Too many hours, too little sleep from @ScrubsMagazine #nightshiftproblems

You can read the article >here<

From the Spring 2014 issue of Scrubs

There’s a lot of talk these days about how detrimental it is for hospital patients to have their sleep interrupted.

Given all we know about the health ramifications of short-changing sleep, it’s a topic that deserves discussion. But there’s another sleep issue with implications for patient welfare that’s not getting nearly enough attention, says sleep expert Ann E. Rogers, PhD, RN, FAAN. That’s nurse fatigue. Rogers, the Edith F. Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta, says it’s a critically important issue because it affects the health and safety of nurses, their patients and the public.

The long hours (75 percent of nurses work a 12-hour shift), the rotating shifts, the propensity to work through breaks and the stress of the job create the perfect storm for sleep deficiency in nurses, says Rogers.

“Our studies show that nurses devote half their free hours sleeping. In other words, if you have 12 hours free between shifts, you sleep about six hours.” But who has 12 hours free between shifts? On average, nurses put in an extra 50 minutes after their shift officially ends, so the hours on duty are much closer to 13. Tack on the commute time (on average, about 25 minutes each way), do the math and you’ll find there’s not a lot of time left over for shut-eye. In fact, using Rogers’ formula, that leaves about 10½ hours of free time after a 12-hour shift, and that means well under six hours of sleep. Not enough when seven to nine is the recommended amount. On top of that, “Sleep loss is cumulative,” explains Rogers. “So nurses who work 12-hour shifts on consecutive days and are sleep deprived become more and more affected cognitively.”

On the face of it, the sensible solution would seem to be a return to the eight-hour shift, but as Rogers explains, that’s not likely to happen.

“Nurses like the 12-hour shift, and while they don’t like mandatory overtime, they don’t want any restrictions on their ability to work overtime.” One study showed that 80 percent of nurses are happy with current scheduling policies. Results from the same study, however, showed that levels of job dissatisfaction and burnout increase with an increase in the shift hours.

While the evidence clearly points out that the extended hours nurses work pose a threat to patient safety and to their own health, there are ways to mitigate some of those effects.

Most importantly, says Rogers, recognize your own limitations, make sleep a priority and don’t accept an extra shift when you should be catching up on sleep.

Agency Nursing vs Direct Hospital Nursing – The Pros and Cons

Have you interacted with agency nurses on your unit at work? Are you a new nurse who plans to do travel nursing in the future? Are you a seasoned nurse who needs a new challenge? Are you a home bird who is climbing the ladder within your own healthcare facility? – These are all scenarios where looking at agency nursing and hospital nursing can help you get where you want to go!

Agency Nursing: What is it?
This is similar to being in a “float pool”, you sign up with the agency who then finds suitable jobs for you in your local area or for travel. These are usually short to long term contracts anywhere between 12-24 weeks long. They offer great benefits, often stipends for relocating, travel, living expenses etc. Also they have health and dental coverage, as well as 401k in most instances. It all sounds too good to be true, well yes. They usually require a minimum of 2 years experience in your specialty area, although they have been known in certain circumstances to take RNs after 1 year. Whats the other downside, well as with all things being new is a challenge, the fundamentals don’t change but the environment, people and protocols do. If you are a quick learner this is for you. Other cons to agency nursing is that, as I have seen at my hospital, agency nurses aren’t always treated that well. I have seen agency nurses floated to different areas each shift, having to constantly adjust. One nurse on my unit I hadn’t seen before, I asked if she was new, she told me she was an agency nurse hired for my unit 3 months ago, but this was the first time she’d actually been assigned to my unit! I was shocked, she didn’t seem to happy with the arrangement either, as my hospital opened a sister hospital 2 years ago, and everyone gets quite disgruntled with the call a hour before work to have to float there. Though this isn’t necessarily typical, it is something to keep in mind, staffing know you are not “one of them” so don’t expect the usual employee treatment 100% of the time.

Direct Hospital Nursing: To contract or not to contract?
To some degree it is always better to skip the contract, but for new grads you really just have to take whatever comes your way (beggars can’t be choosers!). When to contract? Well as a new grad with no other options – yes, if it is for a job that includes a lot of training, such as going up a level of care – from tele to ICU for instance, this may be an option, particularly if you won’t be moving anywhere for approx. 2 years, then why the hell not? Its worth taking the contract to get the training, experience, and then you can move on after to some major $$$. When not to take a contract? When it doesn’t include everything you want. If it isn’t perfect for your needs don’t do it. You’ll only regret it, the regret will make you unhappy, and eventually that will show up with you at work… (don’t be THAT nurse!) Bottom line is you’re going to be stuck for 1-2 yrs, if you’re not 110% sure, then don’t tie yourself down.

