Critical Care Transport Nurses Day is celebrated annually on February 18 and recognizes the varied and fast-paced world of this branch of nursing.
Sponsored by the Air & Surface Transport Nurses Association (ASTNA), Critical Care Transport Nurses Day showcases the distinct field of transport nurses. While any nurse is always in motion, critical care transport nurses are actually doing their job while the patient is being transported.
Giving accurate, empathetic, and multilayered care while potentially in a moving vehicle like an ambulance or in flight on an airplane or helicopter offers an entirely new set of standards. Critical care transport nurses work in environments that are rarely the same and are constantly changing. Supplies might be different or arranged in a different order. Teams are likely varied and have to adapt to each other and to the motion of the transport they are in.
Some care is given in dire conditions. Transporting a seriously ill patient to receive initial care after an accident, bodily injury, or a health event like a heart attack or stroke is filled with pressure. Critical care transport nurses can work in the military moving gravely injured soldiers. They might be called to help deliver a baby who couldn’t wait for the arrival at a birth facility or hospital.
Still other critical care transport nurses attend to patients when they are stable, but being moved between facilities for additional testing or to receive therapies.
Critical care transport nurses are there to make sure every second of available time is used to help the patient. In the time it takes to move a patient from one area to a hospital or facility, life-or-death changes occur.
No matter the environment, critical care transport nurses have to work well on a team and be confident and experienced enough to make accurate split-second decisions about providing the best care. That means they need to assess physical and vital signs, equipment readings, and listen to the team all at the same time.
As a critical care transport nurse, critical thinking skills are essential. You’ll work in high-pressure emergency situations more than you will work with stable patients. Having emergency care experience before deciding on this career path is essential. Once you have decided and have earned any required hours, becoming certified will help you remain current with the latest protocol and evidence-based practices. In general, nurses in this field will become either a certified transport registered nurse or a certified flight registered nurse.
This career is exciting and requires a broad skill set and someone who works well under this type of pressure. If this sounds like a good career match for you, jobs in this area are growing.
A recent Trends in Retirement Security by Race/Ethnicity study by the Center for Retirement Research at Boston College showed what many minorities already know: as a group, minorities are less prepared for retirement security.
The report studied how different groups have fared financially since the recession of 2008. The study examined the wealth holdings and the medial household earnings of white, black, and Hispanic households. It revealed that while all groups saw their funds decline significantly, white households have rebounded better than black or Hispanic households, with Hispanics faring the worst.
According to the study, in 2007, white households held a median net wealth of $183,100 with median household earnings of $63,900. Black households held $39,00 in median net wealth with $39,100 in earnings. Hispanic households held $59,300 with income of $44,000.
By 2016, white households had $132,100 of net wealth with $67,200 in median earnings. Black households had $18,300 in net wealth and $37,000 in median earnings. Hispanic households held $24,400 in net wealth and median earnings of $38,000.
The significant drops in both total net wealth and median household earnings means minority families have less money to pay for everyday costs and little if any income left to save for retirement. And although the study did mention that at the moment Social Security will up the replacement rates for low earners, that’s little comfort for families who aren’t able to save for their futures right now.
The study estimates that half of all households in the United States are at risk for being prepared for retirement, the figures are different for each group. About 48 percent of whites, 54 percent of blacks, and 61 percent of Hispanics are at risk of not having enough to fund their retirement years. And if you are a caregiver to someone and a nurse, you have a distinct challenge.
What does that mean for retirement security and making good financial decisions? Saving any money at all is better than saving nothing. Taking a hard look at where your money goes now is a good first step. Then set a goal. If you want to save $50 a month, you’ll either need to reduce your spending or make more money. That could mean eliminating some things like buying take-out food or drinks. Coffees, sodas, and iced teas are rarely worth the price away from home. Packing meals and snacks to bring to work or to tide you over for a long day of clinicals and classes also makes a difference. Examine your cable bill, your phone costs, your entertainment expenses, and clothing expenses. Keep only what is absolutely necessary.
If there’s little space to reduce your expenses, think of ways to bring in a little more income and put it aside for retirement. Whether it is selling clothes online, tutoring nursing students, or taking a short-term consulting job, extra income can make a big dent in retirement goals.
Whatever you do, don’t sell yourself short. You are saving for your own future, and that alone is worth making it a priority.
Did you greet 2019 with so much enthusiasm that you set big, audacious New Year’s goals? Maybe you thought: A fresh year to grow (and glow) personally, an exciting new beginning, with endless opportunity to slay professional goals!
So, what happened to those goals?
If you’re anything like most of us, they were ditched (long-forgotten, even) way before Valentine’s Day rolled around. That feeling of inspiration that struck on January 1st, which is symbolic of unlimited potential, turned into discouragement, apathy, and dismay.
