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Autism spectrum disorder: Questions answered

Autism spectrum disorder: Questions answered

By Julie Cullen, Managing Editor, American Nurse Today

I recently spoke with Donna Swanson, MSN, CS, APRN, executive director and co-founder of the FOCUS Center for Autism in Canton, CT. Donna, who has over 30 years of nursing experience, specializes in the assessment and treatment of children and young adults with autism spectrum disorder (ASD). She shared some insights and offered advice for nurses caring for patients with ASD.

Autism is a broad term. Can you provide a definition or overview?

The clinical term for autism is autism spectrum disorder or ASD. It’s is a bio-neurological developmental disorder that generally appears before the age of 3. It impacts the normal development of the brain in the areas of social interaction, communication skills, and cog-

Donna Swanson, MSN, CS, APRN, executive director and co-founder of the FOCUS Center for Autism

nitive function. Depending on where an individual may fall on the spectrum, they may also have comorbid medical conditions such as epilepsy, feeding and sleep problems, and sensory processing problems. My simple definition for ASD is “creatively wired and socially challenged,” because no two people with ASD are alike and this is what makes them so hard for professionals to assess and treat.

What challenges might nurses encounter when caring for a patient with ASD? Are the challenges different between children and adults?

ASD is very challenging in and of itself, regardless of the age or the setting. The most important first step is building a relationship and offering a safe comfort zone when you first encounter an individual with ASD. I’m very aware of personal space and my approach is thoughtful. Kindness, empathy, and just saying “I’m here to help” are good places to start. Trying to find something in common to begin engagement is also helpful. Your approach should be slow, not rushed or frenetic and talking should be in a simple and down to earth manner. Too many questions, directions, and information all at once can be overwhelming and increase anxiety to a level of flight or fight. Offer encouragement and ask patients what they’re most concerned about today. Ask if there’s anything you should know about them or their worries that will help you do your best for them today. Proceed cautiously; the person with ASD can pick up on anxiety and may intuit your level of comfort in these situations   Make sure to ask what’s most helpful to make the visit a success.

What tips/advice can you offer to nurses to ensure patients (adults and children) feel safe and secure during a healthcare encounter?

Anxiety is often a big factor in any encounter and being aware of the many faces of anxiety is crucial. Sensory issues are also a factor, so make sure the environment is as comfortable and as predictable as possible so patients with ASD know what to expect. Lights, noise, people coming in and out of the room are triggers for increased anxiety, so make other staff aware of this individual’s needs. Always introduce yourself and others every time you meet. Also ask about food preferences and when they last ate; anxiety increases metabolism and irritability, and food offers love and comfort. Keep some sensory tools handy like squeeze balls, silly putty, fidgets, and drawing and coloring materials.

What kind of training/education would you recommend to nurses so that they’re prepared to care for patients with ASD?

Understand that autism is a spectrum disorder and affects each individual differently. Individuals can have minimal symptoms through moderate to severe limitations in functioning, understanding, use of language, and ability to read and process social cues and situations. Read what you can about ASD, not only from professional journals but from the literature—books and magazine articles written by individuals with ASD or families of children/teens/adults with ASD. This will help you understanding the range and spectrum of functioning. If possible, take time to visit an ASD clinic, center, or school to make observations and have some personal interactions with individuals on the autism spectrum.

If a nurse has an encounter with a patient (child or adult) who hasn’t been diagnosed with ASD but whom the nurse suspects might fall on the spectrum, what should he or she do? What kind of referrals can the nurse make? What kinds of questions should the nurse ask?

This is a delicate area certainly…it can engender fear, anger, and denial in some parents to bring up the subject of a concern about their child’s development. A good start may be to ask the parent if he or she has ever had concerns about the child’s medical well-being or developmental or social functioning. Ask how the child is functioning in daycare, school, or playgroups. What do they hear from adults who interact with the child?

Gently share with the parent what you notice that makes you wonder if further evaluation is warranted. For example:

  • I notice he’s covering his ears when I speak in a normal volume; am I sitting too close for his comfort level?
  • He seems very anxious and is looking around a lot…Is he especially sensitive to noise?
  • Do you think something in the environment upsets him?

If the child is school age, some questions can be gently directly to him or her.

These questions may prompt a discussion between you and the parent, which can lead to a recommendation to have further concerns brought to a provider. Become familiar with the local birth to three programs, developmental clinics/children’s hospitals, child psychologists/psychiatrists who can be sources of information and further referral. Ask the family if they’d like to sign consent for you or your clinic/office/hospital to share your observations and concerns with these resources to help facilitate the referral process.

