This past spring, Chenjuan Ma, PhD, and Amy Witkoski Stimpfel, PhD, RN, both assistant professors at NYU Rory Meyers College of Nursing, published a study in the Journal of Nursing Administration that examined whether working overtime can negatively influence how nurses collaborate with other nurses and physicians. In their study “The Association Between Nurse Shift Patterns and Nurse-Nurse and Nurse Physician Collaboration in Acute Care Hospital Units,” the researchers concluded that one third of all nurses work longer than they are normally scheduled, and as a result, their ability to collaborate decreases.
Drs. Ma and Stimpfel took time to talk about the study and its results.
Why did you decide to do this study in the first place?
Dr. Stimpfel: There has been increasing interest in how to manage shift work and overtime hours for nurses due to the impact of fatigue on patient safety and quality. Collaboration has been identified as being a factor that is influential in patient safety and quality as well. We know that our ability to work effectively and regulate emotions—key to collaboration—diminishes with increasing wakefulness and fatigue. We could not find literature to support the relationship between work hours/overtime and collaboration in the nursing literature, which is why we conducted this study.
It’s interesting that nurses who work regular shifts of 11.88 hours or longer regular shifts of 12.17 hours don’t have a decrease in collaboration. But if nurses working that first shift of 11.88 hours had to work a shift of 12.17 hours—which would mean overtime—they would have a decrease in collaboration. Did you discover why this happens?
Dr. Stimpfel: Our data did not detail why working overtime resulted in decreased collaboration. However, the conceptual model in our study helps guide our hypothesis about why this relationship occurs. As nurses work longer shifts, often unexpectedly, this increases wakefulness. Prolonged wakefulness can result in less ability to make decisions and regulate emotions, which may lead to greater difficulties in collaboration. As suggested by our findings, this is more likely to happen when nurses have to unexpectedly work longer than scheduled.
Does any amount of overtime cause problems with collaboration between nurses and other health care professionals?
Dr. Ma: With our current study design (i.e., observational, cross-sectional design), we were not able to detect the minimum amount required to lead to changes in collaboration. However, as the very first study of its kind, our study provided empirical evidence of a significant association between work hours/overtime and collaboration. Our current study suggested that one hour of overtime was associated with 0.17 decrease on the RN-RN scale. In other words, a 0.17 decrease from mean score of the RN-RN scale suggest that a unit’s rank on the RN-RN score would drop from 50th percentile to approximately 30th percentile.
Why is collaboration so important?
Dr. Ma: Collaboration is critical for quality care and patient safety. When working collaboratively, different parties in the patient-care team—including nurses and physicians—will share objectives, responsibility, decision making, and power to achieve patient care goals.
Previous studies have shown that patients receive superior care and have better outcomes in hospitals where nurses collaborate well with other health care providers. Without good collaboration among health care providers, quality patient care may be compromised.
Were you surprised by the results of your research?
Dr. Ma: Not really. Maybe the high number of nurses—one in three nurses—reported working longer than scheduled.
Do you have any suggestions for what should be done so that collaboration doesn’t diminish?
Dr. Ma: One highlight of our findings is the significant association between longer overtime and decreased collaboration. This finding suggests that one strategy to improve collaboration is to minimize nurse overtime as much as possible by a variety of means, better shift scheduling, and predicting and ensuring adequate staffing, etc.
Is there anything regarding this research that you think is important for readers to know?
Dr. Stimpfel: Our findings have broad implications, not just for nurses, but also for other health care providers who are at risk for shift work-related fatigue. Effective teamwork and collaboration are critical to patient outcomes, thus, managing shift work and overtime hours are important for the entire heath care team.
Of all the various facets of the nursing field, hospice, many people think, is the most emotionally difficult to work in. But Connie O’Malley, RN, a hospice nurse for the past three years at Gilcrest Hospice Inpatient Unit in Towson, Maryland, loves her work.
That’s not to say that the work isn’t challenging; it often is. But it also holds a lot of rewards.
How long have you worked in hospice? Why did you get into this area of nursing? What drew you to it?
I’ve loved hospice for more than two decades. I was a geriatric nursing assistant about 25 years ago and worked on one of the medical nursing home floors. A patient with metastatic bone cancer could no longer live at home, and there was no space on the inpatient hospice unit. His prognosis was approximately four to six weeks. He was 60 years old an army veteran and a really wonderful, beautiful human being.
