Off the Charts

Emergency in the ED: Treating Hemorrhagic Shock

Thu, 15 Oct 2020 14:16:25 GMT

Emergency nursing isn’t all drama and adrenaline.

As any ED nurse knows, most of what a nurse sees in the ED is not what would classify as real emergencies—the kind of exciting, life-threatening situations that might have actually been the reason they chose emergency nursing. That’s how it was for me, and getting hired as a new grad to work at New York City’s Bellevue Hospital, one of the country’s premier emergency services, was a dream come true.

However, I quickly learned that most of the people who came through our doors did not have exciting, life-threatening emergencies but rather the more humdrum “urgencies” of life—gastroenteritis, a sudden high fever, a small laceration that needed a few sutures, sprains, and minor fractures. Minor, comparatively speaking, but certainly not minor to the patient, and all requiring attentive care. (For a vivid and poignant inside view of emergency nursing today, see the photo essay in the September issue; the essay is based on Carolyn Jones’s new film, In Case of Emergency, to be released this week for Emergency Nurses Week.)

When the ED doors slam open.

But then there were those sudden life-or-death emergencies that raised everyone’s adrenaline levels—a patient bleeding out was one of the more dramatic scenes. They usually arrived without warning, doors slamming open and a stretcher pushed in by paramedics and then quickly surrounded by nurses as someone paged the trauma team. There’s a visceral reaction to seeing blood pouring out of a massive abdominal injury or chest wound, but then training kicks in as you go through the mental steps and check vital signs, start IV lines and hang fluids, find and stop the bleeding.

What we’ve learned about treating hemorrhagic shock.

The thinking on resuscitation has changed over the years—from flooding the patient with fluids and plasma early on to boost blood pressure to whole blood as first choice and permissive hypotension. The wars in Afghanistan and Iraq have also spurred greater understanding of hemorrhagic shock; as the authors note, “Several procedures developed on the battlefield to treat this condition have been adopted by civilian health care systems and are now used in a number of nonmilitary hospitals.”

Read the comprehensive update from our September CE article, “Trauma-Related Hemorrhagic Shock – A Clinical Review.” Although this article is geared towards the ED setting, it’s also applicable to nurses in the OR/RR, labor and delivery, and med/surg areas who know all too well that there are many reasons a patient may develop acute and severe bleeding. We’re glad we could bring you this helpful article.

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Bringing Escape Room Games to Nursing Education

Tue, 13 Oct 2020 16:50:15 GMT

The popularity of escape rooms has grown exponentially in the past decade, with these simulated group activities becoming an established part of gaming and pop culture. But the concept offers more than just a fun distraction or chance to work cooperatively with friends and family. Increasingly, these games are being incorporated into simulation-based clinical education.

An opportunity for collaboration.

In an escape room activity, a group of people work together to find clues, solve puzzles, and complete tasks within a set period of time. As they do so, they may progress through one room or several, but the goal is typically the same: for the group to “escape” from a simulated situation.

Step-by-step guide.

Educators have been exploring the use of this approach in nursing education to reinforce knowledge and engage students. As nurse educator Janice Hawkins and her colleagues at Old Dominion University School of Nursing in Virginia point out:

“By requiring a group of learners to solve a series of skills-related puzzles, educational escape rooms can help to build critical thinking, communication, and cooperative problem-solving skills.”

In “Behind the Scenes of an Educational Escape Room,” they provide a step-by-step guide to developing an effective educational escape room. Their advice stems from their yearlong experience developing, piloting, implementing, and evaluating an escape room game for first-year nursing students. Their activity takes place in their school’s simulation lab, with students working together to locate clues, solve puzzles, and communicate successfully to safely administer medications.

‘An effective way to practice skills.’

According to Hawkins and colleagues, 90% of participants have felt that the escape room simulation was an effective way to practice skills related to safe medication administration. They note that their activity has also attracted attention from diverse groups of nurses, including alumni who saw the school’s social media posts about the escape room and attendees at a national nursing conference, where the authors demonstrated their simulation:

“Nurses told us they valued the opportunity to practice their skills in a nontraditional setting. Nurse educators affirmed the value of using this teaching strategy, and clinical nurse educators identified the applicability of such a model in reinforcing hospital medication administration policies during orientation programs for newly graduated nurses and new hires.”

Tips for success include creating a ‘meaningful narrative.’

Among the practical advice and insight Hawkins and her colleagues provide is a recommendation that educators create an escape room narrative that is meaningful to students. Their story revolves around their school’s beloved and retired mascot, Big Blue, who, according to the narrative, was admitted to the hospital after celebrating the biggest win in their school football team’s history. In the activity, nursing students “escape” the room after completing clinical tasks that allow Big Blue to be discharged in time for a victory parade.

Game planners should spend some time thinking about local or current events that can have a unifying effect on escape room participants. Additionally, keeping the story line fun and entertaining offsets some of the pressure and anxiety participants might feel about the tasks they have to perform.

At the same time, Hawkins and colleagues note, nurse educators may find they enjoy the process of developing such a learning activity:

“Before developing this educational game, it may be useful for the planning team to participate in a recreational escape room activity to gain a better understanding of the various types of clues and the way in which this game typically unfolds. A field trip to a local escape room facility was a fun and informative activity for us.”

To learn more, read the entire article, which is free until the end of October.

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Patient Input on Obstacles to Sleep Helps Focus One Unit’s Improvement Efforts

Thu, 08 Oct 2020 14:01:55 GMT

Do you know anyone who’s ever had a good night’s sleep in the hospital? As nurses, we hear the complaints; as patients ourselves, or as family members of patients, we’ve been there.

Differing views on the source of a unit’s sleep problem.

After their hospital’s 20-bed telemetry unit received a low HCAHPS survey score on a quiet-at-night question, nurse practitioner Christian Karl Antonio and his colleagues at a northern California community hospital took on the challenge of improving patients’ sleep experience on the unit.

Before designing an intervention, they spoke with patients as well as staff, and were surprised to learn that the two groups see the problem differently.

“Patients perceived being awakened for vital signs, blood draws, and medication administration as the most frequently occurring factors that contributed to noise at night. On the other hand, staff members perceived that noise at night came from staff conversations, equipment with alarms, announcements on the paging system, and delivery carts, among other sources.”

A ‘sleep menu’ and other measures pay off.