If you’re talking to an adult, gently share your concerns and observations and ask if the individual ever noticed the same about himself or herself. For example, you could ask:

  • You seem to have some difficulty looking directly at me. Is that always hard for you?
  • What have you noticed helps or makes the situation worse for you?
  • What else about being with or communicating with others is difficult? Have you ever spoken to your provider about these concerns?

Let the patient know that you can provide resources and ask if you can share information with the patient’s provider.

What else should know about caring for patients with ASD?

See the person with ASD as an individual first. Each is unique and can teach us something new about them (and often ourselves) with each encounter.

Many professionals don’t feel they’re helping someone with ASD if they don’t see results or participation. My strong belief is that anytime you can have a positive and caring encounter with someone with ASD you’ve offered help and added to his or her “relationship bank.” Try to manage your own anxieties and expectations as individuals on the spectrum are very intuitive, whether they’re verbal or nonverbal. Knowing that you care and want to help is priceless.

Julie Cullen, managing editor of American Nurse Today and a curator of online content for the American Nurse Today website, is most definitely not a nurse, but she admires what all of you do everyday. In her Off the Charts blog she shares some of her experiences as a patient and family member of patients, thoughts and ideas that occur to her during her work editing nursing content, and information she thinks you might find interesting. Julie welcomes your feedback. You can submit a comment on the website or email her at [email protected]

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Unit 2 Principles of Health And Social Care Practice

Unit 2 Principles of Health And Social Care Practice

East End Computing & Business College

PEARSON BTEC LEVEL 5 HND IN HEALTH & SOCIAL CARE

Assignment Brief

Unit 2 : Principles of Health & Social Care Practice

Learner’s Declaration:

Unit 2 Principles of Health And Social Care PracticeI declare that all the work submitted for this assignment is my own work or, in the case of group work, the work of myself and other members of the group in which I worked, and that no part of it has been copied from any source.

I understand that if any part of the work submitted for this assignment is found to be plagiarised, none of the work submitted will be allowed to count towards the assessment of the assignment.

Signature______________________________                                  Date______

Learning Outcomes:

On successful completion of this unit learner will :

  1. Understand how principles of support are implemented in health and social care practice
  1. Understand the impact of policy, legislation, regulation, codes of practice and standards on organisation policy and practice
  1. Understand the theories that underpin health and social care practice.
  1. Be able to contribute to the development and implementation of health and social care organisational policy.

Assessment Feedback Sheet

Task 1 – Case Study 1

Denis just arrived at a residential care home where you work, aged 92, after seven weeks in hospital. He collapsed at home with hypothermia, after living at home with no heating for over a week. When asked by the social worker, Denis reports not having money and his pension not going far. He has a severe urine infection and a badly infected foot. He cannot walk and his diabetes, infections, heart and renal conditions had left him very weak. Requiring nursing care, Denis feels isolated and alone after the passing of his wife 2 years ago. Sometimes he says he wishes he was dead. It has been noted by the support workers and doctors that Denis is suicidal and has a high tendency of self-harming due to frustration.

Task 4 – Report Writing

Before you answer this question , obtain a copy of your workplace documents; policies, handbooks, manuals, regulations and procedures as well as a copy of General Social Care Code of Practice for care worker and National Minimum Standards For the Elderly/Adults or any relevant document.

Write a report where you:

Q6:   explain how you have implemented policies, legislation, regulations and codes of practice in significance to your own work in health and social care. [AC 2.1]

Q7:   explain how local policies and procedures can be developed in accordance with national and policy requirements and evaluate the impact of these policies and procedures on organisational policy and practice [AC2.2] [ AC2.3]

Guideline- NATIONAL POLICIES- LOCAL –ORGANISATIONAL POLICIES/PROCEDURES

Q8:   explain the theories that accentuate health and social care practice. [AC 3.1]

THINK: Service users have different needs (Maslow). Explain Erik Erikson theory of human development. Make sure that you show the significance of this to in health and social care settings.

OBSERVATION RECORD

Learner name:
Qualification: BTEC Level 5 HND in Health & Social Care
Unit number & title: Unit 2 : Principles in Health & Social Care
Description of activity undertaken
Assessment & grading criteria
How the activity meets the requirements of the grading criteria
Learner signature: Date:
Assessor name:
Assessor Date:
signature:
Unit 2 : Principles of Health & Social Care (A/Brief) Aug 2016 13

 

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March 2018 Vol. 13 No. 3

March 2018 Vol. 13 No. 3

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Supraventricular tachycardia

Supraventricular tachycardia

Quick action reverses SVT and prevents a disastrous outcome.

