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cjcsoon2bnp MSN, RN, NP

Emergency Nursing
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cjcsoon2bnp is a MSN, RN, NP and specializes in Emergency Nursing.

My specialties are Psychiatric/Mental Health and Emergency Department nursing for the past 7 years. Up until recently I worked as a staff nurse and an adjunct clinical nursing instructor and I’m transitioning into the role of an ED Nurse Practitioner.

cjcsoon2bnp's Latest Activity

  1. cjcsoon2bnp

    Many nurses do not chart?

    I haven't been a Med/Surg nurse in a while because I'm in the ED now and the charting requirements are completely different but my previous nurse manager regarded me as a pretty thorough in the documentation department and I didn't have to stay late in a shift to document very often. Here is what I used to chart on my patients during a given shift: Initial Physical Assessment (Head-to-Toe) - Done at the beginning of the shift and completed using the template provided so if something was WNL (meeting each of the form criteria) then I would check that box and I would elaborate more on the systems that were directly affected by patient's problem (e.g. COPD Exacerbation - Cardio, Resp., Appendectomy - GI, Wound etc.). I don't repeat a physical assessment unless something changes during my shift. In this template we had sections for Fall Risk, VTE/DVT Prophylaxis, Braden Scale etc. Progress Note - Our hospital's policy was that if you worked an 8 hour shift then you only needed one physical assessment note for your patient but if you worked 12 hours then they needed some form of progress note or reassessment after 8 hours. I made a generic note that briefly described that the patient's condition that I was continuing care of the patient and the patient's physical assessment remained was unchanged from my previous note unless otherwise noted. If at any point the patient had a physical change (e.g. New onset of chest pain or abdominal pain with vomiting) then I would open up the physical assessment template for that specific system (cardio-respiratory, GI etc.) and check the findings along with write a comment of the interventions. If it was a complicated situation or had a lot of interventions I would write a progress note instead and put the physical assessment findings in that instead. I would only write a progress note if it was indicated, if I worked 8 hours and the shift was unremarkable then I wouldn't write it. Medications/EMAR - I would chart in our EMAR by scanning the meds. I don't re-write them elsewhere, if I need to say a patient refused or something special then I can add it as a comment in the EMAR for the medication in question. Care Plan - Our facility required us to write on the patient's care plan each shift. I found many nurses didn't do this because they found it to be redundant and a waste of time (I personally did not find it very "value add" documentation myself but I just wanted to follow the rules). I tended to be brief in the care plan and use the template provided to make it faster. Physician Communication or Critical Lab Value - There was a section in the chart for each of these and it was pretty I&O - If I emptied a urinal or admin. IVF then I would add what I needed to at the end of my shift based on a list I made. This was a shared task with the CNA so sometimes it was just me verifying/double checking that it had been completed. V/S - Similar to I&O this was a shared task with the CNA, I would write them if I took them myself but if I didn't then I would simply review it to make sure nothing was abnormal or need to be rechecked. That was my list of required documentation, I did not write a generic progress note that summed up the entire shift because I found it repetitive of the other documentation and it was not mandatory on our unit. When I was writing on the patient's care plan I would tend to include a few brief statements that could be described as a form of shift summary and gave a similar feel to the traditional end of shift progress note. I realize that physicians, case management and everyone else on the team enjoyed having the narrative progress notes that summarized the entire shift because it was easier to find the information (and I honestly liked reading them as well). However, with all of the additional requirements in documentation added to nurses over the years I don't have the time to do something if it is (a) not required per my hospital's policy and (b) if I have already included the same data elsewhere in the medical record (even if it requires a few more steps to find each piece). If our manager had reinstated the end of the shift progress notes or I hadn't chart something elsewhere in the record then I would happy to create a generic progress note. Lastly, here were a few other tips I found helpful. Using the WNL feature of the physical assessment form/template - I say this with caution because you need to make sure your template/form/checklist has a clear definition what WNL is for each category and you need to read through it carefully before you check it. Don't be the nurse that checks WNL under the peripheral vascular or musculoskeletal sections for a patient who is a bilateral below the knee amputee, you will look incompetent, lazy or inattentive. If you don't have a template/form within the chart that clearly defines WNL for something I would suggest you use that phrase carefully because you may need to be able to define the parameters of "normal" in your charting if you were ever to be audited.. Don't repeat the same thing 100X - I see a lot of nurses re-writing the V/S or meds. given in 100 different places on the chart and I don't understand why. If you are writing a progress/event note for a situation that required repeat V/S and med. administration you can write [see Vital Sign Flowsheet] [see EMAR] and that is appropriate. Give yourself time - This means give yourself time to learn what data is the most relevant and to refine your note taking ability. This also means to try to coordinate your shifts to give yourself plenty of time to write if you're someone who takes a long time to write. I agree with the other user who said many times the people staying late are the nurses who either write too much, talk too much, or struggle to plan out their time in the most efficient manner. I hope this helps! !Chris
  2. cjcsoon2bnp

