Meet a Champion of Nursing Diversity: Kimberly Cook

Meet a Champion of Nursing Diversity: Kimberly Cook

Kimberly Cook, RN, BSN, is a highly accomplished nurse leader with a 30-year career in the healthcare industry. She graduated from the University of Virginia with a nursing degree and became a nurse in the Army early in her career. During wartime, Cook showed her dedication and commitment to patient care, which instilled in her a profound sense of duty, resilience, and an unwavering ability to thrive under pressure. meet-a-champion-of-nursing-diversity-kimberly-cook

Throughout her career, Cook has held various management positions where she consistently demonstrated exceptional leadership qualities. She rose through the ranks quickly, earning the respect and admiration of her colleagues, staff, and executive team. Her visionary mindset has enabled her to drive positive change and implement innovative strategies within healthcare. 

Cook holds the Director of Nursing Administration Staffing position at the University of Maryland Capital Region Health, a member organization of the University of Maryland Medical System. In this role, Cook leads a team of dedicated professionals, tirelessly ensuring that the right resources and personnel are available to deliver quality patient care.

Cook is an important nursing leader, and we’re proud to profile her as part of the Champions of Nursing Diversity Series 2024. The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.

Meet Kimberly Cook, RN, BSN, Nurse Director, Nursing Admin/Staffing at the University of Maryland Capital Region Health.

Talk about your role in nursing.

As the Director of Nursing Administration/Staffing, I hold a key leadership position responsible for overseeing the nursing administration and staffing functions within UM Capital Region Health. My key responsibilities include the following:

  • Provide strong leadership and guidance to the nursing administration and staffing team.
  • Develop and implement strategic goals, objectives, and policies related to nursing administration and staffing.
  • Foster a positive and collaborative work environment that promotes teamwork, respect, and professional development.
  • Develop and execute staffing plans to ensure optimal allocation of nursing staff across all departments and shifts.
  • Collaborate with unit managers to monitor and maintain appropriate staffing levels based on acuity and workload demands.
  • Implement effective scheduling practices to ensure adequate coverage and adherence to the Collective Bargaining Agreement and budgeted financial targets.
  • Prepare and manage the nursing administration and staffing budget, ensuring efficient resource allocation.
  • Manage and assess daily productivity and labor management.
  • Monitor and control staffing-related expenditures, identifying cost savings without compromising patient care.
  • Monitor and evaluate staff performance, providing regular feedback, coaching, and recognition.
  • Collaborate with quality management teams to identify improvement areas and implement initiatives to enhance patient outcomes.
  • Oversee the recruitment and selection process for staff and agency staff.
  • Onboard new staff and agency staff.
  • Manage all agency staff recruitment, onboarding, and billing.

How long have you worked in the nursing field?

> 32 years

Why did you become a nurse? 

I attended a Catholic high school where volunteering was a requirement to graduate. I volunteered at a local hospital because it was close to my school. Prior to volunteering, the field of nursing had not crossed my mind. However, observing the fantastic work of nurses during my volunteer service triggered that “ah ha” moment, where I realized that Nursing was the profession I wanted to pursue.

What are the most important attributes of today’s nursing leaders?

There are several important attributes of today’s nursing leaders. The one that is most important for me is adaptability and resilience. The healthcare industry is continuously evolving, and nursing leaders must be adaptable to embrace change and lead their teams through transitions. They should be resilient in the face of challenges, remaining calm and composed while leading others.

What does being a nursing leader mean to you, and what are you most proud of?

Being a nurse leader involves inspiring and influencing others towards a common goal. I am most proud when I can create and sustain effective teams while fostering a positive work environment where staff feel supported and valued.

Tell us about your career path and how you ascended to that role.

My Career began as an Army nurse. After leaving active duty, I remained a federal employee working in a military hospital. My first job was as a manager of two 40-bed Med Surg Units. After several years in a managerial role, I transitioned to nursing supervisor. As a Nursing Supervisor, I had a keen sense of staffing and how it applied to budgeting and productivity. The role of the Director opened, and I was asked to step into the role based on my previous work and reputation.

What is the most significant challenge facing nursing today?

The biggest challenge in nursing today is our ability to change and adapt as healthcare changes. Since Covid, we have had to be creative with staffing to care for our patients. However, we must remember to care for our staff in the same frame.

As a nursing leader, how are you working to overcome this challenge?

By keeping the organization’s goals in sight, but always remaining humble and empathetic.

What nursing leader inspires you the most and why?  

General Hazel Johnson-Brown was the first African-American woman to become a General in the United States Army and the first African-American Chief of the Army Nurse Corps. Her accomplishments and impact have had a profound effect. Her success demonstrated that black women could achieve the highest leadership positions with determination, perseverance, and skill.

What inspirational message would you like to share with the next generation of nurses?

Nursing can be challenging at times, and there may be moments when you feel discouraged. However, it’s essential to recognize that even the most challenging days present valuable personal and professional growth opportunities. Keep moving forward confidently, knowing that tomorrow will bring a fresh start.

A CRNA Career Path: Meet Bijal Chaturvedi

A CRNA Career Path: Meet Bijal Chaturvedi

Nurses considering a career in nurse anesthesiology know the role is complex and demands a high level of critical thinking and commitment. The career path, in which many certified registered nurse anesthetists (CRNAs) obtain a doctor of nursing practice degree, also offers a high salary and an upward projection of job openings. With a dynamic mix of clinical practice and the capability to work in many settings, nurse anesthetists find a rewarding career.CRNA Bijal Chaturvedi headshot in a black top

Bijal Chaturvedi, DNP, CRNA, GHLC is a member of the American Association of Nurse Anesthesiology (AANA) and gave Minority Nurse some insight into this career path.

How did your career path lead to nursing and becoming a CRNA?
During my final year in college, I battled severe bronchitis and sought help at the health clinic. The provider who attended to me was not a doctor but a nurse practitioner, displaying both kindness and extensive knowledge. This encounter sparked a conversation about her nursing career, introducing me to the world of advanced practice nursing. This pivotal moment inspired me to explore nursing as a career path.

Upon college graduation, despite my Indian parents’ desire for me to pursue medical school, I knew I wanted a profession that combined science, pharmacology, and interpersonal interactions. Armed with a bachelor’s degree in cellular biology, I promptly earned another Bachelor of Nursing within a year. Upon graduation, I entered the field of critical care nursing, working in the most acute critical care unit settings such as burn, cardiac, and transplant ICUs.  It was during my time at Northwestern Memorial Hospital’s Neurospine ICU that I witnessed the role of CRNAs. This experience solidified my decision to pursue a career as a CRNA.

I earned my Master of Science in Anesthesia Nursing from Rush University in Chicago in 2005. In 2021, I received my Doctorate of Nursing from University of North Florida, and in 2022 I received my Global Health Leadership Certification from Northwestern University. I have participated in numerous global mission trips and currently co-chair the AANA’s Diversity Equity and Inclusion (DEI) Committee. I am also the chair of the Illinois Association of Nurse Anesthesiology’s DEI committee. I am passionate about healthcare equity and access and have my own nonprofit called Citizens For Humanity which addresses social determinants of health.

