Sarah Matacale

Halloween can be a nightmare for kids with food-based allergies and the parents who have to monitor for them. This seemingly simple holiday is not as easy for some as a knock on the door and getting a treat; it can mean life-threatening anaphylaxis and a trip to the ER. I have been unlucky enough to be on both sides of Halloween hypervigilance. As a child, I was very allergic to chocolate and peanuts. I know...right??!!! Can there be worse on Halloween than the build-up and excitement of waiting to see what sweet treasure gets dropped in your treat bag only to unload the majority into "the parent's stash" later that night? I was stuck with candy apples, popcorn balls and some sweet tarts. No full sized Snickers or 2 pack Reese's peanut butter cups here! When all was said and done, I had a handful of candies and my parents' bucket overflowed. Fast-forward a few decades to our oldest son.....allergy laden from birth thanks to the wonders of genetics. He was allergy tested before he was 2 years old...as I prayed that the massive hive on his scratch test site was not a chicken nugget allergy (as that was all he lived on back then), we were somewhat surprised to hear "He is allergic to peanuts...here is a booklet with instructions and an EpiPen...." He had not even eaten peanuts at that point in his life, so we really did not know what his reaction would be. He is our firstborn, and very type A, so he grew to be very aware of what his food was cooked in, manufactured in a factory with, or possibly containing. Even with the best efforts, he has had a few exposures. Each exposure has brought much worse symptoms than the last. Halloween is now his watchful holiday; I was lucky enough to outgrow my food allergy and the "parent stash" has come full circle for me...Snickers and Reese's for me and my hubby and sweet tarts and Epipen on hand for my son!! As I was writing this article, I reached out to Dr. Purvi Parikh, MD. She is an adult and pediatric allergist and immunologist with The Allergy & Asthma Network. Many children are diagnosed after they have been exposed and have a reaction to a known or unknown substance and receive further testing. Testing is routinely done by an allergist/ immunologist in the office by either scratch test or blood draw and serum markers. A diagnosed food allergy can obviously benefit the health and welfare of your child, however, even with known allergy, the presentation may worsen or change with repeat exposure. Parents, caregivers should be aware of risks and signs and symptoms of food allergies even if the child is not known to have an allergy at present. One risk factor for developing a food allergy is, "having just one parent with any allergies. This can increase risk in a child by 50 percent", according to Dr. Parikh. Some of the biggest food allergy culprits in Halloween candy are milk, eggs, wheat, tree nuts, peanuts and soy. The most common allergic responses noted by Dr. Parikh are, "Rash or swelling which is isolated or can be accompanied by trouble breathing, vomiting, diarrhea, stomach cramps or loss of consciousness. Anything more than a rash can be a sign of a dangerous allergic reaction called anaphylaxis." Dr. Parikh encourages, " all parents: allergies can be life-threatening, please take them seriously even if your own child does not have them, their friends may. If your child or another appears to be suffering from any of the above symptoms, Dr. Parikh recommends, "using an epinephrine autoinjector if your child has one and seek medical attention to be a sure reaction not progressing. If you do not have one seek medical attention so that you can be treated asap in case the reaction is progressing." Keep in mind while trick-or- treating or during holiday parties that "the only food or candy you have control over is what you prepare yourself. The safest thing for food allergic kids is to not eat the candy they obtain. They can still participate and dress up but don't eat it. Parents - have safe candy or toys for your food allergic child as a substitute. Educate kids who have food allergies to not consume food given to them by outsiders." Also keep in mind, "often even candy that may seem safe could be packaged in an area near allergens and cross-contamination can occur". With a few modifications, your child with a food allergy can still have as much fun as all other children. Being alert and aware of potential hazards and having safety precautions and techniques on hand, can be life-saving for a known or even unknown allergy exposure. Talk to your child, your children's teachers and friend's parents regarding your child's restrictions. Remind them all of how serious food allergies can be, and when possible find alternatives to known allergy foods. Some safe options and revisions can make Halloween a fun and Emergency free holiday!! And parents...keep the "parent-of-an-allergic-kid" yummy stash out of reach or hidden from your kids to avoid any temptations, while you make sure not to waste their hard-earned procurements...wink, wink! Dr. Purvi Parikh is an adult and pediatric allergist and immunologist with The Allergy & Asthma Network She completed her fellowship training in allergy and immunology at Albert Einstein College of Medicine's Montefiore medical center. Prior to that, she completed her residency at The Cleveland Clinic Foundation in Cleveland, OH and she is board certified by the American Board of Internal Medicine as well as the American Board of Allergy and Immunology. She completed her B.A. in political science at Emory University and received her M.D. from St. George's University.

For many of us who know of Kati Kleber, it's as a nurse on a cardiac med-surg step-down unit, the author of several books including Becoming Nursey, or as a speaker, blogger and podcaster specializing in educating and supporting brand new nurses. As if this is not enough, there is way more to learn about this super nurse that fuels and strengthens her passion within the profession of nursing. Born and raised in Illinois, Kati declares herself "a midwestern girl at heart". Kati started her nursing journey after graduating from Parkland College in 2007 with an Associates Degree in Applied Science. (She also played basketball while studying nursing at Parkland). By 2010, she obtained her Bachelors of Science in Nursing at Iowa Wesleyan University. For the next 2 years, Kati worked as a nurse on a Cardiovascular med-surg unit in Champaign, Illinois. 2012 was the year that took her out of the Midwest, planting Kati in Charlotte, North Carolina working as a nurse on a Neurocritical Care Unit. Within a few months, the world would become familiar with Kati Kleber RN! This article is featured in the Fall 2018 issue of our allnurses Magazine... Download allnurses Magazine Kati had always enjoyed writing but had no outlet until 2013 when she figured out how to blog on Tumblr and Twitter under the anonymous nurse persona named Nurse Eye Roll. Her passion was supporting and educating new nurses. As her social following began to grow through the blog, one of Kati's friend recommended that she create her own website and begin maintaining social platforms to support it.....NurseEyeRoll.com was formed! Kati remained anonymous through her Nurse Eye Roll persona, adding humor to everyday experiences in bedside nursing. She began writing short but funny posts on time management, delegation and prioritizing. She gained even more popularity. Kati found that she was receiving many of the same questions from supporters and was spending countless hours tending to the blog and followers while still working a full-time job in a busy neurocritical care unit. While searching for a way to be compensated for her work and hours blogging and also a way to provide answers and guidance to new nurses, Kati's friend suggested she write a book. She did just that. In 2014, Kati wrote Becoming Nursey. The biggest struggle at that time was her decision to become public with her real self, no more anonymity. She was encouraged by many trusted friends and colleagues to take credit for her work and revisit all of her prior writings to be sure no violations both personally and professionally had occurred. In November 2014 Becoming Nursey was published and Kati Kleber was no longer hidden from the world. Since its release, it has sold over 20 thousand copies, has been re-published by the American Nurses Association (ANA), and is used by nursing schools and residency programs all over the country. When collaborating with the ANA, Kati made some changes to the first edition and added the title Becoming Nursey, Anatomy of a Super Nurse. Amazon's book description states: "Armed with tons of information- and lots of laughs-anatomy of a Super Nurse shines light onto the dark spots in a nurse's first year, equipping you with everything you need to become a successful bedside nurse". As the book started to generate income, the blog started to gain sponsors, and Kati was asked to do some public speaking. She started to hear from healthcare professionals, potential sponsors and collaborators that they were having a bit of difficulty with the Nurse Eye Roll name. They understood the humor in it, but found it a bit hard to market, and possibly offensive to some. So after much soul-searching, Kati found herself at another crossroads....an opportunity to reinvent herself so-to-speak. If her passion for supporting and educating new nurses was going to be her focus, Kati felt that Nurse Eye Roll may not be the best way to obtain that goal. The name did not convey what she desired most and it began to require explanation...not what Kati wanted to be her focus. During this time of change in 2015, Kati was awarded Nurse of the Year by the Charlotte Business Journal and received the Great 100 Nurses of North Carolina Award and was a guest on the Dr. Oz show! Looking back, this is the time that Kati really feels was a turning point in her career. Kati spent much time in 2015 and money rebranding her entire platform to FreshRN. This allowed her to focus her strategy, which she is so glad she did. Freshrn.com currently contains a blog and podcasts hosting a wide variety of topics for new and experienced nurses alike. It provides both practical information and encouragement for those beginning their bedside nursing career. The website also offers courses designed to educate and provide CE hours. Lastly, there are links to books that can offer more to beginning nurses, those new to the healthcare system, mentoring and precepting, as well as blogging advice. The past two years have been a whirlwind of writing, blogging, public speaking and family growing! Katie and her husband welcomed their first child in 2016 and in December of this year are adding baby#2. Kati has partnered with the American Nurses Association again, publishing two more books. What's Next is written for the nurse who is no longer new, but is not the most experienced nurse on the unit. A nurse in this stage is starting to be asked to mentor and precept as well as take the charge nurse role. This book is designed for this time in a nurses career when the role starts to change and options open up for advanced practice and education. What's Next addresses these and other topics. Admit One was written for patients or those entering the healthcare field and want to learn more about the flow and culture of the hospital. " I go into things like a nurse vs. nurse manager vs. CNA vs. NP vs. physician, the difference between consulting and attending physicians, what to expect from different levels of care, code status and more". Her next book focuses on another area close to her heart. Having found her voice in blogging, Kati encourages nurses to blog as well. "I encourage nurses who have a specific passion to dive deep into that and think about how they can innovatively serve that niche." She motivates fellow nurses to be smart and productive with blogging. "We all see and hear enough complaining, and while writing may be a therapeutic way to deal with some of the challenging aspects of our field, publically publishing a blog simply to complain isn't going to go far." With this in mind, Kati and her friend Brittany Wilson BSN, RN independently published The Nurses Guide to Blogging which has been a huge success. "It lays out how to build a platform on a blog and a community around it". These days, Kati is very focused on completing her Master Degree in Nursing Education. She and her family moved back to the Midwest in 2017 and she states she is very happy to be back to her roots in Illinois. She is still working PRN at the bedside in a cardiac med-surg/step-down unit. Kati feels it is important to keep her foot in the door of practice. "It is really hard to write about/ for an audience when you are physically removed from it. I find a lot of value in providing direct patient care". She works 12 hours a week at the bedside and spends the rest of her week working on her Master's practicum in hopes to complete it before baby #2 arrives. She has also recently released an online crash course for new nurses in neurosciences and is soon to release a cardiac course as well (available at freshrn.com/courses). Kati is very present in the challenges of balancing her time with grad school, clinical roles, social media, and family. Speaking to these challenges, Kati says the key is "proactive communication with my husband (with whom she just celebrated 8 years of marriage with) and family. Intentionally disconnecting from the business/ platform and not being constantly accessible is a really important boundary to have and maintain. I also try to be keenly aware of balancing what I personally enjoy and what brings me joy and not stress/ anxiety, what challenges me, and what brings in income. She enjoys free time (watching Harry Potter, the Simpsons and The Office) and spending time with her family and two adopted dogs (coincidentally named Mac and Tosh...not adopted at the same time or named together..) The field of nursing has been blessed that Kati Kleber found her public and professional voice years ago. She has continued to offer much to both new nurses and seasoned as well. Her career and path thus far speaks volumes to finding your passion and running with it... the number of nurses and patients/ families, and healthcare workers affected by Kati's passion in insurmountable! The power of one voice........

