Nurses have enormous impact on lives and in ways they can probably never imagine. Although neonatal nurses care for newborns and infants, their lasting impact is often remembered over decades.
Today is National Neonatal Nurses Day and the end of National Neonatal Nurses Week, and is a tribute to the ways these nurses change the lives of the tiniest patients. But it’s not just the babies these nurses save—the families of those babies never forget the nurses who cared for their children when they were at their most vulnerable.
If you’re a neonatal nurse, today’s a good day to reflect on how your efforts have a ripple effect. As you care for your patients, think of all the families you have worked with and helped over your career. Then think of all the people who loved those babies as that child grew to a toddler, teenager, or adult and went out into the world.
If that’s an emotional thought, that’s the reason why neonatal nurses are so passionate about and committed to the sometimes joyous sometimes heartbreaking work they do. They care for the newborns who need medical care for a range of medical issues. Their life-saving work is generally done in neonatal intensive care units (NICU), but they may also work in varied level nurseries. Some of these nurses will also make home visits and work in the community to care for sick infants. The infants can range from the tiniest premature baby to a full-term baby born with a critical illness.
If you are interested in a career in this nursing specialty, the National Association of Neonatal Nurses is an excellent resource. Nurses can work as a registered nurse or as a neonatal nurse practitioner. Your educational path will include a master’s degree and potentially a PhD if you want to work as a neonatal nurse practitioner, while a bachelor’s if often sufficient as a registered nurse level. Responsibilities increase between the registered nurse and nurse practitioner levels, as do salary rates.
Neonatal nurses are expected to have a high level of technical competency, and they must remain up-to-date on the constant advances in the field. Certification, as with any nursing field, is always recommended. Certification gives you the advantage of keeping your skills and your knowledge current. The American Assocation of Critical Care Nurses offers three separate certifications for neonatal nurses: CCRN (Neonatal), Acute/Critical Care Nursing; CCRN-K (Neonatal) Acute/Critical Care Knowledge Professional; ACCNS-N (Neonatal), CNS Wellness through Acute Care. There’s no shortage of the ways you can continue your professional and academic path after you earn your degree.
Nurses in this specialty must also have a level of empathy and compassion to care for the tiny babies and the people who love them. You are, in essence, treating the entire family. Helping them navigate the scary ups and downs of daily life in the NICU isn’t easy and is sometimes distracting, but families look to neonatal nurses to guide them. The bond many nurses develop with the families they work with are often strong and lasting. Some of the biggest rewards are hearing back from families years later of the positive effect you had in their lives.
The art of de-escalation is an invaluable tool developed primarily to defuse hostile individuals and situations. In its original usage, the concept of de-escalation implies the existence of both verbal and non-verbal skills and techniques which, if used selectively and appropriately, may reduce the level of an aggressor’s hostility and emotional reactivity.
Although violent incidents may come from a variety of different sources, aggressive and hostile patients appear to be the largest source of workplace violence in the healthcare setting (OSHA, 2015). In 2013, 80 percent of the serious violent incidents reported were primarily caused by interactions with patients in the clinical setting (OHSA, 2015).
Since potential aggressive incidents is an acute behavioral emergency that frequently require immediate intervention, qualified nurses must be prepared to utilize the following de-escalation skills and techniques to promote patient safety and staff protection.
1. Maintain a Calm Demeanor
Maintaining a calm demeanor and intervening early with less restrictive measures, such as verbal and non-verbal communication, reduced stimulation, active listening, diversionary techniques, and limit setting can help relax the patient and promote a culture of structure, calmness, negotiation and collaboration, rather than control. If nurses remain calm and cooperative, the patient will most likely mirror their behavior.
2. Practice Active Listening
While most nurses are often tempted to retaliate when dealing with an aggressive patient, active listening and watching for nonverbal cues may be helpful in the de-escalation process. Active listening is pivotal in pre-empting an angry outburst by looking for, or listening to paraverbal communication that is tone, inflection, and volume.
