Simply Week 5

Another example that change is a "good thing"! (Thanks Levin & Martha Stewart)

Week 5 already!  This class has flown by.  Once again, I'm shocked at how much I am learning and equally shocked how delighted I am with the knowledge.  Pursuit of the ASN was difficult and demanding, but everything was new, bloody, and if I was lucky, disgustingly fascinating.  In contrast, the BSN degree was more administrative than clinical.  The BSN prepares the RN for management and leadership roles, much needed education and experience in nursing, but so vanilla.  Every day, I relish my choice and opportunity to attend grad school, to chase that terminal degree.  Unlike the BSN where the majority of the learning occurs in the classroom, the DNP forces the nurse learn.  A nurse will get from this degree only what she puts in, much like an Easy Bake Oven.  Put in a mud pie, no magic light bulb is going to turn dirt into chocolate.  Your instructors can't force the knowledge and enlightenment on you, but they will show you the path.  (BTW, they make EBO in purple floral now!  And no light bulb!  I'm indignant for the 70's era kids that endured the Pepto-pink, hand searing model.)

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. 

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.

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.