Misconceptions of nursing – what are they? How can we help highlight these issues? Nursing is a profession that isn’t for everyone. But some excel greatly in this career. And while nursing is a remarkable career that provides essential services, there are still misconceptions about it. What are the misconceptions about nursing? How can we uplift nurses?
In this episode, we would like to introduce you to Theresa Brown. Theresa Brown is an author of the New York Times bestseller The Shift. She earned a Ph.D. in English from the University of Chicago and taught English before flipping her career into nursing. She now holds lectures on issues related to nursing, healthcare, and the end of life.
Her new book titled Healing is out now, where she tells a powerful story about navigating healthcare after a breast cancer diagnosis.
QUESTIONS FOR GUESTS:
The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!
What made you shift focus from academia to pursue a career in nursing? What made you choose oncology, palliative, and hospice?
During your first year as an oncology nurse you experienced a sudden death of a patient, how did that make you feel and how did you process those emotions?
Your book Critical Care is an account of your first year as a nurse, what was your biggest take away and how were you able to deal with the emotions and workload of a new nurse?
How different was the reality of nursing compared to your expectations going in?
What do you think are the most common misconceptions about nursing?
What are the struggles you’ve noticed nurses faced?
Going from nurse to patient, how was it navigating through a healthcare system that you’ve worked in?
What were your first thoughts when you were diagnosed with cancer?
How were you treated? Were physicians and other medical staff transparent and timely? Did you feel that you were getting the appropriate “help’?
Do you feel that you were left in the dark or weren’t given the full picture of your situation?
Being both a patient and a nurse, what would you like to change in healthcare or in nursing? Did healthcare fail you?
ENDING QUESTIONS:
Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody, dead or alive, who would it be & why?
You can check out Theresa’s book Healing: When a Nurse Becomes a Patient at https://www.theresabrownrn.com/. Or stay in touch with her through Twitter @TheresaBrown for more information.
To understand more about the misconceptions about nursing, check out the full episode here 👇
TIME STAMPS:
00:00 Intro 01:42 What made you shift focus from academia to pursue a career in nursing? 04:55 What made you choose oncology, palliative care, and hospice? 07:34 The biggest takeaway as an oncology nurse 11:26 The struggles of nursing school 14:25 Tips for dealing with emotions after a patient’s death 23:05 Being a cancer patient 28:12 What patients really need from nurses 32:31 Realizations to improve healthcare 36:59 What would you like to change in healthcare or in nursing? 46:34 How does it feel to be out of leadership status? 50:25 Who do you want to have one last cup of coffee with?
Working as a travel nurse is one of the most liberating areas of nursing. You can choose the areas you want to work in and even enjoy the benefits of financially lucrative travel nursing positions. If you are interested in becoming a travel nurse, get to know which areas pay the most.
Nurses can choose almost any specialty area to work in, in the travel healthcare sector. As travel nurses, you will be making more than a staff position in a position or specialty, it is wise to select from some of the highest paying nursing specialties.
1. Intensive Unite Care Nurse or ICU Nurse
One of the most in-demand areas for travel nurses belongs to the ICU. If you have experience in this department, you are in luck as many hospitals use nurses in the ICU to float around other units because of their broadened skills and knowledge, making them valuable members of the team. ICU nurses are trained to care for the critically ill and have a broad array of skills. As a travel nurse, you too can work in this area as long as you have the skills or experience as an ICU nurse. Most facilities look for at least 1-2 years of experience.
2. Labor and Delivery Nurse
Nurses who specialize in obstetrics and women’s health, especially in antepartum and postpartum care, are constantly in-demand. L&D nurses are also among the highest-paid nurses in the country, and one of the travel nursing positions with the highest pay. However, before you sign the contract, consider a few things first. While you will be taking care of healthy patients in this area, you must be ready to handle any emergencies that could occur. These may include emergency c-sections and many others. If you are up for the challenge, then this could be a fantastic opportunity for you.
3. Emergency Room or ER Nurse
Do you enjoy a fast-paced environment while working as a nurse? If you do, then working as an ER nurse is the best place for you. Many travel nurses can work in this department and earn more pay than their staff job. Keep in mind that working in the ER means you have to constantly use your critical thinking skills, so if you love the idea of solving problems, this could be the right place for you. When looking for an ER position it is always good to look at the hospital trauma level, it may be more acute than your used to.
