EP 113: Nursing School vs Nursing

EP 113: Nursing School vs Nursing

Nursing School vs Actual Nursing

We are going to be discussing the difference between nursing school and actual nursing. Nurses always say to their students or orientees “ Nursing is a lot different than clinical.” We even say it quite often. Nursing school and nursing are 2 separate things. 

G-tubes, catheters, and IV pushes

G-tubes

Remember how we were told to check placement and patiency then flush. Our clinical testing consisted of our instructors observing us put each medication in a separate small cup,  add a little flush in between each ned. Then you let it all go in by gravity? 

There is no time for that. 

Mix the meds together, dilute with water, and push it in. Everything’s going into one place anyways: the stomach. However, remember to always check for placement. 

Foley catheters

Foley catheters can be some of the hardest things to insert. In clinical you were taught to find a landmark. Spread this labia. Locate this, half-a-finger length up, insert, and you’re golden! Smooth and easy.

It’s a bit harder than that. 

The best advice is to get some experience. Walk in with a determined attitude, get some help, put on the lights, and always bring 2 kits and extra gloves. Try to minimize distractions but there’s usually something going on. 

IV pushes

IV pushes in nursing school and clinical was a long process. You standing there in front of the patient and instructor pushing the med for 5 minutes. It’s your first time and the patient’s because no one pushes meds that slow. 

Don’t get us wrong we still push meds like Lasix slowly but not 5 min. 

Physician’s orders and patient compliance

Physician orders

As nursing students, nurses were strictly never to change or discontinue a physician’s order without express over the phone, verbally, or written consent from the doctor physician. Another one was to call and notify the doctor of the refusal of medication by the patient. 

In the real world, we do not call the doctor and say a patient refused a med unless it’s something serious like a pressor or inotrope. We use our judgment, if you aren’t sure then ask around first. 

Patient compliance

In a theoretical textbook scenario, the patient always seems to be compliant. Mr. Thomas have you been adhering to your heart-healthy diet, yes and I’ve never felt better. That’s too perfect of a world, you are going to see the frequent fliers that come for the same thing over and over again.

Double gloving and wet to dry dressing

Double gloving

We were never allowed to double glove in nursing school. If I remember it correctly we were strictly not allowed to do it and had to always re-apply new gloves.  

In the real world, some situations call for double gloving. In attempts to clean up c diff and before changing a betadine dressing are good times to double glove.

Wet to dry dressing changes

How many times did you do a sterile wet to dry dressing change at home, before lab, during class, and at your lab practical?

In the real setting, we do not do as much as the nursing school made you think you would. We have better ways to properly clean and heal a wound.

Short staffing and there’s no black and white

Short Staffing

Short staffing and nurse-to-patient ratios have never been fully enforced in the US, California comes first on the list with the best nurse-to-patient ratios. 

In the textbook world, you always have enough staff, equipment, and medication. You learn nothing about short staffing and how it will affect you physically and mentally. Due to staffing mistakes are unfortunately made. Medications are late, labs take longer than expected, and patients become agitated. It isn’t a perfect world with perfect staffing. 

Nursing isn’t black or white

Nothing in nursing is black and white–not even lab results. Everything is gray. Textbooks make it seem simple, but it isn’t. The human body and mind are very complex, nursing and medicine are too. Keep an open mind and learn to think critically. 

https://nurseslabs.com/book-nursing-vs-real-life-nursing/

http://www.kevinsreview.com/nclexblog/nursing-school-vs-real-world-nursing-6-differences/

https://www.registerednursern.com/nursing-school-vs-real-world/

EP 49: Cardiac Research and are Plant Milk Good

EP 49: Cardiac Research and are Plant Milk Good

Cardiovascular Research and Plant-Based Milk

In this episode, we are going to take a look into 2 different studies regarding the effectiveness of aspirin and the effectiveness of left atrial appendage closures. We are also going to discuss different types of plant milk and how they compare to regular cow milk.

Effectiveness of Aspirin Dosing and Cardiac Disease

There is a standard protocol if you have suffered a stroke or heart attack your doctor will most likely prescribe you a low dose of aspirin. A low dose aspirin is 81 mg but aspirin also comes in a 325 mg dose. Over the years physicians and cardiologists have looked at which dose is the most appropriate one.

