We as nurses want to see our profession thrive and be prepared for the future. We as individuals can take actions that will lead to advancements in nursing as a whole. These steps on their own may not seem like much, but the following can lead to long-term change and elevate the profession.
Belong to Associations
Attending chapter meetings not only helps nurses stay current with new issues and topics, it also helps with networking. Networking is so valuable not only for camaraderie, but also for future jobs or references. Not sure which association to join? You can find your state’s nursing association and corresponding website through the American Nurses Association. Many associations are now holding online or virtual meetings so networking and participation is still possible. Even belonging to associations in one’s personal life lead to socializing and can prevent career burnout.
Continue Your Education
Stay up to date within your specialty – CEUs for RN license renewals are not sufficient. Take courses or go to seminars (check if your employer reimburses). As with nursing associations, education courses are now online and attendance dates and times may be flexible. Sigma Nursing has a web page with links to nursing specialty associations. Another way to make progress within the education realm is to advance your degree. Whatever you decide, be it learning a new skill or obtaining a new degree, either option is a valuable investment in yourself and your nursing career. In the long run, you are advancing the profession by your additional knowledge and by being a well-rounded nurse.
Mentor New Nurses
Mentoring can mean on-the-job or more formally through a college or vo-tech school. By teaching what we know, the mentor actually learns more through questions, explaining procedures and processes. Some facilities have programs that train the mentor. Others utilize the facility’s clinical educator as a resource for mentors. We must remember that we’ve all been “the new nurse.” Some of us have had positive experiences and others, not so much. Mentoring is crucial in bringing the next generation of nurses to practice. Mentoring can be fulfilling, especially once the new nurse “graduates” to being on his or her own.
Write Letters
Are you concerned about staffing ratios or other issues you’re facing on the job? Make the policy makers aware. If we don’t communicate our concerns or issues, nothing will change with the ways things are done. Letters to those in congress or governors can focus on concerns within your state or the county as a whole. If you’re unsure how to craft a letter, the National Council of State Boards of Nursing (NCSBN) has a user-friendly template that nurses can use. The template’s wording is geared toward advanced practice nurses but can easily be tailored to any nurse. This is especially important with upcoming elections, which could lead to the state of the nation’s health being in limbo. Nurses are in a perfect position to speak up to help create changes in policies that would better the profession and health care as a whole.
Continue to Project a Professional Image
Throughout the day we take for granted who sees us…the public, peers, our families. Nurses have been named the most trusted profession for 18 consecutive years for good reason. The public trusts nurses for their knowledge, compassion, and ethics. Nurses must continue to uphold our reputation and our code of ethics to keep those who are ill safe. Although the code of ethics for nurses is not legally binding, nurses should be familiar with the attributes and strive to embody them daily in their practice. Another area to be mindful of is our social media presence. Even though we may be posting personal photos or opinions, if we list the name of our workplace and/or what we do, we are still being linked with the nursing profession.
In Donna Cardillo’s book, The Ultimate Career Guide for Nurses, many additional tips are reviewed. She recommends the concept of career management. This does not just refer to finding a new job, but rather, ongoing maintenance of one’s profession. By maintaining our individual nursing practice, we in turn elevate the profession. A part of maintaining our individual practice is self-care and recognizing our strengths, weaknesses, and limitations. Nurses must realize that by keeping up with our self-care and addressing burnout, we can give more of ourselves and further build up the profession.
Thoughts to Take Away
There are multiple ways to elevate the profession. We discussed that nurses can advance their education or skills, write to those in congress, become involved in associations, and project professionalism. Nurses can also contribute to the greater good by mentoring. The most important piece of advice: get involved! By speaking up and making our voices heard, the profession can flourish for centuries to come.
What does effective communication mean to you? All individuals have their own natural ways of communicating that stem back to culture, past experiences, and background. How one culture communicates may seem very different to another. Health care melds together practitioners and professionals with various experiences, abilities, and backgrounds. Therefore, it is critical for nurses to develop systems to communicate effectively.
Communication is an important skill for any industry. There are numerous resources available that provide tips to improve communication. But what about communication geared toward nurses? Nurses need to communicate changes in patient condition, hand-off during shift changes, and information to families in a succinct and clear way. Brushing up on communication skills or learning new ways to clearly communicate is always a smart idea for both new and experienced nurses.
