Nursing Shortage

Granted, it is a USAToday article.  Okay, but I will read more later when I can.

http://www.usatoday.com/story/money/business/2014/05/07/ozy-nursing-shortage/8807937/

What I am paying attention to here is the nursing shortage abroad.  Don't get me wrong - I want to also serve in the USA - probably the majority of my career.  But I want to live abroad as well and am wondering if there are places in Sub-Saharan Africa and/or India that could work while raising a family.

What can I learn here today?

A big shocker: I hate my job.

I work with awesome people.  These people are good at what they do and they love it.  They have personality, and are funny, and I get the sense that they are just good people.  My work environment is safe, and I am fully aware that there are many people who would love to sit at a desk all day.  I even have grown accustomed to that part and can't say that it's the worst thing anymore.

The problem is that I am absolutely passionate about everything to do with nursing and medicine and surgery and public health and disaster relief, and feel almost exactly the opposite about business cases and risk assessments and board reports. 


A fun little fact: some nurses have to make business cases and board reports.  Assessing a patient is a type of risk assessment.  (I must point out that it's actually not the process of risk assessment that I hate - it's the fact that I am assessing risk on things that are not living beings.  I understand the importance on a mental level, but it does not resonate with me.)

So, I have chosen to be miserable until such a time that I can go to nursing school.  But today I am reversing that decision.  I am going to choose to be as much a learner here as I am when I dig into chemistry videos or articles about nursing as a career.  Every day, I will ask myself: What can I learn here today?  It may be something that only helps me until I leave.  Then again, it might be something that helps me in communicating with doctors, in organizing my thoughts, prioritizing, focusing.  And it could very well be that one day I will need to present to a hospital board of directors. 

Can I give some credit where credit is due?  A dear friend points this out.  Where life is unfair (and this is hardly unfair; I am being paid), there is always a reason -- there is always something we are meant to learn. 

Why am I here today?  What is it I'm supposed to be learning from this?  How can I better live today?

Happy Nurses' Week!!

I have to admit that I did not know that it was nurses week but I'm glad to know now!  I loved this piece in TIME: http://life.time.com/culture/national-nurses-week-time-to-say-thank-you/#1.

What should I do? 
Ideas:
* As I failed to get the name of the extraordinary nurse who cared for me after the birth of Maggie, maybe I should send the nurses of the mother/baby unit something - a fruit basket? Candy? What else do you give as such gifts?  Definitely with a note saying how wonderful they were. Maybe it would be better to send a note now and treats later, as I hope they are covered up in treats this week. 
* Also something for Bev, who has encouraged me to shadow where she is director of nursing.  I still have not followed up with her and need to do so. 

Vital Signs

AJN, American Journal of Nursing:

May 2010 - Volume 110 - Issue 5 - p 11

doi: 10.1097/01.NAJ.0000372049.58200.da

In a short article in the American Journal of Nursing, Louise Rose, PhD, RN reminds us of the importance of monitoring vital signs.  "Abundant research," she says,  "indicates that vital signs aren't consistently assessed, recorded, or interpreted."  This is despite the fact that they are the best indicators of many complications or conditions, and offer clues to the reasons for deterioration of patients.  

Rose offers suggestions as to why vital signs may be pushed off as a menial task.  It is, after all, repetitive and time consuming.  In some cases, machines perform the task automatically; perhaps a nurse is not reviewing these reports.  On the other hand, less experienced medical professionals may deliver inaccurate results.  And, likely as any explanation (probably moreso) is that the nurse workload prevents them from taking and/or recording accurate vital signs.

So, how can and should this be addressed?  Isn't this fundamental?

I won't pretend to have the answer to this problem, but I do think it helps to be aware of the situation.  This is probably very indicative of the environment I will be entering.  If something this fundamental is being overlooked, what does that say about nurse morale and workload?  Or is it something else?

Nursing Jobs for New Grads

Kurtz, Annalyn.  "For Nursing Jobs, New Grads Need Not Apply." CNNMoney.  January 23, 2013.  http://money.cnn.com/2013/01/14/news/economy/nursing-jobs-new-grads/

Another article with some age.  But, it's not as if this is changing quickly, as noted in the article itself.

