Friday, March 27, 2015

End-of-Life Decisions Empower Us

I recently lost a dear friend way too soon. She was young at heart and vibrant, but she had suffered from multiple illnesses and the complications of chronic illness. Of course, as a nurse, she wasn't always compliant with the care prescribed, and being retired, finances often didn't allow for the best options. She always put everyone else first.

So when she was hit with a health crisis that kept building, we knew that she knew exactly what was going on. And soon she took charge and said "no more!" It was heartbreaking to learn that she was "giving up" when in reality she was taking charge! We knew how bad it was and we all had to honor her choice and support her in the last hours, while we hoped for a miracle! Of course that didn't happen, and she crossed over listening to her favorite playlist and was at last at peace. And it was on her terms.

End-of-Life Decisions
End-of-life decisions are difficult to make. Then when they need to be invoked it's not always so cut and dried. What really constitutes comfort measures and how far do you go with them?

When a patient is on hospice and knows he is dying, he often faces the dilemma would he want to be treated with antibiotics if he develops an infection such as a UTI or has respiratory symptoms after aspirating? Is it a comfort measure or does it prolong his life? Will death be hastened if the antibiotics are declined? There are no absolute answers. Sometimes it seems to hasten things, and other times patients pull out of it and go on. We can predict, but we have no guarantees.

NO CPR  Tattoos
I've shared with many nurses over my career that we should all have NO CPR tattooed on our chests or even our foreheads. It's one thing to have a cardiac or respiratory arrest and not be resuscitated, but Advance Directives and POLST forms ask the harder questions. Do you want antibiotics, do you want hospitalizations? And under what circumstances? Get specific.

A common answer or scenario I hear is, "well if I fell and broke my hip, I'd want to go to the hospital and have it fixed." But we know statistically that a major injury from a fall is tied closely with morbidity rates. Yet how many times do you see 98 year old patients having an ORIF?! I've even seen some patients have total hip replacements at that age, while on hospice to boot!

Advance Directives

It's about choice and even with Advance Directives, we have the right to revoke them and opt for another plan. They are guidelines to help us intellectually decide things our hearts may find gut-wrenching when the time comes. But they help our loved ones know what we would want if we can't make our own decisions. We need to be clear about what we want and help our loved ones know this is the course they need to take for us and not feel guilty or burdened.

I had had many conversations with my friend over the years and knew she was going to invoke this if she had the chance. And if she couldn't, her family would have to honor her decisions and make them for her. It just seemed too soon, but we knew her uphill battle was not going to be won either. Her quality of life would be poor at best if she did survive, and that was NOT what she would have wanted. Rest in Peace my friend and than you for having made the hard decisions. It was empowering to know that you had control of your destiny.

End-of-life decisions give us that power. Think about yours, it's never too soon to make a plan.

This post was written as part of the Nurse Blog Carnival If you are interested in participating find out more details and sign up here.


Monday, March 23, 2015

A Guide to Nursing: The Importance of Training

You've finished your degree, gained your nursing qualification and secured full time employment as a nurse. You may be thinking, 'Great! I've finished studying for good!' but this is not the end of your educational journey. As a nurse, you face different challenging situations on a daily basis, dealing with a wide range of patients and scenarios. You are also faced with new technologies that have a huge impact upon the medical world. As such, much like practicing law, training is a key part of your job description as a professional nurse.

Whether you are newly qualified, a seasoned nurse looking to rejuvenate the passion for your field, or wondering if nursing could be the right career choice for you, here is why continual training is so important in this profession.

Open New Doors
One of the greatest incentives for a nurse to keep training is the possibility of more job prospects. While your initial degree or qualification will allow you to practice as a nurse, climbing the career ladder will often require further skills derived from education. Whether you wish to specialize and work within a particular field, or would like to become a nurse practitioner with a larger pay packet, you will have to undertake further training.

In addition, many experts are calling for nurses to use technology. With society's increased reliance on technology and the frequent implementation of new technology on wards and elsewhere in hospitals, employers may soon be asking for competence with new technologies in their job advertisements for nurses.

More Knowledge Equals Better Care
Nursing is a demanding profession with long hours and stressful situations. You are required to think on your feet, remain calm under pressure and deliver a high standard of care. By continuously training and adding to your existing skill set, you will be able to offer better care to your patients.
When you learn about new technologies, treatment methods and medicines, you are also enhancing the level of care that you can provide. You will experience greater job satisfaction and be able to pass on your knowledge to your patients, whether this is about a diagnosed illness or their treatment process. Essentially, staying up-to-date with current research will allow you to administer the most up-to-date care and treatment.

As a nurse, you enter your profession knowing that you are equipped with the knowledge to succeed. However, the field of health care is ever changing, with new developments and technologies. Continuing education is vital in order to prepare you for the future of your nursing career.

