The First Game

Let's say one military is sending a signal but doesn't want the other military to intercept it. Information and security are intricately linked. You want your friends to know stuff, but not your enemies, or random (previously) disinterested third parties.

The simplest solution, at first, is to only communicate when necessary. This just makes it easier for the "enemy" to determine who is communicating and devising ways to eavesdrop on that communication.

Next, you start to communicate more and more so there's noise, but then you encrypt the signals that are important to protect them against the "other". This makes the encrypted signals more interesting.

Then people formulate new ways to make and break encryption and intercept signals ad infinitum.

Go (called Wei qi, baduk or Igo in other countries), the other game I take pretty seriously, is the perfect example of this infinite simultaneous arms race.

There's a contest, it takes place on the board. One player moves, then another.

The moves aren't secret, you can see them right away. You pick the best response out of a huge number of possible lines of play.

I'm getting ahead of myself.

The game is usually played on a 19x19 grid, although beginners do better on 9x9. One player puts a black stone on an empty intersection. Another player puts a white stone on an empty intersection. If a move results in an absence of empty intersections for a stone or group of stones, it's removed. The color that surrounds the most empty space wins. You can't repeat a board position.

That's it. The rules in a nutshell, for a game that is infinitely deeper than chess. People go to school to learn this game, just in the hopes of playing it professionally. I hear the exams are brutal.


So, the thing about this game is that it's a signal/security dilemma that you can replicate anywhere. The funny thing is that there's no way to hide your moves from the other player. They're all visible, there's no way to "fool" or "trick" your opponent from the standpoint of where the actual stones are placed. You can't move them once you place them. Each one is a decision.

The modern solution to the signal/security dilemma is to forget about encrypting or protecting or limiting or obfuscating your signal.

If you have the best signal, it shouldn't matter who's listening in. Let them listen. If you're a better strategist, you already anticipated that they might know your move.

When one entity contests another, both in this metaphor and in the game, you start out operating on one of three basic assumptions:

"This opponent is weaker, I'll win easily and don't have to worry or think too much."

"This opponent is stronger, I'll play cautiously and plan for the worst, and not expect to win."

"This opponent is near my strength, this should get interesting."

Of course, sometimes you know for sure who's the better player, sometimes you don't. You'd have to play to find out.

Supposedly there was some clinical research done in China that suggested that playing Go was good for stroke rehab, and generally strengthened reasoning and judgment skills. I'd buy that.

There are few experiences that match the gravity and seriousness of a Go match. It's more similar to a martial art than a game, requiring both training and study. There is even a concept within the game called "life and death".

Anyway, enough rambling. Check out some links about Go (link, link, link)

Here are some Go pictures.

Strike the Earth!

There are only two games that I play with any "seriousness". Since I haven't had the time or inclination to blog lately, I thought I would rant and ramble about them, mostly because I'm a little sleep-deprived. Work provides endless layers of complexity and occupies most of my thoughts, but when I have time to myself, I shift that level of focus to a "game" that's self-directed and employs that same level of complexity.

The first game I want to talk about is a computer game called Dwarf Fortress, availible for mac, PC and linux 32&64.

There are lots of different styles of games, action, adventure, strategy, role-playing, chance, etc. These are all roads well-traveled and familiar to anyone who has seen, say, a game of chess and a game of mario brothers.

Dwarf Fortress is something that people tend to classify as a management game. It's an unfinished product, still in development, but profound nonetheless. It's a simple game that creates complexity by randomly generating parts of the game. Ms. Pacman was considered an advancement over regular pacman because the "ghosts" that chase the character around the screen had an element of unpredictability thrown in to them, while the original Pacman had the ghosts traveling the same paths over and over, leaving to the player to figure out how to avoid them and clear the level.

Enough about Pacman, back to Dwarf Fortress.

At first you're presented with a list of variables involved in randomly generating the world. The degree to which different x and y axis are correlated with more or less volcanism, savagery, temperature, rainfall, etc can be fiddled with to produce unpredictable results.

After this, history is randomly generated including high levels of detail down to individual people and battles and dragon attacks or anything else you would expect to happen in some random fantasy setting.

