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    L Jane Acree

What its Like Losing Dad

Scan0021Today I lost my dad. I’ve never lost an immediate family member before, and I never understood these kinds of feelings. I’ve heard people talk about their loss, but I couldn’t really relate.

Dad and I argued a lot. And then we would each complain about the other to our friends. Then we would drop it and move on. We were both stubborn, bull-headed (and whiny.)

But besides his argumentative side, he was generous and friendly. He was the kind who made friends and kept them. He was genuinely interested in others. And he could always make you laugh.

He progressively deteriorated with time. But he remained in denial and often complained about living in a care home “with all these old people”.

Then there was a sudden decline Tuesday morning, but he could still understand things and communicate a bit.

That afternoon his best friend called to talk and pray for him as I held the phone to Dad’s ear. Dad was in a much lighter mood for three or four hours after that call.

Wednesday, the Hospice chaplain came, and that was comforting. Dad was not able to communicate, but the chaplain prayed over him where he could hear.

Today (Thursday) his respirations were in the 40’s, deep, and quite loud. He could not communicate at all. His eyes remained shut.

I put a Julie True CD in the player, grabbed his Bible, lowered his side rails, and arranged the chair next to him. I sat and held his hand, and talked to him – doubting he could hear me over the breathing noises – but tried anyway.

I read some Scriptures to him but felt that wasn’t what he needed to hear. I had read him the first 30 Psalms on Wednesday. And my spirit told me this wasn’t what he needed today.

So I prayed. His breathing was so labored, even after another dose of morphine, and I knew he couldn’t carry on like that for much longer. I texted Dad’s best friend and asked him to pray for Dad’s peace, and he said OK.

Then I felt to tell Dad all the things from the depth of my soul. “Its OK, Dad. Its OK. I’ll miss you, Dad, but I’ll be OK. You are a good dad. I’m sorry for my part in all of our disagreements, and I forgive you for your part in them. I love you and respect you. I am proud of you. Its OK. You can rest now. I’ll miss you. I love you.”

Then I didn’t feel prompted to say anything more, so I just held his hand and stroked his arm. Next thing – his respiratory rate dropped to the 30’s for a couple of minutes – and stopped. Another minute or so later – another breath – then another breath a while later – then no more.

I could see his carotid pulse – rapid and small – then it became undiscernible. It was 12:45 PM. The caregiver came by the room– no doubt because his breathing had become quiet. She checked him, hugged me, and went and called the Hospice nurse.

I cried. I knew Dad had gone to a better place. But I had lost my dad – and my friend. His skin became pale yellow. His fever resolved rather quickly.

The caregiver returned and held me for a long while. We exchanged stories of some of Dad’s pranks. We both laughed and cried off and on.

She told me she used to go to Dad’s room, when she had time, and hold his hand and talk to him. He would call her his “pretty doll”, and she would call him her “handsome prince”.

Another caregiver said sometimes Dad acted obstinate and would try to kick her. She would play-kick back at him and challenge him to a duel. Pretty soon they would both be laughing, and he would agree to whatever care she wanted to do for him.

As they told me their stories, it was bitter-sweet. They fixed me some tea. The Hospice nurse came, assessed, pronounced, and told me what would be next. She would make all of the phone calls, and I would need to sign papers in the morning.

When I got home, I was struck by how quiet it felt. I couldn’t understand why it should feel quiet. Dad didn’t live with me in my apartment. Why should it feel quiet now that he is gone? But it did feel very quiet.

As I pondered the quiet, I noticed what I can only describe as a large hollow feeling in my chest – like something had been there – and now was missing. I had heard of feeling hollow inside, and I never really knew what that was. But it was real.

I called the people that needed a personal call, and there were more tears. Generosity and kindness abounded. Dad was well loved by many.

I’ve tried to remain coherent all day – but, honestly, I have felt rather confused. I have been wandering around, starting chores, losing items, and feeling sad. But, really, what are you supposed to do on the day your dad dies?

I’ve never been in this kind of place before, and that empty hollow feeling keeps threatening to come back. There are more emails & texts to respond to.

Now its been eight hours and five minutes since Dad left this world. I never knew losing him would be this hard.

Do I have regrets? Yeah. But all I can say now is that he was a great man, and he loved me.

Holistic Nursing – Healing the Whole Person

Holistic nurses should not be defined only by the use of tasks and procedures that are defined as ‘alternative’. Holistic nursing is a way of thinking, reflecting, practicing, and being-in-the-world.

