As November draws to a close, the end of National Hospice and Palliative Care Month also winds down. Many families spent an unsettled holiday weekend without loved ones, either because they wanted to be safe and not gather with people outside their immediate households or they were unable to travel. In many other cases, illness, from COVID-19 or otherwise, prevented loved ones being together. Still other families have suffered the loss of a loved one this year.
As a pandemic continues to move swiftly into every community in the United States, the subject of death and dying and end-of-life care is much more at the forefront in our society right now. As palliative care and hospice nurses see all the time, many families enter into the last stages of a loved one’s life without any real understanding of what kind of care wishes their loved one would like them to follow.
These last two days of National Hospice and Palliative Care Month focus on end-of-life care and advocacy to spread awareness of how discussions about end-of-life preferences and choices need to happen long before they are actually necessary. While many of us aren’t inclined to have such difficult conversations during the holidays, finding a time when you’re able to start the discussion can save confusion and doubt when you need the information. As a nurse, this is a good opportunity to remind your patients of the value of talking about their wishes with their loved ones.
Palliative care and hospice nurses are often able to help guide families during the last months of life as they care for someone with a life-limiting illness. While the patient is given the best care to make them as comfortable as possible, nurses in this specialty also assist families who may be struggling with sadness and uncertainty about their loved one’s condition.
This area of nursing is growing quickly, according to the U.S. Bureau of Labor Statistics, which predicts growing need for palliative and hospice care workers to meet increasing demand. As the baby boomer segment of the American population continues to age, the need for hospice and palliative care will become more pressing.
It’s essential to have enough workers to fill the hospice nursing need, and the National Association for Home Care and Hospice advocates for all the professionals in this industry. As a registered nurse, you can provide case manager services as well as direct medical care. If you’re a nurse practitioner, you’ll have additional responsibility and duties, including prescribing the medications that help your patients manage any pain they may be experiencing. LPNs provide the comforting physical care and companionship so essential during a person’s last days.
If you think this nursing specialty is a good fit for you, getting additional work experience in a palliative care and hospice care setting will help you make a decision. Working with people at the end of their lives is incredibly rewarding for hospice nurses, but the role isn’t for everyone. If you decide to move forward, becoming a certified hospice and palliative nurse (CHPN) gives you the additional education and knowledge you’ll need to be most effective in this position.
A career in palliative care and hospice nursing is rewarding as you help bring a sense of dignity to a patient’s final days.
There are currently nearly 4 million nurses working within the health care industry of the United States. It is the largest health care profession in the country, and for good reason. Nurses make a difference. They are often the first point of contact for anyone seeking medical attention, and they tend to go above and beyond what is typically asked or required of them.
Even though it is the top health care profession, there is always a growing need for nurses. Thankfully, it’s one of the easiest careers to pursue. Nursing courses are offered almost everywhere, including online, and once you’ve completed your coursework you can enter the workforce quickly. Plus, you can choose your own specialty, depending on your interests or passion.
Nurses also have the opportunity to work almost anywhere in the world, and job security will always be there. But, if you’re already interested in pursuing a career in nursing, you likely already have your own reasons to make it your life’s work.
The better question is, how should you get started? What should you expect as you go through your undergraduate studies, and which career path should you take when it’s time to make that choice?
Getting the Education You Need
The amount of education and training you’ll need to become a nurse depends on what type of nurse you’d like to be. For example, to become a Registered Nurse (RN), you’ll need a minimum of an Associate’s Degree.
If you’re already an RN or if you want to pursue something higher, consider getting your BSN (Bachelor of Science in Nursing) at a four-year university or institution. No matter what degree completion you go through, everyone entering the nursing field needs to complete the NCLEX. This is an exam that is required by the National Council of State Boards of Nursing. You’ll need to apply to take the exam through the state in which you plan on working. A passing grade is required to become an RN, and the categories include:
- Safe, effective care environment
- Psychosocial integrity
- Physiology integrity
- Health promotion
Once you are an RN or have received your BSN, you can decide whether you’d like to choose a specialty or continue your education to become a nurse practitioner. Nurse practitioners must complete a Master of Science in Nursing program (MSN). On top of your previous education, the entire timeline can take anywhere from 6-8 years. If you haven’t yet started your educational journey toward becoming a nurse, it’s never too early. Some nursing programs are available online (at least partially). If you know nursing is your passion, you can begin to take courses early and gain experience that will help you once you find yourself in the workforce.
Facing the Realities of Nursing
No matter what level or area of nursing you decide to pursue, there are a few truths you’ll need to understand before you get started. Maybe you’ve been passionate about becoming a nurse since you were a child. Those passions and dreams don’t have to be “squashed,” but knowing as much as possible about the realities of nursing before you break into the field can help you determine if it’s really the right career for you.
