Speaking from personal experience, many terms (antecedent, parallelism, noun absolutes, etc.) used in perfecting the writings of the proper English language are foreign to nurses.
Granted, as advanced practice nurses, we have practically written a novel of information by the time we graduate from our master’s program and are still unfamiliar with many English language terms other than APA writing style. Despite crafting an impressive field study filled with facts, statistics, and numerous informative findings and formulating individualized daily clinical patient care plans, advanced practice nurses are talented communicators, though not always efficient in perfecting their manuscripts. Forgiving their potential writing inadequacies, many major companies still choose to employ nurse writers in pursuit of their clinical competence and superior evidenced-based knowledge.
How Nurses Obtain Skills to Write Professionally
Although the skills to author the next great novel may not be ingrained in the mind of the average nurse, all is not lost. Nurses are highly adept at communicating complex concepts on all levels of comprehension, whether talking to a physician or a patient; it’s what we do every day. There are several ways to develop the necessary proficiencies for transporting clinical expertise into written education for both public and professional audiences. A few examples are as follows:
Review your favorite blogs or pertinent publications for style/content ideas
Familiarize yourself with content on nurse writer blogs for free information
Take a writing course. Some are even nurse writer-specific
Join a nurse writer Facebook group to learn from peers
Choose a healthcare/nursing niche you know well to offer expert insight
Choose a topic and write, write, write! ‘Practice makes perfect’
Whichever way (I recommend utilizing all available options) you decide to educate yourself and gain the confidence to dip your toes in the waters of being a nurse writer, the most imperative step is taking the first step: action. “As nursing and healthcare continue to grow, nurse writing is a promising field…(&) increasingly popular side hustle” (registerednursing.org) for nurses wanting to make extra money or graduate from the bedside into entrepreneurship.
Why Do Companies Want an Advance Practice Nurse to Write Content?
As nurses, we are not flawless when it comes to impeccable writing content (blog, website, informational brochure, etc.). Still, we know what patients and nurses aspire to know about healthcare and how to explain topics in an understandable manner.
Whether it’s explaining how to perform a procedure or how surgery is done, what to do before/after a procedure, and what to expect, content sourced from an advanced practice nurse creates confidence in knowing information came from a source experienced and well-versed in explaining these processes repeatedly. Although inexperienced in the equities of grammar, advanced practice nurses are committed to evolving into proficient writers of health as inspired by others. Whether it is rhetoric or scientific-based knowledge, nurses hold it all; you only need to unplug the medical jargon to expose the brilliance of nurses.
When a business is granted the opportunity to employ an advanced practice nurse for their content writing needs, the company will succeed others by considering clinical expertise over writing history when choosing new authors. With our combined education and experience, nurses, especially those with an advanced degree/certification, possess an in-depth understanding of health and its deterrents, making those in the profession firsthand experts on managing health situations and, therefore excellent at formulating health-related literature.
Patients with alterations in level of consciousness are among the most difficult to assess and may have subtle neurological changes that can occur suddenly and become life-threatening if they go unnoticed.
Nurses who care for these patients must have the knowledge, skill, and time to confidently perform comprehensive neurological assessments to identify changes that require quick diagnosis and intervention by the multidisciplinary team, according to a new article in Critical Care Nurse.
Co-author Melissa Moreda, MSN, APRN, ACCNS-AG, CDCES, CNRN, SCRN, is an inpatient diabetes clinical nurse specialist at Duke Raleigh Hospital in North Carolina.
“Neurologically impaired patients are among the most vulnerable, often unable to communicate, advocate for, or defend themselves,” she says. “Direct care nurses are at the forefront of care, and it’s imperative to understand key components of an assessment and be able to evaluate trends rather than isolated events.”
The article provides guidance for conducting a thorough neurological assessment, including:
General behavior and body position
Vital signs
Level of consciousness
Mental status
Motor control and sensory function
Cranial nerve function
Pupillary response
Language and speech
Reflexes
Cerebellar function
Many of the components of a neurological assessment are subjective, and changes in status may be subtle, requiring ongoing and astute monitoring. When minute changes are identified quickly, interventions critical for brain preservation can be implemented rapidly to prevent long-term complications and provide quality care for patients with altered levels of consciousness.
