February, 2009 Archive

February 20, 2009, 10:53 am


The National Nurse initiative has come a long way from those early days as a grass-roots initiative to appoint a visible, national nursing representative to promote healthy living and the nursing profession.

Unfortunately, some of our biggest nursing organizations don’t seem to get it.

This is NOT a new position and it WILL NOT cost the government or the taxpayers anything more than what is already funded!

So why is CNA/NNOC against it?

First, let’s take a look at where we stand now, directly from the National Nurse website:

Why is an Office of the National Nurse Needed?

To slow the growing epidemics of preventable diseases:

  • Current estimates predict a 42% increase in the 7 chronic diseases.
  • Risk of type II diabetes is high for more than 41 million Americans.
  • $1.3 TRILLION annual economic impact of the most common chronic diseases.
  • The U.S. ranks 19th in preventable deaths.

Promote health awareness, increase health literacy, and reduce health disparities:

  • Only 31% of Americans can name all 5 heart attack warning signs.
  • Ninety million Americans have poor health literacy resulting in higher mortality.
  • Death rates from stroke are 40% higher in African American adults compared to Caucasian adults.

To promote health careers and increased resources:

  • Severe nursing shortages are projected to continue.
  • Public health workforce needs are critical.
  • Public health infrastructure must be strengthened.

To enhance visibility and public recognition of nursing:

  • Raise awareness of diverse careers in nursing.
  • Demonstrate nursing leadership and autonomy.
  • Encourage youth to explore careers in nursing and healthcare.

Who Will Be the National Nurse?

Congress will designate the existing Chief Nurse Officer (CNO) of the US Public Health Service (USPHS), who also serves as the Assistant Surgeon General, be elevated to become a full time position within the Office of the Surgeon General and be officially titled the National Nurse for prevention. Our goal is to elevate and enhance the Office of the PHS Chief Nurse to bring more visibility to the critical role nursing occupies in promoting, protecting, and advancing the nation’s health.

What Will the Office of the National Nurse Do?

The Office of the National Nurse will perform those responsibilities currently being executed by the CNO and will particularly have these more prominent roles:

Support the Surgeon General’s Focus on Prevention

  • Assist in the initiation of a nationwide cultural shift to prevention.
  • Bolster efforts to focus the public on healthy living.
  • Intensify roles for nurses, including students and retirees, in community health promotion.
  • Provide greater support to the Surgeon General in calling for improvements in health literacy and reduction in health disparities.

Develop Nurses as Community Health Advocates

  • Encourage all nurses to spread prevention messages in their communities.
  • Encourage participation of nurses in Medical Reserve Corps (MRC) units.
  • Provide leadership to network with existing volunteer health promotion efforts.
  • Strengthen linkages with providers, nursing programs, and public health leadership.

Promote Professional Nursing

  • Serve as a visible national spokesperson for professional nursing.
  • Increase public awareness of nursing roles and contributions.
  • Enhance nursing recruitment and education throughout all communities.
  • Support and justify additional funding for nursing education, research and service.


Pretty impressive, isn’t it? We already have the position in place, we just want to see nursing represented in a prominent position in government. It threatens no one’s authority, it makes the nursing profession more visible and costs no more that what our current CNO is doing right now. The position already exists!

We need to let CNA/NNOC know that we are behind this initiative.

For all the money CNA/NNOC pays out to political initiatives I have zero agreement with (my dues, for what it is worth), here is one thing positive that they can do for nurses that will cost them nothing!

An endorsement. The Office of National Nurse, if initiated, will take NOTHING away from CNA/NNOC or the bedside staff nurse. It will be a positive move for the ENTIRE PROFESSION.

So let’s get busy.

The Office of National Nurse dovetails beautifully with CNA/NNOC’s proposed plan for universal health care.

There are dues-paying members of CNA/NNOC who support the initiative (raising hand!).

CNA/NNOC has a huge voice and they are supposed to be speaking for us.

Now we need to let them know it.


Deborah Burger, RN, sits on the CNA/NNOC Council of Presidents. As I understand it, our colleague believes that the Office of National Nurse creates a new entity (it does not) and requires additional funding (it does not).

Please send a respectful email or call Ms. Burger and let her know that you support the Office of National Nurse.

Her office number is (510) 273 – 2200

Her email is “dburger at calnurses dot org”.

