Easy to do in the dead of winter, but not always so easy to do when interacting in the world of social media.

Like interactions in real life, social media interactions are spontaneous and off-the-cuff.  And, like in-person interactions, they can also be contentious.

Social media interactions differ, however,  in that they are on display, in writing, and permanent. Yes, blog posts can be altered, tweets removed and facebook posts limited to “Friends”; but screen shots can be taken, pages and texts can be saved.

Basically, if you say it online or send it in a text, you have to assume that you have (a) said it forever and (b) said it to the world.

In our private lives, this may not seem like such a big issue, but what about engaging in social media surrounding professional issues?

Nurses are a passionate group when it comes to discussing, defending and promoting the profession, and that doesn’t change when the venue is social media. Here are ways to keep your cool when topics are controversial, opinions are flying and the heat is intensifying:

1. Put Your Name On It

You are less likely to say anything you will regret later if your name is attached. For some, anonymity is a necessity, but putting your name on the line adds credibility.

2. The 5 Minute Rule

Incensed by what you’ve read and ready to let ‘em have it? Fine, pen that missive! Then walk away for five minutes. Come back. If you are comfortable after re-reading with fresh eyes, hit the send button.

3. Remember…

Do not forget that there is another person at the end of that tweet, post or comment. Tone of voice, nuances of facial expression and other modes of communication are not present in the written word, and things are easily taken out of context. Rule of thumb: if you wouldn’t say it in person, don’t say it in writing.

What if you are on the receiving end of a heated social media exchange?

1. Take a breath.

Although it can feel like you’ve been hit in the chest, take a step back. Don’t respond immediately. The advantage of a written exchange is you have the chance to focus on a response. A second or third read may reveal content missed on the first run through, and waiting ensures emotions don’t get in the way of a calm, reasoned response.

2. Look At the Other Side

Look at the issue from the view of the other person. Maybe it isn’t personal at all, but simply a passionate response to a sensitive issue. Or perhaps it is an inadvertently insensitive response that happens to make some good points along the way.  Those could be worth engaging in a dialog.

If it the communication is just plain nasty, with no goal but to insult you and your mother’s ancestors, your best bet is to ignore it.

3. Don’t Argue

Don’t argue with someone who is angry. Acknowledge the opinions of the opposition and make your own observations if you feel you need to, but don’t waste your energy in getting into an argument vs. a dialog.

Staying cool while navigating through social media waters can be done. Own what you say, don’t hit “send” in the heat of the moment, and never forget you are dealing with human beings at the other end of the wifi. Don’t respond to attacks impulsively, try and look at the other side and remember that it’s useless to argue with someone who is angry.

Even heated discussions via social media can be productive, with simple rules and mutual respect.

Well, just how much money are you likely to see with an MSN under your belt?

Not much more than you did with your BSN, or so notes a recent U.S. News.com article, Weighing Costs of an Online Master’s in Nursing.

The article notes that in many systems, a BSN and MSN graduate will enter the workforce at the same pay grade, and unless a high-paying specialty is chosen, the salary “bump” for the MSN is about $10,000 a year.

Those who become nurse anesthetists can make up to six figures, but can look forward to the possibility of being on call at all hours and that’s if they are accepted in to what U.S. News describes as “fiercely competitive” programs.

And it’s expensive. Per the article, a master’s degree in nursing can cost between $35,000 and $60,000, depending on which university you attend and what program you select.

That’s a lot of money.

For some, the article notes, the MSN is required to move into a supervisory or management role. Others wish to leave the on-your-feet-all-day shift work of floor nursing behind and become advanced practice nurses, where they can practice in a more autonomous setting.

But really, you don’t have to spend five figures and put yourself through years of disciplined study to make a career change, and many nurses earn their MSN and stay at the bedside.

So why do nurses go for that advanced degree, if it doesn’t mean a big increase in salary?

It has nothing to do with money. Or status.

Or ego.

And everything to do with professionalism.

A desire to know. To learn.

To grow.

There’s an internal fire, a drive that you feel when you first start thinking about that degree.

