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sirI, MSN, APRN, NP Admin 76,105 Views

Joined Jun 24, '05. Posts: 100,915 (17% Liked) Likes: 26,331

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  • Aug 22

    As nurses, we're taught that every patient has challenges, rights, and deserves our respect. And, this is true. But, it's also true that not every patient is respectful, cooperative, or just nice. Nurses are taught that we must be "therapeutic" in providing care; and we must learn to "put the patient's needs first."

    Many nurses do this everyday-we put our patients first, and push our needs to the back burner. We can't even go to the bathroom or enjoy our break, off the floor, much of the time, because we are doing just that-putting our patients' needs first. If we're honest, more often than not, as nurses, we are working through most of our shift non-stop, from the time we hit the clock, and even, after we hit the clock, our thoughts and minds are scattered with so much information and data bits that we can't even get a good night's sleep. And, I won't even mention trying to get a decent vacation without getting that infamous phone call, "Are you able to work an extra shift?"

    But, can I be real? Or, am I being selfish, petty, or "un-therapeutic" when I say some patients can be a real you-know-what!

    I know I'm not sounding professional and maybe I'm not being the bigger person. But, that's just it-I AM a person, with feelings, too. It's not that a particular patient can drive me crazy or be so difficult, rude, and downright indignant, what's more frustrating is when I go out of my way to provide the best service, the best communication, and prioritize my time to make sure I check-in on this patient a little more, purposed with a smile, and then this patient is still not satisfied.

    Also, it seems that in many cases, patients like this are not acting our or responding to their pain or present condition. No, these patients are acting like this because this is who they are-this is their personality. Even more, when I document the patient's rudeness and disrespect, supervisors and managers do or say nothing, nilch, nada! That is the ultimate form of professional disrespect, in my never-to-be-humble-opinion.

    Yes, we've all had stressful days and some days we just wanted to walk off the job. But, I believe the silence on dealing with these type of patients is contributory to the burn out and job dissatisfaction experienced by nurses and documented in many research studies.

    Research has recorded nurses as being, "Stressed out," "under-staffed," and with "too many patients." Also, research demonstrates why some nurses leave their professions because they feel, "burnt out," "dis-respected," "un-appreciated," or even ignored. Nurses have left their jobs or transferred out of a unit because they feel trapped and some nurses have stated they feel their managers and supervisors never defend them. Worse, some nurses feel their managers and supervisors only see them as bodies for the staff or census coverage.

    Should we as nurses toughen up? Maybe, in some cases we should. But, as professionals, we must be able to discuss touchy subjects with our colleagues and managers, and expect that they will listen. As professionals who want to better our units and our profession overall, we must be able to provide viable solutions that are able to address real-time issues when they happen. Sometimes, those issues include sensitive events regarding our therapeutic relationships with our patients.

    Please, nursing profession, if we want to attract and retain good nurses, who are happy with their jobs and feel connected to a unit, employer, profession, then, please, let's start having real conversations about issues that no one wants to talk about. Silence is not always golden!

  • Aug 20
  • Aug 18

    I got a Bachelor's in business back in 2014 after an Associates in accounting in 2011, and let me assure you that Nursing school is much, MUCH harder by far! If you are wondering about heading down this path I would encourage you to take a class in business, management, marketing, entrepreneurship, etc to see how you like it. Many communities also have non-profits that you can consult when you are starting a business for advice. If yours does, that would also be an avenue to pursue for ideas and advice.

    You will find it a whole lot easier than you might think to transfer your skills. Much of what you do in business and management is based on the same theories of trying to balance pleasing various stakeholders while providing good customer service and managing supply chains, etc.

  • Aug 18

    Thank you for this inspiring post!

    If you can get through nursing school and advance your career, you already have the skills needed to become a successful business owner. And the good news? You don't have to go it alone.

    There are many, many resources available today for those thinking of starting and/or growing businesses, such as the conference mentioned here.

    Additionally, if you find yourself lacking certain skills, such as financial literacy (think cash flow statements, balance sheets, income statements, etc.) there are myriad resources available to help you buttress them. Theses resources are often low cost and/or entirely free. For example, local community colleges often have small business development centers designed to help anyone plan, launch and grow a business.

