Established in April 2006, Transplant Nurses Day was created by the International Transplant Nurses Society (ITNS) in order to raise awareness about the tremendous contributions that transplant nurses make in the lives of their patients and the people with home they work. It’s held every third Wednesday in April—this year on April 19.
“The celebration recognizes the skill and commitment of transplant nurses around the world,” says Allison Begezda, senior marketing manager, ITNS. “Transplant Nurses Day is an opportunity to celebrate the contributions our nurses make to patient care, patient and public education, nursing research, and the profession of nursing.”
As part of the Transplant Nurses Celebration, ITNS holds an annual Transplant Nurses Day essay contest. They ask transplant patients to nominate their ITNS Transplant Nurse. This year’s theme was “My Transplant Nurse: Champion of Care,” and six patients submitted essays for consideration.
There are many types of transplant nurses, including transplant coordinators, surgical nurses, post-operative care nurses, research nurses, and more.
ITNS honors its nurses in other ways besides just on Transplant Nurses Day. The society also honors its members each year with two awards that are presented at the Transplant Nursing Symposium.
As Begezda says, with the Transplant Nursing Excellence Award, ITNS “recognizes that the role of the transplant nurse is unique and dealing with patients through the transplant continuum is often complex and challenging. ITNS recognizes a special nurse whose career has exemplified ITNS’s mission: ‘…promotion of excellence in transplant clinical nursing through the provision of educational and professional growth opportunities, interdisciplinary networking, collaborative activities, and transplant nursing research.’ The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
With the Friend of Transplant Nursing Award, ITNS “wants to recognize a friend of the organization who has made an impact in the field of transplant nursing. ITNS recognizes that you do not need to be a nurse to make a difference. The purpose of this award is to recognize an individual outside the nursing profession who has supported the efforts of ITNS and made an impact in the field of transplant nursing.”
This year’s symposium will be held June 24-26. For more information, go to www.itns.com.
Orientation or preceptorship is the introduction to your new career and job and may be long or short in duration. Depending on the area in which you are working, it may encompass several days of classroom learning followed by unit orientation. If you are expected to float, you may also be expected to orient on several different units. No matter the length of orientation, there are several things you can do to make your orientation as smooth an experience as possible.
- Know prior to your first day what type of uniform to wear or the organization’s dress code, what time to show up, where to show up, and what supplies to bring.
- Many areas of nursing, particularly subacute and rehabilitation, may expect you to bring your own thermometers, blood pressure cuffs, and pulse oximeters. Question whether this is the case in your work area.
- Have access to unit specific (i.e. medical surgical) information, skills instructions, and patient drug information in case your facility does not have skills, policies, procedures, and other resources online.
- Complete all necessary paperwork and/or online educational offerings as required.
- Review a unit specific text. This will help to refresh your member on basic concepts.
- Review your nursing skills text.
- If your facility uses electronic medical records, you must still be aware of how to properly author a narrative note and what information is important to include in your documentation. Review documentation guidelines.
- Consider adding an application to your cell phone to access key references. Be aware, however, that some institutions will not allow you to access your phone during work time
Meet and Greet
- Arrange to meet your preceptor (and some of your fellow staff) prior to the start of your orientation or work experience. When you return for your first day of work, seeing a familiar face will help to reduce your stress level.
- Take the time prior to your first day to meet with the staffing coordinator. Obtain a copy of your schedule. Negotiate for any days off you are aware of needing for preplanned vacations, school, or other circumstances.
- Seek out new learning opportunities. It can be a way to introduce yourself to other members of the team.
- Practice good communication. Be an active listener.
- Inquire whether you will be orienting on the same unit and on the same shift. New nurses are often moved from unit to unit during orientation to learn in multiple areas and from multiple nurses.
- If you are moving throughout the facility during orientation, be sure that you will be with one nurse during that time on a specific unit. If you are inconsistently supervised by your preceptor, the documented or actual outcome may not be ideal or fair.
- If your preceptor takes time off during the preceptorship, your orientation may not go smoothly. If his or her time off is excessive (say a week or more), inquire whether you may be assigned another preceptor.
- If you are off an excessive number of days, you will not have a complete orientation and may be ill prepared to work. Plan your vacation accordingly and give yourself plenty of time and opportunity to complete orientation.
