Social media can be a fantastic way of keeping in touch or sharing information, but it can also be a hotbed of controversy. Elizabeth Hanes, an RN who now works as a journalist, unexpectedly experienced this herself, when Dr. Sandra Lee, also known as “Dr. Pimple Popper,” recently commented on a story Hanes had written.
Hanes took the time to talk with us about her experience.
Exactly what happened? Please explain.
On Saturday, June 20 (I believe), Dr. Lee tweeted a link to my WebMD article (from the WebMD Twitter account). The social media people at WebMD had written social sharing text that said, “What’s the difference between sunburn and sun poisoning? A registered nurse explains.” Above this, Dr. Lee wrote, “Why would a registered nurse explain this? Why not a dermatologist?” and included an eyeroll emoji.
The nurses of Twitter did not respond well to that. The thread had, I believe, thousands of comments. I never saw the original post; I only saw the “apology” post, which also has been deleted.
Were you surprised at what Dr. Lee, aka Dr. Pimple Popper, posted? Why or why not?
I was taken a bit aback. My first thought was, “Why wouldn’t a registered nurse explain this?” This is well within the scope of what nurses do on a daily basis. My second reaction was pure amusement. I guess I will have to say I thought it sounded petty.
Many nurses responded—some were angry and even called for the cancellation of her show. Do you think that a lot of health care professionals don’t understand the nurse’s scope of practice? What about people who don’t work in health care?
I think there were two issues here. First, that many people don’t understand nurses’ scope of practice. Second, that people don’t understand how journalism works. It feels strange to have to write out that a nurse’s scope of practice includes patient education. Our entire profession is built, in fact, on the foundation of teaching patients about their bodies, about wellness, about disease, etc. To me, patient education is the essence of nursing practice. So for someone to sort of call that into question felt baffling.
But people also seemed very unclear on how journalism works. They seemed to believe that only subject matter experts should be reporters. But journalists aren’t required to be subject matter experts, themselves, because journalists know how to conduct research to find the facts they need to write a story. Sometimes that research involves interviewing subject matter experts—like a dermatologist. In this case, the process did not include interviews. That’s just how it goes in journalism.
Do all nurses educate their patients as a part of their routine care?
Yes, absolutely. All nurses engage in patient education on a daily basis. Or family education. In fact, nurses are the health educators of the world. That’s not to say physicians don’t also educate. Of course they do. But physicians often provide patient education at a high, over-arching level. For instance, an oncologist may explain to a patient what chemotherapy does, but the oncology nurse will be the one educating the patient and his or her family members about the effects of chemotherapy, how to cope with those effects, how to set up the home environment to best care for a person receiving chemotherapy—and on and on. Doctors don’t do that. Nurses do.
Why do you think it’s important for the masses to understand that nurses are fully qualified to provide health education?
I think most people turn to nurses first for health education on an interpersonal level. They do this without even thinking about it because nursing is the most trusted profession. My experience has been that people, in general, highly value nurses and their knowledge.
I think there’s a bit of a disconnect when it comes to media and reporting. For instance, during the kerfuffle with Dr. Lee, some people on social media directly questioned my background and credentials—was I really qualified to write this article. When members of the public do this, it does not offend me. In fact, I wish more people would engage in this sort of critical questioning of stories in the media. When they see a celebrity offering an opinion on some topic—let’s say it’s how COVID-19 spreads—I wish more people would ask themselves, “But what do actual epidemiologists say?”
It’s a different story when a doctor or fellow nurse or another health care professional questions my credentials—and in public, no less. These people should know that patient education of all kinds—including articles on WebMD—falls well within the scope of nursing practice. It’s disrespectful to question that or to imply that it does not.
What can nurses do to get the word out about this? Or does it need to come from higher up, like health care and/or nursing organizations? Or both?
I would like to see two things happen:
I would like to see more journalists requesting nurses as sources for their health reporting.
I would like to see more nurses become health reporters.
To the first point, I wish that more health journalists would understand that nurses play a different role in patient care than doctors do, and that their stories would be much enriched if they included the nursing perspective along with the physician’s.