(A guest post with links for UK nurses-- holds true for nurses worldwide. )

Thursday, March 19, 2015

Empowering Nurses

"Growth doesn't occur when everything is perfect," is but one of the empowering statements Lorie Brown, RN, MN, JD shares with readers in her collaboration, From Frustrated to Fulfilled: The Empowered Nurses' System.

Eleven nurses, many of whose names you may recognize as top nurse bloggers and authors, share their journey to empowerment and provide information and techniques for the reader to use to empower themselves and renew their love for their nursing career.

Lorie Brown begins by sharing her GIFTS starting with Giving to ourselves and ending with being the Source and no longer vulnerable to the effects of others as a means to empowerment. Accompanied by The Empowered Nurse's Bill of Rights these two cut to the core of so many issues nurses share worldwide. The other collaborators utilize terms such as fighting dinosaurs, change-makers, assertiveness, well being, and self-disciplined to describe their journeys.

Each nurse's journey is distinctly different and yet the techniques and outcomes are similar. This is a book nurses from all walks of life can relate to and learn from. There are many points to take away to help stop the frustration and begin enjoying your nursing career unencumbered.

Nurses Week is fast approaching, give yourself a gift and enjoy the renewed sense
of pride and ownership of your nursing career.

Saturday, March 14, 2015

The Art of Nursing; Find Your Passion Again

One of the things that makes a huge difference for me in my career and life is the ability to bring creativity to my job and to my personal life. When that creativity is stiffed by people who say "just do this" and only allow me to do the mundane parts of my job, I get very frustrated and quite frankly find myself burning out again. My passion is helping nurses learn how to document well while taking credit for all of the loving, quality care they provide.

The Art of Nursing
Nursing is a science yes, and we have tons of best practices to evidence the care and care paths we need to follow and provide. But nursing is also an art. An art of caring with compassion and empathy. It's about showing our patients how to care about themselves and how to modify their lifestyles to accommodate the rules required to control their illness or injury and improve their quality of life and outcomes. Many times that takes a lot of ingenuity, creativity and imagination.

As a home health nurse, I learned long ago the true meaning of necessity being the mother of invention. Improvising is an essential tool when you don't have a central supply just down a few floors, and your office is many, many miles away. Nursing is the melding of creativity and art with the science of health care.

The art of nursing also involves teaching nurses how to take care of ourselves so that we can continue to provide the level of care our patients demand. There never has been, and probably never will be, anything easy about being a nurse. It takes tremendous physical strength and stamina as well emotional strength and stability to handle all of the things we as nurses may see during our shifts. From birth to death and everything in between; it's all fair game in the daily routine of a nurse.

Find Your Passion Again Scala wrote a wonderful book about Nursing From Within which discusses the art of nursing and how to take care of yourself and find renewed joy in your nursing career. The Art of Nursing 2.0 Navigating the Shifts in Healthcare is a course Scala designed to help demonstrate multiple ways to achieve the goal of renewing your love for your nursing career. Elizabeth employs the talents and skills of many top-notch nursing leaders to help provide insight. Employers, patients, politics and life in general can serve to drain us of our reserves and try to deny us any ounce of creativity in our daily routines.

Step back inside yourself to find the reason you wanted to be a nurse again and find that passion that kept you going through grueling hours of nursing school and sitting for the NCLEX. Learn to harness and utilize the tools to help reset your course if you are knocked off again. Celebrate Nurses Week, May 6-12, by honoring yourself with this course. As a BONUS you can earn 9 credit hours of continuing education when you complete the requirements by July 31, 2015.

Take care of you so you can continue to take care of others and find your passion and love for nursing once again. Sign up today.

This post was written as part of the Nurse Blog Carnival If you are interested in participating find out more details and sign up here.

The Many Sides of Nursing

Maryville University Online

Friday, March 13, 2015

The Impact of IT in Nursing

ADU Online RN to BSN Program

How Nurses Stack Up

Maryville University Online

Friday, February 27, 2015

More Great Inventions from Nurses

It's catch-up Friday again. Here are some great new products, apps, and links from our nurse colleagues. Check them out! Be inspired. Find great products and resources.

Many Thanks to Horizon Healthcare Staffing for listing TheNursingSiteBlog as one of the Top 10 Nursing Blogs for 2015!

Drink More Water
The AquaTally cup was invented by a nurse (Julie Bischoff, RN, PHN) to help us all keep better track of our liquid intake of anything from water to coffee (hot to cold). Check out this great video to show you how it works.

 It's a nice design and the bands move easily even if your hands don't work too well anymore! Available in both sipper top and straw design. I'm really bad at remembering to drink enough water everyday and this bright cup sitting on my desk reminds me to both get up and move as well as drink more water! Thanks Julie. (Full disclosure: she sent me a sample cup.)