    And-- because nursing allows us a flexible schedule-- you don't have to quit your day job. You can "test the waters" to see if there's a market for your goods and services before making any kind of substantial investment.

    Where others see problems, small business owners see opportunities in work clothes.

    It is indeed an exciting time in healthcare.

  • Aug 18

    So inspiring! As nurses and (mostly) women, we underestimate our marketable skills and abilities. There is so much untapped potential in nursing. Now more than ever before.

    Say Yes! to that entrepreneurial spark-why? Because it empowers all of us

  • Aug 17
  • Aug 17

    It is an exciting time to be a nurse! There are so many options for today’s nurse and one area that is growing is nurses interested in becoming business owners. What is creating this need for Plan Business? Well one thing is that the number of nurses employed by hospitals is decreasing from what it has been for decades. Today, about 58% of nurses are employed by hospitals compared to 68% in 1980. Many nurses, over 30%, report being burned out and highly dissatisfied with their jobs. The dissatisfaction relates to feelings of frustration, being overwhelmed with new technology (equipment and EMRs) and overworked due to higher severity of illness of the patient load. Nurses have high levels of anxiety over jobs being eliminated and potential lay-offs due to restructuring. There is a large number of nurses, 900,000, over the age of 45 looking to possibly reduce hours but not their income. And for many nurses, Plan A no longer serves them or the nurse that they have become.

    There are huge demands that can be supplied by the nurse business owner. Elder care services, called the silver tsunami, will only increase through 2030. This demand has a variety of businesses well suited for nurses from home residential care facilities, day care services, non-medical in home care, geriatric case management and geriatric patient advocacy type services and programs. Educational programs for family caregivers, caregiver training programs and respite care. Technology is breaking all kinds of boundaries and nurses interested in health information technology, telemedicine and telehealth have a plethora of choices in independent consulting including Documentation Specialists and RN Medical Bill Auditors. Nurses that enjoy teaching can create continuing education units and become CNE providers in any number of specialties. Public Health education is so critical today as patients are released sooner and sicker from the acute care setting. Home Health Care is booming and Wellness Programs are on the rise especially in the corporate setting. Nurses are Authors, Speakers and Consultants in health, wellness and social settings. In fact we have many nurses that are bloggers, podcasters, columnists and social media experts like Nurse Beth!

    If you would ask most Nurses if they see themselves as entrepreneurs I think the majority would automatically say no; but I believe that because they are not seeing themselves clearly. Nurses make great business owners because they are educated in a scientific method of problem solving and resolution. Nurses can think critically, prioritize and organize. Nurses are compassionate, dedicated and professional. While entrepreneurs have their business plan for success, nurses create care plans envisioning the optimal patient outcome. The tug and pull of business responsibilities requires the entrepreneur to wear ten hats at the same time and that is just a routine day for most nurses in a patient care environment! From my own experience, I adapt the Nursing Process and Maslow’s Hierarchy of Needs to every business problem I encounter. I was able to navigate from being a staff nurse at the bedside to being a CEO in corporate boardrooms. I was always happy to tell folks that asked about my business acumen that it was my nursing experience that was the foundation of any success.

    Michael Gerber, the author of The E-Myth, believes that every single man and woman has the entrepreneurial instinct, desire and gift. I agree with him. Most all constraints are self-imposed and our assumptions of what a nurse can be must continually be challenged. There are more successful nurse entrepreneurs today than there was a generation ago. There are many role models that nurses have available so they can accelerate their learning curve and talk with other nurses that have succeeded in areas they are interested in. Nurses can do anything and owning an entrepreneurial mindset begins changing the way nurses look at using their nursing experience.

    Have you thought about starting a business or are you looking for a unique nursing career alternative? The National Nurses in Business Association (NNBA) is hosting its annual Nurse Entrepreneurship & Career Alternatives Conference October 14-16 designed for nurses that are thinking about starting a business, those already in business and those looking for career alternatives. This might be just the thing to help you set your entrepreneurial dreams in motion.

  • Aug 15

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  • Aug 15

    Four Writers Will Split A Total Cash Value of $600!

