Content That Rekkashinorei Likes

Rekkashinorei, BSN, DNP 1,763 Views

Joined: Oct 21, '09; Posts: 11 (36% Liked) ; Likes: 17
Emergency Medicine NP

Sorted By Last Like Given (Max 500)
  • Mar 6 '17

    Thanks for the kind words - I am due to renew my malpractice insurance soon and yes I have 1/6 million coverage. Yes, although I don't plan to use it, I look at it just like I look at my homeowners or auto insurance. My car is paid for, yet I still carry full coverage as it would cost me more money to replace it from ground zero without the help of insurance.

    I respectfully disagree with Risk Manager and have taken the advice of my attorney. I do appreciate the opposing viewpoint and respect their experience, its just my experience has been different.

  • Mar 6 '17

    I am not TraumaRUS, but as the risk manager who does this sort of thing for a living, here are my thoughts:

    First, did you read my article and do you still think it is necessary to buy your own policy:

    Second, the difference between $ 1/3 million and $ 1/6 million is only the aggregate policy limits. For $ 1/3 million, CNA will pay up to $ 1 million for any one claim, and up to $ 3 million for all of your claims in any one policy year. For $1/6 million, CNA will pay up to $ 1 million for any one claim and up to $ 6 million for all of your claims in any one policy year. The chances that you would ever have a malpractice claim that is not covered by your employer, and is therefore covered by your own individual policy is extremely small. The chance that you would have more than one paid claim covered by your own individual policy in any one year is even smaller. The chance that you would have so many paid claims in any one year as to make you grateful that you bought $ 6 million as opposed to $ 3 million in aggregate coverage is probably about one in a trillion. That would mean that you screwed up so bad and so frequently that CNA paid $ 6 million for all your cases in just one policy year, and if that happens, I am pretty confident that you will not have a license since it would have been stripped away by the BON. Probably the more compelling reason to get your own policy is the 'licensure defense' coverage, which provides up to $ 25,000 reimbursement of defense legal fees that you incur in an actual complaint against your license by the BON. Note that it must be an actual complaint to trigger the 'licensure defense' coverage: BON investigations do not trigger coverage and you get no reimbursement of defense legal fees for an investigation. Feel free to post here or send me a PM if you have any other questions.

  • Feb 28 '15

    Reading these boards as long as I have you come to recognize the members who are in the same boat as you are career wise. I had a realization this week and wanted to share.

    I have survived my first week as a FNP. This week was more like clinicals as in I'd see a patient and then go in with my MD for the day or we'd go in together and I'd take the lead on questioning and assessment. Thankfully all of the doctors around me are very supportive and knew I understood the new graduate nerves.

    Did I know everything? No. Did I know every treatment? No. Did I at least ask the right questions and get in the same ball park? Yes.

    Example: headache for almost 2 years. I asked the right questions, did my assessment, and figured the headache was somehow related to neck issues. MD figured occipital neuralgia. Did I know what that meant? No. But had I gone and done a little research (if the MD was not there) I'm sure I could have come to that diagnosis after researching it afterwards. I at least knew it didn't fit a migraine, cluster, or tension headache so more research or consultation was needed.

    I'm trying to keep in mind that school does NOT teach us everything. It teaches us to be SAFE as new health care providers.

    If many of you are like I am you want to be right. You want to know the answer and fix everybody on the first try. I have been told time and time again it won't happen every time and I'm finally starting to realize it (early on thankfully).

    I'm looking forward to these next few weeks in becoming more independent!!

    To others feeling the way I have: you are not alone!!!

  • Jul 7 '11

    Well I took the position. the contract is en route. We shall see

  • Jun 4 '10

    Hi Missy,

    I'm hoping you haven't been too put off by the negative comments you've received. All too often, my colleagues get defensive and suspicious of young people who commit no worse crime than displaying a lot of energy and enthusiasm for their future careers in nursing. They expect you to know everything before you have had a chance to get out there and learn. I am really happy that you are considering a career in anesthesia, and I'm glad you're bringing so much positive energy to the pursuit.

    You're past academic success proves you are smart, so I'm sure you could improve your performance if you were to slow things down a bit. If you are still serious about a career in anesthesia, you might want to speak to your academic counselor about the possibility of converting to a traditional BSN program. If you stop the bleeding now, step back, take a breath, take a lot fewer classes per term and kick ass on your exams in a traditional program, you will have something impressive to show to the grad school admissions committees later on. You will also have a good story to tell, since you'll be able to show them you had the maturity to assess your situation and take some dramatic steps to improve it.

