The Healthy Nurse, Healthy Nation Grand Challenge: Post Op

The Healthy Nurse, Healthy Nation Grand Challenge: Post Op

In August, we covered the 60-day nutrition pilot program Healthy Nurse, Healthy Nation Grand Challenge (HNHN), that is designed to help nurses eat better and improve their eating habits with healthier food options. At three of its locations, the Medical University of South Carolina (MUSC) made sure that its nurses were able to increase the amount of fruits and vegetables they ate daily by getting Simply-to-Go foods, which are healthful, fresh, seasonal, as well as locally sourced.

The program ran for 60 days, starting on June 13. We checked in with Dana Foster, BSN, RN, CEN, a nurse at the MUSC, and Andrea Coyle, MSN, MHA, RN, NE-BC, Professional Excellence and Magnet Program Director at the MUSC, to see how things turned out.

What did you do as a part of the challenge? How did your eating habits change?

Foster: During the challenge, I focused on my snacking habits at work and making better food choices overall. I now opt for the portioned Simply-to-Go fruit and veggie snacks instead of purchasing a bag of chips or candy. During busy shifts, I’ll grab a premade salad for lunch instead of a slice of pizza.

What differences did you notice in yourself? Did you have more energy? Did you lose weight? What happened?

Foster: I have generally been a healthy eater. What I struggle with is being prepared during busy times. I am in a full-time graduate program for my DNP and work as an RN. Sometimes, I just don’t have time to meal prep. Having the healthy options right at my fingertips at work set me up for success on days I didn’t bring a lunch or snacks.

Do you think that you’ll continue with the changes you made in these 60 days?

Foster: I think knowing that there are consistently healthy options in the cafeteria will ease my mind when I am at work without home-prepared snacks and food.

Why do you think that nurses tend to put their health on the back burner? Why do they need to take care of themselves like they do their patients?

Foster: Nurses are naturally compassionate towards others, and we tend to put patients’ needs in front of our own. For example, even if I am hungry, if I have patients that need my care, I feel they deserve my attention first. To go along with that, shifts get BUSY. In the emergency room, where I work, we are constantly working up, running diagnostics on, and treating our patients. There is rarely a “good time” to do self-care practices on breaks. However, nurses are examples to our patients, which is why we need to practice what we preach. The public consistently ranks nurses as the most trusted profession, and our patients look to us for guidance and direction.

Coyle: Nurses are natural caregivers. We want the best for our patients and go above and beyond the call of duty, even if it means neglecting our own health and well-being. However, when you don’t take the time to care for yourself, you will lack the energy to provide care, work demanding shifts, and maintain an overall quality of life.

Why is this kind of program so important?

Foster: In this day and age, we go for what’s easiest and most convenient. It is so important to give people options that are healthy and easy to grab on the go.

Coyle: Promoting healthy life choices among nurses is critical. When you are in health care, you serve as a role model for patients and families. The value of this program is to positively influence care team members along with the community that we serve to make healthy choices.

How Lynn Dow’s 50-Year Career Made Her Dream Come True

How Lynn Dow’s 50-Year Career Made Her Dream Come True

When Lynn Dow, RN, MSN, was a young girl, she dreamed of being a writer, and she wanted to write novels. But when her Dad died shortly before she turned 14, there was no money for college.

“Instead I had to choose between the three occupations available to women in the 1950s—teaching, nursing, or secretarial work. I chose nursing which, at the time, I considered to be the lesser of the three evils. It turned out to be a very good choice as once I got into it I realized that I was meant to be a nurse,” says Dow, now retired from the University of San Francisco Medical Center, where she worked over the years as a staff nurse, head nurse, nursing supervisor, and nursing educator.

Dow staying in the nursing field for 50 years. “Once I got into the profession, I never thought of being anything but a nurse, and when I look back over the last 50 years, I realize how lucky I was to have a career that kept me engaged for such a long time. This attitude kept me going—in addition to the fact that whenever I felt myself getting restless in my job a new opportunity would arise and it would be like starting anew,” admits Dow. “I believe this is one of the greatest advantages of the nursing profession—there is always a new and challenging opportunity just waiting for you to take it on.”

