When Lynn Dow, RN, MSN, was a young girl, she dreamed of being a writer, and she wanted to write novels. But when her Dad died shortly before she turned 14, there was no money for college.
“Instead I had to choose between the three occupations available to women in the 1950s—teaching, nursing, or secretarial work. I chose nursing which, at the time, I considered to be the lesser of the three evils. It turned out to be a very good choice as once I got into it I realized that I was meant to be a nurse,” says Dow, now retired from the University of San Francisco Medical Center, where she worked over the years as a staff nurse, head nurse, nursing supervisor, and nursing educator.
Dow staying in the nursing field for 50 years. “Once I got into the profession, I never thought of being anything but a nurse, and when I look back over the last 50 years, I realize how lucky I was to have a career that kept me engaged for such a long time. This attitude kept me going—in addition to the fact that whenever I felt myself getting restless in my job a new opportunity would arise and it would be like starting anew,” admits Dow. “I believe this is one of the greatest advantages of the nursing profession—there is always a new and challenging opportunity just waiting for you to take it on.”
Lynn Dow, RN, MSN
When Dow started in nursing, she couldn’t have imagined that the career she originally thought she was settling for, but turned out to love, would bring her dream back.
“When I retired, I finally had a little time and decided to take a writing class. I soon discovered I was not a novelist, but was advised by the teacher to write about something I knew,” says Dow. “Unsurprisingly, I chose to write about my experiences in nursing. I did not have any notes or diaries, but as I began to validate my memories with classmates and colleagues, they became a valuable resource in reminding me of certain events and supplying me with old class schedules and notes.”
From this came Dow’s first book, Nightingale Tales, a memoir of stories about how nursing changed from early in her career to the present day. “Without a doubt the biggest change that I witnessed throughout my long career was observing the nurse evolve from being a handmaiden to the physician to an independent practitioner. When I started in nursing in the mid-1950s, nurses were expected to stand up and offer their chair to the doctor when he came into the nursing station, and I was once reprimanded for not doing so—not because I was being obstinate, I just didn’t see him come in. Fifty years later when I retired, nurses are recognized as independent, integral contributors to the patient’s plan of care. What a change!
“Technology has certainly played a part in the evolution of nursing—inventions that enabled the nurse to spend less time performing tasks and more time in practicing the art of nursing. Something as simple as the electric beds we all take for granted now, played a huge part in freeing up the nurse. Not having to stop what you were doing to crank a bed up or down every time a patient needed a position change was a huge contributor to improved nursing care,” recalls Dow.
With a long career, Dow has lots of funny stories. “I was once given a beautiful silk lace half slip by a patient, one of the Hearst brothers of newspaper fame, for emptying his urinal,” she says. “We were never supposed to accept gifts from patients, but I couldn’t resist when he told me to take a box off the shelf in the closet. I stashed it in my purse and didn’t open it until I got home. It was beautiful and probably a bit inappropriate, but it gave everyone a good laugh.”
“Everyone smoked in the 50s, myself included. Going for a job interview, I was met by the director of nursing whose first question as she greeted me was ‘Do you smoke?’ Oh no, I thought, she can smell the cigarette I had just finished, and she doesn’t like a smoker. But when I confessed that I did, she steered me into the converted patient bathroom off of her office and instructed me to sit on the edge of the bathtub, while she took a seat on the toilet, lit my cigarette and proceeded to interview me, while we both flicked the ashes into the sink,” she says.
Although Dow says that she has many more stories to tell, she’s not sure if she’ll do another book of this type. It’s not, though, out of the question. “I am surprised at how many people who have read the book comment on the fact that they view it as an important piece of nursing history. When writing it, I never thought about it in that context, but I am so pleased that people see it as an important contribution to nursing.”
Lately my hospital has had an influx of traveling nurses from all over the United States. And they’ve all been amazing! Some from Louisiana, Illinois, North Carolina, California, etc. And they really seem to enjoy being here. So why are we not all packing our bags and hitting the road?
Traveling nurses certainly have a lot of benefits. Most travelers can obtain up to $3,300 a month for housing expenses in addition to food stipends and their hourly pay. While their hourly pay may sound lower than usual, their stipends are usually tax free. (On a side note, if the nurse has someone to stay with, she can pocket said stipend!) Each of the assignments is usually 8-13 weeks long, allowing travelers to leave an assignment if it isn’t their favorite, but a lot of assignments offer the opportunity to renew, allowing the nurse to potentially stay somewhere for multiple months.
On the other hand, travel nurses have to cope with a certain amount of stress that comes with moving frequently. Being away from family, making new friends, and even finding housing can be stressful. A lot of times travelers take housing in a location without knowing the area well. For some this works out well, but for others they may end up in a sticky situation. Most agencies will offer some agency sponsored housing, which is often a safe alternative.
