Monday, December 31, 2007

we've loved for three years
but all that time you annoyed
now i choose to leave


Holiday funny

Happy New Year

Registered Nurses needed - Homecare - Capreol, Ontario

Seeking Registered Nurses for homecare. The shifts available are eight-hour days, evenings and nights. Client is very flexible and able to accomodate staff with other nursing positions.

Nurses are needed for part-time and casual positions. Candidates must be certified in CPR and have a validated nursing liscence with the CNO.

RN's who are interested in the positions available can contact Darrell MacKinnon via telephone @ 705-858-0073 or by e-mail @

Sunday, December 30, 2007

the missed connection
was due to her stuffy nose
and fourteen hours

Saturday, December 29, 2007

grease drips from the car
john writes with crayon on the wall
planning his future

Friday, December 28, 2007

tingle in the feet
pinch between the shoulder blades
I'm a working slob

What are RSS feeds?

Not really sure what RSS feeds are or how they might help you keep updated? If your library has OVID databases, the new OVID SP has the capability to subscribe to tables of contents of OVID journals through the RSS technology.

Burlew Medical Library at St. Joseph Hospital in Orange, California has developed a brief document that will explain the RSS technology and give you some ideas as to how you might use RSS.

For instance, some of the RSS feeds to which I subscribe are:

Nursing Research table of contents
Krafty Librarian blog
Pubmed search on autistic disorder
Shifted Librarian blog
Consumer Health Forum
Reuters Health

I valiantly try to set time aside once a week to visit my bloglines reader and catch up on all my new feeds. It's really a " one stop" approach to shopping for the new information that meets your particular interests.

Does anyone in the blogosphere want to share how they use RSS technology and what their favorite nursing feeds are?

Thursday, December 27, 2007

Maupin's tackle store
as cute as the trading post
like the tumbleweeds

Wednesday, December 26, 2007

as I drive to work
the snow comes on like Star Wars
an hypnotic split

Monday, December 24, 2007

you smell rich as sleep
and fold around my body
like moon through the glass

Sunday, December 23, 2007

Case Manager Registered Nurse - FOR NEW YORK!

Company: The Mount Sinai Hospital – We're known internationally for our excellence in clinical care, education, and research. Become part of our team!

Title: Case Manager-RN
Location: New York, New York – What can you say about one of the most cosmopolitan cities in the world? Whatever your tastes and whatever need you're looking to fill, you'll find it in New York, the city that never sleeps.

Responsible for determining the appropriateness of admission and continued stay, assisting and implementing in the development of plan of care and identifying the expected length of stay. You will work collaboratively with physicians, social workers, clinical nurses, home care services, and other members of the interdisciplinary team as needed. You will also participate in specific clinical initiatives focused on reducing the length of stay, improved efficiency, quality and resource utilization.

Requires a NYS RN license. Utilization management/discharge planning experience and case management certification preferred.

We offer a competitive salary and benefits package.
(212) 241-9061/(866) SinaiRN (outside NYC)
Visit our website:
chewing on a Bic
a way to stave off hunger
homeless cold and broke

Saturday, December 22, 2007

the moon shines sky full
over the grocery store
shoppers do not see

Friday, December 21, 2007

frosted car windshields
red, silver, white, line by line
dog bites the snowball

Travel Nursing Questions

I recently received the following e-mail from a nursing school student with questions about travel nursing:

Hi Amy.

I *really* appreciate your blog. I have been looking for something like it for a while. Once I graduate, I am going to put in a year in the ER at one of the local hospitals. After that, I plan to jump straight into Travelling. So I have a question for you. When I see all those ads that say, "Make $XX,000 per year", or "$XX per hour", what do they really mean? Is this gross pay before benefits, or does it *include* benefits? For example: "Earn over $90,000 per year." Does that include the cost of benefits? And does that include planned overtime, or is that all straight pay? Same with the, "Earn up to $45 per hour." Gross pay? Or gross pay + housing costs + milage expenses + etc.? I know you are a busy person, and if you can't answer directly, that's okay. But hopefully you can at least blog an answer. I know there are others at my school that would love to have those answers, so I am sure there are many around the country that would too. Thanks for what you are doing!

[Name redacted]
Tacoma, WA

Let me see if I can answer most of the questions in this e-mail.

First, congratulations on your decision to go to nursing school. I didn't know when I decided to become a nurse almost two decades ago how much it would allow me to see the world. I'm sure you will find nursing much more flexible than most any other occupation you could have chosen.

Negotiate Your Package
Second, although each agency offers its own version of payments and benefits most of the packages are negotiable. For instance, you can choose to be paid hourly with or without benefits. If you choose not to have benefits you will receive a higher hourly rate of pay. If you choose to have the agency "provide" benefits then your rate of pay will be reduced. The same is true with the sign-on bonus. If you choose to have a sign on bonus (usually up to $3,000 for a 6 month assignment) your salary or hourly rate of pay will be decreased.

It has been my experience that when the ads say "Make $XX,000 per year", they are talking about the entire package (i.e. gross pay, benefits, sign-on bonus, moving and housing allowances, etc.).

Salary vs. Hourly
Most agencies will encourage you to stay with them long term by offering a higher yearly salary than you would make being paid hourly. I usually choose to be paid hourly because I like the freedom of going where I want when I want and don't like to be tied to one agency. It is really a matter of preference.

Overtime Usually Not Included
However, the ads are usually not calculating money you can make working overtime in their yearly figure. A standard work week is 36-40 hours. Most facilities will allow you to work overtime which is over and above what the ads are including.

I personally know of several travel nurses who work 5 twelve hour shifts per week for 3 months and then take two months off between assignments.

I offer my congratulations to all those who are graduating nursing school this semester. Good luck in the future and keep travel nursing in mind.

P.S. if you haven't found a nursing dress for graduation, check out these nursing dresses for sale.

Thursday, December 20, 2007

she was a white snake
she's not crying in the rain
hope is love, Guanyin

Wednesday, December 19, 2007

christmas lights hung square
an apartment balcony
plastic begonias


I've been thinking about getting a tattoo for years! Especially since going with a friend when she got hers done.
I want something that represents Strength, Courage, Perseverance. Looked into it and found out that the Koi fish is the very think that does. Especially if done in a Yin and Yang form.
Found this pic online.. exactly what I am looking for and I think that this one is cute, feminine and simple.
I just have to figure out where to put it...

Tuesday, December 18, 2007

user interface
must log in to see your friends
fingers speak the words

Monday, December 17, 2007


I got my results and I passed my OSCEs, my written final and clinical rotations! YIPPEE!
Photo Sharing and Video Hosting at Photobucket

Saturday, December 15, 2007

floral pattern sheet
pink and yellow stipple print
dappled with dog hair

Friday, December 14, 2007

On Christmas Break.. for 5 WEEKS!

I am on Christmas Break from Nursing school for the next 5 weeks! YAY!
Happy Holidays to all!
it's a mystery
the reason why you love me
through these several years

Thursday, December 13, 2007

blue panel sunshine
diaphanous fuzz bucket
glitter of christmas

Registered Staff Nurses for Ontario, Nova Scotia and British Columbia

Trust / Employer Beresford Blake Thomas Nursing
City Toronto
Location Worldwide (Outside Europe)
Career Level Staff Nurse
Specialism Adult / General
Working Hours Full Time
Salary £35 - £40 per year
Vacancies 5

OFFERING UPTO $5000 (canadian) for relocation assistance, Free flights, Fully visa and registration assistance, Canada has one of the highest standards of living in the world.

Our clients in Ontario, Nova Scotia and British Columbia are looking for many ICU, NICU,ER and CCU nurses. Applicants must have at least two eyars experience in their speciality and to work in Ontario, applicants must have a minimum of a Bachelors degree in Nursing. Applicants must be eliigble for registration with the appropriate nursing board for whichever province they wish to work in.

Adrian Duffy
8th Floor, Southside
105 Victoria Street

Freephone: 0808 143 6000

Nurse for Dubai now hiring!

Senior Staff Nurse - Prison Healthcare

Reference Nurse Dubai
Trust / Employer Beresford Blake Thomas Nursing
City Dubai
Location Worldwide (Outside Europe)
Career Level Enrolled Nurse
Specialism Adult / General
Working Hours Full Time
Salary Negotiable
Vacancies 9
Start Date ASAP

We are currently recruiting for staff nursing positions throughout the United Arab Emirates, including Dubai, for various clients. You will benefit from extensive career development, generous tax free salary, sign on bonus, retention bonus, free accommodation, free transportation, free utilities, and visa application on your behalf,and many more.
In return, you will be willing to commit to a minimum of 1 year's contract.
The ideal candidate for this role, will have a minimum of 2 years post qualification experience. You will come equipped with valuable skills and experience, and an appetite for a successful career, and new opportunities and development.

