Nursing is a vocation rife with occupational hazards. On a daily basis, nurses come into contact with sick patients, infectious agents, teratogenic chemicals, and radiation, to name a few environmental risks. Additionally, nurses are constantly on their feet, walking several thousand steps per shift. They are expected to help lift, move, and transfer patients several times per day, and face many potential musculoskeletal injuries from strenuous physical labor.
It is not surprising, then, that many nurses worry about the risks inherent in their daily job descriptions once they are expecting. Many nurses are women of childbearing age, and a pregnant nurse has to take certain precautions to keep herself and her growing baby safe. Below are some of the hazards pregnant nurses may face and suggestions for mitigating those risks.
Infection. Perhaps one of the most obvious risks to a pregnant woman and her fetus is infection. A nurse in the emergency department (ED), for example, may encounter patients sick with potential pathogens, from strep throat to tuberculosis to the flu. A pregnant nurse should follow standard precautions with all patients, and may also wish to wear a surgical mask around patients with a fever or suspected respiratory illness. A pregnant ED nurse may also wish to limit exposure to pathogens by reducing time spent in triage, if possible. Pregnant nurses may wish to avoid taking care of patients with active shingles or varicella zoster infections, as well as patients on airborne precautions.
Pregnant nurses should be immunized against influenza; the vaccine is safe for women in all stages of pregnancy. The live attenuated flu vaccine is unsafe for pregnant women. As an added benefit, flu antibodies are also passed to the fetus. If a pregnant nurse cares for a patient with influenza and later suspects she may have contracted the flu, she should speak with occupational health at her hospital to possibly receive a prescription for Tamiflu. Tamiflu works best when taken within 48 hours of symptom onset.
Drugs and chemotherapeutic agents. Because several drugs and pharmaceutical agents have known fetotoxicity, great care should be taken by the pregnant nurse when administering those and any medications to patients. Medication preparation is risky, and pregnant nurses may be exposed to hazardous drugs through skin absorption, inhalation, accidental contact, or needle-stick injuries. Sometimes while drawing up medication, the liquid can splash or make contact with the skin. Nurses should at the very least wear gloves while drawing up any medications or handling drugs, and at the most, should avoid handling known chemotherapeutic agents such as methotrexate.
Nurses should also weigh the risks and benefits of continuing their particular field of nursing while pregnant. Cancer treatment drugs, for example, have known effects of infertility, miscarriage, birth defects, and low birth weights.
Ionizing radiation. Radiation for diagnostic imaging is common in nearly all hospital departments, and nurses are at risk not just of background radiation but also of direct ionizing radiation. Nuclear medicine departments in particular are of high risk to a pregnant woman. Effects of radiation on a fetus depend in part on the dosage of radiation and on the baby’s gestational age. The thresholds of safe exposures are not well investigated, but research has demonstrated an “all or none” effect; that is, significant exposures cause either no effect or a fetal loss. Although dosimeters are used in areas where high radiation exposure is expected, other areas of high ionizing radiation (e.g., the emergency department) are rarely monitored. Expectant nurses should be very aware of their surroundings.
Stress, physical labor, and shift work. It may be necessary for nurses later in pregnancy to modify their shift schedule or behaviors to help accommodate their needs. Nursing is already a physically rigorous vocation, but add in the fatigue of pregnancy and it can be extremely physiologically demanding. In the first trimester, many women experience morning sickness, which to the pregnant nurse can be debilitating. Later in pregnancy, back pain and sciatica can also interfere with nurses’ ability to continue working until their baby is full term. Additionally, the 12-hour shifts typical for most hospital nurses become more taxing later in pregnancy, and it may be necessary for the pregnant nurse to request a modification to shorter shifts or part-time hours. The best solutions for pregnant nurses are to enlist colleagues for help when possible, to always use safe-lift equipment when available, and to speak up when requiring assistance.
If you are pregnant and struggling to perform your duties, certain pregnancy complications are covered by the Pregnancy Discrimination Act. Pregnant nurses should also be familiar with their state and employer’s Family Medical Leave Act policies and eligibility requirements.
For more information about the hazards to pregnant health care workers, you can browse the National Institute for Occupational Safety and Health’s website about the effects of workplace hazards on female reproductive health.
The Clemson University School of Nursing recently received a $5,000 scholarship from the CVS Health Foundation to assist students in their studies to become family nurse practitioners. CVS’s grant is part of the new Advance Practice Nurse and Physician Assistant Scholarship program which launched this year.
