The celebration of IV Nurse Day every January 25 recognizes the work infusion nurses do with and for their patients. Infusion nurses are an essential part of the care team, acting to properly care for infusion needs and collaborating with other members of the health care team.
“Challenges in our ever-changing healthcare system combined with new, developing technologies and complex infusion therapies, afford the opportunity for the infusion nurse to use his/her expertise in infusion therapy to provide holistic patient care,” says Marlene Steinheiser, MSN, RN, CRNI®, director of nursing education of the Infusion Nurses Society (INS), Infusion Nurses Certification Corporation.
Of the primary responsibilities of an IV nurse, acting with the patient’s health and welfare in mind is primary. Celebrated since 1980, IV Nurse Day focuses attention on this essential care. “The infusion nurse acts as an advocate for patients receiving infusion therapy, ensuring that safe, quality infusion care is delivered,” says Steinheiser. “Patient assessment, with particular attention to the patient’s vasculature and prescribed therapy, is important so that the appropriate vascular access device (VAD) is selected to accommodate the treatment plan.”
Steinheiser also says that many infusion nurses also take on leadership roles where they provide education and guidance to other nurses while also continually monitoring for complications and setting in motion effective interventions when needed.
Student nurses interested in the career will find infusion nurses are not limited to specific settings. “Infusion nurses’ roles may vary depending upon the practice setting,” Steinheiser says. “Infusion nurses work in many settings, agencies, and organizations including, but not limited to, hospitals, nursing homes, ambulatory infusion clinicals, physician offices, and patient homes.”
According to Steinheiser, expert infusion nurses can help reduce complications by sharing their knowledge and educating patients, family members, and other healthcare team members and always assessing the patient. “Skilled VAD insertion, prevention of complications and early identification coupled with implementation of interventions, minimizes further damage that can result from infusion-related complications,” she says.
Like any nursing career, this branch of nursing requires continual education to stay current with best evidence-based practices that help prevent, reduce, and treat any complications or challenges. “Due to the invasive nature of infusion therapy, infusion nurses can encounter possible adverse events with any infusion, such as extravasation, catheter malposition, nerve damage, or infection,” Steinheiser says. “The infusion nurse is prepared with advanced knowledge and continuing education to promptly address these situations.”
The INS is an excellent resource for current and future infusion nurses. The organization offers free educational podcasts (available to members and nonmembers) where nurses can learn about and refresh their skills for safe infusion practices. And the learning center provides both virtual education and recorded educational sessions from prior conferences and webinars, and what Steinheiser calls a key resource for infusion nurses, the Infusion Therapy Standards of Practice.
As with other nursing practices, nurses with the desire to specialize in infusion therapy may study and take the certification exam offered twice a year, says Steinheiser. “To assist the nurse in preparing for this exam, INS has study material which covers the eight core components of infusion nursing,” she says. “Once nurses pass this exam, they are considered infusion nurse specialists and can begin using the credential CRNI®. The CRNI® is capable of an expanded role in directing evidence-based clinical practice, research, and quality improvement activities.”
Infusion nurses care for all patients, providing care that helps many other healthcare processes go more smoothly. “Infusion nurses provide for all patient populations, from the neonate to the elderly patient, and follow them along the continuum of care,” says Steinheiser. “Infusion nurses use their critical thinking skills, perform advanced procedures using state-of-the-art technology, and ensure safe infusion care.”
Nursing education is done a little differently at Linfield College. We pride ourselves on creating innovative methods in which aspiring nurses can learn and grow into strong and competent professionals. One of the many ways in which that is done is through our simulation program. Our simulation program is run out of our experiential learning center (or ELC); it includes low, mid, and high-fidelity simulations. With these simulations, our students go in one by one to care for the patients individually for ten to fifteen minutes at a time with each student picking up where the other one left off. They plan the care together using what’s called a mega brain and prioritize the patient’s needs within the plan prior to the start of care for the patient. We have not witnessed this method being used at many facilities.
