Recollections of the Flint water crisis are still vivid in the minds of many Americans. Responses to this crisis in the winter of 2014 needed to be swift and comprehensive. And while it may be hard to believe that access to clean, adequate, and equitable water in America remains at risk, advocates for environmental justice call for continued vigilance in ensuring access to safe and clean water. In this column, we discuss the need to ensure equitable access to this life sustaining resource through advocacy and legislative action with Katie Huffling, RN, MS, CNM, who is the executive director of the Alliance of Nurses for Healthy Environments.
Katie Huffling, RN, MS, CNM
Ms. Huffling, tell me a bit about yourself and how you became involved in addressing environmental health issues?
I trained as a nurse-midwife at the University of
Maryland School of Nursing. While there, I had the great fortune to meet Barbara Sattler and Brenda Afzal. They were leading the only environmental health center at a school of nursing in the country. Through their mentorship, I learned about the many ways that environmental toxicants could affect reproductive health and the health of the growing fetus. It is an area that many of us received little or no content on in nursing school, yet they can have significant negative health impacts across the lifespan. I became very passionate about environmental health issues and when the opportunity arose to work on this full time with the Alliance of Nurses for Healthy Environments, I jumped at the chance! We are the only national nursing organization focusing solely on the intersection of health and the environment. I now work with nurses and nursing organizations around the country on a number of environmental health issues such as climate change, clean air and water, toxic chemicals, and inclusion of environmental health into nursing curriculum.
Can you give me an example of an environmental health issue that is affecting health right now?
Clean water is one of the greatest public health advancements of the 20th century. As nurses, we recognize clean water is essential to health and a basic human right. It is also essential for providing nursing care. Nurses rely on water to wash their hands, give newborns their first baths, and is essential for the clean linens utilized throughout health care.
Here in the United States we have an expectation that when we turn on the tap clean, healthy water is going to come out. Unfortunately, for many throughout the country this is not the case. Every year, millions of Americans experience waterborne illnesses. Waterborne illnesses are caused by a variety of sources, including waterborne pathogens such as viruses or bacteria, human or animal waste, heavy metals such as lead or arsenic, or industrial pollutants. Certain populations may also be more likely to be exposed to unsafe drinking water, including low-income populations and some communities of color.
I know you have been a champion for environmental justice for some time now. What are some key legislative priorities with regard to clean and safe water?
To address a number of urgent clean water issues, the U.S. Environmental Protection Agency (EPA) proposed an update to the Clean Water Act, originally passed in 1972. The Clean Water Act needed to be updated due to the great expansion of knowledge regarding upstream sources of pollution. Researchers now understand how important protecting headwaters and other upstream water sources are to clean water downstream. There was also confusion concerning which waters were protected by the Clean Water Act. This followed two Supreme Court Decisions in 2001 and 2006, directly impacting the drinking water for 1 in 3 Americans.
In 2015, the EPA and the Army Corps of Engineers finalized the Clean Water Rule (CWR). This rule was only finalized after an intensive stakeholder process in which they held over 400 meetings and received over 1 million comments, 87% of which were in favor of the rule. The Clean Water Rule clarifies which “waters of the US” will be regulated under the Clean Water Act. These include traditional navigable waters, tributaries, a small number of waters that have a significant nexus to traditional navigable waters, interstate waters, or territorial seas, and also exempts certain waters such as puddles, ornamental ponds and rain gardens, and continues certain farm exemptions.
After the rule was finalized, a number of plaintiffs sued the EPA. The rule was suspended by the Sixth Circuit court until the outcome of these suits. This stay was overruled in February 2018. During this time the Trump Administration announced they were going to suspend the rule until 2020. This suspension was overruled by the courts in August and the CWR must now be enforced in 26 states.
The issues that the CWR addresses are very important to environmental justice communities. If the rule is repealed, low-income communities and communities of color—who already face disproportionate exposures from other environmental hazards—may be most impacted. These communities, along with rural communities, are more likely to have poor infrastructure that is not able to handle contaminants in the water. These communities also may not have the resources to upgrade their water systems. They may also be more likely to rely on well water that can be more susceptible to pollution from upstream sources.
Turning to implications for nursing, why and how can nurses get involved in addressing this issue?
The EPA has announced they plan to permanently repeal the CWR; however, this repeal has not been finalized yet. If they repeal this rule, the drinking water for over 117 million Americans could be negatively impacted. Once this official announcement occurs, the nursing voicing will be crucial to protecting this vital public health regulation. There are many ways nurses can be active in this policy arena:
Watch the new webinar from the Alliance of Nurses for Healthy Environments for one-hour free CE that reviews the CWR and provides opportunities for action (https://envirn.org/the-clean-water-rule).
