Monthly Archives: January 2012

Especially for the older nursing student – it’s not about what you know

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Nowadays nursing is a popular choice for older students, whether it’s a person who already has a college degree (and is going for Master’s Entry into Nursing, or MEPN), or an LPN going back to get the degree, or somebody who needs to change careers.

Nursing school is a shock to the system

Regardless of how you got to nursing school, you find yourself back in college, back on the treadmill of studying, exams, seminars, group projects – everything. It’s a shock and a transition. For many, the shock is eased by the fact that you needed to take prerequisite courses before you finally got on the bus through nursing school, and this served to get you back into Study Mode. But it is still a shock as you learn what it is that nurses do.

through it all, there is something not to say.

“I already know everything I need to know, I am simply here to get the credential, sit for the NCLEX, and get a job. I don’t want to hear about all this theory. Just tell me what I need to do to pass the exam.”

(yes, I have heard actual students say those exact words.)

I would be the first to admit that getting a job is an okay motivation for choosing nursing, though it takes more cleverness right now than it did a year or two ago ( and yes, the job market will improve in a year or two, by the time you graduate). But if you repeat this statement in front of a faculty member, don’t be surprised if they raise an eyebrow… or two. Usually the response will be “Oh Really?” but that is not what the faculty member is thinking…….

What the faculty knows, that you don’t know

Here is why. Nurses are not paid for what they do, nurses are paid for how they think. This is such an important motto, it ought to be a tattoo (which is of course, the best way for The Youth of Today to study it).  Oh yes, we are teaching you how to insert a foley catheter, how to prepare a medication, how to start an IV, and a pile of other skills. But the skills in and of themselves do not compose the nurse. Don’t get me wrong – you need to be excellent at those skills and more. But, you need to learn how to think about patients in a wholistic manner, and also learn when not to do the skill, or when & how to change the way you do it to fit a given situation. this is the thinking part. Assessment-Plan-Intervene-Evaluate. A nurse is not a Junior Doctor; no matter how much we teach you about medicine that is only part of the nurse’s role.

for the older student

It’s possible that your faculty member may not be familiar with the term “Role Socialization” – but that doesn’t mean you can ignore this concept. Some people look at it and focus on the socialization part – thinking that maybe we mean you should be friends with your classmates. No, that is not even remotely what it means. Role socialization is the way a sociologist would describe the process of becoming a Nurse with a capital N.

Ask Yourself: How would a real nurse deal with whatever situation you are now facing?

The flip side of the coin

Here is a hint: if you ever want to impress your faculty member, ask them “How am I doing with role socialization?” and see what they say. They will most likely be impressed at the sophistication with which you are approaching the work.

If you are having difficulty getting it, the lack of role socialization will show up in your work. When you do patient care, you will miss things that you shouldn’t, and people will give you negative feedback about your “priority setting.” Or else, “lack of caring behavior” – which is of course, a dagger to your heart. A nurse’s number one job is to “care.” – we’ll go into that at some future date.

One solution? just do a websearch on the term.  You will find that there is a whole other universe out there among nursing scholars. The process of role socialization, and it’s success or failure, is a strong current in nursing education. Most of the links to it are to be found in scholarly journals. Looking for a research project?

One small Jedi mind-trick that real nurses use

Here is one tip: if a patient ever asks you a question, resist the urge to give them the answer. Always continue the dialogue by asking a followup question to clarify what ever they just said.

Boys vs Girls

I have two daughters. My wife and I, being children of the sixties, thought we would raise them in a gender-neutral way. Yes, we taught them to enjoy sports and boisterous play, such as throwing a football and go camping, and (later) to drive a stick. I built them a sandbox and got them a toy dump truck and a toy back hoe. But, even without our prompting, the two young ladies would spend time playing with dolls, doing hairplay with each other, and the like. To have kids is a fascinating experience in how girls learn to be girls and boys learn to be boys. Gender roles. the best example of socialization. Hey, I didn’t create the system, I simply bow to the fact that it exists.

Just for Men

Now, for the male student:

There are special challenges in role socialization for men who enter nursing. My best advice is to find the book “You Just Don’t Understand: Women and Men in Conversation” by Deb Tannen. Yes, it was published twenty years ago.  But it is still a classic. It’s a guide to clear communication when gender roles are different. It’s kind of book you can pick up and read from randomly yet you still will get something out of it. And on Amazon, you can get a copy for less than a dollar, plus shipping and handling.

Whenever I have a male student who is having trouble adjusting to nursing school, I lend them this book. Right now, I have no copies left…… hmmmmmm…..

Just one excerpt:


“For girls, talk is the glue that holds relationships together. Boys’ relationships are held together primarily by activities: doing things together, or talking about activities such as sports or, later, politics.” (pg. 85)

“Women and men are inclined to understand each other in terms of their own styles because we assume we all live in the same world. [A] young man in [Thomas Fox’ college] writing class noticed that his female peers refused to speak with authority. He imagined the reason to be that they feared being wrong. For him, the point was knowledge, a matter of individual ability. It did not occur to him that what they feared was not being wrong, but being offensive. For them, the point was connection: their relation to the group.” (pg. 179)

If that hasn’t whetted your appetite, I don’t know what will…… remember, it’s not about what you know, but how you think….

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Nursing students – the glass is half full!

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and why not buy my book? I have been in some difficult patient care situations in my career, but I have found ways to cope. My book may not help you get a nursing job, but maybe it will help you get perspective on what is important in life.

To get a nursing job, be an optimist

Sometimes if you are being discouraged, the person interviewing you picks up on that vibe. There is an old saying that goes “hire for attitude, train for skills” – and it’s true – showing some enthusiasm and engagement wins every time.