Do you specialize in a certain area or population?
Numerous healthcare environments rely on anesthesia services, encompassing fields such as dentistry, podiatry, surgery, obstetrics, and pain management. In my professional journey as a CRNA, I have experienced diverse settings, including community hospitals, ambulatory surgical centers, and plastic surgery centers, and participation in large teaching hospitals as part of an Anesthesia Care Team. The degree of autonomy varies across these settings, ranging from those with no supervision to those adopting a more interdependent model. I have experience working with diverse patient populations, including pediatric, low-income, and critically ill individuals.

What part of your job is particularly meaningful to you?
The profession of nurse anesthesiology offers a richly diverse and demanding path. In the clinical realm, you have the profound privilege of impacting individuals during their most vulnerable moments. A significant aspect of the gratification derived from administering anesthesia lies in the opportunity to support individuals through what may be the most daunting day of their lives. They grapple with fear of diagnosis, anticipation of pain, and uncertainties ahead. Your presence as a reassuring figure by their side during this critical juncture becomes paramount. While your expertise and competence in ensuring their safety throughout the procedure are undeniably vital, it is the compassion and humanity you extend that hold greater significance than any medication you administer.

Is there something or someone that helped you in your career that others thinking of this career path will find helpful?
My foremost recommendation is to shadow multiple CRNAs across various cases. This immersive experience will provide a comprehensive understanding of what lies ahead. Engage in conversations with current students to gain insights into the rigorous nature of anesthesia school. Recognize that anesthesia training demands significant dedication; therefore, it’s prudent to prepare financially by saving diligently.

Building a robust financial cushion alleviates stress and minimizes post-graduation debt, especially considering the constraints on working while in school. Enhance your academic foundation by enrolling in graduate-level courses in anatomy and physiology, pathophysiology, and pharmacology. This not only demonstrates your commitment but also strengthens your candidacy, particularly if your undergraduate GPA is subpar. While these courses may not be transferrable to most anesthesia programs, they serve to fortify your knowledge base and reacquaint you with the rigors of student life.

What would you like others to know about a being a CRNA?
I believe that aspiring RNs should possess a robust grasp of physiology, pathophysiology, and pharmacology prior to embarking on anesthesia school. Embracing challenging assignments, volunteering for cases involving the most critically ill patients, and delving deeply into the rationale behind every action are crucial steps in nurturing a profound understanding of patient care. This comprehension extends to the selection of medications and interventions, ensuring that aspiring CRNAs are well-prepared for the demanding journey ahead. The ability to think critically is paramount in the delivery of safe anesthesia.

CRNAs must excel as problem solvers and keen observers, interpreting data independently and making informed decisions that can profoundly impact patient outcomes. The weight of responsibility underscores the imperative of being both accurate and decisive, recognizing that lives hinge on the choices made in the operating room.

What is your advice for RNs considering a career as a CRNA?
Research various CRNA programs to find the one that best suits your needs. Consider factors such as clinical opportunities, cultural diversity, and program structure. Make an informed decision based on your personal preferences and goals.

Once enrolled in a program, maximize every educational opportunity, even if it seems insignificant. Graduate-level education requires proactive engagement, and your dedication will determine the quality of your learning experience. Learn from every case and practitioner, embracing the lessons they offer.

Collaborate with CRNAs who may be perceived as challenging, as they often uphold high standards and offer valuable insights. Maintain a positive attitude and remain open to feedback to maximize your learning potential. Avoid being labeled as unteachable, as it can hinder your educational progress.

Evidence-based Practice in Nursing: Why It Matters to Nurses and Their Patients

Evidence-based Practice in Nursing: Why It Matters to Nurses and Their Patients

Most nurses are familiar with evidence-based practice (EBP), using research-proven healthcare techniques to enhance patient care and the nursing environment and practices. And the benefits of EBP-led care are well documented. However, with all the positive results, EBP must consistently be taught or implemented in daily nursing practice.evidence-based-practice-in-nursing-why-it-matters-to-nurses-and-their-patients

Despite various studies that show the benefits of evidence-based practice for nurses, patients, and healthcare organizations, adopting the practice could be more widespread. Whether or not they work in an environment that supports EBP, nurses can learn more to apply EBP.

Why Use Evidence-based Practice?

What exactly is evidence-based practice? Kim M. Bissett PhD, MBA, RN, and director of the Center for Evidence-based Practice at the Johns Hopkins Institute, specializes in evidence-based practice and says, “At the most basic level, evidence-based practice (EBP) is a problem-solving approach to the decision-making process that uses the best available scientific and experiential evidence, coupled with critical thinking, to improve care.”

The method works, says Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for Health Promotion and the Helene Fuld Health Trust Professor of Evidence-based Practice at The Ohio State University. “We have such a strong body of evidence that when EBP is implemented, that patient outcomes and safety is better,” she says. “We know that.”

With a patient-focused nursing priority, practicing nurses find inspiration in using innovative and successful methods. “Evidence-based practice is the most essential part of the nursing profession,” says Michael Williams, DNP, APRN, FNP-BC, a lead nurse practitioner at the Center for Health Empowerment-CHE in Austin, TX. “As a collective, organized workforce, it ensures we are keeping up with the demands of healthcare.” As healthcare delivery becomes more complex, Williams says evidence-based practice helps nurses answer their questions. “It allows us to be in a position to keep up with the demands and always be innovating.” 

Patient care is only enhanced when identified and proven practices are followed. “EBP ensures patients are receiving the most current care using the best available evidence,” says Bissett. “By implementing evidence-based interventions, nurses can enhance the quality of care patients receive. For example, implementing evidence-based guidelines and protocols minimizes errors and complications such as medication errors, risk of infections, and unnecessary procedures that could lead to complications.”

Evidence-based Practice Is Good for Nurses

As Williams notes, nurses can pause and reexamine their actions when new evidence-based practices are introduced. “It’s exciting when we have the opportunity to learn something new,” he says. “It’s easy to get caught up in the day-to-day, giving us a chance to reset. When new guidelines pop up, it appeals to that side of nurses that are innovators or creators.”

The kind of pause that Williams mentions also refreshes nurses. “Nurses can use EBP for a variety of reasons. Some include improving or validating current practice, identifying better ways to achieve patient outcomes, and answering clinical questions,” says Bissett.

Stumbling Blocks to Widespread Adaptation

Despite all the good that comes from EBP, complex factors often result in an inconsistent application. A 2021 study found that moving research findings into regular practice takes at least 15 years. Despite medical and technological advances, that number has barely shortened in the past 20 years.

Other studies show that most nurses need to be more competent in EBP. Roadblocks to more widespread adaptation of EBP include a need for a targeted curriculum, too few mentors to show EBP in everyday work, a minimal amount of EBP investment by healthcare organizations, and a fallback to traditional nursing practices.

“In some nursing units, it is not uncommon to have practices persist even after scientific evidence has proven those practices to be ineffective,” says Bissett. “The nurses continue to practice the way they have always practiced. This persists until nurses start to question their practices and start looking for better alternatives.”

Gaining EBP Understanding

Nurses can still gain the needed knowledge even in organizations with little defined EBP work. At work, they can also bring research demonstrating the efficacy of EBP to management. “People are able to negotiate better with evidence,” says Melnyk, noting it can help nurses advocate for change or increase investment.

In general, active and involved nurses will become aware of new guidelines or evidence-based practices as these new developments emerge, and they can position themselves to gain more knowledge. If EBP isn’t part of a nurse’s training, Melnyk suggests nurses take a short, free course to familiarize themselves with the 7 steps of EBP or a more intensive course for mastery of skills.

