When Teri Dreher, RN, CCRN, iRNPA, owner of NShore Patient Advocates, LLC in Chicago, Illinois, was still working as a nurse, she remembers when a patient kept having massive hemorrhagic episodes after a routine surgery. Despite this, the doctor wasn’t running tests to determine what was happening. When she questioned him, he yelled at her, became defensive, and threatened her. But that wasn’t the end of it.
“The next day, he transferred the patient out of ICU. She went into shock, and the family begged me to intercede. I told the daughter what I would do if it was my family member: insist she be transferred back to ICU and get a CT scan for an interventional study to find the cause of the bleeding,” recalls Dreher. Turns out that the patient had a bleeding splenic artery aneurysm that could not be accessed by the interventional radiologist to stop the bleeding.
Teri Dreher, RN, CCRN, iRNPA
“When the patient came back to ICU, she immediately started bleeding again, and we coded her for four hours, transfusing more than 30 units of blood. During the CODE, I had missed scanning out a narcotic, and 10 days later was charged with being a drug-abusing nurse,” says Dreher. Although her urine test was clean, she was put on 10-day suspension. This convinced her that she would never be happy again working as a bedside nurse. Her nurse manager had warned her not to tell the family member what to do to force the issue.
“I took a course in patient advocacy and started my own business. I vowed that no one would ever tell me not to advocate for a patient again,” says Dreher.
“Nurses today are taught to question, speak up, and challenge when they feel something is not right,” says Dreher. “Decades ago, the system was much more patriarchal, and nurses were frowned upon when questioning doctors. Doctors are human and make mistakes. Nurses spend more time with patients—we are the doctors’ eyes and ears.”
She says that good doctors generally listen to nurses, and nurses are free to speak with physicians as well as mid-level practitioners. If you don’t get a response from the doctor, she suggests speaking with the nurse manager, supervisor, and even the risk management department.
Dreher admits, though, that nurses who are “whistle blowers” can be at risk even with the nursing “bill of rights.” “Everything in hospitals is focused on data, stats, and money. If a nurse goes up against a physician, just do the math regarding who is more valuable to that hospital: a nurse who makes 80K annually or a doctor who makes millions per year for the hospital,” says Dreher. “I almost got fired for strongly advocating for a patient. Even though I was right, I was almost fired by a hospital that I had served well and faithfully for over 23 years.”
As a result, Dreher suggests that nurses still speak up, but tread carefully while doing so. “I think it is important to be humble and go up the chain of command carefully. Doctors have more training than nurses, and sometimes there are things we do not know,” she explains. “Communication is key—as well as respect. None of us knows everything, but if we have the courage to confront and work together collaboratively, everyone wins—especially the patient!”
For the last 12 years, Camille Prevost, RN, has worked as a travel nurse. This means that she works for a company via contract which then is contracted with a health care facility. Travel nurses work as temp staff nurses, and they can work for one company or move around as needed.
“There are about 500 companies in the United States, and they vary in terms and benefits,” explains Prevost. “I have worked for five or more, and once as a freelance worker.”
Travel nurses can be contracted for anywhere from 8 to 26 weeks, depending on the facility’s staffing needs. But, she points out, most contracts last for about 13 weeks.
Prevost became a travel nurse “for the adventure aspect, traveling to different parts of the country. I like the challenge of adjusting to a new environment, including working with new people and experiencing different cultures.” As of press time, she’s working at the Northern Navajo Medical Center in Shiprock, New Mexico.
“The greatest challenge being a travel nurse is being ‘the new kid on the block,’ with the facility’s staff. There is the ‘proving ground’ that is always part of a new job. Of course, working in health care is serious business, and you have to develop relationships that include a level of trust and your competency as a nurse,” says Prevost.
The best part of her job? Her patients. “I’m a labor/delivery nurse, so I play a very important role in supporting women during their labor and childbirth,” she says. “My greatest reward is that you are an integral part of a woman’s labor/birth experience—not to mention those magical newborns!”
If you are interested in possibly becoming a travel nurse, Prevost says that you should check the top ten travel companies in the country listed online. “Talk to other travel nurses about their experiences with the companies out there. Pay attention to housing, and make a list of priorities that will work for you. Get all the details—as far as health insurance and when it kicks in, car rental, how far of a commute to the facility etc.,” explains Prevost. “Most facilities require at least 1-2 years of experience in your current specialty. In your telephone interview, ask questions about staffing and the on-call policy for providers. Always know the facility’s protocols and policies specific to them.”
