The Art of Giving Report

The Art of Giving Report

If you ask any nurse why they went into nursing, their response will undoubtedly have a foundation of compassion. Whether it’s an anecdote about a family member, a childhood role model, or a personal experience, a career in nursing starts by caring.

And yet, in a modern health care system burdened by precarious political conditions, technology evolving at breakneck speed, and specialties becoming super-specialties, it’s easy to lose touch with sentiment.

The onus on nursing seems to be heavier than ever, and the workload seems to focus on skills and tasks rather than human connection. Within such a context, reminding a nurse (if you can catch him or her) that they need to give report to another unit may understandably yield a frustrated grunt.

Yet despite how inconvenient, time-consuming, and even unpleasant hand-off may seem, its purpose is not to frustrate the nurse but rather to serve the patient.

Remember SBAR? Have you heard that acronym since nursing school? Health care today is filled with endless acronyms and buzzwords. SBAR and others serve as simple solutions to the impossibly complex knowledge nursing requires. Likely to many nurses’ chagrin, SBAR is evolving, and even specializing, just like nursing; now there is SHAREDPEARLS, and IPASS, to name a few.

What does compassion have to do with giving report? If every nurse gave hand-off as if the patient was their loved one, it is likely that every scratch would be scrutinized, every medication change would be reviewed in minute detail, and personal details would be emphasized (e.g., “She hates when you call her Patty. Call her Trish.”).

Giving good report is not an advanced science, but a simple art that can be mastered with a few pointers rooted in the principle of quality care:

  • Write pertinent information down; do not go by memory.
  • Do not multitask while giving or receiving report.
  • Be thorough; don’t assume the other nurse “should” already know something.
  • Whether SBAR or not, use a simple guideline to be sure you have covered all your bases.

Caring nurses are thorough nurses. If the care that attracted a nurse to the field can inform every report they give (and every other task), nursing can become even more meaningful, efficient, and effective.

Patients with Pups: Nursing with Service Dogs

Patients with Pups: Nursing with Service Dogs

Are service dogs allowed in medical facilities, including doctor’s offices and hospitals, in the United States? If so, what is the responsibility of nurses to care for individuals accompanied by a service dog?

We ask these questions because there are currently more than 500,000 service dogs in the U.S., and the service dog community is growing in popularity. Types of service dogs include: guide dogs for the blind, emotional support, mobility assistance, medical alert, autism support, and more.

The American Disabilities Act (ADA) defines a service dog as one that is “individually trained to do work or perform tasks for the benefit of an individual with a disability, including a physical, sensory, psychiatric, intellectual, or other mental disability.”

This includes psychiatric service dogs who support those suffering from Post-traumatic stress disorder (PTSD), such as individuals active in the military or veterans. For those suffering from PTSD, it can be difficult for them because you can’t see the condition, but fortunately the service dog is trained to do so.

When A Patient Has a Service Dog

As a nurse, what are your responsibilities when a patient enters your medical facility attended by a service dog?

A little known fact is service dogs are not required to wear any specific labeling or attire to indicate visually that the animal is a service dog. Also, the ADA only classifies dogs as an approved service animal.

According to the ADA, you can ask the following two questions to a patient with a service dog:

  1. Is your animal required because of a disability?
  2. If so, what tasks is your service dog trained to do for you (the owner)?

You cannot ask the individual about her disability, to see any paperwork about the dog’s specific training, to have the dog demonstrate its tasks, or order the owner to make the animal wear a “service dog” vest.

Working with Patients and Pups

So as a nurse, what can you do to care for your patient? It’s twofold. First, your primary responsibility is to “protect the rights of the disabled patient,” and second, you want to make sure the owner keeps control of the animal.

Next, you want to follow the safety guidelines for your facility, which may include the restriction of animals in locations where the animal might compromise the environment, including sterile areas such as operating rooms or labs.

If you require want further instructions, you can always check with your facility manager or go to the ADA website to find out more.

