Pursuing a new goal – whether it is a career-related promotion, a personal do-over, or something else fresh – can lead to a variety of emotions.
Initially, just thinking about improving your life is exciting and inspiring. But then the dreaded cycle kicks in. You know the pattern. When it’s time to take consistent steps to accomplish your goal, fear swoops in and blocks your way.
Are you tired of allowing fear to hijack your goals? Can you use it to help challenge yourself to move forward instead of keeping you stuck?
The answer is to rewire your brain to get where you want to go. Listen to an open secret from the universe: Fear is a constant companion. High achievers get scared, too. But they still take action toward meaningful goals, even as they tell their fears through chattering teeth, “Shut up, and move over, I’ve got work to do.”
Ready to push past your fears and stop derailing your do-overs, desires, and dreams? This acrostic provides eight steps to use as a guide to LOSE FEAR:
Limit negative thinking. Create a mantra or ritual to signal it’s time to work. Organize a detailed plan with deadlines. Check completed items. Seek an accountability partner or life coach to help you stay on track. Embrace fear as a motivating tool and not a momentum stopper. Use it to dig deep.
Foster a growth mindset. Resist inertia. Believe your abilities are flexible, not fixed. Ensure your goal is clear and a “must” to accomplish and not just a “should.” Acknowledge that fear never leaves, but tackling a goal minimizes its presence. Refine your plan when setbacks occur. Let failure teach you how to adapt.
Use fear as a motivating tool. That’s a winning strategy worth adopting.
I presented some of the differences between the Doctor of Philosophy (PhD) degree in Nursing and the Doctor of Nursing Practice (DNP) degree. To recap, the PhD is an academic research degree and the DNP is a practice-focused or professional doctorate for advanced practice nurse (APN) preparation. The PhD prepares nurse scientists and the DNP prepares advanced nurse leaders/clinicians.
“PhDs create knowledge for practice and DNPs use knowledge in practice.”
Why Doctoral Degrees in Nursing is Important!
It can be a hard decision for many nurses to continue their education — doctoral education takes a lot of time and money and there may not be a substantial salary increase at the end of the road. Our students need to work and they have family, social, and professional obligations — add in school work, and that makes for one tired nurse! So is it worth the pain and effort of going back to school?
The Future of Nursing report stated that among the health professions, “nursing is the least well-educated.”(1,p.485) The more nurses we have at the doctoral level, the better it will be for nurses, our future patients, and the Nursing profession. “The current demand for master’s– and doctorally-prepared nurses for advanced practice, clinical specialties, teaching, and research roles far outstrips the supply.”2 I don’t know about you, but that sounds like job security to me!
We need doctorally-prepared nursing faculty, desperately! The nursing faculty shortage is being described as “dire” and has a direct impact on the number of applicants being turned away from nursing schools, and therefore on the number of nurses we can prepare—at all levels.3-5 Though faculty salaries are not as high as top-level clinical positions, there are perks to academic life to consider.
Here are some of the tangible and intangible benefits of doctoral education:
Personal growth and development. Besides the knowledge gained, the inherent satisfaction of knowing that you persevered through tough challenges and obstacles to graduate as a doctorally-prepared nurse. Maturity and independence, time management, and advanced skills are all considered prized results of doctoral education.6,7
Personal achievement.6,7 The high honor of knowing that you have attained the highest level of education in Nursing — fewer than 1% of all nurses in the country have a doctoral degree. Scholarly respect is how one author put it.8
Advanced transferable skills, such as critical thinking, clinical reasoning, analysis, research or quality improvement methodology, writing, presentation and communication skills, etc., that you can take with you to any job or position.6,8,9
Impact/transform the Profession by generating nursing science or improving systems of care.
Impact/transform your organization with the skills to deal with and solve complex problems.
Larger professional network,8,9 social relationships, and support systems with classmates, colleagues, and coworkers that you may not have had the opportunity to work with before.
Your future earning potential may be increased.7-9 Higher rank/position = higher pay (and greater responsibilities). In University, to get on the Tenure-Track or be promoted to a professorial rank, you need a doctoral degree. And doctorally-prepared faculty earn more on average than faculty without a doctorate.8 In the clinical setting, DNPs are frequently at a director, department, or administrator level. Higher degrees also qualify you for higher levels on the clinical or career ladder, which usually come with a salary differential.
