Sunday, August 3, 2014

A little bit of change :)

A little about myself: Growing up I always wanted to be a pediatrician or a teacher but nursing seemed easier to a newly graduated high school student that just wanted to hurry up and grow up. So nursing it was. I then changed my goal to a pediatric RN until my pediatric clinical rotation. There I fell in love with the drug addicted babies and wept for their unfortunate circumstance. I was given the task by my instructor to insert a NG tube in a five month baby that nearly brought me to tears. It was then I decided that although I had a great love for the pediatric population I also became quickly emotionally attached to them which could not be a good thing to pursue this particular specialty. Then that day when you come to work and your tolerance is low and your patience is short and here you are on the busy telemetry floor you frequent. You are receiving report from four separate nurses indicating the patient load should have been split from the beginning. Each nurse unable to complete minor yet compiling tasks. … and also had a night that tested their patience so frustration is displaced to you as you are trying to prepare for the 12 hr day ahead of you. Now as you start your day you realize each patient’s night was just as hectic as each of the nurses… You see 2 of your patients both could equal about 1500 lbs together both non compliant in care, both completely dependent of nursing staff and both requiring constant pain management. Then suddenly the nursing super visor calls and sends you to the pediatric floor. Panic suddenly ensues as you recall those moments in nursing school. Anticipation is building not knowing what to expect. You have someone open the doors to the locked unit and you realize you have entered a magical place where the nurse’s smile, the ratio is low and the patients are small. A seven year old child gets to see their favorite characters. Batman, Spiderman, and Flash are regulars visiting the patients, taking pictures and signing autographs. What a nice relief from the usual fast pace hustle of the adult medical floor. Change is not always bad. ~MotherNurse

Clinical Quotes

The first days of clinical for a brand new nursing student can be described similarly no matter the school or demographic. I will use the word “nerve wracking” describe that feeling. To have never stepped foot in a hospital or to have never stepped foot in a hospital in the role of a nurse takes away a sense of control that is a common need of this profession’s personality. As the semester moves forward confidence grows as well. As a celebration to yet another successful semester with a wonderful group of students I have compiled a list of quotes that demonstrates growth within the group and unique experiences this particular group faced.

Each and every time I read these quotes I smile a bit as I remember the moments shared that have built an unmistakable bond be myself and 6 young ladies aspiring to becoming nurses.

  It was a change of life baby”

“I look everywhere for an AED machine, It’s kind of psychotic”

“What makes it a nurse purse?” “You put nurse stuff in it” “Oh, how much does it cost?” “$30” “Omg but I am a student”

“I am finally coming to the light”

“Do I have a jello heart?”

“I had to breathe life into the fish”

“Zinc, it totally sexes you up”

“Every week we come to clinical I feel like I am going on a blind date”

“I am loosing control; days of being on top of things are over”

“He liked it when I touched him”

“Smells like lemon, no it smells like bubbles. OMG am I having a stroke?”

“Whoever finds Dr. Broccoli wins”


Monday, June 9, 2014

Human Becoming

I know sometimes we get lost in the daily struggles of patient care but in order to consider what we do as a profession we must be guided by proven theories. If you as a nurse ever wondered how theory can relate to practice here is a breakdown of a mid range theory by Rosemarie Parse called the human becoming theory. ***************************** The human Becoming Theory by Rosemarie Rizzo Parse is a theory that is unique to nursing. This theory guides nurses to focus on quality of life as it is described and lived. It presents an alternative to the conventional and biomedical approaches and is a combination of the psychological, social, and spiritual approaches of other theories. The human becoming theory values quality of life from each person’s perspective regardless of culture, religion or diagnosis. It should be the goal of nurses to be able to apply this theory in everyday practice in order to provide holistic care because that is what makes nursing different from other medical professionals and helps define nursing as a profession. This theory exclusively focuses on perspectives on what quality of life from the patient’s point of view. The nurse guides ideas, thoughts and perspectives. Through guidance the nurse helps the patients explore options without making or persuading the patient do what medical experts say is best. Over the past few decades the nursing profession has begun a transformation process where more and more nurses embrace theories and frameworks in order to fortify their unique contribution to the health care system. Transformation is gradual and incremental. With Parse’s theory of human becoming, nursing has been and is becoming transformed from the traditional medical science practice to a basic science practice. Nursing practice takes on a new identity when guided by the human becoming theory. The uniqueness of the profession lies in what nurses know about human beings and health as a guide to what they do says Rosemarie Parse.