The students have the option of continuing care as the previous student or changing the plan; they are all the same nurse so if they are in the middle of a task then they are able to continue with that task without starting the steps over again, which saves time and enables them to carry out the task. In the past, we had found that having each student start over took away from the simulation experience and that the students were more focused on the task instead of the patient. This brought about the solution of one mind nursing. The students have found this to be extremely helpful and have verbalized how this increases the realism of the clinical simulation by having them think like a nurse, especially with the situation of end of shift or hand-off. In this situation the students have to consider what is the best option if they receive hand-off in the middle of a nursing task. This is one of the aspects that increases realism.
Another method of increasing realism comes from the use of alumni. We use alumni as family members during the simulation (we have a manikin or a standardized patient as an actor). During the simulation, the alumni act as though they are the family members dealing with that situation. After the simulation is complete, they help with debriefing after we walk through the case and ask high-level critical thinking questions to stimulate reflection, retention, and transference. They tie in clinical examples of how it relates to their clinical practice and emphasize why the clinical reasoning and actions based on clinical judgement are so important. The students enjoy having the alumni because they have shared their experience and have gone through what they have experienced and have become successful after it. The alumni serve as additional mentors and role models in this way, offering advice and further insight into the role of nurses. With this addition to our clinical simulation program, we have created a more realistic and enjoyable experience for our students.
Certified Registered Nurse Anesthetists (CRNA) Week runs this week from January 21 to 27 and is an excellent opportunity for student nurses to find out more about this path in a nursing career.
With more than 52,000 nurse anesthetists and student nurse anesthetists, the career is thriving and attractive for several reasons. Many nurse anesthetists say the patient interaction they have is unsurpassed. They are with patients before, during, and after surgery, so there’s a necessary trust that is quickly established with the skill and care of the nurse.
Nursing students who are considering this as a career have many resources they can reference and various organizations that will help them succeed on this career path. The American Association of Nurse Anesthetists (AANA) is especially aware of promoting health and wellness among the student nurses who seek a career in this branch of nursing. The AANA’s 2017 report Wellness and Thriving in a Student Registered Nurse Anesthetist Population explored the significance of the relationship between student wellness and how well students do in their academic program.
To celebrate CRNA Week, Minority Nurse recently posed some questions to Michael Neft, DNP, MHA, CRNA, FNAP, FAAN, and assistant director of the Nurse Anesthesia Program University of Pittsburgh School of Nursing and nursing student Sara Wilkinson, BSN, RN, CCRN SRNA at University of Tennessee Health Sciences Center. The following are their answers.
Why is the AANA particularly aware of the health and wellness among student nurses looking to enter or actively studying in this field?
Student nurses are the future of the profession, and it is important to cultivate and prepare for a long and healthy career. Students who aspire to enter into nurse anesthesia programs must be healthy mentally and physically. They must have healthy outlets for stress relief, and healthy lifestyle habits that will support them throughout our educational programs.
Nurse anesthesia education programs are required by their accreditation standards to provide education content on wellness and substance use disorder. The AANA actively encourages members, students, as well as educational programs to engage whenever possible in healthy behaviors, whether that includes physical activity or simply reducing stress by encouraging individuals to take time for their loved ones or to engage in an activity they love.
The AANA is committed to providing resources and information about ways to become involved in establishing a healthy lifestyle and even offers fun runs, wellness tutorials and a massage therapy area at many of their conferences.
How does establishing good health and wellness practices now help a student nurse become better? And how will taking care of oneself now carry over once they graduate and are several years into a CRNA career?
Nursing has unique stressors like dealing with patient care situations that require critical thinking, fast decision making, and autonomy is tough. If the student nurse does not have the ability to cope with these situations autonomously, it is very difficult to care for patients. Maintaining both mental and physical health and wellness are at the foundation of successful practice.
