The healthcare industry is constantly evolving, and nurses have to adapt to new demands and changes. As we enter a new decade, the Nurses Services Organization team has identified four key trends and challenges impacting nurses, nursing leaders and nurse educators.
Generation Z’s Impact On Nursing Education and the Workplace
According to American Nurse Today, Generation Z tends to be diverse and entrepreneurial and, despite their competitive nature, members have a strong desire to collaborate and bring about change. These traits are greatly impacting nursing education and the industry as a whole. Notably, educators are adapting their lesson plans to be as interactive as possible to best prepare students for the real world. Among other changes, employers are working to harness Gen Z’s digital know-how and enhance their real-world social interactions, while associations are offering expanded mentorship and encouraging professional development opportunities.
Continuing Challenges in Rural Care Settings
Rural hospitals are closing at a rapid rate – almost a quarter are on the brink of closure – a perilous situation since patients from rural communities often face a higher risk for complex health issues. These circumstances provide nurses with the opportunity to enhance their skillsets and work as generalists to meet patient needs. Although rural hospitals provide nurses with opportunities to learn, they also bring about a fair share of challenges. For example, nurses working in rural areas are more susceptible to high levels of burnout caused by intense demands, isolation, lack of support and resources, lower salaries, and less training than they’d receive in more urban settings.
Telehealth’s Ongoing Disruption
In recent years the adoption of telehealth
services has exploded. In fact, more than three-fourths
of hospitals are currently using or implementing telehealth services. Offerings
like patient portals, virtual appointments, and remote monitoring are a few
features that allow people to conveniently manage their health information
Despite the advantages of telehealth, these services raise many questions for nurses. Some areas of concern include: licensure requirements, impacts on patient-nurse relationships and a heightened need for proper documentation.
More than 80 percent of people look online for
health information, which can have dangerous implications. The internet is a
colossal source of information, but much of that information is often false or
inaccurate, which can lead to misdiagnosis or delay of treatment.
Compounding the availability of false knowledge is social media, which has the power to spread misleading information far
and wide very quickly. This rapid spread of false health information
online – for example, about measles vaccinations – poses a growing threat to
public health. Vocal online groups can gain a disproportionate amount of traction
and create “echo chambers” that make people believe that false health
information is true.
Nurses are in a
unique position to educate, and to counter misinformation with facts. Face-to-face conversations between
healthcare providers and patients and their families can be extremely
influential for decision-making. Nurses must use their expertise to counter
false ideas that can spread and lead to dangerous health consequences.
Overall, there are many changes on the horizon within the
nursing field in the new decade. Nurses must be prepared to adapt to
challenges, whether generational, geographic, technological, or societal. Looking ahead, it will be interesting to see
how these obstacles are overcome, and how it will impact the industry and the
delivery of care.
Death is a natural part of life but that doesn’t make it any easier. Intensive care nurse Rhianna Ferial says that, “as healthcare professionals, we are there for people and their families during the final moments. This can be hard emotionally, so it’s important to recognize and find ways to deal with your feelings.”
Watch the video or read the transcript below [edited for length] — and use the comment tool to let us know how you deal with patient death in your own work.
Rhianna Ferial: Hi, everyone. Today, I wanted to have a
little nurse talk, a sit-down talk, and I wanted to talk about dealing with
patient death. I want to tell you about my first experiences with patient
death, my experiences since then in some ways that I think help coping with
patient death and dealing with your grief or your emotions over the situation.
I honestly think the most stressful and emotionally taxing part of dealing
with patient death is being there for their families, and this is something
that’s very important. I feel like we don’t get enough education or practice
with this part because we’re there for treatment and I know how to take care of
patients. I know how to do ACLS. I know what to do to save them. But when we
can’t save them, what comes after that is dealing with the family while they
say goodbye to their loved one. We’re there with them afterwards while they’re
That’s the hardest thing for me in my career. It was the hardest thing for
me to get used to from the beginning, and I always thought the actual scenario
of trying to save somebody or them passing away would be the hardest. For me,
it’s actually the emotional part of dealing with the remaining family members
who are just grieving and so upset.
My #1 piece of advice in dealing with the families is it’s okay to be
silent. I always used to feel like I need to say something when a tragic
situation was going on. I was in the room with a family who’s saying goodbye to
their dead loved one and I felt like I should be saying something or talking to
them, trying to console them, but there’s nothing you can really say to help
them. There’s nothing you can say to take their pain away. Sometimes just being
there, handing out tissues, trying to hand out waters or anything you can to
just make them a little more comfortable is all you can do.
