One of the most common but preventable hospital-acquired infections is a central line-associated bloodstream infection (CLABSI), also known as a catheter-related bloodstream infection. There are approximately 250,000 cases annually in hospitals across the country, including 80,000 in intensive care units according to a study published in the Clinical Journal of Oncology Nursing. Additionally, CLABSIs cost over $6 billion health care dollars and about 50,000 preventable deaths per a study published in the Journal of Infusion Nursing.
Bedside nurses have the responsibility to implement the right interventions to prevent them. Appropriate training and education in central line management can go a long way in preventing this problem. Nurses are in a unique position to prevent CLABSIs across the health care spectrum. It would not be an overstretch to say that CLABSI prevention is completely a nursing responsibility. Let us consider the current health care scenario: the nursing scope of practice has increased vastly over the past decade and our profession continues to gain significance.
The most common central used in acute care—peripherally inserted central catheter (PICC) lines—are mostly inserted by specially trained nurses. It is also the bedside nurse that accesses the central line to administer medications, obtain blood samples, et cetera. Finally, when the patient is discharged and does not need the central line, it is the bedside nurse that discontinues and removes the line safely. Granted, few central lines are accessed by radiology and rarely by doctors, but the bottom line is that nurses are the ones inserting, maintaining, and removing the lines.
Two distinct situations place patients at a risk of acquiring a CLABSI: insertion and hub manipulation for blood sampling, medication administration, and routine line maintenance. Improper skin cleansing before insertion of the central line poses the risk of introducing deadly pathogens into the bloodstream. The hub, or needleless catheters, are known for harboring biofilms (e.g., bacterial colonies), which can enter the bloodstream during care episodes that involve hub manipulation. One of the most common sources of a CLABSI is the frequent hub manipulation by nursing for care purposes.
What can frontline nurses do to prevent CLABSIs?
The Centers for Disease Control and Prevention and the Infusion Nurses Society provide the following guidelines on insertion, care, and maintenance of central lines:
- Maintain a closed system.
- Scrub access ports (needleless caps) with antiseptic solution (70% alcohol) for at least 15-20 seconds before access.
- Use intermittent infusion caps of luer-lock design to ensure a secure junction.
- Change hubs or needleless connectors when it is removed from the line; if there is blood/debris within the cap; prior to blood sampling; upon known contamination; and per organization or manufacturer guidelines, policies or practice procedures.
- Change hubs or needleless connectors before and after blood sampling provides greater protection to the patient.
The Journal of Infusion Nursing study found that two beliefs among nurses predisposed them to disinfect the needleless cap before manipulation: nurses’ perceptions of peer beliefs regarding disinfection and personal belief that not cleaning the cap will increase the likelihood of patient acquiring an infection. Another significant finding of the study is that older and more experienced nurses were “less likely to consistently use the best practice disinfection techniques” while manipulating needleless IV systems.
One of the biggest lessons we can take from these studies and statistics is the fact that nurses have the power to prevent infection. The researchers found that some older and more experienced nurses tend to neglect disinfection practices, but it is important to remember that nursing is about caring for the patient. Education departments of hospitals can remind nurses by conducting classes on the fundamental values of nursing: caring, patient advocacy, beneficence, non-malfeasance, and so on.
Sometimes patients are discharged home with central lines in place for long-term antibiotic therapy or chemotherapy. Educating the patients and families on the best practices of central line care and infection prevention is the responsibility of nursing staff. Making patients and caregivers partners in therapy by creating educational materials in simple language will help motivate adult learners to assimilate the knowledge. An interactive nurse-led demonstration accompanied by an illustrated guide to best practices of central line management will ensure compliance to strict infection prevention practices. Again, this responsibility of educating patients falls on nurses, and patient education is a powerful tool to prevent CLABSIs. Education empowers the patient and gives them ownership of their own care and condition.
To sum up, evidence-based research points to the fact that frontline nurses are the main stakeholders in CLABSI prevention. Improving practice to prevent CLABSIs will not only save about $6 billion annually, but it will also ensure that 50,000 more patients survive hospitalization and go home to their loved ones. It is up to nurses to make hospitals places to get treatment, rest, and rejuvenation, rather than scary buildings where one remains on the edge of acquiring a hospital-acquired infection. Nurses have been making a difference in patient outcomes for several decades—and now is the time to up the ante.
In part one of this two-part series, we illustrated the types of prejudice and stereotypes that male nurses can often face. What happens, though, when male nurses experience it? What can or should they do?
