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We All Had to Start Somewhere

by Michelle Tanner, MSN, RN | Magazine, Nursing Mentorship, Nursing Students

Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.

One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?

Lack of study time was also noticeable in the part-time evening students. I ­recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared ­nursing ­student.

Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, ­absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those ­struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.

I have contemplated methods to assist nursing students, which have resulted in ­better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:

Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological ­support, which ­surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.

These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.

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Enhancing Happiness Through Your Work

Enhancing Happiness Through Your Work

by Nuananong Seal & Mary Wiske | Apr 20, 2018 | Blog, Nurse Health, Nursing Careers | 0 Comments

Stress in nursing is most likely attributed to the physical and emotional demands of patients and families, work hours, shift work, interpersonal relationships, and other pressures that are central to the work nurses do. Stress adversely affects the health, safety, and well-being of nurses, patients, and health care organizations alike; therefore, it is essential for nurses to reduce job stress and increase their happiness through their work.

Studies show that loving your job has less to do with your job and more to do with you. That’s right, there are simple ways you can ensure your own happiness at work every single day. Because happiness is the sum of love, optimism, purpose, courage, productivity, health, perspective, humor, and fulfillment, you must manage to achieve. Happiness won’t come to you if you do nothing.

Here are six simple actions you can employ to reduce stress and enhance your happiness.

1. Find out what makes you happy.

When you know the answer, you can add it to your life. If you are not sure, you should start taking detailed notes whenever you feel happy.

2. Create and write down a daily goal of joy each day.

Creating a goal allows you to focus on who you are in the moment, recognize and live your values, and achieve your emotional energy and happiness. Try to create one thing that you can look forward to each day at work, whether it’s seeing a specific coworker or your special lunch break. Whatever it is, the simple act of looking forward to it will increase the happiness you associate with work.

3. Make yourself familiar and comfortable with each of your coworkers and patients.

Studies show that working with unfamiliar coworkers and in different settings negatively impacts you at work. Make sure that you take time to introduce yourself to your coworkers and get to know your patients. Being familiar with your coworkers and patients increases your confidence and happiness at work.

4. Be optimistic.

Research shows that positive people are less likely to become ill. Optimism has been linked to an improved sense of well-being so try to look on the bright side whenever you can.

5. Love yourself and take care of your health.

Caring for yourself must be a priority. Eating well, staying hydrated, and getting enough sleep can make you feel good. And when you feel good, you have the physical and mental energy to work through daily challenges and focus on what’s good about the day. Make time to do the things that make you happy in the moment as well, such as listening to your favorite song during a lunch break.

6. Last but not least, put a smile on your face, act happy, and laugh every day.

Acting happy and keeping a pleasant expression on your face puts your mind in a positive state. Try to let go of negative feelings and learn to forgive because forgiveness will help give you inner peace.

We All Had to Start Somewhere

We All Had to Start Somewhere

by Michelle Tanner, MSN, RN

Did you ever look back upon your career and reflect on those humble beginnings? As educators, we sometimes forget that it was not easy to aspire to the higher academic goals we have been so fortunate to have attained. When we counsel our students, we must not disregard that they too have many barriers to overcome in their journey to be successful. In retrospect, we can embrace the challenges we must face in the effort to ensure our students’ academic success.

One morning during break, I overheard one of my student’s discussion with her colleague regarding how lucky she was that her children would be cared for over the weekend. This would allow her time needed to study for the final exam. Knowing this student, I was aware that she was a single parent and working mom, and more importantly, my student was pursuing a future career in nursing no less. It was a revelation that this fortunate incident for her was not expected, but was a gift. I began to ponder how this student would have prepared for the final if the childcare issues had not been resolved. Upon review, I realized that this student’s grades were not always consistent. During counsel, her excuses for poor grades or incomplete homework assignments were due to illness (whether be it her own or one of her children’s) or because of a busy work schedule, which entailed all shifts conceivable. So, when did she have time to study?

Lack of study time was also noticeable in the part-time evening students. I ­recall the blank stares on their faces during a Q&A session in preparation for the day’s lesson. Upon inquiry, the group confessed that they had not prepared for the evening’s lecture in their attempt to balance work, family, homework, and study hours. The weekends had been relegated to study time in preparation for the upcoming week’s assignments, albeit incomplete. Add this to childcare, spousal duties, and familial responsibilities and you have one overworked, fatigued, and ill-prepared ­nursing ­student.