See also: http://www.georgiahealthnews.com/2013/05/nurses-jobs-sign-times/, http://www.healthecareers.com/article/top-reasons-why-new-nurses-cant-find-jobs/172234, and
http://www.workingnurse.com/articles/why-nursing-school-grads-have-trouble-finding-jobs

It's a truth that I do not want to accept. Despite it being shouted from the mountaintops that there is a dire shortage of nurses, nurses, and new grads in particular, are having a hard time finding work. 

I do have a few things working for me.  When I finally finish this degree (ha! start!), I will be getting a BSN.  So, I do feel more likely to find employment than ADNs, especially with the push for BSNs over ADNs that I've heard about happening at more and more hospitals.  My first choice program has a 100% employment rate 6 months after graduation, as well.

I don't even pretend that means I will get my choice of jobs. I am pretty sure that I do want to work in the hospital setting, but a nurse I spoke to yesterday (one whom will actually be helping me to find some shadowing opportunities) reminded me that there are scores of other options for working as an RN.  Allow me to go off on a reflection tangent.

While most of my excitement regarding nursing comes from fantasies of working as a scrub nurse, nurse anesthetist, or ER nurse, public health is another interest of mine.  Before our vacation, I did some research into the public health situations of the countries we would be visiting.  My most basic motivation behind becoming a nurse was a desire to help people.  Perhaps working at the health department is not as exciting as I wish it to be, but working with HIV/AIDS patients is of interest to me.  Helping low-income pregnant mothers-to-be take care of themselves and their babies is very important.  I do fantasize about later being able to take part in my church's medical mission trips, and the assessment skills I would sharpen in those environments would be so helpful there.

On the other hand, I do not know anyone who has not been affected by cancer in some way.  Research is second nature to me.  I may not love it in and of itself, but I could love it for its outcomes. 

Accepting that the hospital is not the only place of employment for new grads is part of the battle.  Because I have had to wait for the right time for nursing school, I have also made experiences for myself.  I can do more, though.  It is very hard to do so, especially for nurses who have other things going on.  It's not just children, but many second-career nurses also have aging parents to care for.  Sometimes, working one job is all we can do. There are many obstacles that can keep us from taking extra time to gain experience outside the job, but when the market is so competitive, it is really incumbent upon us to prove our interests and skills in as concrete a fashion as possible.

While it is not an option I am currently considering, if I do not find a job in any of my top choice area, geriatrics is a good area to look into.  The population is aging, and we helpers are needed to take care of a population that has taken care of us.  

I have some time before I am on the job market.  I have hope that the job market will improve in that time, but I do not expect it to do so quickly.  I think it is important to remember that experience in any area of nursing can inform other specialties.  Elderly people also have surgery; mental health patients have babies; children visit ERs; HIV patients sometimes require addiction recovery services; diabetic patients may require surgery.  There are so many crossovers, that skills built in one area cannot but serve as experience for another, down the road.  It is important, then, to stay alert to these transferable skills, just as someone attempting over years to transition into nursing might do.

Response to Manton's Emergency Nursing piece in the Imprint (forever ago)

Manton, Ann, PhD, RN, FAAN.  “Emergency Nursing.”  Imprint: The National Student Nurses Association Journal.  January 2004.  23 – 25.

 

Anne Manton is an associate professor at Fairfield University, as well as past president of the Emergency Nurses Association.  Here, she writes about the job of an emergency nurse, and the pros and cons of this specialty.  I would like to reflect on the five factors she presents for preparation for a career in emergency care:

First, Dr. Manton emphasizes that quick thinking, the ability to prioritize quickly, and flexibly restructure ones day are vital to being an ER nurse.  To an extent, I believe these qualities are important to all nurses, but very much enhanced in the fast-paced environment.  In my own life, I have experience with this in caring for a family including two babies, while thinking in two languages.  Additionally, when I served as network administrator, information security officer, and operations coordinator, I learned quickly how to wear various hats in any given situation.  Obviously, this is not the critical environment of nursing, but I do know that I am able to multitask and prioritize on the go.  I also believe that having a very firm knowledge of the subject matter enables one to prioritize and multitask efficiently.

