RN Leaders/Academics: No Respect Theory

Ever notice the measuring tool by which we rank our nursing co-workers and charge nurses to decide how to respect them? How to decide if in our verbal and mental descriptions we tag them with “…he/she’s a Good Nurse” or label them with “…he/she’s Not a Very Good Nurse”? In short, how to decide whether or not this colleague has any merit whatsoever for our respect or even our attention?

It is their clinical prowess. Their bedside skill. Their ability to feel, know, acknowledge and rally the clinical team to get the impossible done for the patient. That it (whatever ‘it’ is this time) is right, timely, and physiologically correct leaves us as bystanders admiring them for months and years. We want to “be like that when we grow up!”

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Online LPN Programs

The idea that one could become an LPN by taking a course that is entirely Internet-based is, if you stop and think about it, a truly silly one. Yet every day thousands of Google searches are performed by people looking for online LPN programs. Such things do exist, in a way, but the whole thing is a little more complicated than it seems.

Why Real Online LPN Programs are an Impossibility

Nursing is one of the most hands-on jobs that anyone could choose to do, and therefore clinical practice and experience, in the real world, is an essential part of any nurse’s training, whether they want to become an LPN or an RN. In order to work as an LPN, every state in the US requires that an individual is licensed, and there are clinical hour requirements attached to that license. And yet there are still those who believe in the fallacy that online LPN programs allow you to become a licensed practical nurse without ever leaving the comfort of your own home.

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Is a Bachelor of Science In Nursing Really Better than An ASN?

In every state in the union, a nurse can take his or her state licensing exam to become a registered nurse after graduating from a two-year nursing program that awards an Associates Degree in Nursing.

However, an increasing number of students are deciding to obtain a Bachelor of Science in Nursing degree as well. The question some prospective nursing students often have is why bother with the extra schooling and expenses if both an Associates and a Bachelor of Science in Nursing qualify you to become a registered nurse?

Why take a Bachelor of Science in Nursing? – Like other Bachelor degrees, a Bachelor of Science in Nursing usually takes 4 years to complete and is offered at many colleges and universities across the country. There are also RN to BSN courses available that allow current RNs to gain a BSN in about 18 months.

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Emotional Strengths

During my first shift of this week, I discovered a new appreciation for hospice nurses. I started my shift with 2 patients- the first was a 79-year-old female who was chronically ill with CHF and related respiratory issues; she had been back and forth between the ICU and the telemetry unit over the past month. She had been planning for discharge when she coded on telemetry; she was transferred back to the ICU on a ventilator and multiple drips.

Through that evening, the nurse kept having to increase the amount of vasoactive medications she was on and shortly after the start of my shift that next morning, she was maxed out on multiple medications (vasopressin, epinephrine, levophed, neosynephrine, and dopamine). Her daughter arrived at 0800 and we discussed the fact that her mom probably would not make it through the day no matter what else we tried to do (there’s already so much damage being done to the body on that amount of medication).

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A Battle Plan Against Depression

In one ‘Cathy’ comic, the heroine crossly describes men as ‘all solution, no sympathy.’ For depressed teenagers and their parents, as Dr. Miriam Kaufman has learned over 18 years of work with teens, this attitude can be as misguided as the oft-derided ‘all sympathy, no solution’ approach. She conveys both sympathy and solution in Overcoming Teen Depression: A Guide for Parents, maintaining a scientific, matter-of-fact tone throughout.

Kaufman makes no attempt to gloss over the complexity of depression’s causes and manifestations; she believes that people need to understand their problems in order to deal with them honestly. Thus, she avoids over-simplification and distinguishes between everyday unhappiness and clinical depression as well as between depression and illnesses with similar effects. A diagnosis of major depression requires loss of interest or pleasure in previously enjoyed activities, sometimes experienced as sadness and sometimes as apathy. This feeling must be continuously present for two weeks, accompanied by four of the following: sleep problems; changes in eating patterns; difficulty concentrating; listlessness; feelings of worthlessness, hopelessness or guilt; suicidal thoughts.

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Who owns your DNA?