Developing healthy lifestyle habits early, helps students handle stress more effectively, set clear goals, and develop a clear plan to achieve them. They also assist students with discipline, good study habits, prepare for clinical experiences properly, and self-evaluate objectively. It also helps to establish diet and exercise plans that can be adjusted as one transitions to practice, to avoid elimination of healthy habits out of inconvenience.
Maintaining a school-life balance is also important to develop a support system and find time for small, pleasant breaks to gives a fresh perspective and recharge. Establishing healthy behaviors and habits early is vital to long-term health, wellness, and maintenance of a successful career.
Do you have any advice for student nurses about considering this field and being aware of any challenges unique to this branch of nursing?
For student nurses considering the field of nurse anesthesia, awareness about the depth and breadth of study is valuable, but is important to be well, so that an individual will have the endurance to graduate. A strong support system and personal discipline are necessary to allow for healthy stress relief and appropriate professional conduct. Anesthesia remains the field with the highest incidence of drug abuse and unhealthy coping behaviors, due to high stress and access.
Think about what you do when stressed. Review your lifestyle habits: exercise, eating, alcohol use, and other substance use. Some prospective students may want to employ a lifestyle coach who can look at a person individually and help one to develop positive lifestyle habits that will set one up for success in graduate school and a stressful career. Good study habits, a healthy respect for one’s self and career, use of study resources, and strong, supportive relationships will be required to succeed and thrive in this field.
January 21 through 27 is National CRNA Week, and we’re celebrating by getting up-close and personal with the CRNAs who make the medical world go ‘round! Certified Registered Nurse Anesthetists (CRNAs) safely administer about 43 million anesthetics each year, making surgeries and medical treatments safer. These professionals not only administer anesthesia, but also help ensure patient comfort and security.
CRNAs come from all walks of life and work in a wide range of communities. Interestingly, the American Association of Nurse Anesthetists (AANA) reports that CRNAs are the sole providers in nearly 100% of rural hospitals in some states as well as within the U.S. Armed Forces. Make sure to thank your favorite CRNA during CRNA week and surprise them with something special to say thanks! We love the idea of gifting them a personalized stethoscope with custom engraving as an awesome way to pay tribute.
What Does a CRNA Do Every Day?
What’s life like as a CRNA? Let’s take a closer look. Every day, nurse anesthetists monitor patients during surgery. This requires preparing and administering drugs before anesthesia, managing patients’ airways, and pulmonary status during surgery and closely observing their physical reaction to drugs. They may also perform pre-anesthesia screenings to determine a patient’s risk and administer epidurals in maternity wards.
But there are many other things that CRNAs are responsible for each day, according to Lincoln Memorial University Clinical Coordinator and CRNA Joy Lewis. “We do pre-op and post-op rounds, consults for pain management, place central lines, respond to codes, place and manage labor epidurals, upon consultation implement respiratory and ventilatory management including establish emergency airways,” says Lewis.
Dan Lovinaria, a CRNA with Veterans Affairs at Minneapolis Medical Center, says there’s an emotional aspect to the job, too.
“Being a VA CRNA comes with a tremendous responsibility and a great deal of accountability,” he says. “Patients are often anxious and nervous about their surgical procedures. It is my duty and responsibility to set the tone and make an immediate connection with my patients upon their arrival in the preoperative phase. Something as simple as providing warm blankets to my patients goes a long way. The little things make a significant impact.”
What’s the Schedule Like?
Surgeons have notoriously demanding schedules, whether they’re responding to emergencies or running on a tight, pre-determined schedule. Since CRNAs are required to be present for many of those surgeries, their schedules may be even busier than a surgeon’s.
“Oftentimes our schedules are busier than the surgeons if we work at a hospital with [obstetrics]. Once you place an epidural you may not be able to leave, and they will still want the operation to start on time,” Lewis says.