Sign this petition to Acting Administrator Wheeler asking to him to keep the CWR in place.
Call your Senators and Congress people and ask them to support the CWR.
Engage your professional nursing organizations—write a newsletter article and ask them to write a letter to Acting Administrator Wheeler or to Congress. As the most trusted profession, when our nursing organizations actively engage on issues such as clean water, Congress listens.
The most vulnerable among us are harmed by dirty water. By actively engaging on clean water issues, nurses can help policymakers and the public make the connection that clean water is essential to health.
Are there additional resources we should be aware of?
The American Nurses Association’s Principles of Environmental Health for Nursing Practice with Implementation Strategies (which is available online here).
The Alliance frequently offers webinars (many with free CE) on a variety of environmental health topics. We’re free to join and if you sign up for our newsletter you will be notified of upcoming webinars and opportunities for action. To learn more, visit https://envirn.org.
The annual Gallup Honesty and Ethics Poll was just released and the results show the most trusted profession, ranked #1 for an astounding 17th consecutive year!, is—drum roll, please—nursing.
When a sampling of random Americans were phoned and asked to “please tell me how you would rate the honesty and ethical standards of people in these different fields,” more than 84% rated nurses as “high” or “very high.” (Other ratings they could have chosen were “average,” “low,” or “very low.”)
Gallup has sampled the public’s views since 1976, and while the professions change from year to year, nurses have outpaced all others since 1999 when the role was first included. That is, nearly every year, because there was one time when nurses didn’t top the list. That happened in 2001, after the 9/11 terrorist attacks, when firefighters were included for the first and only time and scored highest. Gallup conducts the telephone survey in late November and releases the results in December.
Health care professions usually dominate the top of the list, and this year is no different. The most trusted groups after nurses were medical doctors, scoring 67%, and pharmacists, coming in right behind at 66%. The lowest rankings for honesty and trustworthiness go to telemarketers and sadly, members of Congress, tied for last place at 8%.
What is it that makes nurses so esteemed for their ethics and honesty? There are many theories, ranging from degree of intimacy (we stand naked—both literally and metaphorically—before nurses) and the fact that nursing is a female dominated profession. The Gallup data suggest that women, on the whole and on average, are seen as more trustworthy than men.
(Estimates are that 90% of nurses are female, according to the American Nurses Association, but that percentage is dropping as more men enter the field.)
Additionally, nurses have a code of ethics to uphold, and they study that topic seriously in nursing school to prepare for difficult ethical dilemmas with life and death consequences. Their licensure also compels them to do what’s right for the patient, not just what’s expedient or in their own (or their employer’s) best interest.
In the end, though, trust is based on personal experience. With nurses making up the largest portion of the health care workforce, almost everyone has had a relationship with a nurse, either as a patient, family member, or friend. They’ve most likely seen that nurses are always there, and always for you, as caregivers and patient advocates.
“Every day and across every health care setting, we are on the frontlines providing care to millions of people,” says ANA President Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN. “Nurses’ contributions to health care delivery, public health challenges, natural disaster relief efforts, research, education, and much more, are unmatched and invaluable.”
Unmatched they are! We would like to congratulation to all the extraordinary nurses for ranking at the highest level for your ethical standards. We know that nurses have many super powers—trustworthiness is maybe the greatest one.
While the holiday season can be a lot of fun, it can also be a time that makes a lot of people become depressed. Whether it’s because they’ve lost family or friends, they’re experiencing rough times, or they are in the hospital and/or are ill, it can make many sad.
There’s a difference between regular sadness and depression, though. And it’s important to be able to recognize if your patients are experiencing depression. According to Sharon R. Kowalchuk, RN, DPN, Director of Nursing at Silver Hill Hospital (an academic affiliate of the Yale University School of Medicine, Department of Psychiatry), nurses can recognize symptoms of depression in their patients. “In any setting, patients may come to our attention with reports of loss of energy, anxiety, aches and pains, headache, insomnia, changes in appetite, or a significant weight loss or gain in a short period of time. These symptoms are not necessarily signs of depression, but they call for further exploration,” says Kowalchuk.
What are the specific signs that you can recognize as being those of depression? “It is easiest to recognize depression when the patient reports feeling sad, empty, hopeless, having difficulty enjoying usually pleasurable activities or sex. The more subtle signs may be irritability, restlessness, becoming more cranky than usual, having difficulty keeping up with everyday routines, or focusing on TV or reading. Expressing feelings of pessimism, guilt about one’s life, thinking a lot about losses or failures, believing things will not get better—these are more concerning symptoms,” explains Kowalchuk. As difficult as it might be, she says, “You will need to ask if they have thought about suicide.”