    Accusing Hospice

    This is a great story, your message and choice of language created a really solid picture, at least in my mind. I agree with the user who suggested that it must be the family who brings up religion in these situations and I can appreciate that you were able to help them work through this with the use of their religion and beliefs (whether you shared those beliefs or not). I have worked with families of dying patients and when religion comes up I do my best to help support them using their belief symptom even if it is not one that I share. !Chris
  3. cjcsoon2bnp

    Nurse-client Relationship Boundaries

    I'm a clinical nursing instructor and I would tell my student that this is a matter of professional boundaries. I agree that it was a mistake and a momentary lapse in judgement but I understand how a student could have done it with the very beat of intentions. I know that if this was my student I would have a honest but supportive conversation with them so that they understood the error and would not make a similar decision in the future but I would not crucify them for this type of mistake (especially if it was a one time issue versus a pattern of behavior with poor decision-making/professional boundaries). As a student if this kind of situation ever came up again I would use the fact that you are a student to "break it gently" to the patient and just say that you would "get in a lot of trouble if you gave out any personal info or contacted a patient outside of the facility/hospital". If you ever are not sure about this kind of thing then you should also follow up with your instructor before acting so that they can help you. I also agree with the other users that that at this time I would NOT tell anyone at your school about this because you may be subject to some sort of disaplinary action. Just keep this advice in mind and if the patient contacts you via email then I would not respond to it. !Chris
  4. I understand the the idea of supply/demand and the concept that quality programs will produce quality graduates and only quality graduates will get jobs. However, I can't seem to get past my personal experience of seeing recently hired NPs in my faculty being poorly prepared to start in the role that they are hired for (Community ED/ER) and it is creating a preference for hiring PAs instead of NPs because it is felt that the PAs are better prepared. I think that when offices/facilities have a bad experience with a new provider because they feel like they are not well educated or prepared for their role then they tend to be quick to generalize the program where the person graduated and if it becomes a pattern then the entire profession gets blamed. The recent NP hires have come from schools with good/strong reputations, some havinf previous RN experience while others were accelerated/direct entry and they all seem equally unprepared for the role even as a novice practitioner. I will openly acknowledge that this is only my personal experience and does not constitute as concrete evidence for anything. It is merely a single pattern in one facility, in one part of the country. !Chris
  5. As usual I think that BostonFNP is right on target, programs that don't or can't secure sits for their students are sending a message that tuition dollars are valued above the quality of their students education. I am a FNP student who comes in with 5+ years of RN experience (5 part time in psych and 3 part time in ED) and I have decided as much as I like psych that I want to be an ED NP. I also love to teach and plan to obtain my DNP eventually just so that I can teach and help lead an FNP program. I am taking about these issues now because I really would like to be a part of the solution in improving NP education. I think that there are some really good points being made in this discussion and I'm glad we could get it back on track. !Chris
  6. cjcsoon2bnp

    Submit a School Review and Qualify to Win $100!

    More schools to add! :) Community College of Rhode Island (Public) Rhode Island College (Public) University of Rhode Island (Public) Salve Regina University (Private) New England Institute of Technology (Private) St. Joseph's School of Nursing (Private) !Chris
  7. cjcsoon2bnp

