LVNs/LPNs/VNs

When I started my first nursing job (I had no nursing experience other than during school) as an RN, I remember that some of the nicest and best bedside nurses were the LVNs I worked with. There really was a difference in the attitudes, bedside manner, and teamwork mentality of the LVNs. They not only spent more time with the patients (this was because they did not have all the responsibilities of the RNs), but they had no problem assisting a patient to the bedside commode or giving a bed bath. They did their job with a better attitude than some RNs I know, whether it was dosing pain meds, changing linens, or assisting with ostomy care. I have encountered many RNs who almost have a chip on their shoulder and act as if they are "too good" to help with certain aspects of patient care. I have even heard of an RN telling the patient it was "not [her] job to empty bedpans" and she would get the CNA to do it. This behavior to me is appalling to say the least. I owe a lot of my nursing 'tricks' and really good technical skills from LVNs who had the time, and were knowledgeable and kind enough, to help a new RN. While I do not think that teaching LVNs would be the right choice for myself, I definitely agree that LVNs are a wonderful and unique category of nurses. LVNs deserve respect and acknowledgement from society and from other nursing professionals.

Mid-Semester Self-Review and Analysis

o 2 Course Objectives and 2 Personal Objectives so far in the course; relate your progress on these objectives to your work in your specific preceptor site.
Course Objectives:
1. Communicate effectively, both verbally and in writing, with individuals, groups, and health care providers. I have had to really struggle to find a preceptor because I have been back in Texas for less than a year and I do not know any nurses in Dallas other than those I work with. In order to complete assignments in this and other courses, I have had to communicate with other nursing professionals and health care providers. I have sent emails, made telephone calls, and met in person with individuals. At staff meetings, I have had the opportunity to effectively communicate with groups of my peers. Communication is crucial in any type of relationship, even in the workplace. As nurses, we communicate constantly with our patients and one another.
2. Discuss current trends and issues in the nursing profession. The completion of Modules I and II required research of current topics of interest in the nursing profession. Issues relevant to our everyday practice were analyzed via discussion board postings and blog communications. I feel that these discussion were interesting and helpful in learning more about the profession of nursing. My change project involves the current trend of alternative and complementary medicine and the effects of spirituality and prayer on healing. To design my project screening tool, I had to research in depth this and other related topics as they relate to nursing.
Personal Objectives:
1. Incorporate research into the practice of professional nursing. Before this course (and my graduate research course last semester) I never really considered how nursing and research coexist. Nursing as a profession has more to do with research and evidence-based practice than I first thought. In order to complete my change project/paper I had to do several hours of research regarding the topic I have chosen. Personally, I feel I have grown as a nurse because I am better educated on facets of the profession other than bedside and clinical skills. I believe that we never stop learning and my research for this course has made me a better nurse because I have spent time reading and learning about unfamiliar topics.
2. Function as a client advocate through collaboration with health care providers. As a nurse, the majority of my focus is on being a patient advocate in some way, shape, or form. Nurses are the often the first and last lines of defense for our patients, as we learned in the discussion boards. Personally, I feel that patient advocacy has always been one of my strong points; I treat every patient as if they are a family member (and my family means everything to me). My change project/paper requires me to assess patients spirituality and feelings regarding it; this is also a form of advocacy because the results are then used to better care for the individual patient's needs.

o An overall review of your personal objectives and reflection on how you have/have not accomplished them, support either with reasons and/or examples;
Overall, I feel that my personal and course objectives have been equally met. I believe I have accomplished effective communication through the acquisition of a preceptor on my own and the implementation of a spirituality assessment and screening tool. I have accomplished client advocacy in the ways stated above. I have also done so by not being satisfied with an "okay" solution to a patient's problem; instead, I kept calling the doctor until a "great" one was determined. I have advocated on a patient's behalf for them to stay another day in the hospital because they were unsafe for discharge to home and through effective communication with the physical therapist, we collaborated on pursuing this decision. I have discussed current trends and issues in the nursing profession on the discussion boards and then carried these over into my workplace. Issues such as staffing, patient ratios, technology, efficiency vs excellency; these are topics that all nurses have something to say about. It was refreshing to discuss these with co-workers and discover we shared a lot of similair beliefs. I successfully incorporated research into the practice of professional nursing through the implementation of my change project. Much research has been required in its design, wording, and actual use in the clinical setting. Research was required for participation in Blackboard discussions and response postings as well.
o Statement and discussion of one way these items have fostered your growth as a professional nurse.
As aforementioned, I believe that I have grown as a nurse because I am better educated on facets of the nursing profession other than bedside and clinical skills. I feel that my research for this course has made me a better nurse because I have spent time reading and learning about familiar and unfamiliar topics. It is important to stay abreast of the latest trends and issues in nursing because patients will see you as better educated and more competent. I feel that I am a well-rounded nurse because I have shared in intellectual discussions with my peers in this (and other) nursing course and looked at topics from different persectives. I have also grown as a nurse because I realize how very important it is to keep up with technology, politics, legislation, and social changes that will affect me, and my family, professionally and personally.