First, it’s important to understand that you will always come second. That’s actually one of the reasons many people become nurses: to provide service to others. Doing so can help you to feel fulfilled and satisfied with your work. But, that doesn’t mean it will always be easy. Some potential “drawbacks” to keep in mind about a nursing career include:
- You’re constantly on your feet, which can cause muscle aches and pains, or even lead to varicose veins.
- If you work in a busy hospital, you may have irregular hours.
- Nurses are at a high risk of experiencing workplace burnout.
- It can sometimes be a “thankless job”.
- Entry-level RNs only make an average of $41,000 per year.
Nursing can be a demanding profession, depending on where you work. But, most people stay in that profession for years because the rewards outweigh any of the disadvantages. It helps to have certain traits and characteristics to enjoy nursing as a long-term career. You have to enjoy working with different types of people every day and be willing to be a major component in a functional team.
How to Land a Great Nursing Job
Once you’ve completed your education and received your certification to become a nurse, the next step is to find the right job. Thankfully, due to the high demand for nurses across the country, your qualifications will often be enough for you to get hired quickly. Nurses are needed in a variety of settings, including:
- Nursing homes
- Local government agencies
Think about the type of setting that would be a good fit for you before applying to different open positions. You may want to start somewhere small to gain experience, especially if you eventually want to continue your training toward a specialty.
Networking is just as important in the health care industry as it is in other business sectors. If you know anyone in the industry, don’t be afraid to reach out to them and market yourself to land a job. Many times, getting the job you want is about “who you know”, so use your connections wisely.
Finally, think about some of the most common questions you could be asked during a job interview. While it’s important to practice your answers for the interview itself, you can also gain more insight into what you really want to achieve out of your career. What are your goals? Why did you want to become a nurse? What are your biggest strengths and weaknesses? By understanding some of those things about yourself, you will have more direction in where you want to take your career.
Nursing is one of the oldest, most stable professions in the country, and it’s still seeing continuous growth. If you are pursuing a career in nursing, keep these ideas in mind to continue your forward progress, and know what to expect as you start your first job.
With a respiratory virus pandemic surging through the world’s populations right now, the goals of the Great American Smokeout are as important and timely as they’ve ever been.
The COVID-19 virus can strike smokers and those with impaired lung functions especially hard, so the present is absolutely an important time to quit or to help your loved ones, colleagues, or patients with their quitting journey. The World Health Organization (WHO) offered this statement on its website, “Smoking any kind of tobacco reduces lung capacity and increases the risk of many respiratory infections and can increase the severity of respiratory diseases.”
Here are some facts about smoking from the American Cancer Society:
- About 32.4 million American adults still smoke cigarettes.
- Smoking remains the single largest preventable cause of death and illness in the world.
- Smoking causes an estimated 480,000 deaths every year, or about 1 in 5 deaths.
- More than 16 million Americans live with a smoking-related disease.
- Once you quit, your body begins to recover and returns to a healthier state.
Whether you’re a smoker or are just interested in how to help someone you know who is quitting, giving up smoking is one of the most important steps to committing to a healthy lifestyle. In addition to reducing the risk of cancer that is inherent with smoking, those who quit are able to reap the many benefits of giving up smoking–from better heart health to saving money on nicotine products.
Here’s what you need to know about quitting smoking.
“It’s Not Easy” Is an Understatement
Those who have quit say it’s one of the hardest things they have ever had to do. Smoking is physically addictive, and it’s also emotionally addictive. People who are trying to quit are breaking their body’s real craving for a substance that it depends on. But they are also breaking an ingrained habit that may have been used to fill a void whether it is to soothe, energize, distract, or relax. Tackling both of those at the same time is challenging, but millions of people have proven it can be done.
If You’re Trying to Quit
Talk to people who have quit to find what worked for them and then explore every option. Look at your habits so you can identify your triggers and be ready to deal with them. There are support groups, medications, and resources that can help—the WHO even has an AI approach to quitting. Find someone who can help motivate you and keep you going when it’s hard—whether that’s a friend, loved one, or a professional. Accept that quitting smoking is going to be as difficult physically as it is psychologically. You’re giving up something that is part of your daily routine.
If You’re Trying to Help Someone Quit
The decision to quit is a deeply personal one. You can offer support and distraction and can be a buddy, but it’s not up to you whether the person you’re supporting succeeds. If you’re trying to help someone who is quitting, talk about what will aid them the most. Do they want you to check in with them at certain times when the urge to smoke might be strongest (when they wake up, during work breaks, after meals) or do they want to be the one to reach out? Would it help if you set up times to go for a short walk or could find a few fidgets to keep their hands busy? Remember, if they don’t succeed the first time they try to quit, they aren’t alone. It takes most smokers more than one try to quit for good.
