Making Self-care a Priority

Making Self-care a Priority

As a nurse, youre empathetic and compassionate and go out of your way to ensure you provide your patients with the best possible care. But when it comes to looking after yourself, self-care may get prioritized far down the list – or not at all.making-self-care-a-priority

Such a mindset may be harmful to you and, ultimately, your patients. Nurses are great patient advocates, but “we do need to start advocating for ourselves because you can’t keep helping everyone. Then you dont have anything left in your reserves,” said Linda Roney, EdD, RN-BC, FAAN, associate professor, Egan School of Nursing and Health Studies, Fairfield University.

“I think you have to be selfish, which is hard in a selfless profession to balance, but I think that is one of the ways that we can keep ourselves healthy. You have to prioritize yourself,” said Crystal Smith, DNP, RN, NE-BC, director of the medical-surgical unit at Childrens Nebraska.

As healthcare professionals and organizations celebrate Nurses Week with its theme of Nurses Make the Difference,” now is a perfect time to assess your attention to self-care. In this article, well offer practical strategies to help you care for yourself.

No Perfect Time

When it comes to self-care, one of the biggest lessons for me is that self-care is not a one-size-fits-all,” said Roney. Nurses need to be aware of their unique needs.

Another awareness is not to wait for the perfect time for self-care. Roney said you can work on small, incremental changes” for five or ten minutes that can accumulate over a day. You might try habit stacking”: combining a potentially burdensome task with something enjoyable, notes Roney.

Days Off and Zen Dens”

Smith meets with her new nurses at Childrens Nebraska in Omaha to discuss a self-care plan. If a nurse is struggling, Smith can consult the nurses plan and see the measures that might help that person.

One self-care policy at Childrens Nebraska allows nurses to take a day off if they need to recharge—if your tank isnt full enough to come in and give all of yourself that day,” said Smith. There are no negative repercussions should a nurse choose to do so.

Nurses are also encouraged to disconnect completely when they need a break. Its very hard to get away from the work when youre at work,” Smith explained. Nurses are encouraged not to take their work phones on break but to trust that the staff can handle the patients while away.

Another self-care tactic involves Zen dens.” When the hospital opened a new tower two years ago, these rooms were built into each unit. Zen dens have a lock, a massage chair, essential oil diffusers, books, and low lighting. A nurse can connect a phone to a speaker to play quiet music. You can go in there and decompress how you need,” said Smith. 

Smith noted that accessibility of these Zen dens is key. We as organizations have always had places for people to do that, but never right on the unit. It’s tough to get a nurse or even a doctor to leave the unit where their patients are without any way to communicate with them.”

Added to these measures is a Thrive” team, a department dedicated to employee wellness, noted Smith. Two members of Thrive are Howie, a golden retriever, and his handler, David. They may, for instance, join the staff for a debriefing after a difficult patient or family situation. Besides Howie and David, Thrive has a team of trained peer supporters and group facilitators available 24/7 for clinical and non-clinical team members.

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Howie, the golden retriever, and his handler, David, make their rounds

Whats more, staff are encouraged to go home after a death in the facility. Death in general is very hard, noted Smith, but I would say especially in pediatrics, its usually very traumatic. To expect the nurse who just went through that with a family and a patient to turn around then and take an entirely new patient, the mental load of that is really heavy. And so, to the best of our ability, we try to give them the option to go home.” At the same time, the facility understands that a nurse may want to stay at work instead of going home as a way of coping.

Back to Basics

As a nurse, you also need to take to heart the common-sense advice you probably give to patients about self-care, such as the following:

  • Sleep and downtime. You may want to spend some downtime on your phone, but be wary of it, noted Roney. You feel as if you are relaxing and having a positive experience. But all this time is going on, cutting into your sleep/wake cycle.”
  • Nutrition and hydration. If you talk to any nurse, most of us would agree we would put our needs after our patient, so there are many times we might miss a lunch break, or we may eat several hours later than we usually do because there might be something going on with our patient and we need to put their needs first,” said Roney. As a solution, really be intentional and plan on bringing your meals and snacks to work.” Stay hydrated throughout your shift, noted Roney.