Your job opportunities may be expanded because you can qualify for top-level positions and may have a greater choice of career paths. Job security goes hand-in-hand with career flexibility.8 Job satisfaction is the desired outcome.7,9
These are only some of the personal and professional benefits of doctoral education.
I urge you to strongly consider taking that next step and continuing your education. Whether you choose the PhD or the DNP, I believe you’ll see that the benefits will outweigh the struggles, in the end.
Strive for Excellence!
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Nursing, while splendid and meaningful, is a physically and emotionally exhausting career. Many of us routinely perform diligent care on critically ill patients and observe tragedies and traumas. Doctors and other health care providers are also exposed to loss and suffering; however, nurses may be more susceptible to the lasting emotional impact. Having a sense of humor will help you cruise through difficult times of your life.
A sense of humor is an important part of coping with physical and mental adversity and challenges. It can also make you healthier. Laughter is said to have great health benefits, such as reducing stress and boosting the immune system. It is a way for nurses to energize themselves and to unite with one another, and it is an especially powerful tool in letting go of the difficult emotions that accompany every day’s work.
“I would hope to see my nurses relishing their work despite the hardships,” says Lisa, a mother of a chronic kidney disease patient. Humor can help nurses build relationships with their patients.
Humor also strengthens the connections between hospital staff in the workplace. “Research shows that humor is a fabulous tension breaker in the workplace,” says Michael Kerr, an international business speaker and author of The Humor Advantage.
Nurses who have access to their sense of humor during stressful events are more emotionally flexible, and can bend without breaking amidst the difficult situations. It is important that you improve and strengthen your humor skills. One of the easiest ways to experience greater happiness is to make small positive changes. Try these tips to help awaken your sense of humor:
Listen to your favorite comedians. Remember a good joke and practice telling jokes and stories.
Learn to laugh at your own flaws, weaknesses, and blunders.
Watch a movie or a YouTube video that makes you smile and laugh.
Share the humor you observe with someone every day.
As a nurse, you have many opportunities to exercise your sense of humor just by observing things that happen around you. Just remember to avoid ethnic jokes, sarcasm, and joking about any patient or their condition.
“Life does not cease to be funny when people die any more than it ceases to be serious when people laugh.” —George Bernard Shaw
Nephrology nursing is projected to grow an astounding 26% over the next decade, driven by the increase in chronic kidney disease and need for dialysis. This provides an opportunity for those interested in nursing who relish the idea of making a real difference in patients’ lives while contributing to advancements in an exciting and evolving area of health care.
For patients, going to dialysis several hours a day, three times a week for many years can be challenging. As the patient’s primary contact at the clinic, the nephrology nurse can make all of the difference in their experience and outcomes. Passionate about patient care, nephrology nurses employ a combination of compassion and proactive guidance to ensure the best outcomes and be sure patients continue their vital therapy and thrive. Providing so much value to patients’ lives can be incredibly rewarding. Nephrology nursing also provides a challenging career path by providing the opportunity to develop deep expertise in the evolving field of kidney care and the opportunity to fulfill nursing ambitions and goals.
Dialysis Patients and Their Nurses: A Unique Relationship
Nephrology nurses develop close and often lifelong relationships with patients, typically learning intimate details of their lives. They can draw on that information to motivate and help patients make life changes that work for them and allow them to achieve milestones, whether it’s making it to a family reunion, losing weight, or not missing dialysis treatments for six months or longer. For example, hearing a patient talk about a granddaughter’s upcoming wedding can provide the opportunity to say, “I know you want to dance at her wedding. Let’s figure out how you can get your weight under control so you can make that happen.” Patients often feel a sense of accomplishment for achieving a milestone they didn’t think was possible, and their nephrology nurses play a vital role in their patients’ successes.
