At any given moment working nurses are pulled in numerous
directions, as multitasking is the currency of the occupation. In many
instances, nurses are caring for high acuity patients on units with inadequate
nurse staffing. Nurses are trained in principles of documentation, the six to
of medication administration, and round regularly on their patients to maintain
Distraction can still wreak havoc on a shift if a nurse is not focused carefully on the immediate task at hand. A 2013 study revealed that “42% of healthcare-related life-threatening events and 28% of medication adverse reactions are preventable.” So how can nurses bring their full attention to what they are immediately concerned with?
Mindfulness Can Help
By embracing the practice of mindfulness. It’s a term that’s mentioned often in relation to relaxation and meditation these days, but it can be helpful during working hours as well as after hours. To be mindful, according to Merriam-Webster, one is “bearing in mind,” “aware,” or “inclined to be aware.” PsychologyToday.com states that mindfulness “is a state of active, open attention to the present.” Essentially, being mindful is being fully present and attentive to what is happening in the present.
Mindful over Multitasking
Nurses can incorporate mindfulness into their everyday
practice by making the effort to bring their focus to the present whenever they
are interacting with patients, which will improve work performance.
Save any multitasking for times not spent working directly with patients.
Before entering a patient’s room, pause briefly and take a breath. Bring the
focus to the specific details of the patient’s case and keep it there as long
as the interaction lasts. Actively listen when they speak.
Before entering a patient’s room, scan your body
for tension – look for tension in common places such as the jaw or shoulders
and relax those areas.
Be aware of feeling rushed or anxious, and
acknowledge these feelings without trying to eliminate them.
Take a couple of mindful breaths, dissolving
your tension and busyness on the exhale.
As you prepare to meet your patient, adjust your
mindset to be fully present.
Knock on the door and make eye contact as you
enter the room.
Introduce yourself and make a personal
Chat with your patient for a few moments before
moving on to your assessment or reaching for your computer.
Whenever you notice your focus has wandered,
gently redirect back to your patient and the task at hand.
Incorporating mindfulness into everyday practice can reduce reactivity to stress. By being more mindfully deliberate, nurses can implement their daily plans with less distraction. Adopting the mindful approach is considered much healthier than multitasking. And paying full attention to patients can only improve assessment skills.
Adopting the practice of being mindful and returning the
mind to the present whenever the focus strays can help keep nurses on task with
less stress and more efficiency. A mindful nurse is far less likely to make
mistakes. And that’s something from which everyone benefits.
Caring Science, Mindful Practice
This seminal work, based on the philosophy of Watson's Human Caring Theory, is designed to help students and practitioners of nursing to simplify Watson's complex teachings and integrate them into everyday practice. The revised second edition includes an abundance of new micro-practice examples for each of the 10 Caritas Processes®; practical exemplars from Dr. Sitzman’s research, enabling readers to cultivate Caritas and mindfulness on a daily basis; and new case studies demonstrating how others have implemented Human Caring Science into everyday life and work.
It’s hard to explain what we do. And so maybe, it’s hard for others to sympathize with our situations. I mean, physicians, mid-levels, and nurses in emergency departments are tied to computers in often cramped work-spaces, even as they are required to be at the bedside almost constantly for the latest emergency or (in other cases) the latest bit of pseudo-emergency drama.
If you haven’t worked there, or haven’t for a long time, it could be that this lack of understanding is what leads hospital administrations to do one of the stupidest things imaginable. What is that thing? Banning food and drink from our work-spaces.
Now, this isn’t the case in my current job. But it is the case in all too many facilities. I talk to people. I hear things. And it’s usually justified with some unholy combination of infection control, Joint Commission and public health clap-trap, coalesced and refined, then circulated as a cruel policy.
When it’s enacted, clinical staff have their water bottles taken
away. Nobody is allowed to eat where they work. Dedicated, compassionate
staff members grow tired and dehydrated and hungry. (Maybe it’s a good
thing. They often don’t have time to urinate anyway, and water just
makes that happen more often.)
