Very soon it will be Halloween, the start of a holiday season that researchers warn adds an average of eight pounds — if you’re not careful about sweets and snacks.
Nurses have a lot of practice saying “no” to treats at work – boxes of candy from grateful families to trays of pastries from coworkers. Temptations abound, but they become especially intense during the next two months of the year.
Of course, we love getting together with teammates to mark Halloween, Thanksgiving, Hanukkah, Kwanzaa, Christmas, Solstice, or the New Year. Plus, we’ll continue to toast other happy occasions: birthdays, anniversaries, weddings, graduations, and job promotions.
So what’s the problem? Some surveys show that nurses are more likely to be overweight than the general population. Could the reason be extreme workplace stress and long shift hours? Or maybe it’s because the nurse population is aging, which correlates to a higher BMI.
You may not be able to do anything about events at work or your own slowing metabolism. But you can control your own actions, which will help you keep on the nutritional straight and narrow.
Here are a few ideas that have worked for other nurses:
First try to become aware of any emotional basis for your cravings for sweets and treats. It’ll then be easier to make behavioral changes, which will go a long way toward keeping you at your healthiest weight.
Decide beforehand on your “food rules” for this season, and then don’t deviate from them. For instance, you may decide to bring low-calorie snacks to events so that you’re not so tempted by sugary, fatty, or salty offerings. A cup of cubed cantaloupe is sweet (only 7 grams of natural sugar), while cut vegetables with Greek yogurt dip and air-popped popcorn with chili spices are savory.
Devise a healthy-eating phrase to repeat silently to yourself when you’re most tempted. Here are a few mantras to try this Halloween, and if some prove helpful, to keep handy all year long.
- “My stress level is through the roof, but chocolate is not the solution.”
- “Sugar is not the best antidote for fatigue from 12-hour shifts.”
- “I can accept the good wishes, but resist the treats from families and staff.”
- “I deserve better than sugary goodies when I work a night shift.”
- “Sweets can not change my not-so-sweet feelings of anger at work.”
In addition, try to cut out sweets in other areas of your life, too. The American Heart Association says to limit added sugar to 6 teaspoons for women and 9 for men. That’s a tall order when you consider that the American average is 22 to 30 teaspoons a day.
You have to be a good detective because sugar hides where you least expect it, like in coffee drinks. Compare a Starbucks’ Grande Vanilla Latte vs. plain coffee with a packet of sugar. The difference is a whopping 32 grams of sugar!
Of course, plain black coffee would be best, but that would probably be too big a shock to the system for a coffee drinker with a sweet tooth.
It’s better to make small and sustainable changes, such as eating and not drinking your snacks and meals. Fruit smoothies, for instance, enjoy a “health halo” but can pack on the pounds because they’re high-calorie, high-sugar, and apparently innocuous.
Sometimes it doesn’t pay to fight the inevitable, like candy on Halloween, though you can sidestep some of the danger. So, don’t go hog wild but instead enjoy a fun-sized piece of candy (80 calories for most bars), and you won’t do too much damage.
It goes without saying, but don’t be the health saboteur who brings bags of candy to work. Your fellow nurses and other staff members won’t appreciate it.
At home, buy your least favorite candy for trick-or-treaters – and fewer bags than you think you’ll need to prevent leftovers. If you want to avoid temptation altogether, give out mini-toys or stickers instead of sugary treats. In a pinch, just reach into your wallet or piggy bank for some quarters and dimes. The youngest goblins appreciate even pennies!
It’s not easy to limit treats around Halloween, but remember, you’re taking good care of yourself, and setting a good example for your patients.
Earlier this fall, Vanderbilt University School of Nursing named Dr. Rolanda Johnson, PhD, MSN, RN as the new Assistant Dean for Diversity and Inclusion. Johnson, who is also the assistant dean for academics and associate professor of nursing, has replaced Assistant Professor Jana Lauderdale, who returned to her faculty role. Johnson is continuing to shape and foster VUSN’s environment of inclusivity. We spoke with Dr. Johnson to learn more about her experience and her goals for VUSN.
