I just returned from Italy - an absolutely glorious vacation…the people, the culture, the food…wonderful!!! I am now settling back in to home and work routines and got to thinking about how different this transition is for those of us who don't work in a clinical setting. As a clinical editor, I have the luxury of picking and choosing what to catch up on first - reading the latest journal articles, catching up on social media, writing the next eNewsletter, or editing some upcoming articles. The list goes on…

Sure, I need to prioritize what needs to be done sooner rather than later, however my return to work is a lot different now then when I was taking care of patients.  As a clinical nurse, there really is no easing back into work. Assessments need to be done, medications need to be given, procedures must be performed, and patient education and support must be provided. This list also goes on...

Thinking about this also brought to mind another common occurrence in my experience. After a return from vacation, I remember being given a heavier assignment, maybe the sicker patients or the families who needed a little more time and TLC. I was considered fresh, well-rested, and ready to go. Never mind the jet-lag or any family drama experienced while away!

I will confess that these are not only memories of my returns from vacation, but also in my role as charge nurse when colleagues returned from vacation. “Sure, Sally can take the patient maxed out on pressors who is a full-code. She just spent a week in Hawaii.” Or, “Give Jeff the ER admission with the fresh GI bleed. He’s been off all week.”

As I write this, I am disappointed in myself and think…would this be considered horizontal violence? It’s just the way that things were and no one ever questioned it, but that shouldn’t make it right. Thoughts?

Living wills. Life support. Do-Not-Resuscitate. These are all phrases that I used frequently working in an adult medical intensive care unit. I rarely had trouble using the words death, dying, hospice, or end-of-life with patients and families.

However, outside of the hospital, these words have been a lot harder for me. My parents do have living wills and have expressed their wishes to me, but not because I initiated any discussion with them. In fact, I’ve actually avoided those conversations despite knowing how important they are. 

There is not really a good time to have end-of-life discussions, so people tend to wait for the "right time" which often turns into the "wrong time" or "too late." The conversation might end up taking place in the hallway of the emergency department or in a critical care waiting room. Sometimes, information is conveyed and decisions are even made over the phone.

I am fortunate that my own family members have insisted on preparing for the end of their lives and sharing their plans and wishes with me. As a daughter, I really don’t like to hear about it. As a nurse, I know that this is a very good thing.

Saturday, April 16th is National Healthcare Decisions Day. Make this day the "right time" to talk with your loved ones and encourage the patients you care for to do the same.

Here are some of the latest thoughts from our journal editors ~ enjoy!

• In Forging the future of nursing, Linda Laskowski-Jones MS, RN, ACNS-BC, CEN, FAWM writes: “We're at a historic crossroad as nurses. We must awaken as a profession and grasp the unparalleled opportunity to move forward in the same direction if we want our rightful place at the table. This means committing to ongoing education, actively engaging in dialog and decision making, and finally resolving the debate over entry-level educational requirements.”
• In Taking responsibility for our practice, Elizabeth M. Thompson MSN, RN, CNOR  shares her thoughts on relating the theme of this year’s AORN Congress “Freedom to be” to perioperative nursing practice. She also uses a clinical example to help define the terms responsibility and accountability.
• Kathryn Murphy DNS, APRN comments on The importance of cultural competence in the March/April editorial of Nursing Made Incredibly Easy! She reminds us that to be culturally competent nurses, we must remember knowledge (of cultures in your service area), attitude (avoid making assumptions and be aware of your own prejudices) and skills (learn new communication skills to simplify language).
• In Food for thought about our most frequently used anticoagulants, AnneMarie Palatnik MSN, RN, APN-BC writes about the challenges of caring for patients on warfarin and heparin and reminds us to “Follow the protocols that have been put into place in your organization, and remember that these protocols are there to keep your patients safe.”
• Suzanne K. Powell MBA, RN, CCM, CPHQ writes “…although many consumers are not clear what a "case manager" is and does, a case manager holds the promise of support and help during their experience in a complex, scary, and ever-changing healthcare environment.” Read more about case management professionalism in her editorial A Rose by Any other Name.

Thanks for reading!

Okay, so I know the words of this title should be hanging in an elementary school somewhere (and probably are), but think about all the reading you do as a nurse. It’s a lot, isn’t it?

From the big textbooks in nursing school to policies, procedures, and protocols in your area of practice, there is a lot of reading that we do. We read to keep up on health care news, drug information, technological advances, and treatment recommendations. We are constantly reading charts, care plans, laboratory reports, notes from other health care professionals, journal articles, and the latest research studies. The list goes on and on!

Social media has expanded our reading list even more. We are connecting online and reading each other’s stories and experiences through status updates, tweets, and blogs. Whole conversations are taking place without any words being spoken. Pretty amazing, isn’t it? Over the past year (since really diving in to the world of social media), I’ve connected with some amazing nurses whom I would have never “met” had I not read their words. 

