Thursday, March 29, 2012

NSNA Convention/ Election

The 60th Annual NSNA Convention is being held April 11-15 in Pittsburgh. One of the important events that takes place at the convention is the election of the Executive Board, the NSNA's governing body. Running for NSNA President this year is Joseph Potts, a nursing student at the University of North Florida and an avid reader of the @MurseWisdom blog. Joseph is a 12 year veteran of the Navy and lives in Jacksonville with his wife Kimberly. If you would like to find out more about Joseph, his campaign, and his vision for the future of nursing you can check out his Facebook and Twitter pages at:!/NSNAJoe

Monday, March 26, 2012


There is a lot of heated debate, especially amongst current Nursing students as to which education produces better Nurses.  BSN or ADN?  So, let's discuss shall we?

Let me begin by just stating that I am an ADN grad and have worked my way up from CNA to LPN to RN.

No matter what kind of Nursing student you talk to they will tell you the same thing.  An ADN student will tell you that Hospitals would rather hire an ADN nurse, especially from his or her program than a BSN student from a near-by and therefore "rival" program.  And a BSN student will tell you the same thing.  Here is a funny touch of Irony, BSN programs better prepare nurses for the type of nursing required in a long term care setting and ADN programs train their nurses for Med-Surg type units and it is usually the opposite when it comes to job placement.  ADN will end up in long term skilled type facilities where as the BSN nurses will flock to hospitals.  I have a friend working at a nursing home that is completely run by ADN nurses.  Not a single nurse has gone beyond the two year mark.  Yet, I met a BSN graduate working as a CNA at a hospital because she hadn't passed the NCLEX yet and since she hadn't gone to a bi-level ADN program she wasn't eligible to take the LPN boards. I was an LPN at the time, in clinicals, telling someone with a BSN that I needed her to do this or that. It was so strange.

Let's try using some simple math to get an answer.  I googled the number of credit hours required to obtain a BSN. I wanted a middle of the road number so I picked Oklahoma City University which, geographically speaking, is pretty well in the middle.  They say it takes 124 credit hours for a BSN.  Any arguments? My college requires 72 hours of Nursing credits in order to graduate.  I graduated with 129 credit hours.  That's just how the system works, between prereqs and liberal arts/humanities electives needed in order to apply, I ended up with 5 more hours than is needed to hold a BSN. So, mathematically it seems to be no different.  (By the way I suck at Math)

(I really hope to get a good discussion going from this blog)

I have talked to nurses that are just straight snobs about their BSN and others that have flat out told me it isn't worth shit, I have friends that have gone on to complete their BSN after ADN.  Me personally I believe we are all just nurses. I mean an RN is an RN is an RN, right? If I go on the get my BSN I don't take another NCLEX, same goes for my Master's level nursing... No new NCLEX.  (However, there is a board certifiaction for Nurse Practitioners if I were to go that route)Those of you in BSN programs... your NCLEX is no harder than mine was and, not to brag, but, I'm sure you won't/didn't do much better on it either.  Surely, its not just a matter of initials after your name, right?

So, BSN students get more class time and more Nursing Theory, whereas ADN students spend their time hands-on in clinicals, labs, simulation, etc...  As far as who is the better nurse... I think we can all agree that that is an individual assessment.  My nursing program didn't make me the nurse I am today, but they did provide me with the essential information I needed to overcome the first big obstacle, which was the NCLEX. 

In my personal opinion, it is better to go through a 2 yr bi-level nursing program.  You can start as a CNA when you start the program. After a year you can test for your LPN and start earning LPN wages and gaining real world experience in nursing. Then after two years (hopefully) you can test for your RN and begin making RN wages and building valuable experience.  Then if you must have a BSN or MSN or ARNP after your name, you can continue your education while working and earning a living.  It may take a little longer than if you just went straight through but you won't be new to nursing when you get your MSN or BSN you'll be a seasoned nurse. 

But what do I know? 

As always, thanks for reading.  Share with your friends, coworkers, and fellow students. And comment! Subscribe! Let me know if I'm pissing you off or hitting the nail on the head.

Send me pictures of your study group or friends doing something vaguely nursing and I might feature it on the Blog. Please don't violate HIPAA. 

Follow me @MurseWisdom on twitter

And special thanks to co-author @That1Murse and to @bigwesyall for his continued support


Sunday, March 25, 2012

Mursing School by @TMFS786

One of the few things I feel like I have the experience to speak from authority about is nursing school. I just graduated so obviously I'm an expert. There is a lot I read on twitter and facebook about and I think some things need cleared up for those of you that are still inside or maybe this will just be funny to the people who made it through and are looking back.

Stop worrying so much! My friends will laugh about that because I was pretty much a constant wreck because I never felt like I was doing well enough. I somehow yoked myself with this feeling of my entire life was riding on how well I did on the next test. If I passed and didn't do great I still felt like a failure. Well the truth is I did fine. I passed without any real worries, except maybe family nursing that was close, but really I was not in trouble. We were told we were already above average students so maybe when things went from easy to mildly difficult I didn't know what to do. Maybe I just became an asshole, that is still a debate, either way I got worked up over nothing and you probably are too. You need to focus on what you need to learn that week and move on. Trust me in your first year of nursing you are going to feel like you learned little to nothing. So all the little details you forced into your brain (mine was aplastic anemia) will mean almost the same as your ability to speak Sanskrit. You are going to learn a lot of details and the teachers are doing their job, but honestly the majority of that is just stuff you have to learn. A hoop that has to be jumped through, the same one those before you and those after you will have to jump through. The broad strokes are the things I have used the most as a new nurse not stuff like the Parkland-Baxter formula. Not that it matters you will have the deer in the headlights look a minimum of six months on your first job anyways.

