Nurses Not Immune to Stress from Disaster

Nurses Not Immune to Stress from Disaster

Two reports find that RNs are both personally and professionally affected by natural disasters

That includes nurses.

“When both personal life and professional life are impacted by an adverse event, as occurred in Superstorm Sandy, stress can exponentially increase,” said Victoria H. Raveis, PhD, director of the Psychosocial Research Unit on Health, Aging, and the Community at NYU College of Dentistry. “The responsibilities associated with the profession of nursing add additional demands that increase the risk for role conflict when a disaster occurs.”

She, along with colleagues at NYU Rory Meyers College of Nursing and NYU Dentistry, recently published two reports in the Journal of Nursing Scholarship that offer insights on emergency preparedness, recovery, and resilience. The studies were centered on nurses working at NYU Langone Health’s main hospital during Superstorm Sandy in 2012. Key themes that emerged were communication — both improving channels and the importance of connecting nurses with others during a crisis — and social support.

Preparedness Training Needed

To understand how nurses at NYU Langone were impacted before, during, and after the storm, the researchers conducted interviews and surveys with 16 nurses who participated in the mid-storm evacuation of more than 300 patients at the institution’s 725-bed Tisch Hospital due to high water levels.

Raveis and her team explored nurses’ experiences in disasters, assessed the nurses’ challenges and resources for carrying out responsibilities, and uncovered some lessons.

After the interviews, an online survey was sent to all RNs assigned to inpatient units at NYU Langone on the day of the storm. The researchers received 528 anonymous responses, including responses from 173 nurses who were part of the evacuation.

While some nurses had previous disaster training and experience, and a few of them reported feeling prepared during the storm and the resulting evacuation, many working the night of the storm lacked prior hands-on experience or deep knowledge of emergency preparedness.

This lack of comfort with emergency preparedness is not uncommon, noted Eric Alberts, corporate manager for emergency preparedness at Orlando Health in Florida.

“I’ve been going across the United States speaking about the PULSE [nightclub mass shooting] incident, and, unfortunately, we’re finding that a lot of hospitals don’t have an emergency plan,” he said.

“Or if they do, they don’t practice it. And if they do practice it, they’re not really practicing it — they’re just doing a flu shot campaign and calling it an exercise.”

Alberts recommended that hospital and health system leaders do a thorough evaluation of their disaster readiness: “Really look at your processes and your people and see what is available during emergencies. Emergency preparedness and healthcare looks and feels different everywhere you go. And then from that, look at what resources and people are able to help those individuals have a good, efficient, and effective plan.”

The researchers also called for more education and planning for future disasters and they recommend FEMA’s all hazards approach to disaster planning.

Personal Concerns Present

Communication was a challenge during Superstorm Sandy when access to electronic medical records, email, and phone communication was unavailable because of power loss.

RNs reported unlocking medication carts in anticipation of the power outage and handwriting medical summaries for patients being evacuated to other hospitals. Of the nurses surveyed, 72% reported that their primary mode of communication was talking face-to-face and 24% used personal cell phones.

The researchers also found that nurses had their own personal concerns during the storm, worrying about their families’ welfare and personal loss. And while many arranged for extended stays at the hospital before the storm, they reported feeling uncertain about leaving their families and later had trouble contacting loved ones.

The survey found that 25% of nurses suffered property damage or loss, and 22% needed to relocate after the storm. Some respondents reported psychological problems after the storm, including having disturbing thoughts (5%) and difficulty sleeping (4%).

Social support from co-workers, hospital leadership, and loved ones was cited as an important resource in helping nurses cope with the stress of the disaster.

“Our research also shows that maintaining good communication with peers and hospital leaders after the hurricane helped the nursing staff feel more connected and less stressed,” said another of the study coauthors, Christine T. Kovner, RN, PhD, professor of geriatric nursing at NYU Meyers.

This story was originally shared on MedPage Today.

Virtual Reality Enhances Ohio University School of Nursing Education

Virtual Reality Enhances Ohio University School of Nursing Education

The Ohio University College of Health Sciences and Professions’ School of Nursing is putting virtual reality to use in the classroom. Assistant professor Sherleena Buchman helped create a Narcan simulation during the 2018 spring semester. Since then, the initial video simulation has been transformed into a virtual reality simulation.

A 360-degree video was made from cameras surrounding the Narcan simulation, which features two college students discovering a friend experiencing an opioid overdose. Throughout the scene, the students call 911 and work together to help their friend by administering Narcan.

“Using virtual reality goggles, the person can turn around and see everything. It’s really amazing,” Buchman shared with the CHSP Newsroom. “When you look down, you can see them going through the bag looking for Narcan. If you hear a noise, you can turn your head to look in that direction to see what’s going on. It’s just like you were physically in the room.”