Many times, as educators we focus on the negative aspects of our students: the fatigue, lack of engagement during lecture or clinical, and the behavioral issues (tardiness, ­absenteeism, and disputes with colleagues). This can hinder our ability to focus on putting interventions into place to enhance our students’ learning abilities. We might complain about time consumed due to providing an inordinate amount of time with a student that was not responding to intense tutelage. Perhaps we should invest in discussions about the ever-changing policies affecting our curriculum or work hours. Somehow, the drudgery of this negative outlook overshadows a focus on the academic pursuits of those ­struggling to attain a portion of our accomplishments. We must be sensitive to the vulnerability of this population during their journey. Whether it be in the case of the traditional, the returning, or the recycled adult learner, financial constraints are taxing. Adhering to professional and attendance policies takes effort. Striving to maintain a precarious balancing act to function commendably in multiple roles are all central themes of the adult learner. In acknowledging this, it is incumbent upon us to assist our students in getting past these barriers.

I have contemplated methods to assist nursing students, which have resulted in ­better outcomes. Some interventions I have put into place have made the difference in my students’ success as evidenced in their test scores. The following interventions are worth noting:

Games: the Millennials love them. Who said learning should be boring? The younger generation thrives off the technological ­support, which ­surreptitiously enhances learning. The games can be competitive, informal, and applied individually or after breaking the class into groups. Games are used best when they can be accessed as a resource after classroom sessions as a study tool before testing.
Provide a quick recap at the end of class. Some students may be so attentive during lecture that they do not take notes that were imperative to have as a review for the next test. This is easy to rectify by providing a short review of pertinent facts at the end of the day, paying special attention to the material that will be included on the test. This quick review gives the learner another chance to process and make note of what the instructor was attempting to stress in the previous lecture(s). This may seem redundant, but we cannot forget that this is all new information for the learner.
Remind the student of your availability. I state my office hours on a weekly basis most emphatically after testing. This publicly reinforces my commitment to their learning needs and hopefully abates their reluctance to seek my instruction.
Review one-on-one over the previous tests taken with students who have scored poorly. Allow the student to reflect, write, and question the material covered in the test(s). Educators have gained insight about their students during these sessions (e.g., what type of learner they are, if there are linguistic barriers, and/or if there is a lack of effective study habits). This session also establishes a rapport between you and the learner, which can be motivational.
Allocate extra time to be available for hours before testing. You would be surprised to see how many students will attend for review after a long, clinical day in anticipation of a test pending the next day. Is it more time consuming? Not nearly as much as counseling them one-on-one would be.

These are a few tips I have used to incorporate in teaching my students before I notice a decline in test scores. As I look back on my humble beginnings, I realize that the barriers I encountered are not so different. I am fortunate enough to have had support and encouragement throughout my career as a student and as a practitioner. It is as challenging for both the educator and the learner; diligence is required from all parties. But we are in the trenches together. We all had to start somewhere.


Michelle Tanner, MSN, RN, has 40 years of nursing experience, which has been derived from a diverse background. Over the course of her career, she has practiced in the acute care setting, long-term care, and management and presently teaches in New England.

The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

The Link Between Cultural Communication, Hospital Safety, and Desired Outcomes

by James Z. Daniels & Janice Bonham West | Apr 23, 2018 | Magazine, Nursing Diversity |

A clinician sees a Somali patient with a primary complaint of back pain and, following an exam, prescribes a traditional course of western medical action. The patient, however, is reluctant to act on the medical advice because he thinks his back pain is caused by a bad relationship with his parents or guilt over something he did. “It is always good (for clinicians) to have some knowledge about their patient’s culture, to know who they are dealing with,” says Fozia Abrar, MD, of Minneapolis. “It might cost time and money, but you save more money by not getting a misdiagnosis, by improving quality of care.”

Suffering from bacterial gastritis, a Somali woman in Minnesota visits several providers but does not take the medication they prescribe. When met with a smile and a greeting in her native language by Dr. Abrar, the patient complies with the same treatment recommended by the previous ­providers—Dr. Abrar successfully ­persuaded the patient to fill a prescription and take the medication because of her ­knowledge of the patient’s culture. This situation is not new or unique—medical ­anthropologist and psychiatrist Arthur ­Kleinman, MD, has spent 30 years championing cultural issues in ­medicine. He says a great body of evidence shows culture does matter in clinical care.

