“Friday Night at the ER” is also Simulation and – your school needs it!

It’s been more than a year since I posted in this blog, but the all-time top two entries are still attracting views. the first is “Myths about becoming a nurse practitioner – things to consider about grad school in nursing”  http://wp.me/p1Kwij-au and the second is “part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere!

I mostly blog about Global Health nursing and Nepal healthcare these days since I no longer live in Hawaii. go to http://www.joeniemczura.wordpress.com

Friday Night at the ER and Scenario-based education strategies

These days one of the trends in nursing education is to adopt scenario-based learning. Most often this turns out to include investing in a skills lab upgrade so as to incorporate much more sophisticated training manikins that require use of a computer as well as a trained operator who can make the manikin breathe, talk or have a cardiac arrest. These are wonders to behold, and supported by marketing from the main company that sells them. Over time, this approach has built an eco-system of professional journals, conferences, web pages and user networks to support dissemination of wisdom about how to provide simulation. Your simulation site can get certified, and there is a book of Standards you can use for ideas.

I’ve been in favor of scenario-based education for a long time, probably ever since I became an EMT in 1975. (was still in nursing school at the time). The American Heart Association uses “megacode” scenarios to advance psychomotor skills and I always enjoyed the game aspect of this approach. In Nepal, I use scenario-based education to promote better critical care response. Minimal lecture, lots and lots of role play.

Scenario-based education is more than just the fancy manikin.

In 2002 I was hired by a school of nursing that suffered a dismal NCLEX first-time takers pass rate and decided to replace some faculty members. Voila, because of my prior management experience I was now teaching the Management and Leadership class with a specific mandate to focus on delegation skills.  I re-wrote the course outline to include activities for this. I was determined to teach it in a manner that reflected the real world.

“Delegation is very boring as a lecture topic, up until that exquisite moment when you realize that you are in legal trouble and could lose your license if you do it improperly, then all of a sudden it is crystal clear and very exciting” I used to say.

Friday Night at the ER is a key vehicle to teach concepts of nursing administration firsthand, that go on all the time, but which nobody ever explains to the new RN. The processes in the game board are extremely well-designed to illustrate the ongoing slog of bed-control and patient flow-through decisions, and players get to apply them. The scoring reflects the financial incentives associated with these processes. Sometimes schools of nursing will assign each senior to shadow a house supervisor for a day to get exposed to these things, but this is a hit-or-miss prospect; Friday Night at the ER guarantees that each participant will get the feel of being a house supervisor.


One game board. Best played in a rally format with may game boards. Like Monopoly, there are many twists and turns and the outcome depends on certain skills possessed by the players.

It’s a game board. And each board accommodates four (maybe five) players. Do the math. A cohort of thirty will require six or more game boards. We had a cohort of fiftysix, and divided the experience into two halves, with eight boards each day. To fully implement it at your school requires buying a set of game boards (I took this to another large school of nursing and once they committed they bought eight game boards) and it requires logistical set-up ( lot of small pieces need to be set out on the board, like Monopoly). Also, the way we did it required an all-day scheduling commitment, taking about six hours to include two de-briefings along the way. A strong recommendation? don’t try to squeeze it into just one three-hour class sessions. Do it in lieu of a clinical day.

If you adopt Friday Night at the ER?

Facilitator: Like the manikin-based approach to simulation, the facilitator of Friday Night at the ER does a better job if they also have real-world experience as a mid-level manager, because they have a better idea of the relative value of insights  available during an open-ended event such as Friday Night at the ER.

Debriefing: the academic nursing journals and websites devoted to manikin-based scenario learning are amply stocked with testimonials as to the need for debriefing, as a means to frame the experience. Like using a manikin, it’s possible to do the experience and not actually learn anything or gain insight. De-briefing is absolutely critical. If you adopt Friday Night at the ER,  you need to include ample time for this, and the students need to commit to the idea that they can’t run out of the class as soon as the last score is tallied up.

Integration: Friday Night at the ER is billed as “discovery learning”  and the company that sells it will tell you not to pre-warn the participants in advance as to how to “win” or to share the scoring system, etc.  This presents a challenge, because it’s herder to “sell” people on the merits of playing. In addition to the usual suspension of disbelief required for good simulation, Friday Night at the ER is more fun and experiential when you all learn as a team ( that’s why it is used by non-nursing and non-health care teambuilding consultants – it forces people to communicate and problem-solve.)

