Content That Joe V Likes

Joe V Admin 73,544 Views

If you made it this far--thanks for visiting. My name is Joe. I'm the tech behind the scene. I'm in charge of everything that makes tick. Isn't she a beauty!

Sorted By Last Like Given (Max 500)
  • Nov 22

    The American Nurse Project is a documentary about US, nurses in the US. Carolyn Jones, an award-winning cinematographer helps to show what we do in our daily work. She traveled the country for a year collecting stories, pictures, and videos of nurses doing what they do and helping people understand what we do.

    She interviewed hundreds of nurses in many specialties: home health nursing, disaster nursing, prison nursing, hospital nursing - all the places where we do our job. Via her movie, she brings the human element to the public as to what we do and take in stride. She honors nursing thru her journalistic efforts. The interviews are riveting:

    • A nurse from New York anguishes about "what if a patient died on my watch - this wasn't supposed to happen."
    • A home health nurse from rural Kentucky discusses black lung disease as a prevalent issue for her patients
    • A prison nurse in a maximum security facility laments about the spread of Hepatitis C in our prison system
    • A policy analyst nurse from Chicago discusses how public policy influences nursing practice

    AllNurses was fortunate to interview her at NTI recently in Houston. AN's Community Manager, Mary Watts, RN showcased this video and what it means to all nurses...

    Carolyn went on to discuss her upcoming documentary which will showcase five nurses in the US from varied backgrounds and career settings. Defining Hope focuses on a journey of investigating how we can make better end-of-life choices.We look forward to this new movie.

  • Nov 22

    Veteran's Day is a day set aside to honor veterans. Its a day when veterans get some of the bennies that they have earned from serving in the US military. Some of these include: free meals, discounts at stores, parades, and other ceremonies honoring their service.

    Recently I was sent a link about the Military Women's Memorial, located in Washington, DC at Arlington National Cemetery. Fitting, that its at Arlington National Cemetery - a place held in reverence by many, isn't it?

    Women in the US military have served proudly and with great bravery for many years:

    More than a decade after she helped kill 27 insurgents who ambushed a supply convoy in Iraq, Sgt. Leigh Ann Hester still thinks about it almost daily.

    In 2005, amid burning trucks, exploding grenades and the piercing sound of machine guns - Hester and her comrades were outnumbered five to one in an intense firefight that would put her in the military history books. She received the Silver Cross for her courage in the face of combat. Because of her and her fellow soldiers, the convoy got safely back to base that night.

    A quick history reveals that Sgt Hester was not the first woman to fight under combat conditions:

    For more than 150 years American women have been struggling to fight alongside men, according to the US military. Here's a brief timeline:

    • Civil War: More than 400 women - Union and Confederate - fought by disguising themselves as men
    • World War II: Female troops are limited to non-combat roles
    • 1976: US military academies admit female students
    • 1983: Women are allowed to pilot helicopters in an armed conflict
    • 1989: A woman first commands US combat troops
    • 1993: Jeannie Leavitt becomes the first female Air Force fighter pilot

    Marine Corps Gunnery Sgt. Jennifer Richardson, 41, describes her combat experience as a satellite communications operator in the Iraq War as "certainly intense."

    In 2006, while serving with the Marines' 9th Communications Battalion, Richardson and her fellow Marines came under attack while setting up a gun position and communications antennas on the roof of an abandoned school in Fallujah.

    "AK-47 rounds were impacting the water reservoir just inches away from our maneuver positions, and mortar rounds were being lobbed around the school yard," she told CNN via email. "It never occurred to us to retreat. It was imperative for our communications to be emplaced for our commander to have a visual on the battlefield."

    Even before her first combat deployment, Richardson made her initial commitment to serving her country in any capacity, including accepting risks that come with the job. is proud to salute our military veterans. Our own, Pixie.RN served overseas and has written several articles about her experiences:

    Deployed Army Nursing: 101 Things I Learned While Deployed - she deployed to Afganistan with an FST (forward surgical team) for 9 months and shared many of her experiences with us on AN.

    Deployed Army Nursing: Finally Double Digits - the different military branches do the same task differently and have different words for the same thing. However, one thing they all agree on is the concept of being "short." Short-timers are those service members who will be PCS'ing (moving permanently), being deployed or transferred "soon." There is always a countdown. this article I have highlighted the actions of female service members. This is not to the exclusion of our male counterparts, just giving a fair shake to the ladies too this time around.

    Next time, you see a female with a US Veteran's tee shirt on, don't assume that she is wearing her husband's clothes - women have served proudly and continue to serve this great country on a daily basis.

    Thank you for your service!!!!!
    Here is a short YouTube video about the memorial:

    How about a roll call for all veterans?

    Give your military service and any other info you'd like to share!!!

  • Nov 22 staff recently attended the AACN NTI Conference in Houston. We were fortunate to interview several well-respected leaders in critical care nursing. One of our interviews was with Judy Crewell, PhD, RN, CNE who is a leader in spiritual care in critical care nursing. Dr. Crewell facilitated a session titled "Spiritual Care Matters in the Care of Critically Ill Patients and Families" in which she discussed the role of the nurse in providing spiritual care and shared strategies on how to provide interventions at the bedside for patients and families.

    In an allnurses interview with her, Judy stated, "Spiritual care has been with us since the beginning of time. It used to be that physicians were also spiritual leaders." Research shows that patients who have religious or spiritual beliefs have better patient outcomes, especially if their spiritual needs are met. As healthcare professionals, it is mandated that we provide for the physical needs of the patient as well as the spiritual needs. In order to do this, we must include a spiritual assessment along with the physical assessment.

    Dr. Crewell recognizes that not all nurses feel comfortable providing spiritual care, however, lack of comfort is not an acceptable reason to not meet the spiritual needs of the patient. The nurse needs to develop a self-awareness of how they feel about providing spiritual care and look for ways in which spiritual needs can be met, either through that nurse or by utilizing another care provider.

    Prayer is often used in hospitals for both patient and staff support and can be quite comforting if used appropriately. Spiritual care must encompass all aspects of religious and spiritual beliefs. Patients and their families are very vulnerable while hospitalized. This is especially true for those in the critical care areas. It's important that nurses take their cues from the patients and their families in assessing spiritual needs and providing spiritual care. In nursing, it is important to remember that spiritual care is about the patient, not the nurse.

    Nursing education has lacked spiritual care information which we often find as we get out into the nursing workforce. Judy stressed the need for incorporating more spiritual care concepts in nursing curriculums.

    Dr. Crewell shared some tips as to what could be done to improve nurse comfort levels with providing effective spiritual care:

    • Obtain support from the religious staff of the facility
    • Look to evidence based practices
    • Collaborate with other nursing staff
    • Don't confuse spiritual care with cultural competency
    • Be mindful of your own bias

    As nurses are the ones who spend the most time with the patients, it is important that they are equipped to address all of the patient's needs, including physical and spiritual.

  • Nov 22

    AllNurses recently interviewed Nurse Nacole, a well-known blogger and YouTuber. She is a critical care nurse who makes an impact via social media. She uses Instagram, Twitter, YouTube, Google and other platforms to get her message across. Her informational blog focuses on clinical tips for the new and experienced RN. Her YouTube channel discusses time management, how to work with a preceptor, and how to collaborate with other staff members.

    Nurse Nacole is an enthusiastic young blogger who is an educated critical care nurse using evidence based practice to spread the word. Nursing is her passion. She relates that NTI is a great conference to network and learn about how other critical care nurses care for patients.

