bobbiesal

When I attended the National Student Nurse's Association conference in 1985, I argued for ADN programs as the entry to practice. My school presented me with an award for this. I argued that bedside nursing doesn't require a BSN & those who wish to do so will continue their education. I practiced in the NICU and PICU for 10 years before receiving my BSN in 1995, as part of a hybrid program at UW-Madison. Then my MSN in 1997. And my PhD in Nursing from Columbia University in 2011. I teach undergraduate nurses in pediatric clinical and practice full time as an NP in Genetics. I still maintain my original argument - there aren't enough faculty and the cost of a BSN program is astronomical - and AD RNs are every bit as capable to provide patient care as BSNs. My ADN program is comparable to the ABSN program I teach in - and apparently prepared me for rich career in nursing. Honestly - support nursing and all the tracks available to get qualified students to the bedside! Focus on excellence in education and feed that curiosity to lifelong learning - make it easier and more affordable to pursue further education instead of stanching the flow of RNs to practice at the bedside!

I've been a manager for going on 8 years now. I hate it. I'm really good at...but I HATE IT!!!!!!!!! I'm good at it from the staff's perspective, I STILL get asked to come back, people I did disciplinary action on still want to work for me, people threaten to quit if I leave. I'm good at it from the doctors' perspective, I earned their repect, changed the behavior that was detrimental to patient care (like telling staff to clear their scedule a day ahead of time), managed the budget from a deficit of 11% to a profit of 25% (where are those bonuses being given?) Administration likes me, except for when I point out things just a LITTLE too loudly to certain departments (like PR). I took my current job because it wasn't a management position, well, guess what? Two months after starting, they got rid of the supervisor, giving me two full time positions...do I get paid for both, he**, n o! I don't like being responsible for the way others spend their time, I don't like budgets, I don't like meetings, I don't like not being able to hands on care. Despite the "virtual nursing shortage," despite the fact I'm a PNP who has seen patients throughout the past 7 years...NO ONE WILL LET ME WORK AS A STAFF NURSE! I could care if I'm over-qualified...why can't I make that decision... Middle management is a very difficult place. You have to answer to staff & upper administration. One thing should guide every decision you make - Is this right? If the answer is no - and you can back it up - then you're always able to say no to senior administration with a clear conscience. I've done it several times, without repercussion, & have later been praised for my integrity!

You know...I would chooose nursing...I have a master's and would like to get a PhD... Although I have to admit, a PhD in Neuropsychology appeals to me greatly as well... As does a PhD in Health Policy.... decisions, decisions, decisions.... :)

Oh man! I am so jealous... I would dearly love to go to Penn for a PhD.... Best of Luck & keep telling yourself - I want this!

My first job as a nurse was in the NICU...I was working as a float student NA & knew every department I DIDN'T want to work for... I worked NICU for 3 years until I had to switch to PICU. After working in the PICU, I couldn't ever work NICU again because of the ethical /moral dilemmas I constantly faced. As an NICU nurse, I sent babies home. As a PICU nurse, I got to see what 'home' looked like for many NICU grads... Don't get me wrong, I think it's important work, and I admire the nurses who work there, and avidly support the advances that have been made in the past 18 years, however, I cannot condone many of the things that occur there because of parents who choose in vitro & decide to keep ALL the fetuses, or the overaggressive residents who attempt to save babies with apgars of 0 - 0 - 1 - 2. (that would be 1 at ten min. and 2 at twenty min.). I'm not being cynical, I'm being realistic. If you love critical care, however, and love babies...it's a great place. Just be prepared to see some things that may make you question what medical advances are really serving.