Takeaways:

  • Atrial fibrillation and atrial flutter are the most common subtypes of supraventricular tachycardia, which is relatively common in women.
  • The treatment of choice for unstable patients is synchronized cardioversion.
  • For stable patients, initial treatment is a vagal maneuver, such as the Valsalva maneuver or carotid massage.
  • Pharmacologic treatment includes adenosine (preferred) or a calcium channel blocker or beta blocker.

By Cindy Ruiz, MS, APN-CNS, CCRN

Susan Brooks, age 75, arrives in the emergency department with new-onset chest pain, shortness of breath, and palpations. Her vital signs are stable, and she’s in normal sinus rhythm. A troponin test is negative, and a 12-lead electrocardiogram (ECG) and chest X-ray are unremarkable. Mrs. Brooks has a history of hypertension, myocardial infarction, and hyperlipidemia; her home medications include lisinopril, hydrochlorothia­zide, and atorvastatin. She’s admitted for observation. That evening, she again experiences palpations and shortness of breath and pushes the call light.

History and assessment hints

supraventricular tachycardiaYou find Mrs. Brooks anxious and dyspneic. She says her heart is “racing.” Her vital signs are blood pressure (BP) 100/66 mmHg, respiratory rate 28 breaths/minute, heart rate (HR) 170 beats/minute (bpm), and oxygen saturation 90%. Her lungs are clear. Mrs. Brooks tells you that her palpations came on suddenly; she’s not experiencing chest pain. You call the rapid response team (RRT).

On the scene

After summarizing your findings, the team administers
2 L oxygen by nasal cannula and begins infusing 0.9% normal saline solution. A 12-lead ECG shows that Mrs. Brooks is in a regular, narrow-QRS-complex supraventricular. tachycardia (SVT) at 170 bpm. You get the crash cart and connect Mrs. Brooks to the defibrillator for continuous ECG monitoring. Mrs. Brooks is stable, and the RRT team instructs her to perform a Valsalva maneuver by blowing forcefully into a straw. The maneuver is unsuccessful, so the physician orders adenosine 6 mg rapid I.V. push followed by a 20-mL bolus of saline. You tell Mrs. Brooks that she may experience a moment of claustrophobia, dyspnea, or chest discomfort. After 2 minutes with no change in her condition, a second dose of adenosine 12 mg rapid I.V. push is administered. Mrs. Brooks’ HR slows and returns to normal sinus rhythm at 80 bpm.

Outcome

Mrs. Brooks is transferred to the telemetry unit. A cardiology consult is ordered and a thyroid function test is performed. She’s discharged the next day with an event monitor and instructed to follow up with a cardiologist. Prophylactic drug therapy is an option for Mrs. Brooks; however, her age, symptom burden, and the frequency of the SVT occurrences should first be considered. Catheter ablation, which uses radiofrequency energy to selectively destroy abnormal conduction pathways, is another option.

Education and follow-up

SVT describes a group of arrhythmias whose fast rate—160 to 250 bpm—is produced from a pacemaker site above the atrioventricular (AV) node. Atrial fibrillation and atrial flutter are the most common subtypes of SVT, which is relatively common in women. Causes of SVT include abnormal levels of potassium, magnesium, and thyroid-stimulating hormone. Symptoms are usually acute in onset and include palpations, lightheadedness, chest pain, and dyspnea; some patients have no symptoms.

The treatment of choice for unstable patients is synchronized cardioversion. For stable patients, such as Mrs. Brooks, initial treatment is a vagal maneuver, such as the Valsalva maneuver or carotid massage. Use caution when performing carotid massage in older patients who may be at risk for carotid atheroembolism. The Valsalva maneuver increases intrathoracic pressure to stimulate the aortic and carotid baro­receptors, causing the vagus nerve to slow input into the AV node and halt the fast heart rate. The patient should be in a supine position and the maneuver attempted for 15 to 20 seconds.

If vagal maneuvers are unsuccessful, medication is the next step. Pharmacologic treatment includes adenosine or a calcium channel blocker or beta blocker. Adeno­sine is preferred because of its lower incidence of hypo­tension and extremely short half-life (10 seconds), which means it should be given close to the I.V. site and by rapid push. Adenosine is highly effective at causing a temporary complete AV node block. Adenosine may cause broncho­spasm, so it shouldn’t be given to patients with asthma or chronic obstructive pulmonary disease.

If not reversed, SVT can lead to syncope, heart failure, myocardial infarction, or shock. You and the RRT team helped Mrs. Brooks avoid a disastrous outcome.

