Failure to Rescue–When Nurses Lack Critical Thinking

Failure to Rescue–When Nurses Lack Critical Thinking

Thousands of hospitalized patients die every year and the cause is directly attributed to nurses and their “failure to rescue” the patients within their care. We’ve all heard about that one patient that came in with one issue and died of another. Those of us who have reviewed charts for malpractice cases refer to it as the “snowball effect”—reading the progress notes of a patient who died due to failure to rescue will make you cringe at the glaring errors.

Patients may have one clinical issue, however minor, that if overlooked by the nurse, cascades into a huge mess of concurrent errors and oversights that often leads to the injury or needless death of a patient. Did you ever wonder why this occurs? Short staffing? Maybe. Nurse burnout? Could be. The main contributing factor, though, is that unfortunately there are many nurses who don’t think creatively or innovatively. They don’t act on their assessment findings nor do they follow up on a change in patient condition. They fail to act as advocates for their patient. Nurses who fail to rescue use “traditional thinking” rather than critical thinking.

Failure to rescue always includes four key elements: (1) Omission of care; (2) a failure to recognize a change in patient condition; (3) a failure to communicate a change in patient condition to medical or other staff; and (4) poor or lack of clinical decision making.

Preceptors and nursing instructors, no matter the level of nursing taught (RN, BSN, MSN, NP, or DNP), should review the below list. It contains elements of traditional thinking. Promoting traditional thinking stifles critical thinking.

Nurses who don’t think critically:

  • Don’t learn from their mistakes or the mistakes of other nurses.
  • Demand that nothing changes and have a “but we’ve always done it this way” attitude.
  • Treat each patient interaction in isolation.
  • Fail to “connect the dots” from one interaction to another.
  • Fail to learn about cause and effect.
  • Do not connect new events with prior knowledge.
  • Do not see what is possible in the future.
  • Solve problems in isolation.
  • Demand that all things be done their way and not any other.
  • Allow personal dislikes and prejudices to cloud judgement.
  • Lack self-confidence.
  • Have poor verbal and written communication skills and do not interact well with others.
  • Do not further their education or promote education for others.
  • Force others to make decisions quickly or set time limits on when decisions can be made.

The behavior and clinical actions of nursing preceptors and instructors affect a student or new nurse long after their clinical rotation or orientation has ended. In fact, the actions of a preceptor or instructor will influence the new nurse far into their nursing careers.

The following statements, said by a preceptor or any nurse to another nurse, will stifle critical thinking:

  • “That’s a dumb idea.”
  • “I can’t believe your school didn’t teach you __________.”
  • “Your idea is good, but it won’t work here.”
  • “It’s too complicated so I’ll just do it and you can watch.”
  • “You spend too much time talking with your patients.”
  • “We tried that here on our unit and it didn’t work.”

How do you teach critical thinking to your preceptees and students? Let us know in the comments!

3 Flexible Nurse Entrepreneur Business Ideas

3 Flexible Nurse Entrepreneur Business Ideas

Many nurses find that they experience burnout in the profession and want to create an opportunity to work for themselves without the stress and wear-and-tear that they get from working in the hospital setting. Most importantly though, they want more flexibility and control of their work. Here are 3 flexible nurse entrepreneur business ideas to get you thinking about your next nursing opportunity. After all, a nursing practice can take many forms.

What will yours be?

1. Nurse Health Coach

Nurse health coaches have the ability to actualize their patient’s health care goals outside of the hospital setting by helping them develop the healthiest version of themselves. By teaching patients how to take optimal care of themselves, the nurse health coach empowers them for life.

Nurse health coaches work with patients to provide guidance and resources to assist their patients in living a more healthy and balanced lifestyle. In terms of nursing experience, nurse health coaches generally have many years of direct patient care in the hospital setting and have the desire to have a more immediate and positive health impact on their patient’s lives.

Many nurse health coaches are entrepreneurs who work in private practice, although some hospitals and doctor’s offices hire nurse health coaches as well. According to some surveys, nurse coaches can earn similar or even more income than they do working in hospitals.