Her theory is just as relevant now as what it was during the time it was written due to the continuing progression of the profession. As the nursing profession evolves so will her theory. It is important for nurses to understand humans in order to continue separating nursing from other medical professions. A person is more than the sum of its parts…. The environment and the person are inseparable. Nursing is a human science and an art that uses an abstract body of knowledge to help people. With this theory the nurse is able to create a stronger nurse-patient relationship because he/she is not focused on “fixing” problems, but is able to view the patient as a whole person living through experiences in his/her environment . . . . The overall aim of the human becoming theory is to improve the quality of life for patients and their family. Everyone experiences some type of traumatic events where they must move on and/or confront life struggles. One challenging experience is a spinal cord injury. Unfortunately for the spinal cord injury patient, they must cope with the realization that one incident can cause severe limitations that will change their life forever. They must adapt and learn to live their life differently. Also, they must come to terms with their new reality. For a person that suffers from a spinal cord injury; independence does not mean doing everything for one’s self but having control over their own decisions in order to be a functional person in his or her environment. In order for the patient to gain independence they must overcome physical, emotional and spiritual limitations during period’s uncertainty. While in the midst of the periods of uncertainty they must invent new possibilities for their future. It would be the nurse’s job to guide the patient through theses different stages according to the Human Becoming theory. ~Mothernurse

Friday, June 6, 2014

Competency time!!

For a nurse who works for more than one facility this is a stressful time of year. One test after another. After a while you just find yourself clicking and not absorbing the all so important information about fall prevention, fires, ect. Information overload is what I believe I am experiencing. Overlapping data that seems to conflict.on and on and on *** *** As a recent education graduate I just don’t believe this is the most effective method of teaching adults but hospitals seem to all use this method. This is probably due to the cost effectiveness… This could be because most of us do their tests on the clock but me I come on my day off to complete it all in one sitting. Is that so wrong? *** *** Just a short rant as I continue to complete my competency :) ~Mothernurse

Tuesday, May 27, 2014

First day of school: Clinical instructors POV

Its that time of year again! The first day of school has arrived. The night before losing sleep due to anticipation. Wondering and thinking about who you are going to meet and the impressions to be left. The first day sets the tone for the whole semester. Your first and last words will be everlasting to your students. Everything you say is imprinted in their brains to be tried and tested time and time again. 

You make sure your scrubs are ironed and coordinated. You have google mapped directions to and from the facility to ensure the best route is taken. You read all of the students materials as well as your own. You think about every question a new nurse could possibly have. 

Once you awaken on that wonderful morning you anticipate getting your first cup of coffee and an energizing breakfast to keep that pep from beginning to end. You show up before the students to set the standards in the beginning. You see your first student walk through the lobby of your facility with a look of desperation and fear as your are ready to comfort her with comforting words to ensure her it seems scarier than it really is. And as you open your mouth that cold you had yesterday had turned to laryngitis. Your voice is gone! Nothing but inaudible squeaks and whispers. As students continue to pour in the first day of school has become an awkard moment for you as if you are the one in school again. Soon the roles have switched and students are encouraging you to persevere through the day!

Thank God for Nursing Students :)

Monday, May 26, 2014

Thick Skin

It is important as a nurse to develop thick skin otherwise we would not have made it through nursing school or our first days on the floor or the verbally and physically abusive patients or the long shifts or the dying patient or the code that goes bad or irregular sleep cycles or the lack of time to eat ... the list can go on on and on but what happens on those days when your skin is not so thick. Those days when emotions get the best of you. Do you take a moment and shed a tear? Do you lash out? What are the outlets for us nurses? 

The reality is that nursing is a difficult profession but not only physically but emotionally. Our role is to be a caregiver, advocate, medicate, counsel, manage, act as a change agent, and research. With all of those roles there are some days it can become overwhelming. Some days we forget about ourselves to the point where our bodies will not allow us to move forward. Our roles and responsibilities have become a norm for us but what about those days during a shift when out when we feel we can no longer move forward?

We just keep going.....