4. Pediatric Intensive Care Unit Nurse or PICU Nurse/ Neonatal Intensive Care Unit or NICU
As a travel nurse, you will have the chance to work with some of the latest technology used in childcare with plenty of nursing opportunities in states like Texas, New York, New Jersey, California, and many others.
5. Medical-Surgical/Telemetry Nurse
The need for nurses with exceptional skills and knowledge in medical-surgical nursing is in demand these days. Since the number of Covid patients is still elevated, there is always a need for nurses in this area. Travel nurses can apply for this position and earn up to $5,000/week. If you are a nurse who can handle several patients and can manage time effectively, this could be an excellent opportunity to take.
6. Operating Room Nurse or OR Nurse
One of the most interesting areas and travel nursing positions with the highest pay belongs to the Operating Room. You will be a valuable asset to many hospitals across the country for travel nurses with perioperative skills. If you are certified at a specific OR skill or have a wide range of operating room experience, t you can snag any OR position,
In Closing
Consider also the location of the place for your travel nursing assignment. Some states pay higher than others. Now that you know which areas pay travel nurses the most, find a good agency that can get you a position in these areas. It is also an excellent option to do more research on travel nursing before asking for an assignment. That way, you know what to expect and still earn more than staff.
Start in a CVICU as a new grad? Why not! One of the exciting areas to start working as a nurse is in the Cardiac ICU. The cardiovascular Intensive Care Unit or CVICU is a hospital ward that caters to and cares for patients with ischemic heart disease and other severe heart conditions.
Patients who suffered a heart attack and need close monitoring are also placed in this unit. The same goes for patients recovering from heart surgery and with other severe conditions like cardiomyopathy, arrhythmia, heart infection, or unstable angina.
Most patients in the CVICU often have various complications such as respiratory failure and renal failure. Therefore, medical staff who work at CVICU are required to have the ability to practice systemic intensive care.
In this episode, we introduce you to one of our followers, James Hatano. James is a New grad nurse in the Cardiac ICU at a Trauma 1 hospital in Cleveland, Ohio. He is also a certified CrossFit coach and a baseball coach. Today we will talk about his new grad experience as a Cardiac ICU nurse. So if you are interested to start in a CVICU as a new grad, this episode is for you.
QUESTIONS FOR GUESTS:
The questions below are some we’d like to tackle. We go off-topic all the time so we don’t expect to hit them all. If you have any ideas please let us know. Looking forward to our conversation!
Your BSN is your second degree, you also have a degree in exercise physiology. What made you decide on exercise physiology and then what made you transition into nursing?
Are there some aspects of exercise physiology that have helped you in nursing school, being a nurse, and/or with life in general?
How did you survive nursing school? What do you think was the key? Time management, good schedule, etc…?
Was the Cardiac ICU something you wanted to get into right off the bat?
Why did you choose the Cardiac ICU? Do you fit the typical cardiac ICU stereotype? (craziest lives but neatest lines, control, OCD)
Biggest difference between nursing school and the ICU?
What’s something you wished you knew going into school?
What did you struggle with most in school? What do you struggle with most now?
Tips for nurses trying to join the ICU.
Nursing is stressful, we can agree that it is never going to change. No matter if there are appropriate ratios and great morale, working with patients that are very sick you’re always going to have that stress on your shoulders.
What do you do to help balance that stress, do you have any issue with not leaving it at work and bringing it home with you?
You’re big into fitness you’re even one of the top 50 fittest nurses in the world, how has that helped you through life?
How has fitness played a role in your life and how has it helped you with nursing?
How has your exercise changed over time?
The drive podcast by Peter Attia, what got you into it and why do you enjoy it, what do they talk about?
Chop wood, carry water book, would you recommend that book, why and/or to whom?
ENDING QUESTIONS:
Before we end the show we have one last question we like to ask all our guests. If you had the opportunity to have a Cup of coffee with anybody one last time, who would it be & why?
You can find James on Instagram @jameshatano to know more about CVICU nursing.
