Thursday, April 29, 2010

The Hierarchy of Nursing

Filipino nurses should be proud of their achievements, whether as an RN or APRN/NP. I am very proud as an RN, an ANP and a Filipino. Tough as it is, knowledge is power and power will take you places and put food on your table..
In order to have power, let me take you to have a glimpse of what "real nurses" are:

Ground Zero - nursing assistants, lay man, anybody without a nursing background.
Some certified nursing assistants in the USA, are doctors or nurses or teachers in the Philippines. When I was new in NYC, one of my nursing assistants was a doctor in Cebu. He was working as a CNA because he did not pass the exam. I know of a very good friend, an adult Nurse Practitioner who worked as a CNA before she became what she is today, and she is not even a Pinoy.
These CNAs are not considered nurses per se. They do not go through rigorous studies or have responsibilities like a real nurse. Most,if not all, are in charge of cleaning up patients, ambulating them, or assisting them in ADLs of residents in the nursing home. In the hospital, they are utilized as helpers, taking vital signs, turning patients, transferring, and the like. In short, they are not nurses as they claim to be. Do not get fooled of titles.

1. LPN/LVN - this is the shortest route in becoming a nurse. The course is 18 mos to 24 months. Technical training and very little nursing knowledge. They are utilized to give medications and help out a little bit but not much of a responsibility. They work under an RN's license and cannot do physical assessment. Although they are considered nurses, they are not RNs. Their salary is only one half of an RN's.

2. Associate degree in nursing - the shortest and fastest route to become a registered nurse in the USA. It is 24 months only with rigorous training and clinical exposure. All graduates are able to sit in the RN exam. (NCLEX)

I was a professor in one of these courses in CUNY, teaching Fundamentals in nursing.
This degree is bound to be eliminated soon, so that all RNs will have a BSN.

3. BSN - 4 and 5 year curricula, with more extensive studies than the associate degree, however, only basic nursing courses.
I had my BSN from USC, Cebu City. WE were the last 5 year curriculum, but the trailblazers of College of Nursing in USC. Presently, BSN is just 4-year curriculum. All RNs can function in any specialty. This is just a general curriculum, and specialization can be acquired through experience. Most certifications require a BSN. All graduates are able to sit in the NCLEX exam to become an RN.

4. Masters degree in Nursing- It consists of clinical or educational track. The clinical track leads to specialization as a CNS or NP; educational track for research and teaching. This is also the entry level for advanced practice RNs.
I did my Masters degree in a CUNY which is mostly research and a few core courses.
MSN prepared nurses can be Director of nursing or hold higher management jobs, but some prefer just to be a bedside nurse or just a few letters after their names.

5. Post-Masters degree in Nursing - can lead to CRNA,adult, geriatric, family Nurse practitioner. I did mine in the College of Mount Saint Vincent, Riverdale, New York . Core subjects include: advanced pathophysiology, advanced pharmacology, advanced physical assessment I and II. I went straight to II as I have challenged the first one. Being an ER nurse saved me some good brownie points and money, even though, I was also a full-fledged scholar by my father in law.

Most advanced practice nurses have prescriptive privileges depending on the state they are in. I am in NY, and I have full prescriptive privileges since 1999.
Advanced practice nurses are forging the future. We hold high caliber jobs that are tantamount to MD functions and responsibilities. We cover for them when they are on vacation or when they are not available. A lot of clinics utilize NP's nowadays.

There was a study done about patient satisfaction and it revealed that patients are more satisfied with advanced practice RN/NP. The answer is very clear, our approach is holistic because we are nurses first.

Recent developments in nursing made this program disappear so the curriculum/ core subjects are included in the MSN program leading to the same clinical track as NPs or advanced practice registered nurse (APRN). This move actually saves time and money for a lot of RNs who want to pursue the advanced role.

6. Doctor of Nurse Practitioner - something new in the nursing arena, which is more clinical in nature. In 2013, the entry level of all advanced practice registered nurses will be a DNP. Maybe by then, we can sign death certificates. Salaries will be the same, I guess.

I do not need to continue, although I only need a few credits. I prefer to travel the world than go back to school. I think I have enough credentials under my belt and in my cap. Besides, it will not increase my salary any more.

Now that you have the knowledge of the hierarchy of nursing in terms of education, you are able to discern a real nurse from a 'faux' nurse. You can take your pick and conquer the world. Good luck to you all.