Taking the first step toward quitting is significant. Stating your intentions is half the battle—then it’s finding and following the best process to success. Join others during the Great American Smokeout and start your path to a healthier life.
As the coronavirus pandemic reaches new heights across the country and hospitalizations rise, nurses are facing extreme and unprecedented demands. A recent study from the Journal of Occupational Health found that the coronavirus pandemic has significantly impacted the mental health of health care workers, especially frontline staff.
The heightened risk of exposure, coupled with inexperienced nurses providing care in fields where they have limited experience and veteran nurses feeling severe burnout, has caused many nurses to quit and move to outpatient clinics or home care.
As a result, hospital systems are turning to short-term travel nurses to fill the gaps in care as they continue to rely heavily on their nursing staff to manage the increase in hospitalizations due to COVID-19. These temporary nurses often struggle to feel connected to the resident nurses which can result in miscommunication and lapses in effective patient care.
These rapidly changing circumstances have put hospital systems in a tough place. Many are focusing all their energy on dealing with the crisis at hand, rather than addressing the deteriorating mental and emotional health of their nursing staff.
To protect one of their most valuable resources–their nursing staff–it’s crucial for hospital systems to think proactively about building resilience among their nursing teams and leaders. In my work with Innovative Connections, we we’ve been able to help nursing leaders at Baptist Health in Montgomery, Alabama, do just that.
In May 2020, it was clear to Gretchen Estill, MSN, RN, CNML, Chief Nursing Officer at Baptist Medical Center East (BMCE), that her nursing leadership team was emotionally exhausted from the nonstop care needed to handle COVID-19 hospitalizations.
“We had a multifaceted challenge,” Estill said. “This strong group of leaders were beginning to run on empty as we realized that this was not a transient pandemic. We are a very relational group, and we were missing the ability to get together in person and debrief.”
Meanwhile, at Prattville Baptist Hospital (PBH), chief nursing officer Meg Spires, RN, MSN, recognized a similar pattern of fatigue and frustration among her team of clinical leaders. Her close-knit leadership team still felt a strong commitment to their mission of putting patients first, providing passionate care, and pursuing perfection. However, the challenges from the pandemic made this mission seem impossible to carry out.
Although investing time in team development and resilience work during a pandemic may have seemed counterintuitive, these nursing executives at Baptist Health understood their teams needed emotional and psychological support to make it through the ongoing challenges of COVID-19.
Nursing teams participated in weekly team coaching sessions facilitated by Innovative Connections, a management firm in Fort Collins, Colorado, via videoconference. Nurses were able to discuss mindfulness, dealing with grief, changing their perspectives and building resiliency.
At the end of each training we give them a mindfulness practice to help ground them during their work. We had nurses dedicate the 20 seconds they wash their hands multiple times each day to practice mindfulness. Instead of adding one more thing to their non-stop schedules, we were able to incorporate this self-care practice into something they already have to do throughout the day.
“This resilience training is a necessary investment before and especially during a crisis,” Laurie Cure, CEO of Innovative Connections said. “If a team has been working to build trust, they are better positioned to show up and do their job when a crisis hits.”
Initial feedback found that the nursing team was grateful to have an opportunity to connect as a group in a designated place to debrief about how they were doing mentally and emotionally with their teammates. Many enjoyed the chance to unplug and understand how others on their team were coping to focus on their collective contributions and strengths during such a stressful time.
“I’ve heard repeatedly from my leaders that they’re extremely appreciative that we, as an organization, cared enough about them and their emotional health to invest in them,” Spires said.
Dedicating the time for resilience and team building during the demands of the COVID-19 pandemic may have seemed counterintuitive at first. However, the awareness that these key team members gained from having protected time to rejuvenate and support one another was invaluable. Pursuing this intervention has contributed to increased efficiency and connectivity for these nursing teams.
“The team had to acknowledge that we have to take care of ourselves before we can take care of others,” Spires said. “We focus on our physical health, but we don’t pay as much attention to our emotional or mental health. We can’t do justice to our patients or our team members if we’re not emotionally healthy.”
Probiotics. We hear a lot about how we should be taking supplements of these because they’re great for your digestive system. But because supplements aren’t regulated by the FDA, how are you supposed to find the one that’s right for you and your patients?
Fear not. Dragana Skokovic-Sunjic, BScPhm, NCMP, is a Clinical Pharmacist with Hamilton Family Health Team, Hamilton, ON as well as a leader in the knowledge of probiotics both in the United States and Canada. In addition, Skokovic-Sunjic is the author of Clinical Guide to Probiotic Products Available in Canada and Clinical Guide to Probiotic Products Available in the US, both of which are updated annually.
