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You might be a medical professional (or a redneck) if you have your own language that only can be appreciated and understood by a fellow medical professional (or redneck)!

This includes creating your own false pseudo-terminology from other terminology that didn’t make sense in the first place…

Artery
The study of fine paintings

Barium
What you do when CPR fails

Cafe’-au-lait spot 
A great little coffee shop

Cesarean Section
A district in Rome

Cilia    
A girl’s name

Colic          
A sheep dog

Coma   
A punctuation mark

Congenital  
Friendly

Dilate  
To live long

Fascia
A Nazi communist

GI Series  
Baseball games between teams of soldiers

Hangnail
A coat hook

Medical Staff
A doctor’s cane

Minor Operation
Coal digging

Morbid  
A higher offer

Nitrate
Lower than the day rate

Node     
Was aware of

Organic
Church musician

Outpatient
A person who has fainted

Protein  
In favor of young people

Secretion
Hiding anything

Tumor
An extra pair

Urine
Opposite of “you’re out”

Varicose Veins
Veins that are very close together

I think I now know where the phrase “laughter is the best medicine” originated from! What would you add to the list?!

Disclosure statement: I’ve picked up these terms along the way over the past year or so. The original sources are not credited since I’ve overheard or read online most of them.

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I had this conversation recently with some fellow professionals: We were discussing the increasingly large void between what they teach in nursing school and what you learn in your first job.

It’s become very clear that most school programs are not focused on teaching you how to be a nurse, but teaching you how to pass your boards. They pour enough knowledge into your brain bucket so that you can pass your national exam.

Is that enough? Or is there more to nursing than one final exam?

Some would argue that you can’t become a nurse and learn the “real-world” nursing skills until you’ve passed your boards. Others would argue that’s the only thing some are concerned with learning.

It’s a double-edged sword, isn’t it? We need a passing grade on that exam, but the exam is not reflective of our practice in motion.

Many in the academic world would scoff at those words, but the truth of the matter is that any new grad is barely prepared to handle what gets thrown at them. It’s only when their practice is set in motion do they truly come into their own.

Are other health care professions the same? I wonder.

I also wonder if there are just some things that cannot be taught but will be learned as you progress in the profession? What if we broke it down into a list?

What you must learn in school:

• Applied anatomy and physiology
• Basic biology
• Applicable pharmacology concepts
• Basic microbiology, mathematics and chemistry

What you will learn once you graduate:

• Efficient time management
• Didactic emotional resistance
• True patience
• Skill development

I guess you could say there are an infinite number of intangibles that cannot be presented in the traditional classroom. And it’s those intangibles that separate our profession from most others. You have to walk in our shoes to appreciate the climb.

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Communication is the foundation of everything we do. It’s how we implement our interventions, how we coordinate tertiary care and how we educate everyone involved. While the spoken word is the gold standard of communication, the unspoken word resonates at a higher volume and frequency. In other words, it’s not what you say but how you say it that matters the most.

This concept is most important when speaking to our patients and their families. Be sure you don’t make these mistakes the next time you are communicating:

Timing

• Be where you say you’ll be when you say you’ll be there. Nothing shakes a patient’s confidence in the care you are delivering more than when you tell them “I’ll be right back” and they don’t see or hear from you for hours. Be specific, be honest, and when all else fails, update them as often as possible.

Body language

• The way you stand, where you place your hands, how you look at them and your eye contact are just a few queues that can draw the line between your body saying “I’m listening” and your body saying “Are you talking?” Focus on what is being said when it is being said.

Every breath you take

• I was extremely guilty of this. I used to give that “sigh” before and after a sentence. Whether I did it out of exhaustion or disgust, all it says to your patients is “I’m annoyed.” Even worse, I used to give that big sigh whenever the patient was talking to me. Nothing sets someone off more than that. Even if you are annoyed, tired or disgusted, be sure to keep it to yourself.

Fiddling

• Stop tapping your finger, clicking your pen, watching your monitor, writing, typing or charting when having a conversation. Stop distracting your attention from the topic at hand–you’re probably missing something important. If you cannot stop what you are doing, be sure to explain to your patient why or what is requiring your attention.