Contact Details
Sharon Rumens
OES Healthcare Recruitment
Business Development Centrte
Eanam Wharf

Tel: 0808 118 1454

Wednesday, December 12, 2007

Systematic Review Made Simple for Nurses

There is an excellent article in SGH Proceedings v 16(2):104-110 2007 by Leong Siew Teing titled Systematic Review Made Simple for Nurses. This article is available as free full text. The SGH Proceedings is a refereed scientific journal of the Singapore General Hospital. The article also highlights a three phase lit search strategy recommended by the Joana Briggs Institute (JBI).
hair like her mother's
some day she'll pluck her eyebrows
square head paper doll

Tuesday, December 11, 2007

yogurt and spices
simmering on the stove top
hindi butter dish

Monday, December 10, 2007

Nurses Recruitment in Kuwait

An Agency company for the worker in Kuwait, Nurses Overseas Employment Corporation (NOEC) is looking for Diploma and Bachelor Nurse (RNs) with 2 years experienced working in hospital especially on emergency and medical department to fill the position of Staff Nurse for Private Hospital in Kuwait. NOEC has recruited many of Nurses from Philippine, India, Suria, Egypt, Jordania and also including Indonesian Nurses.

Those people who qualified for the position will get paid 200 - 350 KD (US 650$ - 1200$) as their salary. Successfuly applicants for Staff Nurse for private Kuwait hospital will have a great career in Nurses Overseas Employment Corporation.

Position : Staff Nurse
Country : Kuwait
Date Posted : Dec 05, 2007
# Requirements Must have a minimum age of 23 yrs. old
# Must have a maximum age of 45 yrs. old

Job Details : Have good relation with the others Staff Nurse and Doctor in colaburation to provide health care services for the patient as a Medical Team.


O bjective
S tructured
C linical
E examination

This semesters are based on psychiatry and geriatrics and emergency procedures (life saving/CPR).

Exam Stress...

I am in finals week... 3 exams total, doesn't sound like much, considering I only have 2 classes, though nursing is 23 hrs a week (that's with 16 hrs of clinical), and I have a 3 hr sociology of health class.

Nursing final (written) is Tuesday and it covers 17 lectures worth 40%.. AHHHH!
Nursing practical (OSCE) are Thursday and frankly I have no idea what they will throw at us!
Sociology is a take home, an essay 2-3 pages long, sounds ok right? WRONG! This class is badly taught and we have to write the essay based on articles read for class. Problem is, we have NO IDEA what the heck he is talking about 3/4 of the time and he gives us HIS opinion and if you disagree he fails your paper...! ARGH!
I plan on writing it Tuesday afternoon AFTER the nsg written final.
she leans in to see
the smallest flaws of her pores
probing fingernails

Saturday, December 8, 2007

father lifts her up
hands up her wrists a red grip
as he spins her high

Friday, December 7, 2007

it is probable
that I am not a writer
because I worry

Samford To Begin Offering A Doctoral Nursing Program

Samford University officials announced today that they will begin offering the Doctor of Nursing Practice degree next year to meet a need for advanced practice nurses. (article)

Cochrane Collaboration on YouTube

Evidenced based resources on YouTube-- who would have thought!!

View this brief 7 minute videotape that gives a great overview of the Cochrane Collaboration and the Cochrane Library.

Thursday, December 6, 2007

take the grievance list
tape it in the complaint book
smug satisfaction

Wednesday, December 5, 2007

Abstract with Commentary

Abstract and Commentary

Robinson, S. et al. (2007). Development of an evidence-based protocol for reduction of indwelling urinary catheter usage. MEDSURG Nursing, 16, 157-161.

Author’s Abstract

Studies indicate 40% of indwelling urinary catheters are unnecessary in hospitalized patients (Gardam, Amihod, Orenstein, Consolacion, & Miller, 1998; Gokula, Hickner, & Smith, 2004). The results of a protocol developed to limit catheter use are described.

Commentary by Dana Rutledge, RN, PhD, Nursing Research Facilitator

The project was framed in the Iowa Model of Evidence-Based Practice (EBP; Titler et al., 2001), the same model adopted at St. Joseph Hospital. Nurses at a large tertiary care center identified a potential problem: inappropriate use of indwelling urinary catheters. The trigger to action was guidelines developed by the Nurses Improving Care to Health System Elderly (NICHE). The guidelines recommend limiting catheters to elders with very specific problems such as urinary retention.

Chart audits of patients with indwelling catheters found 17% with documented urinary tract infections (UTI). A team was formed to develop a protocol to encourage more appropriate use of indwelling catheters. This group reviewed 32 articles on the topic, about half of which were rated as strong evidence sources. Based upon the evidence, they determined when urinary catheters are appropriate in hospitalized patients.[1]

A pre-protocol chart audit indicated that 35% of patients had a urinary catheter at some time during hospitalization. Of these, 42% had no appropriate reason for catheter use. Only 70% had an order for insertion. Almost 40% were inserted in the emergency department. Almost 2/3 were not removed until day of discharge. Symptoms of UTI developed in 38% of patients.

A 2-week pilot test was done with nurses requesting an order for removal of the catheter unless it was used for one of the criteria in the footnote below, along with use in patients 48 hours post surgery. Afterwards, mean days that catheters were in place dropped from 8.6 to 4.5 days, orders to remove increased (43% to 93%), documentation of removal increased (57% to 87%), and only 7% of patients had catheters in on discharge day. In the pilot group, only13% had UTI symptoms.

To institute this change in practice (nurses asking for catheter removal), a multi-method educational effort ensued. Pilot outcomes were disseminated, along with findings from the literature. Physicians were educated at several formal gatherings. This manuscript does not describe outcomes from the full scale implementation.

Can you think of which patients at SJH may have inappropriate urinary catheters? What methods could be used to decrease their use? What resources would be needed to implement these methods?

Titler, M.G. et al. (2001). The Iowa Model of Evidence-Based Practice to Promote Quality Care.
Critical Care Nursing Clinics of North America, 13, 497-509.

[1] For bladder irrigation or instillation of medication; to provide relief of urinary tract obstruction; to permit drainage in persons with neurogenic bladder dysfunction or urinary retention not manageable by other means; to obtain accurate intake and output in critically ill patients; to aid in urologic or related surgery; to manage urinary incontinence in persons with stage 3 or 4 pressure ulcers; and to promote comfort care in the terminally ill

In this site you can find leading hospitals, travel nurse companies and recruitment agencies to help you find your dream travel nurse job!
brown slump-backed sofa
animal fur on the arms
a piece of heaven

Tuesday, December 4, 2007

Medcal Library Association's white paper on magnet recognition

Our blog is mentioned in the Medical Library Association's white paper: Magnet Recognition Program Collaboration Proposal: The American Nurses Credentialing Center and the Medical Library Association. One of the sections deals with Librarians' contributions to their institutions' magnet journey and gives examples of nurse/librarian collaborations. Our blog is mentioned at the end of this section and is the only activity of this kind listed in the contribution section. Way cool!!

Yale University School of Nursing

Yale University School of Nursing is a vibrant, exhilarating and rigorous place to study nursing at the graduate level. Students from diverse backgrounds meet in an environment that nurtures an appreciation for high standards and the pursuit of excellence in nursing practice.
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Rambling on About Care in the Community and bed blocking.

Have you heard about the care in the community shit?

There are no beds in hospital. There is no staff in hospital. The Burger King down the road is staffed better than my ward and that is the truth. There are not enough places in the community and/or nursing homes to care for people. Meanwhile 80% of new nursing grads cannot find jobs and money is getting pissed away on luncheons so that the managers can have another meeting to plan another meeting and never take any action.

I work on a ward that is primarily medical and we take a lot of exacerbation COPD patients. Many of these patients are anxious and cannot deal with the fact that their nurse has other patients who may be sicker. I would feel the same way if I had copd and was struggling to breathe.

They are often on the call bell every 30 seconds for reassurance etc. Many of them are elderly and can barely manage to get out of bed onto the commode without help.

They want to "care" for these people in the community. They cannot even care for them in the hospital. They come in. They get ignored by overwhelmed nursing staff whose heart is the in the right place but cannot do their jobs. They deteriorate.

But home care is not the answer, because it will be managed badly like everything else and their is a higher chance of the ball getting dropped. The hospitals should hire some of the 80% of nursing graduates who cannot find jobs and care for these people in hospital. The matrons and the "specialist nurses" who spend their days drinking tea and coming up with retarded 20 page forms for the bedside nurses to fill in should get their asses to the wards and give a hand. I have a hard time referring to our so called leadership as "nurses". They don't deserve the title.

I don't see how any of our patients could manage at home for any length of time. Even when they are declared medically stable they are still dependent. They would all need one to one community nurses. Hospital care is bad and often leaves these people with more problems BUT this situation is fixable.

At the moment 80% of our patients are medically stable but unable to care for themselves at home. WE have a lot of elderly folks around here and no elderly beds and too few nursing homes. The hospital picks up the slack.

Many many many of my patients have been there for months and months. We have some who are waiting for beds in nursing homes, some who are waiting for care packages to be sorted for at home care, most who are unable to walk thanks to being left in a chair with no moblization because their nurse is so overwhelmed. They have family that won't or can't provide care and yet refuse help from social services. We have these people for months on end and there is no answer.

We have one patient who has been with us for 6 months. It was determined that she couldnt go home and needed nursing home care. She and her daughter picked out a nice one with help from social services. She had a bed at a nursing home near her daughter. She really wanted to go to that nursing home and sat in the hospital for 3 months waiting for a bed at this facility. I shit you not.

