Long known as a month filled with valentines and heart-themed decorations, it’s no wonder that February was chosen as the month to highlight heart health.
The February 2021 celebration marks the 57th annual American Heart Month, and spotlights women’s heart health with a “Heart to Heart: Why Losing One Woman Is Too Many” campaign. In a time when one in three women are diagnosed with heart disease annually, this important month is a time when nurses can check their own heart health and strive to be a resource and help provide patients with accurate and timely information about heart disease.
The American Heart Association stresses the immediate need for information about heart health because of COVID-19’s direct impacts on the cardiovascular system.
As always, people can take lots of steps to keep their hearts healthy and can, in fact, prevent or mitigate a great number of serious heart disease cases. A healthy lifestyle can make a huge difference in heart health and even moderate steps can have significant impact. You don’t have to be a marathon runner to have a strong heart, and it’s important to talk about small lifestyle changes with patients so they feel like they can make a difference in their own health.
What works? According to the American Heart Association, adopting a healthy lifestyle includes
- not smoking,
- maintaining a healthy weight,
- controlling blood sugar and cholesterol,
- treating high blood pressure,
- getting at least 150 minutes of moderate-intensity physical activity a week, and
- getting regular checkups.
And other habits can be just as important for keeping your heart in top shape. Getting enough sleep, keeping socially active with friends and loved ones, and trying to reduce the impact of stress with stress reduction practices (whether that’s a hobby or talking to a professional), all play a part in keeping your heart strong. And everyone should know the symptoms of heart attack or stroke.
Beyond lifestyle changes, do some sleuthing and find out as much as you can about your family’s heart health history. As genetic components can predispose certain families to heart disease, knowing if anyone in your family has had or currently has high blood pressure, a history of heart attacks or strokes, heart valve problems, or heart failure, can help you determine if you’re at a higher risk. It’s especially important to know the ages of these diagnoses as a family history of early heart disease can help guide your own testing and monitoring decisions.
Cardiovascular nurses treat patients with heart disease and often act as a great resource for patients. As they walk patients through their diagnoses and treatment, they are also able to help connect patients and families with other resources including nutritionists, physical therapists, support groups, and other specialists.
The Preventive Cardiovascular Nurses Association (PCNA), believes that prevention is essential in beating heart disease and so offers plenty of heart health resources for nurses. They have handouts for nurses to give to patients to help with everything from peripheral artery disease to diabetes to hypertension. PCNA also offers free resources for health care providers to help improve their practice with additional information around improving communication, a stroke prevention guide, or a cardiovascular risk provider tool.
Heart health impacts everyone and so keeping your patients informed can help them get to a healthy place. And paying attention to your own heart health can help you keep heart disease at bay.
There’s no questioning the difficulty of a career as a nurse. You may have to work long hours, deal with a variety of patients each day, and spend most of the time on your feet. You also have to deal with the risk of things like patient violence or the general sadness that comes from losing a patient you’ve been working with. But, nursing can be an incredibly rewarding career when you’re in the right work environment. A toxic work environment, however, is a different story. It can make getting your job done feel nearly impossible. If you come home each day feeling absolutely drained, and perhaps even frustrated or helpless, you might be dealing with a harmful environment at work.
So, how can you know what a toxic work environment looks like? What are your rights, as a nurse, to a healthy environment, and what can you do to make sure those rights are upheld?
What Does a Toxic Work Environment Look Like?
As a nurse, you probably already understand the importance of being able to adapt to different work cultures. If you’re not sure how to learn more about a specific culture or atmosphere within a workplace, there are a few things you can do to get a feel for it quickly, including:
- Watching and learning from others
- Asking questions
- Staying transparent
The more you observe and the more questions you ask, the easier it can become to see if you’re dealing with an unhealthy work environment. Bear in mind that if you don’t like your job or you’re not satisfied with your work, that doesn’t automatically mean you’re in a toxic environment. You may need to try a different career path. But, toxicity in the workplace is very different. You can recognize it through some of the following signs:
- There is an overall lack of communication
- There are cliques, exclusions, or groups
- The workers aren’t motivated to do their jobs
- Growth is discouraged
- Everyone is burnt out
Finally, there’s nothing wrong with going with your gut. If you get a “bad” feeling about your workplace, even if you can’t quite put your finger on it, don’t ignore those feelings.
How Can It Affect You?
A toxic work environment is more than just an inconvenience. It’s more than just something to “trudge through”. In fact, an unhealthy work environment can contribute to a variety of physical and mental health issues. Some of the most common problems include:
- Upset stomach
- Heart issues
- Muscle aches
- High blood pressure
The toll on your mental health is nothing to take lightly, either. You might find yourself constantly feeling stressed and overwhelmed at work. It doesn’t take much for that to carry into your home life if you can’t let the feelings of the day go when you walk in the door. That constant feeling of stress can lead to mental health conditions like anxiety, or even depression. As that continues, you may end up needing to get extra help just to deal with those conditions.