Have a support group, and make sure they mean it. I was lucky; I have a wonderful girlfriend who is also in the health field so she understands my anger. My friends are good friends and supported me. I highly suggest you pick people to surround yourself in school for all the basics: Studying, travel, test preparation, and people you can trust to vent to when you feel like you have reached your limit. Nothing will ruin your day like traveling for an hour and a half to clinicals with someone that causes arguments in your group. I guarantee you will loathe your life in a hurry if that is your situation. I had a situation where we couldn't even talk in the car after a few weeks or it was an inevitable fight. Trust me when I say that made a long day even longer. You can't avoid all the arguments, we are human stuff is going to happen but someone with similar views and thoughts can go a long way. Just as important is having a support group outside of class. Pick people in nursing, out of nursing it doesn't matter. Make sure they are people you can talk to that see things from an entirely different point of view and use their advice it will come in handy all the time. I have friends that are nurses and cops, both way removed from class. They were there to balance me and keep me on track when my classmates were just as stressed as I was.

Have an outside life. I know we study a lot, I get it. You aren't going to tell me anything that I don't already know about school and tests. No you aren't different and IT IS the same for me as it was for you. You have got to do something un-school related while in the program. You will go crazy if you don't. Besides you can't study all the time you just cant after a while all the words will just run together and be a blur. Go to the bar, take a day off and go the movies it don't matter but stay away from the books every once in a while to put things in perspective. You can only retain so much information at once anyways don't waste your time beating yourself up over something you won't remember anyhow. When you really want to go out for a few hours with your friends, then do it and don't look back and think about the studying. If you make a decision stick with it and move forward. It's a skill you will have to master when you get onto the floor and they expect you to be in charge of people's lives, start practicing now.

Not all of you are going to make it. That's the breaks and it's the truth. If it was easy everyone would be a nurse and we wouldn't be as necessary. Embrace that truth and realize you are a cut above. You are going to be special and make an impact on people who need you the most. That's why it is tough and you have to go through it. If you want it bad enough, you will do it. I had moments of doubt like everyone else. The difference is we that graduated are willing to pay the price to have what we want, if you aren't then maybe you need to find something else. A lot of people can help and give advice, I know I am and so are most of the murses I know, but you have to use it.

Written by @TMFS786

Saturday, March 24, 2012

Know Your Role

I think it’s important in nursing and life in general to know your role and know your qualities.  Are you are leader or a follower?  A critical thinker?  Someone who just wants to get by and draw a check?

I think the lack of knowing this beforehand can contribute to nurse burnout and people with Nursing Degrees working in banks or not working at all.  There are some jobs based on your qualities that may not work well for you.  For example, if you are going to work in a nursing home or an inpatient rehab your leadership qualities will probably be for naught.. and from the time I worked there the most critical thinking that I did was making sure I didn’t give Gertrude the medicine for Olive.  (Now I’m not knocking nursing home nursing, just saying that if you are a person that wants to grab life my the balls and drag it down… nursing home nursing…probably not for you)

I’ve always seen myself as a leader.  I think this is why I gravitated toward ER nursing or critical care nursing in general.  I knew that when the shit hits the fan, I would have to potentially take control of a situation.  We’ve worked multiple MIs, multiple GSWs, and this with one doc in the ER.  I’ve had the doc approach me ask me to assess a chest pain and decide if it’s legit or not.  

I think this is also why I’ve decided to pursue my Nurse Practitioner.  I want to be the guy in charge.  I want to be the giver of the orders not the taker of the orders.  But I know that’s a quality of mine.
What I think you should do, it take a few moments assess the type of person that you are and learn what qualities make you up?  It will pay off and hopefully make nursing a more enjoyable experience.

And as always, follow me @That1Murse and my blog co-author @MurseWisdom.  Feel free to post questions, comments, bitches, whines, moans, groans, and complaints.

Special shoutouts: 
            @BigWesYall and his website  - Thanks for the link to our blog.
@jorrrrd_ (Jordan) and her class at LCCC.  Thanks for posting a link on your FB group page.  Enjoy the read.

Monday, March 19, 2012

The Last Straw by TMFS786

By far the most asked question I am asked is why would I choose to go from police officer to nurse? It's a legitimate question, because some people have see NYPD blue and think we get to throw people around and why would anyone want to leave that. The truth is a series of events in stories that are way to long to put into one blog. I have been able to isolate what may be the three biggest facets of my decision: 1) the justice system sucks, 2) aspects of the jobs themselves, and 3) specific events that happened as a police officer. Before we go any further I think it should be said that I love being a police officer (I still do it part-time) and the officers are great people. Nothing said should be seen as a reflection of the people wearing the uniform and doing their job.

The justice system is broken. I hear a lot of complaints about the health care system and everything that is wrong with it. Well, it looks like a diamond shinning in the sun compared to the justice system. Health care is flawed and I doubt there is a good way to fix it that will satisfy everyone. The justice system just seems to be screwing over most people involved with it. Health care still essentially does it job. If you are sick, most likely, you will be fixed. Yes, there are tragic stories of insurance companies turning down people that need an operation or procedure. Do I feel for those people, of course I do and it sucks. The difference is those are isolated scenarios that need fixed. The justice system has a systemic infection that can't be corrected easily. The joke is lawyers are to blame and in essence that's not a joke. It is heart breaking to stand in court and the suspect say he is guilty and the judge tell him to reverse his plea, because he may be able to get a better deal. Especially when you have put in back breaking hours and manpower into finding a thief, then you have to go to court and then that happens. Afterwards the family inevitably blames the police even though they know we arrested them. When I take care of a patient they get better or they get worse. I get to see it and I can deal with that, but to have a win taken because a judge doesn't care is just heartbreaking. Defense attorneys are another breed of slime that's hard to deal with on a daily basis. They are doing their jobs…blah, blah, blah. A person that can defend another person who admits to molesting children by trying to insinuate that the police officers were wrong is pretty disgusting. Imagine a person that just stood in a room and every time you went to start an IV moved the persons arm.

