Nursing is a vocation rife with occupational hazards. On a daily basis, nurses come into contact with sick patients, infectious agents, teratogenic chemicals, and radiation, to name a few environmental risks. Additionally, nurses are constantly on their feet, walking several thousand steps per shift. They are expected to help lift, move, and transfer patients several times per day, and face many potential musculoskeletal injuries from strenuous physical labor.
It is not surprising, then, that many nurses worry about the risks inherent in their daily job descriptions once they are expecting. Many nurses are women of childbearing age, and a pregnant nurse has to take certain precautions to keep herself and her growing baby safe. Below are some of the hazards pregnant nurses may face and suggestions for mitigating those risks.
Infection. Perhaps one of the most obvious risks to a pregnant woman and her fetus is infection. A nurse in the emergency department (ED), for example, may encounter patients sick with potential pathogens, from strep throat to tuberculosis to the flu. A pregnant nurse should follow standard precautions with all patients, and may also wish to wear a surgical mask around patients with a fever or suspected respiratory illness. A pregnant ED nurse may also wish to limit exposure to pathogens by reducing time spent in triage, if possible. Pregnant nurses may wish to avoid taking care of patients with active shingles or varicella zoster infections, as well as patients on airborne precautions.
Pregnant nurses should be immunized against influenza; the vaccine is safe for women in all stages of pregnancy. The live attenuated flu vaccine is unsafe for pregnant women. As an added benefit, flu antibodies are also passed to the fetus. If a pregnant nurse cares for a patient with influenza and later suspects she may have contracted the flu, she should speak with occupational health at her hospital to possibly receive a prescription for Tamiflu. Tamiflu works best when taken within 48 hours of symptom onset.
Drugs and chemotherapeutic agents. Because several drugs and pharmaceutical agents have known fetotoxicity, great care should be taken by the pregnant nurse when administering those and any medications to patients. Medication preparation is risky, and pregnant nurses may be exposed to hazardous drugs through skin absorption, inhalation, accidental contact, or needle-stick injuries. Sometimes while drawing up medication, the liquid can splash or make contact with the skin. Nurses should at the very least wear gloves while drawing up any medications or handling drugs, and at the most, should avoid handling known chemotherapeutic agents such as methotrexate.
Nurses should also weigh the risks and benefits of continuing their particular field of nursing while pregnant. Cancer treatment drugs, for example, have known effects of infertility, miscarriage, birth defects, and low birth weights.
Ionizing radiation. Radiation for diagnostic imaging is common in nearly all hospital departments, and nurses are at risk not just of background radiation but also of direct ionizing radiation. Nuclear medicine departments in particular are of high risk to a pregnant woman. Effects of radiation on a fetus depend in part on the dosage of radiation and on the baby’s gestational age. The thresholds of safe exposures are not well investigated, but research has demonstrated an “all or none” effect; that is, significant exposures cause either no effect or a fetal loss. Although dosimeters are used in areas where high radiation exposure is expected, other areas of high ionizing radiation (e.g., the emergency department) are rarely monitored. Expectant nurses should be very aware of their surroundings.
Stress, physical labor, and shift work. It may be necessary for nurses later in pregnancy to modify their shift schedule or behaviors to help accommodate their needs. Nursing is already a physically rigorous vocation, but add in the fatigue of pregnancy and it can be extremely physiologically demanding. In the first trimester, many women experience morning sickness, which to the pregnant nurse can be debilitating. Later in pregnancy, back pain and sciatica can also interfere with nurses’ ability to continue working until their baby is full term. Additionally, the 12-hour shifts typical for most hospital nurses become more taxing later in pregnancy, and it may be necessary for the pregnant nurse to request a modification to shorter shifts or part-time hours. The best solutions for pregnant nurses are to enlist colleagues for help when possible, to always use safe-lift equipment when available, and to speak up when requiring assistance.
If you are pregnant and struggling to perform your duties, certain pregnancy complications are covered by the Pregnancy Discrimination Act. Pregnant nurses should also be familiar with their state and employer’s Family Medical Leave Act policies and eligibility requirements.
For more information about the hazards to pregnant health care workers, you can browse the National Institute for Occupational Safety and Health’s website about the effects of workplace hazards on female reproductive health.