Working with pregnant and breastfeeding families for 40 years, I’m passionate about women’s health and empowering women.
The woman’s body is amazing, providing the perfect recipe for milk for their babies. Humans produce milk for human babies, which makes it the best for feeding our little ones while providing benefits for both mom and baby.
Benefits of Mother’s Breast Milk
Our practice relies on evidence-based research that strongly supports the newborn health benefits of breastfeeding. Breastmilk is proven as the best for preterm infants and the prevention of necrotizing enterocolitis (NEC).
The benefits for moms include faster weight loss in the postpartum period since she burns 500 calories a day by producing milk for her baby. The risk for breast cancer, ovarian cancer, Type 2 diabetes, and high blood pressure decreases for a mom’s lifetime risk if she ever breastfeeds a child.
Breastfeeding creates a special bond between mom and baby for which a price tag cannot be placed. It is known that “happy” hormones are released during this bonding time.
Another benefit of breastfeeding is the cost savings and no need to warm breast milk-like formula at 3 am. The formula is also harder on the baby’s gastrointestinal tract. All the above reasons are why breast milk is often called “liquid gold.”
Breastfeeding sends immunities to babies, so during Covid, we encouraged all our moms to breastfeed. The American College of Pediatrics recommends breast milk through the first year of life for all these reasons.
Advise Caution with Weight Loss Drugs
I want to warn expecting and new moms about taking weight loss drugs, such as Ozempic, during pregnancy and breastfeeding.
We recommend that patients wait at least two months before becoming pregnant due to the limited studies done on these drugs based on some limited animal studies. Due to the molecular weight, the amount of drug that passes through the milk is likely low, so the risk of passing to the baby through milk may be lower.
Our recommendation to breastfeeding moms is to avoid these drugs while breastfeeding until more studies have been developed. Be sure to remind moms that breastfeeding burns 500 calories, equating to weight loss in the postpartum period.
Choosing a Breast Pump
Breast pumps can be overwhelming when it comes time to choose one. A mom’s and baby’s needs change throughout their breastfeeding journey, so I recommend a pump that can adapt to those changes. Luckily most insurance companies will cover a breast pump.
The best time for moms to start thinking about choosing a breast pump is around 32 weeks of pregnancy. Ideally, an appointment with a lactation consultant for a prenatal breastfeeding consult can help with those choices. I have a sample in my office to show moms what they are all about and help them make an informed choice.
Keep in mind moms returning to work or those who have busy schedules need to bring their pumps with them, so one that has a rechargeable battery is a great option. They don’t need to be attached to a plug if they want to pump.
Some pumps have a handle, making them easy to carry around. Some have night lights which may be a good option for some moms. There are single manual pumps and double electric. The double electric means both sides are pumped during a pumping session which is important since it stimulates both breasts. It has been shown to get 18% more milk by pumping both breasts simultaneously, with higher fat and calorie content.
Most pumps are designed with two modes of expression to mimic the baby’s natural sucking behavior. The first mode is the short, fast sucks to stimulate the let down reflex. The second mode is a slower, stronger sucking. Most pumps come with two flange sizes, and it would be helpful to see a lactation consultant to have a flange fitting after delivery since the nipple and breast change sizes at that time. The proper fitting flange is essential for comfort and efficient milk production. Different size flanges can be purchased with inserts that customize the flange to nipple size.
Consider recommending moms add a silicone hand pump to their shower wish list. Silicone pumps are handy and easy to use. The Haaka is a brand name, but any generic works the same. They can be used to put on one breast while feeding on the other side to collect the milk that drips while nursing. The amount can be over an ounce of “liquid gold’ collected and then saved and labeled in a freezer bag.
Another great wish list item is a hands-free pumping bra. They are comfortable and reasonable in price. The flange slides into the bra so moms can be hands-free with their double electric pump.
