I'm in a hotel room in Grapevine, TX. I originally intended to blog every day about my experiences here, but things have been so busy I literally haven't had time to sit down and post! There's so much to write about I'll probably have to continue to remember it all over the next week or so. I lost my camera on the way here, it really was an excellent camera, one of my prized possessions. My plan of making a sort of video documentary of vignettes was smashed before I even got on the plane. Not having a camera on this trip pained me deeply. I took some pictures with my new PDA phone. I haven't examined them, but I can tell I won't be very happy with the quality (2-megapixel just don't cut it nowadays)

The bits that are hardest for my memory to hold on to I'll address first.

One of the highlights of this trip for me has been spending time with our new SNA faculty adviser, one of my previous clinical instructors, an MSN with 20+ years of critical care experience along with an education in management. Our previous advisor's taken a new job away from school, and our new advisor's first activity with us has been this trip. We discussed many interesting things that I want to record here so I don't forget about them.

One of the big problems facing nursing right now, as she sees it, is the folding in of administrative management duties into nursing. The Charge Nurse used to have a much different function than they do today. In the past, charge nurses and head nurses had a role that was more closely related to clinical leadership, supporting the nurses on the unit instead of working out schedules and sick-days. "No one is in charge anymore", is what she said. Something the conversation made me think of is that these administrative roles like "assistant nurse manager" and the like could be transplanted to the hierarchy that includes the Health Unit Coordinators (specialized, hard-core secretary types that any unit would explode without), freeing up the nurses to use their managerial powers for clinical leadership and patient care. She was trained in a diploma program, where towards the end she was passing meds and doing assessments and treatments for 20+ patients, with the support of the clinical leadership of the other nurses at her facility.

She told me that I could be really valuable to the profession as a Nurse Informaticist, partially because I have a computer science engineering background and am generally handy with computers. I replied that I'd been in the software development / system administration game before, and it's not really work that I enjoy. I think I can use my knowledge of computers to advocate for sensible technology use no matter what kind of nurse I am. I want my work to be satisfying and inspiring, and tending to the bit-buckets is not that (to me, anyway).

One of the resolutions that we're voting on tomorrow (I mean...today!) is in support of lobbying for the creation of an Office of the National Nurse. The presidents of the American nurses association AND the national league for nursing showed up at the informal resolution hearings to speak against it. I never saw so many camera flashes go off at one of these house of delegates meetings. They only had three minutes to speak, so I asked our adviser to clarify for me what their problem with this was. Apparently, instituting an office of the national nurse would -replace- all of the federal nurse offices that do a lot of good, targeted work with one figurehead who would have less influence and power. The supporters of the resolution think it's important to have a "visible" figurehead to advocate for nursing nationally, but I think most of us would agree that it's more important to get things done. After the presidents of the ANA and NLN spoke, a number of students were furious that non-NSNA members were participating in the debate, and calling points of order to follow the rules for business meetings that limited the speakers to NSNA members. What they failed to realize (because they were ignorant of the RULES) was that these hearings were informal, and although they shared the parliamentary format they were not, in fact, business meetings. People got angry and argued against their presence there because they didn't understand that their advisory roles in our organization are important so they can do exactly what they did. Clue the people who need it in on the "big picture" of how things work in the "real world". I didn't get a chance to meet them, maybe I will tomorrow.

Getting things done is the thing, isn't it?

The resolution I co-authored passed (yay!), in support of the inclusion of the preceptor model in nursing education for RN students. I think the main reason it passed was the positive experiences students in other states have had with preceptorship programs (of course, our research, writing, presentation and campaigning had a lot to do with it as well). Not all students did have positive experiences, but the actual implementation is something that's left up to each state anyway, one important lesson I took away from the process this time around is that the more specific your proposed interventions are in your "resolved" statements, the more things people will have to nitpick and debate with you over. Our adviser pointed out that the "whys and wherefores" are things for the faculty and hospital to figure out, as students we're advocating for advances in nursing education, let the nurse educators themselves figure out the best way to actually do it!

One line was removed from our resolution by a motion from the floor, the line that resolved to work with our constituents to include preceptorship for student RNs in the nursing practice acts of each state. Apparently the big problem with this is that the American Medical Association is trying to get their paws into our practice acts to reduce the independence of Nurse Practitioners. No-effing-bueno! I was incensed when I heard this. How can the AMA hold OUR practice acts hostage? Because they have the cash. Since they have the cash, they can hire the lobbyists with the connections to get the language they want put in the acts. How come they have the cash and we don't? Well, Nurses all belong to professional organizations that are specific to their specialty. Emergency nursing, nephrology nursing, wound-and-ostomy-care nursing, you name it. These are all great professional organizations that do important things, but as a result of all of this diffusion, a small percentage of nurses are dues paying members of one of the FOUR (!) national professional organizations for Nurses in general. Since there are so few dues paying members, and they're spread out between numerous organizations, we can't hire the lobbyists to compete with the AMA. My question for our adviser then was that why can't we, as nurse advocates, lobby directly for our causes? One of the more politically savvy students pointed out that it's illegal to lobby for your own organization. I snickered and supposed aloud that it was the lobbyists themselves who created that situation for their own benefit. The question in my mind, though, is if this diffuse nature of the nursing professional organizations can be used to our advantage, by having nurses from one professional organization lobby on behalf of another whose views they share. Where the lobbyists still have the edge, unfortunately, seems to be in "having connections". What a crappy system. So, nurses are paranoid about opening their nursing practice acts because of the kinds of language wealthier and better organized professional organizations of non-nurses could and would ram down our throats for the sake of their wallets instead of the patients. For shame, docs, for shame.