Mind you, the water bottles are sometimes kept in a nearby room, or on a nearby shelf. It’s an act of kindness, I guess. And the food? Well, all you have to do is take your break and go to the cafeteria or to the break room, right?
Those who come up with these rules don’t understand that a scheduled break is a great idea … that never happens. It’s an emergency department. It isn’t (technically) a production line; however, we try to impose time restrictions and through-put metrics. It isn’t “raw material in/product out.”
It’s “sick, suffering, dying, crazy human being in” and if all goes well, “somewhat better (at least no worse) human being evaluated, stabilized, saved, calmed, admitted, transferred, and sometimes pronounced dead” out of the other end of the line.
Those Herculean efforts can take anywhere from, oh, 20 minutes to 12 hours. During which time, it’s pretty hard to leave the critical patient in the understaffed department, with the “five minute to doctor” guarantee and the limitless capacity for new tragedy rolling through the door.
That setting makes it remarkably hard for breaks or even meals to happen at all.
As such, it’s nothing short of cruel and unusual for anyone to say to the staff of a modern emergency department, “you can’t have food or drink” — especially when it’s typically uttered by people who have food and drink in their offices and at their desks. People who have lunch meetings with nice meals or who have time to walk to the cafeteria or drive off-campus. And who feel so very good about protecting the staff from their deadly water bottles.
The argument, of course, is that the clinical staff work in a “patient care area.” Even when they aren’t at the bedside but are, for instance, behind a glass wall at a desk. If this is the case, then one could argue that the entire hospital (including administrative suites) is a “patient care area.”
They are afraid we’ll catch something. That it’s unsafe for us to eat or drink where we work. Of course, this is while we positively roll around in MRSA and breathe in the fine particulate sputum of septic pneumonia patients. This is while staff clean up infectious diarrhea and wear the same scrubs all day.
This is after we intubate poor immigrants who may well have tuberculosis and start central lines on HIV patients. This is after we wrestle with meth-addicts who have hepatitis C. And this concern for our “safety” occurs in places where physical security, actual security against potential violent attack, is a geriatric joke which is often tabled until the next budget cycle.
And as for our patients? Our food and drink are no danger to them. They and their families fill the exam rooms with the aroma of fried chicken, fries, and burgers, eaten at the bedside (often by the patient with abdominal pain). Their infants drag pacifiers across floors that would make an infectious disease specialist wake from bacterial nightmares in a sweat-soaked panic. In short, our food or drink are no threat to them and no threat to us.
But the absence of food and drink? That’s a problem. Because the ED is an endless maelstrom of uncontrollable events and tragedies, of things beyond our control for which we are responsible. It is a place of physical, emotional, and spiritual exhaustion where we rise to the challenge and manage (against the odds) to do so much remarkable good by virtue of our knowledge, our training, our courage, and our compassion.
In the midst of all that, a bottle of water, a cup of coffee, a glass of Diet Coke, a Styrofoam cup of iced tea is an oasis in the desert. And that sandwich, slice of pizza, cupcake, or salad is the fuel that helps make it happen.
More than that, food and drink are among the few pleasures we have time for each shift. They serve as bridges to the end of the day, small reminders of normalcy in a place where so little is normal.
Doubtless, one day someone will take away our music so that it doesn’t hurt our ears, or offend our patients. We’ll fight that battle when it comes.
But until then, depriving staff of food and drink proximate to where they work is of no health value and strikes me as just one more way of exerting control over the people actually engaged in the hard, grinding work of saving lives.
Thinking creatively about access to women’s health care has always been part of the job for Tracie Kirkland, clinical assistant professor in the Department of Nursing at the USC Suzanne Dworak-Peck School of Social Work.
Kirkland, a former program coordinator for Johns Hopkins Pepsi Beverages Wellness Center in Mesquite, Texas set up a mobile breast screening unit at the Pepsi plant so women could take advantage of mammography screenings without having to take time off work.
“Seeking windows of opportunity to access health care may not always be in a traditional setting,” Kirkland said.
Accessing routine care may be harder for some women than others, depending on individual circumstances and institutional barriers. Scheduling and attending routine health care visits can help women care for all aspects of their physical and mental health as they age.