She took the time to answer questions.
For those who don’t know, what are probiotics and how do they help our bodies?
Probiotics are tiny but powerful organisms that, when taken appropriately, can oﬀer substantial health benefits. While many people believe probiotics are for the gastrointestinal tract only, scientific evidence asserts far-reaching and diverse benefits of probiotics which extend far beyond the gut to include: respiratory ailments, mental health, colic in babies, weight management, vaginal health, and more.
Probiotics offer health benefits through several mechanisms: modulation of composition or activity of the microbiome, modulation of the immune system, effect on systemic metabolic responses, improving barrier function in the gut, and increasing colonization resistance against pathogens. Many other new benefits are being discovered every day with the new research. (Source: https://isappscience.org/for-scientists/resources)
There are so many on the market. How can people choose the best one for them?
Probiotics are potentially beneficial; however, it is important to note that the effects and benefits are strain-specific and disease-specific. One needs to know what to use and why. Taking any probiotic, or a probiotic with the best-looking label or best price does not necessarily mean it will provide the desired benefit. It would be similar to walking into the pharmacy and simply asking to be given medication.
Probiotics are similar to medicines. Each one is unique and has a particular intended purpose. Just as taking medication for pain won’t prevent pregnancy, taking a probiotic to prevent traveler’s diarrhea won’t relieve a baby’s colic symptoms. It is essential that probiotics be prescribed or selected, and taken, appropriately.
All probiotics are not created equal, nor is the science that validates their eﬀectiveness. Unlike medicines, probiotics are not strictly regulated yet. Unfortunately, this means there are many probiotic products on the shelves that make claims that are not substantiated by scientific evidence. This is confusing, frustrating, and is resulting in people wasting money buying the wrong probiotic for the condition they are suﬀering from.
Selecting the proper probiotic and taking it appropriately for the symptoms or condition you wish to relieve is imperative. Be informed when choosing a probiotic. The Clinical Guide to Probiotic Products Available in the US is the only comprehensive summary of probiotic brands that reviews, rates, and summarizes the scientific evidence available for specific probiotic strains and related brands.
Clinical studies supporting the recommendations made by our expert review board are all listed for those who would like to dig deeper and learn more. You can also use a free, quick-access app as your reference tool, by downloading the Probiotic Guide free app to your iPhone or Android smart phone. Make sure to select one for your region—one for the US and one for Canada. Both the website and app contain the same information, including the references, level of evidence, reasons for use, dosage formats, and more.
It is essential to know that not everyone needs to be taking a probiotic supplement. If you are eating a balanced diet, including fermented foods often, not taking antibiotics, and are generally healthy, you do not need to take a probiotic all the time. However, in some situations, such as the cold and flu season, you might look at the evidence for specific strains and products that seem to minimize the risk of common infections disease or shorten the duration of cold and flu.
Are there any things to watch out for?
Most importantly: read the label. The probiotic product you select must show the unique name of the probiotic you need to use on the label. The name is a combination of three critical elements: its genus, species, and strain. The strain is particularly important because it not only reﬂects the physical characteristics of the probiotic, but how it will act, interact, and react with your individual microbiome. Dose expressed in CFU (colony forming units) and potency at the time of expiry has to be clearly stated.
Like any other supplements, the label should provide a non-medicinal ingredients lists, such as traces of dairy, gluten, and other potentially harmful allergens.
Most probiotic strains available in the U.S. and Canada have been deemed safe (GRAS status or NPN designation) for the general population. For critically ill patients, severely immunocompromised patients, and other special circumstances, the use of probiotics can be done under strict medical supervision.
Is it best to take them with or without food? In the morning or evening?
Timing and the best ways to administer probiotics is again, very strain-specific. Generally, most commercially available products can be taken at any time of the day, with or without food. Some strains are available in liquid form (drops) and are very effective even in a dose of 0.5B (billion) CFU. Other probiotic strains need to be taken in an enteric-coated capsule in a dose of 50B CFU in order to survive through the acids present in the gut to reach the target areas and provide benefits. This does not mean one is better than the other: it merely illustrates that not all probiotics are the same.
How can people tell if the one they’ve chosen is working?
If the probiotic is working, you will know! And you will know very soon. The best approach is to identify the reason why you would take the probiotic. For example, you suffer from IBS and would like to try a probiotic. Faced with so many choices, you turn to the Probiotic Guide mobile app, and find a few options with the highest level of evidence.
At this point, you could consult your health care practitioner, or decide to give it a try. Most probiotic products are available without a prescription.