Simple measures such as making sure to take your breaks, eat your meals, and use the bathroom regularly while on shift are a start for self-care, according to Sarah K. Wells, MSN, RN, CEN, CNL, clinical practice specialist, practice excellence team, American Association of Critical-Care Nurses (AACN). Next, prioritize quiet times and activities that bring you joy each day.

Moments of Gratitude

Practicing gratitude can also help with self-care. In talking to an experienced nurse who was struggling, Smith told her, You guys have to remember that the tiniest things you do make the biggest difference.”

Smith says, Sometimes we must find and center ourselves around those tiny moments of gratitude. Its easy to leave work and feel like your entire day was terrible. But really, you probably did many good things throughout the day.”

Meeting Mental Health Needs

Meeting Mental Health Needs

In the press of caring for patients, family nurse practitioners (FNPs) must tend to a patients physical well-being and mental health. Caring for a patients mental status can be vital to meeting healthcare needs.meeting-mental-health-needs

As primary care providers, FNPS play a significant role in tending to mental health concerns. The American Association of Nurse Practitioners (AANP) reflected that 88% of the nations NP workforce are certified in an area of primary care, with over 70% delivering primary care services, notes LaMicha M. Hogan, PhD, APRN, FNP-BC, associate dean/department chair for APRN Programs for the Texas Tech University Health Sciences Center School of Nursing-Graduate Program.

In this article, we’ll offer ways to ensure you’re attending to your patient’s mental health needs and touch on how FNP programs should educate students about mental health.

Great Impact

Though stigmatizing societal attitudes regarding mental healthcare have improved, a patients initial encounter with a healthcare provider will likely have the most significant impact on self-perception of a mental health complaint as well as willingness to seek continued treatment, notes Hogan.

Early detection and intervention lead to the best outcomes, in conjunction with a trusting, collaborative rapport between the patient and FNP to reduce stigma present with having a mental health condition, according to Hogan. FNPs must be aware that a patient’s mental health status has a greater impact on chronic physical health conditions if undiagnosed or left untreated, she notes.

Its imperative for FNPs, especially those in primary care settings, to prioritize the screening of conditions such as depression and anxiety, notes Amanda Ringold, DNP, FNP-BC, CRNP, SANE-A, assistant professor at the University of Pittsburgh School of Nursing. “To ensure effective mental health assessments, FNPs must address and overcome organizational barriers, including time constraints, a lack of a universal screening policy, and providers’ feelings of inadequacy in conducting mental health screenings. FNPs are poised to take on leadership roles within clinical settings to address and mitigate these challenges,” she explains.

Screening Strategies

Various strategies exist for dealing with mental health during patient care visits. For instance, 

Ringold notes that not every screening needs to be done face-to-face with the FNP. Instead, screenings can be conducted with pen and paper in the waiting room or via an app before the appointment. She notes that other team members, including nurses or medical assistants, can be trained in administering the screenings.

Lisa Johnson, DrNP, CRNP, ACNP-BC, associate professor and DNP/NP Program Coordinator at Gwynedd Mercy University, agrees that patients can complete questionnaires in the waiting room or before the visit. However, we have to be cautious not to fatigue patients with questionnaires and to ascertain their reading level and primary language prior to requesting a mental health assessment be completed by the patient,” she warns.

According to Ringold, the care setting and patient population should dictate the most appropriate screening tools. The most frequently used tools, she notes, include the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder -7 (GAD-7), and the Alcohol Use Disorders Identification Test (AUDIT). When time is limited, notes Ringold, FNPs can use abbreviated versions of screenings such as the PHQ-2, a two-question alternative to the PHQ-9.

In an interview, Irene W. Bean, DNP, FNP/PMHNP-BC, FAAN, FAANP, FNAP, CEO of Serenity Health Care, P.C., and Tennessee State Rep for AANP, says to pay attention to a patient’s body language once in a patient encounter. Watch for poor eye contact or note whether a patient has been crying.

