Getting Millennial Nurses to Commit to Your Organization

Getting Millennial Nurses to Commit to Your Organization

We know firsthand what it’s like to be a parent to a millennial nurse. My millennial daughter is married to a travel nurse. They are out living the dream in their “tiny house” on wheels with a beautiful cream-colored golden retriever named Arlo. Jennifer, a nurse herself for 43 years, is a mother to a millennial travel nurse living the good life in California. We each understand the challenges of raising millennials and the challenges of keeping millennials engaged within your organization.

Millennials have a different view of the world than previous generations. Gauging what’s important to them and how to keep them engaged can be daunting. According to the Advisory Board, engagement for a millennial is not a predictive index of intent to stay with a company. Most people think engagement equals loyalty. This is not the case with the millennial nurse. The millennial nurses of today have witnessed their parents go through the ‘great recession’ where they witnessed their parents struggle as loyalty was thrown aside by their employer. The millennial nurse enters the nursing profession with student debt unseen in other generations, creating the desire to move ahead financially to pay down these debts. The millennial nurse is technologically savvy and enjoys being intellectually challenged in new ways; they will resist outdated training and onboarding methods. The millennial nurse also prefers a set schedule, so they can plan their “experiences,” which is more important to them than owning a big house or a nice car.

As professionals in the health care industry and parents to millennial nurses, we suggest switching engagement tactics to drive loyalty from millennials. Deciphering what engagement tactics will work is not as complicated as it sounds. Our best advice: think like a parent and be open to trying out our several tactics below.

Provide a platform for opinions

Millennial nurses want to have input on some issues and appreciate when their opinions are valued. This makes millennials great contenders for a shared governance model. Giving millennial nurses ownership over projects allows them to have a voice in their practice. During staff meetings, millennial nurses have the opportunity to provide input and voice their opinions on the projects that they own. Their peers also have the chance to give feedback, so that the nurse feels valued and respected.

Giving the nurse decision-making influence sets them up for future career advancement and anchors them to the organization.

Understand the environment millennials have grown up in and adapt

As mentioned previously, millennials are burdened with student loan debt more than any other generation before. The average student loan debt for Class of 2017 graduates was $39,400. Given this financial pressure, millennials are looking to advance more quickly in their careers to earn a salary that will offset the added loan payments. Due to the impracticality of quick career advancement, millennials will often take alternative routes in nursing such as travel assignments to earn more money faster.

Since millennials are flocking toward travel nursing, it’s essential to offer bonuses and paths to career advancement within your organization to get them to commit.

Get rid of formal critiques and establish mentorship programs

Millennials also prefer coaching or mentoring over formal critiques and reviews. Constructive criticism is the preferred method of addressing concerns and improvement among employees. However, millennials are more open to receiving feedback from an ally—someone who is championing for their success.

A well-matched nurse preceptor has much power in determining the loyalty of a millennial nurse. Nurse preceptors have the responsibility to address any concerns of the millennial nurse and offer guidance to any problems. This role requires a lot of empathy and intuition to establish a relationship of trust and mentorship among millennial nurses.

Ask what’s important to them

Asking a simple question could be the defining line of what determines a millennial nurse’s decision to stay with an organization. Ask these types of questions in one-on-one meetings with your nurse:

  • What is most important to your job satisfaction here?
  • What are your career goals?
  • How can I help you achieve them?
  • What type of recognition do you like to receive?
  • What is one thing I can do today to make your work more enjoyable?

Asking these questions will show a millennial nurse that you are committed to their success and happiness. They, in turn, will commit to you and the organization if they know you have their best interests in mind.

Tailoring engagement tactics to bring forth loyalty does not have to be a significant project, nor will it require extra time. Following the above guidelines and tracking retention will provide a great baseline to see if your millennial nurses become more committed to the organization.

Working as a NNP in a Level 2 Special Care Nursery

Working as a NNP in a Level 2 Special Care Nursery

I am privileged. I have been to the other side and experienced that the grass is greener. The majority of my career as a Neonatal Nurse Practitioner (NNP) has been in a Level 3 NICU with all the bells and whistles of high acuity, ECMO, high-risk deliveries, transport, and high patient volume. However, I then gained the privilege to also work as a NNP in a Level 2 Special Care Nursery (SCN). What a difference! But also, how similar!