A recent study came out examining the difference in outcomes between 81mg of aspirin and 325mg of aspirin. It took a look at the appropriate dose of aspirin to lower the risk of death, MI, and stroke and to minimize major bleeding in patients with atherosclerotic cardiovascular disease.

  • A total of 15,076 patients were followed for a median of 26.2 months
  • Death, hospitalization for myocardial infarction, or hospitalization for stroke occurred in 590 patients in the 81-mg group and 569 patients in the 325-mg group
  • Hospitalization for major bleeding occurred in 53 patients in the 81-mg group and 44 patients in the 325-mg group

Conclusion

  • no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily.

https://www.nejm.org/doi/full/10.1056/NEJMoa2102137

Effectiveness of Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

A left atrial appendage closure is a procedure done to close off an appendage protruding out of the left atrium. The issue with having an appendage is a risk for developing blood clots then leading to ischemic stroke, especially in people with afib.

The left atrial appendage (LAA) is derived from the left wall of the primary atrium, which forms during the fourth week of embryonic development.

Surgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons.

The primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years. The participants were followed for a mean of 3.8 years. The procedure was performed as an adjunct to primary cardiovascular surgery.

  • Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group

Conclusion

  • Among participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with concomitant left atrial appendage occlusion performed during the surgery than without it.

https://www.nejm.org/doi/full/10.1056/NEJMoa2101897

https://www.heart.org/en/health-topics/heart-attack/treatment-of-a-heart-attack/aspirin-and-heart-disease

How do Plant Milk Compare to Regular Cow Milk

The debate about which milk is healthiest has been going on for years. We know cow milk is rich in many vitamins and minerals and has been drunk for years. Plant milk has been pushed as a good substitute for people who cannot or do not want to drink regular milk. How do they compare? 

The six most popular plant-based milk based on sales data from the past year are almond, oat, soy, coconut, pea, rice and hemp milk

  • Cow’s milk 
    • Naturally rich in protein, calcium, potassium, and B vitamins, and is often fortified with vitamin A (which is naturally present in whole milk) and vitamin D.
      • Cal: 150, Protein: 7 grams, Fat: 5 grams, Carbohydrates: 8 grams.
  • Almond milk
    • One cup of the unsweetened version has just 37 calories (about a quarter the amount in whole milk) and about 96 percent less saturated fat. It is no match for cow’s milk in terms of protein, it has just about 1 gram.
    • Many brands contain additives like carrageenan to thicken and prevent separation.
    • There is some debate about whether carrageenan promotes intestinal inflammation and damage. Still, most of the research on carrageenan and gut health has been conducted in animals and labs
  • Oat milk
    • Oat milk has risen in popularity, sales are up 182% compared to last year.
    • One cup of oat milk has little saturated fat (0.5 grams) and slightly fewer calories than whole milk (120 versus 146) but has 7 grams of added sugars (plain milk has none) and only 3 grams of protein. It also has 2 grams of fiber, but that is not very much.
  • Soy milk
    • When fortified with calcium and vitamins A and D, soy milk is the only non-dairy milk that is comparable to cow’s milk in terms of nutrient balance, according to the dietary guidelines. One cup has 6 grams of protein, 105 calories, and about 89 percent less saturated fat than whole milk. It is also a natural source of potassium. 
    • There’s been some concern about the estrogen-mimicking compounds called isoflavones in soy.
  • Coconut milk
    • It’s naturally sweet and has about half as many calories as whole milk, but has little protein (0.5 grams per cup), and has 5 grams of saturated fats, about the same amount as whole milk, with no healthy unsaturated fat.
  • Pea milk
    • Pea milk is high in protein (8 grams per cup) and unsweetened versions contain about half the calories of whole milk and just half a gram of saturated fat.
  • Rice milk
    • Made from brown rice, the milk has a naturally sweet taste. It has slightly fewer calories than whole milk (115 versus 146 per cup), and no saturated fat; however it’s very low in protein (0.7 grams per cup). When compared with other plant-based milk.
    • The beverage also has fast-digesting carbohydrates, which are quickly converted into glucose.
  • Hemp milk 
    • Hemp milk is made from ground, soaked hemp seeds, which do not contain the psychoactive component of the Cannabis sativa plant.
    • The seeds are high in protein and healthy omega-3 and omega-6 unsaturated fats. Thus, hemp milk contains a slighter high amount of these nutrients than other plant milk.
      • Cal: 60 calories Protein: 3grams, Carbs: 0grams, Fat: 5grams

More research is needed on the type of milk that’s most beneficial and the effects of antibiotics and artificial hormones given to dairy cows.