Every cultural group has traditional health beliefs that shape members’ perspectives about wellness. The increasingly diverse, twenty-first-century patient population requires clear communication and practitioner awareness of patient health perspectives in order to significantly impact patient satisfaction, safety, compliance, and outcomes.
Organizational Culture, Patient Satisfaction, and Safety

Organizational culture informs every worker whether patient satisfaction is a key value. By influencing employee behavior and how ­employees are treated, ­culture drives employee effectiveness, safety, and whether employees take advantage of opportunities as they arise. Organizations that dedicate additional employee resources to patient safety signal to employees that both employee effectiveness and patient safety are high ­priority. In other words, organizational values and beliefs guide employee commitment to patient and worker satisfaction. According to the Agency for Healthcare Research and Quality’s Hospital Survey on Patient Safety Culture: 2016 User Comparative Database ­Report, patient safety improved more at hospitals where they increased employment of staff who reported ­incidents, ­compared to hospitals that did not expand the number of employees who ­reported incidents.

At Atrius Health, a Massachusetts ambulatory care provider with 36 locations, staff can report safety events while updating existing electronic health records (EHRs). This reporting mechanism has increased the number of reported events, and as many as 30% of events reported monthly come in through the EHR tool, according to Ailish Wilkie, patient safety and risk ­management ­director for Atrius Health.

In other words, employee ­accountability shapes ­workplace and organizational culture.
Patient Culture, Provider Culture

In addition to the effect workplace culture has on patient satisfaction and employee competency, two additional areas of culture impact health care effectiveness. Both a patient’s cultural background and the provider’s scientific/medical culture inform patient and provider wellness perspectives. If patient compliance with the treatment plan is the goal, providers need to understand the patient’s cultural identity.

By the same token, patients need to know that their perspectives are respected. Few health care ­observational ­studies have reported ­sufficient information to support the claim of provider bias, but a 2006 study published in the Journal of General Internal ­Medicine reported that most internal medicine residents gain cross-cultural skills through informal training, and most stated that delivery of high-quality, cross-cultural care was important but were skeptical about the expectation of learning every little detail about all cultures. Barriers to ­cross-­cultural care included lack of time, not knowing enough about the religion or ethnic group of the patient they were caring for, and/or dealing with belief systems which are ­different than their own.

A 2000 study in Social ­Science and Medicine found that physicians rated ­minority patients more negatively than White patients; the study also reported that physicians viewed minorities as non-compliant and more likely to engage in risky health behaviors. Clearly, providers need reliable resources to add to their understanding of the patient’s perspective.

A 2017 survey of 111 health care providers revealed where providers currently turn to access cultural training and information, and what types of information providers need when they are unsure/unaware of the patient’s cultural profile and its implications for treatment decisions, patient compliance, and safety outcomes. The survey found that providers want more data on their patients’ use of nontraditional medicine; their faith beliefs; and who the health care decision-makers are.
Diversity and Disparities

An increase in racial and ethnic minority health ­professionals provides greater opportunity for minority ­patients to see a practitioner who speaks their primary language or is from their own racial or ethnic background. This can improve the quality of communication, patient safety, satisfaction, compliance, and outcomes. In addition to ­increasing the diversity of practitioners, hospitals are working to improve hiring diversity, employee cultural awareness, and organizational culture.

In 2015, The Health Research & Educational Trust (HRET) commissioned a ­national survey of hospitals and health systems to quantify the actions they are ­taking to ­promote diversity in leadership and ­governance, and reduce health care ­disparities. Data for this project were ­collected through a national survey mailed to the CEOs of 6,338 U.S. registered hospitals. The response rate was 17.1%, with the sample generally ­representative of all hospitals.

Minorities represent a ­reported 32% of patients in hospitals that responded to the survey, and 37% of the U.S. population, according to other national surveys. In contrast, the HRET survey data show that minorities represent only 14% of hospital board membership, 14% of executive leadership positions, and 15% of first- and mid-level positions.

As a sign of progress, though, nearly half of hospitals surveyed had a plan to ­recruit and retain a diverse workforce matching their ­patient population. Further, 42% said they implemented a program to find diverse ­employees in the organization worthy of promotion.
Cultural Data Collection

The HRET data show that 98% of hospitals are collecting patient data on race. Additionally, other areas of data collection included ethnicity (95%) and first language (94%). But, the percentage of hospitals that correlated the impact these factors have to the delivery of care was a mere 18%. Remarkably, in 2011 only 20% of hospitals analyzed clinical quality indicators by race and ethnicity to identify patterns, whereas 14% looked at hospital readmissions, and 8% analyzed medical errors.