Lovinaria says he and his team work various shifts, including 8-hour, 10-hour, 12-hour, and overnight shifts.
Who’s Their Boss?
But there’s good news, too. CRNAs operate on a more autonomous schedule—they’re not required to be supervised by an anesthesiologist in any of the 50 states—so their shifts and schedules vary compared with traditional registered nurses. CRNAs may work as part of an anesthesia care team or as individual providers.
Robert J. Gauvin, a CRNA who’s also the president of Anesthesia Professionals, Inc. in Dartmouth, Massachusetts, says owning an anesthesia care business means more work but even more autonomy.
“Because of my unique position as a business owner and practicing CRNA, a typical day involves the 30-plus CRNAs in my group taking care of one to 45 patients in multiple facilities, followed by two to three hours of administrative duties,” Gauvin says. “On a weekly basis, I try to build in dedicated office days that allow me to focus on developing the business side of my practice.”
What About the Education Factor?
Because CRNAs have a much more specialized skill set than traditional RNs, they’re required to have extra education. Most CRNAs start out as RNs and are then required to complete a master’s degree in nursing (MSN), which typically takes about two years. CRNAs must then pass the National Certification Exam (NCE), which covers the knowledge, skills and abilities needed by entry-level CRNAs.
“Pursuing my studies as a CRNA demanded my efforts and abilities in many ways: mentally, physically, emotionally, financially, and so on,” says Mary Nguyen, a CRNA at Lourdes Hospital in Paducah, Kentucky. “My whole world was completely changed. With that being said, I’d do it all over again to have the privilege to work in my position as a CRNA.”
Nguyen also emphasized the importance of the CRNA certification exam. “The best advice that I can give to others is: ‘Respect the Test!’ The National Certification Exam (NCE) requires a level of thinking and comprehension of anesthesia that is only attained after rigorous clinical experiences paired with thorough reading and studies,” she says.
And then, of course, CRNAs must put a significant amount of time and money into continued education in order to keep their certification active. According to CRNA Bruce Schoneboom, the Senior Director of Education and Professional Development with the AANA, CRNAs must regularly become re-certified.
“The National Board of Certification and Recertification for Nurse Anesthetists’ new recertification program is called the Continued Professional Certification (CPC) Program and consists of eight-year periods. Each period is comprised of two four-year cycles. Every two years CRNAs will check in through a simple, online process known as the ‘two-year check-in,’” Schoneboom says. CRNAs must complete 100 additional education credits in an eight-year period.
Is It as Rewarding as They Say?
Talk to any nurse, and he or she will tell you that there’s a certain pride in putting on a pair of scrubs every morning. But is being a CRNA just as fulfilling as the traditional RN track? Yes, say CRNAs. And the proof is in the pudding: CRNA is a career with one of the highest job satisfaction ratings within nursing.
“There are so many rewarding moments being a CRNA. The one-to-one patient/CRNA interaction is a very valuable experience, and so is engaging the vets’ caregivers or significant others about the anesthesia plan of care,” says Lovinaria, adding that it’s the critical thinking component of the job and its dynamic changes that keep him on his toes.
Nguyen agrees: “I can honestly and wholeheartedly share that even on my worst day, doing what I love is better and more rewarding than a single day doing something else. I would choose this profession over any other option available,” she says.
Make sure to give your favorite CRNA plenty of props during CRNA Week this year!
When nurses think of the big responsibilities in their careers, patient safety is predominant. But communication skills? Those aren’t often at the top of the list.
Nurses train for years to ensure the safety of their patients. Their unwavering advocacy for patients has done nothing less than transform healthcare. But patient safety can’t happen without clear communication skills. Nurses must have excellent communication skills to provide the best care for patients and to earn the respect of their peers.