Based on these findings, along with a literature review, the team developed a “sleep menu.” Patients could select their intervention(s) of choice from a list of options such as “keep door closed” or “ear plugs.” The project also included staff education and hourly rounding by unit champions and assistant nurse managers to encourage patients to use the sleep menu and to continue to gather input from patients.

These efforts paid off. Among other positive outcomes:

“Five or more hours of uninterrupted sleep per night were reported by 31% of patients in the baseline group, compared with 80% of patients in the intervention group…”

To learn more, read the entire article, “Improving Quiet at Night on a Telemetry Unit: Introducing a Holistic Sleep Menu Intervention,” which is free until the end of October.

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How Do Nurses Feel About Assessing for and Promoting Safe Gun Storage?

Mon, 05 Oct 2020 14:43:01 GMT

My grandfather and uncles were hunters, and they always looked forward to their forays into Michigan’s Upper Peninsula during deer hunting season. But while I was well aware of their activities, they never brought their guns into our house. So I never gave any thought to gun safety issues, even after I became a nurse—not even after caring for one memorable patient, a young man my own age who had been accidentally shot by a companion during a hunting trip.

What can nurses do?

“…a child finds an unlocked loaded gun and accidentally shoots themselves or someone nearby, a despondent teenager makes a rash decision to end their life with the family gun, a homeowner mistakes a family member for an intruder.”

It seems that we read about tragedies like these every day. Can nurses help prevent them? The American Academy of Nursing has recommended that health care professionals “assume a greater role in preventing firearm injuries by health screening.”

In “Nurses’ Knowledge and Comfort with Assessing Inpatients’ Firearm Access and Providing Education on Safe Gun Storage” in the September issue of AJN, Kimberly Smith Sheppard and colleagues report on their original research study, which examined nurses’ knowledge and comfort with assessing patients’ access to firearms and educating inpatients about firearm safety and storage.

Perhaps unsurprising results.

The authors surveyed nurses from medical and psychiatric units in their hospital to learn how comfortable the nurses were with talking about firearms and what might facilitate or present a barrier to having these conversations with inpatients.

Not surprisingly, their results demonstrated the following:

“…most [nurses] were unfamiliar with state gun law, had no prior training on firearm safety or storage, and had no prior training on how to educate others in this area.”

Read the article to learn more about their findings and their recommendations addressing how nurses could be involved in firearm safety screening and education. There, lead author Sheppard also discusses the work of the multidisciplinary Gun Violence Prevention Coalition at Massachusetts General Hospital, which she co-founded.

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Staying Away, Reaching Out: Offering Parents Support During the Pandemic

Thu, 01 Oct 2020 14:18:14 GMT

The ‘circuit breaker.’

Image by Wokandapix from Pixabay

I brace myself as I look over the names printed on my patient list. Our developmental pediatric unit has started an initiative to call our more vulnerable families during the COVID-19 pandemic.

Chan J. DOB: 12/10/2001. As I scan the electronic notes, I learn that mum is the main caregiver of not one but two boys with autism spectrum disorder who require a high level of support. They both usually attend special school, but the school is currently closed because of social distancing measures. We are in lockdown, or ‘circuit breaker’ as we call it in Singapore, and both children have been at home for the past three weeks. My heart sinks in anticipation as I punch in the numbers.

“Hello,” a voice hesitates at the other end.

“Good morning, Mrs. Chan,” I say, putting on a cheery tone. “My name is Jia Yi and I am a nurse from the child development unit. We are checking in with our families and I wonder if you have some time to speak with me?”

“What about?” This mother sounds tired.

“Oh, just checking in on how you are getting on and whether there is anything we can do to help.”

‘”It’s hard,” she says. I hear her stifle a sob. “Never-ending.” Several long seconds pass as I wait.

“My younger boy, David. He doesn’t know how to use the toilet.”

“What’s been happening?” I prompt her, trying to sound encouraging. But I begin to feel afraid at asking questions I may not have answers for.

“He passes motion anywhere and everywhere in the house, and urine too. It’s been a mess. When I smell something, I need to check where it’s coming from to clean it up right way. It’s happening so many times a day now that they are not in school. I don’t want the boys to get sick from it.”

I can imagine the dank ammonia of urine and the gasp-inducing odor of stools seeping through the phone line. My heart cries out for this mother and I try to keep my voice steady as I struggle to think of solutions.

“I am so sorry, Mrs. Chan,” I say. “Do you have any help?”

“My husband is the only one working to earn just enough for our family,” she tells me. “I used to have a volunteer come to help me but now with the circuit breaker they can’t come. Can you help me or send someone please?”

My heart instinctively answers her plea: “Yes, yes, I can help! I will come and help you clean up and look after the children.” But the voice inside my head shouts, “But we’re in lockdown. And you need to be in the clinic to reach out to other children, too.”

I take a deep, quiet breath and then hear myself say, “I would love to come and help you, but the circuit breaker rules apply to us too and we can’t enter homes we don’t live in.” As I say this, I feel helpless and guilty.

“It’s easier if I just stay with him in the bathroom for an hour and then clean him up after,” she says. She begins to weep.

“I am sorry you are having such a hard time, Mrs. Chan. I wish I could do more to help,” I say as I hear her cry quietly on the other end of the line.

“Have you tried diapers?” As I offer this suggestion, I think to myself, “Of course she would have tried this!”

But she doesn’t notice my blunder.

“He doesn’t like the feel of it and refuses to let me put it on. We just need to wait for the circuit breaker to be over,” she sighs, as she collects herself.

I can imagine her wiping away her tears. “I try to keep the boys occupied,” she continues. “There are school activities online but I just don’t have the energy. I just let them watch TV, but then am afraid it will be too much.” I hear the hint of guilt in her voice that mirrors mine from a moment earlier.

‘I think you know what works best for you, Mrs Chan,” I tell her. “Don’t worry about school activities. Do what you can to get through the day and try to get some rest.” As I encourage her, I wonder if even this suggestion is achievable.

Reaching out matters.

“Mrs. Chan,” I tell her as the conversation nears an end, “you are really at the front lines. I know it is hard but you are not alone. We are here for you.”

Am I a fraud for saying this? The emptiness of my words rings through me.

There is a long pause, as if she is gathering her thoughts. “Thank you,” she says. “Thank you for calling.”

It has been 45 minutes since I first dialed and the call is now over. I feel the weight of this mother’s burden. How have I really helped? Mum is back to the grind of managing her two children, pretty much alone. She is exhausted and she needs someone to help her. What have I done to help? A little voice whispers in my ear, “You have listened and she has been heard. You have shared in her burden.”

