Monthly Archives: March 2012

why the theme change?

I am on spring break, in Massachusetts USA and spent wonderful evening with my brother and his wife and their 18-month old son.

I have noticed that my readers don’t click on my hyperlinks very much. I spend time creating those, sometimes they are silly but other times the links  provide useful back ground.

The written content will be the same eclectic mix of whatever-I-am-thinking, but the layout is what changes. The new theme and look of my site will make the hyperlinks easier to see. when you come across a section of text in blue, that means to click on it to find the hidden surprise…..


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Filed under Honolulu, nursing education

Did you ever work with one of these doctors? – the 12 Medical Specialty Stereotypes – too good not to share

Health status update

Had the opportunity to speak with an orthopedic surgeon today, in his professional capacity.

I told him “hey, I am really really good at chest X-rays” (true, I am not bragging here I can back it up) “but I don’t know anything about knees.”

After the physical exam, history taking etc he turned to me to say:

“There is a problem with your knee” at which point I laughed.

I said ” That’s it! you have proved that you are not an imposter. that’s exactly what I expected you to say. You are an orthopedic surgeon through and through!

He chuckled and said, “You know, my advisors laughed at me when I said I was going to study infectious diseases. They said orthopedics was the only logical  specialty for me. something to do with my personality type…….”

“And occasionally I am called to look at a clavicle fracture but I don’t do chest X-rays.”

So it was a pleasant collegial exchange, and BTW it was very helpful. Nowhere near as serious as I was worrying about.  A simple cure, I will spare the rest of the details. I still need to lose weight and get into better shape. To overdo the exercise was what got me into this fix in the first place.

I think the nature of nurses is to worry and to think the worst…… which got me to thinking.

Physician Stereotypes

I did a quick websearch and found this site.

which is the source of this cartoon:

who ever drew this was spot on, IMHO.

We do need to laugh every now and again……… you can share with me as to whether you think it’s true or not…..

at the website where this resided, somebody pointed out that General Surgery was missing…. inexplicably so – probably my fave among specialties –

Surgery Jokes?

Possibly because General Surgery is not funny. under any circumstance.

Many years ago in Maine I was ice-fishing with a General Surgeon, the same guy who did the Caesarean Delivery of my oldest child. We were discussing this very subject, and he told me the following:

An internist, a surgeon and a pathologist were duck hunting one weekend. they were sharing dinner in the remote cabin when some ducks flew overhead.

“Judging by the call, and the flight formation, and the time of day, there a seventy percent possibility that it was a flight of mallards, but we can’t truly rule out Canadian Geese” said the internist.

The surgeon grabs a shotgun, and fires it through thee wall in the direction of the sound.

He tosses the shotgun to the floor, turns to the pathologist, and says

“Make sure they are ducks’

perhaps not quite so au courant in this day of advanced imaging…

Oh, and I forgot to ask him as to when I could resume playing the piano. Oh well….


Filed under nursing education

What Every Nurse Needs to know about “repealing Obamacare”

Private health care is a myth

If you want to learn about a health system that is utterly  on it’s own with the minimal amount of “government interference’ and a lot of “faith-based care” – buy my book about hospitals in Nepal. During my four trips there I met nurses and doctors who worked a lot harder than their American counterparts, but who had nothing in terms of equipment and supplies.  It was inspiring and humbling to work with an international team of dedicated Christian missionaries, but it was also a shock to see the limitations of poverty and lack of investment in health care, even basic public health, faced by most of the world’s actual population.  My first trip especially, was a shock. I had no idea that people were still dying from some of the things I witnessed with my own eyes.

We live in an invisible bubble

I promised myself I would never ever complain about the equipment or the physical plants of any American hospital, ever again.  On my YouTube channel you can tour a hospital in Nepal. Have a seat and join me there……

Obamacare? hah!

I am going to get straight to the point about The Patient Protection and Affordable Care Act.  It’s the best thing we have done in a long time.   For me, I place a lot of trust in the American Nurses Association and their policy analysis. Click here to find the pdf document titled Health System reform: Nursing’s Goal of Quality, Affordable Care for All .  If you haven’t read it, time to do so.