No Posts? No Worries? Gimme your thoughts!

So I’ve been MIA for a hot minute, not for any particular reasons except life is all consuming. I’m still working in the same field, unit etc. I’ve now worked days and nights and know the pros and cons of both. Nursing school is far back in my rear view mirror (where I’d like to keep it). I’m currently on the job hunt, looking to advance in more acute care, but remaining in cardiac, ‘cus thats the stuff I like. I’ve considered posting more regularly since its a new year etc. While I’ve been gone the blog has continued to have traffic which I find pretty amazing. I see potential but I’m not sure what direction to take it, more educational stuff? More on-the-job reflections? Memes/funny stories? I’d like some feedback so please check out my poll, depending on response I’ll pick this beast up again (if there are multiple options you like, you can vote more than once!) Many thanks for reading and happy new year! JaeJxRN

Top 10 highest paying nursing specialties – Repost

Top 10 highest paying nursing specialties (via http://scrubsmag.com/)

After you finish nursing school, or if you’re considering going back for more training, choosing the right nursing specialty becomes your chief focus. With so many specialties to choose from, many prospective nurses find it difficult to just pick…

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Reflection Time…

So I’ve had a very busy month, and an array of patients with interesting stuff going on; but the most time consuming part of nursing doesn’t seem to be the charting – its the family members. Family members can be helpful, complex or just down right annoying. I’ve had all and in between over the last month. One stuck out to me though. He was the son of an elderly woman; he and his sister took turns in caring for her. One week she was with one family, next week with the other, like a child in the middle of a divorce or something. The patient and her two children were so happy though, it seemed that the sharing of caring had totally eliminated that air of burnout which is so common among caregivers.

I went in to check in on the patient and the son was there chatting with her. He said he had something to show me and pulled out his cell phone. He showed me a picture of the most beautiful beach sunrise, it was just idyllic. I told him how pretty it was and how much it made me want to go to the beach. He told me that he took that picture that very morning. I was amazed to think that something that beautiful had happened a few blocks from where I live but, I was so preoccupied I missed it. Sure I was at work, but I never even thought about the sunrise, I was focused on work/details/tasks. He told me that he makes a point of taking a picture every day of the sunrise, to remind him how lucky he is. I was so humbled by this, I understood what he meant, but I saw it as such a feat, that he would fit that moment into his daily life.

I reflected on this throughout my busy day. I thought about how many wonderful things happen everyday and I as so focused that I miss them. So consumed with work, the serious nature of nursing, and the responsibility that comes with it, somehow clouds our view of the small, wonderful things happening around us.

With this, I pass on my reflection to you the reader. Take one moment to reflect on the beautiful things that happen each day. You don’t have to be by the beach like me, but regardless, the sun still rises and falls everyday, giving us one more day to live our lives – that is something to be grateful for.

A New Way To Vent? Twitter Anons…

Everyone who’s anyone know about the new technological issues we are facing with workplace professionalism and social media. The debate over what employers should be able to judge you on when you are “off the clock”, and what is your personal and private life is a hot topic. So is there are growing movement to counter this on twitter? I think so! Many people see social media as a way to communicate their thoughts or feelings with others who they may or may not know. They find commonalities in agreements and disagreements, but somehow, this new outlet of self expression is now being censored because people are afraid of what their employers may see, think or act upon. So in stifling this self expression has caused an emergence of those who call themselves “anons”. They are individuals in the medical and healthcare field who create accounts under a medical theme and feel free to talk about anything they want without threat of their words biting them in the ass later.

There is now a whole community of Anons on twitter: Doctors, RNs, Nursing Students. Much of what is posted is nursing advice, sarcastic jokes, banter, vague but hilarious stories. I follow several Anons and enjoying catching up on my tweets every morning in place of a newspaper – trust me the tweets are much more amusing.

So is this a good thing, or a bad thing? I am pro-anons. I feel that this is a great outlet of self-expression and a perfect answer to the employment bombardment on our private lives. Yes using social media is allowing your private life to be shared, but I don’t believe that your personal life has anything to do with your professional performance. Looking back into history we have had many great leaders who were struggled with demons in their personal lives, and yet, they got the job done.