Selling Hope

My brother recently sent me a quote from the Optimist’s Society, which I will get to in just a bit. I have always thought that one of the most important things a nurse can do for a patient is to offer the hope of a better future. This can be done by looking the patient in the eye and saying one of the two possible things:

“we can get through this”


“It doesn’t have to be this way. we can work together to make things better.”

each of these can be magic, especially if they are backed up with a plan. Frankly, to say a small prayer for yourself will often help the process along – I am happy to report that when my prayer life improved, my nursing care in difficult or challenging situations also improved.

Marie Manthey

There are nurses who have spent a lot of time working on how to offer hope and to be the kind of nurse people look up to. The most notable is probably Marie Manthey.  She has a WordPress Blog, too!  If you have ever been in a work setting where nobody helped each other and everybody seemed to have a chip on their shoulder, you probably wondered what it took to turn things around. Ms. Manthey was one of those persons who identified the results of poor work culture and developed tools to create an environment where nurses supported each other and a positive attitude turned things around. Bravo!

“Thank You”

This is a phrase I use a lot. Once when I changed jobs, at the new job I made sure to thank each of my coworkers at the end of the day. I literally said “Thank you for today. we did a good job, together.” At first they thought I had two heads. Then, tentatively, they started doing it too. And we could build from there. Work does not have to be grim all the time. You can start with a few small steps. Things like learning the names of the custodial staff at your workplace. and using the names. When somebody in a work group starts with an attitude of gratitude, magic happens.


any way, the Optimists Creed is the thought of the day.

Promise Yourself –

 To be so strong that nothing can disturb your peace of mind.
To talk health, happiness and prosperity to every person you meet.

 To make all your friends feel that there is something in them.
To look at the sunny side of everything and make your optimism come true.

 To think only of the best, to work only for the best and to expect only the best.
To be just as enthusiastic about the success of others as you are about your own.

 To forget the mistakes of the past and press on to the greater achievements of the future.
To wear a cheerful countenance at all times and give every living creature you meet a smile.

 To give so much time to the improvement of yourself that you have no time to criticize others.
To be too large for worry, too noble for anger, too strong for fear, and too happy to permit the presence of trouble.

Imagine what your workplace would be like if this was the way everyone contributed.

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Royal Elephant Brass Band at Honolulu Mardi Gras Feb 21st 2012

UPDATE: there are some terrific bands playing at Mardi Gras in Honolulu – They’ve got a cajun band, some zydeco, some swamp rock, and of course, some terrific Brasilian Carneval music. BUT since the Royal Elephant Brass Band and Anti-Poaching Society is  Honolulu’s  one and only New Orleans-style authentic old-school right-from-the-seventh-ward street parady let’s-have-a-jazz-funeral brass band, we are supposed to be everywhere at once. And also, to  s t r e t c h  o u t   our playing and pace ourselves so that we still have some lips left at the end of the gig.

So, for your listening pleasure we have an intricate schedule, and those of you who wish to second line all night, and shake your bootie til it falls off, can take a look.  

Here is the minute-by-minute schedule for the Royal Elephants for Tuesday Feb 21st at the big block party.

5:30 PM the band gathers at The Arts at Mark’s garage. the streets get closed off at the stroke of 6 PM!

6:00-6:15pm – Perform Near Troubadour Stage –

6:30-6:40pm – March into and perform at The Arts at Marks Garage –

7:00-7:15pm – Perform on Int’l Stage –

8:45   -9:00pm – Perform Near Gumbo Stage –

10:00-10:20pm – Perform inside The Arts at Marks w/ Cherry Blossom Cabaret

The Party Itself

The big block party for Mardi Gras in Honolulu will be Tuesday Feb 21st – Mardi Gras, by definition, is always on a Tuesday. The Royal Elephant Brass Band and Anti-Poaching Society will be there. Last year’s Honolulu Mardi Gras was lots of fun for us – though I confess we did not stay until the end. Since we are the only old-school  New Orleans-style brass band in this town, we wouldn’t miss it!

We will actually be the first band to play. The streets get closed off for this event, but they can not start setting up on the street until the stroke of 6 P.M. – consequently the bands which require a sound system and a stage and microphones etc are not able to start until the crew works feverishly to put it together.

We played a short TV promo last year – click if you want to see me in a gold sequined shirt.

Carneval – Oi Brasil!

There is a Brazilian Carneval focus since the Brazilian community of Honolulu is very prominent.

Our band does not need amplification ( my trumpet can be heard a half mile away).

In N’Owlins proper, a small marching brass band is used to herald festive events, including funerals. That’s what we do ( we have yet to play a funeral in this town though). so – we will be on the street, moving around.

Second Line

the general public is invited to “second line” with us. Now, the “first line” at an event consists of the people who paid for the band, but one of the amazing cultural things about New Orleans is that anybody can join in, that’s where the term “second line” comes in – you don’t need to know anybody – just do it.

Need Help?

On YouTube, you can find a short teaching video on how to be a respectable second line dancer. It’s easy and fun. It’s a bit more fun if you have a prop, such as a fancy parasol or a walking cane. And of course, a top hat!


A musical buddy of mine used to say, “we’re not creating music, we’re creating energy.”  I found a terrific description of that way of thinking, as applied to New Orleans music on Good Reads:

“Mac Rebennack, better known as Dr. John, once told me that when a brass band plays at a small club back up in one of the neighborhoods, it’s as if the audience–dancing, singing to the refrains, laughing–is part of the band.  They are two parts of the same thing.  The dancers interpret, or it might be better to say literally embody, the sounds of the band, answering the instruments.  Since everyone is listening to different parts of the music–she to the trumpet melody, he to the bass drum, she to the trombone–the audience is a working model in three dimensions of the music, a synesthesic transformation of materials.  And of course the band is also watching the dancers, and getting ideas from the dancers’ gestures.  The relationship between band and audience is in that sense like the relationship between two lovers making love, where cause and effect becomes very hard to see, even impossible to call by its right name; one is literally getting down, as in particle physics, to some root stratum where one is freed from the lockstop of time itself, where time might even run backward, or sideways, and something eternal and transcendent is accessed.”    ―      Tom Piazza,        Why New Orleans Matters

First Friday Feb 3rd 2012 7 PM to whenever

If you want to get a head start on the second line, be advised: The Royal Elephants will be creating music at the First Friday  Art Walk on February 3rd, starting at The Arts at Mark’s Garage and strolling around from there.  Come join us.

laissez le bon temps roulez!


