Not being forced to write for class apparently means not writing at all! Now that I am back from my self-imposed hiatus, I hope to continue to share my journey to becoming a psychiatric mental health nurse practitioner. Many months ago, I wrote as a harried single mother, full-time student, part time soldier busily juggling (badly!) all the facets of my life. Today, I write as a dynamic person, no not Super Hero fabulous, but dynanmic, ever-changing, evolving towards my end self, the final product of this mess of ingredients that is to be me.
Since the class that created this blog, I have discovered Reiki and Therapeutic Touch. Every day, I add facets of each to my nursing practice convinced by the evidence of their efficacy. I have been blessed to see their benefit in my own life and in the lives of my patients, so much so that I am changing my dissertation. I am unsure where my path will take me, but am absolutely certain if I am doing what needs to be done for my health, both physical and emotional, my journey will end up exactly where it is supposed to be.
Monday, August 6, 2012
Thursday, May 3, 2012
To Feel or Not To Feel, That is the Question!
By the count above, I have 900 odd days to graduation. Translation? My dissertation project had better be completed by then! I'm having the hardest time creating a project. Some of the best ones are incredibly basic yet innovative. I admit it. I'm an over thinker. If there is a hard way to do something; I'll find it.
A good MD, PhD friend of mine told me, "You're not out to change the world. Graduate and then change the world," meaning stop over thinking my dissertation!!! I know that's true just as I know I don't want to waste two years on a project that doesn't mean anything to me. Therein lies the question - To feel or not to feel? Do I select a project I am passionate about or pick the easy A dissertation? Oh, who are we kidding? Anyone that knows me, knows I am ambiguous about NOTHING! I do have my shades of gray, but my black and white are exuberant.
A good MD, PhD friend of mine told me, "You're not out to change the world. Graduate and then change the world," meaning stop over thinking my dissertation!!! I know that's true just as I know I don't want to waste two years on a project that doesn't mean anything to me. Therein lies the question - To feel or not to feel? Do I select a project I am passionate about or pick the easy A dissertation? Oh, who are we kidding? Anyone that knows me, knows I am ambiguous about NOTHING! I do have my shades of gray, but my black and white are exuberant.
Wednesday, May 2, 2012
Evolutionary Psychiatry: Alzheimer's Pathology and the Dementia-Free Kitava...
Evolutionary Psychiatry: Alzheimer's Pathology and the Dementia-Free Kitava...: Over the last two posts I explored the theory that hyperglycemia might be one of the predisposing factors for developing Alzheimer's demen...
Awesome blog post by an evolutionary psychiatrist. Looks like I may take my practice in a new direction.
Awesome blog post by an evolutionary psychiatrist. Looks like I may take my practice in a new direction.
Saturday, April 21, 2012
Doctor Who
Pioneers, that's what we are, but then, when haven't nurses been at the forefront of innovation? The increasing complexity of the health care environment, the movement to doctoral entry for other health care professions like pharmacy and physical therapy, and the projected shortage of competent, qualified health care providers demands a terminal degree in nursing. For too long the pie-in-sky degree attainment for nursing was the Masters, the required degree for practice as an advanced practice nurse practitioner. Current health care needs demand a doctorally prepared nurse. Prior to this decade, terminal nursing degrees existed, the DN, doctorate of nursing and the PhD in nursing, but those are academically focused. The need for a practice doctorate exists. In 2006, the American Association of Colleges of Nursing (AACN) published The Essentials of Doctoral Education for Advanced Nursing Practice outlining the competencies required by practice doctoral programs. The AACN also called for the entry level nurse practitioner to by doctorally trained and this qualification be implemented U.S. wide by 2015. Read Me
Of course the backlash has been rough and steady. Many existing nurse pracs disagree with the suggested change citing discrepancies among pay and possible "second class citizenship". That is not a totally invalid argument. Ask any practicing certificate or associates of nursing (ASN) nurse how she feels working alongside BSNs and MSNs. We can all admit to a little degree-envy. The biggest backlash, however, originates from the physicians' medical associations. Many claim nurse practitioners want to replace medical doctors. Others think we'll all have to compete for a spot in the health care pool. Yes, health care resources are finite. Patients are not. Many specialties are sorely neglected such as primary care and OB. Primary care physicians refer to themselves as a "dying breed" yet worry publicly and voraciously against primary care nurse practitioners.
