November, 2007 Archive

November 29, 2007, 7:35 pm

Doctor Anonymous and Change of Shift: A Match Made on BlogTalkRadio!



Yep! Our very own Dr. Anonymous graciously offered to host this edition of Change of Shiftand he offered “on the air” during his BlogTalkRadio show, so he couldn’t back out!

It’s always fun when I can sit back and read the posts (I didn’t peek before I forwarded the submissions!) and I intend to do just that!

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It seems that my middle name lately is “better late than never”, so I did want to give a belated link to Prudence, MD for her great work on this week’s Grand Rounds (all the way from the Philippines), and a link on the Emergiblog Doctor Blogroll!

This means I get two lattes, one for Change of Shift and one for Grand Rounds!


From the “I-show-up-where-I-least-expect-it” file located in the Shameless-Self-Promotion department:

If you read “Fitness” magazine, I’m quoted in the December issue article on how to stay healthy. I’m on the sidebar!

Remember the post I did awhile back on The site has been renovated with a new perspective and now is called! A much more positive outlook, and Candy from Advance for Nurses and Rita from MSSP Nexus
both emailed me to tell me I’d been quoted in the CareSeek, Inc. press release!

(Trust me, neither quote will ever make it to Bartlett’s Familiar Quotations….)

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November 25, 2007, 3:45 pm

Clinical Competence – Where Did YOU Rate?


My colleague here is pouring something, but she sure looks apprehensive about the whole thing!

I think I looked like that for the first two years after graduation. Heck, I may still look like that and no one has the heart to tell me!

Now, this cap is a 9/10 on the Emergiblog Cap Rating Scale. The only thing keeping it from being perfect is a solid black strip running across the cap approximately one inch from the top border.

My cap is pretty nice with its green and gold stripe. I just wish I could wear it without getting razzed to death. You can hear the smirks across the Bay!


Speaking of nurses and graduation, how much clinical time do you believe is required in a nursing program to produce a competent, functional registered nurse?

We all know that the hospital-based diploma programs were jammed full of clinical time, with the student nurses essentially used as staff nurses on the wards. Those days are gone, and nurses are now educated in colleges and universities.

So, are new nurses getting enough clinical time?


What is more important to focus on in nursing courses: the clinical or theoretical? Should nursing students be proficient in clinical skills on graduation and learn theory on the job? Or should they be steeped in theory and learn to think critically in school followed by learning the technical aspect on the job?

Is there time in a nursing program to address both of these aspects of nursing effectively?


As an ADN grad, I did not feel that I had enough clinical time to become proficient in the technical aspects of nursing care before I graduated. I’m talking foley catheters, naso-gastric tubes, monitors, IV starts, etc. It may just have been my youth and insecurity, but I was scared to death when I graduated. No one cared that you could spout the adaptation theory of Sister Callista Roy by heart and backwards. There was work to be done.

I would say that you cannot do everything in two years, yet my BSN colleagues had even less time at the bedside than I did.

Then there are the programs that allow people with previous experience in a medical-related area to become an RN through a program that condenses the entire clinical experience into a two-week period. Two weeks? Medical, surgical, OB, pediatrics and psych in two weeks?


I’m interested in what you thought of your nursing clinical education. Did you feel prepared to take on the clinical tasks right after graduation? I put in one foley and one NG before I graduated. No IV starts. No training on monitors.

What are the clinicals like out there now? How many hours a week are you actually at the bedside? How many chances are there for you to do procedures? At what point do you take on what would be considered an entire “assignment”? Do you take report and give report? How involved are the staff nurses involved in your clinical education?

And, if you became an RN through one of the distance-education programs, how did you fit in your clinical experiences?


I’m asking from the perspective of someone who is considering going into nursing education. If you are a nurse blogger, write a post about your clinical experiences. Current students and those who were students when the Summer of Love was not a distant memory – let’s compare!

Send the posts to me and I’ll put them in the December 13th issue of Change of Shift.

Have things really changed over the last few decades?

Inquiring minds (mine) want to know!

