AACN Names Vicki Good Chief Clinical Officer

AACN Names Vicki Good Chief Clinical Officer

The American Association of Critical-Care Nurses (AACN ) named Vicki Good, DNP, RN, CENP, CPPS, CPHQ, as its chief clinical officer (CCO).

“As a member of our executive team, the CCO provides leadership of AACN’s initiatives to drive the transformation of acute and critical care work environments to align with AACN’s Standards for Establishing and Sustaining Healthy Work Environments,” says Dana Woods, AACN CEO. “Our CCO collaborates widely within the AACN community and beyond to identify, translate, and facilitate opportunities and integrated action to address current and emerging practice needs and advocacy priorities on issues that matter most to nurses and their patients.”

Nationally known for her patient safety expertise, Good succeeds Connie Barden, MSN, RN, CCRN-E, CCNS, who retires after serving as AACN’s inaugural CCO since 2014.

“Nursing is at a pivotal point. The pandemic illuminated several key areas that have long impacted nursing, and AACN is positioned to be at the forefront to help the profession move forward in areas such as establishing and sustaining healthy work environments, supporting nurses transitioning to critical care, and staffing,” says Good.

After beginning her critical care nursing career at Parkland Memorial Hospital in Dallas, Good served in executive positions for Mercy Health System in Springfield, Missouri, since 2018, including systemwide responsibility for nursing professional development and quality. During the COVID-19 pandemic, she took on an additional role in emergency care for the health system. She has held leadership and clinical roles with CoxHealth, Baylor Health Care System, and Harborview Medical Center.

As AACN president from 2013-2014, a one-year term, Good advocated for nurses to lead the redefinition of safe patient care and optimal outcomes. She recently served on the National Nurse Staffing Think Tank and Task Force, co-led by AACN, to develop recommendations for long-term solutions to the current staffing crisis and the systemic issues exacerbated by the COVID-19 pandemic. As CCO, Good is a member of the AACN Staffing Advisory Group, which is charged with defining the scope and standards of safe staffing for critical care patients.

“Vicki’s expert personal and professional experience with the issues direct care nurses face is one of many strengths she brings,” says Woods. “As a highly engaged AACN volunteer for more than 20 years, Vicki is well versed in our strategic priorities and the care environments our community members practice.”

She served on the external advisory board of Transforming Healthcare through Innovative Nurse-Led Care Delivery Solutions, an initiative of the Institute for Healthcare Improvement and Johnson & Johnson Center for Health Worker Innovation. She is also a member of the American Organization for Nursing Leadership and the Missouri Organization of Nurse Leaders.

She is a scholar of Just Culture and a frequent author and national speaker on workforce solutions, healthy work environments, burnout, and patient safety and quality.

“Just Culture and healthy work environments are pivotal in creating inclusive environments where nurses thrive and patients receive optimal care,” says Good. “As an association, we must continue to advocate for the intersection of these critical components to support our workforce and patients.”

Good earned a Bachelor of Science in Nursing, a Doctor of Nursing Practice from Texas Christian University, and a Master of Science in Nursing from Seattle Pacific University. She completed the Parkland Memorial Hospital critical care trauma nurse internship.

She is a current adjunct faculty member at Missouri State University and active in community organizations in the Springfield, Missouri, area, including as a current board member and past president of the Springfield Child Advocacy Center.

A Day in the Life: Cardiac Nurse

A Day in the Life: Cardiac Nurse

The heart is a crucial part of our life and our world. There are songs about it, movies that focus on it—at least the love part, and without it, unlike other organs, we wouldn’t be able to survive.

So, what’s it like to be a nurse focusing on patient care with the heart?

We interviewed Caitlin Fetner RN, BSN, Cardiac nurse, University of Maryland Capital Region Health . (She’s also a proud military wife. Her husband is an officer in the U.S. Navy.)

What follows is our interview, edited for length and clarity.

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Caitlin Fetner RN, BSN, is a cardiac nurse at the University of Maryland Capital Region Health

How did you get interested in being a cardiac nurse? What drew you to it? How long have you been doing it?

