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.



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.


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.



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.

NSNA Annual Convention 2009 - Day 5

Today was the last day of the convention proper, there were two more rounds of focus sessions and the closing meetings of the house of delegates. I had kind of been slacking on attending the house of delegates meetings, which I felt somewhat guilty about, but hey, I was here this year so I could go to the focus sessions and NOT get hung up in the house of delegates like I was the past two years.

Last night I got locked out of my hotel room because the magnetic ID badge from work that I keep in my wallet wiped out my room key. Whoops! A few trips down to the lobby later and I was in bed by about 4AM. As a result, I missed the 10AM house of delegates meeting that I promised Namrata (Delegate from NJ) that I would attend to help her defend her resolution on limiting noise levels in health care environments. I busted my butt trying to keep the resolution afloat last year, and I would have been crushed if it failed two years in a row. Thankfully it passed. The full text of all of the resolutions that passed can be found at NSNA's website (2009 resolutions aren't up yet at the time of this entry).

I slept through or skipped out on the majority of the resolution hearings but I did get an opportunity to speak from the floor, probably my favorite experience at any of these conventions. The resolution to support using federal stimulus monies to develop nursing residency programs was predictably fractious. What annoys me the most about this process and prompts me to speak is that the average person's ability to separate assertions from arguments is sadly underdeveloped. Even among nursing students, a pretty well-educated bunch, this is true. People spoke out against the resolution because of their political objections to the federal stimulus package in general. The resolution before the house clearly read that -if- the stimulus package passes, the NSNA should encourage it's constituents to lobby for some of that money to be used to develop Nurse Residency programs. Then the argument became "oh, well, that money should be used for cancer research", because people didn't understand that the monies were specifically allocated -already- for programs to alleviate the health care worker shortage. Nurse Residency programs have been soundly proven to improve retention statistics, which is an important facet of the health care worker shortage crisis.

I was nervous about addressing the house of delegates as an outsider for the first time, but my statements were met by deafening applause (much as they were when I was a delegate). I actually spoke -against- a motion to refer and delay the resolution to next year, which was defeated with 91% of the delegates responding Nay. The resolution itself was adopted with just over 80% of the delegates responding Yay.

Here's a dump of the results of the resolution hearings. I got percentages for most but not all of them, since I arrived late and had to rely on patient and understanding gallery members for notes:

In Support of Adolescent Pregnancy Prevention and Education - Adopted 95%
... Legistlation to Increase Penalties for Assault Against Health care Workers - Defeated 54%
... Advocating Nationwide Continuing Education Requirements for Nurses - Adopted 93%
... Evidence-Based Nursing Practice - Adopted 96%
... Increasing Environmental Health Advocacy and Education - Adopted 90%
... Adolescent Sun-Safety Awareness and Education - Adopted 92%
... Including Global Health in the Nursing Curriculum - Adopted 89%
... Liability Protection for Paid Health care Personnel During a Declared Disaster or State Emergency - Adopted 96%
... Increased Collaboration with Child Life Specialists - Adopted 89%
... Herpes Zoster Vaccination of Adults Over 60 Years of Age - Adopted 90%
... Vaginal Microbicide Development - Adopted
... Reduction of Unnecessary Noise in Health Care Facilities - Adopted
... Increasing Education, Awareness and Identification of Preventable Pressure Ulcers - Adopted
... Interdisciplinary Education - Adopted
... Increasing Awareness of the Therapeutic Value of Music Therapy - Adopted
... Increase Awareness and Evaluate Competency of Culturally and Linguistically Appropriate Care - Adopted
... Early Recognition and Intervention Programs in Healthcare Facilities to Prevent Respiratory and Cardiac Arrest - Adopted
... Workforce Data Collection - Adopted
... Prevention, Awareness, and Nationalized Regulatory Standards for MRSA - Adopted
... Awareness and Prevention of Elder Abuse - Adopted
... Electronic Health Records (EHR): Enhancing Patient Safety - Adopted 89%
(arguers against got confused because they were hung up on exactly which electronic record system should be used when the resolution was about supporting EHR implementation in general)
... Increasing Awareness of Mental Health Disparities in Youth - Adopted 97%
... Increasing Awareness for Standardized Patient Care Hand-Off - Adopted 96&
(arguers against got confused because they were hung up on exactly which method of hand-off should be utilized when the resolution was about the necessity for the adoption of standards)
... Utilizing Recent Federal Stimulus Monies Toward Nursing Residency Programs - Adopted around 80%
(arguers against got confused because they imagined themselves to be the US senate and motioned to refer until the NSNA could decide exactly how the money could be distributed, which isn't our role)