Manners

• If a phone call, page or monitor alarm demands your attention, be sure to excuse yourself. Nothing says “You’re not really important” like walking away mid-sentence without some closure or an attentive attitude.

In the end, the lines of communication are like a hinged door: If you  ignore it, sooner or later you’ll get hit by it swinging back at you.

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I recently was doing a little research for school when I realized there are some common and popular nurse/nursing myths out there. It seems there are two trains of thought: There is the public’s view of the nursing profession, and then there are those who actually know about the nursing profession.

I’m not sure if it’s our own fault or if Hollywood has a stranglehold on the general population’s opinion. This particular top 10 list is intended for all those who are considering pursuing the profession of nursing–I’d like to call it the “Here’s what we are not and don’t do” list:

1. We don’t wear all-white uniforms.
2. No, we stopped wearing caps a long time ago.
3. We do more than pass medications.
4. We do more than just clean up “poo.”
5. This is not Grey’s Anatomy – we’re not secretly sleeping with all the doctors. Nor is this House – we do the blood draws.
6. No, not every “nurse” is the same. There is a profound difference between a Nurse Practitioner and a Nursing Assistant (about 6-8 years of education).
7. We actively collaborate in the decision-making process and don’t just take orders.
8. No, we are not all women.
9. No, we work in other places besides hospitals and physicians’ offices.
10. No, we didn’t fail at becoming doctors. We chose this profession.

I know, I know, we’ve beat this horse senseless, haven’t we? I have to admit, I am just scratching the surface here. I think we all could generate an endless list of nursing urban legends.

What would you add?

Images By: Peter Dazeley

Every nurse has been told this during a conversation about job opportunities: “You need to get some regular floor experience before you specialize.”

You can paint it any color you want, but most nurses who hear this are either new graduate nurses or are seasoned nurses who are trying to dive back into the clinical world.

I’m here to tell you it’s a MYTH. It’s an urban legend. There is NO theoretical evidence that a nurse needs prior experience in order to perform well at a chosen job. Okay, maybe there is, but in my travels as a nurse I’ve never seen this myth supported in any way.

I was one of the lucky ones. When I started as a nurse, all specialty nursing units (ICU) were frothing at the mouth for nurses. They didn’t care how much experience you had–as long as you were willing to go the extra mile, they hired ya. And I’m not talking some small four- or eight-bed suped-up telemetry unit, I’m talking urban teaching hospitals with level 1 trauma status.

As my career progressed, the needs and wants of nursing units changed, and then the economy dropped the infamous ball. Now we’re back to square one, with many specialty nursing units shunning away from new grads with no experience. I’m not sure if it was the strain on the economy or some weird paradigm shift?

What I can tell you is this: In my short tenure as a nurse, I’ve seen both sides of the coin. I’ve seen a seasoned critical care nurse from another hospital with umpteen years of experience fail miserably at a new job in critical care. And I’ve also seen a green-behind-the-ears new grad with no experience shine and become a hard-charging, take-the-lead nurse who scoffs in the face of danger.

I personally don’t think it has anything to do with want or need or ability or personality. I think it has everything to do with desire, willingness and cojones.

I can say with 100% certainty that you are either built for this job or you aren’t. There is no grey area in critical care. You either survive or your drown. I like to make the parallel comparison to our profession in general–you are either built to be a nurse, or you aren’t.

The next time someone feeds you this line of bull, be sure and explain to them why you would be a perfect fit for the job. Convince them they could use a nurse like you. Or don’t you have the cojones?

Image By: Roderick Chen

Nurses and intravenous catheters (IVs) seem to go hand in hand. Yes, yes, I know nurses are not the only health care professionals that place and start IVs, but we do the majority of it. My sincere apologies to all the out-of-hospital EMS personnel.

Oh, and as a side note to all the TV fanatics out there: Physicians RARELY start peripheral IVs. In fact, in my short tenure doing this job, I’ve seen ONE physician start one.

Anyway…

Even though my IV skills had a pretty rough start, I thought I’d share some tried and true tips to help increase your chances of success.

Know your anatomy

• This is a simple yet vitally important rule. Don’t go routing around blindly for that “magic” vein. Know where to look and what you are looking for. Most cephalic forearm veins are overlooked, while the median anticubital vein is usually abused. Remember, the ventral side of the forearm is sometimes a gold mine!