    She is currently furthering her education to provide better care for her critically care ill patients. Nurse Nacole is set to receive her MSN in another year and then plans to pursue her DNP.

    Enthusiasm and up to date info is the hallmark of Nurse Nacole's videos/blogs. Check her out.... AllNurses' Community Manager Mary Watts, RN recently interviewed her.

  • Nov 22

    Kathy Douglas, RN, MHA, was one of two recipients of AACN's Pioneering Spirit Award for 2017. According to the American Association of Critical-Care Nurses, "The recipients are directors of two insightful documentaries about nurses, one offering an insider’s viewpoint, while the other presents an outsider-looking-in perspective. Both films showcase the valuable and varied contributions of nurses to patient care and the healthcare system."

    Kathy, a film-maker and former critical care nurse, was "recognized for her conceptual and directorial work on the documentary 'NURSES, If Florence Could See Us Now,' released in 2013." Through the film, Kathy paid her respect to nurses and her lifelong nursing profession by telling nurses’ stories through their own voices, simply interviewing nurses with a camera to capture authentic, candid conversations.

    Allnurses had the opportunity to interview Kathy at the AACN's 2017 National Teaching Institute conference shortly after receiving the award. Nurses sometimes "lose the connection between why we do what we do," according to Douglas in the recent interview with allnurses' Community Manager, Mary Watts, RN.

    Kathy continued in the interview; "We are the most trusted profession" and we must be vocal about what needs to be changed in healthcare today and be strong patient advocates. Now is the time to bring our voices to the table." These comments serve as the basis of the award which according to AACN is; "Successful applicants exemplify a pioneering spirit, influencing the direction of acute and critical care nursing."

    In Kathy's words, "It's hard to find a life that has not been touched by a nurse."

  • Nov 22

    At first studying and becoming competent at interpreting murmurs can seem daunting. However, it all starts with knowing which parts of the stethoscope to use for which types of sounds and also where on the chest to listen for different types of heart sounds.

    While in practice, you may, and probably should, resort to listening all over the chest with both sides of your stethoscope, a nursing exam may want more specifics. It may ask whether the diaphragm or the bell is better for high pitched noises or where on the chest one might hear the aortic valve best.

    Don't get overwhelmed by these details! As I went through nursing school, I compiled a number of mnemonic devices and memory tricks to help me memorize the parts of the stethoscope, which sounds the diaphragm and bell are best at detecting, and where on the heart to auscultate specific valves. I want to share these study hacks with you to help you remember this information for an exam and also for your nursing practice.

  • Nov 2

    Hi everyone, I wanted to share my results because everyone here is and was extremely helpful. Gotta pay it forward ya know.

    88 - Grammar
    88 - Vocab
    88 - Reading
    88 - Biology
    76 - Anatomy and Physiology
    92 - Math

    No idea what's up with all the 88's!

    Quick info: Looking to get into an ABSN program. I took the TEAS IV and the HESI recently. This is about the HESI. I am not good at math, very very average. I took anatomy 2 years ago. And my last English, grammar, vocab class was 8-10 years ago.

    The HESI is 100X easier than the TEAS. I scored an 87 on the HESI A2 and 78 on the TEAS. I will be taking the TEAS again soon.

    Because I took the TEAS first I studied a lot (technically) for the HESI. After my TEAS, I switched over to HESI Books. I was surprised to find much more general questions.

    So I get it, I had a little unfair advantage taking the TEAS first but trust me, the HESI is nothing to sweat over.

    How I studied: I went to barnes and nobles and used every book they had and took the practice tests. Probably over 10 books. I bought one pocket prep TEAS app and used it a few times.

    You're going to hate me for this - The only thing I studied for was Biology and A&P.
    I was always weak in those fields as my scores reflected and its been a few years since i've taken the courses. But...

    You'll love me for this -
    USE Basic quizzes on there help a lot.

    Vocab - most of the words on the test are here. I could only think of maybe 3-5x I had no idea what the word was.

    Reading - Didn't study at all. They really didn't ask tough questions. What was the author's message? Which is his opinion? Which is his fact? What was the intent of the passage? Just take your time, read it carefully is my best advice.

    Grammar - I thought I did bad on this. But I did alright. How to use apostrophes, identify verbs, adverbs, adjectives. A lot of which word in this sentence is used incorrectly. Example: switching the words are and is. They try to use silly tricks sometimes like "He eight soups and salads." or " He was waiting four the bus". ITS REALLY THAT SILLY. Know Their, There, and They're. Incorrect usage was plural's were on there a lot too. (sends, send's, businesses' or business's). Read it over carefully and take your time.

    Math - Alright so I AM NOT good at math. I was mostly C's throughout school. This math actually is harder than the TEAS but its very very achievable. Know: Ratios 1:5:: _ : 50 (this was on there a lot) Know percentages. Know fractions (but dont be scared) EVERYTHING CAN BE DONE ON THE CALCULATOR. 1 1/4 - 1 1/5 = ( JUST PLUG IN THE FRACTION INTO THE CALCULATOR AND GET A DECIMAL AND DO IT THAT WAY ) once u get the answer, go down the list and plug those numbers into the calculator and see if you get the same answer. THAT'S MORE THAN HALF THE MATH SECTION. I think i only got a few wrong because i forgot how many pints are in a gallon. or converting millimeters to meters. KNOW THAT. Besides that i literally just gave you the solutions. also a few very simple word questions. Example: Stupid mom wants to give each child at a birthday party 15 balloons. Each package makes 50 balloons. How many packages does she need to buy to give all 20 kids balloons?

    Anatomy - My worst score. Know most of the bones. A lot of them are common, like clavicle, hyoid , femur. Where digestion starts (oral cavity) - Air exchanges? (alveoli) . I did not get a lot of heart questions. Know the 11 organ systems. Glands. (NOT IN DETAIL -BASIC) What controls sleep mood appetite (Serotonin) (know the hormones that are released by the organs.) Luckily i studied it for TEAS. Just all the basics. Wish i did better. (They asked me a really dumb question like "a girl showed up and her skin is changing colors and shes a vegetarian. What has she been eating? rice and eggs, spinach and beats. carrots and ? If someone knows this answer please share lol )

    Biology - KNOW everything about the cells. Prokaryotic and Eukaryotic. Know which part does what. Golgi apparatus - packages and ships proteins. A lot of questions here. They didn't ask me about plants. No - Punitt Charts. Know basics of DNA AND RNA and The pairs. T-U DOES NOT GO TOGETHER. 1 or 2 questions about meisos and mitosis you should know the steps. Know Osmosis and diffusion. Facilitated or not. Active and passive transport. once again JUST THE BASICS.

    Hopefully me saying "just the basics" - 1. didn't make you mad at me 2. Emphasize that they don't go into to much detail. 3. GIVE YOU CONFIDENCE. YOU'LL BE OKAY!

    If you pray, just pray about it, and pray for me that I get into an ABSN program (remember pay it forward lol)

    I'm not great at responding to questions but i will try.