Cindy Ruiz is a critical care clinical nurse specialist at Northwest Community Healthcare in Arlington Heights, Illinois.

Selected references

Al-Khatib SM, Page RL. Acute treatment of patients with supraventricular tachycardia. JAMA Cardiol. 2016;1(4):483-5.

American Heart Association (AHA). Advanced Cardiovascular Life Support: Provider Manual. Chicago: AHA; 2016.

Hals G, McCoy C. Supraventricular tachycardia: A review for the practicing emergency physician. Relias (Formerly AHC Media). June 15, 2015.

Sohinki D, Obel OA. Current trends in supraventricular tachycardia management. Ochsner J. 2014;14(4):586-95.

Swift J. Assessment and treatment of patients with acute tachyarrhythmia. Nurs Stand. 2013;28(5):50-9.

 

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Team assist: Manage nurse burnout and improve care quality

Team assist: Manage nurse burnout and improve care quality

Nursing teamwork addresses admission, discharge, and transfer workloads.

Takeaways:

  • Multiple simultaneous admissions, discharges, and transfers can create complexity and heavy workloads in acute-care facilities.
  • To ensure patient safety and reduce nurse burnout, nurses must receive support during periods of increased workload.
  • An admission, discharge, transfer team can help improve outcomes for the organization, nurses, and patients.

By Minerva Gonzales, DNP, RN-BC, NE-BC; Carey Rumbaugh, MSN, RN-BC; and Carol Boswell, EdD, RN, CNE, ANEF, FAAN

Multiple simultaneous admissions, discharges, and transfers add another layer of complexity for bedside nurses working in acute-care facilities. To ensure patient safety and reduce nurse burnout, nurses must receive support during these periods of increased workload. Implementing an admission, discharge, and transfer (ADT) team is one solution. These teams report to a nursing unit that needs assistance to provide relief during times of demanding and hectic workload to ensure safe, high-quality patient care and increase nurse satisfaction. (See ADT teams: Backed by the evidence.)

Project overview

In 2014, an urban acute-care facility implemented an ADT team of clinical educators and unit directors (all RNs) for all of its acute-care units. They would respond to the units when needed. Each member arranges to serve 1 day, with three members available every day from 8:00 am to 4:30 pm. All team members receive training on the ADT process and the electronic health record (EHR). When units are in need of assistance, the charge nurse calls the shift supervisor and requests an ADT team assist. The supervisor and the team report to the unit to ensure patient needs are met. After the assistance is complete, the charge nurse completes a card that includes date, unit, start and end times, staffing ratios, and team assist details (including what went well, what can be improved, what was done, and who responded), and a 1-5 Likert scale for satisfaction with the team response. The cards are collected by the shift supervisor and analyzed by the director of education, who serves as the ADT team leader

ADT teams: Backed by the evidence

Research shows that admission, discharge, and transfer (ADT) teams can improve patient care, nursing satisfaction, and organizational outcomes. They can:

  • enhance teamwork and quality outcomes
  • strengthen workflow processes that are disrupted by the admission process
  • improve safety by identifying key signs and symptoms that may have gone unnoticed.

Reversing turnover

Workload is correlated with nursing burnout and turnover, which can be costly to the organization and lower nurse morale. A study conducted by Spiva and Johnson revealed that, after implementing an ADT team, nursing satisfaction increased. The same study found that courtesy of the person admitting patients increased from 90.7% to 92.1%, which indicates an increase from the 50th to the 80th percentile per the Press Ganey patient satisfaction scale.

Challenges and modifications

The key challenge for this program was getting the frontline staff to call the ADT team. Initially, the teams were made up of mid-level administrative staff, and requests for assistance were inconsistent and infrequent, although units raised workload concerns. The staff were worried that calling the team might be interpreted as lack of effective unit management. To address this issue, the ADT team make-up was changed to peers and managers. Nurse educators and other seasoned nurses on the career ladder were trained to function on the ADT team, providing them with another way of maintaining their career ladder designation. A schedule of available times was developed to ensure that the ADT team was well covered. Because admissions and discharges increased in the afternoon, team scheduling was focused during these hours.

team manage burnout improve care quality

Planning for situational workload stressors presented another challenge, so the shift supervisor uses a checklist to assess for potential overload. Unit staff notify the supervisor of anticipated discharges and transfers every 4 hours because each of these is likely to result in an admission. In addition, the supervisors know which units have float personnel or travelers, and they’re kept informed about challenging patients and situations. All of this knowledge is used to anticipate which units might need assistance. So, instead of waiting until the unit calls for help, the ADT team can be placed on alert or a team member can drop by the unit to provide support. If the team member sees that further help is needed, he or she can call the full ADT team to help.

