Category: Clinical Corner

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Clinical Corner: Nurse Burnout and Stress Management

Stress Meditation 1 - Clinical Corner: Nurse Burnout and Stress Management
Recognize Stress Awareness Month by checking in on yourself and finding healthy ways to manage stress and avoid nurse burnout.

By Phil Niles, Clinical Nurse Manager, Medical Solutions

April is Stress Awareness Month, and that’s relevant highly here considering two of the biggest challenges nurses face are chronic stress and burnout. I can tell you from my own experience that unchecked stress leads to physical pain, lack of energy, bitterness, feelings of dread, and becoming mentally checked out of caring for patients. When you burn out, nursing can become a never-ending hamster wheel of dreading everything negative that could happen during your day. These “could happen” scenarios become expected, inevitable truths in your mind each day, even if they do not occur. Pretty bleak, right? 

Healthcare in general is often listed as one of the top most stressful jobs in the United States. A few of the reasons for this trend include workload caused by insufficient staffing and long shifts without breaks. One of the most dangerous effects of this are increased risk for patient harm. Stress makes you tired and confuses your thinking, leading to mistakes and breaks in standard of care.

So, what can be done? Shall we all throw our hands in the air, toss our stethoscopes in the nearest trash can, and go live the hobo life riding the rails? Sure, I exaggerate a bit, but I know a few of you are holding your hands high yelling “Amen!” Obviously, there are steps that need to be taken by health care organizations, which some have done, to decrease the demand on nurses and improve the overall work environment.  Additionally, instead of asking only “What are they doing to help me?” we should ask, “What can I do to help myself?” We need to focus on ourselves and practice mindful self-care. How do we care for ourselves?

STOP and take a deep breath.

It is very common to get caught up in all the things that need to be done and the lack of time to do it. Stopping and taking a deep breath helps clear the frustration that can cripple your ability to think clearly and prioritize care.  After three or four deep breaths ask yourself, “What needs done right now?” You are only one person and cannot be in three places at once, even though it feels like we are asked to do this all the time. Start with the first thing that needs to be done and prioritize from there. Pop your head into the other patient’s rooms and let them know you haven’t forgotten them. This will help your patients feel respected and validated instead of ignored. 

Be vocal and a clear communicator.

Let your Charge know what you have going on and what you can take on to help the team. The only way they know you are feeling overwhelmed is if you communicate. I’m sure many of you have been to assignments where you felt like you could not depend on anyone. Be the positive change of teamwork you want to see! Offer your help when you can and ask for help when you need it. Assuming everyone knows you are extremely busy is the cause of a lot of unnecessary frustration. 

Stay hydrated!

Most nurses are pushing their kidneys into early failure with poor hydration. Dehydration can cause fatigue, headaches, lack of energy, and slower thinking. I can hear it now … “I don’t have time to pee let alone drink any water!” Yes, you do! It is just not a part of your daily work habit — yet. Prioritize yourself for your own health, but also because, in the end, taking care of yourself makes you better able to care for your patients.     

Leave a bad work day at the door and do not assume it will be the same tomorrow.  Easier said than done, I know! It does take work to not let the “black cloud” of a bad day follow you home and shape your mood for the rest of the day and the next. Commit to making time for yourself. Nursing is a very engaged, social profession. Decompression in a quiet space is necessary to let your mind relax. Even if it’s just the drive back home while listening to a podcast, music, or nothing at all! Take an extra spin around the block if you’re coming home to an equally busy household, which many of us are. You’ll thank yourself for the extra five minutes. Your brain needs the downtime!

Take advantage of the resources available to you. 

As a Traveler you may feel alone with no one to call on for support. This is not true! You can always contact your recruiter and some travel companies, such as Medical Solutions, have in-house nurses, such as myself, available to talk with you and truly understand where you’re coming from. This is often an unknown resource to many Travelers. Just talking something out with another nurse does wonders to get it off your shoulders and help you breathe a little easier. 

Stress is a very real and damaging force if not dealt with through healthy channels.  Remember this Stress Awareness Month and all year-round that the only way to provide skilled, compassionate care for your patients is to care for yourself first.

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Clinical Corner: What the Dialysis?!

What The Dialysis - Clinical Corner: What the Dialysis?!
Clinical Corner demystifies dialysis!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

As healthcare providers, many of you have cared for a patient that is dependent on dialysis. Yet, even you may have wondered, what the heck is dialysis? Well, let’s talk about that! A friendly dialysis RN shows up on their dialysis day, takes up your sink, clogs your room with machines, and, in the end, leaves you with a healthy smell of bleach lingering in the air. What happened? You know the basics of the process: The blood is “cleaned” and fluid is removed from the patient over three-four hours. The patient has an access such as a catheter, fistula, or graft that the dialysis RN accesses for the treatment. Patients commonly have three four-hour treatments per week. But, what else is going on during the treatment?