Williams says that nurses may glean excellent information from listening to two or three podcasts in their specialty. They could also subscribe to a few nursing magazines or journals to keep abreast of the latest news. Getting involved in the nursing community by joining a professional organization is excellent. Williams is an active member of DNPs of Color. Bissett says setting up a Google alert for specific topics is an easy way to discover new information. She says conferences are also an excellent source of the most current information.

There’s also a link between nurses who practice with the most proven methods and their well-being, says Melnyk. She says that even the most highly skilled nurses can’t make much progress if they are burned out and acutely stressed. “You have to tackle this in the culture,” she says.

Attaining that additional knowledge is a powerful tool in nursing practice and a professional motivator that leads to more job satisfaction and even better work for individuals and teams. Melnyk says that if nurses negotiate for change and are met with endless pushback or flat-out denial, they may want to consider moving on to a different organization.

Bissett notes that their confidence grows when nurses are equipped to make informed decisions about patient care and have the resources to consider factors such as efficacy, safety, and patient preferences. The critical thinking that comes with EBP means nurses learn something new and have the tools to analyze why it works and then apply it to their practice, she says.

EBP as Workplace Culture

The nursing community offers exceptional learning opportunities if nurses are open to different perspectives. Williams says his position as an experienced nurse means that he learns from listening to the questions and ideas of new nurses. “That’s something that isn’t talked about enough,” he says. “Student nurses will say, ‘This is what I learned.’ And it’s different from what I learned in nursing school.”

Some questions can prompt a reexamination of practices. A workplace culture that encourages information sharing and is open to all questions is one in which nurses can learn from each other in a way that is to everyone’s advantage.

A constant rotation of new nurses and information necessitates continual evaluation of practices. “It is important to understand that once an EBP project is complete and a practice change has been implemented, it does not mean that issue is closed,” says Bissett. “Nurses must continue to verify that their practices are in line with current best evidence.”

Nurses, says Bissett, need to be active consumers of evidence. “We should be constantly looking for ways to improve our practice and to use the best evidence,” she says. “We have to stay well-informed, and that requires some action on our part.”

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Navigating the Doctor of Nursing Practice Program: Top 10 Tips for Success

Navigating the Doctor of Nursing Practice Program: Top 10 Tips for Success

Embarking on a Doctor of Nursing Practice Program (DNP) is a significant stride towards advancing your career in healthcare. Amidst the increasing demand for advanced nursing professionals, selecting the right DNP program becomes crucial. The DNP program has many options: online, hybrid, and in-person.navigating-the-doctor-of-nursing-practice-program-top-10-tips-for-success

However, before diving into the intricacies of program selection and study strategies, ask yourself this most important question: Why pursue a DNP degree?

Clarity on your motivation, the purpose of obtaining your doctorate, and your post-graduation plans sets the foundation for a successful journey. There are various potential roles for the DNP graduate, which include roles in nursing education, administration, health policy, nurse practitioner, or informatics. The DNP program prepares nurses to generate new knowledge through innovation of practice change and translating evidence to practice.

This article explores the top 10 tips for prospective DNP students, covering various aspects such as program selection, study strategies, the importance of a study partner, curriculum evaluation, cost considerations, and understanding program outcomes and final expectations.

Top 10 Tips for Success in a DNP Program

1. Research and Select the Right Program: Choosing the right DNP program is crucial. Consider factors such as accreditation, faculty expertise, and the programs alignment with your career goals. Thorough research ensures a program that meets your expectations and provides a solid foundation for your future in nursing. Speak to other nurses in the current DNP program to get a sense. Selecting a program that meets your personal needs and that is flexible is imperative for your success.

2. Understand the Curriculum: 
Please read every detail in the curriculum before committing to a DNP program. Assess if the coursework aligns with your professional interests and career goals. A well-rounded curriculum ensures a comprehensive education and equips you with the skills needed in todays complex healthcare environment. To be fully transparent, I purposely selected a doctoral program that did not have statistics because I did not want to retake it! However, the program did have a tremendously helpful economics course.

3. Evaluate Program Costs: 
Financial considerations are critical. Evaluate the overall cost of the DNP program, including tuition, fees, and any additional expenses. Look for potential scholarships, grants, or employer assistance programs to alleviate the financial burden. Most institutions have a payment plan that you can set up if needed. I did a lot of research before selecting my university. It was vital for me to have a physical university with an excellent reputation and history. I strongly recommend being strategic and not just paying extra money to have a prestigious school name on your resume.

4. Create a Realistic Study Plan: Balancing a DNP program with work and family commitments requires careful planning. Develop a realistic study plan considering your workload, responsibilities, and preferred learning pace. Creating a realistic plan can prevent burnout and reduce anxiety. I did most of my schoolwork at night because everyone was sleeping. Plus, I know that I function better at night.

5. Consider a Study Partner/Colleague support: A colleague or study partner can enhance your DNP experience. Collaborative learning fosters a supportive environment, provides different perspectives, and facilitates sharing resources and study materials. I had two close friends in the program, and having that continued support was instrumental to my success. We held each other accountable and called daily to check on each other to ensure we were ok or remind each other to submit assignments on time.

6. Utilize Online Resources: Use online resources and platforms to supplement your learning. Many DNP programs offer virtual libraries, discussion forums, and additional study materials. Embracing technology can enhance your understanding of the coursework and make your life easier. Please use all the resources you have available to you. Please learn how to do a proper library search for articles because it will save you hours of work. The librarian can be your best friend throughout the program.

7. Prioritize Self-Care: 
Balancing work, family, and a complex academic program requires self-care. Prioritize physical and mental well-being to sustain energy levels and focus throughout the DNP journey. This is harder said than done. I strongly recommend scheduling self-care time and activities. The DNP program is a rigorous program with high demands. Real talk: I cried several times and wanted to quit. However, I kept thinking of my kids, and my motivation kicked into gear.

8. Effective Time Management: 
Mastering time management is crucial for DNP success. Create a schedule that allocates dedicated time for coursework, work obligations, and personal commitments. Efficient time management ensures a well-rounded and fulfilling experience. It sounds silly, but please read the entire syllabus before your course begins.

9. Stay Proactive and Communicate with Professors: 
Maintain an open line of communication with your professors. Staying proactive ensures that you receive timely guidance, support, and feedback. I procrastinated during my DNP program, so I would not recommend it. Establishing a solid rapport with your professors can positively impact your academic journey. I sometimes found asking for sample examples for specific assignments helpful in understanding the expectations better.

10. Understand Program Outcomes and Final Expectations: Be clear about the DNP programs ultimate expectations and ask many questions. Understand whether you must implement a study or present a project proposal. I had to submit my study to the Institutional Review Board (IRB) for approval. From personal experience, I strongly recommend creating a toolkit. I created a Stress Reduction Toolkit for Nurses. I often joked about using those same stress reduction strategies during the DNP program. Knowing the program outcomes ensures you are prepared for your academic journey and can confidently meet the final expectations.

I strongly recommend not comparing your DNP journey to anyone else. Please give yourself grace and be patient. I failed a DNP course, my DNP proposal course, and I was distraught. It was a long, complicated story that ended in a denied appeal from the Dean. I was distraught when it was happening; however, I realized that perhaps God had a different path for me. We know that not all paths are linear, and neither was mine. It taught me to be more patient and more precise.

