Unemployment

I am still without a nursing job, and despite a rough few months I am positive about the future. Recent reading, conversations, and experiences have revived my spirits. Right now it is easy to be caught up in the fury and pressure to find my first real job. I lost sight of why I decided to pursue nursing and the aspects I love most about the profession.

As I mentioned in my last post, the book Six Months in Sudan renewed my thoughts and plans for my nursing career. The author, Dr. James Maskalyk, describes his time in a war torn area in Sudan. The intense situations and abject poverty are difficult to comprehend, but I learned from his different perspective. I was reminded me of the vast needs in maintaining the basic human right of health care all across the world, and that is one reason why I am a nurse. My nursing career decisions will likely be shaped on my plan to return to service work, hopefully with the Catholic Medical Mission Board.

Now I just started reading Dead Aid by a bold African woman Dambisa Moyo, born in Zambia. A Kenyan professor first introduced this idea to me as she explained how Americans and the West do not want to accept that the popular belief in aid to help Africa is not effective. As Moyo states in Dead Aid,

"The notion that aid can alleviate systemic poverty, and has done so, is a myth. Millions in Africa are poorer today because of aid; misery and poverty have not ended but increased. Aid has been, and continues to be, an unmitigated political, economic, and humanitarian disaster for most parts of the developing world."

This goes against all that the media, celebrities, politicians, and our Western culture has continued to teach us for decades. This book has already started up my brainstorming on sustainable medical help. It's fascinating how listening to or reading a new perspective can possibly change our view of our life and the world.

Finally, I benefited from an enriching conversation with a family member. He is a doctor in the Navy, and by far the most charismatic and intelligent doctor I have met. I listened to him talk about his path as a doctor, his family, the Middle East, health care reform, and more. It was then I realized how beautiful and simple learning can be. As a new graduate nurse, I am overwhelmed by the vast opportunities and endless knowledge that I have yet to discover. But in that moment it was clear that our interactions with new perspectives-in books, conversations, reflecting on our experiences-allow us to learn and encounter the world.

Please pray for me as I find a way to piece together all of my interests & passions into my future as a nurse. And join me in savoring and learning from every discussion, paragraph, experience.

I'm Back!

I'm back! My apologies for the long delay in posting. Since my last post, much has happened in regards to my nursing career. I am a strong believer in hard work (thanks to my parents and grandparents), especially as I graduated magna cum laude with a bachelor's of science in nursing. It was rough towards the end, with one rough week of finishing up my evidence based research paper on service learning and cultural competency after a night shift clinical (later received an A on the paper). In the end, it was all worth it! Most exciting however, was passing NCLEX (!!!) and officially being a registered nurse in the state of Georgia.

Despite the lack of job leads and indecisiveness about relocating, I am hopeful and excited for my future as a registered nurse. I recently read a book-Six Months in Sudan-during my long twelve hour home health care shifts, and it renewed my goals and dreams. I will share my thoughts on this with you soon. Now I'm off to work quite a bit in the next several days, but please check back in the near future for a new post.

Happy 4th of July!! God Bless America! And much love and support to all in our military (in particular several of my friends and their loved ones).

---Anne, RN BSN

Nurses Week 2011

Happy Nurses Week!!
Take some time out this week to reflect on your experiences with nursing. Think about what how your approach to nursing has evolved as you learn from all of your experiences. Check out Sigma Theta Tau International Society of Nursing's "things to do" during Nurses Week 2011, which includes a link to the international nursing library! The American Nurses Association has provided some great online tools for discovering the value of Nurses Week.

Mortality

I have returned! I haven't posted in a long time, but in the meantime I have accomplished quite a bit. I passed my senior comp exam, completed my senior nursing research paper, was inducted into Sigma Theta Tau International Society of Nursing, received a service award, and completed my independent study clinical night shifts on a step down telemetry unit. Phew it makes me tired just thinking about it! I have two weeks of class, one day (tomorrow) at the psych hospital, and a few addiction meetings (for psych), and two finals left in my undergraduate nursing education. Excitement is an understatement!

My clinical experiences this semester led me to contemplate our mortality in relation to modern health care. An overwhelmingly complex ethical dilemma for patients, families, nurses, physicians and all humans with access to modern medical interventions is deciding when a body can survive no longer. Imagine yourself these situations:

--> A person in the final stages of AIDS, appearing obtunded without verbal or visual response, receiving continuous FiO2 flow by thru trach, continuous feedings thru Dobhoff, +4 generalized edema r/t stage IV kidney failure due for hemodialysis.....listed as full code-would it be hard for you to perform the necessary interventions if this person coded?
--> A 100 year-old mother, very mentally sharp (memory intact, makes jokes, and maintains conversation), develops respiratory distress. What would you want to be done for her?
-->A 85 year-old husband, who has had 2 previous strokes and 13 TIAs in the last 5 years, is told that he needs hemodialysis. How would you feel about this?

What is the limit for our interventions for our bodily mortality? Where does the hope for preventing our inevitable mortality lie? Consider this:

"Man's resistance to death becomes evident: somewhere - people have constantly thought- there must be some cure for death. Sooner or later it should be possible to find the remedy not only for this or that illness, but for our ultimate destiny-for death itself. Surely the medicine of immortality must exist. Today too, the search for a source of healing continues...What would it really be like if we were to succeed, perhaps not in excluding death totally, but in postponing it indefinitely, in reaching an age of several hundred years? Would that be a good thing? Humanity would become extraordinarily old; there would be no more room for youth. Capacity for innovation would die, and endless life would be no paradise, if anything a condemnation.


The true cure for death must be different....What is new and exciting in the Christian message, in the Gospel of Jesus Christ, was and is that we are told: yes indeed, this cure for death, this true medicine of immortality, does exist. It has been found. It is within our reach. In baptism, this medicine is given to us. A new life begins in us, a life that matures in faith and is not extinguished by the death of the old life, but is only then fully revealed....Indeed, the cure for death does exist."

-Pope Benedict XVI, taken from the Magnificat: Holy Week 2011


Happy Easter Season!

Anyway

What keeps you going through the difficult parts of our vocation? We all have those days or weeks. The challenging patient, the long shifts and the stressful situations leave you exhausted, overwhelmed and thinking about why you decided to be a nurse. My faith is what keeps me going. This week, I was reading the book A Simple Path with reflections from Mother Teresa of Calcutta. I identified with the following excerpt of the book, linking it to my experiences in nursing care. I wonder if there are others in this field that feel that this applies to nursing...