Benefits of Hands-Free Pumps
Hands-free pumps (Elvie Stride, Mom Cozy) have had mixed reviews from moms. They are costly but convenient. They are hands-free and go in the bra, so moms can do things while pumping. They are small, and each has a collection reservoir built into the pump. They are convenient if moms have a job where they work at a computer or desk and want to pump while they continue to work. Some moms say the suction is less effective than the double electric pumps, but they work well for their work environment.
Time and Space for Breastfeeding Journey
Encourage moms to check out the laws for having time and space (not a bathroom) to pump if they work for a company with 50 or more employees. The Fair Labor Standards Act (FLSA) states, “Most nursing employees have the right to reasonable break time and a place, other than a bathroom, that is shielded from view to express breast milk while at work.”
Remind new moms to stay calm during their breastfeeding journey. It’s an exciting time, and they can reach out for help. Moms should feel confident they are giving their baby an amazing gift. Most importantly, they must enjoy time with their baby because time goes quickly, and they will support their growing families before they know it.
While the average person probably thinks that nurses working via telehealth is something new that came about during COVID, that couldn’t be further from the truth.
“I have personally been practicing in telehealth for the past eight years,” says Mariea Snell, DNP, APRN, FNP-C, an associate professor of nursing and the director of the Doctor of Nursing Practice Programs at Maryville University. “I think the pandemic changes how people access care in large numbers, but it is not new. Many people with access issues due to physical disabilities or needs have used these systems. Others did not fully understand what it could do until put to the test.”
Georgia Reiner, MS CPHRM, a Risk Analyst at the Nurses Service Organization (NSO), agrees that telehealth has been around for a while. She adds, though, that its use has dramatically increased.
“Some nursing professionals, mainly advanced practice registered nurses (APRNs), including nurse practitioners (NPs), worked in telehealth before the beginning of the pandemic. However, there has been a dramatic increase in the utilization and availability of telehealth services due to policy changes implemented in response to the COVID pandemic,” says Reiner. “For example, an analysis by McKinsey & Co found that telehealth accounted for less than 1% of Medicare services before the onset of the pandemic, but by July of 2021, telehealth services accounted for about 13-17% of claims submitted to Medicare. Additionally, licensing requirements were relaxed in many states, which helped enable nursing professionals to practice across state lines via telehealth, as were requirements that patients have an established relationship with a provider before they could receive telehealth services. However, many of those policy changes are set to expire at the end of the public health emergency, leaving the future of telehealth services somewhat in question.”
Additional Training
If you’ve never worked in telehealth before, you may wonder if it’s necessary to receive additional training before working in it. The answer is yes and no.
“All nurses can participate in telehealth,” says Snell. “They would provide the level of care that each are currently licensed to provide. In the case of a DNP/NP, they would treat patients the same way they would in an office setting.”
However, the training that nurses would and could receive will depend on several factors.
“Nurses and advanced practice registered nurses may receive training through their educational programs on the use of telehealth. If nurses do not receive this training in their educational preparation, they may receive it through their employment or workshops and educational programs. There are certification courses that are available for healthcare providers to take as well,” explains Robin Arends, DNP, CNP, FNP-BC, PMHNP-CE, CNE, FAAN, FAANP, the APRN Program Director at South Dakota State University as well as a nurse practitioner at Avel eCare. She’s published and presented both workshops and talks about all aspects of telehealth—regionally, nationally, and internationally.
Nurses have worked in a variety of settings in telehealth—such as school nursing, critical care, emergency care, specialty care, and geriatrics, Arends says. Be sure to check if the state you’re practicing in mandates training or taking a test before providing telehealth services.
She continues: “Nurses should be trained to use the telehealth equipment to complete the assessment and how to help others at a remote location use the equipment. They should understand how to appear on camera and communicate with patients through technology. Nurses should be aware of the background that the patient sees on camera and any sounds occurring in their environment. Nurses must know and comply with HIPAA, information security, and confidentiality. Nurses should also be aware of licensing requirements as they need to be licensed in the state where the patient is located.”