Consider some of the ways nephrology nurses can make a difference:
Work with patients to create individual plans to get and stay healthy – Nephrology nurses work with patients to make lifestyle changes that work for them, whether it’s to lose weight, stop smoking, limit alcohol, or cope with emotional ups and downs. And they can tap into things that will motivate the patient. For example, a nephrology nurse might facilitate a friendship between the patient and another patient four chairs down who struggled with quitting smoking, and finally figured it out. That patient can share his or her success story and give tips to a patient who is currently trying to quit. Patients often try to emulate desirable behaviors. By connecting with patients on a personal level (e.g., tapping into a passion for a particular sports team) or introducing patients to others who have something in common (e.g., a career or personal goal) nephrology nurses pave the way for supportive relationships.
Inspire patients to take responsibility – Nephrology nurses can explain that it is important for patients to take responsibility for their own lives, decisions, and actions, while assuring them that clinic staff, friends, and family are always there for support and input. For example, a nephrology nurse can explain that all of the time spent in dialysis will be futile if the patient doesn’t take his or her blood pressure or other vital medications.
Help patients identify and set up support systems – At the clinic, the nurse and other staff provide strong support. Patients also need support outside of the clinic to help them stay healthy, yet may be reluctant to reach out and ask for help. The nephrology nurse can help patients identify family members, friends, and coworkers who can provide that system of support – and ideas for how to do so – noting that these people in the patient’s life want him or her to survive and thrive.
Teach patients about treatment options – Nephrology nurses can educate patients on the different treatment modalities – including in-center and at-home dialysis – and help them identify which option works best for their individual needs. When it is an option, at-home dialysis offers convenience and improved quality of life by allowing patients to have their treatment at home. At-home dialysis significantly improves outcomes – including survival and treatment adherence – and reduces costs.
Counseling patients on treatment access – Nurses also can play a big role in encouraging patients whenever possible to opt for a fistula, a safer method for vascular access to provide treatment. Because creation of a fistula involves a procedure and time to heal, some patients are fearful of moving forward and prefer to receive their care through a catheter. Nurses can explain why a fistula is the better and safer method, and support them through the process.
Nephrology nurses also enjoy working in a supportive team with health care workers in and outside the clinic – from dietitians to doctors – to ensure high-quality care and patient success.
Career Advancement Melding Patient Care and Expertise
In many areas of nursing, being a jack of all trades is requisite. This is not only exhausting, but also limits the ability to provide in-depth patient care, as well as the capacity to become expert in a particular area. The ever-expanding field of nephrology and ongoing introduction of state-of-the-art equipment fosters the nurse’s development of expertise in kidneys and their care. Nephrology requires nurses to use critical thinking and decision making based on that ever-expanding knowledge. While physicians make the major treatment decisions, nephrology nurses are the ones who most directly influence patient care by identifying issues that develop and proposing solutions. When medical complications arise, nephrology nurses must be on their toes, think fast, and devise a solution. It can be incredibly rewarding for nurses who are drawn to that type of work.
Nephrology nursing also provides multiple paths to professional growth. Nephrology nurses are passionate about outcomes and enjoy taking part in quality improvement efforts. For example, the Fresenius Kidney Care Clinical Advancement Program (CAP) matches nephrology nurses’ ambitions with opportunities. The four practice tier options range from remaining at chairside to choosing advanced practice nursing, such as becoming a case manager or home therapy advocacy manager. Some nurses choose a path outside of direct patient care because they want to make an impact on broader decisions about patient care and feel they can offer a bigger vision for solutions. Opportunities range from spearheading large-scale quality efforts and working externally with regional quality teams to becoming a specialist in transplant education or anemia.
Even those who prefer to remain in direct patient care have opportunities to be part of the quality improvement effort. For example, they can be responsible for ensuring the clinic achieves benchmarks for influenza vaccination. Nephrology nurses can own a quality effort within their clinic by spearheading an interdisciplinary team to identify metrics and design programs. Or they may choose to be involved in a quality project, such as providing training to other nurses and patients.
Nephrology nurses at high-quality dialysis centers often stay for years – even decades – as a result of being highly valued by patients and staff, challenged, and offered multiple career advancement opportunities. It speaks to the passion they have for caring for these patients, and the rewards for helping shape decisions that are made regarding the care of their patients and the field as a whole.
