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!

Nepal

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.

Aloha!

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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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and now, for e-book readers… The Hospital at the End of the World

update: I re-added the links, now they will get you to the e-book site.  thanks for pointing this out.

2009

When The Hospital at the End of the World was published in 2009, e-books and e-readers were just beginning to be popular. We didn’t make a simultaneous e-book version.

2013

I took a plane trip to visit my parents and it seemed as though everyone on the plane was reading a e-book, whether it was a Kindle or an I-Pad.

2014

so my publisher and I decided to make available an e-book version. It is uploaded to Amazon and ought to appear there within a few days.

click here to go to the Amazon site.

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Escape the cold with a Nursing Job in Hawaii Jan 8 2014

note: you are missing the boat if you don’t click on the hyperlinks – the colored text. Click here to see how some Americans live

Two phenomenon:

a) record cold in the mainland USA – colder than it’s been in decades due to a “polar vortex

and

b) a small surge in hits on this blog with the title “Nursing in Hawaii

Q: are they related? or a coincidence?

A: darned if I know! But – it’s no accident that there is always a TV show about Hawaii…..

Fact is, this blog has four or five entries that directly address the nursing job situation in Hawaii, and they have taken an uptick in hits for the last month or so, really noticeable this past week.

The first is:  Read This Before You Move to Hawaii to get a Nursing Job.

Next: It’s Official Hawaii has an “Oversaturated” Nursing Jobs Market

then there is: Hawaii Nursing Jobs Update Oct 2013

and: part One Guide to Hawaiian Culture for the Travelling Nurse

along with: Part Two Guide to Hawaiian Culture for the Travelling Nurse

finally, there are special aspects of culture here, and while this one may seem like a stretch, you can have more fun if you approach it this way: Twelve Steps to Prepare for Global Nursing. If you come here, get off the beach and explore. You will find a wonderful mix of Asian cultures here. There is also something called “local culture” which I love love love.

Humbly, I recommend all of the above. When I lived in rural Maine, we spent winter evenings by the woodstove curled up with a cup of tea of cocoa and reading the seed catalogs. (studying the seed catalogs is more like it.)  I suppose the Youth of Today are curled up by the woodstove with their iPad or laptop (does anyone use a laptop anymore?) surfing the Nursing Jobs Board for Hawaii.

This is not new.

In World War Two, the US Government was desperate to promote nursing as a contribution to the war effort. As part of the marketing campaign, there was a series of books based on the adventures of Cherry Ames, a fictional nurse from Hilton, Illinois ( a fictional town; but I bet it’s cold there today!). The third book of the series was “Army Nurse” published in 1944, and the book opens as Cherry Ames, RN is celebrating Christmas in Panama under the palm trees.  Now, everybody knows she was actually in Hawaii but the information was classified.

What is the answer?

Should you move to Hawaii or – no? Well, if you ask me it’s too late for this year. By the time you get here it will be springtime! The vast majority of nurses working here are from here, and we have excellent schools of nursing. There is a steady stream of military nurses who come through here, as well as spouses of military. In past days when the job market was a bit more inviting, Hawaii was a must-stop for young nurses who wanted to use their profession to work/travel around the USA.  (it used to be, if you had a nursing license and walked into a hospital, you could get a job quickly. Not so much these days).  Alas, we do not presently have an acute shortage.

If you should decide, I invite you to read all my other blog entries to prepare. I have truly loved being here. It’s a special part of America, and the beauty of it extends beyond the climate and scenery.

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to teach delegation part 4 – getting “street smart” Jan 3 2014

note: be sure to click on the hyperlinks, the highlighted text. A prize awaits….

Street Smart is the goal.

My favorite definitions of Street Smart are to be found on Urban Dictionary. warning: adult language and content at times, but funny. Possibility of not politically correct. Street Smart is always contrasted with “Book Smart”

Delegation is key to NCLEX success

To teach delegation is to teach “Street Smart” skills, only they never call it that.  This series is to share with faculty colleagues my views on how to teach delegation skills.  In a final-semester-before-graduation course, sometimes the curriculum will mash together content from “Issues and Trends”  “Career Development” and “Leadership and Management” – this is a widely disparate clump of content. Add this to the idea that the students may be having “senioritis” during the second half of the semester.  Finally, students often need to be convinced that the course is relevant – they want something like ACLS or PALS or more pharmacology.