I got interested in cardiology when I was still in nursing school. I studied at the University of Alabama Capstone College of Nursing. Of all the different topics I studied in school, cardiology was my favorite.

I got a job after graduation in a Cardiac Intensive Care Unit in Tuscaloosa, Alabama, and haven’t looked back since. It was there that I learned more in-depth about cardiology, including cardiac catheterization, atrial fibrillation, post-cardiac arrest, and open-heart surgery.

I started on the night shift, and on slow nights, we would all sit with our notebooks and study hemodynamics and how to manage cardiac patients, specifically bypass patients. I have been a nurse for seven years and have loved every minute. I currently work with open-heart surgery patients.

A cardiac nurse takes care of your heart. We make sure your heart has everything it needs to function appropriately. If it is not functioning as it should, we step in with different therapies to help it get back to where it needs to be. We serve patients whose hearts beat in irregular rhythms to patients who need open heart surgery—and everything in between. We provide medications that help keep the heart in rhythm; we provide teaching and education so when patients go home, they know what to do, and we provide strength and encouragement to help patients get out of bed and walk those days after surgery.

Did you need to get additional education for this position? 

A BSN is the only educational requirement for this position, but there are different certifications you can get as a cardiac nurse, such as a CCRN and Critical Care Registered Nurse Certification. This certification requires a test that goes into more detail on how to care for ICU-level patients. After passing this exam, you could get a specific cardiac certification as well.

What do you like most about working as a cardiac nurse? 

What I like most is the delicate balance we manage between the patient’s vital signs and the medications being given. Whether it is medications running as drips or giving oral medications, the nurse must always be aware of what’s happening and how to change the medications accordingly. The heart and its’ function are a beautiful balance, and I love the challenge of managing it all.

What are your biggest challenges as a cardiac nurse? 

The biggest challenge is managing every detail—but it’s also what I love most. You must dot every I and cross every T and be on your toes all shift, but it’s worth it.

What are your greatest rewards as one? 

My greatest rewards are getting the patients up to walk after surgery who thought they couldn’t do it or seeing the patients who have been down long roads and hospital stays finally get to go home. Also, I love talking to and getting to know my patients.

Every patient has a story, and everyone can learn something from everyone. You never know the things you can learn just by talking to someone.

Anything else that is important for our readers to know?

Cardiac nursing is not for the faint of heart. Cardiac nursing is checking vitals for the slightest changes every minute, measuring EKG strips every few hours, and managing multiple drips that, if they were to run out, the patient’s blood pressure could drop quickly.

The heart function, blood pressure, and volume status are all delicate balances that must be monitored closely. Cardiac nursing is busy and sometimes exhausting, but ever so worth it at the end of the day to see the sickest patients go home to their families once more. That’s what nursing is all about.

Smart Hospitals and the AI Tech Powering Them are Bringing Job Satisfaction Back to Nursing

Smart Hospitals and the AI Tech Powering Them are Bringing Job Satisfaction Back to Nursing

Smart hospitals are helping bring job satisfaction back to nursing, and care.ai, an artificial intelligence company redefining how care is delivered, is leading the way through gen AI and ambient intelligence powerful assistive technologies to empower clinicians to make healthcare safer, smarter, and more efficient by reducing administrative burdens, mitigating staffing shortages, and freeing up clinicians to spend more time with patients.

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Chakri Toleti is the Founder and CEO of care.ai

care.ai’s  founder and CEO, Chakri Toleti, a former filmmaker turned healthcare industry leader, was recently named to the Rock Health Top 50 in Digital Health list for his company’s Smart Care Facility Platform. He founded care.ai to bring the first AI-powered autonomous monitoring platform to healthcare to safeguard patients and improve outcomes. Daily Nurse spoke with Toleti about using the same technology as Tesla and other self-driving car companies to improve healthcare facility management and patient care to move toward his vision for predictive, smart care facilities.

What follows is our interview, edited for length and clarity.

You’re revolutionizing the healthcare industry with the same technology that Tesla and other self-driving car companies use to transform the automotive industry. Talk about how you reached this point in your career and your vision for predictive, smart care facilities.

