About One DNP

I earned my "terminal practice" degree in nursing from the University of Tennessee Health Sciences Center in a journey of excitement and challenge. It inspired me to advocate for an all encompassing clinical credential rather than continuing the hodgepodge of nonsensical initials. I hope these entries will provide entertainment and insight into the Doctor of Nursing Practice experience, which will soon be the entry standard for all advanced practice nurses.

Monday, December 12, 2011

Finals Done and Final Thoughts

The last full week of on-campus learning has come and gone. I find myself both excited and wistful about graduation in May.  Perhaps I have overdosed on sappy Christmas movies and am feeling overly-sentimental, but I feel enormously lucky to have met the peers and mentors I have through the course of the program. But without further blubbering, here is the on-campus week in review:

Psych Seminar
This seminar was aimed at getting folks to narrow down their capstone and start drafting an abstract for APNA. In a move that labeled me teacher's pet, Dr. Cunningham shared the abstract I submitted for 2011 as an exemplar and talked about my prowess as a writer.  Apparently, writing 200 words a day is a prescription for improving writing skills - the blogging comes in handy in more ways than I thought! Since I cannot re-use my own work, I am investigating ideas for how to integrate Traditional Chinese Medicine modalities in to Psych Nursing practice. Based on the feedback I received on the APNA forum, it looks like a practice roundtable might be in order for 2012.

Health Care Economics
Never a dull moment, I did not have to attend this session for the 2.5 points, but I just love the debates that always crop up when Dr. Thomson and Dr. Carter are at the front of the room. While most of us agree that primary care should not be done by physicians and some sort of interdisciplinary comprehensive healthcare exam would be useful for parity purposes, I am in the camp that believes the American Board of Comprehensive Care (aka the third step of the USMLE) is NOT the appropriate answer. One of my pediatric NP classmates was quite persuasive on the matter of differing education and role between MDs and NPs that makes the ABCC test prejudicial in favor of physicians. As she pointed out, many pediatricians cannot pass the PNP board exam.  Moreover, NP education focuses on prevention and primary, community based care, whereas MD education focuses on tertiary, hospital-based acute-care.  It would be far more logical to embed a standards-of-care module into the respective exams for independent healthcare providers with a uniform minimum pass-rate. Whoever can design that will make a fortune.

Evaluation of Practice
A few bumps in the road on this course, which is expected given this is the first year of the re-design. I know from being at the front of the classroom that there are some brands of student that feel the first draft of the syllabus is a sacred tomb not to be altered for anything less than plague, pestilence, or flood. Me, I roll with the changes to make the changes work for me. I also do not  interpret that which is not graded as that which is necessary, and there were a number of ungraded assignments in this course. The end result found me reviewing my Improvement Science project with Dr. Mona Wicks, Associate Dean of Research, who not only provided enormous encouragement and essential edits to my project, but taught me a valuable lesson in professional reflection. I must remind myself I do NOT need a PhD no matter how tempting it sounds!

Clinical Management of Mental Health Disorders
Despite reviewing strategies on how to get out of doing our presentations, we all went backed-down and went through with it.  All of the consultation process were unique and well done. Here is ours for any future students in need of some ideas:

Sunday, December 4, 2011

Worth the Price of Tuition

Every week in clinical I learn something new, but this week was full of particularly intriguing one-liners. Learning is not always quantifiable, but for those that question the value of obtaining yet another advanced practice degree to do what you already do, I raise the possibility that the educational process may at minimum make you think differently than you have been thinking. And thinking changes practice. 


I just don't feel the way I do. 
     - LPN (just chew on that one for a moment!) 


The trouble is not that people change, but that they don't
      - Patient insight


Anywhere else it would be called assault instead of rock'n'roll
     - Paient insight


The truth of everything is known when you achieve it
     - PTSD fear awareness group


It's not hypocritical if you want to believe it
     - Spontaneous response from patient session (something I need to work on)


Anyone can pay for knowledge, but belief has no price tag 
     - Reflective practice insight after patient session

Thursday, December 1, 2011

My First Sponsored Term Paper

I probably should have put a disclosure statement on the bottom of my Health Economics final since Kronos did pay the $1500 conference fee and $200/night hotel room for me to research the topic. All perks aside, you can't argue with cost savings, if they are indeed cost savings since they are very secretive on how much they charge for timekeeping solutions and automation. I am sure there is some kind of business story in there, but that is not my area.

What was surprising was how few nurses were present during the healthcare sessions. Pardon my prejudice, but HR and payroll representatives reporting on the success of a system is not as convincing as hearing it from the people who use it daily to run the hospital, especially when we are talking about a group of people who are generally hesitant to accept change (but are also a lot more fun). Interestingly, I have had about five or six conversations on workforce development technology in the past few weeks that makes me think I should ask for a kickback from the Kronos. . . but I will settle for an invite to the 2012 conference in Las Vegas!

Here is the analysis in all of it's glory . . . note the comments in red at the bottom :)

