Nursing Notes

August 24, 2011

Seventeen Percent of Cancer Nurses Unintentionally Exposed to Chemotherapy, Study Finds

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Here is an interesting article from Science Daily about nurses’ exposure to chemotherapeutic agents.  What I love about the articles I find at Science Daily is the exposure you get to new and exciting scientific data.  The information is usually the early results of formal investigations, but it is interesting to get this glimpse into the workings of the medical, environmental, psychological, biological, and anthropological scientist’s minds.

With that in mind, I present this article about the cost to nurses who are routinely exposed to chemotherapy.  This is probably going to turn into the next big push for safety in the nursing field, so it is pertinent to discuss here.  Please read this article and visit the original site for others similar; then come back here and let’s discuss.


ScienceDaily (Aug. 23, 2011) — Nearly 17 percent of nurses who work in outpatient chemotherapy infusion centers reported being exposed on their skin or eyes to the toxic drugs they deliver, according to a new study from the University of Michigan Comprehensive Cancer Center.

The study surveyed 1,339 oncology nurses from one state who did not work in inpatient hospital units. About 84 percent of chemotherapy is delivered in outpatient settings, largely by nurses. Results appear online in the journal BMJ Quality and Safety.

“Any unintentional exposure to the skin or eyes could be just as dangerous as a needle stick,” says lead study author Christopher Friese, R.N., Ph.D., assistant professor at the U-M School of Nursing.

“We have minimized needle stick incidents so that they are rare events that elicit a robust response from administrators. Nurses go immediately for evaluation and prophylactic treatment. But we don’t have that with chemotherapy exposure,” Friese says.

Safety guidelines for chemotherapy drug administration have been issued by organizations such as the National Institute for Occupational Safety and Health. But these guidelines are not mandatory. Guidelines include recommendations for using gowns, gloves and other protective gear when handling chemotherapy drugs.

The U-M Comprehensive Cancer Center adheres to these safety guidelines and has procedures in place to implement and enforce them for all staff who administer chemotherapy drugs. U-M nurses did not participate in this study.

The study authors found that practices that had more staffing and resources reported fewer exposures. Also, practices in which two or more nurses were required to verify chemotherapy orders — part of the suggested guidelines — had fewer exposures.

“This research shows that paying attention to the workload, the health of an organization, and the quality of working conditions pays off. It’s not just about job satisfaction — it’s likely to lower the risk of these occupational hazards,” Friese says.

Unlike needle sticks where a specific virus is involved and preventive treatments can be given, it’s more difficult to link chemotherapy exposure to a direct health effect. That makes it more difficult for health care systems to respond to these incidents. Unintentional chemotherapy exposure can affect the nervous system, impair the reproductive system and confer a future risk of blood cancers.

Friese collaborated in this study with the U-M School of Nursing’s Occupational Health Nursing Program, which focuses on training nurses to promote injury prevention and protect against work-related injuries and environmental hazards on the job. By combining this practical occupational health perspective with the expertise of quality and safety researchers, the team hopes to better understand what happens during chemotherapy exposure and what can be done in the work place to prevent it.

“If we ensure patient safety, we should also ensure employee safety by strictly adhering to the national safety guidelines…[read more]

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August 11, 2011

5 Reasons Nurses Want to Leave Your Hospital

Here is a really good article from HealthLeaders Media.  I frequently find great articles on this site, so I do encourage you to visit there and look for yourself.  After reading this article, I felt that my thoughts had been broadcasted out into the internet.  This article discusses the comments and thoughts of all the nurses I have ever worked with as well as my own thoughts.  I would like to add a 6th reason for a nurse to be looking to leave a hospital and that is personal safety.  If the facility does not think enough of its nurses to protect them from random attacks, it is definitely time to leave.

Please read this article and come back here to let me know what you think.  I love a good discussion, don’t you?


Rebecca Hendren, for HealthLeaders Media, August 9, 2011

Your nurses have one eye on the door if you do any of the following.

Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.

Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.

1. Mandatory overtime

Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.

Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.

Take a look at the last couple of years’ news stories about RN picket lines. Most include complaints about mandatory overtime.

2. Floating nurses to other units

One nurse is not the same as another. Plugging a hole in a geriatric med-surg unit by bringing in a nurse from the pediatric floor results in an experienced, competent nurse suddenly becoming an unskilled newbie. A quick orientation won’t solve those problems. Forced floating is usually indicative of larger staffing problems, but even so, its routine use is dissatisfying and compromises patient safety.

Instead, create a dedicated float pool staffed by nurses who volunteer and who can be prepared and cross-trained. Institute float pool guidelines that nurses float to like units. For example, critical care nurses find a step-down unit an easier transition than pediatrics.

Float pool shifts open up options for nurses who need more flexibility and offering a higher rate means you’ll never be short of volunteers.

3. Non-nursing tasks

Nurses are already understaffed and overworked. Hospitals with too few assistants rub salt on the wounds. RNs shouldn’t have to take time from critical patient care activities to clean a room or collect supplies. Gary Sculli, RN, MSN, ATP, patient safety expert and crew resource management author, offers a vivid analogy. Imagine if half way through a flight you saw the pilot come down the aisle handing out drinks because the plane was short staffed. It just wouldn’t happen.

Yes, cleaning a room is important, but don’t force nurses’ attention away from their patients. Distractions are dangerous and compromise patient safety…[read the rest]


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August 1, 2011

TN nursing board under scrutiny over discipline case

The Tennessean

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Here is an excerpt of an article I first found on, so I followed the article to the source on The Tennessean.  This article really bothers me because I had never before thought about who monitors our state boards.  I don’t much care for the idea of politics and “good ole boy social networks” being put into play at my state board of nursing.  I don’t know why I had never thought of this possibility before.

We all got to see how outside forces try to interfere in nursing business with the West Texas story of the nurse whistle-blowers that made national news.  Now, it seems we need to start looking at things on an even higher level.

Please read this article and let me know what your thoughts are on this topic.  Are you concerned?  Are you secure that your board is not being pressured by politicians?  I’d love to hear from you.


The Tennessean, July 20, 2011

he independence of the Board of Nursing to regulate the profession is under question as state investigators probe whether strong-arm tactics by lawmakers caused the board to rescind disciplinary actions.

At least two lawmakers, Rep. Tony Shipley and Rep. Dale Ford, pressed for the board to reconsider the suspension of three nurse practitioners accused of over-prescribing narcotics. The Tennessee Bureau of Investigation has launched a probe into these actions, which occurred when the Board of Nursing’s right to exist as a regulatory body was up for renewal by the legislature.

Sharon Adkins, executive director of the Tennessee Nurses Association, said the profession is closely watching the case.

“It is absolutely unacceptable for special interests to put undue pressure on the board to reverse their judgments,” Adkins said.

The board last year suspended the licenses of Bobby D. Reynolds, Tina Killebrew and David Stout, then reversed itself this May. The three nurses from Johnson City, who have not been charged with any crime, are the focus of an investigation, said Kristin Helm, a spokeswoman for the Tennessee Bureau of Investigation.

But the probe into the actions of lawmakers and Tennessee Department of Health employees is a separate case launched after the Board of Nursing rescinded their suspensions on May 5. The House passed a bill to keep the Board of Nursing from sunsetting on May 19, with Shipley, R-Kingsport, and Ford, R-Jonesborough, among those voting in favor of the legislation.

Shipley, who had bragged to an East Tennessee newspaper about holding up the reauthorization bill, was mostly mum after news of the probe broke.

“I can confirm there is a TBI investigation going on,” he said in a prepared statement Tuesday. “I am cooperating fully with them and I expect this matter to be resolved in short order. Due to the fact this is an ongoing legal matter, I cannot comment any further at this time.”…[read more]

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