Celebrating Nurses with a Little Bit of Poetry

IF MY STETHOSCOPE COULD TALK

by Kimberley Ensor, MSN, RN

If my stethoscope could talk what would it say about me today?

Would it say that I rushed through my assessment so I could scope out a place at the nurses’ station?

Would it say that I was thorough or going through the motions?

Did I just kill time until break? Lunch? End of my shift?

What would my stethoscope say?

If my stethoscope could talk how would my listening skills be evaluated?

Did I actually hear my patient?  When medications were refused or when the patient expressed they had enough, would I actually listen?

As my stethoscope moved across their body, did I notice a change that needed to be addressed in the plan of care or did I just do business as usual?

Was I listening to my patient and their family members’ concerns or did I just perform lip service as from a script.

What would my stethoscope say?

If my stethoscope could talk would it say that I had my eyes open as I took care of my patient?

Did I completely understand the physician’s orders?  When my patient addressed me did I provide eye contact or was I too busy looking at monitors and equipment?

Did I notice something and speak up as an advocate for my patient or did I leave it for the next shift to handle?

What would my stethoscope say?

If my stethoscope could talk would it say I half-heartedly gave education and explanations about medications?

Would what I speak actually come from a desire to be a help to my patient or just to look good as an authority figure?

Did I form my words to be culturally sensitive or did I disregard my patient’s views, beliefs and preferences?

When I spoke to colleagues or interacted with the multi-disciplinary staff was I a source of encouragement.

Did I include my unit assistants in the plan of care for the patient?  Did I recognize my charge nurse as a valuable resource?  Did I appreciate my unit clerk for their invaluable help?

What would my stethoscope say?

If my stethoscope could talk, would it say that I am an example of patient centered care?

Did my care come from my passion to be a nurse or am I just hanging around for a paycheck?

Did my body language speak I care about you or was I stand offish and couldn’t be bothered?

Was I first to the room when an IV or bed alarm sounded or did I say ‘that’s not my patient and turn a deaf ear and go about my day?

Did I make myself available to my colleagues, to my patient or was I nowhere to be found during busy periods?

Did I take a moment to step outside and let the sun touch my skin, reminding me of why I wanted to be a nurse in the first place?

What would my stethoscope say?

My stethoscope would say,

I bring my joy and positive spirit with me each time I step on the unit.

It would say I strive to listen with open ears and see with both eyes.

It would say I try to be an asset to my unit and an instrument of excellent care.

It would say I utilize evidence based practices when answering patient questions and use simple languages.

It would say I work daily to be an advocate, a hand to hold, and an empathetic ear.

My stethoscope would say I am a nurse and I put my heart into everything I do.

I wear my stethoscope with pride.

Preceptor education: Focusing on quality and safety education for nurses

Preceptor education: Focusing on quality and safety education for nurses

Publication Date: Jan 2016 Vol. 11 No. 1

Author: Fidelindo Lim, DNP, CCRN; Kimberly A. Weiss, MSN, FNP-BC; and Ingrid Herrera-Capoziello, MSN, RN, ANP NURSING

The transition from novice to expert nurse has been an important topic in nursing circles for more than 30 years, since Patricia Benner adapted the Dreyfus model of skills acquisition to the nursing profession. The model still serves as an excellent conceptual framework for the professional development of new nurses. Combined with core competencies from the Quality & Safety Education for Nurses (QSEN) initiative as the foundation for preceptor education, the model provides a road map for assessing and evaluating skills acquisition of new nurses or new preceptors. QSEN competencies include patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics.
The impetus to anchor preceptor education to a solid framework rests on evidence that prelicensure nursing education, although sufficient for fostering formation of professional identity and ethical comportment, doesn’t provide hands-on clinical experience. By focusing on well-defined competencies such as those outlined in QSEN, preceptors can better guide novice nurses on what skills to focus on and develop.

Preceptor council: Transforming education

Organizations with Magnet^® designation have vibrant, robust unit practice councils that address such core safety issues as falls, pressure ulcers, and hospital-acquired infections. At the Hospital for Special Surgery in New York, NY, a robust preceptor council composed of champions from all units and specialties grew out of a staff-identified need. Co-chaired by two clinical nurse specialists and overseen by the senior director of Nursing Excellence, the council meets once a month to discuss challenges and opportunities for quality improvement. It has become the forum for advocating transformational preceptor education, leading to
a redesigned and interactive preceptor education model based on QSEN competencies.