The usual frustrations with attending the house of delegates were all there. Delegates would argue passionately based on what they felt and not that they read and thought. Delegates would eagerly run through the gamut of logical fallacies to deride resolutions that didn't jive with their local politics. After the session a former Philosophy Major who now studies nursing thanked me for my statements, and we commiserated on the average person's inability to form a coherent argument.

The resolutions in general smacked of the submitters' desire to get a resolution published at any cost, even if the end-result was toothless and uncontroversial. I guess this is a good thing, since the goal is to get as many of the resolutions passed as possible, but the easy passage of most of them and the early dismissal of the hearings was...I dunno..slightly disappointing and kinda lazy-seeming. Having sat through most of this process three times I also thought it was interesting that the understanding and implementation of parliamentary procedure itself changed from year to year. I was, however, happy to see the resolution regarding increased penalties for assault against health care workers fail, as I thought it focused too much (all the way) on punishment and not enough on prevention.

Earlier on in the parliamentary process (I missed this..I was asleep..haha) A motion was filed to ban RN to BSN students from participating in the house of delegates. A couple of people mentioned this to me but thankfully it failed. The fact that it was even proposed kinda pisses me off, since I think that not only should RN to BSN students be active members, but RN to MSN and doctoral candidates as well. One of the major problems the SNA faces at the national, regional, state and school levels is the fast turn-over time. As a graduate of an associate's degree nursing program, I can tell ya by the time you get involved in the student nursing associations and figure out what you can do and where you can do it ... it's time to graduate. Apparently some of the professional organizations have this problem too, as people relocate and take on a different responsibility profile. If we're going to come at this problem from one end - involving pre-nursing students - it only makes sense to include the graduate nursing students as well. Why limit ourselves? Xenophobia is unseemly.

Today was the last day of focus groups. The first one I attended was "The Effect of a Holistic Nurse's Presence", presented by Vicky Slater, PhD, HN-BC, American Holistic Nurses Association (more alphabet for my alphabet soup! I think I'm up to four titles I want now). The American Holistic Nurses Association is based out of Flagstaff, AZ. It was a fantastic presentation, and the only truly interactive presentation I attended. I've always been a big fan of holism, when we were asked to verbally present an inventory of things we were good and not so good at towards the end of nursing school, providing holistic care to my patients was something I brought up as something I thought I did very well.

(She actually used a transparency projector, which she claimed she used to point out that holistic nurses CAN use technology, but failed to back up this point. That's ok. I Love her with all my Heart anyway)

The presentation gave me a lot of ideas on how I can continue to develop my intuition and create sacred space for my residents. The presentation also deepened my appreciation for the RN I've adopted as my mentor at my workplace. The importance of being present to yourself and limiting the influence of toxic emotions was already something I could intellectually grasp, but the cosmic coincidences at play in the actual presentation itself helped to strengthen that understanding and make it more accessible in the moment.

The next and last focus session of the convention was "So, You Want to be a Nurse? That Could End in a Disaster!". It was presented by Steven Busby, MSN, FNP-BC, Clinical Assistant Professor of Nursing/Coordinator of Nurse Practitioner Programs, PhD Candidate, Nursing with Homeland Security Specialty.

