Download CE Module Inside Men looking for fulfilling careers eye the nursing profession

Pr e se n ts
2013
Men looking for fulfilling careers
eye the nursing profession
CE Module Inside
Detecting Prostatitis
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2 013
12
CONTENTS
10 | Upfront
12 | COVER STORY
On second thought ...
20
Men are choosing nursing as their
second careers.
16 | News & Trends
20 | Forging a bright future
AAMN President William Lecher discusses
the organization’s journey and future.
22 | Rock stars
Notable men make their mark on the profession.
26 | CE COURSE
Detecting prostatitis
The module focuses on different forms
of the condition and treatment measures.
26
34 | Dear Donna’s Jobs Advice
36 | Nancy Brent’s Legal Wisdom
38 | State Boards of Nursing
40 | Certification Resources
42 | End of Shift
6
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UPFRONT
Big guys don’t cry
Robert
HESS
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T
he topic of men in nursing is like an onion: There’s always another layer,
waiting to sear your eyes. It’s enough to make you cry. So when I saw one
more comment on Facebook about how men make more money than women
in nursing, I reacted: “That’s old news.” I was abruptly countered by a colleague’s
posting of a not-so-old U.S. Census Bureau analysis of 2011 data. Statistics demonstrated that men not only still enjoyed higher wages than women, but that their
presence in nursing was growing. The percentage of guy nurses (that’s what I call
them) in the profession rose from about 2% in 1971 to almost 10% in 2011.
But if nursing is so lucrative for men, I thought, why aren’t there even more? One
reason is that we lose them in nursing school.
Already a 22-year-old college graduate, I entered nursing school in 1972. I was
the third man ever enrolled in my hospital diploma nursing program. I also was the
only one in my class trying to raise a family by working a full-time evening job in
the same hospital where I was a full-time student. I can honestly say that my gender
made me stand out and feel different in nursing school compared to my college
years, but if nursing school was hard on me because of my sex, I was too focused
elsewhere to notice — and dropping out was not an option.
Oddly, upon graduation, I would go on to work in critical care units that had
an uncharacteristically large proportion of male nurses. Since then, my career has
progressed through a series of jobs in which I’ve encountered the occasional guy
nurse who also made it through his basic program.
Men always have faced gender-related issues in their basic nursing education programs. In the recent article “Men in Nursing” in the American Journal of Nursing,
the authors culled 13 potential barriers to sexual diversity in nursing from recent
and seminal research that examined the experiences of men in nursing. Among
those listed were “sex-related bias in rotations, anti-male remarks by faculty,” lack
of mentorship or male faculty, and teaching methods better suited to women. Apparently, a man has a hard time in a women’s world. And no one collects attrition
rates of nursing students related to gender on a national level. Instead, according
to Chad O’Lynn, RN, PhD, author of “A Man’s Guide to a Nursing Career,” “What
is reported in the literature from American schools is anecdotal or only provides a
partial picture. [But] the data always has the same pattern — that attrition for male
nursing students is higher than for female students.”
Why should anyone even care if more men enter nursing? Because the needs of
male patients might be better met if there were caregivers who better understood those
needs — that is, other men. The 2010 Institute of Medicine report, “The Future of
Nursing: Leading Change, Advancing Health,” encourages strategies to increase the
diversity of nursing, which include gender diversity. According to a Census Bureau
brief released in 2011, 49.2% of the population is male. The American Assembly for
Men in Nursing has made a seemingly modest proposal with its 20 X 20 Nursing
Campaign to increase the number of men in nursing to 20% by 2020. The increase
of men in the nursing population from 10% to 20% in the next seven years would
be larger than the growth from 2% to 10% that took 40 years to accrue. Even that
would be a long way from proportionally representing America’s men. It’s enough
to make you cry. But then again, I’m a guy nurse, and big guys don’t cry. •
Share your opinions with us and participate in our poll
on Facebook. Poll results will be reported monthly.
10
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11
7/26/13 9:07:42 AM
COVER STORY
Growth and change are part of life.
And in life’s long journey, sometimes a
person’s first choice for a fulfilling career
might not seem like the right path five,
10 or 15 years down the line.
T
ake trumpet player Ricardo San Jose. He was talented
enough to earn a full-ride music scholarship to the University of South Florida in Tampa, Fla., and before long San
Jose caught the attention of a national reggae band. He joined the
Supervillains in 2002 and loved the life of a musician — performing at sold-out concerts around the world with popular bands.
Three years ago, however, he decided to relinquish his coveted
spot in the band to start nursing school. Although leaving the
band was the hardest thing he has ever done, his decision to make
a major career change was sealed after he witnessed the role of
nurses when his father was diagnosed with lung cancer.
“I saw the nurses treat my family with dignity and respect,”
San Jose said. “They had the most impact on patient care, and I
wanted to do that. They gave us hope and honesty and explained
the purpose of different tests, what to expect and the side effects
of the treatments. They felt like an extension of my family.”
In December, San Jose, who acknowledges that his choice to
change careers was influenced by a change in values that began
at age 30, will graduate from a concurrent ASN/BSN program
offered through a partnership between the University of Central
Florida and Seminole State College in Florida. His time in nursing
school has only confirmed his decision. “The feeling I get when I
help a patient or family is much more gratifying than the adulation
I got from performing on the stage,” he said. “I’m also happier
because I have job security. I know I will have a lifelong career,
and music does not offer that.”
San Jose will be joining the RN workforce at a time when the
percentage of men in nursing is higher than it has ever been. According to the U.S. Census Bureau, 9.6% of the RNs in the U.S. in
2011 were men — compared to 5.7% in 1990 and 4.1% in 1980.
The percentage of men enrolled in nursing schools nationally is
even higher than the percentage of men in the workforce, which
suggests that the numbers will continue to increase. According to
the American Association of Colleges of Nursing, 12.2% of students
enrolled in entry-level BSN programs in 2012 were men.
William Lecher, RN, MS, MBA, NE-BC, president of the
American Assembly for Men in Nursing, suggests men who choose
nursing as a second career often fall into one of two categories.
“They may be older and feeling like their first college degree isn’t
working out very well, and at this point they have more self-confidence
and comfort with their masculinity, so they are not bothered by the
fact that nursing is a predominantly female profession,” Lecher said.
“Other men are those who have worked even longer and have had
to deal with frequent job changes due to recessions or the economy.
12
By Heather Stringer
Men are saying goodbye
to initial career aspirations and
making the move into nursing
NURSE.com/MenInNursing • 2013
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They may have known they always had an aptitude for science, and
healthcare has less downsizing and better job security.”
INCREASING the male presence
Although the percentage of men in nursing has increased in the
last several decades, Lecher suggests that nursing schools need to
make it a higher priority to recruit and retain men.
“The number of men in the nursing workforce has increased
threefold in 40 years,” said Lecher, who is senior clinical director
at Cincinnati Children’s Hospital Medical Center. “It is disappointing that it took us 40 years to get from 2.7% to 9.6%. Men
make up about half of all patients, and I believe improved gender
diversity in the RN workforce would help improve the health
outcomes of American men.”
To encourage men to enter the nursing profession, the AAMN
launched the “20 X 20: Choose-Nursing” recruitment initiative,
which aims for 20% male enrollment in nursing schools by 2020.
The program includes a website with links to recruitment posters
and schools that have been recognized by the AAMN for recruiting and retaining men in their programs.
David Vlahov, RN, PhD, dean and professor at the University of California, San
Francisco, School of Nursing is actively
working to recruit men.
“It starts with having men in leadership
positions that set the example and communicate by their presence that this is a
great profession,” Vlahov said. “That is one
David Vlahov, RN
of the reasons I took on the deanship.”
UCSF sends men in the profession to college and high school
outreach events hosted by the AAMN, and Vlahov also attends
job fairs to speak to people who are considering nursing. This year
the male enrollment at UCSF was 13.5%, and the number of men
in the second-degree program was more than 33%, he said.
OVERCOMING reservations
Although second-career men in nursing are often highly motivated
when they make the decision to change careers, there still can be
fears about entering a female-dominated profession.
“I was worried about the stereotypes, such as patients assuming I am homosexual or assuming I should be a woman,” said
Tristan Frolich, who is in the accelerated BSN program at the
University of Washington in Seattle. “I wondered how I would
interact with a teen female patient and whether I would be able
to relate to fellow students.”
Frolich was willing to take the risk in spite of these fears
because he was disillusioned with the architecture industry.
“Architecture turned out to be a job sitting in front of a computer
every day and dealing with difficult clients who were bickering
about costs and ideas, and it wasn’t very fulfilling,” he said.
“People make money by cutting corners in construction, and it
was not something I wanted to surround myself with. I wanted
to do something to make a difference.”
NURSE.com/MenInNursing • 2013
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Photos courtesy of Ricardo San Jose
Photo courtesy of Adelphi University
Ricardo San Jose went from
reaching out to fans as a trumpet
player for the Supervillains
reggae band to reaching out to
patients as a student nurse.
THE NIGHT SHIFT
John Lyons at Adelphi University College of Nursing and Public Health in New York
Even though he is one of two male students in a class of 44, his
concerns about being a male nurse have virtually disappeared. “I have
made many close friends and that is a testament to them,” he said.
“The women treat us the same as everyone else, and I have received
overwhelmingly positive feedback from patients.”
Rather than being a liability, John Lyons, a student in the accelerated
second-degree program at Adelphi University College of Nursing and
Public Health in New York, has discovered that it can be an asset to be
a man in nursing. “There is such a demand for men,” said Lyons, who
previously worked in human resources for the New York Islanders professional ice hockey team. “I think it is a positive when going through the
admissions process, and it can give us a leg up in starting a career.”
Although there are benefits to breaking the gender barrier, Lyons acknowledges that there can still be moments that remind him he is a minority.
“Sometimes patients ask me why I decided to become a male nurse,
and I laugh because I didn’t decide to become a male nurse — just a
nurse,” he said. “You realize it is not [about] being a man or woman,
but the right person to be a nurse. Helping people is what it’s really all
about. The best part is watching patients through their hospital stay
and seeing them get better and leave. I tell patients it’s not that I don’t
want to see you again, I just don’t want to see you in the hospital.” •
AT ADVENTIST HINSDALE HOSPITAL in Illinois, a
night shift phenomenon is catching the attention
of administrators: During the night at least one
third of the nursing staff is male in the ICU. This
is three times the number of men who work on
the day shift on these units.
According to ICU night shift nurse Paul Groenewold, RN, BSN, FCCS, these are some of the
reasons the number of men on the night shift has
increased in the last couple of years:
• New graduates often fill night shift positions, and
there has been an influx of male new grads.
• The night shift offers a close, supportive atmosphere because there is less ancillary staff and
less access to physicians.
• It allows flexibility for time outside of work
for additional schooling or activities during
the day.
• It offers autonomy because there are fewer
caregivers on staff at night.
“I like the night shift because I really like the team
we have,” Groenewold said. “The nurses are always
there for me. If I have questions or if my patient is
going downhill, they are willing to take time to help
me out. It is a fun working atmosphere.”
Heather Stringer is a freelance writer.
TO COMMENT, email [email protected].
14
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NEWS & TRENDS
Agent Orange exposure
linked to lethal prostate cancer
Exposure to Agent Orange is linked to lethal forms of prostate cancer among U.S. veterans, according to a study. The
findings suggest Agent Orange exposure history should be
incorporated into prostate screening decisions for veterans,
researchers reported.
The herbicide Agent Orange was heavily used during the
Vietnam War era and often was contaminated with dioxin,
a dangerous toxin and potential carcinogen, according to
background information in the study, which was published
May 13 on the website of the journal Cancer. Prior research
suggests exposure to Agent Orange may increase men’s risk
of developing prostate cancer, but whether it specifically
increases their risk of developing lethal forms of the disease
has been unclear.
“This is an important distinction as the majority of prostate cancer cases are non-lethal and thus do not necessarily require detection or therapy,” Mark Garzotto, MD, of
the Portland Veterans Administration Medical Center and
Oregon Health & Science University, said in a news release.
“Having a means of specifically detecting life-threatening
cancer would improve the effectiveness of screening and
treatment of prostate cancer.”