Lynn Dow, RN, MSN

Lynn Dow, RN, MSN

When Dow started in nursing, she couldn’t have imagined that the career she originally thought she was settling for, but turned out to love, would bring her dream back.

“When I retired, I finally had a little time and decided to take a writing class. I soon discovered I was not a novelist, but was advised by the teacher to write about something I knew,” says Dow. “Unsurprisingly, I chose to write about my experiences in nursing. I did not have any notes or diaries, but as I began to validate my memories with classmates and colleagues, they became a valuable resource in reminding me of certain events and supplying me with old class schedules and notes.”

From this came Dow’s first book, Nightingale Tales, a memoir of stories about how nursing changed from early in her career to the present day. “Without a doubt the biggest change that I witnessed throughout my long career was observing the nurse evolve from being a handmaiden to the physician to an independent practitioner.  When I started in nursing in the mid-1950s, nurses were expected to stand up and offer their chair to the doctor when he came into the nursing station, and I was once reprimanded for not doing so—not because I was being obstinate, I just didn’t see him come in. Fifty years later when I retired, nurses are recognized as independent, integral contributors to the patient’s plan of care. What a change!

“Technology has certainly played a part in the evolution of nursing—inventions that enabled the nurse to spend less time performing tasks and more time in practicing the art of nursing. Something as simple as the electric beds we all take for granted now, played a huge part in freeing up the nurse. Not having to stop what you were doing to crank a bed up or down every time a patient needed a position change was a huge contributor to improved nursing care,” recalls Dow.

With a long career, Dow has lots of funny stories. “I was once given a beautiful silk lace half slip by a patient, one of the Hearst brothers of newspaper fame, for emptying his urinal,” she says. “We were never supposed to accept gifts from patients, but I couldn’t resist when he told me to take a box off the shelf in the closet. I stashed it in my purse and didn’t open it until I got home.  It was beautiful and probably a bit inappropriate, but it gave everyone a good laugh.”

“Everyone smoked in the 50s, myself included. Going for a job interview, I was met by the director of nursing whose first question as she greeted me was ‘Do you smoke?’ Oh no, I thought, she can smell the cigarette I had just finished, and she doesn’t like a smoker.  But when I confessed that I did, she steered me into the converted patient bathroom off of her office and instructed me to sit on the edge of the bathtub, while she took a seat on the toilet, lit my cigarette and proceeded to interview me, while we both flicked the ashes into the sink,” she says.

Although Dow says that she has many more stories to tell, she’s not sure if she’ll do another book of this type. It’s not, though, out of the question. “I am surprised at how many people who have read the book comment on the fact that they view it as an important piece of nursing history. When writing it, I never thought about it in that context, but I am so pleased that people see it as an important contribution to nursing.”

Preventing PIV Infections

Preventing PIV Infections

Peripheral Intravenous Line (PIV) complications can be aggravating at best and deadly at worst. To get more information about this topic and to learn about a new invention from 3M, we interviewed Joseph Hommes, VSN, RN, VA-BC, Technical Service Specialist, 3M Medical Solutions Division to find out more.

Please explain PIVs, their complications, and the use of CHG skin preps and regrowth of bacteria.

Peripheral intravenous (PIV) lines are commonly placed in the arm to administer medications and fluids for therapeutic purposes. In fact, they are the most common vascular access procedure performed on hospitalized patients with 60 to 90 percent of patients requiring an IV catheter during their hospital stay.1

PIVs are often considered lower risk for infection than central lines because of their shorter dwell time and placement,2 but PIVs can be associated with preventable complications such as inflammation, dislodgement, phlebitis, and peripheral line-associated bloodstream infections (PLABSI). And like central line-associated bloodstream infections (CLABSI), PLABSI can lead to a rise in patient morbidity, length of stay, and health care costs for the patient and facility.3

