As families and friends gather for Thanksgiving Day this year, there will likely be oft-repeated tales about favorite recipes or the family stories that always make everyone laugh. In the midst of these gatherings is an excellent opportunity to learn more about what makes your family unique – in every sense of the word.
In 2004, the Surgeon General, through the Department of Health & Human Services, designated Thanksgiving as National Family History Day. This is an opportunity for all families to learn more about the common and rare diseases that can run through several generations.
As you all reminisce about holidays gone by, it’s a good time to begin documenting the various health conditions family members have. If you have high blood pressure and other relatives do too, it’s a great opportunity to educate the younger family members about the disease in an open, honest, and informed manner. The teens in the family don’t need to be terrified about the potential for heart disease or diabetes, but they should be armed with information about how they can help keep themselves healthy.
National Family History Day gives families a chance to uncover common threads they might not have realized. While the Surgeon General’s office found that most Americans believe in the important of knowing a family history, only about one-third have ever tried to document their own family’s health history.
What should you ask about? Really anything that might help you. Once you know the common threads, you can all learn about how to stay healthy or manage those specific conditions. For instance, are there relatives with breast and ovarian cancer (especially early onset) from generations ago? What about testicular cancer? When everyone is together, you can act as an educated group to make sure family members are getting appropriate testing or monitoring.
Because the Surgeon General considers family history as such an important health indicator and screening approach, the office has created the My Family Health Portrait online monitoring tool to help families document conditions and diseases. This tool means the documented history can be shared among family members and updated as health changes occur. Family members can even bring a copy of the document to healthcare visits to help inform their health team about important information.
Nurses don’t need anyone to tell them what kind of a predictor family history is. Each day, they see families with shared conditions. But if they don’t discuss their own detailed family health histories and if they don’t always ask the right questions, they could be missing some important health information of their own. Many families don’t talk about things like reproductive health problems or of mental health issues. Some might not discuss alcoholism or addiction. But each of these health conditions provides an essential piece of a family’s health picture.
Before you begin this process, the Surgeon General’s office has prepared some tips to help you. You’ll want to be ready to get the information, but realize you might not get everything on the first try. Make sure you are clear about what you are doing and why. Some people don’t like to talk about their health issues, but if they realize it could help save a loved one, they might look at your information gathering in a very different light.
Consider this an ongoing conversation among family members, and that Thanksgiving is just a start. Realize not everyone will be on board. Get as much information as you can without upsetting anyone. Be encouraged by what you can find out – you are helping your family now and for generations to come.
With dozens and dozens of nursing specialties, some nurses take varied paths to end up in the specialty that is the best fit. Many try different health care situations or medical training before deciding that one area of nursing is the career where they will make the impact they want and will satisfy their professional goals.
Jose M. Maria, MS, FNP, RN, CEN, director of emergency services at Brookdale Hospital and Medical Center in Brooklyn, New York, says he came to emergency nursing after gaining training and experience as an EMT and paramedic. “Emergency medicine was the next logical choice in starting my nursing career,” he says. “I haven’t looked back since.”
Maria, a native of the Dominican Republic, says his specific EMS experience really gave him a solid foundation to know what he wanted and provided him with the essential capability for any emergency nurse. “It allowed me to develop the skills to adapt to any situation while keeping a cool head,” he says.
But emergency nurses also benefit from having more than a cool head and a great skill set, says Maria. The flexibility to move from one situation to another one that is entirely different is essential for a successful emergency nurse. And then there’s the part where you work your tail off. An emergency nurse who doesn’t complain about the task (or 20 tasks) at hand and does what’s needed will have a much easier time working in such a fast-paced environment.
And when it’s time to transition a patient to inpatient nurses, challenges remain. In fact, Maria says that transition point is one of the most challenging aspects of emergency nursing. “This is a common challenge at every organization I have been a part of,” he says.
Preparation and planning, as with any part of the emergency nurse’s job, can help. And finding out how other nurses work also helps inform your own practice. “I try to stay current in practice and use resources like ENA CONNECT and to speak with colleagues across the states,” says Maria. “Like many professions, preparation is key for success in the emergency department.”
But with those skills and responsibilities, emergency department nurses encounter a lot of critical and crisis situations to adapt to. For Maria, those situations reveal why he does what he does. “The most satisfying and most important part of my job is to save lives,” he says. “It’s a powerful and overwhelming feeling to have brought someone back from death and see them walking out of the hospital.”
