The New Year Is the Time to Take Stock

I’m not sure what it is about the completion of the earth’s revolution around the sun that prompts us to make resolutions for the coming year, but it’s probably not a bad idea. Even if we don’t keep every resolution – or any, for that matter – it’s a good practice to take stock of our lives every once in a while. Most of us would like to try to make life better for ourselves and those we love, and the arrival of a new year gives us that little push to do so.

I’m sure that work on your 2012 resolution list is well underway, but in case you need some additional ideas, here are a few suggestions:

• If you have to discuss your work with someone, don’t do it online.
• Tell someone who needs it about palliative care.
• Get a pedometer and aim for 10,000 steps a day.
• Be a little more patient with patients’ families and visitors.
• Use 10 minutes of your break to take a walk.
• If you don’t have a degree, look into what it would take to earn one.
• Write a thank you note -- the kind that requires paper and a stamp.
• Check out the disaster plan for your workplace.
• Go to bed 15 minutes earlier.
• Think of a way to improve morale on your unit or at your workplace that doesn’t cost money.
• Eat at least two servings of vegetables a day.
• Forego the elevator for the stairs.
• Surprise a co-worker and bring him/her a lunch that you made.
• Stop forwarding those chain emails.
• Be honest with your supervisor; tell him/her what you really need to do your job well.
• Categorize the problems and annoyances in your life as Big Stuff or Small Stuff; then, don’t sweat the Small Stuff.
• Say hello to a housekeeper or maintenance person on your unit and tell them how much you appreciate what they do.
• When you don’t feel like washing your hands, DO!
• Treat yourself to a foot massage.
• If you are new to the nursing profession and have a question, ask a veteran whose work you respect.
• If you are a veteran nurse, let a newbie know that you are available to help.

What are your resolutions for 2012?

Tell us about them.

Kudos to Nurses as NHS Participants

I recently received my semi-annual newsletter from the long-running, three-part Nurses’ Health Study, conducted by Harvard Medical School and Brigham and Women’s Hospital in Boston.

The Nurses’ Health Study 1 (NHS1) began in 1976 with more than 120,000 RNs, ages 30 to 55. Its goal was to examine how lifestyle affects the risk of developing cancer and the long-term consequences of oral contraceptive use.

NHS2 commenced in 1989 with nearly 117,000 RNs, ages 25 to 42, for essentially the same reasons with a few modifications.

NHS3 began in 2010 and examines similar issues, and also looks at how working the night shift and the new generation of birth control pills affect women’s health. This third study is still enrolling both RNs and LPNs/LVNs.

I joined NHS2 in 1989 and look forward to the regular newsletters that keep participants up on study findings. Here is what the latest edition tells us:

• Body mass index (BMI) definitely affects the aging process. An increased BMI in midlife means a reduced chance of surviving to age 70. For example, in the study, obese nurses (BMI of 30 or greater) had an 80 percent lower chance of healthy survival compared to women with BMIs of between 18.5 and 22.9.
• The more weight a woman gained from age 18 until midlife, the less likely her chance for healthy survival after age 70.
• Higher physical activity levels at midlife were significantly associated with healthier survival.
• Women who jogged or cycled about five hours a week nearly doubled their chance of healthy aging.
• Two or more hours a week of brisk walking increased the chance of healthy aging.

The study also looks at genetic factors and the aging of cells.

Scientists know that telomeres, the protective end caps that protect the chromosomes, get shorter each time a cell divides. In the NHS, researchers found that shorter telomeres are associated with a higher risk of certain age-related diseases like bladder cancer and cognitive decline. Investigators also found that maintaining a healthy weight and higher activity levels and refraining from smoking helps maintain telomere length.

Here are a few of the NHS’s earlier findings:

• Taking oral contraceptives decreases the risk of developing colon cancer and the “wet” type of age-related macular degeneration (AMD).
• Taking post-menopausal hormones reduces the risk of colon cancer, hip fractures and wet AMD.
• Current use of hormones in recently post-menopausal women may reduce the incidence of coronary heart disease (CHD).
• Taking estrogen plus progestins for more than five years increases risk of developing breast cancer.
• Breast cancer seems to have no relation to past or current smoking, but there is a positive association between smoking and CHD and stroke. This increased risk disappears within two to four years after quitting.
• Smoking increases the risk of developing colon cancer, hip fractures (for current smokers), cataracts and wet AMD.
• Higher vegetable intake, especially green leafy vegetables, reduces the risk of cognitive impairment.
• High insulin levels, even in women without diabetes type 2, increases the risk of cognitive impairment.
• High consumption of alcohol increases the risk of hip fracture, while low or moderate consumption is associated with greater bone density.

