Thursday, December 31, 2009

The Best Compliment Ever!

And I received it on New Year's Eve. I was working in clinic tonight, and Dr. Kenton Hadley's name came up. You remember, my woman/super-hero/doctor obsession? Well, the attending that was working with us also works with her in Internal Medicine... and he said (I SWEAR) while motioning to me... "You are just like her". I was so excited I could barely even breathe. I think I saw a few stars, felt a bit woozy, and breathlessly muttered a thank you.... He doesn't know it, but he just gave me the biggest ego boost possible. Better than being mistaken for Carla Bruni (which of course has never happened to me). If this is any indication of how 2010 is going to be .... it's going to be a GREAT year!

Well Since Everyone Else is Doing It

I might as well throw out a few of my New Year's Resolutions...

1. Ok, this one is the most important. I really ReAlLy REALLY want to eat different and MORE veggies. I feel like I eat the same 5 vegetables over and over again... despite the millions of varieties on the planet. I just ate my first tomatillo (that I'm aware of) last week!

2. I should also keep an eye on my medical school slacking. I only studied for my histology exam 1 day last block. I managed to do well, but that could really get me in trouble if I'm not careful.

3. I will devote at least one full weekend a month to building my house. I've really been slacking this year. A lot. At this rate I will be living in a bedroom for the rest of my life.

4. I want to start cooking different recipes. I cook quite a bit now... but like the veggie problem I tend to cook the same 20 items. How about 3 brand new recipes a month?

5. Time to dive into EM, and see if I really like it. My elective is starting this month... so I think it's a great chance to really get involved and see if EM is for me. If not, I want to have a chance to explore lots of other fields of medicine before graduation. It would suck to get to 4th year and be like hey, EM sucks... what now???

BFF's in 3 Days

I'm always surprised to see how people seem to associate so quickly into cliques. My medical school is no exception. Maybe I'm just anti-social... but I don't tend to hug, kiss, and call 45 different people my best friends within 3 days of meeting them. I mean, I have FRIENDS. I swear I do. But my class certainly has an element of chumminess that I really don't relate to. Although maybe I'm missing out.

For instance... I remember on my first day of anatomy lab (so this would have been about 4 days into first semester of med school)... I remember one girl who's locker was by mine running up to a guy classmate, jumping on him, wrapping her legs around him, kissing his hair and saying "I LOVE YOU! I missed you SO much yesterday!!" I sorta didn't think too much of it... because I assumed that certainly they must have known each other before med school started... or perhaps they are both from this city and went to undergrad together... or maybe they were stuck in an elevator together for 29 of the previous 48 hours. Who knows? But then I saw the same girl do nearly the identical jumping-slash-kiss maneuver to another guy a few days later.

The weird thing is that she is certainly not the only one. Probably half of my class acts as if they have been joined at the hip for the past 20 years. I don't know how this immediate friendship status comes about.... perhaps it is alcohol induced. Or maybe its the boot camp phenomenon that happens when young guys join the military and are so traumatized during boot camp that suddenly everyone of their comrades is also their best friend.

I guess I have always been the type of person who is really selective with who I become friends with. In fact, I don't really have many friends. Maybe 8 who I consider really close, another 10-20 who are close acquaintances... and probably most of them have been around for a long time.

Old vs. New

Indifferential Diagnosis has hit the nail on the head with a cartoon about the old vs. the new MCAT. I of course, being the savvy MCAT taker that I am, have taken both... more than once... and I have to say the experience is quite different. For those of you who've taken one and not the other... you may not appreciate this as much. But if you have taken both, prepare to laugh to tears. Way to go!

First Year Christmas Vacation

So here's what I did over my first Christmas vacation of med school:

1. Japan!! That was pretty awesome... I have to admit. I hit up Kyoto and Tokyo.
2. Read "Olive Kitteridge", started "Unaccustomed Earth"
3. Went to a life-size gingerbread house and ate the walls. Yay!
4. Cooked a Christmas dinner of duck, mashed potatoes, and asparagus with hollandaise sauce
5. Went out to dinner at a lovely restaurant with my boyfriend
6. Took my dog to the dog park 652 times
7. Worked at a men's shelter doing TB testing
8. Going to a New Year's Eve party tonight!
9. Stocked up my kitchen with new wine glasses, new parts for my Cuisinart mixer and Julia Child's "Mastering the Art of French Cooking"
10. Designed 3 stained glass windows for my house.

Not particularly relaxing... but fun.

Believe it or Not

I wouldn't have guessed this about 2 weeks ago... but I'm actually looking forward to going back to school. I just got back from a super-speedy trip to Japan (which was awesome!) but now I'm done relaxing.

I had a crazy dream last night. But first let me preface it with this. I have always had terrible dreams. Lots of them. Nightmares you wouldn't ever want to even think about. Years ago I trained myself to recognize when I was dreaming... so when these horrible nightmares come around, I just say to myself... well, Ella,... relax... this is just a dream. Bad part is, even when I have good dreams I ruin them by telling myself it's probably a dream.

So.... to make a short story very very long... last night I dreamed I was in medical school. After years of wanting to go... daydreaming about my white coat and working in the ER and intubations and studying pharmacology...I was finally there. But in my dream I kept telling myself "Ella, this is so good its just a dream. Don't get excited."

Of course you know the rest of the story. I woke up. And realized it was true!!! I get to go back to medical school!!!!

Wednesday, December 30, 2009

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Sunday, December 27, 2009

Who wants nurses away from bedside care?

Anytime there is a piece about nursing or care in our hospitals on the net there is always some shmuck posting his thoughts about what the problem is.

"Nurses don't want to work at the bedside" 

"Nurses want assistants to do all the real work"

"Nurses want degrees so they can be paid more and not get their hands dirty" 

People who say these things are Shmucks.

I even had one jerk telling me that the nurses themselves were behind the hospitals drive to hire care assistants instead of nurses because "nurses don't want to get their hands dirty".   Ha ha ha.  As if nurses could dictate to the hospital who they hire.

Nurses were forced away from the bedside.  They did not leave the bedside because they hate patient care.
I wrote another letter to a manager.  I tried to explain that we have more patients than we can handle etc etc etc.  That more care assistants than nurses  on the team means death and is not at all cost effective.

I actually got a response.  But all it does is show that he doesn't have a clue. Nor did he really read my letter.

"Nurses can either take a three year diploma or a four year degree course although there are moves to make all nurses take a degree, and I imagine part of the push behind that is to increase the starting salary. It will also probably mean more assistants on the ward, as the move to make nursing into a more clinical role will mean that the more hands on tasks will devolve to HCAs. This is a shift that has been happening for many years (alongside moving tasks from doctors to nurses) as it reduces costs at the same time as encouraging specialisation."

Fuckhead thinks that "dumbing down" reduces costs!  It doesn't. He wants me to "specialise" and play doctor while the HCA's screw up my patients' nursing care.  As a matter of fact I am sick and tired of having to play doctor and order diagnostic tests etc because it is taking us 10 hours to get a doctor to see our patients in hospital because there are so few doctors.  Example: If the nurses do not order the INR tests for warfarin control then they won't get done for a week. 

I have never seen anyone miss a point so massively.

It was NOT the nurses who did this people.  It's not about the nurses  "not wanting to get their hands dirty".

Edit 28/12.
Clueless management types have destroyed the level of care in our hospitals and driven nurses away.  I agree with the commentator who said that nurses need to be indpendent contractors...was it Suzanne Gordon who first said this?.  Nurses should be independent contractors and move away from this government run crap. It's worse than corporate run crap really.  Let's not be their scapegoats any longer. Let's no longer allow ourselves to be put in situations where we cannot do our jobs.

Saturday, December 26, 2009

Nice resource about RN staffing ratios

Remember two things:

1.  NHS nurses on general wards have anywhere from 10-30 patients.

2.  A health care assistant is not a nurse.  Whenever we are using the term nurse on this blog or in research like the following we/they are referring to RN's.  If you are not licensed to practice you are not a nurse, even if you are wonderful caring person who works in the hospital providing patient care.  You are not a nurse unless you are licensed.  And you are not licensed if you did not go to university.  Unless, of course, you are older than Methuselah .  But if you qualified as a nurse without university you are probably long dead or at the very least retired.

