actualizing
he sits with his coffee cup
hoping for the best

dad calls him tiger
heart of gold he gives away
supporter of life

the engine stalls out
another cursing morning
the lawn is cropped short

Nursing In USA

Have you imagine how working as a Nurse in USA? Did you think that you will work In USA for the next future? Are you eligible working there? How much the salary you will get In USA? Yeah, so many question droop up to your mind, I know, working as a Nurse In America is not easy so many competitor you will be fight with each other, when you want to go there, but don't worry, you are people strong so why not. You can do best and more better if you want just need effort to go there and prepare everything if you are truly want to go to USA.

USA is the last destination Nurses travel and work as nurse there, because the America Government very appreciate to the Nurses with giving more revenue and high income, not like ASIAN country, only few of them they giving good salary like Malaysia, Japan , Australia they have care to nurses payment salary, other ASIAN country such as Indonesia, Philippine, Korea, Hong Kong, China are salary is almost same around $100 -$300 that not enough for monthly living cost, so sometimes any Professional Nurse if they want to go to secondary necessary they come to take Loan for cover their secondary necessary like house, car, even motorcycles.

It is make many Asian Nurse travel to Middle East which consider giving salary more such as Kuwait, Abu Dhabi, Qatar, Oman, UEA. USA is difference with Middle East Country which pay to Nurses according Hour Duty. In Middle East Nurses got salary and paid by monthly even you have more duty there is no allowance. In Middle East you only getting Monthly Salary rate $700 - $2000 every month. Not to bad but if you have chance why not skip to USA, because Nurses in USA will be paid according to hourly which hourly rate $30 - $45, so you will be working 48 hours in weeks, It's enough for you and to radeem all you must have more experiences and eligible to their requirement such as passing NCLEX, passing IELTS, CGFNS. I know it is not easy way, but if you want you can, just study hard your NCLEX, CGFNS, and taking IELTS course so it will be safe you to USA and you can enjoy your life there with much money and more benefits.

Try it, and getting success with many agencies who will healp you to bring your imagine to be real one.

collaborative
the quantum revolution
God doesn't play dice

E-Journal Club #11

Williams, Myrtle,Kathryn Jordan, “The Nursing Professional Portfolio: A Pathway to Career Development”, Journal for Nurses In Staff Development, Vol.23(3), 125-131.

ABSTRACT:

Nursing professional portfolios have moved beyond the traditional listing of past experiences and accomplishments. They now provide a format for self-reflection on practice and for goal planning, capturing both the art and the science of nursing. This article describes the experiences of designing and implementing the use of a comprehensive professional portfolio and the benefits realized by individual staff nurses and their managers.

JUDY’S COMMENTS:

I have posted an article like this in the past because I thought it seemed like a great idea. Now this article takes it one step further. I’ve felt that annual reviews are sometimes viewed as a process of futility for the staff. They see it as an opportunity for your boss to complain or assign you a job for the year. And where’s the follow up they always promise?
Last year, I decided to make a summary on PowerPoint. That way I could include some of the great pictures I’d taken of the off or on campus continuing education, the “teams” I was a member of, etc. It was not only a fun project for me, but gave me a different insight in what I wanted to say and how I viewed my own past year in better perspective.

another fashion
an explosion of chiffon
multilevel gown

slit side jogging shorts
demolition of towers
debunking the facts

we serve each other
us hundreds in happy lines
queued up out the door

on the sofa sauce
leaned back tapping lip to jar
sweet apple mash face

boys in camo skirts
a classroom full of rebels
honor student spite

she knows full remorse
choices made unchangeable
pressure of the crew

what happened to peace
life amplifies when unplugged
and you hear your breath

Graduation

It was, unquestionably, the longest graduation ceremony I have ever attended. Thankfully it was mine, and I knew every single person who walked across the stage. Otherwise I'd have surely died of boredom.
A picture of the school pin. Right now my pin is sitting in a small box on my shelf, waiting for it's place upon my uniform. And I happen to know what color uniform it will be! Teal! I've secured a job working in a CCU at a local hospital. (CCU mostly handles the fresh bypass patients, but they also catch some other acute complex conditions.) I don't start until September 4th, so I've been spending the last few weeks packing my little sister off to her first year of college, giving my room a long-needed junkpurge, and studying for NCLEX.