If you are a NICU nurse, you’ve likely been in this scenario: the unit is quiet, you’re going about your shift, when out of nowhere the ventilator starts alarming. Next, the cardiac/apnea monitor blinks red in rhythm with high pitched chimes. You quickly assess the situation, and the feeling sinks in that your once intubated patient is now possibly, unintentionally extubated. Maybe you were handing a baby over to an eager parent for some much needed “kangaroo care” or you were doing your due diligence by changing old tapes to better secure your patient’s endotracheal tube (ETT). Whatever the case may be, accidental extubations are on the short list of NICU nurse nightmares.
Intubation is a life-saving intervention required for many NICU diagnoses and provides a stable, patent airway for the delivery of mechanical ventilation in high acuity patients. Much like central lines and feeding tubes, ETTs require specific placement to function properly. A malpositioned ETT can lead to complications ranging from atelectasis to pneumothorax requiring surgical intervention. Monitoring the securement and position of an ETT is often the responsibility of the bedside nurse and respiratory therapist (RT). A number of activities like re-securing an ETT or even handling a patient can precede its dislodgement. When this occurs, it is considered an unplanned extubation.
Despite the best intentions of the caregiver, unplanned extubations DO happen. They are considered one of the most common sources of preventable harm in NICUs when compared with IV infiltrates, HAIs, and adverse drug events. Unplanned extubations can lead to severe cardiopulmonary deterioration and are the source of over half of emergent intubations. We know they can lead to long-term damage, even sentinel events, but it doesn’t mean that we stop handling our intubated patients or letting our parents hold their babies.
So how we do we keep unplanned extubations from happening as much as possible? Do we know our practices are effective if we don’t know why unplanned extubations happen, when, and how often? Answering those questions starts with data collection. The collection of data on unplanned extubations is not consistent among NICUs nor is it mandatory due to several factors. One factor is the lack of a unified definition of what qualifies as an unplanned extubation in the first place. There is also a justifiable fear surrounding data collection due to the threat of legal repercussions to the caregiver. Despite these barriers, the occurrence of unplanned extubations is starting to be considered a quality indicator by sources like the U.S. News and World Report—so maybe it’s time put aside our fears and reconsider.
Our level IV NICU does not currently collect data on unplanned extubations. Previous attempts at collecting data proved to be inconsistent and unreliable. This prevents us from being able to quantitatively assess whether current practices are working and what our number actually is, but where to begin? The best place to start is always at the bedside. Respiratory therapists and nurses are the first responders when an unplanned extubation occurs, so a team consisting of RTs and nurses was formed. First, we determined who would collect data. The RT and nurse would debrief immediately after the unplanned extubation once the patient is stable. Because the nurse is usually consumed with hands-on care at this time, it was determined the RT should gather this information and record it.
It was important to the team that the process be user-friendly and simple. We created a data collection tool starting with the basics: name, DOB, gestational age, and date/time of the event. This could help us answer some important questions:
Do most of these occur during lunch hours or possibly during shift change when there are fewer hands on deck?
Are the majority of these micro-preemies or are they older, active babies?
We then needed to identify the activity during which the unplanned extubation occurred. Activities included re-securing the ETT, adjusting ETT placement, transferring a patient to be held, removed by the patient, etc. Simple checkmarks could be placed in the corresponding boxes with room for additional comments if necessary. We also included areas for date of the last chest x-ray, and finally, we wanted to know if resuscitation was necessary.
Current research identifies an average of one to three unplanned extubations per one hundred ventilator days so our next task will be to set a realistic goal for our unit. We can then evaluate our practices to identify strengths and weakness. No one wants unplanned extubations to happen. We have a large, dedicated unit that already goes to great lengths to keep our patients safe, but we are open to change. Through a streamlined process of data collection, we are looking forward to finding out not just what we can improve on, but what we are doing right.
My name is Sarah and I have been a postpartum nurse for about a year. I work on a 36-bed labor, delivery, recovery, and postpartum unit in the Seattle area. We take care of a variety of postpartum patients and babies on our unit, and see gestational diabetes, preeclampsia, small- and large-for-gestational-age babies, late pre-term babies, etc. I work three 12-hour shifts per week, and I am currently working night shift.