Geography: People living in areas far from health providers may find it difficult to travel several hours for an appointment. In a 2017 report on social determinants, researchers found that geography contributed to differences in mortality and morbidity related to smoking, obesity, air pollution and several chronic illnesses.
Family obligations: Women who are parents of young children or caregivers for other family members may have to arrange for child care or other forms of assistance in order to make time for health visits. Data from a 2018 caregiving report from Pew Research Center indicates that women spend more time providing child care than men.
Transportation: In rural communities, women without a car or public transit options may be unable to access a provider. In urban areas, residents might not find care within walking distance or be able to afford costly public transit fares.
Even after women attend a health care appointment, social determinants can keep them from being able to understand and apply health information to their lifestyles. That includes knowing how to reach a provider for a follow-up conversation or how to fill a prescription at the nearest pharmacy. Providers like nurse practitioners can make use of one-on-one time to guide patients through next steps and counsel them on how to make appointments for other visits or needs.
“Know where to seek out services that may be free of charge, like the public health department or Planned Parenthood, where you can utilize a sliding scale in order to receive services,” Kirkland said. Sliding scale services use a variable cost to determine a fee based on how much the patient can afford to pay.
Providers can also look for innovative ways to reach patients for follow-ups or spread awareness about health information.
“We need to really be savvy in the way that we’re utilizing social media to disseminate information versus our traditional face-to-face visits,” Kirkland said.
Social media can help providers reach captive audiences by promoting health information during specific health awareness months. Patients can also use social media to find locations in their community to access health care and information:
Places of employment
Places of worship
Local and state departments of health
Local school district
Publicly funded clinics
Planned Parenthood and women’s health clinics
When using any of these venues to access care, it’s important that patients find a way to follow up with a provider or keep in contact.
“Once we create a connection through rapport, we generally are able to keep bringing [patients] back on a regular basis,” Kirkland said. “Depending on what we find in the clinical examination.”
Recommended Health Screenings for Well-Woman Visits
Even when feeling healthy, women have a lot to gain from routine checkups, including screenings for future medical changes, family planning, vaccinations and healthy lifestyle maintenance.
“Do you wait until your car breaks down to have it serviced, or do you maintain it by changing your oil and your tires?” Kirkland said. “Do you wait until your body breaks down, or do you maintain it?”
A well-woman exam is an annual appointment for women throughout the life span. As women age, their health needs evolve, so the visit may include different types of exams or interviews between a patient and provider.
Similar to an annual physical for children, a well-woman visit includes assessments of physical and mental health but also includes conversations about reproductive and sexual health.
An initial visit, often done when women are seeing their provider for a physical for the first time, may just be a one-on-one to discuss what would actually take place in a well-woman visit, Kirkland explained.
Depending on age and health needs, a well-woman exam can look different for each patient.
When Should Women Seek Reproductive and Sexual Health Care?
Women don’t have to be planning a family to need reproductive health screenings and care. They should start seeking care at the age of menarche — which is when they begin having menstrual cycles — or when they start having sexual partners. “It depends individually on their desire to be intimate, and where they are in terms of maturation,” Kirkland said.
STI and HIV testing: This screening can be a physical exam or a consultation from a provider to discuss sexual activity and test for sexually transmitted infections. The best time to get tested is before being active with a new sexual partner, and it can be done as often as a patient desires.
Breast exam: This is a physical exam that is done routinely on patients even if they have no other signs of developing breast cancer. Any abnormalities can be further tested with a mammogram, which is an X-ray screening for tumors that can’t be felt with a breast exam.
Pelvic exam: This is a physical examination of reproductive organs and is used to screen for ovarian cancer or other abnormalities that can develop as women age. The provider will inform the patient if they need to return for additional testing.
Menstrual health: A provider will ask about the regularity of a patient’s menstrual cycle, contraceptive use and any abnormalities with pain, bleeding or mood.