This study indicates that determining men’s Agent Orange
exposure status is a readily identifiable means of improving
prostate cancer screening for U.S. veterans, allowing for earlier
detection and treatment of lethal cases and potentially prolonging survival and improving quality of life. •
Restless legs syndrome
may increase death risk in men
Men who experience restless legs syndrome may have a higher risk of
dying earlier, according to a study. “RLS affects 5% to 10% of adults
across the country,” study author Xiang Gao, MD, PhD, of the Harvard
School of Public Health, Harvard Medical School and the Channing
Division of Network Medicine at Brigham & Women’s Hospital in
Boston, said in a news release. “Our study highlights the importance
of recognizing this common but underdiagnosed disease.”
For the study, published June 12 on the website of Neurology,
the medical journal of the American Academy of Neurology, 18,425
men with an average age of 67 who did not have diabetes, arthritis or
kidney failure were evaluated for RLS. A total of 690 of the men (3.7%)
met the criteria for RLS at the beginning of the study. Information
about major chronic diseases was collected every two years.
During the eight years of study follow-up, 2,765 participants
died. Of the people with RLS, 171 (25%) died during the study,
compared with 594 (15%) of those who did not have RLS.
The researchers calculated that men with RLS had a nearly 40%
increased risk of death compared with men without RLS. The association dropped only slightly after adjusting for factors such as
body mass index, lifestyle, chronic conditions, lack of sleep and other
sleep disorders. When the researchers excluded people with major
chronic conditions such as cancer, heart disease and hypertension,
from the analysis, the association between RLS and an increased
risk of death rose to 92% higher than those without RLS.
Although RLS can occur in children, the study did not assess
whether there was a long-term risk in this population. •
READ THE STUDY ABSTRACT: Neurology.org/Content/Early/
2013/06/12/WNL.0b013e318297eee0.Abstract.
READ THE STUDY ABSTRACT: http://OnlineLibrary.Wiley.com/
doi/10.1002/cncr.27941/Abstract.
Record number of JHU
accelerated BSN students are men
The number of men — 13% — in the summer 2013 accelerated
BSN class at the Johns Hopkins University School of Nursing in
Baltimore is a new school record, and more than the national percentage of men working in nursing, according to a news release.
A U.S. Census Bureau study based on data from the 2011 American
Community Survey found 9.6% of working RNs are men.
The 122-person cohort of 13-month BSN students includes
16 men, according to the release. This cohort also stands out for
other demographics, such as average age (28), states represented
(29), countries represented (four), percentage holding a graduate
degree (14) and percentage reporting a race or ethnicity other than
white (31), the release stated.
“We strive for diversity in every one of our cohorts. It’s good
for students and for the school,” Nancy Griffin, associate dean for
enrollment management and student affairs, said in the release.
“So this is great news. Of course we hope that one day soon this
won’t be seen as news at all but just the way it’s supposed to be.
That is the goal.” •
16
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NEWS & TRENDS
Study showcases increased
representation of men in nursing
The representation of men in nursing has increased as the
demand for nurses has grown over the last several decades,
according to a U.S. Census Bureau report that was released in
March. The study showed the proportion of male RNs has more
than tripled since 1970, from 2.7% to 9.6%, and the proportion
of male LPNs and LVNs has increased from 3.9% to 8.1%.
The study, “Men in Nursing Occupations,” presented data
from the 2011 American Community Survey to analyze the
percentage of men who are RNs, nurse anesthetists, nurse
practitioners and LPNs/LVNs. The data also provide estimates on a wide range of characteristics of men and women
in nursing occupations.
“A predicted shortage has led to recruiting and retraining
efforts to increase the pool of nurses. These efforts have included
recruiting men into nursing,” Liana Christin Landivar, the report’s author and a sociologist in the Census Bureau’s Industry
and Occupation Statistics Branch, said in a news release.
Men typically earn more than women in nursing fields, but
not by as much as they do across all occupations. Women
working as nurses full time, year-round earned 91 cents for
every dollar male nurses earned; in contrast, women earned 77
cents to the dollar across all occupations. Male nurses earned an
average of $60,700 per year in 2011, while
female nurses earned $51,100.
Because the demand for skilled
nursing care is so high, nurses
have very low unemployment
rates. Unemployment was lowest
among nurse practitioners and
nurse anesthetists (about 0.8%
for both). For RNs and LPNs/
LVNs, these rates were a bit
higher, but still low at 1.8% and
4.3%, respectively. •
READ THE REPORT at Census.
gov/people/io/files/Men_in_
Nursing_Occupations.pdf.
Study connects male-pattern baldness
to heart disease
Male-pattern baldness is linked to an increased risk of coronary
heart disease, but only if the baldness is on the crown of the
head instead of the front, according to a data analysis. A receding
hairline is not linked to an increased risk, according to the study
published April 3 in the online journal BMJ Open.
Researchers with the University of Tokyo checked the Medline
and Cochrane Library databases for research published on male
pattern baldness and CHD and came up with 850 studies published
between 1950 and 2012. Only six satisfied all the eligibility criteria
and were included in the analysis. All had been published between
1993 and 2008, and included almost 40,000 men total.
Three of the studies were cohort studies, with the health of
balding men tracked for at least 11 years. Analysis of the findings
from those studies showed that men who had lost most of their
hair were 32% more likely to develop coronary artery disease than
their peers who retained a full head of hair. When the analysis was
confined to younger men, bald or extensively balding men were
44% more likely to develop coronary artery disease.
Analysis of the three other studies, which compared the heart
health of those who were bald or balding with those who were
not, painted a similar picture. Balding men were 70% more likely
to have heart disease, and those in younger age groups were 84%
more likely. •
THE STUDY IS AVAILABLE at http://bmjopen.bmj.com/content/
3/4/e002537.full.
‘Man Up!’ book for nurses
aims to shake status quo
A new book filled with advice from successful male nursing
leaders aims to help men navigate their nursing careers. “Man
Up! A Practical Guide for Men in Nursing” by Christopher Lance
Coleman, RN, MPH, PhD, FAAN, with contributions from other
successful men in nursing, attempts to shake up the status quo,
according to a news release.
The book, published by the nonprofit Honor Society of Nursing,
Sigma Theta Tau International, comes after the Institute of Nursing
issued a challenge to the profession in 2010 to diversify its workforce by gender and to look at how recruiting men could reduce
the nationwide nursing shortage.
“I believe men need a guide, a blueprint to use to navigate
through the complexity of specialty choice and a culture where,
frankly, a gender disparity still exists,” Coleman said in the release.
“This is an opportunity of a lifetime for men not only to change
the face of nursing in the 21st century, but also to reshape the
public image that nursing is a women’s profession.”
Coleman is the Fagin Term Associate Professor of Nursing and
Multicultural Diversity at the University of Pennsylvania School
of Nursing in Philadelphia and co-director of the university’s
Center for Health Equity Research. •
PURCHASE THE BOOK at NursingKnowledge.org/STTIBooks.
18
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AAMN president builds
strong base for expected growth
By Heather Stringer
M
any people who meet William
Lecher, RN, MS, MBA, NE-BC,
president of the American Assembly for Men in Nursing, may not know
that his first career taught him how to use
jackhammers, climb scaffolding and pour
cement. In fact, he was such a strong leader
within a construction crew in Wisconsin
that he became the foreman. After eight
years in construction, however, Lecher William Lecher, RN
began reconsidering his career path. He realized that the heavy
labor would be challenging as his body aged, and construction
jobs were increasingly difficult to find as the national economy
slowed during the recession in the early 1980s. Lecher decided
to take a vocational assessment test, and nursing was one of
four careers that surfaced as a possible match for his skills
and interests.
“I didn’t give it serious thought at first, but then I had a conversation with an uncle who was a psychologist,” Lecher said.
“He said that if he had it to do all over, he’d be an RN. As a nurse
there are so many areas of practice, the income is good and you
can get a job in any city in the country.”
These words changed the course of Lecher’s life. He went on
to pursue a nursing degree and is currently the senior clinical
director at Cincinnati Children’s Hospital Medical Center. He is
halfway through his second term as president of the AAMN.
“One of the reasons I accepted the role of president is because
I have a personal interest in helping more guys know what a
great career nursing is,” he said. “I want other men to know that
they can do this, too. The job opportunities, variety and career
mobility and development are excellent.”
20
During Lecher’s term, the AAMN has been strategic in its efforts
to become a more visible professional nursing organization. The
AAMN updated its website and created an online store to allow
nurses to become members through the Web. The organization
also dedicated financial resources to support local chapters as
they ventured into the community for activities such as career
days and men’s health screenings.
In the past six years, the AAMN has experienced unprecedented
growth. The group had about 200 members six years ago, and
its membership has grown to more than 1,200 members. There
were six chapters nationwide in 2006, and now there are 56,
Lecher explained.
“The legacy I’d like to leave behind is that AAMN would truly
be better known by all nurses in our country, and the name and
the brand would have tremendous respect,” Lecher said. “I talk to
nurses all the time who say they’ve never heard about us.”
Lecher’s goal during his last term is to prepare the AAMN to
sustain the growth it has experienced during the last several years,
but he acknowledges that this will be difficult if the organization
continues to be primarily a volunteer-run group.
“Board members, while very engaged, do it as volunteers,” he said.
“They all have day jobs that are their first priority, and elected volunteers typically leave at the end of their term. My goal is to be able to
have a funding stream to pay full-time staff members who can drive
the operations of the organization and focus on the recruitment and
retention of our members. Until we get a bigger membership base
and the associated revenue, this will be difficult to afford.”
Lecher is also eager to encourage more women to join the
organization. “We really wouldn’t want the AAMN to be seen as
an organization for men only,” he said. “We are the American Assembly FOR Men in Nursing, not OF Men in Nursing. There are
NURSE.com/MenInNursing • 2013
SG_MEN_FEA-Lecher1.indd 1
7/26/13 9:18:48 AM
a lot of women who believe the profession should be more gender
inclusive and balanced. Our women members bring an important
different perspective.”
Historically about 10% of the board members have been women,
and 7% of the members are women. For women, a motivation for
joining the AAMN may be a desire to improve the health outcomes
of men, which is one of the organization’s priorities.
“Men’s health outcomes continue to be worse than women’s in
many areas, and almost all women have a male significant other
— brother, dad or son — and for this reason women probably do
not want to see these disproportionate outcomes,” he said.
A mentor for the mentor
Although Lecher has an affinity for leadership roles whether he is
in construction, nursing school, the hospital setting or the AAMN,
one reason for his success is a willingness to seek out mentors who
both support and challenge him.
One of Lecher’s most valuable mentors has been a man he spoke
to for the first time in 2008. Lecher
was serving as AAMN’s membership
and chapters chairperson when he
UPCOMING
was looking for people interested in
conference
promoting gender diversity. A fellow
man in nursing recommended that
The 38th Annual
he call Michael Bleich, RN, PhD,
American Assembly
for Men in Nursing
FAAN, who at the time was dean of
Conference, “Men in
Oregon Health Sciences University
Nursing: Guided by
School of Nursing.
the Past, Based in the
“I was surprised when Bleich said
Present, and Unfolding
right away ‘You are right. Gender diOur Future,” will be
versity is important, and it is time
held October 23-25,
that I make a commitment to men in
2013, at the Hilton
nursing, and I will help you.’” Bleich
Newark Airport in
not only formed a new chapter of
Elizabeth, N.J.
the AAMN in Oregon but eventually
invited Lecher and two of his board
members to represent the AAMN in a
project that would later make a significant impact throughout the nation
— the Institute of Medicine’s “The Future of Nursing” report.
“Michael is genuine, incredibly kind to everybody and will challenge anyone on any topic that needs to be challenged,” Lecher said.
“In fact, he is the one who questioned me about whether the rate of
AAMN growth would be sustainable with just volunteers.”
Although Lecher is eager to continue promoting the career path
of nursing to more men, he is aware that this message will spread
exponentially faster if the AAMN’s board and chapters have a
broader base of support. He makes this appeal to men in the
profession who are not members of the assembly. “Become part of
the AAMN,” he said. “Both students and professional nurses, be part
of our movement and join us. The more members we have, the greater
impact we can make. Together we can help the AAMN become known
across the country as a credible voice for men in nursing and a leader
in improving the health of Americans.” •
Heather Stringer is a freelance writer.