Anyone considering emergency nursing as a career path can follow Maria’s advice to rotate through other specialties before deciding on the ED. Each area offers you a new set of experiences and training that will be useful in the emergency department.
“Because we see a wide range of complaints, we can actually help our patients,” he says. “Working in psychiatry for example, helps you build conflict resolutions skills, improve communication techniques, and builds patience needed in the acute psychiatric emergency. Working in the ICU, with their attention to detail, improves your documentation. Working on a medicine floor helps in time management skills. Working a surgical unit, improves your teaching techniques with patients.”
And while the emergency department is intense and fast, emergency nurses do find a way to offer each other the kind of support and camaraderie that is distinct. Their humor might even be considered dark, says Maria.
“People have a hard time understanding that even in the darkest of times, humor helps us deal with our internal anxiety about the cases we work,” he says.
Opioids are a type of narcotic pain medication that is used to control pain. Examples include meperidine, methadone, morphine, oxycodone (OxyContin), oxycodone with acetaminophen (Percocet), and hydrocodone with acetaminophen (Vicodin). There is an increasing number of patients with pain addicted to opioids. According to the Centers for Disease Control and Prevention, opioid overdoses have quadrupled since 1999. Nurses play a vital role in preventing opioid addiction in patients with pain through nursing assessments and monitoring of their patients.
Here are 4 essential steps that nurses can take to help prevent opioid addiction.
1. Perform a comprehensive assessment of pain by using a standardized pain assessment tool.
Nurses need to assess the individual patient’s pain location, characteristics, onset, duration, frequency, intensity or severity, precipitating factors of pain, and how the individual manages his or her pain.To learn more about pain assessment tools, visit www.paincommunitycentre.org/article/pain-assessment-tools.
2. Assess the patient’s pain management and medications used.
Pain medication should be matched to the individual patient’s needs. It is important that nurses assess the patient’s detailed medical history, including a list of currently prescribed and past medications, as well as a history of substance use or substance use disorders in the patient and the patient’s family. Keep monitoring patient use of medications and opioids to avoid overdependence or potential addiction.
3. Evaluate the effectiveness of the pain management through ongoing assessment of the individual patient’s pain experience.
Proper evaluation of pain management requires that all patients have a treatment entry diagnosis that is defined, standard, and objectively determined. An ongoing assessment of the patient’s pain experience during and after treatment is vital for preventing pain medication misuse. Patients can become addicted if they take pain medications or opioids too much or for a long period of time.
4. Educate your patients about pain management.
A better patient understanding of the nature of pain, its treatment, and the side effects and complications is one of the most important steps toward improved control of pain and pain medication use. Nurses should provide written instructions about dosage, adverse effects, how long the medication should be taken, and how to store and dispose of unused medication. Opioids can be dangerous if patients take them with alcohol, or with certain drugs such as antihistamines, sleeping pills, and some antidepressants. Nurses can also introduce the use of non-pharmacological techniques (e.g., relaxation, guided imagery, music therapy, distraction, massage, lifestyle modifications, and heat and cold application) before, during, and after feeling pain to control and reduce pain.
When you’re a nursing student, thinking about your finances seems almost like a pointless task. With the immediacy of paying for school and the almost universal need for student loans that you pay back after graduation, thoughts of your future financial plans stay where they are – way in the future.
Believe it or not, this is actually a great time to think about your future and your finances, which includes retirement but also might include big-ticket things like a car, a house, travel, or additional educational costs. When you start working right after graduation, you’ll want to develop good financial habits right from the outset. If you can begin planning for your future early, you’ll be much better prepared.
You may not be able to set aside money when you’re still taking courses and during clinicals, but you can learn how to make good financial choices.
Set a Budget
As a nursing student, get comfortable with the funds you have, the funds you earn, and the amounts you owe. Don’t guess at how much your food costs are each month—add them up so you know. Use an online budget app like Mint (it’s free!) to calculate that in with your rent or mortgage, any insurance costs, student loan payments, transportation, and costs for entertainment, pets, or clothes.
Balance that with what you take home each month and you’ll get a good idea of your cash flow. If you get comfortable doing that early on, you’ll have an easier time making sure you make solid, financially stable decisions in the future.