Buchman believes that as the simulation becomes more realistic, the students will learn even more than they could in a traditional nursing education setting. Currently, this simulation is only available in the university’s GRID Lab, but Buchman is working to have the simulation eventually available on all smartphones. The simulation will help students learn not only about Narcan and how to administer it, but how to view and think about addiction without a stigma.

“It leaves you with a feeling of ‘Wow, I just watched someone overdose and watched them come back,’” said Buchman. “The reactions viewers gave were interesting and emotional. They showed compassion as we sometimes don’t consider the side of the actual person who overdosed and the feelings of those that found them.”

Currently this simulation is only available for laymen, but Buchman is working on another version specifically for Ohio University’s nursing students that can be used as a teaching tool. She feels excited and grateful about her success with the simulations so far.

“It’s been a pretty amazing journey. I love technology, simulation and education and the students today have grown up with technology in their hands. This is a way we can impact them that’s familiar,” Buchman said. “It’s amazing to think that we can help create something that will help patients and help our community by impacting this generation of students and community members who see this and will be able to carry out these actions on their own.”

How a Nursing Career with VA Changed a Former Combat Medic’s Life

How a Nursing Career with VA Changed a Former Combat Medic’s Life

Jeffrey Ballard, R.N. and Army Veteran, began his medical career as an emergency medical technician (EMT). After gaining experience as a paramedic and a licensed practical nurse (LPN), he became a registered nurse in the Emergency Department at a Level 1 Trauma Center. He was deployed to Afghanistan two years later as an infantry medic, where he sustained injuries in combat. Following a year and a half of surgeries and physical therapy back home, Ballard returned to emergency nursing, but his struggle with PTSD prompted his departure within a year.

Ballard received care at the Manchester VA Medical Center, and he decided to continue his nursing career there. “I wanted other Veterans to have the same comfort I experienced,” he said.

Today, Ballard has been working with the VA for nearly five years and serves in a program that helps elderly Veterans maintain their independence. Working alongside compassionate nurses and caring for combat Veterans like himself has helped Ballard rediscover his passion and flourish in his career. With his experience, he’s been able to better understand and build trust with Veterans in a way that generates comfort and healing for both parties. Recently, Ballard won the title “Red Sox Nurse Hero of 2018” and was invited to throw a game-opening pitch at the historic Fenway Park.

VA offers Veterans not only life-changing care but also life-changing careers. Join our team and discover the unique rewards that come from serving our nation’s heroes. To get started, search for opportunities near you and apply today.

This story was originally posted on VAntage Point. 

Essential Training Helps VA Nurse Save a Life

Essential Training Helps VA Nurse Save a Life

VA Palo Alto nurse Karen Wall saved a woman’s life on a cross-country flight, applying the CPR techniques she learned and taught in a Basic Life Support class at her health care system.

Here is her account of the experience:

If you have ever wondered if it is a good idea to learn CPR, here is proof that it works. On August 11, 2017, I was returning home from a conference I had attended in Washington, D.C. During the Southwest flight from Baltimore to Las Vegas, I became involved in a medical emergency on board.

Whenever I travel, I always let the crew know I am a nurse in case anything happens where they need medical assistance. On this particular day, I was sitting in my seat relaxing with my shoes kicked off and talking with my seatmate, when I heard a commotion a couple rows behind me.

I heard the flight attendant say “Nurse!” I turned around, and she saw me and remembered who I was from boarding. She called me over and there was a lady in the window seat of the aisle passed out.

After grabbing my pocket mask from my carry-on (yes, I always have it with me), I went to her seat after the other people in the row cleared out. When I got to her, I tried to arouse her and get her to respond, but she was gray and cold, had vomited, was not breathing, and had no pulse when I checked her carotid artery.

I called a “code blue” and called for someone to get an Automated External Defibrillator (AED) while the flight attendant alerted the pilot so he could call for help on the ground. My seatmate, also a Veteran, jumped into the row as we worked to get the lady lying down in the row across the seats, as we had no other place that was flat enough to lay her out to begin CPR.

As we were doing this, suddenly two more registered nurses and a doctor came from their seats to help. One of the nurses (who also happened to be a VA nurse) began chest compressions (counting out loud) as I gave breaths—it was two-person CPR in action and by the book.

Once the AED arrived and was turned on, I applied the pads as directed by the AED and then plugged it in. The AED analyzed her and gave the shock just like I had recently learned in a Basic Life Support (BLS) class at work. We continued CPR and eventually got a pulse. She was breathing again! We monitored her vital signs, placed her on oxygen, and turned her on her side so she would not aspirate if she vomited again.

The pilot diverted the flight to Denver where we were met by EMT, who then took over the case and got her off the plane to take her to a hospital.

We need to continually practice our skills.

When I think of the many things I learn in class and the skills I not only learn for myself but also teach others as a BLS instructor, this experience reminded me that there is a reason we teach BLS and teach it the way we do. There is a reason for why we need to continually practice our skills and not take for granted it will never happen to us.

