Friday, 24 September 2021

Nurses, Nurse, Nursing Responsibilities, Nursing Career, Nursing Professionals, Nursing Job


My friends are all leaving me, and I don’t blame them. Throughout the past six months, it seems as though every week I walk onto the unit, I hear that another one of my coworkers has put in their two weeks’ notice. The horribly sad part is that it feels like management just sees it as another job posting to start advertising for, but to the staff that has worked alongside them for years, it feels like a moral injury to see their position so easily replaceable. These nurses provide skills and bring character to the unit that no one else can replace, and although new nurses can bring their own gifts and talents, it is devastating seeing your department’s heartbeat start to change. 

Not only are nurses working in a global pandemic pouring everything we have into helping patients, a new pandemic has hit healthcare workers specifically; it’s called burnout. Unfortunately many of the issues that contribute to this burnout have existed for decades, but COVID has multiplied their effects and are pushing nurses to their extreme limits. 

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Nurses constantly mention that the pay rate in relation to the risk remains one of the main reasons that drives them away from the bedside. 

◉ Nurses haven’t received any hazard pay throughout this entire pandemic, and most have not received any raise larger than the expected cost of living increase. 

◉ It feels insulting when hospital management will not offer any retention incentives, but will pay travelers 3 times the hourly wage to do the same job. It’s no wonder so many nurses are leaving their current place of employment and traveling for a short time, but until hospitals can start offering more incentive for nurses to stay, the problem will only continue to escalate. 

Unsurprisingly, however, the most common reason nurses are leaving the bedside is the increased physical, emotional, and mental demands that have occurred within the past year. Regardless of the department, the pandemic has caused a decrease in staff, supplies, and support which has resulted in nurses picking up extra patients, shifts, and responsibilities. Our breaks have been replaced with extra patients, and our empathy has been replaced with exhausted hearts. Just in the past few weeks, I have heard nurses tell me these reasons they find nursing harder than ever.

◉ “The more I’m in the hospital, the more I hate the hospital”

◉ “It is hard to care for patients anymore”

◉ “I just can’t find it in me to care anymore. I try, but I just don’t care.”

◉ “It is just depressing watching people die all the time.”

◉ “I’m now doing three people’s jobs. Shouldn’t I get paid three people’s salaries?”

◉ “My body can’t handle it any more. I need a way out to save my physical body.”

◉ “I am starting to hate human kind.”

Anonymously share your experience working as a nurse right now - take “The State of Nursing” survey. 

Gone are the days of the idyllic images of Florence and nurses walking around with neatly done hair and large smiles while ambulating their patient down the hallway. Now we have images of nurses in space suits with cracked lips due to dehydration, hair in dreads from the three masks that keep rubbing their heads raw, and bags we don’t even get discounts for recycling under our eyes from doing the work of three other people. 

America is about to see a nursing shortage unlike anything else. Unless we see systemic change beyond what we could even imagine, this profession will endure an inevitable change. I do not place any blame on my coworkers who have chosen to pursue a different career, but for those of us that continue to work at the bedside, it often feels like so much effort to remain upbeat and positive about the nature of our profession. 

Read more about the systemic issues causing nurses to leave the profession, click here. 

Source: nurse.org

Wednesday, 22 September 2021

The elderly have been determined to be among those most vulnerable to coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The mortality rate and severity of the disease in this group are reported to be extremely high. In most countries, COVID-19 vaccination has been prioritized for residents and staff of long-term care facilities (LTCFs) and frontline workers. In Norway, residents of LTCFs primarily receive health care at the facility. They are generally not admitted to hospitals except in emergencies.

Background

It is important to understand the vaccine effectiveness (VE) to determine how much protection it offers to the general population. Unfortunately, only a few studies are available that have determined the effect of the COVID-19 vaccine among the residents of LTCFs.

The unique setting in Norway allowed the scientists to study VE among both staff and residents in LTCFs.

Taking this opportunity, researchers focused on estimating the effectiveness of COVID-19 vaccines in preventing SARS-CoV-2 infections among residents and staff of LTCFs. They also analyzed the effect of the vaccine on the rate of hospitalization among staff and deaths among residents.

It must be highlighted that both these factors, i.e., mortality rate and hospitalization represent disease severity. This research, which can act as a guide for COVID-19 vaccination programs, is available on the medRxiv preprint server.

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Effectiveness of COVID-19 vaccines among residents and health care workers in LTCFs

In this study, researchers obtained data from BeredtC19, a preparedness registry containing individual-level data from various Norwegian registries.

They included all health care workers (HCW) who worked at LTCFs in the third week of January 2021 and residents who registered for a long-term stay at an LTCF in 2020.

This study excluded individuals who did not adhere to national recommendations about the interval between the first and second dose of the COVID-19 vaccine.

To avoid biases, individuals who had prior SARS-CoV-2 infection were not considered in this study. Researchers defined the vaccination status as unvaccinated (less than 14 days after the first dose of vaccine), partially vaccinated (14 days or more after the 1st dose and less than six days after the second dose), and fully vaccinated (seven days or more after the second dose).

In the sample considered for this study, 85.4% of LTCF residents and 71.1% of the HCWs received at least one vaccine dose during the follow-up period. The median ages of the residents and HCWs were estimated to be 87 years 39 years, respectively.

Researchers used Cox proportional hazard models to calculate VE in this study cohort, considering the vaccination status and adjusting for the age, sex, and associated underlying health conditions. They estimated the VE against positive SARS-CoV-2 infection to be 81.5% among the fully vaccinated and 40.8% for partly vaccinated residents and HCWs.

Scientists explained that in this study, personal attributes of LTCF residents, such as sex, age, and underlying conditions, had a minimal effect on the estimation result due to the relatively uniform population characteristics.

The Cox proportional hazard models could not estimate the degree of protection that prevailed among partly vaccinated residents, which may be due to rapid vaccination rollout and relatively short intervals between doses, i.e., residents received their second COVID-19 vaccine dose three weeks after the first.

The mortality rate of the resident population owing to COVID-19 disease was high. As a result, researchers estimated the VE in preventing death from COVID-19. They reported that in the fully vaccinated group, the mortality rate was reduced by 93.1%.

After adjusting for the age, sex, and underlying conditions of the HCWs, the VE against positive SARS-CoV-2 infection was estimated to be 45.0% among the partly vaccinated members and 81.4% among fully vaccinated candidates. Previous studies had reported a low mortality rate associated with COVID-19 in the general population of Norway.

Unlike the previous group, hospital admissions were considered to be an indicator of disease severity among HCWs. The current study reported that around 56 HCWs were hospitalized with COVID-19, among which two candidates were partly vaccinated.

None of the fully vaccinated HCW candidates required hospitalization. This study reported VE against COVID-19 hospitalization to be 81.7% for partly vaccinated HCWs in LTCFs.

Interestingly, this study observed that the total protection of unvaccinated residents significantly increased through staff vaccination. Thus, scientists believe that the outcomes of this study could be essential for the management of COVID-19 in LTCFs.

Source: news-medical.net

Tuesday, 21 September 2021

Shortly after the mass vaccination program against coronavirus disease 2019 (COVID-19) began in the UK, news outlets began to report severe side effects in a minority of those vaccinated. One of the more serious conditions that occurred is known as cerebral venous thrombosis (CVT) – a blood clot in the brain's venous sinuses that can lead to swelling, hemorrhage and death.

Even more worrying, CVT in those who had recently been vaccinated showed a much higher mortality rate than CVT that had been triggered by alternate sources. Headache is the most common symptom following vaccination, and is also one of the most frequent symptoms of CVT.

Researchers from the Akershus University Hospital in Norway investigated 77 cases of CVT in vaccinated subjects to identify risks and warning signs to better predict these severe side effects. The group's findings can be found in the Journal of Headache and Pain.

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It is worth noting that these symptoms only occurred in a very small minority of individuals, and authorities recommend that everyone eligible to become vaccinated does so.