Just taking time to really listen and offer a few words of comfort, deeply felt and sincerely spoken. This is all we can do and must do, to reach out when we have to stay away. I’ve realized that even if we can’t meet our patients in person, we can still care for them. And as we show compassion to others, it helps to remember that we too are deserving of that same compassion for ourselves.

The author, Jia Yi Bong, is a pediatric development and behavioral nurse working on a child development unit at a hospital in Singapore.

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October Issue Highlights: Data on RN Suicides, Autism Spectrum Disorder, Starting a Research ...

Mon, 28 Sep 2020 12:47:02 GMT

“As a nurse, I believe in science as a guide for our actions….As a human being with morals, empathy, and compassion, I believe there are lines no person, certainly no government leader, should cross.”—editor-in-chief Shawn Kennedy in her editorial, “No Time for Silence”

The October issue of AJN is now live. Here are some highlights.

Original Research: Suicide Among RNs: An Analysis of 2015 Data from the National Violent Death Reporting System

The authors of this study sought to determine the number of suicides and estimated rate of suicide among RNs. Their findings indicate that RNs may die by suicide at higher rates than the total employed population in the 16-to-64-year age range.

From the CDC: Understanding Autism Spectrum Disorder

An evidence-based review of the risk factors for autism spectrum disorder, its epidemiology, common concurrent conditions, evaluation, diagnosis, treatments, and outcomes.

New Series: Nursing Research, Step by Step: How Does Research Start?

This article—the first in a new series on clinical research by nurses—focuses on how to start the research process by identifying a topic of interest and developing a well-defined research question.

Special Feature: Behind the Scenes of an Educational Escape Room

How the authors created, piloted, and evaluated an immersive gaming experience to teach first-year nursing students about safe medication administration.

Cultivating Quality: Improving Quiet at Night on a Telemetry Unit: Introducing a Holistic Sleep Menu Intervention

A quality improvement initiative aimed to resolve the causes of sleep disruption and increase patients’ uninterrupted hours of sleep.

There’s much more in our October issue, including:

A Nursing Resources collection of websites to inform nurses about the upcoming election and empower them to make their voices heard.
An AJN Reports on the U.S. COVID-19 testing failure.
A What I’m Reading book review of Quinn Grundy’s Infiltrating Healthcare: How Marketing Works Underground to Influence Nurses.

Click here to browse the table of contents and explore the issue on our website.

A note on the cover.

The political cartoon on this month’s cover depicts a harried nurse in PPE casting her vote for president. Drawn by Pulitzer Prize–winning cartoonist David Horsey, the cartoon symbolizes the power of nurses as voters and also references a defining issue faced by U.S. nurses this year: shortages of PPE. Its interpretation is of course up to the reader.

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A Nursing Perspective on Addressing Racism and Health Inequities

Thu, 24 Sep 2020 12:55:03 GMT

Editor’s note: We’ve all witnessed the recent public outcry against instances of racist behavior and brutality. As nurses, we also witness the toll racism takes on health as well as the racial inequities in access to care and within health care institutions. In the below blog post, AJN senior editor Corinne McSpedon excerpts her recent conversation about these topics with Monica McLemore. I also encourage you to listen to the recent webinar, Nursing’s Role in Addressing Racism, in which a panel of nurses address structural racism, how it prevents health equity, and what actions one can take to change or influence change. You can earn one contact hour of CNE credit.—Maureen Shawn Kennedy, AJN editor-in-chief

Confronting racism during the pandemic.

Over the summer, I spoke with Monica McLemore, PhD, MPH, RN, FAAN, to discuss antiracism efforts amid the COVID-19 crisis and the nationwide demonstrations against police brutality. McLemore is an associate professor in the Department of Family Health Care Nursing at the University of California, San Francisco, where she is also affiliated with the Bixby Center for Global Reproductive Health. She previously worked for nearly three decades as a public health and staff nurse.

Below are highlights of this discussion. The full article, A Conversation with Monica R. McLemore, is free this month.

Practical tools.

Amid ongoing calls to address institutional and structural racism, McLemore talked with AJN about how nurses can confront and address racism and elaborated on some practical tools to guide this work.

“There are five tools and skills nurses can implement incrementally,” McLemore says. “I use ‘SPLIT’ to describe these: simulation, public health, leading, immersion, and tension. SPLIT is a relatively simple way to think about what we can do right now about not only COVID-19 but also the racial awareness people are starting to wake up to. . .”

‘Basic shoe leather epidemiology.’

“We in health services provision think we always have to recreate the wheel,” McLemore notes. But, she points out, “there are books, webinars, modules, and seminars people can take that really look at the science and tools for public health professionals around dismantling racism . . . tools we can disseminate, share, and amplify.”

“I see our colleagues on social media being mad about mask wearing, which is a public health intervention,” she observes. “Have we gotten so far away from basic shoe leather epidemiology and public health interventions that we don’t remember the purpose of quarantine, masks, contact tracing, and physical or social distancing?”

Leadership.

McLemore describes various ways nurses can use their power—individually and collectively—to work to dismantle racism during the pandemic. This includes taking the lead in honoring those who’ve died from COVID-19.

“Who is doing the creative thinking around honoring the people who have died, a disproportionate number of whom are people of color?” she asks. “Nursing should and could lead that. It feels purposive not to, and it’s a separate layer of the onion as to why you see racial protests in the street. These issues are intertwined and not happening at the same time by chance. Risk is not equitably shared in life or death.”

Additional information.

An article about Bernardine Lacey, a nurse leader, educator, political advocate, researcher, and clinician, was referenced during the abovementioned webinar and may be of additional interest. Lacey details, in her own words, the racism she experienced during her childhood and early in her education and career in ‘You Don’t Have Any Business Being This Good’: An Oral History Interview with Bernardine Lacey, which appeared in AJN’s August issue. As authors Sandra Lewenson, EdD, RN, FAAN, and Ashley Graham-Perel, MS, RN-BC, NPD-BC, CNE, note, “her story allows for an exploration of some of the difficult truths about racism, the culpable role of nursing in this history, and the impact of historical accounts on the profession’s current inclusivity and diversity efforts.”

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Frontline Nurses Speak Out – A Health Care Crisis That ‘Didn’t Have to Be This Way’

Tue, 22 Sep 2020 13:47:24 GMT

Themes of heartbreak, heroics, exhaustion, sadness, and anger.

