EP 24: News – Covid, C. Auris, US Elections, and Abortion in Poland

EP 24: News – Covid, C. Auris, US Elections, and Abortion in Poland

Covid 19 is still widespread in the world. Countries including the US are pushing for another shutdown. Candida Auris is a new emerging multidrug-resistant fungus that is becoming a problem. The US elections are at complicated crossroads. Poland has tightened their abortion laws, citizens react in protest. 

Global and US Covid Stats

Cases: 50,123,657 Deaths: 1,255,392

US: 10,166,227

Deaths: 243,186 Recovered: 6,433,976

US Case Count

  1. Texas – 1,011,237
  2. California – 967,468
  3. Florida – 837,077
  4. New York – 562,036
  5. Illinois – 477,978

Candida Auris 

10/26 case count 1,364

-NY and IL have the most

Candida Auris is an emerging fungus that presents a serious global health threat. CDC is concerned about C. Auris for three main reasons:

  • It is often multidrug-resistant, meaning that it is resistant to multiple antifungal drugs commonly used to treat Candida infections. Some strains are resistant to all three available classes of antifungals.
    • Think of MRSA – methicillin-resistant Staphylococcus Aureus 
  • It is difficult to identify with standard laboratory methods, and it can be misidentified in labs without specific technology. Misidentification may lead to inappropriate management.
  • It has caused outbreaks in healthcare settings. For this reason, it is important to quickly identify C. Auris in hospitalized patients so that healthcare facilities can take special precautions to stop its spread.

From the CDC website: “We don’t know if patients with invasive C. Auris infection are more likely to die than patients with other invasive Candida infections. Based on information from a limited number of patients, 30–60% of people with C. Auris infections have died.”

Hospital protocols for C. Auris

  1. No stethoscopes, equipment, or other items from outside rooms. 
  2. Proper PPE (gown, gloves) Can’t enter without proper PPE for a “quick IV adjustment” 
  3. Wipe down the work area with Oxivir or bleach x1 a shift. This includes IV pumps, computers, isolation cart & other services. 
  4. No C-Auris patient should be paired with post-op patients, ECMO, CRRT, or other high-risk patients
  5. Wash your hands with soap, 20-sec scrub

How is it diagnosed?

  • C. Auris infections are usually diagnosed by culture of blood or other body fluids. However, C. Auris is harder to identify from cultures than other, more common types of Candida.
  • It can be confused with other types of yeasts, particularly Candida Haemulonii.

Who is at risk?

  • People who have recently spent time in nursing homes and have lines and tubes that go into their bodies, such as breathing tubes, feeding tubes, and central venous catheters.
  • Risk factors for Candida Auris infections are generally similar to risk factors for other types of Candida infections.
    • Recent surgery
    • Diabetes
    • Broad-spectrum antibiotic and antifungal use. 
    • Infections have been found in patients of all ages, from preterm infants to the elderly.

How do we treat it?

  • Most C. Auris infections are treatable with a class of antifungal drugs called echinocandins. Some C. Auris infections have been resistant to all main classes of antifungal medications, making them more difficult to treat. 
    • In this situation, multiple classes of antifungals at high doses may be required to treat the infection.

Death rate

  • ⅓ people die due to complications caused by C. Auris
  • C. Auris infections are more likely to die than patients with other invasive Candida infections.
  • 30–60% of people with C. Auris infections have died. However, many of these people had other serious illnesses that also increased their risk of death.

How did it spread

  • CDC conducted whole-genome sequencing of C. Auris specimens from countries in the regions of eastern Asia, southern Asia, southern Africa, and South America. 
    • Whole-genome sequencing produces detailed DNA fingerprints of organisms. 
  • CDC found that isolates within each region are quite similar to one another, but are relatively different across regions. These differences suggest that C. Auris has emerged independently in multiple regions at roughly the same time.

