My diverse career as a nurse

I wanted to be a nurse for as long as I can remember. I started volunteering at a local hospital as soon as I was old enough and when college application time care around I was certain that nursing school was where I wanted to be. After a 4 year program and with my BSN under my belt, I began working as an RN in the medical intensive care unit of a university hospital.

After a few years, I decided to return to school and further my education. While I remember considering a critical care nurse practitioner program, I ultimately decided to study women’s health. It took me about 4 years to get my Master’s Degree – working weekends while attending classes and clinicals during the week. Caring for women (mostly healthy and many pregnant!) in an outpatient setting was a very different experience than caring for critically ill patients in the hospital.

The next stop in my career was as a clinical editor. I just happened to see an ad for a position in a local nursing publication, and although I wasn’t entirely sure what “clinical editor” even meant, I decided to apply for the job and find out. What a change I was in for! I was in an office setting and wearing real clothes. I spent my first 6 months in a film studio helping to produce nursing videos. If anyone had ever said that as a nurse, I could someday be writing scripts on ECGs and I.V. insertion, recruiting talent, and spending time in an edit suite, I never would have believed them!

Of course, there were bumps in this road…financing my education, reality shock, planning and managing personal and family responsibilities, just to name a few. I’ll have to save those for another post! Well – that’s my story, what’s yours?

 
Posted: 2/24/2010 3:56:42 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career


Putting a face on ostomy complications

Both the American Journal of Nursing and Nursing2010 published articles in their February issues on ostomy management and complications.  I read these articles with great personal interest but I wondered, where were these articles 10 years ago? 

My oldest daughter was diagnosed with ulcerative colitis when she was 7 years old and despite aggressive treatment for her disease; she required a total colectomy, temporary ileostomy, and an ileo-anal anastamosis when she was 12.  As a nurse I thought I was equipped to care for her ileostomy; was I ever wrong.  I had experience taking care of hospitalized patients with ostomies, but I quickly learned caring for someone who is active is a totally different story. The 3 months she had her ileostomy were sheer hell!  She developed a multitude of complications and we went through several different types of appliances before we found the one that fit her and wouldn’t fall off when she moved. The nurses who were helping us were good but, it was clear there wasn’t a real understanding of how to manage active patients, let alone children, and their complications. 

I am thankful that my daughter is well. If you ask her, she will tell you that the date of her surgery was the beginning of her new life.  But she will also tell you, living with an ostomy was the most challenging experience she has ever endured.  Thank goodness we now have access to the information and equipment that can make an active person’s experience living with an ostomy better.     

Posted by Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Posted: 2/17/2010 7:09:17 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


To report or not to report?

Last week, a nurse in Texas was acquitted after a being on trial for reporting a doctor for practicing bad medicine.  Here are some of the details from the case, which came to be known as the “Winkler County nurses” trial:

  • Two nurses, Anne Mitchell and Vicki Gale, reported a doctor because they were concerned about his practice being below the standard of care and affecting patient safety. Another concern was his use of “nontherapeutic treatments and prescriptions.”
  • The case against Gale was dismissed; however the felony indictment will remain on her record.
  • Mitchell faced a third-degree felony charge and up to 10 years in prison for trying to protect her patients.
  • Both Mitchell and Gale were fired from their jobs.
  • The American Nurses Association (ANA) and Texas Nurses Association (TNA) both demonstrated their supported openly. The TNA created the TNA Legal Defense Fund to “to support the legal rights of these nurses in Winkler County – and the rights of every practicing nurse in Texas to advocate for patients.”
  • On February 11, 2010, Anne Mitchell was found not guilty.

You can read more about the details of the case as chronicled by the TNA here

“I was just doing my job,” relayed a jubilant Anne Mitchell, in a phone conversation with TNA immediately following the not guilty verdict, “but no one should have to go through this,” she said.  “I would say to every nurse, if you witness bad care, you have a duty to your patient to report it, no matter the personal ramifications.  This whole ordeal was really about patient care.”