Because she works as a risk analyst, Reiner takes a deeper dive when explaining the training nurses need and why.
“Nursing professionals working in telehealth need to verify with relevant state professional licensing boards the practitioners — known as “qualified providers” — who can legally provide telehealth services. Nurses must be appropriately credentialed to practice in the state(s) where their patients or clients are located and work under that state’s scope of practice for nursing professionals,” Reiner says.
“Prior to beginning any telehealth work, nurses need to be prepared and have a backup plan in place in case of an emergency or technology breakdown. In addition to obtaining their patient’s/client’s consent before participating in telehealth services, nurses must also clearly convey to their patients/clients the inherent technical and operational hazards that may impede communication, such as:
System compromise or hardware failure, which could lead to an incomplete or failed transmissions.
File corruption or other data transmission issues, resulting in less than complete, unclear, or inaccurate reception of information or images.
Unauthorized third-party access, which may lead to data integrity or information security problems.
Natural disasters, such as hurricanes, tornadoes, and floods, which can potentially interrupt operations and compromise computer networks.
Whether a nurse can or should provide telehealth services from their residence depends on factors including state regulations, their employer’s policies, and procedures, their home environment and infrastructure, their ability to comply with technical, security, and confidentiality considerations from their home, as well as the nurse’s comfort level with engaging in telehealth practice from their home.”
Challenges
Working in telehealth may seem much easier because it can be done from nearly anywhere. However, there are some challenges to working in it.
“The biggest challenge is that providing services via telehealth is so different from traditional, in-person care, where a patient is physically present in front of the nurse. When providing telehealth services, the nurse relies entirely on technology for the patient encounter. In addition to adhering to traditional clinical standards of care and practicing within the scope of practice authorized by law, there are also technical considerations,” says Reiner. “Equipment and software must be routinely tested, maintained, and updated for quality assurance. Nursing professionals and their employers must also track how well a telehealth program functions carefully. Indicators should capture clinical, efficiency, and satisfaction outcomes, including:
Patient/client complication and morbidity rates
Compliance with provider performance criteria
Diagnostic accuracy
Adherence to clinical protocols
Referral rates
Patient/client satisfaction levels
Cost per case
Delays in accessing consultations, referrals, or specialty practitioners
Arends says that another challenge is that nurses must remember to maintain licenses in the states where their patients are located—and follow that state’s practice rules and regulations.
Remember Documentation
Just as you would if seeing a patient in person, nurses need to do documentation.
“Telehealth sessions should be as thoroughly documented as all other patient/client encounters. Just because some information may be automatically captured by software doesn’t negate the nurse’s professional responsibilities around documentation,” Reiner states. “Documentation in the patient’s medical record should be in accordance with the same documentation standards of in-person visits—including documentation of all communications with the patient or other providers (whether verbal, audiovisual, or written), clinical observations, orders, test results, and patient education and follow-up instructions.”
Telehealth Helps Nurses Become a Key Player
According to our sources, if you haven’t decided whether to look into providing telehealth, you should.
“Nurses should consider getting into telehealth because this is the direction that healthcare is going in. Incorporating technology in care will continue to develop and will never go back,” says Snell. “It is important to stay current with this trend. You won’t necessarily make more money, but you will be more marketable and have a better work-life balance.”
Arends agrees. “Nurses should consider working in telehealth because there are increasing opportunities in this area of healthcare. Patients saw the benefit of telehealth during COVID and want to continue to receive healthcare through this modality. Telehealth has shown high patient and provider satisfaction. I predict that telehealth will only continue to grow and expand.”
In addition, Arends believes that nurses will become key players in telehealth. “Nurses are the core of healthcare. In traditional settings such as hospitals, they are the first to alert providers to changes in the patient’s condition and are truly the front lines of healthcare. This will continue to be seen in telehealth,” she says. “Many studies have shown that nurses utilizing telehealth for remote monitoring as well as real-time audio video telehealth formats have reduced complications and readmissions and increased access to care.”