People hate cops. It's a fact of life any police officer will likely tell you depending on how much complaining he wants to deal with after they are honest. People want us out busting crime, enforcing traffic laws and making society safe. That is until we start asking them questions then we are nothing but worthless and harassing someone. It always has to be that they are black or a woman or they drive an expensive car. Nobody has ever said “I realize you stopped me because I match the description of the person robbing houses and I happened to drop my wallet in their house” or “I know I was in the wrong going fifteen miles over the speed limit.” In the end it's always our fault that they did something wrong. A nurse is seen as something in society that represents what people aspire to be. We are trusted and thought of as capable by the public. I want to do my job and do it the best as I can without people hating me for doing it. Another officer and I responded to a child drowning. It was at a house party and accidents happen. The officer and I arrived to find the girl and began doing life saving measures and actually got the young lady to begin breathing again even it wasn't pretty. The party however never stopped and I yelled for the music to be turned down and people to step back, because silly me I wanted to let EMS know what was going on and to have room to work. After the incident several family members came up to me and demanded an apology. I wasn't expecting a thank you, but I certainly didn't see this coming. They said it was obvious since I was the only white person there that the reason I yelled for the music to be turned down was because it was rap music and I was racist. It never occurred to them I guess that I wanted to relay information to the paramedics who were on their way to get the daughter. That was a hell of a way to end that call. The other day, working as a nurse, a parent thanked me profusely for saving their kids life, even after I told them repeatedly that I only helped and I really didn't do that much. That everyone else around me had done much more. It's hard to argue with an appreciative mother with tears in her eyes. That is another reason to leave being a cop and become a nurse. Not only was I thanked, but I was thanked for just being there.

I have been in way worse situations as a police officer then I will ever be as a nurse. That doesn't mean there isn't stress, there is a ton of stress as a nurse, but it's not the same in the field when you are involved in the action. One of the boring but safe reasons for being a nurse over a cop is there is dramatic drop in the safety of being at work. Never has a room burst into flames while passing meds. Nobody has pulled a gun on me while adjusting them in bed. I have seen a lot of things that have made me different than I was before them. Some things can not be unseen or changed in your memory no matter what you do. Trust me I tried and tried. I don't know how I became so unlucky but I had a habit of being at the wrong place, at the wrong time, a lot as a police officer. Over time these incidents wore on me and they still place a weight on my shoulders. It is expected and it hasn't inhibited me in any real sense of measure. A lot of times I am asked essentially “what straw broke the camel's back?” A story that I will keep brief and I have been told may be too graphic for many is the answer. A structure fire was reported and then it was dispatched that children may be in the house. If I had drove to that house any faster I would have went back in time. I had been in some tough situations before, but anything involving kids always seems to hit harder. The house was hot…real hot when we arrived and I knew it was going to be bad. The flames had busted out the front and sides of the house and were extending pretty far into the air. It's something I don't know if I can explain with a thermometer but looked like something out of a movie. I just didn't think it could be real. Eventually we were able to get one child out of the house and into the hands of paramedics who took the child away. One was still reported in the house. I screamed and inhaled black smoke at an alarming rate something I am sure my lungs will repay me for in the future. In the end we got the other one out but it wasn't enough. At the hospital helping the coroner, I saw all the nurses standing there. They were upset but they had done everything possible to help both children which was way more than I had felt I had done. I was envious of the feeling of being able to help and I wanted to feel it more than anything else I could imagine. Hopelessness is the absolute worst feeling in the world. So I made the decision pretty much right then and there. As nurses we affect lives directly and indirectly and we do so from the moment we clock in till the moment we clock out. I am proud to be a police officer and I would never trade this time for anything, but I look forward to the time spent helping others and maybe someday someone will remember that one murse that helped them.

Thursday, March 15, 2012

Dealing with Grouchy Nurses

So several people have requested that I write about how to deal with grouchy nurses… and some of this is not going to be cheerful news.  First things first, you are going to deal with bitchy people in any profession… There are bitches in nursing, bitch doctors, bitch lawyers, bitch mechanics… hell even bitches in the Burger King.  The idea is to learn how to handle the situation appropriately so that you remain sane and don’t become the bitch yourself. 

If you are a nursing student and the nurses on the floor are being grouchy… sorry but it’s best to keep your mouth shut, keep your head down and survive the day.  If you butt heads with a nurse on the floor as a student… you will lose every time.  Every clinical day should be a job interview because you never know if you will be colleagues with these people and if you snap on the floor you will get blackballed in that department… hell maybe even the whole facility.
If you are a new nurse, you need to do a few things to deal with the grouches.
  • ·         Realize that nurses eat their young.. It’s not pleasant but it’s true.  Put yourself in their position. As they get older or grouchy, they figure their days are going to be numbered.. so to them they see you as the replacement (and they have to train you). In their clouded sense of judgment, if they run you off they won’t be replaced.
  • ·         Learn how to deal with that specific grouch. 
o   Some of them are dealing with problems at home or general unhappiness.  If that’s the case either it will get better eventually or they will stay a grouch and you either try to friend them.. or avoid them.
o   Some may be grouchy, but only at work.  These are those grouches that are horrible to work with, but when you go hang out away from work they are fun, relaxed, and a joy to be around.  These nurses typically have been “the bitch” for so long they feel obligated to live up to that role.  Nurse Ratched is a bitch… but Becky is fun to hang out with.  Once you figure out this type, the grouchiness at work won’t bother you near as much.
o   Last common type is those nurses that are trying to push your buttons.  They want to push you to see how far you’ll go and to test you.  My dealing with this type of grouch was about 3 months into my time of working there.  I worked the night shift and this nurse came in and without asking about my night she immediately started complaining about me not stocking.  Finally being pushed far enough, I stood up and yelled that if she’d like I’d stay after my fucking shift and stock the ER.  From the point that I stood up to her, we never had another problem.  She wanted to push me to see if I would stand up to it and once I did, we were fine.
  • ·         Don’t take it personal.  Do you think they woke up and said.. hmmm I’m gonna be a bitch to Debbie today?   If that’s happening or you’re thinking it’s happening, then those issues go deeper than this blog.  Don’t let their shitty attitude get you down.  There is enough stuff in nursing that can get you down, depressed, or become cynical… don’t let one shitty attitude be the downfall to your day. 
·         Find the positives in your day.  The patient smile, the thank you’s, the pimpin murse, the slurse that you can tell is wearing a thong, the free drink in the cafeteria cause the cashier sensed your bad day, getting an IV on the first stick, or realizing…..shit you’re getting paid for this now. 
Couldn’t end this on a negative note and didn’t want you think I hate nursing.  I love it….. there are times it sucks. But the positives far outweigh the negatives.
Lastly, shoutout and huge thanks to @weshelton for featuring our blog on his website,, check it out (We are listed on the partners page .  Dude is a multitasking fool… looking over his site, I think he’s doing a little bit of everything.
And as always gotta do a shameless plug.  Follow me @that1murse and my buddy @mursewisdom

Sunday, March 11, 2012

@MurseWisdom the Combat Medic

Before I transitioned to civilian life, and before I became an RN, and Long before I became @MurseWisdom, I was "Doc" the Combat Medic. 

