As most nurses certainly are aware, this year’s flu season is exceptional. It has surged earlier than in previous years and as of mid-January is widespread across all 50 states. There has been a significant wave of flu cases in doctor’s offices and hospitals across the country, affecting everyone from children to the elderly. Emergency rooms (ERs) are inundated with flu patients, and in many cases patients line the hallways in overcrowded facilities without space or beds available due to additional patient volume. Patients are boarding and holding for inpatient beds in the ERs, which exposes additional patients, visitors, and staff to the flu.
Below are some friendly flu reminders, tips, and tricks to keeping yourself and your patients healthy and safe this season and beyond.
Hand hygiene is the most effective way to stop the transmission of the flu. Flu spreads via droplets coughed or sneezed by infected persons onto shared surfaces. Washing your hands thoroughly and frequently and using alcohol-based gel sanitizers is an effective way to prevent flu. But one thing we often forget about is our patients’ hands. Especially when I work in triage, I’ve started asking my patients and their visitors to use hand sanitizer before triage and before they enter their patient rooms as well.
If your hands are feeling the burn after so much vigorous washing and sanitizing, reach out to your infectious disease department to see if it can provide some hospital-approved pump-style lotions for your cracked hands. At home, try using Bag Balm or deep healing lotions and placing mittens on before bed to help salves and creams absorb overnight.
If you have flu symptoms, you should stay home from work. Not all employers have the same regulations regarding sick leave and doctor’s notes, and some are certainly more rigid than others. But the best thing you can do for yourself, your patients, and your colleagues when feeling under the weather is to stay home. This doesn’t just help you get better faster, but also prevents you from endangering your fellow nurses. The flu can spread so rapidly through a department that it can quickly decimate staff numbers and leave no one else to care for other ill patients.
You should feel empowered to communicate with visitors about the flu. It is imperative that nurses educate family members and patient visitors about their role in flu prevention. If your facility hasn’t already done so, consider limiting visitors to your patient rooms, especially children. It is wise to limit visitors under the age of 12 to protect this vulnerable age group from germs. You should feel empowered to ask ill-appearing visitors not to enter a patient’s room if you are concerned for their health. The safety of patients is the utmost priority.
Tamiflu is not for everyone. Most cases of the flu do not require treatment with antiviral medication such as Tamiflu. Clinical judgment will determine whether a patient fits criteria for treatment with antivirals. In most cases, treatment is most effective if given within 48 hours of symptom onset. If you have cared for influenza patients and are starting to see symptoms in yourself, reach out to your employee or occupational health department as soon as possible. In some cases it may be taken prophylactically.
It’s not too late to vaccinate. Make sure to teach patients that even though the flu vaccine has been less effective this year, it still helps save lives by reducing the severity and duration of the influenza virus. Remind patients that it is not too late to receive their flu shot. Everyone six months and older should get the flu shot, especially children, the elderly, and pregnant women.
Mask yourself, mask your patients. If you suspect someone has the flu, you should immediately begin droplet precautions. Place a mask on the patient in triage or when leaving his or her room, and keep yourself protected with a mask and gloves at all times. Remind patients to cover their coughs to help keep you safe.
Resort to basic teaching. Effective discharge teaching can help prevent repeat doctor’s office or ER visits and can help patients stay healthy. Remind patients that the best place for them to be if they are feeling sick is at home. Most people who get the flu will have a mild illness that does not require hospitalization. Fluids, rest, and over-the-counter antipyretics are effective in treating most cases of illness. People with suspected flu should stay home until at least 24 hours after their fever has gone away. Emergency symptoms that require immediate evaluation in an ER include shortness of breath, difficulty breathing, sudden dizziness or confusion, severe or persistent vomiting or diarrhea, or pain or pressure in the chest or abdomen. In children or infants, watch for signs of dehydration, fast breathing, lethargy, and rash.
Keep yourself as healthy as possible. In addition to washing your hands frequently (while at work and not), you should also try to boost your immune system by eating nutritious foods, including fruits and vegetables; staying hydrated; and getting exercise and sleep. Staying well rested and well hydrated can help keep your immune system in good shape to combat this flu season.
The alarm goes off; you groan. How can it be time to get up already? You check the clock, hit the snooze button, and decide to skip breakfast in your head. You can eat something later—there’s no time.
Now that a new year is upon us, it’s time to renew some healthy habits. Many people resolve each new year to exercise more frequently or to eat healthier. I’ve got an easy suggestion for your nursing new year’s resolution: One of the best habits you can instill in your day is simply to eat breakfast before your shift.
As nurses, we know and can recognize the symptoms of hypoglycemia in our patients. But so frequently, the symptoms of low blood sugar are manifesting in ourselves and we don’t even notice. It is so important to eat breakfast, as it helps energize your morning, stabilize your blood sugar, and set you up for clear thinking and communicating at the beginning of a 12+ hour day.