If you recognize these signs in patients, it’s important to get more information about any action they may have taken to prepare for suicide. “A key question is whether they have attempted suicide or began a suicide attempt that was interrupted by another person—or they stopped of their own volition,” says Kowalchuk. She adds that these questions are outlined in the Columbia-Suicide Severity Rating Scale (C-SSRS), a protocol that uses simple, plain language questions that anyone can ask to assess risk.
Depending on the level of risk or the particular setting, says Kowalchuk, the nurse caring for this patient may need to refer him or her to a mental health professional.
“Holidays are times that bring up life events, feelings of loss or loneliness, placing all of us at risk. The consequence of undetected depression is death by suicide,” she says. “According to the suicide experts at The Lighthouse Project, ‘Just ask, you can save a life.’”
’Tis the season to be jolly, and to have your festive follies land you in the emergency room. Holiday cheer can dissolve into tears after any number of seasonal accidents around Christmas time, from falling while hanging lights to cutting yourself with a knife while cooking. Below, we’ve rounded up eight major reasons for the seasonal injuries that often happen in the last few days of December. If you’re working in the ER on or around Christmas Day, keep these causes in mind as you put on your holiday scrubs.
Wrapping and Unwrapping Gifts
As mundane as these tasks seem, wrapping and unwrapping gifts is a major cause of injury around Christmas—and there’s a huge spike in cases on Christmas Day in particular. Knives, scissors, and box cutters can easily slip, resulting in lacerations. Even those awful hard clamshell plastic cases can pose a risk if you catch your skin on a jagged edge. Wrapping gifts can also result in lacerations and even major paper cuts if people aren’t careful. If this sounds silly to you, just wait until you work Christmas morning in the ER and watch the patients come through the door.
Decorating the House
Deck the halls with boughs of holly, but just be sure not to injure yourself in the process. Decorations pose all sorts of dangers. You can shock yourself while putting up lights, fall while hanging a garland over a door, or cut yourself on a broken ornament or figurine. In particular, children can get into a lot of trouble around decorations, such as swallowing small ornaments, hurting themselves on heavy stocking holders, and tripping over ground-level decorations. Keep that in mind when you’re decorating your house, or while you’re treating a patient who injured himself or herself doing these very things.
Hanging the Lights
Hanging lights inside or outside may be a time-honored tradition, but it’s also a dangerous one. Like decorating the house, hanging Christmas lights comes with all sorts of hazards. There’s the obvious risk of falling off a ladder or roof, resulting in bruises, broken bones, and/or a concussion. But you can also throw out your back while reaching up high or blow out your knee while climbing a ladder. Plus, there’s always the chance of cutting yourself on a broken bulb or shocking yourself with electricity when you plug in the lights. Around Christmas time, you may find yourself wishing your patients had simply put some battery-powered candles in the window and left it at that.
Trimming the Tree
Trimming a Christmas tree holds all the dangers of putting up decorations and hanging Christmas lights, all at once. If you manage not to throw out your back or pull a muscle while getting the tree into the house and setting it up in the stand, there’s still the possibility of falling off the ladder while you drape the lights or put on the tree topper. Of course, you can shock yourself while plugging in the lights as well. If you get through that unscathed, there’s still the chance that you will cut yourself on a busted ornament or lightbulb or trip on the tree skirt. Trimming a tree is all fun and games, until it isn’t.
Getting the Flu
Okay, so the flu isn’t related to Christmas directly, but December does fall right within the window for flu season. (The extended flu season for 2017-2018 lasted all the way from November to March and was the worst outbreak in the U.S. in almost a decade.) Flu viruses will already be circulating by Christmas, and the stress and travel of the holiday can wear down people’s immune systems, making them more prone to contracting the flu. Expect to see severe cases of the flu starting in November and continuing through the rest of the winter holidays, including Christmas—and be sure to encourage any healthy patients you see to get the vaccine!
Cooking the Food
Cooking that delicious Christmas dinner can also prove harmful to your health. Knife lacerations are a common injury around the holidays, as cooks are often distracted while chopping and inexperienced chefs find themselves pressed into cutting vegetables. Burns also happen often due to splattered oil or gravy, as well as brushing up against a hot pan or stovetop burner unknowingly. Less common are full-on cooking fires, which are thankfully more rare but more serious when they do occur. Come Christmas, you’ll probably find yourself patching up more than one overambitious chef, so brush up on your burn and wound care skills.
Eating the Food
You’ve managed to get through cooking all the food without burning or lacerating yourself, so you’re home scot-free, right? Wrong. Food poisoning can happen during holidays due to undercooked meat–which harbors salmonella–or any dishes left at room temperature for too long, which allows nasty bacteria to grow. There’s a high likelihood you’ll see patients with nausea, vomiting, diarrhea, abdominal cramps, and/or fever, all classic signs of food poisoning. You might also get some cases of more mild gastrointestinal distress (“mild” being relative) with symptoms such as severe gas, bloating, constipation, and abdominal pain. Traditional Christmas dishes are full of fats, oils, sugars, spices, and other irritants, and many people overindulge on the holiday, leading to seriously upset stomachs.
