Infection prevention is one of the standards of nursing practice. Keeping infections from starting or from being passed along through contact is essential to keeping nurses and patients healthy. International Infection Prevention Week (this year marked on October 15-21) is an annual event to highlight the best practices to prevent infection and to bring awareness to the issue of infection prevention.
Infections are largely preventable, Marie Wilson, MSN, RN, CIC, FAPIC, an infection preventionist in the Quality Division of Fred Hutchinson Cancer Center, and a chair of the communications committee for the Association for Professionals in Infection Control and Epidemiology (APIC). Wilson says her career path was determined in part by her time as an ICU nurse. “I saw too many patients become afflicted with infections as a result of the disease process or from care,” she says.
Education, says Wilson, is one of the top ways to help stop infection from spreading. “We saw a glimpse of this in the beginning of the pandemic,” says Wilson. There were constant reminders of hand washing, social distancing, and covering your face to prevent the spread of disease. “Those are all things we became very familiar with,” she says.
Hand hygiene continues to be one of the most important actions in infection prevention, says Wilson. For nurses, hand washing is a focused, professional step in patient care. What is important to remember? “Taking the time to observe the five moments of hand hygiene when you are interacting with patients and washing your hands at the right time,” says Wilson. When nurses do this, they model the right behavior for peers, patients, and their families as well.
But putting the best approaches into practice isn’t always perfect. Misinformation can work against infection prevention, even despite the best intentions. For instance, Wilson says there’s no need to reuse personal protective gear or masks when there’s not a shortage. Now, she says, supplies are available, so using new items is the best option. And wearing two masks, like a mask over an N95 that has been fit tested, can actually worsen any infection prevention as the top mask can negatively impact the fit of the N95.
Sometimes Wilson says she sees gloves used as a replacement for hand hygiene which is not effective for infection prevention.
And in a chaotic environment, nurses can forget to wash their hands. Or they might use an alcohol-based hand rub out of eyesight of a patient who then asks the nurse to wash their hands for reassurance. “Be receptive to feedback,” says Wilson. And although there seems to be debate about alcohol-based hand sanitizer versus soap and water for effectiveness, Wilson says they each are excellent–the biggest issue is to just use them. “In a healthcare setting, alcohol-based hand rub is preferable,” she says. “It’s easy to do and effective. When the hands are visibly soiled, use soap and water as the hand rub may not penetrate the heavily soiled areas.”
In addition to hand hygiene, cleaning and disinfecting areas with proper disinfectants keeps germs from spreading. But, says Wilson, be sure to know what you are using so it is the most effective cleanser and be extra careful to never mix cleaning agents. This is a great safety rule for nurses to pass along to patients, as the fumes created from mixing solutions that contain bleach and ammonia can be deadly.
Vaccines are also a top way to prevent disease and infection for individuals themselves and for the greater public. “They are so highly effective and protect people,” says Wilson.
Infection prevention has some basic actions, but the layers of it are complex and require constant attention. Wilson says she is grateful for all nurses do to help control infection and their persistence through the hardship, staff turnover, and burnout nurses have endured in the past few years. Their work continues to make a difference in infection prevention.
As the population in the United States ages, healthy aging is going to become a concern for a growing segment of people and the healthcare teams that care for them. September’s Healthy Aging Month designation brings an awareness for nurses who want to offer appropriate care for their aging patients and who also want to be mindful of healthy aging practices for their own health.
Dr. Sharon Bronner, DNP, MSN, ACHPN, GNP-BC, RYT-500, is a member of the Gerontological Advanced Practice Nurses Association (GAPNA), and she shared some insight with Minority Nurse about how gerontological nurses play an essential role in helping folks age with a focus on health and wellness.
“Gerontological nurses can promote healthy aging by assessing and evaluating the body, mind, and spirit of each individual older adult,” says Bronner, who has been a gerontological nurse for four decades. “The keys to promoting healthy aging start with food choices, healthy life choices, movement of the body, and socialization.”
Gerontological nurses also adapt their approach to tune into the ways older adults thrive, she says. For instance, older adults respond to compassionate listening, social engagement, complementary alternative modalities, and holistic care. Promoting healthy aging means that gerontological nurses want to acknowledge cardiovascular and cognitive decline and give patients information and education to help them in those areas.