It’s a combination of excitement and dread all at once.

Maybe even a little queasy.

All of the reasons why you can’t do it start to be overridden by why you can do it. Why you should do it.

Why you are going to do it.

If you don’t have this fire, there is nothing in the world that can make you take on the task of earning that degree.

If you do have it, there is nothing that can stop you.

That’s how I felt when I was earning my BSN.

It was an amazing feeling.

If you have your MSN, what was your motivation to go back? Did you have that feeling I described? What kept you going through the program?

And exhausted.

I’ve attended a lot of conferences. Nursing conferences, BlogWorld, BlogHer.

I learned the hard way that it is very easy to overdo it and wear out, when you really want to have energy so you can enjoy the experience.

Here are six tricks I use to make sure I have enough energy to make it through a conference, with some to spare!

1. PLAN YOUR SCHEDULE

Print out the brochure and map out which sessions you want to attend.  You can always change your mind later, but this way you can be sure (a) the sessions do not overlap and (b) you aren’t missing something of interest because you are making a decision on the fly.

2. GET THERE EARLY

Get to the conference location early on the first day. Save yourself the agony of long registration lines. Give yourself some time to check out the layout of the rooms, the location of the general sessions, the restrooms and the location of snack bars, restaurants and coffee.

3. SHOES, SHOES, SHOES!

You will be walking. A lot. Especially at a convention center. Go for comfort. If you have great looking shoes that are also comfortable, great; but unless you are a presenter, no one cares what is on your feet.

4. PACE YOURSELF

There are early bird sessions, breakfast sessions, lunch sessions and parties at night. Some of those “early bird” meetings are at 0600! If you are young and full of energy, that is wonderful! Otherwise, make sure you plan for down-time during the day to recharge. Know your limits. A party tonight will make that early bird session tomorrow mighty difficult.  On a related note…

5. SLEEP

Cut your sleep time and you’ll be dozing off in those sessions you so diligently selected ahead of time. It can be tempting to stretch the night out, especially in a city you’ve never visited, but you’ll wind up losing out on what you paid so much money to attend – the conference. Who wants to walk around like a zombie the next day?

6. WHAT’S YOUR HURRY?

If you can swing it, try to schedule your departure for the day after the conference ends.  Trying to store your luggage, make the last few sessions and high-tail it to the airport on that final day makes for a stressful end to what should be a fun experience. Staying that extra night gives you time to unwind, go through all your swag, put your feet up, and get a good night’s sleep before tackling the TSA and the friendly skies.

The key to a fun, successful conference is having enough energy (and staying awake!) to enjoy the entire event. These tricks help me, if you have any tips for conferences that help you make the most of your trip, share them!

I’m planning on attending a few this year!

It’s a no brainer.

Nurses are patient advocates.

It’s what we do.

We advocate for our patients

We help them advocate for themselves by helping them heal physically, mentally, emotionally.

We assess what they know about their condition and we provide information and resources so they can make informed, intelligent decisions about their care.

It’s such a basic tenet of the nursing profession, one would believe it unassailable.

Right?

Not always.

You see, advocacy is fine when it means protecting patients from medical errors or protecting their privacy.

No one has a problem with that.

Not physicians. Not hospital administrators. Not hospital corporations.

But patient advocacy also means assessing the level of the patient’s knowledge of their condition (including any tests or procedures they are undergoing) and assessing if there are any questions or concerns.

If there is a knowledge deficit, or in plain English, if there are gaps in their knowledge and they want more information or have questions, the registered nurse is obligated to provide the patient with access to that information prior to the test/procedure.

Whatever form this takes, whether answering the questions directly, providing literature, arranging a referral to case management or social services, or withholding the signing of the consent form until full information is provided to the patient by the physician, the nurse is obligated as the patient advocate to act.

Now here’s where it can get a bit dicey.

You see, information is power. An informed patient is an empowered patient, able to make informed decisions in their best interests.

When a patient has not been fully informed of their options, becomes informed and then makes a change regarding treatment, it changes the balance of power in the medical relationship.

