For Nurses, “Just” Is A Four-Letter Word

Words are powerful, and the words we use to describe ourselves, such as “I’m JUST a nurse,” can have far-reaching effects — for others, and within our own psyches.

From Nurse Keith’s Digital Doorway

If you’re a nurse, when was the last time you said, “Oh, I’m just a nurse” or “I’m not really an expert—I’m just a nurse“? If you stop to think about it, what are you really saying when you deny your expertise? Words are powerful, and the words we use to describe ourselves can have far-reaching effects — for others, and within our own psyches.

For a number of years, I’ve used the soapbox of this blog to cajole nurses to embrace their nurse identity while also embracing their individual and collective value as skilled clinicians.

Like I’ve said before, nurses have been voted the most trusted professionals in the United States every year for good reason, and that’s because, whether we feel like experts or not, the general public views us as honest and knowledgeable professionals with whom they trust their lives—and the lives of their loved ones.

Sadly, many nurses simply don’t feel like experts, and the common use of the above-mentioned phrase — “I’m just a nurse” — demonstrates for us the fact that nurses suffer from collective low self-esteem.

While some nurses are clearly more expert than others (or more educated, experienced or specialized in their practice), every nurse is an expert in some way, shape or form. Having survived nursing school, learned how to be a nurse, developed specialized assessment skills and been issued a license to practice, you deserve to call yourself an expert.

Face it, you’re a nurse and you’re an expert when it comes to being a nurse. And in the eyes of the general public, you’re part of a special breed whom they see as either angels, saints or some other superlative creature.

Of course, your nursing career itself is a creature that will only continue to grow and evolve, and that ongoing evolution is a wonderful thing. Nurses are required to participate in continuing education in order to maintain and renew their license, but many nurses also seek out education and specialization because they’re professionals who want to always be learning something new, increasing their level of knowledge, skill and expertise—and that’s a wonderful thing.

When I coach nurses, I try to instill in my clients the undeniable fact that they are indeed experts. I also make the demand that they never again say “I’m just a nurse.” Using that small “four-letter word” — just — is an affront to who you are and what you do. In this context, “just” is a diminishing term, a word whose purpose is to relieve you of authority, intelligence, and your undeniable importance.

You are not “just” a nurse. You’re a nurse, and nurses can be described as both the lifeblood and the backbone of the entire healthcare industry. Take away nurses, and the system as a whole would cease to function.

We’re not simple handmaidens to the all-knowing physicians (like it was in the bad old days). We’re skilled in the art and science of nursing, and this art/science is made more powerful by decades of research, practice, theory, skill-building and knowledge accumulation.

You are not “just” a nurse. You are a nurse. Period. And you deserve to erase that one particular four-letter word from your nursing vocabulary.

Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century,” and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Necessity of Continuing the Advancement of Clinical Trials

Despite vast patient benefits, clinical trials have struggled to recruit their target number of participants, with many recent studies failing to reach 33 percent of their original recruitment goal.

by Jennifer Landis

Clinical trials offer patients the opportunity to contribute to the development and approval of new therapies, drugs, treatments and medical devices. This research has the potential to improve the participating patient’s quality of life. In fact, recent advancements in the health care field over the past few decades can be attributed to clinical trial testing.

The vast patient benefits of participating in clinical trials include contributing to new research, access to the latest medical developments and positive effects on patient well-being. Despite this, clinical trials have struggled to recruit their target number of participants, with many recent studies failing to reach 33 percent of their original recruitment goal.

Patients decline to participate in clinical trials due to personal inconvenience and concerns with protocol, including using treatment methods unapproved by the FDA and conflicts with the research process. The development of programs that are focused more on patients rather than on statistical outcomes could increase the success of future programs.

Program Improvements

Clinical trials aren’t without fault. Improper reporting, misinterpreted outcomes, misleading reports and lost data are several of the items that skew trial results and occasionally render them unusable. Researchers can minimize these pitfalls by paying careful attention to detail, performing objective data analysis and reporting all trial results.

To encourage additional patient participation, trial administrators can work to develop programs specific to the outcomes relevant to patients in addition to clinician-reported outcomes. In the past, outcomes important to patients, such as death or outcomes, were considered to be of little value to completed studies or not reported at all.

Patient outcomes of interest include life expectancy, how they feel and how they function on a daily basis. Studies that share these metrics, as well as the symptoms and side effects experienced by participants, will garner more interest and be of more value to individuals suffering from the disease.

For successful trials to continue, qualified patients of all ages and backgrounds need to participate. A diverse trial group stands the best chance at representing the population that will be using the tested treatment options or devices.

Reduce Failure Rates

Approximately 50 percent of Phase III clinical trials fail by not exhibiting effective treatment outcomes, having severe or unexpected side effects or by not proving to be financially beneficial. Nearly 70 percent of Phase II clinical trials fail, though this is expected as these trials are in a more preliminary stage.