One of the heaviest hitters is the Kentucky Medical Association (KMA). They have a bright, inviting website encouraging patients to seek qualified health care and declares, "Not everyone called "doc" is a medical doctor." The site further warns against receiving potentially unsafe, unqualified care from chiropractors, optometrists, midwives, nurse practitioners, pharmacists, psychologists, and any health care provider without an MD or DO behind their name. Hmmm...where are the physician's assistants? KMA Nastiness
Sadly, Kentucky is not alone. In most states, medical associations have successfully lobbied to limit the scope of practice of nurse practitioners. Most require agreements with collaborative physicians. Should your collaborator move, quit his practice, die, or lose her license, the NP is without a job immediately. Even though NPs are reimbursed at a lower rate than physicians (Medicare pays 85% of the doc's rate), many medical doctors continue to view NPs as a threat to their livelihood. The threat intensified with the advent of the DNP. PhDs in nursing are doctors. PhDs in anything are doctors! But the doctor of nursing practice conveyed upon nurse practitioner who look like medical doctors, diagnose like medical doctors, prescribe like medical doctors, the title "doctor". Suddenly became a hideous threat to the health care of our nation destined to fool unsuspecting patients into believing we are medical doctors.
Therein lies the most offensive part of the whole debate. If I wanted to be a medical doctor, I would have gone to medical school. I wanted to be a nurse. Nursing was an informed choice for me. With nursing, I can focus on the patient and how the disease, illness, or injury process affects the patient, his or her family, and community. Nursing is a holistic practice. We are rich with our own theories and concepts, evidenced-based practices and interventions. I can't even blame the era into which I was born. The 70s were ripe for feminism and equality. If I wanted to be a medical doctor, I would have. Instead, I wanted to be a nurse. And GI Joe....Wonder Woman....a television reporter....a hand model for Palmolive (yeah, I was a weird kid)...a writer...and a mom. I've accomplished five of those things. I still hold out hope Palmolive will call me yet.
Of course the backlash has been rough and steady. Many existing nurse pracs disagree with the suggested change citing discrepancies among pay and possible "second class citizenship". That is not a totally invalid argument. Ask any practicing certificate or associates of nursing (ASN) nurse how she feels working alongside BSNs and MSNs. We can all admit to a little degree-envy. The biggest backlash, however, originates from the physicians' medical associations. Many claim nurse practitioners want to replace medical doctors. Others think we'll all have to compete for a spot in the health care pool. Yes, health care resources are finite. Patients are not. Many specialties are sorely neglected such as primary care and OB. Primary care physicians refer to themselves as a "dying breed" yet worry publicly and voraciously against primary care nurse practitioners.
One of the heaviest hitters is the Kentucky Medical Association (KMA). They have a bright, inviting website encouraging patients to seek qualified health care and declares, "Not everyone called "doc" is a medical doctor." The site further warns against receiving potentially unsafe, unqualified care from chiropractors, optometrists, midwives, nurse practitioners, pharmacists, psychologists, and any health care provider without an MD or DO behind their name. Hmmm...where are the physician's assistants? KMA Nastiness
Sadly, Kentucky is not alone. In most states, medical associations have successfully lobbied to limit the scope of practice of nurse practitioners. Most require agreements with collaborative physicians. Should your collaborator move, quit his practice, die, or lose her license, the NP is without a job immediately. Even though NPs are reimbursed at a lower rate than physicians (Medicare pays 85% of the doc's rate), many medical doctors continue to view NPs as a threat to their livelihood. The threat intensified with the advent of the DNP. PhDs in nursing are doctors. PhDs in anything are doctors! But the doctor of nursing practice conveyed upon nurse practitioner who look like medical doctors, diagnose like medical doctors, prescribe like medical doctors, the title "doctor". Suddenly became a hideous threat to the health care of our nation destined to fool unsuspecting patients into believing we are medical doctors.
Therein lies the most offensive part of the whole debate. If I wanted to be a medical doctor, I would have gone to medical school. I wanted to be a nurse. Nursing was an informed choice for me. With nursing, I can focus on the patient and how the disease, illness, or injury process affects the patient, his or her family, and community. Nursing is a holistic practice. We are rich with our own theories and concepts, evidenced-based practices and interventions. I can't even blame the era into which I was born. The 70s were ripe for feminism and equality. If I wanted to be a medical doctor, I would have. Instead, I wanted to be a nurse. And GI Joe....Wonder Woman....a television reporter....a hand model for Palmolive (yeah, I was a weird kid)...a writer...and a mom. I've accomplished five of those things. I still hold out hope Palmolive will call me yet.
Tuesday, April 10, 2012
My Personal Nursing Philosophy
Two weeks ago, we were assigned a paper describing our personal nursing philosophies. The paper was limited to three to five pages and the final draft I turned in was short some of the better 'stuff'. I'm posting my philosophy here for other nursing students to find when they frantically Google "personal nursing philosophy" for their own assignments. It's not a masterpiece, but it is personal and meaningful to me. So here it is....
