Tomorrow marks the 40th anniversary of National IV Nurse Day, which was made a national recognition day in 1980.
For 40 years, National IV Nurse Day has honored the day-to-day professional work and accomplishments of infusion nurses across the world. This path of nursing is one that informs each step of patient care and treatment.
According to the Infusion Nurses Society, patients rely on the expert care of the infusion nurses who work with them to administer fluids and medications and establish best practices for infusion therapy.
Healthcare teams rely on infusion therapy nurses to begin any kind of infusion therapy and in all kinds of settings. Whether it’s in the hectic emergency department or in pre-op care, patients depend on IV nurses to administer precision care with a calm and professional demeanor. Patients respond to IV care with a range of emotions and reactions, so IV nurses must be ready to do their work on both calm and agitated patients as well as on patients of all ages.
As with the entire nursing spectrum, IV nurses must remain current on the specialty’s best practices and any evidence-based changes that will make patients’ health and safety more assured and will make their jobs easier. A certified registered nurse infusion (CRNI) is a nurse who has received certification for infusion therapy to ensure the highest standards in practice. Nurses who aim for this highly recommended certification must prepare for a rigorous exam that will test them in all aspects of IV care.
Because this specialty continues to improve and develop with medical advancements and technological improvements, remaining current in the field is essential. Nurses who achieve this credential are able to provide the best nursing care based on the latest information on medications, physical responses, line placement, and equipment changes.
With this knowledge, they care for patients in organizations and are also able to help educate patients, families, and caretakers of patients who may go home with some kind of IV line. They can teach about why a patient needs this treatment and how this kind of IV line will help the patient. They also offer education about how to care for the site, what to watch for, and what to do in certain circumstances.
As a registered nurse with a specialty, IV nurses will see a robust career outlook with a predicated continued demand for nurses. Because IV nurses are involved in so many aspects of patient care, they are a vital member of the healthcare team and their specialty practice only increases that value.
On National IV Nurse Day, take a moment to thank the IV members of your organization. And if you’re an IV Nurse, thank you for all you do!
The start of a new year brings new opportunities to organize all areas of your life. Some of that enthusiasm definitely starts to wane as January drags on, so this is a good time to plan some small tasks that you can do to make your whole year better.
Here are a few items to add to your to-do list that really will help get your life on solid footing.
1. Run a Credit Report
You can request a free credit report once a year from each of three different credit bureaus. Set a reminder to do one in January, May, and September, and you’ll have a much better control over your credit. Having a credit report run frequently lets you organize your credit, check in, and make sure nothing is amiss.
2. Evaluate Your Retirement Contributions
There are many different ways to set up your retirement savings, and no matter what you do, make sure you reassess your plan each year. If you got a raise last year, you should be able to put more into your retirement savings. If you turned 50 last year, you can add extra funds as part of a catch-up plan for those over 50. If saving money is one of your resolutions, this is where you put that into action. Designate what you might give up and figure out how much that would be each month (for instance, give up one coffee a week and save $20 a month). Then choose that as a set amount to automatically withdraw from your paycheck and go to your retirement.
3. Reset Your Environment
Lots of people advise clearing out the clutter to organize and have a more peaceful home environment, but that’s an overwhelming thought when you’re working a week of back-to-back shifts while juggling family and all your other commitments. So in the next month pick just one area of your environment that would bring you the most peace. Do you have a long commute? Maybe a clean and tidy car would make you feel a sense of calm. Is your kitchen the hub of your home? Cleaning off the counters will be like a breath of fresh air. Even a new playlist each month or a small bouquet of fresh flowers in your bathroom can brighten up your mood and get your day off to a good start.
4. Learn Something
Yes, learning a new language would be fantastic, as would playing the guitar or succeeding at skiing. But if you’re short of time, inspiration, and energy, find a small goal and perfect it. Learn how to make one go-to appetizer so you’re not perplexed when going to a party. Nail down your elevator speech. Find a new route to an old place. Clean up your resume. Fine tune three yoga poses to take care of yourself. Learn how to make your signature drink (coffee, alcohol, fruit – whatever you like). Gaining control over one thing often helps launch other accomplishments.
