R-E-M-E-M-B-E-R (Part 2)

Hi again! Here’s part 2 of my mnemonics list. These tips need a little more explanation, but they worked for me, so perhaps you’ll find some value in them as well.

To remember the types of white blood cells and their descending proportion in a blood sample…
“Never Let Monkeys Eat Bananas” = Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils


To remember where lymphocytes mature…
B cells mature in the Bone marrow; T cells mature in the Thymus


To remember the cranial nerves…
“On Old Olympus Towering Tops, A Finn And German Viewed Some Hops” = Olfactory, Optic, Oculomotor, Trochlear, Trigeminal, Abducens, Facial, Acoustic, Glassopharyngeal, Vagus, Spinal Accessory, Hypoglossal


And to remember the functions of the cranial nerves (sensory [S], motor [M], or both sensory and motor [B])…"Some Say Marry Money But My Brother Says Bad Business Marry Money."


To remember the location of the adrenal glands…
Think ADD RENAL; they're "added" to the renal organs, the kidneys.


That’s all for now! Here’s R-E-M-E-M-B-E-R (Part 1) in case you missed it!



Posted: 2/18/2011 9:45:32 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

R-E-M-E-M-B-E-R (Part 1)

As you can imagine, I do a lot of reading about nursing. Journals, books, newsletters, blogs - you name it and pretty much I’m reading it! I think I’ve mentioned before how some titles really hook me. I love lists, so when I come across anything that starts with “Top 10” or “Tips for” or “List of” chances are that I will open to that page or click that link. Another one of my favorite things are mnemonics, or easy tricks for remembering complex things, which in nursing school and in practice, are very helpful!

Here are some of my favorites:

To help organize your day…
IMAGE: Introduce yourself, Medications, Assessment, Goal, Explain & Educate


To evaluate a symptom…
PQRST: Provocative/Palliative (what makes it better/worse), Quality/Quantity, Region/Radiation, Severity, Timing


To assess skin lesions…
ABCDE: Asymmetry, Border, Color/Configuration, Diameter/Drainage, Evolving


To assess pupils…
PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation


To include in your documentation…
PIE:  Problem, Intervention, Evaluation


More to come soon...do you recall the one for remembering all the cranial nerves?

Posted: 2/17/2011 9:44:06 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

Snow day?

As I sit here, looking out at the 16+ inches of snow, telling my kids that “Yes, you have another snow day,” I am reminded of the 'snow days' back when I was working in the ICU. Those days were a little different. They involved phone calls upon phone calls trying to round up staff in preparation for an upcoming storm, setting up cots in hallways, and packing a bag knowing I’d be spending a few days at the hospital. One year, our manager actually got a hotel room across the street from the hospital. We’d ‘tag-team’ each other, taking turns heading over to get a few hours of sleep. I have to admit it was fun and definitely fulfilling, despite the sleep deprivation!

Do you have any particular snow day memories in your career? Do you find that you are spending a little extra time at the hospital this winter? Thank you, nurses, for your dedication and caring! Be safe!

Posted: 1/27/2011 10:36:13 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

Getting ready for the future of nursing

Have you made any adjustments in your career goals or education plans based on the RWJF and IOM Report , The Future of Nursing: Leading Change, Advancing Health, released last October?

I have been away from clinical nursing since 2001. I can’t believe that it has been 10 years. I’ve always believed that someday I would go “back to the bedside” and I really do miss taking care of patients. It’s been a little more noticeable to me lately just how much I miss the clinical side of nursing. I’m not sure if it’s because the fact that it’s been 10 years overwhelms me or because I am excited about the direction in which our profession is headed. Perhaps it’s a little of both.

