Certified Nurses Day is here again! In honor of this special day, DailyNurse interviewed Matt and Jesse Malone, a pair of married CCRNs whose shared nursing experience included working together on their certification.
How did you meet?
Matt: We first met early in my nursing career in 2005. I was working in the emergency department at Inspira Medical Center in Vineland, N.J., and Jesse was shadowing a fellow nurse and mutual friend, Jane, to see if nursing was for her. Over the years we crossed paths a few more times, until I finally got the nerve up to ask her out on a date in 2010. We have been inseparable ever since. We were married in 2012 and now have two sons, Trevor and Bryce.
Did you decide to work toward your certification at the same time–or did you take turns? And how did that decision work out?
Matt: One summer day in 2017, Jesse brought home a flyer about a CCRN prep course being held in the fall. We had been talking about taking the exam for quite some time. A few days later, on my birthday, we found out we were pregnant with our first son, Trevor. That flyer was still on the counter and literally the next day, we said either we buckle down now and do this or it will be a long time until we get another chance to give it the preparation it deserves.
Jesse: That’s exactly what we did. Study, OB appointments, study, furnish the nursery, study, discuss baby names… it was a blur. We can’t forget our dog Rocco. He was a big help, serving as our practice patient from time to time. After listening to us for months, we joked he should sit for the test as well.
At 20 weeks, we wrapped up our own studying, attended a three-day prep course, and sat for the exam at the same time. We went into it promising each other if one of us didn’t pass the first time that we would treat it like we both didn’t pass and keep studying together. Luckily we both passed on the first try!
What do you think are some of the benefits of being certified?
Jesse: One of the biggest benefits is the recognition that you are well versed in your area of specialty. Medical team members recognize the caliber of a person it takes to obtain national certification and respect your input on the care of the patient. It feels good when a physician specifically seeks you out in the ICU to ask questions.
Matt: Another large benefit is the doors it will open. Ever since I was an EMT before nursing school, I wanted to become a flight nurse. Most programs will not even schedule you for an interview until you are nationally certified. They recognize that it puts you one peg higher. It confirms you know the care needed to take care of the most critical patients. Thanks in part to my CCRN certification, I have been working my dream job as a flight nurse since 2018 and loving it.
What advice can you offer to nurses considering certification?
Jesse: Go for it! Yes- it’s
scary, yes, it is time consuming, but it will all be worth it in the end. Do
not let the material overwhelm you and get a study buddy if you can to prepare
with you. Hardly anyone is an expert in every part of the content on those
exams. Recognize your strengths, but even more important your weaknesses. Key
in on those areas and improve your scores.
Matt: Exactly… recognize areas where you need to beef up your knowledge and keep tackling practice questions. Honestly, one of the biggest benefits in preparing for the CCRN exam was the fact we both agreed we became better nurses because of it. Brushing up our skills in those weak areas truly has made both of us better nurses.
How will you celebrate Certified Nurses Day?
Matt: Certified Nurses Day will be the perfect day to cash in on the massage gift cards (with babysitting included J)my mother gave us for Christmas. Every so often, it is important to take a few minutes to relax and unwind. Otherwise, you won’t be at the top of your practice for your patients, coworkers, family, or yourself.
For more information about Certified Nurses Day, visit here.
As the U.S. battles to limit the spread of the highly contagious new coronavirus, the number of health care workers ordered to self- quarantine because of potential exposure to an infected patient is rising at an exponential pace. In Vacaville, California, alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.
Across California, dozens more health care workers have been ordered home
because of possible contagion in response to more than 80 confirmed cases as of
Sunday afternoon. In Kirkland, Washington, more than a quarter of the city’s
fire department was quarantined after exposure to a handful of infected
patients at the Life Care Center nursing home.
With the number of confirmed COVID-19 cases mushrooming by the day, a
quarantine response of this magnitude would quickly leave the health care
system short-staffed and overwhelmed. The situation has prompted debate in the
health care community about just what standards medical facilities should use
before ordering workers quarantined — and what safety protocols need to become
commonplace in clinics and emergency rooms.
Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health
Security, is among those arguing hospitals need to change course.
“It’s just not sustainable to think that every time a health care worker is
exposed they have to be quarantined for 14 days. We’d run out of health care
workers,” Nuzzo said. Anyone showing signs of infection should stay home, she
added, but providers who may have been exposed but are not symptomatic should
not necessarily be excluded from work.
The correct response, she and others said, comes down to a careful balance
of the evolving science with the need to maintain a functioning health care
While hospitals are supposed to be prepared for just such a situation, Nuzzo
said, their plans often fall short. “Absent any imminent public health crisis,
it may not be one of their priorities,” she said. From 2003 to 2019, federal
funding for the Hospital Preparedness Program in the U.S. was cut almost in half.
In Northern California, potential exposure to the new coronavirus was
exacerbated because hospitals were caught unaware by the community spread of
the virus and hampered by federal protocols that initially limited diagnostic
testing to patients with a history of travel to a country where the virus was
known to be circulating or contact with a person with a known infection.