But what to say about graduation?

The sheer length of the ceremony, the number of speakers, the pictures, the songs... all of these things gave me a real sense of closure on my undergraduate education. I thought "It's really, finally over. I did it." But it wasn't until we said the nursing pledge that I felt a real sense of pride. After we walked across the stage, we didn't return to our seats, but instead went back into the choir loft (the ceremony was at large local church building). They dimmed the lights and we passed fire from lamp to lamp. Then, when everything was glowing around us, some soft music began to play. One of our instructors led us in recitation, and as we spoke into the wavering flames I could see all of my classmates' pins and eyes shining. It was actually a little spooky, since it felt not only solemn, but sacred. I think I will always hold that moment as a very special memory. Something to comfort me in difficult hours.

There were so many parties afterward.


I was supposed to be at the Hurst Live Review today with the rest of my classmates, but because money is tight at the moment, I was waiting till the last minute to sign up. And then what happened? After weeks of open spots, it finally filled up the day I wanted to register. Dang. So now it looks like my only review option is Kaplan Online. No more live reviews are handy for months and months and months! (Did any of you do Kaplan? Online? I'd greatly appreciate your feedback on it before I buy it later this week.)

So, until I start my job I will continue studying. I will post to let you know how the NCLEX went, but I don't intend to write about my job here since it is somewhat riskier. I am uncertain whether I will keep any other nursing blog after this one... I'll have to see whether it's possible or not. (While I'll no doubt have commentary on my life as a real nurse, I fear HIPAA... and to a lesser extent, workplace politics).

I've been so thankful for the few readers who have kept up with me these last 2 years. I feel like our dialog has been fun, and you have certainly been an encouragement to me at times. I hope I was equally encouraging to you. If you are in school, hang in there. You will make it.

So, I'm through! No longer a nursing student! (Though that isn't really true, I have so much to learn for the rest of my life.) Also, my goal is to begin grad school within 5 years. No, not as a to be a CRNA (Ew!) Probably an NP.

I hope to show you a picture of my license in a few months. Until then, thank you so much for reading.

unwrap the plastic
you think the insides are food
shelf life of two years

he has a scrapbook
loose pages pressed with Fall leaves
bronze and gold and white

Take a Guess: Which one do you think is telling the truth?

Patient number 1 is a early 40ish man with no medical history that comes in from his job at a construction site where he suffered a sudden onset of right flank pain. Driven in by a co-worker he is barely able to walk in, hunched over, pale, sweaty, diaphoretic, writhing on the gurney, tachycardic and hypertensive. Shortly after getting to triage he starts vomiting. During triage he seems apologetic when he rates his pain a "7 or 8."

Patient number 2 is a twenty something who is brought in from the parking lot in a wheelchair by a friend, they are laughing and talking on their cell-phones when you bring him in for triage. Chief complaint is a twisted ankle. Despite apparently being able to walk to the car at home he is now unable to walk and has to be brought into triage in a wheelchair. In triage his skin is pink, warm and dry and vitals are normal. He rates his pain a "12."

Patient number 1 is given Toradol and Compazine IV and has complete relief of his pain. He is diagnosed with a small, non-obstructing kidney stone. Discharged home with prescriptions for Motrin, Vicodin and Flomax as well as a urine strainer.

Patient number 2 is diagnosed with muscle strain. He is offered an stirrup splint and a prescription for Motrin. He is unhappy and demands a pain shot, crutches, work note and a prescription for Vicodin. He is told no at which point he jumps off the gurney and stomps out of the ER in a huff, screaming "I'm never coming back to this motherfucking place." Another miracle cure, courtesy of emergency medicine.

This is the kind of thing that clogs up ER's all over our country. America is filled with people that contribute nothing to society but come equipped with a massive sense of entitlement, they want what they want, when they want it, when they want it. Told no, they became belligerent and assualtive, spewing threats toward they staff. Fearing patient complaints or confrontation, more than one practitioner has taken the path of least resistance. Hospital administration, driven by their wish for high patient satisfaction scores, fails to allow MD's to practice medicine and join JCAHO in forcing us to be legalized drug pushers rather than medical practitioners.