  • Nov 1

    I love the freedom (and income) of being a freelance healthcare writer. When bedside nursing full time was no longer an option for me, writing healthcare content satisfied my desire to remain working while still using my hard earned knowledge of medicine. Best of all, I'm still able help to help others (patients, nurses, caregivers), just in a different way. But, all the sunshine and rainbows of being a freelance writer has a way of fading quickly if you feel overwhelmed or unable to start and can't complete the task at hand - create content. The irony of my current situation is not lost on me here. It's actually quite comical that I am experiencing a bit of writer's block (and even mild anxiety) for this very article - procrastination at an all time high in addition to a dwindling clock and a fast approaching deadline. Never fear! This article will be completed (eventually) and here's how:


    Personally, I find making outlines to be one of the most helpful tools for writer's block. I've used many different types (and kind of shoot from the hip). Use what feels good and works for you. Here's a great website discussing several different outline options:

    Go Back to Your Pitch

    When pitching a client via email, I usually include a few brief bullet points that describe major themes of the potential article. If I'm feeling particularly stuck (or even unable to start) writing an article, I like to have the email pulled up in a separate browser tab and use it to structure my piece into a list type - much like how this article is structured. Your original pitch can serve as a handy outline and contains your initial ideas surrounding the topic. Use it and expand out from there.

    Change of Scenery

    Some days I love working from my home office. I enjoy my own routine of lighting a scented candle, turning on the radio and tending to some fresh flowers in my personal workspace before starting my day. However, working from home can also be incredibly distracting. I should really organize that closet, clean those dishes, prep dinner, throw in some laundry. When my home becomes more of a hindrance than a help, I make my office mobile. I'm fortunate enough to live in a temperate climate year round, so heading outdoors is usually an option. On days when it's not (or the outdoors is also somehow a source of distraction) I like to work from a quiet, comfortable cafe that's not too far from home. I find switching up your scenery (even if it's just a different space in your home) can sometimes make all the difference in your overall productivity.

    Take a Break!

    When other methods fail, take a break. It's probably your brain's way of screaming for a breather anyway. Many recent studies have found multiple benefits from taking regular breaks from doing anything for too long, studying, sitting, working, etc. For example, this article from examines how taking a break can actually improve one's attention span; author Rick Nauert PhD writes, "even brief diversions from a task can dramatically improve one's ability to focus on that task for prolonged periods".

    Get Moving

    Expanding on the theme of taking breaks, try stretching your legs. Increasing the flow of blood and circulating oxygen, physical exercise has a way of refreshing the mind. I read several articles by fellow freelancers that discuss scheduling regular gym time into their daily routine. Awesome idea, but let me be honest here, I'm definitely not one of those people. However, whether it's a brisk walk, hike, bike ride, swim, weights or yoga - all are beneficial for both mind & body.

    Read Something, Anything

    When I can't seem to write, I like to read...anything. Reading has always been a favorite hobby of mine since I was young. The escapism a well-written novel can provide is something I consider to extremely therapeutic. I find reading a great work of fiction, an interesting online blog or in-print magazine frequently provides inspiration, direction, or a fresh perspective for a piece I'm currently working on.

    Talk with a Colleague

    Being a nurse, writing for other are surrounded by potential future readers of your work. While at my bedside job I like to sometimes pick my coworker's brains. What are they interested to know on the topic? What clinical questions do they have? Use having unlimited access to your target audience to your advantage. What tips/tricks help you beat writer's block?


    Seven Types of Outlines

    Taking Breaks Found to Improve Attention

  • Oct 31

    That you get before you take clinicals? I am just not sure. I have seen that ACLS and BCLS are required for certain positions in hospitals and I do not know what it is. I did get my CPR thing done a few months ago and I and certified in that. Is that what this all is?

    (The following ACLS AND BCLS videos added by staff to help readers.)

    ACLS Video Review

    BCLS Orientation for the American Heart Association Certification Class

  • Oct 31

    The day of a typical med/surg nurse.

    You crack one eye open as the clock next to your bed starts blaring some song about love, loss, or riches; it's 5:15am. You entertain the idea of rolling back over and trying to get another 5 minutes of sleep but you know if you do that you'll fall back into a dead zone and end up being late. So throw back the covers, brace yourself against the chill and get through the shower that you're hoping will help wake you up- knowing that the real energy will come from the cup of coffee you're grabbing from the dunkin donuts down the road.

    The car ride in wouldn't be so bad, now that you're semi-awake with coffee in hand; except you know where you're driving. Despite this knowledge, you talk yourself into the possibility that maybe all those patients who drove you over the edge last week and made you want to run out of the hospital screaming, all got discharged over the weekend and today won't be too bad. Fat chance, but there's always hope.

    Morning report begins and yes, you have the six patient team; patient #1 an elderly woman who fell at home and has a change in mental status- and yes she will be trying to get out of bed. But the nursing office didn't feel like they needed to cover her with a constant observation so it's going to be up to you to make sure she doesn't fall. Patient #2 who was found down on the street and was brought in for drug overdose and alcohol abuse a few days ago- chances are they'll be starting to withdrawal from said substances today. Patient #3 who is homeless and suffers from "chest pain" on a weekly basis, though has amazingly never been found to have a heart attack. He's already paged the nurse's station 3 times in the past 10 minutes looking for his dilaudid- "it's the only thing that works!" patient #4 had a copd exacerbation and is getting nebulizer treatments every 3 hours in addition to their 4 different inhalers, eye drops and other medications. Patient #5 came in with cellulitis of their leg and is being treated with 3 iv antibiotics which the doctor ordered all to go up at the same time, through their one peripheral iv site. And finally patient #6 who came in with a gi bleed and hasn't been able to eat for the past day, but there is still no actual time for their scope- and oh yes, they haven't been prepped yet. Fantastic.

    Out of report and to the nurse's station to place your charts back and you already have a critical value from the lab, blood work that needs to be drawn on two of your patients because the doctors put the orders in late and phlebotomy already came and went this morning, and there is a family member on the phone who has called twice to see the condition of your patient. Deep breath, just the start of the day. Record the lab values, call the doctors (and inevitably put the orders in yourself because they're too busy to do that and you have all the time in the world), hunt up a nursing assistant to draw the blood- which gets a scowl and a roll of the eyes seeing as they're trying to grab vital signs and get patients cleaned up at the same time. Take the call from the family member on a patient you haven't even seen yet that morning and attempt to answer the same questions the night nurse said they answered for them a few hours earlier- no, ma'am, there's no change. Call pharmacy and be sure the kayexelate will be coming on the next run for your patient's potassium level of 5.9. Oh, right. The patients.

    Walk into patient #3's room and are able to greet them with "Hello, I'll be your nurse to-" before they threaten to choke you if you don't medicate them for their pain- 7:34am, only 7 and a half more hours to go (unless you're working a 12 and then god bless you). On your way out of said patient's room you walk passed patient #1s room to find her caught in her oxygen tubing, call light and iv tubing, attempting to climb over the bed rail without anyone else in sight. Scrambling to reach her before she falls- she of course needs to use the bathroom but your cna is nowhere to be found so you hold her up and help her "pivot" to the commode at her bedside. Of course while doing this you strain your back because she can't bear her own weight. Of course you can't set her on the commode and leave her there, so it takes 10 minutes for her to finish, clean her up and get her situated back in bed. Finally you're able to pull pt #3's meds and by the time you get back in there, he's demanding to speak to your supervisor and screaming that he's in *pain* but isn't being treated. Nothing's being done for him here and it's the worst hospital he's ever been to! Attempting to assure him that you have his percocet over his screaming accusations does nothing for his temper. He demands that he needs his dilaudid and his pain is so great, 10/10 don't you know, that he knows the percocet isn't going to work so he's not even going to try it and you can tell the doctor he says so! And while he's at it, he's not going to take any of his other medications until he gets that dilaudid- which by the way he's not due for for another 3.5hours. Somwhere in the back of your mind comes the question "where is that kayexelate?" another call to pharmacy.