Anyway

People are unreasonable, illogical, and self-centered,
LOVE THEM ANYWAY
If you do good, people will accuse you of
selfish, ulterior motives,
DO GOOD ANYWAY
If you are successful,
you win false friends and true enemies,
SUCCEED ANYWAY
The good you do will be forgotten tomorrow,
DO GOOD ANYWAY
Honesty and frankness make you vulnerable,
BE HONEST AND FRANK ANYWAY
What you spent years building may be destroyed overnight,
BUILD ANYWAY
People really need help
but may attack you if you help them,
HELP PEOPLE ANYWAY
Give the world the best you have
and you'll get kicked in the teeth,
GIVE THE WORLD THE BEST YOU'VE GOT ANYWAY.


From a sign on the wall of Shishu Bhavan, the children's home in Calcutta.

Research Challenge #3: Service Learning & Cultural Competence

My school requires all seniors to pass standards for advanced writing, and for senior nursing students this means writing a major research paper. My goal was to find a topic that was interesting to me in order to improve my motivation to write a high quality paper (and learn something along the way). As a part of the Research Challenge, I want to share an article on one of the topics I am considering.

[If you are new to my blog, you should know that this choice is motivated by my own experience with international service learning.]

Article: "The impact of service-learning on cultural competence"
Amerson, R. (2010). The impact of service-learning on cultural competence. Nursing Education Perspectives, 31(1), 18-22. Retrieved from EBSCOhost.

There were many limitations to the study, including a smaller sample size (of 60 nursing students), but the article provides a basis for the development of further studies on the role of service-learning in nursing education.

The study used a tool to measure "self-perceived cultural competence" in nursing students before and after local and international service-learning clinical experiences during a community health course.

It is helpful to read this article in order to understand how service-learning is defined in nursing and to realize the dynamic aspects of cultural competence. Based on my research, primarily through CINAHL, I have found that there are few studies on the effect of service learning on cultural competence in nurses and/or nursing students. My future nursing career may have to consist of research on the topic!

Essential quote and conclusion to the article:
"The hope exists that this awareness, and the knowledge and skills attained through encounters with different cultures, will lead to an increased desire to provide culturally congruent care as new graduates begin their roles as nurses of the future."

I fully support the author's conclusion, as I have greatly benefited from both local and international service-learning experiences in this last year of my nursing education!

[Don't forget this is part 3 of the challenge! In case you missed my other posts, catch up on part one and part two.]

National Nutrition Month

March is National Nutrition Month!!

This is an appropriate time to evaluate the quality of your education, awareness and knowledge about nutrition. Our fast pace, technology based health care settings often prevent us from recognizing the importance of teaching patients about nutrition. Nursing education in particular has lost focus on this topic. Last year, I participated in a group discussion with all of our department's professors, the director of nursing, and several other nursing students. The purpose of the gathering was to critically evaluate the nursing curriculum. All of the students agreed that we felt our knowledge base was inadequate in the area of nutrition. As a result of this evaluation, I believe our nursing department is going to require a core nutrition class design for nursing students.

Nurses need to take professional responsibility for learning about the dynamics role of nutrition in nursing care. If nurses have a strong knowledge base on nutrition, they will be able to collaborate with dietitians and reinforce interventions with patients. BSN programs need to recognize this need and incorporate a nutrition class into their curriculum. Hospitals need to assess their nurses' knowledge and implement educational programs on nutrition specifically for nurses.

Be an educated advocate for nutrition education at your hospital or school, and be the paradigm of a healthy lifestyle:

*Nursing Link Nat'l Nutrition Month Resources
*Eatright.org: Primary site for resources associated with this year's Nat'l Nutrition Month. Offers specific resources for health care professionals!

Research Challenge #2: Innovation

Update: I will not continue the challenge and posting until the week of March 21st. I will be taking a much needed vacation in sunny Florida to relieve some stress! Also, prayers to all those in Japan.

I am sharing article #2 for the Research Challenge. According to the levels of evidence, the article is only a level VII, but a publication by professional and advanced degree nurses is worth reading.

Article: "Unlocking the Power of Innovation"
This article is a part of series of publications on "Nursing and Technology: Innovation and Implementation" in the American Nurses Association's Online Journal of Issues in Nursing.

The article defines innovation and analyzes its components in relation to nursing. The content of the article is necessary to understand the dynamic nature of innovation in order to optimize the process. The authors claim that there are 3 components necessary for innovation to be successful:
1. person(s) creative process
2. the product of creativity: innovative solution
3. environment, or context, in which the innovative idea is developed and implemented
If one of these 3 components fails, the innovative process cannot be completed. The authors provide examples from research to demonstrate how each of these components can be preserved in bedside nursing.

The other major part of the article is an analysis of 2 main methods for building a basis for innovation in nursing settings:
1. IDEO: This method focuses on the following steps: "observation, storytelling, synthesis, brainstorming, rapid prototyping, and field testing." This method produced the Nurse Knowledge Exchange, an innovative solution to sharing information at shift change.

2. Transforming Care at the Bedside: In this method, "nurses identify the issue, suggest multiple possible solutions (the more the better), and determine which of the ideas to test." Benefits to TCAB include efficiency in adapting the innovative processes, and it's based on feedback directly from nurses.

The article mentions another great facilitator of innovation in health care: The Innovation Learning Network, which aims to "...ignite the transfer of ideas, and provide opportunities for inter-organizational collaboration." The numerous examples of the successes approaches to innovation in nursing (such as the ones listed above) are an excellent way to deepen your grasp and view of innovation.

Ultimately, the examples from the leaders in innovative health care solutions serve to lead you to the authors' final conclusion:

"Unlocking the power of innovation requires the engagement of clinicians at the bedside."

I highly recommend reading this article and the others published by the ANA to engage the innovative world of nursing!

Blakeney, B., Carleton, P., McCarthy, C., Coakley, E., (May 31, 2009) "Unlocking the Power of Innovation" OJIN: The Online Journal of Issues in Nursing Vol. 14, No. 2, Manuscript 1.DOI:10.3912/OJIN.Vol14No02Man01

Clinical Experiences: Public Health & Intermediate Care

I have had lots of quality clinical experiences recently, and I thought I would share!