The benefits to patients are seemingly endless. “Nurses work where the patients are. Some patients cannot travel to clinics because of weather, physical condition, or other factors. Nurses who work in telehealth can care for patients when the patients are not able to seek care from traditional locations. Like home visits, nurses can visit the patients in their home environment. They can assess how the patient moves and works in their environment. They can assess for safety hazards in the home environment as well.”
Finally, working as a nurse with patients in telehealth can also be immensely rewarding. “The greatest award of working in telehealth is helping the patient achieve the best health outcomes while minimizing barriers to accessing healthcare,” says Arends. “Helping a patient who may not be able to access healthcare for various reasons achieve control of chronic diseases or feel healthier is a huge reward for telehealth. In addition, helping patients meet their personal care goals in their preferred environment is also optimal.”
The soaring fame of GLP-1 agonists, like Ozempic, developed to assist individuals in managing Type 2 diabetes and obesity, has garnered attention in the media due to its side effect of weight loss, catching the interest of celebrities and influencers. However, this surge in popularity has also led to questions concerning the potential impact of these medications on pregnancy and fertility.
Overview of Ozempic
Ozempic (semaglutide) is an injectable (subcutaneous) prescription medication that’s part of a drug class of medications known as GLP-1 (glucagon-like peptide-1) agonists. It mimics a hormone found naturally in your body, GLP-1 (produced in your gut and released when food is consumed), which regulates digestion, insulin, and blood sugar levels. GLP-1 agonists enhance glucose-dependent insulin production, reduce glucagon (which increases blood sugar levels) production, slow gastric emptying, and promote satiety, which can lead to weight loss.
In addition to managing blood sugar levels in individuals with type 2 diabetes, Ozempic is used to lower the risk of serious cardiovascular events in those with a history of heart diseases like heart attacks or strokes.
This medication is FDA-approved for managing type 2 diabetes when accompanied by an appropriate diet and exercise regimen. Although weight loss is a common side effect, it’s important to note that Ozempic is not FDA-approved for weight loss but may be prescribed off-label by healthcare providers.
There is currently no generic for Ozempic (Semaglutide), resulting in higher costs, even for individuals with insurance coverage. Ozempic can also be bought without insurance through online pharmacies like Marley Drug, which offer free home delivery via cold shipment.
Side Effects of Ozempic
Some common side effects of Ozempic may include the following:
Weight loss
Nausea
Vomiting
Diarrhea or constipation
Stomach pain or discomfort
Injection site reactions
Hypoglycemia
Some serious side effects of Ozempic may include the following:
A lump that may appear in your neck
Difficulty breathing and swallowing
Vision problems, including vision loss, spots or dark strings floating in your vision, and blurred vision
Feeling anxious, including shakiness
Confusion
Swelling that may occur in your legs, ankles, and feet
Rash or itching
Risks
Ozempic should be avoided if a patient has multiple endocrine neoplasia type 2, a history of medullary thyroid cancer, insulin-dependent diabetes, or diabetic ketoacidosis.
Black Box Warning
Ozempic may increase the risk of developing thyroid C-cell tumors.
This medication may cause pancreatitis.
Ozempic may also cause diabetic retinopathy complications.
Can Weight Loss Drugs Impact Fertility?
Healthcare providers may prescribe weight loss drugs, like Ozempic, to patients with specific conditions such as polycystic ovary syndrome (PCOS) or those undergoing in vitro fertilization (IVF). As you may already know, PCOS is characterized by irregular periods, elevated androgen levels, and obesity. And for those living with obesity or who are overweight, hormonal imbalances can disrupt ovulation.
Research suggests a connection between obesity and infertility, especially when ovulation disorders are present. However, even a modest amount of weight loss can help restore hormones essential for ovulation while lowering the risk of miscarriage and pregnancy-related complications.
Conversely, underweight individuals might experience a reduction in estrogen production, leading to a lack of ovulation and regular periods. Remember that ovulation is vital for the release of an egg, which needs to be fertilized by sperm for conception to occur.