Competency and life-experience osmosis

In the United States, the average age of the practicing nurse is near 50. Contrast this with 31—the average age of nurses graduating with their initial nursing degree (considerably higher than the 1985 average age of 24). Additionally, 52.8% of new RNs received a previous bachelor’s degree and 7.2% hold a master’s degree or higher. The implications of these evolving demographic trends vary and require careful consideration when planning preceptor education. For example, older students with higher qualifications may be more experienced and have more confidence in addressing patient-care issues than traditional nursing students. When planning preceptor education, the overall lived experiences of new RNs must be taken into account.
Considering that preceptors generally are chosen from a pool of more experienced senior nurses, the potential for transferring hard-earned clinical skills and professional comportment is significant. Failing to use this prolific source of human capital to the full potential as knowledge, skills, and attitude transfer agents would result in a great loss. Because a growing majority of new RNs are entering nursing with professional backgrounds, they bring valuable and diverse life experiences that can be harnessed to shape their competencies in clinical judgment and technical proficiency.

Best practices for preceptor education

Situated learning, reflection on action, and outcomes measurement are a few examples of evidence-based practices in high-quality preceptor education.

Situated learning

Situated learning uses contextualized scenarios based on actual events and demands of the nursing unit. Interactive exercises in small group discussions using realistic and unfolding precepting case scenarios engage would-be preceptors in situated learning, helping them analyze and solve practice issues that might arise during preceptorship.
In this type of preceptor education, five carefully designed scenarios dealing with such issues as generational differences, experiential or learning gaps, missed opportunity, safety breaches, and work­around and work ethic issues are appraised and critiqued. Learners are asked to identify safety concerns, handle crucial conversations, suggest a quality-improvement or a research project to address the issues identified, and reflect on the merits of precepting best practices. Learners then present their work to their peers and the facilitator uses reflective questioning to address nuances of the scenario.

Reflection on action

Reflection on action is a deliberate ongoing process of learning from experience that will shape clinical judgment for future situations. Because precepting is a high-stakes interface among staff members and patients, it can cause significant stress. Effective preceptor education should allow exploration of novel precepting challenges, either in carefully designed scenarios or anecdotal reports from participants. The goal of reflection on action is to highlight what preceptors gain from their experience that contributed to their ongoing professional development and to build capacity for clinical judgment in future situations.

Outcomes measurement

The preceptor council’s deliberation at the Hospital for Special Surgery conducted a pre- and post-training survey to assess how full-day preceptor training was received and to appraise participants’ attitudes toward precepting. Another survey was sent to trained preceptors after they precepted a new staff member. Compared to pre-training survey data, post-training data indicated an improved level of comfort and confidence in precepting and an overwhelmingly positive attitude toward the preceptor role. (See Three strategies for effective precepting.)

Preparing future preceptors

Seen through the lens of the QSEN competencies, preceptor education prepares future preceptors not only as socializers of novice nurses into the profession, but also as guardians of patient safety and quality care. A conceptual or theoretical framework is an essential foundation for a well-designed preceptor education. In organizations with Magnet designation, creating a preceptor unit practice council fosters an impetus to provide evidence on measurable outcomes.

Fidelindo Lim is an assistant clinical professor at New York University College of Nursing in New York, N.Y. Kimberly A. Weiss is a clinical nurse specialist in the postanesthesia care unit and Ingrid Herrara-Capoziello is a clinical education specialist and coordinator in the Office of Professional Development at the Hospital for Special Surgery in New York, NY.

Selected references
American Nurses Association. Fast Facts. The Nursing Workforce 2014: Growth, Salaries, Education, Demographics & Trends. http://goo.gl/uwHPH5
Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-7.
Benner P, Sutphen M, Leonard V, Day L. Educating Nurses: A Call for Radical Transformation. San Francisco, CA: Jossey-Bass; 2010.
Budden JS, Zhong EH, Moulton P, Cimiotti JP. Highlights of the National Workforce Survey of Registered Nurses. J Nurs Regulation. 2013:4(2):5-15.
Dreyfus SE, Dreyfus HL. A Five-Stage Model of the Mental Activities Involved in Directed Skill Acquisition. ORC, 80-2, Operations Research Center, University of California, Berkeley. 1980.
Ramsburg L, Childress R. An initial investigation of the applicability of the Dreyfus skill acquisition model to the professional development of nurse educators. Nurs Educ Perspect. 2012;33(5):312-6.
Tanner CA. Thinking like a nurse: a research-based model of clinical judgment in nursing. J Nurs Educ. 2006;45(6):204-11.
U.S. Department of Health and Human Services. Health Resources and Services Administration. Bureau of Health Professions. National Center for Health Workforce Analysis; April 2013. The U.S. Nursing Workforce: Trends in Supply and Education. http://goo.gl/ZjvLJs
U.S. Department of Health and Human Services. Health Resources and Services Administration. The Registered Nurse Population: Findings from the 2008 National Sample Survey of Registered Nurses. 2010. http://goo.gl/1iyvPO

