Digital Challenges in Nursing Practice

Digital Challenges in Nursing Practice

Digital technology thus far is pervading and influencing nursing practices. Every nurse today is expected to be able to use knowledge, information, and digital technology to maximize their nursing care and improve efficient ways of working in the health care system. More than 50% of nurses reported using digital technology in their everyday nursing practice. The Future of Healthcare 2022 Hospital Vision Study shows that the use of mobile devices is expected to grow up to 40% for all hospitals across the countries by 2020, and 97% of nurses will use mobile devices at the bedside by 2022.

The culture for nursing care used to be a direct patient contact and care; however, the advancement of digital technology has changed the nursing and medical fields and made patient care more efficient. Both patients and care providers are now able to communicate remotely and access personal health information, lab results, and treatments at any time from their computer or smartphone.

Digital technology has changed the way nurses communicate and collaborate with patients and other health professionals. Nurses are able to schedule and record activities in real-time faster and with more accuracy. As a result, patients who have timely access to health care services can reduce the need for hospital admission and healthcare costs. Digital technology in health care is affordable and deeply engages patients in their treatment and recovery. It also brings opportunity for nurses to provide exceptional levels of care and improve their patients’ quality of life.

Digital technology will continue to evolve and nurses need to keep up with and be ready to utilize that technology and tools to deliver quality nursing care. Here are some tips to help you prepare yourself for improving your digital skills.

1. Be open-minded and change your perspective.

It is important that you see the advantages of digital technology at work and allow yourself to focus on the potential opportunities and positive aspects of technology rather than being inconvenienced.

2. Spend more time to explore and learn.

Write down the topics or skills you want to learn and set a goal. This will help you create a learning plan for yourself that fits both with where you are now and where you want to be next.

3. Talk to your expert colleagues and ask questions.

Don’t be afraid to ask questions. Asking questions is a sign of being open-minded and motivated to learn. Holding back on asking questions is a missed opportunity.

4. Be patient.

Learning a new technology or new skill can be frustrating and can take time. Be patient and give yourself plenty of breaks to digest and process new information. It is always possible to learn new technologies and skills. All it takes is openness to the experience and willingness to put in the necessary time to acquire new skills.

Nurse-Related Suicide: Breaking the Silence, Part 2

Nurse-Related Suicide: Breaking the Silence, Part 2

Judy Davidson, DNP, RN, FCCM, FAAN, EBP, is the lead author of a recent research paper titled “Nurse Suicide: Breaking the Silence” published in the National Academy of Medicine’s Perspectives: Expert Voices in Health & Health Care.

We interviewed Davidson at length about this incredibly important topic to help raise awareness during National Suicide Prevention Month. What follows is Part 2 of our interview. (Check out Part 1 here.)

It seems like nurses—when it comes to suicide—don’t matter as much in the eyes of the health care system as other health care workers do. Why?

I don’t agree with this statement. It is our own problem that we don’t track these issues or actively address them. Believe me, when the Chief Medical Officer and CEO read the results of our pilot extending the Healer Education Assessment and Referral Program (HEAR) to nurses and hospital staff, they were right on top of it, working out a strategy for how to fund the program moving forward. We, as a profession, have to frame it as a problem with data to back up our emotional plea to move this into the public light.

I am very grateful for nurses who are now coming forward to share their stories, putting a “face” to the problem and helping to destigmatize mental health issues. When our initial data was published in the Journal of Nursing Administration on the same day “Breaking the Silence” came out, the American Foundation for Suicide Prevention changed their website from “Physician” Suicide Prevention to “Healthcare Clinicians.” The content is heavily geared towards physicians, but that is only because we haven’t studied or tested enough strategies with nurses to have more prominence on the page. As soon as we do, they will gladly market best practices for others to learn from.

Since they take the most prominent role of caregiver, do you think this is why they are being ignored? Why hasn’t more research been done? Why haven’t more programs been developed to help nurses prevent suicide and deal with its aftermath?

We are not being ignored, we have ignored ourselves. No one is to blame. We didn’t know what we didn’t know. No one thought to ask. Now that the questions are being asked, we will find the answers. We learn a great deal at an organization level by participating in the HEAR program and offering our nurses the interactive encrypted anonymous risk screening. They tell us about actionable risks that can be reduced in the workplace. Top on the list is bullying and lateral violence. Every leader has an obligation to actively reduce bullying in the workplace. It’s not just an issue of employee satisfaction and retention, workplace wellness—when you come down to it—is about saving lives.

How can nurses recognize signs in coworkers that they may be severely depressed and possibly contemplating suicide?