Pap smear: This is a physical exam during which a provider collects cells from the cervix to test for cervical cancer. This exam can also help find cells caused by HPV and is recommended every few years for women between the ages of 21 and 65.
Literacy about sexual health can be pivotal to women’s ability to control and plan for their future. Being able to afford contraception is one thing, but maintaining a treatment plan can be an issue — particularly when there is a lack of understanding about different types of contraception, their efficacy and how to use them. The more that providers can empower patients about seeking and understanding health information, the more meaningfully women can be engaged in their decision-making and health care.
The state of Minnesota is making headlines this December, not for its freezing temperatures or a new record snowfall, but for increasing medical cannabis access. Clinical cannabis got its start in the state when former governor Mark Dayton signed the first Minnesota medical cannabis bill into law in 2014. Many criticized the bill for being far too restrictive as it listed only 9 qualifying conditions and stipulates a lengthy patient registration process. However, as of December 3rd, 2019, the state added macular degeneration and the much more generally outlined chronic pain to the list of qualifying conditions. Minnesota can now expect to see more registered medical cannabis patients thanks to the expanded list of qualifying conditions.
Making Medical Marijuana More Accessible
Though many American states have taken steps to legalize clinical cannabis, a number of potential patients still do not have access. In most cases, state regulations prevent people with certain conditions from using medical cannabis. If the state regulatory body does not list a medical condition as qualifying, then people suffering from that condition may not use cannabis for medicinal reasons, even if a medical professional recommends it as a potential treatment. The stringent nature of qualifying condition lists make Minnesota’s addition of chronic pain as a qualifying condition a massive win for medical cannabis advocates.
Chronic pain is a very generally defined medical condition. Any number of ailments can cause it and is usually up to the patient to define. For these reasons, acquiring a recommendation for medical cannabis can be far easier than it is for other conditions. There is little doubt that Minnesota’s clinical cannabis patient registry will expand greatly in the coming months thanks to the addition of chronic pain and macular degeneration. According to the Boston Globe, “As of October, nearly 18,000 patients were certified for the state’s medical marijuana program.” That number is bound to increase as more conditions make the list.
The Future of Medical Cannabis in Minnesota
Many consider Minnesota as having one of the more severely restrictive medical cannabis programs. Though Minnesota’s list of qualifying conditions is still small, it is encouraging that the state continues to implement updates. Lawmakers must work with patients and advocates to continue to pursue the creation of a fair and easily accessible medical cannabis program. If the state continues to update its list of qualifying conditions, it can at least begin to change the narrative.
Most NYC dwellers, including myself, do not have a car. We rely almost exclusively on public transportation. In the course of my career, I have commuted on regional trains, subways, buses, bike-sharing programs, and of course, my own two feet. Navigating public transportation in the crowds and the temperamental weather patterns of New York is a triumph and a skill.
Over the years, I have learned the written and unwritten rules of New York City travel. It goes something like this: leave early, be ready to give up your seat to someone who needs it more, ride your bike as if no one else is paying attention, ride on the left of the escalator to climb and the right to stand still, wear those snow boots twice a year (but on those two days you desperately need them), expect delays, take your backpack off on the train, never use a speakerphone in public, let others off the subway before getting on, and so on. Thankfully, today I live so close to my job in Hell’s Kitchen, my commute is nearly nonexistent.
I have noticed subtle differences in the patients we see, the procedures we do, and the teams we work with in NYC, compared to when I worked in the suburbs. It is only in the city that I have experienced proximity to fame, both in the patients and physicians. One of my first jobs as a nurse was at a well-known dermatology practice where we did Mohs procedures, as well as cosmetic dermatology. The practice saw many celebrities.
This challenged me to put certain nursing principles to work: taking an egalitarian approach to our patients, and being especially mindful to protect their privacy. I have since had many similar experiences with patients in the OR. Working with renowned surgeons, I have to remind myself that I am there for patient care, not surgeon care. My work is to care and advocate for the patient, not to placate the surgeon — although of course, I do prefer when everyone’s happy.