What kinds of communication skills will nurses use? Here is just a small sample of how nurses use various communications skills throughout the day:
- Communicating with healthcare team members on a patient’s condition, diagnosis, treatment, complications, progress
- Explaining to patients about self care, about their diagnosis and prognosis, about resources, and about everything from medications to diet and exercise
- Talking with family and loved ones about patient needs, follow-up care, disease, recovery, medication
- Communicating with professionals in non-healthcare fields to help secure grants, influence policy, or explain a professional need
- Educating the public on healthcare issues that are important to their age, region, or personal health, or educating students on nursing practices or nursing career options
How can you improve your communication skills? Here are a few pointers:
- Be precise and clear. If you need information or you need someone to do something, say so. If you are giving information, present it in basic terms.
- Ask if anyone has questions. Your audience could be a roomful of academics at a conference, a team of colleagues in your unit, or a single patient—always ask if anyone has follow-up questions. Don’t assume that your audience heard and understood everything you said. This last step gives you an opportunity to recognize where your communication can be strengthened and to convey the needed information.
- Write clearly. Whether you are writing a memo or a research paper, use fewer words and make them have greater impact. Decide what you are trying to say, use short paragraphs for ease, add bullet points to emphasize your main points, and make sure you reread everything before you send it..
- Consider your tone and body language. The way you speak and hold yourself can support your words and intent, but if they are out of whack, your unspoken actions can cause confusion. Make sure you speak in even tones when possible and that your body language is approachable.
- Learn about best practices. You’ll find books, seminars, presentations, and even casual discussions that can all help you sharpen your skills. If you’re a nurse manager, bring this up in each employee review and ask for it in turn from your own supervisor.
Communication can always be improved. Each time it is, your capability as a nurse is strengthened.
Can a simple B vitamin like folic acid really prevent serious birth defects? The answer is a resounding yes, but taking the vitamin in the easiest days and weeks of pregnancy is key.
When women find out they are pregnant, staying healthy often becomes a top priority. Making sure they are eating nutritious foods, getting enough rest, remaining active, and generally taking care of themselves comes to the forefront. But one of the most critical times for preventing certain birth defects is before a woman even knows she is pregnant.
Sufficient intake of folic acid (folate) can prevent serious birth defects, so January 7 to 13 marks Folic Acid Awareness Week. The observation offers a timely opportunity for nurses to become aware of their own folic acid intake and to open up discussions with their female patients of child-bearing age.
According to the National Birth Defects Prevention Network (NBDPN), sufficient folic acid intake before pregnancy occurs can “prevent up to 70% of some serious birth defects of the brain and spine, called neural tube defects.” Specifically, the vitamin has protective benefits against spina bifida and anencephaly, which begin to develop in the early weeks of pregnancy, often long before a woman even realizes she is pregnant.
Because approximately half of all pregnancies in the United States are unplanned, raising awareness about the protective benefits of sufficient folic acid intake before a pregnancy happens is essential. Luckily, getting the recommended 400 mcg of folic acid is as easy as taking a daily multivitamin or eating fortified pasta, rice, breads, or cereals (at mealtime or as a snack). Often, one small bowl of a fortified cereal can supply the minimum amount for the whole day.
Women who prefer to get enough folic acid from unfortified sources can turn to dark leafy greens, some juices, and many beans. But they need to be aware of the amounts they need to consume to meet the minimum requirement. According to the National Institutes of Health, these non-fortified foods are top sources of folate: beef liver, boiled spinach, black-eyed peas, asparagus, Brussels sprouts, and romaine lettuce.
According to the NBDPN, babies born to Hispanic women have the highest rates of these birth defects and that, in general, Hispanic women consume less folic acid overall and are less aware of the protective benefits of the vitamin during pregnancy.
For nurses, using Folic Acid Awareness Week to open up a conversation and give patients some easy-to-follow information for preventing these birth defects is worthwhile.
As the demand for educated and qualified nurses continues to grow, prospective nursing students might wonder how they can afford nursing school now to open their career possibilities over a lifetime.