Burnout and compassion fatigue can lead to or coexist with depression. Recognizing those issues when they occur, and preventing them with caregiver support strategies, can go a long way. We tested a strategy for caregiver support that was originally published by Susan Scott at the University of Missouri. Peers elect peers that are naturally good at helping colleagues through rough days. These peers receive special training to become emotional first aides. They keep on the watch for people who might need help and provide comfort as the need arises. When they sense that this collegial help is not enough, they go up an emotional aide type of chain of command to get their colleague the help they need. It is a wonderful program. We are now expanding the HEAR program to include this level of caregiver support.

In addition, our HEAR counselors who become experts at workplace crisis management also provide emotional debriefings for groups and individuals after a significant clinical event. We don’t wait for them to ask for help. Risk management informs the counselors that there has been a significant event and the counselors proactively offer their services.

If they do become aware of these indicators, what’s the best way for nurses to intervene to help other nurses?

Once the HEAR program is in place, after getting into the habit of recognizing each other when there is stress or crisis, the counselors that run the screening help to triage and find people the professional help they might need.

Is there anything else that you think is important for people to know?

If you or someone you know is suffering from depression or suicidal thoughts, contact the National Suicide Prevention Lifeline at 1-800-273-8255.

For more information about starting a suicide prevention program in your own organization, contact

Do not try to create a screening program on your own. The program at AFSP has been tested and works.

Tips for Aspiring Nurse Entrepreneurs

Tips for Aspiring Nurse Entrepreneurs

Are you thinking about using your expertise as a nurse to launch a business? Do you have innovative ideas about patient care? Are you eager to create a new opportunity at the forefront of health care that is independent, flexible, and profitable?

Perhaps owning your own business is your next move.

As a nurse entrepreneur, you control everything, from your calendar and career path to your success or failure. Whether you plan to launch a nursing education business, work as a legal nurse consultant, start a community-based elder care business, or sell products, growing a profitable business requires information, inspiration, and insight into industry needs.

So what do you need to know and do to avoid costly mistakes?

Adopt an entrepreneurial mindset.Thinking like a business owner instead of an employee, is essential, says Michelle Podlesn, RN, president of the National Nurses in Business Association (NNBA) and author of Unconventional Nurse: Going from Burnout to Bliss! “When you realize you are your business, you start looking at everything with fresh eyes from that viewpoint. And yes, every nurse can adopt it. In my book, I ask nurses to make this paradigm shift so that they can strengthen and prosper their careers, regardless of their setting,” says Podlesni,

Create a business plan. It can be simple, but having one is essential.  In short, it’s a description of your business goals and the strategies you will use to meet them. Update and revise when necessary.

Clarify your business focus or niche. Be clear about your idea’s scope and target audience. Who are your intended customers for your services or products?

Research market place need. Ensure a market exists for what you want to do with your business. Do a market analysis to help you see potential opportunities and threats as well as the strengths and weaknesses of your competition.

Find a mentor. Relationships matter. Get a mentor you trust and respect to brainstorm ideas. Learn from his or her mistakes and setbacks. When you are ready to take your business to the next level, consider a business coach.

Keep learning. Developing your business skills is a wise move. Running a business requires skills in marketing, negotiating, and branding. Read widely, attend conferences, take classes, and consider a certificate program on innovation and entrepreneurship.

For resources, including mentors, check out the NNBA, a professional nursing association for nurses transitioning from traditional nursing to small business ownership and self-employment.

As a nurse, you are keenly aware of what needs to be fixed to improve patient care. As a nurse entrepreneur, you can provide solutions and advance patient care while being your own boss. Are you ready?

How Every NICU Encounter Counts

How Every NICU Encounter Counts

In honor of National Neonatal Nurses Day, Nurse Elizabeth (Liz) Drake, RNC-NIC, MN, NNP, CNS, CHOC, of Children’s at Mission Hospital in Mission Viejo, California, shares her experiences in spreading the word on NICU encounters across the United States, and why her work is important.

“When you meet families in the NICU for the first time, you see sadness, fear of the unknown, stress, shock, etc. Many moms have been on bedrest, some mothers have done ‘everything right,’ many families have birth plans—and then the unexpected happens. They meet us, which is something a new parent never expects. Spending time with and partnering with a family at the bedside allows you to walk alongside this roller coaster journey with them,” says Drake. “Your words, your education, your compassion can change a parent’s fear into confidence as you encourage them to learn every aspect of their infant’s personality and behavior. You develop a bond with them. They consider us as family because you are with their infant over the course of days, sometimes months. They look to the team for encouragement, education, and reassurance. Every day you leave work, you know that you have impacted a family and their infant.”

How does your teaching throughout the country help families?

The mother, especially, has developed a history with her infant, such as history of movement patterns, smells, and tastes from her diet. The infant also recognizes the redundancy of her voice and body sounds along with others in the home. This is so important to remember as we explain to families that their presence is vital to their infant. Providing skin-to-skin contact when possible, providing breast milk, quietly speaking to their infant—these are all things that are familiar to the infant in an unfamiliar NICU. Educating, role-modeling, and emotional support are all things that the NICU nurse provides to the parents to empower parents to bond with their infant. Teaching them their infant’s engagement and stress cues are important, so the parents can develop this reciprocal relationship with their infant. The infants then thrive because they have a caregiver who knows them, listens to them, and responds in kind to their needs.

