10 Tips for Night Shift Nurses

The night shift can be challenging to your success at work and also to your ability to maintain physical and emotional health.  Whether by design or by necessity, when you find yourself working the night shift, practice these tips to help you manage your work-life balance:

• Sleep and eat well prior to your shift.  After all, most "daytime people" come to work after a good night's sleep and a healthy breakfast!

• Before trying to go to sleep, allow end-of-day decompression time.  "Daytime people" relax after work.  You should too!

• If you must rotate shifts, do so in a forward fashion (days to evening, evenings to nights, and nights to days).  This allows for better physical adjustment and is not as disruptive to your circadian rhythm.

• Don't lose your connection with family life.  Remember, your family relies on you for more than your paycheck!  Your job, colleagues, and career come after your family – just like the "daytime people".  As a night shifter, you also have an advantage.  You can volunteer at your child's school or visit your significant other at work during the morning hours!

• Avoid excessive reliance on caffeine.  This habit may get you by the occasional slump, but can become addictive and disruptive to your circadian rhythm.  If you feel the need for a "rush", excuse yourself from your duties for a few minutes and take a fast walk.  This will wake you up!

• Avoid intoxicants or medications to get to sleep.  They alter your sleep architecture; thus making sleep less restful and possibly giving you a hangover with poor performance at work.  These vices are also habit forming!  

• Use the morning hours after you get off from work for personal business.  Run errands while you still have your wits about you and businesses are at their freshest level of service!

• Live on your day shift income.  Don't rely on night shift differential to make ends meet.  Plan your budget upon basic salary figures in the event of unexpected changes or disability.  Use your night shift differential income for specific short-term purposes like: debt reduction, investment, or a vacation fund!  Don't become dependent on the extra money night shift differential provides - - you may never be able to go off nights (if you want to)!

• Have sleep-preparation rituals that promote good sleep patterns.  Regularity of preparations, even the same go-to-sleep music, will flip your mind switch to, "I'm going to sleep now."  Use a sleep mask, blackout curtains, ear plugs, or other sleep aids if necessary.  Silence the telephone ringer so the "daytime people" don't bother your sleep.  After all, you don’t bother theirs! 
• People say, "Good Night" to you in the morning as you leave.  Insist upon saying, "Good Morning," to maintain a better sense of balance! 

Peak technique: Preparing your patient for hemodialysis

When a person's kidneys fail to function properly, life-sustaining treatment, such as hemodialysis, may be required. Hemodialysis works by removing blood from the body; putting it through a dialyzer to clean the blood of toxins, excess water, and electrolytes; and then returning clean blood back to the patient (see Picturing hemodialysis). There are approximately 300,000 people receiving hemodialysis three times a week. At this rate, it's likely that you'll prepare a patient for hemodialysis. In this article, you'll learn what you need to do minimally to keep your patient safe before and after a hemodialysis treatment.

The nuts and bolts of hemodialysis

Hemodialysis can be performed using one of three different access devices. The most common access used is an arteriovenous fistula (AVF), which is created peripherally by connecting an artery and vein together. This surgical connection of the artery and vein causes increased blood flow, which stimulates the size and thickness of the AVF. After about 6 to 12 weeks, the AVF is strong enough to withstand the high volumes of blood flow needed for dialysis treatments.

When a patient doesn't have blood vessels strong enough to grow adequately, an arteriovenous graft(AVG) may be created. An AVG is created by using synthetic material to connect the artery to a vein. The time required for an AVG to mature in size is usually about 3 weeks. Whether your patient has an AVF or an AVG, time is needed for it to grow (see AVF and AVG access). Meanwhile, a temporaryhemodialysis catheter will be placed in your patient's subclavian, femoral, or internal jugular vein for immediate use (see Hemodialysis catheter access). Regardless of the type of access device your patient has, there are precautions you'll need to take before you send your patient for a dialysis treatment.

Patients on dialysis are typically on a 3 days a week schedule. Treatment usually lasts for 3 to 5 hours. What you do before your patient has dialysis can make all the difference in how well your patient responds to the treatment. In some rare cases, what you do or don't do can even make the difference between life and death. This is why it's very important to make sure you understand what should and should never occur when preparing your patient for hemodialysis.