She says to pay attention to slurred speech and be aware of signs such as a patient who typically speaks loudly suddenly speaking in a whisper or a normally talkative patient now being reserved.

FNP Programs

Johnson says NP educational standards emphasize assessing mental health in varied patient populations. Healthcare providers and institutions of higher education need to focus on the cultural considerations of mental health disorders and further emphasize collaborative communication between primary care and mental health providers, she notes.

Hogan says clinical competencies are best attained via a competency-based educational model throughout the FNP curricula. Specialized courses on mental health, simulation training, interprofessional education, and clinical rotations in primary care settings can develop competence. She says that after graduation, FNPs should maintain continuing education specific to FNP’s scope of practice and evidence-based care for mental health concerns.

Ringold notes a growing trend of students at the University of Pittsburgh School of Nursing opting for dual FNP-PMHNP degrees.

Scope of Practice

While FNPs can treat mental health conditions such as basic anxiety and depression, they need to be mindful of their states scope of practice, says Bean. For patients with conditions such as bipolar disorder or schizophrenia, you may be stepping outside your practice scope and may need to refer the patient to a specialist, Bean says

One thing that I would stress, and I stress to my students, is that you want to protect your license. You want to ensure the patient is safe while protecting your license,” Bean says.

Calling on Compassion

When you realize your patient is anxious, depressed, or dealing with a mental health issue, What you don’t want to do is rush that patient from that conversation,” says Bean. You’re going to miss a lot of things when you rush patients who have a mental health crisis through your clinic,” Bean says. 

You have to have compassion for patients dealing with a crisis. Their crisis may not be something you feel is a crisis, but to them, its everything. You cant discount their feelings, and you cant discount what youre seeing in that patient.”

Nursing Informatics: Connecting Tech with Care

Nursing Informatics: Connecting Tech with Care

Are you the tech-savvy nurse on the unit? Do your colleagues seek you out with questions about the quirks of your electronic health record (EHR)? If so, consider turning that know-how into a career in nursing informatics.nursing-informatics-connecting-tech-with-care

Leveraging Bedside Experience

Nursing informatics reads a definition from the ANA’s Nursing Informatics: Scope and Standards of Practice, 3rd Edition, “is the specialty that transforms data into needed information and leverages technologies to improve health and healthcare equity, safety, quality, and outcomes.”

A background at the bedside is critical for a successful nursing informatics role. “There’s typically some kind of clinical experience involved before jumping into an informatics role,” said Christy St. John, MSN, RN, NI-BC, CPHQ, president of the American Nursing Informatics Association (ANIA), in an interview. “To come straight from your studies into informatics is fairly rare.”

A combination of clinical nursing experience and education in informatics is essential, according to Melinda L. Jenkins, PhD, FNP, associate professor and director, nursing informatics specialty, Rutgers School of Nursing. Experience with patient care in the clinical setting is essential to the nursing informatics role because this role is the connection between the clinical setting and the technology piece of healthcare, says Lori Martone-Roberts, DNP, RN, CHSE, director of simulation and professor of the practice of nursing, Wheaton College.

Although training and hands-on experience with technology is important, Michael Mickan, chief nursing informatics officer at Memorial Hermann Health System, looks for experience using the tools on hand and a natural curiosity that leads to self-teaching. He feels that a nurse with that kind of informal experience is usually more successful as a nurse informaticist than those who wait to be formally trained before exploring a new technology.

Range of Skills

You’ll need to bring many skills to a nursing informatics role. Mickan outlines a variety of abilities:

Communications: Nurse informaticists must be able to provide “translation” of patient care, and clinician needs to technology partners as well as technology concepts and requirements to clinical users and communicate with various disciplines.

Problem-solving: Informaticists must be able to identify the real problem with astute observation and critical thinking encompassing people, processes, and technology.

Change management: Nurse informaticists must understand change management strategies and be comfortable facilitating, guiding, and managing change.

Project management: Often, a nurse informaticist facilitates collaboration between clinical and technology partners to solve problems and support the optimal use of technology. To do this effectively, proficiency in project management is a must.