    Onto patient #5, finally someone who greets you with a smile! You greet them and tell them you'll be right back with their medications. On your way back you pass patient #3's room and his pain seems to have subsided, miraculously, seeing as he's on the phone talking and laughing about what his plans will be for later that night. Let's let that one sit for a bit. Scanning patient #5's meds into the computer, the secretary comes over the paging system and announces that there is a doctor on the phone for you. Paging the doctor back when you're available won't work so apparently the 3 antibiotics that each take an hour to go in will be late since you only have 2hrs to hang all of your meds and this doctor *needs* to speak with you now. Excusing yourself from the patient's room and scooping up the meds on your way out, you find out from the doctor that patient #6s scope is scheduled for noon and they'll need to take the golytely as soon as possible. Right…

    And so your morning continues. A battle to try and get medications in on time, fielding phone calls from doctors, finding a commode for your patient who will be sitting on it from now until their scope, taking phone calls from every member from one patient's family and dealing with one doctor who keeps putting in new orders every 10 minutes on a patient, in addition to helping clean up patients who have been incontinent or want to get washed up for the day. By the time you're finally finished giving 8:00 meds, checking labs and being sure your orders are up to date- it's 11:30… time for 12:00 meds! The day progresses. After the 11:00 hour it is impossible to find your nursing assistant and so you take on that job as well, making sure that everyone is being repositioned every 2hrs, your patients are being fed that need assistance- well sure you have time for that- and while you're at it you can split yourself into 3 different places so that you can help each of your patients who are complaining about needing to use the bathroom. Oh, and patient #3 is in agony again, demanding his dilaudid. Quick! Patient #1s bed alarm is going off…

    1:00. Patients are settled. Lunch is cleared up. You only had one misshap with getting patient #6 off the floor; while calling the doctor to get a travel off telemetry order they insist the patient needs to stay on telemetry and therefore you need to travel with them. Oh, sure. Let me leave the floor and my other 5 patients in my fellow co-worker's equally busy hands. After checking with your supervisor and the nursing supervisor, neither who are able to travel with your patient- you call the physician back. You state that there is no way anyone is available to travel with the patient and the scope will have to be pushed back to a different time. Amazingly the doctor tells you that the patient- who by the way has no cardiac history and has been in normal sinus rhythm in the 70s since admission- can travel off tele.

    Paperwork done, patient #6 is off the floor. I&os are done. A quick peek of everyone and no one needs the bathroom and no one is complaining of pain. A miracle! You now have 1.5hrs to chart before the orders and rounds for the next shift print out. Oh and what's that? Looks like patient #2 is starting to take swings at the staff, peed on the floor and is verbally abusing the cna who walked in to check on them. You can hear him screaming now, too… okay, ciwa – check. Get up and start the ativan.

    You manage to chart on two patients when the secretary lets you know that patient #1 is being discharged- to a nursing home that they have never been to before and the case manager needs the patient to be gone by 4:00pm, so they booked the ambulance to pick the patient up at 3:30- that won't be a problem, right? Grabbing the chart you start attempting to write a discharge note. Two call bells go off and you're informed that your cellulitis patient who needs an antibiotic dose at this time had his iv infiltrate and he's a really hard stick. Place a call to the iv team. Meanwhile lab slips printed out for another patient, the doctor wants to recheck someone's blood levels- but no one told you. Suddenly you hear that doctor asking for you by name at the secretary desk and before you know it, they're demanding an explanation for why that blood work was not drawn and sent. It's important! (gee, thanks) hunt up a cna again- but wait, what cna? Because they can't help you right now, it's their lunch break. Lunch break? What's that? And speaking of breaks you've had to go to the bathroom for the past 3 hours, and you really don't want your 5th uti this year. Draw blood first, then bathroom. Walk past pt #1s room and there they go trying to get out of bed again because *they* have to go to the bathroom. Patients first. Finally they're cleaned up and back in bed, but no bathroom break for you because that doctor is watching you like a hawk. Okay, okay draw blood and send it off. It's now 2:00 and you have 30 minutes to chart on 4 patients and get as much discharge paperwork as you can done because by the time you're done giving report, the ambulance will be here to take that patient- and you still have to call report to the nursing home.

    You aren't sure how, but it's 3:15. You've managed to chart on all of your patients. A wound dressing didn't get done and you're not exactly sure if that infiltrated iv was replaced with a new one- both comments earn you a roll of the eyes by the evening nurse. Most of that discharge paperwork is done and when the evening nurse gives you that evil eye glare you hear yourself saying "but i'll finish that up and call report before I leave." tack on an additional 45 minutes after you were supposed to be done. But finally you're done and are walking back to your car, ready to escape the madness. Of course you know that you forgot to report something or didn't chart or do something that will inevitably have an effect on the next shift. Forget it, you're in your car by this point and if you remember you'll call the unit. Of course the chances of you remembering anything at this point are slim to none seeing as you're delirious anyways. How did you get home…?

    Nothing would make you feel better than a nice, cold glass of wine and maybe some of that emergency chocolate you're hiding in your fridge but of course that won't suffice for dinner so now you suddenly get to take care of yourself (and anyone else that may be living with you). Didn't you have to go to the bathroom earlier? Fix dinner, clean the house,make sure you have enough energy and you're paying attention to those around you because if they start complaining that you're not paying attention or you find yourself zoning out and aren't exactly sure what they were so excited to tell you about, you you're going to feel guilty. It would be so nice if someone were able to take care of you for once! But how can anyone else understand the stress you're put under and everything you have to deal with at work. You can't even grasp it each day.

    What you do know is this: most days you're going to get yelled at by someone- a patient who wants their pain meds or feels neglected or a family member who is anxious about the fact they don't know what's going on or doesn't feel the plan of care is working for the patient or is demanding to see the doctor. You know you're not going to go to the bathroom at work- no matter how badly you have to go, because inevitably each time you even think about relieving your bladder- one of your patients is going to need to go. And heaven forbid if you ask someone to wait 5 minutes; either they or their family will be complaining to the supervisor about how you're neglecting them in a heartbeat, you can bet on that. You're not going to eat lunch. Period. You may get a few bites in between meds, charting, phone calls, family members, assessments and bathroom calls. Maybe. You know that people are going to assume you can take anything you unleash on them. They'll yell, scream, complain, punch, kick, spit, swear, throw items at you. They'll bleed on you, pee on you and move their bowels- not always intentionally either. One of your patients at some time or another is going to hit on you and make inappropriate comments to you and be shocked and take it out further on you when you tell them it's inappropriate. You know that maybe not today, but sometime withing probably the next week or so a doctor will be put in an order for a urine culture, call to make sure you saw the order, and then one hour later call you away from your work again and ask why the result is not showing up in the labs. (well, unless you place an order for me to straight cath the patient to get the culture, we need to let nature take its course there, doc.) you know that a family member is going to demand you telling them every little thing you're doing for the patient, and while you don't mind teaching and explaining- them demanding to know and not allowing you out of the room so you can check on a bed alarm that's going off isn't the best time.