Some future topics of exploration include physical ability and disability; optimism and resilience; and how sleep affects health.

The best and most amazing aspects of these studies are their longevity, size and the response rate of participants, which is about 90 percent. Nurses have been exceedingly cooperative when it comes to completing questionnaires and doing follow-up testing. This faithfulness to research will not only benefit nurses but women everywhere.

If you are an RN or LPN between the ages of 22 and 45, consider signing up for NHS3. Unlike NHS1 and NHS2, researchers are not sending out signup forms, but rather are relying on nurses to join by visiting www.nhs3.org.

Do your part!

Have you been a participant in either NHS1 or NHS2?

What do you think you’ve gained by participating?

Do you have any advice for nurses who are considering participating in NHS3?

Tell us what you think.

Too Few Nurses, Too Little Time

I have this theory that if we could get everyone to live healthy lifestyles and give health care providers more time to spend with patients, we could eliminate a huge portion of this country’s health problems.

Just think about it: many of our illnesses are caused by a poor diet and lack of exercise, and another bunch are caused by patients’ confusion about things that require more time to explain than their health care providers have.

Two recent news articles prove my point.

The first tells of the rising incidence of sexually transmitted diseases (STDs) in those older than 50 years. According to an article published in the November/December issue of MEDSURG Nursing, most health practitioners don’t even ask people over 50 about the possibility of contracting HIV/AIDS, herpes, syphilis, human papilloma virus (HPV) and other STDs.

The article was authored by Lisa A. Jeffers, MSN, CRNP, FNP-BC, NP-C, CWS, a nurse practitioner in Berlin, Md., and Mary C. DiBartolo, PhD, RN-BC, an associate professor of nursing in the Department of Nursing at Salisbury University, Salisbury, Md. You can read the entire study at http://www.medsurgnursing.net/archives/11dec/285.pdf.

Older people are “often neglected in terms of risk assessment, screening, and education regarding STDs,” the authors write, partly because of unease their providers have about the subject, but also because talking with patients about anything at length takes time, and no one seems to have any these days. Let’s face it: taking a detailed sexual history is nigh impossible with today’s time constraints, so the topic of STDs gets relegated to the bottom of the patient’s list of multiple problems.

The second story stated that in a recent survey, more than 40 percent of unmarried 18- to 29-year-olds said that they “knew little about birth control pills,” and two-thirds said that they “knew little about even more effective long-lasting contraceptives.”
"We have a whole generation now of young adults, the vast majority of whom are sexually active, who are in a fog about modern contraception," Sarah Brown of the National Campaign to Prevent Teen and Unplanned Pregnancy said in an Associated Press story. "They don't know enough to make a reasonable choice."

To help patients sort out all the birth control options, Brown established the interactive website www.bedsider.org . It’s a great teaching aid, but in the end, patients will still have questions, and it’s a nurse who should be there to answer them. But again, this all takes time.

In today’s health care environment, it takes a village to care for a patient. Physicians, nurses, social workers, pharmacists, physical therapists and nutritionists – all of these are needed on the team because health care is complicated and so are a patient’s needs. Nurses are an important part of that village because they are excellent teachers, and it’s been proven that whenever nurses are employed to help or monitor patients, health care costs go down.

When health care institutions think about saving dollars, they think about cutting staff nurses. But eliminating nurses will, in the end, increase costs. That’s because when patients are not fully educated or don’t understand, there is an increase in the repeat doctor visits, medication mistakes, accidents and admissions.

Do you feel the time crunch when dealing with patients?

If so, what problems do you think it causes, or could cause?

Do you have any examples of how, if you’d had more time, problems would not have occurred?

Tell us about it.

Sometimes It Takes Whatever It Takes

Sometimes It Takes Whatever It Takes

When all else fails, there is always bribery.

Or call it an incentive, if you like.

Either way, getting middle school students to update their vaccines by offering a chance to win a free iPod did the trick, thanks to a nurse in a San Diego County school district.