When I first met him, I didn’t want to bond with him because he was dying. And so I put up a barrier around my heart and gave him good care, but was not my normal self like I was with other patients. I found this exhausting after only a week.
One day when his hospice nurse came to check on him, we spoke about this. I told her that I was holding back from getting to know him and love him because he was dying. But at the same time, I felt like maybe our paths have crossed for a reason. This hospice nurse said, “Don’t think that we don’t love our patients and grieve for them when they die. When we care for people in their homes, we are invited into their families. We sit in their favorite chairs and interact in their lives in a way that is different than any other kind of health care. We grow to love them, and when they die, we are sad. You are allowed to love him, and it is okay if you cry when he dies. You can’t have a meltdown where you need to be sent home or take a bereavement day. But if you go take a 5- or 10-minute break to cry on the patio, that is okay. You will find your own way to grieve the patients you lose—whether it is a special song you listen to on the way home or if you drive home silently. You will make your own way to grieve them and honor them. But please love your patients.”
Some people might say that working with those who are dying is depressing. Do you feel that way? Why or why not? What do you think you bring to people who are dying?
Working with dying people is an honor and completely humbling for me. I get to care for people when they are at the very end of their life, and for their families in one of the hardest parts of life’s journey. The majority of families open themselves up and allow me not only to provide my nursing expertise and care for their loved one, but also love the patient and their family.
When you care for someone for several weeks, nurses and staff become family to the patient and their loved ones. It is an honor that I am aware of every day that I work. It is much like being with a friend who is giving birth—it is a special place between this world and the next. To be able to help someone’s body be comfortable through the process and provide education and support and normalcy to their loved ones is an amazing thing.
When I first came to hospice, a dear friend told me he thought that it was such a depressing job. I don’t allow myself to focus on the fact that I lose patients. I feel the exact opposite—I get people. I get to care for people at their absolute most vulnerable state of being. I get to hold their families’ hands and help them learn how to let go. I get to give them education to make a terrifying situation less scary and a little bit easier. Every family changes my life, and I don’t feel that I lose them when they die. I feel fortunate that our paths have crossed and that I have been able to be their nurse at this time.
How do you keep your spirits up?
Being a hospice nurse is exhausting—especially in the inpatient setting. We care for people of all ages. Young people are especially tough on our hearts and minds, and sometimes when families are struggling, it wears on us.
To combat the heaviness that I carry, I make sure that when I am off work, I do things that make me happy and are relaxing. I’m a creative person. I like to crochet, and I make sure that I have projects to work on. I spend time with family and friends enjoying them. Simple things like getting coffee at a diner or spending the night at my mom’s apartment and watching movies together are priceless.
What kind of skills do nurses need to be able to work in hospice?
I came to hospice with four years of cardiac telemetry hospital experience. Despite our patients being at end of life, we use all of our nursing skills daily. We still have patients that have complicated care that needs to be given, so anyone with any kind of nursing background would do well. Very often a lot of people have the idea that everything is very low-key in hospice, but honestly there are nights that I am clinically busier than I ever was on a cardiac unit.
What are the biggest challenges of your job?
Families who fear medication interventions for comfort. Even though hospice has been around for 30 years, there is still a lot of fear around administering morphine and other comfort medications to patients. My biggest challenge is to educate families in what pain looks like and reassurance that medication does not accelerate death. The second biggest struggle is educating people about normal end-of-life occurrences—mainly the truth that everyone stops eating at end of life and that it is normal. A lot of families and visitors struggle when our patients stop eating.
What are the greatest rewards?
The greatest reward is to meet a family on their first day who is struggling with a terminal diagnosis for their loved one, and who are so resistant to any comfort measures and any education about what happens at end of life, and to watch them walk the path and see their minds and hearts change and grow in this process.
A lady was with us for 10 weeks, and all of the staff grew to love her and vice versa. When she was in her last few days, I approached her husband to ask for a good time to come say goodbye to her as I did not want to intrude on his and their daughters’ time with her at the end. He put his arm around my shoulder with tears in his eyes and said, “You come when you want to and as often as you’d like; you are family. Please tell all of the staff too. You have loved us all and become our family, and you are welcome at this time just as much as the last 10 weeks.”
