Tag Archives: Nurses

Religious Ethics

The religious ethics theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically.  One particular faith, Jehovah’s Witness, does not allow for blood transfusions.  This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent.  The treating neonatologist will need to get a court order to do the transfusions.  In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order.  As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child.  But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).

The parent refusing to allow treatment of transfusions to their baby, would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a  family-centered type of care involving the caregivers in the decision making and treatment  (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010).  When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms.  I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments.  By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal.  You as the parent are watching and hearing this because in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you, there is not a curtain.  As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done.

With the use of the religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life.

References

Denisco, S. M., & Barker, A. M. (2012). 25. In Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from https://campus.capella.edu/web/library/home

Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enterocolitis. Special Articles-Ethics rounds. http://dx.doi.org/10.1542/peds.2010-0079

Rosie Moore, RN, DNP

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Is There Still a Nursing Shortage

It seems that the nursing shortage has been an issue since I was going to school.  I remember at one point I received a one year full scholarship to go to nursing school my first year; then the 2nd year I received a letter that stated the President decided the nursing shortage was over and cut my full scholarship for the second year, forcing me to get student loans. That is enough to make you mad! But now as I practice as a nurse, I see that there is still a shortage of nurses in many fields (Moore, 2015). For instance in the hospital what I see is that they do not hire too many nurses because if they have too many on the unit and they don’t float them to another unit, they will send them home without pay because there is not sufficient work. When my son was in the Neonatal Intensive Care Unit, I had to walk past high risk antepartum, one day the lights were dim, and there was no one around. I got a bit concerned that something had happened.  There was a sign that said, “unit closed.” When I inquired, someone stated that the unit was closed because the patient census was down.  Of course two days later, it reopened.

I see that nurses are overworked because of the shortage as well.  The shortage is only getting worse as the years go by because the baby boomers are soon going to be retiring and there are no new nurses to take their place (“Focus on Education,” 2010). There are also articles that speak about new nurses graduating, but their minimal level of education required will be the bachelor’s level plus all the clinical involved with that level.  There are entrance exams to some nursing schools, making it difficult for the student to pass.  Of course, education should be taken to the next level due to the more complex illnesses and family dynamics that we have today.

In order to not continuously have a shortage, employers need to realize that yes there is a shortage and hiring more staff to help the current nurses and not over tap them will be more productive in the long run.  The medical cases are getting more complex these days for patients in the hospital, therefore making it important for nurses to have a higher level of education. The colleges have to start sending representatives to the high schools to start recruiting future nurses so that when they graduate, we can add more nurses to the profession.  Recruiters need to present the pros and cons of being a nurse and look for candidates that will be a good fit for the nursing profession.

References

Moore, M. (2015). The nursing shortage and the doctor shortage are two very different things. Retrieved from http://www.washingtonpost.com/news/to-your-health/wp/2015/06/05/the-nursing-shortage-and-the-doctor-shortage-are-two-very-different-things/

The future of nursing: Focus on education. (2010). Retrieved from http://nursejournal.org/articles/the-future-of-nursing-infographic/

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com
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Changes in Regulations

Many states want to make changes that will impact nurses and how they practice nursing.  Advanced practice nurses (APN’s) should stay abreast of potential changes in relevant nursing or related regulations.  Nurses already have to take continuing education courses in order to maintain their licensure.  As an APN, the basic requirements that a registered nurse has to take are not going to be sufficient for an APN.  The best way to stay current is to join an association and become a member nationally and then join the local chapter.  Being a member of a national organization will allow the APN to get current regulations that affect the entire country and the local chapter will give the information that pertains to the state where the APN practices.  The local chapters of an organization can provide opportunities as well for speaking engagements where the APN can be involved in presenting a topic that is researched to also expand upon the APN’s knowledge (DeNisco & Barker, 2012).

References

DeNisco, S. M., & Barker, A. M. (2012). Government regulation: Parallel and powerful. In Advanced practice nursing: Evolving roles for the transformation of the profession (2nd ed., pp. 231-260). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home?deepLink=true

Rosie Moore, RN, DNP

Visit my Website to learn more www.rosiemoore27.com

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Strategies on Cultural Competence

In my own nursing career as a supervisor for field case managers, I have encountered patients and staff that come from diverse cultures. Every two weeks, our entire region would participate in Grand Rounds and during those rounds, our medical director reviewed four cases that had been submitted prior to the meeting in order to evaluate them for a better plan of care to help the patient.  My team consisted of a mixture of different cultures.  I had some wonderful nurses from different Caribbean Islands, some of them had a very strong accent, but that did not stop them from providing good care.