The researchers searched through PubMed for all case studies and reported cases of CVT, as well as examining reports from the United States Centers for Disease Control and Prevention and the European Medicines Data. They evaluated these gathered cases based on certain variables, including age, sex, use of contraceptives, use of hormone replacement therapy, presence of a headache, presence of additional symptoms, the interval between headache and first symptom, intracranial hemorrhage and death.

For a control group, they used reports of headaches following the vaccines from the United States Vaccine Adverse Event Reporting System. A search of 'headache' against coronavirus vaccines returns over 100,000 results.

To analyze the cases, univariate logistic regression was used, with a standard 0.05% confidence limit. In total, 4.2% of patients suffering CVT were between 60 and 69, 95.8% of patients were below sixty, and 46.5% were below 40. This is supported by previous studies from CVT in non-vaccinated patients, showing that individuals ~30 years old are at most risk. Women were more affected than men, and made up 89.7% of cases. Five patients used contraceptives, and one was receiving estrogen therapy.

It normally took over a week following the vaccination for the first symptom to present – in 50% of cases, this was a headache, with various systemic or neurological symptoms in the other 50%. In ~25% of cases, multiple location thrombosis was recorded. In 24.7% of cases, the patient died. The statistical analysis clearly showed that In patients with CVT, the presence of headache was associated with increased risk of hemorrhage — but not with increased risk of death.

While headache is a very common side effect, in the vast majority of cases, it is resolved harmlessly and quickly. In almost all of the cases of CVT in which the headache was described, the onset was delayed for a week or longer – a rarity in patients that did not suffer CVT. The headaches were also severe, became progressively more so, and did not respond well to treatment.

The authors highlight the value this early warning sign could provide, especially as most cases of CVT are not immediately diagnosed, and delayed treatment reduces patient prognosis significantly. They urge that physicians be informed of this warning sign. Informing recently vaccinated individuals could also increase survival rates – although it may easily increase vaccine hesitancy as well. CVT can be detected with computed tomography, which will could show warning signs such as hyperdense veins or sinus, venous infarcts, edema or intracranial hemorrhage. World Health Organization recommended treatment includes immunoglobulins and non-heparin-based anticoagulants.

Source: news-medical.net

Monday, 20 September 2021

Nursing Career, Nursing Responsibilities, Nursing Professionals, Nursing Roles, Nursing Certification


As an ER nurse, I am more nervous than ever for the future of our hospitals. When I say this, I am not referring to the catastrophic outcomes that have devastated so many patients and their family’s lives. I am talking about the abuse this pandemic has beaten down our staff with by hurling unrelenting punches in successive order; and I am worried about how hospitals will respond to this crisis. 

For the first time in my career, I am seeing nurses, doctors, techs, and a myriad of other ancillary staff express an anger towards some of the patient’s we are caring for. There are staff members that are verbalizing frustration and disdain directed at patients as a result of exhaustion. 

Under normal circumstances, many healthcare workers use dark humor and sarcastic banter directed at patients as a coping mechanism. But right now there is no comedic goal woven into the words I am hearing at work. There is anger, frustration, exhaustion, and apathy. My friends around the country are so burnt out; they have lost their desire to pour their hearts into this job because it keeps sucking the life out of them. 

Walking around the hospital hallways, I miss the joy. I miss the spark. I miss seeing my friends come alive after a meaningful patient interaction. I miss feeling supported. I miss the days when we talked about the headlines in one another’s lives instead of the headlines on the news. I miss seeing each other’s smiles. 

Compassion Fatigue

Compassion fatigue, defined as “the physical and mental exhaustion and emotional withdrawal experienced by those that care for sick or traumatized people over an extended period of time,” is slowly killing the future of nursing. Although this has always had disastrous ramifications for any nurse throughout their career, we are seeing unprecedented amounts of nurses fleeing the bedside because they can no longer deal with the secondary trauma related to our work. Understaffed and overworked has just become the new normal. Nurses have been refused vacation time, mandated overtime, forced to care for double the patient load, and required to work on new units. The disruptions in supply chains have made our jobs increasingly more challenging as we have to adapt to new materials and add extra steps to already complicated processes. 

Regardless of an individual’s personal opinion on the vaccine, both sides have felt the shift from being “essential” to being “expendable.” Some nurses feel personally disrespected as unvaccinated patient’s charge into our hospitals demanding that we save their lives. Other nurses fear losing their jobs after loyally serving a given institution for their entire career. The compounded amount of tension on top of an already stressful job has already pushed many nurses away from the bedside and in some hospitals has caused a division among their own staff. 

The REAL Nursing Shortage

The spring and early summer weeks gave us time to imagine what life might be like when this is all over. But, I worry that entering into another round of continually living in “fight or flight” mode in the hospitals will eventually use up all the reserve that some nurses have to give. Hospitals are currently treading water. They are unable to fill their hundreds of open clinical positions, older nurses that remained in the fight to get us through the initial wave are now retiring, new nurses coming into the profession have not been able to receive the same level of experience that they should, and the health of their current staff is declining at the rates COVID is increasing. 

As the months and years ahead begin to unfold, I am confident that the term “nursing shortage” will be thrown around like a football on a beach day. 

Let me be very clear. It is not that there is a shortage of nurses in this country. It is that there is a shortage of facilities that have been able to provide adequate working conditions throughout this pandemic to retain their staff. I fear for the endless ramifications this will have on my future in this profession. 

Read the report on the REAL reasons behind the nursing shortage

But perhaps my greatest fear is this. 

That in a few years when one of your family members is hospitalized, they will be missing out on some of the kindest, most compassionate, gracious, and attentive nurses because this pandemic pushed them away from the bedside. So America, please help do your part to end this. And please, be kind to my friends across the country who continue to show up despite having a tank that is well below empty.

Source: nurse.org

Tuesday, 14 September 2021

NICU Nurses, Nursing, Nurse, Nurse Career, Nurse Manager, Nursing Responsibilities


In honor of NICU Awareness Month, which started in September, the popular baby gear brand  4moms is helping out NICUs across the country by donating nearly $18,000 worth of MamaRoo baby swings to 15 different hospitals. 

The giveaway campaign from 4moms is being done in partnership with Project Sweet Peas, a non-profit that supports NICU families as well as families who have experienced infant loss and The Superhero Project, which raises money for NICUs, donates needed items like gift baskets for parents, and works to place Angel Eyes cameras so families who need to be away from their hospitalized infants can always keep a close eye on their little ones. 

All of the organizations involved are incredible and like any family who has experienced a NICU stay knows, every thoughtful gesture makes an entire world of difference. 

How to Win a MamaRoo for Your NICU Unit

The way the giveaway campaign works is simple: parents, families, or nurses can all nominate any NICU that they think is deserving to win the MamaRoo infant seat donation. In total, 15 hospitals will receive donations of the MamaRoo infant seats. 

4moms has sponsored this giveaway in the past, but this year has expanded its program to donate swings to 5 more hospitals, giving almost $10,000 more in product. Last year’s recipients were:

◉ Ascension Saint Vincent’s Hospital (Birmingham, AL)

◉ Elliot Hospital (Manchester, NH)

◉ Grandview Medical Center (Birmingham, AL)

◉ John Muir Medical Center (Walnut Creek, CA)

◉ Prisma Health Richland (Columbia, SC)

◉ Saint Joseph Hospital (Denver, CO)

◉ University of Maryland Medical Center (College Park, MD)

◉ Valleywise Health (Phoenix, AZ)

◉ Willis Knighton South (Shreveport, LA)

◉ Woman's Hospital (Baton Rouge, LA)

Because 4moms hopes to reach as many hospitals as possible, the 10 recipients from last year aren’t eligible for the gifting this year but can be nominated again in 2022. 

How MamaRoos Benefit NICUs

According to 4moms, the mamaRoo infant seat is instrumental in the NICU, especially because it can be an effective non-pharmacological intervention for babies experiencing symptoms of Neonatal Abstinence Syndrome (NAS). 