A serious flaw in the HRET survey was zero data collected on hospital patient national origin. The report listed myriad reasons why hospitals might be failing to meaningfully use the data, such as fearing potential liability issues after publicly acknowledging disparities in care, concerns about the public relations backlash, and a lack of knowledge in developing clinical programs that would reduce or eliminate inequalities. Plus, some hospitals noted the lack of a “diversity champion” on their staff to help lead the effort.

Hospitals seem to be making progress in educating staff on diversity, with 80% providing cultural competence training during orientation and 79% offering continuing education opportunities on cultural competency, according to the survey.
What’s Next?

Hospitals have begun to include leadership goals ­designed to reduce care disparities by implementing ­diversity initiatives such as: allocating adequate resources to ensure cultural competency/diversity initiatives are sustainable; ­incorporating diversity ­management into budget ­planning and ­implementation process; increasing hospital board diversity to reflect that of its patient population; board members demonstrating completion of diversity training; developing plans specifically to increase ethnic, racial, and cultural diversity of executive and mid-level management teams; and executive compensation tied to diversity goals.

Beyond the C-suite, hospitals are developing diversity plans with initiatives that include diversity goals in hiring manager performance expectations; implementation of programs to identify diverse, talented employees within the organization for promotion; documented plans to recruit and retain a diverse workforce that reflects the organization’s patient population; required employee attendance at ­diversity training; hospital collaboration with other health care organizations to improve health care workforce training and educational programs in the communities served; and education of all clinical staff during orientation about how to address unique cultural and linguistic factors affecting the care of diverse patients and communities.

This increased implementation of appropriate health care and adherence to effective diversity and cultural education programs at every level of health care will ultimately result in improved patient ­satisfaction, compliance, hospital safety, and patient health outcomes.


James Z. Daniels & Janice Bonham West
James Z. Daniels, MPA, MSc, is a consultant and writer who lives in Durham, North Carolina, and frequently contributes to ­Minority Nurse.

Janice Bonham West, MEd, is a writer and consultant who lives in Raleigh, North Carolina.

Transitioning wound care patients to post-acute care

Transitioning wound care patients to post-acute care
January 2018 Vol. 13 No. 1
Setting goals and meeting needs.

Takeaways:

When discharging patients from acute care facilities, consider cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care.
Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort.
After discharge from an acute-care facility, patient medication management, diet, and lifestyle can help support wound healing.
Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition.

By Armi S. Earlam, DNP, MPA, BSN, RN, CWOCN; Lisa Woods, MSN, RN-BC, CWOCN; and Kari Lind, BSN, RN

Discharge to post-acute care settings such as rehabilitation and skilled nursing facilities, long-term care hospitals, and home health depends on the patient’s overall health. Other factors that must be considered include the patient’s cognitive and functional status; the home environment; family or caregiver support; access to services, medications, and transportation; and follow-up care. In this article, we’ll focus on the needs of wound care patients who are transitioning to post-acute care.
Elements of a wound care discharge plan transition wound care patients post acute. When discharging a patient who needs wound care, acute-care clinicians (wound care nurse, discharging nurse, and case manager) should evaluate the comprehensive wound care plan, asking questions related to the goals of care, discharge setting, care provider, products and resources, patient factors that influence wound healing, and follow-up care.

What are the care goals?

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Depending on the patient’s situation, the three goals of wound care are healing, maintenance, and comfort. If the goal is wound healing, treatment should focus on wound granulation and eventual closure. However, if the wound is unlikely to heal (for example, an elderly patient with arterial wounds who is too frail for a vascular intervention), the goal is to keep the wound clean, stable, and free of infection.

For patients receiving end-of-life care, comfort is the goal. Treatment includes dressings that are changed less frequently, cause less pain, adequately absorb drainage, and control foul odor.

Keep in mind that goals may overlap and evolve, so the wound care plan should be modified as necessary.

Where will the patient go?

Wound severity and complexity may affect the choice of post-acute care setting. For example, a patient with multiple wounds requiring either negative pressure wound therapy (NPWT) or twice-daily dressing changes may be best placed in a long-term care hospital. On the other hand, someone who needs once-daily wound packing can be managed at home if the patient or family can perform dressing changes between home health nurse visits.