I enlisted prior to 9/11... Hell, I enlisted when Clinton was in office.  I became a Combat Medic and a Practical Nurse in 2001.  I will leave specific details out to maintain anonymity.  I was a assigned to a combat arms unit.  I spent a tour of duty in Operation Iraqi Freedom in 2003, we were the first troops in.  Well, our task force went in on the first day as did the 101st and the 1st Marine Expeditionary Force (MEF).  As a matter of fact, I was assigned to the same task force as Jessica Lynch, if anyone remembers her 15 minutes of fame. 

The purpose of this blog is not to talk about combat, or my personal experiences there.  That's between me and the VA. Suffice it to say I saw my share of the "Shit" and it is wild, terrifying, and surreal. Men died, men were wounded for life, and I know what a man being burned to death smells and sounds like.  My intention here is to talk about the self reliance and the amount of responsibility one has as a Combat Medic in a forward area.

First off it should be understood that almost all decisions made by a Combat Medic has one general purpose and that is to "Preserve the Fighting Strength". Which means to keep 'em healthy enough to fight or send them to someone who can.  We always operated under the "guidance" of a Medical Officer (PA) and a Brigade Surgeon (MD) however they were usually distant and only reachable by radio. (Cell Phones had yet to be widely used by the military at this time)

Let me do some copy and paste work here and provide the Army's description of a Medics duties and then I will compare and contrast.

The Health Care Specialist is primarily responsible for providing emergency medical treatment, limited primary care and health protection and evacuation from a point of injury or illness. Health Care Specialists are often called "combat medics" in the Army, because some Soldiers in this MOS are assigned to deploy with Army combat units, and provide emergency medical treatment directly on the battlefield. Other Heath Care Specialists are assigned to military hospitals and clinics to assist doctors and nurses with the health care needs of patients.

Duties performed by Soldiers in this MOS include:
Administer emergency medical treatment to battlefield casualties.
Assist with outpatient and inpatient care and treatment.
 Interview patients and recording their medical histories.
Take patients' temperature, pulse and blood pressure.  
Prepare blood samples for laboratory analysis.
Keep health records and clinical files up-to-date.
Give shots and medicines to patients.
Prepare patients, operating rooms, equipment and supplies for surgery.

In addition to all of that listed above I also had to know how to be a diesel mechanic to fix my Humvee and to fix generators if needed. I also had to be an expert on indigenous wildlife, including venomous arthropods and snakes.  And specifically for my mission, I was the team "Wheeler and Dealer" trading medical goods for supplies/services to help with the mission.  I was especially good at trading.  I was once able to trade some OTC meds for a case of Starbuck's Carmel Frappachinos which made me a hero amongst the 11 other men in my team. 

I have performed minor surgeries, however minor they may have been it still involved local anesthesia in the form of a total nerve block, along with the cutting and stitching involved.  Yes, I did stitches, staples, & I prescribed meds.  All of those things well beyond my scope of practice.  I would on occasion have the opportunity to call in Dustoff, but most of my Evacs were by ground. I assisted in the inoculation of some 10,000 troops with Anthrax and Small Pox vaccines.  I was doing all of this without the supervision of my Medical Officer and all at the age of 20, and without ever losing a pt under my care. 

Now, here I am, almost 30, and I have to call a doctor to get an order for a band aid to treat a <1cm skin tear.  And I've had more training than I ever had as a Medic.  It is frustrating to me that we have achieved so much throughout nursing school and so much in the last century as a profession and we still have our hands tied.  "Dr Mom" is allowed to do more than we are without a Doctor writing an order. 

Don't get me wrong, I don't want to go back into the Army.  My body is broken down now thanks to the Army and I'm afraid that is a young man's game.  Any of you considering military service after nursing school need to approach it with an open mind.  My service was unique to me and my unit, and does not reflect the everyday mission of nurses in the Army or other branches of service.  However, I currently have a Congressman's card in my wallet who wants me to call him about serving in the National Guard, apparently he is also a Colonel or General or something.  Don't hold you breath, pal!

I am interested in working for the VA or the DHHS.  Hell, I would love to work for the CDC or FEMA, but those are dream jobs...  The VA is attainable and I may try that in the near future.

If you have any comments, please feel free to leave them.  Questions can be emailed to be sure to follow me on twitter @MurseWisdom.

I would also like to give a special thank you to Wes Helton, @BigWesYall for plugging us on his website Go check out his website, I think he sells edible clothing, which is always good to have in the event of an emergency.  It may prevent starvation.


Saturday, March 10, 2012

Stories from the ER

At the request of @MGstudent, I figured I would tell a few stories of the ER and maybe mention a few mistakes along the way.

First mistake is to know the dosages of your medications, particularly sedation medications.  We had a young lady come into the ER with a dislocated joint.  I had been bragging to the EMS staff about the medication.  Unfortunately, the dose of the medication was 0.3 mg/kg and our doc was not wise to the medicine so he took my recommendation of 0.1 mg/kg.  We didn’t sedate her, just got her good and drunk and she started spouting off pick-up lines… “Wanna play lion tamer? You be the lion and put your head in my mouth.” And  “Is that a keg in your pants, cause I’d love to tap that ass.”  Needless to say, I was the laughing stock of the ER for a while and we ended up calling anesthesia to sedate her.