A 4moms representative tells Nurse.org that both doctors and nurses have found the natural bouncing and swaying motion of the MamaRoo Infant Seat to be a valuable tool for helping to calm and soothe these fragile patients when their families can't be there.  

If you’re not familiar with the magic that is the mamaRoo, allow us to explain it: unlike traditional baby swings, which only swing back and forth or sometimes, side to side, the mamaRoo is completely different. It doesn’t swing like a traditional baby swing but instead, bounces both up and down and from side-to-side, mimicking the motion of a baby being in a parent or caregiver’s arms.  

If you’ve never noticed how a baby will cry when you’re sitting down, but magically be happy again when you stand up and bounce them, you’ll understand exactly why the mamaRoo infant swing can be so helpful, especially in a NICU setting when babies need a lot of cuddling to thrive. The swing and seat combo provides much-needed movement as an extra “set of hands” for the hardworking and always-busy NICU nurses on the unit. 

Nominate a NICU

If you know of a NICU that you’d like to nominate (including your own, if you’re a NICU nurse!) you can fill out a form on the 4moms website to share about the NICU you’ve nominated and enter them to win. All you need to do to nominate a NICU is share a little bit of information about yourself, the NICU you’re nominating (you’ll need name, city, and zip code) and a 500-word submission about why you’d like 4moms to donate infant swings to that NICU unit. 

The 4moms website explains that the NICUs are chosen based on many different factors, including the submission story itself, how many times the NICU is nominated and if Project Sweet Peas or The Superhero Project are able to deliver in a market. The nomination submission period ends on September 30, 2021, so get out there and start nominating! 

Oh, and one last thing: 4moms also has another way to support NICUs if you’re already a mamaRoo infant swing owner--you can donate your gently used mamaRoo through 4moms partner program, Good Buy Gear, and in return, mamaRoo will donate one new infant seat to a NICU. Pretty cool, right?

Source: nurse.org 

Monday, 13 September 2021

There seems to be a tendency to hastily use imperfect and questionable data to train an AI solution for COVID-19, a dangerous trend that not only does not help any patient or physician but also damages the reputation of the AI community. Dealing with a pandemic – as significant as it is – does not suspend basic scientific principles. Data has to be curated by medical experts, and full and rigorous validations have to be performed, and results have to be reviewed by peers before we deploy any solution or even proposal into the world, particularly when the society is dealing with many uncertainties.

COVID-19 AI Research, COVID-19, Artificial Intelligence, Surge of Sensationalist, Coronavirus

It is safe to say that we are all deeply concerned about the COVID-19 pandemic. This coronavirus has drastically changed our reality: stress, restrictions, quarantines, heroic sacrifices of caregivers including staff, nurses and physicians, losing loved ones, economic hardships, and massive uncertainties about what is in store in the coming months. Under such circumstances, it is only natural that many of us are thinking of ways to help - in the fastest ways possible. The AI community is not an exception.

Machine learning methods live from data. They learn from labeled data to classify, predict and estimate. The quality and reliability of any AI method directly depend on the quality and reliability of the labeled data. In computer science, we talk about “garbage in, garbage out” (GIGO) which summarizes the experience that low-quality input data generates unreliable output or “garbage”. This becomes even more critical when we are dealing with highly complex data modalities, such as medical images - data that generally require highly specialized knowledge for correct interpretations.

Within the AI community, we are fully dependent on data. As long as the domain is not sensitive (finance, healthcare, surveillance, etc.), we usually assemble our datasets by using different methods; From the manual gathering of samples up to highly sophisticated crawlers to parse through the Internet and other publicly available repositories. In medical imaging, we deal with a highly sensitive domain in which a long process is generally required to curate and access a set of labeled images. Needless to say, the curation has to happen within the walls of a hospital not just because the experts are there, but also due to the required de-identification of images to comply with privacy regulations.

But, sometimes we get impatient; we create our toy datasets by the manual collection of publicly accessible sources (e.g., online journals) - and there is generally no concern about this approach. Most of the time we – as AI researchers with no clinical or medical competency – create our toy datasets to run initial investigations and get a feeling for the challenges to come. This usually happens in anticipation of receiving a professionally curated dataset, a process that is often slowed down by ethic reviews and intellectual property negotiations.  

To be clear, a “toy dataset” in the medical imaging domain is not a toy just because it is commonly very small, but more importantly because it has been created by engineers and computer scientists, and not by physicians and medical/clinical experts. And, nobody would complain if we play with our toys inside our AI labs to get prepared to deal with the actual data from the hospital.

Radiologists around the world are understandably very busy, to put it mildly; it is not the best time to forge collaborations with radiologists if you are an overambitious AI researcher who wants to help. So, some of us have started to assemble our own dataset to get prepared for future tasks.

Collections of x-ray and partly CT images – scraped from the Internet – seem to emerge here and there and appear to be evolving as the creators continue to add images. Because of the availability of such datasets on one side and the ubiquity of basic AI knowledge and tools on the other side, many AI enthusiasts and start-ups have impulsively begun to develop solutions for COVID-19 in x-ray images. One finds websites and blogs that advise how to detect COVID-19 from x-ray scans with high accuracy. Others provide a sort of tutorial on detecting COVID-19 in X-ray images. We are even starting to see non-peer-reviewed papers that go a step further and baptize their solution with aggrandizing names like “COVID-Net”. This type of works commonly lacks many experimental details to explain how one has dealt with a few images from a very small number of patients to feed the deep network. Such papers report no validation, and no radiologist has guided the experiments. Many of these works were hurriedly made public before the creators of datasets could even provide sufficient explanation about their collection process. In an attempt to overcome the small data size, AI enthusiasts and start-ups mix the few COVID-19 images with other public datasets, i.e., pneumonia datasets. This is generally quite clever but I looked more closely at one case and the trouble is that the pneumonia cases were pediatric images; so the COVID-Nets are comparing pediatric pneumonia (children one to five years old) with adult COVID-19 patients. Well, this happens when we exclude radiologists from research that needs expert oversight.

Why are we rushing to publish faulty AI results on tiny datasets mixed with wrong anatomies, with no radiological backing, and with no validation? Do we want to help COVID-19 patients?

Perhaps the abundance of funding opportunity announcements in recent days, and the possibility of getting exposure for our research is misleading us into faulty research conduct; we cannot abandon fundamental scientific principles due to lockdowns and quarantines. AI is neither a ventilator nor a vaccine nor a pill; it is extremely unlikely that the exhausted radiologists in Wuhan, Qom or Bergamo download the Python code of our poorly trained network (using insufficient and improper data and described in quickly written papers and blogs) to just obtain a flawed second opinion.

Yes, we all want to help. Let us wait for real data from hospitals, let us do the ethics clearance and de-identification, and let us work with radiologists to develop solutions for chest issues of the future. Otherwise, we may create the impression that we are doing sensational research and are more concerned with self-promotion than with the well-being of patients. Radiologists are working day and night to understand the manifestation of this virus in medical images. Let us work with them and learn from them to unleash the true potential of AI for combating viral infections in the future.

Source: news-medical.net

Saturday, 11 September 2021

Sleep plays a key role in human function and cognition, affecting learning, memory, physical recovery, metabolism, and immunity. The functional role of sleep is well documented across species, and more recently, research has revealed the function of sleep in regulating emotion. The relationship between the two is reciprocal; sleep is crucial for mental and physical health while regulating emotion plays a vital role in decreasing the detrimental effects of emotional stress on sleep physiology.

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How does sleep affect the processing positive and negative stimuli?


It is widely accepted that sleep is strongly implicated in the processing of daily stresses and emotions. Scientific literature has shown how sleep appears essential to our ability to cope with emotional stress in everyday life. Sleep loss and insomnia have been found to affect emotional reactivity and socialization. The effect of sleep has been well documented at various levels of function, such as on the psychomotor, sensory-motor, and cognitive levels; however, the emotional effects are less descriptive.