What Nurses need to know

Health care in America follows an industrial design.    I am devoted listener to NPR, and whenever the economist from Princeton named Uwe Reinhardt is interviewed, he always has things to say about the health care workforce as it related to cost and outcomes.

March 19, 2012

NPR has been broadcasting a wonderful informative series on the Health Care Reform bill, in the run-up to Supreme Court Hearings on the legislation. professor Reinhardt was interviewed on Monday March 19, 2012.  They also interviewed Tony Carnevale, a labor analyst from Georgetown University.

U.S. Health Care Workforce larger Than Ever

Every nurse needs to listen to this segment on the health care workforce.  CLICK HERE.

Here is an excerpt from the March 19th 2012 NPR transcript:

CARNEVALE: What is outstanding about the health care workforce is the extent to which it’s female and the extent to which it’s female at higher wage levels and higher education levels. This is in much the same way the manufacturing workforce – the old industrial economy – was a boy’s economy. The health care economy – the post-industrial economy – is a woman’s economy.

SIEGEL: And it’s an educated person’s economy.

CARNEVALE: And an educated person’s economy.

SIEGEL: People, obviously, who are doctors, have M.D.s, but there are also a lot of people with certificates and associate degrees from community colleges in there.

CARNEVALE: Health care is the most credentialed industry, apart from education itself, in the American economy. ( the interview continues, you would benefit from listening to the whole thing.)

You can get the entire transcript, here.

the bottom line

the bottom line is, when the politicians are talking about controlling costs, they are talking about eliminating nurses jobs. Money does not actually cure or care any body’s  illness. Money pays for the people who do the work to cure or to care. The Federal government has a choice as to budgeting and the congress can fund an industry with (mainly) female-oriented jobs, or else pay for highway improvements (more male-oriented).

I didn’t invent the system by which people choose an occupation, but I see a lot of sense n the way that Rienhardt and Carnevale describe it when they use those terms…… every one, I get to observe it and report on it. Yes folks, that’s the way it works…..

My conclusion?

a lot of this blog is devoted to the issues of nurse employment – esp for the nurses we are now producing, new to the workforce.

 In summary,

I believe that many hospitals ( large employers) have gotten very conservative since we are all waiting to see if the Federal Government will make some dramatic change in health care funding. During this uncertainty, hiring is very very conservative.

I believe that if we  repeal the The Patient Protection and Affordable Care Act, there will be continued cutbacks in the nursing workforce, despite a demonstrated need as the baby Boomers enter retirement age.

I also believe that we have a choice. If we elect politicians who vow to repeal the The Patient Protection and Affordable Care Act, we chose one future. If we elect others who support The Patient Protection and Affordable Care Act, we can impact the direction of health care, and of the nursing workforce.

for these reasons ( and a whole lot of others that are not directly nursing-related) I plan to work for, and vote for, Barack Obama for President, and for other federal officials who will also support full implementation of this critical law.

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Filed under nursing education

Myths about becoming a nurse practitioner – things to consider about grad school in nursing


If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at


UPDATE:  as of February 3rd, 2015, this entry has 38,633 (thirtyeight thousand, six hundred and thirty three) separate views. It’s the single most popular blog entry I have written. Please feel free to add your feedback and comments. 

UPDATE #2 My book, The Sacrament of the Goddess, was published in April 2014 in USA.  Click here to see reviews on Amazon and order a copy. see the cover on the left, below. People  in USA think of Everest when they think of Nepal. Or maybe the earthquake of April 2015. Right now, the political situation in Nepal is precarious; and one aspect of working in a Low Income Country is the feeling of being out on a limb. My book explores the peculiar terror of being a neutral medical volunteer when everyone else is choosing sides. It’s a fast-paced pageturner! The book has nothing to do with APRNs, but might give you some insight as to why any body would ever want to be a nurse…. why not buy it and become one of the cool people? 

related link about paying for NP education, click here!

Disclaimer: I myself went to grad school fairly early in my career – after just one year as an RN. In those days (the 1970s) the federal government supported nursing education with generous grants and stipends which we knew would not last forever. I did not incur any debt for grad school, whatsoever. sweet!  I continued to work as an RN after grad school, and the MS credential surely came in handy when I finally needed to have it. So – I am in favor of graduate education.

