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Incredibly Easy blog
The Incredibly Easy blog will expand on selected topics presented in the print journal.
Monday, September 15, 2014

My husband and I just returned from an amazing trip to Yellowstone National Park. It was wonderful, beautiful, and inspiring. I wasn’t thinking about nursing when I left, but on the first day of our tour…there it was. Nursing 101! One of the members of our group fell hard on a trail about 1 mile out. She went straight down, fracturing her wrist and injuring her ankle and knee. Thankfully, that was all she injured, but first aid had to be done to ensure her safety until we could get help.

Our wonderful tour guide began administering first aid with some commentary from the nurse present. He had taken first aid classes offered by the American Heart Association and he did a fabulous job. A member of our crew went to get the ranger for help because our companion was immobile and we were quite a ways out. The ranger arrived, a real take charge guy, and guess what--he was a ranger/nurse/EMT…wow!

It took an hour, EMS response, and a transport stretcher with a huge central wheel along with six strong men to get this woman back to the parking area and loaded for transport. The next day, we spoke to her husband. He was so complimentary of the care she received at the trauma center. “The most amazing was the nursing staff. They were phenomenal,” he gushed, “How would we survive without nurses?” At that point, I let him know that I was a nurse and I couldn’t agree more.

Once again, I was reminded what an integral role we play in all aspects of service and care. Nurses are a diverse group who fill multiple roles and lead in many areas of healthcare and supportive care. Nurses will appear in places you never dreamed of and make a difference. As we stood the next day watching geysers near Old Faithful, the group was discussing how fortunate that our companion’s injuries weren’t worse and recounting the excellent care she received. Of course, I had to emphasize the role of nursing in her rescue and recovery. A group of young women turned and looked at me: “We’re nurses. Nurses rock!”

Be proud, you make a difference every day.

Lisa Lockhart, MHA, MSN, RN, NE-BC

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.

 


Tuesday, September 02, 2014
Working everyday as a nurse manager, it isn’t uncommon to find myself in the role of communication facilitator/mediator between physicians and nurses. This critical relationship is often beset with the problems that accompany status and perceived power or influence. As I work with the people in this role, and often find myself in the midst of the power struggle myself, I can’t help but wonder what effect this has on patient safety and just culture. I’ve been told by physicians that, as a nurse, my “opinion”--no matter how based in evidence it may be--is the opinion of a nurse; the provider makes the final decision. Although the role of the provider in the final decision-making process is without a doubt the law and chain of command, is it just culture?
 
Just culture is based on a team approach that’s trusting and utilizes an evidence-based, fair, investigative approach and process. In a just culture, the patient’s care and safety is central. I suggest that repairing or recalibrating the relationship between physician and nurse should be the first step. Look at the hierarchy and long established history behind this collaboration and how it fits in our healthcare world today. How does this relationship work within a just culture? How does the relationship work within your facility or organization?
 
Although the relationship may be collegial, is it equitable? Do your peers fear standing up when the issue isn’t a nursing matter but a physician concern? Is there evidence of administrative support when such matters arise? How does your chief nurse respond to clinical nurses’ attempts to stand up in the face of such pressure?
 
Looking at blog sites from our peers across the country, I can comfortably say that this is a problem shared with nurses everywhere. One solution I, and others, offer is to be involved in your professional organizations and arm yourselves with evidence-based data and practice standards. We have the power to improve nurse-physician relationships. Let’s make it happen!
 

Lisa Lockhart, MHA, MSN, RN, NE-BC

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Monday, August 25, 2014

I recently read an interesting article on cognitive stacking—a wonderful term for multitasking—the coveted nursing trait that truly isn’t to be coveted at all. It’s an evidence-based fact that when multitasking occurs (and it must for any healthcare professional to survive), it comes at the high price of patient safety and quality. Fortunately, multitasking is short-lived and hopefully not associated with the need to make serious decisions.

Cognitive stacking is a form of overload—the main stay of any healthcare environment. The provider is inundated with a constant bombardment of data from every angle. This occurs while we’re simultaneously multitasking; what a combination to function in and be responsible for life and death decisions. People think air traffic controllers have it tough, well, they aren’t alone. 