Data analytics: Nurse informaticists must have a solid grasp of the data that validates the problems to be solved and provides the baseline for measuring progress.

Day-to-Day Projects

What kind of work will you do on a daily basis? An example, notes Martone-Roberts, could be to evaluate workflows or improve usability and streamline processes, leading to improved functioning and efficient data capture.

She notes that nurses in the nursing informatics role will work with EHRs in various ways, including managing information and troubleshooting issues when healthcare professionals use the system. Other projects involve training, validating, and reporting data and ensuring the collected data is useful.

She suggests that one example of a project could involve using chatbots to keep a patient engaged and decrease re-hospitalization. Similarly, Mickan outlines workflow analysis and optimization projects, working with clinical decision support systems and EHR implementation and optimization.

Growing Field

When it comes to future demand for nursing informaticists, “I see it as a growing sector,” says St. John.

“I think sometimes it’s a matter of being a little bit more broad in the way we think about nursing informatics,” she notes. Instead of simply searching for the term on a job site, a job search can be more about “opening my eyes to things that might include AI, analyst, or health informatics roles. I think nurse informatics roles will be more in demand in the bigger picture of health technology.”

Education and Certification

According to Martone-Roberts, you’ll need an RN and BSN to serve in a nursing informatics role. Also, she says, a nurse with a master’s degree in healthcare informatics, nursing informatics, or data management will be better positioned to succeed.

As in most nursing roles, certification can enhance your standing. The ANCC’s Informatics Nursing Certification (NI-BC) is one of the foremost certifications specifically focused on the characteristics of the nurse informaticist’s role, says Mickan. While not specifically focused on nursing, he says the HIMSS Certified Professional in Healthcare Information and Management Systems (CPHIMS) certification demonstrates knowledge of informatics.

Serving the Patient

Although one of the more technical roles in nursing, nursing informatics still has patient care as the end goal. “At the end of the day, what we’re after is better outcomes for the populations that we’re serving, whether that’s in the inpatient setting, whether that’s in an ambulatory setting, whether that’s in our communities,” says St. John.

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Practical Strategies for Implementing Evidence-Based Practice

Practical Strategies for Implementing Evidence-Based Practice

Basing your nursing practice on the latest evidence and research remains critical to providing optimal patient care. Practicing nursing based on tradition, how weve always done it,” or outdated research can lead to poor patient outcomes, inappropriate care, or serious errors.practical-strategies-for-implementing-evidence-based-practice

No doubt you studied evidence-based practice (EBP) in school, read it in journals or attended in-service sessions about using evidence in practice. You no doubt have every intention and desire to base your nursing practice on the latest research. But how can you do that when your days quickly spin into a whirlwind of patient admissions, procedures, and more?

In this article, well offer a few perspectives and approaches on ways to help base your practice on the latest evidence. But first, a quick refresher on the importance of EBP.

The Importance of Evidence

“By integrating the latest and most robust evidence into our day-to-day nursing practices, as nurses, we ensure that our interventions are grounded on the most recent or latest advancements in healthcare and patient preferences and values, thus promoting safe, effective, and high-quality care,” according to Meredith Padilla, PhD, RN, CCRN-CMC, clinical practice specialist for practice excellence at the American Association of Critical-Care Nurses (AACN). Moreover, EBP fosters a culture of continuous learning and professional development and elevates the standards of nursing practice. Additionally, a recent study reports that EBP culture and mentorship increase job satisfaction and intent to stay among nurses.”

Highlighting the importance of bringing evidence into practice, an entire field of research is now dedicated to determining the best methods and strategies (or interventions) for facilitating the implementation of research evidence in healthcare decision-making, including day-to-day nursing practice, according to Jennifer Yost, PhD, RN, FAAN, professor, M. Louise Fitzpatrick College of Nursing, Villanova University. She notes that this is commonly referred to as implementation science, knowledge translation, or translational science.