    Questioning a doctors order

    To the OP, I'm sorry that this was the response you encountered to a good question about patient care. As nurses, we need to remain vigilant about checking orders for our patients that are entered by LIP (physicians, nurse practitioners and physician assistants) as well as those from other disciplines (pharmacy, PT/OT, dietary, speech therapy etc. to make sure that they are safe and appropriate. Another user mentioned that many of the tasks that we do can easily be taught to anyone (monkey or otherwise) but the difference is the critical thinking that accompanies the carrying out of these tasks. Now here is some food for thought, you mentioned that it was your nursing supervisor who scolded you for suggesting that you question the physician's order. I have found in my nursing career that how nurses interact with physician's and other LIPs is highly culturally dependent. Keep in mind when I use the word culture I don't just mean race or country of birth/origin. When I use the word "culture" I'm referring to the total picture that includes: age, generation, race, religion, gender, personal communication style, educational background, institutional politics/hierarchy and other factors. I don't wish to make sweeping generalizations but I have noticed that sometimes nurses from certain cultural groups may be less likely to question the orders a physician because that was how they were raised. I have also noticed that nurses who are from the Baby Boomer generation approach communication and organizational hierarchy differently than Generation Y as another example. We should also keep in mind how someone's nursing education and background may play into this as well. I once worked with a nursing supervisor who was very knowledgeable in our speciality but he often told me that his ADN program emphasized the role of the nurse in carrying out orders and delivering care so he often felt that it wasn't in the RNs role to "challenege" the physician, although he would vocalize his concerns in obvious cases of a mistake on the part of the doctor. My only suggestion to the OP is when you have a question or concern about an order that you use a little finesse when "questioning" the order. I will review an LIPs progress notes at the time of the order change to see if they have discussed why they are writing a specific order and if it isn't addressed then I will contact them to "seek further clarification" or to "help me understand the rationale for my knowledge/education" and usually it goes over without an issue. I try to ask myself, is this something that I really need to address at this time (e.g. when I worked nights on a med/surg unit I tried not to call at 3 AM for an order that could wait to be addressed when the team did rounds in the morning). Keep your chin up OP and try to remember that it IS your job to question the safety and appropriateness of orders for your patients (just doing so in a mature, professional way). !Chris
  8. cjcsoon2bnp

    AANP National Conference 2017 Roll Call

    Sure did! I've signed up for a bunch of them including an basic splinting one, minor procedures, suturing etc. I know it makes me a huge nerd but I can't wait! !Chris
  9. cjcsoon2bnp