With more and more service dogs assisting those with disabilities across the U.S., the likelihood of seeing an increase in service animals in medical facilities should be anticipated as is the proper treatment of these types of patients.

This story is brought to you by Michael O’Keefe at Consumers Advocate.

Getting Certified: Is it Worth it?

Getting Certified: Is it Worth it?

Many are cognizant of the controversy circulating the topic of nursing certifications. Nurses wonder: Is getting certified worth it? Will I get a raise? How will this benefit me? Does it make a difference? Why are so many hospitals recommending it? In fact, some even degrade the importance of obtaining certifications. However, several hospitals, especially those with magnet status, those that desire magnet status, or even those that have a clinical advancement ladder, encourage their employees to obtain a certification relevant to their specialty. Additionally, many of said hospitals have reimbursement opportunities to assist individuals with the financial burden associated with exam fees and study tools.

Nursing is an evolving profession that requires us to remain up to date with current evidence-based practices. I like to think of certifications as continuing my education—although, evidently on a significantly smaller degree. I’m here to share my story of how obtaining my certifications played a vital role in my career advancement. I personally used it as a tool to expand my knowledge base and advance in my career—and, you can too!

As an Associates Degree in Nursing (ADN) student, I knew I wanted to work in a large medical center after I obtained my Bachelors of Science in Nursing (BSN). After graduation, I was under the impression that the only obstacle between said hospital, and me, was my BSN. Therefore, I worked on an acute care unit, at a small community hospital, while I completed my RN-BSN program. Soon after, I applied, and after months of not receiving a call, I got the notion that they were not interested in me. It was evident that I was required to strengthen my application to become a competitive candidate; so I got back to the drawing board.

I decided the next step I had to take was to get experience working in the specialty that I desired the most. Subsequently, I transferred to critical care and worked there for approximately two years before trying my hand again at my dream job. Again, no call for an interview. I was confounded; I was sure I took all the steps I needed to take to land the job, but my mentor begged to differ.

She encouraged me to familiarize myself with certifications and consider obtaining one. After dedicating the next few months of my life to endless studying, I received my Critical Care Registered Nurse (CCRN) and Stroke Certified Registered Nurse (SCRN) certifications, all at the expense of my employer. Getting certified not only enabled me to advance up the clinical ladder at my place of employment, but I finally got the job! Let us not forget about the thoughtful recognition that came with it!

Furthermore, if you ask me, “is it worth it,” I would say “yes.” Will you get a raise? All hospitals are different, and although some hospitals may give you a pay increase, many hospitals apply it as points that will allow you to advance up the clinical ladder; and others give you additional educational funds. However, it is worth looking into with your employer. How will it benefit you? It could help you achieve career advancement, just as it did for me—and much more! Why are so many hospitals recommending it? I have my speculations, but there is a lot of literature surrounding this topic; I highly recommend you dive into them to get the best answer. Does getting certified make a difference? In my opinion and by the example of my experience, without a doubt!

In all, I hope my story gives you some insight on how nursing certifications can have a critical impact on your career. If obtaining a nursing certification has never invigorated your mind before, I foresee that after reading this article you have become inspired to do your research on certifications relevant to your specialty and the associated requirements. Now, go out there and get certified—good luck!

The Unexpected Challenges in Labor and Delivery Nursing

The Unexpected Challenges in Labor and Delivery Nursing

Many student nurses become enamored with Labor and Delivery nursing and the infectious joy surrounding most births. This specialty, however, is not without its challenges to effective care. It requires nurses to remain vigilant and current on the advances in obstetrical care while working with pregnant patients from all walks of life.

Be Prepared to Teach

Many expectant women and young girls arrive unprepared for childbirth, having foregone prenatal instruction or obtained their childbirth education from the internet and YouTube. They may have misconceptions that foster unrealistic expectations for delivery.

