Monday, December 31, 2012

Patient Satisfaction Survey

When PediNP wrote about "Customer Service" in relationship to her clinic, it was something that most practitioners, from the techs to doctors, understand. We are the ones who actually touch the patients and talk to the patients and families on a daily basis.  
Most health care facilities around the country now provide some sort of “Patient Satisfaction Survey” after the patient has had their care. Hospitals, clinics and other healthcare services rely heavily on these surveys. Some information can be beneficial, but most of it is for the administrative bean counters and managers who never touch a patient.   

Facilities tailor these questions to their specific needs, but here is a generic form from the Department of Health and Human Services. See the flaws, sometimes these surveys look like something you would fill out after staying at the Embassy Suites or Days Inn.  When was the last time someone had a hip replaced, heart valve surgery or got a cast at a hotel or restaurant. We who touch the patients provide a different service. OK, sometimes we provide you a blanket and some mediocre food. (That is another post topic).

These hospital scores are posted online through a National database (No not Yelp). How does a survey compare a hospital or clinic that treats the under served and homeless versus one in the gated upscale suburbs? New hospital additions have private rooms and flat screen TVs, while the community hospital still has two and three beds to a room. Do you think the satisfaction score might be lower, if the patient on the other side of the curtain is on the commode all night doing his GoLytely bowel prep. Patients will provide positive or negative feedback depending on the amount narcotics given out or refused at a clinic or ER.   

Wednesday, December 19, 2012

Clostridium difficile and the dog

Really. This WebMD article says researchers in the Netherland taught a dog to sniff out C. difficile. Poor dog.  The dog was a 2-yer-old beagle named Cliff. Come on Cliff and C. diff, researchers are not very cleaver with word play. Anyway, when other dogs are taught to sniff out drugs and bombs, they are rewarded with tasty treats. What do you give a dog that is taught to sniff out C. diff.  I’m thinking maybe a bath.

Seriously did they spend a lot on this research, because I bet 75% of nurses with some experience at the bedside can tell you if a patient has C. diff. Even from the hallway at that particular time, nurses can make an educated guess as to whether someone has C. diff.

If fact nurses are so good we can tell the difference between the smells of a GI bleed bowel movement, C. diff diarrhea and hospital cafeteria food flatus.  Don’t try to impress your friends or family with this fact during Christmas vacation.  

Another good way to know if a patient has C. diff.  When you are floated to a new floor, look at your assignment. Yes, your patient in isolation will be the one with C. diff.   

You want me to spend my life doing what? Pick him, no pick him.

Friday, December 7, 2012


Just need a break.

One more week and finals will be over. Tests are stressful, but not as much as when your instructor comes out to your primary care site to evaluate you. That is stressful. They come and sit in the corner of the exam room and say just ignore me. The patients don’t have a problem with it, but the students are a wreck. Did I diagnose it right, did I come up with the appropriate differential diagnosis and did I order the right meds and consults.

I would love to be out in the woods breathing fresh air and walking a Labrador. That is the best way to beat stress. Until then I just need to keep the goal in mind for six more months, then I can get a job and dog.

Tuesday, November 13, 2012

Nurse Practitioners Week

November 11-17, 2012

OK I did not know there was such a thing until yesterday. Nevertheless, I guess everybody gets a day, week or month these days and thanks to Hallmark.

According to the AANP, there are approximately 155,000 nurse practitioners in the US. I would guess they work in more than 20 different specialties and areas in and out of hospitals and clinics.

Compare that to the roughly 850,000 active physicians, of which about 350,000 work in primary care. There are many different statistics from different sources about the numbers, but this seems to be the average. Anyway, for years they have been predicting an MD & DO shortage.

Nurse practitioners are not doctors or junior doctors; we are nurses with advanced degrees that can do some diagnosing and prescribing. A nurse practitioner will never have the book smarts of an MD and their medical school and residency training. However, in the wake of the aging population we should be able to work alongside and help with coming patient load that will tally in the millions.

Thursday, October 25, 2012

Time management

Thought blogging though school was a good idea. However, I cannot believe how busy things have become. One day a week, we have lecture and classes for 10 hours, then 2-3 days a week we spend in clinical settings.

As a nurse, time management is a part of the job. In graduate school, I believe one of the biggest tests becomes time management. Yes, you are warned to put your life on hold until it is over and in some ways you do.  However, as an adult student that is not realistic. Family, kids, bills and work to pay those bills, all becomes a part of your time management. As important as those are, school, lectures, tests, papers, studying and clinicals are more important to get to your goal.     