    AANP National Conference 2017 Roll Call

    I'm going! I'm a post-grad. FNP student (my MSN is in Nursing Education) and I graduate in Dec. 2017. I'm looking to go into ED or Urgent Care so I'm trying to work on developing some of those skills and procedures so I can find an ED job when I graduate. It's my first AANP conference but I didn't want to pass it up. !Chris
  10. I am happy to see that my article has generated so much discussion from the users and visitors to AllNurses. It is nice to share stories and see what the opinions are of other people in the field. It appears that the discussion may have gotten a little contentious and slightly shifted away from my original point so I would like to reiterate why I wrote this article. 1. I absolutely believe that breastfeeding is the best source of nutrition for babies and provides a countless number of health benefits (and there are probably more than what we know with current research. 2. Women and babies need a lot of support when learning to breastfeed because while it is natural it isn't easy to learn and is physically, mentally and emotionally exhausting for both mothers and babies. Support is encouragement, reinforcement and patience. 3. Counseling new mothers on the benefits of breast feeding and potential downsides associated with formula is fine. Part of nursing is health coaching and that includes discussing the effects of negative or unhealthy behaviors and there is a way to do that without chastising people or having to sugarcoat things either. It's about having a balanced, professional approach that is geared to helping patients meet THEIR health needs with what tools work for them (and that might not always match with our ideology as healthcare providers or what we would do personally if in the patient's shoes). 4. Overall, we are really happy with our experience in the hospital and remain thankful for all of the providers that cared for of my son and wife intra and postpartum. I think that the LC had really good intentions but needed education on the principles of health coaching and motivational interviewing which would have resulted in a better interaction and likely a better outcome. I have not written off all LC, I know that their job is important and that everyone has a different teaching style. This was only meant to bring light to what I feel is a very important issue. !Chris
  11. Before I go too far into this article, and risk being stoned to death by the maternal-child nurses, lactation consultants, and midwives out there, I would like to make a few critical points. I'm not against breastfeeding. I absolutely believe that breastmilk is the best food and source of nourishment for babies. I think that mothers should be encouraged to breastfeed their babies and supported throughout the process. I make no claim to be an expert in neonatal, obstetric, or pediatric fields. However, I'm a husband and a father and I will fight for what is best for my wife and child; even if that means it doesn't fit with the strict guidelines of the "baby friendly hospital" or "exclusively breastfed movement." As I mentioned in my last article, my wife and I are both nurses. Throughout this pregnancy, we have read every article about raising healthy babies/children and have committed to improving the health of our family. We live in a smoke-free home, try to cook healthy meals, engage in primary care regularly, and believe in the benefits of immunization/vaccination. So before our son arrived, it seemed like a no-brainer that he would be exclusively breastfed as recommended by the American Academy of Pediatrics (AAP) and World Health Organization (WHO), among many others. Fast-forward to after bundle of joy arrived as I helplessly watched my wife and son struggle with the complicated process of learning to breastfeed. One-by-one each nurse caring for my wife and son would help with positioning and latching, but it never seemed to work correctly. After each nurse had left the room, I saw the look of exhaustion and disappointment in my wife's eyes because it was becoming harder with each feeding and not easier. We inquired about using one of the hospital's breast pumps to help stimulate milk flow but this was met with a great deal of hesitation and remarks of "It's really best to just keep trying naturally, he will catch on soon." Next came the lactation consultant, a nice enough woman who is clearly passionate about her job but made it clear that there is only one way to feed a baby "breast is best". To her credit, she spent an extensive period of time coaching my wife and helping my son. She strongly discouraged the use of a breast pump by suggesting that this be reserved until closer to when my wife would return to work. Whenever my wife voiced anxiety, concern, or disappointment she was told that this was "a part of the process", "completely normal" and "just because it's natural doesn't make it easy." We were discharged from the hospital with packets of paperwork, breast shields, and other tools that reminded us to keep up with the exclusively breastfeeding. Over the next 24 hours at home my wife, put our son to breast at least every two hours (usually every hour), and he would latch for 15 - 20 minutes on each breast but continued to appear fussy after feedings. We were told that this was common with "cluster feeding" and not to worry or allow this to derail the breastfeeding efforts. He remained alert, active and had plenty of wet diapers, so we continued to watch him closely. At