If nurses would like to work in hospice, is there any specific training, certifications, or experience that they would need?
A valid nursing license in whichever state you want to work in. I would say that hospice is a field that a nurse has to be drawn to. It is intense and there is a lot of psychological and emotional weight that we carry on a daily basis. A large number of the nurses that I work with have had family members—parents especially—who have died under hospice care, and it seems that we seek out this work to repay that care that we received when our loved ones were dying.
During the last three months, I had the opportunity and privilege to participate in a work program that collaboratively raises standards for learning and teaching, leading students to the highest levels of engagement and success. This was an eye-opening experience, allowing me to evaluate my own teaching practices in higher education and giving me additional tools to be more adventurous as I continue on with my role in academia.
Here are my five takeaways from the experience:
1. Make sure your students are actively learning enough.
Current evidence in higher learning no longer supports the effectiveness of sole lectures in the classroom setting. Instead, increase use of Active Learning Strategies (ALS) in the classroom setting to offer improved student learning and outcomes. Examples of ALS include: Minute Paper, Think-Pair-Share, Small and Large Groups, Role Playing, Storytelling, etc. One of the biggest student complaints with ALS is the idea that students are teaching themselves. When properly implemented, ALS helps to initiate learners and faculties into effective ways to help learners engage in activities that encourage deep learning.
2. Traditional “lecturing” still has a place in the classroom.
Many educators are considered the “experts” and offer a wealth of knowledge when they step foot in their classrooms. Most of us are familiar with traditional lectures in the classroom setting, where we had a professor “lecture” for hours in front of the classroom. However, many can argue that these professors are not necessarily “Sages on the Stage” but rather “Bores at the Board” for the majority of the time. Do not forget that higher education encourages educators to be more “Guides on the Sides” and become facilitators of student learning as they guide them from the sideline. Whichever method you choose to do in the classroom, you must be humble enough to accept if certain practices require tweaking for improvement.
3. Preparing the adult brain for learning: Evidence has shown that deep learning requires the adult brain learner to be primed.
But how does one prepare the brain to be at the optimal state in which the learner is alert and focused on learning? Several techniques have been noted to help students learn best, including but not limited to: Breathing Exercises, Nutrition, Music, Aroma, and Visualization. All these techniques work in various ways, but more importantly can help in how the adult brain is able to process information. How are you helping prepare your students for learning?
4. Technology belongs in the classroom.
Imagine a classroom without technology… For most of us, this can be very strange, as we are surrounded by technology on a regular basis. And our students are ALWAYS using technology, whether they are using laptops or tablets to take notes or their own personal devices (mobile phones) to stay in touch with their social media world. We must embrace that technology is here to stay, and figure out better solutions in including them in the classroom setting.
5. As educators, we must also be willing to learn (from peers and our own students).
Just because we have completed our studies and are now educators does not preclude us from learning new things. We must never cease to inquire and acquire knowledge. If anything, being an educator challenges us to be the best that we can possibly be for the students that we serve.
What has been your experience with student learning, both good and bad? Please share your own experiences, as I want to better myself as an educator. To be able to meet the students from where they are at, and take them on their own educational journey!
This year, National Influenza Vaccination Week (NIVW) is December 2-8. NIVW provides an opportunity for nurses to promote flu vaccination before flu season swings into full gear. The flu can be dangerous and result in serious health problems (complications), such as pneumonia, bacterial infections, or hospitalizations. Flu can sometimes even lead to death. All people are at risk for serious flu-related complications and certain groups, such as young children, pregnant women, people with certain chronic health conditions like cancer, diabetes, heart disease, asthma or lung disease, and people 65 years and older, are at higher risk.
Getting a flu vaccine is the first and most important step in protecting against the flu and its serious complications. Annual vaccination is important because influenza is unpredictable, flu viruses are constantly changing, and immunity from vaccination declines over time. Flu vaccination can also prevent serious medical events associated with some chronic conditions. A meta-analysis study published in JAMA shows that flu vaccination has been associated with lower rates of some cardiac events (i.e., unstable angina, heart failure, or stroke among people with heart disease).