The program is aimed at reducing the nationwide shortage of family nurse practitioners and physician assistants by supporting these promising future health care professionals. Scholarships will be provided to accredited academic institutions around the nation to be distributed to family nurse practitioner and physician assistant students for covering costs of tuition, books, and other academic fees.
Clemson is thankful for the scholarship funds which will go towards helping deserving students become excellent family nurse practitioners. Eileen Howard Boone, president of the CVS Health Foundation, credits the scholarship as one of many steps that the foundation is taking to increase the number of qualified healthcare professionals in South Carolina and around the nation. Boone tells The Newsstand at Clemson.edu,
“We know how important having a strong pipeline of family nurse practitioners and physician assistants is to making high-quality, convenient and affordable health care services more accessible. We’re proud to support schools like the Clemson University School of Nursing who are providing quality education to students pursuing a career as a family nurse practitioner.”
The scholarship will be awarded to students in good academic standing who are pursuing advanced practice nursing master’s degrees, doctorate family nurse practitioner degrees, or master’s degrees as a physician’s assistant. Scholarship recipients are also required to intern or volunteer with an organization supporting underserved populations, and at least 25 percent of the scholarship funds will be awarded to bilingual students.
If you’re taking care of an aging parent, you will likely face days when the tasks seem overwhelming. By acting strategically, however, you can ease the burden. In honor of National Family Caregivers Month, here are a few pointers to make your life easier.
Tap Community Resources
Your support system may center on family and friends, but it’s also critical, say experts, to tap every possible resource. Fortunately, most communities have offices dedicated to supporting older adults and their families with referral, informational, and other help. Since the Older Americans Act debuted in 1965, Congress has funneled trillions of federal dollars into state and area agencies on aging to provide an array of community and individual programs. Often in combination with other state and local funds, the money facilitates partnerships with area service providers to help seniors and their caregivers cope with all manner of aging issues. By checking with your local office on aging, chances are very good that you’ll be able to connect directly with the resources you need or at least with other groups that offer them. “Seeking out your county office is a great starting point for navigating local resources that are available,” says Meg Stoltzfus, a lifespan service manager in the Office of Work, Life, and Engagement at Johns Hopkins University in Baltimore, Maryland.
Strut the Small Stuff
There are many aspects to staying organized, but taking a few small steps can keep things under control. Although you likely can craft a list of your own, Amy Goyer, a family and caregiving expert for AARP, suggests a few starters: Focus on one task at a time to avoid procrastination. Use paperless statements and online billing to eliminate paperwork. Embrace technology of all sorts since it can streamline your world. If you’re smart phone savvy, for instance, take advantage of user-friendly apps to help track records, share schedules, and keep your caregiving circle informed and engaged. Even though you have options, Goyer recommends three: CareZone, CaringBridge, and Lotsa Helping Hands.
Locate via a Locator
Although identifying area resources is a logical first step, don’t be shy about going national. Stoltzfus, for instance, routinely recommends Aging Life Care Association, a nationwide association of nurses, social workers, and other practitioners dedicated to the delivery of high-quality health care for elderly and disabled adults. With expertise in a variety of areas key to aging well, these geriatric care managers serve as both guides and advocates for families with various resource needs. To find an appropriate professional in your community, visit www.aginglifecare.org. “This is a fantastic resource, particularly when you’re providing care long distance,” Stoltzfus says. “It’s a way to find an extra set of hands, get resource ideas, or just provide care coordination that’s difficult long distance.”
Hire a Personal Assistant
Celebrities aren’t the only people who can benefit from a Gal Friday. Hiring a personal assistant by the hour to run errands in a pinch can free you up to concentrate elsewhere. Goyer, for instance, employs a concierge to assist her with tasks not directly related to her 93-year-old father’s Alzheimer’s care, but critical to her schedule nonetheless. Whether that involves taking her to the airport, sorting her stacks of mail, or doing whatever needs to be done at the moment, her assistant takes over the minutia so she can focus on the bigger picture. “I can hire Debbie for two hours,” says Goyer, “and she gets more done than I would get done in a week.”
Chart Your Requests
You may be missing willing volunteers because they just don’t know what needs to be done. Carol Abaya, MA, a nationally recognized expert on aging and elder/parent care issues, suggests creating a simple chart by dividing a piece of paper in three parts vertically to sort out your options. In the first column, list all the things your elder charge can do. In the middle column, add those things that require some help. Fill the third column with those tasks that he or she can’t do at all. On a second paper, note your resources, whether that includes individual siblings, agencies, or others from the community. Once you’ve identified the possibilities, match your needs with volunteers and let them know. “Many times a family member will say, ‘What can I do?’ and the primary caregiver really doesn’t know,” she says. “This is one way of dividing the chores.”