“Physical activity daily can go a long way with facilitating healthy aging,” she says. “Some physical activity can include walking, mindfulness movements, yoga, qigong, light weight training, and movement of the body energy. Movement that is conducted three times a week would be ideal for healthy aging.”
For example, Bronner says, yoga can assist with regulating the autonomic nervous system, which can decrease anxiety, increase spinal flexibility, and correct spinal imbalances. Strengthening and protecting the spine can help reduce falls, which often become a traumatic event for older adults.
As the nation faces an increasingly older population, Bronner says the biggest challenges in the new millennium are nurses not prepared to work with older adults and a shortage of nursing staff in nursing homes and hospitals. “Older adults have complex medical conditions and a multitude of chronic conditions that often are not managed appropriately,” she says.
And nurses and families can introduce the idea of planning for healthcare emergencies with advance directives. These plans, she says, are often not discussed until there is a crisis or end of life is approaching. This lack of direction can cause upheaval for both the older adult and other family members who might not be sure what to do.
Families and healthcare teams can also help promote healthy aging with the implementation of telehealth monitoring of blood pressure, weight, blood oxygen level, and virtual assessment. Keeping a close eye on conditions with remote telemonitoring, whether in a skilled nursing facility or in a private home improves the patient and provider relationship while also allowing quick intervention for chronic conditions. “Monitoring geriatric conditions and symptoms can aid in the prevention of falls,” she says, “while assessing nutrition could assist with promotion quality of life.”
For nurses considering gerontological nursing, Bronner says the specialty has offered her a nursing career she loves. “Gerontology has been a love of mine for many decades,” she says, “and I am able to holistically incorporate many modalities to assist with healing. The joys that resonate in my entire soul include the autonomy in my practice and the connection with the interdisciplinary team during the development of care plans.”
As a gerontological nurse, Bronner often works closely with an older adult’s loved ones and forms close bonds. That kind of support can help families if they need to navigate the end-of-life stage. “I enjoy when a family member gives hugs and appreciates the compassionate care at the end of life,” says Bronner. “The trauma of death is hard for each person involved. Providing comfort, education, and stillness (mindfulness) is a skill that I feel helps individuals through these difficult times.”
There has been a greater focus on creating healthy work environments in recent years, and nurses deserve kindness, too. Regardless of your nursing position, remember that kindness is still in style.
If you are a nursing student, new graduate nurse, educator, or chief nursing officer, remember that the foundation of nursing is rooted in caring. I don’t know what has happened to nursing over time, but we must return to caring basics as a nursing profession. Emotional intelligence and empathy can go a long way in nursing.
Research shows that kindness and helping others can decrease stress and benefit our mental health. Demonstrating kindness has been shown to reduce cortisol levels, increase self-esteem, compassion, and empathy and improve your mood.
Being kind to ourselves and caring for ourselves as nurses should be a priority.
Here are some self-care activities you can implement to be kind to yourself and others.
Sleep
Sleep is truly underrated. It is crucial to get your rest and relaxation.
Healthy Eating
It’s not easy sometimes, but try to look for healthy eating options as much as possible. I know nurses love all things caffeine. However, reducing caffeine can be helpful.
Massage
Massage can be highly relaxing and stress-reducing. Some nursing positions can be physically demanding, so try a nice massage. Some insurance will cover this as well.
Exercise
Even if you are not a big workout type, you can at least go for regular walks. Walking outside and being in nature is also relaxing.
Music
Research shows that listening to 30 minutes of music a week can reduce stress and have physiological benefits such as reduced blood pressure.
Aromatherapy
Aromatherapy has also been proven to reduce stress. Even having different lotions, such as lavender, can instantly reduce stress.
Deep Breathing/Stretching
These are easy to do and can only take a few minutes but have powerful positive effects.
Healthcare providers must prioritize putting their health first. Remember to take time off regularly. No job is worth your mental or physical health. It is time we start normalizing taking time off regularly in the healthcare industry. If you are in leadership, please encourage the staff to take time off. When the team feels happy and relaxed, they can be more productive.
Be kind to yourself so that you can have more kindness for others.
Nurses face various challenges in their day-to-day activities, and one of the most prominent currently is the ongoing healthcare staff shortage. The shortage creates greater stress for nurses but can also affect patient outcomes, workplace safety, and meaningful career growth.
Administrators and industry leaders must commit to meaningful systemic changes to address the issue. However, nurses’ commitment to helping one another throughout this crisis is also essential. By offering support, guidance, and insights in key areas, nurses can empower one another to thrive throughout these challenges.