Poland Moves to Near Abortion

    • Poland’s highest court ruled that abortions due to fetal defects are unconstitutional, moving the country towards a near-total ban on terminations and sparking angry protests in the capital Warsaw.
    • Warsaw Mayor Rafal Trzaskowski said more than 100,000 people were in attendance.
    • Police detained 37 people Friday, the vast majority of whom were football hooligans, Sylwester Marczak, spokesman for the Warsaw Police headquarter. Taking into account the huge number of participants, it was a “very peaceful” protest, he added.
  • Around 98% of abortions in Poland had been conducted as a result of fetal defects, meaning the ruling bans virtually all termination procedures taking place in the country. It could force women to carry a child even if they know the baby will not survive childbirth

 

Work Cited

  1. https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html#:~:text=auris%20first%20reported%3F-,C.,to%201996%20in%20South%20Korea
  2. https://www.cnn.com/2020/10/31/europe/poland-abortion-protests-scli-intl/index.html
  3. https://www.cnn.com/2020/10/22/europe/poland-abortion-fetal-defect-ruling-intl/index.html
  4. https://www.cdc.gov/fungal/candida-auris/candida-auris-qanda.html#:~:text=auris%20infection%20are%20more%20likely,increased%20their%20risk%20of%20death
EP 82: 5 Ways to Build Confidence as a Nurse

EP 82: 5 Ways to Build Confidence as a Nurse

How To Build Confidence as a Nurse

How to build confidence as a nurse? There are times in nursing when even the most experienced nurses are faced with a new situation, making them feel like their confidence is shaken. Nursing has those moments that make you wonder if you’re even in the right profession at all.

When you begin orientation as a new graduate nurse, you know one thing for sure: nursing school doesn’t teach you everything you need to know to be successful on the floor. 

5 Ways to Build Confidence

Confidence is a skill just like anything else, and with a little bit of practice, you can learn to generate this feeling on demand!

  • Posture and eye contact

Have you ever considered the image that you present when you’re slouched down, looking down on the ground? That posture shows defeat “I don’t know what I’m doing”

If you’re not careful, your body language may be projecting a very different image than what you intend. You are in control of [the message] you are sending out.

When standing, imagine a string pulling your head up toward the sky. Picture a straight line existing from your earlobes through your shoulders, hip, and the middle of your ankles.

Eye contact to look at a human and acknowledge them as a human, that is common courtesy. Whether it’s a handshake or asking how you are doing.

  • Don’t compare yourself to others

Nothing will take your confidence away faster than comparing yourself to others. It is so easy to get caught up in thinking about how your co-workers are sizing you up. And while you want to be part of the team and fit in, it’s so important to not let other people’s (perceived) opinions about you cause you to lose sight of why you’re really there!

The honest truth is, human beings make judgments, and typically their judgments have far less to do with what you’re doing, and more to do with themselves! Spending time trying to make other people like you (and not acting like yourself as a result) is a recipe for disaster. 

  • Expanding your knowledge

In medicine knowledge is power, when we feel like we are educated with a certain circumstance, you tend to feel more confident in your abilities. Usually, time is the greatest factor in experience and gaining confidence. You can also take additional workshops, classes, and seminars to expand your judgments. 

Education also doesn’t have to be just nursing, it can be like leadership. Being able to handle a specific situation or resolve conflict will help you stand out and get acknowledged, boosting your confidence. 

  • Asking questions

You hear us talking about this all the time but it’s that important. It even happened to be this past week having a question about the pacemaker. Avoid falling into the trap thinking you know everything. That is when you become dangerous.

It’s better to be sure than to make a mistake, especially in the life and death world of nursing. Also if you have a question there is a good chance that someone else had the same or a similar one.

  • Practicing self-compassion

Let’s say you miss an IV after two tries and spend the next few minutes (or hours) putting yourself down mentally. That negative behavior won’t serve you or your patients. 

When things don’t go the way that you want them to or you make a mistake, speak to yourself the way that you would your good friend. You wouldn’t tell them everything they should have done differently or suggested that this isn’t for them

Instead of “I’m never going to understand all of this, it’s too much information to remember. 

Try this “I am a new nurse who is learning a lot of new information, I will be patient with myself to learn. This is part of the process.” 

Also, do your best to limit your comparison only to how well you did yesterday. Imagine comparing yourself to coworkers constantly that “she passed meds faster than me every time” 

Travel nurses and confidence

Travel nurses often experience a “crisis of confidence,” especially in the early days of any new assignment. Even if they know that they have been well trained and have a wealth of experience themselves, entering a new situation, and working with a new group of colleagues presents a challenge.