5. Accept Yourself
This one is harder than just about any other personal commitment. Once a day (or more if you remember!) tell yourself you are good enough and that you are strong. Say it out loud so you set that as an intention. Yes, we all can get better and can improve, but we all fail. We all mess up. Humans are far from perfect (even the ones on Instagram who look like they have it all together).
What are some other ways you can take small steps for big gains?
Palliative care is defined as a practice with emphasis on maintaining and improving a patient’s quality of life that can be incorporated at any stage during the disease process. With a focus on symptom management and identifying clear goals of care, palliative care plays a vital part in optimizing quality of life. Currently, palliative care services are offered at a multitude of health care organizations that may consist of a team of physicians, advance practice nurses, social workers, chaplain services, etc. And although palliative care can be beneficial for the patient and their loved ones, there are still many barriers preventing its integration in care delivery. This can result from a misunderstanding of what palliative care can offer, its presumed synonym to hospice, late referrals to the palliative team, or a complete lack of consultation where a patient could have benefited. However, how can direct care nurses integrate the principles of palliative care in their everyday clinical practice?
Palliative care is multifaceted; however, some essential components include pain control, symptom management, and addressing goals of care.
Regarding pain control, the direct care nurse can begin by completing a comprehensive pain assessment. By understanding how to properly assess a patient’s pain, nurses can have a better understanding on how to effectively treat it. While the Numeric Rating Scale can provide some insight to the severity of pain, nurses can also utilize the OPQRST mnemonic to supplement their pain assessment.
- Onset: Was the pain sudden or developed gradually? What were you doing when the pain began?
- Provocation: What makes the pain worse? What makes the pain better?
- Quality: Could you describe the pain? Words like sharp, stabbing, burning can help the nurse better understand what the patient feels.
- Region: Is the pain localized in one area of the body or does it move?
- Severity: From a scale of 1 – 10 with 1 being minimal pain to 10 being extreme pain, how would you rate your pain?
- Time: When did the pain start? Have you experienced this type of pain before?
A functional assessment plays a very important role in controlling pain as well. For example, if a patient states no pain staying in only one position however discomfort when standing or sitting, that patient would be described as having limited functional ability due to inadequate pain relief. Providing efficient pain relief does have its barriers. Patients may be hesitant to accept narcotics in fear of being seen as drug-seeking or they may feel apprehensive to admitting they have pain. Because of this, education is especially important to allow patients better control of their symptoms.
Additional tools that a nurse can incorporate in their pain assessment are noticing body behaviors, like those presented in the Face, Legs, Activity, Cry, Consolability (FLACC) scale for children as well as non-verbal adults. A patient may state minimal pain; however, grimacing, clenched teeth, sweating, and tachycardia might indicate otherwise. Finally, when an intervention is implemented, such as medication, a pain reassessment should be conducted within an appropriate timeframe to evaluate its effectiveness. However, if repeated ineffectiveness of the current pain regimen, nurses should feel empowered to inquire about a proper pain management consult if services are provided at that health care institution.
From a physiological standpoint, multiple symptoms can prove to be quite challenging in supporting a patient’s comfort level. Symptoms such as shortness of breath, consistent coughing, fatigue, nausea, vomiting, constipation, and diarrhea can be a difficult burden. Hospitalized patients introduced to new medications and treatments are at risk for developing side effects, which is why medication education is especially important for patients in understanding what they may expect. For example, opioid treatment may be met with resistance for fear of its constipating side effect; however, effective management is possible by addressing fears, providing education, and potentially supplementing with a stool softener.
While pharmacological interventions are utilized more often in the hospital environment, manipulating the environment can provide some benefit as well. For example, in conjunction to oxygen support and medication, having a fan blow cool air in the direction of the patient or lowering the temperature in the room can provide some additional relief. Dyspnea is not always caused by a patient’s low oxygen saturation as contributing factors such as anxiety could produce the feeling of difficulty of breathing.