Tuesday, September 4, 2012

How to become a Nurse Practitioner

Frequently at work other nurses ask me about my journey through my nurse practitioner program. They want to know what it is like, how hard it is, and is it worth it. I tell them it is worth it and yes, it can be hard at times. For some nurses this is just our small talk, and for years they have asked me the same questions. However, a few are really interested and I can sense they are feeling the way I was a few years ago. If they are serious, I will encourage them that this is the time to apply and go into a Nurse Practitioner or CNS program. Their next worry is about the admission process.

There are some tricks to increase your odds of being accepted. However, the first thing is start your paperwork, goal statement, and lining up those people who will write your reference letters. In the end, waiting will be the toughest part. As for the reference letters, they should be from influential people related to the health care field you want to enter. Preferably, from doctors, alumni, managers and other nurse practitioners etc, and not your nurse lunch buddy from the renal unit.

Have some volunteer or other experience to put on your application that reflects your area of interest. They notice if you are applying for a community health specialty, and the closest thing in your background is working at Kmart. That does not match your goal, so go volunteer at a free clinic or somewhere with people. Just because you might have a family, does not qualify you for a family nurse practitioner. Working with kids, seniors or under served people not related to you.      

Those are some important things, but what is really important if you want to be in school next fall and not saying I should have again for another year, then you need to be flexible.
 There are many graduate nursing programs and schools around the country, so you need to apply to more than the one in your hometown. Chances are the school closest to you is smaller with only a couple specialties, like family nurse practitioner (FNP) and nurse educator. A small school near here admitted 12 FNP students last year. Other universities will offer more areas of study for a nurse practitioner and may have clinical nurse specialist (CNS) programs. A good option if you want to stay in the hospital setting.
Then there are the large universities and institutions that offer an extensive number of specialties for nursing students. An example of these larger and better-known schools would be the University of California San Francisco, University of Washington and the University of Pennsylvania. Yes, there are other big schools like Johns Hopkins University, but I think these are the biggest and have upwards of 15-20 different specialties beyond a BSN degree. The one I attend has approximately 600 nursing students in the Masters, PhD and DNP programs. Meaning instead of 10 new students a year, they admit more like 150-200. I explained this to a nurse at work, who was thinking it would be easier to get into a smaller program. People need to apply to these larger schools.  
The other most important thing to increasing your odds to being accepted at a larger school is to think outside the box. Having talked to faculty and individuals working in the admissions office, do not be like everybody else and think specialty.  
Your admissions office might be able to give you hints, but the most heavily applied to areas in my school and probably most are of course the hardest to be accepted, these include:
Family Nurse Practitioner: I understand this is by far the most heavily applied to area and hardest to get into. For some reason everybody wants to be an FNP, they remind me of the old family practice doctors and they treat just about everybody. This was not for me, because although I like kids, I do not want to deal with their parents.
The Nurse Midwife/Women’s Health Nurse Practitioner
Pediatric Nurse Practitioner.
Acute Care Nurse Practitioner; most schools require at least a year or two of ICU or ER experience to even apply. Even so, they get more applications than spots available. Most of these student want to stay in the hospital setting.   
Doctors have been specializing for years and I think you will see more of this in the NP programs, so look at other specialties that interest you. Apply for an Adult Nurse Practitioner with a specialty in Occupational and Environmental Health or a Psychiatric Nurse Practitioner. Apply for a CNS in Oncology or Cardiovascular care. If you really do not want to have direct patient care you can go into research and get your PhD. Adding a minor to your specialty like forensic science, palliative care or global health can only help.
Again, the biggest thing is to apply. No matter who wins in November there is a growing need for nurses with advanced degrees. I remember in the fall of 2009 thinking I am too old and it will take too long to go back to school. Well, I am done soon and anyone starting next fall will be done before the 2016 person is sworn-in.

If you have never been a nurse and have a degree in another area, there is always the MEPN option if you want to be an NP, CNS or other specialty.

So how do you become a Nurse Practitioner. Apply

*This was all my opinion and if you have any questions ask. I only guarantee that if you do nothing you will not get in.

Thursday, July 12, 2012

It is all about the money

The two commercials you see on TV constantly are pharmaceutical companies advertising their drugs and lawyers wanting to sue pharmaceutical companies.

Why do so many drugs created to cure one thing, have twenty-times as many side effects.

Tuesday, July 10, 2012

Through the Cambodian interpreter, retired patient tells me how he got a laceration on top of his thumb while using a handsaw four days previously. He was able to stop the bleeding, but now it was so infected he had to come in. After a prescription for some antibiotics and some instructions to elevate and use warm compresses, he was on his way. Although, I had to say that just because it is called a handsaw, does not mean you saw your hand. Lame, but least I got a small laugh from the interpreter and patient.