The day before she was to go there she told her daughter that she changed her mind and wanted to go to another nursing home. Daughter cancelled the nursing home bed and then came and told us (nursing staff)about an hour before she was to go. A surgical admit was slated to come into that bed in the afternoon. I shit you not.

It will be another 2 weeks before the new nursing home will come to assess her, and then we can find out if they will accept her. Then she will wait for a bed. Social services want the nurses to fill in another 20 page nursing assessment form again that is complete bollocks. No one will have time on any shift to do this. I am sure she will be with us another month AT LEAST. It may very well be a lot longer.

Then she gets angry when we have acutely ill patients and she gets less attention. The patient in the bed across from her arrested and whilst we were doing CPR she was overheard complaining that she has been at our hospital for months and never received that kind of attention. Makes me go grrrrr. This is not one unusual patient. This is 40-60% of our patients at any given time.

Some do get discharged home without adequate care in place because they want to create free beds. 72 hours later they are back in casualty with dehydration and a fractured neck of femur.
Meanwhile I could get the accident and emergency staff brought up on harassment charges for ringing every 30 seconds making threats. I don't blame them really. It's their ass if their patients breech the 4 hour rule. And it is all completely out of their control.

So we are getting constant bullying harrassment phonecalls from accident and emergency and the bed manager ordering us to "get people the hell out" because patients are breaching the 4 hour waiting times in Accident and Emergency and there are no beds. There are so many more patients coming to the hospital than they can deal with. We have a side room where the roof is leaking and tiles are caving in due to flooding and I was ordered to put a patient in there.

I have recieved a phone call at 0200 that a bed has become free in an outlying hospital and to pick a patient and get them transferred out there NOW because we are breaching. Why are we nursing targets and not patients? Not one of my patients are going to be happy about woken up at 0200 and transferred god knows where. I was threatened and told that if I don't walk away from what I am doing (never mind the 50 year old patient who has just suddenly developed expressive dysphagia and numbness and weakness on one side and I am trying to get a doctor up and I am the only nurse) that I will be disciplined.

And their relatives are going to fly into a rage about grandpa being woken up at 0200and getting shipped out to god knows where. They will chew out the nurses that's for sure.

I focused on the poorly patient first rather than deal with the transfer. I'll get busted for that you know. I was the only nurse and I couldn't leave the unwell patient to sort a transfer (transport, informing relatives who will go ballistic etc etc etc).

It is the same damn problem in every post I make.

Monday, December 3, 2007

This is ENA

The EMERGENCY NURSES ASSOCIATION (ENA) is the national Association for professional nurses dedicated to the advancement of emergency nursing practice.

1996 to 2007

Memories from 1996... I was there with my friend Irene. 15 days of Olympic fun!

why do I do this
every day laboring
over a few words

Sunday, December 2, 2007

the wind has wide cheeks
wind beats on the door 'hello'
'who will let me in'

Saturday, December 1, 2007

Friday, November 30, 2007

all the aisles are full
if there wasn't a deadline
would you still buy it

List of Nursing Schools

List of Nursing Schools, Nursing Programs, Nursing Degrees, Nursing Certificate, Registered Nurse, Licensed Practical Nurse, Pediatric Nurse, Nursing Courses, RN Schools, LPN Schools, Colleges & Universities in USA

Nursing in the USA

Geneva Health has partnered with a top United States based company who work with International nurses for job placements in the States. By taking this route you work directly for an agency in the U.S. each with many years of successful recruitment experience.

Thursday, November 29, 2007

head heavy pillow
curve of the eyebrow smooth clean
eyelashes mingled

Wednesday, November 28, 2007

Tuesday, November 27, 2007

Travel Nursing

Travel nursing is a form of temporary nursing employment where nurses are relocated to assignments that generally range from 4 to 13 weeks.
the way the tongue feels
fat against the crooked teeth
one last excursion

Monday, November 26, 2007

My night to shine

OK, so yeah, I am tooting my own horn. I don't do it often, so that makes it ok!
I won a scholarship from school, from the nursing department. It was a fun night, though after an 8 hr shift and being up since 5AM I was a little tired. I got my second (or third) wind and made it through the ceremony. My two best nursing school friends came with me and I saw the other nursing students and friends/family. We made up the largest group, as our dept has the most awards/scholarships to give out.
The awards I won is called the Gail Hodson Award.

US Board of Nursing Directory

Are you looking for a travel nurse assignment or a nursing job in Connecticut? Possibly interested in picking up a per diem shift in Connecticut?

A Mistress A Day Keeps the Doctor Away

I'm no Dr. Laura, but I can only guess what she would have to say about a male patient I had to take care of the other day. He had injured his back and right leg after falling off a latter at work.

His wife had slept on the pull out bed in his hospital room the night before my shift and was giving him a sponge bath when I first visited his room. Later she spoon fed him breakfast and lunch even though he was able to feed himself. After spending the entire day waiting on him I heard her say she needed to go home to fix dinner for the kids. I can only assume she meant THEIR kids. Although appearances can often be misleading, she seemed to really love her husband and when she left I thought to myself "what a wonderful relationship they have."

About thirty minutes after his wife left I overheard him on the phone telling someone "She left already. Come on up." As I walked out of his room ten minutes later I passed a skanky dressed woman walking in. On my next visit to the room the woman was sitting on the bed next to my patient with her hand in his lap. The man didn't even seem a little embarassed by the fact that I knew his little secret.

Maybe his wife knows about his mistress. Although I usually try not to make judment calls about my patients, it sure was hard to look at him the same way after finding out about the other woman.

As my shift came to an end the two asked me if I wanted to use some tickets they no longer needed to a show at the Civic Center that night. I took the tickets, but I still don't approve of their relationship.
trucks parked with the tide
lights sparkled the silica
digging razor clams

Sunday, November 25, 2007

the sunset was green
if green was apricot red
and a tide capped white

Friday, November 23, 2007

Nursing Job Resources

Hi, my name is Hellen Hover and I'm an RN originally from Nashville, Tennessee. Visit my Web page; I hope you find it useful.

Travel Nursing Jobs

Travel nursing is becoming more and more popular these days, with more and more nurses turning to this kind of work.

It is easy to find travel nurse jobs on the internet, as sites such as accept online applications.

Bridgewater College

Bridgewater College has led the way for more than 125 years developing leaders in fields such as business, industry, medicine, law, communications and education.

How I Select A Travel Nursing Assignment

This post is in response to a number of e-mails I have received this week asking me about how I select my travel nursing assignments.

Let me start by saying I am currently registered with more than a dozen travel nursing agencies although I have used only two or three of them during the last year or so. I keep my paperwork up to date with all of the agencies. This allows me to receive e-mails from all of the agencies detailing the available travel nursing assignments . I have previously posted one of the e-mails I received last summer with a listing of assignments on it here. That e-mail is typical of all of the agencies.

Select Your Location First
The first thing I do is select where I want to take an assignment. Being registered with so many travel nursing agencies increases the likelihood of finding an assignment in any location I choose. So far the only difficulty I have had in finding an assignment has been when I have wanted to work in smaller towns with smaller facilities. I have never had a problem finding assignments in cities with more than 30,000 people.

My husband and I have used a number of methods to choose a location. We have picked some locations after visiting them on vacation (Knoxville, TN), some because we just wanted to see what it would be like to live there (Bellingham, WA), some to be near relatives for the holidays (Jacksonville, FL) and some for the money (Orange County, CA). It has been my experience that anywhere you choose there will be at least one medical facility that hires travel nurses.

If you are not sure you will like the location you have chosen ask your agency for a shorter 3-4 week assignment. It is my understanding that some agencies will work with you on the length of the assignment. Most assignments I have taken have been 6 weeks or longer.

Select An Agency
You do not have to limit yourself to one agency. I have come up with several checklists I use when registering with an agency. The checklists deal with Contract Terms, Housing Stipends, Medical Facilities, Benefits and Insurance.

I hope this e-mail has answered the e-mails I have received this week.

Wednesday, November 21, 2007

steaming saucepan eyes
over-cooked teflon peeling
egg and cheese burning

Monday, November 19, 2007

Find some links to Arizona's Jobs

Arizona's Job Guide

I was born in Arizona, "The Grand Canyon State," and thanks to travel nursing, I have the chance to visit friends and family there from time to time.
her name is cow eyes
shoes wet as the streets she walks
voice like a drill bit

Sunday, November 18, 2007

Handover Fun

One day I was the only registered nurse for 18 patients (worse than normal number of 15) for all of my shift from 0730 until 2130 hours. At 2100 my relief comes in. She has been off duty for a week and does not know the patients. She is a newish pool nurse. I need to give her a detailed report on each and every patient. She will be in charge of their care on night shift. Even if I only spend 2 minutes per patient during the report session, handover will still take 36 minutes. But two minutes per patient will not even scratch the surface in telling her everything she needs to know and handover to the day staff so they know. Three of the patients are acutely ill right now and have some really complex things going on. Most of them have relevant past medical histories that would take longer than 2 minutes to handover.

I had an admission at 2100 so I start handing over at 2115. The oncoming nurse cannot touch a patient until she gets report and knows about them. Doing that is begging for litigation. We really need to get started with this handover.