Last week, I completed my community & public health clinical. I went to three sites each week, each with different yet overlapping aggregates within the city. I put a lot of work into one of the sites, which was a unique faith-based organization that provides housing for 16 families, 40 single men, and 16 single women. One of the directors wanted us to work on bringing a TB testing clinic to the residents. All of them are at risk from their previous homelessness and current community living setting. Currently, they don't have a process for verifying the TB status of the residents. I agreed to take on the project, and I had no idea what I was getting myself into! Here's about how this whole process went:

Week One: Find the contact info for the TB case manager at the county health department. Find contact info for a local clinic that provides health care for the homeless, then find out they don't open until 1pm (very convenient, right?). Research training requirements for being able to read/administer TB testing to be able to provide free and easy help for the (potential) clinic.

Week Two: Finally talk to TB case manager. Apparently, she doesn't know much about this housing. I relay numbers and overall ideas to her. She has to go to the nursing directors. Leave multiple messages for the local clinic for the homeless.

Week Three: TB case manager says the clinic may be possible! I answer more questions about the details of the housing and residents. More failed attempts at contacting the clinic by phone and email.

Week Four: Health department says they don't have enough funding to provide enough tuberculin tests to cover the residents. They don't get funding from the state or federal levels for TB testing. Finally get in touch with the local clinic. My contact says that they are trying to set up a mobile clinic, and could include our site. He is going to forward my email to his boss. [Later we get turned down by them.] In perfect timing, nurses from our health center on campus offered TB certification for the nursing students! I am now TB certified until 2014!

Week Five: The health department had surplus influenza vaccines, and offered to have a mini flu shot clinic at our site! The residents are required to go to community meetings in the morning. There are two large groups: one for men, and one for women & families. Another nursing student and I worked together, and we taught the groups about influenza & the vaccine and TB. After we were done, other nursing students, the TB case manager, and another nurse from the health department, were all set up and ready to run the mini flu shot clinic. More residents than expected get the flu shot, and there were many questions about getting tested for TB!

Week Six: The health department had expressed early on that they wanted the site to develop and establish a process for testing new residents to prevent the need for a large clinic again. I came up with a draft for the site that included steps they needed to include. The director I worked with throughout this whole ordeal graciously thanked me. Even though the clinic failed, she was able to meet the TB case manager and show her the needs of the residents.

And that folks, is the state of public health in the United States! No funding for TB testing and a nursing student being the liaison between the health department, housing for the homeless, and a local clinic for the homeless.

Coming full circle, I worked along a nurse on an intermediate care unit on Friday from 7pm to 7am. I was actually on the same unit for both my clinicals last semester, so it was great to be back! It was overwhelming at first because we had four patients, and one of those was an admission right at the beginning of our shift. The day before, I had been reviewing practice NCLEX questions and one mentioned a hyperosmolar hyperglycemic state. I had no idea how that was treated....but I do now! Our admission was diagnosed with a hyperosmolar hyperglycemic non-ketotic state. Nothing like studying for NCLEX with a live patient!

I have another night shift on the intermediate care unit Monday night. The third week in March I start the clinical for psychiatric nursing. It's hard to believe these are my last clinicals!!

Job Search: Hospital Profiles

In my search for hospitals I would like to work for after graduation & passing NCLEX this summer, I decided that creating "hospital profiles" would organize my information. I am new to this whole RN job search, so I am unaware if this is a common tool for nurses to use. Here's what my hospital profile tool consists of:

Hospital Name:
Location:
Philosophy (overall and specifically nursing):
Mission:
Specialties of Care:
Awards/Recognition (e.g. Magnet status):
Nurse Empowerment (i.e. shared governance, continuing education):
Website:
Contact Info:
Specific Application Requirements (references, cover letter, etc.):
Connections (with a nurse, administrator, physician, etc. thru alumni, contacts at job fairs, contacts thru community involvement, friends, family. etc.)

Nurses have the right to be employed by a hospital that empowers them and supports high quality nursing care. The job market may be challenging, but as a highly educated professional you have the right to choose a quality employer.

Additional Resources: Your national, state, local, and specialty nursing organizations offer career resources and excellent networking opportunities. [The ANA's Career Center has a good list of resources available, which I was referred to by the Nursing Site Blog. For another example, the AACN directs you to NursePath.com.]

Research Challenge #1: Nurse's Work Schedule & Patient Mortality

"To understand God's thoughts we must study statistics,
for these are the measure of His purpose."
- Florence Nightingale

This is my first edition of Nursing Idea's Research Challenge (I'm a little behind in the challenge). I was a consumer of nursing research in junior and senior year nursing classes, but only as a confused outsider. I'm about halfway through the senior nursing research class, and it has been fun to actually begin to understand terminology and the research process when critiquing studies. I'm in the beginning stages of developing my research skills, but it's never too early to start participating in this important part of nursing.

Published Study of Interest:
"Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality"

My interest stems from my experience with both day and night 12-hour shifts for home health care and clinical. I have felt the toll of exhaustion working multiple twelves in a row. Last semester, a lunch break discussion with my clinical instructor and a staff nurse on the unit gave me some insight into nurse's experiences with 12-hour and 8-hour shifts. One of my professors mentioned this study, and my search led me to this summary.

Recently, nursing research literature has described the effects of nurse staffing ratios and education on patient outcomes. The authors of this study found that one individual aspect of nursing care has been left out of the literature--work schedules. Their lit review notes that studies have shown that 12-hr shifts cause fatigue and sleep deprivation, but "their impact on patient outcomes is largely unknown" (1).

Work schedule variables included: time on call, working while sick, mandatory overtime, time between shifts, days in a row worked, hours worked per week (and more).

Mortality was measured with the following Agency for Healthcare and Quality (AHRQ) In-patient Quality Indicators (IQIs): "pneumonia, congestive heart failure (CHF), acute myocardial infarction (AMI) and stroke, and postsurgical procedures related to abdominal aortic aneurysm (AAA) repair and craniotomy" (1).

Significant associations occurred between the following:
Pneumonia deaths with long work hours and lack of time away from work.
AAA deaths with lack of time away.
CHF mortality with working while sick.
AMI mortality with nurses' weekly burden (hours worked per week).

The authors intertwine fatigue and sleep deprivation into the themes of the article, and they provide many references to literature that ties these themes to 12-hour shifts. They state, "The work schedule component most frequently related to mortality was that of lack of time away from the job. This has been found also to be important for nurse injury and fatigue..."(1).

The main conclusions focus on the need to fill the gap in the literature and a call to confront the assumed popularity of 12-hour shifts among nurses. The authors conclude, "Attention to work schedule is now warranted on the basis of the impact of scheduling on patients as well as nurses. Therefore, policies should be refocused on the work schedule as a means of improving patient care and nursing working conditions" (1).