Second was an error on the docs side.  We had an STEMI come in and he ordered TPA so we could ship to a larger facility with a cardiologist.  I mixed it, drew it up, and was walking to the patient when he ran in telling me not to give it.  I realized at this point that I would have to waste a 3,000-4,000 dollar medication.
Last “mistake” would be a word of advice.  Remember that sometimes the patients you think are faking are sometimes the sickest and will make you feel the shittest about your cynical attitude.  Like the mom that had an ear infection that caused a brain abscess or the man that walked into ER that had a spinal tumor (he didn’t know about) paralyze him while in the ER.

So let’s not end on a sour note…   Thorough my several ERs that I’ve worked.  I’ve fought a cranked up naked black man at 5 in the morning in the middle of the ER.  I took care of a guy that danced around with an artillery shell firework and explode out the back and burnt his leg (missed his package by millimeters) and the guy that left a dildo up his ass for 3 days hoping that it would pass on its own.

I’ve known of nurses blowing doctors while on duty.  I’ve walked in on people fucking in the ER, blowjobs in the ER, handjobs in the ER, fingerings in the ER… Not sure what the hell it is about the ER that makes people wanna get busy in there.  

I’m not sure that I had a point to this blog other than to provide a few experiences from the ER.  You will literally see everything from birth to death, crazy to sane, and skanky to slutty.  

But I loved it, it’s a rush not know what’s going to walk in the ER and that you could go from no patients to 5 traumas at once and back to no patients.  If you think you would like to work in an ER, I say try it.  It’s a trial by fire and you get thrown into the shit pretty much instantly but it really is an experience.  


As always, comment here or on twitter.  Follow me the other author on twitter.  @That1Murse and @MurseWisdom

Thursday, March 8, 2012

Another Rant by @TMFS786

  I am a murse. In school I never thought I would actually get to say that. I drove my
friends, and family nuts with the talk about making it. It’s crazy that a few months ago
all I could think about was school and the Nclex and now I sit here and wonder what
was I so worried about it. Notice I said murse, not nurse. Of course I am a nurse; I am a
Registered Nurse to be exact. That’s not what most people see they see a male and then
they see a nurse. You ever hear someone say “oh there goes a girl nurse.” Even in my
department which has a heavy male concentration we are still out numbered at least 6 to 1.
 In school on an OB rotation a woman thought I was a doctor, I don’t know how. I was
standing in scrubs that had my school name embroidered all over it and in completely
different colors than any other nurse near me. She sat there and asked me questions and
thoughts on things. When she thought I was a doctor I could have put my arm up to my
elbow in her vagina and she wouldn’t have cared at all. It was going great even if I was
unhappy about it. I mean I don’t want to see birth; it’s like a vagina blowing a meat
bubble. Then there are things called the “Wood’s screw maneuver” I mean Christ on a
crutch it makes me flinch thinking about it on my couch. Anyways eventually she found
out I was a student-nurse and she blew up. She didn’t scream that I was a student; she
repeatedly said “you’re a nurse?” She said it with a tone in her voice like I asked her
for a rim job. I wanted to say, “Yeah a nurse just like I was when I walked in here.” She
freaked out so bad she kicked her husband out. Poor guy was surprised and he should be I
mean didn’t she realize he obviously had seen whatever she had going on down there?
Does anyone get into this job for the scenery? It makes me gag when guys say they
should be a gynecologist. First, ladies it’s like staring at the predator down there. Second,
these guys obviously forget that while the Victoria Secret Angels have to get checked up
so do the woman from Jerry Springer. There are a lot more ugly women that hot ones.
Choose wisely when you are trying to decide what you want to specialize in. I can only
imagine the nightmares I would have in an OBGYN office. I don’t think enough steel
wool and bleach exist to clean my eyes after seeing what they see. Third, it’s not all about
looks that would be too easy. Ever smell your gym bag after a week? Yea get the hint.

 Not to say that guys are always the cleanest creatures on earth. I have never experienced
it but I have heard many stories from friends who work in nursing homes about guys.
My kid will be circumcised, guaranteed. The horror of hearing “you have a yeast
infection…in your penis.” I couldn’t deal with that. Oh the world of a male nurse. I am
glad though I love it when someone calls me “doctor.” Not that I really want to be a
doctor but man it pisses off nurses and some female doctors. Especially when someone
looks past them because they believe I am the doctor. It’s a sweet victory.

Misconceptions of Nursing

What is it about non-nurses that make them think they know everything about MY profession. I know it probably happens to everyone at some point.  That guy who argues with the cops because he knows his rights, or the that picky customer at the butcher shop who knows exactly how to cut a steak.  "Really sir, you don't like T-bones but you love a NY strip?"

So, lets get into this.  This is for the friends, siblings, in-laws, and various others who seem to think that they know how to do your job. 

  1. I don't care if you took A&P and can name all of the bones in the human body.  That is child's play. Try telling me the difference between Buck's traction, Bryant's traction, Dunlop's traction and Russell's traction!  How bout that smart-ass?
  2. Oh you watch every episode of Nurse Jackie? Well, I learned to be a fighter pilot by watching Top Gun!
  3. This is a little off track, but the next person that gives me that knowing look, that makes me want to fucking vomit, as the warn me about having to change poopy diapers in my newborn, I'm going to lose my shit! Really?!? Breast milk/Formula poop?  Try C-diff and GI Bleeds! Try a 400 lb man's diaper! Try changing a 96y/o combative Alzheimer's pt who is screaming "Rape!"  GTFOH!
  4.  The next Dr I hear say that I don't know anything because I'm a nurse....  I'm going to show him that I know how to throw a punch! Who brings all of these little things to your attention? Who did the assessment that gave you all the information you needed for a Dx? This know-nothing Nurse did.
  5. I heard a guy once tell me that he has his Med-aide certification, which is practically an LPN which is practically an RN.  Well, I played HS football, which is basically college football, which is basically the NFL.
  6. Did you guys know that all you do as a Nurse is sit on your ass at the nurses station and play on the computer? 
  7. Paramedics... I love you guys, but you are not Nurses. I've done your job, and I've done your job while under fire.  There are days when that was easier than Nursing.
Well, the wife has dinner ready and I'm running out of material.  Have you had any moments like these? Post a comment and share.