Dr. Rolanda Johnson
What has been your career path so far and how has it led you to your current role as assistant dean of diversity and inclusion?
My desire to work as a health care professional began when I was elementary age. As an 11th grader, I decided to attend nursing school. I completed my Bachelor of Science in Nursing degree at Tuskegee University in 1985. Those were very formative years of training and education when I gained a wide range of clinical experiences with diverse populations. After graduating from Tuskegee University, I worked in a community hospital in Montgomery, AL, at Fairview Medical Center where I was exposed to people who I now know had limited access to health care. At Fairview Medical Center, I witnessed a sense of family among employees who were dedicated to providing the highest level of quality care to all that were in need with genuine caring attitude. I later began employment at Jackson Hospital in Montgomery, AL, working in numerous roles including that of nurse educator and clinical nurse specialist. During this time, I obtained a Master of Science in Nursing from Troy State University located in Troy, AL. Working as a nurse educator, I developed a desire to have a greater impact on African American health. Shortly, thereafter I began doctoral studies at Vanderbilt University and later obtained a Doctorate of Philosophy in Nursing Science degree. I have worked in numerous roles of nursing including clinician, educator, researcher and administrator, which led to my current position.
How has your professional background influenced your passion for diversity and inclusion?
Throughout my education trajectory, I have always been keenly aware of the health disparities and inequities some groups of individuals face. I am employed in Nashville while residing and working with my husband in an extremely underserved rural county in Mississippi. The social determinates of health naturally impact the health status of many. Who you are, where you live and what you have, sadly, monumentally impacts the quality of care one receives and access to health. As an educator, I work with students across the spectrum who are often impacted by these factors either individually or through family and friends. For me, all of these experiences have translated to my desire to make a difference in the lives of those that are often overlooked and to help others see the integration of all facets that impact the lives of our students and their performance.
Where did your passion for diversity and inclusion in the nursing field begin?
My passion for diversity and inclusion began during my studies at Tuskegee University. Those were very formative years of training and education. The wide range of clinical experiences with populations across the socioeconomic spectrum and from rural Tuskegee, AL, to metropolitan Atlanta, GA, opened my eyes to the varying degrees of heath care and access for different groups of people. Naturally, at that time I could only assess health disparities from my early developmental lens but these experiences have proven to be instrumental in guiding my nursing career.
For the past 20 years, I have resided in Macon, MS, a low-income, rural community, and have been employed approximately 300 miles away in metropolitan Nashville, TN. This has afforded me the opportunity to observe health care delivery cycles and the degree of effectiveness across diverse populations including associated gaps and health disparities. This phenomenon has fueled my passion to educate advanced practice nurses who will be equipped to fill these gaps and better meet the health care needs of all populations. The key to have advanced practice nurses who can deliver quality culturally sensitive health care.
How do you define diversity and inclusion at Vanderbilt?
Within VUSN, our core belief is that all students, staff and faculty regardless of our differences should feel included and equitable. This is reflected in the VUSN diversity and inclusivity statement, which states at VUSN “we are intentional about and assume accountability for fostering advancement and respect for equity, diversity and inclusion for all students, faculty and staff.” The full statement can be found on the VUSN website.
What are you most excited about with your new position?
The most important part of my new role is the possibility of enhancing the culture climate within VUSN and creating a path for continued improvement for years to come. I am humbled to be a part of this endless journey. I hope to leave an indelible imprint of creating a difference in this area within VUSN.
What strategies do you feel will have the most positive impact on the Vanderbilt Nursing community?
The umbrella strategy is to transform the level of diversity and inclusion within VUSN by minimizing bias across our core areas of academics, faculty practice, research and informatics among faculty, staff and students. Additional strategies will be to improve the cultural climate of VUSN for all students, faculty and staff and to increase the diversity representation among faculty, staff and students.
What are the biggest challenges that you will face in your new role?