Nurse health coaches help their patients by working with them in the following ways:

  • Understanding patient’s unique health care dynamics
  • Assessing patients’ readiness for change
  • Identifying client opportunities and issues for improved health
  • Identifying and setting goals to achieve optimal health
  • Encouraging and empowering patients to reach their goals

Perks to becoming a nurse health coach:

Nurse health coaches generally have more autonomy in this role than they do in other nursing careers. While nurse health coaches must work very hard to be successful, the career offers flexibility with setting one’s own schedule, work atmosphere, and patients.

2. Legal Nurse Consultant

A legal nurse consultant (LNC) is an RN expert for legal cases involving medical incidents and issues. LNCs are extremely valuable because they bring clinical expertise and medical experience to attorneys in the litigation process.

LNCs clinically analyze and evaluate facts and testimony related to the delivery of nursing and other health care services and outcomes. They also analyze and review the nature and cause of injuries in legal cases.

Legal nurse consultants’ responsibilities vary depending on the employer and often include:

  • Attending medical reviews by independent medical examiners
  • Testifying in court as an expert witness
  • Reviewing cases to identify strengths and weaknesses
  • Preparing chronologies or timelines for medical records
  • Working with lawyers to plan health care litigation
  • Drafting legal documents in medical cases under the guidance of an attorney
  • Educating attorneys and paralegals about health care issues

Perks to becoming a legal nurse consultant:

This option makes for a great nurse entrepreneurial business idea because LNCs have the ability to combine their clinical expertise and medical experience with the law. As business owners, LNCs can work as much or as little as they want and have complete control over what they accomplish.  In addition, LNCs can often choose which clients they work with and types of cases they consult on.

3. Nurse Blogger/Freelance Writer

Nurse bloggers and freelance writers create and manage websites containing useful information for readers. They are generally developed based on the creator’s medical and/or personal niche.

A great benefit to becoming a nurse blogger/writer is that each post or article can be written from a completely different perspective. Nurses work in many different specialties with diverse patient populations. Therefore, each nurse has different skill sets and experiences within their career that they can draw unique information from. In other words, nurses can bring a lot of life experience into their writing.

There is a wide range of nurse bloggers on the internet writing about:  nurse mom lifestyle, nursing informatics, nurse money topics, new graduate nursing, nurse humor, nursing apparel, nursing specialties…  and the list goes on and on.

As a nurse blogger or freelance writer, you can:

  • Set your own work hours and schedule
  • Have total creative control over your content and products
  • Improve and continue to develop your writing skills each time you create a new piece
  • Become a better thinker because the writing process forces you to pause and think deeper
  • Develop strong opinions about nurse topics that matter
  • Discover thoughts and ideas about the nursing profession that you didn’t even know you had

Perks to becoming a nurse blogger or freelance writer:

Nurse bloggers and freelance writers are also entrepreneurs who manage their own businesses. Many often also have full-time positions and do their writing/website design in the evenings or weekends. There is no set schedule, therefore they can decide to work or not work whenever they want.

The Warning Signs of a Gaslighting Boss

The Warning Signs of a Gaslighting Boss

In 1944, Ingrid Bergman and Charles Boyer stared in the famous movie thriller “Gaslight.” If you like psychological drama, I encourage you to watch this film. If you want to learn what some bosses do to their employees, look up the verb “gaslight.” Just like in the film when Gregory (Boyer) purposefully manipulates information in such a way as to make his wife Paula (Bergman) question reality and her memory, a boss who gaslights you is manipulating and harassing you.  If you have a boss who makes you doubt yourself and your reality, then you are the victim of bullying on a whole different level — gaslighting. The boss that uses this technique is fully aware that what they are doing is wrong.  

Gaslighting is a subtle technique employed slowly and artfully. Your work life may have started out uneventful; with your boss complimenting you and your work. Your thought your opinion was valued and that you were appreciated. You felt respected.

Bosses who are bullies don’t want you to succeed because they will lose their power over you; they will do anything to impede your success, make you miserable, and block your momentum. But why does a boss gaslight? Because they want you to bend their will, to make you lea your job or to get you fired. If you challenge them, they will make the attacks worse. They employ their tactics to confuse and frustrate you. They want you to be discredited in the eyes of your fellow employees and supervisors. You are not “allowed” to have any ideas, thoughts, or actions different from theirs; your existence at your place of work is a problem for them.