In one of the earlier blogs in this series I gave the rationale for all this emphasis on delegation, but it bears repeating.

read this carefully:

Every Nurse Practice Act includes rules of delegation which are based on the definition of nursing.

The NCLEX content is not solely determined by NCLEX corporation. it is dictated by NCSBN, which uses a sophisticated process to determine the “test plan”

NCSBN test plan says that 20% or more of the exam will be on – delegation.

NCSBN defines delegation and also publishes their own documents to support their definition. Working with Others is the main one. Every nursing students needs this!

therefore,

it makes sense to devote time in nursing school to the specific materials from NCSBN. This is not rocket science.

If your class work on “legal & ethical issues” focuses only on  such things as how not to get sued, or defining “beneficence” or “utilitarianism” – you are wasting your students’ time.  You need to focus on what the rules say.

As an aside, I think one reason that faculty go astray is that few of the nurses who actually managing a ward want to  become faculty members. they are paid too well doing what they do!

and now for today’s Pearl of Wisdom

first, as the NCSBN monograph says: The key to effective delegation is to have assertive interpersonal skills in conflict resolution. So – don’t just teach this by lecture or directed reading. Find ways to make up exercises for the students to role play.

second, when a student is new, they just focus on their own assignment, and the goal here is to develop the skills to analyze how the assignments of all the nurses mesh with each other. Predicting not just what will happen with your patient, but predicting how many nurses will be needed by the unit overall. Figuring out how to work together as a team, how to help each other.

Too often this is taught by just assigning  the student to multiple patients, and watching them flounder around – “sink or swim.”  I guess some students will only start to pay attention when they see that they are not as good as they think they are – but a better way is to teach all the stuff I am listing here.

Friday Night at the E.R.

all this leads me to the subject of today’s blog. Friday Night at the E.R. is a resource for nursing students, and I think every nursing student should play it, especially if they are thinking of a hospital career. I see that for January 2014 the company that makes and sells it, has upgraded the game board a bit to make it easier to play.

An Excellent Simulation Learning exercise

we tend to define simulation learning narrowly these days, as if it can only be done with a high-fidelity manikin and a room with a two-way mirror. That is an artificial constraint IMHO.

FNER was developed as an interactive game to teach teamwork and decisionmaking, not necessarily limited to nurses. It is used by people interested in Organizational Development. It is a board game with a gazillion small parts. It’s expensive but worth it IMHO. It does have complicated directions and requires a facilitator who knows what it is about. (the company has a policy of only selling it to people or agencies that have a registered facilitator.) if you are going to use it, you need to carefully manage the logistics of it – for example, if you have a class of thirty students you need eight game boards. for a class of sixty you may need to have half the group do it one week, the other half the next. You need to schedule extra time – it can not be done in just three hours – the debriefing is as important as the game itself. Simply critical to debrief.

The most important thing about this simulation game, is that the students learns things about their own problemsolving, which is a reason why the makers of the game are a bit vague about the exact conduct of it. I went to YouTube to see if there was anything there that might entice you to seek further information.  I found a gem in which the professor seems to be trying to teach the students “the right way” to do it prior to playing – the exact opposite of it’s intended lesson. And better yet – it’s in French!

If you buy the game, you do get a DVD that tells a lot more. The idea behind that strategy is to allow the students to discover certain things for themselves and not over-teach.

Achieving Street Smarts?

When I have done the Friday Night at the ER  exercise with students, they come back to class after a week or two and tell me that up until then they did not know what the manager of their unit, or the house supervisor, actually did during a work day. “Didn’t have a clue” they say.

But now their eyes are opened and they see their own role as part of the larger team.  They are more focused on admission/transfer/discharge. They have a better sense of their own “agency” – ability to shape their destiny. They are more able to describe the parameters of problemsolving. all kinds of good stuff like that.

I would love to hear from others who have used this…..

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teaching delegation and the Nurse Practice Act, part 3 Jan 1 2014

Third in a series.

Background: How did I get involved with the topic of delegation?

Yes folks, I have fifteen years of critical care nursing  experience, and I am a former ACLS Instructor and ACLS Regional Faculty. I love those subjects, they are exciting and fun.