This was by far the most entertaining speaker of the bunch. He's a former paramedic who transitioned to nursing and went on to get his masters and board-certification as a family nurse practitioner. I didn't get a hand-out so I cant trace his entire illustrious career but he spoke at length about his copyright-pending theory of multiple-casualty incidents and his experiences responding to national emergencies. I had never heard of the strategic national stockpile before and it's a pretty interesting concept. Apparently there are multiple stockpiles of medicine, food, water, and medical equipment scattered throughout the country in secret locations, and a single drop-off of supplies from one of these locations can be delivered to anywhere in the country within 12 hours by 8 semi trucks. He shared with us pictures of his own training in disaster nursing, including an exercise where his team was doing so well the instructor came up to him (who was leading the team) and informed him that his oxygen had run out and was now unconscious, and the rest of his team had to rescue him and carry out the mission with the leader as a burden rather than an asset. Very inspiring! He also shared with us a very interesting program they've implemented in ... AZ I think ... Where they get all the statewide localities to donate their GIS data to multiply their situational awareness a thousandfold. As a computer geek myself it was a pretty interesting idea. Live video feeds of key infrastructure locations, google earth resolutions increased to one pixel = 6 inches, all the things you could possibly want to maximally prepare a region for disaster.

I was honored by a just less-than-a-minute blurb from Cheryl K. Schmidt, PhD, RN, CNE, ANEF, ANA-Appointed Consultant to the NSNA, I asked her to tell y'all why these conventions are important:

I also ambushed a random student and asked her to do the same:

Afterward, they played one of my favorite songs (and books) at the Irish Pub: The Ballad of Finnegan's Wake.


NSNA Annual Convention 2009 - Day 4

Once again, the Expo was my first stop. This time I checked out the Poster Presentations prepared by nursing students and faculty. They were all really interesting, and some of the topics look like they would make good resolution fodder in the coming years.

(Capital University Columbus Ohio - Pediatric Hospice)

(Capital University Columbus Ohio - Kangaroo Care for Infants)

(Adelphi University - Public Health issues in NYC)

(Westchester University - Original research on how nursing attire impacts patient perceptions of skill and empathy. Very impressive! They created their own research tool for this one. Check out the pics.)

(Reports on the service activities of U of Maryland - Baltimore Nursing students)

(Brigham Young University - Nursing-oriented Global Health curriculum and it's importance)

(Mount Vernon Nazarene - Stress and Coping skills in Nursing Students)

I'll try to record more of these tomorrow.

Hanging out in the poster presentation section ended up lending almost more useful career advice than the rest of the expo. The faculty on video above from Adelphi university told me they have the combination of CNL and RN-to-MS programs I'm looking for, and it's only 30 minutes away from NYC (who does not have those programs)! I'll have to look them up online later.

A trip to the expo wouldn't have been complete without a quick stop at the AZ booth:

After I had once again filled up my convention tote bag with free goodies, it was time to hit up more focus sessions.

First I attended "Managing Complex Medical Issues through the Application of Rehabilitation Nursing Principals". I figured "hey, I work in rehab/long-term care, I might as well check it out". The speakers were Karen Manning, MSN, RN, CCRN, CAN, Associate Professor, Salem State College, Salem MA and Pamela Larsen, PhD, CRRN, FNGNA, Assistant Dean and Professor, University of Wyoming, Laramie, WY. Karen Manning started out by telling a story about how she ended up in Rehab by accident, and told a story very similar to my own. Difficult job market, few openings for new grads, accepting a position in a rehab facility out of desperation and then finding the work exciting and fulfilling. The presentation reminded me how important rehab nursing is and how deep and complex the clinical issues are, promoting independence, managing complex and acute conditions, coordinating care among many different groups of carers. The speakers gave voice to a lot of the potential I see in where I've started my career. One worked more with children, the other worked more with older adults. Pediatric rehab sounded interesting, because it's not exactly "rehabilitation" but "habilitation", since the patient is being helped to acquire new skills, not re-acquire lost skills. Their presentation had me considering staying in rehab/long-term care for two years instead of the one I was originally planning on, so I can get my CRRN (Certified Rehabilitation Registered Nurse). Hah. I'm already conspiring to form the alphabet soup that would be my title.