Imagine a news story about a new cancer treatment that not only includes quotes from the researcher about the chemistry involved and quotes from a physician about how this treatment will provide more options for patients—but also includes quotes from an oncology nurse about how this treatment might affect a patient on an everyday level, when they’re at home after receiving it. Currently, we typically get the first story: the one that only includes quotes from the researcher and physician. But the second story gives a much deeper perspective that would benefit readers. For this type of reporting to happen, health system media relations people need to cultivate and support nurses as sources for the press and then suggest and offer those nurses as sources when appropriate.
To the second point, as a nurse reporter myself, I’ve adopted a mission through my RN2writer project “to transform health care communications by making nurse-created content the industry standard for excellence.” Toward that end, I train other nurses in basic journalism skills to start them on a path toward a reporting career. You know, there’s a lot of inaccurate health information on the web. I think one way to combat that is by having nurses produce more health content. I think, subsequently, that publishing more nurse-created health content will reinforce the understanding that patient education is the essence of what we do as nurses.
Nursing care coordinators today are asked to do much more with less in managing the health of high-risk and chronically ill patient populations. The COVID-19 pandemic adds another layer of complexity to this already difficult job.
Nurse care coordinators have always been responsible for managing large caseloads of chronically ill patients. The goal is always to help them improve health. So, what has changed since the COVID-19 pandemic began?
During this time of pandemic and resulting economic constraints, nurse care coordinators can expect to be called upon to manage larger, more complex caseloads with fewer resources.
The value that nurse care coordinators deliver now is measured by much more than reduced cost of care, patient satisfaction, and better outcomes related to chronic disease management, although those measurements are significant.
Today, value is also measured by how quickly the nurse care coordinator assesses the chronically ill for additional or changing socio-economic issues and community health care inequity due to the COVID-19 pandemic. Value also is measured by the expediency with which action is taken to facilitate resolution for a larger and more complex case load.
The impact of COVID-19 on communities served by nurse care coordinators becomes even more critical where chronic disease and health care inequity exists and social determinants of health (SDOH) are not favorable.
Due to reductions or closures, some patients sheltering in place are becoming disconnected from community agencies and services that once served them. Others are experiencing a new life event – such as the loss of work, income and health insurance.
Nurse care coordinators have their fingertips on the pulse of available community resources and can quickly make those often life-saving connections.
Web-based care coordination technology tools are available that help health care organizations coordinate care for high-risk patients across the care continuum and support electronic collaborative communication between the nurse care coordinator and the patient’s primary provider at the point of care, regardless of the electronic health record used (EHR) or location.
These tools can enable organizations to move to value-based care, manage total population health, ensure appropriateness of care across all care settings, and achieve high-quality outcomes.
When managing high-risk and chronically ill patient populations, it is imperative now to quickly reach out to those patients and screen them for actual COVID-19 exposure, potential risk of exposure, and educational needs related to COVID-19 risk, to ensure that time-critical management occurs.
How to guide high-risk patients
Effective screening requires evidence-based assessments that lead to the development of actionable evidence-based care coordination care plans. These care plans can help address the additional health, SDOH, financial and educational needs of high-risk patients.
There are a range of important questions to ask that can be linked to workflows that uncover SDOH challenges for patients. These questions are important for guiding high-risk patients in a manner that helps prevent and manage exposure to COVID-19.
Some of those questions are:
Are you experiencing a decrease of income to cover current expenses?
Have you experienced a job loss?
Are you currently sheltering in place?
Do you have a safe place to shelter?
Do you have access to food and meals?
What support systems do you have?
Do you have medications readily available for the month?
Do you need any additional medication resources?
The response to each of these questions may require the nurse care coordinator to complete one or more actionable care plan interventions to resolve an identified problem. This may require collaboration with a patient’s primary provider, health plan, health system, community agency, support system and extended care team.
Standardizing the care coordination process leads to better outcomes. Consistently engaging and linking patients to high-quality community resources, health care providers, services, and care team members can also reduce the cost of care, reduce health care inequity, and improve patient satisfaction.
That’s a great value to the patient, community, and health care organization.
Becoming a Certified Registered Nurse Anesthetist (CRNA) can be a daunting journey, and it’s often difficult to know where to even begin.
the moment you decide that CRNA is the career for you all the way to
the glorious finish line, there are 8 strategic steps you can take to
ensure that you are as highly qualified as possible before you apply
to CRNA school.