And there are some who do not take kindly to an empowered, informed patient.

Physicians. Hospital administrators. Hospital corporations.

It’s rare, but it happens.

What happens is a backlash against the nurse for acting as a patient advocate. Within the scope of practice. Within hospital policy.

As nurses, we cannot lose sight of the fact that patient advocacy is our duty, no matter how difficult it becomes.

Not only is it our duty, but it is our right to practice in our role as patient advocate without fear of professional reprisal or abuse from physicians, administrators or corporations.

It’s not just about us.

It’s about the patients.

It’s a no brainer.

____________

For a look a the case of a nurse fired for exactly the situation described above, check out Arizona Nurse Has License Threatened by Doctor After Providing Patient Education at The Nerdy Nurse, and Fellow Nurse In Jeopardy – Call to Action at iCoachNurses.

When looking at the commitment involved in earning an MSN, it’s nice to talk to nurses who have “been there, done that.”

Part two of my interview with family nurse practitioner Jennifer Scott looks at her practice, the impact of health care reform and her views on the DNP for advanced practice nursing.

You can find Jennifer’s blog at The Nurse Practitioner’s Place.

What is your practice like?

 I work in a Federally Qualified Rural Health Clinic which is partly funded by government grants. Most of my patients either don’t have any insurance and see me on a sliding fee system based on their income, or they have Medicaid. We take almost all types of insurance.

I am a Family Nurse Practitioner, so I see infants ranging from 3 days old to my oldest patient who is 95 years old. I love this mix because there is usually something interesting happening in my day. I see an average of 15-24 patients daily.The closest hospital is 22 miles from my office so I often see acute injuries from the local farming community, tire shops, and local restaurants. The town is very small and only has one blinking traffic light!

I have an awesome working relationship with the front desk staff, nursing staff, and the other health care providers in our practice. We have a true collaborative working system and we are all listened too equally in the practice. In fact, one doctor asked if I could challenge the medical boards because he thought that I could pass them. Talk about high praise! I have never been made to feel like a question that I have asked is stupid. The only thing that I am still trying to do, is break our CEO of calling NPs and PAs “mid-levels”, which is a term that I despise! She’s getting better!

How has health care reform impacted your practice?

Health care reform has impacted my practice in a few ways. There has been an influx of grant money into the health care system which facilitated a larger office space and better equipment. It has dumped a lot of funds into the National Health Service Corps which made it possible to get my student loans dropped from $83,000 down to just $3,000 in three years. This has made it feasible for me to contemplate going back to school to finish my DNP before my credits expire.

I would like to see Florida FINALLY join the ranks of all the other states that allow NPs to have prescriptive authority. I hate to have to bother my collaborating physicians for a script for a sleeping pill. I can’t write the children’s ADHD meds or the men’s testosterone meds either. I can legally write medications that can stop your heart and kill you, but God forbid I help someone get a good night’s sleep!

Health care reform may impact NPs in the future by including the ability to Baker Act an unstable patient, declaring death and signing death certificates, writing home health orders, and maybe one day, independent practice. I look forward to seeing what happens in the next few years.

You have your MSN. Some are calling for the DNP to be the entry-level to advanced practice nursing. Do you see this affecting your practice?

The push for the Doctorate is a hot debate right now. Will it affect my practice? Not likely. Our company has not declared a need for the Doctorate and realizes that we can take care of our patients with the degree that we already have.

I see it as the same push that has been around for years regarding the BSN as the entry level. THAT still has not happened either. I think that if you want to get the terminal degree, go right ahead! Right now, it doesn’t make any difference in practice. There are no additional privileges such as prescriptive authority, better reimbursement, or independence. I doubt that there will be a huge pay grade difference either.

People are wondering if patients will prefer a NP with a Doctorate over a Master’s level NP. I don’t think that they will. Patients don’t care whether there is a DO or a MD behind physician’s names because they don’t know the difference between the two. All they want is someone to listen to them and make them feel better. That’s medicine and nursing in a nutshell.

