As we usher in the 116th Congressional Session beginning January 4, 2019, lawmakers (newcomers and incumbents) will have the opportunity to address a number of legislative and regulatory issues. Immigration reform, access to affordable health care, climate change, and national and global security are among a long list of issues that will be discussed and debated during this new congressional session. And while there are numerous competing demands as with all other legislative sessions, nurses are encouraged to remain abreast of issues that impact health care and the nursing profession.
This year promises to be another great year to continue improving our policy acumen and advocating for those issues that are most important to us and the communities we serve.
Moving forward in 2019, newly elected Lauren Underwood, MSN/MPH, RN, of Naperville, Illinois will represent the 14th Congressional District of Illinois beginning January 3, 2019. Rep. Underwood is committed to ensuring that everyone has access to affordable health care. She is currently one of two nurses serving in the U.S. Congress. Other nurses across the country hold elected positions in their state legislatures and government appointed positions or serve on a number of advisory committees or boards.
This session, lawmakers committed to eliminating health disparities will work to enact legislation that will propel us toward achieving health equity, particularly for underserved populations who suffer disproportionality from a number of illnesses and poor social conditions. No doubt the issue of health care reform will remain front and center, especially in light of the recent ruling from a federal Texas judge deciding that the Affordable Care Act is unconstitutional. Because this debate is far from being over, we must remain vigilant in monitoring what is happening with this historic legislation. And just as 2018 was deemed the Year of Advocacy by the American Nurses Association, we must be mindful that advocacy is always in season calling us to lend our voices on behalf of those we serve. Regardless of position or setting, every nurse can seize the opportunity to weigh in on policy issues that are of importance to them.
So, consider how will you stay engaged and informed of federal and local policies or regulations that may influence your practice or even the degree to which health care is available to those you serve. Remaining updated on policy issues is becoming even more essential for today’s health care professional. Our professional and specialty nursing organizations provide key resources and often have a specific policy agenda. Have you explored what your professional organization’s position is on a number of policy issues important to nursing?
Consider attending an actual or virtual lobby day this year. Each year nursing organizations such as the American Association of Colleges of Nursing (AACN), the American Organization of Nurse Executives (AONE), and the American Nurses Association (ANA) convene lobby days in DC but also provide opportunities to participate virtually for those who cannot attend in person. Visit their web sites for more details. Numerous state nursing organizations and other health related organizations across the United States also convene lobby days providing yet another venue to lend your voice to a number of health-related causes. And remember to touch base with the Office of Government Relations within your health care system, university, or college.
Be resolved to visit a legislative official this year to learn more about their health policy agenda and promote the profession as well. Commit to reading the local news for policy hooks as they say, “all politics is local.” Subscribe to the Federal Register to stay informed about opportunities to offer comments on proposed regulations, policies or key reports. The Register also highlights opportunities to apply to serve on national advisory committees. Volunteer to give testimony at hearings and town hall meetings as lawmakers can benefit from hearing directly from nurses on health care matters. Well that should keep us all pretty busy. In the meantime, check out some of the resources listed on the right to help with advancing your engagement in policy advocacy.
Key Resources to Stay Abreast of Health Policy and Legislative Issues
Nursing and Health Care Related Issues
Health Care Access and Other Health Care Related Issues
Health Equity and Disparities Reduction
State Specific Data
Check with your local and state Departments of Health to locate recent and local statistics.
Tracking Legislative Bills
During this week’s National Skilled Nursing Care Week (sponsored by the American Health Care Association), registered nurses working in these facilities can take stock of all they do to help their patients. Skilled nursing facilities help patients who require longer-term care and so nurses who work in these facilities often get to know their patients well. Nurses who are new to the career or who have particular interest in helping the populations served by a particular facility will find the experience they gain valuable.
Skilled nursing facilities often care for patients who require long-term care for conditions ranging from Alzheimer’s or dementia to people with physical or cognitive disabilities. Nurses working with patients in these settings help them with activities of daily living, medical care, and, often just as essential, a familiar and caring relationship. Because the people in these facilities are generally there for a long time, nurses are able to get to know them well and understand their needs, preferences, family dynamics and stories, and what helps them most.
Familiarity with patients also helps deepen the relationships nurses can develop in this setting. Rather than a nursing role where nurses see a patient just once or possibly only periodically, skilled nursing care facilities offer round-the-clock care for the same individuals.
RNs who are new to the profession often find skilled nursing facilities are a good place to work directly with patients and their families. Nurses who work there and with the same patients will begin to learn what an Alzheimer’s patient might find soothing or agitating. They will become acquainted with how someone prefers to move around or the music they like to listen to. With this kind of familiarity also comes the ability to see small, but significant, changes in a patient. Nurses might recognize a decline with troubling behavior or improvement in someone’s condition.