Previously on this blog, I posted about the Frontline Nurses WikiWisdom Forum, an initiative AJN joined back in March to bring forth the experiences and thoughts of nurses working at the point of care during the COVID-19 pandemic. Together with Cynda Rushton (Johns Hopkins School of Nursing & Berman Institute of Bioethics and AJN editorial board member) and Theresa Brown (nurse, author, and AJN contributing editor) and the folks at New Voice Strategies, we solicited stories from nurses from around the country. Of the many who visited the site, 463 nurses joined and shared their experiences.

Forum moderator Cindy Richards, a professional journalist, worked with four “thought leaders” from the nurses to organize the themes and recommendations from the rich content posted by the nurses.

And while we recognize that the pandemic is far from over (United States cases as of September 20 were over 6.7 million, approaching 200,000 deaths and still on the rise), we felt we had reached a critical mass of content. The stories echoed repetitive themes of heartbreak, heroics, exhaustion, sadness, and anger.

“Nurses often put their patients’ needs before their own. That didn’t change during the pandemic. What did change is that nurses saw the level of sacrifice asked of them and denounced their working conditions under COVID-19 as both unfair and dangerous.”

In the resulting report released last Friday, WikiWisdom Forum – Frontline Nurses, authored by Richards, we hear the nurses’ raw comments and suggestions, which “provide a roadmap for protecting and supporting nurses and ensuring the next virus does not wreak havoc on America and the nursing profession. The Year of COVID-19 has been terrible, but it presents an opportunity for meaningful positive change. If we as a nation listen to nurses, protect nurses and support nurses, 2020 could turn out to be the Year of the Nurse after all. ”

Recommendations born of the conviction that it didn’t have to be this way.

The 14 summary recommendations from those at the front line provide an important perspective born of the reality of dealing with dying patients and grieving families, making do with unsafe equipment, fearing for their own lives and those of their families, and knowing that it didn’t have to be this way. Some of the recommendations can be implemented locally wherever nurses are working and others require policy changes.

The report is free to read and download and we urge you to distribute it widely, especially to administrators, boards, trustees, policy makers, and those who can help make a difference in how we manage the next pandemic. Watch for an expanded summary of the report and podcast in the December issue of AJN.

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How Do You Feel When Your Patients Can’t Afford Care?

Thu, 17 Sep 2020 11:03:34 GMT

“Every day in the United States, nurses watch patients forgo beneficial treatment they cannot afford despite nursing’s moral standard to treat patients without regard to financial condition.”

How often have you been left, pretty much on your own, to figure out a way that your uninsured and/or homeless patients have access to something (anything!) that will maintain their health when you aren’t with them? Are there meds they can’t pay for? Do they need prenatal care that they can’t afford? Can they possibly function without home care of some kind?

Moral distress as a call to seek systemic change.

In “Ethical Issues: The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost” in this month’s AJN (free to access until October 7), Douglas Olsen and Linda Keilman discuss the moral distress of nurses when we are unable to meet the needs of patients who don’t have the money to pay for care in our for-profit health care system.

The authors argue that individual nurses who find they can’t improve patients’ access to health care are in fact being confronted with wider systemic problems.

“Moral inclination as well as the ANA Code of Ethics obligate nurses to provide care regardless of the patient’s ability to pay; yet because many work in hospitals, nursing homes, and other facilities that withhold care without payment, nurses are vulnerable to moral distress at the individual and collective professional level.”

In this article, the authors argue that our personal moral distress, as well as our intimate knowledge of the precise ways in which the U.S. health care system fails our patients, can fuel efforts to change the system.

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‘Didn’t You Use to Be a Nurse?’: Finding the Nurse Within

Tue, 15 Sep 2020 18:42:48 GMT

The author of the Reflections essay in AJN‘s September issue, Kathleen Resnick, confronts a question many nurses must confront at some point: what is it to be a nurse?

And a related question: what is the essence of nursing work? If you can no longer work as a nurse because of physical constraints or for another reason, are you still a nurse?

Writes Resnick in “A Different Kind of Nurse“:

My nursing career was spent in hospitals, working mostly in critical care as a bedside nurse, then in management. I worked hard and my work was a large part of my sense of self-worth. I loved patient care and the satisfaction of making a difference. As a manager, I felt my primary mission was to enable those I served to do their best work. . . . I was somebody. Now what am I? An acquaintance asked me, “Didn’t you use to be a nurse?”

Once a nurse, always a nurse.

After a period of struggle with having lost her sense of purpose and identity, the author one day finds herself in a tragic and dramatic situation in which all her nursing instincts and skills are called back into service. And they are right there, ready to respond.

The event reminds her that nothing will ever change the fact that she is a nurse, and gives her the hope to find a way to apply her knowledge in new ways. In losing a beloved profession, Resnick learns that she will always carry the profession within.

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Documentary Filmmaker: The ED Reflects Everything Going on in Our Country

Thu, 10 Sep 2020 18:18:29 GMT

A new documentary profiles emergency nurses.

If you think the photo on the cover of the September issue is dramatic, it’s because it was taken during the emergency treatment of a young man with a gunshot wound. (See On the Cover for details.)

The photo is from the new film by filmmaking team Carolyn Jones and Lisa Frank, In Case of Emergency, which was made in concert with the Emergency Nurses Association to mark its 50th anniversary.

Michelle Lyon, RN, an ED nurse at the University of Kentucky Albert B. Chandler Hospital, Lexington.

The film’s release is scheduled for October 14th, the beginning of Emergency Nurses Week, and we highlight the film in a photo-essay in the September issue. (The article is free until the end of the month, and best viewed as a pdf.)

The film follows the work of ED nurses in several parts of the country. As a former ED nurse, I was struck by the ability of these filmmakers to accurately capture the work.

Scenes showing what ED nurses deal with daily, from dramatic resuscitations to routine lacerations to heartbreaking cases of patients with mental health issues, are spot-on, and as Jones said in my podcast interview with her, the “ED reflects everything that’s going on in our country.”

A closer look at trauma-related hemorrhagic shock.

ED nurses will also appreciate the CE article in the September issue, Trauma-Related Hemorrhagic Shock: A Clinical Review. The authors provide a comprehensive update on new thinking underlying the pathology of shock, assessment parameters, and “damage control resuscitation,” including preventing the trauma triad and whole blood vs component therapy.