Nice one. And the conditions over here are triple brutal.

Hope everyone had  a nice Christmas.  I'm a bit busy but will be back to blogging and answering emails soon.

Job Vacancy for Registered Nurse in Oman

AMBE Consultancy Services Pvt. Ltd. is a business company located in Mumbai - India, which staffing many of private medical services in Middle East (kuwait, Qatar, Oman, UAE, Saudi Arabia and Oman). Recently they got order from their client (Engineering Company involved in Oil & Gas, Petrochemical) to looking for Male Nurse with relevant experience at petroleum company.

This Job vacancy open for Diploma or Degree in nursing qualification, including pass graduated nurse. The nurses will get interesting salary and other benefits from company including Transportation facility. They also offer Home Commitment Element, the Expatriation Allowance and the Gratuity in lieu of pension.

Interested candidates at job vacancy above may send their CV or resume, photographs, copy of nursing certificate, experience certificate (if available), and copy of passport to the E-mail : or

Working in Oman as a Nurse or other medical professional has to undergo licensing exam conducted by Ministry Of Health (MOH) Oman. After passing exam (simple and on basic to test your knowledge only), you will be given license to work in any hospital around Oman. Those apply for this job vacancy will get visiting visa to do the exam, After they pass the exam their visit visa will be converted into job visa and will be given as residency card.

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Thursday, December 24, 2009

POEA Approved Nurse Jobs

The Middle East country of Saudi Arabia is again in search of qualified Filipino nurses to fill various nursing positions in this POEA approved nurse jobs. This POEA approved nurse jobs was approved last December 11, 2009 for a recruitment agency located in Malate, Manila. The vacant positions in the above mentioned POEA approved nurse jobs are for staff nurses and have a corresponding job order balance of 144 POEA Approved Staff Nurse Jobs.

All interested parties who wish to apply for the above mentioned POEA Approved Nurse Jobs must submit their application to the recruiting agency as soon as possible. For more info on the qualifications, requirements, and placement fees, you can contact the recruiting agency in their contact infos stated below.

Skills International Company Inc.
Room 201-206 & 301-310 Discovery Plaza
1674 Mabini Street, Malate

Tel Nos: 5268823 / 5268828 / 5250733
Email Add:

POEA Approved Nurse Aide Jobs

The job order for this POEA approved nurse aide jobs was approved last December 10, 2009. It was approved for a recruitment agency based in Makati City and will provide employment to 15 female and 3 male Filipino nurses who will qualify for the said POEA approved nurse aide jobs. The chosen applicants for this POEA approved nurse aide jobs will be placed in the oil rich country of Saudi Arabia.

To apply for the said POEA approved nurse aide jobs, just visit the office of the recruiting agency and submit your application. For further details on the qualifications and requirements for the said nurse aide jobs abroad, you can contact the recruiting agency in their landline numbers indicated below.

Philippine Hospitals & Health Services Inc.
5th Floor Trans-Phil House
1177 Chino Roces Avenue cor. Bagtikan Street
Makati City

Tel. Nos: (632) 8991850 / (632) 8972406 / (632)8950831 / (632)8903272
Fax: (632) 8974743

Email: /

Wednesday, December 23, 2009

Midwife Connection Goes on Vacation

Midwife Connection is taking a holiday break. Season’s Greetings and best wishes for a happy, healthy, and prosperous New Year from your friends at the American College of Nurse-Midwives.

Tuesday, December 22, 2009

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Monday, December 21, 2009

Premium tax would hike health-insurance costs

By: Health Insurance

Why? Because Congress wants to levy a $6.7 billion premium tax on all private health plans each year for the next decade to pay for reform.

That's a $67 billion tax.

Health plans will have no choice but to pass these costs on to the consumer. This tax will make it tougher for families to afford coverage, increase the difficulty for small-business owners trying hard to insure workers, and stifle job creation.

In Florida, small businesses are the bedrock of our economy. This tax will hit our economy especially hard. It's just not what families and small businesses need as they dig their way out of a severe recession.

The Congressional Budget Office evaluated this tax and found it will lead to "higher premiums for private coverage." The nonpartisan CBO estimated that premiums for individual coverage could rise by as much as 13 percent.

This tax also might be disruptive to policyholders, because it could damage the ability of health plans to deliver all the benefits that members expect.

That's because Congress is ready to impose this health-insurance tax in 2010. That's after families have already signed up for coverage for next year, and after small businesses have already negotiated coverage contracts.

The result? Health plans may not receive enough premium to cover the costs of the massive tax, and benefits might suffer.

Unfortunately, health plans have been demonized in the pursuit of reform. But in reality, it's not true to claim that health plans make a lot of money; their profit margins are actually pretty small.

In 2008, private health plans made $8.61 billion in total profits nationally, according to Forbes magazine. The industry's profit margin was just 2.2 percent, ranking health plans 35th out of 53 industries in terms of profitability.

As the president and CEO of SantaFe HealthCare — the parent company of AvMed Health Plans — I am truly concerned by this proposed tax. As one of Florida's oldest and largest nonprofit health plans, AvMed reinvests its earnings each year to continually improve on the benefits and services it offers to members in Orlando and elsewhere.

Obviously, a health-insurance tax that wipes out most of our annual earnings is counterproductive to our mission. Surely, congressional leaders must grasp that this tax doesn't make sense.

There are better ways to pay for the systemic health-care reform that AvMed and other health plans support.

Instead of taxing health insurance, Congress should focus on the underlying costs of medical care. We can achieve huge cost savings by ending unnecessary treatments and services, rooting out rampant fraud and ending frivolous medical lawsuits filed by trial lawyers.

Health reform shouldn't hurt Florida's families and small businesses. It shouldn't hamper the ability of health plans to provide benefits.

Time's running out.

Please contact your congressional representative and Florida's two senators today. Ask them to vote against this harmful health-insurance tax. We can achieve true, lasting reform in better ways.

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Article Source: - Premium tax would hike health-insurance costs

Jean Watson's Theory

Jean Watson Theory of Human Caring: Caritas Process Five
The following discussion of Caritas Process Five is from Jean Watson’s newest book: Nursing: The Philosophy and Science of Caring, 2008 edition, published by University of Colorado Press
Carative Factor 5: Promotion and Acceptance of the Expression of Positive and Negative Feelings has evolved into Caritas Process 5: Being Present to, and Supportive of, the Expression of Positive and Negative Feelings

This Caritas Process cannot be discussed without realizing how essential it is to the development of a trusting-caring-healing relationship. Acceptance of another’s feelings, when positive is easy. But, accept even the negative feelings, and a deep trust, an authentic relationship can develop. “When one is able to hold the tears or fears of another without being threatened or turning away, that is the act of healing and caring.” Although we think of positive emotions and negative emotions, there is no right or wrong to our feelings; they just are. Expression of strong emotions may be due to intellectual-emotional dissonance (incongruity or conflict). The Caritas Consciousness Nurse may be the only one to hear and see and accept the person behind the strong emotions that frequently accompany illness, encouraging the patient to release the feelings that were due to fear, anger, and confusion. It is precisely during this time that the nurse’s equanimity (evenness of mind, even under stress) may help them to regain control and stability. This deepens the authentic, caring relationship to enhance healing and become “healthogenic”.
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Saturday, December 19, 2009

Unsafe Staffing: Time to Jump Ship.

I have a meeting with our chief nurse next week.  Again.  Let's hope he shows up this time.  I am going to ensure that my words ruin his christmas.

I am sick of nurse leadership.  They don't have a clue.  They don't know what to do.

I'd like to organise something like this for as long as I stay here.