Multiple benefits

Nursing workload can significantly impact an organization through turnover due to job dissatisfaction and lost revenue because of quality of care issues and recruitment costs. In addition, the amount of time nurses spend in patient rooms can affect patients’ perceptions of their care. If nurses are consumed with multiple admissions and discharges, some patients may not receive as much time with their care providers as they expect, leading to dissatisfaction.

Implementing an ADT team can help nurses spend more time with their patients, leading to higher quality care, shorter lengths of stay, and increased patient satisfaction. And allowing both clinical and nonclinical nurses to respond to team assist calls promotes teamwork throughout all nursing units and departments, which increases job satisfaction and decreases turnover.

The bottom line is that an ADT team can result in positive outcomes for the organization, nurses, and patients.

Minerva Gonzales is director of the RN-to-BSN program and assistant professor at the University of Texas Permian Basin College of Nursing in Odessa. Carey Rumbaugh is the nurse educator/bridge and CNE coordinator and stroke unit director at Medical Center Hospital in Odessa, Texas. Carol Boswell is a professor and James A. “Buddy” Davidson Charitable Foundation Endowed Chair for Evidence-Based Practice and co-director of the Center of Excellence in Evidence-Based Practice at Texas Tech University Health Sciences Center School of Nursing in Odessa.

Selected references

Berkow S, Vonderhaar K, Stewart J, Virkstis K, Terry A. Analyzing staffing trade-offs on acute care hospital units. J Nurs Adm. 2014;44(10):507-16.

Kirkbride G, Floyd V, Tate C, Wendler MC. Weathering the story: Nurses’ satisfaction with a mobile admission nurse service. J Nurs Manag. 2012;20(3):344-53.

Spiva L, Johnson D. Improving nursing satisfaction and quality through the creation of admission and discharge nurse team. J Nurs Care Qual. 2012;27(1):89-93.

Van Bogaert P, Kowalski C, Weeks SM, Van Heusden D, Clarke SP. The relationship between nurse practice environment, nurse work characteristics, burnout and job outcome and quality of nursing care: A cross-sectional survey. Int J Nurs Stud. 2013;50(12):1667-77.

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Hospital-level care at home…Is that a thing?

Hospital-level care at home…Is that a thing?

Last week I shared an article about the decreasing number of hospitals in the United States and wondered about what that would mean for healthcare. Where will care take place if not in the hospital? Then, this morning, I encountered a story on NPR about “hospital-at-home” care.

At Brigham and Women’s Faulkner Hospital in Boston, some patients can opt to have their “hospital stay” at home. They’re visited by providers and nurses twice a day in and wear a small monitor that tracks vital signs and movement.

In the scenario described in the story, a physician recommends this care option to a 71-year-old woman with pneumonia, explaining to her that by staying home, she can avoid some of the pitfalls of hospitalization, including infection and sleeplessness. That sounds great to me. I remember my last hospital stay a few years ago seemed to be one sleep interruption after another. And I friend of mine ended up with C. Diff while in the hospital.

A 2016 small, randomized, controlled trial compared the healthcare use, experience, and costs of Brigham patients who received either hospital-level care at home or in the hospital. The study, published in the Journal of General Internal Medicine, found that home-care patients experienced no adverse events and their treatment costs were significantly lower—about half that of patients treated in the hospital. The lower labor costs associated with home care accounted for most of that reduction, in addition to fewer lab tests and visits from specialists. Both groups of patients were happy with their care, but the patients at home were more physically active. In addition, caregivers reported less stress when they didn’t have to travel to the hospital to visit their loved ones.

Obviously, hospital-at-home care isn’t appropriate for all situations…or even all patients…but it seems like an option worth paying attention to. I should also point out that insurance companies aren’t sold on the idea yet, so I’m sure more studies will be forthcoming. I’ll keep my eye out for them and share when I can.

Source: npr.org/sections/health-shots/2018/03/07/591018896/patients-like-hospital-care-at-home-but-some-insurers-are-skeptic

Julie Cullen, managing editor of American Nurse Today and a curator of online content for the American Nurse Today website, is most definitely not a nurse, but she admires what all of you do everyday. In her Off the Charts blog she shares some of her experiences as a patient and family member of patients, thoughts and ideas that occur to her during her work editing nursing content, and information she thinks you might find interesting. Julie welcomes your feedback. You can submit a comment on the website or email her at [email protected]

 

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Opioids vs non-opioids: Which are better?

Opioids vs non-opioids: Which are better?

