This week honors transplant nurses around the world as they continue to set a high standard of excellence and work in a constantly changing nursing specialty. The International Transplant Nurses Society, which celebrates its 30th anniversary this year, marks this year’s Transplant Nurses Week from April 25 to May 2.
Transplant nurses work with patients, their families and caregivers, and all the relevant healthcare teams as a patient progresses through the different stages of solid organ transplant (preparation, transplant, recovery, and maintenance) as a recipient or a donor. Transplant nurses also work on teams where a deceased patient is an organ donor, and they work quickly and respectfully for this lifesaving match to have the most potential for success.
Although transplant nurses may not directly care for COVID patients in their daily routines, the pandemic has nonetheless impacted this area of nursing in untold ways.
People who live with a transplanted organ are often immunocomprimised because of the medications they take to prevent rejection of the transplant and that has posed complications for their risk for contracting the virus.
All of those recent developments influence the daily work of transplant nurses and those they care for. As advocates for their patients, transplant nurses are equipped to offer the highest quality, evidence-based care. They may take advantage of professional development and certification to keep their skills current.
Transplant nurses also know that they are ambassadors for organ transplant and donation. According to the United Network for Organ Sharing, spreading the word about organ donation will make a difference in how many lives are saved. The more people who understand the process of a live donation or who take a few moments to register as an organ donor when they renew their license, for instance, can save more lives every year.
Nurses in their specialty know every bit of accurate information around the process helps more people understand the life-saving potential and possibly become a donor. Nurses can help spread the word in casual interactions with family and friends, or they can advocate in the larger community. They can offer formal information sessions in their hometowns, to professional organizations, or to legislators and other government officials who can help move forward transplant-related or transplant-beneficial legislation.
If you’re a nursing student considering transplant nursing as a career choice, be sure to spend some time with transplant nurses and their patients. Understand the complexity of the transplant process, the commitment to lifelong learning, and the intense emotional highs and lows of working with the families who are involved in some way. The rewards of this nursing specialty are significant and provide a lasting and meaningful career.
Wound, Ostomy, and Continence (WOC) Nurse Week runs from April 17 to 23 this year and celebrates this nursing specialty and the nurses who dedicate their talents to this area of care. To find out more about what makes this career path so rewarding, Minority Nurse heard from Vanessa Maxwell MSN, RN, CWON, PLNC and owner of Wound Care Solutions by Vanessa, LLC. Maxwell has been a WOC nurse for nearly 12 of her 19-year-long nursing career and says she wouldn’t change anything. She’s also a nurse entrepreneur who found a patient need that she’s able to help fill with her business.
Please tell me a little about your background and how you decided to become a WOC nurse.
I am a first-generation college student. My parents both completed high school but did not attend college. I started out with my associate’s degree in nursing, returning to obtain my Bachelor of Science in Nursing a year later and then returning to graduate school to complete my Master’s of Science in Nursing in 2014. I have been a nurse for 19 years, and I have spent my entire nursing career working for one healthcare organization in the Memphis, TN area in various nursing departments.
I started as a new graduate nurse working med-surg/ telemetry and oncology and staying in this area of nursing for four years. I went on to work in the emergency department (ED) observation unit/float pool where I worked for three years, floating to various nursing units in the hospital. One day, my assignment was to assist the CWON (Certified Wound Ostomy Nurse) with tasks in the wound ostomy department, so that she could concentrate her time on evaluation of the patients. Prior to floating to the Wound Care department, I was always inquisitive about wounds wanting to know the science of wound healing, why a particular treatment over another type of treatment, how the wound would heal, dressing choices and why a particular dressing was chosen, how to stage the wounds properly, the mechanism of action of the treatment.
It was not until I was hired in the role of Wound Ostomy RN that I learned my true love was ostomy care. Wound ostomy, continence, and foot and nail care all can be performed by the same nurse, and we can seek certification for all or any of the combination. A position came open in the Wound Ostomy department and the rest is history. I have been a CWON ostomy for almost 12 years now and I still love this role.
When did you discover WOC nursing and what about this specialty appeals to you?
I discovered WOC nursing when I started as a nurse extern. I externed on a post-surgical unit and there was a patient with an extended length of stay. This patient had a large pressure ulcer and the nurses caring for her would allow me to perform her wound care. I had no problem with the nurses allowing me to change their patient’s dressing; I enjoyed it. I was able to pack the patient’s wound and apply a nice cover dressing. I was able to see the wound was get smaller; even though I was not able to truly understand what was taking place as I do now. With wound care, either you like it (in my case love it) or you don’t. I have not noticed an in between. In this specialty, I love to teach my patients and their family members about the disease processes that caused their wounds and to teach them treatment and preventative measures.
