With the recent groundswell of the MeToo movement concerning sexual harassment and power inequity, it’s no surprise that industries across the board are reevaluating their working cultures. Health care is no exception and the recent Time’s Up Healthcare movement is gaining attention.
The movement began as a response to the Time’s Up Foundation’s widespread success at promoting safe and healthy work environments and calling attention to how power plays a role in harassment people experience in the workplace.
Time’s Up Healthcare’s website states a mission “to unify national efforts to bring safety, equity, and dignity to our healthcare workplace.” The organization, in partnership with organizations such as the American Nurses Association, American College of Physicians, and the Council of Medical Specialty Societies aims to call attention to the disparities in health care workplaces and the undue burden that kind of culture can carry.
When nurses work in an environment where they are concerned about their own safety or that of their colleagues, the quality of care they can give to patients can be disrupted. The distractions caused by an environment where sexual harassment is either accepted or present but expected to be ignored are enormous. Health care workers in those situations can feel the implications of that stress physically, mentally, and socially.
Instead of being able to concentrate on giving the best care possible, health care workers must constantly weigh the risks. They are required to take the temperature of their workplace and wonder what kind of retribution might happen if they speak up. The cost of speaking up could mean losing their job or even enduring additional threats.
Workplaces like this are entirely unacceptable. Time’s Up Healthcare is shining a spotlight on what’s happening and why it needs to change. The movement is hoping to also build a support network where people who are impacted by harassment at work can go for resources and direction. They also hope to promote an awareness around the issue and exactly the kinds of situations or scenarios that might fall under this kind of problem.
With that aim, the organization hopes to help eliminate this problem. Through education and trainings, harassment and power inequity can be challenged, examined, and eliminated.
Harassment is not okay. Nurses and other healthcare workers deserve better. Their patients deserve better. Time’s Up Healthcare is taking that big leap.
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
From a student nurse deciding on a career path to a seasoned nurse looking to advance into administration, each step along a nurse’s career is filled with questions. Fortunately, mentors in the nursing industry are becoming a more visible presence.
The Nurse Mentorship Program at Stanford Health Care is one such valued and valuable mentoring program. Introduced in 2004 for graduate nurses, the program now encompasses a range of nurses in different areas of their careers.
Minority Nurse spoke with associate chief nursing officer for inpatient services and magnet program director at Stanford Health Care at Stanford University Anita Girard and with Stanford’s program manager of nursing excellence Kevin Tsui about the distinct benefits of this kind of program.
Girard and Tsui say many nurses seek mentoring for varied reasons. They might seek leadership advice or they might want guidance for switching specialties. Still others may be looking for assistance with specific tasks such as writing or giving a top-notch presentation at a conference.
Any nurse can gain from a mentoring relationship, says Girard, but a specific benefit is one that will help a nurse professionally and personally. “The biggest benefit is the networking nurses have being in a mentoring program,” she says. “Mentoring opens you up to a whole new world.”
Tsui agrees and notes the satisfaction nurses reap from establishing a firm footing in their careers and having someone who can help guide them. The resulting good feelings lead to happier nurses, and the benefits stretch far. “Those mentoring connections streamline goals, build positivity and retention, and nurses feel a sense of control,” he says.
Nurses, says Girard, can feel siloed. Despite being in the same profession, nurses have varying specialties and may not have opportunities to hear from nurses in different areas. Mentoring includes both the one-on-one discussions and the larger access to others in the industry that becomes available. “Mentoring gets you out of that box,” says Girard.
So how does a mentoring relationship benefit the nurses and their organizations? According to Tsui, “It’s crucial. By sharing an organization’s mission, vision, and values, it makes transparent the format for mentoring,” he says.
Nurses in a mentoring relationship within the same organization are working within the same culture, so are able to set clear goals and create objectives that are going to be important to the nurse’s career within that organization and in the larger industry. Often, says Girard, mentors will give guidance based on what they already know about the organization. They will be able to help a nurse put priorities in order for certification, advancement, skills development, and personal improvement.
Mentors are also able to be objective about a nurse’s path, so they can help nurses align their goals and use their own knowledge to help a nurse achieve those goals, says Tsui.
A mentoring relationship is definitely a give and take, says Girard. “You really need to make an effort to understand why you want to get into a mentoring relationship in the first place,” she says. And mentees need to make a solid commitment and understand that any mentoring activity needs to be given top priority, she says.
Mentees are responsible for reaching out, setting up clear timelines, and even using tools to streamline online tasks such as emails and calendar appointments. Any communication should have an agenda with clear and succinct ideas and questions. By doing this, the mentee shows the mentor clear goals and intentions mean they have a goal for mentoring and that it will be productive.
