All nursing jobs have instances of stressful situations in them. It’s the nature of the field. But working at a Shock Trauma Center can be even more so.
Rashidah B. Francisco, BSN, RN, CCRN, CPAN, TCRN, with the Lung Rescue Unit at the University of Maryland R Adams Cowley Shock Trauma Center (STC), took some time to answer our questions about her amazing job.
What follows is an edited version of our Q&A:
As a Shock Trauma Nurse, what does your job entail? What do you do on a daily basis?
On the Lung Rescue Unit, our shifts are extremely unpredictable. Taking care of some of the sickest patients in the state of Maryland—and possibly the world—at the only Primary Adult Resource Center is something that demands skill, dedication, communication, and a sense of teamwork like no other.
Our exclusive Veno-Veno extracorporeal membrane oxygenation (VV ECMO) unit at Shock Trauma is one of the only units of its kind in the country. Our patient population on this unit consists of patients in need of a machine that bypasses their lungs to deliver 100% oxygen to the patient’s blood, as their lungs are incapable of this function. Having the critical care skills, knowledge, and critical thinking to recognize when your patient is in trouble is half the battle of managing this patient population.
Our patients are suffering from acute illnesses and come to us at the most critical moment in their lives. Because of this, we have little time to think, but must come together as a team and put our skills and expertise to work. The interventions for our VV ECMO patients can also be very different from your typical ICU patients, but are directly in line with evidence-based practices. We may prone our ECMO patients, walk them, and get them out of bed daily and into a chair to optimize their recovery.
Why did you choose to work at Shock Trauma? How long have you worked there? What prepared you to be able to work in such a stressful environment?
Coming to Shock Trauma was not my initial plan, but critical care has always been a dream of mine. I have been in the nursing profession for almost 20 years (three as a patient care technician, 11 as an LPN, and seven as an RN). After going through a critical care fellowship at a large hospital in Virginia, and spending a couple of years on their complex critical care unit, I felt that I was ready for something bigger and more challenging. I wanted something that would enhance my skills, and push me to go further in bettering myself and my career.
When asking myself where I could go to be a part of the best, where only the best is expected of me, and where my skills and education would be the only determining factor in how far I can go in my career, I chose Shock Trauma. I have been at STC for over 4 years, and there is not one day that I have not been pleased with my career choice.
How do you keep yourself from bringing the stress of the job home? What do you do to relieve your stress?
Gratefulness and self-reflection helps me to de-stress. Reflecting with my team and relying on them while I am at STC helps me to keep things into perspective.
What are the biggest challenges of your job?
The biggest challenge of my job is knowing that I cannot save everybody—that everyone’s story is not to be taken on as my burden, but it is my duty to do the best that I can. Knowing that I am human, and I can only do so much. Remembering that I am here by choice, and that some of my patients, no matter what choices they have made, are there because they have to be, and are depending on me to utilize my skills to help them in their most critical hour. Remembering that it could be me lying in the bed, and them taking care of me.
What are the greatest rewards?
Seeing a patient get off of ECMO and return home or go to one of our critical care units. Just seeing that they have reached a point where they are able to evade such a lifesaving piece of equipment is a reward. Hearing a patient’s voice after they have been extubated. Seeing them walk after being in the prone position intermittently for days. Hearing that a patient who has been waiting months for lungs has finally gotten them.
Being a part of a team—that these things are just as important to them as they are to me—is also a reward in itself. To have someone who is going through the struggle with you and cares as much as you do.
What would you say to someone considering this type of work? What kind of training or background should he or she get?
No matter what your background, come with a sense of teamwork, with a sense of family, and with the ability to take on the most challenging situations, but with the humblest attitudes. Be ready to learn, no matter what you think you know. At STC, you will see and learn things beyond what you even thought. Have a strong critical care background for some of our units, but if not, have an open mind and a willingness to learn. Be ready to see and care for people who are very different from what you may have experienced, but be ready to save them, and care for them as if they are one of your family members.
Is there anything else that is important for fellow nurses to know?
Wearing the pink uniform is something that for the last four years I have been very proud of. It is to me like putting an “S” on my chest when getting ready for my shift. However, it is something that comes with a heavy responsibility and a possession of skills that I am expected to have and use when I walk through the doors of STC. My days are not blissful, my days are not easy, but they have been more rewarding at STC than they have my entire nursing career.
To shine a light on a deadly disease, World Hepatitis Day on July 28 gives this chronic liver infection the attention it deserves.
According to the World Health Organization, more than 300 million people worldwide are afflicted with hepatitis B (240 million) or hepatitis C (80 million). The infections contribute to approximately 1.4 million death annually, numbers similar to deaths caused by tuberculosis, HIV, and malaria. World Hepatitis Day calls attention to these staggering numbers, but also shows hope that the disease can be eliminated.
In fact, the Global Health Sector Strategy on Viral Hepatitis is an aggressive goal to eliminate viral hepatitis as a public health threat by 2030. Like other communicable infections, hepatitis is hard to control.