“At the very beginning [of an outbreak] this will happen because you don’t
know patients are infected and you only realize later that people were
exposed,” said Grzegorz Rempala, a mathematician at the College of Public
Health at Ohio State University who models the spread of infectious diseases.
Now that the disease has started to spread through the community, any
patient with respiratory symptoms potentially could be infected, though health
officials note the likelihood remains low. As providers start routinely wearing
protective gear and employing strict safety protocols, accidental exposure
The Vacaville case offers stark insight into the fallout from the narrow
testing protocols initially established by the Centers for Disease Control and
Prevention. When a woman was admitted to NorthBay VacaValley Hospital with
respiratory symptoms on Feb. 15, dozens of hospital workers walked in and out
of her room performing daily tasks. Days later, as her condition worsened, she
was sent to UC Davis Medical Center, where dozens more employees were potentially
Because the woman did not meet the testing criteria in place at the time, it
took days for UC Davis to get approval to have her assessed for the
coronavirus. After the test came back positive, about 100 NorthBay workers were
sent into self-quarantine for 14 days. At UC Davis, an additional 36 nurses and
88 other employees were quarantined, according to the unions representing those
workers. (A spokesman for UC Davis said the figures were not accurate but
declined to give an estimate.)
“We’re not used to being concerned, before we even do the triage assessment, whether the patient is infectious and could infect hospital workers,” said Dr. Kristi Koenig, the EMS medical director of San Diego County. She said that thinking started to evolve during the 2014 Ebola outbreak. Hospitals should routinely mask patients who come in with respiratory symptoms, she said, given any such patient could have an infectious disease such as tuberculosis.
Yet providers don’t often think in those terms. “In many ways we’re spoiled
because we’ve gone from a society 50 or 100 years ago where the major killers
were infectious disease,” said Dr. Michael Wilkes, a professor at UC Davis
School of Medicine. “Now we’ve become complacent because the major killers are
heart disease and diabetes.”
Faced with this new infection risk, many hospitals are scrambling to retrain
workers in safety precautions, such as how to correctly don and doff personal
Sutter Health, which has 24 hospitals in Northern California, started
ramping up its emergency management system five weeks ago in preparation for
COVID-19. Before coming to the emergency room, Sutter patients are asked to
call a hotline to be assessed by a nurse or an automated system designed to screen
for symptoms of the virus. Those with likely symptoms are guided to a
telemedicine appointment unless they need to be admitted to a hospital.
Anyone arriving at a Sutter emergency room with signs of a respiratory
infection is given a mask and sequestered. “A runny nose and a cough doesn’t
tell you much. It could be a cold, it could be a flu, and in this weather it
could be allergies,” said Dr. Bill Isenberg, Sutter’s chief quality and safety
officer. A doctor or nurse in protective equipment — including N95 mask, gown
and goggles — is deployed to assess the patient’s symptoms. If COVID-19 is
suspected, the patient is moved into a private room.
Sutter has treated several coronavirus patients who arrived from Travis Air
Force Base, which housed evacuees from the Diamond Princess cruise ship
quarantined off the coast of Japan after an outbreak was detected on board. The
Sutter patients were placed in negative pressure rooms so that contaminated air
did not circulate to the rest of the hospital, and staff used an anteroom to
take off gowns and masks.
“We do everything humanly possible to minimize the number of people who have
to enter [the room],” Isenberg said. Still, he said, some workers have been
quarantined; Sutter would not disclose the total.
Not all hospitals are adapting so quickly. National Nurses United, a union
representing more than 150,000 nurses, recently held a news conference to call
on hospitals to better protect their workers. Of the 6,500 nurses who
participated in a survey the union circulated, fewer than half said they had
gotten instruction in how to recognize and respond to possible cases of
COVID-19. Just 30% said their employer has sufficient protective equipment on
hand to protect staff if there were a surge in infected patients.
As the virus continues to spread, hospitals should be stockpiling such
equipment, figuring out how to add beds and planning for staffing shortages,
said Dr. Richard Waldhorn, a professor of medicine at Georgetown University and
contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a
Hospitals should already be training providers to take on expanded duties,
Waldhorn said. If a hospital becomes overwhelmed, the Medical Reserve Corps can
be mobilized, as can networks of providers who have volunteered to aid in
emergency situations. Once workers have been infected and recover, it might make
sense to have them treat other coronavirus patients since they will have
Eventually, as a disease becomes widespread, quarantine simply stops being a
priority, said Nina Fefferman, a mathematician and epidemiologist at the
University of Tennessee-Knoxville.
“There’s a point where we stop trying to quarantine anyone and we just say,
OK, we’re going to have more deaths from the fire department not being able to
fight fire than from everyone getting the disease.”
This Kaiser Health News story first published on California Healthline, a service of the California Health Care Foundation. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.
With the ongoing online and television coverage of COVID-19, it can be hard to distinguish authoritative information from rumors, unsubstantiated statements, and sheer panic brought on by the excesses of mass media. In such a situation, the public particularly looks to nurses and physicians for guidance and education, but where can healthcare providers go to obtain the most current and accurate facts?