Bartholomew, K. (2008). Why nurses eat their young: A look at nurse-to-nurse hostility and why it occurs. Retrieved from http://www.realityrn.com/more-articles/nurse-relationships/why-nurses-eat-their-young%e2%80%a6/542/
Mariner, W. (1995). Rationing health care and the need for credible scarcity: why Americans can’t say no. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615628/
My Personal Nursing Philosophy
Brandman University
March 2012
Embrace the Past...Engage the Present...Envision the Future
Nursing is a practice discipline with multiple, interwoven theories sharing similar concepts, but lacking a singular defining nursing philosophy. Individual nurses develop personal philosophies to govern their own practices creating a philosophy of nursing rather than defining philosophy of nursing. Nursing philosophy can be understood as “an attitude towards life and reality that evolves from each nurses’ beliefs formed in three elements: conceptual analysis, assessment of argument, and concern with metaphysical and epistemological questions" (Edwards, 1996, p. 2).
The first step in identifying a personal nursing philosophy is defining nursing. Nursing as defined by the American Nurses Association is the “protection, promotion, and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations” (ANA, 2012). Understanding what nursing means to the individual nurse is a deeply personal journey. Defining nursing is relatively simple; embodying nursing is difficult.
Building upon the definition of nursing, the nurse explores her personal philosophy through recognition and refinement of her personal belief system, ethics, career goals, experiences, the experiences of other nurses, and nursing theories. The personal nursing philosophy becomes an articulation of these. The task of gathering theories used in practice, concepts of evidenced based practices, examples of instructors and respected peers, and personal beliefs to organize and record for others to read is daunting. I have identified the personal nursing philosophy that most closely aligns with my own to start. Virginia Henderson stated, “Nursing is rooted from the needs of humanity and is founded on the idea of service. The nurse is temporarily the consciousness of the unconscious, the love of life for the suicidal, the leg of the amputee, the eyes of the newly blind, a means of locomotion for the infant, knowledge and confidence for the mother, and the mouthpiece for those to weak or withdrawn to speak” (Roberts, 2012, p. 1). In this philosophy, the nurse is essentially an advocate for all patients, significant others, and the community. Advocacy is a main element of my personal nursing philosophy. In addition to advocacy, my philosophy addresses five other concepts: knowledge, equality, economy, continuity, and unity.
Advocacy – Patient advocacy is any activity that benefits the patient from competent, compassionate, bedside care to actively legislating for improvements in health care systems or processes for patients. “Nurses act to change those aspects of social structures that detract from health and well being” (ANA, 2010, p. 2). Patient advocacy is not merely the defense of patient rights and the safeguarding of patient privacy. Advocacy stems from a philosophy in which nursing practice is the holistic sustainment of the patient, ill or well, to promote his or her total well-being as understood by that individual. Advocacy may take the form of finding reliable, timely information, financial aid, or appropriate referrals for patients. Advocacy includes protecting the patient from “incompetent, unethical, illegal, or impaired practice by any member of the health care team…or any action on the part of others that places the rights or best interest of the patient in jeopardy (ANA, 2010, p. 7). The nurse recognizes an ill and vulnerable patient cannot be a strong, self-advocate, is unfamiliar with the health care system, and unaware of his or her individual patient rights. Nursing advocacy is a continual process in the implementation of nursing care. Nursing advocacy requires critical thinking skills, appropriate assessment, and intervention, providing culturally sensitive information and education to the patient and significant others, ensuring equal access to care, and supporting the patient and family’s decision for care. At times, the nurse must have courage to be a voice for her patient within the interdisciplinary team maintain collegiality, but ensuring the responsibility to maintain the nurse-patient relationship above all else. In the past, advocacy consisted of ensuring the patient complied with the doctor’s orders. Today, nursing advocacy represents a new paradigm addressing issues not formally considered nursing concerns. I will listen to my patient and have the courage to advocate on his or her behalf.
Knowledge - The responsible, ethical nurse informs her patients about the issues, seeks new knowledge and best practices, and maintains credentials. Not only should the nurse actively seek new information, she should be excited to educate her colleagues and patients, offer solutions to identified problems, and to effect changes in practice to deliver better patient outcomes. The advancement of nursing practice relies on every nurse as an educator. I continually will seek knowledge whether formally or informally and share appropriate information with patients and colleagues.
Equality – Patients are human beings. Black patients, Jewish patients, and female patients are not inferior human beings by any genetic measure; only cultural biases place human beings on a scale of worth. As Virginia Henderson admonished in 1955 to “get inside the skin” of patients, I continue to do so today. In my practice, kind and quality of care is not determined by age, color, creed, religion, rank, or status. Triage determines treatment and urgency.