Patients who participate in Phase III trials are typically in late-stage conditions. These patients may have exhausted other treatments or have limited time available to find a successful option. Failed trials put them at risk for emotional distress and decreased quality of life.

The failure rate for Phase III trials can be reduced by defining specific protocol earlier on in the testing process, before beginning Phase II trials. A clear path forward during testing will reduce the number of treatment options that move to Phase III trials. This may increase the success rate of clinical trials and increase patient interest and involvement.

Future Possibilities

Remote clinical trials offer patients and clinicians a flexible option for participating in and conducting new research. Patients living in rural communities or patients that have difficulty commuting to a research facility have the option of participating in studies that otherwise might not have been available to them. Remote trials can solve the problem of patient participation as a larger audience can be reached.

Clinicians can ensure the integrity of trials by directing patients to one central location where specific protocols can be followed. Researchers can then work together to analyze and track the patient data being provided in one area. This reduces the potential for lost data or information being left out of analysis.

New apps have been developed that enable communications between patients and physicians directly. Patients can also track and record their progress through these apps and share this information with physicians through the app. This lessens the financial burden on patients as the number of visits to the clinical trial center and travel costs are reduced.

Registered reports are a new method to ensure clinical trial information is shared regardless of the outcome. In the first stage, the clinical trial process is peer-reviewed and sent back for revisions, if necessary. Once the protocol is accepted, the journal agrees to publish the results of the study regardless of the outcomes. This removes pressure for clinicians to leave out negative results and promotes trust among participants, since reviewed and defined processes will be followed.

Clinical trials are necessary to continue to make advancements in medical treatments. Reviewed, established protocol before beginning trials can ensure a higher success rate. This, along with a more patient-centric approach and remote trial options, can increase the number of participants.

Jennifer Landis is a freelance writer and healthy living blogger. She drinks tea in excess, has a collection of peanut butters, and is a super nerd at heart. Read more from Jennifer on her blog, Mindfulness Mama.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Dave’s Blog: It’s Time For PA Practice In Puerto Rico

Puerto Rico is the last place that is part of the USA that does not allow PA practice. Why?

by Dave Mittman, PA, DFAAPA

I live in Florida but my soul is that of a New Yorker. It has been said that all New Yorkers are eventually a blend of each other. I believe that. That being said, NY is home to the largest population of people of Puerto Rican ancestry outside of the Commonwealth itself. When Hurricane Maria struck, I personally felt it. I know the people there. Obviously, my thoughts turned to healthcare and just who was going to provide it? Even the question of whether PAs could go down there to help? Let me explain…

If you don’t know, Puerto Rico has been experiencing a “brain drain” as physicians and nurses from there leave to make considerably more money on the mainland. Their economy has been hurting and the healthcare system had manpower shortages before the Hurricane. I can’t imagine that it will get better after. Imagine getting your degree, finishing residency and being able to make tens or even hundreds of thousands of dollars a year more for doing the same thing. It would be a challenge for any of us to stay. After Maria that challenge becomes something that can not be ignored.

Puerto Rico is the last place that is part of the USA that does not allow PA practice. Why? Most agree it is because of the pressure imposed by organized medicine. There are NPs there as they have legislation which is fairly new but they have problems also.

In a report issued January 2017 from the Health Policy Resource Center titled “Puerto Rico Healthcare Infrastructure Assessment”, this was said about PAs and NPs; “The health care provider shortage is exacerbated by a lack of midlevel providers like physician assistants (PAs) and nurse practitioners (NPs). PAs are not licensed to practice in Puerto Rico, and according to many respondents, physician groups have exerted ongoing pressure to maintain this arrangement. Some said that general practitioners worry about competition from PAs and the pressure this might create to further reduce reimbursement rates. By comparison, NPs face marginally better acceptance from the Puerto Rican medical community than PAs. Recently, Puerto Rico passed a law allowing NPs to practice, and several NP training institutions exist in the commonwealth. However, most graduates of these programs are either foreign students or Puerto Ricans intending to leave to practice elsewhere. Like physicians, bilingual nurses and NPs are in high demand on the US mainland and can earn significantly higher salaries there than in Puerto Rico”.

It’s time for PA legislation in Puerto Rico. It’s time to allow those that want to take some time and go down there to practice their profession the ability to do so. I know many of my PA friends over the years have wanted to, only to be told they were not wanted or needed. More than that let’s not settle for legislation that will tie our hands and not allow us to practice to the full extent of our education and clinical abilities. Let’s draft legislation for PA practice with OTP or as close to it as possible. We don’t need to hamper ourselves and this is a place that both needs and deserves PAs doing what we do best; providing medical care. Let’s look at what the NPs are trying to do and possibly work together and I hope all of us can team with the physicians there to provide the Island’s citizens with the healthcare they so desperately need.

