Name: Vicki N.
City: Tyler
State: TX
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Your medical scrubs and lab coats aren’t the only part of your look that your patients are paying attention to. Tattoos can be a significant part of one’s appearance, which makes it hard not to wonder what effect they have on patients’ perceptions of their caretakers. This article from NurseConnect.com looks at how tattoos relate to professionalism and what some hospitals are doing about it.
If you have an opinion on this topic, leave a comment when you’re done reading.
Do Tattoos Reflect Professionalism?
By Debra Wood, RN, contributor at NurseConnect.com
Art and beauty may lie in the eyes of the beholder, but some hospitals are requiring nurses to cover all tattoos and other body art in case patients don’t find them beautiful or professional.
“They are concerned about what consumers will think, and whether they want people to care for them with visible tattoos or body piercings,” said Myrna Armstrong, RN, EdD, FAAN, professor and RN-BSN director at Texas Tech University Health Sciences Center, whose research interest is body art: tattooing, body piercing and branding.
There is no current research that clearly identifies patients’ perceptions of nurses with body art, but there appears to be generational differences. General indications suggest that older adults frown on tattoos and young people are more supportive, Armstrong said. She added that 25 percent of 18 to 30 year olds have tattoos and 32 to 50 percent have body piercings, somewhere other than an earlobe.
Nurses are currently required to cover up their tattoos at many leading hospitals, such as St. Mark’s Hospital in Salt Lake City; Florida Hospital Memorial System in Ormond Beach, Florida; Children’s Health System in Birmingham, Alabama; and Cleveland Clinic in Ohio.
“When you walk into a room as a stranger, you have to build rapport and a sense of trust,” says Nancy M. Albert, Ph.D., RN, director of nursing research and innovation at the Cleveland Clinic. “A tattoo or piercing is another sign of a cultural difference or being hip. The perception is not professional.”
Albert added that walking in with a tattoo gives the impression the nurse is not taking the position seriously. She said nurses at the clinic have not voiced opposition to the policy.
That’s not the case at the Seton Family of Hospitals in Austin, Texas, which is considering a dress code that requires nurses to cover body art. Some nurses object.
“We are moving to a policy that addresses professional appearance and demeanor,” said Yvonne VanDyke, RN, MSN, vice president for nursing education, nursing practice and research at Seton. “The core of what this is about is decreasing anxiety the patient or families might have in the patient?nurse interaction.”
VanDyke acknowledges that body art and piercings are popular, yet patients may not view it the same way as the person with the tattoo. Seton is discussing the proposed policies with staff and hopes to implement or phase in a policy starting in January 2009.
Armstrong said that many nurses have tattoos in locations that are not on display, but in some settings, such as working with adolescents or on a mental-health unit, a visible tattoo might help in establishing relationships with clients.
Nurses working in facilities that ban visible body art may wear long sleeves to cover tattoos. But if it is on the face or hands, they may need to wear a bandage. Armstrong expects nurses with visible tattoos likely would not be hired in the first place.
Although external, Armstrong said that people get body art for to feel special or unique. She said there is still a backlash?internal reasons toward women with tattoos.
“People who have them have made the decision for themselves,” Armstrong said.
In addition to requiring nurses to cover tattoos and piercings, the Seton system plans to introduce standard colored uniforms for nurses as part of the dress code, so that patients, visitors, physicians and staff can identify them more easily.
Which color is ultimately chosen might also rest on the public’s perception of which is more professional.
Albert has researched patients’ responses to different uniforms. Nurses at the Cleveland Clinic wear white and, Albert said, most are happy with it. Her research showed that patients age 45 and older thought white was more professional. Older patients, age 70 to 100 years, also believed that fitted, white uniforms reflected professionalism more than scrubs.
Seton officials have not made a decision yet about the proposed dress code.
“We want to make sure nurses’ ability to carry out their role is not compromised by a patients’ anxiety or lack of confidence in them,” VanDyke said. “This will help the nurse in many ways.” ■
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This article from NurseConnect.com offers insight into long hours and sleep deprivation in the nursing profession. If you can relate, which I’m sure many of you can, continue reading to see what it has to say about the effects of nurse fatigue and solutions for reducing it.