Having said that, since the game applies principles of delegation and illustrates they way a health care organization works, you can prepare the students to play it as part of a sequence of learning about delegation, the Nurse Practice Act, etc. I wrote a four-part sequence of blog entries to describe the how I taught delegation, right here on this blog.

Where to get Friday Night at the ER

go to http://blearning.com/

Disclaimer: I am not associated with the company in any way not am I being compensated for this full-throated endorsement in any way. I am merely a satisfied user since 2003. I have led this exercise about forty times I think. (memory is a bit fuzzy). I am very experienced in use of scenario-based education for critical care, especially debriefing.

While we are on it, the company needs to grow their followers on Twitter. go to @FNER_Game and you will find them. pass the word!

My other blog entries on this topic

The first was part 1: Secrets of a Nurse’s Brain – six steps to success at clinical practice, or anywhere! This one addresses personal organization to promote personal accountability, the first step to understand delegation.

The second was part two: checklist culture and your role in quality

The third was How to teach delegation and the Nurse Practice Act, part 1 dec 29 2013 This one explores how delegation is defined in (most) state Nurse Practice Acts.

Another was teaching delegation and the Nurse Practice Act, part 3 Jan 1 2014 This one will show you a free resource from NCSBN that is absolutely critical for every school of nursing to teach, and for every future NCLEX test-takers to read.

And finally, to teach delegation part 4 – getting “street smart” Jan 3 2014 How an organization made up of individually-accountable nurses will support legal practice.

Here is my offer to consult with you on delegation issues in the curriculum

As you can see from the above, I believe strongly that delegation can not be “integrated” into the curriculum as some sort of subliminal brain telepathy. Subtlety does not become it, delegation needs to be laid right out there and preached. And, delegation is not well delivered when presented by a “talking head” as a dry academic experience.   In the paper “Working Well With Others” from the National Council of State Boards of Nursing (NCSBN) a key statement is:

“The strongest set of delegation rules will not work unless the nurse possesses the interpersonal communication skills to enforce them” (paraphrased).

The best way to hone interpersonal skills is to use them and get feedback.

Please note: the Friday Night at the ER site lists experts you can hire. UPDATE: at first glance I thought there weren’t any  nursing educators, but I have been gently reminded (below)  that there are two – Dr Mary Dolansky at Case Western, and Dr Carol Durham at UNC. They come highly recommended.

Dr. Mary Dolansky’s  page is https://nursing.case.edu/about/directories/faculty/dolansky/


Dr. Carol Durham’s faculty webpage is http://nursing.unc.edu/people/carol-fowler-durham/

I plan to ask Breakthrough Learning to add me to their list. If your school’s aggregate NCLEX scores show the need to buff up the area of delegation,  I will happily work with you to revise the senior-year curriculum, including coming to your school to help you do it (for a fee). Alas, I do not own any of my own game boards. You would need to buy or rent these on your own.


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Hello from USA October 15th

Welcome to this blog.

Feel free to browse. There’s lots of advice for new nurses here.

You will see that I have many interests, and I’ve written two books. These days I am spending more time on my Global Nursing blog. Periodically I go to the country of Nepal and teach nursing there.

I spent 2014-2015 in Nepal and yes, I was there for the earthquake.

My second book is fiction. I wanted to describe the role of women in Nepal society. This was a more readable way to do it. Nepal is HIindu and Buddhist yet they fought a civil war. How could that be? The book looks at that question as well.....

My second book is fiction. I wanted to describe the role of women in Nepal society. This was a more readable way to do it. Nepal is HIindu and Buddhist yet they fought a civil war. How could that be? The book looks at that question as well…..

The earthquake shook up the political situation in that country. I am not a political expert, but one thing I noticed: the USA news is not covering the politics.

So lately I’ve been blogging on that. When, I post on DailyKOS. It’s got a different format which makes it easier for readers to find me.


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Sept 1st back in USA

Hi –

I’m back in USA and still following the Nepal news.

I’ m keeping this blog “up” but not focusing on it right now. My main effort has been going to the blog that accompanies my second book, the novel about Nepal.

Nepal is presently in political turmoil (to say the least) and you can read my thoughts about it here.

sending the best karma to all my readers.

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from CCNEPal about Joe Niemczura, post-earthquake April 26th, 2015

For readers of this blog, you know that it has not been active during this year that I am teaching critical care nursing skills in Nepal.

I am actively blogging on CCNEPal page, go there to read what I have to say.

For the record, I was in Bhairawaha Nepal on the day of the quake. In Bhairawaha, I noticed something odd at 11:56: the water in the glass was sloshing back and forth all by itself. I immediately got up, alerted the other people nearby that it was an earthquake, and we all left the building.