Recently worked a 12 hour shift.  There were two staff for over 20 beds.  That was it.  Twenty heavy medical patients that mostly required two to transfer, multiple IV's, patients with dementia constantly falling out of bed, 10 or 12 of them crying and screaming for a nurse all at once all shift.  WE couldn't even physically get to any of them 90% of the shift.The shift after us had one nurse.

Our sister ward had one member of staff.-an RN and that was it.  A 35 bed surgical-ortho ward had 1 nurse and 1 care assistant.  Express medical admissions had 2 people staffing it for 12 hours.  So basically I had it good.  My patients are a lot more stable and there were 2 RN's.  Horrendous but better than other wards.  I have never had so much back pain in my life.  I am in agony and can barely sit still while I type this.  Merry fucking Christmas.  Decent hospital management is supposed to invest in frontline staff and regular staff pools as well as on call staff.  They cannot invest enough in this kind of thing and it would save them money in the long run.  But instead they let everyone go, and try to band aid everything with agency care assistants (NOT NURSES).  Then they refuse to allow us to call agency anyway.

A couple of Patients were on the phone (mobiles) to their families about the lack of care.... who then got all upset and tried to ring the ward and speak to the "nurses" to find out what was going on.  The constant ringing phone just took us away from those patients even more.  They complained about us if we didn't answer the phone, but when we did leave the area where we could see the patients to answer the phone our patients got hurt.  Not one of those family members rang management to complain about staffing levels.  They just laid into the nurse who was trying to get away from the phone and get back to the patient area.

The site manager (nurse supervisor on duty) did what he could.  There was no staff anywhere in the hospital to pull from.  He tried to come to each ward for some minutes and take over to give each staff member a quick break. He did this all night.  No stopping for him.  Twelve hours is a long time to go without food and water and constant cognitive overload.

A teacher, office worker, etc would have lost their rag after 10 minutes. Imagine a teacher's reaction to having to work 12-14 hours non stop in an area of education that they were not used to teaching.  Then give them 30 kids they never met before. Then set it up in such a way that they are having to leave their classroom every 2 minutes to answer the phone and speak to families members of their pupils.  When I call my kids' school I leave a message for the teacher and she rings me back in the next day or two.  And it's not like she has life and death situations to walk away from in order to answer the phone!  Imagine if a classroom teacher had to run to the office and answer the phone every two minutes and imagine if this action could get one of her pupils killed.  Then imagine that her headteacher was threatening her with disciplinary action every time the phone didn't get answered while refusing to hire admin staff. Teachers would run a mile in this situation.  Run a mile.

My patient had a reaction to a drug.  Scared me enough to really make me tremble and get nauseous.  The drug I needed to stop the reaction was not on the ward.  Pharmacy was closed.  I had to leave him and my other patients and ring around until I found a ward that had the drug.  The only other member of staff had a bleeder and we were dealing with that as well.  Could not leave the ward. My patient was not crashing out but very unwell.  Believe me when I say we could not leave that ward. Add a dozen 90 year old patients to the mix screaming for their mamas over and over again and you can get a feel for the situation.

But then I had to ring around and find a ward that had the drug and enough staff on duty for one to leave and bring it to us.  Couldn't leave my ward with only one person.  God knows what the porter was doing.  He said he couldn't get the drug and bring it. I asked him what he was possibly doing that was more important!  They are fucking porters for christ sake not professionals with accountability.  Rather than waste time arguing I went back to ringing wards and found one with 3 people on duty and my drug.  They legged it up to me.  It took me way too much time on the phone to obtain this drug in an emergency situation. 

When the ringing relatives managed to get their call answered they pissed and moaned about the line being busy for so long, the phone not being answered right away....keeping me away from the patients even longer to give me an over the phone bollocking.  These people must have some level of mental retardation.  Morons probably think I was on the phone chatting to one of my boyfriends.  Remember that everything these idiots ever learned about Nursing comes from the Daily Fail and No Angels.

We are getting no help from the NMC, the unions etc.  

Make no mistake about it, nurses and senior nurses have been reporting these issues and believe me the NMC will to go after frontline staff.  If the NMC, the RCN, and Unison say that we haven't been whistleblowing  then they have confused me completely. Those in a position of power will not even acknowledge the staffing issues and the antiquated system/layouts/and ward set up nor will they acknowledge other management failures.  Our incident and grievance forms are probably being used to light some administrators oven.  Too many NHS nurses cannot function at all in their working conditions, not even the good ones.

They are only focused on going after individual nurses.And like the public they are blind to the real issues.  They just don't want to face it.  It's more fun to go after the frontline nurses who are trapped in a situation where they cannot function.

It's time to jump ship.  I have said this for a long time but have not been pro-active about it.  But the housing market is improving.  Had a long talk with the other half recently. He hasn't got a transfer back overseas yet that we have been waiting for.  We are not waiting any longer.  I hate to mess up his career in this economy but he is packing it in and we are getting out. It's a big thing to ask.  But he understands and is supportive.  At least someone (who is not a nurse) is understanding and supportive.  I am sure that somewhere in the NHS there are wards functioning well...but they probably won't be for long and I am not going to risk it.

Staff Nurse Jobs

This nursing jobs abroad is being offered to Filipino nurses who are qualified for the position of Staff Nurse I. It has a job order that was approved for recruitment by the POEA last December 10 and 11 for a recruitment agency based in Ermita, Manila. The job order balance for the said staff nurse jobs is 29 and 27 staff nurse jobs respectively and the chosen applicants who will qualify will be placed in the Middle East country of Saudi Arabia.

To apply for the said staff nurse jobs, just proceed directly to the office of the recruiting agency to submit your application. For further info regarding the qualifications and requirements for this staff nurse jobs, you can contact the recruiting agency through their landline number and Email address specified below.

LBS E-Recruitment Solutions Corporation
M3, M4, M5, 300, 304 Gochangco Building
610 T.M. Kalaw Street, Ermita

Tel No: 5244745
Email Add:

POEA Approved Nurse Jobs

The job order for this POEA approved nurse jobs was approved last December 8, 2009. It was approved for a recruitment agency based in Malate, Manila and will provide employment to 49 Filipino nurses who will qualify for the said POEA approved nurse jobs. The chosen applicants for this POEA approved nurse jobs will be placed in the oil rich country of Saudi Arabia.

To apply for the said POEA approved nurse jobs, just visit the office of the recruiting agency and submit your application. For further details on the qualifications and requirements for this nurse jobs abroad, you can contact the recruiting agency in their landline numbers indicated below.

Ideal Placement & Manpower Services Inc.
Ground & 2nd Floor, MH Del Pilar cor Sinagoga Street
Malate, Manila

Tel Nos: 5255049 / 4501174-76
Email Add:

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Friday, December 18, 2009

Congrats on being 1/8 of a Doctor

Whew! It's been a heck of a few weeks! I just finished the last of my finals before Christmas break. Metabolic biochem, Physio, and Histo all this week. And I'm happy to report... all classes passed! Officially! P=MD. Actually when I got home from my final today I had an email from the school that said "Congrats on being 1/8 of a Doctor". That actually made me feel pretty darn good. And the best news of all? I'm headed to Japan tomorrow!!! So I guess I'm officially on blog hiatus for a couple weeks... but knowing me I'll probably still post.

Ok, until then...

Thursday, December 17, 2009

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What Do CNMs/CMs Think about Planned Homebirth?

by Eileen Ehudin Beard, CNM, FNPAn interesting study in the December issue of Birth explores American nurse-midwives’ attitudes toward planned homebirth and their impact on a woman’s choice of birth site. The findings suggest that, as a group, nurse-midwives have a “moderately favorable” attitude about planned homebirth and that their education and practice experiences may greatly influence

Wednesday, December 16, 2009

Do You Match with a Midwife?

by Melissa Garvey, ACNM Writer and EditorHave you ever taken one of those online quizzes that matches you with the political candidate who most shares your views? So many people are surprised to find they match with a political candidate they never considered. It’s easy to cast a vote in favor of the candidate who gets the seal of approval from family members, friends, or the media rather than to

Tuesday, December 15, 2009

Dr. Elizabeth Dowdell cited in article on drug abuse

Dr. Elizabeth Dowdell, associate professor, Villanova University College of Nursing, was cited in an article on a recent report on teen drug abuse in the Christian Science Monitor. Dr. Dowdell is a specialist in parent-child health and forensic nursing.