Someday, when there is an epidemic or surge of casualties from a natural disaster or terrorist attack the ER won't be able to care for those victims because we will be full of patients with 'chronic pain' who are seeking drugs.

my red light future
includes yelling at strangers
and sweating the time

beauty stands graceful
the way he wears his blue jeans
tending to his nails

to get to the beach
one must drive through Werribee
it totally pongs

CONSORT statement website redesigned

The CONSORT Group are delighted to announce a redesign of the CONSORT
Statement website.
http://www.consort-statement.org
The CONSORT Statement is an evidence-based, minimum set of
recommendations for reporting randomized controlled trials. It offers a
standard way for authors to prepare reports of trial findings,
facilitating their complete and transparent reporting, and aiding their
critical appraisal and interpretation.
Thanks to the financial support of the UK National Coordinating Centre
for Research and Methodology, the new CONSORT website enhances its
capability to keep up with the growing complexity and increasing impact
of the CONSORT Statement.
Some highlights of the site:
* The definitive version of the CONSORT Statement
* The CONSORT checklist: examples and explanation of each item
* Translations of the CONSORT Statement into ten languages
* Extensions to the main CONSORT Statement for different trial designs,
interventions and data types
* Browsable bibliographies of the evidence underpinning CONSORT
* History and impact of CONSORT
* News articles on the developments of CONSORT
* A full glossary of terms
* A simple yet powerful search facility
Please circulate widely. We will be delighted to hear what you think of
the site.
cheers
Douglas
--
Mr Douglas Badenoch
Director, Minervation Ltd
-------------------------
23 Bonaly Grove
Edinburgh
EH13 0QB
-------------------------
Tel: +44 131 441 4699
Web: www.minervation.com

she smokes a cigar
bean bag plush around her limbs
tropical dreaming

are you a blessing
confident within yourself
or are you turmoil

E-Journal Club #10

Cummings, Greta; Hayduk, Leslie; Estabrooks, Carole, “Mitigating the Impact of Hospital Restructuring on Nurses: The Responsibility of Emotionally Intelligent Leadership”, Nursing Research, January/February 2005, Vol 54(1), p 2-12.

Abstract:
Background: A decade of North American hospital restructuring in the 1990s resulted in the layoff of thousands of nurses, leading to documented negative consequences for both nurses and patients. Nurses who remained employed experienced significant negative physical and emotional health, decreased job satisfaction, and decreased opportunity to provide quality care.
Objective: To develop a theoretical model of the impact of hospital restructuring on nurses and determine the extent to which emotionally intelligent nursing leadership mitigated any of these impacts.
Methods: The sample was drawn from all registered nurses in acute care hospitals in Alberta, Canada, accessed through their professional licensing body (N = 6,526 nurses; 53% response rate). Thirteen leadership competencies (founded on emotional intelligence) were used to create 7 data sets reflecting different leadership styles: 4 resonant, 2 dissonant, and 1 mixed. The theoretical model was then estimated 7 times using structural equation modeling and the seven data sets.
Results: Nurses working for resonant leaders reported significantly less emotional exhaustion and psychosomatic symptoms, better emotional health, greater workgroup collaboration and teamwork with physicians, more satisfaction with supervision and their jobs, and fewer unmet patient care needs than did nurses working for dissonant leaders.
Discussion: Resonant leadership styles mitigated the impact of hospital restructuring on nurses, while dissonant leadership intensified this impact. These findings have implications for future hospital restructuring, accountabilities of hospital leaders, the achievement of positive patient outcomes, the development of practice environments, the emotional health and well-being of nurses, and ultimately patient care outcomes.

Judy's comments:
The objectives of this original research seem huge. First to develop a theoretical model seemed confusing and impossible to me. Then to take the subject of “emotional intelligence” and adapt it to this model seemed pretty daunting. But the author’s seem to pull it off with little effort and present some thoughtful introspection into some concepts that the bedside nurse doesn’t always dwell on. Specifically, how does her manager affect her working environment.