Learn Where to Save
When you have a budget, you’ll know what you have and don’t have. You can figure out if you can cut back on one thing to make some extra money for something you want. Eliminating a take-out lunch once a week and you can easily save another $50 to $70 a month. Add that to an emergency fund until you have enough to cover three to six months of expenses. Then start putting it in a retirement fund. You’ll never notice the difference.
Pay Your Loans
This one is simple, but can be difficult. If you have student loans pay them on time every single time they are due. Defaulting on your student loans or being late on payments can wreak havoc with your credit score. And you’ll need good credit to secure a car loan, a loan for a home, or even future student loans if you return to school. Don’t let a mistake limit your life that much.
Plan Your Next Steps
Set some financial goals. Do you want to save $1,000 this year? Do you want to commit to saving 15 percent of your income? Figure out how much that breaks down to save each week and then do that. Either have it automatically withdrawn and placed in a different account or fund or do it yourself each payday. Setting concrete goals complete with amounts and the steps you have to take to reach your goal is half the battle.
Start implementing steps toward setting good financial behaviors now and you’ll be thankful years down the road.
This week, the American Association of Nurse Practitioners is highlighting all the work nurse practitioners (NPs) do with National Nurse Practitioner Week.
The week kicks off today and runs through November 18 and honors the work NPs do both on the job and as ambassadors for the nursing profession.
Minority Nurse caught up with Dr. Scharmaine L. Baker, FNP, FAANP, FAAN, CEO at Advanced Clinical Consultants, to talk about the role of a nurse practitioner. After Hurricane Katrina, Baker’s New Orleans patient caseload swelled from 100 to 500 in three months. With a critical shortage of health care facilities and providers, Baker’s skills as an NP not only saved her patients, but also clearly showed how invaluable her thorough NP training is.
National Nurse Practitioner Week, says Baker, is a way to give nurse practitioners the recognition they often don’t receive. “National Nurse Practitioner Week gives us the positive spotlight that we deserve,” she says.
This kind of national attention to the nurse practitioner’s work shows the devotion nurses have to caring for a patient, and also helps clear up any misunderstandings about the role and how an NP works within a health care team. “Nurse practitioners don’t just prescribe a medicine and send you out of the door,” says Baker. “We take the time to listen to the patient stories about their children, spouses, pets, and job promotions. These stories often solve the complicated puzzle of making an accurate diagnosis. It’s called holistic care of the total man.”
When prospective nursing students are deciding on a career path, Baker urges them to consider a few things. Top in their minds should be the honest assessment of their commitment to making this career decision. Taking the time to complete the challenging NP studies isn’t easy, she says. “Once they have decided that this is indeed the right time to pursue an Advanced Practice Nursing degree,” she adds, “then the necessary preparations as far as letting family and friends know that they will be somewhat unavailable for the next three to four years because the schooling demands all of your time for successful completion.”
But when the degree completion and training are done, the potential for a lifelong career that challenges you, uses all your skills, and lets you connect with and help people is gratifying on many levels. As a nurse practitioner, you’ll be diagnosing, assessing, and treating medical conditions. You’ll also look at the whole patient. NPs take into account the interplay between a patient’s physical and emotional well-being as well as the environment they live in. By doing so, they can help treat every part of a patient’s condition.
“I get to hear the stories that make my patients happy or sad,” says Baker. “Then, I get to connect those stories to their physical state. They are always related. I enjoy providing health care on this advanced level. I get to take care of the whole patient.”
Baker also points out that while NPs continue to earn recognition and some states are allowing them to practice on their own, there is still work to be done. “The most challenging and frustrating part of advanced practice nursing is the many restrictive laws that prevent us from practicing to the full extent of our scope,” she says. “It’s downright ridiculous! I long for the day when all states will actively have full practice authority.”
Currently, nearly two dozen states allow nurses to have full practice authority where they practice without physician oversight. Baker continues to advocate for full practice authority among all nurse practitioners. She also urges NPs and the nursing profession to continue to honor the nurses who worked so hard to get all nurses where they are today.
“Many have fought for us to be where we are,” says Baker. “Every time we show up and provide stellar care, we make our founding nurses beam with joy. We must never forget their sacrifices.”