The next step is to take the selected probiotic as recommended in the Probiotic Guide or on the product label. After you achieve symptom relief, you can stop taking it and see what happens.
Quite a few of my patients with IBS do safely stop taking probiotics after the initial treatment while others may need to take the probiotic continuously.
The length of time one needs to stay on a probiotic may different for each individual and the reason the probiotic is taken. Once symptoms are gone, you can try to stop and see what happens.
Due to the ongoing coronavirus pandemic, telehealth visits conducted via video calls are becoming more common than ever, and more insurance companies are covering them, too. The annual physical you once had in a doctor’s office may now be taking place over your webcam instead. You may be wondering how you can make the most of your telehealth appointment and make it easier for your nurse, doctor or other professional in cotton scrubs. Here are seven things that you can do to improve the experience on both sides.
1. Know what you want to talk about.
Just as with an in-person visit, you should come to your telehealth appointment prepared to discuss your health concerns. Make a list of everything that you want to cover, and prioritize them from most to least important. If you’ve been exhibiting symptoms, track them in the weeks leading up to the appointment and keep a log of them so you can note any trends over time. Have your notes with you, as well as a working pen or another way to jot down things during the appointment. This will maximize your appointment time and help your doctor or nurse treat you more efficiently.
2. Test the telehealth service beforehand.
If you’ve never had a telehealth appointment before, download the software or create an account and log in before your appointment begins. You won’t be able to actually video chat your provider until the appointment starts, but you can familiarize yourself with the platform and make sure that your camera is working. Depending on what service your provider uses, you might also be able to message your providers, schedule an appointment without having to call and more. If you have any trouble with the platform, contact tech support and try to get it resolved before the day of the appointment.
3. Get a strong internet connection.
Video calls require a strong internet connection, so run a speed test to ensure that your internet connection can support your video call without dropping. If your internet connection is weak, you might need to ask other people in your household to refrain from streaming videos and other activities that take up bandwidth when you’re in your telehealth appointment. If your Wifi is still weak and you’re the only person on it, you might need to look into upgrading your plan, getting a better router or installing a signal booster to extend the range of the Wifi.
4. Choose a quiet room.
Selecting the right room is equally important to having a good internet connection. Choose a quiet space with a door that can close so you won’t be interrupted. If you have pets, put them in their kennels or a separate room for the duration of the call. Let your partners, roommates, and children know that you’ll be on a call and that they shouldn’t interrupt you. Make sure that the room is clean, double-check that the background behind you is plain and professional (a blank wall is fine) and confirm that you have good lighting so your provider will be able to see you clearly.
5. Log in early.
Don’t wait until the last minute to log into the platform in case you have any unforeseen technical difficulties. Five to 10 minutes before your appointment is supposed to start, get set up in your room and go ahead and log in. There may be a virtual waiting room where you can chill. If not, you can just sit on the platform. Try not to get distracted by social media or other websites. You don’t want to miss the start of your appointment! If you have any medical devices your provider will need to look at, set those out on the table so you can easily access them during the appointment.
6. Volunteer to offer feedback.
Many health care providers have only recently installed telehealth platforms, and may still be working out the kinks. You may receive a survey after your appointment asking you how the telehealth visit went. If you’d like to help your providers improve the platforms, be sure to fill that out and let them know how it went from the patient side. If they aren’t sending out a survey, you can suggest the idea to them, or offer to provide more informal feedback via email or another way. After all, the whole point of health care is to improve patient outcomes–so as the patient, your opinion matters.
7. Know when you need an in-person visit.
Telehealth is a great technology, and it offers many advantages over in-person visits. However, sometimes you simply need to see a medical professional in person. An emergency is an emergency, so if you have sudden chest pain, weakness on one side of the face or body, or sudden difficulty breathing, you need to go to the emergency room or call 911 immediately. Your doctor may also prescribe some in-person visits, such as bloodwork and other tests, that cannot be conducted virtually. Use common sense and schedule an appointment in the office when it can’t be taken care of virtually.
A nurse can’t listen to your lungs with their stethoscope via a telehealth visit, but there are many positive aspects of virtual appointments. Telehealth keeps both providers and patients safe from a contagion, and increases access to care for patients who have trouble leaving the house for one reason or another. If you’re new to telehealth, or just looking to have a good experience during your next appointment, follow the seven tips outlined here. Your provider will appreciate all the prep work that you did and you’ll be way more likely to have a positive telehealth appointment.