Figure. Picturing hemodialysis

Before hemodialysis

Weight

Before your patient undergoes a hemodialysis treatment, you'll need to obtain an accurate weight measurement. Expect that your patient will be a few pounds heavier than the previous day; this is the result of water buildup between treatments. Document the weight obtained and be sure to share this with the hemodialysis nurse. The weight measurement will help determine the amount of fluid that will need to be removed during hemodialysis so that your patient can return to his dry weight. The dry weight is the patient's goal weight without the fluid buildup between hemodialysis treatments.

Vital signs

Obtain a complete set of vital signs and document your findings. Assess whether your patient's BP indicates hypertension or hypotension. Avoid monitoring BP in the arm with the AVF or AVG; doing so can cause clotting and result in loss of access. Assess your patient's temperature for fever, which could indicate infection. Assess the rate and quality of respirations. Patients undergoing hemodialysis are prone to the development of dysrhythmias; when assessing the heart rate, be sure to also take note of the rhythm.

During the time you collect vital signs, it's also a good time to assess the overall condition of your patient. Do this by assessing his skin, mental status, and whether your patient has any complaints, such as pain or nausea.

Access site

Before sending your patient for a hemodialysis treatment, you'll need to make sure that the access site is functioning properly. Your assessment interventions will depend on the type of access your patient has. If your patient has an AVF or AVG, you'll need to check for obvious problems. Assess for bleeding at the site, oozing or drainage, redness, warmth, and patient complaints of pain at the site because these are key signs of infection and should be reported to the healthcare provider.

It's extremely important to assess the site for circulation. This is done by assessing distal pulses, palpating for a thrill (feel the thrill), and auscultating for a bruit (hear the buzz). You will feel the thrill by gently placing your fingertips or palm over your patient's access site; you should notice a vibration. To hear the bruit, place your stethoscope over the site and listen for a swishing or whooshing sound. If either is absent or barely noticeable, it could indicate loss of access and you'll need to contact the healthcare provider in addition to the hemodialysis nurse for instructions on how to proceed before sending your patient for treatment.

When dialysis is anticipated on a short-term basis or during the period of time when an AVF or AVG matures, your patient may have a hemodialysis catheter placed. These catheters are most often placed in the subclavian vein, but can also be placed in the internal jugular or femoral veins. A hemodialysis catheter has two lumens: one will be used to remove blood and the other to return the clean blood back to the patient. When assessing this type of access, you'll need to monitor the catheter site for drainage and redness of surrounding skin. It's very important that you maintain sterile technique when working with hemodialysis catheters. You shouldn't use these catheters to administer routine fluids or medications, and they shouldn't be flushed with normal saline solution. Most facilities restrict use of these catheters to only the hemodialysis nurse; review your facility's policy on your responsibilities when caring for a hemodialysis catheter.

Lab results

Review the last ordered lab results; specifically review the chemistry results for levels of sodium, potassium, phosphorus, blood urea nitrogen, and creatinine. Anticipate that these will be elevated. Knowing the predialysis electrolyte results will help determine the effectiveness of the treatment by comparing them with the postdialysis lab results.

Review the complete blood cell count, particularly the red blood cell (RBC) count, hemoglobin, and hematocrit levels. Anticipate that these will be decreased from normal levels, but understand that dialysis doesn't correct abnormal RBC, hemoglobin, and hematocrit levels. You should anticipate receiving other orders to address these low levels; for example, administration of packed RBCs and RBC-stimulating medication (also known as erythropoiesis-stimulating agents).

Important reminder: Make sure that labs are never drawn from the arm with the AVF or AVG.

Scheduled medications

Review the list of medications for your patient, scheduled up to 4 hours before the treatment. There may be some that you shouldn't administer. Because your patient's BP will drop during treatments, all antihypertensive drugs should be held before hemodialysis. In most cases, antiarrhythmic medications are given as scheduled due to the high incidence of patients developing arrhythmias during hemodialysis. Certain types of drugs will pass through the dialysis machine and not provide benefits to the patient. These drugs are any type of water-soluble vitamins, so they should also be held before treatments.

Your facility will provide guidelines for the safe administration of medications to patients before and after hemodialysis treatments. Remember to contact the healthcare provider for individualized orders for your patient.