Always thank your nurse,
Sometimes the only one between you and a hearse.
~Carrie Latet

Nursing would be a dream job if there were no doctors. ~Gerhard Kocher

Marissa Torres Langseth
RN, MSN, Adult Nurse Practitioner
Board Certified

Sunday, April 25, 2010

HYPOCRISY AND IGNORANCE SHOULD BE ELIMINATED!

HYPOCRISY AND IGNORANCE SHOULD BE ELIMINATED!
By Noel D. De Ocampo, MSN/ED, RN
http://thefilipinonurseforum.blogspot.com/
April 25, 2010

Gays, lesbians, bisexuals, transgender (GLBT) have been in the Philippine society perhaps since the human became human. Since those words were even invented. Why question their involvement in politics? Aren’t they human, too? Don’t they deserve representation just like many other sectors of our society? It’s time to stop the ignorance. GLBTs are productive, too, more productive than most.

I understand that the church has the moral obligation to teach what is right, but teaching to act right should start within their communities. And what is their definition of “right” anyway? They call GLBTs “abnormal”. What about the GLBTs working within the church? What do they do with them? What do they do to clergies found to have been sexually abusing women and children? Is moving them to another congregation or another country the “right” way to address it? Are they even considering sexual abuse of women and children “abnormal”?

“Help the needy.” If you become pregnant while in a Roman Catholic nursing school, you’ll be expelled. Why is that? She needs more help now than before she became pregnant. Expulsion will only increase her burden and lessen the chance of better future for her and her baby. Is this how they support the needy? This should be the time that more support is provided and the school should figure out a way to work on how to finish her schooling. More support, not expulsion. That’s how you help the needy.

There will always be hypocrisy and ignorance within our society, but people are now becoming more educated and can better understand how our acts have been. There is nothing wrong with having certain religious beliefs, but we cannot become fanatics. You don’t have to discriminate just because your pastors and priests said so. They’re all are human, too. They’re not God. They make mistakes, and the way they interpret the religious teachings in the books they read to you are subject to the same interpretation mistakes all human make. I believe their interpretation that GLBTs are “abnormal” is a BIG mistake.

“Do unto others what others…..” Great quote and it’s still great to teach...and practice...

Thursday, April 8, 2010

World-class Filipino Nurses!

Hello dear world-class nurses!


Kamusta mga pogi =)


Last week I wrote a piece on “Top 10 Traits of Successful Speakers”. I was delighted and excited with one nurse’s response. Thank you, Ryan because he asked so many good questions. I have just spent 40 minutes replying to all the questions you raised Ryan and was thrilled with my responses, and when I went to send them, my PC came back with some type of error and I lost all the reply so I got mad for about 30 seconds and then looked for the learning in the situation… Yes, maybe I was meant to share my replies to nurse Ryan’s questions with everyone so, here goes...


This time round, I’m going to be more concise than the first time. If you haven’t read my post from last week, check it out now and see Ryan’s questions below it. Here are the answers to these great questions. I will contextualise all my answers this time and give you examples from nursing with each one. I will try to address the essence of the point in the context of nursing this time and I would like to go as far as saying that these are the traits of a world-class communicator.


Trait # 6: Successful People Make Decisions Quickly

To clarify what I mean by quickly here – quickly may mean 1 minute, 1 day or 1 week depending on the gravity of the decision to be taken. However, successful communicators make decisions quickly compared to unsuccessful people. As a world-class nurse, you would make the decision about what to do with a patient who’s had a fall in a heartbeat. An unqualified nurse would take longer or hesitate on what to do. When you have confidence in yourself, your expertise and know that you make decisions that are ecological (good for you, those around you and the planet as a whole), then you always make good decisions and you can make them quickly, remembering that “quickly” is relative to the situation at hand. Ask yourself where you need to improve your decision making efficiency? Some nurses I’ve talked to tell me that their decisiveness falters when doctors ask them questions in a high-pressured situation. If this is true for you, trust you instinct, your expertise and believe in your ability to make good decisions for yourself and your patients.


