Robbie’s Four Rules of Professional Practice

Robbie’s Four Rules of Professional Practice

I received a call from Dr. Gloria Rose, my former professor at Prairie View A&M University College of Nursing, asking me to be the keynote speaker at the Pinning and Hooding Ceremony on May 9, 2018. After taking a breath, I accepted the offer and stated, “Yes, I am honored to do it.” As soon as I got off the phone with Dr. Rose, I called my mother and she was so proud of me.

As a nurse practitioner (NP), my work experience includes opening a clinic and managing house calls, as well as serving in homeless shelters, skilled nursing facilities, pediatrics, family practice, community, personal care homes, private homes, weight management, pain management, and the Redi-Clinic. Throughout my sixteen years of practice, I have developed four rules which have assisted me to accomplish success. The following rules have supported my differential diagnoses and plan of care for clients.

Robbie's first rule of professional practiceRule 1. Get a Good History

One of my favorite jobs was working at the homeless shelter. I recall a case that continues to stay with me to this day. The medical assistant presented: “He is here to have his string cut from his chest. The NP before you just cuts it and then he returns again when it gets too long.”  I was thinking what is going on with string cutting from the chest.

As the man is sitting on the examination table, I asked how he is doing and right away he states, “I just need you to clip this string and then I will be okay. That’s what they do, clip it.” He removes his shirt and right away I see the healed surgical incision down the middle of his chest, but in the center is dark blue string protruding from a very small hole.

“When did you have the open-heart surgery, sir?”

“I think it has been about three years,” he replied.

“Have you been getting the string cut for the past three years?”

“Yes, ma’am,” he replies.

“I am not going to cut the string today. This is suture string that is hanging out of your chest from the open-heart surgery. We do not have radiology services here. I want to get all of the string out for good.”

Then, I secured the string with gauze and taped it to his chest. I arranged for him to go to a special procedures clinic. I provided cab vouchers and informed him to leave now. A couple of days later, the man returned. He was smiling. He stated that he had a gift for me. He gave me an envelope. I opened it. It was filled with suture string. Then he said, “Thank you! You solved the problem!”

Robbie's second rule of professional practiceRule 2. Take Your Time

I learned this in graduate school. I saw a young female who presented with missed periods, vomiting, and fatigue. I was focused on her vomiting, and I was in a hurry. I left the room. I failed! Turned out she was pregnant. They say that you learn from your mistakes. I learned that day to always “take my time.”

 

Robbie's third rule of professional practiceRule 3. Be Professional At All Times

At the homeless shelter, I saw a man and asked him how he was doing. “I am not doing well. The doctor gave me this medication for my blood pressure. Oh man! I keep peeing from left to right. As a matter of fact, I got to pee right now.” I reviewed the chart. The medication was hydrochlorothiazide. It is a diuretic which causes frequent urination. I changed the medication to lisinopril to treat his blood pressure and instructed the man to keep a log of his BP readings by going to the CVS around the corner. I gave him pens and a pad and instructed him to return in two weeks for follow-up. When he returned, I was off. My collaborating physician followed up with the patient. He called my supervisor upset that I changed the medication he prescribed. Upon my return to work my colleagues stated, “Robbie, you are in trouble.” I held my tongue. I remained calm and quiet. As I reviewed the chart there was a copy of his blood pressure log, which showed improvement in his blood pressure since taking the lisinopril. This man is homeless and does not have the comfort of a home with a restroom. He has to locate a public restroom to relieve himself. In my professional opinion, changing the medication was the best treatment for him and improved his quality of life.

Robbie's fourth rule of professional practice Rule 4. Go With Your Gut Feeling

During a house call visit the client stated she had a sore and cannot understand how it got there. She reported, “at first I had pain at that same area.” (gut feeling) “Then this sore appeared. Went to the emergency room (ER) and was told that it was an insect bite.”

“Okay, let me see the sore; lift up your shirt.” I saw a fluid filled lesion on an erythematous base. “You have shingles.”

She looked at me, “are you sure?”

“Yes, I am.”

“But the doctor at the ER said it was an insect bite. You are a nurse.”

“I am a nurse practitioner. I can contact your primary care provider (PCP) to prescribe the medication to decrease the severity of the shingles.” She was still not convinced. “Okay, let’s take a picture with your cell phone and then you can send it to your PCP.” As I was leaving, the doctor’s office called and verified the diagnosis. Pain is a symptom that occurs before the lesion appears.