You can find the links to some of my favorite blogs here under Nursing Blogs (right column, about halfway down the page.) Do you have a favorite blog or even have your own? Please share the link ~ I’ll be sure to check it out! Thanks

On March 22, 2011, the Editors-in-Chief of the top LWW nursing journals got together for a roundtable discussion about the Institute of Medicine and the Robert Wood Johnson Foundation Report on the Future of Nursing. For those of you who listened in, I hope you enjoyed the conversation about how these nurse leaders interpret and understand the key messages and recommendations from the report. For me, the task at hand is now clearer. It is now up to us nurses to bring our profession and our own careers to the level we deserve. I’d like to share some of what I took away from this discussion.

Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC, Chief Nurse of Wolters Kluwer Health/ Lippincott Williams & Wilkins and Ovid Technologies, moderated the discussion and reminded me that there are 3.1 million nurses (which is the largest group of health care providers) in the United States and we “need a seat at the table” to “make changes happen.” Anne then went on to explain in detail the key messages and recommendations in the report.

Maureen "Shawn" Kennedy, MA, RN, Editor-in-Chief of the American Journal of Nursing, spoke next about what the Report means to “nurses at the point of care” - which includes staff nurses, nurses practicing in home care, nursing homes, and other areas where direct patient care is occurring. She speaks about professional practice and having a voice when it comes to priorities of care.  Later in the webcast, Shawn talks about the education of nurses being for the public good and she includes good points about responsibility for funding.

Rich Hader, PhD, NE-BC, RN, CHE, CPHQ, FAAN, Editor-in-Chief of Nursing Management and Senior Vice-President and Chief Nursing Office of Meridian Health System gave his take on the report and what it means for managers and other nurse leaders. Some of his great words included “forge partnerships with academic colleagues” and “produce lifelong learning.” He commented on the timeliness of the report and brought up the idea of economic incentive for nurses going back to school. Rich also lists some key ideas for leaders and managers.

Jamesetta Newland, PhD, FNP-BC, FAANP, DPNAP, Editor-in-Chief of The Nurse Practitioner and Clinical Associate Professor at New York University shared her views on the report with regards to advanced practice nurses (APNs). She commented about APNs being trained holistically and the push to move the healthcare system to one of wellness, instead of illness.

Janet Fulton, PhD, RN, Editor-in-Chief of Clinical Nurse Specialist and Associate Professor at Indiana University spoke about clinical nurse specialists in acute care. Her comments about all APNs collaborating with each other to provide inpatient and outpatient care were eye-opening, especially her quote “nursing collaborating with itself.” Another good one…for all APNs to “push the boundaries to meet the public’s need.”

Suzanne Smith, EdD, RN, FAAN, Editor-in-Chief of the Journal of Nursing Administration and Nurse Educator spoke about the meaning of the report for educators and students. She suggested that we refer to guiding reports from organizations such as the NLN and the AACN. Specifically, Suzanne refers to the AACN’s “call for imagination” and the need for “dramatic change in Master’s education.” This discussion proceeds to the issue of cost.

The entire webcast has been archived and will be available until March 22, 2012. Take some time to listen in to the words of these nursing leaders!

I love a hospital. There I said it. Now I know “love” is a strong word, but a recent trip over to our local hospital for an x-ray evoked some strong feelings in me. I miss it. I really do. The patients, the beeps, the smells, the camaraderie among the staff…. The itch to get back into the clinical setting is getting stronger.

As I waited in the hallway, I could hear nurses calling out for help and replies of “be right there” (while thinking to myself…Can I help too?), patients coughing up sputum (Can I see that? We might need to get a culture), and beeps of portable monitors (Excuse me…I think a lead came off). Even the familiar scent of hospital soap on the technician's hands smelled good to me.

I felt at home even as a visitor. Is that odd?

It was Sunday night, 7 pm, and I was just starting my third 12-hour shift in a row. I was happy to see my assignment was the same as the previous two nights - two fairly stable patients. One was a “challenge-to-wean” patient who was recovering from ARDS and who had two restful nights on Friday and Saturday. The other was a patient who was post-stroke; she was not intubated, was minimally communicative, and had stable vital signs (I had been surprised that she had not been transferred out of the ICU during the day.)

I was a few minutes early so I went to print out telemetry strips for both of my patients before getting report. Part of our documentation each shift consisted of printing and interpreting each patient’s ECG intervals. We had a certain way to fold the strips so we could tape them in the appropriate spot on the flowsheet (next to the strip from the previous shift).