Association Offers Guidelines for Reducing Nurse Fatigue
By E’Louise Ondash, RN, contributor at NurseConnect
To NICU veteran Bill Willis, RNC, it’s no mystery why the National Association of Neonatal Nurses (NANN) has issued a formal position paper outlining risk-reduction strategies to decrease nurse fatigue.
“Every hospital I’ve worked in has always been understaffed,” he said in a phone interview from Lancaster, California, “and the NICU is typically the busiest unit in the hospital. They like you to work 60 hours and some hospitals work you two weeks on days, then two weeks on nights. It’s hard doing the turnaround like that. I don’t think it’s a good idea. It’s best on your body to stay with one shift or the other.”
The authors of the August 2008 paper agree and outline specific ways to reduce stress and fatigue in all areas of the hospital, including the neonatal unit. Follow these guidelines the association says and the safety of both patients and nurses will be improved.
Some of NANN’s suggestions include:
• Assigning nurses to one shift permanently. If an employee must work both day and night shifts in the same week, he/she should be scheduled to work the day shift first. • Limiting the number of patient-care hours a nurse can work to a maximum of 12 hours in a 24-hour period, and no more than 60 hours in a seven-day period. • Incorporating the number of on-call shifts in a seven-day period into a nurse’s total scheduled hours.
The statement also lists nurses’ responsibilities. They include:
• Arriving at work rested and prepared. • Recognizing that multiple workloads and work settings affect fatigue levels. • Limiting the hours they agree to work to 12 hours in a 24-hour period and no more than 60 hours in a seven-day period.
The position paper also cites a survey conducted by the American Nurses Association, which found that:
• Between 2 and 5 percent of nurses work more than 60 hours a week. • 28 percent of RNs work shifts that are 12 hours or longer. • 36 percent of those who work in intensive care units put in more than 12 hours a day, on average.
The survey concluded that the nurse shortage will make it difficult to change these patterns now or in the future.
The paper also notes that some researchers suggest that extended shifts (beyond 12 hours) may improve continuity of care. Because there are fewer changes in care providers, there may be fewer errors. This, however, has been actively debated since the Accreditation Council for Graduate Medical Education implemented work-hour restrictions in 2003.
Others researchers argue that the team-based care model is superior because it focuses on good communication, the use of documentation systems and appropriate workload distribution, allowing “greater ease in transitioning care from one clinician to another.”
NANN’s position is that, regardless of which model is adopted, “Nurse fatigue is an unacceptable risk and hospitals should schedule sufficient numbers of nurses,” said Marilyn Rutkowski, a social worker and senior marketing manager for NANN, which is headquartered in Chicago.
She also said that NANN will send its paper to nursing organizations across the country and all state boards of nursing so they know the organization’s position. “When they are called to establish policies, they can use this as a reference.”
Jenny Selan, BSN, RNC, agrees that there is a need for a balance between work and rest. She currently works the night shift in the NICU at Kapi' olani Medical Center for Women and Children in Honolulu, Hawaii. She noted that many of her co-workers pull extra shifts – meaning they add four hours to their regular 12-hour shifts, adding up to twice the number of hours that most jobs require.
“Some don’t seem to mind working four hours on top of their 12-hour shift,” she said, “and some don’t mind working multiple extra shifts. The nurses that I see who do that are fine, but they have no social life or normal life, because they are always working or sleeping. But being sleep deprived probably opens up some room for error.”
In general, Selan added, “I think hospitals overwork night-shift workers, mainly because they are short staffed. If they call us to come in early on a shift, and we’ve worked the night before, they don’t take into account that at the time they are calling us, we are sleeping.”
Willis, who has worked in NICU since he graduated in 1992, admits that on occasion, he has worked too many 12-hour shifts. His record is 13 consecutive 12-hour shifts. “That’s not advisable, though,” he admitted.