Figure. Hemodialysis catheter access

After hemodialysis

Your nursing interventions when your patient returns from a hemodialysis treatment are almost identical to your predialysis interventions. As soon as you resume care of your patient postdialysis, you'll need to obtain a set of vital signs and a weight measurement and assess the access site. Compare your findings with the predialysis results and report anything not within the defined limits as predetermined by the healthcare provider. Infection is a complication that should be continually assessed by looking for elevations in temperature and white blood cell count and assessing for warmth and redness at or around the access site. Monitor the access site carefully for bleeding. Early detection and treatment can prevent life-threatening hemorrhaging that could result from heparin used during treatments. Monitor your patient closely for signs of confusion, decreased level of consciousness, and sudden severe headaches because these neurologic changes could be related to a potentially life-threatening complication known as disequilibrium syndrome and must be reported immediately.

Determine when the next ordered labs will be collected and keep a lookout for the results to review. You'll also need to give the medications that were held before sending your patient to hemodialysis. This should be done only after your patient has stabilized, which is usually within 2 to 4 hours after treatment.

Live long and prosper

The number of people requiring dialysis is increasing every year. Patients with kidney failure can live long and productive lives with the help of hemodialysis. Nurses who practice in acute care hospitals, dialysis clinics, and even home health may be responsible for providing direct care to a patient in need of hemodialysis. This article describes the minimal interventions that must be done each time you send and receive a patient to and from a hemodialysis treatment. Using this information, in addition to the specific policies and guidelines at your facility, will help to ensure you provide the best possible care to your patient.

History of Registered Nurses

Early Days

Although nurses have existed in some aspect throughout history in nearly every culture, the nursing profession didn't take shape until the early 19th century, when famed nursing pioneer Florence Nightingale and a small staff of nurses helped attend to wounded war veterans. According to Biography.com, Nightingale was credited with improving the condition of patient care during the Crimean War, leading to hospital overhauls and the professionalization of nursing. Nightingale is usually referred to as the founder of modern nursing.

Education

Hospitals held the first nursing classes in the first part of the 1900s. The classes mostly dealt with house chores for a few years, before moving up to teach such skills as how to sterilize medical equipment and to provide minor first-aid care. That was the norm for the profession until the start of World War II,when professional nurses became responsible for direct aid to the wounded for the first time in nursing's decades-long history. The profession flourished during the war and gained support from the medical community.

Changes

During America's economic boom following the WWII, the demand for nursing increased, leading government officials to require more stringent educational standards for potential nursing students. That led many colleges and universities to implement their own nursing programs. A division soon emerged in the nursing profession, leading to a distinction between Licensed Practical Nurses (LPNs) and the more advanced Registered Nurses (RN), whose licensing requirements varied by state.

Divisions

As set forth by the post-war education standards, RNs require more training than LPNs, although each received the same basic medical education. RNs are allowed more freedom to make medical decisions and supervise other nursing staff. Registered Nursing came to the forefront of the medical community in the 1980s, and today RNs have many career opportunities, from working in hospitals and clinics to working as traveling nurses or in highly specialized disciplines within healthcare.

Registered Nursing Today

Modern times sees a high demand for nurses, and traveling RNs have become a hot commodity in the medical job market; they work relatively short-term contracts (usually a few months) at hospitals with nursing shortages.

Due to the extent of their education, many RNs now have the ability to specialize in many areas of medicine, such as pediatrics or acute care in hospital or clinical settings or in public schools or prisons, to name a few. RNs also can work as flight nurses on medical helicopters.

With advanced training (and usually a Master's Degree), RNs can work as assistants to anesthesiologists or advance to work as nurse practitioners.

Boosting Supply Chain Efficiency: Tips for Success

No matter what supply chain strategies are chosen to increase efficiencies, it's important for hospital supply chain managers and executives to consider the following tips for success:

1. Integrate supply chain management with overall hospital operations and encourage all clinical and non-clinical staff to learn and understand specific goals and work toward them to improve overall patient care.

2. Enlist physician support of supply chain management and engage in regular dialogue to ensure that business and clinical needs are consistently met.

3. Set goals and deadlines for tackling supply chain inefficiencies and track progress made toward overcoming them to hold yourself and your hospital accountable for the process.

11 Tips for Effective Negotiations With Suppliers

Reducing supply expenses takes costs out of the system permanently and reroutes dollars directly to your ambulatory surgery center's bottom line. For most purchases, it is more cost effective to rely on your GPO contract, which may cover as much as 80 percent of your routine supply and services needs. For some purchases, however, it may be worth your while to take a more aggressive approach.

Here are 11 tips for improving supply chain negotiations.

