The Flip Side: How Nurses Can be Good Patients

The Flip Side: How Nurses Can be Good Patients

No matter how hard you try to avoid it, it happens. The nurse becomes the patient. Whether you’ve given birth, had surgery, or a horrible case of the flu, there are times in life when conditions will send you to the hospital. And being on the proverbial other side of the hospital bed, as Jenny Ang, MSN, ARNP, FNP-BC, an NP in Washington State, says. So how can nurses be good patients?

“When the caregiver suddenly becomes the one who needs care, it’s an extremely unsettling, vulnerable, and helpless feeling,” says Ang. “Nurse can be good patients by showing patience, kindness, and compassion to their caregivers, while trying not to micromanage their health care professionals.”

Over the years, Ang has cared for many doctors and nurses in the ICU for a number of diagnoses in critical situations. She says that, for the most part, these patients have been good ones. But it’s because they had their questions answered, were updated regularly on their care, and understood both the risks as well as the rationale behind what was being done for them. So what is a “not good patient” in Ang’s opinion? “Someone who requires an excessive, grossly unfair amount of time and resources from a nurse, compared to a patient in a similar circumstance,” she says. “I have had only one patient who was a nurse act this way, but countless other non-health care people behave like this.”

Ang says that as nurses, you tend to advocate for the best care for your patients. “When we become the patient, we tend to advocate for ourselves like a mama grizzly bear protecting her cubs.”

What can you do to be a good patient? Ang has some tips:

  • Remember that your professional judgement is clouded when the case is personal.
  • Remember that you’re in a vulnerable state.
  • Don’t lash out at your health care providers out of defensiveness.
  • Don’t micromanage your health care professionals. Remember they are pros, and have sworn the same oath to do no harm, just like you have.
  • You are a professional. Remember to act like one.

“It makes many nurses defensive when they are suddenly in the position of being the patient. Like in any other field of work, it is not wrong to question a health care professional, but how you ask your question is key. Don’t be accusatory,” recommends Ang. “It is most appropriate to maintain positive, clear communication with the health care professionals caring for you when they come to check on you in your hospital room. Nurse know how the system works.”

Take Care of Yourself—Find Balance

Take Care of Yourself—Find Balance

Well it has been a while since my last post, due to the “busyness” of life. Often times we let the things in our life take so much of our time, that we forget about taking care of ourselves. As nurses we are focused on taking care of others: our patients, our family, our friends, and sometimes even strangers. We have heard of the saying “Take care of yourself, so you can be there for others,” but how many of us actually practice this? This really hit home after hearing about the unexpected death of two colleagues over the past month. They both devoted so much time to their job and neglected to relax and take care of themselves.

St. Thomas, VI

Credit: Leslie McRae-Matthews

We have our plates so full with other people’s issues, cares, and needs, yet there is no room on the plate for us. There has to be a balance between work and relaxation. This is not new information for us—we just need to apply it to our lives. Many of us advise our patients about taking time to relax, meditating, and thinking about things they enjoy to decrease stress. These are some of the same principles that we can use.

When you start noticing that you are feeling anxious, moody, or depressed, these are signs that it is time to step back to refocus, recover, and renew. Many people relax by traveling, but you do not have to spend a lot of money to relax. Engage in simple activities, such as drawing, photography, taking a walk to enjoy nature, riding on a swing, or going for a swim. These activities are not an escape from reality or stepping into a “fantasy world,” but they will help you take your mind off of work or other issues, so that you can refocus. Take care of yourself and find that balance.

Time to Get Serious About Health Care Social Work

Time to Get Serious About Health Care Social Work

When patients seek care because they are struggling with health challenges, they encounter a complex system that’s often difficult to navigate. How will they access, pay for, and continue care in the face of insurance approvals, financial challenges, and the everyday pressures of life? And for those patients who are also facing socioeconomic challenges, these difficulties are compounded by additional serious health issues including disproportionate levels of diabetes, heart disease, obesity, untreated mental health problems, and maternal health complications. As a health care system, it’s time to redouble our efforts to fight health care disparities, and social workers need to play a more critical role. We need more social workers on the front lines to address these disparities and help make the health care system work better for all people.

Despite the profession’s long-standing commitment to clients’ health and wellness, social workers remain an often discounted component of health care teams. However, social workers play an indispensable role in helping patients navigate insurance, in-home care, community resources, economic assistance, and mental health services at the conclusion of a hospitalization. One misconception is that the role of counselor, coordinator, and advocate is needed only as an acute medical intervention draws to an end, when the reality is that a social worker can be beneficial throughout a patient’s entire medical journey.