To read Report: marijuana, prescription drug use up among teens click here:

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Monday, December 14, 2009

A day at the ER

Podcast on Intro to EBN by Rebecca Kolb, RN, BSN, CEN

Check out this excellent podcast by Rebecca R Kolb, RN, BSN, CEN which provides an introduction to Evidence Based Nursing including a succinct explanation of the Johns Hopkins Evidence-Based Practice Model .

Some viewers may need to download Quicktime in order to view this.

Sunday, December 13, 2009

The Slovenian model of care

Wake up and smell the coffee with Ronald Reagan circa 1981.

Correct me if I am wrong here  (really I mean that) but isn't this model of care pretty much everywhere except western Europe.

Currently, the residential homes in the UK are  little victorian townhouses with lots of steps. The staff is comprised of care assistants.  Once those patients deteriorate and age enough to the point that they are confused and /or cannot mobilise they get sent into hospital and wait 8 weeks for a bed in a nursing home.  The minute a patient becomes confused suddenly or mobility deteriorates they are sent into hospital. 

The nursing homes here are wee little old victorian townhouses with lots of steps.  They have RN's on duty 24/7 as well as care assistants.  But, they do not take patients on IV fluids of any kind, they cannot give IV antibiotics and if a patient needs a chest xray they get sent into hospital. Many of them will not cannot take peg feeds etc. 

Is it really any goddamn wonder why are acute medical hospital floors in the NHS are 75% nursing home patients who are very demanding but not acutely ill?  Their relatives expect them to be cleaned and fed and entertained constantly.  They don't seem to realise that the hospital is only staffed with just enough nurses to barely keep on top of all the IV meds for the 25% acutely ill.  The hospital is the worst place for any medically stable but dependent elderly person to be. Duh.

Are they really just figuring out now that this set up is bad and that they need to "modernise"?

They should have figured it out in '81.  No excuses.  The NHS should have planned for his and implemented something before Reagan was shot and anyone ever even heard of Madonna.  Here we are in 2009 and suddenly they wake up?  Fucktards.  And nurses are taking the heat for the elderly getting poor care? Christ.

I worked in a "long term care" facility- in lets say- Maryland many many (more than 10) years ago.  It was set up very similiar to what is described in this article.

Ground floor was physio, OT, patient entertainment, restaurant etc.

Floor One: residential care with 60 beds.

Floor Two: EMI with  60 beds

Floor Three: nursing home with 60 beds

Floor Four. 30 beds. Skilled nursing unit for patients needing IV antibiotics, blood, IV fluids, Peg feeds, complex pressure ulcer management etc.  This was to keep extreme geriatric patients out of the hospital unless absolutely necessary.  Hospitals are the worst place for medically stable but extremely geriatric dependent patients.  The hospital staff cannot cope with acute patients and nursing home patients at the same time.  They are not staffed too cope.

Floor four had another 30 beds.  This was ultra skilled nursing care: long term patients on ventilators etc.

The local area was full of such homes.  They were known as nursing homes.

Sometimes patients needed to get sent to hospital.  But 24 hours a day we had a respiratory therapist on staff at the facility.  The GP's and specialist doctor surgeries  who were responsible for the patients did daily rounds and always had one on phone duty to give the nurses any orders required  We had a guy with a mobile x-ray machine and we could get one done 24 hours a day.  We had a phlebotomist who came in to get the bloods that needed to be taken every morning.  We had our own pharmacy.

If a patient became confused we checked their temperature and dipped their urine...maybe got the doc to order a chest x-ray from our in house chest x- ray guy.  When elderly people become confused it is sometimes due to an infection.  We could start IV antibiotics and fluids right then and there if that is what the doctor wanted. Other problems like extreme bradycardia and ecg changes would warrant a call to 911 and transfer to the local hospital a&e.   It was the doctors decision. But we even treated DVT's at the facility. he gave IV heparin infusions.  The skilled unit also functioned as a stepdown, rehab area for hospitals to discharge elderly patients too.   If they couldn't care for themselves at home once they recovered they stayed with us and moved downstairs. We took patients who paid privately and medicare, medicaid patients as well as insurance patients.

When a residential home patient became unwell but did not require hospitalization they were moved to the skilled nursing floor.  If their cognitive or mobility issues continued to deteriorate, which is what happens to most elderly people whether or not the decline is accelerated by a disease process, then they moved onto the nursing home floor at this same facility.

The NHS may be looking at this model of care but I doubt they will want to fund it and staff it properly.

At work in the NHS we get many many phone calls from angry family members of our patients.  "The residential home won't take 99 year old granny back because she can't walk now AND IT IS ALL YOUR FAULT BECAUSE YOU LET HER LAY IN BED."  Umm. Granny had a massive stroke.  Anyway Granny will wait 6-8 weeks for a nursing home and develop a pressure ulcer and hospital acquired chest infection.  Much of the time we are not staffed in away that allows us to bathe and feed granny at any point without killing KILLING our acute patients. Sorry.  We (frontline staff) did not create this situation nor can we control it. We aren't the ones who want it to be this way.  We want a controllable workload so we can do basic care for our dependent patients as well as deal with all the other things getting thrown our way.

We get patients from residential homes who are sent in due to confusion, diagnosed with a urine infection, given oral trimethoprim and stay in the hospital for 6 weeks because the residential home "cannot cope".  Yeah it does take this long to sort out another place for them to go on discharge.

Elderly people will deteriorate cognitively and physically. A disease process that you or I would get over quickly will accelerate this decline in elderly patients and most of the time they will not get their former level of function back.  The nurses did not do this to your gran. 

The current system in place for dealing with our elderly patients is a total fail and it cannot function in the 21st century as the geriatric population explodes dramatically.  We may be keeping people alive more now but not always at a level where they can function independently. Don't blame the hospitals and for god's sake please don't blame that lone RN running between 15 acutely ill patients and trying to care for  multiple elderly and dependent patients between giving IV drugs etc.

The system is not set up in a way that they can manage the rapidly growing aging population. 

Look at the system.

Is it any wonder why our elderly community is suffering?  Who still believes that their suffering and lack of care is down to uncaring nurses who require dignity lectures? Some people just need to be slapped and then thrown off a fucking cliff you know.   If only these older out of touch nurses would focus on the real problems rather than indulging in the nursing profession's greatest pastime-eating their young. If only....
Personally, I would love to turf the acute patients and drug users out of my face and sit with and nurse sweet granny all day.  But you would never know it when I am at work and running past these poor elderly patients at 10 miles an hour, ignoring their cries because my pregnant heroin user just shot up in the day room and collapsed on the floor at the same time that some one else has started with a lethal GI bleed.

Am I wrong?  Am I way off base about nursing and residential homes in England? Am I wrong about the ones overseas?  Let me know.  One can still be provincial even if  she has lived all over the world. Seriously.

Owned Part two

Read part 1 first.

So I arrive onto the clusterfuck "surgery suite" at 0800. There was a list on a table of patients due to arrive. Two were already there pissed off that there was not a member of staff there to greet them. The list had 11 people's names on it along with the names of each of their consultants.  Names I didn't recognize.  What the list did tell me was the general order that they would be going to theatre in and what they were having done.   There were 3 charts on the desk.  That means 8 charts are missing.  The charts provide me with names, dates of birth, hospital identity numbers, past medical history, whether they had pre op assessments etc etc.  These are all things that I need to get pre op bloods and all the paperwork done etc.  I was guessing about the pre-op bloods.  The two patients now there did not know if they had any done. Great.  Each patient all need 5 forms filling in for admissions, tpr forms, operation checklists, consent forms, care plans, make identity wrist bands out for each one etc etc.  All patients were told to come in by 9 AM.  The last person on the list was scheduled to go to theatre at 3 PM.