I grew up around physicians. Though I’m not a provider, my mom, dad, and sister are physicians. Now, my daughter wants to become one. So, there are many healthcare people in the family, but I wanted to go a different route. I’m the black sheep of the family. In my previous companies, we were always looking at technology from other industries and trying to bring the learnings from different industries into healthcare. That’s what I’ve always wanted to do. In care.ai, we focused on bringing ambient technology to help the bedside teams be more efficient, just like a smart home. A smart patient room that gives you real-time visibility into operational clinical workflows.

How can it improve outcomes and efficiency in delivering that care within the hospital’s four walls? That’s our focus at care ai. Ambient technology, like self-driving cars, can be used in every other industry. For example, this cup of coffee that I’m drinking has AI in it. When manufacturing happens, cameras observe these cups. And if there’s a small tear, it pushes to the side. Technology is used in many forms; every vertical is usually in your smart home. You have a ring doorbell. Or a Nest thermostat. You can pick up your smartphone and control your garage door; it turns lights on and off. So, this technology improves our lives in multiple dimensions. You have Alexa devices and multiple voice-enabled capabilities as well. And with the advent of AI and bringing AI into regular use has transformed the acceptance and utilization of ambient technology dramatically. We’re doing that at care.ai, the single modality of capturing information. We are challenging the status quo.

So, a provider can walk into the room, do their job, and walk out without touching a keyboard or a mouse. The technology, which is transparent to the bedside team, should be able to document and understand what happened in the room and push it into the electronic medical record. And that’s what we’re trying to achieve. And now, when you bring virtualization capability into the room, your bedside team and other nursing teams can be anywhere, do the hourly rounds, admit discharges virtually, and interact with the patient more effectively in a focused way. With our experience during a Zoom call, a nurse can have the same experience with the patient to complete the admission mission. Some clinical and nonclinical tasks can be done remotely.

Talk about some of the hospitals that are currently using the Smart Care Facility Platform.

We work with some of the largest health systems, from HCA to Vanderbilt to Houston Methodist, for-profit, not-for-profit, and education institutions. We’re very strong in the acute and post-acute nursing spaces.

How is the Smart Care Facility Platform empowering Smart Care Teams?

We start with words, and nursing is one of the core modules and the core feature and workflow to centralize all the admissions discharges and help the bedside nurses. That’s the number one focus for many organizations we work with. In some institutions, when we deploy, it impacts employee satisfaction—reducing burnout. Turnover has dramatically come down, and people are applying to go into these units where we are deployed across the organization from one hospital to another, saying, ‘Hey, you know, we do have some additional support. So we’re not running from room to room to room as we used to do before.’

From employee and patient satisfaction, a significant fundamental paradigm shift of how changes to the care delivery process and redesigning the care delivery process is accelerating our growth.

Healthcare has a growing problem because there aren’t enough clinicians to deliver healthcare, and they spend more time with administrative tasks like filling out paperwork. Talk about how care.ai can help mitigate the staffing shortage, freeing clinicians to spend more time with patients.

There’s a significant burnout because you ask nurses to do more with less. That’s the fundamental challenge. More nurses are retiring and want to be still involved, but they don’t have the capabilities. Today, with platforms like these, retired senior nurses with experience can do the same work from home, doing the virtual nursing component and the administrative as they have been doing for decades. They have the experience to share, so when new nurses come on to the job and have to intubate a patient, they may not have the knowledge, so mentorship is a huge thing, or working remotely from home. In a five-day week, one day, they can work remotely, and the rest of the four on the bedside so they can change pace. So, there are multiple ways to empower the bedside teams that are changing how they look at the day-to-day work structure. Imagine if you’re giving them one hour back rather than them doing these documentation tasks. And the remote team takes all that there’s a significant value to the website team – amazing customer satisfaction.

