Are you a Nurses’ Nurse?

I’m always surprised when someone asks: “What’s a Nurses’ Nurse? 

Maybe it’s because I’ve been an RN for so long that my perceptions are biased by eyes that are constantly assessing and looking for remedies to multi-faceted problems. 
This makes for the assumption that everyone else is doing the same thing and watching out for each others’ backs.

As I explain this expression “a nurses’ nurse”, one more time to a twenty-something-year-old who rolls their eyes at me, clearly my vision of care for the caregiver is not so well understood.
When I study the types of nurse leaders that have come before and the kind I’d like to be, I’m drawn to the concept of a transformational kind (think Cinderella). 
One that walks the talk, never asks you to do something they hadn’t done themselves (like scrub a toilet), supportive but never patronizing or condescending, comes to mind. A nurse shaman, an enlightened leader who integrates the principles of body, mind and spirit into the next generation of RNs.

Delusional? I think not.

Nursing students: a new generation that covers each others’ backs. Tattle-tails and bullies need not apply.
I’ll never forget the time one of my coworkers was promoted to manager, then quickly rose to the ranks of administrator. 

It was as if she had been struck over the head, as she forgot what it was like to work short-staffed and behaved as if she had never worked as a bedside nurse when we asked for more help. I remember a fellow labor and delivery RN, comrade saying:,”I’m not at all surprised, our manager never was a nurses’ nurse.”

That’s when it struck me: 

The nursing profession has always been ruled by a set of doctrines that follows a higher law. Why then do we not pertain those laws to each other and behave like a nurses’ nurse?
Is it our “do or die” mentality that stems from the arduous work we are programmed to perform?

As a nursing instructor it was rare for me to find mentors for my students without amnesia, who could remember what it was like to be a budding Nightingale. Most of us have been strong-armed or bullied because that’s the kind of tutelage our superiors came from.

Generally speaking, western medicine has had a longstanding quality that initiates its fledglings with cruel hazing. That’s why we’re often called the profession that “eats its young”. It takes one tough cookie to make it through nursing school.
This attitude which has flowed from a managerial nursing leadership has got to stop if we want true accountable care in the ACA. 
Again think about Cinderella and how she was transformed by optimism and collaboration.
Ask yourself, “Am I a Nurses’ Nurse?”
If the answer is “no”, google transformational leadership & apply the principles of encouraging and inspiring other nurses into your own practice.

By the nurses nurse

Medication Errors: How to avoid them

 

By Collins Onyango

We’ve all made mistakes, most of them small and inconsequential to the patient’s health, but sometimes the mistakes are serious.

Medication errors can compound a medical crisis, sometimes with tragic results — yes and nurses administer most medications. 
It’s common fact that I, and every nurse and doctor, have made medication errors.  Most hospitals where we work have put in place systems of checks and balances to be sure serious mistakes don’t slip through therefore most of the time, our errors don’t amount to much.
You often left with the knowledge that you almost harmed a patient you were trying to protect even when your mistake is caught and a potential crisis averted. Little is known regarding organizational factors that facilitate nurses’ efforts in performing this vital safety function yet, despite studies illuminating the critical role of nurses in the interception of medication errors.

Medication administration is a complex multi-step process that encompasses prescribing, transcribing, dispensing, and administering drugs and monitoring patient response. An error can happen at any step. Although many errors arise at the prescribing stage, some are intercepted by pharmacists, nurses, or other staff

Almost did it

My worst mistake ended up not mattering at all, but it still pains me to think about what could have happened as the result of my error.As a critical care nurse I try to catch up with emergency medications after the patient’s condition changes and this requires several procedures. The patient is intubated.
I decide to push it through the IV canula. During the haste I almost fail to notice the “look alike” warning on the ampule but fortunately stops just in time when she realizes she’s about to make a serious mistake. Unfortunately, most administration errors aren’t intercepted.

10 key elements identified by the Institute for Safe Medication Practices (ISMP) have greatest influence on medication use are:

1. Patient information
2. Drug information
3. Adequate communication
4. Drug packaging, labeling, and nomenclature
5. Medication storage, stock, standardization, and distribution
6. Drug device acquisition, use, and monitoring
7. Environmental factors
8. Staff education and competency
9. Patient education
10. Quality processes and risk management.

Preventing Medication Errors in Nursing

Administration errors account for 26% to 32% of total medication errors. Considering the magnitude, a conscious effort to prevent medication errors in nursing is a must. While an electronic medication and prescription system may help avoid some handwritten mistakes, human error can creep in at each step, errors and adverse drug effects may seem inevitable.  