“Communication skills can be effectively trained but are best achieved through reviewing our own style of communication,” according to K.C. Rajashree, author of a 2011 study on training programs in communication skills for health care professionals. As a component to improving our communication skills as nurses, we must take an honest look at ourselves and how we as individuals communicate. If we do not assess ourselves, we won’t realize the areas we need to improve on in the first place. We can assess ourselves by checking if the information we’re communicating is clear enough or too detailed; do we “get our point across?” Or is the person guessing at what we’re trying to say?
As we know, “effective communication within a healthcare setting is critically important. Workers of varying skill sets within a healthcare setting must communicate clearly with each other to best coordinate care delivery to patients, ” says Haran Ratna, author of a 2019 study published in Harvard Public Health Review. One commonly used method is SBAR. SBAR means Situation Background Assessment Recommendation. Clinicians use this acronym because it delineates the pertinent information that is to be conveyed. Some facilities provide SBAR tear-off worksheets so that it can be used conveniently and consistently.
Other communication methods include Call-Out, Check-Back, and Hand-off. These tools involve team communication and many are “closed loop.” That means the person receiving the message repeats it back to ensure accuracy and receives confirmation that what they’ve heard is correct. Closed loop is beneficial particularly during a code or emergency when someone must ensure the information conveyed is accurate.
Ticket-to-Ride is a method for brief hand-offs. This method would be used if the patient were leaving the unit for a test. Ticket-to-Ride would convey basic information to the staff accepting the patient in order to keep the patient safe. This method is not the same as a change of shift hand-off; it is only basic information for short-term care.
Studies have shown that training nurses on improving communication increases patient safety. A study by Dingley, et al developed a communication “toolkit” that provided various communication strategies and ways to implement teamwork. The toolkit included four “tools”:
SBAR (or a standardized communication tool)
An escalation process
Daily multi-disciplinary rounds with goals
Team huddles during each shift
The study also revealed that using the toolkit consistently could be translated into other care settings besides a hospital. Using the toolkit showed improvement in communication between disciplines; however, implementation was dependent on managers and leadership. With creating any new habit, consistency is key. Providing education can encourage consistency as well as having the tools easily accessible through templates or worksheets.
BATHE protocol is another method, similar to SBAR. BATHE stands for Background, Affect, Trouble Handling, Empathy. This method is useful for communicating with patients, their families, or in a conflict situation. Observing the affect of the person is useful. If the person has a flat affect or is withdrawn, the nurse’s tone of communication may differ compared to having an upbeat or happy affect. Trouble Handling is another component to consider. What is troubling the patient and how are they dealing with it? This method is useful in psychiatric settings.
Which method is best? It all depends on the situation. In an emergency, closed loop communication works by repeating back the information. During change of shift hand-offs, more information is conveyed and clarity is important. In the case of Ticket-to-Ride, the information is brief and basic—just the facts to keep the patient safe. SBAR and other methods are appropriate when speaking with doctors and other team members by organizing information and maintaining consistency in the way communication occurs. Check with your unit’s educator or hospital policies. Your hospital may prefer one method versus another.
Nurses may take for granted the act of effective communication. However, communicating clearly and accurately makes all the difference in quality of care and patient safety. Utilizing SBAR, Hand-off, BATHE, or other tools with closed loop methods can improve transfer of information between nurses and others. By polishing nurses’ communication skills, patients and the health care team as a whole will benefit.
We’ve all been experienced it: maybe new graduates are experiencing it right now…it’s the first day on the job with our freshly minted nursing degree and “what in the world am I doing here?!” is running through your head. Despite studying diligently to pass those exams, surviving the NCLEX, and making it through on-the-job training, Imposter Syndrome still hits close to home for many graduates. We’ll be discussing what it is, who is affected by it, and how to overcome it.
What is Imposter Syndrome?
Let’s not confuse imposter syndrome with new nurse jitters. New nurses may feel unsure of themselves and their knowledge especially during the first year on the job. However, Imposter syndrome is a constant, relentless feeling of never being good enough or that one is a “fake” at his or her job or responsibilities. In Patricia Benner’s classic book, From Novice to Expert: Excellence and Power in Clinical Nursing Practice, she compared being a novice nurse to learning a new skill like learning a new language: “in the beginning, performance is halting and rigid, and one must pay attention to explicit instruction. Performance is rule governed.” Imposter Syndrome is more of a feeling or a mindset than an action.
Who Experiences It?
Not just nurses experience this phenomenon. People from all ages and industries can feel the pangs of Imposter Syndrome. It seems to be experienced when someone is new to a role or has taken on different responsibilities. Therefore, it would make sense that new nurse graduates could have thoughts or feelings of being an imposter. “The syndrome is most common among women leaders who feel they don’t deserve the success they’ve achieved despite external evidence of their competence,” according to researcher Rose Sherman. It’s also likely to be experienced by people who describe themselves as perfectionists. Other people who are prone to this syndrome are those who have a competitive nature or those working in high stress environments.