The job tasks are identical … morning signout, collection of data from the medical record, physical exams, and writing notes. I touch base with the bedside nurse, case management, social worker as needed, and any ancillary staff. Consults are typically by phone. Sporadically, we may physically see an ophthalmologist, ENT, or cardiologist; but these occasions are not usual and customary. In addition, I can stand in one spot with full visual assess to all patients; as long as the census does not exceed 7 in the ‘main unit.’ The unit has evolved from a one room unit with one light switch, where either all lights were on, dimmed, or off equally. The SCN now is a state of the art unit of 7 individualized spaces to offer developmentally appropriate care, more patient privacy, and family-centered care. It is phenomenal!

Now, one may be thinking what a piece of cake. Well before we slice the cake, the grass really is not always greener. You see, regardless of the nursery level, the families are all experiencing a crisis. Acuity and level of nursery does not matter! The hopes, dreams, and vision these families had for their pregnancy, birth, and hospital experience are all shattered in the blink of an eye. The level of medical acuity has no direct correlation to the level of crisis for families. Due to lower medical acuity and lower patient volume, I am afforded the privilege of being able to take more time with families. I have the pleasure of sitting next to them, listening with my ears and eyes, to be in the moment with them. I can truly experience what the crisis or fears are. I feel a great sense of connection with the families. Regardless of the nursery level, these families become our family during their infant’s hospitalization. The communication, both active and passive, are vital for these families to emotionally survive this experience.

I have never experienced cross-trained nurses prior to working in a Level 2. This certainly is another privilege! This has positively enhanced my perceptions of the significance of the staff nurse presence in the delivery room, nursery, and postpartum area. In a Level 2, there is a staff of one NNP per 24-hour shift with attending back-up. The attending does rounds and meets with us daily, is present for all high-risk deliveries, and is always just a phone call away. This was a change coming to a Level 2. I realized how much I depend on my colleagues by just randomly shouting out to a fellow practitioner … ”What do you think?” Here, there is no one to just ‘bounce’ something off. However, it does afford me the opportunity to strengthen my knowledge by needing to know the answer ‘why’ and utilizing resources to confirm, learn, or discover answers. Because of the lack of colleague presence, the cross-trained nurses are a life-saver. They have a different level of competency, assessment, and confidence. It was awkward at first coming from a staff of 20 nurses per shift to having only 1 or 2 nurses. It truly reinforces the impact of communication and establishing rapport with others. Since there are fewer nurses, you work with people more infrequently, so communication, planning, and evaluating are essential—especially when those emergent situations do occur.

I still have the privilege of experiencing transport in a Level 2. The exception is that instead of going to receive the infant, I am sending them out. What an eye opener! This is where experience, confidence, and collaboration are vital. I remember my first meconium that clinically decompensated and overhearing, ‘I can’t remember a baby being this sick here.’ What a powerful lesson! This has afforded me another privilege of truly understanding the significant impact on providers and staff in managing these infants in an environment where resources may be more limited or staff may not be routinely used to managing these infants. I feel I have gained a level of inner strength, confidence, and resilience in handling distress in the clinical setting. It also reinforces the magic of nursing. Just like a Level 3, in a Level 2 the level of teamwork is there with everyone pulling together to do what is needed. Though a sick patient who requires transport is not usual and customary, the nurses are able to stabilize and do what is needed to optimize patient outcome. As a NNP, it is a humbling experience. Typically, as I stated previously, on transport I would pick up these infants to ‘give them what they needed.’ Recognizing you can’t fix this and need help is a character builder and essential professional trait.

In summary, I am privileged to experience the green grass on both sides of my world. I am so appreciative for my Level 2 experience because I am more proficient in looking outside of the box. I am not only a better practitioner, but a better listener, communicator, and mentor as well. I certainly have gained more than I can ever give back. And with that …I will go slice that piece of cake!