Here, nothing was damaged. not only that, but it was mild enough that things stayed on the shelves and tables. I spent much of the day (it was my day off) answering emails and messages to re-assure my friends that I was safe.  I am fine. I am not personally inconvenienced in any way.

I am on my long-planned “Road Trip” – fifteen sessions of my course outside the Kathmandu Valley. Five have been completed and ten remain. I am teaching today.

I would point out that CCNEPal, my organization, has trained 1,775 nurses and docs in Life Support skills, and about 800 are in Kathmandu. For that reason, I suppose you could say that CCNEPal has “pre-positioned” for this event (though I would not wish this on anybody). I am 100% certain that the Nepalese people will be helping each other, it is something I have always admired about this beautiful country. There is ample capacity to shift medical personnel from within the country, and I am sure that such a move will be easier than to bring in people from outside.  For those who wish to help, I guess the first thing is – send money to aid organization of your choice. (not to me!)

In general, I think it’s too early for nurses and doctors to come here unless they speak fluent Nepali and already know about the hospital system (most hospitals are intact). I do not think the needs will be quite the same as they were directly after Haiti, for example. Logistically, a self-contained team would be good.

From reading about other disasters in other parts of the world, I think that the early period will focus on recovery of victims. The time when foreign nurses can help will be down the road, when disaster fatigue sets in, and also to “backfill”  basic health services in unaffected areas where the Nepali nurses have and doctors have been shifted to Kathmandu.

We will all learn more as the full extent of damage is revealed in coming days.

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the perfect #NurseWeek present for the #nurse in your life, or for a new graduate

This blog entry will be brief.

Nurses Week comes up soon, in May.

Also, this year’s crop of new graduates will proudly walk on to the stage and accept their diploma.

If you need an idea for a present?

give them money.

But sometimes money is not enough, or too crass, so – buy this book. The Sacrament of the Goddess was written as an adventure story that will appeal to health care workers who have the daydream of using their skills in a Low Income Country. If you order it now it will get to your house before May 6th.

It’s a page turner, set in a hospital in Nepal during the Nepal Civil War.

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Nursing in Hawaii blog is still on Hiatus while I’m in #Nepal until May 30

Thank you for wandering into this blog site!

Though it’s titled Nursing in Hawaii, most of it is devoted to general advice about nursing. There are three blog entries that seem to get the most hits – look on the list at the right and you can see them in all their glory.

Work in Hawaii?

I do have specific advice for nurses from the mainland who want to work in Hawaii. In summary, if you enjoy the cultural stuff, you will love it here. You can maximize your fun by studying the different cultures of the patients and co-workers you will meet. Browse the blog entries to find the gems…. I love Hawaii!


You may wondering why the blog is suspended. Well, the answer is, I have been following a lifelong dream and working in Nepal for a year. I am making a difference in health care in this country, and every day I thank God for designing my life so I can do this.

Read my Book?

My second book is a novel about Nepal health care. It’s titled The Sacrament of the Goddess, and there is a FaceBook page for it. Click here to get to the Amazon site.  Also I have another blog, just for the book.

The book is enjoying popularity here in Nepal, as crazy as that sounds. Want to read a review in Nepali language?

I will return to USA after May 30th.


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2014 in review for Nursing in Hawaii

Most of my blogging has shifted to http://www.joeniemczura.wordpress.com while I am in Kathmandu. But this blog is still up. I am humbled by the fact it reached 124 countries.

Wishing you all success for the new year!

The WordPress.com stats helper monkeys prepared a 2014 annual report for this blog.

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 43,000 times in 2014. If it were a concert at Sydney Opera House, it would take about 16 sold-out performances for that many people to see it.

Click here to see the complete report.

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Kaci Hickox and her license to practice nursing in Maine Oct 30 2014

The right wing nut jobs are going crazy about Ebola.

First off, before you go anywhere, check out one or the other of my two books on Amazon. Yes, I am a USA Registered Nurse, with both teaching experience and adult critical care experience; yes, I have worked with infectious diseases though not Ebola; and yes, I try to convey to my readers about the experience of nursing in a Low Resource Setting. I have a nursing license in the country of Nepal and I’m currently living in Kathmandu teaching critical care nursing.

Get to the Point?

I heartily applaud Kaci Hickox, RN, BSN, MPH for her work with Ebola victims. On the internet I found a small PR piece about her from the U of Texas at Austin, which gives a short version of her CV. She is the kind of person we need on the front lines fighting this illness.