Saturday, May 17, 2014

Graduation day

Graduation is approaching quickly! I am attending my third graduation; once for high school, once for my bachelors and now once again for my Masters of Science in Nursing education.  So a little about me: My background was med/surg tele. As a new nurse with novice expertise I would constantly arrive to work frustrated and overwhelmed with the responsibility of caring for patients and knowing that my decisions would or could affect a person’s wellbeing. I watched the unit I worked on go through many transitions and I therefore I found comfort in knowing and understanding that change is constant. During that time I got married and had a beautiful daughter, suffered with postpartum depression that caused me to struggle daily at work. I began to understand that nurses really do “eat their young.” I learned during that time that I have to take of me (which is a lesson that most nurses struggle with). This sparked an “aha” moment that drew me to return to school. All I knew at this time is that I wanted to share my experiences and perspectives with “our young” and aspiring nurses.

 During the first semesters of my graduate degree I found solace in the campus life. I enjoyed the first days of school as if I were in elementary school again. The anticipation of the unknown was exhilarating. Not knowing who I was going to meet, how hard and/or different graduate classes are and most importantly how I was going to be able to write ALLLL of those papers on the syllabus. Now, two years later graduation is approaching. With yet another transition approaching I some decisions to make that affect not only my career but my family as well. For the past two years I have the luxury of working prn in the float pools of two different hospitals which provided the flexibility I needed to be home with my young daughter and focus on my schooling. Now I have to decide if I want or need to work fulltime. Should I become a faculty member at a college? Should I teach part time? Should I work for a hospital? Or should I return to school and pursue a Family Nurse Practitioner?

I have learned overtime that as your life transitions you must be flexible and optimistic. At this point in my transition I am leaning toward FNP program. Although teaching is my goal I am not sure I have made it to a point in my career where I can see myself as fulltime faculty. I have learned things about the roles and responsibilities of faculty members that I am not sure I am ready to take on with a young growing family but I also know that if continue to hone in on my clinical skills with an advanced practice degree I can make a similar impact on healthcare until the time comes for me to “settle down.”
Suggestions/comments are well appreciated. J

~Mother Nurse

Tuesday, May 13, 2014

OT vs RN

The overall goal of both professions is to improve quality of life for their patients. Both professions overlap in a way that confuses the patients. Both assist with patient interventions. Both provide plans of care but from different perspectives. With so many commonalities why does it seem like each profession does not get along with the other? I have worked on a unit where the therapists have one refrigerator and the nurses have another. They have two microwaves, and separate unit parties where one group is not included and given leftovers after the celebration is complete. I find this to be an odd phenomenon because although the professions have differences we still work side by side with a common goal of ensuring patients are cared for in the most optimal way. I have watch therapists bellies grow and be excluded from the baby shower celebration. I have been to staff meetings where one profession bashes the other. I have walked in a room with a patient and the therapist questioned the care I am administering in front of the patient. What is that saying to the patient? On the flip side I have heard nurses complain about the therapists. I have heard them have a total disregard for the occupational therapy profession. How is this in the patients best interest. My solution is educating both professions on the differences between the two. Maybe if there were an understanding between both parties then maybe an alliance can form between the two thus provide a more collaborative and efficient way of providing care. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (American Nurses Association,2014) Occupational therapist complete an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and also completes an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan, (The American Occupational Therapy Association, 2014)

“The very first requirement in a hospital is that it should do the sick no harm.” Florence Nightingale


Monday, May 12, 2014

How do I feel about the legalization of marijuana???

Ok I am totally against the recreational use of marijuana. Like any other substance use without supervision can be deadly but I do not understand why a person cannot use a drug for medical purposes that are proven to be effective for multiple symptoms in certain diseases. Currently marijuana is a schedule I controlled substance in the same category as LSD GHB and heroin. Let’s consider the effects of marijuana vs other prescription drugs or better yet other legal drugs. Neurontin, for example, is an antipsychotic drug which is used in the treatment of seizures and is a schedule V drug.  Schedule V means the drug is widely accepted for medicinal use and has a low potential for abuse but the side effects of Neurontin taken orally include depression, suicidal thoughts/attempts, mood changes, drowsiness, tiredness, and blurred vision. These side effects are similar to the so-called “high” caused by marijuana. Neurontin and marijuana share similar side effects and treat similar symptoms such as seizures. However, Neurontin is legalized as a prescription drug in Maryland but marijuana is not.