Celebrate National Nurse Practitioner Week this week and spread the word about these highly skilled professionals. Use #NPWeek to share photos and tags on your social media posts to help others see just what satisfaction a career as an NP can bring.
According to the Centers for Disease Control and Prevention, shift work and a lack of sleep due to long shifts can cause a serious health burden. Shift work sleep disorders (SWSD) contribute to the development or exacerbation of various co-morbid conditions, including cardiovascular disease, diabetes, obesity, GI disorders, and depression. It can affect your work performance and quality of life.
Nurses are particularly at risk for SWSD, which can cause physiological and psychological distress and lead to errors in their work. Thus, it is important that nurses are aware of this risk and focus on their sleep hygiene. Here are 7 tips to prevent SWSD and promote your sleep hygiene.
1. Avoid consecutive shifts longer than 12 hours and avoid working an extensive amount of overtime.
After night shifts, it is recommended that you have at least 48 hours off so that your body can recover. When you have a day or two off from work, it is good idea to catch up on rest.
2. Establish a regular sleep schedule.
This will reinforce your body’s sleep-wake cycle.
3. Create a sleep-inviting environment for restorative sleep.
Keep your room a cool temperature (between 60-67 degrees), which can help aid the process of cooling your body. Keeping your bedroom dark and quiet can help promote your sleepiness.
4. Avoid large meals, spicy foods, alcohol, nicotine, caffeine, and other substances that interfere with sleep at least 4 hours before bedtime.
Also try to limit the amount of caffeine you drink during the day.
5. Reduce screen time.
Light, noise, and content from televisions, smartphones, and tablets are stimulating and can cause difficulty falling asleep.
6. Avoid exercise before bedtime.
Exercising before bedtime can cause difficulty falling asleep.
7. Avoid stressful and stimulating activities, such as doing work or discussing emotional or serious issues, before bedtime.
Physically and psychologically stressful activities can cause the body to secrete the stress hormone, cortisol, which is associated with increasing alertness. Reducing stress and unwinding from the day can help you fall asleep faster and achieve a better quality of sleep.
When young children and young adults don’t hear about nursing as a viable career choice or learn about how to pursue a nursing career, the world loses an untold number of excellent potential nurses.
Mona Clayton, MSN, RN and CEO of Nurses 2 Roc Pub, knows all too well how some dreams need a little nudge. She is making sure that will happen with a goal to reach out to 100,000 people worldwide to tell them that a nursing career might just be the best career for them.
As a kid growing up in South Central Los Angeles, Clayton didn’t have the encouragement she needed to even think of nursing as a career. “You could say nursing chose me, I didn’t choose nursing,” says Clayton. “I didn’t think about nursing as a career at all. I didn’t like blood, and I didn’t like math. And I never had anyone tell me I could do this.”
She didn’t have professional role models telling her that her fascination with health care and the medical dramas she watched on television might mean she had a passion worth pursuing. They could have told her she could overcome her queasiness about blood and that improving her math just meant she had to practice.
Clayton aims to be the inspiration and mentor for those who might want to follow the same path. With seminars in person and online, casual discussions, a blog, and a pure determination to have good people become good nurse, Clayton spreads her message.
Clayton’s path changed when her cousin became a nurse and when Clayton herself worked in a trauma unit while attending college. After forays into journalism, pharmacy, computer science, and business, Clayton went back to school for her nursing degree in her mid 30s. As an older single mom who was also a minority and didn’t consider herself great in math, Clayton says the unknown was scary. “I think the main barrier for many people is the mindset that they think nursing is an impossible venture,” she says.
In fact, Clayton says when she is running a seminar, the young adults she is speaking with invariably ask her the nuts and bolts of how she achieved her goals. They want to know how she applied to a nursing school and how she even knew which one to apply to. They ask how she was able to pay for classes and did she work and go to school simultaneously. They want the details on how she managed while being a single mom and how hard her classes were. They are all hungry for information on how to make their dream become reality.
Clayton admits the road for her wasn’t always smooth. Her daughter was active in lots of school activities, and Clayton relied on extended family to help fill in the gaps as she continued to work and go to school while raising her daughter. When the going got tough, Clayton says she just looked at her daughter. “She kept me going,” she says. “I wanted her to see the importance of education. I wanted her to see how I did it and then they think, ‘If she did it, I can do it, too.’”