I am a nurse...married to a Doctor. That notion seems to spark a lot of interesting conversation and questions in the non-medical public. The title of this article being one of them. "Oh wow....is it just like you see on Grey's Anatomy?" My husband and I usually look at each other, wink and giggle because at first it kinda was. I mean when you are in your twenties and dating someone new, no matter the profession, isn't it all kind of sexy and flirty? Fifteen years, both of us now working primarily from home, three kids and two dogs later, our life is more like Jurassic Park. Some kind of "crisis" coming at you every few seconds, severely outnumbered, fatigued, and in pure survival mode. (Teehee, reminds me of my CCU days). Anyway, there is no one I would rather be on this wild ride with, so I will share our story...the good, the bad, and the ugly of this Doctor-Nurse love story. To start with, we did not meet at the hospital. That's usually the first question. We actually met at a bar. A dive bar for that matter. As it turns out neither of us was planning on being there that night. He had just come off a bazillion hour internal medicine residency shift (this was back when there was no cap on number of hours residents would work) and I was out to decompress with my best Critical Care nurse friends. My husband approached me first, but I had a general rule against dating someone I met in a bar, so I flirted along a bit without intention of seeing him again. He asked for my phone number and I said no. I don't give my number to guys in a bar either. I will say I was intrigued by him that night. My husband is very funny, and smart and quite handsome, but I went on my way that night with friends I came with, lots of laughs, the smell of smoke and bad beer on me. ( I hate beer, but somehow every night in a bar when you are in your twenties has you leaving with beer spilled on you...blechh). A week or so later, I was getting ready for resident/fellow rounds on my CCU patients, and in walks my now husband...scrubs and all. He had worked all night and was reporting on his new admits. Say what???? He was going to be working in my unit for the next month! Surprise to me, but he knew I worked there was tickled with the potential. I was actually scheduled for a lot of overtime on nights that month, setting us up for the "Grey's Anatomy" questions for years to come. We started to talk a lot. Got to know each other over our sick as snot patients who circled the drain every few hours requiring both of our full attention and time. So, was it sexy? Yes it was....I mean who doesn't like seeing their guy in scrubs, a little 5 o'clock shadow from working the last 36 hours, engulfed in what he does best, focused, in control of the situation, and rocking his biceps while putting in a central line! Whew! I am not sure that I had much sexy going on at 3am in my scrubs and crazy socks, tending to our crisis at hand, but my husband tells it different and that's what matters, right?! We had tons of fun learning and working together. He would bring me a cup of coffee every morning, we would try to have lunch or dinner together, we stayed up way too late at a diner talking and learning about each other on our "off shifts". There were no negatives during that time to our nurse-doctor duo. We were in a bubble so-to-speak with working and dating in a teaching hospital. Fast forward a bit...we fell in love, got married and moved to a small town with a tiny small town hospital where we both took jobs. My husband was a hospitalist and I was an ICU nurse. The "nurse married to a Doctor thing" became a thing. I was surprised. No real negatives came his way, but I on the other hand was in a whole new world with new battles. The first thing I realized, was a bizarre sense that I married up (in the medical team world). I was treated different by my fellow staff members. They were afraid of talking or venting about their "doctor frustration" as I will call it. They were very guarded in taking me in, unsure of my allegiances. This was so weird to me. I was, am, and always will be a nurse. My job is to care for my patients and their families. I work as part of a care team. We are all supposed to be part of the same team and there should not be a nurse versus doctor dynamic. Then came the belief that if my colleagues could not get the orders they were looking for that I could call my husband and influence him to speak to his partners to get the orders. Uh...no. I am not a liason. I was asked to call to get patient's moved out or into the unit, medication changes, lab orders etc. In the small town we lived in, my husband and I would socialize with other doctors and administrators and their wives/ husbands. Now I was really "in" with the physicians and admin. The nurses looked for gossip on the doc's we worked with. What does his wife look like? Is she more relaxed outside of the hospital? Does he drink? The list goes on. I have always been relaxed around people, no matter their job title. I don't see myself as less than, or anyone as greater than me. We each have unique jobs and educations. I do mine, my husband does his. Sometimes the two intertwine but it's always professional. I don't pull any strings or ask for favors, and neither does he. As he started climbing the career ladder, I would overhear other staff members complaining about him or his team. Man was/is that hard. I really felt stuck in between two worlds. I want to say that the benefit I have found in marrying a doctor is that I am always learning. When I too would question why my doc wouldn't give the OK for morphine for my patient, I can ask why without seeming to be challenging a judgement call. I can find the medical reason why it would not be beneficial. I did not go to medical school or study in depth pharmacology. I went to nursing school and I rock at advocating and caring for my patients. When I ask why, I can then explain to my patients and families better. More information can be soothing. In my current job, I can ask my husband again for his knowledge and expertise before I approach another physician with a query. (I now work in Clinical Documentation). I do all my own work and always have, but sometimes an inhouse "medical Google" comes in handy. As he and I have changed jobs and areas of work, we have encountered new challenges. Mostly the challenges are mine. When asked to join committees, or climb the career ladder at a hospital where my husband is well established and well respected, I find myself asking, did I get this role because of me or my last name? I am smart, focused, and opinionated (sometimes good, sometimes bad- it's a "born-in-Jersey-thing"). I have to strive each day to prove that I am not riding on my husband's white coat tails. It is emotionally tough when in a group of colleagues where I am treated as an outsider. I am "one of them" not just a nurse. We've come a long way since our "Grey's Anatomy" years. These days, we wake up way before our kids to start our work day, as we both work from home. We juggle work and kids in school with tons of activities. We rock paper scissors on who takes the dogs out, who scoops the cat's poop, and who makes dinner that night. Our sexy, is now a comfortable pair of yoga pants for me and gym shorts for him work attire, with medical questions and "can you read this before I send it?" being yelled across our country farmhouse with a big echo and lousy internet. We attend conferences and meetings together but sit with our colleagues and as always we strive to maintain professionalism. I will say that what has not changed over the years, is that he still brings me a cup of coffee every morning, and that he is just a sexy as ever doing what he does best. I do love our life, that just so happens to be a doctor-nurse love story!