2115 hours
I start handing over at 2115, at 2116 a patient requests pain meds so I administer them, on the way back to handover a patient requests the commode so I help her with that. Phone call comes in from lab that new admit has an HB of 6. Eek. Call doctor. He orders a group and have blood tonight etc etc. It will take a lot of time in itself between getting the blood from path lab, setting it up, moniter for transfusion reactions etc.

2130 hours
take patient off the commode and settle her into bed. She asks for a drink, my HCA's are tied up with a confused patient so I get this lady her drink. Can't handle complaints from patients saying that the nurse couldn't even be bothered to get someone a cuppa.

2135 hours
back to handover room. I was halfway through the first patient so I continue. I am in here and there is no RN to care for my patients whilst I am handing over.

2136 hours

phone rings. Angry relative wanting to know if the nurses "bothered" to change mum's nightgown today. He gets nasty. He obviously is in a bad mood and wants to kick out. Probably a regular reader of The Times who thinks there are lots of nurses up here eating the patients food and discussing politics since we are too academic now to wash and don't care about patients.

2138 hours
back to handover. we tick on nicely until...

2145 hours

I realise that patient who has an infusion of IV insulin is way over due to have her sugar checked. This is not something you can put off until later. It will need checking again in an hour. HCA's are still tied up so I do the BM. She asks for commode while I am there. I am useless at saying no.

2150 hours

back to handover.

2200 hours
I am just in the middle of telling on coming nurse what we need to do for a patient that has a drip with a med that she has never seen before....explain what we need to watch for, labs that are getting drawn in the night that she needs to stay on top of...

Visitor (who shouldn't be there at this time but has special permission) bursts into handover room. Demands that I get up off my ass and clean his mother up.

I am concerned with time at this point as it is way past the time that the night nurse should have started her assesments and drug rounds. Lateness could fuck things up royally for these 18 patients. 9PM meds have not been started yet. I see the HCA getting someone a pillow. I point her out to the visitor and say that I'm sorry cannot help you now...can you ask that young lady over there. He tells me that he didn't ask her because "that nurse looks busy meanwhile you nurses are sitting in here chatting" I resist the urge to punch his ignorant face.

2205 hours
It takes less time to sort out patient than to argue and explain to the visitor why I can't so I go to help her with assistance of oncoming nurse. It takes 5 minutes to clean her up and 20 minutes listening to the visitor and patient tell us what useless slags we are for not being at her bedside all the time, all shift. Arguing back is pointless.

Back to handover. Ten call bells are ringing throughout the rest of handover. This is more than 2 HCA's can handle. If we go out there we will never get through this. Ever. Things are getting desperate now. I fly through the rest and say a silent prayer that I am not forgeting anything critical.

Phone call from patient's cousin who wants to know the ins and out of everything we are doing for his loved one. I have no choice but to be abrupt with him.

I finish handover and realize that the hourly blood sugar check for the IV insulin patient is a little overdue as well as 100 other such things. I go to check it so night nurse can get started. Get stopped for 3 commodes on the way back to nurses station. The night nurse and HCA are tied up. One patient starts telling me off as she has been ringing for 15 minutes and asked why we couldn't be bothered to see to her.

Path lab has blood ready. That was fast.


Head Home. I have been here since 0715 this morning and have been unpaid since 2130. I WILL be deducted on hours pay for lunch breaks I didn't have. Phone call comes in. I let night nurse get it. It is a relative screaming because their loved one was left to starve yesterday. Patient was NBM for an operation. Don't these people have anything better to do at this time of night other than stopping nurses from seeing their patients and interrupting them whenever they try to hand over critical info to the oncoming shift? WTF? During the day the phone never stops ringing due to this shit. At least there are less calls at this time.

I am going home. I am tired. Fuck the paperwork I haven't done. They can pull my registration for all I care at this point.

0400 hours

Wake up to see what why my baby is crying and it suddenly occurs to me that I forgot to tell oncoming nurse about a patient who should be NBM from midnight for a FBS test in the AM. Call work since she probably won't have time to look at the charts causing the patient to get breakfast. I am not the only nurse who calls in the middle of the night with this kind of stuff. There is way too much info to keep track up and no time to stop and review and take stock. At least this was relatively minor.

How different would things be if there was at least one other RN on duty with me to cover problems while I was handing over? You should see what it is like when we are one RN to 35. There was another RN on duty on the ward but she was even busier with her 18 patients. I don't know what time she got out. Her patients were on the other end and we didn't really see eachother.
tin can radio
discussion of the sasquatch
he'll never forget

Saturday, November 17, 2007

I feel disjointed
lost behind the flat panel

Friday, November 16, 2007

she plays exotic
gluing silver adhesive
flecks around her eyes

Thursday, November 15, 2007

Travel Nursing Agencies

Traveling Nurse

The Traveling Nurse: a Sought-After Professional

A traveling nurse is a registered nurse who contracts for short term nursing assignments in locations that are usually far from home. The assignments are typically 90 days to one year, but arrangements can vary and shorter term assignments are also occasionally available.
bare branches divide
splicing out to the smallest
until there is none

Wednesday, November 14, 2007

the red strap flip flops
summer creased your sole open
pleasure of neglect

Tuesday, November 13, 2007

The Catholic University of America School of Nursing

The School of Nursing offers undergraduate, graduate master's and doctoral programs. Students in CUA’s nursing programs gain clinical experience in 100 of the Washington Metropolitan area's premier health care facilities often with alumni preceptors.

Staff Nurse ICU for New Zealand

Job Title: ICU Staff Nurses- New Zealand
Contract: Permanent
Salary: $NZ50,000 median
Hospital Type: Public Sector
Location: New Zealand
Specialities: ITU/ICU

Job Description:
NZ's capital city is looking for experienced ICU nurses. If you have 2 years ICU experience we would love to hear from you. In 2008 the brand new state -of- the- art hospital will be opened, it is 5 minutes from the heart of Wellington, the cafe capital of New Zealand! The lifestyle in NZ is one to be envied by other countries, you are never far from the sea, adventure sports abound we have areas just like Switzerland, great skiing yet we also have long sandy pristine beaches with long warm summers.


RN1 NMC Registered Post grad ICU course very desirable


2 years ICU experience

pls email:

women when they talk
pause to emphasize deep thought
hoping to appeal

Monday, November 12, 2007

Nursing Clinics of North America

The first Clinics of North America were published in the early 20th century by W.B. Saunders Publishing Company in Philadelphia. In 1912, The Surgical Clinics of John B. Murphy and the Collected Papers of the Mayo Clinic, known respectively as The Surgical Clinics of North America and Medical Clinics of North America, were launched. Today, there are nearly 60 different Clinics titles, each one covering a distinct area of surgery, medicine, veterinary medicine, nursing, and dentistry.
everyone I know
I know through my employment
my friends are not friends

Sunday, November 11, 2007


Check out this link and vote for my fur-babies! I've entered a few pics...

VOTE for Nadia in The 3rd Annual World’s Coolest Dog & Cat Show!

VOTE for Sjoukje in The 3rd Annual World’s Coolest Dog & Cat Show!

VOTE for Tisha in The 3rd Annual World’s Coolest Dog & Cat Show!

VOTE for Bear in The 3rd Annual World’s Coolest Dog & Cat Show!

VOTE for Papa Doc in The 3rd Annual World’s Coolest Dog & Cat Show!

Stateside Nursing International

SNI is an American company based in Colorado, USA. Our director, Pat Decker started SNI in 1996. Before that time Pat spent many years working in international nurse recruitment. Since 1996 SNI has recruited hundreds of nurses for our client hospitals.
why won't you love me
I know my eyes dilate
happy to see you

Saturday, November 10, 2007

Pineapple Plant

I went to the grocery store and saw this cute pineapple plant... I had to get one!

you should not believe
the monstrous myth of terror
our masters tell us

Friday, November 9, 2007

be silent my love
for when you speak you ruin
the ridiculous

Thursday, November 8, 2007

Southern Nursing Research Society

The mission of the Society is to:

1. Advance nursing research

2. Promote dissemination and utilization of research findings

3. Facilitate the career development of nurses and nursing students as researchers

4. Enhance communication among members

5. Promote the image of nursing as a scientific discipline

Visit the website.
the boy and the girl
sit in the bay window and
watch the clouds roll by

Wednesday, November 7, 2007

Julie's picks from the Nursing Literature Oct 2007

Check out these "picks" from recent articles dealing with nursing research or evidence based nursing.