“The dream begins with a teacher who believes in you, who tugs and pushes and leads you to the next plateau, sometimes poking you with a sharp stick called ‘truth’.” – Dan Rather
For those of you teaching nursing and those aspiring to teach nursing, there has never been a time when Dan Rather’s words resounded more loudly than they do today. Although compassion for others will always remain its essence, nursing continues to become more complex. Therein lies the challenge for each aspiring and current clinical nursing instructor!
How do we ensure that our students’ hearts remain firmly invested in the patient as a person, while the pull and stream of technology steers them away from the bedside? Truth is our most powerful tool. Truth in teaching the ideals of nursing and the true realities of nursing in today’s health care environment is our most difficult task.
If you are reading this blog, then you are possibly a clinical nursing instructor now, or may be thinking of becoming one. Either way, see how you score in answering a few questions below that are commonly posed to both aspiring and seasoned clinical instructors alike:
Place a T for true and F for false next to the following statements. Then, review the answers that follow below.
- I will need to prove my clinical competency on a daily basis.
- I will contribute to the nursing profession.
- I must be friends with my students.
- All of my students will like me.
- All of the unit’s staff nurses and aides will be happy to take guidance from me.
- I need to spend time on the clinical unit, and become familiar with the staff and the nursing systems before I bring my students to the clinical setting.
- I must know every detail about every patient that my students are assigned to.
- I must personally supervise every procedure and all interactions between my students and patients.
- I will earn more money in this position as a clinical instructor than as a staff nurse.
- All of my students will be motivated learners.
In the book that I co-authored with Eden Zabat Kan, Fast Facts for the Clinical Nursing Instructor, we share our combined classroom and clinical site teaching experience of over 50 years. In our book, you will find invaluable guides to such topics as:
- Preparing for your clinical teaching assignment
- Getting to know your nursing students: Who are the best and who are the rest
- The performance appraisals: Clinical evaluations
- Managing the clinical day
- Satisfaction in the role
Here are the answers to 5 of the quiz questions, please see chapter 1 in our book for the remaining answers.
- False. Some of you are transitioning from practice as expert staff, others are tenured professors, and advanced practice nurses. Whatever your background, remember that you are there to supervise and guide novice learners. Learning to refrain from doing the procedure yourself will be a challenge. Your role is not to prove your competency daily but to enhance student learning by supervising and not performing skills. Use strategies like questioning, role playing, and discussions to improve student thinking and problem solving skills.
- True. Whether as a part-time or full-time professor, you are contributing to a profession that is in great need of successful instructors who can teach students how to effectively care for patients.
- False. If you go into clinical teaching thinking that you can be “friends” with your students, then your tenure in this role will be short. Friendships with students can lead to difficult situations, particularly during evaluation periods. Keep personal information about yourself to a minimum.
- False. Face it; we all want to be liked by our students. Stay away from focusing on where you are liked or disliked. Instead of focusing on “like” or dislike” be that instructor that fosters the “aha” moment with your questions and guidance.
- False. Remember you are a GUEST on the unit. Your goal is to teach students. You can use any example on the unit as a teaching experience. Incorrect nursing examples often can teach the most to your students. You need some degree of humility as you foster growth in your student, and maintain working relationships with the nurses and staff on the units that you teach.
There is not a better job than that of being a clinical nursing instructor! Your legacy will continue as a nurse in each of the students that you teach.
Have fun and good luck.
Sometimes, you just can’t squeeze an entire exercise session into your hectic schedule. But, if you can carve out five minutes before work, these three yoga poses can ease muscle tension, invigorate you, and jumpstart your day no matter how jam-packed your calendar is.
So, grab your yoga mat and get moving!
In celebration of Certified Nurses Day, we asked certified nurses why they chose to earn extra skills in particular areas of nursing and what their favorite parts are of being a nurse. We heard from quite a number. Thanks to all for your responses!
“I’m certified in adult critical care. I always saw certified nurses as those who’ve gone above and beyond in their profession to distinguish themselves among other cohorts as those who are driven, have the utmost competence in their skillset, and are knowledge seekers, and that is what I wanted to be.
I love the diversity in the patient population. I work with anyone from the age of 17 and beyond. I describe the value of certification to my coworkers as a distinguished honor; it’s something one works very hard to achieve, and while the journey may not be easy, it’s worth it. I tell my patients who ask what a CCRN is that it’s certification which shows individuals I am more than competent and capable to provide the best evidence-based care possible.”