The list tells me that the first person on the list is the first person I need to get ready.  But you have to move fast because theatres change the order on the list without communicating that to the ward staff.   They might just show up at 9 AM to take the patient that is last on the list, and he better be ready.  So it is a situation where you move as fast as you can to get everyone in gowns, the admission and pre op paperwork which must be sorted before they can go the theatre, bloods for group and save etc.  Make sure that they are consented, venflon are in and any pre op medications are ordered and available to give.  Once the doctor has prescribed them you have to harass and chase pharmacy for the drugs.

But without charts it was impossilble.  The first thing I did was tell the patients to change into theatre gowns and sit down while I went to the phone and rang around to look for the notes.  No one had a clue so I had to leave the surgical suite and hunt them down from the wards that they were supposed to go to.  The "never worked in a hospital before" care assistant was useless.  She was offering patients cups of tea!!  They are all nil by mouth for their operations for christ sake!!  She couldn't even do pre op blood pressures.  The patients thought she was a "nurse" and of course laughed  at a typically stupid nurse who didn't know that they weren't allowed to eat.

By 09:30 they were all there and I had all 11 notes.  I was running my tits off trying to get everyone ready along with bloods paperwork and other problems that need sorting before theatre because any one of them could get called to go 1st thing. I started with the people who were scheduled to go first on the list and went from there.  Many of them hadn't been to pre assessment and hadn't been consented which means I had to figure out which docs to page, what there page numbers were and tell them that patients were not consented.  At our hospital they must be consented before theatre, and a senior doc has to do it.

By 10:00 I was getting there.  I had established a good rapport with the patients and my 1st one had got to theatre, everything done for his operation. Yay me.  I hadn't forgot as much as I thought about surgical.  I was having to move quickly though.

At about 10:15 a timid looking young woman walked into the surgical suite.  I asked her name.  She told me it was Miss Doe.  Her name was not on the list.  She was just an extra 12th patient that they sent to me with no warning.  She handed me a letter from the hospital that told her to arrive at 9 AM for her termination of pregnancy that was scheduled for today.  She apologised for being over an hour late. Poor thing.  No wonder she looked horrible.  I felt so bad for her. I had no notes for her.  And I had to spend 10 minutes finding them.

And as I explained in part one I have no idea at all about abortions or they do it by giving them a pill to induce miscarriage?  Do they operate?    Do they do it by sticking a coat hanger up their vagina?  Damned if I know.  I have not a clue.

If I had some warning the night before that I was going to be looking after gynae patients I would have been on google looking stuff up until 2 AM.  But there was no warning.  At 10:15  Miss Doe showed up, she was an hour late, I had no notes or drug chart for her and I know nothing about gynae.  Site manager confirmed that she was indeed going to be my patient and so were a few other gynae patients as the gynae ward was full.

Her notes had just arrived on the ward.  No pre-assessment.  No consent. No nothing and a blank drug chart to boot.  Shit.  I had just stepped over to the nurses station to ring the gynae ward and ask what I am supposed to do with this girl.  First I was going to ring the gynae team and see if they had any orders.   I got through to the gynae team secretary as the docs were not answering their bleeps.  The only thing she could tell me was that the gynae consultant knew this girl was coming to the makeshift surgery suite and was on her way down.

No shit, I couldn't believe my luck.  Having the gynae doc here so quick would give me the guidance I needed.  At 10:25 the gynae consultant walked onto my surgical suite.  The patient had been there 10 minutes.  The consultant immediately picked up the patients notes, glanced at the drug chart and threw it into a wall.  We had the following exchange in front of all the patients, including Miss Doe.  Consultant gynaecologist is in caps. because she was screaming like a banshee.


"Um. Her what?"  "She has only been here a few minutes and I don't have her...."




I couldn't really get a word in edge wise. She went on and on with the above type of stuff for about 10 minutes. I honestly do not know where all of that poison directed at me came from.

  But it did dawn on me that they must give termination of pregnancy patients some kind of vaginal pessary to make things easier.  It sounded like the things come frozen and need to thaw first.  It sounded like it needs to go in a few hours before the procedure to maximize the effect.   Doctors don't always remember to prescribe thing (happens with a lot of things) and depend on experienced nurses to know it needs to be prescribed.  They expect the nurse to know and call them and tell them that the patient is here and hasn't been ordered her whatsitcalled yet.  And we cannot obtain anything important like that without a prescription from the doctor written on the drug chart.

Now I didn't know anything about a pessary until the gynae consultant from hell started shooting her mouth off.   But had I had just a few more minutes with the patient I would have been able to get one prescribed by a doc and obtained from pharmacy.  The gynae ward nurses would have given me a heads up.  If only I had ever got a chance to phone them in the 10 minutes I was aware of Miss Doe's existance....well the 3 minutes out of 10 where I wasn't chasing after her notes as well as sorting my 11 other patients out.  We nurses help eachother out a lot via phone when one is floated to an unfamiliar area.  I had a gynae nurse on the phone to me once as her ward was taking medical patients and she didn't have a clue.  I clued her into many things that the doctors will not write or communicate with you but expect you to do.

The gynae consultant from hell had her gynae junior doctor with her.  Throughout the consultants tirade the junior doctor folded her arms across her chest and glared down at me, and every few seconds she added her two pence worth whilst nodding her head.  "yes what you have done is very bad, very bad indeed, very cruel towards the patient, very cruel indeed".  All within earshot of the patients of course.

Now I am perfectly capable of standing up for myself but really I couldn't get a word in edgewise AT ALL and I was not going to stoop to her level.  I had never seen, heard of, or worked with this doctor before.

We had 12 pairs of eyes, merely a few feet away focused on us. Those eyes belonged to my 11 patients and the 12th patient, Miss Doe who was listening intently.  Had they not been there I would have called that consultant a stupid bitch to her face, kicked her in the cunt and walked away.  But they were there.  I got the prescription, I got the pessary, I thawed it out and it was in the patient plenty of time before she went to theatre.  She was fine.  I managed to pull everyting together for everyone else as well.

But the rapport I had worked hard to establish with those patients that morning was ruined.  For the rest of the day they looked at me as if I was some incompetent bitch who wouldn't get them what they needed. 

Wow gynae doc, what a way to make sure that the blame for any fuck ups caused by the unorganised chaos in this hospital will not be attributed to you.  Kudos and applause, even if you are a total bitch.

When I blog on here I often changed details.  No details were changed here .    This happened just as I wrote it, it happened to me, it happens a lot to registered nurses and it is definitely militant medical nurse raw.

But at least it wasn't a fuck up in some area that was really critical and acute, as happens to many floating nurses when doctors don't bother to write out orders or strike out prescribed drugs that shouldn't be given .............drugs that are still prescribed on the drug chart to be given.  The nurses actually do get the heat for that you know.

This stuff happens all the time, and it is the reason registered nurses throw such temper tantrums when they are asked to float.

Nurse Anne Gets Owned by a Consultant PART 1: The Intro

Argghhh.  I hate it when we get moved off of our ward in order to staff one we are unfamiliar with. 

Yeah yeah I am fine. It's been a long time since I got verbally murdered by a doc.  I have been a nurse a long time, I know how to treat a doctor with the respect she deserves (at work anyway) and I know how to get things done  and done well in less than ideal conditions.  I never have any run ins with the physicians.  Of course all that applies to the specialty I work in currently and most of my career.  I am a general medical ward nurse.   I can handle general surgery basics as I spent a few years doing that.  But anything else and I am out of my scope of practice.

Nurses do not graduate from nursing school knowing how to work alone in every speciality.  That is impossible these days.  Impossible. If they  wanted to graduate nurses with that kind of knowledge they would have to keep them  in nursing school for ten years.