Besides housing, traveling nurses must beware of the hospital they are traveling to. Frequently in the NICU, I see travelers that come from a NICU that doesn’t accept certain types of patients or doesn’t offer a specific procedure. When you travel, you are expected to be able to perform the duties of that hospital’s nurses. Know your boundaries and always make sure you are comfortable with the assignment you are receiving. Sometimes a CVICU in one place isn’t the same as another. And watch out for those assignments that always give the worst assignments to travelers. Travelers are a blessing to a hospital in need and so they should be treated!
One of the most important things to look at when considering traveling is the implications of traveling on your current job. Will you come back to your position and be guaranteed a spot? Will you have to go to night shift and work your way back down the waitlist to days? Make sure you look into this before making any commitments.
There are a lot of advantages to traveling, and a lot of challenges as well. It’s important to know yourself and know what you’re prepared for. Doing things on your own, exploring new places, and getting to know different methods of doing things can be really enjoyable with the right attitude. The first step is to contact an agency and begin to explore their options and what licensure requirements are for you. There is no harm in investigating!
If you’ve ever watched a series like Grey’s Anatomy or ER, you know that hospital scenes are always dramatic on screen. And if they’re in the emergency department—well, they pretty much always are. In real life, though, that’s not quite the case. Sure, there are times where the ER can get hectic. So to get the real truth in honor of Emergency Nurses Week, we decided to go straight to the source.
Sarah Emami, RN, BSN, CEN, CCRN, a staff RN in the ED at Sibley Memorial Hospital admits that she was surprised when she began working as an emergency nurse. “I thought working in the ER would involve a lot more Code Blue situations and ACLS [advanced cardiac life support] protocols. There are a lot of these situations, but mostly you’re preventing people from reaching a critical situation,” says Emami.
Emami, who has worked in the ER for six years, decided to work there because she loves a fast-paced environment as well as having a lot of autonomy as a nurse. Before working in the ER, she worked in the ICU and doing that gave her a lot of critical care experience, albeit at a much slower rate.
Even though she’s worked in the ER for a while now, Emami admits that there are still surprises. “Most people don’t think about the food that they eat: they eat junk food, processed food, and fast food a majority of the time, and they are surprised when they are tired, lethargic, and have GI issues,” she explains. Another surprise is that “people want a fast fix for chronic medical conditions.”
The biggest challenges for Emami about working in the ER are what she calls “boarders.” These are patients who are admitted to the hospital, but have to stay in the ER because there are no available rooms or there’s not enough staffing at the time. Emami also says that managing patient expectations can be tough—like the aforementioned desire for a “quick fix,” and teaching them that the best way to stay healthy is a combination of a good diet, exercise, and stress management.
When she can get through to patients about how to stay healthy, that’s the best. “The biggest rewards are when I can teach a patient something new about their diet, medication, or how to navigate the health care system,” says Emami.
Nurses know what happens when a colleague has to call out due to sickness or an emergency or is due for vacation—others often end up working double shifts. If you want to, that’s one thing. But when it’s required because of lack of staff, it can cause the nurses to feel overworked and contribute to their stress and anxiety. There’s now a nursing staffing agency that operates via an App, and it’s changing the way nurse staffing occurs.
“There have always been nursing staffing agencies that have served our clientele for more than 100 years, but they have historically been using traditional, inefficient methods of scheduling via spreadsheets, fax machines, and telephone. We believe that we are the first truly on-demand, app-based nursing agency for the per-diem market,” explains Chris Caulfield, RN, FNP-C, one of the founders of IntelyCare. “There wasn’t a good solution for nursing coverage for last-minute call outs or to fill in holes in the schedulers’ calendar on a shift-by-shift basis.”
Caulfield co-founded the business with health care IT expert Ike Nnah in 2015. They currently serve post-acute nursing organizations using RNs, LPNs, and CNAs. To date, they serve more than 200 skilled nursing facilities, rehabs, and assisted living facilities in Massachusetts, Rhode Island, Ohio, and Pennsylvania.
The business is changing how on-demand nurses are used because they are able to cover a number of shifts that are requested by the facilities with only two- to twelve-hours’ notice. As a result, staff nurses don’t have to pull a mandatory double, and other nurses who can fill the spot get to choose when, where, and how much they would like to work.
Caulfield stresses, though, that this type of work is not for new graduates, as they believe nursing professionals should have at least a year of experience before they begin floating to various facilities. But being able to browse an App and determine extra shifts they can take on is already changing the workplace for nurses.