Sometimes people just need a hug. Not everybody is a hugger, but sometimes
family members just want you to be there with them. Sometimes they need a hug,
a shoulder to cry on, and you can be that person. You don’t always need to be
saying something. Don’t be scared of saying the wrong thing. Don’t be worried
that you’re not saying enough. Honestly, there is no right answer here, and all
you can do is what feels right. Oftentimes, for me, I found that that’s silence
and waiting for them to start talking. If they talk and initiate and want to
have a conversation more about what’s happening, I’m there and I’ll talk to them
The second piece of advice I have… and these are in no particular order.
I’m not saying one of these is more important than the other. But the second
thing I would say is please try not to blame yourself and try and find things
wrong with what you did when somebody dies in your care. We’ve tried everything
we can to save somebody. We’ve given blood and ACLS, done CPR, done everything
we can think of, tried to save this person, and they just couldn’t make it.
Their body couldn’t handle it, and it was just time for them to go, even though
it doesn’t feel like it’s time and doesn’t feel like it’s right. There’s
nothing that you could have done, not one thing specifically that you could
have done or changed what you did, or change the timing is something usually
that would have saved that person.
There’s too much, too many factors going on, so try not to blame yourself,
try not to replay scenarios over and over again in your head blaming yourself. I
know a lot of newer nurses or younger nurses that are dealing with death for
the first time tend to do that. I’ve had people tell me they do that. I’ve done
that in the past before, too. Just realize that that’s not a productive way to
deal with your feelings, and it’s just going to make you feel worse.
This kind of leads me into the third thing that I wanted to talk about and
that is don’t compare your feelings to how other people are feeling during this
situation. Everybody processes situations and feelings and emotions
differently. Just because one nurse is extremely upset and one doesn’t seem to
be upset at all does not mean that either one of them is dealing with the
situation in the wrong way. We all just handle things in our own unique ways.
Obviously, you need to be able to keep it together during the situation. You
can’t really be functioning during the code or like a mass transfusion protocol
or any kind of dire situation if you’re completely overwhelmed and upset. If
that’s happening during the situation, obviously that’s another issue that needs
to be addressed, but I’m talking about afterwards.
Take things at your own pace, deal with things how you feel like you need to
deal with them. If you’re upset and you need to go in the bathroom or the break
room and cry for a second, do that and don’t think there’s anything wrong with
that. If you’re not upset and you feel like you can go right into your next
patient’s room and provide them with care, and you feel like you need to keep
going, keep yourself busy, do that as well. There’s no right answer here.
Everybody deals with it differently. I just wanted to say that because often in
healthcare there’s this kind of vibe that you shouldn’t get upset about things.
You should keep a wall up. You shouldn’t get upset about patients or
situations. You should kind of just move on to your next task. That’s not
always the case.
The fourth thing I wanted to say is something that has really helped me in the past and continues to help me is find an outlet for yourself, whether that be working out, whether that be crafting, whether that be continuing education, something that you can focus on and spend your time on that’s for you. This isn’t just with patient death, but with stress in general. Having something for you is very helpful, something productive that makes you feel good, which makes you feel like you’re getting stuff done and you can put your mind and soul into and really focus on that.
Now, the last piece of advice I have, I think it would be tip #5, is to talk
with others, whether this be your co-workers who are there with you during the
incident or whether this be a therapist or a counselor, or somebody who can
help you deal with your feelings. Obviously, don’t violate HIPAA if you’re not
talking to your co-workers who were there in the situation, but you can talk
about situations without giving details. If you need to see a therapist or a
counselor, do not feel bad about that. Sometimes you need somebody objective to
talk to who’s very neutral and can just give you advice and just be there for
you to listen and you don’t feel like is judging you.
Talking to your co-workers can be great, too, if you have good co-workers
and just depending on the situation. If you come home and you just had a really
bad day, you lost a patient, something horrible happened, don’t be afraid to
tell your family that you’re just really not feeling good and you had a bad day
at work. You don’t need to go into detail or make it gruesome for them or tell
them anything specific. Maybe you just need to go take a bath or listen to some
music or read a book or go sit in your room by yourself for a little while, but
oftentimes they’ll be very understanding of this. I’m sure they know your job
is stressful. Just don’t be afraid to vocalize when you need a little you time.
