Breast Cancer Awareness Month
October is breast cancer awareness month, and people are wearing pink to raise awareness of breast cancer, and to raise money for further research and treatment of the disease. Breast cancer is the second most common cancer to affect American women (skin cancer is the most common). However worldwide, breast cancer is the most common cancer in females. National Breast Cancer Foundation Inc, 2019 at: https://www.nationalbreastcancer.org/breast-cancer-facts Men can also get breast cancer. The incidence is much rarer in men than in women, at a rate of around 1 in 1,000 American men. Although not all of the causes of breast cancer are clear, the most significant risk factor is age, with 80% of all female cancers being diagnosed after age 50 years, and age 60 years in males. Other risk factors are known to be having a family history of the disease, drinking alcohol, being overweight, and taking the combined contraceptive pill and hormone replacement therapy. Symptoms The first symptoms of breast cancer usually appear as an area of thickened tissue in the breast or a lump in the breast or an armpit. Other symptoms include: pain in the armpits or breast that does not change with the monthly cycle pitting or redness of the skin of the breast, similar to the surface of an orange a rash around or on one of the nipples discharge from a nipple, possibly containing blood a sunken or inverted nipple a change in the size or shape of the breast peeling, flaking, or scaling of the skin on the breast or nipple Most breast lumps are not cancerous. However, women should visit a doctor for an examination if they notice a lump on the breast. Stages Staging of breast cancer is done by using information about the tumour size and location, lymph node involvement, and metastases. There are stages 0 to 4, with some sub groups within these grades. Here is a brief overview of each stage and sub group. Stage 0: Stage zero (0) describes disease that is only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called non-invasive cancer Stage 1A: The tumor is small, invasive, and has not spread to the lymph nodes Stage 1B: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller Stage 2A: Any 1 of these conditions: There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant parts of the body The tumor is 20 mm or smaller and has spread to the axillary lymph nodes The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes Stage 2B: Either of these conditions: The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes The tumor is larger than 50 mm but has not spread to the axillary lymph nodes Stage 3A: The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes. It has not spread to other parts of the body. Stage IIIA may also be a tumor larger than 50 mm that has spread to 1 to 3 axillary lymph nodes Stage 3B: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not spread to other parts of the body Stage 3C: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall. Metastatic cancer found when the cancer is first diagnosed occurs about 6% of the time. More commonly, metastatic breast cancer is found after a previous diagnosis of early breast cancer. Breast cancer subtypes There are 3 main subtypes of breast cancer that are determined by doing specific tests on a sample of the tumor. These tests will help your doctor learn more about your cancer and recommend the most effective treatment plan. Testing the tumor sample can find out if the cancer is: Hormone receptor positive: Breast cancers expressing estrogen receptors (ER) and/or progesterone receptors (PR) are called “hormone receptor positive.” These receptors are proteins found in cells. Tumors that have estrogen receptors are called “ER positive.” Tumors that have progesterone receptors are called “PR positive.” Only 1 of these receptors needs to be positive for a cancer to be called hormone receptor positive. This type of cancer may depend on the hormones estrogen and/or progesterone to grow. Hormone receptor-positive cancers can occur at any age, but are more common in women who have gone through menopause. About 60% to 75% of breast cancers have estrogen and/or progesterone receptors. Cancers without these receptors are called “hormone receptor negative.” HER2 positive: About 10% to 20% of breast cancers depend on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers are called “HER2 positive” and have many copies of the HER2 gene or high levels of the HER2 protein. These proteins are also called “receptors.” The HER2 gene makes the HER2 protein, which is found on the cancer cells and is important for tumor cell growth. HER2-positive breast cancers grow more quickly. They can also be either hormone receptor positive or hormone receptor negative. Cancers that have no or low levels of the HER2 protein and/or few copies of the HER2 gene are called “HER2 negative.” Triple negative: If a tumor does not express ER, PR, or HER2, the tumor is called “triple negative.” Triple-negative breast cancer makes up about 15% to 20% of invasive breast cancers. Triple-negative breast cancer seems to be more common among younger women, particularly younger black and Hispanic women. Triple-negative cancer is also more common in women with a mutation in the BRCA1 or BRCA2 genes. Experts recommend that all people with triple-negative breast cancer younger than 60 be tested for BRCA gene mutations. For more information about treatment options for patients with breast cancer visit: www.breastcancer.org www.cancer.net/cancer-types/breast-cancer www.nationalbreastcancer.org
Latest blogs
From the Frontline: Brittany's Story
Hello, my name is Brittany and I am a Canadian trained registered nurse of five years this year. In the year 2019, I continued my nursing passion in the United States (US) through Conexus MedStaff. I work for one of the largest hospitals in the South East of the US. I am a psychiatrist nurse, caring for those with substance abuse issues and mental health illness, a population that has largely been affected by COVID-19. COVID has brought many things, increased need for Personal Protective Equipment (PPE), increased the need for social distancing and hand hygiene, but it has also brought an increased need for compassion, empathy, support, and awareness of what it means to prevent illness. There has been an increase in the infection rate of COVID-19 with fear and stress in the workplace but I am fortunate to work with staff members I can trust, working together as a team, if it means wearing a mask or PPE when it causes discomfort, monitoring patient’s physical, emotional and social needs more closely, or picking up an extra hour to assist with acuity. My team and I have remained strong. I maintain my strength through daily exercise, adequate rest, proper nourishment of my physical body, and nourishment of my brain through reading, meditation, and communication with loved ones. COVID 19 has changed a lot of things but what doesn’t need to change is the fundamentals of living a simple, healthy, and holistic life. We are all in this together!