Trust your gut

• After your initial survey, if you know in your gut that you’re going into it blindly, stop what you are doing and ask for help. Ask for assistance or simply hand the task off to someone who is more experienced. There is no shame in knowing your limits, but don’t be afraid to fail, either.

Stick to your own routine

• For some reason, every nurse thinks his or her way of prepping the vein, applying the tourniquet and exposing the vein is the best way. Ehhhh. Wrong answer! Once you develop your skill, be sure to follow your own routine. Your routine will ensure you do it the right way, each time, every time.

Hone your skills of palpation and touch

• This seems to be a dying art these days. Just because you can’t see the vein doesn’t mean it’s not there. Be sure to practice your palpation skills. Practice and sharpen this skill by closing your eyes and palpating a known large exposed vein on a well-hydrated patient. When you see “that” patient with the good veins, be sure to palpate the veins with your eyes closed. Do it over and over again until you can recognize what the vein should feel like. Don’t ever rely on just your sight.

Don’t forget there’s a patient attached to that vein!

• Once again, we nurses get so focused on the task that we forget there is a human being on the other side of that vein. Just because the dorsal hand veins are prominent does not mean you ignore the forearm! You are inevitably causing pain to your patient–be sure to empathize and make every attempt to increase their comfort level. I haven’t met a patient yet who actually likes being stuck with a needle!

Starting an IV is a skill like all others–practice makes perfect. It also follow our mantra, “If you don’t use it, you lose it.” Don’t handicap your practice as a nurse by letting your IV skills lapse. It’s better to try and fail than to never try at all!

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May 6-12 is when nurses are nationally recognized for their efforts during Nurses Week. It’s a celebration of all things nursing. During that week, you have National Nurses Day, Student Nurses Day, and School Nurses Day to recognize the individual efforts of these “types” of nurses. The week ends on May 12, the birthday of the founder and mother of the nursing profession, Florence Nightingale.

Everybody with me?

Until recently, I’ve always enjoyed Nurses Week. I usually got a cool trinket or gift from my employer, and my fellow nurses would joke about the one time of the year we nurses actually are noticed.

These days, it seems the only time of the year we DO get recognized is now being watered-down (and maybe even flushed away) next to another nationally recognized week–National Hospital Week, which is also May 6-12 this year. The only difference I see from year to year is that the actual dates for Hospital Week can differ slightly, while Nurses Week always starts and ends on the same dates!

I guess maybe that’s my problem. Why must another week-long national celebration trample on the toes of our celebration?? (I kept getting circling results, so I gave up searching for some relevant history on National Hospital Week and the coinciding date.) Obviously, the celebration dates for National Nurses Week bear significance with one of its founding mothers.

In my opinion, nurses are getting shortchanged simply because most nurses work in hospitals, so it’s more convenient and cost-effective to celebrate both weeks jointly than to have two separate celebrations (it’s always about the money, you know).

Also, the health care personnel who are being recognized are equally shortchanged, because now they share their “week” with a much larger group of fellow health care professionals (nurses).

It’s become so common and convenient to lump them together that I found numerous articles that meshed this celebration into one singular event (I refrained from naming names here).

Deep breath.

Maybe I’m being selfish. Maybe I’m being obtuse. But the last time I checked, we nurses rarely, if ever, ask for recognition. And the one and only time the nation recognizes our sacrifices they decide to divvy up the recognition with another holiday?

What am I missing here?

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Over the years, I’ve learned to deflect most of the work-related “drama” that can consume you. We nurses can be vindictive, catty, diabolical, cold, mean and down right unappreciative many of the hours we spend saving and improving the lives of others.

We do this to ourselves, our coworkers, our patients and their families. The worst type of offensive behavior is the kind where the nurse denies or is unaware of his or her evil ways. The stress of the job and the toughness of life can weigh a person down sometimes, and the repetitive brow beating we get from all aspects of our job can turn any positive person into a “Negative Norm” or “Negative Nancy.”

We forget how awesome our job is sometimes. We forget how blessed we are with the knowledge and skills we have. We forget how good we really have it.