Buzzwords. The Trend Du Jour.

Advanced Practice Nursing is a big buzzword nowadays and we are using the idea of it to attract people to the nursing profession. Throughout the USA there is a proliferation of “three-year’s wonder” programs, the idea being that the student does an entire nursing program the first year, then takes NCLEX, then spend two more years getting their MSN and NP while they work part-time as an RN. It’s particularly attractive during the down economy we are experiencing, because there are plenty of people out there with prior BS degrees who are looking for a fulfilling job. It is oh-so-seductive to think they can gain the RN skill in just one year.

Okay, so it’s a wave – lots of schools and universities are offering these programs. there are plenty of stats to provide a rationale for the career track we are inventing.

The aging of the population

The lack of Medical Doctors to provide primary care

the overall need for RNs to replace the RNs in the baby boom who will be retiring soon.

etc etc etc

I am not disputing those trends, but I am bemoaning some things that seem to be getting lost along the way.

Myth One – no need to learn basic personal care

To begin with, role socialization into nursing goes out the window when the time is compressed. Many of the persons who come from these programs seem to me to be unaware of how nurses work as a team, how nurses work in a hospital, and how to do any kind of personal care for a sick person. In other words, such things as cleaning up “fecal incontinence.”  When this comes up in conversation, they say “oh, well, I am going to be a nurse practitioner and I will be in an independent practice, I don’t need to learn those things.”

Oh Really?

My retort would be: If You are hoping to get a part-time nursing job to put yourself through school while you get the next two years of grad school under your belt, you will be judged according to the standard of the nurses around you, not to the other standard. It is extremely unlikely that you will be getting anything other than a staff nurse job while you work during school. 

also, don’t discount what a staff nurse learns. accountability and integrity are a big piece of the socialization process. A staff nurse in a labor-intensive setting like a hospital, gets daily role modeling from the older nurses. daily mentoring. any new nurse needs to develop trust with those already in the setting, and people will trust you more if you aren’t afraid to get your (gloved) hands dirty.

Think about this: if a patient has been incontinent of feces, no real nurse ever just lets them lay there. Never ever. You may not have to clean them yourself, but you do need to know how. Being clean is a critical element in the dignity of human beings. a very simple precept, really….. and if you as a student disrespect this, you will not gain the trust of the nurses around you.

Myth Two – independent practice

The next myth for Advanced Practice is that “I will be in an independent practice and I am not going to need to learn to work in the kind of subservient hierarchy that a traditional staff nurse needs to navigate through”

If that is truly the case, you will need to borrow money to rent office space, hire a billing agency, advertise to the community, all those things just like you were opening up a furniture store. Ask yourself if you have the business skills to do it, or to get a loan. There are some great resources out there, I particularly recommend one book by Carolyn Buppert; but – is that what you want to do? Most Medical Doctors gave that up twenty years ago, the hassle of “hanging out a shingle” was way too much. We are training you to provide population-based care, which means many of you will be making frequent rounds in a Long Term Care Facility, as part of a group practice. The retired frail elderly population of USA is burgeoning, right? your job will consist of freeing up time for the doc you work with so they can focus more on the technical side.

The small population of ARNPs who will be doing more acute care will be drawn from among those nurses who went the hospital- nursing route and solidified their skills before they enrolled in NP school.

let’s reserve the topic of subservience for some future blog, shall we?

Myth Three

I will be making a lot more money than a staff nurse

In many states the recertification requirement for any ARNP is 40 to 80 hours per year. If you maintain dual-certification, you may have more. This works out to ten working days per year where you are in classes (or being online). When you are in class, you are not seeing patients, and your income is affected. You will also have to pay higher malpractice costs. If you are in a family specialty, you will have many patients who don’t have insurance.  All these things detract from the bottom line.

Myth Four

If it doesn’t work out, I can always fall back on a job as a faculty member somewhere.