—CPT Laura Wyatt RN, BSN, CCRN, a clinical staff nurse in the United States Army currently working at Tripler Army Medical Center in Honolulu, Hawaii
“I’m certified in Critical Care, Progressive Care, Nursing Education, Healthcare Simulation. I enjoy working in critical care because I find it rewarding to see patients make rapid improvements in response to my interventions. I appreciate the autonomy that this area provides, and I enjoy the low nurse-patient ratio because it provides me with opportunities to provide holistic nursing care and make deep personal connections with each of my patients and families.”
—Jodi Berndt PhD, RN, CCRN, PCCN, CNE, CHSE, College of Saint Benedict/Saint John’s University and St. Cloud Hospital in St. Cloud, Minnesota
“My first certification was the Pediatric CCRN, and I took the exam almost as soon as I had enough hours to qualify because I was so excited at the opportunity to become certified. Once I entered the role of unit-based educator in the Pediatric ICU and had enough hours in nursing professional development, I also became certified in Nursing Professional Development. After completing my MSN, I became certified as a Family Nurse Practitioner. Now that I primarily do research, writing, and teaching, my CCRN has been modified to a CCRN-K, a relatively new credential for nursing professionals who influence the care delivered to acutely/critically ill patients. In this role, I no longer have enough direct patient care hours to qualify for the original CCRN, and I was beyond ecstatic when I learned that AACN offered an option for nurse managers, educators, and those researching or teaching with the same patient population.”
—Alvin D. Jeffery, PhD, RN-BC, CCRN-K, FNP-BC, Post-Doctoral Medical Informatics Fellow (U.S. Department of Veterans Affairs, Nashville, TN) & Education Consultant (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH)
“I wanted to get a certification in nephrology to show my dedication to it. My mom was a dialysis nurse, so I’ve been around it since I was born. I picked nephrology because of the opportunity to take care of patients and their families in a different way than any other outpatient or inpatient fields.
You have to have hard conversations in nephrology, at times, and I love being part of that process as a patient advocate. I also love helping patients during difficult times and making them smile.”
—Kristin Brickel, RN, MSN, MHA, CNN, Director of Clinical Services at DaVita Kidney Care
“I currently have two certifications in infusion therapy: Certified Registered Nurse Infusion (CRNI) and Vascular Access Board Certification (VA-BC). I have spent most of my nursing career specializing in infusion therapy and the sub-specialty of vascular access. I initially was interested in certification purely for the educational opportunity, studying for my certification taught me a broad base of clinical knowledge.
I find infusion therapy to be extremely rewarding. It offers a near perfect mix of technical procedural excellence, while retaining the individual patient care that I value. Outpatient infusion therapy allows you to create a unique personal 1:1 connection with patients. Some of my best memories as an infusion nurse are the conversations I’ve had with these inspiring patients. In my role today, I get to apply my experience connecting with patients to my passion for improving care through research, education, and product design innovation that can help enable continued progress in care quality.”
—Kristopher Hunter BSN, RN, CRNI, VA-BC, Senior Technical Service Engineer, 3M Critical & Chronic Care Solutions Division
“I am a certified oncology nurse. I got certified because I wanted to be able to offer my patients the best care possible by staying on top of the rapidly changing knowledge base in cancer care and research. I find that being certified gives you a wider base of resources and opportunities to network with other oncology professionals.”
—Alene Nitzky, PhD, RN, OCN, CEO & Founder, Cancer Harbors and Author, Navigating the C: A Nurse Charts the Course for Cancer Survivorship Care
“I am now certified in hospice and palliative nursing. I knew the certification would enhance my professional skills. Earning the CPHN also gave me time to learn more about how hospice and palliative care has come to be seen globally, which is especially important because the patient population at MJHS Hospice and Palliative Care is as diverse as you’d imagine. I also appreciated the opportunity to better learn the ins and outs of the operations, insurance, and reimbursement processes.
I love my patients and my work. Contrary to what people think, being a hospice nurse isn’t depressing. Yes, it’s challenging and it’s hard to look into the face of a family member whose loved one is dying. However, it’s so rewarding to provide holistic care, help educate patients and families about what happens at the end of life, as well as to support people during a time when they really need it.”