There’s usually a learning curve as you get to know the personalities and politics of the department and the facility, and you might feel like everyone is watching you, the “new kid” to see what you can do — and whether you will make mistakes. While there is little besides the time that can help you get past the first day jitters, you can build your confidence as a nurse going forward, and reduce those nagging feelings of self-doubt.

Bottom line 

Even when you have been a nurse for many years, there will be situations that shake your confidence. If you stay focused on improving your skills, self-talk, ask questions, and relationships with others, you’ll gain the self-esteem you need to handle anything that comes your way.

EP 83: How to Function as a Night Shift Nurse

EP 83: How to Function as a Night Shift Nurse

Transitioning From Night Shift to Days

Have you ever wondered how it feels to work a night shift or how people transition from working nights to days? We will explain how to transition from a normal schedule to working at night. We want to help optimize your schedule, sleep, and eating so that the night shift doesn’t destroy you. 

Night Shift 

One of the most difficult careers out there is nursing. Nursing is similar to all medical careers in that it is a 24-hour job. This means there are people working all around the clock. 24-hour careers require a certain amount of people to work the night shift. 

The hardest part about working nightshift is the transition over to it. We are not nocturnal animals, we are meant to be awake during the day and asleep at night. Our circadian rhythms are programmed under the awake during the day and sleep during the night cycle. The key to being able to work the night shift is having a proper schedule during your shift and outside. The transition between nights and days is what most people seem to find the hardest. 

Here are some tips on how to have better night shift transitions.

Your Schedule

How do you like to line up your work schedule? Different nurses have different schedules when trying to work nightshift. There are only so many nights a nurse can work in a row.

  • 3 in a row: There are a lot of nurses that work 3 in a row and then are off for the next couple. This is good because you are not transitioning from night to day as often. It is hard to do because the quality of life between shifts isn’t very high. In between shifts, you won’t have much time for anything besides eating and sleeping. 
  • Every other day: There are nurses out there that enjoy working every other day. This gives you room in between shifts to recover and take care of errands. 
  • 2 on 1 off: the most common one for nurses is to work 2 shifts in a row and then their third shift another night in the week. It is hard to do 3 in a row and some nurses rather just do 2. You aren’t transitioning back and forth as much as every other and it still allows you to do stuff in between shifts. 

Your Sleep 

Your sleep-wake cycle is going to be changing a lot when working the night shift. The biggest struggle for night shift nurses is getting enough sleep and not feeling tired. 

  • Aim to get at least 8 hours of sleep.
      • Some people can function with less, if you can get away with 6 then work on 6. You need to find out what your minimum is. There is going to be a difference between how much sleep you’ll need between shifts vs your off days. 
  • Take a nap before work
      • If you are a night owl you won’t need as big of a nap prior to working. The typical morning owl working the night shift is going to most likely need a long nap. Believe it or not, there are different nap times and their benefits. 
        • Power nap: 10-20 min, energizing nap. Good for when you are feeling a little drowsy
        • Short term nap: 30-60 min. The body begins to enter deep sleep. This can help with memory but it takes about an hour to be fully alert again.
        • REM nap: 90 min, equal to about 1 sleep cycle. Shown to help with memory and learning new skills. 
      • The nap you should take depends on how you feel. A good idea is to wake up at least 2 hours before the tour shift, especially if you are taking a long nap. 
  • When to sleep
    • When you are coming off your shift and have to be up for another it is always wise to shower and go to bed. You shouldn’t be running any errands. Most of the time you will be exhausted after your shift, there’s no need to tire yourself out even more. 
      • Sometimes nurses have trouble falling asleep after a night shift, they have the energy to expel because naturally, their body is telling them to wake up because the sun is out. If you have a hard time falling asleep after you get off a night shift do something simple that can burn that energy. Going to the gym or going on a run for a few minutes helps most nurses. 
    • When you are coming off your shift and you’re off the next day there are a few options you can take. It will depend on under which one you can function best and on how many days off you have.
      • 1. Going directly to sleep: most nurses choose this route, they go to bed after their shift and wake up later on at night as if they would be going to work. They start their day off that way. The negative part is that youve slept the day away but it doesn’t mean you cant to anything else. Lots of time nurses focus on little tasks that can be done quickly or at home to be productive on their first day off. You’d be usually awake from about 7 pm until midnight or 1 am. You don’t want to stay up too late because you want to continue onto a dayshift schedule the next day. 
      • 2. Staying up all day: Some nurses choose to stay up the whole day then go to bed early. This is the hardest route to take but probably the most effective if you are trying to transition back into days quickly. Nurses that choose this route to stay up all day and then usually go to be early. 
      • 3. Staying up then napping: Another route is to stay up for a few hours take a nap and continue the rest of the day. Some nurses transition by getting off shift at 7 pm run a few errands then take a nap around noon for a few hours, wake up and continue their day. 
      • 4. Napping after the shift: A good amount of nurses also get off work take a small nap and continue their day. There are a lot of nurses that do this and it helps with transitioning to days while still being productive throughout the day.
    • Sleeping environment
      • As night shift nurses we sleep during the day. To get the quality sleep you need to sleep in a dark room. Light inhibits melatonin production and it will make it hardware for you to fall asleep.