1) Graduate from an accredited BSN program
It doesn’t matter how you obtain your BSN, but be wary of pass/fail programs because they will hurt your GPA. If you already have your MSN you can still go back for CRNA. (Hopefully some of your graduate coursework will transfer!)
in mind that your ADN GPA will matter more than your BSN GPA because
your ADN demonstrates your competence in core sciences. For example,
if you get a 3.0 in your ADN but a 4.0 in your BSN and your average
is a 3.5, you might still fail to get an interview. This is because
they look at your science GPA from your ADN which would not meet the
minimum to apply (3.0), or it isn’t competitive enough. I have met
a wide variety of CRNA’s with various educational backgrounds,
dentistry, EMT, business, accounting, NP, military, just to name a
no matter how you obtain your BSN just focus on your GPA as much as
possible, especially your core sciences.
2) Maintain good grades
To be considered competitive for CRNA school you should aim to have a
3.5 or higher. Keep in mind that a lower GPA will still be considered
because they look at the candidate as a whole.
there are necessary steps you need to take to be competitive with a
lower GPA. They will evaluate your core science GPA, like chemistry,
A&P, micro-bio, etc.
GPA is calculated differently in each school. Some only consider your
BSN or the last 60 credits along with core sciences. Others combine
all grades (all degrees) to figure overall GPA. Some even look at
high school GPA and ACT/SAT scores.
Rejection is common regarding lower GPA, so be willing to apply to multiple schools and to go the extra mile to make up for a less competitive GPA by retaking courses and/or graduate-level courses.
aware that science grades have to have been completed within the last
5-10 years, depending on the school.
Another thing to keep in mind is some CRNA schools limit how many times you can interview/apply, (two times seems to be the max at schools that set a limit). This is why it is important to reach out and get guidance prior to applying.
3) Obtain critical care experience as an RN
Before you apply to CRNA school, ideally you should accumulate 3-5 years of experience to be competitive. You should always shoot for a level 1 adult ICU (not ER). However, in areas that this is not possible a level 2 can still be competitive. If you do not want to work in an adult ICU know that you may struggle to find a school that will accept your experience. (Some will accept NICU/PICU/ER.)
note that a lot of schools only require 1-2 years at minimum for ICU
experience, but to be competitive aim for more than the minimum.
often determine that ICU experience greater than 5 years could
potentially hinder your ability to be a “teachable” student
again. Do not let this intimidate you, but go into the application
and interview knowing that you need to make it clear that you are
ready and able to be a novice again.
It also helps to have taken a recent graduate-level course in which you get an A to provide proof that you are ready academically to be a student once again.
you do not have a level I or II hospital near you, consider commuting
to get this experience. Remember where your program of choice is
located, if the school is near a level one hospital you will be
competing with those applicants.
quality over quantity in most cases.
4) Be a leader in your community—get involved
Seek out learning opportunities. It will help give you a competitive
extra certifications, (CCRN at minimum even if it is not required).
involved in a unit leadership committee, precept students, volunteer
or offer to work on a research project with your unit’s CNS.
5) Job Shadow
Do this as much as possible. A highly competitive CRNA candidate on average spends 40 hours or more shadowing. Even if the school only recommends shadowing experience, still DO IT!
programs turn away highly qualified candidates simply because they
did not take the time to shadow a CRNA.
want to see you have put a lot of thought into pursuing anesthesia
and that you have taken the time to make sure this is a career in
which you will thrive.
can be difficult to get this experience. I encourage you to continue
to start with your current hospital of employment.
that does not work, then reach out to local hospitals or surgery
you still can not find experience, call your program and ask for
6) Take the GRE/CCRN
Most schools will require prospective CRNA candidates to take one or the other or even both. If the schools say they require the GRE but do not give you a benchmark score, know that to be competitive you need a score of 300 or greater with a 3.5-4 on writing.
schools will state the minimum GRE to be 290-300. Know that getting a
290 or 300 is equivalent to just having a 3.0 GPA in the realm of
being competitive, so always aim for more than their minimum.
schools do not look at CCRN scores, but some do. It never hurts to
find this information out ahead of time- you can even use it to your
advantage on your resume if you did score high.
