five twitter feeds every nursing student should follow

note: the hyperlinks are carefully chosen. click on them. If  you like this, please follow this blog. click on the button to the right. you know you want to….

Does TL;DR mean anything to you?

It stands for “too long; Didn’t read” – the ultimate putdown. Now that everyone’s handheld electronic device is their personal mass communication device, we are flooded with things to look at. Back in the sixties, Andy Warhol once said that we each get fifteen minutes of fame. (click for the exact quote).Well, social media nowadays means that we get fifteen seconds. Then everyone moves along.

We are getting to the point where even the compulsive people will ignore you. If you don’t make it snappy. If it’s not expressed in simple sentences. If it’s too long.

And so, twitter. the shortest of all. every tweet is a haiku. Been experimenting with it, and wondering what the fuss is about.

Five Twitter feeds every nursing student should be on.

Seems as though every student has a smartphone these days. Here is a disconnect. The faculty has no idea what the capability of these devices actually may be.  Oh, we’re all using course software, PowerPoint, and stuff that goes on a desktop or laptop, but we are still behind on smartphones. For faculty, look around when you next stand in front of the classroom – the students are using their phone. probably to text or tweet about you. And it may not be complimentary. But that’s another story. We are smart enough to tell the students to put them away during exams,  (most of us are anyway). But it ends there.

Top Five

Anyway, here is the list of five twitter feeds that every nursing student should follow:

@NCSBNLearnExt – this one is from the National Council of State Boards of Nursing. Don’t know who they are? why, NCSBN is the group that tells NCLEX what to put on the NCLEX exam. their feed is full of tips about your R.N. license. how to how about getting your Authorization To Test,  and that sort of thing. I have always told people that the NCSBN document on their site about Delegation is a must-read for test prep, and their twitter feed is simply excellent. Note:  any nursing school that does not use Working With Others as part of their regular curriculum is guilty of educational malpractice in my view. And by “using it,” I mean: getting the PowerPoint and Video, lecturing on it, testing on it, and doing the group roleplays.

@ReviewNursing is also quite good, they have put out 2,0oo tweets! something I like about them is that they remind you of vocabulary. Vocabulary is a very important concept in NCLEX, I have often thought that a long unusual word will be used in the question stem just to distract the test-taker from what the actual question is about.

@KaplanNCLEX is also good, I think their tweets include a bit of zen, which hopefully will keep the compulsive student from going completely overboard. Solid material is mixed in with advice about stress, quotes from Florence Nightingale, and the like. They have 4,426 followers.

@NCLEXprep this is my own humble feed, I just started. For this one, the plan  is to find bite-sized pieces of nursing wisdom that will guide you in applying your knowledge to a test question. There is a long tradition in medicine called the Pearls of Wisdom – factoids that are easily turned into rules ( “if the patient is taking Lasix you should be alert for hypokalemia”) – things that every prudent nurse ought to be able to call up whenever needed. I will choose Pearls that are from everyday practice.  When I look up the definition on the internets, I note that the phrase is often use dismissively by those who wish to engage in evidence-based practice, but the idea stands nonetheless; there are things every nurse oughta know. (“when you give your patient an opioid, always enquire about their last bowel movement”)

and finally:

@YourSchoolCohort.  Why not? social media democratizes information. Make your own. When you go to nursing school, you are joining an intense group experience, whether you have thought about it or not. The people you go to nursing school with, will learn things about you that your family, significant other, and God, do not know. We promote teamwork among nursing students, and if you work with a team to do the studying you will be a more effective nurse. For that reason, form your own Twitter feed, whether it’s from the Class Officers, or from the  members of your group.

This is not the final list

and, if you think about it, NCLEX prep actually begins on the first day of nursing school, not the time between graduating and sitting for the exam. why not follow these from the start of nursing school?

Please feel free to add your suggestions below, and it would help to include a short review as to what you like about it.

In the meantime, I leave for Nepal tomorrow, and will spend the summer teaching critical care nursing skills. This blog will be relatively quiet, I will tell the tale of Nepal nursing on CCNEPal2013 blog, and also on a Twitter feed, CCNEPal2013 I invite you to follow me.

NCLEX prep tips in short manageable and digestable pieces

New Uses for Twitter

go to www.twitter.com/NCLEXprep and follow, if you like.

share with your friends. please!

the plan is to post #NCLEXtweetoftheday which will include short factoids or pearls of wisdom designed to enhance NCLEX scores.

It will be like writing nursing haiku I guess. If I share one little tidbit a day, the followers will grow to become big and strong, like feeding nourishing food to a child.