Your Nutrition

A night shift nurse is forever a snack nurse. Nurses love to snack at nightshift. Studies have shown that a disruption in the circadian rhythm that is associated with the night shift causes us to crave calorie-dense carbs, sugary food, and salty snacks. Sometimes the thing that is making your nightshift life hard is the foods you eat. We know that high sugar and high carb foods are associated with insulin spikes leading to spikes in energy. These peaks and troughs may be putting a toll on your body.  Make sure to optimize your nutrition.

  • Eating schedule
      • When is the best time to eat? Unfortunately eating food at night is never ideal so there really is no best time on nights to eat. It will depend on your schedule. Since your body is created to be eating at night it won’t depend so much on the time that you eat but it will depend on what you eat. Make sure to always eat a meal prior to going into work, ideal 2 or 3 hours prior.
        • Intermittent fasting: intermittent fasting has been shown to have many benefits and as a nurse, you can still get away with doing it. It isn’t for everyone but it can help with your transitioning. If you work better when you have a set schedule this may be good for you but pick a time that you don’t need to flip between on your off days. For example, fasting from midnight until 4 pm may not work for you because you won’t have much time to eat at work but noon until 4 am wont work on your days off. 
        • Big meals vs small: some people prefer to have frequent smaller meals throughout their shift. This can help them stay awake as well as increase energy. The drawback is that you will need to make time for eating more often. Some nurses eat one or 2 larger meals at work. This is good because it will keep you full longer so you aren’t always picking at your food, however, most people do feel more tired after a larger meal. 
        • Always eat before work: Make sure to always eat a meal before coming to work so you aren’t hungry or thinking about food right away. 
  • What to eat
    • The first thing you need to do when you are struggling with the night shift is to cut down on the sugary snacks. They taste good and might wake you up a bit but they’ll make you more tired when you crash. Dieting is completely doable while working nights, you don’t need to sacrifice your diet but you still need to stick to it. 
    • Eat foods that make you feel fuller longer, many times these will be foods that are high in protein. 
    • There is no secret food to help you with working nightshift, you need to find what works for you. The key thing is to eat healthily. 
    • Bring healthy snacks. You will have an urge to snack, that is why it is important to bring your own healthy snacks. 
    • This goes for outside of work as well. Maintain a healthy diet in and out of work. Your body will need optimal nutrition especially when it is put in suboptimal situations like working nightshift. If you have a well-balanced eating structure your body will be better at taking on the stress associated with nightshift. 
  • Drink plenty of water
    • Dehydration will make you feel tired and depleted. Make sure you drink plenty of water and use the bathroom. 
  • Caffeine
    • Caffeine is a drug and there is a proper way to use it. You do not want to be over-caffeinated because that just leads to a giant crash. Drink coffee or an energy drink with a purpose. The onset of action for caffeine is about 1 hour and lasts about 3-4 hours. Plan drinking your coffee accordingly and at appropriate amounts. 