Next, it's time to choose the area in this world you plan to play the game in. Proximity to settlements from other civilizations have to be considered for hostility and caravan access, you want to pick a site that's likely to have fresh water or magma or whatever else you think is important. Caves maybe.

Next, you select the skills, abilities, and starting equipment of seven dwarves (yes, seven dwarves, try not to laugh). You can select their degree of skill among well over 30 different jobs, everything from mining to farming to soap-making, tanning, butchering, hunting, trapping, soldiering, weaponsmithing, lye-making, siege engineering, mechanics, and that's just off the top of my head. You start off with a certain amount of money you can use to buy wood, work animals, weapons, mechanisms or anything else you can think of that will help those seven dwarves survive.

Then it's time to embark! Your Seven dwarves relocate to the site of your new fortress, and it's time to get to work.

"Work" is accomplished not by telling any individual dwarf what to do, rather you give them all permission to work some of these specific jobs, then you plan out and designate what kinds of work has to be done (mining, farming, etc). The dwarves will then go about their business, working in time to eat, sleep, play, have kids, throw tantrums, etc, all without you being able to directly control all of it.

So, you have to plan. How far away is the primary food stockpile from the kitchen? Do we have enough people available for cleaning and refuse hauling? How's that military coming along? Are the fortifications ready? do we have enough crafted stone flutes to meet the demand of the next caravan? The dwarves will mostly do what you tell them to, but they also have their own agendas and can not be 100% relied upon, even though they can be 99% relied upon.

You have to create a system that is tolerant of those occasional glitches and faults, and sometimes even the best planning only results in more complex glitches and faults...all because of the emergent properties of the complex system you are attempting to manage.

"Best Practices" come into play. "Hey, if you're going to try to pump water out of that river, let's build in a shut-off switch in case we start a flood"

Simple things like that, all products of "lessons learned".

The motto in dwarf fortress is "losing is fun!". A failure that wipes out days of hard work gives you simultaneously the satisfaction of watching a large complex construction collapse with people running around in terror or slowly starving to death, it also gives you a better idea how to prevent that from happening at the future. You have to review.

In those moments before you trash a fortress and whip up a new one, there's a flash of insight. "Well, this would have worked better if I had done this instead."

Since the game is always random, there is never a specific order of steps that can be learned to be effective, there must be analysis of the local situation and appropriate delegation of the correct jobs to the right people to survive those circumstances.

People will write, at length, beautiful novellas about individual games they've played on the Forums for this game. The level of detail simulated borders on absurd (down to the degree of injury to individual toes, dwarves paying rent, breaking the law, throwing parties and fighting each other.

In addition to the "fortress" mode of the game, there's "adventure" mode. Instead of managing a population, you control a single individual and explore the remnants of old fortresses you previously created, seeing how the events that happened in the game changed the simulated history, inspired different themes in the artwork and statuary, things like that. You can wander from town to town taking on quests or hunting jackrabbits or trying to build a huge pile of mushrooms and then set it on fire, whatever.

This gives you the opportunity to explore the game you just played in a different way...as one of the uncontrollable individuals from the management-game. Maybe a hallway and dining-room seem a lot different when you're designing one versus when you're running through it.

One final mode simply allows you to browse the simulated history for the world you've generated.

The graphical representation of this detailed simulation is entirely minimalist and old-school. The graphical representation is more like the old terminal games from the early 80's like Rogue or Nethack.

The game is displayed with simple computer characters. % is a piece of food. ^ is a trap. @ might be a guard and $ might be money. a strip of floor with a stairway at the end of it might look like .,.,,,...,,,.> or ++++++X depending on if you were looking at a dirt floor with an up-staircase or a polished stone floor with an up/down staircase at the end of it.

Despite the simplicity of the graphical interface (which is all manipulated by keyboard, with some recent limited mouse additions added in), this game runs on almost any computer, but requires a powerful computer to play deeply.

