Don’t reuse needles!

Top Ipod touch/Iphone apps for Nursing Students

Here is a list of 15 apps… most of them free (or really cheap) that I find the most useful on clinical rotations. If anyone has found better… leave a note in the comments.

1. Medscape: This is my favourite medical application- it has a VERY comprehensive drug database providing dosing, pharmacological and adverse reaction data- it also has a comprehensive disease/conditions/procedures database that can be downloaded for offline viewing— FREE!! Medscape App

2. Epocrates Rx: Nice app with a number of free features; offers a comprehensive drug database as well as data tables (ACLS etc) and resource section all free. Other useful features require a paid subscription.  Epocrates Rx

3. Instant ECG: Provides ECG basics; rhythm examples (movies) and exams. Very useful!  InstantECG.org

4. ECG Guide: More of the same, great clean interface. QxMD software

5. Informed Critical Care & Nurses: These guides are great… around $10 each… and are quite comprehensive- provides lab values, ACLS guidelines and assessment considerations etc. Informed Guides

6. Medical Lab Tests: Great information in here… look up common reference values plus get the indications for common lab tests. West Samoa Consult

7. Acid Plus: An awesome acid-base calculator- graphical! Free Radical Software

8. Lytes: From the makers of Acid Plus… a electrolyte program… same link as above. Free Radical Software.

9. MedCALC: A free medical calculator- you may find the dose calculator and iv management calculations particularly useful. MedCALC app

10. ABG: An ABG calculator… although not as nice as Acid plus. ABG App

11. Auscultation: Auscultation program for learning common cardiac, pulmonary and abdominal sounds—also has an exam section to test your knowledge. Auscultation app

12. SizeMe Lite: A set of callipers to measure stuff (great for wound size measurement—don’t stick your Ipod in a wound though…) SizeMe Lite App

13. 3D Brain: An educational application about the brain. 3d Brain App

14. Convert Units: Self explanatory. Convert Units App.

15. Groupy: This app allows you to organize your contacts by group– I use it to store all my hospital and health teaching related contact info in one group… so I don’t have to scroll through personal stuff all the time. Group App

My own sense of empowerment

The concept of empowerment has been articulated in many different ways in the professional literature. Some describe empowerment as the “strengthening of an individual’s belief in his or her sense of effectiveness” (Conger, 1989 as cited in Leyshon, 2002 p. 467). Others see empowerment as a “liberating sense of one’s own strengths, competence, creativity and freedom of action…the power to act and grow” (Robinson, 1994, as cited in Leyshon, 2002, p. 467). Despite many conceptual perspectives, empowerment is indeed a process that can occur for nursing students during the consolidation experience. I use the word can, because I believe it to be largely dependent on the attitudes, freedoms and trust allotted to the student by the clinical preceptor. Furthermore, it is possible that preceptor behaviours can be disempowering for the student if they are unwilling to relinquish control and allow the student to make clinical decisions independently and experience the trial and error of learning (within reasonable, and safe limits).

A quick literature review of the concept yielded an interesting study conducted by Chandler (1992). While old, I feel that it is particularly insightful and descriptive of empowering situations occurring in acute care nursing. Chandler (1992) determined that acute care nurses view patient care encounters that utilize nursing skill and judgment and alter patient outcomes (behaviour and health) as the most empowering. Nurses also cited interactions with physicians, particularly instances where nursing input is valued and added to the plan of care, as significantly empowering (Chandler, 1992).

In my own experience, I can confidently say that this final rotation has been an empowering experience for me. I have had numerous opportunities to believe, act upon, and expand my own sense of effectiveness as a future nurse. In fact, the last few weeks have elicited powerful feelings of professional growth and liberation from the confines of being recognized as a student only. My preceptor believes in me, and empowers me to make decisions independently for my patients…as a nurse. Her statement, “I would be doing you no favours if I made all the decisions and instructed you on how to provide the care… you need to make these decisions on your own and act upon the knowledge you already have” exemplifies her philosophy of empowerment.

Interestingly, Beecroft, Dorey and Wenten (2008) argue, when empowerment increases self efficacy, then organizational commitment, autonomy, job satisfaction and perceptions of participative management result. Perhaps my preceptor realizes this, and is trying to create an environment for which I will want to work and stay.

References:

Beecroft, P., Dorey, F., & Wenten, M. (2008). Turnover intention in new graduate nurses: a multivariate analysis. Journal of Advanced Nursing, 62 (1), 41-52.

Chander, G. E. (1992). The source and process of empowerment. Nursing Administration Quaterly, 16 (3), 65-71.

Leyshon, S. (2002). Empowering practitioners: an unrealistic expectation of nurse education? Journal of Advanced Nursing, 40 (4), 466-474.

Resolution of health human resources crunch (in north) requires macro approach

The Canadian Women’s Health Network (2008) suggests that, “a global crisis in health and human resources have once again brought attention to the lack of nurses and other healthcare providers who are willing to work in rural and remote settings across Canada” (as cited in McIntyre & McDonald, 2010, p. 26).

Resolution of this problem will be a difficult task, requiring a macro approach incorporating both the efforts of nurses, clients and the political entities that represent them. Nurses have a unique opportunity to facilitate positive change by advocating for healthy public policy that is holistic and in consideration of the “social, cultural, and historical influences…economic and political forces… that shape the Canadian health services and systems” (McIntyre, Thomlinson & McDonald, 2006, p. 30).