My Journey as a New Nurse in the Midst of COVID-19
Hello, my name is Saul Villalobos and I am originally from Mexico. I moved to the U.S. with the intention of becoming a health care professional, not knowing exactly which path I would take, yet very excited for the new adventure. Thankfully, I met great people along the way who encouraged me to become a nurse. "Without thinking twice..." After looking into it and without thinking twice, I began my career in nursing. In December 2019, I graduated from school and began working with Conexus to find my first assignment as a Registered Nurse. I was excited and very scared at the same time. After all, I knew I would soon be taking care of real people with real health problems. Little did I know it would all happen in the midst of a pandemic. "Everything that was happening around the world was very scary..." About a month before being deployed to my new assignment with Conexus, the World Health Organization (WHO) announced, for the sixth time in history, a public health emergency of international concern. Everything that was happening around the world was very scary, it just seemed like we didn’t know enough. New guidelines came out from the Centers of Disease Control and Prevention (CDC) on how to prevent and stop the spread of COVID-19. Besides people hoarding toilet paper, there was a positive attitude towards such recommendations. "It makes me feel safe in the workplace... to fulfill my role as a nurse..." As a nurse and caregiver, I am happy to see people wearing masks, washing their hands as often as they can, and practicing social distancing. It makes me feel safe in the workplace, which in turn allows me to fulfill my role as a nurse in a more effective and efficient way. What a blessing! "There is still much work to do..." This fight is not over yet. Despite the many efforts we have made to fight COVID-19 there is still much work to do. We are being bombarded with negativity from different sources of media, which can be detrimental to our health, and we need to do something about it. Nurses are and have always been, in the front lines of care. We must first take care of our physical, mental, emotional, and spiritual health if we want to make a difference in the world. We are not alone in this fight. Stay healthy, stay positive!
The New Gap in Healthcare
Normally, healthcare worker, nurses, therapists, etc., complete classroom and also in-person practical clinical training as part of their education to practice their specific profession. During the initial onset of the COVID pandemic, we witnessed healthcare facilities reaching out and directly recruiting new nursing graduates, many even prior to graduation and without practical clinical experience, to start working immediately at the bedside. As the pandemic has continued, clinical training opportunities prior to graduation have been limited, providing a decrease in clinical training for new nurses graduating. Since COVID, these professions have had to quickly adjust to continue classes online in smaller groups and move to more simulation, v-sim, and fewer in-person practical hours at the patient bedside. The immediate impact? Some universities are evaluating delaying graduation if clinicals cannot be completed by their students. While educators and students alike are adapting, what does this mean for the longer-term impact and the future employer of these nurses -- the healthcare facility? We may not see the full ramifications until May and June 2021 graduations. So how has nurse education and clinical preparation during this crucial time-shifted, and what is the potential impact on healthcare in the longer term? Some questions to ponder: Will additional orientation and training be needed? Will a smaller number of new grads be accepted to facilitate more precepting? Will healthcare facilities opt to use other resources like agencies and recruiting companies to recruit higher-skilled nurses? Can the healthcare facility afford to not have new grads (i.e., retirement and turnover of staff)? And for the healthcare professional, how are they being prepared for success in their profession post-graduation? We are already in a nursing shortage. We need new nurses to be successful and stay in nursing. Nursing is a profession critical to all of us and we should pay closer attention to the critical skills needed for the job. TalentLyft refers to a skills gap as “the difference between the skills required for a job and the skills employee actually possesses.” Forbes called the skills gap “a gap between what employers want or need their employees to be able to do, and what those employees can actually do when they walk into work.” How are higher education institutions and healthcare facilities preparing for this change in how clinical requirements are being managed? Collaboration must occur between the two industries. Some solutions to consider for the success of our future first responders: assess individually each healthcare professional for what their specific training needs will be for the specific healthcare facility where they will begin their career. In addition, provide preceptors further training on coaching and leading these individuals. Provide evaluations and feedback in collaboration with the healthcare professional more frequently. To talk with Cathy about partnering with Conexus MedStaff, email: c.vollmer@conexusmedstaff.com Sources https://www.ncsbn.org/Education-Requirement-Changes_COVID-19.pdf https://www.healthleadersmedia.com/nursing/survey-nurses-have-taken-leadership-roles-feel-less-respected-physicians Nurse Journal, Changes to Nursing Programs’ Clinical Requirements in Response to COVID 19 October 28, 2020 https://nightingale.edu/blog/nursing-shortage-by-state/ https://www.ncbi.nlm.nih.gov/books/NBK493175/
Premium Processing: Is it Worth it?