We arrive, get our assignment, and begin data/chart review while receiving report. During this time, we walk our rounds, answer patient questions, stop to assist a patient need, and leave to get a phone call from a family member or caregiver. We may then get paged that our new admission is coming up from the ED and transport is here to pick up our patient in room 211. The physician needs us to assist with rounds, the nutrition department is delivering breakfast, and The Joint Commission is due. And this is all before 0800!

This isn’t overblown; actually, it’s probably a tame shift start for some as staffing becomes tighter and tighter and the request to multitask has gotten increasingly important. However, this is far more than multitasking; this is cognitive stacking—overload that can create errors, poor patient and staff satisfaction, and burnout.

What’s your work environment like? What do you think can be done to minimize the demand?

Lisa Lockhart, MHA, MSN, RN, NE-BC

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Monday, August 18, 2014

The impact of compassion fatigue is significant and reaches our emotional, physical, professional, and personal well-being. In our professional environment, compassion fatigue may show as assignment avoidance, lack of empathy toward patients or caregivers, and increased use of sick leave. In our psychosocial world, it can appear as depression, anxiety, substance abuse, anger management issues, memory loss, insomnia, irritability, oversensitivity, and perceived lack of objectivity. Physically, it can manifest as cardiac issues, hypertension, fatigue, panic attacks, muscle pain, and digestive issues.

Compassion fatigue poses a significant health risk to healthcare professionals and the family members and patients for whom they care. The question then becomes how do we recognize compassion fatigue and how do we combat it? The first line of defense is recognition; education about the signs and symptoms of compassion fatigue is imperative so you can recognize it in yourself and your peers. Education should include the importance of nurse mentors and support systems to facilitate open communication, involvement of group support, and available organizational employee assistance programs. Openly recognizing the significance of compassion fatigue and giving credence to its impact are significant barriers in many organizations.

Strengthen your knowledge level regarding care for the caregiver, self-care, and combating compassion fatigue (see suggested reading). What does your organization offer for compassion fatigue recognition and treatment? What are the thoughts and perceptions of your peers? Topics worth discussion, indeed!

Suggested reading

Anewalt P. Fired up or burned out? Understanding the importance of professional boundaries in home health care hospice. Home Healthc Nurse. 2009;27(10):591-597.

Figley CR Compassion Fatigue: Coping with Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York, NY: Brunner-Mazel; 1995.

Sabo BM. Compassion fatigue and nursing work: can we accurately capture the consequences of caring work? Int J Nurs Pract. 2006;12:136-142.

Watson J. Theory of human caring. http://watsoncaringscience.org/images/features/library/THEORY%20OF%20HUMAN%20CARING_Website.pdf.

 

Lisa Lockhart, MHA, MSN, RN, NE-BC

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.


Wednesday, August 13, 2014

How many of you have ever been a patient or had a sick loved one? Experiencing the hospital from the other side is a great care lesson. The things you notice that are and aren’t done. It’s amazing how intuitive you become to conversations in the hallway, body gestures, and language. Wait times triple in your mind, or is that because you know how long it truly takes to get the results back? You understand short staffing and want to be sympathetic, but somehow you can’t.

I think being a patient or caregiver to a hospitalized loved one is the best lesson in customer service any healthcare professional can have. The idea that service matters; transparency is essential; and simple, direct answers are a patient’s life line.

I was recently hospitalized for a hip dislocation, and I had to spend the night after a closed reduction was performed. I waited 8 hours to have my surgical procedure that really could have been done with conscious sedation, the surgeon of record never actually spoke to me, and his physician assistant who discharged me the following morning had no idea about my care plan or restrictions. The saving grace? The nursing staff!

The nurses were wonderful, they saw to my needs, educated me on all of the essentials, made sure I had my call light and TV controls, and inquired about my pain level in a timely fashion. If not for the nurses, I would have left there a bewildered, “educated” patient. There was no education from the physician at any time.

What you do as a nurse makes all the difference in the world in the lives of your patients and their family members. Never underestimate the importance of everything you do and say to your patients and their caregivers. You’re the link between them and the care they receive. Nurses are the face of healthcare.

Lisa Lockhart, MHA, MSN, RN, NE-BC

Nurse Manager, Specialty Clinics

Alvin C. York VA Medical Center

Murfreesboro, Tenn.

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NursingMadeIncrediblyEasy
The mission of the peer-reviewed journal Nursing made Incredibly Easy! is to meet the ongoing educational needs of nurses in a refreshingly original, easily understood format.

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