Economy – Resources are limited; wants and needs are unlimited. This is the economic law of scarcity. As it applies to health care, improved medical technology, the belief of entitlement to care, and the coming change in the age structure of the population has increased the demands for health care (Mariner, 1995). Health care resources are finite, a belief the American populace cannot accept. Many believe all individuals are morally entitled to unlimited longevity and good health at any cost and believe denials of services by providers or insurers are unfair or arbitrary. Unless a shortage occurs and rations are necessary as was the case with H1N1 vaccine, Americans do not appear likely to accept the fact of scarcity of health care resources. I will not order or cause to be ordered unnecessary tests or treatments and if uncertain will seek the opinions of collaborating health care providers to protect valuable health care resources.
Continuity – Continuity of care is “the process by which the patient” and provider “are cooperatively involved in ongoing health care management toward the goal of high quality, cost effective medical care” (AAFP, 1983, p. 1). Continuity of care is more than maintaining adequate nursing documentation and records. Continuity is more than collaboration with interdisciplinary professionals such as doctors, therapists, dieticians, social workers, chaplains, and case managers. Continuity of care involves ensuring the patient is able; mentally and physically to follow through with referrals and to provide self care upon release. Assessment of the patient’s needs and abilities allows the nurse to determine what interventions the patient needs to be successful. In my practice, this has meant signing up a chronically ill patient up for a free, guaranteed ride home program from work to calling a patient to remind him to schedule an appointment with the cardiologist. Not as an enabler, I will empower the patient to make necessary changes and seek follow-up care to grow and be well.
Unity – Nursing is not for the weak stomached or weak spirited. Nurses are strong, dedicated, flexible, and empathetic. Somewhere, perhaps to gloss over the bodily fluids and pounds of flesh, the idea of nurses as angels of mercy was popularized making nurses ethereal, otherworldly creatures. Satisfied patients hold to the nurse as angel ideal while nursing students may describe some seasoned nurses as openly hostile. Sadly, nurses eat their young is a common phrase used to characterize this relationship. “A major issue in nursing is our failure to achieve unity…From a feminist perspective; the real issue involves divisiveness and fragmentation that sustains oppressive relations in an industrialized, patriarchal medical system. Remaining divided from one another serves the interests of the dominant group. Rather than benefiting us, fragmentation in nursing serves to confuse us, to keep our minds and hearts focused on the dominant system for solutions that never materialize” (Edwards, 1996, p. 1).
First as a Registered Nurse, now as a doctoral student, and eventually as an Advanced Practice Nurse, I will strive to incorporate the concepts important to me: knowledge, equality, economy, continuity, and unity, in my life and in my practice and always remember:
The Army Nursing Creed
“My patients depend on me and trust me to provide compassionate and proficient care always. I nurture the most helpless and vulnerable and offer courage and hope to those in despair. It is a privilege to care for each of these individuals and I will always strive to be attentive and respectful of their needs and honor their uniquely divine human spirit.”
- LTC Leigh McGraw 2012
References
American Academy of Family Physicians. (2010). Definition of continuity of care. Retrieved from http://www.aafp.org/online/en/home/policy/policies/c/continuityofcaredefinition.html
American Nursing Association (2001). Code of ethics. Retrieved from http://www.nursingworld.org/MainMenuCategories/EthicsStandards/CodeofEthicsforNurses/Code-of-Ethics.pdf
American Nursing Association. (2012). What is nursing? Retrieved from http://nursingworld.org/EspeciallyForYou/StudentNurses/WhatisNursing.aspx
Bartholomew, K. (2008). Why nurses eat their young: A look at nurse-to-nurse hostility and why it occurs. Retrieved from http://www.realityrn.com/more-articles/nurse-relationships/why-nurses-eat-their-young%e2%80%a6/542/
Edwards, S. (1996). What is philosophy of nursing? Retrieved from http://www.ruth-s-coleman-college-of-nursing.com/What_is_a_philosophy_Edwards_Art.pdf
.