    You will still have to face tough questions from them (e.g. "Accelerated BSN programs are hard, but grad school -- especially in anesthesia -- is a lot harder, so please tell us why you think you can hack it even though you couldn't hack the accelerated BSN program"). But I'd rather have you answer that question with a set of good grades from a traditional program than explain a more mediocre performance in a completed accelerated program.

    The idea is that you want to have some good strengths to play off against any weaknesses in your application. I would even recommend that you take a couple of grad school classes after you finish your BSN just to show them that you can do grad level work without problems. But that's for further down the line. For now, I'd say focus on recalibrating your academic progress through a slower, traditional program, go work hard as a nurse for a couple of years and then get ready to apply to anesthesia school if you're still committed to it at that point.

    Missy, I can relate to your situation somewhat. I was a very good student as an undergrad, but I wasn't the type who could ace a ton of classes in one semester. I always took the minimum number of classes and made sure I had time to excel in each of them. It wasn't until later on, after I finished my first degree and went out into the world and worked for awhile, that I was able to return to school and kick butt in an accelerated BSN program for second degree students (my first degree was in Latin American Studies, of all things). From there, it wasn't too hard to convince the admissions committee that my range of experiences in school and work proved I'd do well in anesthesia school. Your story will be different, but you will still be able to make a strong case if you make good decisions from here on out.

    Don't let the haters hold you back. Just keep in mind that grad schools know what they want and it's up to you to make the choices necessary to give them what they want.

    Hope this helps! If you have any further questions, just let me know.

    Hugh, CRNA

  • Jun 4 '10

    Have you read this blog here on allnurses yet?

    This is MY vent for the day. If you are a person who thinks that becoming a nurse is the quick-fix to your personal situation, please realize that being a nurse requires more than intelligence (it CERTAINLY DOES), and ability to get good grades.

    You have to care.

    And I mean A LOT.

    I'm tired of reading threads about people with or without advanced degrees trying to "speed through" so that they can get to the "top" specialties without even THINKING about their impact on the lives of people.

    I don't hear the "I want to be a good nurse."

    All I hear is "HOW FAST CAN I BE A CRNA??????? or NP????"

    You know what else I hear????

    ME, ME, ME, ME, ME.

    Anyone care about the PATIENT?????????

  • Jun 4 '10

    Anesthesia is not for everyone, that is the plain simple truth.

    When I was a program director, one of the hardest things I had to do was dismiss students from the program. The reasons usually were not academic, but were related to difficulty learning clinical skills, inability or understand the politics of the operating room or rigid thinking regarding anesthesia techniques.

    Now that the admission requirements are more rigid, students are comfortable with many of technical aspects of one to one patient care and with ventilators and tubes.

    As a CRNA, I have seen some mediocre colleagues (the ones you wouldn't request for family members) and I have seen some spectacular anesthetists. This is probably no different from any profession.

    As a legal consultant, I have seen some really bad practice, usually by CRNAs who have become complacent, have not kept up with current practices or have substance abuse issues.

    As you know, I love anesthesia, but it is not a profession for anyone who doesn't like it. You have to be comfortable in the anesthesia environment, like patient care a lot and be willing to participate in life-long learning.

    We are an elite profession with an excellent professional organization, AANA and have an amazing history. But, if you need a lot of direction, not comfortable making your own decisions or have difficulty dealing with stressful situations, you need to reconsider anesthesia.

    yoga crna

  • Jun 4 '10

    Quote from traumaRUs
    ....... CRNA's bring to the playing field more than just anesthesia, they are nurses too!

    You may not be a CRNA, traumaRUS, but you do understand perfectly well the vital differences between nurse anesthetists and the other anesthetists. I applaud your insight.

    Anesthesia is an arcane, a cloistered world. Closed to outsiders. CRNAs must learn to be quietly satisfied with their own work each day, with each patient they care for, satisfied with a Job Well Done: compassionate, efficient, with the accuracy of Science, and even with the elegance of hands-on Art -- satisfied to pat oneself on the back, so to speak, and not requiring external kudos, because no one else can truly appreciate such an arcane process *except* other anesthesia providers, and the doctors in anesthesia all too often do not recognize or they refuse to acknowledge superior care.

    Which brings me back around to the *single* major drawback of being a CRNA: the politics. The playing field traumaRUs refers to is NOT a level playing field. Very frustrating.

    When Nupe4sleep says in the Very Unhappy With My Career thread ".....I'm tired of the arrogant surgeons, condescending and controlling anesthesiologist and the constant rushing in the OR at the expense of patient safety......" I hear lack of autonomy; I hear a CRNA prevented from giving nurse anesthesia care, required instead to provide just Anesthesia. CRNAs have survived political attacks for over a hundred years because we put our hearts into our work. Hands-on care for us is not just manual labor.