However, in general, the reaction to negative emotion has been documented to be significantly enhanced, while reactions to positive events are often subdued. A sleep deprivation study found that the response to positive stimuli was faster relative to the response elicited from negative and neutral stimuli. Other studies have corroborated this, showing that sleep loss increases subjective reports of stress, anxiety, and anger in response to low-stress situations and increases impulsivity towards negative stimuli. Notably, impulsivity is correlated with aggressive behavior – a tendency associated with sleep deprivation.

In another sleep deprivation study, 33 participants were subject to repeated functional magnetic resonance imaging (fMRI) sessions to determine the effect of 42 hours of sleep deprivation and after sleep recovery on brain responses and circadian rhythm in 33 healthy participants. The results showed participants' feelings of emotional distress (negative affect) remained comparatively stable during the first day, later significantly worsening after the first and second melatonin onsets in their circadian rhythm, which signals sleep.

The disruption or deprivation of sleep is both a symptom and a risk factor for several psychiatric disorders. In studies with children and young adults, insufficient sleep has increased incidents of confusion, anger, and depression alongside feelings of irritability, aggression, and frustration. This occurred in even as little as one night of sleep deprivation; subjects saw an increase in psychopathology schools for anxiety, depression, and paranoia. In this same research group, sleep deprivation was associated with a decreased ability to accept blame.

The long term effects of sleep deprivation on mental health


Sleep disturbances impede a sense of well-being and may affect the development and prognostic outcomes of affective disorders like depression. Since both rapid eye movement (REM) and non-REM (NREM) sleep help modulate emotional and motivational drives, these two sleep phases allow greater emotional capacity and adaptiveness during wakefulness. Healthy sleep repairs functional brain activity and adaptive processing. The integrity of the medial prefrontal cortex-amygdala connections is important in emotion regulation processes. Indeed, one night of sleep deprivation triggers a 60% amplification in the amygdala's reactivity to emotionally negative pictures relative to a normal night of sleep.

Another main aspect of regulation is the regulatory action of the hormone cortisol, which is involved in the control of stress and reactivity against emotions. Melatonin, which can regulate the reaction of cortisol, is a source of circadian disturbance and explains the change in emotional reactivity and alteration of the circadian cycle as a result of sleep deprivation – which is a source of emotional dysregulation.

As well as the exacerbation of emotional reactivity and responses to fear, sleep can create a negative outlook and increased levels of anxiety. Collectively, research demonstrates that sleep deprivation increases worry about future events, particularly if subjects are predisposed to anxiety in general. In one such study, sleep deprivation was found to increase anticipatory anxiety. Brain scans of 18 healthy young adults observing images containing emotionally disturbing or emotionally neutral content were used to trigger anticipatory anxiety. Ahead of viewing these images, subjects, when well-rested and subsequently sleep-deprived, were given visual cues before each series of images to convey the emotion to be elicited (neutral, negative, or either). Brain activity in response to the anticipatory signal was greater when the participants were sleep-deprived relative to the well-rested state, and this was pronounced in response to participants waiting in suspenseful anticipation. These responses were found to be particularly pronounced in the amygdala and the insular cortex. This was particularly amplified in subjects who were reported to be innately anxious. Explanations for this difference are attributed to changes in the amygdala, the emotional control center. Here, sleep-deprived participants show a 60% higher level of activity in this area relative to the well-rested state. Moreover, sleep deprivation has been found to disrupt the connection between the amygdala and the medial prefrontal cortex – this area regulates the amygdala function. Sleep deprivation causes the amygdala to overreact to negative stimuli as it becomes disconnected from brain areas that normally moderate its responses.

Sleep loss is also associated with reduced empathy and emotional recognition; therefore, poor sleep may reduce understanding between partners in a relationship, increasing the potential for conflict. Reduced empathy and empathic accuracy are also associated with increased levels of miscommunication and increased propensity to retaliate during conflict. These effects are linked to another finding; just one night of sleep loss impairs problem-solving, exacerbating an inability to resolve conflict.

Sleep loss compromises optimal effective functioning, affecting emotion generation the ability to regulate emotions and express them. The consensus is that getting an adequate amount of sleep each night promotes improved mood and health.

Source: news-medical.net

Thursday, 9 September 2021

The primary role of a nurse is to advocate and care for individuals and support them through health and illness. However, there are various other responsibilities of a nurse that form a part of the role of a nurse, including to:

◉ Record medical history and symptoms

◉ Collaborate with teams to plan for patient care

◉ Advocate for the health and wellbeing of patients

◉ Monitor patient health and record signs

◉ Administer medications and treatments

◉ Operate medical equipment

◉ Perform diagnostic tests

◉ Educate patients about management of illnesses

◉ Provide support and advice to patients

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Patient care


A nurse is a caregiver for patients and helps to manage physical needs, prevent illness, and treat health conditions. To do this, they need to observe and monitor the patient, recording any relevant information to aid in treatment decision-making.

Throughout the treatment process, the nurse follows the progress of the patient and acts accordingly with the patient’s best interests in mind. The care provided by a nurse extends beyond the administration of medications and other therapies. They are responsible for the holistic care of patients, which encompasses the psychosocial, developmental, cultural, and spiritual needs of the individual.

Patient advocacy


The patient is the first priority of the nurse. The role of the nurse is to advocate for the best interests of the patient and to maintain the patient’s dignity throughout treatment and care. This may include making suggestions in the treatment plan of patients, in collaboration with other health professionals.

This is particularly important because patients who are unwell are often unable to comprehend medical situations and act as they usually would. It is the role of the nurse to support the patient and represent the patient's best interests at all times, especially when treatment decisions are being made.

Planning of care


A nurse is directly involved in the decision-making process for the treatment of patients. It is important that they are able to think critically when assessing patient signs and identifying potential problems so that they can make the appropriate recommendations and actions.

As other health professionals, such as doctors or specialists, are usually in charge of making the final treatment decisions, nurses should be able to communicate information regarding patient health effectively. Nurses are the most familiar with the individual patient situation as they monitor their signs and symptoms on an ongoing basis and should collaborate with other members of the medical team to promote the best patient health outcomes.

Patient Education and Support


Nurses are also responsible for ensuring that patients are able to understand their health, illnesses, medications, and treatments to the best of their ability. This is of the essence when patients are discharged from hospital and need to take control of their own treatments.

A nurse should take the time to explain to the patient and their family or caregiver what to do and what to expect when they leave the hospital or medical clinic. They should also make sure that the patient feels supported and knows where to seek additional information.

Source: news-medical.net

Wednesday, 8 September 2021

NCLEX, NCLEX-RN, Nursing Responsibilities, Nursing Career, Nursing Professionals


If you're preparing to take the NCLEX-RN, you're probably wondering what to expect? What will the test consist of? How long does it take to get your results? How should you prepare? Keep reading for everything you need to know about the NCLEX and how to get ready for it.

What to Expect on the NCLEX-RN

According to the National Council of State Boards of Nursing (NCSBN), here's what you can expect on the NCLEX:

1. The first thing you'll need to do to take the NCLEX (after completing an accredited nursing program) is apply for licensure/registration with your nursing regulatory body (NRB)

2. Next, you'll need to register and pay the exam fee to Pearson VUE via the Internet or telephone.

3. Then, you'll receive Acknowledgement of Receipt of Registration from Pearson VUE by email. BON/RB makes you eligible in the Pearson VUE system.

4. After that, you'll receive Authorization to Test (ATT) through an email from Pearson VUE. You must test within the validity dates (an average of 90 days) on the ATT. There are no extensions.

5. Now you can go ahead and schedule your exam appointment online or by phone.

6. When your exam date arrives, you'll show up for the exam appointment and present your acceptable identification.

7. After the test is over, you'll receive your official results from your BON/RB up to six weeks after your exam (this time period varies amongst BONs/RBs).

What Does the NCLEX RN Consist of?