The challenges are immense, which is why I'm so astounded that this seems to be mostly the product of one primary developer. The game seems simple enough, but when you have to keep track of up to 200 dwarves, all with clothing, jobs, spouses, toes, food, money, workplaces, preferences and desires, things get a little complicated. Just figuring out where everything's GOING gets complicated. Once you throw in realistic fluid dynamics (water will seek to find it's natural level, spreading and exerting pressure, just in real-life), weather and economics, you're asking a LOT of your computer.

I've let my computer slide in the past couple years. Nursing school and starting my career caused keeping my computer hardware up-to-date to take a back-seat. Now that I'm more settled into my job, I've decided it's time to upgrade mostly so I can play dwarf fortress longer. Things start to slow down to the 10 frames-per-second range (30 or even 20 would be great) once the population of my fortress hits 90 or so. My computer was pretty beefy when I put it together, but I've let it slide for too long.

I've got half the parts delivered already for the new one, I look forward to putting it together, mostly so I can extend my discovery of this game to the next level of managing populations over 150 entities. Watching some of the video tutorials has been instructive.

Anyway, back to the game. The level of randomly-generated (what's properly called "procedurally generated", since it's not "truly" random I guess) detail is staggering, and it's actually too much to keep track of. Oh, sure, in an ideal world you'd make sure that the one dwarf assigned to fishing doesn't mind being out in the sun, but if your fisherdwarf really hates the sun, do you spend the time training a replacement or do you build them a hut to fish under? Maybe you just stick it out and risk a tantrum while you make other arrangements?

Each dwarf has it's own thoughts and preferences, and it's reflections on it's short-term and long-term experience are immediately available. Oh, this one really hates goats but loves silver, raspberries and statues made of granite.

Well, that's nice, but we all have to get along in an environment that is NOT tailored to suit your exact tastes.

You can set your dwarves up to succeed, or you can set them up to fail.

Both are fun, both are educational, but why are you playing?

Letter to the Editor

I found Rex Reed's brutal miscategorizations and stereotypes about people with Asperger's syndrome in his recent review of the movie "Adam" published on 7/28 extremely offensive.

His comments, while ignorant and hurtful to those of us who are not "neurologically typical", speak more to his difficulty coping with people who are different in a way he doesn't understand.

Even still, this kind of hateful misrepresentation of people with Asperger's presented as -entertainment- can and will be bad for your business.

Those of us who act and think differently than most may be a minority, but we struggle for our rights and dignity just as hard as any other minority. There's a lot of misunderstanding about mental illness and developmental disorders out there, and people who contribute to those misunderstandings risk alienating them from a small but unique and exceptional group of people. It wouldn't be acceptable to smear people with bipolar disorder as "untrustworthy" any more than it is acceptable than to smear people with Asperger's as unloving or incapable of putting other people's needs above their own.

Classy

My employer sent me to IV therapy training last week. I only had one overnight shift all week, and two days of Nursing 101 revisited in the staff development room of another facility across town. I kept staring at the door labelled "DSD Office" trying to figure out what it meant. Dry Sterile Dressing office? Day Staff Director? It wasn't until the second day that I figured out that it meant "Director of Staff Development". How great it must be to have one of those around! Before I left the second day I scribbled down the URL on the back of one of the DVDs, Bathing without a Battle.

This was the first "Training" I'd actually received since getting my license. The content was extremely familiar, basically recapping a couple classes in nursing school about IV access devices, very basic level fluid/electrolyte stuff, and reminders about what kinds of complications you'll run into.

The pharmacy we use puts on the classes, apparently it makes them "look good to the state" or something to put nurses who work in long-term care facilities to sit through this class before fiddling with the IV pumps.

The content was all very basic, and I was surprised to find myself sitting through a lecture covering a watered-down, cliff-notes version of content I was responsible for knowing to get licensed in the first place.

The other classmates were mostly LPNs and ranged in age from just-out-of school to grizzled veteran. They all dutifully wrote down everything the instructor said in preparation for a short multiple-choice test on the second day.

Something I noticed back in nursing school is that -not- taking notes tends to disturb or offend the speaker. While everyone else huddled over their notes, I just stared at the presenter intently. She carefully avoided eye contact, I could tell that the fact that I hadn't picked up my pencil in 5 hours was bothering her.