Communicate About the Causes
It is likely to be clear to all nurses that there are significant staff shortages in the healthcare industry across a range of roles. There are various reasons, including aging populations living longer, which has increased the demand for services. Many professionals are aging out of the industry. Toxic workplace cultures – resulting from stress, insufficient pay, and patient abuse – can also contribute to a lack of new nurses.
Nurses must understand these causes and what is causing specific staffing shortages in their area. With a clear idea of the root problem, it can be easier to have clarity on how to find solutions.
Perhaps most importantly, nurses should communicate with each other about staffing problems. Nurses representing traditionally marginalized demographics or interacting with minority communities can also highlight specific challenges. The better insights everyone can gain about the shortage causes, the more empowered everyone can be when navigating them.
Promote Self-Care
A recent National Council of State Boards of Nursing survey found that 45.1% of nurses reported feeling burned out, contributing to many professionals leaving the industry. While burnout isn’t a diagnosable illness, it does have physical and psychological symptoms that can have long-term negative impacts. Relentless workplace stress and toxic working environments can lead to sleep loss, weight fluctuations, anxiety, and suicidal behavior. It’s no wonder nurses are leaving the profession rather than risk continued burnout.
Certainly, some of the root causes of burnout are related to systemic issues that administrators must address. However, from the perspective of nurses supporting nurses, one of the key contributions professionals can make is encouraging one another to prioritize self-care.
Prioritizing self-care is challenging, particularly given how busy working life as a nurse can be. This only emphasizes the importance of keeping colleagues accountable for taking care of themselves. Nurses must encourage one another to take breaks, eat healthy meals, and engage in hobbies. Committing to looking out for signs of exhaustion and stress in one another can open up conversations leading to effective resources.
Another key form of self-care as a nurse is advocating against inequalities and toxic environments contributing to burnout. Particularly among nurses from marginalized populations, the cumulative effect of microaggressions can be disruptive. One study found that 80% of nurses have witnessed workplace or nursing school discrimination. It is important to talk to one another about the presence of these elements and present a united front in highlighting the problem to administrators and demanding change in the workplace.
Influence Inclusive Recruitment
There are certainly recruitment issues that contribute to the healthcare shortage. It’s important to recognize that one of the most positive ways nurses can help one another address this is to be meaningfully involved in influencing recruitment. After all, no one has better insights into the challenges, benefits, and needs of the nursing industry than those who are a part of it. Importantly, nurses from minority backgrounds can ensure recruitment approaches are more accessible and welcoming to a wider proportion of the population. This can help bridge the labor gap and bring much-needed diverse cultural perspectives into the industry.
It can be helpful to encourage administrators to engage in meaningful community outreach. This may involve arranging formal opportunities for experienced nurses from various backgrounds to visit schools or community organizations. They can then discuss the options and provide practical advice on pursuing the path.
During outreach, it’s vital to share nurses’ experiences that have made later life career switches to the industry or pursued educational courses despite tough socioeconomic conditions. Nurses can also act as much-needed mentors among still under-represented minority communities. One recent study found that only 19.4% of registered nurses are from minority backgrounds. These outreach efforts give community members a sense that people with similar challenges can thrive in the industry, which may prompt engagement.
It can also be wise for nurses to have frank discussions with human resources (HR) personnel about facilities’ current recruitment processes. It’s common for systemic biases to result in recruiters overlooking ways to reach more diverse candidates. There can also be cultural hurdles that HR staff must be aware of. Providing these insights and suggesting solutions can help more potential nurses enter the sector.
Conclusion
Nurses committing to supporting one another through the healthcare staff shortage is essential. Communicating with one another about the causes of the shortages can aid well-informed approaches to addressing the issues. Promoting mutual self-care – including advocating against toxic workplaces – can help mitigate the potential for burnout. Engaging in more inclusive community recruitment can also positively impact greater nursing numbers and more diverse professionals in the field.
Though nurses’ contributions can be invaluable, it’s also important to take only part of the responsibility for meaningful change on their shoulders. Nurses are already overworked and face significant career stress. Recognizing personal limitations, setting strong boundaries, and seeking solid resources are essential for navigating this difficult time.
Tara Rynders, RN, MFA, BSN, BA, admits she hasn’t had the easiest life. From when she was a child, though, she would heal from it through dance. In fact, she wanted to be a professional dancer before she thought about being a nurse.
