Action needed to support retention of nursing staff in Wales

Wales staffing act must be extended to all settings where NHS Wales commissions or provides nursing care.

National action across Wales needs to be taken to support the retention of nursing staff, so safe nurse staffing levels can be achieved, the RCN has said.

The comments were made as RCN Wales launched a new report that provides detail on the progress made by health boards on nurse staffing in the past 18 months.

The RCN says that overall, the Nurse Staffing Levels (Wales) Act 2016 has changed NHS culture in Wales for the better. Significant investment has already been made to increase the numbers of nursing staff in wards covered by the act. In addition, nurse leadership has been strengthened and safe nurse staffing levels are being discussed at board level.

Helen Whyley, Director RCN Wales, has challenged the Welsh Government to work with the RCN to develop a national retention strategy for nursing that includes flexible working and career opportunities, as well as improved access to continuing professional development, as part of their ‘Healthier Wales’ programme.  

She added: “NHS Wales has more to do to support the retention of nursing staff in a strategic and meaningful way. This action is needed now to achieve the implementation of safe nurse staffing levels in every setting to protect patient care.”

There are more than 1,500 nursing vacancies in the NHS in Wales alone and the care home sector is also struggling - for registered nurses and health care support workers.

What are some important things to know as a cardiac nurse?

Things to know:

1. Cardiac rhythms
2. ACLS/BLS
3. Cardiac meds and diuretics
4. Cardiac muscle structure and function
5. Understand, I mean really understand all forms of MI and stroke. 
6. Labs associated with the above
7. Understand hypertension and meds
8. Understand how diuretics influence kidney and cardiovascular function
9. Understand anticoagulant function and associated labs and the physical manifestations of bleeding
10. Know the code cart like the back of your hand.  Know how to use the equipment
11. Understand and know how to physically use various oxygen delivery systems such as BiPAP and CPAP and non-rebreather masks
12. Get very good at placing large-bore IVs
13. Understand pacemakers and their associated influences on EKG rhythms and what it looks like when they aren't working
14. Recognize the various lung sounds and their clinical significance.  Particularly, fluid overload.
15. Understand COPD and interventions
16. Have strong general nursing skills as all the body systems are connected and can influence the heart.
17. Understand ABGs

- Frank

What are some societal problems in nursing?

Safe staffing is a big political issue among nurses just now. Depending on state laws and the institution in question, some employers can require nurses to work overtime on short notice, or to take patient loads that they see as unsafe. I’ve also worked for some employers who subtly encouraged nurses to violate labor laws, e.g. to get to work early, take reports on patients and “get themselves organized” before punching in.

Any job with as many variables as nursing is inevitably going to be difficult at times: we all are familiar with having to work late when an emergency derails our routine; we’re all used to being called and asked to pick up more hours; we’re sometimes called on to work shorthanded. The problem arises when short staffing is the norm rather than the exception.

There have been many studies on this issue. Although results have been varied, the general consensus is that, all other things being equal, a higher nurse-to-patient ratio does result is fewer patient complications, and lower mortality rates.

What is a certified nurse-midwife?

A nurse-midwife becomes an RN first and then goes to school to be a midwife for another 2 yrs. So she has a master in midwifery. She is a CNM and can prescribe medications and do hospital births. Rarely does a CNM do home births.

A direct-entry midwife goes straight into midwifery school for 2 yrs, pass a national exam and do about 3–5 yrs of internship She is a Certified professional midwife, usually with a state license. “ CPM”. CPM’s do mostly home or birth center births. Generally, she can’t do hospital births and have only a few medications they can use, taking only low-risk clients.

Then there are “traditional” midwives that are not licensed, have no requirements for schooling, usually trained by apprenticeship only. In some states this is legal and other states a traditional midwife is illegal.

Do you think people in comas can hear

Yes. I, too, had a tough time accepting that comatose patients can hear us because, like many others, I was fooled by movies into believing that coma = a state of being sort of dead.

But then, in the first year, just before allowing us to start clinical rotations at the hospital, the school gave an instructional class on bedside manners and etiquette.

It was stressed, over and over, that we must greet the patients, introduce ourselves, and give them an overview of what it is that we’d be doing next.

For example, ‘Good Morning, Mr. Potter! I’m Shreya, your respiratory therapist for today. I’ll take a quick listen to your lungs and then draw a bit of blood to see where we stand on that oxygen this morning. I’ll talk you through it, okay? Let’s get started’

It was emphasized that the etiquette remains the same across all patients — conscious or unconscious, sedated or comatose.

