Retention, Recruitment, Resilience.. Oh, My!

These three words are dominating the media when it comes to nursing. Facilities attempt to retain their current staff while also trying to combat the ever-increasing staffing shortage by recruiting new hires. Staff are also reminded and educated on ways to be resilient and how to prevent burnout.

Unfortunately in America, even nonprofit hospitals have to be run like a business. Our bedside nurses are the number one asset to a successful hospital as they care for the income drivers.. the patients. Bedside nursing is a physically and emotionally demanding job that wears on even the best of nurses. I left the bedside for these reasons and also to follow my career path of leadership and education. By accepting my position into Nursing Professional Development, I see the leadership perspective of how to run a hospital.

Yes, staffing is a problem. Yes, nurses are not getting paid enough. Yes, there are more and more demands placed on nursing without incentives or relief. But, one of the main issues regarding increasing nursing staff is actually getting additional nurses into the door. The time to hire is a challenge for many organizations. This can be related to slow HR processes (they are short-staffed, too) and/or the amount of time it takes to train a nurse for the assigned unit. Even an experienced nurse can take several weeks to get acclimated to a facilities’ policies and procedures. Certain positions, such as the OR and Critical Care, are noted to be some of most challenging positions to fill due to the scope and specialty.

According to the 2022 NSI report, “on average, it takes 87 days (3 months) to recruit an experienced RN.” During this period, more staff may be leaving, additional positions, and the cycle continues. As the need increases, the vacancy rates continue to increase, and bedside nurses leave due to thin staffing, hospitals cannot keep up with the demand.

I write this mainly to draw attention to our strained and flawed healthcare system. Pay incentives and large recruitment bonuses are only temporary solutions. Long-term solutions can only be successful if we can recruit, retain, and promote resilience within our organizations. Be sure to listen to the staff, be transparent, suit their needs, and acknowledge the work that each individual contributes.

Until next shift,

Shania

Click to access NSI_National_Health_Care_Retention_Report.pdf

Living as an Oxymoron

Do you ever get a little bit tired of life? Like you’re not really happy, but you don’t wanna die?

“Having anxiety and depression is like feeling tired and scared at the same time. It’s the fear of failure, but no urge to be productive. It’s feeling everything at once, then feeling paralyzingly numb.”

As Em Beihold in her song “Numb Little Bug” and Rich Wilkerson Jr. brings to life, mental health matters. Did you know that female nurses are 70% more likely to die by suicide than female doctors, and nurses, in general, have higher rates of suicide than physicians and even the public (WebMD)?

We screen patients for suicidal and homicidal ideation on admission with questionnaires like the Columbia- Suicide Severity Rating Scale (C-SSRS).. “Do you ever fall asleep and hope to not wake up?”

“Have you ever had any thoughts of killing yourself?”

“Have you ever planned to end your life?”

Some patients laugh at these questions or make jokes about living with their spouse, however, more increasingly patients rate positive on these scales and require closer surveillance. The importance of checking in with our co workers also cannot go unnoticed. Working a stressful job on top of having anxiety, depression, or other mental health condition creates a difficult shift in itself. As patients are presenting with higher levels of aggression and/or are increasingly sicker, the job becomes more taxing. The struggle with mental health is that it is not often seen, unless carefully observed.

Taking time to fully listen to others, honestly answer “How are you?”, and having a healthy level of self-awareness is crucial to promote a healthy mindset.

Knowing that violence, depression, and anxiety are not “just part of the job,” allows solutions to be made. Speak up and speak out for yourself and others’ wellbeing. I am lucky to only have anxiety, rather than the anxiety-depression duo. Every day I take my pill and work on myself to create a life worth living.

If you ever need someone to talk to (even if we have never met), send me a message.

Until next shift,

Shania

Defensive Medicine: Protect Thyself

The NIH defines defensive medicine as “departing from normal medicine practice as a safeguard from litigation.” In essence, it is over-prescribing to prevent from getting sued due to missing any clinical components. But this isn’t the type of defensive medicine I am referring to. The type of defensive medicine I am talking about involves appropriately and effectively documenting in order to cover your a**. We often use the improper term of CYA documentation.