I also found an NCLEX site run by NCSBN, theirs is really super, go to NCSBN NCLEX

It’s Official – Hawaii has an “oversaturated” market for nurses

note: be sure to click on the hypertext links, they are either underlined or else in a different color, and BTW you can also find the surprise

Is this really news?

The Honolulu Advertiser Sunday April 28th edition included an article on page D-1 titled Nurses Wait for Jobs.

The subtitle?  recent graduates end up competing for a few positions in an “oversaturated” market.

Here is the link, but there is a warning – The Honolulu Star-Advertiser will ask you to buy a subscription in order to read it. Bummer. It is well-written though.

In summary, the Honolulu article describes the recent closure of Hawaii Medical Center East & West, the number of currently registered nurses who are working in jobs that do not a require an RN, the predictions of the Hawaii State Center for Nursing, and the statistic from one of the major hospital groups that they now have 150 recently-graduated RNs on the payroll in non-nursing positions. This latter effort is admirable but it makes you wonder how long it can be sustained.

The article tries to end on a hopeful note, saying that in a year or two things will be better.

National Student Nurses Association

It’s important to get a feel for whether this is just a collection of stories or not. Here is some data.

There is a quarterly publication of the National Student Nurses Association named “Dean’s Notes” and their Jan 2013 issue focused on the results of a nationwide survey of new graduates that showed a lot of info about this very subject. click here to find the URL - go to “Jan 13 issue” and it will appear by magic.

UPDATE May 17 – one of the Universities is offering a refresher course in clinical skills this summer for those RNs not employed in the RN role. I think this is a great idea for keeping skills sharp.

I am very curious to know my reader reactions on this subject. please feel free to comment.

Nursing Students and FaceBook episode #3,148

social Media and HIPAA

we’ve all heard the warnings about nursing students who posted patient information on Facebook.

Social Media and Job Hunting

I myself wrote a past blog warning students to be careful what they post on FaceBook since future employers nowadays are always reading your stuff. They tend to question your judgment if you post a lot of photos in which you are drinking champagne out of a slipper or displaying ink in places normally covered by clothing.

Social Media and student-faculty interactions

this one is new. and you heard it here first :-)

A couple of weeks ago some students who are about to graduate let me in on a secret. Since the very first semester of nursing school, they have all been members of a secret FaceBook page which is limited to members of their cohort. They have used it to coordinate such things as group assignments, carpooling, social gatherings (of course!), study groups, and the like.

and what was new?

The new part was, this particular group has also shared considerable information about the faculty, such as comments made on evaluations and emails in response to questions asked by members of the group. Every time a class officer asked for clarification on any item, the reply was posted.

It is a longstanding tradition in academia that students “scope out” the faculty, and there are public websites such as ratemyprofessors.com where they can post an evaluation. A couple of years ago, I applied for a nursing faculty job and the search committee chair had read my reviews there. It’s part of your portfolio now, whether you like it or not. For that matter, I did a YouTube search on a school of nursing in the northeast, and found a video the nursing students had made as a farewell to their faculty. it was not a slick Public Relations Video but it was a gold mine of information….. In that case, it made me want to work there!

something that surprised me was that a faculty person had sent a student an email describing the student as “rebellious” – a word choice I would have never made, even if I thought it was apt. In context, it seemed to be a putdown. It was there for the entire cohort to read and digest. There were other examples in which a given faculty was disrespectful toward a given student. This was a shock, but it backfired – I just don’t think the faculty expected that the student would share the email with everybody.

Summary

for the students: I can’t say I blame you for using a new route to communicate with each other. In fact, you are advocating for yourself in a powerful way. I guess I would hope that you are doing it with a sense of positivity. I actually think every student cohort should do this. I have worked in settings where the staff did something similar using a notebook or other tools. It’s professional nursing behavior. it really is.

Let me expand on that last point: if you are to be a lifelong learner, you will need to figure out ways to mobilize resources, develop theories about the way some new disease works, and test out possible responses. As a professional nurse, when you do this learning-from-your-direct-experience strategy, we call it “praxis” – the essence of development. Teams of nurses do this. Yes they really do.

for the faculty:  some of these are old rules. never put anything in writing for one student which you don’t think will be read by every student. don’t use personal attacks or attribute motivation that would be not correct – focus on specific behaviors instead. A new faculty in particular, needs to learn how to welcome feedback. Realize that the students will be “scoping you out” and organizing themselves this way.

Finally – a question -

have you noticed this at your school? want to share examples?

New Blog for new book The Sacrament of the Goddess

As many of you know, I have been writing a second book about Hospitals in Nepal.