For further reading, check out my previous commentary on sleep deprivation and a discussion with A.M. Trinkoff and J. Geiger-Brown, two nurse researchers (one is an author of this study-see below citation) that have contributed a tremendous amount of literature on sleep and the 12-hour shift.



1. Trinkoff, A., Johantgen, M., Storr, C., Gurses, A., Liang, Y., & Han, K. (2011). Nurses' Work Schedule Characteristics, Nurse Staffing, and Patient Mortality. Nursing Research, 60(1), 1-8.

Music Wednesday: Rodrigo y Gabriela + Research Challenge

Posting 2 days in a row=extremely productive week. Lately I have been fueled by natural energy originating in excitement, stress, and running [I ran cross country competitively for 11 years. My last season was Fall 2010]. Of course, I have had some additional help from coffee and all natural Steaz energy drinks.

Overwhelmed and exhausted, my mind needed some relief to allow for a restoration of innovative thinking. Therefore, I bring your attention to the amazing duo Rodrigo y Gabriela. The two started in a metal band in Mexico, and then joined the musician life in Dublin. Their inspirations include classics like Jimi Hendrix, Pink Floyd, Led Zeppelin, and many more incredible artists from all over the world. Wordless songs and pure acoustic sounds, their songs are perfect for focusing your mind and energy. One review states, "The key to their success is bringing a rocker's high-energy attitude to songs beautifully rendered on classical guitars."

"Hanuman" from their newest album 11:11 is the song that sparked my interest...


And I love the official music video of "Diablo Rojo"



Upcoming challenge: Joni from Nursetopia recommended that I take on Nursing Idea's Nursing Research Challenge. I have committed to one research article each week. It's perfect timing because I have been waiting to read an article in the newest edition of Nursing Research, which just arrived this week at my school's library. The bloggers of Those Emergency Blues and Nurse Story have also taken on the challenge. Keep an eye out for my first article in the challenge!

And here's the remainder of my week: Focus in on taking on new challenges and experiences [to build confidence] while taking in the glorious sounds of Rodrigo y Gabriela.

[If you missed the first "Music Wednesday" be sure to check it out!]

Confidence

Confidence is gained through overcoming challenges. Confidence can be found in the elation and pride we feel after any small or major challenge. Whether it's being kind to a difficult patient or finding data to support your research thesis, we are assured of our potential through these challenges.

The beginning of my confidence building began with the challenge of studying abroad in Rome, Italy. This was the first major challenge to my world view, and my first exposure to other countries and cultures. As I first stepped off the bus on a busy street in the center of Rome, I was very uncomfortable-a good indicator I was being challenged. As I returned home after 3 months from Austria-by myself-I was loving and thriving in my independence. The entirety of the transformation that occurred in Rome was not apparent until I returned. I entered classes and campus involvement with acute awareness of my strengths, weaknesses, passions, and excitement. This confidence carried over to success in my core nursing classes and clinicals, and inspired diligence and enthusiasm for nursing.

Last semester, my confidence faded in clincals. My clinical evaluations were great, except I needed to work on confidence. Some may say this is typical of a nursing student, but there is a distinct difference between nervousness and doubting your abilities. Many aspects of nursing in the hospital setting contributed to my uncertainty. However, being out of the hospital setting in my public health clinical has helped restore my confidence. Facing public health issues in specific community aggregates and engaging clients expanded my view of nursing, and renewed my interest and passion for nursing. My lacking confidence in clincials last semester interfered with my ability to reach my full potential, and it made me value the challenges and experiences that contributed to my confidence.

Confidence affects the practice of nursing students and nurses everywhere. Nursing is a highly technical and skilled profession, but it is often undermined and not fully appreciated [by the public, patients, physicians]. Along with many other factors, this can impact nurses' confidence, and consequently affecting their practice. Confidence is an important part of nursing excellence that is not specifically addressed often. Understanding the effects of confidence can be very informative and helpful. "Confidence in Critical Care Nursing" published (2010) in Nursing Science Quarterly, found "preserving a sense of security despite barriers and accommodating to diverse challenges" (1) as themes in the confidence in their study. A business blog-Blogging Innovation-states "You’ll find confident leaders have broader spheres of influence, attract better talent, engender more confidence, and earn more loyalty and respect..."

Building confidence requires self-awareness and competence. Both of these come from challenges and experiences of any kind. Value your unique experiences, and continuously reflect on them to learn more about yourself. Be attentive to the effect of confidence on your practice. Engage your reality, and embrace challenges. A confident nurse is the best kind of nurse.

1. Evans, J., Bell, J., Sweeney, A., Morgan, J., & Kelly, H. (2010). Confidence in Critical Care Nursing. Nursing Science Quarterly, 23(4), 334-340. Retrieved from EBSCOhost.

Maximizing the potential of data & information

The shift to electronic medical records has been a little shaky for some, but it has the potential to complement the (pending) health care reform very well. The electronic records could increase collaboration and communication between health care providers, and provide community & public health nurses with clear data to target their interventions. This article prompts nurse managers to embrace this shift to electronic records, and outlines some of the benefits.

Check out the video below-from Nursing Ideas-about a way to better utilize and maximize electronic records:

Standardizing and Collecting Nursing Data from Robert Fraser on Vimeo.

Then check out this video-from TED- for another perspective on how health care providers can advocate for their patients by providing information in an effective way:


Technology can help us shift the focus to preventive health...Are you embracing technology in your work or viewing it as another hindrance to your nursing care?

Articles: Combating Stigma [HIV/AIDS Part 2]

Part 1 conveyed my personal experiences and views on caring for patients with HIV and AIDS. In this post [aka Part 2] I want to share some research and outside opinions that have been published on stigma associated with HIV/AIDS among health care workers. Adding on to the resources I mentioned at the end of Part 1, Avert.org is great for health care workers to expand their perspective. The site states, "Stigma and discrimination in healthcare settings are not confined to developing countries." They give recommendations for ways to combat stigma in health care settings:

"Health care workers need to be made aware of the negative effect that stigma can have on the quality of care patients receive; they should have accurate information about the risk of HIV infection, the misperception of which can lead to stigmatising actions; and they should also be encouraged to not associate HIV with immoral behaviour."

Recent research has been focused on experiences of the patients seeking treatment, counseling, and support. The findings of research of this nature are essential to health care workers. This site reviewed a published study, and reported, "Stigma in healthcare settings was especially upsetting if it involved indifference or awkward social interactions." This statement in particular resounded with me as I remembered the experience I relayed in Part 1.