1. Focus your efforts. Unless you're part of a very large organization with dedicated, experienced team of materials professionals, you probably don't have the resources to negotiate most of the purchases you make. Focus your energy on the purchases that will make the most difference.

2. Know the product you're attempting to buy. It is important to understand the capabilities of the product and the market dynamics for that product category. How many close substitutes are there? How does the product perform in circumstances similar to how you intend to use it? Gather as much competitive pricing information on supplies from as many sources as you can.

3. Leverage available expertise. If your ASC is aligned with an acute-care delivery system, leverage the parent organization's supply chain expertise and buying power to realize substantial savings.

4. Align your overall purchasing plan with your business plan. Major purchases must be aligned with your organizational strategy and business plan

5. Understand your financing options. These can make a major impact on the overall cost of the final product.

6. Use a request for proposal from the main suppliers under consideration. This is an effective way to establish an "apples to apples" basis for comparing similar products and pricing, and establishing terms on which to negotiate. Introduce requirements and expectations as early as possible in discussions with suppliers and make sure they are all listed and fully understood by both parties before negotiating specific terms.

7. Create mutual value. Since a contract creates a long-term business relationship between your ASC and the supplier, the final terms must be reasonable for both parties in light of the responsibilities and risks involved.

8. Prepare for ongoing negotiation. Even though the contract is signed, negotiation with the supplier will continue throughout the length of the contract.

9. Include ancillary products and services which will impact your use of the product, including delivery, installation, training, maintenance, etc.

10. Leverage your GPO relationship to get the best possible deal. You can often start with the available GPO price and terms as a way to capture more value.

11. Focus on process, not people. Negotiations are most successful when they focus on interest, not positions. The parties involved invent options for mutual gain. Objective criteria are used for evaluating options. People are separated from the problem — that is, the negotiations are not allowed to become personal.

Tips for Effective Nursing

Nursing Tips 1 - You can't possibly know "everything". Be sure to continue to be inquisitive throughout your nursing career. Study, ask questions, and be proactive.

Nursing Tips 2 - Mistakes will sometimes happen. Don't beat yourself up over it, but learn from those mistakes and get over it. Don't let it eat at you. Rise above and keep on moving.

Nursing Tips 3 - Like with any job, make sure you show up on time.

Nursing Tips 4 - You can learn a lot by watching other nurses. How do they perform compared to you? Are you at their level? Do you feel confident with the task at hand? Learn what you don't know. Your patients are depending on you.

Nursing Tips 5 - RELAX! Tension will eat at you and interrupt your ability to administer care effectively. If the stress is getting to you, take a 5 minute break to get it together and compose yourself.

Nursing Tips 6 - Always keep a small notepad and pen with you. This will save you a lot of time and headache remembering details, patient names, prescriptions, and so on.

Nursing Tips 7 - BE STRONG! Your patients are often nervous and they're looking to you for strength. Exude confidence.

Nursing Tips 8 - Don't take risks with your patience lives. If you are uncertain about a particular procedure, ask another nurse or doctor for assistance.

Nursing Tips 9 - Learn to laugh. They say laughter is the best medicine. Joke around with the doctors and get your patients laughing (if they can). This helps everyone. And it just might keep you from going crazy during stressful operations or procedures.

Nursing Tips 10 - Take the time to stay on top of what is "new" in the world of nursing. It's always changing, but there are books, conferences and others nurses to gain information from.

Nursing Tips 11 - Listen to your patients when they tell you what is wrong with them. Never dismiss anything they say because they know their bodies far better then you ever will. If they say something is not right, then something is not right.

Nursing Tips 12 - Don't forget to take care of yourself. While it is rewarding to help care for others, forgetting yourself means that there is a possibility that you will be to run down to give others the proper care you want to give them.

Nursing Tips 13 - Learn to be sensitive to other cultures. You will see patients from all walks of life during your years as a nurse, be ready to learn as much as you can from them.

Nursing Tips 14 - Keep yourself organized. Know where the important things are, and if you have a tendency to forget then keep a small notebook in your pocket with reminders.

THE EVOLVING HEALTHCARE SUPPLY CHAIN

Nationwide healthcare reform is having a significant impact on the industry’s supply chain, says Eric O’Daffer, research director with Gartner. The effects are especially being felt in the executive suites of hospitals. Reduced reimbursement levels, along with the ever-growing need to scrutinize cost, is creating a “burning platform” for healthcare managers. What’s more, given that supply-chain processes today account for between 40 percent to 45 percent of a hospital’s total operating costs, “supply chain is on the hot seat.”