The book is nearing completion. That does not mean that it will appear on bookstands tomorrow. There is a very long lead-in time between finishing  a draft of a novel and the actual publication of the book.

I have written about the process by which the book has evolved, here and there. I needed to create a single place for it, and so, I have now created a blog page with the same title as the book.

go to

http://sacramentofthegoddess.wordpress.com/

and if you want further updates, please subscribe.

2012 in review – in case you are wondering

The biggest uncertainty of any blogger is to wonder whether anybody is actually reading what you write, or if they care about what you had to say. To answer this, WordPress supplies lots of data about views etc. I was surprised to see that at the end of the year I could get a summary. The WordPress.com stats helper monkeys prepared a 2012 annual report for this blog.

Here’s an excerpt:

4,329 films were submitted to the 2012 Cannes Film Festival. This blog had 22,000 views in 2012. If each view were a film, this blog would power 5 Film Festivals

Click here to see the complete report.

should a new nurse get malpractice insurance?

summary: yes, you should get insurance. you would be crazy not to.

note; be sure to click on the links!

I decided to write this because of a recent experience on a FaceBook page in which a nurse was saying, “no you don’t need it, nurses never get sued and my husband is a malpractice attorney so he should know!”  I vehemently disagreed and was a bit surprised to be belittled and insulted. Be that as it may, the internet is a public square…. I was surprised to learn that the person who flamed me about it also  had a PhD in nursing and was employed as an administrator.  It reinforces some negative stereotypes about administrators and educators in terms of being in touch. Most are actually well informed and have been educated as to the laws governing nursing in their state, and their own legal and ethical responsibilities.

insurance covers more than just malpractice

It may be very well be true that nurses are not often targeted in lawsuits and are therefore not likely to be sued. (disclosure: I have had insurance for decades but I have never been sued.) BUT, malpractice insurance covers more than just being sued for malpractice. It covers something called “license protection” – and this is of vital importance.

Sad and shocking, but true

here is the sad story. There was a case a number of years ago which became known as “The Death Angel” – a nurse named Charles Cullen who practiced in NJ and PA and OH for more than ten years and jumped from job to job. When he was bored he would inject potassium into his patients, causing their heart to stop so that a Code Blue could be called. The investigators finally concluded he probably killed ( yes, murdered!) forty or more patients that way.  One estimate said 400 – in which case he would be the most prolific serial murderer in US history. There have been other such nurses, just google the term and you can find the details.

Proactive approach needed

we can read the post-event details of how the criminal justice system tracked these people down, but these highly publicized cases served to cause all the State Boards of Nursing to ask how this could have been prevented. There were three Boards involved, shouldn’t they have caught him somehow? And one commonality was that the perpetrators of these crimes were often people who skipped from job to job, leaving each under a cloud of suspicion. Charles Cullen was the prototype. He had ten jobs in sixteen years in three different states, usually working night shift in ICU.

Once this became known, more than thirty states adopted regulations that require all employers of nurses to report a nurse to the State Board if they are discharged from employment due to concerns about competence and a threat to the public. The National Council of State Boards of Nursing is a resource on this issue, and at their website they list the types of complaints against nurses that can result in being reported to the Board of any given state.

You can even get a state-by-state interactive map that shows how many nurses have been disciplined – i.e, had action against their license. For example, in 2012 there were 109 RNs in New York state, and 44 in Maine. That’s only the ones who were “guilty” – not the total of complaints. The NCSBN publishes a model nursing practice act, and on pages 8 and 9 you can see that the intent is to make it easy easy for a nurse to be reported to state board.  I think all 50 states now use the Model Act.

Here is where it gets tricky

I am certainly in favor of tracking down any future Death Angels; and also am in favor of excellent practice. I personally have reported suspicions about fellow nurses to my employer(s) and ultimately these persons got reported to the Board. But, just because you are reported does not mean that you are a threat to the public.  Maybe it means that you were a bad fit for the organization or hospital where you worked. But you will be reported nonetheless. and it’s your bread-and-butter which is at stake. You are entitled to Due Process and a fair hearing.

In Maine, where I was State President of the Nurses Association, we would get calls from nurses asking for advice. there was one particular employer that had a highly questionable pattern: they seemed to find ways to fire their RNs, long-time employees, when they got within a year of being vested in the pension program.  Nobody could prove that was truly what they were doing; but it seemed suspicious. They would trump up some sort of reason.  there was also a unionised hospital in Maine which tried to fire one of the leaders of the nurses union when she gave two aspirin to a patient in the middle of the night without a doctor’s order. (Management was watching every move she made, just looking for a reason to fire her. in that case, the Board threw the case out since it was obviously retaliation). and of course, we have all heard of doctors who reported nurses to the Board when the nurse stood up and advocated for their patient. I think the State Boards have a good record of supporting nurses in those cases. Read here for more information about a case in Texas that should make you stop and think.