    "So why do you do it?" this is what people ask. Or people say "well every job has its bad days." or they'll try to compare their job to what you're doing. Let me say this: yes, every profession has its bad days. Yes, i'm sure that you have your fair share of troubles at your job. But from the moment someone decides to be a nurse, their life is uphill. They struggle through nursing school- the classes, the clinicals, the rough assignments and the second guessing themselves. The textbook knowledge you'll aquire that doesn't even begin to prepare you for what real nursing is like. But the system makes you go through it anyways. You'll have good teachers and bad teachers, and yes, you'll be able to tell the difference- it would be easier if you couldn't. You'll have one test that you take at the end of your education that will determine if all the hours of studying, all the late night study sessions, the missed down time, not hanging out with friends, and all the tears were worth it. Because fail it, and you have to start over. Pick a new career.

    But those lucky enough to pass, you then enter a world where nurses eat their young. Which is good and it's bad. Good because it helps you build a backbone in a profession where you definitely need one, and bad because you'll feel as if you don't have support unless you're lucky. You'll want to quit every week. Doctors and families will hound you over absolutely everything and you'll have to hound those doctors who shouldn't be in their profession because they don't care for the patients. You'll have to stand up *to* the patients who try to run you over and take advantage of you and you'll have to stand up *for* those same patients as their advocate in the hospital. You'll have to be compassionate enough to understand that every patient is a person, have enough patience to know that even the one who is swearing and spitting and hitting you deserves your care for their medical problems. You'll have to understand that missing your family and bending over backwards to the extent that you're off balance and unhappy to make other people and their families happy is going to suck the energy out of you and you're not going to feel as if you have any left over for yourself or your family.

    So why do you do it? Because, call me naive, i think everyone needs help that comes into the hospital. And while i could be more attentive to those nice and pleasant patients who don't ring their call bell except when they truly need something and less attentive to those who drive me crazy- the drug seekers, the confused patients, the ones who suck the energy out of you… they need good care, too. So i treat all of my patients with the same amount of attention and care i would want in the hospital because i'm hoping that at somepoint they realize they were given something they needed, deservedly or not. Because i'm human and when I'm at my worst, i want someone to give me their best. And that, is a nurse.

  • Oct 31

    Changing the education requirements in nursing is inevitable. The current trend is to require a bachelor's of science in nursing. As we move forward in nursing practice and education, nursing leaders look for ways of training nurses to be more competent and more capable of critical thinking upon graduation from nursing school. Some are proposing that a master's degree should be required. We do not believe a master's degree is necessary or appropriate for entry level nursing. According to an article by Drennan: "...despite the centrality of critical thinking to educational curricula, achievement of this outcome has not been evaluated." (Drennan 2010) if the outcome we seek is a better prepared nurse and this outcome's achievement has not been evaluated, where do we stand on this debate? One cannot assume that more education will make nurses more competent. Rather, it is the individual that seeks to make themselves a more competent nurse. The research is not out there to support the need for a master's degree as the basis for entry into nursing practice. One must also question whether this would decrease the nursing force. Would potential nurses no longer consider nursing as a profession if they were required to obtain a masters degree? This could leave us with an even bigger nursing shortage than is already in existence. There are no established benefits of requiring this higher degree for entry into practice and there is certainly the potential of producing undesired effects.

    One group that has an opinion on nursing education is the american nurses association (ANA), started in 1911. "This organization was established when it became apparent that training was necessary to protect the sick and injured from nurses who were incompetent and unable to provide adequate care," (Smith 2009). The ANA's mission statement is quite simple: "Nurses advancing our profession to improve health for all." (ANA 2010) In regards to education, whose ultimate responsibility is it for the nurse being the best possible nurse he or she can be? Is it the school of nursing, the employer, or the nurses themselves? The stance of the ANA is as their website states, that the nurse is personally responsible for "maintaining professional competence," (ANA 2010). Simply obtaining a master's degree in nursing would not accomplish this.

    Looking back into the history of nursing education, we have moved from an "apprenticeship model" to the development of the "partnership model." the goal is now the "provision of opportunities for interprofessional learning linked to patient-centered care provided by multiprofessional teams," (Glen 2009). This is now the basis for most nursing school education.

    Presently, nursing has several programs that allow an rn to gain entry into practice: Diploma, ADN, BSN, and Master's. In 2004 a study was done to determine the percentages of rn's that held certain degrees of education:

    17.5% 3-year diploma
    33.7% 2-year adn
    34.2% 4-year bsn
    13% masters or phd

    (Glen 2009) when we consider well-educated nurses to be essential for providing adequate care, we must determine the necessary level of education for nurses to enter into practice. Right now there is change happening all over the country where specific health care institutions are starting to require that their nurses have more education to be employed. The diploma and adn nurses are being asked to seek a bachelor's of science degree in nursing in order to practice at a specific institution. Is this the right answer for seeking a more competent nursing force? Or is it a formality that requires nurses to have a higher degree in order to call themselves "professional?"

    As a profession, one of our main agendas in health care is to provide the best quality health care at an affordable cost. We must determine an educational standard for entry into practice that will meet the challenges of quality care and cost containment. All states in the united states require that every graduate of nursing schools pass the national council licensure examination (NCLEX) before they can enter into practice. This standardized test is designed to assess whether or not the candidate is minimally competent for entry into nursing practice. The american nurses association determines what should be included on the NCLEX - rn test and the percentage needed to pass the exam to get licensed. This exam does not test for additional knowledge gained from the higher levels of education, like what a master's may provide. This test is revised every three years to adjust for changes in practice in the many facets of nursing.

    Some studies are showing that it's not whether or not the student has had a two, three, or four year education in determining competency; it is the nurse who has received the most clinical time, face to face with patients (Finlay, James, and Irwin, 2006). Thus, the approach of adding more classroom time, instead of clinical time, with a master's of science in nursing would not improve the competency of the bedside nurse who is just entering into practice.

    Currently hospitals are playing a bigger role in determining requirements for the entry level nurse. Hospitals are becoming more competitive in the healthcare industry in order to maintain an adequate market share. In doing so, hospitals are trying to earn magnet status and/or similar accreditations. To maintain magnet status a hospital must meet certain requirements of their nursing staff and in their role within the hospital setting. One of those requirements is to maintain a certain percentage of nurses who have a bachelor's degree or higher and provide monetary motivation.

    The health maintenance organization act of 1973 gave root to managed care which was supposed to help control costs of healthcare (Wooley and Peters 1973). Managed care has failed in controlling the cost of healthcare. Since nursing is the largest profession in the healthcare field, pay is kept at a flat rate in order for institutions to be able keep up with technology and pay their bills. It stands to reason that students who begin an educational path where they must obtain a master's degree will do so in a market where pay is a reflection of educational achievements and not where pay scales remain flat.

    If the purpose of the msn as an entry level for nursing practice is to improve competency and patient outcomes, we must consider the possibility that this measurement can only be achieved on the job. When there are evidence based practices that are mandated, healthcare facilities provide ways to educate the staff to apply these practices on the job to ensure competency of the staff. In addition, the licensure of each state mandates continuing education hour requirements before a license can be renewed. There are many types of certification programs that can help a nurse become a specialist in their field of nursing also. It is up to the nurse to take the initiative to follow through with these offerings beyond the minimum that is mandated. The responsibility, ownership, and accountability of each individual nurse to remain competent throughout their career is essential in providing quality care to the public (Hallin, 2008). These individualistic traits cannot be taught in any degree program.