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How “Whoopie Pie” got started with backpacking

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Ever since they were little, I took my kids hiking, camping and canoeing. I was (still am…) an Eagle Scout.

Ten days in the summer of 2000.

Many of the readers of this blog will know that my younger daughter Amy, also maintains a blog, and she often writes about outdoorsy stuff.  Amy has many accomplishments in the area of camping/hiking/backpacking/canoeing, not the least of which is that she did a through-hike of the Appalachian Trail in 2010.  For the  uninitiated, this is a marked footpath through the mountains of the eastern USA which is 2,170 miles from Georgia to Maine. She started Jun 1st and finished Oct 29th.

“Did she do it alone?” is always the first question any woman asks.

Um, sort of. She was a party of one, but I would say she was not alone for very long. How do I describe the cult-like traveling community of fellow-hikers that forms, re-forms, and mutates along the way? Amy was “Whoopie Pie” and joined the cult. No, she was not alone. But as to who she was “with” –  that’s another story. Amy’s sister joined her to traverse New York; her mother joined her in the huts of  the White Mountains; and though our paths crossed in Glencliff New Hampshire, my own co-hike consisted of the section between Bellview New York and the Susquehanna River – in other words, about ninety miles in the Great State of New Jersey. (which was nice – please refrain from the New Jersey jokes. the A.T. in NJ does not go through Newark… we did climb the highest point in the state, aptly titled “High Point, NJ”).  This was considered to be a bit odd. Most through-hikers have a support team of sorts, but the support team evidently does not join the pilgrimage, most of the time.

The through-hike is best told by Amy. For me, I was flattered recently when she wrote about a previous hike she and I shared, the Hundred Mile Wilderness, in 2000. Back then, I had ten days off and decided I needed to do a trip. She came along.

Trail Stories

There are too many favorite vignettes of the y2k trip to tell them all. How we got our Trail Names. The secrets of the logbook. Spending five of the ten nights as the only people at whichever lean-to we bunked in. The night some sort of Creature approached Potaywadjo Spring Lean–to and we prepared to fight it off. The lunch on the flat rocks, an hour gazing at a micro-universe of tadpoles in the shallow water. The people we met. Crossing rivers, climbing mountains, surviving the weather. Obsessing about the chimney at Chairback Gap. Standing on Little Boardman Mountain looking south and using my walking stick to say “see that ridge in the distance? That’s where we’ll be in four more days of continuous walking.”  Almost burning down the Cooper Brook Fall Lean-to. Chances to just sit on a high place and dream about the world. Meeting the other long distance hikers and realizing that 98% were male.  Meeting and sharing a lean-to with through hikers who had come all the way from Georgia already….

But one story I will tell.

The second night of the trip we spent at Wadleigh Stream Lean-to, partway along Nahmakanta Lake. When I was there in 1982, it was brand new; I dunno why I expected that it still would be, eighteen years later. As the trail approached the lean-to, it was obvious that it was occupied. Lounging on the wooden floor,  five women casually played cards while singing a folk song  – in harmony. I said hello, and they greeted me with a chorus of southern drawls….. “are you ladies from the South, by any chance?” they all gave the “oh puh-Leeze” gesture at once, and the oldest  batted her eyelashes as she said “we don’t go divulging our secrets to any old YANKEE!”

I took off my Stetson cowboy hat and held it over my heart with a flourish, silent for a moment. I tried to sound like Colonel Sanders as I intoned “I do believe there is a standard of northern hospitality which I will endeavor to follow and I am honored to make the  acquaintances of five southern belles such as yourselves”

And with that we settled in. I got a space near the wall, and Amy would sleep between me and the five ladies, two of whom decided to move to their small tent. I knew Amy would now have some role models for women hikers. Turns out three were from Tennessee and two were from Utah. They all talked with Amy. Good. One of the Utah girls sported a black-and-blue on her thigh the size of a tea saucer, now turning green.  Amy listened wide-eyed as the hiker told of her fall coming down the chimney of Chairback Gap,  and how she was too hurt to hike anymore that day. The young lady had pitched her tent at that spot and stayed a day til she decided she felt better. Dad, how many days til Chairback Gap?!?!?!?!?!

The evening was pleasant. In the middle of the night there was a burst of torrential rain, and I got up, took everyone’s clothes off the clothesline, and brought it all in.

 Breaking Camp

Morning starts early on the Trail, and my habit on that trip was to get up and boil water so as to hand Amy some cocoa and some oatmeal while she was still in the sleeping bag. I was determined to show her some small luxuries and consideration so she would enjoy backpacking. Next to her, the Utah girl with the bruise was preparing her pack for the day.

First, she rolled up the sleeping pad and the sleeping bag in a very particular way. Just So. The she made her breakfast and ate it; but afterwards returned every single item to the exact place where it belonged in her pack. Meticulously.  It was crystal clear that she had a system to locate each item and that she had practiced this setup dozens of times, if not hundreds. I could see Amy’s eyes widen as she watched.  Wordless. But taking it all in. The Utah Girl was doing her daily routine but I wonder if she knew that she was performing for a highly discerning audience (of one). Amy and I shared one of those long silent pauses holding eye contact that told me we would dissect this at length later. Which we did. From then on, Amy sharpened her observations as to any little  technique of backpacking shown by others.

And that was the beginning.

