March is National Nutrition Month and offers up a good time to think of tweaking your diet.
Nurses are especially prone to falling into an eating-on-the-run trap. With long shifts that barely offer time to sit, nurses rarely have the luxury of taking the time to eat a relaxing meal when they are on the job. No one recommends eating quickly, but, let’s face it, most nurses have to eat quickly or they won’t eat at all.
During National Nutrition Month, the Academy of Nutrition and Dietetics helps people focus on making nutritious choices. Knowing that nurses have short bursts of time in which to get the most nutrition possible, they have to plan ahead to map out what is the best eating plan for them. Leaving it all to chance means fast food that might be higher in fat and salt and lower in things like fiber.
What makes sense for nurses? Figure out what and how you eat throughout the day and try to find foods that can fit that pattern but that offer a nutrition boost. Do you make a coffee run and add in a danish or a roll? Is lunch whatever is left in the vending machine and that you can eat in the few minutes you have?
Packing your food at home and bringing it with you is an easy option. Once you get into the habit of prepping your food at home (beware – it can feel like a chore until you get into a groove) you’ll have an instant fallback of food you like to eat, that gives you energy, and that provides you with the most nutrition possible.
Salads are an excellent way to pack in vegetables, fruits, and some great protein, but they take a lot of time to eat. You can keep the focus on the nutrition a salad provides and bring other foods that are healthy but take less time to eat. One of the easiest ways to pack in all those veggies and fruits is with a smoothie. Throw all the ingredients into a blender, add some protein powder or high-protein Greek yogurt, and you have an easy-to-digest and quick-to-eat option.
Lots of granola bars in the supermarket offer wholesome ingredients without extra sugar or added binders. With pure ingredients like nuts, seeds, and dried fruit, these bars are easy to tuck into a bag, don’t take a lot of time to eat, and offer energy-boosting nutrition. You can also make your own trail mix to bring. Customize it to include the ingredients you like and you’ll get an even more pure (and less sugary) small meal. Pair it with a yogurt drink, a hard boiled egg, or a few slices of rolled deli meat and you’ll feel more energized for a longer time.
If you think it will fit into your day, pack smaller portions, but eat more frequently. A small bowl of brown rice or quinoa, lentils, beans, or chicken, and some finely chopped veggies takes less time to eat than a bagel with cream cheese and offers a powerhouse of hunger-fighting fiber, protein, and nutrients.
And one of the best ways to keep yourself energized is to stay hydrated. Instead of fueling with caffeine all day, add in some other beverages. Try to swap out soda with flavored seltzers (add in some juice if you need more flavor) or throw a couple of fruit-flavored herbal tea bags into your water bottle with a little lemon. Being even slightly dehydrated quickly saps your energy and makes your body work harder at everything.
With a few small changes, you can give your body the energy and nutrition to have a more productive day and better overall health.
National Patient Safety Awareness Week (March 11 – 17) focuses attention squarely on one thing at the top of every nurse’s list – keeping patients safe.
Minority Nurse spoke with Patricia McGaffigan, RN, MS, CPPS, vice president, safety programs at the Institute for Healthcare Improvement (IHI) about the ongoing issues around patient safety and how nurses can continue to implement positive and productive change.
While nurses provide a majority of care in inpatient settings, McGaffigan says the issue of patient safety extends to a wider setting as interprofessional teams are responsible for so many levels of care.
Because of the nurse’s role, they are especially able to impact patient care. “Nurses represent the largest segment of the healthcare workforce, in roles that range from the bedside to the boardroom,” says McGaffigan. “One specific and relatively easy way that nurses can effect change is to become educated in foundational safety science.” Nurses who aren’t trained in safety science can obtain training, and many student nurses receive the training as part of the curriculum. “Nurses are perfectly positioned to be able to identify risks and hazards in their work environments that may be mitigated before harm occurs, and this daily commitment to mindfulness about preventing harm before it happens is vital.”
As nurses, ongoing education, and maintaining and obtaining appropriate certifications help nurses provide the optimal care when they are with patients. Consistency in providing care and following a standard of care plan help patient outcomes as well.