The question that really gets to me is where do I want to be? Critical care was my home for most of my clinical career.  I loved the thrill of caring for acutely ill patients and their families. Titrating vasoactive drugs, assisting with invasive procedures, using the latest technologies - all so cool! Admissions from the ER, “road trips” to diagnostic tests, end-of-life discussions, and the list goes on…

However, my “other list” is quite impressive to me also. As a women’s health NP, it was so fulfilling to be in the community and make a difference educating women about preventive care. Also, contraceptive counseling, prenatal care and teaching, helping someone find some relief from her symptoms of menopause, and so on…. Primary care practitioners have so much to offer and the need is so great.

The very first key message from the IOM report states “Nurses should practice to the full extent of their education and training.” Does this mean that it is my duty to practice as an NP because I have the degree and license? Would I be disregarding this message by returning to staff nursing in the ICU? I sure hope not. Then again, I could always pursue another degree…critical care NP might be the answer. Now there’s something for me to think about!

Perhaps as we prepare for the future of our profession, we should all take this time to look at our individual goals as well. What is your future in nursing?

Posted: 1/13/2011 2:23:09 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Education & Career

Second-career RNs

Change is not usually easy. Nurses who have made nursing their second (or third or fourth…) career deserve much recognition and respect. Imagine being an expert accountant, someone who people seek out to answer their financial questions and meet their needs, and then starting over from scratch in a new environment, with new people, learning new skills and knowledge.  Imagine returning to the novice role after already having travelled that path of novice to expert. Remember those days of care plans and clinicals, searching for a job, and then starting work in an unfamiliar unit or facility. Now imagine doing it all over again. A bit overwhelming, isn’t it?

In the January/February issue of Nursing Made Incredible Easy, Sally Jo Borrello, MSN, RN, CTTS, takes a closer look at the second-career nurse.  She reminds us that while individuals pursuing nursing as a second career are usually adult learners who are more serious and confident than their younger counterparts, they still face the same long hours of studying and class preparation. Many are also sacrificing personal and family time to obtain their degree.

The author goes on to share tips for experienced nurses to mentor second-career nurses. Building a mutually respectful and trusting relationship is key. Remember that this mentee is bringing his or her background and knowledge to the relationship also, so be open to learning quite a bit yourself. Use positive feedback to support and guide this student or new nurse.

Are you a second-career RN or currently pursuing nursing as a second career? Please chime in with your thoughts and experiences!

Posted: 1/3/2011 2:35:54 PM by Lisa Bonsall, MSN, RN, CRNP | with 18 comments

Categories: Education & Career

The Future of Nursing...can we steer through the bureaucracy and make it a reality

In 2008, the Robert Wood Johnson Foundation (RWJF) and the Institute of Medicine (IOM) launched an initiative that looked at where the nursing profession was and where it needed to go. Their purpose was to make  recommendations for an ""action-oriented"" blueprint for the future of nursing. The group looked at the educational levels of nurses, the roles of nurses, and where nurses practice. This week, RWJF and the IOM released recommendations on how the nursing profession needs to transform to better meet the healthcare needs of people across the country.

The four key messages are:

1. Nurses should practice to the full extent of their education and training.

2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression.

3. Nurses should be full partners, with physicians and other health care professinals, in redesigning health care in the United States.

4. Effective workforce planning and policy making require better data collection and an improved information infrastructure.

As I read the report brief, it occurred to me that their recommendations seem like common sense. The evidence clearly shows all these things are true. It will be interesting to see if we are able to steer through the "politics of bureaucracy" and make these recommendations a reality. What do you think?

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


Posted: 10/7/2010 10:40:05 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

Students on a mission - An interview with Dr. Susan Fletcher

Last week, I had the pleasure of speaking with Susan Fletcher, EdD, MSN, Professor at Chamberlain College of Nursing. I had heard about the International Nursing Service Projects that she developed and was anxious to learn more about the experiences of the students who accompanied her to countries such as Brazil, Kenya, Bolivia, and Uganda.