Wednesday, March 7, 2012

Preceptorship/Nursing attitudes

At the request of @xoBSox I will discuss preceptorships and at the request of @MomofDivas2 about the attitude of nurses and I’m pretty damn sure I can incorporate both into this entry.
First off, think of preceptors as your own personal Yoda of nursing. “To you will be given education.” Now there are good preceptors and bad preceptors and you really can learn from both and before you decide if your preceptor is good or bad put yourself into their position for a minute. If I’m precepting you as a new graduate nurse, #1 My day just went from 12 hours to probably 14 and #2 I’m going to have to provide more explanation of everything that I’m doing. 95% of my days, I’m fine with that but those days where I’m assholes and elbows busy, it’s a pain in the ass. Now I know this isn’t your fault but you are probably going to take the brunt of my attitude because you’re there. Now I might sound like an asshole and a “bad” preceptor but I’m not, I’m being real. Most days I will sit and explain everything to you but other days you need to realize it’s not a good day to ask what “NIBP” means (I’ve been asked that in the middle of a code?).

Precepting is walking a fine line between teaching you nursing and letting you experience nursing. If I was a “good” preceptor and let you watch everything I did and didn’t let you do anything , then you’d be frustrated as hell and think I was bad. But if I just toss you out there and expect you to do it, then you’d be frustrated as hell and think I was bad.

Regardless of the type of preceptor you have, you will learn nursing whether you think you are or not. I was the one that was tossed out there to sink or swim. I swam and became a strong nurse, others floundered and sank. It happens. Take what your preceptor says… Learn from it.. and make it your own. Regardless of how your preceptor gets you to the end you still get there. Be strong enough to survive no matter the type of nurse that gets assigned as your preceptor. Which brings me to my other point…. Don’t be the nurse that sits on your ass at the desk. NEWSFLASH You are not the queen of the fucking hospital or nursing home and you are no better than the CNAs that are turning patients and wiping asses. When I started at a nursing home, I asked to be placed on the floor as an aide my first 3 days. The DON looked at me like I was crazy. My point was that I was brand new to the facility and wanted to show the staff I was willing to do what they do. I earned their respect and when I got jacked around at that job…those aides came to my defense….because I didn’t put myself on a pedestal above them. Also because I had their respect, they did anything that I asked. Your CNAs can make your day pleasant or completely fuck your day up.. so don’t be a condescending asshole to them and your days will run a bit smoother.


Tuesday, March 6, 2012

Hip-Hop Heart Rhythms

Had to put it up on the Blog too.  I know some of you don't trust links.  Hang in there till the end, the good stuff is towards the end.

Caduceus vs Asclepius

I just tweeted about this and now I'm inclined to blog about it.

 Caduceus or the Staff of Caduceus: Shown in various forms as a Staff with two serpents wrapped around it, usually with wings at the top.  This is known as the magical wand of Greek god Hermes, messenger of the gods, inventor of (magical) incantations, conductor of the dead and protector of merchants and thieves. It may have gotten its medical connection through Hermes' connection to Alchemy.  In 1902, this symbol was mistakenly used by the US Army as the symbol for their Medical Corps and has become the most recognized symbol of medicine in the US. 

The Staff of Asclepius: Professional and patient centred organizations (such as the NZMA, in fact most medical Associations around the world including the World Health Organization) use the "correct" and traditional symbol of medicine, the staff of Asclepius with a single serpent encircling a staff, classically a rough-hewn knotty tree limb. Asclepius (an ancient Greek physician deified as the god of medicine) is traditionally depicted as a bearded man wearing a robe that leaves his chest uncovered and holding a staff with his sacred single serpent coiled around it, (example right) symbolizing renewal of youth as the serpent casts off its skin. The single serpent staff also appears on a Sumerian vase of c. 2000 B.C. representing the healing god Ningishita, the prototype of the Greek Asklepios.

However, there is a more practical origin postulated which makes sense...

The probable medical origin of the single serpent around a rod: In ancient times infection by parasitic worms was common. The filarial worm Dracunculus medinensis aka "the fiery serpent", aka "the dragon of Medina" aka "the guinea worm" crawled around the victim's body, just under the skin. Physicians treated this infection by cutting a slit in the patient's skin, just in front of the worm's path. As the worm crawled out the cut, the physician carefully wound the pest around a stick until the entire animal had been removed. It is believed that because this type of infection was so common, physicians advertised their services by displaying a sign with the worm on a stick.

Now for the rant.  WHY, would anyone get a tattoo that they are unsure of its origins? Or whether or not it's the right symbol.  Sports fans will tell you! Lets say you wanted to get a tattoo of your city's Team.  We will use the Cowboys (against my better judgement) since they have an easily recognizable symbol.  Lets say I got a blue star tattooed on my chest and then I showed Jerry Jones (The owner of the Cowboys for those of you who aren't sports fans) my tattoo and it looked like this:

Would Jerry Jones approve?  OR  Would Jerry think I'm a FUCKING MORON?

That was rhetorical of course.  The point here folks is please get your symbology right before branding yourself forever.  Unless of course you are or were in the Army Medical Corps... in which case it's ok because that is their adopted symbol.

Back to your regularly scheduled programming.


deliˈti(ə)rēəs- A rant supplied by @TMFS786

If you gave the Nightingale pledge at this moment I’m here to inform you, we have failed in some ways as nurses. Admittedly I am new to nursing, real new. Already though I have seen something that has truly just rubbed me completely the wrong way and I can’t believe everyone before me hasn’t said much about it. If you have, the roar was not loud enough.

I walked into a patient’s room and saw two very completely opposite signs hanging over their bed. One said very clearly “DNR” and the other just as clearly “Family wants intubation.” My first thought was how sad the family wants that, clearly they don’t understand what DNR means. Only then did I found out it wasn’t the family that didn’t understand, but it was me.