    We had some great articles submitted in April, May, and June. Thank you to everyone who submitted articles as well as those who read, liked and commented! We had several first-time writers. I hope you will continue to write articles and share your stories with us. There is always an article contest going on.

    It is always hard to select the top 10. That has been done and now it's your turn to help pick the Top 4 winners. The authors of the four articles with the most votes will each win $150!!!!

    Use the poll below to vote for your 4 favorite articles. You may select up to 4 articles. You must be a registered member to vote.

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  • Aug 15

    It's 0653. I pull up to the hospice unit, clock in, fill my coffee mug, and get my nursing brain printed out. At 0700, I count narcotics and take report on six patients. It's going to be a busy day, one of those days where I must control the chaos, take the time to support patients, complete as many of the thousand tasks set before me as I can, and be prepared to deal with the unexpected.

    I work in a palliative/hospice inpatient unit, a place where patients come when they are in crisis,can't be cared for at home, or simply have no place else to go. One of my patients today is in indigent man who has no one in the world.We cannot locate his family. We don't even know his real name. He slipped into a coma yesterday and is non-responsive. We take care of him, call him by the name we think he has, and witness his last hours or days.

    In the room next to the indigent man is a very, very old woman, the matriarch of a large Native American family. Her family comes and goes all day. At any given time there are 5 or 6 people in her room on folding chairs. Children walk the halls as if they own the place, but they are respectful and polite.Volunteers keep the cookie jar full, the coffee pot brewing. The family has filled the kitchen with potluck dishes. They tell the staff the food is for us, too, and the family members of other patients if they want it.

    As I head towards the med cart, the smell of bacon fills the unit. A CNA is cooking for one of the patients who is still eating. I meet the wife of one of my patients in the hallway. She's tearful and scared. I have four patients who need scheduled meds now, but I take her aside and listen to her for a few minutes. I say the only thing I can say with honesty: “I know this is hard. We are here for you.” The tears start to spill and she turns away and heads to her husband's room.

    I run to the med cart and pull the meds. One of my patients, let's call him Robert, is actively dying. I admitted him three days ago and have not seen him since. He's a younger cancer patient. His cancer moved fast. Three months ago he was living a full life. When I admitted him he was still talking, expressing his grief, telling his horrendous tale of all the invasive treatments he had received. I could tell how traumatized he was by the expression on his face as he was reliving his recent ICU experiences. He was admitted directly from the hospital. He said that after the last treatment he just wished he could die right then and there. I asked what were the most important things we could do for him here. He said he wanted quiet,no alarms, no more tests or treatments. But most of all, he wanted peace. I told him, “This is not a hospital. You are in the driver's seat here.” I pointed out that there were no alarms here. I said we would try very hard to make sure he was comfortable and at peace.That was two days ago. Robert was now actively dying.

    I am a newer hospice nurse. I am still learning the ropes. I left my successful job in a pediatric ICU/step-down unit three months ago. I had one very hard year as anew-grad nurse, two very good years, and two years of slow burn-out.In the ICU, I often took the dual roles of life-saver and torturer.Many times the torture was worth it. But many times it was not. My shifts were task-oriented, intense. They had to be. I focused on the monitors, drips, airway, vent, labs, juggling all of that very carefully. The patient sitting in the ICU bed was a human being whose feelings were, at that moment, secondary to the more immediate and important need of saving their life. And sitting in the dark corner of their room, scared and silent, was that patient's parents, living their worst nightmare. Once in awhile I would try to find a break in the million tasks I needed to do on time, so I could go and explain what was going on, offer to get them a cola, or validate their feelings. But more often than not, I just had to let them sit. I didn't have time. I went into nursing to heal. And while the ICU certainly did that much of the time, I became burned out. I lost the heart of nursing. Thus, my calling to hospice.

    As I enter Robert's room this morning,I notice his breathing is heavy, his forehead wrinkled. I call his name and he opens his eyes. They search the room, unfocused. I put my face near his and smile and say, “Hello, Robert. Good morning!”and his eyes find mine for a second and hold them. He relaxes and smiles, and then his eyes let go of mine and close. He grimaces again. His breathing is still heavy, chest congested. I give him his PRN dose of morphine and ativan, but I see very little improvement. I leave to go email the doctor on call to ask for an increase in Robert's medication. I still have patients who need scheduled meds but Robert urgently needs a med adjustment. He is, at the moment, my first priority. Two family members approach Robert's room. I know it will pain them to see him in such distress, and I tell them I just contacted the doctor and more medication should be available very soon.