First, we start with water. A single dialysis treatment uses over 150 liters of water. Water from the faucet cannot be used because there are impurities, trace heavy metals, and chlorine in standard faucet water. This is all fine and dandy for us to drink, but during dialysis this water will come into contact with the patient’s blood, so it must be as pure as possible. One of the machines that a Dialysis RN brings into the room is a reverse osmosis machine or RO. This machine moves solutes from a concentration to a higher concentration producing high-concentrated water (waste water) and very low concentration water (RO water). The RO water is used for the treatment and delivered to the hemodialysis machine by a product hose. Tap water generally has total dissolved solutes level of 100-200 parts per million. Dialysis water is 10-15 parts per million — a much lower concentration. Before the water can be used the Dialysis RN must conduct a series of quality control tests to be sure the water is good to use. The main test is a chloramine test. Chloramine is a derivative of ammonia that’s used to treat drinking water. It cannot be in the product water because regular levels of chloramine would cause seizures and potentially death in your dialysis patients. After all the tests are complete, the water is considered good and the hemodialysis machine can now be set up.  

The dialysis machine is then put through its own tests and it is “strung.” Stringing the machine means installing the blood tubing and dialysis filter, and priming out all of the air in the system. During this process “acid” and “bicarb” are added to the water being delivered by the RO. Acid is acetic acid or vinegar with electrolytes added specific to the patient’s needs. The bicarb is just sodium bicarb. The machine mixes dialysate at a ratio of one part acid, two parts bicarb, to 40 parts water. The pH is blended to the pH of normal blood. Dialysis patients are usually in early metabolic acidosis before treatment. The dialysis treatment normalizes this, while also balancing electrolytes and removing excess body fluid. 

Once the machine is set up and has passed all quality control tests, the patient can be accessed and bled on to the dialysis tubing, which is called the circuit. Patient access is either an externalized catheter or internalized fistula or graft. The catheter is commonly surgically placed in the right or left jugular vein then tunneled under the skin four-six inches to where it comes out into two limbs, the arterial and venous access. The blood being accessed is venous blood. The arterial limb is called arterial only because it is moving away from the body. The “venous” limb returns cleaned blood back to the patient. A fistula is an access created by a passthrough or “fistula” between an artery and a vein that was not there before. This causes higher pressure arterial blood to flow through a lower pressure larger vein. Over time, usually two-three months, the vein enlarges due to the increased pressure and the walls of the vessel thicken. At this point the newly developed fistula vessel can be accessed by larger fistula needles. New fistulas are accessed by 16-17-gauge needles until the vessel becomes accustomed to the needlestick. Standard dialysis treatments are run with 15-14-gauge needles. Two needles are required — an arterial needle to pull blood to the dialysis machine and a venous needle to return the newly cleaned blood. Needles are placed at least an inch apart from each other to prevent recirculation, or recleaning of freshly cleaned blood. A graft access is a synthetic tube that is placed under the skin connecting a vein to an artery. The optimal access for a dialysis patient is a fistula. However, not all patients are candidates to receive one. 

The biggest rule to follow is to never allow the extremity with the fistula or graft to be occluded, including and especially taking blood pressures. All lab draws and blood pressures must be done on the non-fistula extremity. Occluding the vessels or the fistula itself can lead to it clotting off and potentially losing that access. Many long-term dialysis patients do not have many options for accesses, so it is so important to protect your dialysis patient’s access while in your care. This is their lifeline!

The dialysis process itself is a fairly simple one that works on two principles — a concentration gradient and a pressure gradient. Diffusion, as most of you are very aware, is the movement of solute from a high concentration to a lower concentration. This is the entire science of electrolyte balance in a dialysis treatment. Potassium is usually high in a dialysis patient needing treatment. The dialysate mixed by the machine has a specific potassium prescription based on a sliding scale. This prescription will bring the patient’s potassium to a normal level after dialysis. The dialysis treatment does this with all electrolytes. It is important to note that the dialysis treatment only balances electrolytes in the blood. Higher levels may exist in the tissue and as dialysis progresses these higher levels continue to shift to the blood stream throughout treatment. Lab values are not accurate until at least an hour after dialysis treatment. It is highly discouraged to order labs before this so that inaccurate results are not given. 

