March, 2009 Archive

March 25, 2009, 9:18 am

Detached

capnoseMuch to the amusement of her classmates, Nurse Jones belatedly discovers she is allergic to her nursing cap.

If that cap was any larger, she’ d be into “Flying Nun” territory.

Aw, who am I kidding.  I didn’t have a capping ceremony, but I bawled my eyes out when I put that plain white cap on my head for the first time. It was my second quarter of nursing school.  I was nineteen, and had coveted that cap for ten years.

I wore it around the house.

And how proud I was when I could add the green stripe at the beginning of the second year lay the gold stripe under it my last quarter!

I have a pristine version of it in my closet right now.  I’d kill to wear it again.  I still get chills when I put it on.

As it is,  I just pull it out for Nurses Week in May.

My colleagues tease me.

My patients love it.

(For the record, that is a photo of Dorothy Bradley, taken in New York in December of 1949 by photographer Martha Holmes for Life Magazine.)

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Don’t forget, Change of Shift will be here at Emergiblog next Thursday!

I’ve already gotten some wonderful submissions! If you send it, I will post it!

Unless you are a spammer. I don’t care how you spin it, I cannot justify the inclusion of poodle grooming, prom dresses or commiserate with you over the “bad rap” dietary fat is given.

Everybody else? My in-box awaits your submission!

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Code blue.

Overhead page.

Dammit.

Why the hell an ER nurse has to respond to these is beyond me. Fifty thousand staff members all monitor certified and an ER nurse has to go.

Tonight, that’s me.

*****

I grab the intubation bags.

Oh, there is intubation material upstairs but our docs like specific things.

Not a problem, they’re easy to carry.

I’m way too old to be taking these stairs two at a time.

*****

The sole role of the ER nurse?

Monitor person.

That’s it.

The pads are always on by the time we arrive.

I stand at the end of the bed.

Watch the monitor.

*****

CPR in progress.

Someone is intubating.

Someone is pushing drugs.

On cue, I push a button.

Charging.

Clear.

Shock.

Nothing.

Lather, rinse, repeat.

Nothing.

*****

The code is called.

I wrap the monitor strips into a neat little roll and hand it to the unit nurse.

Grab my (unused) intubation bags and head back to the unit.

This time I take the elevator.

And it hits.

*****

She’s dead.

Someone just died.

Someone’s wife, mom, aunt, granddaughter, grandmother, sister.

Friend.

Phone calls are being made.

Lives are being altered.

Devastated.

Shock. Grief.

It’s all starts right now.

As my elevator touches the ground floor.

*****

Back to work.

Queen Bee from the wealthy part of town who decided a hang nail was an emergency is miffed by the wait.

Mr. Intoxication is screaming profanities at me.

(Whore? Hell, I’d probably make more money, but the benefits are terrible.)

The Entitlement family demands antibiotics for all seven kids, right now!

But do we have samples? You see (they say while covering up the mouthpiece on their iPhone(s), they don’t have the money to get the prescriptions filled.

Someone just died! I want to scream.

I don’t.

My god.

They have no clue.

*****

Family members begin to arrive.

In groups of two.

They look numb.

Upstairs, monitors are unhooked

Airways are removed.

The patient is detached.

So was I.

I thought.

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March 18, 2009, 10:44 pm

Change of Shift: Volume 3, Number 19

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Welcome to the Emergiblog version of Change of Shift!

It’s been a while since I have hosted, and it’s fun to check out the posts as they arrive! Oh who am I kidding, I wait until almost the last minute!

Check out the calendar, if you are interested in hosting our esteemed carnival there are openings available.

Send me a postcard, drop me a line…all together now….and let me know what date you would like to host!

And stay tuned for some MAJOR news about the medblogger meet-up!  I’m literally on the edge of the diving board and DYING to spill da beans!

Now, without further ado, I present Change of Shift, Volume 3, Number 19.

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Oh, man. When the message is devastating, the recipient isn’t the only one affected. OncRN presents news posted at oncRN.

The American Journal of Nursing has a blog! It’s called Off the Charts and this week Editor-in-Chief Diana J. Mason asks, State Boards of Nursing: Can They Protect the Public From Unsafe Nurses? Find out what she discovered in her interview with Dr. Marianne Alexander, RN, Chief Officer of Nursing Regulation for the National Council of State Boards of Nursing. Audio link provided!  Oh, and while you are there, check out the poll Nursing and the Economy!

