As nurses, we have the ability to use compassion and genuinely want the best for our patients. We understand our patients and want to help them find the best treatment that will help them. There are also nurses and doctors who do not exercise cultural competence in what the patient’s beliefs and wishes are. As nurses, we have to validate our patients’ feelings of fear of not being able to provide for their families. Many hospitals have case managers who focus on the hospital losing money and allow patients to treat at their facility but if they do not have insurance, they are very quick to send them elsewhere. Many times when this happens, these case managers that are gatekeepers, are not thinking of the patient’s safety.
Social workers and nurse case managers are the peacemakers in these delicate situations, involving patient advocacy. A good nurse case manager will identify the problem right away and diffuse it so that the focus is back on the patient. Sometimes our culture in America imposes our beliefs on others thinking that they have to accept a specific method of treatment, but the reality is patients have a choice. If a choice is explained well to someone, they will make the right decision. We as healthcare providers have to explain things to the patient and family to help them understand and make an informed decision.
The skill that the staff needs to learn about caring for patients from other cultures is to remember that we as healthcare providers have to be sensitive to someone’s beliefs or culture. Just because they do things differently does not mean it is wrong, it is just different. We as healthcare providers have to be respectful (Barr & Dowding, 2012).
Cultural expectations were seen in my previous job while I was the manager of a team of nurses and social workers. There was a manager from England and then there was myself, of Hispanic background. The majority of my team was from a different culture. There was a nurse on my team who was great, but she spoke with a thick island accent, however her patients loved her. The other manager like myself was from England. During a case presentation, the other manager stated how hard it was to understand her and she should not present again. I stated that was not a fair statement because she presented cases and her skills and case were valid. The other manager did not reply to my statement verbally but she made herself known by challenging everything I said in the future. It is instances like this that discourage people from staying in jobs.
Barr, J., & Dowding, L. (2012). What makes a leader? Leadership in healthcare (2nd ed., pp. 32-44). [Vital Source Bookshelf]. http://dx.doi.org/ Retrieved from
Source: Rosie’s Nurse Corner
The ethical situation that comes to mind this week is religious ethics. This theory focuses on religion, which is depicted by the parent’s upbringing and the older family members typically. One particular faith, Jehovah’s Witness, does not allow for blood transfusions. This is very important when you have a baby in the NICU (Neonatal Intensive Care Unit) that is in need of the transfusion and the parent will not consent. The treating neonatologist will need to get a court order to do the transfusions. In an extreme emergency, if two doctors sign off that it is an emergency, then the baby will receive the transfusions while they await the court order. As a parent of a premature baby myself, I could not imagine not doing everything I could to save my child. But in this case, the religious code of ethics is based on the upbringing of the parent (Denisco & Barker, 2012).
The parent refusing to allow treatment of transfusions to their baby would be a hindrance to the baby’s care, while at the same time as nurses we are trying to promote a family-centered type of care involving the caregivers in the decision making and treatment (Meadow, Feudtner, Matheny Antommaria, Sommer, & Lantos, 2010). When my baby was in the level 3 critical NICU, they had open rooms, because the babies were too critical to be in closed rooms. I watched a baby in front of us get sicker by the day and hearing the nurses and the doctors speak about the need for a blood transfusion and other treatments. By the time they gave the baby the blood transfusion, it was too late, and the baby was terminal. You as the parent are watching and hearing this because, in this type of critical setup, there is nothing between you and the next bed except a curtain and in front of you there is not a curtain. As a nurse I thought to myself, how can they be having this discussion right in the open this way? As a parent I thought, how can these parents watch their baby die? I thought about how those nurses felt and if I were the nurse in that situation, what would I have done?
With the use of religious ethics, we may not agree with the family, but as nurses, we need to respect the other person’s customs and beliefs as long as the baby is being taken care of and there is not a medical threat to the baby’s life. When I stop and think about the nurse manager that was supposed to be the example, all we heard from her was complaints about the parents and how ignorant they were. A part of me agreed, however, the nurse part of me, the part that is compassionate with the parents dealing with a decision they probably hate to make came out. I said to the manager, we are all very much entitled to our opinions and they may not be the views of our patients, but in this crisis, we just need to support the parents because the baby will receive a transfusion whether they agree or not by court order.