They also offer opportunities for leadership roles and exposure to more complicated care situations. Skilled nursing care means you will assess people over a span so you can monitor factors like their medications, food intake, and socialization as their physical condition undergoes changes. If an injury has caused limited mobility, various impacts like weight gain or less social interaction can change a patient’s mental and physical health. As a longer-term care provider, you can advocate for your patients when you see these subtle changes.
As nurses become more experienced, they also might find a specialty they want to pursue more. As some skilled nursing care facilities are for older patients, nurses might find they want to pursue certification in a gerontological nursing. They may choose to become a certified rehabilitation registered nurse if they work with people who have had life-altering injuries.
As skilled care providers, nurses should always be aware of the help and care they give and just how deep of an impact that makes on patients. Nurses also want to be mindful of their own health and be aware of any feelings of burnout. Taking good care of their own physical and mental health will help them offer the best care while also leading a balanced life.
The American Association of Neuroscience Nurses (AANN) honors the dedicated efforts of nurses whose work focuses on the brain during this year’s Neuroscience Nurses Week (May 12-18). Neuroscience nurses work with multidisciplinary teams as the field can involve so many body systems.
According to the AANN, neuroscience nurses have many roles. They care for those who have suffered brain injury or trauma from an accident. They also work with patients who may have neurodegenerative conditions like Alzheimer’s, multiple sclerosis, Parkinson’s, or epilepsy. They may care for people with spinal injuries that impact brain activity. And care offered to patients can be short-term for recovery or long-term for life-long illnesses or those that have progressed.
The American Board of Neuroscience Nursing offers certification for nurses in this field. Nurses who are fascinated by all the activity and operations of the brain are bound to gravitate toward this specialty. They also have an opportunity to make an impact throughout the field by assuming roles within care units or extending their reach into policy and legislation, academia, administration, or research.
Advances in brain science are moving rapidly and each new development can have a life-changing result for today’s neuroscience patients. Certification boosts the recognition for nurses who want to take the extra step and become as informed as possible about these developments, evidence-based practices, and patient care.
Neuroscience nurses work with all ages of patients and so they must understand the body systems of infants all the way up the the most elderly of patients. They are there to help people live a successful life with whatever condition they have or cope when the conditions or situations worsen. These nurses are also there to help with the physical, emotional, social, and even daily activity implications of brain functions. They help families learn to care for their loved ones and educate them about different conditions and symptoms. They can also help them recognize even the slightest progress or be alert for any red flags.
No matter what path of neuroscience a nurse chooses, being a patient advocate is one of their biggest responsibilities and one they are often most dedicated to. People with neurological issues can’t always advocate for their own needs so nurses are there to help them get what’s necessary to live their best life.
Nurses can spread the word about Neuroscience Nurses Week and come together with their own groups in their organizations. They can take stock of the year’s accomplishments and make plans for continuing to provide patients with the best, most cutting-edge care possible.
Catie Harris, PhD, MBA, AGACNP, FNP, ANP, and a nurse entrepreneur, knew she loved nursing, but she also knew the crazy schedules weren’t giving her the balance she needed and wanted in her life. Rather than leave nursing, Harris took another look at how she could continue in an industry she loved, but with more control over her schedule, projects, and even her salary.
With her knowledge from a nursing career and a business degree and a lot of innovation, NursePreneurs was born. Harris is determined to help other nurses find a nursing path that suits their needs best.
For National Nurses Week, Harris recently answered a few questions from Minority Nurse about the importance of finding your best path.
Many people, nurses included, overlook the essential business skills nurses bring to the industry. How can nurses determine if an entrepreneurial path is a good match for them?
Nurses are trained in nursing school to be entrepreneurial. In fact, I relied more heavily on the nursing process to teach me how to run my business than anything I learned from getting my MBA. That might sound surprising, but the MBA teaches you how to operate within a business, not start one from the ground up. Whereas the nursing process teaches you how to assess a population, diagnose a problem, plan for a desired outcome, intervene with the solution and evaluate the response. These are the essential business skills needed to be an entrepreneur. Even though every nurse learns this entrepreneurial design in the nursing process, not every nurse wants to become an entrepreneur. There are certain qualities that simply stand out in entrepreneurs such as:
- Adaptability – business is inherently risky and unpredictable. A business rarely becomes successful from the first unaltered idea. When the idea is floated to an audience, the market decides what it wants and the entrepreneur either adapts the business or risks failing. An entrepreneur must be flexible enough to adapt to whatever evolution the business needs to go through to evolve and sustain itself. Change is inevitable and an entrepreneur has to be willing to accept it frequently.
