Working with Patients Who Have Alzheimer’s Disease

Working with Patients Who Have Alzheimer’s Disease

While some nurses may find it difficult to work with patients who have Alzheimer’s disease, others find it to be a calling.

Take Christine E. Crouch, RN, BSN, for example. As a Licensed Nursing Home Administrator and the Vice President and Senior Administrator at Bethesda Health Group, specifically working with Charles Village and Southgate, she loves what she does. “It is extremely rewarding, hard work, and the families become part of your life,” says Crouch. “And they are so appreciative of the care you provide their loved one.”

In honor of National Alzheimer’s Disease Awareness Month, Crouch took some time to answer our questions about what it’s like to work with Alzheimer’s patients. What follows is an edited version of the interaction.

As a nurse working with patients with Alzheimer’s disease, what does your job entail? What do you do on a daily basis?

As a nurse working with Alzheimer residents, my goal is to provide a safe environment while promoting self-worth and dignity for the resident. I want each resident to be able to do as much for him/herself as possible while having a meaningful life.

Why did you choose to work with this type of patient? How long have you worked in this particular area of the nursing field?

I have chosen the geriatric field of nursing because I love working with seniors and have cared for residents with Alzheimer’s disease since the 1970’s. I have always enjoyed talking and interacting with older people because they are so interesting and have had so many life experiences.

What are the biggest challenges of your job?

The different stages of Alzheimer’s disease affect residents in different manifestations of behaviors and daily life skills. So when you are caring for 27-30 Alzheimer residents on your neighborhood in different stages of the disease process, it is a huge challenge to meet every person’s needs (person-centered care) and wants.

What are the greatest rewards?

When someone who has not spoken, smiled, or engaged with staff or family all of a sudden talks, sings, or smiles.

What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?

This type of nursing is actually a calling. You have to want to care for this special group of individuals. Most of the time a nurse assistant or medication tech who worked with this population makes the best nurse.

They would definitely need geriatric nursing training and specialized skills and competency in dementia care. The Alzheimer’s Association offers some training, and also, there are other special programs like the Teepa Snow training and Landmarks for living program, just to mention a few.

5 Habits That Will Help You Become a Great Nurse

5 Habits That Will Help You Become a Great Nurse

We all know a great nurse—someone whom we look up to and wish we could be like one day. These nurses didn’t start out as role models. They had to work hard to become who they are today. The good news: You, too, can become a great nurse! Here are five habits to incorporate into your nursing practice that will help you along the way.

1. Review your charting.

Take a few minutes at the end of your shift to review your charting for the day. You may find a mistake or remember something you forgot to chart. It’s important to remember that everything you type could be reviewed in a court of law. If something wasn’t charted, then it didn’t happen. By reviewing your charting, you are protecting your nursing license and ensuring an accurate medical record for your patient.

2. Remember your safety basics.

Don’t forget the safety basics you learned in nursing school, like wearing gloves or scrubbing the hub. These practices will protect you from occupational hazards and protect your patients from harm. Over time, your safety basics will become habits that you will be able to maintain even when you are busy or stressed.

3. Keep up with the latest information.

Every day a plethora of new information is released into the nursing world. It is crucial that you stay up to date on everything in your field of nursing so you continue to grow and evolve. Nurses who are behind the times and unwilling to change their practices could endanger themselves and their patients. Join your local professional association and read your hospital and unit newsletters to stay abreast of new information specific to your field of nursing.

4. Stay organized.

It is easy to become overwhelmed and disorganized when you are taking care of several patients. A great nurse is always thinking three steps ahead of what she is doing. Find an organizational system that works for you to help plan your day, or use a checklist to ensure that you get everything done. Having a system in place will help you stay on track when an emergency happens in the middle of your shift.

5. Don’t cut corners.

It may be tempting to cut corners to save time, but safety measures were put in place for a reason. By skipping a step, you could be risking your patient’s life. Maintaining sterility or performing the five rights of medication administration may be time consuming but could be disastrous if skipped. Infection, sepsis, overdose, or allergic reaction are all possible outcomes. Protect your patients, yourself, and your license and don’t cut corners.

Talk to Nursing School Admission Officers Online on 11/29

Talk to Nursing School Admission Officers Online on 11/29

DailyNurse wants to help you plan the next step in your nursing career! Our online open houses will help you plan your next step and guide you through the nursing school application process. These events also serve as an easy and effective way to connect with admission officers from the comfort of your home, school, or office.


