So when did nursing get to be a job where 90% of what you do everyday consists of filling out 20 different forms documenting the care you are supposed to provide? Of course that is if you have time after all that writing. Why is it that nursing is not nursing anymore? Why can’t we CARE for patients instead of just checking off checkboxes that say what we would do if we had time to get into our patients’ rooms? I understand documenting to a certain extent….but is it really necessary for us to say three different ways on three different sheets that yes  we did in fact brush our patients’ teeth that day? And why do we have to justify why and how we gave pain medication on numerous forms? As a nurse are we not capable of assessing a patient and determining what needs to be done? Why is the medication record not enough anymore?

There are so many more important skills a nurse has that could be put to use rather than spending most of the their day writing on useless papers that are put to them by people in offices far removed from patient care. These people do not understand what nursing consists of. I feel like a kindergartner sometimes as I make sure to fill in every box on my flowsheet…..leave one undone and you just might find yourself in timeout…

Anyway, just a few thoughts on the new direction of healthcare…where nurses work from the desk and only care for patients once all i’s have been dotted and every last t crossed! Then if your patient wishes to have a massive MI or bleed out from a ruptured ulcer….well you can see if you have time to provide nursing care.

Ok, you are catching me in a bad mood today! All of this healthcare reform talk has got my feathers puffed up like a crazy rooster about to attack (except for the fact that roosters are male and I’m not but, you get the point). All I keep hearing over and over is how nobody can afford insurance and how the government is going to cut costs out of Medicare and make healthcare affordable for all.

What I don’t get is why in the pre-natal Medicaid clinic in the hospital, at least 60% or more of the patients I see have their nails done, pedicures and carry Iphones or Blackberrys. What happened to the good ol’ pay as you go phone, they don’t require you to carry a media package that costs $115.00 a month. Let’s not forget the expensive purses and jewelry that is usually sported and the kids that are dressed like they stepped off the cover of a Dillards magazine.

What about the emergency room loaded with patients that have NO insurance yet, fit the same profile as far as accessories. They don’t want to pay $90 to see a Dr. for an ear infection that they have had over a week and decide it is an emergency, so they are seen, sent a bill for about $1,000.00 and never pay it. What about the patients that do have Medicaid yet come to the emergency room for every little cough, bump or scratch. Some prefer to ride the ambulance because they think it will get them seen faster for their sprained ankle. Good tax dollars at work there!

It infuriates me to no avail that my tax dollars are spent in this way! NO ONE in this country is denied medical treatment if they do not have insurance in an emergency room. If you have been in a car wreck and need surgery yet, you are uninsured; you are still given the same stat treatment. You get your surgery, you are still taken care of in the intensive care unit, given whatever medications, equipment and therapy you may need.

I fully admit there are those that truly need Medicaid; I have a family member that is one of them. It’s the abuse of the system that drives me insane. One day, just out of curiosity, I had a well dressed pt. come in with her medicaid card. I just happened to step out back as she was leaving…. in her brand new 7series BMW.

Why do people expect physicians to work for free? Do people not understand that they have to pay for their office, their nurses, their staff? What about the $350,000.00 loans they are trying to pay back from going to school an extra 12 years. We have the best physicians in the world in this country yet the government keeps cutting reimbursement.

If you owned a restaurant and the meal I (the government insured) ordered costs you 15 dollars to make but, the max I pay you is 12 dollars…uh I’m no mathematician but I think that would constitute a FAIL! So in effort to make up for the 3 dollar loss every time you fed a patient like me, you have to charge the (private insurance company) 22 dollars to make up the difference. So in effort to cover their overhead and rack up their profits they up the insured’s diners rates.

It’s all a mess, the fraud, the abuse, it’s sickening. The private industry is a wreck, they keep hiking rates because of this cycle. It’s crazy the profit they turn! It to makes me want to vomit. Bring in good ol capitalism, what this country was founded on! Let them truly compete against one another to bring down costs. Instead they have created monopolies that dictate what the physicians can do and how they can treat their patients because they literally own the states. Healthcare reform is a must but, socializing medicine will put us in the same boat as so many others. I heard a patient bitching the other day in the waiting room because they had to wait two hours to see the Dr. , I was thinking to myself, just wait to see if Obamacare passes, you will be waiting two and a half weeks.

