June 27th is National HIV Testing Day and this brings an opportunity for all nurses across the nation to spread the word about the importance of getting an HIV test and to encourage patients and their family members to stay in care, and to support HIV prevention.
According to the CDC, approximately 1 in 7 people in the United States who have HIV do not know they have it. Getting HIV testing is the only way to know whether a patient has HIV. Knowing HIV status is crucial to keep patients and their family members healthy. The CDC has recommended that everyone between the ages of 13 and 64 should get an HIV testing as part of their routine health care.
Here are four key things nurses can do to help support HIV prevention.
1. Inform patients and their family members about where to get HIV testing.
There are several testing services, health centers, and other resources that provide HIV testing. Patients can easily find HIV testing and care services through the HIV Testing Sites & Care Services Locator, or they can call 1-800-CDC-INFO (232-4636). Getting tested for HIV regularly (at least once a year) is an important part of good sexual health.
2. Educate patients about the window period for HIV test.
The window period is time between potential exposure to HIV infection and the point when the test will give an accurate result. The window period can be from 10 days to 3 months, depending on individuals and types of HIV tests. Patients who test HIV-negative during the window period will need a follow-up test after the window period to confirm the results.
3. Encourage people at higher risk to get tested more often.
HIV can affect anyone regardless of sexual orientation, race, ethnicity, gender, or age. However, certain groups are at higher risk for HIV, for example, sexually active gay and bisexual men and injection drug users. These groups may benefit from more frequent testing (for example, every 3 to 6 months).
4. Encourage patients living with HIV to prevent passing disease to others.
There are many actions that patients can take to lower their risk of transmitting HIV to their partner or family members. HIV can spread by contact with infected blood, semen, or vaginal secretions or from mother to child during pregnancy, childbirth, or breast-feeding. Here are some examples to prevent passing HIV: taking medicines to treat HIV infection, using a new condom every time they have sex, telling their sexual partners that they have HIV, and encouraging their partners who are HIV-negative to get tested for HIV regularly.
As nurses, we have an important role to play, regardless of the area of expertise, in promoting prevention, testing, and early treatment of HIV.
Summer is here, and the time is right…for taking vacations.
Think you don’t have time? Think again. Flo Leighton, MS, RN, PMHNP-BC, a board certified mental health nurse practitioner as well as an adjunct faculty at New York University College of Nursing, has a private practice in Chelsea, New York, where she sees health care professionals, including nurses and nursing students. Leighton’s background also includes working in inpatient psychiatry and the adult ER at NYPH/ Columbia University medical center.
Leighton took time from her busy schedule to answer some questions about why nurses not only should, but also really need to take vacations.
What are the main reasons nurses should take time to take vacations?
Nurses have the type of job that requires a lot of mental clarity, physical demands, and empathy towards patients and their families. Nurses often care for a full load of patients and have to juggle many competing priorities throughout the course of their shift. Many nurses work 12-hour shifts, evening or night shifts, and may be on their feet for several hours at a time. Nurses that work in ICU, Oncology, ER, or other high-acuity areas are repeatedly exposed to stressful events. It is for these reasons nurses need to make time for themselves by taking vacations.
What justifications do many nurses use for why they can’t take time off?
Some nurses may state they cannot take time off due to financial issues, family obligations, being in school while working, having another job, or wanting to save their elective time up for a rainy day. Sometimes nurses may be prevented from taking peak time—summer or holiday—off for vacation due to staffing issues or not having seniority with highly requested weeks.
Suppose nurses don’t have the funds to go away. Is taking a staycation good enough? If so, what limits should they put on them or what tips can you give for how nurses can stay relaxed during a staycation?
A staycation is a great alternative for those who do not have the money to take a big vacation. The most important thing to keep in mind is to set limits for yourself by limiting work-related projects and correspondence while not at work. Refraining from checking work email will help facilitate being more present and connected in what you are doing in your personal time and help create a better work/life balance. It is easier to feel recharged and less burnt out at work this way.
Whether it is taking a day trip, a yoga or spin class, going for a run, lunching with family or friends, or a spa day—there are simple ways to make the most out of a staycation.
How will taking vacations or time off help nurses? What can it do for them physically and mentally?
Taking vacations can be a great tool for managing stress and preventing burnout and compassion fatigue. Nurses who struggle with stress on the job are more likely to make medication errors, not feel engaged at work, have higher turnover, and negative patient outcomes.
If they decide to take vacations, what can they do to make them less stressful?