Suppose you look at a simple workflow for discharge. If I do discharge instructions for a patient, I’m called ten different ways. So I tell them, ‘Hey, I’ll be back in five minutes and go and do something else come back.’ So you cannot spend that 20-30 minutes, focused, dedicated time with the patient to complete the discharge. And you’re doing five other things. That’s where a virtual nurse can be focused, dedicate 20 minutes one-on-one, and complete the discharge much more effectively. HCAHPS increased dramatically for patient satisfaction. Education is much more adherent. All of those impacts have a multi-dimensional effect.

Nursing leaders talk about how they see telemedicine and technology playing a critical role in bringing back retired nurses who can oversee nurses at the bedside. It’s a way of being part of the nursing team without being in the environment. Do you have any examples of how technology is enhancing patient care?

We have a great story from one of the bedside nurses. He injured himself at work. He couldn’t be on the floor standing for hours and hours. But he still wanted to be a part of the team. So he came back to work. And he’s now in the command center on-site. He’s part of the huddle every morning. And then he returns to his bunker, does all the admits, and discharges.

care.ai recently partnered with Google and is building Google Cloud’s generative AI and data analytics tools into your Smart Care Facility Platform. How is this partnership a game-changer for nursing, healthcare, and patient care?

AI is fundamentally going to redefine how care is delivered. If it has clinical context, imagine a virtual AI assistant helping you document the entire conversation and presenting it to you. And then you can say, ‘Yes, this is accurate, and then publish it to the medical record.’ So, those workflows will fundamentally change how you do your job daily, like using ChatGPT to write an article. It will write an article, but it’s not there yet. You still need a human in the loop. But it at least gets you 70-80 percent there.

Imagine when it comes to tools like Med-PaLM to make a generative AI large language model where you can ask a question to the model. It passed medical boards with 86% accuracy, which is top-performing. Medical students get those scores. So, the democratization of that knowledge is a fundamental change. As humans, we will have to get used to imagining a remote village in Africa having those tools that a Stanford professor who’s a neurosurgeon or a neurologist or a cardiologist has but now multiplied by 10,000 times those types of people training and in AI, that can give that kind of diagnosis and tools to people who didn’t have access to that before. Imagine someone sitting in Tallahassee, Florida, or getting access to a Stanford professor or someone in Nemours Children’s Hospital—some of the best minds in the world, and having access to that. Similarly, when you take the collective knowledge of thousands of nurses, imagine the best of them. Taking an understanding and teaching algorithms to document is a pretty passive task.

What’s next for care.ai?

We are focused on building technology that is transparent to the bedside so that they would never have to interact the same way they would have been interacting with technology. We build these complex electronic medical records and all these tools that are becoming barriers to the bedside teams to provide more human care. That empathetic care is why nursing exists. Bringing that job satisfaction back is what we’re focusing on, and building technology that gives that capability back to the bedside teams. AI will help us get there. As humans, we are prone to errors and mistakes. In the airline industry, 80%-90% of the flying is done by algorithms and computers. You still need humans in the loop. We’ll get to a point where, for safety, you can depend on some of these tools, and at care.ai, we are diligently working on improving patient safety to the maximum possible in a care setting. That’s our aim.

Do you have anything else to add?

We are building tools for nurses. We are building tools for the bedside teams who never stopped caring. They wake up, go to work, they come home, same thing. They never stopped caring, either at home or at work. And that’s the community that we’re working with. And it’s a privilege to be helping that community build tools that will truly transform how they work and live.

A Passion for Breast Cancer Advocacy and Unique Perspective on Survivorship: Meet The Pink Warrior 

A Passion for Breast Cancer Advocacy and Unique Perspective on Survivorship: Meet The Pink Warrior 

Being one of 240,000 are great odds if you’re playing the billion-dollar Powerball, but not when those odds are for being diagnosed with breast cancer.

According to the CDC, close to 240,000 cases of breast cancer  are diagnosed in women and about 2,100 in men each year, and Courtney Shihabuddin DNP, APRN-CNP, was one of those women in 2020.

Shihabuddin was diagnosed with breast cancer on February 13, 2020. Since her diagnosis, she’s become an educator and advocate for others, creating and founding The Pink Warrior to advocate for young women with breast cancer by sharing her personal story and working with national breast cancer organizations.