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21
SG_MEN_FEA-Lecher1.indd 2
7/26/13 9:18:52 AM
A GEM of a guy
By Janice Petrella Lynch, RN, MSN
This year, Nurse.com continues its tradition of recognizing and
celebrating the achievements of dedicated nurses at regional awards
programs held throughout the U.S., the culmination of which is
the naming of six special nurses as national winners of the 2013
Nursing Excellence GEM awardees.
In the New England region, 30 finalists were chosen, and
Edward Burch , RN, MS, CNRN, professional development
manager, Tufts Medical Center, Boston, was one of them.
“I am in an amazing position to be up here and receiving this
prestigious award, and I want to thank my colleagues because
without them, I would not be standing up here,” Burch said from
the stage at the GEM Awards gala May 13 in Newton, Mass.
Upon accepting the award, Burch likened his unit to a Rubik’s
Cube, because of its members’ success in consistently aligning their
abilities and talents to form a collaborative, effective team.
Burch said he is grateful for what nursing has given him over
the years, from his early beginnings as an orderly, his journey from
an LPN and RN to a bachelor’s- and master’s-prepared nurse, and
now his role as professional development manager at Tufts.
“I think it is important to remind ourselves where we have been
so we know the direction that we are heading in the future,” said
Burch, who saved a thank-you card from an appreciative patient
for many years and still has his first patient assignment card from
when he was an orderly.
Central to Burch’s current role is his passion for teaching the
art, science and practice of nursing. He is admired by his colleagues for his knowledge and inquisitive mind and for seeking
out innovative improvements in care.
“In an ever-changing and complex healthcare environment
with compressed time frames to achieve specific patient out-
comes, it is better to change to meet
the needs of the new demands rather
than stay stagnant,” said Burch, who is
described by colleagues as a transformational and fully accountable leader
who is passionate about evidencebased practice and nursing research.
Burch recently earned his neurology certification and said it has given
him additional credibility and enabled
him to move practice forward.
Respected for
his ability to lead
EDWARD BURCH, RN, MS, CNRN,
by example and
professional development manager,
take complex
Tufts Medical Center, Boston
concepts and
cases and individualize them into teachable moments, Burch is
considered by his colleagues as an expert in hospital-acquired and
alcohol-related delirium, as well as fall and injury prevention.
Burch spearheaded new delirium and bedside hand-off models
that are part of quality initiatives on the unit and throughout the
hospital. He also developed a nursing orientation program focused
on postop care of cardiac patients and patients transitioning from
critical to intermediate care, and created a multidisciplinary heart
transplant manual. •
Janice Petrella Lynch, RN, MSN, is nurse editor and a nurse executive.
NURSE.COM MAGAZINES have featured some notable men in nursing over the past
year. From their charitable pursuits to their innovative patient care ideas and their unique
routes to becoming nurses, many of them have made us take notice. Here are just a few of
the profession’s men who have made the pages of our magazine. They represent an evergrowing list of high achievers in the profession.
22
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By Linda Childers
If Martin Schiavenato, RN, PhD, were to gaze into a crystal ball, he would
envision a future in which patients no longer experience pain. Schiavenato,
who until recently was an assistant professor at the University of Miami
School of Nursing and Health Studies, has spent the past several years
working with a team of medical engineers to create an orb-like device that
has the ability to assess pain in premature infants. The device uses sensors
to monitor a patient’s behavioral and physiological signs of pain. Schiavenato hopes his device will lead to better pain management practices.
While Schiavenato’s invention still needs to undergo additional
testing, it shows great promise for detecting pain both in infants and
in nonverbal patients, such as intubated patients or those who suffer
from cognitive impairment. “Assessing pain in infants has always been
one of the most difficult challenges for clinicians,” Schiavenato said.
As a result, Schiavenato says, pain has often been undertreated in
infants, with many clinicians fearing the adverse effects of analgesics,
such as morphine, and weighing the risks of these medications against
the potential advantages. “Until recently, it was believed that neonates
didn’t feel pain,” Schiavenato said.
While clinicians have walked a fine line as they determine how to
treat pain in infants, Schiavenato says there is evidence that failing to
treat their pain early can lead to significant and long-lasting physiological consequences. These can include hypersensitivity to pain and
developmental delays.
Schiavenato’s own interest in how
pain is managed in infants began 18
years ago when he was working in the
NICU of a Tallahassee, Fla., hospital.
One of his young patients had a rare and
painful genetic disease that caused her
skin to blister and slough off. The baby died
days after birth but left a lasting impression
Photo courtesy of Martin Schiavenato, RN
Orb ADVANCES
pain management
Martin Schiavenato,
RN, PhD, second
from left, explains
his pain-detecting
orb to students.
MARTIN SCHIAVENATO, RN,
PhD, associate professor,
Washington State University
College of Nursing, Spokane
on Schiavenato. “When it was time for me to choose a specialty,
I decided to work to alleviate pain in infants,” he said.
A patent is pending for the orb device, which uses a
computer chip to interpret a patient’s pain signals. Leads are
placed over a patient’s chest to calculate heart-rate variability
in response to distress, while another sensor is placed in the
palm of the hand to record an instinctive finger-splaying
response to pain. A third sensor monitors facial responses to
pain. The computer then calculates the subject’s pain levels
and displays the findings on a glass orb that can turn various
colors to reflect the patient’s pain levels. “Twenty-plus years
ago, open-heart surgery was being performed on infants
without any pain meds,” Schiavenato said. “We’ve come a long
way since then, and hopefully
in the future, we will have an
even better handle on how
to effectively manage pain
in all patients.” •
Linda Childers is a
freelance writer.
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23
7/26/13 9:00:29 AM
2012 Nursing EXCELLENCE
Winners
By Lisette Hilton
In November,
Nurse.com
announced
the six national
winners of its
2012 Nursing
Excellence
Awards. Last
year’s pool of
nominees and
finalists included
several men,
including the
following two
gentlemen, who
walked away
with two of the
six top honors
for the year.
Dennehy was the 2012 national winner in the Home, Community and Ambulatory Care category. Dennehy is known by his colleagues for his dedication to
patients — many of whom are among the poorest and most medically complex
in San Francisco. He visits indigent patients in their homes or shelters and
oversees their healthcare.
Physicians and other providers at an HIV unit in San Francisco said
Dennehy has the special ability to reach seemingly unreachable patients, and
often turns their lives around. A colleague who nominated Dennehy wrote
of a patient with AIDS, lymphoma, severe mental illness
and substance abuse issues who distrusted the medical
PETER DENNEHY, RN, San Francisco
establishment. Dennehy was able to create an alliance
Department of Public Health, Health
with the patient and ultimately convinced the man to
at Home program
comply with treatment.
Dennehy chairs an HIV nursing network, helping
to train nurses and patients in HIV care. As a representative of the public health department, he
attends monthly meetings with San Francisco HIV providers to keep them apprised of what’s new
and relevant in patient care.
Dennehy said when his patients thrive, he thrives.
“A lot of the people I see have lost a lot of relationships and support from family because of addiction,
mental health [issues] or lifestyle,” he said. “It is our job to make sure these people get access to the same
healthcare that [we have] by being nonjudgmental and supportive. These people rely on us to advocate
for them. I have very supportive peers, and we work as a team with all disciplines. I feel I am part of
something bigger.” •
Nguh was the national winner in the Volunteerism and Service category.
Nguh said these words from Marian Wright Edelman, founder and president
of the Children’s Defense Fund, resonate with him: “Service is the rent we
pay for being. It is the very purpose of life, and not something you do in
your spare time.”
Nguh takes his purpose to heart and has organized and spearheaded
several mission trips in the U.S. and to developing nations. In response to
the earthquake in Haiti, he organized a group of 50 nurses to volunteer to
care for victims. Nguh often spends his summer vacations in remote areas of
the U.S., such as Alaska, where he serves indigenous people with limited care
access. He oversees faith-based organizations’ trips to East Africa, providing
food, clean drinking water and other basic health needs to people suffering
from the effects of famine and civil war.
In 2009, Nguh spearheaded an effort to raise
more than 1.2 million vaccine doses for children
JONAS NGUH, RN, PhD, MSN, MHSA,
in Kenya, South Africa and Sudan for the prevenpast director of nursing, University of the
tion of measles, mumps and rubella.
District of Columbia, Washington, D.C.
Nguh said he has witnessed the disenfranchisement experienced by minority women, and
has made it a point to advocate for women. In 2005, he founded Community Leadership Inc., a business
that promotes international networking among women.
When asked what drives him, Nguh again refers to others’ words of wisdom.
“I love the message of Mother Teresa, who said: ‘Some people feel that what they are doing is just
a drop in the ocean, but the ocean would be less because of that missing drop. No one can do great
things, only small things with great love.’” •
Lisette Hilton is a freelance writer.
24
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ESCAPE from Congo
By Linda Childers
When Joseph Mbungu Nsiesi, RN, BSN, fled his native Congo
in 1996, he never knew his path would lead him to California
and training for a new career as a nurse. At the time, Nsiesi was
forced to flee his native land and leave his family behind because
of his support for an opposing political party.
Nsiesi, 43, recounts his story in his book, “A Compass of Faith:
A Man’s Journey to America” (WestBow Press, 2012). His memoir
paints a vivid picture of a country embroiled in turmoil and how
Nsiesi fought poverty, disease and ongoing violence in his quest
to escape Africa in search of a better life.
It took Nsiesi more than a year to escape from the Congo —
first by cargo ship, then by plane. He reached America, where he
settled in California and began working as a nursing assistant.
“One of my patient’s families offered to give me a recommendation for a job at Kaiser Permanente,” Nsiesi said.
Working there, Nsiesi was encouraged by his colleagues to
consider a career in nursing. He began juggling school with his
full-time job and graduated in 2006 with an associate degree.
Soon after, he began working in the med/surg unit at Kaiser Permanente’s Los Angeles Medical Center. He returned to University
of Phoenix and earned his bachelor’s degree in 2012. He also was
inspired to give back to those still living in the Congo.
“Working as a nurse, I see how so many diseases are preventable,” Nsiesi said. “Most people in the Congo have no
access to medical care, and six out of 10
Congolese children die before reaching
their fifth birthday.”
In an attempt to provide access to
healthcare in Africa, he founded The
Nsiesi Foundation for Disease Prevention in Congo, a nonprofit dedicated to
preventing disease and promoting good
health. Nsiesi is working to arrange his
first medical mission
to the Congo. “I felt I
JOSEPH MBUNGU NSIESI, RN,
needed to reach out
BSN, Kaiser Permanente’s
and help those in the
Los Angeles Medical Center
Congo who are going
through so many of
the things that my own family went through,” he said.
Nsiesi hopes his foundation can make a difference in the lives
of Congolese children. He has been working to collect donations
of medical equipment and clothing, shoes, computers and other
items that he can take to the people of Congo.
Nsiesi credits his strong faith with helping him survive his
journey out of the Congo and hopes his book will inspire others
who face obstacles in their own lives. •
Linda Childers is a freelance writer.
Delivering a message of HOPE
Like many nurses, Jeffrey Albaugh, RN, PhD, APRN, CUCNS, is
motivated to help his patients overcome their problems. As the
director of the William D. and Pamela Hutul Ross Clinic for
Sexual Health within NorthShore University Health System’s
John and Carol Walter Center for Urological Health in Glenview,
Ill., Albaugh has been able to do just that.
At Northwestern Memorial Hospital in Chicago, where he
started his career, Albaugh said he recognized a common problem
facing many of his patients, both male and female: sexual dysfunction. His passion for his work and desire to grow professionally
led him to continue his education, culminating in a PhD from
the University of Illinois at Chicago.
There, Albaugh met Carol Ferrans, RN, PhD, FAAN, associate
dean of research at the UIC College of Nursing. Albaugh said
Ferrans inspired him to pursue research focused on improving
the quality of life of those suffering from erectile dysfunction
and other sexual problems.
One study Albaugh researched helped differentiate which inflicted
more pain on men using penile injections to treat ED: the needle
or the injection itself. “It wasn’t the needle,” Albaugh said. “Some
colleagues say they quote that study to patients every day.”
Albaugh said such research helped him develop the professional skills he now uses as director at the Hutul Ross Clinic.
Albaugh also has written a book, “Reclaiming Sex and Intimacy
By Jonathan Bilyk
After Prostate Cancer: A Guide for Men and
Their Partners.”