Thankfully there was a minimum of that "Former Acute Care Nurse talking down to us SNF/LTCF-ers", but on some level I couldn't help but find the simple presentation of the material itself to be condescending. Yes, I know the anatomy of a vein. Yes, I know how they are different from arteries. Yes, I will replace a sterile dressing that's starting to pull away at the edges instead of reinforcing it with tape. No, I will not try to pull a PICC line back out if I notice the catheter has migrated deeper into the resident.

For the first time since I really got into my job at the SNF, I found myself missing Med/Surg. I'd probably still be putting up with training there, but at least it would be training that would be picking up where nursing school left off, not rehashing the basic principals of what I got my degree in.

So anyway, now I'm "certified" by our local nursing-home mega-pharmacy to manage IV infusions, a skill I laboriously practiced as a student and then was not allowed to practice at all at my first 9 months with my employer. The infusion pumps we use are the same decades-old model I used as a nursing student at a large inner-city hospital in our state's capital. Peristaltic pumps, no volumetric pumps here. They must be pretty sturdy and reliable if people are still using them. No backprime feature, but our instructors taught us how to do everything by gravity anyway.

The funny thing is, we rarely even have infusions where I work. I've seen IV antibiotics maybe twice, IV hydration once or twice. A CAD pump once. Sitting through a class doesn't replace real-world experience, a point my clinical training made rather forcefully. Even though I've sat through this class, will I be any more competent at managing IV therapy if I don't have any residents receiving IV therapy for another six months?

Fortunately the class reminded me that I DO, in fact, know what I'm doing. Maybe better than some of the people around me.

What I've been up to

..not blogging obviously! Work and Play have kept me mightily busy. The RN job continues to be a constant source of intellectual stimulation and growth, and the summer has been filled with music. New London's summer music festival was a blast, even if I missed out on playing this time around. Watching local music around here grow and evolve makes me proud of this little city, of my friends up on stage. It also makes me miss the ones who've left. This. All of it, the amazing job, the amazing local music scene, and the amazing friends. I could see it coming, and foolishly thought we'd get there together.

Build your own custom video playlist at embedr.com

That Magic Time of Night

I first noticed it while talking to one of my mentors, a retired psych nurse. When she was the most comfortable, I was not consciously aware of the fact that she's disabled.

I have the privilege of working the 3-11 shift, and I'm lucky enough to be present for their transition into sleep, a critical factor in maintaining health and speeding recovery.

When someone is really comfortable, the fact that the person has an illness or disability just melts away in my mind. When the lights are low, the features of the face soften and you see them the way they might remember themselves. The brave warrior and the epic princess are still the brave warrior and the epic princess... but how many people can see them?

What you do to the infant, you do to the old man. What you do to the old man, you do to the infant.

The life span isn't some sequence of events. It's a life. Sometimes this is hi lighted dramatically when persons with dementia begin to step backwards through all of the developmental stages, more or less in order. At a variable rate. Until they're infants again, back to basic trust vs. mistrust, requiring what we like to call "total care".

This particular disease process is illustrative in that some particularly tricky areas to enforce arise which I'll call "dignity".

Say someone has mentally regressed back to their toddler stage of development. They may still recall war stories and be able to tell jokes and stuff but if you start contradicting them and yelling at them, you can expect some people to act more childish. This is well understood in pediatric nursing, where they have to deal with kids dropping a developmental level or two because of the psychological adaptation to hospitalization.

There's a hard and fast rule in pediatric nursing that I picked up in school, one that I haven't always seen enforced. Basically, "don't do invasive procedures while the kid's in the bed, take them to the treatment room and do the procedure so it doesn't screw up their association with their bed and sleep/rest".

This seems obvious, but the connection between all of this I think is that this is an area of improvement for adults in skilled nursing facilities. If we should strive to preserve the sacred space of the bed for children in health care facilities, why not for adults? Especially adults with cognitive decline?

No matter what bed it is, there's a chance it's the last bed you'll ever lay in. This is more obvious at some times than others.