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Courtney Shihabuddin DNP, APRN-CNP, is a member of the American Association of Nurse Practitioners, educator and breast cancer survivor.

Daily Nurse spoke with Shihabuddin about her deep passion for breast cancer advocacy and her unique perspective on survivorship. What follows is our interview, edited for length and clarity.

Talk about what you do in your role as a certified nurse practitioner.

I work primarily as an assistant clinical professor at The Ohio State University’s College of Nursing. I teach in the graduate nursing program and am the specialty track director for the Adult-Gerontology Primary Care NP program and the Adult-Gerontology Clinical Nurse Specialist Program. So, I help run those two programs and teach the Adult Gerontology Primary Care Nurse Practitioner Program. I practice clinically at the Columbus Free Clinic on Thursday evenings, which is a clinic that serves the uninsured and underinsured population of the Columbus, Ohio area, providing primary care services and specialty services, including gynecology, urology, neurology, and psychiatry. We recently founded a Rainbow Clinic as well that exclusively serves members of the LGBTQ population. And so while I’m there, I’m precepting my nurse practitioner students and first and fourth-year medical students. And it’s just been a great experience. I love working there. I’ve been there for four years and serve on their board. I’m the medical director of quality, and it’s a big part of my job, work, and daily life.

Talk about being diagnosed with breast cancer in February 2020.

I have to start a little bit before that. My mom is a three-time breast cancer survivor, three separate new-growth breast cancers, not recurrence. And my father’s sister has had breast cancer twice. And so they both had genetic testing, and they’re both negative for any genetic abnormality that could indicate a genetic propensity to breast cancer. But when I was 24, I found my first one. And so, knowing my family history, I didn’t mess around with that at all. I had just started nursing school at that point. I did nursing as a second career. And so I didn’t have the level of knowledge that I have now. I knew something was wrong and wanted to get it checked out. And so I did, and it was a benign fibroadenoma, a benign fibrous growth. It was followed for a couple of years, and then I relocated, and my OBGYN recommended that I enroll myself in a high-risk screening program offered at the medical center. So I went into that program, which did surveillance every six months, either with a mammogram or an MRI. I stayed in that program when I lived in Oklahoma. Then, in 2018, when we moved to Columbus, I transitioned into the program that we have here at the James (The James Cancer Hospital and Solove Research Institute), our cancer hospital. And I went every six months as scheduled in August 2019. I had a normal mammogram. Then, in February of 2020, I had a grossly abnormal MRI compared to previous imaging. And so they did an ultrasound and biopsy. So we did all of that. I was diagnosed on February 13, 2020, with invasive lobular carcinoma in my right breast. In my left breast, I was diagnosed with lobular carcinoma in situ (LCIS), which is a pre-cancerous finding. According to the MRI imaging, the lobular carcinoma in situ was made up of greater than 50% of the breast tissue on my left side, so my only surgical option for treatment was a double mastectomy, which I was planning on doing anyway because I didn’t want to have to go through cancer more than once. Seeing that two of my first-degree relatives had had to do it more than once, I knew I didn’t want that option. And then, of course, COVID happened and complicated things tremendously. On March 31, 2020, my surgical oncologist called me and told me that my mastectomy was canceled because it was considered an elective procedure. And I nearly about lost my mind. My oncologist also felt that that was not an adequate treatment plan. My surgeon wanted me to start tamoxifen because I had hormone-positive cancer, and said then we’ll revisit this when this COVID thing is over. My oncologist said, ‘Absolutely not you need surgery. Your entire treatment plan is based on testing that we want to do on your tissue. And without surgery, you don’t have your tissue.’ So she moved it up to the following Monday. And I had my double mastectomy. I was very lucky because of the high-risk screening program that I was in. It was caught quite early. My tumor was just over two centimeters but had not spread into any of my lymph nodes. And so I was stage 1B. My treatment plan was surgery and then hormone suppression for ten years with tamoxifen. So, I’m currently three years into that ten-year journey on hormone suppression. I follow up every six months with my oncologist and pray that I never have any recurrence. I’ve had eight surgeries in the last three years, which is never fun being a mom. My husband is also an emergency room physician, so that meant going through treatment during a pandemic with an ER physician husband who can’t take any time off to take care of you when I had a one-year-old and a five-year-old was quite an experience. But we got through it. They say whatever doesn’t kill you makes you stronger. Now, I work hard to teach my students and patients about the risks that young women can have with breast cancer, being that I was 35 when I was diagnosed. I know many other women under the age of 40, who I know personally or who I’ve read about or interacted with on the internet, who have also been diagnosed at a much younger age and have often had care delayed because they’re too young. Or that’s not what breast cancer feels like. Or it’s probably benign. And we’ll check it in six months or something to that effect. Much of my advocacy work has to talk about self-advocacy as a patient and knowing your own body and what your normal is so that if you find something abnormal, you go to your provider, insist on some imaging, and advocate for yourself. In my personal and professional opinion, it’s always better to over-order than miss a potentially lethal diagnosis.

