And so it goes...

"For last year's words belong to last year's language and next year's words await another voice. And to make an end is to make a beginning."
--T.S. Eliot

See you next year!

Nuggets for December 31

It's finally here, the end of 2008. The year always seems like forever for me until I get to December. Funny how when you have your birthday late in the year, it can put things into perspective !

Nevertheless, I'm not going to do a recap of all the best nuggets this year. You'll just have to go look at the rest of them and decide on your own, but here are a few of the latest crop.

Enjoy your 366th day today...it'll be over soon enough and you won't get another for four more years.

From the 'net...

Tight blood sugar control is mentioned in just about every article you read about diabetes these days. This article from the NY Times mentions another great reason to keep your blood sugar controlled--memory loss.

I, like some of my other fellow nurse bloggers, am a big fan of soup in winter. I ran into this handy, dandy red lentil soup one today. Get your protein (when combined with rice, etc.) and enjoy the cold with this aromatic soup. Since we're all coughing and hacking here, it can't hurt!

Did Santa bring you some new shoes? This article from ADVANCE for Nurses talks about what kind of shoes nurses should wear to work.

Goodies from work (or a few things I've encountered recently on the floor...)

Here are some of the pharmaceutical items:

• Short chain fatty acid enemas- This was a big, 60cc syringe of cloudy fluid one patient used twice weekly. This article on ulcerative colitis talks about this treatment.
• Mometasone Furoate - It also goes by Asmanex and we've got a few people using this twisty inhaler lately.
• Vantin - 'Tis the season for pneumonia, especially in SCI patients.

Finally, I had a patient recently with a history of PSVT. Medscape has a great article about this arrhythmia with sections on diagnosis, treatment and a multimedia section with graphics of what an EKG might look like.

More nuggets to come...stay tuned!

The beginning of the end

No, it's not the end of blogging as Monkeygirl is doing, it's the end of the year. And what a year it's been!

In the news today, I saw an article about the vaunted rumor that there will be no more free pens at some of the conferences because of perceived conflicts of interest. What, oh what, I ask, will the docs and NPs bring to impress the floor nurses with now, since there is no more swag? An old, leftover pizza from that drug rep's lunch just doesn't make the same impression as the light up pens and the pens with highlighters AND post-it notes attached. I guess we like them because they're things we can actually use.

As the year counts down, I'm thanking my lucky stars that I came to the VA from Saintarama Rehab. The top three reasons: no low census, no low census, no low census! Some of the things that go with the job aren't the greatest, but that benefits package is great considering everything in these recessionary times.

Finally, I'm thankful that I still have this blog. It keeps me out of trouble and keeps my mind humming. I have so many ideas for next year, I ought to be busy!

The end is near, but this is just the beginning...so stay tuned and have a great night!

Ack!

Nothing like calling in on a Monday morning. The supervisor didn't sound too thrilled, but then again, it's sucks when 1) you've hacked and coughed green stuff all night, 2) you can't talk and 3) you ache so bad you feel as if you've just completed an assignment with 3- 300+ lb. tetraplegic patients.

Back to bed for me...more later.

The party's over...

We survived, even though, the guest list was short again. The crazy weather drove away more than a few people. We did have fun, though. The cold has returned, as I found out when I got the paper today...no ice, yet.

The kids were a riot. Some of them just prefer boxes and bows to toys. You'd be surprised how long three boys were playing with some curling ribbon.

We cleaned up and were done by 2030 last night. We've all got colds now (guess Zicam didn't quite work...) so it wasn't too bad to turn in early. I washed my new scrub sets (came yesterday via mail) and tried to watch one of my new DVDs (I fell asleep before it finished).

More fun next week...from days to evenings again. It's always a trip doing that.

Party? Maybe...

I'm all ready, the food's ready and I got my first call-in at 10AM. One of my friends will be spending her time at the hospital with her hubby. He just had major surgery and is in a stepdown unit, which was not originally how they planned to spend this weekend.

The weather here is crazy. We're seeing rain, when usually in this area, all we'd see now are fluffy white flakes. When you can go outside with a light raincoat, you know something sinister is afoot. We'll just wait and see what happens.

The crock pots are warming away and so is my spiral ham. Off I go to glaze it...more to come.

Happy Boxing Day

Believe it or not, it's a holiday here in the US if you work for the VA. It's not really Boxing Day per se, but W declared it a federal holiday, so most federal workers could get an extra day off. I was at work, but I'll get holiday pay...hooray!

Today was not too terrible. I had the assignment I've had the last three days, so it's been manageable. Get the one guy who gets up up and at 'em right away, so he's happy, then take care of the other two.

For the most part, the other two are very nice, although, the quad is very demanding. He's on the phone constantly, but doesn't want an ECU (no private calls that way). He really needs a Bluetooth with a soft touch button he could use with his one working arm, but that's way beyond what we have at Madison. Sometimes he won't even use the soft touch, much to my chagrin (and it's pretty darned unsafe, too!)