Now, I am asked sometimes what is the appeal of backpacking? Why go through all the hardship and privation? Well, there are joys involved, the camaraderie of the Trail, and all that. But I have come to realize that a person needs to have a sort of compulsive streak in order to do this sport. That morning I watched Amy as she watched the Utah Girl assemble her kit for the day. I knew at that moment Amy possessed the type of focus (yes, you could call it a compulsive streak..) that would make her want to go deeper into it.  And excel. People take up backpacking as a way to tweak their compulsive gene.

Okay, just one more

One of the shining moments of the trip came close to the end. We’d eaten most of the food, and both packs were considerably lighter.  We got to the ford of Long Pond Stream, and the water was a couple of feet deep there. Too lazy to take off out boots, the water was slowmoving  and we could have waded across, about thirty feet, holding the packs above our heads. Too much hassle. So we searched upstream for a better crossing point. There was a place about ten feet across where two large flat boulders fronted each other. If only… if only we could get a running jump, we could make it across.

And yes, without a backpack there would have been no doubt. I went first. Uff. Landed on the rock on my belly but slipped in slo-mo fashion into the water, unable to grip the smooth rock to stop myself. Still about four feet deep, but I went all the way in and got my hair wet. Back pack soaked of course. Hat started to float off.

And there was Amy, standing on the rock, laughing at me. “Smart Aleck. Now I will show you how it’s done”

Okay your turn. Loosen your waistbelt. I got out of the way. And she did the exact same thing. She looked over at me as she scrabbled to find a grip on the rock, but she slowly slipped into the stream. Years later when I saw the scene in Lord of the Rings where Gandalf is dragged to his doom by the balrog, I got a flashback to Amy’s crossing of Long Pond Stream.  She come up for air cackling like a bedraggled chicken.

We both slogged to shore, took off out boots and socks, drained the back packs and decided the only logical thing was to have a snack. Ordinarily getting soaked by accident this way might be viewed as a crisis by some people, but what made it so memorable was as we were putting everything back together, we were chuckling and giddy about it. What fun.

I told Amy that ordinarily, people only did stupid stuff like that if they had been drinking.

There were other times that week when I thought about Amy as a lifetime Trail Buddy, but at that moment I knew. Amy was going to thrive as a backpacker. She had discovered her lifetime sport.

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Description of an art object I own…. the “Bird’s Eye” Thangka of Nepal

Most of this blog is devoted to nursing issues, but I have also travelled to Nepal, the setting for my narrative nonfiction book. Want to subscribe to this blog? just go to the little box on the right that says sign me up.

About the Nepal “Bird’s Eye” Thangka

Okay, so the thangka I bought this past summer is 32 inches by 52 inches, and it’s too big to photograph. So – I decided to photograph parts of it. You can use your imagination as to what the entire grand piece looks like…… the nature of this particular thangka is to draw you in, and make you stand closer – there is simply too much detail when viewed from a distance, anyway.

It was purchased at the Thamel neighborhood of Kathmandu in July 2011. To paint a thangka is an ancient tradition. This one shows river rafting, bungee jumping, and the cable gondolas at Manakamana (center-left) so it is not older than 1998.  I had seen it on the wall of a shop, then came back after thinking about it for two weeks. I  was told that this Thangka became available due to the renovation of a hotel lobby in Kathmandu where it was displayed.

Most Thangkas depict a “mandala” – an abstract wheel.  Many Buddhists believe that the Kathmandu Valley itself is a giant mandala, and that the layout of temples and sacred places within the Valley will help the untrained mind to reflect on Buddhist teachings.

In this Thangka, you can see more than just Kathmandu, however, and in fact that’s what appealed to me  – landmarks in the left of the painting show Tansen, a Newari hill-town in the Palpa District; The Bus Park; “Elephant Gate;” and Tundhikel (parade ground). Tansen is the setting for My book, “The Hospital at the End of the World,” (available on Amazon dot com.) and the inclusion of these proved to be irresistible.

Guide to other famous localities depicted in this Thangka.

Bottom edge. Lower Left – Lumbini, the birthplace of Buddha.  Center of bottom edge – Chitwan, nature preserve where rhinoceros, tigers and elephants roamJanakpur, legendary birthplace of the Goddess, Sita. Jhapa, the easternmost district of the Terai, the plain at the border with India.

Left border: Tansen (see above); Jumla.The tower in the upper left corner is thought to be Mongolia, but may also represent the top-secret America C.I.A. monitoring post maintained during the cold war. The forest is Siberia.

Upper leftPhewa Tal Lake, near Pokhara, with the island temple. Devi Falls. Fort with gray steps is Gorkha. River rafting is depicted on the Trisuli River, as is the tourist gondola to the top of Manakamana.

The Himalaya (“snow-covered”) forms the spine of Nepal and is a focal point here, rightfully so!  Peaks depicted include Annapurna, Rum Doodle, Machhapuchre, Langtang, Everest, Makalu, and others.  Note the Yeti and salt traders with a caravan of yaks. A team of alpinists seeks their destiny on the slopes of one peak. Perhaps the ill-fated Mallory expedition of 1924.

Along the upper border: The Great Wall of China; the temple at Muktinath on the Annapurna Circuit; Mt Kailash “The Crystal Mountain;” and the Tibetan Plateau. Monasteries in Tibet include the Potala Palace in Lhasa; Tyenboche, and other pilgrimage sites.

Upper right: Bhutan (denoted by a different style of architecture); Namche Bajaar, in the Solu Khumbu region at the foot of Sagarmatha (Everest); and Taplejung.

Center right edge Ilam, the region of tea plantations. Throughout the painting, there are small scenes of village life, including herding of animals, weaving, and farming.  Women carry the ubiquitous dokha, or woven pack-basket. Terraced rice-paddies punctuate the steep landscape.

