Clarian Nursing

Marker Days

Monday, August 23, 2010 by Sherry Holden, BSN, RN, Associate Partner

This has been a very good week at Outpatient Transfusion - if one uses the threefold criteria of “difference, learn and fun” as the yardstick. Actually, I think it has been a smashing success, because I believe in some unique way we are making a difference, probably leaning more than my brain can contain, and we certainly are having fun. Nonetheless, as I reflect on the events of the week, my mind has been on 4-S at IU.

Five years ago, I was diagnosed with lung cancer. I have had many interesting twists and turns since then and many “marker days” that vividly invade my mind unannounced. This week I visited my oncologist and he kicked me out of his program: a command to go out and embrace life cancer free! Victory! As I walked out of his office I wanted to shout, dance…do something crazy. It was obviously not the place to celebrate. Many people surrounded me who remain in the throws of the battle, without reason for joy. My prayer was that they still maintain hope.

So, what did I do? I went to 4-S! Some people might say, “I’m going to Disney World”! Not me. I went to 4-S and hugged some very special people. Sorry, Mickey, they have a bit more pizzazz than you do. I carefully and purposely engulfed myself in the moment because I know the people on that unit five years ago were part of my healing process. They willed me to live. I have a big lump in my throat right this moment recalling the extraordinary things people did for me. I’ve attempted to express my gratitude over the years but there are some things that cannot be expressed with words or deeds. Those things just continue to consume me with what is good and right in life. If you will, ponder kindness.

In reality, what constitutes a “unit?" In whatever context you use the term, measure comes to mind; and, beyond that, value. When I think about a unit in the hospital, I wonder how one might measure its value. I firmly believe the answer is, “by its people.” Each unit has its own heartbeat, powered by individuals. When those individuals care for one another, they are able to provide care to others. I have been very fortunate to have known “care” from both sides of 4-S. Priceless!

How do you measure the value of your “unit” at Clarian? Do you care enough to care?

Sherry

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

There’s No Charge to Check Ethics Baggage

Tuesday, August 17, 2010 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist

I am an ethics geek. I believe consulting with someone who is an expert in identifying ethical issues in complex patient situations and who has negotiation skills helps patients and helps the people who care for patients. So why is it so hard for people to ask for help in ethically challenging situations?

“Ethics” comes with baggage. In the old days, people would call ethics when someone was behaving badly. Physicians in particular were naturally defensive when they would hear “We’ve called ethics” because that translated into “You are behaving badly” or worse “You are unethical.”

Ethics is personal and when someone says, “We need help from ethics” it feels like hearing someone say, “Your morals are not good enough!” Ethics may be personal, but ethics consultation is professional. So how does one overcome this attitude on top of so much baggage from the past?

At Clarian, we’ve adopted a policy for ethics consultation. It describes what an ethics consultation is, namely a service meant to help patients, families and health care providers address ethical dilemmas. The goal of an ethics consultation is to promote and support sound ethical reasoning and thoughtful problem-solving in clinical practice.

Perhaps the most significant challenge to requesting an ethics consultation is the fear that asking for help will get someone in trouble. Intimidation and or reprisals (retaliation) for seeking help are inconsistent with Clarian’s core value of a community of trust and respect. Retaliation comes in many forms: cold shoulder, questioning judgment, changing an assignment, even yelling at someone. None of these responses, from anyone, is appropriate when an ethics consultation has been requested.

Clarian has an open access ethics consultation policy, meaning anyone involved in the care of a patient may request assistance from ethics. It takes a great deal of courage to seek help in a situation where you feel more than one choice may be right, and it is unclear what is best for a patient.

Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

ACRONYMIZED

Friday, August 13, 2010 by Sherry Holden, BSN, RN, Associate Partner

I am now an RN BSN AP who works for the OPBB which is a part of the DPLM-CH. Consequently, as part of my orientation, I have been reading a whole new set of manuals. Yesterday, I was in the P&P section of the online LAM, reading CC 11,016, which addresses the billing requirements of the CMS, formerly the HCFA, which is a division of HHS. It deals with ABN’s, ICD-9-CM’s, LMRP’s and NCD’s. It took me a bit of time to grasp all of this. Ultimately, I even found some things beneficial.

I have also made a trip to the CPL. I found that very fascinating and wish I would have had that opportunity before I transfused any blood components as a staff nurse. Now, I notice the CPL has made a few revisions that took effect August 9. I am totally discombobulated that WBC will now be known as TNC! HELP! Yes, I really mean HELP! That is about as monumental as changing cc to ml!

In the course of my day, I often travel to these places: BB, SPD, HIM, SIM, PSR, CD, and, of course SP&D where I get a marvelous CCC! Should you come to visit, K. & I are located at MH, GL, at the OPTR, which is just past POCT. If you reach IDTU, you missed us.

I have a concern that the time will come when none of us will be able to speak, write, spell or understand the King’s English. We will exist in a world of acronyms without understanding one another. Mental gridlock. It is no wonder the JACHO, ISBH & HIPPA, to mention a few, list communication as the number one issue on their radar.

Perhaps, those of you who TT&T have no problem being acronymized. Am I TOOOILF? RUOKWT? LMK.