Trait # 2: Successful People Make No Excuses

I used to make excuses and give reasons why things weren’t working in my life. Now, I try to turn every negative or misfortune into a positive so that there are no failures, only feedback and no excuses to go with the failures. To give the example, I gave above; - I spent 40 minutes carefully considering these questions from last week’s blog and answering them in detail, when I lost all I’d written. I shouted at my computer for 30 seconds and then decided that maybe the moral of that little mishap was that I should share the answers with all of you. Generally speaking, all successful people turn negatives into positives and don’t make excuses. Learning is a game of give and take of course and sometimes we can learn from others and sometimes we have something to teach others but either way, there is always something to be learned from every misfortune, every “failure”. Think about what you would consider a “failure” or a “mishap” in your nursing career? How do you react to mistakes you make – because we all make mistakes, right? Do you dwell on the mistake or do you look for the lesson and make a change. One nurse once told me that she was annoyed because another nurse couldn’t read her handwriting in the patients’ file so she got annoyed. The problem got worse, animosity and stress increased and her work station was not a pleasant place to be. She hadn’t thought of changing her handwriting to make it more legible or write in capitals because she’d concentrated on the hurt the other nurse was causing her. When she did make a small change to her writing, the other nurse started to help her out more, became her writing buddy almost in helping her with any questions she had and they became best of friends within a year.


Trait # 7: Successful People Make Leaps of Faith

It’s important to clarify here what I meant last week by “taking a leap of faith”. When I use this expression, I refer to taking the first step on the stairs even though you don’t know what’s at the top of stairs. To give you an example, I was recently giving a lecture to nursing home managers and nurses here in Ireland around the topic of communication in “patient-centred care” when a resident from the nursing home that was hosting the talk walked in and started shouting loudly. I had two choices; I could let her shout and demonstrate that flexibility is vital in patient care or I could have stopped and waited for a nurse to escort her out so I could continue. I chose to do the first even though I had no idea what the lady’s words meant or why she was angry. I wanted to demonstrate the essence of patient centred-care in my lecture so I let her speak, without understanding. My audience of 50 learned more about patient-centred care in those 30 seconds than in the remaining 30 minutes. I know that as world-class nurses, you know the importance of taking a leap of faith for your patients sometimes and you do so ecologically, in a way that’s good for you, them and everyone involved. Do remember that “patient-centredness” is not about the words you use sometimes, it’s about the ones you don’t use so you can listen. You nurses have taught me that so keep up the good work.


Trait # 8: Successful People Spend Money to Save Time

To clarify, what I mean by this is that highly successful people know the value of their time. I charge my private clients €250 per hour for communication consultation so I choose to pay to have my car washed in the machine because if I wash it and it takes 30 minutes, it’s cost me €125 and that’s an expensive car wash, even by Irish standards! All I want to say on this one is value your time. As world-class nurses, your time is very valuable. How can you use it wisely so that you get the highest return for your expertise and skills? Are you using your time wisely?


Trait # 10: Successful People Take IMPERFECT Action

To clarify on this point from last week, there are two important words in this sentence – imperfect and action. Highly successful people don’t sit around making their business ventures perfect before they release them. Bill Gates didn’t sit at home until he’d come up with Office 2003 before he released Windows. He released Windows 1995 and then improved on in every year. As a nurse, are you holding back your opinions or your input into the medical system because you’re afraid it’s not good enough or not perfect? If so, change that today and start striving for 80% success in offering your opinions or taking a new action and then improve on it every time after that. Of course, I’m not talking about administering drugs to a patient when I say this. I’m talking about speaking up with colleagues and having your opinions heard, even if they’re not perfect.


I have worked with many world-class professionals and Filipino nurses are among the top 10% of all world-class professionals I’ve worked with, because of your work ethic, your high level of education, your communication skills and your flexibility among other traits.

Keep up the good work and above all, speak up and believe in your expertise!


Warm hugs from Ireland.

Until Next Week,

Marie

Wednesday, April 7, 2010

English Is Our Second Language!

English Is Our Second Language!

By: Noel D. De Ocampo, MSN/ED, RN
http://thefilipinonurseforum.blogspot.com/
April 7, 2010

I don’t want to create animosity, I don’t want to chastise or be chastised, and I will never say I am best in written or spoken English. I can’t say my command of the English language is perfect because I know it’s not, but I think it is very important that Filipino nurses discuss the importance of knowing, speaking, and writing (in) the English language. Katulad ng karamihan, sa mahal kong Pilipinas din ako ipinanganak at lumaki. Mahal ko ang aking sinilangang bansa at mananatili akong marunong magmahal sa ating wika. I’m not saying that all of us are using English primarily at work. Of course it depends on what country you are residing, but English is still the preferred way of communicating, even here on Facebook.