It’s best to choose organic milk from cows that are free of growth hormones. Milk alternatives can also be part of a healthy, balanced diet.

https://www.healthline.com/nutrition/healthiest-milk#4.-Coconut-milk

 

EP: 112 Pros vs. Cons Working in a Teaching Hospital

EP: 112 Pros vs. Cons Working in a Teaching Hospital

In this episode, we will talk about the pros vs. cons of working in a teaching hospital. Working at a teaching hospital can be great for learning and you’ll work with new residents every other month but at times it can be frustrating as well due to the lack of experience. The residences tend to be very smart and catch on fast. 

According to the American Hospital Association, there are over 1,000 teaching hospitals that directly employ 2.7 million people and are among the largest employers in their communities.

Every state has at least one, with some states having over 50 teaching hospitals. Most teaching hospitals are non-profit. 

Academic enterprise at teaching hospitals has research centers covering cardiovascular, genetics, gene therapy, gastroenterology, neuroscience, immunology, surgery, organ transplantation, stem cells, biomedical imaging, and cancer, with clinical trials and research projects.

The Pros of Working in a Teaching Hospital

  • There is 24-hour physician coverage and support for nursing staff and patients.
  • Exposure to cutting-edge medical care with research and innovation, including new medication technology and procedures 
  • Research and development findings are commonly shared with the staff
  • Greater job satisfaction due to enhanced exposure to learning and witnessing current outcomes. 
  • Teaching hospitals are the backbone of medical services in the USA. The nation’s 1,000+ Teaching hospitals train more than 100,000 new physicians and other health professionals every year. They disproportionately deliver specialized services, complex treatments, and life-saving care – including 88% of comprehensive cancer care centers and 71% of all level-one trauma centers. This makes teaching hospitals a natural choice for physicians working in these specialized services.
  • Teaching hospital offers one other major advantage: improved career prospects. Whether through mentoring, research, published articles, or simply exposure to leading-edge treatments and technologies and high-caliber peers, working at a teaching hospital is good for your career.

https://www.myhealthtalent.com/article/the-benefits-of-working-in-a-teaching-hospital-56

The Cons of Working in a Teaching Hospital

  • MDs are on duty 24-hours a day to write and adjust orders, which requires nurses to be vigilant about initiating orders in a timely manner like that 2 am urinalysis. 
  • Patients become the teaching tool because there are always groups of residence with MDs tending to a patient. This can be tiring for the patient.
  • Sometimes “more” than less, with regard to lab tests and diagnostic studies, is ordered. This subjects some patients to unnecessary testing. A great example like replacing potassium they might replace 20 mEq/L  at a time recheck K+ and replace it again, instead of the full 40 mEq/L.
  • A new rotation of residence in clinical areas requires frequent orientation of where things are and hospital protocols. 
  • During a code, there tend to be more people than necessary. This can be overwhelming for families and even the medical staffing running the code. 
  • There is a heightened need to check the accuracy of physician’s orders due to the new waves of medical students in the clinical areas. For example, ordering 3 stool softeners all schedules instead of as needed. 
  • Staff tends to be younger and more mobile in a teaching hospital, which means turnover is tremendous. That, too, can be a plus or a minus.

The perspective is that today’s medical students are tomorrow’s doctors. Every physician has to learn clinical knowledge and facility processes. 

 

EP 48: The Gut Biome

EP 48: The Gut Biome

In this episode, we are going to talk about the importance of the gut microbiome. There is current research going on about our gut health, specifically what grows in our gut. For many years we have overlooked the importance of our gut microbiome and the negative effects of dysbiosis. The majority of our immune system is housed in our gut so it makes sense to look at the place that is introduced to foreign objects because it is responsible for the breakdown of food and anything else that enters the mouth. Our gut is what keeps us alive, the microorganisms living in you are the ones that are keeping you alive and functioning. 

