses do amazing work. We conduct research, develop innovative approaches to care, and carry out quality-improvement projects that change outcomes and make a real difference in patients’ lives. We need to share with other nurses and health care professionals what we observe and learn in our work, and writing is the best way to do that. When you solve a problem, discover previously unseen connections, or find a better way to care for patients, writing enables you to disseminate your knowledge beyond the bedside for the benefit of many.   For example, take a quality-improvement project you’ve completed on your unit that has resulted in positive outcomes for your patients. Perhaps they are better able to self-manage their diabetes or are more prepared for a complex surgery, resulting in less fear preoperatively and improved pain management postoperatively. Talking to co-workers spreads the information within your unit or to the wider facility. Presenting at a conference shares it with a few hundred or even a thousand attendees. But publishing has the potential to spread the information to thousands of nurses across the country and around the world. And that means your efforts to improve care for a few will benefit an untold number of patients.   Write to bear witness. As nurses, we are present at the most profound events—from the beginning of life to the end of life and everything in between. We are there with the mother who hears her baby’s first cries, and we are there with the mother whose baby is born in awful silence. We are there with the patient who awakens from surgery to hear his or her prognosis, and we are there as that patient figures out what that prognosis means. We are there when patients recently diagnosed with diabetes realize that, yes, they can administer their own insulin—they’re going to be all right, after all.   Sharing these stories offers meaning and insight to other nurses and those who experience situations similar to what we write about. These stories ease suffering and provide paths to new perspectives that help people heal. When people recognize themselves in stories, they realize they are not alone, that others have been where they are and have made it through. Through that recognition, they may come to a place where they are able to say: “I will be OK. I will get through this, too.”   Write to share your own stories. When we write about our own experiences, we communicate the unique perspectives of two worlds—the world of the healer and the world of the sufferer. We cannot separate our stories from what we’ve learned and lived as nurses. When our personal stories are embedded in that knowledge, they gain power and have potential to be transformative.   I am a survivor of intimate partner violence (IPV) and, as a nurse, have cared for many patients who have experienced IPV. Writing as both a survivor and nurse gives a weight to what I write that neither perspective alone would have. It engenders trust and credibility and, therefore, creates an opportunity and—I believe—a responsibility to share my personal story for the possibility of change.   Recently, I visited a class of graduate students to talk about writing. They had been assigned to read some of the pieces I’ve written about IPV over the years, including opinion pieces, blog posts, poems, and research findings. The responses of two students illustrate the impact writing can have.   The first confessed that, when she saw the topic of the reading assignments, she was not happy. “I thought, ‘Oh no, this is going to be such a downer.’” But the insights she gained from reading about IPV in those formats—stories, poems, and opinion pieces—made her realize how little understanding she had of the experience of IPV and how her misconceptions had resulted in her providing poor care to women who suffered from it. She was determined to change her practice.   The second student was a woman who was in an undergraduate class I had visited a few years earlier, a class that also had read some of my writing on the subject of IPV. Now, in this graduate-level class, she asked if she could read something she had written. It was a personal essay about reading my stories and how it had given her courage to finally speak about her own experiences as a survivor of IPV. Through writing, she was able to break through the silence and isolation and begin to heal. These two examples illustrate the tremendous power of writing to transform lives, professionally and personally.   Write to tell the stories of others. Nurses have a long history of speaking up for the vulnerable and the voiceless, beginning with Florence Nightingale, a prolific writer, and onward to nurses such as Lillian Wald, the great pioneer and champion of public health nursing. Wald published a series of articles in The Atlantic Monthly that later evolved into her book, The House on Henry Street. In the articles and the book, she told stories of the poor and disenfranchised that she and her organization of nurses cared for, a population of new immigrants to the city who were unable to speak for themselves.   As Wald writes in The House on Henry Street, “Conditions such as these were allowed because people did not know, and for me there was a challenge to know and to tell” (p. 8, italics original). Writing is the best way to tell—not only because, as noted above, it can potentially reach so many, but because it endures. Speaking about a story or a project resonates in the moment, but writing can resonate through time. A hundred years after she wrote them, Lillian Wald’s words enhance our understanding of social injustice and move us to do something about the injustices we see today.   Write to understand. Writing forces us to see gaps in our thinking. We cannot write well about a topic unless we understand it completely. When we see gaps, two things may happen: 1) We go out and seek more information, which may cause us to question preconceived ideas, change perceptions, and open ourselves to discovery of new ideas, or 2) we begin to formulate questions that will guide research to help fill the information gaps. Eventually, writing leads to new understanding, not only for ourselves but for other nurses and health care professionals.   Writing also helps us make sense of this world of health and illness, trauma and redemption that we inhabit. We are called upon day after day to deal efficiently and logically with suffering, to apply science and rationality to the irrational. Moving quickly through a morass of tubes and wires, we combine numbers and evidence with the subjectivity of the life in front of us. Amongst all the equipment, diagnostics, and data, writing keeps us connected to humanity. It helps us interpret and analyze our actions and reactions. It helps us see some small part of ourselves in our patients and, as a result, to be that much more empathetic and to go back the next day and do it all again. Maybe better.   So, why write? Our experiences as nurses—our stories—are about life, all of its confused messiness as well as its transcendent truths. Few other professions put members in the thick of it like nursing does. When we write about it, we make connections, improve care, and transform lives. Isn’t that the very essence of what nursing is? RNL   Karen Roush, PhD, APN, assistant professor of nursing at Lehman College in the Bronx, New York, USA, is the author of A Nurse’s Step-by-Step Guide to Writing Your Dissertation or Capstone. Roush served for many years as editorial director and clinical managing editor for the American Journal of Nursing (AJN) and continues her affiliation with the journal as an editorial consultant. The founder of The Scholar’s Voice, established to help professionals and scholars in the health sciences, particularly nurses, become skilled, confident writers, Roush blogs regularly for AJN’s “Off the Charts” and advocates against gender-based violence by writing and speaking on the topic.