We are often asked by nurses if we will file Premium Processing for their Priority Date (PD). We often give a lawyer-like response and say, “it depends,” because it really does. U.S. Immigration law is complex, and no two cases are the same. Sometimes paying extra for expediting a case is worth it, and other times it’s not. What is premium processing? Premium processing is a service offered by USCIS that expedites the processing time for specialized employment-based green card petitions, such as the EB-3. With premium processing, USCIS guarantees that your I-140 form will be processed within 15 calendar days of receiving the petition. We understand that the immigration process involved in starting your career as a nurse in the U.S. can be time-consuming. The waiting time between submitting your application and finding out if your application has been approved can be long and stressful. So, knowing the outcome of your application in 15 calendar days can certainly give you peace of mind. But for nurses making a new application, there are not many more benefits to premium processing. Here are our thoughts on the subject: Paying the premium processing fee ($,2500) does not give you an advantage in the selection process. Ok, so you may be given an answer within 3 weeks; however, there is no telling what the outcome of your application will be. You could receive an Approval, but it is just as likely to receive an RFE (Request for Further Evidence), a NOID (Notice of Intent to Deny), or a Denial. If the answer is a Denial, USCIS does not refund the cost of Premium Processing. Unfortunately, premium processing does not jump you to the head of the line; you still need to wait for your priority date to be current prior to receiving your EB3 Visa. Regardless of filing regular processing or premium processing, your priority date remains the same. The date your application is sent to USCIS becomes your priority date. There are circumstances however when premium processing is worth it. For example, if you have been abandoned by a previous sponsor and already have a copy of a previous Approval Notice with a priority date, we will file premium processing. Of course, some of our nurses prefer the peace of mind that premium processing offers. For those nurses who are willing to pay the difference between regular processing and premium processing, our Immigration Team will gladly file for premium processing. Our advice for nurses is to be patient, think positively, and rest assured that the Conexus MedStaff team will be there to support you, always. Learn more about how Conexus MedStaff supports our nurses on their immigration journey to the U.S. here, follow us on our social feeds, or start your application today.
in the news
The 2020 U.S. election is a week away and a record-shattering turnout is expected to vote. With more than 58 million Americans already submitted their ballots, it is clear to see that people are determined to express themselves and exercise their right to vote. Another record high in the 2020 U.S. election is the number of Naturalized Citizens eligible to vote. In this election, Naturalized Citizens make up 1 in 10 U.S. eligible voters. According to Pew Research Center, since the year 2000, the size of the immigrant electorate nearly doubled to 23.2 million, that’s an increase of 193%. So why has there been such strong growth in the foreign-born eligible voter population in the U.S.? First, the number of immigrants living in the U.S. has increased steadily since the 1960s when the Immigration and Nationality Act became law. In 1965, in the U.S., 9.6 million immigrants made up just 5% of the population. Fast-forward to 2020 and the 45 million immigrants living and working in the U.S. now accounts for about 13.9% of the population. Second, newly-naturalized citizens are one of the fastest-growing voting groups in the United States. The U.S. Department of Homeland Security states that between 2009 and 2019, around 7.2 million immigrants naturalized and became U.S. citizens. What is Naturalization? Naturalization is the process by which U.S. citizenship is granted to a lawful permanent resident after meeting the requirements established by Congress in the Immigration and Nationality Act (INA). Becoming a U.S. citizen has many benefits, with one of the most notable being that as a U.S. citizen, you will be able to exercise your right to vote and have your voice be counted– something so many people around the world don’t have the opportunity to do. The Pathway to Naturalization As part of the Conexus MedStaff Career Pathways program, we offer our nurses support to become an American citizen. Career Pathways not only focuses on the continued growth of a nursing career in the U.S., it also allows the option and support to become a naturalized U.S. citizen. If they choose to pursue citizenship, our Immigration Team processes Naturalization applications for our nurses and their family members to become U.S. citizens -- an average expense of anywhere from $3,000 - $5,000 per person. To learn more about our Career Pathways program, and your pathway to naturalization, get in touch with our Recruitment team here. Ready to get your U.S. journey started? Apply here.