Why? you may ask. Precisely because several comatose patients have been reported to be able to hear us and hence, as a general rule, all of them deserve to be forewarned about any poking and prodding they’d be a recipient to.

The guest lecturer, a Physician himself, continued to share a related incident to drive his point home.

He told us that once, while in the room of a comatose patient, he let his usual ‘serious doctor’ guard down while writing new orders to tell his colleague that he couldn’t find his wallet anywhere. He was upset because he thought he’d lost it and replacing all the cards in the wallet was going to be a lot of work.

He had since forgotten all about the conversation.

A few weeks later, while in the company of the same patient, who had now woken up from the deep slumber, he was asked this —

Refer: Shreya Thacker

As a surgical nurse, what's the weirdest thing you've seen

It’s difficult to say which is the weirdest as you see a lot of odd things! There was a Vicar with a potato lodged in his bottom, a teenage boy with a glass tomato sauce bottle stuck on his penis (which he had tried to smash off with a hammer), an elderly gentleman with an umbrella handle stuck in his bottom… the best bit is the stories of how said items became stuck!

The strangest thing I’ve seen was a well educated business woman who was absolutely convinced that she needed her ovary removed, despite the fact that there was nothing wrong with it (she had CT scans, Ultrasound scans, x-rays, blood tests). She was adamant, she screamed and shouted and had about 5 diffferent medical opinions. Threatened to sue the hospital if else didn’t comply… being the NHS we are not prone to giving patients surgery just because they want it. She refused to have a Psyciatric evaluation and discharged herself-to find a hospital that would comply with her request.

Can a midwife become a gynecologist

You would need to apply to medical school then to an Ob-gyn residency. I have met a few nurses that have done just that, RN to MD but not from CNM to MD.

But if you want to do surgery than that is the way to go.

The midwives that were in my practice did a lot of office gyn (Well Woman Care) but had no interest in surgery.

If you are already a midwife why would you want to spend 8 more years relearning many of the things you already know?

 Refer: Claudio Delise

What are some interesting country specific facts about plastic surgery

Iran isn’t exactly known as a beacon of open societies.

Islamic law is strictly enforced in the country. We (Westerners) often read up on and then practice great caution when traveling to such regions as it is, culturally, a world away from the life we live here.

They used to legislate what makeup women could wear. The TV networks are controlled by the government, and there is no satellite TV permitted.

So it is a bit surprising to learn that Iran has the highest rate of nose jobs in the world.

I would have assumed my home country (U.S.) owned such a title. But — via Hollywood — we are part of the reason for it.

1 in 700 Iranians gets a nose job:

It’s an interesting statistic nonetheless:

Most of the nose jobs are from the children of the wealthy elite in Tehran. And it isn’t just women. Many men do as well.

And lastly, the most surprising law in Iran?

They permit sex changes. And actually have the second most sex changes in the world, second only to Thailand.

 Refer:Sean Kernan

Do mental health nurses wear uniforms in the US. Why!

Mental health workers are encouraged to dress in street clothes.
Mental health problems have such a stigma that people fear being observed talking to a mental health worker for fear of repercussions,

Also, patients tend to have bad associations with scrub wearing professionals, it could trigger an episode of PTSD.

I also think it's about respect. I'm wearing my normal dress because it's appropriate and clearly indicates I'm not worried about our interaction NEEDING the boundaries of a uniform.

Dealing person to person is the most respectful and therapeutic approach one can make.

Refer: Tasha Poslaniec

What is the difference between ICU and CCU in the hospital

ICU is the Intensive Care Unit. It is where the sickest or most injured patients are kept. Our hospital had a ICU staff ratio of 1 patient/1 nurse. It is equipped with almost every item to substain a life within easy reach and has separate care practices per case. It also has a stricter set of rules on visitation and “get well” items that are receivable.

CCU, Ctitical Care, is the step down unit from ICU. There is still a lot of monitoring but not a one on one team. Those patients who aren't bad enough to need a private nurse, or can risk being more than 5 steps away from staff but still bad enough or unstable enough they need extra monitoring, special care plans, etc. will usually start or end their stay here.( Second day heart procedure patients, concious stroke/accident victims, etc.) Hope these differences helped a bit.

 Refer: Amy J. Spencer

What is the difference between psychology, psychiatry and mental health nursing

Psychology is the scientific study of human behavior and mental process. In this field, a professional practitioner or researcher is called a psychologist. Psychologists explore behavior and mental processes, including perception, cognition, attention, emotion (affect), intelligence, motivation brain functioning, and personality.

