Let Me Tell You a Story: Teaching and Learning through Narrative Pedagogy

Let Me Tell You a Story: Teaching and Learning through Narrative Pedagogy

Storytelling is the oldest form of education; storytelling has been used to communicate critical information about safety, recipes, teach lessons, remove bad habits, and explain events. In our various cultures we hear stories from our family members, in school, and at work. It is part of our oral tradition and how history is shared. I remember hearing stories as a child that explained why we have certain practices and why humans have internal ethical struggles. The lessons from these stories stuck with me in a way that made me evaluate my choices carefully when making a critical decision.  When these tools are used to teach nursing students they can have a wondrous effect.

Storytelling and mental modeling often go hand in hand; when people are told of a situation or told a story, they will work out the process of that situation within their brains to see how the situation resolved or could have resolved if other steps were taken. The individual may go through different algorithms to work out the most correct path for the situation. This is a clear demonstration of critical thinking and may help with improving clinical reasoning in nurses.

Research shows that storytelling is a method of learning that can be transferred; students remember the “war stories” that their nursing instructors have told them about their clinical experiences. I can remember being told a story by an instructor about a congestive heart failure patient that she had that was receiving fluid and developed wet lungs and frothy pink sputum. She was so vivid in the way that she was describing the sputum that I never forgot to correlate strict intake and output with congestive heart failure patients. As a nursing educator myself, I have told stories of patient care that aligned with what I was teaching to the students to the students didactically and have later gotten a phone call or email from a student saying that they saw a similar case in clinical or in their practice and remembered what I told them.

Storytelling is an excellent method of instruction and provides auditory and visual stimulation to learners in a manner that connects to the concepts being taught to the students. And they provide an opportunity for reflection and transference. Telling a story in the right context that links to the concepts being taught may help the individual visualize the situation in their mind and then practice the concept/skill.

How are you using storytelling in your instructional practices?

“Stories are a communal currency of humanity.” —Tahir Shah, in Arabian Nights

Job Search Tips for Minority Nurses From Headhunter Nick Corcodilos

Job Search Tips for Minority Nurses From Headhunter Nick Corcodilos

Are you about to start a job search and confused by all the changes within the world of nurse recruiting and not sure who to ask?:

“A recruiter sent me a DM on Snap—what do I do?”

“I got a recruiting text from a bot—what do I do?”

“I submitted a ton of online applications to hospitals but I’m not getting call backs—what do I do?”

Well, who better to advise you on your job search than a nationally-known recruiter? Nick Corcodilos, publisher of the popular website Ask The Headhunter has all the answers. His work has appeared in The Wall Street Journal, Reader’s Digest, USA Today, The New York Times, Fast Company, and PBS NewsHour.

In this Q&A interview, Nick delivers hints and tips specifically for minority nurses, who may have unique roadblocks along their job search journey.

For example, there is some evidence of name-based discrimination in recruiting. So, a resume with a “white-sounding” name will result in calls 50% more often than one without. The University of Chicago study is titled: “Are Emily and Greg More Employable Than Lakisha and Jamal? A Field Experiment on Labor Market Discrimination.” Though not a health care employer-focused study, the researchers do note: “The racial gap is uniform across occupation, industry, and employer size.”

According to the Bureau of Labor Statistics, hospital unemployment is at an extreme low of .9%. And yet, discrimination may be so unconscious that it continues, even in a market where health care employers are scrambling to fill long-empty positions.

job search tips from Nick Corcodilos

Ask the Headhunter Nick Corcodilos

Is there anything a minority nurse applicant can do to sidestep hazards of the current recruiting landscape?

Digital “recruiting” and job hunting create special problems for minority job seekers because—and I’ll be very blunt about this—it enables biased employers to waste your time. If you get selected from an online application and then invest your time for an interview, only to find that the employer suddenly realizes you’re of a certain race or the “wrong” sexual preference or other characteristic, you get suddenly rejected out of hand.