—Neema Bandyopadhyay, RN, CHPN, RN Case Manager, MJHS Hospice and Palliative Care in New York City
“When I began my nursing career, I worked in OR and met the Chief of Surgical Oncology at Duke University. I transitioned to work on his surgical oncology team and felt that the additional Oncology Nurse Certification added credibility to my career. It also enabled me to move through administration into progressively more responsible positions, including Vice President.
As an OCN, I feel that effective national education in the U.S. is required to resolve the most difficult medical cases. Adult Oncology is a rewarding nursing genre. Patients need support in all aspects—mind, body, and spirit—in order to maximize benefit from their treatment regimens. Families also need support during this time which includes both medical education and emotional support.”
—Gail Trauco, RN, BSN-OCN, CEO, The PharmaKon LLC and CEO, Front Porch Therapy
Besides making sure that patients have everything they need to heal, nurses also have to ensure that their patients are safe. Sharon Roth Maguire, MS, RN, GNP-BC, Chief Clinical Quality Officer at BrightStar Care, has an extensive health care background with more than 15 years of experience in the health care field. Maguire works closely with nurses—in addition to having worked as one herself—and she knows how important patient safety is.
Maguire agreed to answer our questions on patient safety in honor of Patient Safety Awareness Week. What follows is an edited version of our interview.
What are some of the most important tips that nurses need to know regarding patient safety?
Nurses are uniquely poised to think of patient safety in a very broad way—emotionally, physically, socially, and environmentally—while simultaneously narrowing it down to the specific care situation. We need to think of our patients comprehensively, especially within in the home. We at BrightStar Care follow the national patient safety goals of the Joint Commission as accredited home care agencies.
Home safety evaluations are essential. What within their home environment could put the client at risk for falling? We need to evaluate adequate lighting, plumbing, furniture that is hazardous as a way of support, throw rugs, etc. Clients who are on oxygen in the home are at a significant risk for potential fire outbreaks. It’s important that the nurse educate clients and their family members on oxygen safety in the home.
Medication safety is a Joint Commission national patient safety goal. BrightStar Care nurses collect information about what medications clients are taking (prescribed and over-the-counter as well as home remedies) and are aware of potential hazards of the actual medication as well as how it interacts with other medications, diet, alcohol, etc. We advise clients and their family care partners about the risks we’ve identified. These interventions are critical to safe medication practices in the home setting.
What should nurses do if they make a mistake that results in possible patient harm/injury?
Nurses are skilled at following policies, process, and procedures, but despite their best efforts, a mistake can be made occasionally. Nurses are taught and held to a standard of high integrity including the importance of reporting any sort of mistake. The worst thing to do would be to hide a mistake. The quicker the mistake is reported and acted on, the quicker the potential negative outcome can be reduced.
What are the most common tips that new nurses should know so that they can keep their patients safe? What about keeping themselves safe?
When in doubt, ask questions. Even though nurses may have gone to school for many years, they might have never had the chance to practice a particular skill. Never hesitate to ask for help. If you’re unsure, don’t think you know something—instead just ask a more experienced nurse. Have a more experienced nurse mentor be your partner when you’re doing something for the first time.
Some patients tend to get scared in the hospital, rehab center, or any place they would be treated by nurses. What can nurses do to alleviate their fears?
Most patients really just want someone that they can trust and feel safe and confide in. Nurses should be reassuring and empathizing while explaining things simply to patients. It’s also important to listen to our patients and understand their concerns. Be kind and be patient.
Don’t let the schedule dictate your response. At the end of the day, your patient is your primary focus and although tasks need to be done, that shouldn’t be at the expense of your patient. Patient safety, comfort, and peace of mind are top priorities.
Is there any other important information regarding patient safety awareness that nurses should know?
Safety is so extremely important. Nurses should slow down, take time to understand what is required to be safe—whether that’s when performing a procedure, giving a medication, or reading physician orders. Safety is paramount in the world of a nurse especially in the nurse-patient relationship.
As nurses, and even nursing students, we all know how difficult it can be to balance eating at work. It should be easy to eat, right? You may be a nurse if you relate to any of the following:
- What’s eating? There is no time to eat. None. Zilch. Zippo.
- After you cath someone, insert a rectal tube, and empty a fresh wound vac you simply have no desire (or need at this point) to eat.