Nursing

You know, Parkland has an RN position that is listed as "Call Center RN." The blog posted by Professor Anderson immediately reminded me of seeing this job title while I was job searching last summer. I checked again today, and there is a Call Center RN position available. Same one? I have no idea, but it was listed as open since Sept. 2009. While I don't necessarily think it is fair to exclude those individuals who lack manual dexterity or fine motor skills from being nurses, I don't really see any other options. Nursing by definition is, "the provision, at various levels of preparation, of services essential to or helpful in the promotion, maintenance, and restoration of health and well-being or in prevention of illness, as of infants, of sick and injured, or of others for any reason unable to provide such services for themselves" (Dorland's Medical Dictionary, 2007). The American Nurse's Association states that the "function of a nurse involves the physical intimacy of laying on of hands." The basis of nursing involves interaction with patients and acts (by the nurse) of healing and caring to some degree. Even if later on a nurse becomes a Call Center RN, or an Advanced Practice Nurse who is more removed from bedside nursing, he or she still has the previous experiences and the knowledge gained from hands-on caregiving to refer to when practicing. Training is an important part of being a nurse...would you want a doctor who had graduated from medical school without ever palpating an abdomen, giving an injection, or closing a wound with stitches? Would you want a lawyer to defend your life who has never been in a courtroom, practiced giving depositions, or been in a mock trial? The point is that certain professions have specific skill sets and duties that only people who hold that title can perform. Society expects some level of performance and mastery of these skills by those individuals within such a profession. No, I do not think that someone who cannot perform the physical duties of nursing should obtain the title of Registered Nurse. I think that their own knowledge, book learning, and unique personal experiences can provide them with great insight on nursing, but this is not the same as actually "being" a nurse.

Change Project

In my Research in Nursing course last semester, I had to pick a topic and write a literary review of current, available research. Like Rachel, I picked something I am passionate about: Faith, Religion, and Spirituality, and how they affect patient outcomes. I proposed a screening tool for patients that allows the health care provider to assess whether or not this aspect of the patient's life ought to be included in an assessment. We talk often of 'holistic' care in nursing and of 'treating the whole person.' For many people their faith and belief in God have a major impact on their daily lives. If every other aspect of a person's being is considered when providing care, why should health care ignore spirituality? For my change project, I would like to refine and implement this spirituality screening tool in order to provide more individualized patient care. Based on the evidence I found while researching this topic, a significant percentage of the population would like for their health care practitioner to include spirituality in their plan of care. Many patients prefer that their health care team pray with and for them prior to surgery or treatment, like chemotherapy. I know that this topic might not appeal to everyone, but if health questionnaires can (and do) ask about recreational drugs, number of sexual partners, and alcohol use (which are offensive to some), why is religious belief any different? I am excited to see where this project leads.

My BS in Nursing

I graduated from an ADN program in 2007 and started back to school in 2008 for my Bachelor's. I originally chose the ADN program because a. it was cheaper b. it was close to home c. I could start working as an RN sooner. I always planned on pursuing an advanced degree in Nursing and have always wanted to be an FNP. Like Rachel, I get lots of questions any time someone hears I am in school. A lot of times people think we are not quite RNs yet and I have to explain that, yes we already are, but that I want a higher degree.
I will not change jobs, I will not make more money, and I will not even get a new nametag at work. Having a Bachelor of Science in Nursing is one of my own personal goals, and it allows me to continue on with the rest of the graduate classes I need to take. I am doing this for me and for my family; more doors will open for me with each degree I obtain. For example, at MD Anderson in Houston they only hire BS-degreed RNs.
I started taking online BS classes at TWU while I was still living in San Diego. Since my husband and I weren't sure how long we would be out in California, I planned on taking as much of the BS-MS program that I could online. I would have received a raise of $1.50 per hour for having my BSN in California...that was additional motivation at the time! Now, I look forward to the additional career opportunities and possibilities that having my BS will bring.

Politics in Nursing revisited

At work this week, someone I know began discussing the article Leah posted about nurses starting to unite and work with union reps. from California. This same person also pulled up the article and had the other nurses read it...it was really interesting because every single person felt very strongly that we should have more input regarding our profession and the parameters in which we work. It was also insightful how many people already knew about the march on the Capitol in Austin and other political nursing activities...people who never bring it up or even mention it at work. I think a lot of nurses are afraid to discuss certain things at work because they do not want to have negative repercussions from management. Just the word "union" can have an odd effect on the atmosphere of the floor.

In one of my courses, we just discussed End-of-Life issues and the presence of family members during CPR...it really got me thinking about my own preferences-both as a nurse and as a daughter/sister/wife. This topic is something that we all need to be prepared for, especially as the baby-boomers age and technology continues to allow people to live longer.
After graduation in May, I will stay where I am at work and finish my MS. I know in California they pay you more if you have your BS, do most places do that here in Texas as well? My present employer does not and I was just curious.