Another surprising fact: Neurontin is the primary cause of 968 deaths from January 1997 to June 2005. Seventeen other FDA approved drugs were the primary cause of 10,008 deaths during the same time frame. Marijuana was the primary cause of none.Now healthcare providers think about this: how many times have you seen a person come into your facility with violently ill withdrawal symptoms of marijuana? Now think about how many times you have seen a person come in with violently ill withdrawal symptoms of alcohol? Methadone? Dilaudid?  Oxycodone? All legal and widely used.

Hey, at this point I feel like a hippy encouraging one to throw one in the air but really I am advocating for patients being treated with what I feel is the safest method of treatment. If someone can explain why it should not be used I welcome the feedback.


Thursday, May 8, 2014

Whats wrong with paper??

Today I was mandated to take a course to educate us nurses on the new upgrades to our computer system (meditech). Which btw is an upgrade to the upgrade that was done 3 years ago. This mandatory upgrade was in direct relation medication reconciliation. Some functions changed or moved slightly but in essence this is the same program that we had been using.
So as I am sitting through this course it was mentioned on more than one occasion that this is a requirement to do this correctly 100% of the time because "we" would receive an unknown amount in government funding and this is a mandate of the state.
As I am sitting  through this overly redundant course I think to myself what is wrong with documenting the patient's home medications on paper. Now don't get me wrong I am all for the evolution of processes but I do not understand how this helps the patient. At this point in the technological advancements at this particular hospital we do 50% on paper and 50% on the computer. Many orders are placed on the computer but just as many are written by hand. I also began to think to myself why is the government requiring that patients medications be loaded on a computer. We already depend on a computer so much but what if a computer fails at some point where does the patients information go? It was further explained to me that patients will have access to this information through a portal so I immediately thought of HIPPA and weather the government has access to patient information. I mean really, is the government handing out money to access patient information?
This post is being written on nurses week so I must also mention does this unknown amount of money in some way benefit the nursing staff? I am not sure what your hospital did in celebration of nurses week but this hospital claimed that there was no budget to have a decent celebration. We received lifesavers one day stating we are a "lifesaver" and on another day a sheet cake was split between each of the floors. Now please do not take this as complaining because I do not do what I do for a gift but I would like to point out in the seven years I have been a nurse I have watched nurses week celebrations dwindle. One of the first years of becoming a nurse we had a hospital wide cook with music, hamburgers hotdogs etc. Now it seems that nurse appreciation is not budgeted but there is more being required of nursing staff.

Just a rant :)

Saturday, May 3, 2014

Super Nurse or naw

Do you consider yourself a super nurse? What qualifies as a superpower? Do all nurses share the same purpose?
I think the profession of nursing is special. We do something that no other healthcare profession is capable of. We are patient advocates, we facilitate communication between healthcare teams, our role is ensure our patients are safe and their best interests are taken care of. Overall, I think those are the superpowers that we possess. Healthcare is foreign to most. The language, the environment, the procedures, and protocols. Think about going to Germany. The language/s, the environment and laws are all something that you know nothing about. Think about how difficult it would be for you to drive to the store and go grocery shopping for a few items. Would the items you are looking for look the same will the staff be friendly and patient with you. How about something as simple as driving... will the road signs be readable? That is a lot to think about and you will be overwhelmed. Think about how much of a difference it would make if you knew the language or better yet have someone guide you through the process with compassion that you know you can trust.

Now lets think about the patient who has to get a simple procedure done... for example insertion of a foley catheter and the dr uses words like urethra, insertion, bladder, infection, in less than ten seconds then walks out. Of course that patient would be overwhelmed.... But here comes SUPER nurse to save the day! So the next time you go to work think about the simple yet major impact you are having on each and everyone of your patients that day. Also give yourself a pat on your back for withstanding the trials and tribulations that come along with being a nurse that day and ENJOY your nurses week!!...Each and everyone of you no matter  your specialty.