OK, bite my head off, BUT... Last time I went to the ER (3 years ago, I only go if I can't walk because I'm in so much pain & can't diagnose myself OR I'm bleeding profusely OR something's broken....) I was told to walk to the bathroom to give a urine specimen (never mind I arrived in a wheelchair because HEY - I COULDN'T WALK CUZ I WAS IN SO MUCH FLIPPIN' PAIN!)...then my nurse came in the room, "Mark's my name, nursing's my game!" I groaned. I had told my husband I'd be nice...so, I was nice...even when Mark didn't take the arm I gave him to start the IV, because...'he saw a vein,' & proceeded to give me a 2 inch high hematoma..."ooopsie," he said, & was able to easily get in the vein I told him to go for in the first place... Thank God someone else took over for him so I had at least 30 minutes of compassion... Sorry...but I've worked the ER as well, have had experience with men & women, & a lot of men just don't like being 'told' what to do... even when they're not being told, simply asked.... My two cents... Bobbie Salveson MS RN CPNP

I started my career w/an associate degree - wouldn't have done it any other way! Why? Because the board passage rate for my school compared to the two 4 year programs was close to 100% compared to their 75% and 60%. Also, I received a scholarship based on GPA only, so was able to attend for $14/credit hour, compared to $10,000 a semester. It wasn't a difficult decision... That was in 1986... I worked as a staff nurse for 12 years, straight nites, all ICU - loved every minute of it. I wouldn't have been paid a dime more for a BSN. I went back to school because I wanted to go to grad school - THAT is something you can do with a BSN that ADNs cannot do. I'm a PNP now, and will start my PhD in the fall of 2005 - because I cannot believe we turn away tens of THOUSANDS of students per year due to lack of instructors, then raid other countries' supply of nurses because - damn(!) - we have a nursing shortage... As for quality of nurses? It depends on motivation of the person - not the degree you hold. If you are motivated to keep up on latest practice, commit yourself to being the best you can be, practice evidence based medicine/nursing..that's what makes a quality RN, NOT what the letters are behind your name... Bobbie Salveson MS RN CPNP

Migraines....what a PAIN! Migraineurs were my #1 patient population when I practiced in neurology. Having suffered from them since I was 6 (at least), my patients knew I could relate... Unfortuantely, what works for one, may or may not work for another, since migraines are all tied in to our serotonin system, & in women, further complicated by our hormonal system. What has worked best for me, is Topamax 100 mg at bedtime (120 mg gave me the tingly feet & hands side effects), Zoloft 100 mg at bedtime both as prophylaxis. During my periods, I take Amerge, 1mg BID as prophylaxis, and Immitrex tablets 100 mg for breakthrough. You can take up to 3 Immitrex in a day, not to exceed 6 in a week if necessary. I do use the injectabel 6mg Immitrex if I'm traveling, because then i need to be at a talk, or I'm in a plane or some such thing, otherwise, I stick with the tablets cuz I hate injections. In the world of triptans, the newer, non-narcotic medications, there are many options to choose from. If one doesn't work for you (you need to give each a chance, about 3 tries) then another may work well. I find nasal sprays are the most difficult to use, only because the technique is difficult to master. The newest, eliatriptan, promises to work the fastest, but physiologically, they all take about 30 minutes. The key here is to take them at ONSET! Not to wait & see if your headache gets worse - cuz it will, you know it will...taking the triptan is better than going to the ER any day! As far as ER visits go, I was amazed that anyone went to the ER for self-limiting pain. Now, people will say I've never had a bad migraine then. 3 days of crawling on the floor vomiting is a pretty bad headache, I think. I just always knew it would go away. In the ER, you will ALWAYS be treated like a drug seeker, the lights are bright, it's noisy, you 'only' have a headache, & you will be triaged to the end, so you may be waiting hours to be seen. I'll take my own bed in a dark room any day. And yes, I told my patients this, too. I'm a big advocate of massage. That being said, it's frightfully expensive, unless there are training programs in your locale, then you can get an hour massage for 10-15 dollars. I've tried accupuncture, and it is effective, but time consuming & not covered by insurance, so I'll pay for massage over that. There has been research demonstrating effectiveness of accupuncture with migraine. I wouldn't recommend chiropractic in your case, only because of the surgery you've had. Cervical manipulation is not a good idea in your case. Feverfew is a good plan, and so is vitamin B2 as a preventive, however, it takes 3 months before a noticeable effect occurs. One of the VERY best things you can do for yourself is to keep a headache diary. You can find them in various places on the net, there are many fine headache sites that have examples. I've been keeping one for 10 years now, & it has shown me when I can expect to get headaches, when I need to be more careful about diet & sleep, etc. Knowing your triggers is perhaps the most important thing in learning to gain some sort of control over your migraines. I had patients who would tell me they had no triggers, but after keeping a diary were amazed to find that indeed, they did. Self-awareness, always a wonderful discovery. Best of Luck! You can beat these rotten headaches! Bobbie :angryfire

