Is nursing really for me?

During my first year of nursing school, my grandfather underwent quadruple bypass surgery. My father and grandmother were very proud to introduce me to the nurses caring for him as “his granddaughter, a future nurse.” I have to admit that I felt quite a sense of pride with that introduction as well. Then we walked into his room in the surgical ICU…

My clinical experience had been minimal thus far, really just “communicating” with actual patients a handful of times.  Did practicing reflection, active listening, and restating prepare me for what I was about to see? I’m guessing not, since after I took one look at my sweet grandfather with all his post-op CABG attachments, I promptly hit the floor. That’s right, I fainted.

Uh-oh….was I really cut out to be a nurse? I wasn’t so sure anymore. My grandfather recovered without incident and fortunately, once he was out of ICU, I was able to visit him without any further incidents myself. I didn’t let this alter my career path and I continued on with my nursing education.

The following year, my father had surgery for skin cancer. The procedure involved attaching a flap of skin from his forehead (which remained attached there) to his nose, where the cancer had been removed. This flap would remain for several weeks until it began healing in its new location. I was a sophomore in school now and had a little more clinical experience under my belt, albeit not much. My parents planned his surgery during my winter break so I could be home and help out with his wound care. Big mistake - yet again, I was not very helpful. I could barely look at my father, even with his dressings in place, without getting light-headed.

Well, believe it or not, I did finish nursing school and found my niche in critical care nursing. When I think back to the types of patients I cared for in the medical intensive care unit, I’m amazed that I never once lost consciousness! How could I have doubted my decision to become a nurse? I thrived on caring for the sickest patients, using highly-technological interventions, and even dealing with the ugliest of wounds. Even post-mortem care was not an issue for me - I had a respect for that privilege that is indescribable.

So what is the message here? Expect to have doubts, but don’t let those doubts throw you off track. Talk to someone about your concerns. Remember why you wanted to become a nurse and what drove that decision initially. Look to your peers, clinical faculty, and other nurses for support and guidance. Chances are that you will meet at least one person who has had similar feelings and experiences. Be open to advice and encouragement, and be confident that in the end, you will follow the path that is right for you.

Posted: 5/14/2010 1:10:30 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Inspiration


I've got your back....

What do you really want for Nurses Week?  Is it the pen, the water bottle, the shirt, or food?  Do these things really make you feel appreciated?  While I won't deny I am happy to receive these token gifts; what I really want is for my colleagues to say thank you for having their back.  The last shift I worked was especially busy.  Most of the patients were on ventilators and vasopressors.  Each room seemed to have a more critically ill patient than the last room.  The Emergency Department had several critically ill patients to transfer up to us and the medical/surgical units were backed up with patients, so they couldn't take any transfers.  This scenario is typical for anyone that works in acute care today. 

What made the day a good day, yes that's right I said a ""good day""; was the fact that we all worked together.  When one nurse had a patient in crisis, the other nurses were right there to pick up her other patients or help her handle the crisis.  The day ran like a ""well oiled machine"" because we had each other's backs and we took the time to say ""thank you"" to each other.  Never was the situation out of control, never did chaos reign supreme. 

It doesn't matter whether you're an advanced practice nurse, an RN or an LPN; we're all colleagues working together for one purpose.  So to all my colleagues out there; ""Happy Nurses Week and thank you. I''ve got your back because I know you have mine.

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

Posted: 5/5/2010 8:46:35 AM by Cara Deming | with 1 comments

Categories: Inspiration


Get up to speed on Kawasaki disease

Several weeks ago, my goddaughter was diagnosed with Kawasaki disease (KD). Luckily, her pediatrician had seen this before (although only in the distant past) and diagnosed her and initiated treatment early in the course of the disease. Both her mother (also an NP) and I had never heard of this rare condition, and yet while spreading the word to family and friends, several people had a Kawasaki story to share.

Whether you have young children of your own, know someone with young children, or care for young children, it is important to be aware of this rare, yet serious disease. My goddaughter had most, if not all, of the classic signs and symptoms:

• persistent, high fever
• red eyes
• red lips
• red tongue with white coating
• red palms of hands and soles of feet
• swollen lymph nodes
• joint swelling and pain
• swollen hands and feet
• skin rash (worse in the groin area).

KD causes inflammation of the blood vessels and the major risk is the possible development of aneurysms in the coronary arteries. Fortunately, she received the standard treatment of IVIG and high-dose aspirin and is doing well.

Want to learn more?
• Kawasaki Disease Foundation
• Short film to raise awareness of KD  (Kawasaki Disease Foundation)
• American Heart Association: Kawasaki Disease

Posted: 4/26/2010 5:40:03 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


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


The "D"s have it

What type of personality did the last cardiac patient you took care of have?  When I think about my last cardiac patient, a Type "A" personality automatically comes to mind. But, an article in the American Journal of Cardiology may change our perception about who is having a heart attack. The article I am referring to looked at patients who either had a myocardial infarction or died of it. People with a Type "D" personality had triple the risk of having an MI or dying of an MI. What does a Type "D" personality look like you ask? It's someone who is angry or suppresses their anger. 