What to Say
If confronted by someone who believes that men don’t belong in nursing, you should be professional and take the opportunity to educate them. “I would tell them to check the data,” says Donnell Carter, MBA, MS, CRNA, clinical staff nurse anesthetist at Saint Vincent’s Hospital in Worcester, Massachusetts. “Many men are turning to nursing because it is a secure and rewarding profession with plenty of opportunities for personal growth. Nurse anesthetists, in particular, practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.”
Tell them to walk the walk. “I would ask them to join me for 12 hours and see if they could do what I do. Walk a mile in my clogs,” says Jeremy Scott, MSN, RN, CCRN, a resource pool nurse at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania.
Look into history. Kody Colombraro, LPN, EMT-B, a hospice care consultant at Regency Hospital in Augusta, Georgia, suggests that you give them a history lesson. “If it hadn’t been for the crusades, males would still be the dominate sex in nursing. The first nurses were the Knights of Hospitaller, also known as the Order of St. John. They were believed to have been the medical caregivers to the Knights of Templar. It wasn’t until Templar numbers decreased that they were militarized and sent to battle.” When that happened, women began filling the need for nurses.
Ask Why? Les Rodriguez, MSN, MPH, RN, ACNS-BC, APRN, clinical nurse specialist/clinical education specialist pain management for Methodist Richardson Medical Center in Richardson, Texas asks them why they think that way. “Men are just as capable of being nursing as women are in being physicians. Men are just as capable at being nurturing, compassionate, empathetic, and caring as women are,” he says. “We have females in the battlefield, flying planes, and running corporations. Why can’t and shouldn’t a man be a nurse?”
Enlighten Them. “When you consider the aging and declining health in America, I firmly believe that we will need every man and woman who aspires to to be a registered nurse,” says Dave Hanson, MSN, RN, ACNS-BC, NEA-BC, regional director of nursing practice, education, and professional development at Providence Health & Services Southern California in Burbank, California. “According to the 2010 Institute of Medicine (IOM) report, The Future of Nursing: Leading Change, Advancing Health, men provide a unique perspective and set of skills that are important to the profession and society. The IOM report also noted that the nursing profession needs more diversity—in gender as well as ethnicity.”
What Action to Take
If you’re a male nurse and dealing with stereotypes, prejudice, and/or discrimination, there are actions you can take. “Discrimination is a big problem. If any nurse is being discriminated against, he or she should contact human resources, their union representative, and, if needed, a lawyer,” advises Basler.
“The first stop should be their nurse manager—unless that is an issue. Then, human resources—unless that is an issue, with the next stop being an attorney on the way to a new job,” says Scott. “I personally would not deal with nonsense.”
Regarding stereotypes, they still exist, and, for some people, always will. But male nurses can do their part to help eliminate them. “One way to dispel stereotypes is to understand that it’s typical to have variations within any group, including the nursing profession. Recognizing and respecting the diversity that exists within the nursing workforce is what will strengthen and grow our profession,” explains Hanson. “It’s essential for the larger community of registered nurses to stand together to advocate for ongoing education, research, policy, and dissemination of information about men’s health issues and men in nursing.”
And be all that you can be. “Do an outstanding job and go above and beyond for their patients and team members,” says Carter. “I would also recommend seeking leadership, teaching or mentoring experiences to help change public perceptions. It’s important for men to actively seek to change the face of nursing by highlighting their diversity.”
Carter continues: “My career has rewarded me with many opportunities. The face of nursing has truly changed over the last two decades. I expect that more men will decide to pursue a career in nursing in the future.”
Concentrate on the job at hand. “Just keep your nose to the grindstone and surpass all negativity,” says Robert Whigham, RN, a staff nurse at Doctors Hospital in Augusta, Georgia. “Watch your life flourish.”
“You decided to join a profession that has been dominated by women for generations,” says Jonathan S. Basler, RN, a clinical nurse at West Front Primary Care in Traverse City, Michigan. “Choose your mentors wisely and be the best nurse you can be. Let your knowledge, skills, and compassion define you as a nurse—and not your gender.”
With nearly 30 million people nationwide living with diabetes nationwide, it’s no wonder that the disease is a national issue. But diabetes hits racial and ethnic minority populations especially hard, so it’s helpful to take the time to help your patients who might be more vulnerable to diabetes.