Culture of Inquiry

In bringing evidence to the bedside, nurses must cultivate a culture of inquiry, notes Padilla. Asking questions is the initial step toward EBP,” she says. She suggests using the PICOT format (Patient/population, Intervention, Comparison, Outcome, Time) to frame the question.

Also, use an EBP model to guide your work. Examples of EBP models, she notes, include the Iowa Model, the Johns Hopkins Evidence-Based Practice Model, the Advancing Research and Clinical Practice through Close Collaboration Model (ARCC), and the Stevens Star Model of Knowledge Transformation. 

All of these models, she notes:

  • Emphasize the importance of identifying and defining specific clinical questions that require EBP solutions and utilize the PICOT format guide to search for evidence.
  • Share a step of conducting a systematic and thorough review of the best available evidence related to the clinical question.
  • Have a common goal of the translation of evidence into clinical practice.
  • Emphasize evaluation of the implementation process and continuous improvement.

Tap your resources, Padilla says. Collaborate with a colleague, nurse leader, or interdisciplinary team member who can provide support and mentorship as you explore the evidence behind a clinical question.

Along those same lines, cultivating a culture of peer review and mentorship is pivotal, says Sandra Russo, PhD, RN, director of nursing and chairperson of the nursing program at Touro University. She notes that peer-reviewed journal club meetings and mentorship programs can provide a platform for exchanging knowledge and developing critical skills.

Access to Resources

Having easy access to EBP resources is key. Hospitals and healthcare agencies should support EBP by providing nursing staff with easy access to reputable nursing journals, online databases, and institutional access to academic resources, says Russo.

In addition, dont neglect to consult your institutions policies and procedures, says Pamela Barnwell-Sanders, EdD, MBA, MSN, RN, associate professor of practice at Egan School of Nursing and Health Studies, Fairfield University. She says that even if youre performing a procedure regularly, you may discover that the policy or procedure has been updated to reflect the latest evidence.

Resources to help nurses identify the best available evidence, notes Padilla, include published clinical practice guidelines research databases like PubMed, CINAHL, and the Cochrane Library. 

When it comes to searching for evidence, starting a search for the already-synthesized evidence (for example, systematic reviews or clinical practice guidelines based on systematic reviews) can improve search efficiency, according to Yost. Searching repositories of evidence syntheses (for example, Epistemonikos) and databases, such as PubMed, that allow one to limit searches to systematic reviews is also helpful, she says.

Continuous Improvement

As with most aspects of healthcare, analysis and feedback are critical. Regular audits of nursing practices are necessary to assess adherence to evidence-based guidelines, notes Russo. She says constructive feedback, recognizing positive behaviors, and addressing areas requiring improvement is the cornerstone of a continuous improvement cycle.

The nurse at the bedside should always be asking why, says Barnwell-Sanders. With a firm understanding of and grounding in EBP, youll have a solid knowledge of why a practice or procedure provides the best evidence-based care for your patients.

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What to Look for in a Nurse Residency Program

What to Look for in a Nurse Residency Program

As in most things, getting off to a good start as a nurse can help ensure a long, successful, and satisfying career. With nursing shortages and nurse burnout still taking a tremendous toll on the profession, hospitals must do all they can to ensure new nurses have the tools to succeed.
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Organizations help ensure success for new nurses through nurse residency programs, also called transition to practice or new grad programs. These structured learning experiences can be of great benefit.

One recent study found that

readiness for practice improved significantly for nurse residents, as did nurse retention perceptions, indicating that nurse residents were more likely to be retained at the study organization. The 1- and 2-year nurse retention rates during the 3 years of the study showed notable improvement.

In this article, we’ll offer specific suggestions on what to look for in a nurse residency program so that you can find a good fit. But first, let’s look at when you should start investigating those programs.

Start Early 

To discover if a nurse residency program is right for you, don’t wait until you pass your licensure exam. “Waiting until they pass their NCLEX many times is too late,” says Sheri Cosme DNP, RN, NPD-BC, director, Practice Transition Accreditation Program (PTAP), Advanced Practice Provider Fellowship Accreditation, American Nurses Credentialing Center (ANCC).