So, what can you do now if you still really want to do and be your best self this year? You can still look forward to making the most of the coming months, even if that means starting over again with resolutions and goal setting.
In fact, you may have seen the meme taking over social streams that says: “I’ve decided 2019 doesn’t start until February 1st. January was just a free trial.”
Consider mid-February your chance for a do-over. Only this time, go with something other than the traditional goal-setting systems, which may work for productivity gurus, but don’t for the majority of us regular folks.
One offbeat method you may want to try that is to choose one word for the coming year, to represent what you want versus listing specific actions or results. That single word will guide you and help you focus, so you live more intentionally day to day, month to month.
Here’s how to choose your word for the year.
First, brainstorm a long list of words that feel meaningful to you and “hang out” with them for a while. You’ll find that some relate more closely to goals you’ve had in the back of your mind for a while. They may even suggest some action steps that you can do in the coming months that will bring you closer to your dreams. Soon, one will present itself as the clear winner.
Some examples of word of the year, culled from recent conversations about this “right-brained” goal setting method: Positivity, Intention, Simplify, Pause, Restore, Build, and Believe. Other popular choices that show up year after year include: Balance, Focus, Organize, Grow, Gratitude, Grace, and Finish.
Okay, now that you’ve picked a word for the year, write it down wherever you will refer to it often during the day. A good place to add it is on the front of your paper planner (or write it out in fancy lettering, with doodles even, at the top of every page, to really drive the message home). Type it up, print out, and slap it up on the wall above your desk, or on the fridge, or your bathroom mirror. Use it as part of your login password, like L1Ve_L0Ve<3, so that you’re reminded of your focus word everyday.
You’ll be amazed at how your subconscious mind gets to work, suggesting actions to further your intention. For example, say you chose the word “Build” as your focus word for 2019. You’d like to build community, build connections, and build trust. You find yourself inspired to join a local nursing organization and regularly attend their meetings. At the end of the year, you might be surprised at how you have indeed built strong, trusting relationships. And that it happened without setting specific, quantifiable, time-sensitive, or sensible goals.
The 57-year-old woman is standing in the hall outside of the exam room. She is agitated. “I’m waiting for the doctor. I’m freezing! My back is killing me!” I note she is pale, unable to stand still, and has a sheen of perspiration on her forehead. She is in withdrawal. I get her a blanket and ask her to wait in her room. The pain clinic nurse is downstairs at the pharmacy getting the patient’s prescription for Suboxone for induction. Induction is the process of starting the patient on medication and finetuning the dose.
An hour later the patient is back in the hall calling me, “Thanks for the blanket!” She is smiling. Her color is back. She is clear eyed, calm, and collected. What happened? Suboxone. Suboxone is a combination of buprenorphine and naloxone that is used to treat opioid addiction. Buprenorphine is a partial agonist of the μ-opioid receptor with a high affinity and low rate of dissociation from the receptor. In English, the buprenorphine molecule sticks to the opioid receptor in the brain, but only partially activates it. Then it stays there for a long time, blocking it from opioids, before dissociating. What this means for the addict is that they get enough opioid receptor activation that they don’t get sick from withdrawal. They can function normally with less of the problematic effects of a full agonist like morphine or heroine.
The addition of naloxone, a full opioid antagonist (blocker), keeps the Suboxone pills from being crushed and injected. Though naloxone has a strong effect when given parenterally (by injection), its effect when given by mouth is negligible because it is poorly absorbed sublingually. Suboxone disintegrating tablets are given under the tongue.
So, what is this wonder drug all about? In 2000, federal legislation (Drug Addiction Treatment Act of 2000) made office-based treatment of narcotic addiction with schedule III-V drugs legal. Until then, the only option for addicts was abstinence-based treatment or methadone clinics. The ever-increasing rates of drug overdose deaths in the United States showed this was not working. At first, only MDs specially approved by the Department of Health and Human Services could prescribe medications to treat addiction. In 2016, President Obama signed the Comprehensive Addiction and Recovery Act allowing nurse practitioners and physicians assistants to prescribe schedule III-V drugs for the treatment of addiction. Previously, they could prescribe these medications to treat pain but not to treat addiction.