This article is featured in the July 2018 edition of our allnurses Magazine... Download allnurses Magazine School nurses have always been one of the most diverse and unique subspecialties in nursing throughout the decades. While the specific job responsibilities and pay may have changed some, the mission and purpose of the job remain constant. The National Association of School Nurses defines school nursing as " a specialized practice of nursing, that protects and promotes student health, facilitates optimal development, and advances the academic success" of its population. First and foremost I want to stress the many areas in which school nurses serve the community, the vital roles they play with our youth today, and the challenges that come with those roles. As we dive into the 2018 allnurses.com salary survey results we can see trends in the field of school nursing such as salary comparisons, full or part-time hours, years of experience etc. Are school nurses compensated for their responsibilities appropriately? I will let you decide. Let me start by saying that I am not a school nurse. I am a nurse that has worn many hats in my 20+ year career, but school nursing is not one of them. I will say, however, that I have ALWAYS wanted to be a school nurse. As a child, they were the nurses that I had the most exposure to on a daily basis. They seemed to always play a huge role in the school's day-to-day function. I was awed by what school nurses knew, the fact that they teach AND practice medicine to hundreds of students, staff, and visitors. They were so organized, knew who to call and when and what was a true emergency. At the end of the day, they knew that sometimes we just needed a hug, a listening ear, and some TLC. I decided to be a nurse because of my school nurses. After nursing school, it was apparent that I needed to get experience before applying to work as a school nurse. So I did. When the "right time" in my career came to jump in, I realized that school nurses love what they do! They don't leave their jobs until they retire and I can't say I blame them. So my career and calling as a nurse went in different directions. Then, my admiration for school nurses was taken to a new level when I became a mother to three little hooligans, who, despite my best efforts grew up and started school. I was about as much of a wreck as any other mom on our first child's first day of school. He is still to this day, at 12 years old, our clumsiest child, peanut allergy laden, and asthmatic. This added to my anxiety by sending him to school, epipen and all. No joke, on the FIRST day of school, I got a call from his teacher to tell me that my son had walked into a wall and had a large goose egg on his head. I was then asked by the teacher what did I want her to do with him. What? I said...well, if you think he needs attention, send him to the school nurse. That's when I found out that, in our school district, a school nurse visits each school only one day a week and serves up to 4 or 5 schools! During that day, the nurse's job consists of managing paperwork and teaching teachers how to give kids their medicine's, perform CPR, manage seizures, anaphylaxis etc., until emergency personnel arrives. SAY WHAT??!! Since that day, I have become a school nurse advocate extraordinaire. I believe in my heart of hearts that school nurses serve as one of the most important members of our community. Their job is so broad, ever-changing, and wide-reaching, that it cannot be compared fairly to any other in the field of nursing. They work as health educators and medical and mental healthcare professionals. One would think that school nurses would be one of the most valued members of a school system and the community as a whole, which would then lead to appropriate compensation, respect, and funding. Boy, was I wrong..... I was shocked with several statistics that I discovered in writing this article, but this is one of the most profound to me. According to the Centers for Disease Control 2017, 18% of schools have NO school nurse at all or serve in a part-time capacity, and over 55% of schools have nurses responsible for 2 or more schools at a time! As parents, we send our kids to school entrusting that they will be in a safe, cared for environment. If, in the worst case scenario, they need medical attention for a chronic illness or an emergency such as injury or life-threatening condition that the school would be staffed to handle the situation. Obviously, this is not true for many of us. How are teachers and school administrators expected to care for these needs? Teachers are educated in teaching. Administrators are educated in administration and education. Nurses are educated in healthcare, health education, and medicine. Simply put, teachers and administrators are not nurses and should not be responsible or accountable for that role. According to the U.S Health Resources and Services Administration (2016), over 20% of students that are enrolled in school, enter with a chronic health condition. Such chronic diseases as diabetes (with complicated glucose management systems), seizures, asthma, and of course allergies, (the dreaded food allergies included) are just a few examples off hand. School nurses are able to trend patterns seen with these conditions and can play a major role in student's disease management through collaboration with pediatricians, specialists, parents, pharmacies, and community health staff. They can safely administer prescribed medication and assess and intervene if necessary. When/ if an emergency arises, they can communicate effectively with other medical personnel and start care immediately which can be crucial in many situations. Let's talk about mental health in children. Many mental health disorders are not "officially" diagnosed until children are school-aged or older based on patterns in behavior, grades, and social situational responses. Collaboration with teachers, school nurses, pediatricians and mental professionals is pivotal in providing quality outcomes for these kids. School nurses participate, initiate and intervene in the treatment and management of ADD, depression, bullying, suicidal behaviors and autism, just to name a few, common mental health issues seen in schools today. Roughly â…“ of visits to the school nurses are mental health related. School nurses get to know the children and family situations they serve. From a community health perspective, think of the impact they have on children who may be abused, neglected, malnourished or lack adequate healthcare. Early intervention can prevent further mental health crisis down the road. Nurses are trained in the management of factors that come with mainstreaming children with mental health disorders. This is one area of education that is ever changing and can be very challenging for teachers and staff. Education is a key job responsibility for school nurses. They educate staff regarding health care issues of students and other staff. They participate in producing policies and procedures for environmental safety emergencies both outside and inside the school building. They educate students about maintaining their own health and wellness, diseases, social pressures, mental health, and community health concerns. They educate parents and caregivers on issues affecting their children such as diseases, immunizations, and concerns noted by school staff. This of course, is just a broad overview of some of the vital roles school nurses play in schools and the community at large. With the amount of responsibility placed on these nurses and the number of "patients" they serve each day, lets venture into some of the statistics from 2018 allnurses.com survey such as salary versus hourly pay rates per state/ regions, number of years as a nurse and years of experience in current job title (school nursing). OK...shocking statistic #2 for me....according to results from the 2018 allnurses Salary Survey, the average pay for a full-time school nurse is only $37,164 for hourly employees and $51,043 for salaried employees. The hourly pay per year feels very low to me given the responsibilities of a school nurse at large. Keep in mind with the next set of values, that for some states only a handful (sometimes only 1), school nurse answered the survey representing their respective state. Some of the highest paid school nurses reside in the states along the west coast and northeast coast. For example, New Jersey hourly paid school nurses make an average salary of $50K per year and salaried nurses make an annual salary of $67K per year. The Texas nurses that responded to the survey were all annual salary based and average $50K per year. This is a sharp comparison to Montana (who only had 1 nurse take the salary survey) making $20K as an annual hourly salary and Georgia with a few more responders making an average hourly salary of $25K per year and an annual salary of $15K per year! This made my brain spin and my stomach upset! I began to think about how much experience school nurses have and whether this plays into the average pay rates. As I suspected most of the respondents have 5 to 35+ years of career-long nursing experience. As far as the number of years in their current job, those numbers were pretty evenly spread over the span of less than one year to more than 10 years. I wonder whether this number spoke more to years as a career school nurse or years in their present job as a school nurse. Of the school nurses that responded, 99% were women. I further polled the allnurses' school nurses and asked about whether they work year-round or have the summers off. The majority of school nurses do keep their summers off to vacation or spend time with families etc. Some work part-time at their schools and other work in the hospital or as camp nurses during the summer. In wrapping this up, I have come full circle to where I began with how much I love school nurses. I admire them now more than ever, knowing how much they balance and the grand scope of their practice. I am grateful beyond words for the people who watch over our children as though they are their own. Those who put bandages on our children's wounds both internal and external. Those who watch, listen and truly hear our children and their needs. Those who advocate for our kids individually, school-wide, statewide, and nationally. School nurses are vital to our children and the community's health and welfare. So do we compensate them fairly based on those roles and responsibilities? For those states and counties where schools either don't have nurses or have them part-time or less, we need to look for creative ways to fund full-time nurses in our schools. We need to advocate and speak up for our children. As our nation's healthcare needs evolve and change over time, we have a responsibility to provide a voice for those without one......just as school nurses have done for our children for decades! As a side note, there are so many more aspects to the discussion of school nursing as a career in terms of roles, challenges, more pertain thought-provoking questions regarding the number of hours worked per day, degrees most commonly held, whether CNAs or LPNs can fill some of the gaps, continuing education requirements etc. Please add more to the conversation! by Sarah Matacale RN, BSN, CCS

To all of us health professionals (professionals being the key word here), this one will leave you speechless. I am sure by now many of you have seen the viral YouTube video of an Atlanta dermatologist dancing and twerking with her staff over an unconscious and exposed patient. In the video Dr. Windell Davis-Boutte and her staff lip sync and dance pointing to the patient's exposed buttocks to a song about "big bottoms". During another video....yes I said another, as there are over 20 videos posted on her YouTube practice page, she cuts into the patients' flesh on cue to the song lyrics about cutting. She posts these as "marketing videos" for her Atlanta area practice. Dr. Boutte is board certified in dermatology but also performs plastic surgery and general surgery neither of which she is board certified in. Her practice web page boasts rave reviews from hundreds of her patients over her 22 years in practice. The web page states that she specializes in Brazilian Butt Lifts and Smart Liposuction. Her surgeries are performed at an outpatient "full-service medical spa and cosmetic surgery center" that is not licensed or accredited. If you type Dr. Windell Boutte's name into the Google tab you will come up with a plethora of hits from her videos to the growing number of malpractice lawsuits cited against her for a variety of reasons. She has settled at least 5 malpractice lawsuits and has 4 more pending. At Dr. Boutte's surgery center, no general anesthesia is used. One of the settlements is with a patient, who was a nurse, that now suffers permanent brain damage and requires round the clock care. This patient arrested on the surgical table after 8 hours of surgery under a cocktail of sedative medications including Propofol. Within the lawsuits, she is cited for not following "board guidelines for office-based surgeries that define you to report any incident that leads to a patient's death or to a hospital". So where do we even begin to have a conversation about this? One of my questions would be how do 20 plus of these videos exist and who are the patients? Do the patients have knowledge or give consent to being on camera and presented to the world as the subject of Dr. Boutte's "marketing"? If patients have not consented, then how has she been able to continue not only making these videos but practicing medicine as well? Should patients in the videos be made aware that they unknowingly were filmed and that the videos were used as a marketing tactic? The HIPAA rights clearly were violated unless the patient waived these rights. Would you want to know if it were you? My next question is who are the staff that are participating in this behavior? Have none of the staff members found this unethical or just plain wrong? Has no one spoken up on the patient's behalf? Should they be subjected to punishment as well? Are there no other physicians that practice in the same group that are aware of these videos or malpractice lawsuits and voice objection? Should they turn her into to governing bodies? How did we get here? A few months ago the "funky flu" video filmed by a nurse in Florida went viral. In it, the emergency room nurse gave several informational facts and instructions on how to keep the flu at bay. The nurse was turned in to the board of nursing and was under a great deal of scrutiny over her "sarcastic tone". Somehow, these videos from Dr. Boutte have taken a while to reach the public's "spotlight". Why is that I wonder? My next thought is that surgeons frequently use music as a background distraction during surgery. Each surgeon has his/ her own preference of music style. At what point does the line get crossed when you trust your physician and team to care for you at your most vulnerable moments? How much "goofing and fun" is acceptable when you are the professionals? I would love to hear your opinions and thoughts on this matter and the issues surrounding it. Does anyone have any similar experiences? What repercussions should Dr. Boutte face if any?