Typically, I have three to four couplets each night, all needing vital signs, assessments, medications, 24-hour newborn screenings and much more. I am lucky enough to work at a baby-friendly hospital where we encourage breastfeeding, so I spend about 30% of my time as a postpartum nurse educating and assisting my patients with breastfeeding. The rest of my time is spent delivering hands on nursing care (about 40%) and charting (about 30%).
It would be nearly impossible to write about the many things I do during my 12-hour shift, but I will try to describe a typical day as a postpartum nurse:
17:00: My alarm goes off. I snooze for another 15 minutes while I cuddle with my cat.
17:30: Shower time. Once I am squeaky clean, I eat a bagel and cream cheese and drink my English breakfast tea. I always make time to sit down and eat before I go to work so that I can fuel my body and mind.
18:10: I braid my hair, do my makeup, and put on my scrubs.
18:45: I say goodbye to my cat and she meows in protest. I head to my car and listen to NPR during my 10 minute drive to the hospital.
19:00: I clock in, grab a work phone, drop off my bags in my locker, fill my pockets with my essential nursing supplies, and sit in the break room to hear the unit’s announcements and safety concerns.
19:10: Out on the floor I am greeted by the day shift nurses, who are extremely happy to see the night shift nurses. I have been assigned three couplets tonight. Two are vaginal deliveries and one is a caesarean section. One of them is an experienced mom, and the other two are first-time moms. All have chosen to breastfeed their babies (yay!).
19:15: I find the day shift nurse who has my patients and we go into their rooms to get SBAR report, introduce me to the patients, and write my work phone number on their white boards. As I congratulate each set of parents and ask about their baby’s name, I scan the room and patient to make sure all my emergency supplies are available, tubes and drains are functioning properly, and the bed and bassinet are locked and safe.
19:40: After getting report, I sit down at a computer to gather additional information on my patients and plan my night. For each patient, I look at their history, orders, medications, and labs, and chart a Braden skin assessment and Morse fall scale. I plan out when vital signs, medications, and other tasks need to be done during the night.
20:15: Feeling organized and ready to take on the night, I visit each of my patients to tell them their plan of care. While I’m in the room, I restock supplies, take out trash or dirty linens, and tidy up the room.
20:30: I get a call from one of the dads. Baby pooped for the first time and they need help with the diaper change. I enter the room to find a screaming baby and panicked dad. Dad hands me the baby and I proceed to change the diaper while I educate the parents on diaper basics. The parents look at me with wide eyes as they see the sticky black meconium. I reassure them that this is completely normal as I swaddle baby and hand him to dad.
21:00: It’s time to do the first set of vital signs on my cesarean section patient and her baby. I get blood pressure, temperature, and do a full assessment on mom. Her belly is distended from the c/s and she hasn’t passed gas yet, so I talk with her about taking a medication to help relieve the gas and other alternative therapies she can try. She agrees to take the medication and try walking the halls, so I grab the gas pill, simethicone, as well as her Advil and Tylenol that are due. I assess her pain and give her the medications. I then listen to baby’s heart and lungs and do a full assessment. Baby has a wet diaper, so I quickly change it and swaddle him.
21:30: Spotting my charge nurse in the hall, I stop to give her an update on my patients and ask a few questions. She tells me there are cookies in the break room from a thankful patient, so I make a mental note to grab one later in the night.
22:00: I take my 15-minute break and scarf down an apple with peanut butter, pretzels, and cheese. I drink some jasmine green tea on my way back to the unit.
23:00: More vitals and medication administration. While in one of the rooms, I notice that baby has managed to wiggle out of his swaddle, so I wrap him up and spend a few minutes cuddling and cooing at him until mom has returned from the bathroom.
00:00: I get a phone call from one of my dads and he expresses concern about baby being fussy. I go into the room to see if I can help soothe baby. I educate the parents about the many reasons baby might be crying: hunger, wet/poopy diaper, wanting to be held, etc. The parents soak up the information like a sponge and begin to discuss what baby might want. They decide that baby needs to be re-swaddled and might want to be held. I watch and give feedback as mom swaddles the baby. It takes her two tries, but she is thrilled to have done it by herself.
