What’s it Like Working as a Perianesthesia Nurse?

What’s it Like Working as a Perianesthesia Nurse?

When patients have surgery or other procedures in which they have to receive anesthesia, a team works together to ensure the patient’s safety and best care. One of these team members is the perianesthesia nurse.

Terry Clifford, MSN, RN, CPAN, CAPA, FASPAN, has worked in this field since 1991 and took time to answer our questions about it.

As a perianesthesia nurse, what does your job entail? What do you do on a daily basis?

Within the scope of perianesthesia nursing, there are a number of opportunities to serve. From 1991 until 2015, I worked as a clinical bedside nurse in the PACU (post anesthesia care unit). Throughout that time, I often worked as the clinical resource nurse for the unit, not only caring for patients emerging from anesthesia, but helping to coordinate resources within the unit to ensure safe patient ratios, appropriate breaks for staff, etc.

Today, I am the perioperative nurse manager responsible for leadership of 60+ staff members working between the preoperative clinic, the ambulatory surgery unit, and the post anesthesia care units. My current role in perianesthesia nursing includes oversight of unit-based budgets and productivity, staff education and guidance, and active participation in surgical services activities geared at optimization of services and providing quality care.

Why did you choose this field of nursing?

After graduating from nursing school in 1981, I was fortunate to have many opportunities to work in a wide variety of subspecialties, from med-surg, to cardiac rehab, to care coordination, to house supervisor. Upon graduating from a master’s program in 1991, I happened upon a clinical position in the PACU and never left.

It’s an amazing privilege to be able to help guide a patient and family through experiences that can seem frightening, during a time when they are most vulnerable and often fearful. There have been such wonderful advances in the science of anesthesia and pain management that being on the cutting edge of change is always exciting.

What’s the most surprising thing about your job that other nurses wouldn’t expect?

I think one of the interesting things about perianesthesia care is that while we can be confident that we have provided incredible support to safely and competently guide a patient through a surgical or procedural experience, many times the patient does not remember anything. This was disappointing to some nurses who highly value the nurse-patient relationship, but I believe that even in the fog of anesthesia, and the fact that the patient may or may not remember, we do an amazing job of keeping the patient experience a positive one.

What would you say to someone considering this type of nursing work?

I highly encourage staff to pursue their passion—if this is an area of interest, by all means, find a way in!

I think that perianesthesia nursing is the best kept secret in this profession. Every day, I am grateful for the privilege it offers as far as providing safe, respectful care to patients as well as providing safe, respectful leadership to staff.

Have a Heart: Working as a Cardiovascular Nurse

Have a Heart: Working as a Cardiovascular Nurse

Nurses can go into so many different areas in the field, cardiovascular nursing being just one of them. But as with all career choices, nurses need to have the right information to determine if this area is right for them.

We interviewed Jill Price, PhD, MSN, RN, senior director of Chamberlain University’s College of Nursing Post-Licensure programs. Price has nearly two decades of experience in Critical Care and Cardiovascular Nursing, and trained nurses at the first cardiac care center in the U.S. Virgin Islands—St. Croix—in critical care and cardiovascular care. Previously, Price worked as an advanced cardiac life support instructor and pediatric advance life support instructor.

What are the different types of nurses used in cardiovascular care? What do their jobs entail?

For nurses who don’t have any sort of critical care experience and want to go into cardiovascular nursing, I would first recommend the nurse seek out a critical care training course and then either a job in a critical care step down unit or an intensive care unit. Some hospitals require a year of medical-surgical nursing experience first before seeking a position in a critical care unit, so the nurse would need to check with the institution on what their requirements entail.

The different types of nurses who pursue cardiovascular care are those who love taking care of very sick patients with several comorbidities. These nurses are a unique group in that they like to help patients with complex medical problems, often times requiring advanced technology to maintain their heart rate. Cardiovascular nurses have advanced critical thinking skills.

If nurses want to pursue a job in cardiovascular care, what additional training or certifications do they need?

In terms of certification, I would recommend getting certified as a critical care nurse with the American Association of Critical-Care Nurses (AACN) organization. Additionally, they should seek out advanced cardiac life support (ACLS) and advanced pediatric life support (PALS) certifications.

What are the biggest challenges of being a cardiovascular nurse?