How to Overcome It
John Discala lists six ways to overcome this mindset. It can be helpful to try a variety of strategies to shift away from this mode of thinking. Two ways are staying positive or talking with a friend. Dr. Lowinger coaches health professionals and in her 2019 article for Hospital and Healthcare, discusses other tips for managing Imposter Syndrome. She notes building confidence is key. How does someone build confidence? Taking an honest look at strengths and weaknesses and being realistic. Is what ever the nurse is feeling really the truth in the scenario? It’s important for the person to be honest with herself. Lowinger includes tips for both individuals and leaders for building confidence. Once someone is feeling surer, other negative feelings of inadequacy may dwindle and reality may be clearer to see.
Why Is It Important to Help Nurse Graduates?
“[Imposter Syndrome] has important implications for individual health professionals and the system as a whole,” says Lowinger. As a nursing profession, we should be mindful that new nurses commonly feel Imposter Syndrome. It’s important that nurse educators and programs in nursing schools teach about this. It would be interesting if more studies existed that investigated new nurses leaving the profession due to Imposter Syndrome. Could they truly be leaving because of this mindset? Could this mindset be so strong and detrimental? More research is needed. The nursing workforce cannot afford to lose more capable future nurses from this way of thinking that is treatable.
Imposter Syndrome is a persistent feeling or state of mind that the person is not good enough or a “fraud” in his or her job. Many people, despite industry, experience these feelings and particularly so if they are new to a role. People with specific personality traits such as high achievers or perfectionists tend to experience Imposter Syndrome more. There are several strategies available to minimize these feelings and there is much data showing this syndrome is common. It’s important to address this in nurse graduates because the nursing profession has the potential to retain more nurses who could otherwise leave due to Imposter Syndrome. Nurse graduates should be reassured that this phenomenon is felt by many and utilizing the strategies can help. A final suggestion is if the strategies in this article aren’t helping, to consider seeking professional help from a counselor or coach.
What progress have we made in increasing nurse retention within the nation? This topic has been widely researched for many years globally. “Nurses” can be adult nurses who have been in the profession for many years or new graduate nurses. According to a study by Auerbach, et al (2015), “the number of nurses leaving the workforce each year has been growing steadily from around 40,000 in 2010 to nearly 80,000 by 2020.” To tackle this problem, there are several points to consider. We must figure out why nurses leave, what interventions work, and what has changed in the past 10 years in retention efforts.
Why Do Nurses Leave?
First, let’s realize and take seriously why nurses leave. Well, it really depends on the nurse demographic. A graduate nurse will have different reasons for leaving than a seasoned nurse. Due to this fact, retention interventions should not be “one size fits all.” There could be numerous reasons for a nurse to leave. Two common ones are insufficient staffing and increased stress levels. Another major reason is work environment. This could mean a hostile work environment or a milieu of low autonomy or empowerment. Inaccurate job expectations or an inability to adjust to the pace of the job are possible causes for a graduate nurse to leave.
The Impact on the Workforce
Evidence in a study by Jureschek, et al (2019) revealed, “…Shortages of RNs will worsen in the next two decades.” It’s similar to the scenario of what came first: the chicken or the egg? Did low nurse retention rates cause shortages in staffing or did poor staffing ratios fuel low retention? Rates of retention and shortages seem to go hand in hand. It would make sense that poor retention rates would exacerbate shortages. Low retention also puts big costs onto hospitals and facilities. In order for the nursing workforce to stabilize, we as a nation must initiate successful interventions.
What Interventions Work?
Interventions need to occur on multiple levels: from individual, leadership, and organizational. In other words, the organization as a whole needs to be committed to keeping nurses. Nurse practice models used in Magnet hospitals have had some success in boosting retention. Various practice models enable nurses to be empowered and result in high job satisfaction.
From a leadership level, nurse managers should be cognizant of retention trends within the country and should work closely with the organization’s human resources. Leadership training also can provide support to the nurse manager. More studies and research are needed to further investigate leadership’s role in retention efforts.
Individual levels look to internships and residencies and the availability of a support system such as a nurse educator. Individual levels of retention appeared to focus on the nurse graduate demographic. A study by Halter, et al (2017) found that “Based on the strongest evidence, the highest retention rates were associated with retention strategies that used a preceptor program model that focused on [the] new graduate nurse…”
What Has Changed in the Last Decade?