Nurses can call from anywhere, but we especially would like you to call if you support the ONN and you are a member of CNA/NNOC.

I don’t get “political” very often, but this transcends politics and benefits everyone and every nurse.

I’m making the call.

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February 19, 2009, 3:18 pm

The Nursing Profession: Absolutely Nuts or Totally Unique?

I absolutely adore this picture!

I’m not sure if the doctor is incredulous over something she said, or just deep in conversation!

The nurse is Celia “Barkie” Williams.

Her nickname was Barkie and from what little information I can find she was well loved by her colleagues, was into antique autos and was photographed in the 1950s in a dress her mother had in 1880!

Where the name “Barkie” came from, I’m afraid to ask!

This photo, taken by Thomas D. Macavoy for Life Magazine is dated 1960 and was taken in Cottonwood, Arizona.

Nurse Barkie looks at least 70 in this photo.

I wonder where she went to school? How long did she practice?

I bet she could have told some stories.

I tried, just for the heck of it, to google her name and I found her! At least I know her first name, but that is about all I could get. Would have liked to know more about her.

I’m not even going to mention the wrinkled cap; any nurse still working at the age of 70 can wear her cap any way she wants!


Change of Shift if up at This Crazy Miracle Called Life! Many thanks to Amanda for hosting this edition! The next edition will be at The Nurse Practitioner’s Place, so be sure to check her site for info!


Nursing is an extremely interesting profession.

It’s either absolutely off the deep end or it’s totally unique.

From the entry levels of practice to the terminal degrees available, nursing doesn’t look like, act like or educate like any other profession.

And it shouldn’t.

Because nursing isn’t like any other profession.


Let’s take entry level into practice. How’s that for jumping into the frying pan?

You can start nursing with an AA degree that should be two years but can’t really be done in two years so it’s actually more like three years with all the pre-requisites done first.


Or…you can go for a BS degree which takes four years and can actually be done in four years unless you have to go a summer session (like my daughter), which really makes it over four years. This is supposed to be the desired entry level for practice. HOLD YOUR FIRE, I SAID “SUPPOSED TO BE”!


If you already have a BS or a BA degree, you can go into an entry level Master’s Degree program because it is really dumb to go back and get an AA degree because you already have a BS degree and you really don’t need one of those again, right, and the MS degree program is only 12 – 18 months.

And somehow through all this, you have become an RN.


But…now you are wondering if you should go for a higher degree….



If you have an AA and you want to get your BSN you can go back to school either on campus or online, for which you will pay a lot of money as there are a lot of RN-to-BSN programs out there to help you if you think maybe you should do it as the BSN is SUPPOSED to be the desired degree and you feel as though it is your professional duty to do it, but you won’t get any more money for it or anything, but you will have BSN after your name which, if you are like me, is worth every penny and every bead of sweat….

Sorry, I digress…

Or, if you want to do something other that bedside nursing you can take that BSN and get your BSN-to-MSN either on campus or online or if you are really ambitions you can go right for the RN-to-MSN programs since you have an AA degree under your belt and now you can be a manager or a nursing instructor or work in public health and make approximately 50% less than you did as a staff nurse, but hey, you are willing to sacrifice for your profession.


But it gets better!

You can take that BSN or MSN and head for a doctoral program if you really want to do research and teach, that would be a PhD, or wait!, you want to be an advanced practice nurse or nurse practitioner as they are called and now you have to have your doctoral degree when you only used to need an MSN but they changed the rules and now to do that you need a doctoral degree called the DNP, which is different from the PhD because it is a practice doctorate as opposed to a research doctorate…..


No wonder folks outside the profession think we’re off-the-wall.

But we aren’t.

We’re unique.

Our profession is flexible.

In spite of the light-hearted take on the educational opportunities, if you read between the lines what you see is that there is an entry level into nursing for everyone at any stage of their lives who are willing to work for that “RN” after their names.

What you see is an unbelievable number of opportunities to advance your education in a variety of ways. If you want it, it is available.  No four-year-undergrad-followed-by-three-years-graduate school, like lawyers. Unless that is what you want to do.  We have options. In that, we are unique.

What you see is a profession that has two terminal degrees in the PhD and DNP. Now, I’ve heard there is some controversy about this, having two doctoral pathways in nursing. I see it as flexibility in being able to receive a higher education that will take your career where you want it – to the classroom/research or to an increased responsibility for patient care.