- The cafeteria has served the same taco salad for the last four days that you’ve worked. Does anyone else notice that?
- You wear Invisalign (like me) and have no desire to put your MRSA covered hands in your mouth to remove your retainer or brush your teeth in a hospital bathroom after you eat.
- The doctors have been next door rounding for an hour and your patient is next (cue the jeopardy jingle).
- Your favorite hall buddy has been on her 30 minute break for an hour and 10 now. (The jeopardy jingle continues…)
- Who even has time to pack a lunch when you get home at 8:30 and have to be back the next day?
- You get full-blown judged by the “normal suit and tie” people when they see you walk in with a cooler containing a breakfast, a lunch, a snack, an afternoon soda, an afternoon sweet, and a partridge in a pear tree.
- By the time you finally do get to eat at 3 pm you’re as good as drunk and you go for whatever is in sight in the break room: cake, cookies, chips—and topped off with a grilled cheese and tots from the café.
- Your “normal suit and tie” friends post IG stories eating an Açaí bowl or a fresh Chipotle bowl or a kale salad with their coworkers (who are also wearing the cutest Banana Republic outfits) while you eat applesauce and PB&J in the break room while everyone around you complains about poop.
So, my friends, it’s time to fix this problem. Here’s another list for you, because all blogs are more fun to read in numerical list form, right?
1. Avoid eating in the break room.
Tag team with a buddy and go eat outside. Seriously, it’s amazing what 30 minutes in the fresh air does for your mind. Northern friends: I have no clue what to tell you right now.
2. Meal prep.
Nothing crazy, but keep reading to learn some legit good and easy meals you can make at home and have ready for three in a row.
3. Order takeout once a month.
Not everyone can get on board with the meal prep, so treat yourself to a real meal once in a while if you are eating sandwiches and café food all the time (and even if you are meal prepping!).
4. Plan a potluck.
Best way to celebrate a holiday as a nurse? Potluck, potluck, potluck. All the luck transfers to your patients so it’s a win-win.
5. Plan your breaks ahead of time if you can with your hall mates.
If you have a mate that doesn’t do too great (ah, poet and I didn’t even know it) with coming back on time, suggest that you go first after you finish this and then you’ll be back by xx:xx. Letting your buddy know that you respect her break might awaken her to reciprocating.
Pro tip: Nursing students everywhere, please don’t be afraid to tell your preceptor you need a break. I almost passed out once waiting for my preceptor to finally take a break. You are a student and you are totally allowed to pull that card and take a full 30-minute break. Believe me, you’ll have your days of missing your break and starving.
And finally, some of my favorite “easy to eat” things to meal prep and pack for lunch include:
- Egg muffins! One of my friends taught me this recipe. Simply mix up some eggs, ham, cheese, tomatoes (or whatever you like), and pour it into a greased muffin pan for a yummy take-with-you breakfast. If I’m bringing breakfast to eat at work, I usually make breakfast burritos and freeze them or simply make a big batch of scrambled eggs, mixed veggies, and sausage to eat! It’s a small enough meal that can be eaten quickly with roughly the same nutrition in some of these super dense granola bars that aren’t always the healthiest.
- Pasta and veggies. Pasta sauce and mix veggies (spinach, kale, tomatoes, peppers, etc.) go great together and make a super easy lunch. For a healthy mix up, try pairing it with black bean pasta!
- Sweet potatoes. Every week I make two sweet potatoes, a big bowl of stir fried veggies, and bake two chicken breasts. Mix it up! Shred the chicken and put it over a sweet potato with barbecue sauce and goat cheese…weird, but delicious! Or chop up your chicken breast and make a southwest bowl with mashed sweet potatoes, corn, black beans, salsa, and lettuce. It’s all about finding foods that you can use for multiple things.
- A salad bar in your fridge is a great way to mix it up as well. Put items like strawberries, blueberries, slivered almonds, pepitas, dried cranberries, hard-boiled eggs, carrot slices, etc. into tupperware and have your lettuce washed and dried in a big container in the fridge. You can pull out the toppings you want and instantly make a delicious salad and save $7. Pro tip: the cafeteria usually has little 2 oz containers you can use to pre-package your salad dressing!
Hope you enjoy these tips! Please share your favorite recipes with us in the comments.