The NCBSN recommends prospective NCLEX test-takers download the NCLEX Candidate Bulletin to get the full picture of what to expect before, during, and after the NCLEX RN. We reviewed it for you and outlined the main takeaways:

1. How Much Does the NCLEX Cost?

For U.S. candidates, the NCLEX-RN will cost $200 in 2021. 

2. How Long is the NCLEX RN?

The minimum number of questions on the NCLEX is 75 and the maximum number of questions is 145. The max amount of time you can take on the exam is 5 hours, including all breaks.

3. What Subjects are on the NCLEX RN?

The NCLEX RN covers the following subjects:

Safe and Effective Care Environment

◉ Management of Care - 17-23%

◉ Safety and Infection Control - 9-15%

Health Promotion and Maintenance - 6-12%

Psychosocial Integrity - 6-12%

Physiological Integrity

◉ Basic Care and Comfort - 6-12%

◉ Pharmacological and Parenteral Therapies - 12-18%

◉ Reduction of Risk Potential - 9-15%

◉ Physiological Adaptation - 11-17%

4. What Format is the NCLEX Test In?

The NCLE is taken in a computerized adaptive testing (CAT) format. Essentially, the test will recalibrate itself based on your answers to questions. According to the NCBSN, "The computer’s goal during the NCLEX is to determine the ability of the candidate in relation to the passing standard. Every time the candidate answers an item, the computer re-estimates the candidate’s ability. With each additional answered item, the ability estimate becomes more precise." 

5. How Will You know if You Passed or Failed the NCLEX?

As we mentioned above, you'll receive your official results up to 6 weeks after you take the test. There are 3 different scenarios the CAT testing format uses to determine whether or not a candidate has passed the test according to the NCBSN:

NCLEX, NCLEX-RN, Nursing Responsibilities, Nursing Career, Nursing Professionals


1. 95% Confidence Interval Rule

This is the most common rule. Essentially, when the computer has determined with 95% confidence that you've either passed or not passed the test, it will stop giving you questions. 

2. Maximum-length Exam Rule

This is when the computer keeps giving you questions until you've reached the full number of possible questions. It will do this when you're really close to the passing standard. Then it will look at your final ability estimate to determine if you've passed.

3. Run-Out-Of-Time-Rule (R.O.O.T.)

If you run out of time before reaching the maximum number of items, one of two things can happen. If you answered the minimum number of questions, then the computer will score you based on your final ability estimate. If you didn't answer the minimum number of questions, you'll fail the exam.

Source: nurse.org

Tuesday, 7 September 2021

21st Century nursing is the glue that holds a patient’s health care journey together. Across the entire patient experience, and wherever there is someone in need of care, nurses work tirelessly to identify and protect the needs of the individual.

Beyond the time-honored reputation for compassion and dedication lies a highly specialized profession, which is constantly evolving to address the needs of society. From ensuring the most accurate diagnoses to the ongoing education of the public about critical health issues; nurses are indispensable in safeguarding public health.

Nursing Responsibilities, Nursing Professionals, Nursing, Nurse, Nurse Career

Nursing can be described as both an art and a science; a heart and a mind. At its heart, lies a fundamental respect for human dignity and an intuition for a patient’s needs. This is supported by the mind, in the form of rigorous core learning. Due to the vast range of specialisms and complex skills in the nursing profession, each nurse will have specific strengths, passions, and expertise.

However, nursing has a unifying ethos:  In assessing a patient, nurses do not just consider test results. Through the critical thinking exemplified in the nursing process (see below), nurses use their judgment to integrate objective data with subjective experience of a patient’s biological, physical and behavioral needs. This ensures that every patient, from city hospital to community health center; state prison to summer camp, receives the best possible care regardless of who they are, or where they may be.

What exactly do nurses do?


In a field as varied as nursing, there is no typical answer. Responsibilities can range from making acute treatment decisions to providing inoculations in schools. The key unifying characteristic in every role is the skill and drive that it takes to be a nurse. Through long-term monitoring of patients’ behavior and knowledge-based expertise, nurses are best placed to take an all-encompassing view of a patient’s wellbeing.

What types of nurses are there?


All nurses complete a rigorous program of extensive education and study, and work directly with patients, families, and communities using the core values of the nursing process. In the United States today, nursing roles can be divided into three categories by the specific responsibilities they undertake.

Registered Nurses


Registered nurses (RN) form the backbone of health care provision in the United States. RNs provide critical health care to the public wherever it is needed.

Key Responsibilities

◉ Perform physical exams and health histories before making critical decisions

◉ Provide health promotion, counseling and education

◉ Administer medications and other personalized interventions

◉ Coordinate care, in collaboration with a wide array of health care professionals

Advanced Practice Registered Nurses


Advance Practice Registered Nurses (APRN) hold at least a Master’s degree, in addition to the initial nursing education and licensing required for all RNs. The responsibilities of an APRN include, but are not limited to, providing invaluable primary and preventative health care to the public. APRNs treat and diagnose illnesses, advise the public on health issues, manage chronic disease and engage in continuous education to remain at the very forefront of any technological, methodological, or other developments in the field.

APRNs Practice Specialist Roles


◉ Nurse Practitioners prescribe medication, diagnose and treat minor illnesses and injuries

◉ Certified Nurse-Midwives provide gynecological and low-risk obstetrical care

◉ Clinical Nurse Specialists handle a wide range of physical and mental health problems

◉ Certified Registered Nurse Anesthetists administer more than 65 percent of all anesthetics

Licensed Practical Nurses


Licensed Practical Nurses (LPN), also known as Licensed Vocational Nurses (LVNs), support the core health care team and work under the supervision of an RN, APRN or MD. By providing basic and routine care, they ensure the wellbeing of patients throughout the whole of the health care journey

Key Responsibilities

◉ Check vital signs and look for signs that health is deteriorating or improving

◉ Perform basic nursing functions such as changing bandages and wound dressings

◉ Ensure patients are comfortable, well-fed and hydrated

◉ May administer medications in some settings

What is the nursing process?


No matter what their field or specialty, all nurses utilize the same nursing process; a scientific method designed to deliver the very best in patient care, through five simple steps.

◉ Assessment – Nurses assess patients on an in-depth physiological, economic, social and lifestyle basis.

◉ Diagnosis – Through careful consideration of both physical symptoms and patient behavior, the nurse forms a diagnosis.

◉ Outcomes / Planning – The nurse uses their expertise to set realistic goals for the patient’s recovery. These objectives are then closely monitored.

◉ Implementation – By accurately implementing the care plan, nurses guarantee consistency of care for the patient whilst meticulously documenting their progress.

◉ Evaluation – By closely analyzing the effectiveness of the care plan and studying patient response, the nurse hones the plan to achieve the very best patient outcomes. 

Nurses are Key to the Health of the Nation


◉ There are over 4 million registered nurses in the United States today.

◉ That means that one in every 100 people is a registered nurse.

◉ Nurses are in every community – large and small – providing expert care from birth to the end of life.

◉ According to the January 2012 “United States Registered Nurse Workforce Report Card and Shortage Forecast” in the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2009 and 2030. In this state-by-state analysis, the authors forecast the RN shortage to be most intense in the South and the West

◉ Nurses' roles range from direct patient care and case management to establishing nursing practice standards, developing quality assurance procedures, and directing complex nursing care systems.

Source: nursingworld.org

Sunday, 5 September 2021

NCLEX, Nursing Responsibilities, Nursing Degree, Health Professionals, Nursing Practitioners, Nursing Exam US


The final hurdle to become a fully licensed Registered Nurse is the National Council Licensure Examination (NCLEX).

To some, this is a daunting feat requiring countless hours of preparation and thousands of sample questions. Others take lengthy review courses in conjunction with online study programs. According to the National Council of State Boards of Nursing (NCSBN), 85% of new graduates passed the NCLEX on their first attempt in 2021.

So what does that mean for the other 15%?

