What Nursing Independence? And Other Notes from the Nursosphere…

Here’s some stuff we’re reading online this week:

In one of the health systems that I interface with nurses can no longer document that they held a patient’s medications based on ‘nursing judgment’. Such an instance might be when a patient had hypotension from pain medication and thus the morning anti-hypertensive is held. Instead, they need an order from a physician to hold such medication. Further, something like ‘Tylenol’ on a patient’s medication record ordered for fever could not be administered by the nurse for a headache if the patient requested it because that would be ‘practicing medicine without a license’.  A nurse cannot order a social services consult, flush a urinary catheter should it become clogged, refer a patient for diabetes education, etc., etc., without an order from the supervising physician.

That’s from a smart, if somewhat depressing, blog post at Nurse Story called “Independent Nursing Practice: Reality or Still the ‘Physician’s Hand’?” The writer, Terri Schmitt, goes on to wonder just how nurses can carve out areas of independent practice, even in the most basic matters. Good questions.

And here’s a question of interpretation raised by an incident in Colorado involving a nurse and the policeman who stopped her for speeding:

When Colorado Springs cardiac nurse Miriam Leverington was stopped for speeding, she grumbled to the police officer.

“I hope you are not ever my patient,” she reportedly told him.

What happened next has become a topic of widespread debate in Colorado and on the blogosphere. The police officer, Duaine Peters, complained to the […]

A Nurse Cartoonist Worth Checking Out

Drawing on Experience is a blog run by a student who’s been completing an accelerated BSN program in nursing and who illustrates his education and personal life with remarkably subtle and witty cartoons. Hat tip to a recent Change of Shift blog roundup at Emergiblog for letting us know about his work. It would be wrong to reproduce this artist’s work here without permission, and he might not like it, so I’m just including a really really tiny version of a recent cartoon illustrating his induction into the nursing honor society. It links back to his original Web site, where you can see this and many other cartoons in full, legible size (and of course, upon request, we’ll gladly remove the thumbnail image here!).

What makes this artist’s work so much fun? The tongue-in-cheek, martial-arts-disciple-and-wise-man narrative? The humility and sense of pleasure in life’s ironies and challenges? The quality of line? The attention to apparently trivial details? The way his mini-narratives play with genre conventions? At any rate, it’s a welcome addition to the nursosphere; I don’t see any contact info on this artist’s blog, but we hope he’ll find time to continue (and consider letting us publish one of his drawings on the blog or in AJN).—JM, senior editor/blog editor

I Simulate, Therefore I Am…

One after another, the student nurses pump the hand sanitizer dispenser and approach the bedside. They turn the patient’s name band to check his birth date and full name and say, in that singsong manner typical of young adults, “Good morning, Mr. Johnson, I’m your nurse today. How are you feeling?” The patient is a manikin called SimMan, short for simulation man, and I’m his voice. Hidden behind a one-way mirror, I also control SimMan’s physiological responses to the students’ interventions. My goal is to replicate the essential aspects of a clinical situation in order to prepare the students to encounter them in a living patient.

That’s the start of the September Reflections essay, written by a nursing instructor who experiences a curious role reversal as he plays the patient in a simulation exercise. Read the rest of it here, and let us know what you think.—JM, senior editor/blog editor

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After the Angels: In Search of A ‘Knowledge-Based’ Professional Identity

If you’re looking for angels, you’ve come to the wrong place. So says GuitarGirlRN in her latest blog post.

One stereotype of nursing (and it’s perpetuated by nurses as well as by those not in the medical or nursing fields) that bothers me is that of nurses as “angels of mercy.”

We’re expected to smile while up to our elbows in bloody shit and vomit, be pleasant to rude and sometimes violent people, put up with crap from doctors, managers, patients, their families, nurse techs, and janitors yet keep our cool, never cry, never sweat, never lose our tempers with each other, always be prepared and be right there when we are needed.

Her point is that nurses are human; they do the best they can with scant resources, but they aren’t superhuman. They aren’t saints, they have lives of their own, and they can’t always be all things to all people. Back in 2005, noted author Suzanne Gordon wrote, with Sioban Nelson, an article for us called “An End to Angels.” In it, they presented the idea that nursing is a profession with a serious image problem, one that undercuts recruitment efforts and ill prepares new nurses for the reality of their work. The arguments in the article are subtle and thought provoking, and impossible to summarize. Here, anyway, is the introduction:

Nurses often disagree on the causes of and possible solutions to the current nursing shortage. Mandatory staffing ratios versus Magnet hospitals? Sign-on bonuses […]

Maybe Palliative Care SHOULD Go to the Dogs

By Shawn Kennedy, MA, RN, AJN interim editor-in-chief

Last week, we took Sam, our ailing 14-year-old Labrador Retriever, on what became his last trip to the vet. Sam had been diagnosed with bone cancer in February after we noticed the right half of his head enlarging. Because of where the tumor was, it was inoperable. We felt that at his age chemotherapy wasn’t a realistic option, and we didn’t want the last few months of his life to be bad ones.

His veterinarian, who’d treated Sam since his puppy days, supported the decision, saying she would make the same choice for her dog. And so we spent the last few months adjusting doses of steroids and pain meds to enable him to live as normally as possible. For Sam, “normal” was being able to greet all comers to our door, to be the leader on his walks, to be smack in the middle of where his family was. (If people were in the basement and on the second floor, he would lie equidistant from where everyone in the house was. If we were in the same room, he sat, front legs crossed in his “elegant dog” pose, where he could see us all.)

So last month, when we saw that he would no longer get up to greet visitors or his family; was reluctant to go on walks (he did, but with a great sigh and lots of panting after even the shortest […]

2016-11-21T13:15:45-05:00September 13th, 2010|Nursing|6 Comments
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