Coughing can interfere with adequate sleep and oral intake and can lead to physical exhaustion. Positioning and removing environmental irritants can be supplementary interventions that can be utilized alongside medications. A full respiratory assessment should be conducted, especially in regard to assessing the characteristics of a patient’s cough. Adjectives such as dry, moist, and productive can help the provider prescribe the appropriate medication.
Constipation and diarrhea attributed by underlying disease or medication side effects are distressing and exhausting symptoms that impacts patient mood and dignity. What can be done to help alleviate these symptoms? In regard to medication-induced constipation, commonly seen through opioid usage, prophylactic laxatives/stool softeners can be started to help potential side effects. Having a consistent regimen and re-evaluating its effectiveness allows the nurse to assess if the patients’ constipation is being managed appropriately.
Communication is the foundation of palliative care; through proper communication and transparency amongst the health care team can patients and families make informed decisions around their treatment options. The nurse is pivotal in accompanying the patient through the illness journey, whether it be simply through active listening and presence to ultimately providing guidance regarding treatment effectiveness. This nurse-patient relationship is built on trust and through supporting patients and families to be active participants in their care.
How can direct care nurses improve their communication skills, especially when it comes to a goal of care conversation? One strategy that can be implemented is to utilize open-ended questions. Questions such as “What do you understand about your medical condition?” elicits the patient’s perspective of their disease course. The conversation can delve deeper potentially into the patient’s perspective of their prognosis and the treatment options they believe to be available. This Ask-Tell-Ask strategy explores the patient’s understanding first before the nurse provides information. This back and forth cycle between the patient and nurses addresses four main principles: the patient’s perspective, information that needs to be delivered, response to the patient’s emotions, and recommendations from the nurse. When delivering information, the nurse should avoid using medical jargon and speak in simple terms. Finally, trust and compassion provide a foundation of effective palliative communication. Many times, when palliative care is discussed, the conversation can be somber as it may be dealing with advanced illness and burdensome symptoms. Therapeutic presence results in empathy, thus creating a safe space to discuss difficult issues.
Unfortunately, barriers still exist that prevent palliative care from being effectively delivered to those patients who would benefit from it the most. Palliative care is time and time again mistaken with death or hospice, thus resulting in reluctance to appropriate consults being in place. Additionally, some nurses may feel inadequate in engaging the patient and family in palliative topics or believe that these conversations should be solely conducted by the physician. Nurses need to be involved in overcoming these barriers to reduce misconceptions and ensure that other health care providers, patients, and families understand the benefit of palliative care implementation. These benefits include early focus on comfort treatments, reduction in cost of care, and overall decreased length of stay. Nurses play a crucial role in palliative care, and with continued self-education and engagement can the direct care nurse utilize their skills and knowledge to benefit their patients by acting as that essential extra layer of support.
Certified Registered Nurse Anesthetists (CRNA) Week kicked off on January 19th and recognizes this specialized area of nursing. Sponsored by the American Association of Nurse Anesthetists (AANA), the week honors all these nurses do.
CRNAs recently received a public recognition of their career path when U.S. News and World Report published a Best 25 Jobs of 2020 and nurse anesthetist came in at the number 21 slot.
This nursing career has a lot going for it. It pays well, is constantly changing, and has lots of patient interaction. Nurse anesthetists often assist during surgery or may be in charge of the patient’s entire anesthesia plan and process. In fact, in some places, including rural areas or on the frontlines of the military, nurse anesthetists are often the main providers of anesthesia care to a patient.
Nurse anesthetists bring home a large paycheck. Although the U.S Bureau of Labor Statistics reports the amount will vary based on location, an average annual salary comes in at $167,950. Nurses interested in this path will complete a rigorous educational training. After your early nursing career, a typical path starts out in a critical care role, such as the intensive care unit, where they gain valuable training on evaluating and caring for patients with life-threatening injuring or illnesses. These nurses often have a masters’ degree, but more and more nurse anesthetists earn doctoral degrees. Beginning in 2022, all nurses entering accredited anesthesia programs will be required to earn a doctorate in the specialty.