It was then, when I went to tape the strip on that I noticed something very different. The patient’s ST-segment was significantly elevated compared to the strip 8 hours before. The day shift nurse came over to start report and we compared the strips - same leads, definite ST-segment changes. She grabbed the 12-lead ECG machine and yelled for the resident while I assessed the patient. She was lying in bed and appeared comfortable. Her vital signs hadn’t changed and her oxygen saturation was 93%. She did not look like someone experiencing an MI. But she was.

Within minutes (or so it seemed), anesthesia had arrived to intubate her, cardiology was at the bedside, and we were hanging nitroglycerin and heparin infusions. After a very busy night and despite all of our efforts, this patient coded and died.

I tell this story because it is not often that “cutting & pasting” a six-second telemetry strip leads to this turn of events. As a critical care nurse, I was both exhilarated by noticing the change in her ECG and devastated by the outcome.

When I considered writing about this particular night, my first thought was that anyone could have noticed the change in her ECG. Would someone who was not a nurse have recognized the change and realized the implications? Perhaps. But is there anyone else but a bedside nurse who is present and in tune to the patients they care for 24 hours a day, 7 days a week, 365 days a year?

Nurses are there. Nurses are present. Nurses are paying attention.

This week is Patient Safety Awareness Week, an annual education and awareness campaign led by the National Patient Safety Foundation. I did a quick search of articles from our nursing journals to bring you some of the great content we have related to patient safety...

• Creating cultures of safety: Risk management challenges and strategies
• Preoperative communication to improve safety: A literature review
• An overview of error-reduction options
• Cut down on SSIs
• Legal Department: Hand-Off Communication Does Affect Patient Safety
• 10 Organizational Characteristics That May Prevent Falls in Home Healthcare and Hospice
  

Want to read more? We also have an entire collection of resources devoted to the topic of patient safety. In addition to articles and continuing education opportunities, Focus On: Patient Safety includes a PowerPoint presentation on medication error prevention and a quick reference on pressure ulcer prevention. Have a good week!

I enjoyed putting together our first Editorial round-up last month and I hope you enjoyed reading them! Here are the latest thoughts and opinions from our editors. All are free to read ~ take a moment or two to learn from these leaders of our journals!

• In Get on the road to professional development, Richard L. Pullen EdD, RN shares his views on the importance of clinical experience, maintaining CE credits, and certification. In his editorial you’ll also find special tips for developing career goals.
• In Building healthy bodies one child at a time, editor-in-chief of The Nurse Practitioner, Jamesetta Newland, PhD, RN, FNP-BC, FAANP, FNAP, asks “Why is federal legislation needed to address concerns about child nutrition?”
• In This is The Decade For Nursing, Kathy A. Baker PhD, RN, ACNS-BC, CGRN, FAAN encourages us to be involved in shaping the future of our profession and shares ways that we can.
• Did you know that there are only 12 states in the U.S. that allow APNs to practice without arbitrarily assigned limitations? In It's time: Lift restrictions on APN practice, Richard Hader PhD, NE-BC, RN, CHE, CPHQ, FAAN shares his views about this.
• From the Journal of Infusion Nursing, Mary Alexander MA, RN, CRNI®, CAE, FAAN updates us on The New Gold Standard in Infusion Nursing.

That’s all for now ~ enjoy!

This post is inspired by Joni over at Nursetopia, who recently posted Jargon Invasion and recounted the story of using public health jargon (“healthy BMI”) when discussing weight loss and exercise. I think Joni’s post makes sense to most of us nurses who regularly use words and phrases from our “nursing world” out in the “real world.”

My best friend is a nurse practitioner and when we are together with non-medical friends and family members, they often laugh at us or shake their heads at our choice of discussion topics and the words we use. The fact that both of us studied women’s health and think nothing of discussing the intricacies of women’s bodies and sexuality sometimes makes others uncomfortable. This has also added quite a bit of language to the vocabularies of our children which sometimes makes us uncomfortable as well!

Do you find that you use nursing or medical terms in your everyday life that might sound odd to others who are not health care professionals? Describing my daughter’s drug rash as diffuse and morbilliform might give her pediatrician a clue that I am a nurse. When my children use the word vomit instead of throw-up or puke, I know that they are listening to my choice of words (no, they haven’t picked up on emesis yet!) Other things I’ve said that have garnered some odd looks include disease process, laboratory analysis, and cardiac event. When I say umbilicus instead of belly button, my kids know exactly what I’m talking about. Using the word axillary to describe a temperature reading is normal at our house.

I even find myself using medical abbreviations in my everyday writing. For example, I’ve got to clean my daughter’s newly pierced ears b.i.d. My grocery list might contain veggies with ranch (but instead of with I’ll use ‘c’ with a line over it.) And I’ve been known to email a colleague to review something for me stat.

It’s all part of being a nurse, I guess. It sure keeps things interesting! Have a comment to share? I'd love to hear your assessment of this post...document your observations here!