Sherry

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Hot Topics

Friday, August 6, 2010 by Gwenn Christianson, MSN, RN, CSPI

Whew, it’s another scorcher - hot enough to make your ears sizzle! Makes you break out into a sweat just thinkin’ about it! Am I talking about the weather? Well, I could be, especially with our unseasonal heat wave the past few weeks, but actually I’m not. What I’m really talking about is the Capsicum species, otherwise known as hot peppers!

Hot peppers, jalapeno peppers, habanera peppers, chili peppers – they’re a staple of Poison Center calls this time of year. The species grows well in Indiana and when they ripen and have to be prepared for storage, exposures (and calls to the Poison Center) sky rocket. That capsicum juice is HOT! When you get it on your skin, it burns - and without treatment, keeps on burning for 6 to 8 hours or longer. That can result in a pretty miserable afternoon or evening for the unlucky victim.

So, what should you do? First, repeat after me, “ALWAYS wear rubber gloves when working with hot peppers”. If you prevent the exposure, you’ll never have the sad experience of searching for relief from the burning pain of pepper juice.

What if it’s too late? What if you’ve already let the fierce pepper juice come into contact with your hands and arms, and now you are very, very sorry? The following tips and tricks should help you out!

First, you need to flush the exposed skin with comfortable temperature running water for 30 minutes. Lather well with a mild soap several times. Rinse with alcohol (rubbing alcohol or beer work well), to cut the oil, several times, and then go back to using water.
Once the flushing is done, the pain may be gone. If so, hurray! Make sure to change your clothes and launder them several times before you wear them again. And, from now on, ALWAYS wear rubber gloves when working with hot peppers!
If the pain continues, proceed to Step 2. You’ll need to apply zinc or magnesium based ointment or liquid to your skin. You can soak your hands and arms in an antacid like Mylanta® or Maalox®, or you can apply a zinc oxide ointment such as Desitin® diaper rash ointment to your skin, and then wear something such as white cotton socks over your arms. You should have significant relief within an hour or so. Re-apply the topical product as needed, until the pain is completely gone.
And finally, ALWAYS wear rubber gloves when working with hot peppers!

Keep in mind that you can call the Indiana Poison Center at 1-800-222-1222 any time for help with this and any other dermal, ocular, inhalational or oral poison exposure.

Gwenn

Gwenn Christianson, MSN, RN, CSPI
Senior Partner and Team Leader
Indiana Poison Center, Methodist Hospital

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

In-Side-Out and Up-Side-Down

Monday, July 26, 2010 by Sherry Holden, BSN, RN, Associate Partner

It has been just about a month since I last made an entry and announced that I was making a major move. I’m in the process of settling-in: not settled. I have learned a lot about myself in this process, and bits and pieces about a whole lot of other “things.” For instance, there are “things” in life that are pretty absolute. “Things” that don’t co-exist: night and day, up and down, in and out, front and back, life and death... Play with that for awhile and you will realize that you cannot mix and match, you must choose. So, here is my new dilemma: IN-patient and OUT-patient! Hello brain-freeze! Hello melt-down! Hello, Alice! Am I in-side-out or up-side-down? And, where is that Walrus when you need to “talk of many things!”

Comfort zones are wonderful places. That zone might exist in the midst of chaos but it is what one knows and it is OK. Somehow you make it work almost to the point of discomfort. Since man landed on the moon, I have been an IN-patient, multi-specialties nurse except for a clinic stint somewhere in the 70’s. When I abruptly moved, I went all OUT and entered the OUT-patient zone: initially, a new type of chaos for me. I think after comparing IN and OUT to the point of driving my preceptor totally daft, we have settled on this as the trigger point: “Dorothy, you are not in Kansas anymore!”

In reality, this has been a whirlwind month. I have been challenged. I am learning something new every day. (A word to new grads: We survive! We are resilient.) I am having fun. I enjoy the people I have met and I have embraced a wonderful new patient population. Synergy is alive and well on my radar. Out-patient Synergy! WOW! And, I used to think I knew something about blood... merely a drop in the bucket! It is exciting OUT here. The challenge for me is that I’m not IN there.

So, I have moved my cheese. Literally. During this change, I decided I would try new cheese with my new move. I have discovered a magnificent stout Stilton-blue from Britain and a fabulous slice of nursing in a remote corner of the basement in Methodist Hospital.

Sherry

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Teamwork Promotes Safe and Ethical Behavior

Saturday, July 17, 2010 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist

When was the last time you tried to name Disney’s Seven Dwarfs? (Doc, Grumpy, Dopey, Sneezy, Sleepy, Bashful and Happy.) It’s a safe bet the Seven Dwarfs knew each other’s names, and Snow White learned them pretty quickly. The dwarfs had to rely on each other, and Snow White had to rely on them. They were, in essence, a team, in part because of established obligations of fidelity.

Like the fictional world of Disney, our very real world of health care involves obligations of fidelity. These obligations arise whenever a health care professional establishes a significant relationship with someone else, usually a patient. Fidelity establishes a commitment to another person, a promise to be faithful and loyal. Obviously we need to establish this relationship with patients, but what about establishing one with our teammates?