The other half of the dialysis treatment is fluid removal. This is accomplished by the dialysis machine exerting a specific negative pressure on the dialysis filter that causes fluid to move from the blood stream to the dialysate side of the filter and be disposed of. Generally speaking two-four liters of patient fluid is removed from the patient during a four-hour treatment. Fluid removal is the component of the dialysis treatment that can lead to episodes of low blood pressure in the patient. This occurs when fluid is being “pulled” faster than the patient’s vasculature can tolerate. The ability to tolerate fluid removal varies greatly from patient to patient. Blood pressure and other vitals are watched and recorded at least every 15 minutes during treatment. Fluid removal also requires work from the body to shift that fluid.  Patients are often very tired after treatment due to this. 

And there you have it! I hope this sheds a little light on the often-mysterious ways of dialysis and gives you more knowledge to better care for you patients. I also hope it makes you more aware of what your kidneys do for you! Uncontrolled diabetes and high blood pressure are the top causes of kidney failure. Love, protect, and care for your kidneys!

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Clinical Corner: Team Nursing and Delegation

Team - Clinical Corner: Team Nursing and Delegation
Team Nursing can be a great, collaborative experience for patients and healthcare workers — as long as you know how to navigate the process!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

Many of you have encountered the concept of team nursing during your travel and/or nursing careers. If you have not encountered it, you might one day hear something like, “Your assignment will have you taking a 1:10 assignment.” Then you might say, “What???” and they might reply, “Don’t worry — it’s team nursing!” Even more confused at this point, you might ask, “Well, what is team nursing?” What a great question! Let’s start with some definitions.

Team nursing is pairing nurses of varying skill sets and experience levels to care for a larger group of patients. This team can consist of an experienced nurse and a new nurse, a RN and an LPN, or either of these two with the addition of a nurse aide. The team is intended to create a collaborative, supportive environment that will collectively meet patient needs and promote improved communication between team members.

Team nursing is not meant to be an authoritarian hierarchy with one person ordering everyone else around. In fact, many factors go into determining how the workload is divided. Team members collaborate at the beginning of the shift to divide tasks amongst each other according to skill, scope of practice, and familiarity with each patient. A common misconception of team nursing is thinking you’d have to control every detail of care for all patients assigned to you. It’s difficult to get out of the mindset of primary nursing (one nurse to a group of patients) and give up a little control and the idea that you need to do everything yourself. For Travelers working an assignment with team nursing for the first time, it can be a challenge at first to adjust. So, let’s address a few questions you may have about team nursing as a Traveler.

What can my team members legally do in their scope of practice?

This is probably the most commonly asked question and an important topic to address. Scope of practice of LPNs and nurse aides varies by state, so it’s important to study up on the Nurse Practice Act of the state you are traveling to ahead of time. Each state’s Board of Nursing website is a good resource for this. You can also reference the National Council of State Boards of Nursing (NCSBN) website. Click here and you’ll find they have a drop down box where you can select your state and to generate a link to its Nurse Practice Act. You can also ask the floor manager or even the team members themselves! It is important to remember that hospitals may not allow the same scope of practice that a state lists as acceptable, so never assume anything. Even after reviewing your state’s Nurse Practice Act, make sure to ask the manager about the hospital’s specific LPN and nurse aide scope of practice.

What if something goes wrong with a patient whom an LPN or aide on my team was assigned to?

What is your accountability when delegating tasks to others? Every member of the team is accountable for their own actions. For example, an LPN may be held accountable for negligent or improper care that resulted in patient harm. However, the RN may also be held accountable for improper delegation or not intervening in the negligent care if the RN had knowledge that the care was not to standards of care.  There is a balance to be struck between delegating care and assuring that care was carried out. The RN is in a supervisory role in team nursing when the other member of the team is a LPN or aide. No one in a supervisory role should ever assume when you hand off a task that it was completed without verifying this themselves. As the RN Traveler in a team nursing scenario, you will likely see the same patients throughout the day while doing separate tasks. Take this time to also verify that all care was delivered and appropriate. 

What if the other members of my team do not communicate with me?

Team nursing relies on clear, consistent communication between all team members, so never be afraid to ask questions. Often, drops in communication happen because the other person assumes you already know the information. For example, a good way to approach this type of situation would be to say, “I’m going to see Mrs. X next. Did you already change her dressing? Do you have time to change it with me now, so we can both assess it?” This is a collaborative approach with clear communication. The other person will not be threatened or feel ordered around and will likely make a plan with you. On the other hand, an approach I do not recommend is to say, “Hey! When are you going to change Mrs. X’s dressing? You need to talk to me!” As you can tell, this may spark a bit of defensiveness and potentially damage your working relationship. Still, there are those that once in a while do not respond well to coaching, so you can always go to your charge for support if you feel your team is not working well together or have a concern about a particular team member. 