And while Clayton’s message connects her with people worldwide, you’ll also find her talking to people in Target or at the gym. She talks to kids who are curious about nursing and older people who are thinking about going back to school for nursing. And she recruits men and women believing a balance of genders is necessary in the workplace.
“I could go and work as a nurse and not do this,” says Clayton, “but this is a passion and drive I have. It feels great when I see someone succeed.”
In the four weeks since Hurricane Maria ravaged the island of Puerto Rico, 76 people have fallen ill with suspected Leptospirosis, according to CNN, and two have died from the bacterial disease, which is spread through water, food, or soil contaminated with the urine of infected animals.
One patient, a 61-year-old bus driver from Canóvanas, a city in northeast Puerto Rico, became sick after drinking from a stream near his house one week after the storm, according to press reports. Within a few days, he developed a fever, turned yellow, and eventually died at a local hospital.
Outbreaks of Leptospirosis are common after natural disasters and floods and a number of the patients appear to have contracted the illness the same way the bus driver did—by drinking from local streams after being without running water in their homes. People may have also acquired the infection by bathing or wading in contaminated freshwater as the bacteria can easily enter blood stream through open cuts or wounds, or via mucous membranes in the eyes, nose, or mouth.
The island’s deadly Leptospirosis outbreak is just one example of the sort of health crisis that can arise in the aftermath of a hurricane. In the midst of what’s been one of the most active hurricane seasons in recorded history, here’s a look at some of the serious health hazards that can lie in a storm’s wake.
When Hurricane Harvey dumped more than 19 trillion gallons of rain on the Houston area in late August, it turned low-lying streets into rivers—but the river that ran through southeast Texas was little more than a toxic cesspool tainted by human waste, chemicals, and other contaminants, according to USA TODAY.
J.R. Atkins, a former firefighter and paramedic from Missouri City, Texas, nearly lost his arm after contracting infection from the floodwaters while helping to rescue stranded neighbors. Atkins told ABC News it all started with small bug bite on the top of his arm. Within 24 hours, the small bite turned into a raging infection that was diagnosed as necrotizing fasciitis, or flesh-eating bacteria.
After a harrowing few days in intensive care, Atkins recovered from the nasty bug, but others have not been as lucky. Nancy Reed, a 77-year-old Houston woman, developed a flesh-eating bug after she fell inside her son’s flooded home and broke her arm. She died approximately two weeks later. On October 16th, a 31-year-old man who had been repairing hurricane damaged homes in Galveston also died after developing an infection in his arm with flesh-eating bacteria.
Floodwaters are a haven for microbes. Water samples taken from one flooded Houston home contained the fecal bacteria E. coli at 135 times the upper limit of what is considered safe, according to The New York Times, which organized the testing. The testing also turned up an unspecified strain of the Vibrio, a Gram-negative bacteria that thrives in coastal waters and can cause severe and sometimes fatal illness, including necrotizing fasciitis.
While there were no reported cases of flesh-eating bacteria in Florida following Hurricane Irma, several east coast beaches, rivers, and lagoons reported high levels of enteric bacteria, indicating fecal contamination. Coming into contact with the pathogens cause upset stomach, diarrhea, eye irritation and skin rashes, according to the Florida Department of Health.
Puerto Rico, meanwhile, continues to face a critical situation with 1 million people – nearly 30% of the island’s population—still lacking access to drinkable tap water, according to Weather.com. Residents there are urged to boil water before drinking and not to drink from streams, which may be contaminated with sewage, but as the current Leptospirosis outbreak indicates, some are not heeding that advice.
Mosquitoes are the planet’s most deadly creatures, transmitting diseases that cause millions of deaths worldwide each year. Unfortunately, the conditions after a hurricane—in particular, the abundance of standing water left behind—make it ripe for mosquito breeding.
Two weeks after Irma walloped Florida, Hernando County Mosquito Control, which covers a region located about 53 miles north of Tampa on Florida’s Gulf Coast, trapped roughly 26,000 mosquitoes over the course of 16 hours. A normal catch for that time frame would be about 500 mosquitoes.
Mosquitoes can spread an array of diseases, including dengue, chikungunya, West Nile virus, and Zika. Zika can cause serious birth defects like microcephaly. There have been 40,000 cases of the disease in Puerto Rico since 2016, though in June the island declared its outbreak of the virus was over.