If Left Untreated: The Fallout of Nurse Fatigue and Burnout
It seems like only yesterday we were raising the flag on the importance of our nurses and their impact on quality outcomes and patient care always, but particularly in the midst of a global pandemic. But our universal fatigue of COVID-19 has quieted the excitement and the accolades for the unsung nursing heroes who continue to take care of patients as they always have. And to add insult to injury, in the midst of this situation, we continue to experience a shortage of healthcare professionals. The pandemic is a marathon, not a sprint. We cannot let our fatigue get in the way of appreciating and supporting nurses during this difficult time. Nurses are known for being “caregivers” vs “care receivers", always thinking of the patient. Now, nurses are caring for patients who are sicker, one right after the next, requiring care that is more intensive. Yet we are seeing the nurse also expected to care for a higher patient load and acuity. Nurses are working longer and harder hours, and then being asked to work additional shifts to cover shortages. What is this doing to our nurses – both short-term and long-term? “Nurse burnout is a physical, mental, and emotional state caused by chronic overwork and a sustained lack of job fulfillment and support. Common burnout symptoms may include physical or emotional exhaustion, job-related cynicism, and a low sense of personal accomplishment. Rather than improving on its own, untreated burnout may lead to clinical depression, as unaddressed symptoms compound over time” (as defined by Nurse.org) We cannot give up on the support that we provide to our valued healthcare workers. We need to provide resources and relief now. We need to continue to acknowledge their tremendous value to our healthcare system. This should be through words, education, resources, support, and good deeds. Words of gratitude and acknowledgment go a long way. Education can be provided through resources on wellbeing and mental health, mobile apps, or even YouTube. Recently, Conexus MedStaff provided webinars to our nurses presented by a Clinical Educator on identifying nurse fatigue/burnout and ways to care for themselves. Additionally, we provided education for our managers who support our nurses. Support can be providing an ear when the nurse has had a particularly hard day, or they have questions on how to communicate the need for additional support in their healthcare facility. Finally, remember hearing about all the good deeds that communities, businesses, and whole cities were providing to our healthcare heroes when COVID first struck? Don’t stop! Let’s pick up where we left off -fight the fatigue and give energy back to our frontline heroes! We have come so far in shining the light on healthcare workers and their value and their impact and their importance to all of us. Let’s not let our fatigue get in the way of the accolades and support they deserve. Our Mission at Conexus is to focus on the wellbeing of people and communities by supporting talented and dedicated nurses by training and listening to them along the way. We believe in investing in our people to fuel their growth and putting their wellbeing first and foremost. Take a look at the values that drive our days and the way we work here. Sources https://nurse.org/articles/nurse-burnout-statistics/
Breast Cancer Awareness Month
October is breast cancer awareness month, and people are wearing pink to raise awareness of breast cancer, and to raise money for further research and treatment of the disease. Breast cancer is the second most common cancer to affect American women (skin cancer is the most common). However worldwide, breast cancer is the most common cancer in females. National Breast Cancer Foundation Inc, 2019 at: https://www.nationalbreastcancer.org/breast-cancer-facts Men can also get breast cancer. The incidence is much rarer in men than in women, at a rate of around 1 in 1,000 American men. Although not all of the causes of breast cancer are clear, the most significant risk factor is age, with 80% of all female cancers being diagnosed after age 50 years, and age 60 years in males. Other risk factors are known to be having a family history of the disease, drinking alcohol, being overweight, and taking the combined contraceptive pill and hormone replacement therapy. Symptoms The first symptoms of breast cancer usually appear as an area of thickened tissue in the breast or a lump in the breast or an armpit. Other symptoms include: pain in the armpits or breast that does not change with the monthly cycle pitting or redness of the skin of the breast, similar to the surface of an orange a rash around or on one of the nipples discharge from a nipple, possibly containing blood a sunken or inverted nipple a change in the size or shape of the breast peeling, flaking, or scaling of the skin on the breast or nipple Most breast