    I fly into my last rooms, give the scheduled meds, see that they are stable and doing fine, and log into the computer to check my email. An order change for Robert!Robert, luckily, had central line access. I give the meds immediately and stay to watch as he relaxes, his breathing becoming less labored,and his face more peaceful. I tell the family I want to position him on his side, and they hold the pillows for me. As I am positioning his cancer-wasted body, I point out the mottling of his knees and feet, how they feel cool, and how he is sweating, and how these are all signs that death is approaching. They bravely listen and nod in acceptance. They ask, “”How long do you think he has?” I tell them, “Each person has their own timing. It could be very soon. I am guessing hours to a day or two. But I think it will be sooner rather than later” I tuck him in and put my hand on his forehead,something I do with all my patients, as tenderly as I do my own children, and I say a silent prayer for peace. Then I leave and close the door behind me.

    I navigate my way past the crowded hallway filled with family of the Native American matriarch, and I hear singing from within her room. I go into my last room, a woman whose pain crisis is now being managed well. She has a few more months, and hopefully she will be able to remain comfortable. She is snuggled with her small dog in her bed, her son at her side. I workaround the dog in doing my assessment. She is due to go home later today. I return to my nursing station, peeking in on each patient as I pass their rooms.

    I have a mountain of paperwork to do.How will I ever be able to do it all? I need to print out medication instructions for the patient with the dog. Before she leaves I will have to find another nurse to count her controlled meds with me. I still need to enter the email order of Robert's increased medication doses in the paper chart, to be co-signed by another nurse, and then print out a new MAR sheet for that order and sign it. I still have wound care to, and in another 30 minutes it will be time to turn everyone with the CNA's assistance.

    As I am working behind the stacks of charts and papers, the sad wife comes up to me. “I'm sorry for interrupting your work . . “she starts off. I stand up and come out from behind the counter. I tell her, “You are not interrupting me.It is my job to support you. That's why I'm here.” She relaxes and asks questions about what steps to take next, what to expect. Some of her questions are better answered by the social worker, so I escort the wife back to the room and go and talk to the social worker about her needs. As I make my way back to the desk, I peek in on the patients again. I notice our chaplain sitting at the bedside of the indigent man, singing a hymn.

    I continue to do my paperwork and emailing. Something tells me to look up, and I see Robert's door opening. His uncle steps out, and he has that look on his face that I have gotten to know: shock, grief. I reach for my stethoscope as he approaches. He says, “I think Robert's gone.” I walk in with him,find the bed surrounded by loved ones, all silent. All eyes are on me. I can tell from first glance that he's lifeless. I take Robert's hand in mine and hold it gently, feeling for a pulse. I put my stethoscope on his chest and listen. Everyone holds their breath.Silence. I listen for a few more seconds, then look up, make eye contact with everyone and tell them, “I'm so sorry. Robert is gone.” The tension breaks. Tears are released and pour down cheeks.People hug each other. There is relief in the long, drawn-out death.

    I stand to the side for a moment and wait for the first wave to pass. I say, “Take all the time you need with Robert. We are here for you. Please come and find us if you need anything, anything at all.” The uncle nods. I turn and close the door quietly. I go to our patient census board and wipe out all the details of Robert that no longer matter, leaving only his name. I write in, “TOD: 1246.”

    I give out my next round of meds,continue to assess my patients, update the doctor. I am invited to take some lunch from the buffet of the Native American family, and even though I brought my own lunch, I know they have a need to feedus. I fill a plate as one of the sons nods approvingly. I go back to my desk and start to break down Robert's chart and prepare to destroy his controlled meds.

    A woman rushes in, tearful, and asks where Robert's room is. I stop her and ask if someone has called with an update on him and she nods and said, “Yes, I know. He just died.” She starts to turn to the room and then stops and turns back to me. She puts her hand on my forearm and asks, “Was it peaceful?Did he go peacefully? Because that's all he wanted.” I look her in the eyes. I can honestly say “Yes, he did. He was very relaxed and breathing easily, and he was very comfortable.” Tears form and she says, “Thank you. Thank you” before the words leave her. She enters his room.

