January 7, 2010, 1:32 pm

Speaking of Degrees…

cutiedollI love this doll!!!!

She’s so cuuuuuute!!!!!!!!

I should buy her. Found her at Ruby Lane, which has a bazillion shops, but if you type “nursing” into the search box you will find a treasure trove of nursing ephemera. Diplomas, pins, yearbooks, prints, journals – I’ve found stuff I didn’t even know existed.

Bought an entire year of the American Journal of Nursing (’58) and it is in my closet, just waiting for me to scan!

I see a resemblance.

Must be the freckles.


interviewLooking to hire nursing staff?

You might want to check out All Health Jobs and All Nursing Jobs. They will post your job openings for free – just use the coupon code “Emergiblog”.

Are you looking for a new job? They’ve got hundreds of positions listed. I know, I’ve checked it out. Not that I’m looking for a new job, or anything. Just like to keep an eye on what is going on out there.


The discussion regarding the entry level for nursing has been ongoing for decades. I have articles written in the 1940s extolling the virtues of the BSN long before the first ADN program opened in 1952.

Every now and then, someone broaches the topic of making the BSN the entry level and BAM! the flames that ensue make the health care reform debate look like Mr. Roger’s Neighborhood.

Why the rancor?

Well, if one states that the BSN should be the entry level for a registered nurse, then it follows there must be a reason why an ADN should not.

That does not sit well with ADN graduates.

It sure didn’t sit well with me.


Now, 5 months away from graduating with my BSN, I see a difference.

Or, I guess you can say I feel a difference.

I am a different nurse than I was 2 1/2 years ago.

Notice, I didn’t say “better”.


My clinical skills are the same.

If you want to define nursing as the ability to put the right tube in the right orifice using the right technique, the BSN gives no advantage. Clinical skills for the ADN and the BSN are taught in class but honed in practice. While the ADN program may include more clinical hours, it has been my experience that neither program produces nurses ready to “hit the road running”.

My understanding of nursing has broadened.

Some disdain nursing theory and say it has no basis in daily practice, but have they really looked at what theories are out there? All nursing programs are based on one. For me it was Sister Calista Roy’s Adaptation Model. Theories give a framework, a way of approaching assessment and care, a nursing philosophy.  You can argue that it’s useless, but you are using one every day, whether you realize it or not.  Now, it will be a cold day in Hades before I use “Energy Field Disturbance” as a nursing diagnosis but until I studied theory, I had no idea that Rogers’  Science of Unitary Human Beings even existed.  When I saw Jean Watson’s Theory of Human Caring, it was like getting hit by lightening. Watson’s theory, to me, is nursing.

Do my patients know which nursing theory I adopt? No. Do they care? No.

But I know. And I care. My nursing care has more depth, more perspective and a greater meaning to me because of the wider knowledge obtained through an in depth study of nursing theory.

I didn’t get that in my ADN program.

The nursing profession is more diverse than I imagined.

Okay, yeah I knew there was home health and public health was something done “out there” somewhere and some nurses worked 9-5 in a clinic, but like a horse wearing blinders, all I saw is what was right before me. Bedside hospital nursing.  That’s what I was educated to do.  Anything outside of bedside nursing required a BSN, minimum. No way was I going to do that! Blech! I lived nursing full time as it was.

As a result, I was never able to take advantage of opportunities that were there when I was so burnt out at the bedside I left crumbs when I walked.

Case management, nurse practitioner, becoming a nursing professor, home health, nursing research, school nursing and lord almighty, public health!!!!  I had no idea about public health – I thought it was visiting people in homes and running immunization clinics. It’s is that, but it is so much more!

You can advocate for patients, thousands at a time, in so many ways!

I was not exposed to that in my ADN program.


I guess you could say the last 2 1/2 years have been a transforming process for me. The BSN program has enriched my life, my practice and, although they would never know it, my patients.

So, do I think the BSN should be the entry level degree into nursing?

Well, if I said yes, I’d need Secret Service protection!

I would say if you are just entering the profession and it’s at all feasible for you, go the BSN route from the start.

I think it should be required – BUT (hold your fire!) there much to be said for being an ADN grad and then going for the BSN. In fact, I would almost recommend that. I know that I have gotten so much more out of the BSN education with many, many years of clinical practice behind it.

When you are an ADN and you are studying for the BSN, you have perspective, a place to assimilate what you are learning into your current practice. Subjects like nursing theory and research take on a clearer perspective, as opposed to being vague ideas and dull methodologies.

The BSN is worth getting.  I know I have developed both personally and professionally.