This time, we’re talking with fellow blogger and family nurse practitioner Jennifer Scott.

Jennifer blogs about her life as a family nurse practitioner at The Nurse Practitioner’s Place.

Today, she provides primary care in a rural health clinic. In Part One of our interview, I asked Jennifer to describe her path into nursing, and to share some advice with those who might be considering a family nurse practitioner career.

How did you come to choose nursing?

My nursing path actually started from a potentially tragic episode. I had pre-term labor with our youngest child and was relegated to bed rest from the 4th month. I had nothing to do but read and I read every book that I could get my hands on regarding pregnancy. The health spark was on!

After the baby was born (full term and healthy), my husband asked what I wanted to do with my life rather than go back to being a cashier/back office clerk at Wal-mart. I thought long and hard (about 20 seconds) and said I wanted to become a nurse.

I started prerequisites for nursing at my local college at the ripe old age of 30 with a 3 month old breast feeding infant.

Where did you obtain your MSN, and why did you choose to go for the FNP program?

I chose Florida State University. It was the only close online program that would not interfere with my full time work schedule. I first tackled the BSN and then onto the first online Master’s level program that they offered.

I knew going into nursing school that I would not stop at being a RN; I wanted to take care of my own patients as an ARNP someday. I graduated with my RN in 2001. I worked on a Med/Surg floor where I had done a lot of my clinicals and felt comfortable.

I hated the idea of “having to get in that one year of Med/Surg” because I originally wanted to become a Labor and Delivery nurse and then a Midwife. I stayed in Med/Surg for 7 years. Those years as a floor nurse help me tremendously, even today.

Do you have any advice for future MSN students interested in becoming APRNs?

• You must be very disciplined and able to complete tasks without an instructor breathing on your neck. I am a professional procrastinator and work better under pressure. Others are really good at tackling things in manageable bits. Every semester I swore that I would turn into that person. Don’t fool yourself for a second that it will happen!

• Warn your family just how much time this program will take.  My youngest child asked one day if I would EVER put down my books. I realized that I was missing a lot of important family time. I made a point of allotting time with no computer or books so that I could become mentally grounded and it helped me to remember why I was working on the program in the first place. Burnout can sneak up on a student just as quickly as burnout can on a regular nurse.

•  Make sure that you completely understand the requirements of the NP programs that you are interested in. Do they require you to travel long distances to take tests or to do check offs? Do you understand the total costs of the program? Can you find good preceptors? Start asking around now, even before you start. I see too many students on the discussion forums begging for information on preceptors in their areas. We are few and far between! I actually precepted with several doctors who didn’t realize that I was trying them on for size as prospective employers. Some didn’t make the grade!

• Make sure that coding is part of the curriculum. Billing properly is very important in  making you a commodity worth keeping in an office setting. It was not part of my program and it actually made working stressful.

________

In Part Two, we’ll talk about Jennifer’s practice, the impact of health care reform and her opinion on the DNP question.

“Knowledge can be communicated, but wisdom cannot. A man can find it, he can live it, he can be filled and sustained by it, but he cannot utter or teach it.”
–Hermann Hesse, German-Swiss writer and poet

It’s the perfect description of nursing education.

It’s the perfect description of nursing.

In nursing, wisdom follows knowledge, builds on knowledge. We become nurses through knowledge; we develop wisdom through practice.

Wisdom comes from caring for countless patients over time; from dealing with life, sickness and death. It develops through resolving crises, by working through stressful situations successfully.

Wisdom comes by learning through mistakes.

Wisdom understands. It understands when words aren’t necessary, when presence is everything. It understands trusting your gut instinct. Always.

Wisdom means knowing when it’s time to stand up and fight, and when to just let it go.

Wisdom in nursing is no different from wisdom in life. It develops through experience, from having “been there, done that”.

As much as veteran nurses would love to impart wisdom to younger colleagues, it isn’t possible. We can pass along “pearls” of wisdom, bits of advice honed by decades of experience, but not wisdom itself.

