Monday, November 12, 2012
BELATED HAPPY EIGHTIETH OLDER MAN!
When "only the best is good enough"...HAPPY 80TH DAD!!!
Thursday, November 8, 2012
Tuesday, November 6, 2012
EZRA SKYDIVING OCT. 27, 2012
http://www.youtube.com/watch?v=fhmSoK916N0&feature=fvsr
Wow!
...More balls than I have!!!
Wow!
...More balls than I have!!!
Wednesday, October 24, 2012
DARTON – FALL 2012 10-20-12 PPMH-ED OBSERVATION PAPER
My second
mandated Saturday clinical was another blessing in disguise. Initially I balked
at having to do a clinical on a Saturday, for I only work two days a week, and
they are always Saturday and Sunday. So therefore, I effectively loose a
half-week’s worth of pay every time I pull a Saturday clinical. However, the
primary blessing of these Saturday clinicals was my clinical instructor, Mrs.
Cynthia Chaney. Mrs. Chaney, you truly radiated an inspirational charm that
inspired students towards enjoying their opportunities to learn under your
leadership. I for one feel blessed to have been afforded these two Saturday
clinicals with you, Mrs. Chaney, and I really appreciate every effort and
consideration you contributed towards ensuring that we were each placed into an
area and under the guidance of a nurse that best suited our individual learning
needs.
Now I will focus
on answering the objectives of this assignment. How does the role of the nurse
within the emergency department differ from that of other nurses? Emergency
department nurses are relentlessly challenged with an endless variety of
patients whose needs and conditions are unlimited, and the volume of the influx
of these patients is never predictable. As my primary nurse, Donica, so
eloquently explained, emergency department nurses are expected to be capable of
caring for anything and everything that may walk or be wheeled in at anytime.
Their patients are not confined within any age or specialty categories, and
other than the patients who are brought in by EMS,
have not been pre-sorted or pre-treated by any other medical specialists and
therefore require complete assessments, frequent re-assessments, and a myriad
of treatments. The average number of patients each emergency nurse must care
for far exceeds that of most hospital nurses and each new patient potentially
presents with problems that may be entirely different from those of the
previous patient’s. Emergency nurses are expected to remain current in a
variety of disciplines, and frequently seek to update their knowledge base of
ever-changing treatment modalities and medications as patients are often
presenting with reports of new therapies and varied histories.
Some nurses
may never have to deal with the patient’s family, but the emergency nurse often
does. These family members always broaden the care efforts that the nurse must
extend. Just as the nurse must make a quick assessment of the patient, the
nurse must also incorporate accurate judgments in determining how to
effectively converse with and communicate effectively with the patient’s family
member or visitor. How a nurse responds to the patient’s visitors will often
determine the patient’s response to the medical staff and to their care
efforts, especially when the patient is a pediatric or is mentally impaired. The
emergency nurse’s role should include taking into account the eventual
incorporation of the family into the patient’s care whenever appropriate.
Emergency
nurses are exposed to hazards far beyond those of the average nurse. Emergency
nurses are on the frontline in the war on terrorism and are always at risk of
exposure to infinite threats. As Donica reminded me, emergency nurses assume a
certain element of risk, for they face caring for patients who may have been
exposed to weapons of terrorism, and they quiet likely may unknowingly become
victims themselves. Donica reminded me of the report of the nurses and doctors
who had died as a result of treating the victims of the Tokyo
saran gas attacks. Another sobering reminder of the risks faced by emergency
and flight nurses and flight paramedics was observed outside the trauma
resuscitation rooms. I read the plaque honoring one of each of them, and was
chilled to remember the time that the flight paramedic Michael Elam assisted me
on an emergency ambulance call as a “good Samaritan” volunteering to assist at
a motocross accident in Crawford County, Georgia.
Maybe this is off-track from the objectives of this assignment, but I felt
compelled to acknowledge his contribution towards assisting me in my care of a 17-year-old
race participant who sustained an angulated thoracic spine, paralysis, and
critical internal injuries. That patient was the same age as my son was at the
time, and Michael’s supreme guidance and assistance during what was one of my
most memorable calls of my 30 years of EMS
experience will forever remain etched in my mind. Even though I did not get to
perform anything exceptional clinically speaking, the opportunity to view that
plaque was an occurrence that equated to applying icing on a cake. Therefore, I
view my emergency department clinical rotation within Phoebe
Putney Memorial Hospital’s
Emergency Department as one of the best clinical learning experiences of my
entire 33-plus years in the medical field.
