Why It’s Time to SHIFT Nursing

Why It’s Time to SHIFT Nursing

The Year of the Nurse and Midwife hasn’t really turned out the way any nurse I know (including myself) would have imagined.

You thought the NCLEX was hard? What about the gripping fear that comes from realizing the way you’re being asked to use your N95 would’ve resulted in you failing out of nursing school clinicals? Or the horror you feel about being unable to give patients what they most need: a loved one to hold onto as they transition out of this life? Or the overwhelming anxiety that you might carry an infectious and potentially deadly disease home to your spouse, your children, or your aging parents?

Turns out COVID-19 is the pop quiz none of us ever wanted to take.

While we love the free pizzas, the 7 p.m. applause and the increased visibility, we nurses also see what so many outside of our profession don’t. Nurses witness firsthand the unacceptable toll this pandemic has taken on health care workers, with more than 900 dead in the United States so far—and even more horrifying, COVID’s toll on health care workers of color, who make up 62 percent of that fatality list.

We know that while the data collected are woefully inadequate so far, this disease is having a heartbreakingly disproportionate impact on our patients who are Black, Indigenous, and people of color.

Beth Toner, RN, MJ, MSN
Beth Toner, RN, MJ, MSN

Those of us who chose this profession to make a difference in others’ lives are willing to work hard to ease the suffering of others. We know our patients. We know they are far more than the condition that landed them in our care. It is food insecurity, inadequate housing, low wages, and unreliable (or no) transportation that have as much effect on people’s health as the medication they take and the health care they receive.

Yet this pandemic has shown us just how fragile this system we call health care is. How can we take care of patients if we can’t even take proper care of ourselves?

Here’s the good news: There’s never been a better time for nurses to make themselves heard and push hard for the changes we have been calling for since, well, forever. The National Academy of Medicine is hard at work on the next Future of Nursing report and it will focus on how nurses can be supported as they address the problems in communities that prevent so many from living their healthiest lives.

A new report from the WikiWisdom Forum—which spent nearly six months listening to nurses across the nation discuss the heartbreaking conditions on the COVID front lines—has made recommendations on how to avoid a similar tragedy in the next pandemic, which will surely come. The report calls for everyone—policy makers, the public, and nurses themselves—to listen, protect and support nurses.

I’ve heard similar themes from the nurses who playing starring roles on SHIFT Talk, a new podcast supported by the Robert Wood Johnson Foundation, that addresses bullying, PTSD and preceptorship in our profession. The host and guests tackle tough topics and point out that the pandemic has only made worse the problems nurses have been facing for a long time.

But again, there are a few bright spots. Nurses are so resilient. Not only will we get through this, we will, I believe, get through this stronger. We have solutions to the problems the nation’s health care system faces. We know what we, and our patients, need.

It’s time to speak up boldly. It’s time to fight the injustices so many of our patients—and so many of us—face. It’s time to stare down systemic racism within our profession. It’s time to bring a variety of voices to the table. It’s time to make the shift and make this a Year of the Nurse we will remember for all the right reasons.

Nurse of the Week Diane Foxen Treats Babies in the ICU, Kittens at Home

Nurse of the Week Diane Foxen Treats Babies in the ICU, Kittens at Home

Nurse of the Week Diane Foxen has two callings. The Sunnyvale, California nurse cares for human infants during shifts lasting up to 16 hours in the neonatal ICU at Santa Clara Valley Medical Center, and works part-time at El Camino Hospital as well. After she leaves the ICU, Foxen goes on shift at home, treating newborn felines as a volunteer for her local Humane Society. Her home-grown kitten clinic has been a refuge during the pandemic: “Kittens are bouncing around, running around, jumping up in the air. There’s no way you cannot laugh if you have a kitten or puppy in your life because they are just funny. And in this time of COVID, everybody needs a little bit of funny.”

Over the past decade, she has fostered some 200 homeless kittens, occasionally making room for 13 at a time. Foxen’s first feline charge was Smudge, a young tuxedo cat who was suffering from lymphoma. Smudge was expected to live for no more than six months, but under Foxen’s care he survived for three years. Cristie Kamiya, chief of shelter medicine at the Silicon Valley Humane Society said, “Having a foster parent of Diane’s caliber taking on some of the most challenging cases has been critical to our mission. Diane has literally saved the lives of the many kittens she has taken in.”