We all know that our teams look different this time of year. July is a difficult time. The hospital is flooded with new interns and residents typically just after an influx of newly graduated nurses. We haven’t had a chance to get to know each other or establish relationships. A recent study reviewed deaths from medication errors and found a 10 percent spike in these events in teaching hospitals in July. The authors of the study hypothesized that part of the explanation for this was that medical residents operate more independently than on a team.

Anyone who has ever been involved in a medication error knows that an entire team is involved in the administration of medication, not just the physician. An intervention to improve patient safety offers a simple, reasonable opportunity for us to address the “July effect.” It’s called the activation phenomenon.

Better teamwork is observed when people on a team take the time to introduce themselves to each other. When people know the names of others on the team, they are more likely to speak up if they see a problem.

Take the time to establish a relationship with members of your new team. Introduce yourself and make sure your teammates know you are committed not just to patients, but also to the success of the team. Formally establishing fiduciary relationships with each other in support of safe, quality patient care promotes ethical practice.

Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

The Walrus Said

Monday, June 28, 2010 by Sherry Holden, BSN, RN, Associate Partner

Regardless of the “sense and non-sense” and endless interpretation of Lewis Carroll’s writings, I have always enjoyed a certain segment of the poem The Walrus and the Carpenter which is tucked away somewhere in the adventures of Alice Through The Looking Glass. The poem has been around since the 1870’s and I learned it from my grandmother and passed it on to my children. My grandchildren will not be spared. I have not done any great in-depth analysis of the poem, as many have, but often repeat these lines:
   The time has come, the Walrus said,
   To talk of many things:
   Of shoes..and ships..and sealing wax..
   Of cabbages and kings..
   And why the sea is boiling hot
   And whether pigs have wings.

We could have a great talk about sealing-wax. In my mind, I would love to see it make a comeback. However, the time has come to talk of many other things:
   Of early mornings that become endless days..
   Hallways that are racetracks..
   Opportunities, timing, choices.
   Bundles and sets
   Of Policies, Protocols, Politics & Patient Care
   Fear of falling; Fear of not falling; Fear of Failing; Fear of Succeeding; Fear of You
   Anagrams: ITYK
   Input, output, opinions, ideas, place
   Of crossroads, decisions, direction, self-evaluation
Oh, we could talk of many things! But, someone has to listen! Is that me or you?

And, we could talk of life. Of times when roads diverge and we are compelled to stop
and carefully analyze the complex maze of direction choices on the map before us. And, we could talk about what Alice really saw in the Looking Glass! Well, this is what I see: the cheese is moving, pigs are flying, the oysters are dead and after 17 years on 4-medicine, I’m moving to the Mother Ship. Why? Because the Walrus said, “The time has come”!

What is in your Looking Glass?

Sherry

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.

Perpetual Students

Thursday, June 24, 2010 by Gwenn Christianson, MSN, RN, CSPI

The first week in May is the week of the American Association of Poison Control Center’s national examination for Certified Specialists in Poison Information. As employees of Indiana Poison Center, passing this examination is central to our continued careers – we all must be certified to work at the Center. Certification involves passing the exam the initial time and then re-certifying every 7 years.

Four of my colleagues are taking the exam this year, 2 re-certifying and 2 certifying for the first time. Naturally the anxiety level around the center has been high. People are constantly quizzing each other, researching answers on-line, even digging out textbooks to confirm their conclusions.

While I appreciate the natural nervousness that comes with taking exams, especially exams upon which one’s job is dependent, I am always glad to see exam time come around each year. It does wonders for the level of intellectual stimulation in the center! Instead of approaching days as routine, RNs are starting each day looking for new and different things “that might be on the test.” “Old” topics are reviewed and novel themes are discovered. Fresh approaches to known subjects are suddenly found, resulting in new knowledge.

It would be delightful if we could each find it within ourselves to keep that “study” mindset available year round. If we were always open and ready to learn, actively seeking knowledge, not just waiting for it to be fed to us, think what a difference it would make in our careers and our enjoyment of them!

Gwenn

Gwenn Christianson, MSN, RN, CSPI
Senior Partner and Team Leader
Indiana Poison Center, Methodist Hospital

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

No One Likes to Make Mistakes, but Owning Them Means You Have Integrity

Wednesday, June 16, 2010 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist

In ethics, some concepts and themes repeat themselves over and over again: truth telling, trustworthiness, integrity to name a few. Maybe the reason for the repeat performances is because although the concepts are not hard to understand, sometimes they are hard to apply.

I can remember making a big mistake as a child and being faced with the choice to tell my parents and suffer the consequences, ignore it, cover it up or try to pin it on someone else (usually one of my siblings).

The worst part was knowing deep down inside that I had to tell someone what I had done. It always takes courage to admit a mistake, but being accountable for my actions means I have integrity. People can count on me to do the right thing even when it is hard.

Integrity has to be nurtured when you work in a field like health care where the stakes are high. Who in their right mind wants to relive the feeling of having to tell their parents they made a mistake, especially if the mistake caused harm to someone else?!

We have a code of ethics to remind us, even when it is hard, that we have made a promise to the people in our care that we will try to do the right thing. We will be answerable and responsible for our actions.