“I’d speak at conferences, and people in the
audience — healthcare professionals — would
tell me, ‘This is such great information. How do
we get it to patients?’” Albaugh said. “So I wrote
the book.”
Martha McCurdy, RN, BSN, who has worked
with Albaugh for two years at Hutul Ross, said
Albaugh’s mentorship has “made
JEFFREY ALBAUGH, RN, PhD,
me a better nurse,”
APRN, CUCNS, director, William D.
and Pamela Hutul Ross Clinic for
particularly relating
Sexual Health, Glenview, Ill.
to the nature of her
patients’ problems.
“All I can tell you is Jeff has changed a lot of people’s lives,” McCurdy
said. “He gives them options many people never knew were available
and helps them move on and enjoy their relationships.”
Ferrans said Albaugh’s greatest contributions might be still to
come.“But at this point in time, Dr. Albaugh’s most significant
contribution is the message of hope that he communicates, not
only to his patients, but to healthcare providers throughout the U.S.
and the world, and in turn to their patients,” Ferrans said. •
Jonathan Bilyk is a freelance writer.
NURSE.com/MenInNursing • 2013
SG_MEN_FEA-Profiles1.indd 4
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7/26/13 9:00:34 AM
CONTINUING EDUCATION
The planners and authors have declared no real or perceived conflicts of interest that relate to this educational activity. Gannett Education
guarantees this educational activity is free from bias. See the page before the post-test to learn how to earn CE credit for this module.
26
NURSE.com/MenInNursing • 2013
SG_MEN_CE309_1.indd 1
7/29/13 8:04:44 AM
THE GOAL OF THIS CONTINUING EDUCATION PROGRAM is to enhance clinicians’ knowledge of the management
of prostatitis. After studying the information presented here, you
will be able to:
1
Describe the major differences among acute bacterial
prostatitis, chronic bacterial prostatitis, chronic prostatitis/
chronic pelvic pain syndrome and asymptomatic prostatitis.
2
Understand specimen collection for the pre-/post-massage test.
3
Identify treatments and nursing care measures for patients with prostatitis.
By Gail DeLuca, RN, APRN, FNP-BC, and Carol Jo Wilson, RN, APRN, FNPBC, PhD
Mr. Maine, a 60-year-old, long-term patient in your practice complains of difficulty with his urination for the last month. He states
it takes longer for his urination to begin, and once he starts to
urinate, his stream does not have the force it used to. After urination, he has dribbling of urine. Lately, he notes he must be standing to initiate his urination. Now he notes that even though his
fluid intake has not increased, it seems he needs to urinate more
frequently, with less overall volume. This is annoying to him, and
coupled with the increased length of time it takes to initiate and
complete his void, he feels that he’s planning his life around his
urinary habits. His friends assured him that these problems were
normal as men age as he probably has “prostate problems.” He’s
worried that he may have prostate cancer.
Mr. Maine is in a married, monogamous, sexually active relationship. He has a vague aching in his perineum and rectum that is
unrelieved with defecation. Ejaculations are not painful, nor has
he noted blood, but he notes there is an aching associated with
ejaculation. Through a careful history, there’s no fever, weight loss
or change in his bowel habits. He denies any discharge from the
penis. He admits his interest in sex has waned and attributes this
to his age. He has a past history of hypertension, dyslipidemia and
has class I obesity. Since his company downsized and he was let
go one year ago, he has been unable to find work and expresses
loneliness and depression as his wife now works full time. He quit
smoking 10 years ago, and enjoys a martini with dinner nightly.
His current medications include lisinopril 20 mg daily, simvastatin 20 mg daily and ASA 81 mg daily. Mr. Maine looks healthy,
but is concerned. How will you as the clinician determine the root
of Mr. Maine’s problem? Is it true that loss of libido and urinary
complaints are a normal function of aging?
P
rostatitis is a common genitourinary complaint in men
that spans all age groups between adolescence to late
adulthood. Simply, it’s an inflammation of the prostate
gland, sometimes with infection present as well. Symptoms may
be absent, mild, or severe and life threatening. The constellation
of symptoms associated with this poorly understood condition
can be straightforward or obscure, perplexing both providers
and patients. Prevalence statistics vary because of differences in
definitions of disease. Some authors report a lifetime prevalence
of 5% to 9% with risk of repeated attacks progressing to chronic
disease. Others cite lifetime prevalence rates up to 14%.1
The diagnosis of prostatitis can include symptoms ranging from
acute to chronic, systemic to localized. The word prostatitis is
actually a blanket term for four distinct groups of prostate disorders. Classification is based on the existence of prostatic pain, the
presence or absence of white blood cells (WBCs) in the urine and
urine culture results. The National Institutes of Health (NIH)
created groupings of symptoms and clinical criteria to assist the
clinician in categorization and treatment of this syndrome.
The NIH lists the following categories of prostatitis: Category
I, acute bacterial prostatitis (ABP), category II, chronic bacterial
prostatitis (CBP), category III, chronic prostatitis/chronic pelvic
pain syndrome (CP/CPPS), and category IV, asymptomatic prostatitis.1,2 Category III is subdivided further into two categories,
IIIA (inflammatory) and IIIB (noninflammatory), depending
on the presence (IIIA) or absence (IIIB) of WBCs in the semen,
expressed prostatic secretions (EPS) or urine sample obtained
after prostatic massage.2 Category III prostatitis is the most
common presentation of this syndrome and accounts for 90%
to 95% of cases.3
Category I, acute bacterial prostatitis
ABP is an infection usually associated with gram-negative bacilli,
such as E. Coli, other enterobacteria, enterococci and Pseudomonas.2 Clinicians theorize that ABP comes from either an ascending
urethral infection, reflux of infected urine or an extension of an
infection from the rectum, lymphatic system or bloodstream.4
ABP usually affects young adult men who are at risk due to unsafe
sexual practices and elderly men as structural changes in their prostates occur. Patients experience generalized illness with chills, fever
and/or malaise. Other symptoms include dysuria; urinary frequency;
difficulty initiating urination; mild to complete obstructive urinary
symptoms; hematuria; suprapubic, perineal and/or low-back pain
radiating to the kidneys; and painful defecation and/or ejaculation.
Pain is sometimes referred to the tip of the penis.4
Risk factors associated with category 1 prostatitis are the same
as those that increase urinary tract infection risk and include
immunosuppression; conditions that impair bladder emptying,
such as prostatic hypertrophy; or history of recent urinary instrumentation, such as catheterization.1 Other risk factors, though not
well supported by research, include trauma from bicycle riding,
sexual abstinence and dehydration.6
The patient with ABP looks ill and is in severe pain, thus he
may not tolerate prostate examination. The prostate will feel warm,
enlarged, very tender, and either firm or boggy (which may differentiate between isolated ABP and an acute flare of CBP). Rectal
exams should not be performed because of the risk of spreading
bacteria to the systemic bloodstream through the prostatic blood
supply, which can result in sepsis.1 ABP complications include
prostatic abscess, sepsis or deterioration into CBP.
As you reflect on Mr. Maine, you note he looks well today. His
complaints, while irritating, are mild overall. Even though he has
some of the symptoms of ABP, such as urinary frequency, he lacks
the systemic symptoms. His age is a negative risk factor, as ABP
affects younger men more frequently. In the older age group, he
lacks risk factors for ABP, such as recent urinary instrumentation. He is not immunosuppressed, but whether he has prostatic
hypertrophy is unknown.
NURSE.com/MenInNursing • 2013
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7/26/13 9:02:33 AM
Category II, chronic bacterial prostatitis
CBP, which usually occurs in men older than 50, usually has
milder symptoms than ABP. It’s associated with risk factors such
as multiple urinary tract infections and prostatic calculi.5 E. coli is
most commonly presumed to be the offending pathogen; however,
any uropathic gram-negative bacteria could be the culprit. E. coli
has been well-studied as a causative agent in both urinary tract
infection and CBP, and researchers queried the differences in time
needed to effect a cure as the causative organism was frequently
the same. Historically, antibiotic treatment times for prostatitis
are longer than simple UTI or pylonephritis and have been attributed to difficulty in the antibiotic penetrating prostatic tissue.
Recently, pathogens including both aerobic gram-negative and
gram-positive bacteria may have implication in CBP, leading to
recurrent UTI or prostatic abscess in older men.
In fact, CBP usually presents as a UTI. However, if fever
occurs, an acute recurrence of chronic prostatitis should be
considered.5 CBP may originate as a complication following ABP,
and gram-negative rods are most often the offending organisms.
A high index of suspicion should be present in men with UTI
symptoms or recurrent infection.4 Symptoms include urinary
complaints, such as hesitancy, urgency, dysuria, difficulty initiating and terminating urine flow, and a decrease in the strength
and volume of the urinary stream. Other symptoms may include
hematuria, hematospermia and painful ejaculations.4 Chronic
low-back pain or discomfort in the perineal, scrotal or penile
areas may be present along with irritative voiding. Examination
of the prostate may reveal a normal or boggy and mildly tender
gland.6 WBCs and bacteria will almost always be found in the
urinalysis; rarely, they may be absent. Relapses and recurrences
are common in CBP.6
Category III, chronic prostatitis/
chronic pelvic pain syndrome
More than 90% of patients with prostatitis are grouped into this
category, which effects 10% to 15% of the male population and
accounts for two million outpatient visits per year.5 The striking
feature as compared to both category I and II prostatitis is the
absence of uropathic bacteria in the presence of pelvic pain.1 In
fact, even though category III is called chronic prostatitis, some
authors report that the prostate may not even be the source of
the pain.3,6 Because of the absence of culturable pathogens, its
waxing and waning nature and the absence of solidly identifiable causes, it’s largely a diagnosis of exclusion. Category III is
further subdivided into categories IIIA (inflammatory) CP/CPPS,
characterized by leukocytes in the EPS, and IIIB, noninflammatory CP/CPPS, which lacks leukocytes in the EPS. There are five
proposed causes including infection, though bacterial organisms
are absent in the urine and prostatic secretions in Category III;
detrusor-sphincter dysfunction/neuromuscular etiologies, such
as pelvic wall muscle tension; immunological dysfunction/autoimmune disorders; interstitial cystitis; and neuropathic pain.2 In
addition, allergy-mediated reactions and psychological stressors
are other possible causative factors. Pontari in 2008 reported
that men with CP/CPPS were more likely to have cardiovascular
disease, vertebral disk disease, sinusitis, anxiety and depression.
The common thread of these associations is unknown.3
28
Category IIIA and IIIB are the most common and most poorly
understood forms of prostatitis. The presence of pelvic pain for at
least three months within the last six months is a requirement for
diagnosis.2 Even though this is categorized as prostatitis because of
the pelvic pain (predominant), urinary and sexual function symptoms, researchers theorize that the symptoms may be extraprostatic.
Generalized illness is absent, and patients may describe urinary
complaints of frequency, urgency and dysuria, as well as rectal,
perineal and ejaculatory pain.3 Patients may experience changes in
sexual function that range from decreased libido to impotence.3
In Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/
CPPS), the main predictor of quality of life is pain, followed by
urinary dysfunction and depression.2 Depression and comorbid
behaviors, such as catastrophizing and feelings of helplessness,
impact the patient’s perception of pain and can present as a level
of disability out of sync with physical findings found in conditions
like fibromyalgia or chronic fatigue syndrome.3
Mr. Maine’s symptoms seem to fit both CBP and CP/CPPS as well
as urinary tract infection. Urinary infection needs to be ruled out. In
considering prostatitis, he’s the right age group for both categories.
Frequency and urgency are prominent symptoms of both CBP and
CP/CPPS. Perineal discomfort also is experienced in both forms of
prostatitis. The one-month duration of his symptoms favors CBP
and argues against CP/CPPS, as a requirement for diagnosis of
CP/CPPS is presence of pelvic pain for at least three months within
the last six months. However, this could be the start of CP/CPPS.
His history of depression favors CP/CPPS as the large percentage
(90%) of patients with prostatitis share this diagnosis.