Since most patients that arrive at the hospital are fearful or anxious, it is not uncommon for some patients to utilize anger or aggression as a coping mechanism. Therefore, nurses should utilize active listening as a tool to help comfort and reassure patients that they are invested in their safety and recovery.
3. Provide Patients an Opportunity to Vent
After actively listening to the patient, nurses must be able to offer thoughtful comments that demonstrate an awareness of the patient’s unique feelings and concerns. By offering patients an opportunity to vent, it allows the nurses and patients to work collaboratively and address underlying issues.
When a patient appears to be upset or is demonstrating early signs of anger, it is imperative for nurses to substantiate what they see or hear, so that the patient feels validated. Often times, nurses are accustomed to telling patients what to do, that they forget to provide patients an opportunity to sufficiently express themselves. Therefore, when nurses provide patients a chance to vent, it not only provides patients an opportunity to voice out their frustrations but also diminishes the likelihood of physical violence to ensue.
4. Display a Non-Defensive Posture
Another important technique that must be considered when de-escalating an aggressive and hostile patient is displaying a non-defensive posture. By keeping the hands in front of the body, open and relaxed, and maintaining appropriate eye contact, it illustrates authenticity and compassion towards the individual. While proper eye contact is subjective however, it is imperative not to stare.
Since a nurse’s reaction can greatly influence the emotional reactivity of highly dysregulated patients, the nurse must maintain a neutral expression at all times. By remaining calm and sustaining a neutral appearance, patients are less likely to overreact allowing nurses to regain control of the situation.
5. Impart Empathy and Compassion
Lastly, nurses should also be able to properly express their concern by conveying empathy and compassion towards the patient. The art of empathy and compassion helps reassure patients that they are not alone. Paraphrasing can be an effective tool in de-escalating a patient because it not only communicates empathy but also demonstrates understanding. By using phrases such as “I understand how difficult this can be for you,” nurses can connect with patients much more effectively which can help facilitate the healing process by re-establishing trust and rapport.
Once the patient is successfully de-escalated, the nurse is then responsible for settling any unresolved feelings or concerns the patient may hold. During the resolution stage, the nurse should identify how the patient would like their anger to be dealt with if and when a similar situation recurs. During this time, the nurse should work collaboratively with the patient to re-establish therapeutic rapport and ensure all feelings and concerns are individually validated.
There are those who consider themselves ineligible for nursing because they are afraid of needles, shriek at the sight of blood, or believe they couldn’t handle the pressure of caring for sick patients.
So-called “squeamish” individuals need not write off nursing as a career. There are many nonclinical roles in nursing such as research and leadership, but they often require nursing experience. The following is a broad overview of careers for the squeamish nurse.
Within the Hospital
Many mental health nurses are not exposed to trauma, and depending on patient acuity, they may only administer oral medication. Similarly, nurses in narcotic detox facilities give out medication by mouth and rarely, if ever, deal with the more physically graphic aspects of nursing. Naturally, there are other considerations one would need to take into account in terms of disposition when addressing these patient populations.
There are hospital positions that require little to no medication administration. For some pre-procedure nurses, their work often focuses on preoperative interview and assessment. This may involve minimal physical contact with patients, such as assistance with surgery prep, disrobing, or preoperative skin prep. It requires well-developed assessment skills and familiarity with different surgical procedures. These positions will depend on how the facility distributes perioperative responsibilities among nursing.
Mother-baby nursing may be an appropriate position for the mildly squeamish nurse who can handle the occasional unexpected event. To the extent that mother-baby nurses are not required to rotate through labor & delivery or work with high-risk births; their role is mainly assessing newborns and managing the care of young, and mostly healthy mothers. This type of nursing involves a unique, highly specialized skill set for working with the youngest patients.
Outside the Hospital
Home health nursing positions are increasing where registered nurses oversee the work of ancillary nursing personnel, such as home health aides, and certified nursing assistants. Home health nursing may involve direct patient care where nurses assess patients, administer medications, and refer to advanced practitioners for any changes in patient regimens. Home health nurses may also work with insurance companies to protect patient coverage and advocate on their behalf.
