Nurse Practitioners… I believe too… but why the pink?

Well, it has been quite some time (again) since my last post. Another year done… I do say the last couple months have been quite busy. It ended well… I was especially happy with my last clinical placement! I worked for a number of weeks with a Nurse Practitioner on a busy acute pain service in our local hospital. It was really interesting to see the NP role in action, especially in the acute care (inpatient) setting. My preceptor was incredibly knowledgeable, and gave me great advice about expanding my nursing horizons. She really emphasized the point that I should have a number of years of experience under my belt before I attempt a masters degree though- I think this is good advice because the NP role is challenging and carries with it great responsibility.

On a side note, I saw this poster at a local bus shelter- I am intrigued by RNAO’s choice to utilize what some would (stereotypically) deem to be feminine colours. Perhaps more gender neutral colours would yield a more subtle invitation for both men and women to join the profession?!

I know that nursing is a predominately female profession, and that saying these are “female only” colours only serves to reinforce/illustrate gender stereotypes…… but isn’t the idea to make nursing more appealing to everyone?

Maybe it’s just me… and this is a non-issue to others.. I would love to see some comments!

Introducing the “Just Clean Your Sink” campaign

As many in Ontario know, there is a huge push to increase hand hygiene compliance in amongst health-care workers to curb health care associated infections. What happens when the sinks we clean our hands in are actually the culprit? A recent report suggests that the sinks in a Toronto surgical intensive care unit actually harboured Pseudomonas aeruginosa, in the form of “biofilm”. Even more interesting was the finding that water splashing directly into the drain actually propelled these bacteria up to one one metre.

Read the CBC article here

Some important lessons I learned from this:

A. Probably not the best to use a patient sink to wash hands- Instead, (unless hands are visibly soiled) use the hand sanitizer immediately, and then find a designated hand wash sink outside of the patients environment. If you have to use a patient sink- perhaps it would be best to use a alcohol based hand sanitizer afterwards (ask infection control)

B. Use that alcohol sanitizer at point of care- before you begin care! You can pick something up in the short distance from the door to the bed.

C. Don’t prepare dressings on the countertop next to a sink and if gloves are sitting next to a sink… they are likely contaminated

D. Think about what gets dumped down a patient sink….. urinals (patients may not see a problem with this) and basins come to mind. Yuk!

Further Reading:

• Outbreak of Multidrug-Resistant Pseudomonas aeruginosa Colonization and Infection Secondary to Imperfect Intensive Care Unit Room Design (Abstract)
• Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review.
• Hand Hygiene Fact Sheet for Health Care settings (PIDAC)

Nurse practitioner or MD?

I am now entering my third year of nursing (3 of 4 leading to a BScN); I have given considerable thought to applying to medical school but am reluctant for a number of reasons. First, the costs related to attending medical school are enormous! Tuition, books, time out of the workforce, social isolation (studying)… it all adds up. I do feel however that in the end, a career in medicine is worth the rewards of both financial compensation and personal autonomy.

Another option I have been considering is the nurse practitioner route. Before anyone says it, I realize that a nurse practitioner is NOT a doctor… and that’s not what this particular post is about anyways! With that said, my interest in the nurse practitioner field has grown and looks to be quite lucrative for any budding nursing student.

I’ll highlight more information as I start to dive into the decision process, but for now.. some quick definitions:

What is a Nurse Practitioner?

According to the College of Nurses in Ontario (Albeit, definitions may be a little different region to region) a Nurse Practitioner is,

“RN(EC)s, also known as Nurse Practitioners (NPs), are Registered Nurses who have met the advanced requirements necessary to enter the Extended Class. They provide comprehensive nursing services including health promotion, disease and injury prevention, treatment, cure, rehabilitation and support. RN(EC)s have advanced knowledge and decision-making skills, and work in a variety of settings such as community health centres, clinics,public health units, long-term care facilities, and hospital in-patient and outpatient units.”

In addition, Nurse Practitioners are able to:

• Communicate a diagnosis to a client or the client’s representative;

• Prescribe a drug from the approved list of drugs and drug categories;

• Administer by injection or inhalation a drug the RN(EC) prescribes; and

• Order the application of a form of energy such as diagnostic ultrasound.

Also, RN(EC)s can order certain X-rays, laboratory and diagnostic tests (Prescribed list)

In special circumstances, RN(EC)s can complete a Medical Certificate of Death.

PLEASE READ THE CNO Fact Sheet on RN(EC)s and Nurse Practitioners here.

What are the schooling requirements?

According to the Nurse Practitioners’ Association of Ontario the current requirements for entry into a Masters program for Nurse Practitioner is:

• Current registration with the College of Nurses as an RN
• Minimum overall average in Nursing (BScN) of 70%
• Equivalent of 2 years practice experience as an RN within the last 5 years.