The brain has a direct effect on the stomach and intestines. For example, the very thought of eating can release the stomach’s juices before food gets there. This connection goes both ways. A troubled intestine can send signals to the brain, just as a troubled brain can send signals to the gut. Therefore, a person’s stomach or intestinal distress can be the cause or the product of anxiety, stress, or depression. That’s because the brain and the gastrointestinal (GI) system are intimately connected.

Given how closely the gut and brain interact, it becomes easier to understand why you might feel nauseated before giving a presentation or feel intestinal pain during times of stress. That doesn’t mean, however, that functional gastrointestinal conditions are imagined or “all in your head.” Psychology combines with physical factors to cause pain and other bowel symptoms. Psychosocial factors influence the actual physiology of the gut, as well as symptoms. In other words, stress (or depression or other psychological factors) can affect movement and contractions of the GI tract.

https://www.health.harvard.edu/diseases-and-conditions/the-gut-brain-connection

What is the Gut Microbiome

We humans consist of 100 trillion microbes. Microbes outnumber our human cells 10 to 1. The majority of those microbes live in our gut. The microbiome consists of the genetic material from all the microbes – bacteria, fungi, protozoa, and viruses – that live on and inside the body. “The number of genes in all the microbes in a person’s microbiome is 200 times the number of genes in the human genome. 

The microbiome may weigh as much as five pounds.” The bacteria in the gut:

  • Digest our food
  • regulate our immune system
  • protect against other disease-causing organisms
  • help make vitamins like vitamin B, vitamin B12, thiamine, riboflavin, and Vitamin K. 
  • “The microbiome was not generally recognized to exist until the late 1990s.”

https://depts.washington.edu/ceeh/downloads/FF_Microbiome.pdf

Why is the Gut Microbiome Important

The microbiome is essential for human development, immunity, and nutrition. The bacteria living in and on us are not invaders but beneficial colonizers. Autoimmune diseases such as diabetes, rheumatoid arthritis, muscular dystrophy, multiple sclerosis, and fibromyalgia are associated with dysfunction in the microbiome. Disease-causing microbes accumulate over time, changing gene activity and metabolic processes and resulting in an abnormal immune response against substances and tissues normally present in the body. Autoimmune diseases appear to be passed in families not by DNA inheritance but by inheriting the family’s microbiome. 

Things you didn’t know about your gut

  1. Your genes are outnumbered
    1. The genes found in your gut microbiome outnumber your human genes 150 to 1.2 When scientists discovered that human DNA was  99.9% the same, human to human, they were a little perplexed.
    2. the dynamic gut microbiome is potentially capable of contributing to these differences. Your gut microbiome can influence gene expression and biological functions, making humans wonderfully unique.
  2. The microbiome has more biodiversity than a rainforest 
    1. When we imagine a vibrant ecosystem with many different species of plants and animals, we usually think of the Amazon rainforest. But the Amazon pales in comparison to your gut microbiota
  3. The “bad guys” that aren’t all bad 
    1. We were too quick to label certain bacteria like E. coli “bad guys.” Only to realize that we actually need them within our gut.  E. coli helps stimulate the regeneration of the gut lining, making the digestive tract healthier.
  4. Your gut microbiome is like your second brain
    1. The gut microbiome is called your second brain because it affects your mood, happiness, motivation, and even can contribute to suboptimal neurological performance later in life. Your microbes actually produce about 90% of serotonin or your “happiness neurotransmitter.”
    2. Along with what’s called the vagus nerve, the bacteria in your gut are in constant communication with your brain and influencing your behavior. It might sound hopeless knowing your gut is in control of your mind and behavior, the good news is you have a lot of influence over them through what you eat.
  5. Antibiotics create a warzone 
    1. Antibiotics are like a bomb to your microbiota and can quickly change its composition, potentially leading to dysbiosis (an imbalance in the gut microorganisms). This can have both short and long-term effects on your health since the microbiome is critical in many physiological processes, including regulation of metabolism and immunity. 
  6. Can predict if you’re overweight or lean 
    1. Looking at the composition of your gut microbiome, researchers can tell with 90% accuracy whether you’re overweight or lean. This has fascinating implications because we know that the microbiome is essential to metabolism through harvesting and storing energy.
    2. Though the connection hasn’t yet been made about whether or not certain microbes can actually make you fat, there is an interesting correlation between metabolic health and certain bacteria.
  7. It’s shrinking 
    1. As a whole, the Western world is losing diversity in its gut microbiome. Things like antibiotic use, spending all of our time indoors, and moving into the cities have contributed to this loss in biodiversity.