For example, in an effort to have a “painless birth,” an expectant mother may request an epidural in order to feel nothing at all. If not properly educated beforehand, she may panic as the loading dose of the epidural begins to wear off and she feels the pressure of the baby moving down. The primary responsibility for re-educating these women falls on the L&D nurse.

Go With the Flow

The pace of activity on the L&D unit can vary to extremes. There can be long lulls of relative inactivity suddenly interrupted by a dash to the operating suite. Potential emergencies can be as dire as a patient delivering prematurely due to deliberately rupturing her own membrane. Therefore, nurses must be able to perform well with the ebb and flow of activity and under a variety of circumstances. A nurse who needs constant stressors to stay sharp may not adapt well to these fluctuations. Fostering good teamwork is critical to staying attentive at all times.

Put Your Game Face On

Nurses in Labor and Delivery must also be capable of maintaining a calm demeanor and appearance even in the face of tremendous stress and even fear. For example, they must have the fortitude to deliver a stillborn infant and care compassionately for the mother, despite this being the most unpleasant outcome.

On most Labor and Delivery units, the nurses will look out for each other. They may take measures to protect each other emotionally where stillbirths are involved by sharing those assignments. This ensures that no one nurse is assigned a disproportionate number of stillborn deliveries.

To learn more about the ins and outs of Labor and Delivery nursing, go here.

Nursing Salary Trends in the U.S.—How Much Can I Earn?

Nursing Salary Trends in the U.S.—How Much Can I Earn?

Nurses are in high demand as baby boomers continue to age, which means there’s a greater demand for nurses in hospitals, nursing homes, assisted living facilities, and rehabilitation centers. Due to the increasing demand for qualified nursing professionals, it’s no surprise that nursing salaries have continued to rise over the last few decades. Many employers throughout the United States are eager to attract qualified nurses to their facilities and are offering competitive compensation packages and relocation assistance. Let’s explore some of the most attractive states for Nurses in the U.S.

Here are the top ten states for annual nursing salaries as follows, according to the U.S. Bureau of Labor Statistics’ data for 2017:

  1. California: $102,700
  2. Hawaii: $96,990
  3. District of Columbia: $90,110
  4. Massachusetts: $89,330
  5. Oregon: $88,770
  6. Alaska: $87,510
  7. Nevada: $84,980
  8. New York: $83,450
  9. New Jersey: $82,010
  10. Connecticut: $80,200

Travel Nurse Salaries

One option is to explore opportunities within the realm of travel nursing. Traveling nurses can earn outstanding wages. Competitive salaries, along with free housing and benefits, surpass the median annual income for nurses who work in facilities, according to BluePipes.com.

The average salary for a travel nurse is $91,514. The five highest-paying states for traveling RNs are California, Alaska, New York, Texas, and Massachusetts.

This is an exciting time to be a nursing professional and adventure awaits! Whether you choose to work in a hospital as a staff nurse or take a three-month traveling assignment in beautiful Hawaii, the possibilities are endless. The U.S. nursing salary trends are definitely looking up!

Critical Care Nursing Certifications: How They Can Help Your Career

Critical Care Nursing Certifications: How They Can Help Your Career

Nurses often want to move ahead in their careers, and in order to do that, they need to learn more, understand more, and do more. One way to make this happen is to earn specialty certifications. Throughout the year, we’ll be giving you information about various certifications, what they mean, and how you can earn them.

First up: CCRN, CCRN-E, and CCRN-K.

According to Denise Buonocore, MSN, RN, ACNPC, CCNS, CCRN, CHFN, an Acute Care Nurse Practitioner for heart failure services at St. Vincent’s Multispecialty Group, St. Vincent’s Medical Center in Bridgeport, Connecticut and the chair of the national board of directors for the AACN Certification Corp.—the credentialing arm of the American Association of Critical-Care Nurses (AACN)—the CCRN certification program was founded in 1976. (Please note that the AACN Certification Corp. is a separate entity from the AACN.)

What do CCRN, CCRN-E, and CCRN-K stand for? While all of them are certifications, they are not abbreviations. So they aren’t short forms of any particular words and/or phrases.