The main difference between psychologist and psychiatrist is Psychologist cannot prescribe medicine but psychiatrist do provide medicine. A psychologist is not able to write prescriptions, but may be recommended a patient be seen by a fellow psychiatrist in order to receive medications.

A psychiatrist is a physician who specializes in psychiatry, the branch of medicine devoted to the diagnosis, prevention, study, and treatment of mental disorders.Psychiatrists are medical doctors, unlike psychologists, and must evaluate patients to determine whether their symptoms are the result of a physical illness, a combination of physical and mental ailments, or strictly psychiatric.

Psychiatrists are medical doctors (MDs) who graduate from medical school, have a year of medical internship and have 3 years of residency in the assessment and treatment of mental health disorders.

Psychologists have a doctoral degree in an area of psychology, the study of the mind and human behavior. They’re not medical doctors. A psychologist can have a Ph.D. in philosophy or a PsyD in clinical or counseling psychology. Typically, they do 1-2 years of internship.

Psychiatric nursing or mental health nursing is the appointed position of a nursing that has specialized in mental health and cares for people of all ages with mental illness or mental distress, such as schizophrenia, bipolar disorder, psychosis, depression, dementia and many more. You will first need to earn a bachelor's or master's degree in nursing. While doing so, you should also concentrate on taking several mental health courses. Once you earn your nursing degree, you will also need to pass the proper license to become a registered nurse or advanced practice nurse.

 Refer: Pragya Mishra

Do you trust foreign-educated health care providers as much as their US-graduate counterparts

I suppose, the author of the question means that foreign-trained doctors conduct themselves less professionally comparing to their American-born counterparts.

Here is my observation, as I am a foreign-educated doctor myself: No foreign doctor (except Canadian) can practice medicine in the USA independently unless he/she successfully passes US Medical License Examinations and a complete a minimum of three years of USA-based the training program, and passes USA American Board exams.

Some doctors come from the countries where it is normal for a physician to speak to their patient from a position of authority. In some countries, women are treated differently than men and physician may have difficulties to adjust to the new cultural norms in the USA . Some foreign physicians have strong accents and are poorly understood by their American patients. But in many other cases, they go extra miles, acting more emphatically and attentively than their American counterparts, just because they are aware that they are being judged with the biased eye.

It really depends on a particular doctor. I don’t think that there is a definite trend.

  Refer: Kathleen Maynard

How are male nurses viewed by women in the health field

I am a male nurse here. The nursing field is traditionally and still remains a female-dominated field. For me, I have no problems with it. My colleagues and I are more concerned about the heavy workload to be done in so little time than bickering on gender-related issues. If you are in the ward, you and the team (actually just three of us) have to take care of more than 30 to 50 patients; giving them meds, talking them, assisting when going to the bathroom, replacing IV fluids, tracking and calling missing doctors, receiving marching orders, endorsing, and having no time to even sit down. There is no way you can stop and reprimand how males are so downtrodden in the profession!

Let me cite some studies here. In a 1976 study published Journal of Health and Social Behavior, female nurses were given questions regarding attitudes toward male nurses. Results show that female nurses view gender as irrelevant, and feel that more males should enter the occupation. Another study, conducted in Canadian students in 2010 that males in the nursing field were viewed negatively. Male nurses were still viewed in a negative light, according to a 2016 study, but patients changed their attitude after receiving care from a male nurse.

So that means that discrimination between genders in the nursing field still exists. In this modern society where sexist attitudes toward females are still widespread, the opposite happens in the world of nursing.

But seriously, if you are a male and thinking of entering nursing, go ahead. It is a rewarding and noble career.

 Refer: Josquin Charpentier

What are the emerging challenges in pediatric nursing

Staffing is always a problem everywhere. Cost-effective plans to keep the hospital in the black makes things difficult in all departments. Visitor policies can change back & forth. Type of new care for conditions will be a challenge! Keeping toddlers in beds or cribs is a constant challenge. New inventions for this & all care, brings about new challenges.

 Refer: Alice Regan

Why do most Americans leave their old family members in nursing homes or just avoid their parents in general

Most Americans don’t. It’s too expensive. There are a few reasons why it becomes necessary:

·         Most older people have very fixed opinions about how things should be that they first formed in their youth when the world was different. Hey, the world has changed! Trying to force your grown children or grandchildren to live in a world that doesn’t exist anymore can be just annoying, or it can be totally offensive. If the old folks can’t stop trying to run their adult children’s lives, they are not likely to be fondly embraced. Keep in mind that the world is changing much faster than it has in the past. Humans were never evolved to adapt to change this fast - the majority of learning takes place in childhood - it’s difficult to learn new ways of life after childhood. Older people can become an intolerable burden on their adult children. Some older people can have a very destructive influence on their grandchildren.