While there have been no reported outbreaks of mosquito-linked illnesses thus far this year, they can take some time to appear.
Researchers noted a more than two-fold increase in cases of West Nile virus in parts of Louisiana and Mississippi in 2006, one year after Hurricane Katrina devastated the region. Most individuals infected with the virus develop a fever and other symptoms that run a self-limiting course, but one out of every 150 infected individuals will develop serious illness that can be fatal.
Mold and Pollution
Mold growth can cause serious problems in the aftermath of a hurricane. In flooded homes, fungus usually develops within 24 to 48 hours and remediation is costly.
Mold exposure can be particularly harmful for individuals with lung conditions, such as asthma or chronic obstructive pulmonary disease (COPD), and evidence suggests people can develop allergy symptoms to mold in the wake of catastrophic flooding. Following Hurricane Katrina, 78% of children tested in one study had allergies to mold, compared with the typical rate of 50% in other major urban areas.
Toxic pollutants are another concern.
Damaged petrochemical refineries and other industrial facilities in and around the Houston area accidentally released millions of tons of airborne emissions after Harvey hit in Texas, according to The New York Times.
Despite reassurances from the Environmental Protection Agency that residents were not in any immediate danger, Elena Craft, a senior health scientist at the environmental Defense Fund, told the newspaper that the pollution contained “cancer-causing compounds, like benzene and butadiene” and said her group is “very concerned about people’s long-term health in the area.”
In Puerto Rico, meanwhile, thirsty and desperate residents with no access to clean drinking water have reportedly been filling up jugs with water from wells at a federally designated hazardous waste site contaminated with toxic industrial chemicals like tetrachloroethylene and trichloroethylene, a known carcinogen.
Natural disasters don’t just take a physical toll on people—they take a mental one, too.
One study found that a third of the adult survivors of Hurricane Katrina suffered from some form of storm-related mental distress, such as depression, anxiety, and post-traumatic stress disorder (PTSD), and nearly 40% of children tracked in the study were were diagnosed with a mental disorder after the storm.
It’s not just survivors who are impacted. First responders and recovery workers who are separated from their own loved ones for long periods of time can develop mental fatigue.
The psychological burden will be even greater in places like Puerto Rico, where recovery is lagging. At least nine people have died by suicide since the storm, according to the Latin Times, and residents are overwhelmed by the disaster that has left so many homeless and jobless and struggling to survive.
There have been increasing claims of nurses being sexually harassed. Some male nurses have reported being harassed; however, more than 50% are female nurses. The harasser may be male or female, and the victim may be of the opposite sex or the same sex as the harasser. Sexual harassment is not acceptable and unlawful. It can affect a person’s emotional and mental health, as well as lead to significant stress and anxiety.
The U.S. Equal Employment Opportunity Commission (EEOC) states that “harassment does not have to be of a sexual nature, however, and can include offensive remarks about a person’s sex. For example, it is illegal to harass a woman by making offensive comments about women in general.” Sexual harassment is defined as unwelcome behavior of sexual advances, a request for sexual favors, and other verbal or physical conduct of a sexual nature that explicitly or implicitly affects an individual’s employment, unreasonably interferes with an individual’s work performance, or creates an intimidating, hostile, or offensive work environment (EEOC).
Types of sexual harassment include:
- Telling lewd jokes, or sharing sexual anecdotes;
- Making inappropriate sexual gestures;
- Staring in a sexually suggestive or offensive manner, or whistling;
- Asking sexual questions, such as questions about someone’s sexual history or their sexual orientation;
- Making sexual comments about appearance, clothing, or body parts;
- Making offensive comments about someone’s sexual orientation or gender identity;
- Inappropriate touching, including pinching, patting, rubbing, or purposefully brushing up against another person.
Whatever form the sexual harassment may take, it is important that it is recognized, and that prompt action is taken against the harasser. Preventing sexual harassment and taking proactive steps to deal with harassment that does occur is especially critical.
Here are eight steps to protect yourself from being sexually harassed:
- Be informed about the definition of sexual harassment.
- Be knowledgeable about institutional policies regarding sexual harassment.
- Take an active role in fostering a work environment free from sexual harassment.
- Attend sexual harassment prevention courses or training.