Health policies change rapidly at the national, state, and community level and are especially critical during times of international health crises. Nurses are positioned on the front lines of both health care delivery and health policy development. In particular, advanced practice registered nurses (APRNs) have a unique perspective that allows them to offer meaningful input at many levels. Nurse practitioners play a significant role in shaping health policies, including:
- Health care access
- Health care equality
- Health care legislation
- Nursing scope of practice
- Community-wide disease response
Nurses are an essential part of informing health policies, educating the public, and applying health policies in practice.
National Health Policy
Strong nurse leaders represent their communities and patients across the nation. Nurse practitioners who engage in health policy development at the national level may work with other health professionals to adopt or change guidelines put forth by the Centers for Disease Control and Prevention (CDC), Food & Drug Administration (FDA), Center for Medicaid and Medicare Services (CMS), and the U.S. Health Resources and Services Administration (HRSA). These policies guide decisions for the creation of public health guidelines that affect the entire nation. With their background in direct patient care, nurse practitioners offer a wealth of knowledge and clinical insight to help inform the development of new health policies and improve existing policies. Health care issues that are addressed at the national level include:
- Access to care
- Quality of care
- Cost of care
- Public health crises
- Legislative decisions
National nursing organizations such as the American Academy of Nurse Practitioners (AANP) and the American Nurses Association (ANA) lobby extensively for policy change and advocacy for all nurses at the national level. As strong advocates for the entire profession, nurse practitioners demonstrate an understanding of the necessary details to create health policies that help, rather than hinder, nurses working in direct patient care. With this first-hand experience in patient care, nurse practitioners serve as invaluable advisors for educators, policy makers, and lobbyists. Nurses can help create legislation that affects both national and state-level laws regarding nursing practice, patient safety, and access to health care. Nurses are also able to review proposed health care legislation to help determine changes that promote best practices.
State Health Policy
Changes in global health policies impact health care delivery at the state level. For example, state-specific guidelines regarding telehealth practices were implemented to help maintain access to health care during COVID-19. This required rapid action by policy-makers—including nurses. As officers in state nursing organizations, nurse practitioners can directly influence policies that relate to both scope of practice and education standards. By understanding the training and education involved in the profession, policies that aim to allow nurses to use the full extent of their training are essential. Nurse practitioners can express with certainty which policies will affect nurses, other health care providers, and the general population.
Local Health Policy
Through direct observations in their own communities, nurse practitioners have a unique advantage in recommending guidelines for community-wide, school, and even environmental health issues. Nurse practitioners can also be involved in advisory boards for city and county planning regarding water conservation, hazardous waste disposal, and ongoing public safety concerns. Policies that affect the natural environment directly influence the health of residents, and nurses can play a key role in advocating for the public and keeping the community safe.
Facility Health Policy
Health policy also impacts the operation of hospitals, outpatient health centers, long-term care facilities, and schools in communities nationwide. Health policy nurses bring their expertise to understand the challenges and risks facing the public and health care workforce. Once the challenges are identified, nurses can offer meaningful solutions based on clinical insight from direct interaction with patients. Additionally, nurses can influence facility policies such as patient care standards, the use of electronic medical records, and guidelines regarding specific populations.
Research in Health Policy
Master’s degree or doctorate-prepared nurses play a crucial role in both qualitative and quantitative health research. This includes working directly with medical, pharmaceutical, and environmental agencies to identify and understand gaps in health care knowledge. This may include gaps in health care delivery, a lack of current guidelines for specific health concerns, or the ways that environmental toxins affect population health. Nurse-led research involves real-world problems that affect individuals in their own practices. Quality research results are critical to passing health care legislation, improving patient care, and advancing the nursing practice.
Nurse practitioners take direct clinical experience to the local, state, and national level to identify key challenges, inform decisions, and solve health care-related issues. In order to influence health policies and guide communities through times of crisis, it’s important for nurses to offer their unique skills in understanding and caring for patients. A strong presence of nurses in legislative review and health policy planning is critical to promote change and ongoing improvements in health care across communities.
One of the most appealing aspects of the nursing profession is the wide choice nurses have when deciding on a specialty. Depending on personal interest or experience, educational goals, or opportunities, nurses have the ability to work in virtually every location and with every population.
Nurses who choose the forensic nursing specialty are driven to offer medical and emotional care while also helping law enforcement. Forensic nurses specialize in treating patients who have suffered injury and trauma due to intentional violence or neglect.
According to the International Association of Forensic Nurses, forensic nurses treat those who are in physical and emotional pain and who are traumatized by what happened to them. Patients they see may have suffered domestic violence, sexual assault, or have been victims of random violence or a catastrophic event. They might have experienced severe neglect leading to health problems and emotional pain. Some nurses work with the perpetrators of violence and work with criminal offenders in a psychiatric forensic nurse specialty.