If you have a 3.4 GPA or less, having a good GRE score can help
admission committees look past this shortcoming. Some schools will
require GRE from students with a lower GPA. Even if they don’t, it
would be in your best interest to take the test as long as you are
prepared to do well on it (and only if you have exhausted other
measures, like graduate level courses).
In my opinion, if they do not require the GRE, you would be better off taking more than one graduate-level course that will transfer to prove your academic abilities.
taking the GRE is one more modality to overcome a less than desirable
7) Take Graduate level courses
If you want to be a competitive candidate for CRNA school this is a must.
Taking a graduate-level stats or chemistry that will transfer into the program will help boost your application and is a MUST for candidates with less than a 3.4 GPA.
in mind that if you have a science grade (undergrad) of a C or less
that you may have to take that class over again.
Start by assessing your core science GPA. If you have less than a 3.4 then consider retaking an undergrad science class (if you got a C or lower) on top of a graduate-level course.
consider where you are applying and what their average student GPA
is. If you do not know, then email the admissions counselor to find
8) The interview is KEY
You can have the most competitive application, but without a good interview you will not be accepted by a CNRA school. So preparation is of vital importance.
should start well before you get an invite to interview. All schools
have a different interview style.
hit mostly personal questions (emotional intelligence style), while
others hit pathophys/Pharm. Some do both along with a written CCRN
style test (math, and on the spot short essays).
is very beneficial to network and attend open houses. Speak with
current students to determine what to expect.
houses are also a great opportunity to talk to the program director
and allow you to get to know them. This helps take the edge off on
interview day when you see a familiar face.
following these 8 steps, you can ensure that you will stand out
amongst a sea of applicants and be well on your way to reaching your
goal of becoming a CRNA!
While you will face a number of challenges along your path, you are not alone in this journey. Check out the CRNA School Prep Academy. Membership provides access to a powerful community, individual instruction, and accredited guidance. Another helpful resource is the 4,500+ member Facebook Group, I.C.U. Dreaming About Anesthesia.
Technology is leading the way as hospitals and clinics around the world fight coronavirus. The latest medical software and health care tech help health care providers give patients the lifesaving care they need as they test and treat COVID-19. From the likes of artificial intelligence to Electronic Health Records, technology is a crucial component in the battle against the virus. Read on to learn five ways technology is helping hospitals combat COVID-19.
1. AI Detects the Spread of COVID-19
In order to fight the coronavirus as effectively as possible, hospitals must rely on testing todetect infected individuals and predict the spread of the virus. Thanks to artificial technology, hospitals and other medical facilities are using AI platforms to provide accurate data and identify trends, helping medical professionals anticipate the spread of COVID-19. To illustrate, systems like Bluedot correctly predicted the path of the virus, alerting epidemiologists to important insights about the movement of the virus.
2. Interactive Maps Monitor Regional Cases
The incredible rate of infection is one of the reasons COVID-19 is especially dangerous. With the rest of the world struggling to keep up with the latest developments regarding the virus, hospitals are relying heavily on interactive maps to monitor regional cases. These interactive maps act as dashboards to track and visualize all reported cases on a daily basis as they display recoveries, confirmed deaths, and new cases of the virus. Sourcing data from the CDC, WHO, and similar organizations from around the world, this technology provides the medical professionals and the general public with real-time data.
3. Innovative Tech Detects the Virus
As the coronavirus spreads at a rapid rate, health care workers struggle to keep up with the rate of infection. The latest technology makes it easier for hospitals and clinics to quickly detect the presence of the virus within hours, making it easier to provide proper medical care to infected individuals. This rapid technology is essential for hospitals that are overcrowded as it will allow health care workers to isolate patients that are infected with the virus from those that are not.
In addition to tech for rapid testing, hospitals and other businesses use thermal imaging technology to determine the status of an individual’s health. These thermal imaging cameras allow businesses and hospitals to scan an individual’s temperature safely to detect if they have a fever. While this technology doesn’t test for coronavirus, it can pinpoint which individuals are at risk with higher than average temperatures.