Public health specialist and epidemiologist Dr. Sandro Galea
urges providers to consult the Centers for Disease Control’s (CDC) website for
authoritative recommendations and updates and suggests beginning with the community
health section. Also useful is the CDC page directed at healthcare
Below are five main points about COVID-19 based on
information from the CDC and other public health experts, updated to reflect
the latest known facts.
How severe is the virus, on average?
According to the World Health Organization (WHO), about 80%
of all cases of COVID-19 display mild to moderate symptoms. In the majority of COVID-19
cases, patients who are not asymptomatic tend to experience little more than
cold/flu symptoms such as cough, fever, and a runny nose. Also, while WHO’s
figures place the current mortality rate at around 3.4% (for the sake of
comparison, the 2002-3 SARS epidemic had a death rate of more than 10%), this
refers only to the rate among reported cases. Experts argue that the fatality
rate is probably in fact lower than the current WHO figure, as many of those
infected by the virus are unlikely to have even visited a doctor.
In 14% of cases so far, symptoms have been more severe and dangerous.
These instances are often accompanied by pneumonia. The highest-risk group
includes the elderly and people who are already in poor health. However, for
patients outside these groups, health officials speaking to the Washington
Postrecommend “stay[ing] home
if your symptoms can be handled with over-the-counter cold and flu aids from
your local drugstore.” The Post also notes, “If everyone with a cold
floods their local emergency rooms, it will be harder for health-care workers
to treat patients who are critically ill.”
How is COVID-19 transmitted?
The CDC says that according to current data, “spread is
thought to occur mostly from person-to-person… among close contacts.” Close
contact is regarded as being within about 6 feet of an infected person for a
prolonged period, with particular risk attached to direct contact with respiratory
droplets, sputum, serum, and blood. If you’re wondering what to do if exposed
to a patient with COVID-19, check these guidelines
on risk assessment and potential exposure. The CDC states that it can take anywhere
from 2-14 days after exposure for signs of the illness to appear, hence the
widespread imposition of a 14-day quarantine period.
Dr. Galea responds
that “Health care workers providing care for patients with confirmed COVID-19
or under investigation for coronavirus should use Standard Precautions, Contact Precautions, Airborne Precautions, and use eye protection.” You can also visit
the CDC FAQ on Personal Protective Equipment for detailed recommendations regarding
gowns, gloves, and respirators.
Dr. Galea tells DailyNurse that “It is appropriate to get tested if indicated by a clinician, due to a combination of exposure to an area where the outbreak is known to be present and exposure to someone with coronavirus or suggestive symptoms.” In a recent policy change, the CDC announced that anyone can get tested, provided they receive a doctor’s approval. They suggest that clinician judgment calls on testing should be based on “signs and symptoms compatible with COVID-19,” local epidemiology, and whether patients “have had close contact with a laboratory-confirmed COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas within 14 days of symptom onset.”
How can we avoid “fake news” about COVID-19?
In addition to directing patients to consult the CDC website, healthcare providers can help to warn the public about fallacious sources. Public concern about the virus has been feeding what WHO calls an “infodemic” of dangerous misinformation and it can be hard to avoid exposure. There is a seemingly endless round of statements from apparently reputable-sounding websites, public figures, and talking heads on television, and nurses should impress upon patients the importance of applying critical thinking amid the media storm. To keep up with some of the most dangerously misleading content being circulated online, see the Newsguard Coronavirus Misinformation Tracking Center. You can also track down false stories spread in all forms of media on Factcheck.org’s Coronavirus page.
Although Internationally Educated Nurses (IENs) are often
associated with struggles with differences in language, culture, and healthcare
systems, they may also “contribute to a more educated and stable nursing
workforce in patient care units” according to a new study published
in Nursing Economic$.
One point raised in the study was that units with internationally educated nurses tend to experience less turnover. The authors remark that “previous qualitative research has shown IENs are more inclined to stay on a unit longer.” Results also indicated that internationally educated nurses stay on their unit longer than peer US-educated nurses, and that the overall tenure of nurses on units with a higher proportion of IENs is longer than the average. In addition to reducing expenses for hiring and training new staff, the authors suggest that lower turnover rates can have a positive effect on collaboration among nurses.
Units with a higher number of Internationally Educated Nurses also included a greater proportion of staff with BSN degrees. This finding, the study authors suggest, is owing to the fact that internationally educated nurses “are more likely to have a baccalaureate degree to qualify for the U.S. nursing licensure exam (NCLEX-RN).” This is all to the good, as a higher level of education in nurses has been shown to lead to better health outcomes for patients. “Research shows that having more nurses with bachelor degrees improves patient safety, so it is possible that internationally educated nurses are contributing to improved health outcomes,” said Chenjuan Ma, PhD, an assistant professor at NYU Meyers and the study’s lead author.
The study was based on 2013 survey data
from the National Database of Nursing Quality Indicators, and analyzed
responses from 24,045 nurses (2,156 of whom were trained outside the U.S.)
working on 958 units across 160 U.S. acute care hospitals. The authors of the
study are Chenjuan Ma, Lauren Ghazal, Sophia Chou, Emerson Ea, and Allison
Squires of New York University’s Rory Meyers College of Nursing.