I recently completed my DNP program in organizational leadership. My goal is to combine my experience in emergency medicine, education, and leadership into an exciting role where I can apply all my knowledge and skills. I am passionate about education, career development, and growth for all nurses, particularly novice nurses.

I am dedicated to improving workplace culture and wellness due to my previous experiences with toxic workplaces, discrimination, and bullying. My mission is to empower all nurses globally to pursue their personal, professional, and business goals. I started my DNP journey three years ago, and it has been a roller coaster ride. My experience of juggling a full-time job, a young family, and a business highlights that completing a DNP program is feasible and immensely rewarding with determination and a strategic approach.

Enrolling in a Doctorate Nurse Program can be overwhelming, but success is achievable with careful consideration and strategic planning. Integrating these top 10 tips into your DNP journey allows you to navigate the challenges and reap the rewards of advanced nursing education.

Remember, there is never a right” time to start; its about finding the time that works for you and committing to the journey.

Good luck! 

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The Alarming Trend of Seasoned Nurses Being Laid Off: Profits Over Patient Care? 

The Alarming Trend of Seasoned Nurses Being Laid Off: Profits Over Patient Care? 

During the COVID-19 pandemic, the National Council of State Boards of Nursing (NCSBN) (2022) estimated over 100,000 registered nurses left the profession and predicted that another 800,000 nurses would follow them by 2027. The top reasons reported for leaving were burnout, feeling undervalued, and a high patient-to-nurse ratio. However, hospital layoffs are another culprit driving experienced nurses from their profession. In a short-sighted attempt to recoup costs, healthcare organizations cut more experienced nurses.alarming-trend-of-seasoned-nurses-being-laid-off-profits-over-patient-care

According to the Joint Commission (2022), 1,441 sentinel events were reported in 2022, a 19% increase from 2021. Getting rid of seasoned nurses will not solve the hospital’s financial problem. Instead, it will increase their financial losses due to increased sentinel events and a decrease in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores due to poor patient outcomes. This article plunges into this issue, exploring the possible reasons behind these layoffs and the potential impact on patients’ outcomes.

The Profit-Driven Healthcare Environment

One of the key factors contributing to the layoff of seasoned nurses is the profit-driven nature of the healthcare industry. Healthcare organizations, both public and private, are under constant financial pressure to maximize revenue and minimize costs. In this pursuit of profit, hospitals and healthcare facilities may resort to reducing labor costs, including laying off experienced nurses. “It’s just business, nothing personal,” one Human Resource Partner told a nurse of twenty-three years when her organization was eliminating her position.

Financial Constraints and Budgetary Cuts

Healthcare institutions often face financial constraints, with shrinking budgets and reduced reimbursements from insurance companies and government programs. As a result, they may resort to downsizing their workforce as a cost-cutting measure. Unfortunately, this approach fails to consider the long-term impact on patient care and the loss of invaluable experience and expertise that seasoned nurses possess, which is critical to the success of novice nurses.

The Nurse Journal reports that novice nurses’ most common errors are medication errors, infection issues, documentation errors, and not reporting the correct information to healthcare providers when their patients’ condition is deteriorating. These errors can cause serious harm or adverse outcomes to patients. The pandemic affected the novice nurses’ orientation tremendously due to the need to have nurses on the frontline quickly, possibly prohibiting them from getting the proper orientation they were due. According to the National League of Nursing (2022), many nurses graduating from nursing school between 2021-2022 never interacted with patients until they were on the floor with their preceptor. Therefore, novice nurses are ill-prepared to practice safely as registered nurses.

New Graduates and Lower Salaries

Another factor contributing to the layoff of experienced nurses is the availability of a steady supply of new nursing graduates. Hospitals and healthcare facilities may opt to hire freshly graduated nurses willing to accept lower salaries as they appear more cost-effective. This preference for hiring entry-level nurses over seasoned nurses can lead to more sentinel events due to lack of experience.

Impact on Patient Care 

The consequences of laying off seasoned nurses can have a negative impact on patient care. Experienced nurses bring knowledge, clinical judgment, and critical thinking skills acquired through years of practice. Their expertise in handling complex cases, recognizing subtle changes in patient conditions, and providing effective interventions must be replaced. The loss of seasoned nurses may result in a dramatic decline in the quality of patient care, therefore increasing medical errors and compromising patient safety.

Continuity of Care and Nurse-Patient Relationships

Seasoned nurses often develop strong bonds and trust-based relationships with their patients over time. These relationships enable them better to understand patients’ needs, preferences, and circumstances, leading to more personalized and effective care. When experienced nurses are laid off, this disrupts continuity of care and established nurse-patient relationships, potentially affecting patient outcomes and satisfaction.

The Importance of Balancing Profit and Patient Care

While financial stability is crucial for healthcare institutions, it is critical to strike a balance between profitability and patient care. Healthcare organizations should recognize the value of experienced nurses and invest in retaining them rather than prioritizing short-term cost savings. Strategies such as mentorship programs, professional development opportunities, and identifying the contributions of seasoned nurses can help retain their expertise and ensure optimal patient care.

Conclusion

Laying off experienced nurses favoring cost-cutting measures reflects a troubling trend in the healthcare industry. Prioritizing profits over patient care compromises the quality and safety of healthcare services. Healthcare institutions and policymakers must address this issue, emphasizing the importance of retaining and valuing experienced nurses for the well-being of patients, the nursing profession, and the healthcare system as a whole.

References

American Nurses Association (ANA) (n.d, August 24). Why nurses quit and leave the professionhttps://www.nursingworld.org/practice-policy/nurse-staffing/why-nurses-quit/

Joint Commission (2023, August 24). The sentinel event data 2022 annual review. https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safety-topics/sentinel-event/03162023_sentinel-event-_annual-review_final-(002).pdf

Mcfanhn, C (2023, August 24). Some workers at U.S. hospital giant HCA say it puts profits above patient care. https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122

Muoio, D (2023, August 24). Layoff are ramping up among hospitals and health systems. Here are 72 examples from 2023. https://www.fiercehealthcare.com/providers/layoffs-ramping-among-hospitals-and-health-systems-heres-34-examples-2023

National Council of State Board of Nursing (2023, August 24). NCSBN research projects significant nursing workforce shortages and crisis. https://www.ncsbn.org/news/ncsbn-research-projects-significant-nursing-workforce-shortages-and-crisis

Practical Strategies for Implementing Evidence-Based Practice

Practical Strategies for Implementing Evidence-Based Practice

Basing your nursing practice on the latest evidence and research remains critical to providing optimal patient care. Practicing nursing based on tradition, how weve always done it,” or outdated research can lead to poor patient outcomes, inappropriate care, or serious errors.practical-strategies-for-implementing-evidence-based-practice

No doubt you studied evidence-based practice (EBP) in school, read it in journals or attended in-service sessions about using evidence in practice. You no doubt have every intention and desire to base your nursing practice on the latest research. But how can you do that when your days quickly spin into a whirlwind of patient admissions, procedures, and more?

In this article, well offer a few perspectives and approaches on ways to help base your practice on the latest evidence. But first, a quick refresher on the importance of EBP.