8 Tick Prevention Tips to Use Now

8 Tick Prevention Tips to Use Now

While it’s possible for ticks that carry Lyme disease or other tick-borne infections to be present year-round, they’re especially active in the spring and the summer months. May is Lyme Disease Awareness Month, and it’s a good reminder to exercise extra caution when you’re outdoors. To prevent tick bites when you’re outside, following these recommendations, according to the CDC.

1. Be cautious of your surroundings.

Wooded areas, leaf litter, and tall, overgrown grass are among the favorite hangouts for ticks. Steer clear of these areas as much as possible. If you enjoy hiking, walking, or running in wooded areas, try to stay in the middle of the paths or trails.

2. Use tick repellent.

The CDC recommends using a long-lasting tick repellent on your skin that consists of at least 20% DEET, picaridin, or IR3535. When applying the product on children, use the product as instructed.

If you’re looking for a natural alternative to chemical sprays, rosemary, lemongrass, cedar, peppermint, thyme, and geraniol essential oils have tick-repellent qualities and are commercially available at many stores.

3. Spray your clothes.

Planning to be outdoors for several hours to days? If so, consider pre-treating your clothes with a product containing 0.5% permethrin. Permethrin lasts for several washes and can also be used on outdoor gear like tents and hiking boots. Additionally, you can purchase pre-treated clothing from a variety of well-known sporting goods stores.

4. Bathe when you come indoors.

The CDC suggests bathing within two hours of coming indoors to wash off or identify any ticks that may be crawling on you.

5. Perform tick checks.

When you come in from outside, scan your body for ticks. This time of year, nymph ticks are the most active and may be small (like the size of a poppy seed) and can easily go undetected. Use a mirror so you can check your entire body, paying particular attention to the more hidden places like the belly button, behind the ears, the scalp, the armpits, the groin, and the back of the knees.

If you find a tick, promptly remove it by placing a fine-pointed pair of tweezers between the skin and the tick, and pull it straight out. You may want to save the tick to be tested and consider talking with your doctor. In highly endemic areas, your physician may choose to do a prophylactic course of antibiotics, or they may take a different approach to monitoring tick-borne diseases.

6. Check your outdoor gear.

Ticks can hitch a ride on practically any item, so be sure to carefully look over your things before bringing them into the house.

7. Inspect your pets.

Another vehicle ticks can use to move from one place to another is your pets. In addition to examining your pet’s fur, the American Kennel Club recommends looking in their ears, between their toes, under their tail, in the genital area, around their eyes, and under a collar or harness.

If you’re unsure of how to protect your pet this season, talk with your veterinarian about your options.

8. Dry your clothing using high heat.

To kill ticks that might be on your clothing, use the highest heat setting on your dryer for 10 minutes—ticks can withstand cold and medium temperatures.

Many people who contract Lyme disease or other tick-borne infections have no recollection of being bitten by one of these bloodsuckers. Although it may seem like a hassle, take tick prevention seriously because a small tick bite can cause significant health problems.

Why It’s Great to be a Nurse in 2018

Why It’s Great to be a Nurse in 2018

Whether you’re caring for patients, assisting physicians, or talking with families, you love what you do. No day is ever the same. We asked nurses why they love being a nurse in 2018. They gave us many different reasons, but they all agree on one thing: being a nurse rocks!

Thanks to all who contacted us. Here’s what some of your fellow nurses had to say.

“I get to help celebrate new life with mothers/fathers and family members by working in the Mother/Baby unit. Where else can you celebrate a new beginning, literally every day?”
—Teresa Kilkenny, DNP, APRN, CPNP-PC

“Being a nurse is great because I can focus on the holistic care of the patient—taking care of their physical, emotional, social, and spiritual needs.”
—Kim Hinck, BSN, RN

“I’m excited to be a nurse in 2018 because as health care evolves and improves, our ability to make a difference in our patients’ lives improves as well. Every day that nurses go to work, they have an opportunity to make a difference. That difference can be with lifesaving interventions or it may be providing explanations to our patients and their families in their times of need. Every day as a nurse is different and exciting, but also incredibly rewarding knowing your actions matter.”
—Megan Meagher, RN, CFRN, Care Fight Flight Nurse Truckee Base Supervisor

“With all the changes in health care over the past few years, I look forward to nursing in 2018 to bring innovative partnerships with community members, focusing on enhancing healthy lifestyles and preventive patient care through REMSA’s outreach programs in community and rural health.”
—Kristine Strand RN, BSN, REMSA-Care Flight Clinical Services and Quality Manager

“As more and more evidence confirms the high-quality care that nurse practitioners provide patients, 2018 is a great time to be a nurse practitioner (NP)! NPs are recognized for delivering patient-centered, comprehensive care, and meeting the health care needs of patients in more than 1 billion visits annually. NPs are improving access to primary care nationwide and consistently demonstrating excellent patient outcomes.