You have a full plate professionally and at home with two kids, but you’ve been busy advocating for others since your diagnosis. Talk about The Pink Warrior and your work with other national breast cancer organizations.

In October 2022, I launched The Pink Warrior, a website where I share my story. I offer resources for other people who may be caregivers or patients themselves, working through treatment, or how to talk to your family and tell your children. I also offer many external resources to assist them wherever they are throughout their treatment. I also created a small shop. That was my goal as a young woman with breast cancer. There wasn’t much geared towards a younger woman with cancer. Everything you see on television or read in popular culture about breast cancer is really for postmenopausal women. And there wasn’t this place where I felt I belonged in the breast cancer narrative. So, I tried to create that and inject some levity into the gravity of a cancer diagnosis. So I have snarky cards, a candle for tits and gigglesand fun little thingsI partner with an organization, and it changes every quarter. I donate 10% of the entire shop to that organization at the end of the quarter. So, for Q4, we’re partnering with the PSF Foundation, and they work to help people who cannot afford breast reconstruction find surgeons and then pay for their reconstruction because so much of treatment is what comes after so much.

Survivorship is that part that no one prepares you for. So many things happen in survivorship that are unaccounted for what I feel as a survivor and nurse practitioner. My oncologist certainly didn’t prepare me for hot flashes, menstrual abnormalities, intimacy with my husband, body image disorders, or any of the things that come with amputation of your breasts and multiple surgeries. And getting thrown into menopause at 35 and what that looks like. So that’s what I strive to do, to help normalize with the Pink Warrior. You have a place to go if you know somebody who has been diagnosed and you want to send them something that shows that you care that’s loosely related to breast cancer, but also to have conversations. People email or chat with me on Instagram in direct messages, constantly saying, ‘I’m so glad that I found your page, or thank you for sharing your story.’ Or ‘I was just diagnosed, and I feel like I’m drinking from a firehose,’ what questions should I ask? Even if I help one person, that’s so rewarding for me because I was completely lost. I had all of the medical knowledge, and I still felt like I was drinking from a firehose with a pandemic on top of it.

I was at an event with somebody who had their mastectomy two weeks ago, and they had just gotten their pathology results. And they had no idea what it meant and how to interpret it. They were told that they had ductal carcinoma. They showed me their path report, and they no longer had ductal carcinoma in situ; they had invasive ductal carcinoma, which spread to their lymph nodes, and no one had explained it to them. As a provider, I can’t imagine releasing a path report like that and not having a conversation with the patient but also not ensuring that by the time I hung up that phone, I knew my patient understood what that meant. Even if it wasn’t breast cancer and it was something else, I would want to make sure that my patient understood their diagnosis and give them time to ask questions. As a patient, you could ask all the questions at that moment and completely black out without recollection of that conversation. So, the benefit of the doubt to this person’s provider. So I sat down with her, and I explained what everything meant. I gave them my phone number and said if you have any questions or want me to come to an appointment with you, I’m happy to do that because that’s what advocacy is to me. It’s helping somebody else through their struggles in a way you can relate to.