The Importance of Evidence

“By integrating the latest and most robust evidence into our day-to-day nursing practices, as nurses, we ensure that our interventions are grounded on the most recent or latest advancements in healthcare and patient preferences and values, thus promoting safe, effective, and high-quality care,” according to Meredith Padilla, PhD, RN, CCRN-CMC, clinical practice specialist for practice excellence at the American Association of Critical-Care Nurses (AACN). Moreover, EBP fosters a culture of continuous learning and professional development and elevates the standards of nursing practice. Additionally, a recent study reports that EBP culture and mentorship increase job satisfaction and intent to stay among nurses.”

Highlighting the importance of bringing evidence into practice, an entire field of research is now dedicated to determining the best methods and strategies (or interventions) for facilitating the implementation of research evidence in healthcare decision-making, including day-to-day nursing practice, according to Jennifer Yost, PhD, RN, FAAN, professor, M. Louise Fitzpatrick College of Nursing, Villanova University. She notes that this is commonly referred to as implementation science, knowledge translation, or translational science.

Culture of Inquiry

In bringing evidence to the bedside, nurses must cultivate a culture of inquiry, notes Padilla. Asking questions is the initial step toward EBP,” she says. She suggests using the PICOT format (Patient/population, Intervention, Comparison, Outcome, Time) to frame the question.

Also, use an EBP model to guide your work. Examples of EBP models, she notes, include the Iowa Model, the Johns Hopkins Evidence-Based Practice Model, the Advancing Research and Clinical Practice through Close Collaboration Model (ARCC), and the Stevens Star Model of Knowledge Transformation. 

All of these models, she notes:

  • Emphasize the importance of identifying and defining specific clinical questions that require EBP solutions and utilize the PICOT format guide to search for evidence.
  • Share a step of conducting a systematic and thorough review of the best available evidence related to the clinical question.
  • Have a common goal of the translation of evidence into clinical practice.
  • Emphasize evaluation of the implementation process and continuous improvement.

Tap your resources, Padilla says. Collaborate with a colleague, nurse leader, or interdisciplinary team member who can provide support and mentorship as you explore the evidence behind a clinical question.

Along those same lines, cultivating a culture of peer review and mentorship is pivotal, says Sandra Russo, PhD, RN, director of nursing and chairperson of the nursing program at Touro University. She notes that peer-reviewed journal club meetings and mentorship programs can provide a platform for exchanging knowledge and developing critical skills.

Access to Resources

Having easy access to EBP resources is key. Hospitals and healthcare agencies should support EBP by providing nursing staff with easy access to reputable nursing journals, online databases, and institutional access to academic resources, says Russo.

In addition, dont neglect to consult your institutions policies and procedures, says Pamela Barnwell-Sanders, EdD, MBA, MSN, RN, associate professor of practice at Egan School of Nursing and Health Studies, Fairfield University. She says that even if youre performing a procedure regularly, you may discover that the policy or procedure has been updated to reflect the latest evidence.

Resources to help nurses identify the best available evidence, notes Padilla, include published clinical practice guidelines research databases like PubMed, CINAHL, and the Cochrane Library. 

When it comes to searching for evidence, starting a search for the already-synthesized evidence (for example, systematic reviews or clinical practice guidelines based on systematic reviews) can improve search efficiency, according to Yost. Searching repositories of evidence syntheses (for example, Epistemonikos) and databases, such as PubMed, that allow one to limit searches to systematic reviews is also helpful, she says.

Continuous Improvement

As with most aspects of healthcare, analysis and feedback are critical. Regular audits of nursing practices are necessary to assess adherence to evidence-based guidelines, notes Russo. She says constructive feedback, recognizing positive behaviors, and addressing areas requiring improvement is the cornerstone of a continuous improvement cycle.

The nurse at the bedside should always be asking why, says Barnwell-Sanders. With a firm understanding of and grounding in EBP, youll have a solid knowledge of why a practice or procedure provides the best evidence-based care for your patients.

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The Benefits of Earning Your DNP

The Benefits of Earning Your DNP

A nursing career offers many avenues for nurses of all stripes and interests to fulfill their professional goals. For some, earning a doctorate is a lifelong aspiration that they are keen to fulfill, and nursing offers three options for this accomplishment: the DNP, the PhD, and the Doctor of Nursing Science (DNS or DNSc).the-benefits-of-earning-your-dnp

Doctoral programs offer what is frequently referred to as terminal” degrees since they represent the highest possible level of educational achievement in most disciplines (some areas lack a doctoral option. Thus, the masters becomes the default terminal degree). Considering that a DNP is generally clinically oriented, and a PhD and DNS are geared towards academia and research, a nurse wishing to take their clinical knowledge and education to the highest pinnacle would do well to look at the DNP as a very promising direction.

If youre wondering about the benefits of earning your DNP, theres no time like the present to explore the career potential and professional development that such a high-level educational accomplishment can confer on your nursing career. 

A Rigorous Education 

One clear benefit of earning a DNP is that it offers an unequaled rigorous clinical training pathway. In some DNP programs, you can choose a clinical nurse specialist or educator track, or you can choose to focus on direct patient care as an expert clinician.

Your DNP program will provide a much deeper dive into the theory and science driving evidence-based advanced nursing practice. Your education may also steer you into organizational leadership, systems thinking, IT and technological advances in nursing and medicine, healthcare policy and advocacy, and quality improvement.

This form of doctoral education will enrich your understanding and professional perspective on multiple aspects of patient care, preventive medicine, population and community health, and other areas of study. Depending on the focus of the DNP program you choose, you may also gain a keener grasp of emerging ideas in nursing and medical science, the effects of climate change and the environment on populations around the world, the social determinants of health, and other trends to keep an eye on in the years to come.

With the promise of the most extensive clinical training possible for a nurse, doctoral education can open your mind and help you look at the world around you with a more discerning, critical, and perceptive eye. It will also deepen your understanding of identifying trends that can impact how you practice, the state of the broader healthcare system you are a part of, and your patients health and the well-being of larger communities and populations, including the most vulnerable.

DNP Earning Power and Job Opportunities, and Professional Parity

The Doctor of Nursing Practice designation demonstrates to your colleagues, your patients, and the world that you have pushed yourself to achieve the highest possible level of education as a nurse, accumulating more extensive knowledge and expertise.

In many job markets, nurses with a doctoral degree can sometimes command higher salaries than some of their masters-prepared counterparts. According to Payscale, DNPs earn an average of $112,000 annually, and NPs earn an average of $106,413, an arguably nominal difference.

However, CRNAs can expect to earn an average annual salary of $179,343. And since a DNP will be the entry-level degree for all CRNAs as of 2025, newly enrolled CRNA students have been automatically enrolled in DNP programs since 2022.

When applying for executive leadership positions, candidates with a doctoral education can have an advantage over their masters-prepared colleagues since a DNP education provides advanced training in organizational management, systems thinking, and the leading of multidisciplinary teams. Executive leadership positions include chief nursing officer (CNO), patient care director, nursing home administrator, director of nursing, or chief nursing information officer. As far as earning power, a CNO can expect to earn an average of $141,000 per year.

Professional Parity 

Since many healthcare colleagues — including MDs, dentists, and physical therapists — are required to achieve a doctorate, earning your DNP can provide you with professional achievement and equality of standing regarding professional parity.