With CARA, NPs have stepped up to the plate to help combat the opioid crisis. Beyond primary care and our work to provide care to the nation’s most vulnerable populations, NPs working in acute and specialty care are also meeting the growing the needs of health care systems and the demand for mental health services as mental health NPs. The opportunities to make a difference for patients, families, and communities have never been greater—making 2018 a great year to be an NP—and a great year for states to enact full practice authority so that all patients can directly access NP care.”
—Joyce M. Knestrick, PhD, CRNP, FAANP, President, American Association of Nurse Practitioners

“I think it is great to be a nurse in 2018 because the different ways in which you are able to help patients is endless. From floor nursing to rare disease education, from a cruise ship to an elementary school, from the beginning of life to the end, and every phase in between, there is a nurse who is willing to listen and do all they can to make your day a bit brighter.”
—Shannon Ambrose, RN-BSN, Clinical Nurse Educator at Horizon Pharma

“As I look back on my career, I realize my practice has spanned four decades! It has been great to watch our practice change from routine to evidence-based (EBP) and the application of technology to both diagnostics and patient teaching. As an OB nurse, one of the most gratifying moments is when a new life is delivered into a mother’s waiting arms. Being able to help families identify their baby’s signals can give a new parent the confidence they need to get through the first night at home. As a nurse, I have so many tools to utilize for parent teaching, and we can customize them to our families’ needs and language—such as teaching them comfortable breastfeeding positions or practicing mindful diapering to promote bonding and protect sleep (something every new family cherishes!).

I remember my first months as an OB nurse in the 1980’s and feeling conflicted when some of my colleagues taught patients based on their opinions that babies could be held ‘too much.’ Fortunately, science has proved hugging your baby improves brain development, so nurses can encourage bonding. I can hardly wait to see what the future of nursing holds and will get to watch it unfold through the eyes of my daughter-in-law, Becky Faifer, who chose the NICU as her nursing home.”
—Felicia Fitzgerald BSN, RN, RNC-OB, C-EFM, CLNC, Perinatal Outreach Educator and Huggies Nursing Advisory Council member

“It’s not every day you hear that someone loves what they do after doing it for 35 years. I can say that I have the opportunity to live my passion every day and have for 35 years in the NICU. I get to observe and listen to the language of babies and even sometimes speak for them. Many medical technologies have changed the course of premature infant lives over the past 10 to 15 years, but one of the most powerful is simply listening and observing the language of their movement, cues, and cries. I love teaching parents and the health care team about the uniqueness and language of the premature infant and how every touch and relational experience we have with the premature infant can have impact on who they will become.”
—Liz Drake, RN-NIC, MN, NNP, CNS, NICU Clinical Nurse Specialist at CHOC Children’s and Huggies Nursing Advisory Council member

Precepting, Part 1: The Trials of Teaching

Precepting, Part 1: The Trials of Teaching

I had the opportunity to precept a nursing student this month and I thought it would be a perfect blog post to share with you all, from my perspective as a nurse, and that as a student who not too long ago completed the preceptorship process myself. As it turns out, both parties have a lot to teach, a lot to learn, and a lot in common.

Here are six things I learned from my precepting experience.

1. I am tired.

No matter how hard I tried to be wide awake and energetic for my student, I realized I am just exhausted. My life is exhausting, my job is exhausting, and frankly, my student is exhausting. Lesson to be had from this slew of exhaust: space out your days when precepting a student. There are sacrifices to be made when precepting, and giving up the 3 on, 4 off perfect schedule is one worth making. The weeks where I was 2 on, 2 off, 1 on were refreshing for both my student and myself, even if we had different patients. In all reality, my student needed more variety in patient load anyhow, so it’s a win-win.