In the center is the Kathmandu Valley, capital of the country and main tourist gateway. Curiously, the modern airport is missing, along with the Prithvi Highway.  The location of Shangri-La seems to have been obscured intentionally, though I do have fond memories of my pilgrimage to that mystical place.  My time there will serve as the setting for my second book about Nepal.

Center: In the north Valley is Buddhanilkantha, where the “Sleeping Buddha” rests under a serene pool of water, and Shivapuri.

On the left of the valley cluster is Swayambunath, the “Monkey temple.”  In the city center is Kathmandu Durbar Square.  Narayanhiti Palace faces the “Rani Pokhari” pool. The two towers are the mosques – Sundhara and the “Clock Tower.” On the right of this cluster is a major temple complex which serves as the sacred and auspicious location for Hindu funerary rituals, Pashupattinath. The river here is a tributary of the Ganges, though it is not shown here.

Below that is Mangal Durbar in Patan, across the Bagmati River. A team of men uses ropes to pull the Mechhandranath juggernaut, in a ritual seven hundred years old. To the right of Pashupattinath is the Great Stupa at Boudhanath, largest such temple in the world, centerpiece of the Tibetan expatriate community. The ancient Malla kingdom of Bhaktapuris depicted to the south of Boudhanath, a collection of brick temples with multi-story pagoda-like roofs.

They say you can tell something about the traveller by examining the things he or she brings home. In fact as tourism is promoted, great study is made of the type of traveller likely to visit a place and what they are interested to buy. A certain type of person will bring a t-shirt with the name of the place; still another will bring trinkets. (And of course, a vagabond traveller will bring home some sort of intestinal infestation) The usual traveller to Nepal buys a khukri, or a singing bowl, or a pashmina shawl, or a Tibetan item. And yes, thangkas are on the list but usually these are more abstract. For me, I make a careful assessment of items likely to remind me of daily life – sometimes this is quirky, such as taking home  one of tiny  hand-fired clay pots used to send stool samples to the lab!  One of my best souvenirs is a shawl that was given as a gift from my hosts at the medical center in Bharatpur – it”s the type of men’s shawl worn by the close-to-the-land farmers of the Terai, hand-embroidered with the Kulsani plant ( hot peppers). I tend not to buy the “usual” touristy art objects, but this time I could not resist.

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Should a new nurse go to graduate school right away if they can’t get a staff nurse job?

Funny you should ask… I will answer in a minute, but before you read on, please take a look at my book about hospital care in a Low Income Country. My book won’t help you get a nursing job, but it will remind you of the value of nursing.  And why not go the right of the screen, and click oon the little box that says “sign me up” ?????

It’s a tight economy for nurses

The job market has changed from just two or three years ago. This past month, three different new graduates told me they were worried about their prospects of getting  a staff nurse job. Each of the three asked me the same question.

“If I can’t get a nursing job right away, should I go to graduate school?”


“What track should I take? Is it better to be a nurse practitioner or a nursing administrator?”

The pros:

You will have more credentials.

You will be doing something productive.

In the long run, you can get it over with before you have other responsibilities.

The cons:

Running up more debt in student loans.

Not having enough experience to draw upon.

Still having job search trouble after graduating.

As always, the answer that fits you depends on your circumstance. If you are young and your parents will still foot the bill this is different from being say, thirty and with two kids.

My story

For me personally, I went to grad school after being an RN for a year, worked in ICU while in school, and then took a management job for ten years after grad school. I knew I wanted to teach eventually, and the MS degree was always in the back pocket, just in case. By the time I made the move, I had two kids and a house and a mortgage; I was living in rural Maine far from the nearest graduate program. Having the credential allowed me to make a career change within the nursing profession that would have eluded me if I needed to go back to school right then. So, the timing was auspicious.

I did my grad school in a “Clinical Specialist” track, what would now be lumped in with other ARNPs. There was a window of opportunity in the nineties, when the ARNP standards were revised during which I could have become an NP with nine more post-Master’s credits, but I decided not to at the time. The classes would have been 65 miles away; it would have cost $2500; I would have needed to do a clinical placement in an MD office practice. Finding the MD sponsor would not have been a problem, but I always did ICU and the thought of looking at otitis all day or dealing with management of HPTN, was not appealing. Those things are important but in my heart of hearts I wanted to be doing hospital-based acute care.

Call me a traditionalist.

How many NPs do we need?

For awhile there, the federal government was subsidizing the expansion of NP programs around the USA. There are statistics to say we need these primary care providers, but I wonder. When layoffs and restructurings happen in the health care industry, reductions in clinic staff always seem to involve the NPs before the doctors. I just don’t think the underlying reimbursement structure is well-established enough. And if you are a family NP? There are fewer kids nowadays and family care includes a lot of clients who lack insurance. This has been true for decades. Even in the 1980s, both of the two pediatricians in town had less take home pay than I did as ICU manager of the local hospital (they had office overhead, employees, etc).

What does an ARNP do all day?

A friend of mine in Maine is a women’s health APRN. She spends her whole work day doing contraceptive counseling, pelvic exams, and fitting diaphragms, IUDs and depo-provera inserts. She loves what she does. Simply gushes with enthusiasm. I don’t want to deny the importance of women’s health – it is critical. But would I want to do that? No way.

There is significant Continuing Education required to be an ARNP – to maintain certification takes 80 hours per year (varies from state to state).  this is a sizeable investment of time and money. Yes, we need to stay current in our field. But this is time spent away from patient care activities.

How to fix the nursing job market

In My Humble Opinion, we need to fix the gridlock in Washington DC before the health care situation will be improved. We have a series of paradoxes: lots of patients; lots of need; a huge cohort of older nurses preparing to retire in the next few years; and a larger supply of newer ( younger) nurses waiting in the wings. But jobs in health care are being held hostage by Congress. We need to get some grownups in charge back in the Capitol Building.