Category IV, asymptomatic prostatitis
Asymptomatic prostatitis is often found incidentally in patients
who are not experiencing pelvic or prostatic complaints but
who are being evaluated for other urinary issues. The etiology
is uncertain. With this type of prostatitis, WBCs are only found
concomitantly in prostatic secretions when they are elevated for
an unrelated cause.1
Looking for clues
When taking the history of a man with genitourinary complaints,
a clinician should ask the patient if he has a history of UTIs, GU
disorders or GU surgeries. Understanding age group prevalence and
risk factors can help clinicians categorize patients’ complaints. It’s
also important to take a sexual history that includes information
about past episodes of sexually transmitted diseases and new sexual
partners (and any of the new partner’s GU complaints). Finally, the
onset and progression of the current problem should be explored.
Ask about painful urination, blood or pus in the urine and frequent
urination at night. Urethral discharge or itching, frequency or urgency
in urination, low-back or perineal pain or pain with ejaculation may
be present, as well as systemic symptoms of fever, malaise, loss of
appetite and weight loss. Pain, voiding and the impact on quality of
life should be assessed using the NIH Chronic Prostatitis Symptom
Index (NIH-CPSI).7 Comparison of repeated testing scores can
indicate the effectiveness of treatment.
During examination, assess the general appearance of the
patient, as well as vital signs to detect systemic illness. A thorough
exam of the GU system should include the testicles, scrotum, penis
NURSE.com/MenInNursing • 2013
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and inguinal lymph nodes. Examine the prostate by a digital rectal
exam. If ABP is suspected, hold off on palpation of the prostate
due to the risk of sepsis. Palpate the inside of the rectum for pain,
tenderness or enlargement of the prostate. Additionally, examine
and palpate the abdomen and flank for masses or renal tenderness, the bladder for distention, and the lower back for strain or
neurological or disc disease.
Both the patient’s history and physical exam findings can
narrow the differential diagnosis. Other diagnoses to be considered besides prostatitis are UTI, pyelonephritis, urethritis,
cystitis, detrusor muscle impairment and infection; neurogenic
conditions, such as neurogenic bladder and sciatica; and prostate
cancer, benign prostatic hypertrophy and prostatic stones.
Diagnosing through glasses, massage and
other methods
Analysis and culture of a divided urine sample can establish a
diagnosis of prostatitis. Two methods for obtaining the urine
specimens are the Stamey-Meares four-glass localization method
and the pre- and post-massage test. Note that neither of these
tests is used for ABP because of the extreme pain associated with
ABP and the risk of dissemination of the prostatic infection to
the systemic circulation.
The Stamey-Meares four-glass localization method (also known
as sequential or segmented voided urine culture) was the gold
standard for diagnosis. It was based on the acquisition of four
specimens. The first, VB1, was the first 10 mL of void. VB2 was
a midstream urinalysis. The clinician then performed a prostatic
massage through the rectum and milked the prostate for expressed
prostatic secretions (EBS) for culture. Finally, a third urine specimen, VB3, was collected after the EBS.
The pre- and post-massage test, also called the two-glass
method, is the more utilized test for diagnosing prostatitis. This
test is overall simpler to obtain, and it has sensitivities that almost
equal the four-glass method.4 For this test, the patient obtains
an initial midstream urine sample and then a second sample
after prostate massage. Both specimens are sent for microscopy
and culture. Findings from the pre- and post-massage test differ
with the etiology of the prostatitis. For example, urine micrology
with CBP will reveal greater than 13 WBCs/HPF in both preand post-massage urine specimens, while urine cultures of both
specimens will be negative. With CP/CPPS (IIIA), fewer than 10
WBCs/HPF will be found in the pre-massage urine, and as many
as 10 to 20 WBCs/HPF in the post-massage urine. As with CBP,
cultures will be negative.1
Additional laboratory tests can differentiate prostatitis from
common conditions, such as diabetes, sexually transmitted infections and renal calculi, which have similar presenting signs
and symptoms. Gram stain of the urine can guide the choice of
antibiotic therapy until cultures are available.6 Besides culturing
any penile discharge, CBC, BUN and creatinine will be assessed
to evaluate renal function. Electrolytes, glucose and blood cultures can help differentiate prostatitis from benign prostatic
hypertrophy, urinary tract infections and renal calculi. Additionally, clinicians may consider an IV pyelogram and a transrectal
ultrasound to detect prostatic calculi; a urine cytology to rule out
malignancies; and urodynamic testing, depending on the patient’s
history and presenting symptoms.4 CT scanning can determine if
prostatic abscess, a complication associated with ABP, is present.
To reduce the risk of sepsis, antibiotics prior to the ultrasound
may be initiated.4
You instruct Mr. Maine to obtain a midstream urine sample to
obtain the first specimen in a pre-post massage test and to obtain
a urine dip to examine for evidence of urinary tract infection. The
dip shows absence of blood but shows small leukocytes. During
the visit you observe the healthcare provider complete a prostate
examination and prostatic massage. The patient tolerated this well
(excluding ABP). A second urine sample is obtained, both containers are respectively labeled, and sent for complete urinalysis and
cultures. A basic metabolic panel, which includes electrolytes, glucose,
blood urea nitrogen and creatinine will give additional information
about renal function. Because of the lack of fever or systemic illness,
a CBC is not included.
Treatment modalities
Depending on the severity and classification, prostatitis may be
treated on an outpatient basis. On the other hand, if a patient
is acutely ill with fever, chills and severe pain, he may require IV
antibiotics and hospitalization. After cultures are obtained, first
line therapy is usually initiated with a parenteral broad-spectrum
antibiotic. European Association of Urology guidelines recommend
either a broad-spectrum penicillin, a third generation cephalosporin
or a fluoroquinolone (all can be combined with an aminoglycoside)
for initial therapy of ABP (Level of Evidence III, Grade of Recommendation B).8 Treatment continues until asymptomatic and in less
severe cases, a fluoroquinolone may be given orally for 10 days.8
In CBP and CP/CPPS if infection is suspected, a fluoroquinolone
or trimethoprim should be given for two weeks after the initial
diagnosis. Antibiotics should be continued for an additional four
to six weeks if upon reassessment, the pre-treatment cultures prove
positive or patient reports positive effects (Level of Evidence III,
Grade of Recommendation B).8 Fluoroquinolones, such as 500
mg twice a day of ciprofloxacin (Cipro); or 500 mg of levofloxacin
(Levaquin) daily, are being used more often as first line therapy
due to their higher cure rate.9 They should be continued for at
least four weeks, but neither antibiotic selection nor treatment
length has been studied in comparative trials.4 It’s accepted that
treatment of prostatitis requires longer intervals of antibiotic
therapy and differences exist among treatment recommendations.
While some have recommended beyond 90 days, most researchers
recommend four to six weeks. The prolonged length of antibiotic
use is not due to antibiotic resistance but to the poor penetration
of antibiotics into prostatic tissue. One study looked at repeat
urine cultures seven days into antibiotic therapy and found that
those cultures negative at that time predicted cure at the end of
the four- to six-week course of antibiotics.4
It’s important to understand the cure rates for antibiotics
so clinicians are aware that patients may not be improving. A
urinalysis and culture is recommended one month after therapy
is started, and then every month. Urine samples and cultures
should be repeated at four weeks to six weeks.
NIH Category III CP/CPPS is the most difficult prostatitis to
treat because the cause is unknown; there are no cultured bacteria
to guide treatment protocol. It’s still debated whether bacteria
NURSE.com/MenInNursing • 2013
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7/26/13 9:02:35 AM
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30
play a role in the cause of CP/CPPS. Researchers attempted the
use of the polymerase chain reaction to identify bacterial gene
products in prostate biopsy specimens in men with CP/CPPS, but
they were unsuccessful in finding bacterial evidence.6 Empirically,
many patients have experienced some relief of symptoms with a
long-term course of antibiotics. Thus in CP/CPPS, often a fourto six-week course of a fluoroquinolone may be tried for newly
diagnosed patients not previously treated with antibiotics,2 but the
literature advises against repeat courses of antibiotics.3 Research
does not describe significant benefits with antibiotic therapy.6
Alpha-adrenergic blockers are recommended for newly diagnosed
CP/CPPS patients not previously treated with alpha blockers.2
Alpha-adrenergic blockers, such as terazosin (Hytrin), tamsulosin
(Flomax) and alfuzosin (Uroxatral) assist in urinary flow, and
using these with finasteride (Proscar) may improve urinary flow
and reduce obstructive symptoms in CP/CPPS.4,6,10 These medications have a lowering effect on blood pressure, so the patient must
be educated on potential orthostatic changes. Longer courses of
treatment (12 weeks to six months) may be most effective.11
In treating CP/CPPS, the most salient point is that utilization of multimodal therapies provides greater relief of symptoms than isolated therapies.3 Pain control and relief measures
are important due to the level of patient discomfort. Nonsteroidal anti-inflammatories can be effective in pain control
and inflammation.3,6 Tricyclic antidepressants may blunt the
neuropathic pain associated with CP/CPPS and may alleviate
associated depression.3
Phytotherapies include pipsissewa, saw palmetto, comfrey, buchu,
couch grass, quercetin and cernilton.3,12,13 Herbs with antibiotic and
anti-inflammatory properties such as Echinacea, golden seal, and
garlic may help to reduce inflammation.1 Drinking copious amounts
of water or drinking cranberry juice may also be helpful in controlling urinary symptoms.13
Nonpharmacologic comfort measures include avoidance of
alcohol, coffee, tea and spicy foods that may irritate symptoms.
Over-the-counter cold preparations may contain decongestants or
antihistamines that increase urinary retention and aggravate preexisting prostatic hypertrophy.6 Patients should also avoid stress.
Some successful nonpharmacologic therapies to aid with voiding
dysfunction include biofeedback and pelvic floor training. Pilot
studies and clinical trials are investigating the promising uses of
botulinum toxin injections to the urethral sphincter, electromagnetic
stimulation or electroacupuncture.2,9 Physical therapy and myofascial release can improve symptoms and sexual functioning.3
Adjunctive measures may be added to enhance comfort and
reduce future exacerbations. In addition to pain medication and
hydrotherapy/Sitz baths, relief of discomfort may be obtained with
bed rest, donut-shaped cushions and stool softeners. Antispasmodics, such as oxybutynin (Ditropan), alone or in conjunction
with diazepam (Valium), may control bladder spasms. Frequent
ejaculations or regular prostatic massage may be beneficial in
promoting prostate contraction.
Because Mr. Maine has positive leukocytes on his office urine
dip, trimethoprim/sulfamethoxazole 80/400, one tablet two times
daily was initiated pending the results of his complete urinalysis
and cultures. This is the appropriate therapy for UTI, CBP as well
as CP/CPPS. Duration of therapy will be determined after review
NURSE.com/MenInNursing • 2013
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of the culture results. To help Mr. Maine with symptom relief, you
instruct him to avoid OTC cold preparations, and encourage dietary
changes including avoidance of caffeine and spicy foods. At the
conclusion of the visit, you mention to the healthcare provider that
Mr. Maine has been depressed due to his change in job status and
his continuing discomfort. Because multimodal therapies provide
greater symptom relief, nortriptyline for depression and pain is added
to the therapeutic regimen along with as needed ibuprofen.
Resources
Further information and current research on prostatitis
may be obtained from:
• Agency for Healthcare Research and Quality
Publications Clearinghouse: www.ahrq.gov
• American Urological Association Foundation:
www.urologyhealth.org
• National Kidney and Urologic Diseases Information
Clearinghouse: www.kidney.niddk.nih.gov
• National Library of Medicine: www.nlm.nih.gov
• The Prostatitis Foundation: www.prostatitis.org
Clinicians need to communicate to patients that prostatitis is
not infectious, contagious, or a precursor to cancer. Patients and
partners also need to know that sexual activity may continue.
While prostatitis often can be treated in an outpatient setting,
most frequently in the primary care office, patients who are not
responsive to therapies may be referred to urology. It’s imperative for the clinician to coordinate multimodal levels of care, as
monotherapy is usually not successful. The care of patients suffering from prostatitis must include compassion and understanding
from all healthcare professionals, who should be aware of the
chronicity and morbidity associated with this disease. Open
dialogue with patients and their partners may make concerns or
misconceptions disappear. Provision of information and referral
to support groups will help patients understand this illness. •
Gail DeLuca, RN, APRN, FNP-BC, is an assistant professor at St. Xavier
University and works as a family nurse practitioner in the Student Care
Center at the University of Chicago. Carol Jo Wilson, RN, APRN, FNP-BC,
PhD, is dean and professor at the University of Saint Francis, Joliet, Ill. and
works as a family nurse practitioner at the University of St. Francis Health
and Wellness Center.