A gaslighter will:

  • Pretend not to see you, acknowledge your existence or your work but will then be overgenerous with compliments and concern.
  • Change project guidelines, adding extra work and increasing the potential for failure.
  • State you are too emotional, your needs don’t matter to the bigger organization, that you are making a “big deal” of things, tells you to move on and forget the issues that concern you — by doing this they are trivializing you and your place in the facility. They do this because they want you to feel that what you are feeling is not reality.
  • Invade your privacy, listen in on your conversations, follow you, snoop within your office, monitor your location within the office, and watch who you speak to.
  • Withhold important information so that you cannot complete your work.
  • Share your private information with other employees.
  • Tell you one thing and then later deny it was said.
  • Allow work cliques to exist so that you are isolated.
  • Publicly humiliate or ridicule you using snide remarks, racist comments, and off-color jokes.
  • Micromanage.
  • Not be fair in the treatment of all — different rules for different employees.
  • Allow supervisors to mistreat and bully employees.
  • Gossip and lie to others regarding your appearance, health, personal life – in order to damage your reputation. The goal of this behavior is to make others believe you deserve the unfair treatment you’re given.
  • Attempt to give the appearance that they are listening to you when you speak, when in reality they do not care.
  • Take credit for your idea, telling you they had to “fine-tune” your original idea making it, no longer yours. Either this or they take an idea of yours that they had originally openly criticized.

What can you do?

  • Document! Trust your feelings that you are being harassed and abused and that you feel overwhelmed, depressed, and anxious. Documenting will be necessary should you choose to contact Human Resources.
  • Always have another coworker present when you meet with a gaslighter. If you are alone with a gaslighter, send a follow-up email to any conversation. Copy all employees that should have access to the information.
  • Limit your communication to emails and memos and make sure directives and instructions for projects are in writing and are clear and based on facts only.
  • Surround yourself with work friends who will reaffirm your talents and skills, because you will begin to doubt your self-worth.
  • Set boundaries that you will not let anyone cross, including your boss. If your react emotionally to them, they will merely point out that you are one with the emotional issues and that you are reacting inappropriately. They will make your emotional punishments worse than in the past. 
  • If you decide to contact Human Resources, be sure that you speak to a representative who you trust and bring your documentation. Be prepared to request a department transfer or search for a new job.
  • Some employment specialists recommend that you confront the bully; however, the person who gaslights will not tolerate being confronted, in fact, the aggression will become worse.
The Life of a Per Diem Nurse and Military Spouse

The Life of a Per Diem Nurse and Military Spouse

It’s no secret that the nursing industry is facing a serious staffing crisis. According to the American Association of Colleges of Nursing (AACN), more than 1 million nurses will reach retirement age within the next ten to fifteen years, and more than fifty-five percent of registered nurses are reported to be age fifty or older. This crisis is compounded by the fact that the graduation rate of new nurses is not keeping pace with the additional 203,700 new RNs needed each year through 2026 to replace retiring nurses.

The nursing shortage is also fueled by burnout. Between juggling difficult schedules and long shifts, nurses are frequently torn between their passion to care for patients and the rigorous demands of the profession. We may leave our physical work behind when we clock out, but the mental piece of it follows us home. For many of us, flexibility is a precious, practically unattainable commodity. We work our eight or twelve hour shifts when scheduled—no coming in late, leaving early, or switching shifts without jumping through hoops with management. When all these factors combine, it is easy to understand why nurses are burnt-out and leaving the profession in large numbers, either as a result of (early) retirement, career changes, or a shift to part-time to attain some semblance of work-life balance.

One thing I never imagined while earning my BSN was that being a military spouse would make it difficult to maintain my nursing career. After graduation, I found work immediately in Washington state, so I was surprised by my difficulty finding work in Rhode Island when we moved here a year later. While attending my first and only interview, I was told by the hiring manager, “We don’t like to hire military people” because it’s a given that we will move again. I had no idea that I would face this kind of bias when I became a nurse; I had heard about it from other spouses, but I didn’t believe it would actually happen to me, especially since I have a MS and I will begin my PhD at the University of Delaware School of Nursing this fall. After sending out thirty-five resumes with no luck, I considered applying for non-nursing jobs. Just when I was eyeing a cashier position at the local Home Depot, connectRN, a digital platform that gives nurses the opportunity to work per diem shifts when, where, and how often they want to work, contacted me through LinkedIn. Instead of being employed full-time by a single facility, per diem nurses are placed on temporary assignments and can choose where they want to work and the shifts that are most convenient for them. Per diem nurses also receive higher average hourly wages compared to salaried nurses. At a time in my life when I felt constricted in my career, per diem nursing offered a glimmer of hope to help me reclaim ownership of my career.