This role requires initial certification and continued professional certification as the field changes rapidly. Lifelong learning in this specialty is essential for providing the best nursing care and ensuring the best patient safety.
Because of their role in providing essential care, nurse anesthetists routinely work in many areas, so finding a role that suits your career plans and your lifestyle is possible. Flexibility within this role isn’t as common as within other nursing roles, but because there is such a high demand for this role, the job variety is excellent.
According to the AANA, nurse anesthetists provide care to patients in varied locations and settings. From a chaotic battlefield to an organized dental office, nurse anesthetists are required to provide focused, deliberate, and incredibly precise anesthesia care. This role is also essential in pain management clinics and in surgical settings.
CRNAs also play an active and important role in the policies and regulations surrounding the patient care and the professional standards of this specialty. The CRNA Political Action Committee represents the interests of CRNAs and their patients in Washington and in the political establishment of each state.
Nursing leaders and those who take an active role in political decisions can offer a perspective that speaks to ensuring patients have equal access to the best care possible, no matter where they live or their income. These nurses are also proficient in speaking about veterans’ affairs, the opioid crisis, and patient safety.
CRNAs are a vital part of patient care. This week is acknowledgement of all they do.
Geriatrics is the medical specialty serving patients 65 and older. Usually multidisciplinary, the geriatric team may consist of primary care providers specializing in geriatrics, diabetes educators, psychologists, medical social workers, pharmacists, and support staff. The goal is to keep patients functional at their highest level throughout their elder years. This might mean the difference between a patient living independently, semi-independently, or in a skilled nursing facility.
Let’s say your next patient is a 75-year-old female admitted to the ER for confusion. Vitals are HR 98, BP 102/60, RR 20, SpO2 96, T 98 oral. The patient arrives by ambulance from home. Her clothing is wet with foul smelling urine. She is not oriented to person or place. Her affect is flat. Tenting is elicited on her hands. Skin is warm. You note she has lately been to the ER several times for falls and failure to thrive.
What to do for your patient? After the work up, the patient is diagnosed with a UTI and dehydration. Confusion is often seen in the elderly as the first sign of a UTI. Of course the foul smelling urine and new incontinence were the giveaway. This patient is going to need more than a course of antibiotics and fluid. Although she lives with family, the recent visits to the ER make it clear that the family is overwhelmed. A quick conversation with the daughter confirms this fact. You suggest a geriatric consult to the ER provider and she agrees.
Some inclusionary factors for a geriatric referral are age 65 and older, increased utilization of services, changing/increasing needs, decreased functioning, confusion or dementia, failure to thrive/weight loss, falls, and age related health problems. Our ER patient meets several of these criteria. If the patient has a PCP, coordination with that provider would be necessary. Geriatrics will often do a consult to see if the patient is the right fit. It looks like our patient and her family could use the services of a multidisciplinary team.
Active addiction/alcoholism, recent suicide attempt, acute psychosis, or untreated mental health issues would require different referrals. Substance abuse problems, active mental health issues, or suicide attempts would need to be addressed by addiction services and/or mental health services and the patient stabilized before geriatrics could assess age related changes to memory or dementia. These issues would cloud the clinical picture and make diagnosis of cognitive impairment impossible.
The geriatric primary care provider is part of an interdisciplinary team. Because of this, our patient will have access to a range of services that are can be outside of the ability of the primary care provider to manage. Having everyone under the same roof, steps away, using the same electronic record system, allows for an integration of care that would be impossible using outside specialists. Our patient will get a referral from the ER after the ER provider consults with the patient’s primary doctor if she has one.
The patient will be scheduled for a geriatric consult as soon as her condition has stabilized.
Meet the Geriatric Team
Dr. Nirmala Gopalan, MD, is the site manager for the Santa Clara Valley Medical Center Downtown Geriatric Clinic in San Jose, CA.
“On the patient’s initial visit, I’m looking for inclusionary factors. Does this patient need us? There are a lot of elderly patients whose health care needs are well met by their PCP. The ideal patient to come aboard our service meets the inclusionary factors, has a desire to onboard to our services, and is looking for quality of life, not just disease care.”