If you have applied to schools and are receiving acceptances and award letters, it’s time to crunch the numbers to figure out the best choice for your money. Schools offer many awards including merit scholarships, grants based on merit or need, and loans that fall into many categories. You can also make some other adjustments to shave off some costs without impacting your education.
How do you know you can afford nursing school? Here are some questions to ask.
Will You Be a Full-time or Part-time Student?
Some colleges and universities award scholarships based on the student’s academic load. If you are trying to decide which route is for you, check with the schools to see if there is substantially more money available that could impact your choice. Consider your employment potential as well. Part-time status takes longer to complete, but you may be able to work and go to school (and your employer might pay for part of your education).
Where Will You Live?
Living on campus generally costs more money. Attending a college that’s closer to home lets you save thousands of dollars on campus housing and meal plan fees. If you are already living at home, you’ll save by continuing to live at home and commuting to school.
Can You Take a Hybrid Route?
Are there any online courses that cost less? If you are aiming for a BSN, could you take a prerequisite class and some of your basic classes at a cost-saving community college and then transfer to a four-year college to finish your degree?
What Aid Is Available?
A strong academic record and solid application will likely land you some merit scholarship funding. Like a grant, that’s money the school gives to you. You don’t have to pay it back, but you do need to find out if the award will be renewed each year you are at the school. If you apply to a four-year college, you need to know you can afford all four years.
How Much Debt Are You Willing to Take On?
After any merit or need-based scholarships and grants, you can be awarded loans. Loans always have to be paid back. Federal loans come from the government and while they have to be paid back, they often have low interest rates, and you don’t start repayment until after graduation. If federal loans don’t meet your entire need, you can apply for private loans, which have higher interest rates and varying repayment policies.
What Are Your Post-graduation Plans?
Some nurses can have some student debt forgiven if they apply for and fulfill the requirements of the NURSE Corps Loan Repayment Program. In addition, some states offer specific loan repayment or forgiveness plans for nurses.
Figuring out how to afford nursing school is going to be different for each student, but there are many options and choices available. For many students, finding the right balance just takes some investigating.
The 2017 clinical excellence conference organized by the National Association of Indian Nurses of America (NAINA) concluded on December 2nd at Houston, Texas. It was for the first time that NAINA as a minority organization ventured to engage in a clinical excellence conference titled “Advancing Health through Excellence in Clinical Practice.” This conference, hosted by the Indian Nurses Association of Greater Houston, Texas (INAGH), was attended by over 200 participants and nurses were provided with 8.91 CEUs by the Southwestern University Hospital, Texas. Participants applauded the organizers for providing an opportunity to network and immerse in a day full of activities that provided thought provoking information to bring back to their own clinical practice.
The APN committee chairperson, Dr. Lydia Albuquerque, set the tone of the conference by welcoming the Houston chapter President Accamma Kallel, MSN, APRN, APN-C, CCRN, president of INAGH and local chapter APN local planning committee chair, to deliver her welcome address. The key note speaker, Melissa Herpel, MSN, APRN, FNP-BC, challenged the participants to embark on pathways to excellence in independent practice as nurse practitioners. As an entrepreneur, she shared success stories of her own business model, how she overcame the challenges that she faced during the process and dared to challenge the participants to go out and start clinics that would provide primary care to the communities. All other speakers delivered their topics of interest and expertise with recent practice guidelines to the participants.
Poster presentations were coordinated by Dr. Letha Joseph, Dr. Solymole Kuruvilla, and Dr. Simi Jesto. Bindu Jacob, BSN, RN (New Jersey) was awarded the first prize, Jessie Kurian, MSN, RN (Dallas) was awarded the second prize, and Dr. Lisa Thomas (Houston) was awarded the third prize. Dr. Rachel Koshy, committee chair of the NAINA Journal, motivated the participants to submit scholarly articles for publication. The NAINA Journal was released by NAINA President, Dr. Jackie Michael. This Journal has been published for the second time with a goal to continue publications at least twice a year.
