Making the Most of July in Teaching Hospitals

It's the time of year when many who work in teaching hospitals are welcoming new medical students and interns into their organizations. Due to the inexperience and lack of clinical knowledge, July has been associated with poorer patient quality outcomes compared to other months. Experienced registered nurses, nurse managers, and advanced practice nurses can be more proactive during this time to reduce their own stress and provide support to their medical colleagues. For instance, if your unit has a set of protocols, provide them to the medical students and first year residents. Don't expect that someone else is going to do it. You may want to take a step further and schedule a unit orientation. You may need to coordinate this with the director of the graduate medical education; however, this could prove to be very helpful and appreciated. Lastly, many facilities are establishing inter-disciplinary rounds. This can be a great communication tool, it can facilitate learning, and it can improve patient outcomes.

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

Posted: 7/2/2010 2:29:13 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

Are you a member of your professional organization?

Answers to this question vary depending on the level of nursing education and practice. I have been a member of different types organizations at different stages of my career depending on my practice setting, type of patients I cared for, and the certifications I earned. I have always seen the value of association membership in helping me to advance my career, but clearly all professionals don't feel the same way. As a result, membership in organizations has been decreasing in recent years. Maybe you should take a look to determine if membership will help you achieve your career aspirations. 

First, some of us got our introduction into a membership society with honor societies. Your first membership in an honor society may have started as far back as high school. This is membership by invitation and doesn't necessarily imply a personal committment or involvement.

How about membership in a State Nurses Association? Now you're making a conscious choice to affiliate yourself with fellow nursing professionals who have common goals to advance the nursing profession and to protect the rights of nurses as a whole.

As you have move further into your career, you may choose a specialy area such as rehabilitation, critical care, or medical surgical nursing. If you have earned certification in your specialty, you certainly have a made an effort to solidify your commitment to the specialty. I recommend that if you have not joined the related nursing organization, go online and find out what they have to offer you. There are mentorship opportunities, local meetings, and continuing education offerings to help you maintain your certification.

Lastly, there are interdisciplinary organizations such as American Heart Association, American Cancer Society, or American Pain Society. These organizations are made up of individuals from multiple health professions and members of the healthcare industry who have common goals for researching, diagnosis, managing, and treating specific diseases or caring for a partcilar body system. As you develop your career, it will be imperative for you to be activity involved in a professional organization. Don't wait until it's time to make the next move. Membership may enhance your career at any stage.

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

Posted: 6/25/2010 10:17:44 AM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Education & Career

Nurses, get ready to retool your careers!

   Change is upon us. According 2008 data from the U.S. Dept of Labor (DOL) Bureau of Labor Statistics, most of the 2.8 million employed nurses are working in hospitals. While the DOL projects that the demand for nurses will require over a half million new positions by 2018, nurses are more likely to be hired in non-acute care settings including primary care offices, home care, and long-term care facilities. There are a number of factors contributing to this trend including: the aging population, increased access to healthcare, and advances in healthcare technology. As more people are living longer, there is a greater need for continuing care beyond hospital discharge and services to manage chronic conditions and disabilities. Healthcare reform is going to provide more individuals with access to primary care and preventive care who couldn’t afford it in the past. As the science and technology of healthcare advances, more patients are opting for less invasive diagnostics and surgeries that reduce length of stay in hospitals or eliminate the need for an admission. 

   Instead of mourning the loss of hospital jobs, nurses should retool their careers for the new and expanded opportunities. The following are examples of education and skills that may prepare nurses for the future.

  • Return to graduate school and become a nurse practitioner to fill the demand for primary care providers.
  • Earn wound ostomy and continence nursing certification to fill the need for WOCNs in wound care clinics and in home care.
  • Obtain certification in infusion nursing or insertion or peripherally inserted central catheters (PICC) to meet the requirements of home infusion services or clinics that provide  blood components, chemotherapy and other I.V. medications.

   Of course there are many more skills and certifications that nurses could acquire that will position them well in the future job market. Regardless of nurses’ current roles or work settings, they should stay in tune with the trends and embrace change by continually developing contemporary skills and credentials. 

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

Posted: 4/23/2010 2:19:28 PM by Lisa Bonsall, MSN, RN, CRNP | with 1 comments

Categories: Education & Career

More on NPs and healthcare reform

Recent articles such as The New Doctors in the House  and Doc deficit? Nurses' role may grow in 28 states highlight the role that nurse practitioners can play in health care reform. No matter what your feelings about health care reform, I think as nurses and nurse practitioners, we need to embrace this opportunity to demonstrate our value to patients.

While our roles may overlap with other health care disciplines, our presence and expertise should not be threatening. Our goals are the same - to keep people feeling well, help them when they are not feeling well, and improve quality of life.  Why are we so concerned about stepping on each other’s toes? As described by Anne Woods in a previous post: Healthcare providers: will we ever play nice in the same sandbox?

Part of the threat, I think, is due to the word “doctor.” Nurse practitioners are not medical doctors. That sounds simple enough, but the difficulty lies in the question: how should we refer to ourselves? I don’t have that answer. When discussing this blog post with a colleague, she recounted the following story to me:

“I have a friend with a PhD. who had a nurse managed primary care office and she hired her collaborating physician. When you called the office, the receptionist answered, ‘Hello, Doctor’s office!’

Hmmm - is that an appropriate greeting? When I was in practice, I introduced myself as Lisa. I was comfortable with patients calling me by my first name. I also explained that I was a nurse practitioner. Many questioned what that meant, some insisted on seeing the medical doctor, and others were happy that a nurse practitioner was part of the practice. How do you introduce yourself? What do patients call you? How do you explain your role?