Nurses who’ve failed their boards on the first attempt -- as well as nursing experts -- explain that it takes commitment, perseverance, humility, and grace to overcome this hurdle. A shocking number of new graduates fail their boards on the first attempt, but it’s rarely discussed.

Interestingly, a large number of nurses have a coworker who failed the NCLEX. In fact, including internationally educated nurses and repeat test-takers, the pass rate in 2021 was only 66% on the first attempt, per the NCBSN.

Signs You Failed the NCLEX RN

While the only way to know for sure whether or not you passed the NCLEX is to wait for the official results, we all know it can be impossible to wait. Especially when it can take up to 6 weeks to get those results.

So you can have some sense of how you did on the NCLEX exam, let's dig into how it's scored. 

How the NCLEX RN Is Scored

The NCLEX is taken using a Computerized Adaptive Testing (CAT) format. Basically, the computer adjusts the type of questions and number of questions you answer based on how you responded to previous questions.

Because of this, many people try to gauge whether or not they passed the test based on how many questions they were given. 

According to the NCBSN, there are 3 different scenarios their testing software uses to determine whether or not a candidate has passed the NCLEX:

1. 95% Confidence Interval Rule

With this rule (the most common way they judge test-takers), when the computer has determined with 95% confidence that you've either passed or not passed the test, it will stop giving you questions.

Since the minimum number of questions you'll take on the NCLEX is 75 and the maximum is 145, this could happen at any point between those 2 numbers. Theoretically, the computer could know from your first 75 questions that you failed and stop giving you more, or it could know that you passed. It's impossible to know which scenario you fall into based on how many questions you answered alone.

2. Maximum-length Exam Rule

If you end up answering the full 145 questions, that is an indication that you're close to the passing standard and the computer is going to keep giving you questions until you've reached the full number of possible questions.

So, don't think just because you had to answer all the questions, or the test is taking you longer than others, that you failed! The computer is just doing its best to determine where you are at. It will look at your final ability estimate to determine if you've passed, rather than the 95% confidence rule mentioned above. 

3. Run-Out-Of-Time-Rule (R.O.O.T.)

If you run out of time before reaching the maximum number of items, one of two things can happen.

◉ If you answered the minimum number of questions, then the computer will score you based on your final ability estimate.

◉ If you didn't answer the minimum number of questions, you'll fail the exam.

So, one sign that you did fail the NCLEX is if you ran out of time before completing the minimum 75 questions. Other than that one scenario, unfortunately, you're going to have to wait for those official results to really know whether or not you passed. 

What to Do If You Did Fail the NCLEX

If you did fail the NCLEX, don't freak out! You can take it again. And now that you have some experience with the exam, you're even more well-equipped to nail it the second time around. Here's what to do if you failed the NCLEX:

1.) Analyze Why You Failed the NCLEX

It’s important for nurses to recognize why they failed, and for every nurse the reason will be different. Some fail due to personal responsibilities, including family. Others suffer from lack of preparation, difficulty with critical thinking and multiple choice questions, the inability to focus during studying, or being distracted during testing.

Each of these can be overcome but require immediate and focused attention.

A study conducted in 2008 by the NCSBN concluded that for those who fail, it’s important to retake the NCLEX as soon as possible. It found that delaying the exam after graduation doesn’t increase the chance of failure. Rather, delaying after initially failing can increase the chance of failing a second time.

Once it’s been determined why you failed, think about what you need to do differently in order to change the outcome.

Enrolling in NCLEX prep courses can be helpful for those requiring personalized attention and in-person reviews. Many of these courses are instructor-based and offer a money back guarantee. Review courses can increase confidence and help with critical thinking skills.

It’s important to take multiple practice tests and answer hundreds of questions in order to become increasingly familiar with the test format and questions. Some questions have multiple answers that may in fact be correct, but the NCLEX searches for the best possible answer. Sample online tests can be found through various websites or through NCLEX study books.

2.) Take Action to Make Sure You Pass the Next Time Around

After determining why you failed, it’s time to take action with this information. First, write down as many of the topics from the initial test that you can remember. These could include lab results, obstetrics, cardiology, or time management questions.

If there’s one area where you feel especially weak, spend some time reviewing content material related to this subject. Some experts suggest answering 50 questions per day with a specific focus on areas of weakness. 

Study guides containing review questions are a potential nurse’s best friend. Every day, regardless of outside factors, experts recommend at least 150-250 questions should be answered. The questions answered incorrectly should be reviewed and content material reexamined if there is still confusion. 

Lippincott's NCLEX Review Guide contains more than 3,000 sample questions with correct and incorrect answers and rationales, as well as a diskette containing an additional 100 questions. The book is separated into different clinical areas so that you can concentrate on your weak area and not spend too much time on areas where you’re more comfortable. 

3.) Stay Positive!

Despite the hours of preparation, the most important advice any nurse can give is to stay positive and expect to pass. Failing the NCLEX on the first attempt doesn’t adversely affect one’s future nursing career. It’s important to not get stuck in a cycle of depression or self-doubt after failure.

Don’t give up. Remember, you made it through nursing school, so you have the persistence to pass the state boards and earn your license to practice.

Source: nurse.org

Thursday, 2 September 2021

Nursing Career, Nursing Responsibilities, Nursing Professionals, Nursing Practitioners, Nursing Skill


"In order to mitigate negative staffing impacts on Texas healthcare systems and EMS agencies, the state of Texas will only allow personnel deploying for this emergency response to be NON-RESIDENTS of Texas only and to have not been employed by a Texas Acute Care hospital or EMS agency within 30 days.

This is mandated from the state of Texas. All healthcare workers with applicable licensure are eligible for ANY Krucial Staffing contract opportunities that are direct agreements and not directed by entities outside of the healthcare facility," Krucial Staffing posted on Instagram.

Nursing Career, Nursing Responsibilities, Nursing Professionals, Nursing Practitioners, Nursing Skill


A quick search on several travel nurse job boards will find many job postings stating that Texas is not currently accepting nurses who are residents and who work in Texas to work for FEMA or government-funded disaster contracts. Here is one such job posting

We reached out to Krucial Staffing for information on the mandate and instructions on how out-of-state nurses can apply. Here is their response,

We are following the mandate from the state of Texas that those healthcare personnel Krucial Staffing recruits for deployment in Texas must be non-residents of Texas and cannot have been employed by a Texas Acute Care hospital or EMS agency within 30 days.

All healthcare workers that meet this standard and have applicable licensure are eligible for any Krucial Staffing contract opportunities that are direct agreements and not directed by entities outside of the healthcare facility.

Our mission is to help the hospitals and ultimately the individuals who are suffering in their greatest time of need. If you are interested in applying with Krucial Staffing, please go to this link

Details

Governor Abbott passed a mandate that prohibits Texas residents who are currently employed from working for FEMA or state-funded disaster response agencies. The problem apparently lies in this sentence from his August 9, 2021 press release announcing the actions he planned to take in response to rising COVID-19 cases: “The Texas Department of State Health Services (DSHS) will be utilizing staffing agencies to provide medical personnel from out-of-state to Texas health care facilities to assist in COVID-19 operations.”

Apparently, that little stipulation that the medical personnel is from out-of-state has resulted in current employed Texas nurses or current travelers based in Texas being unable to work government-funded disaster response contracts if they have been employed at a hospital within the state in the past 30 days.

Texas in Dire Need of Thousand of Nurses

Texas is looking to fill 6,500 healthcare positions from out-of-state or unemployed Texas nurses to help with the COVID-19 response. Texas is dealing with a record number of ICU hospitalizations from COVID-19 and thanks to a severe shortage of nurses, the state has extended its state of emergency. 

Last Monday, Texas Governor Greg Abbott requested help from the Texas Department of State in dealing with the surge in cases. Part of that help included funding to hire travel nurses as outlined in the document titled, "Governor Abbott's Proactive Response To The Coronavirus Threat."