Because of the criminal nature of the injuries inflicted, law enforcement officials are often involved in these cases. Patients in the care of forensic nurses need compassionate and careful medical attention, and they are often asked to work with law enforcement to bring justice. Even if they want to provide details and tell their side of the story, doing so can trigger new trauma for patients.
Forensic nurses work with their patients to help them heal and recover, but they do so with a careful approach that never loses sight of the patient’s experience. While nurses provide care, they are also collecting evidence that can be used to help bring those who abused or harmed the victim to justice. Forensic nurses are often called upon to provide testimony about the care they gave, the injuries they saw and recorded and other details that may help investigating law enforcement and a legal team.
If this specialty is something that appeals to you, becoming a registered nurse is your first step. Many forensic nurses go on to earn nurse practitioner credentials and certification as well. And as a forensic nurse, there are many opportunities for you to continue to advance your education so you can help your patients most effectively. Since 1976, the Sexual Assault Nurse Examiner (SANE) nursing program has helped victims of sexual assault by offering compassionate healthcare while also collecting essential evidence. States implement their own programs, like this SANE program in Massachusetts and this SANE certification program in Texas.
Although no nursing specialty is easy or free from seeing trauma, a forensic nurse’s role sees significant trauma on a daily basis. To continue to offer the best nursing care possible, forensic nurses should be particularly mindful of their own mental health so they are able to cope with the impacts of violence and neglect they see every day.
Forensic nurses serve a vulnerable population that depends on the life-changing care they provide. If you’re motivated to help patients and have a commitment to justice, this is a good career path to explore.
The caps are tossed in the air, there are no more discussion boards due, and you have submitted and closed out your Capstone or Project. Time to get to work! However, you quickly learn there is much to do and consider. The ink has barely dried on your degree and your head is in a tailspin looking at career opportunities, salary offers, malpractice insurance, and everything in between. Before you get yourself in a tizzy, check out some tips from other NPs to help you navigate your first year as a new Nurse Practitioner.
1. Don’t just take a job for the high salary.
Although it may be tempting with the student loans or financial implications that incur from graduate school, the highest paying job offer may not be the best option. Definitely know your worth and what you bring to the prospective company, but you should keep in mind that NPs often have other financial obligations that can quickly eat into that large salary. For example, credentialing can be a couple thousand dollars alone. Several of my colleagues have said that continuing education stipends are very important factors in the salary package. Some employers do not pay any continuing education money, while others pay several thousands. As an NP, you are required to have CME for your credentialing body as well as for your nursing license. Also, think about the payor source for your service. “The Centers for Medicare & Medicaid Services (CMS) is the single largest payer for health care in the United States. Nearly 90 million Americans rely on health care benefits through Medicare, Medicaid, and the State Children’s Health Insurance Program (SCHIP).” Unless your practice is private insurance only, chances are, your organization will need you to be credentialed through CMS. The cost for Credentialing through CMS is just over $500. The details on job offers are just as important as the bottom line salary. Consider the cost of health / malpractice insurance, retirement, and student loans if you have them.
2. Become active in your professional organizations.
There are state and national organizations for nearly every specialty of NP. It is important to get involved and be in the know. These organizations allow NPs to continue to grow professionally and stay current on changes in the profession. I make it a point to attend at least one nursing related conference every year if possible. The world of health care is rapidly evolving due to the COVID-19 pandemic, legislature regarding full practice authority, and marijuana legalization. You would be amazed at the many facets of diversity these organizations offer. Seek out Nurse/Nurse Practitioner organizations here. Network often and purposefully. I often reach out to NP colleagues if I run across an area in their wheel house. There is much accuracy to the statement “two heads are better than one.” I have met some very knowledgeable and diverse friends at local conferences that I have stayed connected with.
3. There is the Good with the Not so Good.
Every job has its pros and cons. When researching for a position, be sure to ask pertinent questions. So often in interviews for provider roles we ask the same generic questions: “What is my expected patient load in a day?” Or “Do I take call or cover weekends?” Perhaps, we should add to those questions, “Is this position based on Relative Value Units (RVUs) or salary?” RVU-based positions may be beneficial for high need specialty areas, like psychiatry or pediatrics as the compensation is based exclusively on productivity, with no regard to a guaranteed base salary. Large corporations tend to lean more toward salary based NP jobs that offer income stability but may cap earning potential. More about RVUs is located here. Also, be sure the company you are working for understands your scope of practice as an NP. I have had peers inform me that some organizations did not fully understand the scope of the NP. This is a conversation to have during the interview. It is also important to familiarize yourself with your state’s Board of Nursing guidelines for practice.