The answer might not be you. In an era when the map of the human genome can be accessed by any professor with an Internet connection, the question becomes more crucial every day. Courts and lawyers and legislatures wrestle with it; people who joined medical studies wonder just what their participation means. Courts have ruled that people who donate actual tissue — pieces of organs, tumors or blood, for example — have no right to financial compensation if a drug or treatment is developed from research done on that tissue.

But DNA, which contains the genetic blueprint from which you were built, seems more personal, something whose fate you and you alone should have the right to control.

Oregon is the site of the most recent battle over the rights to DNA. The state’s 1995 genetic privacy law, one of the first in the nation, gives a person property rights to his or her own DNA. A proposed change to the law last year would have taken those rights away. An advisory committee is expected to offer recommendations to the governor next month on how to proceed.

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How The Economy is Literally Killing People

At the very beginning of our shift, we received a transfer from the telemetry floor; a 50-something-year-old woman who was admitted 2 days prior with chest pain and elevated cardiac enzymes.

And, at the time, that was all the information we had. She arrived to us having 10/10 (worst pain imaginable, per patient report) chest pain, she was vomiting, diaphoretic (sweating), and so short of breath that she could barely sit back in the bed long enough for us to get a 12-lead EKG. Her EKG showed major ST changes and her blood pressure was quickly dropping to 62/34.

By this time, multiple calls had gone out to the cardiologist and he had scheduled her to go to the cath lab at 10 a.m. (it was 9 a.m. at this time) and he was given all the same assessment information that we had in front of us.
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Nurse Staffing Ratios

Nurses are expert professionals that provide direct patient care. There is no other business or healthcare professional that is taught or tasked with the critical thinking, the science, the legal responsibilities, or the multitasking workload of the clinically performing nurse. Clinically practicing nurse professionals have no less than (and some have more) education and experience than their nurse-colleagues that have chosen not to perform in a clinical environment and instead pursue careers in nursing leadership and nursing education.

Nurses are college-educated, board-tested, and licensed to practice nursing; physicians are also college-educated, board-tested but they are licensed to practice medicine. Nursing professionals are not responsible for medically diagnosing patients or performing surgical procedures, hence the additional four years of graduate medical education is not needed. Both professions enter into residency periods following graduation that provide supervised training for the independent and specialized practice of their careers. Nurses are not doctors, obviously, yet neither are they junior-doctors, wanna-be-doctors, doctor-servants or in any way connected to the practice of medicine …other than they share a patient population and a goal – the safe healing of patients.

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Dear Stepford RNs

I have watched with reserved opinion and bridled interest as the first of you graduated your Masters of Nursing programs and entered our ranks at the bedside of patients throughout the hospital.  We’ve all been watching you.

When you were in “clinicals”, we were fascinated that you knew almost nothing about patient care.  Some of you knew less than nothing.  You had no clinical group class, per se, with an instructor to assist you.  Each of you was individually assigned throughout the hospital and regular clinical staff were assigned to babysit teach precept you.  Most all that you learned clinically, was taught to you, one-on-one by good ol’ regularly educated, trained and experienced nurses.  Nurses that were confused yet happy to share with you.

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Thinking of the Big Picture

download-47I often get frustrated at work with the difference in the way doctors think to the way that nurses think. (Well, the good nurses anyways). Doctors don’t often see the “big picture” or what’s in the patient’s best interest. An example from my work week: Patient has been in the hospital for 3 weeks. He had open heart surgery, followed by a long recovery plagued by respiratory, musculoskeletal, and mental/cognitive issues.

For 3 days or so, we (the medical team…nurses, all 6 doctors on his case, social services) had been talking about sending this man to a rehab facility to improve his strength and coordination until he is able to return home… very common occurrence for our long-term patients. By the time we started talking about the patient being transferred to this rehab facility, he was fully ready to leave the hospital.

He’s sick of his ICU bed, sick of the same ol’ hospital food, sick of the daily routine, etc, etc; long story short, he needs a change of scenery. So, we have everything set into place, all the doctors have signed off on the case so the patient can transfer except the hospitalist.

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