March 1, 2009, 2:19 am


al-fenn-6551And the staff gathers ’round to watch the last episode of ER…..

I hear George Clooney will be back.

Doesn’t matter, I can’t stand that show.

It’s like being at work, only I’m not getting paid.  Clooney may be handsome, but he’s not that handsome. Now, if Will Smith or Jeff Goldblum had been in the show, that would have been compensation enough for me!

My husband could never understand why watching “Trauma: Life in the ER” was not high on my list.


(Photo credit: Al Fenn for Life Magazine. June, 1955. Omaha, Nebraska)


If you have not tentatively RSVP’s for the medblogger conference, be sure to do so on the survey to the right! It’s not a commitment, we just need to have a ball park figure!  Thanks!


It’s time for an intervention.

I have to admit it.

I am Facebook illiterate.

People poke me, send me goodies, invite me to groups, send me really cool memes on rock songs, buy me drinks, send me plants.

And I have no clue what to do with those.

Okay, I do know how the Pirate game works and I will steal your gold coins if I find them, but that’s it.

Oh, and I learned how to upload videos – found an old Boyce and Hart video. Totally cool.


I’m in a mood.

Luckily, I’m not at work because moods don’t really make one popular with one’s colleagues.


This patient came into the clinic the other day…

Oh, you thought I worked in an ER?  Well, that is what it says on the sign on the street and over the sliding doors, but trust me, I work in a clinic.

And, if you walk into your place of business and it says “Emergency” over the door, you probably work in a clinic, too.



I give the general public, health care consumer, client, guest (or whatever the current politically correct term-of-the-day might be), credit.

Yes, I give the vast majority of those people who walk into the ER credit.

Credit for knowing exactly what they are doing and why they are doing it.

  • Credit for knowing what a true emergency is: chest pain, stroke symptoms, broken limbs, eye injuries/pain, difficulty breathing, uncontrolled bleeding
  • Credit for being concerned that something dangerous might be happening.  You can have gastroenteritis from hell and think you are dying.  Pain so severe it cannot wait until the next day.  An ankle the size of a grapefruit and you aren’t sure if it’s broken.  Cut a wide berth of slack here – pain is frightening.
  • And most of all, I give most folks credit for knowing when an emergency department visit is not appropriate, but they use it anyway….because…

1.  They can’t be turned away.

2.  They don’t have to pay a penny up front.

3.  They don’t have to wait for an appointment with their doctor.


Are you surprised by #3 up there?

I know we are supposed to believe that the emergency department crisis in this country is tied to the 45 gazillion un-insured amongst us.

Not in my experience.

I would hazard an educated guess that at least 80% of the patients I see for non-urgent problems have primary doctors, and that is a low estimate.  I know, because I ask them at triage.  Which means they have insurance coverage of some type, even if it is through the state.

If they have Medi-Cal, they are supposed to use the county hospital and clinic system, but they don’t because our ER is (a) nicer, (b) faster, (c) convenient. So, these insurance companies and the State of California are paying through the teeth for emergency department visits that did not need to happen.

Or, they don’t pay at all, which drops the over $1000.00 bill right into the patient’s lap.

And often, the emergency department doctor is not paid for their services and the hospital takes a loss because, well, not everyone can handle a debt like that, and not everyone makes payment arrangements.

If you get my drift.

One. Thousand. Dollars.


For a cold, a stubbed toe, back strain, minor fever, cough x 5 weeks, headache x 8 months (I’m not kidding), STD testing, family of five children with runny noses (I’m serious),  family of five with no symptoms who were rear-ended and “just want to be seen”….


As long as it is convenient and there is no incentive to do otherwise, the ER will continue to be populated by people with clinic-type chief complaints that have no place in an emergency department – see #1, #2 and #3 above.

Meet the Emergency Medical Treatment and Active Labor Act (EMTALA), the King of Unfunded Mandates.

So, how do we provide the incentive to use a primary physician or clinic when the patient actually has one?

It’s called a medical-screening exam.  A provider evaluates the patient at triage and if it is determined that the patient is not having a life or limb-threatening emergency (see above), and the patient has a primary doctor or clinic, they are told to follow up with their provider and will not be seen in the emergency department.


What is the advantage of the Medical Screening Exam?

I know it can seem harsh to send a patient away from the ER.

But in the end, it is a patient-centered procedure.


  • Staff can focus on the patients who need care the most.
  • The ER is not tied up with non-urgent/emergent cases, decreasing wait times for the patients who need care the most.

Meaning, the patients who truly require the resources and procedures of an ER receive those services more efficiently.

And while they may be miffed at not getting an emergency department berth, by being triaged to their doctor or clinic for follow up, the  patient with the clinic complaint is (a) not saddled with an ungodly bill for unnecessary ER visit, a bill they may not be able to pay and (b) sitting in a waiting room, possibly for hours.


I know I’m a nurse and I should have unmitigated mercy and compassion for all those with whom I come into contact with in the course of my duties.

I ain’t feelin’ it.

Especially when I know that most people are not dumb and they know exactly what they are doing when they come to an ER for a non-urgent problem.

I give them credit.

Now give me time to work with the patients who really need me.

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.

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.

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...

Continue reading »

Find Me On...
Twitter     Technorati

Subscribe to Emergiblog
Subscribe toNursing 2008
Nursing 2008

or compare prices on Nursing 2008 magazine.
Office of the National Nurse

Zippy Was Here

Healthcare Blogger Code of Ethics

  • Perspective
  • Confidentiality
  • Disclosure
  • Reliability
  • Courtesy

I Support the Public Library of Science

Health blogs

Medicine Blogs - Blog Catalog Blog Directory

Alltop. Seriously?! I got in?

Health Blogs - Blog Rankings