https://www.viome.com/blog/14-surprising-things-you-didnt-know-about-your-gut-microbiome?refcode=vpm_go&campaign=2038903639&keyword=&gclid=Cj0KCQjw4cOEBhDMARIsAA3XDRjTD1PIfX95Ve9X-uo6Q1ybUifxuTaHHqYVAmk9N0zmDrlMdEDYOtQaAlRJEALw_wcB

How The Microbiota Benefit The Body

Microbiota stimulates the immune system, breaks down potentially toxic food compounds, and synthesizes certain vitamins and amino acids. Fast digest carbohydrates such as sugar and lactose are absorbed quickly in the small intestine. Foods with higher fiber travel down to the large intestine. 

These metabolites are: 

  • Short Chain Fatty Acids (SCFA)
  • Trimethyl Amines
  • Amino acid metabolites
  • Vitamins

 

The microbiota in the large intestine help breaks down these compounds with their digestive enzymes. The fermentation of indigestible fibers and resistant starches causes the production of short-chain fatty acids (SCFA) that can be used by the body as a nutrient source but also play an important role in muscle function and possibly the prevention of chronic diseases, including certain cancers and bowel disorders. SCFAs also are speculated to play a key role in neuro-Immuno endocrine regulation, the hypothalamic-pituitary-adrenal axis. 

Clinical studies have shown that SCFA may be useful in the treatment of ulcerative colitis, Crohn’s disease, and antibiotic-associated diarrhea.

How bacteria in your gut interact with the mind and body by the AHA

Dr. Kirsten Tillisch, professor of medicine at the David Geffen School of Medicine at the University of California, Los Angeles, led a study in 2013 that was the first to show eating a bacteria-friendly, or probiotic, food – in this case, yogurt – affected regions in the brain associated with the processing of emotion and sensation in healthy women with no psychiatric symptoms. Four years later, her team linked specific gut bacterial profiles to brain differences in those regions.

Those bacteria interact with the brain and other organs in three ways. First, the gut and brain communicate by molecules carried in the blood, and microbes influence those chemical messages.

Microbes also interact with the gut’s special nervous system, called the enteric nervous system. It has a direct, two-way connection with the brain via the central nervous system.

Finally, the immune system of the gut wall and the body’s other immune components respond to gut microbes, affecting the brain and organs.

Here’s one example of how it all ties together. You might have heard of serotonin and dopamine, neurotransmitter molecules that steer mood and behavior in brain circuits. These molecules also are found in the gut. In fact, Stevens said, most of the body’s serotonin comes from the gut wall.

Gut bacteria also use them to signal the gut’s nervous system and its direct link to the brain. The bacterial messages also can prompt responses from the body’s immune system.

Summed up: “Your gut, your brain, and your immune system interact,” Stevens said. “The triangulation of those things controls much of your other physiology, whether its blood pressure, metabolism, or mood.”

https://www.heart.org/en/news/2020/05/28/how-bacteria-in-your-gut-interact-with-the-mind-and-body

Short-chain Fatty Acids (SCFAs)

The SCFAs acetate, propionate, and butyrate are the main metabolites produced in the colon by bacterial fermentation of dietary fibers and resistant starch.

The hypothesis is supported by studies in animals and humans showing that gut microbiota dysbiosis has been implicated in behavioral and neurologic pathologies, such as depression, Alzheimer’s (AD) and Parkinson’s (PD) diseases, and autism spectrum disorder (ASD).

The Microbiota-Gut-Brain Axis

The brain-to-gut signaling can directly affect the microbiota, either via the immune system or gut functions such as motility, the release of neurotransmitters, and intestinal immune tone. Bidirectional gut-brain neural relays control satiety signaling and appetite regulation. 

There is growing evidence that shows alterations in the maternal microbiome during pregnancy, such as the use of antibiotics or probiotics variations in diet, immune activation, and exposure to stress can modulate the microbiome, neurodevelopment, and behavior of offspring in both rodents and humans.