“If it’s not charted, it wasn’t done.” This is a phrase I heard all of the time in nursing school. I understood this intellectually when it came to nursing skills, procedures, and medications, however, I didn’t realize that I would need to document a physician response, tagging and changing IV tubing, patient education, patient mobility, etc. Even the most mundane nursing activities must be documented.

In order to protect yourself from lawsuits or chart reviews, we have to chart everything that we do to our patient during our shift. It always made me laugh when I had to document inappropriate patient comments or physician responses that were either rude or incomplete. Documentation is what saves your butt. Even though it’s tedious, it is necessary.

Remember to CYA.

Until next shift, Shania

Communicating for Change

“All communication must lead to change”- Aristotle

In acting, we learn that words are useless. Words only become effective once humans add purpose to them. The greatest actors understand the power of each word and use that power effectively to change the person they are speaking to. The change can be a perspective of a topic or a perspective about themself. We sometimes use the same words with different meanings or inflections to mean different things. This is the beauty of language and communication.

We conducted a communication survey within our facility to evaluate our current communication methods, strategies, and opportunities. A majority of the respondents voiced that they were “not confident” or “fairly confident” about our internal communication, communication with hostile patients/ family members, and communication to different departments.

With Covid, we realized that nurses are out of practice with communicating with visitors and the routine communication with interdisciplinary staff, most of which was eliminated during Covid.

There are two main types of communication that can be evaluated here: assertive communication and aggressive communication. Assertive communication is standing up for your beliefs, voicing your concerns, and not being afraid to communicate different viewpoints. Assertive communication is essential for leaders as it does not just go with the flow, but uses words effectively to evoke a positive change. Aggressive communication is not normally effective because it downplays other views, does not accept criticism, and has the “I am always right” mentality. Rather than offering suggestion like assertive communication, aggressive communication demands a certain way.

Communication is essential for a healthy work environment and relationship with coworkers. Ensuring that all voices are heard, points are spoken clearly, and evaluating different approaches are all ways to improve current communication modalities. If people have the sense that they have a say, their motivation for change can be greatly improved.

To Err is Human- A Case for Medical Errors

“To Err is human; to forgive, divine”- Alexander Pope

In light of the recent criminalization of former Nurse Radonda Vaught, the topic of medical errors is quite relevant. According to the National Institute of Health, “Medical errors cost $20 billion per year and take the lives of 100,000 people every year.”

There are many different types of medical errors and reporting such errors helps to improve the process and prevent repeatable errors in the future.

Medicinal errors can include acts of omission (not giving a medication when it is ordered) or commission (giving the wrong medication). The main 5 rights of medication administration are taught in nursing school: right patient, right drug, right route, right dose, right time. We are taught to do no harm and every nurses’ fear is to kill somebody.

If a nurse tells you they they have never made a medication error before, they are likely lying. A lot of the time, the error causes no harm and goes basically unnoticed. The nurse will communicate the error to the appropriate people and it is evaluated and a new process may be created. That’s it. In the unfortunate cases where the patient is harmed or dies, that is when the stakes are higher. But, every single error made can possibly lead to death. Fortunately, most of the time the nurse can take a deep breath and carry on with the shift.

Medicinal errors can involve:

Giving the patient a medicine they are allergic to (most often this is caught with electronic systems and pharmacy checks, sometimes it is not flagged),

Giving a drug that the doctor ordered on the wrong patient (nurses can catch this if they understand what the medication does and the story of the patient)

Giving the correct drug but wrong patient label (same drug, same dose, wrong patient)

And so so many more scenarios.. some are very minor and are not noticed. Some are major and become national news. But ALL are human errors involving medicine.

What makes this case so scary for nurses is that reporting a medical error previously is already shameful no matter how small or big. And now that Vaught is now labeled a criminal, many more errors will now go unreported. In a time where we are facing an ever increasing nursing shortage, and now sending nurses to prison for a medical error, how is that going to affect the future nursing workforce?

The healthcare system is in need of some major changes. Where is the forgiveness that is indeed divine?