Foxen's kittens gather for dinner.

After she had taken Smudge under her wing for the Humane Society, the Society was quick to adopt Foxen: “I started getting phone calls from the Humane Society, saying, ‘Hey, Diane, we’ve got this really sick kitten—it’s just like NICU nursing—can you take care of it?’ And so now my specialty is fostering very sick ringworm kittens.”

Although ringworm is a skin fungus, it is so contagious that many cats are put to sleep simply to prevent it from spreading. When Foxen fosters kittens with ringworm, she isolates them in a special room, where she treats them with medicated baths and oral fungicides until they are worm-free.

Tending to the rescued kittens is emotionally rewarding, and also helps to relieve the stress of working in an ICU. Foxen told the Mercury News that “They say that we’re heroes but actually, especially after that second lockdown where I sheltered away from my sister, these kittens were my heroes. They’re giving me that contact that I need. They’re giving me a safe place to cry my tears where I’m not burdening anybody else who has had a hard time with this themselves.”

Her volunteer work with animals complements her career and enriches her life: “Having this transition from a kitten that may not make it to this healthy kitten that is now running around and playing, that is just reward in itself,” she said. “Having a foster—whatever animal—I highly suggest it; it can really help people make it through tough times.”

The full story on Diane Foxen is available at Los Altos Online.

Droplet or Aerosol? Debate Over How COVID Spreads Can Sway Your Hospital’s PPE Policy

Droplet or Aerosol? Debate Over How COVID Spreads Can Sway Your Hospital’s PPE Policy

The droplet vs aerosol question has front-line health care workers caught in the middle as infection control specialists and hospital administrators debate over how the novel coronavirus is spread ― and therefore, what level of protective gear is appropriate.

At issue is the degree to which the virus is airborne ― capable of spreading through tiny aerosol particles lingering in the air ― or primarily transmitted through large, faster-falling droplets from, say, a sneeze or cough. This wonky, seemingly semantic debate has a real-world impact on what sort of protective measures health care companies need to take to protect their patients and workers.

The Centers for Disease Control and Prevention injected confusion into the debate Friday with guidance putting new emphasis on airborne transmission and saying the tiny aerosol particles, as well as larger droplets, are the “main way the virus spreads.” By Monday that language was gone from its website, and the agency explained that it had posted a “draft version of proposed changes” in error and that experts were still working on updating “recommendations regarding airborne transmission.”

Dr. Anthony Fauci, the top U.S. infectious disease expert, addressed the debate head-on in a Sept. 10 webcast for the Harvard Medical School, pointing to scientists specializing in aerosols who argued the CDC had “really gotten it wrong over many, many years.”

“Bottom line is, there’s much more aerosol [transmission] than we thought,” Fauci said. [10-07-2020 UPDATE: On October 5, 2020, the CDC updated its website to state that “under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example, while singing or exercising.”]

The topic has been deeply divisive within hospitals, largely because the question of whether an illness spreads by droplets or aerosols drives two different sets of protective practices, touching on everything from airflow within hospital wards to patient isolation to choices of protective gear. Enhanced protections would be expensive and disruptive to a number of industries, but particularly to hospitals, which have fought to keep lower-level “droplet” protections in place.

The hospital administrators and epidemiologists who argue that the virus is mostly droplet-spread cite studies that show it spreads to a small number of people, like a cold or flu. Therefore, N95 respirators and strict patient isolation practices aren’t necessary for routine care of COVID-19 patients, those officials say.

On the other side are many occupational safety experts, aerosol scientists, front-line health care workers and their unions, who are quick to note that the novel coronavirus is far deadlier than the flu ― and argue that the science suggests that high-quality, and costlier, N95 respirators should be required for routine COVID-19 patient care.

Dr. Anthony Fauci, the top U.S. infectious disease expert, addressed the debate head-on in a Sept. 10 webcast for the Harvard Medical School, pointing to scientists specializing in aerosols who argued the CDC had “really gotten it wrong over many, many years.”