Trying to use time off as a mental vacation in addition to a physical location change is really important. We are accustomed to multitasking and doing structured tasks with multiple deadlines. It is good to try not to plan anything that is too structured or choose a location that offers planning of activities so that you don’t have to. Allowing others to plan is a nice departure from a highly structured and stressful job as well.
Is there anything that is important for readers to know?
Nurses who repeatedly are exposed to stressful situations—deaths, cardiac arrests, violence on the job, etc.—either directly or witnessing through others are at risk to develop symptoms of Secondary Traumatic Stress (STS). Examples of STS may include irritability on the job, frequent call outs, higher turnover, changes in concentration, and avoidance of stressful situations on the job. If not managed properly this can develop into PTSD (Post Traumatic Stress Disorder). Great stress management, including taking time away from work is crucial.
When preparing for an interview, it is important to not only focus on what questions you might be asked, but also questions to ask the employer. Your inquiries will help you determine whether the job will be a good fit for you and give you insight into what it is truly like to work there. Your questions should cover three main topics: unit basics and training, the working environment, and the employer’s management style.
Unit Basics and Training
A lot of employers will outline the basic job details in the job application or during the interview, but if they do not, then go ahead and ask! It is important to know the unit and training basics such as: patient-to-staff ratio; hours; call shifts; holiday work expectations, scheduling, and weekend requirements; training length; and probationary period. If you would like to go above and beyond to learn more about the unit try asking these questions:
- What is your unit’s retention rate for new graduates and employees?
- How would you support a new employee who was struggling after their training was over?
Most nurses will tell you that the biggest aspect of their job satisfaction is their work environment. Daily interactions with nurses, doctors, and techs has a huge impact on retention rate and overall happiness. Focus on asking questions that will help you understand if the unit uses teamwork and supports one another. Try asking these questions:
- What is the culture of your unit like?
- How do you help new nurses adapt to the unit? Do you have a mentorship program?
Your managers are there to support you and help you succeed as a nurse on your unit. Asking questions about the unit’s management style will help you gauge how well you will fit in and be supported. Try asking questions that reveal how the managers deal with conflict and struggles that the unit faces:
- What have been this unit’s most notable successes and failures over the year?
- What are the biggest challenges that your nurses face daily and how do you help them overcome them?
When Jean Snyder, DNAP, CRNA, read a story about a vibrant boy who went in for routine surgery and instead of coming home, died during, she knew she had to do something. The cause of the child’s death was a medication error. “As a mother and as a nurse anesthetist, my heart grieved for this loss. I knew that if we had a safe means to keep our syringes and vials, the mistake may have been recognized earlier, and perhaps that child may have had a different outcome,” says Snyder, owner of Jean F. Snyder CRNA Inc. and co-owner of Goodwin and Snyder Anesthesia Associates, PLLC, who also works full-time for Bon Secours DePaul Medical Center. “I knew I had to invent ERMA [Error Recovery and Mitigation Aide].”
“I developed an ERMA prototype in 2008 but had no means to refine and market it. In 2016, as part of my doctoral program at Virginia Commonwealth University, I wrote a whitepaper discussing medication errors within the context of error critical systems. ERMA was a means to provide early recognition and, hopefully, mitigation of medication errors. I then submitted my whitepaper and prototype to Innovation Institute, a medical device incubator that is affiliated with my hospital system. Innovation Institute worked with me to refine ERMA and obtained a provisional patent. We are presently working to market ERMA,” states Snyder.
Snyder explains what ERMA is and what it does:
“ERMA is a clear reservoir inserted between the re-entry proof top and opaque terminal disposal portion of a traditional needle box. It allows a practitioner in any high-risk area (OR, ED, ICU) to have visualization of all the syringes and vials used during the course of a procedure, anesthetic or surgery. At the end of a single procedure, a trap door in the bottom of the reservoir is released to allow those sequestered vials and syringes to drop into the bottom of the needle box for terminal disposal. Providers now have a means to refer back to any medication delivered for an individual patient. ERMA allows us to recognize errors in a timely fashion and address the untoward events that may arise from the error in a timely fashion.
“Research has revealed that medication errors occur despite concentrated efforts to prevent them partly because medication administration has become increasingly complex. In addition, providers are distracted, tired, [and] face environmental barriers such as low lighting as well as production pressures. In anesthesia, the normal system of checks and balances in the administration of medication are eliminated as one person prescribes, prepares, administers, and charts the medication. A single anesthetic often administers several doses of up to 20 medications. Nanji et al determined that 1 in 20 perioperative medication administrations and every second operation resulted in a medication error and/or an adverse drug event. ERMA allows medical personnel a second chance—a method to make sure that the medication they thought they were giving is actually the medication they gave. If an error was made, it buys the practitioner precious time that would have been spent in trying to figure out the precipitating cause of the medical crisis.”