One answer to avoiding fatigue and sleep deprivation, he added, is for states to enact a mandatory nurse-to-patient ratio, like the law passed in California.
“I really like California because of their mandatory staffing ratios,” he said. “It’s the best of anyplace I’ve been. This type of legislation is good.”
For more information, visit NANN’s Web site.
Copyright © 2008. AMN Healthcare, Inc. All Rights Reserved.
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Happy Halloween everyone! Before you read the news from this week take a look at the Halloween spirit that’s going on inside Lydia’s today. These employees went all out with their costumes and they look awesome. I hope that before the day is over I get to see more costumes that are this good.

And don’t forget, I always like to hear from you. If you have pictures of a Halloween costume that involve scrubs or a medical coat (or any costume that you think is spectacular) then send them in and I’ll post it on the blog.
Now here’s the news from the week:
Healthcare Professionals in the News:
Health News:
Blogs:
Happy Friday everyone! Get your weekend started by entering this month’s Editor @ Large Contest for your chance to win a $50 gift certificate to Lydia’s Uniforms. There’s only one week left in October which means you have between now and next Friday to get your entry in-so get going!
Now here’s the news from the week.
Healthcare Professionals in the News:
Health News:
Blogs:
Happy Friday everyone. Below is the weekly roundup of the news and I want to take a minute to point out a couple of links that are especially noteworthy.
The article Health Watch: Color Scrubs to Fight Infection (the first article under Health News) is a story about a hospital that is testing a new method to fight infections in the O.R. The hospital is only allowing certain medical clothing uniforms in the O.R. in an attempt to control germs that are brought in on hospital scrubs. I found this article really interesting. I’ve always wondered about the standards and regulations regarding scrubs being worn outside of the hospital before or after shifts. It seems that many employees and patients have concerns about germs being transferred in and out of hospitals on medical clothing uniforms, but that many workplaces are not recognizing this worry. Is it common practice for workplaces to enforce rules about where you wear your scrubs or are most employees free to use their own discretion? Tell me about the policy at your workplace and what you think about it.
I also want to point out the Change of Shift link in the Blogs section. Change of Shift is a compilation of blog posts about nursing. Anyone is free to submit their post, whether you’re a nurse, patient or student. So if you’re interested in submitting something or just reading what others have to say, check it out!
Healthcare Professionals in the News:
Health News:
Blogs:

In recognition of National Dental Hygiene Month I would like to shine the spotlight on one of our valued customers, Judy. Judy is a Registered Dental Hygienist Alternative Practice; she provides services to patients in long-term care facilities. I interviewed Judy about her career and found out that it’s a tough, but rewarding job. Here’s what she had to say:
What factors influenced your decision to become a Registered Dental Hygienist Alternative Practice?
I have been a dental hygienist for over 26 years and the last 2 years practicing as an RDHAP. This has allowed me freedom to practice preventive hygiene care to patients who have little or no access to dental care, to serve the underserved.
What type of schooling is required to become a Registered Dental Hygienist?
A dental hygiene education is a minimum of 2 years, but it can be a long as 4 years. A 2 year program offers a diploma, certificate, or associate degree. A four year program offers a baccalaureate degree. There are some schools that offer Master's degrees for those interested in education, research, or administration. An accredited dental hygiene program requires an average of 1,948 clock hours of curriculum. This includes 585 clock hours of supervised clinical dental hygiene instruction. For a list of all dental hygiene programs in the country you can utilize the American Dental Hygienists' Association website.
As an RDHAP working with patients in long term care, what does your job consist of?