In some situations, the answer may be neither. In a recent randomized clinical trial of 240 patients with moderate to severe chronic back pain or hip or knee osteoarthritis despite analgesic use, the researchers found no significantly better pain-related function when patients received opioid versus non-opioid medication.

In the opioid group, patients were started on immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. The non-opioid group of patients started with acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. In both groups, medications were added or adjusted based on individual patient response. Over 12 months, the groups did not significantly differ on pain-related function.

You can read more about the study here. And for an opioid update, download this infographic.

Source: jamanetwork.com/journals/jama/article-abstract/2673971?redirect=true

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Why your nursing networks matter

Why your nursing networks matter

Networks help you advance your career, provide high-quality care, and support your colleagues.

Takeaways:

  • Professional networks are crucially connected to quality patient care.
  • Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization.
  • Professional networking has rules, such as adding value to others, building a professional image, and being prepared and positive.

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN, and Tanya M. Cohn, PhD, MEd, RN

nursing network matterMaria is a direct-care nurse working on a medical/surgical unit in an acute-care hospital. She recently achieved certification and became a member of a national nursing organization for her specialty, both of which are needed to advance through the clinical ladder at work. However, Maria isn’t sure why her hospital values membership in the national organization or how it will help her career. She has a busy personal life and doesn’t have time to volunteer in her local chapter.

Maria’s lack of understanding about the value of professional networks isn’t unusual. Many nurses never make the investment of getting involved with professional associations or take the time to ensure that they have a strong network of colleagues within and outside their own organization. They wonder why they should spend what free time they have on an activity that seems so indirectly related to their work, and they fail to see how a network can enhance their professional growth or be a wise career investment.

The value of professional networks

Maria, like all direct-care nurses, is part of the profession of nursing. As a member of the profession, she has the opportunity to develop through continuing education, certification, and membership in nursing organizations. These activities will help Maria evolve from a novice to an expert nurse and open doors to professional networks. Professional networks also will provide her with mentorship, support, and teamwork opportunities. For example, if Maria’s interested in developing specific skills or advancing her education, she can use her network to identify a mentor for skill development or guidance on educational opportunities.

Professional networks are crucially connected to quality patient care. Specifically, healthcare demands evidence-based practice, but nurses across the nation frequently are faced with variations in patient care and deep-rooted sacred cows of practice that are neither evidence-based nor current. Working in silos of individual clinical settings, nurses are left with less-than-optimal patient care and the need to develop evidence-based solutions from scratch. This is where professional networks can promote evidence-based practice through collaboration. For example, as a member of a national organization, Maria has access to networking with other medical/surgical nurses. Together they can compare and share best practices or research findings from their clinical practice, reducing the need to re-create the wheel individually. The result is consistent evidence-based, high-quality patient care.

For young nurses like Maria, a strong network can help when looking for new career opportunities. Many positions are never advertised, and workforce recruiters acknowledge that their best referrals come from professionals whose judgment they trust. Today’s healthcare environment is volatile, so building a strong network should be part of a professional insurance policy.

Steps to building a network

Building a professional network can take two paths: a network in your immediate clinical environment or one created through an organization. Both require common steps.

First, establish an understanding of your goals and who can help you achieve them. For Maria, this could include using her knowledge and experience as a certified medical/surgical nurse to establish a unit-based education program or to take part in a unit-based council to work collectively with other nurses through
evidence-based practice and nurse competencies. Maria also might be interested in tapping into the nursing organization she’s joined to seek out up-to-date practice alerts. Regardless of the professional network, after goals are set and the right people are identified, you can interact, share knowledge, and receive plans to help you achieve your goals.

If you don’t have a specific goal in mind, building a professional network might seem daunting or unclear. Start by putting yourself out there in the nursing profession. For Maria, who may not be able to commit to joining a committee within the nursing organization, she can plan to attend the organization’s annual conference. While there, she can take steps to maximize the networking experience. First, she should think about some conversational topics and introductory questions to use when interacting with other attendees. Depending on Maria’s professional goals, the topics and questions could revolve around clinical practice, leadership development, or advancing education. In addition, Maria should be professionally prepared for the conference, including wearing professional attire and taking business cards. She also should plan to attend all social events and interact with the conference vendors, who could be potential future employment opportunities or offer cutting-edge evidence-based products she can share with her clinical colleagues.

