Monthly Archives: January 2014

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

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

2009

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

2013

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

2014

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

click here to go to the Amazon site.

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

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

Two phenomenon:

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

and

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

Q: are they related? or a coincidence?

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

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

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

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

then there is: Hawaii Nursing Jobs Update Oct 2013

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

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

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

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

This is not new.

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

What is the answer?

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

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

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

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

Street Smart is the goal.

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

Delegation is key to NCLEX success

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

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

read this carefully:

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

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

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

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

therefore,

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

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

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

and now for today’s Pearl of Wisdom

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

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

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

Friday Night at the E.R.

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

An Excellent Simulation Learning exercise

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

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

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

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

Achieving Street Smarts?

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

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

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

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Filed under NCLEX, Nurses Brain, nursing education, Uncategorized

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

Third in a series.

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

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

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

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

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

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

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

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

I always preface it with the following disclaimer:

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

Usually that short speech creates student buy-in.

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

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

Cultural comfort with perceived aggressive behavior?

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

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

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

 

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Filed under foreign nurses in USA, NCLEX, nursing education, Nursing in Hawaii