·         The multigenerational family propagages “family games” down the generations. Co-dependencies and enablements are taught to each new generation of children. This is how abuse (sexual, physical, and emotional) is passed down through the generations. Each new generation is taught to play a specific “role” in the family games. Often the only way to break the patterns of family games is to isolate the older game players away from the children.

·         At some point, many older folks have severe health problems. When this happens, children are faced with deciding whether it is better to place them in a facility that can care for them and preserve their lives for a little longer, or whether it is better to let them live with family and die a little sooner. Americans have been trained by their society to prolong life, even if it means prolonging suffering. We Americans are really cruel when it comes to suffering instead of being allowed to die.

 

        Refer: Tayoh Dey

·          

Are dental implants impossible for women who have had bone loss in their jaws due to the use of meds for osteoporosis and the treatment of estrogen receptor-positive breast cancer

Dental implants are an elective treatment modality. As in, they are not urgently and compulsarily required. There are substitutes available for them.

Dental implant surgery requires an efficient immune system, coagulative system, and reparative system. There are myriad of factors, which can disrupt either of these systems. Also, the recepient bone needs to be of a good density too.

The integration of dental implants with the bone requires a good vascular supply, normal functioning osteoblastic and osteoclastic cells, and a sound reparative capacity of the body.

Certain systemic conditions and medications alter the physiologic processes, leading to delayed or non-integration of dental implants. Such conditions may also predispose the patient towards early implant failure.

There are investigations available to find out if the systemic processes are in a physiologic state or not. If yes, and if the status can be maintained for long, implants can be done. If not, then it is better to go for substitutes or alternative treatment modalities, such as bridges and removable partial or complete dentures.

  Ref: Smiti

What is the most stressful part about being an oncology nurse

In my opinion the most stressful thing about being an oncology nurse is finding out that patients are terminal with no chance of recovery. It's very sad especially when you have to be in the room to break the news or list their options knowing there is no quality of life and they will likely be suffering their last days before entering hospice care if they wish to enter hospice care. They sometimes think they have early stage cancer, and it turns out to be so advanced sometimes the doctors don't even pursue either treatment and they enter into hospice care. It's a sad thing to watch and very very stressful.

 Refer: Desiree Valero Winkle

Is it wrong that I hate nursing schools and wish nurses/nursing lecturers rotted in hell? What can I do to save my soul after a "nursing" disaster

In addition to the other responses here, I'd like to add a story of mine:

I was part of a class that was accused of cheating (except for the one who told the administration). A fire alarm was pulled by a middle schooler that was on a field trip during our pharmacology final and we had to give our tests half completed to an instructor, who allowed us to go do whatever we wanted, even study, as we didn't know if we were returning later to finish the test. Later in the week were kept after our last final, forced to sign a contract that said that if we confessed to accessing online material to study during the alarm, we can get no higher than a C. If we didn't, they'd investigate and if they found out we had logged into our online education site, we could receive a failing grades and disciplinary action. We also heard that the instructor who was proctoring us, the one that took the tests

was facing possible termination (who also happened to be one of my cohort’s favorite instructors). This instance really set my cohort up to be very distrusting and pessimistic about our program. The program felt terrible, but after talking to other RNs, it seems a lot of people have had to go through some BS to get their BSN.

Now I'm happily working in an ICU. Hang in there. You have to jump through a lot of hoops.

 Refer: Ian Gabriel Garcia

Do doctors ever do surgery on themselves

A nurse here.

I gave myself a flu shot. I didn’t want to go to the CVS and pay $20 for it. We had gallons of it for the patients and I wanted to get one. That day I knew I couldn’t be a drug user (or a diabetic who had to give himself insulin!)

I once tried to draw my own blood. That was a disaster. I should not have closed my eyes when I stuck the needle into my arm. I thought to myself, “Oh shit, I missed!” and I was screaming when I wiggled it around (the front desk staff came in and screamed when she saw what I was doing to myself.)

I wanted to send out some blood for tests (the doctor whom I worked with was out that week and she signed the orders a few days prior to that.) I wouldn’t trust her to draw my blood either because she had not done it for years.

Never again!