Jarrin, O. (2007). An integral philosophy and definition of nursing. Retrieved from http://digitalcommons.uconn.edu/cgi/viewcontent.cgi?article=1049&context=son_articles&sei-redir=1&referer=http%3A%2F%2Fsearch.yahoo.com%2Fsearch%3B_ylt%3DA0PDoX29vIRPZBEAEiuJzbkF%3Fp%3DJarrin%252C%2BO.%2B%25282007%2529.%2B%2BAn%2Bintegral%2Bphilosophy%2Band%2Bdefinition%2Bof%2Bnursing.#search=%22Jarrin%2C%20O.%20%282007%29.%20An%20integral%20philosophy%20definition%20nursing.%22 Mariner, W. (1995). Rationing health care and the need for credible scarcity: why Americans can’t say no. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1615628/
McGraw, L. (2012). Army nursing team creed. Retrieved from http://armynursecorps.amedd.army.mil/assets/home/NursingCreed.pdf
Roberts, K. (2012). Virginia Henderson: A contemporary nurse 1897-1996. Retrieved from http://www.contemporarynurse.com/archives/vol/5/issue/3/article/3027/virginia-henderson-a-contemporary-nurse-18971996Thursday, April 5, 2012
Foreign Nurses
"My philosophy in life is that any human being, however unpleasant, yields to the honest, caring hands of another. I believe this is the essence of nursing—to heal not only the ailing physical body, but also to mend bruised feelings and self-esteem."
Anyone who listens to the news, not just medical professionals, has heard of the nursing shortage in this country and the shortfall is expected to rise. To supplement the shortage, many organizations particulary long term care facilities recruit foreign nurses. Here in my area there are many Filipino, Caribbean, and African nurses to fill the gaps. I've heard some of the prejudices, but thankfully never encountered that kind of behavior at a facility where I've worked. The more I learn of the barriers nurse practitioners face "breaking in" to the primary practice world dominated by medical doctors, the more I understand what they must face.
Keep Your Clients; I Have Patients
“Caring is the essence of nursing practice.” -McKenna
The term client is reserved for those who purchase goods and services. While the insurance companies and lobbyists refer to health care as a commodity, medicine is a deeply personal service. Users of our services expose themselves physically, psychologically, emotionally, and spiritually. Providers of these goods and services are privy to intimate details. Only two other professions come to mind when I hear the term client: lawyers and escorts*. We share the same intimacy in seeing personal and private lives exposed, but I don’t care to call those whom I care for “clients”. Clients visit attorneys and escorts for services. When people seek medical care, they are looking for something more. Patients are seeking care. That is the fundamental difference between a client and a patient – caring. A competent lawyer may provide a quality service for his client and do so without caring. A nurse cannot provide health care with caring. The basis of many of our practice theories is grounded in caring: Nightingale, Watson, Kolcaba.
I have never sat and cried over a diagnosis with a client; but I have cried with a patient and helped him tell his wife. I have never held a client’s hand while she gave birth; but I was there to wipe the sweat of a laboring patient’s brow. I’ve never searched for hours for alternative therapies for a deeply religious client who refused modern medical care; but I did find a homeopathic treatment and spend half a day explaining it to a patient.
I’m sorry Nursing Community-at-Large; I will never have a client. I will always have patients.
Wednesday, April 4, 2012
Traumatic Brain Injury Twitter
Traumatic Brain Injury Clinical Resources in 140 Characters or Less
Clinicians, Check out the tools available for those treating TBI and co-occurring conditions! Pretty cool! I'm definitely downloading the mobile app. Enjoy!
Clinicians, Check out the tools available for those treating TBI and co-occurring conditions! Pretty cool! I'm definitely downloading the mobile app. Enjoy!
Friday, March 30, 2012
Baby, You Can Count On....?
I took the day off to attend school conferences and spend
time with my kids who had a short day.
Instead, I sit here vainly attempting to write one coherent sentence of
a three to five page paper due in less than 48 hours. Ironically, the paper will be an easy one to
write as I feel passionately about the subject, but I’m blocked from putting a
word on the page. The seconds I steal
for laptop time are punctuated with ten minutes of referee duty for broken toys
and broken feelings. For the past hour, every
single minute has been punctuated with screams or crying, mine and theirs. Once again, I feel the dim nausea of doubt in
the pit of my stomach. I have no
business doing this. What was I
thinking? Working full time, soldiering
part time, and attempting school full time.
When is successful parenting time?
Many months ago I gave up vacuuming and regular bedding changes. It’s like District 12 here but with plenty of
food and no electrical fence. There’s
not much left to surrender. I power
grocery shop in 15 minutes or less. I
gave up exercising, dating, sleeping, washing my hair – all in an effort to
squeeze more time into my day. I don’t know
what more to give. In the time I furiously wrote down my feelings
– 3 crying jags. “Ha, Ha,” says Count Von Count. “That’s one crying child. Two crying children. Three, a crying mom.”
Maybe sometimes Sesame Street is all you've got.