In the United States, flu viruses are most common during the fall and winter. The exact timing and duration of flu seasons can vary, but influenza activity often peaks between December and February, and it can last as late as May. The CDC recommends everyone at 6 months of age and older gets a flu vaccine by the end of October, before flu activity begins every year. However, getting vaccinated later can still be beneficial.
Here are some essential preventative actions that we can do, in addition to getting a flu vaccine, to beat the flu and protect ourselves, our families, and our patients.
- Wash your hands often, especially after coughing or sneezing. Cover your nose and mouth when you cough or sneeze and wash your hands often and thoroughly. After using a tissue, throw it in the trash and wash your hands.
- Frequently clean and disinfect surfaces and objects that may be contaminated with germs like flu.
- Boost your immune by getting adequate sleep, eating plenty of fruits and vegetables, drinking plenty of water, and taking time to exercise.
- Last but not least, stay home when you are sick. If you are sick with a flu-like illness, the CDC recommends that you stay home for at least 24 hours after your fever is gone.
The Josie King Foundation believes that nurses are leading the charge for a safer, more compassionate health care system. But they realize that in addition to the joys of healing, nurses face many emotional upheavals related to patient suffering, a complex workplace, new technologies, and fear of clinical errors. When personal pressures from everyday living are added to the already heavy load, the weight can lead to nurse stress, anxiety, depression, or burnout.
The Josie King Foundation developed the Nurse’s Journal in 2004, to help alleviate stress through expressive writing. (The journal was a response to results from a research project, Care for the Caregiver, that indicated it was sorely needed.) Created with the help of experts on the topic and specifically for nurses, it is offered by the nonprofit as a tool for self-directed writing or through facilitated journaling workshops.
The Nurse’s Journal is an attractive 61-page spiral bound notebook and is filled with helpful content such as evidence-based theories about journaling, before and after stress evaluation forms, and suggested resources to help nurses cope with work-related stress.
The majority of pages are low-content, with just short guided writing exercises to help you reflect on the stresses of your work life and personal life. For instance, the first one is titled “Guided Writing: Signs of Stress,” and includes the following prompt:
“Things to consider. Do you notice stress-related symptoms in your life? Is there a particular time of day or day of the week in which you feel more stress? Do your stress symptoms affect your job performance or your quality of life? What do you do to combat your stress?”
The page ends with a quote from the Dalai Lama about avoiding the burnout associated with witnessing great suffering.
In between the prompt and the quote, the page is empty so that a nurse is free to write out their own personal thoughts and feelings, as an antidote to workplace and life stressors.
Since launching the Nurse’s Journal in 2004, the Josie King Foundation has distributed them to more than 15,000 nurses. Many hospitals buy the journals in bulk as a gift for nurses during the winter holidays, or to mark Nurses Week, or at anytime for staff training and development purposes.In addition, they offer a companion Nurse’s Journal Guidebook for anyone who would like to facilitate journaling workshops for nurses.
For more information about the mission of the Josie King Foundation and their line of specialty journals for nurses, caregivers, and patients, visit http://josieking.org.
Although many people don’t like to think about death and dying, it will happen eventually. When it does, those who are fortunate enough to have hospice and palliative care nurses caring for them will understand the importance of these nurses’ roles.
Palliative and hospice care nurses provide care for those who are the end of their lives. They are there for the final transition and use an entire array of medical knowledge and tools, skills, compassion, and life experiences to help in the best ways they can. Hospice and palliative care nurses strive to make patients as comfortable as possible both physically and emotionally. As their physical body shuts down, these nurses can use a combination of medication, music, talk, touch, and companionship to make the process something the patient is comfortable with.
The Hospice & Palliative Nurses Association and the National Hospice and Palliative Care Organization offer resources and education about this nursing specialty. Palliative and hospice nurses often provide education to the public as many people think of nurses as providing life-saving care and aren’t sure what end-of-life care entails. If they haven’t had interactions with hospice care, they may not comprehend all that goes into the nursing practice as someone approaches end of life.
While many find the end-of-life stage difficult to cope with, these nurses often consider it a supreme privilege to be present during someone’s last days. Nurses often develop deep connections with these patients as they try to meet their wishes and help them die with a sense of dignity and control. They also become close to families and even provide guidance and education to help families cope and to make them feel like they can take an active part in offering comfort and acceptance.