“Bottom line is, there’s much more aerosol [transmission] than we thought,” Fauci said.

The topic has been deeply divisive within hospitals, largely because the question of whether an illness spreads by droplets or aerosols drives two different sets of protective practices, touching on everything from airflow within hospital wards to patient isolation to choices of protective gear. Enhanced protections would be expensive and disruptive to a number of industries, but particularly to hospitals, which have fought to keep lower-level “droplet” protections in place.

The hospital administrators and epidemiologists who argue that the virus is mostly droplet-spread cite studies that show it spreads to a small number of people, like a cold or flu. Therefore, N95 respirators and strict patient isolation practices aren’t necessary for routine care of COVID-19 patients, those officials say.

On the other side are many occupational safety experts, aerosol scientists, front-line health care workers and their unions, who are quick to note that the novel coronavirus is far deadlier than the flu ― and argue that the science suggests that high-quality, and costlier, N95 respirators should be required for routine COVID-19 patient care.

Tips for Doing a Video Interview

Tips for Doing a Video Interview

Pre-COVID-19, most job interviews were conducted in person. You may have had an initial phone interview, but having your second or third interview on video wasn’t generally done.

Welcome to a whole new world.

If you haven’t regularly used video or just want to get some good tips/strategies for looking and doing your best, we’ve got you covered.

Dina Neilsen, PhD, Senior Manager, Learner, Career and Alumni Services of Nightingale College, took some time to answer our questions about what nurses can do to improve their video interviews.

What is the first thing nurses should do when they find out they have a job interview via video?  

Think about what you want to accomplish in the interview; carefully review the job description and then perhaps make notes about those qualities and skills that might set you apart in the interview.

How can nurses properly light themselves for an interview? What should they use for a background?

If possible, try to set up your computer so you have natural light on your face. This is better than electric light for keeping your skin a natural color.

Consider background. Is there an open closet behind you? Are there stacks of boxes? Does it look like you are sitting on your couch in your living room? An “office” type of setting is best, but if you don’t have a space like that, a neutral wall in the background is better than something that appears to be too “homey.”

To prevent noise, pets, and children making entrances, what should they do?  

Be sure you will have quiet, uninterrupted time during the interview. If you have family or roommates at home, be sure to let them know what you are doing and that you need privacy for that time. Coffee shops, parks, etc., can be problematic because you won’t have any control over noises or interruptions.

Are there any colors/patterns they absolutely should not wear? Any recommendations on what to wear?  

Wear colors. Computer cameras tend to wash you out, so having some color will help you look healthy and engaging. It may be worth applying some make-up, particularly to your eyes and mouth, to avoid looking washed out.

Should they rehearse? How should they do this?

A tech rehearsal with a friend or family member can be very helpful, though it could be just as helpful to simply do a mock interview. Prepare the questions you think you might be asked and then run through them a couple of times. But remember, you’ll probably be asked something you didn’t anticipate—relax and remember your interviewer wanted to talk with you.

What are the biggest mistakes they could make that they should be aware of and try to avoid?  

Becoming flustered or nervous is common—something that might help would be to tape the job description, resume, cover letter, and questions you have for them on the wall behind your camera so you can review them without looking down at papers.

In terms of the interview itself—is there anything different they should do as opposed to if they were on an in-person interview?

Make sure you continue to make eye contact and keep your body language still and relaxed.

Because you are not meeting in person, it is important to remember to still be engaging with the interviewer as if you were face to face.

Johns Hopkins Launching DNP/MPH Program in 2021

Johns Hopkins Launching DNP/MPH Program in 2021

Starting in summer 2021, nursing graduates interested in working with local and global health agencies, advocacy groups, non-governmental organizations, or other setting related to health policies will be able to pursue a dual-degree Doctor of Nursing Practice Executive/Master of Public Health (DNP/MPH) program at Johns Hopkins.

The Johns Hopkins School of Nursing and the Johns Hopkins Bloomberg School of Public Health are now accepting applicants for their new DNP/MPH program. The prerequisites for applicants are a master’s degree in nursing, RN licensure, and 2 years of health care experience. The combined program can be completed in as little as three years.