Yes, we do have a shortage of nursing faculty. and the minimal requirement to teach is a Master’s Degree. This is one that puzzles me.  For years now there has been such emphasis on going the NP route, that very few nurses enroll in an education track for graduate school. The result? a shortage of faculty, now being filled by recruiting from among those Master’s Prepared nurses who are unsatisfied with an NP job, and who get hired to teach.

There is a problem with this. A converted-over NP with a MS degree does not automatically have the clinical knowledge base to teach in an inpatient clinical setting; and they also don’t have any course work in pedagogy, the science of teaching, how to lecture, how to construct a valid exam, none of the things an educator needs to know in order to be effective.

So far this trend has been under the radar. Any school of nursing where the administration is addressing this, will be ahead of the game.

Myth Five “I can work as an RN after the first year, and use that money to pay for the second and third years, so it’s really not so expensive after all!”  go to my latest blog entry to explore this one. Plan carefully.

Got it off my chest!

So, what you have just read was a “rant” –  the kind of complaining I always dislike. If I were to stand up at a professional meeting,  I am sure there would be  a pregnant pause when I was done. People would look around the room, and then some sweet and wise person would bravely ask And what do you propose that we do about this?

My answer would be:

for the student: realize that you are entering a profession with a long history of service and where you will learn from all those around you in any setting you enter. The more responsibility you are given, the more direct (and sometimes brutal) the feedback will be.

study the idea of role socialization. don’t let it be a hit-or-miss proposition. realize that your thinking style will be changed by becoming a nurse. oh yes it will…..

don’t disrespect the basic skills of personal care. paradoxically, the more likely you are to work in critical care, the more you will need the kind of  teamwork and excellent personal care skills you learn at a basic level.

don’t disrespect the work done by staff nurses, whether it is in a hospital, long-term care facility, or other setting. not ever.

for the schools: be realistic when advertising what a fast-track program can provide and how it fits into a clinical track. When a MEPN student is disrespecting the work of staff nurses, call them out.

emphasize the whole role socialization piece. Insist that the skills portion of undergrad curriculum is rigorous and incorporates socialization, not simply mechanical performance.

insist that converted over NPs who take on a faculty role be given the maximum in mentorship

reclaim the nursing focus of advanced practice nursing. I think it is too easy to slip in to a purely medical model…..

I am fully aware that I will get feedback on this one……. I don’t pretend that this is the end-all and be all of the discussion – But, as oif you have another idea, 2016 this comment section is closed.


Filed under APRN education, nursing education, nursing faculty jobs in Hawaii, Nursing in Hawaii, Obamacare

My Relationship with Saint Patrick, as a fellow “snake man”

Erin Go Bragh!

March 17th is Saint Patrick’s Day, and of course we think of the Irish. My two daughters are half-Irish and they grew up with vivid memories of fun family gatherings with a large extended Irish-American family in Boston.  Here in Honolulu they hold another massive block party downtown in the Arts District (which also happens to be the Bar District). We were never big into the Saint Patrick’s Day party scene and I am told that in Ireland they look askance at the carryings-on here in the USA.

Irish culture and heritage includes more than just JFK, beer, River Dance, and “the troubles.”

Snakes in Ireland

Saint Patrick was famous for having driven the snakes out of Ireland.

Snakes in Tansen, Nepal

If you have read my book about hospital care in Nepal, you will no doubt have gotten to the chapter about care of snakebite victims.  The book tells the story in detail – I knew at the time it was going to be a “lifetime war story” simply because it was such an amazing set of circumstances. Of all the stories I wrote about which eventually became the book, this was the first chapter to be set onto paper – and what you read is 95% the first draft – the story told itself. which is of course, a characteristic of all the best stories.

If this picques your interest in reading the book – please do so – but I have to warn you , not every story in it has an upbeat ending……

The best part of a medical tale?

the best part of course, is that the patient survived. And even better: Even though the story has fantastical elements,  I have witnesses.  a Year after the episode,  a friend from Honolulu decided to also volunteer in Tansen, and the first thing he did when he got there was to inquire as to whether the snakebite story ever really happened.  Yes, they told him – Joe is “The Snake Man”

The Even better bestest  part?