The biggest challenge is to keep the diversity and inclusion momentum moving forward within VUSN. Within any organization, change is often difficult and once that change has occurred, it is so easy to be complacent with past accomplishments. The test is to bask in accomplishments for the moment and then move forward to the next challenge and goal.
What diversity goals do you have for yourself and Vanderbilt’s School of Nursing?
My goal is to pursue a high level of excellence in health care by finding creative ways to deliver this level of care to underserved populations. From a diversity and inclusive view, I desire to minimize bias, improve the cultural climate and increase diversity representation in faculty, staff and students within VUSN.
What is a fun fact about you?
I am a college football fanatic.
Have you discovered that you have leadership potential, and are now interested in developing your leadership skills? A significant part of becoming a great leader is to motivate yourself to strengthen the skills that are needed to become an effective leader. An abundance of opportunities exists all around you, and it is up to you to reach out and explore what your options are. Listed below are a few recommendations on how you can begin to build your leadership skills and tap into your capabilities while you are in nursing school. These options are some of my personal favorites, because they were beneficial to me as I progressed during my undergraduate nursing program. The skills that I acquired from those experiences helped to shape my goals and overall career aspirations that I have set for my nursing career.
The National Student Nurses’ Association (NSNA)
One of the earliest commitments you can make to the nursing profession is during your undergraduate experience by joining the National Student Nurses’ Association (NSNA). This association is committed to the development of nursing students as they work towards their undergraduate nursing degree. A great way to develop as a leader using this platform is to become an active member. One way to do this is to become an engaged member in your school’s chapter of the NSNA. Develop the leader within you by serving in a specific role or becoming involved on a special projects committee. There is a range of leadership opportunities, such as serving as chapter president, vice-president, treasurer, secretary, or projects chairperson. There is also an opportunity to serve as a delegate or spokesperson at the annual NSNA convention.
Sigma Theta Tau International Honor Society of Nursing (STTI)
Sigma is committed to scholarship, leadership, and service efforts. High achieving nursing students are invited to become members based on their academic performance while in an undergraduate or graduate nursing program. Licensed nurses can join the society based on their demonstrated leadership efforts as a professional nurse.
It is imperative for nurse leaders to speak effectively. Nursing students and professional nurses oftentimes find themselves in a position where they need to present information. At some point during your education experience or while on the job, you will be expected to stand in front of a group of people to give a presentation. Just the thought of presenting in a classroom in front of peers, a boardroom in front of a group of nurse leaders, or to a large audience at a conference, is sometimes enough to spark a feeling of anxiety or even fear for some. It is during nursing school that you should begin to practice the art of speaking. Improving your communication skills will help to alleviate the anxiety and fear as you advance in your education and career. Toastmasters International is a reliable source that many successful people have deemed to be very effective. First, I recommend that you explore the national website to read about the features and benefits of the program. Next, find a local group close to you and make a guest visit. Third, commit to the program and take advantage of the special leadership development activities that they offer.
Omicron Delta Kappa
Do not be afraid to venture outside of nursing as you seek leadership opportunities. To give you an example, the National Leadership Honor Society (ODK) is an organization that is designed to support the leadership development of students. A national convention is held annually to expose members to further leadership and development opportunities. Check to see if your university is affiliated with this national leadership platform.
Campus-Wide Leadership Opportunities
Do not limit yourself. Another way to tap into your leadership potential is to explore campus-wide opportunities. Many universities have a campus life center that offers leadership and volunteer programs that will get you engaged on campus and within your surrounding community. Some creative examples include taking part in the student government association, or even committing to the Greek life by joining a sorority or fraternity. Participating in volunteer activities is a strategic way to build leadership skills. The great news is, if you cannot find anything that suits your talents and interests, many schools and universities will allow students to create a special interest group of their own.
So, there you have it. I have shared with you some of my best ideas that I believe will help you develop into the nurse leader that you aspire to be.
Mental illness is a growing epidemic in today’s modern society. Due to the prevailing societal stigma that exists for this vulnerable population, there is often a huge disparity and lack of empathy present in the care provided for individuals suffering from psychiatric disorders.
