Taking Nursing to the Streets

Taking Nursing to the Streets

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.”

Nurse Educators’ Vital Role in the Future of Nursing

Nurse Educators’ Vital Role in the Future of Nursing

The nationwide nursing shortage isn’t slowing down anytime soon, as the baby boomer population continues to age and average life expectancy increases, building demand for medical care. That’s not all—the U.S Bureau of Labor Statistics predicts nearly 1.1 million new registered nurses (RNs) will be needed by 2022 in order to replace 500,000 retirees and fill 100,000 new RN positions each year.

This is good news—and an ideal opportunity to advance your nursing career to become a nurse educator. After all, who is going to train all these new nurses?

Nurse educators play a vital role in ensuring that the next generation of nurses is prepared to meet the growing demand for healthcare services. Nurse educators are also instrumental in shaping the future of the nursing profession, encouraging a focus on holistic patient care and illness prevention, as well as promoting community health. Right now there is a strong need for educators — 83 percent of nursing programs sought to hire new faculty in 2015.


Why are nurse educators so important?

Nurse educators serve an important role within the hospital system. Having professional nurses who are trained to deliver information to other nurses, who understand their challenges and how to convey critical and lifesaving knowledge is essential to a hospital’s success. A nurse educator can help mitigate mistakes, streamline processes, shorten new hire ramp time and identify opportunities to improve processes and mitigate risks to the patient, nurse and hospital.

In 2008, the Institute of Medicine released a report recommending that 80 percent of the registered nurse (RN) workforce have a bachelor’s degree in nursing (BSN) by 2020, causing many hospitals to reevaluate their criteria for hiring new nurses. Additionally, hospitals aspiring to Magnet status are likely to hire more BSN-prepared nurses, due to better expected patient outcomes.

That’s why many hospitals are looking to work with educational institutions such as Herzing University to meet the rising demand of BSN degrees, such as through an online RN-BSN program.
As registered nurses return to school and new students seek entry to BSN programs, colleges and universities are under increased pressure to find qualified faculty to educate and train future nurses. Thus, nurse educators’ skills and experience are continually in demand, and essential for expanding the RN workforce to meet the healthcare needs of current and future generations.

How are nurse educators preparing nurses for the future?
Nurse educators are instrumental in shaping the future of healthcare by providing their students not only with the technical skills that they need to be successful in their field, but also the refined skills and depth of knowledge that will help advance quality of patient care.

• The importance of community nursing:
As the focus of patient care shifts from acute care to prevention models, a nurse’s role expands to health education and advocacy, community care, agency collaboration and political and social reform. Today’s nurses need to understand their evolving role in the community and how to provide holistic care for patients. As a nurse educator, you help nurses understand the principles behind the work that they do and how they can proactively contribute to the health and well-being of the communities they serve.

• Essential leadership skills:
Good leaders aren’t born—they’re made! Nurse educators help prepare today’s nurses for future leadership roles by introducing management and organizational theories that will allow nurses to take initiative in a variety of roles. In addition, nurse educators help students learn how to improve patient-care quality, how to make cost-effective decisions and how to evaluate patient outcomes to improve future practice.

• How to implement evidence-based practice:
Nurse educators can also help nurses learn how to critically evaluate new research. This is an important skill that allows nurses to become more effective decision-makers and problem-solvers and help improve patients’ health and well-being.

Becoming a nurse educator:
Becoming a nurse educator doesn’t mean that you have to forgo your clinical work; many nurse educators continue to care for patients in addition to their teaching duties. In order to become a nurse educator, you must obtain your MSN. Educational opportunities such as Herzing’s MSN-Nurse Educator program empower students to fulfill the ongoing and vital need for quality instructors in the field.
Helping to shape the future generation of nurses is a truly rewarding career, and one that is essential to ensuring quality healthcare for our nation. By choosing to pursue a career in nursing education, today’s nurses can help pave the way for a healthier future.

Six Health and Wellness Tips for Nurses

Six Health and Wellness Tips for Nurses

As a nurse, you already know that staying healthy should be a top priority. But too often other demands get in the way and doing what’s best for your physical, mental, and emotional needs gets pushed aside.

It’s time to stop this unhealthy cycle and work on increasing your energy and decreasing your stress. Health and wellness are the foundation for success not just at work but in your personal life, too. When you feel better, you perform better.

What better time than midway through 2017 to either create or improve steps to make your overall fitness a top priority. Here are six tips to help you improve your health and wellness:

1. Eat a healthy diet.

For starters, step away from sugar. It’s tough to do, as sugar is everywhere. Avoid foods with sugar listed in the first five ingredients.  Why? “Sugar makes you fat, ugly and old,” Brooke Alpert, a registered dietitian and coauthor of The Sugar Detox: Lose the Sugar, Lose the Weight — Look and Feel Great told CNN. “What we’ve discovered in the last couple of years is that sugar is keeping us overweight. It’s also a leading cause of heart disease; it negatively affects skin, and it leads to premature aging.”