Customer Service is an inadequate term for what I'm describing, despite it's popularity in the corporate world.

The only thing required is to be here. Now. The 8-year old ballerina is still there, see? The daring captain of industry is still at sea, see?

When people's caregivers start TREATING them like children, however, you head down a slippery slope that tends to end in behavior tracking and routine antipsychotics. When you treat people kindly and be there for them and listen to them, they'll still have their good days and bad days, but they'll present less problems for you in the course of provisioning them with care. Always. When the work of their care increases, it doesn't even seem like work.

It's your dear friend. The princess. The emperor. The fool. The hanged man. Any other series of archetypes you want to throw at it. This is what all of those symbols were tasked with describing. Some people do this, some people do that. They all get taken care of, because they're all here to be taken care of.

Whatever difficulties or concerns or hallucinations that arise are perfectly acceptable and to be expected. If a caregiver reacts to one of these difficult times with hostility, a tragic and avoidable spiral of behaviors increase our workload by 10.

Care requires a negative amount of effort. It actually makes the work at hand easier, because you're actually interested in what's going on. I first applied this oft-written about trick while I was in nursing school, and really found my instructors fascinating and wise people for 20 or so hours a week, even if I didn't like them at first. I learned more from them when I really listened to them. No notetaking, just paying attention. I eventually became fond of all of them, of course.

It's impossible to learn something from someone without becoming fond of them, I've almost always said.

A sleep doctor once told me that the bed should only be used for sleep and sex to prevent associations that interfere with sleep.

Still, once in a while, it's nice to have a conversation while lying in bed.

The Long Goodbye

A person I've become very close to is about to pass. I was surprised he didn't pass in front of me...I secretly wished he had passed on my time instead of with someone who didn't appreciate him the way I thought I did.

Everyone says their goodbyes in different ways. Sometimes they'll say their goodbyes before they go on vacation, or they'll say them with a song sung at their bedside. They might say goodbye literally, or they might not. They might say goodbye with a deep, passionate kiss of lips or morphine. Sometimes with a touch or swab-on-a-stick full of ginger ale.

I never feel obligated to perform a goodbye ritual. As I see my friend dying in front of me, the care I give is the care I gave him every day. No goodbye is necessary. Every act was the goodbye. Every encouraging word conceals a cognitive assessment. Every touch relays volumes of information about the body.

Touch is so important but so overlooked and suppressed in our culture (and, curiously, in middle-eastern cultures...both are comortable a foot-and-a-half away from eachother, while most of the earth's population is comfortable six inches away from the person they're talking to), so I take every opportunity to make those simple connections that the "professional" world overlooks..something a cherished colleague referred to as "comprehensive care", which I prefer to refer to as "holistic care"(.

I got the compliment regarding delivering comprehensive or holistic or whatever care because I dropped some music he liked in his room with one of my devices. While I was a nursing student I always imagined some nonprofit service that would provide any music electronically for free to the dying. Now I've done it.

A concept related to this in some arcane way in my mind is the concept I ran across in a journal article I read while working on a resolution for the NSNA (a beautiful and talented colleague of mine did the actual research). I don't remember the name of the article or where you can find it, but it was about a synergistic model of nursing education (maybe that was the title).

From this article I extracted an axiom of sorts. Don't treat anybody else around you worse than you'd treat a patient. Even more than that, use the same approach to teach a patient as you would to teach junior faculty. The nursing process is basically the scientific method personalized a bit, and you can apply it to anything, just as you can apply the scientific method to anything. "Assessment, Diagnosis, Planning, Implementation, Evaluation" might as well be "Characterize, Hypothesize, Deduce and Experiment". The major difference is that in the provision of routine care, you don't experiment. You implement the evidence-based practice that has been proven to optimize outcomes (if you have the resources). Nursing Research, of course, is a rich field of exciting developments in evidenced-based practice, but the in-the-trenches reality of the workplace often necessitates a certain amount of compromise.

Some measures are easy to implement, however, those "holistic" or "comprehensive" nursing measures. The most obvious way to enact these holistic or comprehensive provisions of care is to make the process pervasive in all interpersonal communication. Why would you treat a patient worse than a dear friend?