In 2018, I joined connectRN. Unlike traditional staffing agencies, connectRN lets members view all available shifts near them and request the shifts that make the most sense for their individual schedules. Rather than being employed by a single facility and locked into the schedule assigned to me, I now work on my own terms and only choose the shifts that I want. I currently work three to four NOC shifts per week at an acute care rehab facility less than five minutes from my home, and I couldn’t be happier.

Per diem nursing gives me the opportunity to work in a field I love, the flexibility that makes sense for my life, the financial compensation I desire, and the sense of freedom a typical nursing career lacks. As a per diem nurse, I have gained a sense of empowerment I was missing earlier in my career. As caregivers, nurses often take care of themselves last. Per diem nursing has restored my ability to make the best decisions for me and my family and it has put me back in the driver’s seat of my career. Best of all, connectRN knows my husband is in the military and employed me anyway. In fact, I hope to continue working for connectRN whenever my husband is reassigned to a new base.

One Step at a Time: A Nurse’s Journey from EMT to Flight Nurse

One Step at a Time: A Nurse’s Journey from EMT to Flight Nurse

What follows is an interview with Stephen Lee, RN, BSN, a nurse who started as a volunteer EMT and worked his way up the rungs of the medical ladder to become a flight nurse. His career progression and determination highlight a long road to success.

First off, how are you currently spending your time?

I currently live in Louisiana, a few hours north of New Orleans, and I’m training in a position as a flight nurse. I recently left a position in the cardiac-medical intensive care unit at a regional heart transplant center. I’m part of the forensics team (sexual assaults, domestic violence, simple assault, and burns) and I work PRN in the emergency department (ED) at the only level 1 trauma center in my city. I also volunteer with an urban emergency medical service (EMS) system as a paramedic.

What was your first job in health care?

Several years ago, I started as a volunteer EMT (emergency medical technician), which I affectionately deem to be the bottom rung of the medical ladder. Looking back on those days, I knew close to nothing but was caring for critical patients in unstable environments. I had no idea that I was interested in the medical field until I started as an EMT, but I loved the marriage of critical thinking in a high-pressure environment, and I developed the (very useful) ability to look at life and say, “give me your worst.”

What was it like to be an EMT? Where did you go from there?

I loved being an EMT. I was in a position to completely manage a patient’s prehospital care, even if it was with only six drugs. I was taught how to give the best care with very few resources, and the fraternity that I experienced was like nothing I had ever experienced. I spent some time with private ambulances and slowly got more and more interested in the complex tools, patients, and therapies that you can’t really see outside the hospital. I was lucky enough to witness the incredible nursing teams at DC hospitals, and that’s when nursing became my dream.

Where did you go to school, and what did that progression/path look like?

I had earned my Bachelor of Arts degree in a completely unrelated field, so I didn’t have a single science credit when I decided to go back to school for nursing. I had two choices: I could spend three semesters doing foundational science prerequisites, then do an accelerated BSN (Bachelor of Science in Nursing) over two semesters (and pay $50,000), OR I could get my ADN (associate’s degree) at a local community college where I would be able to take pre-reqs for a BSN at the same time. I chose community college!

So you graduated with an associate’s degree? What was your first job?

After I passed the NCLEX and became an RN, I realized how restricting the ADN was. I wasn’t eligible to work at any magnet hospitals, and all critical care programs require a BSN. I wanted to work in emergency medicine, but I had no ED/ICU practicum experience (community colleges often do not get this opportunity), so it was hard to stand out. Luckily, I had hopped on earlier as an emergency department technician at a smaller DC hospital, and that department hired me as a new grad. I received a full-ride scholarship to earn my BSN a year later.

Tell me about your first job as a new graduate nurse.

I was in a small community ED for my first year as a nurse. It was a nice, gradual introduction to emergency care, and I loved it. It was not a teaching hospital and not a trauma center, but it was like learning within a big family.

Where did you go from there?