lumps are not cancerous. However, women should visit a doctor for an examination if they notice a lump on the breast. Stages Staging of breast cancer is done by using information about the tumour size and location, lymph node involvement, and metastases. There are stages 0 to 4, with some sub groups within these grades. Here is a brief overview of each stage and sub group. Stage 0: Stage zero (0) describes disease that is only in the ducts of the breast tissue and has not spread to the surrounding tissue of the breast. It is also called non-invasive cancer Stage 1A: The tumor is small, invasive, and has not spread to the lymph nodes Stage 1B: Cancer has spread to the lymph nodes and the cancer in the lymph node is larger than 0.2 mm but less than 2 mm in size. There is either no evidence of a tumor in the breast or the tumor in the breast is 20 mm or smaller Stage 2A: Any 1 of these conditions: There is no evidence of a tumor in the breast, but the cancer has spread to 1 to 3 axillary lymph nodes. It has not spread to distant parts of the body The tumor is 20 mm or smaller and has spread to the axillary lymph nodes The tumor is larger than 20 mm but not larger than 50 mm and has not spread to the axillary lymph nodes Stage 2B: Either of these conditions: The tumor is larger than 20 mm but not larger than 50 mm and has spread to 1 to 3 axillary lymph nodes The tumor is larger than 50 mm but has not spread to the axillary lymph nodes Stage 3A: The cancer of any size has spread to 4 to 9 axillary lymph nodes or to internal mammary lymph nodes. It has not spread to other parts of the body. Stage IIIA may also be a tumor larger than 50 mm that has spread to 1 to 3 axillary lymph nodes Stage 3B: The tumor has spread to the chest wall or caused swelling or ulceration of the breast or is diagnosed as inflammatory breast cancer. It may or may not have spread to up to 9 axillary or internal mammary lymph nodes. It has not spread to other parts of the body Stage 3C: A tumor of any size that has spread to 10 or more axillary lymph nodes, the internal mammary lymph nodes, and/or the lymph nodes under the collarbone. It has not spread to other parts of the body Stage IV (metastatic): The tumor can be any size and has spread to other organs, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall. Metastatic cancer found when the cancer is first diagnosed occurs about 6% of the time. More commonly, metastatic breast cancer is found after a previous diagnosis of early breast cancer. Breast cancer subtypes There are 3 main subtypes of breast cancer that are determined by doing specific tests on a sample of the tumor. These tests will help your doctor learn more about your cancer and recommend the most effective treatment plan. Testing the tumor sample can find out if the cancer is: Hormone receptor positive: Breast cancers expressing estrogen receptors (ER) and/or progesterone receptors (PR) are called “hormone receptor positive.” These receptors are proteins found in cells. Tumors that have estrogen receptors are called “ER positive.” Tumors that have progesterone receptors are called “PR positive.” Only 1 of these receptors needs to be positive for a cancer to be called hormone receptor positive. This type of cancer may depend on the hormones estrogen and/or progesterone to grow. Hormone receptor-positive cancers can occur at any age, but are more common in women who have gone through menopause. About 60% to 75% of breast cancers have estrogen and/or progesterone receptors. Cancers without these receptors are called “hormone receptor negative.” HER2 positive: About 10% to 20% of breast cancers depend on the gene called human epidermal growth factor receptor 2 (HER2) to grow. These cancers are called “HER2 positive” and have many copies of the HER2 gene or high levels of the HER2 protein. These proteins are also called “receptors.” The HER2 gene makes the HER2 protein, which is found on the cancer cells and is important for tumor cell growth. HER2-positive breast cancers grow more quickly. They can also be either hormone receptor positive or hormone receptor negative. Cancers that have no or low levels of the HER2 protein and/or few copies of the HER2 gene are called “HER2 negative.” Triple negative: If a tumor does not express ER, PR, or HER2, the tumor is called “triple negative.” Triple-negative breast cancer makes up about 15% to 20% of invasive breast cancers. Triple-negative breast cancer seems to be more common among younger women, particularly younger black and Hispanic women. Triple-negative cancer is also more common in women with a mutation in the BRCA1 or BRCA2 genes. Experts recommend that all people with triple-negative breast cancer younger than 60 be tested for BRCA gene mutations. For more information about treatment options for patients with breast cancer visit: www.breastcancer.org www.cancer.net/cancer-types/breast-cancer www.nationalbreastcancer.org