Our current president (until tomorrow when we vote in a new one..or rather later when they actually assume office) told us a story at the opening meeting of the house of delegates. She had to correct a medical interne's understanding of a physiological process. He received the tutoring gratefully and said "wow, you should really go to medical school!". She shot back with "you really should NOT go to nursing school". Hah! I like her, she's sassy.

During the candidates forum, she asked one of the presidential candidates to explain what his fiduciary responsibilities would be as the NSNA president. He asked for a definition of "fiduciary". She shot back with "I just asked YOU for the definition". Classic.

I spent a lot of my time helping out delegates and authors attached to resolutions that I wanted to see pass but didn't. One woman spoke eloquently and passionately about the need to reduce noise levels in the hospital, citing some alarming statistics about the decibel levels at night and during the day in med/surg and ICU environments. Having some acoustical engineering background, I felt compelled to jump into the debate. Her problem was that she included a number of specific ideas in the resolved statements for how to decrease noise. This wasn't necessary, this is something industrial psychologists and biomedical engineers need to hash out, we just need to tell them "hey, this is a problem, these people are dying from lack of sleep, do something about it!". I gave her some advice on how to rewrite the resolution, and also discovered she didn't understand much about parliamentary procedure, so I explained to her how she could get someone who voted against it to file a motion to reconsider at the next business meeting, and even hooked her up with delegates who voted against it so she could show them the revised language. I hope she makes it. I'm not a big fan of florence nightingale (for many years she was a strong proponent of excluding men from the nursing profession, and I trace a lot of the tradition-as-sickness we experience as a profession straight back to her and people who overvalue tradition), but the quote she included about how unnecessary noise is the cruelest failure of Care for the sick and the well, or something like that, was powerful and appropriate.

I even got a chance to utilize one of the more entertaining motions, rising to a point of order (calling attention to a breach of the rules). You can interrupt the speaker by doing this, just like you can with calling for a division (forcing a counted vote instead of a voice-vote), which I did for our resolution last year. My point of order was that one of the other students (who clearly didn't read or understand our resolution, because she got -all- of the facts wrong and was clearly only speaking on impulse and emotion) was debating a WHEREAS statement, something that is explicitly forbidden, since whereas statements are facts that have been supported by our research, reviewed by the resolutions committee and accepted. Many other debaters debated WHEREAS statements during these proceedings, and I'm kicking myself for not calling attention to it earlier. I think the president and resolution chair dropped the ball in a big way by not interrupting speakers when they did this. I actually did this by mistake last year and was interrupted by the previous president. A learning experience to be sure!

As usual, people came up to me to thank me and compliment me on my speaking. I don't think I spoke as well this time around as I did last year. I think the resolutions I debated last year were things that I was better prepared to speak to extemporaneously, I was just...."off" this time around. Still, I accomplished my goals and impressed a few people along the way just the same. Lots of the people I talked to thought I was a legislation education official or something like that. "No, just a school president", I'd say. Another student voiced something I would only think to myself after one of these incidents: "No, just someone who read the business book".

Seriously, people. There are rules. They tell you them. They print them out and give them to you, and expect you to read them. So read them! One of the delegates from a large constituency came up to me after my initial presentation and asked me for information that we included with our research to support the whereas statements. When I directed him to inspect the research that's been available in the resolutions office this -whole time-, he actually said to me "I don't -want- to read the research, just tell me". He admonished me by saying I should find it very difficult to get my resolution passed. Turns out, it was easy as pie. Much less of a nailbiter than our last resolution about education articulation programs.

I made a lot of friends and exchanged a lot of contact info, mostly with people who feel like I have "got it together" (how poorly they know me!) and would be helpful to them in writing and speaking on their behalf. I visited some of the caucuses, where state constituencies of delegates get together in conference rooms to go over resolutions and invite candidates to come speak in a smaller setting. This is where a lot of the politicking went on, which was interesting to see but also somewhat repulsive. I really enjoyed hanging out with the State officers from Arizona, I tagged along with them for a caucus and some late-night restaurant adventures. Good times were had and very dear friends were made. I must remember to visit Arizona sometime. Seriously. I will miss them.

What the caucuses pointed out to me was that my state constituency of delegates is relatively disorganized and ineffectual as a group, even though individuals (namely me), can still make some waves. Having an organized group in this process, though, carries a lot of advantages when getting deeper into the way things actually get done in the organization. We have some ideas as to how to address this. Interesting ideas.

Pictures to follow, stay tuned!

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