According to the sector report, the five strains of hepatitis infection (A, B, C, D, and E) can occur through different transmissions. Hepatitis B and C are blood-borne and can be spread through tainted medical practices, injections including drug use, mother-to-child at birth, and sexual contact. Hepatitis D is also blood-borne and only infects those with a co-infection of hepatitis B, so is preventable. Hepatitis A and E are spread through unsanitary food and water conditions. Neither of these causes a chronic infection and so do not pose a threat of long-term liver damage including cirrhosis and liver cancer, but can be miserable to cope with.
Luckily, hepatitis A, B, and E are preventable with a vaccine series (and hepatitis D by proxy of receiving the B vaccine series). There is no vaccine for hepatitis C, although it is preventable and new treatments can cure up to 90 percent of infections.
The challenge comes because hepatitis infections have not received the traditionally high attention of other communicable and preventable, although equally deadly diseases. Many people aren’t aware they are infected and can spread the disease unknowingly, and access to affordable, preventative vaccines and health care, accurate medical information, and government funding is spotty at best in some parts of the world.
Nurses can use World Hepatitis Day to inform patients about hepatitis infections and about their risk for infection. Remind them that hepatitis infects people globally and can happen in anyone—even sharing a razor with someone who is infected puts you at risk because of the potential exposure to bodily fluids. Talk to patients who might be at obvious risk (those who received blood transfusions, those who could be traveling to countries that might have active A and E problems, or those who have been IV drug users at any point in their lives or sexual partners of past or present IV drug users). Also have conversations with those whose risk is less obvious (those who might not discuss unsafe sex practices, who could have been infected during an unsanitary tattoo or piercing).
Discuss topics like prevention through available vaccines and safe practices around sexual activity, preventative hygiene habits (not sharing razors, toothbrushes), and drug use. Also be willing to guide patients to available testing and have some information about current treatments.
With such a push to end the threat of hepatitis across the globe, nurses can do their part from the close relationships they develop with patients. The earlier hepatitis infection is detected, the greater likelihood of starting treatment that can be potentially life-saving.
New student orientation at most colleges and universities starts within the next six weeks, and for new nursing students, the prospect is both exciting and daunting.
How can you make the transition to nursing school easier? Here are five tips.
1. Get to Know Your School
Follow your new school’s social channels. Twitter, Facebook, and LinkedIn offer excellent insights into what your school is all about, and they’ll probably even share tips that will help you. Check out the campus maps online, and take a virtual tour, so you’ll know where all the buildings are, where you might grab a bite to eat, and where you’ll find your classes and the gym.
2. Learn About the Area
Your campus might seem like a bubble, but it probably is an integral part of the wider community. Whether your school is in an urban center or a rural outpost, find out about the neighborhood. What’s around the school? How are students helping out in the community? Are there places that seem safer than others? Look at the local Chamber of Commerce to find out about nearby attractions and things to do.
3. Find Our About Your Courses
Nursing often has one of the most structured curriculum plans in any school. With so many required courses, it’s good to have an idea of what you’ll need to graduate. The school’s course catalog (often found online) is an excellent resource. Here, you’ll find out about the faculty in your department, the required courses and credits for your degree, and the course descriptions. If you know this, you’ll have a good idea of what your college courses should look like, and you’ll be less likely to be surprised by any forgotten requirements.
4. Meet People
Host or go to a gathering of students in your area. Join a Facebook group for your class and any of the clubs you’re interested in. Talk to your roommate in one way or another. If you are close enough, take a trip to campus to walk around and talk with people. Once you get to campus, you’ll be glad to meet up with familiar people.
5. Get Excited
Yes, this is like stepping into the big unknown. But, it’s also the start of a journey that will take you to one of the most rewarding careers possible. You’ll have successes and failures, and you’ll learn different things from both. Start envisioning this new path and welcome the changes it will bring.
DeeQuiency M. Donerson is studying in nursing school, but unlike some students, he already knows what he wants to be after he becomes an RN: a travel nurse. Since May 2010, Donerson has been working as a Certified Surgical Technician with Trustaff, and he likes what he does so much that he now wants to take on more and become a nurse.
“Every contract is 13-week assignments. I am almost always offered an extension because of my knowledge of surgical procedures. The longest contract I have done was nine months in Miami, Florida, which was a great experience,” says Donerson. “I wanted to become a traveler to gain as much experience as possible of surgical procedures, doctors’ preferences, instrumentation, and sterile supplies.”
Before 2007, Donerson wasn’t in the health care field at all. In fact, he worked as manual laborer making minimum wage. At the time, he even had to live out of his car. He decided that he wanted to attend surgical technology school, but when he had to fill out the application and include his address, Donerson wrote in his license plate number. Luckily for him, college staff realized that he was homeless and arranged for him to live in a dorm for the rest of that school year.
When a Trustaff representative spoke to college students about becoming a traveling health care worker, Donerson was interested. After graduating and getting a year of experience, Donerson became a travel CST. His first assignment was in the Virgin Islands. After that, he traveled the country, working in Louisiana, California, North Dakota, and in several cities in Florida.