Eating something in the morning is better than eating nothing, but some choices are better than others. The best breakfast choices are usually high in protein, fiber, heart-healthy fats, and complex carbohydrates. (And no, that mug of coffee doesn’t count as breakfast!)
Especially during winter, I urge you to try a bowl of oatmeal. Quick-cook oats take just two minutes to cook in the microwave, and they are so versatile. Try adding dried mango and shredded coconut, applesauce and cinnamon, or fresh fruit and Greek yogurt. Top with some raisins or nuts for added protein. Oatmeal is filling: it contains both soluble and insoluble fiber, which helps regulate your blood sugar and reduce your cholesterol levels. Even better, oatmeal is cheap! An entire canister of oats is usually less than $4 at the grocery store.
Oatmeal can be quick and easy to make and prepare (I set mine out the night before in a microwave-safe container, so in the morning I just add water and go), and I guarantee it will keep you full longer than that cup of coffee or berry smoothie. Overnight oats are a unique twist and make prep in the morning even faster. If you aren’t into hot cereal in the morning, try an oatmeal bar, the powerful effects of the oats are still available in bar form too, although be wary of excess sugars.
Whatever you grab as you walk out the door, make sure you’re setting yourself up for the best shift you can possibly have. Our job as nurses is hard enough without doing it on an empty stomach.
The emergency department (ED) presents a set of unique challenges for patient care, not the least of which is unstable patients who are at great risk for falls. I once heard a nurse educator proclaim: “Everyone is a fall risk in an ED.” From the elderly to the acutely ill, most patients in the department are at possible risk of falling, whether due to their age, their complaint, or the medications and treatment they are receiving. Additionally, many EDs do not have bed or chair alarms available for gurneys to assist with patient falls. Fall prevention is almost solely in the hands of the busy ED nurse.
Here are six ways you can help prevent patient falls in the emergency setting.
1. Use universal falls precautions.
All patients—from the 30-year-old with abdominal pain to the 65-year-old post–total knee replacement—are at risk of falling. In your own practice, using universal falls precautions can be helpful. Treating all patients as though they have the same risk for falls is a good start. Additionally, performing individual fall risk assessments on each patient at the beginning of his or her visit is important to both assessing risk and documenting that risk in the medical record. If completing a falls risk assessment is not mandatory at your facility, consider printing out the Morse Fall Scale and attaching it to your ID badge for quick reference. A standardized tool can help you quickly quantify the risk of patient falls so you can intervene accordingly.
2. Plan your interventions.
My personal favorite fall prevention intervention is the call light. On patient care whiteboards in the ED rooms, I write my name and the phrase, “Please use your call bell for ANY reason” on the board. I orient patients to the call bell immediately and make sure that it is in reach. I explain to them why both side rails need to stay up. Additionally, you may place fall risk socks (or grippy non-skid socks) on your patient as soon as you get them undressed into a gown. Use a fall risk yellow arm band if they’re available to you.
3. Orient your patient.
“I’m going to be your nurse today, and the best way we can work together is for you to help me keep you safe.” I remind patients that even if they feel fine, that trying to get up after laying down or after receiving high-risk pain medications can cause them to feel weaker or dizzier than they might imagine. I encourage patients to use the call bell so I can help assist them out of bed for any reason, but it is also important to set expectations. “It may take me a few minutes to respond, but I will be there as soon as I can.” Try to point out IV lines and oxygen tubing to patients as well as their EKG cables and monitoring leads to remind them that they will need to stay in bed and cannot get up without assistance.
4. Active toileting.
One of the biggest reasons that patients fall is because they have to use the bathroom. For male patients I always place “just in case” urinals at the bedside, and I encourage female patients to use the call bell as soon as they think they have to use the restroom. It is also recommended that you offer toileting as frequently as possible so that you are able to prevent the “have to go right now” urge that draws patients out of their beds.
5. Teamwork works.
It would be impossible for a nurse to be able to be in all of his or her patients rooms at all times, especially within the environment of the ED. If you have a patient who is a high fall risk, who perhaps has dementia or is uncooperative, notify your charge nurse and your colleagues on the unit. Try to move the patient to a room in sight of the nurses’ station or near a hallway. Keep the curtains to the room open if possible to allow as much sight as possible from passersby. If staffing allows, perhaps you could request a safety sitter to help watch the patient to keep them safe.
6. Speak up.
If there are conditions on your unit that continually put patients at risk for falls, report them to your manager and supervisors. It is everyone’s responsibility to help prevent patient falls.
