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 The expo is all packed up and has already been replaced by what looks like a convention about purchasing cards.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.


Departure anniversary

It's that time again. The flight's booked, the hotel's reserved, and tomorrow I'll be heading out to Nashville TN for the annual NSNA convention. I'm bringing along a few fun toys on this trip, I just picked up a Flip HD camcorder, with which I intend to capture some fun video and post it here for those of you who are missing the convention.

I suppose that now I'm an RN and a card-carrying member of the ANA I should hit up some of their conventions, but the NSNA conventions I've been too in the past were so much fun I just couldn't pass it up. Since I'm no longer a student I won't be able to do all of the house of delegates stuff I've done in years past, and although I'll miss arguing pros and cons and displaying my superior knowledge of parliamentary procedure in front of the 1000+ member house of delegates, I'll be just as happy to advise students on how to get their resolutions passed, while keeping my fingers in the dirty politics and nasty tricks that always seem to surround the annual elections.

I'll also be bringing my Tenori-On and Kaoss Pad just in case I'm called upon to generate phat beats (you never know).

This will also be a nice opportunity to catch up on my blogging, as some of you may have noticed I've been slacking on the blogging front lately, mostly because of the plethora of music projects I've gotten myself into.

I tried and tried to find someone to drag along for the ride this time around, partially because travel is more fun with a companion and partially because the annual NSNA convention marks a rather maudlin anniversary for me.

I'm flying solo, and I'm not traveling with a group or anything, but I always find groups of cool kids to hang out with, almost instantaneously. One of my former classmates pointed out I have a gift for that sort of thing.

Work is going great, by the way. I'm starting to get noticed for the things I do exceptionally well, much to my surprise I won some hard-earned praise for my -assessment skills- (as a new grad that's one area that I'm constantly unsure of myself in). One of the non-nursing higher-ups pointed out that my customer service background from working at radioshack have also turned me into an asset. I'm picking up tons of extra shifts and winning brownie points left and right. I was a little worried at first that my attempt to "hard-reset" the local gossip structure would backfire, but now even the aides are saying nice things about me!

It's time for a break though, some rest. Six days in Nashville should do the trick, even though warm weather and hospitable southerners don't agree with me all that much. After a few 3p-7a and 7p-7a shifts, a few days off to relax, write, play and converse with some of the most motivated, intelligent and caring people in the world is just what the Nurse ordered.

Some of ya I'll see there, and the rest, watch for videos!


another wordle.

Wordle: Nursing2

A guide to smoking

I've noticed a couple of people try to take a drag of a cigarette for the first time and not actually figure out how to do it without coughing. I thought I'd write a guide.


Place the cigarette between your lips, and establish an airtight seal around the cylinder.


Hold a portable source of flame in your dominant hand, activate the flame if nessisary.


Close your mouth completely. Your mouth should contain no air. Clench your jaw, it'll happen. Breathe through your nose. Then,


Next, with the flame touching the far end of the cigarette, slowly open the mouth while keeping the seal around the cigarette and also keeping the tongue at the bottom of the mouth. A vacuum created by the new space you created in your mouth will draw air and burning plant particles into the space inside your mouth.


Exhale completely.


Relax your seal on the cigarette and take a breath of fresh air. Inhale completely (beginners may find it easier to inhale through the nose rather than the mouth, the mixture of the smoke with humidified air from the nose is less irritating to the airway). The smoke contained in your mouth will travel into your lungs. If you don't take a deep enough breath you'll expose your sensitive bronchii to extremely high temperatures, so it's best to speed the flaming pieces of plant matter on their way to the alveoli of your lungs. With membranes one cell layer thick there probably aren't many nerves hanging around to relay signals through.


Hold your breath. The increased pressure in your lungs will ensure that the desired agent (nicotine) will get driven through that cell-thick layer that much quicker (along with all of the other colorful by products of setting plants on fire). Hold your breath for as long as comfortable to maximize effect.


Exhale as desired.