My four rules of practice have provided me with a solid foundation and are the framework of my practice. Every day, I use my four rules of practice and the outcomes are immeasurable. It’s great to know when you have improved the client’s quality of life. This is the greatest satisfaction of all to achieve as a NP.

Resources for Staying Informed and Engaged

Resources for Staying Informed and Engaged

As we usher in the 116th Congressional Session beginning January 4, 2019, lawmakers (newcomers and incumbents) will have the opportunity to address a number of legislative and regulatory issues. Immigration reform, access to affordable health care, climate change, and national and global security are among a long list of issues that will be discussed and debated during this new congressional session. And while there are numerous competing demands as with all other legislative sessions, nurses are encouraged to remain abreast of issues that impact health care and the nursing profession.

This year promises to be another great year to continue improving our policy acumen and advocating for those issues that are most important to us and the communities we serve.

Moving forward in 2019, newly elected Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois will represent the 14th Congressional District of Illinois beginning January 3, 2019. Rep. Underwood is committed to ensuring that everyone has access to affordable health care. She is currently one of two nurses serving in the U.S. Congress. Other nurses across the country hold elected positions in their state legislatures and government appointed positions or serve on a number of advisory committees or boards.

This session, lawmakers committed to eliminating health disparities will work to enact legislation that will propel us toward achieving health equity, particularly for underserved populations who suffer disproportionality from a number of illnesses and poor social conditions. No doubt the issue of health care reform will remain front and center, especially in light of the recent ruling from a federal Texas judge deciding that the Affordable Care Act is unconstitutional. Because this debate is far from being over, we must remain vigilant in monitoring what is happening with this historic legislation. And just as 2018 was deemed the Year of Advocacy by the American Nurses Association, we must be mindful that advocacy is always in season calling us to lend our voices on behalf of those we serve. Regardless of position or setting, every nurse can seize the opportunity to weigh in on policy issues that are of importance to them.

So, consider how will you stay engaged and informed of federal and local policies or regulations that may influence your practice or even the degree to which health care is available to those you serve. Remaining updated on policy issues is becoming even more essential for today’s health care professional. Our professional and specialty nursing organizations provide key resources and often have a specific policy agenda. Have you explored what your professional organization’s position is on a number of policy issues important to nursing?

Consider attending an actual or virtual lobby day this year. Each year nursing organizations such as the American Association of Colleges of Nursing (AACN), the American Organization of Nurse Executives (AONE), and the American Nurses Association (ANA) convene lobby days in DC but also provide opportunities to participate virtually for those who cannot attend in person. Visit their web sites for more details. Numerous state nursing organizations and other health related organizations across the United States also convene lobby days providing yet another venue to lend your voice to a number of health-related causes. And remember to touch base with the Office of Government Relations within your health care system, university, or college.

Be resolved to visit a legislative official this year to learn more about their health policy agenda and promote the profession as well. Commit to reading the local news for policy hooks as they say, “all politics is local.” Subscribe to the Federal Register to stay informed about opportunities to offer comments on proposed regulations, policies or key reports. The Register also highlights opportunities to apply to serve on national advisory committees. Volunteer to give testimony at hearings and town hall meetings as lawmakers can benefit from hearing directly from nurses on health care matters. Well that should keep us all pretty busy. In the meantime, check out some of the resources listed on the right to help with advancing your engagement in policy advocacy.

Key Resources to Stay Abreast of Health Policy and Legislative Issues

 Nursing and Health Care Related Issues
Health Care Access and Other Health Care Related Issues
Health Equity and Disparities Reduction
State Specific Data

Check with your local and state Departments of Health to locate recent and local statistics.

 

Tracking Legislative Bills
Suggested Reading
Celebrating Remarkable Nurses During Skilled Nursing Care Week

Celebrating Remarkable Nurses During Skilled Nursing Care Week

During this week’s National Skilled Nursing Care Week (sponsored by the American Health Care Association), registered nurses working in these facilities can take stock of all they do to help their patients. Skilled nursing facilities help patients who require longer-term care and so nurses who work in these facilities often get to know their patients well. Nurses who are new to the career or who have particular interest in helping the populations served by a particular facility will find the experience they gain valuable.