The combination of pain, stress, uncertainty, and a lack of control can be a recipe for conflict. Think about the times in your career you’ve heard things like, “What are we waiting for? Why aren’t you helping me? Do you know what you’re doing? When is the doctor coming? This is ridiculous.”
We encounter difficult patients and experiences all the time. Because of the additional stress that the medical or hospital setting can induce, small stressors can become escalating and potentially dangerous situations. When patients are scared, anxious, or in pain, otherwise benign miscommunications can be amplified. Conversations can quickly become confrontations.
Therapeutic conversations are part and parcel of a nurse’s daily work. One of the most important things we do for our patients is communicate. As the nurse, we often act as liaisons between family, patients, and physicians. Good communication can be the difference between a good interaction and a poor one. Preventing escalating behavior before it starts can keep everyone safe.
Naturally, you cannot control other people’s behavior, but you can control your response to it. Below are some tips for how to defuse and de-escalate conflict interactions.
Start with empathy. When someone first starts to become anxious or upset, try to start by considering why. Are they in pain? Are there precipitating factors that are contributing to their outburst? Try to use your active listening skills to show the person respect. Reflect back to the patient, repeat what they are saying, and really put yourself in their position.
Stand back. Have you ever heard that communication is 7% verbal and 93% nonverbal? Uncross your arms, use an open body stance, and position yourself in a respectful and non-confrontational pose. Approach patients from the side, and try not to back anyone into a corner. Maintain a safe talking distance. Most people are more comfortable with about three feet of buffer.
Be mindful of how you say it. Verbal communication encompasses tone, inflection, and volume. When someone begins to escalate a situation, be sure to use a slow, calm, and low volume for communication. Matching their aggression does not help defuse a situation.
Set limits. When patients get upset or defensive, sometimes it is because they are seeking information. Try to provide information about their care or answer their questions within the context of limits. For example, a statement such as, “When you keep your voice down, I will be able to tell you why we are waiting” can help set expectations of behavior.
Drop your own defensiveness. When a patient starts to get anxious or upset, he or she tends to act irrationally and become very defensive. When someone lacks a sense of control, he or she may start yelling or start actively refusing the plan of care. When you in turn become defensive, this only matches their energy and leads to even greater irrationality. Try not to take actions or words personally and remember to maintain professionalism.
Know when to remove yourself from a situation. There are many reasons that you may need to get a coworker or teammate to “tap in” and help you with a situation. If you are ever truly feeling threatened, do not handle the situation alone. Keeping yourself and your patient safe at all times should be your main priority.
De-escalating anxious or tense situations helps prevent violence or conflict and keeps everyone—staff and patients alike—safe. There are several courses available for certification in therapeutic interventions and crisis prevention. Visit the Crisis Prevention Institute to learn more.
You know the feeling. It’s your third shift in a row, it’s a particularly difficult patient or family, it’s a heartbreaking story, it’s an intense diagnosis, it’s short-staffed night on the unit. Nursing is profoundly tiring—physically, emotionally, and intellectually. Our shifts are long: Even on a normal day, by hour number 10 you may be feeling strained. You can pull from your reserves, but sometimes there isn’t anything left. You have compassion fatigue. You’re experiencing caregiver burnout.
These moments on the unit can be tough. You may feel yourself start to become anxious, or more stressed out that normal. An otherwise meaningless interaction with a doctor, colleague, or patient can leave you nearly in tears. What can you do to avoid burnout?
First of all, in the heat of the moment, take a second to breathe. Try to center yourself by inhaling through your nose and breathing out through your mouth for at least five breaths. This can help calm your body and mind, even when you don’t think it will work.
After your shift ends, it’s time to practice self-care. As nurses, it can be incredibly difficult for us to do this. But just like oxygen masks on an airplane, we all know deep down that it is difficult to care for others when we ourselves are in a fragile, fatigued place.
In theory, the easiest two things to control are our diet and sleep. In practice, we know this isn’t always the case. Aim for quality over quantity: If you can’t get enough sleep, try to make it the best sleep possible. Spend time enhancing your sleep environment with room-darkening shades, white noise machines, comfortable bedding, and a great mattress. Use the “do not disturb” feature on your cell phone. If you’re a night shifter, you could write a note on on your front door that anyone who rings a doorbell will be met with fire and fury.
For your belly, try to pack healthy, filling options for meals and snacks. Aim to always eat breakfast. Low blood sugar can easily translate into crankiness, so try to stay ahead of your curve by packing granola bars in your scrub pockets or bringing easy to eat meals for times when you can’t get a lunch break. (Which, let’s be honest, is every day.)
Most importantly, assess yourself. We as nurses are in the business of assessing our patients, but we rarely turn that critical eye on ourselves. Try to really check in with your emotional reserves, and try to find healthy ways to process your stress. Make a care plan for yourself, and re-assess frequently.