Add additional comments or areas that apply. I would also like to know of any other work you do during the summer

School nurses....do you work through the summer? Is it mandatory? If so how many hours per week? I am writing an article including the results of this poll in the next issue of allnurses magazine.

A "safe house" for drug users to use drugs with clean equipment and trained professional supervision using public funding.....what the what????!!! Am I reading this correctly? This instantly stirred up strong feelings and opinions for this nurse, mom and taxpayer. While this concept was news to me, "safe injection houses", which are currently illegal in the United States, have secretly been in existence in the US for at least 3 years. The idea is to provide drug users with clean needles and equipment as well as medical supervision by professionals in the event of overdose. The staff on hand is also available to guide, educated and provide services to willing participants who wish to get clean. Injection sites are legal in countries such as Australia, Canada, Denmark, France, Germany, Luxembourg, the Netherlands, Norway, Spain and Switzerland. This is different than the clean needle exchange programs that at one time were also illegal in the US and now are legal in 33 states. I read an article in the New York Post about two researchers who secretly evaluated a "safe injection house" in the United States. This sparked my interest to research more on the subject so that I could form a more educated opinion on the matter. According to a New York Post article, two researchers have been evaluating a "safe injection house" for over two years and recently published their report online in the American Journal of Preventive Medicine. "As a condition of their research, they didn't disclose the location of the facility - which is unsanctioned and potentially illegal - or the social service agency running it", reports The New York Post. According to the researchers, the underground space consists of two rooms. One "injection room" with stainless steel clean stations with stools and mirrors. Drugs such as heroin, cocaine, methamphetamines, and pain pills are allowed to be used there, however smoking is not. The second room is where participants go afterward to be monitored by trained "non-medically licensed" staff. Not much information was provided through the research. It is presented that over 100 participants utilized the "safe injection house" more than 2,500 times. They released that only 2 overdoses were reported and one death at the site itself, but little to no additional information on population, cost service etc due to the secrecy of the program. Such sites have been backed by lawmakers in New York and California, along with officials in cities like Seattle, San Francisco, Boston, and Ithaca, New York in an effort to combat overdose rates as well as drug use related transmission of Hepatitis C and HIV. This report may help support lawmakers in their efforts to pass laws allowing "safe injections" to exist in the US. As one would expect, there are many opponents to "safe injection sites", for a number of reasons. According to the New York Post article: "critics have argued these places may undermine prevention and treatment, and seem to fly in the face of laws aimed at stopping use of deadly illicit drugs." As nurses we have a duty to do no harm. If we know that these drugs are so harmful that they cause death, have long term side effects and addiction, how would we stand a collective group on this subject? It is an interesting topic that I am sure we will hear more about in the coming years. The initial response from those I talked to casually about this subject was that this is the worst idea anyone has ever come up with and how on earth did we get here as a society? After much discussion some interesting questions regarding this and other similar topics arose creating some "grey areas" in the thoughts. In researching this, I think I am left with more questions than I answered for myself. I would love to hear what you all think. Do such places encourage drug use though ease of access and legal use? Would new users take advantage of "safe injection sites" to try new drugs? Who pays for these places? Does the cost of running them outweigh what is spent yearly in Emergency Room visits and hospitalizations for overdose or addiction treatments? What kind of regulations and research are needed to determine the societal worth of such places? What do you think? Report reveals 'safe house' where heroin users shoot up under supervision | New York Post