As a nurse with a DNP, you will find yourself collaborating with multidisciplinary colleagues, often in a leadership position. A doctoral degree can bestow a feeling of self-respect and the right to expect and demand equal treatment as a highly educated, knowledgeable, professional healthcare leader.

Achieving Your Highest Goals

Nurses are all individuals whose personal circumstances and preferences dictate what level of education will bring them a sense of achievement and satisfaction. An aversion to accumulating student loan debt can be enough of a deterrent for some nurses to advance their education. For some, an ADN, BSN, or MSN is enough to scratch their educational itch, and the idea of a doctorate feels foreign, excessive, or simply unnecessary to reach their career goals.

However, there are always some ambitious nursing professionals whose eyes have always been on the prize of a doctorate, whether for personal achievement, professional advancement, or a combination of these and other motivating factors. Doctoral education is an intense and enriching educational experience that some individuals look forward to with relish and excitement, if not a healthy dose of trepidation at the amount of work that completing their education will entail.

Whether for personal reasons, professional advancement, earning power, career mobility, professional parity, or simply as a quest for knowledge, earning a DNP can deliver a unique sense of accomplishment for each individual.

Only you can decide if the DNP pathway is right for you and your career. Before you take the plunge:

  • Do your due diligence.
  • Research your options.
  • Talk with those whove walked this route before you. 

There are many benefits to earning your DNP, and you can make a prudent decision once youre armed with enough information to choose from a place of wisdom and certainty.

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Meet a Champion of Nursing Diversity: Elodia Mercier

Meet a Champion of Nursing Diversity: Elodia Mercier

For almost 40 years as the Director of Nursing for Throughput Operations at Montefiore Health System in New York, Elodia Mercier, RNC, MS, has been advancing patient care and creating and defining new roles for fellow nurses and other providers.

In June 2021, Montefiore was evaluating performance improvement initiatives to enhance patient experiences and alleviate flow challenges and decided to open a discharge lounge. The idea of a discharge lounge isn’t new, but being assisted by the clinician with whom patients just bonded is.meet-a-champion-of-nursing-diversity-elodia-mercier

Mercier was chosen to open the discharge lounge and met the challenges of a crowded emergency department (Montefiore is amongst the busiest in the country) and limited beds for admissions. Under Mercier’s supervision, the lounge, intended to assist 10 patients daily, quickly increased to 30-40. Over 27 months, Montefiore’s Discharge Lounge received more than 678 patients per month. On average, patients stay for approximately 35 minutes. This time spent in the lounge has equated to more than 10,800-bed hours saved, the equivalent of 62 additional beds – a total game-changer, particularly for an urban hospital. Mercier showcased this success at the New York Organization for Nursing Leadership last September.

In addition to the discharge lounge, Mercier developed Montefiore’s SHHH (Silent Hospitals Help Healing) program and other vital initiatives. She is also an active participant in the College of Mount Saint Vincent’s mentorship program, which pairs successful alums/trustees and friends of the college with bright, dedicated students eager to gain skills and insight that will allow them to channel their passion and talents into successful, satisfying careers.

As a recipient of a National Association for the Advancement of Colored People (NAACP) award for her participation in community affairs in 2011, Mercier is an important nursing leader, and we’re proud to profile her as part of the Champions of Nursing Diversity Series 2024. The series highlights healthcare leaders who are prominent figures in their organizations and are making transformational impacts in nursing.

Meet Elodia Mercier, RNC, MS, Director of Nursing for Throughput Operations at Montefiore Health System in New York.

Talk about your role in nursing.

As a nurse of nearly 40 years at Montefiore Health System, I’m always focused on the people we serve regarding safety, getting well and their patient experience. My role as Director of Nursing for Throughput Operations combines these three aspects, specifically focusing on the discharge process and ensuring this takes place in a calm and comfortable environment.

Our Henry and Lucy Moses Hospital Discharge Lounge is the last impression patients have when leaving our hospital, and we want it to be a good one. I’m focused on this positive experience and memory for patients and their families, ensuring all needs are met and leaving them as fully satisfied customers.

How long have you worked in nursing?

July 23, 1984, to present. I started as a part-time nursing attendant at Montefiore while attending the College of Mount Saint Vincent from 1980-1984.

Why did you become a nurse? 

I became a nurse because I like helping people. Also, when my great-grandmother was ill in this very hospital, I did not understand what was happening to her. This memory stayed with me, and in my mind, I knew I wanted to make a difference for patients and their families, helping them better understand what is happening in terms of care and being able to teach and help heal. Last but not least, I was the first in my extended family to attend and graduate college. This was important to me, coming from a Caribbean /Afro-American Hispanic background.

What are the essential attributes of today’s nursing leaders? 

Being a transformational leader. This means keying into the emotional intelligence of the people you lead. It also means finding a way to help people best understand their roles and values and the importance these factors play in helping our patients. Each person learns and processes things differently. A good or transformational leader finds ways to help each person on the team understand how they process information and produce the best outcome. I believe in leading by example and rewarding staff, even if it’s a simple acknowledgment or a thank you birthday card sent to them at home outlining their contributions throughout the year as a nurse on the unit. I have always believed that happy staff leads to happy patients and great outcomes. A good leader listens and values their team.

What does being a nursing leader mean to you, and what are you most proud of?

Being a nursing leader to me means supporting my teams by way of education, accountability, and pride. I am proud of a few things, so it is a challenge to name just one.

-I am proud of having the highest consecutive year-after-year Press Ganey scores on my units as a nurse manager.

-I am proud of having the highest 365 degree and staff satisfaction surveys.

-I am proud of the creation of the Silent Hospital Help Healing Program that I initiated at Montefiore for noise reduction.

-I am proud that I established the motto now commonly used around the campus, “Happy Monday” or “Happy Friday.” I intended to help nurses and anyone else focus on the good things in life and all the good things they may have accomplished and still hope to achieve.

Tell us about your career path and how you ascended to that role.

I started as a staff RN in 1984 in the Neurology unit of Montefiore and then moved to the Rehabilitation units for long-term care. I was then promoted to become a Patient Care Coordinator and then a Nurse Manager in the Department of Medicine. After consecutive years of consistently meeting high Press Ganey (patient. satisfaction scores), it led me to the next step of my career, which was being promoted to director of nursing.

Then, in 2021, Peter Semczuk, SVP and executive director of the Moses and Wakefield Campuses in the Bronx invited me to become the Director of Nursing for Throughput Operations and help open our discharge lounge. My focus now is on healing our patients and working with our nurses and other staff to focus on barriers that might hinder their safe discharge or could unnecessarily increase the length of stay in the hospital.

Data is the driving force of the discharge lounge. Our data helps empower our nurses to think of discharging from day one – from decanting the emergency department to getting patients home safely. Sample data include the average length of stay in terms of bed saved hours per unit and when patients are discharged to the lounge. Our data reflects how each unit contributes to the end goal. When the lounge opened, the intent was to assist 10 patients per day, but that number quickly increased to 30-40. Approximately one-third of adults leaving our Moses Campus and emergency department are cared for in the discharge lounge today. We’ve also saved approximately 11,000+ bed hours, equivalent to more than 62 additional beds – a game-changer for a busy, urban hospital. Currently, my colleagues and I use data to help specific units achieve target measures for throughput. Nursing is so diverse and has so many opportunities. I enjoy focusing on throughput as this position focuses on relationship-centered care.