And just as this way of being becomes incorporated into a holistic nurse’s professional identity, it becomes part of their personal way of life.woman doing yoga

So, what exactly is Holistic Nursing? It is all about healing the whole person. Florence Nightingale modeled holistic nursing as care that focuses on unity, wellness, and the interrelationship of human beings and their environment.

The American Holistic Nurses’ Association, 1998, Described Holistic Nursing as: “all nursing practice that has healing the whole person as its goal”.

They may integrate alternative modalities with conventional to treat the whole person. Convential/Alternative Modalities is  shortened to CAM.

Key in holistic nursing is to integrate self-care, self-responsibility, spirituality, and reflection in clients’ lives to facilitate the healing process.

Holistic nursing embraces, as its goal, all nursing practice that promotes enhancement of healing the whole person from birth to death.

The American Holistic Nurses Association (AHNA) is active in integrating this field into accepted standards of nursing practice.

***Holistic nurses can start their own private practice which is rewarding and empowering, but does require planning and work. Many have gone before you and are paving the way for you.

Also called Complementary Health Nurses, Holistic Nurses use many modalities to treat the whole person – understanding that many illnesses originate in our mental, psychological, emotional, and spiritual areas. This field is becoming an increasingly sought-after, niche field.

What types of treatments do Holistic Nurses provide? Your training for practice will include: acupuncture, stress management, aromatherapy, massage, hypnosis, hydrotherapy, balneotherapy, Chinese and Eastern healing practices, and wellness coaching.

How and from whom can I get this training? You will begin with your ASN or BSN and pass your state boards exam.

Next you will earn your HN-BC Board Certification from the American Holistic Nurse Certification Corporation (ANHCC). After that, you may wish to earn your Master’s Degree in Advanced Holistic Nursing.

As in any profession, core values must be identified. In this case, they are as follows: 1) Holistic Philosophy and Education; 2) Holistic Ethics, Theories, and Research; 3) Holistic Nurse Self-Care; 4) Holistic Communication, Therapeutic Environment and Cultural Competence; and 5) Holistic Caring Process. (See references below.)

Notice, please, that “holistic nurse self-care” is centered exactly in the middle of all five core values. You will not see that element being promoted in traditional nursing environments.

More detail on this specialty and receiving training for this field can be found from the following resources, as well as from the two offers at the top, right sidebar of this blog post.

Frisch, Dossey, Guzzetta, & Quinn, 2000

http://scrubsmag.com/10-most-exciting-jobs-in-nursing

http://www.ahna.org/About-Us/What-is-Holistic-Nursing

http://www.discovernursing.com/specialty/holistic-nurse#.VNGbYmjF-So

http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume62001/No2May01/HolisticNursingPractice.html

http://jhn.sagepub.com/

publicrelations@ahna.org

http://www.ahna.org/edu/certificatin.html

 Cheers!

Save Lives in the Air – Flight Nurse

Does saving lives give you an absolute adrenalin rush? Do you love being the one in charge? Then flight nursing might be perfect for you!

What is Flight Nursing? Flight nurses transport unstable trauma or medical patients in critical condition, either in helicopters or fixed-wing planes, for military or civilian entities. Their expected skill level far exceeds that of typical ED nurses.

What do flight nurses do on scene? They may need to perform physician-level procedures to save lives in the air. Their training is extensive and gains them respect.

On arrival to an accident, the flight nurse typically takes charge of the scene. They utilize ground support to assure optimal stabilization and then quickly transport.

What special skills would I need? The flight nurse is a one-man-show in the air. You arehelicopter responsible for every aspect of patient survival. Per established protocols, you will administer medications, perform ACLS, and other first aid procedures to get the patient to hospital alive.

You may even have to insert femoral lines or chest tubes in flight – once you are qualified.

Where do flight nurses work? They typically work out of hospital emergency departments, trauma centers, fire departments, search & rescue outfits, or independent med-evac companies. Military flight nurses are generally stationed in war zones.

How will I know if I would like this field? A few years working in a busy emergency department or large ICU will give you a great education and enough experience to know if you want to remain in emergency nursing. A few life flight trips, as an observer, will cinch it for you.

How much do flight nurses get paid? One website (nursetheory.com) reported $55,000-$85,000.  (payscale.com) reports pay as high as $94,858/yr which includes bonuses. This could vary significantly according to many factors.