- Resilience – there will be many failed attempts at starting and scaling a business. An entrepreneur must see every attempt as an experience and not a failure. No entrepreneur would ever be successful if they focused on all the things that go wrong. Entrepreneurs must see every obstacle as a challenge to overcome and not a dead-end.
- Persistence – Entrepreneurs have to be persistent. A “no”, simply means your audience doesn’t understand what you are offering and the message needs to be adjusted. You have to be ok with getting candid answers to the solution your provide. Entrepreneurialism is not for people who attach all their self-worth into a solution or suffer from perfectionism.
- Excellence – Entrepreneurs love to over deliver and provide massive value. They are consumed by learning, growing and sharing their knowledge. The entrepreneurial path is for people who want the freedom to pioneer their own way and decide how to focus their attention and energies. This is definitely not the space for anyone who needs to follow an agenda.
In what ways can an entrepreneurial nurse make an impact on healthcare policies and industry practices and, of course, patients?
All nurses can make a huge impact on healthcare policies, industry practices and patients. Being at the bedside, nurses know more than anyone what patients need, want and desire. Nurses are the number 1 trusted profession, and because of that ranking, patients trust us with incredibly sensitive information. Patients tell us their fears and frustrations about their disease and health conditions. Nurses are in a unique position to use that information to create businesses that serve the patients in a way that benefits them.
Nurses are also keenly aware of how hospital policies and industry standards impact the services provided to patients. For instance, one of my students is working on a business model that helps cancer treatment centers to educate their staff on how to communicate with patients. There are many questions and concerns that patients have that never get addressed out of embarrassment, worry that they are taking up too much time or being burdensome or because they simply don’t understand what is going on. This type of business has strong potential to alter how cancer education is delivered in the healthcare system.
What can nurses do to gain business skills and education that will help augment their nursing skills?
Nurses can gain business skills and education through books and online education. There are many groups out there who are helping nurses to gain the knowledge they need to support their business models. Investing in seminars, conferences and networking events is also hugely beneficial. Finally, nothing will fast track business success more than finding a mentor who has done what it is that you want to do and start working with that person as early on as possible.
How did you discover this path for your own nursing career?
I have had the entrepreneurial itch for decades! I also suffered from “bad employee syndrome”, meaning I always wanted to pioneer my job in directions that weren’t exactly in line with what my employer had in mind for me. I didn’t like being reigned in and having a defined job. I wanted to explore what was possible and continue growing and learning. The only “job” that truly allows this type of occupational freedom is the one you can create for yourself. I might not have started my business if I found a job with occupational freedom that paid well, but it didn’t exist for me, so I created it.
What makes your role as a nurse entrepreneur so rewarding?
I love seeing the impact of my students on their clients. When they have success, I celebrate it as if it were my very own. When you see how your work helps others to help others, it’s incredibly rewarding. My goal is to help 1000 nurses to start up their businesses in the next 2 years. Imagine the impact of 1000 nurses in business helping others to achieve healthier lifestyles, improved outcomes and live happier lives. Pursuing my passion, living my purpose and using my talents is what makes being a nurse entrepreneur so rewarding.
There’s no better time than during National Nurses Week to pay attention to the skills nurses have that aren’t acquired in any classroom. Kristi Tanisha Elizee, RN, BSN, and a current master’s degree student focusing on Clinical Nurse Leader (CNL), knows first-hand about the power of a nurse’s intuition.
This past February, Elizee was working the NICU night shift of a Kansas hospital and had been assigned to a mother-baby pair. From the hand-off report with the previous nurse, she had been told, and was able to observe, the baby had head-molding after delivery. Although Elizee noticed the baby’s head looked strange, continued observation revealed only typical behavior. The baby slept, woke, and breastfed well about every three hours.
When she went to perform a head-to-toe assessment of the baby (after notifying the parents), Elizee became alarmed. “When I assessed this baby’s head I could not believe what I felt,” she says. “This baby’s anterior fontanelle was very wide and bulging which extended to her forehead. On top of her head felt soft, the posterior fontanelle was not palpable, and in the same area where the posterior fontanelle was supposed to be, instead the skull was protruding.”
All the baby’s vital signs were good as were the other assessments of the baby, but Elizee knew something was wrong. She also knew she had to trust her intuition. “For me, this was not head-molding,” she says. “I brought the baby back to her mom’s room and immediately went to review the doctor’s documented assessment again on this baby.” Everything appeared to note head-molding, so Elizee, who would need to perform another assessment in four hours began researching information while monitoring the baby and her other patients.