    Two more hours pass. Robert's family tell me they ready for me to call the mortuary. I make that call, and go back to the afternoon tasks. I perform my wound care, finally: an elderly woman who was found down, broken hip and and multiple severe skin tears. She never fully regained consciousness. It is clear that until her accident she had been in good health. Her family is still in shock. They asked how long it might be. I tell them that once a person stops eating and drinking, as she had three days ago, it would be about a week, give or take a few days. Her daughter nods bravely.I reassure her that her mother appears comfortable and we plan to keep her that way. She swallows hard and says a quiet, “Thank you.”

    I send the woman with the dog home after giving report to her home nurse. In my later afternoon rounds I notice that the indigent man's breathing pattern has changed. His head is arched back and he is grimacing slightly. I moisten his dry mouth and lips and administer a PRN dose of morphine, turn him on his side, tuck him in, and touch his forehead with my prayer before leaving his darkened room. I do another round of scheduled meds, and some PRN's, too.

    The man from the mortuary is here to pick up Robert. I have him sign some forms and take him to Robert's room and introduce him to the family. A few minutes later Robert's body is wheeled out. His family lingers in the lounge. Each of them hugs me or shakes my hand and says thank you as they trickle out. I have so much paperwork to do, but I stop those thoughts as I take the time to shake hands with them. It's hard for them to leave, to know that it's over. I am helping them to do that.

    It's dinner time. The Native American family offers (insists!) that we take some more of their food, so we all do. I make my last rounds. I notice the indigent man has slipped away as quietly and anonymously as he walked through his life. I confirm his death. TOD: 1803. I remove his pillows and position him straight. I call the county's indigent burial number and know that someone will pick him up soon. I set aside his chart. The night nurse can finish his discharge.

    My charge nurse hands me a sheet: “We have another name,” she says. I take report on the patient who will going into Robert's room in about two hours. Our unit is in high demand, a revolving door.

    As a hospice nurse, I have to continuously strive to not get lost in the tasks, to prioritize, and to do the most important ones well. Hospice nurses have a lot of“wiggle room” to make nursing judgments. Each patient is different, and so are the rules for each patient. I'm still adjusting to this shift in model of care, still untangling my mind from the ICU. Slow down. Meet the patient where they are on their journey,walk the pace that they set. Look at the patient, not the machines.

    It's 1905. I count narcotics with the oncoming nurse. I give report, trying to pace myself to give the most important details about each patient, but not so long that the important things get buried. 1930: I should be done, but I'm not. I take my paper charts to the break room and I finish writing out my narratives on on each chart. The Native American matriarch, the woman with the broken hip, Robert who is now at peace, the woman with the dog, the man with the grieving wife, and the indigent man. I relive my day with each of them. It hits me, as it does almost every day,the sacredness of the work I do, the journey I am allowed to walk with the patients, and the job I have of facilitating that journey so it is as peaceful as possible. And knowing that it just as much as honor to be there for the last breaths of life as it is to be therefor the first breaths. And then there is still paperwork to do. I pick up my pen and finish charting.

    2003: Finally I am done. Am I forgetting anything? I hope not. I clock out. As I walk through the lobby, some of the members of the Native American family wave to me and call out “Thank you! Goodnight!” I enter the crowded parking lot. I see four people hugging each other and crying. The county mortuary van pulls up and parks. He is there for my indigent man. I get in my car and head home down the dark streets. I see life all around me: a family out for a bike ride, people pulling out of the grocery store parking lot. I call a friend and catch up as I fight fatigue. “How was your day?” she asks. I have so much I could share, but I'm so tired. I have no words. I have a thousand words. I finally settle on saying simply, “Good. I had a really good day.”