You’ve expanded your nursing career to begin your own business. How did you decide to make the leap as a nurse entrepreneur?
I saw a huge need in the wound ostomy field of nursing with gaps in several aspects of nursing in the nursing home, skilled-nursing facilities, home healthcare, acute care, and even with nurses (including Advanced Practice Nursing). I can further elaborate… Bedside nurses still have problems with staging pressure injuries and implementing proper preventative measures. Some nurses also lack a solid knowledge of understanding the care they can provide to their patients that is within their scope, without having to rely on the wound ostomy nurse. That is important in that, we do not want a moist wound to become dry and that is considered a worsening wound. With all the co-morbidities against a patient (malnutrition, vascular disease, and diabetes), we certainly do not want a wound to worsen.
What market need does Wound Care Solutions by Vanessa, LLC fill for patients who need WOC care?
I offer wound and ostomy care in the patient’s home in collaboration with the patient’s physician. Since COVID the nursing and healthcare industry, like any other industry, has been hit tremendously. The nursing shortage is at crisis level. Skilled-facilities and home-healthcare have had to turn patients away due to lack of staffing. A lot of these patients have nowhere else to turn. I offer wound and ostomy care services at Wound Care Solutions by Vanessa, LLC. I am private pay; however, my prices do match the fact that the patient is being billed and not a third-party payer. I also can contract with facilities to provide evidence-based education to their staff to ensure they are provided the best treatment and prevention for their patients.
How has Wound Care Solutions by Vanessa LLC helped you expand your nursing and business skills?
Being the owner of Wound Care Solutions by Vanessa, LLC, I have had to dive into business courses and work with a business coach to ensure that I am running a successful business that can stand up to my standards, as well as my clients and potential clients. I want to provide a professional service that people want to refer client to my business and to also utilize my services in the future. I am always working on ways to improve my business. I attend workshops and webinars to further develop my nursing and business skills. I have added another certification since starting Wound Care Solutions by Vanessa. I am a Professional Legal Nurse Consultant (PLNC) and provide legal nursing services to attorneys. I utilize my wound and ostomy knowledge with the training I have received as a PLNC to assist the attorney with the facts needed for a case.
What kinds of benefits does your business provide to patients and how does that impact your approach to patient care?
Whether I am training staff to properly provide wound or ostomy care to their patients or providing services to my clients in their home setting, they can find comfort in knowing that I am a very knowledgeable CWON who is constantly educating herself to ensure I am keeping up with the current evidence to provide optimal outcomes to my clients. I provide individualized care tailored to my client for evaluation, treatment, and follow-up. I also communicate with my patient’s physician after my visit and provide recommendations. Collaborating with the patient’s physician allows prompt intervention and we can keep the patient at home and out of the hospital. This became very evident during COVID and even now when ER wait times are high and inpatient beds are scarce.
What has helped you most in your nursing career as a WOC nurse?
I would say mentors, certification, support of loved ones, professional associations have all been beneficial in my nursing career. When I started in nursing as a new graduate, there were many that encouraged me and even celebrated me when I became a CWON. When I started my own consulting business, I had many that celebrated with me. Instead of having mentors, I have become a mentor encouraging others to choose nursing as a career and to also go into wound ostomy nursing, as well as entrepreneurship. I belong to several professional organizations and the network and support is great. But, no matter what I have the support of my mother she rallies behind me and assists me in whatever way she can.
Minority Nurse recently caught up with David Nguyen, an early career nurse in Boston who decided when he was young that a career in nursing was his path. After graduating from the University of Massachusetts at Lowell, Nguyen jumped full time into a role at Boston Medical Center where he enjoys working on a diverse team that provides care for a diverse population.
Please tell me a little about your background and your current job.
I am a first-generation Vietnamese American college graduate. I aspire to leverage diversity as a tool to enhance understanding and compassion in the medical field. My goal as a nurse is to increase access to care, lessen patient stigma, and provide exceptional care. More specifically, my aim is to provide quality care to underserved populations, which includes people experiencing homelessness, intimate partner violence, immigrants, and people with substance-abuse disorders. Serving these vulnerable populations is important to me because they are often stigmatized and have negative health outcomes associated with social determinants of health.
I am currently a registered nurse at Boston Medical Center in the Medical Intensive Care Unit. I chose to work at Boston Medical Center because I’ve witnessed how the nurses and interprofessional staff execute skillful care on a daily basis to all of their patients without regard to their race, gender, religion, socioeconomic status, ethnicity, and culture, directly impacting social determinates of health for all patients.
When did you realize nursing was the right career choice for you?