Similarly, case management uses nursing expertise in a nonclinical setting. Nurses utilize their understanding of patient population-specific needs, but they do not provide direct patient care. More commonly, case management involves advocating for patient access to necessary services and following up with patients to ensure their health needs are being met.
Outpatient clinic and primary care nursing focus on assessment and treatment of minor illnesses. Under this umbrella are school nursing and specialized outpatient clinics, such as internal medicine, pain management, psychiatry, and orthopedics. Primary care nurses do administer medication and perform wound care, therefore, the squeamish nurse may want to investigate site-specific duties.
Aesthetic nursing may be a good choice for a nurse who doesn’t want exposure to sick patients. This is a growing skill set within nursing and nurses can generate a lucrative income. Nurses in these roles will often administer injections.
It is important to keep in mind that every employer has different expectations and policies. Each individual must understand their own personal limits and job requirements before taking a nursing position. Furthermore, even positions suitable for the squeamish nurse require highly specialized skills and critical thinking.
All nurses are trained to work with a variety of patient populations, including the acutely ill. There is no way through nursing school without exposure to situations that many would consider either upsetting or even repulsive. That being said, there are many nurses who formerly identified themselves as queasy in the face of illness who find the reality of patient care much more tolerable than they anticipated. For many nurses, the spirit of service, and perhaps a bit of repeated exposure, together outweigh the upsetting sensory experience they formerly identified with nursing.
According to The Harm Reduction Coalition, harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It was originally coined to address substance users but its implications have broadened as its application has become meaningful among other populations. Nurses are empowered to employ harm reduction techniques, whether or not they work in practices specifically dedicated to that aim. This can be done through direct care with individual patients or on an administrative level.
With Individual Patients
With experience, every nurse becomes familiar with the nature of their role as caregivers. Nurses’ responsibility is to treat, care for, and educate patients, in accordance with the dictates of advanced practitioners’ directed care. It is not, however, within the nurse’s scope to ensure that every patient lives and acts according to their prescribed treatment plan. It is not uncommon to encounter patients who are noncompliant or noncooperative with treatment. For these patients, harm reduction can be a helpful guiding principle for nurses.
Nurses can utilize the principles of harm reduction with the more salient issues of IV drug use and risky sexual behaviors but also use them for smoking, diabetes, and hypertension. Nurses can minimize the negative effects of patient choices that are counter to their well-being by offering alternatives without requiring patients to practice complete abstinence.
Patient education is the greatest technique of harm reduction that nurses always have at their disposal. For willing patients, understanding the resources that are available to them is key to taking actions that minimize their risks. Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) for HIV/AIDS has led to great strides in limiting the spread of the disease. Many patients would not even know about the option to protect themselves in this way if it wasn’t for having trusted resources in their health care team. Knowing about local smoking cessation, needle exchange, condoms, PrEP/PEP, and health promotion programs is a great tool for any resourceful nurse.
On the Larger Scale
For nurses who see a trend among patients who could benefit from harm reduction programs, it is within their purview to address these issues on an administrative level. It is not uncommon for policy changes to be initiated by a brave nurse who decides to use his or her voice to advocate for patients. These nurses choose to go beyond knowing about resources and encourage their employer, or even their government to be the resource. This can be unit-wide, facility-wide, or even taken to Capitol Hill to enact change on a government level.
Harm reduction started out as a small group of providers taking action to support IV drug users. They discovered that imposing abstinence on a patient who isn’t ready can actually preclude their care. Harm reduction has become a broader term that allows patients to make the lifestyle choices that they would anyway, without severing their connection to health care resources that can protect them from potentially devastating consequences to themselves or their community.
The important role that nurses play in our society cannot be overstated. From their bedside manner to their deep medical understanding, nurses have long been the backbone of our health care system. Now, many nurses are transitioning to a new and influential role: nurse entrepreneur.
With unique insight into what the health care industry needs, nurse entrepreneurs can create businesses that help patients and nurses. Many nurses have successfully made the shift from practicing nursing to running a business, and their nursing skills play a big role in their ability to perform well.