Every day is varied. I try to stay flexible with the resident patients, the nursing staff, and all the adjunct support staff. I usually have a list of residents to see, but sometimes it is not a good time to visit...sometimes they are in the beauty shop having their hair done, or they are in the shower room, or physical therapy, or in activities. Heaven forbid we disrupt a hot game of Bingo! Each patient that is seen, their facility chart is checked for their current medical and drug status. I then will see the resident in their room, in their bed, wheelchair, or reclining chair. Complete an intra and extra oral assessment. Chart missing, decayed, broken teeth. Complete a periodontal assessment; perform preventive hygiene services as
necessary such as scaling, root planing, and applying fluoride. I try to adapt toothbrushes, and other intra-oral aids for ease of use of the resident or for the staff or family members that may be assisting the resident in their oral care. Then the charts are completed and equipment is packed and moved to the next room. At the end of the day a Resident Oral Health Needs Assessment form is filled out for the residents that are seen on that day. This form addresses the acute needs, suspicious oral lesions, denture concerns that will need the attention of the facility's dentist.
Some days I do an inservice for the nursing staff or an informational evening with resident's family members. I am a speaker that promotes and provides education on prevention of oral health diseases and total health to the public, special needs and senior caregivers, other professionals, and government agencies.
What are the things you love about your job and what makes your job difficult?
I love the people! Everyone has a story to tell. Most all my patients are thankful for the services I provide, and it is rewarding to see the improvement in my patient's oral health and the improved self esteem they have.
What makes my job difficult is the long hours. Takes about an hour to pack my supplies for the day and load my car. It is a set-up time of approximately 15 minutes before seeing a resident, and a tear-down time of about 20 minutes before I can move on to another resident's room. Upon the return to my home-office it is time to unpack, clean, sterilize instruments and equipment and pack up my mobile cart again. Then there is the paperwork and billing insurance and Denti-Cal. Each resident seen takes about one hour of clinical time and the same in preparation and completion of paperwork and equipment maintenance.
Is there a dress code at your place of employment? If so, what is it? If not what do you wear on an average day? Do you have a favorite medical uniform?
No dress code, when seeing residents I wear single color scrubs, with a white lab coat with my name embroidered on it. I love Landau Scrubs especially the pull-on pants. I think I have all the colors! When meeting with the public or giving an inservice I usually wear nice street clothes with my lab coat.
Will you be doing anything specific to participate in National Dental Hygiene Month 2008?
Yes, on October 30th my local dental hygiene society along with dental hygiene students will be having a "Sugarless Shack" at a market night. We will have stuffed "goody bags" with sugarless treats, toothpaste and toothbrushes and floss. The dental hygiene students will be demonstrating tooth brushing techniques, and some tooth fairies in costumes appear! It's a fun time for adults and children alike!
Every year I get extremely excited about autumn. My favorite part of the season is Halloween because I love to dress up, although apple cider, horror movies and an excuse to eat candy also add to the appeal. Unfortunately, year after year, my costumes are disappointing. October 31st is preceded by a month of planning and plotting my costume. Then, unexpectedly, October 30th comes around and I realize I haven’t actually put together a costume! I would like to think that this year will be different, that maybe I’ll decide on a costume and have it ready and waiting in my closet by October 29th, but it’s doubtful. It’ll probably be like every other year, a last minute compilation of pieces from thrift stores thrown together at the last minute.
So hopefully this post will serve as a reminder that Halloween is quickly approaching. If you plan on dressing up, get your costume ready in advance. If you have children to dress up, start looking for ideas soon so you’re not frantic at the last minute. And if you plan on showing your Halloween spirit at work, here are a few options for spooky medical scrubs. If you don’t wear prints, try a pair of hospital scrubs that show off the colors of the season, like reds and oranges.

Left: Peaches Scrubs- Costume Kids Two Pocket Scrub Top
Right: Cherokee Scrubs- Scooby Rikes Two Pocket Scrub Top
And don’t think you can only wear Halloween print nursing scrubs on October 31st; you can wear them all month long (if your job permits it!) So stop reading and get ready for Halloween early this year. Have your Halloween scrubs ready to wear and your costume planned out in advance. And help me avoid the frantic last minute madness by sharing your favorite costume ideas, tips and tricks!
P.S. Don't forget to enter the Editor @ Large Contest- So far the entries are great and I'm excited to read more.