However, the funding stipulates that it only can be used to hire nurses who aren’t currently working (staff or travel contracts) in Texas -- and the move is both enticing travel nurses outside of the state with high-paying disaster response crisis contracts and angering Texas nurses who are now prohibited from quitting their staff or travel nursing assignments to work these disaster response crisis contracts in hard-hit areas of their own state.

What’s Happening in Texas? 

Basically, things are bad in Texas. So bad that Sophia Morris, vice president of account management for the travel nursing agency Aya Healthcare, called it “the worst that we’ve seen in Texas.”

The problem is that the Delta variant has swept the state, leading to 11,522 current hospitalizations, the highest it’s ever been during the pandemic, at the same time that there is a nursing shortage from so many nurses being burned out or falling ill. 

Serena Bumpus, Director of Practice in Nursing for the Texas Nurses Association told CBS Austin that the state was already 30,000 nurses short in Texas in 2018 and it was predicted by 2032, Texas would be short 60,000 nurses. However, the pandemic sped up that timeline. “The prediction is that we have well surpassed those numbers due to the pandemic,” she told the news outlet. 

The Texas Hospital Association (THA) explained in a statement that it’s the combination of a lack of nurses and the current surge that has overwhelmed the medical system and led to the dire need to call in contract workers.  

“This surge is nothing like anything we’ve ever seen,” the THA said. “Hospitals are doing everything in their power to figure this out. Staffing is a critical issue and this spike is unsustainable without help. Many hospitals have already idled non-essential services and are offering bonuses and incentive pay just to keep staff.”

To help with the situation, the Governor did outline specific steps he planned to take to deal with the influx of patients, including asking the THA to request that hospitals stop non-emergency medical procedures, opening antibody infusion centers, and expanding vaccine administration. Along with proactive steps, Abbott also requested that additional travel nurses and healthcare staff from out-of-state be brought in to help with the overwhelming needs inside of hospitals and healthcare facilities. 

And unfortunately, as we heard warnings from the start of the pandemic, it’s not just COVID-19 cases that are the problem–it’s the fact that the beds are filling up so fast that people without COVID have nowhere to go for their medical needs. 

“This thing has really overwhelmed our resources,” explained Texas Tech University Health Sciences Center Regional Chair of Surgery Dr. M. Haris Nazim to a local news station. “The ERs are full, I can tell you there are patients that are getting transported hundreds or thousands of miles away just to seek care. It may not be COVID related.”

What's Causing The Nursing Shortage in TX?

According to the THA, Texas is attempting to fill the gaps in nursing care with out-of-state healthcare workers, all coordinated by the state through staffing agencies. The organization explained that the hospital industry has lost a ton of nurses throughout the pandemic as a result of both extreme burnout and illness themselves. 

“Many have left the profession due to the extreme nature of the work during a relentless pandemic,” the THA states on their website. 

However, there’s a minor complication that some nurses are seeing with the whole situation in Texas. Namely, that they feel the state is punishing nurses who do live there by prohibiting them from working contract positions during this time of crisis.

How Are Nurses Reacting

Some Texas nurses aren’t happy that they have been left out of the opportunity to help in their home state by working disaster-response contracts and earn a wage that, let’s face it, they deserve more than anyone. They feel the ban exists to try to ensure that staff nurses in Texas don’t quit their jobs in order to take higher-paying disaster response crisis contracts and that ultimately, it’s only going to add to the already-dire nursing shortage in Texas in the long run.

“Of course they don’t want TX Nurses because they are mad the Nurses don’t want to be staff anymore,” commented one nurse on Facebook. “And instead of paying them what they deserve, to care for critically ill patients and higher nurse ratios, they try to block TX Nurses. But… there are literally 49 other states! Nurses do not forget. So doing this isn’t going to help the problem. It’ll make it worse.” 

Other nurses in Texas are begging for help in getting the ban reversed. 

“If you know a nurse and appreciate what we do, please support us,” another Texas nurse pleaded on Facebook earlier last week. “Call Abbott and demand he allow crisis response agencies hire Texas travel nurses."

Source: nurse.org

Saturday, 28 August 2021

COVID-19, Nursing Responsibilities, Nursing Career, Nursing Professionals, Nursing Degree, Nursing Degree US, Nursing Exam US, Nursing Certification


Today, in a long-awaited move, the FDA has finally granted full approval to Pfizer’s COVID vaccine, making it the first FDA-approved vaccine for COVID-19. The FDA’s official statement reads: 

“The FDA’s approval of this vaccine is a milestone as we continue to battle the COVID-19 pandemic. While this and other vaccines have met the FDA’s rigorous, scientific standards for emergency use authorization, as the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product,” said Acting FDA Commissioner Janet Woodcock, M.D. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated. Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.” 

In a statement about the vaccine’s approval, the FDA also noted that there has been a name change to the vaccine: formerly known as the Pfizer-BioNTech COVID-19 vaccine, the vaccine will now be called Comirnaty (koe-mir’-na-tee). According to a joint press release from Pfizer and BioNTech, the name is a combination of the terms COVID-19, mRNA, community, and immunity. 

Details about the Vaccine

The newly-named Comirnaty vaccine (given in 2 doses, 3 weeks apart) is fully approved for people ages 16 and up, while emergency authorization (EUA) will continue for anyone 12-15 and for a third booster shot in immunocompromised people who qualify. 

Like the Moderna vaccine, the Comirnaty vaccine is an mRNA vaccine--which means the vaccine contains mRNA that will create a protein similar to the one in the virus that causes COVID-19. However, the FDA noted in their approval that the mRNA is only in the body for a short amount of time and is not incorporated into or alters a person’s genes. 

If you’re curious about what’s in the vaccine, the package insert also lists all of the ingredients of the Comirnaty vaccine (formerly known as Pfizer’s vaccine):

◉ lipids: (0.43 mg ((4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate), 0.05 mg 2-(polyethylene glycol 2000)-N,N-ditetradecylacetamide, 0.09 mg 1,2-distearoyl-sn-glycero-3-phosphocholine, and 0.2 mg cholesterol)

◉ 0.01 mg potassium chloride

◉ 0.01 mg monobasic potassium phosphate

◉ 0.36 mg sodium chloride

◉ 0.07 mg dibasic sodium phosphate dihydrate

◉ 6 mg sucrose

◉ The diluent (0.9% Sodium Chloride Injection, USP) contributes an additional 2.16 mg sodium chloride per dose.

◉ COMIRNATY does not contain preservatives

What Took So Long?

If you’re wondering what exactly took so long to get this vaccine officially approved by the FDA, you’re not alone--but the FDA did address what exactly goes into the approval process. (And for the record, historically, vaccine approvals have taken several years, so even though many people felt like the vaccine should have been approved months ago, this was still a relatively speedy process.)

The FDA explained that the approval for any vaccines follows a “standard process” that reviews the quality, safety, and effectiveness of a medical product. Vaccine approval also involves:

◉ Evaluating data and information from the manufacturer’s biologics license application (BLA)

◉ Additional information from both the EUA data and ongoing data

◉ Manufacturing process review

◉ Vaccine testing results for vaccine quality

◉ Site inspections where the vaccine is made

◉ An FDA-specific analysis to ensure the vaccine meets FDA standards

They also listed some detailed information about the specifics of the safety and efficacy results of Pfizer’s vaccine that led to the full approval. 

Effectiveness

◉ Data from approximately 20,000 vaccine and 20,000 placebo recipients ages 16 and older (with no evidence of the COVID-19 virus infection within a week of receiving the second dose) was used

◉ Based on results from the clinical trial, the vaccine was 91% effective in preventing COVID-19 disease. 

Safety

◉ Data from approximately 22,000 people aged 16+ who got the vaccine and 22,000 people who had a placebo was used.

◉ Over half of the clinical trial participants were followed 4 months after the second dose and overall, 12,000 people who had the vaccine were followed for at least 6 months.

◉ The most common side effects were: pain, redness and swelling at the injection site, fatigue, headache, muscle or joint pain, chills, and fever.

