Welcome to the Nursing Jobs.org edition of Change of Shift, the nursing blog carnival!

It’s the first edition of the new year, so let’s jump right in!

******************************

Sandy Szwarc weighs in this edition (pardon the pun) with two timely posts from Junkfood Science. It’s the new year, and many of us have made a resolution to lose weight. What are the chances for success? In a two part submission, Sandy first looks at Part One: What does the evidence reveal? Can diets work? Get ready for a shock in Part Two. And then take a breath and relax. I did.

Mousie presents a real-life nightmare in A Steep Learning Curve. (Part 1.). This is my biggest fear. I’m still trying to get my pulse back to normal. You’ll find Part One posted at Mousethinks.

Emily gives a wonderful primer for the new nurse blogger in Guide for the New (and old!) Nurse Blogger . I’ve been blogging for 2 1/2 years and I can’t add a thing to this wonderful list of ideas for the new blogger and refresher for us oldies. The advice is posted at NursingBytes.net. Check it out. And if you aren’t already blogging, please consider it - you have much to contribute to the online dialog!

*****

Oh, this one is a doozy! And if it didn’t come from Mother Jones herself, I’d have never believed it! But it’s true and you can read all about Dirty Talk at Nurse Ratched’s Place. Don’t say I didn’t warn ya!

Marachne is a palliative/hospice nurse and frequent contributor to the Nursing Voices forum. In her first submission to Change of Shift, she shares with us the feelings of seeing her profession and her activism merge in Intersecting Worlds: Bearing Witness, found on her wonderful blog, A Window For Your Home.

Alvaro Fernandez is a frequent contributor to Change of Shift and this week he presents an interesting look at Brain Evolution and Why it is Meaningful Today to Improve Our Brain Health via an article by Larry McCleary, M.D, former acting Chief of Pediatric Neurosurgery at Denver Children’s Hospital, posted at SharpBrains. Find out how diet and exercise can keep our brains functioning at maximum capacity.

*****

Well I have to catch up with my fellow nurse bloggers! Beth over at Pixel RN has a new look and a beautiful story of being in the right place at the right time to bring encouragement to her patient. You can read about it in Healing a Different Kind of Pain. Great story! Beth was also a web designer in a former life and has some suggestions for would-be nurse bloggers in Design Resources for the Nurse Blogger.

Nurse Sean has made a New Year’s Resolution to keep an eye out for the “big picture” where his patients are concerned. Check out his Nursing New Year’s Resolution. How do you keep on top of things?

Ever dealt with low morale at work? Disappearing John is doing just that and has figured out why in Something Went “Click”. Management by memo, sign and email? I most definitely can relate…

*****

Another first time Change of Shift blogger! Katie Bee at Young and Restless Nurse wants to know what you think about labor unions and their impact on your practice. She mentions a CNA/NNOC ad campaign referencing “CheneyCare”, a campaign which ticked me off big time! So, join me in reading MAD Money and let Katie know what you think!

Over at Medscape, Beka made it home for the holidays - in her case celebrated in the Swedish tradition - but still wondered about her patients back home. Her Holiday Memories sound wonderful. I’d go for making an ice rink in the backyard! All we have is mud! Her blog can be found at Medscape’s In Our Own Words.

Vreni Gurd is not a nurse, but she presents a rather entertaining look at Hospital food - an Opportunity Waiting? posted at Wellness Tips. If I’m ever in the hospital, she can cook for me!

*****

Just for fun, I pulled an old post from the Emergiblog archives, specifically January of 2007. My submission this week discussess what to do when the burn out has hit and it’s time to move on in If You Don’t Have the Answer, Why You Still Standin’ Here?

The next edition of Change of Shift will be up on January 24th and hosted by Beth at Pixel RN. Submissions may be sent to Blog Carnival or to beth at pixelrn dot com.

Thanks so much for reading and for your continued support of Change of Shift!

Do hospitals take on too much responsibility for patients? Is it really up to a healthcare establishment to fix everything wrong with a patient’s life? If a patient comes in with a broken foot but is also homeless, is it up to the hospital to find a place for that person to go in addition to treating the broken foot?

That’s how Geena begins the latest poll over on Nursing Voices, and she continues:

When a patient is discharged and has a home but no one can come and pick them up, why is it our job to get them cab fare or a bus token?