How do I become a flight nurse? Once you have your nursing degree, and have a few years  experience working in critical care, you can earn your advanced degree in emergency nursing.

When you are ready, you can sit for the Certified Flight Registered Nurse Examination. Be sure to get trained and certified in as many aspects of flight nursing as possible.

This might include earning your Certified Emergency Nurse (CEN), Certified Critical Care Nurse (CCRN), and Paramedic (EMT-P). Also keep your ACLS current, study Air-Medical Crew National Standard Curriculum, and take an Altitude Physiology Course.

You also want to take these courses: Trauma Nurse Core Course (TNCC), Basic Trauma Life Support (BTLS), Pre-Hospital Advanced Life Support (PHALS), Pediatric Advanced Life Support (PALS), Neonatal Resuscitation Course (NRS), and Critical Incident Stress Debriefing (CISD).

For military personnel, it is the same – plus there is additional, specialized, military training required.

Advice:

Retention rate in this field is high and turnover is low. So, be  patient, and use your great networking skills to get an inside track for the next opening.

Keep your body in shape and have healthy, fun, outlets outside the job to keep your balance for the long haul.

If your heart thrills to save lives at all costs, then flight nursing might be just right for you!

Cheers!

Resources:

http://scrubsmag.com/10-most-exciting-jobs-in-nursing

http://www.healthcare-salaries.com/nursing/flight-nurse-salary

http://nursewithoutborders.org/becoming-a-flight-nurse/

http://seaox.com/wannabe.html

Forensic Nursing

Do you love a mystery? Enjoy watching CSI? Then this field might be just the ticket for you!

What is Forensic Nursing? Forensic nurses collect physical evidence from crime victims, conduct interviews, address emotional reactions to violence, educate, conduct research, and more. They are specially trained to work hand-in-hand with law enforcement and victims/patients.

Forensic nurses may participate in death investigations, sexual assault victim examinations, elder abuse exams, family support, and child advocacy.

What exactly do forensic nurses do? In short, your job would be to solve crimes and catch criminals.forensic investigation

You could expect to be quite self-directed to conduct interviews, collect and manage specimens, take pictures, measure wounds, and analyze evidence.

You would likely be involved with interpersonal violence, emergency and trauma services, patient care facility problems, public health and safety, and death investigations.

What special skills would I need? The forensic nurse should be a good problem solver, critical thinker, have excellent research and communication skills, have a mastery of technical terms, be able to explain in lay-man’s terms, be an advocate for victims, and convey compassion.

They work not only with victims and their families but may also work with confined perpetrators.

Where do forensic nurses work? They typically work in hospital emergency departments, laboratories, or courts of law. But some may decide to advance to become an independent forensic nurse consultant or an international practitioner.

What experience would help me to know if I would like this field? Three to five years experience as an RN (or a lesser period combined with prior SANE, emergency or OB/GYN experience), nursing experience with sexual assault/survivors or victims of violence, and experience in psychiatric nursing would help you a lot.

How much do forensic nurses get paid? One website reported earnings of $1-$4 per hour more than regular nurses with training, education, experience, geographic location all affecting pay.

Another website said the median salary for a forensic nurse is $39/hour ($81,800/year) with a range from around $50,000/year to around $140,000.

How do I become a forensic nurse? Depending on your nursing experience, budget, amount of free time to study, and desired future income, you may wish to obtain certification or take a graduate level course in this specialty.

There are over 500 clinical forensic programs available as well as certificate programs. And Sexual Assault Nurse Examiner (SANE) training will be a very important part of your training.

The International Association of Forensic Nursing (www.iafn.org) offers two certifications  — the Sexual Assault Nurse Examiner (SANE-A/SANE-P) certificate and the Advanced Forensic Nursing (AFN-BC) certificate. Certification may be optional – depending on your preferences and what your employer expects.

Anyone entering this field should understand that it can be very emotionally demanding. You will be dealing with the traumatic effects of violence on a daily basis.

You will need to keep your compassion tank full and the analytical side of your brain fully charged. But the rewards are tremendous for those cut out for this kind  of work.