Skilled nursing facilities often care for patients who require long-term care for conditions ranging from Alzheimer’s or dementia to people with physical or cognitive disabilities. Nurses working with patients in these settings help them with activities of daily living, medical care, and, often just as essential, a familiar and caring relationship. Because the people in these facilities are generally there for a long time, nurses are able to get to know them well and understand their needs, preferences, family dynamics and stories, and what helps them most.

Familiarity with patients also helps deepen the relationships nurses can develop in this setting. Rather than a nursing role where nurses see a patient just once or possibly only periodically, skilled nursing care facilities offer round-the-clock care for the same individuals.

RNs who are new to the profession often find skilled nursing facilities are a good place to work directly with patients and their families. Nurses who work there and with the same patients will begin to learn what an Alzheimer’s patient might find soothing or agitating. They will become acquainted with how someone prefers to move around or the music they like to listen to. With this kind of familiarity also comes the ability to see small, but significant, changes in a patient. Nurses might recognize a decline with troubling behavior or improvement in someone’s condition.

They also offer opportunities for leadership roles and exposure to more complicated care situations. Skilled nursing care means you will assess people over a span so you can monitor factors like their medications, food intake, and socialization as their physical condition undergoes changes. If an injury has caused limited mobility, various impacts like weight gain or less social interaction can change a patient’s mental and physical health. As a longer-term care provider, you can advocate for your patients when you see these subtle changes.

As nurses become more experienced, they also might find a specialty they want to pursue more. As some skilled nursing care facilities are for older patients, nurses might find they want to pursue certification in a gerontological nursing. They may choose to become a certified rehabilitation registered nurse if they work with people who have had life-altering injuries.

As skilled care providers, nurses should always be aware of the help and care they give and just how deep of an impact that makes on patients. Nurses also want to be mindful of their own health and be aware of any feelings of burnout. Taking good care of their own physical and mental health will help them offer the best care while also leading a balanced life.

 

Neuroscience Nurses Week Focuses on a Diverse Specialty

Neuroscience Nurses Week Focuses on a Diverse Specialty

The American Association of Neuroscience Nurses (AANN) honors the dedicated efforts of nurses whose work focuses on the brain during this year’s Neuroscience Nurses Week (May 12-18). Neuroscience nurses work with multidisciplinary teams as the field can involve so many body systems.

According to the AANN, neuroscience nurses have many roles. They care for those who have suffered brain injury or trauma from an accident. They also work with patients who may have neurodegenerative conditions like Alzheimer’s, multiple sclerosis, Parkinson’s, or epilepsy. They may care for people with spinal injuries that impact brain activity. And care offered to patients can be short-term for recovery or long-term for life-long illnesses or those that have progressed.

The American Board of Neuroscience Nursing offers certification for nurses in this field. Nurses who are fascinated by all the activity and operations of the brain are bound to gravitate toward this specialty. They also have an opportunity to make an impact throughout the field by assuming roles within care units or extending their reach into policy and legislation, academia, administration, or research.

Advances in brain science are moving rapidly and each new development can have a life-changing result for today’s neuroscience patients. Certification boosts the recognition for nurses who want to take the extra step and become as informed as possible about these developments, evidence-based practices, and patient care.

Neuroscience nurses work with all ages of patients and so they must understand the body systems of infants all the way up the the most elderly of patients. They are there to help people live a successful life with whatever condition they have or cope when the conditions or situations worsen. These nurses are also there to help with the physical, emotional, social, and even daily activity implications of brain functions. They help families learn to care for their loved ones and educate them about different conditions and symptoms. They can also help them recognize even the slightest progress or be alert for any red flags.

No matter what path of neuroscience a nurse chooses, being a patient advocate is one of their biggest responsibilities and one they are often most dedicated to. People with neurological issues can’t always advocate for their own needs so nurses are there to help them get what’s necessary to live their best life.

Nurses can spread the word about Neuroscience Nurses Week and come together with their own groups in their organizations. They can take stock of the year’s accomplishments and make plans for continuing to provide patients with the best, most cutting-edge care possible.

Lindsey Harris: First African-American President of Alabama Board of Nursing

Lindsey Harris: First African-American President of Alabama Board of Nursing

What better time than National Nurses Day to call out important leaders within nursing? And as a platform for minority nurses, Minority Nurse wants to pay special attention when a minority nurse advances to a leadership role.

Lindsey Harris, DNP, FNP-BC, was recently elected to president of the Alabama State Board of Nursing and will be the first African-American nurse to lead the board in its 125-year history.