Tuesday, March 27, 2012
Simply Week 5
Another example that change is a "good thing"! (Thanks Levin & Martha Stewart)
This week I am working on my personal philosophy of nursing. I’ve been working on it for two weeks, but I could wax philosophical and say I’ve been drafting my own personal philosophy of nursing my entire nursing career. On a subconscious level, all nurses are developing their own nursing philosophies. Nursing philosophies, a compilation of personal beliefs, what we have evidenced in our own practices, sometimes the experiences of other nurses, and the nursing theories taught in school are fluid. Nursing philosophies change as we expand our practices and grow richer, more complex.
I believe it is important to write down your personal philosophy. If you are a continual student like me, draft a personal nursing philosophy the beginning of every new degree. Evaluate it periodically and make changes PRN. I’m looking forward to grounding my practice and reminding myself of my personal, core nursing values through this week’s exercise.
Monday, March 19, 2012
One Team, One Fight
"You will either step forward into growth or you will step backward into safety."
- Abraham Maslow
One Team, One Fight - Four words issued by our COL guaranteed to halt any disagreements among our team members. We are from different backgrounds, opinions, and viewpoints, but we're on the same team fighting the same battle. Like soldiers, nurses struggling to gain acknowledgement and respect from their interdisciplinary peers are one team with one fight yet we waste precious time and energy bickering among ourselves. With the precision reserved for describing decubitus ulcers, nurses differentiate among their own: ASN vs. BSN, MSN vs. DNP, DNP vs. DON, floor vs. clinic, clinic vs. academic, ICU vs. ED..... The ways to categorize are many and the separating of ranks is the reason MDs are able to pass legislature restricting DNP practice.
I was reminded of this simple truth this weekend during a group project exercise. Conflicting personalities and opinions hindered the group's efforts necessitating multiple phone calls, texts, and emails. During one exchange, a group member referred to me as a "psych nurse". I corrected him and asked why he thought I was in psych. He assumed I was a psych RN as I am pursuing the mental health nurse practitioner track and had an unspoken attitude regarding non-psych nurses specializing in mental health. Many teams, many fights. Psych nurses have the extensive background and experience to be mental health providers. Tactfully, (brownie points for the former Brownie!) I let that go.
I have yet to form an opinion whether having a strong background in psych makes a better mental health provider. There are pros and cons with this argument. A psych nurse works closely with the future patient population but in the scope of nursing practice, not advanced nursing practice. However, I firmly believe all patients are psych patients. The type of care received depends on the nurse. Does she treat only the physical symptoms or does she acknowledge and ameliorate the emotional ones? Does he pursue comments made and follow up with a referral to behavioral health when appropriate? The young woman newly diagnosed with breast cancer, in addition to physical diagnoses, may have inadequate coping mechanisms, fear, acute anxiety r/t her new diagnosis, and risk for situational low self esteem. The employee seen for transient elevated blood pressure c/o stressful commutes and long work hours. He may suffer from anxiety, ineffective coping mechanisms AEB elevated BP, and a disturbed sleeping pattern. The military wife at her newborn's two month check up is not the patient, but she has acute fatigue, impaired social interaction, loneliness, fear, anxiety and parenting role conflict r/t the prolonged absence of her deployed spouse and treatment of the baby involves emotional care of the parent.
Show me a patient and I'll show you a mental health referral. No, I'm not being flippant and certainly not lumping all patients together [patient individuality is huge in my PPN (personal philosophy of nursing)]. Being human means being subject to the human condition. None of us are immune to the very human state of human emotions, wants, needs, and desires. Maslow told me so. Emotions unexpressed, wants and needs unfulfilled lead to mental distress. No one has everything he desires; no one is exempt from mental or behavioral health issues. Every patient is a psych patient, even you & me.
Wednesday, March 14, 2012
NCP, the Un-MD
Smiling because she hasn't encounterd bullies like Angie in 7th grade....
or that horrible LT in BOLC
or that horrible LT in BOLC
I never took kindly to bullies. The baby in a family of all girls, I grew up clueless to the ways of the bully. My wake-up call happened Kindergarten, Fall of '77. Having waited patiently for my turn at the drinking fountain because waiting patiently is something all good, little girls did, I was shocked when leaning down for a drink, the wild child of the class shoved my face in the fountain. I didn't mind getting my ponytails and sporty. yarn ribbons wet nearly as much as I minded the trail of blood snaking down my nose from the cut on my forehead left by the faucet. I was shocked. I was speechless. I was a vibrating mass of wet, angry indignance. What manner of barbarism was this?! Sure, my older sister tortured me when my mom wasn't looking, but that was different. That was sibling-on-sibling tough love. This attack by a total stranger was something completely foreign and I was pretty sure my sister wouldn't have drawn blood; she was too smart to leave marks.
Sadly, this was my first, but not last encounter with a bully. There was "Keri" in 4th grade who refused to let her group of friends use my name, "Carrie" because it was her's. And Angela Whaley. There's a special place in one of Dante's circles reserved for Angie, a rather large child with an unfortunate last name.