Next I planned on attending "Nursing Leadership for the New Millennium: Essential Attributes", but when I arrived I found that it had been moved to...yesterday. Whoops! I scrambled to find a different focus session that looked interesting and settled on "Care Coordination for Complex Patients Across the Healthcare Continuum and Beyond", presented by Lois Tucker, BSN, RN, Care Coordinator, Gundersen Lutheran Medical Center. What a lucky accident! As it turns out the presenter is part of a pilot program that coordinates care inside and outside the hospital among all of Gundersen Lutheran's many clinics and hospitals around Wisconsin, centered around the Gundersen Lutheran Medical Center in La Crosse. Their program really is unique and revolutionary, a team of RNs, Social Workers and office workers help patients who have complex medical needs and are having difficulty coping with their medication regimen, respite care and visits to multiple different doctors/PAs. They provide a single point-of-contact, an RN with a caseload of 50-60 patients (Social workers take on 70-100). The entire department follows over 1000 patients at any one time. An RN comes with them to some of their doctors appointments and takes notes, and they call up and check on them to make sure they're checking their blood glucose or weighing themselves or getting enough sleep or whatever it is they need to do. She said it was sometimes simple things, but having a go-to person to help them navigate the healthcare maze results in a massive return-on-investment for this FREE service (who's laughing now, FREE=MORE nuts?). People use the emergency room/urgent care center less often, they are more likely to get a general family practice physician, outcomes are improved, and when people eventually die they have a Registered Nurse advocating for them every step of the way. Ms. Tucker's Daughter was also in attendance, she's a Care Coordinator who specializes in pediatric cases. When the presentation was over I stayed and chatted with them a bit about information technology and care management.

It was a fascinating presentation, but made me a little sad, thinking about when I was thinking of moving to wisconsin..

After that, a belly full of sushi became an urgent necessity. Then I came back to my room to charge up the electronics, upload videos and write this entry! Stay tuned! Next I'm going to drop by the resolutions hearing, now that one of the friends I made last year from AZ reminded me I can speak from the floor at any time, I just can't file motions or vote (which is fine, I can convince other people to do those things for me. Hah. Politics.)


NSNA Annual Convention 2009 - Day 3

I never, ever made it to the 9AM plenary sessions, and this year was no different. Hey, I'm sorry, I'm not getting up at 8AM, I'm just not. It looked interesting, though, The topic was "The Politics of Caring" and legislative issues surrounding the nursing profession. The session was moderated by Rebecca M. Patton, MSN, RN, CNOR, President, American Nurses Association. Speakers were Suzanne Begeny, MS, RN, Director of Government Affairs, Ammerican Association of Colleges of Nursing and Virginia Trotter Betts, MSN, JD, RN, FAAN, Commissioner of the Tennessee Dept. of Mental Health and Developmental Disabilities. The political stuff actually looks pretty interesting, and I intend to get in touch with my state or national ANA governmental relations committees once I get home. The idea of directly lobbying on capitol hill for health issues is appealing, but maybe I'll wait and take on a support role until I have beefier credentials.

My first stop today was the Expo, a combination job and school faire. I didn't find -any- schools that had a Clinical Nurse Leader MSN program, and few offered RN to MS, but I had some nice conversations and snagged some nifty hand-outs. The National League for Nursing booth was a worthwhile stop, the regional sales manager I met there knows my old Director of Nursing from back at school (who's since been elevated to a state-wide position), and we chatted about career opportunities and issues particular to CT (apparently the Northeast is -much- harder for new grads to find positions in hospitals than other areas of the country). She gave me her card and invited me to look her up when I got back once I had an idea which facility/school I wanted to get in to (if it's in CT, that is).

The booth for Baylor Health Care System caught my eye, since like many of us I work and enjoy Baylor shifts (work 12 hours on a weekend and get paid for 20). I asked if they invented the Baylor shifts and they DID! I told them I used to think it was "Bailer" shifts, as in, students work the shifts and then bail on the organization once they're out of school. hah. From what the RN from Baylor told me they're actually phasing out the practice because no one wants to work 7a-7p or 7p-7a on a weekend. It's different in nursing homes, we agreed.