Recovering From Night Shift

Recovering from your nights is just as important as working. Make sure to have a routine on your off days. Get some exercise and make healthy food choices. Your body life consistency and any aspect that you are consistent with will help with working nights. Plan out days for yourself, be mindful of how much you are working and when you are burnt out. The better you are at having consistency the better outcomes you will have with working nights. 

EP 85: Travel Nursing Myths

EP 85: Travel Nursing Myths

Travel Nursing Myths

Travel nursing has been on the rise and yet there is still some negative stigma associated with it. There are many myths that are spoken about regarding travel nursing. Many nurses have different opinions about travel nursing and this is the perfect way to clear the air.

  1. Travel Nurses Qualify for Tax-Free Money if They’re 50 Miles Away

    • The 50-mile rule is that allows nurses to get tax free money on certain expenses. For a nurse to benefit from this tax credit they need to be 50+ miles away from their permanent home address. 
    • Not everything is untaxed. The IRS allows businesses to pay tax-free reimbursements for lodging and meals & incidental expenditures when the employee needs to sleep or rest to meet the demands of work while away from their tax-home.
  2. Travel Nurses Can Work At Home For A few weeks a Year To Continue Receiving Tax-Free Money

    • A common thing to hear about tax-free money is that you can continue taking travel assignments at the same hospital for as long as you want and all you have to do is return home to work a few shifts for a week or two every year.
    • There is no hard rule on this, the rule of thumb is to never work in one location for more than 12 months in any 24 month period.
    • The IRS considers your tax-home to be your main place of business. Many IRS court cases have established that if you spend the majority of your work time in one location, then your tax-home will shift to that location.
  3. Travel Nurses Make $10 an Hour

    • Why would a nurse accept a job that pays 10/hr. This is done to maximize your nontaxable benefit. 
    • The 10/hr is your taxable hourly base rate. This is the money you will be taxed on. Doing this causes the nurse to have a higher net income.
    • Travel agencies pair up a low base pay that is taxable with a higher non-taxable benefit pay. 
    • You’ll often hear that taking a really low hourly wage will “raise a red flag.” This refers to an increased chance of being audited. Even though there is no standard base rate the agency should stay within market standards to avoid an audit. 
  4. The Travel Agency Needs All of Your Paperwork Before They Can Work With You

    • This isn’t true. The agency can give you information regarding work and pay prior to you submitting more information.
    • They need a minimum amount of information to give you a rough estimate of what you can be making and where. 
    • There is a lot of paperwork and information to submit prior to accepting a contract so sometimes an agency might bait you into doing all that work to lock you in
  5. Travel Nurses Always Float

    • Usually, as a travel nurse, you will be the first to float. This is not always the case. It depends on their staffing and your contract. 
    • One contract you may float many times another you can ne strictly in your assigned unit. You can always talk to a charge nurse or a manager and arrange for you to not always be first to float.
    • You can ask your recruiter if they can add it to your contract but it is not a common clause. 
  6. Travel Nurses Only Get Paid 1.5x Their Hourly Taxable Rate

    • Only getting 1.5x your base rate of $10 or $20 is not much. 
    • The overtime law does state that an employee needs to make 1.5x their hourly taxable rate when picking up overtime. 
      • The law is not set to be standard but be the minimum amount and employee should be paid. 
    • Overtime rate will vary by agency, they can easily pay you more than 1.5x your taxable base rate. 
  7. Most Nurses Get Ripped Off

    • Essentially you are one of the products in travel nursing and just like in any sales position people will take advantage of one another. 
    • There are certainly cases where travel nurses get the short end of the bargain when it comes to paying packages. The majority of nurses a well paid and reimbursed.
    • Ripping off travel nurses would not be a good business strategy for long-term success.
    • We are bug proponent of travelers negotiating their whole contract with their agencies
Intermittent Fasting

Intermittent Fasting

INTERMITTENT FASTING

Most people have heard of the term fasting. Most will recognize fasting from Ramadan, which requires people who follow the Muslim faith to be abstinent of food and water from sunrise to sunset. Intermittent fasting is very similar. The approach is to consume no calories for 16 hours then consume your required calories within an 8-hour window. This process is repeated and done every day, 16 hours of no food consumption, and 8 hours of eating. No calories are to be consumed during the 16 hour fast. The exceptions are water, coffee, sugar-free gum, and zero-calorie sweeteners. Diet sodas have zero calories but venture away from those types of drinks.