The largest obstacle or biggest challenge I see reflected in my compatriots is not being fully present. Everyone in every role requires us to be HERE AND NOW and not somewhere or sometime else. Routines make this difficult. A sense of reverence makes this easy.

At first it's difficult to meditate because it hurts. Later it's hard to meditate because you fall asleep. See?

I don't say goodbye because it's all a goodbye. To you, to them...is this me saying goodbye? I hope not. I'll always hold out hope for some amazing advancement in science that allows my consciousness to exist anywhere, indefinitely. Secretly I'm afraid it'll happen while I'm on my deathbed, and I'll be left behind, forgotten.

It's ok, you did it right. Don't worry. Here, have some of this. We'll miss you. Maybe we'll see you soon.

Nurse May Pronounce

Although pronouncing someones death is a task that's technically the responsibility of a medical doctor, it's commonly delegated to RNs and Paramedics every day. Paramedics and some nurses have the luxury of elaborate standing orders that allow them to perform this delegated task whenever appropriate, I have to open a chart and look for a physicians order. Many orders pack the entire box with text, this one is a simple, minimalist "NMP", a date, and a medical doctor's signature.

The ritual is simple. It begins when you notice that breathing has stopped. Maybe something happened to remind you to check. A sudden change in weather. A premonition.

Next, you listen to the chest cavity for a full minute and verify that the heart has stopped beating.

Then, you watch the person for two full minutes to verify that they aren't breathing. I like to place a hand on the carotid artery (located in the neck) while I'm doing this.

Corneal reflexes are next, lightly brushing the eyelids to detect an autonomic response.

Finally, a sternal rub. I've heard pinching the trapezius muscle in the shoulder is preferred, but I like the symbology of the sternal rub. I'll quietly, gently, say the person's name a couple of times as I do this.

Time speeds up now. The realization that I still have a full census (minus one) to take care of sinks in. Post-Mortum care is delegated to the nurse's aides. If they haven't done it before they might need a little bit of intraprofessional caring to get them through it. The doctor needs to be called, leaving a message with the answering service is generally sufficient. The informant needs to be informed (or woken up), and then asked when I should call the funeral director. The funeral director gets the next phone call, and the estimated time of arrival is relayed to the family. There's one more MD order to obtain, something else delegated to us: "Please release body to funeral home of family's choice". If you write it post-mortum as a telephone order no one will mind. Getting this order ahead of time might be a good idea if the idea of writing telephone orders without a doctor on the phone makes you nervous.

The family might need various things. Food and drink, emotional support, explanations as to what happens next. Children seem to be the most resilient, asking questions out of curiosity and comforting their family better than I could.

Finally, the death certificate. The final bureaucratic nail in the coffin. All the relevant details of the recently concluded life are boiled down into a simple official document. What was their name? Where/when were they born? When/where did they die? What was their most recent address? What were their parent's names? Were they married? Did they have children? What are their names? Were they in the military? What did they die of? Was an autopsy performed? Was a medical examiner contacted?

Nestled in the middle of the document is my signature. This, it feels, is the final stroke. Actually watching the process of death conclude makes me relieved that their suffering is over. Signing that document makes me miss them terribly. It's my final act of care for that person, my final duty to them is discharged. To my process-oriented mind, their life did not actually end until I record all the intimate details of their life into that document and sign it, even though I was the one responsible for verifying that they had passed.

Hugs all around, then it's back to work. The med-pass waits for no one. The thunderstorm had passed and the rest of the residents were waking up. I grabbed my MP3 player with the built-in speakers and queued up a selection of jazz and proto-blues from the 1930s-40s and stuck it on my med-cart.

Link

This is a great interview for Nurses and MDs to listen to. Title is "BBC World Service - Forum 02 May 09: Robert may, Abraham Verghese, Gillian Tett.

I haven't had much time to write lately, my laptop is busted and I rarely write at home.