    A very important measurement of quality nursing care is the national database of nursing quality indicators (ndnqi) which look at the nursing sensitive indicators and relate this data to different aspects of nurse staffing. Not only are they evaluating nurse/patient ratios, but they are also looking at the mix of education levels of nurses working on the unit. Experts are also researching staff satisfaction in their job, years of experience, and turn-over rates and comparing it to the quality data. The nursing sensitive indicators are 1) occurrence of urinary tract infections, 2) falls, 3) vascular catheter infections and 4) pressure ulcers. The data is showing that the number one cause of a decline of quality and safety is when the nurse/patient ratio goes up. The education level of the nursing staff had insignificant effect on the quality indicators so far in the research, but it is premature to come to a conclusion at this time (Davidson, 2009).

    However, what some are debating is that right now nurses must recognize the growing challenges that lie ahead in the future of healthcare, and in order to be a part of this, they need a graduate-level degree. Nurses must be prepared to sit alongside other health care professionals and assume active roles in decision-making opportunities. It is possible that until nurses take the same accountability and advocate for higher levels of education, they will continue to lack voice and influence on future health care decisions. This individual accountability could be achieved with a bsn. There has never been a more challenging time than now for the nursing profession and healthcare as a whole as we see health care reform becoming a true reality.

    The aging population, economics, and complex technologies all contribute to the need for a wider knowledge base that incorporates decision-making, critical thinking and management skills. Nursing leaders have successfully taken control of establishing standards for nursing education. However, there is still no single educational standard for entry into the nursing profession (Smith, 2009). The infamous 1965 ANA position paper recognized that the future of nursing is dependent on nursing education moving to a higher level with the recognition that nurses were the least educated of all health care professionals. Their recommendation was for nurses to acquire a bachelor's degree for entry into nursing (ana, 1965). However, as the demands on the nursing profession have exceeded expectations with the advances in healthcare, we may be faced with extending the requirements to the master's level in the future. Nevertheless the healthcare industry is concluding from research that the evidence identifies the bachelor's degree as quality entry level in the nursing field, not necessarily a master's. (ANCC, 2008), (Speziale and Jacobson, 2008).

    Now is the time for requiring a bsn, not a master's degree. As less educated members of the health care team, nurses are not typically invited to participate as members of governing boards. Some believe that this leads to the situation of nurses having less voice in developments within the healthcare system than do other professions that require higher education levels. What is truly needed is to band together as the experienced professionals who provide the quality care. As one voice, nurses will be heard loud and clear. We must work together.

    A study was conducted to explore critical thinking as an outcome of a master's degree nursing program. This was a cross-sectional cohort study conducted in ireland. Graduates of a master's degree program demonstrated significantly higher critical thinking skills than the students who were beginning a master's degree. According to this study, similar scores were also demonstrated in the united states. The study demonstrated that master's level study could influence the development of critical thinking ability. "the development of critical thinking skills is probably best achieved by a cumulative set of mutually reinforcing experiences over an extended period of time. Critical thinking can best be developed by courses that involve problem-solving over role learning, written assignment, multiple choice examinations, class discussions or didactic lectures," (Drennan, 2010). Drennan states that there is a need for reinforced experiences throughout a period of time and yet critical thinking can still be learned in the classroom. For the nurse entering a field where hands-on skills and patient relations is something that can only be learned in the clinical setting, one has to wonder how the nursing student seeking to enter practice can best learn to care for patients and prevent disease and promote health.

    Nursing care has always been directly linked to patient safety. Some studies say that patients need access to nurses and to better educated nurses. Every 10 percent increase in nurses holding a bachelor's degree or higher, is associated with a 5 percent decline in mortality and failure to rescue after common surgical procedures (Aiken, 2005). However, the challenges that faced healthcare in the 1990's created situations where hospitals were forced to restructure as they faced financial constraints. Many nursing positions were reduced or eliminated. These included positions of direct patient care as well as positions of consultation, education, and administration. As a result, following these acts we saw an increase in patient morbidity and mortality (Long, 2004). What the studies do not clarify is the position of the nurse with a master's degree. Are they at the bedside or are they unit educators? There is unarguably a need for graduate level nurses; their ideal position for best overall patient-outcomes may not be at the bedside. Further studies need to be done to determine the best entry level for nursing education. Studies do not indicate that a master's level nurse performed better than a bsn nurse.

    What would be the effects on the nursing shortage if the educational requirements were raised? Today's nursing shortage is much more complex than supply and demand. The complexity of this shortage should overpower any call to raise the requirements of entry level nursing to a master's degree. In 2008, nursing was, without a doubt, the largest profession in the healthcare field. Nurses held approximately 2.6 million jobs, in a variety of capacities and settings. According to the u.s. Bureau of labor and statistics, new positions for nurses will grow another 22 percent by 2018. This is only one aspect that would be further reason to maintain that a master's degree should not be required for an entry level nurse, (OOH, 2010).

    In march, 2010 the federal division of nursing released the findings of the 2008 national sample survey of nurses. This survey projected that the average age of nurses to be 44.5 years old by 2012 with the largest portion of the workforce to be in their 50's. The nation must face the fact that the largest percentage of nurses are part of the baby boom generation and will soon be facing retirement and many will become part of the population that require more care. These staggering demographics further emphasize that an increased requirement of a master's degree to enter the field of nursing would only serve to decrease the number of nurses that will be able to care for the health needs of our population (HHS, 2010). With these facts looming in our future, we need to encourage entry into nursing rather than add another layer of educational requirement for entry level nurses.

    Just as every profession has a natural progression from novice to master, nursing has a natural progression. As nurses enter the workforce, they are able to view all that is available and needed. Many options are available for today's entry level nurses and with an impending nursing shortage on the horizon we need to encourage and develop the natural progression of novice nurse to master.

    While studies have shown that a bsn education is linked to patient safety and improved patient care, there have not been sufficient studies that would indicate a master's degree for entry level nurses is needed or desired. When a national (and global) shortage of nurses is expected, we need to focus our attention on getting quality nurses at the bedside. Forcing novice nurses to make premature choices on career pathways only serves to decrease the number of qualified nurses entering the workforce. (Baurhaus, Donelan, Ulrich, Norman & Ditmus, 2006)

    "Health promotion and disease prevention" is starting to become a catch phrase within the healthcare community, and it is becoming the role of the registered nurse to promote this view. Do we become a part of this simply by having more nursing school education? Or is it something that cannot be taught in a classroom? If the ANA believes that the nurse is personally responsible for "maintaining professional competence," (2010) then the prospect of adding more letters behind your name, (what one of my adn professors referred to as "alphabet soup"), should purely be optional for the rn practicing in acute care settings such as hospitals and outpatient clinics. As we gain more understanding from the perspective of seeking to have the most competent nursing force possible, we glimpse into the future of the nursing profession, wondering what other changes may come. Forty-four years ago the american nurses association took a position declaring that nurses enter the practice with at least a bachelor's degree in nursing. Only now are employers starting to adopt this view, even without state laws declaring it be mandatory. This century may be one of great growth and change and the bedside nurses will be the ones that feel the effects. We have come very far in our profession. One has to wonder if there is, at times, superficial growth for the sake of change, or genuine growth for better patient outcomes.