Ms. Hickox has become a celebrity, by a strange twist of fate. Most likely she would not be famous unless Chris Christie, the Governor of New Jersey, hadn’t tried to wrongfully imprison her in The Garden State. I do not know any USA nurse that would voluntarily forego a daily shower or opportunity to practice meticulous hygiene; What was Christie thinking?

One thing that makes me laugh is so many comments saying that the Maine Board of Nursing (MEBON) should pull her license – i.e., take it away or prevent her from working in Maine. A fellow nurse went so far as to find the MEBON website where it lists possible disciplinary actions.

This is simply not possible. Why? because Ms. Hickox does not have a Maine RN license in the first place.  (you can search for the licnese of an RN in Maine, online). For that reason, the MEBON can not do anything about her. From what I can tell, Ms. Hickox is going to Maine to chill out for awhile and await the 21-day period. It’s a fine place for that sort of thing.

As an aside, this reminds me of that famous quip by the late John Silber of Boston University. They asked his opinion of nuclear power. He replied “Maine is a good location for a nuclear power plant-where the damn thing could have an accident and not hurt anybody.”(sic). This did not endear him to the people of Maine.

disclaimer: I don’t speak for the Maine State Board of Nursing. I am writing this because I doubt that the Board will make any statement. It’s not a political agency.

Nursing licenses, like most professional licenses, are administered on a state-by-state basis. The exception is the “multi-state nursing license compact,” of which Maine is a member, but even then, Maine has no jurisdiction over Ms. Hickox. If you don’t have a nursing license in Maine, and you don’t try to practice nursing in Maine, the Maine State Board of Nursing will not do anything about you.  It’s not in their mission.

The Board’s mission is “to protect the public” from incompetent or impaired nurses and to regulate the practice of nursing. Since Ms. Hickox is hanging out at her boyfriend’s house and not seeking employment, she is no threat to the public.

The Board can only act against the license, not the person. The Board can not put a person in jail.

Finally, it is crystal clear that Ms. Hickox in engaging in public advocacy in the highest tradition of American democracy and the Code of Ethics for nurses.  Any nurse knows that the most important part of their job is to “speak truth to power” and that is what she is doing.  Boards of Nursing in general are reluctant to use their authority  to limit this type of activity. To give a corollary from Medicine, Bill Frist, the doctor/former Senator from Tennessee, did not lose his license to practice medicine despite his pronouncements about Terri Schiavo.

Finally, even if Ms. Hickox does develop the fullblown illness, it does not change the validity of her position on the abuse of power taking place. She is presently not contagious. She is following the CDC guidelines. Christie ( and now LePage) need to actually seek the advice of scientists, and stop making things up as they go along.


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This blog is not dead, it’s in suspended animation

Why no entries lately?

I keep my blogs separate ( or try to…) and since I’m in Kathmandu, Nepal, the action has moved to my Critical Care Nursing in Nepal blog. Click here and you will be transported to that other place.

The Sacrament of the Goddess

in case you are wondering, my second book, the novel about love in the time of the Nepal Civil War, has been published in USA. You can find it on Amazon. No, it’s not on the New York Times Best Seller list. Not yet anyway.

Nepal edition?

I’m working to get it published in Nepal. The people here are interested in this book – after all, it’s about their country!

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Add May 1st to your literary calendar

the water at the tap outside was cold but she shampooed her hair anyway because that is how it always was.

the water at the tap outside was cold but she shampooed her hair anyway because that is how it always was.

be sure to click on the highlighted text, those are the hyperlinks

UPDATE: You can now find the book on Amazon. and – pre-order it. Click here to find The Sacrament of the Goddess and order your copy!

Brief announcement

The Sacrament of the Goddess will be published around May 1st 2014. This is my long-awaited second book, a novel of Nepal.

There is a FB fan page for The Sacrament of the Goddess. Please “like” the page. The book has no photos, but the FB fan page will post some so as to help people visualize events ( even though it is a work of fiction).

And there is a blog as well.  I  invite you to become a devotee of the blog.

Book Giveaway

On GoodReads, there will be a book giveaway. If you have a Goodreads account you can enter. If not, create an account. It’s easy.

Pre-Publication reviewers needed.

One challenge when a book is released is how to inform people as to the topic, etc.  For this reason, it’s important to get some reviews posted on GoodReads and also Amazon. I am willing to send pre-publication copies of the book to a half-dozen or so persons who might write a review of it. feel free to contact me and we can discuss.


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