We never know when we will be “the one” who makes a difference in a person living or dying. When I had time to think back on the events of this day, it was as if we had taken the book out and literally followed the steps that lead to a positive outcome for real.

Never have I ever felt so proud to be a VA nurse than at the moment that passenger opened her eyes, looked at me, and smiled!


About the author: Karen Wall, EdD, RN-BC, OFS, LMFT, is a Geriatric & Dementia Care Coordinator at the Palo Alto VA Health Care System

This story was originally shared on VAntage Point. 

Working in the ER: It’s Not Like on TV

Working in the ER: It’s Not Like on TV

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.

The Nurse’s Guide to the Flu

The Nurse’s Guide to the Flu

As most nurses certainly are aware, this year’s flu season is exceptional. It has surged earlier than in previous years and as of mid-January is widespread across all 50 states. There has been a significant wave of flu cases in doctor’s offices and hospitals across the country, affecting everyone from children to the elderly. Emergency rooms (ERs) are inundated with flu patients, and in many cases patients line the hallways in overcrowded facilities without space or beds available due to additional patient volume. Patients are boarding and holding for inpatient beds in the ERs, which exposes additional patients, visitors, and staff to the flu. 

Below are some friendly flu reminders, tips, and tricks to keeping yourself and your patients healthy and safe this season and beyond.

Hand hygiene is the most effective way to stop the transmission of the flu. Flu spreads via droplets coughed or sneezed by infected persons onto shared surfaces. Washing your hands thoroughly and frequently and using alcohol-based gel sanitizers is an effective way to prevent flu. But one thing we often forget about is our patients’ hands. Especially when I work in triage, I’ve started asking my patients and their visitors to use hand sanitizer before triage and before they enter their patient rooms as well. 

If your hands are feeling the burn after so much vigorous washing and sanitizing, reach out to your infectious disease department to see if it can provide some hospital-approved pump-style lotions for your cracked hands. At home, try using Bag Balm or deep healing lotions and placing mittens on before bed to help salves and creams absorb overnight.

If you have flu symptoms, you should stay home from work. Not all employers have the same regulations regarding sick leave and doctor’s notes, and some are certainly more rigid than others. But the best thing you can do for yourself, your patients, and your colleagues when feeling under the weather is to stay home. This doesn’t just help you get better faster, but also prevents you from endangering your fellow nurses. The flu can spread so rapidly through a department that it can quickly decimate staff numbers and leave no one else to care for other ill patients. 

You should feel empowered to communicate with visitors about the flu. It is imperative that nurses educate family members and patient visitors about their role in flu prevention. If your facility hasn’t already done so, consider limiting visitors to your patient rooms, especially children. It is wise to limit visitors under the age of 12 to protect this vulnerable age group from germs. You should feel empowered to ask ill-appearing visitors not to enter a patient’s room if you are concerned for their health. The safety of patients is the utmost priority.

Tamiflu is not for everyone. Most cases of the flu do not require treatment with antiviral medication such as Tamiflu. Clinical judgment will determine whether a patient fits criteria for treatment with antivirals. In most cases, treatment is most effective if given within 48 hours of symptom onset. If you have cared for influenza patients and are starting to see symptoms in yourself, reach out to your employee or occupational health department as soon as possible. In some cases it may be taken prophylactically.

It’s not too late to vaccinate. Make sure to teach patients that even though the flu vaccine has been less effective this year, it still helps save lives by reducing the severity and duration of the influenza virus. Remind patients that it is not too late to receive their flu shot. Everyone six months and older should get the flu shot, especially children, the elderly, and pregnant women.

Mask yourself, mask your patients. If you suspect someone has the flu, you should immediately begin droplet precautions. Place a mask on the patient in triage or when leaving his or her room, and keep yourself protected with a mask and gloves at all times. Remind patients to cover their coughs to help keep you safe.

Resort to basic teaching. Effective discharge teaching can help prevent repeat doctor’s office or ER visits and can help patients stay healthy. Remind patients that the best place for them to be if they are feeling sick is at home. Most people who get the flu will have a mild illness that does not require hospitalization. Fluids, rest, and over-the-counter antipyretics are effective in treating most cases of illness. People with suspected flu should stay home until at least 24 hours after their fever has gone away. Emergency symptoms that require immediate evaluation in an ER include shortness of breath, difficulty breathing, sudden dizziness or confusion, severe or persistent vomiting or diarrhea, or pain or pressure in the chest or abdomen. In children or infants, watch for signs of dehydration, fast breathing, lethargy, and rash. 

Keep yourself as healthy as possible. In addition to washing your hands frequently (while at work and not), you should also try to boost your immune system by eating nutritious foods, including fruits and vegetables; staying hydrated; and getting exercise and sleep. Staying well rested and well hydrated can help keep your immune system in good shape to combat this flu season.


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