First and foremost, social workers are trusted guides in a complex health care system that can’t always meet patients where they are. Social workers can advise on important decisions, improve communication between provider and patient, and dig more deeply to identify root causes and concerns a physician may not have time to unearth. Patients can turn to social workers with questions and concerns they may be too intimidated to discuss with their health care provider. With the time to more closely work with patients, social workers can increase compliance with care instructions, ensure proper follow-ups, and ultimately improve patient health outcomes.

Social workers can also be patients’ best advocates in a care setting, making sure their voices are heard and their needs are fully met. This is especially true when it comes to counteracting bias in the provision of care. For example, studies have shown that African American patients’ pain is often undertreated relative to that of Caucasian patients. Faced with these challenges, social workers in a care setting can help resolve communication issues, encourage patients to persist in making their needs known, and provide insights into how best to pursue proper care when a pathway doesn’t always seem open. By working to confront bias, social workers can even help correct damaging assumptions that can lower the quality of care received.

Social work is a calling, and we need more practitioners to meet the increasing demands placed on the health care system, including those caused by the opioid crisis and aging Baby Boomers. The Bureau of Labor Statistics has predicted 16% growth in the need for health care social workers through 2026, and meeting that demand with skilled, compassionate men and women is critical. If we have any hope of meaningfully reducing health disparities and better caring for disadvantaged populations, it’s time to get more serious about health care social work.

That begins with raising social workers’ profiles within the health care system. Patients and their families should know that a social work team is available to support them throughout their treatment and follow-up. Next, health care educators must do more to connect students interested in health professions to this field. When we talk to students about careers in the health care industry, health care social work should be included with other clinical disciplines. Finally, social work support should be expanded in high-need communities. With smaller caseloads, social workers can best do their jobs, which, by improving patient outcomes, provides long-term savings to our health care system.

In the media and in discussions with students, we often stress the need for the next generation of doctors and nurses, and that is undoubtedly important. However, even without a stethoscope or a prescription pad, health care social work is an essential career option in making a difference in patients’ lives and improving health care for our communities.

The Black Maternal Health Caucus Is An Idea Whose Time Has Come

The Black Maternal Health Caucus Is An Idea Whose Time Has Come

In April of this year, Congresswomen Alma Adams (NC-12) and Lauren Underwood (IL-14) launched the Black Maternal Health Caucus in North Carolina. Over the last 30 years, the staggering statistics associated with maternal mortality in the United States and the rate of black women who ultimately die during or after child birth due to complications raises many unanswered questions and the need for an immediate response from Congress and the medical community. The impact of maternal and infant mortality in the black community is devastating and this vulnerable population cannot continue to be invisible.

The gift of life is wondrous, to grow a human inside your womb simply defines the miraculous abilities and physical strengths of mothers. To say that this experience is joyous and simultaneously overwhelming is an understatement. While the baby is in the belly, the mother is in control and provides safeguards and protection to her unborn child through her handling of everyday stressors, her body’s ability to supply the baby with nutrition to grow and develop, and of course her intrinsic love. Most would agree this protective state of pregnancy is innate, mothers are genetically wired to provide security and safety to her unborn child. Pregnancy should be uninterrupted, uninhibited, and a celebration of procreation—life’s most precious moment.

Procreating for black mothers has unfortunately become a traumatic experience, the joys and happiness surrounding pregnancy and delivery of a newborn are drowned out by alarming statistics as more black mothers lose their lives trying to bring their children into this world. Environmental stressors, delays in treatment, poor access to health care, and miseducation plague the black maternal community. There is a great divide and misalignment of health care resources creating tragic events for mothers and families as they try to welcome a new life in the world but are often faced with raising a child without a mother.

While there has been significant research done on the causes of maternal mortality, solutions for why the underlying factors of maternal mortality in black mothers is steadily increasing in a nation rich with health care facilities and experienced clinicians remain frustratingly elusive. Is the life of a black mother and black child not as important in this country? The devastation of loss in the black community is felt for generations as we are faced with raising children without their mothers. Although the child may be supported and surrounded by love from the father and extended family members, there are lingering feelings of abandonment and an emotional disconnect by not experiencing the love and care by the mother. The impact of maternal mortality in the black community has a clinical and psychological impact that will extend into the generations yet to come. The need is great to not only decrease this statistic but to preserve the sanctity of the black family for the future.

To close this critical gap in maternal health care, three major points of action should be taken into consideration, (1) develop a standardized model of obstetric patient-centered care that targets mandatory documentation of patient education, (2) provide transparency in the costs and fees associated with the continuum of care for obstetric patients, and (3) implement a national campaign for healthy moms and healthy babies to improve community awareness and collaboration with existing maternal health organizations. Such an investment not only has a direct effect on the health and wellness of mothers and their newborns, but also drives positive outcomes for the health care system.