As a Pediatric NP, I have to take a recertification exam every year! Now...I could choose to opt out with practice hours or CEU, however, we are on a 6 year cycle, and out of that 6 years, at least 2 of the years must be exams. So, now you've heard. I'm thinking that neither field knows enough about the other to throw stones. I considered going to PA school prior to going to graduate school, actually took all the prepratory classes to do so. (1 extra year of chemistry, 4 extra cedits of microbiology) However, when it came down to it, the university I attended strongly discouraged nurses from applying to their program. Fact is, they would have to "unteach" the nursing perspective & try to instill the medical way of thinking - a difficult prospect for an instructor... Is there a difference in practice? Absolutely. NPs are hands down better at teaching, and better at seeing the bigger picture. The teaching part comes from what we are taught in every program from LPN on up, the bigger picture is what nursing is all about. And altho some PA programs offer graduate degrees, most are very minimal on research. I am, however, very encouraged that NPs & PAs are working together to forma a new organization to tackle the legislative issues that continue to threaten autonomy. And as far as practicing autonomously, that comes from experience, not from degree....

Having done pelvic exams on young women under the very worst of circumstances (I was a SANE nurse), I can tell you that it's the talking through & explaining everything that REALLY helps. I worked for a year in a grant funded family planning clinic as well (not Planned Parenthood, but similar) & I didn't have one complaint from a patient. I live in a small town and have 3 sons, the oldest would often bring his friends in for free condoms, putting me in the wonderful position of having to teach them how to use the condoms. Likewise, I ended up performing exams on girls that "knew" my son, daughters of cousins, daughters of friends, girls I'd see later in McDonalds... It's not always easy being on the other side of the stirrups either! From my personal experience, I wish I'd gone to Planned Parenthood, or somewhere that really explained birth control instead of simply prescribing it like my pediatrician did. I ended up pregnant at 18 after a course of tetracycline for a UTI because no one thought to tell me about the potential interaction, nor the importance of taking the pill the same time daily! I'm very glad young women today have all the options they do, and I never have missed an opportunity to discuss those options with my sons' girlfriends! In the big scheme of things, pelvic exams are really a nuisance at worst. Small price to pay for taking good care of yourself! Best of luck!!!!!!

I had to float to the ER on Halloween of all nites. And lucky me, I got the 350 pound, 50 yr. old woman c/o abdominal pain who hadn't had a BM in 4 days. The doc ordered an enema (of course), something we seldom did in the PICU. I dutifully admistered this, and was somehow able to get a fracture pan underneath her. She said she was done, and could finish in the bathroom, however, when I was helping her get up, she had explosive diarrhea that covered me from the knees down...into my shoes, my socks, I was absolutely squishy.... I decided that this was some sort of test of will- not reacting by screaming, "EWWWWWWW-GROSSSSS!!!!" I got her up into a wheelchair, her husband was laughing (i was not) and helped her to the bathroom, while everyone in the hallway was whispering, "what's that smell?" I had to take off my shoes, socks, change into new scrubs, and when I asked the nursing assistant to help, he replied, "my shift doesn't start for 5 minutes." So, I left the mess for him to clean up, took my bag of stuff, had the hospital buy me new shoes, and warned the ER staff that I'd never some back if they did this to me again. They didn't! Bobbie