As systematic reviews of studies have found, it is difficult to discern the real evidence, as there are many studies on the issue but with questionable quality. This is shown by small sample sizes and inconsistent data. The evidence we have shows that we still have a long way to go. However, in the last decade we have learned interventions that have worked. By using these persistently, nurses may stay in the profession longer. Evidence has consistently shown that work environment plays a large role in retention. “According to The Future of Nursing: Leading Change, Advancing Health, “Much of the data showing the impact of reducing turnover by focusing on workplace environment comes from the acute care setting. Nonetheless, these data are instructive in their demonstration of a triple win: improving the workplace environment reduces nurse turnover, lowers costs, and improves health outcomes of patients.”
The challenge of retaining nurses in the workforce is still an obstacle to higher quality health care and higher nurse satisfaction. There are some interventions that work. It is more important than ever for organizations to implement proven strategies that increase retention. Strategies are effective when they are implemented from several levels: organizational, leadership, and individual. We have made strides in finding varied causes of low nurse retention and working environment is a big factor. More quality studies are needed to gather more accurate data. Not only is our nation’s health care on the line, our nursing profession is as well.
Home health nursing is a niche for nurses who have experience and enjoy being on the move and working independent from the hospital. Visiting nurses, now termed home health nurses, date back to the 1800’s. Lillian Wald founded the Visiting Nurse Service of New York in the late 1800’s and the current structure of home health care is based off that model.
Home health nursing consists of providing nursing care in an individual’s home. The nurse must possess ingenuity as the conveniences and equipment found in the hospital are generally not available. Nurses carry their own supplies and regularly utilize the nursing process and honed assessment skills.
There are many varied clinical responsibilities the home care nurse has. Some of these are reconciling medications, managing foley catheters, providing drain care, and teaching the patient. Serving as a case manager is another responsibility. This means caring for the patient from beginning of service to discharge back into the community or prior baseline. This includes coordinating with doctors, family members, and other members of the health care team. Building rapport and familiarity with a patient is more important than ever with the current COVID-19 epidemic.
The COVID-19 epidemic poses one of the biggest challenges across the entire health care arena including home care. Due to this epidemic, changes have been made to the delivery of home health care. These include utilization of telehealth, increased incidence of homebound patients, changes to PPE usage, and temporary waivers and allowances of Medicare requirements. Changes are evolving frequently and this information is current at the time of this post.
Due to COVID-19, nurses may provide telephone or telehealth assessments in addition to in-home visits if the patient’s condition is stable. These “visits” are allowed if the patient’s doctor permits. A combination of telephone/telehealth and in-person visits lessens the number of exposures the nurse has with the patient. A phone call or telehealth assessment involves asking questions in order to determine the patient’s status and identify any new or worsening health issues. If the patient has current technology telehealth video visits can be conducted that allow for the nurse to see the patient on the computer screen.
In order to qualify for home care a patient must be deemed homebound. This may be determined from a doctor’s order or due to the patient’s health condition. A patient can be admitted into home health if he or she is homebound. Due to recent temporary Medicare changes if a patient is suspected COVID positive or confirmed COVID positive, he or she can be considered homebound. These measures reinforce the stay at home theme to help in lessening COVID spread.
Changes to PPE usage are the same as the requirements in the hospital. If a patient is COVID positive, Airborne and Contact Precautions are taken. This means the home health nurse would wear a N95 mask, face shield, goggles, gloves, gown, and perform proper donning. Upon exiting the patient’s home, the nurse would doff and leave the used PPE outside the home according to his or her agency policies.
Current guidelines from the CDC and NAHC (National Association for Home Care and Hospice) require all home care staff to wear masks when in contact with any patient. If the patient is COVID positive, then a N95 mask must be worn. Patients who are COVID positive must stay separated from others in the home preferably in a room with a closing door to assist in quarantining. It is also recommended that all patients — regardless of COVID status — wear a cloth mask during each visit.
Home health nurses are providing increased education to patients and their families focusing on infection prevention in the home. Handouts from reliable sources such as the CDC are being provided to family members. Nurses are also providing education on proper hand washing technique and disinfection guidelines for laundry, surfaces and other areas of the home.
As noted earlier, COVID-19 has impacted all areas of health care and home health is no exception. By providing increased education to staff, patients, and families; the goal is to decrease the intensity and mortality rate of this pandemic. Nurses are on the front lines and need to stay abreast of frequent changes to Medicare rules. It’s also necessary to take current measures to protect themselves and their patients during this challenging time in history.