Since cardiovascular disease—which includes heart attacks—is the leading cause of death in the United States, nurses working in cardiovascular care, inclusive of interventional cardiovascular laboratories, are on call often. This requires not only working during the week at normal scheduled hours, but also being on call after normal working hours. And when a nurse is called in, they have less than 30 minutes to drop whatever they are doing to get to the hospital and save a patient’s life. Cardiovascular nurses are dedicated and committed to their job and time away from families can be challenging for some.

What are the greatest rewards?

Resuscitating a patient back from being in full blown cardiac arrest and seeing them walk out of the hospital like they were never sick. Or witnessing a patient whose limb was blue from an arterial vascular occlusion and working to open the occlusion and save the person’s limb by witnessing the blood flow restoration in the limb.

What were some of the most important things you learned while doing that kind of work?

I learned that with new devices and drugs consistently being developed, the cardiovascular nurse must stay abreast on all the latest technology and innovation in order to advocate for the patients’ best interests and choice in health care. Also, timing is everything, from saving the heart to the brain. You have to essentially dedicate your life to this kind of nursing, and even if you make a difference in one person’s life—but there will be many—you will feel proud knowing all that dedication and rushing to their care was worth it.

If nurses are interested in becoming a cardiovascular nurse, what advice would you give them?

Be prepared to devote time away from your family in return for helping save lives. Work in telemetry or acute care settings right out of nursing school and enroll in a critical care course, with the goal of becoming a certified critical care nurse, as soon as possible.

With advance research always being conducted on how to help decrease, prevent, and treat cardiovascular disease, you will get to learn something new every day.

Operation Smile: Bringing Happiness Worldwide

Operation Smile: Bringing Happiness Worldwide

For Sally Herman, RN, nursing was a calling. Having been born with a crossed-eye that required a number of surgeries at different hospitals in a few states, Herman had spent her childhood being bullied. She became a nurse, as she had hoped, and shortly after she graduated from school, she saw commercials for Operation Smile.

She knew she had to help, as she didn’t want other children to suffer like she did. She recently returned from her 50th medical mission with the organization, having spent 20 years as a volunteer. Today, she’s their clinical coordinator and is still moved by the group’s results.

“My first trip was to Nairobi, Kenya. I was working as a Recovery Nurse for the team. I was hooked as soon as the surgical team placed a child who had his cleft lip repaired, and I got to place the baby in her mother’s arms. The tears of that mother will stay with me forever,” recalls Herman. “I knew this is what I wanted more than my life itself. The redemption moment of child reuniting with her parents, repaired and opening up school opportunities, job opportunities and marriage—a world that child would have never seen, if Operation Smile would not have stepped in! I was hooked and never looked back. I still cry at that very moment, every time.”

Herman explains that “Operation Smile is a nonprofit organization that joins together with other countries in the treatment of cleft lips and cleft palates that occur in their countries. Many of the countries do not have access to safe surgery or the people who know how to do it. Our goal is to get rid of all clefts and teach a country how to meet their surgical needs for those children and adults suffering,” she says.

If you’re interested in becoming involved with Operation Smile, Herman says that you begin by submitting an application. To work as a volunteer nurse, you need to have PALS and CPR certification as well as pediatric experience. You will also need to have specific skills, depending on the area you want to volunteer in: they have pre and post op nurses, recovery room nurses, and OR nurses. If you want to volunteer, but don’t have the skill set, you can volunteer helping with medical records or with photography.

“For whatever area you get accepted in by your application, you will receive training on how the mission works and your roles and responsibilities,” says Herman.

As the Clinical Coordinator, Herman organizes the team on the ground, and she makes sure that all the nurses know their jobs and that every area is set up correctly to standard. She also screens all the patients on screening days, and works with the team leader surgeon, pediatrician, and anesthesia, they decide which patients that are able to operate on and which they can’t.

During their surgery week, she organizes patient flow to and from OR, RR, and post-op. She is also available for every emergency.

“I love this position so much as I get to be involved with the families and my team equally,” says Herman. “The one thing that constantly unites us as a team are those children. We are seriously giving them a future.”

Herman says that people may wonder why she does all this work for free and uses her vacation time to do so. “I have been to about every country in the world and even was inspired to start a feeding program in South Africa from my experiences,” she says, “It restores humanity to your life; it builds compassion and brings nursing to its real roots.”

If you’re thinking about becoming involved with Operation Smile, Herman says that you should do it. “It will be the most inspiring work you could ever do,” she says. “It is their smiles that keep me going back.

To learn more, visit www.OperationSmile.org.