Nevertheless, Oscar and Felix (they really are odd but get along) are doing reasonably well. Felix is in pain a lot, but we medicate him before dressing changes and with his new low-airloss bed with the slick sheet, he can turn a lot easier without him screaming out in pain every time we turn him. He had more pain and problems with his "good" leg today, so hopefully, that is better this weekend. He is a trainwreck in terms of dressings, and he's got grounds for a lawsuit against the place he came from in another state. Thankfully, he is not mean to us (he is upset) but he is thrilled he's at Madison, since we should get him healed up well, barring no other issues.

Oscar has been with us many times. He likes to leave AMA when it suits him. He was here when I started, but left before summer. He's back again, with another suspected caregiver-inflicted wound. It's a doozy and the other hospital tried treating it with a WoundVAC. If only they'd read the instructions about using one with necrotic tissue....arrgh! The docs were aghast when they saw that and away it went as soon as he arrived. We're treating it with the old reliable Santyl moist/dry dressings BID until Dr. Plastic has a look at it after the holidays. Thankfully, it's starting to look better.

'Tis the season for game playing...and I don't just mean with the new games sets that a few families dropped off on the unit yesterday for Christmas, but with the patients, too. We've been having a lot of different varieties.

One is the "Oh, I can't get up to go to therapy" game. This is one of our active rehabbers who's playing this one. He is such a pervert (wiggles his tongue around suggestively when he's getting his intermittent cath) and I really, really wanted to kill him the other night, because he was being such a jerk.

The other game said jerk was playing was "Divide and conquer". Some of our patients try to do this by using the old standby of "no one of this race (color, uniform, you name it) will take care of me right because I'm white/black/Marine/Army/Navy/etc., etc." Said jerk had one of our nurses in tears on my last stretch of evenings. I was really pissed off.

What did he win for that? A smackdown from the neuropsychiatrists. If I would have had one on call, I'd have had them smack him at 2200 while he was up to all his shenaningans, but he had to wait until the next day. They're all off on vacation right now, so they won't harass him until next week. If he were in private rehab, his derriere would be kissing the curb right now since most of them have the "no therapy, no stay" rule. If you decline to go to therapy, you get to leave. Not us, we serve the veterans, and the RPIAs (royal pains in the a*&) really push it sometimes.

Nevertheless, I am happy I survived my holidays at Madison. Now, I'm going to get ready for a holiday party...more to come.

Merry working Christmas

Back to the old grind today, just like yesterday. Should be interesting....more to come. There's lots brewing but with all the work going on, little time to talk about it.

Stay tuned!

So many posts...

...so little time. I can't believe 400 have flown by this fast! Whew.

Work is crazy lately, even though it's not the full moon this weekend. I am so tired. Not sure if it's the hours I'm keeping lately or the virus-of-the-month the doc tells me is going around. We have two people scheduled to go home tomorrow and three arrivals on Tuesday. (I'm so glad I'm off!)

More later...back to decorating before work.

Other random weirdness

Today passed reasonably quickly. I had only one patient and the med wagon again today. Things were pretty good. A few people didn't feel well, so things were quieter than normal. The Slug was still her lazy old self, taking an almost two hour lunch so we got to deal with the doc admitting her patient, but nothing new about that.

My patient was a riot. Instead of complaining to my boss the first thing this morning, as he's been doing for the last few days that I've worked, he sits up and tells me, after I get him a pan of water to wash up with, "Maybe I can get in the shower." "Sure you can," I say, "that's why the bathroom's attached to your room." This works out well, especially with rehab patients, since we can get them to do things on their own when everything is nearby in your own bathroom. (We're an old unit, so each room does not have a private bath attached.)

I go down to pick up a shower chair, which is basically a wheelchair with a padded seat with a hole in the middle. Said patient, who did a wonderful sit-pivot transfer for me yesterday, refused to do it today. I had to go roll out the old, reliable hoyer lift and deposit him on the shower chair. I ran the water, got it the right temp, and rolled him into the bathroom. Once he was in there, he was oohing and aahing to no end. He washed himself from top to bottom pretty well and all I had to do was wash his back. It's amazing how much work it is to get clean from top to bottom, but he did it. I even got the unit blow dryer and he dried his hair to finish up. It wore him out, so he skipped his AM therapies.

He ate lunch in bed and then just before he's supposed to get up and go back down to therapy he says, "I have to take a dump." Yes, the docs call him a simpleton, and yes, he's got those earthy quips to prove it. After about half and hour waiting for the farts to become feces, I convinced him to give up until his bowel program in the evening.

Again, I hoisted him out of bed and into the wheelchair, got him all situated and escorted him down to therapy (the docs want to make sure he actually goes). He goes and hangs out with the rest of the guys and all was well.