EDITOR’S NOTE: References available online at CE.Nurse.com/CE309-60.
CE309-60D
1. Acute bacterial prostatitis is generally
caused by:
a. Gram-negative organisms, such as E.
coli, Pseudomonas, Klebsiella
b. Gram-positive organisms, such as
Streptococcus, Staphylococcus,
Enterococcus
c. Gram-negative organisms, such as
H. influenzae, Mycobacterium, M.
catarrhalis
d. Fungal organisms, such as C. albicans, Microsporum, C. glabrata
2. Which of the following types of
prostatitis generally includes signs
and symptoms of generalized illness
(chills, fever, malaise), dysuria, frequency and pain?
a. Acute bacterial (ABP)
b. Chronic Prostatitis/Chronic Pelvic
Pain Syndrome (CP/CPPS)
c. Chronic bacterial (CBP)
d. Asymptomatic prostatitis
5. The proper sequencing of specimens
in the traditional Stamey-Meares fourglass localization method is:
a. Expressed prostatic secretions, initial
void, midstream void and final void.
b. Midstream void, final void on day
one, then initial void, expressed
prostatic secretions on day two.
c. Midstream void, final void, expressed
prostatic secretions, initial void.
d. Initial void, midstream void, expressed prostatic secretions, final
void.
6. The key symptom necessary for a
prostatitis to be categorized as CP/
CPPS is:
a. Urinary urgency
b. Dysuria
c. Pelvic pain
d. Frequent urination
3. The category of prostatitis most common in men over 50 and characterized by urine hesitancy, dysuria,
urgency and decreased flow is:
a. ABP
b. CBP
c. CP/CPPS
d. Asymptomatic prostatitis
7. The clinician notes 17 WBCs/HPF but
a negative culture in both the initial
and post-massage urine specimens.
This finding may represent:
a. Urethritis
b. CP/CPPS
c. CBP
d. Cystitis
4. Treatment of ABP consists of:
a. Antivirals and NSAIDs
b. No antibiotics, antispasmodics if
needed.
c. Antibiotics and NSAIDs
d. No antibiotics, but alpha-adrenergic
blockers if needed.
8. More WBCs/HPF will be found in the
post-massage urine as compared to
pre-massage in patients with:
a. ICPPS (IIIa)
b. Prostatitis
c. Urethritis
d. Cystitis
9. The key to diagnosing acute bacterial
prostatitis is obtaining:
a. Emergency ultrasound
b. Patient presentation of chills, fever,
prostatic pain
c. A pre- and post-massage test
d. A CBC and BUN
10. Patients with prostatitis should be
encouraged to:
a. Consume water, alcohol, coffee and
tea to dilute the urine.
b. Wait until culture results are back
before taking an antibiotic.
c. Take over-the-counter cold and allergy preparations if needed.
d. Avoid stress and spicy foods.
11. Recommendations for nursing care
for patients with prostatitis may
include:
a. Sitz baths, bedrest and NSAIDS
b. Cold packs to the perineum, acetaminophen and aspirin
c. Vigorous massage of the prostate
d. Direct injection of antibiotics to the
prostate
12. Providers should advise patients with
prostatitis to:
a. Abstain from sex to avoid infecting
partners.
b. Continue sexual activity because frequent ejaculations may be beneficial.
c. Continue sexual activity, but use
condoms each time.
d. Abstain from sex so antibiotics
have time to pool in the prostate to
increase effectiveness.
NURSE.com/MenInNursing • 2013
SG_MEN_CE309_1.indd 6
31
7/29/13 9:23:54 AM
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ADVICE
DEAR DONNA’S
JOBS ADVICE
Our career-management expert tackles your toughest workplace dilemmas
By Donna Cardillo, RN, MA
Here’s a sampling of some questions and answers from my online
“Dear Donna” advice column. Log on today at Nurse.com and ask
your question. I’m waiting to hear from you.
DONNA CARDILLO
RN, MA
Donna Cardillo is Nurse.com’s
“Dear Donna” and author of “Your
First Year as a Nurse: Making the
Transition from Total Novice to
Successful Professional” and “The
Ultimate Career Guide for Nurses:
Practical Strategies for Thriving at
Every Stage of Your Career.” To ask
Donna your question, go to:
CAREER ISSUES
Nurse.com/
AsktheExperts/DearDonna
Find “Dear Donna” seminars near
you at Nurse.com/CESeminars. To
order Donna’s books or register for a
seminar, call 800-866-0919.
34
Dear Donna,
In 2012, I graduated from nursing school and
passed the boards. After training at a skilled
nursing facility with a nurse who refused to
give prescribed pain medication to a man in
severe pain, I was scheduled to work on the
unit and had up to 25 patients all to myself. I
was switched to different shifts without orientation. At times, I was alone in the unit with
50-60 patients, with no training on codes or
falls. The pace needed for dispensing medications in a timely fashion was unsafe, and
proper assessment of residents was impossible.
Now I’m unemployed.
I refuse to go back to a SNF, and other
positions still require two years of acute care
experience. I’m working on my BSN. In the
meantime, I’m volunteering in a clinic drawing
blood. I’ve applied to residency positions in
remote areas with no success. I don’t know
what else to do.
Unemployed New Nurse
Dear Unemployed New Nurse,
A SNF is one possibility for some new
nurses, but you have many other options.
While some employers require hospital ex-
perience, there are others that are precepting
new nurses. You may have to look longer and
cast your net wider, but the opportunities
are out there. More importantly, you have
to be proactive in the job search process.
You must have top-notch self-marketing and
networking skills. Read this article: “New
nurse, new job strategies” (Nurse.com/
Cardillo/Strategies) and be sure you are
doing everything suggested.
Furthering your education and doing volunteer work is great. Attend nursing association meetings, such as ones held by your area
chapter of the American Nurses Association
and specialty associations that interests you.
It’s even better if you join and participate. As
a new nurse, it is vital you immerse yourself
in the nursing community.
While travel nurse agencies require experience because you have to hit the ground
running, some regular nursing agencies may
have other types of nonhospital work. Be
sure to contact outpatient hemodialysis facilities, acute rehab facilities (those affiliated
with a larger healthcare system), cancer care
centers and psychiatric facilities.
Donna
NURSE.com/MenInNursing • 2013
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Dear Donna,
I resigned from my job before I was terminated, as a direct result of horizontal violence
and hostility that affected patient care. I have
thought about claiming there was a failure to
provide a safe working environment, but am
not sure how to pursue that claim.
Feeling Abused
Dear Feeling Abused,
This is something to discuss with a nurse
attorney who is uniquely qualified to interpret the law and is familiar with issues
related to healthcare and nursing. Find a
nurse attorney by asking around, getting a
referral from your state chapter of the ANA
(NursingWorld.org), whether or not you
are a member, or from the American Association of Nurse Attorneys (TAANA.org).
This way you can find out what recourse
you have, if any, and where to go from
here. Many nurse attorneys offer an initial
complimentary consultation to determine
whether you have a case. An attorney also
can advise you on the issue of whether
you were unfairly terminated or forced to
resign, if that is what happened.
Donna
Dear Donna,
I’m a nurse with a BSN and am working
on my master’s in community health in Malaysia. In Iran, I worked as a head nurse
in an OR for 10 years, and in Malaysia I
worked as an interpreter. How can I find a
job online in the U.S., and how can I register
for Nursing Without Borders?
On The Move
Dear On The Move,
To find a nursing position in the U.S, I
would suggest you contact an international
nursing agency that places nurses from
your current country in the U.S. You can
find these agencies online. It would be ideal
if you could find another nurse from your
country who is now in the U.S. and has
used such an agency, to be sure the agency
is legitimate and reliable.
You also can get referrals through
the Iranian-American Nurses Association (I-ANA.org) and the Asian American Pacific Islander Nurses Association
(AAPINA.org). Both of these associations
can advise and support you coming to the
U.S. to work as a nurse.
Regarding Nursing without Borders,
I’m not sure if you are referring to working
as a nurse with the organization Doctors
Without Borders, doing other medical
volunteer work or something else entirely. For DWB, contact the international
office at DoctorsWithoutBorders.org/
offices/?ref=nav-footer#international. For
medical volunteer work, there are many
agencies that offer this, depending on the
country or specialties you are interested
in. So search the Internet for medical volunteer agencies for nurses and further
specify a country or specialty.
Donna
Dear Donna,
I have an opportunity to work with a psychiatric nurse practitioner in her private
practice. She is offering me an hourly rate
without benefits. Is this an opportunity to
identify myself as self-employed — as sole
proprietorship, a limited liability company
or a corporation? Or would I have to work
for her as an employee? I would be providing
services such as testing, education, counseling and billing patients’ health insurance
for reimbursement.
Possible Sole Proprietor
Dear Possible Sole Proprietor,
The answer to your question might
depend on what you work out with the
NP. What is her expectation — are you an
employee or an independent contractor?
Which arrangement would you prefer?
If you are an employee, then there are
certain things she will have to do including withholding taxes, Social Security and
Medicare taxes from your paycheck. If
you are going to be designated as an independent contractor, then you have to be
given the flexibility to work at your own
schedule. You also would be responsible
for paying your own taxes.
There are rules and guidelines that
define and govern this. Do an Internet
search to learn the difference between an
employee and an independent contractor.
If you do end up being an independent
contractor, or at least want to consider
both, you don’t necessarily need to set up
a business entity — unless you are going
to do this on a frequent and ongoing basis.
Talk to an accountant and a nurse attorney
about this situation.
Donna
You may have to look longer
and cast your net wider, but the
opportunities are out
there ... you have to be
proactive in the job
search process.
— Donna Cardillo, RN, MA
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7/26/13 9:04:54 AM
ADVICE
NANCY J. BRENT’S
LEGAL WISDOM
Find out about issues that RNs confront in their daily practices
By Nancy J. Brent, RN, MS, JD
If you haven’t checked out the Brent’s Law section of Nurse.com,
you don’t know what you’ve been missing. Ask your own question by
logging on to Nurse.com/AsktheExperts/BrentsLaw.
NANCY J. BRENT
RN, MS, JD
Nancy J. Brent, RN, MS, JD,
is an attorney in private practice in
Wilmette, Ill. This information is for
educational purposes only and is
not intended as legal or any other
advice. The reader is encouraged
to seek the advice of an attorney or
other professional when an opinion
is needed.
LEGAL ISSUES
Nurse.com/
AsktheExperts/BrentsLaw
36
Dear Nancy,
We count narcotics verbally, including saying
the patient’s name, medication, dose and
number of pills left, even when there are
patients present. I am uncomfortable doing
this, but my director insists. Is this a violation
of the Health Insurance Portability and Accountability Act or other privacy laws?
Joseph
Dear Joseph,
It is unclear why your director of nursing
requires narcotics counts to be done verbally. Has anyone asked why this needs to
be done? Having a rationale might help
correct parts of the process that seem to be
violations of a patient’s privacy, confidentiality and HIPAA, when patients and others
are in hearing range of the information.
Perhaps one way to change the process
would be to do the verbal count in the
medication room or the nurse’s station with
a closed door, so only those in the room or
nursing staff would hear the information.
This would not be a violation of HIPAA or
the patient’s privacy and confidentiality.
Nancy
Dear Nancy,
Is it a violation of the Health Insurance
Portability and Accountability Act to take a
picture of a patient’s injury on a cellphone?
There is nothing identifying the patient, and
it was not posted anywhere. I work at a
unionized hospital.
Concerned
Dear Concerned,
A nurse using a cellphone to take a photograph is of major concern in this era of
social media. It’s probable your employer has
adopted a policy about the use of cellphones,
and it is assumed the union’s bargaining
agreement with the facility has adopted that
policy for its members. Regardless of what
the union agreement says about how you
may be disciplined for a violation of the
policy, a violation is a violation, so arguing
your union member status probably will
not help you.