Our Culture of Safety survey results suggest that individuals experience apprehension when faced with reporting errors or concerns, yet to maintain a “Just Culture,” apprehension or not, we are obliged to come forward.

Mnemonics are popular because they can help remind people what to do in situations where stress may cloud judgment. Sometimes we all need a little Cultivation of our Professional Responsibility, CPR.

A colleague of mine created something that might help you the next time you have to tell a difficult truth. Remember the CODE: Courage to be moral, Obligations to honor, Danger to manage and Expression and actions. The space between knowing what is the right thing to do and acting is bridged by courage.

Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

A Compliment in Disguise

Friday, May 28, 2010 by Lucia D. Wocial, PhD, RN, CCNS, Clarian Nurse Ethicist

Skilled communication demonstrates authentic leadership; respect for others.

A colleague recently paid me a huge compliment. She was direct, professional and clear. We had a conversation and she was trying to tell me some important information, but she told me that I had cut her off. How in the world is this sort of feedback a compliment?

My colleague was demonstrating behavior consistent with an organizational culture that fosters respect for individuals. She demonstrated skilled communication when it was difficult and by doing so, showed what authentic leadership is all about (AACN Standard for a Healthy Work Environment). She maintained a duty to herself by keeping her dignity intact and letting me know that my actions were not respectful (ANA Code of Ethics). She focused on the professional and did not make it personal.

She believed enough in an ethical climate at work – one that respects open honest communication – that she took a chance and called me on my behavior. To me, this feedback is an enormous compliment. My colleague trusted me and valued my role on the team enough to give me feedback that could help me in the future.

At the time of our conversation, I thought I was skillfully keeping her focused, but I was wrong. I didn’t mean to be, but clearly I was rude. Thankfully she had enough courage to help me see what I had done.

May is a busy time at Clarian. We are preparing for a large influx of newly graduating nurses. My recent experience made me think about what impact each of us will have on our new colleagues.

Will we embrace them and be intentional about our healthy work environment? Can we count on each other to be accountable when our behavior is not consistent with an ethical climate at work? I for one am grateful to colleagues who believe enough in me to give me opportunities to grow.

Lucia D. Wocial, PhD, RN
Clarian Health Nurse Ethicist

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

Where Are You From?

Monday, May 24, 2010 by Sherry Holden, BSN, RN, Associate Partner

IU 4-Medicine is an eclectic mix of humanity: both patients and staff. A few days ago, I was prompted to think about our diversity based on a conversation I had with an elderly patient. He was 76 years old and hospitalized for diagnostic studies. I asked him where he was from and he replied, “Tennessee” and then proceeded to tell me the name of a very small town he was sure I wouldn’t remember. He was right, I don’t! Then I asked, “How did you get to IU from Tennessee?” He replied, “I have LIVED in Indianapolis for 68 years. You asked me where I was FROM!” Point taken. There is a distinct difference between where we are from and where we live.

Since I have been transplanted many times, I have always been curious to know where people are from. Over the years, I have learned a lot about the people, cities, towns, and states where I have lived from patients and staff. Once a man responded to that query by saying, “Well, I am Kentucky breed and Indiana feed!” One of my favorite encounters occurred several years ago at IU when I asked an intern, Dr. Khan, where he was from. His reply, “Where do you think I am from?” My response: “Some place very far East of here.” To my surprise, and his great pleasure, he replied, “Mongolia!” Without hesitation, I told him we were probably related. Then I gave him a great explanation of the westward migration of Mongolians centuries ago. Many of them went to the area of the Ukraine where my mother’s family lived. Consequently, it was very probable we had family ties. Naturally, he thought I was very strange. Thereafter, whenever he came to the unit, I referred to him as “Cousin Kahn” and he always smiled in disbelief. I’d like to think that he has told this story over time from his angle - still smiling in disbelief.

So, where are you from? I posed this question to some of my colleagues and got these responses: Indianapolis, Gary, Avon, Hope, South Bend, Linton, Evansville, Terre Haute and C-ville. (You have to be an insider to know that Indiana town.) Chicago, IL; Bettendorf, IA; Lagos, Nigeria; Manila, Philippines; Cincinnati, OH; Milwaukee, WI; Kampala, Uganda; Bangkok, Thailand; Kansas City, KS; Hastings, MN; San Paulo, Brazil; Addis Abba, Ethiopia; and I am from Valley City, ND - some people consider that a foreign country with its own language! Really, no passport needed. Finally, one nurse admitted being from “Heaven.” I suspect she is one person who really can go home again!

Our journeys have brought us to this place from the North, South, East, and West. We all have stories to tell of the roads we have traveled. My curiosity wonders why we are all here at this place and time - individually and collectively? As a staff, we exist only for a brief period of time. This month, some people are going and new people will come. Soon we will be a different mix and our identity will change. Who are we, and where are we going?

In the scheme if it all, my great hope is that we do not miss one another along the way.

Sherry

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Racing for Poisons

Friday, May 14, 2010 by Gwenn Christianson, MSN, RN, CSPI

What does May in Indiana mean? The Indianapolis 500 race of course! Racing cars are on everyone’s minds, as we keep a close eye and ear on the results of Poles and Bumps and the Race itself. Races are fun to watch and of course cars are essential for most of us for transportation. At the same time, cars are also a source of toxins that can wreak havoc upon the individual who encounters them.