As the article points out, “Despite the important role nurses play in caring for patients with trauma-related hemorrhagic shock, much of the literature on this condition is directed toward paramedics and physicians.” This article does much to change this trend. And like all of our CE articles, it’s free to read.

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A Message from the Tri-Council for Nursing: Nurses Need to Vote in 2020

Fri, 04 Sep 2020 12:57:21 GMT

The Tri-Council for Nursing, an alliance between the American Association of Colleges of Nursing, the American Nurses Association, the American Organization for Nursing Leadership, the National Council of State Boards of Nursing, and the National League for Nursing representing nurses in practice, nurse leaders, and nursing educators, urges you to exercise your right to vote in the 2020 election.

The Tri-Council for Nursing calls upon all nurses to carefully weigh the positions, proposals, and legislative voting records of candidates who aspire to elected office on November 3, 2020. In these unprecedented times, voting may look different, especially with early voting options and vote-by-mail opportunities becoming increasingly relevant.

As we get closer to Election Day, the Tri-Council strongly recommends that you consider the safest way for you to cast your vote. To ensure you have the best information available and are ready to cast your ballot, follow these three simple steps:

Register. Double check if you are registered to vote by going to vote.gov. Some states allow same day registration, but it is important to check now to ensure that you are prepared for Election Day.
Do Your Research. While 2020 is a presidential election year, there are many open seats at the state and local levels as well. It is important to research not only who will be on the ballot, but any proposals that may also be up for consideration this election season.
Vote. With COVID-19, states are also looking at how to provide socially distant voting in person. Look at your work schedule, check out voting options in your state, find your polling site, and determine the best way for you to vote in this year’s election.

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Two Nurses Who Traveled to New York City to Care for COVID-19 Patients

Thu, 03 Sep 2020 12:32:20 GMT

“I’d been watching social media and seeing former colleagues and classmates who were working in New York City. [They were] very, very, burnt out and tired. I couldn’t turn down the opportunity to go and help them.” – Caitlin Doane

In the spring, when New York City was the U.S. epicenter of the COVID-19 pandemic, we watched with increasing concern as hospitals became overwhelmed, nurses and doctors worked long shifts for days on end, and PPE was rationed.

Reports from nurses working under these conditions were often horrifying. (Read one nurse’s story from those early weeks here: https://ajnoffthecharts.com/deserted-note-from-a-young-icu-nurse-as-covid-19-pandemic-intensifies-in-u-s/)

Nurses understood.

Nurses from around the country understood far better than the general public just how dire the situation was in New York City hospitals. Some of them traveled here to help. AJN had the opportunity to sit down (virtually) with two of these nurses after their return home, and their stories are featured in the August Profiles column.

Caitlin Doane, an ED nurse from Ithaca, New York, who comes from a family of first responders, joined a medical mission organized by her hospital to travel downstate to hospitals in the city. Brent Whitaker, a cardiovascular ICU nurse manager, traveled to New York City from Cleveland along with 14 other nurses and 10 physicians.

As a mom of two teenagers, Doane developed a special connection with some of her teenage patients. She “took on some of the ‘mom’ role” for these seriously ill young people while visitors were not allowed in the hospital.

The same type of patient, bed after bed.

Whitaker recalled the strange experience of seeing “the same type of patient bed after bed after bed—intubated and sedated.”

He and his seasoned Cleveland teammates dove into the work. Whitaker describes their attitude as “Just give me some work to do; I’ll be able to handle it.”

You can also listen to the podcasts of our interviews with Doane and Whitaker here.

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September Issue Highlights: Discussing Gun Safety with Patients, Trauma-Related Hemorrhagic ...

Tue, 01 Sep 2020 12:51:36 GMT

“It is abundantly clear from this pandemic that we are all connected and need the strength of nations working together to thwart any threat to global health and well-being. We ignore
our connectedness at our own peril.”—Pamela F. Cipriano in her guest editorial, “Standing with the WHO”

The September issue of AJN is now live. Here are some highlights.

Original Research: Nurses’ Knowledge and Comfort with Assessing Inpatients’ Firearm Access and Providing Education on Safe Gun Storage

The authors sought to determine hospital nurses’ knowledge of firearm safety and current state law, and their comfort with asking patients about gun access and educating them on gun safety.

Trauma-Related Hemorrhagic Shock: A Clinical Review

This article discusses the general principles underlying the pathophysiology and clinical management of trauma-related hemorrhagic shock.

Special Feature: An Intimate Glimpse of Emergency Nurses at Work

A photo-essay featuring scenes from a new film by Carolyn Jones, In Case of Emergency, which profiles the daily lives of ED nurses across the country.

Cultivating Quality: Nurses’ Perceptions of Technology Used in Language Interpretation for Patients with Limited English Proficiency

How nurses viewed the use of a telephone-based interpretation technology versus a video interpretation system, specifically their effects on patient rapport, nursing care, and the quality of communication.

Ethical Issues: The Moral Distress of Nurses When Patients Forgo Treatment Because of Cost

The authors discuss the moral compromise of nurses whose patients refuse care they can’t afford—and make an appeal to the nursing profession to advocate for systemic change on behalf of these patients.

There’s much more in our September issue, including:

An AJN Reports on reproductive care during COVID-19.
An Update from the CDC on how state scope-of-practice policies impact NP care.
A Conversation with nurse, scientist, and activist Monica R. McLemore about dismantling racism in nursing.

Click here to browse the table of contents and explore the issue on our website.

A note on the cover.

On this month’s cover, ED staff at Ascension St. John Hospital in Detroit care for a patient who, while out with his wife, was struck by a stray bullet when a fight broke out nearby. This photo is from the film In Case of Emergency, out on October 14. To learn more about it and see additional photos, read this month’s Special Feature.

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Bringing Redemptive Voices from Greek Tragedy to COVID’s Frontline Clinicians

Thu, 27 Aug 2020 13:45:26 GMT

Bearing witness.

I enter my patient’s room and hear the sucking click as the door slides shut behind me. Vacuumed silence, negative pressure—but all the pressure in the world seems to settle onto my shoulders, my head, and down through my back, filling my feet like wet cement.

I need to move. His oxygen saturation is dropping again. He’s grimacing. Is he in pain? I wonder as I step closer to the bed. My pulse quickens as I take in the scene before me: glassy eyes inset upon a sunken, sallow complexion; bleeding mouth; the imperceptible rise and fall of chest to the biddings of the ventilator; swollen limbs. A lock of hair falls into my eyes, but my PAPR hood prevents me from pushing it aside. His heart rate and respiratory rate are higher now. Maybe he needs more sedation. If only he could speak. I take in a measured breath of filtered air as I suction his breathing tube. Breathe.

