Monday, March 24, 2014

Not a physician, not a nurse...what?


APRN Advanced Practice Registered Nurse
ACNPC Acute Care Nurse Practitioner-Certified
CCNS Certified Clinical Nurse Specialist
CEN Certified Emergency Nurse 
Are you following the pattern?  I could go on...
These are examples of just some of the many certifications for nurses in specialized areas of care. And please excuse the underlying snarky tone as I am not feeling so "happy" after this past Certified Nurse Day.

Disclaimer: I am very proud to be a nurse and promote clinical excellence through certification - this is not a swipe at certification  or certified nurses!

So let me set the scene. I primarily work as an ACNP specifically as a Hospitalist and part time as a CNS. I also work as nursing faculty at a local university. During this past certified nurses day a unit clerk asked in general to anyone in earshot is it CNA day? (meaning certified nursing assistants day)  I spoke up and said no, it's certified nurses day - a day to recognize nurses that have obtained specialty certification, I gave him examples of my certifications and the clerk pointed to a list on a wall and said I was not on the list and finished with "well you're a doctor". "Umm, well actually I'm not. I did not go to medical school. Well you're not a nurse anymore," was the reply. Wow! I was not prepared for that. As it turned out this person was not alone in this perception.

Interestingly, I am no longer considered part of the nursing staff but not "part" of the medical staff. I have to abide by the medical staff by laws. I am not allowed to eat meals in the medical staff lounge or get free meals in the cafeteria. I am part of the "Allied Health Staff" which includes NPs, PAs, CNRAs,  & CMWs; we all pay dues. But we have no leadership. No meetings. No organization. No lounge. And we are not welcome at either nursing meetings or medical staff meetings.

So if I'm not physician and not a nurse, what am I? I know that I am not the only nurse practitioner or clinical nurse specialist that has been experienced something similar? Please don't get me wrong, I have a great working relationship with most of the medical and nursing staff members and I love my both of APRN positions. And most of all I LOVE being a nurse.

I continue to educate the staff on my evolving roles (I started out as a staff nurse and worked my way through school and various positions).  And to either our determent or benefit, I think we [nurses] will continue to educate others on what we do at every level as we continue to diversify our roles in healthcare.

I know I am not a physician. I do not pretend to be. I am an acute care NURSE practitioner and clinical NURSE specialist and I believe that I offer my patients something my physician counterparts do not. I am proud of my roots and my education and experience...and most of all my certifications. All of them!

Thursday, October 17, 2013

Always a lesson in every situation...

I haven't blogged in some time. I would like to think it's due to the fact that I am so busy with juggling several jobs, raising a teenage daughter, planning a wedding (and getting married!), assisting my new in-laws with their move and other, numerous time-sucking things I have been doing this summer. But perhaps it is laziness in part; not taking time to put my thoughts down on issues that matter to me. Well, today that changed - well at least in part. These are not my words, but those of a friend and fellow blogger. I had to share simply because I was struck by the emotion of the words (the story was not new to me) and the renewal of the call many of us have answered in following a career in healthcare.

I invite you his blog and read about Pip, the flying squirrel.

Because of Pip: Taking Action


Thursday, May 30, 2013

Put one foot in front of the other...

I have to admit that is what I first thought of when the President-elect new theme was unveiled. Then I gave it more thought..Dare to Step Forward...nice. The themes fit very well. Of course all of the themes fit well...these are very smart woman and NURSES!

It was a week a firsts for me. My first trip to Boston. My first time sightseeing in a city by myself and see the path of great Patriots. My first time presenting at NTI. A week of stepping out of my comfort zone and into something bigger. I can hear all the past themes running through my head.

We are once again reminded that we, as individuals not to mention as unified group can do great things. Each one of us. We all matter. We deserve to be happy. And we must rest. Wow...powerful stuff.

In the weeks before I left for Boston, I was struggling with whether or not I still wanted to go and if I had it in me to present at NTI in the API track (step forward). Whether I wanted to travel to a city that had suffered a brutal, cowardly attack (together, stronger, bolder). Whether I wanted to go essentially alone, save my colleagues and friends from my AACN Chapter. I was so wrong...I not only wanted to go, I needed to go (dare to).

I learned so much - not just about clinical practice and being an advanced practice nurse but about myself (act with intention)

There are so many things that left an impression on me. So much that touched me and is pushing me to work harder and to do more (stand tall)

So the big questions is how will you Step Forward this year?

One foot in front of the other


Wednesday, May 15, 2013

The NTI countdown begins

So we are just days away from undoubtedly the largest gathering of nurses - the AACN's NTI conference in Boston, MA.

I have to admit, I have been slow to get excited for this conference; especially since the bombing occurred. Glued to the TV for days as the events of the attack unfolded, I was shocked and horrified and angry that yet again a senseless tragedy occurred on American soil. Relief poured over me when details emerged and the suspects were caught.

As many of my nursing colleagues have thought about I'm sure, I have prayed for not just the victims but the numerous nurses, paramedics, physicians, and other healthcare providers impacted by this act of terrorism. No doubt we will hear more this week from these frontline providers that worked tireless to save lives.