California law requires that all students in seventh grade and higher must have their diphtheria, tetanus and pertussis (TDAP) vaccines or boosters, or present a waiver before starting school. As it turned out, students in San Diego County had the second lowest compliance rate in the state.

It was this statistic that prompted Rotary International in 2010 to challenge San Diego County nurses to promote vaccinations; school nurse Julia Hart-Lawson, RN, with the Carlsbad Union School District near San Diego, accepted that challenge. She recognized, however, that it would take more than a take-home note to motivate families in her district to comply with the state mandate, so she came up with an idea.

Hart-Lawson returned to the local Rotary club and asked them “to consider purchasing iPod Nanos as raffle prizes,” she told the local newspaper. Every student who complied with the vaccination regulations would get a lottery ticket for a chance to win an iPod.

“I wanted to incentivize the Carlsbad Union students and families to comply,” Hart-Lawson said.

The club approved her idea and provided the iPods and the result of the promotion was “a more-than-99-percent compliance, including a perfect 100 percent” at one of the three middle schools – not an easy accomplishment considering the diversity of the district’s population.

So kudos to Hart-Lawson and her team of school nurses who not only understand the importance of making sure students are vaccinated or have their waivers on file, but for coming up with a plan to get that message across.

What do you think of providing incentives or rewards for complying with health mandates or to help in achieving health goals?

Have you seen it work, or not work, in other situations?

Tell us what you think.

What Do Nurses Want?

I received an email recently from a nurse friend and former co-worker from whom I hadn’t heard in a long time. Since we last communicated, she has had several jobs. What caught my attention, though, is why she left one job when it seemed perfect because of her expertise in maternal and child health.

She wrote that the clinic was poorly managed and the doctors treated the nurses poorly. The bottom line: she was afraid patients were going to suffer and she didn’t want to be blamed. Her work environment became intolerable so she left to protect herself, and that clinic lost a good nurse.

I think many nurses would agree that what makes them happiest is to know that their patients are well taken care of, but achieving this goal depends on several factors in the work environment:
• Do team members work well together?
• Are there lines for effective communication?
• Do all members of the medical staff exercise respect for all other members?
• Are adequate assistant resources available?
• Do nurses have a say in decisions?
• Are continuing education opportunities available?

A recent study headed by Maja Djukic, PhD, RN, of the New York University College of Nursing in New York City, confirms that when nurses rate their work environments high, they also believe that the quality of patient care is high.

The study was published recently online in Health Care Management Review. (The quality of care was not validated with measurements of actual outcomes.) The research was done in the context of the projected nurse shortage (250,000 nurses over the next 15 years) and how institutions may have to devise ways to improving work environments other than increasing the numbers of staff nurses.

For the study, a survey was first sent in 2006 (with follow-up surveys the following years) to nurses who had been licensed for the first time between Aug. 1, 2004 and July 31, 2005. Slightly more than 2,000 nurses answered, for a response rate of 68 percent. Nurse managers should take note of the results, the authors wrote.

"Our evidence demonstrates the importance of considering [nurse] work environment factors other than staffing when planning improvements that may affect patient care."

About four years ago, researchers at the same college of nursing conducted a study looking into factors that increased nurse-retention rates. They asked the same cohort of nurses about their “work-group cohesion.” Many reported the lack of adequate support from their supervisors; two-thirds said they had experienced verbal abuse. More than a third said they’d be looking for another job within the year, and those who had already left said they did so because of poor management and stressful work conditions.

I don’t think any of this is news to supervisors or management, and yet these adverse working conditions seem to persist in many institutions. It’s not surprising that these institutions may have problems filling their nursing positions, while hospitals with reputations as excellent work places actually have waiting lists.

What do you think nurses want most in the workplace?

What amenities do you think attract nurses to a hospital, clinic or long-term care facility?

Tell us about it.

Nurses Can Navigate Through the Health Care Maze

I recently read about a new hospital position that has “RN” written all over it.

It’s called “patient navigator,” and as some of my nurse friends pointed out, we’ve been doing this job informally for a long time for our patients, our family and friends.

A patient navigator is one who helps guide patients through “difficult medical journeys.” Navigators aren’t always nurses, but in most cases they are, and hospitals are hiring them at ever increasing rates.