The even better best part, is that though I was involved in saving the life of a fully-envenomated person by using a mechanical ventilator for the first time, the staff and crew of Mission Hospital has built upon what they learned, (and subsequent trainings by other volunteers including Respiratory Therapists) to save the lives of about fifty more. Yes, folks, I am proud of what I contributed; but I am especially proud of what the Mission Hospital staff is now able to do. Every time they save a life with this technology, I can vicariously share in their success.

The Real Snake Man of Tansen

Back to Saint Patrick. Maybe there were no literal snakes, and the figurative snakes of Ireland were the elements of the Druidic religion – who knows. But there are tips for how to really get rid of a snake, even if the goal is to not kill it. In Tansen, there is a local go-to guy who does all the snake relocations. and I have him on video.   I was able to see him at work, getting rid of a snake that lived in the thatched roof of a mudbrick house –  this involved building a smoky fire to drive it away – not something I personally would have attempted ( occasionally the house burns down, this way…)

I will be back next week with more directly nursing-related blog entries –  in the meantime, wear green and have fun but be careful out there!


Filed under Honolulu, Nepal

Part 3 Nurse’s Brain – Nurses and Obsessive-Compulsive Disorder (OCD) – how is yours today?

NOTE: run your mouse over this section, and the hyperlink will show up……take the quiz!!!! the whole point of this blog is to discuss your reaction to the quiz….

True Story of my daughter when she was five

One March, a blizzard started working its way up the east coast of the USA, and in Maine we had five days to read the daily report on the front page of the local newspaper which breathlessly warned what it was going to be like by the time it got to Maine. It was the topic of conversation every day. My younger daughter was worried. we lived out in the country. In addition to the lights and fridge, we had a well with an electric pump. We expected to lose power.

To assuage her worries, the family sat down with paper and pencil over a cup of cocoa, and made a list of all the things to do to be prepared for a blizzard. Buckets of water ( to flush the toilet), flashlights, candles, wood from the woodpile, snow shovels handy, groceries stocked up. Every thing. then we checked off the list and said ” the only thing left is to make snowmen when it gets here and keep the driveway shoveled.”

It helped. the blizzard was serious, but we felt better about it. we were ready. The list was useful. the fears were greater than what the truth turned out to be. And in the meantime, our daughter got the demo of a terrific coping tool.

Thought for the day

Are we raising a new generation of nurses to have Obsessive-Compulsive Disorder?

Recent blog entries

I have written about the ways to use a Nurse’s Brain in the recent past, and also about ways to succeed at the job search as well as at work once you get the job. I gave contradictory advice as to whether nursing students should be taking ACLS or not, and I also heaped praise upon the book by Atul Gawande, The Checklist Manifesto.

It’s been clear to me for years now, that if you want to succeed in a hospital staff nurse role, you have to develop a system for keeping track of dozens (hundreds?) of small details during the course of a day, in order to be on top of what is happening. The Nurse Brain is an aide to your brain to do that without going crazy.  We have developed an entire discipline, “Informatics” to study the science of how to assist people in doing this kind of detailed work.

There is a point, however, when you have to step back and ask yourself whether you have stepped off the path of sanity and into the wilderness of doubt,  and developed Obsessive-Compulsive Disorder.

Take This Quiz.

AT a site named Psyche Central, they have a self-quiz.  I invite you to check it out – take it. you don’t have to share the results with any body.

Rational fears versus irrational fears

Naturally, there are flaws with the questions – for example, the person who built the quiz probably thought they were dealing with takers that had the irrational fear of such things as death, accidents, contracting AIDS, etc.

The truth is, in many nursing settings, for many nurses, these are entirely rational fears. We have a job that is a bit unusual in that respect. “Do you find yourself washing your ahnds every five minutes or perhaps cleaning compulsively?” – yes I sure do especially if my patient has a communicable illness…… so – I suppose it may be skewed – or maybe it is one more indicator that what I am talking about is real. You can go overboard….. or can you?

In defense of the Brain

if it is any consolation, one way to use the Nurse’s Brain is to re-assure yourself that you did do everything you set out to do – and then to fold it up and shred it at the end of the day, knowing that you do not need to worry anymore about what you left undone. We are all in search of certainty, the knowledger that we did what we could. Certainty is not exactly the same as serenity, but it gets you there…..