2. Move your body.

Find activities you enjoy and commit to doing them for at least 30 minutes several days a week. Don’t like to jog? Walk. Hate lifting weights? March in place with soup cans while watching your favorite TV show. Increase your steps as a baseline. Be imaginative.

3. Focus on the present.

Adopt mindfulness. Pay attention when speaking to someone. Make time to connect with loved ones on a regular basis. Minimize multi-tasking. Consider scheduling one weekend a month as a time to disconnect from all digital devices.

4. Protect your sleep.

Adequate sleep protects your health. Make a date with your pillow and keep it so you feel motivated and ready for a new day.

5. Embrace education.

The American Nurses Association (ANA) noted that with over 200 free, online courses at Medline University, nurses can learn more about topics that will help enhance their well-being, including safe patient handling and hand hygiene best practices.

6. Join healthy employee initiatives.

Get fitter at your workplace. Not only are you taking charge to improve your health, you build camaraderie with your coworkers as you work toward your goals together.

The ANA designated 2017 as the Year of the Healthy Nurse. Do your part to make that true!

When Words Do Harm

When Words Do Harm

Last year, the American Diabetes Association prohibited the use of the word “diabetic” to describe patients in its publications. And at a recent conference, the group cautioned health care providers against using the “ic” term and other words that might alienate patients.

Among the objectionable words: “uncontrolled,” “non-adherent,” and “non-compliant.” Even using words like “good” and “bad” to characterize a patient’s blood glucose levels can have a negative impact, diabetes experts say, leaving patients feeling judged and stigmatized.

Better choices, they say, would be “in range” or “out of range,” or “high” or “low” — and it’s not just a matter of semantics. How we talk about diabetes directly impacts patients’ behavior.

If this sounds a bit far-fetched, think about it this way: When you tell the night shift nurse during bedside shift report that “Mr. Smith is a 54-year-old diabetic” you’ve just defined Mr. Smith’s entire being by his disease. When you jot down that Mrs. Jones has been “non-compliant” because she hasn’t been regularly testing her blood glucose levels, she feels the sting of a scolding—and maybe a sense of personal failure, too.

At the end of the day, these judgmental words and phrases can erode an individual’s motivation and actually worsen their blood glucose control. That’s because it contributes to “diabetes distress”—the fear and futility that creeps into a patient’s head when the process of managing diabetes begins to seem overwhelming.

It’s not just in the endocrinology clinic that words can do harm. A 2010 study published in the journal Spine found that patients with low back pain had a more negative perception of their prognosis when their physicians attributed their back pain to a “degenerative” process involving “wear and tear” of the spine or “crumbling” or “collapsing” discs.  In essence, when it sounded bad, the patients viewed their condition as worse than it necessarily was—and that hopeless mindset made them more hesitant to engage in therapies that might actually improve their health.

The impact of word choice is especially evident in psychiatric care and nurses should be careful to avoid using stigmatizing language. In an article published last year in the Journal of the American Medical Association, then-drug czar Michael Botticelli and Harvard professor Howard Koh opined that it wasn’t all that long ago that individuals with mental illness were referred to as “lunatics” and the hospitals where they were treated as “insane asylums.”

Just as those insensitive terms were appropriately abandoned, we need to rethink the way we talk about problems like addiction. A patient isn’t a “drug abuser;” they’re a “person with a substance abuse disorder.” Instead of referring to drug results as “clean” or “dirty,” they should be characterized as “positive” or “negative,” or “substance-free.” The word “drug habit” is problematic too, because it can imply that a substance abuse disorder is a personal choice, rather than simply a disease.

As we incorporate a better vocabulary into our practices, we must also remember that non-verbal language can be just as powerful as the spoken word.

For me, that lesson became crystal clear several years ago while caring for a patient who’d been hospitalized for a warfarin-associated G.I. bleed.

It had been a rough 24 hours, but after several bags of vitamin K, the patient appeared to be improving significantly. His INR was coming down and the attending had just told him that he was out of the proverbial woods. So I was flummoxed when the patient burst into tears as I was taking his vital signs.

“Are you in pain? What’s wrong?” I frantically asked.

The usually cheerful, middle-aged man grabbed my hand, sniffled, and in between unrestrained, breathless sobs asked me if he was dying. “I’ve been watching you all morning,” he confided, “and every time you take my blood pressure, you have this terrible, serious look on your face—so I figured I must be dying and you’re just too nice to tell me.”