I hope this gives you guidance and arms you with information if you ever work in a team nursing environment. I also hope you see it as an opportunity to meet your patients’ needs in a new way.

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Clinical Corner: Assignment Safety

Safety First - Clinical Corner: Assignment Safety
Keeping yourself, your patients, and your license safe while Travel Nursing is essential to your success!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

The ratios are too high, the hospital is too busy, and there isn’t any help! What do I do?!

As a Traveler, you may have felt these sentiments or even voiced them. Feeling unsafe on assignment is a scary experience — and that can be especially true in a new hospital where you really don’t know anyone. Who do you turn to for support in that situation? Because every scenario is different, there are no black and white answers, but let’s look at some assignment safety concerns commonly reported by nurses and how you can best address them.

Ratios

Many nurses report being “out of ratio” or facing high ratios. What exactly is high?  Well, it really comes down to what the nurse’s experience is and what their expectations are of a hospital. California is the only state with nurse:patient ratio laws. Med-surg, for instance is a 1:5 ratio there, but this ratio could be much different elsewhere in the country. Some states see up to 1:7-8 ratios and more!

So, what is “unsafe”? Well, one common average is 1:6 on a med-surg floor. If a Traveler comes from California and starts an assignment on the east coast, they could suddenly see 1:7 ratios when they are used to seeing 1:5. This is a drastic difference.  The nurse could suddenly feel overwhelmed and unable to meet the needs of the patients. Their expectation of the position may have been unrealistic as well. 

Perpetually Short-staffed Units

Another common complaint is that a unit consistently does not have enough staff to care for the patients on the floor, causing higher ratios as well. Most Travel Nurse positions exist because a hospital recognizes that there’s a critical shortage of nurses on their floors. So, travel assignments will often be short-staffed due to the nature of the work. However, this makes a big difference whether or not a hospital is actively seeking new permanent employees and/or Travelers to fill its gaps.

It’s important to do your research before accepting a position. Ask why they have a travel need when interviewing. This is a great way to get more information about this area. Even gauging how the interviewer answers the question will give you insight.

Being Asked to Take Patients Outside Your Skill Set and Comfort Level

This is a very serious situation. Travelers asked to take patients outside their skill set often feel like they have to — to keep their job and stay in good standing with their travel company. But hear this: No nurse should be forced into taking an assignment outside of their ability! Travelers must be vocal when this issue arises and calmly state the reasons they cannot accept a patient assignment. The worst thing you can do is blindly accept this kind of assignment and hope to “fake it, ’til you make it.” Be professional but be firm. Always know that anything that happens with the patient under your care will be your responsibility and under your license. Continue to take the issue up the chain of command if the hospital is adamant. Also, contact your recruiter! Many travel companies — including Medical Solutions — have in-house clinical staff that can be your advocate in the field. Find out if you have this resource before you accept an assignment with a company.

Being Asked to Cut Corners Because “That’s How it’s Done Here”

There are no circumstances where it’s acceptable to do anything outside of the standards of practice set forth by Joint Commission standards and state laws. A commonly reported situation is perm staff telling a Traveler that a physician does not like to be called at night. So, they just order labs and the physician signs it the next day. This is never acceptable, unless there is a protocol order signed by the physician in the chart already. Always call the physician. Will they be upset? Probably. But this is better than ordering something without an official physician’s order and having a complaint sent to the BON on you practicing out of scope. The core staff will do what they do, but don’t assume that risk yourself just because everyone else is doing it!

There are several other issues that Travelers tend to report as unsafe, and many of them are valid. Overall, what can you do to protect yourself?

Ask more questions. If the manager says their ratio is 1:5, but sometimes can be 6-7, then ask how often someone on the floor carries more than six patients. If the manager says Travelers float, then ask if they float round-robin with the staff or if they float first. Ask if floating mid-shift or more than once per shift is common. Ask where they expect Travelers to float. It is never out of line to ask questions during an interview. 

Also, take a personal inventory and know your expectations of each assignment. If your expectations don’t align with what the hospital expects, then it may not be a good fit. Trust your instincts! 

Lastly, talk to your travel company and have them work for you! Get enough information about an assignment from your recruiter before an interview so you can make an informed decision and be prepared to discuss any questions you have.

Traveling is an amazing experience, and you can make sure that it is just that and no less for you. Get answers to your questions, clarify your expectations, and find that perfect match!

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Clinical Corner: Viva La Resolution!

A cup of coffee and notepad on white wooden table.