01:00: It is time for the 24-hour screening, so the tech and I gather our supplies and head into the patient’s room. The baby is sleeping, so we take advantage of the quiet time to do the CCHD heart screening and jaundice check. Baby passes the CCHD test, but the jaundice level is higher than average. I explain to the parents that while I do the metabolic screening, I will also be gathering a small tube of baby’s blood to test the serum bilirubin level. The parents are asking questions about why baby’s bilirubin is higher, so I sit down to explain and educate them about newborn jaundice. While I’m discussing this with the parents, the tech is weighing baby and warming baby’s foot for the heel poke. Once the baby’s foot is warmed up, the tech holds the baby in her arms while I clean, poke, and gather blood from the heel. The baby doesn’t cry during the whole procedure and the parents proudly state that they have a brave baby.
01:30: I run the bilirubin test to the lab. I then get a phone call. One of the moms is having difficulty feeding her sleepy baby and she would like me to come help.
01:40: I enter the patient’s room and baby is sound asleep on mom’s chest. It has been almost three hours since baby’s last feeding, so I pick up baby to try to wake him. As soon as I change the diaper, baby is awake and crying…success! I help mom with her positioning of the baby and latching. It takes several tries to get baby on the breast, but after about 15 minutes, we are finally able to get him actively sucking. Mom is so excited and profusely thanks me for helping. I leave the room feeling accomplished and sweaty. Helping with breastfeeding is one of the more physically taxing parts of my job.
02:30: I sit down at the computer to do some charting and look at the baby’s bilirubin lab result. While chugging my water I see that the baby’s bilirubin level came back normal. I go tell the parents and they are noticeably relieved.
03:00: Break time! I grab a warm blanket and settle into one of the large lounge chairs in the break area. I typically try to eat healthy while I am at work to avoid feeling sluggish. Today, I have a salad with a variety of exciting toppings, rice cakes, and a La Croix sparkling water. I watch TV on my phone as I munch on my food. During the last 15 minutes of my break, I lay my blanket on the floor and do some stretching while I drink peppermint green tea.
04:00: Feeling refreshed and ready for the last few hours of my shift, I head back to the unit. I give pain medications to a patient, grab a set of vital signs on another, and help with a breastfeeding.
04:30: I get my cesarean section patient up to the bathroom with the help of my tech. While I am in the bathroom with my patient helping her with peri care and Foley catheter removal, the tech is changing the bed linens. The patient stands up from the toilet and says she is feeling dizzy, so we quickly escort her back to bed to relax. She hasn’t slept in over 24 hours, so I encourage her to get a quick nap in before the next breastfeeding.
05:00: I check in on one of my patients I haven’t heard from in a few hours. She is resting in bed with baby skin-to-skin on her chest, and she excitedly tells me she was able to get baby to latch all by herself. I congratulate her and chart about the breastfeeding and a poopy diaper.
06:00: A worried grandmother comes out in the hall seeking help for her daughter’s baby who is spitting up. I hurry into the room and help baby work up the amniotic fluid. I educate the parents on how I helped baby, clean baby up, and put the baby skin-to-skin on dad’s chest.
06:30: My tummy grumbles and I remember about the cookies. I sneak into the break room hoping there are still some left. I snag the last one and hungrily snack on it as I review my charting for the night.
07:10: Feeling a bit delirious, I give report to the day shift nurses. I say goodbye to each of my patients and introduce them to their new nurse. One of my patients gives me a big hug and expresses how much I helped her survive the night. My heart swells as I walk out of the room thinking, “This is what makes it all worth it.”
07:35: I clock out, feeling excited and relieved to have survived another shift.
07:45: Finally home. I am greeted at the door by my very-happy-to-see-me cat. I quickly shower, put on my PJs, turn on relaxing music, and read my book while I snack on nuts and berries.
08:50: Snuggled in bed, I set my alarm for 17:00 and get some much-needed rest so I can wake up and do it all over again!
Fast Facts for the Antepartum and Postpartum Nurse
All aspects of safe, effective, holistic care for birthing mothers, newborns, and their families are included in this easy-access guide for new antepartum and postpartum nurses and their preceptors during the orientation period.