You’ve wasted your time because their bias never allowed you to really demonstrate your abilities and value so that you might be chosen for what you can do.

 How should a minority nurse go about applying for a job, if not through a hospital career portal or a recruiter’s texts/emails/calls?

The smart alternative is to invest some time tracking down either the hiring manager, or at least someone who works for or with that manager.

(Studies, again and again, suggest that up to 70% of jobs are found and filled through personal contacts, not random digital applications.)

Of course, bias can be introduced into the hiring process all kinds of ways, but I find that doing this person-to-person also helps you quickly identify people who are more interested in your abilities than your sex, race, or football team preference! They’re the people who will speak up and personally recommend you.

This is the only way I know to avoid the almost random, rote digital process of recruiting that often results in rejection due to discrimination and bias that surfaces too long after you’ve already invested your valuable time.

Employers don’t realize how this process hurts them, too, because it costs them potentially great hires.

For tips on how to make professional connections, Nick recommends his blog post: “Network, but don’t be a jerk!” Also, read his post on working with recruiters: “How to Judge A Headhunter”.

Any final food for thought for minority nurses embarking on a job search?

All those conversations you have with people who surround the manager will build a very personal picture of what you can do—and that’s how you get presented to a hiring manager as a great worker who’s worth hiring for their abilities.

I would rather have an early opportunity to recognize biased and discriminatory employers so I can avoid them, rather than let them waste my time.

Of course, the very powerful option you always have is to file an Equal Opportunity complaint. But my job is to help you identify and meet worthy employers. And the best way to do that is to get introduced to them by people they know and trust. Your challenge is to cultivate relationships with those “friends and associates” of the hiring managers—people who are not biased and who will recommend you for your skills and great work ethic.

Have We Forgotten Our Role as Advocates?

Have We Forgotten Our Role as Advocates?

Have you ever gone on a first date that went so well that you ended up spending three or four hours just speaking to this person over some coffee? When you walk away from that interaction, although it’s the first time you met the person, you feel like you know so much about them already. This is analogous to how I spend my days with my patients.

As an ICU nurse, I spend 12 to 13 hours a day with, on average, just two patients. This is so much time that I often know the depths of a patient and family’s social situation as well as the depths of their health and livelihood. Having only two patients per day, I spend about 6 to 7 hours on each patient. There is no other discipline of medicine or health care professional that spends this amount of time with a single patient. This gives me plenty of time to understand the depths of my patient’s needs emotionally, physiologically, socially, and economically.

With that knowledge comes a responsibility for me to play my role as an advocate to speak up for that patient. This might mean speaking out to the providers for a patient without health insurance to receive a prescription of the more affordable version of their blood thinner, or this might mean speaking out to the social workers for a patient who needs resources to assist them in purchasing their home medications. This might also mean recommending a diabetic education consult for a patient who is showing signs of knowledge deficit in managing their disease.

As bedside nurses, we have a lot of responsibility. A large piece of the weight to facilitate a good outcome for our patients lies on us simply because we spend the most time with our patients and are expected to know the most about our patients. Many members of the health care team depend on our assessment of the patient and recommendations to perform their duties. We must not neglect what might be our most essential role that we play: an advocate. This might be the most important role that we play in terms of the patient’s outcome and well-being. We must not forget this role and how vital it is. As bedside nurses, we are ideally positioned to be advocates for our patients. Speak up to the health care team, speak up to the doctors, and speak up to the social workers because often no one else does.

Today Is Critical Care Transport Nurses Day

Today Is Critical Care Transport Nurses Day

Critical Care Transport Nurses Day is celebrated annually on February 18 and recognizes the varied and fast-paced world of this branch of nursing.

Sponsored by the Air & Surface Transport Nurses Association (ASTNA), Critical Care Transport Nurses Day showcases the distinct field of transport nurses. While any nurse is always in motion, critical care transport nurses are actually doing their job while the patient is being transported.