Nursing does not have a lockstep education pattern. We don’t have a “one size fits all” education system because we don’t have “one size fits all” nursing opportunities.

And we most definitely don’t have “one size fits all” nursing personalities.

Think about it. Nursing allows changes in specialties. Unlike law or medicine, we can change our focus and switch our area of specialty long after we’ve entered the profession.


Sure, we argue and debate amongst ourselves. All the way from the best way to become a nurse down to whether or not we have one or two terminal degree options.

But folks, we’re all nurses. We are more alike than different and at our core we are solid.

So maybe we need to come together (Beatles reference!) and realize that all the different factions of nursing need to embrace the fact that we are nurses.

We can do that, I’m sure of it.

Because nursing is unique.

And that’s why we do what we do.

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February 16, 2009, 3:35 pm

It’s Grand Rounds, What Do You Think? GOSH!

When I was contemplating hosting Grand Rounds, did I realize that I was hosting a compilation of serious interdisciplinary dialogue relating to the practice of health care?

Did I understand the enormity of the task I had chosen to undertake?

Heck yes I did!

I chose to use a “Napoleon Dynamite” theme anyway as that is pretty much the coolest movie ever made.

If you’ve seen it, you’ll get it. If you haven’t, you’ll think I’m nuts (but I have great nunchuk skills….)!

So grab your coffee, and get ready for a good read!

Or, as Napoleon’s Grandma says, “just make yourself a dang quesa-dilluh!”

Welcome to Grand Rounds…


“What are my skills?” “Well, you have a sweet bike. And you’re really good at hooking up with chicks. Plus you’re like the only guy at school who has a mustache.”

(Napoleon with friends Pedro and Deb. Napoleon assures Pedro he does have skills to run for Class President.)

The Happy Hospitalist takes on relationships and skills in this provocative post on nurse practitioners, PAs and MDs. Check out Dr. Nurse, The PA Perspective, and Your Differential Diagnosis. Be sure to read the entire post and then join in the lively comments section!

Speaking of differential diagnosis, Aequanimitas has some advice for a physician colleague about that exact topic in To the Night-shift A&E Doctor.

Over at In Sickness and in Health, Barbara and Richard discover why they think so differently in MBTI and Illness: Judgers and Perceivers.

We use our skills at resuscitation every day. Mediblog999 wants to know what constitutes A Successful Resus. His conclusions made me rethink my definition.


The Defect in That One is Bleach

(Napoleon wins a medal from the Future Farmers of America by identifying defects in milk, specifically bleach and onions! The following posts look at things that aren’t quite right…)

Walter at Highlight HEALTH sheds some light on Clearing Up Concerns Over Vicks VapoRub. Interesting research with surprising results. It’s not what you think.

Sandy Szwarc at Junkfood Science finds a number of defects in the research touting the Obesity Virus – a New Risk Factor ? Sandy then emphasizes the importance of critiquing research reports vs. media headlines in What You Didn’t Hear About the Latest Study of Sudden and Unexpected Infant Deaths.

Day of the Doc looks at the myth of mental illness and violence in research, as seen through the media and adds some observations/questions of his own in Mental Health Mythbusters: Violence.

And then Doc Gurley takes on the same topic in Mentally Ill Does Not Mean Violent. Bottom line, it’s great news for those of us and our patients who deal mental illness and it the research results need to be disseminated to the general public!

InsureBlog‘s Bob Vineyard explains that newer isn’t always better when it comes to treating mental illness. Gee, could it be a financial issue? Check out Good Money in Mental Health.

Laika at Laika’s MedLibLog observes: “Personalized Medicine has not (yet) fulfilled its promises because there are often no good quality studies that show a clear and strong association with a particular gene (expression variant) that IMPROVES prediction.” Check out Personalized Genetics: Too Soon, Too Little?

What happens when you know the “what” but not the “why”? Canadian Medicine reports: Elevated Cancer Rates Found Near Oilsands, but No Explanation Forthcoming.