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November 21, 2007, 4:40 pm

The Office of National Nurse: THE Logical Choice



A funny thing happened on the way to creating the Office of National Nurse.

We have one.

The leader that Teri Mills envisioned has been sitting in Washington all this time.


She is already in place.

She is already a nursing leader.

All she needs is the title and the authority to expand her position.

She is the Chief Nursing Officer of the United States Public Health service and her name is Rear Admiral Carol A. Romano.

A rose by any other name….? Not quite.


Here are the changes the Office of National Nurse will bring, as stated on the National Nurse website:

  • Establish symbolic national leadership by elevating and strengthening the Chief Nurse Officer of the USPHS to make this position visible to the nursing profession and the public.
  • Complement the work of the US Surgeon General.
  • Promote involvement in the Medical Reserve Corps to improve the health and safety of the community.
  • Incorporate proven evidence-based public health education when promoting prevention.

Sounds good, yes?

Then why aren’t the leaders of the nursing profession on board? This is a simple, yet profound change that will have far reaching results in terms of the visibility of nursing and a positive impact on public health.

This post was inspired by a recent article in Nursing Spectrum that is no longer available online. The article quoted many leaders of nursing groups who are opposed to this change in title. I was dumbfounded. I wrote to express my concerns and my support for the Office of National Nurse. Here is my letter to the editor of Nursing Spectrum, they asked for permission to use it so it may be in a future issue:

Dear Editor,

This is a response to your article, “National Nurse Debate Fuels Concerns” by Debra Anscombe Wood, RN, on November 9, 2007.

I’m a registered nurse and member of the Emergency Nurses Association and the California Nurses Association. I fully support making the position of Chief Nursing Officer into Office of the National Nurse.

In thirty years of nursing, I was never aware that this country had a Chief Nursing Officer. Having a visible, recognizable nursing leader would be a fantastic recruiting tool for the profession. It would increase the visibility of the United States Public Health Corps, put a new emphasis on public health nursing and increase awareness of the Medical Reserve Corps.

I want to see Rear Adm. Romano on TV, hear her opinions, have her opinions sought out regarding health care issues so that the public sees and hears that nursing is relevant. What a wonderful, under utilized role model we have already in place!

It is hard to grasp the reasoning behind the dissent expressed by the nursing leadership of our various organizations. Everything Teri Mills envisioned for the ONN is already in place! All that would be required would be funding to increase the visibility of this current national nursing leadership position.

Why is it so hard to envision this is a win-win situation for the country, for nursing and for our patients? Is it solely a question of money? Fund the Office of National Nurse and increase the visibility of the USPHC and their work in public health and you will have more nurses choosing public health as their specialty, which leads to greater patient education in the community and more efficient use of health facilities for care (better use of clinics, primary care providers such as Nurse Practitioners and appropriate use of the ER are just a few examples).

Ah, there is the rub. Funding. Everyone is afraid of losing their funding and so we once again see the disconnect between nursing leaders and those of us on the front lines. How will nursing ever get the respect it deserves when its leaders cannot even support the expansion of a leadership position that already exists? The Office of National Nurse is a grass-roots effort funded by educators and staff nurses (like me!) who see the need for a more visible presence of nursing in the media and in the communities. The American Association of Nurse Executives can’t see funding the Office of National Nurse because they feel all money should go toward fixing the nursing shortage. The quote from their representative, Jo Ann Webb, states, “…we don’t see the need for a national nurse.”

With all due respect to the AONE, we already have one! Her name is Rear Adm. Romano. Expand that position into the Office of National Nurse. Fund it! Utilize Rear. Adm. Romano in a way that every citizen in the United States knows we have a national nursing leader. That message will not be lost on the young men and women who are choosing their careers.

There are no losers should the CNO become the Office of National Nurse. Why that can be so obvious to a staff nurse and not to the leadership of the ANA, the AACN or the AONE is hard to fathom.

Make the Chief Nursing Officer position the Office of National Nurse. It is right, it is needed and it makes sense.

Kim McAllister, RN

You can get more information on the Office of National Nurse at the official site. And here’s a video starring Teri Mills and some of our future colleagues discussing the issue.

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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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