“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

“What is it like to be a Correctional Nurse?” —The DailyNurse Podcast

Part Three of a Three-Part Series

Sherry Cameron, a medical recruiter for correctional facilities across the US, recently wrote a post for DailyNurse as the first part in this Three-part series. (For part Two, see What to Expect as a Correctional Care Nurse). Now, she’s starring in the latest DailyNurse podcast, “What is it like to be a Correctional Nurse?”

Sherry Cameron, correctional facility recruiter for CoreCivic

Nurses in correctional facilities work so closely with other members of the healthcare team that Sherry describes it as a “family-oriented environment.” Often looking after inmates who have never received regular medical care, these nurses perform the usual nursing tasks such as administering medications, blood sugar checks, and tending to injuries incurred in the kitchen or carpentry shop.

Also, correctional facilities offer the opportunity to experience one of the most gratifying aspects of nursing. Corrections nurses act as educators for people who have rarely had any sort of relationship with a healthcare provider. Sherry recalls, “one nurse said to me that ‘it’s a very special moment when you see a patient come to tears because someone took the time to finally talk with them and educate them about their health.’ That to me is a true nurse at heart”.

In this episode of the DailyNurse podcast, you will hear Sherry discuss the character traits that she looks for in potential correctional nurses, the concerns they have when they first consider a career as healthcare providers in a correctional facility, advice for those interested in correctional nursing, and much more.

Certification is not required to be a nurse in correctional facilities, but getting certified always helps! Visit the National Commission on Correctional Healthcare to learn more about the field, and for details on how to become a Certified Correctional Health Professional [CCHP-RN].

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Nurse Practitioners Honored This Week

Nurse Practitioners Honored This Week

The week of November 10-16 is National Nurse Practitioner Week, the annual recognition of the vital contributions of nurse practitioners (NPs) nationwide.

Providing Much-Needed Access to Primary Care

For over 50 years, Nurse Practitioners have been championing the needs of patients. In fact, “Patients are benefiting now more than ever from the comprehensive, patient-centered health care services NPs provide,” said Sophia L. Thomas, DNP, APRN, FNP-BC, PPCNP-BC, FNAP, FAANP, president of American Association of Nurse Practitioners (AANP).  “At a time when millions of patients in our country lack access to primary care providers in their own communities, Nurse Practitioners are growing the capacity of our health care workforce to meet patient demand and challenging regulatory roadblocks that prevent patients from choosing NPs as their health care provider.” 

In every state, NPs assess patients, order and interpret tests, make diagnoses and provide treatment – including prescribing medications. Further, Nurse Practitioners can be found in clinics, hospitals, emergency rooms, urgent care centers, nursing homes and private practices nationwide. As clinicians that blend clinical expertise with an emphasis on disease prevention and health management, they also bring a comprehensive perspective to health care and are the health care provider of choice for millions of patients.

Serving 1.6 Billion Patient Visits a Year

“In the next decade, seniors will outnumber kids for the first time ever. Health care provider shortages are a growing concern, yet the growth of the NP role is addressing this challenge head-on. The faith patients have in NP-provided health care is evidenced by the 1.06 billion patient visits made to Nurse Practitioners annually,” said Thomas. “NP Week helps to educate patients about their choice in health care providers, and to create awareness of the many services NPs provide that enable patients to access excellent care, no matter where they live.”

To help strengthen public awareness of NPs, the American Association of Nurse Practitioners has created We Choose NPs (WeChooseNPs.org), a national multi-media public awareness campaign integrating television, radio, digital, and in-person events that reach communities nationwide.  The campaign provides useful information about patient choice, the importance of finding a primary care provider and the critical roles NPs play in patient health. 

The “Voice of the Nurse Practitioner”

AANP is the largest professional membership organization for NPs of all specialties, representing the interests of the more than 270,000 licensed NPs in the U.S. As The Voice of the Nurse Practitioner®, AANP provides legislative leadership at the local, state and national levels, advancing health policy; promoting excellence in practice, education and research; and establishing standards that best serve patients and other health care consumers. For more information about NPs and to locate one in your community, visit WeChooseNPs.org.