The Nurses’ Health Study 3 Needs You

The Nurses’ Health Study 3 Needs You

The third round of the Nurses’ Health Study (NHS3) promises to reveal information as transformative as the first version of the study. But this time around the revolutionary study is looking to make a change that will resonate with minority nurses nationwide. To better reflect the nation’s increasingly diverse population, the study is especially interested in the participation of minority nurses—both ethnic and racial minorities and also male nurses.

We need nurses,” says Dr. Jorge Chavarro, the principal investigator of NHS3. Chavarro became involved in the third round of the study 15 years ago, with a special interest in infertility and reproductive health.

When the first Nurses’ Health Study launched in 1976 (and the second in 1989), the scientific focus was to follow women for clues to breast cancer. Specifically, the study wanted to find out if there was any correlation between birth control pills and breast cancer risk, but it also gave more general information about cardiovascular heath and diabetes as well. From there, the information gathered has revolutionized areas of healthcare.

Interestingly, the nurses’ study has always been defined by an occupation, but it has never been an occupation cohort,” Chavarro says, noting that NHS3 will now include occupational health issues such as heavy lifting, radiation exposure, or exposure to cleaning agents. Study investigators recruited nurses to participate because they were excellent responders who had a thorough understanding of specific medical terms and could participate with less margin of error.

What’s new in NHS3?

  • a targeted effort to recruit more minority nurses
  • a targeted effort to recruit more male nurses
  • a new participation option for Canadian nurses
  • a focus to capture occupational exposure concerns and understand how that impacts a nurse’s health
  • an entirely web-based participation

We want to involve as many minority nurses as possible,” says Chavarro, “and it’s the same for male nurses.” Canadian nurses are also welcome to participate, and many of them have already been long-term participants. Chavarro says the team realized it’s not difficult to continue collecting information from nurses who have moved to Canada, and so opening the study to all Canadian nurses is only going to be helpful for study results..

The Nurses’ Health Study collects vast amounts of data on lifestyle, nutrition, exposures, and health events. The study’s history is revealing in itself and shows the vast changes over the past decades. Nurses were the designated cohort after some trial and error in the first study. Initially, doctor’s wives were going to be the chosen cohort in the pilot study as birth control pills could only be prescribed to married women then and most physicians were men.

The second choice was nurses,” says Chavarro, “and it was the best decision ever. It changes the questions you can ask.” Nurses are going to be very clear about any medical events that happened to them and that makes all the difference in evaluating the data, he says. They can also do other tasks that are extremely valuable and that are primarily unavailable to the general population. For instance, collecting varied biological specimens is something nurses can, and do, perform with ease and accuracy.

Chavarro says nurses who participate are making a change in the health of future generations and that’s often why they get involved. The time commitment is fairly low and the benefits to humanity are significant.

To continue being impactful, we need all nurses, but especially those who give us a picture of how the US looks as a whole,” says Chavarro. “Nurses are amazing and are the best participants ever. This is a definite opportunity to join this study and make enormous contributions as they have done in the past and will continue to do for many decades to come.”

Find out more information about signing up for NHS3.

Not a Parent’s Guide to Transgender Children

Not a Parent’s Guide to Transgender Children

I sprained my knee. That’s how I found out my 14-year-old daughter was struggling with her gender identity. I was combing the house for an ace wrap and found it in the dirty clothes basket in Karen’s room. It looked like it had been through a war. No elastic left. Karen had always been a tomboy. She wanted to mow the lawn, play with bugs, play sports…she was always moving and had zero interest in “girl stuff.” I took her to Claire’s in the mall a few times and she looked totally lost as I picked out headbands, earrings, and miscellaneous froufrou. I guess she was sending signals for years, but I wasn’t picking up the phone.

I don’t know how it dawned on me that she was binding her breasts. It just came to me and so I asked her, “Are you binding your breasts?” She started crying.

“I was born in the wrong body!” She said between racking sobs.

I’m ashamed to say it, but my first thought was, “Why me?” I took her to the pediatrician. She told me that this is just a phase. Karen is hanging out with the wrong people. Monitor her closely. Watch her friends. Ignore it and it will go away.

I was already pretty obsessive about who she hung out with. On play dates I would make sure I went in the house and met everyone involved. When I took her and her friends to the mall, I quizzed the friends about their home life and their grades. I thought I was doing everything right. Over the next year, our relationship deteriorated. I found marijuana, vape pens, bongs…she became a stranger to me. It was all yelling and grounding and taking the phone away. She didn’t do homework. She hated me. So much for the pediatrician’s advice.