You can also watch the full episode here 👇
TIME STAMPS:
00:00 Intro 00:45 Episode Introduction 01:33 About the guest 03:29 James Hatano and nursing 06:46 How does nursing school impact life 09:57 Transitioning out of nursing school 12:17 Life lessons you learned from being a CVICU nurse 13:51 Struggles as a new grad 20:03 Balancing Work and Life 22:15 Managing time 25:03 Managing relationship 30:32 How is it working with a female dominant profession 33:44 What would you like to improve in the healthcare system 37:00 A thing that you always have 39:47 The person outside nursing 43:52 Personal interests 46:34 Who would you want to have the one last cup of coffee?
Full codes and partial codes cannot be avoided whenever there is an emergency. But the question is, should people have an option to be a partial code? Is there any benefit to partial codes? Many people think there should only be two options; full code or no code.
What is the code status?
Code status is used in all hospital settings. All patients admitted to a hospital or outpatient center are assigned a code status. A code status essentially means the type of emergent treatment a person would or would not want to receive if their heart or breathing were to stop.
Your chosen code status describes the type of resuscitation procedures you would like the health care team to do if your heart stopped beating and/or you stopped breathing. During this medical emergency, resuscitation procedures are provided quickly to keep you alive. This emergency procedure is commonly known as cardiopulmonary resuscitation or CPR.
In the same way, there are different treatment options and goals. The expected outcomes after cardiac or respiratory arrest differ depending on the person, the severity of illness, the cause of arrest, and other factors. It is essential to discuss code status before a crisis occurs and as a condition changes.
Outcome of Resuscitation
Cardiac arrest is when the heart stops beating. About 350,000 cases occur each year outside of a hospital, and the survival rate is less than 12 percent. CPR can double or triple the chances of survival.
Even though CPR can restart someone’s heart, it can also cause harm or even prolong the dying process. The success of resuscitative efforts is not like how it is on tv, that stats are low. In 2016, the survival rate for adults after a cardiac arrest was:
Out-of-Hospital Arrest: 12%
In-Hospital Arrest: Less than 25%
The average survival-to-discharge rate for adults who suffer in-hospital arrest is 17% to 20%.
Survival rates are lower for patients with advanced age, cancer, sepsis, renal failure, or liver failure. The survival rates for patients with a chronic illness or advanced illness average 5% and less than 1% respectively.
More than 40% of survivors are discharged with a significant decrease in their functional ability.
Different Types of Code Statuses
Just like there are different treatment modalities there are different code statuses. There isn’t only 1 route and you can choose different options, however, there is a limit on what we can and can’t do.
Full Code: We do anything and everything to try and bring you back. This includes CPR, intubation, medications, lines, and procedures.
DNR: This is a Do Not Resuscitate order. When your heart stops we will not attempt to do anything. We will let you pass without any interventions.
Partial Code: This one can be a little complicated because there a few measures you can choose to have done or choose not to have done.
Meds Only: In this situation, if your heart were to stop we would not perform CPR or intubation. What we would do is use medication to bring you back. We can push epinephrine, give bicarbonate, start levophed or other pressors to try and keep your heart beating or start it back up.
No CPR: Some patients do not want CPR performed but are open to everything else. Defibrillation, intubation, and medication are all used.
DNI – Do not intubate. There are patients that want everything to be done but not get a breathing tube placed
What is the Ethics of Partial Codes?
The main objection to partial code orders is that they are ineffective in sustaining life and can potentially deceive the patient and/or patient’s family into believing that resuscitation is possible when, in fact, the patient’s death is imminent.
The concept is that you need hands on the chest to resuscitate someone. Once a heart stops beating there is no more circulation so there is no oxygen being fed into the tissue. Every second cell dies without any pressure from the heartbeat.
People always want to make exceptions for everything. But when it comes to life it’s either you’re 2 feet in or 2 feet out. Is there such a thing as partial living? Then why should there be partial codes? Why should we hold back or delay treatment if the person/family is set on them surviving? Why not give them a full opportunity?
Many people would agree that there should only be 2 options;
Full code as in to do everything
No code as in does nothing but comfort.
It’s either we try to keep them alive or not. Why do people persistently make partial codes as in they want to “maybe” live?
Why partial codes?
Many people don’t understand the reasoning behind a partial code. Let’s think about it.
If you have ever seen a code blue with good chest compressions it is not a pleasant thing to witness. A lot of times a guy pushes on someone’s chest very hard and most of those times it leads to the sternum and other bones being broken.