By Phil Niles, Clinical Nurse Manager, Medical Solutions

It’s nearly a new year and many of us will soon be seeking paths that lead to self-improvement through resolutions. Lose all the weight! Write a book! Learn to play the guitar and become a STAR!

A new year brings hope for positive change and the drive to get started. I feel this hope and drive at the end of each year, yet almost every new year I abandon my goal in the first month and don’t follow through — and I’m not alone. Statistically, one in two people will make a New Year’s resolution at the start of 2019, but only one in 10 will succeed at upholding their resolution for at least a year. 

My past resolutions have included learning to play the guitar, speaking fluent Spanish, getting out of debt, and, of course, the ol’ tried and true lose weight and get fit.  Unfortunately, I am not a world-famous guitarist (but I now own two cool guitars), I speak only broken, butchered Spanish — finding myself asking for a goat with fancy socks when I wanted a burger with fries, and I also continue to have a fan club of creditors that check in on me monthly.

However, in 2018 I did make a resolution to get to the gym on the regular. At the time, I was fairly active but only sporadically and it involved mountain biking chased by a couple beers afterwards. My initial goal in 2018 was to leave work at lunch, go to the gym, and walk on the treadmill every day. To my great surprise, I kept it up! I even started mixing in running intervals with the Couch To 10K app, and soon I was running more than walking.

Then I started talking to a trainer at the gym.  He asked me what my goals were, and I realistically replied, “To build enough strength to carry in groceries for my wife without groaning. She would be so impressed with my incredible ability!” We high-fived and came up with a plan to achieve this. At first, I thought he was trying to find ways to keep my body in a continual state of pain and suffering, but I stuck with it and slowly saw improvement and positive change. That was eight months ago. 

Now, I’m not the perfect example of how to create positive change, but as we’re all creating our 2019 resolutions, I want to share some tips with you on how I stuck with my resolution and met my goals — because I know you can do it too! 

Don’t try to climb the tallest mountain on day one. 

The most important advice I can give is to start with a goal that’s modest and attainable. Start by forming a habit that you can easily repeat week to week. I started by going to the gym and walking the treadmill at lunch four times a week. Some weeks I went all five workdays, some I only made it twice, and I was OK with that. The main thing was that I was going! It’s said that you need to continue a new activity for at least two weeks solid to make it a habit. I laid this groundwork and then when I felt ready built on that habit and set new goals. 

Turn frustration into motivation.

Everything did not go perfectly. I had setbacks, like pulled muscles, illness, and the unpredictability of life. But I made a point not to get discouraged or frustrated. I picked up where I left off and even took a step back to be sure I didn’t overdo anything. I also did not weigh myself often or diligently document weight training progress. I would hop on the scale every month or so, but I didn’t use this as the only measure of success or failure. Remember, this is about positive change, not just losing weight or getting stronger — it is about feeling better! Milestones are important to monitor, but they do not define your success. 

Be flexible. 

So, let’s say you didn’t get through your workout this week … END OF THE WORLD! WHY AM I EVEN TRYING? LIGHT ALL THE THINGS ON FIRE! Life is not always going to cooperate with your plans. Accept that this will happen and roll with the punches.  Incorporate whatever is blocking you into a challenge and make new goals. Always remember that YOU are in charge of what happens to you, not a hard workout, not discouraging remarks from others. Value yourself and be proud of what you have done to improve your life. To channel the wise, wonderful Yoda, “Do or do not, there is no try.”

Make that change and have a great 2019!

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Clinical Corner: Happy Movember!

Two Bearded Friends Drinking Coffee and Taking Selfie in Restaurant

Happy Movember!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

For those of you who can grow them, I hope those mustaches are coming in strong this Movember!

This month we’re celebrating Movember, an annual mustache-growing event that aims to raise awareness about men’s health. Of course, women’s health is of paramount importance, but let’s face it, guys: We stink at caring for ourselves. Statistics show that men take more physical risks and are 24 percent more likely to have not visited a doctor in the last year. Men also are reluctant to visit a doctor when facing mental or physical illness. For example, wrecking your mountain bike, breaking a couple of ribs, cracking your sternum, and then refusing to go to the ER because you’re “fine.” Oh … maybe that’s just me? Well, then I’m guilty, too.

There is also a general lack of public awareness of men’s health issues. Women being proactive and engaging in preventative activities is widely recognized and established as the norm.  Men on the other hand, who are equally at risk, are not as often actively encouraged to see their doctor on a regular basis. Movements like Movember and Men’s Health Month in June help bring the issue of men’s health to everyone’s attention. Movember also specifically brings attention to prostate cancer, testicular cancer, and men’s suicide. If you’re 40 or older, you need to start having conversations with your doctor about prostate cancer screenings. And make sure to regularly screen yourselves for testicular cancer, which can occur in young men as early as 15.