“I saw a variety of problems including pictures of the way this baby’s head was shaped, and it was called ‘Craniosynostosis,’” she says. According to the Mayo Clinic, “Craniosynostosis (kray-nee-o-sin-os-TOE-sis) is a birth defect in which one or more of the fibrous joints between the bones of [a] baby’s skull (cranial sutures) close prematurely (fuse), before [a] baby’s brain is fully formed. Brain growth continues, giving the head a misshapen appearance.”
Elizee wasn’t sure if what she found was the problem, but she had to speak up. “I was not sure what this baby was diagnosed with but I knew this baby’s head was not normal,” she says. She notified the other nurse on the NICU shift, then her supervisor, and the providing physician was immediately called. The physician initially believed the baby had head-molding as well. “I started to doubt myself again, but I knew deep down this was not normal,” Elizee says. After performing her own assessment, the physician agreed with Elizee. From there, a pediatrician came onboard, and Elizee says she carefully documented everything.
The experience has been simultaneously transformative and heartbreaking. “I have never cared for a baby diagnosed with this condition before so this was my first time,” she says. “The day after when I came back to work, the nurse whom I gave report to about this baby, told me that my assessment findings were right. They had to do a head CT scan and it revealed that this baby had ‘Craniosynostosis.’” The baby was referred to a different hospital, and although Elizee doesn’t know her current story, she’s confident that her persistence made a huge difference in the baby’s life.
“I just had a gut feeling that what I felt was not normal and knew I had to speak up,” says Elizee. Although she doubted herself based on what others were saying, Elizee says she had to honor her intuition. “Nurses just need to follow their instincts,” she says. “Once you know it is not normal or not right, then take action. Do not second guess yourself.”
Big Move for Her Career
Elizee hails from St. Lucia. “I made the decision to move to the U.S.A for growth and development through Avant Healthcare Professionals, an international nurse recruiting agency,” says Elizee, who says she initially considered a career as a veterinarian. “I want to take my nursing career to the next level.”
Oddly enough, Elizee had been considering a switch out of NICU because she was struggling with the role. “When I first started working as an RN new grad, I worked on the medical unit for a month, later I was sent to work in the NICU which I have been in for eight years,” she says. “The first few months being there was tough, and I almost made the decision to go to another unit to work. I was just not enjoying it.” But her NICU nurse-manager noticed and became Elizee’s mentor.
Under her guidance, Elizee says she gained confidence working with these tiny babies—none of whom can tell their caregivers what is bothering them. The experience made all the difference. “NICU is a challenging place to work,” she says now, “but I love the challenge. Every day is a learning experience, and I am embracing it. Now I want to become a neonatal nurse practitioner.”
How to be a charge nurse may not be part of your nursing school curriculum, but it will likely become part of your nursing career, particularly if you are working in a hospital. Generally, it’s a position that appeals to only a few nurses because it comes with a tremendous amount of responsibility, both clinical and logistical.
The charge nurse can be described as the sieve through which all information and people must pass on a given unit. The role may have mild variations depending on the type of unit, but ultimately, the charge nurse oversees the nursing staff, patient bed assignments, and almost anything that affects those two factors. The nurse in charge is the first tier in the “bumping up” process, whether it be a staff grievance, patient complaint, near miss, or sentinel event.
Needless to say, one of the prerequisites is relatively thick skin. However, if you are the sensitive type, acting as charge nurse need not be faced with dread; it can either be the bane of your existence or perhaps simply a valuable exercise in character development.
When a patient is scheduled for admission to the unit, whether immediately or with just several hours’ notice, the charge nurse finds and assigns the patient a bed and a nurse. The process is hardly ever simple. If the unit is full, the charge nurse must find a way to either justify another patient’s discharge or to fight the incoming patient’s admission. One rarely finds a consensus among stakeholders in this situation: the receiving unit of your discharged patient may push back, the incoming patient’s team may hurry you, the staff nurses may argue for changes to their assignment, and the patient’s physicians or families will have their own agenda. Depending on where you work, this may all be happening while you manage your own patient load.
There is good news. The key to success for any charge nurse is awareness, namely awareness of resources. It is absolutely essential that every charge nurse knows the boundaries of his or her scope. That will likely be institution-specific and thus easily accessible. For example, if you are a charge nurse in the OR and two surgeons try to book emergency cases at the same time, it behooves you to know who makes the call of who goes first. (Hint, it’s probably not you.)
Navigating your work within the confines of the boundaries established by your employer will arm you with the tools necessary to find the sweet spot between authority and your peers as a charge nurse. And no matter how pressured the work may feel, you must always take time for a deep breath.