In regards
to the actual clinical learning opportunities I experienced while in the
PPMH-ED, I have mixed emotions. I was assigned to a very serious and
knowledgeable seasoned nurse who apparently availed herself as much as
possible, but unfortunately seemed to be too busy to allow me many
opportunities for skill practicing. Nevertheless, she (Donica) did go out of
her way to instruct me, and once even researched a textbook on the subject of
disseminated intravascular coagulation (DIC) before furthering her instruction
to provide an in-depth answer to a question I had posed. She also allowed me to administer an
intravenous injection of an anti-emetic, oriented me to areas while instructing
me on equipment used within the emergency department, and explained some of the
processes common to the emergency department. She even complimented my quick
detection of missing items from the set-up arrangement in the trauma
resuscitation rooms. After demonstrating a calm and purposeful approach to
assessing a new arrival, she allowed me to accompany her in transferring and
attending the 8-year-old trauma victim to the CT scan. While attending within
the radiology room, she answered questions yet never seemed disturbed by my
barrage of questions. I accompanied her to the blood bank, and witnessed her
correctly verifying the receiving of two units of fresh-frozen plasma (FFP).
Later, in the ER, I observed as she again verified identity and the correctness
of the FFP with the charge nurse and with the
patient before administering the fluids at a wide-open rate of infusion. I
observed her diligence to following the rules of infusion of blood products,
and was reminded of the importance of staying with the patient during the first
15 minutes of transfusion, of the need to do assessments before, during, and
after the transfusions, and of the never-ending need to provide frequent and
thorough documentation on all of her patients.
Although I
do not feel like I gained much experience in actually performing clinical
procedures, I did stay mostly busy, and was able to observe nurses who were
steadily engaged in nursing activities. In the early after-lunch period, I was re-assigned
and was able to observe another nurse’s interactions with one patient. Although
I have nothing negative to say about that experience or about the nurse I was
temporarily assigned to (Ashley), I did gain a deeper appreciation of the attention
that Donica had committed towards ensuring my clinical experience was instructional.
When the opportunity seemed appropriate, I returned to observe Donica in
action, and was rewarded with more instructional opportunities. If it were
possible and practical, I would enjoy more time in clinical observation of
emergency nurses, and probably would request to attend more such activites on a
volunteer basis.
I have
enjoyed my clinical learning experience, and I would like to take this
opportunity to thank you for this wonderful blessing. I guess I am an
adrenaline junkie, and despite having already spent over 30 years in emergency
medicine, I just cannot seem to get enough of the action. This emergency room
was a busy place, but it certainly was not the most intense emergency
department I have ever worked in, for I was trained at the Air Force’s largest
medical facility, which is one of three trauma center in San
Antonio, Texas. However, I was
impressed with the level of the staff’s expertise, their professionalism and
teamwork, and with the layout and the set-up of the emergency department. I
felt honored to be a part of the team and again, I really appreciate the
opportunity you have provided for me. Most of all, I deeply respect, admire,
and appreciate you for your part in providing educational instruction for the
whole emergency department team and for your efforts to lead, motivate, and
inspire each of us as nursing students of the bridge program. You are an
exceptional leader, I admire your style, and I hope you know you are truly
appreciated by all of the students whom I have heard comments from.
Sincerely,
Eric M. Simpson (“EMS”)
Tuesday, October 9, 2012
Wednesday, October 3, 2012
Role Transition Paper
It was due on September 30th. I turned it in on time, but somehow I forgot to publish it "for your reading pleasure"...or possible displeasure. Anyway, here goes "something". I HAD to turn in something...
Abstract
While
carefully considering how the role of a registered nurse differs from that of a
paramedic, how I perceive this change in roles, what I have gained in trying to
make this transition, and where I see this transition potentially taking me in
my future career, I realized that I am undergoing a role transformation
tantamount to a partial metamorphosis. I know it is not as if I am undergoing a
molting and shedding my outer coat, but there definitely is an element of
evolution in my professional-development life cycle. Therefore, I suspect that those
who are scrutinizing my actions and behaviors will soon perceive me
differently, and as a result, may become more confident in me. As I transition
into the role of a registered nurse, the shift in paradigm will encompass five
critical areas of changes. The first area of change will involve the
environment and the routines under which I will perform my duties. The second
significant change will be my becoming a collaborative member of a team of
healthcare professionals (Medical-Surgical Nursing, Patient-centered
Collaborative Care, Sixth Edition, p.3). The third change will be an
opportunity to interface with the patient and their family on a basis beyond
the initial entry into the healthcare system. The fourth change will be undertaking
the responsibility to educate the patient and their family about their current
illness or conditions and actions they can take to improve their overall
wellbeing. Finally, as a fifth change, there will be vast choices in terms of
employment options and educational advancement opportunities.