It is now widely known that peripheral insults that cause a systemic inflammatory response might affect ongoing inflammation in the CNS mainly by microglial activation (neurotransmitter inflammation), production of inflammatory molecules, as well as recruitment of immune cells into the brain. This is why shaping cerebral inflammation that may seriously affect neuronal function.

Inflammation also affects gut pathologies with increased permeability of the intestine barrier due to decreased expression of tight junction proteins. This opens the pathway to translocations of bacterial products which will cause the immune system to fight off pathogens causing the production of cytokines and impact the blood-brain barrier. 

https://pubmed.ncbi.nlm.nih.gov/26923630/

Microbiota and Neurodegenerative diseases 

Many studies talk about how the microbiota may contribute to the progression of neurodegenerative diseases and dementia. Neurodegenerative diseases such as Alzheimer’s disease, vascular dementia, Parkinson’s disease. Symptoms include a deterioration in memory, thinking, behavior, and being able to perform daily activities.  A commonality amongst dementia is chronic neuroinflammation, involving overactivation and dysregulation of microglia, immune macrophage cells of the brain. 

What is the function of the microglial cells?

Microglial cells are a specialised population of macrophages that are found in the central nervous system (CNS). They remove damaged neurons and infections and are important for maintaining the health of the CNS.

When Microglial cells are activated their morphology changes secondary to increased secretion of proinflammatory cytokine. The release of reactive oxygen and nitrogen species can lead to neuronal cell death, loss of the Blood-brain barrier (BBB), and brain damage. There are consistent findings supporting a role for the gut microbiota in the pathogenesis of neuroinflammation in this mouse model, antibiotic administration also limits β-amyloid pathology and neuroinflammation.

Blood-brain barrier (BBB)

The BBB is now considered to be part of a neurovascular unit comprising brain microvascular endothelial cells, pericytes, astrocytes, neurons, microglia, and extracellular matrix, which together contribute to regulating BBB stability and function.

The imbalance in the Neurovascular unit starts with disease states from trauma or infections which causes a disruption of endothelial tight junction leading to the translocation of blood-borne immune cells, inflammatory mediators such as cytokines, and microbes with their products that activate microglia, resulting in inflammation and ultimately cell dysfunction and death. 

Gut Microbiota Influencing brain health

The gut microbiota transforms dietary components, including macro-and micronutrients, fibers, and polyphenols, into a range of metabolites, including short-chain fatty acids, trimethylamines, amino acid derivatives, and vitamins. These microbial-derived metabolites and dietary components have essential metabolic and signaling functions which can modulate host homeostasis, including BBB integrity and brain function.

Future Areas of interest

Imagine manipulating microbes to resist disease and respond better to treatments. We are in the beginning of differentiating in the microbiome between healthy individuals and those with chronic diseases such as diabetes, gastrointestinal diseases, obesity, cancers, and cardiovascular disease.

https://www.innerbody.com/home-health-tests/microbiome-testing#:~:text=Microbiome%20tests%20attempt%20to%20detect,and%20diversity%20of%20its%20microorganisms

https://www.frontiersin.org/articles/10.3389/fendo.2020.00025/full

https://www.tandfonline.com/doi/full/10.1080/19490976.2019.1638722#:~:text=The%20absence%20of%20gut%20microbes,pathogen%20free%20(SPF)%20mice.

Viome

In the name of science, we are putting our guts to the test. We are going to do the Viome’s Health and Gut Intelligence Tests. Viome offers information relating to Health and food insights, supplement, prebiotic, & probiotic recommendations to support:

  • Gut Microbiome Health
  • Cellular Health
  • Mitochondrial Health
  • Immune System Health
  • Stress Response Health
  • Biological Age

It can give you a potential answer to these questions:

  • Does your body say you are younger or older than the age on your birth certificate?
  • Is your immune system prepared for invading bacteria or viruses?
  • How is your gut microbiome impacting your glycemic response?
  • Are you eating more protein than your body can handle?
  • Are your cells receiving enough energy to function efficiently in order to prevent accelerated aging?
  • Are your cells performing their functions efficiently or undergoing stress due to oxidative stress, inflammation, or environmental toxins?
EP 111: Nurse Liability

EP 111: Nurse Liability

In this episode, we will be talking about nurse liability. Talking about the legalities of nursing and medicine are not the most exciting things but it is something every nurse should be aware of. What exactly are nurses liable for, what is liability insurance, and should you buy liability insurance.