The DNP/MPH courses will be a hybrid of online and onsite learning. Students will be able to customize their public health coursework and implement their integrated DNP project in a real-world setting.

Dual degree programs can be valuable tools for professional advancement. They also offer advantages of economy and speed: dual degrees require fewer credits, so students can attain their degrees at a faster rate and a lower cost than other programs.

One of the great virtues of the DNP/MPH degree, according to Bloomberg School of Public Health Dean Ellen J. MacKenzie, PhD, ScM, is that “When nursing and public health bring the best of their skills together, there is so much to be accomplished within advancing health equity and developing solutions to our changing national and global health needs.”

The benefit of combining public health studies with nursing practice in a DNP/MPH program is particularly timely, says Johns Hopkins School of Nursing Dean Patricia Davidson, PhD, MEd, RN, FAAN: “COVID-19 has amplified the critical importance of nurse leaders who develop interventions that are based in both nursing and public health,” Davidson remarked in the announcement. “We are excited to be able to launch the program during this time in history when the perspective of nursing is well recognized and ever essential to creating the path forward to a healthier and more population-focused future.”

For application details, visit this page at JHU School of Nursing site.

CDC: Restaurant Dining Linked to COVID Infections

CDC: Restaurant Dining Linked to COVID Infections

Patients with symptomatic COVID-19 were more likely than uninfected controls to report some form of restaurant dining — including indoor, patio and outdoor seating — in the 2 weeks prior to symptom onset, CDC researchers found.

Compared to controls without COVID-19, case patients were more than twice as likely to have reported dining at a restaurant (adjusted OR 2.4, 95% CI 1.5-3.8), reported Kiva Fisher, PhD, of the CDC, and colleagues.

When the analysis was restricted to case patients with close contact to anyone with confirmed COVID-19, case patients were still more likely to report having visited a bar/coffee shop (aOR 3.9, 95% CI 1.5-10.1) or restaurant (aOR 2.8, 95% CI 1.9-4.3) than control patients, albeit with wider confidence intervals, Fisher’s group wrote in the Morbidity and Mortality Weekly Report.

Not surprisingly a substantially larger proportion of case patients reported close contact with a person with COVID-19 versus controls (42% vs 14%, respectively).

This data was previewed at the National Academy of Sciences and Medicine (NASEM) workshop on airborne transmission as part of the growing “circumstantial evidence” suggesting airborne transmission may play a role in COVID-19 spread.

“Reports of exposures in restaurants have been linked to air circulation,” the authors wrote. “Direction, ventilation, and intensity of airflow might affect virus transmission, even if social distancing measures and mask use are implemented according to current guidance.”

Researchers examined data from adults tested for SARS-CoV-2 at one of 11 Influenza Vaccine Effectiveness in the Critically Ill (IVY) Network sites in July. COVID-19 cases were confirmed via PCR testing for SARS-CoV-2 from respiratory specimens. For every case, control patients who tested negative for SARS-CoV-2 were matched based on age, sex and study location. The investigators then followed up with phone interviews. After screening, Fisher and colleagues had 154 case patients and 160 controls for analysis.

Controls were significantly more likely to be non-Hispanic white, have a college degree or higher and report at least one underlying chronic medical condition compared to cases. Self-reported mask compliance was high in both groups, with 71% of cases and 74% of controls reporting always using face coverings in public. About half of close contacts reported (51%) were family members.

About half of all participants reporting going shopping or visiting someone inside of a home with 10 people or less at least once in the 14 days prior to symptom onset. However, there was no difference between cases and controls in reported shopping, gatherings in homes irrespective of the number of guests, going to an office or salon, using public transportation, patronizing a bar or coffee shop, or attending church/religious gatherings.

Overall, 107 participants said they’d gone to a restaurant and 21 to a bar or coffee shop. Cases not only outnumbered controls in these groups, but were also significantly more likely to report that “almost all patrons” at the establishments weren’t wearing masks or maintaining safe distances.

“Implementing safe practices to reduce exposures to SARS-CoV-2 during on-site eating and drinking should be considered to protect customers, employees, and communities and slow the spread of COVID-19,” Fisher and colleagues concluded.

By Molly Walker, Associate Editor, MedPage Today

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