SOURCE: American Association of Nurse Practitioners

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Anti-Vaxx: a Sane Perspective on a Crazy World

Anti-Vaxx: a Sane Perspective on a Crazy World

The anti-vaccination (“anti-vaxx”) movement is a global phenomenon that has received a great deal of press, but how much do we really know about it? How do educated adults come to turn against medicines that have been saving literally millions of lives since the early days of smallpox inoculations?

Doctors prepare to vaccinate an infant.

One partial explanation is offered by health policy reporter Stuart Lyman. In a February column for STAT, he writes, “The [pharmaceutical] industry has been engaging in bad behavior for several decades, and these self-inflicted wounds have turned much of the public against it…” After reciting a horrifying litany of pharma-company scandals the public has witnessed, he concludes, “All of this has contributed to the prominent anti-pharma themes voiced by the anti-vaxx crowd.”

Anti-Vaxx is No Longer In Its Infancy

But “the anti-vaxx crowd” shows no signs of giving up their crusade anytime soon. From their original focus on parents of autistic children, they have proceeded to target orthodox Jewish communities and recently bereaved parents. Perhaps the most influential US group behind anti-vaccine campaigns is ICAN (Informed Consent Action Network). According to the Washington Post, ICAN, founded by former daytime television producer Del Bigtree, is largely funded by New York city philanthropists Bernard and Lisa Seltz, who have contributed $3 million since joining in 2012.

Lisa Seltz now serves as ICAN president, and continues to fund the organization’s message that the government and “Big Pharma” are colluding in a massive coverup regarding the hidden dangers of vaccines. Robert F. Kennedy, Jr, a nephew of the late president, runs Children’s Health Defense, his own anti-vaxx organization, and another flush-with-cash group, The National Vaccine Information Center, is run by Barbara Loe Fisher (who claims her son’s learning disabilities were the result of a 1980 DPT shot that was followed by “convulsion, collapse and brain inflammation within hours”).

Some Quick Tips from NSO’s Georgia Reiner

Considering that these wealthy and powerful organizations are finding fertile ground in today’s conspiracy-minded culture, DailyNurse interviewed Georgia Reiner, a risk specialist for Nurses Service Organization (NSO), to request a few tips for nurses who find themselves confronted by this strange controversy.

DailyNurse: What are the actual dangers posed by the anti-vaxx movement?

GR: It is important to state up front that the vast majority of people do vaccinate. However, the anti-vaccination movement has gained a lot of attention and helped foment outbreaks of largely preventable diseases that can be deadly. The anti-vaxx movement spreads misinformation and conspiracy theories online on social media, and by word-of-mouth in tight-knit, culturally isolated communities.

Anti-vaxx propagandists have helped to create pockets of unvaccinated people, which have contributed to public health issues like the measles outbreak seen recently in Orthodox Jewish communities in New York and New Jersey. These outbreaks of highly contagious diseases such as measles put vulnerable people, including newborn babies and people who have weakened immune systems, at great risk.

Outbreaks also distract and divert resources from other important public health issues, and cost state and local governments millions of dollars to contain. However, nurses are in an ideal position to counter this messaging.

DN: What are nurses doing to counter the anti-vaccination movement?

GR: Nurses are a trusted source of credible information and can have tremendous influence over the decision to vaccinate. This is true even for parents who are vaccine-hesitant. Working on healthcare’s front lines, nurses can help inform families about vaccinations and the role they play in keeping their children healthy and stopping the spread of disease. Nurses can also learn about questions parents may ask about vaccines, and how to effectively address common concerns.

DN: How can nurses cope with anti-vaxx parents?

GR: First, nurses should assume that parents will vaccinate. Research has shown that when healthcare providers use presumptive language, significantly more parents accept vaccines for their child. Then, if parents are still hesitant or express concerns, nurses should work with the treating practitioner to convey the importance of vaccines.

Nurses should listen to parents’ concerns, work to understand why they are questioning the science, and respond respectfully. Provide parents with information about vaccines and vaccine-preventable diseases, both verbally and in writing. Document parents’ questions and concerns.

If parents still decline to vaccinate, the parents should sign a Refusal to Vaccinate form. Parents should sign a new form each time a vaccine is refused so there is a record in the child’s medical file. To minimize potential legal exposure, nurses should document all discussions, actions taken, and educational material provided.