“On-demand nursing is a great option for nurses who want more flexibility, higher pay, and who like a change of scenery,” says Caulfield. “I strongly believe that over the next two-five years, there will be some flavor of on-demand nursing—either from an outside staffing agency or an Internal per-diem pool—at every licensed health care facility in the U.S.”
As nurses, we know every patient is special, but I can think of no greater contribution I can make right now than being a nurse to those who’ve served our country. I work every day with veterans dealing with dementia in my role as the clinical nurse leader for the geriatric extended care line at the Chillicothe Veterans Affairs Medical Center in Ohio.
As a clinical nurse leader with a background in evidence-based practice, I’m always looking for ways to improve the long-term care environment for our veterans with dementia. One idea we arrived at is focused on therapeutic design, which encompasses many things all addressing the senses, thus improving the external environment in a way that can lead to internal healing and peace. Agitation, anxiety, and depression are common in individuals with dementia; we’ve seen how therapeutic design can help alleviate these symptoms.
One tactic we’ve introduced is the use of interactive cats. You may have seen these for sale in stores or online. They have touch sensors in their head, ears, and cheeks and will nuzzle in when petted; these toys purr just like real cats. The point is that through therapeutic design we now have patients with dementia who love to play with these toys; many haven’t been around pets for many years.
We’ve also installed a jukebox in a common area; this music has transformed a sterile setting into one with lively sounds throughout the day. Songs can evoke feelings, bring back fond memories, and bring smiles to faces. As you walk down our main hallway murals brighten the walls and bring color and life. We also have implemented aromatherapy, which is calming and helps patients sleep better as well as reduces their pain.
Importantly, caregivers report that they appreciate the value of sensory-stimulation interventions, which have proven helpful in improving caregiver confidence and reducing distress. Happier patients have also led to a decrease in caregiver burnout rates. This is a stark contrast from how things were before, when veterans who were cognitively impaired would be in a unit with bland colors on the walls, no pictures to look at, and little to remind them of home.
Recently, I had the opportunity to share the lessons I have learned while implementing this innovation with others in the Veterans Affairs system, the largest integrated health care system in the country. The VA is in a unique position to advance, change, and disrupt the way America delivers health care. At the Veterans Health Administration’s Innovation Experience, held in Washington, D.C., I was able to share my experiences and help the entire system understand how we’ve provided better care and support for veterans.
In addition to presenting, I also learned from others, such as Shannon Munro, PhD, who is chair of the national VA nursing research field advisory committee. She serves veterans as a nurse researcher, nurse practitioner, and many other roles. Munro and her team in Salem, Virginia, have significantly reduced the risk of developing hospital-acquired pneumonia by providing consistent oral hygiene during hospital admissions. They named their initiative Hospital-Acquired Pneumonia Prevention by Engaging Nurses (Project HAPPEN); it encourages clinical staff to assist veterans to complete oral care two-to-three times each day. This practice ensures non-ventilated patients receive oral care by providing consistent staff training, educating patients about oral care, and its association with pneumonia, and standardizing oral care supply and distribution. At the Salem VA Medical Center, the incidence of pneumonia decreased by 92% from the baseline in the first year. The intervention has expanded across eight VA hospitals, yielding an estimated cost avoidance of $4.7 million and 21 veteran lives saved to date.
We know our veterans gave their all when they were in active duty. Now, we are glad to work together to ensure we are providing the best in care, as well as the innovations in care, that are needed now and into the future.
Whether you like retro games such as Pac Man, Centipede, or Asteroids or more modern ones like World of Warcraft, Call of Duty, or Madden NFL, you’ve got to admit that there’s something fun about making your way to the next level or finally getting a really high-scoring game. Mercy Medical Center in Baltimore, Maryland has taken the concept of video games one step further—and is using them to teach skills and information to its nurses.
Susan Finlayson, DNP, RN-NE-BC, Sr. Vice President, Operations and Stacey Brull, DNP, RN, NE-BC, Sr. Director Research, Education and Nursing Informatics, at Mercy Medical Center, took time to answer our questions.
How are video games used to help in training nurses?
We use video games as a teaching tool to help explain complex information, onboard new nurses, and provide an alternative to classroom training. Using both plug-and-play games as well as customized games provides our nurses with information they need when they need it, and in a fun, interactive format.
The World of Salus™ is an excellent example of a video game that we use in orientation to cover key topics pertinent to nurses starting at Mercy. Instead of sitting through 3 days of classroom lectures, our new employees venture into a World where they create an avatar, earn badges, explore knowledge objects, compete on a leaderboard, and complete challenges to make it to Finales and receive their certificate of completion.
The World of Salus is a complex adventure game; however, we also simpler games that we can quickly customize for more specific types of training. Doesn’t playing a slot machine game to learn about infection control practices sound like fun?
