One of the issues I’ve been grappling with is the current trend of people collecting certifications in areas they don’t work in. Just so they can have bragging rights. They do this by using review courses and cramming to take the exam.

In some cases the certifications don’t have a practice component so all they are doing is collecting knowledge.

I think this is bad for certifications, and for specialty nursing.

As I research both areas. I”m going to post my thoughts and what I find.

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Did you know it was easy to produce your own #FOANed Content?

You don’t need a studio or expensive equipment to produce your own FOANed content.  Everyone has access to PowerPoint.   Make your slides, concert them to PDF and in my case I send them to my iPad to an app call DoodleCast.  You then play then as a slideshow and record your audio over it.  Then bingo, you have your own content.  You can save it to YouTune and link to it as needed, or to your local drive.

Give it a try!

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Do you want to provide certification prep classes for your staff but can’t afford it.  Well here’s an idea.  There is a ton of free, open source material out there that you can use.  You just have to put it together.  Set up a document on your intranet, you can use a word document, a PDF or a web page, doesn’t matter, just use what you have available and are comfortable with.  

Download the test blueprint from the certifying agency.

Past the URL of the YouTube video, the web page the wiki article etc, so interested people can access the content.  Once people start using it, you can hold some informal on demand discussion on the subject.

The motivation for your staff is up to you.   

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Other things to think about

The nursing and medical stuff you need to know are obvious, but there are other things to think about that can keep you from achieving that expert status.

  1.  Finaances – I”ve discovered that the stressors of life can distract you from acieving mastery.  Setting a budget, paying off debt made a big difference.  Now I can go to conferences it I wasn’t and not depend on someone else to pay for.  I can take a class that I want, etc.  I use “YOU NEED A BUDGET” which is an app as well as a system, but any of them would work.

  2. Hobbies – You need a hobby, or hobbies and you need to actually partake in them.   You can’t focus on nursing 24/7  or you’ll burn out.

  3.  It’s a lot harder to do it alone than with friends.  Having friends to help and challenge you as well as support you makes this journey a lot easier and enjoyable

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Nursing isn’t taking to FOAMed like the medical community is.  So I was thinking.  How about a CEN (Certified Emergency Nurse) prep course for nurses using #FOAMed concepts.  The tools are there.   We could do it cheaply in cost, but in time on the other hand, that might be a bit expensive.

Not only would nurses who complete the proem be ready to take the CEN exam, but they would also be well grounded in SOME and FOAMed.

Any thoughts, idea’s

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It’s been a bit since I’ve updated this. I’ve been busy and I guess I”m not really a blogger.

So the next step in becoming a Master/Expert in nursing is getting in the habit of reading and updating your knowledge base.

As an emergency department nurse I have to be current in a wide range of subjects and they aren’t covered completely in a single journal. I counted them up this afternoon and I read 94 different journals. Now I don’t read every single one of them from cover to cover. There are a number of tools that can be used to sort through them.

Currently I’m using a program called Read by QXmd ( that gives me the abstract and table of contents of each of those journals, I can pic and choose the ones I want to read. I supplement that with suggestions from people I respect and listen to on Twitter, Google+ and Facebook. I then use an academic login to the school library to actually read the articles. There journals I actually read from cover to cover I actually subscribe to. I subscribe using a combination of professional organizations. ENA and AACN as well as a few others. I subscribe to generic nursing journals using journal subscription service. That way I don’t have to worry about it.

Choosing journals. As I said earlier as an ED nurse I need to be knowledgable in a wide range of topics. I start with the Journal of Emergency Nursing, Critical Care Nurse and American Journal of Critical Care. I get these from my professional organizations. I then read a couple of the Emergency Med MD Journals. That way I know what the Docs are reading and can predict what they are going to be doing, expecting of me. I then branch out to specialty area’s like Pediatrics, Ortho, Cardio, and pre-hospital medicine. From there it branches down to more specialized care and things I”m interested in. The farther down the list I go, the less I actually read. I book mark and store for reference. It’s amazing how many times we’ve heard a zebra in the ED and I’ve been able to grab my iPad and find a reference for some infectious disease or medication no one has ever heard about.

I now schedule myself 8 hours a month for nothing but journal reading. Since I’m a Mac Fan, I’ve got iPhone and iPad so I’ve always got the stuff close at hand when I’ve got a down time or spare moment.

Besides knowing things, you eventually start to get some respect because you start to speak the same language. When calling report to specialty floors, I can speak their language. They start to recognize it. And eventually you get to a point were the docs start asking my opinion on things.

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Time to stop limiting scope of practice! – Repost

Over the past few years state Boards of Nursing have passed rules limiting registered nurses ability to give certain medications. The primary medications are medications used for procedural sedation and rapid sequence intubation.

As i reviewed what documentation that was freely available from the BON’s it was obvious that these rules were based on the fact that themanufacture labeled the medication and anesthetic on the bottle. Not based on any fact, and in a few cases based on information that is at best outdated.

Primary example is the use of Ketamine. At our hospital, the surveyors from DNV (JC Clone) told our DON that it was illegal for nurses to give Ketamine. Didn’t qualify it, just made a blanket statement. Now it’s ok for me to push the paralytic, but I can’t push the Ketamine. I don’t know about you, but I”m scratching my head.