What are the most important things that NICU nurses tend not to know about interaction with a premature infant?

I think with the way health care has evolved, it has placed more “tasks” for the nurse to “do.” We are professionals who assess, evaluate, process, intervene, and integrate knowledge into care. Because of how health care has changed, the nurse is often left to accomplish a lot of things.

When I first started, I was not taught about the things I’ve shared with you. So, I often reflect on the impact I may have had on infants and families early in my career. Now that I know better, I work to do better and make sure others just starting out know the importance of our impact. I believe that with education, everyone will desire to do the right thing and provide excellence in all their care.

What do the families not know that you believe is important for nurses to communicate to them?

Just because their baby is born doesn’t mean that they are ready to do what other infants can do. It’s important to share and teach that infants’ brains, especially those in the NICU, are still developing and learning. NICU nurses must protect that development as best we can, the way you would have if they were still inside: dark and quiet, with not a lot of non-relational touch.

What qualities are most unique about premature infants?

The first thing that comes to mind is that premature infants, even the tiniest and most fragile of babies, have personalities and ways of communicating with you. When you take the time to just observe them, you will see that. Every Change Matters explains that while pain in premature infants can be difficult to identify and distinguish from stress, certain indicators such as facial expressions and body movements can be used for pain assessment and management. They speak with their body movements (e.g., you may position them a certain way after care time, and they will keep moving, trying to turn their head or their own body. If you position them in the way they are moving, they will settle down. They didn’t ask to be turned verbally, but you were still able to figure out what they wanted!)

They speak with facial expressions, like a grimace when they are in pain. They do cry and let you know when they are not happy. The most beautiful thing to watch is when you show the parents how they can comfort their baby with a firm hand on their body or by the sound of their voice telling them they are there and then watching the baby settle down. Watching the parents’ faces after that melts your heart.

What are the biggest challenges of working with premature infants?

Some babies don’t survive. That never gets easier.

Another challenge is that sometimes it doesn’t matter that you provide your best technology as well as medical and nursing care. Babies born at the earliest of gestations are at risk for outcomes that will be challenging all of their life. Issues a person may experience at three, 13, or 23-years-old could be completely because they were born prematurely. Even with lifelong problems, the care and environment the parents provide can overshadow the “what ifs.” The strength and resiliency of families of premature infants is beyond anything you have ever seen. They make us better human beings for watching and experiencing their strength.

What are the greatest rewards?

The greatest rewards are knowing you do your best in understanding these infants and seeing what your impact is on their—and their families’—lives. When you get Christmas cards, Facebook messages, or hear about major life milestones (college graduations or marriages) from past families and children, your heart smiles, and it reminds you of why we do what we do.

Working with a team of professionals that are as passionate as you are, some who have been in the job for years and still love what they do—That’s the reward: loving what you do. I feel very lucky to say that I love what I do after 35 years.

Meeting the Needs of the New Graduate Nurse: Self-Care Education

Meeting the Needs of the New Graduate Nurse: Self-Care Education

New grad training programs have been recognized over the years as a necessity to help new nurses transition successfully from the role of student to professional nurse. These new grad training programs provide a structured curriculum to acclimate nurses into the organization and the nursing profession. These programs provide a foundation for the nurses’ career. This foundation would be strengthened with the addition of self-care education.

In order to prepare new nurses to use advancing technologies, to provide safe care, and reduce employee turnover, structured new grad training programs were developed at number of ANCC Magnet designated and/or University-affiliated hospitals. In 2011, the National Council of State Boards of Nursing (Chicago, Illinois) conducted a multi-site study of nurses transitioning to practice at hospitals and the results supported the previous research and recommendations. Based on their study, they recommended that new graduate programs have the following essential components:

  • 9-12 months in length
  • Trained preceptors
  • Institution based orientation
  • Opportunity for feedback and reflection
  • Institutional support
  • Safety and critical reasoning focus in the program
  • QSEN core competencies of patient-centered care, teamwork and communication, evidence-based practice, quality improvement, and informatics

What was not included in their recommendations, were core competencies in self-care strategies. These include prevention of burnout, compassion fatigue, or secondary trauma, all of which are experienced by nurses engaged in increasingly complex care. Self-care is an essential skill that new grads need and something that the large percentage of new grads, millennials, are looking for.

Who are Millennials?