Monday, July 2, 2012

New Clinicals

Started a new clinical rotation over the weekend in an urgent care clinic for a large HMO. There were about a dozen MD’s & NP’s working, and my preceptor handles mostly musculoskeletal injuries. She also had a good sense of humor, which helps when you see so many people in the course of a shift.
I found the patients rather pleasant to deal with, maybe because they had insurance and did not have to wait around in some ER to be seen for their minor injuries and accidents. We saw bike riders who found out pavement is not very forgiving and a trail runner who now prefers flat ground after a nice spill. Although she blames her boyfriend because he made her go. A father who was practicing acrobatics with his daughter and had to leave in a foot cast, and I never realized so many people slammed their fingers in car doors. Thirty seconds and the use of a cautery pen to relieve the pressure and they were on their way.  

Friday, June 29, 2012


I believe that suicide is not so much about someone wanting to kill him or herself. As it is a desperate attempt to escape their current situation in life.
Some do manage to change, while some retreat into substances or other addictions. Others will do the next closest thing to suicide and runaway cutting themselves off entirely from everything they know and their current world to try to start again somewhere new.
In this world or the next, may they find what they were looking for.

Friday, June 15, 2012

Chain of Knowledge

Finals time again and truthfully, sometimes it feels that all these classes and clinicals have come together nicely to form links in a chain of knowledge to be accessed when needed.
Then again other times, like when trying to take a test and accessing those links and chains of information. It feels like some deranged person has entered my mind with a set of bolt-cutters and annihilated those links.

Thursday, June 7, 2012

Lost in Life

Almost forgot about blogging, although probably like most people who are excited about starting a new life and journey in school you get lost. All the sudden you are inundated with work, work and work. Not going to lie, school is kicking my ass and at times doubts creep in about finishing. It is fu***** hard all the work of graduate school.   

I could just go back to travel nursing with no rent or worries. Zero bills, free insurance and travel. That sounds wonderful…. Truthfully, travel nursing has some drawbacks. Like meeting people who become distant friends as soon as you take the next assignment. Or meeting someone you really care about and then they are gone.

Current stress 100%, travel nursing stress 90% less than that. What to do?

Wednesday, April 25, 2012

Health care law explained

Being in health care, people want your opinion of the proposed health care law, and even want you to explain it. Not having read the over thousand pages of law, including all the added pork Congress members and Senators seem to add to everything. Then this short video does a good job of explaining it while remaining unbiased. Just like the bill, some will like it, some will not.   

Thursday, March 15, 2012

Military soldier kills 16

A military individual kills 16 people in Afghanistan and people are surprised. I am just surprised this does not happen more often.

We recruit hundreds of thousands of these young men and women out of their homes. We train them to be killing machines with minimal thinking or questioning involved. We tell these kids when to eat, drink, sleep and shit. Then send them 7000 miles away to live in close quarters away from their families and friends, in a country where they are mostly not welcomed.

Pretend you are not involved, but our tax dollars built this soldier/machine, so it is your fault.

This is not different from someone flying an unmanned Predator drone thousands of miles away, then hitting a button and killing innocent people at a wedding party. Or on the other hand, the President saying drop the bombs to start “Shock and Awe”, killing untold numbers.

This soldier was older, but it does not change the fact that this US machine broke down,  and since we paid for it, it is our fault and not a surprise.

Friday, March 2, 2012

Wednesday, February 22, 2012

Evil Stepmother

It is not school and working part time that has been consuming all my time. Longer than I have been in school we have also been fighting a court battle over the estate of my late father. The evil stepmother description fits this situation well. His estate that was put in trust, then disappeared and she is refusing court orders to provide an accounting and hiding facts. The longer she can drag this out and cost us money, the more she thinks we will disappear. Not going to happen, but that is how she deals with problems.

The problem is it involves 3 states and jurisdictions. I have gone to Oregon several times and tomorrow when I should be putting the final additions on a research paper for submission, and preparing for tests, instead I will be flying to Nevada for a 9am court appearance. Next week back to Oregon for another hearing. These are the frustration I would love to blog about and get out of my head, but then again I become more hesitant of who is reading this and giving details about our case.

Life pulls us all in multiple directions and tests us regularly, hopefully this is just another life lesson.

Thursday, February 16, 2012

Fork in the Road

I drive by this sign often and sometimes wonder if I should just stay in the other lane today.
Kind of like life and the decisions we make, it is not about looking back, but more about going forward.

