You worked hard to obtain your nursing license. As a minority, you had to overcome barriers many of your fellow students and current colleagues never had to address or consider. And now that you are here and building your career, it is up to you to protect it. Unfortunately, one small mistake at work or a less-than-professional occurrence in your personal life could lead to a license suspension or revocation. While you may not be able to eliminate this risk, there are ways to mitigate the risk of a complaint against you and disciplinary action.
Here are five steps you can take on a daily basis to protect your nursing license.
1. Focus on communication.
You need to clearly communicate the information you have to others. Breakdowns in communication between nurses, physicians, and other medical professionals lead to medical errors and poor outcomes for patients. Ensuring you communicate as best you can with your colleagues requires reviewing your facility’s systems and procedures, and then working within them as best you can. It may also require being vocal about improvements that could be made.
2. Always follow facility protocol.
When working in a stressful and fast-paced environment, there may come a time when someone wants to take a short cut. You may be asked to do something out of line with your facility’s procedures and policies. Always say no. If you believe what you are being asked to do is unethical per your state’s nursing board’s standards, refuse. It is always up to you to ensure your actions align with the law, your profession’s ethical standards, and your facility’s guidelines. Also, if you are not entirely sure of your facility’s protocols related to your position, it is up to you to learn them. Ignorance of a policy is never a defense.
3. Avoid relying on coworkers.
You want to be able to rely on your colleagues and help each other out from time-to-time. However, it is safest to assume that if something is your responsibility, you need to ensure it gets done. Do not ask your coworkers for favors. When something is your task, it will be on you if it goes wrong. Also, if a task could be done by more than one of you on duty, never assume someone else will get to it.
4. Keep your social media profiles private.
While it is perfectly OK to have social media profiles as a nurse, you must remember that everything you post online reflects upon you as an individual and professional. Aspects of your personal life can negatively impact your license and position. Because of this, keep your social media restricted to friends and family and be careful about what you post. If you are not sure how colleagues or your supervisors would take a comment, tweet, picture, or video, err on the side of caution and keep it offline.
5. Assume someone is watching.
No one wants to look over their shoulders all the time. However, nursing is heavily regulated and state boards are quick to suspend or revoke licenses. It is up to you to ensure your actions are above reproach. If you assume that all of your actions at work will be seen and judged, you have a consistent reminder to complete your tasks yourself, follow protocol, and communicate with your colleagues.
Have You Received a Letter From Your State Board?
Learning that someone has filed a complaint against you, and now you are subject of a board investigation, is all too common in the nursing profession. How you handle this information next matters. Your first instinct may be to try and deal with situation on your own. You may feel a simple explanation will clear things up. Unfortunately, that is rarely the case. Instead, you should contact an attorney who is experienced in administrative law and professional licensure. With an attorney on your side, you have someone who will protect your rights and fight for you to retain your nursing license.
A nursing license defense attorney can evaluate your situation and help you understand your options.
February 5 through 11 is a national observance of National PeriAnesthesia Nurse Awareness Week, sponsored by the American Society of PeriAnesthesia Nurses (ASPAN). Nurses who help transition patients pre- and post-procedure are there to offer intensive medical care and equally essential caregiving. They especially want patients to know they are there for them. They are their advocates throughout the process.
If you are interested in a career as a perianesthesia nurse, you’ll find the challenges of the position range from using your advanced nursing skills in urgent situations to incorporating the most basic hands-on comfort skills. Charged with caring for patients at critical pre- and post-procedure points, perianesthesia nurses must be able to multitask, to identify and respond to patient conditions immediately, and to do this all with a calm demeanor to help keep patient stress at bay.
Perianesthesia nurses especially enjoy their work caring for patients before and after procedures that require any anesthesia. Before a procedure, they are the nurses who are there to find out any information that could have an impact on the anesthesia care. With more and more patients appearing with several health conditions, they have to factor in variables like medications, physical condition and limitations, and emotional stability in their patient assessment. While they are assessing and gathering information, they are also providing a calm and unwavering support to help nervous patients know they are in trusted hands.
Perianesthesia nurses are also there when patients come out of anesthesia and are sometimes confused, uncomfortable, or even nauseated or vomiting. Post-procedure, nurses are once again continually monitoring a patient, assessing vital signs, reassessing existing health conditions, and at the same time, offering that hands-on caregiving that helps patients feel safe. Perianesthesia nurses then help determine how a patient can safely move to their next place whether that is to home, another hospital, or another care facility.
Many perianesthesia nurses say they have perfected a way to develop a rapport with patients that can build the trust necessary for completing such a long task list in a short time and under pressure. Once a nurse has identified a topic that helps the patient relax, they can begin conversations about family, pets, schooling, movies, or books that are both informative for nurses and distracting for patients. Many nurses also say they use those nuggets in the conversation to help bring a patient out of a drowsy and sometimes confused anesthesia.
