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.