So, if you’re shadowing me and I’m visibly exhausted, hold me accountable! Don’t let me slack on teaching, but do realize there are times when you can use your resources to look things up, too. Sometimes I just need my morning coffee, too, so don’t worry if at 6:35 am I’m not bright eyed and bushy tailed—I’ll get there by 9, I promise!

2. I will never get to bed “early.”

All that being said, I will not and cannot get into bed as early as I wish every night. I definitely have my nights where I go to town and make it happen, but that’s not going to be every night before precepting, and that’s OK. I spent so much time beating myself up about not getting into bed early enough and not packing my lunch ahead of time so I could get more sleep that I could’ve just been taking a power nap. Chances are, students probably don’t go to bed before midnight, either.

3. I’m not that smart, and I probably won’t ever be, and that’s OK.

Nope. I don’t know. I don’t know the obscure gene correlation between the microorganism and its vectors or whatever mumbo jumbo there is to know. But you can absolutely ask! Please ask me, but please don’t judge me when I don’t know! Let’s look it up together and learn together. I would be a bad nurse if I told you I knew every single thing.

Further, quite honestly, there is nothing worse than a know-it-all, and we all know that. When you come into work with the idea that you know more than me, need to teach me, and want to point out in rounds that you know more than me, it just turns me off to teaching. I do believe you really know more than me and have lots to teach me, just remember that there is a time and a place for everything. Let’s have a “think through” discussion where we sit down and get a break, instead of debating in front of a family. Even a healthy debate about medical treatment can come across as inconsistency and lack of confidence to a family who doesn’t know the terms that we’re speaking about.

You are smart—this I know—but I am also here to teach you about my experiences, and that I do have more of, so allow me to help you put all of your awesome knowledge into clinical experience, too!

4. I make a lot of mistakes. And I don’t enjoy having those pointed out to me.

So if I dial up the IV pump for 35 ml instead of 36 ml, please don’t say so very dramatically in front of the patient or the patient’s parents. Instead, calmly remind me when we step to the side or calmly suggest adding an ml to the pump. If I make an urgent mistake please tell me immediately, but handle all with caution. Patients, especially children, pick up on the mood in the room. If you look worried, they will too. Confidently and calmly reminding me is a good way to keep everything under control.

5. I should’ve taken it easy on my teachers when they didn’t sign that form in 24 hours.

Let me tell you, it’s hard. I already get 15 emails a day from work, and when I get another email asking me to sign and fax a form, sometimes it just gets lost in the virtual pile. Don’t be afraid to remind me, and please be forgiving! I would prefer to be asked about these things while I’m at work, but if I’ve forgotten something you need immediately, you can absolutely reach out when I’m not at work. I would double check this with all of your preceptors, though, to make sure they are comfortable with being reached off the clock. Point being, it’s never malicious if we forget to respond to your email, forget to fill out your paperwork, or sign a form. That being said, there’s nothing worse than waiting till the last minute to hand it all to me and tell me it’s due tomorrow!

6. Learn, learn, learn. . .and then learn some more.

The experiences you’ll have as a student, a new graduate nurse, or an intern are some of the best experiences. We intentionally put you with patients that present learning opportunities. So please take them and love them! Your day isn’t over at 7 pm; you should go home and look up 3 things you didn’t know—just 3! Don’t study medical textbooks for hours on end, but google things, read opinions, read facts. In nursing we don’t always have to know down to the microbe, but we need to know the big picture. Ask yourself: Could I teach a parent how to feed through a g-tube? Could I explain necrotizing enterocolitis to a friend? Save the specifics for nursing school exams; focus on learning how all of the systems work together and the bigger picture when you’re at clinicals or with your preceptor. Always ask yourself why while you’re learning. Why are we doing this? Why does this child have this condition? Why is the doctor changing this order? Try to look things up on your own when you can, or ask me while we are charting or breaking!