  • Aug 15

    We all know we have to keep it objective and professional when we write a note, but clinical notes are really masterpieces of restraint. They summarize our chaos in a way that makes us look like Daenerys Targaryen calmly walking through fire as everything burns behind her. Let's be real though; the sense of humor we have gained from this job can only be kept at bay for so long. Any nurse could write a book about their life and entertain the masses enough to retire like JK Rowling and be done with it. Our notes, however, appear to be lacking that certain je ne sais quoi that makes us who we are. That is, until you know what it is we are really saying. At this point even the MDs are able to joke about the note that will follow our conversations. So keep on writing your notes, hopefully with a smile, and know that I know what you really mean by:

    "MD aware. No new orders received" a.k.a told physician and nobody cared; butt covered

    "Patient arrived to unit"= Here we go again. All hands on deck

    "Patient alert oriented and independent" - yessssss

    "Patient Intubated and sedated"- That'll do donkey. That'll do.

    "Will continue to assess and notify MD with changes"= RN knows something is up; will continue to harass physician until something is done about it

    "Patient repeatedly reminded to..." = oh my god. oh my god. sttaaahhhhpppp

    "RN called provider to bedside, provider at bedside to assess..." a.k.a They saw this **** too, it was not just me!

    "RN asked provider for...; provider said not necessary at this time"- Oh man I told you so

    "Notified charge nurse patient requiring 1:1 care"= Can someone throw me a life raft over here? Anyone? Anyone? Buelleeerrr??

    "Lab notified RN specimen clotted"...are you serious..seriously..

    "Medication not available"- Sorry sir our pestle and mortar downstairs must have broken today

    "Respiratory Therapist at bedside"- I needed an adult. They can't even breathe around here without us today

    "Patient voiding <30mls/hr"- RN has voided 0mls/12hours....

    "Patient had large bowel movement"
    Code Brown! Save yourselves! How was the ceiling even in range?!

    "Patient ambulated around unit" aka I am NOT about to disimpact you today sir

    "Patient managed to get out of restraints and..." =...sigh. Houdini over here. What the F... We've got a lively one over here folks!

    "Patient demanding to sign out AMA"
    oh please oh please I triple dog dare you (jk please just get better and be nicer)

    "at 0745 RN noticed patient showing sings of distress, 0830 first unit hung..."= so this is the first time I've sat down, my day was a shitshow and my shift is over. This is going to be one long run on note and that's that

    "RN notified resident... resident stated we will discuss on day rounds" = Where are the adults at this party? can we get some coffee up here?

    "RN walked into room, found family touching equipment"= AW HELL NO

    "At 0700/1900..."= because of course that's a good time to start anything

    "D/C teaching complete; patient being discharged today" - You're on your own now. You know what to do. Take your meds. Don't talk to strangers. You can do this! buhbyeee

    The truth is our notes can never really tell the whole story, so if you're not one of us: buy your nurse friends a beer and ask them about their day. Steady your stomach and prepare for some anonymous stories and an all around good time. We documented. It happened. Just check our notes.

  • Aug 15

    To the Young Girl Thinking of Becoming a Nurse...
    (A note to myself at 17)

    The world will speak at you in many ways. You will read how the medical world is full of red tape, rules, ratios and never ending charting, but there are a few things they are missing. The world needs good nurses called into the profession; and you, girl, can make a difference. Here is what no one tells you...

    No one tells you that you will be scared--
    Of the pressure.
    Of messing up.
    Of not knowing something.
    Of doing the wrong thing.
    Of letting down your medical team.

    No one tells you this will make you a better nurse.

    No one tells you the ways patients will affect you--
    With their struggles.
    With their stories.
    With their faith.
    With their determination.
    With their fight.

    No one tells you this will make you fight harder.

    No one tells you there will be days when your faith becomes shaken--
    When you don't think you can.
    When you don't know what to do next.
    When you just want to walk out of the patient's room.
    When you think, "Why am I here and how do I fight harder for this life?"

    No one tells you that you will start to believe in you.

    No one tells you that patients and families will change you--
    With their harsh words as they are at their worst.
    With their loss as if it's your own.
    With their happiness in the successes of small daily battles.
    With their joys in new beginnings and the miracle of life.

    No one tells you that your character will strengthen through empathy and grace.

    No one tells you how your coworkers will influence you--
    To want to be a part of a work family.
    To understand sometimes all there is left to do is pray.
    To learn to be a better listener and supporter.
    To realize that you are not in control.
    To realize who is.