Until next shift,

Shania

It’s Just a Bad Shift: The Importance of Mindset

In the past several weeks, I have transitioned into a new job, got scammed out of $1000, lost and found my “sold” wedding dress, messed up my personal website, and our house closing has gotten delayed. Reflecting on these many frustrations, I remind myself that these are so little mishaps in the grand scheme of things.

I remind myself that I am so thankful that my family is healthy, my country is not under war, Covid numbers are decreasing, I have a successful side job that I love, we are building our first new home, among so many other amazing events that life brings.

There are bad days at the hospital, but there are also bad days at home. It is normal for humans to doubt their abilities and question our life paths. It is so easy to live in life’s frustrations, rather than choosing to embrace the oxygen that we breathe at every moment.

It’s our attitudes and perspectives that determine our outlook on each situation. It is so important to magnify the good and simply experience the bad. Experiencing every emotion- the good, bad, and ugly, is part of a healthy life. The problem lies in adopting a negative viewpoint that determines all future reactions and paths for greater things.

Inpatient nursing is already a high stress environment, so why bring such negative emotions and perspectives to the work? A negative aura is felt by others around you. It truly is amazing how just thinking negative thoughts can affect an outward appearance.

We need to choose to accept healthier perspectives and view all sides of a situation. A bright person is just as recognizable as a negative Nancy.

Until next shift,

Shania

What do you want to be when you grow up?

Growing up and even now, many ask themselves this question, “What do I want to be when I grow up?”

After witnessing mental illness in my family and then struggling with my own eating disorder, my answer became “a nurse.” I chose to be a nurse because I wanted to influence others and educate others into creating a healthy lifestyle.

But just the answer of being a “nurse”, only goes so far. I then decide whether I prefer inpatient or outpatient, which unit, which patient population, short term goals, long term goals, etc.

I, ultimately, settled into an adult medical-surgical floor that also served pediatrics and Oncology. I began nursing school wanting to do pediatrics, then ER, then inpatient oncology. There was rarely a job available at the infusion clinic, so I remained on med-surg for 5 years and I enjoyed it.

I started as a student nurse tech, then a nurse extern, then a new grad nurse, then staff nurse, then charge nurse, and now a nurse Retentionist! My medical unit offered classes on chemotherapy administration and pediatric care at no cost to me. I was able to get a wide variety of training and experiences by remaining on the medical floor for as long as I did. I also had the opportunity to switch shifts and worked days, nights, and weekend nights.

Each different experience I had and extra step I took for myself, allowed me to be open for leadership opportunities. My transition into a charge nurse was not as difficult as I thought. And the creation of my new position as a Nurse Retentionist, allowed me to step fully into the role as a nurses’ advocate and leader.

Though the actual transition away from the bedside and into a 8-4:30 job was difficult mentally, the actual work came natural. I was able to utilize my strengths of communication, boldness, and listening to incorporate challenges at the bedside into solutions to present to nursing leadership.

I never went into nursing school thinking I wanted to go into leadership, but it was something that found me and I love it. Though I am not a typical bedside nurse, I am still a nurse. Instead of caring for patients, I advocate for the nurses that continue to care for them.

What do you want to be when you grow up?

Until next time,

Shania

Developing a Nursing Identity: a Unique Proposition Statement

What creates job satisfaction? What factors encourage employees to stay in the same workplace for years? Why are humans so hesitant about change culture, but ultimately seek different opportunities?

A unique proposition statement is a fancy word for catchphrase in the voiceover industry. While building my voiceover business, having a logo and UPS are important in the development of my brand and marketing. My UPS is “the cure for the common read.” Within that phrase, I was able to combine my two passions of nursing and acting into one. It also reveals my unique qualities that I can provide for voiceovers. Having a medical background helps me see medical narration from a nursing point of view, rather than studying how to communicate large words.

I realized that identifying what makes you stand out is also important in a professional nursing career. Because no one nurse is the same and there are so many things you can do with RN at the end of your name, it is important to develop your own nursing identity to help guide a successful nursing career. Dr. Sarah Gray with Sigma International speaks highly of this and details the importance of a professional brand with a mission and vision as necessary definitions to guide each nurse’s professional journey.