Bullies are everywhere. They are driving next to you at rush hour and in line behind you at the grocery store. If you want to observe them in their natural habitat, spend quality time watching a line for one of the popular rides at Disney World. In my experience, bullies share common traits: insecurity, inability to accept change, a wee bit of narcissim, and low self esteem. They're almost to be pitied, if only they weren't so mean!
This week, our class has been reading about bullies in health care. Health care, what patients seek during times of distress, illness, or injury. Hospitals and clinics are places to be viewed as safe havens and instead, for some practitioners, they are the site of acts of covert and overt aggression and belittlement.
I don't wish to give the impression that nurse practitioners are chronic complainers or incapable of defending themselves from their detractors. Any good NP knows her most useful skill is the ability to coordinate care across multiple organizations with multiple disciplines. What we are discussing is the accepted belief of the inferiority of nurse practitioners. Nurse practitioners are viewed as somehow less-than. To prove the point, I encourage the reader to google the simple phrase NP vs MD and read a few of the 33,330,000 results. The most venomous of the results are found on "doctor blogs". Below I've posted the link to an article a classmate posted during our discussions.
If you are confused by the NP vs MD debate, I encourage you to talk to an NP or DNP student. We're more than happy to talk about our practice!
http://takingnote.tcf.org/2010/04/the-battle-over-letting-nurse-practitioners-provide-primary-care-.html
Wednesday, March 7, 2012
Hx of This Student
This blog fulfills a requirement of my current course, Transitions in Practice: The Advanced Practice Nurse as DNP. The course calls for a "reflective journal" to be completed at least once a week throughout NURU601. This is my second course in Brandman University’s BSN to DNP program and I continue wrap my head around the concept of Carrie the Doctor. It's Happening!
Many roads lead to an RN. Mine started with an ASN from Keiser University (Shout out to Keiser Melbourne and all my nursing school friends for life - Anna, Stacy, Lisa, Kim M., Deanne, Kim, J.R....!) For many nurses, that first step is the initial hazing, a comparative shut-up-and-drive-or-get-out-of-the-fast-lane style of nursing instruction. We entered with various backgrounds and skill levels and left competent, qualified nurses. My first job as a GN was in the ER so complete was my training. (I've since mentally blocked my Intro to Nursing instructor's name just so you know. She was one scary combination of Jean Watson-sy theory and Attila the Hun.)
From the initial ASN, I plowed my way through the obligatory BSN. I chose University of Phoenix online for the support provided to the military and for the flexibility afforded to a busy, working mom. If asked my opinion and I rarely am, the ASN is a practice focused degree while the BSN is a management focused degree. Everything I know (to this point), I learned in ASN school. (An aside – this is why you need your BSN, better patient outcomes. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce )
So you've completed your BSN, what's next? Okay, after going to Disney World (literally, took the kids because we had a house near Orlando); I looked at my practice and wondered where I was headed. I had graduated with an ASN and hit the ER like a tornado later fizzling out with a 300+ pediatric caseload in the Department of Health. Moving from Florida had many disadvantages. Primarily, I moved FROM Florida. I had to wait a year, enlist help from my Congressman, and call the Board of Nursing daily to obtain my MD license. Awesome. During a recession, that and a can of Coke bought me a $28 dollar an hour job in the heart of the inner city handing out condoms to high schoolers and dodging flying metal detectors. Sometime ask me the antidote to pepper spray. I now know.
Eventually I found my way into a job with a government agency (that I love) with people (that I love), but there's another group of people I love just as much and they are hurting. In 2009, I took my fancy, new nursing degree and traded it in for a pair of ACUs and a lifelong (seemingly) commitment. AHA Moment! She knows what she wants to do with her life. The best way for me to help my fellow soldiers is through mental health care. There is a shortage of mental health providers. I am currently pursuing a degree in Family Mental Health. My capstone project involves PTSD (more to come on that!)
Now you know the who-what-where-why, I’m free to discuss what I’ve learned. Our introductory class was the first time in my nursing education and nursing career that nursing theory made sense. Not only did theory make sense, I’m using it in my practice! There are three theories I’m incorporating into my advanced nursing practice: Maslow’s Hierarchy of Needs, Kolcaba’s Comfort Theory, and Roy’s Adaptation Theory. Best Parts??? I can intellectually defend my choices AND I care about them. That’s a long way from the nurse who made fun of “sacred space” and “singing bowls”. The three I have selected genuinely benefit the patient base I’ve chosen to target. Theory Rocks!