- Report the harassment to your supervisor immediately, or to a higher authority if your supervisor is the harasser. Consult with your human resources office and government agency if necessary. Never be afraid to report a comment, action, or gesture by somebody that made you feel uncomfortable.
- If possible, speak with the individual directly and inform him or her that you feel the behavior is inappropriate.
- Seek support from family members, friends, colleagues, or your state nurses’ association.
- Document the harassment in writing as soon as possible.
It is important for all nurses to become familiar with various strategies to prevent or reduce the likelihood of medication errors. Here are ten strategies to help you do just that.
1. Ensure the five rights of medication administration.
Nurses must ensure that institutional policies related to medication transcription are followed. It isn’t adequate to transcribe the medication as prescribed, but to ensure the correct medication is prescribed for the correct patient, in the correct dosage, via the correct route, and timed correctly (also known as the five rights).
2. Follow proper medication reconciliation procedures.
Institutions must have mechanisms in place for medication reconciliation when transferring a patient from one institution to the next or from one unit to the next in the same institution. Review and verify each medication for the correct patient, correct medication, correct dosage, correct route, and correct time against the transfer orders, or medications listed on the transfer documents. Nurses must compare this to the medication administration record (MAR). Often not all elements of a medication record are available for easy verification, but it is of paramount importance to verify with every possible source—including the discharging or transferring institution/unit, the patient or patient’s family, and physician—to prevent potential errors related to improper reconciliation. There are several forms for medication reconciliation available from various vendors.
3. Double check—or even triple check—procedures.
This is a process whereby another nurse on the same shift or an incoming shift reviews all new orders to ensure each patient’s order is noted and transcribed correctly on the physician’s order and the medication administration record (MAR) or the treatment administration record. Some institutions have a chart flag process in place to highlight charts with new orders that require order verification.
4. Have the physician (or another nurse) read it back.
This is a process whereby a nurse reads back an order to the prescribing physician to ensure the ordered medication is transcribed correctly. This process can also be carried out from one nurse to the next whereby a nurse reads back an order transcribed to the physician’s order form to another nurse as the MAR is reviewed to ensure accuracy.
5. Consider using a name alert.
Some institutions use name alerts to prevent similar sounding patient names from potential medication mix up. Names such as Johnson and Johnston can lead to easy confusion on the part of nursing staff, so it is for this reason that name alerts posted in front of the MAR can prevent medication errors.
6. Place a zero in front of the decimal point.
A dosage of 0.25mg can easily be construed as 25mg without the zero in front of the decimal point, and this can result in an adverse outcome for a patient.
7. Document everything.
This includes proper medication labeling, legible documentation, or proper recording of administered medication. A lack of proper documentation for any medication can result in an error. For example, a nurse forgetting to document an as needed medication can result in another dosage being administered by another nurse since no documentation denoting previous administration exists. Reading the prescription label and expiration date of the medication is also another best practice. A correct medication can have an incorrect label or vice versa, and this can also lead to a med error.
8. Ensure proper storage of medications for proper efficacy.
Medications that should be refrigerated must be kept refrigerated to maintain efficacy, and similarly, medications that should be kept at room temperature should be stored accordingly. Most biologicals require refrigeration, and if a multidose vial is used, it must be labeled to ensure it is not used beyond its expiration date from the date it was opened.
9. Learn your institution’s medication administration policies, regulations, and guidelines.
In order for nurses to follow an institution’s medication policy, they must become familiar with the content of the policy. This is where education comes into play whereby the institution’s educator or education department educates nurses on the content of their medication policy. These policies often contain vital information regarding the institution’s practices on medication ordering, transcription, administration, and documentation. Nurses can also familiarize themselves with guidelines such as the Beers’ list, black box warning labels, and look alike/sound alike medication lists.
10. Consider having a drug guide available at all times.
Whether it’s print or electronic is a matter of personal (or institutional) preference, but both are equally valuable in providing important information on most categories of medication, including: trade and generic names, therapeutic class, drug-to-drug interactions, dosing, nursing considerations, side effects/adverse reactions, and drug cautionaries such as “do not crush, or give with meals.”
Utilizing any or all of the above strategies can help to prevent or reduce medication errors. Nurses must never cease to remember that a medication error can lead to a fatal outcome and it is for this reason that med safety matters.