Let me start by saying that I am a Nurse and my husband is a Physician and neither one of us go anywhere near Pediatric patients in our professions. We don't even pretend to know what's up with that portion of the medical world's population. Since the time the kids were born, we have never diagnosed them for 2 reasons...#1 kids are not little adults....#2 they are our kids. Both of these reasons, we feel make us a bit skewed on what is an actual issue and what is a minor "normal kid thing". However, that being said, a mama does have her intuition and when you have medical knowledge and genuine understanding of the "worse-case scenario", you can be in for quite the emotional ride, when one of your children gets sick.....very sick. This fall our oldest son (11 years old), who is a serious asthmatic, got an upper respiratory virus. High fever (104 F) for almost a week, cough, wheeze, the works. After 2 weeks and a few rounds of steroids and antibiotics for secondary infections, he was on the mend and back to school. Ahhh, peaceful house again....not so fast....remember we have 3 kids! Our youngest son and I start about the same day with same symptoms. I truly felt awful and my baby boy (7 years old) was pitiful. Same story. High fever, cough, but as I got better, he got worse. He developed pneumonia. So for him, 2 rounds of tushie shots, oral antibiotics, pushing fluids and steroids successfully kept him out of the hospital. So no surprise when my sweet girl (age 9y) most stoic, toughest of the bunch, "best sick child" started down the same path. I say to this day that God was really watching over us for a number of reasons as you will read, but for now you should know that my husband (the WORST sick person in the house) never got sick AND I never had 2 sick kids at the same time. Our daughter is a beautiful strawberry-blonde with green eyes and freckles...tons of them. Her smile and giggles make everyone smile. She is tough though...afterall she is her mother's daughter! She never complains when she is sick, takes shots like a champ and even makes it to the toilet when she needs to throw up! Huge, I know! Anyway, she followed the same course as her younger brother and developed what was a clear bacterial pneumonia on chest x-ray. She too got 2 rounds of tushie shots and oral antibiotics since one would think we were dealing with the same bug as everyone else had. She started to get a bit better by Friday of the first week. Started to eat a bit and drank well. Less cough and no fever after 5 days of 104 F. That night she told me her upper lip felt funny inside. It was at bedtime when she mentioned it, and I briefly looked and felt comfortable putting her to sleep with the thought that she probably had a cold sore after having had such a high fever for several days. By then next morning, she woke me with a very swollen upper lip. I could clearly see the skin sloughing and blisters by then. I brought her straight into the peds office where we did some blood work for some more common causes, but nothing stood out. Both the Pediatrician and I feared Stevens- Johnson Syndrome (though just in one area of her mouth) or Kawasaki disease (though she is a bit old). She felt well and had no fever, so we decided to take her home and "watch her closely"....since we are medical people, everyone was fine with that. I was told that any sign of change for the worse, and I was to just go ahead and take her to our large trauma/ teaching hospital 45 mins away (since the local hospital would not handle this...whatever THIS was.. there). Oh, so I forgot to mention that my cub scout leader husband had our two boys on a campout that weekend, which I thought was for the best so that our daughter could rest. So we were back and forth by phone with all of our worries, but I convinced him that I had it under control. I am a CCU/ ICU trained nurse with burn unit experience ( sister unit to the CCU in the major university hospital that I worked in for years). Fast forward a few hours, and my sweet girl started to look pitiful. She got real weak, 104 fever came back, her mouth started to blister more around her lips and she was actually asking for me to take her to the hospital to feel better. So I did just that. My husband hung with the boys until we had some kind of diagnosis or plan and Mommy and daughter spent some quality time in the ER. We were rushed through pretty quickly as you could actually watch the blisters form and pop and begin to slough off on her lips and gums. It was moving quickly. We were staying in the hospital...still no solid differential. Among the list was Kawasaki, Stevens-Johnson and, less likely, hand- foot-mouth. (My daughter was particularly offended that anyone would even suggest that she puts her feet in her mouth!). So we get admitted by "Red" , as we affectionately called him, senior resident on-call for the night. He had red hair and freckles and our girl adored him. While she was getting admitted, I had a medical friend send me a message that encouraged me to look into this "rare" diagnosis that her cousins, nephew twice removed etc etc etc had been diagnosed with a few years ago. His symptoms sounded similar to our daughters she said. To this point, I had avoided looking anything up. I did not want to know anything that may worry me unnecessarily. I did not want to be "that-nurse-who-is-married-to-a-doctor-kinda-mom". I did look it up.....and ya know what? It did sound just like her symptoms and time course; so I turned into "that-mom". I marched right out to find Red. He was on rounds, which I interrupted, holding up my phone with my google search (I know, not even a genuine medical search) and I asked him nicely if he could look into this diagnosis. He kindly gave me a face and said..."you do know that that is just walking pneumonia, right?" I said, of course I do, but its the rest of it that I want him to look at. I admitted that it sounded out there and far fetched and did not mean to take over, but that I would really appreciate if he could look into it. He reluctantly agreed and I found out the next morning that he did. On the second morning of our hospital stay, we met Dr. Dazzle as we dubbed the pediatric infectious disease doctor. My daughter thought that was what his white coat said, but it was just creased a little funny. We found his nickname to be a perfect fit. He had a dazzling personality to go with his years of training. He was calm, cool, wore a bow tie and was full of jokes and uplifting comments to keep our girl from being scared of the unknown. He announced to me on that day that the diagnosis that I asked Red to look up was now the primary differential. Labs were drawn to definitively confirm this, and it would take several days for those labs to come back, but he felt that she fit the symptoms. Good news right...well...not really. Symptoms will get worse and spread to other mucosal areas such as eyes and "girl parts". This diagnosis came with a "symptom management" treatment plan....comfort, palliative care. As the night and days went on, her pain and symptoms got worse. The pneumonia looked better on x-ray, but her oral cavity was progressing rapidly. I watched and asked about everything. What the nurses gave her, when things were scheduled, what labs were ordered, what doctors were on, vital signs. I closely watched every assessment, read facial expressions, studied every detail of my daughters changing symptoms, and as teams of residents or nurses changing shifts gave report over her bedside, I added, corrected, and filled in the blanks as needed. I became part of the care team. We quickly realized that my daughter got upset over bedside discussion of plan of care or differential diagnoses, so we started to step into the hall. I was always asked to join in on rounds. I became my daughter's voice and advocate as her ability to talk went away. Her oral mucosa sloughed off throughout her whole mouth, down her throat, and her tongue and palate as well. Each day brought new pain and less and less smiles. The night that we got a definitive diagnosis was one of the worst nights as a nurse mom. That afternoon, our daughter's airway was becoming more affected. She had a lot of sloughing and swelling in her throat and palate. She could not swallow well and was not speaking as it hurt too much. As a critical care nurse, I laid awake all night, watching the sat monitor, and her breathing pattern. I must have dozed off at one point and woke to a nurse, not ours, squeezing by me to turn down the Spo2 monitor alarm...not the sound, the limit! I woke right up and saw a beautiful pleth and a oxygen saturation in the low 80's. That nurse did not assess my daughter or wake her, she just stopped the alarm from doing what it was supposed to do. When I think something is wrong I am a bulldog nurse and a big grizzly bear for a mama...combine the two and watch out! I knew baby girl was not ok. Our nurse's response was not enough for me....I asked for the primary care team to come in and repeat a chest x-ray, get some labs and assess her. Her pneumonia and atelectasis combined with pain medication, and most importantly her swollen airway were all contributing to her low sats. She had also started to develop sloughing in her "girl parts" and her eyes poured continuous tears with conjunctivitis. At that time, the results of her labs had come back confirming that what were in fact seeing was Mycoplasma pneumoniae with associated mucositis (MPAM). While M. Pneumoniae is a significant cause of community-acquired pneumonia in children, the mucositic involvement is rare. It falls in the spectrum of Stevens-Johnson Syndrome but affects the mucus linings in the body only. There were so few cases documented in the past 60 years, and only a handful of children (especially girls), that there was little literature about how to treat this autoimmune response. Given her respiratory distress that night and swelling, the team decided to try a dose of high dose steroids, and another round of antibiotic. By this time, she already had a PICC line inserted and we were doing TPN for nutrition, fluids, and continuous Morphine with PCA dosing. She made it through those tough few days without needing to be intubated. My tough girl! The primary care team and Dr. Dazzle had begun to utilize many subspecialties from ENT, to dentistry (mouth care was near impossible),dermatology, to pediatric oncology as the mucositis is common in the immunocompromised kids. I had the idea of getting the cold compress maxi pads from OB/GYN and dermaplast spray to make her girl parts more comfortable. Each morning the team and I brainstormed about what would help with that days new symptoms. My sweet girl whose smile could light up a room was not smiling anymore. She was getting discouraged, irritable, stubborn, and less and less cooperative. She would write notes to me in capital letters with exclamation points that she "DID NOT WANT TO TRY ANYMORE MOUTHWASH BECAUSE EVERYONE TELLS HER THEY WILL HELP AND THEY DON'T!!!" She could no longer open her mouth at all and lock-jaw was a becoming a concern. We had to get her to open her mouth and get some oral care done...it had been weeks. I was the primary source of her frustration and anger. She was in such pain and was scared and I had to get her to push through that to work her mouth open. Then we realized that her tongue had become stuck to her teeth in its healing stage, making the pain that much worse. She had to tear her tongue to get her mouth to open. I cried with her, rocked her, reassured her, sang to her, but now we needed to do this. As she wrote me the next sentence, my heart broke, "I JUST WANT YOU TO CONSOLE ME AND HAVE COMPASSION FOR ME! IT HURTS SO BAD!!!!" I had to step out of the room and call my husband...and cry. I had been comforting her for weeks and would continue, but I knew that she had to do this or it was going to become a bigger, more complicated problem. Even with our efforts, it still might go there. So, I asked her to be strong with me and that my heart hurt worse than hers to see her go through this. I would truly do it for her if I could......then she took a deep breath and she did it. Crying the whole time with her finger on the PCA button continuously, she did it...she opened her mouth. We quickly did oral care which made her more comfortable. We could get a look in her mouth for the first time in days and it actually looked better! She started to improve from then on. Talking and eating were huge challenges as her tongue had some damage. She could not talk well, the muscles were weak. She could not move food around her mouth and had to have speech therapy come teach her how to move food around with her finger and how to practice her speech. Her taste buds had been harmed as well, making food taste not like it should. She did not want to eat what tasted bad or bland. Ultimately what should have been a 6 week ordeal (according to the literature) lasted a few weeks and she was able to go home. The day after she discharged from the hospital with a huge smile and tears over leaving the doctors and nurses she would miss, she headed back to school. She wanted to be "normal" again. She missed her friends and routine and even math! I have a newfound respect for pediatrics. Those care providers have the entire family to care for, not just the patient. Watching my daughter go through this, was one of the hardest times of my adult life. Being a nurse, was helpful overall, but really set my anxiety bar very high. After she would fall asleep at night, my husband and I would discuss all of the what if's, her labs, the updates of the day, our medical worries, how we would work out the schedules for our boys and dogs, her school work etc. Life was very hard for the whole family those weeks but we made it! I will never forget my little boy's reaction when I picked him up from school one day while his sister was in the hospital. She started TPN that day and I was tearful. He started to cry and asked if she was going to die since she could not eat. He was hysterical stating that she could not die because she was not just his sister, but his best friend (they have always been exceptionally close). Of course, I explained it all to him and we both settled down some, but whew...tough stuff! She is 100% healed now approximately 2 months after the beginning of symptoms. She has definitely had some post-traumatic stress since that stay. While she coped so well at that time, she has been overly worried about every sniffle, cough, lump and bump thinking it will all lead to a PICC line insertion or hospital stay. We are getting through it though. The visits from school staff, her friends, our friends and family, cards, flowers, stuffed animals, prayers upon prayers, the amazing child -life specialists who brought crafts each day and played games, the Ronald McDonald House and donations of time, food etc were so overwhelming. Seeing these things day in and day out as a nurse is one thing, but when it's your baby, you realize just how important support and love are to a sick family. Seeing my beautiful strawberry-blonde, freckle faced girl smile each day makes my heart smile. I have not taken that smile for granted even one day since!