We’ve heard of internet identity theft, but did you know that medical identity theft is also a danger? Our colleague at Reality Rounds (a renaissance nurse if there ever was one!) takes on this topic in Realities of Medical Identity Theft, including a link to an article on the same topic in the Chicago Tribune.

*****

Online Nursing Degrees has a consistently relevant nursing blog.  This post is no exception.  It is also very timely.  Find out why nursing is Unbreakable. And then take every bit of the credit you deserve for making it so.

Mark from Medicblog999 shares his vision of improved psychiatric services from a U.K. perspective. Much of what he proposes would be a great improvement in the U.S., also.  Check out Psych ER.

Watch out Baltimore! The ER nurses are heading your way for their 2009 Annual Meeting! For those of us who have never been, and for those of us who want to go back, the Maryland Emergency Nurses Association has a fantastic blog with all the inside info on getting there, staying there (and partying there!).  Check out ENA 2009 Annual Meeting in Baltimore!

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Whoa. Can there be too much trust between a provider and their patient? NPs Save Lives looks at the question from a personal perspective in Trust Is A Huge Responsibilty posted at The Nurse Practitioner’s Place. And check out her new site at www.npplace.com! Nice digs!

.38 Special once sang, “A heart needs a second chance”. Shrtstormtrooper agrees and gives a poignant example in Second Chances posted at New Nurse Insanity: Fundus Chop!.

Have something you feel like telling your manager, but aren’t quite sure you should do it?  Well, the folks at Advance have a blog where you can tell a nurse manager what you think! Mary Bylone, RN, is a nurse leader and she not only can take what you dish out, she wants to hear it!  Mary asks What Will It Take To Strike Up A Conversation? at Things You Wish You Could Tell Your Nurse Manager. (Disclosure: I’m on the regional editorial advisory board for Advance.  My job? I give my opinion on stuff! I’m highly qualified to do that!)

*****

Strong One jumps in this week with some advice for our new colleagues in Your First ‘Code’ as a New Nurse | My Strong Medicine. Okay, Strong One where were you when I needed you?  Oh. Probably not born yet. Never mind. You can find him at My Strong Medicine.

Too old to learn anything new? Sorry, that won’t fly! Find out the latest on keeping your brain flexible as Alvaro presents Michael Merzenich: Brain Plasticity offers Hope for Everyone posted at SharpBrains.

The nurses over at the NurseConnect blog have some great posts this week.  Nurse Kathy gives a get-your-kleenex-lump-in-throat post as she describes her Unforgettable Patients.  Ah, nursing care plans. Haven’t seen one for a bazillion years (god bless the ER).  But…why do we have them and are they actually useful? Nurse Kathy asks Are We Charting Separate Courses?

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Dean from Rebuild Your Back always has interesting tidbits on back health and this week he takes on an interesting question in Sciatica and Food: Is There A Secret Cure? Now that’s a new one for me!

Ahem.  Somebody is turning fifty! Find out who at Nurse Ratched’s Place! (Now if they would only make that outfit in my size….)

And now I present the “Oh, why not, Carolyn is nice and the site looks good” post.  Since nurses happen to be in possesion of a heart, you may fnd these of interest!  Anybody out on the road during rush hour traffic?  Watch your ticker! Carolyn at presents Can Rush Hour Traffic Increase Your Risk for a Heart Attack? posted at Healthy Hearts with Heartstrong.  She also presents Heart Healthy National Nutrition Month Tips to help us keep those tickers ticking!

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That’s it for this edition.  Looks like I’ll be your hostess-with-the-mostest for next edition too, so email me with all your posts!  That means you! Do it now, so you don’t forget!  : )

Speaking of don’t forget, Change of Shift 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.  Many thanks to Walter Jesson at Highlight Health for setting those feeds up!

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March 14, 2009, 8:26 pm

The Future of Nursing Education: Do I Detect Ageism?

ImageChef.comDo you know how much it costs to be a major Nascar sponsor?

Around $25 million!

No, I didn’t hit the jackpot in Reno, but it would be pretty cool to actually sponsor a driver!

I could always go half-sies with Budweiser over Kasey Kahne and call it….

“EmergiBud”!

It’s a Nascar-free weekend; they take a “brake” (get it?) after five weeks.

Unfortunately I do not, and I’m having withdrawls.

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Calling all nurses! Don’t forget Change of Shift is here on March 19th! Hit that contact button up top and send in your submission, the theme is….wait for it….Nursing! I know you have been writing up a storm, so share it with your colleagues!

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You should have been there when I realized I could obtain a PhD in Nursing without getting a Master’s degree first.

I was thrilled.