My heart goes out to both Mitchell and Gale for all that they have endured over the last months. While the verdict is a success for nurses and patient safety, what damage has been done simply by the fact that such a case was brought to trial? What are your thoughts? Have you ever been in a similar position in which you felt patient safety was being compromised by a colleague? How did you handle it?

 

Posted: 2/15/2010 8:03:39 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Beauty from the inside out

Recently I read the story about Heidi Montag and her obsession with plastic surgery.  Looking at the before and after pictures, it was difficult to see why someone as beautiful as she was before the surgery, wanted to have plastic surgery at all.  Did she really have Body Dysmorphic Disorder; a preoccupation with an aspect of one’s appearance real or imagined?
 
According to the American Society for Aesthetic Plastic Surgery statistics from 2008, the top procedures for the 18 year old and under age group were rhinoplasty and laser hair removal (160,283 procedures collectively).  For the 19-34 year old age group; breast augmentation and laser hair removal were the most common (2.2 million procedures collectively).  Research has shown that if a BDD patient has surgery, their symptoms don’t disappear.

I asked my 3 daughters, who are 11, 16, and 21 years of age, what they thought about aesthetic surgery in young people.  While the 2 older ones extolled the virtues of laser hair removal over shaving; they told me that some of their class mates were given plastic surgery for birthday and graduation presents.  The 3 of them all agreed that if you aren’t happy with who you are inside, you will never be happy with who you are on the outside.

What do you think about young people and aesthetic surgery?   As nurses, how can we help identify people with BDD and get them the help they need? 

Posted by Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Posted: 2/10/2010 7:14:27 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


Everything I know about nursing, I learned in… wait – when did I learn that?

For those of you who follow me on twitter, you know that I try to write a daily nursing tip. Sometimes, these tweets generate discussion. One tip in particular that seemed to get people talking was this:

“Don't palpate both carotid arteries at the same time or press too firmly; pt could faint or become bradycardic.”

I did ponder posting this one, because really – don’t all nurses know this already? But then I got to thinking – did I know this already as a nursing student? As a new nurse? When did I learn this?

It’s been a while since I was in nursing school, but I do remember learning a lot about nursing theory, even more about care plans, and of course, I’ll never forget the steps of the nursing process (assess, diagnose, plan, implement, evaluate!) I can’t deny that all of these things built the foundation of my nursing knowledge. But what isn’t clear to me is when the clinical skills and knowledge became ingrained in my brain – when I learned how to calculate a dopamine infusion to maintain someone’s systolic blood pressure above 85 mmHg, when I learned to approach a family about end-of-life issues, or how I learned to prioritize the needs of critically ill patients. When did these things happen?

In 1984, Patricia Benner published From Novice to Expert: Excellence and Power in Clinical Nursing Practice. In her landmark work, the author describes nurses as going through five stages of development – novice, advanced beginner, competent, proficient, and expert – with each stage building upon the knowledge and skills of the previous one. Think of your own experiences – where do you fit in this model? How will you get to the next level? 

Posted: 2/8/2010 10:05:38 AM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Education & Career


Lancet retracts MMR vaccine and autism risk paper

Earlier this week, Lancet retracted an article published by Dr. Andrew Wakefield in 1998 which stated the MMR vaccine could increase childrens risk of developing autism.  "According to the judgment of the U.K. General Medical Council's Fitness to Practice Panel on January 28, 2010, it has become clear that several elements of the 1998 paper by Wakefield et al, are incorrect in particular the claims in the original paper that children were consecutively referred and that investigations were approved by the local ethics committee have been proven to be false. Therefore, we fully retract this paper from the publishing record."