The significance of the election isn’t lost on Harris. “This makes me feel I am living my passion,” she says. “It makes me a little nervous, too. I have big shoes to fill.”

Harris says she finds a nursing career a definite calling. “I chose nursing because I always had a passion for helping others,” she says. “Being a nurse is one way I can help others when they are in a vulnerable time of need.”

But Harris also sees education as a big part of a nurse’s role and looks forward to having a bigger voice in the nursing industry to help spread the word about education. Because nurses teach patients and the general population about their health, about taking care of themselves or loved ones, and about prevention, their practice encompasses more than just a specific illness or injury.

It is every aspect,” says Harris. “It’s about the physical, emotional, and spiritual.” And Harris says her own decisions have been led in part by her own faith and spirituality. “For me, I just feel God has put me on this earth to do something bigger than myself,” she says.

And for Harris, one of her biggest drives and skills is being what she calls a “connector.” When a student needs a preceptor, she can scan her network and help connect people. When a patient needs an appointment with a specialist but isn’t sure where to go, Harris can get that all moving.

And being elected the first African-American nurse president of the organization makes her feel good. “It’s important being an example for African-American women and showing them they can do this,” she says. “They can be leaders.” Harris plans to use the platform to help bring nurses in the state together to unite their voices. “We have 100,000 nurses in Alabama,” she says. And many varied nursing associations represent these nurses including the Birmingham Black Nurses Association and Central Alabama Nurse Practitioners Association, both of which Harris is also a member of. “Imagine if we all came together and had one voice,” she says. “We could make real decisions about moving nursing forward.”

Some of the more pressing issues Harris sees is the mounting healthcare crisis that intensifies with each hospital or facility closing. “Access to healthcare is significantly decreased,” she says, noting some people have to travel for hours to reach a facility when the closest one to their location closes.

As a minority nurse, Harris found joining professional organizations to be an excellent way to connect with other like-minded nurses and to make a difference. As for the Alabama State Board of Nursing, Harris says they can make an enormous impact on nursing legislation and policy. “We are the voice of nursing,” she says. Increasing the membership numbers is one of Harris’s goals as is building strong connections within the nursing community and reaching out to the organizations that touch on nursing issues and patient care.

Nurses are dealing with so much more,” says Harris. “The good thing is there are new advances and opportunities for growth within nursing. They can do anything and can work in hospitals, schools, factories … there are so many opportunities for nurses. And it’s so rewarding when a patient says to you, ‘I can tell you really love what you are doing.’”

Nurse Entrepreneurs: Finding Your Path in Nursing

Nurse Entrepreneurs: Finding Your Path in Nursing

Catie Harris, PhD, MBA, AGACNP, FNP, ANP, and a nurse entrepreneur, knew she loved nursing, but she also knew the crazy schedules weren’t giving her the balance she needed and wanted in her life. Rather than leave nursing, Harris took another look at how she could continue in an industry she loved, but with more control over her schedule, projects, and even her salary.

With her knowledge from a nursing career and a business degree and a lot of innovation, NursePreneurs was born. Harris is determined to help other nurses find a nursing path that suits their needs best.

For National Nurses Week, Harris recently answered a few questions from Minority Nurse about the importance of finding your best path.

Many people, nurses included, overlook the essential business skills nurses bring to the industry. How can nurses determine if an entrepreneurial path is a good match for them?

Nurses are trained in nursing school to be entrepreneurial.  In fact, I relied more heavily on the nursing process to teach me how to run my business than anything I learned from getting my MBA.  That might sound surprising, but the MBA teaches you how to operate within a business, not start one from the ground up. Whereas the nursing process teaches you how to assess a population, diagnose a problem, plan for a desired outcome, intervene with the solution and evaluate the response.  These are the essential business skills needed to be an entrepreneur. Even though every nurse learns this entrepreneurial design in the nursing process, not every nurse wants to become an entrepreneur. There are certain qualities that simply stand out in entrepreneurs such as:

