April, 2007 Archive

April 17, 2007, 11:27 am

One Year On: Grand Rounds Returns to Fat Doctor!


A year ago, Grand Rounds was hosted by Fat Doctor.

After a very eventful year for our favorite famine resistant colleague, she is back again with her “witty brilliance” present and accounted for!

Again, many blogs that are new to me are highlighted this week – the medical blogosphere just keeps expanding!

Take in this week’s offerings here.

(Don’t forget that Change of Shift will be hosted this Thursday at Blissful Entropy. Email your submissions to erica at letterperfectediting dot com.)


I think I’m going to stop watching the news. I’m not sure I can take anymore of what we’ve seen these last two days.


I’m heartsick over the massacre that occurred at Virginia Tech.

Like everyone else today, I am trying hard to get my mind around what happened.

I can’t.

Evil is incomprehensible.

As the mother of a current college student, I’m suddenly anxious for the safety of my adult son. As the mother of a daughter who will attend college in a year, safety is now a primary criteria for her college selection.

I grieve for the children and for the professors. I ache for the parents and family and friends and classmates.

Today my prayers, like those of everyone else, go out to the families of the victims and to the Virginia Tech community.

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April 16, 2007, 2:34 pm

RN to BSN: At A Computer Near You!


Can’t get out of bed?

I can’t seem to stay in bed.

I have the dreaded “sleep in four hour blocks” syndrome.

Today I was the recipient of a phone call from a national political committee which shall remain nameless.

The fourth call this week.

They woke me up.

Folks, don’t ever give money to a national political committee. They will hound you via mail and phone until the proverbial cows come home. Donate to local candidates instead.

I swear if they call me again, I’m going to vote the Spongebob Squarepants/Squidward ticket and be done with them.

What do you mean, Spongebob isn’t running?

Everyone else seems to be.


I’m studying for my BSN because I can.

At home, in my pajamas and sweats. I don’t have to sit in a classroom and I can join in class “discussions” at three in the morning.

I’m studying for my BSN because for the first time in the history of the profession, I can take every class required online with my community health clinical right here in my own county.


If you are working as a registered nurse, trying to attend classes can be difficult. You must be in a certain place at a certain time, with little control over when your required classes are offered. You may have to find childcare. Maybe you work night shift and have erratic sleeping patterns.

Every time I would think about going back for my BSN, it just seemed like too much work. Too much hassle.

Well, guess what? It is a lot of work!

But it is not a hassle any longer.

Online learning is the best thing that has happened to me in terms of my professional development.


It isn’t for everyone.

You need to be motivated. You need to want to learn.

You have to be excited about what you are doing.

You see, online education is not passive. The material is not fed to you through lectures. You are given the reading requirement, some background on the issue by the faculty via the class website and the actual assignment. It is up to you to do the research, participate in the class “discussions” by responding to your classmate’s postings and get those assignments in on time.

You are teaching yourself the material, with an instructor available for feedback if you have questions.

You will get out of the assignments exactly what you put into them.

You will retain more than you ever would sitting in a lecture, because you are responsible for your own learning and you are actively involved in all aspects.

You will find that you learn an enormous amount of information from your own “classmates”, nurses who work in real-world situations just like you do. Nurses who bring with them years of experience, usually in a specialty/facility you are not familiar with.


You need to be organized.

Online classes do not lend themselves to the practice of cramming at the last minute. Part of your grade is based on turning in assignments on time and responding in discussion groups by deadlines.

Assignments are uploaded as attachments to the instructor, who then gives you your grade/feedback online.

On the other hand, there is flexibility. Have a family crisis? Been down with the flu for a week or spent some time in the hospital for emergency surgery? Fire an email off to the instructor and let them know. Unlike a physical classroom, the discussions stay up the entire semester, so you can always catch up in your participation.


So, what do you look for in an online program?

I looked at three before I found my match, you may need to examine a few more.

Let’s look at why I chose the University of Wisconsin-Green Bay’s BSN/LINC program, and you will get an idea of what to look for in your prospective program:

  • I received the maximum amount of credit for all the various classes in humanities and political science that I have taken over the years. This is extremely important. You want a program that acknowledges your educational accomplishments both in and out of nursing.
  • The site was easy to navigate and understand, with the majority of the information right on the BSN/LINC website. It gave me the confidence to actually apply; that “Hey! I can do this!”
  • The University made personal contact with me after I expressed and interest in information. Immediately I had an advisor’s name and someone I could call personally for additional information. Later, after my initial registration, I received another call to make sure I had all the information I needed. While online learning is predominantly self-directed, you want to have the human interaction when you need information.
  • You are allowed to take a BSN/LINC nursing class before committing to entering the program. Of course, being me, I just jumped right in with both feet. It just felt right.
  • Flexibility. In the UW-GB BSN/LINC program you can “sit out” a semester if you need to, and to get back in you just reapply with no fees involved.
  • The ability to take classes outside the university. An online BSN is pricey, no doubt about that. You want to find a program that allows you to take the non-nursing classes locally, for less money. If I need a “world culture” class to fulfill a requirement, I can take it at a local junior college and have the units transferred. I found I was so enamored of the online learning process, I chose to pay and take the non-nursing classes I needed online, too. I’m telling you, it’s really something else!
  • Money. The price-per-unit of each university varies dramatically, so you have to balance the fees with getting what you want out of the program. Online programs available through state universities may be cheaper if you reside in the state. Needless to say, I’m an out-of-state tuition for Green Bay, but the tuition is worth it.