“For more than 40 years, CCRN has been the hallmark specialty credential for nurses who provide direct care to acutely/critically ill adult, pediatric, or neonatal patients,” explains Buonocore. “Nurses interested in this certification may work in areas such as intensive care units, cardiac care units, combined ICU/CCUs, medical/surgical ICUs, trauma units, or critical care transport/flight. CCRN-E and CCRN-K are extensions of the CCRN certification program.”

Buonocore says that she decided to get certified because “I was fortunate that I had a few colleagues support and encourage me when I was considering taking my first certification exam. These were nurses who were CCRN certified and were well respected for their knowledge and skills within our unit. Their confidence in me and their encouragement inspired me to study and take the exam. In turn, I have paid their support forward, mentoring and encouraging several potential certificants through the years. That first certification was also a catalyst to further my education, eventually becoming a certified nurse practitioner and clinical nurse specialist.”

A CCRN-E is a credential for nurses introduced in 2007, initially as a certification renewal option. In 2011, it became an initial exam option. “The CCRN-E credential is for nurses who monitor and care for acutely/critically ill adult patients from a centralized or remotely-based tele-ICU location that is networked with the bedside via audiovisual communication and computer systems,” says Buonocore.

As for the CCRN-K, Buonocore says, “A growing number of acute and critical care nurses are shifting to roles where they influence patient outcomes by sharing their unique clinical knowledge and expertise rather than providing care directly. The CCRN-K certification program, launched in 2014, is for nurses who positively influence the care delivered to acutely/critically ill adult, pediatric or neonatal patients but do not primarily or exclusively provide direct care. These nursing knowledge professionals work in a multitude of roles, including educators, researchers, administrators, care coordinators and managers, and in a variety of settings, including hospitals, health networks and nursing schools.”

Buonocore answered additional questions about these three certifications.

How do certifications help nurses in their careers?

RN licensure measures entry-level competence. Certification validates specialty knowledge and experience. Although certification is not mandatory for practice in a specialty such as critical care, many nurses choose to become certified. Like many other professional credentials, nursing certification involves a willingness to test one’s knowledge and expertise against national standards of excellence. Some employers prefer to hire certified nurses, because they have demonstrated a high level of knowledge in their specialty through successful completion of a rigorous, psychometrically sound exam, which is based on a comprehensive study of practice.

Becoming certified helps position nurses for recognition and advancement, and it spurs a critical sense of confidence, empowerment, and pride in their achievement. Research has found that certified nurses believe they make decisions with greater confidence and feel more satisfied in their work.

One salary survey found that specialty certified nurses in critical care in the United States make on average of $18,000 more per year than their non-certified counterparts.

What do nurses need to do to attain CCRN and related credentials?

Applicants must have a current, unencumbered U.S. RN or APRN license, and each certification program has specific eligibility requirements based on verifiable practice hours. For example, a critical care nurse must provide direct care to critically ill patients for a minimum number of hours with a single patient population (adult, pediatric, or neonatal) to be eligible for the CCRN exam.

Specifically, for CCRN, the clinical practice eligibility requirements include 1,750 hours of direct care in the previous two years, with 875 of those hours accrued in the year preceding application. Alternatively, candidates may have completed 2,000 hours and a minimum of five years in direct care of acutely/critically ill patients, with 144 of those hours accrued in the year prior to applying. CCRN-E and CCRN-K have slightly different eligibility requirements. For all three certification programs, the majority of hours for eligibility must focus on critically ill patients.

Nurses considering certification have access to many exam preparation resources including handbooks, test plans, practice questions, and review courses available through AACN. The exams are administered via computer-based testing at over 300 locations across the United States.

Certified nurses validate their continuing knowledge of current practices in acute/critical care nursing through a renewal process that includes meeting continuing education and practice hour requirements. CCRN, CCRN-E, and CCRN-K certifications must be renewed every three years.


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