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patienttalk

Retention, Recruitment, Resilience.. Oh, My!

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These three words are dominating the media when it comes to nursing. Facilities attempt to retain their current staff while also trying to combat the ever-increasing staffing shortage by recruiting new hires. Staff are also reminded and educated on ways to be resilient and how to prevent burnout.

Unfortunately in America, even nonprofit hospitals have to be run like a business. Our bedside nurses are the number one asset to a successful hospital as they care for the income drivers.. the patients. Bedside nursing is a physically and emotionally demanding job that wears on even the best of nurses. I left the bedside for these reasons and also to follow my career path of leadership and education. By accepting my position into Nursing Professional Development, I see the leadership perspective of how to run a hospital.

Yes, staffing is a problem. Yes, nurses are not getting paid enough. Yes, there are more and more demands placed on nursing without incentives or relief. But, one of the main issues regarding increasing nursing staff is actually getting additional nurses into the door. The time to hire is a challenge for many organizations. This can be related to slow HR processes (they are short-staffed, too) and/or the amount of time it takes to train a nurse for the assigned unit. Even an experienced nurse can take several weeks to get acclimated to a facilities’ policies and procedures. Certain positions, such as the OR and Critical Care, are noted to be some of most challenging positions to fill due to the scope and specialty.

According to the 2022 NSI report, “on average, it takes 87 days (3 months) to recruit an experienced RN.” During this period, more staff may be leaving, additional positions, and the cycle continues. As the need increases, the vacancy rates continue to increase, and bedside nurses leave due to thin staffing, hospitals cannot keep up with the demand.

I write this mainly to draw attention to our strained and flawed healthcare system. Pay incentives and large recruitment bonuses are only temporary solutions. Long-term solutions can only be successful if we can recruit, retain, and promote resilience within our organizations. Be sure to listen to the staff, be transparent, suit their needs, and acknowledge the work that each individual contributes.

Until next shift,

Shania

Click to access NSI_National_Health_Care_Retention_Report.pdf

Living as an Oxymoron

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Do you ever get a little bit tired of life? Like you’re not really happy, but you don’t wanna die?

“Having anxiety and depression is like feeling tired and scared at the same time. It’s the fear of failure, but no urge to be productive. It’s feeling everything at once, then feeling paralyzingly numb.”

As Em Beihold in her song “Numb Little Bug” and Rich Wilkerson Jr. brings to life, mental health matters. Did you know that female nurses are 70% more likely to die by suicide than female doctors, and nurses, in general, have higher rates of suicide than physicians and even the public (WebMD)?

We screen patients for suicidal and homicidal ideation on admission with questionnaires like the Columbia- Suicide Severity Rating Scale (C-SSRS).. “Do you ever fall asleep and hope to not wake up?”

“Have you ever had any thoughts of killing yourself?”

“Have you ever planned to end your life?”

Some patients laugh at these questions or make jokes about living with their spouse, however, more increasingly patients rate positive on these scales and require closer surveillance. The importance of checking in with our co workers also cannot go unnoticed. Working a stressful job on top of having anxiety, depression, or other mental health condition creates a difficult shift in itself. As patients are presenting with higher levels of aggression and/or are increasingly sicker, the job becomes more taxing. The struggle with mental health is that it is not often seen, unless carefully observed.

Taking time to fully listen to others, honestly answer “How are you?”, and having a healthy level of self-awareness is crucial to promote a healthy mindset.

Knowing that violence, depression, and anxiety are not “just part of the job,” allows solutions to be made. Speak up and speak out for yourself and others’ wellbeing. I am lucky to only have anxiety, rather than the anxiety-depression duo. Every day I take my pill and work on myself to create a life worth living.

If you ever need someone to talk to (even if we have never met), send me a message.

Until next shift,

Shania

Defensive Medicine: Protect Thyself

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The NIH defines defensive medicine as “departing from normal medicine practice as a safeguard from litigation.” In essence, it is over-prescribing to prevent from getting sued due to missing any clinical components. But this isn’t the type of defensive medicine I am referring to. The type of defensive medicine I am talking about involves appropriately and effectively documenting in order to cover your a**. We often use the improper term of CYA documentation.

“If it’s not charted, it wasn’t done.” This is a phrase I heard all of the time in nursing school. I understood this intellectually when it came to nursing skills, procedures, and medications, however, I didn’t realize that I would need to document a physician response, tagging and changing IV tubing, patient education, patient mobility, etc. Even the most mundane nursing activities must be documented.

In order to protect yourself from lawsuits or chart reviews, we have to chart everything that we do to our patient during our shift. It always made me laugh when I had to document inappropriate patient comments or physician responses that were either rude or incomplete. Documentation is what saves your butt. Even though it’s tedious, it is necessary.

Remember to CYA.