Fake mustache fun

Get your mustaches AND your healthly habits on this month!

The top three leading causes of death in men are heart disease, cancer, and accidents. Many of these ailments are preventable! According to the Centers for Disease Control (CDC), 12.4 percent of all men age 18 and older rate themselves as having fair to poor health. Here are a few more enlightening statistics from the CDC:

  • 58 percent of men 18 and older report meeting the federal physical activity guidelines for leisure or other aerobic activity
  • 8 percent of men 18 and older report smoking regularly
  • 6 percent of men 20 and older are obese
  • 1 percent of men 20 and over have high blood pressure
  • 9 percent of men under the age of 65 do not have health insurance coverage

These are some of the problems, so what can you do about it?

First, get moving! Stand up and walk around. This is the simplest thing you can do for yourself to positively impact your health. Just this action alone can reduce risk for heart disease, high blood pressure, type 2 diabetes, depression, osteoporosis, and even some cancers, according to the CDC. Obviously, quitting smoking, eating healthy, losing weight, and seeing your doctor regularly are also important. However, just getting up from your chair once a day and walking for 30 minutes can drastically improve your health. This can be as simple as walking around the block!

Be an advocate for your own health. See your doctor when you’re not sick! Crazy, right? A preventative doctor visit will cost you a co-pay and maybe a new prescription. An average hospital stay costs $10,000. The choice seems obvious, even just considering the financial impact. Another, powerful reason men do not go to the doctor is fear; fear of the unknown and fear of disease. A rational rebuttal to this is that if there is a disease lurking it will be there whether you know about it or not. Fear, however, is not rational. It can force a person to turn a blind eye to symptoms and minimalize them as just a passing thing. Seeing your doctor regularly is not only cost-effective, but it can also catch health risks and help prevent chronic health problems. According to the CDC, up to 40 percent of deaths from common health issues could have been prevented.

Bottom line? Get off your butt, make healthy choices, and go see your doctor. Do it for your family. Do it for yourself. Make the proactive choice to improve your health by taking one step (literally, sometimes!) or several steps as needed. And keep rocking those incredible mustaches!

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Clinical Corner: Travel Nurse Interview Tips

Travel Nurse interview

Bring your A-game to your next Travel Nurse interview.

By Phil Niles, Clinical Nurse Manager, Medical Solutions

Hello, my traveling friends! I’m Phil, a Clinical Nurse Manager for Medical Solutions and I’ll be taking over Clinical Corner. I’m a RN BSN with 16-plus years of experience in ICU, acute dialysis, and management. My work at Medical Solutions has given me the opportunity to support all of you fine people in a variety of ways as you craft your career. But for this installment of Clinical Corner, I want to focus on one specific area where I provide support: Interviews!

I don’t have to tell you that as a Traveler you’re constantly interviewing and selling your skills and experience to hospitals — typically over the phone as opposed to in person. I conduct pre-screen interviews for our hospital partners and have experienced quite a few bad interviews in my time. They had the skills and the experience but were terrible in the interview. In the spirit of not being that guy or gal who fails to represent yourself to fullest in your interviews, here are a few tips that may help you land that next assignment:

Be on time!

Even though this is most likely a phone interview, it is very important to be ready a couple minutes before any scheduled call. Often the interviewer has multiple candidates to call and will not be able to accommodate you 10 minutes after the scheduled time. Be ready early.

Treat it like an in-person interview.

Most sane people would not swear, sigh, eat, or be confrontational during an interview, but these are things that I have personally witnessed. For example, you wouldn’t walk into an interview eating a sandwich, talking with your mouth full, and chatting up a buddy you brought with you, right? Be polite, engaged, and undistracted. Impress them with your professionalism.

Mature African American man talking on cell phone and working at laptop at kitchen table

Most Traveler interviews happen by phone. Be sure to call from a quiet location where you have good service!

Call when you have good service.

“I’m going through a tunnel … *static* … ” This is not the best first impression to give to a prospective employer. Make sure you’re somewhere you have uninterrupted service, even if this means pulling over on the side of road at the top of a hill. A cellphone cutting out constantly during an interview may lose you an opportunity with a great employer.

Call from a quiet location.

I’ve experienced being called from a mall, fast food drive-thru, at a train station with a train going through, and in what sounded like a day care with 50 screaming children. Now, many things are hard to predict and you cannot control everything around you, but make your best effort to find a spot that is quiet and as free from distraction as possible.