The reason why regrowth may occur so quickly even after the use of CHG skin preps is related to the location of the bacteria,4 the presence of microbial biofilms on skin,5 and the significant variability of bacteria density and species from one person’s skin to another.6 Research studies show that up to 20 percent or more of the total skin flora is beyond the reach of routine disinfection. These bacteria are located in skin crevices where lipids and the superficial cornified epithelium protect them; and deep in the roots of hair follicles and sebaceous glands where they cannot be removed without injuring the skin.7 According to Gonzalez et al, biofilms with or without underlying dermal disease, will help reduce the efficacy of CHG, which, in turn can contribute to bacterial regrowth.8 In the case of peripheral vascular catheter or needleless connector use, the sustained presence of an antimicrobial agent serves to keep the bacterial counts low to absent.9

How can health care systems protect patients against these PIVs?

All IVs have the potential to be contaminated through two sources: extraluminal, where bacteria originate on the skin surface and intraluminal, where bacteria enter via the catheter hub or IV access point.

Although PIVs aren’t monitored or researched as frequently as central lines, it’s extremely important that health care facilities and clinicians pay close attention to these lines because approximately 1.6 million PIV infections occur each year globally.10

A growing interest in comprehensive PIV maintenance bundles is emerging based on different recommendations or practice standards from the Centers for Disease Control and Prevention (CDC) guidelines,11 Infusion Nurses Society (INS),12 and the Society for Healthcare Epidemiology of America (SHEA) compendium guidelines.13 One recently published study from Mercy Hospital in St. Louis, MO found that implementing a comprehensive PIV maintenance bundle was associated with a decrease in the rate of PLABSIs, from 0.57 to 0.11 per 1000 patient days (p < 0.001).14

Why should health care systems work harder to protect patients against these PIV infections? How dangerous are they?

PLABSI can be incredibly detrimental to both patients and health care facilities. In addition to PLABSI being potentially fatal for some patients, it can significantly impact a facility financially, with some cases costing $10,000 to $20,000 per patient,15 and up to $40,000 in intensive care unit (ICU) settings,16 giving hospitals a large incentive to prevent PLABSIs to improve patient outcomes and reduce costs.

What do the 3M antimicrobial PIV dressings do? How is this better than what is otherwise offered? Have you done any research on their effectiveness? If so, can you give me some information about the research and its conclusions?

Short-term PIVs account for a mean of 23 percent of all hospital-acquired CRBSIs.17 Additionally, one hospital determined that the leading source of health care-acquired S. aureus bloodstream infections over an 8-year period was associated with PIVs due to normal skin flora migrating down the catheter tract through the IV line.18

Protecting patients from risks associated with PIVs needs to start with the surface of the skin, disinfecting the catheter IV access points and continuing through monitoring the catheter insertion site until it is removed. The latest addition to 3M’s portfolio in the fight against extraluminal contamination of PIVs is the 3M Tegaderm™ Antimicrobial I.V. Advanced Securement Dressing. This dressing provides site visibility, catheter securement, and enables consistent application. Chlorhexidine Gluconate (CHG) is integrated throughout the adhesive to better suppress regrowth of skin flora on prepped skin for up to 7 days as compared to non-antimicrobial dressings.19 The transparent dressing allows continuous site visibility to enable early identification of complications at the insertion site. It is also designed to minimize catheter movement and dislodgement.

It’s important to note that peripheral line bundles should also include disinfection and protection at all intraluminal access points too. Using a peripheral line bundle that includes 3M Curos™ Disinfecting Caps for Needleless Connectors and 3M Curos Tips™ Disinfecting Cap for Male Luers provides effective disinfection of catheter IV access points. Effective disinfection of needleless connectors and male luers on PIV lines has been associated with a significant decrease in primary PLABSI.20

What else do you think is important for people to know about PIV bloodstream infections?