Denisco, S. M., & Barker, A. M. (2012). 25. Advanced practice nursing: Evolving rules for the transformation of the profession (2nd ed., pp. 569-581). Retrieved from https://campus.capella.edu/web/library/home
Meadow, W., Feduter, C., & Matheny-Antomennaria, A. H. (2012, April 13, 2010). A premature infant with necrotizing enetrosoliteis. Special Articles-Ethics rounds. http://dx.doi.org/10.1542/peds.2010-0079
Source: Rosie’s Nurse Corner
Our technology through the years has been advancing to provide patients with nurses that can manage their care through the telephone and through field visits in their homes. With the recent pandemic that has spread throughout the globe, more than ever the field of nursing doing telehealth has become important.
Through my job as an independent nurse consultant, I am able to provide much needed and sought after medical information to my patients and their family caregivers via telephone and telehealth. In order for me to do this, I must be able to have good communication skills and if I am providing telemedicine a good eye for what may be concerning my patient. In the past few years, telehealth has grown. According to the American Academy of Ambulatory Care Nusring (AACN). “Telehealth practice originally began when registered nurses (RNs) were available to patients by telephone to ensure they had access to health care. The RNs triaged patients to appropriate levels of care. ”
Many people lately since the pandemic occurred ask me what do you do for work? My answer is, as a nurse consultant, I educate and assess my patients about their medications, symptoms, and chronic disease processes. I ensure that they are making follow up appointments with their primary care doctors or their specialist. Together we develop a plan of care that will best suit their current situation. Now I also have injured workers that are seeing their doctors and anxious to get back to work. They sometimes have chronic conditions that through my assessment they may or may not know about. These are the moments when as a nurse consultant, I can educate them, provide best practices, and refer them to their primary care doctor to get the help that they need. As for their injuries, I help them to get the right treatment ordered and coordinate their visits to another specialist that can help them when a referral is needed. My job does not end there though, coordinating light duty work for the,m with their employing agency is another aspect of what I do.
Having a telehealth nurse allows doctors the ability to follow up with patients that are not able to come to the office as frequently by carefully monitoring the medications that they are on after they are reconciled with their pharmacist. It also allows for a team approach in managing their healthcare with their caregiver and the patient to provide autonomy, a willingness to participate, and be involved in their own healthcare.
One important time that my patients benefit from is pre and post-surgery. These are scary times for patients and knowing that they have a nurse to contact them and review their instructions before surgery, plan for their needs after surgery, and contact them afterward, assures them that they can manage their needs while waiting for the follow up with their doctor.
This year with Hurricane Dorian almost hitting Florida, there was preparation to plan ahead for patients especially those that were in need of a special needs shelter due to compromised health. It takes preparation at the beginning of the hurricane season to assess all your patient’s needs and plans for disaster. I usually start this around June 1st right when hurricane season starts so that if one should happen, we are prepared with the patient’s plan of care. Once the warning is issued that we need to prepare, then I contact each one of my patients and put their emergency plan into place. I visit each patient and make certain that they are prepared. Once the danger is over, I follow up with each patient by phone and when it is safe to go out, I will visit them in their homes to ensure that they are safe.
Most all my patients receive an in-person visit from me at their home or doctor’s office but they also receive phone calls to maintain the communication lines open about their care. Usually, I have flexibility in my schedule to take time off to spend it with my husband and my son or catch up on housework to free up my weekends. However, during this pandemic of COVID-19, my short days have turned into 16 plus hour days almost 6 days a week and somedays 7 ( although I try to not let that 7th day happen). Many ask what happened to your comfortable hours? Well COVID-19 changed that !! My patients are scared, they have more questions, I have more telehealth visits at doctor’s offices with patients because I am not able to go per my contracted client accounts; it is for their protection and mine. So although tiring, I am grateful that I can still provide the care that they need through telehealth.
So today someone dropped off a sign at my door that says they are praying for healthcare heroes and first responders. I am honored to be among the professions that help support our patients at home to keep them safe during this pandemic. Every telehealth visit that I make with each patient has a COVID-19 question and answer session and they know that if they have a question, they can contact me.
So today, find a healthcare worker and honor them with a kind word of encouragement. We are here working for the health of our country.