After my first year in nursing, I had completed my BSN and ED residency. I was ready to get beat up. I found a position at University Medical Center in New Orleans, the only trauma center in a city with an incredibly high rate of both crime and weirdness. I saw some truly incredible things there, and I loved it to death.

What are your short- and long-term career goals? Where do you see yourself in five years?

I’m living my ultimate dream: flight nursing. Flight nursing requires a combination of the technical finesse of an ICU nurse with the mentality of an ER nurse, all in the prehospital environment where it’s just you and your partner. All of my career moves over the last several years have been toward this goal, and I’m now doing orientation and training. This type of work is the pinnacle of emergency critical care and prehospital care, and I could honestly see myself doing it for the rest of my life.

What advice would you share with anyone who is interested in pursuing flight nursing?

First of all, and quite unfortunately, there are no shortcuts. I meet a lot of people who finish nursing school or get their medic cards and immediately want to be a flight nurse. Truthfully, you need a minimum of 3-5 years of grueling experience before you would even be considered, and that’s a good thing. I’ve worked 60+ hours a week for the last two years in a Level 1 trauma ED and a cardiac ICU simply to gain experience, and I still have so much to learn.

Relatedly, this type of life is not compatible with normal socialization. One of the reasons I’ve been able to throw myself into work is because of my lack of attachments. I moved 1,000 miles with two week’s notice; I’ve taken pay cuts for my last two jobs because I rent a room month-to-month, keep everything in storage, and have zero debt. This is a lonely life, no doubt about it. I pretty much stopped trying to date because I work six days a week and when I do have time, all I can talk about is work. If that is something you don’t think you can handle, maybe this career path isn’t for you.

If you want to fly, get EMS experience. I can’t stress this enough. Beyond learning about the prehospital environment, you learn how firehouse life works, which a lot of nurses (especially from ICU backgrounds) struggle with. You are not colleagues with your flight team, you’re family—a family that uses curses as terms of endearment and who knows things about you that you never even told your closest friends. Working in that type of environment builds bonds that can never be broken and are instrumental to providing the best care together.

This is very important, even for nurses who don’t want to fly: Learn some of the skills of those around you in the hospital (respiratory therapists, EKG/ECHO techs, IV team), because there’s going to be a time that you’re going to need something done by them and they’re not around (keeping inside your scope, of course). Plus you will learn so much! I’ve come in on my days off to shadow respiratory therapists and IV nurses to see how they do things.

Lastly, be a team player, but never accept help until you really need it. If your patients are settled, then it isn’t time to relax, it’s time to help your coworkers. Avoid accepting a hand just because it’s offered, but take help when you’re drowning. Build a reputation of being self-sufficient but also very helpful to your coworkers, so that when you have that tough assignment and you say “I really need help,” people will jump right in. You’re not going to get far doing this job without a team, and you also won’t get anywhere without hard work.

What Does it Mean to Be an Admissions Nurse?

What Does it Mean to Be an Admissions Nurse?

Hospitals are constantly in flux as patients come in and out. As patients are admitted to the hospital, nursing staff must perform detailed assessments and gather a significant amount of information as part of the admission process. As you can imagine, this can be a time-consuming process.

Think of an 80-year-old patient who is on 17 prescription medications, has numerous comorbidities, and can’t recall their past medical history. It might take a while to gather the necessary information. Add this admission onto an already difficult patient load where the nurse is currently managing three or four sick patients and it’s easy to understand why the admissions nurse role was created.

An admissions nurse was created with the thought of reducing the burden on admitting units. They often operate hospital-wide and will go from unit to unit to complete patient admissions. The admissions nurse will come to the room of the newly admitted patient to perform a complete head-to-toe assessment, gather important contact information, review and document that patient’s medication list and pertinent medical history; next they will orient the patient to their room and unit and complete all other admission documentation. Then they will discuss any necessary information with the nurse who will be taking care of the patient.

The admissions nurse role is a unique opportunity for nurses to familiarize themselves with the hospital and to work with staff outside their normal unit. They often work part of their FTE as an admissions nurse and the rest of their FTE on their dedicated unit. This role can get mundane at times, but it does allow for nurses to gain valuable experience with numerous patient populations and helps them to build relationships with staff outside their home unit.

Admissions nurses serve as an important part of workflow management by taking on much of the burden of the admission process. They quickly become experts on the admission process and are valued by all the units they serve.

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