1. Wilhelmsson S. Lindberg M. Prevention and health promotion and evidence-based fields of nursing -- a literature review. International Journal of Nursing Practice. 2007 Aug; 13(4): 254-65. (27 ref) Burlew has some online access, no print issues. AN: 2009640528 NLM Unique Identifier: 17640247.
NLM Serial ID Number9613615

2. Matchim Y. Armer JM. Measuring the psychological impact of mindfulness meditation on health among patients with cancer: a literature review. Oncology Nursing Forum. 2007 Sep; 34(5): 1059-66. (41 ref) Burlew carries this journal AN: 2009667780 NLM Unique Identifier: 17878133.
NLM Serial ID Number7809033

3. Rawson KM. Newburn-Cook CV. The use of low-dose warfarin as prophylaxis for central venous catheter thrombosis in patients with cancer: a meta-analysis. Oncology Nursing Forum. 2007 Sep; 34(5): 1037-43. (30 ref) Burlew carries this journal AN: 2009667778 NLM Unique Identifier: 17878131.
NLM Serial ID Number7809033

4. Jansen CE. Miaskowski CA. Dodd MJ. Dowling GA. A meta-analysis of the sensitivity of various neuropsychological tests used to detect chemotherapy-induced cognitive impairment in patients with breast cancer. Oncology Nursing Forum. 2007 Sep; 34(5): 997-1005. (35 ref) Burlew carries this journal AN: 2009667775 NLM Unique Identifier: 17878128.
NLM Serial ID Number7809033

5. Delgado-Passler P. McCaffrey R. The influences of postdischarge management by nurse practitioners on hospital readmission for heart failure. Journal of the American Academy of Nurse Practitioners. 2006 Apr; 18(4): 154-60. (17 ref) AN: 2009153576 NLM Unique Identifier: 16573728.
NLM Serial ID Number8916634

6. Mickle J. Reinke D. A review of anemia management in the oncology setting: a focus on implementing standing orders. Clinical Journal of Oncology Nursing. 2007 Aug; 11(4): 534-9, 590-4. (19 ref) Burlew has some years. AN: 2009646490 NLM Unique Identifier: 17723966.
NLM Serial ID Number9705336

7. Moore SM. Duffy E. Maintaining vigilance to promote best outcomes for hospitalized elders. Critical Care Nursing Clinics of North America. 2007 Sep; 19(3): 313-9. (40 ref) Burlew carries this journal AN: 2009660369 NLM Unique Identifier: 17697952.
NLM Serial ID Number8912620

8. Kelly T. Howie L. Working with stories in nursing research: Procedures used in narrative analysis. International Journal of Mental Health Nursing. 2007 Apr; 16(2): 136-44. (37 ref) AN: 2009544947 NLM Unique Identifier: 17348965.
NLM Serial ID Number101140527

9. Closs SJ. Postoperative ibuprofen increased bleeding complications in hospital and did not improve pain or physical function at 6-12 months after total hip replacement. Evidence-Based Nursing. 2007 Apr; 10(2): 57. (5 ref) Burlew has some online access, no print issues. AN: 2009552902 NLM Unique Identifier: 17384109.
NLM Serial ID Number9815947

10. Stone C. Rowles CJ. Nursing students can help support evidence-based practice on clinical nursing units. Journal of Nursing Management. 2007 Apr; 15(3): 367-70. (13 ref) Burlew has some online access, no print issues. AN: 2009546843 NLM Unique Identifier: 17359437.
NLM Serial ID Number9306050

11. Garbett R. Hardy S. Manley K. Titchen A. McCormack B. Developing a qualitative approach to 360-degree feedback to aid understanding and development of clinical expertise. Journal of Nursing Management. 2007 Apr; 15(3): 342-7. (23 ref) Burlew has some online access, no print issues. AN: 2009546840 NLM Unique Identifier: 17359434.
NLM Serial ID Number9306050

12. Jansen J. van Weert J. van Dulmen S. Heeren T. Bensing J. Patient education about treatment in cancer care: an overview of the literature on older patients' needs. Cancer Nursing. 2007 Jul-Aug; 30(4): 251-60. (35 ref) Burlew carries this journal AN: 2009646256 NLM Unique Identifier: 17666973.
NLM Serial ID Number7805358

13. Dunne M. Kelvin J. Derby S. Montefusco M. Cawley K. Lucas J. Gilman J. Bringing the evidence to practice: development of guidelines for mucositis prevention and management in patients receiving cancer therapies. Oncology Nursing Forum. 2006 Mar; 33(2): 396-7. Burlew carries this journal AN: 2009169830.
NLM Serial ID Number7809033

14. Baldwin KM. A case for using evidence-based assessment scales. American Journal of Critical Care. 2007 Jul; 16(4): 394-5. (10 ref) Burlew carries this journal AN: 2009616894 NLM Unique Identifier: 17595372.
NLM Serial ID Number9211547

15. Labeau S. Vandijck DM. Claes B. van Aken P. Blot SI. Critical care nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia: an evaluation questionnaire. American Journal of Critical Care. 2007 Jul; 16(4): 371-7. (32 ref) Burlew carries this journal AN: 2009637067 NLM Unique Identifier: 17595369.
NLM Serial ID Number

16. James V. Clark JM. Focus. Benchmarking research development in nursing: Curran's competitive advantage as a framework for excellence. Journal of Research in Nursing. 2007; 12(3): 269-87. (34 ref) AN: 2009645900.
NLM Serial ID Number101234311

17. Woodward V. Webb C. Prowse M. Focus. The perceptions and experiences of nurses undertaking research in the clinical setting. Journal of Research in Nursing. 2007; 12(3): 227-44. (67 ref) AN: 2009645892.
NLM Serial ID Number101234311

Nurse Immigration USA

This web site is dedicated to educating nurses worldwide regarding US employment, immigration and licensure...
the panda is mad
clawless mitts and toothless smile
he wields a red pen

Tuesday, November 6, 2007

University of South Alabama

The College of Nursing at the University of South Alabama has an excellent record of making a difference by preparing professional nurses who are outstanding clinicians, leaders, and managers. Our graduates possess the knowledge and skills to be successful in their careers as professional nurses.

Open House 2007

I worked Open House for my school again this year. It was fun, even better now that I am in 3rd yr. Feels like we are more important somehow. We are treated more like equals with staff at times, and the 1st yrs look up to us... more like they can't quite figure out HOW we got there as it all seems so impossible now! LOL... Ah, first year.. when doing AM Care felt hard, hahaha.

dancing is absurd
moving like wet puppies run
linoleum lights

Monday, November 5, 2007

The Long Overdue Ending

I know I promised to tell you about my NCLEX a couple months ago. I've just been so busy I've hardly had time to write in my regular blog, much less my nursing one! But let us get down to business first. This is what NCLEX was like for me:


I purchased the Kaplan Online Complete package for far too much money. The online course was soooo boring, but had some nice ideas and flowcharts and such. The online question bank was the best investment in the package, however. Answering several hundred questions really got my brain into NCLEX mode. I highly recommend the Qbank, but can take or leave the rest of the course.

My classmates went to the Hurst Review. I flipped through their book and listened to their stories after the course was over. Apparently it was hilarious and awesome and useful because the crazy jokes and anecdotes caused all the review points to stick well in your mind. The book was much simpler and digestible than my own Kaplan book, but it lacked the review questions I found so useful. So I recommend the Hurst Review as well, though only if you're able to attend a live class.

On the whole, I recommend you do any review course, period. They help refresh your brain, and statistically those candidates do better. Which kind you pick really depends on your style.

The Exam

I arrived early to the small testing facility. I opened the door to find a gentlemen seated attentively and upright behind a desk. He stared at me as I entered and sat. After I'd arranged myself in the chair, he asked if he could help me. Yes, I explained, I'm taking NCLEX.

"Your authorization to test, please. Thank you. Please take this paper and read it. Let me know when you have finished." He was a very formal guy, whose tone was as crisp as his pristinely ironed shirt. I sat and read the paper. When I came back I had to give him my ID, sign my name, let him scan my finger 5 times, get my photo taken, sign my name again, lock up my things, on and on and on. Finally he gathered my papers, scanned my finger one last time, and walked with me two steps into the hallway.

There was a woman seated in the monitoring station, watching the test takers. Though calling it a monitoring station is a kind of visual understatement. It might be better described as a space pod, since it's sphere of glass looked down upon so many screens I felt certain that touching one of them would surely cause the entire thing to blast off.

She took my ID as well, scanned my fingerprint, activated my test in the computer, and escorted me inside to my terminal. I noted that I was seated at computer #7, and hoped it was a lucky omen.

There were a tiny pair of earplugs before the monitor that I didn't use. I started clicking at the tutorial pretest questions and reading yet more rules and warnings. When the test finally began, it looked exactly like the review books describe them. I didn't feel nervous at that time. I felt like I had a really good chance.

Every time I answered a question and clicked "Next", I checked the counter at the corner of the screen. I've heard people say that they were never more terrified than when the cutoff screen popped up and ended the test. I was actually the opposite. I was terrified when I hit Next on question 75, because if it didn't cut off then that would mean that I still hadn't passed. At least I'd know it was over if it cut off at 75. If I had to keep answering questions after that, I would have been terrified.

Thankfully, it did cut off at 75. They scanned my fingerprint again when I left. As I understand it, they scan your fingerprint if you so much as get up to go pee. I was glad to be out of there.


I didn't check exactly 48 hours later. I spent the day working, then spent the evening at a friend's house soothing his grief over his recent breakup. So when I finally got around to checking the site in the middle of the night, I was somewhat disgruntled when I was greeted with only a few lines of text saying my name, number, and the word PASS.

I blinked heavily. Where were the trumpets??? At the very least couldn't they have included an animated gif? Or perhaps the word "Congratulations"? Make no mistake, I was thrilled. But it seemed almost an anticlimax to these years of struggling and studying. I printed out a screenshot to keep with my other school momentos. And then I went to bed, and didn't dream at all.


I'm now a full time RN in a Cardiac Care Unit, and almost finished with orientation. And I have to say, I love it. I absolutely love it. While I found my experiences as a nurse tech extremely beneficial while in college, I cannot tell you how physically demanding it could be on me sometimes. This job is so much better, and I don't feel like a zombie all the time from having to balance work and school.