I’m by no means a Harvard grad or carry a masters of any sort but, I do have common sense, a huge heart and love my country. If someone is hungry I will feed them, if someone is thirsty I will give them a drink. The American population as a whole is full of wonderful, charitable human beings. Look out how we donated to Haiti. I’m not talking about the government but, the personal donations of millions of caring, selfless, loving Americans.

I am going to stop this rant now because I could go on for HOURS! Just had to get that little bit off my chest, my feathers seem to have de-poofed a bit. Guess we will just have to see what happens.

My husband brought up an interesting point…(I know, what a crazy way to start this post!) Anyway, he was asking what will make us happy? When will we finally be happy? Well, I thought we were kind of happy already….but I got his meaning. We are both so busy trying to get to the next thing…whether that is school, work or something we want to buy. What will finally be enough? These are pretty tough questions. I thought about it a while and I think I don’t know what will eventually make me “happy.” I am still in school, working on my master’s degree. I will have my Women’s Health Nurse Practitioner’s license when I graduate in December, but I have already been thinking about what is next. I would like to be a Certified Nurse Midwife as well. This will mean more school and time commitments. Will I then be happy? Or will I want to get my doctorate? When can I stop and enjoy the life that my family is living around me? These questions really made me think.

I think that just because I still seek out challenges does not mean that I am ignoring what is happening around me. I want to give my children the best life I can….though this means that I am not always home when I would like to be. I hope that by going to school and having more autonomy in my profession that I will eventually be making my own schedule and can spend as much time with them as I want. I know children don’t always understand the sacrifices we make in hopes of a better future for them…all they know is that you are not there watching them when they look up at gymnastics practice as they finally get that flip just right…

This post is more of a question to you, the readers, than it is a definitive statement.  My question is this: what is a nurse to do when there’s a conflict between her clinical suspicion and a doctor’s orders?

I vividly remember an incident that occurred on a surgical floor when I first started in practice.  A nurse I’d gotten to know (over shared cups of coffee while charting) was clearly distressed about something.  When I asked her what was wrong, she reluctantly relayed the following situation:

A patient had been admitted to the floor to a surgeon with a diagnosis of abdominal pain.  The work-up was still in progress and a GI consult had been obtained.  After two or three days, there was still no diagnosis, but the patient still complained of increasing pain.  It was Saturday in the early afternoon, the surgeon’s partner, who was covering for the weekend, had already rounded.  The patient was getting increasingly demanding for pain relief, so the nurse called the covering surgeon to tell him that she was concerned about the increasing pain and her feeling that the patient’s abdomen was more tender than it had been the day before.

The surgeon stated that the patient had “nothing wrong with them” and that they were just drug seeking, then declined further therapy.  The nurse called back a few hours later, again with a petition for more pain meds given the patient’s increasing complaints of pain.  The surgeon got angry and belligerent, again refusing more medications, again stating that there was nothing wrong with the patient.  The nurse disagreed, and so called the GI doctor to pass along her concerns and her dilemma with the surgeon’s refusal to address the patient’s symptoms.

The GI doctor assessed the patient, but felt that there was nothing he could do other than give more analgesics, which he did.  The next day the surgeon was absolutely livid- screamed at the nurse, screamed at the floor nursing director- stating that it was absolutely inappropriate for the nurse to have “gone behind his back” to call the GI doctor when the surgeon covering for the admitting doctor had already declared the patient “fine”.  He asked that the nurse be written up and a note placed in her personnel file.

On Monday, the patient ended up going for a diagnostic laparoscopy by the original surgeon when he returned to work.  I forget what was wrong with the patient, it was not life threatening, but there was some minor pathology found which accounted for the pain.