For those considering this branch of nursing, ASPAN offers many resources and is an excellent reference to find out information about certification (through the American Board of Perianesthesia Nursing Certification, Inc.) that must be renewed every three years, scholarships for education, career resources, mentoring opportunities, conferences, and up-to-date anesthesia information.
This week, recognize and appreciate the perianesthesia nurses on your team. Their skills often help the entire procedure proceed smoothly and safely.
The connections between the eye and the brain have been well known and established for centuries. Indeed in a sense the eye is a part of the brain. Often described as the window of the soul, the eye can actually be a window onto our cognitive and neurological functions, being a visible and accessible organ that frequently reflects changes in the larger network.
Conditions such as Alzheimer’s disease, Parkinson’s disease and even Multiple Sclerosis can have eye-based indicators. On a more basic level, the excessive avoidance of eye contact can be suggestive of autism. With roughly 83% of our perception, learning, cognition and activity mediated via sight, the eye is by far our most important sensory organ.
Across the globe eye disease is reaching epidemic proportions. According to a study published in The Lancet last year, in 2015 36 million people worldwide were blind, while a further 217 million were suffering from moderate or severe distance vision impairment. Glaucoma in Asia and Africa is a huge problem that is still on the increase, but the shocking (if hopeful) fact is that 75% of visual impairment is avoidable. 1.1bn people are vision impaired because they don’t have access to spectacles. That is a failure of social, economic and political causes rather than a scientific one. In the meantime, the development of new treatment methods and technology could see the possibilities for full and partial restoration of sight increase dramatically over the next few years.
Rohit Varma, MD, MPH, is a world leader in the study of eye disease. He has recently been researching new imaging techniques in early diagnosis of glaucomatous optic nerve damage and is involved in developing implantable intraocular pressure sensors and drainage devices. He is particularly concerned with studying eye disease in minority populations.
Elsewhere, implantable visual prosthetics have been developed by companies in California (Second Sight), Germany (Retina Implant AG), and France (Pixium Vision), while ground-breaking trials have been carried out in the UK. In 2015, Manchester surgeons restored partial sight to a blind, 80-year-old sufferer from age-related macular degeneration (AMD) using a visual prosthetic, while in 2016 a blind woman was successfully given a “bionic eye” at Oxford Eye Hospital.
So-called bionic eyes stimulate the brain with light from a tiny video camera, but scientists have also begun researching ways to restore vision by working directly on the brain, bypassing the eye altogether. We perceive patterns of light as a result of electrical impulses delivered to the visual cortex. On this basis, Second Sight has begun developing a device that generates similar electrical signals and hopes to recreate some degree of visual perception without working on the eye at all.
In recent years we have seen a huge and helpful boom in smartphone apps to diagnose medical disorders. The applications have also been employed in treating eye conditions. Peek Retina is a portable ophthalmoscope in the form of an app on your phone that can be used to capture and record retinal images and to measure visual acuity. It has been successfully used in diagnosis in remote areas such as sub-Saharan Africa.
EyeNetra meanwhile have developed a diagnostic device for easily spotting refractive errors. A headset is combined with an app to flag up errors in perception and to recommend the correct eyeglass prescription.
Advances in treatment of the eye could also be made possible using the CRISPR-Cas9 gene editing technique. CRISPR has been used to repair a genetic mutation producing retinitis pigmentosa in induced pluripotent stem cells from a patient suffering from the disease. Research at the Center for Genome Engineering at the Institute for Basic Science suggests that CRISPR can be used to correct the effects of non-hereditary conditions as well as inherited ones, following gene surgery on mice suffering from AMD.
It is to be hoped that research will provide us with a better understanding of the connections between the eye and the brain, and the way in which vision works, as well as providing practical solutions to the widespread problems of blindness and vision impairment. Speculation that virtual reality technology might one day be able to recreate our full field of vision within the visual cortex may seem far-fetched but is not beyond the bounds of possibility. Whether brain diseases and even mental illness can ever be treated using similar methods remains to be seen. When we recall that what we see is an interpretation of the world rather than the world as it is, it may be thought that problems of adjustment and understanding could be literally related to how we see things after all.
This month, New York University (NYU) Rory Meyers College of Nursing welcomed Jacquelyn Taylor, PhD, PNP-BC, RN, FAHA, FAAN, as the inaugural Vernice D. Ferguson Professor in Health Equity.
Taylor has already had a notable career. In January 2017, she was awarded the Presidential Early Career Award for Scientists and Engineers by President Barack Obama, the highest honor awarded by the federal government to scientists and engineers, where she will examine next-generation sequencing-environment interactions on cardiovascular outcomes among African Americans.