Early exposure to state-of-the-art care made nursing a sound career choice for me. At a young age, I was constantly in and out of a hospital for a physical ailment. I experienced doctors and nurses working diligently to provide the best care they could for me as a child in a low-income, non-English-speaking family. I aspired to be like them as they advanced the healing of people and promoted good health and well-being. Later on in my life, my grandmother was diagnosed with kidney cancer, and I became keener on medical professionals, specifically doctors and nurses. When I joined my grandmother during her chemotherapy treatments, I noticed how doctors reported diagnostics, while nurses served an essential role in helping the patient maintain good vigor and health. Ultimately, by observing the compassion and care of the nurses, I was inspired to choose nursing as a profession.
How did you decide on a specialty area of nursing and why are you drawn to that area?
I decided on my specialty area of critical care in my senior year of nursing school when I did my role transition nursing preceptorship clinical in the Medical Intensive Care Unit at Boston Medical Center. I am drawn to critical care because of the team aspect of working with many interprofessionals, providing care for the patients and families during a vulnerable time. Critical care has taught me the importance of advocating for and honoring patients and families.
How has the transition from nursing school to full-time nurse been? What helped you along the way?
My transition from nursing school to becoming a nurse has been smooth so far. I strongly feel that the University of Massachusetts Lowell nursing professors prepared me for real world experiences and nursing skills. As a new graduate at Boston Medical Center in MICU, I have many resources and support systems in place, which include my nurse educator, nurse managers, and nursing preceptor. Working with these professionals, who are knowledgeable and experienced, is helpful to my growth as a critical care nurse.
When we talk about diversity in nursing, it also includes male nurses because nursing is a profession dominated by women. How has your experience been being a male nurse? What do you bring to your patient care approach that you think is especially valuable?
At Boston Medical Center, I have felt welcomed as a male nurse presence since I work in a very diverse and supportive unit in the hospital. Knowing a second language has also been an asset as I can translate and converse with my Vietnamese patients. Sharing the language with Vietnamese patients helps me establish a sense of community and ensure that my patients feel comfortable and trust my care. Lastly, serving as a male nurse is important to my patients since it brings representation and changes to the nursing profession.
Have you had mentors or is there a particular person who has helped you in your nursing journey? Why is that important for a new nurse?
I had many mentors who have helped me in my nursing journey. One of my mentors in nursing school was my nursing professor advisor, who taught me the importance of resilience in achieving my degree as a nurse. Currently in my work environment, my mentors include my nurse educator, nurse preceptor, experienced ICU nurses, previous new grads nurses, and doctors. They helped me develop my critical thinking, nursing skills, and understanding as a new grad in the MICU. As a new nurse, I feel it is important to have a well-structured new grad nursing program,in which they provide support and resources both in and out of the hospital.
Do you think the profession could use more male nurses?
I think the nursing profession could always use more male nurses because nurses provide care indiscriminately; there should be more diversity among staff members to represent the patients. Staff diversity and inclusion enables us to connect with and provide appropriate care for all patients.
What are your plans for the future?
My plan for the future is to become a nurse leader in the nursing profession. As a male nurse, I am working towards overcoming gender barriers and minority barriers with the goal of bringing diversity to the health care team.
Healthcare practices have been transformed over the past decades in large part due to advances in tech and nursing. In addition to advances in equipment and knowledge, providers began to implement more technology into their daily tasks including electronic health records (EHRs). And then unexpectedly, the COVID-19 pandemic ushered in sweeping changes. From increased virtual visits to additional monitoring and data, healthcare teams are tasked with striking a balance between providing patient care and using data and technology to enhance that care.
A recent Elsevier Health/Ipsos Clinician of the Future report shows the line between technology’s advances and burdens to healthcare providers. While technology can actually reduce time for finding trends or receiving urgent alerts, many clinicians who responded to the report are concerned that the additional technology could end up taking more time out of their already packed days–and away from their patients. In fact, the report states that 69% of U.S. nurses say they believe the volume of patient data available is overwhelming and that training will help reduce that burden.
“Technology must support nurses in selecting out what the crucial facts they need to pay attention to right now, how the status of the patient has changed, and what action is needed,” says Marion Broome, PhD RN, FAAN, Ruby F. Wilson Professor of Nursing at the School of Nursing, Duke University. The Clinician of the Future research says 51% of U.S. nurses believe the widespread use of digital health technologies will enable positive transformation of healthcare in the next 10 years, but 79% also say this will be a challenging burden on their responsibilities.
Although tech-literate nurses might have an easier time adapting to the tech and nursing advances, all nurses require the dedicated time and skill to apply the data. “The biggest challenge for nurses is interpreting the massive amount of data each patient generates,” says Broome. “They are expected to look for trends, understand how their status has changed over time, know whether to worry or get a second opinion. It’s important that nurses anticipate issues before things get out of control.”