The subject of ‘emotional intelligence” caught my eye recently. I am still exploring the topic. I also haven’t found many articles that explore the history of the hospital restructuring of the 1990’s, of which I was a part of. Sometimes we don’t value our history enough.

dreadfully bad poems
can make you appreciate
your own eloquence

snow blanket tucked in
sleep bounding over your knees
comfort of home

Michelle Pfeiffer's breasts
dangle as she leans over
her star of honor

all I write about
is a kid in the wrong place
with no one to help

wind struggles again
the pale curtain holds its form
light has no entry

R Privacy Issues

Let's face it, ER's are crowded and noisy. Despite our best attempts to maintain a patients privacy, when the next patient is six feet away with only a thin curtain between them, it is hard not to over hear what is going on next to you.

One night we had an elderly gentleman in curtain area 1 and next to him a prim, middle aged lady. The PA was trying to explain to the man what his diagnosis was but his efforts were being hampered by the fact that the man was very hard of hearing. The problem was something of a personal nature so the PA was trying to be discreet.

PA: Sir, you have pubic lice
PT: What's that you say?

PA: I said you have pubic lice.
PT: What?

PA: You've got lice down there
PT: Can't hear you son, you have to speak up

PA: I SAID YOU HAVE BUGS DOWN THERE
PT: Oh.

Of course we all overheard the conversation, including the prim lady in the next cubicle, who was red as a beet by now. The ER staff, dignified until the end, were draped across the counters shaking with silent laughter until tears ran down our faces.

Most of the time privacy in the ER is an illusion maintained by patients pretending they don't see or hear what is going on around them. Sometimes it is impossible to pretend.

and then he woke up
found the internet was logged
and he was inside

help is on the way
his fingernails are dirty
she closes her eyes

dreary day driving
the spotted hunchback pavement
no conversation

down on bended knee
confessing sins you're born with
your soul must be saved

how careful I was
true of every detail yet
you pushed me aside

Botox Round 2

I went for my secon round of Botox injectiosn today...

The doctor did my calf muscles again and this time we added the hamstrings too. Yup, it hurt... bad. I am hypersensitive to regular touch so imagine a needle... 8 of them (at least I stopped counting at 8).

As promissed from last time I took pictures, ok well, I didn't take them, my friend Janel did. I was busy trying not to scream... much.






Botox is purified form of the neurotoxin produced by an anaerobic (grows in the absence of oxygen) bacterium called Clostridium botulinum.

Although there are seven serotypes of botulinum neurotoxin, only A and B are currently approved for clinical use in the United States, and A is, by far, the most commonly used.

Botox (any serotype) works by blocking the release of acetylcholine.

To begin, it's important to understand what makes a muscle contract. In short (very, very short), an action potential is carried by axonal activity from the spine, down the nerve and to the linked muscles. At the neuromuscular junction, a measure of a chemical called acetylcholine is released into the very tiny space between the end of the axon and the muscle. Acetylcholine changes the electrical potential of the resting muscle fiber membrane and initiates a process that causes a contraction. (So, think of acetylcholine as working in a very similar manner as gasoline in a combustible engine. Gasoline is released in a small amount; it reacts (explodes), which sets about a chain of events that leads to motion (piston moving down, crankshaft turning... etc.).

Now, within the nerve ending itself are a series of proteins that are necessary to allow the synaptic vesicles to bind with the nerve endings and allow the release of the acetylcholine. One of these proteins is called SNAP-25, which is the one serotype A acts upon. So, basically, the botox cuts out a necessary protein in the chain of events leading up to the release of acetylcholine. The acetylcholine is never released, thus the action command is never communicated to the muscle.

Okay, here’s the cool part. The body recognizes that it is sending a signal to the treated muscle, telling it to react, but nothing is happening. The nerve terminals actually begin to sprout, sending those sprouts toward the muscle to form new synaptic contacts. Terminal nerve sprouting!!!

Scientists used to believe the treated nerve endings were permanently impaired and that the muscle returned to full functionality by receiving its messages from these new contacts. Recent tests are showing that the original contact heals, and once it becomes fully functional again, the sprouts retract.

What is NOT known, and what I find very interesting, is whether or not these sprouts retract on a newly innervating muscle.

My thanks to Mica (BPI Friends board) for writing this to explain how it works!

shoeboxes make feet
clay marbles comprise the street
I am defeated

her touch is gentle
as she explores the layers
of my rhythmic heart