“Nurse-sensitive indicators that reflect structure, process, and outcome are of great importance to nurses.” she says. “As a profession, we want to ensure that we have appropriate numbers of skilled nursing professionals who are able to meet the unique needs of patients and families. Process measures are focused on ensuring that we deliver the right care in a consistent and reliable manner.”
Patient harm can result when there is a lack of guidance or an absent standard to follow, says McGaffigan. For instance, harm can result when patients aren’t regularly repositioned or when oral care in ventilated patients is neglected. Other areas of particular importance include medication errors, falls, hospital-acquired infections, or complications, and other injury.
To provide the best care, nurses must also be able to care for themselves. If they are overly fatigued, do not feel supported or able to thrive in their organizations or if they are working in an organization where a culture of safety is not emphasized, patients cannot receive optimal care and nurses themselves might be at greater risk.
“Nurses are increasingly and very appropriately focused on their own physical and emotional safety, as well as cultures of safety,” she says.
The interactions that build relationships between nurses and patients are key to keeping patients safe. “Nurses are often the profession that has the most interaction with patients and families,” says McGaffigan. “We can consistently strive to identify the needs and preferences of patients and families, and also ask patients and family members what matters to them, and what they might be worried about.” McGaffigan knows this first hand. “As a former pediatric critical care nurse, one of my greatest ‘early warning systems’ was when a parent might tell me that ‘something just doesn’t feel right about my child,’” she says.
When errors do happen, a transparent process to understand what went wrong, assess the cause, and prevent future harm is essential. “Punitive cultures exacerbate reluctance to report near-misses and errors,” says McGaffigan. “Nurses can become more familiar with Surveys of Patient Safety Culture, identify areas where unit and organizational performance is stronger or weaker, and play a key role as leaders and participants in initiatives to improve scores on their survey domains.”
Patient safety continues to evolve as new medical technologies are introduced and as patient care continues to become more complex and more challenging.
“Nurses, as well as our other colleagues in healthcare, have chosen our profession because we have a core value of ensuring that our care is not only technically sound and appropriate, but is safe,” says McGaffigan. “As nursing professionals, we come to work every day to ensure nothing less than safe care. Whether we are in traditional roles at the bedside or as nursing leaders, educating our next generation of nurses, sitting on boards of directors of health care organizations, serving in formal patient safety positions, contributing to progress in the medical device and pharmaceutical industries, or more, we individually and collectively embody safety as our core value.”
Those who enter the profession do so knowing they are often a patient’s greatest advocate and a crucial partner in receiving the best care. “We are committed to creating a world where patients are free from harm,” she says, “and we advocate and anchor our healthcare system to not simply regard safety as ‘one more thing that we do,’ but understand that ‘it is the one thing that must permeate and provide the foundation for all that we do.’”
It might seem ironic that the kickoff of the National Sleep Foundation’s Sleep Awareness Week starts with an hour less of precious shut eye.
While Daylight Savings Time has most of us springing our clocks ahead one hour early in the morning of Sunday, March 11, it also means we are losing that extra hour of snoozing.
But paying attention to your forty winks is nothing to slack off on. Nurses, traditional whirlwinds chameleons thanks to long shifts, nighttime hours, family and school obligations, and just plain stress, are typically fairly sleep deprived. Known to fit amazing amounts of tasks into one day, nurses often accomplish these things while shorting their bodies of necessary sleep.
Here are four reasons to pay more attention to your sleep.
1. Your Work Performance
According to the American Sleep Association, lack of dreamtime contributes to big problems on and off the job. You know you’ll feel sleepier during the day, and that’s a problem for nurses when they are working. Given the fast pace of the job and the critical thinking necessary to dose medications or provide care, chronic sleepiness will impact your patient care negatively.
2. Your Health
Not getting enough slumber can also lead to potential health problems. A body that is sleep deprived gets the hormones that regulate appetite mixed up. Not only are you awake extra hours, but you are hungrier during those hours as your body tries to stay alert. If you aren’t careful, this can quickly lead to weight gain and associated problems like high cholesterol or high blood pressure. Lack of sleep can even trigger an improper processing of glucose and can make you more prone to developing Type 2 diabetes.
3. Your Mood
Sleepiness can easily turn to crankiness as your body craves needed rest. Sleep gives you the extra cushion against the things in the world that irritate you. When you haven’t had enough good rest, your mood takes a nosedive and everyone around you notices it. You might be more short-tempered with your friends and loved ones, but it can also impact your attitude with your patients and with your colleagues.