Tsui says that sometimes mentees are not clear about the process and expect the mentor to initiate or complete tasks for them. Instead they need to keep in mind they need to be committed to change and driven to use the guidance of the mentor to advance their goals.
At Stanford Health Care, the mentoring program satisfies a magnet hospital requirement, but the benefits have been extensive. “We are driven to excellence,” says Girard. “It is a journey of innovation and inquiry and what we can do to make things better.”
This year’s Certified Registered Nurse Anesthetists (CRNA) Week, celebrated from January 20-26, calls attention to the work of nurse anesthetists and the patient care they provide.
Sponsored by the American Association of Nurse Anesthetists (AANA) , this week of celebration was once known as National Nurse Anesthetists Week. The Additional of “certified registered” helps people understand the rigorous training and continuing education for this specialty.
Nurse anesthetists work closely with a medical team and in some states, they are often the sole anesthetist on a team. According to the AANA, nearly 53,000 certified nurse anesthetists and student nurse anesthetists provide care throughout the country. Career growth in the field continues to attract top talent as the opportunities for lifelong learning and fast-paced advancements offer a dynamic environment. In addition, nurse anesthetists are among the highest paid nurses with a median annual salary of $165,000.
CRNAs have a vital role in patient care at all stages of surgery or a procedure. They assess patients prior to anesthesia, monitor them during the procedure, and continue to watch for any difficulties or problems after they come out of anesthesia. In this role, nurses offer compassion, comfort, and an intense focus on the details of medical care. They must assess visually and with equipment readings to understand how a patient is tolerating anesthesia.
In this career, CRNAs can work with a wide range of medical teams. They can practice in hospitals, stand-alone facilities, dentist offices, trauma teams, surgical facilities, military units, or pain management clinics to name only a few areas. The variety of settings means a CRNA can choose to work in specialties that hold particular interest or match an educational background or a life experience best.
Anyone interested in this field should have the correct path of educational attainment. According to the AANA, “graduates of nurse anesthesia educational programs have an average of 9,369 hours of clinical experience.” Programs for nurse anesthetists can range from 24 to 51 months. Program requirements can vary with the university, but will include essential clinical placements. Certification and recertification are also required to become a CRNA and maintain that professional standing. By 2022, students will be required to enter doctoral programs for this field.
Many CRNAs say the direct patient care, the satisfaction of being an essential part of the medical team, and the technical challenges of the work make this an exciting career path. In some states, CRNAs provide the majority, if not all of, the anesthesia care. Anesthesiologists work with patients of all ages and in settings so varied, their days are never the same. But the responsibility of keeping patients safe and being their advocate in a vulnerable time is rewarding.
Sometimes nurses know they are destined for a lifelong nursing career; for other nurses, it’s as if the career chooses them.
That’s how Jonathan Llamas DNP (c), BSN, RN-BC, PHN, found his way to nursing. Knowing the career would be a good fit for his compassionate nature and his innate ability to have empathy for others, Llamas applied for nursing school right out of high school.
“I knew the work was selfless and inspiring,” he says, “but I went into nursing school with some naiveté. I knew I had the qualities to be a successful nurse, but I didn’t understand the amount of hard work and dedication required for me to excel in the heavily science-based coursework.”
Llamas was unprepared and struggled with the demands of the course load. Looking back, Llamas sees how his path started to become rockier, even as he wanted to succeed. He lacked the mindset to focus on his work. “I didn’t commit the time necessary for me to be successful,” he says.
Transferring to community college, Llamas finished his prereq courses, but says his lackluster GPA set him up for a cycle of rejections from other nursing programs. Determined, Llamas pressed on but struggled with setbacks that would have had other students choosing another path.
“Based on my GPA, my community college counselor said, ‘You don’t have what it takes to be a nurse,’” says Llamas. Feeling demoralized by the comment, Llamas still felt that nursing was his calling. He just had to find a way to get there. “I had to prove to myself I could do it,” he says, “and that I could do well under pressure.”
The toll from the rejection was growing though. As a first-generation college student from a supportive Filipino family, Llamas recalls his mother’s upset at all the rejection for him and it struck a nerve.
“I looked in the mirror and thought, ‘How do I want to be remembered? Do I want to be a father who inspires his kid to rise above adversity or fold under pressure?’” Llamas says. “I didn’t want to be the latter. I wanted to make something of myself.”
Determined to succeed, Llamas applied to West Coast University’s nursing program, and they gave him another chance. He didn’t throw it away and graduated in 2013. I learned that if I wanted to be successful, I have to apply myself,” he says. “I carry that now. If you want something, you have to work for what you want. We are all different in terms of the resources we have initially. We are not all starting at the same starting line.”
“Hopefully my story will inspire others,” says Llamas. He wants students to be academically and mentally ready at the outset so they aren’t surprised by the intensity and high expectations of nursing school. “You have to sacrifice to be successful,” he says. “It’s hard, but it’s temporary. Do your research, and know why you want to be a nurse. Have a vision for yourself and your future.”