At this conference, NAINA presented a donation towards the Hurricane Harvey Relief Fund which was accepted by Mr. Zafar Tahir, Houston planning commission representative on behalf of the mayor of Houston. NAINA received a grant from Boston scientific and generous sponsorship from educational and pharmaceutical companies. Our grand sponsor, “APRN world,” an independent educational organization started by Dr. Harila Nair, a nurse practitioner and entrepreneur of Indian origin based in California, needs a special mention for his generous support.
Conference hosting chapter, INAGH, facilitated the Gala night celebration with Bollywood dancing, a grand finale of the Texan dance choreographed by the nurses of Houston chapter, and other entertainment programs. The plenary committee members along with the planning committee were given a standing ovation for conducting an excellent conference which was inspiring, energizing, and remarkable.
As an experienced nurse, a new nurse, or a nursing student in 2018, it’s tough to admit you might be biased toward some of your patients. But it happens, and the best approach to fixing implicit bias is to recognize its presence, and then constantly reassess how you feel and your approach.
Why do nurses have inherent bias? It’s a subconscious human trait and frequently interferes with best nursing practices. An inherent bias doesn’t mean you are racist and it doesn’t mean you shouldn’t be a nurse. Recognizing an inherent bias means that you understand you might have certain feelings about populations, appearances, or mannerisms that need to be addressed and dealt with to provide the best possible care.
In 2017, BMC Medical Ethics published a systematic review assessing a decade’s worth of publications for implicit bias in health care professionals. The conclusions stated a need for additional reviews and more homogeneous methodologies, but determined that implicit bias exists in health care settings and impacts quality and equity of care. Authors Mahzarin Banaji and Anthony Greenwald address the issue in books like Blindspot: Hidden Biases of Good People, as does Augstus White, III, MD, in Seeing Patients: Unconscious Bias in Health Care.
Here’s how to pay attention and fix it.
Notice Your Assumptions
Everything from language barriers to job status to regional inflections can cause people to assume a patient has certain traits, behaviors, or beliefs that you might not agree with. Notice that feeling when you are trying to explain treatments to a patient, when responding to their needs, or when dealing with an extended and involved family.
Understand What Assumptions Trigger in You
You might find there are certain accents, specific items of clothing, or ways of speaking that cause you to tag someone with undeserved qualities. A patient’s race, accent, clothing style, or appearance can spark an instant judgment in you. Do you hold back certain levels of compassion for patients who are more short-tempered? Do you assume low standards in a disheveled, unkempt patient? Does someone’s race affect how you see them?
Know Why It Matters
An implicit bias is not only harmful because it is undeserved, but it can also lead to disparities in care. Even if you are unaware of how you are feeling, your body language, your focused attention, and your level of care can be impacted directly by the way you are feeling. Each patient deserves your full care, so understanding what might trigger you to act differently will make you a better nurse.
Know Your Patient
Talking with your patients is a good way to learn more about them. Understanding cultural differences can also help you become aware of any unconscious bias and begin to overcome it.
Talk About It
You have a bias, but you are not alone. Talking about implicit bias in your work setting opens the conversation, removes the taboo, and paves the way for better patient care and outcomes. When nurses are able to address this topic in an open and nonjudgmental manner, everyone benefits. If you are a nurse manager, holding talks, open sessions, one-on-ones, and seminars gives your staff nurses the tools to confront the issue head on and make significant changes.
Everyone knows about overt bias and the harm it causes, but implicit bias is just as dangerous, and many nurses aren’t even aware they may have a bias. Becoming aware of the problem and realizing if you have any bias is a first step toward fixing the problem.
As the opioid epidemic continues to grow throughout the nation, it’s not surprising that this kind of addiction, as well as others, can also affect nurses. If you’re a nurse in New Jersey and have a problem with addiction, however, there’s a treatment program specifically designed to help you.