Ginny Estupian, PhD, is the geriatric clinic psychologist at Santa Clara Valley Medical Center and works closely with Dr. Gopalan. “My role on the team can be divided into two parts; providing individual therapy and neuropsychological evaluations.”
“When I conduct individual therapy, I focus on reducing troublesome mood symptoms such as depression and anxiety. I may focus on helping the patient cope with chronic health conditions that exacerbate their mood such as COPD, chronic pain, diabetes, and cognitive changes. I help the client understand the relationship between the sleep, pain, mood triad, and we focus on improving one or more of those areas. Mood symptoms can improve by learning coping skills, engaging in age-appropriate exercise, or simply processing how they feel about their overall health.”
“The second part of my role is conducting neuropsychological evaluations. I assess for changes in cognition that may occur due to Alzheimer’s disease, vascular disease, or other age-related conditions. Findings from neuropsychological testing are discussed with the multidisciplinary team, then discussed with the patient and family in order to coordinate ongoing care that meets the specific needs of each client.”
Carol Lee, PharmD, is a pharmacist for Santa Clara Valley Geriatrics Clinic. “The first thing I do with the new patient is go over the medication. I’m looking for appropriateness, contraindications, drug interactions, compliance…”
“I look at the patient in terms of the 5 Ms of geriatrics: Mind, Mobility, Medications, Multi-complexity, and Matters Most. Does the patient have dementia, cognitive decline, delirium, or depression? Can the patient tell me why he or she is on this medication? Is the patient an active participant in care or is someone else managing it? Age is just a number. Patients have a wide variability in ability. We don’t prejudge, we assess.”
“Can the patient navigate the pharmacy system? Are they having difficulty with refills or medication timing? Our pharmacy can set up automatic refills, home delivery, blister packs, and other services to assist our patients.”
“Another thing I asses for our patient population is herbal supplements. I educate them on the pros and cons of taking supplements and over the counter medications. The patient needs to weigh if they are getting benefit or detriment from them. I go over each one with them, looking for interactions.”
“Finally, polypharmacy has to be addressed. Some patients have been to many doctors over the years or have seen multiple specialties and they can have a lot of medication burden. Having the patient’s care totally within our system, on the same electronic charting system, and doing a medication reconciliation with each visit helps me to drill down to exactly what the patient is taking, what we can toss, and what we can keep. The patient has health goals, that’s what ‘matters most.’ The proper medicine, and nothing extra, is my job with the geriatric patient.”
Danette Flippin, MSW, MSG, also at Santa Clara Valley Medical Center Geriatric Clinic, looks at not just the whole patient, but at the patient’s support system.
“When assessing the new patient I always think in terms of biopsychosocial and spiritual assessment. Starting with the patient, I ask what is this patient’s level of functioning in the world? What are the physical, cognitive, emotional, and psychological abilities that allow this patient to address needs or to cope with challenges? What deficits are preventing healthy coping or access to health care, or engagement with community support?
“Simultaneously, as a medical social worker, I am looking at the patient’s environment and support systems such as family, friends, social/senior networks, church communities, etc. What is important to this person as they navigate the later stages of their life cycle, place meaning and address the existential questions and factors in their lives?
“When we look at an older adult, we are assessing the well-being of the caregiver as well. The patient and family centered approach is key to assessing, identifying problems, and integrating helpful, successful interventions. When all the information is in place I form a plan on how best to serve this person, not this person’s diseases.”
As we each progress through the stages of life, it’s good to know there are resources available. Not every elder patient needs the services of a geriatric specialty clinic, but the ones that do definitely get value. Don’t forget to evaluate your geriatric patients for specialized care.
Many organizations are moving towards an annual mandatory Personal Development Plan (PDP), also referred to as an Individual Development Plan, as a way of not only identifying avenues of interest for employees, but as a succession planning tool. No matter the agenda for the organization’s necessity for this document, nurses, and especially nurse leaders, should be using this tool to identify and track both career and personal aspirations. Thoughtful and intentional time spent on your PDP can make the difference between a career that happens to you and a career that happens for you.