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Ten chores every Maine Nurse needs to do this winter to fight the MaineCare cuts.

You are invited to browse previous topics of this blog. Click on the little button to the right that says sign me up. If you want to see a video of me in Nepal,  click here.

Yes, folks, I still read the Maine news from where I am now.

I still have an active Maine R.N. license, and I am still a member of ANA-Maine, the professional association for nurses in the Pine Tree State, and I was very pleased to see that the current officers are continuing a proud tradition of activism as they speak for nurses and patients.

Disclaimer: I  am not  presently an officer and I am not authorized to speak for the Association.  I support their position against the MaineCare cuts, wholeheartedly.

I got the  ANA-Maine position statement on the proposed MaineCare cuts, via email and I wish to chime in.

The Bangor Daily News  added a piece on the impact of the proposed cuts, to the hospitals and health systems of Maine. There isn’t much I can add, except that Maine is already struggling. You have a state with vast distances, weather challenges that tend to isolate people, and a system of small hospitals that are critical to the communities they serve.


Part of daily life is to do your chores, and I propose that every RN in Maine add the following chores to their list.

1) find out who your State Representative is. You can go to the State of Maine website, go to the list of towns, and click on it.

2) find out who your State Senator is. similar to the above, go to the State Website. 

3) It goes without saying, that you should send them an email or a Tweet, or write a letter on the subject of how the cuts will affect you personally, but more importantly, how the cuts will affect the health services in your town.  This is doubly important if your rep or Senator is on the Health and Human Services Committee or the Appropriations committee. One person can make a difference.

4) attend a meeting of your town’s Republican or Democratic Town Committee. It doesn’t matter which. Health is a bi-partisan issue.  Go to the one you feel comfortable with. Raise the issue of the budget cuts there, when you go. Get the  email contact info of the town Chair, and get their Twitter info while you are at it. Twitter will allow you to keep abreast of issues in “real time.”

5) offer to meet with your Representative or Senator when they are back home in the district.   Give them a tour of your workplace (obviously, you need to get permission) and work to educate them as to what you do. You may be surprised to learn that they may not actually know what nurses do, or what your agency or hospital does, or how many people you serve.  This is true regardless of which party they belong to – Republican or Democratic.

6) Organize. nowadays, through FaceBook and the internet, this is easier than it used to be. Join the FaceBook page for nurses opposed to the cuts. Start collecting email addresses of  other nurses, start forwarding news to other nurses. send your list of email addresses to ANA-Maine, so they can add you to the list.

7) work to elect candidates who know the value of nursing and what nurses do. As above, this can be nonpartisan, because health is a nonpartisan issue. 2012 is an election year.

8) join ANA-Maine. you can invest in the future of nursing. Many of the state budget cuts are the result of federal policies, since one of the major parties in DC is doing everything they can to cut budgets and obstruct. We won’t succeed in Maine unless we can get help from Washington, DC

9) write a letter to the editor, start a blog, change the conversation. One of the reasons the politicians think they can make these cuts is, they never see any opposition.  We need to change the conversation away from  one in which MaineCare is somehow the enemy, and toward the idea that there are vulnerable persons who need help on a daily basis, to lead their lives. It’s true. They are there. The average citizen doesn’t see them every day, but nurses surely do. Every Mainer deserves dignity and respect. Just because they suffer from Alzheimer’s Disease, or mental illness, or physical disability, does not take away their humanity.

10) share this list of activities with every Maine nurse you know.  Click on the little button, below.we can do this, together.

and while you are at it, read my book about health care in Low Income Countries.  People complain about Maine’s health system, but they often have no idea about how most of the world does by comparison… book will not help you preserve Maine’s system, but it will remind you as to why we all do this job…….. hint: it’s not for the money!

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ANA-Maine statement on proposed MaineCare cuts January 2012, re-posted

reprinting this here as a public service.

will chime in with my own two cents, in a separate entry.


American Nurses Association – Maine Position on Proposed Maine Care Cuts to Beneficiaries
January 3, 2012
For Immediate Release: Contact Irene Eaton-Bancroft and Juliana L’Heureux
American Nurses Association of Maine
Cuts to eligibility for 65,000 Maine Care Beneficiaries

Position Statement on Governor Paul LePage’s Proposed Supplemental Budget
As presented to the Second Regular Session of the 125th Maine Legislature
The American Nurses Association- Maine is a constituent of the American Nurses Association (ANA).
ANA-Maine supports the right of every person to have access to quality and affordable health care throughout their life span, regardless of their socio-economic status. Access to health care is a basic human right of all people (ANA-Issues Brief: 2010)
The mission of the American Nurses Association is to advance the practice of nursing by improving the access to quality health care for all people.
For these reasons, the ANA-Maine supports access to health care for the proposed 65,000 people currently targeted for removal from the Maine Care benefit, as per the Supplemental Budget proposed by Governor Paul LePage, to the Second Regular Session of the 125th Maine Legislature.
Maine Care is an essential safety net for low income eligible people who include
(a) frail elderly living alone or in assisted living
(b)serious and persistently mentally ill
(3) people living with disabilities, and
(4) children.
Even without Maine Care coverage provided for eligible beneficiaries, an estimated 10 percent of Maine people still have no health insurance whatsoever. (Morning Sentinel- Kennebec Journal: Alice Knapp; January 2, 2012)
Removing another 65,000 people from the Maine Care benefit, without providing for their health care coverage, will unjustly cause further strain on Maine’s health care providers, many of them already facing deficits due to low reimbursement from insurers. .
American Nurses Association – Maine Position on Proposed Maine Care Cuts to Beneficiaries
Additionally, the ANA-Maine is concerned about how the proposed Maine Care cuts are being considered and evaluated given the following impact information:
1. Cutting 65,000 people from the Maine Care benefit will impact on every community in Maine by putting at risk the public health and safety of people who will be without access to health care.
2. Providing health care to uncovered individuals will immediately lead to a rise in health care costs for charitable institutions, where the indigent will seek urgent help; as well as to hospitals, that will be forced to pass the cost of increasing amounts of free care to their private insurers and private paying clients.
3. Although cutting 65,000 beneficiaries out of the Maine Care benefit is a short term solution to growth in the program, in the long term, these proposed cuts will end up increasing the utilization of more expensive, and less supportive, or proactive services, like prevention and wellness initiatives.
4. Maine citizens who are currently employed in community health organizations where Maine Care beneficiaries are receiving primary care and social services, will loose their jobs. The quality and the integrity of many excellent community health programs and mental health facilities will be at risk as a result of high staff turnover.