One of the students had a neat demonstration display of an eye-tracking interface for people who are unable to speak or write, where they can use their eyes to select words or letters, using predictive text entry like cellphones. The rig cost 15,000USD even though it clearly consisted of about 300USD worth of hardware. I guess that's what happens when Medicare covers 80% of it. I didn't go through the entire calibration routine so I found the eye-tracking somewhat finicky, but the student presenting the unit assured me that with lengthier calibration the control is more exact. We talked about Neurofeedback for a while, I really think EEGs would be a more effective way to control the interface, and wouldn't even require you to have both eyes or a steady gaze.

The military was out in force, as usual, particularly the Army. I didn't get a chance to visit all of the booths, but tomorrow I'm going to hit up the US Public Health Service booth as well as the pain management nursing booth and a few others that looked interesting.

(Video of expo walkthrough pending)

Having been released from my obligations to sit through the house of delegates I actually got a chance to attend two whole focus groups! I avoided the Pharmacology Made Insanely Easy session, since I remembered from past years that it's just a sales pitch for their book. First I hit up "What Every Nursing Student Should Know-Malpractice Case Studies", presented by Kate Mager, Association Manager, Nurses Service Organization and Delores Hunsberger, BA, Healthcare Division of Affinity Insurance Services, Inc. I greatly enjoyed last years malpractice focus group presented by a woman from the National Council of State Boards of Nursing Education, and was skeptical about a presentation given by someone who's here to sell us malpractice insurance, but it was actually a pretty good presentation. We were shown some as-yet-unpublished statistical data the NSO has collected about nursing malpractice lawsuits and got some good advice on practices to adopt to protect our practice. The NCSBNE presentation last year had more interesting case studies, but this year we got more practical information about how to prevent malpractice suits and how to protect ourselves in case we are named in a suit.

Next I hurried over to the "Oncology Nursing: Real-time Personalized Medicine" session so I could grab a seat near the electrical outlet to charge up my devices. This session was presented by Amy Strauss Tranin, MS, ARNP, AOCN, Quality Outcomes Coordinator, The University of Kansas Hospital, Cancer Center, Kansas City KS. She was a great extemporaneous speaker, a quality I enjoy (since I have it myself and get bored/offended by people who read slides to me). She only briefly talked about DNA analysis of tumor cells to select effective chemotherapy agents, though, and spent the rest of the time talking about herself. She definitely inspired us towards membership in the Oncology Nurse's association, it looks like even though I'm not an oncology nurse, if I can prove that I see enough patients with cancer (and nursing homes are full of 'em) over a 1-year period I can actually become a certified oncology nurse through their organization (I'd have to take a test like you do with ENA or other professional organizations). She went on to become a Genetics councilor and has her own private practice! Although the talk was somewhat limited to self-exposition, it was an inspiring example of how a Nurse can become an expert at something and operate an independent practice.

I stopped by the first Resolutions hearing where they go over all the resolutions, but I remembered the first one is rather boring, they basically just go over them. Later on they debate them and that's where I always had the most fun. I'll have to refresh my memory on the times and circumstances a sustaining member can speak from the floor, they set a microphone up by the gallery, I just don't remember when I'm able to do that.

Flipping through the resolutions, I only see one I'd be compelled to argue against. It's right up front. "In support of Adolescent Pregnancy Prevention and Education". Well-intentioned, I'm sure, but there's a story about this I'll tell the house if I get the opportunity:
During my labor and delivery rotation, one of my last patient assignments was two rooms. A woman in her early/mid 20s diagnosed with incompetent cervix and Type I diabetes, confined to bed. Completely resistant to teaching and non-compliant with the hospital's suggestions. In the next room was a young hispanic woman in her mid teens, who had just given birth to twins. Some of my classmates made snide comments about the latter, but while tending to this woman and her twins, I got to meet three generations of mothers and fathers lending their support, and found through my assessment that the young mother was extremely knowledgeable and prepared intellectually, socially and emotionally for motherhood. It was the patient in the next room I was worried about.