There seems to be a fair degree of disagreement and animosity between medicine and nursing over the role and scope of a Nurse Practitioner:

National Review of Medicine

Nurse Practitioners Part of the Solution (Letters to Kingston Whig Standard)

Family Health Teams on Hold (Editorial in Toronto Sun)

Nurse-led clinic column misleading (Letters to Kingston Whig Standard)

Understanding the role of nurse practitioner (2005 Paper by Canadian Medical Association)

More to come!

A snapshot of Ontario’s (RN) nursing workforce

I thought it may be interesting to pass along some information curated by the Canadian Institute for Health Information; From a report entitled Regulated Nurses: Trends, 2003 to 2007 these are some of the interesting Ontario Registered Nurse (RN) numbers:

Only 4.5% of the entire Ontario RN workforce is male (Not surprised… only 3 guys in my class of 50)

The average age is 45.9 years (Hmm… I don’t want to say that’s old but…)

63.1% Ontarian RNs enjoy a full time position (Better than I expected, but still…)

63.4% Work in hospital (Probably what I’ll end up doing… but I think these #’s will change with the shift to more home care)

88.3% provide direct care (Likely related to the high number of hospital positions as staff nurses)

88.2% are employed by a single employer (I’d rather have one job thank you!)

68.2% are diploma prepared; 28.9% Baccalaureate; and 2.8% Masters/Doctoral (Very interesting… I wonder what the increased education requirements will do for this profession… I think good things!)

91.3% are Canadian trained (And proud of it!)

Click the link above for more information… it’s interesting.

Found an amazing ICU resource for RNs

I was browsing over at allnurses.com, a site I visit regularly, and came across a thread about useful links to help ICU and critical care nurses learn the complexities of these special environments.

What caught my eye was a website called icufaqs.org; this website is great! It outlines a variety of topics from peripheral IVs to reading EKGs. Please check out this site! The material is free to download, and you can purchase a polished copy of the content in book format if you so desire…

These topics are presented really well!

Enjoy.

Ontario decides to delay hiring of 9,000 nurses

Hmm, last year I was pretty excited to hear about the new nursing graduate guarantee. With all the economic turmoil, I figure that I chose a  relatively recession proof profession. Yup, nurses are always needed and even more so because we are already experiencing  a critical nursing shortage. Surely hospitals won’t scale back on the hiring of new nurses because we are already in a bind?!

Nope, CBC had an article a month or so ago:

Nursing groups decry Ontario decision to delay 9,000 hirings

The Ontario government decided to,  in light of a looming $500 million deficit, stretch the hiring of 9,000 nurses over 5 years instead of 4; I might add that this is at a projected savings of $50 million this year.

Hmm, I said again… maybe all of those RNs that are set to retire (who are patiently waiting for reinforcements and workload reductions) may bail earlier than expected. I also wonder if this may drive some new nursing graduates to the good ol’ US of A?!

Read the Registered Nurses’ Associate of Ontario response here

Now this was bothering me a bit, but I remain optimistic because there is a plethora of nursing work out there- I am bound to find something!

Well, check this out… in Ontario, hospitals are now required to balance their budgets or face cutbacks/removal of block payments from LHINs (I don’t think that this is totally unreasonable because we need to have some accountability, and drive to improve efficiency and cost effectiveness) but look at this:

• Expect more patient problems (Letters)
• Ensuring the right care provider (Response)
• Job cuts loom at KGH

What does this mean?

More PSW and RPN positions in acute care (cheaper on the payroll)  and less RNs? I wonder how much that will cost in the long run?! I guess we’ll have to wait and see.

Maggots for wound care

So I was surfing around the internet the other day and I came across something particularly interesting- the use of maggots in wound care. Yup, you heard correctly, maggots! For the squeamish, this seems almost unbelievable, but these little critters are actually in wide spread use- and enhancing patient care.

Wikipedia defines maggot wound care this way:

“Maggot therapy (also known as maggot debridement therapy (MDT), larval therapy, larva therapy, larvae therapy, biodebridement or biosurgery) is a type of biotherapy involving the intentional introduction by a health care practitioner of live, disinfected maggots (fly larvae) raised in special facilities into the non-healing skin and soft tissue wound(s) of a human or other animal for the purposes of selectively cleaning out only the necrotic tissue within a wound (debridement), disinfection, and promotion of wound healing.”

Wikipedia further states that maggot therapy was a relatively common procedure before the advent of antibiotics. Its use was quite widespread by the Maya and Aboriginal tribes in Australia. Furthermore, maggots were also a key player in reducing battlefield mortality during military campaigns as far back as the Napoleonic era.

Modern use dates back to 1929, when Dr. William S. Baer, an orthopedic surgeon used these little critters to treat 21 patients with intractable chronic osteomyelitis The development of antibiotic resistant bacteria served to reintroduce the idea. In 1989 Dr. Ronald Sherman, a physician at UC-Irvine reintroduced maggot therapy by setting up fly breeding facilities that would serve to treat wounds of spinal cord patients whose ulcers had failed to heal after two or more courses of conventional wound care (Read more Wikipedia article)

Take a look at this video (Warning- shows a nasty ulcer and maggot debridement- not for the squeamish)

Links:

• Nurse receives award for maggot therapy in wound care

Please consider these further readings:

• MAGGOT DEBRIDEMENT THERAPY IN THE TREATMENT OF NONHEALING CHRONIC WOUNDS

  A research project by Dodie L. Martin submitted to Witchita State University

• HEALING WOUNDS WITH MAGGOTS: Maggots Can Be Useful for Treating Deep Wounds

  A WebMD Health News article

• Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy.