What is the most significant challenge facing nursing today?

As a result of COVID, many new nurses missed out on opportunities to experience more clinical rotations when in school. When they arrive in the workforce, they depend on strong leaders and strong support to help guide them. Also, many senior nurses are leaving the workforce and preparing for retirement. This creates a more significant gap in mentoring and preceptorship by the senior nurses for the newer nurses. This is why it is imperative to have strong, supportive leadership.

As a nursing leader, how are you working to overcome this challenge?

Along with many of my colleagues and the outstanding nursing leaders at Montefiore, efforts are being made to help teach, engage, and provide more supportive and educational opportunities to meet the needs of both new and current staff. This month, for example, I conducted a Joint Commission mock survey prep for our radiology department. For many, it will be their first time participating in a Joint Commission survey, so I took the nurses on a walking tour of our radiology department instead of a formal class. We reviewed where some of the equipment, like the oxygen valves, were, and we reviewed the power of non-verbal communication, like body language. The message was that if a surveyor asks a question, then everyone should come to the support of one of our nurses. This sends a message of confidence.

What nursing leader inspires you the most and why?

Joanne Duffy, an adjunct professor at Indiana University because she focuses on the quality caring model and relationship-centered care. She believes in taking affirmative action to serve problems rather than identify and report them. I can very much relate to this.

Maureen Scanlan, our SVP and Chief Nurse Executive, is inspiring at Montefiore. Maureen exemplifies nursing theory and practice goals, has a calm demeanor, and is always gracious, supportive, and professional. As I have transitioned to various nursing roles, she has always been there to advise me and ensure I am kept abreast of all nursing-related topics within Montefiore.

What inspirational message would you like to share with the next generation of nurses?

Help, support, and never be afraid to try new things because success is derived from trying and learning – you never know unless you try.

Is there anything else you’d like to share with our readers? 

I have loved being a nurse at Montefiore. I have worked hard here, and Montefiore has been excellent and supportive of me. If you want to see and experience a family, community, and well-organized hospital, visit – I will have a hot cup of coffee or tea waiting.

Implementation of Trauma-informed Principles in Nursing Education: An Appeal for Action

Implementation of Trauma-informed Principles in Nursing Education: An Appeal for Action

Exposure to traumatic stress can have a life-altering negative impact on student nurses. Traumatic stress can challenge effective coping, emotional regulation, and the ability to focus, retain, and recall nursing concepts. According to the Substance Abuse and Mental Health Services Administration (SAMHSA, 2014), the “3 E” conceptualization of trauma are Event (single or cumulative), Experience (neglect, abuse, betrayal), and Effects (anxiety, loneliness, depression, feeling unsafe ) are manifested in various ways in people with exposure to trauma.

An individualized student-centered approach is crucial in understanding and adapting teaching pedagogy in nursing education to realize, recognize, respond, and resist re-traumatization (SAMHSA, 2014)in student nurses with a history of traumatic stress.

This article discusses the concept of trauma-informed pedagogy in nursing education and its significance in promoting equity and inclusion. Trauma-informed pedagogy suggests that past experiences can negatively impact health outcomes and learning (Garfin D. R. et al., 2018). As a result, educators must be able to identify signs of trauma and adapt their teaching methods to meet their students’ unique needs. It discusses the impact of trauma on nursing students’ physical and mental health functioning, and it then delves into implementing principles of trauma-informed pedagogy in the classroom.

Background/Significance 

Trauma is defined as an event or set of circumstances that an individual experiences as physically or emotionally harmful or threatening, resulting in lasting adverse effects on their functioning and well-being (Bremner, J. D. 2006). College students, despite their excitement to succeed, often experience severe psychological distress, with 70% reporting such distress. Additionally, 35% of students were diagnosed with anxiety, and 29% had depression (American College Health Association, 2022).

Transgender and LGBTQIA students report higher levels of mental health issues than their straight counterparts. Microaggressions are also experienced by underrepresented students, creating a sense of unsafety on campus. Evidence suggests that Colleges should pivot to a learning space that promotes inclusion and equity. Only 40% of college students think colleges are doing enough to support mental health (Veneable, M.A., & Pietrucha, M. E., 2022).

The Universal Design for Learning ( UDL) recognizes that every student has different learning needs, and a one-size-fits-all approach is an ineffective instructional strategy. Similarly, implementing trauma-informed pedagogy principles within the nursing curriculum is a significant step toward meeting every student’s learning needs and experiences, promoting accessibility, equity, and inclusion in nursing education.

How Traumatic Stress Affects the Brain

Traumatic experiences can affect the brain’s development, structure, and function. It is critical to understand normal brain development to distinguish brain abnormalities. The areas of the brain responsible for stress responses are the amygdala, hippocampus, and pre-frontal cortex (Bremner, J. D., 2006). When an individual is exposed to traumatic stress, there is an increase in the level of cortisol and norepinephrine. Repeated exposure to stress increases the level of cortisol and norepinephrine and affects normal brain functioning and stress regulation, resulting in pathophysiological change(Bremner, J. D. 2006).

Students who are affected by traumatic stress may have difficulty learning concepts, focusing, and retaining information, resulting in course failures and higher attrition rates compared to their peers who have not experienced trauma. Traumatic experiences can cause anxiety and depression in some students. Past and current data suggest that trauma-informed care is critical for the promotion of equity in people with a history of trauma (Han et al., 2021).

Students’ sense of safety is disrupted, and the cumulative effects are difficulty adjusting to college experience, low grades, and high attrition rates. According to (Corello J., 2018), educators should adopt trauma-informed teaching and be compassionate and consistent in the learning environment. Despite the impact traumatic experience has on the brain, there is hope and possibility for students to be successful.

Implications for Nurse Educators

In the Four “Rs in the Trauma-informed approach to teaching student nurses(SMASHA, 2014), the nurse educator must convey empathy, possibilities, and hope to student nurses and focus on “what happened to you, instead of what is wrong with you’. Implementing trauma-informed principles is an issue of equity and inclusion and must be viewed through the lens of disability.

Realization 

Research suggests that 66%-85% of youth report exposure to traumatic events by the time they enter college (Read et al., 2011). Additionally, approximately three-quarters of college students, 77 %, experienced moderate to severe psychological distress (ACHA, 2022). Understanding that traumatic experiences can affect the development, structure, and function of the brain, the nurse educator must acknowledge that trauma happened and provide a trusting teaching environment that emphasizes hope and transformation.

Realizing that trauma affects the student’s ability to function optimally, the nurse educator must stay involved in world events that may be traumatic to students: for instance, racism, disability, COVID-19, sexism, sexual harassment, and sexual orientation. Modeling emotional intelligence skills, self-reflection, and situational awareness, the nurse educator can convey trust and transparency when discussing and understanding sensitive topics in the classroom.

Recognize  

The nursing process is a framework taught in nursing education to provide care for diverse populations. It begins with an assessment. Likewise, the nurse educator must be able to recognize signs of traumatic stress and respond with empathy, kindness, and understanding. Some signs and symptoms are difficulty focusing on a topic, lack of engagement, absenteeism, anxiety, low grades, and difficulty adjusting to the college environment.