WHAT EXACTLY IS A NURSE ENTREPRENEUR?
Nurse entrepreneurs apply their nursing backgrounds and professional experiences to create businesses in the health care industry. Much like other entrepreneurs, they identify a need in the marketplace and conceptualize and build a business that fills that need. They may offer independent nursing services, such as patient care or consulting, or create and sell medical devices or home health care products. Others take on writing or coaching roles.
Just like any entrepreneur, nurse entrepreneurs usually take on a great deal of risk because starting a company always comes with the possibility of financial loss. They may have to work to find investors and experts to help them successfully launch their business.
The Nurse Buff blog has recommended identifying a problem in the health care field that you have the skills to fill, creating a business idea to help alleviate the problem, identifying your target market and studying your competition before you start a nursing business. In short, like any person launching a business, nurse entrepreneurs should carefully research and consider their moves to ensure they bring the right product or service to the right audience.
It will take long hours and undoubtedly some setbacks to get the business off the ground. Entrepreneurship is no easy task, but nurses seem to be up for the challenge. In fact, for many nurses, entrepreneurship helps them avoid nurse burnout and apply their skills in new and exciting ways. Whatever the specific nurse entrepreneur idea, it’s easy to see how nursing skills can help professionals easily transition to running a business.
TRANSLATING A NURSING BACKGROUND TO BUSINESS
Research based on data from Census Bureau and the Internal Revenue Service between 2007 and 2014 revealed that entrepreneurs were 125% more successful if they had previous jobs, especially in the field where they were starting a business. That means, nurses have a good chance of succeeding when launching nursing related businesses given their background in the health care field.
Many nursing skills translate nicely into entrepreneurship. Outside of all the scientific knowledge nurses must possess, they also have a plethora of skills they use in their professional nursing careers that help them transition perfectly into the entrepreneur role. Here are a few:
Nurses must be able to communicate with professionals and patients from a wide range of backgrounds daily. This helps them when they start a business because they’re able to connect easily with various stakeholders and customers.
Nurses learn to be incredibly organized because their patients’ well-being depends on it. These organizational skills make them incredible business leaders who can keep track of many moving pieces.
Nursing and entrepreneurship are similar in how they throw curveballs constantly. Nurses have to think on their feet and adapt quickly, traits that allow them to be successful business owners.
Nurses have been on the front lines of the health care industry and understand it in a way that outsiders simply can’t compete with. As mentioned above, this experience makes them exceptionally prepared to be successful entrepreneurs.
Long shifts, tough situations and the drive to help others give nurses perseverance that is hard to match. Nurses know that challenges will be put in their path, and they’re skilled at finding ways to overcome them. This is an admirable trait in an entrepreneur.
BUILD YOUR NURSING SKILLS
A great step to consider when making the transition from nursing to business is expanding your horizons in the classroom. Furthering your education with a bachelor’s degree can give you experiences that you can apply to both your nursing career and future business ventures.
These are just a fraction of the skills nurses have that help them make incredible entrepreneurs. Their skills coupled with their unique insight into the health care industry have helped many nurses create unique and useful businesses.
SUCCESSFUL NURSE ENTREPRENEUR IDEAS
Nurses are on the front lines of health care. That’s why they’re able to create ideas that positively affect the industry. Here are a few successful nurse entrepreneurs.
SHARON ROGONE, SMALL BEGINNINGS, INC.
Sharon Rogone worked as a NICU nurse in the 1980s. In that job, she made many makeshift tools when what was provided wasn’t right for tiny babies, some under two pounds. With just $2,000 in her pocket, she started Small Beginnings, Inc. The company makes products specifically designed for premature infants, such as diapers, positioning solutions and pacifiers. Since its founding in 1981, the company has grown significantly into a huge operation. Sharon and her products were added to the Smithsonian archives in 2008.
KEITH CARLSON, NURSE KEITH COACHING
Keith Carlson became a nurse in the mid-1990s. He worked in various specialties and leadership roles before becoming a nurse entrepreneur. He now helps other nurses navigate their nursing careers with his career coaching business, hosts a podcast called The Nurse Keith Show, and works as a freelance writer while maintaining his blog called Digital Doorway.