For further information, visit the American Academy of Pediatrics site document “Countering Vaccine Hesitancy.”

Frontier Nursing University Wins Second Consecutive HEED Award for Excellence in Diversity

Frontier Nursing University Wins Second Consecutive HEED Award for Excellence in Diversity

INSIGHT Into Diversity magazine has just recognized Frontier Nursing University’s commitment and accomplishments for the second consecutive year. FNU has now added the 2019 Health Professions HEED (Higher Education Excellence in Diversity) award to their shelf alongside their award from 2018.

INSIGHT Into Diversity magazine's 2019 HEED Awards
About the Health Professions HEED Award

“The Health Professions HEED Award process consists of a comprehensive and rigorous application that includes questions relating to the recruitment and retention of students and employees and best practices for both; continued leadership support for diversity; and other aspects of campus diversity and inclusion,” said Lenore Pearlstein, co-publisher of INSIGHT Into Diversity magazine. The magazine is the oldest and largest publication on this topic in higher education and is well-known for its annual Higher Education Excellence in Diversity (HEED) Awards.

Pearlstein adds, “As we continue to see a record number of Health Professions HEED Award applicants each year, nearly every school tells us they use the application itself as a tool to create new programs and to benchmark their accomplishments across campus. The process allows them to reflect on their successes and also determine where more work needs to be done. We also continue to raise the standards in selecting HEED institutions.”

Diversity Impact at Frontier Nursing University

FNU’s history of emphasizing and valuing inclusion was formally instituted nine years ago, when it instituted the Diversity Impact Program in 2010. Each summer, FNU holds the Diversity Impact Conference for nurse practitioner and nurse-midwifery students plus faculty and staff to foster collaborative discussions, address health disparities, and find proactive solutions to improve minority health among underrepresented and marginalized groups.

FNU’s diversity initiatives span all facets of the university, but one of the most telling and important data points is the percentage of students of color enrolled at FNU. In 2009, that number was 9 percent. In 2019, it has grown to 23 percent.

“We are incredibly proud to receive the prestigious HEED Award again this year,” said FNU President Dr. Susan Stone. “To receive this award two years in a row is a wonderful honor. Our graduates serve people of all races and cultures and are increasingly coming from diverse backgrounds. It is imperative that our students, faculty, and staff have cultural awareness and competency in order to effectively advance our mission. The HEED Award confirms the value of our efforts and validates our continued emphasis on diversity and inclusion within the culture of FNU.”

INSIGHT Into Diversity Magazine

INSIGHT Into Diversity magazine is the oldest and largest diversity publication in higher education today and is well-known for its annual Higher Education Excellence in Diversity (HEED) Award. In addition to its online job board, INSIGHT Into Diversity presents timely, thought-provoking news and feature stories on matters of diversity and inclusion across higher education. Articles include interviews with innovators and experts, as well as profiles of best practices and exemplary programs. Current, archived, and digital issues of INSIGHT Into Diversity magazine are available online at insightintodiversity.com.

For further information on Frontier Nursing University and the Health Professions HEED Award, visit the FNU site.

Palliative Care Nursing: Inner Strength and Moral Distress

Palliative Care Nursing: Inner Strength and Moral Distress

Alexander Wolf, author of the study Palliative Care and Moral Distress.
Alexander Wolf, DNP, RN, APRN, author of Palliative Care and Moral Distress, a study of moral distress among critical care nurses.

Palliative care nursing mainly revolves around enhancing the quality of life of seriously ill patients and their families during life-sustaining treatment and at the end of life. Whether or not they have been trained in palliative care, critical care nurses frequently have patients who are in need of such care. How prepared do they feel?

Or, what happens when critical care nurses encounter a lack of palliative care for their patients, or find themselves in circumstances that run counter to their precepts of care-taking? Alexander Wolf, DNP, RN, APRN has published a paper on nursing, palliative care, and the impact of “moral distress” on critical care nurses. DailyNurse conducted an interview with Dr. Wolf to discuss his paper and its findings.

DailyNurse: What are some examples of palliative care nursing practices a critical care nurse might perform?

Alexander Wolf: Critical care nurses are regularly tasked with assessing and managing the distressing physical, psychological, and spiritual symptoms of critical illness.  Those of us who are palliative care specialists can benefit from critical care nurses’ insight into patient/family dynamics, psychosocial situation, and cultural background. 