Resources:

http://www.bc.edu/schools/son/programs/masters/specialties/forensicnursing.html

http://education-portal.com/search/find.html?c1=312&c2=366&c3=ALL&q=ALL&schoolType=locationAll&zip=&state=ALL&clk=artb

http://www.forensicscolleges.com/programs/forensic-nursing

http://www.discovernursing.com/specialty/forensic-nurse#.VM02b2jF-Sp

http://nursingschoolprograms.net/careers/forensic-nurse/

http://education-portal.com/articles/How_to_Become_a_Forensic_Nurse_Step-by-Step_Career_Guide.html

http://scrubsmag.com/10-most-exciting-jobs-in-nursing

http://www.healthcare-salaries.com/nursing/forensic-nurse-salary

http://www.discovernursing.com/specialty/forensic-nurse#.VM02b2jF-Sp

http://www.forensicscolleges.com/careers/forensic-nurse

http://www.theforensicnurse.com

http://www.forensicnurses.org

Cheers!

Telephone Triage and Advice Nurse

Does your back constantly ache after so many years at the bedside? Have you dreamed of being a telephonic triage and advice nurse? Let’s see what is involved.

What does a telephone triage advice RN do?  They sort out patient problems using careful listening, critical thinking, assessment skills, and good clinical judgement.

They use excellent decision-making skills to promote appropriate utilization of emergency services. They help the patient understand the actual urgency of care needed. You can see more detail at work.chron.com .

Who hires telephone triage / advice nurses? According to nurse.com , doctors’ offices, insurance companies, hospitals, clinics, and telephone triage and advice centers hire RN’s for this position.

Typical work surroundings for a telephone triage advice nurse? The work is performed at a desk – using a computer and telephone – and some telephone nurses work from home.

Some organizations hire nurses to be responsible to monitor, on a schedule, only those patients in their caseload. Other organizations hire emergency telephone advice nurses to triage and advise all participants who call them on their shift.

There are also other similar positions. The university student advice nurse gives appropriate advice to university students regarding their health. There are Hospice telephonic triage RN, appointment/advice call center nurses at Kaiser Permanente. and Advice Prescription Refill Nurse – to name a few.

What makes this work different? A typical telephone triage advice RN generally works regular hours, has short-term patient relationships, uses written protocols, receives specific training, and experiences a wide assortment of types of calls.

How to qualify? The RN should have excellent critical thinking skills, possess good telephone manners, typing and computer skills, and have prior triage experience – such as in an emergency department. Generally, a minimum of five years clinical experience is required.

Wild Iris offers an accredited 3 CEU course on telephone triage advice nursing for $24.00 through nursingceu.com at this link.

How much do telephone nurses get paid? According to monster.salary.com , the range is from $57,709 to $76,613, with a median yearly salary of $64,479. Although this may be less pay than you are used to, it also has innumerable side benefits that money cannot buy.

What cities tend to pay better? Cities who tend to pay more for telephone triage advice nurses include: Chicago IL, Minneapolis MN, Fresno CA, Washington DC, and Nashua NH – according to monster.salary.com .

What other information should a telephone triage advice nurse know? They should know locations and phone numbers of physicians that are on call, which hospitals are on drive-by status, be able to submit prescriptions to pharmacies per physician’s orders, utilize patients’ emr’s to help connect reported symptoms to known conditions when applicable, and more – according to the job description listed at bouldermedicalcenter.com .

It is an autonomous and very responsible position, protected by protocols, but is also very closely inter-related with the other disciplines.

If this helps, or if you have additional information to add, please share in the comments section. Your contribution is very valuable.

Cheers!

Be a Diabetes Educator

Want an office of your own? Want to be consulted by the doctors? How about becoming a Diabetes Educator – AKA Diabetes Self-Management Educator (DSME)?

What are the five main functions of the Diabetes Educator? Assess the patient’s specific educational needs, identify their goals, educate, evaluate, and document. Rinse and repeat as needed.

The Diabetes Educator may be consulted to provide education on all needed aspects of diabetes and treatments to both adults and children.

Diabetes Educators bill insurance companies for their services just like doctors do. They normally work in physicians’ offices, hospitals, home health, clinics, and with wellness programs.

When looking for specialized training in this field, be sure your selected program for Diabetes Education is an Accredited Program and meets the national standards for diabetes self-management education. Look for the letters: DEAP.

American Association of Diabetic Educators offers guidance and recommended, approved resources – including information on becoming certified.