I found an excellent article (available online!) from the Journal of the International AIDS Society, entitled "Combating HIV stigma in health care settings: what works?." The authors base their recommendations on the following claim:

"...there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour."

Being attentive to the above causes of stigma in health care settings can make a difference. If you are aware this stigma exists, you can evaluate its presence and effect on the health care setting you work in. In many circumstances, an unfamiliarity and perceived foreignness of HIV/AIDS prevents us from knowing how to establishing a trusting relationship with patients living with HIV when we encounter them. I recently read a study about increased protection of confidentiality and more knowledgeable interactions with HIV/AIDS patients among African nurses than nurses in Western health care settings. It reminded me of the remarkable care provided by the nurses in Uganda (as described in Part 1). Unfortunately, due to saving complications in CINAHL, I can't find it. If anyone comes across it, please let me know!

Update on Sudan: Southern Sudanese voted for the referendum. Now let's hope the split goes as smoothly as possible, and any massive killings are avoided.
Update on Egypt: I'm sure you have seen images and stories the crisis/chaos that's happening in Egypt. It will be interesting to see the uprising's continued influence in both Africa and the Arab nations.
Update on Midwest Blizzard: I'm enjoying the first snow day that my school has had since 1978. :)

Caring for Patients with HIV/AIDS [Part 1]

Last semester, I cared for a patient with a diagnosis of cryptococcal meningitis, an opportunistic infection secondary to the patient's HIV. At first it was an odd experience for me because it was the first HIV patient I had cared for since my experience in Uganda, and the only HIV patient I had cared for, or encountered, in clinicals. In this particular situation, I felt there was an unspoken uncertainty among the nurses on how to address or go about this positive HIV status. The family of the patient clearly felt it too. I overheard one of the family members say to others in the room, "I just feel as if they aren't telling me something." The family was aware of their loved one's HIV status, so that was not the perceived "secret" being kept by the staff. Somehow the knowledge that this was an HIV positive case changed the manner the nurses approached the patient, the patient's family, and their care overall.

The nurses in Uganda approached each patient who was HIV positive with an acute awareness of the impact of HIV and AIDS. The case was handled in a delicate manner in order to respect the privacy of the patient. The nurses used the term “ISS” [Immune Suppressive Syndrome] to avoid the stigmatization that came along with the dreaded “HIV.” Their understanding of the complex effects of HIV/AIDS on their patients allowed the nurses to also speak frankly and openly. The open dialogue between nurse and patient seemed to maintain their dignity as a person, and not a diagnosis.

The most enriching experience I have had learning about HIV/AIDS was in the city of Arua in northern Uganda. My other nursing friend and I traveled to visit Indiana natives and friends at Radio Pacis. We were scheduled to appear on one of their English health segments. The other guest was a man named Wadri. Together we all discussed the importance of communicating as a couple about your HIV status and going to get tested together. He was well spoken and very knowledgeable about HIV/AIDS, a result of sponsored training and education. Wadri has been HIV positive for about 20 years, which is remarkable since he was diagnosed during the beginning stages in the discovery of HIV/AIDS. Another remarkable thing about Wadri is that he is open about his HIV status, and speaks on the radio every week as an openly HIV positive person. We spent part of our short time at Radio Pacis with Wadri, walking through the city, and talking about his life. He took us to the local AIDS Information Center, and taught us more about what he wants to do for the community as an HIV positive person. Wadri is the paradigm for what mutual openness about HIV/AIDS can do for the community and health care.

Nurses need to openly and respectfully engage the HIV/AIDS community, and fulfill their obligation to the community by being their sound voice in health care. Nurses have to ensure they are aware and comfortable in their care for patients with HIV and AIDS. Otherwise--like anything-the perceptions, ignorance, and uncomfortable issues surrounding HIV and AIDS will impede nurses from optimally caring for their patients. Nurses and nursing students can seek out resources to help develop their knowledge and awareness. The Association of Nurses in AIDS Care [ANAC] is a leader in research, information, and career development for nurses. On their website, ANAC states, "All nurses need to think of themselves as HIV nurses." HealthHIV provides a plethora of educational resources, and can lead you to other organizations dedicated to the same purpose. The Act Against AIDS campaign is yet another great resource for both health care providers and the community. The University of California at San Francisco [UCSF] has a Nursing HIV/AIDS Center that has links to nursing research they h

ave completed. It's important to realize that HIV/AIDS does not just affect Africa and developing countries. In recent years, it seems as if HIV/AIDS has been driven out of the focus of many Western health care providers and consumers. The United States Healthy People 2010 and 2020 include HIV in its objectives. HIV remains a major health concern in Western health that should not be avoided. Nurses worldwide can continue to lead the way in fostering openness, awareness, and respect for people affected by HIV and AIDS.

Fight for Democracy in Egypt

Have you heard or seen about what's happening in Egypt?
The people are not merely engaging in protesting--they are fighting for democracy. The current president, Hosni Mubarak, has been in power since 1981. One person, one party in control over a country and its people for 3 decades! At the end of my History of Africa Since 1800 class last semester, I chose to do a presentation on Egypt. It's a fascinating country, and not because of our ideas of an Egypt of pyramids, King Tut, and Cleopatra. Egypt is an African country with tons of influence with its location at the Nile River delta, and the country's recent push for industrialization. Egypt of course has a hugely significant role in maintaining the stability of the Arab region. Egypt's intertwined political, geographical, and religious influences are evident in the country's recent developments: attacks against the Coptic Church; a plethora of modern youth pushing for the spread of modern ideas; and progress in the role of women in Egyptian society.
The seeds for the Egyptian's uprising were planted in the December 2010 elections. The opposing parties claimed fraud and rigging of the parliamentary elections by the government's ruling party. Anger ensued, and thus the ball was rolling.

Now, partly in response to politics in Tunisia, the Egyptian people have decided it's time to get Mubarak out of power. All eyes should be on Egypt. This is a long time coming, and the stability of Egypt threatens the stability of African and Arab nations. And the outcome of this uprising may give us some insight into the future of democracy in Egypt. Check out the BBC's news coverage in Egypt. I particularly like the photo seen below. The West might think feminism is dead in Egypt, but this picture certainly shows an Egyptian woman with power!
Update: I apologize for my long silence in between posts. It seems I'm still adjusting to my new schedule. Now that I'm settled in with clinicals, everything should balance out soon enough. Thanks for your patience! Look for more posts this weekend!