It’s time for PA practice in Puerto Rico.

Dave Mittman has been a PA and later NP leader for thirty years. He co-founded the LIU PA Program student society, was President of the New York State Society of PAs from 1978-1979 and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981-1983. Dave was also the first USAF Reserves PA permitted to practice. Dave spent 9 years in primary care in Brooklyn, N.Y. and left to begin a career in medical publishing with Physician Assistant Journal. Dave has also won the AAPA Public Education award for leading the march in Trenton NJ to establish PA practice. Dave left PA Journal to co-found Clinicians Publishing Group (1990) and Clinician Reviews Journal in 1991. Dave has authored papers in publications as diverse as “Chicken Soup for the Expectant Mothers Soul”, “U.S. Pharmacist”, “The British Medical Journal” and others. Dave¹s paper in the BMJ was the first internationally written paper written on PA practice. Dave and a few very close PA colleagues co-founded the PAs For Tomorrow”” in 2012 which is a new national professional organization representing and advocating for PAs in an different way. Dave as spoken at hundreds of NP and PA meetings and always has some interesting thoughts on the future of both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. Dave is married to his sweetheart Bonnie for 32 years and has two wonderful children.

PAs, NPs, and Physicians Deliver Comparable Patient Care

Across the outcomes studied, results suggest that NP/PA care was largely comparable to PCP care in community health centers.

A recently published study in the journal Medical Care, researching patient care outcomes in community health centers, has found that physician assistants and nurse practitioners deliver comparable care, services, and referrals to those of primary care physicians.

Using data collected between 2006 and 2010, including the analysis of 23,704 patient visits to 1139 practitioners, researchers at The George Washington University School of Nursing found seven of the nine outcomes studied showed there was no statistically significant difference between PA/NP and PCP provided care. The two remaining outcomes studied showed that visits to PAs and NPs provided patients with more health education/counseling services than visits to physicians.

These findings should serve to reassure patients who see PAs and NPs in community health centers, the numbers of which have grown significantly due to the Affordable Care Act.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Mind Has It

Exploring the merits of cognitive-behavioral therapy techniques, namely the act of mindfulness, in your therapy practice.

from Evidence in Motion

I went to PT school way back in the Dark Ages, when everything was extremely heavily pathoanatomically based and while we talked about the biopsychosocial model, no one was particularly clear on how to implement it. However, I think most of us are well aware of the advances we have seen in pain sciences and the impact of the –psycho- piece of that, and hopefully more of us are clearer on how to implement it, at least with our patients with chronic pain. Cognitive-behavioral therapy techniques have become a huge part of my practice (which is largely patients with chronic pain, many of whom have some pelvic floor component-though not all), far more than I would have ever thought back in PT school when I was busily memorizing information about upslips, downslips, and counternutations!

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Best Ways to Survive as a Travel SLP

Are you an SLP who’s dreading traveling from building to building or house to house each day? Here are some helpful tips to survive it.

from Speech Time Fun

Now that kids have gone back to school, many SLPs find themselves split between two or even three or four buildings. Some SLPs travel from house to house if you work with early intervention. It is a very common thing. Yet, many struggle to stay organized, calm, prepared, and confident. Keep reading to see how I have survived in the past and what I would do if faced with the challenge again.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Lateral Violence in the Workplace

Lateral violence has been defined as “nurses covertly or overtly directing their dissatisfaction inward toward each other, towards themselves, and toward those less powerful than themselves,” which can take many forms.

from On the Pulse

The media often portrays the discord between physicians and nurses, but little attention is given to the issue of nurse-on-nurse discord, or lateral violence in the workplace, yet it is estimated that 46 to 100 percent of nurses’ experience lateral violence (i.e. incivility and bullying).

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nurse Be Nimble, Nurse Be Quick

The notion of pivoting in your nursing career isn’t a new one, and that readiness to pivot can emerge from a nimbleness of mind and a willingness to read the tea leaves of your career. Are you nimble?

From Nurse Keith’s Digital Doorway

The notion of pivoting in your nursing career isn’t a new one, and that readiness to pivot can emerge from a nimbleness of mind and a willingness to read the tea leaves of your career. Are you nimble?

Being nimble in terms of your career means that you’re willing to think beyond what’s right in front of you. It also means doing the work of preparing and paving the groundwork for something that you want — and if you don’t know what you want, you’re at least asking the right questions.

Many nurses appear to settle into an area of nursing, rest on their laurels, and think less of the future than perhaps they should. These nurses don’t necessarily think a great deal about what they may want in five or ten years; thus, when they’re suddenly feeling unhappy and itchy for change, there’s much more work to be done due to the years they’ve spent avoiding any forward movement or thought for the future.