Cost-Benefit Analysis of Workforce Management Technology
Jaclyn Engelsher
University of Tennessee Health Science Center
          Since the 1960’s, increased productivity and decreased labor costs have contributed to the adoption of employee self-scheduling in hospital and healthcare systems (Hung, 2002). While the majority of nurse managers continue to use paper sign-ups and e-mailed spreadsheets as the scheduling platform, an increasing number of facilities are implementing workforce management technology programs that deliver web-based and mobile solutions to optimize labor cost, manage absenteeism, and minimize compliance risk (Mercer, 2010). Development companies claim the savings generated from cost-effective staffing pay for the total cost of ownership, generate additional revenue, and improve patient and provider satisfaction. With the current unstable economic environment and implementation deadlines for healthcare initiatives approaching, hospital financial offers are searching for cost containment tools to help manage labor costs, the largest component of net operating hospital revenue (Williams, 2008). A cost-benefit economic analysis of workforce management technology will determine impact on cost, productivity, and compliance in the healthcare setting.
Background
          In few other industries are outcomes more linked to staffing than in 24-hour healthcare operations. The fluctuating nature of patient acuity and needs dictate the skills sets and ratios necessary to deliver high quality of care. The nation faces a new nurse attrition rate of up to 25%, a workforce where the median age is 48.9 years, and an anticipated need for over three million nurses within this decade (Bernard Hodes Group, 2011). Absence contributes to 35% of annual payroll costs, 9% of which is attributed to incidental and extended absences (Mercer, 2010). Whereas the cost of planned absences can be budgeted, unplanned absences from casual sick-days to FMLA leave result in lost time with the average employee missing 5.4 days per year. For a staff of 500, this results in a loss of 783 workdays per calendar year and up to a 29% decrease in productivity. The Fair Labor Standards Act places burden of proof on the employer for alleged violation. Just to go to court for an alleged FMLA violation costs employers an average on $150,000 per case (Kronos Incorporated, 2011).
          When staffing levels fall below patient requirement by as little as eight work hours under optimum ratio, risk to patient safety and mortality increases up to 6% (Needleman et al., 2011). Units delivering increased care hours by staff with the most applicable skill set to the patient population results in lower rates of infection, failure to rescue, length of stay, and decubitus ulcers (Blegen, Goode, Spetz, Vaughn, & Park, 2011). When considering the expense of recruitment, training, productivity loss, sentinel events, and coverage labor, turnover can costs employers up to $64,000 per nurse (Jones & Gates, 2007). Staffing and communication are the top two areas for improvement reported by nurses with shift and work-life balance ranking in the top five reasons for recruitment and retention (Bernard Hodes Group, 2011).
          Employee self-scheduling increases job satisfaction by providing choice and control over work-life balance and has a beneficial impact on primary and secondary health outcomes in staff (Joyce, Pabayo, Critchley, & Bambra, 2010). While most hospitals offer some variation for employee input into scheduling, the manual process of can be cumbersome, inequitable, and result in hours of management time lost trying to fill open shifts with the best staff member at the lowest cost (Mercer, 2010). Workforce development technology companies have integrated automation into self-scheduling systems to reduce labor costs and compliance risk while increasing productivity and patient care. Unlike the unit binders or email requests, the technology can be expensive and require hors of training to master. A cost-benefit analysis is the first step to determine if implementing an automated self-scheduling solution is an appropriate intervention for an individual healthcare system or facility.
Cost-Benefit Economic Theory
          Santerre and Neun (2010) explain cost-benefit analysis (CBA) as a decision-making tool that estimates the total cost and expected benefits of a proposed health policy, intervention, or technology. When the net benefit is greater than the estimated sum of direct and indirect costs, implementation would be recommended. Implementation may also be recommended if the costs and benefits are equivalent, depending on if emphasis of value is placed more on the cost or the benefit. Implementation is unlikely in the event the cost significantly outweighs the benefit. While the CBA can help direct an organization toward solutions that maximize benefit and minimize cost, inaccurate calculations, unaccounted for expenses, and unfulfilled outcomes may occur.
          Direct costs are narrowly calculated, predictable expenses directly attributed to the proposed product or service. In workforce development technology, these include purchase or rental of hardware, training time, service agreements, licensing fees, updates, and installation. Training on workforce development software takes an average of 2 hours for users up to one-two days for managers (Kronos Incorporated, 2011). Training can be delivered remotely, as part of new employee orientation, or by company representative site-visits. Most companies do not publish pricing data due to the tailoring required for each individual organization, variable incentives, and negotiating flexibility. Conservative cost estimates range from $50 per month for limited functionality in small hospital systems, to $100,000 per licensed user for sophisticated solutions. Indirect costs are associated with the proposed product or service, but are not clearly traceable or quantified. Obsolescence, system malfunctions, hardware replacement, software updates, re-training, and sub-optimal utilization, are indirect costs that are difficult to predict and calculate. Examining how various solutions have functioned in like-organizations and reviewing consumer reports of products can help with estimation.
          Outcome benefits are commonly measured in time, money, or satisfaction. A substantial benefit of workforce management technology implementation is reduction in the cost of absence. The benefits paid as a result of absence, such as sick or vacation time, may not significantly vary, however productivity loss from using a less efficient replacement can improve by as much as 5% of payroll by reducing use of overtime employees, agency staff, redistribution among coworkers, or reallocation of work to the supervisor (Mercer, 2010). In a hospital employing 500 nurses with an average salary of $43,000, this results in a savings of nearly $370,000 per year. When Norton Healthcare implemented the Kronos workforce productivity and analytics tool, they saved $5.5 million in labor costs among their 9,700 employees in their first year (Kronos Incorporated, 2008).
          Timekeeping tools decrease labor expense by analyzing patterns of absenteeism and tardiness, labor laws, time-off accrual, and use of agency staff. When using the Kronos mobile scheduler, 70% of open shifts are filled within five minutes of sending a text alerts (Kronos Incorporated, 2011). University of Utah Healthcare saw an 80% drop in agency labor cost the first year of use and the community-based Arch of Baltimore saved $900,00 in total labor costs. Ford Healthcare Systems replaced the office “white-board” with Shiftboard’s online nurse scheduling software which decreased time spent in recruitment, applicant review, and payroll, which aided their expansion into three neighboring states (Shiftboard, 2009). After implementing API Healthcare’s solutions, Coffee Regional reduced overtime cost by $625,000, eliminated $3000 in payroll error, and increased staffing efficiency to a level where for every two retiring nurses, only one replacement was required (API Healthcare, 2010). Data analytics in these solutions allow managers to ensure consistent application of scheduling policies by providing equal opportunity for employees to request time-off, fill open shifts, swap shifts, and be considered for first-cut.
Recommendations
          Workforce development technology should be implemented for organizations that need to maximize operating efficiency of healthcare delivery and decrease compliance risk. To determine potential, an organization must first calculate the cost of absence, compliance violations, sentinel events, and turnover that can be attributable in part to inefficient staffing. Staff input regarding current scheduling procedure and preferred solution platforms must be elicited to determine level of interest and resistance. Review of patient surveys should focus on complaints that effect loyalty such as time spent with providers, staff attitudes, and quality of care. Once the benefits have been quantified, a budget can be created in which to research available workforce management technology. Pricing data varies from between companies and it is important to keep in mind that all direct costs are negotiable and competitive. Once the CBA has been completed, a cost effectiveness analysis can be performed to compare relevant competing solutions.
References
API Healthcare (2010).  Case study: Coffee regional medical center. Reterieved from http://www.apihealthcare.com/_asset/r80vgj/API_CSCR-0310-Coffee_Regional.pdf
Bailyn, L., Collins, R., & Song, Y. (2007). Self-scheduling for hospital nurses: an attempt and its difficulties. Journal of Nursing Management, 15(1), 72-77.
Blegen, M., Goode, C., Spetz, J., Vaughn, T., & Park, S. (2011). Nurse staffing effects on patient outcomes: safety-net and non-safety-net hospitals. Medical Care, 49(4), 406-414.
Bernard Hodes Group, (2011). RNs at risk: Understanding key tenure points. Retrieved from http://www.hodes.com/rns-at-risk
Jones, C. & Gates, M., (2007).  The costs and benefits of nurse turnover: A business case for nurse retention. The Online Journal of Issues in Nursing, 12(3)
Joyce, K., Pabayo, R., Critchley, J., & Bambra, C. (2010). Flexible working conditions and their effects on employee health and wellbeing. Cochrane Database Of Systematic Reviews, (2)
Kronos Incorporated. (2008).  Norton Healthcare leads change for consumer transparency with help from Kronos. [Press Release] Retrieved from http://www.businesswire.com/news/home/20080623005101/en/Norton-Healthcare-Leads-Charge-Consumer-Transparency-Kronos
Kronos Incorporated. (2011). Does my staffing level matter? Using analytics to correlate staffing with risk and quality events. Unpublished paper presented at Kronosworks 2011: The World’s Leading Workforce Information Exchange, Orlando, FL.
Mercer, (2010). Survey on the Total Financial Impact of Employee Absences. Portland, OR: Mercer Health and Benefits LLC
Needleman, J., Buerhaus, P., Pankratz, V., Leibson, C., Stevens, S., & Harris, M. (2011). Nurse staffing and inpatient hospital mortality. New England Journal Of Medicine, 364(11), 1037-1045.
Santerre, R.E. & Neun, S.P. (2007). Health economics: Theories, insights, and industry studies (5th ed.). Mason: Thomson South-Western. 6
Shiftboard, Inc. (2009). Case study: Nurse scheduling Ford Healthcare Systems. Retrieved from http://www.shiftboard.com/casestudies/Shiftboard-Online-Nurse-Scheduling-Ford-Healthcare.pdf
Williams, J. (2008). A team approach to cost containment. Healthcare Financial Management Association Magazine. Westchester, IL
You have a good idea but clearly the actual data are very short. Most of what you could find to report is information from the company.  This is always suspicious – they are selling a product.  As you saw, finding all the costs are a problem and limit your ability to do a cost-benefit analysis although you tried.
Background = 10  Application of theory = 8 Conclusions/Recommendations = 9 Grammar = 10 Total = 37 (out of 40)

Wednesday, November 23, 2011

Occupy With Grace

From the Engage with Grace rally to revolutionize end-of-life planning . . . 