What a great thread! I simply cannot believe that this is generating so much controversy... I'm a 40 year old pediatric nurse practitioner, one who firmly believes it doesn't matter which parent stays home with the kids, as long as someone does. I've been married to the most wonderful man for 12 years, he gave up his career to raise MY 3 boys, who were 8, 4, and 2 at the time. Now young men, they credit their adoptive dad with their successes in life, and we couldn't be more proud. I worked the weekend plan for 7 years, 12 hour shifts, Fri, Sat, Sun, straight nites to pull in the money to make life good and get my master's degree, while Scott worked part time evenings during the week. Our kids simply accepted the fact that dads stay home. (BTW, one of my brothers is the primary caregiver for his daughters and has full custody of them as well) This just seems to be a family value for us. What has it done for our sons? It has given them the gift of sensitivity toward their mom, and other women as well. It has taught them that anyone can cook & clean & run errands, that the world doesn't have to be one that assigns jobs based on chromosomal makeup. That personality, much more than sex, determines who should raise kids and who should be the breadwinner. Pressure? Well, maybe...but I do carry insurance in case anything were to happen to me, just like any man would do. And will wonders never cease, my 18 year old son just graduated from highschool and is strongly considering a career in nursing-no gender bias there! Enough of this archaic predetermination of who should do what based on gender, instead, let's base life on who does what BEST! Oh, and BTW? Since when does staying at home and raising children consist of "sitting on one's duff?" Bobbie

I LOVE being a nurse! When people ask what I do, I say proudly, "I'm a nurse." When they ask where I work, I tell them I'm a nurse practitioner in a neurology clinic. The next question is always..."Oh, so you're going to be a doctor soon, then, right?" Then I have to explain why I never want to be a doctor... I love nursing for all the opportunities it has given me. I started as an ADN grad and worked NICU for 4 years, then PICU for 8, while earning my BSN & MSN. I'm a PNP now, but very disappointed as an NP, and will probably end up back at the bedside where I belong I've been a supervisor, a SANE nurse, worked in a family planning clinic, the ER, burn, trauma, started my own clinic in a residential care center for adolescents, and am now taking a position as the supervisor of clinical research for the organization I work for. (and I'm only 40!) What other profession offers all these choices?! You're only limited by your own inability to change in nursing. I'm very happy to say that one of my own sons is heading toward a career in nursing as well. He has a gift!

My son is a senior in HS this year... and has the gift of helping kids with disabilities feel that they have none...would I encourage him to be a nurse? ABSOLUTELY! He has a level of caring that surpasses most teenaged boys. And...he's a jock! I've been a nurse for 15 years, it enabled me to support our family, be a single parent, my second husband was able to stay home and raise our sons. I was able to work weekends and make excellent money, attend school during the week and earn a master's degree, become a PNP. I've changed my focus of nursing many times in my career...what other career offers the opportunity to do all that nursing does? Yes, it can be hard work, but absolutely rewarding work. I worked straight nights for 11 years...I know all about no breaks, low staffing and everything else everyone complains about. But through it all, I've never for a moment regretted my choice, and am heartily recommending it to my son, and anyone else who shows an interest in health care.

I've read all of the postings in this thread...& I'm truly saddened by what I've read. I've been a nurse for 15 years, & I still feel the same way about patients that I did as a new grad. Idealistic? Perhaps, but this poem illustrates why I became a nurse-to care for patients. Do I work hard? Yes, I do. Am I overwhelmed at times? Yes, I am. Are there not enough hours in the day? Occasionally. But the intrinsic reward of nursing remains the feeling of peace and well-being we can offer our patients & their families. I worked ICU for 9 years, home health care during that time, while I was earning my BSN, then my MSN. As a nurse practitioner and supervisor of a neurology clinic now, I never hesitate to help the clinical assistants in my department so they can get their breaks and offer their best to our patients. My 17 year old son is a nursing assistant on a busy orthopedic floor, and he cannot understand why everyone is always grousing about "how busy" they are, he never hesitates to help a patient, even if it is not"his." BTW, he cannot wait to go to nursing school. Bottom line all of you-caring is our business, if this is not making you happy, then really, you should find a new career, or a different path in nursing that does not involve patient care.