4. Your Quality of Life
As a nurse, you work hard for everyone else’s well being. You spend your days taking care of other people and other needs, often while neglecting what you need. Not getting enough sleep is a sure-fire way to put a wrench into your forward momentum and finding a balance that is sustainable.
The next time you find yourself skimping yet again on crawling into bed, think of how often you tell your patients they need rest to heal and rest to recover. Treat yourself the same way and see if it makes a difference in your life.
So many times, nurses treat patients whose lives have been touched by drug or alcohol abuse. But what happens when the nurses themselves are addicts? Sadly, this happens more often than you might think. The American Nurses Association (ANA) has estimated that 10% of nurses suffer from a drug dependency, which could amount to around 300,000 addicted nurses.
Why do nurses abuse drugs and alcohol? For the same reasons other people abuse drugs and alcohol. One of these reasons is stress. Nursing can be a highly stressful profession. People with stressful jobs sometimes turn to alcohol and drugs to try to cope. Of course, using drugs and alcohol to deal with such stress can lead to dangerous repercussions for nurses and their patients.
Why Nurses Shouldn’t Try to Treat Themselves
Nurses are accustomed to achieving things and getting things done. Many nurses assume they can treat their addictions just as they handle other things in their lives. They treat other people in the course of their jobs, so they assume they can treat themselves as well.
This could be a mistake – a grave mistake. If nurses are drinking heavily and stop drinking abruptly – if they go cold turkey – their bodies could revolt. The symptoms could include DTs (delirium tremens), which can cause confusion, hallucinations, heart problems, and even death.
Instead, nurses with addictions might want to consider seeking help at dual diagnosis treatment centers. (A dual diagnosis occurs when people have both a substance abuse problem and a condition such as bipolar disorder, anxiety, or depression.) Such treatments might help their clients address their drug and alcohol abuse. Why shouldn’t nurses try to seek the same help themselves?
Addiction Also Hurts Patients
Unfortunately, health care workers’ addictions can hurt more than the health care workers themselves. It can also hurt their patients. If nurses abuse alcohol or drugs, the nurses might:
- Take frequent absences from work. This could create staffing shortages where not enough nurses are available to care for patients at a doctor’s office or medical facility.
- Not be physically present when patients need them. This could be because the nurses are occupied using drugs or alcohol and not in the office or on the floors of the hospital.
- Be too distracted by hangovers or drug cravings to focus on their patients’ needs.
- Forget to administer their patients’ medications, give them the wrong dosages, or give them the wrong medications entirely.
- Steal medications from their patients.
This last consequence points to the widespread nature of opioid addiction. According to the National Institute on Drug Abuse, around 1.9 million Americans struggled with problems related to prescription opioids in 2013. Nurses seem especially vulnerable because they often have ready access to such drugs. But addiction does not discriminate. It harms all types of people from all walks of life, hurting their health, relationships, jobs, and other areas of their lives. It’s simply the nature of the beast.
Opioids’ qualities can also contribute to this abuse. As we’ve said, nursing is stressful. Opioids are drugs that can relax people and produce effects that temporarily relieve stress, so nurses might turn to these drugs in times of crisis. A popular television show, Nurse Jackie, depicted a fictitious nurse using drugs in this way.
In real life, there is help for such drug use. Professionals at rehab centers acknowledge that stress and addiction often go hand-in-hand. The professionals can work with their clients to find ways to relieve stress that don’t involve drugs.
Opioids also provide painkilling effects. Since nursing can be incredibly physically demanding, many nurses struggle with pain. Some nurses turn to opioids to handle this pain. Some become addicted to them.
Doctors are also prescribing large numbers of opioids, increasing the likelihood of addiction even more. The Centers for Disease Control and Prevention (CDC) reported that in 2012, medical professionals issued 259 million prescriptions for painkillers. Nurses are just some of the millions of Americans who have access to such powerful drugs and have experienced their effects.
What Can Nurses Do?
Fortunately, addicted nurses can find help. On a state level, nurses can contact state boards of nursing and state nursing associations, such as the Massachusetts Nurses Association. They can direct nurses to programs and other treatments to help address their addictions. They could also help nurses if they are facing discipline for their actions.