Nursing students should “use the time that they’re in school to start identifying those organizations that they want to work at sooner rather than later,” notes Cosme. Many programs start only two to three cohorts a year, so they have very specific recruitment timelines for when they accept applications from new graduate nurses, she says. “My biggest piece of advice to a new graduate nurse is not to miss that window.”

Cosme says to take advantage of your time at your clinical rotations and interview the facility. “That’s going to give them a good sense of what the organization is all about.”

In addition, Cosme suggests checking social media to learn what nurses say about the organization. Also, reach out to employees. You might also ask to speak to a nurse who has recently completed the program to find out how they balanced class time with working off-shifts, suggests Sara R. Grieshop, MHI, BSN, RN, practice excellence supervisor, American Association of Critical-Care Nurses. “Don’t hesitate to interview the programs as much as they are interviewing you,” notes Grieshop.

Make sure, says Cosme, that the organization has a specific plan in place for the program. For instance, the organization should tell you how much time you will spend with a preceptor or the milestones you need to hit to reach full competence.

What to Look for in a Nurse Residency Program

As you research nurse residency programs, consider the following areas:

Accreditation. Find out if the nurse residency program carries accreditation. As of mid-November 2023, some 250 programs in 831 healthcare sites were part of the ANCC Practice Transition Accreditation Program.

Accreditation helps ensure that programs provide a rich educational experience. “Accreditation validates that the programs are consistently following evidence-based standards that support nurses in their transition to nursing practice,” according to Christine Young, MSN, MBA, RN, NEA-BC, DNP, chief of hospital-based services and chief nursing officer, Akron Children’s Hospital.

Length of time. Cosme says a nurse residency program will run between 6 and 12 months. “A majority of the time, the programming is front-loaded,” she notes so that during the first part of the program, the nurse gets more concentrated professional development and support.

Seek programs that provide at least 6 to 12 months of program support and a preceptorship, which will help you acclimate to your intended specialty with a structured orientation and clinical training at the bedside, suggests Laura Douglas, MSN-Ed, RN, NPD-BC, CCRN-K, manager of the transition to practice programs (nurse residency, fellowship, and respiratory residency) at Memorial Hermann Health System.

While clinical orientation may last only 3 to 6 months, depending on specialty, a residency program supports the new graduate first through orientation, then through the initial phases of independent practice for up to a year, according to Young. Support into the second year is also ideal, she notes.

The nurse residency program should provide opportunities for participant feedback and evaluation, including regularly scheduled formal meetings to examine strengths and areas for growth, as well as provisions for individual self-assessment/self-reflection, according to Karen T. Pardue, PhD, RN, CNE, FNAP, ANEF, associate provost for strategic initiatives and professor, School of Nursing and Population Health, University of New England. Also, the program should dedicate attention to activities and interactions that build a sense of community and provide peer support, heightening the new employee’s sense of connection and belonging, she suggests.

Preceptorship. It would help if you were working with a preceptor, and ideally, one or two preceptors through the orientation phase of your residency program, notes Cosme. You should also check if you will have a mentor. While those two roles intersect, they provide different support, notes Young. The mentor, Young notes, could be a previous nurse resident who remembers what it was like to be a new grad in the specialty area they are working in and is willing to connect with the new nurse regularly to offer support, identify resources, and so on. The preceptor must evaluate the new nurse’s ability to demonstrate competency in practice and provide feedback during orientation.

Specialty experience. Determine if the nurse residency program will provide education in your specialty area, notes Cosme. If you’re unsure which unit is best for you, look for a residency program that allows you to work in various units, notes Grieshop. “This will allow you to broaden your horizons beyond what your clinical hours achieved,” she notes.

Never-Ending Learning

Nurses in a residency program, notes Cosme, should “be a sponge, soak it all up, wring themselves out, and soak up even more because they will be learning in nursing every day. I think the biggest blessing in healthcare is that things are constantly changing. We’re always learning.”

Read the January issue of Minority Nurse focusing on RN-to-BSN and Nurse Residency Programs here.

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