4. Genome Sequencing Discovers Potential Vaccines
As COVID-19 continues to wage war against the world, scientists and health care professionals are rushing to create a vaccine. Technology like genome sequencing makes it easier to understand how the virus is transmitted, creating a vaccine, monitor viral evolution, and prepare for the future. When it comes to how the coronavirus is transmitted, genome sequencing focuses on understanding variations in the virus’ genetic sequence as genomes are collected from various patients. This allows researchers to create a “family tree” to monitor the spread of the disease.
In addition to understanding how the virus is transmitted, genome sequencing is helpful in designing vaccines and treatments. Researchers can use the information from the gene sequences to design therapies that target specific aspects of the virus. With the help of completed gene sequences, scientists around the world continue to develop diagnostics and vaccines. Additionally, this information will make it easier to track the virus and monitor its evolution as it spreads and changes.
5. Electronic Health Records Give Easy Access to Patient Information
As hospitals fight against the clock to treat COVID-19 patients, it’s important for them to have access to medical software that lets them instantly access patients’ electronic health records. As many patients with coronavirus may also have chronic diseases, instant access to this patient information makes it easier to provide special treatment when fighting the virus. This type of software centralizes patient information, improving the response of healthcare professionals when treating patients.
Technology affects every aspect of the health care industry. With the right tech and advanced software, health care professionals will be well-equipped to treat their clients and meet the needs of those at the forefront of this coronavirus epidemic.
As staff struggle to cope with the working conditions created by the COVID-19 crisis, nursing leaders may find themselves in new territory as they strive to support them. Eloise Cathcart, MSN, RN, FAAN, director of the nursing administration program at NYU Rory Meyers College of Nursing, has some valuable tips on leadership during the pandemic. She observes that this is a uniquely difficult time: “No nurse manager practicing today has experienced anything like the coronavirus pandemic… None of us has managed this degree of chaos, complexity, and uncertainty before so, in a sense, we’re all new nurse managers trying to find our way.”
1: Embrace your leadership role, even if you’re uncertain about what to do
Worried that you’re not ready to take on the challenges of leading in the middle of a crisis? As we have often been told, the current situation is “unprecedented.” Keep your focus, and remember that you’re not alone. Remarking that “no one has done this before,” Trust your clinical skills and judgment, Cathcart counsels, but “Don’t hesitate to reach out to a more experienced nurse manager colleague or your director for help.” Be sure to establish a supportive presence, she recommends, and “be visible and available to engage in patient care so that you can assess how individual members of your team are coping.” This will also keep you up to speed on the particular needs of COVID-19 patients and help you to uphold the highest standards of care.
2. Now, more than ever, your comportment is your most important management tool
Healthcare workers are especially vulnerable to a virus like COVID-19. While fear is a natural response, though, it has to be managed and overcome. Like an officer on a battleground, the nursing leader’s behavior and demeanor exerts a powerful influence on the esprit de corps. Be present and connected to your staff, Cathcart says, and approach them with empathy and understanding: “As you strive to meet individuals where they are emotionally, it’s okay to relax your boundaries a bit so you can connect with your staff on a very real and human level. This is a time to give people more room to express their feelings.”
3. Express a vision for the day and acknowledge short-term wins
At the start of each shift, show respect for the courage of your team, and remind them of their duty to keep themselves and their patients safe. Cathcart also notes, “Staying focused on the present and acknowledging the small wins that come from a team working together to do their best can help bolster staff morale.” However, she urges leaders to remain grounded and realistic, warning that “there’s lots of difficult news, but denying reality makes people assume you’re out of touch.”
4. Keep the voice of the clinical nurse in the conversation
Finally, Cathcart emphasizes how important it is for nurses to make their voices heard, and to use this experience to reaffirm their passion for nursing. A leader should recognize that the clinician’s voice is vital: “Intentionally creating opportunities for nurses to speak about their experiences will validate the value and worth of the incredible work they’re doing and lessen the tremendous burden they carry.”
Leaders working on the front lines are in an excellent position to hone their abilities and learn to excel. “Ask yourself,” Cathcart suggests, “how you’ve learned to focus your mind, control your stress, excel under pressure, work through fear, build courage, and adapt to adversity. Knowing these things about yourself can help you develop the spiritual and ethical resilience that will form you into a great leader.”