Talk about nurse practitioners’ work in helping screen and treat women with breast cancer.

So, the program I teach in which I operate is primary care. Our goal as primary care providers is for prevention and screening. We should be counseling all of our patients over 40 that they should be getting annual mammograms, and we should be ordering those exams. We should be having conversations with our patients about their risks. And suppose they do have a family history. In that case, we should be screening them before age 40 and evaluating whether that be genetic testing, a screening, an ultrasound, or a referral into a high-risk program. That is our role. Their primary care is prevention, and we are there to help them stay in tune with their body, know their body, empower them, be aware of what they’re looking for, educate them, and help steer them in a path that is here towards the best possible outcome. And that means early detection.

Please share some insight about what women need to know or should be asking. 

Breast cancer, in general, can be abstract. You can tell somebody what they’re looking for. You can tell somebody what’s normal or what’s abnormal. But to me, a picture’s worth 1000 words. And it’s so much easier to give somebody a visual than to explain something, especially if your patient’s first language is not English. There could be some misunderstanding or lack of knowledge from your communication. There is a charitable organization called Know Your Lemons. And they have a free app that teaches you how to perform a breast self-exam. It shows you how to do it feeling from just under your collarbone down over your sternum, all of your breast tissue, and up into your armpit, and it tracks your cycles and helps you equate anything that you may find with where you are in your cycle. It reminds you to do your self-exam. And the most important thing I think about the app is that it visually shows you the 12 Signs of Breast Cancer on lemons.

So it shows you what it would look like if there were warmth or a red spot, or what it would look like if there was an inverted nipple, or dimpling, or thickening of the skin, or discharge from the nipple. It visually shows you what all these things would look like. But on lemons, that makes it much more real to a layperson or a medical person, but a picture is much easier to understand. Oh, my breast looks like that lemon. I should get that checked out. It also helps translate. When you’re feeling your breasts, what if you feel something hard, like a lemon seed that’s fixed in the flesh of the lemon and hard to move around? That’s something that you want to be concerned about and get evaluated. Those are usually benign findings if you feel something that’s soft, like a pea or a kidney bean. They’re typically movable within the tissue. They’re usually soft and not as concerning as something hard like a lemon seed. And that’s how I explained it to my patients: here’s what you’re looking for. And I can always see this lightbulb moment. When you accept that you’re looking for something that’s hard, fixed, and doesn’t move, they have no idea what that means. But if you tell them, it’s like when you slice into a lemon, and that seed is like you can’t get that seed out. And it’s hard. That’s what you’re looking for. That’s what we’re worried about. It’s seeing their understanding and knowing, okay, I’ve empowered this person, and they know what they’re looking for now. My job here, I’ve accomplished that education. And I know now that I can move on to my next patient and do the same thing, knowing that they’ll know when to come to me if they find something abnormal.

Is there anything else to add about breast cancer and the need for early detection?

We must recognize our BIPOC community because our Black women are at a much higher risk and have a 40% higher chance of mortality from breast cancer. And that’s not because they have more breast cancer. It’s because of various health disparities. They’re often diagnosed when their cancers are later. Their cancers are usually quite aggressive. And, whether that’s because they didn’t seek care, or because they sought care and weren’t believed, or they were too young, or whatever it was, there is a problem with that statistic. We need to be better as healthcare providers in trusting our patients so that when they say, ‘This doesn’t feel right,’ we are taking them at their word, doing our exam, and ordering the necessary imaging to ensure that if this patient is telling me that they felt a lump, that we’re examining that lump because 40% risk of higher mortality is just unacceptable.

The other thing is that 80% of women under 40 find their breast cancer. That’s a pretty significant number, and that’s because we are saying there’s not a great screening for young women. Our breasts are dense, and mammograms don’t catch much. And so if you’re not feeling your breasts, if you’re not checking yourself, if you don’t know what’s normal for you, how do you know what’s abnormal? So, feel your breasts. I tell people to feel them on the first. It’s easy to remember the first of every month. It’s the same time every month, so you’re traditionally in the same part of your cycle because you’ll be the first one to tell if there’s something different.