Occupy With Grace

Once again, this Thanksgiving we are grateful to all the people who keep this mission alive day after day: to ensure that each and every one of us understands, communicates, and has honored their end of life wishes.

Seems almost more fitting than usual this year, the year of making change happen. 2011 gave us the Arab Spring, people on the ground using social media to organize a real political revolution. And now, love it or hate it - it's the Occupy Wall Street movement that's got people talking.

Smart people (like our good friend Susannah Fox) have made the point that unlike those political and economic movements, our mission isn't an issue we need to raise our fists about - it's an issue we have the luxury of being able to hold hands about.

occupy_with_grace_logo

It's a mission that's driven by all the personal stories we've heard of people who've seen their loved ones suffer unnecessarily at the end of their lives.


It's driven by that ripping-off-the-band-aid feeling of relief you get when you've finally broached the subject of end of life wishes with your family, free from the burden of just not knowing what they'd want for themselves, and knowing you could advocate for these wishes if your loved one weren't able to speak up for themselves.

And it's driven by knowing that this is a conversation that needs to happen early, and often. One of the greatest gifts you can give the ones you love is making sure you're all on the same page. In the words of the amazing Atul Gawande, you only die once! Die the way you want. Make sure your loved ones get that same gift. And there is a way to engage in this topic with grace!

Here are the five questions, read them, consider them, answer them (you can securely save your answers at the Engage with Grace site), share your answers with your loved ones. It doesn't matter what your answers are, it just matters that you know them for yourself, and for your loved ones. And they for you.

theoneslide

We all know the power of a group that decides to assemble. In fact, we recently spent an amazing couple days with the members of the Coalition to Transform Advanced Care, or C-TAC, working together to channel so much of the extraordinary work that organizations are already doing to improve the quality of care for our country's sickest and most vulnerable.

Noted journalist Eleanor Clift gave an amazing talk, finding a way to weave humor and joy into her telling of the story she shared in this Health Affairs article. She elegantly sums up (as only she can) the reason that we have this blog rally every year:

For too many physicians, that conversation is hard to have, and families, too, are reluctant to initiate a discussion about what Mom or Dad might want until they're in a crisis, which isn't the best time to make these kinds of decisions. Ideally, that conversation should begin at the kitchen table with family members, rather than in a doctor's office.

It's a conversation you need to have wherever and whenever you can, and the more people you can rope into it, the better! Make this conversation a part of your Thanksgiving weekend, there will be a right moment, you just might not realize how right it was until you begin the conversation.

This is a time to be inspired, informed - to tackle our challenges in real, substantive, and scalable ways. Participating in this blog rally is just one small, yet huge, way that we can each keep that fire burning in our bellies, long after the turkey dinner is gone.

Wishing you and yours a happy and healthy holiday season. Let's Engage with Grace together.




To learn more please go to www.engagewithgrace.org.This post was developed by Alexandra Drane and the Engage With Grace team.

Thursday, November 17, 2011

The Sandusky Teaching Moment: Unfortunate Silence

It started with a many suspicions and a random post of the Penn State fan forum.

Perhaps more accurately, it started with molestation and loyalty to the institution over the community.

The ongoing reports out of Penn State for the past two weeks have brought forth discussions and elicited strong emotions from those in every sphere of my life.  At first, I started quoting the standard mandatory reporting regulations for sexual assault and how Child Protective Services, at least in Kentucky, do not accept third-party reporting - it has to come from the victim, the witness, or the individual the victim or abuser discloses to. I thought Joe Paterno's retirement at the end of the season announcement was bold and bordering on arrogant, and was exceedingly irritated that many news reports focused on his firing and the unfortunate silence that led to the end of a great coach's career. I did not graduate from a university with a BCS championship-claiber football program, so I have a hard time relating to the initial student protests of his ousting in light of the allegations.

More details concerning the access Jerry Sandusky had to the facilities after his employment immediately brought forth the thought "this is beyond cover up - there are probably others paying in kind to have access to these boys or to keep quiet." With records missing from Sandusky's charity Second Mile, non-communication with the university lawyer following McQueary's report to Paterno, District Judge and Second Mile contributor Leslie Dutchot letting Sandusky go home without bail, Sandusky's interview with Bob Costas where he admitted to showering with the boys appropriately, and police reports on victims going back to 1998, the rabbit hole gets deeper and deeper.

Teaching Moments
In the real world, these kinds of stories are opportunities for all of us to open the dialogue on healthy relationships. Since this story broke, I have asked many of my patients with young children if they have had these conversation and if this story has affected the family in any way. Most report a heightened sense of awareness and want to introduce or re-empasise body rights and choice. This article provides several useful tips: How to Talk to Your Child About Molestation For the teen or tween: Talking to Teens about Paterno, Penn State, and the High Price of Bystanding.

Every state is different, however mandatory reporting for teachers, healthcare professionals, and law enforcement are generally standard. Some states extend the duty to report to all residents, but this is not typically well known. To look up the statues that apply to you, visit State Laws on Reporting and Responding to Child Abuse and Neglect.

The "coach" position is a gray area, as evidenced by Penn States's policy that you report to your superior before reporting to the police or emergency teams. While it is in the rhelm of possibility that a federal mandatory reporting act could pass as a result of this tragedy, the Center for Ethical Youth Coaching posted an excellent guide for action when a coach, or anyone, witnesses child abuse: Procedures for Handling Abuse

May communities have domestic violence and sexual assault shelters that provide community outreach.  The Center for Women and Families is one of our city's greatest gifts and they provide information on spotting, preventing, and healing from these traumas: Educational Brochure Library

Of course, no OneDNP post would be complete without a nursing mention. When stories of abuse break like this, many victims relive their own traumas and can experience setbacks, especially when in the midst of therapy. It is important when providing care that nurses are aware of the effects of vicarious trauma and transference issues. To learn more about preventative healing and self-care, visit Reveal, Release, Reconnect

Remember that silence kills mind and body. The arguments many nurses make to avoid reporting peers for issues such as substance abuse  - ruining a peer's career, not wanting one's name connected with the report, fear of retaliation or disbelief, looking bad on the profession, practice, or organization - are the same reasons the powers at Penn State rationalized their silence. And no, it's not different.