It’s critical for clinicians to better understand that PIVs are responsible for a significant number of total infections. According to a recent survey of 650 U.S. infection preventionists and clinicians, only 60 percent of infection preventionists are familiar with their facility’s PLABSI prevention protocols and procedures, yet 56 percent of all respondents believe that PLABSI poses a real threat to patient safety.21

With up to 90 percent of patients requiring a PIV during their hospital stay,22 clinicians should be paying closer attention to PIV care, making it a central part of their infection risk reduction programs. To get started, free educational courses about how to address clinical challenges associated with PIVs are available at 3M’s online learning platform, 3M Health Care Academy.

 


  1. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J Infus Nurs. 2015; 38(3): 189-203.
  2. Hadaway L. Short Peripheral intravenous catheters and infections. J Infus Nurs. 2012; 35(4): 230-240.
  3. Kilgore, M. and Brossette, S. Cost of bloodstream infections. Am J Infect Control. 2008; 36: S172 (e171-e173).
  4. Selwyn, S and Ellis, H. Skin Bacteria and Skin Disinfection Reconsidered, British medical journal, 1972, 1, 136-140.
  5. Gonzalez T, Biagini, Myers JM, Herr AB and Hershey K. Staphylococcal biofilms in atopic dermatitis. Curr Allergy Asthma Rep (2017) 17: 81.
  6. Gao Z, Tseng, C-h, Pei Z and Blaser MJ Molecular analysis of human forearm superficial skin bacterial biota. Proc Natl Acad Sci USA (2007) 104: 2927-2932.
  7. Selwyn, S and Ellis, H. Skin Bacteria and Skin Disinfection Reconsidered, British medical journal, 1972, 1, 136-140.
  8. Gonzalez T, Biagini, Myers JM, Herr AB and Hershey K. Staphylococcal biofilms in atopic dermatitis. Curr Allergy Asthma Rep (2017) 17: 81.
  9. Casey AL, Karpanen TH, Nightingale P, and Elliott TSJ. An invitro comparison of standard cleaning to a continuous passive disinfection cap for the decontamination of needle free connectors. Antimicrobial Resist Infect Ctrl (2018) 7:50.
  10. Assumes median PVC infection incidence 0.2% (Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: Peripheral IV catheter failure. J Infus Nurs. 2015; 38(3): 189-203.); and average PVC dwell time of 3 days.
  11. Centers for Disease Control and Prevention. Guidelines for the Prevention of Intravascular Catheter-Related Infections, 2011. http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
  12. Gorski L. A., Hadaway L., Hagle M., McGoldrick M., Orr M., Doellman D. Infusion therapy standards of practice. J Infus Nurs. 2016;39(suppl 1):S1-S159. https://www.ins1.org/Default.aspx?TabID=251&productId=113266
  13. Society for Healthcare Epidemiology of America (SHEA). Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, 2014. http://www.shea-online.org/index.php/practice-resources/priority-topics/compendium-of-strategies-to-prevent-hais
  14. Duncan, M, Bernatchez, S.F. et al. A Bundled Approach to Decrease the Rate of Primary Bloodstream Infections Related to Peripheral Intravenous Catheters The Journal of the Association for Vascular Access, Volume 23, Issue 1, 15 – 22.
  15. Kilgore, M. and Brossette, S. Cost of bloodstream infections. Am J Infect Control. 2008; 36: S172 (e171-e173).
  16. Elward, A.M., Hollenbeak, C.S., Warren, D.K., and Fraser, V.J. Attributable cost of nosocomial primary bloodstream infection in pediatric intensive care unit patients. Pediatrics. 2005; 115: 868–872.
  17. Mermel L. Short-term peripheral venous catheter-related bloodstream infections: A systematic review. Clin Infect Dis. 2017; 65(10):1757-62
  18. Mestre G, Berbel C, Tortajada P, et al. Successful multifaceted intervention aimed to reduce short peripheral venous catheter-related adverse events: A quasiexperimental study. Am J Infect Control. 2013;41: 520-526.
  19. 3M data on file.
  20. 3M data on file.
  21. Survey of 650 infection preventionists and clinicians, commissioned by 3M and conducted by a third-party research firm in April 2018, Human Factors and the Future of Infection Prevention, 2018. 3M data on file.
  22. Znigg, Walter et al, peripheral venous catheters: an under-evaluated problem. International Journal of Antimicrobial Age sj. Volume l34 S38-S42.
Working in the ER: It’s Not Like on TV

Working in the ER: It’s Not Like on TV

If you’ve ever watched a series like Grey’s Anatomy or ER, you know that hospital scenes are always dramatic on screen. And if they’re in the emergency department—well, they pretty much always are. In real life, though, that’s not quite the case. Sure, there are times where the ER can get hectic. So to get the real truth in honor of Emergency Nurses Week, we decided to go straight to the source.