Nurses who work in patient care settings feel these impacts directly, says Broome. “In patient care settings, technology has a tremendous impact,” she says. “Nurses are required to do a lot of the information intake and assessments. There are policies in each system around the timeframe they have to do those – usually within 24 to 48 hours of admission. Some of the admission questions are hundreds – 150-200 last I looked. When caring for patients, it falls on nurses to document all of their care, anything they do for the patient – medication, dressing, communication, discharge planning – just the entire thing.”
Often the EHR, a huge benefit to organize patient records and allow access among providers, is a responsibility of the nurses, says Broome, especially in acute care settings. “With EHRs, there are lots of alerts–recommendations for care, medication interactions, planning, etc., that pop up,” she says. “Any interactions or calls between the physician and family must be documented–there’s a burden involved. Depending on the hospital, you’re often caring for 4 to 8 patients. Many nurses will talk about the EHR as an additional patient. And it’s not like they’re sitting at a computer most of the time! They are with the patient.” Reliable voice recognition is a tool many providers would welcome and that could help reduce the burned on documentation.
And although the majority of tech and nursing practices use the same EHR platforms, many nurses will need to adapt to varied technology from the first day on the job. “Think of the kind of care required for COVID-19 patients,” says Broome. “There are patients who require 10-20 intravenous solutions (i.e., drips). Every single drip is delivering a different medication and using different pumps. And those pump settings are managed by nurses. Then, when patients are in the ICU, nurses are expected to understand respiratory settings. While it’s the primary responsibility of a respiratory therapist, it’s critical nurses be able to use that technology.” Nurses have to be fluent in each unit’s technology so they are alert to changes.
The report offers insight for tech and nursing in the future, noting that nurses believe the three most valuable capabilities right now are critical thinking, clinical knowledge, and communication skills. Over the next 10 years, they anticipate a shift that prioritizes technology literacy, clinical knowledge, and critical thinking.
According to the “Clinician of the Future” report, in the next 10 years, doctors and nurses anticipate a health care system where technology is infused throughout patient care–from the technology companies as key stakeholders in managing healthcare systems to clinicians who will base the majority of their decisions using decision support tools that utilize artificial intelligence or even the patients who will engage with chatbots at higher rates.
Broome says the report highlights challenges, offers solutions, and highlights some areas of concern that deserve careful attention. “A challenge,” she says, ” is moving forward with technology, while considering major concerns around tech literacy, loss of empathy, and making sure health care becomes more inclusive, not less, are critical.”
Each year, the National Institute on Minority Health and Health Disparities designates April as Minority Health Month to help promote information and understanding of the health disparities and conditions in minority populations.
In recognition of the continuing pandemic and the disproportionate toll COVID-19 has taken, and continues to take, on minority communities, the theme for 2022’s Minority Health Month is Give Your Community a Boost! The theme centers on the importance of vaccination and getting boosters to help control the spread of and the toll from COVID-19.
They can act as minority health ambassadors in their communities to promote the importance of screenings and healthy behaviors.
They can educate patients and give them information and resources that can help them take control over and prevent some common diseases.
They can act as a support for their loved ones to make sure they have accurate information and know how to work with their healthcare providers for the best possible outcomes.
They can care for themselves to act as role models and to live the healthiest lives possible.
Racial and ethnic minority populations continue to experience the greater impact of many diseases while also struggling with resources and access to high-quality, culturally competent healthcare.
Patients want to meet with healthcare providers who look like them and who understand some of the cultural influences that can impact their healthcare choices and options. If a nurse understands that instructing a patient to avoid all high-fat or high-salt foods might not be possible in many families, then a more culturally sensitive plan can be worked on.
Patients don’t want to feel judged and so understanding, for instance, how a patient shops for food, accesses transportation, plans a list, and cooks meals, and for how many people, can shape a more collaborative and acceptable treatment plan and likely be one that is more successful.
In keeping with this year’s theme of Give Your Community a Boost!, nurses can work with patients around the health equity of the pandemic. They can make sure patients understand how to access vaccines and boosters, determine if they need assistance with transportation, ask if they have supports in place if needed or a plan to cope with potential side effects, and have accurate information about vaccination. Nurses can stress the evidence and the science behind the shots while being sensitive to any mistrust or caution based on misinformation around the vaccines. Patients also need information about the vaccines’ protective benefits in minority communities where COVID-19 raises the risk for hospitalizations and deaths.
During this month that’s devoted to minority health, nurses are excellent educators for their patients and their communities. The more they can help support people to take an active role in their health, to advocate for themselves and their loved ones, and to understand the importance of their own conditions or risk factors, the healthier, and stronger, communities will become.