  1. Adaptability – business is inherently risky and unpredictable.  A business rarely becomes successful from the first unaltered idea.  When the idea is floated to an audience, the market decides what it wants and the entrepreneur either adapts the business or risks failing.  An entrepreneur must be flexible enough to adapt to whatever evolution the business needs to go through to evolve and sustain itself. Change is inevitable and an entrepreneur has to be willing to accept it frequently.
  2. Resilience – there will be many failed attempts at starting and scaling a business.  An entrepreneur must see every attempt as an experience and not a failure. No entrepreneur would ever be successful if they focused on all the things that go wrong.  Entrepreneurs must see every obstacle as a challenge to overcome and not a dead-end.
  3. Persistence – Entrepreneurs have to be persistent.  A “no”, simply means your audience doesn’t understand what you are offering and the message needs to be adjusted.  You have to be ok with getting candid answers to the solution your provide. Entrepreneurialism is not for people who attach all their self-worth into a solution or suffer from perfectionism.
  4. Excellence – Entrepreneurs love to over deliver and provide massive value.  They are consumed by learning, growing and sharing their knowledge. The entrepreneurial path is for people who want the freedom to pioneer their own way and decide how to focus their attention and energies.  This is definitely not the space for anyone who needs to follow an agenda.

In what ways can an entrepreneurial nurse make an impact on healthcare policies and industry practices and, of course, patients?

All nurses can make a huge impact on healthcare policies, industry practices and patients.  Being at the bedside, nurses know more than anyone what patients need, want and desire. Nurses are the number 1 trusted profession, and because of that ranking, patients trust us with incredibly sensitive information.  Patients tell us their fears and frustrations about their disease and health conditions. Nurses are in a unique position to use that information to create businesses that serve the patients in a way that benefits them.

Nurses are also keenly aware of how hospital policies and industry standards impact the services provided to patients.  For instance, one of my students is working on a business model that helps cancer treatment centers to educate their staff on how to communicate with patients. There are many questions and concerns that patients have that never get addressed out of embarrassment, worry that they are taking up too much time or being burdensome or because they simply don’t understand what is going on.  This type of business has strong potential to alter how cancer education is delivered in the healthcare system.

What can nurses do to gain business skills and education that will help augment their nursing skills?

Nurses can gain business skills and education through books and online education.  There are many groups out there who are helping nurses to gain the knowledge they need to support their business models.  Investing in seminars, conferences and networking events is also hugely beneficial. Finally, nothing will fast track business success more than finding a mentor who has done what it is that you want to do and start working with that person as early on as possible.

How did you discover this path for your own nursing career?

I have had the entrepreneurial itch for decades!  I also suffered from “bad employee syndrome”, meaning I always wanted to pioneer my job in directions that weren’t exactly in line with what my employer had in mind for me.  I didn’t like being reigned in and having a defined job. I wanted to explore what was possible and continue growing and learning. The only “job” that truly allows this type of occupational freedom is the one you can create for yourself.  I might not have started my business if I found a job with occupational freedom that paid well, but it didn’t exist for me, so I created it.

What makes your role as a nurse entrepreneur so rewarding?

I love seeing the impact of my students on their clients.  When they have success, I celebrate it as if it were my very own.  When you see how your work helps others to help others, it’s incredibly rewarding.  My goal is to help 1000 nurses to start up their businesses in the next 2 years. Imagine the impact of 1000 nurses in business helping others to achieve healthier lifestyles, improved outcomes and live happier lives.  Pursuing my passion, living my purpose and using my talents is what makes being a nurse entrepreneur so rewarding.

Never Ignore Your Nurse’s Intuition: One Nurse’s Story

Never Ignore Your Nurse’s Intuition: One Nurse’s Story

There’s no better time than during National Nurses Week to pay attention to the skills nurses have that aren’t acquired in any classroom. Kristi Tanisha Elizee, RN, BSN, and a current master’s degree student focusing on Clinical Nurse Leader (CNL), knows first-hand about the power of a nurse’s intuition.

This past February, Elizee was working the NICU night shift of a Kansas hospital and had been assigned to a mother-baby pair. From the hand-off report with the previous nurse, she had been told, and was able to observe, the baby had head-molding after delivery. Although Elizee noticed the baby’s head looked strange, continued observation revealed only typical behavior. The baby slept, woke, and breastfed well about every three hours.

When she went to perform a head-to-toe assessment of the baby (after notifying the parents), Elizee became alarmed. “When I assessed this baby’s head I could not believe what I felt,” she says. “This baby’s anterior fontanelle was very wide and bulging which extended to her forehead. On top of her head felt soft, the posterior fontanelle was not palpable, and in the same area where the posterior fontanelle was supposed to be, instead the skull was protruding.”