Get Legal Control
Being authorized to pay the bills and handle other business transactions are critical in ensuring someone’s safety and security. If you anticipate that your elderly parent won’t be able to care for his or her own financial or legal affairs, you need to act as quickly as possible to ensure that you can do so. Obviously, there has to be trust between the two of you, but you want the proper documentation to write checks, manage assets, and make other decisions in your family member’s best interests. That likely will involve signing a power-of-attorney. “People are often afraid that if they give a child a power-of-attorney, they’re going to lose the power to take care of themselves,” says Abaya. “But it only comes into play when they can’t handle those chores.”
After discovering that funds had been embezzled from her father, Polly Shoemaker, RN, BSN, MBA, the director of clinical systems at St. John’s Hospital in Tulsa, Oklahoma, was more than willing to get the ball rolling when he asked, “Polly, how can you protect me?” The two of them not only drew up a power-of-attorney, but also put her name on a new checking account, updated his will, and made sure that correct beneficiaries were listed on his portfolio assets. Even though being her dad’s eyes and ears on such matters was draining, Shoemaker wanted to ensure that he had signed everything pertinent so she had license and direction. “When he said to me, ‘Polly, I just want to do what’s best for you,’” says Shoemaker, “I told him, ‘Dad, it’s not about me. If you tell me what you want done, I need it in writing because we can’t go on word of mouth.’”
Practice a Little Jujitsu
Achieving progress acceptable to you and the person who needs you may require changing your approach. For starters, experts suggest making sure you make decisions with an elder, rather than just for him or her. Obviously, the dynamic will change depending on the mental and physical capabilities of the elder in your charge. Yet you need to honor this person’s opinions at the same time you pace the conversation to reflect where he or she is at that moment.
For instance, when Abaya was taking care of her own ailing mother’s real estate business, she quickly learned to limit her inquiries to one or three questions per hospital visit, just enough for the woman to process. She also made it a practice to never hire anyone without letting both parents vet the individual first. “Too often sandwich generation caregivers make decisions for an elder that are not in tune with that person’s likes and dislikes,” she says. “But we have to consider their preferences and values.”
If you are a nurse you’ve likely experienced stress now and again. Long hours, sicker patients, staffing issues, and other specifics tied to the job can torpedo the joy of doing it. But what happens when families of your patients add their own unique dynamics to the mix? Your stress levels likely surge even higher!
Most relatives want the best for their loved ones, but uncertainties of all shapes and sizes can provoke tension even in the most loving families. And people who let past disputes, present rivalries, or even personal demons overshadow the problem at hand can quickly disrupt the flow of quality care, not to mention cause angst for nurses.
The unfortunate reality is that you may not have time to process what’s occurring, even though doing so can be a safety valve for your own mental health. As Teresa Conte, PhD, CRNP, assistant professor of nursing at the University of Scranton, notes: “There’s always a patient in the next room to think of so you never get to pause and deal with it. So you’ll either start crying in the car or you’ll push it off and push it off without realizing the small effects it’s having on you until you yell at the dog or get really annoyed when your child spills the milk.”
A Proactive Pact
As a nursing professional, you’ve likely found ways to center yourself after an untoward event or other encounter. Perhaps you talk with your colleagues or even debrief as a unit. Yet taking steps at the first simmering signs of tension or an issue can go a long way in helping you advocate for your patients and their families. By establishing rapport, setting boundaries, and knowing your limits, you can calm agitated nerves—both theirs and yours!
Even though you’ll likely have an admitting diagnosis and impressions from colleagues during report, you probably won’t get a true sense of what’s going on with the patient and family until your first assessment. That’s why it’s important to establish common ground when you enter the room: Acknowledge the players, explain what you’re doing, and ask for any questions or concerns. From that point forward, your goal is to keep people in the loop by delivering information in ways that either empower or soothe. Also, always remember that being a patient or the family of the patient is a difficult place to be under any circumstances.
“What nurses do best is to educate patients and families,” says Leslie G. Oleck, MSN, PMHCNS-BC, LMFT, a psychiatric clinical nurse specialist and a graduate instructor at the Indiana University School of Nursing. “When people feel like they have a better understanding of what’s going on, they’re able to cope better. They don’t get short with each other or the patient as frequently—and the patient doesn’t get short with them.”