So back to my question: what is a nurse to do?  Yes, you can document your doubts and suspicions to cover yourself, you can state the doctors’ response to your queries, but what can you do if a doctor shuts you down and doesn’t address your concerns?  Are there usually policies or protocols to follow to allow for bypassing the doctor or at least getting a second opinion?  How does a nurse protect her patient in a situation when there is a perceived threat to their well being through indifference?

It seems like having a pre-ordained structure to address differences of opinion would relieve exactly the kind of antagonism, anger and suspicion that caused this observant professional to be disciplined just for trying to protect her patient.

I am the first person to admit that while I can cut into your chest and crossclamp your aorta within about 2 minutes, I cannot balance a checkbook.  I make a mean souffle, but my eyes cross whenever I try to enter even a month’s worth of expenditures into Quicken.  Since I plan on toddling into the nursing home in $800 Louboutin 5 inch heels, I had to admit my weaknesses and seek expert financial advice.

While my husband and I were still surgery residents, we first started visiting with a certified financial planner.  Now keep in mind that in our last year of training, our net worth was somewhere around negative $350,000 since our school loans/car payments/credit card debts far outweighed our meager assets which consisted of….. a lot of used scrubs and some drier lint.  To say I was skeptical about our need to see someone who might pee their pants looking at our bank statements….. you get the picture.

But it turns out that it was one of the best things we ever did.  They helped us set up accounts for important – future- life events such as a college fund (now funds with the addition of daughter #2), retirement planning, investment accounts and a debt paydown strategy which allowed us to eek away at the monster loans while still going out to dinner occasionally.  Now all of these accounts started out with only meager initial contributions, but those little seeds grew over time.  Granted, they got squashed like bugs on a windshield when the markets collapsed a year ago, but they’re now once again worth more than we’ve put in, which cushions us for the future.  And most financial planners charge little for initial consultations or offer them for free.

If I had stuck with my pitiful financial sense and my Scarlett O’Hara-esque sense of “tomorrow’s another day” then I’d likely be shuffling into SunnyShades Retirement on a pair of Payless bargain rack specials instead of plugged into some Jimmy Choos.  So let me please recommend seeking out a certified financial planner (the “certified” part is important – you don’t want somebody’s smelly aunt Franny who claims to be an expert, but got her “degree” from a Bazooka bubble gum wrapper) to help you set up a goal and devise strategies for getting there.  We chose a firm recommended to us by a friend with expertise in advising health care professionals because that was a good fit for us.

A good financial planner will fit your needs.  For those of you starting a new family, I recommend Vita Vie financial planning.  They specialize in helping young families plan their financial future.  I couldn’t say it any better than Kristin Harad, their founder, so check them out at their video link Certified financial planner.

Remember, it’s all about the shoes!

I got the biggest compliment of my life the other day. My little boy who is 10, was playing with his neighborhood friend who crashed his bike. In they come, neighbor kid with a bloody knee and a nice case of road rash. My little boy looked at his friend and smiled then said “My mom is a nurse, she can fix anything.”  I giggled, knowing good and well I wish I could fix anything. We got the injured knee all washed, cleaned and bandaged and out the door they flew only to take on the days challenges that were left.

My little boy was so sincere when he was talking to his friend. It really made me stop and think how wonderful children are and how they look up to us for so many things. It by no means had to do with the fact that I’m a nurse he feels that way, he also feels that way about his dad who is a laborer. It’s the fact that he looks up to us all for guidance and has every ounce of confidence we as parents and step parents can “fix anything”. His dad has taught him so many things, the man literally can fix anything.

Even though we are divorced we are fortunate to have put are children first. I’m by no means saying we haven’t had our knock down drag outs, but we did the best we could.   We are both now with other people so my crew of 2 kids turned into 4. His crew of 2 turned into 5. Our children are so lucky to have step parents that love them like their own. Now being the proud mom/step mom of four, the laundry load has certainly increased but, I love every minute of it!

I know this has nothing officially to do with being a nurse but, I just wanted to share with you the biggest compliment of my life. Sometimes it’s nice just to slow down, take a look around and truly appreciate what God has bestowed upon you.