Sarah Emami, RN, BSN, CEN, CCRN, a staff RN in the ED at Sibley Memorial Hospital admits that she was surprised when she began working as an emergency nurse. “I thought working in the ER would involve a lot more Code Blue situations and ACLS [advanced cardiac life support] protocols. There are a lot of these situations, but mostly you’re preventing people from reaching a critical situation,” says Emami.

Emami, who has worked in the ER for six years, decided to work there because she loves a fast-paced environment as well as having a lot of autonomy as a nurse. Before working in the ER, she worked in the ICU and doing that gave her a lot of critical care experience, albeit at a much slower rate.

Even though she’s worked in the ER for a while now, Emami admits that there are still surprises. “Most people don’t think about the food that they eat: they eat junk food, processed food, and fast food a majority of the time, and they are surprised when they are tired, lethargic, and have GI issues,” she explains. Another surprise is that “people want a fast fix for chronic medical conditions.”

The biggest challenges for Emami about working in the ER are what she calls “boarders.” These are patients who are admitted to the hospital, but have to stay in the ER because there are no available rooms or there’s not enough staffing at the time. Emami also says that managing patient expectations can be tough—like the aforementioned desire for a “quick fix,” and teaching them that the best way to stay healthy is a combination of a good diet, exercise, and stress management.

When she can get through to patients about how to stay healthy, that’s the best. “The biggest rewards are when I can teach a patient something new about their diet, medication, or how to navigate the health care system,” says Emami.

Changing Up the On-Demand Nursing Market

Changing Up the On-Demand Nursing Market

Nurses know what happens when a colleague has to call out due to sickness or an emergency or is due for vacation—others often end up working double shifts. If you want to, that’s one thing. But when it’s required because of lack of staff, it can cause the nurses to feel overworked and contribute to their stress and anxiety. There’s now a nursing staffing agency that operates via an App, and it’s changing the way nurse staffing occurs.

“There have always been nursing staffing agencies that have served our clientele for more than 100 years, but they have historically been using traditional, inefficient methods of scheduling via spreadsheets, fax machines, and telephone. We believe that we are the first truly on-demand, app-based nursing agency for the per-diem market,” explains Chris Caulfield, RN, FNP-C, one of the founders of IntelyCare. “There wasn’t a good solution for nursing coverage for last-minute call outs or to fill in holes in the schedulers’ calendar on a shift-by-shift basis.”

IntelyCare on-demand nursing appCaulfield co-founded the business with health care IT expert Ike Nnah in 2015. They currently serve post-acute nursing organizations using RNs, LPNs, and CNAs. To date, they serve more than 200 skilled nursing facilities, rehabs, and assisted living facilities in Massachusetts, Rhode Island, Ohio, and Pennsylvania.

The business is changing how on-demand nurses are used because they are able to cover a number of shifts that are requested by the facilities with only two- to twelve-hours’ notice. As a result, staff nurses don’t have to pull a mandatory double, and other nurses who can fill the spot get to choose when, where, and how much they would like to work.

Caulfield stresses, though, that this type of work is not for new graduates, as they believe nursing professionals should have at least a year of experience before they begin floating to various facilities. But being able to browse an App and determine extra shifts they can take on is already changing the workplace for nurses.

“On-demand nursing is a great option for nurses who want more flexibility, higher pay, and who like a change of scenery,” says Caulfield. “I strongly believe that over the next two-five years, there will be some flavor of on-demand nursing—either from an outside staffing agency or an Internal per-diem pool—at every licensed health care facility in the U.S.”

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