Secondly, Dr. Manton says that assessment skills, as well as the ability to apply those assessments, are key.  Again, I feel that a thorough knowledge, gained through study and experience, are what enable a nurse to assess correctly and to understand the significance of the information gained.

Thirdly, “[e]mergency nurses need a strong knowledge base in every area of nursing.”  This is especially attractive to me.  Along with my desire to work in a fast-paced environment, I am interested in a complete picture of knowledge in nursing.  And, like in number one, I do think that this knowledge is helpful no matter what area of nursing one is in.  However, it is absolutely vital for an emergency nurse.

Next, Manton stresses the importance of critical thinking and notes that, as opposed to other specialties, many ER patients do not yet have a diagnosis.  This, again, is especially attractive to me.  Of course, it could be very stressful to deal with situations in which there are big unknowns.  However, I have always enjoyed putting pieces of information together, as well as working with a team.  It also seems like a test of knowledge, but under higher stakes than usual.

Finally, “good communication skills are imperative,” says Manton.  I think I excel in this area, and in two languages, at that.

 

I think often about my desire to be an emergency surgery nurse, and whether that is a dream that I can make into a reality.  I also think about where I want to work before working in the emergency department.  Manton suggests gaining experience in medical/surgical nursing, which suits me just fine as I am dying to get into an OR.  I also wonder if my path does still involve nurse anesthesiology.  This would guarantee OR work – but would be quite a bit different (as all nursing is) in the ER, as well. 

I’m not sure I’ve drawn any conclusions here.

20140207 Current Events

http://www.medscape.com/viewarticle/820234?src=rss#3 Mandatory Flu Vaccinations for Nurses

This article on medscape tells about a pregnant nurse who was fired for refusing the flu vaccine.  I find this situation to be very interesting.  I really want to side with the nurse.  I want to be able to say that I believe that should have been her option.  I want to say this because, in other cases, I myself would like the right to refuse a vaccination if I feel that it is not safe.

However, this is the flu vaccine.  I myself have never received it, but I do get it for my children every year, and when I begin nursing school, I will begin taking the shot.  I simply do not take it because I have never had the flu and I do not currently work with an at-risk population.  Since my children's immune systems are immature, I feel incumbent to vaccinate them.  Because the flu is so contagious, I do believe that anyone working in a hospital, long term care facility, or, really, anywhere where there is a concentration of people (such as a school) should receive the vaccination if they do not have a solid reason not to.

This nurse was pregnant, and she feared that the vaccination could put her baby at risk.  Her anxiety over this was so great that she was able to get a physician's note saying that the stress from worrying about this was putting her baby at risk.  However, this just is not fact-based.  While no group of pregnant women is assembled as part of a study of effects on pregnancies before the vaccine is released, data from after the vaccine is released shows that receiving the vaccine may actually lead to lower incidence of pre-term birth.

In an age of evidence-based practice, do we want a nurse who won't use the evidence?

And then, I do see her side.  How do we know what is true?  But anecdotal stories of things going awry are hard to critically examine, since they don't really give us enough information to prove causality.  In some cases, it is less clear. With a disease so easily spread as the flu, I just don't think there is enough evidence against the vaccine. Could her employer have given her some tasks away from patients until after she had the baby, or after flu season? It is possible, but would that be her job? I am all for being flexible, and I think employers should be flexible. But I can also see how they wouldn't want her in the building, and also that there might not be another job suited to her with minimum patient contact. It could truly be a dangerous precedent.

http://www.recorder.com/news/townbytown/shelburne/10549654-95/letter-nursing-shifts

letter to the editor regarding nurse demands in a strike; nurses being overworked; quality of care

This is a letter to a paper editor, spurred by a patient's observations about nurse scheduling and overtime, as well as an impending strike. The patient appreciates the competence demonstrated by her nurses and expresses dismay at the focus on profit rather than patient outcomes.