Healthy Nurse and Your Weight Goals

 Unpacking the pounds that weigh you down

Publication Date: June 2012 Vol. 7 No. 6

Author: Gary Scholar, MEd

How long have you dreamed of losing weight and keeping it off—of what it would feel like to be healthier and have more energy for your nursing job and your personal life?
University of Maryland nursing researchers found 55% of nurses surveyed were overweight or obese. For many nurses, weight loss remains an elusive dream that never becomes a reality. Weight loss and weight management can drive you up the wall and down the other side. It’s easy to slip into negativity and end up sabotaging yourself. To stop struggling with your weight, you need to know the three critical factors for unpacking the pounds that weigh you down, and create a list of priorities to help you manage your weight.

Getting unstuck

The first critical factor that keeps you stuck at the same number on the scale is the emotional and physically demanding nature of your job. For many nurses, the second factor is the huge disconnect between overperforming in your job and underperforming when it comes to your own self-care. This disconnect stems from what I call the Nurse Type E Personality—you do Everything for Everybody, ignoring your own needs.
The third major factor contributing to overweight is fear: Fear of disappointing others if you don’t take care of their needs first. Fear of having to give up your favorite comfort foods on a diet. Fear of committing your time and energy to weight loss. Fear of failing to lose weight. Fear of losing weight but gaining it back.
Fear is an emotional trap that holds you back from a healthier weight. A nurse wrote to me about how her fear, challenging work environment, and Type E personality contributed to her weight gain. She explained, “Since I was a child, I’ve never been somebody who could easily put myself before other people. I can read other people well and adjust my behavior to please them and get their needs met….As a nurse, I have a difficult time setting boundaries. ‘Sure, I can pick up the 12-hour shift after working my own shift. Take care of an extra patient? No problem!’ It doesn’t stop there. It carries over to my second shift of responsibilities when I get home, taking care of my family’s needs. The result is I constantly feel overwhelmed and burnt out, and I eat unhealthy comfort food to ease my stress…I’ve always sabotaged myself when I try to lose weight because of my fear of failure, caused by my yo-yo dieting over the years and my fear that if I give up comfort foods, I won’t be able to cope with my stress.”
Sound familiar?

Patients as role models

To rise above the factors that stymie successful weight management, think of the ill patients you’ve known who’ve successfully transformed their lives. Have you ever witnessed how illness seems to give some patients a new lease on life, how it gives them a strong sense of priorities and clarifies what’s really important? Suddenly they feel more alive and engaged, as if they’ve been given a second chance. Illness forces them to take a hard look at their past, present, and future. It gives them a chance to reconnect with themselves and be the person they were meant to be by rising above their fears, procrastination, and skewed priorities.
These patients transform their lives by being fully committed to integrating what I call their N.E.W. priorities. You can apply the hard lessons they’ve learned to help rise above your own weight-management struggles. To manage your weight, reconnect with yourself and be the person you were meant to be.

The N.E.W. approach

To kick-start your weight-management campaign, you need to fully commit to your N.E.W. priorities and set specific goals in line with them. The N.E.W. approach centers on what I call the weight-management triage list:
N stands for Nurturing self-care
E stands for Exercise, nutrition, and sleep
W stands for Work empowerment.
Managing your weight successfully means integrating these priorities into your life. It doesn’t mean you should make weight an obsession.

N: Nurturing self-care

When patients commit to transforming themselves to be healthier, they put nurturing self-care at the top of their priorities. Nurturing self-care helps you rise above your Type E personality and conquer your fear by helping you see that you deserve to succeed in managing your weight so you’ll be healthier.

E: Exercise, nutrition, and sleep

Daily exercise, healthy nutrition, and proper sleep are essential for ill patients hoping to regain their health. Similarly, to manage your weight, you need to integrate these three elements into your lifestyle. (See Power grocery shopping below.)

Power grocery shopping On your next shopping trip, use these tips to help fill your cart with healthy food choices. Buy produce during the week, because most deliveries are made Monday through Friday. Look for produce that’s in season. Select lean cuts of meat. Choose beef from grass-fed, not grain-fed, cows. Select cold-water fish, such as wild salmon, halibut, and tuna, because they sustain energy levels and satisfy hunger. Avoid prepackaged and canned foods (other than soup and beans). Choose whole-grain pasta and brown or wild rice. They fill you up so you’re less likely to overeat. Select low-sugar cereals with 6 g sugar or less per serving. Adapted with permission from Fit Nurse: Your Total Plan for Getting Fit and Living Well by Gary Scholar (Sigma Theta Tau International, 2010).