Tuesday, November 1, 2011

Highlights from APNA 25: Psych Nurses Have More Fun

This was my second year attending the American Psychiatric Nurses Association annual conference, and the experience again renewed my enthusiasm for live CEU events. There were plenty of excellent speakers, exhibition (sales) booths, and poster presentations, but that is not what makes this a must-do yearly event. It is the camaraderie within the profession and the fact psych-nurses know the importance of having a good time. Here are a few of my personal highlights.

   


Venue: Disneyland Hotel
An excellent location to blend education and fun. Although the place was under construction and wi-fi was a bit spotty, the staff managed to make it magical. We had an awesome renovated room in adventure tower with a view of the evening fireworks. Since we were not run ragged with sessions and the conference ended early on Saturday, there was plenty of time to explore downtown Disney and the parks without the need for car rental or long monorail/bus rides. There were excellent places to eat (Napa Rose for high-brow, Trader Sam's for sips and apps), wonderful spa (ask for Carlos), and a fine collection on shops with live music until 10 or later every night. There were plenty of pens and pads along with a good selection of breakfast and boxed lunch choices. And Pluto, of course!



    

Inspiration: Jean Watson
Her presentation Caring Science and Psychiatric Nursing: Relationship and Emergence of Human Spirit included a singing bowl meditation and an honest discussion on how PMH nurses can use authenticity, interconnectedness, and belonging as instruments of healing.  While speaking on esoteric topics is commonplace in my CAM conferences, I was delighted her powerful delivery made it into an area that does not like to stray far from evidenced-based practice. "Being" is not a concept easily researched through science!  Jean was referred to often throughout the rest of the conference - I gave her a nod in my presentation on the role social networking plays in world connectedness - and she had a huge line of folks waiting to shake her hand following her talk. I studied her middle-range theory of human caring in my MSN program, but there is nothing like a personal illustration by the creator to bring life to a concept that seems more simple and obvious on paper than it does in clinical practice. Watson Caring Science Institute


Mentorship: Pat Cunningham
My advisor won this year' award for excellence in practice and we whooped it up when they presented her award. What is amazing about Pat from a student perspective is her ability to individually listen to each of us, evoke the best practice and thought out of ourselves, and to use that blunt humor so characteristic of the best psych nurses. I imagine her patients feel the same way!




Trend: Integrative Therapies
Last year there were a few posters that addressed CAM use by nurses and I was excited, but this year saw an explosion! Mindfulness training, supplement and nutrition use, and schools of nursing integrating various CAM certifications as part of their psych-np programs are just some of the new blends of therapies to benefit our patients.  I found out one of my current teachers has been using hypnotherapy with some of her pediatric clients and a former psychiatrist colleague has been instrumental in establishing integrative practices in the Long Beach VA's mental-health program. I am excited that the future may hold a number of niches I fit into without having to carve them out on my own. There may be opportunities to expand NP ability to practice certain CAM therapies as part of their scope of practice similarly to how MDs already have, and I would love to be a part of making that happen.

 
   
Coolest Product: Mindability
This product was cool for 2 reasons. First, all the promo literature was on a flash drive that I was able to use to store my presentation when I could not find mine (it resurfaced in my backpack yesterday). Second, the rep gave me a fun wallet card targeted to control emotional reactions. It included some great phrases such as:
  • "If I'm reading this, it means I'm more upset than is good for me."
  • "However I'm feeling is exaggerated"
  • "Whatever I am thinking is distorted." 
  • "Whatever I'm thinking about saying or doing, DON'T, until I calm down."

If reality TV stars had these in their pockets, there would be no reality TV stars! In all seriousness, this brought out a new idea for PTSD group I hope to use during clinical soon.

   

International Perspective: Holland
While a group of use were relaxing by the pool area in between sessions, a fellow nurse from Holland decided to sit and chat with us. I found it interesting that while the US is trying to establish mental health parity, in Holland, they have decided those with mental illness will now have to pay over-and-above the standardized government health insurance rate for supplemental coverage if they want psychiatric services. We also had an interesting conversation about different nursing roles and marijuana bars.





Obligatory Gala: California Dreamin'
Hosted on Adventure lawn, the Friday night reception was included in the conference registration rather than having to purchase separately. An excellent buffet and cash bar (boo!) was well staffed, and the all-dentist band made for a wild evening. The dance floor was defiantly too small for this crew as all-ages crowded it and boogied down. Later we went to my room for a wine tasting wind down that resulted in one of my classmates deciding to commit to the ascot. Pittsburgh better watch out in 2012!

  

Friday, October 21, 2011

APNA Presentation & Resource List

Uploaded to slide share and ready to view! Well, except my cool social-media sun did not transfer over well.Please remember to take the survey: Social Networking and Mental Health Providers

Resources
ANA's Social Media Toolkit - What every nurse should know

Health Vault - The possibilities for collaboration and consultation are encouraging

VA Directive 6515 (Social Media Policy)

Healthcare Communications & Social Media #hcsm Sunday's at 9pm EST

People Say I'm Crazy John Cadigan, schizophrenia patient, movie maker, twitter junkie

Google Privacy Center  An excellent primer

Facebook Privacy The place to update your settings

Thursday, October 13, 2011

Working the System to Make the System Work for Me!

One of our big projects this semester is an economic analysis of a healthcare issue or technology.  Between my APNA presentation and Capstone project, I am a little spent (ha, I made a pun) on social media and wanted to tackle something a bit more juicy: Collaborative practice agreements.

After about 10 hours reading a lot of stuff I already knew:

  • The Institute of Medicine's position that APRNs should be full partners and allowed to practice their full scope of practice
  • In states without collaborative practice agreements APRNs rank as high or better than MDs when it comes to outcomes 
  • State medical boards have banned together to push the idea that nursing is actually medicine and must be regulated by state medical boards
  • MDs are still bitching to each other on Sermo and publishing their opinions that so-called mid-level providers are only competent so long as they hand 5-15% of their revenue over in exchange for an on-paper collaborative agreement
I learned some interesting things I did not know regarding the Federal Trade Comission citing that the collaborative practive agreement could be considered monopolistic and a restraint of trade.

Then I decided, I like my blood pressure where it is, and scrapped it. I decided to analyze workforce management solutions for healthcare systems, specifically when it comes to mobile technology. Why? Because there is a Kronos conference in Orlando this November that I have been invited to that will allow me to get first, the latest data, second, the ability to network as part of the research, and third, to write off the entire trip.


Now thats some health economics!

Sunday, September 25, 2011

The New & Improved ANA Social Networking Principles!

While I am not narcissistic enough to believe my contributions during the "open to public comment" period had anything to do with the excellent edits, I like to think the synergy of many like-minded nurses worked to improve the specificity and decrease the Ratched. The ANA was also nice enough to provide a Tweet and Learn #anachat for 0.5 CEU credits. Now we own it!