While numerous studies following this paper reported that there wasn't a relationship between the MMR vaccine and Autism, the damage was already done. This study resulted in parents not having their children vaccinated and led to an outbreak of measles in the U.S. in 2008 and an increase in disease in the U.K. Too often lay persons and clinicians accept the results of one study as being enough to change assumptions and practice.  As nurses we need to educate our peers and the public that research must be reviewed for validity and accuracy.  Just because something is published, doesn't make it good science. We must use established evidence-based and best practice resources to guide our practice. Cochrane Systematic Reviews, the Joanna Briggs Institute, and other established evidence-based practice resources and journals can help us improve practice and improve outcomes.  What resources are you or your facility using to improve patient outcomes?

By Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC

Posted: 2/3/2010 1:19:14 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Evidence-Based Practice


Is there an app for that?

Technology – seems many people either love it or hate it. I must admit that I am one of the former.  It amazes me that my children won’t ever have to do a paper by solely researching in textbooks or encyclopedias, or dare I even say it – using a typewriter! 

In the critical care unit where I worked, we often trialed new I.V. pumps, thermometers, telemetry monitors, pulse oximeters, and the like. I never minded the required inservices – I looked forward to learning about new machines that would help us provide better care.

These days, technology goes beyond the excitement (!) of tympanic thermometers. Nurses now carry any number of personal digital assistants, or PDAs, and have information literally at their fingertips. Amazing! Getting drug information right at the bedside? Sure. Lab results delivered by text? Why not?

On our Facebook and Twitter pages, we recently posted a QTc calculation “just for fun” and the lack of response really surprised me. Was it too difficult? Were our fans and followers just not into it? Or perhaps nurses don’t have to calculate a QTc anymore because it is done for them – either directly on the telemetry monitor or 12-lead ECG machine, or perhaps the QT and R-R interval can just be plugged into their (insert device of choice here) and Voila! -  the QTc appears.

All of this talk about technology reminds me of a very helpful tip though – Treat the patient, not the machine! I’ll admit I’ve been guilty of running into a room thinking a patient was in ventricular tachycardia only to find him brushing his teeth. How about you?

Also, I’m curious, when is the last time you calculated a QTc?

By Lisa Bonsall, MSN, RN, CRNP

Posted: 2/2/2010 10:46:21 AM by Cara Deming | with 1 comments

Categories: Technology


Trusting nurses to influence health care

Last week, Gallup released the results of the survey: Nursing Leadership from Bedside to Boardroom: Opinion Leaders' Perceptions. The results of this survey, performed on behalf of the Robert Wood Johnson Foundation (RWJF), revealed that nurses do not have as much influence on health care decision making as perhaps we should. The experts interviewed (insurance, corporate, health services, government and industry thought leaders, and university faculty) reported viewing nurses as trusted professionals and the majority said that nurses should have more influence on health policy, planning, and management.

So what are the barriers? Here is what they found:
• Compared to doctors, nurses aren’t perceived as important decision makers or money makers.
• Nurses focus on primary rather than preventive care.
• Nurses don’t have a single voice on national issues.

On a similar note, each year, Gallup surveys Americans about the most honest and ethical professions. 2009 marked the 8th consecutive year that nurses have been voted the most trusted profession in America.

So if the both the experts and the American public feel this strongly about our trustworthiness and decision making capabilities, and if we believe that we can truly make a difference, what are our next steps as a group? How about as individuals? How can we overcome the reported barriers?

Posted: 1/25/2010 4:17:45 PM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Education & Career