Canada prides itself in its ability to offer health care that is universally accessible to all Canadians (McIntyre, Thomlinson & McDonald, 2006); unfortunately, for those living in the rural regions of this country a disparity between access to and the provision of certain health services exists. This gap is so pronounced that those living in these regions often have poorer health outcomes than their urban counterparts (Ministerial Advisory Council on Rural Health, 2002 as cited in McIntyre & McDonald, 2010).

These issues and the already looming shortage of nurses across Canada (Canadian Nurses Association, 2009) make the illumination of barriers to nursing practice in these regions an important task.

Barriers

Tackling and addressing these issues of improved access and health care delivery from a health human resources perspective requires pause to consider what makes the rural environment particularly challenging for many health practitioners. Much like trying to define “where rural is” (Pitblado, 2005), pinpointing the day to day job characteristics of rural health care workers, particularly nurses, often eludes a solitary definition.  Rural nurses “work in a variety of environments and their nursing work reflects this diversity” (McIntyre & McDonald, 2010, p. 18). In the text, McIntyre & McDonald (2010) present a comprehensive overview of the challenges faced by rural nurses, some of the more poignant challenges facing these professionals include: (1) working in situations with minimal support, few resources and as the sole health care provider; (2) working in a variety of professional and non-professional roles, often which are not nursing related and (3) working in a discipline that is mainly governed by policy and decision making that is urban centric, and neglectful of the practice employed (generalist vs. Specialist) by rural nurses.

Solutions

There are no easy solutions for solving the challenges faced by rural nurses and improving the overall diminished access to care experienced by rural Canadians. Recruitment of nurses to the rural setting remains a challenge (Van Hofwegen, Kirkham & Harwood, 2005) however, amidst these challenges, many nurses testify great fulfillment from the diversity of practice and professional autonomy they experience as professionals there (McIntyre & McDonald, 2010; Van Hofwegen, Kirkham & Harwood, 2005). These testimonies may be the greatest asset for future recruitment campaigns.

Van Hofwegen, Kirkham & Harwood (2005) further contend that additional value and enticement is found in providing undergraduate nursing students with learning experiences in a rural environment. The value of these experiences is further supported by the findings of Bushy & Leipert (2005) that “nurses educated in rural communities or small towns are likely to stay in those communities” (as cited in McIntyre & McDonald, 2010, p. 26).

Finally, continuing education in the rural nursing community must be a high priority. Rural nurses have consistently indicated that they place a high value on “building and maintaining competency in clinical skills” (Hegney et al., 2002b, as cited in McIntyre & McDonald, 2010, p. 26) Barriers to providing these opportunities such as staff shortages, administrative support and budgetary constraints must be addressed at a policy level (McIntyre & McDonald, 2010).

References:

Canadian Nurses Association. (2009). The Nursing Shortage- The Nursing Workforce. Retrieved November 15, 2009, from Canadian Nurses Association: http://www.cna-aiic.ca/CNA/issues/hhr/default_e.aspx

McIntyre, M., & McDonald, C. (2010). Realities of Canadian nursing: Professional, practice and power issues (3rd ed.). Philadelphia: Lippincott Williams & Wilkins.

McIntyre, M., Thomlinson, E., & McDonald, C. (2006). Realities of Canadian Nursing: Professional, Practice, and Power Issues (2nd ed.). Philadelphi: Lippincott Williams & Wilkins.

Pitblado, J. R. (2005). So,What Do We Mean by “Rural,”“Remote,” and “Northern”? Canadian Journal of Nursing Research, 37 (1), 163–168.

Van Hofwegen, L., Kirkham, S., & Harwood, C. (2005). The strength of rural nursing: implications for undergraduate nursing education. International Journal of Nursing Education Scholarship, 2 (1), 1-13.

Organization for new graduate nurses

Well, I am on the home stretch now; 3 months from now I will be a BScN graduate. I am loving my final placement on an acute cardiothoracic surgical unit. It certainly has been challenging, and my organization skills have been stretched to the max (in a good way). 12 hour day/night shifts are a world apart from the 8 hour shifts we experienced previously- especially because I now care for a full patient load. The increased workload has forced me to reconsider how I organize my day. I created an organizational sheet, which I have found to be helpful. I thought I would share it here… and feel free to modify as you see fit. It’s still a work in progress… so if you have suggestions… or would like to share one with me… leave a comment.

Download here.

Happy nursing.

Canada’s Fight and H1N1

The Public Health Agency has developed a website to disseminate information about the pandemic H1N1 flu virus in Canada. Unfortunately, the general consensus among many seems to be that the pandemic “swine flu” is over blown. Regardless of where you stand on the issue, information is key, and all of us can take basic steps to slow the spread of infection.

Furthermore, it will be interesting to see how this pandemic flu evolves during flu season… and even more interesting to be the guinea pigs for the new H1N1 flu vaccine.

The Who recommends that Health care providers be vaccinated first

This statement from the Who also concerns me:

“Since new technologies are involved in the production of some pandemic vaccines, which have not yet been extensively evaluated for their safety in certain population groups, it is very important to implement post-marketing surveillance of the highest possible quality. In addition, rapid sharing of the results of immunogenicity and post-marketing safety and effectiveness studies among the international community will be essential for allowing countries to make necessary adjustments to their vaccination policies.”

Nursing students, chime out about how you feel about all of this!

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.