CCU is all about bypass patients and other thoracic surgeries, though we get other intensive care patients from time to time. I've been learning so much every day, and feel like I'm almost ready to do the job all by myself. I hope to work back here for a year or more, then perhaps for a while in the ER too before I eventually go back to grad school. What do I want to be? Probably an NP, though I'm not sure yet! I have lots of time to think.

Final Thoughts

This is my last entry, and I will not be posting in this blog anymore. I have to concentrate on my career and starting my new life. I considered writing another blog for a while called "I Am No Longer a Nursing Student"... but realized how silly that statement is. I will always be a student. I feel like I'm growing and learning all the time.

Studying nursing has been good for me in so many ways. Certain parts of my personality were already predisposed to this kind of work, but other parts of me were not at all suited to the task. For example, when I began clinicals I was a very shy person. That might not have come out in my posts so much, but I had a hard time talking to new people. As little as 6 months ago I still had a phobia about calling people on the phone. But by working as a tech and working with my classmates, I've grown past those anxieties and gained a measure of self-confidence. The changes were subtle and slow, but when I look back, I'm amazed at how far I've come.

I think that finding a path in life that both complements and challenges you is precious. I think that, in this culture full of disillusionment, I was lucky that college "worked" for me. It actually helped me in the classical sense by shaping my identity and strengthening my character. Of course, it was tedious and taxing. And in the years before I transferred and changed majors, it was downright depressing. But here I am now, with a degree on my wall and initials after my name. After all of it... after everything... I made it.

You can make it too. Hang in there. <3

Thanks for reading.
she sees he's a tool
his shell necklace and buzz cut
the smell of fresh grass

Sunday, November 4, 2007

they say books are dead
let me be buried
my eyes see by reflection

Saturday, November 3, 2007

staring at your words
I can't see what you're saying
until you log off

Friday, November 2, 2007

First Field Trip of the Year and No Emergencies

I've always thought it was interesting how states appropriately spend so much time making sure we keep our seatbelts on and our kids buckled, but allow 60 students and 5 adults to cram three people to a seat on a little yellow bus with no seatbelts and limited supervision. But that is not the subject of this post.

Yesterday was a lot of fun. I took a day off work and traveled with my oldest son and two 5th Grade classes to the Little Grand Canyon on a geology field trip. Don't worry. I didn't make him sit with me on the way up. I really don't think he would have minded, but I remember when I was that age what it was like to have a parent chaperone school activities.

I rode on the bus on the way up because one of the kids has juvenile onset diabetes and another severe ADD. The child with diabetes had to have a specific low calorie meal and diet drinks and had to check his blood sugar periodically. The child with ADD needed medication. Nothing a concerned mom could not handle but the school wanted someone with medical training. I also brought along inhalers and epi pens just in case. We didn't need them.

The Canyon was beautiful. There were a ton of dogwoods, chestnut oaks, hickory, wax myrtle and magnolia trees. Their leaves were turning red with the change of seasons and the acorns on the chestnut oaks were huge. The soil was a combination of red Georgia clay, sand and lava rock. I still don't know where the lava rock came from as Georgia is not really known for its volcanic activity.

One of the kids found a perfectly intact arrowhead made out of Kaolin (I think that is how it is spelled) which is the main ingredient in Kaopectate and cat litter. I wonder if the Native Americans of yesteryear knew about its medicinal properties. They probably did. In any case, the State Park would not let the kid take the arrowhead out of the park. Instead, they took a picture of the kid holding the arrowhead and they are going to mount the arrowhead on a plaque with his picture and put it on the wall at the visitors center. The arrowhead was apparently a rare find given the park ranger's reaction to it.

Well, it is back to work today. My shift starts at 2:00 p.m.

Archives of Disease of Childhood launches two new blogs

Archives of Disease of Childhood has launched two new blogs. While these blogs don't directly pertain to nursing research or evidence based nursing, I wanted to bring them to your attention as I believe they offer some innovative ideas for us. Wouldn't it be cool if we were able to highlight key nursing articles in one sentence as the Precis blog does? For those of you accessing this blog from St. Joseph Hospital, Orange or Children's Hospital of Orange County, you will be able to click on the full text of the article.

1. The Précis Blog Précis starts with the idea that any good paper can be summarised in one sentence. That sentence may sometimes be complex, and should normally leave you wanting to know more, but it will contain the core of what the paper is about. This is, by its nature, idiosyncratic, and hopefully sometimes controversial. The blog focuses on the online first part of ADC:

2. The Archimedes Blog You'll be familiar with Archimedes, the bimonthly section of evidence-based questions and answers, and with the Archimedes blog you: Get to see the questions as they are being asked, and can comment on the answer you expect to see. Can argue about the interpretation of evidence from the published topic report. Can add new information to older reports. There are also teaching tips, bite-sized explanations of EBM concepts and links to other places where the practice of evidence-based child health can be discussed.The bloggers explain why they think this is important in an editorial in the November issue of ADC.
Don't forget to sign up for the Blog RSS feeds so you don't miss anything.
I'm not doing shit
all these people making things
like they're getting paid

Thursday, November 1, 2007

National Guard Hospitals Nursing Jobs - Saudi Arabia

  • 12 month contracts

  • free flights at start and end

  • mid year flight home after 6 months with 10 days leave

  • over 50 days annual leave

  • free modern accommodation

  • end of contract cash bonus

  • tax free salaries around $60000 Aust a year for Australian or New Zealand trained staff nurses with 2 or more years experience.

  • higher salaries for senior and management grades

  • save $50000 a year!

  • roles across all areas at the present time

Fax 61 2 4969 2911 Email
wide leaves shade the yard
luminous green through the glass
seen from the inside

Wednesday, October 31, 2007

A Trip to the Mini Grand Canyon

Well. The summer came to an abrupt end this week. Overnight the temperature dropped 20 degrees, the wind blue in and the jackets came out of the closet. Those of you who live in the northern part of the country (or at least north of south Georgia) may say it's about time.

Gone are the four day getaways that come with having the kids out of school. Replaced by homework assignments, mad rushes out the door to get the kids to school on time and the oft used phrase around our house during the school year "Mom, I can't find my shoes." But with school back in session I also have a chance to accompany my kids on field trips as a parent/nurse. I am going on one such field trip with my oldest son (the one holding the aligator in the picture at the top of this page) to the "Little Grand Canyon" this week.

The Little Grand Canyon is a naturally created miniature replica of the real Grand Canyon. It's official name is Providence Canyon and it is located in Western Georgia.

I have been asked to accompany my son's class on their excursion because several of the students have medical conditions that require a nurse to be with them at all times. Although I hope my nursing skills are not required it is nice to be able to help out his class in this way. I will post some pictures of our trip when we get back.

Research Interview

First of all I would like to thank all the nurses who have been interviewed for allowing us to showcase their projects. Secondly I would like to wish Happy Holidays to everyone!
We are now coming to the end of an exciting year in evidence-based practice and research here at St. Joseph Hospital with many new projects to come in 2008. As you have seen from the other articles our nurses are busy! This issue I would like to introduce you to Kathleen Close, the Colorectal Nurse Navigator here at St. Joseph Hospital and her study is called “Gum Chewing for Post-Colorectal Surgery Patients.”

Q. What is your study about?
A. “My study is about determining ways to prevent ileus following colorectal surgery. We need to know if providing patients with gum after colorectal surgery decreases their incidence of time to flatus and bowel movements and if this leads to a decrease in ileus.”

Q. Is it an EBP/ResearchProject?
A. “This is retrospective pre/post comparative study.”

Q. What made you interested in this project?
A. “As the Nurse Navigator for colorectal patients I am responsible to identify and follow-up on any patients who have been newly diagnosed with any type of colorectal disease. I follow them from the time of diagnosis, through surgery, and then post surgery. I am available to them 24 hours, 7 days a week until they are home and comfortable. Our colorectal cancer patients I keep in touch with on an ongoing basis because I help coordinate our support group. Due to this role I really decided to look in to the research and see if there was any information on decreasing ileus to help these patients after their surgeries. As the Colorectal Nurse Navigator I love my role and I love my patients, therefore I want to decrease any complications they might have if I can.
My daughter heard an article being discussed on the radio one morning from JAMA as a possible health program and told me about it. I had our library pull all the current articles regarding this study and the Japanese study was among the articles I received which is called, “Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy”, (Asao, T. et al. 2002). These researchers found patients undergoing laparoscopic colectomy for colorectal cancer who chewed sugarless gum three times per day passed flatus and defecated sooner than did patients who did not with good significance (p<. 01). I thought this is great! Especially since the amount of literature on this subject is very limited.”

Q. How did you go about doing your research?
A. “After reading this article and a few others, my daughter and I decided I should try to replicate this study. So I presented the idea to the three physicians I work with and we decided this would be a great idea. I then brought the idea to Dana Rutledge in the Nursing Research Department and we worked on the logistics as far as what type of study I should do, how many charts, and what information we should be looking at. We used the other studies I looked at as a basis for data collection. We developed a tool to audit my charts. I then went to the IRB and presented my project. Once approved, I was on my way. Since then I have been working with you to collect my data. We will soon be analyzing the data.”