Definiting of Floating:  Floating is when a site manager has 3 nurses on one ward and 1 nurse on another equally large floor.  They will send one of the three nurses from the first ward to cover the second.  This is the case even if it is an area that she has no experience in.  They are covering their asses and putting the patients at risk and the nurse's license at risk when they do this.  The NMC tells us that if we are asked to do this and feel that it is unsafe we should refuse. The hospital bosses tell us to float or else.  They will not accept our explanations as to why it is unsafe.  They think nurses merely make beds and bedbath and feel that we should be able to do that anywhere.  Refuse to float and your job is on the line. Float and your license and your patients lives are on the line.

A medical nurse who has only every worked medicine would be like a fish out of water on a surgical ward.  A surgical nurse who gets sent to medicine for the day would be out of her depth.  Sending me to ITU would be like signing death warrants for those patients.  And when they send ITU nurses to general medicine they are in tears over trying to do a drug round for 20 people. In tears.  They cannot handle not be able to assess patients properly and dividing their attention between more than 2 patients.  An RMN cannot function on a general medical floor.  The powers that be tried to use an agency RMN to take a side alone on my floor once.  I would not know where to even begin on a psychiatric floor nor am I at all familiar with the drugs they use etc.

 In the USA they staff their maternity floors and psyche floors  with registered nurses rather than midwives or RMN's and have been known to float those people to work in charge on medical floors.  Not safe.  Those nurses may be registered nurses but if they are working in maternity and psyche they don't know dick about working on a medical floor and vice versa.  They are no longer familiar with those drugs, the diagnosis, the interventions that those patients need etc. It's a mess.  But floating is what hospitals do to try and cover up the fact that the staffing ratio matrix that they use is a joke and it is what they do to cover up the fact that their lack of investiment in hiring and retaining people on the frontlines is a total fail and it is murder.

I arrived to work one tuesday morning to find that there were three of us-registered nurses- to staff my large medical floor along with 3 care assistants. Not enough but better than the usual. 

Then the phone rang.  It was the site manager.  "One of the trained nurses has to staff a surgery suite for short stay and day surgery.  There are just not enough beds and many elderly medical patients who came in overnight ended up in beds on surgical wards.  Those beds were earmarked for incoming surgery patients.   We are putting the incoming surgical patients into this thing we opened up on the third floor and praying that some of the beds on wards are vacated by the time they come out of theatre."

Oh shit.  This sounds like a clusterfuck in the making. The other two Registered nurses I was on with (Julia and Kate)had both floated recently and it was my turn to go.  Yesterday Julia was sent to staff a bay for overflow a&e patients.  She started work at 0700.  She was due to finish at 3PM.  No relief showed up for her as the site manager had no one to send at 4PM..

 It is illegal for Julie or any registered nurse to leave until she could hand over to an incoming RN.  If there is no incoming RN you are legally mandated to stay even if your pissed off babysitter is about to walk out on your 2 year old because you are late.  If you don't stay it is patient abandonment and you will be struck off. She was there until past 7PM.  That is when they finally send her some relief.   She will remain unpaid completely for those extra hours. She was not keen to have another go at floating now that her childminder walked out on her for picking up her kids 4 hours late.  Julia may not have received payment for those hours she was legally mandated to cover unpaid.  But she still had to pay the childminder.

Kate had also recently floated.  She had been sent to colo-rectal surgery.  She had 12 patients there and failed them all because she didn't know that area of nursing nor did she know the floor.  She was just dumped down there with no support.  This is what happens to us when my ward sister staffs my ward with 3 registered nurses.  One usually gets sent away.

Nurse Anne on the other hand, hadn't floated in months.  So it was my turn to run up to and staff the clusterfuck hastily put together "surgical suite".

Oh shit.

Let's set the scene even more.  They hastily opened this place to take overflow surgery patients who were all scheduled to have their ops today.  The place wasn't prepared, there was no notes, I don't really know the routine with surgery any more or how to prep the patients excactly. I didn't know where anything was.  And I was alone up there with an agency HCA who never worked in a hospital before.

And I don't know a goddamn thing about gynaecology anything.  Not a goddamn thing.  Not at all.  I don't even think we ever really covered that in depth in nursing school.  I never worked in gynae in my life.  I have female bits and I know where they are.  That is the extant of my knowledge about gynae.  Just to reinterate, I do not know the first thing about gynae.

And this is where it all went to hell. 

But how badly can you screw up with a short stay gynae patient? It's not like it's coronary care right?

Will continue this later on.

Saturday, December 12, 2009

Free Food Count #1, #2, #3 and #4

So I thought it would be fun to start a count to see how many free meals I get though the course of med school. I know I´ve probably already had over 100 this semester... but lets start from zero.

This week I had four. And I even missed a few!

1. Dinner at Emeril´s with the Neurology Department. Mmmm. Steak, potatoes, banana cream pie... and lots of wine

2. BBQ - student appreciation luncheon- pulled pork sandwiches, slaw, beans, bread, YAY!

3. 60th Anniversary party - Psych department at the Chateau Bourbon Hotel, dinner, dessert, drinks, the works

4. Club lunch for medical missions - veggie wraps

Still Screwed... but Significantly More Excited

I found out yesterday that I was assigned to do my first year elective in the Emergency Medicine! I am really excited... as I have been dying to jump in and get some EM experience. I'll be working in a Level I trauma center at a rival med school... but WHO CARES? So excited I can't believe it. Starting in January. Yay!!!

Ok, back to studying for the 3 exams that will be kicking my ass later this week.

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Thursday, December 10, 2009


That's what I am. So this block is only 3 weeks, 3 classes and 3 final exams. I'm almost at the end of week 2 and can BARELY find a shred of motivation to study. All I can think of is Friday next week when I'm done and heading out to vacation for 2 weeks. Seriously, I've studied a total of about 6 hours this block. Ask me what I know about excitable cells? Not too much, sweetheart. Like I said, I'm screwed... and not in the good way.

New Experiences

So I thought I'd make a list of ways that I've changed over the last year. Not sure if these are due to medical school, having a dog, or building a house... but for SURE none of these would have occurred in my prior life without SEVERE emotional distress:

1. Today dog poop fell on my hand while I was picking it up at the dog park. I just rinsed my hand with water (NO SOAP AVAILABLE!!), and went on with my conversation (while drinking coffee). Normally I would have been itching to get home to disinfect.... but folks, I didn't even think about it!

2. My clean dishes are on a dishrack in the BATHROOM. Why? Because this is the only place I have to wash dishes. Yes, there are probably fecal colonies forming on them. But I'm ok with it.

3. I made persimmon cookies the other day, and threw away the persimmons after getting what I needed for the batter. Later I found out I needed more persimmon pulp for the glace. Since these were the only 2 persimmons in the city I could locate, I actually took the persimmon OUT of the TRASH, washed it off, and used the pulp from the inside. O-my-god. This is huge.

4. This year I cut up a human body. Ok... fair enough this one I'm still not at peace with. I actually still can't go in the anatomy lab without holding my breath. But hey, I did it.

5. My beloved SUV, which I have babied and polished and waxed, and kept its leather conditioned and every knick painted.... is doggie-fied. Hair everywhere. Toys, doggie shampoo, poop bags (empty of course lets not get nuts), etc. I do give it an overhaul every few weeks... but in between it's a total dog car. You would certainly mistake it for a soccer-mom car.

A Few of My Favorite Comments

by Melissa Garvey, ACNM Writer and EditorComments are what make a blog come to life. A blog without comments is no different than a magazine article, an online newsletter, or a plain old webpage. That’s why every comment we receive at Midwife Connection puts a smile on my face. Long, short, positive, negative—I love them all. Here are a few of my favorites.About Should a Pharmacist be Able to

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Wednesday, December 9, 2009

Commentary on Report on Nurses' Tobacco Cessation Behaviors

Research Abstract with Commentary

Frequency of nurses’ smoking cessation interventions: Report from a
national survey

Linda Sarna, Stella A Bialous, Marjorie Wells, Jenny Kotlerman, Mary E Wewers and Erika S Froelicher. Journal of Clinical Nursing, 18, 2066–2077.