Working every day in a toxic environment can wear you down. So much so, that it can even weaken your immune system, making it easier to get sick. As a nurse, you know the importance of taking care of your mind and body. If you don’t make self-care a priority, it could impact your personal life in a negative way. Your work environment shouldn’t be the thing that compromises your health.
How to Find a Healthier Environment in Your Field
If you find yourself in a toxic work environment, the best thing you can do is leave. An environment that large isn’t likely to change, even if you address the issues. You need to prioritize your needs when it comes to your career and your overall well-being. But, leaving a job isn’t always easy if you need the income.
Waiting to leave until you have another job lined up is always a safer option. Or, you might consider going a more nontraditional route with a remote job. Remote jobs allow you to work from home (or anywhere!), eliminating everything from toxic employees to negative patient interactions. Working remotely can help to reduce your stress levels and offer more flexibility.
Obviously, not all nursing jobs are able to be done remotely, but there are some that will allow you to work from home while still caring for others, including:
- Clinical appeals nurse
- Health informatics
- Nursing instructor
- Nurse auditor
- Telephone triage nurse
Some larger hospitals and even national health care groups are always looking for nurses who can work remotely and fulfill these needs. These particular jobs might be different from what you’re used to, but that could be exactly what you need to break free from a toxic environment. In doing so, you can learn to enjoy your work again, and find fulfillment in helping patients while taking care of yourself, too.
A perianesthesia nurse is a constant and steadying presence for anyone undergoing a medical procedure. This week’s PeriAnesthesia Nurses Week (February 1-7) acknowledges the nurses in this role and the work they do with patients in varied settings and under changing conditions.
Perianesthesia nurses are with patients throughout their entire procedure, although many patients don’t realize this. If you’re thinking about this career path, many nurses say they enjoy being a continuous presence for patients and enjoy being an advocate for them when they are not able to do that for themselves because they are sedated.
But nurses in this role also enjoy the close interaction with their patients. They gain satisfaction from being able to make their patients comfortable and less nervous about what’s happening. Perianesthesia nurses may not see their patients for a long time—the pre- and post-op when patients are most aware can be fast moving—but the impression they make is important. This career offers many choices where you can practice including hospitals, ambulatory care and day surgical sites, as well as pain management clinics.
According to the American Society of PeriAnesthesia Nurses, perianesthesia nurses are committed to patient safety and so they are always assessing a patient to watch for any changes at all. They are also responsible for helping the patient wake up from sedation and so their pre-op routine is often an information gathering process. During their pre-op interaction, they are gaining medical history but they engage patients in casual conversations about things that may seem random but are actually very precise. During this pre-op, nurses are finding out about the patient and learning about topics they will be able to mention in post-op to help the patients gradually awaken and be soothed by a familiar topic.
What might perianesthesia nurses ask? They can talk about anything from the patient’s career to their pets. They ask about family members, hobbies, travel, movies, books, or favorite routines. Over time, this becomes a highly developed skill in perianesthesia nurses’ toolbox as each nurse is able to find a conversational style that checks all the boxes of information they need to gather. They learn the subtle approaches for people who are especially quiet or those who are agitated or those who may be scared.
When the patient is sedated, the perianesthesia nurse is a constant presence and watches and monitors both the patient and all the equipment for any signs of change or potential trouble. As perianesthesia nurses work, their skill set during procedures is also fine tuned. They are watching for all the steady vital signs on monitors, but they also scan the patient to look for any even less obvious signs or signals. They are watching skin tone and feel, listening to the breathing patterns, and noticing muscle movements or changes.
Then the nurse and patient will be in post-op as sedation wears off and the patient wakes up. The unpredictable nature of post-op is another situation perianesthesia nurses are ready for. As they are monitoring the patient, they use those nuggets of information they discovered in pre-op to help the patient get oriented. And for all the work they have done, perianesthesia nurses say that some patients may not remember their presence or understand the nurse has been there the whole time. So self-motivation is a big career skill—nurses in this role find meaning in helping patients and understand the situation might not lead to any recognition from the patient.
As with any nursing career, certification will help ensure you’re providing the best patient care possible. Perianesthesia nurses can find certification information through the American Board of Perianesthesia Nursing Certification, Inc. (ABPANC) where the Certified Post Anesthesia Nurse (CPAN®) and the Certified Ambulatory Perianesthesia Nurse (CAPA®) programs are accredited by the Accreditation Board for Specialty Nursing Certification (ABSNC).
If you’re a perianesthesia nurse, celebrate with your team this week and appreciate the difference you make for patients each day.
This week, certified registered nurse anesthetists (CRNAs) and the work they do are honored with the annual CRNA Week.
