Back to reality

I just returned from Italy - an absolutely glorious vacation…the people, the culture, the food…wonderful!!! I am now settling back in to home and work routines and got to thinking about how different this transition is for those of us who don't work in a clinical setting. As a clinical editor, I have the luxury of picking and choosing what to catch up on first - reading the latest journal articles, catching up on social media, writing the next eNewsletter, or editing some upcoming articles. The list goes on…

Sure, I need to prioritize what needs to be done sooner rather than later, however my return to work is a lot different now then when I was taking care of patients.  As a clinical nurse, there really is no easing back into work. Assessments need to be done, medications need to be given, procedures must be performed, and patient education and support must be provided. This list also goes on...

Thinking about this also brought to mind another common occurrence in my experience. After a return from vacation, I remember being given a heavier assignment, maybe the sicker patients or the families who needed a little more time and TLC. I was considered fresh, well-rested, and ready to go. Never mind the jet-lag or any family drama experienced while away!

I will confess that these are not only memories of my returns from vacation, but also in my role as charge nurse when colleagues returned from vacation. “Sure, Sally can take the patient maxed out on pressors who is a full-code. She just spent a week in Hawaii.” Or, “Give Jeff the ER admission with the fresh GI bleed. He’s been off all week.”

As I write this, I am disappointed in myself and think…would this be considered horizontal violence? It’s just the way that things were and no one ever questioned it, but that shouldn’t make it right. Thoughts?

Posted: 5/3/2011 9:41:30 AM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

The Future of Nursing Roundtable

On March 22, 2011, the Editors-in-Chief of the top LWW nursing journals got together for a roundtable discussion about the Institute of Medicine and the Robert Wood Johnson Foundation Report on the Future of Nursing. For those of you who listened in, I hope you enjoyed the conversation about how these nurse leaders interpret and understand the key messages and recommendations from the report. For me, the task at hand is now clearer. It is now up to us nurses to bring our profession and our own careers to the level we deserve. I’d like to share some of what I took away from this discussion.

Anne Dabrow Woods, MSN, RN, CRNP, ANP-BC, Chief Nurse of Wolters Kluwer Health/ Lippincott Williams & Wilkins and Ovid Technologies, moderated the discussion and reminded me that there are 3.1 million nurses (which is the largest group of health care providers) in the United States and we “need a seat at the table” to “make changes happen.” Anne then went on to explain in detail the key messages and recommendations in the report.

Maureen ""Shawn"" Kennedy, MA, RN, Editor-in-Chief of the American Journal of Nursing, spoke next about what the Report means to “nurses at the point of care” - which includes staff nurses, nurses practicing in home care, nursing homes, and other areas where direct patient care is occurring. She speaks about professional practice and having a voice when it comes to priorities of care.  Later in the webcast, Shawn talks about the education of nurses being for the public good and she includes good points about responsibility for funding.

Rich Hader, PhD, NE-BC, RN, CHE, CPHQ, FAAN, Editor-in-Chief of Nursing Management and Senior Vice-President and Chief Nursing Office of Meridian Health System gave his take on the report and what it means for managers and other nurse leaders. Some of his great words included “forge partnerships with academic colleagues” and “produce lifelong learning.” He commented on the timeliness of the report and brought up the idea of economic incentive for nurses going back to school. Rich also lists some key ideas for leaders and managers.

Jamesetta Newland, PhD, FNP-BC, FAANP, DPNAP, Editor-in-Chief of The Nurse Practitioner and Clinical Associate Professor at New York University shared her views on the report with regards to advanced practice nurses (APNs). She commented about APNs being trained holistically and the push to move the healthcare system to one of wellness, instead of illness.

Janet Fulton, PhD, RN, Editor-in-Chief of Clinical Nurse Specialist and Associate Professor at Indiana University spoke about clinical nurse specialists in acute care. Her comments about all APNs collaborating with each other to provide inpatient and outpatient care were eye-opening, especially her quote “nursing collaborating with itself.” Another good one…for all APNs to “push the boundaries to meet the public’s need.”

Suzanne Smith, EdD, RN, FAAN, Editor-in-Chief of the Journal of Nursing Administration and Nurse Educator spoke about the meaning of the report for educators and students. She suggested that we refer to guiding reports from organizations such as the NLN and the AACN. Specifically, Suzanne refers to the AACN’s “call for imagination” and the need for “dramatic change in Master’s education.” This discussion proceeds to the issue of cost.

The entire webcast has been archived and will be available for a limited time. 

Posted: 3/28/2011 2:26:45 PM by Lisa Bonsall, MSN, RN, CRNP | with 0 comments

Categories: Education & Career

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 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

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