It is essential to acknowledge that the traumatic event happened, and an evidence-based action plan is activated to promote healing and agency to enhance academic success. The nurse educator must be knowledgeable about topics or events that may trigger traumatic stress and develop a lesson plan or teaching strategies to avoid triggers—for instance, disparities in healthcare outcomes for minorities. Nurse educators must adopt several strategies to effectively support students’ learning experiences in teaching sensitive topics. To this end, the nurse educator should consider the value of establishing eye contact with students and facilitating opportunities for them to share their lived experiences. The nurse educator must also demonstrate a genuine interest in the student experience. By applying these strategies, nurse educators can foster an environment that supports students’ learning journey and promotes their well-being.

Respond

When a student goes through a traumatic experience, their sense of safety can be severely affected. As a nurse educator, it is essential to demonstrate emotional intelligence while conversing with such students regarding traumatic stress. Using the student’s name and giving them enough time to contemplate and respond is crucial. In addition, the nurse educator should offer their presence to show kindness and compassion, which can provide comfort and support for the student.

As a nurse faculty member, you can support your student’s academic journey by referring them to the Office of Accessibility and Disability. The office provides essential services to students with disabilities, ensuring they have the resources to succeed in their studies. Letting your students know you are available for office hours and phone calls is essential, as this can help them feel more comfortable and supported.

Creating a respectful and inclusive learning environment is crucial to the success of all students. You can do this by promoting a culture of civility and respect in your classroom and being mindful of your students’ diverse needs. If a student is experiencing anxiety or stress, consider extending assignment due dates to help alleviate their concerns.

Finally, it is essential to recognize that some students may have a history of trauma that could impact their ability to learn. To increase the accessibility and inclusion of these students, incorporate multiple teaching modalities that address the cognitive, psychomotor, and affective domains of learning. Doing so can help ensure that all your students can succeed.

Resist re-traumatization 

In a nursing education culture that prioritizes diversity, equity, and inclusion, it is essential to recognize that some college students may have experienced trauma. By intentionally incorporating transformative, trauma-informed practices into nursing education, we can foster a sense of human dignity, promote academic growth, and help students thrive. To prevent re-traumatization, faculty and peers must have zero tolerance for discrimination against students. The learning environment must prioritize civility, human caring, compassion, and consistency (Corello, 2018) while avoiding punitive measures and implementing clear policies and procedures. Sensitive topics should be approached with empathy and understanding, and training modules focused on trauma and its effects can help create awareness and build a strong sense of community.  

Conclusion 

Integrating trauma-informed practices into nursing education requires comprehensive changes across multiple levels, from micro to macro systems. At the micro level, nurse faculty must demonstrate empathy, benevolence, courtesy, and honor towards individuals who have survived trauma. They must also remain watchful in recognizing, validating, and averting re-traumatization for student nurses who have experienced trauma. By nurturing a learning environment that fosters personal development and transformation, faculty and students can collaborate to establish a warm and accommodating community open to everyone.

References:

1. American College Health Association -National College Health. (2022). Assessment III: Undergraduate Student Reference Group Executive Summary Spring 2022. Silver Spring, MD: American College Health Association.

2. Bremer, J. D. (2006). Traumatic stress: effects on the brain. Dialogues in Clinical Neuroscience, 8(4), 445-61.

3. Carello, J. & Thompson, P. (Eds). (2021). Lessons from the pandemic: Trauma-informed approaches to college, crisis, change. Palgrave Macmillan.

4. Garfin, D. R., Thompson, R. R., & Holman, E. A. (2018). Acute stress and subsequent health outcomes: A systematic review. Journal of Psychosomatic Research, 112, 107-113. doi: 10.1016/j.jpsychores.2018.05.017

5. Goddard, A., Jones, R. W., Esposito, D., & Janicek, E. (2021). Trauma-informed education in nursing: A call for action. Nurse Education Today, 101. doi: 10.1016/j.nedt.2021.105064

6. Han, H. R., Miller, H. N., Nkimbeng, M., Budhathoki, C., Mikhael, T., Rivers, E., Gray, J., Trimble, K., Chow, S., Wilson, P. (2021). Trauma-informed interventions: A systematic review. PLoS One, 16(6), e0253209. Doi: 10.1371/journal.pone.0253209

7. Kubala, J. (2020). Of Trauma and Triggers: Pedagogy and Affective Circulations in Feminist Formations, 32(2), 183-206.

8. Read, J. P., Wardell, J. D., Vermont, L. N., Colder, Ouimette, P., & White, J. (2012). Transition and change: Prospective effects of posttraumatic stress on smoking trajectories in the first year of college. Health Psychology, 32(7), 757-767.

9. SAMHSA’s concept of trauma and guidance for a trauma-informed approach. (2014). HHS Publication No. (SMA) 14-4884. Substance Abuse and Mental Health Services Administration, Rockville, MD.

10. Veneable , M. A., & Pietrucha, M,E. (2022). 2022 College Mental Health Report, Best Colleges.

Casey Green Talks About Critical Care Transport Nursing

Casey Green Talks About Critical Care Transport Nursing

As a sponsor of the annual Critical Care Transport Nurses Day on February 18,  the Air & Surface Transport Nurses Association aims to raise awareness of this nursing career path while simultaneously celebrating the nurses who work in dynamic critical care transport settings. Headshot of Casey Green critical care transport nurse

The critical care transport nursing specialty offers variations of work settings so nurses can work in settings including air transport, ground transport, and military transport. Critical care ground transport nurse Casey Green, BSN, RN, CCRN-CMC, CTRN, CFRN, CEN, TCRN, CPEN, CNRN, NRP says the skills and approach to nursing care in this specialty appeals to her.

“I really enjoy the autonomy of nursing care in the emergency department and the intensive care units, and transport nursing is a combination of using both skill sets to assess, monitor, and treat patients safely,” she says.

Because critical care transport nurses work in ambulances, helicopters, or on ships, they are often the nurses who reach remote areas, trauma situations on roadways, and work in areas that are unfamiliar. They could transport one patient to a hospital or be part of team that needs to transport many people out of an area. The challenge appeals to Green. “I like the variety of patients and just how complex their care is,” she says.

As with any nursing situation, things can change quickly and nurses have to be ready. But transport nursing poses additional challenges including vehicles, weather, and terrain. Green says that transport nurses need to be aware of any potential situation. “To prepare myself for this line of work, I took a lot of courses in patient care for all patient populations, especially those who are critically ill,” she says. “Each shift I work I refresh myself on equipment, medication, or a patient population that we may have not transported recently just to keep the information fresh in case we have a request during my shift.”

Nurses who are interested in this specialty should enjoy the physical challenges, fine tune their critical thinking, and have an ability to read and react to a situation immediately. “Two of my biggest takeaways are to develop strong assessment skills because they help guide your intuition if something feels or seems off during transport,” says Green.

As with other nursing career paths, transport nurses don’t operate in a vacuum even though their work is done outside of a typical hospital or health care facility setting. “Teamwork needs to be at the forefront of your mind when you step on a transport vehicle,” Green says. “Often, your team is all you have between hospitals, and all levels of patient care have a say in patient care during transport.”

Critical care transport nursing is an exciting career path, and Green says if a nurse is interested in pursuing it, preparation is key. “Get experience in the ICU and the ED and apply,” she says. “Don’t worry that you may not have what an employer is looking for; get your experience and develop strong critical thinking and assessment skills.”

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