True, there are risks associated with adolescent pregnancy, but there are also risks associated with introducing solid foods too young and some cultures do that as well. Who are we to say that the young hispanic woman shouldn't have had children? Maybe the presence of multiple generations of parents is an advantage, a source of strength. There's some research to support this but I can't point to it at the moment, that human civilization advanced rapidly once people lived long enough to be grandparents. The point is that I think the resolution shows a lack of cultural competence, one of the major nursing buzzwords lately.

Flipping through the rest, I silently cheered when I saw "In Support of the Reduction of Unecessary Noise in Health Care Facilities" (hopefully they'll correct the spelling in the next session). The resolution was introduced last year but failed because it contained too many specific solutions to the problem of noise in health care facilities, which is really a problem for biomedical engineers to figure out. This year's version of the resolution has a lot of the changes I suggested to Namrata Jani last year (who was the resolution's author, I think), unfortunately a poorly managed House of Delegates denied her constituency the opportunity to revisit the revised resolution (I was extremely disappointed with the lack of knowledge of parliamentary procedure last year compared to two years ago). Hopefully this year they'll get it passed.

Hardly any of the remainder of the resolutions look contentious, but you'd be surprised what people will fight over that looks like it should be a done deal. "In Support of Legislation to Increase Penalties for Assault Against Healthcare Workers" might draw a couple of criticisms for being too focused on punitive measures and not prevention. "In Support of Advocating Nationwide Continuing Education Requirements for Nurses" looks like it's going to trigger the whole "States rights" issue that people (including me) in the past have invoked to derail a resolution. Worst case though they'll strike one of the resolved clauses and simply resolve to encourage constituents to pursue continuing education whether it's required or not, leaving out supporting mandatory continuing ed.

"In Support of Evidence-Based Nursing Practice" looks like a no-brainer, an easy way to get a resolution passed and gain some kudos, same with "In Support of Increasing Environmental Health Advocacy and Education" (a popular issue lately), "....Adolescent Sun-Safety Awareness and Education", "...Liability Protection for Paid Healthcare Personnel During a Declared Disaster" (another hot-button issue lately..a gem from the res: 551 disasters have been declared between 1999 and 2008!), "...Increased Collaboration with Child Life Specialists", "...Herpes Zoster Vaccination of Adults over 60 years of age", "...Vaginal Microbicide Development", "...Increasing Education, Awareness and Identification of Preventable Pressure Ulcers", "...Interdisciplinary Education" (another hot-button issue and authored by Johns Hopkins, who usually sends along the heavy artillery when it comes to debating, I'm glad I've only entered debates on their side in the past!), "...Increasing Awareness of the Therapeutic Value of Music Therapy", "To Increase Awareness and Evaluate Competency of Culturally and Linguistically Appropriate Care" (a BIG BIG issue lately and contains a great RESOLVED statement: "...that the NSNA create awareness that failure to provide appropriate language services to patients is a direct violation of Federal mandates under CLAS and Joint Commission standards"), "...Early Recognition and Intervention Programs in Healthcare Facilities to Prevent Respiratory and Cardiac Arrest" (basically in support of hospitals having rapid response teams, something I couldn't imagine a hospital lacking), "...Workforce Data Collection", "...Prevention, Awareness, and Nationalized Regulatory Standards for MRSA", "...Awareness and Prevention of Elder Abuse", "...Electronic Health Records (EHR): Enhancing Patient Safety", "...Increasing Awareness of Mental Health Disparities in Youth"

... These all look like no-brainers, and a quick readthrough of the RESOLVED statements didn't reveal any glaring weaknesses to exploit logically. You never know, of course. Debate, especially in some of the less..shall we say...literate constituencies is not always constrained to logical arguments. Fortunately it looks like most of these sidestepped the mistake we made a couple years ago by using language that was too complex (we got it passed anyway but it took some fancy parliamentary maneuvering to get someone to change their vote and get it reconsidered).