DrRich at The Covert Rationing Blog discusses the delicate (t)issue of intestinal screening procedures in Now Wait Just A Dadgum Minute. Hilarious, but you had me at the “David Geffen School of Medicine”! : D



(It looks like brother Kip is the lucky one here, as Napoleon “pulls” him into town on rollerblades. Hey, exercise keeps you healthy. The following posts could do the same…)

Jolie Bookspan, The Fitness Fixer discusses research showing Surgery for Knee Arthritis, Meniscus, Not Needed to Stop Pain, Restore Function.

After pointing out that most neck pain is not serious and will resolve on its own, Dean Moyer of The Back Pain Blog offers a simple checklist readers can use to answer the question, Neck Pain: When to See a Doctor?

Allison at Lemonade Life looks at the reasons “comfortable” may not be a good state of being. Break out of your comfort zone! You can start right here: Uncomfortable.

A new, non-invasive way to monitor the aggressiveness of prostate cancer? Helen Jaques: In Sickness and in Health looks at the research behind the news in Researchers Identify New Prostate Cancer Marker Detectable in Urine.

David at Health Business Blog looks at Another Perspective on the Vaccine/Autism Issue with insights from pediatric neurologist, Michael Segal.

Paul Auerbach gives a great overview of Illnesses and Injuries in Wilderness Athletes over at his Healthline blog Medicine for the Outdoors.


“Build her a cake, or somethin’.”

(Pedro “built a cake” for Summer Wheatly, the cheerleader he wants to take to the dance. Here are some posts whose authors “built a cake” for some of the people in their lives…)

WellroundedType2, in her blog of the same name, talks about her care surrounding a miscarriage in Recovery Room. If I ever need an endocrinologist, I want hers….

Award winning author Laurie at A Chronic Dose, discusses a recent New York Times article in her post Nurses and Patients. The Library Journal named Laurie’s book Life Disrupted one of 2008’s Best Consumer Health Books. Congratulations!

Even though she hates Valentine’s Day, diabetes blogger Kerri at Six Until Me writes a “thank you” to her husband for being such a supportive spouse of a person with diabetes in Mushy Stuff: Diabetes Edition.

MD/PhD student Mudphudder has a mother with an unusual gift for lab coat analysis in Give it Up for the Supernatural Ability of Mom.

Alison of SpinDyeKnit wanted to include a positive post in this GR edition, also, so here is the cake she built for Seven Unknown Heroes.


“They say you’re not allowed to have pinatas that look like real people, but in Mexico, we do it all the time.”

(Poor Pedro. He gets in trouble for making a pinata in the image of Summer Wheatly, who is running against him for Class President. He didn’t know he wasn’t being PC!)

Speaking of politically correct, the ACP Internist takes on PC terminology in Making Medicine Politically Correct. Enough is enough!

While we’re on politics, the stimulus package has funding for EHR. David at Health Blawg notes :“The EHR piece of the stimulus package will bring on one big feeding frenzy. Let’s make sure we spend the money wisely.” Observations and suggestions are found in HITECH Act Part of Stimulus Package Heading to President’s Desk: Steady, Boys!


“The worst day of my life, what do you think?”

(This is Napoleon’s description of his school day. I’m sure we can all relate. Here, Napoleon tries the time machine bought online by his Uncle Rico. It doesn’t work.)

If I had to pick a post that had me absolutely floored, it would be this one by Alison at SpinDyeKnit as she details her desperate attempt to get authorization for her medication in So, Today… There is an afterward to this post that sent me reeling. Alison writes “The end result of this one is that Blue Cross and Caremark delayed getting me that Humira for five days, during which my colon deteriorated greatly. The doctor had tried to order the med after a colonoscopy.  I will never know now whether it would have worked had they gotten it to me the next day like my doctor wanted; the end result is, two weeks ago Thursday, my entire colon had to be removed to save my life.” Oh my.

Neuroanthropology hosts an essay detailing the study of Post-traumatic Stress Disorder by Notre Dame undergraduates as they talk with veterans from all eras who suffer from this disabling syndrome. You’ll understand more, too, after you read Forever at War: Veterans’ Everyday Battles With Post-traumatic Stress Disorder.

Over at The Pink Tee Shirt, there is a post that has made me choke up for a woman I never even knew. Not much I can add to One More…for Dawn.

In his email for this post, Bongi at Other Things Amanzi described this post as “frustrations seen philosophically”. Oh my. I have no words, other than to say my daily frustrations are nothing compared to what Bongi reports in Philosophical.