Are you thinking about becoming an Anon, or following some? Search for names like Nursing Anon, Premed Student or Nightshift MD – there are so many. Follow one and see the similar options provided by Twitter, that is a helpful way to network the anon community. If you are becoming an Anon, think about you name, that is what people will be basing their decision to follow you off of.

So join the community, reclaim your self-expression and live without fear! Social media is a powerful and wonderful thing, lets share the knowledge and love around in the healthcare community!

Nursing Skills: NG Tubes!

NG tubes. Yes, they’re pretty gross. Anything going in or coming out of the nose is gross, have you seen the stuff that comes out when an NGT is put to suction? I’m talking rainbow secretions! All joking aside, if you think they are gross, just imagine how the patient feels. I put a NG tube in the other day and was struggling to get it around the sinuses, it isn’t a straight route y’know.

So advice for NG insertion:

  • Explain EVERYTHING to the patient! Tell them it will be uncomfortable. Tell them you will be there for them. Tell them that it is crucial to swallow. Tell them you are going to try to do the procedure as quick as possible. REASSURANCE is key!
  • Pre-medicate if necessary. This is controversial. My patient the other day got morphine sulfate IV before the procedure, this totally helped in chilling out her gag-reflex and made the process easier BUT, if your patient is prone to becoming sedated or unable to follow commands then lay off the meds – use your judgement.
  • Measure correctly. Remember that it is nose to ear to xyphoid process – mark it with tape.
  • Lube, lube and more lube! We need that tube to slide and it has a long way to go, so be liberal with that lube!
  • Encourage your patient to sip water. The swallowing effect with assist you in moving the tube down the esophagus.
  • Don’t give up in getting it down! There may be issues along the way so troubleshoot fast. If you cannot get it pass the sinuses, twist and manipulate the directing you are inserting the tube. Have the patient open their mouth to check for coiling in the back of the throat.
  • Lastly, always check your placement. Use the piston to blow an air bubble in, listen at the xyphoid process with your stethoscope for the air bubble. Placement is also checked with a follow up CXR.

There are many reasons why an NG tube may be placed. There are reasons to suction, give meds, remove acid, or feeding – regardless they are not comfortable for the patient and careful consideration should be made for skin breakdown in the nares or insertion site.

Nursing Skills: Starting a killer IV!

So students seem to think of IVs as the holy grail of nursing school, veteran nurses are still bummed out when they can’t get a stick, and there is always that one IV go-to person on the unit that can somehow find a vein that you never saw during the 30 minutes you spent combing those upper extremities! Ahhh the IV!

So some tips on getting that first stick golden IV! Firstly, get to know your IV catheter. My hospital just changed from the small catheters which have the needle safety cap on withdraw, but doesn’t have the valve so you have to hold pressure on the vein below the catheter while connecting the tail and flush – to now we have the huge long catheters with the button for needle retraction. Honestly they both have their pro’s and con’s, and I have found that both need a modification in getting the vein just right. So like I said, get to know the catheter; if you’re a student, roll up some gauze and practice getting the needle in at the right angle and gliding in the catheter with your index finger.

Before starting your IV, get prepared! Have extra IV catheters in case you don’t get the first stick or the vein blows. Set up your stuff, your IV lock and flush etc. I like to set up my tape too, because I still do chevron when I have time to secure the hub.

Check out the extremities before applying the the tourniquet, there is no point just throwing on the tourniquet above the elbow, look to see if you can see a clean vein before applying, this will make the process quicker.

Once you have your spot and tourniquet applied, tap the vein to get it to stand up. It will make it much clearer and easier to puncture.

Use your non-dominant hand to keep the area taught, this will reduce rolly veins from running or sinking away from you.

If you don’t get a good stick, don’t beat yourself up. Sometimes it happens and who knows the pt might end up with a PICC due to poor venous access anyhow!

Practice makes you better! If you are a student take every opportunity to watch or attempt an IV start. If you are a new nurse and still intimidated by IVs, tell your colleagues to let you know if they have a pt who needs an IV, let the charge nurse know you want to practice or assist them in starting IVs – they will be impressed by your eagerness to learn and guaranteed you will get better! Good luck and get sticking!

This is a decent video for students who want a start to finish visual on venipuncture!