Giving accurate, empathetic, and multilayered care while potentially in a moving vehicle like an ambulance or in flight on an airplane or helicopter offers an entirely new set of standards. Critical care transport nurses work in environments that are rarely the same and are constantly changing. Supplies might be different or arranged in a different order. Teams are likely varied and have to adapt to each other and to the motion of the transport they are in.

Some care is given in dire conditions. Transporting a seriously ill patient to receive initial care after an accident, bodily injury, or a health event like a heart attack or stroke is filled with pressure. Critical care transport nurses can work in the military moving gravely injured soldiers. They might be called to help deliver a baby who couldn’t wait for the arrival at a birth facility or hospital.

Still other critical care transport nurses attend to patients when they are stable, but being moved between facilities for additional testing or to receive therapies.

Critical care transport nurses are there to make sure every second of available time is used to help the patient. In the time it takes to move a patient from one area to a hospital or facility, life-or-death changes occur.

No matter the environment, critical care transport nurses have to work well on a team and be confident and experienced enough to make accurate split-second decisions about providing the best care. That means they need to assess physical and vital signs, equipment readings, and listen to the team all at the same time.

As a critical care transport nurse, critical thinking skills are essential. You’ll work in high-pressure emergency situations more than you will work with stable patients. Having emergency care experience before deciding on this career path is essential. Once you have decided and have earned any required hours, becoming certified will help you remain current with the latest protocol and evidence-based practices. In general, nurses in this field will become either a certified transport registered nurse or a certified flight registered nurse.

This career is exciting and requires a broad skill set and someone who works well under this type of pressure. If this sounds like a good career match for you, jobs in this area are growing.

Start Your 2019 Over, With Better Goals

Start Your 2019 Over, With Better Goals

Did you greet 2019 with so much enthusiasm that you set big, audacious New Year’s goals? Maybe you thought: A fresh year to grow (and glow) personally, an exciting new beginning, with endless opportunity to slay professional goals!

So, what happened to those goals?

If you’re anything like most of us, they were ditched (long-forgotten, even) way before Valentine’s Day rolled around. That feeling of inspiration that struck on January 1st, which is symbolic of unlimited potential, turned into discouragement, apathy, and dismay.

So, what can you do now if you still really want to do and be your best self this year? You can still look forward to making the most of the coming months, even if that means starting over again with resolutions and goal setting.

In fact, you may have seen the meme taking over social streams that says: “I’ve decided 2019 doesn’t start until February 1st. January was just a free trial.”

Consider mid-February your chance for a do-over. Only this time, go with something other than the traditional goal-setting systems, which may work for productivity gurus, but don’t for the majority of us regular folks.

One offbeat method you may want to try that is to choose one word for the coming year, to represent what you want versus listing specific actions or results. That single word will guide you and help you focus, so you live more intentionally day to day, month to month.

Here’s how to choose your word for the year.

First, brainstorm a long list of words that feel meaningful to you and “hang out” with them for a while. You’ll find that some relate more closely to goals you’ve had in the back of your mind for a while. They may even suggest some action steps that you can do in the coming months that will bring you closer to your dreams. Soon, one will present itself as the clear winner.

Some examples of word of the year, culled from recent conversations about this “right-brained” goal setting method: Positivity, Intention, Simplify, Pause, Restore, Build, and Believe. Other popular choices that show up year after year include: Balance, Focus, Organize, Grow, Gratitude, Grace, and Finish.

Okay, now that you’ve picked a word for the year, write it down wherever you will refer to it often during the day. A good place to add it is on the front of your paper planner (or write it out in fancy lettering, with doodles even, at the top of every page, to really drive the message home). Type it up, print out, and slap it up on the wall above your desk, or on the fridge, or your bathroom mirror. Use it as part of your login password, like L1Ve_L0Ve<3, so that you’re reminded of your focus word everyday.