During our grand rounds, the medical director selected two of my case managers to present their case.  The case was presented in our own team meeting and as a team, we thought it would be a great case to present.  The one case manager we will call her Ms. R. presented a case about a member that had too many cats in the home and she was having difficulty staffing the case with home health aides because no one wanted to go in the home with so many cats. The medical director gave his evaluation of the case and the case was closed with the new information for the nurse case manager to implement.

During a manager meeting with about six other managers, the topic of case presentations came up and how each team needed to submit two cases per week, even if they were not selected for grand rounds.  A manager from England, who spoke with an English accent, stated that my team presented a lot of cases all the time.  I confirmed and stated that our strategy was that in our team meeting as an exercise we would bring two every week so that everyone had a chance to comment and it helped the presenting nurse in case her member was selected for grand rounds.  The English nurse manager asked me how I even understood Ms. R. and a few other staff from the islands that I had.  I politely let her know that I did have a diverse team and every one of them was a great nurse or social worker and did their jobs quite well.  As for understanding them, I listen to what they were saying intently and I did not multitask when they were speaking so that I could capture every word they said. Her response was “I am glad that they are on your team (Clark et al., 2011).”

A week later, I resigned from that position and unfortunately for my staff four of the team went to this one manager and the other nine went to someone else.  But of the four there was one from Haiti, one from Grenada, one from Puerto Rico and the other one was African American.  I  heard from all four about the poor treatment they were receiving from this manager. I, of course, could only listen, since I was no longer working there, but this is a perfect example of how not all nurses follow the code of respect of others cultures.

With patients, it is the same thing,  as nurses, we are not always going to understand what someone is saying whether it be a language barrier, dysphagia from a stroke, or dementia, but as nurses, we need to be able to read the body language.  We need to fine-tune our ears to try and understand what the person is saying. Living in Florida I am exposed to many cultures.  I myself am of Hispanic descent and although born in the states, I understand the diverse cultures that there are here.

In integrating health teachings, many materials are available in Spanish and Creole, However for the ones that are not, the use of translation companies are available through hospitals or managed care companies to help with the teaching that we are offering the patients.

References

Clark, L., Calvillo, E., De La Cruz, F., Fongwa, M., Kools, S., Lowe, J., & Mastel-Smith, B. (2011, May-June). Cultural Competencies for Graduate Nursing Education. Journal of Professional Nursing, 27(3), 133-139.

Implementing Changes in the Emergency Room

An emergency room nurse asks how can he make changes in his emergency room to better serve the patients?

My response to the ER nurse was to acknowledge that I understood his enthusiasm in wanting to make the changes in his emergency department. In such a fast paced department where it is a matter of life and death,  it is hard to implement changes because the nurses may feel they do not have the time to learn but as managers we know that a change must take place (Stevens & Caldwell, 2012).  The emergency department is one of those places where there is never a happy medium making it difficult to staff and do trainings.  But as the website for the American Academy of Healthcare Communication noted “communication is the key to exceptional patient care” (http://www.health.gov/communication/resources/Default.asp).

emergency-room

In order for the nurse to feel that there needs to be a change, there has to be an explanation to them impressing that remaining in the same pattern is not helping the patients.  As managers though, we need to be careful on how this is communicated to the staff, because people are sensitive and if they feel that the work they are doing at the moment is not good enough, they will not accept new changes favorably.

new-year

One way to implement change is by communication in a narrative format;  doing a synopsis of what has been happening in the emergency department.  For example, how many patients have had complications as a result of starting an IV on patients with difficult vascular access because too much time was spent on trying to get an IV line in or calling someone else when attempts have failed?  Without laying blame on anyone,  if this study is brought as a statistic and narrative then it may help the nurses see the importance of a quick ultrasound to see the access.

Everyone is always afraid of change but if presented in such a format where they are given the time to learn it, for example paid education to come to the training on an off day with different options given for the training based on the two or three shifts that the hospital has.  Once the plan is implemented for training, being able to have the educators follow-up with each nurse on how they are doing, will show the staff that the management genuinely cares.  It is important to know if the new transition towards the change is working and if not why, so that the training can be revamped.

nursing-education-2col

Once the nurses see that the change is going to make their jobs easier and the patient’s quality of care rises to a new level, they will be more receptive.

change-challenges-for-nurses-2-13-638

 

References

Stevens, K. R., & Caldwell, E. (2012, August 29, 2012). Nurse Leader Resistance Perceived as a Barrier to High-Quality, Evidence-Based Patient Care. The Ohio State University Research and Innovation Communications. Retrieved from http://www.health.gov/communication/resources/Default.asp