As Llamas has learned, there is a level of commitment to nursing that is necessary to be an exceptional nurse. “There’s a difference between your passion and your purpose,” he says. Having the inherent ability to be a successful nurse often makes one’s passion for nursing grow stronger, he says. “I understand that nursing requires sacrifice, but the most rewarding thing you can do is provide such incredible care to a patient.”
For Llamas, persistence has paid off. He is set to graduate this spring with his DNP from Loma Linda University and juggles his academic load with a full-time schedule as a psychiatric mental-health nurse. “I am fortunate to have hit this stride in my career,” he says. The advanced degree will help him reach his future goals of influencing change in nursing by providing a different form of influence beyond the bedside. He envisions working as an NP, becoming an educator to help future nurses, and using his platform to help other nurses.
“If you had said to me 10 years ago that I would accomplish this, I would have said you were crazy,” he says. “If I have impacted someone’s life for the better, then I have lived a life worth living. I feel blessed, humbled, and grateful for the opportunities that have come my way.”
Nursing education is the foundational pillar that enables future nurses to become competent and knowledgeable in their respective practices. This education was normally provided to nursing students through various didactic theoretical lectures and practical clinical training but recently, the use of advanced simulation technology as an adjunct educational tool has slowly become a significant addition to student centric learning.
History of Simulation
The concept of simulation practice can be traced back to the fields of military, aviation, and nuclear power (with military having used simulation the longest), dating back to the 18th century. Simulation was initially created as a cost-effective strategy for training professionals because it was considered exorbitant to train in these areas in the real world. As the years progressed however, the healthcare profession realized the practicality and usefulness of incorporating advanced simulation technology into educational practice and as a result, spurred the growing movement of simulation in healthcare training settings and educational establishments around the world.
The Impact of Simulation on Nursing Students
The emergence of computer technology has led to the development of innovative tools for healthcare professionals such as simulation technology and patient simulators Simulation technologies have had a profound effect on the nursing profession because it allows nursing students to apply their recently learned skills and knowledge to solve real life scenarios in a safe and structured setting.
In a typical simulation session, two students are often asked to participate and mimic the roles of a registered nurse or a certified nurse assistant (CNA). The rest of the remaining students are then asked to go to a separate room and observe the scenario through a one-way mirror and a live video stream. At the start of the session, the facilitator usually gives report on the patient, which allows the students to familiarize themselves with the patient’s situation, history, charts, and medications in order to successfully manage and implement high quality nursing care for the patient. As the simulation progresses, the facilitator controls the patient’s prognosis and provides cues to the team to enhance the realism of the situation. Once the simulation is completed, the students are then asked to head back to the debriefing room to discuss their experiences.
During the debriefing session, the students learn through self-reflection, group interaction, and questions asked by the facilitator. The use of group discussion engages students in reflective learning and enables the group members to consider a situation from multiple perspectives and consider other alternatives in order to broaden their scope of practice and clinical understanding. By performing simulation scenarios on a regular basis, students are able to develop better critical thinking skills, decision-making abilities, and application of theoretical knowledge in real-life situations.
Facilitating Simulation into Nursing Practice
According to the Institute of Medicine (IOM), approximately 98,000 people die every year from medical errors in U.S. hospitals, and a significant number of those deaths are associated with medication errors. This means that adverse events affect nearly 1 of 10 patients in the hospital setting. Based on this staggering number, the IOM called for a systematic change in healthcare practices and identified simulation practice as a resource to address the needed reform. By fostering experiential learning, simulation ingrains good nursing habits early, while discouraging bad nursing habits from forming before it becomes second nature.
In addition to allowing individuals to hone their nursing skills, simulation has also proven to increase student confidence and self-efficacy once they transition into the clinical setting. Nursing efficacy is an important aspect in nursing practice because it gives the students the confidence required to provide excellent nursing care to their patients. By incorporating what they have learned in simulation, more students are self-reliant in their capabilities, which are invaluable in ensuring that patient safety is implemented in the hospital setting.
Implications for Future Nursing Practice and Further Study
The shortage of availability of clinical sites is quickly becoming the norm for many nursing schools due to changing healthcare reform and the struggling economic crisis. One solution to combat the shortage of clinical sites however is to utilize simulation practice to replicate essential aspects of clinical situations for beginning nursing students. The National Council of State Boards of Nursing is currently conducting a landmark, longitudinal study to examine the knowledge and clinical competency outcomes of students when simulation technology is used in the place of actual clinical experiences. Although calls for additional research in these areas need to be performed, simulation is still quickly gaining momentum as the gold standard for effective learning practice in nursing education.