Doctors, nurses, and health care providers are on the front lines of the coronavirus pandemic, providing care and saving lives. Given how little is known about the virus, and how contagious it appears to be, many health care workers are understandably nervous about contracting the disease or bringing it home to their loved ones. Whether you’re a nurse in the ICU or a home health care worker in a senior facility, here are seven precautions you can take to combat COVID-19 and protect yourself, your family, and your friends.
1. Make sure your facility is following CDC guidelines.
At this point in the coronavirus epidemic, your facility should already be following the guidelines from the Centers for Disease Control (CDC). This includes measures such as identifying airborne infection isolation rooms (AIIR) or negative pressure rooms for quarantine and screening. Another important measure is outlining staffing protocols to facilitate the care of patients with COVID-19. Since developments are changing so rapidly and new research is proceeding apace, you should double-check that your facility is staying up to date with the most current findings. You can find more guidance from the CDC’s centralized portal.
2.Observe proper PPE protocols.
Personal protective equipment (PPE) shortages are a sad reality in some areas, even as companies and individuals race to make more masks, face shields, gowns, and gloves. As much as possible, you should wear PPE and follow safety protocols, including proper hand sanitation. Sanitize your hands, step into your isolation gown, put on your N95 respirator, add your goggles or face shield, wash or sanitize your hands again and put on your gloves. Then, you may finally enter the patient room. Before exiting the room, remove the gloves and gown and dispose of them. After exiting the room, perform hand hygiene before and after removing the face shield and mask.
3.Watch yourself for symptoms.
Health care workers are unfortunately at a greater risk of catching coronavirus, especially if they are working directly with patients who are ill with COVID-19. Watch yourself carefully for symptoms such as fever, cough, and shortness of breath within 2-14 days of exposure. Symptoms present very differently from individual to individual, and you can also be asymptomatic while carrying the virus without knowing it. You can measure your temperature to make sure that you’re not sick if you think you might have been exposed. If you start exhibiting symptoms, it’s imperative to get tested immediately. You don’t want to infect otherwise healthy patients, so the safest action you can take is to self-isolate and wait for your test results.
4. Educate your patients.
Yes, health care providers can spread the coronavirus — and so can your patients. In fact, the vast majority of people have picked up the virus from other civilians in perfectly ordinary situations, like going to the grocery store. Talk to patients about the importance of self-isolation and following CDC guidelines, such as not touching their faces, washing their hands properly for at least 20 seconds, and limiting trips outside the house. Make sure that your patients are only coming in for an appointment if absolutely necessary. If there’s any chance they have coronavirus, even if their symptoms are mild, it could be best for them to ride it out at home rather than to come in and potentially infect other people. As always, make sure all patients consult with their health care providers about any such decisions.
5.Leave the germs at work.
Bring a set of clean clothes and shoes with you to work in a sealed plastic bag. At the end of your shift, perform hand hygiene and change into the new clothes and shoes. Place your scrubs in another sealed bag to bring home with you and don’t put the dirty clothes in the same bag as the clean clothes if you plan to reuse them. If you can, leave your slip-resistant shoes in your locker so you don’t have to take them home with you. Once you leave the hospital, wipe down your cell phone, pager, and other personal devices with disinfectant. You might also want to disinfectant the door handles, steering wheel, and other high touch areas in your car.
6.Clean your scrubs and shoes.
At home, leave your shoes outside the door. Take off your clothes and put them in the washer immediately alongside your nursing scrubs. Wash the clothes on the hottest setting possible with plenty of detergent. If you want, you can also add bleach to the wash cycle. Dry the clothes for at least 30 minutes on the hottest setting available. If your shoes are made of a hard material, wipe them down with disinfectant after each shift. If they’re not, wash them periodically in a separate load.
7. Protect your family.
Even if you’re not currently exhibiting symptoms, if you work in a role that exposes you to patients that likely have coronavirus, you might want to self-isolate from your family. You can isolate yourself in your own living space, but you’ll need to sleep in a different bedroom, use a different bathroom, and eat your meals separately from the rest of your family. If your current living arrangement doesn’t allow you to do that, some hotels and short-term rentals are offering accommodations to health care workers for drastically reduced rates so they can keep their families safe.
Following these guidelines and erring on the side of caution will cut down on your odds of spreading COVID-19 or catching it yourself. Stay abreast of the latest guidelines and do everything you can to leave the germs at the hospital.