Q. What are your expected outcomes?
A. “Well initially, I was really hoping we would see a difference with gum chewing, but at this point after collecting the data I noticed there was not a decrease in ileuses. One study actually said that gum chewing might be a safe way to provide benefits of stimulation without the same complications of feeding (Asao, T. et al) but I’m not sure if the data we found actually has the same results. Since we don’t have statistical analysis yet, I do not know statistically what we have actually found. It is so hard to know what your research will lead you too.”
Q. Have you done research before? If so what did you learn?
A. “ Yes, I was involved in drug research with Bristol Meyers on a drug many years ago. The drug was to help with diagnosis and prevention of early Alzheimer’s but the medication never made it to the market. I never actually found out what the results were. I thought the medication actually made a difference but the patients may have done better because we gave them a lot of attention, so it could have been a placebo effect.”
Q. Will you do an EBP/research project again?
A. “Yes. I enjoy doing research. My results may help other people regardless of positive or negative outcomes. Research also helps find new and exciting questions and answers. I don’t really find research to be that difficult once you start. The biggest problem has been getting other people excited initially about the project. But once I got everyone on board, it took off. Working with you made data collection easier since we had a great system worked out for getting the charts from medical records. Once I got a system with auditing the charts, it actually went fast! I am looking forward to our analysis.


Asao, T. et al. (2002). Gum chewing enhances early recovery from postoperative ileus after laparoscopic colectomy. Journal of the American College of Surgeons, 195, 30-32.
she watches her soup
the broth is cold and she waits
while customers sit

Tuesday, October 30, 2007

tangled bare branches
fingers draping from the trunk
dangle to the lawn

Monday, October 29, 2007

Paediatric Registered Nurses in Australia needed

Job Details:
Position: Paediatric Registered Nurses
Agency/Recruiter: Beresford Blake Thomas Ltd (BBT) [Profile]
Employer: Beresford Blake Thomas Ltd (BBT)
NJ Ref: NJ/5400
Location: Brisbane, Queensland Australia

Our client, located in the heart of Brisbane CBD, is a state of the art facility providing the highest standards of care to infants and children.

With almost 200 beds available, this public hospital services the Brisbane metropolitan area with medical staff, who specialise in Paediatric care.

The Role:
BBT is currently seeking dedicated registered nurses, who hold a current QLD registration with clinical experience within paediatrics to join this well established Children's Hospital.

BBT now has many full time permanent positions available within the following areas of paediatric nursing:

* Medical
* Oncology
* Theatre
* General surgery
* Orthopaedic
* Neurology

Job Type: Registered Nurse
Employment Basis: Full Time/Part Time/Casual
Specialties: Critical Care
Intensive care
Medical & Surgical
Date Job Added: 26-Oct-2007
Job Starts: ASAP
Instructions: For more info or to apply please contact Amy Parkinson on (02) 8235 4513 or email:
Agency/Recruiter: Beresford Blake Thomas Ltd (BBT) Display profile of Beresford Blake Thomas Ltd (BBT)
Contact: Amy Parkinson
Phone: (02) 8235 4513
Email: [Apply]
Postal Address: Level 9,
The Clarence,
50 Clarence St
NSW Australia 2000
he says he can't think
without the radio on
silence distracts him

Sunday, October 28, 2007

dramatic music
encourages a new brush
to fix your hygiene

Saturday, October 27, 2007

A Journalist Gets It Right (and he's not from the UK)

He is an Editor turned Nurse turned Editor from the Wall Street Journal. This is a huge Newspaper in the US.

This is the kind of stuff we need to see from British Journalists. Here are some excerpts.

"In 2002, at age 40, I left my job as a page-one editor at The Wall Street Journal, my professional home of 15 years, to take a giant leap of faith -- in myself. Like a lot of people, I questioned my purpose after Sept. 11, 2001. Jolted from the complacency of a comfortable career, I became convinced that I could achieve selfish fulfillment through devotion to service -- to the individual, to the community, to the vulnerable.

I considered teaching. I considered law, medicine, pure science and research. But my thinking always returned to the nurses I had watched care for my mother a few years earlier, when she lay in an intensive-care unit in her final illness. I marveled at the way they melded an aloof, precise professionalism with a mysterious human (and humane) instinct. They seemed to operate in a purer space, beyond worldly distractions. I would be a nurse."


"My skills were those of any new nurse. With easily shattered confidence, I could start an IV, administer medications, bathe a bed-bound patient and change linens, change dressings, insert all sorts of catheters and tubes, read lab results and electrocardiograms. I knew to be vigilant against infection, pneumonia, pressure ulcers, medication errors and the many other lurking threats to hospital patients. On the burn unit, pain control loomed large. I also knew, as both executor of treatment plans and patient advocate, to keep a close eye on what doctors ordered. They make mistakes, too.

But in those first months, I felt stupid and slow, and thus dangerous. I hadn't yet mastered the ruthless efficiency of thought and motion that lent veteran nurses the appearance, at least, of enviable ease. Next to my crazed back-and-forthing, they floated around the unit, maintaining a cool composure no matter what crisis erupted.

The night began with the shift change, from 7:30 to 8. "The arrival of the replacement killers," as one nurse liked to put it. We straggled in, one by one, from the locker room to the nurses' station, crowding around the assignment sheet, groggy from unsatisfying daytime sleep.

Assignments were subject to wide variations. Typically, a critical but stable patient, often on mechanical ventilation, came with a second and even a third patient, in less serious condition, perhaps even a "walkie-talkie" -- alert, oriented and ambulatory, in clinical nurse-speak. If the rooms were spaced apart, I could look forward to spending 12 hours trotting like Edith Bunker back and forth across the unit, from patient room, to med room, to supply room, to another patient's room, to supply, back to the first patient's room, and on and on.

Already thin, I lost weight as a nurse.

Shift change was a noisy time, as day nurses, relieved to be relieved, gave "report" to the night nurses. I was anxious during report. For my patients' sake, I couldn't miss details -- "He may try to yank out his feeding tube," "You may need to bump up the sedation" -- but I was already parceling out the time. Second hands relentlessly swept the clocks mocking me from the walls.

Basic nursing duties were enough to keep me on my feet until dawn: initial head-to-toe physical assessments; hourly vital signs and other monitoring tasks; medications; bed baths and dressing changes; regular suctioning. First thing, I reviewed my patients' charts, checking for any outstanding physician orders that might devour precious minutes -- a blood draw for early lab work, perhaps, or an order to start tube feedings, or, as encountered one night, hourly enemas.

There could be no skimping, no coasting through a shift because of a headache or trouble at home. For 12 hours, I belonged to people whose survival was at stake. A sloppy physical assessment could later explode in disaster if a potential problem -- a bum IV, an incipient pressure ulcer, abnormal lung sounds -- went unnoticed. Rooms required meticulous inspection, too, to ensure that vital equipment was present and functioning: A missing bag mask -- attached to those blue vinyl footballs you see TV doctors and nurses rhythmically squeezing in emergencies -- could cause lethal delays.

Then came 9 o'clock medications -- for me in my early days, 9:15ish at best. Patients received as many as a dozen medications at once: injections, IV infusions and pills, either swallowed or crushed in mortar and pestle, dissolved in water and squirted down a feeding tube with liquid meds. Ointments applied, eye drops administered. For one patient, I could spend 30 minutes just gathering it all together and double-checking it for safety.

Burn care was a nightly abyss to be crossed with every patient. It was a big, messy, smelly job that demanded painstaking attention to detail. We usually helped each other or enlisted a patient-care technician -- the latter a negotiating tactic I began to cultivate after that night working alone without the lubricated mesh I needed. We had to work fast because burns impair the body's ability to regulate temperature; exposure can cause life-threatening hypothermia. And simply moving and turning a patient can cause blood pressure to soar or the heart to jump into a dangerous rhythm.

These were the basic functions, and on an uneventful night, I could just manage them -- the tasks themselves, and the documentation of them. If it isn't documented, the saying goes, it wasn't done.

I wanted to hover over my charges like a jealous hound, alert to the tiniest shifts in their biological function. I talked to my patients, to assess their mental status and their pain, to dispel their fears, to teach them about their conditions and treatments, and to learn details about their lives that might affect healing and recovery beyond the burn unit. But I felt hurried, with little time for the reassuring smile and comforting touch one sees on TV commercials that laud nursing as the caring profession.

Most nights, unexpected contingencies unwound the tight choreography of the shift, diagrammed in hourly increments in the sprawling spreadsheets of patients' charts. I lurched from one task to the next, fulfilling all requirements, but little more.

For a while, the electronic thermometers we used were in short supply, and the shift started with a mad dash to nab one. We made a joke of it, but behind the laughs, I heard the clock ticking. Infection control slows down all movement: Hands must be washed before and after every contact with a patient, and fresh gown and gloves donned every time one enters a patient room, to be discarded when exiting. A thermometer or any other piece of equipment moved from one room to another must be cleaned, too.

Often, it seemed, I came on shift to discover a clogged feeding tube. I had to pull the tube, insert a new one (in the nose, down the esophagus), and then wait for X-ray confirmation of correct placement in the patient's stomach before feeding could resume.