There is nothing wrong with having an MSN, it’s just that my personal goal is a doctorate, specifically a PhD.

Well, nursing is full of debates and the BSN-to-PhD is apparently one of them.

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I came across an editorial from a 2003 edition of the American Journal of Nursing discussing the BSN-to-PhD degree program.

The writer, Editor-in-Chief Diana J. Mason, PhD, RN, FAAN doesn’t think it’s a good idea.

Sigh.

Well, let’s look at why.

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Ms. Mason recounts a time in her career when she accepted a position teaching pediatrics.  She had never practiced pediatrics and did not know much about the specialty. She notes that, “I felt like an imposter.”  She vowed to never teach outside her area of expertise and to maintain a nursing practice while teaching.

Sounds good.  Now what has that got to do with BSN-to-PhD programs?

Ms. Mason is concerned that utilizing a direct BSN-to-PhD program would produce nurses with minimal clinical experience teaching at the beside and having nursing clinical instructors without clinical background teaching clinical skills is not a good thing.

Agreed.

*****

But here’s where she goes off track.  I quote from the editorial (emphasis mine):

Nursing faculty tend to get an associate’s or bachelor’s degree first and practice for several years before returning to school for a master’s degree. They then practice for several years more as advanced practice nurses before completing the doctorate through part-time study—particularly if they have families who need their salaries. According to the AACN, by the time they are ready to enter tenure-track professorships, they are, on average, 46.2 years old and have only about two decades in which to teach.

Is it me, or is there a hint of ageism here?

What is wrong with teaching for “only” two decades?  What is wrong with not starting the teaching portion of a career until the average age of 46.2?

If a clinically competent teaching force is the goal, what is wrong with this? Am I missing something? You have nurses who have decades of experience on the floors/units with the nursing students. Not to mention that not all MSNs practice as nurse practitioners; some of them begin teaching with the Master’s degree.

*****

Let me answer some of Ms. Mason’s questions, from a personal standpoint.

  • “What would nurse educators prepared via the BSN-to-PhD route really know about clinical nursing practice?”

Ms. Mason assumes that a BSN-to-PhD candidate goes straight through their education with nothing but their basic nursing clinical rotations as experience.  Not all BSN-to-PhD candidates are newbies.  Some of us, in fact, will have four decades of clinical experience before we even get to the PhD program.

  • “How could they teach the subtleties of hands-on care that are apparent to an experienced nurse—how to know simply by looking at a patient that his condition is deteriorating? Or how to motivate a postoperative patient to get out of bed for the first time?”

By using exactly what Ms. Mason is worried they won’t have – hands on experience.  The intuition that allows a nurse to know  patient is deteriorating comes from exactly that, experience.  You can teach the theory, you can teach the clinical. You cannot teach intuition, but you can impart what you have learned from your intuition over the years and that is often more practical than anything that comes out of a book.

  • “Would generations of student nurses really benefit from three or four decades of teaching from a nurse who’s not at a proficient or expert level of practice?”

No.  But they would certainly benefit from two decades of teaching from a nurse that has four decades of clinical experience.

And finally, a response to this comment in the editorial:

Proponents note that not all faculty must teach clinical courses; instead, they argue, some faculty spend much of their time conducting research. But researchers who haven’t practiced are unlikely to investigate the concerns that are important to practice.

Try telling that to the Nurse Researchers from the Magnet hospitals I met in Reno this week, who work with the bedside clinical nurses in conducting research that is precisely directed at concerns important to practice.

*****

I have yet to see a BSN-to-PhD program that will accept any nurse who has not made a mark in the profession.  Please correct me if I am wrong, but anyone can apply with clinical experience, it is the nurse who can demonstrate something “extra” that gets accepted.

God willing, I have something “extra” to demonstrate.

*****

Assuming I am accepted into a BSN-to-PhD program in the fall of 2010, I will be 53 years old when I start and 57 when I finish.  I will have, by the end of that time, 37 years of clinical experience at the bedside.

I intend to do research, and I intend to teach.  And I do not intend to retire.  So, if I put in my “two decades” of teaching/research I’ll be 77.  If I put in three decades I’ll be 87.

Why on earth would an experienced nursing workforce who chooses to use their experience for the good of the up-and-coming generation of nurses, be considered a detriment because of their age?

The answer to Ms. Mason’s dilemma is simple: BSN-to-PhD programs should not accept nurses without at least a decade of hands on experience.  Better to have a nurse educator with experience who only teaches “two decades” as opposed to a nurse educator who can teach “three or four decades” with minimal experience.

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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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