Sure, we have stressors. There are “corporate suits” out there who do not make our job any easier. Or the patient or family member that treats you like the maid or butler. Yes, there are plenty of allied health care professionals who have no clue what kind of job we do, nor do they care how much they need nurses.

But through it all, we still have a pretty awesome job.

We have a relatively stable profession in an economy with a rickety foundation these days. Our job doesn’t require us to brave the elements for endless hours a day. Our pay scale is respectable compared to most. We have unlimited growth opportunities if we just put forth the effort and sacrifice. And quite honestly, people are living longer and getting sicker these days–that itself equates into some impressive job security (hint of sarcasm there).

I think we all are guilty of driving through life at the speed of sound, not stopping every so often to appreciate what is around us.

We all could follow the example from this fabled tale (I’m sure there are many versions of the story, but you’ll get the message):

Life Throws a Brick at You

A young and successful executive was traveling down a neighborhood street, going a bit too fast in his new Jaguar. He was watching for kids darting out from between parked cars and slowed down when he thought he saw something. As his car passed, no children appeared, instead, a brick smashed into the Jag’s side door. He slammed on the brakes and spun the Jag back to the spot from where the brick had been thrown.

He jumped out of the car, grabbed some kid and pushed him up against a parked car, shouting, ‘What was that all about and who are you? Just what the heck are you doing?’ Building up a head of steam, he went on. ‘That’s a new car and that brick you threw is gonna cost a lot of money. Why did you do it?’

‘Please, mister, please, I’m sorry. I didn’t know what else to do!’ pleaded the youngster. ‘I threw the brick because no one else would stop.’

Tears was dripping down the boy’s chin as he pointed around the parked car. ‘It’s my brother,’ he said. ‘He rolled off the curb and fell out of his wheelchair and I can’t lift him up.’ Sobbing, the boy asked the executive, ‘Would you please help me get him back into his wheelchair? He’s hurt and he’s too heavy for me.’

Moved beyond words, the driver tried to swallow the rapidly swelling lump in his throat. He lifted the young man back into the wheelchair and took out his handkerchief and wiped the scrapes and cuts, checking to see that everything was going to be okay.

‘Thank you, sir. And God bless you,’ the grateful child said to him. The man then watched the little boy push his brother to the sidewalk toward their home. It was a long walk back to his Jaguar… a long, slow walk. He never did repair the side door. He kept the dent to remind him not to go through life so fast that someone has to throw a brick at you to get your attention.

I would like to challenge all my fellow professionals out there to pick up that (imaginary) brick and throw it at your fellow nurses. Have them slow down and simply appreciate life. I know I’ve needed it thrown at me a few times.

Anton Prado | Veer + Scrubs

A little over a year ago, I wrote a brief FYI blog post about the future goals of advanced practice nursing and the role of the DNP according to the consensus model by the AACN. Questions have come up that I’d like to address.

Will there be a set of uniform guidelines that each state follows in transitioning the requirements from an MSN to a DNP for a current practitioner?

As most nurses have discovered, state requirements are very different from national requirements. While all states share the same minimum requirement of following national certification guidelines, each state’s specific requirements for licensure and employment is at its own discretion.

In my opinion, this means each state will choose how you may transition. If the current state protocols are a reflection of things to come, be sure to do your homework and contact your local state agencies to get the details. I would not assume the guidelines for one state will mirror another, no matter how close their geographic locations are.

I’m in the last year of my ACNP program and we quickly are learning that there are many hoops to jump through and red tape to follow when applying for licensure.

What incentives does acquiring a DNP have other than just being a requirement?

Many nurses are questioning the motives behind the impending changes and what incentives exist to motivate a current nurse to pursue the DNP. More specifically, are there pay rate changes to the DNP as opposed to the MSN? I mean, we’re technically being required to get another 12-24 months of advanced education–are we being compensated? More education should equal more pay, right?

It’s not a simple answer.

The NP profession sort of shot themselves in the foot with this one. For years, NPs fought for independence. Independence in the practice, and then independence as a practitioner. Granted, this fight was more for the general practitioners (Family Nurse Practitioners), but since the NP profession has become more specialized, it affects all specializations.

Now in some states, an FNP can open a clinic or office with the assistance of an MD. And in some states, the FNP can practice without the actual physical presence of the MD (just a phone call away).