I was working along (as a school nurse) years ago. Although I had a nursing supervisor (my boss) who was down the hall from me, her needle skills were bad (she had not started an IV for ages while I was doing it almost weekly there.)

  Refer: Winton Sawatdee

What is the most important part of being a good surgical nurse

First and foremost, we need to dissect what makes a “good” Nurse. I would say the key elements are having an empathetic, caring, and warm nature. You need to feel comfortable being around sick people and staying calm in stressful situations. You must be genuine and honest at all times, making sure you always put your patient first.

Secondly, Surgical Nurses are there to assist surgeons during surgery. This could be a minor or major procedure, but the fundamental requirements of a Surgical Nurse is the same.

Qualities of a good surgical nurse include being extremely organised, efficient, and forward thinking.

·         You must be okay with looking at blood, bone and other exposed body parts.

·         You must be able to comfort the anxious patient at what can be a very scary time for them.

·         Depending on local or general anaesthetic, you will need to talk to your patient and check on them throughout the surgery if they are awake.

·         You will need to advocate for them and uphold their dignity and rights at all times if they are asleep.

·         You will need to know what instrument the Doctor will require without him requesting it, and have it ready to put in his hand.

·         You need to be alert at all times, cleaning up blood off your patient so they are not covered in it.

·         You will need to cut sutures efficiently.

·         You will maintain a sterile field at ALL times.

·         Your job is basically to make the surgeons job as EASY as possible.

           Refer: Olivia Lewis

How many times do hospital nurses have to wash their hands and/or replace their gloves

It depends on how many patients they care for. They should be washing their hands with each patient contact and before they glove and after they glove also they need to wash them well after they use the BR. themselves. If the person has infectious stool or drainage you also would not want to move the organisms from one part of their body to the other. You never really know if there are breaks in the integrity of the gloves. So you would use one pair for wiping their peri area, then wash and re-glove to suction them. Some procedures only require that one uses clean gloves and others require sterile gloving. There are some procedures that do not require gloves at all, but proper hand washing technique is still the most important step in keeping well.

 

  Refer: Carmel Maalouf

Larix International Conference on Nursing

Larix International Nursing Conferences

Larix International is a group of ranking publishers and organizer’s for scientific conferences around the globe nesting well-known Doctors, Engineers, Scientists, and Industrialists. Larix is a self-functioning, independent organization wholly focused on arranging conferences in multi-disciplines of research on various science fields. The conferences are administered by global influential scientists and scientific excellence. We are even open for the upcoming scientists and scholars, who are in need of a platform to give their voice a much needed larger volume.

World Summit on Nursing and Women Health (Nursing 2019) is going to be organized in the beautiful city of Kuala Lumpur, Malaysia on November 23-24, 2019 at Holiday Inn Express, primarily focusing on the theme “Advanced Nursing for Trusted Care”.

THE NURSING

Nurses play an essential role in the health care industry because they are primarily focused on patient care. They work in a variety of specialties to help people improve their health and to prevent and heal illnesses and injuries. Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups, and communities, sick or well and in all settings. It includes the promotion of health, the prevention of illness, and the care of ill, disabled and dying people.

ALL ABOUT IT

Nurses and midwives account for nearly 50% of the global health workforce. There is a global shortage of health workers, in particular nurses and midwives, who represent more than 50% of the current shortage in health workers. The largest needs-based shortages of nurses and midwives are in South East Asia and Africa. For all countries to reach Sustainable Development Goal 3 on health and well-being, WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030. Nurses play a critical role in health promotion, disease prevention and delivering primary and community care. They provide care in emergency settings and will be key to the achievement of universal health coverage. Investing in nurses and midwives is a good value for money. The report of the UN High-Level Commission on Health Employment and Economic Growth concluded that investments in education and job creation in the health and social sectors result in a triple return of improved health outcomes, global health security, and inclusive economic growth. Globally, 70% of the health and social workforce are women compared to 41% in all employment sectors. Nursing and midwifery occupations represent a significant share of the female workforce.

DISCUSSIONS

Nursing Education & Nursing Management; Clinical Nursing; Surgical Nursing; Emergency Nursing Practice; Midwifery & Women health Nursing; Advanced Nursing Practice; Pediatric Nursing Disaster Nursing & Travel Nursing; Oncology Nursing; Nursing Primary Care; Cardiovascular Nursing Psychiatric and Mental Health Nursing; Nursing Informatics; Dental Nursing; Public Health & Community Health Nursing; Wound Care Nursing; Operating Room Nurse; Gerontology Nurse; Nursing Rehabilitation & Management; Nurse as Caregiver.

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