  • Jun 4 '10

    CRNA is an advanced practice role for nurses. I am not a CRNA, but am a CNS (another APN role).

    I agree with others that prior to choosing an APN role, you need some type of experience as an RN and then some shadowing time with a CRNA. It would be a real drag to go through all the work of getting into CRNA school and then you decide it is not for you.

    To be honest, you need some RN experience before deciding on an APN role. Otherwise, you do risk the possibility of being "locked into" one role over the other.

    To MSPCRNA - just curious, what is your educational background? The military? A couple of years ago while working in the ER, I had the good fortune to meet a wonderful nurse who was a CRNA who had her training during the Vietnam era - she was absolutely someone who I really admired and did a great job too. What impressed me most was that she was a nurse first, then a CRNA. I think CRNA's bring to the playing field more than just anesthesia, they are nurses too!

  • Jun 4 '10

    Here are the tuition figures for Samuel Merritt University in Oakland, California:

    2010-2011 Tuition and Fees | Samuel Merritt University

    Here is a flyer I got from one of the informational meetings

  • Jun 4 '10

    certified registered nurse anesthetists (crnas) at a glance

    nurse anesthetists have been providing anesthesia care to patients in the united states for nearly 150 years. crnas administer approximately 30 million anesthetics to patients in the united states each year.

    what is the role of an individual crna?

    a crna takes care of a patient’s anesthesia needs before, during and after surgery or the delivery of a baby by:

    • performing a physical assessment
    • participating in preoperative teaching
    • preparing for anesthetic management
    • administering anesthesia to keep the patient pain free
    • maintaining anesthesia intraoperatively
    • overseeing recovery from anesthesia
    • following the patient’s postoperative course from recovery room to patient care unit.
    the credential crna (certified registered nurse anesthetist) came into existence in 1956. crnas are anesthesia professionals who safely administer approximately 30 million anesthetics to patients each year in the united states, according to the american association of nurse anesthetists' (aana) 2007 practice profile survey.

    crnas are the primary anesthesia providers in rural america, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, and trauma stabilization services. in some states, crnas are the sole providers in nearly 100 percent of the rural hospitals.
    according to a 1999 report from the institute of medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by crnas and their physician counterparts.*

    crnas provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. when anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.

    as advanced practice nurses, crnas practice with a high degree of autonomy and professional respect. they carry a heavy load of responsibility and are compensated accordingly.
    crnas practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and u.s. military, public health services, and department of veterans affairs healthcare facilities.

    nurse anesthetists have been the main providers of anesthesia care to u.s. military men and women on the front lines since wwi, including the conflict in iraq. nurses first provided anesthesia to wounded soldiers during the civil war.

    a specific list of crna functions and practice parameters is detailed in the aana scope and standards for nurse anesthesia practice .


    further info: compiled 12/2/2002 by kmchugh crna

    what are the prerequisites for crna?

    first, you must be a registered nurse, and you must have a bachelor’s degree. not all programs require a bsn. in many cases, being an rn with an unrelated bachelor’s degree is sufficient for admission. check with programs where you intend to apply for this information.

    next, most schools require an undergraduate degree gpa of 3.0 or higher. if your gpa is below this, check with the school that granted your degree about the possibility of taking more classes, or retaking classes to raise your gpa.

    most programs will look at applicants’ gpa from a few different angles. the first consideration is the overall gpa, which must be at least greater than 3.0. next, the applications committee will consider grades applicants received in the science courses, such as chemistry, microbiology, etc. finally, the committee will look at grades received in nursing school. there is a lesson in this. if you have a 3.5 gpa, but your science and/or nursing school grades are lower grades, this may hurt you.

    many schools will require you to take the graduate record examination (gre), and will have a requirement for a minimum score on this test. the test is administered at most sylvan learning centers. there are a number of books and computer programs available to prepare you to take this test. taking the test “cold” is probably not a good idea. you can retake it if you do poorly, but both scores will be reported to schools where you are applying. also, the test is fairly expensive, so if you can avoid taking it twice, you should.

    nearly all schools require one year of experience in an icu before an applicant will be admitted to the program. most will not accept er, or, or other experience (though a few programs are a bit more lenient). there is a good reason for this requirement. you will need experience with vasoactive drips, ventilators, and other things that you can only get in an icu. larger hospital icu’s are generally preferable to smaller ones.

    many students wonder whether one year’s experience is sufficient. generally, the answer is yes. however, some may feel more comfortable applying after two or three years experience in an icu. the bottom line is one year meets the requirement. after that, it is up to the prospective student to decide when they feel comfortable.