Random Links to Check Out

1. I have another professor that's a fan of concept maps [For more info-See this post]. My prof recommended this site today. You can actually create your own concept map online. The site is basic & easy to use. Another plus is that you end up with a neat, colorful map that's easy to read. This site would be great for creating concept maps to put up in your room, office, or workplace as a visual reference and informational guide.

2. Yet again, Invisible Children has led me to an interesting site. IfItWereMyHome.com allows you to compare what your life in the United States would be like if you had been born in another country. And it's not just developing countries. Canada happens to be the featured country of the week. I'm pretty Irish, so what if I were born in Ireland? Turns out I would have a greater chance for being unemployed and make less money, but I would have more free time and even live just a little bit (0.17 years) longer!

American Stalemate

Saturday was the 38th anniversary of the United States Supreme Court decision in the case Roe v. Wade. Tomorrow is the annual March for Life in Washington, D.C. where anti-abortion/pro-life activists will march to the Capitol building for their cause. I thought it was fitting that I discuss it, especially since abortion has been addressed quite a bit in the media recently [in particular with health care reform].

Abortion is one of those controversial issues that make most people vaguely uncomfortable and, in many debates, very angry. Consequently, it's difficult for something to actually being done regarding the issues surrounding abortion. Currently, neither side wants to admit that there's a stalemate.

Think about it: The media will occasionally cover a story on abortion, and the extremists on both sides of the abortion debate are cited. Each side vilifies the other, and spends the majority of their energy trying to dismantle the primary opposing claims to their stance. As far as the middle ground goes, the majority of people stand wherever is the easiest, appeasing both sides, in line enough with their philosophy about life.

I would merely like to bring to attention two major consequences of this stalemate:

1. Women are suffering at the expense of this debate. Roe v. Wade was, in fact, decided on the role of women in society. Now the reasons why women seek abortion are overlooked, and instead the opposing sides of the abortion debate rage on in their accusations against each other. In the midst of this stalemate, women are not being fully supported before and after pregnancy. For example: 38.5% of single mothers are in poverty (2009 Census data), which is a percentage that is steadily increasing. Both sides agree that there is a need, as President Obama said in his 2007 presidential campaign, "...to prevent the kinds of situations that lead to women having to struggle with these difficult decisions and we should be supportive of those efforts." Each person can interpret this statement differently, but the point is that abortion is not a sign of women being supported. In fact, it's quite the opposite. Whatever your views are, supporting women before and after pregnancy is not out of the question.

2. The driving force behind this stalemate is ignorance. People quickly form opinions on abortion from the media, their religion, their friends, their family, their age group, etc. There are not many people who actually have informed opinions on abortion. The debate has been raging on for 38 years after Roe v. Wade. Almost two decades of passionate debates has led us further and further away from the truth. My advice is to steer away from mainstream media. Figure out your reasons for your opinion [religion, feminism...] and then find the most original, unbiased sources of those reasons [example-the pioneers of feminism, church documents, etc.]. Abortion is not something that you should be apathetic about, considering it's significance in politics has been unchanging for two decades now.


That's my brief commentary on the abortion stalemate. It shouldn't have made you too uncomfortable or angry. Before the two decade mark of Roe v. Wade, educate yourself on what to do about the two major consequences of the stalemate. If you aren't from the U.S., your country probably has the exact same, if not similar, stalemate so this applies to you too!

Syringes and HIV

This innovative idea is important. Marc Koska has drawn attention to the re-use of syringes by health care workers, which is not always addressed when it comes to the spread of HIV. It's not necessarily an effective or fool-proof idea, especially when the syringes are used by intelligent individuals like nurses. In Uganda, we used these syringes sometimes. And we were promptly taught how to get around the built in safety mechanism. The nurses had a system to get around it, which was typically used in a safe way. For example, if you had a child who had regular oral electrolyte supplements through an NG tube. The large syringes used for this were in short supply, and also happened to lock after you pushed it all the way through. The stomach is not sterile, though, so the syringe was re-used-only for that child. We re-used a syringe for drawing up Quinine for malaria treatment. The syringe was used throughout the day, but never actually in contact with a patient's IV. The medication was injected directly into a sterile bottle of D5 (we used D5 with Quinine to prevent hypoglycemia). One thing that never occurred was actually injecting different people-be it subcutaneous or intramuscular-with the same syringe. [This is one of the problems Marc Koska addresses.]

Along with the new syringes, it is necessary to implement measures to increase awareness in the areas at risk for the re-use of syringes. Education among staff at clinics has the potential to make a tremendous impact. Programs that ensure proper disposal and clean up of the used syringes could go a long way. Most importantly, consideration of the context in which the re-use of syringes in clinics is essential. To an outsider, it probably seems disgusting and irresponsible that nurses could possibly do this. What if you had to treat fifty patients with the supplies shown in the picture to the right? Clearly this is not a black and white matter. With anything in nursing, there has to be a multifaceted approach to any problem. Nurses do more than give a medication for a simple solution. You assess, intervene, analyze, evaluate, and teach.

I'm not sure if this problem exists in Western hospitals and clinics....any experiences of problems with syringes in these settings would be appreciated. It could be more of a problem with wasting syringes in Western health care. I have had nurses open a syringe packet simply to demonstrate something then dispose of it without putting the (sterile) syringe to use. I'm not implying that nurses look to re-use syringes. I did not approve of-and felt uncomfortable with-some of the times the nurses in Uganda re-used syringes. [I simply did not participate in medication administration that I thought was unsafe.]

Nurses and health care workers need to be aware of their potential role in spreading HIV when re-using syringes. Nurses everywhere have to realize the importance of syringe use to the situation in which they are working. And as for Marc Koska-he does do more than just distribute syringes! Check out Marc's non-profit: Safepoint. He has even done projects in Uganda!

Music Wednesday: South African Music

It's halfway through the week, and most of us are getting tired. So I figure Wednesday is a good day for some uplifting music. Besides, relaxation can help us become more innovative thinkers! If you enjoy this Music Wednesday, I would be more than happy to make this a blogging tradition of mine.

Moving on...

I am more than a little biased when it comes to the video above featuring Vusi Mahlasela performing with Dave Matthews Band [DMB/Dave]. My family and I have been listening to a version of DMB's Everyday with Vusi for probably a couple years now [it's one of my dad's favorites]. Not to mention I have been to 7 Dave concerts, and I currently have 607 Dave songs in iTunes. [In case you were wondering, my love for DMB stems from my older brother and cousin.] Even if you hate DMB, watch the video. Vusi is entertaining up until the last second of the song. The dancing really steps up after about 5:15 in the video, so you can always skip to that.