You’ll be amazed at how your subconscious mind gets to work, suggesting actions to further your intention. For example, say you chose the word “Build” as your focus word for 2019. You’d like to build community, build connections, and build trust. You find yourself inspired to join a local nursing organization and regularly attend their meetings. At the end of the year, you might be surprised at how you have indeed built strong, trusting relationships.  And that it happened without setting specific, quantifiable, time-sensitive, or sensible goals.

Six Ways CRNAs Can Manage Risk

Six Ways CRNAs Can Manage Risk

Certified Registered Nurse Anesthetists (CRNAs) provide important anesthesia care for many different types of surgeries and services. However, as they gain more and more autonomy, their risk for facing malpractice lawsuits increases as well.

“CRNAs practice with a high degree of autonomy, and they play a critical role in patient outcomes,” says Georgia Reiner, Risk Specialist, Nurses Service Organization (NSO). “This also makes them more vulnerable to a malpractice lawsuit if anything goes wrong.”

According to Reiner, although most states still require that CRNAs work under physicians’ supervision, some states—and the number is growing—are allowing them to practice independently. The good news is that, as Reiner says, CRNAs have been able to provide a lot more anesthesia care in more rural areas of the U.S. that otherwise wouldn’t be able to—such as including obstetric, surgical, and trauma services. “CRNAs are also trained and qualified to treat pain patients. With the ongoing opioid epidemic in the U.S., and with millions of patients still suffering from chronic pain at the same time, the services CRNAs provide are essential to promoting safe and effective pain management,” explains Reiner.

As for the top risks that CRNAs face, Reiner says, “According to claim metrics from NSO’s underwriter, CNA, some of the top allegations made against CRNAs in malpractice lawsuits involve improper treatment or intervention during a procedure, medication errors, inadequacies in the anesthesia plan, and failure to monitor the patient’s condition. CRNAs encounter these liability risks on a daily basis, so it is important for them to identify and manage these risks to protect their career and livelihood while also improving outcomes for their patients.”

The NSO recently reviewed two case studies and then identified six ways that CRNAs can manage risks. They are as follows:

1. Maintain competencies (including experience, training, and skills).

Competencies should be consistent and up-to-date with the scope of authority granted by state law, the needs of the CRNA’s assigned patients, patient care unit, and equipment.

2. Obtain and document informed consent for any planned anesthetic intervention.

Patients or the patients’ legal guardian must be informed of the potential risks, benefits, and alternatives to the planned anesthetic intervention and surgical procedure(s). CRNAs should verify that informed consent was obtained by a qualified member of the patient’s health care team and documented in the patient’s health care record prior to any intervention.

3. Document pertinent anesthesia-related information in the patient’s record.

Review the patient’s clinical history, including relevant social and family history; evaluate the patient and determine if they are appropriate for anesthesia and the proper method of anesthesia. CRNAs should document this process, including their rationale, and any discussions with the patient.

4. Communicate in a timely and accurate manner initial and ongoing findings regarding the patient’s status and response to treatment.

It is essential for CRNAs to report changes in the patient’s condition, any new symptoms displayed by the patient, or any patient concerns to the practitioner in charge of the patient’s care in a timely manner. Document patient responses to treatment, whether positive or negative.

5. Provide and document the practitioner notification of changes.

In addition to communicating any change in the patient’s condition or symptoms, or any patient concerns, CRNAs also need to document the practitioner’s response and/or orders in the patient’s health care record.

6. Report any patient incident, injury, or adverse outcome.

CRNAs should report any patient incident, injury, or adverse outcome, and the subsequent treatment and patient response to their organization’s risk management or legal department. If CRNAs carry their own professional liability insurance, they should alert their insurance carrier to any potential claims, as timely reporting ensures that an incident, if it develops into a covered claim and is not excluded for other reasons, will be covered.

“Facing a malpractice suit can be stressful and overwhelming because it is a long, unpredictable, and costly process. One step I recommend for CRNAs to take is maintaining their own professional liability insurance to help protect their careers,” says Reiner.