Chat with nursing school admission officers on Wednesday, November 29th (12pm-3pm EST)

Next week, aspiring nursing students interested in a BSN or MSN degree will have an opportunity to meet with admission officers from Herzing University. Herzing has opened applications for the following programs:

  1. RN-BSN
  2. RN-MSN
  3. MSN-Family Nurse Practitioner
  4. MSN-Nurse Educator w. emphasis in Staff Development
  5. MSN-Nurse Educator w. emphasis in Faculty Development
  6. Post Master Certificates
  7. MBA w. Concentration in Healthcare Management

Whether you are new to nursing or want to further your career with an advanced degree, Herzing offers program options as well as support teams to help you succeed. Register now to chat online from any device, and connect with admissions officers for 1-on-1 chats next week.


The Nurse-Practitioner Abroad: Working as an NP Internationally

The Nurse-Practitioner Abroad: Working as an NP Internationally

This story was originally published by The Professional Nurse blog, a trusted and reliable source for nursing career advice, news, and academic resources.

Ever since the advent of the Nurse Licensure Compact, working as a registered nurse in half of the states in the United States has become almost seamless. The multistate license is particularly helpful for nurses who work as travelers and for nurses who live near state borders. The evolving APRN Compact will similarly provide for nurses in advanced practice as long as they continue to work in the United States.

As someone who lives in the Metropolitan DC area, I see friends and neighbors move from country to country as readily as many people seem to go to the grocery store. The area is, naturally, home to a large number of government and international agency employees. I started to wonder, how would I continue to work as a nurse-practitioner if my family needed to relocate overseas? I found my options limited. Few countries recognize the role of an advanced practice nurse (APN).

Registered nurses in the United States enjoy a broad scope of practice compared to nurses in much of the rest of the world. The concept of advance practice nursing? Virtually unheard of outside North America and Europe. In only a handful of countries would it be possible for me to continue working legitimately as an advanced practice nurse. Once I had met local requirements, that is.

Setting aside visa, work permit, and language-proficiency requirements, let’s look at what it would take to work as an APN in some of these places.

The APN role in Canada has come a long way during the past 15 to 20 years. It is similar to the APN role in the United States. Canada recognizes nurse-practitioners as autonomous providers. An APN license requires both graduate-level education and clinical experience. The process for foreign-trained APNs to qualify for licensure in Canada varies among Canadian provinces. In general, you would need to have your NP educational program approved, apply (a multi-step process) for and pass the appropriate NP exam, supply copies of your various licenses and pay fees in excess of $2,000.

Once you leave North America, your options for practicing as an APN are limited. In Nigeria, for example, where decades of wars, conflicts and political instability reduced medical manpower, the APN role has started to evolve. Nigeria recognizes only the advanced practices of midwives and certified registered nurse anesthetists. Licensure in those specialties requires application, verification of your state nursing license, a statement of good standing from your state board of nursing, official transcripts from the nursing school(s) you attended, approval of your educational program, taking and passing Nigeria’s licensing exams, and the completion of three months of orientation.

In Israel, where advanced practice nursing is still in its infancy, one must be a citizen or resident of Israel to qualify for nursing licensure. The process of obtaining licensure in Israel is not unlike the process in Canada and Nigeria – it requires paperwork, testing (including simulation testing) and fees. In fact, these requirements are fairly standard.

What is not standard is the scope of advanced practice nursing. In places like Nigeria and Israel, advanced practice nursing is restricted to certain specialties. In Finland, nurses work in advanced practice roles but do so without any standardization in education and without an advanced practice license. Thailand recognizes APNs, but the APN role is not well defined. One third of APNs in Thailand work in places where doctors are not present and often end up providing care beyond their legal scope.

Obtaining a license as an APN in another country will require planning and patience. The process can take as few as six months or as long as two years. Many countries do not recognize educational programs that are completed online. You should expect compensation to be much less than you would earn in the United States.