    No one tells you that you will learn another side of the meaning of love.

    No one tells you that you will have days when you feel the fragile flicker of mortality--
    When a patient gets better and then back to worse in the blink of an eye.
    When you code a patient for the first time.
    When you have your hands on a chest praying for that life to stay grounded.
    When that life breaks it's earthly chains.

    No one tells you that you will, in these moments, recognize that there are two types of patients-- those who should be able to be saved, and despite all medical resources, aren't. Those that shouldn't have a chance to survive, and by divine medicine, do.

    No one tells you that you will go to church in a patient's room--
    When your patient just needs to talk or hold your hand.
    When your patient's family members want answers you don't, and won't ever, have.
    When you and your team have exhausted all efforts and you gather around the bed and pray...and cry.

    No one tells you you will find your beliefs in those walls because you finally understand He is never far away.

    No one tells you of the days when--
    You find peace in your calling.
    You finally see why you are in this role.
    You realize that you are a tool and an avenue for great work to be done.
    You understand that you are human and your best IS good enough.
    You believe.

    No one tells you that you'll look back at your journey with a heavy heart at the ones who branded it and are no longer with you, of the ones who stay with you for all the best reasons, or the days when you felt like you were right where you needed to be.

    No one tells you that when you are doing what is your calling, that it is all that matters and, most importantly, all that ever will.

    No one tells you that you will find peace in your work because it is far more than just a job.

    No one tells you that sometime later you will look back at how it all started, with tears in your eyes, and realize--
    That the days of doubt were trials and you passed, not always prettily, but you did it and you have built character as a result.
    That the positive far outweighed the negative.
    That the days of not knowing your purpose are over.
    That you are the mother, daughter, sister, and spouse you are because you endured.
    That the pieces of all these experiences you have carried with you now quilt your being.
    And, lastly--
    That even on those long days and nights over the years when you felt your heart breaking and healing, that those on this adventure with you saved a piece of you as well. You're journey is not over, it has only begun; the trail is merely better marked now as a result of your experiences. It can only make your footprints clearer for those who travel along it with you and for those who follow after you.

  • Aug 15

    Last night, my first class of nursing students graduated. It was a momentous and beautiful moment that really got me pondering the challenges and triumphs of being a nursing instructor. I decided to sit down and write out all of the things I wish my students could know, so without further fanfare…

    1. Our greatest wish is for you to succeed.

    It is a common misnomer that nursing instructors have it out for students. We really try to give you all of the tools you will need to become successful. It pains us greatly when you fail.

    2. No, we cannot be friends.
    Right now, I cannot be your friend. I am here to help shape you into a conscientious, critically thinking nurse. I would be doing a grave disservice to you (and possibly, your future patients), if I am easy on you. My job is to teach you and evaluate you on the concepts and skills that you have learned. One day we may be peers and that relationship will be different but right now, I have a job to do. I promise it does not mean that I do not like you.

    3. Everyone has a unique and often difficult story.
    I know that you work full time during the day, your car can barely make it here, and there is no one to watch your child. My heart really does go out to you, and I will help you in any way that I can for you to be successful. If you put 100% in in my class, and I know it may be hard, I will always be in your corner.

    4. Respect is earned and reciprocated.
    You are going into a noble, yet physically and psychologically difficult profession. Take it seriously. Take nursing school seriously. Respect your peers, respect your patients, respect your nursing instructors. It is a two way street with me, and I will hold you to your side. Insubordination is absolutely, unequivocally never okay, ever.

    5. I see you texting.
    Listen, if it is a special circumstance and you absolutely need to text or call, that’s fine- outside my classroom. You may use your phones for research purposes not involving texting, Snap Chat, Instagram, Kik, Facebook, etc.. I know sitting still for often three and a half hours is difficult and tiring, but please save the texting and phone surfing for your break.

    6. Do not bother to cheat.
    I am a mother of boys, I have eyes in the back of my head. Aside from that, you can’t cheat the NCLEX or for that matter, life. Just don’t do it. If I catch you, and there is a good chance I will, you will be expelled. It’s not worth it, besides, you do have it in you to pass the right way.