Let’s take this one step further. When a nurse practitioner has a doctorate degree…then what?  “Hi, I’m Dr. ________ and I’m your nurse practitioner.” Is this too confusing to patients? What do you think?

Posted: 4/19/2010 10:42:07 AM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Education & Career

International Perspective on Nursing Shortage

Christine Kessler, MSN, CRNP of Walter Reed Army Hospital in Washington, D.C. delivered the opening address at Nursing2010 Symposium in Las Vegas on April 6. In her presentation titled ""What Would Florence Do? Nursing Past, Present, and Future"", Kessler reported on experts' projections about the severity of the nursing shortage over the next ten to fifteen years. Kessler also warned that we should not assume that the nursing shortage is over because many markets that are experiencing a downturn in the economy have little to no vacancies. The global trend is that the aging nursing workforce will result in many practicing nurses and nursing faculty retiring at high rates. Kessler made optimistic suggestions for increasing numbers in the profession, and generated keen interest from a group of nurses traveling from Jordan who shared their story about the nursing shortage.

I met two of the nurses from Jordan at the reception that evening and asked them if I could share their strory in my blog. Randa, a doctoral nurse and Alia, a baccalaureate nurse, were eager to discuss how there is a shortage of female nurses in their country. They explained that not only are fewer women entering the workforce than men, but that the women often leave the profession when they marry and have children. A factor that compounds the problem is that in this predominently Muslim nation, there are religious traditions that dictate who can deliver care based on gender. Randa said that ""men an women are separate floors in the hospital"" and ""women only are permitted to care for other women and children"". Therefore, these nurses are very concerned about the quality of care of women and children. Randa and Alia are encouraged by the government's action of setting quotas in nursing schools that require admission of a higher percentage of females. Still they are seeking additional ideas from Nursing2010 Symposium to take back to Jordan and disseminate in papers and presentations.

Like these Jordanian nurses, nurse exectives, nurse educators, and government officials around the globe must collaborate to find realistic solutions to the nursing shortage. To learn more about the global nursing shortage, go to the International Council of Nurses website at and the World Health Organization website at

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

Posted: 4/9/2010 1:50:11 PM by Lisa Bonsall, MSN, RN, CRNP | with 11 comments

Categories: Education & Career

Memories from Nursing School


The good:
*The people... what’s better than connecting with others with similar goals?
*The knowledge...from anatomy and physiology to pathophysiology to pharmacology - wow, I learned a lot!
*The communication skills...these skills have helped me in “everyday life” too!
*The classes...electives on death and dying, nutrition, human sexuality - might not be interesting to everyone, but I loved them!
*The could I get a ‘C’ on an exam but then my grade turns into an ‘A’ because everyone else got a ‘C’ also?

The bad:
*The many & so heavy! With all the technology available now, is this still the case?
*The anxiety...even the thought of giving someone acetaminophen made me nervous.
*The would I remember all of the generic names, trade names, indications, dosages,  interactions, adverse reactions, and special instructions?
*The hours...I was at the hospital by 7 am and my roommates didn't have classes before noon!
*The care plans...need I say more?

The best:
*Knowing that in the near future, I would be making a difference!

Posted: 3/24/2010 9:16:55 AM by Lisa Bonsall, MSN, RN, CRNP | with 4 comments

Categories: Education & Career

HCR: Change on the horizon

When I graduated from nursing school, I instantly became the “go-to” person in my family for all things medical. I’m sure many, if not all of you, can relate to this phenomenon. I was immediately the one who was called if anyone was injured or sick. It was just expected that I had all the answers because I was an RN, even when the questions were beyond my knowledge and experience.

Over the past year, it has also been expected that I had the answers about the proposed health care reform bill. How would it affect my parents’ medication expenses? Will everyone really have access to health insurance, even those with preexisting conditions? Would my 25-year old cousin who is unemployed be able to access coverage through his mother’s employer? 

Last evening, the U.S. House of Representative passed President Obama’s health care reform bill (passed by the Senate in December).  While there are still political technicalities to be addressed before the bill becomes law, I think it’s important for us nurses to know what this health care reform can mean in the immediate future and down the road. Here are some resources that I think are helpful for understanding the details of HCR:

Please share your resources on health care reform information by leaving me a comment here.  I’m sure more questions will be headed my way!

Posted: 3/22/2010 4:07:18 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories: Education & Career

Conference Highlight: HIMSS

I am at the HIMSS Conference in Atlanta, Georgia right now.  For those of you who don't know what HIMSS stands for, it is the Healthcare Information and  Management Systems Society.  This conference is one of the most cutting-edge conferences I have ever attended.  According to the HIMSS representative I spoke to, their attendance is 25,000 this year.  For those of you interested in how technology can improve practice, this conference is for you.  Nurses involved in informatics, clinical leaders, and nurse leaders presented how information management systems, electronic health care records, computerized prescriber order entry, and different types of monitoring systems can fit into workflow and give nurses the clinical support they need to deliver the highest quality, evidence-based care. What I was most impressed with was their Interoperability Showcase which used patient case studies to demonstrate how different systems can exchange information and seamlessly work together.  Many of the sessions stressed the importance of having nurses part of the decision making process when new technology is being evaluated.

It was refreshing to see healthcare institutions sending their nurse leaders, clinical leaders, and nurse informatics specialists to this conference to find ways to use technology to improve patient care.  If you're interested in how technology can improve nursing practice and improve patient outcomes, or your facility is looking at new technology, then I would highly recommend you attend this conference.

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

Posted: 3/3/2010 1:59:07 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

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

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

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