Author Archives: Beth Toner

Nurses Can’t Care for Us if We Don’t Care for Them

May 9, 2022, 10:00 AM, Posted by Beth Toner

After two years of a pandemic, nurses are more stressed and burned out than ever, and too many are leaving the profession. What are the systemic changes needed to truly support them? 

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I confess I have felt ambivalent about Nurses Week since 2011, my first year as a second-career registered nurse. Back then, in addition to a full-time communications job, I was working weekends in a long-term care facility. Despite having no experience other than clinical rotations just nine months before, I had been given a short orientation that I essentially had to structure myself; I was then thrown onto a skilled nursing floor with 15 residents during the day and 32 residents at night—most of them unable to walk on their own, some with dementia, and all with at least one chronic condition. I was hanging tube feeds, flushing central lines, and dressing stage IV pressure ulcers, all while trying to keep everyone safe and happy.

My colleagues and I received many tributes during Nurses Week—a message from the administrator, posters and food in the break room, giveaways. Don’t get me wrong; the gestures and the sentiment were lovely. But what I wanted more than encouraging emails and pizza was help. What I wanted was permission to say “I’m scared and could use some more support,” but nursing culture there—and in many places, still—was “sink or swim.” Not long after, I decided to “swim” out of long-term care, rather than make an error that would cost me my license or, worse yet, a resident his or her life.

I’m not telling you this so you’ll feel sorry for me; I’m telling you this because I have come to realize that I wasn’t alone in feeling frightened and overwhelmed on the job. Almost anyone who takes their nursing responsibilities as seriously as they should has felt that way at one point or another. And now, this Nurses Week, with two years of this awful pandemic under our belts, nurses—particularly those on the front lines—are feeling more stressed and burned out than ever; many are leaving the profession.

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Everyone Has a Role in Building the Future of Nursing

May 13, 2016, 11:30 AM, Posted by Beth Toner

Nursing students working on a mannequin during a class.

Six years ago, I graduated from nursing school at the age of 40-something—a feat accomplished while working full time, attending class and doing clinical rotations nights and weekends—with no small amount of support from my husband, my teenage children and my almost-3-year-old.

Frankly, when I graduated, I should have given each of them a gift for their support.

Instead, my then 15-year-old daughter gave me a copy of the book Critical Care by Theresa Brown, who, like me, was a second-career nurse. She’d heard her interviewed on National Public Radio and thought I might enjoy it. What I read in that book got me through some very rough overnight shifts when I was working per diem at my first job in long-term care. Her book reminded me that every new nurse is scared, tentative and not quite sure of her or himself. Yet somehow we muddle through, and we do the very best for our patients.

Fast forward to 2013, and I’d come to work at the Robert Wood Johnson Foundation.

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When Springtime Turns Ugly: Public Health and Disaster Preparedness

Jun 6, 2014, 11:24 AM, Posted by Beth Toner

A woman looks at the destruction following a tornado. EMOTIONAL AFTERMATH: A resident of Alabama, overwhelmed by the sight of her ruined home after tornadoes struck at the end of April, 2011.

Ah, springtime: especially welcome for those of us who experienced a particularly harsh winter. Spring often conjures up images of blossoming trees and blue skies, freshly cut grass and picnics.

Yet in May, several anniversaries of devastating natural disasters reminded us that springtime can also bring with it some of nature’s most violent weather phenomena:

  • On May 20, Moore, Okla., marked the first anniversary of the devastating tornado that killed 24, including seven children at an elementary school. It was the second EF-5 tornado to strike the city in 15 years; the May 3, 1999, tornado left 46 dead.
  • In Joplin, Mo., residents remembered the May 22, 2011, EF-5 tornado that killed 161 people.
  • On May 31, Johnstown, Pa,., observed the 125th anniversary of the devastating flood that leveled the entire city and killed 2,209.

While improved warning systems and 21st century technology have certainly played a role in reducing the number of lives Mother Nature’s temper tantrums claim, the fact remains that these events have a substantial impact on our health as a nation.

We recently talked to Paul Kuehnert, director, Bridging Health and Health Care portfolio—as well as a pediatric nurse practitioner and longtime state and local health official—to get his thoughts about the role public health plays in helping us prepare for, cope with, and learn from natural disasters.

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We’re All in This Together: Let’s Bridge the Gap, Not Widen It

May 12, 2014, 4:14 PM, Posted by Beth Toner

 A nurse checks a hospital patient.

At the end of April, the New York Times published an op-ed by Sandeep Jauhar, a cardiologist who—reacting to a New York bill granting nurse practitioners the right to provide primary care without physician oversight—argued that in primary care, “there will always be subtleties and complexities that demand a doctor’s judgment.”