Some of the biggest rewards that Snyder has had in inventing the ERMA is that she has learned she has both the heart and mind of an inventor. In fact, she says that she’s already given two more ideas to the Innovation Institute and already has others “simmering on my backburner.”
Her biggest reward, though, hasn’t happened yet. But she hopes it does. “I would be extremely gratified to hear practitioners in high risk areas tell me that ERMA helped them recognize and mitigate a medication error. My biggest reward would be meeting the mother that lost her child to tell her that her loss was not in vain. I want to let her know that her story motivated me to change the way we recognize medication errors and that my product may prevent another family from suffering such a great loss,” says Snyder.
She also has advice for other nurses who have good ideas about improving something in health care. “I believe all nurses are inventors at heart. We develop workarounds every day at work. We innovate every day. We don’t have the power and means to move our ideas to reality. My advice is to find a mentor. I have some amazing mentors at Bon Secours, VCU, and Innovation Institute,” she says. “Read about other nurse inventors and reach out to them. By definition, nurses are nurturers and delight in the ideas and successes of our colleagues. Reach out to your hospital system to see if they are affiliated with a medical incubator. Google scholar and Google patent are amazing resources because sometimes your idea is so good, it has already been invented or patented! Read the research to look for inspiration.
“I encourage all nurses to innovate. Through nursing innovation, we will improve patient safety. Innovation is a positive feedback loop; as we innovate and take our places as experts in the medical field, administration will reach out to us as the experts.”
You’ve read my thoughts on being a preceptor, but now it’s time to explore things from the other side: as an orientee. In the last two years, I’ve had the opportunity to orient as a student in nursing school, as a precepting practicuum student, and as a new graduate orienting to my current position in the NICU. It certainly doesn’t take much to channel these inner thoughts from what was not so long ago timewise, but feels like ages ago when I think back to where I was with my nursing skills. Here’s what I learned from the student experience.
1. I’m sorry for a lot of things.
“I’m sorry! I’m sorry! I’m sorry!” is all I can think. I’m sorry I didn’t remember to run a flush, I’m sorry I just kicked the back of your foot. I’m sorry! I know it’s annoying to keep apologizing, but I’m just very nervous and I’m sorry! I feel like I’m annoying you, I’m really worried you’re gonna tell my professor I did something wrong, and they’ll tell the hospital and then I won’t get hired and I won’t have a job! Point being, I’m a nervous wreck and I’m sorry I keep saying I’m sorry.
2. My preceptor is a bear tonight.
I get that it’s not always the most exciting gift to be given a student or a new grad to orient, especially when you’re not expecting it, or if your baby kept you up all night and you didn’t sleep, or if you had extensive plans to Facebook message and Tinder all day long. But… I’m here and I’m excited to learn…. and my preceptor is being a bear! If you could please try to not hate me and teach me something I would really appreciate it. Also, when you answer my question with an attitude I can’t help but feel like I shouldn’t ask any more questions, so please try to be understanding! P.S. We all know the look of a nurse that didn’t want a nursing student so please don’t think it’s not visible! Also, feel free to tell me to go sit at another computer while you’re charting if I’m not needed to help. Odds are that I want a break from you, too, and I could probably use some time to look things up!
3. I’m not as smart as I think.
I’m definitely not as smart as I think or act. I definitely don’t know all (or any) of the acronyms you’re using so please treat me like I know nothing and I can tell you if there’s something I’ve already learned. Further, please don’t leave me alone in a patient room while drawing labs off a central line for the first time (not that that’s happened to me or anything…). There will also be times when I’m acting like a know-it-all, but it’s probably just me overcompensating for realizing how little I actually know. If you work in a specialty unit, AKA anything other than med/surg, don’t forget that nursing school wasn’t focused on your specialty! So, no, I don’t know anything about your 23-week-old baby! Specialties are just that, specialties, so help me learn them!
4. These uniforms will never be less humiliating.
I feel like whenever anyone sees me in my student nurse uniform it’s a shout-out like “hey, ask me to come position your patient” or “I’m free to help transport patients—pick me!” When in reality, I’m here trying to learn. I do enjoy understanding that nursing isn’t all exciting procedures and numbers and diagnoses to learn; half the battle is balancing all of those things and still having time to turn your patients and meet their psychosocial needs, but my time is valuable and if I’m still in school I’m technically paying to be here, so I want to learn the skills I don’t know! Also, my uniform definitely does not mean that anyone can make jokes about what I don’t know or treat me like less of a person. I trust you and you are my guiding light for the day. Knowing that you have my back will help me relax and forget about the sign hanging around my neck that says “student”!