    how do i apply for a crna program?

    application requirements vary from program to program, so for specific information check with the schools where you intend to apply. you will have to do this in any event, as you will need an application packet from the school.

    generally speaking, you will first have to send in a “paper” application that the school will send you. there will usually be a required non-refundable application fee that must be sent in with your application. check carefully that you meet the requirements of the school before sending in your application. if you do not, you will probably have wasted your application fee.

    some applicants consider sending out applications in “shotgun” fashion, sending out as many applications to as many schools as they can afford. this is not a good idea. beyond being expensive, scheduling interviews at all these different schools can become a real headache. it is better to pick out two or three schools that most interest you, and apply to those schools.

    once the application deadline has passed, the school will go over all the applications, and will select a certain number of applicants for interview. those applicants will travel to the school at their own expense for a face to face interview with the program director and the admissions committee. these interviews can be stressful. see the next question for more information on interviews.


    how do i prepare for my interview?

    admission to anesthesia school is highly competitive. if you have reached the interview phase, you have passed a major hurdle, but you are not at your goal yet. most schools will interview something like two to three applicants for each available seat. you will want to avoid giving the selection committee a solid reason to choose someone else over you.

    -be on time! if you are late, even if the committee waits for you, you have given yourself a black mark that may be impossible to overcome.
    -wear conservative business attire, such as a suit or conservative dress, to your interview.
    -insofar as possible, be relaxed during your interview. the committee will expect nervousness, but if it makes you incoherent, that’s a pretty good sign you don’t handle stress well.

    it is impossible to predict what kinds of questions the application committee will ask, but be prepared for certain “stock” questions:

    -why do you want to be a crna?
    -what do you know about what a crna does?
    -what have you done to ensure you really want to do anesthesia?
    -what steps have you taken to prepare to get through school (generally, though not always, a financial question)?
    -also, most interviews include a question or two on vasoactive drips (i.e. dopamine, nitroglycerine versus nitroprusside), or some other aspect of nursing you should have learned working in an icu.

    be prepared for questions to which you don’t know the answer. most interviews will try to find such questions, to discover how you handle that situation. when these questions arise, don’t waffle or try to “bs” your way through. stay composed, and admit you do not know the answer.

    one other note: every school has its criteria in looking for students. it cannot hurt you to contact the directors of the programs you are considering and asking them what you can do to make yourself a more attractive student. admission to crna programs is very competitive. give yourself every advantage.


    where are schools that have a crna program?

    the american association of nurse anesthetists maintains a website with a link to all schools currently accredited by the council on accreditation. this site can be found at: accredited nurse anesthesia programs


    what are the “best” crna programs?

    there is no “ranking” of schools. the term “best” has little meaning, because it means different things to different people. rather than worrying about finding the “best” school, it is probably better to find a school that is the “best” fit for you. in your considerations, you should include geographical location (is the school close by, or in an area you are willing to relocate to), length of schooling, and program cost. if a school is accredited, it will provide you with the education needed to pass the certification exam and become a crna.


    what are the differences between crna schools?

    as mentioned above, schools offer a variety of different options. length of school varies from 24 months to 36 months. some schools grant masters of nursing (which require some core nursing classes, such as nursing theory) degrees, while many others grant masters of nurse anesthesia degrees, which are not strictly speaking “nursing” degrees. while there are a certain number of core clinical experiences all students must get, clinical experiences vary as well. at some schools, clinical is slowly phased in while in didactic education, while in other schools, the didactic education is “front loaded.” some schools have clinical education in the same area as the school location, while others offer clinical education at “satellite” locations. the point is there are a number of different options that must be considered when selecting a school.


    can i work during school?

    generally, the safe answer is no. nearly all crna programs are full time programs that require an enormous amount of study time to be successful. some students manage to work on a prn basis, but are very limited in the actual number of hours they work. working full time while attending a crna program is nearly impossible. not to worry; see “how do i finance crna school?”


    how do i finance crna schooling?

    many of the same government no interest and low interest loans for undergraduates are available to graduate students. additionally, there are a number of companies that offer loans to students in medically related fields. these loans may all be used to pay for tuition, books, and other school related expenses. these loans may also be used for day-to-day living expenses. most crna’s graduate programs with what seems like a pretty heavy debt load, but remember, a crna will earn two to three times the annual salary of a staff nurse. provided you don’t go overboard, the debts are easily managed.


    how much does a crna earn?

    this varies based on location and time. crna salaries are constantly changing, so exact figures are difficult to give. it is safe to say that at the time this was written, salaries for new graduate crna’s ranged from $90,000 to $140,000, plus benefits. many anesthesia groups and hospitals, in addition to this salary, offer overtime pay for any hours worked over 40 hours per week.