Benefits of Intermittent Fasting


INCREASE IN METABOLISM

The way intermittent fasting indirectly boosts your metabolism is through norepinephrine. During acute starvation, short-term calorie negligence, your body increases norepinephrine levels. Norepinephrine causes an increase in the release of glucose. 

We associate a decrease in metabolism when we do not consume calories for long periods of time. When you are unable to consume calories, your body will naturally slow down and decrease its metabolism to adapt

In intermittent fasting, your metabolism does not decrease because the fasting is short term. It increases, you initially put mild stress on the body which equals a higher work demand. There is a higher work demand because now your body has to break down fat stores for energy. Before you allow your body to go into starvation mode, you flip over to eating. Once you start eating your body has a natural decrease in stress because it is now getting calories from an outside source. The body adjusts back to your baseline, slowly raising the threshold and becoming more efficient.

IMMUNE FUNCTION

One of the main ways intermittent fasting boosts your immune system is a concept called autophagy. Autophagy is the process of programmed cell death. It is also the ability to find damaged cells and destroy them. During fasting, the body is breaking down glucose, fat, and ketones for energy. On the immunological level, it is also breaking down white blood cells for resources to rebuild. White blood cells is a general term used to associate all our immune cells. Our body naturally breaks down damaged cells and uses those components to create new mature white blood cells for the future.

Intermittent fasting also decreases oxidative stress and inflammation. Long-term effects of oxidation and inflammation increase the risks of developing cancer and other chronic diseases. A decrease in chronic disease, in turn, helps decrease the workload of the immune system. Cell regeneration is escalated during intermittent fasting. While intermittent fasting the human body is always in optimal shape.

BRAIN HEALTH 

The origins of fasting came from philosophers. Their intention was to increase mental capacity and function. Those Greek thinkers found a correlation; fasting increased their cognition and provided a cleaner more efficient way of thinking. Clearly, it worked because we now refer to them as philosophers. You take the work and time needed to consume food and put that effort into brain function and mental processing. This is also aided by autophagy, except this time with brain cells. Intermittent fasting may even regenerate damaged neurons, which is what neurologists are currently researching. The same way you clean your immune system you can cleanse your brain, intern leading to increased mental acuity and cognitive ability.

Intermittent fasting can increase a hormone called BDNF. Studies show that The chemical Brain-derived neurotrophic factor (BDNF) is decreased in depression and other brain issues. An increase in BDNF can make you feel better on a neurological level. During Intermittent fasting more of the BDNF proteins are present in your brain so the likelihood of you getting depressed or even sad should decrease.

SELF CONTROL

How many times have you been hungry at an inconvenient time? You consistently put off food because you are too busy to eat. Intermittent fasting allows you to be on a schedule. You can only eat for 8 hours a day. The human body adapts to this schedule, so you are just hungry for those 8 hours. The food eaten during the 8 hour period has to be nutrient-dense, it has to provide for the whole daily value. If you consume empty calories, like processed food, junk food won’t hold you over. You will be struggling with fasting. The cravings developed will be for healthy foods because the body knows what foods provide the most nutrition. Simply, you’ll feel better because clean food will be going into a clean body.

Intermittent fasting leads to higher productivity. With intermittent fasting, you will be better at planning because you are already on a schedule. If you can mentally change your hunger and cravings, you can change any aspect of your life.

PERSONAL EXPERIENCE

I’ve been fasting on and off for the past few months. The goal is to be as adamant with intermittent fasting as possible; unfortunately, things do come up, and schedules can change relatively quickly. My 16-8 intermittent fasting is consistent for most of the month. I do notice the differences when I stray away from fasting for a few days compared to when I am persistent. I feel that intermittent fasting did indeed increase metabolism, immune function, brain health, and self-control.