Donerson says that he loves working with his recruiter, Danny Laurence. “He basically knows exactly what I’m thinking before each contract and after,” says Donerson. He also recommends that nurses thinking of becoming travel nurses be on a first-name basis with their recruiters. “Not having a great recruiter will more than likely end in disaster for a contract,” he says.
Marygrace Colucci (center) along with her supervisor/nurse manager Louise Esposito (right) and Marianna Vazquez, CNO (left)
Imagine moving to the United States from the Philippines and building a nursing and military career. That’s what Marygrace Colucci, RN, BSN, MSN, did when she migrated to the U.S. in 1995. Today, Colucci is living her lifelong dream as a staff RN in the ophthalmology operating room at Northwell Health at Syosset Hospital in New Hyde Park, New York.
In May, Colucci was honored with the Zuckerberg Nursing Excellence Award during National Nurses Week. The award recognizes exceptional nurses at Northwell Health.
“Ever since I was a little girl, I wanted to be a nurse,” Colucci says. “I have seven siblings, so my parents could only send me to a two-year midwifery program due to the financial constraint to support a four-year BSN program. I graduated at 18, passed the midwifery board but couldn’t get my license until I was 21 years old. I started working as a midwife in the hospital with just a permit, and I remember having so much fun delivering babies, and assisting in C-section procedures.”
Colucci says that when she first arrived in the U.S., it was a huge culture shock. “I missed my family and friends. I was homesick, but eventually got over it,” she says. “I was afraid to talk to people because of the language barrier; not because I didn’t know how to speak the language, but more because I was shy of my English and my accent.”
Colucci was inspired by her cousin who served in the U.S. Army as a nurse. “He was sort of my role model, and that is why I joined the Army Reserve in 1998,” Colucci says. “Joining the Army helped me overcome most of the challenges I had to face back then such as the language barrier, being shy, and lacking self-confidence. The Army taught me how to face all kinds of adversity. I’d have to say the Army really turned me into the kind of person I am today.”
Another supportive influence for Colucci has been her husband. “When I graduated with my associate’s degree in nursing, he told me I should go back to school, which I intended to do anyway. I went on to finish my BSN, and he told me again that I should go for my master’s, which I intended on doing. But him pushing me to go further was really a good motivator. And now that I’m done with my NP, he said go for your doctorate, which I’m still considering.”
Colucci says for now she is focusing on her military career. She hopes to be promoted to major in the future. “I also want to focus on helping soldiers from my unit, which I am currently commanding,” she says. “I try to motivate my soldiers and tell them that they can do so much with their skills, and that there are so many opportunities available if they’ll just work hard for everything that they want to achieve.”
“I also tell my fellow Filipino coworkers to advance their education by going back to school,” she says. “I told them that if I can do it, so can they. I’m not really smart; I just happen to be disciplined and really put a lot of time and effort into everything I set my mind on achieving.”
Colucci sees herself working in emergency medicine in the future. “I had a great time when I was doing my clinical at the urgent care centers. I told myself I will embark in that field if given the chance. I think emergency medicine is a very good and rewarding field to practice. I would like to be promoted to major in the next two years; and eventually to lieutenant colonel in the Army Nurse Corps.”
According to the HIMSS 2017 Nursing Informatics Workforce Survey, nursing informaticists are in a growing field that offers a rewarding career move and one that also helps to advance the field of nursing. Nursing informaticists use their nursing backgrounds, cutting-edge technology, and all the data, communication, and information that is produced in the field to make a healthier world.
According to the American Medical Informatics Association, nurse informaticists are challenged with a wide set of responsibilities, most of which focus on the systems and technologies in which patient information, healthcare results, and research findings are used, stored, and connected. Survey respondents classified their jobs into three main categories: systems implementation, utilization and optimization, and systems development.
Some informaticists tasks include building regional and nationally connected data and communication systems, determining the best ways to ensure that research findings are accessible through practice, promoting information presentation and retrieval in a manner that supports safe patient care, and even defining healthcare policies.
According to the survey, nearly half of the respondents reported great career satisfaction earning salaries of more than $100,000. Because the field is progressing so rapidly, given the technological developments, nursing informaticists receive both on-the-job training and additional training. Forty-one percent of the respondents said they are participating in some kind of degree program to get additional training—including a formal degree program or a non-degree degree program or coursework.
Many nursing informaticists are registered nurses and then go on to earn a bachelor’s or master’s in nursing to gain expertise in the field. Some nursing informaticists might earn an advanced degree in an information technology area like computer science. For those looking to earn an advanced degree, scholarships are available through the American Nursing Informatics Association.
If you are interested in nurse informatics, certification from the American Nurses Credentialing Center is also available and the survey results showed that about 51 percent of respondents indicated they would be pursuing some kind of certification and that they thought this additional education would have a positive impact on their careers.
If you’re a nurse who enjoys technology, check out this branch of nursing.