An analysis of 60,000 medical professional liability cases, from 2007-2016 indicated that nurses account for less than three percent of the 104,000 defendants associated with those cases.

When nurses are identified as the primarily responsible service for cases, individual nurses represent less than 15 % of defendants (regardless of the injury severity). More often than not, the liability in such cases falls on the organization where the nurses practice, or to the physicians who were also involved in the patient’s care.

Nurse Liability and Malpractice

Nursing is consistently voted the most trusted of all professions. One that involves providing medical and personal care for individuals at their most vulnerable. So, why should nurses consider carrying nursing liability insurance to protect themselves from litigation? Because we live in an increasingly litigious society. Nurses are human, and, unfortunately, they can make mistakes. 

 

What is nurse negligence?

In order to be found legally liable, it is generally necessary to show that the nurse acted negligently, or acted in the way they shouldn’t have, which can occur even when a nurse has good intentions. A nurse can be found to be negligent if these three standards are present:

  • The nurse owed a ‘duty of care’ to the patient, or was obligated to care for the patient
    • The nurse was supposed to do something and didn’t
  • The nurse ‘breached’ that duty of care, or failed to properly care for the patient
    • Did the incorrect thing
  • The breach resulted in ‘measurable damage’, injury, or harm to the patient
    • The action resulted in harm to the patient

When determining whether or not a nurse owed a ‘duty of care’, and whether or not that duty was breached, the court will consider the standard of care appropriate for a nurse with similar education, training, and experience when encountering the same or a similar situation. A nurse in her first weeks of work will not be held to the same standard as one with years of experience. Also, a nurse will not be held to the same standard of care as a surgeon who worked on the same patient.

Nursing Malpractice

Nurse liability laws also apply to malpractice, which is when a nurse fails to perform his/her medical duties, that failure harms the patient. A great example of this is private nurses performing care in a personal residence or at a nursing home. Malpractice in the form of abandonment may occur if the nurse suddenly stops providing patient care without notifying the supervising doctor or nurse. 

To prove medical malpractice, the attorney must be able to pinpoint when the medical professional chose to act against your best interests.

Common examples of malpractice in nursing

  • Failing to monitor a patient – It is your nursing duty to monitor the patient, keep track of vitals/condition and inform the attending physician of all changes. If a nurse fails to assess a patient’s condition, that can result in harm or injury.
    • Missing changes in vital signs
    • Failure to respond to a patient 
    • Not following up with a doctor when necessary
  • Errors in Medication – Nursing administration is always your responsibility. Careful also to check allergies and drug compatibility. 
    • 5 medication rights
      • Right patient
      • Right drug
      • Right dosage
      • Right route
      • Right time
  • Documentation Mistakes – Nursing responsibilities is to record accurate documentation of the patient’s condition (vitals, medication, dosage, reactions, progress)
    • Inaccurately charting
    • Using incorrect verbiage or abbreviations
    • Failing to update changes in progress

21 Century Cures ACT

As of December 2016 as a part of the 21st Century Cures Act, patients have the ability to access their clinicians’ notes from their electronic health records. This is a new form of transparency in the medical field as a move in the right direction. 

Implementing the final rule, promotes patient access to their electronic health information, supports provider needs, advances innovation, and addresses industry-wide information blocking practices.

The notes that must now be open to patients include:

  • Consultation notes.
  • Discharge and summary notes.
  • History and physical.
  • Imaging narratives.
  • Laboratory report narratives.
  • Pathology report narratives.
  • Procedure notes.
  • Progress notes.

https://www.physiciansweekly.com/mark-your-calendars-nov-2-patients-gain-access-to-clinical-notes/

Malpractice Insurance for Nurses

Malpractice insurance costs anywhere from $100 – $200 annually. There’s a range of coverage options from $500,000 per claim/$1 million aggregate to $2 million per claim/$6 million aggregate. 

https://www.nursingcenter.com/journalarticle?Article_ID=423284&Journal_ID=54030&Issue_ID=423107

https://www.rmf.harvard.edu/Clinician-Resources/Newsletter-and-Publication/2019/SPS-April-Nursing