The current class explores the history of doctorally prepared advanced practice nurses, regulatory issues, conceptions and misconceptions, etc… all issues that affect DNPs. Apparently, there are quite a few physicians bothered by our use of the term “Doctor”. I think they prefer if we enter the examination room and introduce ourselves, “Hi, I’m Carrie. I’ll be your server today.” There’s even a list of states in which I am barred from calling myself a doctor even though I’ll have earned a doctorate of practice. Honestly, if we just pooled our monies and bought the loudest protestors Porsches would that ameliorate the insecurities? No one is usurping their doctorieness. Calling doctorally prepared nurses, pharmacists, or psychologists “Doctor” does not detract from their authority or achievements. I have yet to find a valid argument for their fear of the Nurse-Doctor. I’m not scary; I'm geeky smart and tell funny stories. I’m the least threatening person you know. Until you tell me I can’t have something and then I’m simply determined. Dr. Nurse. Yes, that sounds just right.
Many roads lead to an RN. Mine started with an ASN from Keiser University (Shout out to Keiser Melbourne and all my nursing school friends for life - Anna, Stacy, Lisa, Kim M., Deanne, Kim, J.R....!) For many nurses, that first step is the initial hazing, a comparative shut-up-and-drive-or-get-out-of-the-fast-lane style of nursing instruction. We entered with various backgrounds and skill levels and left competent, qualified nurses. My first job as a GN was in the ER so complete was my training. (I've since mentally blocked my Intro to Nursing instructor's name just so you know. She was one scary combination of Jean Watson-sy theory and Attila the Hun.)
From the initial ASN, I plowed my way through the obligatory BSN. I chose University of Phoenix online for the support provided to the military and for the flexibility afforded to a busy, working mom. If asked my opinion and I rarely am, the ASN is a practice focused degree while the BSN is a management focused degree. Everything I know (to this point), I learned in ASN school. (An aside – this is why you need your BSN, better patient outcomes. http://www.aacn.nche.edu/media-relations/fact-sheets/nursing-workforce )
So you've completed your BSN, what's next? Okay, after going to Disney World (literally, took the kids because we had a house near Orlando); I looked at my practice and wondered where I was headed. I had graduated with an ASN and hit the ER like a tornado later fizzling out with a 300+ pediatric caseload in the Department of Health. Moving from Florida had many disadvantages. Primarily, I moved FROM Florida. I had to wait a year, enlist help from my Congressman, and call the Board of Nursing daily to obtain my MD license. Awesome. During a recession, that and a can of Coke bought me a $28 dollar an hour job in the heart of the inner city handing out condoms to high schoolers and dodging flying metal detectors. Sometime ask me the antidote to pepper spray. I now know.
Eventually I found my way into a job with a government agency (that I love) with people (that I love), but there's another group of people I love just as much and they are hurting. In 2009, I took my fancy, new nursing degree and traded it in for a pair of ACUs and a lifelong (seemingly) commitment. AHA Moment! She knows what she wants to do with her life. The best way for me to help my fellow soldiers is through mental health care. There is a shortage of mental health providers. I am currently pursuing a degree in Family Mental Health. My capstone project involves PTSD (more to come on that!)
Now you know the who-what-where-why, I’m free to discuss what I’ve learned. Our introductory class was the first time in my nursing education and nursing career that nursing theory made sense. Not only did theory make sense, I’m using it in my practice! There are three theories I’m incorporating into my advanced nursing practice: Maslow’s Hierarchy of Needs, Kolcaba’s Comfort Theory, and Roy’s Adaptation Theory. Best Parts??? I can intellectually defend my choices AND I care about them. That’s a long way from the nurse who made fun of “sacred space” and “singing bowls”. The three I have selected genuinely benefit the patient base I’ve chosen to target. Theory Rocks!
The current class explores the history of doctorally prepared advanced practice nurses, regulatory issues, conceptions and misconceptions, etc… all issues that affect DNPs. Apparently, there are quite a few physicians bothered by our use of the term “Doctor”. I think they prefer if we enter the examination room and introduce ourselves, “Hi, I’m Carrie. I’ll be your server today.” There’s even a list of states in which I am barred from calling myself a doctor even though I’ll have earned a doctorate of practice. Honestly, if we just pooled our monies and bought the loudest protestors Porsches would that ameliorate the insecurities? No one is usurping their doctorieness. Calling doctorally prepared nurses, pharmacists, or psychologists “Doctor” does not detract from their authority or achievements. I have yet to find a valid argument for their fear of the Nurse-Doctor. I’m not scary; I'm geeky smart and tell funny stories. I’m the least threatening person you know. Until you tell me I can’t have something and then I’m simply determined. Dr. Nurse. Yes, that sounds just right.
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