I reached out to one of the pediatricians I had worked with and respected and asked him to recommend a doctor who worked with transgender teens. I made an appointment. Dr. Mitch spent an hour with Karen…without me in the room. When Karen came out of the appointment, a weight seemed to have lifted from her shoulders. Later, Karen told me the nurse had given her a shot to “make my period go away.”  I was beside myself. I called the office and demanded to speak with the doctor. My rights as a parent had been violated. How dare he give my child something without discussing it with me first. I wasn’t against the shot so much as being cut out of the decision.

Dr. Mitch called me back that afternoon and spent an hour on the phone with me. Can you imagine? An hour. He patiently discussed what Karen was going through and informed me that children over 12 can get birth control without parental consent. I had no idea. He explained that Karen had gender dysphoria: The constant feeling that her body was the wrong sex.  Karen had anxiety, anger, feelings of hopelessness, and diminished self-worth. My child was in pain. Thus, started my education in transgender children. I knew by now that it wasn’t a phase but, I have to admit, I was still hoping that it would go away.  My own feelings of self-worth had taken a hit, honestly. What kind of a parent was I? How could I let this happen?

WPATH (www.wpath.org) is the World Professional Association for Transgender Health and they write the standards of care for transgender health care. Dr. Mitch suggested I look over the information on the website and I did. It answered a lot of questions. Dr. Mitch assured me that there was nothing wrong with me and that Karen was always going to be my child. He suggested that if Karen wants to dress like a boy, it’s not permanent. He suggested I just back off and let her do what makes her comfortable. Of course, I was terrified that she would start taking hormones and have permanent changes that she would regret later. Dr. Mitch told me that Karen needs to live as a boy for a year and see a therapist every week to discuss her journey to make sure it’s the right thing. He wouldn’t prescribe hormones until Karen has been living as a boy for a year and his therapist signed off on the treatment.

Karen started seeing therapists who specialized in transgender teens. Insurance was a constant battle. The quality of the therapists was spotty. Karen, now Tony, was angry and impatient. He wanted testosterone now, now, now. He went to group meetings with other transgender teens and I think he saw how many of them struggled with no parental support. I remember seeing a young boy with long lanky hair and a defeated demeanor at a couple of his pizza party groups. I saw him, or her I should say, walking there and walking home. I really felt sad for this kid who wanted to be a girl so much. Tony told me the girl was grinding up DVDs and eating them because she heard the plastic works like estrogen. I really felt terrible for her. I determined that I was not going to be like her parents. However, I was not going to let Tony make any irrevocable decisions until we both were sure this was the way forward.

That year was a bit of a blur. Lots of appointments, Tony being angry. Kids and teachers at his school wouldn’t get with his name change and preferred pronoun. I blew it myself many times. I was so used to Karen, my daughter…not Tony my son. Problems at school came to a head and Tony pulled out of high school in favor of going to an alternative school. Things got better and worse, better and worse. I was at my wits’ end. All Tony wanted was to be seen by others as he saw himself, as a boy, not a girl. He bought some binders online and that worked, but they were uncomfortable and over time, left him bruised and misshapen. His girlish hips and curvy legs were problematic.

When he finally got the go ahead to start testosterone, he was so excited. Looking back, I think he thought that once he started hormone therapy, he would magically change into another person. It wasn’t like that. He still had problems with his old friends misgendering him. He still was behind in school. He still had all his old problems. That first year was the angry year. From my perspective, things got worse once he started testosterone. The doctor assured me that it wasn’t the hormones, it was just teenage angst. Tony went from twice a month dosing to once a week, halving the dose. I don’t know if that made things better or worse or didn’t do anything. I was scared, Tony was miserable.

Over that first year of testosterone, Tony gradually got more stable. I guess it was probably two years all in all before Tony got the body he wanted…or close enough that he can live with it. He’s 18 now and looks very boyish. He doesn’t bind his breasts anymore, but he does hunch his shoulders and tape his nipples flat when he goes out. We’ve discussed top surgery and I think the conclusion is that he can live with a small chest for now. There’s no talk of bottom surgery. I think Tony is finding a new middle ground between being a boy and being a girl. I tell him he doesn’t have to be binary, either/or. He can just be himself and I’m cool with whatever that self is. He is OK with being a boy with breasts. I know that given a choice he would choose not to have them. However, for now, the discomfort and risks of surgery are not worth the benefit.

Being a teenager is difficult in the best of circumstances. Tony is an adopted immigrant from Vietnam with a white single gay parent and born in the wrong body. Is it a surprise that his teen years were stormy? Not really. Tony worked all summer long at Chipotle and saved up his money. He bought his own car. He works two jobs. He’s smart and responsible. He’s good with money. He’s still afraid of school. He was tormented in high school and I think he has a lot of anxiety about going to college. I gently nudge him, but there is no hurry. He’s just about as perfect a person as I’ve ever seen. The trauma of those years of his transitioning is with us both, but gradually fading. I’d say he is a success story. He’s my son.

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