Not to minimize the concept, but Uncle Ben from the Spiderman comics said it best: “With great power comes great responsibility.” If we as a profession want to have the power to work independently and function with that kind of “power,” it is our responsibility to be prepared. More responsibility equals more education, period.

Oh, and let’s not minimize the ever-expanding complexity of health care, our patients and their health challenges. The truth of the matter is, our patients are living longer and have more health challenges that did not exist a decade ago thanks to advancements in treatment. We as the practitioners need to “up our game” to meet these challenges. Upping our game means attaining a higher level of education.

So the “motivation” for attaining your DNP is simple. Do it to improve the care of our patients.

If you’re worried about not being compensated for your additional education, we might want to take a step back and look at our economy as a whole. Our profession is one of the few that is not being affected by the current economic strain. There are MANY health care professionals out there who have no job opportunities at all.

I, for one, predict that depending on the area you choose to work, the pay rate will change, but not because you simply got your DNP–rather, because your role as a practitioner has expanded and will continue to expand in the years to come. Yes, an MSN prepared NP functions just as a DNP prepared NP does currently, but I foresee that changing very soon.

In the end, if the impending educational requirement from an MSN to the DNP is affecting your decision to advanced your degree or swaying you towards not advancing your degree all together, then maybe it’s just not for you.

Links of interest:

• http://www.iom.edu/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health.aspx
• http://msntodnp.com/average-salary-msn-vs-dnp/
• http://community.advanceweb.com/blogs/np_7/archive/2010/05/04/will-employers-pay-for-a-dnp.aspx

Some additional articles:

• http://scrubsmag.com/5-perks-of-an-np-degree/
• http://scrubsmag.com/a-doctor-in-nursing-uniform/
• http://scrubsmag.com/doctoring-the-doctor-title/

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It’s one of those ‘under the breath’ hush-hush topics that is usually only discussed in the break room or behind closed doors. The dating scene mixing with the working scene. We all have come across it, heck some of us may have even tried it! Do you think cupid has a place at work?

I mean, it’s not like we don’t have lives outside of work (right?). OK, maybe some of us do? Okay, okay…maybe some of us try! The fact of the matter is, we spend a lot of time working side-by-side with the same people. And given the right set of circumstances, and the right set of interests, that really cool co-worker you love to work with could develop into something more.

We all know  and work with nurses who are in relationships with other health care professionals. *cough *cough* (I’m married to a nurse). Is it right? Is it wrong? Why? Why not?

What if things go wrong?

I, for one, have never had a workplace romance as a nurse. I had a few failed workplace dates in my previous pre-nursing life, though. And, well since they were failures it made the workplace a tad uncomfortable. I use the word tad loosely for anyone who has walked in those shoes before. Stress levels are bad enough at work, do you really think you need that ‘ex’ crossing your path multiple times during your day? They are referred to as an ‘ex’ for a reason. And at work there is no escape sometimes.

I would say this is the major reason for being careful when deciding if this date/ romance is something you want to explore with your co-worker. If it doesn’t work out, how are you two going to handle the end-game when you’re both at work. That cool working relationship will be gone – jus’ sayin’. It’s food for thought.

But then again, what if things go right??

Now on the flip side of that coin, my wife and I have worked side by side. I think a couple can have a great working relationship as long as they keep it professional and respectful. There is no need to be calling each other pet names during the shift. Seriously. Oh, and the PDA (public displays of affection) – yeah that’s a big no-no. Remember, keep it professional. You’re not at home or out at a restaurant, you’re at work.

Oh, then there is the whole delegation of authority issue. Unless you are both holding the same rank in the greater scheme of things, this will definitely become a sensitive subject both in and out of work. When you and your significant other are having a ‘disagreeing’ moment – how are you going to handle giving or taking orders from them? Hmm, just more food for thought.

Oh, and one last piece to this puzzle. The last time I checked most facilities have a policy that addresses this very thing. In most cases you can’t work in the same department, although there are exceptions. I think these policies are in place to safeguard from any of the above ‘difficulties’ I have mentioned. If you start that romance, is he/she worth leaving your department?

Does cupid have a place at work? Both scenarios are workable, but I think it boils down to what will change if cupid shows up (or disappears for that matter!). Can you live with those changes?