In a post from 2015, I wrote:

Listen to the voices that you hear. Pay attention to the ever-evolving zeitgeist of your industry. Know what other people are thinking, and if you work in an evidence-based profession, follow the evidence when it pertains to you and your area of expertise.

The Consequences of Non-Action

In Buddhism, the concept of non-action is an important one. You know the old adage, “Don’t just sit there, do something”? Well, in certain circumstances, it’s sometimes better to turn that around, and say, “Don’t just do something, sit there.” However, when it comes to your career and its ongoing trajectory, I prefer action, even if that action is listening, thinking, and asking salient questions.

Let’s say you’re a nurse like me who worked in home health for the first decade of your career. You’ve never worked in the hospital, and while you love home health, you’ve actually been feeling called to finally take the plunge and enter the world of acute care. This may be a tough row to hoe since you’ve been in outpatient nursing for your entire career, but there’s no saying it’s not possible.

During these past ten years when you’ve been focusing exclusively on home health, you haven’t done any networking, your resume is a mess, and you have few contacts beyond your small universe of home care colleagues. All along, you’ve never considered that any of the hospital staff whom you’ve met could be helpful to your career in any way, so you haven’t connected with anyone on LinkedIn, built relationships, or otherwise laid the groundwork for the future.

In your mind, you’d like to jump right into the ICU, but common sense says that without any hospital experience since nursing school, you’re going to have to pay some dues, prove your mettle, and begin with a position in med-surg, step-down, or a sub-acute floor. Sure, you’d love to land an ICU position, but you simply don’t have the nursing skills or the connections to get you there. Your road will be challenging, but it’s not impossible — it’ll just take time, and diligent action on your part.

Reading the Inner Landscape

Being nimble of mind means being open to possibility. It also means that, in terms of your career, you’re steeped in curiosity and expansiveness, rather than wearing blinders.

As a nurse who is nimble of mind and quick to grasp opportunity, you not only read your immediate surroundings and the healthcare landscape around you; you also read the landscape within your heart and mind.

If there’s an inkling in your head or heart that what you’re doing now won’t hold water for you in a few years, now is the time to take inspired action in a new direction. That inspired action can simply be chatting with a nurse or manager who you know and trust, reaching out to a career coach for inspiration or ideas, or seeking informational interviews with professionals who are holders of information that may be helpful to you.

If you maintain awareness of how you’re feeling about your career and work life, you’re more likely to take preemptive action that will foment change, rather than being reactive when the going gets tough.

Remain Awake and Aware

We can all get sleepy and lazy at certain points in our lives. We feel comfortable, we settle into the status quo, and we conveniently forget or ignore the fact that we may want something more down the road.

You must remain awake and aware to possibility, understanding that every colleague who you meet could be a source of brilliant information that will wake you up to something new. If you’re feeling complacent in your career, there’s no time like the present to do something about it and take a forward step.

As professionals, there’s always the micro and the macro. The micro is the minutiae of the day to day, the details of our lives and work. Meanwhile, the macro is the bigger picture, the bird’s eye view, and this is where we need to keep at least a little attention. It’s easy to get caught up in the web of details, but those details can blind you to the wider career horizon.

Being nimble and quick doesn’t necessarily mean turning on a dime or being blown in some new direction with every wind that comes your way. Being nimble and quick means that you’re listening, that you’re willing to change, and that you are quick to perceive that change may be in the air.

Is your workplace unstable? Are you becoming unhappy in your role? Do you feel limited or stuck? Is there something you’ve always wanted to do as a nurse? Is your current specialty area drying up and being supplanted by new technologies or skills?

I’m glad if these questions make you uncomfortable, because a little discomfort will galvanize you towards change, if change is what is called for.

Nurse be nimble, nurse be quick. Nurse, consider your future, and keep your eyes wide open.

Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century,” and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

15 Books Every Healthcare Professional Should Read

Do you want to offer your patients better care, increase your own industry understanding, and improve your own understanding of your field? Read these 15 books.

from Physician’s Weekly

Do you want to offer your patients better care, increase your own industry understanding, and improve your own understanding of your field? Reading books is one of the best, fastest and most enjoyable ways to up your game. It’s also a great way to pass commute times on public transportation, give your eyes a screen break, and keep up with the latest industry news. Check out these books healthcare professionals should read, and don’t forget to leave your own review to help others find the best books.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

10 Stubborn Cybersecurity Myths, Busted

As common half-truths and misperceptions plague information security, we separate truth from fiction and outline steps to take in order to make your healthcare institution safer.

from HealthcareITNews

The state of healthcare cybersecurity is bad enough without a host of inaccurate information floating around the industry. Hackers honed in on healthcare’s technology weaknesses in 2016, pummeling the industry with massive spear phishing campaigns and ransomware attacks. And 2017 has been even worse.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.