Benefits
  • Networking and nurturing relationships 
  • Exchange of knowledge and forum for collegial interchange 
  • Dissemination and discussion of nursing and health related education, research, best practices 
  • Educating the public on nursing and health related matters 
Risks 
  • Information can take on a life of its own where inaccuracies become “fact” 
  • Patient privacy can be breached 
  • The public’s trust of nurses can be compromised 
  • Individual nursing careers can be undermined
 ANA’s Principles for Social Networking 
  • Nurses must not transmit or place online individually identifiable patient information.
  • Nurses must observe ethically prescribed professional patient — nurse boundaries.
  • Nurses should understand that patients, colleagues, institutions, and employers may view postings.
  • Nurses should take advantage of privacy settings and seek to separate personal and professional information online.
  • Nurses should bring content that could harm a patient’s privacy, rights, or welfare to the attention of appropriate authorities.
  • Nurses should participate in developing institutional policies governing online conduct.
6 Tips to Avoid Problems
  • Remember that standards of professionalism are the same online as in any other circumstance.
  • Do not share or post information or photos gained through the nurse-patient relationship.
  • Maintain professional boundaries in the use of electronic media. Online contact with patients blurs this boundary. 
  • Do not make disparaging remarks about patients, employers or co-workers, even if they are not identified.
  • Do not take photos or videos of patients on personal devices, including cell phones.
  • Promptly report a breach of confidentiality or privacy.

Friday, September 23, 2011

Research for Capstone Research

I am currently developing a survey for my DNP capstone project to examine usage trends and perspectives on social media within a number of psychiatric healthcare disciplines.  I am looking into a number of online survey sites to determine which one provides the most feature with the lowest (free?) cost.  It seems there is not one company that dominates the Doctorate student market, but if anyone has a great experience with a particular company, I would love to hear about it! Here are the links:

QuestionPro

SurveyShare

FluidSurveys

SurveyMonkey

SocialSci

SurveyGizmo

PsychData

LimeSurvey

I hope to have the survey up and distributed via a number of social media platforms and professional organizations by the APNA conference in October.  Check back soon!

Thursday, September 1, 2011

¡Viva, Terminado y Voladores!

It is off to Spain in a few hours . . . well, off to a 6 hour layover in Atlanta and THEN Spain. I get to play journalist for a week by gorging on cured meats and stomping through vineyards. But the biger point is:


  • Group Meta-Analysis Project: Done and Sent to Project Leader
  • Health Economics Paper: Done and Submitted
  • PMH Pediatrics Quiz: Done with 100%
  • PMH DB Posts for This/Next Week: Done
  • APNA Slide Presentation: Done and Uploaded
  • APNA Post Test Questions: Done and Submitted



Which means the only thing I ran out of time to do was pre-write my Health Economics DB posts for next week. Unless I want to stay up another 3 hours and pull an all nighter . . . which I don't. But I probably will anyway. 


I think I have put on 5 years in the last 12 months.



Sunday, August 14, 2011

First Week Down

I have been spoiled by summer break and have now retreated into my isolative, distractible state. On-Campus week was a blast and I will get around to posting the highlights from Dr. Carter's talk on the future of primary care, but in the meantime, this is what I am looking at for a schedule:

Evaluation of Practice:
Formulate a PICO question to post to discussion board and respond to those who post on mine while also posting advice to others, complete 4 CITI modules, take the 7 IHI Open School courses, work on my part of the clinical phenomena group project on care transitions (testing), work on my portion of the group meta-analysis project, and read. A bunch.

Healthcare Economics:
Answer the assigned questions by posting on Blackboard and responding multiple times within the group to show I read all of the assigned readings and have some independent thought and understanding of the topics, format my first essay paper and decide what topic I want to write about, watch some powerpoint presentations of economic theories and applications in healthcare, and read a few chapters in the Health Economics texts (and these guys must know what they are talking about since the cover price for the book is $236 - I bought the international edition for $50 brand-new on eBay. How's that for economics?!).



Management of Mental Health and Psychiatric Disorders:
Attend a conference call . . . while inputting all of my clinical notes into Medatrax, spend 2 days at my clinical sites, decide which consultation project to tackle and hopefully get a couple of others to join in, and read a couple hundred pages from textbooks and secondary sources.

For this next week - see above. I also need to get my butt in gear for the APNA. I have most of the powerpoint complete but I find the balmy 85 degree temperatures much more tempting than my laptop.

Friday, August 5, 2011

What's in a Set of Initials?

During on-campus time this week (more on that later) some of us were looking through the UTHSC yearbook and realized every other health discipline with the exception of nursing only listed their highest academic/licensed achievement. For those that were strictly degreed and certified in one discipline (i.e. only a medical doctor or a pharmacist rather than a physical therapist with a philosophy doctorate), their formal listings looked something like this:

John Doe, MD
Neurology

Jane Doe, DDS

Will Brown, PhD

Sara Brown, DPT

Steve Norris, AuD

Nancy Norris, Pharm.D

 . . . and then there was the nursing department:

Ann Smith, PhD, DNSc, MSN, APRN, FNP/GNP-BC, BSN, RN-BC

(Really? Yes, really.)


On a few of my professional LinkedIn groups, a number of threads have been started questioning the need for alphabet soup credentials and in what order to put them in. One of the participants posted an informative article from ANCC called Playing the Credentials Game (and quite appropriately, the author had an absurd number of credentials listed after her name) which reccommends listing degrees highest to lowest, state license, ANCC certifications, fellowships, and other awards. So I guess my high school GED comes before my RN-BC which comes before the Walden Theatre Unicorn Award I won for being a team player, but after my Golden Key Honor Society membership.

What it comes down to is that without a national scope of practice represented by one designation, as most of our healthcare colleagues have, we are likely doomed to feel listing degree, licensure, state designation, and national certification essential. I suppose either bravado or compensation makes us feel it necessary to list awards and certifications. As for myself, I will stick with my original response to the question of how to present one's name:

I am passionate about the over-listing of credentials that nurses have adopted in comparison to other healthcare professionals that pick their highest degree/license. I list my highest licensing credential (APRN) and that is it because it encompasses my RN and graduate level education (which you cannot have without some level of undergraduate, and for that matter high school education). After reading the article Francis posted (thank you), I am more compelled with my plan to list my DNP only, since it is the terminal degree for advanced practice, just like the MDs, PsychDs, DPTs, and PharmDs do:

Jaclyn Engelsher, DNP
Family, Psychiatry

Tuesday, August 2, 2011

"We Take Care of It"

It's that time of year again. Time for me to curse Delta, humidity, and numb-butt. On campus for our third semester means 10 months until graduation . . . 10 months + 1 day until student loans go back into repayment. It also means I get to explore a bit more of downtown and contemplate how exacly to formulate a group session on alcohol therapeutics.

Compared to last year, it is almost like we are barely on campus. Monday was for the newbie and the only thing on the official agenda for Tuesday was Evaluation of Practice. I proudly waltzed in an hour late along with several other slackers (all of which I believe were from the Psych option) and spent most of my time looking up old evidenced-based practice lectures from my MSN to refresh myself on what a PICO question was. I would love to report I have any idea what the class was about, but a revised syllabus, 2 detailed assignment lists, and a lesson in literature search later and all I know is everything must be submitted electronically and the professors are willing to fire our group partners for us if they are not pulling their weight. You fire our problem? I don't think so. In psych, if we have a problem, we take care of it. No need to resort to tattling (I think that is a king to rook four on the lateral violence chess board, but I need to look it up to be certain).  I think this class is going to be the Epidemiology of year two.