Until next shift, Shania

Communicating for Change

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“All communication must lead to change”- Aristotle

In acting, we learn that words are useless. Words only become effective once humans add purpose to them. The greatest actors understand the power of each word and use that power effectively to change the person they are speaking to. The change can be a perspective of a topic or a perspective about themself. We sometimes use the same words with different meanings or inflections to mean different things. This is the beauty of language and communication.

We conducted a communication survey within our facility to evaluate our current communication methods, strategies, and opportunities. A majority of the respondents voiced that they were “not confident” or “fairly confident” about our internal communication, communication with hostile patients/ family members, and communication to different departments.

With Covid, we realized that nurses are out of practice with communicating with visitors and the routine communication with interdisciplinary staff, most of which was eliminated during Covid.

There are two main types of communication that can be evaluated here: assertive communication and aggressive communication. Assertive communication is standing up for your beliefs, voicing your concerns, and not being afraid to communicate different viewpoints. Assertive communication is essential for leaders as it does not just go with the flow, but uses words effectively to evoke a positive change. Aggressive communication is not normally effective because it downplays other views, does not accept criticism, and has the “I am always right” mentality. Rather than offering suggestion like assertive communication, aggressive communication demands a certain way.

Communication is essential for a healthy work environment and relationship with coworkers. Ensuring that all voices are heard, points are spoken clearly, and evaluating different approaches are all ways to improve current communication modalities. If people have the sense that they have a say, their motivation for change can be greatly improved.

To Err is Human- A Case for Medical Errors

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“To Err is human; to forgive, divine”- Alexander Pope

In light of the recent criminalization of former Nurse Radonda Vaught, the topic of medical errors is quite relevant. According to the National Institute of Health, “Medical errors cost $20 billion per year and take the lives of 100,000 people every year.”

There are many different types of medical errors and reporting such errors helps to improve the process and prevent repeatable errors in the future.

Medicinal errors can include acts of omission (not giving a medication when it is ordered) or commission (giving the wrong medication). The main 5 rights of medication administration are taught in nursing school: right patient, right drug, right route, right dose, right time. We are taught to do no harm and every nurses’ fear is to kill somebody.

If a nurse tells you they they have never made a medication error before, they are likely lying. A lot of the time, the error causes no harm and goes basically unnoticed. The nurse will communicate the error to the appropriate people and it is evaluated and a new process may be created. That’s it. In the unfortunate cases where the patient is harmed or dies, that is when the stakes are higher. But, every single error made can possibly lead to death. Fortunately, most of the time the nurse can take a deep breath and carry on with the shift.

Medicinal errors can involve:

Giving the patient a medicine they are allergic to (most often this is caught with electronic systems and pharmacy checks, sometimes it is not flagged),

Giving a drug that the doctor ordered on the wrong patient (nurses can catch this if they understand what the medication does and the story of the patient)

Giving the correct drug but wrong patient label (same drug, same dose, wrong patient)

And so so many more scenarios.. some are very minor and are not noticed. Some are major and become national news. But ALL are human errors involving medicine.

What makes this case so scary for nurses is that reporting a medical error previously is already shameful no matter how small or big. And now that Vaught is now labeled a criminal, many more errors will now go unreported. In a time where we are facing an ever increasing nursing shortage, and now sending nurses to prison for a medical error, how is that going to affect the future nursing workforce?

The healthcare system is in need of some major changes. Where is the forgiveness that is indeed divine?

Until next shift,

Shania

It’s Just a Bad Shift: The Importance of Mindset

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In the past several weeks, I have transitioned into a new job, got scammed out of $1000, lost and found my “sold” wedding dress, messed up my personal website, and our house closing has gotten delayed. Reflecting on these many frustrations, I remind myself that these are so little mishaps in the grand scheme of things.

I remind myself that I am so thankful that my family is healthy, my country is not under war, Covid numbers are decreasing, I have a successful side job that I love, we are building our first new home, among so many other amazing events that life brings.

There are bad days at the hospital, but there are also bad days at home. It is normal for humans to doubt their abilities and question our life paths. It is so easy to live in life’s frustrations, rather than choosing to embrace the oxygen that we breathe at every moment.

It’s our attitudes and perspectives that determine our outlook on each situation. It is so important to magnify the good and simply experience the bad. Experiencing every emotion- the good, bad, and ugly, is part of a healthy life. The problem lies in adopting a negative viewpoint that determines all future reactions and paths for greater things.

Inpatient nursing is already a high stress environment, so why bring such negative emotions and perspectives to the work? A negative aura is felt by others around you. It truly is amazing how just thinking negative thoughts can affect an outward appearance.

We need to choose to accept healthier perspectives and view all sides of a situation. A bright person is just as recognizable as a negative Nancy.

Until next shift,

Shania

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