(Now, if I can just get through this last semester…)

December 30, 2009, 6:15 pm

Emerging From the Holiday Coma

constipationConstipated since childhood, but after 63 years, she decided to deal with it on Christmas at 0400.

Okay, not really.

Apparently, if you are constipated you should eat yeast.

Plain squares of yeast.

I don’t get the mechanism.

Yeast rises in a warm environment.

So, if you eat it, does it keep expanding until it explodes everything in front of it out the, uh, exit door?


I will say that the most interesting chief complaints tend to cluster around the holidays.

It goes something like this:

“Hi! I’m Kim and I’m the nurse; what is the problem this cold, icy, rainy holiday morning?”

“I’ve had a flaky left baby toe for a week.”

“Is it painful?”


“Does it itch?”


“What have you done for it so far?”

“I saw my doctor and he gave me a cream, but I don’t want to use it.”

“Really? Why didn’t you want to use it?”

“Because my toe is flaky!”

Well, okay then…


Something is changing on night shift.

Used to be you could clear out the PM patients by 0100 and only have a rare patient before 0530. Left a lot of time for studying.

No more. Now there is a flurry at 2300 (almost all pedi fevers) and a steady stream after that, all the way up to day shift. Croup, abdominal pain, migraines, chest pain, nausea/vomiting, cough, asthma, it’s all there. Can’t blame it on H1N1, either; it’s been like this for awhile. Summer slump? Haven’t seen one for at least two years.

The problem with this is not that people need care – that is why we are there. It’s that the unspoken benefits of working the night shift (the slower pace, the down time) has virtually disappeared.

It’s getting harder and harder to deal with a dissonant circadian rhythm.

Some of my co-workers are older than I, and they work doubles and double-backs and seven, eight 12-hour nights in a row.

Just the thought of a 12-hour shift makes me want to run for Zoloft.

When did I turn into a wimp?

(Could be the constant ingestion of sugar, salt and fat over the last four weeks……nah)

I mean, I am Nurse, hear me roar…

…right after I’m done yawning.

December 24, 2009, 4:21 pm

It’s a Merry Christmas Change of Shift!

OffwhitelogoIt’s Christmas Eve and time for a new Change of Shift!

Between the hustle and bustle of the holiday rush (and the ending of fall semesters), the nurses of the blogosphere put fingers to keyboard and busted out a joyful Change of Shift!

Grab an Egg Nog (spiked, of course), and settle in for some nursing stories!


Nuthin’ Says “Happy Holidays!” Like a Code Green!, or so goes the ode written by Reality Rounds for your holiday reading pleasure. It’s a “Code Gray” in my hospital, which makes it sound like a Weather Channel prediction…

See Jane Nurse has seen it from both sides and she isn’t pleased with what she sees In the Holding Tank. “If we all wanted stable we would work in the doctor’s office!” I think I’ll tattoo that on my chest. In the meantime, here’s a hearty AMEN, SISTAH!

AIDS has been with us for nearly thirty years, and it’s easy to forget the fear and stigma so rampant in those first days. Except when you see it happen. Again. Medic/Nurse’s Blog begins a series on The Many Faces of AIDS, Part 1.


“Miracles happen there.” Laney at Nursing Student Chronicles busts a PICU myth. Find out how at Gives Me Hope.

I’ve always said that being a patient makes you a better nurse, if only that you can see the perspective from the other side of the gurney. Kim at Prosaic Paradise describes her experience as a patient in Revisiting My Hospital Stay. She starts her nursing education soon – welcome to the profession, Kim!

It’s raining men! Or at least a list of the 10 Most Famous Male Nurses in History, over at Nursetini. Long before Flo grabbed a lamp, nursing was led by the guys!


Some are perfectionists, some are just adequate, but Lisa at Experiences of an ICU Nurse makes it clear that Incompetence is a Four Letter Word. For some professions, a laissez faire attitude just doesn’t cut it.

What do you think about nursing unions? I’m rather ambivalent about mine. Jennifer at NursesPTO doesn’t know any unionized nurses and wonders  Are Nursing Unions Necessary? Stop by and weigh in!

Dr. Dean is married to a nurse, and he used to deliver babies. Now, he writes TheMillionaireNurse.com Blog (Millionaire nurse? Isn’t that an oxymoron? Sorry, Dean, couldn’t resist!) and offers a course in resuscitating your finances in Retirement Account Balances: Like Watching Paint Dry.


That’s it for this edition! The next Change of Shift will be right here at Emergiblog, so keep sending in your submissions!

Thanks for reading and have a very Merry Christmas, Happy Hanukkah and a great New Year!!!!

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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