Managers are being driven to standardize processes. They are being forced to become more aggressive about controlling users’ preferences for certain products. “They’re now needing to look at what the patient outcome is from that procedure,” says O’Daffer, “and how much they’re getting reimbursed.”

Purchasing groups, which control the spend for multiple hospitals, are gaining in importance. At the same time, their overall goal and purpose are evolving. Today, they are looking to achieve lower levels of cost by aggregating demand locally, and committing to specific volumes. The strategy involves making targeted purchases. “People don’t say, ‘Here’s our volume in theory,’” says O’Daffer, “but ‘Here it is in aggregate.’ They’re willing to be held accountable for their decisions.”

O’Daffer sees three major changes occurring in the healthcare sector. There’s a strong move to capture and standardize products, allowing managers to gain control over all non-labor-related spend. There’s an attempt to tie the choice of products to patient outcomes. And hospitals are increasingly moving toward owning their distribution processes, opening consolidated service centers, and taking control of “hundreds of millions of dollars” in supply-chain expense.

A Complete Nursing Career Overview

With almost 2.6M registered nurses (RN) in the United States, nursing is now the largest health care profession in the country. If you think that hospitals are the only place a nurse could be found, you are certainly misled. Public health agencies, communities, ambulatory care centers and other places where health care services are rendered also commonly have nurses employed.

1. The Nursing Practice

Nursing covers a wide area of practice. It includes

- Childcare

- Elderly care

- Services for pregnant women

- Services for newborn infants

- Specialty area - injury nursing

- Specialty area - cancer nursing

- Specialty area - forensic nursing

2. Choose Your Nursing Program

The first step to be a nurse is to graduate from a nursing program. This would enable you to take a state licensure examination. In the US, more than 1500 nursing programs are offered. Three of these programs prepare you in assuming different tasks once you graduate.

A. A Bachelor of Science in Nursing (BSN)

This is a four-year curriculum offered in colleges and universities. A graduate of this course has the advantage of learning health care settings that includes leadership and management. A degree in BSN is preferred and often required in many fields of nursing.

B. Associate Degree in Nursing (ADN)

This is a 2 to 3 year program offered in community college as well as in junior collages. This program prepares the student in handling direct patient care.

C. Hospital Diploma

This is a 2 to 3 year program that is based in hospitals.

3. Nursing Positions

Now that you've covered the basics, let's take a closer look on some of the nursing positions you can occupy. These positions are based on your experience and education.

A. Entry-level nursing position

This is the Staff Nurse Position. The nurse takes on making judgments based on scientific knowledge. You have to rely on procedures and standardized care plans.

B. Certified Mid-wife

This is a specialty nurse position where the nurse aids childbearing women. It starts during the preconception stage and goes through the prenatal, labor and delivery. Postpartum period care is also included in her duties. The nurse also provides family planning counseling as well as gynecological care for women.

C. Case Manager

Over time, a nurse can become a nurse case manager. In this position, the nurse will be involved in the process of organizing as well as coordinating the resources and services of an entire group of nurses, such as an entire hospital.

D. Nurse Educator

This is also a position a nurse could get involved with. Educating people about proper health care needs and procedures would be the basic tasks for this position. A Nurse Practitioner on the other hand conducts physical exams on patients, conducts diagnoses and provides treatments. A nurse practitioner could also write prescriptions and could also manage patients with chronic conditions such as diabetics and those with hypertension.

E. Nurse Anesthetist

A Certified Registered Nurse Anesthetist assists during operations. They give anesthesia to the patients before and after the operation.

There are also various specialty nursing programs that would help you specialize in a specific area. Radiology Nursing, Rehabilitation Nursing, AIDS Care Nursing, and Forensic Nursing are few of these specialty areas. Radiology Nurses are concerned with patients that undergo diagnosis in radiology imaging environments. It also includes Ultrasonography, magnetic resonance and radiation oncology. Rehabilitation Nurses or Psychiatric Nurses takes on providing physical and emotional support both to the patient and their families. They deal with patients having mental incapacities. An AIDS Care Nurse manages the physical, psychological, spiritual and social needs of a patient suffering with AIDS. A Forensic Nurse works in a different environment with other nurses. They work with the law enforcement officials to help in the investigation of crimes like sexual assault and accidental death. They also help in the treatment of the victims of these crimes.