The golden rules of networking

Networking opportunities exist everywhere, including online with sites such as Facebook, LinkedIn, and Twitter. Many nursing organizations have Facebook and Twitter accounts that nurses can follow to support networking about clinical practice and professional development. LinkedIn, on the other hand, helps nurses identify mentors and colleagues with similar interests. Regardless of whether you’re networking at a conference, within an organization, or online, you’ll need to follow some rules. (See Expert advice.)nursing network matter expert advice

Networking for introverts

nursing network matter conversationIf you’re naturally introverted, networking may not come easily. You may even avoid networking events because they’re exhausting and force you outside your comfort zone. The hardest part can be walking through the door into a room. Fortunately, most people would rather talk than listen, so let others do the talking. You can never go wrong asking questions and establishing common ground. (See Get the conversation started.) Chances are that once you start asking questions, the conversation will flow easily. Most nurses like to be asked about their opinions and sought out for advice. You’ll be seen as a great networker because you take the time to listen.

Join the networked world

Over the course of her career, Maria will learn that building a network is one of the most powerful opportunities that membership in a professional association can provide. A good network outside her clinical setting will help her gain access to and act on new information quickly. She’ll also save time and energy by accessing other professionals who’ve overcome some of the same challenges she’s facing. Many young nurses have fast-tracked their careers by getting involved with association committees or running for office.

We live in a networked world, so developing your networking skill set is important to your career success. You never know what new opportunities you’ll encounter or who you’ll meet until you extend your hand, introduce yourself, and start asking questions.

Rose O. Sherman is a professor of nursing and director of the Nursing Leadership Institute at Christine E. Lynn College of Nursing, Florida Atlantic University in Boca Raton. You can read her blog at www.emergingrnleader.com. Tanya M. Cohn is a nurse scientist at West Kendall Baptist Hospital Nursing and Health Sciences Research in Miami, Florida.

Selected references

Cain S. Quiet: The Power of Introverts in a World That Can’t Stop Talking. New York: Broadway Paperbacks; 2012.

Henschel T. How to grow your professional network. 2018.

Jain AG, Renu G, D’Souza P, Shukri R. Personal and professional networking: A way forward in achieving quality nursing care. Int J Nurs Educ. 2011:3(1):1-3.

Mackay H. Dig Your Well Before You’re Thirsty: The Only Networking Book You’ll Ever Need. New York: Currency Press; 1997.

Maxwell JC. The 21 Irrefutable Laws of Leadership: Follow Them and People Will Follow You. Nashville, TN: Thomas Nelson; 2007.

Sherman RO. Building a professional network. Nurse Leader. 2017;15(2):80-1.

 

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What your patient would like you to know about TBI

What your patient would like you to know about TBI

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Social media missteps could put your nursing license at risk

Social media missteps could put your nursing license at risk

Learn the rules and what to do if you make a mistake.

Takeaways:

  • For nurses, social media use has daily applications in their personal and professional lives, facilitating conversations with colleagues about best practices and advancing healthcare.
  • Inappropriate use of social media can create legal problems for nurses, including job termination, malpractice claims, and disciplinary action from boards of nursing (BON), which could negatively impact their nursing license and career.

By Melanie L. Balestra, NP, Esq

Without a doubt, social media has become an integral part of modern life. Today, seven in 10 Americans use social media to get news, connect with others, and share information. Facebook leads the way with more than 2 billion users worldwide, followed by other popular platforms such as Twitter, Instagram, LinkedIn, and YouTube. For nurses, social media use has daily applications in their personal and professional lives, facilitating conversations with colleagues about best practices and advancing healthcare.

social media nursing license risk

Although social media offers many benefits, inappropriate use can create legal problems for nurses, including job termination, malpractice claims, and disciplinary action from boards of nursing (BON), which could nega­tively impact their nursing license and career.

What to avoid when posting

Remember that professional standards are the same online as in any other circumstance. And although you should approach all social media posts with caution, several high-risk areas deserve closer examination.

Breaches of patient privacy and confidentiality

Whether intentional or inadvertent, social media posts that breach patient privacy and confidentially are the most egregious. They include patient photos, negative comments about patients, or details that might identify them, the healthcare setting, or specific departments. Even when posted with the best intentions, such as trying to get professional advice from colleagues about patient care, these posts are discoverable and can lead to legal problems, with potential fines and jail time for Health Insurance Portability and Accountability Act (HIPAA) violations, termination or other discipline from your employer, action taken against your license by a BON, civil litigation, or professional liability claims.

According to the 2015 nurse professional liability exposures claim report update from the Nurses Service Organization, examples of civil litigation and closed claims in connection with inappropriate electronic and social media use include:

  • An RN who took a picture of a man getting an electrocardiogram and posted it on Facebook.
  • An RN who sent text messages to another nurse and physician describing a sick child and his mother in an unfavorable light.
  • Staff members at a long-term-care facility who videotaped and photographed a certified nursing assistant colleague who was in labor. They allegedly mocked the woman, posting photos, including of her vaginal area, on various social media sites.