    (AUTHORED BY Sharon Anderson, RN, Jackie Brown, RN, M. Jean Whitaker, RN, Jennifer Henry, RN)


    american nurses association. (1965). position paper. new york: american nurses
    association. retrieved through

    american nurses association. (2010).

    american nurses credentialing center. (2008) application manual magnet recognition . program
    aiken, l., (2005). improving patient safety: the link between nursing and quality of care. investigator awards in health research. 12. retrieved through
    Page does not exist. | Robert Wood Johnson Foundation - Investigator Awards in Health Policy Research

    buerhaus, h., donelan, k., ulrich, b.t., norman, l. & dittus, r. (2006). state of the registered nurse workforce in the united states. nursing economic$, vol. 24 (1), pp.6-12.

    drennan, j., critical thinking as an outcome of a master's degree in nursing programme. (2010). journal of advanced nursing. vol. 66. issue 2 422-431.

    finlay, n, james, c., irwin, j. (2006) nursing education changes and reduced
    standards of quality care british journal of nursing: vol15. no 13. 700-702

    glen, s. (2009). nursing education - is it time to go back to the future? [editorial].british journal of nursing, 18, 498-502.

    hallin, k, danielson, e. (2007) registered nurses' perceptions of their work and
    professional development. jan original research. 62-70

    life expectancy at birth by race and sex, 1930-2005 (2006) national center for health statistics, national vital statistics reports (nchs), vol. 54, no. 19. retrieved electronically on 10/28/10 from

    long, kathleen ann, aprn, phd, faan. (2004) rn education: a matter of degrees.
    nursing 2004. volume 34, number 3. 48-51

    smith, t, (2009). "a policy perspective on the entry into practice issue" ojin: the online journal of issues in nursing. 15(1) doi:10.3912/ojin.vol15no01ppt01

    speziale, helen, jacobson,linbania. (2008). in registered nurse education program. .nursing education perspectives, vol 26 no 4,230-235
    the american nurse. (2010) january/february pg 4 and 6.

    u.s. bureau of labor statistics, 2010. occupational outlook handbook (ooh), 2020- 2011 edition. retrieved 10/10/2010, from registered nurses

    u.s. department of health and human services health resources and services
    administration (hhs) (2010). registered nurse population: findings from the 2008 national sample survey of registered nurses. retrieved 11/ 01/10 from
    bhpr - health workforce studies

    woolley, j.t. and peters, g. (2009).the american presidency project[online]. santa barbara, ca. available from world wide web: Richard Nixon: Statement on Signing the Health Maintenance Organization Act of 1973. retrieved on 11/30/10

  • Oct 31

    Something is just brewing inside of me that needs to come out...

    This primarily an emotional response but there's some logic and reason that gird it...

    Try as I might, I just can't help myself...

    Flat out, I...


    OK, here it is... I...

    really like

    my job...

    and I almost consider it a privilege to work there (though I'm an unabashed capitalist and unionist).

    The patients...

    Some of my patients truly touch me... and I feel tinges of what the "it's a calling" crowd must be referring.

    Some of the patients are trying... but even many of them are an adventure...

    And some of the patients are complete jerks... and mostly I just blow them off and pat myself on the back for not letting them win the emotional tug-of-war in which they insist on engaging.

    I had a patient on whom a colleague asked me to start an IV... she was being confrontational. I'm always up for a good confrontation so I took the bait. At one point she said, "Your bedside manner sucks." I replied, "Yep, it does... but I'm really, really good at this so you need to decide if you want a 'one-and-done' IV stick by me or repeated pokes by Nancy-NiceNurse." She picked me and we ultimately found a functional way to interact.

    My coworkers...

    Most of them are kind and decent people who've got my back. It's almost like being in the military again.

    A (minute) few of them are catty and, um, doggie, but I actually enjoy engaging them and trying to win them over. Since I refuse to be respect someone's attempt to block me out and push me away... and because I continue to go out of my way to be helpful, we generally end up in pretty decent working relationship.

    The docs

    Oh yes, the physicians... they can be a pretty pushy, demanding, demeaning group of people..... whom I refuse to treat, or address, any differently than I do anybody else.

    However, nearly all of the ED docs, are really great to work with... love to teach... will happily engage if engaged... and recognize how much the patients need the nurses in order for anything to get done.

    Medical residents? I find them to be some of the most interesting people I've ever been around and I would hate to work someplace without them. (They also don't get ***** when I call them... and if they do, they're ~just~ residents :-)

    Even some of the attending MDs with ferocious reputations among the staff, have their way about them, and I enjoy figuring out how to connect. Sometimes it's by learning a lesson from doggie dominance... wherein I basically expose my throat and give them the option to rip it out... from then on, we usually get on fine... and I take barbs really well and can turn almost everything into a joke.

    Well, I've got my gripes, to be sure... but having been a senior manager with direct reports and budgetary authority... I also recognize that (a) I probably *couldn't* do it any better and (b) that I wouldn't want to even if I could.

    I've had a lot of bosses in my life and I can easily say that the food chain where I currently work is populated by a pretty good group of folks, especially by comparison to some that I've work for.


    Could I earn more? Sure. Have I earned more? Well, actually not... though I work an insane amount of OT to get it.

    Being an hourly, non-exempt employee under a codified contract (I'm a fan of the California Nurses Association) is a great way to work. I've been salaried/exempt... I've been at-will... I've worked as much as I do now but not been paid for it... and I've recently worked in nursing for $25/hr less than I presently earn with scant benefits... Yes, I earn twice what I earn at my last FT nursing job.

    I've got a good thing going... and we're not the highest paid nurses in the region... by any means... but we've got very good bennies and a good work environment.

    So, for anybody who's looking for a reason to go into nursing, I can say that, if I could magically change and be a doc or a pilot, I would, but nursing can lead to a very good thing... though it's not a given by any means.

    To summarize: I am a nurse, I am happy to be a nurse, and... while it's not cool to admit, I hereby confess that I *like* my job.

  • Oct 31

    Dear Soon to be Applicant to Nursing School,

    So here you are on allnurses, looking for the best option for you. After all, you're a kind and caring person. You're good looking, and gosh darn it, people like you. You want this. You're committed to it.

    How committed to it are you? Let's look at this, point by point.

    You want....

    ***cheap! You can't afford this. For whatever reason, you can't get much in aid or loans, and you don't make much money. So you're looking for cheap.

    Here's the deal - everyone wants cheap, and that means more competition. Also, cheap may decrease value. Does the cheapest option have a decent reputation? Or does the cheapest option terrify HR departments everywhere? Unless Dr. Kervorkian is getting out anytime soon (hmmm.... Maybe he is already out? Anyone know?) cheaper may be a terrible idea. Research. Don't just sign the dotted line.

    ***fast! You can't walk away from life for years. You have responsibilities. You also can't fathom spending years in school.

    Dude. Step back for a second. Let's say you've had an embarrassing accident involving a skyscraper, a rusty nail and a poorly placed eyelid. You go to the ER and you get the dynamic duo!!!!! The MD and RN both landed the fastest programs they could find just to get licensed and come care for YOU!!!!

    Wonder twin powers! ACTIVATE!!!!!

    ......wait. Do you want a nurse who did a 3-4 year educational process in 10 months? Would you want a doc who crammed 8 years of school into 2, and 4 years of residency into 10 months? Maybe it feels okay to get your educational as quickly as possible, but would you want to be cared for by the nurse who picked the fastest program possible?

    (The answer to that is "no". You do not want that nurse or that doctor. I took the longest possible option for my degree and I won't even start to admit how much (little???) I was actually able to remember from it two weeks after graduation. Faster means less time to actually lean LIFE SAVING INFORMATION.)