A couple that stand out as resolutions that are potentially fractious are "...Utilizing Recent Federal Stimulus Monies Toward Nursing Residency Programs", "...Increasing Awareness for Standardized Patient Care Hand-Off", and "...Including Global Health in the Nursing Cirriculum" (they really need to spellcheck these).

The Federal Stimulus resolution, of course, is going to incite conflict along red and blue lines, and with the small sample size of our delegations, you don't want to underestimate the bible-belt voting block (they reared their ugly head in the DNR vs AND and providing condoms to prison inmates debates a couple years back..unsuccessfully thankfully). The Standardized Patient Care Hand-Off and Global Health in Nursing Curriculum resolutions are going to inspire some arguments about the WHEREAS statements...even though parliamentary procedure doesn't allow you to debate WHEREAS statements, people who don't know this try to do it anyway every year (3 years ago that was me, hehe).

Should be a pretty smooth set of resolutions hearings, with the occasional heated debate. I'll swing by to watch in between focus groups. Tomorrow I think I'll hit up "Managing Complex Medical Issues through the Application of Rehabilitation Nursing Principles" (since I work in a rehab/long-term care environment after all) and "Nursing Leadership for the New Millennium: Essential Attributes". Saturday has some of the toughest decisions for focus groups, but I'll get to those later.

I bought this hoodie last year, but didn't try it on first, and discovered that girls mean very different things by "Extra Large" than boys do. I had to give that one away, but this time I got an XXXL, which is only slightly too big for me (I like a spacious hood in my hoodie, though)

NSNA Annual Convention 2009 - Day 2

Day 2 is really day one, I like to arrive at these things a day early and leave a day late. You know, just in case.

First up was a couple of presentations on Breakthrough to Nursing and Legislation/Education. BtN sported the only familiar face so far, a friend I made at the last convention in Texas, a former member of the Kansas SNA, now a presenter. The BtN and L/E focus groups had a lot in common, the Big Issues are still the Big Issues no matter which lens you're viewing it through. How do we recruit more nurses? How do we recruit nurses that reflect the diversity of our country that speaks more than 300 languages? How do nurses take control of their own practice and advocate for better health in our communities? These were familiar quandaries to me and renewed my enthusiasm for getting involved in the professional nursing associations. I had to laugh for a second when I remembered that I thought this same thing last year, and resolved to drop a line to my state's chapter of the ANA to get in touch with their government relations committee.

After this I swung through the house of delegates, and remembered how laborious I found the opening meeting. I carefully avoided the roll-call where all the states put on their cutesy cheerleading displays, and dropped in just long enough to listen to the parliamentarian go over the basics of parliamentary procedure (something I imagine I'll be explaining to people again later). Part of me was glad I didn't have to sit through the mandatory boredom, but another part missed being involved with the house of delegates, and I know I'll be grinding my teeth when I'll have to sit out the opportunity to tear apart arguments like I did in years past.

Next up was a small collection of graduate nursing schools organized by the American Association of Colleges of Nursing. I swung through and chatted with some of the schools' representatives and found that a few of them talked a pretty good game. Right off the bat I explained that I was interested in getting a graduate degree but my personality resisted the idea of "specializing" in something. A rep from Buffalo (Buffalo buffalo Buffalo buffalo buffalo buffalo Buffalo buffalo) told me it sounded like Clinical Nurse Specialist was the right degree for me. I did a double-take and pointed out that "Specialist" was right in the title. He corrected himself and told me there's a relatively new major called "Clinical Nurse Leader" that is basically an advanced bedside nurse generalist. Perfect! For years nurses have told me that it's too hard to generalize in the nursing profession and that it's better to specialize. I'm of a kind that believes that "specialization is for insects" and generalization is the way to go. After talking to some of the other schools there I found that not only could I get a graduate degree in Clinical Nursing Leadership, I could take a few classes and become a Nurse Practitioner afterward (once I passed the NCLEX-NP) without doing the whole degree over. The most enticing offers came from Rush in Chicago and Rochester in NY, since they both explained that I could do all this for free if I worked at their hospital. I'll have to ask around CT for a comparative deal.