Aims and objectives. To describe the frequency of nurses’ delivery of tobacco cessation interventions (‘Five A’s’: Ask, Advise, Assess, Assist, Arrange) and to determine the relationship of interventions to nurses’ awareness of the Tobacco Free Nurses initiative. Background. Tobacco cessation interventions can be effectively provided by nurses. The delivery of smoking cessation interventions by healthcare providers is mandated by several organisations in the USA and around the world. Lack of education and resources about tobacco cessation may contribute to the minimal level of interventions. The Tobacco Free Nurses initiative was developed to provide nurses with easy access to web-based resources about tobacco control.
Design. Cross-sectional survey of nurses (n = 3482) working in 35 Magnet-designated hospitals in the USA (21% response rate).
Method. A valid and reliable questionnaire used in previous studies to assess the frequency of the nurse’s delivery of smoking cessation interventions (‘Five A’s’) was adapted for use on the web.
Results. The majority of nurses asked (73%) and assisted (73%) with cessation. However, only 24% recommended pharmacotherapy.
Only 22% referred to community resources and only 10% recommended use of the quitline. Nurses familiar with TFN (15%) were significantly more likely to report delivery of all aspects of interventions, including assisting with cessation (OR = 1.55, 95% CI 1.27, 1.90) and recommending medications (OR = 1.81, 95% CI 1.45, 2,24).
Conclusions. Nurses’ delivery of comprehensive smoking cessation interventions was suboptimal. Awareness of Tobacco Free Nurses was associated with increased interventions.
Relevance to clinical practice. Further efforts are needed to ensure that nurses incorporate evidence-based interventions into clinical practice to help smokers quit. These findings the value of Tobacco Free Nurses in providing nurses with information to support patients’ quit attempts.

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

This timely article describes one in a series of studies done by Sarna and colleagues related to nurses’ roles in international tobacco control efforts. The assumption behind the sample selection (nurses employed at Magnet hospitals) is that this group of nurses may have better tobacco cessation practices compared to nurses at non-Magnet facilities. Specific findings were of interest to those of us at St. Joseph who have been involved in the tobacco cessation education of nurses here (nurses on all units were to have completed the 3-hour classes offered through Clinical Education).
 73% of nurses ask about tobacco use
 62% advise about the risks
 62% assess motivation to quit
 37% assist with patients’ cessation efforts
 19% arrange cessation strategies
 22% refer to resources
Some unpublished data from a year long hospital study of nurses who have taken the St. Joseph class (Matten, Morrison, Rutledge, Chen, Chung, & Wong, 2009) indicate that our class is enhancing these types of nurse behaviors (see table).

Nurses’ Perceptions of their Skills to Counsel Patients

Action* Pre 3 Months 6 months 12 months
(n = 98) (n = 39) (n = 38) (n = 34)
Ask 3.69 (1.1) 4.33 (0.8) 3.87 (1.0) 4.24 (0.7)
Advise 3.06 (1.2) 3.72 (1.0) 3.87 (1.1) 3.85 (0.9)
Assess 2.65 (1.0) 3.28 (1.0) 3.53 (1.2) 3.56 (0.8)
Assist 2.36 (1.2) 3.49 (.9) 3.35 (1.2) 3.59 (1.0)

*Response set: 1= poor; 5 = excellent

Tuesday, December 8, 2009

Should a pharmacist be able to refuse to fill a prescription?

by Heather Bradford, CNM, ARNPChair, ACNM Government Affairs CommitteeHere in WA State, a prescription refusal issue is working its way through the legal system. Many people are calling it “Refuse and Refer” claiming that it is appropriate for a pharmacy or a pharmacist to refuse to fill prescriptions to which they object on religious or moral grounds, and refer clients elsewhere. A few claim

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Monday, December 7, 2009

Role of Nurse Needs Met In Security and Safety

Role of nurses in the fulfillment of security needs can contribute directly or indirectly. Direct care nurses can do in nursing to clients who experience problems associated with unmet security needs. The nurse's role in fulfilling the security requirements are as follows :
  1. Direct care givers (care giver); nurses providing direct assistance to clients and families experiencing problems related to security needs.

  2. Educators, nurses should provide health education to clients and families to the client and the family doing the family's health care program related to security needs independently, and are responsible for family security issues.

  3. Health inspector, a nurse must do a "home visit" or a regular home visits to identify or perform assessment of the security needs of clients and families.

  4. Consultants, nurses as a resource for families in dealing with family safety issues. In order for families to ask for advice to the nurse the nurse-family relationship must be nurtured well, nurses must be open and trustworthy.

  5. Collaboration, nurses also must cooperate with various programs as well as cross-sectoral in fulfilling the security needs of families to achieve health and optimum family security.

  6. Facilitator, the nurse should be able to bridge both the compliance with the security needs of clients and families that are not risk factors in the security needs can be addressed.

  7. Inventor cases / problems, nurses identify safety problems early, so that does not happen injuri or risk falling to the clients who are unable to meet its security needs.

  8. Modification of the environment, nurses must be able to modify both the environment and the home environment in order to create a community environment healthy environment to support the fulfillment of security needs.

Genetics expert to be national resource for nursing education

In December 2009, Suzanne Tracey Zamerowski, Ph.D., R.N., associate professor, was notified by the Genomic Healthcare Branch of the National Human Genome Research Institute of the National Institutes of Health that she will be one of their genetics nurse education experts and an invited member of the Consultation Directory: Genetics/Genomics Education Exemplar Resources. The directory will provide a valuable resource for faculty to access and facilitate integration of genetics into their curricula and education programs. Her commitment extends through September 2010.

Dr. Zamerowski, on faculty at Villanova since 1979, has been teaching genetics for 40 years and integrating the content through her maternal-child health and health promotion specialty areas. Why this commitment? “Personally and professionally, I am dedicated to the role of genetics as a key determinant of health,” she says. “As the era of personalized health becomes a reality, genetic knowledge will be of paramount importance for individuals and health care professionals. Since nurses are widely represented in health care, they are in a key position to provide genetics assessment, education and care.” She explains further, “As a nurse educator, I want to do all that I can to ensure that nursing graduates emerge as well prepared professionals in this era of genomic medicine and contribute to the promotion of health and prevention of disease. Serving as a faculty champion will allow me to be a change agent in one of the most exciting times in health care.”

Her broad contributions thus far reflect her commitment to the arena of genetics which began at the start of her career after her son Tommy was born with a genetic disorder. “I have continuously advanced my genetic knowledge through pursuit of doctoral education, conducted genetic research, attended numerous educational conferences and professional meetings, and participated in training programs and continuing education offerings. Through my role as an educator, I have been able to apply this knowledge towards numerous educational initiatives to advance genetic knowledge, change attitudes about genetics and prepare genetically competent nurses.” For instance she developed the required undergraduate Nursing course Cell Biology and Genetics and the elective course Genetics for Health Care Professionals. Her goals will be furthered through her service as a faculty genetics champion in this national exemplar program.

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Sunday, December 6, 2009

Interviews - Post 2

Everyone is freaked out by the questions that you will (or will not) be asked... Fear not, the point of interviewing is just to assure the admissions committee that 1) you can string along a few words in a mildly coherent fashion and 2) that you aren't "grossly offensive" in some way undiagnosed on your paper application. 99% of interviewers feel the same way... less than 1% are actually "out to get you" (meaning they want to stump you or make you look comparatively stupid in contrast to their all-knowing godly physician-ness).

That being said, lets first discuss what you CAN do to grossly offend the 99% of interviewers:

1) BS'ing. Meaning that you've been asked a question that you don't know the answer to... and instead of owning up that you aren't actually familiar with EMTALA or the HENT receptor or the new CDC guidelines for treating HIV... you decide to BS. A lot of times you've been asked this question on the presumption that you won't know the answer... because the interviewer wants to assess how you deal with stress and how your ego works. They're hoping for a response like "No, I haven't heard about that. When did that happen?" or "I have no idea what that is. I'll have to check it out later." If you BS'd your answer, not only will your interviewer likely know you BS'd, but they'll also think you're an ego-maniac that can't admit fault. That would suck.