Please contact the American Nurses Association of Maine for more information regarding our position on the Maine Care benefits cuts to 65,000 people as proposed in the Governor’s Supplemental Budget to the Second Regular Session of the 125th Maine Legislature.

Contact Information:
Irene Eaton-Bancroft, President ANA-Maine
Juliana L’Heureux
Chair, Legislative Committee


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student nurse job description – the unwritten rules for success

This one of a series of blog entries on the interface between nursing school and work. Every new grad needs to make the big leap. Past blogs have addressed issues of resumes, cover letters, etc.  Future blogs will address issues of how to make the transition to critical care. You are invited to subscribe. click on the button at the right!

Worked at McDonald’s, ever?

Nursing school admission is competitive these days, and you need to have a good GPA in order to get a seat in the class.  There is a difference between the nursing students from ten years ago, and the ones nowadays.  When studying is the main goal to the exclusion of everything else, it’s less likely that the student has had a part-time job outside of school in the past, not even at a McDonald’s. 

This means that when we teach beginner nursing students, we  also need to teach them about work behaviors. Oh, I believe in focusing on the illness the patient is experiencing, but the faculty would be missing something important unless we spent time saying what it means to have a job and be part of a team. Nursing is labor intensive and twenty-four hours a day seven days a week.

Unwritten rules for any job

The odd thing is that there is always a set of unwritten rules, things that are so common-sensical that a person who has been in the workforce takes them for granted. But when I have a kid who is just twenty years old and not had a time-clock type of job,  I go over “The Rules.”

Nursing is eclectic, and draws from a wide variety of sources for inspiration.  Don’t disrespect McDonald’s – it’s the entry-level job for many a sixteen-year-old around the USA – they teach people how to have a job.

 The Few, The Proud, the Brave

You may laugh, but there is another large organization in USA which has been around a long time, and which has gained a lot of experience giving responsibility to young people. They hire a lot of eighteen- to twenty-year olds every year, and teach them how to behave at their first job.  And so, I have borrowed the minimal job description from them. It’s – The United States Marines. Every Marine is required to memorize a set of Rules during boot camp.

Here is the Job Description for a sentry in the Marines:

“The Rules”

  • 1. Take charge of this post and all government property in view.
  • 2. Walk my post in a military manner, keeping always on the alert and observing everything that takes place within sight or hearing.
  • 3. Report all violations of orders I am instructed to enforce.
  •  4. To repeat all calls [from posts] more distant from the guardhouse than my own.
  • 5. Quit my post only when properly relieved.
  • 6. To receive, obey, and pass on to the sentry who relieves me, all orders from the Commanding Officer, Officer of the Day, Officers, and Non-Commissioned Officers of the guard only.
  • 7. Talk to no one except in the line of duty.
  • 8. Give the alarm in case of fire or disorder.
  • 9. To call the Corporal of the Guard in any case not covered by instructions.
  • 10. Salute all officers and all colors and standards not cased.
  • 11. Be especially watchful at night and during the time for challenging, to challenge all persons on or near my post, and to allow no one to pass without proper authority

Let’s break them down one by one and comment on what they mean when they are applied to a nursing unit.

1. Take charge of this post and all government property in view.

Be on time, and be very specific about which patients are yours and which tasks you will or will not do.  Introduce yourself to all other persons present and communicate.

2. Walk my post in a military manner, keeping always on the alert and observing everything that takes place within sight or hearing.

Don’t sit down on the job, make frequent rounds and check on things regularly. Don’t lose sight of the Big Picture.

3. Report all violations of orders I am instructed to enforce.

Learn what the orders are in the first place, and have a plan for every “order” whether you understand it or not. Know who to call when you need help.

 4. To repeat all calls [from posts] more distant from the guardhouse than my own.

Help the people around you as much as you can.

5. Quit my post only when properly relieved.

Don’t ever leave the floor without telling anybody. Don’t go to the rest room without telling anybody.  Don’t hand off a pateint without giving a report as to how your day went. Always share information.

6. To receive, obey, and pass on to the sentry who relieves me, all orders from the Commanding Officer, Officer of the Day, Officers, and Non-Commissioned Officers of the guard only.

see report, above. check in with your nurse frequently in case the “orders” change.

7. Talk to no one except in the line of duty.

don’t use FaceBook on the job. Turn off the mobile phone. Keep frivolous talk to a minimum.

8. Give the alarm in case of fire or disorder.

have a CPR card, get help when you need it.

9. To call the Corporal of the Guard in any case not covered by instructions.

This is about teamwork and communication. Ask questions when you don’t understand something.

10. Salute all officers and all colors and standards not cased.

Your faculty member, the staff, the housekeepers, every one else who works there – deserves your respect.  If somebody tells you anything, write it down and try to follow it. Yes, there is a pecking order, but that does not mean you should disrespect those who might be further down on the hierarchy. You can not do your job unless the housekeeping staff does theirs!

11. Be especially watchful at night and during the time for challenging, to challenge all persons on or near my post, and to allow no one to pass without proper authority

pay attention to the activities of the patient even if they do not involve you directly. who is seeing your patient and what are they contributing.