Additional considerations include clinician time needed to perform wound care and equipment availability. Some post-acute care settings may not have the resources for frequent dressing changes or clinician visits. The discharging facility must establish that the necessary equipment and clinical personnel are available.

Who will perform wound care?

Clinicians need to assess whether the patient is functionally and cognitively able to perform wound care. If not, other options include a home health nurse or a family member or friend. If the patient lives in a remote area and wound care will be done by a family member with only periodic visits by a home health nurse, the in-patient nurse needs to assess the caregiver’s ability to complete care tasks and provide education. The teachback method allows caregivers to demonstrate what they’ve been taught so the home health nurse can assess comprehension and ability.

If the patient is being discharged to a setting other than the home, the facility must demonstrate the availability of clinicians who have the knowledge and skills to manage the prescribed wound therapy.

What products and resources will the patient need?

Each facility and agency has its own formulary of wound care products; the brands used in the hospital may not be the same used in post-acute care. The patient’s insurer also may dictate what products will be used. For example, different manufacturers of NPWT products have contracts with different insurers, which will dictate what brand can be used at home.

Insurance companies reimburse home health agencies a set amount depending on the patient’s diagnoses. Daily dressings or costly products may not be feasible after acute-care discharge. However, an expensive product that requires twice-weekly dressing changes rather than twice-daily saves clinician time, making it a more cost-effective choice. Alternatively, substituting a less-expensive comparable product or therapy for an expensive one without loss of efficacy may facilitate a timely transition.

What patient factors should be addressed?

After a patient is discharged from an acute-care facility, medication management, diet, and lifestyle can help support wound healing. For example, patients with diabetes who have foot wounds must control their glycemic levels by following medication regimens and dietary recommendations, and patients who smoke should begin a cessation program. Patients with heart failure who have leg swelling and blistering that results in wounds must adhere to their diuretic therapy. To avoid infection that can impede wound healing, all patients must adhere to prescribed antibiotic regimens.

When treating pressure injuries, addressing the etiology is crucial. Clinicians or family members may be using the appropriate wound care products, but if the affected body part is not properly offloaded and pressure not redistributed adequately, then the wound treatment will be futile. For example, a pressure injury on the heel won’t improve if the cause of the pressure isn’t addressed by using offloading boots or pillows under the calves when the patient is resting in bed.

What are the follow-up care plans?

Discharge instructions should include detailed wound care guidelines and contact information for the provider with whom the patient should follow up. Plans for future supply procurement, conditions for revising the care plan, and access to transportation for follow-up care also should be considered.
Successful transitions

Safe and effective care transitions not only are best practices, but they’re also essential in today’s healthcare environment. Changes in reimbursement, including both incentives and penalties for certain discharge outcomes, along with a much-needed emphasis on quality, accountable care have encouraged this attention. Patient and family engagement and education, including their goals, preferences, and concerns, are fundamental to a successful transition. Nurses can help ensure that treatment goals and patient needs are met by providing support, education, and care.

The authors work at Lutheran Medical Center in Wheat Ridge, Colorado. Armi S. Earlam is the lead certified wound ostomy and continence nurse, Lisa Woods is a certified wound ostomy and continence nurse, and Kari Lind is an RN working in wound and ostomy care.
Selected references

Adkins CL. Wound care dressings and choices for care of wounds in the home. Home Healthc Nurse. 2013;31(5):259-67.

Agency for Healthcare Research and Quality. Care Transitions from Hospital to Home: IDEAL Discharge Planning: Implementation Handbook.

Alper E, O’Malley TA, Greenwald J. Hospital discharge and readmission. UpToDate®. April 3, 2017.

Dreyer T. Care transitions: Best practices and evidence-based programs. Home Healthc Nurse. 2014;32(5):309-16.

Hudson R, Comer L, Whichello, R. Transitions in a wicked environment. J Nurs Manag. 2014;22(2):201-10.

Krapfl LA, Peirce BF. General principles of wound management: Goal setting and systemic support. In: Doughty DB, McNichol LL, eds. Wound, Ostomy and Continence Nurses Society® Core Curriculum: Wound Management. Philadelphia, PA: Wolters Kluwer; 2016; 69-79.

Milne C. Challenges of transitioning wound patients through the continuum of care—Q & A. November 2016.