Personal Safety for Nurses

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Workplace safety is a topic of major concern and discussion for workers and employers in a variety of occupations and workplace settings. In nursing, patient safety is an essential and vital component of quality nursing care. However, the recent Ebola outbreak and the growing risks of antibiotic-resistant microorganisms have created a heightened awareness around the fact that nursing is still one of the most dangerous occupations in the United States. This raises the following question: Just how safe are nurses in the work setting? In this 21st century, one may easily assume that nurse safety has been addressed. However, the answer is not clear.

Data from the Bureau of Labor Statistics (BLS) show that the health care sector continues to be the most dangerous place to work in America. According to the Occupational Safety and Health Administration (OSHA), health care workers are confronted with the following job hazards: bloodborne pathogens and biological hazards; potential chemical and drug exposures; waste anesthetic gas exposures; respiratory hazards; ergonomic hazards from lifting and repetitive tasks; laser hazards; workplace violence; hazards associated with laboratories; and radioactive material and X-ray hazards. In 2010, there were 653,900 workplace injuries and illnesses in the health care sector, which is more than 152,000 more injuries than the manufacturing sector, according to a 2013 Public Citizen report.
The paradigm for promoting nurse safety is changing, but slowly, and has not kept up with the technology to prevent injury, says Amber Hogan Mitchell, DrPH, MPH, CPH, president and executive director of the International Safety Center. “There have been a lot of advances over the last few decades to significantly improve nurses’ safety, but more can be done to collect and analyze data that would help speed adoption of innovative technology and spur swifter action to revise and implement stronger safety-related best practices and policies.”
The issue of nurse safety is pervasive. Unfortunately, musculoskeletal injuries are common from lifting patients without enough assistance. Nurses lift the equivalent of 1.8 tons every eight hours. Unanticipated exposures to blood and body fluids (BBFs) pose infection and illness risks to nurses on a daily basis. In the process of caregiving, patients or family members occasionally strike out at the nursing staff. Assaults from patients and patient visitors are far from being listed as isolated incidents. 
“Health care has reached a critical tipping point,” says Alexandra Robbins, author of the New York Times bestseller The Nurses: A Year of Secrets, Drama, and Miracles with the Heroes of the Hospital. “With looming physician shortages and an increasing demand for services, workplaces will have no choice but to make changes to accommodate nurses, our largest health care provider.”
Clinically Proven Textile Technology
About one in two nurses experience blood exposure, other than from a needle stick, on their skin or in their eyes, nose, or mouth at least once a month, according to a 2012 study by the International Healthcare Worker Safety Center at the University of Virginia. In fact, nurses experience these exposures most often while providing direct care, when they are least expecting it and not wearing protective clothing, according to data from the International Safety Center’s Exposure Prevention Information Network (EPINet).
In order to better protect nurses from unexpected exposures to harmful pathogens, we need to first address the role their daily attire can play in protecting them, says Barbara DeBaun, RN, MSN, CIC, consulting vice president of clinical affairs at Vestagen Technical Textiles, Inc. When exposure is unexpected and nurses are not donning personal protective equipment (PPE), traditional scrubs leave nurses vulnerable to direct contact with harmful contaminants that stay with them all shift long.
“Traditional scrubs allow micro-organisms, blood, and other body fluids to leach through the fabric, resulting in nurses carrying contaminants from patient to patient and home to their families,” DeBaun says. “New ‘active-barrier’ textile technologies, made with fabric such as Vestex, contain fluid-repellent, antimicrobial, and breathability properties.”
Debaun explains that this innovative fabric technology combination is key in helping reduce the acquisition, retention, and transmission of harmful pathogens on health care worker attire. Working together, the fluid-repellent barrier causes harmful contaminants to bead up and roll off the fabric, and the antimicrobial agent limits growth of bacteria on the fabric. Vestex’s active-barrier apparel is currently the only textile technology that has shown clinical effectiveness at reducing MRSA infections by 99.9%, in comparison to traditional attire.