The doctor appears and is talking to me, but her voice is barely audible above the steady stream of air rushing past my ears. We’re practically shouting. The plan, a combination of trial and error, science, and visceral, pit-of-the-stomach intuition, is shaky at best.

As she moves away toward the door, I want to call out to her, to beg her to stay, to look upon the suffering and feel its weight, but I am silent and she disappears into a sea of blue scrubs. I am alone in this sealed room with my patient, his only witness. I feel an obligation to stay a few moments longer, even if he is unaware of my presence. No one should suffer or die alone.

Eloquent voices of suffering across the ages.

Theater of War? I had never heard of it, and now I’m a panelist. Tonight. Weary and windblown, all I want to do is dash home from my shift, slip into PJ’s, and fall into bed, but I have this thing to do.

Two weeks ago, I got a call about a project called Theater of War that presents dramatic readings of ancient Greek tragedies via Zoom. The readings feature Oscar-winning actors like Frances McDormand and are used to open up conversations for frontline medical professionals about burnout, moral distress, isolation, personal risk, and grief.

I agreed to be a panelist without giving it much thought. I was skeptical yet intrigued. Now as I scurry to prepare for the 7 PM broadcast, slipping out of my scrubs and into the shower, I do my best to let all my memories and images from the day wash down the drain—a necessary daily ritual. My sister told me to wear a vibrant-colored sweater, so I pair a freshly pressed coral mock neck with gray sweatpants, camera ready yet comfortable.

To open our eyes and see the truth of this affliction.

Is anyone even gonna show up? I wonder as I settle into the couch with a splash of double IPA in hand. I need a drink if I’m going to spend the next couple of hours talking about my feelings after another long day in the trenches of COVID-19. The last thing I want to do is “connect.”

But here I am in my living room, one of tonight’s four panelists, tuned in alongside more than 400 clinicians from the Baltimore area, as Frances McDormand, cloaked by the dimly lit corner of her bedroom, delivers an arresting portrayal of the dying hero Heracles.

Her agonizing calls for someone to witness her suffering, commanding the audience to “open [our] eyes wide…take in the damage done by the disease to this tormented body,” uncannily echo things I’ve heard and seen in the ICU earlier today.

My hair stands on end as the lines between hospital and home fall away. McDormand’s savage rendition of Heracles’ suffering pierces me, her gut-wrenching wails penetrating my defenses. The dying protagonist becomes my patient—giving voice to the eerie silence of air hunger and pain caused by COVID-19—and, by extension, we the audience become a collective witness to this silent tragedy:

“It sticks to my ribs. It feasts on my flesh. It invades the lining of my lungs where it scrapes against my chest with every breath.”

As Heracles cries out in pain and we, looking on, shudder in the eaves, he implores us to see “the truth of [his] affliction”—the universal experience that is suffering.

A sense of unity.

At once, I am weightless, suspended across space and time, tethered to Heracles, to my patient, to the actors and to the audience—we are one. In the discussion that follows the performance, the audience, members of the local medical community in Baltimore, become a resounding Greek chorus, each giving voice to the myriad scenes of suffering that he or she has encountered on the front lines of the pandemic over the past three months.

The raw, open dialogue dispels the illusion of separation and reveals suffering as a stimulant for compassion and empathy, culminating in a healing cacophony of voices expressing hope and fear, redemption and betrayal, connection and isolation, restoration and loss. Theater of War invites each of us to expose our humanness—our imperfections, afflictions, soul-wounds and all—as we come together to give voice to the sound of suffering, especially for those, like my patient, who remain silent.

Caitlin McGeehan, BSN, RN, CCRN, is a critical care and palliative medicine nurse at Johns Hopkins Hospital in Baltimore, Maryland. She was a panelist on a Theater of War production on May 24, in the midst of the coronavirus surge in her region.

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The Pediatric Illness PANDAS: Easy to Misdiagnose, Often Overlooked

Mon, 24 Aug 2020 10:27:32 GMT

What would you do if your young, previously healthy and happy child suddenly developed obsessive-compulsive disorder or symptoms of Tourette’s syndrome?

In “PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection,” authors Christine Pabst and Kim Subasic discuss an unusual pediatric illness that, although identified more than 20 years ago, is not well recognized by clinicians: PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection.

PANDAS is characterized by the sudden and dramatic onset of “psychiatric” symptoms such as the ones above, appearing during or shortly after infection with group A streptococcus.

Two factors make PANDAS difficult to diagnose.

First, it seems so obviously a psychiatric disorder that psychotropic or other psychiatric medications may be prescribed without further investigation.
Second, carrying group A streptococcus without signs of actual infection can also precipitate PANDAS, making it difficult to connect PANDAS symptoms with a previous medical illness.

Many providers unfamiliar with PANDAS.

“Unfortunately, many health care providers are unfamiliar with PANDAS or have no experience diagnosing or treating the condition. Parents often see multiple providers before receiving an accurate diagnosis.”

The end result of our unfamiliarity with this condition can mean misdiagnosis, treatment failure, and lifelong complications. For information on PANDAS epidemiology, signs and symptoms, a possible pathogenesis, and treatment course, read this free CE article in the August issue of AJN.

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Verified: Nurse Media Influencers

Thu, 20 Aug 2020 13:49:34 GMT

Responsible science communication can literally be the difference between life and death. Mass media, especially the news, as well as social media sites such as LinkedIn and Twitter, have a significant influence on people’s health beliefs and actions. As nurses we have a critical role to play in how the media reports on health issues and public health policy and on what messages the public and policy makers receive.

As clinicians, researchers, educators, public health practitioners, policy makers, and more, nurses need to use our expertise and voices to bring about change. At no other time in our recent history has this been truer than during the current pandemics of COVID-19, racial injustice, and health inequity.

But nursing is a field often misunderstood by the public and the media. Most people think of nurses solely as clinicians at the bedside who do nothing more than take orders from physicians. But nurses are highly trained subject matter experts who work in a wide range of specialty areas including public health, social justice, law, history, research, education, school nursing, and more.

Nurses rarely recognized or ‘verified’ as experts.