I actually discharged a patient once in this situation. He said he had no one to pick him up, so if I could just take him out to the bus stop he’d take it from there. I felt really weird doing that. I’ve had other patients demand cab fare to get home.

Am I making sense? I don’t mean to sound insensitive, but I don’t see how we can fix everything.

If the patient has nowhere to live, and there’s nowhere to take them - what are we supposed to do? I feel like the way things are going, we’re going to have to start feeding patient’s cats while they’re in the hospital.

Of course it would be nice if we could fix everyone’s problems, but our resources are already stretched thin.

What’s your opinion?

Let her (and all of us) know by voting today!

We’re helping Nursing Voices with the official launch of their new nursing forum by giving away two brand new iPhones! Check out their official announcement for full details.

Geena from Code Blog writes over on Nursing Voices:

When I started out in nursing, the hospital I worked at required CNA’s to wear cranberry, RT’s to wear teal, and RN’s to wear royal blue. We could wear certain scrub tops that were approved and that matched the royal blue pants. The hospital did not pay for them.

When I moved and got a new job, there were no standard uniforms. We could wear whatever we wanted. Some people took this too far and started looking a bit unprofessional - scrub pants with little t-shirts that actually showed off belly buttons when the nurse moved around.

…

I’m curious about how many out there are required to wear a certain type/color of uniform?

Let them know by voting in the poll!

Geena from Code Blog writes over on Nursing Voices:

Do you call the docs you work with by their first names?

Docs get to call us by our first names, but why is it not reciprocable? (Yes, I made that word up)

I’ve been at my current hospital for 7 years, but there are only a handful that I call by their first names. One or two have told me that I can; with the other few their first names just came out one day and since they didn’t seem offended, I just kept at it.
I always call them “Dr. SoAndSo” if we’re in earshot of patients or families.

There are some nurses I work with that call many doctors by their first names, but those are usually the nurses who have been there for decades working with these docs.

What do you do?

Let them know by voting in the poll!

If you’re a nurse working in a hospital, chances are you’ve recently attended a customer service workshop. I just went to a program on AIDET as part of nursing orientation. A lot of what was talked about was not new:being respectful and attentive, giving clear and concise explanations and including the patient and family in the decision making process. What did surprise was when the instructor said that customer satisfaction scores are now being tied to federal funding.

That got me thinking. Up to now I’ve only been familiar with the Press Gaineys, a private survey firm. I’m sure your hospital has something similiar. Patients are selected to receive the survey after discharge and they rate the hospital, nurses, doctors and other services. It is hospital driven and customized to the institution. In 2005, however, the Centers for Medicare and Medicaid Services(CMS) came up with a standardized survey to track customer satisfaction, wordily called the Hospital Consumer Assessment of Health Providers and Systems. HCAHPS, or Hospital CAHPS, or the CAHPS hospital survey, is a voluntary survey. However, according to this article from the New York Sun, hospitals that don’t report their results can lose 2% of their inpatient Medicare funding. At this time, hospitals do not have to pay to participate.

CAHPS(with and without the first H) are funded and administered by the U.S. Agency for Healthcare Research and Quality(AHRQ). The CAHPS program was started almost a decade ago, so that a standardized system of patient surveys could be put into place to help improve patient centered care. There’s a CAHPS for dental plans and another to assess the health care experiences of Native Americans’ use of tribal clinics, among others. The survey results are part of the public domain and available online.

So why should any of this concern us as nurses? Besides the fact that it’s an hour of my life I’ll never have back again. I’ve heard much grumbling from the trenches about how this is just another ploy by the hospital to make money and make our jobs harder. What matters is delivering top-notch nursing care, not being warm and fuzzy. Nurses are a tough crowd with the best of topics, but try telling them that they’re not being nice enough and you’re liable to have a revolt on your hands.

Patient satisfaction is important(sorry, to me they’re still patients, not customers). My experiences as a transplant coordinator bear this out. As I’m sure you know, asking a family to donate their organs couldn’t happen at a worse time. Who wants to make such an important decision when dealing with the death of a loved one? Unfortunately, time is of the essence and we work in a small window of time to make the request, sometimes only a few hours. Gaining a family’s trust is tantamount. I’m not talking about putting one over on people. I’m saying that within the short time frame allowed, you have to not only help the family come to terms with brain death, you have to give them all the information they need to make an informed choice. This doesn’t just apply to life and death situations. Patient education and planning care are synonymous with nursing. Managed care means that many of our patients are only with us for a few days. In the ER or Same Day Surgery, a few hours. It should come as no surprise to anyone that increasing a patient’s satisfaction, increasing their trust and comfort levels, is going to enhance their learning and increase their desire to participate in the healthcare plan.