The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

The “Do Tell” Your Doctor Tool Helps Parkinson’s Patients

While Parkinson’s can be a difficult disease for many patients to deal with, there’s now a new online tool that can help them initiate helpful—and in fact, crucial—dialogue with their health care workers.

We spoke with Karen Jaffe, MD, co-founder and vice president of InMotion, a community center for people with Parkinson’s and other movement disorders. A retired OB/GYN physician, Jaffe was diagnosed with Parkinson’s in 2007. She gave us important information that nurses need to know about the “Do Tell” Your Doctor Tool.

What is the “Do Tell” Your Doctor Tool, why was it created, and how does it work?

Sample word cloud, as delivered via email upon completion of the “Do Tell” Your Doctor Tool

The “Do Tell” Your Doctor Tool aims to improve communication around “off periods” between people with Parkinson’s and their doctors. “Off periods” are the re-emergence of Parkinson’s symptoms, which can be hard to identify because they differ for each person and sometimes from day-to-day. These factors can make it difficult for people with Parkinson’s to communicate about their symptoms with their family, friends, and health care professionals.

The tool is based on a clinically validated questionnaire developed by Duke University, called the Wearing-off Questionnaire 9 (WOQ-9). Users review nine Parkinson’s symptoms and rank how bothersome each symptom is (for example, “Very Bothersome,” “Bothersome” and “Somewhat Bothersome”). After completing the questionnaire, users will receive a customized word cloud via email that visually displays the symptoms they chose, with the largest words depicting the most bothersome symptoms. They can then bring these results to their next doctor’s appointment to help guide and prioritize the discussion about their Parkinson’s symptoms.

As part of the “Live Well. Do Tell.” steering committee, my organization, InMotion, had the opportunity to participate in beta testing for the tool to ensure that it’s user-friendly.

What do nurses need to know about it?

People with Parkinson’s who experience “off periods” may not discuss their symptoms or communicate the impact to their health care professionals, as they may believe that the re-emergence of symptoms is just part of their condition, or they may rationalize the impact because they fear it signals their condition is progressing. The intent of the tool is to initiate better dialogue between people with Parkinson’s and their health care professionals about their symptoms and about “off periods.”

How can they utilize this tool or recommend that their patients use it?

If patients are having a hard time talking about their symptoms, pointing them to this tool may provide them and their care partners with a guide to recognizing and recording symptoms that may be overlooked.

The tool is an easy online resource that people with Parkinson’s can use in advance of their doctor’s appointments. With the resulting word cloud shared via email, they’ll be armed with an actionable item they can share with their health care providers, who can in turn help them better manage their Parkinson’s symptoms to live well.

Why is it important for this tool to exist? What does it provide that is new?

Many factors make it difficult for people with Parkinson’s and their care partners to distinguish their most bothersome symptoms, and many often have a hard time articulating the impact of their symptoms during a doctor’s appointment.

The “Do Tell” Your Doctor Tool can impact the care people with Parkinson’s may receive—offering a visual guide that helps to recognize and record a person’s bothersome symptoms and providing a resource they can bring to their next doctor’s appointment to spark discussion and lead to more effective communication.

The need for this kind of tool was first identified in the “Live Well. Do Tell.” Statement of Need, which serves as the foundation of the initiative and outlined actions for the Parkinson’s community to help identify and communicate about “off periods.” The Statement of Need was developed based on learnings and insights from a multidisciplinary steering committee of leaders in the Parkinson’s community who collaborated to discuss unmet needs in understanding and communicating about Parkinson’s symptoms.

The “Do Tell” Your Doctor Tool is available online at LiveWellDoTell.org/takeaction.

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Complementary and Alternative Medicine: What Nurses Need to Know

Acupuncture, aromatherapy, supplements, and the like—more and more people across the nation are using these therapies. Because a number of these people will be your patients, it’s important for you, as a nurse, to know complementary and alternative medicine and about how to get more education if you’d like to implement them into your practice.

First, let’s make some distinctions: while “complementary” and “alternative” both represent the same types of therapies, they are different. Both words refer to non-mainstream treatments such as aromatherapy, meditation, massage, etc. However, when a health care provider uses complementary medicine, it’s used in conjunction with common, Western medicine. When the provider uses alternative medicine, it’s used in place of common, Western medicine.

Within this article, we will use the abbreviation CAM, which stands for complementary and alternative medicine. The focus here is not on if it’s used with or without Western medicine, but how it is used with patients at all.