ED Nurses Going Beyond the Call of Duty: Meet ENA Connection’s 20 Under 40 Class

ED Nurses Going Beyond the Call of Duty: Meet ENA Connection’s 20 Under 40 Class

From flight nurses to military members and mayors to parents, emergency nurses go beyond the call of duty and the 2023 ENA Connection 20 Under 40 class has it all.

ENA announced the third class of 20 extraordinary nurses as part of the celebration of Emergency Nurses Week.

Each honoree in the 2023 class has achieved significant milestones in their healthcare careers and demonstrated positive contributions beyond their professional work. One nurse from Bhutan created the BEAR, or Bhutan Emergency Aeromedical Retrieval Team, which uses his country’s only helicopter for rescue missions. Another helped launch a program called “Caring for the Caregiver” to help nurses cope with critical incidents. Those are just the beginning of what this class of honorees has accomplished.

Many in the new class were inspired by nurses they had encountered in the past. Some followed in their family’s footsteps, while others fell into the profession later. One thing they all have in common is the goal of helping people and inspiring and teaching the next generation of nurses.

“Having seen what these 20 nurses have accomplished, I can say with certainty that the future of emergency nursing is in good hands,” says ENA President Terry Foster, MSN, RN, CEN, CPEN, CCRN, TCRN, FAEN. “The amount of knowledge, passion, drive, and skill we have among the ENA membership is outstanding. I can’t wait to see how these young professionals continue to contribute to emergency nursing throughout their careers.”

Meet the ENA Connection’s 2023 class of 20 Under 40 honorees featured in the magazine’s October issue.

  • Christine Alston, DNP, RN, CEN, TCRN, CPEN, CFRN, CTRN, of Florida
  • Levon Aharonyan, MSN, RN, PHN, GRN, NPD-BC, of California
  • Tyler Babcock, MSN, MBA, RN, CEN, TCRN, of Pennsylvania
  • Jermaine Clayborne, MSN, APRN, NEA-BC, NNP-BC, CCRN-Neonatal, CCRN-Adult, CFRN, FP-C of Virginia
  • Kiran Biswa Diyali, RN, Flight Nurse, of Bhutan
  • Megan Duke, MSN, RN, CNS of California
  • Sean Elwell, MSN, RN, NE-BC, TCRN, EMT, of New Jersey
  • Juan M. González, DNP, APRN, AGACNP-BC, FNP-BC, ENP-C, CEN, CNE, FAANP, of Florida
  • Kelsea Heiman, MSN, RN, CEN, TCRN, of Texas
  • Shannen Kane, BSN, RN, CEN, of North Carolina
  • Adam Lawrence, BSN, RN, CTRN, CEN, TCRN, EMT, of New York
  • Jacob Miller, DNP, RN, APRN-CNS, APRN-CNP, RN, of Ohio
  • Daniel A. Misa, MSN, RN, CEN, CPEN, NE-BC, of New Jersey
  • Wilson Pierce, DNP, RN, CNE-CL, TCRN, of Georgia
  • Philip Prousnitzer, MSN, RN, CEN, TCRN, CCRN, CPEN, CTRN, CFRN, of Arkansas
  • Heather Purcell-Mullins, MSN, RN, ACCNS-AG, CEN, CPEN, CDR, Nurse Corps, USN, of California
  • Jamin Rankin, RN, EMT, CEN, CFRN, TCRN, CPEN, CTRN, of Louisiana
  • Crystal Rose, PhD, MHA, RN, CNE, of Arkansas
  • Lena Sutch, MSN, RN, CEN, of Maryland
  • Jessica Wilson, MS, RN, CEN, CPEN, TCRN, EBP-C, of Maryland

Each class of honorees is chosen by a panel of reviewers who assess their accomplishments in their profession and communities, their contributions to emergency nursing, and how they plan to shape the future of the specialty. Their peers nominated 44 nurses, and 75 nurses submitted applications.