You might learn from this situation by
reviewing important guidelines for you
as a nurse and the use of social media in
that role. Read the National Council of
State Boards of Nursing’s Practice Paper,
NURSE.com/MenInNursing • 2013
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“A Nurse’s Guide to the Use of Social
Media” (2011), available at NCSBN.org;
the American Nurses Association’s “Code
of Ethics for Nurses” (2001), Provision 3,
states the nurse “safeguards the patient’s
right to privacy. The need for healthcare
does not justify unwanted intrusion into
the patient’s life.” The ANA’s “Principles for
Social Media Networking and the Nurse:
Guidelines for Registered Nurses” (2011),
and the “Foundations of the eHealth Code
of Ethics” by Bette-Jane Crigger of the Hastings Center (2001) (IHealthCoalition.org/
Foundations-of-the-ehealth-code-of-ethics)
also would be required reading.
The protections afforded a patient by
the laws of privacy, confidentiality and
HIPAA, and the ethical mandates a nurse
must adhere to when practicing nursing
cannot be understated. It is not known why
you took the picture, but it is hoped that
whatever the outcome of your situation,
you will have learned those laws and ethical
mandates cannot be ignored.
Nancy
Dear Nancy,
I was let go from my position, and I was
told it was because I was not a good fit for
the unit. The acting manager said I would
be eligible for rehire, but I have been rejected for every position I’ve applied for at
that hospital. I requested an opportunity to
view a copy of my personnel record. Human
resources said it was against their policy
to let former employees view their files. I
feel there is a form of discrimination at
play here. Explaining my situation on job
interviews has been a challenge.
Frank
Dear Frank,
Although you did not mention what your
basis was for thinking that the termination was discriminatory, if you believe
this is the case, your best bet is to consult
with a nurse attorney or attorney who
concentrates in employment law and who
represents employees. You will need to be
specific about what discrimination you
think took place, so details, facts and how
other employees were treated in your situation would be important information for
the attorney to have when analyzing the
termination circumstances.
You can file a claim with the Equal Employment Opportunity Commission on
your own, but you will need specifics to
file this claim. The EEOC evaluates claims
based on discrimination because of gender,
religion, race, creed, national origin, age,
disability and genetic information. You can
review information about the EEOC at
EEOC.gov.
Nancy
Dear Nancy,
I was terminated for violating the social
media policy. I do not have a Facebook
account, but another employee took a photo
of several nurses at the nurse’s station
and, without our knowledge or consent,
posted it on her Facebook page. I know
that unless I belong to a union as an RN
and am employed by a hospital, I am an
at-will employee and can be terminated
for almost any reason. How could I violate
the policy when I never gave my consent
or had access to the photo? Should I suffer
the same consequences as the person who
took the photo and posted it?
Christa
Dear Christa,
Your termination is an unfortunate one, but
it is difficult to discuss without knowing your
facility’s social media policy. It is assumed,
though, that the policy is broadly stated and
requires that anyone, including simply those
who are in a photograph, can be disciplined
when a photo is taken in the workplace.
You might want to review the policy and
determine whether you might be able to
grieve the termination because of your lack
of knowledge about what was going to be
done with the photo. If, however, there is
a strict policy that there be no cameras or
smartphones used at all in the workplace,
that argument may have little weight.
What happened to the others in the
photo? Were they terminated as well? In
other words, was the policy evenly applied
to all who participated, either as one being
in the picture or as one taking the picture?
If you have some doubts about how your
termination was handled, a consultation
with a nurse attorney or attorney in your
state might help resolve your concern or
provide you with some options on how
to challenge the termination.
Nancy
A nurse using a cellphone
to take a photograph
is of major concern in this era
of social media. It’s probable your
employer has adopted a policy
about the use of cellphones ...
— Nancy J. Brent, RN, MS, JD
NURSE.com/MenInNursing • 2013
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7/29/13 9:27:28 AM
STATE BOARDS OF NURSING
Alabama Board of Nursing
Idaho Board of Nursing
Missouri State Board of Nursing
Alaska Board of Nursing
Illinois Department
of Professional Regulation
Montana State Board of Nursing
P.O. Box 303900
Montgomery, AL 36130
334-293-5200
ABN.state.al.us
Robert B. Atwood Building
550 W. Seventh Ave. Suite 1500
Anchorage, AK 99501-3567
907-269-8161
DCed.state.ak.us/occ/pnur.htm
Arizona State Board of Nursing
4747 N. Seventh St., Suite 200
Phoenix, AZ 85014
602-771-7800
www.AZBN.gov
Arkansas State Board of Nursing
University Tower Building
1123 S. University, Suite 800
Little Rock, AR 72204-1619
501-686-2700
www.ARSBN.arkansas.gov
California Board of Registered Nursing
P.O. Box 944210
Sacramento, CA 94244-2100
916-322-3350
RN.ca.gov
Colorado Board of Nursing
1560 Broadway, Suite 1350
Denver, CO 80202
303-894-2430
www.DORA.state.co.us/nursing
Connecticut Board of Examiners
for Nursing
410 Capitol Ave.
MS #13PHO, P.O. Box 340308
Hartford, CT 06134-0308
860-509-7624
CT.gov/dph/cwp/view.
asp?a=3143&q=388910
Delaware Board of Nursing
Cannon Building, Suite 203
861 Silver Lake Blvd.
Dover, DE 19904
302-744-4500
DPR.delaware.gov/boards/nursing/
index.shtml
District of Columbia Board of Nursing
Department of Health
899 N. Capitol St. NE
Washington, DC 20002
877-672-2174
HPLA.doh.dc.gov
Florida Board of Nursing
4052 Bald Cypress Way, BIN C-02
Tallahassee, FL 32399-3252
850-488-0595
DOH.state.fl.us/mqa/nursing
Georgia Board of Nursing
237 Coliseum Drive
Macon, GA 31217-3858
478-207-2440
SOS.georgia.gov/plb/rn
Hawaii Board of Nursing
DCCA-PVL, Att: BON,
P.O. Box 3469
Honolulu, HI 96801
808-586-3000
www.Hawaii.gov/dcca/pvl/boards/nursing
38
P.O. Box 83720
Boise, ID 83720
208-334-3110
IBN.idaho.gov
320 W. Washington St.
Springfield, IL 62786
217-785-0800
IDFPR.com/dpr/WHO/nurs.asp
Indiana State Board of Nursing
Professional Licensing Agency
402 W. Washington St., Room W072
Indianapolis, IN 46204
317-234-2043
www.IN.gov/pla/nursing.htm
Iowa Board of Nursing
400 S.W. Eighth St., Suite B
Des Moines, IA 50309-4685
515-281-3255
Nursing.iowa.gov
Kansas State Board of Nursing
Landon State Office Building
900 S.W. Jackson St., Suite 1051
Topeka, KS 66612
785-296-4929
KSBN.org
Kentucky Board of Nursing
312 Whittington Parkway, Suite 300
Louisville, KY 40222
502-429-3300
KBN.ky.gov
Louisiana State Board of Nursing
17373 Perkins Road
Baton Rouge, LA 70810
225-755-7500
LSBN.la.gov
Maine State Board of Nursing
161 Capitol St., 158 State House Station
Augusta, ME 04333-0158
207-287-1133
Maine.gov/boardofnursing
Maryland Board of Nursing
4140 Patterson Ave.
Baltimore, MD 21215-2254
410-585-1900
MBON.org
3605 Missouri Blvd.
P.O. Box 656
Jefferson City, MO 65102-0656
573-751-0681
PR.mo.gov/nursing.asp
301 South Park, 4th floor
P.O. Box 200513
Helena, MT 59620-0513
406-841-2340
BSD.dli.mt.gov/license/bsd_boards/
nur_board/board_page.asp
Nebraska DOH and Human Services
Regulation and Licensure
301 Centennial Mall South
Lincoln, NE 68509
402-471-3121
DHHS.ne.gov/publichealth/Pages/
crl_nursing_nursingindex.aspx
Nevada State Board of Nursing
2500 W. Sahara Ave., Suite 207
Las Vegas, NV 89102-4392
702-486-5800
www.Nevadanursingboard.org
New Hampshire Board of Nursing
21 S. Fruit St., Suite 16
Concord, NH 03301-2431
603-271-2323
State.nh.us/nursing
New Jersey Board of Nursing
P.O. Box 45010
124 Halsey St., Sixth floor
Newark, NJ 07102
973-504-6430
NJconsumeraffairs.gov/nursing
New Mexico Board of Nursing
6301 Indian School Road, NE
Suite 710
Albuquerque, NM 87110
505-841-8340
www.BON.state.nm.us
New York State Board of Nursing
State Education Building
89 Washington Ave.
Albany, NY 12234
518-474-3817
www.op.nysed.gov/prof/nurse
Massachusetts Board of Registration
in Nursing
North Carolina Board of Nursing
Michigan Board of Nursing
North Dakota Board of Nursing
Minnesota Board of Nursing
Ohio Board of Nursing
Mississippi Board of Nursing
Oklahoma Board of Nursing
239 Causeway St., Suite 500
Boston, MA 02114
800-414-0168
Mass.gov/dph/boards/rn
Bureau of Health Professions, P.O. Box 30670
Lansing, MI 48909-8170
517-335-0918
Michigan.gov/healthlicense
2829 University Ave. SE #200
Minneapolis, MN 55414-3253
612-617-2270
Nursingboard.state.mn.us
1080 River Oaks Drive, Suite A100
Flowood, MS 39232
601-664-9303
www.MSBN.state.ms.us
P.O. Box 2129
Raleigh, NC 27602
919-782-3211
NCBON.com
919 S. Seventh St., Suite 504
Bismarck, ND 58504-5881
701-328-9777
NDBON.org
17 S. High St., Suite 400
Columbus, OH 43215-7410
614-466-3947
Nursing.ohio.gov
2915 N. Classen Blvd., Suite 524
Oklahoma City, OK 73106
405-962-1800
OK.gov/nursing
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Oregon State Board of Nursing
17938 SW Upper Boones Ferry Road
Portland, OR 97224-7012
971-673-0685
OSBN.state.or.us
Pennsylvania State Board of Nursing
P.O. Box 2649
Harrisburg, PA 17105-2649
717-787-8503
DOS.state.pa.us/bpoa
Puerto Rico Board of Nurse Examiners
800 Roberto H. Todd Ave., Room 202, Stop 18
Santurce, PR 00908
787-725-7506
Nurse.org/pr-index.shtml
Rhode Island Board of Nurse
Registration and Nursing Education
3 Capitol Hill, Room 105
Providence, RI 02908
401-222-5700
Health.ri.gov/hsr/professions/nurses.php
South Carolina State Board of Nursing
Synergy Business Park
P.O. Box 12367
Columbia, SC 29211-2367
803-896-4550
www.LLR.state.sc.us/pol/nursing
South Dakota Board of Nursing
4305 S. Louise Ave., Suite 201
Sioux Falls, SD 57106-3115
605-362-2760
DOH.sd.gov/boards/nursing
Tennessee Board of Nursing
227 French Landing, Suite 300
Nashville, TN 37243
615-532-5166
Health.state.tn.us/boards/nursing
Texas Board of Nursing
333 Guadalupe, No. 3-460
Austin, TX 78701
512-305-7400
www.BNE.state.tx.us
Utah State Board of Nursing
160 East 300 South
Salt Lake City, UT 84111
801-530-6628
Dopl.utah.gov/licensing/nursing.html
Vermont State Board
of Nursing
Office of Professional Regulation,
National Life Bldg. North FL2
Montpelier, VT 05620-3402
802-828-1505
VTprofessionals.org/opr1/nurses
Virginia Board of Nursing
Perimeter Center
9960 Mayland Drive, Suite 300
Henrico, VA 23233-1463
804-367-4515
www.DHP.virginia.gov/
nursing/default.htm
Washington State Nursing Care
Quality Assurance Commission
P.O. Box 47864
Olympia, WA 98504-7864
360-236-4700
DOH.wa.gov/hsqa/professions/
Nursing/default.htm
West Virginia Board of Examiners
for Registered Professional Nurses
101 Dee Drive, Suite 102
Charleston, WV 25311-1620
304-558-3596
WVRNboard.com
Wisconsin Department
of Safety and Professional Services
P.O. Box 8935
Madison, WI 53703
608-266-2112
Dsps.wi.gov/Boards-councils
Wyoming State Board of Nursing
1810 Pioneer Ave.
Cheyenne, WY 82002
307-777-7601
Nursing.state.wy.us
Virgin Islands Board of Nurse Licensure
P.O. Box 304247, Veterans Drive Station
St. Thomas, VI 00803
340-776-7397
VIBNL.org
SEND ADDITIONS OR CORRECTIONS
to [email protected]
NURSE.com/MenInNursing • 2013
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CERTIFICATION RESOURCES
AIDS Nursing — ACRN
Gastroenterology — CGRN, CGN
American Nurses Credentialing
Center — various specialties
Healthcare Quality — CPHQ
Association of Nurses in AIDS Care
3538 Ridgewood Road
Akron, OH 44333
800-260-6780
ANACnet.org
8515 Georgia Ave., Suite 400
Silver Spring, MD 20910-3492
800-284-2378
nursecredentialing.org
Asthma Education — AE-C
National Asthma Educator
Certification Board
4001 E. Baseline, Suite 206
Gilbert, AZ 85234
877-408-0072
NAECB.org
Cardiac Medicine — CMC
AACN Certification Corp.