All the baby’s vital signs were good as were the other assessments of the baby, but Elizee knew something was wrong. She also knew she had to trust her intuition. “For me, this was not head-molding,” she says. “I brought the baby back to her mom’s room and immediately went to review the doctor’s documented assessment again on this baby.” Everything appeared to note head-molding, so Elizee, who would need to perform another assessment in four hours began researching information while monitoring the baby and her other patients.

Persistence Works

“I saw a variety of problems including pictures of the way this baby’s head was shaped, and it was called ‘Craniosynostosis,’” she says. According to the Mayo Clinic, “Craniosynostosis (kray-nee-o-sin-os-TOE-sis) is a birth defect in which one or more of the fibrous joints between the bones of [a] baby’s skull (cranial sutures) close prematurely (fuse), before [a] baby’s brain is fully formed. Brain growth continues, giving the head a misshapen appearance.”

Elizee wasn’t sure if what she found was the problem, but she had to speak up. “I was not sure what this baby was diagnosed with but I knew this baby’s head was not normal,” she says. She notified the other nurse on the NICU shift, then her supervisor, and the providing physician was immediately called. The physician initially believed the baby had head-molding as well. “I started to doubt myself again, but I knew deep down this was not normal,” Elizee says. After performing her own assessment, the physician agreed with Elizee. From there, a pediatrician came onboard, and Elizee says she carefully documented everything.

The experience has been simultaneously transformative and heartbreaking. “I have never cared for a baby diagnosed with this condition before so this was my first time,” she says. “The day after when I came back to work, the nurse whom I gave report to about this baby, told me that my assessment findings were right. They had to do a head CT scan and it revealed that this baby had ‘Craniosynostosis.’” The baby was referred to a different hospital, and although Elizee doesn’t know her current story, she’s confident that her persistence made a huge difference in the baby’s life.

“I just had a gut feeling that what I felt was not normal and knew I had to speak up,” says Elizee. Although she doubted herself based on what others were saying, Elizee says she had to honor her intuition. “Nurses just need to follow their instincts,” she says. “Once you know it is not normal or not right, then take action. Do not second guess yourself.”

Big Move for Her Career

Elizee hails from St. Lucia. “I made the decision to move to the U.S.A for growth and development through Avant Healthcare Professionals, an international nurse recruiting agency,” says Elizee, who says she initially considered a career as a veterinarian. “I want to take my nursing career to the next level.”

Oddly enough, Elizee had been considering a switch out of NICU because she was struggling with the role. “When I first started working as an RN new grad, I worked on the medical unit for a month, later I was sent to work in the NICU which I have been in for eight years,” she says. “The first few months being there was tough, and I almost made the decision to go to another unit to work. I was just not enjoying it.” But her NICU nurse-manager noticed and became Elizee’s mentor.

Under her guidance, Elizee says she gained confidence working with these tiny babies—none of whom can tell their caregivers what is bothering them. The experience made all the difference. “NICU is a challenging place to work,” she says now, “but I love the challenge. Every day is a learning experience, and I am embracing it. Now I want to become a neonatal nurse practitioner.”

Charge Nurse Work: What You Need to Know

Charge Nurse Work: What You Need to Know

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.

School Nurses Help Their Communities

School Nurses Help Their Communities

School nursing today is nothing like it was a generation ago, and today’s National School Nurse Day is a time to recognize all the contributions school nurses make to their communities. Some things are a school nurse’s constant—there are always scrapes to be cared for, nervous tummies to settle, and accidents that can happen on the playground or in the hallways. But no one would argue that the landscape of a school’s environment has evolved to mirror the growing unrest in the larger society.

With so much going on, it’s no wonder that school nurses can never expect to have a typical day.

As a school nurse, you offer physical and emotional care, education, stability, and guidance to the kids you serve and to their families as well. School nurses today see children of all ages who cope with greater anxiety and depression. Greater numbers of children are exposed to trauma than they were 30 or 40 years ago. They are coping with social media and all the struggles to understand the open and unspoken social rules that surround the technology that is available at their fingertips. And the increasing episodes of school violence, from terrifying school shootings to dating violence to tensions between students within a school, are becoming more prevalent than ever before.

How can a school nurse be prepared?

Honor your knowledge

As a school nurse, you know your student population. You know what they are dealing with and what the predominant struggles are within your school and district. Keep in close contact with the other nurses in your school and your district if possible. That open communication can help you keep current with issues that may begin to bubble up in your own school.