Friday, May 2, 2014

Alcohol Abuse

Servodidio, C. A. (2011). Alcohol Abuse in the Workplace and Patient Safety. Clinical Journal Of Oncology Nursing, 15(2), 143-145. doi:10.1188/11.CJON.143-145

Have you ever been in the situation where you suspected substance abuse in a co worker. What signs did you notice? As a nurse it is our responsibility to to assess for substance abuse in individuals all of the time. We have acronyms such as CAGE to help us remember how to assess. When it comes to our co-workers we tend to turn a blind eye. In a situation that I was in I saw the signs and symptoms but did not relate it to substance abuse. In this case this person displayed professional signs that included inappropriate behavior, moving to off shifts, complaining about personal problems, and volunteerng for extra shifts. This person was vounteered for extra shifts on multiple units so it was not known how many hours she was working. A policy in the institution was created because she was able to accumualte 80 and 90 hrs a week. She became unkempt in her appearance and if you cared for a patient after her you would spend most of the shift playing catch up. She did not document, many tasks were not completed, meds were missing. As a new nurse at the time, I did relate that to abuse behaviors but after her dismissal it was found she was suffering alcohol abuse with multiple dui's and mandated to go to treatment. This was a sad situation to watch for she was the perosn who helped train me. :(

Thursday, May 1, 2014

Quote of the day "If you are not serving then you're on the menu"

What does that mean to you???? How does this relate to nursing???

I believe that many of us nurses are typically found on the menu. How many times have administration changed a policy that you did not agree with? How many times have you complained that nothing gets done? Or worried that your patient was going to suffer at your expense. The reality is many nurses do not have a voice because we do not serve on the committees or professional associations. We do not take action as a unified front. Many time we find ourselves combating against each other and  bullying one another.

There are 2.8 million nurses in the united states... and how many of you are apart of the ANA, or any other professional organization. Nursing is a unique profession that requires a voice and forward thinkers. 
Now let me ask how many are apart of their homeowners association. On a smaller scale if there was no HOA in your community think about how many of the landscaping needs and equipment failures would be prevalent. Or if you are not on your HOA how many times do you wish your community had something that does not exist but if you did serve  or at least attend meetings you could vocalize your opinions to those who make decisions for your community.  Or if you do not have a HOA how well kept is your community?

Just my thoughts

Saturday, April 26, 2014

A day off??!!?? What u say

That Saturday  as a mommy, wife and nurse u have nothing and I mean nothing to do. You beg for metime or downtime but the moment you get it what do you do?
Saturdays are usually spent with an extra shift or a mandatory shift catering to patients needs. Or on a Saturday hauling the children around to tae Kwan do or whatever enriching activity you believe is necessary for your child to participate in. Or on a Saturday doing required wifely activities that usually include family members that you're not  fond of 90% of the time. Or housework ... Or yard work... Or schoolwork ... And so on and so on. So that leaves us on this beautiful Saturday morning trying to figure out what me time really means n what to do with it. Please enjoy your Saturday who knows what the next one will bring :)

Friday, April 25, 2014

Transgendered patient...

Caring for a transgendered patient has sparked many thoughts that have required myself to dig deep into my personal beliefs. Believing that a person is the gender that they appear is engrained in our cultural beliefs. Wanting to say she or he when in fact it is undecided. Those personal issues I can deal with....
But what happens...
When this person requests to be addressed by a name other than what has been legally appointed. This could ultimately lead to an unfortunate circumstance. Because this topic is sensitive it is usually not spoke of but it should be talked about there is a reason for patient identifiers. For example if a person is legally married and wishes to be identified by their maiden name typically this request is not granted. Identification of a patient with name and date of birth are basic patient identifiers that can cause confusion in the caregivers and therefore become a patient safety issue. I understand and agree that people are people and should be treated as such but the reality is that people are uncomfortable with things/people they do not understand... thus the reason why it is such a sensitive subject.

What are your feelings?

Thursday, April 24, 2014

Elder abuse

             Nurses are in direct contact elderly population on a day to day basis. The elderly is a fragile population that is dependent the nurse’s assessment skills while in  the care of medical professionals. The nurse needs to be aware of elder abuse in different communities in order to identify and report when necessary. Typically elder abuse was hidden from the public view or just ignored. As time passes and evidence accumulates, it is being discovered that it is an important public health and societal issue. Elder abuse can be defined as “a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person” (World Health Organization, 2012) Abuse can come in many forms which include physical, psychological/emotional, sexual, and financial. Many times abuse can happen and be undetected and unreported. Many people, including nurses may not be able to identify warning signs which can lead to unintentional and intentional neglect.  In 1996, it was found that 449,924 people 60 years or older had been physically abused or mistreated in some way (Acierno, Amstadter,Resnick,Steve, Muzzy &Kilpatrick, 2010).