CRNAs are highly trained nurses who have a focused skill set and responsibilities that require close patient interaction. According to the American Association of Nurse Anesthetists (AANA), this year’s celebration coincides with 2020’s historical event few will forget—the World Health Organization’s declaration of a global health emergency because of the COVID-19 pandemic and the discovery of the first case of the virus in the United States.
In the past year, CRNAs have faced challenges they could have never anticipated. An overwhelming caseload of extremely ill patients, uncertainty of how to treat patients with the deadly virus, concerns about their own safety and that of their families, and lack of PPE supplies in some of the most advanced facilities in the world dawned in 2020.
Like other medical staff, some CRNAs have described conditions over the past year as “a war zone” and their heroic efforts to help and care for patients was evident. As a CRNA, these nurses are with patients before, during, and after procedures where anesthesia is necessary. The typical cadence of procedures changed in 2020, with big dips in elective surgery during COVID-19 surges and increased emergency situations for patients who were desperately ill. CRNAs needed to use their critical thinking and fast adaptation skills constantly.
Even before the pandemic, the need for CRNAs was on the rise. The U.S. Bureau of Labor Statistics predicted a 45 percent increase for trained CRNAs (along with nurse midwives and nurse practitioners) in the workforce by 2029. If you’re interested in pursuing this nursing path, you’ll want to plan carefully. In general, CRNAs hold at least a master’s degree and usually complete an average of 9,369 hours of clinical experience during their rigorous academic program
Beginning in 2025, the requirements for this career path will change. At that point, nurses who want to hold this position will need to obtain a doctorate degree to become a CRNA. The current CRNA master’s degree programs will fold into these degree programs. If you’re already a CRNA by then, you won’t need to return to school for the additional degree.
But the rigorous preparation leads to a meaningful and financially stable career. U.S. News & World Report listed nurse anesthetists as holding the #10 slot in best paying jobs and #39 in the list of the top 100 best jobs and with an average annual salary of almost $175,000.
Above all else, CRNAs find their daily job gives them plenty of opportunities to use all their nursing skills—from complicated math to compassionate direct patient interaction. And having a positive impact where they focus on improving the outcomes of surgeries and procedures for the patient and for the larger medical team is something for which all CRNAs strive.
Today’s observation of National IV Nurse Day marks a year filled with change, upheaval, and continuous learning like few other years.
Minority Nurse spoke with Crystal Miller RN, past president of the Infusion Nurses Society (INS) and current co-chair of its Diversity, Equity, and Inclusion (DEI) Task Force, to hear how the COVID-19 pandemic and the social upheaval around race has shaped the way INS is defining a path around DEI.
Above all else, the role of an infusion nurse (also known as a vascular access nurse) is one that focuses on the patient. “The pandemic has challenged us to look at the way we deliver infusion and vascular access care in our patients as never before,” says Miller.
IV nurses work in roles where taking care of immediate needs is essential, but, she says, they must constantly look at the bigger picture. “We have to look down the road so our patients get what they need from the outset,” she says. “We need to look long and hard at the best device to treat patients, especially those who are impacted by COVID-19.” A device or approach that might have worked when a patient was admitted to a facility may no longer be effective as the patient’s condition changes.
Miller is unequivocally proud of her specialty and of being part of the INS. “We are more than the equipment we use,” she says. And with vascular access as a global issue, Miller says INS decided to take a fresh look at what a global approach means to their nurses and patients.
“We’ve always been proactive in how we deliver the care we give,” she says. “We make sure the people who are at the table represent those in their areas.” Doing so makes sure INS is present and aware of diversity, equity, and inclusion issues and how they impact healthcare delivery and outcomes. “We want to make sure people have a voice,” says Miller. “And we want to make sure as an organization that every patient we see has a voice and is represented.”
DEI work is not a one-and-done deal, says Miller. “Whatever we develop and put forth, we need to make sure it’s ongoing work.” That means looking at how diversity is represented including different genders and identities, sexual preference and orientation, practice settings, and culture and race. “To the best of the abilities of our organization, we want to make sure we don’t put forth something that doesn’t consider how people feel,” she says. “We challenge others to listen with empathy and care.”
One of the best ways to learn about and to improve on DEI work is to talk with people, says Miller. Learning about what is important to people, how they do things, and how they see the world imparts the kind of detailed knowledge that can make all the difference to a patient. Once you are informed, you can always do things a little better and that gets noticed. “When you prove your credibility, there are no limits,” she says. “When you recognize things are outdated, you change them up.”
With a focus on diversity, equity, and inclusion, a new interaction with patients opens up, especially with those from underrepresented populations. “Patients are grateful for the advocacy,” says Miller, “because there is someone in their corner, who is advocating for them and listening to them.”