I was told that even if the patient wants to be DNR, but the family wants us to continue, then we continue. I was told the family would sue us if we didn’t, so, we continued even if it was against the patient’s wishes. What? They would be alive to sue and the patient would be dead so we went with the option that presented the least legal ramification. How is it possible that a person’s last and maybe most important decision and wish are to be discarded that easily? I am positive that it says in any medical pledges or oaths that we are to do what is best for our patients. What could be more important?

My first duty is to my patient, but clearly hospitals and lawyers see things differently. In school, nursing ethics is pushed so hard we almost choke on it. Talk about being completely unethical, but you are ordering me to violate my patient’s wishes to keep them alive when they don’t want to be? This seems to be happening at an alarming rate as I hear of surgical procedures being done for operations that are unnecessary and only complicate and prolong suffering in the patient who didn’t want it or need it in the first place. How has this become acceptable?

As a profession we are capable of amazing things, how did we get to this point? If a patient wants to leave against medical advice even though it could harm them we allow it. If a parent refuses to bring their child to a doctor for religious reasons then we are not allowed to act without a court order. If a patient refuses a medication we don’t force them to take it. Yet, an adult who in advance gives a directive that they want followed for the course of their life we discard it because the family is unwilling to accept it?

I submit, out of all the problems America currently has with health care, this is the biggest. We have forgotten what we are here for and who we are supposed to be taking care of when they are in the hospital.

Friday, March 2, 2012

Differences between Nursing School and the First Year of Nursing
By: @That1Murse

So as we near another graduation year, I decided I would discuss what I learned in nursing school versus the first year of actual nursing. I had several other good ideas given to me and I will get to them within the coming weeks.
Ok, let’s be honest. Nursing school is difficult, time-consuming, frustrating, and a pain in the ass. But
it’s the hoops that you have to jump through to get those letters behind your name. The old adage of
what do they call the person who finished last in his class in medical school… they call him doctor. The same applies to nursing. It doesn’t matter if you finish first or last, you will still be a nurse. My badge does not say, That1Murse, RN (B student).
So why is nursing school so freakin’ hard? Well here’s the honest truth. It’s all about Pass Rates. The
nursing school has to have high NCLEX Pass Rates to not be looked at by the state Board of Nursing. If a schools NCLEX pass rate is low enough, they have to submit a plan of correction to the Board of Nursing. So it’s difficult to make sure you are prepared to take that test. Most of everything in nursing school breaks down to passing the NCLEX. Day 1 of nursing school we stated with 40 eager people. When we graduated in 2 years…. We were down to 17 of those original 40.
Nursing school gives you the picture perfect world where every patient will present with the same signs and will give the exact same complaints and everything is rainbows and buttercups when you practice in the Ivory Tower. I’m not taking away from nursing school because it does give you a nice foundation but you’re learning will take place in the first year after school.
The first year after school is sometimes more difficult than nursing school itself. You will sometimes feel inept and stupid and I guarantee at least once you will say, “What the fuck did I get myself into?” To give you some examples, my first LPN year (went to a bi-level ADN program) I worked at a nursing home. In that year, I had a fire (and had to evacuate the home at 10 p.m.) and had a guy show up with a gun looking for me (apparently, my sarcasm is lost on some people). My first RN year in the ER, I couldn’t get a successful IV stick to save my life. This was also when I worked lots of traumas and codes. Your first year of nursing truly is a trial by fire. The important thing to remember is not to get discouraged and remember why you went to nursing school. If it was for the money, then I’m sorry but in 5 years you probably won’t be nursing any longer.

Other thoughts from your first year of nursing: You will always remember the name of your first death. Lean on the staff you have to work with. Ask questions. This is when you will truly learn to be a nurse. Nothing is like it is in the book. A smile to a patient will sometimes forgive ineptitude. Have fun. Find a support system (prefer medically) to vent on. If you are future murse and you are in a relationship with someone not in the medical field, it’s going to be more difficult than if she was in the medical field (Think about it you go home always talking about what Becky did or Jamie was so funny or Michelle didn’t do this.. all you talk about is women). Know that it takes time to build trust with your docs but once you get that life gets so much easier.
The idea of this blog is to not discourage you or make light of nursing school but you should know that the first year is going to be hard (maybe even harder) than nursing school. But this year is when you will learn nursing and then your life will start getting better.


Hey, @MurseWisdom here, I wanted to expand on this one a little and talk about career choices.  I bet you get asked this at least twice a day in clinical... "Where do you want to work after graduation?"  I just want to point out that you will more than likely not get to do what you want right out of the gate.  I'm sure that working on a Peds floor or a NICU or being a Flight Nurse is your dream job.  Hardly anyone says, "I want to work in a Nursing Home", or "I want to work for Hospice."  Well, I want to make it clear that this nursing "Shortage" includes Nursing Homes and Hospice.  And you, my friend, will have no experience and you are going to have to take whatever you can get at first. 

I just reread that and realized what a bummer that shit is... Ok, lets not get discouraged.  You need the experience that you get at that first job out of school.  Do you really want to be two days into your RN and be on a helicopter running a code by yourself?  I have performed medical treatment on a helicopter in flight.  You think this shit is hard in the hospital, try it at 200mph in a sardine can.  There I go again, I'm just negative today, I apologize.  You need to spend some time in the trenches of Med-Surg or a similar type of floor.  The most rapidly growing population on the planet right now is the elderly.  The need for nurses in Longterm Care is great and contrary to popular belief it is challenging.  Med-surg you may have 4-1 or 5-1 ratio on a bad day you may have 8 or 10-1.  Everyday at a nursing home is 40-1 or greater and it's you and a squad of  minimum wage CNAs. That is a challenge. 

I don't even remember what point I was trying to make.  Just keep your options open. 


Thursday, March 1, 2012

Studying for the aspiring Nurse

I was asked to write about studying tips.  I wish I could sit here and say I'm a subject matter expert on studying, but I'm not.  You can ask my study group, they will all tell you that I was probably the worst study-er in the class.  There is a silver lining in that though... I still graduated and I still passed the Nclex.  So, here are some good tips, but alot of them will be a "Do as I say not as I do" kind of a thing.