Did I mention 10 months until graduation?

Friday, July 29, 2011

A Final Word on Epidemiology

This time last year I was in knots of excitement over starting the DNP program and had no idea I was in store for one of the most challenging and frustrating courses since Mr. Wilhelmi's 7th grade science class (I contend his leaf identification test is still the most difficult exam of all time). So in honor of Epi memories of yore, and since I am stuck with the textbook which couldn't even pass "acceptable" status on Amazon buyback, I would like to share the following quotes:

"People commonly use statistics like a drunk uses a lamppost: for support rather than for illumination."—Mark Twain

"Epidemiology is nothing to hang your hat on. Correlations may indicate something about populations, but if you, yourself, find you exercise better at a particular time of day, they are almost useless." - Mark Sisson

"To every complex question there is a simple answer … and it is wrong."—H.L. Mencken

"Of course we don't know what we're doing, that's why it's called research."—Albert Einstein

"The greatest public health threat for many American women is the men they live with" - Anna Quindien

"Being approximately right most of the time is better than being precisely right occasionally."—Anonymous

"Prejudice is a great time saver. You can form opinions without having to get the facts."—E.B. White

"Chance favors the prepared mind."—Louis Pasteur

"That's all very well in practice, but will it work in theory?" - Anonymous

Wednesday, July 27, 2011

"I'm Going to Disneyland!"

I am officially registered for the APNA conference . . . a good thing since I am presenting!


3011: Social Networking for Psychiatric and Mental Health Nurses
Jaclyn Engelsher, RN-BC, APRN, FNP-BC, DOM; Tanitha Moncier, FNP
Abstract
Social networking, a relatively new communication phenomenon, has the ability to provide education, foster advocacy, promote the profession, and influence mental health policy. It also has the potential to violate boundaries, infringe on privacy, create liability, and damage professional credibility. A review of the literature revealed limited research has been conducted concerning the impact and use of social networking sites in nursing practice and other healthcare disciplines. In 2010 the ANA issued an informal resolution regarding use of social media in keeping with the Code of Ethics and called for additional study.
In Psychiatric/Mental Health Nursing, communication is the foundation of the therapeutic alliance. Because social networking communications have the potential to positively and negatively affect this alliance, it is imperative to develop guidelines for prudent and resourceful usage of social networking media that complies with practice acts, promotes professionalism, and maintains work-life balance for the psychiatric mental health nurse. This session will provide an overview of different types of social media outlets, review published position statements from other healthcare disciplines, and consider best practices for Psychiatric/Mental health nursing.



After looking at the schedule, I wish I was multi-planer because there are a lot of interesting topics going on at the same time including a military specific track, integration of mental and physical healthcare practice, and use of complementary modalities from music making to use of heavy quilts as a comfort measure for depression. I must admit, I am hope the LACE discussions are as lively as they were last year. I love a good nurse fight (getting it out is far better mentally and much more entertaining then letting angst fester into lateral violence later on!).

Saturday, July 16, 2011

Networking Nurse Notice

Just "LinkedIn" with author and fellow FNP Stephen Ferrara from NYC. Check out his awesome blog about the nursing world: A Nurse Practitioner's View

Sunday, June 19, 2011

Fat Nurses

I have been one.  And felt like an absolute hypocrite when preaching excellent nutrition, exercise, and rest education that I struggled practicing.
 

It is not just nurses, but healthcare workers in general often make horrible role models of wellness. We eat out of vending machines, grab the greasiest thing in the cafeteria or drive thru, work long shifts without taking breaks thinking it is good for the waistline to skip meals, bring in baked goods for any reason that presents itself, crash diet, OD on artificial sweeteners, consider walking during their shift/playing with their kids the big exercise of the day, and on and on. Although I have never been a smoker, it falls in the same category. Many hospitals have banned smoking on-site leading workers to retreat to their cars or form a line-up across the street of scrubs and smoke. If there is anything to the detrimental effects of 3rd-hand smoking, I think hospital staff has to be the worst of the offenders. Yuck.


Since last year I have lost roughly 30 pounds. The first year of the DNP program has left VERY little time for food tracking on Sparkpeople which was a big contributor to helping get realistic about how much I was eating previously. I was in a total exercise rut for a good part of the winter. I had a feeling it was going to happen so I lifted heavy in January/February before slacking in March/April. I think that was a big help since I have been fluctuating between the same 5 pounds since the beginning of the year. I used to be a huge snacker, especially with stress, but I forget to when I am caught up studying and writing papers on things I find interesting. 

I am currently on a 30-days to Vegas personal challenge to get back on the fitness wagon and have been doing a ton of new circuit training videos. Despite being a total narcissist, I love Jackie Warner's Xtreme training DVDs - she is very encouraging, tough, and motivating. Your Body Breakthru Circuit with Michelle Dozios is also solid. I picked up Kelly Coffey-Meyer's 30 minutes to fitness and while I like the workout and variety of pre-mixes, I cannot get over her background exercisers are wearing tank tops with her name on them. Naturally, I am also continuing with Beach Body workouts and supplements - sure it's a big fat pyramid scheme (excuse me, multi-level marketing) but both Shakeology and their fitness programs are awesome. If you want to help me pay for next semester, order something from my site: http://jingbody.com and make sure to select me, Jing Body, as your coach ;)

I plan to finish up with the required clinical hours before my vacation and, in theory, I could take a month off before classes start back in August. However, my awesome and savvy teachers gave everyone an incomplete in clinical so we could front load hours over the summer for the next semester. I am taking full advantage of this and should have an extra 40 hours to my credit. I am probably going to take a break from teaching in this Fall as well so I can grab an extra clinical day and front load for the Spring. And so I can avoid the fat-rut for the winter! 

Monday, June 6, 2011

Sweet News!!!


Geneva, Switzerland; Valletta Malta, 7 May 2011 - Expressing extreme
concern at the lack of nursing policy presence within the World Health
Organization (WHO) structures, an emergency resolution* was passed by the
governing body of the International Council of Nurses (ICN) at its biennial
meeting held in Valetta, Malta. The official representatives of ICN’s member
national nurses associations voted unanimously to demand that the WHO
Director General empower and finance nursing leadership positions throughout
the organization.
“At this time of health system redesign aiming to enable access and costefficiency,
it doesn’t make sense for WHO to advocate for nurses to fully
participate in the health care team at the clinical level, yet exclude them from
playing their full role at the policy table,” declared ICN President Rosemary
Bryant.
“As we move to discussion of the Resolution on Nursing and Midwifery at the
upcoming World Health Assembly, we urge member states to add their weight to
the call on Dr Chan to remedy the appalling lack of nursing leadership positions
throughout WHO structures, including at headquarters and in the regional
offices, beginning with reestablishment of the post of WHO Chief Nurse
Scientist.”