What do you think???? How can we stop this? Have you witnessed or even contributed to elder abuse? What did you do?


Ok, So I am a Nurse

I am a nurse. Nursing cannot compare to no other profession. I can more closely compare it to the women’s rights movement. Every day it is a struggle to be heard, and respected. Every day you hope the doctor takes you serious enough to listen and a person doesn't have to suffer a near fatal complication. Nursing is a very submissive role where you are responsible for the patients well being but you cannot make your own decisions for the patients well being. When the patient has made a turn for the worse you must jump in and “save a life” yet the doctor is the one receives the credit. Interesting right????? Being a nurse means that the stress of saving a person is on your hands for all 12 hrs of the day while being under paid, not respected or even appreciated. And don’t think that management is any better. They are just the ones who do the dirty errands for the hospital representatives while making nothing compared to upper management. They have the stress of young vibrant nurses wanting to make a difference and asking for the things they need to be good at it. While upper management breathes down their throat in order to save a dime. That seems stressful right??? Ok so I am a nurse…. Where to go? What to do?  Who to look up to???  After thinking long and hard I decided to go to school for education.


Friday, April 18, 2014

Have you ever??

Have you ever.....

1. Thrown away the linen.... I mean really sometimes its not worth saving
2. Just wanted to tell the pt their life is in my hands so "watch your mouth"
3. wondered why people bring infants to the hospital... hospitals are the best host for germs.
4. wondered why they make these hospitals look like a hotel if they want pts to treat it like a hospital. 5. had a doctor blame you for a mistake in front of a patient.
6. had a fellow nurse tell you they would not cosign insulin
7. used desk tape instead of medical tape
8. witnessed a painful procedure and smiled just a bit because the patient was just plain annoying
9. cried at the witness of your first code
10. put your confused pt in a geri chair just so you could eat lunch


FPN United

Float Pool Nurses United! That rare day when there is only one staff nurse. Agency make up the floor on this day! Staff nurse is stressed to the max! Forgetting that she is not alone but lashing out on the agency nurses. Burning bridges and not even aware. Sad Sad A very long 12 ahead. Your only telemetry nurse is agency and she leaves @ 3. cosign help transfer Witness Hanging blood Answer call lights Answer phone calls ( O did I mention there is no secretary) Unit or United. Today we are United :) ~MotherNurse

Wednesday, April 16, 2014

unit or every nurse for herself

Each shift, on each unit, each day begins the same. Receive report from an unknown nurse. Using detective skills to fill in the holes. Introductions to patients, Nurse technicians and charge nurse. Fellow nursing staff are identified by nameless navy blue. Assessments, medication adminstration, documentation a continuous cycle. Each shift, on each unit, each day. Spoken to only when needed. Addressed as so and so's nurse. As an outsider knowing I don't belong maintaining a friendly demenor. Speaking only when spoken to. Using the magic words please and thank you, even when not needed in order to appear friendly even when exhausted. Attempting to fit in the sea of blue nameless nurses. Following protocols, following dress codes, following rules, following the culture of the unit all of which change with the unit. Each unit having different standards and requirements. Each and every shift blending with the next. Each nurse blending with the next. Each patient blending with the next. Through experience it can be assumed that a nurse should have a fellow nurses back. It should be expected that a nurse should have the same goals but most do not. Progression of the nursing profession should be the first goal. Ensuring we maintain the patient relationship in caring for the patient even when the ever evolving healthcare system continues to attempt to strip all indentity, all compassion, all indepencence in nursing judgment. Expect that all are less than perfect at least some of the time although some pretend otherwise. Your nurse my seem like supernurse answering constant phone calls, delegating, managing medications, etc but really we are not. We are really the sum of our experiences. Experiences dictate learned behavior, our interpretation of education, and our reaction in an unfortunate. Not every nurse was an "A" student in fact most are not. Maybe to identify the the "A" nurses, we should label them with a scarlet letter in order to identify. Or Should we identify who's goals and objectives are the in the best interest of the profession as a whole. ~MotherNurse