I understand the purpose of BON’s, but the implementation of them is shaky at best. A bunch of nurses who don’t practice nursing, making decision on how I’m going to practice. Some times their decisions don’t make sense. In one state I worked in, it was legal for me to pull a PA Catheter, but it was outside my scope of practice to take out the stitches that secured the inducer before I took it out.. DUH.

The use of medications like Ketamine are becoming a standard of care. Limiting nurses from being able to safely administer medications is actually keeping patients from getting the appropriate care that they need.

So what do we do?

1. Completely redesign and repurpose BON’s. Not going to happen anytime soon.

2. Get an interdisciplinary team together to establish scope of practice and instead of saying NO, establish standard for a safe environment to administer meds.

On a daily basis, I give many medications than can kill my patients. Oxygen, used incorrectly is a toxin. I give medications that have a high risk of anaphylaxis. I give medications that can stop my patients heart of cause him/her to have a stroke. we don’t limit those medication.

In the same states that limit specially trained RN’s from giving those medication, allow EMT-Paramedics with less training to give those medications. In GA the paramedic scope of practice allowed Paramedics to give medications that are approved by the Medical Director.  This means that when I transfer a patient, the paramedic can basically run with whatever meds I’ve got running.

Maybe it’s time for us to get involved.  Talk to our legislators, lobby our BON’s.  Don’t just take it sitting down, stand up and make your voice heard.


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First let me start by saying I’m pro PA & NP.  But my faith in their education system, not so much.

I found 2 applications on my desk when I got to work and a note asking my opinion on them. 

Applicant #1 was a 26 year old PA-C.  went right from undergrad into PA school.  Only health care “experience” was shadowing provider.

Applicant #2 was a new grad DNP.  Went right from BSN program into DNP program.  Only nursing experience was doing clinical.  Only did 800 hours in her program.

Both graduated at top of their class.  We are a small rural organization were all our providers have to be self sufficient.

I had to put a big red NO on the return message.

I just don’t get it.  How can the professional organizations support this.  How can either profession maintain any credability?

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My path to excellence. Step #2 Certification

As part of my ongoing path to excellence I had to look at my certifications.

During that time where I thought I knew everything I obtained both my CEN and my CCRN.  The CEN was a legitimate certification.   I actually knew that stuff.  I had been teaching it for years.

The CCRN on the other hand, not so much.  I crammed for it. I listened to prep courses and took the test.   I used a couple of reputable courses.  But I didn’t really learn it.   The only things I remember from the tapes are the protamine came from fish eggs, and that if you take to much phosphorus, it can look like you have MS.   And I learned I’ll never be able to understand a new york accent.   (yeah some of you will be able to figure out who’s tape I listened to.)

I set out to actually learn the material.   I started carrying reference material with me.  LOTS of books.  This was actually the early days of google.  I asked questions, Looked stuff up and in 2002 I took the exam again.   And FAIL miserably!  I went back and discovered I was just skimming the material because I thought I already knew it.  I started outlining, and making cheat sheets.  I focused my studying on patients I had.  Real patients, not simulated ones.   I studies the night before and was able to ask questions during rounds.

During the next year, something changed.  I had developed the habit of studying and working at it.  My standing among my peers and the Docs had risen greatly, to the point were I was asked to give presentation at Tuesday resident grand rounds.  It wasn’t until I failed though that i was able to learn my failings and REALLY try to change.  in 2005 I took the CCRN exam again and blew through the exam in 20 min, not quite acing it.  I still don’t know an IABP wave form from a hole in the wall.

Another thing happened.  My co workers watched what I was doing, and started along their own path to excellence.  We would meet after work and have study session at Jimmies over breakfast.   (Threw that in for my fellow Baltimoreans).

Without intending to, Others were motivated.

My patient care got better.  After 20+ years I actually felt that I could call myself a nurse.

Take certifications seriously!  Don’t just cram for it.  Take a year, set up a plan and work toward it. Go ahead and take the prep course, but do it as a refresher before you take the test.

Where are  you on your path to excellence?

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So I’ve shown you what I read every month, and given you an idea on what I think a nurses path to mastery should include.

The one thing I didn’t mention is what really got me started on my path.

There was no sudden epiphany, I can’t really give you a time or date when it happened.   But one day I realized I wasn’t as good as I thought I was and I didn’t know as much as I thought I did.

I spent the first 20 years of my career believing that I know more than everyone else.  Yeah I know, what an ego.  I worked military, civilian, flight, I was teaching, even spent some time covering a President.  It started around 2001.  A cocky, “no longer young” nurse started working in one of the US premier teaching hospitals.  Over an 18 month period, I discovered that just about everyone there knew more than I did and was better than I was.  I crammed and got both my CCRN and my CEN.  There PROOF that I knew it all!

Nope, didn’t work.  Every time I turned around, there was something new, or a skill that I didn’t have.  Crap.  All that cramming didn’t work.  Besides,  since I crammed.  I didn’t retain all that stuff.   Still have no clue what a Balloon Pump waveform means.

Then I started to realize what was different about those nurses, who knew more than I did.   They knew in their heart and not just in their brain, that they didn’t know it all.  They approached things thoughtfully with the intent to be a better nurse, not just to prove they were better than everyone else.  That had been my biggest mistake when I took that those first steps to mastery.   I was doing it for the wrong reason.

I won’t argue that my ego still isn’t a strong motivator.  But it’s no longer a sole motivator.

So at that moment I took my first real step along my road to mastery.

Have you taken your first step?

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