As a psychiatric-mental health nurse, I have worked closely with patients suffering from a wide gamut of psychosomatic disorders ranging from schizophrenia to bipolar disorder, and I have discovered that the art of empathy is often a necessity to ensure quality patient care is maintained at all times.
Last month, I was caring for a young girl suffering from major depressive disorder. Based on the report I received from the previous nurse, I discovered that the girl was noncompliant with all her medications as well her treatment at the hospital. When I first met the girl, she appeared extremely depressed and exhibited little to no motivation to participate in her plan of care. Upon closer inspection of her chart, I was surprised to discover that it was her birthday, so I decided to collaborate with my team members to see if we can possibly bring a cake for her to enjoy on her special day. When the cake arrived, I noticed that we did not have any candles so I decided to be creative and use a crayon instead, which worked perfectly since it was also made out of wax. When we went into her room, she was pleasantly surprised to see us standing there with a cake in our hands singing “happy birthday.” Witnessing her smile for the first time brought a tear to my eye because it illustrated to me the importance of treating all patients with the same dignity and respect regardless of their mental illness or diagnosis. After that encounter, I noticed a significant difference in her overall demeanor and we ultimately established a rapport that enabled her to take the medication and treatment she needed in order to regain her sense of well-being.
As a nurse, I have come to realize that patients do not solely rely on medications to get better, but rather on the bond and trust formed between themselves and their designated health care provider. As a result of this realization, I try to make a concerted effort every day to continue to develop not only creative approaches to my nursing care but also empathetic techniques that ensure patient safety and satisfaction is achieved across the patient gamut.
As the prevalence for individuals requiring inpatient psychiatric treatment and stabilization has increased over the years, more and more nurses are becoming curious as to what a psychiatric-mental health nurse actually does on a given shift.
Before I delve into the specifics as to what my roles and responsibilities are as a psychiatric-mental health nurse, I want to begin by providing you a brief background on my education, training, and reasoning behind choosing psychiatry as my specialization.
Prior to working as a psychiatric-mental health nurse, I received my BSN degree from West Coast University. As a nursing student, I was exposed to a wide gamut of psychiatric illnesses such as depression, anxiety, mood disorders, and schizophrenia, but I never truly understood the subtle complexities that psychiatric-mental health nurses endure behind the scenes.
After graduation, I worked briefly in the ER and ICU settings, which taught me invaluable lessons such as time management and prioritization, but it never fully gave me the satisfaction I was yearning for. It was at this moment that I decided to pursue a career in psychiatry in hopes of better understanding not only mental illness but also the psychological, emotional, and spiritual ailments that patients experience on a daily basis.
Because of the stigma associated with working in psychiatry, I am frequently asked what my typical day looks like working with this vulnerable population. And to put it plainly, working as a psychiatric-mental health nurse can be both extremely challenging yet rewarding.
Typically in psychiatry, most mental health hospitals utilize an 8-hour shift system, which is evenly divided to AM, PM, and NOC shifts. Since I currently attend graduate school full time, I work per diem NOC shift, which is from 11:30 PM – 08:00 AM.
11:00 PM – 11:30 PM: During this time, I look at the schedule to see where I am assigned and what my role will be for that day. Depending on the staffing situation, my role may vary as the charge nurse, staff nurse, preceptor, or a breaker.
Once I know where I am appointed to and what my role will be, I normally like to go to my assigned unit, perform medication count with the previous shift, and speak with the nurses as to how their shift went. I do this because it gives me an opportunity to “feel out” the unit and get a sense of what might be required depending on the type of patients we have and the acuity level of the hospital.
11:30 PM – 12:00 AM: Once I’ve performed my aforementioned tasks, my team and I receive report on each patient on the unit. In psychiatry, our reports are more heavily focused on “patient presentation,” which details the patient’s mood, affect, their medication compliance, comorbidities, and their behavior. Since most patients admitted to our hospital are either held involuntarily on a 5150 hold for Danger to Self, Danger to Others, or Gravely Disabled, it is essential for us to know how each patient is responding to treatment as well as their behavioral presentation.