Hospice and palliative care nurses deal with grief, often very profound grief, on a daily basis. While the dying patient is coping with life coming to an end, a circle of loved ones is doing the same and trying to prepare for life after the person’s death, while also making the most of the final days. These nurses are especially skilled in managing grief and helping others learn coping skills while they still focus fully on the patient.
Hospice nurses need to take special care to make sure they are also able to cope with profound levels of grief and death in their lives so they don’t get burned out or experience compassion fatigue. Forming strong relationships with other nurses in this specialty is important as is joining professional organizations devoted to hospice and palliative care and even continuing education like certification or additional coursework or conferences. There is much to be learned from others in similar work and hearing how they cope and even what might be a red flag to take notice of. Turning to others and counseling professionals if needed can help nurses stay focused while acknowledging and honoring the challenges of providing end-of-life care on a daily basis.
This career path is one that offers great rewards and hospice nurses are often remembered as a steady presence in a chaotic time.
Thanksgiving is over, but the spirit of the holiday doesn’t have to end. In fact, the warmth and introspection can help illuminate this season as we plunge into darkness. When you count your blessings you probably list your loved ones, the roof over your head, and every cupful and plateful that nourishes you.
But do you consider your profession and how it supports you financially, and in less tangible ways? You don’t have to wait for National Nurses Week in May to celebrate your role.
At the beginning of this holiday season I wrote blog posts about gratitude for this site. At the same time I was also interviewing nurses for other blog posts and articles so I’d casually ask them what they were thankful for right now. Big, small, and in between—it was fascinating to hear their responses.
They confirm some of what I’ve learned over the years talking to nurses from different backgrounds and in varied health care environments and specialties. Almost always, I hear that nurses are grateful for some, if not most, aspects of their chosen career.
Here are some of the main reasons nurses say they’re thankful:
Nurses make a difference in someone’s life every day. When they go to bed at night they have the gratification of knowing their work matters. A lot of people in other jobs, whether blue collar, pink collar, or white collar, don’t have that satisfaction. Many of this nation’s workers are now employed in “paper shuffling” occupations that don’t seem to have intrinsic meaning.
Nurses are working in a field that’s in high demand and that pays a family wage. Kiplinger magazine recently reported that the best return on investment when it comes to a college major is nursing. Based on the average income that a graduate could anticipate and the average tuition and fees to earn a bachelor’s degree, nursing came out on top. Their next best choice for major is biomedical engineering.
Nursing has so many different specialties and paths, so as a nurse you don’t have to ever get bored. Nurses can also stick to the same specialty but switch to a different health care environment. One nurse said she was thankful that when it was too physically demanding for her to work as a floor nurse in a busy hospital she was able to transfer over to a quieter asthma clinic.
Nurses are also able to add to their skill sets or even go for advanced degrees, and often their employer will cover the tuition. That’s becoming less common as companies refuse to pay for training and development for their existing workforce.
When nurses start families and want to be home more they can often cut their hours to part-time. Or when they get to the point that they want to retire, they can sign on with a travel nursing company that will get them temporary jobs in their preferred locations.
Some semi-retired nurses hit the road in an RV, taking their homes with them. That way they’re comfortable as they travel to assignments. They can also choose to work in resort areas or to pursue outdoor activities, wintering in the mountains and summering at the beach, for snow skiing and water skiing adventures.
Finally, nurses are making a real impact on health care as doctors and administrators have become more bottom-line or left-brain oriented in their approaches. The nursing profession still holds a holistic view of patients and encourages a humane approach to care. Patients (and fellow staff) are fortunate to be surrounded by nurses, genuine people who carry so much kindness and eagerness to do good.
The more that you recognize the positives of your role as a nurse, the easier it is to put up with the negatives. Because every field has its pros and cons, periodically it’s good to examine what you’re getting out of it. That awareness and sense of gratitude is what makes for a happy and healthy nurse, which makes for a long and sustainable career.
The holidays are just around the corner! Many of you are looking for healthy holiday gift ideas and thinking about spending money on things that promote the health and wellness of your loved ones. To maximize the joys of the holidays and to show how much you care about your loved ones this year, here are some healthy and meaningful holiday gifts that won’t cost a fortune.