4. Time is valuable.
Administration time is a valuable commodity. Working as an NP is more than just patient visits. The NP has to follow up on phone or electronic medical record messages, laboratory, and imaging results. Administration duties that go beyond the exam room are common. When establishing a work schedule or even in the interview process, the NP should be sure to ask about this space which is more commonly referred to as “Admin time.” For example, say you saw 18 patients on Friday and ordered labs. On Monday, these results return and some require you to schedule follow up, or even referrals. If you are scheduled to be right back in the clinic to see 18 more patients, you may not have the chance to perform these duties. Admin time also helps if you have other projects like research or practice improvement in your responsibilities. Consider business/practice meetings and education in-services that are required for the NP to attend when thinking about admin time. Some practices have this time built into schedules while others expect clinicians to work it into their day. It is important to have a clear definition of how and if you want to incorporate admin time into your schedule before you start your role.
5. Work-life balance is more valuable than gold.
With all the duties and responsibilities of being a health care provider at any practice, remember to keep yourself healthy. If a schedule or workload interrupts the time you have with the people you care about most or for self care, then it is not healthy. Many organizations have begun incorporating mindful moments into the workplace as an avenue to prevent burnout. I once had a position where I worked 7am to 6pm Monday through Friday and worked on my laptop or on call until bedtime every night as well as most weekends. This job interrupted precious time with my family, time for myself, and I quickly resented it and resigned after just one year. Whatever that balance is for you, it is important that you maintain it and allow yourself to be at the most optimal state. We can better care for our patients when we are at a healthy state, which includes being rested, not stressed, and physically healthy. Commit to making yourself (your most important patient) a priority by preventing burnout. Here are a few tips located here.
With these tips, you can set yourself up for a happy career where you focus on taking care of people, including yourself. Hopefully, the new and exciting profession you have just spent the last however many years working to enter is all that you dreamed it will be. There are so many aspects of being an NP that make it a satisfying and rewarding profession. Congratulations on becoming an NP! Now, go bring something to the profession to make it better because you are in it.
Perioperative nurses are an essential part of any surgical team. This week’s Perioperative Nurses Week spreads awareness of this career path while also educating the public about this vital operating room role.
Nurses in this role fill a pre-op and post-op need while also remaining with the patient during a procedure. According to the Association of periOperative Registered Nurses (AORN), they are the eyes and ears for the patient while a procedure is going on, but they are also helping prepare the patients emotionally and physically beforehand and helping them during the immediate recovery. They impart a sense of calm and caring while using precise nursing skills to constantly assess what’s happening with the patient.
In this role, nurses simultaneously gather vital patient health information, communicate effectively with the patient and the patient’s loved ones, and continually monitor the patient during all stages of pre-to-post op for a smooth and safe surgery. Periop nurses may do many tasks at once, but their focus on the patient must remain absolutely unwavering.
Because they are charged with monitoring the patient as they are going though surgery, periop nurses have to have a keen ability to know when something has changed. They remain alert for fluctuations in heart rate or blood pressure that will appear on the monitors. But they also must watch the patient to notice any signs of distress or change that monitors may not pick up like a subtle change in the patient’s breathing pattern or skin tone or muscle activity.
Periop nurses are the advocate for the patient at a time when they are most vulnerable and unable to advocate for themselves. An acute sense of perception and a dedication to patient care and advocacy are hallmarks of nurses in this role. Nurses who are with patients throughout a surgical procedure must also have excellent critical thinking skills and have the confidence in their professional skills to act immediately and not second guess what they are noticing.
If you’re a nursing student and thinking of this as a career, you’ll need varied hands-on nursing experience so you can develop your skills. Taking swift, decisive, and accurate action is part of the job and something the medical team and the patient depend on. If you think this career path matches your goals, you can begin building your nursing skills with this as a focus.
Aside from exacting medical skills, periop nurses also have a special ability to connect with people so they are able to help them through any anxiety about what’s happening. They have an innate sense topics that people want to talk about and that will help both soothe their nerves while also giving valuable information about who they are and what their lives are like.
This might seem like chit-chat, but it helps the nurse in a couple of ways. The answers to questions can give the nurse a few things to talk about as the patient is coming out of anesthesia and needs something familiar to grasp in conversation. A patient who told a story about a spouse or a pet will likely be happy to do that again in post-op.
Answers to other questions might also offer insight for the nurse as treatment plans are being figured out. Maybe a patient is concerned about getting medication or doesn’t understand some previous instructions. Periop nurses know how to get important information from patients that will help them recover faster and improve their outcomes.
Periop nurses have a valuable skill set that balances professional excellence with unsurpassed interpersonal communication. If you have periop nurses on your team, celebrate all they do this week. And if you’re a periop nurse, notice how your hard work makes a patient feel more relaxed while you know you are offering excellent care.