    a word about benefits: for crna’s, benefits may be quite substantial compared to what a staff nurse receives. they may include education loan repayment options, full health and dental care for the crna and his/her family, retirement packages, malpractice insurance, life insurance, and others. in considering contracts, benefits should play a major role in your decision. when they are included into the salary package, they can increase your actual income substantially.


    when should i sign a contract?

    you may be presented with some different options after being accepted to a crna program. some hospitals and anesthesia groups may offer you a contract as soon as your are accepted to a program. these contracts usually will include some benefit to the student while s/he is in school, such as a stipend or help with loans. there are rare groups that even offer contracts that pay for tuition and books while you are in school. none of these contracts are without strings, of course. these contracts will include a clause that requires you to work for the contracting hospital or anesthesia group for a set period of time, usually at least two years. therefore, it would be to your benefit to know as much as possible about the hospital or group before signing the contract. ask questions about hours required, call time, pay, etc. see the next question for more information.


    what should i consider if i am considering signing a contract before finishing school?

    there are a number of factors that you must factor in when considering a contract, especially if you have not finished a crna program.

    -salary: check out other anesthesia groups in the area. is the salary competitive? some places may offer contracts that are competitive at the time you sign the contract, but by the time you begin to work, the agreed upon salary may be well below what the local market has risen to. some contracts will have a clause that covers this eventuality.

    -benefits: these could include, but may not be limited to, health and dental insurance coverage for you and your family; retirement packages; student loan repayment options; malpractice insurance; overtime pay for overtime work, etc. carefully consider these benefits, as they make a substantial contribution to your annual income. it might not hurt to compare what you are offered with what is offered elsewhere in the community.

    -hours: check with people already working with the group or hospital you are considering. how many hours per week are they averaging? how many hours per week do you want to work?

    -call: many groups and hospitals require crna’s to be on various levels of call. how often will you be on call? are you required to stay in house when on call? is the day after call a normal work day, or are you off on post-call days?

    -location: it may seem stupid, but is the group or hospital offering the contract in an area where you want to live? rest assured, if there are no crna jobs exactly where you want to live, there are probably jobs within about a 30 minute drive of where you want to live.

    -what type of anesthesia does your prospective employer do? there are a number of different ways and places that anesthesia may be done. if peri-partum anesthesia is something you want to do, make sure that the place you are considering does anesthesia in labor and delivery. if you enjoy doing anesthesia for open heart surgery, make sure the group you work for does open heart anesthesia, and allows crna’s to do these anesthetics.

    many prosepctive crna’s do not find out what they really enjoy doing in anesthesia until they have the opportunity to try out different things in school. so, if you sign a contract prior to finishing school, you may find that you enjoy something totally different than what is done where you are going to work. for this reason, many student anesthetists avoid signing contracts until they have been exposed to a number of different environments.


    what are the employment prospects for crna’s?

    in a word, excellent. currently, there is a shortage of crna’s. this shortage is compounded by the fact that the average age of crna’s is rising. crna’s are retiring at a higher rate than the programs that produce crna’s can possibly produce graduates. so, there will be job openings for the foreseeable future, with good prospects for increasing salaries and benefits.

    if you are curious, go to the following site:

    you will be surprised at how many jobs there are, and this is only one site. there are a number of sites out there that help crna’s find employment.

    you can also go to a “headhunter” to find a job. these are people/companies whose sole purpose is to match people with needed skills to jobs that need to be filled. once accepted to a program, you will begin to receive numerous mailers from these companies. one warning: these companies make their money only when a crna is placed in a job. therefore, they will work hard to get you into a position. don’t be afraid to say no, and don’t be afraid to say you want to think about the decision before you sign. generally, these companies are pretty professional. but, remember, the job they have is to sell you on a location.


    where do crna’s work?

    the short answer to this question is that crna’s work in hospital operating rooms, labor and delivery wards, and anywhere there is a need for anesthesia services. in the more urban areas, crna’s generally work for the hospital or the anesthesia groups under the supervision of the anesthesiologist. in more rural areas, there may be no anesthesiologists. in these locations, you will often find an anesthesia group that is owned by crna’s. as a general rule, crna’s at these locations are more independent, and have less back-up available for assistance. new graduate crna’s are often more comfortable working in locations where there is more readily available assistance.

    there are also crna’s who work for travel agencies. these may look attractive at first, since these type positions generally pay considerably more than other positions. the thing is that these positions are straight pay. there are no benefits connected with most of these positions, and you are responsible for your own taxes.


    how many hours does a crna work on average?