A typical personal development plan asks the participant to identify numerous career and personal goals to achieve over a set time period. Many organizations, such as Kaiser Permanente, also require that the goals be aligned to the strategic initiatives of the company such as patient care, safety, or financial acumen. It is also not unusual for establishments to require the employee to record a set number of goals in the PDP document. If there is no requirement from the organization, nurses should choose at least three goals for their PDP tool; one short-term professional, one long-term professional, and one personal.
All goals should be written in the S.M.A.R.T. format: Specific, Measurable, Achievable, Relevant and Time-bound. For example, using this format, a goal for completing a master’s of science in nursing (MSN) degree would read, “Complete MSN at Emory University by June 2020.” The relevancy need not be described in the goal as most PDP tools will ask the writer to describe how the goal will relate to or affect the organization. These sections are included in many PDP tools:
- Goal/learning/development to achieve
- Action required to achieve the goal
- Relevance to the organization
- Evidence of completion
- Target date of completion
Nurses are expected to engage in professional development not only as a means to stay current in nursing practice, but as a commitment to nursing as a profession. The PDP is an excellent tool to capture and record these developmental goals and can be used as an atlas to guide your career. Many people underachieve in their career aspirations by simply failing to plan their path. A well-crafted PDP provides the blueprint for how to build your ideal career, clarifies resources needed to meet your goals, and enlists the support of your leaders.
The professional development plan is not a one-and-done task to be completed each year. A strong PDP should be a living document that is updated at least every quarter to keep you accountable to your desired career trajectory. Ways in which a PDP is useful include:
- Clarity – The document should be able to keep you accountable to what you have achieved so far and where you want to take your career.
- Motivation – By updating and streamlining your PDP several times a year you will be able to answer the “why am I doing this?” question in order to stay focused and aligned to your goals.
- Action – By setting written goals in the PDP for both short and long-term accomplishments, you can move backwards from the goal to create monthly, weekly, and daily actionable items that will move you towards your end game.
- Performance – Keeping your PDP current will also allow you to track your performance in any given focus area, which is another good reason to have multiple goals of varying timelines. This also allows you to “toot your own horn” when the time comes for the annual self-evaluation.
Nurses with intentions to move into a leadership role or another specialty area should have this conversation with their manager, unit leader, and mentor. There are many ways in which the manager can assist the aspiring nurse, such as selecting them for committees that provide exposure to other departments and other managers, providing direct coaching on communication styles, and/or sponsoring the nurse for introductory leadership roles within the organization. By setting intentional goals in the PDP tool, nurses can ask managers and leaders for support in meeting these professional targets. To put it in more simplified terms, leaders cannot help you if they are unaware of your intentions.
By sharing your professional goals with your leader, you are also assisting the organization with succession planning as the need for replacing retired RNs will be at a critical state by the year 2022. Whatever your professional goal is as it relates to the company should be of great interest to them as they plan for the mass exodus of the baby boomers over the next decade, given that all areas of nursing will need to be covered. From leadership roles in specialty areas such as intensive care, labor and delivery, emergency services, recovery, cath lab, GI, or neonatal intensive care to advanced practice nursing roles including NPs and clinical nurse leaders, your institute can plan accordingly by knowing where you intend to take your career.
Personal goals are also important to include in your PDP. This not only helps you stay accountable and provides all the benefits listed above, but it also allows your direct leader and administration to see you as a whole person and not just as the career employee. Are you planning to run a marathon? Do you have a goal to serve on an overseas charity project utilizing your nursing skills? Starting a blog or podcast about your nursing specialty? If it is important to you, it should be important to your leader to support. You never know when opportunities or networking can arise from allowing people a glimpse into your personal aspirations.
The personal development plan is a dynamic tool that is created to provide a roadmap for your career and personal goals. Thoughtful, intentional, and frequent time spent on the creation and maintenance of this document should be viewed as an opportunity to take purposeful control over your future.