That day I learned that language is more than just words, and I began to practice my poker face.

Quality Compressions and Tips for Better CPR

Quality Compressions and Tips for Better CPR

Perhaps you give CPR (cardiopulmonary resuscitation) almost every shift, and you consider yourself a code blue champion. Maybe you work on a med-surg unit or in a surgery center that rarely has to code a patient. Despite the ACLS (Advanced Cardiac Life Support) certification card in your wallet, you may find your skills need brushing up on. Below are some tips for ensuring that you are providing excellent CPR.

1. Get your hands on the chest quickly.
As soon as you notice that a patient is pulseless, place your hands on the chest to start compressions while yelling for others to help. Minimize interruptions to CPR.

2. Use your equipment.
If possible, use a stool so that the compressor is at the proper height, and also place a backboard or use the backboard setting on a mattress to get the proper resistance for compressions.

3. Go fast, but not too fast.
Occasionally compressors get so full of adrenaline that they compress at a rate of 120-150, which is too fast to allow for ventricular filling. The rate should be between 100-120. Tip: Music services such as Spotify actually have entire playlists created for the ideal rate of CPR!

4. Depth is important.
Get the proper depth to allow full recoil of the chest. The recommended depth for adults is 2 to 2.4 inches. Sometimes this may mean lifting your hands completely off the chest after each compression.

5. Too much of a good thing.
Pause for breaths without an advanced airway, but also be careful not to “overbag” the patient. Excessive ventilation can increase intrathoracic pressure and decrease coronary perfusion pressure.

6. Use end tidal to measure your compressions.
End tidal carbon dioxide monitoring can reveal the quality of your compressions. End tidal greater than 20 is associated with greater survival outcomes. Values of less than 20 indicate that you need to adjust your rate and depth. If end tidal suddenly jumps into the 40s, you likely have return of spontaneous circulation.

7. Switch compressors to combat fatigue.
Proper CPR is exhausting. Switch every two minutes, and you can give epi every two compressors.

8. Designate a CPR coach.
If you have extra eyes or hands, designate a CPR coach who will monitor the depth and rate of compressions and who will help ensure that compressors are switching appropriately and end tidal is appropriate.

High quality compressions lead to greatly improved patient outcomes.

4 Ways to Relieve Tension Headaches

4 Ways to Relieve Tension Headaches

A few days ago, a friend of mine asked me if I had any tips for managing tension headaches; she’s been experiencing them more frequently from working long hours as an ER nurse. Like many nurses, she spends most of the day on her feet. By the end of her shift, her muscles feel stiff, her head is pounding, and she needs a few, quick tools to relieve her pain. If you experience tension headaches while at work, hopefully, these tips will be useful to you as well.

1. Loosen up your muscles

In an online article, Mayo Clinic recommends the application of heat or ice to loosen up tense neck and shoulder muscles. “Use a heating pad set on low, a hot water bottle, a hot shower or bath, a warm compress, or a hot towel. Or apply an ice pack (wrapped in a cloth) or a cool washcloth across the forehead.”

Although using a heating pad at work might not be practical, resting an ice pack on your neck when you’re at lunch or on a break might be an easy fix to help lessen muscle tension and mitigate your headache.

2. Try some breathwork

In February, we discussed some of the benefits of breathwork, like encouraging relaxation, reducing anxiety, energizing you, and lessening the feelings of physical and mental stress. Additionally, breathwork can decrease muscle tension, particularly if you try The Five Count Breath. This technique, implemented in Pilates exercises, oxygenates your body and reduces muscle tension in the rib cage and thoracic spine. Here’s a recap on how to use this simple breathing exercise:

Start with a slow inhale through your nose to the count of five. Then, exhale your breath through your mouth also to the count of five. Picture yourself wringing all the stale air out of your lungs and replenishing them with fresh air. With each breath, imagine the tension dissolving from your head, neck, shoulders, and back. Repeat this cycle five to 10 times or whenever needed to reduce overall physical and mental stress.

3. Sneak in a neck stretch

The chin tuck is an effective way to stretch your neck muscles. Sit comfortably in a chair with your feet flat on the floor. Draw your shoulder blades together and keep your head facing forward. Gently move your head back, making sure to keep it level; you don’t want your chin to lift up or dip down. Hold this stretch for five seconds and repeat five to 10 times.

4. Treat yourself to a massage

If you’re not finding relief with basic measures, consider getting a massage. The American Massage Therapy Association believes that massage can be used to alleviate tension headaches and improve postural alignment. Looking for an excuse to treat yourself to a little TLC? Now, you have one!

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