According to The Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It was originally coined to address substance users but its implications have broadened as its application has become meaningful among other populations. Nurses are empowered to employ harm reduction techniques, whether or not they work in practices specifically dedicated to that aim. This can be done through direct care with individual patients or on an administrative level.
With Individual Patients
With experience, every nurse becomes familiar with the nature of their role as caregivers. Nurses’ responsibility is to treat, care for, and educate patients, in accordance with the dictates of advanced practitioners’ directed care. It is not, however, within the nurse’s scope to ensure that every patient lives and acts according to their prescribed treatment plan. It is not uncommon to encounter patients who are noncompliant or noncooperative with treatment. For these patients, harm reduction can be a helpful guiding principle for nurses.
Nurses can utilize the principles of harm reduction with the more salient issues of IV drug use and risky sexual behaviors but also use them for smoking, diabetes, and hypertension. Nurses can minimize the negative effects of patient choices that are counter to their well-being by offering alternatives without requiring patients to practice complete abstinence.
Patient education is the greatest technique of harm reduction that nurses always have at their disposal. For willing patients, understanding the resources that are available to them is key to taking actions that minimize their risks. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV/AIDS has led to great strides in limiting the spread of the disease. Many patients would not even know about the option to protect themselves in this way if it wasn’t for having trusted resources in their health care team. Knowing about local smoking cessation, needle exchange, condoms, PrEP/PEP, and health promotion programs is a great tool for any resourceful nurse.
On the Larger Scale
For nurses who see a trend among patients who could benefit from harm reduction programs, it is within their purview to address these issues on an administrative level. It is not uncommon for policy changes to be initiated by a brave nurse who decides to use his or her voice to advocate for patients. These nurses choose to go beyond knowing about resources and encourage their employer, or even their government to be the resource. This can be unit-wide, facility-wide, or even taken to Capitol Hill to enact change on a government level.
Harm reduction started out as a small group of providers taking action to support IV drug users. They discovered that imposing abstinence on a patient who isn’t ready can actually preclude their care. Harm reduction has become a broader term that allows patients to make the lifestyle choices that they would anyway, without severing their connection to health care resources that can protect them from potentially devastating consequences to themselves or their community.
Ask anyone about a memorable experience they had as a patient and they will invariably describe an interpersonal one:
“The team was nasty. They rolled their eyes when I asked for anything, talked about their vacations while putting in my IV as if I wasn’t there and in pain, and chatted loudly near my room at all hours of the night.”
“My nurses were the best. They always gave a report to each other in front of me, including me in the plan, they checked on me often, and patiently answered my questions.”
In both of these examples, the concern of the patient is less about the skill level with which the injury or disease was managed, but rather the care team’s ability to communicate effectively and considerately with the patient. Furthermore, evidence suggests patients who have a good rapport with clinicians do better overall. And it doesn’t end with the patient. Effective communication among members of the care team is just as essential to the patient’s well-being as direct interaction with the patient themselves.
Communication and Outcomes
A fundamental feature of quality patient care is bedside manner. Although this implies the inpatient setting, it includes all interpersonal engagement with patients. Practicing empathy and establishing trust are two benefits of effective communication that not only makes the experience more pleasant for the patient and the team, but also it improves clinical outcomes.
It’s not difficult to understand why. A patient with less stress is physiologically better off. A patient who trusts their providers may be more candid about sensitive and pertinent health history information, such as recreational drug use and sexual behaviors. Similarly, a transparent interprofessional care team may be more willing to admit mistakes or ask questions without fear of ridicule.
Guidelines for Effective Communication
Although the specialized skills of all clinical professionals are essential, the importance of effective communication with and about the patient cannot be overlooked. Consider the following guidelines for effective communication:
- Greet patients and colleagues.
- Inform the patient before touching them or undertaking tasks.
- When in doubt, ask.
- Reserve casual conversation for breaks and non-clinical areas.
- Act with integrity: treat patients as if their loved ones are around.
Such simple considerations can have a tremendous impact on the patient encounter, in addition to making it a more pleasant and fulfilling experience for everyone.
It’s not an exaggeration to say that technology has become the driving force behind every industry and health care is no exception. Clinical informatics is a thriving field for all types of clinical professionals who have expertise in information technology. For nurses, it presents the opportunity to improve patient care by participating in the evolution of health care on a systematic level.
Most nurse informaticists have nursing experience and an advanced degree, either a Master of Science in Nursing (MSN) or a Doctor of Nursing Practice (DNP), with a focus on clinical informatics. Most nursing schools offer these types of degrees today.
The Role of Nurse Informaticist
More rigorous experience and education requirements are warranted for nurse informaticists because often they fill leadership and consultant roles. For example, a nurse informaticist may be part of nursing administration within a hospital, serving as a liaison between staff nursing and the executive team. In this instance, the nurse informaticist serves as a resource for both: educating nurses on effective and efficient use of electronic health records (EHR) and other relevant technology, and translating any issues or insight into a pertinent context for leadership, some of whom may be non-clinical.