By contrast, delegation is boring, a sort of grind-it-out, eat-your-spinach-and-take-your-medicine area of nursing.  At least, up until the time you get in trouble with it somehow.

In 2002 I took a faculty job at a school of nursing on the east coast where they were having a low pass rate on the NCLEX exam for first-time takers. At the time of hire I was tasked with re-evaluating course content for the leadership and management class I would teach, to strengthen the NCLEX first-time takers pass rate. (I detest the idea of using in-class time to do review questions.)  After researching this, I found the resources I list here in these blog entries. And by the way, that school on the east coast had a timely and gratifying increase in our pass rates once we gave proper attention to this material.

The first part of the this series dealt with a way to conceptualize the definition of nursing in a way that makes “delegation” easy to understand, using a short YouTube video;

The second part dealt with how a teacher can use certain in-class simulation exercises to show a practical way that nurses implement the Nurse Practice Act every day at work. Summary: give them a list of patients on an imaginary ward and have them make out the nurse’s assignment. then discuss and critique. this takes the content beyond a dry lecture about styles of ward organization. In that blog I recommended the resources from Ruth Hansten, RN PhD, especially her YouTube videos.

Today – the third part of the puzzle. Working With Others from the NCSBN.  This is a 40-page FREE publication of NCSBN that goes into the subject of delegation-  in detail. Originally published in 1998 and updated in 2005.

The next piece from NCSBN is one I recommend highly. it is a package. First a video“Delegating Effectively: Working Through and With Assistive Personnel,” and also a set of overheads. It costs $299. If you click on the hyperlink with the title above, you can see the video broken into five-minute clips on the www.learningext.com website. Now I hate to criticize, but the video(s)  are not the most exciting ever. It’s the accompanying overhead package that is valuable. I used to omit presenting the video and go straight to the overheads.

I always preface it with the following disclaimer:

“This is not the most exciting. in fact, it is as boring as things get. BUT, the material comes straight from the NCSBN, and they are the ones who dictate the content on the NCLEX exam. It says in the exam map that 20% or more of the content of NCLEX is “delegation.” If you wanted to do well on the exam, doesn’t it make sense to go to NCSBN, find out what teaching materials they have provided, and then incorporate those exact teaching materials into this curriculum?”

Usually that short speech creates student buy-in.

ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY ROLE PLAY

In the Working With Others paper, there is a section on interpersonal skills, in which the point is made that “the best set of delegation rules will not be effective if the RN lacks the interpersonal and conflict-resolution skills to carry them out.” (sic).   and so the Working With Others paper has a lot of emphasis on communication and interpersonal skills. This is excellent, very practical. In the package with the overheads and video, you will find a set of seven suggested role play exercises dealing with conflict arising out of delegation. These are pure gold. I always use them. they provide excellent fodder for in-class discussion of delegation.

Cultural comfort with perceived aggressive behavior?

As a complete aside, while in Hawaii I volunteer as a guest lecturer for NAMI and friends, a group in Waipahu that works with newly arrived immigrants from the Philippines who attended nursing school there and now wish to prepare for the USA NCLEX. I always provide this content for that group. When I do the role-plays with recent immigrants in the class, they invariably have difficulty showing assertive behavior. There seems to me to be a cultural component in the reluctance to deal with conflict.  this is in sharp contrast with the more-acculturated students of Asian descent who are educated here in USA.

There are also generational implications for this. If the RN is fresh out of school, they may be in a situation where everybody they supervise is older than they are. but that is subject for another blog entirely…..

I have one more entry in this series. why not subscribe to this blog and be sure you won’t miss it?

 

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2013 in review for Nursing In Hawaii blog

Hi – did you ever wonder how many readers these things get?

The total for this blog for 2013 was 21,748 page views.  Average of 90 per day.

when you own a blog you can check the statistics day-by-day if you wish.

The statistics include such things as the most often used search terms that brought people to your site.  very entertaining.

The WordPress.com stats helper monkeys prepared a 2013 annual report for this blog. I am sharing it with you. I am humbled to see that it is read in 113 countries. After all, It’s a specialized topic. Thank you for reading!

Here’s an excerpt:

The concert hall at the Sydney Opera House holds 2,700 people. This blog was viewed about 33,000 times in 2013. If it were a concert at Sydney Opera House, it would take about 12 sold-out performances for that many people to see it.

Click here to see the complete report.

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