Starting with their fuel, cars are filled with fluids that can harm you. Gasoline is a hydrocarbon, which if swallowed and aspirated, can result in hydrocarbon pneumonitis. The end result can be devastating or even fatal. How might someone swallow gasoline?

Usually people do this when they are siphoning fuel from one vehicle to another. The moral of this is to never siphon orally! Motor oil and transmission fluid are also hydrocarbons, but because they are so much thicker than gasoline, they are much harder to aspirate, so are less likely to be a problem.

Other automotive fluids that are poisonous are radiator and windshield washer antifreezes. Radiator antifreeze contains ethylene glycol, while windshield washer antifreeze contains methanol. Both are extremely toxic in extremely small (teaspoons) amounts. Ethylene glycol can cause kidney failure, while methanol can cause blindness, and both can cause death, if very much is ingested. Brake fluid is similar to the antifreezes in toxicity.

How do people accidentally swallow these fluids? The most common error they make is to drain the fluid into a handy pop can or cup, which they then mistake for the can or cup that contains their drink. They take a big swig from it and unfortunately, one swig is enough to be a problem. Young children see the can sitting there and sip from it too – and can also wind up with serious problems.

Fortunately most hydrocarbon exposures don’t end up as aspiration pneumonitis and we have very effective treatments for both methanol and ethylene glycol exposures. Still, the best treatment for any exposure is Prevention. Don’t siphon gasoline or any automotive fluids. Drain automotive fluids into clearly marked waste containers and never use beverage containers for drainage purposes.

Enjoy May and Race Fans……. start your engines!

Gwenn

Gwenn Christianson, MSN, RN, CSPI
Senior Partner and Team Leader
Indiana Poison Center, Methodist Hospital

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Celebrating Nurses Week: Making it Creative and Meaningful

Saturday, May 8, 2010 by The Clarian Health Nurse Recruitment Team

Clarian Health has traditionally celebrated National Nurses Week at its downtown Indianapolis hospitals with an extensive lineup of events, activities, get-togethers and giveaways.

It used to start in late April and run through the end of May, usually capped with a day or two for nurses and nurse leaders at the Indianapolis Motor Speedway, watching cars practice or compete for spots in the famed Indy 500 race.

Of late, we’ve taken a second (and third) look at our celebrations and asked ourselves: Do umbrellas as gifts and offers of free makeovers really make nurses feel appreciated for the work they do? Do they want to take time away from their families and friends and spend it with us – their employer – at an event we stage after hours to say thanks for a job well done?

More and more, we’ve realized that it’s not the gift or event that counts. It’s the motivation and the thought behind it. Is it genuine? Is it meaningful? Is it appropriately thanking those you intend to thank?

Last year, we changed our Nurses Week lineup and substituted some new things and got rid of some old habits in hopes of instilling a new way of thinking among our professional nursing staff.

For example, in lieu of a small gift for each nurse, we opted for charity and asked our nurses to identify nurse-led or nurse-inspired programs operating at our hospitals so that a significant donation could be made in the name of nursing, in honor of Nurses Week.

One program RNs identified was “Got You Covered” at Methodist Hospital’s Emergency Department, which provides sweatpants and sweatshirts to patients who don’t have clothing to wear after they are treated and released. A nurse started it; a nurse still runs it; and nurses KNOW it makes a difference to patients. We were happy to donate money to that cause in the name of great nurses at Clarian.

We’re doing the same thing again this year, and already, triple the number of nurse-led or nurse-inspired programs have been identified as potential recipients of a Nurses Week donation. That’s a step in the right direction, I think.

I believe, as does Clarian, that nurses are at the heart of health care. Nurses Week is an opportunity to say thanks to nurses who do the work of heroes, but it’s also an opportunity to think differently about how we recognize and appreciate that work … every day of the year.

Lydia Ostermeier, MSN, RN, CHCR
Director of Nurse Recruitment, Retention, Workforce Development, Resource Allocation & Customer Service
losterme@clarian.org
317-962-1886

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Got It in the Bag

Wednesday, May 5, 2010 by Gwenn Christianson, MSN, RN, CSPI

I took my 2^1/2 year old grandson to the library last week. Our library has a great children’s area. It has a big play area with a train table, a Lego table and a puzzle area. But he wasn’t interested in any of those – he wanted to play with my purse! Fortunately he was more interested in my car keys than any of the other contents.

Purses, book bags and other items you use to carry items you use daily, are all sources of potential poisons for the children in your life. Let’s take a look inside the average bag & see what should be avoided.

Makeup – generally not a problem

Perfume – contains alcohol, small amounts cause local irritation

Visine®, Afrin® etc – allergy nasal sprays & eye drops – extremely toxic in small amounts, can cause extreme sleepiness, respiratory depression and bradycardia

Medicine – whatever you are taking – remember, Child-Resistant Caps are just that – Resistant, not Child Proof! The average 2 year old can remove them after a few minutes work.