Established in 2003, the New Jersey State Nurses Association (NJSNA) Recovery and Monitoring Program (RAMP) has helped more than 2,000 impaired nurses since its inception, says Terri Ivory, RN, MSN, Director of NJSNA. “RAMP is the only program for registered nurses and licensed practical nurses of its kind contracted through the Board of Nursing,” explains Ivory. “RAMP is important because it supports impaired nurses and protects their licenses so they will be able to work again with monitoring once they have completed evaluation and treatment. What makes the program special is that nurses are taking care of nurses who understand the challenge of being a nurse.”
Ivory agreed to answer questions about the program. Following is an edited version of our interview.
Tell us about RAMP.
The goals of the program are to provide safety to the public though early detection and monitoring, reduce the time between identification and treatment, and provide a process for the nurse to recover that is non-punitive and non-public.
Entering the RAMP program, which is voluntary, protects the nurses’ licenses. While in the recovery phase, the nurses’ licenses may become inactive, but not revoked, which protects the licenses. The licenses can be re-activated once the process is completed and the return to work is issued.
How does it work? Is it a rehab/detox? Do you provide counseling?
RAMP is a recovery and monitoring program, which means it makes referrals for treatment, detox, and counseling. It is not rehab and detox nor does it do counseling.
The RAMP process includes evaluation, toxicology screenings, referral for treatment, weekly peer support group meetings, monthly reports, check-ins, monitoring, and a return to work process. There are peer support groups that RAMP participants must take part in during their time in the program.
Are all nurses accepted into the program? Do they need to apply? Does their employer get notified?
All RNs and LPNs practicing in New Jersey are eligible for the program and can be self-referred or referred by their employer or the public (such as family, attorney, friend). After a nurse self-identifies or is referred to RAMP, the first thing that happens is an evaluation process, which includes a psychological evaluation and random toxicology testing that can take up to 90 days. Nurses must check in with RAMP every day during the evaluation phase. During this time, the nurses do not need to disclose to their employers that they are in the program.
After evaluation, the nurse will get recommendations—whether to stay in the program or discharge—based on the results of the evaluation. If it is recommended a nurse stay in the program, the nurse must disclose the program participation to her/his employer.
Participation in the program may last up to five years.
RAMP notifies the New Jersey Board of Nursing (NJBON) as soon as the referral comes in, and the NJBON works with RAMP throughout the process. Dialogue with NJBON happens every two weeks or more often as needed. If nurses do not comply with recommendations, they are discharged from the program and reported to the BON.
It is within the nurses’ scope of practice to report fellow nurses.
Do the nurses pay for the program or is it covered by insurance?
Insurance does not pay for the program itself, which includes lab fees, evaluation fees, peer group fees, and therapist fees. All fees must be paid up front.
Hard medical costs, such as a lab fee or therapist, might be covered by medical insurance.
If they complete the program, how do they get back to working as a nurse? What tends to happen?
During their time in the program, a return-to-work program is implemented. Sometimes there are restrictions on work hours (no overtime), medication administration, and on specialty or place of employment. Nurses are monitored while they are working and monthly reports are sent to RAMP. Monitoring can be done for up to 5 years. Upon return to work, the only person that knows about the nurses’ participation in RAMP is the potential supervisor and human resources.
What have your outcomes been?
The overall success rate of the program is 60%. There are a total of 607 nurses in the program as of October 31, 2017: 493 nurses being monitored, 27 in intake stage with 23 monitoring out-of-state with 36 peer support groups, and five mental health groups. Two hundred thirty participants have been discharged as of October 31, 2017.
The most important thing for nurses to know is not to be afraid to report, either self-reporting or peer reporting. This helps close loop and gets the nurse the help they need. The main goal of the program is to have nurses to practice safely, protect the public, and protect the nurse.
RAMP has a 24-hour hotline for questions: 800-662-0108.