Here are two examples of nurses who lost weight by integrating self-care, exercise, nutrition, and proper sleep into their lives. When her granddaughter was born, Kim, age 45, started thinking about her weight and the things she might miss out on if she didn’t lose weight. She didn’t want to be a grandmother who couldn’t play with her grandchild, so after years of yo-yo dieting, she set out to create a healthier lifestyle by nurturing herself and integrating daily exercise, healthier nutrition, and plentiful sleep. She implemented her “Couch to 5K Plan” by jogging 3 miles several times a week and lifting weights. She lost 150 lb.
Josephine, a trauma nurse, also lost 150 lb—and has kept it off for 2 years. She started eating healthier and taking Zumba (dance fitness) lessons. Eventually she became a Zumba instructor. She went from viewing healthy living as a punishment to seeing it as a form of enjoyment.

W: Work empowerment

When patients return to work after an illness, one of their priorities is to be assertive in getting their needs met and creating a supportive work environment. Otherwise, stress and an unhealthy environment could negatively affect their health and well-being. The same is true for you as a nurse trying to integrate healthier weight management into your daily life. To become more empowered and promote your own and your colleagues’ weight-management efforts, advocate for effective support initiatives in your workplace. (See Workplace strategies that promote weight management below.)

Workplace strategies that promote weight management Nurse administrators and managers might want to consider implementing the following strategies to help staff nurses manage their weight. “Let’s do lunch” initiatives Quality-time meal breaks can promote healthy eating. Too many nurses skip meals because they are busy or feel guilty taking time out to eat. But when you skip a meal, your blood glucose level drops and your metabolism shuts down (what I call “nurse glycemia”). As a result, you go into your next meal famished and eat more than you should. Quick, healthy food choices Nurses need quick, healthy food choices. Providing onsite healthy snack carts at nurses’ stations can help you sustain your energy level by maintaining adequate blood glucose levels throughout your shift. Wellfood cafeteria Transforming unhealthy hospital cafeterias to wellfood cafeterias makes healthier foods available to shift nurses. Wellfood cafeterias also can serve as healthier-nutrition outreach models for patients and the family members and friends who visit them. Healthy food zones To create a healthy food zone, encourage workers, patients, and visitors to only bring healthy foods to the hospital. Fitness activities Onsite yoga, tai chi, and Zumba classes can help nurses raise their endorphin levels, metabolism, and energy levels, which in turn aids weight-loss efforts. Chair massages Stress can cause unhealthy comfort-food eating. A chair massage program, where nurses can get a 10-minute chair massage several days a week, can reduce stress. Education on adapting to long shift hours Topics might include how to integrate meals into the shift, the best foods to eat during long shifts, the most effective types of exercise for shift workers, and how to create proper sleep patterns. Emotional support programs When a patient dies, many nurses “suck up” their emotions. This can exacerbate stress, which can cause nurses to pack on the pounds. Instituting an emotional support program can help reverse this trend. In one hospital’s pilot program, when a cancer patient died, the charge nurse conducted an emotional needs assessment of that patient’s nurse. The nurse was permitted to take 20 minutes off to meet with an “emotional support” nurse—a nurse who volunteered to provide emotional support to colleagues on that unit.

An overweight nurse complained to me about her unhealthy eating habits, but wouldn’t take responsibility for them. I asked her, “Who does the grocery shopping in your family?” She replied, “I do.” “Who does the cooking?” She replied, “I do.” “And who puts the unhealthy food in your mouth?” She said, “I do.” Then I asked, “So whose responsibility is it that you eat an unhealthy diet?” Without hesitation she replied, “It’s my husband’s fault because he drives me crazy!” While this story makes you laugh, it also drives home the point that we all need to take responsibility for our actions—including those that jeopardize weight management.
You become what you believe. Choose to believe you can make a shift toward healthier weight management by modeling the N.E.W. priorities of patients who’ve transformed their lives.

Gary Scholar is a health and wellness consultant, wellness coach, speaker, and author of Fit Nurse: Your Total Plan for Getting Fit and Living Well.

RN and a Healthy Lifestyle

 Living a healthy lifestyle

Publication Date: March 2014 Vol. 9 No. 3

Author: Beth Battaglino, RN, BSN

As nurses, we know how to check blood pressure, administer medications, and counsel patients about healthy living. But let’s face it—some of us don’t practice what we preach. At the end of a long shift taking care of others, we sometimes fail to take the best care of ourselves.