Yet, the field of nursing is rarely recognized by the public, journalists, or even social media sites for this expertise. Open up any news article, or turn on any news program, and the vast majority of subject matter experts quoted or interviewed are our physician counterparts. As was reported in “The Woodhull Study Revisited: Nurses’ Representation in Health News Media 20 Years Later,” published in 2018, just two percent of health-related stories over the previous 20 years included an expert source who was a nurse.

Scroll through Twitter to examine verified Twitter accounts of health care “experts” and the vast majority are physicians. During the early days of the coronavirus pandemic, Twitter “hustled” to verify more physicians, but for the good of the public and public health, we need more nurses verified — and recognized — as well. Additionally, LinkedIn recently released its Top Voices in Healthcare for 2020 and not one top voice on that list was a nurse—even though 2020 is being celebrated by multiple international organizations as the Year of the Nurse and Midwife.

Currently, the Twitter verified account program is on hold and Twitter has not announced when its new, more transparent verification process will go live. But when it does, we need to be sure that nurses apply and get verified.

We need nurses to be verified and recognized for a number of reasons:

To amplify the influence and relevance of the field of nursing science
To control the health and health care narrative from a nursing perspective
To grow our voice as health and health care experts
And most importantly, to debunk the fake news, misinformation, and conspiracy theories that circulate on social media (recently it was reported that of the top influencers on Twitter, a large portion of those discussing COVID-19 topics were not even people but bots!)

Nurses are uniquely equipped to tell compelling stories about individuals, families, and the communities they serve. They understand the need for individual interventions and treatment to broader landscape stories about policy solutions. They can address structural racism and health inequities. They can connect the dots to bigger social issues, like housing, jobs, education, and food insecurity.

How do we get nurses ready to be nurse media influencers?

First, nurses need to own their expertise, then commit to gaining media competencies.

Gaining media skills teaches you how to frame a clear, concise message for the audience you are trying to reach (policy makers or others); it also builds confidence. Build the skills you need to make the case for policies that improve public health.

Media skills prepare you to successfully pitch a story idea to a reporter. What do reporters want? News they can use. What’s the news hook? How will you capture the attention and interest of the journalist and their audience? These skills are an important factor in pitching relevant, newsworthy, brief, structured, and timely stories.

The “Woodhull Study Revisited,” as well as a companion paper published in AJN (“Original Research: Journalists’ Experiences with Using Nurses as Sources in Health News Stories“), found that journalists are stuck in old stereotypes of nursing and do not have a clear understanding of the range of a nurse’s knowledge, skills, areas of research, and policy expertise. We must educate reporters on the breadth, depth, knowledge, and experience of different nursing roles both within health care settings and outside of the typical health care space.

Second, make yourself known!

The Woodhull Study Revisited also found that journalists are unsure how to find nurses for interviews and that they often have little time to track them down. How will a journalist find you, and what will they find when they do locate you on a Google search? Are you easy to contact by email or mobile phone? If not, fix that. One quick way is to create a LinkedIn or Twitter profile. Additionally, creating a personal website is easy to do for free on “drop and drag” platforms such as Wix.com. Journalists are on deadline and if it’s too hard to reach you they move on to the next source.

Third, cultivate relationships with journalists who cover health stories.

Start by reaching out to local health reporters. Local reporting gets you traction. Be on top of the news cycle so you can comment on what a reporter usually follows and pitch them your idea. Move quickly. When a story in your area of expertise breaks nationally, pitch that local reporter and tell them you’re a nurse from their local community who is available to be interviewed on this issue.

If you are interviewed, at the end of the interview, talk to the journalist about suggestions for other stories that may be useful to them. If they are not going to cover the nationally reported story, tell them you are available for future stories. Reporters are always on the search for a good health news story. Journalists use Twitter to find stories and sources for their health news reporting. Follow health reporters—tag them in response to a story, and they may follow you back. Thank them on Twitter when they use nurses as sources in their reporting.

Finally, be your own nurse media maker.

Write an op-ed, commentary, editorial, or letter to the editor in response to a published article. These media opportunities get your name and expertise out there. Create a plan to achieve media goals that are meaningful to you. That could include pitching a story to a journalist, starting a blog, producing a podcast, or writing an op-ed.

Communicating science starts upstream—once it reaches the pages of a newspaper, the nightly news screens, or the Twitterverse, it’s too late. We can’t wait for Twitter to verify us, and we can’t wait for journalists to invite us to be interviewed or to contribute op-eds. During these confusing and concerning times, the public needs to hear from nurses, the “most trusted profession” for reliable, science-based information. Let’s work towards changing the health narrative in the media landscape to reflect more diverse voices in health news. It’s time for nursing as a profession to verify ourselves! #nurseverified

By Marion Leary, MSN, MPH, RN, is the director of innovation at the University of Pennsylvania School of Nursing, and Barbara Glickstein, MS, MPH, RN, is the Founder of Barbara Glickstein Strategies, a training company providing media training, leadership development and media advocacy skills.

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In a Formidable Nursing Career, Bernardine Lacey Faced and Overcame Racism

Mon, 17 Aug 2020 13:38:48 GMT

Her story is important to know, because it offers an opportunity to learn from the not-too-distant past and explore some of the difficult truths about racism in nursing, the role of the profession in this history, and the effect of these accounts on current diversity and inclusivity efforts.

Lacey meeting with first lady Barbara Bush in the White House in the 1980s.

So write Sandra Lewenson and Ashley Graham-Perel in their article in the August issue of AJN, ‘You Don’t Have Any Business Being This Good’: An Oral History Interview with Bernardine Lacey. In the article, they recount Lacey’s upbringing in the South and the many racial barriers that made it difficult for her in getting an education and pursuing her career—which became a formidable one. As a result of her many accomplishments in education, practice, and leadership, she was named a Living Legend by the American Academy of Nursing in 2014.

Racial barriers remain.

But sadly, the obstacles Lacey faced are not a thing of the past. Events of recent months have brought home more than ever that we have yet to adequately address the barriers that exist from entrenched attitudes and policies leading to structural racism.

Free webinar.

On Wednesday, August 19, AJN will host a free CE webinar, Nursing’s Role in Addressing Racism, in which a panel of scholars and researchers will address the role racism has played in nursing education and practice and how we can make changes for the better. We hope you will join us at 3pm EST.

As I note in AJN’s August editorial:

…nursing must actively address racism by calling it out when we see it; standing up for colleagues who experience it; working to change policies in our educational institutions, organizations, and workplaces; and voting out those who allow it to thrive.