Inhalers – albuterol or other inhalers – can be a problem if used excessively

Tylenol®, Advil® - or other OTC pain killers – can always be toxic if a little one gets too much of them

Cough drops – choke hazards

Tums® – safe, choke hazard

Gum – Despite what you may have heard, swallowing gum does not cause “gum balls” to develop in your stomach. However, eating large amounts of sugar-free gum may cause diarrhea, because most of those gums are sweetened with sorbitol, a laxative.

Nicotine gum – potentially quite toxic. Eating 1 piece of nicotine gum is the equivalent of eating one cigarette, which is a problem for a small child

Cigarettes – one cigarette is potentially toxic

Tobacco Dissolvables® – Orbs, Sticks, Strips – one of these is equivalent to one or more cigarettes and children tend to eat several, since they look like candy

Cigarette lighters – contain butane, which is a hydrocarbon and can cause pneumonitis

Matches – large amounts can cause kidney problems

Sunscreen – not toxic but eating some may cause a child to vomit, since it has a slimy texture

Insect Repellent –most contain DEET, which is quite toxic. If a small amount of repellant is ingested it will cause only local irritation, but if a large amount is ingested it can cause seizures

Hand Sanitizer – contains ethanol, small amounts cause local irritation

Batteries – small button sized batteries are a risk if swallowed, because they can lodge in the esophagus without causing symptoms. All batteries can be a problem if ingested

Coins – the larger the coin the greater the risk if ingested because they can become stuck in the esophagus

Cold sore meds – often these contain camphor, which can cause seizures if enough is ingested

Hair Spray – contains ethanol, small amounts cause local irritation

Mace – greatest risk is being accidentally sprayed with the mace, which causes immediate pain and tearing and can cause respiratory irritation

Keys – not toxic, but not good for your teeth!

Cell Phone – pieces can come off & be a choke hazard

Pens & Pencils – may make a mess but are not toxic

So, keep your bag “up and away” from children and be aware of what dangers lurk inside. If you suspect a poison exposure has occurred, don’t wait, call the Indiana Poison Center at 1-800-222-1222 right away!

Gwenn

Gwenn Christianson, MSN, RN, CSPI
Senior Partner and Team Leader
Indiana Poison Center, Methodist Hospital

To be a registered nurse at Clarian, visit Registered Nurse Job Opportunities.

Critical Care Nurse Teaches Cake Baking on Costa Rican Vacation

Monday, May 3, 2010 by Teresa Weller Sundine, BSN, RN

How many nurses get burned out because they don’t take time to take care of themselves? I would venture to say there is A LOT! While we are taking care of our patients at work, we need to be thinking of how we are going to take care of ourselves at home. A vacation is a much-needed item for everyone, but especially nurses. Even if you do a staycation, you NEED to take the time off and pamper or challenge yourself. JUST DO SOMETHING FOR YOURSELF!

My husband and I just got back from 10 days in Costa Rica. Now it was not really my choice of country to visit, but hey - it was an international trip. We tagged along with my brother and his wife while they are interviewing countries and states for retirement homes. We did Ireland last year with them.

One of the things that struck me was how poor the country seemed when we left the airport in San Jose. The homes there are tattered looking, with rusted metal roofs and fences around everything. Looks can be deceiving though. The people dress well and they eat well, although now that there are more Americans and Canadians retiring there, the cost of food, shelter and property is starting to increase. On the bright side though, many people have lime, mango, papaya, and banana trees growing out in their yards!

We were headed to Grecia which is about 40 minutes from the airport. It is up in the mountains and away from all the congestion and the pollution. The air is definitely cleaner than in the USA. One of the things we got to do while there was a “Canopy Tour,” which is a zip line that rides high above the tree tops of the rain forests. I did not hesitate to swing on that zip line like Tarzan meeting Jane. It was exhilarating to say the least. We went to a national park and got to see monkeys in the trees (not cages) and sloths (ugly creatures) and to hear the wild apes further in the rain forest. We ate wonderful Costa Rican food and met regular Costa Ricans, not Americans.

The highlight though for me was when I found out one of the ladies that worked at the bed and breakfast (La Terraza) was just getting into cake decorating. I had a connection there! I showed her my cakes on Cakecentral.com that I had done and told her I would send her some things to help her with her decorating. That was the BEST part of my vacation… being able to share some of my knowledge with someone new who was just starting out in her profession. It is no different than sharing your nursing knowledge with new nurses. Some things, although different, are still the same.

So ladies and gentlemen… start looking for someplace to vacation , to pamper yourself, and hold at bay the “burnout mode” that can come if you don’t take care of number one - YOU!

Happy Nursing.

Teri

Teresa Weller Sundine, BSN, RN
Neuro Critical Care Unit, Methodist Hospital

To be a registered nurse at Clarian, visit Jobs for Registered Nurses.

Enjoy Nurses Month; Eat Some Ice Cream

Monday, May 3, 2010 by Sherry Holden, BSN, RN, Associate Partner

Get ready, set, go…it’s May! From the first to the last day, there will be some type of race: horse races, people races, cars races. We will move from inside to outside and begin grilling, gardening, biking, hiking-it seems endless. Add an ING to just about any word and we will do it in May. I’m a bit weary thinking about all of the possibilities and the month is only a few days old!