Somehow, much to my surprise, I turned 40 a few years ago. I don't know how it happened, but I double checked my birth certificate and sure enough...40 years old! Shortly after this shocking realization, came a letter in the mail from my gynecologist office telling me it was time for my annual physical AND a mammogram. Say WHAT??? A mammogram.....I actually laughed out loud. See, there is some history to this, that at my own embarrassing expense I will share with ya'll. First of all you have to know my personality. There is nothing too private or personal for me to not share. I have always been the one to call out the "elephant in the room" so to speak. My husband sees this as a fatal flaw at times, but I have always felt that my stories can not only be really funny, but also help others by putting it out there for the world to hear. You never know who you might help. My first mammogram is one of those stories. As a pre-teen/ teen, I dreamed of the time that I would NEED to wear a bra. As a 40 something year old woman, I still dream of that day. You see, I was not blessed with a voluptuous Victoria's secret set. You ladies know what I mean, the kind that you pay $45 for beautiful, uplifting, supportive bras for. I was given the Walmart sale section kind of tatas....$6 bargain bin. Bra's for me, are not necessary to make me feel beautiful and supported but rather to (with the help of some padding) give me the subtle appearance of breasts. Yup, part of the itty bitty club over here. I spent years not sleeping on my stomach to encourage their growth and avoid stunting them. I followed all the teenage guidelines that should help them to grow...nothin did it, I say, Nothin! When I was a new Mom, these "girls" were supposed to take on a new purpose. Feeding. I wanted desperately to breastfeed my babies. Here is another elephant.....if you have nipple inversion (like the Never EVER come out kind) then it becomes very difficult, and for me impossible, to breast feed. Despite tricks of the trade from every lactation consultant from the hospital to the health department and industrial strength breast pumps, those guys were not coming out. (I still to this day swear that one particular pump would repeat over and over again..."You're a loser, you're a loser" as it would pull a few dribbles of milk from me after hours of trying to get enough to sustain life for my child). Bottle fed it was...and to my surprise all 3 kids are happy, healthy and mostly well adjusted members of society in light of my early worries and "loser status"-per my breast pump. That's the history of my girls. So when the, "It's time for your mammogram letter came", you can understand why I would giggle thinking about what new boobie adventure this would bring. How on earth would the "girls" fit between the x-ray plates. I was thinking the dentist's office oral x-ray plates might be a better fit.....or I offered the tech that maybe a plain chest x-ray might be better suited for my size. I mean, there is nothing to squeeze. No tissue to see past or through. I was actually nervous about how this would work. I told the mammography tech all of my concerns and she informed me that she had been doing this job for over 20 years and I quote, " I can find tissue to squeeze on everyone no matter how small their breast size." Uuuhhhhhh....yikes! First we started with the nipple markers. Talk about funny to me. I have never had nipples. These were like little nipple prosthetics! I asked her if I could try them on with my tee shirt, just to see! I mean come on it was a whole new world!! I told her I wanted to mess with my husband...he would be shocked if he saw those through my tee shirt after almost 20 years of marriage. She gave me a whole package to take home...no kidding! I got a goodie bag from the mammogram! Then came squish time. I couldn't believe it, but do you know that woman did find tissue to squish! I truly believe it came from as far down as my v-hoo-hoo and as far up as my neck, but she got some kinda tissue in between those x-ray plates. I could not breath, because if I did it would ruined all of that woman's hard work in getting them in there. So I was still for what seemed like forever. As I was joking about my tini-tiny- itty-bitties, the mammography tech was telling me about the lady she scanned before me that needed six different films to complete one image due to the size of her larger than large breasts. One breast did not fit on a whole x-ray plate...it took six shots! God gave that woman part of what was supposed to mine...I am sure of it! Anyway.....the tech and I made it thru laughing the whole time at this crazy adventure of turning 40 as a woman. To all who wonder, my scans were clean. Nothing to worry about. Cleared till my next due date. I got one more chuckle as I read the results saying, "dense tissue bilaterally" and thought to myself "of course it's dense tissue...she squeezed my sternum, rib cage and likely part of my spine into that machine!" I encourage all women to go for their screenings, an hour out of your day once a year can save your life. You can laugh through your nerves like I did. These "girls" are our responsibility to care for and monitor whether they are $45 dollar Victoria Secrets or $6 dollar Walmart bargain bins.

I am a critical care trained Registered Nurse turned patient who developed one of those RARE side-effects that can happen when you take any medication. The only medical condition I have is Irritable Bowel Syndrome, (the "C" kind.... constipation). As with all chronic illnesses, you can be doing great, cruising along at a steady state, good symptom management when BAM.....there it is again! In my case, severe left upper quadrant abdominal pain with constipation, crazy bloating ("no I am not 5 months pregnant...it's gas!"), nausea, reflux and eventual diarrhea after you eat, drink and do everything in your power just to poop. There, I said it.....this whole medical mess I found myself in was because of poop, or lack of it! So, my story starts like this......I have been seeing the same gastroenterologist for years. He, very literally, knows me inside and out. He knows what I eat that agrees with me and what blows me up like a balloon. We have worked over the years to get my ever-evolving symptoms under control. With Irritable Bowel Syndrome, it's a matter of managing flares and keeping things moving along as smoothly as possible. I had been "stable" taking a few different medications that control contributing factors of IBS-C for a few years until about six months ago. My stress level went up tenfold in a short time. We decided to build a new home, so we bought land, sold our current home very quickly, (less than 24 hrs), moved into a very small rental and 2 storage units with three kids and two cats, started a new job, adopted a puppy, mother-in-law got very sick postoperatively......all in about 2 months time. Needless to say, the stress affected my IBS and I was in a constant flare. After cleared CT scans, a colonoscopy, and multiple dietary changes we started to adjust medications. With adjusting these medications you go through many unwanted side effects for a few weeks. Fatigue, dry mouth, nausea, dizziness, etc., many of the "typical" side effects mentioned on the TV commercials, magazine ads, and medication information inserts. These side effects are usually temporary resolving over time as your body adjusts. After trying a few "lesser of the evil" medications, no luck, still struggling. So we finally decided to wean off one class of drugs as we introduce and increase another. This is where it starts to go bad. Within the first few weeks on this new medication, I knew it did not agree with me. I was not just moody, but in full meltdown mode if the computer did not boot up fast enough. Crying in the corner on the floor. Every time I had to say no to my kids, (you guess by their ages 11, 9, and 7 how often in a given day that happens), I would convince myself that I was the worst mom ever. Crying so hard like I scarred them for life because they could not have a can of Dr. Pepper at 8 pm! My brain knew what was rational but my emotions told me another story and one that was difficult to forgive myself for. So I made an appointment with the GI specialist to discuss this and work on getting me off this medication. During the day or two before my appointment, I felt palpitations here and there. They were significant enough to take my breath away but did not last long. I mentioned it to my husband and we chalked it up to stress or caffeine. The day of my appointment, I was feeling more frequent palpitations so I asked when my vital signs were being checked what my heart rate was. The nurse very casually said 120 bpm. She said that it had been up as high as 140 but settled in around 120. I was not nervous or anxious at that time but was surprised and concerned. I am a runner and am athletic. My normal resting heart rate in between 50 and 60 bpm. I mentioned this to the physician when I was seen and he agreed with all of the symptoms I was having on this particular drug that gradual weaning off was the answer and tapering up another class of drugs that will hopefully give me and my colon the desired effect of peace and calm. That night I was aware of my more frequent high heart rate. By the next morning, I was about to start a cycling class and I checked my heart rate prior....135. Being a bit stubborn and a lot stupid, I took the class anyway. I went about class as intensely as I would normally. My heart rate went up as high as usual. I did not feel dizzy or severely short of breath. Stress test complete! I passed, except after class, my rate stayed above 140 and I had the shortness of breath and now a sense of someone sitting on my chest. That day my husband and I met to choose the tile for the new house we are building and I felt worse. As far as I could tell my heart rate was never going down. I had more episodes of pressure, shortness of breath and a few dizzy spells. It was now time to go to the hospital. At the hospital, I got the typical cardiac work up. Besides being tachycardic in 150's, I had a negative cardiac profile as well as electrolytes, thyroid, and CBC. I had a positive D-Dimer (who doesn't) which started the workup for pulmonary embolism. After scans, that too was cleared from my differential list. Despite bolus', maintenance intravenous fluids, and antibiotics (incidental finding of urinary tract infection) my heart rate would not budge. So ultimately, I was able to discharge after four days with exactly the same symptoms as I came in with. The only answer was that I was having a reaction to the medication. This particular medication causes irregular tachyarrhythmias and widened QT intervals in a very small percentage of the population.......me. Lucky me! So today is, as I type this, the last day of my wean from this medication. I am still having intermittent bursts of tachycardia, but much less frequent. I am looking forward to being done with this mess. We never know when starting a new medication how our body will respond. With different hormone levels, metabolisms, and system functions even that .001% of medication reaction possibilities can happen to you. Be aware of your body. Know your baseline. Report any changes from that baseline to your prescribing doctor, and definitely go to the hospital for any potentially life threatening symptoms. I am glad that I have maintained an active lifestyle, so that my heart was able to tolerate the sustained high heart rate for so long without damage. All this trouble just because of poop! Who'd have thought!