Stay connected

As much as you can, stay in touch with town leaders, especially the emergency responders and police. Monitor social media to learn what is trending among the age population you serve. Vaping is a big problem among even younger students right now. Try to learn about what kids are doing.

Continue your education

Attend seminars, watch online tutorials, gain certification through the National Board for Certification of School Nurses and any other areas that may help you care for students. If you are seeing high rates of anxiety and stress, learn about how kids can cope and even how technology can help them. Are you seeing more diabetes or cancer in your school population. Learn how to best help and educate them and even what barriers they may have to remaining healthy. Check resources through the National Association of School Nurses to continue learning.

Care for yourself

School nursing is challenging, rewarding, and extremely tough. The needs of the students and the hard times they may be faced with can sometimes overwhelm even the strongest nurse. You have to help without being pulled under, so take the time to find a way to relieve your own stress. Find a hobby that captures your attention enough that you can really focus. Incorporate purposefully stress reducing activities into your life—yoga, exercise, meditation, dance, cooking, spiritual gatherings, gardening, roller derby—whatever activity helps you get away from your thoughts for a bit.

The Road to Resilience: Nurses Week Edition

The Road to Resilience: Nurses Week Edition

Overcoming adversity is a demanding task that requires a great deal of emotional resilience and mental toughness. While many people react to such circumstances with a flood of emotions and a sense of uncertainty, others may choose to adapt positively in response to their life-changing situations and stressful conditions. As a medical-surgical nurse, Jamie Davis, RN, understands the meaning of handling adversity both professionally and personally. In this Q&A interview, Davis discusses the importance of emotional resilience and how rising above adversity ultimately shaped her into the nurse that she is today.

Jamie Davis discussing her road to resilience

Jamie Davis, RN

How did you become a nurse?

In 2006, I attended college in Michigan with a major in cosmetology. I met someone who was working as an LVN at the time who asked if I needed a job. During that moment, I did not have any intention of working in the health care industry. But during the interview however, I was asked, “how would you feel if you were unable to help someone you were caring for?” Surprised by this question, I simply responded, “I would feel horrible, but in the end, I would do everything in my power to assist them and make them feel better as a person.” It was at this moment that ultimately began my journey as a future nurse.

Why did you choose the specialty you currently work in now?

In 2007, I received a distressing phone call from my parents informing me that my brother was admitted into the ICU. After hearing the news, I booked a flight to California and headed straight to the hospital where he was staying at. When I walked into the room, I saw my brother lying lifeless in bed with machines hooked up to him. At that moment, so many memories rushed through my head and I began to have all these endless questions – What am I going to do if he doesn’t come out of this bed? How are we going to move on? How are we going to make it through this? Luckily, my doubts and fears went away when he began to improve so I decided to fly back home.

A few months later around Christmas time however, I received another troubling phone call from my mother telling me that my brother got readmitted again to the ICU but this time with worsening complications. As I rushed to the hospital, I distinctly remember seeing all the tubes hooked up to my brother and the nurses working tirelessly to save him.

Unfortunately, the following morning, I received the phone call that nobody ever wants to hear – my brother has passed away. It was a life changing moment that my family and I will never forget, but ultimately inspired me to become the nurse that I am today.

Therefore, although I currently work on the medical surgical unit, my dream is to one day work in either the ER or ICU settings to one day help those patients who are also in critical need.

How has your brother’s passing impacted the care you give for your patients? 

Although my brother’s passing continues to affect me each and every day, I’ve learned to keep his memory with me every time I come to work and care for my patients. Despite his unexpected death, I’ve learned to understand that being resilient is learning how to not only live with those painful memories but also deal with it in a positive way.

What kind of advice would you give our readers on how to overcome tragedy as a nurse and develop resiliency? 

One piece of advice that I would like to give the readers on how to overcome tragedy as a nurse is understanding that overcoming adversity is a personal journey. It’s okay to grieve from time to time, but it’s also important to take your sadness and create something positive out of it. Because of this, I have learned to become a more vocal advocate for my patients and their loved ones in times of need. By doing this, I am able to honor my brother’s spirit through my work as a nurse.

Do you have any parting words of encouragement for those interested in pursuing a career in nursing? 

To anyone else who may be going through a difficult time, please don’t give up. Regardless of how difficult and emotionally challenging life can seem, personal success all depends on how you choose to deal with your given circumstances. Therefore, I am a living example that no matter what life puts you through, your dreams can become possible if you believe it.