Vusi is a native South African just like Dave Matthews who is from Johannesburg. The "About Vusi" part of his website begins by saying, "Vusi Mahlasela, is simply known as 'The Voice' in his home-country, South Africa, celebrated for his distinct, powerful voice and his poetic, optimistic lyrics. His songs of hope connect Apartheid-scarred South Africa with its promise for a better future." If you do not know about the violent racism of apartheid in South Africa, you need to. The disturbing part of this product of colonialism is that it was not dismantled until 1993, and its effects are still evident today. I learned about the destruction of the apartheid in South Africa in my History of Africa Since 1800 class last semester. In his book The African Experience: An Intoduction, Vincent B. Khapoya says, "It was the place where the humiliation and the degradation of African people has been articulated as an ideology, codified into law and institutionalized as the system of apartheid." For an easy, short read about the effects of apartheid in S.Africa, I recommend Peter Abrahams' novel Mine Boy,which is a novel that exposes the conditions that blacks in S.Africa endured through the story of a young mine worker.

As an activist for his fellow Africans, Vusi is lucky to have survived and thrived after apartheid. His work and music is very significant in that context. Besides, he is a hilarious dancer and excellent singer. Here are a couple more Vusi videos (without DMB):

Live at the S.Africa World Cup last summer

Live at a TED Global Conference

Enjoy trying to learn Vusi's dance moves!

Community Health Nursing Surprises

My first clinical rotation for the semester is community health. Today was one of our two orientation days, and we spent the day visiting a few of the different sites we can choose from. I have been pretty negative about this semester's clinicals, thinking that this "just isn't my thing." Today really surprised me though. Eventually, when that inevitable burnout comes, I could see myself working in some kind of community health nursing role. I have been able to establish a couple friendships with my clients in home health, and today I could see how that allowed me to be more open to the sites. I also found myself getting excited as I identified the many similarities the services provided had to my experiences in Uganda. Although the context and intensity of the settings are drastically different, the principles for community health are the exact same. Immunizations, poverty, preventative health, communicable diseases, prenatal care, and on and on....nurses in both the United States and Uganda can have a tremendous impact in these areas.

Another surprising part was the public health nurses' positive and welcoming attitudes at all of the sites-my professors included in that. They really are excited about the work they are doing, and their compassion for their clients was very evident. They face challenging situations, and yet they expressed hope for the future of health care. The director at one of the sites mentioned this video from Healthiest Nation. It's a short and basic video, but it causes you to shift your focus away from the more expensive side of nursing that occurs in hospitals. Our life expectancy in the United States is actually decreasing for the first time in years due to health problems like obesity, hypertension, diabetes-all of which are highly preventable with public health.
I thought this course and clinical would not help me develop skills useful in a hospital setting. However, today helped me realize that I can take part in public health by educating the patients while they are in the hospital. It's the perfect opportunity to assess and intervene to help a person's social, financial, environmental and psychological health.

As the nurses we met today pointed out-it's up to my generation of nurses to change the focus to the health of the community. For now, I'm just relieved that I can actually look forward to learning something useful this semester.

Powerpoint and Critical Thinking

Update: In addition to the reading and assignments I received today [my last first day of class ever], I am going to take on some new books. The first is Lipstick in Afghanistan and the second is The Designful Company: How to create a culture of nonstop innovation. The latter I discovered from this post on the blog Nursetopia, which is concise, informative, and a great nursing blog to follow.
Today one of my professors referred to an article from The New York Times that discussed the effectiveness, or lack therof, of powerpoint presentations when she was discussing her teaching methods for the course. I think I found the article she was referring to, and it's entitled "We Have Met the Enemy and He Is Powerpoint." It's an interesting commentary of the overwhelming use of powerpoint in the Army to explain extremely complex situations. There's no need for uproar about war strategy here-our purpose is only to evaluate the significance of the article's claims for nursing. The article states, "Commanders say that behind all the PowerPoint jokes are serious concerns that the program stifles discussion, critical thinking and thoughtful decision-making." I think it's fair to say that nursing education addresses complex issues, and powerpoint is commonly used to explain these complexities. I can't tell you how many trees I have killed printing off pages and pages of powerpoints for my nursing lectures. I have relied heavily on them in every nursing class. Outside the classroom, I have encountered powerpoint at a continuing education critical care conference organized by a local hospital. Every physician, surgeon and nurse presenting at the conference used a powerpoint presentation. I do understand the necessity for powerpoint in nursing. The issues are so complex and can often be easily broken down into simple categories such as assessment, diagnostics, treatment. The simplicity of a powerpoint presentation can be much easier to understand than dense textbooks or research articles.

So it may be necessary sometimes, but is powerpoint an effective teaching method? I am typically an A/A- student, but I have all too often studied hours and hours for nursing exams and not done well on them. What did I use to study in these instances? Powerpoint. Finally this academic year, I have cut down on study time and improved my test taking skills by using concept maps. With med-surg and oncology clinicals junior year, we had to complete concept maps as a part of our clinical paperwork. I had excellent professors that were difficult graders on these, but now that I look back their feedback and teaching with the concept maps helped develop my critical thinking skills. The outline we used junior year was basic, and already designed by our professors. It required you to fill in the primary diagnosis, assessments that are necessary for that diagnosis, and the previous medical history. Then you had to fill out four boxes with a nursing diagnosis, priority of that diagnosis, and the specific assessment data from the patient. This method was often effective in learning how to break down and prioritize assessments and interventions for patients with multiple diagnoses.

My professors last semester taught us how to use concept maps in a more complex way for learning lecture and clinical material. The lecture was advanced med-surg, so the content was very complex. We used concept maps mostly when reviewing for exams. This allowed my peers and me to interconnect topics-both recent and older course content. Concept maps forced me to critically think about the lecture content. In contrast, powerpoint often led to me dozing off, even in spite of excellent professors and very interesting content (ARDS, MI, trauma, etc.). The pictures are of a couple of my own concept maps from studying last semester. Please keep in mind these were probably done between 2 and 3 in the morning....