That’s it for my tips for dealing with death. Obviously, there’s many more
things you can do. That’s just kind of some things that I found that are
helpful. I hope they were helpful to you guys as well. If you have any tips or
things that you do to help you cope with loss, please leave them in the
comments below because people who have dealt with stuff before can help new
nurses, new health care workers who are just now dealing with it for the first
time. By sharing your feelings and experiences, you can really help lift them
up and help them realize that they’re not going through this alone.
than 20 years ago, Veronica Castellana, RN, BSN, EMLS, had been working as an
Emergency Room nurse for several years when she developed a major hypersensitive
allergy to latex. Since it was used extensively in the nursing field at the
time, she needed to leave her job and find another one—preferably in the
needed a new career option to support my kids,” she says. After taking a
beginning course on Legal Nurse Consulting, Castellana realized that she needed
more information in order to make it a long-term career option. She spent a
year developing her own system that worked. When she discovered that other
nurses had the same problems in finding information about this career that she
had, Castellana developed the training as a certification course.
then, I have practiced as a Legal Nurse Consultant and Expert Witness, while
also training nurses to do the same type of work,” says Castellana, who has
worked in this field for the last 19 years.
Castellana answered our questions about what’s involved with this type of career.
this be full-time work?
There are definitely enough cases out there for a full-time case load. Testifying as an expert witness alone would typically not offer full-time work. When combined with behind-the-scenes reviews, the work can definitely be full-time. Those nurses typically work on a contract basis, so they have the freedom to take on as many cases as they wish.
Do nurses need specific training to become Legal Nurse Consultants?
Training is not required to become an Expert Witness or Legal Nurse Consultant. Nurses have extensive medical expertise, and that is why they would be hired by attorneys. However, we do recommend that most nurses receive some training so that they can transition easier into this field and learn the intricacies to this type of work. The transition from medical to legal can be challenging for many nurses, so most new Legal Nurses will benefit greatly from some training. If they are working as an Expert Witness, some sort of preparation is highly recommended so that they know what to expect.
How do you train nurses how to do this?
My course is called LNC STAT (www.LNCSTAT.com).
We train nurses how to utilize their medical expertise in legal cases, and act
as expert witnesses. It is home study
format. Nurses learn at their own pace using online training and some printed
manuals that are included. They practice with real cases from start to finish. We
include mentoring and support throughout the entire process. After they work
through much of the course, they can choose to attend a live event where we
review the content.
Most people only know what they see in trials on TV
dramas. Is that what it’s really like?
definitely add some unrealistic drama. While some trials can be very emotional
for the parties involved, most expert witness work is rather straight forward,
especially for nurses. When nurses act as expert witnesses, they are typically
used for medical clarification, so very little drama is involved. They are
asked to explain the events in the medical records, explain the medical
standards of care, and discuss any failures to adhere to those standards of
care. These are topics that nurses are very familiar with, so it isn’t very
difficult for them. Just like anything else, the first time can be
intimidating, but most nurses get used to it very quickly.
What did you enjoy most about working as a nurse in
the legal field?
Most nurses cannot work clinically for their entire
career because of the strenuous physical requirements. This career option
offers some great alternatives for these nurses. They have the freedom to work
as much or as little as they want. This career path allowed me to continue
working in the medical field. Most nurses really enjoy the positive impact that
they have on people’s lives. Legal Nurse Consultant and Expert Witness work
allows me to continue helping people in another way, and allows me to see the
direct results of my efforts.
What would readers find most surprising about the work
Many nurses don’t really
understand how valuable their medical expertise is in the legal field. Most
Legal Nurses earn $30-$150 per hour reviewing medical records and around $300-$500
per hour acting as expert witnesses. After many years in a hospital setting,
nurses are often surprised to hear that their expertise is worth so much. They
would also be surprised as to how many legal cases need their expertise.
What would you say to someone who was considering getting
into this kind of work? What would they need to do to prepare themselves? What
skills do they need?
Their medical expertise is
what is in demand. If they have 2 or more years as a nurse, they are already
qualified. We recommend completing a training course so they can make the
transition easier and understand what is expected of them in this new field.
When it comes to choosing a course, the most comprehensive training will
benefit them the most, so they know exactly how to find the cases and work them
from start to finish.