It is direction, mentorship, and openness to opportunities that encourage nurses to stay in the profession and at a certain facility. The facility must encourage professional growth and provide access to resources that promote successful career advancement.

Before starting nursing school, I told myself that I wanted to work in the ER. I quickly realized that the culture was not right for me, and I worked Med-Surg as a bedside nurse for nearly 5 years. Eventually, I noticed that I did not have as much compassion as I once did, and bedside skills were seeming kind of monotonous, so I began to think about how I wanted to further my nursing career. I connected with Dr. Sarah Gray who helped me to develop my own nursing mission and vision. It was then that I was able to identify what I loved most about nursing and combined those with my strengths to decide where I want to see myself in the next few years. Ultimately, I decided that that was not as a bedside nurse. I have a passion for leadership, mentorship, and nursing education. I was able to step into (and help create) my current position at the same facility as the first Nurse Retentionist- a creative position that focuses on nursing advocacy, empowerment, and professional career planning.

Without first recognizing what my nursing identity is, I would have done more trial and error positions to figure out where I would fit in the nursing profession. Change forces us out of our comfort zones, however positive change motivates lifelong learning.

My personal mission and vision:

Mission: As a voice for medicine and nursing professionals, I will lead others to think creatively in order to foster healthy relationships, a healthy self, and a healthy work environment.

Vision: Health care professionals will engage in meaningful work and have a passionate voice in the workplace.

Until next shift,

Shania

Row, Row, Row Your Boat..

When we hear those first 5 words.. “Row Row Row your boat..”, we can’t help but finish the nursery rhyme, “gently down the stream, merrily merrily merrily merrily, life is but a dream.” This is simply a commonality that humans share with one another. In nursing, in order to connect with people, it is important to find that common knowledge that we both share to develop a healthy rapport. And sometimes, we must be creative to motivate our patients to do things that would benefit them.

We had an elderly man with dementia and we were rolling him in the bed to change his sheets. He just started singing “Row Row Row your boat” as he was rolling, and of course we all sang along with him. It is those small moments of laughter that can brighten our day along with our patient’s day.

Another time, a nurse began dancing with her elderly patient, just to get him to get out of the chair. They both had a good time!

Some other creative patient encounters included:

  • Bringing a patient to the main lobby to play the piano and sing
  • Wheeling a patient around the unit in a wheelchair to get them out of their room
  • Baptizing a patient in the chapel
  • We have married multiple patients in the hospital room
  • Sitting a patient at the nurses’ station because they didn’t want to be alone
  • And so many more!

All it takes is just a moment to make a connection.

Until next shift,

Shania

Being Grateful for the Little

. “… The foundation for greatness is honoring the small things of the present moment instead of pursuing the idea of greatness.” – Eckhart Tolle, A New Earth

Last night, I cared for a lady with covid who seemed very down when I first walked into the room. She remained on the phone with family as I tried to speak with her and give her her nighttime medications. I began to get frustrated because she was not acknowledging me as she continued to talk on the phone while I do my assessment. After she took her pills, I stepped out of the room and completed the rest of my med pass.

Throughout the night, I checked on her every couple of hours to make sure she didn’t need anything.

At the end of the shift, I rounded my last time and she asked me to bring her a piece of paper and to write down her care team for the night. I brought her the paper and she looked at me with tears in her eyes and said, “you are my favorite. You are the first person that has come in here to check on me multiple times.”

That broke my heart for a couple of reasons.. First, from our first impression, I was not going above and beyond to make her happy since we did not develop a connection due to the initial lack of mutual communication. I felt almost guilty because I shrugged off her persona since she wasn’t wanting to talk with me when I was in the room. Second, Something so simple as to walk into the room to check on a patient should not be so unheard of. This patient so greatly appreciated the human interaction that she wanted to recognize us for simply caring for her.

These covid patients are locked in their rooms for days and unable to see family. Oftentimes, nurses are the only people they physically see while they are in the hospital and it is at those encounters that we can provide the encouragement they need to get better.

Don’t forget the impact that little acts of care and kindness can bring.

Until next shift,

Shania