Vernice D. Ferguson (1928-2012) was a distinguished nurse leader, educator, and executive who championed the health of all people throughout her career. Ferguson, who received a baccalaureate in nursing from NYU, pioneered leadership positions for nurses and elevated the nursing profession through advocating for increased opportunities, respect, and wages, as well as fostering nursing research.
Taylor says it’s a tremendous honor to be selected to serve as the inaugural Vernice D. Ferguson Professor in Health Equity. “It is my sincere hope that the research I lead is as beneficial to the public as the work of the iconic Vernice D. Ferguson.”
Over the course of Taylor’s career her work has focused on health equity in Black populations for common and chronic diseases such as hypertension, both in the United States and in Africa.
“African Americans have the highest incidence and prevalence of hypertension than any other ethnic group in the U.S.,” says Taylor. “In particular, African American women have the highest incidence and prevalence of hypertension than any ethnicity or gender. Understanding the genomic underpinnings and social factors that contribute to this disparity can help providers to intervene early in life to eliminate such disparities. On a personal level, my father had hypertension and had a stroke, and my mother had cardiovascular complications as well. I would like for the work that I do to help others to avoid these complications.”
Another primary goal for Taylor is to study the genomics of lead poising in Flint, Michigan. She says the purpose of this project is to better understand the harmful effects of chronic lead exposure, the psychosocial insults of the Flint water crisis, and the underlying omic mechanisms involved that may contribute to increases in blood pressure in this already at-risk African American population in Flint.
“An intergenerational, multi-omic (genetic and epigenetic), and psychosocial approach will be utilized to understand one of the major symptoms of chronic lead exposure—high blood pressure—among African American families in Flint,” Taylor explains. “This research will provide critical insights that will add a layer of functional outcomes for health providers to best understand, assess, and intervene with tailored treatments based on an individual’s unique environmental, omic, and psychosocial profile and will help in mitigating long-term cardiovascular and other health risks.”
Taylor says her primary goal during her professorship is to continue to build on the work she has done in omic-environment interaction studies among minority populations by utilizing multiple advanced genomic techniques and expanding to more minority populations across the USA and abroad.
“I would also like to expand my reach as a leader in nursing science by taking on a more key administrative role that will aid in building up the next cadre of minority nurse scientists.”
With suicide rates rising and an alarming number of teens and young adults at serious risk for suicide, many health professionals are not fully prepared to recognize a patient’s psychiatric difficulties. A team of researchers at the National Institute of Mental Health (NIMH) recently came up with the ASQ Toolkit, a simple four-question survey for health professionals to help identify and get help for at-risk youth.
NIMH’s Division of Intramural Research Programs created the free Ask Suicide-Screening Questions (ASQ) Toolkit that can be used in various medical settings. According to the NIMH, the toolkit (available in many languages) is easy to use, making it effective in many settings including emergency departments, outpatient clinics, primary care offices, and inpatient medical/surgical units.
Before using the toolkit, organizations must have a plan in place to have a standard set of effective next steps for patients who do test with an outcome that indicates they are at risk. Whether that is a further evaluation with an on-site mental health counselor or another trained professional, the toolkit isn’t meant to be used without a follow-up plan.
No matter what their area of practice or setting, nurses and physicians can quickly assess patients by asking the four questions in the toolkit. If a patient answers yes to any of the questions, it’s a red flag for the medical professionals to consider the patient at risk for suicidal thoughts and behaviors. From there, the toolkit offers guidance on the next steps that will be most helpful for the patient and will also help them access the help they need.
Gaining this extra knowledge is essential skill to have no matter who your general patient population is. According to the World Health Organization, “Suicide accounted for 1.4% of all deaths worldwide, making it the 17th leading cause of death in 2015.” With such astounding facts, it’s imperative that nurses are able to have the tools to support them in identifying youth who might be at-risk. To help that, the toolkit even offers scripts like this nursing script for emergency room settings or this nursing script for inpatient medical/surgical settings.
The toolkit’s importance is highlighted in the rising numbers of youth who die by suicide. But underneath those shocking numbers are the hidden numbers of even greater numbers of people who are suffering with thoughts of suicide or even attempts at suicide. In fact, the American Foundation for Suicide Prevention estimates that for each person who dies from suicide (all ages), 25 more make a suicide attempt. Early intervention by healthcare professionals who can identify the risk and then have the resources to help the patient can be a turning point for the youth.
The ASQ Toolkit is only one resource for nurses to use in helping patients in a mental-health crisis or who are suffering from long-term suicidal ideation. With proper steps in place to help patients who do screen positive, it is also a potentially life-saving tool that healthcare setting and organizations might find worth investigating.
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.”