the next day appointment with the pediatrician we were told that our son had severely elevated bilirubin, lost 12% of his birth weight, and had to be readmitted to the hospital. As parents, we felt that we had failed our child. We followed the treatment team's discharge instructions implicitly, and still he decompensated so quickly. We are nurses, and yet we have missed such significant weight loss. How could we have let this happen? If I had only gone to the store and bought some formula, I might have avoided this. He was readmitted to the hospital and placed in phototherapy, we sat by him and watched helplessly hoping that it would help his little body to remove the excessive bilirubin quickly. My wife remained quiet, but I saw the look on her face knowing that she felt like she was a failure as a mother. I requested that the nurses provide us with formula and a breast pump while we resumed a two-hour breastfeeding schedule with formula supplementation to ensure he received at least 1 oz. per feeding. Breastfeeding continued to be a struggle, but after each attempt, he was offered pumped breast milk and formula (if needed) to ensure he had enough to eat. In the morning the same lactation consultant came to our room to visit us with a commitment to help "fix the problem." She "permitted" my wife's use of the breast pump after each feeding to obtain additional breast milk but wanted to work on getting the baby "back to the breast where he belongs." She made no qualms about "strongly discouraging" any use of the formula because it "can't match the nutrition that your breast milk provides" and "we only want the baby eating the best and most nutritious food". Each time that my wife expressed concern with the idea of stopping the formula supplementation I saw the lactation consultant shut down her protests. As a psychiatric/mental health nurse, I knew that this form of coaching transitioned from inspiring and supportive to instilling guilt and dismissive of my wife's needs, a method that was sure to fail in the long-term. Eventually, I decided that this dad had enough and I had a "come to Jesus" moment with the well-intentioned lactation consultant and spoke to her "nurse-to-nurse". I told her that my wife would continue to try to breastfeed, but I would not allow her to be bullied into doing things only one way and that my son will be fed in whatever way he needed to grow. I refuse to sacrifice her mental health and ability to bond with him just to say that he was "exclusively breastfed the natural way". While the consultant's intentions were good and she was clearly an expert in this area, I told her that this form of coaching does not best ensure a patient's long-term compliance with any health promotion intervention (e.g. weight loss, smoking cessation, breastfeeding). If a patient's needs are so easily ignored then it creates a divide between patients and providers that is unhealthy to the working relationship. As you might expect, this was not met with tears of joy or heartfelt thanks but we came to an understanding that we would do what needed to be done for our child. We are now at home, my son primarily consumes breastmilk out of a bottle with some formula supplementation, and he is doing very well. This may not be what works for everyone and does not follow the strict recommendations of exclusive breastfeeding for the first six months of life but it works for us. I haven't told this story to discourage people from breastfeeding their babies or to imply that we ungrateful for all of the help and support we received in the hospital. I shared our story to help educate parents and healthcare providers. Parents, you need to listen to their instincts and if you feel something is jeopardizing the safety of your child(ren) then you need to speak up. You need to work with your healthcare providers to achieve the best possible health your child(ren) because you are on ultimately the same team. Healthcare providers, we have a great deal of knowledge and access to resources that the public doesn't have but if we don't listen to parents/families then we won't be able to foster therapeutic relationships or achieve the best possible health outcomes for our patients. I would like to begin a discussion with the allnurses.com readers include the perspective of parents/grandparents/family members and healthcare providers. Here are some questions to consider... Do you think that we have gone too far in advancing the "breast is best" movement Should we be advocating for "fed is best" instead? Have you personally felt pressured that breastfeeding is the only correct way to feed a baby? Do you see patients being pressured to feel this way in your workplace? If so, who are the groups/individuals who are responsible for this? How do you feel about some baby-friendly hospitals refusing to provide parents with formula unless there is a physician's order (as a method of enforcing exclusive breastfeeding)? What are your tips for encouraging breastfeeding in a way that is supportive of parents without being dismissive of their concerns and beliefs?
  12. Thank you for understanding that and you make some great points. I'm working on a follow-up piece to this article that talks about what happens when your baby/child is sick or has an unexpected complication and you struggle to separate yourself from parent versus nurse. I really struggled with this and I'm sure that its something that I will continue to struggle with for a while. !Chris
  13. cjcsoon2bnp