Why Learn About CAM?

If CAM isn’t used yet at every health care facility, then why should nurses learn about it? “Patients are using them. Time and time again, research finds that the majority of the population is using integrative health products, and this rate is much higher for patients with higher socioeconomic status and/or patients who suffer from chronic health conditions,” says Jessie Hawkins, PhD, director of the Franklin School of Integrative Health Sciences. “Without guidance from their care providers, patients are left to self-educate through online sources. This results in reduced efficacy at best and injury at worst.”

With so many patients using CAM, Mollie Aleshire, DNP, MSN, FNP-BC, PPCNP-BC, FNAP, DNP program director and clinical associate professor at the University of North Carolina at Greensboro School of Nursing says, “It is essential that nurses have knowledge about common CAM and obtain information to elicit use of CAM therapies from the patient history.”

“It’s important to help patients get information from reliable sources and to know if a suggested alternative treatment, such as herbal supplements, may interfere with the medications they are currently prescribed or may be detrimental to their health,” says Tina M. Baxter, APRN, GNP-BC, president and CEO of Baxter Professional Services, LLC.

“Patients are now looking for alternative therapies. A lot of people don’t want to go with pharmaceutical drugs anymore,” says Jennifer Burns, NMD, founder of Burns Integrative Wellness Center. “It’s nice to have other modalities to help the patients.”

“It’s important for nurses to learn about alternative therapies because they offer patients new avenues that may improve their conditions and overall health,” says Linda Steele, PhD, MSN, BSN, APRN, ANP-BC, program director for Walden University’s nurse practitioner programs.

The Most Commonly Used CAM

According to Baxter, there are eight most commonly used CAM therapies in health care: acupuncture, aromatherapy, hypnosis, massage therapy, meditation, Tai Chi, therapeutic touch, and vitamins/herbal supplements. These, she says, are the most researched and studied.

“For example, aromatherapy oils are now used post-op in some hospitals to reduce anxiety and pain after surgery so that patients will require less pain medications. Meditation has been used in psychiatry through progressive muscle relaxation, guided imagery, and mindfulness meditation to augment the practices of cognitive behavioral therapy and dialectic behavioral therapy. Tai Chi has been shown to improve balance and flexibility for older adults and thereby reducing falls in long-term care and community settings,” explains Baxter. “Herbal supplements such as CBD oil have shown some efficacy in reducing seizures, pain, and anxiety. Hypnosis is a treatment that is offered for smoking cessation and obesity treatment. Massage therapy and acupuncture have been demonstrated to be beneficial in addiction treatment. Therapeutic touch has been demonstrated to help with pain in some instances by manipulating the energy fields that surround the body.”

Audrey Christie, MSN, RN, a self-employed holistic wellness practitioner, says that CAM has become more common because of evidence illustrating their benefits. “Things like aromatherapy in labor and delivery units, as well as mindfulness and meditation or Reiki-style practices, are becoming more and more mainstream,” Christie says. “They can help with pain reduction, mindset, relaxation, anxiousness, and many other aspects of the body-mind connection. In recent years, science has been beginning to catch up to what we have known intuitively for years.”

Hilary Erickson, RN, BSN, a labor and delivery nurse and creator of Pulling Curls says that if patients are pregnant with breech babies, she will often recommend that they see a chiropractor, as she believes that a skilled practitioner may help prevent them needing a C-section.

Christie makes another good point: “All therapies were once considered alternative—even antibiotics. We know that there is far more to healing than just applying a chemical compound or mechanical procedure to the human form—that intrinsic mind and spirit aspect can be a real determining factor in whether or not a patient gets better.”

Getting Educated

Don’t be like your patients and simply look up information about CAM online. If you want to implement it into your practice, it’s necessary for you to get some kind of formal education.

“Integrative health is a concept that is rapidly growing and expanding worldwide. Sales of dietary supplements are up year after year, and the industry itself is a multi-trillion-dollar global market. Patients are using alternative therapies, and that use is increasing,” says Hawkins. “Continuing education in integrative health is one of the best career investments a nurse can make.”

But there are other reasons to study CAM. “Nurses should be skilled in the therapy before providing it, and it should abide within hospital policies so that they can maintain the standard of care the hospital wants them to provide—and so that they are protected,” cautions Erickson.