◉ According to post-EUA safety data, the FDA concluded there is an increased risk of myocarditis and pericarditis, especially within 7 days of the second dose. The risk is higher in males under age 50, with the highest risk in men 12-17. The FDA noted that “available” data shows most people’s symptoms resolved on their own, while others required intensive care support.

◉ Syncope (fainting) upon administration also received a special address in the Comirnaty’s packet insert, as some people have experienced syncope with the vaccine, although according to the company, it’s not clear why. 

“Our scientific and medical experts conducted an incredibly thorough and thoughtful evaluation of this vaccine. We evaluated scientific data and information included in hundreds of thousands of pages, conducted our own analyses of Comirnaty’s safety and effectiveness, and performed a detailed assessment of the manufacturing processes, including inspections of the manufacturing facilities,” Peter Marks, M.D., Ph.D., director of FDA’s Center for Biologics Evaluation and Research said in the FDA’s statement. “We have not lost sight that the COVID-19 public health crisis continues in the U.S. and that the public is counting on safe and effective vaccines. The public and the medical community can be confident that although we approved this vaccine expeditiously, it was fully in keeping with our existing high standards for vaccines in the U.S."

What Happens Next?

There is hope from both political leaders and healthcare officials that the full FDA approval will help encourage vaccine-hesitant individuals to get vaccinated. In an address from the White House, President Joe Biden called on Americans who had been waiting for the vaccine’s full approval to get vaccinated as soon as possible. 

"If you are one of the millions of Americans who said they will not get the shot until it has full and final approval of the FDA, it has now happened. The moment you've been waiting for is here, it's time for you to go get your vaccination, and get it today. Today,” he said. 

The American Medical Association, the American Hospital Association and the American Nurses Association also released a statement applauding the FDA's full approval of the Pfizer COVID-19 vaccine.

“According to recent polling, 30 percent of unvaccinated people said they were waiting for vaccines to receive full approval before getting vaccinated. We are there now; this vaccine is fully approved. If uncertainty was holding you back, now is the time to act. And if you still have questions about the vaccines or about COVID-19, please consult your health care professional,” the statement reads. 

“With millions of data points on the vaccine’s safety and efficacy over nearly nine months of vaccinations, every ‘i’ is dotted and every ‘t’ is crossed. This vaccine is safe, it prevents severe COVID-19, hospitalization, and deaths, and it will save your life. Science, data, and thorough research have given us the tools to defeat COVID-19. With the delta variant surging, there has never been a better time to get vaccinated.”

Source: nurse.org

Thursday, 26 August 2021

Nursing Schools, Nursing Career, Nursing Responsibilities, Nursing Professionals, Nursing Degree, Nursing Degree US


Congratulations, you’ve made it into nursing school! You've worked so hard to get to this point and now here come the nerves. You're thinking to yourself, “What have I gotten myself into?!” Well, thankfully there are nurses who’ve been here before you and have lived to tell the tale. Read on to get an idea of what to expect during nursing school, including:

◉ What do you learn in nursing school?

◉ What classes do you take?

◉ When do clinical rotations start?

◉ How hard is nursing school?

What is Nursing School Like?

Your study habits will change

You're going to be asked to learn A LOT of material. As a result, you will have to become aware of your study habits and adapt them to maximize your information intake. It will be challenging in your first semester, but you'll quickly get the hang of it.

You’ll learn to go beyond the textbook

A lot of information will be provided to you -- via textbooks, lectures, and other coursework content -- but you will also need to use your judgment to obtain the information in different ways when you don't fully understand the material. Read the text, watch videos, or get actual experience through volunteer work or hired work.

What Are Nursing School Exams Like? 

You will be challenged with exams that are structured in ways that are very different than in the hard sciences. Nursing is not black and white and because of this, exams can be especially challenging.

Build the ability to understand what is being asked of you. These exams are not created to set you up to fail, but rather to get you to think in a certain way. This way of thinking will help you in your nursing practice.

How Are Nursing Classes Structured? 

Although every nursing school will have its own curriculum, typically your first semester consists of three to four days of lecture, with one to two days of simulation lab. You will find yourself on campus a lot, both in scrubs and in regular clothes. 

What Classes Do You Take During Nursing School?

The first semester of nursing school usually has three to four major courses, typically:

◉ Fundamentals of Nursing 

◉ Health Assessments

◉ Pharmacology

In addition to the didactic courses, you will be in Skills Lab (or Simulation Lab) for a certain amount of hours once or twice a week. Here, you will learn how to perform the various skills required of the profession: inserting peripheral IV's, NG tubes, and other important tasks. 

You will need to wear your scrubs, and bring all your tools as if you're going into a day at work in the hospital.

When Do Clinical Rotations Start?

Some programs begin exposing first-semester nursing students to the actual hospital environment, while other programs do not offer clinicals until the second semester.

If your program does have clinicals in its first-semester curriculum, it will usually be in the latter half of the semester.

What Do I Need To Buy For Nursing School? 

In addition to your textbooks, scrubs, and stethoscope, you may be exposed to a whole slew of items marketed to nursing students. These products can include simulated charting programs to practice documenting, iPhone and Android apps that offer reference material, and other products that may seem like the keys to success in the nursing program. 

Be wary! There’s a lot of free material available to you and no product is going to pass nursing school for you. It just takes time and dedication, something you are already capable of! 

How Hard Is Nursing School?

Nursing school will definitely challenge you academically, but it will also be hard emotionally, physically and mentally. How hard is nursing school? That depends on the program. But, don’t worry, here’s what you need to know to get through it. 

Emotional challenges

Being a beginner is really hard. There's so much to learn, which can make you feel insecure. When you're first starting out, the sheer amount of things that you need to learn seems like an impossible feat. This is when all the questions come rushing in: “Can I do this?”, “Am I good enough?”, “Is this right for me?” Just remember that this is totally normal. 

To overcome these feelings, you NEED a support system. It can be your best friend, partner, mom, or all of the above. You just need someone to check in with you who can see with a more objective view of how hard you're working and how far you've come. 

Secondly, seek out a mentor. Ideally, this would be someone in the field who can give you perspective on what you're learning. A professor, preceptor, or even another Nurse.org community member -- reach out!

Physical challenges

The nursing school schedule is demanding. You’ll have long days, early days, days filled with sitting in a lecture followed by a few more hours of simulation in a lab.

Here are my not-so-secret tips to surviving a demanding schedule: 

◉ Drink water. 

◉ Take your vitamins. 

◉ Keep a consistent workout schedule that is flexible for your coursework. 

◉ Find ways to decompress your stress - being in nature, time with friends, etc. 

It sounds simple, but it’s SO IMPORTANT. Doing these basic things to take care of yourself will help you enjoy the process so you don’t end up hating your life while you’re in school.

Mental challenges

One of the biggest challenges is stepping into an environment unlike any you’ve had to deal with before. If you’ve never worked with the ill, it may be a shock to you when you witness your first death or are present while a patient is suffering from an intense manic episode. 

It’s going to be a struggle at first, but over time you’ll learn to maintain your calm and stay professional even during intense moments. It won't come right away, but it will come. Be patient and simply take note of how those around you have found ways to keep their cool.

How to Prepare for Nursing School? 

You've already seen the memes and videos about how demanding a nursing program can be. Yes, there is a lot of content to learn over the course of a short time, but one of the biggest challenges is putting the information into context. 

When you enter nursing school without any former medical experience, it can be very difficult to relate the material to real-life situations. You need to think about, 

◉ How do I apply this to my day-to-day duties on the job?

◉ What does this mean for my patients? 

◉ How does this play into the bigger picture? 

Learning the "bigger picture" of healthcare is not something that happens in one semester, or even after your first year as a nurse. This is part of being a novice -- you are figuring out care and how your work impacts patients on both a microscopic and a macroscopic level. Be patient with yourself and learn to be a confident beginner! 

Source: nurse.org

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