    Hourly charting

    I have a few favorites in my charting when I have to write something. Many times I will put something like... "Patient resting on stretcher with eyes closed, respirations even and unlabored. No signs/symptoms of acute pain or respiratory distress. RN will continue to monitor." "Patient updated on plan of care by RN, no questions/concerns at this time." "Patient denies pain currently and reports resolution of nausea/vomiting after ***** administration. MD aware and RN will continue to monitor." You get the jist, just something that basically says you know the person is still alive in their room and haven't completely abandoned them. I am always a little hesitant of attaching charting requirements to ESI levels because I have seen nurses lower a patient's ESI rating because they don't feel like having to deal with the increased monitoring and charting (Rating a level 3 abdominal pain workup as a level 4 just to avoid the more frequent V/S and more detailed charting). !Chris
  14. Most people who know me from this site know that in addition to being a practicing nurse and graduate student, I'm also a new dad. For the entirety of my wife's pregnancy, I read everything I could get my hands on about babies and fatherhood and my free time was spent reviewed the current literature and evidence-based practices about childbirth and care of neonates. As you can imagine, my wife's OB/midwife and the nursing care team found my incessant questions helpful, thought-provoking and refreshing. Throughout most of this pregnancy I was able to form intelligent thoughts and remained relatively coherent, but as soon as we were admitted to the labor and delivery unit I felt my IQ plummet and all that I have learned as a nurse escaped me. I started writing this from the comforts of a plastic pull out chair in our delivery suite. Its not because I'm disengaged from the process but because my wife has ordered me to do something that will keep me busy and provide her with a moment of peace from my dissent into madness. Now that we are heading into the tail end of this adventure, here are a few things I have learned so far. 1. Pack the car early, be ready for anything and realize the birth plan is merely a wish list. My wife and I arrived at the OB/midwife's office for our 40-week routine check-up appointment, and within 15 minutes of the visit she was being transported to the labor and delivery unit for admission because of hypertension and possible preeclampsia. This was certainly not in the birth plan but thankfully my wife insisted that pack the car earlier in the week "just in case". Even though my wife and I are both nurses, the whole situation left us feeling confused, overwhelmed, and frightened. Thankfully it has worked out well and we have our little guy safe and sound. 2. Television and movies often make childbirth appear as if it is quick and results in the perfect child. My wife ended up being induced for medical reasons and then delivered our son vaginally 30 hours later. I'm not saying that there aren't people who come to the hospital and deliver their child within a few minutes/hours (especially for multiparous women and those waited until the later stages of labor before leaving home). However, many women come to the hospital actively in labor and end up waiting hours before delivery (a fact emphasized by the nurses on the labor and delivery unit). I'm by no means an expert, but Dads need to be patient and realize that you may be waiting a while for your little one even after Mom gets admitted to the hospital and is actively laboring. The second part of this is that Hollywood has a nice way of showing newborn babies as chubby, normocephalic and free of any and all blemishes. Babies are amazing and beautiful little creatures, but sometimes they look a little funky when they first arrive. Case in point, If a woman is delivering vaginally, there is no way in heck that the baby isn't going to have the characteristic baby cone head. Cone head is expected and will resolve within the first few days of life but I have yet to see a television show or film that depicts a real cone head baby. They also don't show a lot of babies with blemishes such as stork bites, cafe au lait spots or Mongolian spots and yet 80% babies have at least one type of birthmark. Why do I mention this? I say it because your baby is likely to have a few birthmarks and maybe have a little cone head going on but when you see them for the first time you are blinded by their perfection. 3. Treat the nursing staff well and they won't forget it. My mother told me that when I was born my father made a point of buying the OB nurses a ton of snacks and took every opportunity to remind them how much he appreciated all of their support during the delivery and postpartum phases. Interestingly enough, my mother found that her medication was never late and many of the nurses volunteered to sit with me so that she could have time to sleep while recovering from delivery no matter how busy the unit was. As a nurse myself, I know that we are usually not paid nearly enough for all that we do and any acknowledgment or sign of appreciation from a patient only inspires me to work even harder. The unit we were on has been very busy over the past few days and I have taken the chance to buy food (pizza, cookies, fresh fruit/veggies, etc.) for the nursing staff on a few occasions during our admission to show our thanks. I'm not sure if it has influenced my wife's care but I've noticed that all of the staff seem to go out of their way to ensure that she and the baby remain comfortable. Besides the potential of gaining the love of the OB staff, its nice way to show the appreciation for all of the hard work that they do including: labor coaching, breastfeeding assistance, parenting education and administration of direct care. My next step once we are settled at home is to write the hospital a letter of appreciation that will include the names of all of the nurses that helped us during our stay (I made a few quick notes so I wouldn't forget). 4. Take help whenever you can get it. I realize that we are lucky to have such a supportive network of family and friends and not everyone has such a support system but if you do don't be afraid to accept help when it is offered. We have had people bring us food, help with household chores, help to watch the baby for short periods of time while we rest and just provide a supportive listening ear or shoulder to cry on. Don't be afraid to set limits with visiting and having guests to see the baby but also realize that if you are clear with what you need for help many people are understanding and willing to do whatever it takes. 5. Sleep is by and far the most valuable commodity. Money means nothing to us anymore, I am exhausted but I have been able to catch more naps than my poor wife who is up constantly to feed our little guy (cluster feeding is a sick joke of mother nature by the way). I joked with some of my new Dad friends (I'm already working on getting "Dad friends") that I would sell my soul or empty my life savings to buy my wife some much-deserved rest. Right now we are just taking it day by day and I know that it will get better with time but I remain firm that sleep is the most valuable commodity. 