There are a lot of articles that talk about who millennials are, and they are typically described as those born between 1980 and 2000. These nurses are on their way to becoming the largest generation in the nursing workforce. They are also usually described as tech savvy, highly educated, highly engaged employees who are well suited for the diverse, global world. Some other generalizations about millennials include a desire for flexibility and higher turnover rates. Millennials did not grow up with a belief in job security in the same way that previous generations did. Milennials are looking for a job that provides work-life balance, an emphasis on social relationships, and opportunities for growth that aren’t based on hierarchy. Obviously these are generalizations and individuals vary, but taking into account the characteristics of a large portion of a workforce are important to designing a training program.

Reality Shock

New graduates hired into hospital training programs, even when well structured, experience high levels of stress. In fact, the NCSBN study results showed that new grad participants had the highest reported stress during months 6-9 after starting as a new nurse. In a 2013 article by Elaine Riegel, RN, MSN, the period of transition new grads experience is “a time of stress, role adjustment, interpersonal conflict, and reality shock.” School programs haven’t prepared students for that intense period of adjustment and many new graduates did not anticipate the difficulties they would face.” New grads report feeling overwhelmed, anxious, and disillusioned when facing the reality versus expectations. In addition, new grads hired into high acuity or specialty areas need extensive emotional support.

Facing this reality shock and role transition is what contributes to the high stress that new grads report. However, these stressors are not over once they have successfully transitioned into the professional role. This is why incorporating self-care content into the new graduate program will allow new nurses to develop skills to sustain them throughout the entirety of their career. Nurses need essential training in preventing burnout and compassion fatigue, while practicing skills that maintain their compassion satisfaction. They don’t need self-care skills defined by commercial media who focus on facials and massages (although who doesn’t love a facial), but with evidence-based education that looks at self-care through the mental, emotional, spiritual, and physical domains. This education is essential for creating a work-life balance that milennials desire while managing the unique stressors of the nursing profession.

To Overtime, or Not to Overtime?

To Overtime, or Not to Overtime?

That is the question, my friends. I recall receiving this piece of advice in nursing school: “The secret to nursing is to never work overtime. Work 3 days a week and only 3 days a week.”

Unfortunately, this piece of advice was coming from my favorite nurse that i had worked with in clinicals, the one that never had a bad attitude, was a team player, and was down for whatever came his way. So what to believe??!

Here’s the thing. Nursing is crazy. It’s all so different, yet so similar. For instance, an ED nurse or a NICU nurse might feel differently than an adult med surg nurse. The ED and the NICU carry on around the clock. Babies don’t know the time difference, and the ED sometimes gets crazier at night. But during my practicum I learned that med surg units often have quiet hours for their patients from midnight to 0600. So, in this case, discussing overtime with a night shift NICU nurse might not be as daunting as it is for a med surg nurse to stay awake for a fourth night of the week. So, definitely do your research and get to know your unit and your position before tacking on a bunch of overtime. What is the night shift vibe for overtime? What’s your day shift vibe like on your fourth shift? I personally found on night shift I really wasn’t able to work a lot of overtime because it just exhausted me, but on day shift I don’t have any problems as long as my shifts aren’t all in a row!

The whole “getting to know your unit” concept brings me to what I believe to be the most important aspect when deciding whether to pick up overtime. It worries me to no end when brand new nurses two weeks post NCLEX are picking up four and five shifts a week. Even nurses a few months into it. I urge you all to give yourselves time; you are adjusting to far more than you realize. The biggest harm I think we can do to our patients as nurses is not taking care of ourselves. There is obvious harm like forgetting a med, but the biggest harm is when stress builds up, and fatigue piles on, and before you know it, your attitude about your patients, your mission, and your duty has changed for the worse. It doesn’t happen overnight; it happens over time. Just be mindful. Know your boundaries, and take your time. Quite honestly, even nurses with ten years of experience scare me when they pick up five or six consecutive shifts. There is no rush whatsoever for overtime. If you’re a new grad you likely have 40+ years for overtime anyway!

And finally, your motivation for picking up extra. Watch out for becoming dependent on overtime. I personally am guilty of this to the extreme. It’s really easy to plan a few trips and pay for them with overtime, but ideally you’re not paying for your car payment or your rent with extra shifts. Make sure you are living within the means of your normal paychecks and using any extra cash for trips, treats, holidays, etc.

So, I didn’t end up following that nurse’s advice after all. I do pick up overtime. Sometimes I pick up a lot. Ultimately, I had to use discretion about who I took advice from and what their role is. This nurse happened to have a wife and three kids at home, which isn’t my current situation. Be mindful of who you’re speaking to. In fact, be mindful of my advice! Maybe my situation isn’t the same as yours right now. Talk to people who are in similar situations as yourself or who have been in your place. Find out what works for them and sit down and think through the benefits and risks for yourself.

While we may all be nurses, we’re all different. And worst case scenario, you’re just not sure if it’s right for you, then give it a try! One shift wont hurt. See how you feel and go from there.

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