May is also “Nurses Month” at Clarian. It is really supposed to be Nurses Week, but Clarian always goes above and beyond. This year’s agenda is no exception. There is certainly something for everyone. Several awards are bestowed to highlight excellence in practice, banquets are held and a few lucky people get to spend a day at the track. I personally enjoy the Nursing 2000 Scholarship Banquet. It is a great cause for nursing and a great venue for networking. Sherry G., the person who hires me 17 years ago, is usually there. I consider her one of the greatest nurses I have known over a long career and a wonderful human being. Colleagues are the greatest! I also like the concept of “Nurses Helping Nurses”. While nurse gifts in the past were appreciated, I think it’s much more appropriate to make a donation to a nurse-inspired charitable program. I like to see the innovative contributions nurses are making. Most of the time, I am oblivious to these programs but May brings them to the forefront. I like the traditions that surround the festivities and I like the improvisation: last year on 4-Medicine we had a surprise birthday party for Florence Nightingale!

I have concluded that one of my favorite traditions of Nurses Month is Ice Cream Day. Sure, some nurses would prefer a healthy alternative, and that is fine. But me, I really like ice cream! I think in moderation it is a good thing. I also really like the concept of administrators coming to MY space to serve me ice cream and say “thank you” for a job well done. It would be great if Ms. Lydia O. would bring my ice cream this year. How fun would that be? Ice cream is such a good celebration treat: versus broccoli, for example.

I am also a person that needs a little recognition and appreciation now and then, which is another reason I find Nurses Month so fitting. Fifty years ago, my grandfather gifted me with a simple work ethic I have carried all my life: if someone is willing to hire you, you owe that person 100% effort for a day’s pay. I strive to reach that mark everyday. I have also learned over time that the reward of nursing is much more than the pay we earn. It is in the work of our hands and hearts and it returns to us through the lives we have touched.

This month is a time for all nurses to celebrate. A line from the musical, Camelot, says, “It’s May! It’s May! The month of YES, you may!” This month, I am consciously going to say: YES to nursing, YES to appreciating my colleagues, YES to having fun and YES to ice cream! Next month….. I’ll eat broccoli!

Happy Nurses Month!

Sherry Holden, BSN, RN
Associate Partner, 4South, IU Hospital

To be a registered nurse at Clarian, visit Registered Nursing Position Indiana.

It Matters That Your Nursing School is Accredited … to Teach NURSING

Friday, April 16, 2010 by The Clarian Health Nurse Recruitment Team

Clarian Health has a long-standing practice of only hiring nurses who are graduates of schools of nursing that are accredited by the National League for Nursing Accrediting Commission (NLNAC) or Commission on Collegiate Nursing Education (CCNE).

Some people may wonder why this practice is important. I can tell you from experience there are several reasons, but most important among them:

Accredited programs have established standards for nursing education, curriculum and faculty.
Accredited programs consistently prepare nurses to care for Clarian’s high-acuity patient population.

Before enrolling in nursing school, be sure to check whether the program is accredited and consider whether your employer of choice makes hiring decisions with that in mind. It could have an impact on your ability to find a job you want after graduation.

And bear in mind that even though a school claims to be accredited, YOU need to verify from where that accreditation comes. Being accredited to teach HIGHER EDUCATION COURSES is NOT the same as being accredited to teach NURSING PROGRAMS. There is a difference!

If you have questions about which nursing schools are accredited by NLNAC and CCNE, check out these Web sites for an up-to-date list:

NLNAC: NLNAC Accredited Nursing Programs
CCNE: CCNE Accreditation Reports

In Indiana, another good resource can be found on the Nursing 2000 Web site. It summarizes what to look for in an accredited school at this link: Guidelines to Consider in Applying to Indiana Schools of Nursing (PDF)

Lydia Ostermeier, MSN, RN, CHCR
Director of Nurse Recruitment, Retention, Workforce Development, Resource Allocation & Customer Service
losterme@clarian.org
317-962-1886

To be a registered nurse at Clarian, visit RN Job Opportunities Indiana.

Be Good to One Another

Wednesday, April 14, 2010 by Sherry Holden, BSN, RN, Associate Partner

I am in the midst of a little Spring downtime. Tomorrow I am going to North Dakota to visit my family. Time off is always a good thing. It changes perspective and allows one to hit the refresh button. Before my adventure begins, I would be remise if I didn’t remark on the events of last week on 4-Medicine.

My manager and one of my colleagues made it possible for me to go the “Celebration of Life” of a dear, dear patient who passed away on Easter Sunday - very fitting for Mr. F. I was scheduled to work that day and it required some sacrifice on the part of two people to get me there. I went with another nurse from our floor and we had a wonderful time. The family treated us like family and it was well known that the IU nurses were there.

As I have been reflecting on the entire event, one word comes to mind: goodness. Mr. F’s life was filled with goodness, he left a heritage of goodness and my colleagues exhibited goodness in responding to an unplanned, last minute need. I like Webster’s take on goodness. Among other attributes, he describes it as the “best part of a thing, the essence.” I am also wondering about the giver and receiver of goodness. It seems to me it is a two-way blessing in any circumstance. Blessed and grateful - that would be me.

So, a reminder regarding the essence of it all: be good to one another - it’s the best part of anything.