Navigators are called in when someone receives a diagnosis of any illness that is going to require multiple doctor and/or hospital visits for some months to come, and probably requires one or more specialists. This is often the case for a cancer diagnosis, and typically, most people are overwhelmed when they learn they have it. Once they gain their bearings, they often have many questions.

At a time when clarity and focus are most needed, patients must deal with multiple emotions, concerns and the unknown. They might ask: “What treatments are available? What are the side effects? How effective is the treatment? Will my insurance cover my care? Can I still work? Will I lose my job with an extended absence? Who will take care of the children while I’m receiving treatment?”

Maybe the most important part of the navigator job is acting as patient advocate. Nurses know what questions to ask, whom to ask and how to get what patients need.

According to the story in my local newspaper, the National Cancer institute has more than 200 programs that offer navigators, and the American Cancer Society has more than 100 programs with navigators. In some hospitals, clinical care coordinators often perform navigator duties, and in other hospitals, the duties of transition specialists parallel those of a navigator.

A friend of mine told me recently that she hired an independent nurse to help expedite the solution to a health-care access problem she’d been dealing with for months. She said the nurse resolved the problem within a week and it was more than worth the money.

Some nurses become navigators simply on the strength of their experience and know-how; others earn masters degrees in patient advocacy. Like any evolving specialty, there is much discussion as to what the standards and training should be. One list of various programs can be found at http://healthadvocateprograms.com/masterlist.htm

Do you think using patient navigators is a good idea?

Have you ever acted as a navigator, formally or informally?

Have you ever referred patients to a navigator? What were the results?

Tell us what you think.

Whose Responsibility Is It, Anyway?

It seems that hardly a day goes by that you don’t see the word “obesity” in the news, but the topic takes on a new dimension when you are talking about children.

Experts on the topic of childhood obesity are meeting in Baltimore and they say that the problem has reached crisis stage.

“The childhood obesity problem is becoming entirely too common,” said Jay A. Perman, MD, a pediatrician with the University of Maryland, last year. It is “the leading health challenge” for children today and “will take a confluence of social, economic and medical resources to solve.”

We’ve all heard the dire predictions about the explosion of diabetes in the coming decades – mostly type 2, which is linked to obesity. Growing numbers of children – some as young as 10 years old -- are currently either at high risk for developing type 2 diabetes or already have it, mainly because they are overweight.

Also in the news recently are the findings of a study out of the University of Montreal, published in the Archives of Pediatric and Adolescent Medicine. Researchers have found that they can reliably predict whether a child will be obese or not by looking at the mother’s behavior around the time of birth.
If mom’s lifestyle promotes obesity, they said, her child starts out with a strike or two. Because children are completely dependent upon parents who determine the family’s lifestyle decisions, the responsibility for the child’s health falls cleanly and completely on parents.

Now, overlay all of this onto a backdrop of an accountable care organization (ACO), which is focused on improving patient outcomes, and health care providers have problems.

On paper, nurses, doctors, therapists, hospitals, nursing homes and social services are responsible for producing these improved patient outcomes, which should translate into lower health care costs. As an incentive for keeping costs down, third-party payers monetarily reward medical groups, hospitals and nursing homes if they do such things as lower the re-admission rate, lessen infection rates, decrease falls, assure that all pediatric patients are vaccinated, and lower the average A1C levels of diabetics.

Sounds like an admirable win-win proposition for both providers and patients. However, when it comes to caring for diabetics of all ages, improving outcomes really rests with patients and parents of the patient. Yes, we provide all the information, tools and encouragement we can, but in the end, the buck stops with patients and parents.

There are some nurse practitioners, diabetes educators and physicians who have discovered how to motivate their diabetic patients, parents of diabetics and those who are obese. In general, however, it’s a huge uphill battle, and according to statistics, the majority of our population continues with its unhealthy lifestyle.

Patients complain that their providers don’t talk to them about losing weight, and providers say their patients don’t listen. I think the best arrangement is when providers and patients understand that maintaining health is a cooperative effort between both parties. Neither can accomplish anything alone. There are so many diseases and disorders over which we have no control, but, working together, providers and patients can control the factors that lead to obesity and diabetes.

Let’s not dodge the talk about responsibility, because when patients and providers fail to uphold theirs, all of society suffers.

Do you think that nurses should take a more proactive role in talking to patients about the tough topic of obesity?

What motivational tricks or cooperative tactics can you share?

Tell us what you think.