In addition to this, the previous shift notifies us if there are any patients that require 1:1 observation (reserved for patients who are highly suicidal, combative, or medically compromised) as well as any potential “watchers” who can be unpredictable, violent, or dangerous. Providing this information is crucial because it not only makes us more mindful of any potential issues we may encounter during our shift but also hypervigilant in ensuring our unit remains safe and secure.
Lastly, the previous shift also provides us with a report on any incoming or pending admissions as well as any discharges that are expected to occur the following morning.
12:00 AM – 12:15 AM: Once report is completed, the charge nurse then assigns the nurses with their patient load as well as their assignments for that day. Once I receive my assignment, I normally like to check on my patients who are asleep and introduce myself to those who are awake. By doing this, it gives me an opportunity to not only meet my patients, but also form a rapport with them while discussing any concerns they may have.
12:15 AM – 04:00 AM: After checking up and introducing myself to my patients, the rest of my day ultimately depends on what needs immediate attention (pending admissions, patients requesting for PRN medications, medical or psychiatric emergencies, etc.).
If for example there is an incoming admission to be expected, I usually take this time to read more about the patient, why they are coming to the hospital, and organize their chart and paperwork for them to sign.
Although performing an admission can be a tedious process, inpatient psychiatric admissions are unique in that it depends on the patient, when they arrive, and how cooperative they are. If patients are uncooperative, admissions can be difficult and timely so efficiency is truly predicated on how organized the nurse is.
If there are no pending admissions, however, I usually take this time to chart on my patients, which involves filling out nursing flowsheets, writing or updating care plans, auditing charts, and reassessing behavioral statuses. In addition to this, the nurses and floor staff is required to round on their patients every 15 minutes to ensure that patients remain safe, secure, and free from any harm.
04:00 AM – 05:00 AM: During this time, I am on my break. Regardless of the demands of the day, I normally try to eat some food and utilize my break time as a way for me to recharge and revitalize before coming back on the unit.
05:00 AM – 07:00 AM: Once I arrive back on my assigned unit, I take this time to carefully go over and make any necessary revisions to my charting to ensure that it’s valid and free from error. I also check up with my patients to ask how they slept and to reassess their psychosomatic symptoms and behavior to determine if their individualized treatment is either effective or ineffective.
After speaking with my patients, I then take this time to administer any scheduled or PRN medications they may require. Depending on the type of medication the patient is taking, I typically like to ask my patient how they feel about the medication and if they notice any improvement in regards to their psychosis or behavior.
As a psychiatric nurse with five years of experience, I have learned that active listening is critical in psychiatry because it not only validates what the patient is saying, but also reaffirms their trust in you as their health care provider.
07:00 AM – 07:30 AM: At this time, we typically serve breakfast to our patients while providing grooming necessities for individuals who want to shower.
While breakfast is being served, I make an effort to make my rounds around the unit to ensure that the 15-minute rounds are being completed while checking on the patients who refuse to eat or are actively psychotic, hearing voices, or feeling anxious and choose to stay in their rooms. Depending on the patient’s presentation, I do my best to lend an empathetic ear while offering support and guidance in addition to offering PRN medications to help them in their current psychotic and behavioral state.
07:30 AM – 08:00 AM: Once breakfast is over and the patients’ needs are attended to, we give report to the incoming AM shift and discuss any significant behavioral changes or issues that we encountered during our shift. In addition to this, I make it a point to relay how my patients are feeling regarding their treatment and any concerns they may have on their medications.
Once I completed my report, I say my farewells and introduce my patients to the incoming AM nurse who will receive my caseload. This is to ensure that my patient is aware of the shift change and that continuity of care is promoted.
In a call for conversations and action between health care providers and their patients about travel health, the Centers for Disease Control and Prevention (CDC) has launched a new travel awareness campaign. The goals of this campaign are to help health care providers protect the health of and diagnose infectious diseases in international travelers.