Ersilia Pompilio RN, MSN, PNPStoryteller, Educator, Producer, Nurse, and Super Cool Lady! I can't wait to introduce Ersilia Pompilio to everyone at allnurses! As her subtitle reads, she is a nurse innovator and entrepreneur, that has found a niche using many of her talents, interests and strengths combined with her passion for nursing. Ersilia Pompilio is the Creator and CEO of Rogue Nurse Media 501c3 whose mission is to empower nurses to tell their stories. "I teach and develop innovative educational tools focussed on healthcare that are in alignment with current trends in social media, mainstream media, art and technology. The goal is to abolish fake news in healthcare and change the stigma around how people see nurses and patients in the media. My goal is also to encourage nursing schools to change their curriculum and bring them more into the mainstream technology using social media." Ersilia has several tools and productions that are moving her mission forward: The Well Written Nurse: Writing workshops that teach nurses storytelling, screen/ TV writing, journalistic writing, memoir writing, blogging, and how to get published. Ersilia and her team are set to launch a screen/ TV writing workshop in November of 2017 called Mapping the Story of Genome, A Screenwriting Workshop for Healthcare Professionals. The workshop will focus on the character developement of the healthcare professional...nurses and patients.Nurses and Hypochondriacs Storytelling Show: a storytelling show where real Nurses, Patients, and Hypochondriacs take the stage and tell true, unscripted comedic stories.Nurses and Hypochondriac Podcast: Nurse experts, patients, and hypochondriacs come together to discuss hot topics in healthcare.Since Ersilia has a teaching background, she was able to get her courses approved by the California BRN for CE's! How this all got started!?!Ersilia admits that she loves to tell stories. "When I was working as a Pediatric Nurse Practitioner on a busy pre surgery unit, I often had many nurse friends from around the hospital that I knew stop by to ask: 'Got any new dating stories?' They loved my perils of being single in Los Angeles and dating wacky men. I attracted a certain type of guy in my dating world. My HIPPA attorney friend and fellow writing buddy affirmed in the middle of a story one day: 'You sure do date a lot of hypochondriacs!'" So it was born! Due to "burnout" from teaching nursing and working as a nurse practitioner, in 2008, Ersilia started taking writing classes at a boutique writing school in downtown Los Angeles' Art District. She found writing healing and cathartic, and soon published her first short story, "Our Little Hospital Ghost". This opened a creative portal, and Ersilia started to gather a team of creative writers to help her produce her one woman show The Nurse and the Hypochondriacs. After 3 runs of the show, she "put it to bed", feeling deflated and defeated, until a few audience members told her how much they learned through the show. Ersilia "resurrected" the show in 2015 and made a few changes, turning it into a storytelling show called Nurses and Hypochondriacs. She produced 5 productions for the Hollywood Fringe Festival with 20 storytellers. The show was a slow hit, but once again the audience affirmed how much they learned through the show. At the end of 2015, Ersilia had one of Oprah's "ah-ha moments" and she got to work developing Rogue Nurse Media 501c3. While writing an article for Working Nurse Magazine on Nurses in the media, it all came together, the only way to change the stigma of nursing is to teach and empower nurses to write and change it for themselves! BarriersMoving from the Health Care Nurse Practitioner world into the creative unknown was very intimidating to Ersilia. She learned that she needed to listen to the voice inside and trust that her intuition was leading in the right direction! Her motto (from Field of Dreams) was "Build it and they will come!" So, Ersilia jumped in head first creating websites, working with graphic artists, hiring and firing people, working with ensues for shows, directing and coaching storytellers, and now learning to podcast! Advice to Give Aspiring Nurse EntrepreneursThe best advice that Ersilia would give to aspiring nurse entrepreneurs is "not to listen to your co-workers and the naysayers! Follow your gut and create. Spend lots of time outside of your 'Nurse' box! Do fun stuff like go to museums, take art classes, watch stage shows etc....do something that makes your soul sing and dance! Read books that teach and inspire you! Journal, meditate, and write!". When asked what the best way to prepare and nurture dynamic innovators for the future of healthcare practice, Ersilia offered that nursing schools need to start offering creative classes for innovative nurses. "Your career needs to be malleable to what your personal needs are! Nursing schools need to start teaching that!" Career Role Models and Inspirational Persons"I recently attended a one act play at the Hollywood Fringe Festival 2017 called Mary's Medicine. It was an adaption of Mary Seacole's autobiography. Mary Seacole was a Scottish-Jamaican Nurse who invented ginger beer. She married a Scottish man who was sickly. She too was a hypochondriac magnet. Mary was a great inventor, entrepreneur, nurse, and pioneer. I related with her character and her story in the play. I have faced and currently still do face many of the same challenges she did. Creating something unique and empowering nurses and patients to tell their stories through storytelling and podcasting has brought about much scrutiny from people in the profession who are used to runnings on the same treadmill of life and are afraid of getting off and doing something different!" The Single Most Important Issue For Nurses to Address in the next 2 yearsErsilia feels that most important issue that the profession of nursing needs to address is the image of the profession itself. "We have nurses getting their Ph.D.'s and DNP's yet the mass population still sees us as the bedside nurse. Nurses are great innovators and educators. The public needs to understand that...the only way to do that is by telling and educating the public about what we do as nurses through our stories!"

This may be one of the coolest and most challenging innovator articles I have written yet! I want to make sure I give justice to this awesome group of nurses who came together with interest in one specific population and developed an idea that gives comfort and strength to the emotions and symptoms of this very underserved patient population. These five ladies come from different institutions, backgrounds, states, and educational and nursing experiences, but share one common interest, AYA patients (Adolescents and Young Adults) with cancer. Their interest in this group comes from their recognition that AYA are not the same as children with cancer or older adults with cancer. This population has unique needs. They are tech savvy and use their own style of language and communication. They like to be connected with others of similar age and experiences. So, who are these nurses, how does a group like this come together, and what is their idea? What Have These Innovators Created?These five nurses from 5 different parts of the country have come together to create an "IPad app that allows adolescents and young adults with cancer to share their symptom experience (presently at one time point) as they complete the app." The idea behind this is that they are able to "See their symptom experience for themselves- which they have noted to be helpful in 'putting it all together' and thus, managing the symptoms they are experiencing""Have the ability to share it with others such as caregivers and healthcare providers so that they might help""At present the tool is used exclusively for AYA cancer patients (and a different iteration that was used in menopausal women) but we have had interest from others who manage other chronic diseases who see its potential utility in other groups as well."-notes Kristin Stegenga. Who Are These Entrepreneurs?Catherine Fiona Macpherson PhD,RN,CPON"I am a staff nurse on an inpatient pediatric oncology unit and have been for my entire career. During my doctoral program at the University of Washington School of Nursing, our faculty encouraged us not only to contemplate what established path we might choose but to consider crafting our own path. My 3 dearest mentors Dr. Kristen Swanson, Dr. Pam Hinds, and Dr. Nancy Woods supported my desire to remain in clinical practice as a staff nurse while simultaneously pursuing clinical research as a nurse scientist, which is an unusual combination. I would advise other nurses to follow their passions and surround themselves with people who share those passions. During my formative years in my undergraduate program at the University Faculty of Nursing, I learned that as a nurse you could be whatever you wanted to be and do whatever you wanted to do, and that nursing as a service to humanity depended on innovation." Suzanne Ameringer PhD, RN"I am as associate professor at a school of nursing where I teach and conduct research. I have been in this position for nearly 10 years. Prior to this position I have practiced as a pediatric nurse in a variety of settings, including inpatient and outpatients units, pediatric primary care, and public health. After many years of practice, I decided to go back to school and obtain a PhD so that I could conduct research on issues that I found most troublesome in practice. Some current barriers in my position are the significant amount of resources (e.g.' funds, university infrastructure, personnel) it takes to conduct meaningful research. While working on my masters, I met a nurse researcher who would eventually be my mentor. Her work was in pain management with adults, and I thought about how I wanted to make a difference for adolescents with cancer and sickle cell who experience pain. This experience led to my decision to get a PhD and conduct research with this population. Dr. Sandra Ward was my mentor in my doctoral program and she was an excellent role model of a successful scientist. Dr. Deborah McGuire has been a role model and mentor these past 4 years and exemplifies how to be a senior faculty member and scientist. I have felt very fortunate to be with these amazing individuals". Jeanne Erickson, PhD, RN, AOCN"I am currently on the faculty at the University of Wisconsin-Milwaukee College of Nursing. In this academic role. I teach undergraduate and graduate students and maintain a program of research related to symptom management of adolescents and young adults with cancer. I have been an oncology nurse for my entire career; I have had positions as a staff nurse, clinical nurse specialist, nurse educator, and I previously taught at the University of Virginia before moving to Milwaukee 3 years ago. The barriers that I face today are related to conducting research in an academic health system where I am not formally employed. I need clinical partners to help me navigate the systems where I recruit and enroll patients for my research studies. I encourage other innovators to keep a list of research questions and ideas that interest you. Find opportunities to discuss your ideas and interests with colleagues who share similar interests, but also be open to discussing your ideas with others who are different from you or who have a different set of skills or perspectives. Nurses need to develop partnerships and work on interprofessional teams in order to bring about that are needed in health care. One of my personal career role models is Dr. Pamela Hinds is a nurse scientist whose work has made a difference to nurses and to young patients with cancer. She has been a mentor to many nurses, educators, and researchers, and she inspires me with her intellect, productivity, generosity, and warmth." Lauri Linder PhD, APRN,CPON"I am an Assistant Professor at the University of Utah College of Nursing. My position also includes a 20% appointment as a Clinical Nurse Specialist with the Cancer Transplant Center at Primary Children's Hospital. I have actually been working at Primary Children's since I graduated with my bachelor's degree in 1989. In 1996, I moved to a joint appointment with the College of Nursing to serve as a clinical track faculty member teaching pediatric clinical nursing to our undergraduate students. After finishing my PhD, I accepted my current tenure track position in 2010. For me, my clinical practice drives my research questions. Remaining immersed in the clinical setting keeps me current on clinical practice issues and positions me as a team member for conducting my research. It can at times be challenging to balance expectations and responsibilities at both sites. I am fortunate to have leadership teams who support this joint appointment at both the academic and practice settings. As for role models, two individuals come to mind. I first became acquainted with Dr. Pamela Hinds work during my master's degree studies. I actually became a participant in one of the studies she was supporting. Throughout the years Dr. Hinds has become a mentor and role model both in terms of the quality and quantity of her research and the manner in which she invests in the up-and-coming generations of nurse scientists. Dr. Nancy Woods became a mentor in 2010. Although the primary focus of her research is in a separate population, she has invested in our team with our shared interest in symptoms and symptom clusters. She has challenged our team and served as a source of encouragement." Kristin Stegenga PhD, RN, CPON"I am a nurse researcher at Children's Mercy Hospital in Kansas City. I have always worked in hematology/ oncology/bone marrow transplant. It is the one thing I said I would never do when I started nursing school but I found that I had a passion for kids and teens with cancer and never looked back. I recognized early on that there was never a good time to get cancer but the teen years were particularly bad! I also realized that I had a lot of questions about why we did what we did and how we could help our patients more. I think we need to recognize just how important we are to solving the issues that surround health care. Often people think of nurses as somehow secondary in the healthcare world but our position so close to patients makes us so very primary that we may well be positioned BEST to understand what is needed to provide safe, meaningful and cost-effective healthcare in the future. Funding for research is tight and so it is hard to do all the important research that needs to be done. The work we are doing now has come from as a group has been funded three different ways in smaller bits. With tight funding, you also find yourself tight on time. You find yourself doing much of the work yourself because there isn't money to have a lot of help. I love the interaction with patients 1:1 but I do most of my own work so I track patient appointments, do data collection and work with the research team across the country all in the same workday! My mentor Dr. Pam Hinds has been instrumental in helping me learn to be an excellent nurse and nurse researcher. She has been my role model ever since I met her!" How Did This Group of Innovators Come Together?They all got together bit by bit. Some knew each other from working on their PhD's at the same school, some knew each other from the same nursing organizations, APHON and ONS. They noted that they had similar interest in symptom management and the AYA population, and began to come together. Some of the reason that they came to work together is, shared interest, some is that they really enjoy each other and the different strengths they bring to the table and some is the realization that group is not large, so cooperation is key to reaching the population. "Together we are incredibly strong and apart, it would take us a long time to get this kind of work done, both because we are individual researchers at individual institutions and because the populations are so small at most places." Why the AYA Population?"What we are seeking to do with our work is to meet AYA in their own realm, with technology because they are tech savvy, and language that is appropriate to their world and recognition that they are just starting to become aware of their symptom experience. We want to give them the tools to make sense of the experience for themselves and to make it possible for them to reach out to those around them as they want/ need to in order to manage their cancer experience in the best way for them", notes Stegenga. This is a fantastic example of innovation, teamwork and collaboration from different areas of knowledge and expertise. These 5 nurses have found each other through shared experiences and professional organizations, and what was born from this is a voice to an often lost group in the medical world. What an amazing blessing to those AYA who are able to reach each out to each other in a way that would never have been possible before this group of minds came together. I have been so eager to share this story with readers and my own daughter as a spectacular example of women in science AND nursing as well as the capabilities that result from innovative, brave, strong minds coming together! From Left to Right: Fiona Macpherson, Nancy Woods (mentor), Kristin Stegenga, Lauri Linder, Jeanne Erickson, Suzanne Ameringer, Pam Hinds (mentor)