You can also find a podcast conversation I had with Bernardine Lacey and lead author Sandra Lewenson on the AJN website.

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School Nurses as the New Front Line in the Struggle to Contain COVID

Wed, 12 Aug 2020 13:20:23 GMT

School nursing services did not end when our brick-and-mortar buildings closed in March because of COVID-19.

School nurses continued to provide a full spectrum of care in the most innovative ways. We supported parents as they grappled with the enormity of the sudden pivot to remote learning and linked parents and students to community resources that school nurses know so well. We continued care coordination, working with our most vulnerable students and families; created pathways to provide virtual school nursing services; and provided health education. Certified school nurses became contact tracers, delivered meals to students and families, and explained the transition from in-person medical appointments to telehealth. And we continue to support our parents in scheduling much-needed physicals and immunization updates before school reopening.

The front line of our struggle with COVID will now be at school and school nurses will be the first responders. Students and staff with one or more COVID symptoms may be asked to isolate for a minimum of 10 days following department of health guidelines. There will be mass absenteeism of both staff and students, as close contacts for those who have tested positive will also have to quarantine for 14 days.

This information has not been communicated clearly and consistently on a statewide level to our school communities. Youth community spread of the virus is already here and we are in an ever-changing landscape in terms of COVID-19 containment—we are chasing this virus and the virus is chasing us.

Too few nurses in too many schools.

One important question to ask is, “Does your school have a school nurse?” According to the National Association of School Nurses (NASN), 25% of schools across the country do not and 35% have only a part-time school nurse. The remaining 40% of schools with a full-time school nurse may have thousands of students and multiple buildings. There are approximately 95,000 school nurses for almost 57,000,000 students.

The gap between CDC guidelines and real-world implementation.

School nurses are being asked to set up isolation rooms without available PPE to care for students and staff who may be symptomatic for COVID. And without access to quick, reliable, point-of-care testing, we are guessing who is safe to be in our buildings.

The Centers for Disease Control and Prevention (CDC) guidelines are vague about isolation areas, mechanism of contact tracing in school, and managing anticipated classroom and/or school closures and reopening. They use language like “if feasible,” which may end up being interpreted as not possible if not feasible. When nonmedical decision-makers read statements like “if feasible,” they can easily discount the value of established, evidence-based public health strategies.

There is a big difference between theory and practice. School nurses will be implementing and evaluating the soundness of the plans as we work to reopen schools safely. But not all school nurses have been included in the planning process.

Unrealistic mitigation strategies?

One of the many related challenges we face is the need for community buy-in for mitigation strategies such as masks, social distancing, testing, isolating when ill, and quarantining after exposure. Contact tracing has been promoted by the departments of health and education without having any infrastructure in place with local and regional health departments and schools.

We are faced with implementing multiple public health mitigation strategies that may not be fully actionable given how school communities function. The reality is that testing and reporting of results to health departments are sorely lagging, thus impeding ongoing community mitigation strategies. And many schools have not even started testing.

The combination of lack of contact tracing infrastructure in schools, delay in test results, lack of community buy-in, and lack of the necessary PPE to protect our school nurses and staff could create a perfect storm of outbreaks among our school communities throughout this country.

The five W’s.

Right now, these are the ONLY tools we have in our toolbox to keep our students and staff safe at school. Remember the “5 W’s”:

Wear a mask
Wash your hands
Watch your distance
When you are sick, stay home
When the health department calls, answer the phone

Conflicting safety priorities.

I could add a 6th ‘W’ for windows—opening windows, and doors, for improved ventilation. (The irony is that we are instructed to lock our doors and windows in response to school shooters and now we need to open our windows and doors to improve ventilation. So which guidelines do we follow?)

School safety was precarious before COVID-19. It is now in disarray, propped up with a series of ever-changing guidelines from previously trusted sources like the CDC. School safety has become a political football in a country that cannot even agree that wearing masks should be part of a united national response to this deadly epidemic.

We need a clear road map.

School nurses are voicing their concerns about the safe reopening of schools and lack of public health guidance from the highest level of state government. The NASN’s vision is that “all students are safe, healthy, and ready to learn.” We are ready to support learning, but health and safety must be at the center of every decision made about school reopening.

The question that must be answered is, “How will we know when it is safe to reopen school buildings?” We need parameters, metrics, a road map. Anything less is a guessing game of hope and crossing our fingers and toes that we won’t have an exposure at school.

Robin Cogan, MEd, RN, NCSN, is a blogger, a school nurse in Camden, New Jersey, and a part-time lecturer at Rutgers-Camden School of Nursing.

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Many in Health Care Have Made Sense of COVID Through Art or Poetry

Fri, 07 Aug 2020 13:58:10 GMT

Since March, AJN has been inundated with COVID-19–related manuscripts from around the world, ranging from prospective feature articles to submissions for this blog as well as our Reflections and Viewpoint columns. Not unexpectedly, we are also seeing many visual art and poetry submissions to our Art of Nursing column as we all try to make sense of this pandemic experience.

Art of Nursing selections.

In the July issue, we feature a drawing and two poems that reflect the times, as well as a reprint of a recent post from this blog.

The drawing, Behind the Front Lines, is by Hayley Jasper, an award-winning artist who is a junior in high school. Hayley’s piece was inspired by her mother, who is an ICU nurse in a COVID-19 unit.

The poem “Alone, surrounded” was written by Dublin geriatrician Shane O’Hanlon. Behavioral health nurse Marianne Broyles wrote the poem “Using Time Wisely During COVID-19.” Here’s a brief excerpt:

And I feel very small, like a field mouse.
It is all I can do to
Blend in and hope the great
Horned owl will pass me over…

We hope both poems will invite you to reflect on your own experiences at this time. (For the Art of Nursing drawing and poems, please click through to the downloadable PDF versions in the upper left of each landing page to get the best version.)

Care for yourself first.

And don’t forget to “put on your own oxygen first” during these stressful months. In “Practicing the ABCDEs of Self-Care in Pandemic Times,” psychiatric NP Diane Solomon offers a potentially more hopeful spin on all this stress:

“We are familiar with posttraumatic stress, but what’s less known is a very real concept called posttraumatic growth, which occurs when we transform adversity into resilience and growth.”

For nurses, our commitment to the people we care for is often our “default” setting. Especially during trying times, don’t forget to care for yourself, too.

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