Hospitals love to have good survey results. They plaster them in the papers and work them into their advertising. So is all this good PR for the hospital? You bet. Should nurses be valued for their ability to start an IV as well as their winning smile? Absolutely. But the bottom line is that keeping patients happy can also be good for their health.

Nursing research is very serious business.

It’s what our practice is based on.

It’s why we do what we do the way we do it.

Being new to the concept of nursing research, I learn a lot by writing this column every week.

There are some pretty big projects going on out there and I’m amazed at the amount of research that nurses are involved in.

I really had no idea.

******************************

One thing I have learned is that there is research done by nurses and then there is research done on nurses/nursing. I’m not sure the latter qualifies as “nursing research” but occasionally the projects are interesting or the results are surprising.

I was surprised to find a study in Applied Nursing Research that attempted to ascertain the opinion of nurses regarding single vs. multiple occupancy patient rooms.

It’s no secret that private rooms help decrease infection, increase privacy, decrease noise, minimize the possibility of errors and allow interaction with family and friends. Nurses know this - we see it everyday.

In this study (funded by the Coalition for Health Environments Research and Facility Guidelines Institute), the preference of nurses for single occupancy rooms is established and documented.

Why am I surprised?

I’m surprised that a group of non-nursing researchers evaluated the available literature on the effect of single occupancy vs. multiple occupancy rooms on patient outcomes and realized were no studies involving nurses.

So… they went and solicited that input in the form of a research project asking nurses to make comparative assessments between the single and multiple occupancy patient rooms.

The results. Nurses prefer them in every way. From room set-up to actual patient care, single occupancy wins every time.

We knew that.

Now there is literature in the research community that confirms it.

Maybe I should not be amazed that a group of researchers decided to obtain the opinion of nurses regarding the physical set up of a hospital unit.

Then again, who would know better than the nurses who function in that environment?

The fact that these researchers realized that nurses have a unique perspective and sought to document it shows respect for the nursing profession.

That is always good to see.

******************************

Resource: Chaudhury, H., Mahmood, A., & Valente, M. (2006). Nurses’ percepton of single-occupancy versus multioccupancy rooms in acute care environments: an exploratory comparative assessment. Applied Nursing Research, 19(3), 118-125.

Last month the Egyptian government banned all female “circumcision” following the death of a 12 year old girl. Technically it had been banned in 1997, but continued on through a loop hole that allowed it in cases of medical necessity. Research done by Unicef in 2005 found that 96% of Egyptian married women aged 15-49 reported being circumcised. All this was first brought to my attention by TofuLou at her blog, Manifest Destiny. It’s a good post and she has drawings and descriptions of the different extents to which it’s done.

I prefer the term Female Genital Mutilation. Circumcising a woman, if that is what’s done, would be the equivalent of removing a man’s foreskin, meaning the clitoral hood would be removed. In FGM, the entire clitoris is removed and in many cases, the labia minora are also removed. In a practice called infibulation, the the clitoris and the surrounding area, including the labia minora, are excised and the labia majora are sewn together. I once took care of an older woman who had this done. She was in heart failure and needed a foley catheter inserted. She was very upset about having to disrobe, but with her female relatives helping her and her privacy protected, she did. As I went to insert the foley I was astonished to find-nothing. There was nothing there except for the tiniest orifice. I knew what FGM was, but I never expected to see it.

Although sometimes associated with Islam, FGM is more of a cultural phenomenon and is practiced by followers of animism, Christianity and Islam. In other Muslim countries it is unheard of. FGM is usually done on prepubescent girls, but has even been done on infants, according to the WHO. Very often, it is done without anesthetic and in unhygienic conditions. (The State Department) Although families with money will find doctors who will do it under anesthetic and in better conditions, the World Health Organization considers the “medicalization” of FGM to be unethical and condemns the practice. Defenders say that being “cut” ensures a woman being faithful to her husband and that without it, she is unmarriageable. Suffice it to say, this practice is known to cause numerous complications, not the least of which is the risk of bleeding and infection at the time it’s done. According to Our Bodies, Ourselves For The New Century, long term complications include abscess formation, scar neuromas, dermoid cysts, painful sexual intercourse, and vulvar adhesions. Scar tissue can lead to urinary retention and infections, kidney stones, dysmenorrhea and chronic pelvic inflammation, which can lead to infertility.

