A Certified Team: Married CCRNs Share Their Story

A Certified Team: Married CCRNs Share Their Story

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.

COVID-19: Surge in Healthcare Worker Self-Quarantines Raises Concerns

COVID-19: Surge in Healthcare Worker Self-Quarantines Raises Concerns

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 system.

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 should decline.

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 exposed.

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 protective equipment.

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 COVID-19 pandemic.

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 immunity.

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.

COVID-19: Making Sure You Have the Facts

COVID-19: Making Sure You Have the Facts

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 professionals.

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.

What precautions should healthcare providers take when treating COVID-19 patients?

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.

Who should get tested?

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.

Study: Internationally Educated Nurses Add Stability to Nursing Workforce

Study: Internationally Educated Nurses Add Stability to Nursing Workforce

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.

Brittany Molkenthin’s Early Call to Innovation

Brittany Molkenthin’s Early Call to Innovation

This series takes a look at the stories appearing in The Rebel Nurse Handbook, which features inspiring nurses who push the boundaries of healthcare and the nursing profession. This installment focuses on Brittany Molkenthin and the pivotal moment of her innovative nursing career.

In her junior year of nursing school, Brittany Molkenthin envisioned a new premise for a major maternal healthcare innovation. While shadowing a Lactation Consultant in the maternity ward, she encountered a mother attempting to breastfeed for the first time. What should have been a beautiful and life-affirming experience quickly went south. After months of planning to breastfeed her first-born child, multiple classes, and a volume of research, she had continuous trouble with positioning the baby, each time unable to get the right latch. The few times it worked, neither the mother nor the attending staff had any way of gauging how much milk the baby was receiving. After the numerous attempts that afternoon, an overall exasperation filled the room, accompanied by tears running down both the baby’s and the mother’s face. Desperate for her baby to eat, she asked for formula and a bottle.

Brittany replayed the incident over and over, throughout the
day and later that night. As a student, she was directly exposed to the concept
of innovation and the pain point/solution mindset through her school’s
Healthcare Innovations Program. Musing upon the dilemma, she identified the
pain point as the inability to register how much milk a baby was receiving from
its mother. A solution, she surmised, would be to develop “a device that
accurately calculated the amount of breast milk that infants receive during
breastfeeding.”

After working with a team of biomedical engineers to develop
a working prototype, Brittany was ready to enter in her university’s “Shark
Tank” event. Although she did not win the competition, she was undeterred.
Brittany reached out to one of the event’s judges to discuss plans for her
device further and, thereafter, push forward with her startup. The year after
graduation, she filed a provisional patent and launched into a flurry of
networking, pitch decks, and attendance at innovation events.

While applying for startup business grants and working to
keep her nascent company alive, Brittany had her hands full: employed as a
bedside RN in pediatric intensive care and simultaneously studying to become a
pediatric primary care NP. Her breastmilk gauging device, Manoula, is designed to inform
“mothers and providers how much breastmilk a baby has consumed” and share the
data via wireless technology. The product is moving toward its alpha prototype
and is expected to enter the market in 2021.

DailyNurse asked Brittany: What was the hardest part
of starting your LLC and creating a new medical device? And what was the most
rewarding?

She responded, “the hardest part about starting an LLC and
creating a medical device was the mere fact of starting with no previous
medical device development, business, or entrepreneurial background. I thought
I was going to be a nurse, that was it… I never imagined it would get this
far. The most rewarding aspect is seeing how far the company and the device has
come since that drawing of my “vision” started as a Crayola picture
and a school project. It is amazing to think this device will be in the hands
of breastfeeding mothers someday.”

Brittany also has some advice for any nurse who has an innovative idea and is interested in turning it into a new product: “Find a team. Team is essential to the success of any startup or any innovative idea. A team that shares your passion, drive, and vision can help bring an innovative idea to fruition.”



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