Sherry

To be a registered nurse at Clarian, visit Registered Nursing Opportunities Indiana.

Nature: Touch, Feel, Smell, Taste, and Be Poisoned By It

Wednesday, April 14, 2010 by Gwenn Christianson, MSN, RN, CSPI

Nature
LXXXV
by Emily Dickinson

A Light exists in Spring
Not present on the Year
At any other period -
When March is scarcely here

A Color stands abroad
On Solitary Fields
That Science cannot overtake
But Human Nature feels.

Part of human nature seems to be the overwhelming urge to touch and feel, to smell and taste, all that is a part of nature. Now that the days are growing longer and the weather is growing warmer, we find ourselves going outside to play or to relax and too often our encounters with Nature are somewhat less than benign.

I am thinking specifically of plants, and the almost irrepressible urge to eat them felt by some young children. And why not? Plants, and flowers in particular, are pretty, brightly colored, smell good – why wouldn’t they be something good to eat? And when you think of all of the plants we strongly encourage our children to eat – broccoli, lettuce, peas, beans, celery, squash, tomatoes, peppers – every color, shape and size under the sun – why should they see any difference in a leaf of lettuce vs. a leaf of a hickory tree? Why would yellow pepper strips be any different from yellow river reeds?

What plants are a problem? Well, the list is so long that there is no way I can cover it all in one short blog. If you want the entire list, you can get it by going online to www.clarian.org/poisoncontrol and downloading it, or you can call IPC at 1-800-222-1222 to request a free information packet be mailed to your home. I will talk about just a couple of poisonous plants below. Some of the more common landscaping plants that are toxic include Yews, Holly, Azaleas, and Rhododendron. Flowers include Lily of the Valley and Foxglove, as well as Morning Glory, Wisteria, and Delphinium. “Wild” plants that can be trouble include: jimson weed, nightshade, water hemlock, and acorns.

So, what do you do if an exposure occurs? First, make sure the child is awake and breathing normally. If not, call 911. If the child is OK, take a clean wet cloth and wipe their mouth out, removing all plant material. Wash their face and hands well with soap and water. Get a good sample of the plant (leaves, stems, berries, flowers – all of the different parts), then bring the child and the plant to the phone and call IPC at 1-800-222-1222. We will help you obtain a plant ID and have the child appropriately cared for, most often safely at home.

What can you do to prevent or prepare for an exposure? There are two main things:

Know what is in your yard!! Get a good plant guide or a knowledgeable friend or neighbor and go around and identify each plant, shrub, flower and tree in your yard. Label them with indelible markers. Make a map showing where each one is and the name(s). Remember, you may not be home when the exposure occurs, so relying upon your memory alone is not a good method!
Only buy non-toxic plants. Check the list of non-toxic plants. If the plant isn’t listed on our short list, does that mean it’s OK? NOT AT ALL! It just means we didn’t have room to include it. Call IPC BEFORE you purchase, with the common and scientific (Latin) name of the plant and we can look it up and tell you whether it is safe to have around little children. Don’t rely upon what birds or other animals eat – children aren’t birds and what birds can safely eat can sometimes be very dangerous for children!

Enjoy the lovely weather, while it lasts, and have a safe & happy Spring!

Gwenn

To be a registered nurse at Clarian, visit Registered Nurse Job Opportunities.

I Am a Staff Nurse, Bedside Nurse, Nurse Clinician, and Associate Partner Everyday

Wednesday, April 7, 2010 by Sherry Holden, BSN, RN, Associate Partner

I lost the month of March! I had a major interior house project done and my computer was shut down. A month of e-mails is a terrible thing to face! This whole situation raises the question: what would you do without technology for a month? No desk-top, lap top, T-3’s, I-3’s, cells or for that matter, TV. I found myself in the garden and I caught up on some reading: what a novel idea! Nursing journals: oh, my! It’s enough to make your head swim.

I was particularly interested in one snippet in NurseWeek that was a simple letter to the editor from a retired nurse in Michigan. She was concerned that the nurses receiving recognition were administrators, managers, educators, practitioners - everyone but the “everyday nurse.” She went on to describe the “everyday nurse” as the person who was everything to everyone all of the time. From patient and family care to linens, floors & garbage, she drew a picture of the “everyday nurse” and felt they needed more recognition.

I didn’t disagree with any of that, but I was a bit perplexed regarding the terminology “everyday nurse.” It was new to me, and for some reason, I didn’t like it. It reminded me of everyday shoes or everyday “wash and wear” or an everyday hair-do. Naturally, when something niggles me, I want to know what other people think. I guess I need verification that I am not an odd-ball! I did a random survey on 4-Medicine, assuming there were no odd-balls there, and discovered the same response. People did not like it, but they weren’t sure why. The terminology itself seems to have negative connotations for people. Over-time I have been a staff nurse, bedside nurse, nurse clinician, associate partner…Of the mix, people seem to like staff nurse the best. It has a stellar tone.

In reality, when it is all said and done, I am an “everyday nurse.” Just don’t call me that!

Oh, and whatever my title, I need recognition.

Sherry

To be a registered nurse at Clarian, visit Registered Nurse Career Job Search.