Most of us have been in the situation where things happen beyond our control. Well….when a patient gets the bright idea to rip out some tube or line or other very important and most often not easily reinserted piece of medical equipment….who gets the blame most often? NURSES. Now, I really do not find this to be fair. While we are the ones that are responsible for those that we care for, we cannot be at the patient’s bedside at all times. We have meds to gather, physicians to round with, charting to do, and yes every now and then we have to use the restroom or eat. Though I can say that there have been days I have not entered the bathroom door at work and I was lucky to shove in a bite or two of whatever happened to be lying on the break room table for lunch. Most of us have more than one patient as well which makes it impossible to watch each one at all times.

Anyway I say all of this because we as nurses get blamed for crazy patients pulling out their chest tubes, central lines, endotracheal tubes, and yes even ventriculostomy drains….NO nurse wants to make that call to the neurosurgeon and tell him such news. I have seen nurses in tears over this. I realize that taking a patient back to the OR on a Sunday afternoon is not fun, but it truly isn’t always OUR fault that these things happen. Most often it is that the patient is not sedated enough (per your orders), has Houdini powers and managed to wiggle out of restraints, or had been perfectly with it until they started seeing the bugs on the ceiling and decided to rip out that chest tube to use as a weapon….It really wasn’t my fault….I’m just sayin…

(This is guest post by Sandra Stevens, a Career Blogger. For more information on Certified nursing assistant Training you can visit her blog over at http://cnatraininghelp.com)

Have you been thinking about a career as a nurse?  Are you looking into nursing schools for your new career or to attend upon graduating from high school?  If so, you might want to consider training to become and working as a certified nursing assistant first.  You might even have noticed that some nursing schools require applicants to have the CNA Certification.

A CNA certification does not take long to obtain.  In fact, you can find many courses that only run for 3 to 6 weeks.  During that time you will have classroom instruction, demonstrations and clinical lessons.  You will learn to perform a variety of nursing assistant skills.  The duties of a CNA depend on the setting in which they work.

Nursing assistants often help to teach patients range of motion exercises.  A nursing assistant will take and record vital signs.  A CNA will help patients with their activities of daily living.  Nursing assistants are often asked to help bathe and groom patients.  A nursing aide can help patients to use the toilet or to change patients who are unable to use the restroom on their own.

If you decide that you want to or need CNA Training, you will want to find a nursing assistant training course that is fully accredited to provide you with the credentials you need to take the examination for certification.  You must attend your classes and make good grades on your exams to prepare for the certification exam.

When it comes time to take the certification exam, you will need to answer a series of multiple choice questions.  After that portion of the test, you will need to demonstrate nursing assistant skills to the person administering the examination.  Once you pass the exam, you will be eligible for your certification.

Consider working as a CNA for a few months before applying to enter into a nursing school.  This will give you time to work as part of the nursing team.  You will learn to provide kind and compassionate care for patients.  The time you work as a CNA will prepare you to move on to a career in nursing with more responsibilities and challenges.

Working as a CNA, will give you time to practice your bedside manner.  You will learn a great deal about how to work with patients who are scared and sick.  Of course, you will also learn how to work with and interact with other members of the healthcare team.  This will benefit you when the time comes to do your clinical rounds when you do attend nursing school.

It will be easier for you to gain acceptance to a nursing school if you have your nursing assistant certification.  In fact, you will find some schools for which this will be a requirement.  You will even find that some of your coursework in nursing school as a result of what you already learned during your training and work as a certified nursing assistant.

When a girl gets married, it is expected that she will take her husband’s name. This may seem romantic to some, like ownership to others. The process though can be quite complicated. The level of complication has a lot to do with where you are in life at the time of your marriage. A young girl just out of high school maybe has to change her driver’s license and social security card and that is it. A woman that is older may have a bit more trouble.