Learn Those Heart Rhythms
Sorry to say I can't really offer a true review of this product because I have an iPhone, not an android device, but the concept seems terrific! Ricardy Ricot RN designed an app, RITM to provide an alternative take on EKG learning. (Caution it is NOT for diagnostics!)

I remember vividly in nursing school struggling with those heart rhythms and one day the light bulb turned on. Sadly many of my classmates still struggled. The instructor was quite harsh sometimes and intimidated the students. I know we had to learn to recognize them quickly as anyone in telemetry, ER or intensive care settings, etc would, but really??? Anyway this seems like it would be very helpful app. And maybe Ricardy will learn to code IOS apps too. Watch for more teaching apps from Ricardy.

Social Media Links for Great Nursing Sites
Thanks Brittney Wilson (The Nerdy Nurse) for the Ultimate List of Nurse Blogs and Social Media Accounts to Follow. It's a huge comprehensive list where you can LIKE and FOLLOW from one site. Please take a look and spread the word.

Snagajob App
This isn't from a nurse, but is a great app to help nurses snag those nursing jobs right from your phone or tablet. offers both IOS and Android versions.

Are you a nurse who has invented something, or do you have an invention that's relevant to nurses? Send me your info and I'll consider posting a link.

Thursday, February 26, 2015

Renewed Interest in Patient-Centered Care

Patient-centered care is not a new idea. It was quite popular when I was in nursing school in the mid 1970's. It's what drove me out of hospital-based care and into home health care within three years of graduation. I wasn't able to make the difference I wanted to make because we couldn't achieve patient-centered care.

Reemergence of Patient-Centered Care
Nurse Blog CarnivalNow as we are mandated to cut and manage the soaring costs of healthcare and improve outcomes all at the same time, the importance of patient-centered care is reemerging. To a new generation of nurses and health care professionals it is new and exciting, and to those of us familiar with it, we are once again inspired. I hope this time around it really catches fire. I know that it has been integral to quality home health and hospice care for decades and one of the reasons they are thriving industries today.

So what is the fuss all about? It's not that complex, but I still believe hospitals will struggle to achieve patient-centered care wholeheartedly just because there simply is not, and probably never will be, adequate staffing and nurse-patient ratios. Perhaps if the concept begins to prove to lower costs and improve outcomes, administrators will see the light and make some changes. Yes, I know I'm a dreamer. But think of the impact we could have on wellness and preventative care if all nurses had the opportunity to practice true patient-centered care!

Integrating the Whole Patient into the Plan of Care
Patient-centered care means whole-patient care. This is why it works well in home health and hospice. The nurse (and the care team) meets the patient, his family, his caregivers, his pets, and despite the best HIPAA efforts, often his nosy neighbors. With a glimpse into the patient's home and environment we get to see his true lifestyle, culture, traditions, beliefs, superstitions, fears, wants, desires, and all of what makes up this patient. In the physician's office, clinic, ER, or hospital room we only see small parts of the picture.

The home health or hospice nurse becomes the eyes and ears of the physician often to learn why the patient is non-committal or non-compliant; why the treatment is not effective; why the patient is not improving. In that sterile environment of the hospital he thrived. But back home he has his whole-person lifestyle to contend with. The plan of care has to include these factors.

Empowering Patients
Patient-centered care means we need to examine and consider all of the components of the patient. The patient's values, cultural traditions, social circumstances, financial matters, family situations, and personal preferences have to become an integral part of the plan of care.

Once we meet and see the whole patient, patient-centered care involves:
  • providing coordination of care and open communication with all members of the team including the patient and designated family members  
  • providing support and empowering the patient to take responsibility
  • providing ready access to information and care 
  • the autonomy to make decisions without judgement
As we educate the patient and monitor the plan of care we have to include all of these factors in order to help guide the patient and empower him to understand his health status, his options and the benefits and risks without bias or judgement. We have to give the patient the information and the right to make informed choices and then the guidance to help him achieve the best outcomes possible under the circumstances. Again we cannot judge or present bias; only information and options as we move forward with the plan of care.

The Institute of Medicine (IOM) and the Institute for Healthcare Improvement have conducted many studies on patient-centered care and the results show improved patient outcomes, higher quality health care, and a higher level of patient engagement. All of these will lead us to a much improved overall health status and eventually help to contain and lower the staggering costs of health care.

How is patient-centered care working in your job? 

This post was written as part of the Nurse Blog Carnival. More posts on this topic can be found at Big Red Carpet Nursing. Find out how to participate.

Patient-centered care
Patient-Centered Care: What it Means and How to Get There
Chasing the Quality Chasm

Monday, February 16, 2015

Home Health Aide Information

Home Health Aides