6. Childbirth is the messiest and yet most beautiful process in life. My wife actively labored (pushing at 10 CM and 100% effaced) for 2 hours before our son was ready to come out. For the first hour and a half, it was her nurse and I coaching her, holding her legs and helping her to push before the OB arrived in the last 30 minutes to catch the baby. In my wife's own words, the whole ordeal was hot, sweaty, messy and a "crime scene of body fluids". Nurses aren't squeamish and I have seen more than my fair share of body fluids so it wasn't a big deal for me at all but for some dads it might be a lot to process all at once. All I can say is that even when she felt "hot, sweaty and disgusting" I was in complete awe of her and couldn't have been prouder of her. She was as beautiful to me in those moments as she was on our wedding day and I will never forget it. All I could do was continue to whisper in her ear that I was so proud of her and she did such a good job. 7. Don't be surprised if you suddenly forget everything you ever learned about being a nurse. I am an experienced ED nurse, I have cared for children of various ages and when it is someone else's child I can remain calm and collected even when they cry and appear in great distress. When I hear my boy cry I become a stupid and clueless mess, on some level I know logically that as long as he is clean/dry, warm, and fed that he is not suffering and just needs to be held and settled but that doesn't stop me from going into crisis mode. I know that in time this will get better and we will eventually get settled into a routine but for now his mother and I need to cut ourselves some slack. The hardest thing to and realize that we aren't his nurses/healthcare providers I know that there is more but I think that sleep-deprived delirium is beginning to set in so I will call it a wrap for this article. I ask you allnurses.com readers (dads, moms, grandparents, etc.), what stories or advice do you have to share about childbirth, becoming a parent for the first time, and the challenges of switching from "nurse mode" to "mommy/daddy mode"?
  15. All nurses begin with a foundation of basic knowledge instilled during nursing school to which we add specialized knowledge in specific area(s) of practice through continuing education and experience. Developing clinical content mastery requires an extensive amount of time, training and practice as well as a personal commitment to lifelong learning. Being recognized as a content expert amongst our peers can be helpful to instill pride in our work, improve patient care, and promote camaraderie amongst healthcare teams. Following these steps, you can begin your path to becoming a content expert and advancing your professional nursing career. Step I Take a moment to examine your specialty and make a list of topics, procedures, and practices. After you make a list, pick a few of the items for which you have expertise, interest and a plan to continue with ongoing education. Take a few minutes to consider these items and make a list (you can write it out or make the list in your head). For example, my specialty areas are emergency department and psychiatric/mental health nursing and so I make lists for each specialty. A list for emergency nursing could include procedures (e.g. IV access in children, burn/wound care, NG tube insertion, urinary catheterization); practices (e.g. triage, physical assessment documentation, behavioral de-escalation); topics (e.g. acute management of COPD exacerbation, opiate overdose, diabetic ketoacidosis). The list of topics goes on and on so if you are struggling for ideas you can check the professional organizations for your practice area (e.g Emergency Nurses Association [ENA] for emergency nursing). Consider, have you have ever received feedback from your peers that they admire how you complete ABC? Or do they always ask for your opinion on XYZ? If that is the case you should consider add it to your list. I like to make a list that includes both my psychiatric/mental health and emergency department nursing experience. In my position as a PMH nurse, I am recognized for my knowledge in psychopharmacology, acute management of substance withdrawal (alcohol, anxiolytics/sedatives, and opiates), and psychiatric nursing assessment documentation. In my position as an emergency department nurse, I am recognized for my ability to verbally deescalate agitated/anxious patients, complete an comprehensive triage assessment, document detailed physical assessments, and obtaining difficult IV access (stronger skills with adults and children versus elderly patients). Step II Gain recognition as a content expert by identifying your interest in the topic to peers and management/leadership, volunteering to participate on related committees/groups, completing CEU and/or attending workshops/conferences, and offering to assist or teach peers. So now that you have figured out your topics of expertise, its time to figure out how to gain appropriate recognition. Keep in mind that this is not accomplished instantly, it takes place over time with experience and practice. Begin with completing CEUs, reading journals, attending workshops/conferences, obtaining specialty certifications and share that information with your unit. Speak to your management team to indicate your interest and see if there are opportunities to join a related committee/group or to provide an in-service to other nurses on the unit. It sounds simple but offer and be willing to assist your peers, they may not ask for a lesson but may appreciate your help in completing a task (such as interpreting an EKG). Don't forget that no one is an expert in everything and no one likes a no-it-all! Make sure that you acknowledge your areas of weakness and seek the guidance of peers who are content experts in these areas. Step III Be an advocate for advancing the standard of care/practice in your unit by contributing your content expertise. Step III is really just a continuation of Step II because it is not enough to simply possess knowledge, but we must share it and then use it to help others. Examine how your unit or setting approaches a particular situation or condition (e.g. initiating cardiac workup in emergent chest pain, successfully obtaining IV access in young children in community/non-trauma center settings) and start a discussion with nursing leadership, clinical education and direct care staff on how to improve existing practices. If you are suggesting any changes in policies or procedures at your office/facility, make sure that you have evidence-based research to support your recommendations. We have only scratched the surface of this topic but hopefully, it has inspired you to become the "go-to" guy/girl on your unit for content with your nursing specialty! So allnurses.com readers, tell me what are you a content expert in and how do you maintain that mastery?
  16. cjcsoon2bnp

    $29/hr--why am I still in this job!?

    After reading this I'm sad that I can only hit the "Like" button once. As always, Jules tells it like it is. She is an APRN who makes no apologies for having high standards and being appropriately confident her abilities and self-worth. !Chris