2)Talking shit. Hopefully, you're thinking "Isn't that obvious?"... but I've seen candidates come to interviews and complain about the poor organization of the interview day, bitch about how cold the city is, describe how boring their student host was, whatever. Bad form. Because anyone who hears you is going to think "Good god, this person bitches so much they can't even control themselves on an INTERVIEW? Yikes. This is probably how GWU ended up with a disgruntled student submitting some 500 odd complaints against them and getting put on probation. Um, NEXT" Additionally, talking shit breaks the "no assholes rule" (see Interviews - Post 1).

3)BO. Again, hopefully obvious... but for whatever reason some people can't figure it out. And BO comes in the most unexpected packages sometimes. Cute little blonde girls who wear Louis Vuitton and Christian Dior makeup. Who would have ever guessed? If you are even remotely unsure, here's my suggestion. Sit down with your best friend in the entire world (who hopefully doesn't also have BO) and say these words. "I have an important question that will affect the course of my entire life, and I need you to tell me the absolute truth no matter how much you will think it will hurt my feelings. I want to be a doctor more than I care about breathing... and if you don't tell me the truth I will never become one. Do I have BO?"

4) Being ungrateful. In any sense. Please make time to thank your interviewer for their time, thank your student host for their hospitality, and thank the secretary for making the day happen. No one owes you an interview or an acceptance. There are about 70,000 people who take the MCAT every year, 40,000 apply to med school, and about 17,000 get accepted somewhere. If you don't appear grateful, someone else will.

OK, let's move on to the questions you should be prepared for. I've seen med-school interview books with 100's of questions. If you are of normal intelligence, you don't need to "prepare" for more than about 5 standard questions. The rest can be answered by just being honest, humble, and mild-mannered. Here's the ones you should be able to answer cold.

1) Why do you want to be a doctor?

Great answers address the following:
- Why being a doctor is a different/better match for you than your other interests (note that I didn't say to slam other careers)
- The process that led you to the decision to pursue medical school (because you shouldn't have decided overnight)
- The aspects that appeal to you in medicine (like the fusion of humanity and science, or the lifelong ongoing learning)

Less than great answers go something like this:
- My dad was a doctor and I decided to become one when I was 4 (way to demonstrate that you have no free will)
- I broke my arm when I was 12 and that's when I made the decision (probably shouldn't rely on the life-long committments you made at 12)
- I want to be rich, drive a Ferrari and pick up lots of women (OK, I've never heard of an applicant say this, but I have friends who are physicians who say this is why they went to medical school... scary)
- I want to help people (duh!)

The general idea is that you want to show that you have solid reasons for becoming a physician that are unique to being a physician. For instance, if you say you want to help people... that's great.. but why not go volunteer at an nursing home and save yourself a decade of work? That is not a sufficient answer. You need to explain yourself better. When I interviewed I was asked why I didn't want to continue on as a high school science teacher. The interviewer commented that it was similar to medicine in that it helped people, had elements of science, and facilitated learning. I answered that while it did have all those things (which I appreciated about medicine), that I didn't feel that being a teacher was challenging for me. I didn't feel that I was growing as a person. In medicine I could help others while challenging myself.

2) What are your strengths and weaknesses. I hate this question. It's so dumb. As if anyone has the ability to TRULY assess their own strengths and weaknesses, and if they did... who would admit them? Is somebody really going to say "I have a stellar rack, which really helps me get attention from important people" or "I'm incredibly brilliant while the other earthlings are complete morons " or "I am secretly addicted to meth, but I still show up for work on time"

BUT, you should still have some good answers up your sleeve for when this question comes up.

For Strengths:
Pick something that the interviewer CARES about. Like I'm resourceful, I'm a mediator, I'm innovative, I'm a strong bench researcher, I speak Vietnamese, or I get along with most everyone. Pick something that will affect THEM, but doesn't sound too boring or egotistical. It's a fine balance. Don't pick something subjective like "I'm nice" or "I'm intelligent"... because frankly, you have no way to assess that yourself.

For Weaknesses:
Well after the Obama, Clinton, Edwards debate a few years ago you now really have to answer this question well. For those of you who missed it... all three were asked about their weaknesses... Clinton answered that she is too hard of a worker, Edwards said that is is too philanthropic (or something like that), and Obama said that he's completely disorganized and his desk is a disaster. Well the media jumped all over him for admitting that he was disorganized yada yada, and his response was "I must have misunderstood the question. I thought I was being asked what my weakness was... and I guess I was supposed to answer with a strength disguised as a weakness"

Point taken. Answering with a strength disguised as a weakness is well, weak. Lame. It makes you look like a pompous ass, actually. So you need to come up with a real weakness. But not too much of a real one. Don't go around admitting that you cut yourself when you stress out before exams or that you steal $100 bills from your Grandmother's secret jelly jar. You should also avoid admitting anything that will send up a red flag on your application. Don't admit weakness in regards to grades, stress, not getting along with people, not liking sick people, not being able to deal with authority, having a learning disorder, not sleeping regularly, having OCP, etc.

Pick something either 1) totally unrelated to med school 2) something that is a subjective weakness or 3) something that USED to be a weakness but you've overcome it.

- I used to interrupt people because I get excited about what they are talking about... but I've tried to become conscious of it, and I don't do it as much anymore
- Everyone in my family plays tennis except me. I'm terrible in sports and I'd like to work on that.
- I'm really bad about keeping in touch with my old friends. I get so busy sometimes months go by before I notice.
- I eat a lot of junk food because I have a crazy schedule, and I always say I'm going to start packing healthy lunches for myself... but I never do
- I ask a lot of questions out of general curiosity which I think people can mis-interpret as me doubting the validity of what they are saying. I have really had to work on how I frame my questions.

These are truthful, but pretty benign in the grand scheme of things. You'll give off the impression that you're authentic, but smart enough not to reveal anything inappropriate.

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Saturday, December 5, 2009

Identifying And Leveraging A Nursing Recruitment Agency

Whether you’re new to the nursing job market or you’re a seasoned nurse that’s looking for a better job opportunity, a nursing recruitment agency might be a wise choice. Not only is this a company that has your best interests in mind, but they can also steer you in the path of financial security. By taking the time to learn what this kind of company offers, you can begin to get on your personal path to nursing success.

What is a Nursing Recruitment Agency?

Needless to say, this arrangement offers a lot of benefits for the nurse. Not only will the nurse for hire have more access to more jobs, but they can also stay at their current job without any interference of the job hunting process. In fact, this is usually the reason why so many nurses stay in jobs they don’t like – they just don’t have the time to spend on looking for something new. With a recruiter, they will handle the legwork and the paperwork needed in order to get a job hunt started and a new job found.

In addition to this, a nursing recruitment agency also helps match up the right nurse to the right job. By looking at the skills and the experience of the applicant, the agency can determine whether or not they are over or under-qualified for a position. This helps the employer out too as they will be receiving applicants that are right for the job.

Leveraging Your Skills with an Agency

What you will want to do is make sure you are representing yourself honestly with a nursing recruitment agency in order to match up with the best job for you. By listing the experience you have as well as the training, you will show a recruiter what you are best suited for. But in addition to that, you will also want to make sure the recruiter is aware of your personality and what pace you enjoy in nursing. Slow and steady workers will be better suited for places like private practice or home health care, while fast paced workers may be better for a hospital type arrangement.

The truth is that a nursing agency allows you to be in the control seat of your employment. Instead of having to look for jobs that suit you, the recruiter will do this work for you and then you can decide what the best fit is. Instead of being in a job that you don’t enjoy, you do have choices.

Nursing is one of the fastest growing professions and it’s only going to be more popular as the years pass on and older nurses retire. This job market is working in your favor – why not simply see what a recruiter can do for you?

By: Grant Eckert