What does this mean for the addict? For starters, Suboxone and similar drugs are now more widely available. Until recently, the only way for a heroin addict to keep from getting withdrawal sickness was to use more heroine. These patients were considered toxic to regular doctors because their disease lead to ever-increasing doses, seeking medications from multiple providers, decreasing levels of health, and ultimately death. Now that there is an option other than going cold turkey, the addict without some kind of pain diagnosis can get access to health care whereas before they would avoid it because of the stigma of being an addict. Because Suboxone is a partial agonist with high affinity to the μ-opioid receptor, it decreases the ‘high’ if the patient continues to use narcotics causing the patient to lose interest. It offers the benefit of allowing the addict to function in life, decreases the likelihood of death from respiratory depression, and increases the quality of life because there is no need for the addict to ride the wheel of withdrawal—drug seeking, using, running out, and then seeking again to the exclusion of every joy of life.
What happens when a person starts buprenorphine? After a largish battery of tests, the prospective recovering addict will be asked to abstain from narcotics before induction to Suboxone. How long before the first dose the addict has to abstain depends on the person’s addiction. Longer acting drugs like methadone could be 24 hours. Shorter acting drugs like morphine could be as little as six hours. The person should be in the early stages of withdrawal. The reason for this is the “partial” part of partial agonist. The buprenorphine molecule will muscle other narcotics off the receptor site where it was fully activating the receptor. Now, the higher affinity buprenorphine is sitting there doing half the work that the heroine was doing and this leads to symptoms of withdrawal. Giving a person a drug that puts them immediately into withdrawal will turn them off to it completely. You won’t see that person again. Higher success rates are tied with higher levels of symptoms of withdrawal before induction. Now instead of precipitated withdrawal, the person has relief from symptoms of withdrawal even if they are not getting high.
A person who has been successfully inducted to Suboxone therapy will find almost immediate relief. The terrible body aches, muscle pain, abdominal pain, depression, diarrhea, and cravings evaporate. Our patient might just have found a new way to live, free from the constant need to find more narcotics. She can focus on her life instead of her disease. Most of the clinic patients have jobs. They want desperately to be productive members of society for themselves and for their families. Buprenorphine therapy coupled with lifestyle interventions provided by mental health professionals, self-help groups like Narcotics Anonymous, and patient-initiated interventions (like taking a class or going back to school) are part of the success story of a growing number of recovering addicts.
What’s it like to come off Suboxone? Eh, probably a lot like getting off heroine. Same withdrawal profile or pretty close. Patients wanting to get off all narcotics, including Suboxone, can be weaned off gradually depending on their desired treatment goals. Someone facing a jail sentence or travel overseas that needs to detox from opioids quickly may be on a tapered dose of Suboxone for just a few days or weeks. Other people may decide that the burden of staying on Suboxone is worth not having to go through withdrawal and choose to stay on a maintenance dose for the rest of their life. The addiction specialist will help guide the patient through the decision process. Many patients decide to stay on the medication as a hedge against relapse since buprenorphine has a higher affinity for opioid receptors than street drugs. This coupled with the very slow rate of dissociation means that a person would have to stop the buprenorphine well in advance of restarting heroine or other opioid in order to get high.
What does this mean for health care? For one, at least some addicts who eschewed health care in the past can now get treatment for this disease. At some point, most addicts will desire to get off narcotics. Having a real treatment option available instead of a far-away methadone clinic or withdrawal will work to drive these patients into recovery. Another thing is that it’s possible that some of the stigma of addiction will be lifted, at least slowly, as treatment becomes available and success stories become commonplace. As the DEA and FDA work to get a handle on the 70,000 overdose deaths per year by educating doctors and enforcing distribution laws, these drugs will become harder to get. During the 12 months prior to July 2017, overdose deaths fell in 14 states for the first time during the opioid epidemic, according to the Centers for Disease Control and Prevention. In the rest of the nation, at least the numbers have leveled off. Greater access to Narcan (brand name of naloxone, one of the drugs in Suboxone), and more treatment options for addicts will hopefully drive these numbers lower over time. It’s not time to celebrate, but at least there is a glimmer of hope. The priority is to keep addicts alive until they can (or they are ready to) get treatment for their disease.
Certified Registered Nurse Anesthetists (CRNAs) provide important anesthesia care for many different types of surgeries and services. However, as they gain more and more autonomy, their risk for facing malpractice lawsuits increases as well.
“CRNAs practice with a high degree of autonomy, and they play a critical role in patient outcomes,” says Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO). “This also makes them more vulnerable to a malpractice lawsuit if anything goes wrong.”
According to Reiner, although most states still require that CRNAs work under physicians’ supervision, some states—and the number is growing—are allowing them to practice independently. The good news is that, as Reiner says, CRNAs have been able to provide a lot more anesthesia care in more rural areas of the U.S. that otherwise wouldn’t be able to—such as including obstetric, surgical, and trauma services. “CRNAs are also trained and qualified to treat pain patients. With the ongoing opioid epidemic in the U.S., and with millions of patients still suffering from chronic pain at the same time, the services CRNAs provide are essential to promoting safe and effective pain management,” explains Reiner.