How can we promote ourselves to be the best nurses around the world if we can’t correctly express ourselves in English? How can Filipino nurses convey a message if constructing simple English sentences is considered a challenge by some? I admire those who are continuously posting Facebook messages in English, but I think we all need to be cognizant of how we construct our statements. You can get angry at me, but I’m just trying to be constructive.

Why talk about it? All of us knew that wherever we go, even in countries where English is not used, we tend to speak to locals in English until we realize that they don’t understand the language as well. In nursing school, we use American books, or English language books, as the most common method of learning (and teaching). We had English courses since grade school and half (or more) of our college courses are also in English. We, Filipino nurses should set higher expectations for ourselves. If we were able get through nursing school, we should at least be able to know if the way we are using the English language is right or wrong, verbally or in writing.

There are many ways to improve command of the English language. Read, read, and read. Watch English talk shows. Use Microsoft Word when writing, even for short sentences in Facebook (just copy and paste it). It will tell you if you’ve done something wrong. Use the Thesaurus option to check your choice of words. Practice, practice, and practice, again and again and again. Accept criticisms.

I won’t blame anyone for getting angry at me for saying these things, but I want to again reiterate that I didn’t write this piece to promote myself or to say my command of English is better than all of you. The fact is, Filipinos are still better than most non-English speaking countries as far as command of the English language is concerned. North Americans, Australians, and Europeans respect us for having this asset. Let’s keep that respect coming. Thank you!

Monday, April 5, 2010

TO: YOU, Future Filipino Registered Nurse

Dear Future Nurse,

Good day! First of all, I like to express my warmest appreciation for spending your most valued time reading my letter. It must be pretty hard for you to joggle things up in your hectic schedule, especially now that you are on your way to start all your Nurse Licensure Examination preparations. It has already been a year when I, with my greatest capacity, got ready for the much awaited NLE. I, too, was in the exact position as you are right now a year ago, filled with all the ambivalence I never imagined I would be experiencing—anxious yet excited, determined yet hesitant. That’s why I decided to send this letter, exclusively for you to let you know that you are not alone in this endeavor and that almost every successful Registered Nurse in this world experienced everything that is going on with you right now. I would love to help you in all ways I know. Sana makatulong ‘tong liham ko sa iyo.

After my graduation, I don’t even have a single hint on how I would proceed then. It was like I wanted to end everything in my diploma. No matter how hard I try to convince myself, I was still faced in the imperishable reality: A REGISTERED NURSE SHOULD BE A R.N. However, the path towards success (as we all know) was NEVER easy… especially for someone like me. I am often belittled and underestimated by people. I have always been remarked as the sordid, lunatic, and come-what-may rocker who was expected to live a life of cigarettes, alcohol, and gigs—JUST THAT. I could still vividly remember the term those people used to address me: BASURA. Oh di ba ang sakit! Another factor that made everything much more difficult and complicated was my passion with music. I am deeply in love with it, way before I became madly in love with my fiancĂ©e now. That’s why, arriving at the decision of taking the NLE that time was, for me, as hard as performing a Slapshock song in front of a crowd without even knowing how to blurt a growl! And the worst part is, I have to make the hardest decision of my life on or before my mom’s deadline (tsk!). It’s like a “whether you like it or YOU LIKE IT” thing leaving me with empty options! This means that I have to set aside all my compositions and my guitar, kiss my band mates goodbye, and let go of my ambition to pursue a rock star career (lol) after college.

I bet that right now, you might be undergoing similar situations. It might be a different issue; however, it is still an impediment that keeps you from moving on to reach your NLE goal. Well, don’t fret. Chill... You can check out some of my B.O.A.R.D. E.X.A.M. tips that you might want to try.