November is designated as National Diabetes Month – a great opportunity to remind patients with diabetes of the importance of self-care and consistent medical care. But it’s also an opportunity to speak with patients who don’t have the disease but are at a higher risk for it about prevention and being alert to any trouble.
Because it’s silent, many people don’t take the potential complications from diabetes seriously enough until it’s too late. Urging all patients to keep their blood sugar in check is essential, but according to the FDA, minority populations also need to know that their heritage can put them at an even greater risk of not only having diabetes, but also experiencing more severe complications and having worse outcomes.
According to CDC survey results, Hispanic or Latino adults and non-Hispanic or Latino black adults have a 13.9 and 13.8 percent of the population with diabetes compared to 6.6 percent for non-Hispanic or Latino white populations. With such a disparity, it’s clear that education and care are crucial to keeping diabetes symptoms in control.
As usual, discussions about healthy habits like eating well, exercising, getting enough sleep, stress management, and being monitored for any problems or complications can’t be neglected.
Easy enough, but every nurse knows that patients often hear what they want to hear. Or maybe they hear it, but their cultural expectations or beliefs, living situations, or other barriers interfere with what they need to do.
This month, take the extra time to dig deeper and find out what your patients might have getting in the way of good diabetes management or self care in general. Do they have access to fresh foods? Transportation to doctor’s appointments? A comfortable, quiet place to sleep? Are they experiencing any pain that’s keeping them from exercising?
By asking a few more questions, you might be able to uncover important information that can give you insight into your patients’ lives and can help you find solutions for them. You might not be able to fix everything, but if you can fix something, it can be an enormous help. And when a patient feels listened to, the trust you build is especially valuable.
Many people experience some kind of discrimination, stereotyping, or even prejudice against them at some point in their lives because of their race, sex, sexual orientation—and even sometimes because of their jobs.
While more and more men are entering the nursing field, it’s still a profession that is primarily comprised of women. So we asked a number of male nurses what they’ve experienced, how they’ve dealt with it, and their advice for other nurses who may experience something similar.
In this article, we begin with what kinds of stereotypes they’ve experienced.
Are You the Doctor?
Nearly every male nurse we interviewed said that he had, at least at one time, been mistaken for a doctor. They all, though, handle it in their own ways.
“I have walked into an exam room where a patient is waiting, and before I had a chance to introduce myself, they said, ‘I thought I was seeing Dr. Weber.’ I just smile and say, ‘You are seeing Dr. Weber. You just get to see me first. I’m Jonathan. I’m a nurse, and I’m going to check your INR before he comes in,’” explains Jonathan S. Basler, RN, a clinical nurse at West Front Primary Care in Traverse City, Michigan. “Then they usually say, ‘You’re not as pretty as his old nurse.’ When I worked in nursing homes, it was common for me to hear, ‘Thanks, Doc!’ as I was leaving a room—and it didn’t matter how many times I introduced myself as their nurse.”
Keynan Hobbs, MSN, RN, PMHCNS-BC, a clinical nurse on the PTSD Clinical Team at VA San Diego Healthcare in California, says that he is mistaken for a doctor all the time and was even back in nursing school. “It happened even more when I moved into an advanced-practice nursing role and wore a white lab coat every day,” he says. Because he works in psychotherapy now, he is often called “doctor.” His response is, “I’m not a doctor; I’m an advanced-practice nurse, and you can call me Keynan or Mr. Hobbs.” Although he doesn’t find this now in psychotherapy, he says that when working in a hospital, “People would look right past me when I told them I was a nurse because some see nurses as less powerful in that setting.”
Sometimes, nurses use humor. Jeremy Scott, MSN, RN, CCRN, a resource pool nurse at Penn Presbyterian Medical Center in Philadelphia, Pennsylvania, says that patients will sometimes be on the phone, and when he walks into a room they say to the person they’re talking to, “My doctor is here. I have to go.” He then tells them that he is their nurse. “People have asked, ‘When will you go back to become a doctor?’ and I jokingly tell them, ‘I’m not interested in all those loans. I enjoy being a nurse.’”
It’s Not You, It’s Me
Sometimes, patients or their family members don’t want a male nurse—simply because he’s a guy.
“I’ve experienced stereotyping as a male nurse. I’ve had patients tell me they don’t want me to be their nurse. I’ve been called gay. I’ve been told by family members that they don’t want me to care for their loved one,” says Carl A. Brown, RN, BSN, director of patient care services for BrightStar Care of Western Riverside County in Sun City, California. “As a nurse—but especially as a male nurse—you need to have a strong outside to let those comments bounce off. But you also need to have a warm heart for those who hold the prejudices. I think it is important for people to know that my gender does not prevent me from providing quality care to each of my clients.”
