In Defense of On-the-Job Learning in the ICU

Image via Wikimedia Commons

By Marcy Phipps, RN, who is a regular contributor to this blog. She emphasizes that the identity of the impatient practitioner described in this post has been altered in significant ways to prevent any chance of recognition.

“This is why new nurses have no place in critical care!” said the trauma physician. “I’m sure she’s a fine nurse, but she should be getting experience with these situations on the floor!”

The issue of whether new nurses should work in critical care comes up from time to time. It seems to polarize people, and it always touches a nerve with me. I was hired directly into the ICU upon passing the boards, as were many of the nurses I work with. My hospital offers a program to new graduates that includes training and education specific to critical care and an extended clinical experience with a preceptor. Admittedly, there is a steep learning curve, but I wouldn’t consider it unsafe—and comments that suggest the contrary irritate me, because they undermine new nurses and foster negativity.

This patient probably would have pulled his PEG tube out no matter how experienced his nurse was, and I’m not sure the step-down floor would have been a “better” place for a new nurse to manage that situation. The patient acuity is lower on the floor, but there are also fewer nurses around to help out, and a […]

2016-11-21T13:11:33-05:00November 2nd, 2011|career, Nursing|6 Comments
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One Take on the Top 10 Issues Facing Nursing

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

So I’ve been in Dallas at the Sigma Theta Tau International (STTI) biennial meeting. The venue is the Gaylord Texan, a large, climate-controlled resort under a glass dome—as you leave your building and walk “outside,” you’re really not. Don’t believe the flowing stream or flowers or gardens (all real) along the walkways, or the Longhorn steer (fake) behind a fence that stands outside my building—you’re still inside. And to make it even more surreal, there are Christmas holiday decorations everywhere, including a gingerbread house the size of a small hotel room. It will be strange to step back in time to Halloween when I get back home.

A daunting list. There are a few thousand people here for the meeting, way too many sessions to choose from (20 different topics for each concurrent session period), plus rows of posters and exhibit booths. And of course, great networking. One lively session I attended was standing room only—and that’s after any floor space had been occupied by people sitting cross-legged. It was a discussion of the top 10 issues facing nursing, led by STTI’s publications director Renee Wilmeth (she’s not a nurse, which probably makes her less biased). The issues were compiled from responses provided by 30 nursing leaders, and were presented in question form:

  1. Is evidence-based practice (EBP) helpful or harmful? (Amazing how many interpretations there were of EBP, some of them—as I know from our […]
2016-11-21T13:11:34-05:00October 31st, 2011|students|10 Comments
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Legacy of the Living Legends: Slackers Need Not Apply

By Shawn Kennedy, editor-in-chief

Earlier this month, I attended the American Academy of Nursing 38th Annual Meeting and Conference. With e-mails flooding my inbox and a full meeting agenda over the next few days, I was thinking of skipping the 2011 Living Legends event that took place on the first evening. Thankfully, an old friend, nurse historian Sandy Lewinson, talked me into going—it was one of the more memorable nursing events I’ve attended.

The academy honors “Living Legends” in recognition of the multiple contributions these nurses have made to the profession and the impact these contributions have made on health care in the United States and abroad. This year’s honorees are shown in the photo, from left: May L. Wykle, Meridean L. Maas, Ada Sue Hinshaw, Suzanne Lee Feetham, and Patricia E. Benner.

Credited with such achievements as creating a nursing taxonomy on nursing error, building the science of pediatric nursing in the context of the family, conducting ground-breaking nursing research, developing and implementing professional nurse governance in employing organizations, promoting policy change, and addressing the nursing shortage, these nurses join 77 other nursing notables who’ve been so honored since the first class was named in 1994. […]

2016-11-21T13:11:35-05:00October 27th, 2011|career, nursing perspective|2 Comments
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Changes in Latitude: Comparing Health Care Systems with Nurses Down Under

By Peggy McDaniel, BSN, RN, who writes the occasional post for this blog and currently works as a clinical liaison support manager of infusion in Australia, New Zealand, and Asia Pacific.

I recently found myself sitting on a boat, enjoying a “sausage sizzle,” dressed as a pirate no less. In Australia, a party that includes barbecued meat usually includes sausage; thus the name. The pirate theme was an added bonus. As an American and a nurse, I was pleasantly surprised to find myself seated at the same table as two Australian nurses. What were the chances of that? The conversation that evening gave me some insight into the Australian health care system, which I am just getting familiar with.

Comparing health care systems. Once we all realized we were experienced nurses and shared the belief that quality patient care should always be the primary focus of health care, the conversation turned to cost. In Australia, there is a public health option that all Australians can access. It is paid for by taxes. If you choose to do so, you can also purchase a private plan to supplement this public option. I have yet to determine what part, if any, employers play in paying for health care or private insurance. However, a sick Australian will always […]

2016-11-21T13:11:39-05:00October 26th, 2011|health care policy, nursing perspective|43 Comments
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The Dance of Empathy

By Peggy McDaniel, BSN, RN. An infusion practice manager currently based overseas, Peggy has written for this blog a number of times in the past.

by Augustin Ruiz, via Flickr

Although it’s only late October, this time of year finds me pondering holidays past, which were often spent working at a hospital. As a younger nurse, I worked in a neuro-trauma-rehab unit at a large children’s hospital. We had a strong primary nursing model and often cared for the same patients throughout their stay, which could last days, weeks, or months. Memories of patients from that unit and others occasionally come back to mind at this time of year, often spurred by holidays.

One of my first assignments was a beautiful youngster who had suffered a brain injury. It was a difficult case and the family spent many hours on our unit, helping me provide basic care and praying for a recovery. But after more than three months, the child’s strong and previously healthy body stopped fighting and the child passed away, with family at the bedside.

Years later, after being away from this facility, I returned for a short stint as a per diem on the float team. I dropped in to work when and where needed, days or nights. Many of the same people I’d loved working with were still there, and I […]

2016-11-21T13:11:40-05:00October 25th, 2011|nursing perspective|4 Comments
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