So, those are the things I looked for in an online BSN program.

What’s important to you?

If you are even remotely thinking about returning for your BSN, consider doing it online. Nurses with a few years of experience behind them will find this style of learning enlightening.

Trust me, I’m a proud ADN graduate of almost 29 years and I’m learning aspects of nursing I never knew existed.

My soon-to-have-PhD colleague said this about a BSN: “It won’t change the way you practice…but it will change the way you think.”

She was right. It has changed the way I think about my profession.

But it has changed the way I practice in subtle but significant ways.

It has energized my enthusiasm for nursing.

Let it do the same for you.


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April 13, 2007, 3:02 pm

Oh, HELL No!


If ever I needed a good shot of Bromo Seltzer it is now.

My nerves need soothing.

My head is pounding.

I have an acute case of acid reflux.

My blood pressure is sky high.

I’m not sick.

I did however, receive an email from the Emergency Nurses Association.

If you have ever considered joining ENA, now is the time.

They are on our side.

Somebody has to be.

JCAHO has finally crossed the line.


I present to you the latest in Stupid JCAHO Tricks, as described in an email sent to all ENA members.

On April 6, the Joint Commission rescinded the Interim Action for Standard MM.4.10 EP 1 for Emergency Departments. Therefore, in accordance with MM.4.10 EP 1:

“…prior to dispensing, removal from floor stock, or removal from an automated storage and distribution device, a prospective pharmacy review is expected for all medication orders unless a licensed independent practitioner controls the ordering, preparation, and administration of the medication; or in urgent situations when the resulting delay would harm the patient, including situations in which the patient experiences a sudden change in clinical status.”

Translation: before you are even allowed to remove a medication from your Pyxis or take down a bottle of medication from the shelf in your ER, the pharmacy has to review the order. Except when the resulting delay would hurt the patient.

JCAHO acknowledges the delay!

Am I missing something here?

Never mind the effect on already impacted emergency departments.

Never mind that the only “licensed independent practitioner” in an ED is the physician (or maybe a nurse practitioner or physican’s assistant). They will now have to “control” the ordering, preparation and administration of all medications the pharmacy can’t review.

I hate to be the one to break this to JCAHO, but some hospitals don’t have the luxury of a twenty-four hour pharmacy.


Never mind all those pain medications you order for patients with chronic back problems or migraines.

  • You can’t touch that dial on the Pyxis until you are given permission by the pharmacy.

What about the patients that come in with a single-spaced 81/2 by 11 medication list that must be transcribed?

  • Better write up that medication reconciliation form STAT, because the pharmacy won’t take the patient’s list. You have to fax them the official list for review. In my facility we asked if we could just copy the patient’s sheet and attach that to the form. Apparently this will occur about the same time as pigs begin to fly (I’m paraphrasing).

What if the pharmacy does not recommend giving the ordered drug (for whatever reason) and the doctor disagrees?

  • Can the ED staff still give the ordered drug?
  • Can the pharmacist actually override the physician’s ability to prescribe a specific drug?

How long before we have to fill out a special form to document an “urgent” situation if we do give medication before the review?


JCAHO, you told us we had to put locks on all the doors and we did. We thought it was stupid, but we did it.

Then you told us there must be a medication reconciliation form and almost every hospital I know of put the onus of this on the emergency room nurses. We think it is asinine. But we do it.

You told us we had ask about and document cultural beliefs on the chart. Every single patient I ask looks at me like, “What the heck are you asking?”. That mandate was useless. But we do it.


JCAHO, you may say “JUMP!” and the hospitals will say “How high, Master?” but the emergency departments will not.

The Emergency Nurses Association is in partnership with the American Academy of Emergency Medicine (AAEM) and the American College of Emergency Physicians (ACEP) to oppose this accreditation standard and this mandate will not stand.

Make no mistake. We will fight this with every fiber of our being.

Hell hath no fury like that of the nursing profession when pushed to the brink. And this time we and the doctors are of one mind, one opinion.

JCAHO, you are in danger of becoming a joke.

Your standards are ludicrous.

Enough is freaking enough.

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About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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