This career path can be very
exciting, rewarding, and challenging, but it is usually something that requires
nurses to take an active approach to implementing. They should be motivated,
willing to learn something new, and willing to step outside of their comfort
This series takes a look at the stories appearing in The Rebel Nurse Handbook, which features inspiring nurses who push the boundaries of healthcare and the nursing profession. This installment focuses on Brittany Molkenthin and the pivotal moment of her innovative nursing career.
In her junior year of nursing school, Brittany Molkenthin envisioned a new premise for a major maternal healthcare innovation. While shadowing a Lactation Consultant in the maternity ward, she encountered a mother attempting to breastfeed for the first time. What should have been a beautiful and life-affirming experience quickly went south. After months of planning to breastfeed her first-born child, multiple classes, and a volume of research, she had continuous trouble with positioning the baby, each time unable to get the right latch. The few times it worked, neither the mother nor the attending staff had any way of gauging how much milk the baby was receiving. After the numerous attempts that afternoon, an overall exasperation filled the room, accompanied by tears running down both the baby’s and the mother’s face. Desperate for her baby to eat, she asked for formula and a bottle.
Brittany replayed the incident over and over, throughout the
day and later that night. As a student, she was directly exposed to the concept
of innovation and the pain point/solution mindset through her school’s
Healthcare Innovations Program. Musing upon the dilemma, she identified the
pain point as the inability to register how much milk a baby was receiving from
its mother. A solution, she surmised, would be to develop “a device that
accurately calculated the amount of breast milk that infants receive during
After working with a team of biomedical engineers to develop
a working prototype, Brittany was ready to enter in her university’s “Shark
Tank” event. Although she did not win the competition, she was undeterred.
Brittany reached out to one of the event’s judges to discuss plans for her
device further and, thereafter, push forward with her startup. The year after
graduation, she filed a provisional patent and launched into a flurry of
networking, pitch decks, and attendance at innovation events.
While applying for startup business grants and working to
keep her nascent company alive, Brittany had her hands full: employed as a
bedside RN in pediatric intensive care and simultaneously studying to become a
pediatric primary care NP. Her breastmilk gauging device, Manoula, is designed to inform
“mothers and providers how much breastmilk a baby has consumed” and share the
data via wireless technology. The product is moving toward its alpha prototype
and is expected to enter the market in 2021.
DailyNurse asked Brittany: What was the hardest part
of starting your LLC and creating a new medical device? And what was the most
She responded, “the hardest part about starting an LLC and
creating a medical device was the mere fact of starting with no previous
medical device development, business, or entrepreneurial background. I thought
I was going to be a nurse, that was it… I never imagined it would get this
far. The most rewarding aspect is seeing how far the company and the device has
come since that drawing of my “vision” started as a Crayola picture
and a school project. It is amazing to think this device will be in the hands
of breastfeeding mothers someday.”
Brittany also has some advice for any nurse who has an innovative idea and is interested in turning it into a new product: “Find a team. Team is essential to the success of any startup or any innovative idea. A team that shares your passion, drive, and vision can help bring an innovative idea to fruition.”
The Rebel Nurse Handbook
This compilation of stories from more than 40 diverse nurse leaders, innovators, and entrepreneurs portrays the winding and demanding paths that every nurse has braved in order to improve themselves, their patients’ care, and the healthcare of today.
The Rebel Nurses featured in this book are pushing the boundaries of their profession by demanding a seat at the table of healthcare innovation, lobbying on Capitol Hill, and expanding their horizons to fix the broken healthcare systems around the world.
physician residencies have been the norm seemingly forever, nursing residencies
are still fairly new. If you’re interested in one, you need to know basic info
about what you’d experience.
McGill, MSN, RN, CCRN, Chief Nursing Officer, Norman Regional Health System in
Norman, Oklahoma says that nurse residencies are new, having been around in
their current form for about the last decade. However, in the last five years,
they’ve become quite common in acute care nursing.
“The Nurse Residency Programs are designed to establish a smooth transition from student life to professional practice. These programs seek to establish clinical competency, provide emotional support through the transition, and facilitate recruitment and retention of strong nurse beginners who are committed to the nursing profession and the hospital,” says McGill. “The residency program is meant to build on the foundation provided by nursing schools and unit orientation through reflection, case reviews, and critical thinking that strengthens what it means to be a professional nurse.”
At Norman Regional Health System, McGill says nurse residents receive both formal as well as informal learning opportunities. “[They] focus on our institutional policies, procedures, and standards of care while introducing them to key persons and structures needed to execute the institutional and departmental routines,” she explains. “Our Nurse Residency Program includes an evidence-based practice project and presentation of that projection. The purpose is to ensure the residents are fully aware of the process that results in continuous learning, developing, and enhancing patient care based on evidence. The learning never stops.”