There are instances in which patients will request a female nurse because of religious reasons. “I respect patients’ wishes because they are in control of the management of their health, so I simply switch assignments. I’m never offended by this,” says Donnell Carter, MBA, MS, CRNA, a clinical staff nurse anesthetist for Northstar Anesthesia at Saint Vincent’s Hospital in Worcester, Massachusetts.
Robert Whigham, RN, a staff nurse at Doctors Hospital in Augusta, Georgia says that it’s common for patients to have preconceived notions about his level of compassion because he is a guy. He’s found that patients in maternity wards and pediatrics may ask for someone else. “They are sometimes uncomfortable with a male nurse helping them,” he says.
In the psychological setting, Hobbs says that “someone who has experienced sexual trauma and doesn’t feel comfortable talking to a man about it” may ask for a female therapist. If they later want to talk with a male, he says that he will be available for them.
Specific Stereotypes for Male Nurses
Les Rodriguez, MSN, MPH, RN, ACNS-BC, APRN, clinical nurse specialist/clinical education specialist pain management at Methodist Richardson Medical Center in Richardson, Texas, says that while in his more than 30-year career as a nurse he hasn’t experienced discrimination, he has come across stereotypes that people think regarding male nurses. They are: all male nurses are gay, men only get into nursing so they can see women naked, men who become nurses are failed doctors, and men go into nursing because it’s easy.
Rodriguez disputes all of them: “In my experience, the number of male nurses who identify as gay is not greater than that reported in the general population. [Re: Seeing women naked] That is an expensive and long, drawn out way just to see what you could see in magazines or strip bars. [Re: Failed doctors] This has to do with relegating the physician to a higher order of professional…Yes, there are some individuals who were in medical school and didn’t survive the program for various reasons, and so they took their academic credits and directed them towards nursing. That does not make them ‘failed doctors.’ It makes them very knowledgeable nurses. [Re: It’s easy] That nursing is easy is a major myth. You are required to learn a lot of detailed information in a very short time…Nursing is not an easy profession, and many males that I have encountered go into nursing because they have a caring disposition.”
Now that we’ve outlined what some of the prejudices and/or stereotypes are regarding male nurses, the next step is to educate them on what they can do. Stay tuned for part two of our series next week where we’ll explore the actions that male nurses can take.
I had never received the backhanded compliment of “oh, she has such a pretty face” until recently. That was a compliment reserved for fat women. I did not consider myself fat at all. I would describe myself as overweight, but never fat. If I could still purchase clothing out of regular department stores, I did not believe myself to be obese. Even when I was hospitalized last year and the doctor’s notes said “…obese, 47yrs old female,” it did not truly register. However, once my vanity was attacked it hit home.
Sometimes, I see myself in the mirror and wonder how did it get to be this way. I am 5’4″. I weigh 210 lbs and am a Registered Nurse! Euphemisms like “thick,”” full-figured,” and ” healthy” only mask what I know to be the truth. This body that I live in is well on its way to diabetes and hypertension. Thankfully, in this moment I do not have any of those diseases, but it is just a matter of when, not if.
Being overweight has affected my self-esteem, my sense of self-worth, my self-love. It feels like a self-inflicted punishment. When I think back to when I was slim and feeling good, it almost brings me to tears. I start asking myself how did I let it get this out of hand? Why didn’t I just get up from the table? Stop eating at fast food restaurants? Continue to exercise? I am not a fat person who does not know how I got fat. I know exactly what I did, which I think makes it all the worse.
There are times I find it difficult to teach my patients about health and wellness. I wonder if they are looking at me and finding me a hypocrite. Or are they realizing that I, too, understand how hard it is to walk that path.
The heavier I became, the more crap I accepted from the men I dated. I no longer felt I that should be respected or loved entirely. Glad that they were in my life was enough. Trust me, when you do not love you, no one else does either. I stayed with a man who told me that he did not usually date “big girls.” So, I sat wondering, should I feel special that you chose me? I found myself always trying to overcompensate for not being thin, for not being his ideal of beauty. I was showing him that my love was not worth it because it did not come in a perfect size 4, 6, or 8. I was depleted walking out of that one.