Be honest about your skillset.

“Oh yeah, I’ve done it all — open heart, brain surgery, face transplant, and delivered five babies at once.” It may be tempting to talk up skills that you are rusty on or have little experience in. However, the interviewer will take you at your word and expect you to be able to perform everything you spoke to. Be honest, be open, and highlight what you are good at. If you’re asked if you have experience that you do not possess, then be transparent. Often, managers do not expect you to be proficient in addressing every single patient experience they see on their unit. They just want to be sure you can cover the majority of what they see.

Be clear, informative, and succinct with your answers.

Beware the urge to tell a long story when a shorter, direct answer will work.

Manager: “Tell me about some of the patients you see in ICU?”

You: “Well, I was born in 1994 on a cold, crisp, winter eve … ” 

Personal examples are excellent when you’ve been asked “Give me an example of X” type questions.

Also, one word or “canned answers” should be avoided. An interviewer will likely see this as a red flag and try to catch you off guard by asking multiple follow-up questions. Think of compelling, unique answers for standard strengths and weaknesses type questions. Instead of saying the cliché “great team player” line, switch it up to something like “I’m a strong resource for my team and I never let anyone down.”  Make yourself memorable!

Interviews can be stressful, and nerves may get the better of you if you let them. Always remember you are just talking about you — and you are the expert on you! Therefore, this the absolute best topic you could ever talk about! There is no reason to worry about what they’re going to ask. You already know all the answers. So, take a deep breath, remember that you are a rock star, and knock ’em dead!

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Clinical Corner: Delegation

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

One of the most underrated skills that nurses possess is delegation. This skill is so very important to providing quality care in the healthcare environment. Furthermore, it has an even bigger impact as time moves on and the nursing shortage grows. More than ever, nurses need to work effectively to utilize their resources and assistive personnel. Proficient delegation is not always taught and it can be hard to master. It’s now more important than ever to have competent and appropriately supervised personnel in the delivery of affordable, quality care.

To achieve this outcome, the RN must assign tasks based on the needs and conditions of the patient, potential for harm, stability of the patient’s condition, complexity of the task, predictability of outcomes, abilities of the staff to whom the task is delegated to, and the context of the patient’s needs. One of the biggest rules to abide by with delegation that many nurses are not aware of are the five rights of delegation. These five rights include:

  1. The right task
  2. Under the right circumstances
  3. To the right person
  4. With the right directions and communication
  5. Under the right supervision and evaluation

When following the five rights of delegation, nurses must use good critical thinking and professional judgment. Please refer to the following decision tree for assistance with delegation:

Nursing Delegation

Delegation is a crucial skill in the delivery of patient care. This decision tree provides assistance with delegation.

To assign a task to assistive personnel, the right communication must also occur to make sure directions are clear, concise, correct, and complete. The nurse must also assess the comprehension of the assistive personnel. To assess their understanding the nurse should ask how they will accomplish the task and when or how the information should be reported. The nurse should also determine what the assistive personnel’s expectations are and provide any clarification, as needed. In addition, the nurse should pursue the role of teacher provide guidance and support to the assistant.

Once the nurse has delegated a task to the assistant it is then his/her responsibility to monitor their performance and ensure that it meets the standards of practice as well as policy and procedures within the facility. This is the hardest portion of delegation as a Travel Nurse. Knowing all of the different equipment as well as policies and procedures is one thing, but to know the skill level of all assistive personnel and whether or not they are compliant with policies and procedures of the facility is even more challenging. The important thing to know as a Traveler is that diligent follow up is needed. Patients should be monitored frequently, but the nurse should also follow up with the assistant to determine areas of difficulty or gaps in comprehension.

The last and perhaps the most important part of delegation is feedback. The nurse should take a moment to reflect on all delegation to determine areas of difficulty and areas of strength. This will help tremendously in continuing to delegate and adjusting overall patient care according to changes or learning needs. This step is often overlooked or forgotten, and it is crucial to for nurses to evaluate the effectiveness in their delegation skills. Evaluation leads to development and this equates to better delegation which ultimately leads to improvement in patient care!

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Clinical Corner: Emotional Intelligence

Emotional Intelligence

Emotional intelligence helps nurses deliver superior patient care.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

What comes to mind when you hear the term “emotional intelligence”? More importantly, what does emotional intelligence have to do with nursing? Emotional intelligence is an ever-evolving and changing concept, and something that’s becoming increasingly important in the realm of nursing and patient care.