This is so evident over the course of the first year or two of nursing practice. New graduates arrive full of knowledge and spend the majority of their energy learning the tasks of nursing, the pace of the job, how to put it all together. Then, over time, you sense wisdom in a tone of voice, hear it in a judgment call made without hesitation, maybe note a “pearl” passed along to a colleague.

The best gift we can give future generations of nurses is patience during this process of accumulating wisdom, giving them full support, “having their back”, while they have their opportunity to “be there, do that.

It’s the wise thing to do.

I’d been a nurse for 25 years before I heard that term, and I heard it from my nurse manager.

The “Three B’s of Nursing” are (a) bitching, (b) bickering and (c) backbiting.

Yikes.

Not a very attractive portrait of the profession, is it?

But let’s take another look at those behaviors.

What purpose are they serving? Are they really as negative as they sound? Are they replacing more productive behaviors?

1. Bitching

Nurses “bitch” about management, workload, policies, schedules, overtime, physicians, etc. The definition of the verb “to bitch” is “to express displeasure, grumble.” So, let’s rephrase that.

Nurses express their displeasure with management, workload, policies….ect.

Nothing wrong with that. Nurses have a right to express displeasure with management or workplace issues. “Bitching” is a derogatory term, applied to a largely female workforce, that allows concerns to be minimized.

This is a problem when there is only continual verbalization, with no concrete actions taken by the nurses to force management (or staffing, or a physician) to address the issue. Talk is easy, action is not.

2. Bickering

Bickering is defined as “arguing about petty and trivial matters.”

Another derogatory term that infantilizes the nursing workforce.

Nurses are varied personalities in close proximity in pressure-cooker environments.

Disagreements happen.

Nurses don’t “bicker”.  Nurses have disagreements, and to the nurses involved they are neither petty nor trivial.

This becomes an issue if the problem cannot be solved between the nurses, affects department morale or, most important, affects patient care.

We don’t have to like each other, but we have to respect each other.

3. Backbiting

Call it gossip, call it dissing, call it spite…

I got nothin’ for this one.

Can’t excuse it. Can’t rationalize it.

Can’t explain it.

The only way is stops is one nurse at a time.

Don’t start it, don’t listen to it.

It’s just wrong.

Period.

And so I take umbrage with the “bitching, bickering and backstabbing” image of nursing.

Nurses are assertive professionals who are not passive when confronted with an unacceptable situation, whether from management, other health professionals or their own colleagues.

We need to work on supporting each other; having each others’ backs. Work to make our units collegial, supportive environments so that when we speak up and take action, we know we are not alone.

Keep speaking up, but remember that all the talk in the world won’t change some problems. Take action when you need to take action. Don’t be afraid of disagreements. Get it out in the open and then let it go.

Make sure the gossip stops with you.

And the next time you hear an old “nursing phrase”, look at it closely.

Don’t take it at face value.

These last few posts, I’ve sort of been counting down “my favorite things.”

Maybe I should sing like Julie Andrews!

Or not…

Well, these aren’t exactly “raindrops on roses and whiskers on kittens”, but they are my two main nursing causes!

The National Nurse for Public Health

The National Nurse Act of 2011 (HR 3679) will take the current position of Chief Nursing Officer (CNO) of the US Public Health Service (USPHS), and make it a full time position in the Office of the Surgeon General.

More importantly, it the position would officially become The National Nurse for Public Health.

Why the change? Per the National Nursing Network Organization (NNNO):  “Our goal is to elevate and enhance the position of the Chief Nurse Officer of the USPHS to bring more visibility to the critical role nursing occupies in promoting, protecting, and advancing the nation’s health. “

The National Nurse for Public Health would still perform the current duties of the CNO of the USPHS. In the expanded role, the National Nurse would promote a shift to wellness and disease prevention, develop nurses as community health advocates and promote the nursing profession. (A full overview is on the official site.)

I support the movement for a National Nurse for Public Health; I am on the advisory board of the National Nursing Network Organization. I have watched this grow from a small grass roots movement to what it is today. It shows what “regular” nurses can accomplish!