- Be honest about your limitations, your skills ability, and your knowledge base. Think about enrolling in an RN refresher course prior to your job search. Make your preceptor aware of any limitations in skill level so that they can be addressed during orientation.
- Don’t perform nursing care outside your scope of practice. Know your limitations with regard to what you have been taught and basic nursing practice.
The preceptorship of a nurse or student has far-reaching effects, influencing everything from the safety of the patient, to the quality of care the patient receives, and the employment, retention, and job satisfaction of the new nurse. The preceptorship experience will be remembered long after the preceptee has left the facility. How the preceptor conducts both himself or herself and the orientation period will not only influence how the preceptee feels about the profession of nursing for years to come, but the quality of care his or her future patients receive.
Listed below are behaviors attributable to an ineffectual nursing preceptor. If you notice that they reflect your teaching style, then take advantage of preceptor education. Recognize that these behaviors can be changed and that the most successful preceptors do not exhibit these qualities. You are an ineffectual preceptor if:
- You are unclear about the goals of orientation.
- You do not ascertain the preceptee’s skill and knowledge level prior to the start of orientation.
- You do not question the preceptee to determine if there are any patient care areas in which he or she feels weak.
- You do not introduce the preceptee to fellow team members and do not help the preceptee feel like part of the team.
- You do not orient the preceptee to the unit so that he or she does not know where items or located or typical procedures to follow.
- The goals and expectations for orientation are unclear and are not stated in writing.
- The goals you establish are not measurable or achievable.
- You do not review the goals for the day or for orientation with the preceptee.
- You are inconsistent in your communication style.
- You do not allow the preceptee time to practice skills prior to attempting them.
- You do not build new skills upon current skill level.
- You delegate to the preceptee beyond his or her skill level.
- You do not seek out new learning experiences for the preceptee but instead allow the preceptee to find learning situations on his or her own.
- You fail to provide guidance in the completion of a new skill, assessment, or other nursing function.
- Your clinical skills and technique are not evidence-based or correct; you take shortcuts to save your time but in doing so may unknowingly endanger the patient. You pressure the preceptee to perform these skills as you do.
- You leave the preceptee to do the work that other staff do not wish to complete.
- You are continually rude to the preceptee, fellow staff, families and patients.
- You allow the preceptee to experience a lot of “down time,” for example by allowing him or her to “hang around” the nurses’ station rather than engaging in patient care or learning new skills.
- You frequently cancel scheduled meeting times with the preceptee, the unit manager, the unit educator, or faculty members, therefore fallowing communication to break down among all parties.
- You allow the preceptee to be utilized as staff prior to the end of preceptorship.
We know about the dangers of opioid prescriptions: A recent study linked opioid addiction to just one encounter with opioids for pain control, usually prescribed in an emergency department. (To learn more about safe opioid prescription medication patient teaching, read an article here.) The question is, how can you effectively manage pain without opioids? Pain requires frequent assessment and the setting of realistic expectations by a patient and his or her care team. Patients need to know that although it may not be possible for them to feel entirely pain-free, they are still entitled to some level of pain control. Below is a review of non-pharmacological methods for controlling your patients’ pain.
Heat it up or cool it down. Many of us neglect the value that a hot blanket or heating pad or a cold pack or bag of ice can have on our patients’ pain. It may not help with their chronic pain, but for acute pain, applying heat or cold can be very effective. Just monitor the patient’s skin for any burns or skin irritation at the site, and leave heat or cold on for no longer than 15 minutes at a time.
Guided imagery or relaxation. There are several guided imagery scripts you can find online that you can run through with a patient or even print off and hand to a family member at the bedside. Several institutions have caring or healing patient channels that provide relaxing music or imagery exercises.
Distraction. Can you help your patient turn on the TV, or bring them some magazines or books? When patients are lying in a bed with nothing to focus on but their pain, their perception of the pain can increase. Try to distract the patients with music, TV, art therapy, or books. These methods can help a patient alter their perception of pain.
Promote rest. Make sure your patients can get plenty of sleep. We all know that the hospital is ironically one of the worst places to get a good night’s sleep, but sleep deprivation decreases the patient’s pain threshold and increases their stress response. Excessive stimuli should be reduced for patients as much as possible, so take care to eliminate excess noise by closing doors, adjusting the room temperature, and decreasing harsh artificial lighting.