She adds that your certifications must be current. For example, basic life support, advanced care life support, neonatal resuscitation program, pediatric advanced life support must all be up-to-date, depending on the area in which you work.
Prevost gives one final suggestion: know the different computer programs for charting because you will most likely only receive a short orientation to each unit—about 3 days, and then you’ll be considered ready to work.
While people in the United States still use Western medicine, many are also doing so in conjunction with Eastern treatments used for centuries. Jennifer Bjork, MSN, RN, Clinical Educator and Interdisciplinary Partnership Council Site Coordinator at Sutter Maternity and Surgery Center, implements aromatherapy and healing arts with patients. The center began using aromatherapy with patients in October 2016, and added additional techniques in December 2016.
Bjork, who has earned certifications in Clinical Aromatherapy in Obstetrics and Level 1 Integrated Healing Arts, took time to answer some questions about these for us.
Regarding Aromatherapy and Healing Arts: Please explain what these are to those who may not be familiar with them.
Integrated Healing Arts, which includes gentle touch techniques, simple breathing techniques, presence, imagery, and use of essential oils—or aromatherapy—are used to help hospital patients undergoing some sort of stress. We know that hospitals can be stressful places, and we integrate these techniques with traditional medical treatments to help our patients heal by decreasing their stress. We also teach these techniques to our staff, because we know that we are best at helping others when we first help ourselves. Here is a breakdown of our Aromatherapy and Healing Arts program components:
- Aromatherapy is the use of essential oils—liquids taken from plants, flowers, and trees that have been used for centuries to reduce symptoms, such as pain and emotional distress. They are also disinfectants and used to promote a sense of peace and well-being.
- Gentle touch techniques—such as a gentle massage—are simple techniques from many healing traditions used to help a person relax.
- Simple breathing techniques help the body release tension and slows the brain activity.
- Imagery is using your mind to imagine an image that brings a patient relaxation, decreases anxiety, and promotes overall healing. Our bodies do not know the difference between “imagining” an experience and actually experiencing it. We get the same benefit from both.
When do you use these procedures?
We use these therapies any time a hospital patient is feeling pain, fear, anxiety, depression, nausea, or any other form of stress. Any patient, actually, any person—including staff—can benefit from the Integrated Healing Arts.
Why do you use them for the patients?
Being sick, having a baby, and having a surgery or procedure can be very stressful. This stress can cause fear, pain, anxiety, depression, poor sleep, etc. Stress activates hormones and chemical reactions in our bodies that can decrease immunity and not allow us to heal.
How does it help?
We use them to reduce the human stress response by promoting relaxation and stimulating the release of chemicals in our brain that improves immunity, allowing hospital patients to heal. The work with our bodies’ neuro-hormonal-endocrine system helps promote consciousness and relationships.
What are these processes bringing to patients that other methods don’t?
These techniques, or treatments, are used together with traditional medical interventions to treat the human response to illness (i.e., reduce stress, reduce pain, increase well-being, enhance immune function, diminish emotional distress, promote rest, or sleep, etc.). For instance, if a pain medication is not working for our patient, we use one of our techniques to help our patient relax, and thus, allow the medication to work fully and, hopefully, with the least amount necessary to alleviate her pain.
Is there research that it benefits patients or are you going based on anecdotal evidence?
There is a multitude of evidence-based literature to support our use of the Integrated Healing Arts. In our electronic medical record at Sutter Maternity and Surgery Center, our care plans have these methods as interventions for the human response to illness based upon evidence-based practice. These plans are reviewed every year with updated evidence. There is strong evidence that the use of the Integrated Healing Arts can improve traditional medical care by assisting the mind, body, and spirit.
What would other facilities or nurses need to do to implement this into their own situations?
You need support from the leadership team, experiential training in these techniques, a policy that supports the use of these Integrated Healing Arts, rounding to support the staff in using these techniques, and sharing of successful stories to assist the culture in believing that these techniques actually work.
What else haven’t I asked you about regarding your use of Aromatherapy and Healing Arts that you think is important to know?
We know the biological impact of stress or negative emotions can decrease immunity and increase our chances of becoming ill, and once we are ill, not allow us to heal. These Integrated Healing Arts all help ourselves as caregivers, allowing us to be present and get our nurses back to the bedside, where they can do what they do best: provide compassionate care for our patients and assist them in their healing process. We also know these techniques can improve our hospital patients’ overall satisfaction with their care.