Hospitals face a challenge with OCD among nurses

this will be a short blog, but I leave you with one thought. after you have checked your own OCD level, look at that of the nurses you work with. If the workplace is dominated by nurses with OCD, chances are, they spend time focusing on the small details, beating each other up as a means to feel better about perfectionist behavior. I would politely say that such a work environment is out of balance, and not a healthy one.

And it’s worse if the manager has OCD

OCD is a reaction mechanism to try to control things that are essentially not able to be controlled. Yes, a nurse with OCD can be a great nurse, but what happens when such a nurse is hired to be in a leadership role? usually they are the ones who have the least ability to delegate, the least flexibility, and the least ability to inspire and lead.

what do you think? take the quiz and let us know the result ( if you are brave…). agree/ disagree?


Filed under Maine, nursing education

If you, as a nursing student, MUST learn EKGs…..

want to learn what’s really important in nursing? it’s not what you think… I don’t often get to the point of revealing my deepest secrets to the world, it takes a lot  to actually put these things in print.  For example, even though I know the name, hand gesture and usage of the  One Universal Surgical Implement, when I was initiated into the cult I was sworn to secrecy that I will only reveal it to those cognoscenti that show themselves capable of handling such knowledge…..

Responsibility always comes with knowledge.

Remember that. Before i would ever reveal anything, you must prove yourself worthy. And of course, the first step is to buy and read my book about Nepal. It’s the kind of book you can give to the nurse in your life for Nurses Day or for graduation from nursing school.

Anyway, there were too many protests to last last blog

They call this “push-back” – readers who said they just needed to be ekg-certified….. O to be young again!

The Six Rhythms

There actually only six you need to know. trust me. This Pearl of Wisdom has been enshrined in the American Heart Association Manual for twenty years, but somehow people gloss over it and say, it can’t possibly be so simple….

Link to a website

In Nepal I met Jason Waechter, an MD from Canada who was working with Patan Hospital.

He was wicked cool.

has all kinds of great stuff about critical care on his website.

I particularly recommend the handout on basic ekg.

also – I have a two-page handout on rhythm strip analysis which I will share.

To get the two-page handout,

subscribe to the blog,

share with all your friends, and

send me an email.

ten-four, over and out in Honolulu today…..


Filed under nursing education

What every new nurse or nursing student needs to know about ACLS and certification

I have taught ACLS and related skills since 1980. click here to see me teaching this material in Nepal.

Okay, so this is just my opinion, but on the other hand, I have been around. Recently, a senior nursing student told me she was looking for a job on The Mainland, maybe in ICU. I asked her if she was comfortable with ACLS, and she replied “What is that, anyway?”

Welcome to the world of Initials!

On the right hand column of this blog is a link with the title “Did you ever wonder what PHTLS stands for?”   and I guess the first thing for me to say is, on that site you can find a guide to all the possible initials and credentials for critical care, that have ever been invented. Your nursing education is not over just because you graduated from nursing school, and if you want to work in something really high-tech, it is inevitable that you get some kind of qualification to do so. The Nurse’s Guide to Alphabet Soup is a great resource and introduction to all of this.

If you have to ask, it is not a good sign

I was glad she asked me before she applied for the job. When you apply for a job, the employer expects that the applicant be familiar with the requirements. If the job requires ACLS and the applicant were to give that answer, the interview is over. it will stop right there.

TIP about reading job ads

For a lot of job ads, they will list a very specific picture as to what they are looking for. If the job to which you are applying has a list, in bullet-points, of skills and qualifications, it is a good idea for your response to go right down the list of bullet-points and provide concrete evidence that you meet each one.

Back to ACLS

Not too long ago in clinical, there was an emergency involving a patient who was not “one of ours” – i.e., not assigned to one of our students. I had listened to morning report on the person, (I always listen to all the report) and there had been nothing to tip us off that he was about to have a problem.  It was nearing the end of the clinical time and we were doing our charting when the staff nurses rushed into the nurse station to get the Crash Cart. I knew what that meant, so I jumped up off the chair and followed them. The man in question was having a respiratory arrest. The staff nurses called for the Code Team to arrive, and in the meantime I took his carotid pulse, while the staff nurse got oxygen going and started bagging. Then I helped hook up the chest leads for the heart monitor, get the hard surface under him, get an IV started, etc.