Nursing residencies last anywhere from six months to one year, but most are a year long. They should encompass unit-specific orientation, hospital orientation, be paired with a preceptor and a mentor, include a peer support component, and should focus on developing the skills that nurses need to grow as professionals.
“Nursing residencies can be administered differently across hospital settings. The NRHS Nurse Residency Program includes all new graduate nurses hired into the acute care hospital setting regardless of specialty. This allows relationship building across units and service lines enhancing teamwork and collaboration,” says McGill.
If you’re looking into a nurse residency program,
McGill suggests that you do your research. Be sure to ask recruiters about
nurse residency programs. If you’re looking for nursing positions, search for “New
Graduate RN” or “Nurse Resident” listings. And during job interviews, be sure
to ask questions about a health care system’s nurse residency programs.
The greatest rewards of nurse residencies, says McGill, are “the peer support the nurse residents receive during the program and the lifelong connections formed with the nurses from different departments. The ability to learn about the hospital as a system and not just the unit they work on,” she says. “This helps build the interdisciplinary component that health care is striving to achieve. The nurse resident can also get a perspective of the care a patient receives on other units and how each area impacts the patient’s care overall.”
If you love being a nurse, but also love to travel and fly like Sue Treseder, BSN, RN, then being a commercial flight nurse might just be a great gig for you.
Founded in November 2016, Flying Angels is a medical escort service that provides nurses to fly with patients who are stable but have medical needs. They travel on commercial flights with patients all over the world. Treseder, a charge nurse at Virtua Memorial Hospital’s Emergency Department, has been working with them since their inception. Overall, she has been doing this kind of work for about 12 years. Averaging about 20 trips per year, Treseder says that she has been all over the United States and all over the world.
“These patients have a wide range of medical issues.
Typically, they fall ill or sustain an injury while they’re away from home and
need assistance getting back. We also transport patients who need to get to a
different hospital for specialized care. For example, we might take someone
with a spinal cord injury to a facility that specializes in that particular
niche,” explains Treseder.
Here’s how it works: a coordinator with Flying Angels
makes sure that everything with the sending and receiving parties is arranged
so that all patients have what they need at all times. They get special
clearance from airlines if they have to bring equipment along such as oxygen. And
nurses travel the entire way with the patients—from one bedside to the next.
Before they can work for Flying Angels, nurses are
trained in flight physiology and also have to pass a test before flying. Once
this is done, they can fly with patients.
“It is a paid position, although most of us love what we
do so much that we would probably do it for free!” says Treseder.
While flying with patients, Treseder says that she talks
with a lot of them. “We’re usually like best buds by the time I drop them off,”
she says. “Often there are hugs, tears, and pictures at the end of the trip.”
There are reasons why they can become so close, so soon. “Most
of our patients find themselves in seemingly impossible situations. Often, they
are in hospitals in a foreign country where they don’t speak the language and
the care may be of significantly lower quality than they would receive at home,”
Treseder says. “They’re frightened and overwhelmed, as are their families. A
huge weight is lifted off their shoulders once we get involved.”
Although she loves what she does, Treseder has had some
challenging experiences. She’s flown with patients who have psychiatric
problems or dementia. “They sometimes act out during a flight and are difficult
to redirect,” she says. “Human behavior is always the toughest thing to prepare
Sometimes, she says, the most difficult cases can also be the most rewarding. “I had one patient who was in Atlanta visiting his nephew when he tripped and fell, and sustained a spinal cord injury that left him a quadriplegic and on a ventilator. He lived in a remote part of China. The logistics of getting him home were formidable, between getting the stretcher and ventilator through the two airports (connecting through Seoul), carrying all the equipment (we had to buy extra seats on the plane just to accommodate all the medical gear), to arranging the 12-hour ambulance ride through the back roads of China — this was a really tough case,” admits Treseder. But the payoff was worth it. “When we finally got there, the family was waiting, along with a crowd of locals and the news media. The outpouring of love and gratitude was overwhelming, and it was just such a great feeling to know we had performed this service for this man and his family.”
One place Treseder hasn’t been to yet is Australia. “But
I’ll get there one of these days,” she says. Besides just seeing new places,
though, Treseder has also learned a lot. “Although cultures around the world
are very different, we have more in common with each other than you might think,”