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Adapting to Overnight Shifts: 5 Common Mistakes and How to Avoid Them

Mar 30, 2018 | Blog, Minority and Community Health

Working overnight shifts is a big change for many nurses, but it’s also extremely common. With the 24-hour demands of the bustling, modern health care system, there’s a good chance you’ll have to work the night shift at some point in your career, especially when you’re starting out. But don’t fret! There are many ways to ensure that the transition from day to night goes as smoothly as possible.

All nurses need to be on their A-game with technical medical skills and emotional resilience no matter what time of day they’re working. Night shift nurses have to shoulder even more burdens because they often work mostly or entirely alone for their shift. While there’s no one “right” way to adapt to the night shift, there are several common mistakes that you’ll want to avoid to build good habits.

Common Mistakes to Avoid When Switching to the Night Shift

Going against your circadian rhythm is no small task. However, resorting to quick fixes will only make your shifts more difficult in the long run. Avoid these five common mistakes and you’ll adapt to the swing of a night shift quickly.

1. Not getting enough rest before starting a shift.

As a nurse, it’s important to always be sharp on the job. The staff at Gurwin Jewish Nursing and Rehabilitation Center emphasize that not getting enough rest is the number one mistake that new night shift workers make, and it’s one of the most dangerous. Since shifts are often upwards of eight hours long, there’s no safe way to “power through” on too little sleep. This goes for both on-shift work and driving when sleep-deprived.

How to Avoid It:

Install blackout curtains where you sleep and get a fan or white noise generator.
Turn off your phone, get a “Do Not Disturb” sign, and inform loved ones of your schedule.
Staying up for a few hours to relax and take care of yourself may be easier for some nurses than going straight to bed at the end of a shift. You’ll figure out what works for you with time, so don’t be afraid to experiment.
Take proper care of your legs and feet while on your shift, so you won’t be troubled by pain or soreness when you’re trying to sleep.
Light soothing candles and practice stretches to relax yourself before bed.

2. Leaning on sugary foods, alcohol, or caffeine instead of proper nutrition.

It can be tempting to snack on chocolate or chug coffee to keep yourself going through your night shift. Keep in mind that, if consumed in excess, coffee can lead to jitters at first, followed by a crash. You’ll be far better off if you instead focus on getting more sleep.

How to Avoid It:

Plan and pack your meals ahead of time to avoid relying on vending machines.
Schedule your heavy meals so they won’t interfere with sleep.

3. Letting your personal life fall into disorder.

Sometimes it’s hard to keep your personal life in order while working the night shift. Errands, social gatherings, and childcare all battle for your attention when you’re not at work. This reduces your ability to get good sleep and, in turn, to focus at work.

How to Avoid It:

Yoga and meditation help you relax and leave work behind so you can be present when you’re engaging with family or friends.
Establish a schedule for sleep, chores, and activities. This will reduce the stress of missing out on things.
Plan gatherings ahead of time with friends and family to ensure you can make it to fun gatherings.

4. Not asking for help or feeling like you have to “do it all.”

Yes, there are fewer resources available overnight at the hospital. This can lead to superhero-esque thinking, where you refuse or even genuinely forget to ask for help. Being honest about needing a hand is better than dropping the ball because you’re juggling while tired.

How to Avoid It:

Get to know the others who work nights so you can trade favors.
Get to know the resources available to you during your shift.
Ensure that your roommates or family are sharing the load with you at home.
Choose sleep over chores when possible at home. Others can help you with chores, but they can’t sleep for you!

5. Missing out on workplace bonding, training, or resources due to night shifts.

It’s easy to feel forgotten when working the night shift. Try not to miss out on opportunities for bonding, continuing education, or extra support because of your schedule. It can be hard to make time or schedule changes for these opportunities, but they’re integral to your career development down the line.

How to Avoid It:

Check announcement boards and learn about opportunities available at your workplace.
Make it known to your boss and coworkers that you’re interested in additional training, support, resources or team bonding even if you work the night shift.
Ask if there are online resources available for any opportunities that you simply cannot attend.

Your job as a nurse is important. Don’t let working the night shift get in the way of providing the best care possible to your patients and yourself. Getting enough sleep is integral to your job performance and personal health, but that’s not always enough. You also need to make sure you’re practicing good self-care and focusing on your health along the way. With these great tips, you’ll adapt to the night shift in no time!

Deborah Swanson is a medical office professional with two decades of experience helping small practices and large hospitals alike improve efficiencies. She recently started consulting with allheart.com providing insight into the daily activities of medical professionals and how best to serve them.