“My earliest memory is of holding a neighborhood performance in my backyard—and it’s a lifeline that I’ve held on to through all of life’s highs and lows,” Rynders explains.
So Rynders graduated high school and headed to Hollywood. But she soon realized that the business was more focused on outward appearance rather than the inward healing dance provided.
“After my time in Hollywood, I realized that I wanted to be able to offer both emotional and physical healing. Nursing allowed me the entry point into that space. It’s a profession that offers flexibility to keep connected to my lifeline—dancing,” she says.
Trauma Hits Home
Rynders came to embrace dance and bring it into the world of nursing after her tough times. She cared for her mother until she passed. Rynders says that losing her mother made her entire world fall apart. At the time, she was working as a nurse but decided to reach out again to what had always helped—dance. So, she cut down her nursing hours to earn a master’s degree in dance.
Her sister became ill during that time and went into a coma for months. Rynders took off a semester and went to live with her in rehab until she was transferred from California to Colorado, where Rynders was living.
“In my sister’s hospital room, my dance and nursing worlds began to collide,” recalls Rynders. “Every night, I would dance to Miley Cyrus’s ‘Party in the USA.’ And I discovered that although my sister couldn’t speak, she could laugh. That became my goal—to make her laugh.”
When Rynders returned to school, she created an immersive theater performance called You & Me that was connected to her experience as her sister’s caretaker and her work as a charge nurse in the ER.
The show You & Me traveled nationally and internationally to more than five countries.
“What I realized when I cared for my sister was the gift that comes from having one-on-one intimate moments with another human being—to bathe her, feed her, and help be her voice,” says Rynders. “During the day, I would hold the suffering and loss with my sister, and at night we would hold the joy as I danced. It felt like I had both my joy and my grief coupled together in all that I did.”
One more scary experience brought Rynders to where she is today. When her twins were six months old, she learned she was pregnant again. But this time, it was an ectopic pregnancy.
“When I arrived at the hospital, things moved quickly. I remember the ER tech rolling me on the bed with too much force to start my IV; the ER physician and his caring face took extra time to see and listen to me. I remember feeling his compassion for my situation. I remember being transferred to a room when my fallopian tube burst and my abdomen began to distend with blood,” says Rynders.
“They called a code yellow—the code they call before a code blue when your heart stops. My room was full of people,” she says. “I passed out, but I could still hear everything being said. I felt my nurse grab my hand. She leaned into my ear and said, ‘I am here, and you will be okay.’ I remember thanking her for remembering me because I was so scared and couldn’t speak.”
This experience caused Rynders to have an epiphany.“I realized that nurses are everything to their patients–their voices, their advocates, their support, their healing hands. I experienced this firsthand as a patient and realized how many opportunities I was missing as a nurse to connect and see my patients authentically. I became passionate about this in my practice as a nurse and began researching authentic connection in nursing,” she says. “Everything pointed to one thing: our nurses are tired, overworked, and our healthcare systems are not set up for them to thrive and successfully care for patients.”
Rynders decided she was going to change that.
Bringing Dance to the Nurses
Pre-COVID, Rynders says that nursing leadership was downplaying nurses burnout. And in 2017, nurses weren’t ready to talk about it openly.
But the CNO and CEO where she worked approved her creating a two-hour immersive theater experience at the hospital to raise awareness of compassion fatigue and burnout. She created the performance with artists Jadd Tank and Lia Bonfilio and worked with playwright Edith Weiss.
“The 2-hour performance took place in the hospital and was open to the general public. The nurses, doctors, and other healthcare personnel testimonials were breathtaking. Most along the lines of ‘Thank you for giving us a language to understand the unrelenting grief and trauma we have been carrying with us,’” says Rynders.
After raising awareness about burnout, Rynders co-created, with Dr. Clare Hammoor, a six-week grief and trauma workshop series. The nurses connected with it so much that they began having monthly meetings post-workshop, which continued until COVID.
“At the height of COVID, my CEO asked me if I would come off the floor and focus on caring for our nurses as they cared for our COVID patients. This told me he also saw that our staff would need ongoing support,” says Rynders. The position was temporary, though; she would eventually work as a clinical nurse educator at another health care system.
Today, Rynders is also an advanced grief recovery specialist and a RESTORE (Resiliency and Equity Support and Training for Organizational Renewal) peer responder who is on call for health care personnel when they need immediate support.