A literature review-on the significance of concept mapping- entitled "Concept mapping: an effective, active teaching-learning method" was published in Nursing Education Perspectives in 2006. Clayton concludes, "Despite the limitations in these studies, it seems apparent that concept mapping has the potential to be an effective teaching strategy in nursing education." Hopefully more studies on the effectiveness of concept maps in nursing education will be completed in the near future. Until then, I challenge you to fight against the dullness of powerpoint. Critical thinking is essential to excellence in nursing, so for your next continuing education hours or nursing class, go beyond bullet points on a powerpoint slide.

Action on AONC, Snow, and Sudan

Remember when I said I was the queen of sleep deprivation? Many times, that is related to the reality that I am also the queen of procrastination. My family claims it's a "Maguire" trait, with my brother winning the ultimate procrastinator award by a landslide. That's one of the reasons why The Art of Non-Conformity was very appropriate and useful for me. In addition to transforming your views, AONC has the purpose of inspiring action. Of course throughout the book I was constantly envisioning my goals and projects I could start working on. However, I think it's best for my procrastination if I focus on daily action towards my goals. [Especially with the onset of senioritis and the threat of the mentality that claims "It's senior year, live it up!"] To ensure that you are productive, the author Chris Guillebeau states, "Create a continual metric for your most important work."

Tomorrow I head back to school-hoping I make it through the snow and hoping I can find the entrance to buildings in the 40 inches of snow. I have to evaluate how I am going to spend my time in my very last semester. My classes-finally all nursing-consist of the following: Community Health Nursing, Psychiatric Nursing, Nursing Research, and a self-designed Independent Study [includes clinical on an intermediate care unit & working one-on-one with one of my favorite professors]. In addition to classes, I am the president of a club, designated secretary of another club, peer mentor to first year nursing students, peer minister in campus ministry, and somewhat of an athlete [I'm technically done with my season, but there's still the pressure of staying in shape]. Not to mention it's my last few months living within a ten minute walk of the majority of my closest friends. So here's my "continual metric for [my] most important work":
1. Have two people review my resume each week. [My brother worked in a career office for 3 or 4 years- he had about 200 people review his resume.]
2. Read for a half hour each day [does not include reading for class].
3. Do 30 NCLEX questions each day.
4. Review ten medication flashcards each day.

I figured that's easy enough-give up some Facebook, have an extra cup of coffee to skip a nap...

Lastly, I have been trying to keep updated on the voting process in Sudan. The Sudanese are voting on a monumental referendum that would declare Northern and Southern Sudan separate countries. There has been strong support for passing the referendum, but there are major concerns over the potential for extremely violent backlash. The United States media has failed to bring attention to the voting in Sudan this week. For international news, I have found BBC news to be very informative. Check out BBC's special report page on the Sudan referendum to read more on the referendum. Here are two short videos that offer some information and perspective:

My Impressions: Art of Non-Conformity

I have some good news--in the 24 hours between Wednesday and Thursday nights, I was very productive. I worked 16 hours and managed to finish two books! While it's fresh in my mind, I want to share my impressions of Chris Guillebeau's book The Art of Non-Conformity. I have briefly mentioned this book in my previous posts Reading Suggestions and Reasons Why. My parents, caught up on the word "conformity," claimed that I didn't have any problems with questioning the norms. However, the author's intentions are far from my parent's initial impressions about rebelling against what most people enjoy or like. Instead, this book challenges your approach to your career and life goals in an enriching and inspiring method. Chris verifies this in the first sentence of the book by stating, "The purpose of this book is to transform your thinking about life and work."

Chris is believable and compelling because he has successfully lived out his book since his 20's. Countless authors make claims and suggestions in their writing, but fail to actually apply them to their own life. Christ provides you with examples from his own life for each major principle, and concurrently he encourages you to individualize the process for your interests and goals.

To benefit from the ideas presented in his book, Chris says the following: "You must be open to new ideas. You must be dissatisfied with the status quo. You must be willing to take personal responsibility. You must be willing to work hard." If you meet those, then he challenges you to fully evaluate what you want most out of life. The way he does this abruptly made me realize that I had never fully determined what I did want out of life or my true life goals. It got me thinking, "What I am I actually working towards?" [One of Chris's life goals happens to be traveling to every country in the world by the time he is 35. Currently he is at 149/192-you can track his progress here.]

Chris maintains that most people don't live to retire, but rather they live to work. For many, work gives them purpose, meaning, and even happiness. However, valuable time is wasted on pointless work. Therefore the goal is to continuously be focused on doing "great work" and eliminating all of the things wasting your time (meetings & emails are included in this).

Chris intertwines multiple steps and parts to the process of dedicating your life to great work, so I will leave that to your reading. I have given you the idea behind the book. Now I want to answer a couple questions on my impressions.

1. What are my criticisms of the book?
Chris states, "As a part of the experience of being alive, I believe we're looking to find our place in the world. On a planet of seven billion people, where do we fit in? This is essentially the central question of life..." I definitely am critical of that statement and many more he makes throughout the book along these lines. At the end of the book, Chris dedicates an entire chapter to our need to leave a legacy behind. Although your legacy and finding where you fit in the world are important, I do not believe these are our motivations in life. Our human nature causes us to have an eternal desire to be satisfied in something more, something greater. I believe this is our desire to seek fulfillment in God, and these desires are only fully and truly satisfied in Him. As Saint Augustine wrote, "You have made us for yourself, O Lord, and our heart is restless until it rests in you." We seek love, joy, peace, happiness-which are all manifested in Christ.

2. What does this book mean to nursing?
The practice of nursing is often guided by the safe way of doing things. Safe, in this case, meaning "the way we have always done things." Evidence-based practices in nursing, prime examples of innovative approaches to patient care, interrupt the monotonous ways of going about your day. Stepping out of the safety zone and actually focusing on great work can add a lot to improving the quality of nursing care. Rushing through patient assessments and encounters may seem necessary with the fast-paced environments on hospital units, but does that really achieve great nursing?

Nursing is on a fence right now. With the struggling economy and potential for system overload with the new health care reform, nursing can easily spiral downward. It's obvious that nursing dissatisfaction is rapidly rising with these tensions. If nurses take charge and challenge the old way of doing things, nursing has the potential to pull through strongly. Is the current way of doing things sustainable? Do you really think that your day is filled with great work? Instead of wishing that the circumstances of your job were different or better, take action on your ideas.

Continuing to consider the implications of the ideas of The Art of Non-Conformity, here are two quotes to reflect on this quote that you can find in Chris's book:

"I don't understand why people are frightened of new ideas.
I'm frightened of the old ones."
- John Cage

"The gap between ignorance and knowledge is
much less than the gap between knowledge and action."
-Annonymous