Dr. Fletcher, whose background includes community health, emergency room, and school nursing, has been taking students on mission trips for over 12 years. I was in awe after hearing about the patients they cared for and how innovative the students were in their planning and interventions. They had to think “outside the box” and come up with clever ideas to improve the quality of life of the people. For example:

  • In the slums of Fortaleza, the students saw a quadriplegic man who was regaining some use of his arms. His house was a brick area the size of a closet and he spent his life in bed. Family members would bring him food sporadically. The students noticed pinpoint red marks on his toes. After seeing him for 3 days in a row, they realized these marks were rat bites. The students thought to all take off their socks and put them on his feet to make it harder for the rats to get to his skin.
  • Another patient, an elderly woman, was bed-bound with heel decubiti. There was nothing to use to elevate her feet and reduce the pressure. Students filled rubber gloves with water and placed them under her ankles.
  • In Bolivia, students met a woman with a severely prolapsed rectum. They gave her pads and a belt to use for support.
  • In Africa, where the prevalence of HIV infection remains high, there are many orphans. Students saw families of children taking care of children. In one case, an 11-year old girl was responsible for 3 younger brothers and sisters. She’d cook over an open fire dug into the ground. Students cared for burns, infections, and injuries in various stages of healing.
  • Another patient, a man with TB and AIDS, was dying. Students would help the family clean him up. There was one student whom he consistently followed with his eyes. This student learned that “sometimes all you can do is ‘be there.’”

Dr. Fletcher discussed the transformative nature of these experiences. The students developed amazing clinical skills and enhanced their critical thinking ability. They learned to understand the differences in cultures and the problems related to the lack of healthcare facilities, caregivers, and medical supplies. Students became more comfortable using local resources and learned to “create from nothing.”

To be eligible to go on a mission trip, students must maintain a certain grade point average, complete an interview form, provide a letter of recommendation from clinical faculty, and have a one-on-one interview. Dr. Fletcher described the living conditions as “often sleeping on the floor, sometimes eating rice three times per day.” In Kenya, students woke at 6 am, walked 3 miles to the village and then spent all day in the clinic. On that trip, the students saw about 2,500 people in 2 weeks.

Difficulty of leaving… “touch and let go”
In Kenya, as the group was preparing to leave, a 2-year old orphan was squatting outside the clinic, crying. The students “couldn’t stand it; they wanted to take her home.” Dr. Fletcher reassured them  that someone had taken the time to dress this child and would be back for her. She told students, “These are the life circumstances here and we can’t rescue all the orphans.” Another important message, conveyed by one of the team members with the group, was “although you are upset, remember that because you were here, you’ve saved lives.”

Posted: 8/11/2010 9:56:57 AM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Education & Career

PhD or DNP, what's right for you?

I'm very excited now that I am less than two weeks away from starting a doctor of nursing practice (DNP) program at George Washington University. In reflecting on my decisoin to pursue this practice-focused degree, I thought it would be helpful to share my journey through the decision-making process with you.

It is 15 years since I completed a master's degree and became certified as adult NP. When I started, I was sure I would continue my education to the doctoral level, but I was struggling, to decide on what degree I should pursue. I really didn't think I wanted to go into the academic role, nor did I think I would fully take advantage of the years of research training, not to mention the blood sweat and tears of a dissertation. Therefore, I never applied to any PhD programs. Until the recent emergence of DNP programs, I did not find any doctoral program that were going to help me in my practice and professional development roles. "Finally..they created a doctoral degree for me!"

Boland, and others in the April 2010 issue of The Nurse Practitioner journal did an excellent job in providing the background on the history and process of developing DNP programs. In summary, the doctor of nursing practice is intended to provide advanced education to clinical leaders and advanced practice nurses. Don't worry if you are not a nurse practitioner. DNP's can be in varying roles including: nurse executive, clinical nurse specialist, or nurse informaticist. In contrast, the PhD prepares prepares nurses for a research-focused role. In addition to clincial roles, the authors expect that DNPs will also be an essential part of the nursing faculty in BSN, master's, and doctoral programs.