Not all DSME’s are nurses. Some of the other professions that may become diabetes self-management educators include: clinical psychologist, optometrist, occupational therapist,  physical therapist, MD, DO, podiatrist, pharmacist, dietitian, physician’s assistant, as well as quite a few other professions. (See http://www.ncbde.org/certification_info/discipline-requirement/ for a longer list.)

How long is the training? As most of the courses are online and self-paced, how long it takes to complete the work depends greatly on the individual. Here are a few of the courses available:

Capella University advertises self-paced online training.

Teachers College Columbia University offers totally online MS courses designed for the working person.

The University of Phoenix, and others, may also be good options.

Expected pay? $115,500 – $145,500 is advertised for a Diabetes Clinical Nurse Specialist in San Francisco according to Clinical Management Consultants , per Indeed.

A starting hourly rate of $31.39 is offered for a Certified Diabetes Educator with BS in Nursing (or) BS in Nutrition  in Oregon according to Peace Health (also per Indeed.)

USA Jobs is advertising a Diabetic Education Nurse position for the salary of $68,398.00 to $83,788.00 / per year.

Since the pay varies so much, from job to job, one must consider the qualifications required for each position. Obviously, to command a six figure income in this field, one must possess higher qualifications.

However, there is no shame in starting off at the pay normally offered to nurses since you will be functioning in an elevated capacity and gaining valuable experience.

Once you are qualified, Endocrine Society offers a place to post your resume to be seen by employers across the country.

As part of one’s preparation for this field, one should strongly consider learning the Spanish language fluently. Diabetes is increasing dramatically among the Hispanic population.

After 1000 hours (at least 40% of which are earned in the most recent year of application for certification) clinical experience working in the field, one may apply to become certified. Earning your CDE brings greater earning potential and many other benefits.

Additional resources are: http://www.discussdiabetes.com and  http://www.diabeteseducator.org

If this information sparked your motivational juices, please let me know in the comment section!

Cheers!

Autonomy of a Wound Care Nurse

tiny flowers 001What motivates a nurse to specialize in wound care? Salary is reported to range from $44,190 to $95,130. Work hours tend to be daytime with weekends and holidays off. And there is very rarely a wound care emergency.

The wound care management niche is greatly appreciated, since not all nurses possess the skills or knowledge to fulfill this vital role.

With the aging population, namely the baby boomers, demand for wound care nurses is expected to rise.

Wound care nursing is unique in that it is the nurse who creates the treatment plans for patients for whom they have been consulted. So there is that added responsibility and prestige.

Within the healthcare industry, wound care nurses are considered leaders, educators, and consultants.

What education and training is available? With certification as the goal, a nurse should have their bachelor’s degree and their current RN license.

Plus, in order to qualify to certification, they should either: successfully complete an accredited wound care program, earn a graduate level nursing degree that includes clinical work, or finish 50 wound care CE hours recently.

Wound care education programs that prepare nurses for certification usually last about two to three months.

In what settings do we usually find wound care nurses? Wound and ostomy care nursestiny flowers 003 normally work in hospitals, nursing homes, wound care centers, long term care facilities, hospice, public health, and/or home health settings. And there can be cross-overs for some.

Is there career advancement for wound care nurses? Yes. Wound care nurses may move up to advanced practice nurses, researchers, supervisors, administrators, educators, or expert consultants.

In a wound care center, opportunities for advancement might be greater than other work environments.

Are there positions available for travel wound care nurses? Yes, indeed. There are many RN wound care travel nurse jobs offered online.

The wound care nurse who used to come to assist with patients at my previous hospital had her master’s degree in wound care nursing. She worked quite independently. She educated patients, families, and even hospital staff.

She was mainly a home health wound care nurse, but she was the one the doctors consulted for complex wounds or new ostomies in our hospital’s patients.

I asked her how she liked her work, and she said she loved it. She said she particularly enjoyed the independence. But she admitted that being able to focus on just one aspect of patient care was also very freeing.

She told me she enjoyed great job satisfaction when she could actually see the rewards of her work and watch wounds healing. That was a big motivator for her.

Does this sound like something you might enjoy? If so, I hope you investigate it further while you are thinking about it.

Cheers!

Resources:

Johnson&Johnson https://www.discovernursing.com/specialty/wound-and-ostomy-nurse#.VK78ASvF-So

Careers http://www.innerbody.com/careers-in-health/how-to-become-a-certified-wound-care-nurse.html

Indeed http://www.indeed.com/q-RN-Wound-Care-Travel-Nurse-jobs.html

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