In addition, these nurses frequently have a difficult job of bearing witness to suffering, providing a therapeutic presence in difficult circumstances, and employing two-way communication skills to help determine the treatment goals of the patient and family.  These nurses must also be adept in ethical and legal aspects of care, for instance. They also need to be able to help interpret patients’ advance directives and to advocate for the wishes that patients have outlined, when appropriate. 

Critical care nurses are also instrumental in providing expert, compassionate end-of-life care in the intensive care unit, which may involve the careful withdrawal of life-sustaining treatments such as dialysis and mechanical ventilation.  This often requires thoughtful preparation and culturally sensitive communication with patients and family members, and skilled symptom management throughout the dying process.

DN: What is the phenomenon of “moral distress” that affects many palliative care providers?

AW: Nurses and other providers frequently report episodes of moral distress, in which an individual identifies the morally correct action to take, but feels unable to take it due to some type of constraint.  Helplessness or frustration are just a few of the many emotions that an individual might feel as a result — others might include outrage or guilt, among others. 

“Critical care nurses tend to experience frequent and intense moral distress in situations pertaining to the end of life, such as providing treatment perceived as inappropriate or futile, prolongation of life or death and lying to or withholding information from patients or family members.”

Alexander Wolf, Palliative Care and Moral Distress, Critical Care Nurse, Vol. 39.5, October 2019

Previous studies have also indicated that these feelings don’t seem to entirely go away either.  “Moral residue” often remains, and repeated episodes of moral distress often remind an individual of the previous episodes, causing their distress to intensify.  As a result, an individual may try to protect themselves by avoiding or withdrawing emotionally from ethically challenging situations, or by quitting their job. 

DN: Is palliative care training appropriate only for certain providers?

AW: Palliative care has evolved so much in recent years — it is no longer solely a subspecialty — now it is an important skill set for all healthcare providers, including nurses and physicians.

In addition, there is a continued shortage of specialists relative to the number of patients with palliative care needs. This really underscores the importance of nurses and other healthcare providers to be proficient to provide basic palliative care.  In 2014, the National Academies of Medicine recommended taking measures to improve the palliative care knowledge base of all clinicians. 

Numerous medical professional societies recommend timely access to palliative care, including for patients in the intensive care unit, but the lack of provider training remains a significant barrier.  Our study indicates that many critical care nurses have not had much palliative care education, so we still have to work hard to better prepare nurses to meet patients’ care needs.

DN: Ideally, what changes would you like to see result from your study?

AW: There are many changes we would love to see, but here are a select few.

Bedside nurses — particularly those who have had palliative care education — need to be empowered as leaders for integrating palliative care in their practice environment. They would be in an ideal position to educate their peers and interprofessional team members.  We need to better recognize nursing excellence.  Physician and nurse leaders need to collaborate to ensure that bedside nurses have a voice when they feel their patients’ needs are not being met.

The critical care nurses in our study seemed to highly value palliative care, but few felt highly competent, and even fewer reported having any recent education in palliative care.  Many nursing programs have done a great job in recent years to include palliative care in school curricula and in student clinical experiences, but it cannot just be “squeezed in”.  There is clearly still a lot we need to do to integrate palliative care as a key competency area for nurses across specialties, particularly in critical care.

“Nearly half of respondents [in this study] rated themselves as not competent or somewhat competent in knowledge of advance directives, living wills, and do-not-resuscitate order policies. Previous studies have illuminated knowledge gaps among acute and critical care nurses in this domain…. Given the legal and ethical implications, this knowledge gap should be a key focus of palliative care education initiatives…”

Wolf, Palliative Care and Moral Distress, Critical Care Nurse, Vol. 39.5, October 2019

Additionally, the nurses in our study placed a high value on interprofessional collaboration.  In continuing education for nurses it would be wise to be inclusive of other healthcare professionals. This could help foster increased recognition of patients’ palliative care needs by all team members.

For more information on Critical Care Nurse and the AACN, visit http://ccn.aacnjournals.org/.

Thanks are extended to Alexander Wolf, DNP, RN, APRN, Nurse Practitioner, Palliative Care, at TriHealth

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