1. Fitness Tracker, Pedometer, and Heart Rate Monitor.
These gifts can help encourage your loved one to keep moving and can make them mindful of how much they are moving. Some only feature step counting, heart rate monitoring, and reliable sleep tracking; others have a built-in GPS or WiFi capability. You can find these gifts for around $50 or less, but you can spend more if your budget allows.
2. Healthy Cookbooks.
There are dozens of amazing cookbooks out there with recipes that are nutritious and include everything from salads to instant pot recipes. A healthy cookbook would make a great gift for your loved ones who like to cook.
3. A Gourmet Gift Basket.
A gourmet basket of fruits, an assortment of nuts, bottles of almond or olive oil or balsamic vinegar, are all great healthy gifts. Giving these gifts is a perfect way to show your care and love and also add colorful addition to their home.
4. Aroma Essential Oil Diffuser or Beeswax Candles.
Both diffusing aroma essential oils and beeswax candles are safe and can help reduce indoor air pollution. Not only is it functional and practical, but also healthy and beautiful.
5. Motivational Quote Art Prints and a Mouse Pad.
Both cute art prints and a decorative mouse pad are cheerful and they are perfect gifts to add a touch of inspiration without overwhelming a space. They can make someone smile and boost the mood of your loved one.
6. Hand Cream Gift Set and Travel Size Hand Sanitizer, Assorted Scents.
Both hand cream and hand sanitizer are great gifts for everyone this time of year—and they are inexpensive. They can be used at home and outside. Pick a scent you know your loved one is crazy about, or opt for a calm-inducing classic like eucalyptus or spearmint.
Public health is an important aspect in the nursing profession because it involves addressing medical illnesses on a global scale. Due to the aging population and the advancement of medical technologies, public health nurses are vital in developing and providing skilled nursing care aimed at promoting preventative measures to increase the global health of the population. It is this understanding that fuels public health nurses to continue their efforts to not only educate society about certain illnesses, but also promote healthy lifestyles across the patient gamut.
What is Public Health?
According to the Public Health Institute, public health is defined as “the science and practice of protecting and improving the health of a community, as by preventative medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards.” The focus of increasing public health awareness is significant especially in today’s society because of the growing paradigm shift towards preventative care versus diagnostic care. In addition to this, public health awareness also requires a collaborative and multidisciplinary effort consisting of physicians, epidemiologists, statisticians, and dietary professionals. This interprofessional collaboration is vital because it involves gathering a sizeable amount of clinical data to effectively screen and prevent a disease from adversely affecting the general public.
The Impact of Nursing in Public Health
The impact of nurses in supporting public health efforts is invaluable because of their strong emphasis on health promotion and disease prevention. Nurses not only possess the proficiencies but also competencies to tackle the burden of health determinants and the various environmental and behavioral factors associated with it. Subsequently, nurses must have the skillset to proactively confront these challenges within an individual and societal context. In order to evaluate these activities, nurses must be diligent in both planning and implementing to ensure public health concerns are addressed directly. Finally, nurses who are actively involved in lobbying for societal and structural reform are then able to promote effectual health care strategies aimed at reducing negative health outcomes associated with poor health decisions and a lack of knowledge.
Why is Public Health Important?
Due to the health care industry shifting towards more preventive care strategies, nurses continue to play a major role in leveraging public health awareness. By identifying and monitoring health concerns that may affect entire communities, public health nurses are uniquely qualified to not only advocate, but also promote societal change to safeguard the health and well-being of all individuals around the world. Therefore, a nurse’s role in health promotion includes various responsibilities related to advocating, enabling, and mediating activities to ensure salubrious decisions equate to healthier outcomes.
Are you an accomplished Family or Adult Gerontological Nurse Practitioner? It’s time for you to be in the spotlight! Springer Publishing is looking for a select group of rock star nurses to inspire and educate the next generation in your area of expertise. Apply now to be featured in our Day-In-The-Life profiles on our upcoming website, NursesGetCertified.com. Eligible candidates are:
- Actively certified as an Adult Gerontology Primary Care or Family Nurse Practitioner
- Working clinically in this area of certification
- Interested in helping future nurses understand what life is like after the exam
Fill out our form by Tuesday, November 27th for your chance at this opportunity. Selected candidates will participate in a 30-minute interview which will be featured along with a photo on our new website. You’ll also receive a $25 Amazon gift card for participating. Join us in our mission to make nursing certification simple!