    again, this varies with position and employer. in some places, crna’s are offered contracts that guarantee no more than 40 hours a week. some of these places will allow you to work overtime if you want it, but will not require it. in other locations, you may be expected, depending on your position in the call schedule, to stay until cases are finished for the day. in some of these locations, it is not uncommon for crna’s to work 50 to 70 hours a week. these are all avenues that must be carefully explored before you sign a contract.


    what does a crna do?

    crna’s do anesthesia of all types. in school, you will learn about general anesthesia, regional anesthesia, and spinal and epidural anesthesia. you will also spend time performing obstetric anesthesia. you will learn to manage the anesthetized patient with various co-morbid diseases. you will learn skills such as intubation, arterial line placement, central line and swan-ganz catheter placement, spinal anesthesia, and epidural catheter placement.

    in short, you will learn the science and art of anesthesia. what you do after school will depend on your preferences and what is expected of you by your employer.


    other sites for crna information:

    questions and answers: a career in nurse anesthesia

    american assoc. of nurse anesthetists: becoming a crna

    srna web --created for and by the srnas of southern illinois university edwardsville

    each of these sites will also provide links to other sites. there is a wealth of information about nurse anesthesia on the internet.

  • Jun 3 '10

    In our ED, it's not uncommon for us to see inmates from the local adult detention center. They are always accompanied by deputies, meaning they need a more private room because of the size of their entourage and propensity for associated drama-either the patients themselves being unruly, or the irresistible urge other patients or family members feel to become spectators to the patient's situation. So even with a potentially high-acuity patient, it's not uncommon for inmates to be placed on the fast track side of the ED where the rooms are private.

    One such patient came into one of my fast track rooms as the first patient of my shift, transported by county EMS. From the beginning, it became apparent that jail personnel suspected this patient of faking stroke symptoms to get out of jail. It wasn't overtly stated, of course, but the disbelief could be heard in the tones of voices. Because we'd recently had a patient with similar symptoms from the jail who was found to be ultimately faking symptoms for a little "vacation from incarceration," skepticism was running high.

    Such skepticism resulted in a five-hour difference between the time of the patient's onset of symptoms and complaint to jail personnel to the time the patient hit my ED bed. The paramedic who brought the patient in expressed skepticism as well, but there was something about this patient that kept my index of suspicion very high-I just had the feeling that the issue was genuine, and I took swift action in getting our physician into the room. After a rapid assessment (and noting that my patient was also very hypertensive), we had the patient over to the CT scanner and on the table within just minutes of arrival. There was just something in the way that my patient's left arm looked-not just flaccid, but with the hand almost contracted inward-that told me it was real. I'm glad I went with my instincts.

    As it turns out, my patient had untreated hypertension and had stopped taking a prescribed beta blocker a year previously, and now had an intracerebral hemorrhage. I administered meds to lower my patient's pressure a bit without dropping it too fast, while our team leader and secretary worked on the unique logistical challenge of flying a prisoner and a deputy with a sidearm by helicopter to a local Level 1 with neurosurgeons on staff.

    Then, for my patient, the last straw: the deputies refused to allow my patient to call or contact family so that they could be aware of what was transpiring. My patient wore a look of fear; whereas the deputies seemed to have no grasp of the severity of the situation and my patient's condition, my patient certainly did. After discussing this turn of events with my team leader, I went into my patient's room and got the phone number my patient wanted to call. With my patient's permission, I called my patient's elderly parents and apprised them of the situation.

    I understand that the deputies have rules about contact and allowing people to know when a prisoner is going to be in transit or out of incarceration; of course, this is a perfect time for friends and/or family to plan a jailbreak. However, I felt that, given my patient's situation, contacting my patient's family would help give my patient some peace of mind. And, as my patient noted (sense of humor perfectly intact), my patient's entire left side was useless, eliminating the chances that my patient would (or could!) run anywhere.

    As the helicopter crew packaged my patient, I told my patient that I'd contacted family, as requested. My patient thanked me tearfully, and told me that sometimes people need just one person like me to be on their side. While I'm sure the deputies were not happy with me (with good reason, certainly), I chose to act for what I perceived to be the best interests of my patient, who had already been treated poorly; I thought my patient deserved just one break that day.