Everything Happens for a Reason by Jaclyn Hall
Colt was a six week old male Boxer puppy who was brought into the clinic by his breeder to be euthanized. He was underweight, under-developed, and appeared to have some severe neurological issues. He was about 1/4 of the size that a Boxer pup of this age should be. His head was dome-shaped and completely disproportionate to the rest of his body. He struggled to keep his head up and was wobbly on his legs.
We all took pity on this poor little guy and talked his breeder into relinquishing him to the clinic so that we could get some much needed nutrients in him and do some diagnostics to figure out exactly what was going on with him. If at all possible, we would then nurse him back to health and adopt him out. The breeder agreed after some coaxing and all legal documents were drawn up and signed.
Immediately following all the logistics of relinquishment, we began syringe-feeding him a high-fat, high-calorie diet every hour on the hour, as he wasn't eating on his own. His blood work came back normal, but a skull rad revealed an unfortunate truth... this little pup was suffering from hydrocephalus.
Hydrocephalus, or water on the brain, is a sad condition which spans across all the breeds, as well as all species (don't ask me about it's effects on people as all my patients have either four feet or feathers). This diagnosis is not a death sentence in the least, although it does cause severe mental retardation - and therefore - a very special owner.
We kept the wobbly pup safe in a kitten condo with padding on all sides. He required round-the-clock care and so at night when the clinic closed and on weekends, my now soon-to-be-husband (also with veterinary experience) and I cared for him at our home to ensure Colt had the best chance for survival. We took turns feeding him through the night and cleaning up his frequent 'whoopsies' which were often used as paw-paint throughout his padded kennel.
Slowly and steadily, but not without the occasional speed bump', Colt proved to be strong enough and brave enough to make an outstanding recovery. His weight increased and with the proper nutrition, his natural hunger drive began. He no longer had to be syringe-fed and with that caught on to the idea that he didn't want to soil where he slept. He began walking on his own, still with a slight wobble, but with enough neck muscles to hold his head up. He began growling and playing with the toys we had gotten him, and he even began doing the classic Boxer butt-wag. We were now faced with an encouraging realization... Colt was actually happy and healthy enough to be adopted!!
It was terribly sad to see him go, seeing that we had spent so much time caring for him. He had become a big part of out hearts while on the other hand it was unbelievable gratifying to know that we aided in his great success and ultimate survival. My fiancé and I contemplated making him a true member of our family; however our pet situation at that time would not have been the best situation for Colt. We just would not have been able to continue giving him all the attention he would require as he grew into the adult dog we worked so hard to get him to become.
With the help of a local rescue organization, all of us at the clinic, and of course my fiancé; we were able to find this sweet little boy an absolutely wonderful forever home. His new family had a 3 year old female Boxer that took Colt under her wing and showed him the ropes. She watched him like a hawk and would rush to his side anytime she thought he needed assistance. It was amazing! An assistive dog for a dog! It was the sweetest and cutest thing to see - truly endearing and awe-inspiring.

Colt is now 3 years old and doing great! He still has
a slight wobble, and often uses people, and his older Boxer sister for support. His hydrocephalus is till present, but he was able to grow more into his head. He remains intact as there are several anesthesia risks associated with his disorder. Despite the fact that his family lives far away from me, they do let
me see him from time to time. This pic was taken
of him and me on his third birthday earlier this summer. As you can see, he appears to be very normal and healthy. Though he does suffer from seizures as well as retardation, he is still extremely happy, healthy, and content.
Being given the opportunity to be a part of this fur-kids life is a constant reminder of why I do the work I do. Despite the fact that not every patient is happy to see me nor easy to work with, and the majority of our patients are sad, sick, and only masking the pain to appease their owners, at the end of the day they go home and they feel better. That to me is the most gratifying feeling in the world.
Colt knows that he was saved and his personality reflects that knowledge. He is always ready and willing to be a part of the fun things life has to offer and always wants in on the action. I understand that he has successfully finished his training to become a therapy dog and frequents Children's Hospital on a weekly basis. His Mom states that the children are so fascinated with a dog that has physical and mental challenges - proving that he makes a positive impact on their lives. This just goes to show us that everything does happen for a reason and that Colt has found his reason.