Overall, having a student is an awesome experience. It is refreshing to have such a bright, eager mind, it is humbling to have someone remind you that you’re not that far from when you were a new grad, either, and it’s invigorating to watch your student grow and succeed. I am happy to have you, but every student has a different learning style and that takes me time to learn, too. Be patient with me, be kind to me, and let’s conquer this together. Understand that I’m human too—I get stressed, overwhelmed, and tired, too. With open communication we will be able to get to know each other and grow together!

Stay tuned next week for Precepting, Part 2: Inside the Student Experience for my perspective as a student! ​

Staff Orientation in the NICU

Staff Orientation in the NICU

I vividly remember my first day of working in the NICU. I had two years of adult nursing experience under my belt and was excited to transition my career to caring for the world’s tiniest humans. The first few months were humbling. This was a far cry from my previous unit where my patients were able to articulate their aches, pains, and needs. I was no longer privy to my patient’s feelings. No one was telling me what to ask the doctor or what felt different. Instead, I now had 12 hours to learn a baby’s baseline and communicate with the medical team when behavior and physical assessment differed from normal. In the NICU, subtle changes can mean something is wrong. A thorough, supportive orientation in the NICU made developing these new skills and critical thinking possible.

The hospital I work at conducts a 12-week orientation with an assigned preceptor and is structured for assignments to progressively increase in difficulty. Each week the babies get more complex and require stronger critical thinking. While the unit’s standardized pathway helps an orientee gain experience caring for a wide variety of patients, it is easily modified to individualize the orientation to meet an orientee’s needs. Multiple meetings with the NICU educator, preceptor, and orientee are conducted throughout this period to facilitate open communication. During these sessions, feedback regarding an orientee’s strengths and weaknesses aid in tailoring future assignments to support the orientee’s success in the NICU.

Orientees spend their first four weeks in our Transitional Care Unit (TCU) where they learn how to care for our feeder/growers and babies and their families preparing for discharge. This section of orientation hones in on learning “normals” and establishes a foundation for effective time management. From learning how to pace and feed an ex-28 weeker to learning to quickly intervene on a baby experiencing a bradycardia episode, my early days in the TCU were overwhelming. With back-to-back Q-3hr feeders, congenital heart screenings, car seat tests, and discharge instructions, time to sit down and chart is precious. Aside from its fast pace, the nurse plays a huge role in transitioning the baby and family to going home. The reality and implications of discharge often creates anxiety for parents. Their baby’s nurse serves as an empowering supporter, teaching families all the skills they need to leave the isolettes, loud alarms, and tangled wires behind.

Just when I started to feel comfortable in the TCU, I transferred to the intensive care unit, where I would finish out my eight remaining weeks of orientation. My newfound confidence quickly deflated. The dim lighting, the bright blue bili-lights, and sounds of babies crying and alarms buzzing put me into sensory overdrive. I’ll never forget seeing my first 24-weeker laying in that big isolette, small as could be, but strong as ever as she clenched her tiny fist onto her endotracheal tube. In those early days, I doubted my ability to care for these tiny, vulnerable patients, but the pathway continued. The more I learned each day, the more comfortable I felt. I transitioned from caring for just one baby to providing care for two babies. I graduated from stable babies on CPAP to unstable micro-preemies on high-frequency oscillating ventilators requiring frequent blood gases and multiple drips. I gained experience caring for them all. By the end of my orientation in the NICU, I was able to safely manage critical 1:1 assignments by myself. I learned to advocate for my babies during rounds, question new orders that sounded inappropriate, and trust my gut instinct when something just seemed “off.” Prior to my orientation concluding, I spent two weeks as the first admission nurse and participated in the resuscitations of my “new admits.” Needless to say, I gained a healthy appreciation for NRP.

Following orientation in the NICU, I began a 12-week “post-orientation pathway” that gradually advanced the acuity of my assigned patients. Additionally, at the start of every shift, I was assigned a “resource buddy.” Resource buddies were more experienced nurses that served as easily accessible sources of information. My resource buddy was always working in the same pod as me, so I always had someone to turn to if I ran into a problem or a question arose.

No one in the NICU expects new hires to know everything. The learning never stops. While the novelty of the NICU has faded and I am no longer intimidated by the sights and sounds that once took my breath away, the magnitude of the work we do has not.

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