Tag Archives: ACLS

what did you do for your summer vacation

school begins again soon.

if you really must know, here is what I was doing all summer….


It was fun but I will be happy to be back in a routine.


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Nursing student advice – are you an adrenaline junkie?

please share. as we start the fall semester, it’s time to think about the challenges ahead

ACLS again
I spoke with a nursing student yesterday who took ACLS this  summer during an internship, and she told me two things. First, during the class she loved the competitiveness of trying to “win” the ACLS scenario. Next, during the internship she saw the practical applications of ACLS at work, and she profoundly agreed with one of my previous blogs in which I wrote that the main idea of ACLS is to prevent the need for such intense intervention and to be pro-active.

Then she said it: ” I admit, I am an adrenaline junkie.”

I laughed. Been there done that.

Adrenaline produces a “rush”

Most people have heard the term, and way way back in 1991 there was a movie named “Point Break” in which the hero went out of his way to experience danger.  (oddly enough, that particular movie combines big-wave surfing with bank robbing and skydiving.)

In the TV show “ER,” every time they showed the team responding to a cardiac arrest or trauma code, the soundtrack would ramp up, pulsating and flashing.  ( nobody supplies a similar soundtrack in real life, except occasionally there are surgeons who use a playlist in the OR to keep the team relaxed – creating the opposite effect and enhancing “flow”)

With the growing popularity of women’s sports, as evidenced by the Olympics, more nursing students come to the profession with a background of knowing how to compete and wanting to “win.”

Here is a definition of adrenaline junkies

Adrenaline junkie is a colloquial term used to describe someone who is addicted to thrilling and fear-inducing situations. The act of conquering fear creates a rush of endorphins that is simultaneously energizing and relaxing. This natural high leads adrenaline junkies to seek out ever-bigger thrills and excitement.

Some adrenaline junkies place themselves into dangerous situations. Others prefer to know that they are physically safe, but pit themselves against obstacles that make them feel unsafe. Halloween events and roller coasters particularly appeal to adrenaline junkies.

And of course, a self-assessment

You can determine for yourself if you have the tendencies to become an adrenaline junkie, here is a self-test that focuses on your present approach to life.


And of course, the paradox. First, you need to be pumped up and “on it”  in order to deal  with emergencies effectively. Second, in the long run, you need to cope with stress and to develop a mature approach. If you are a young student, there is an undeniable appeal to all the technical details of high-tech nursing care, and when you are in your early twenties you are at the peak of brain power in terms of training your memory. At some point though, you will need to engage in self-care activities, setting limits on your own stress-seeking behavior.

the answer

Naturally, I have a ready-made solution for you… a two part prescription.

the Nurse’s Brain.

If you are using a Nurse’s Brain, you already have a major tool for keeping your stress level in check.  You need to adopt this tool to gain the skills needed to step onto the playing field.

balance and – mindfulness

Taking inventory of the stressors and dealing with them. Whenever I have been with critical care nurses and somebody outside the ICU suggests this, the response is always eye-rolling and incredulity – every critical care nurse knows that simple stress-reduction techniques are not enough unless they are coupled with a clear-eyed approach to the challenges of clinical practice. In other words, at a stressful clinical site, the management and team members must all participate in effective problem-solving. All the meditation and Kum-Bye-ah in the world will not help the stress unless you have supportive coworkers and an effective manager.

But seeking balance in your life, affirming the good things and valuing your own self, are still the way to go.



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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. joeniemczura@gmail.com

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


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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  http://www.amazon.com/Sacrament-Goddess-Joe-Niemczura/dp/1632100029/

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!







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the ultimate video link to summer 2011 critical care nursing project

sorry if this is crossposted too much – but I wish to share this widely. Twenty three minute description of my Nepal summer project 2011, done by a professional photojournalist. partially edited.


Several things to point out.

First,I was grateful for the use of the classroom space at Lalitpur Nursing Campus in Sanepa. The school is located in a former Rana-era palace, and this was the ballroom -crystal chandelierand all.

Next, we did these drills every class day. There were three simultaneous stations; only mineis shown.

If you listen carefully to the background during theinterview at the end, some women in the neighborhoood were chanting a Buddhist hymn.



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Back to Honolulu and ready to start teaching here in Manoa

The trip to Nepal for 2011 is complete, and it would be misleading to continue blogging from there, but fortunately wordpress has a solution for this – leave the old blog up on the intertubes; start a new blog!

And that is what I will do.

Anyway, I am back to Honolulou and to teaching at University of Hawaii School of Nursing And Dental Hygiene. (SONDH).

I am “refreshed” – and grateful that UH SONDH allows me the flexibility to do what  I do during my holiday. I can honestly say I love my job. The students are wonderful and hardworking. They always step up to plate a nd reposnd to the challenges of nursing education. I have some terrific co-workers.

I am seriously considering book two. More on this later. I have lots of research, the basis for a plot and characters, and the idea that a work of fiction set in Nepal woudl be of interest. Wider interest than a work of nonfiction.

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