So often I do not post now because I use Google Docs, Gmail, Blogger, Google + and have a YouTube account. Actually, Google has well over a hundred products that they have decided to tie together, which makes it easy to figure out who you are. Therefore, like many bloggers if I cannot say things because others know me, so I am debating if blogger is not the right tool to keep using.    

Sunday, February 5, 2012

The Shallows

Is it pick on teens week? This was reported on WebMD out of the University of Winnipeg, and finds that teens who text a lot tend to be more selfish. Well, they said more concerned with wealth and image, rather than morals. I'll hold me comment because I see plenty of so called adults who text more than they talk.

The Shallows by Nicholas Carr, referred to in the article. It is an interesting topic and book we discussed in-depth last year about the ever-increasing short attention span we are developing related to technology and the Internet.   

Friday, February 3, 2012

Please don't care.

A little thanks to the USPS.

A plastic bag in my mail with a crumpled ripped up letter inside. Taking the mangled letter out of the bag and flattening it I notice what it is. The bag apologized for the inconvenience the postal service had caused, along with other words of nothingness.
I do not care if the occasional letter gets mangled, especially if it another credit card ad or monthly bill. However, this piece of mail they randomly destroyed was my yearly W-2 form. Ripping the bottom out of a folded document produced four separate pieces of my State and Federal forms. Maybe I will do my taxes the old fashion way this year instead of electronically. I will mail my excessively stapled and taped up mess of paperwork to the IRS this year so they can have a laugh too.

Thursday, February 2, 2012

Just another day, week, month...

So much to do and so many irons in the fire, I get lost and some days do not know where to start. School continues to be a challenge of attrition with all the work and papers that need to be completed. Everyone I talk to in and out of my specialty group has that same deer in the headlights feeling. You talk to them and notice this pathetic little satisfaction they have knowing people besides themselves are suffering under the workload. My practitioner peers almost make me proud.

Thursday, January 12, 2012

Might not be Einstein, but...

“Don’t say you don’t have enough time. You have exactly the same number of hours per day that were given to Helen Keller, Louis Pasteur, Michelangelo, Mother Teresa, Leonardo da Vinci, Thomas Jefferson and Albert Einstein.”   - -  H Jackson Brown

I just need better time management and to prioritize.

Tuesday, January 10, 2012


Treat your family honorably and in the right way now.

Jobs, status and school: Yes, they are important, but not the most important thing as people seem to forget and jeopardize everything trying to get ahead.

In the end, it will not be your job or status that will come to care and visit you on your deathbed.
It will be your family who is there, that is if you happened to be there for them earlier.

Monday, January 9, 2012


This ran through my head as I heard just ONE of the new fully armed F35 fighters would cost $184,000,000 dollars.  

Wars that cost trillions of dollars a year to operate.

Military machines and weapons that cost billions of dollars a year to build and they sit waiting to do their jobs.

Death row inmates costing $257,000 a yr to lodge, feed, supervise and supply medical and dental care.

So much money in this world is consumed by governments with the ultimate outcome of death.

Is it any different when patients are denied coverage of new and more expensive treatments, only because health insurance and pharmaceutical companies think about money to owners, stockholders and board members first. Experimental drugs and treatment are denied daily, that is unless you have money.  Research is pretty conclusive that has shown the more affluent you are, the better your health care and access. Not just in the States, but worldwide. 

Saving our loved ones and providing the best care possible should be worth more than a plane, bomb or even one of those tires off of a 184 billion dollar plane.

Just my little rant.   

Monday, January 2, 2012

Minnesota Teacher Salaries

Teachers are an important part of our society and I have two of them in my family. If you compare their pay to an athlete making millions for playing a game or some of those Wall Street rube's making millions from others suffering, then yes they are underpaid.

However, do not feel too sorry for the profession they choose. (Minnesota teachers Pay)

Many teachers, including my family members, want it both ways.
My brother-in-law is very happy to tell you all the rewards of being a teacher. Relishing in his summers off, and never having to work a holiday. He likes that there are only 180 school days a year, and that every month has a long-weekend so he can hunt.

In casual conversation, my brother-in-law and sister acknowledge that new teachers put in some extra prep time outside of those school days. However, saying by the time you are tenured you have a set curriculum that just needs a little tweaking each year.

 On the other hand, these two are quick to pull out the poor teacher card whenever it suits them or benefits their cheapness. Here is the problem with their claims. These two middle schoolteachers who cry poor me, each make over $72,000 a year, and I had to call them out.

You see since taxpayers pay their salaries, there is a freedom of information act. Their income is posted for all to see. So be cheap, just don't make excuses.

What your teacher or public employee makes is public information.  
Here is a link for Minnesota. Just go to the education part and type in their name.