Communities in the US with high percentages of immigrants may see an influx of FGM. According to the CDC, in some communites, doctors report that as many as 2/3’s of their population has had it done. It is becoming common enough that they have introduced ICD codes for the condition. It goes on to say that women that have undergone infibulation must have surgery before they can have intercourse or deliver a baby. Multiparous women who have undergone infibulation and then reinfibulation following birth are more likely to have complications and a high incidence of maternal and fetal death with subsequent births.

Women who have undergone FGM live in our country and it’s possible you will encounter them in your nursing practice. If a woman presents in labor she may have to have surgery to enlarge the vaginal opening or have a C-section. Knowledge of this practice will help you understand the many complications that can result. Of utmost importance is to be nonjudgemental in your dealings with them. Some may worry that being against FGM could be considered racist or not being culturally sensitive, but this practice is condemned by the WHO, the UN and many other international organizations, as well as leaders in some of the countries where it is practiced. For more information go to CARE.

Before there were blogs, there were books. Nurses told their stories the old fashioned way, and they were just as intriguing as blogs today. Just out of nursing school I came across Echo Heron. I first read her book Intensive Care: The Story of a Critical Care Nurse. I was impressed with what she accomplished; returning to school as an adult with a child, helping to establish a critical care unit in her hospital, her expertise in caring for complex patients. I devoured the sequel, Condition Critical, The Story of a Nurse Continues, like dessert.

Although not a nurse, Suzanne Gordon is probably one of our biggest advocates. Again, soon after becoming a nurse I stumbled across her book Life Support. It follows several nurses at Boston’s Beth Israel Hospital (now Beth Israel Deaconess Medical Center) and the struggles they face. This book was written during the mid-1990’s when dust from managed care’s take over was settling, and Gordon does a great job showing how it effected the health care system and nurses. I’m waiting for a few spare moments to read Nursing Against the Odds, her latest look at the nursing profession.

One of the more recent nurse authors on the block is Tilda Shalof. Her first book, A Nurse’s Story, tells it like it is for an ICU nurse. Her follow up, The Making of a Nurse, reveals her first experiences as a nurse.

In my search for nurse authors, I came across Janice Hudson, self proclaimed Trauma Junkie. Seeing I like to live out my adrenaline nursing fantasies vicariously through others outside of labor and delivery (we have our own style of adrenaline nursing), I am going to have to check this one out.

Does our nurse friend look familiar? Have you been there, done that? Does this cartoon sum up the story of your (professional) life?

Did you make the last meeting of your “journal club”? Is your stack of unread AJNs gathering dust in the corner? Oh, and how’s the research project going?

You don’t have time for all of the above?

Me, neither.

We are so busy practicing nursing that there is very little time for actually keeping up on research, let alone utilizing new evidence based practices.

*****

I happened upon a study in the February, 2007 issue of Applied Nursing Research that discusses the divide between research and actual practice. Nursing practice committees promote innovations and turn expert knowledge and research findings into standards of practice. Nursing research committees help build a research-friendly environment, encourage evidence based practice and serve as resources. You would think the work between these two groups would be seamless.

The researchers found a divide/gap between the research guiding nursing practice and the actual practice itself. In fact, when comparing their results to studies from ten years ago, they found virtually no change in how staff nurses implemented research findings. One remedy proposed was adding a hospital-based nurse researcher career track so that nurses can blend their research and clinical interests.

*****

This is a thought provoking study.

Those working in a large metropolitan medical center comprised of a hospital and medical school would find it very applicable to their situation, I’m sure.

For those of us who work outside teaching institutions in small community hospitals, the idea of a nurse researcher career track seems unworkable, to say the least.

Given that the “traditional venue for nursing research has been the academe”, how does this assist nurses outside of the teaching facilities when there is a noted gap between research and practice in the actual research setting?

How do you get the research to filter down to the bedside staff nurses who work outside those academic institutions, in facilities that don’t have a research committee?

Sounds like a research study waiting for a home, if you ask me!

******************************

Resource: Smirnoff, M., Ramirez, M., Kooplimae, L., Gibney, M., & McEvoy, M. (2007). Nurses’ attitudes towards nursing research at a metropolitan medical center. Applied Nursing Research, 20(1), 24-31.