“Don’t let the door hit you on the way out”

an unintended consequence of the reporting law is that it gives employers another weapon to use as a threat against activist nurses such as the union activist or those two nurses in Texas. They can compel you to go to the Board and defend your license, which costs money. that’s where License Protection comes in. Even if you never get sued for malpractice, most policies include license protection insurance, and this can save you the $10,000 it would have cost out-of-pocket to defend yourself.  ask yourself if you wish to be protected against nuisance complaints?

I like to attribute good motivations to administrators and I like to think that a nurse-administrator would always be acting out of a sense of justice. Every reader can ask themselves if they have ever met a nurse-administrator who chose to be “tough” somehow – and use this as a way to twist the knife when an employee parts company. There are ample war stories out there. Not every work culture is healthy.

As a parting thought – every agency needs to make certain that their administrators know the details of the mandatory reporting law. we all have a stake in protecting the public.

if you wish to share below, let me know.

oh yes, and please look to the right for a link to my book about nursing in Nepal.

 

 

 

 

 

dealing with nurse-burnout, a simple trick

Back to normal

The election is over, and we can all take a bit of time to decompress. I was of course, happy with the outcome, but I also note that a few people dropped their subscription to this blog. Oh well, it’s a voluntary system, people come and people go. The readers are not my prisoners, though of course, it can be torturous to read my writing.

Though I’d share something I have found to be useful when dealing with stressful situations. When I wrote my book about volunteering rural Nepal, I included a reference to this little Jedi mind-trick. People told me that they started using it and it made things better. I did not invent it and I suppose we could discuss what the meaning of “better” might be.

Inner child

The thinking technique is one that derives from the work of Eric Berne, the founder of a movement in pop psychology known as Transactional Analysis. “T.A.,” as it was called, was a way to express complicated theories of personality and motivation in terms that were accessible to the general public, and I think it is the place where references to the “Inner Child” started to become popularized.

I won’t rehash the entire theory, I leave that up to you. we live in the age of the internets, go use them!

But, the short version is, when you anticipate a stressful or upsetting situation about to take place, you take a minute or two to perform this exercise, and it will lead to better execution of whatever things you need to do.  I suppose that some lay persons will respond by saying “hey, when the s^&t is about to go down, take your self away from that place, wherever it is!” - yeah, well, that’s true but it’s not an option if you want to be on the trauma team or if you wish to deal with people in any kind of crisis.

the long term issue is “secondary stress’ which I have written about before. a health professional takes on the stress of helping. entirely understandable.

so here it is:

You visualize your self as a five-year-old, presumably a happy innocent version of yourself, but vulnerable to upsetting things like ghosts stories or anger or abuse. picture that five-year-old version of yourself, the part that would cry if a bee stung you, or that would be amazed to see a butterfly; or that likes milk and cookies.

Then put on the voice of yourself as the all-knowing mom or dad. The all-knowing mom or dad says

“grownup things are about to happen now but you will not need to be part of this. I am going to tell you (the five year old) a story, give you a glass of milk, and put you to bed now, where you will be safe while the grownups do some work. when you wake up, we will laugh and sing. I love you”

You know it is working when your mind is cleared while you run through the ACLS or ATLS protocols.

Mister Spok

A similar technique has been called “going into Spok mode” based on the Star Trek character. Spok was the humanoid from planet Vulcan who had no emotion or nonscientific judgement, and was only able to deal in facts and logic. to go into Spok mode, you just make a decision to do two things: 1) only open your mouth to share something factual; and 2) not respond to anything that is not factual (or at least, evaluate everything that happens as to whether it is fact-based or not).

Christian coping?

and finally, a technique many Christians use. prayer.

the shortest prayer in the Bible. Matthew 14:30  which is of course, a direct plea from the Inner Child…. but also has its place :-)

the best way to lose your “virginity” Oct 26 2012

Saw this video on YouTube today.

This is the way I raised my daughters, the kind of values I wanted them to have…

Lena Dunham:Your First Time

enjoy!

Oct 19th Nurses against Obamacare?

There are still nurses who are unsure about Obamacare.

This is the clearest description yet…

click here

oh, and by the way – I have worked in low income countries where there was no public health infrastructure, and where women’s and children’s health was not supported.  I wrote a book about my experiences. browse this site and you can find my FaceBook fan page, etc.

If we continue to support the current GOP congress, we are headed there sooner than we think.

please share the video above with every nurse you know!