The first thing you want to do is figure out how you learn.  There is some heated debate over whether or not this is complete BS.  I think it works. Hell, it works for me and thats good enough.  Check out this link and answer 16 questions to help determine what type of learner you are.  I am an auditory learner, which is, in my opinion, the best kind to be.  I simply have to be in the room and hear, not listen, but HEAR something and I remember it.  Maybe I can't remember it forever, but, thanks to the redundancy of nursing school and nursing alike, I don't have to.  I am aware that this skill is irritating to most students, so, if you are like me, try to avoid bragging about it. 

As I've already mentioned, I studied in a group. This is a great approach, because everyone thinks differently and remembers things in a different way.  Collaboration is key.  Unless you plan to work alone, you will need to build this team-work ethic asap.  Our group would generally study independently and then two nights before or the night before the test get together and take turns reading questions aloud to the group. We would read hundreds of questions over every subject.  If you school is like mine there is probably an average of 12 chapters per test, so these nights can be long.  Bring food and CAFFEINE. 

Ok, lets say you don't like groups, or do better on your own.  This is my wife all over.  We have a desk set up for her with a corkboard (like her Pinterest for this weeks Unit) on the wall above it.  She reads, and makes flow charts, idea maps, draws things, she has an anatomy coloring book that she colors.  (She is kind of "Artsy Fartsy" with her degree in Theatrical Arts) This helps her out, well, that coupled with having me around to clarify things.  I may see whats on the board this week and post up a pic in the blog. See Below:

This week is Endocrine so I posted an older pic off of her Facebook page.  Even drawings of the Endocrine system are boring. 

This brings me to the note takers... The furious typers, and the mad scribblers.  You guys are rockstars.  My hand cramps after a half page of nursing notes.  If that helps you memorize it, more power to you.  I would suggest that you use notecards and write down the "Cliff Notes" version of things so that you can cover more material faster.

Don't forget to eat, drink lots of water, and take breaks. You are only human.  You will be amazed at your capacity to guess the correct answer at times.  You are in nursing school, you are not stupid, you will survive.  And if you don't make it..... Well, there is always radiography ;-)

Now for the Pre-Req students... those aspiring for the un-ending hellish nightmare that is nursing school.  WTF are you thinking?  I'm Kidding! Unbunch your panties! Listen up, your classes are not that hard.  Read your material, write your papers, and show up to lecture.  If you want to prep for nursing school simply do the following:  Read your assigned material 3 times, double the length of your papers, and volunteer at a hospital in your free time. Oh, and I forgot to mention that you are not allowed to sleep more than 5 hours in any 24hr period. (My all time longest is 55 hours straight) I'm not into sugar coating this.  Nursing school is not for the timid.  But as George Sheehan put it "Happiness is different from pleasure. Happiness has something to do with struggling and enduring and accomplishing."  Hopefully, nursing will make you happy. Otherwise, Old George here doesn't know squat.

I doubt this has helped with your study skills.  I would tell you to stay off twitter, and pinterest and quit reading blogs but thats hard on business. Plus, this shit will help you graduate, Guaranteed or your money back!

Guys and Gals, @That1Murse and I want to help you and we want to guide you in the right direction.  We also want you to see the lighter side of nursing. That and working 12s leaves me with alot of spare time.  Leave comments, ask questions, make suggestions for blog topics, send us pictures of crazy shit you do... 

Until next time...


ER misconceptions by @That1Murse

Here are some common misconceptions that patients have about the ER and ER nursing.  Like @mursewisdom if you have questions or want to hear the unedited truth about life in nursing or life in the ER, hit me up.

Top Ten Misconceptions from the patient’s view of the Emergency Room.

1.      Prescription Drugs are a “magic bullet” that will fix everything immediately.  This is not usually the case.

2.      To you it’s an emergency (and we respect that), but to us it’s another day at the office.  We deal with emergencies all the time.  If you see us running and stressed out, it’s a bad thing.

3.      There is not a magic shot that we take so we don’t get sick.  (I’ve actually been asked about this).  In actuality, we are exposed to so much we build up a significant immunity.

4.      The emergency room is a place to manage your chronic pain or conditions such as diabetes or hypertension.  In actuality, this is not the case because there is a good chance you won’t see the same doctor every time and that’s what the primary care doctor is for.

5.      The emergency room is a place where you are brought back immediately and diagnosed quickly after all it’s an emergency room.  If you are brought back immediately you are a very sick person and diagnosis takes several hours and involves lab work,  x-rays, CAT scans, and numerous other diagnostic tools.

6.      I know you don’t trust this doctor and think he’s a quack and I have to listen to you tell me that without saying anything but please know that I would in fact trust this doctor with my life.  It’s you that I don’t know or trust after all like House says “Everybody lies.”

7.      Acting a fool in the Emergency Room will get you attention however it will probably be in the form of being restrained and then tied to the bed and if you continue to act out, the police will be contacted.

8.      You are angry that it’s taken the doctor 2hours to come see you for your fever. I understand that and I will apologize immensely; however, there are times I want to drag you into a room of someone we are working hard to save and show you what a true emergency is.

9.      Patients are all treated the same.  While in a perfect world this should be true, in fact, if you respect me and the situations that I’m placing myself in and I will go out of my way to make sure that your ER visit is as unstressful  as possible.  Give respect, get respect.

10.  ER Nurses don’t care.  While these misconceptions may seem cynical (and I won’t deny that), nurses do care. Patients don’t see us go home and cry about the family that lost their baby or see us go home and watch our children sleep and thanking God that we still get that chance.  ER Nurses care immensely and that’s probably why we become cynical because for every life we save there are 10 bullshit cases that don't belong there.  We have saved lives and lost lives but we still go to work every day hoping to make a difference to someone.


Quick one

I found this little video a while back while working nights. Thought it was worth sharing while I try to come up with another blog post.  Anything you guys want to hear the unedited truth about? Post some comments and let me know.