His conclusion? “If we want more primary care providers, let’s have them be doctors”—and, he added, “let’s find a way to increase their pay.”

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What Would Melanie Do?

Jun 25, 2013, 11:20 AM, Posted by Beth Toner

A critical response medical team walking in a hospital corridor.

The Robert Wood Johnson Foundation has long been committed to the improvement of nursing education—and to supporting academic progression in nursing. While nursing shortages may wax and wane, it’s clear that the baby boomers will need high-quality nursing care as they move into later life. Meanwhile, nursing schools turn away more than 75,000 qualified applicants each year.

In short, really good nurse educators have never been more necessary, yet they are increasingly in short supply. Last week, we lost one of the best I’ve ever known.

I heard about Melanie’s death, sadly, the way we sometimes do when we’ve lost touch with people—via a community college classmate on social media. Melanie had learned she had pancreatic cancer in January—and given a grim prognosis; in the end, she lived less than five months after diagnosis, dying far too young—at the age of 58. In the first awful moment, I felt a crush of regret that I’d learned of her death this way. And then I found myself smiling, thinking of when I’d first met Melanie on a warm August night in 2008—squeezed into a stuffy and cramped classroom with 31 other people in a room better suited for 15.

We were, all of us, first-year nursing students on our very first day of nursing school. We were, in many respects, a motley crew—ranging in age from our early 20s to our early 60s (I was somewhere in the middle). Stay-at-home moms rejoining the paid workforce, retired Army medics, and second-career students (like me) all shared one emotion that evening: fear. How would we manage full-time day jobs and evening/weekend classes and clinicals? From studying material that was completely foreign to me—with what felt (at the time) like a worthless master’s degree in journalism—to learning tasks that seemed incredibly complicated (how could I stick a needle in another human being?), I didn’t feel up to the task ahead. What the heck had I been thinking? Me? A nurse?

Melanie gave us an overview of the semester ahead. She calmly answered each agonized question we asked her. As she wrapped up her remarks, she smiled at her nervous charges and said, “I know you feel overwhelmed right now, and you feel like there’s so much to do. I’ll just remind you that you can do this the same way you’d eat an elephant: one piece at a time.”

It was exactly the right thing to say at exactly the right time. Melanie would repeat those words to me—often just saying “one piece at a time”—when she saw me in the hallway, agonizing over a clinical skill I hadn’t mastered or a lab value I couldn’t remember, more times than I can remember. I would often come to class exhausted and near tears from a grim day in corporate America, but Melanie would, with her real-life stories of patients to illustrate that night’s lecture, remind me why I had decided to become a nurse in the first place. We knew her for her pithy summary of the most obvious fact (“smoking is baaaaaaaaaaaaad!” she would say in a near-hiss), but also for her fierce love of, and advocacy for, each and every patient.

I made it through nursing school, passed the NCLEX, and thought of Melanie as I worked weekends in long-term care. If my patient had been Melanie’s mom, what would she have wanted me to do for her? When I felt as if I couldn’t make it through my first night shift alone, I remembered Melanie’s words of advice on that first day.

I thought of her again last week, and realized what a loss the world of nursing education suffered with her passing. It’s not only important to support our nurse educators—and to encourage others to join their ranks—but to thank them for sharing their love of nursing and their patients with us. I never got to say a proper “thanks” to Melanie. But you can bet that I’ll remind each nursing student I see that she (or he) can get there, one piece at a time.

Got the Flu? Antibiotics Won’t Help (So Please Don’t Ask for Them)

Jan 28, 2013, 12:09 PM, Posted by Beth Toner

Beth Toner Beth Toner

One look at the latest flu map from the Centers for Disease Control tells you everything you need to know: We are smack-dab in the middle of flu season. Make no mistake: Influenza, at best, can make you miserable—and, at worst, kill you. If you are one of the many Americans suffering from the flu this season, you will probably try anything to get relief from your sore throat, high fever, body aches, and chills. But do us a favor: Please don’t ask your doctor for an antibiotic. There are medications—called antivirals—that may decrease your symptoms and shorten your illness by a day or two. Antibiotics, however, won’t help you if you have the flu. 

Antibiotics don’t fight infections that are caused by viruses, including influenza. Yet every year flu sufferers are prescribed antibiotics. According to a policy brief from Extending the Cure (ETC), a project funded by the RWJF Pioneer team, that researches and examines solutions to address antibiotic resistance, between 500,000 and 1 million antibiotic prescriptions are filled each flu season for patients who have the flu and no bacterial illness.

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