Active-barrier apparel is already available in scrubs and white coats for health care workers and health care facilities to purchase. Hospitals such as Baptist Health in Jacksonville, Florida, have already established a systemwide uniform policy that requires staff to wear active-barrier protective uniforms. The organization made a commitment in 2014 to transition more than 6,000 workers, and all patient attire, to Vestex garments to enhance their culture of safety.
“As more data shows the risk that attire can play in transferring harmful contaminants, we believe that advancements in textile technologies will soon become the new industry standard for nurses in all health care settings,” DeBaun says.
Better Security
Nursing is the third most dangerous profession in the country because the vast majority of nurses are attacked by the people they are trying to help. According to data from the BLS, U.S. health care workers experience the most nonfatal workplace violence compared to other professions by a wide margin, with attacks on them accounting for almost 70% of all nonfatal workplace assaults and causing days away from work.
In 2014, 68-year-old Charles Emmett Logan, a patient at a Minnesota hospital, attacked a group of nurses with a pipe pulled from his hospital bed. The incident, which was caught on video, showed Logan running through the nurse’s station wielding a metal pole, hoisting it over his head, and hitting nearby nurses who attempted to flee the scene. One nurse suffered a collapsed lung, another fractured her wrist, and others had cuts and bruises. Medical staff told police that Logan, who died in police custody, suffered from paranoia.
“Hospitals do not protect their nurses, and it’s time they do,” says Robbins. “There is so much more that can be done, both tangible changes and major shifts in attitudes.”
Some hospitals believe that posting security personnel near triage looks negative, so they don’t put enough security staff at the entry points to the hospital and near triage. This puts the triage staff at risk when patients who are high, drunk, or psychotic come in the door, explains Robbins.
After the episode in Minnesota, the hospital initiated a training program to teach workers how to recognize and de-escalate potentially violent situations. However, many hospitals lack this basic safety measure — an oversight that leaves caregivers vulnerable.
“Understandably, nurses are focused on providing the highest quality and safest care to their patients, and often at the unintended risk of not protecting themselves,” Mitchell says. “A shift towards promoting a culture of safety that encompasses both patient and worker safety and security can create an overall better, more effective health care environment.”
To help promote a culture of safety, Robbins recommends that hospitals take the following steps:
• Install metal detectors to reduce the chances of patients or visitors injuring nurses and other staff members with weapons.
• Keep a computer database that flags patients known to be belligerent or aggressive.
• Install bulletproof glass and beef up security.
• Practice safe staffing and hire enough nurses so that the nurse–patient ratios are safe.
“The secret to improving American health care is to hire more nurses and insist that workplaces do a better job of protecting our frontline responders,” Robbins adds.
New Policies and Procedures
Exposures to BBFs pose a very large safety risk to nurses. According to data from EPINet, 47.7% of nurses were exposed to BBFs while on the job in 2012. Perhaps even more alarming, from 2003 to 2012, 83.9% had BBFs touch unprotected skin. These rates are high because nurses aren’t protected from unanticipated exposures, and compliance with PPE is surprisingly low. There is mounting evidence as well that nurses’ attire is contaminated with pathogens and can thus become a vector of transmission to other nurses as well as the patients they treat.
Mitchell believes that hospitals need to have programs in place that not only promote the use of PPE, but also measure compliance. This type of surveillance can allow the facility to identify where risks are high and compliance is low, and target programs in those areas, thus reducing exposures and reducing risk.
“EPINet is free to use and is an example of a surveillance system that can help hospitals to reduce risks,” Mitchell says. “The National Institute for Occupational Safety and Health [NIOSH] is launching a national system called the Occupational Health Safety Network [OHSN], and it is compatible with EPINet. Using systems like these allow facilities to compare themselves to others like them and to constantly improve.”
It is important to remember that safety is guided by a hierarchy of controls, which means that it is important first to eliminate hazards and risks to the lowest possible extent. Mitchell says this is done using engineering controls such as safety-engineered devices that eliminate or protect needles (e.g., needleless IV systems, retracting or shielded needles used on syringes, and blunt suture needles). For exposures to BBFs that splash and splatter, engineering controls might include closed systems for suction canisters or spill-resistant specimen containers. It may even include the use of new innovations in textiles, including those that are fluid-repellent and antimicrobial so that BBFs run right off of them, and fluids don’t soak in to the skin.
There will always be more that can be done to address nursing safety risks, Mitchell believes. Organizations like OSHA, NIOSH, and the Association of PeriOperative Registered Nurses, are always open to feedback, and it is only in providing them with your experiences and opinions that they can provide better guidance.
Mitchell adds that addressing nursing safety risks means creating the safest possible working environments and identifying and measuring hazards, so that programs and interventions can be designed to target and prevent them.
“This involves frontline nurses contributing to the review, evaluation, and selection of engineering controls, medical devices, and even textiles used in their hospitals,” Mitchell says. “Finally, it means working together across specialties, across units, across facilities, and across disciplines to share ideas, foster collaboration, and learn from each other.”

Terah Shelton Harris is a freelance writer based in Alabama.