The keynote address was the next stop. They picked a hell of a speaker, Rear Admiral Carol A. Romano, PhD, RN, FAAN, Assistant Surgeon General, Chief Nurse officer of the US Public Health Service. I actually met her once in the past, and she put the idea in my head to join the Public Health Service years ago. Very inspiring speaker. As I write this the video of her keynote address is still uploading so I'll append it to this post later. The Opening remarks were made by Rebecca Patton, MSN, RN, CNOR, President of the American Nurses Association; and M. Elaine Tagliareni, EdD, RN, President of the National League for Nursing (they went all out, eh?). It was a struggle to sit through all the glad-handing and gratuitous award presentations, but hearing Admiral Romano speak for 24 minutes or so was well worth it. I sadly didn't have enough camera storage left to get the tail end of her speech but what I did get was pretty good. Below is the NLN and ANA president's greetings.

After the keynote there was a reception put on by the Army Nurse Corps, they give out an award every year to the most excellent student and host a reception afterward that doubles as a recruitment drive. I was hoping for ice cream, but none was to be found. (Video and hilarious story pending)

The performer is apparently Sergeant First Class Jamie Buckley of the USAREC Entertainment Team. As a musician, I was offended that he pantomimed playing a guitar instead of actually playing one. Deeply offended.

Today reminded me why I came here in the first place. Inspiration. Direction. Goals. All that good stuff. There's important things happening, and I'm one of many (but still tragically few) new nurses with skills from other fields that will revitalize and recontextualize the nursing profession. Now nurses have previous experience with marketing, business, sociology, computer science, construction, you name it. We're used to finding problems and solving them within our lifetimes. Within a business cycle. If there truly are solutions to our healthcare crisis, we have a major role to play.

(Keynote Address)

(And then of course the nightclub)


NSNA Annual Convention 2009 - Day 1

As is usually the case with events like this, I left the packing to the very last minute and got little sleep. On the way to the airport, I realized I had forgotten my regular digital camera, my travel tripod and the charger for the MP3 player. Oh well, no big deal. I sleepwalked through the airport, air travel having become somewhat routine for me by now. I briefly entertained notions of leaving the flip camcorder on as I passed it through the TSA checkpoints but then thought better of it.

From CT to Atlanta to Nashville, the last leg of the trip was only a 37 minute flight, and I barely had time to nap or play with sis' laptop.

The Gaylord Opryland is an impressively large resort, although the Gaylord Texan where we had last year's convention set the bar pretty high. From what I can tell so far I like the Texan better, since there were more casual places to eat and drink, and a sports bar with large sofas you can lounge on and smoke a pipe with your beer (The Opryland is no-smoking inside). The lack of casual dining/pubbing is disappointing (it was in these environments I made the most entertaining acquaintances last year), but we'll see what the on-site nightclub "Fuse" has to offer. It's billed as a "Las Vegas style nightclub". No word yet on if that means there's gambling inside or strippers or what.

(::Sigh:: cowboys and angels...remember that tom robbins book?)

When I got to the desk to sign in for the convention, they didn't have my registration on file! A quick scan of my email revealed that I never got a confirmation email. I ended up having to pay AGAIN for the convention, fortunately the member services chap gave me the discounted pre-registration rate. Still, though, after the shuttle, repaying the registration fee, picking up some sundries I forgot (shave, deodorant, hairbrush, etc), and sitting down for a burger and a cold beer I have..let's see...probably about 100 dollars left...and I have 5 more days to go! I scrambled to call one of the credit card companies I had completely paid off and got them to express deliver a new card (I had destroyed the old one), but that won't get here for "1 to 2 business days". Looks like I have some challenges to my creativity and frugality ahead.

I finally managed to get a shower, after walking around the massive complex for a couple hours getting the lay of the land. Shaving with a non-electric razor is wierd! First time for everything I suppose.

Time to check out that nightclub. Pictures soon!

EDIT: Nightclub was somewhat lame, but thankfully I can charge drinks to my room.