Read them, Learn them, live them

Sometimes I am met with incredulity when I talk about these rules with beginner students. They ask “how can this be? aren’t nurses independent professionals?”  They are surprised to learn that there may be any regimentation in nursing. The answer is, we need to have structure and a plan in order to accomnplish anything great.  An experienced nurses makes all his or her activities look like they just unfold naturally and there is a sense of  flow; but there is an underlying structure, always.

I suppose that discipline gets a bad rap when the indoctrination is mixed up with intimidation, such as the stereotype of a Marine Corps Drill Sargeant would present.  Nursing education is conducted with a lot more finesse than a USMC boot camp.

The fact is, we all need to work together as a team, and nobody will give you more responsibility unless you have shown that you can deal with the simple responsibilities. As Atul Gawande and others have described, sometimes excellence is a question of diligently working on the same thing every day and having good habits.

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Tips for nursing students attending your first Job Fair

I invite you to subscribe to this blog. click on the button at Right. Also, check out my book.  It won’t help you get a job but it will remind you why nursing is important.

Job Fairs?

Here in Hawaii we don’t often conduct a “job fair.” It’s  not how things are organized here.

but now I have readers from That mythical place known as The Mainland,  and a Job Fair is one of those ways to get face time with people who are involved in hiring.

Here is how it works: somebody gets a large public space, like a hotel ballroom during a conference, and rents out booths to exhibitors or vendors. Often the organizer is one of the Nursing Specialty Organizations or the State Professional Association such as ANA-Maine or The OR Nurses. The revenue from the vendors is part of the conference budget. The sponsoring organization brings the nurses, the vendors are promised that the schedule will include free time for the attendees to wander around. Often, the conference program will list all the vendors or exhibitors in advance.

Here is a story about Speed Dating

Ten years ago was the first time I taught the senior level management and issues class at a small college on the east coast. We had thirty seniors, since it was a residential college they were all about twenty-two years old. Our career center organized a small job fair right on campus, to which about two dozen local employers came. The Job Fair was held on the day of the class, and I decided to cut class short so as to allow all the students to attend.

I wandered down to the job fair myself about fifteen minutes later and watched what happened. Where was everybody? Half the students were gone within a few minutes; they had strolled through and spoken to nobody. The others were standing in small clumps on the other side of the room from the vendors. This is not good, it’s like a junior high school dance, I thought to myself.

Within a half hour all the nursing students had left. We were a bit embarrassed, as the hosts, because we had hoped that each vendor would make some kind of meaningful contact with our group. Fortunately we had not charged the vendors very much, and nobody came from a long distance, or I would have felt like we should return them their money.

The Assessment

At the next class meeting we spent a bit of time talking about getting over your nerves when you make a “cold call” to a job recruiter. The students expressed the idea that they didn’t know how to start the conversation, or how to act. Now, when these same students were in uniform in clinical they were confident and verbal, comfortable with the hospital setting where they meet patients and families every day. But somehow when the setting changed, the confidence took a hit.

The Plan

We needed to role play a job interview, and we needed to have a better strategy. So, the next semester, when we repeated the Job Fair, we did things very differently.

The week beforehand, we role played an interview, and assigned readings from the book using the chapter on the hiring process.  This included a review of basic body language that people fall back on during times of threat or stress.

The Implementation

The day of the job fair, we did two things. first we paired the students, and gave them an actual role to play. for each booth at the job fair, one was assigned to be the Talker, and the other was assigned to be the Observer.

The Talker was expected to ask all the questions and do the interacting. The Talker was expected to bring a list of questions to ask. At any interview there is always a time when the job seeker is asked “what questions do you have?”  – this is a time where the Job Seeker can display their verbal ability and enthusiasm. If you are the kind of person whose has a brain cramp at this moment, it helps to write the questions down and practice them. There are some standard questions used by a lot of interviewers, and you should be prepared to answer.

The Observer was given a small checklist, and told to stand back and – Observe. Complete the checklist during the interaction, as if this whole thing  were an experiment in a sociology class.

The checklist was simple. it included:

eye contact?

handshake and introduction?

“open” body language?

asking three questions?

answers to questions?

looking enthusiastic?

positive statements?

Each pair was to use this at six booths, taking turns so they Talked three times and Observed three times.  In between each booth, the pair was assigned to go to a corner and debrief, so the Observer could give their partner feedback as to how she did in meeting all the elements.

Picking the order of booths to visit is a strategy

I also told the students  to choose the order in which they approached each booth. If there was a vendor that was truly the one they really really wanted, they should go to that one last. If there was a vendor there representing some hospital or agency that was too far away or where they Talker never intended to apply, don’t simply omit this one. Go there anyway, and talk with them. You might find that they are more interesting than you think, and also, the stress will be lessened because there is nothing at stake.

The Evaluation

When we used this approach, the students stayed a lot longer, and after it was over, the vendors expressed their appreciation. Every vendor at a Job Fair works to send people who will be approachable and nonthreatening, and every Human Resources Professional knows that the person being interviewed will be nervous. The vendors could tell that the students were not so nervous as the previous time.

At the end of the exercise, the paired students submitted their raw notes to me. This wasn’t really “graded” but it did support the self-learning about socialization and seeing how you come across. The only way to do this better would be to video the interaction and allow people to have an instant replay.

One of the students said “it’s like Speed Dating for job interviews”  which is exactly what it was. The Observer partner was the “wing man” for the Talker, and the opportunity to discuss the interaction with a nonthreatening friend was very valuable.

You can go a long way with the dating analogy. Just because you talk to somebody does not mean you need to go down the aisle with them…..

It goes without saying that you should dress for a job fair as if you were being interviewed; and that you should consider writing a followup to each recruiter for whom you have a specific interest.

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