Monday, May 30, 2011

Thoughts on the ANA Social Media Policy Draft

Three cheers for the ANA who developed a task force late last year to help write some rules and regulations for nurses to refer to in the uncertain environment of social networking. We are on par with other health care disciplines in the scramble to determine the implications of potential boundary violation of both patient and provider before the lawyers carve out a new specialty branch of practice. I think this is an overall great start (even though it is a direct crib from the AMA's policy) but I would like to see some more specific and supportive language.  Naturally, this nurse has plenty of public comment which is lovingly provided alongside each of the following provisions in glorious technicolor!

APRIL 25, 2011
FOR PUBLIC COMMENT (click to add your 2 cents)
PRINCIPLES: SOCIAL NETWORKING AND THE NURSE (click for the full document)

Background
Relying on an Action of the 2010 ANA House of Delegates, “Social Networking and the Nurse,” ANA staff, in consultation with the CNPE Practice and Regulation Workgroup and the ANA  Ethics Advisory Board, developed an outline of professional principles to guide nurses in their use of social media. The House of Delegates Action resolved that ANA “support the application of ANA’s foundational documents – the Code of Ethics for Nurses, Nursing’s Social Policy Statement, and Nursing: Scope and Standards of Practice –to the use of social media.” The following provisions from these foundational documents helped to inform the draft principles for Social Networking and the Nurse.  Code of Ethics for Nurses with Interpretive Statements (ANA, 2001) – The Code of Ethics for Nurses is a seminal ANA document establishing ethical standards for the nursing profession. It provides a framework for nurses to use in ethical analysis and decision-making. Each of the nine provisions of the Code, along with select Interpretive Statements, provides guidance on the application of professional values and personal judgment in nurses’ use of social networking and media.


In addition to reliance on ANA’s three foundational documents, the draft principles for Social Networking and the Nurse also consider pertinent statutes and legal documents,  the experience of health professionals with social networking as reported in the media,  as well as the social media policies of other health care organizations.

Preface
Nurses who are currently practicing or preparing to enter the workforce have a professional obligation to understand the nature and consequences of participating in social networking of all types. The social network and the Internet provide an opportunity for unmatched knowledge exchange shared quickly among many people. There are many positive implications for nurses and nursing practice: it provides an opportunity for broad dissemination and discussion of nursing and health –related education and communication; it can nurture relationships and mentoring among developing professionals; and it provides a forum for collegial interchange and the development of an online professional presence. It also offers the profession a vehicle for educating the public on many nursing and public health matters. At the same time, information contained on a social network has the capacity to propagate itself, taking on a life of its own in cyberspace. Nurses must be aware that the social media venue is shared by their patients, and that unintended consequences of poor decision-making can breach a patient’s privacy, damage a patient’s trust in the individual nurse and the profession, and further damage a nurse’s professional and personal future. Inaccuracies become “fact” by mere repetition, which is a particular danger when discussing public health needs. Despite the feeling that comments, videos, photos, or other online materials may seem transient or “gated,” the nature of the Internet is that such materials are permanent and just about anyone can and will see these postings. Thus, it becomes essential for nurses to consider a number of guidelines when functioning within the “virtual” world of social media:

Principles
1. Patient privacy is a fundamental ethical and legal obligation of nurses. Nurses must observe standards of patient privacy and confidentiality at all times and in all environments, including online. Nurses must not transmit or place online individually identifiable patient information. The nurse’s primary commitment is to the patient and nurses are ethically required to practice with compassion and respect for the inherent dignity and worth of every individual. The key here is "identifiable" and I would like the ANA to include a statement addressing acceptable or exemplar generic comments. Reporting a bad day at work or mentioning difficulties with performing a particular procedure should not be grounds to call "breech!" Likewise, mentioning the good feelings that come from providing benefit that day should not be labeled inappropriate if are patients not "identifiable." 

2. Nurses who interact with patients on social media must observe ethically prescribed patient –nurse professional boundaries. The precepts guiding nurses in these matters are no different online than they are in person. Does this refer to professional social networks such as those run by the CDC or Mayo Clinic or those which have private encryption such as the telemed/psych services at the VA? This provision needs to differentiate between personal and professional persona. Public social media outlets provide no guarantee of privacy, therefore engaging with a provider on a social network implies that the client understands confidentiality cannot be guaranteed. Just as a consumer cannot ask a provider a medical question on a talk-show or radio program and expect it to constitute a through and private assessment, the same is true for social media outlets. The client cannot ask the nurse a healthcare related question then accuse the provider of a violation if the provider answers the question or cry "patient abandonment" if they do not acknowledge the interaction - label it the "call-in clause." If a nurse chooses to maintain a professional site, a statement regarding privacy, who is allowed in the network, and reminder that members can see other members participation should be clearly noted so everyone knows what they are getting into if they choose to join, for example, a Facebook page or twitter feed. The ANA might consider creating example statements that nurses could post as an FYI to fellow networkers. For example, these are from my professional and personal facebook page (suggestions for improvement are welcome!): 


***Social Media Policy Statement: While Jing Acupuncture/OneDNP is a health care provider, this page is for entertainment, advocacy, and education by a private citizen - not diagnosis, treatment, and advice from a professional. All interactions on this social networking site are open to anyone who has the good fortune to visit this page. Visiting or "liking" this page does not constitute or imply a therapeutic relationship and is not bound by confidentiality, practice acts, or codes.


***The ANA's new social media policy recommends providers uphold our code of ethics by maintaining professional boundaries online. I am currently not accepting friend requests from current patients who have visited Jing in the past 3 years. To stay in touch professionally, "Like" my page at http://www.facebook.com/JingAcupuncture or follow me at http://www.twitter.com/JingAcupuncture 
My Social Media Policy Statement: While I am health care provider, I use Facebook as a private citizen for entertainment, advocacy, and education - I do not diagnosis, treat, or provide medical advice in any professional capacity whatsoever. All interactions on this social networking site are open to anyone with access to this page including "friends," random hackers, and administrators. "Friending" me does not constitute or imply a therapeutic relationship and is not bound by confidentiality, practice acts, or codes. (And yes, this necessity is ridiculous!)

3. Nurses should take advantage of privacy settings available on many social networking sites in their personal online activities, and seek to separate their personal and professional sites and information online.  I would also like to see the sanctity of provider privacy addressed in relation to self-care.  Curiosity about the personal lives of providers is natural, yet a patient may be able to gain access to a nurse's social network in spite of him/her taking reasonable privacy precautions. In such instances, the nurse should not be held to standards over-and-above those of maintaining privacy and confidentiality in good faith and be free to express personal opinions without fear of professional consequence. Many nursing associations recommend avoiding personal relationships of any kind with a patient after discharged from care for 6 months to 5 years to never -  virtual, "friending" patients does constitute a personal relationship that can have consequences in the 3-D world.  Having a general guideline for the nurse to fall back on would help lessen the potential feelings of personal rejection for clients who want to keep in touch. I feel the ANA should not condone any hiring practice that requires an applicant to allow the potential employer access to their social networking sites, and there should be words to that effect. Support from state boards, organizations, associations, and accrediting bodies would help protect the personal/professional buffer while preventing multiple guidelines that may conflict with each other. 