    Ironically, my last patient of that same shift was a younger person who came in complaining of dizziness and hypertension. This patient had stopped taking beta blockers prescribed for known hypertension five days earlier. This patient told me the beta blocker made this patient feel funny, and that the patient's spouse "nags" the patient to take it. So I said, "Your spouse is right; let me tell you a little story," and I told this patient (without going into too much detail, of course) about my earlier bleed patient who had stopped taking a beta blocker, which just happened to be the same beta blocker prescribed for this patient. This patient was horrified, saying, "I need my left side!" I said, "You also need your right side, and your whole brain." This patient was so utterly flabbergasted, it was nearly comical-either this patient had never grasped what had been related by physicians about the potential dangers of untreated hypertension, or this patient had been in denial and wasn't open to the teaching at the time. The patient said, "Oh my God, I'll never not take my medicine again." When it came time for me to leave at the end of my shift, I went into the patient's room to tell the patient about the nurse who'd be taking over for me, and to wish this patient well. The patient told me that they'd always remember me, and that they would definitely be taking their blood pressure medication. And as many times as we've all heard patients lay claim to future compliance, saying, "Oh yes, I'll take my medicine from now on," I saw the look on this patient's face and believed it.

    In just one day in the ED, I felt as though I'd made a difference in the lives of two patients with very similar stories, and what could have been similar outcomes down the road. I think this was the first time I truly experienced the power of nursing. I work with so many nurses who are the type of nurse who is so memorable, that a person who is fortunate enough to be in their capable, caring hands will always remember them and what they did for them during what is sometimes the worst time of a patient's life. That is the kind of nurse I aspire to be, and in this moment, I became that nurse.

  • Jun 3 '10

    One of my very first patients off orientation as a new graduate nurse was named Ida (name changed for obvious privacy reasons). Ida was a morbidly obese lady in her early 70s. Ida came to us from an understaffed and unsafe local nursing home. She had type II diabetes and as a result had necrotic toes on her feet. Infections were common in her feet, and they tried relentlessly to treat in the nursing home. But one of the sad things about state run nursing homes are the not so good doctors that oversee too many patients. Her doctor put her on some pretty heavy duty antibiotics which ended up being toxic to her kidneys and landed her in Acute Renal Failure. On top of everything else, Ida was developing pneumonia from being bedridden for so long.

    I walk into Ida's room on the first day I was assigned to her and she just gave me a hollow look. I smiled, introduced myself, and informed her I would be taking care of her for the day.

    "Ida, I'd like to do a quick assessment on you to see how you're doing, is that alright?"

    "Okay," she answered me in a raspy voice. I would go through my assessment noting extreme edema, coarse breath sounds, and a fungal rash on her skin. I pull out her pharmacy of morning meds and go through each one with her, dropping them in the medicine cup one by one.

    "Alright Ida, can you take your morning meds for me?"


    "Why, not Ida?"

    "Not now, later. In a few minutes."

    A few minutes passes. "how about now Ida?"

    "Okay." I place the first pill in her applesauce and try to give it. "No, Please. Not now, later." It circulated like this all day. I never got one pill in her.

    Ida was not able to move on her own, therefore we needed to turn her every two hours. With Ida being a rather large lady, we needed three nurses to attempt to budge her. It was awful trying to move her and Ida wanted nothing of it. She would scream and yell every time we would touch her, "No, please. No, Please. NO, PLEASE! NOOOO, PLEEEEEAAAASE!" But we had no choice but to do this every two hours so she wouldn't develop painful bed sores. It was harder and harder to find other nurses every two hours to help me turn her. Nobody wanted to deal with her screaming, thrashing, and hitting if they didn't absolutely have to.

    Ida also kept spiking really high blood pressures one day I was caring for her with pressures in the 190s/110s. After receiving orders for IV anti-hypertensives, I had to check her BP every 15 minutes due to its potency. I came into put the cuff on her. "No, Please."

    "Ida, I need to keep track of you pressures so they don't fall dangerously low."

    "NO PLEASE. I'm done, no more. I don't like it. NO PLEASE!" I placed the cuff on her anyways. She screamed and shrieked when the cuff inflated. I held her hand and attempted to console her but she wanted nothing of it. She repeated this every 15 minutes when I needed to retake her pressures.

    On the third day I took care of her, she was beginning to get dirty and unhygienic. She refused her bath everyday from the CNA and did so that day as well. I told the CNA not to worry about her, and that I would get her cleaned up today. I filled up a pink tub with hot water and soap, place a couple of washcloths in the basin, and swung some towels over my shoulder to dry her off with.

    "No, NO BATH! I don't want it!"

    "Ida, I need to clean you up, you are getting sweaty, dirty, and uncomfortable and this will make you feel better. I promise this is for comfort, you will feel better."

    "No, no, please." But she said this with less force this time so I took my chance and got in there and stated cleaning. Once we got into it, she accepted it more and let me. She however still did scream when I had to lift her arms, get between her legs, or clean under her fat folds. I was trying to make conversation with her throughout the bath, but she wanted nothing of it and ignored all my friendly advances. Finally to break the awkward silence, I turned the TV in her room on. She immediately turned her attention to it realizing it was there for the first time.