If the overseas licensing process is overly daunting, you might want to consider other career possibilities. You may not be able to work the way you do in the US, but you may be able to teach, do research or hold management positions in health care – all without going through the laborious licensing process. International healthcare jobs are plentiful owing to USAID, the US State Department, the CIA, the United Nations, and the World Health Organization and will generally not require a foreign license. International job listings can also be found at and

What Nurse Practitioners Can Do in the Opioid Crisis

What Nurse Practitioners Can Do in the Opioid Crisis

The impetus to address—and combat—the opioid epidemic that is plaguing our country has never been more urgent. Overdose rates have more than quadrupled since 1999, making opioid overdoses now the leading cause of death in Americans under 50. For every person who obtains opioids on the streets, there are many more who abuse prescription drugs that are prescribed to them.

Nurse practitioners (NPs), in primary care and in specialties, can help break this cycle. Nurse practitioners are on the frontline in patient care and have the skill and authority to intervene. As a provider, I have seen firsthand how pain medication can help patients regain control of their lives, when prescribed and taken correctly. I have also seen people become so dependent on these medications that they will do almost anything to get access to them. Part of my role at Columbia University School of Nursing is to oversee the school’s faculty practice, ColumbiaDoctors Primary Care Nurse Practitioner Group, which offers combined primary care and mental health services in New York City.

At the practice, we handle opioid prescriptions with a three-prong approach: comprehensive history and assessment, opioid patient-prescriber agreements, and educating our faculty NPs to engage in Medication-Assisted Treatment, particularly the authority to now prescribe Buprenorphine, an opioid medication used to treat addiction.

Nurse practitioners bring an evidence-based and culturally-competent approach to primary care. I connect with my patients and am able to understand a patient’s needs by eliminating barriers to care. This includes a comfortable environment that allows for ample time to interact with the patients and is focused on building the patient-provider relationship. When it comes to pain management especially, we want patients to feel comfortable sharing the root causes of their problems, so that we can provide the most appropriate course of treatment.

If we feel the problem stems from a multitude of factors, we may refer them to our mental health nurse practitioner, or other specialists before prescribing opioid prescriptions. By taking the time to assess the problem, we aim to ensure that opioid medication is methodically prescribed—and not our first course of treatment.

We know that this alone is not enough, which is why we also ask our patients to sign an opioid patient-prescriber agreement. This helps us to ask for accountability from both the patient as well as the prescriber.

Beyond just promising to take medications at the dose and frequency prescribed, our patients must agree to come in for a random “pill count” whenever asked. They must always bring the original pill bottle with unused pills in to every appointment, and we will even ask for consent for random drug screenings.

The purpose of these precautions is to remind our patients that this treatment modality will be taken away from them at any time if they cannot adhere to our safe practices. It also reminds our prescribers to keep a watchful eye to ensure the patient’s treatment does not become habit forming.

For those who come to us already addicted to opioids, NPs can now legally prescribe Buprenorphine, an opioid medication used to treat addiction, thanks to the Comprehensive Addiction and Recovery Act (CARA), passed just last year. This allows patients to come to us when they need help, and allows us to devise a plan of action from the convenience of our primary care practice. Patients appreciate being able to be treated in the familiar surroundings of our practice, and in the care of an NP who knows their complete health history.

Last year, the opioid epidemic claimed 64,000 American lives. Today, there are more than two hundred thousand nurse practitioners in the country who are prepared to help. Perhaps, this is one of our greatest assets. We offer access to quality and patient-centric care, especially in underserved and underinsured communities across the United States. As we recognize Nurse Practitioner Week, November 12-18, it is important to remember our role in combating this escalating health crisis.

Careers in Nursing: An Interview with Emergency Nurse Angela Fennington

Careers in Nursing: An Interview with Emergency Nurse Angela Fennington

Nurses who work in Emergency Rooms/Emergency Departments often deal with incredibly stressful situations on a regular basis. Angela Fennington, RN, CEN, works in the Emergency Department (ED) at the University of Maryland Upper Chesapeake Medical Center (UM UCMC) in Bel Air (Harford County), Maryland. Fennington also assumes the role of a charge nurse as assigned by the ED leadership team. She took time from her busy schedule to answer questions about what it’s like to work in the ED. And although there’s no George Clooney around, she loves her job anyway.

Angela FenningtonAs an emergency nurse, what does your job entail? What do you do on a daily basis?