This makes a lot of sense when you think about it. Someone who is always angry or suppresses their anger, does sound like quite a few of the cardiac patients I've taken care of recently. Do we tell patients to let loose with their anger? Of course not. We need to help educate these patients in anger management techniques and connect them with a counselor who can teach them to handle their emotions in a more constructive way.  

So next time you take care of a patient experiencing a cardiac event, don't be so quick to give them an "A". They may be a "D" after all.

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

Posted: 4/21/2010 7:01:18 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Diseases & Conditions


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 www.inc.ch and the World Health Organization website at www.who.int.

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


Where do you get your drug information?

As I mentioned in a previous post , one of the most stressful things I experienced in nursing school was memorizing all of the drug information. I can remember preparing for clinical the night before with medication lists for my two patients, a drug reference book by my side, a stack of index cards, pencils, and various color highlighters. The lists would be long as if my instructor picked out my patient assignment solely based on the number of meds I would be administering and it never failed that my patients’ medication lists had no overlap. For example, it seemed that even if both were cardiac patients with a history of hypertension, one was on a diuretic and the other on an ACE inhibitor! The joke was usually on me though, for no matter how well I memorized the drug names, indications, dosages, side effects, and interactions, there were always one or two drug orders that were changed by the time I arrived for clinical. Of course, those newly ordered medications would be the ones my instructor asked me about!  Ahhh…the joys of nursing school!

I had heard a lot about the “reality shock” of starting out as a new RN. I knew I would not be able to research my patients the night before and learn all about their medications ahead of time. How would I manage medication administration? Would I deliver them safely and be alert for every potential side effect? Would I make an error?

One of my most important nursing tools when I was a new graduate was a drug handbook that my preceptor gave me. She advised me to highlight in it, mark pages, take notes, and do anything else to it that made it easier for me to safely administer medications. Through the years I bought new editions but I continued to use it in the same manner as that first book.

It is now easier than ever to access drug information. The internet allows us to get any information within seconds. However, it is so important to make sure the information you are accessing is accurate and up-to-date.

Oftentimes, prescribing information can be found on the pharmaceutical company websites or by searching FDA approved drug products. For safety information, the FDA’s Drug Safety Labeling Changes and the Institute for Safe Medication Practices are good sites to add to your favorites. Also, be sure to check out drug updates here on NursingCenter. We’ll keep you informed about drug news, medication errors, and the latest drug-related articles and CEs that publish in our journals. What resources do you use?

Posted: 4/5/2010 9:05:11 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Patient Safety


Watch your body language!

Any article that has the word “tips” or “list” in the title always seems to grab my attention.  To me those words mean that the article is a quick read with valuable information that I shouldn’t miss. In this month’s OR Nurse 2010, I quickly turned to 7 tips to improve your professional etiquette. In this article, the author advises us on introductions, the importance of a confident handshake, specifics about body language, and more. I especially appreciated the following list of gestures to avoid:

“Some gestures may be misunderstood and considered offensive to people from other cultures. To play it safe, try to avoid these in conversation:
• the "okay" sign
• thumbs up
• the "V" for victory sign, especially with the palm facing inward
• pointing or snapping your fingers
• waving your hand with your arm raised.1

I must admit that I’ve been guilty of using several of these gestures, especially with mechanically ventilated patients or patients who were unable to communicate verbally for other reasons. Do you know of anything else that should be on this list? 

1. Pagana KD. The Nurse's Etiquette Advantage: How Professional Etiquette Can Advance Your Nursing Career. Indianapolis, IN: Sigma Theta Tau International; 2008.

Posted: 3/30/2010 2:46:55 PM by Lisa Bonsall, MSN, RN, CRNP | with 2 comments

Categories:


Social and Professional Networking: Opportunities and Caution

Social networking and social media are not new concepts. Social communication has gradually advanced from face-to-face conversations and early forms of written and print communication to using the telephone for party lines and conference calls. Now we are using computers for group email (list serv), online forums, chat rooms, instant messaging, and blogs. Interactive social networking websites like MySpace.com and Facebook.com are becoming popular for staying connected with friends, classmates, and others with similar social, political, or entertainment interests.  Some examples of professional networks are LinkedIn, Tagged, and Plaxo. These sites and professional organization websites are helpful for making business contacts, finding jobs, and discussing challenging professional and business issues. 

The newer features of social networking allow the users to more easily exchange documents including articles, policies, and documentation forms. Some websites allow the nursing community to mentor newer nurses; recommend great job openings; and give advice about going back to school for advanced degrees. What's also helpful is that these discussions are archived and can be searched for later use.  

Professional and social networking have many benefits for nurses, but some nurses have not been very cautious about their use of these websites. Here are some examples of how to avoid making mistakes online.

  1. Think before you post messages, photos, and videos. You would never want to tarnish your professional image, to embarrass a colleague, or to hurt your chances of career advancement.  
  2. To protect yourself from identity theft, you must be aware that social networking sites are not private and limit the amount and type of personal information you share.
  3. To avoid risk of a HIPAA violation, never publish patient information without written permission.

For those who want to share new techniques you discovered, search for cost-effective ways to deliver patient care, or to announce your recent accomplisments, there are many great websites waiting for you to post your news or to ask your questions. Happy blogging!

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

Posted: 3/29/2010 1:57:44 PM by Lisa Bonsall, MSN, RN, CRNP | with 3 comments

Categories: Technology


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