Check out the list of endorsements here. The latest news can be found on the blog.

The Truth About Nursing

Handmaiden, battleaxe, bimbo, waitress, doctor’s lackey…nursing stereotypes are everywhere: television, movies, books, articles, advertisements. The media portrays us as uneducated airheads – when they manage to include us at all.

Enter The Truth About Nursing. Headed by director Sandy Summers, the group keeps tabs on all media portrayals of nursing, observing, reporting and most importantly, educating when errors are noted.

No organization is too big to take on, no article too small to notice. If nursing is mentioned, The Truth About Nursing is looking to ensure accuracy. And I’m not talking a quick scan – I’m talking line-by-line analysis. Each report is accompanied by a call to action with names and addresses of who to contact with opinions and requests for changes.

Why is this so important? Here is a quote from the Truth About Nursing Mission Statement:

“The Truth About Nursing is a 501(c)(3) non-profit organization that seeks to increase public understanding of the central, front-line role nurses play in modern health care. Our focus is to promote more accurate, balanced and frequent media portrayals of nurses and increase the media’s use of nurses as expert sources.”

This site gets my adrenaline going on a regular basis. Trust me, read The Truth About Nursing and you will begin to change how you view nursing in media.  You will view with a more critical eye, and see not just blatant stereotypes, but the more subtle ways nursing is pushed into background and discredited.

You will also be empowered to speak up, write that letter, make that call, and know that hundreds of nurses are doing the same!

____________________________

I am proud to support both these causes with my time and donations. I recommend checking them out. If you are involved in any nursing causes, leave a comment, and share it with us!

We’re talking worshiping at the altar of the Macintosh.

I’m typing on a MacBookPro, following Twitter on my iPad and waiting for a call on my iPhone 4S. If I was rich, I’d buy any of the vintage Macs on eBay right now.

Yeah, it’s that bad.

So it isn’t surprising that I find uses both the iPhone and the iPad at work.

In terms of recommending apps, I’d go for these four:

1. Google Translate

Google Translate is an iPhone app that translates your words into any of 63 different languages. You type the phrase into the app or state the phrase in English, the phone then speaks the phrase in the language you choose and translates the written phrase for the patient to read.

The patient speaks their response into the phone, which translates it back to you in English. The patient need not touch the phone, you simply hold the speaker in front of them.

The advantage is having a quick translator when going through the translator phones would be too cumbersome. I have one of my ER docs to thank for turning me on to this app. Once it’s on your iPhone, you’ll wonder how you lived without it!

2. Medscape and 3. Epocrates

Medscape and Epocrates are reference apps that give you the ability to look up drugs, drug interactions, and diseases/conditions. I place them together but while similar, there are major differences.

Medscape is free, and includes a comprehensive Procedures and Protocols section. Epocrates is also free, but puts their disease/conditions search behind a pay wall in their Premium version. Medscape includes a in-depth news section. Epocrates’ news is related to medication and sponsored by pharma companies. Epocrates does include a “Tools” section with a large number of “MedMath” calculators.

I have both apps on my iPhone and I am partial to Medscape. With the ability to look up diseases/conditions and procedures, I find myself turning to it more often. Epocrates is great for the calculators.

4. Nursing Essentials

Disclosure: Informed Publishing advertises this app on my blog, Emergiblog.

Nursing Essentials is a reference app developed specifically for nurses. This is actually the perfect app for a new nurse. It’s a good reference for all the basic assessment skills, tube insertions, injection sites, procedures and common drugs.

Experienced nurses will also find it useful. For me, it’s the pediatric calculators and medication list, and I use it to refresh my neuro information (cranial nerves, anyone?). If you run across a procedure you haven’t seen in awhile, this is the app you want in your pocket.

This app is $5.99

__________

I have, and use, all four of these apps in the ER.   I’m always on the lookout for new apps, so if you have apps that you have used and liked (or used and not liked!), leave a comment and share your insights!

An app a day makes me a happy gal – I may need an iPhone with more storage if this keeps up!