Some students had trailed me into the room and stood in the corner, watching this unfold. The man survived and was transferred to ICU.

Naturally, the post-conference was dominated by discussion of this  event. One student said; “I want to know how to get a nursing job where I do that?”

Oh, to be young again…..

Be prepared for a pearl of wisdom

Here it is: the goal is to not do ACLS if you can avoid it. Act before the person has a cardiac arrest. The goal is to identify in advance, every situation that might deteriorate in to an arrest situation, and to convene the Rapid Response Team to address the issues before the patient’s breathing stops. The more clever you are at this, the better the nurse you will be.

this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at

this book is about medical missionaries in Nepal. sure to become the number one beach read for summer 2014! go to Amazon and pre-order your copy at

The fact is, we are conditioned by medical TV shows to think of the dramatic aspects of health care, the high tech response that salvages somebody who is right at the very Brink of Death, staring into the precipice of Doom. The TV shows emphasize the heroic nature of this work, and the rest of us overlook the depersonalization that comes with high tech medicine. It’s exciting and glamorous.  Most of health care is not actually like that, though, and the dramatic events are followed by a long recovery in which attention to detail is needed and progress may be slow.

For that reason, when nursing students ask my advice about doing critical care, I usually try to gauge their ability to make and use a Nurse’s brain, and to perform diligent physical examination, along with their maturity level. Excessive enthusiasm about using ACLS skills, as if it is the only thing that happens in critical care, is actually a sign of inexperience.

Oh, and by the way, the man at clinical did just fine and was discharged from ICU after a day or two.

What do you think? I promise to answer any questions related to this topic…… fire away!







Filed under Uncategorized

What if every nurse did this today? Major TIP for today

Want to make a good impression at you nursing workplace? I have worked in hospitals all my adult life, and I am about to impart a secret that will help you get ahead, every time.  When you use it, let me know how you make out. All I ask in return is that you share this blog with as many friends as you can, and consider adding as a subscriber. For an added bonus, look at the fan page for my book about Hospital Care in Nepal. 500 photos, some videos and commentary on health care in Low Income Countries.

There is a secret group of employees at your hospital

They are unseen, and often unrecognized, but you can’t do your job without them.  It’s the housekeeping staff.

Once I had a student group at a Catholic Hospital in the Northeast. I like and respect Catholic healthcare ( yes, I am Catholic myself and I do go to church. Yesterday’s sermon was about Abraham and his obedience to God. we were all happy that Abraham’s son got off the hook, even though it was last-minute if you ask me).

But I digress – back to the Catholic Hospital

The C.E.O. of the place was a Catholic nun. Wonderful person. Truly. She had this amazing ability to appear on the ward at odd times just whenever there was some sort of conflict happening with a patient or family. It was like magic. Uncanny.

I discovered it by accident

Turns out that the housekeeping staff all had cell phones and she’d given them her cell number. The housekeepers there were all longtime employees – we are talking thirty years or more in some cases. The CEO would host them  for breakfast now and again. The CEO always had a good word for me, because I had long ago adopted a policy to be nice to housekeeping. There was one who was Polish-American  and I sang her my favorite Polish Christmas Carol.

Now – I have never seen such an effective under-the-radar surveillance system at any other place. But whether this kind of informal network exists or not, you can do your self a favor by adopting one simple practice. Learn each housekeeper’s name, say hello to them every day, and be friendly.

That’s all you need to do. that’s the tip for the day. I think especially for a new nurse, a hospital setting is overwhelming and there are so many people to figure out, that it is easy to retreat into a small shell and only interface with people who are above you in the food chain somehow.

try it for a week, and let me know how you make out….

and yes, if you are applying for a job, be kind to every person along the way, including such persons as the receptionist in the Human Resources Office. Even if they do not have the CEO’s cell phone number…..



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