As for the top risks that CRNAs face, Reiner says, “According to claim metrics from NSO’s underwriter, CNA, some of the top allegations made against CRNAs in malpractice lawsuits involve improper treatment or intervention during a procedure, medication errors, inadequacies in the anesthesia plan, and failure to monitor the patient’s condition. CRNAs encounter these liability risks on a daily basis, so it is important for them to identify and manage these risks to protect their career and livelihood while also improving outcomes for their patients.”
The NSO recently reviewed two case studies and then identified six ways that CRNAs can manage risks. They are as follows:
1. Maintain competencies (including experience, training, and skills).
Competencies should be consistent and up-to-date with the scope of authority granted by state law, the needs of the CRNA’s assigned patients, patient care unit, and equipment.
2. Obtain and document informed consent for any planned anesthetic intervention.
Patients or the patients’ legal guardian must be informed of the potential risks, benefits, and alternatives to the planned anesthetic intervention and surgical procedure(s). CRNAs should verify that informed consent was obtained by a qualified member of the patient’s health care team and documented in the patient’s health care record prior to any intervention.
3. Document pertinent anesthesia-related information in the patient’s record.
Review the patient’s clinical history, including relevant social and family history; evaluate the patient and determine if they are appropriate for anesthesia and the proper method of anesthesia. CRNAs should document this process, including their rationale, and any discussions with the patient.
4. Communicate in a timely and accurate manner initial and ongoing findings regarding the patient’s status and response to treatment.
It is essential for CRNAs to report changes in the patient’s condition, any new symptoms displayed by the patient, or any patient concerns to the practitioner in charge of the patient’s care in a timely manner. Document patient responses to treatment, whether positive or negative.
5. Provide and document the practitioner notification of changes.
In addition to communicating any change in the patient’s condition or symptoms, or any patient concerns, CRNAs also need to document the practitioner’s response and/or orders in the patient’s health care record.
6. Report any patient incident, injury, or adverse outcome.
CRNAs should report any patient incident, injury, or adverse outcome, and the subsequent treatment and patient response to their organization’s risk management or legal department. If CRNAs carry their own professional liability insurance, they should alert their insurance carrier to any potential claims, as timely reporting ensures that an incident, if it develops into a covered claim and is not excluded for other reasons, will be covered.
“Facing a malpractice suit can be stressful and overwhelming because it is a long, unpredictable, and costly process. One step I recommend for CRNAs to take is maintaining their own professional liability insurance to help protect their careers,” says Reiner.
The PeriAnesthesia Nurse Awareness Week is celebrated this year from February 4-10 and is a time when nurses in this specialty are recognized for the work they do. The week also allows an opportunity for education about the specialty and the type of care these nurses deliver.
The American Society of PeriAnesthesia Nurses (ASPAN) is an important resource for nurses who work in the perianesthesia realm and those who are considering this specialty. Many people know perianesthesia nurses as part of the essential surgical team, but they are also intricately involved in pain management procedures that involve anesthesia.
Perianesthesia nurses are present during all aspects of anesthesia care. They work with patients during pre- and post-operative care. They also monitor and advocate for patients during procedures. As a perianesthesia nurse, one must remain vigilant for any signs of difficulty in the patient, so nurses are constantly monitoring vital signs and breathing.
Because of the careful and meticulous preoperative care, these nurses also know how to monitor visually to make sure the patient is tolerating the procedure well. If there are any problems, nurses are there. When patients are recovering from a procedure, the nurse continues to monitor their recovery as the anesthesia wears off. They are a professional medical presence and a calming personal presence as well.
As with other specialties, certification is important for perianesthesia nurses as the challenges of medications, patient health, and procedure can make for a complex situation. All ages of patients undergo anesthesia, so nurses need to have training and experience with every age from newborns to the very elderly.
Conditions can make people more frail and the potential for an allergy or a bad reaction to anesthesia is always present. Remaining educated with the latest information and evidence-based practices is critical in this specialty.
As a perianesthesia nurse, time is especially important during patient interactions. They have a short window of time to assess a patient, put that person at ease, and find a common thread or conversation point that can be used during postop care. Often perianesthesia nurses will try to find an interesting detail about the patient and use that as a conversation point to help orient patients after procedures.
Some perianesthesia nurses work in pain management, helping patients and monitoring them closely as they receive different anesthesia, some of which is not entirely sedating, for pain. In this case, they act as advocates as patients manage the procedures and the effects of the anesthesia.
If you’re a perianesthesia nurse, celebrate all you do this week. If you have perianesthesia nurses on your team, give them recognition for the essential role they play in your organization and in patients’ lives.