“Imagine you’re weightless, in the middle of the ocean, surrounded by tiny little seahorses.”

(And so goes Deb’s advice to Napoleon’s Uncle Rico as she takes his photo for the name tag he’ll use as he heads out to sell Tupperware. He’s pretty pleased with himself, don’t ya think?)

The “Sweet!” award for this GR edition goes to Am Ang Zhang over at The Cockroach Catcher for his post on….coffee! Panamanian coffee! Find out the secret at Coffee in Panama: Faking is not All Bad!. I’m up for any taste test between Kona and Panama coffee!

Aggravated Doc Surg takes the “patient” vs. “consumer” debate to a whole new level in The Hard Sell. Act now and you may get a second post for $19.95! Too funny!


“I see you’re drinking 1%. Is that ’cause you think you’re fat? ‘Cause you’re not. You could be drinking whole if you wanted to.”

(Napoleon offers Deb a compliment. Sort of.)

Napoleon may have thought he was just making small talk, but Dr. Deb reminds us that February is Eating Disorders Awareness month in The “F” Word. “Fat”, That Is.

Rachel of Tales of My Thirties also blogs for Diabetes Daily. In Save Me a Cupcake, Elizabeth, she tells us what she thinks of food, Type 2 Diabetes and low-carb dieting.

Nancy at Teen Health 411 asks What is Sexual Harrassment?, and discusses what it is not. On a lighter note, it’s college selection time in College Touring – Oh What Fun it is to Ride!


“You gonna eat your tots?”

(Napoleon stores his tater tots from lunch in his pocket so he can eat ’em while he studies. Wish I had some tots for these studies…)

Allergy Notes reports a relationship I never would have considered in Rhinitis/Sinusitis and Asthma Relationship is a “Two-Way Street”.

Clinical Cases and Images notes a study showing Low Temperatures in Winter Increase Blood Pressure in the Elderly. Check out the comments for what this means for dialysis patients!

Alvaro at Sharp Brains submits commentary on a study whose findings seemed to suggest that acquired characteristics can be genetically transmitted. See A Love Affair Across Generations: A Lamarckian Reincarnation?

Uric acid as the “good guy”? Find out how (and when!) as Rheumination discusses the implications of Darwin’s Big Toe!


“Pedro offers you his protection.”

(Pedro’s tough low-rider cousins help keep bullies at bay as a way to get Pedro elected Class President. Health care and health insurance offer protection, too…)

Dr. Jeff Segal offers an interesting idea on How to Reduce Costs and Improve Quality in Health Care: A Legal Approach, hosted at Getting Better With Dr. Val. Truly a unique vision for health care reform!

Louise at the Colorado Health Insurance Insider notes: There are plenty of people who advocate a free market approach to health care, and are complaining that the government shouldn’t be allowed to dictate that a particular treatment isn’t cost effective. But private health insurance does exactly the same thing… Get the whole picture at Government Research and Health Care.

Protection. Restraints and seclusion can be used for protection of patients and staff. Rita, at Supporting Safer Healthcare looks at the regulatory side of in Restraints and Seclusion – A Hot Topic for Hospitals. She also writes a wonderful post on hanging in there as we go through the Culture Change in Healthcare – Weathering the Storm.


“… I love technology, but not as much as you, you see… But I STILL love technology… Always and forever.”

(I can’t say much about that quote without giving away a great part of the movie. Napoleon loves to draw Ligers, saying “It’s pretty much my favorite animal. It’s like a lion and a tiger mixed… bred for its skills in magic.” Well, I don’t know about the magic, but I couldn’t resist this shot of my man, Steve Jobs!)

And I do love technology, the technology that makes fun projects like Grand Rounds possible.

Many thanks to those who submitted, who shared their wonderful work and put up with my silly theme!

Also, props go out to Colin Son and Dr. Val for keeping the foundations of Grand Rounds up and running and to Nicholas Genes for starting it all way back when!


And while Deb here solicits sales for her boondoggle keychains, Peggy at The Blog That Ate Manhattan will be soliciting submissions as she takes the hosting duties for Grand Rounds next week.

Check her site for details.

(Don’t forget, Grand Rounds now has subscription options; you can follow by email or RSS feed. An aggregated feed of credible, rotating health and medicine blog carnivals is also available.)

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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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