B-oard is BROAD
The Nurse Licensure Examination is not the typical exam that you have back in your college years. It’s more like taking an exam of ALL the things that you studied during the time of your BSN program. Unlike your usual departmentalized exams wherein the ranges of topics are most often predictable, the NLE may contain even the rarest ones that you are least expecting to come out. During that time, I begun my review by doing a complete recollection of the topics that I know, I am familiar with, and those that I really don’t know. It would be helpful to take note of the topics that you haven’t encountered yet so that you wouldn’t end up leaving them out. Also, there is a thin line of difference between the topics that you know and that you are ‘familiar’ with for the latter requires a bit more of your mastery. Of course, even if you already have the list of the topics that you already ‘know’ about, it is still very beneficial to allot some time to read or master them once again.
O-verconfidence
It’s unhealthy to be morbidly ashamed of one’s abilities. However, you shouldn’t be too confident that you can do everything. You have to recognize that you too have your own weaknesses and that you might need the assistance of other people. Don’t hesitate to raise your concerns. Consult some RNs you know, your previous professors (in case they are amenable with that) or your review instructors. They can provide you much enlightenment on those topics that you find vague or difficult.
A-mplify!
Amplify everything in you—friends and family ties, faith in the Almighty, and your will power. Fortification of these can further help you endure all the challenges that you might encounter along the way.

R-eadiness
Having been able to prepare your list of review topics and resource materials, you are on your way to proceed with your review per se. Attending classes in review centers are optional. However, if you really feel that you are more comfortable with that type of review strategy then go for it! Most importantly, you have to demonstrate preparedness to what I call your PIES—physical, intellectual, emotional, and spiritual aspects of your present status. If you don’t feel like taking the NLE just yet; maybe because of an emotional upheaval or a physical condition of some sort, don’t be afraid to postpone it. Like in my case, I wasn’t really up for the June NLE that time because I feel that I am not yet ready, that is why I decided and told my mom that I am going to take it in November. I strongly believe that you have to create balance within these four major factors of readiness in order for you to proceed in your NLE prep smooth and sound.

D-art your target
One thing I learned in Philosophy is that “an action is always driven by a motive”. It might help to remember this equation: MOTIVE=TARGET and that TARGET=PASSING THE NLE. You have to set your goals for they will act as your ‘blueprints’ to your success. Some of my friends said that they wanted to pass the board exam because they don’t want to break the ‘R.N. legacy’ in their clan. For some, it might be not reasonable enough. However, for my friends, that reason is strong enough for them to get on their feet and keep working! We all have our personal reasons in taking and PASSING the NLE. Whatever it is, if it keeps the drive in you, well then GO!

E-limination
As our body takes away all the unnecessary entities in it for it to function more effectively, I think it would be reasonable enough to incorporate that ‘dogma’ within your review or NLE preparation period. ELIMINATE everything that might cause distraction. Like in my case, I have to temporarily quit performing with my band because I think it would make me lose my focus. If you think something won’t help you in acing the NLE, naku forget mo muna.

Xeroxed notes are worth your glimpse!
The NLE is fast approaching and you want to stop reading or reviewing. Oops, not so fast. If you still have ample time, try to go over your photocopied notes. You might want to welcome the possibility that, maybe, the topics in there might show up. Never lose a chance! :D
A-ddress check!
It’s a week before your board exam. During my time, I found out my test venue five days before the NLE. I am not good at directions or shortcuts. That’s why I decided to survey the location in order to know my room number and even the route, landmarks and establishments around. Having done so, I was able to reach my testing venue without the hassle.

M-eme early
Nothing beats having a complete eight (or make it ten) hours of sleep. Enjoy your slumber for the biggest day of your Nursing Life!


I hope these pointers I mentioned will help you in a way or two in your venture towards your board exam. As for me, I was euphoric when I found out that I passed the NLE when the results were released in the evening of January 31st of the present year. All of my sacrifices had paid off. Remember the kontrabidas I mentioned earlier that called me BASURA? It was relieving enough that even if I am just the ordinary Tina, I PROVED THEM WRONG by becoming the new RN in town (lol).

Kaya naman tol, maniwala ka sa kakayahan mo at sa Nakatataas na handang tumulong sa iyo. The NLE, though considered as the qualifying exam to become a full pledge RN, doesn’t measure your totality as a nurse. Tol, wala sa score yan o kung nagtake ka agad ng NLE… Ang importante, kapag ganap ka nang may lisensya bilang nars, ay ang busilak na hangarin mong magbigay pagbabago sa sangkatauhan—bilang tao at bilang FILIPINO NURSE.

See you on your oath taking my future COLLEAGUE.







Lovelots,
Nurse Tina