My job as a nurse in the ED entails a lot of decision making and presence of mind. Patients in the ED can arrive with a wide variety of symptoms, and it’s my role to assess these patients in a timely fashion. On many occasions, several patients may arrive at nearly the same time. As an ED nurse, I have the challenge of assigning a priority level to each of them, all while trying to make people understand the triage process (assigning priority level) and why they may have to wait while others are taken into a room immediately. Identifying life-threatening events and responding promptly to them requires presence of mind, substantial expertise, and a lot of compassion.

Always being prepared is an essential characteristic of an ED nurse. It’s important to anticipate the worst-case scenario when patients arrive for care. We strive to provide prompt attention with the compassion and expertise that we have developed through the years.

Being prepared is vital and makes us thrive at being effective in what we do. It’s a daily norm to face the unknown every time we take care of a patient who presents with non-specific sets of symptoms. When patients arrive in full cardiac arrest, we have the task to be quick in our response and to restore signs of life even though we do not have all of the information about the event. We work through the pieces of information that we get from EMS and other sources.

Why did you choose to work in the ER/ED? How long have you worked there? What prepared you to be able to work in such a stressful environment?

I choose to work in the ED because I like the challenges that the setting provides to nurses. I like the unpredictability and the adrenaline-pumping scenarios that we encounter on a daily basis. The degree of autonomy that we assume to take care of our patients fuels our self-esteem and can be gratifying in so many ways.

I have been working in the UM UCMC ED for nine years. I went through rigorous preparation to be an ED nurse, including attending a “boot camp” for nurses where I was exposed to didactics and scenarios to prepare me cognitively and psychologically for the role of the ED RN.  During training in the department before I became an independent ED nurse, my mentor and preceptor provided me with the right blend of freedom and supervision so that I could develop my critical thinking skills for the role.

Reflecting on my journey since I started the ED nurse role, I see that my teammates are so instrumental in my success in this setting. In times of crisis (patient is crashing etc.), there are always available hands willing to help and provide the best care for our patients. Teamwork is deemed integral towards a positive experience of an RN in the ED setting.

How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?

ED nurses thrive with stress. The experiences that we have had in the ED made us who we are now—caring and strong nurses. It is necessary for an ED nurse to be able to manage the stress of the job—not everyone can handle what we see and do every day.

Stress can be overwhelming in the ED. I had to figure out what worked for me so that it would not have a negative effect on me when I go home to my husband and children. If I have a particularly stressful night, I go home and sit in my driveway for 5 to 10 minutes and listen to music to calm me down and help me relax.

What are the biggest challenges of your job?

The most significant challenge that we face in the ED is accommodating everyone, even those who should be seeing their primary physicians for their health problems. Because of lack of health insurance, a significant number of people continue to crowd the ED for these non-emergent health problems.

Another challenge we are seeing is related to the narcotic epidemic. It is challenging to see so many people, especially young ones, losing their lives to this problem. Witnessing and dealing with the family and friends of these victims is heart-wrenching.

It is always a challenge for ED nurses to try to make patients who are asked to wait in the ED waiting room understand that there are others who are sicker than they are. Patients who are brought back to a room as soon as they arrive usually have signs of a life-threatening condition that with even a little delay may bring an adverse outcome.

What are the greatest rewards?

I feel privileged every time we save a life in the ED. Helping people and witnessing positive changes happen—a heart regaining its rhythm after a standstill or long pause, or when a blue and cyanotic face turns pink and the chest starts to move up and down—are rewarding experiences that fuel us despite a hectic and tiresome day.

When a patient’s family hugs me and thanks me for an excellent job, I feel all my aches and pains disappear. Those sincere appreciations are all it takes to alleviate the rigor of a busy day in the ED.

What would you say to someone considering this type of nursing work? What kind of training or background should he or she get?

It takes a particular breed of a nurse to thrive and be successful in the ED. Some nurses first start in a medical or surgical unit before considering moving to the Emergency Department. Persistence and determination are critical. Things may be difficult at the start, but it will get better as they become familiar with the art of emergency nursing.  Becoming an ED nurse requires patience and a lot of receptiveness to learning—we deal with a wide range of specialties. Even though I have been an ED nurse for nine years, I still learn every day.

Is there anything else about being an emergency nurse that is important for people to know?

We believe with great conviction that we can make a difference to someone’s life every time we provide care. If someone has to wait in our waiting room, I hope they know that is often because we may be saving someone from the brink of death and that we will take care of them as soon as we can.