NSNA Annual Convention 2009 - Day 6

Well, it had to happen eventually. The expo is all packed up and has already been replaced by what looks like a convention about purchasing cards. The newly elected NSNA board members had their transition meetings in the morning, after which the lobby gradually started to fill with departing student nurses and faculty. The three interviews I had lined up for today had all bailed or reconsidered (the trick, I've decided, is to get people to agree and record on the spot rather than scheduling something for later and giving them a chance to reconsider). One of the newly elected board members clued me in to the fact that everyone was warned right off the back to "go home and clean up your facebooks the first chance you get" after the election and "be careful about what shows up in your blog". Of course, some of the people I spoke to didn't even really get what a blog was, so out of uncertainty many people declined. Fortunately, one intrepid future nursing leader gave me a couple minutes of his time in the lobby while he was waiting for his shuttle:



All the paranoia and sniping about what shows up on people's blogs and facebooks is, I think, stupid. Did y'all hear the one about the high school cheerleading coach that got fired because it came out that in years past she posed for playboy? I've read similar things in the past like being fired for a picture of you with an alcoholic beverage in your hand turned up on someone's myspace.

This crap has got to stop, seriously. Attacking someone because of something in their past is the dirtiest of dirty tricks, behavior befitting politicians maybe but not nurses and educators.

Anyway, I'm getting off-track. Check out Trauma Queen for an example of truly excellent health care blogging. Other People's Emergencies and A Day in the Life of an Ambulance Driver are also great reads.



I rescheduled my flight to arrive back in CT earlier, so I'll be waking up at 7:30AM and coming home by way of Chicago (estimated transit time 10:30-4:20).

This place feels different without thousands of people walking around with NSNA badges and tote bags. Coming here without a constituency was a little isolating at first, and it wasn't until I spoke from the floor at a resolutions hearing that people started to come up and introduce themselves. Debating at resolutions hearings was probably the most fun I've had in the past three years of attending these vacations, so I'll have to remember to do that more next time.



Midyear is in Arizona this fall, and Annual will be in Orlando FL this time next year. I think I'll go again, even though one of the major things I took away from the experience this time around is the importance of getting involved in at least two professional organizations in addition to the NSNA (which will be mostly for fun/rejuvenation/reorientation of purpose).

The ANA is an obvious first place to start, Dr. Schmidt (the ANA-appointed consultant to the NSNA) suggested I start out by getting involved at the state level and figure out what's going on there. My next three stops, I think, are going to be the Association of Rehab Nurses, the Oncology Nursing Society and the American Holistic Nurse's Association...for starters, anyway. Those represent the first three certifications I think I can get in the next two years with my current job.

Grad-school might be a game-changer, too, though. Depending on how things work out, a school that offers CNL, Family NP and DNP as well as an RN to MSN bridge program...might not be a local school. We'll have to see who offers what.



Now that the convention is over I'm anxious to get back to my facility. I'm going to come in at change of shift the day before I'm scheduled to return to work and get updated on everything that's happened since I've been away. I'm particularly excited to apply some ideas that came to me during the Holistic Nursing focus session that weren't contained specifically in the presentation but reminded me of a wide body of knowledge and reading I had done before I had even considered going to nursing school. The Rehab Nursing presentation also deepened and fleshed out my enthusiasm for the work we do.

Another great idea that I've had during this week is regarding what direction to take this blog in. I'm currently operating under an onus not to discuss day-to-day activities at work. I still feel that writing and sharing experiences about what we all learn about patient care is important, but for the time being at least I can focus on my involvement in professional organizations, since that's one area of the nursing profession that could use a lot of improvement if we're going to combat the monolithic lobbying engine of the AMA. At one of the early focus sessions one of the speakers told us the average age of a Delegate in the ANA is around 55. Now that there's a new position on the ANA board for a recent grad, now is the perfect time for younger nurses to get involved and take on projects in things like governmental relations.

The Gaylord Opryland was, when you think about it, a perfect place to have a convention of health care workers. No smoking inside, and the layout necessitates about 2-3 miles of walking per day just to get around. Who needs the fully decked-out gym?

I'm looking forward to rolling into my hometown. I have a ukulele festival and some pleasant company to look forward to.