    ***low GPA!!!

    Look, I'll be the first to say you probably don't need an amazing grade in world history to be a good nurse. It's nice to be smart, knowledgable, and all that fun stuff, but not all of it is vital.

    But....... A lot of it is, in ways you haven't figured out yet. Additionally, programs use your GPA as a prediction of how you will commit yourself and subsequently perform at their program. Their accreditation actually is weighed in part by their students' successes.

    Maybe you don't test well, maybe you never applied yourself because you didn't know what you wanted to do when you grew up. (God knows I didn't.) Even if the truth is that you don't need straight As to be successful in nursing school, those who have them will be accepted first. You HAVE to accept that. You'll find programs that will have a cohort whose average is lower than 3.5 sometimes, but to look for it and expect to find it is not necessarily realistic.

    Another thing to consider with this, though, is, again, reputation of your school. Is your school known for accepting low GPAs? You might not be very valued as an applicant with that school's name on your degree. Go retake those classes. Get better grades.

    If you are a person who genuinely struggles with school, take advantage of campus resources. But even before that, go talk to nurses. Talk to nurses who will be honest with you, and bring your thick skin. The sad truth is that some people, no matter how badly they want it, aren't meant for nursing. The good news is there are other avenues in healthcare that don't require the same education or skill set. Research!


    Okay, really?

    No, REALLY?!

    How are you going to learn patient care without caring for patients? Look, even after a nursing program, you're going to be awful at doing everything, but at least you've had basic instruction, face to face, on actual PEOPLE. Nursing school, at the LPN or RN level, cannot be done online. Stop looking.

    I offer my support as you get started on this journey. There may be times when my answers aren't sweet and loving. Nursing school will teach you that direct and clear communication (as off-putting as it may be) is required sometimes. I will, however, promise to be honest. I promise to be thorough. I promise I will try to always be patient. I will take responsibility when I misjudge or misspeak. And I will always expect the same of you.

    Congratulations on embarking on this tumultuous journey, and remember to always keep your expectations realistic.

    Hugs and kisses,

  • Oct 31

    Well, it's happened.

    Despite my best efforts to provide excellent care, I've been involved in a serious error.

    I say "involved" rather than "made" not to avoid my role but to recognize that it was a chain of events that led to the error.

    I'm sure many people are familiar with the concept of the Swiss cheese model of medical errors... in order for the error to happen, all the holes have to align to provide a path from the patient to the error... and in this case... unfortunately... they did... and the very last hole ran right through... me.

    So, now I'm one of 'those' nurses... the ones who are so easy to criticize... to shun... to ridicule... though thankfully, I've thus far been treated with compassion and empathy by those around me.

    A whole host of thoughts and emotions accompany the experience... fear, shame, humiliation, self-doubt, frustration, anger... and a few that I cannot even name (I'm just not a wordsmith)

    I've no idea of the repercussions though I'm hopeful that all the talk about creating a non-punitive environment in which errors can be explored and preventive measures developed is sincere and that I can play a role in educating our docs and nurses in how to avoid another event like this.

    I'm thankful for my colleagues who've listened and encouraged... and who've recognized that I'm not some lame-butt doofus who's carelessly nor mindlessly working on patients... and who've recognized that they could very easily be standing in my shoes.

    Still... I feel shame and humiliation... and whatever other nameless emotions accompany having to accept that, despite my best intentions, I have hurt another person who was counting on me to help them... To Hippocrates or whomever, I have to say, "I have done harm." To that patient I would have to say, "You did not receive from me the care that you have a right to expect" and, from the patient's perspective, the reasons don't really matter...

    Now, for some perspective... it really could have happened to anyone... it was one of those "seconds-count" emergencies... with sequential system failures, any one of which would have prevented the error-train from ever having arrived at my station... though it did... and my chosen role is to be the person at the end of the line so it's not something I can shirk.

    The truth is, though, that despite my strong desire to tuck tail and run... and perhaps the desire among some to demonize me or toss me under the bus...

    I am a BETTER nurse today than I was last week - precisely because this has happened... not only regarding the specifics of this event but in ways that will impact every moment of nursing career henceforth.

    I am moment-by-moment learning how to live with this new recognition of myself... how to bear the scarlet letter that I've now affixed to my scrub tops.

    What does the face of a serious error look like? For me, I simply have to look in the mirror.

    Be very careful out there because you never know what you don't know... until you do...

  • Oct 31

    Of note, I am specifically not posting this to the NICU forum since NICU nurses already know this stuff (and probably take it for granted). Rather, I think many of the non-NICU nurses might find these quirks surprising, shocking, and amusing. So without further ado....

    Ways the NICU is its Own Little World

    To bathe our patients, we literally place them in the basin that adult nurses use to wet their washcloths. Many NICU nurses have not done the ‘roll the linens under your patient’ technique since nursing school, because you can lift your patient with one hand. When our patients are acting out, we can swaddle their arms up next to their bodies like a straightjacket, but we don’t have to document on restraints q 2.

    A ‘big juicy vein’ in the NICU resembles a capillary in an adult. It is not uncommon for NICU nurses to use rubber bands as tourniquets. And we especially love starting lines in babies’ heads. In fact, you can walk a pale, bald baby around a NICU and hear nurses say, ‘Look at those veins—you sure he doesn’t need an IV?’ Although the veins are tiny we’re lucky when we start IV sticks because you can literally hold a light up to your baby’s limbs and see all of vasculature.

    You can also use a flashlight to find a pneumothorax; a pneumo will glow when you hold a bright light up to a neonate’s chest. Babies are basically tiny glowworms. We draw almost every lab the same way you a check blood sugar. We poke a capillary bed (in the heel of the foot rather than the finger), and scoop the blood drops into a tube, literally drop by drop. The technique goes squeeze, drip, scoop, repeat.

    We use straight-up sugar as a pre-med for lab draws, art sticks, and circumcisions. Babies are so sucrose-naïve that a 20% sugar solution (less than the concentration of sugar in soda!) serves as an anesthetic.

    A systolic blood pressure of 50 is acceptable, a heart rate of 60 is dangerously low, and we don’t become truly concerned about blood sugar until it drops below 25.

    It is perfectly acceptable to cuddle your patient in your lap while you sit and chart. It also isn’t offensive if your patient grabs your boob. Our tiniest blood pressure cuff will fit around your pinky finger. The concept of IV push doesn’t exist. Every bolus is given over a syringe pump, which ‘pushes’ the syringe for us at a controlled rate.

    For an ‘advance feedings as tolerated’ order, a generous feeding advance would mean the baby gets an additional 8 mL of milk or formula q shift.

    A 1 lb baby is small, a 3 lb baby is medium, and a 5 lb baby is large. On the rare occasion that we get a term baby on the unit (i.e. 8 lbs) we practically consider them a toddler. We can, however, have babies up to a year old on the unit if they’ve stayed with us since birth. We sometimes have kids who can smile, giggle, and get to watch the Wiggles on DVD. It isn’t shocking to find two patients sharing a single bed.

    Calling our patients “honey,” “sweetie,” or “darling” is encouraged, and greeting your patient by saying “hey handsome boy” will not result in a lawsuit. It’s totally acceptable in rounds or report to use the phrase “he had a big poop.”

    It’s a whole different world down here, and we wouldn’t have it any other way.