The pandemic has shifted DEI efforts in ways that no one could have predicted. Of all the different healthcare practices or interactions patients may or may not be comfortable with, the need to separate people and keep them isolated has created an enormous burden for families and healthcare staff. “There are no family members present who can speak to a patient’s preferences,” says Miller. Vascular access nurses have shifted into finding innovative techniques to overcome this barrier.
On this year’s IV Nurses Day, Miller says although the typical celebrations aren’t possible, it’s still important to honor the work infusion and vascular access nurses do. “For me personally, I think there’s so much uncertainty in work and in healthcare now—it’s good to know we get to recognize our specialty,” says Miller. “We are the best resources where vascular access is concerned and we take that very seriously.”
When you decided to become a nurse, you knew it wouldn’t always be easy. You expected the long nights, the grueling shifts, the heartbreak of losing a patient. But something you probably didn’t think much about the possibility of not getting along with your patients. After all, you entered this profession because you wanted to care for your patients, not clash with them.
The fact is, though, that nursing means caring even when it’s hard. It means loving your patients even when you don’t like them. And that’s perhaps the most difficult and most important lesson that nursing school can never teach, the lesson that only your most challenging patients can teach. This article provides tangible strategies for new nurses dealing with difficult patients, without losing your sanity, your health, or your professional passion.
Seeing Through Your Patients’ Eyes
The first step to dealing with a difficult patient is to try to understand what’s causing their behavior. It’s highly unlikely that a patient is going to be difficult just for the fun of it. Chances are far greater that something has gone wrong and that’s fueling the problem.
Many patients’ behavior, for example, may be explained by their particular medical condition. Those with dementia, Alzheimer’s, end-stage renal disease (ESRD), or certain mental health disorders, may react aggressively, irrationally, or non-compliantly simply because their illnesses have impaired their ability to understand their circumstances or respond appropriately.
In addition to physical and mental health challenges, environmental and situational factors may also be driving your patients’ contrarian behaviors. Patients who have been recently diagnosed with a catastrophic or terminal illness may be grieving the loss of their health and function.
Or they may have experienced the loss of a loved one, the loss of a job, a divorce, or some other significant trauma that is causing them to be hyperreactive. Likewise, cultural and language differences may be limiting the patients’ ability to understand, ask questions, or express themselves effectively, and a frustrated patient is far more likely to act out in negative ways.
An important strategy for understanding your patients’ perspective is to practice active and empathetic listening. Ask questions and reflect your patients’ views back to them accurately and without judgment. This will not only ensure your own understanding, but will also reassure your patients that they’re being accepted, heard, and understood.
How to Respond
Once you have a better understanding of your patients’ perspective, you can then begin to formulate a response that is productive and beneficial to the patient and your relationship with them. But that’s going to require you to be self-reflective as well.
After all, nurses are only human, and there’s no such thing as complete, unimpeachable objectivity. Just as with your patients, your own responses may be influenced by factors that you’re not even aware of. We all have our own internal biases, not to mention the ordinary stressors of daily life, that may make us respond in inappropriate or ineffective ways to some patients.
Your patient, for example, might remind you of a contentious relationship in your own life, and you may project negative emotions regarding that person onto your patient. At the same time, if you are feeling overwhelmed by a particularly stressful day, you might find yourself feeling short-tempered, unsympathetic, and ready to lash out at any patient who adds yet more problems to your day. So, when you’re figuring out how to respond to a challenging patient, you have to determine, first, whether it’s the patient or whether it’s you and, above all, try not to take it personally.
Another key to managing difficult patients is to focus on de-escalation. That means focusing on remaining calm and non-defensive and, ideally, on allowing your patient to express themselves freely. This includes giving your patients a safe place to vent when needed.
De-escalation strategies can also be employed at the organizational level. For example, in the wake of the COVID-19 pandemic, health systems nationwide are facing significant reductions in revenues and staffing. That’s leading to a surge in patient wait times and perhaps unprecedented levels of stress on health care providers. Using hospital resource management strategies (HRM) can help your organization run more efficiently in the face of the current crisis and beyond. And that’s going to improve your patients’ experience and decrease your workplace stress.
Another important tool for dealing with tough patients is to help them become more educated about their condition and to feel more empowered to take charge of their health. One of the most significant stressors associated with a difficult diagnosis is the patients’ sense of lost autonomy.
Equipping patients with the resources they need to make informed decisions about their own lives, and their own care, can be a tremendous benefit in reducing negative behaviors. Mobile apps, for instance, can be used to help patients with their meal planning, lifestyle choices, and treatment plans. Connected patients can even access online communities reserved for other patients, their families, and health care providers.
Nursing can be more rewarding than you ever dreamed. But it can also be more challenging than you ever imagined. The key to dealing with difficult patients, though, is to not take it personally, to focus on understanding the roots of their behavior and figuring out a response that is productive for and protective of you both.