An order for bedside dialysis for a patient in acute kidney failure entailed mastering a contraption that looked like a prop from "Lost in Space" -- a big beige metal box on wheels, with knobby green and red lights flashing, rotors whirring, alarms buzzing. It came with printed instructions. Even so, obtaining the necessary solutions from pharmacy, priming the machine, attaching it to the patient and getting it running took a couple of hours, and then a lot of catching up.

A medication missing from the med room could prompt a trip down dark corridors to the pharmacy and back. Blood sent to the lab went bad before it could be tested, requiring a second draw. Dressing supplies ran out, calling for creative solutions. Patients being taken out of deep sedation yanked out their feeding tubes and IVs and fretted with their dressings. A fire in the city could yield new admissions, to be parceled out among us. And of course, infection or shock or some other problem could turn a stable patient into an emergency.

Regardless of the job at hand, my mind raced through the list of others awaiting my attention, convinced that my own feelings of being overwhelmed compromised my patients' well-being. Twelve hours weren't enough. I finished my shifts breathless, and delivered to the day nurses confused, fractured reports before hopping a train home in the morning rush hour.

So it went for the first six or seven months of my nursing career. The 12-hour frenzies, worry about my patients and paltry sleep bred chronic fatigue. I was often in a fog: At home, I spooned coffee into my cat's food bowl, and mistook toothpaste for shampoo. One afternoon, I leaped out of bed, showered, dressed and noticed only as I was heading out the door that it was 10:00 a.m. I had been asleep an hour, and didn't have to be at work for another nine. A deep ache gnawed at my lower back. My feet felt like ragged stumps. I fell asleep in chairs, on subway trains, in taxis, at movies, at supper tables."

If you click on the link there is even more good stuff. He talks about how having one patient who requires your constant presence at the bedside causes your other patients to suffer and be at risk and there is not a damn thing you can do about it.

This guy was on a burn unit with a small number of patients. I wonder how he would function in the NHS where the nurse to patient ratios cause the battle to be lost long before we come on duty.

Ladies and Gentlemen: We found a journalist who is not a learning disabled ,lying, incompetent pig. It is a special day.
I would never sleep
I could stay up days on end
if he would let me

Friday, October 26, 2007

Yet More Shit from the Times

Okay Nurses (and everyone else) this is a call to arms. This is war. I hope that everyone reading this sends The Times a letter. I have sent a few comments in. I hate liars. The Times is officially on my shit list now.

Here is another shining example of Journalism.

1. ITU nurses take better care of their patients than ward nurses because they are paid more and care more. WTF?

2. ITU nurses are so superior that they never have patients starving or lying in their own filth.

Not one statement is made of the fact that an ITU has one patient and mega back up and a ward nurse has anywhere from 10-35 patients with NO backup.

Not once is it mentioned that patients on the wards now would have been in ITU a few short years ago. Patients are more sick and more complicated today while staffing levels are falling dramatically.

This is like some kind of nightmare. We are never going to get our wards safely staffed if this is how people think.

The Times Dishes Up More Bullshit

Let's take this pile of shit apart piece by piece.

Nurses dish up nil by mouth

NOT ONLY are they too posh to wash, but today’s nurses are too posh for nosh. “I don’t do food,” says one nurse in Nursing Standard (Oct 10).

Even if this quote is true it is likely presented out of context. My years of experience tell me that this kind of attitude is no where near the majority. Most hospital nurses I work with would go medieval on a nurse that stated that she "let's patient starve". Is that even what she really said? Did she mean that she is responsible for the drug round at tea-time (as the only RN) and getting meds out late because she spent 4 hours feeding 20 people would land her a disciplinary? Or did she mean she intentionally lets people starve because she is crap? If that is the case and she is in the minority. I need to hunt up that edition of Nursing Standard and look at it in context. I don't do food either in my double in I DON'T EAT.

Hospital caterers claim that there has been a shift in attitudes since nurse education moved into universities. Nurses now believe that serving meals and helping patients to eat is beneath them.

Oh Pray tell me what a hospital caterer knows about what is happening on our wards? I have never. ever. once.ever seen a caterer spend any amount of time on the wards. Never. What would they know about staffing levels, patient acuity, nurse accountability, the situation with the patients at mealtime? They know fuck all. I'd like to see them manage to give 20 IV meds due in the next 30 minutes (due or else there is hell to pay) and cater at the same time. What the hell kind of a source is a hospital caterer? Unless he sat in at handover and knows the score with patient acuity and staffing he is useless as a source. I love to feed people (it's a chance to sit down for the first time in so many long hours) but if someone is having chest pain I won't leave his nitro,obs,ecg transfer to CCU until 4 hours later when I am done feeding all those that need feeding. How would a caterer even begin to understand this?

“Florence Nightingale was happy to wash and feed patients and make them feel comfortable, but today’s nurses think that because they have a degree they do not have to do the basics,” says one manager in Dorset, who heard a senior nurse say: “I am paid too much to feed patients.”

In Florence's day there was no such thing as IV cardiac meds on titration, insulin drips, chest tubes, vents, cardiac arrests that were actually dealt with, bloods, critical lab results that must be reported, drug rounds, prep for theatre, extensive post op care, bladder irrigation, blood pressures to check regularly to deal with dangerous readings, ECG's to get when someone has an MI, equipment failures, IV pumps beeping that need trouble-shooting or else meds don't get infused, anaphylactic reactions to meds weren't deal with as they weren't understood so those folks just died, no blood transfusions with Frusemide to give whilst monitoring for heart failure etc. etc. etc.

People in her day died horrifically due to the lack of these things. Maybe we should return to that way of delivering care and I can happily and stress free spend my days bathing people. Sounds good to me. There is no love lost between me and florence. She hired convicts and prostitutes as nurses and they didn't want to be there. She had to be medieval to keep them there. This set the stage for people's attitudes towards nurses. Criminals who need to be kept in line.

Oh and you heard a senior nurse say what? What the hell kind of pre-school journalism is this? Someone heard someone say? A manager heard this? Probably the same kind of manager who kills people by short staffing wards and is looking to deflect the blame. What the hell kind of a source is "I Heard". I had a Medill graduate as a teacher of journalism in college and was the editor in chief of my college newspaper. "I heard" as a source would have landed us in hot water. I can see the veins popping out on Mr.Parrone's head as we speak. That was college journalism for christs sake. If she said that than she is a twit but certainly not a spokesperson for nurses.

“Nurses believe serving meals is not part of their job � it is beneath them,” adds a Berkshire-based caterer.

Bullshit. Another caterer who doesn't know shit jumps into the ring. Are these guys for real? I can say with all honesty that this is not the view of the majority of nurses. In would love to have protected meal times so I could feed my patients in peace. Nurses at my hospitals are fighting for protected mealtimes. I cannot stop docs from showing up to do ward rounds at mealtime. I cannot stop people from crashing at mealtime. I cannot stop phone calls from relatives at mealtime. I cannot stop call bells from ringing at mealtime. I can't make the important drugs that are due at mealtime go away. Even if I could, it would be nearly impossible to feed the sheer number of patients who need it, with only 3 of us. I can't make management give us more staff.

Public sector jobs
The attitudes were revealed in a survey carried about by the Hospital Caterers Association. Neil Watson-Jones, chair of the association, says: “I would like to see a return to basics. Care is about more than a clinical intervention. It is also about making the patient journey more comfortable.”

No shit Sherlock. We are very well aware of how the basics and comfort promotes healing. That's why we are fighting this fight Einstein. We want our patients to be comfortable and we want to provide basic care.

Peter Carter, the Royal College of Nursing general secretary, agrees that the switch from on-the-job training to classroom tuition may have gone too far.

“The lurch from the apprenticeship model to the academic model was far too great,” he says. “Nursing is the sort of occupation that primarily you have to learn in the work setting. There is no substitute for experiencing hands-on patient care.”

Oh dear me Peter. You have been missing in action as a bedside nurse for too many years. Research is showing that patients have a higher survival rate in hospitals that have a higher ratio of degree nurses. What everyone knows is that we need is a combination of academic theory and rigorous on the job experience. Student nurses will not survive unless we have both of these elements in nursing education. They need a gruelling mix of both to be top notch. But who wants to go through that just to get abuse? The vast majority of nurses nursing in hospital now are PRE PROJECT 2000.

There is also a concern that a softly-softly culture has developed in the NHS, putting staff before patients. Modern matrons who need to discipline nurses have to talk to them in a nice, soft voice, says Harriet Sergeant, a fellow of the Centre for Policy Studies, they can’t just bawl out sub-standard nurses.

Our matrons won't come anywhere near the liability minefield wards. They run from the ward nurses as they know they are letting us down. They know we are pissed off. One of them put her damn hand on my shoulder the other day and said "we all feel so bad for you guys as we know it is impossible down there" I gave her the look of death. Same matron came onto the ward to work once and left after 2 hours because it was "too much for her". I have seen them bawl people out, usually to save their own butts.

I'd like to see the Times actually interview bedside nurses. I am sure that they would interview over 50,000 of them until they found one stupid young pre-nursing student who says "I don't wanna wash". That is who they would quote whilst the quotes from the other 50,000 go to the shredder. They have to stick with their agenda you know. We can't have the truth get out can we? Too many powerful people would be in deep wouldn't they?