ANTHONY BATTAGLIA, POCKET NURSE
Former nurse Anthony Battaglia saw a need in the nursing realm in terms of simple organization. In 1992, he developed Pocket Nurse. At the time of its founding, Pocket Nurse offered one product, a pocket organizer that included bandage scissors, a hemostat, an integrated penlight and a nameplate. Now, the company offers more than 5,600 products including nursing simulation tools and medical supply solutions.
MELISSA GERSIN, TRANQUILO
As a maternity nurse and certified infant crying specialist, Melissa Gersin often saw new parents struggling with colicky babies. She felt it was her life’s mission to help these parents overcome the challenges of the newborn days. Her invention, the Tranquilo mat, mimics a mother’s womb with vibrations and white noise. Tranquilo launched on Shark Tank in 2017, and the company has sold tens of thousands of mats since.
These nurses are just a few of the professionals who identified a need and used their nursing background to turn that need into a profitable business. Today, more and more nurses are discovering that they can make a difference not just in the health care community, but in the business world, as well.
HOW TO BECOME A NURSE ENTREPRENEUR
There’s no clear path to becoming a nurse entrepreneur. While most nurse entrepreneurs hold multiple nursing degrees and have extensive professional experience, each nurse entrepreneur’s path will be different, and that’s to be expected. The important thing is to be thoughtful in your approach.
A great step to consider when making the transition from nursing to business is expanding your horizons in the classroom. Furthering your education with a bachelor’s degree can give you experiences that you can apply to both your nursing career and future business ventures. Notre Dame of Maryland University’s online RN to BSN program allows you to develop the skills you need to enhance your nursing career, whether in a health care setting or entrepreneurship. Plus, we help you do it quickly. Most students complete their online program in 15 to 18 months.
On most days nursing is extremely rewarding. At the end of our shift, we feel we’ve done a good job caring for the needs of grateful patients. But occasionally, we encounter patients who test our patience and make it challenging to effectively care for them. So how can we improve the situation when caring for difficult patients?
1. Lend an Ear
No one is at their best when they’re in the hospital, a rehab center, or receiving medical care at home. They may have pain or nausea, or maybe they are still struggling with a change to their ordinary lives as a result of an accident or illness.
Provide them with an opportunity to talk about their situation if they feel comfortable, and make the effort to actively listen. Nurses can get caught up in the endless to-do list on any given day and aren’t always able to take the time to connect adequately with their patients. While listening closely to them, a nurse can learn what a patient’s expectations for recovery are as well as any concerns they may have about their care or prognosis.
2. Body Language Barrier
During a day’s work, our patients are often in a hospital, home bed, or sitting in a chair. When we are talking to them, we’re standing above them, which can make them feel uncomfortable. As often as possible, make the effort to put your body on the same plane as theirs. Avoid crossing your arms over your chest, putting your hands on your hips, or in your pockets, none of which communicates receptiveness and may further agitate someone who is already upset. Face them when speaking to them and modulate your voice appropriate to their hearing ability.
3. Culture Clash
Does your patient have a culture different from your own? Be respectful of any differences and try to learn what you can about their culture. You can learn either through resources available to you or by asking questions, but only if they’re receptive to educating you about their ways.
4. Build a Bridge to the Unknown
Alleviate any concerns they may have about what is unknown to them. Encourage discussion about their health condition, medications, or upcoming procedures. Welcome questions that will allow them to open up. Building a relationship with them can motivate the patient’s own investment in their care and help smooth a rough nurse-patient relationship.
5. Autonomy Can Be Helpful
Many patients express feelings of helplessness in the face of their illness, which can lead to difficult behaviors. Restoring some of their autonomy can go a long way to returning a sense of control within their lives when caring for difficult patients. Allow them control over that which can be allowed: bathing, medication times, meal times, and any other choice that can be accommodated without contradicting their physician’s orders.
Making the extra effort to reach out when caring for difficult patients can often smooth the path to a better nurse-patient relationship.