5. The elephant in the room: Lunch!
I promise it’s really OK if you don’t want to eat lunch with me. If you don’t and you do it out of obligation, I’ll know and feel uncomfortable, especially if it’s me, you, and eight of your friends all talking about your weekend plans that I’m not apart of. I’d honestly rather go eat with a fellow student at that point. Plus, I may be a vulnerable student, but I’m also an adult and can handle and enjoy eating on my own. And likewise, I’ll let you know if there’s a night when I really need to sit down with you and talk something through or talk about my experiences.
Ultimately, I’m stoked to be with you as a student, intern, or new grad. I look up to you, trust you, and likely want to be just like you. I know it’s hard having a student, but it’s hard to be one, too. Work with me so I can work with you. After all, nurses eating their young is so prehistoric, don’t you think?
Tina M. Baxter, APRN, GNP-BC, has worked in both acute care and long-term care. A board certified gerontological nurse practitioner, she now teaches through HIS Solutions Health Care and works as a legal nurse consultant for Baxter Professional Services, assisting attorneys in nursing home litigation cases. Baxter took time to tell us what nurses can expect when working in long-term care.
Describe a typical day in the life of a long-term care nurse.
A typical day depends on your background. As an RN, you are responsible for the assessment and care plan for the resident. You may be responsible for staffing the unit and completing assessments in the hospital to determine if the resident is appropriate for admission to the facility. You may also function in the capacity below as is described for the LPN. As the director of nursing, you will be responsible for the day-to-day operations of the nursing unit by supervising other nurses, nursing assistants, and volunteers. You are responsible for making sure you stay within budget for care, approving the allocation of resources, and providing guidance to the staff.
As an LPN, you will begin with shift report, round on your residents, and morning med pass. After med pass, you usually begin your wound care treatments, breathing treatments, or other treatments needed. You also will begin your documentation of your assessment of the resident, field phone calls from the MD/NP for orders, review labs, fax pharmacy new orders or requests for refill medications. You then get ready for noon med pass, help monitor the dining room, and repeat the above. Afternoon med pass is anywhere between 2 p.m. and 5 p.m. You will document your assessments of the residents, attend to any resident urgent needs such as injuries, sick complaints like a headache or pain, and make additional phone calls as needed. Also, you will answer any family or resident question or concern that may come up during your shift.
As an advanced practice nurse and nurse practitioner, the NP will round on the residents similar to rounds in the hospital or for a primary care visit. The NP will assess the residents, address any medical or psychosocial concerns, document the findings, recommend treatment, and write orders for medications and treatments. The NP may meet with the staff, residents, and/or family to discuss the overall course of treatment, review any proposed changes to the plan of care, and discuss the best therapeutic options. The NP will also review and interpret laboratory and radiological testing and sign off on recommendations from other disciplines, such as dietary and physical therapy.
What kinds of nurses would do well in this role?
Nurses who love a challenge, can practice autonomously, and have a solid background in nursing across the lifespan. You have to be a generalist, as you will use your medical-surgical nursing, mental health nursing, community nursing, and nurse educator skills on a daily basis. You have to be comfortable with knowing that your resident may not ever become discharged from your facility until death.
What are the biggest challenges?
One of the biggest challenges is managing family and resident expectations. Often, residents come from the hospital and the ratio of patient to nurse is very different. Also, the expectation of the length of stay at the hospital is temporary. Residents come to long-term care (LTC) to live and therefore, they are in their “home.” The resident and family need to understand those changes in the dynamics. Sometimes, you have to have the difficult conversation of discussing curative versus palliative care. The goals of being in LTC is to keep the resident safe, provide for the best quality of life as possible, and to provide an enjoyable living environment.
What do you love most about what you do?
I love working with the residents and knowing that I can make someone’s day by just giving a listening ear, giving a cup of water, or explaining to a resident’s family a complicated procedure and having them appreciate the care that we give to the resident.
What do you wish more people knew about the job?
I wish more people knew that, while maybe not as glamorous as working in the critical care unit of a major hospital, LTC nurses are required to utilize a lot of the same skills as those in critical care. LTC facilities have come a long way and they are not the “sad prisons” for the elderly as they are portrayed in the movies and on television. There are many nurses and nursing assistants who work hard to care for the residents and do so with grace and dignity.
If a nurse is thinking about working in a long-term care facility, what kind of training should s/he have?
They should have some training in medical-surgical nursing and/or rehabilitation nursing.