Some nurse informaticists find themselves working in the business and technology sectors, completely removed from the clinical setting. In such cases, nurse informaticists are often considered consultants, whereby they serve as clinical experts advising and overseeing the development of new technology relevant to nursing. For instance, companies that develop EHRs hire nurse informaticists to analyze if the implementation and evolution of their technology are feasible in the real world of nursing. Because health care technology is in a state of constant progression, these nurse informaticists often find themselves with permanent positions within these sectors.
Indirect patient care
One consideration for every nurse interested in informatics to consider is the cessation of direct patient care. Although nurse informaticists in clinical settings may interact with patients, there are few if any informatics positions that include typical nursing tasks. Instead, the nurse informaticist’s prior experience as a nurse serves as a boon to implementing positive changes in care that benefit nurses and patients alike. In this way, the nurse informaticist can be considered a provider of indirect patient care, as they are empowered to improve patient care on a greater scale than they otherwise could as bedside nurses, especially as technology has an increased role.
As nursing has evolved into an ever-more complex field where science, humanity, pragmatism, and professionalism intersect, the clinical nurse educator has emerged as an essential presence among nurses. Whether they are teaching in the classroom, educating patients and families, or mentoring nurses and nursing students, the nurse educator plays an important role in guiding nurses on the leading edge of rapid and continuous progress in health care education and practice. Naturally, the process of becoming a certified nurse educator requires rigor and commitment. To many, the pinnacle of this process is the oft-dreaded Certified Academic Clinical Nurse Educator (CNE®cl) Examination. What follows is a brief breakdown of the exam itself and tips for success.
The CNE®cl Exam
The CNE®cl exam consists of 150 multiple-choice questions. One hundred and thirty of those questions count toward the test taker’s score; the remaining twenty are unscored or “free” test questions, usually experimental. The test is broken down into six topics, each of which makes up a certain percentage of the exam as follows:
- Facilitating learning (22%)
- Facilitating learner development and socialization (14%)
- Using assessment and evaluation strategies (19%)
- Participating in curriculum design and evaluation of program outcomes (17%)
- Pursuing systematic self-evaluation and improvement in the academic nurse educator role (12%)
- Engaging in scholarship, service, and leadership (15%)
Tips for Successful Studying
As with any credentialing exam, there is an abundance of resources available to test-takers, including apps, videos, classroom preparation, and online self-training. Many schools include test prep as part of the curriculum. The best place to begin the studying process is to speak with an academic advisor to find out if the school includes formal test prep in the curriculum. From there, speak to former students who have taken the exam and find out if they supplemented the classroom material.
Lastly, as the saying goes, know thyself. In choosing a method of study, it’s best to choose the learning techniques that have worked best for you in the past. For audio learners, seek out an audiobook or lecture series. For visual learners, try an app or video study guide. For collaborative learners, seek out a classroom or save money and recruit classmates for a self-guided group study. Many graduate nursing students are also full-time nurses, therefore, time management is key. The greatest preparation tool one can have is the peace of mind that comes with an early start and consistent practice.
How to be a charge nurse may not be part of your nursing school curriculum, but it will likely become part of your nursing career, particularly if you are working in a hospital. Generally, it’s a position that appeals to only a few nurses because it comes with a tremendous amount of responsibility, both clinical and logistical.
The charge nurse can be described as the sieve through which all information and people must pass on a given unit. The role may have mild variations depending on the type of unit, but ultimately, the charge nurse oversees the nursing staff, patient bed assignments, and almost anything that affects those two factors. The nurse in charge is the first tier in the “bumping up” process, whether it be a staff grievance, patient complaint, near miss, or sentinel event.
Needless to say, one of the prerequisites is relatively thick skin. However, if you are the sensitive type, acting as charge nurse need not be faced with dread; it can either be the bane of your existence or perhaps simply a valuable exercise in character development.
When a patient is scheduled for admission to the unit, whether immediately or with just several hours’ notice, the charge nurse finds and assigns the patient a bed and a nurse. The process is hardly ever simple. If the unit is full, the charge nurse must find a way to either justify another patient’s discharge or to fight the incoming patient’s admission. One rarely finds a consensus among stakeholders in this situation: the receiving unit of your discharged patient may push back, the incoming patient’s team may hurry you, the staff nurses may argue for changes to their assignment, and the patient’s physicians or families will have their own agenda. Depending on where you work, this may all be happening while you manage your own patient load.
There is good news. The key to success for any charge nurse is awareness, namely awareness of resources. It is absolutely essential that every charge nurse knows the boundaries of his or her scope. That will likely be institution-specific and thus easily accessible. For example, if you are a charge nurse in the OR and two surgeons try to book emergency cases at the same time, it behooves you to know who makes the call of who goes first. (Hint, it’s probably not you.)
Navigating your work within the confines of the boundaries established by your employer will arm you with the tools necessary to find the sweet spot between authority and your peers as a charge nurse. And no matter how pressured the work may feel, you must always take time for a deep breath.