Fed is best. If your patient is able to eat, ensure they are getting adequate nutrition and enough food to feel full. Hospital food can be notoriously unappetizing, but a feeling of hunger can also exacerbate patient perception of pain. If possible, suggest to family or friends that they bring some favorite snacks or meals for the patient to enjoy.
Advocate. Frequent assessment and evaluation of patients’ pain and their response to pain interventions is crucial for our patients. Be sure you are re-assessing frequently and advocating to the physician if you feel that pain is being inadequately managed.
Janine Do* is a globetrotter, and nursing is a career that meshes perfectly with her wanderlust. With a BA in Psych and an MA Psychology already under her belt, Janine decided to go for first an AA, then a BS in Nursing after working abroad during her summer vacations. Currently an RN working in postpartum for a well-regarded hospital in Southern California, Janine is on her way back out into the world and agreed to talk to us about her unique approach to her career. If you’ve ever thought about taking a nursing career on the road, maybe Janine’s experience will inspire you.
Janine, you worked in orphanages and group homes in Costa Rica the summer after finishing your bachelor’s degree, and you volunteered in Haiti for a month while you were a nursing student. Do you feel like these experiences planted the seed for you to want to work in more developing areas, or is it the other way around?
I have always been drawn to helping professions as I really love helping people. Right before I graduated with my master’s degree, their Costa Rica program was created. I went on the first year as a student and then went back as a teaching assistant to the professor the other two times.
The Costa Rica trip/field study really impacted me, and I just knew that from then on I had to work in developing countries. My professor also greatly shaped my interest in international work.
What was it that pulled you from psych to nursing?
Initially my goal was to get my PhD in psych, but as I was getting my master’s and thought about it more and more, I thought it would be a good combo to cover both mental and physical health. Also, the medical world seemed a bit easier in some ways in terms of being able to work anywhere, not that you can’t with psychology, but there tends to be more cultural complications/interpretations with psychology when going into other countries.
Do you feel like your psych training has affected your approach to nursing?
Definitely! Both the formal schooling and the fieldwork have greatly impacted my nursing. I think I have a wider perspective when interacting with patients and families and am able to think about how mental health can affect physical health and vice versa. The two are so interrelated that it’s hard to separate them.
I think most people trained just in the medical world often only think of the physical problems when mental health is a huge factor. My work with children with developmental delay was mainly conducted in home settings, which allowed me to be comfortable in a wide variety of environments (sometimes crazy ones!).
Now that you’ve been working in SoCal hospitals for three years, what elements of the developing nations opportunity are calling you away from a stable job in a sterile environment?
Good question! This might be hard for me to summarize in words. I just feel drawn to work with people in impoverished situations. Not that I don’t make an impact at the hospital I’m working at now, but I feel like I can make a bigger impact by getting out in the world.
You’re hoping to apply for Doctors Without Borders soon. What was it about this particular organization that attracted you in the first place?
Honestly, initially I just thought it sounded cool before I even knew much about it. I knew they did work in many developing countries, and it seemed like a well-respected humanitarian organization. I have always believed that every human, no matter their background, is deserving of proper medical treatment and care, and MSF (Médecins Sans Frontières – Doctors Without Borders in French) was a way I thought I could actively be involved in that. It just sort of became my goal when I decided to switch career paths to the medical world.
I have always enjoyed working with children, and now I am a postpartum RN, which I enjoy because I work with not only babies but also the entire family unit. The majority of MSF’s patients are women and children.
Doctors Without Borders requires three years of nursing experience in a hospital setting before you can apply—is that correct? Was that the only reason you pursued working in a U.S. hospital?
Yes, that’s correct—three years of experience. Initially it was two years of experience, but they recently changed it to three years (not sure exactly when that change occurred), but this wasn’t my only reason for working here. I thought it would be a good idea to get a solid base regardless of what I ended up doing. I also think it’s always a good idea to see both sides of the spectrum—our facilities, training, education, etc. are high quality, so I thought it would create a good foundation before experiencing the medical world in a developing nation.
Based on your schooling and personal research, do you feel like nursing with relief and aid organizations is a career option for nurses that offers a real future? How would you characterize its benefits?