We can understand how enduring it is for the family to see. They see their loved ones and want them to at least have some chance. But partial codes give the lowest chance.
Maybe there should be orders that state can intubate for respiratory distress but now when a pulse is lost. But then what if the pt loses a pulse during intubation.
How much time do we have until brain damage?
When cardiac arrest occurs, cardiopulmonary resuscitation (CPR) must be started within two minutes. After three minutes, global cerebral ischemia, the lack of blood flow to the entire brain, can lead to brain injury that gets progressively worse.
By nine minutes, severe and permanent brain damage is likely. After 10 minutes, the chances of survival are low.
Even if a person is resuscitated, eight out of every 10 will be in a coma and sustain some level of brain damage. Simply put, the longer the brain is deprived of oxygen, the worse the damage will be.
TIME STAMPS:
00:00 intro 00:51 Plugs 01:23 Episode Introduction 02:37 What happens in a code status 05:25 A very slim chance of surviving a cardiac arrest 07:25 What is a code status? 09:16 Full Code, No Code, Partial Code 11:58 Family members are not educated well with code status 14:45 Partial Code rarely or does not work at all 17:45 Sad situation of a full code patient 20:12 How much time do we have until brain damage? 21:53 Call for physicians to step up and decide code status in real-time 25:12 Improvements that can be done 27:25 Patient’s family are very reliant on healthcare providers 30:27 Getting clear on what code to choose
Improving Patient Communication with Jennifer George
Improving patient communication is an effective way to provide patient care. Without proper communication, it is easy to miss out on your patient’s needs. But how can you become effective in this situation? Will this help lessen the stress nurses feel?
In this episode, we will talk about effective communication and how nurses can improve the way they speak to their patients to get the message out. We also welcome our guest, Jennifer George. She is a compassion-focused physiotherapist with vast experience in the private and public care sectors.
Jennifer has spent the last 14 years learning and reflecting on the importance of communication in our health and education systems.
She is also a mentor to future and current health providers on discovering their purpose, achieving fulfillment, and creating empowering patient experiences. Author of her book, Communication is Care: 9 Empowering Strategies to Guide Patient Healing.
QUESTIONS FOR GUESTS
As a physiotherapist, what do you do, and what are some significant takeaways or life lessons from your career?
Work on inputs rehab currently
Patients need a team of professionals; physical therapy is only one piece of a much bigger picture in the healing process
Helped me to recognize the whole person
How was your role as a caregiver for your father shape your personal experience of healthcare and later your professional career?
The power of communication and connection on healing – feeling disempowered, unheard, rushed, at times – good: learned to empathize and be an advocate for patients and families
When did you realize how important communication was and its importance in healthcare?
After the first two years of my practice – I learned to better connect with patients before conditions and diagnoses and look at the bigger picture of their life and the impact of pain and suffering
Then after my dad died, it was like I became super conscious of the fact that my life as a caregiver/daughter shaped my professional interactions
Is there a difference between communicating in social engagements vs. communicating with patients? How should this differ?
How can you keep a professional yet personal communication style with patients?
Is there such thing as communication burnout? I talk to my patients and many other people in/outside of work. Sometimes that gets tiring, and I need a day to myself and silence.
Where do you think misunderstandings arise from? When there is a break in communication, it causes misunderstandings.
How/when does communication fail? What goes wrong?
When speaking to patients, what do they mainly seek to learn? Or how can you pick up on what they are looking for? Does it vary between situations?
Learn how you can communicate more effectively with your patients by watching the full episode here 👇
TIME STAMPS:
00:00 Intro 02:37 Episode Introduction 04:08 The feeling of seeing your patient progress 06:00 The importance of communication in improving patient care 09:54 Building rapport with your patient 12:12 What are the barriers that affect communication with patients 15:06 How to be true to your patient’s care 17:36 How to start a conversation with a patient 19:43 Gauging patient for a good conversation 24:42 How to solve miscommunication 28:39 Guiding and educating patients to empower themselves again 33:35 The importance of Interprofessional Communication 35:41 The inspiration of how the book came up. 39:20 Caretakers aren’t taken care of 46:26 Patient safety as the main goal 49:33 Healthcare’s reactive approach to solving the problem 57:08 Wrapping up the episode
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