This is the sign that was left on our front yard today( Pardon the garden we were going to start planting flowers in it until COVID-19…times are too busy for gardening)
Rosie Moore, DNP, RN
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Website: Windermere Baby and Family
Source: Rosie’s Nurse Corner
In my previous employment, I went through some challenging issues that started at the leadership level. I was a manager of case managers at the time. The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014). Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose of the change. When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases. As nurses, we are not always in our comfort zone to explain why changes need to be implemented. We should be prepared to explain why this change is needed and what improvements these changes will make.
Generally, people will always be resistant to change. But as professional nurses, our focus is to build trust and credibility. The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).
Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract. Evidenced-based nursing was in a sense required as far as the patient care when our case managers were managing a case. However on the same note, although our case managers were not performing hands-on care, they were required to know about all their diagnoses and treatments. We had social workers and nurses alike seeing the same types of members. The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise. They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems. A suggestion was made when I arrived at my workplace to utilize the social workers in conjunction with the nurses to manage the social aspects of the patients, however, the decision was denied. It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands-on care, it was case management.
There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports. It was an ideal job for someone that had an interest in the perfection of numbers and statistics. Every other day, there was a new change that was being implemented. We often questioned why there was a change, but what we were told was that the change was immediate and mandatory. For the staff case managers, these changes were difficult because the staff was in the field. They may receive an email about something that needed to be changed as soon as possible, however, they may have just returned home at 4:30 or 5pm in the afternoon looking forward to the end of their day. When the case managers check their emails, they find deadlines on multiple items due. These changes affect the staff because they have to work after hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.
As nurses or leaders, we tend to fall into the routine of lecturing due to the pressures that we are under. However, two of the six dimensions of dealing with complex dynamic changes are creativity and intuition. As a leader we should not just teach our group something, we should implement a way to bring creativity into the change and use intuition to know how to speak to our group. The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.
The leadership theory that most resembles mine is the coaching leadership style. The coaching leadership style allows me to work closely with staff at different levels and empower them to meet their goals and gain confidence in their strengths. By being confident, they can focus on themselves as they work on their weaknesses. In my previous job, the leadership style seemed like a dictatorship; however, for the purpose of the discussion here, it will be stated as coercive. My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions, 1 second wait time, no, good. It’s due by close of business.” If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager make it happen. My manager always reminded me that she did not take lunch or breaks and she had “no life!” For fun, she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).
Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home
Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home
Source: Rosie’s Nurse Corner
In the words of Florence Nightingale:
“Nursing is an art: and if it is to be made an art, it requires as exclusive a devotion, as hard a preparation as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts; I had almost said, the finest of Fine Arts.”
In today’s world, many people do not respect nurses and the work that they do. There are many types of nurses in different fields. I personally have had the privilege of working as a nurse in medical-surgical units, labor and delivery, legal nursing, home care, case management, workman’s comp, and field nursing. The experiences that I gained in working in all of these different areas of nursing make me who I am today.
Through out the past month, these same nurses that did not receive any gratitude have now started to receive recognition, some negative and some positive. Nursing as we know it has changed many lives. We have had to adapt to the way that we reach out to our patients for their protection and ours through telehealth nursing. For many patients, this has been a great thing because they can still talk with their nurse and their doctor. I see clients in their home and doctor’s offices, but during the COVID-19 shelter in, I have had to reach out by telehealth to my clients in order to continue to provide the services that they need.
Many people have been so scared that they are losing sleep and feeling stress due to not working and how are they going to pay their bills. Then there are the nurses that work frontline in the hospitals and doctor’s offices and the nurses that now have to see patients through telehealth measures. One would think that those of us that have jobs still amidst this pandemic would be grateful and kind, but instead, for some people, it is causing stress and anxiety as a result of undisclosed fear.
Fear’s acronym that has been shared is false evidence appearing real. In this case, though it is fear of the unknown. Will there be work, will I get infected? Will my family be okay? These are all questions that go through people’s minds. What can we do as nurses? Pray and ask God for that peace to be the light in the midst of darkness. Second, understand that we can’t change the world and those that are in it; but we can change the way we look at it and how we handle circumstances.
A friend paid me the greatest compliment the other day, he said “Rosie Moore you followed The Great Physician! Bringing healing and hope to those in despair. keep up the good work. There is a crown waiting for you!” So today know that every type of nurse is important whether in the frontline or via telehealth. When COVID-19 is over, never forget what our country went through and the work that nurses and other healthcare workers did.
Source: Rosie’s Nurse Corner