A number of our sources recommend that nurses first look to the American Holistic Nurses Association for educational opportunities in CAM. The organization offers certification as well as online training programs.

“There are some complementary certificates available, such as the two-year program with alternative therapies expert Dr. Andrew Weil,” says Steele. “Many nurses also get certified as a licensed massage therapist or acupuncturist.” Steele also notes that some conferences, like the annual one offered by the American Academy of Nurse Practitioners, may offer CAM single sessions and in-depth training.

“We train nurses to become board certified health coaches, herbalists, and aromatherapists. We focus on these specific areas because they are the dominant integrative health fields in nursing practice,” says Hawkins, speaking of the Franklin School of Integrative Health Sciences.

“These therapies complement a nurse’s practice by providing additional tools that can be used to boost overall quality of life as well as patient compliance with wellness programs. For example, much of the research on aromatherapy is specific to pre-procedural applications such as anxiety relief before a surgical intervention. For many applications of herbs and essential oils, there is high quality evidence supporting its use,” explains Hawkins. “Sometimes this evidence also clarifies its use. For example, recent research we conducted found that children with an autism spectrum disorder respond differently to pre-procedural aromatherapy than the general population. This helps to demonstrate not only that these interventions work, but with which populations they are found to be effective.”

Most nurses can streamline their training at Franklin because they have general health education. Nurses train via interactive distance learning—so they can still work—and most complete their programs within a year.

While many institutions teach CAM, Christie advises nurses to use caution: “Only spend time and money on accredited schools. The kind of education they need depends entirely on the state in which they are practicing.”

“Medicine is evolving, as is the state of health. It’s critical to explore options and be at the forefront of new therapies. In fact, most nurses took an oath to continue educating themselves,” says Christie.

CAM and Patients

While many patients will be using some form of CAM, you may encounter some who aren’t. As a result, you’ll need to explain it to them to make them comfortable.

“Never force them,” says Christie. “I try to come from a place of explaining it on their level. If you think of something like a breathing technique and work from there—often in conversation and assessment—you can find a connection to discuss with the patient and make them comfortable. If they never get to comfortable, I try to send them with some education to learn more about the therapy on their own time.”

Steele suggests that nurses begin by giving basic tips to their patients to improve their overall health and wellness. “Ask the patient to identify what types of therapies they have heard about and what their level of comfort with them is. Always assure them that they will have access to different medical recommendations, including alternative therapies, if and when they are ready to take that step,” says Steele. “Stress the idea of complementary medicine and nursing as a blend of both Western traditional medicine and Eastern modalities, which are more than 2,000 years old. Patients become much more comfortable when they realize they have choices in their health care.”

Baxter says that she explains to patients that there is research and evidence for the prescribed therapy as well as how the therapy may benefit them. “I would be very careful, as some clients are concerned about promoting a specific religion when you talk of medication and Tai Chi. I encourage the clients to think of it as learning to ‘quiet your mind’ and ‘learning to move your body to promote healing’ as opposed to supporting a particular ideology,” she says.

Cautions to Keep in Mind

With any kind of health therapy, there are cautions to be aware of. For example, just because vitamins and other supplements are sold over the counter, that doesn’t mean that they are safe at all times. Steele says that there are still precautions nurses should take. “As with any medical or physical therapy, all have side effects and can cause potential harm or injury to the patient,” she says.

“Avoid a one-size-fits-all approach. Like medications, what works for one person may not work for another. I have clients who do not respond well to aromatherapy but may respond better to some acupressure,” says Baxter. “I would make sure that if I am recommending any treatment, I would first research it for the evidence that it may be effective and make sure that you are qualified to provide the service that is offered. For example, Tai Chi is of great benefit to older adults, but I am not a certified instructor. I do know some basic moves from a video that I will often demonstrate to the other health care providers to show them the movements, but I refer clients to a certified instructor if they want to take the class.”

Hawkins stresses that nurses need to know if their individual state or facility where they practice allows alternative therapies. Some don’t. But they also need to know how the therapies, if allowed, will affect their patients as well.

“Nurses should be aware that alternative therapies are not free from risks and contraindications. Many of these therapies interact with conventional medications or treatments, and many others pose risks to patient health,” says Hawkins. “There are also restrictions on how these therapies should be used, even on otherwise healthy patients. For example, some essential oils can slow breathing in infants. Others can cause someone who does not typically burn to get a sunburn. Studying integrative health provides the framework needed to keep patients safe.”