According to the manufacturer of Ozempic, considering the drug’s half-life, it’s recommended that individuals taking Ozempic discontinue the medication at least two months before trying to conceive to minimize any potential impact on fertility during this period.
Is it Safe to Take Ozempic During Pregnancy?
The safety of using Ozempic during pregnancy remains uncertain due to limited data on its effects on pregnant women. While animal studies have indicated potential negative impacts on pregnancy outcomes, the direct implications for human pregnancies are still unclear.
Due to the lack of comprehensive human studies and the potential risks involved, it is generally advised to avoid taking Ozempic during pregnancy. Some animal studies have shown that pregnant rats exposed to Semaglutide experienced congenital disabilities and pregnancy losses. Although the effects observed in animal studies may not directly translate to humans, the potential risks of taking Ozempic while pregnant are considered significant unless there is a compelling medical reason to do so.
According to the recommendations from the manufacturers of Ozempic, taking this medication during pregnancy should only be considered if the benefits to the developing fetus significantly outweigh the potential risks involved. Although the importance of understanding that while it has its risks of severe side effects, uncontrolled diabetes during pregnancy can also have detrimental consequences. Poorly managed diabetes during pregnancy can increase the likelihood of congenital disabilities, preterm delivery, and pregnancy loss. Therefore, making decisions about using then product during pregnancy requires carefully evaluating the risks and benefits to ensure the best possible outcome for both the mother and the developing fetus.
Both weight loss and malnutrition during pregnancy can lead to complications and harm to the fetus. Therefore, the use of Ozempic during pregnancy should be carefully assessed for its potential risks and benefits by the patient’s healthcare provider.
Is it Safe to Take Ozempic While Breastfeeding?
Although the presence of Ozempic in breast milk has been observed in animal studies, its impact on human breast milk remains uncertain. Traces of Ozempic were detected in rat milk, but the transfer of medications into human milk may vary between species due to differences in lactation processes. While the extent of Ozempic transfer into human milk is not well-established, it is generally believed that if a drug passes into rat milk, it may also pass into human milk.
As a result, since the potential risks to nursing infants are not fully understood, healthcare professionals typically advise against using Ozempic while breastfeeding unless the benefits of the medication significantly outweigh the potential risks.
The American Association of Nurse Practitioners (AANP) commends Sens. Merkley (D-OR) and Lummis (R-WY) for introducing the Improving Care and Access to Nurses (ICAN) Act in the U.S. Senate.
This legislation would strengthen healthcare access for Medicare and Medicaid beneficiaries by removing federal barriers to practice for nurse practitioners (NPs) and other advanced practice registered nurses (APRNs).
“Every day, nurse practitioners are striving to meet our country’s growing need for high-quality healthcare in all practice settings yet outdated federal barriers limit patient access to NP-provided care,” says AANP President Stephen Ferrara, DNP. “This important legislation will move our nation’s healthcare system toward one that more accurately reflects the modern healthcare workforce. It is vital that the millions of Medicare and Medicaid patients who choose NPs receive timely access to high-quality healthcare. AANP applauds the introduction of the ICAN Act by Senators Merkley and Lummis in the U.S. Senate, and we urge its swift passage by Congress.”
NPs are the fastest-growing Medicare provider group, and approximately 40% of Medicare beneficiaries receive NP-delivered care. The ICAN Act would improve timely access to care by authorizing NPs to order cardiac and pulmonary rehabilitation, certify when patients with diabetes need therapeutic shoes, have their patients fully included in the beneficiary attribution process for the Medicare Shared Savings Program, refer patients for medical nutrition therapy, certify and recertify a patient’s terminal illness for hospice eligibility, perform all mandatory examinations in skilled nursing facilities, and more.
AANP strongly supports the ICAN Act and efforts to modernize policies to ensure every American has timely access to high-quality healthcare from their chosen healthcare provider. Earlier this year, the House of Representatives introduced companion legislation that has garnered the support of more than 235 national, state, and local organizations.