Drinking Too Much
Just as many people overindulge in food over the holidays, so they also overindulge in alcohol. While alcohol-related incidents are a bit more common on New Year’s Eve, many people also imbibe to excess during other winter holidays, including Christmas. Drunk driving is obviously a major concern, but plenty of other minor mishaps can result from drunkenness, such as slips, falls, and injuries caused by sluggish reflexes.
While some of these resulting injuries might not be so different from ER visits the other 11 months out of the year, it helps to know the possible cases that might walk through the door, especially if you’ve never worked a holiday shift in the ER before. Keep these eight injuries in mind as you treat patients, and consider rewarding yourself with a nice Christmas gift, such as sturdy nursing shoes or a new stethoscope once you get through the craziness of holiday injury season.
The holiday gift buying season is upon us! You’re probably going down your shopping list and trying to find just the right gift for friends and family. You may even have nurse friends and colleagues that you want to gift with fun nurse-themed items you hope they’ll love.
But what about you? Maybe you, like many nurses, have a tendency to forget to take care of yourself. (It’s hard for many caregivers to remember that they need to take care of #1!)
When you’re in the thick of a crazy work shifts and off-duty holiday goings on, it’s easy to become overwhelmed. You need a little break, though you may not know the exact remedy that your mind and body needs in hectic moments.
So, why not find some go-to self-care items for whenever you need a pick me up in 2019? Have fun doing your self-gifting by shopping online (Amazon is the biggest bazaar!) or at local independent shops and craft fairs. You can combine convenience and also support makers on Etsy. It’s like a massive online craft pop-up with thousands of amazing shops from around the world. Not only can you find one of a kind pieces, but you’re also supporting small creative enterprises.
Here are some favorite gift ideas on many nurse wish lists this season.
Socks, footies, and shoe inserts—not glamorous but oh so comfy.
If you’re on your feet all day long, a great gift idea may be a thick pair of warm footie socks for the winter season, or a pair of compression socks (there are some stylish choices out there!), or a foot massager and DIY pedicure kit. Shoes need some cush? Try a comfort insert from a drugstore or specialty shoe store that stocks the Birkenstock brand.
Warm, snuggly blanket for hygge comfort, or a weighted blanket for stress-relief.
Enjoy your days off under a perfectly knitted wool throw, chunky or light as a cloud—the type of knit that invites you to snuggle in with a good book. Or try one of the new weighted blankets that are gaining popularity for their health benefits. They help many people reduce workplace stress and improve sleep, especially nurses on shift work suffering from off-kilter circadian rhythms.
Healthy snacks for the active nurse, or artisan food and drink for foodies.
Being a nurse means being on the go, so nurses may not have extra time to pack a lunch or snack to bring to work. That often means relying on a vending machine or cafeteria to fuel up for long shifts. Disaster! A gourmet gift basket of healthy treats like nuts and dried fruit may help you hold out until you can enjoy a nutritious meal. On your days off, sip on a favorite at-home drink, such as a matcha green tea latte. And savor it in an encouraging mug, with a witty or wise nurse-life quote and graphic.
Manicure, pedicure, massage, or other spa treatment!
Hand lotion gift sets make great gifts to help sooth away skin that gets dry from a grueling hand-hygiene regimen. (Harsh hand cleansers and sanitizers are murder on delicate, weather-beaten skin!) Bubble bath products and spa baskets filled with bath products in a keepsake basket will give you a night of much deserved pampering.
Or better yet, treat yourself to a mani/pedi or an all out body care pampering session at a spa. Men make up a fast growing percentage of spa goers, so don’t let gender stereotypes stop you from getting or giving a gift certificate for spa services.
A journal, some gel pens, and washi tape.
If you equate journal with diary, and you haven’t kept one since middle school, you may be surprised at the popularity of new journaling methods. Bullet journals are one way to goal-set, and keep yourself motivated and organized. Many nurses also love to express themselves in a “bujo” through doodles, watercolor, fancy lettering, or stickers and washi tape.
You can treat journaling as a time to explore your inner life, a form of meditation, if you like. In that case, the Nurse’s Journal from the Josie King Foundation is wonderful. Create an introspective ambience by lighting a couple of candles. Artisan candles—with sparkles, soy waxes, exotic oils, or delicate flower petals— add some magic.
I hope that seeing some of these ideas will inspire you to treat yourself to some self-care. We all need reminders to take time to relax and do what makes us happy!