    7. Please ask me questions.
    I am here to tell you what you need to know, and if I do not immediately have an answer, write it on the board and I will find out for you. It’s my pleasure to answer your questions and explain the rationale as to why we do things the way we do in nursing. Thinking like a nurse isn’t easy, it is often a process and I am here to help you discover that process and help guide you to the other side, so to speak.

    8. I will ask you questions.
    I will absolutely ask you questions at random, often in the middle of lecture. Why? I want to know if you understand the information, and if not, I want to facilitate your discovery of that knowledge. It’s not because I want to embarrass you, or make you look foolish. I want to see and hear that you are learning.

    9. I will hold you to the outlined academic program standards.
    Please don’t ask me to not mark you late, or give you extra points when you haven’t worked towards them. It is not fair to the students who are on time and who turn in their work on time. Also, when you are in uniform, I expect you to abide by the program’s rules that you signed: no jewelry, no nail polish, hair up off the collar, white shoes. Yes, I check. Do not leave the unit floor unless I give you permission, and do not disappear behind the nurse’s station. You need to be with your patients unless otherwise specified. I notice when you are not back on time and where you need to be. Turn in your assignments on time and without a story. Do what is outlined in your program contract and you will be all right with me.

    10. I was once you.
    Yes, it may seem like 1000 years ago (actually, twenty), but I went through the very same program and had the same concerns, complaints, and stressors that many of you do. I get it. Because of this I am secretly cheering and rooting for you. I am really in your corner. When you do well on your test, I am happy for you, when you pass my class, I am ecstatic, and when you graduate, I am overjoyed for you. Words cannot express how wonderful it is to see my students on their very first day, scared and hopeful and to see them all the way through their journey. It is the best form of compensation, ever. When I see my students graduate, I see shades of what is to come- glimmers of the next wonderful generation of nurses in a sea of white caps, all smiles as they venture out into the amazing, yet intimidating world of nursing.

    My students, I only wish for you to succeed and accomplish all of the goals you set out to. I believe in you, I know you can do it!


    Your nursing instructor.

  • Jul 29

    The mobile app is no longer supported. We recommend that you UNINSTALL the app from your devices.

    We fully disabled the app due to low usage and more specifically the app company changed its Privacy policies / Term of Use over the past years.

    We are sorry for the inconvenience this may cause some of you.

    Moving forward, we are focusing on introducing new and exciting content to help you move forward. We are focusing on mobile apps for nurses and students. We are focusing on improving page loading time. We are focusing on improving every corner of

    At this time there is no ETA of when we will offer another mobile app.

    Thank you for understanding.

  • Jul 26

    You have 14 posts. One more post and you have private messages enabled. However, most questions are fine in the public forum and will benefit more members. I tell most private messengers to post their questions online. Some are offended, but as you can see, I do put some work into my posts and I like the idea that they may benefit more than just one person.

    Also there is also a possibility that someone else will contribute a reply adding to the answer or pose an important related question that you didn't think of. I'm oldfashioned I suppose, but I see real value to public forums that you don't get with FaceBook or networking privately.

    I invoice weekly on Monday for the prior week 30 days net. So you are at most, on average, only three weeks behind a weekly employee check.

    A financial cushion of several months is a good idea even as a regular traveler. If you are ever terminated for any reason (including illness) it will often be a month before you have cash flow again.

    I was a frugal and well paid traveler for 8 years before going independent so cash flow has never worried me.

    Yes, even two months of delinquent accounts receivables is a concern for small fry like us. A lot of money in one basket. I declined to work at one hospital that had just declared bankruptcy as too much risk. A simple Google search for hospital name news is prudent due diligence.

    I did a lot of work for a vendor manager that had previously declared bankruptcy. They had an escrow account to help soothe agencies and I've worked for one other hospital that had a secured account of some sort.

    For my own contracts that I write, I use business standard terms of 30 days net. Late payments are contractually required to add 1% per month interest in late fees. That's good money so I'm always hopeful but I've never collected interest.

    In general, hospitals have deep pockets so you can usually collect (in theory). I'd be wary of contracts with public hospital. While they have the backing of taxpayers and can't really go broke, it can take years to collect sometimes (I hear). Late payment seems to be the norm.