Disaster Preparedness: Education and Training

  Hi, I'm Karen Innocent, Director of Continuing Education and Conferences for Lippincott Williams & Wilkins. I'm very delighted to have this privilege and opportunity to share insights on continuing education and other issues related to nursing professional development with you through this blog.
  The topic for today is education and training on disaster preparedness. By now you have encountered more than a week of news reports about the earthquake in Haiti. This strikes close to home for my family. My husband grew up in Haiti, and has friends and family still living there. While most of the family has made contact, the communication problems has left the well-being of others unknown. Like many other compassionate observers, we wait anxiously for good news and are doing what we can to send help.
  As a nurse, the most troubling part about witnessing the aftermath of this disaster is seeing the uncoordinated rescue efforts and difficulties that had occurred with providing medical services and supplies to survivors. It is a shame that many people may die because of lack of access to basics such as antibiotics or clean drinking water. This underscores the importance of government and social agencies having a plan and trained professionals ready to respond to emergencies.
  Not many of us were aware of the possibility of an earthquake in Haiti, particularly because the Caribbean Islands are more concerned with the threat of hurricanes. Just as this unexpected tragedy occurred, there is a possibility that natural disasters or accidents of large proportions could occur anywhere. Nurses may be called upon to assist in these emergencies. While nurses are highly educated and have specialized skills, we all might want to brush up on emergency response because we never know when a disaster might hit our home towns.
   We'd like to know what you are doing in your community to prepare for disasters, and how your employer is training nurses on the leadership, organizational, and clinical skills needed to respond to emergencies.

Resources
   If you do not practice in emergency, trauma, or public health, it's likely that you could use a review. So I've collected a group of links to websites with reading materials on emergency preparedness that are designed for nurses, health professionals, and the general public.

Emergency Preparedness for Home Healthcare Nurses, Home Healthcare Nurse, January 2006: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=621933

Essential links: Emergency Preparedness, Home Healthcare Nurse, January 2006: http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=621942

Ready. gov: http://www.ready.gov/

National Library of Medicine, Disaster Preparation and Recovery: http://www.nlm.nih.gov/medlineplus/disasterpreparationandrecovery.html

How Can I Help?

For those who want to volunteer, you may be interested in contacting the following organizations that are sending healthcare professionals to support the rescue and recovery efforts in Haiti.

Center for International Disaster Information: http://www.cidi.org/

United States Government: http://www.usaid.gov/locations/latin_america_caribbean/country/haiti/eq/dstechas.html

The American Red Cross: http://www.westred.org/Volunteer-Disaster.htm

Post by 
Karen Innocent, MS, RN, CRNP, ANP-BC, CMSRN

Posted: 1/22/2010 8:46:32 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Education is good, but action is better

Since last April, a big part of my job has been reading, researching, and writing about H1N1 influenza. Many friends, family members, and colleagues were aware of this and came to me for information about the virus, and then, in the fall, about the H1N1 vaccine.

I’ll admit that I was skeptical about the vaccine at first; however, I made the decision to follow the recommendations of the CDC and get vaccinated. I called my doctor’s office….”No vaccine in yet”. This was the response for several weeks. In the meantime, my children got vaccinated at school (seasonal and H1N1) and my husband got both vaccines at work (he’s a respiratory therapist). We also all got....THE FLU! H1N1? Maybe.

So, here it is, January 20th, and still no vaccine for me. I contemplated skipping both my seasonal and the H1N1 vaccines this year since we are so far into flu season already. Then last week, in an open letter to the American people, the CDC reminded me (and the rest of Americans) that flu season traditionally lasts until May. In that same letter, I also learned that there are currently over 110 million doses of the H1N1 vaccine available. Great – I thought – I’ll do it! I called my primary care office to make appointments for the seasonal and H1N1 vaccines but wasn’t able to schedule them because while they do have the vaccines, they don’t have enough staff to administer them. I was instructed to call back next week.

This got me thinking... While it is great that we educate and encourage people to get vaccinated, how can we make it easier for them to do so? One colleague recently needed several vaccinations as well as a titer drawn for varicella before some upcoming travel abroad. Luckily she was able to get all of her needs met at occupational health where she works. While I am happy my colleague could get her needs met in a timely fashion, in one appointment, in a convenient setting, would this be as easy for a layperson? My husband got both his vaccines at work, during his shift – great for him, but how about the patients he cares for who have to wait for appointments and may have to schedule multiple visits to get their needs met?

While it is great that we educate our patients and the public about staying healthy, how can we improve the system?

Posted: 1/20/2010 3:20:15 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


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