Emotional intelligence is the ability to understand and manage one’s emotions as well as the emotions of others they interact with. Possessing this ability is important in nursing because it enables nurses to make better decisions, manage their patients more efficiently, and improve relationships amongst their interdisciplinary teams — and it follows that emotional intelligence consequently has a big impact on the quality of care that patients receive. Due to the influence that emotional intelligence has on patient care, it is important to understand the concept and its relevance to nursing practice.

Many arguments have been made on whether emotional intelligence is a cognitive ability or a personality trait. Some believe that emotional intelligence can be learned, and others believe that it is simply a trait that some possess and some don’t. The most likely reality is that emotional intelligence is actually a combination of ability and a personality trait. The take-away from this controversy and difference in opinion is: How can we recognize traits of emotional intelligence and how can we instill these skills in our nurses at the bedside?

Traits associated with emotional intelligence include self-awareness, self-management, social awareness, relationship management, and communication ability. Equally important to these traits is the ability to empathize with others and to motivate others and yourself. Individuals with emotional intelligence are motivated to want to try to understand their own internal emotions as well as other people’s emotions. It is reasonable to conclude from these findings and characteristics that nurses who are attentive to themselves and their own emotions and reactions tend to be nurses who possess emotional intelligence.

Implications for Patient Care

What does any of this have to do with patient care? If you think about nursing and the emotions that a nurse experiences throughout the day, you know that managing these emotions is crucial to providing the care needed for your patients.

For example, let’s say that you’re caring for a patient who is dying from diabetes. This patient is non-compliant and has been all their life. You, as the nurse, start to experience emotions in caring for this patient because your dad passed away from complications related to diabetes. Your dad, unlike your patient, was very diligent in caring for himself and he always did what he could to make sure he was as healthy as possible. For you as the nurse, this situation may expose some emotions that you didn’t know you had, like frustration, anger, or sadness. It is important to be able to recognize such emotions and to reflect on the situation so that you don’t take it out on the patient. Emotionally intelligent nurses are self-aware in that they know what they are feeling, and they know the emotion a certain situation elicits. They will be able to empathize with their patient and have the awareness to treat this patient professionally, rather than to get angry at the patient’s noncompliance.

Emotional intelligence is an up-and-coming concept that can really make an impact on patient care. Self-discovery can be a huge part of that for many nurses and healthcare professionals. It is time for the nursing profession and the healthcare industry at large to get on board and to implement this into nursing so that patient care can advance and progress in the right direction.

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Clinical Corner: Marijuana Law

Marijuana leaf and stethoscope.

Can a nurse or healthcare professional be fired for using recreational marijuana on his or her day off when recreational use is legal in that nurse’s state? The answer is yes.

By Kora Behrens, Clinical Nurse Manager, Medical Solutions

The public is becoming more supportive of marijuana law reform every day, with new polls showing that more than half of the country is in favor of legalizing marijuana. In 2012, Colorado and Washington became the first states to legalize the recreational use and sale of marijuana. Since then, 23 other states and the District of Columbia have legalized medical marijuana and supporters are commending the ability to regulate, tax, and test marijuana. Even though there’s much support for legalization, in all states where medicinal and recreational use is allowed, employers may still enforce and comply with a drug-free workplace. So, what does this mean for hospitals and other companies in states where marijuana use is legal?

Many employers are navigating how state laws affect employment and have policies stating that a positive drug screen is grounds for termination. Whether or not an employer can test employees for drugs is controversial and laws on this vary from state to state. Industries like transportation and nuclear energy are heavily regulated by the federal government and don’t give much say to the employer. Local and state governments, on the other hand, may have different regulations and leave much of the decision up to the employer. If the employer chooses to drug test employees, they must follow their state’s rules and procedures, which are intended to prevent discrimination and inaccurate collection of samples. Many states allow testing based on the following guidelines:

  1. The applicant knows that testing will be a part of the screening process.
  2. The employer has already offered the applicant the job, contingent on passing the drug test.
  3. All applicants for similar jobs are tested in the same way.
  4. The tests are administered by a state-certified lab.

Today, most companies that conduct drug testing will have their applicants submit an agreement to the testing.

As a Traveler and healthcare professional, you are agreeing to drug testing under federal law. This poses a question that many may not know the answer to: Can a nurse or healthcare professional be fired for using recreational marijuana on his or her day off when recreational use is legal in that nurse’s state? The answer is yes. It is still illegal to use marijuana under federal law even if it is legal in your state. The take-home message is that you should never want to risk your career and the federal law trumps any state laws.

Legalizing marijuana will have many ramifications in the workplace. The biggest and most influential ramification is patient safety. The best way to ensure quality care and to make sure patients are safe is to keep the workplace drug free.