Other help is also available. On a national level, websites such as AddictedNurse.com can help nurses with substance abuse and other issues. Other nursing and medical organizations offer resources for nurses who are dealing with substance abuse or recovering from it.
Nursing can be a tough profession. Substance abuse is also tough. But there are different kinds of resources and care, such as dual diagnosis treatment centers, that can help nurses seek the treatment they need to help themselves and their patients.
Certified Registered Nurse Anesthetists (CRNA) Week runs this week from January 21 to 27 and is an excellent opportunity for student nurses to find out more about this path in a nursing career.
With more than 52,000 nurse anesthetists and student nurse anesthetists, the career is thriving and attractive for several reasons. Many nurse anesthetists say the patient interaction they have is unsurpassed. They are with patients before, during, and after surgery, so there’s a necessary trust that is quickly established with the skill and care of the nurse.
Nursing students who are considering this as a career have many resources they can reference and various organizations that will help them succeed on this career path. The American Association of Nurse Anesthetists (AANA) is especially aware of promoting health and wellness among the student nurses who seek a career in this branch of nursing. The AANA’s 2017 report Wellness and Thriving in a Student Registered Nurse Anesthetist Population explored the significance of the relationship between student wellness and how well students do in their academic program.
To celebrate CRNA Week, Minority Nurse recently posed some questions to Michael Neft, DNP, MHA, CRNA, FNAP, FAAN, and assistant director of the Nurse Anesthesia Program University of Pittsburgh School of Nursing and nursing student Sara Wilkinson, BSN, RN, CCRN SRNA at University of Tennessee Health Sciences Center. The following are their answers.
Why is the AANA particularly aware of the health and wellness among student nurses looking to enter or actively studying in this field?
Student nurses are the future of the profession, and it is important to cultivate and prepare for a long and healthy career. Students who aspire to enter into nurse anesthesia programs must be healthy mentally and physically. They must have healthy outlets for stress relief, and healthy lifestyle habits that will support them throughout our educational programs.
Nurse anesthesia education programs are required by their accreditation standards to provide education content on wellness and substance use disorder. The AANA actively encourages members, students, as well as educational programs to engage whenever possible in healthy behaviors, whether that includes physical activity or simply reducing stress by encouraging individuals to take time for their loved ones or to engage in an activity they love.
The AANA is committed to providing resources and information about ways to become involved in establishing a healthy lifestyle and even offers fun runs, wellness tutorials and a massage therapy area at many of their conferences.
How does establishing good health and wellness practices now help a student nurse become better? And how will taking care of oneself now carry over once they graduate and are several years into a CRNA career?
Nursing has unique stressors like dealing with patient care situations that require critical thinking, fast decision making, and autonomy is tough. If the student nurse does not have the ability to cope with these situations autonomously, it is very difficult to care for patients. Maintaining both mental and physical health and wellness are at the foundation of successful practice.
Developing healthy lifestyle habits early, helps students handle stress more effectively, set clear goals, and develop a clear plan to achieve them. They also assist students with discipline, good study habits, prepare for clinical experiences properly, and self-evaluate objectively. It also helps to establish diet and exercise plans that can be adjusted as one transitions to practice, to avoid elimination of healthy habits out of inconvenience.
Maintaining a school-life balance is also important to develop a support system and find time for small, pleasant breaks to gives a fresh perspective and recharge. Establishing healthy behaviors and habits early is vital to long-term health, wellness, and maintenance of a successful career.
Do you have any advice for student nurses about considering this field and being aware of any challenges unique to this branch of nursing?
For student nurses considering the field of nurse anesthesia, awareness about the depth and breadth of study is valuable, but is important to be well, so that an individual will have the endurance to graduate. A strong support system and personal discipline are necessary to allow for healthy stress relief and appropriate professional conduct. Anesthesia remains the field with the highest incidence of drug abuse and unhealthy coping behaviors, due to high stress and access.
Think about what you do when stressed. Review your lifestyle habits: exercise, eating, alcohol use, and other substance use. Some prospective students may want to employ a lifestyle coach who can look at a person individually and help one to develop positive lifestyle habits that will set one up for success in graduate school and a stressful career. Good study habits, a healthy respect for one’s self and career, use of study resources, and strong, supportive relationships will be required to succeed and thrive in this field.