I realize that there are so many articles, blogs, books and inspirational bookmarks, coffee cups, and laminated lanyard tags that tell you how to be a great nurse. You learn throughout nursing school how to calculate BMI, use your posture to leverage a patient, "therapeutically communicate" and to give an orange the proper dose of insulin for the blood sugar you just checked with fake sugary blood. Not surprisingly there are some "real life, hands on, I have been there in the trenches for a few years and lived to tell a tale or two ", pearls that I want to share that work. These few tips will save you time, frustration, tears (yours), and will increase your job satisfaction and patient satisfaction. Before you leave the patient's room, ask if there is anything else they need This one is huge! Listen up people...you will save yourself tons of time and frustration in the long run each day if you do this. I can promise you that when you are rounding with you're 8am meds, if you just go in and hand the patient their meds and leave, the call bell WILL go on as soon as you are 2 doors down! Here's the rest of how this scene plays out..."Susie, your patient in 202 needs fresh water." You bring water and leave again to continue with med rounds..."Susie...your patient in 202 is out of straws"....head to pantry, grab straw, deliver and leave......"Susie, your patient in 202 needs to use the bathroom"......"Susie, 202 would like sheets straightened"..."Susie, 202 has family here and would like to ask you some questions".....AHHHHHHHHHH! Multiply 202 times the 10+ patients you have today. Here is my "go-to" of how to work with 202's. When you go into the room, smile and boldly and cheerily say good morning! Ask about the patient's night as you clean up their bedside table. Check on straws, cups, and tissues. Dump old pitcher of water. Tell patient you will be back in second as you get them a pitcher of fresh water with ice (people love that hospital ice), grab straws, cups etc while you are there. When you come back in and put it all on bedside table, chat with your patient about your crazy kids this morning, your animal's antics , really anything personal to open communication. Tell your patient what pills they are taking and for what. Discuss medical plan for the day, tests, labs, time doctor is expected in etc. Any questions 202? Ask if patient needs to use restroom, if yes, straighten sheets or change them if needed while out of bed. If no, straighten the sheets out. Ask if patient is warm enough or cool enough. Place the bedside table, call bell, and channel changer in reach, ask if patient wants blinds open......and last but not least, "Is there anything else I can do for you? I will be back to do an assessment at (such and such) time." Bam! Five to 10 minutes and the patients will love their attentive nurse and not want to bother you knowing you will be back soon. Bonus is that you visually did a pretty thorough assessment of 202 while you were in there. Know Where To Go When You Don't Know Yet another biggie. You will NEVER know all you need to know. However, if you know where to go to find out then you'll be in good shape. On any unit, you will soon figure out who the seasoned staff are. There are always those with special "skills sets". Some are great with inserting IV's; some foleys; some know a ton about cardiac rhythms. Call pharmacy as a resource for any and all questions related to medications or interactions, allergies etc. Use your drug reference handbooks. There are always a few super awesome easy to talk to physicians, nurse practitioners, or physician assistants that love to share information and answer questions. Be friendly, ask questions about disease processes, medications, patient histories or whatever you may have questions about. Be a sponge with any knowledge you can get your hands on. Never be afraid to ask.....I have always been bold and outgoing with questions and I stick my nose and ears on primary physician and specialist conversations. I butt in on wound care during dressing changes, radiology during procedures etc. Let me share a little story of my own. When I came out of nursing school, I went straight to work as a hospice nurse for 5 years. Nothing more unnerving than coming out inexperienced and working in a location where you are autonomous and have no other nurses with you. So one of my first patients had a colostomy and I was to do her ostomy care and assessment for her during my visit. I never had the ostomy experience in my 4 years of nursing school. I read about it, passed the test doing care on a "torso mannequin", but real life is something different. OK, I can think critically, figure this out somehow, right? What did I do? "Mrs. XYZ, why don't you show me how you care for your ostomy so that I can see that you and your family know how and also it will allow me to do it the same way you do when I come". Yup, Mrs. XYZ unknowingly taught me ostomy care! Education opportunities come from many angles. Be Prepared! As a seasoned nurse and the wife of a physician, I can tell you that no doctor wants you to call them with a question or wanting a new order if you don't have all of the information necessary together, and IN FRONT OF YOU. Let's say your patient is in respiratory distress. When you call, you better know: your patient's lung sounds, respiratory rate, amount of oxygen on, medications given, allergies, changes in the patient's overall condition, pertinent labs, etc. Have your computer up and running, logged on. Have paper to jot orders on. Most importantly be by the phone! Most hospitals now have nurses carrying their own phones. If you do put out a call and have to go care for your patient, tell everyone around that you are waiting on Dr. PQR to return your call. Don't go potty then, do not get on the phone with pharmacy on the number the doc is supposed to call you back on. If your patient is in distress, call in your team to help while you talk with the doctor, after all you know the most about your patient. Another area to be prepared for is talking with patients and families. First of all, know who you can talk with (permission) and what you can share. Be aware of who is in the room with the patient if you are sharing personal information about their care. Know what will be going on with your patient thru the day, including labs, tests etc. Explain in common, non-medical language what is going on with their care or diagnosis. I always consider myself the translator between the doctor and the patient. As nurses we bridge a lot of gaps and the medical jargon is just one of those areas, so be prepared to explain what's going on. It is OK to tell the patient that you are unsure about something and need to look into it further, just make sure you provide an answer before you leave for the day. That builds trust in you and for the nurses coming after you. Remember Why You Are a Nurse Everyday start fresh. On your way to work, remind yourself of the reasons you became a nurse. I like to say, most of us were born nurses. We are caring, compassionate, smart, quick thinkers, adaptable, team players and we want to make a difference in someone's life or death everyday. Some days that happens, some day not, but take the few extra minutes when you are in a patient's room to get to know your patient. Small talk about things unrelated to being in the hospital. I live in the south, so when meals come and I help set up, I ask about grandma's biscuits, or if my patient likes to cook. Food is the universal leveler y'all...everyone can small talk about food. In these small things, you get those moments that you went to school for. These small moments make the day brighter for you and your patient. I can't tell you how many chin hairs I have plucked (Btw...designate a family member to tend to that renegaid if you are in the hospital...they pop up when least expected), hair I have curled, faces shaved etc. All to make a difference to that one patient and watch their family glow when they walk into the room and mom has her famous red lipstick on. In other words, humanize your patient. In the current healthcare world, everything is technology, task, and chart. Nothing touches your heart there. Your patients can feel very lost and scared in that world. Bring it back to the basics of biscuits, small talk and hand holding. I do want to stress that as a good nurse, your skills will be picking up subtle changes in your patient during those times too. Skin changes, bowel and bladder habits, confusion, dyspnea, new onset weakness, etc. To wrap it up, I hope you can tell that I love the art of nursing on so many levels and always have, despite any role I have taken in this field. You make all the difference. Somedays you may leave crying in frustration and failure, but many other days you will leave feeling like you mattered to someone. You gave that patient a piece of you. Hopefully this will help some of you with the down and dirty, tips to survive your shift! Nurse on my colleagues!!

Nurses note: respiration easy and unlabored at 20 breaths per minute, heart sounds regular and even at 70 beats/min, resting comfortably in bed, side rails up×2. No distress noted