This is my first time presenting at NTI. Part of me is terrified. But I am starting to feel a tiny bit of excitement build deep within me...I am after all presenting on something I feel very patient about.

Over the past week or so I have given much thought about this trip to Boston...specifically NTI. I was reminded by someone very dear to me that it is a time to recharge my nursing batteries with many strong and powerful nurses. He's right. Nurses are strong and overcome crises and struggles everyday to care for patients and ensure the best possible outcomes. We are passionate and forward moving.

It turns out that Boston is a great place for NTI this year. Nurses and other providers always rise to the occasion and remain strong and resolute. So has Boston.

Yeah, I think I'm ready.


Boston Strong                                 Nurses Strong

Friday, March 29, 2013

Patient safety lessons from Starbuck's

Anyone who knows me, would agree that saying I like coffee is an understatement. In fact, coffee is truly one of my life's pleasures. Right up there with anything chocolate and the beach. A good cup-a-joe, anytime of the day - hot or iced, frappuccino or espresso, I'm guaranteed to love it.

So what does my love of coffee, Starbuck's and healthcare have in common? Probably very little at first glance; besides the fact that coffee is the fuel of healthcare providers and clinicians everywhere...we may be able to learn something from the highly rated java-giants.

A typical shift day for me begins with a trip to the local Starbuck's for my usual special latte for one last jolt of caffeine to get through my unpredictable day. No matter what time I visit, I am always greeted by a friendly voice in the drive-thru that identifies themselves first and says something like "Good morning or welcome, my name is so-and-so, how may I help you today?" WOW! It always impresses me...really. Every day. All the time. No matter the person taking my order. I respond the same...."Good Morning! (It's contagious you know) I'll have...I won't bore you with my special coffee needs" And here's the best part...wait for it.....the friendly barista READs BACK & VERIFIES my ORDER! (RBVO) Ta-Da! Yes, they verify what they heard you say. Amazing. And if it is wrong they correct it on the spot and you get the wrong drink in addition to the corrected order. Now granted, no one is going to die or be injured with the wrong coffee-drink, but that is not the point.

In our clinical practice settings we give and receive orders or diagnostic results or other patient-related communication all the time and it is extremely easy to misinterpret or transcribe them incorrectly. The difference is, we can't take back the wrong treatment, medication or diagnostic result and it can most definitely harm the patient. I give telephones quite frequently and I am surprised at how many times they are not read back & verified. I often ask them to repeat the order back to me or I repeat it myself.

If Starbuck's thinks it is important enough to Read, Back & Verify your Order (RBVO) shouldn't it be important enough to us where the stakes are much higher? Incidentally, those of use that work in the acute care (hospital setting) know that CMS and The Joint Commission already think so...this was a National Patient Safety Goal for many years; it is now part of the Provision of Care Standards and yes a hospital can actually be penalized for not demonstrating evidence that a verbal or telephone order was RBV.

Startbuck's greets their customers with kindness and reads back their orders to maintain a high level of customer service and satisfaction, not because people will die. Clinicians and providers at every level should make reading back and verifying communications a natural part of their practice and a priority for patient safety.

Saturday, January 12, 2013

Hard spill to swallow???


For many Americans sweet dreams are not obtainable. They complain of poor sleep everyday - or more appropriately every night. The elderly are much more likely to report sleep problems. Due to a myriad of reasons, most physiologic sleep is altered and they find themselves up at night when they should be getting restorative sleep. For that reason the use of sleep aids has increased...and so have the consequences. Many drugs leave patients with 'hangover' effects impairing judgment and physical mobility long into the daylight hours after taking these prescription sleep aids - especially long-acting formulas. For the elderly this can be especially dangerous leading to increased risk for severe injuries related to falls, mismanagement of medications and other accidents. Some hospitals have reduced the use of such medications in hopes of reducing confusion, falls and other sequelae (especially in the elderly). In the hospital setting, patients often do not recover from untoward events. 
Cascade Iatrogenesis is a series of adverse events triggered by an initial medical or nursing intervention initiating a cascade of decline. It often results in a poor outcomes for the patient or inability to return to pre-illness level of functioning and is preventable. Many of these events are precipitated by medications - either a new medication, too many medications (polypharmacy) drug-drug interactions, over-sedation, so on and so on...
As for the use of sleep aids, especially in the acute care setting, it cannot be overstated - we must be vigilant and cautious when utilizing these or any medications in the elderly patient. Having an a lower dose option may be helpful, however we should really be considering alternatives rather than adding one more pill to the the medication soup

See the following:
Wall Street Journal: Citing Dangers, FDA Requires Lower Doses for Certain Insomnia Drugs http://online.wsj.com/article/SB10001424127887324081704578233652166139618.html?mod=dist_smartbrief 
National Sleep Foundation: http://www.sleepfoundation.org/article/sleep-related-problems/sleep-aids-and-insomnia

Monday, December 31, 2012