For instance, although obstetrics is usually a happy specialty for Lexi Dunn, MSN, APRN, CNM, a midwife and doctoral candidate at Emory University School of Nursing, sometimes she has to deal with the inevitable tension that arises when expectant parents have to make tough medical choices. Whatever the issue, the fact that events can turn on a dime can be a “shocker for people,” she says. “There’s high emotion and a lot of tension because of the nature of the situation.”
Dunn admits that while disagreeing with the parents about their choices can make her feel sad or even helpless, she stays focused on her mission—to educate and empower them so they’re comfortable with the decision. “Most of the time when you have conflict it’s because there’s so much going on that people miss important information,” she says. “So I want to reassure them that I’m here for them, that I want to know what’s bothering them, and that I’m giving them all of the perspectives to come to an agreement.”
Even though illness can bring out the worst behavior, you likely don’t want to wait for an unruly family member to erupt before taking action. Outlining your rules at the first sign of a problem not only tells people what’s acceptable and what won’t be tolerated, but it also may keep security at bay.
For instance, when the wife of a heart transplant recipient made it clear that his adult children couldn’t see their father, Christy Hogue, BSN, RN, CCRN, was equally frank. As the supervisor and day shift charge nurse in the cardiovascular intensive care unit at the Medical City Dallas Hospital in Texas, she not only let it be known that she’d do whatever was best for her patient, but they’d have to either put their differences aside or stay away if they couldn’t be civil. “We’re not counselors or the police,” she says. “As nurses, we’re just trying to do the best for the patient. Sometimes we need to set acceptable boundaries with families so we can provide that quiet, healing environment.”
Know Your Limits
As a caregiver, solving every issue that’s sucking the energy out of the room might be an appealing notion. Yet it’s not your job to deal with the bigger, entrenched problems haunting a family—even if circumstances have pulled you into the drama. Resisting whatever urge you have to fix what you likely can’t fix helps you stay focused, even though you might have to leave your ego aside to do so.
For instance, when one mother’s abusive behavior toward her child’s pediatric oncology nurses started affecting unit morale, Conte’s administrative colleagues arranged for volunteers to sit with the boy multiple times a day. They were concerned that the woman’s off-putting antics were not only stressing the nurses, but also jeopardizing his care. Giving her multiple breaks admittedly didn’t change her personality, but it allowed the nurses to work without fear of entering the room. “People have issues that are not going away just because a loved one is sick,” Conte says. “If anything, that compounds the situation. We may wonder why they can’t get it together, but it’s their reality. You can’t change it.”
But you can be effective in redirecting the course of events by putting your ego aside and being mindful of your words and delivery.
For instance, when a combative father went Papa Bear ballistic on an emergency room nurse trying to test his 18-year-old daughter for brain function, Lourdes Lorenz, DHA(c), MSN-IH, RN, NEA-BC, AHN-BC, swooped in immediately. The founding CEO of International Integrative Health Institute in Ashville, North Carolina, was rightly concerned about protecting her then-hospital colleague. She also knew that she needed to clear up the man’s confusion about the prognosis. Even though the girl was non-responsive after aspirating from a roofie-laced drink, her father misread a cardiologist’s assurances that her heart was stable as a sign that she was getting better.
Lorenz immediately legitimized the dad’s concerns by suggesting that anybody in his position could be similarly confused. But she also provided the parents with a full picture of what was occurring before circling back to the doctors to make sure that they’d be better at coordinating their messaging in the future. “Before you can control the situation you need to be very mindful of what you’re thinking and let your ego out of it,” Lorenz says. “If you don’t do that it can become a bigger conflict.”
Final Thoughts: Safety First
Whatever you do to keep everyone on an emotional even keel, it always comes back to safety. Your institution likely has protocols in place to deal with progressively difficult or challenging situations.
Calling security is clearly a front-and-center option if people are threatening or nasty. But it may not come to that if you can move family members to a quiet place for a heart-to-heart with a social worker, chaplain, or yourself. Beyond an actual face-to-face meeting, however, instituting a behavioral or visitation contract further cements the fact that you mean business about someone’s menacing attitudes or verbal abuse.
You may be fortunate in that you won’t need to put your rules in writing. Then again, putting them to paper may be the best way to clip the wings of potential troublemakers and give you much needed stress relief. “Sometimes when you lay it out for people,” says Conte, “it kind of jars them into realizing, ‘Oh my gosh, I need to make some changes.’”