    "Ida, do you want to want to watch this station?" She shook her head, so I changed stations until we got to an old game show. "How about this Ida?" She nodded her head. "You like game shows?" She nodded her head again. "Ida, what is your favorite game show?" I didn't expect her to answer.

    "Let's Make A Deal," she croaked. I was flabbergasted. After three days of yelling at me and ignoring me, she was connecting with me on a friendly human level. It was at that point I no longer viewed her as a combative difficult patient, I saw all the humanity and suffering within her. There was a real woman in there that had been broken by her terrible situation.

    Ida didn't communicate with me any further for the rest of my time with her. She didn't communicate with anyone. Doctors would come into her room and ask her questions and she would just ignore them, or lead them around in circles. The doctors would then look to me for answers, not that I had any. I knew Ida didn't want to live anymore; she didn't want any more treatment and tried to be my patient's advocate and communicate that to them.

    Ida never married, and only had one living niece. She came in and visited with her one day for a mere 15 minutes. She couldn't handle seeing her Aunt in such an awful situation. She stayed only long enough to give her blessing as her power of attorney for a DNR/DNI order.

    A few days later when I had a different patient assignment, I walked by her room and noticed that it was occupied by a different patient. I figured they discharged her back to her nursing home and didn't think anything else of it.

    The next day at during lunch time I was flipping through the local newspaper. I happened along the obituaries and noticed a familiar name. There was Ida, written that she died at the hospital two days prior. I was floored and couldn't believe that she passed a mere day after I cared for her. When talking to the charge nurse who knew of this, she informed me that Ida took one look at her nurse stated that she was done with everything turned her head to the other side of the pillow and died.

    I was sad, but knew that was what she wanted most. Sometimes patients die; actually they all do at one time or another. Ida was an important learning experience my first week off orientation and is just one of the many sad stories I've come across everyday during my short time so far in this profession. It has made me a stronger nurse and I will carry Ida's story with me always.

  • Jun 3 '10

    Choosing nursing as an undergraduate degree was largely to heed my father’s wisdom. It was later on that I learned the vocation nursing truly is. Nursing provided a knowledge that was rewarding and unmistakably focused on the individual’s needs at the bedside. Practicing nursing day in and day out made it practically challenging to see that there was a different world out there and that the focus can shift.

    Moving to America provided a rich ground to explore ways to be effective in more ways than one, without having to give up nursing altogether.

    I was ecstatic to learn that nurses in America, with the proper investment, can apply their skills and knowledge in a myriad of ways!

    It was then that the University of California San Francisco gave me the opportunity to be a part of their Master of Science in Nursing program, specializing in Clinical Research Management. It was a natural fit for my desired transition to become more involved on a larger scale in public health by way of clinical research, and specifically in drug safety and pharmacovigilance – collecting, reporting, reviewing, and aggregating safety data for products that will later on, if approved by regulatory authorities, be used by the public at large.

    After doing this for a number of years, I now have the desire to learn how to quantitatively make sense of the data and effectively communicate findings to the stakeholders including our patients, regulatory authorities, and scientific community.

    Enter: MPH with specialty in epidemiology...and I just might pursue this soon. I envision applying epidemiological methods to pharmacological issues I meet in clinical trials, e.g., pharmacovigilance, drug utilization, effectiveness comparisons, and adverse event monitoring.

    Collaborating with colleagues, this education will allow me to conduct benefit-risk assessments of a molecule or drug which will be important in building the product’s safety profile that clinicians will use in their practice and streamline or build appropriate risk management programs. I will be able to contribute to the design of studies estimating the probability of a product’s beneficial effects in special populations like the elderly or HIV patients; or conduct a Phase IV study to identify post-marketing issues that could not be evident while the product is being studied in a limited and strict protocol environment; or data mining a registry housing information on pregnant women who have been exposed to HIV – all, of course, under strict subject protection guidelines. This is application of nursing in a global setting.

    I imagine this and other opportunities to further one’s reach beyond bedside are not only available here in the land of opportunity, but elsewhere as well.

    I, however, feel that America, despite its imperfections, is indeed one that nurtures and values individuals as well as groups and societies to pursue and protect life, liberty, and happiness.

    Cheers to my colleagues worldwide who focus on individual care as well as to those making a difference in the global scene!

  • Mar 11 '10

    That is not correct. I am in New Mexico and I do not have any physician involvement as we have completely independent practice. I am in a practice that is NP owned. The formula I sent the BON is my formulary. I do not have a medical director.
    You are not required to have any physician supervision at all.