So now at this juncture, I am ready to lose the weight. I mean do what is necessary to get to where I feel comfortable in my skin. This is not simply about my vanity, but about my life, my health, and self-love. So, I am inviting you on this journey with me. Come along.
Hi, I’m Erika.
This year’s presidential election is affecting just about everyone. It’s causing so much stress, arguments, and overall negativity, that we couldn’t even get any nurses to go on record with tips on how they remain less stressed in this crazed political time and help their patients remain so as well. Many were concerned that if they gave their opinions—even about how to help others—that because it had to do with politics, they may be reprimanded or even possibly lose their jobs.
That says a lot. Most nurses love to help other nurses. But in this case, the fear was tangible.
Instead, we contacted professionals in the mental health field to get their advice on what you can do to reduce your stress in this final week before the presidential election and how to keep it reduced after it’s over.
Use the Oxygen Mask First
If you’ve ever flown on an airplane, you know that the flight attendant always instructs people that in case of an emergency, to put your own oxygen mask on first. You won’t be any good to others, if you can’t breathe yourself.
The same case applies with lowering your stress. “In ‘helping’ professions, it is common for providers to ignore their own needs. Focusing on self-care, though, is critical during high-stress times like election season,” says Lisa Long, PsyD, a licensed psychologist, executive coach, and interventionist as well as owner of a private practice in Charlotte, North Carolina. “Taking a personal inventory of one’s stress level and well-being is a good start. Paying attention to yourself is a major aspect of doing and feeling your best. If you notice changes in yourself and how you are feeling, make the time to get connected with people you can talk to. Keep a list of things that make you feel relaxed, and make time to do at least one—even when you feel you have the least amount of time for it. Listen to your own body and needs—just like you do with your patients.”
Laura Dzurec, PhD, PHMCNS-BC, ANEF, FAAN, a dean and professor of the Widener University School of Nursing in Chester, Pennsylvania, says that recognizing that an individual, emotional response is not going to change the election is an important first step in lowering your stress. “The stresses accompanying the debates, deliberations, discussions, and arguments surrounding the presidential election have encouraged emotional responses,” she explains. “One important tip to use in lowering stress is to pay attention to personal responses. Are they defensive? Angry? Anxious? By backing away from pointless debates and thinking through responses that are immediate, nurses can lower their own stresses regarding what’s happening with the election.”
Tips To Help You Reduce Your Stress
Let’s face it—although we’ll get some relief after Election Day, there will still be fallout for some time no matter which candidate wins. Now that you have been reminded to take care of yourself first, what can you do?
“Humor is a fantastic coping strategy when it comes to situations that seem out of our control. Think of all the political parodies at the current time. Turning to humor helps reduce the experience of stress,” says Marni Amsellem, PhD, a licensed psychologist with a private practice specializing in health psychology. “Another great strategy—regardless of the stressor—is trying to tune out or take some time away from the stressor. For example, if the negativity of the conversation happening around you is becoming overwhelming, temporarily remove yourself from the situation, turn off the TV, take a social media holiday, and the like.”
One of the easiest things you can do is just breathe. “My tip for all nurses is to set the alarms on their watches or cell phones to remind themselves several times per day to perform two activities—breathe and practice mindfulness. Three nice deep breaths several times a day can do a world of good to clear the mind and refresh the body. As for mindfulness, take a few seconds, clearing the mind of all thoughts except for noticing the temperature in the room and being mindful of all safely and calmness,” recommends Mary Berst, PhD, the associate program director of Sovereign Health Group in Palm Desert, California.
Amy Oestreicher, a PTSD peer-to-peer specialist, health advocate, and speaker for TEDx and RAINN, suggests deep breathing as well and agrees that humor works. “Humor creates a common language the breaks barriers,” she explains.
Oestreicher also suggests that nurses try a couple styles of management with themselves, two of which are Active Management and Calming Management. With Active Management, she says, you take all of the energy that’s fueling that stress and use it—exercise, run, shout, or scream. Do whatever makes you feel better.
With Calming Management, you do just that—take actions that will work to keep you calm. That might be breathing deeply, meditating, getting a massage, or even taking a warm bath.
Finally, A.J. Marsden, PhD, a former Army surgical nurse and current assistant professor of psychology and human services at Beacon College in Leesburg, Florida, suggests that nurses encourage optimism and refute negative thoughts. “Smile! Research shows that people who smile really will feel better,” says Marsden. “Focus on all of the good work you’re doing. When we feel that our work is making a positive difference and an impact on the world, we feel more positive and happier.”