In October 2015, Diane Hosmer, RN, MSN, IBCLC, Sutter Medical Foundation, Women’s Services at Sutter Amador Hospital, held the first Grandmother Tea, which is an educational program and celebrations for new grandmothers. Hosmer says that they have hosted four Grandmother Teas (the event is held twice a year) with more than 125 participants.
What exactly is a Grandmother Tea? It’s an event held on a Saturday afternoon for three hours, and it teaches the latest information in newborn care to Grandmothers-to-be as well as expectant moms.
Hosmer took time to answer some questions about this program.
Why did you and/or the hospital believe it was important to offer this program?
I saw firsthand the difference in newborn information that is provided now compared with what I received as a mother. As a grandmother, I wanted to help bridge the gap by creating a Grandmother Tea and received wonderful support from the hospital to create the program.
Grandmothers spend a lot of time caring for the infant or providing advice to the new mom. In my position, I see how much things have changed in the past 10 to 15 years in information that we were providing new moms as opposed to what their own mothers were taught. Grandmother Tea allows us to educate generations of women and each topic touches the participants in a different way.
What do moms-to-be and grandmothers learn at this program? Where is it held?
Each tea is held at the hospital and is taught by board certified lactation consultants and labor and delivery pediatric nurses. We teach topics ranging from safe sleeping and breastfeeding to cue-based feeding and baby-wearing.
The program is broken down into three activities. Between activities we pose a related question then have a discussion over tea. Presenters sit with participants to discuss the topic, often answering additional questions and guiding the discussion to a positive outcome.
We honor the experience Grandmothers have, while acknowledging ways newborn care has changed over the years and how we continue to learn new ways of doing things. Many women tell us this is one of their favorite parts of our program.
Do the attendees get any items to bring away with them? If so, what are they and why do you give them out?
Similar to a baby shower, each grandmother and mother is left with armfuls of gifts, including local resources and information to take home thanks to Sutter Amador Hospital and community sponsors: Amador-Calaveras Breastfeeding Coalition, First 5 Amador, WIC, Calaveras Public Health, and Amador Public Health.
How successful has the program been? What do you enjoy about it?
We have received great feedback about the program and hope to continue to see it grow. The next Grandmother Tea is October 14, 2017. We plan to continue offering the program twice a year.
Is there anything about the Grandmother Tea that is important for readers to know?
It all starts with a vision. I encourage other nurses to think creatively and enlist others in the quest to find unique ways to engage patients and their families in educational opportunities.
In March 2016, Sutter Health and WellSpace Health started The Street Nurse Program. Funded by Sutter Health, the program is geared to meet the needs of an underserved population—those affected by homelessness—in Sacramento, California. To date, it has helped more than 200 people who have received access to on-site care, medical advice, disease management education, and wound care.
Amanda Buccina, RN, BSN, is the program’s sole nurse. While they are looking to expand the program, Buccina is making a huge difference in the meantime on her own. “I’m happy to be selected as the first nurse in this role. I was previously in a position managing Medicaid case management programs for a large managed care corporation,” explains Buccina. “When I saw the street nurse job description, it sounded like a great opportunity and one that aligned with my experiences. For the first time in a long time, I felt excited and inspired by a nursing role, so I knew that it was the right opportunity to pursue.”
According to Sutter Health, The Street Nurse Program provides a vital piece in the continuum of care, with programs and partners seamlessly working together to provide a whole health stability model for the most vulnerable among us.
“The Street Nurse Program is an effort to provide an access point into a traditionally very guarded population, enabling us to start linking the homeless to the services they desperately need,” says Buccina.
Oftentimes, those affected by homelessness won’t come to clinics. As Buccina says, “Working with this population, you have to be willing to meet people where they are.”
A great deal of her job involves building relationships. “I work to build trust and rapport with my clients so even if they don’t need me in that exact moment, we have a relationship and familiarity with one another. This comes in [handy] when clients do want and need support, like medical advice, an advocate at a doctor’s appointment, help getting into an alcohol or drug rehab program, or just general wound care,” explains Buccina. “Sometimes, honestly, they just want someone to listen to them–that there is somebody who is consistent and that they trust. If they know someone is invested in them, it makes it slightly more likely they will be invested in themselves.”
Buccina finds it touching when her clients let her into their lives. “They don’t have to let me into their world at all—and they do. It’s kind of like a window into their world. And if they trust me enough to help them,” she says, “it’s kind of a big deal.”