Role
Transition Paradigm Shift
According to the “taketheleap”
website, you should “think of a paradigm shift as a change from one way of
thinking to another” (http://www.taketheleap.com/define.html).
In preparation for the role transition from paramedic to that of a registered
nurse, I am adjusting my way of thinking for this fast approaching paradigm
shift. Aware that many changes in thought processes must occur, I am shifting
my mannerism from that of a paramedic’s to that of a registered nurse’s. While
critical thinking processes will continue to govern my intellect, my actions
now must comply with guidelines of a new scope of practice, and my mind-set
must adhere to a new set of rules, regulations, policies and practices as I
undertake this paradigm shift. The five critical areas of change that I
anticipate assuming in my transition pertain to:
1-
the environment and the routines under which I
will perform my duties
2-
becoming a collaborative member of a team of
healthcare professionals
3-
opportunities to interface with patients and
their families on a prolonged basis
4-
the responsibility to educate patients and their
families about their current illnesses or conditions and actions they can take
to improve their overall wellbeing
5-
vast choices in terms of employment options and
educational advancement opportunities
The first major change I anticipate
in this role transition is environmental and performance related. As a
paramedic responding to emergencies in a variety of environments, on many occasions
conditions were less than favorable, and often they were hostile and dangerous.
My primary focus and responsibility was to utilize my skills, knowledge, protocols,
standing orders, and the limited equipment that I had available to me on the
ambulance to assess and provide emergency interventions in an effort to resuscitate,
ameliorate, or stabilize patients while on-scene and when transporting them to
the hospital. Due to the inherent nature of the risks involved in such a
variety of potentially hazardous environments, it always seemed to be a windfall
if we could do this, arrive alive, and be well upon termination of the call. As
a field paramedic, I sometimes had extra personnel in terms of first-responders/fire-fighters,
occasionally may even have another EMT or
paramedic to assist on-scene or enroute to the facility, and I always worked
with a partner. However, when transporting, my partner was generally driving,
so I usually had only myself to rely upon to perform whatever care measures the
patient needed. Because I desired that patients have the best outcomes
possible, actions usually were initiated on an impromptu basis; having the
luxury of awaiting for orders was not a viable option. Touting over a
quarter-century of experience and a history of sound judgment, supported by
standing orders and personal recognition from doctors who would later sign for
treatment rendered, as a paramedic I usually performed procedures and
administered medications without hesitation or consultation. Nevertheless, those
actions were all undertaken as a paramedic working in the field under standing
orders. Now I recognize the limitations that govern a registered nurse’s scope
of practice, and I realize that while working in a “controlled environment”, I must
abide by a new set of rules and perform in accordance to the role into which I
am transitioning. That means I now must wait for the doctor to do (or order)
what I previously had done (under standing orders) on my own.
The second major change I foresee with
this role transition is my becoming a collaborative member of a team of
healthcare professionals. The role of the registered nurse is multifaceted and
intertwines with numerous health-team members. Guiding the patient and their
family through an illness or injury and ensuring all members of the care team
have correctly assessed and provided appropriate care is tantamount to
providing the patient with the best care possible. Developing a relationship
with the patient and establishing trust so that accurate assessments are
completed is a critical nursing intervention skill needed for a successful
outcome. This trust allows the patient to share private information and to feel
secure that their confidentiality will be maintained. The registered nurse is
the “relationship builder”. In order to match the needs of the patient with the
appropriate services, the registered nurse must build a meaningful relationship
with the entire team of healthcare professionals. Good relationships can
translate into quality care for the patient. Good relationships with the
patient and their family helps them to be more open to the education the nurse
can provide, and to be more compliant with following instructions, thereby
leading to better healthcare outcomes.
Developing a good understanding of all of the resources available in the
work setting is critical to the success of the registered nurse and to the
survival of the patient. Critical thinking includes knowing how to pull all of
the needed resources and interventions together into a plan that will best meet
the needs of the patient, and is a primary role of the nurse. The knowledge I
have gained over the course of the nursing program will provide the foundation
for assessing the needs of the patient, and will guide me in seeking
appropriate interventions through collaboration with other healthcare
professionals.
Having opportunities to interface
with patients and their families on a prolonged basis is the third major change
I predict upon transitioning to the nursing role. As a paramedic responding to
emergency calls, there was minimal initial contact with the family, and often that
contact ended once a report was given and the patient had been handed over to
the care of emergency room personnel. It was not always that simplistic though,
for many calls did involve non-emergency transports, hospital-to-hospital
transfers, and hospital discharges to residential locations, so family contact
sometimes was sometimes markedly increased. However, I believe while
functioning in the role of the registered nurse, there will be far more opportunities
afforded to interface with both the patient and their caregivers than what was
available to me as a paramedic, and that these contacts will benefit the
outcome of the patient in a variety of ways. For example, for hospitalized
patients, the registered nurse may function as the bridge between the family
and the doctor after the family was not available when the doctor-patient
contacts occurred.
