We all have them, those moments when caring for patients or listening to co-workers tests the limits of our sanity. Call it compassion fatigue. Call it the nature of the business. Either way, wouldn't it be helpful to find a quiet place to collect your thoughts, take a few deep breaths and ready yourself for the day's next challenge? We have such a place, an oasis we call the relaxation station. Here's how you can, too.

• Zone out. Dedicate a small area where nurses can kick back and relax for a few minutes without being disturbed. A back corner of our hospital's conference room serves the purpose for us. Support beams separate the area from the rest of the room so nurses can use the area even when meetings are in progress. Find a quiet atmosphere away from gabbing lunch cliques and water cooler gossips.
• Comfort measures. Fill your relaxation station with calming influences. We purchased a massage chair and brought in a CD player, card table and jigsaw puzzles. Nurses can listen to relaxing music, soothe sore muscles or lose themselves for a few minutes in a puzzle. Involve your staff in setting up the area. Ours voted on the style and features of the massage chair and brought in favorite puzzles from home. We've found that completing the puzzles is relaxing and a great team-building exercise.
• Quiet, please. Two simple rules should govern your relaxation station: Staff can't be called out of the area (unless needed for a clinical emergency, of course) and talking must be kept to a minimum.

We'll soon start measuring the area's direct benefit to our nurses, but their anecdotal feedback has been overwhelmingly positive. They truly appreciate having an area to filter in and out of during breaks and have helped establish and maintain the area's relaxed atmosphere.

Susan Okuno-Jones, MA, MS, RN-C
Coordinator of Evidence-based Practice
Advocate Lutheran General Hospital
Park Ridge, Ill.
[email protected]

Surgical Ambassadors Reach Out to Patients
A few months ago, we started a new volunteer program that pairs surgical patients with trained volunteer "ambassadors" who act as liaisons between hospital personnel, the patients and their families. Our team of surgical ambassadors, several of whom were already members of our hospital's volunteer corps, received special training in customer service and communication before assuming their new duties. They visit with patients and their friends and family members during their stays in our hospital, asking them direct questions, listening to their concerns and working on the patients' behalf to address any non-medical questions they may have. The volunteer team works closely with nursing leadership to ensure that complaints are addressed or resolved as soon as possible. By linking friends and family members with hospital services such as waiting areas and meals, the ambassadors also help keep visitors comfortable and informed as they wait for their loved ones to come out of surgery.

The program's been a big hit. By improving communication between patients, medical personnel and nursing leadership, our volunteers are helping to enhance the surgical experience. And most important of all, our patients really like this new service.

Sallie Piazza, RN, CNOR
Surgical Services Nurse Manager
Brooks Memorial Hospital
Dunkirk, N.Y.
[email protected]

Investing in Staff Education Pays Off
Staffing surgery positions at our community hospital can require resourcefulness and creativity, especially since there tends to be a shortage of qualified candidates in our rural location and it can be difficult to attract potential hires to relocate here. One solution that's worked for us is "home growing" our own product.

Our hospital and long-term care facility offers a nurses' aide training program that graduates nine or 10 students a year into the workforce. The trainees are locals, mostly, often high school grads or mid-life career-changers. We'll hire one or two of the best students in each class as aides at our facility. If they excel, we'll ask if they're interested in advancing in the healthcare field. If they are, we'll offer the financial support for them to attend one of the nursing schools in our region.

The manager of our ER and several RNs here started out as nurses' aides. But the education benefit is offered to all employees throughout our facilities. Our one-time medical assistant is now an OR nurse, two phlebotomists trained to be scrub techs and a housekeeper is now our manager of plant services.

There is a commitment involved, of course: If we're able to offer them a job here, they're obligated to work one year for every year of schooling that the hospital funds. If they choose to leave before that commitment is fulfilled, they can pay us the balance. But most work their time, and the majority of them, being locals, are inclined to stay on beyond their required term. Who could have foreseen that a past administrator's efforts to encourage staff into continuing education would also keep turnover low?

Bill Minion, RN
Director of Ambulatory Services
Hillsdale Community Health Center
Hillsdale, Mich.
[email protected]

Don't Underestimate Surgeon-to-Surgeon Marketing
I'd been trying to recruit two new surgeons to use our single-room ENT surgery center for more than a year. I'd paid numerous visits to their offices and the hospital, promoting our single-specialty staff (I told them our OR team knew the instrumentation they'd be using as well as they did) and our excellent turnover times (our two RNs have their hands in the sink washing instruments just as often as our tech does), but to no avail. So I enlisted our two physician-partners to meet with the potential recruits in an effort to convince them with firsthand experience. One of our surgeons asked to see a recruit's schedule for the day and remarked, "You could have been back in your office by 2 p.m. if you'd done today's cases in our center." (It was our good fortune that the recruit had suffered delay after delay at the hospital that day.)

That sold them, and it convinced me of the importance of involving your physician-partners in recruiting new surgeons, since they can truly show them the advantages. Without their assistance, I don't think the two new surgeons would have joined us.

Judy Witowski, RN, BSN
Administrator
Surgical Care Center
Worcester, Mass.
[email protected]

Transport Children Just Like at Home
Every parent knows that crying babies like to be held by an adult. Comfort level and the ability to be consoled are important in post-anesthesia assessment of children. Whenever possible after a procedure, we transport hemodynamically stable, healthy babies and small children from the operating room to the recovery room in the arms of an anesthesia provider rather than in a rolling crib. Although I must note that not all pediatric patients are suitable for carrying, such as those that are still intubated and combative children.

In the anesthesia provider's arms, the child's airway and breathing can be continuously assessed by the basic life-support techniques used in CPR: "Look, Listen and Feel." Stridor, wheezing and apnea in the child can be detected and acted upon promptly. During transport, a child can hear the adult's heartbeat and feel their body warmth, which give them comfort. On arrival in the PACU, the child can be monitored and transferred to the mother's arms as soon as possible.

Daniel K. O'Neill, MD
Assistant Professor of Anesthesiology
New York University School of Medicine
New York, N.Y.
[email protected]

When Not to Rely on Pulse Oximetry
Pulse oximetry is the standard measure used to assess oxygenation during anesthetic and sedation procedures. But did you know that once you administer supplemental oxygen to a patient, the pulse oximeter becomes a very late detector of hypoventilation for a sedated patient breathing spontaneously? Significant hypercarbia can develop in the patient without oxygen desaturation when you apply supplemental nasal oxygen at 2L/min to the patient during a procedure. Rather than rely on the pulse oximeter to assess adequacy of ventilation when you administer supplemental oxygen, observe the patient closely. Even placing a stethoscope on the patient's chest to listen for respiration makes good sense. You might also consider new technology that can amplify the sound of air movement. A sensor on the trachea can give an audible signal of the adequacy of ventilation. One more thing: The measurement of end-tidal carbon dioxide or transcutaneous carbon dioxide should be included as part of routine monitoring in sedation cases as well as in general anesthesia.

Michael A. E. Ramsay, MD, FRCA
Chairman, Department of Anesthesiology
Baylor University Medical Center
Dallas, Texas
[email protected]