What do you mean in terms of a “real future?” Being able to support oneself? I guess it just depends on what people want out of life. It’s definitely not the area to go into for making a lot of money. It’s sustainable, but it provides for a simple life.
I think the overall benefits are slightly different than working in a typical hospital. You don’t have the monetary factor, and I think that people who are drawn to aid organizations are hoping to make a stronger impact on the world (not that U.S. hospital nurses don’t).
Do you know personally of any resume benefit aid/relief nursing has when applying for more mainstream positions?
I think in any job these days, management likes to see a variety of experiences—and not just a variety, but unique experiences. Being able to work in a very uncontrolled environment with minimal supplies and with a culturally diverse group of people is a nice skill set to have. Being adaptable is also a huge asset!
Interested in knowing more about Doctors Without Borders? Click here to read about their requirements for fieldwork!
*Ms. Do’s name has been changed out of consideration for the fact that she describes career aspirations here beyond her current position.
With the aging baby-boomer population, one of the largest patient populations a nurse will encounter in the field is the geriatric population. Care of elderly people presents several significant challenges, especially patients with impaired communication or cognitive status deficits. It takes a special health care team to give this unique population the care that they both need and deserve. Here are five tips to keep in mind that will help you provide the compassionate and competent care they are hoping to receive.
1. Meet the patient where they are.
Cognitively speaking, many geriatric patients are not completely intact. They may experience confusion, disorientation, or even delusions and hallucinations. Providing competent and compassionate care requires that you assess the patient for these deficits before providing care. Educate your aides about what a patient’s deficits are so that they can provide the best care possible. While you may be able to successfully reorient some patients, others are not able to be reoriented. These patients may require you to be understanding and compassionate of their orientation level, choosing not to challenge their beliefs and assumptions while providing care. If the patient is calm and relaxed in their disorientation, it may be a safer place for them than if you were to challenge these beliefs.
2. Assess for sensory deficits.
A patient who cannot hear or see well may become agitated when care is being provided simply because they do not understand what is going on. Imagine resting peacefully in bed with your eyes closed and having someone start to roll you or manipulate your body…what sort of reaction would you have? You would probably be startled and attempt to fight back. Taking the time to gently notify the patient that you will be providing care, and making the attempt to communicate through words, motions, or even written words, will help the patient be comfortable and confident in what to expect as you provide care. If the patient normally wears glasses or hearing aids, make sure they are in place before you start. The more a patient feels in control, the better their experience will be.
3. Engage with the patient.
Most health care professionals and ancillary staff know what it feels like to be overwhelmed and exceptionally busy. It often feels like there is little time to stop and converse with our patients before we need to move on to our next task. For a patient who is alone in a room all day, however, a bit of conversation may be what they are craving. Take a few moments before leaving the room to show interest in the patient. Be empathetic if they need to talk or complain. Do not patronize or assume they have little to offer conversationally. Many of these patients have so much to say and great stories to share…you may even learn something surprising about them! A few minutes of genuine, engaged conversation may be the bright spot in that patient’s day and it takes so little of a nurse’s shift, and is certainly worth the effort it takes.
4. Manipulate the environment to enhance comfort.
Harsh lighting and loud noises can be frustrating or even upsetting to patients with sensory deficits. If a patient seems resistant to care and easily upset, try altering the environment by decreasing background noise, eliminating distractions, and providing distance between yourself and the patient when you speak. These simple interventions may seem inconsequential but can be very effective in calming an anxious or agitated patient.
5. Involve the patient in their care.
Perhaps the biggest complaint you will hear from geriatric patients is that they feel they aren’t kept informed about what is going on with their health care. Whether it is a cognitive deficit, communication barrier, or perhaps even a lack of education to understand terminology, the geriatric population often feels powerless over the care they are receiving. Nurses can help this situation by taking time to ask their patients what they understand of their diagnosis and plan of care. Do not assume that they don’t have an interest in what is going on. Allow them to be front and center in their course of treatment by educating them at their level of understanding. Make sure they have an opportunity to ask questions. If they are able to read, written materials can go a long way in helping the patient to understand what is happening to them.
As nurses, we want to empower our patients and give them a positive experience. The geriatric population certainly presents challenges to providing our best care, but by incorporating some of these simple interventions you will likely make a big difference in the patient’s perception of their care.