Before administering medication

1. Utilize at least 2 identifiers that are specific to the patient. For example, along with the patient's name, confirm date of birth to be sure the order matches the patient. For patients who have similar names, another identifier may be needed to avoid medication errors. a special sticker or marker on the patient's chart can be useful
2. Review notes and confirm with patient about allergies and reactions to medicationsbefore any new medication is administered. update this information in patient chart.
3. Avoid abbreviations, which can be easily misinterpreted when documenting medication allergies.
4. Review patient's critical diagnoses which can affect not only the selection of medication but also dose and frequency. Patients with renal, liver and psychiatric disorders, cardiac as well as diabetes mellitus and pregnant fall under this category.
5. Note and update the patient's current medication regimen after every doctor's including any over-the-counter medicines or vitamin visit on the same chart for easy access.
6. Learn and decipher similar drug names. Some the drugs that sound similar or are spelled similarly to another drug have different uses. Celebrex is commonly used to treat arthritis while the similarly named Cerebyx is used to treat seizures
7. Repeat the order when calling prescriptions for a patient. Make sure to read each number individually such as "1-0" instead of 10 to help prevent errors in dosage.
8. Keep "high alert" or similar-sounding drugs in separately and well organized to avoid confusion.
9. Keep current on new information relating to prescription medications and their reactions.   Purchase the latest editions of drug reference resources such as. Look to the Institute For Safe Medication Practices (ISMP) for continuing education classes and their newsletter for further tips on how to prevent medication errors in nursing.
10. Take time out between rechecking calculations. Nurses are more likely to find their own errors when there is time between rechecks. Even with the practice of double checking medications with another nurse, studies suggest that there is always a great chance for error. Individuals see what they expect to see. So whatever medication or patient name one nurse may read, the second nurse has a tendency to see as well. A better way to implement double checks would be to have one nurse read what is on the medication package or dose and have the other nurse check it against the order, and then reverse the process.

Be sure to use the safety practices already in place in your facility. Eliminate distractions while preparing and administering medications. Learn as much as you can about the medications you administer and ways to avoid mistakes. 

Read more

1. Better Environments for Nurses Mean Fewer Medication Errors
2. ASHP Guidelines on Preventing Medication Errors in Hospitals
3. Medication Error Prevention for Healthcare Providers

How to ask for References and Letters of Recommendation

By Collins Onyango

 
Are looking for a job? Or graduating soon? Asking for references can be a daunting task. When you apply for a job, internship, or other professional experience, you most often will need references, recommendation letters, or both

A letter of recommendation is a written statement supporting your application for a specific internship program, fellowship, or graduate school.  It differs from a reference in that it is always written and is addressed to a specific program.  Many organizations that require a letter of recommendation will provide you a form that will include a confidentiality waiver.

With the increased competition for new graduate nursing positions, it may be wise for any student to keep common etiquette and professional standards in perspective during their years in college.

References and letters of recommendation form essential parts of any application process. Typically, references will be requested for most employment opportunities, while letters of recommendation will be needed for academic pursuits such as graduate or professional school.

Who to Ask

• Majority of your referees should be academics themselves, ideally in the field of interest to you if you are applying for admission to an academic program, academic position, or scholarship/grant award.
• It very important to have a good idea of what they are going to say about your background and your performance. It's perfectly acceptable to use references other than your employer.
• It’s important not to assume an individual will write a letter of recommendation for you. Choose individuals who can provide positive feedback regarding your teaching abilities and your experience with students.

Choosing your References

• Three letters of recommendation are standard for most teaching positions. However, asking more than three individuals will allow you to choose those you feel are the strongest or most appropriate for the position/district
• They should be persons you have built a strong relationship with you. It is also beneficial to include a professional reference that can speak to your abilities in a work environment. This could be a past supervisor or boss.
• Preferred references: cooperating teacher, principal, student teaching supervisor, another teacher, professor, adviser, or supervisor from a student related experience.
• Least preferred references: Individuals associated with non-teaching related experiences

Preparing your References

• Plan ahead so you have your list of references and/or letters of recommendation ready as you begin applying for teaching positions.
• Once your reference has agreed to write a letter of recommendation for you, arrange to meet in person. This will allow you to provide additional information about yourself. It will also ensure your reference writes about areas you think they can best demonstrate.
• File your folders together if applying for a graduate or professional program. Each referee should be briefed with information about each of the programs you area applying for. Then you submit the letters along with a copy of your resume before deadlines
• If you will be using the letter for a job or internship, provide the referee with your resume, the job description, and some information regarding your interest in the position and organization. In addition to references, you may be required to provide contact information of your supervisor. However, prospective employers should get your permission before contacting your current supervisor to avoid jeopardise your current position.
• Give your potential references plenty of time to write a strong recommendation

Maintaining relationships with references

Lastly, remember to send each of your letter referees a thank you note after the submission process. During your job search, take the time to thank your references and provide them with updates about your search.

• Contact your references each time you give their name to an employer. This will help them be prepared and provide a solid recommendation for you.
• You will also need to inform them when you have news to share about the position or admissions process. Serious recommender's always love to hear feedback from you. Updating them also strengthens your future professional network
• Stay in contact with references over time. View reference cultivation as a career-long process and always be aware of who might be a good reference for you in the future

Read more

1. Advice for new grads: How to get great references from faculty
2. Hiring nurses share how to ask for, receive letters of recommendation
3. How to get great recommendation letters
4. How to Get a Great Letter of Recommendation