Unprofessional behavior

A second high-risk area are posts that could be considered unprofessional or reflect unethical conduct—anything defined as unbecoming of the nursing profession. For example, negative comments about your workplace, complaints about coworkers and employers, or threatening or harassing comments fall into this category.

The highly publicized firing in 2013 of an emergency department nurse at New York–Presbyterian Hospital demonstrates the risks connected with posting workplace photos. The nurse shared a photo on Instagram depicting an empty trauma room where a patient had been treated after getting hit by a subway train. Although the post didn’t violate HIPAA rules or the hospital’s social media policy, she was terminated for being insensitive.

Posts about your personal life also can negatively affect your professional life. Posting photos or comments about alcohol or drug use, domestic violence (even comments about arguing with a spouse) and use of profanity, or sexually explicit or racially derogatory comments could lead to charges of unprofessional behavior by a BON. And keep in mind that complaints can come from anywhere, including employers and coworkers, family and friends, and intimate partners, so the privacy setting on the social media platform won’t protect you.

Court rulings have supported disciplinary actions by BONs against nurses for unprofessional behavior in their personal lives. A key example is the 2012 decision by the California Supreme Court, which left intact an appellate ruling (Sulla v Board of Registered Nursing) that allowed a state board to discipline a nurse who was caught driving drunk, even though his arrest had nothing to do with his job. The BON placed the nurse on 3 years’ probation after his arrest. The appeals court ruled that state laws authorize disciplinary action against a nurse who uses alcohol, on or off the job, in a way that endangers others. The result is that nurses in California who are convicted of driving under the influence will have their nursing license suspended by the BON. This has clear implications for social media posting about alcohol use (or any high-risk topic) in your personal life. (See How to avoid social media pitfalls.)

social media nursing license risk avoid pitfalls

If you hear from the BON

If you receive a letter from the BON about an investigation, don’t represent yourself. Hire an attorney who specializes in administrative law and procedure—ideally one who’s familiar with your state BON. Decisions about a complaint can take from several months to more than a year, and outcomes can range from case dismissal for lack of merit or insufficient evidence to referral to the state’s attorney general office for prosecution. If no settlement is reached, you and your attorney will argue the case at a hearing with potential outcomes that include public admonition/reprimand, restriction, probation, suspension, or revocation of your nursing license.

Other serious repercussions are possible. Decisions made by BONs are communicated via Nursys.com, a national database for verification of nurse licensure, discipline, and practice privilege administered by the National Council of State Boards of Nursing. If disciplined, you also could receive a letter from the U.S. Department of Justice restricting your ability to work in any facility that receives reimbursement from Medicare and Medicaid. In addition, disciplinary action in one state may affect your license in another. After you’ve been disciplined, each state in which you hold a license can review or open the case.

To protect yourself, carry your own malpractice/disciplinary insurance (don’t rely on the insurance carrier for your hospital or private practice). This is especially important with the anticipated increase in medical professional liability claims associated with social media use.

Think twice

Social media is a great way to connect personally and professionally. But remember that online posts live forever and that social media misfires could negatively affect your license and ability to practice. To protect yourself, think twice before you post content that could be judged as unprofessional.

Melanie L. Balestra is nurse practitioner and has her own law office in Irvine and Newport Beach, California. She focuses on legal and business issues that affect physicians, nurses, nurse practitioners, and other healthcare providers and represents them before their respective boards.

Selected references

Brous E. How to avoid the pitfalls of social media. Am Nurse Today. 2013;8(5).

Brown CG. Must-read social media advice for nurses. Nurse.org. June 9, 2016.

Nurses Service Organization. Nurse professional liability exposures: 2015 claim report update.

Egelko B. High court lets nurse’s probation stand. SF Gate. August 8, 2012.

EveryNurse.org. How nurses should be using social media.

Jackson J, Fraser R, Ash P. Social media and nurses: Insights for promoting health for individual and professional use. Online J Issues Nurs. 2014;19(3):2.

National Council of State Boards of Nursing. A Nurse’s Guide to the Use of Social Media. November 2011.

National Council of State Boards of Nursing. Welcome to Nursys.

Pew Research Center: Internet & Technology. Social media fact sheet. January 12, 2017.

Ramisetti K. ‘NY Med’ star Katie Duke speaks out on getting fired from NYC hospital for posting Instagram photo of trauma room. New York Daily News. July 8, 2014.

 

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