It doesn’t have to be that way. Take it from me—a busy practicing nurse, chief executive officer of a women’s website, a wife, and the mom of a 1-year-old boy: You can fit healthy habits into your life. You just have to want to. And once you do, you’ll see how much better you feel, physically and emotionally. As a bonus, exercise and healthy eating habits improve your cardiovascular health—a major concern as we age. (Heart disease is the #1 killer of women.) If improving your own health and well-being isn’t reason enough, keep in mind that getting healthier can help you take even better care of patients.

The power of exercise: Working out your body and your stress

I learned at a young age I’m not one of those women who can eat whatever they want and stay thin. I also discovered I can’t simply cut calories to lose weight; I need to exercise, too. For weight and overall fitness, I can’t stress enough the importance of physical activity. As a country, we exercise more today than we did 10 years ago—yet obesity rates are higher than ever. Why? Researchers suggest diet and other lifestyle changes are also components to maintaining a healthy weight.
Most people need to exercise (and eat well) to keep weight off and stay fit. The American Heart Association recommends at least 150 minutes of moderate exercise or 75 minutes of vigorous exercise each week, or a combination. This comes to at least 30 minutes, 5 days a week—a good goal.
What form of exercise is right? Like me, you might want to mix up your workouts to keep your mind and body challenged. I run one day, do kickboxing the next, and go to boot camp the next. (Kickboxing and boot camp are great ways to relieve work stress, by the way.) I also do strength training a few times a week.

To stay motivated, I exercise with friends. It’s much harder to make excuses for skipping an exercise session when you know others are counting on you. Once you show up, friends will push you to give it your all. I run with a group of 40+ moms every Saturday morning. Last year, I trained with the group and completed a half-marathon and three triathlons. Running is a great therapy session, too. One of us might say, “Hey, I’ve been having this problem at work”—and get great feedback from friends while running.
During the week, I fit my workouts in early—at 5:30 in the morning, while my husband stays home with the baby. He gets his turn to work out at night. It’s all about juggling and balancing your schedule to fit exercise into your life.

Nurse Nutrition 101

I plan my meals ahead of time. Healthy eating is crucial to controlling weight and promoting cardiovascular health. Research has deemed the Mediterranean diet a winner for a healthy heart. With this diet, you consume a lot of vegetables, fruits, beans, whole grains, and olive oil, plus a weekly intake of fish as the primary protein—but very little red meat or other sources of saturated fat.
To follow both the Mediterranean diet and U.S. nutritional guidelines, try to eat fish high in omega-3 fatty acids, such as tuna, salmon, or mackerel, at least two or three times a week. As an added bonus to its heart-healthy benefits, fish may improve brain function and fight depression. (And in nursing, we all know the power of a clear head and a positive mood.)
Here are more nutrition tips:

• Always eat breakfast. To be on your feet all day taking care of patients, you need the proper fuel. I never miss breakfast. My regular breakfast is instant, high-fiber maple oatmeal with walnuts. If I go out for breakfast, I order an egg-white omelet with cheese and ham.
• Keep healthy snacks with you at all times. Unless you plan ahead, a busy shift can leave you reaching for the worst convenience foods. Mix a pouch of tuna with low-fat Greek yogurt topped with avocados (hold the mayo). Sprinkle this over your lunch salad or make a sandwich packed with super foods. Also, I never leave home without an apple, yogurt, an energy bar, and a package of almonds.
• Don’t set yourself up for a binge. Fight the urge for a peanut-butter cup. If my sweet tooth beckons, I give in—but just a little. If I really feel as if I need something sweet, a few Twizzlers or Swedish fish usually do the trick. (Editor’s note: If you work shifts, read “Nutrition for night-shift nurses” for more ideas on how to eat healthy.)

No need for extremes

You don’t have to go on an extreme fad diet or exercise 3 hours a day to become a model of health for your patients. Healthy living isn’t hard. Go online and bookmark webpages that offer tools on how to eat right and maintain a healthy lifestyle. If you incorporate small, enjoyable steps into your life, before long you’ll see a real difference in how well you work and play.
Click here for a list of selected references.

Beth Battaglino is the chief executive officer of Healthywomen.org, a nonprofit organization providing objective, in-depth, medically approved information on a broad range of women’s health issues. In addition to her BSN, she holds degrees in political science, business, and public administration from Marymount University (Virginia) and the University of Oklahoma. Ms. Battaglino currently serves as an educational consultant to the National Fisheries Institute, a nonprofit organization that offers a health-focused website with fish tips and recipes.

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

Why be content with going nowhere?

By Christopher Lance 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. Published 1/12/2016, Vol. 42, No. 1