As the opioid epidemic continues to grow throughout the nation, it’s not surprising that this kind of addiction, as well as others, can also affect nurses. If you’re a nurse in New Jersey and have a problem with addiction, however, there’s a treatment program specifically designed to help you.
Established in 2003, the New Jersey State Nurses Association (NJSNA) Recovery and Monitoring Program (RAMP) has helped more than 2,000 impaired nurses since its inception, says Terri Ivory, RN, MSN, Director of NJSNA. “RAMP is the only program for registered nurses and licensed practical nurses of its kind contracted through the Board of Nursing,” explains Ivory. “RAMP is important because it supports impaired nurses and protects their licenses so they will be able to work again with monitoring once they have completed evaluation and treatment. What makes the program special is that nurses are taking care of nurses who understand the challenge of being a nurse.”
Ivory agreed to answer questions about the program. Following is an edited version of our interview.
Tell us about RAMP.
The goals of the program are to provide safety to the public though early detection and monitoring, reduce the time between identification and treatment, and provide a process for the nurse to recover that is non-punitive and non-public.
Entering the RAMP program, which is voluntary, protects the nurses’ licenses. While in the recovery phase, the nurses’ licenses may become inactive, but not revoked, which protects the licenses. The licenses can be re-activated once the process is completed and the return to work is issued.
How does it work? Is it a rehab/detox? Do you provide counseling?
RAMP is a recovery and monitoring program, which means it makes referrals for treatment, detox, and counseling. It is not rehab and detox nor does it do counseling.
The RAMP process includes evaluation, toxicology screenings, referral for treatment, weekly peer support group meetings, monthly reports, check-ins, monitoring, and a return to work process. There are peer support groups that RAMP participants must take part in during their time in the program.
Are all nurses accepted into the program? Do they need to apply? Does their employer get notified?
All RNs and LPNs practicing in New Jersey are eligible for the program and can be self-referred or referred by their employer or the public (such as family, attorney, friend). After a nurse self-identifies or is referred to RAMP, the first thing that happens is an evaluation process, which includes a psychological evaluation and random toxicology testing that can take up to 90 days. Nurses must check in with RAMP every day during the evaluation phase. During this time, the nurses do not need to disclose to their employers that they are in the program.
After evaluation, the nurse will get recommendations—whether to stay in the program or discharge—based on the results of the evaluation. If it is recommended a nurse stay in the program, the nurse must disclose the program participation to her/his employer.
Participation in the program may last up to five years.
RAMP notifies the New Jersey Board of Nursing (NJBON) as soon as the referral comes in, and the NJBON works with RAMP throughout the process. Dialogue with NJBON happens every two weeks or more often as needed. If nurses do not comply with recommendations, they are discharged from the program and reported to the BON.
It is within the nurses’ scope of practice to report fellow nurses.
Do the nurses pay for the program or is it covered by insurance?
Insurance does not pay for the program itself, which includes lab fees, evaluation fees, peer group fees, and therapist fees. All fees must be paid up front.
Hard medical costs, such as a lab fee or therapist, might be covered by medical insurance.
If they complete the program, how do they get back to working as a nurse? What tends to happen?
During their time in the program, a return-to-work program is implemented. Sometimes there are restrictions on work hours (no overtime), medication administration, and on specialty or place of employment. Nurses are monitored while they are working and monthly reports are sent to RAMP. Monitoring can be done for up to 5 years. Upon return to work, the only person that knows about the nurses’ participation in RAMP is the potential supervisor and human resources.
What have your outcomes been?
The overall success rate of the program is 60%. There are a total of 607 nurses in the program as of October 31, 2017: 493 nurses being monitored, 27 in intake stage with 23 monitoring out-of-state with 36 peer support groups, and five mental health groups. Two hundred thirty participants have been discharged as of October 31, 2017.
The most important thing for nurses to know is not to be afraid to report, either self-reporting or peer reporting. This helps close loop and gets the nurse the help they need. The main goal of the program is to have nurses to practice safely, protect the public, and protect the nurse.
RAMP has a 24-hour hotline for questions: 800-662-0108.