4. Use of privacy setting and separation of personal and professional information online does not guarantee, however, that information will not bleed through or be repeated in less protected forums. Therefore, it is prudent for the nurse to evaluate all his or her postings with the potential for patient, colleague, or employer viewing in mind. Online content and behavior has the potential to either enhance or undermine not only the individual nurse’s career, but also the nursing profession. This provision may be necessary because, as Voltaire said, "common sense is not so common," however it creates a culture of second guessing one's actions, lays the field wide open for unnecessary scrutiny into the life of a private citizen who works in public service, and implies that a nurse can never be "off-duty." Any implication that the ANA would support employers, accreditation bodies, or state boards taking punitive measures against employees for posting political, religious, social or other opinions as a private citizen demonstrates a distressing lack of advocacy. Ditto for supporting employer social media policies that allow a company to govern any aspect of personal online activity of employees and use it as part of an evaluation process. It is one thing to ask yourself if your post passes the "mother" or "headline" test, it is another to fear the thought police and think your license or job is in jeopardy when off the clock.

5. Nurses who view content posted by a colleague that is unprofessional or that potentially violates ethical or legal obligations should first bring the questionable content to the attention of the individual, so that the individual can take appropriate action. If the posting is egregious enough or if the individual does not remove the posting, the nurse has the obligation to report the matter to supervisors or other authorities. This is in keeping with what occurs in the real world, however, the lateral violence potential here is unlimited. I can envision managers or coworkers stalking social networking sites in search of dirt they can use against an unpopular peer. I do think there is a better likelihood of a peer confronting a peer online than in person because it seems less like a scolding and more like an FYI. 

Wednesday, May 18, 2011

Two for Tuesday

Morning Session


I woke up early this morning for a much needed workout and SVU reruns. The morning starts with a call to AAA, once again validating my 12-years of membership dues, and the discovery I can get $30 off my nightly hotel rate since I am at UT. Fabulous!

Our only class today was recapping and sharing some stories on our therapy experiences this semester. It solidified my love for the self-pay business model. No federal money means no federal rules . . . other than the usual ones we all have to abide by.

Afternoon Delights
Because I live by the notion that everywhere is Vegas if you have the right attitude, I have an amazing low back/hip massage, reflexology, and a facial at Rachel's Salon and Spa. As usual, I am given the royal treatment by both my therapist and the receptionist with promises to return on the next trip in August. I top the afternoon off with some awesome BBQ duck nachos and a drinkable Bulleit Bourbon Sidecar from Flight ("we don't have a cocktail menu, but we have a full bar" is my new sign to order Makers on the rocks).


Liquid Therapy
A group of us from class decide to end the semester in the traditional nursing fashion: drowning martinis, forking dessert, and discussing various clinical experiences involving genitalia.

We started out at Huey's - the hundreds of toothpicks shot in the ceiling via straw left me reasonably certain I was about to hear he "we have a full bar" line in answer to my cocktail menu questions. I was right. We decide to take a walk over to the sushi/Thai resturant after everyone fails in their attempt to spit hard enough to add to the decor.

Our new haunt, Bankock Ally, is appropriately named for the direction of the conversation. In the interest of professional courtesy and confidentiality, I will refrain from specifics. Sufficed to say, if you are a nurse you know what we talked about. If you are not a nurse, we discussed how awesome it is to work for cute doctors and be angels of mercy. And what serendipitous fortune! We are presented with the Two for Tuesday menu and toast to the fruits of our semester's labor. And to all a good night!

 

Monday, May 16, 2011

Fight, Flight, Freeze, or Caregive . . . . or Have a Cocktail: Kicking Back with Bowen's Family Systems

Got into Memphis at 8am courtesy of Delta (still the only direct flight to Memphis and a steal at $500 a ticket) and whisked off to the ever reliable Springhill Suites via Last Minute Transportation (superior service, as always).

Afternoon Funk

Nothing gets a trip started like a some sailors jammin' to "Ride Sally Ride" and a hot dog from a cart!

Individual Group and Family Therapy 2-6pm

Sylvia Landau gave an amazing presentation on Bowen's family systems theory. My new mantra: "I'm not being selfish, I'm fostering self-actualization." Seriously, I now have an explanation for why neither mom's Catholic or dad's Jewish guilt trips work on me and new rational for my relative lack of concern for doing what is expected. Of course, there is a fine line between ass and actualized, but it seems those who adopt a Machiavelli attitudes suffer fewer health issues and far more joy than those who take on the world's woes and feel compelled to do either everything for everybody or nothing for themselves. I must have had a self-care premonition since I already booked myself for a facial and reflexology at Rachel's for tomorrow afternoon! Some great points from the lecture:
  • Who we are is defined by the family gossip
  • You are just one bean in the soup
  • Active listening gives the patient permission to do their own work and trust themselves
  • Health is to become whole
  • Saying nice words does not negate the impact of scary thoughts
  • Get neutral, not guilty
  • Psychosis can be an adaptive coping response
  • Like matter, anxiety can neither be created or destroyed, rather it is projected and absorbed.
  • Be a friend, not a blood sucker
  • We run from reality as long as we can get away from it
  • The system will try and change you back
  • Cancers are cells in other systems' business 
  • Present mindfulness helps extinguish automatic role patterns and tolerate the familiar
  • Feel your emotions, but don't get too sentimental
To top it off, we received a copy of Caterpillars Chrysalis to Butterflies: Humans Change Through the Family Process which Dr. Landau was kind enough to sign for me. Interestingly, we share "All the Way" in common, although Fred and I prefer the James Darren version to Sinatra's.

I am working my way through nearby fancy-town dining and had a lovely chat with the bartender about cocktails, sake, and bourbon. May I suggest the Memphis Passion Martini, Shrimp Spring Rolls, Beet Salad, Creme Brulee, and the Memphis French Martini should you care to visit?! 

Saturday, May 14, 2011

On the Road Again

For once, it is me this time and not the husband. Being alone all of the time kind of sucks mental health wise - social media tools just don't have that interpersonal touch that makes you believe no man is an island. The good part is that I get to realistically try out some self-CBT before recommending a particular exercise to a client. I even managed for the first time in my post-secondary, oh hell, post-first grade education turn a paper in a whole 30ish hours before it was due.  I am still debating if taking on a an teaching gig was helpful or harmful to my overall development.  On one hand, it was a psych class and the 20 hours a week I spent on prep provided forced study time I may have otherwise neglected. On the other hand, I would not have flaked out on a few Blackboard discussions, could have delved deeper into the material, and, at least theoretically,  concluded my clinical hours without having to take an incomplete.

I love hindsight.

In these last few hours before I leave for Memphis, I have a final in assessment strategies, 2 SOAP notes, 1 Reflective Journal, and 1 process recording to do. When I get back, I also have roughly 90 hours of clinical time I need to log before August. Thankfully, my second clinical site came through so I should just get done before I have to start over again.

If I am not mistaken, the new deadline for the end of the world comes while I am in school. At least I get to go out listening to Elvis with a belly full of barbecue and a blueberry sidecar.

Until the road gets rolling  . . .