Video games also help identify areas needing further training and education. As with most technologies, we are able to develop specific reports telling us areas where a nurse(s) may have struggled with a specific topic as well as areas needing less time and attention. Video games, with reporting functions, create individualized learning plans for the learner versus a one-size-fits-all.
Are these regular nurses or nursing students?
The current games we use are primarily for current and new nurses entering Mercy Medical Center.
Please explain in detail how you use them.
We started small using free online games in staff meetings and other learning environments where we could plug and play our material. For example, one of our educators was teaching specific regulatory information and used a quizzing game during her presentation as an interactive tool to supplement her lecture. Another educator used a QR code to have employees perform a scavenger hunt through an online app during their unit orientation.
We now create a lot of our games. For example, we have a game called The Quest for Magnet Status where nurses had to go to different pyramids and learn about the components of the Magnet Model. Each pyramid has a hieroglyphic that the nurse needs to decode to find the secret of the ancient legend. Other types of games we have created include puzzles, trivia, and races. We have even begun to venture into virtual reality games.
Regardless of the type of game we use, our goal is to utilize the best game mechanics in developing a positive avenue for engagement. Since we know people are playing online games all over, why not use games in training?
What video games are used?
We create a lot of our own video games, but we also use Kahoot, Classcraft, C3Softworks, and other online games in our gaming toolbox.
How did you come up with the idea to use them?
We were seeing a lot of our employees texting under the table or continuously checking their phones during classroom presentations. We had the ability to pull reports indicating that staff members were just clicking the “next” button all the way through our online modules on our learning management system in order to answer the obligatory questions at the end. More importantly, we found that despite teaching—and many times reteaching—behaviors and outcomes weren’t changing. Therefore, we knew we had to find a more effective and efficient way to reach our staff and came across a new term at the time called “gamification.”
We looked extensively into what gamification was and how it was being used in other sectors to see if we could adapt it in health care. We even took a course on gamification. Through this discovery phase, we knew we had to give gaming and gamification a try, and now that we have, we would never go back.
What benefits have you seen as a result of using video games?
In addition, games are a wonderful tool for teaching material that isn’t used a lot or reinforcing aspects of a course to the students. Since the end-user can quickly go in and learn what they need to know, they are more intrinsically motivated to play. There is so much diversity in games, too. Games can easily be changed using different colors, different interactions, or different game mechanics. And, games are adaptable so they can be used for quick need-to-knows as well as competency management. Having an employee play a timed code cart video game to find the necessary equipment in a code situation is much more powerful than having a cart open in a classroom for the employee to “explore.” Video games have improved the way our staff critically thinks and approaches problems.
How do the nurses respond to it?
The nurses love using games in learning. They enjoy the fact that it is self-paced, providing them with as little or as much time as they need to learn the content. The environment provides them with opportunities to make mistakes and learn from them without feeling incompetent. In fact, our orientees have enjoyed The World of Salus so much that our current staff is asking if they can go back through orientation and play the game. That statement is a true testament to the impact video games have had on our organization.
How long do they use them? What do they do?
Video games provide the end user the ability to play when they want and where they want. The World of Salus game takes about 4 hours to complete in its entirety. Other games, such as Code Card Blitz, take about 15 minutes.
Do you use video games all the time for training nurses?
We use games as much as we can in training. If we aren’t using games, we are committed to using some type of interactive teaching tool in our training including a variety of multimedia and online media platforms.
How do video games help nurses learn with real patients?
The world of possibilities using video games is mind-blowing. Whether the game is single player, multiplayer, 2D, 3D, or virtual, a video game could be made for just about any situation and any type of patient. The good news is that having these situations in a video game provides nurses with the ability to make mistakes without harming a patient. To us, providing a safe, fun environment where nurses can essentially create their own learning pathway will help them make better choices when working with real patients in any health care setting.
What are the challenges to using video games in this way?
One of the biggest challenges to using video games in training is having the time and resources to develop them. Making video games isn’t easy and needs a variety of skilled professionals. The World of Salus took a little over two years to develop.
What are the rewards?
Engaged staff! When you have nurses asking for additional training or wondering when the next contest or game is coming, you have their attention. When you have their attention, you have better outcomes and more satisfied staff.
Is there anything else that you think is important for people to know?
Since gaming is relatively new and innovative in health care, we wanted to be at the forefront. But there is still a lot of research that needs to be conducted to better understand the uses of gaming in nursing education. Having said that, using games to help train nurses has been one of the most exciting and energizing journeys we have been on at Mercy.
However, don’t reinvent the wheel. Reach out to other fellow gaming educators, like us, and learn from each other. The sky is the limit, and it’s a great time to take training to a new level in health care.