My first marriage was right after high school and I had no problem changing my name…7 years later I was divorced and everything I had accomplished, college, nursing degree and license, certifications, maybe a few credit cards, numerous bills, my four children…well they were all attached to that name. I did not change my name back to my maiden name after divorce for that reason. Then 6 more years passed…and I was married again. I have been married about a month and a half…and still not everything is changed over to my new name. Every week I try to change my name with one of the various agencies that knows me. It has begun to seem like it will never end. I couldn’t change my name at work until my nursing license was changed….so I had to use my old name there, my new name on checks, my old name at school, and my new name somewhere else…it was confusing! Many times at work I signed a medication record with two different initials. I finally changed my name at work, but all my logins to the med pyxis and supply pyxis and computers all still use my old last name…yet another thing to change…

All the while, my new husband has no similar distress to worry about. His name is his name. Some women decide not to change their name with marriage and I think that is understandable, and some men are accepting of that. Though I do know of a woman that kept her ex husband’s name even after 20 years of marriage to someone else…I have already told my new husband that he cant have his name back! This is the last time I am changing my name….not just because I love him with all my heart and am so happy to be with him, but well….it is just too much trouble!

Are nursing unions really necessary? I am trying to look at this from all angles of medicine. The first point of view I am going to take is that of being a patient. I have been very fortunate in my times as a patient to be surrounded by amazing, educated and capable nurses. A good nurse is worth their weight in gold. Nurses are not only the number one patient advocates but, they are the eyes and ears of the physicians. Most of the nurses I have come across in the past 11 years are great but, there are those few that made me wonder how they kept their license but, they did lose their jobs. So, as a patient, does a union make it harder for hospitals/clinics/etc. to fire bad nurses? The reason I ask this is because I was married to a union guy. I have a ton of friends that are union members but, none of them medical. I hear them make fun of the companies they work for saying, “they can’t fire me, I’m union” that has always made my skin crawl! What the hell did they mean by that? The way I was raised if you were not productive, then you simply, got fired. Why would a company continue to pay a lack-luster employee? So as I was reading about the new national nurses union which empowers 154,000 nurses, are the risks the same for not being able to get rid of bad nurses?

Ok, angle number two is going to be that of a nurse. Let me just start by saying that, there are non-unionized nurses where I practice. The number one complaint I hear from my friends that work on the floor is the staffing ratio. Too many patients for too little nurses, this does nothing good for anyone involved. The nurse is overworked and is more prone to make an error. The patient is put at an increased risk from overworked staff; you sure don’t have to be a medical professional to know a small medical error may lead to a huge problem for the patient, sometimes death. A medical error by a nurse means trouble for the hospitals. After all, it’s the hospital that hired the nurse. The attending physicians are drug into this mess as well; after all it was their patient. So in my little simple mind correct me if I’m wrong here but, wouldn’t it just make more sense for a hospital to provide ample staff to ensure the safety of their patients? Would this not lead to an improvement for all? Fewer errors, less lawsuits, lower malpractice coverage and nurses that are doing what they were trained to do, take full care of their patients! Wouldn’t it make sense that if a nurse was caught using drugs that they stole from the hospital they would lose their license? Simple, if you are a dumbass and can’t do your job, or maybe you are late all the time putting immense stress on the staff covering your duties you uh…GET FIRED?

Third angle, MONEY! That being said, nurses from this area make approx 3 times more a year if they work agency to cover strikes. I know many nurses that went agency to work the strikes in California, they banked. But agency nurses that fill in during strikes would not make 3 times the money if, well, there were… no strikes. I know agency nurses that work in specialty areas that make more than the full time hospital employees, usually 1 ½ times-2 times more. Let’s take the operating room for example; it takes a minimum of six months to train a nurse, to cover operating room call. So if a hospital is short handed, it makes more sense for them to pay more to a nurse that is already trained to make up for the shortage until the position can be filled or, a full time staff nurse can be trained to fill that specialized spot. So how much more do unionized nurses make versus non-unionized nurses? I have no idea, I know no union nurses.Well, this could ramble on forever and I don’t have an attention span that long. I was just wondering what ya’ll thought. Are nursing unions really necessary?