“I help teach resilience, equity, and anti-racism courses for our entire system. I do this alongside my position as executive director of The Clinic Performance. I see both of these roles mutually honoring each other as I bring my whole self into all my experiences,” she says. “We dance in the hospital at our meetings, and having a pulse on nursing in the hospital setting is vital to creating workshops that tend to our nurses—meeting them where they are emotionally.”
Tara Rynders in her dance workshop
Dance Workshops
Rynders workshops touched many people and were so effective that Kaiser Permanente asked her to bring them to nurses across California. These six eight-hour workshops with up to 600 nurses began in April and will run through September.
“Our workshops are now titled (Re)Brilliancy, a play on the word resiliency. I was tired of hearing everyone tell us to be more resilient during the pandemic. Nurses are some of the most resilient humans I know. We need resilient systems that reflect the brilliant and resilient humans we already are. (Re)Brilliancy workshops help us reflect on and honor the brilliant and resilient humans we already are,” says Rynders.
Until they experience the workshops, nurses often don’t even realize that their stories or experiences have continued to both of them.
Rynders knows that her workshops are keeping nurses from leaving the profession. “I have seen firsthand nurses ready to leave—completely burned out and done with the profession. [They’ve] attended our workshops on an ongoing basis and have a rekindled joy and fervor for caring for themselves and their patients,” she says.
But more needs to be done.
“Nurses go into this field to make a difference in the lives of others. At some point, we begin sacrificing ourselves to do this. We don’t have to sacrifice our mental well-being. These workshops help us disentangle our worth and identity as caregivers from being directly related to how much we can sacrifice our well-being. Our workshops help remind us what we love, what we are passionate about, and what we need to feel seen, heard, and cared for,” says Rynders. “If healthcare systems want to retain their nurses, they need to start thinking creatively and bringing in non-traditional and innovative ways to care for their teams. Wellness must be embedded as a cornerstone that everything else builds upon.”
July is a prime month for sunburns, but protecting your skin from sun damage is a year-round task. No matter where you live, putting sunscreen on before you head out the door is just as important in the summer as it is in the wintertime. With July marked as National UV Awareness Month, this is a great opportunity to educate patients (and yourself) about protection from the sun’s damaging rays.
Skin protection doesn’t mean the end of beach days, but it does call for extra attention and a little planning. The American Academy of Dermatology Association raises awareness about this campaign each year and offers lots of resources and tips for folks who are interested in how to easily incorporate sun protection into their routines.
Many people realize that sunscreen is important to bring and use for a day spent outside, but the regular sunscreen habit is important for a few reasons. Making sunscreen a habit means you’ll protect your skin from damaging UV rays every day, not just when you’ll be outside for an extended time. And that makes a big difference over the course of your lifetime because all those smaller days without protection quickly add up with the minutes you’ll spend walking the dog, running errands, gardening, or sitting by a sunny window.
According to the Skin Cancer Foundation, the color of your skin makes no difference in the need to protect yourself from UV rays. Sun protection is essential to keep both cosmetic issues like wrinkles or premature aging and serious threats to health like skin cancer at bay. For people of color, the very darkest skin tones may offer some minor sun protection, but nothing that would offer the safety that sunscreen will. Companies are beginning to recognize how important it is to offer sunscreen that will work with different skin tones.
Sun protection also comes in other forms. You can wear hats with a wide brim to protect your face, ears, and neck, but even a baseball cap can help (just be sure to put sunscreen on the skin that’s not covered–particularly the tops of your ears and your neck). Tightly woven clothing can also offer protection that rivals an SPF (but a regular t-shirt offers only about the equivalent of an XXX SPF). Swim shirts and shorts are excellent for when you’re spending time in the water and won’t be able to reapply sunscreen frequently.
Of course, the earlier you start protecting your skin, the better. Many adults who have spotty or little history of using sun protection can take important steps now. Visiting a dermatologist every year for a full-body skin check will allow your team to spot any concerning changes in your skin. They should check every area of skin–from your scalp to between your toes–because melanoma, the most deadly skin cancer, can appear in areas that have never been exposed to the sun.
Between visits, keep an eye on your skin and don’t second guess new moles or areas that seem itchy, are bleeding, or look like a pimple that won’t go away. Those concerning areas need to be checked to rule out anything serious or to develop a treatment plan for something that is, or has the potential to be, cancerous.