101 Columbia
Aliso Viejo, CA 92656-4109
800-899-2226
AACN.org
Cardiac Surgery — CSC
AACN Certification Corp.
101 Columbia
Aliso Viejo, CA 92656-4109
800-899-2226
AACN.org
Case Management — CCM
Commission for Case Manager Certification
15000 Commerce Parkway, Suite C
Mount Laurel, NJ 08054
856-380-6836
CCMcertification.org
Correctional Nursing — CCHP
National Commission on Correctional
Health Care
1145 W. Diversey Pkwy.
Chicago, IL 60614
773-880-1460
NCCHC.org
Critical Care Nursing — CCRN
AACN Certification Corp.
101 Columbia
Aliso Viejo, CA 92656-4109
800-899-2226
AACN.org
Developmental Disabilities
Nursing — CDDN
Developmental Disabilities Nurses Association
P.O. Box 536489
Orlando, FL 32853-6489
800-888-6733
DDNA.org
Diabetes Educators — CDE
National Certification Board
for Diabetes Educators
330 E. Algonquin Road, Suite 4
Arlington Heights, IL 60005
847-228-9795
NCBDE.org
Emergency Nursing — CEN, CFRN
Board of Certification
for Emergency Nursing
915 Lee St.
Des Plaines, IL 60016-6569
877-302-BCEN
bcencertifications.org
40
American Board of Certification
for Gastroenterology Nurses Inc.
401 N. Michigan Ave., Suite 2200
Chicago, IL 60611-4267
855-25-ABCGN
ABCGN.org
Healthcare Quality
Certification Commission
18000 W. 105th St.
Olathe, KS 66061-7543
913-895-4609
CPHQ.org
Holistic Nursing — HNC
The American Holistic Nurses’
Credentialing Corporation
811 Linden Loop
Cedar Park, TX 78613
877-284-0998
AHNCC.org
Hospice Nursing — CHPN
National Board for Certification
of Hospice & Palliative Nurses
One Penn Center West, Suite 229
Pittsburgh, PA 15276
412-787-1057
NBCHPN.org
Medical/Surgical Nursing — CMSRN
Medical-Surgical Nursing Certification Board
East Holly Ave., Box 56
Pitman, NJ 08071-0056
866-877-AMSN
msncb.org
Multiple Sclerosis Nursing — MSCN
Multiple Sclerosis Nurses
Certification Board
359 Main St., Suite A
Hackensack, NJ 07601
201-487-1050
MSNICB.org
Nephrology Nursing — CNN, CDN
Nephrology Nursing
Certification Commission
East Holly Ave., Box 56
Pitman, NJ 08071-0056
888-884-6622
NNCC-exam.org
Neuroscience Nursing — CNRN
American Association
of Neuroscience Nurses
4700 W. Lake Ave.
Glenview, IL 60025
888-557-2266
AANN.org
Infection Control Nursing — CIC
Nurse Administration,
Long-Term Care — CDON/LTC
Intravenous Nursing — CRNI
Nurse Anesthetists — CRNA
(Certified) Legal Nurse
Consultant — CLNC
Nurse Educator — CNE
Certification Board
of Infection Control
and Epidemiology Inc.
555 E. Wells St., Suite 1100
Milwaukee, WI 53202
414-918-9796
CBIC.org
Infusion Nurses
Certification Corp.
315 Norwood Park South
Norwood, MA 02062
781-440-9408
Ins1.org
Vickie Milazzo Institute
5615 Kirby Drive, Suite 425
Houston, TX 77005-2448
800-880-0944
LegalNurse.com
Legal Nurse Consultant — LNCC
American Legal Nurse Consultant
Certification Board
401 N. Michigan Ave.
Chicago, IL 60611
877-402-2562
AALNC.org
Managed Care Nursing — CMCN
American Board of Managed
Care Nursing
4435 Waterfront Dr., Suite 101
Glen Allen, VA 23060
804-527-1905
ABMCN.org
Maternal/Child Nursing — RNC
National Certification Corporation
for the Obstetric, Gynecologic and
Neonatal Nursing Specialties
142 E. Ontario St. Suite 1700
Chicago, IL 60611
312-951-0207
NCCwebsite.org
National Association of Directors of
Nursing Administration/ LTC
Reed Hartman Tower
11353 Reed Hartman Highway, Suite 210
Cincinnati, OH 45241
800-222-0539
NADONA.org
Council on Certification
of Nurse Anesthetists
8725 W. Higgins Rd., Suite 525
Chicago, IL 60631
866-894-3908
NBCRNA.com
National League for Nursing
61 Broadway, 33rd Floor
New York, NY 10006
800-669-1656
NLN.org
Nurse Midwifery — CM, CNM
American Midwifery Certification Board
849 International Dr., Suite 120
Linthicum, MD 21090
866-366-9632
AMCBmidwife.org
Occupational Health Nursing
— COHN, COHN-S
American Board for Occupational
Health Nurses, Inc.
201 E. Ogden Ave., #114
Hinsdale, IL 60521-3652
888-842-2646
ABOHN.org
Oncology Nursing — AOCN,
CPON, OCN
Oncology Nursing Certification Corp.
125 Enterprise Drive
Pittsburgh, PA 15275
877-769-ONCC
ONCC.org
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Orthopaedic Nursing — ONC
Orthopaedic Nurses Certification Board
P.O. Box 87
Columbia, SC 29202
888-561-ONCB
ONCB.org
Pain Management — FAAPM
American Academy of Pain Management
975 Morning Star Drive, Suite A
Sonora, CA 95370
209-533-9744
Aapainmanage.org
Pediatric Nursing — CPN, CPNP
Pediatric Nursing Certification Board
800 South Frederick Ave., Suite 204
Gaithersburg, MD 20877-4152
888-641-2767
PNCB.org
Perianesthesia Nursing —
CPAN, CAPA
American Board of Perianesthesia
Nursing Certification
475 Riverside Dr., 6th Floor
New York, NY, 10115-0089
800-6ABPANC
CPANCAPA.org
Perioperative Nursing —
CNOR, CRNFA
Plastic Surgical Nursing — CPSN
Plastic Surgical Nursing
Certification Board
500 Cummings Center, Suite 4550
Beverly, MA 01915
877-337-9315
psncb.org
Progressive Care — PCCN
AACN Certification Corp.
101 Columbia
Aliso Viejo, CA 92656-4109
800-899-2226
AACN.org
Radiology Nursing — CRN
Radiologic Nursing Certification
Board, Inc.
7794 Grow Drive
Pensacola, FL 32514
866-486-2762
ARINursing.org
Rehabilitation Nursing — CRRN
Association of Rehabilitation Nurses
4700 W. Lake Ave.
Glenview, IL 60025
800-229-7530
Rehabnurse.org
School Nursing — CSN
Competency & Credentialing Institute
2170 S. Parker Road, Suite 295
Denver, CO 80231
888-257-2667
CC-Institute.org
National Board for Certification
of School Nurses Inc.
1350 Broadway, 17th Floor
New York, NY 10018
888-776-2481
NBCSN.com
Sexual Assault Nurse Examiner — SANE-A
International Association of Forensic Nurses
6755 Business Parkway, Suite 303
Elkridge, MD 21075
410-626-7805
Forensicnurse.org
Urology Nursing — CURN, CUNP, CUCNS
Cert. Board for Urology Nurses and Associates
East Holly Ave., Box 56
Pitman, NJ 07081-0056
888-827-7862
SUNA.org
Vascular Nursing — CVN
Society for Vascular Nursing
100 Cummings Center, Suite 124 A
Beverly, MA 01915
888-536-4786
SVNnet.org
Wound Care — CWS
American Board of Wound Management
1155 15th St., NW, Suite 500
Washington, DC 20005
202-457-8408
AAWM.org
Wound, Ostomy & Continence — CWON
WOCN Certification Board
555 E. Wells St., Suite 1100
Milwaukee, WI 53202-3823
888-496-2622
WOCNCB.org
SEND ADDITIONS OR CORRECTIONS
to [email protected]
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NURSE.com/MenInNursing • 2013
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41
7/26/13 9:19:24 AM
END OF SHIFT
A JOB
WELL DONE
Patient gives hospice case manager
an unexpected gift
M
ost of our patients don’t look forward to dying; they
struggle to survive against daunting odds. I never had
heard anyone complain about being alive until I met
92-year-old Esther, a hospice patient.
Bedridden and near tears, she angrily told me: “I am no good
to anyone. All my life I have taken care of everybody else, and
look at me now. I’m just so useless.” Lifting an arm a few inches
off the top sheet, she let it drop to demonstrate her wasted condition. “Why can’t I just die? Every day I ask the Lord to take
me home,” she cried. “Why does God keep me here? I can’t do
anything for anybody.”
I wanted to help her, but how? It would have been ludicrous
to tell her, “Everything is fine, Esther. You will be dead in no
time.” She had been a productive farm wife who kept busy
with family, church and volunteer work. Although her mind
was still sharp, she physically had deteriorated to dependence
for every ADL.
I decided to appeal to her strong faith. “Perhaps God is not
finished with you, Esther,” I said. “Maybe you have a job left
undone. After you complete it, then he will take you home.”
My wife and I recently had sent our oldest son off to the war
in Afghanistan. On my next visit with Esther, my son’s departure
was very much on my mind. Since hospice patients have enough
problems of their own, I had resolved I would not share my
personal difficulties with them.
Near the end of our visit, I violated my code and asked, “Have
you ever had to send a son off to war?” I regretted saying those
words as I spoke them.
“Yes, twice,” Esther said. “One died in the war, the other
a little later.” I was shocked. I do not remember what I said,
or how I ended our visit, but I recall feeling great embarrassment. Instead of making her feel better, I just brought back
painful memories.
About six weeks later, there was a knock on my door at home.
The soldiers in Army uniforms said our son was killed in the
war. They said something about his being a hometown hero.
42
My wife and I plunged into a whirlpool of
grief that will continue as long as we can
still feel love.
When I was able to return to work after
three weeks, Esther was the first patient
on my list. She was still alive, but this time
she was calm. “I heard about your son,” she
said. She proceeded to tell me about the
nightmarish tortures she faced as a mother
who twice lost sons.
Mike Barry, RN
She told of her grief, how much she
missed them, that their lives made her so proud. She spoke of
her faith, where she found comfort in her distress. She expressed
how, instead of anger at their loss, she came to feel gratitude for
the years she had with them. She told of looking forward to seeing
them again in eternity.
Esther explained grieving in a way I never had heard or imagined. We talked, cried, laughed and remembered our sons. It was
a visit where time did not matter. Only a parent who lost a child
could have spoken like Esther.
At the end of our visit, while I was thanking her for what she
did for me, she suddenly lifted her head off the pillow. Looking
at me she said, “You! You are the reason I am still alive. This
was a job only I could do. To think that in my condition I could
actually help someone.”
As her head settled back, she said, “My work is done; now I
can go home.” I’ll never forget the beam of satisfaction — the
feeling of a job well done — on her face.
A few days later I got a phone call. She passed away in her
sleep. Peacefully.
Thank you, Esther. •
Mike Barry, RN, MA, is a former hospice case manager who now serves on
the oncology unit at St. Joseph’s Medical Center in Kansas City, Mo. The
patient’s name was changed for this article.
SHARE YOUR THOUGHTS: [email protected]
NURSE.com/MenInNursing • 2013
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