What some master's prepared NPs are concerned about is whether they should go back to school. With the expectation that new NP graduates have DNPs by 2015, it is a job security issue. I recall, when I was beginning my master's program, there were several NPs and nurse midwives who had certificates who were grand-fathered and allowed to practice. But they were challenged by the employment market or pressured by employers to return to school. Therefore, if you have a career of 10 years or more left, it might be the logical conclusion. Nursing may not have come to terms on entry into practice; however, it is clear that a doctoral degree is where we are going.

By Karen Innocent, MS, RN, CRNP, ANP-BC, CMSRN


Posted: 8/5/2010 9:51:01 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

Are you a critical thinker?

Critical thinking is a skill so important for nurses to learn, yet not an easy one to master. Much focus in the literature is on assessing or measuring a student’s or nurse’s critical thinking ability. How, as that student or nurse, can you improve your critical thinking skills?

Scheffer and Rubenfield describe critical thinking in nursing as being comprised of 11 affective components (perseverance, open-mindedness, flexibility, confidence, creativity, inquisitiveness, reflection, intellectual integrity, intuition, contextual, and perspective) and 7 cognitive skills (information seeking, discriminating, analyzing, transforming knowledge, predicting, applying standards, and logical reasoning). Thinking about these components brings to mind the following advice for fine-tuning your own critical thinking:

  • Be assured that critical thinking will come with experience.
  • Be open to new learning situations and seek them out when you are able.
  • Be flexible. Floating to a new unit, changing shifts, or working with a different preceptor might not be all bad!
  • Be confident, but not afraid to admit when there is something you don’t know. Ask questions!
  • Don’t ignore your “inner voice.”  Nursing intuition is a true phenomenon.
  • Learn from your mistakes and those of others.
  • When overwhelmed, take a moment to pause and think through a situation.
  • After a code or any critical event, take some time to think about how the pieces of the puzzle fit together. Was there something else that you could have done or something that you could have done differently?
  • Practice your skills! Your confidence will improve and you’ll be able to recognize problems.
  • Learn your facility’s policies and procedures (and know where to find them!)
  • Talk with other nurses and colleagues from other disciplines. Plan care together and discuss assessments, problems, interventions, and evaluations. Communication is key!
  • Plan ahead and think of potential consequences of your actions. Giving a diuretic? You might want to check your patient’s potassium.

I know there’s more advice to add here - please do so!  Also, Scheffer and Rubenfield’s article was referenced in Nursing Student Stories on Learning How to Think Like a Nurse, a great read (and FREE!) from Nurse Educator.

DiVito-Thomas P. Nursing Student Stories on Learning How to Think Like a Nurse. Nurs Educ. 2005;30(3):133-136.

Scheffer BK, Rubenfield MG. A consensus statement on critical thinking in nursing. J Nurs Educ. 2000;39(8):352-359.

Posted: 8/2/2010 10:41:10 AM by Cara Deming | with 2 comments

Categories: Education & Career

Health Care Reform: What's in it for Nursing?

How many of you are really familiar with how nursing will impact health care reform?  I recently had a discussion with a colleague of mine about this issue and I was dismayed about her lack of understanding about this issue.  As I asked more and more nurses about what they knew about ""what's in it for nursing,"" it became clear that many nurses aren't familiar with the important role nurses will play in implementing health care reform. We are key drivers in this change that will provide health care for 34 million people who aren't currently receiving care. Keeping patients healthy and out of the acute care system through preventative care, transitional care, and chronic disease management will start to move health care in this country from a focus on illness to one of optimum health and wellness. 

I encourage you to read Diana Mason's article in the July issue of the American Journal of Nursing titled: Health Care Reform: What's in it for Nursing. This article will give you a great overview of the importance of nursing in health care reform. Every nurse needs to be able to speak articulately about our role in health care reform to not only other nurses but,  to everyday people. After all, we are their hope for better health.

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

Posted: 7/7/2010 10:31:57 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

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