Clinically, in the city, we see different traumas than in the suburbs. For example, we seldom see major traumas from automobile accidents because the city congestion precludes high speeds. Also, many patients come from elsewhere because they know the names of hospitals and physicians in New York, and have experienced failed treatment elsewhere. For this reason, we see many patients with highly complex cases.
A Day in the Life
I work a 7-3 shift Monday through Friday. Because I live so close to work, I wake up at 5:55 am. That gives me enough time to have coffee, do a brief meditation, take a shower, get dressed, and get to work early enough to change into my OR scrubs. Occasionally I’ll wake up earlier and do stretching and a workout. From there, the day is like any OR: fun, fast-paced, and unpredictable. I work as a head nurse of certain specialties, which allows me the autonomy to take breaks when the workload allows, rather than relying on relief staff. Sometimes that means I’m able to go home and relax or run an errand, and sometimes it means I take smaller breaks throughout the day of five or ten minutes to have a bite or clear my head. Although my shift ends at 3 pm, I leave after most of the day staff because I need to prep for the following day, or to assist with nursing needs as they come up.
Most days I’m home by 3:45 pm. I often take a nap, food prep for the next day, then head to a dance class or meet up with a friend. I have a late dinner with my fiancé and work on one of my art projects: another way I keep my head clear and soul happy. Recently I’ve learned to sew and have started making clothing for myself and others. I’m lucky because, in NYC, I can decide I want to learn a new skill and then quickly find a resource. There is no lack of teachers and services in NYC.
The last thing I do before bed is catch up on homework. I’m in school for my MSN in informatics and my MBA. Schoolwork calms me and I get into bed with a leisure book between 10 and 11 pm. Other days I forego all these activities and allow myself to enjoy the home that I work to have. Sometimes I need to relax after being on my feet all day, rather than pound the pavement, and I give myself that time off. I’m kind to myself so I can be kind to my patients and my coworkers.
This is part of a monthly series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight the founder of the nonprofit Women of Integrity Inc.
For her full-time job, Shantay Carter, BSN, RN, works for Northwell Health Systems. But in her free time, she works for the nonprofit she founded in 2010, Women of Integrity Inc. in New York.
Carter says that she founded the organization because she
was experiencing a tough time in her life and wanted to work with youth, which
she’s always enjoyed. “I decided to channel that negative energy into something
positive,” Carter explains. “I created WOI so that it would be a resource and
support system for the women in the community. Our goal is to empower and educate
women of all ages and ethnicities.”
WOI holds a number of events throughout the year to help both
girls and women. They hold an annual prom dress drive, a prom dress giveaway, a
prom makeover project, a women in business brunch, educational workshops,
mentoring, and a Galentine’s Day celebration. Carter says that they also
partner with other local community organizations to help host girls’
“I think it’s necessary to have an organization like WOI
because our young girls and women need a safe place, they need support, they
need to know that they are loved and worthy, and that their voices are being
heard. We provide them with the tools necessary to achieve their goals and aspirations,”
says Carter. “Through WOI, we have been able to create a platform that has
helped many entrepreneurs start or grow their businesses, and we have mentored
so many young women over the years. We have also hosted numerous educational
workshops on health, etiquette, and finances. We have created a
network/sisterhood of like-minded, positive women who enjoy giving back to
their community and want to make a difference.”
Carter admits that she’s experienced some challenges. She
needed to select the right team members to help, gain the support of the
community, and raise money. “There are times when you may feel like giving up,
but then you have to remind yourself of your purpose and why you are doing this,”
If you’re a nurse and want to start a nonprofit, Carter has some advice:
Find your passion first, and then it will lead
you to your purpose.
Research your target group or area that you want
your organization to serve.
Get a lawyer when it comes time to get your 501 (C)
Learn to network strategically and
Support those who support you.
Know your competition so that you can learn how
to stand out.
Have a great team behind you.
“The vision for the organization has to be bigger than
you because it’s not about you,” Carter says. “It’s about the community and the
people you serve. Don’t try to compete with others. Just focus on what you are
doing and your end goal. You may feel like giving up and become frustrated, but
you have to keep pushing. What’s meant for you will be for you.”