The fourth major change I look
forward to is the responsibility to educate patients and their families about
their current illnesses or conditions, and actions they can take to improve
their overall wellbeing (Fundamentals of Nursing, 7th Edition, p.10).
As I transition into being a nurse, my responsibilities will encompass teaching
the patient and their family. As a paramedic, I voluntarily advanced my
knowledge level, became an instructor in several disciplines, and taught for
several years. However, I mostly only taught allied health professionals basic
and advanced life support classes and all of the teaching was optional; never
was any of it expected as a job responsibility. I enjoy teaching and sharing
knowledge with others. Therefore, I look forward to helping patients develop a
better understanding of their illnesses, injuries, or conditions, and I yearn
to teach them how they can improve their overall wellbeing. Not only are
educated patients more receptive to their care, but family members who were
instructed by a nurse also have a better understanding of the patient’s needs and
are more apt to assist the patient in being compliant with their care
(Maternal-Child Nursing, Third Edition, p.799). Teaching the patient and their
family is one of the main job responsibilities of a nurse, and I anticipate
giving my best efforts in that regard.
The fifth and final main change I
recognize in the transition from the paramedic role to a registered nurse role
is the vast choices in terms of employment options and educational advancement
opportunities. Because I knew the pay and the hours were better, there always
were many more job offerings, the working conditions were less hazardous, and
the physical requirements were less strenuous, for several years I have advised disgruntled or frustrated
paramedics who were either burnt-out (or otherwise unhappy with their current
employment) to consider nursing as an optional opportunity of advancement. According
to information published by the U.S. Bureau of Labor Statistics, “Employment of
registered nurses is expected to grow 26 percent from 2010 to 2020, faster than
the average for all occupations” (Occupational Outlook Handbook, 2012). Now
knowing a lot more about nursing than I did when I began this bridge program, I
am still convinced of each of those benefits to transitioning from a paramedic
to a registered nurse. I also now realize there are numerous areas of expertise
within the nursing field to specialize in, and several avenues to continually
advance within each of those fields.
In conclusion, the final shift that I need to
address is where do I go next? The possibilities are vast. The United States
Bureau of Labor Statistics, Occupational Outlook Handbook, predicts a twenty
six percent-growth rate in the need for registered nurses over the course of
the next ten years. Nursing is predicted
to be one of the biggest growth markets in our country. I am still undecided
regarding my exact next steps. My entire focus has been on getting to the end
of this long and challenging journey. I have learned through some preliminary
exploration that some doors are closing in the hospital arena for nurses who
hold an associate’s degree. Many hospitals have set deadlines for nurses to
obtain bachelor degrees. I have worked to not be discouraged by this, but
rather to see it as another step in my journey. The future holds the promise of
being able to touch the lives of patients and have an impact on their health
and wellbeing. I long for this challenge. My transitioning from performing
according to the roles of a paramedic into the realm of responsibilities expected
of a registered nurse reminds me of the renowned words of Neil Armstrong, “That’s
one small step for man, one giant leap for mankind” (http://www.space.com/17307-neil-armstrong-one-small-step-quote.html). However, I do not feel as
if my transition is equivalent in importance to his accomplishment, for in my
opinion, my transition ranks more along the humble lines of, “That’s one giant
leap for (this) man, one small step for mankind”.
References
Ignatavicius, D.D., & Workman, M.N. (2010). Medical-Surgical Nursing, Patient-Centered
Collaborative Care, Sixth Edition. St.
Louis, MO. Saunders
McKinney,
E.S., James, S.R., Murray, S.S.,
& Ashwill, J.W. (2009). Maternal-Child
Nursing,
Third Edition. St.Louis, MO.
Saunders
Potter,
P.A., & Perry, A.G. (2009). Fundamentals
of Nursing, 7th Edition. St.
Louis, MO. Mosby
Unknown, A. (23 Sept 2012). Occupational Outlook Handbook. U.S.
Bureau of Labor
Unknown, A.,
(23 Sept 2012). Paradigm
Shift, Moving From One Thought System to Another. http://www.taketheleap.com/define.html
Wolchover, Natalie (23 Sept 2012).‘One Small Step for Man’: Was Neil Armstrong
Misquoted?. SPACE.com, http://www.space.com/17307-neil-armstrong-one-small-step- quote.html
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