  Article by Sherman RA: Diabetes Care, 2003 Feb; 26(2): 446-51 (PubMed)

• MAGGOT THERAPY: The Role of Maggots in Modern Wound Therapy (PDF Presentation)

  Bio-surgical Research Unit: NHS Copyright 2001.

So, if you have a festering wound… ask your doctor or nurse practitioner about it today!

Back on track

With the new school year just around the corner I am taking this opportunity to reflect on what an amazing summer I have had. As some may already know, I got married this summer- I also had the opportunity to work on a local medical/surgical floor and with the Canadian Red Cross. For the last couple of weeks I have also taken some time to start a new internet project called BPNURSE.com. While I am saddened that I didn’t have the funds, or the initiative to continue the iamastudentnurse project (not this blog- but a sister site for those who are not familiar) – I am excited to say that I think this new internet project looks more promising.

Why another site?

At the Canadian Red Cross I was responsible for developing teaching materials for unregulated care providers in the community. Basically, I was charged with creating materials that would teach some rationale for some of the nursing skills many support workers were already utilizing in the community. It was an interesting project- however I discovered that it was difficult to find best practice information that I could freely use in my presentations. Much of the literature was wrapped up in huge databases that the Red Cross could not afford to subscribe to; I ended up using a textbook for most of the information.

While browsing ALLNURSES.com, it dawned on me that there are many seasoned nurses out there that are more than willing to share their wealth of knowledge. So with that in mind, I created the BPNURSE project. The project will be setup like a wiki where nurses can come together and share practice information. Users will have an opportunity to author content and “critique” each other in the discussion forum. It’s a work in progress, but take a look at www.bpnurse.com- and if you are a seasoned nurse that loves to share information- apply for an account.

I’ll be chronicling my success (I’m speaking positive) with the site here on my blog- as well as all my other day to day experiences in nursing school.

Year three here I come! J

It’s all over

School has finally ended!!

Amy and I were driving to the college to confirm my school year income for the student loan lady today when she commented that I had “purplish bags under my eyes”… I blame school- as it’s been probably the busiest couple of weeks I have experienced to date. I wrote five exams this semester and they seemed exponentially more difficult than the last time around. It seemed that many of the questions had a “pick the most correct” answer feel to them which is more challenging when trying to cover a ton of content. With that said, I think the exams went fairly well and I will be taking another swing at things next year in my fifth semester of this stuff. Amy and I are putting the final touches on the marriage plans… hard to believe that it’s only 22 days away. I’m pretty excited! We also went down to IKEA during exam time to purchase a whole bunch of furniture. We got an EKTORP couch, TV bench, side tables, and a kitchen table for our new apartment. I move in on the first of May; Amy moves in 17 days later. It will be nice to have a place of my own as I have been living at a flop house with a bunch of my church buddies… I’ll miss the guys as much as Amy will miss her family… Anyways, onwards and upwards I always say; I am definitely feeling quite blessed right now and plan to get caught up on some needed rest. In the pandemonium of exam time my domain expired, so I’ll be working sometime on that project- but I think I’ll take some time off from nursing web stuff to enjoy my wedding first. I also will be starting a new job at the end of this month as a PCA (basically as nurses’ aide) in a local acute care hospital. I am excited about this because it’s on a medical/surgical floor that I already had a rotation on—so it shouldn’t be too unfamiliar! Pay is pretty good too!

Thought I’d give you all an update, and I plan to do some critical care modules/learning I’ve found around the internet… I’ll post some if it’s worth taking a look at.

The cost of risky behaviour

Today I debated that people who engage in risky behaviour should pay more for health care. Here in Canada we pride ourselves on equal access to quality health care regardless of socioeconomic status so you can imagine the uproar we caused when my debate group proposed that people who smoke, drink, or engage in illegal drug use should pay more for their health care. Okay, before you jump down my throat about being “judgemental” about other peoples behaviour, I should tell you that this was an assigned topic. But here are some points of interest. Are you fellow Ontarians aware that only 57% of you are paying more for health care already? Yup, we discovered that with the Ontario Health Premium the 57% of Ontarians who make more than $20,000 a year have to pay up to $900 a year extra for health care. We thought this sounded a little unfair- especially because we pride ourselves on a system of equality and fairness. Maybe its fair that the more affluent in society take care of those who are less privileged… just a thought   

On a side note…. we also discovered that in 2002 the Canadian tax payer shouldered the burden of approximately $39.8 billion for health costs related to substance abuse (tobacco, alcohol and illegal drugs mind you) Food for thought eh!

 Anyways.. here’s a link to that last study I mentioned…..