US residents are traveling to destinations around the world where they can get sick from infections such as yellow fever, Zika, Lassa fever, dengue and travelers’ diarrhea. Resources tied to the “Think Travel” campaign will give primary or urgent care physicians, physician assistants, nurse practitioners, and pharmacists tools to help them keep their patients healthy during and after international travel. Here is how Think Travel can help you in your practice:
Think Travel Can Prevent Disease
While conducting a routine physical exam, your patient mentions an upcoming Amazon cruise through the Brazilian rainforest. You ask if she has scheduled a pre-travel consultation. During the pre-travel consultation, international travelers receive preventive guidance, vaccines (e.g., yellow fever), and medications for prophylaxis (e.g., malaria) or self-treatment (e.g., travelers’ diarrhea) recommended for their destination. She tells you she has not, but will as soon as she leaves. Thinking travel may have helped prevent any number of infections in this traveler.
Think Travel Can Save Lives
A patient presents to your emergency department with fever, chills, and myalgia. The resident on duty prescribes oseltamivir for suspected influenza. From the hall, you overhear the patient sharing with a Ghanaian nurse that his parents live in Ghana. You step in and ask about the last time he visited his family, and it turns out he returned from Ghana only recently. After additional tests, a blood smear reveals Plasmodium falciparum malaria. Thinking travel may have saved this patient’s life.
Think Travel Can Protect Communities
A mother brings her 6-year-old child to your clinic with fever, rash, and upper respiratory symptoms. You ask about travel history and learn that the family just got back from vacation in France, where there is currently a measles outbreak. Upon further questioning, the mother tells you that her child has not received an MMR (measles-mumps-rubella) vaccine. Thinking travel helped identify the exposure risk in your clinic and potentially prevented the spread of measles to other unvaccinated people.
Get Your Patients Travel-Ready
US-based travelers made nearly 90 million international trips in 2017, with only an estimated 14% seeking any sort of pre-travel advice. A pre-travel consultation is your opportunity to provide patients with the protection they need against travel-associated diseases: recommended vaccines, medications, and guidance about preventive behaviors (such as insect bite prevention and food safety). If you have patients planning international travel, make sure to provide pre-travel care with Think Travel support resources. If your clinic does not offer these services, help patients find a travel health clinic here: https://wwwnc.cdc.gov/travel/page/find-clinic.
CDC offers several resources to help you conduct pre-travel consultations, including:
- A Pre-Travel Guide: highlights major topics of discussion to support pre-travel consultations with patients traveling abroad.
- A Destination Finder Tool: provides destination-specific information on disease risk, CDC recommendations for vaccines and medications, and topics for patient counseling.
- A Pre-Travel Tool: offers step-by-step tool for clinicians conducting pre-travel assessments and generates customized recommendations for vaccines, medications, and counseling.
Always Ask About Recent Travel
People who live in the US are traveling internationally more now than ever before. Increasingly, they are traveling to areas where tropical infections, such as Zika, dengue, and Lassa fever, are a risk. Taking a travel history from an ill patient can help you expand your differential diagnosis to include etiologies that would be much less likely for patients who had not left the United States.
CDC posts travel health notices (https://wwwnc.cdc.gov/travel/notices) that identify international disease outbreaks or notify clinicians and travelers about diseases appearing in new or unexpected locations or outbreaks that exceed baseline disease-endemic case rates. Being aware of these notices can assist you, if you think to ask about recent international travel or include questions about recent travel as part of the patient intake.
In addition, CDC offers resources for clinicians evaluating recently returned travelers, including specific guidance for ill travelers with:
- Skin and soft tissue infections
One Conversation Is All It Takes
When providers have conversations with their patients about travel, they can help them have a safer, healthier time abroad. Thinking travel can also help clinicians arrive at solutions to diagnostic challenges. Thinking travel can help prevent disease, save lives, and protect communities. Go to www.cdc.gov/ThinkTravel to find CDC resources to help with pre-travel consultations and post-travel evaluations.