I would have put him back in bed, but one of the nurse assistants told him the store was going to be open until 5PM tonight. He got his money and was off to do some Christmas shopping. I made sure he was ready and wished him well.

Finally, I finished up my med wagon paperwork. It is always so much fun. I save some of the work until the end so I can get things squared away when things aren't so crazy. I finished everything and walked out of work to a stiff breeze and light snow. Things should be interesting tomorrow. I just hope I don't freeze my toes in the snow!

More later...

My life and nuggets for December 15

Hello all! I survived the weekend and all the assorted festivities for my birthday. Turning over a speed limit birthday recently on the odometer wasn't as bad as I thought it would be.

Bubba is alive and well and still coughing here and there, but not as much. School was closed today due to weather. With the forecast for the coming week, we'll see how it goes. Dahey is working outside right now and I don't think he was too upset about stopping due to the cold and ice. Thank goodness the heat works on our unit (some places better than others, anyway).

Today, I was passing pills and doing my best to get my patient up to therapy today. I took care of this guy last week, but he stayed in bed. Today, he was motivated. It's amazing how they get that way when the docs tell them they'll be with us until February if they don't get up. We even practiced transfers to and from the commode in the middle of the day (just one of the joys of unscheduled bowel routines...when you gotta go, you gotta go.)

Some of my coworkers just look aghast when a patient tells them they have to go. I guess they're just a little too used to a lot of quads and others who can't tell when they have to go and going on their bowel routine (usually in the AM or after dinner). I figure the unexpected is the often the most important part of rehab--teaching people how to live. And yes, Virginia, living involves a lot more than seeing Santa Claus. It involves boring old stuff like moving your derriere to the commode and toileting.

Surprisingly, my patient was duly proud of himself and his transfer efforts. (I needed backup on the way back to the chair, but we did it.) I made sure I told the therapists so they have something to work with in therapy with him, or at least, they'll have a chuckle or two at their next team meeting.

When I wasn't busy today, I spent some time reading my Nursing Practice in Multiple Sclerosis: A Core Curriculum book. I also cleaned up my locker. Now I can actually find things!

Here are a few nuggets I encountered on the internet when I was working.

I read that one of our patient's had a T6 corpectomy with decompression surgery and cages. This page at Augusta Orthopedics in Staunton, VA shows different cages and how they're used in spinal surgery. If you want to know more about cages and spinal surgery, check out this Google book, Complications of Spine Surgery or this Google book, Motion Preservation Surgery.

One physician even has his own blog about spinal surgeries: http://drlloydhey.blogspot.com/. Another group of medical professionals has a site devoted to spinal issues here: http://www.spine-health.com/.

Finally, if that's not enough spinal issues, check out http://www.spine.org/Pages/Default.aspx for more information on NASS, the North American Spine Society.

And when I wasn't finding stuff on the spine, here's the latest NY Times article about the effectiveness of colonoscopies. We have a lot of patients visiting us for these procedures lately.

Did you know...living with your in-laws can stress you out? It was a very big deal in this Japanese study.

More goodies to come...stay tuned.

Customer service?

I really enjoyed Kim's recent post on the patient/client dilemma. Yes, the business world creeps into every little area, including your friendly, neighborhood hospital, and hospitals run by Uncle Sam, like Madison.

So, since I'm nosy (and a former employee in this business sector), I looked around to see what everyone's been talking about for medical and/or hospital-oriented customer service and here's what I found.

First, I went to Google and did a few arbitrary searches and the results are listed below:

• 17,900,000 for hospitals+customer service
• 12,000,000 for hospitals+bad experience
• 18,200,000 for healthcare+customer service
• 453,000 for healthcare+bad experience
• 463,000 for doctor's office+customer service
• 422,000 for doctor's office+bad experience
• As you can see, this is a pretty popular topic.

Next, I went sifting through some of the results. Not surprisingly, some of the searches revealed more articles linked to bad experience than those linked to customer service.

So what was really interesting about these searches? Many are advertisements for training clerical staff. From one newspaper site, Boston area hospitals employed secret shoppers to check on staff on phones and in doctors' offices. Most likely, they are using secret shoppers based on this article from Houston that shows the bottom line for many hospitals is coming down to customer service. If you aren't nice to people in certain areas of the hospital, they won't come back and spend money on their outpatient services.

Finally, the most interesting thing I came across was this article called "What can we learn from Mickey Mouse" which talks about the book "If Disney Ran Your Hospital" by Fred Lee. This article was interesting because even though it is three years old, people are finding it and still commenting on it.

Here are some of the best comments, including one from the author. I think the last one reiterates what I think and what Kim mentions in a nice, little package.

Comment from: Jane RN, MS [Visitor]
Disney does customer service like nobody else, having experienced it myself in '04. Our comfort was their priority. Nothing seemed beyond consideration, and each employee made us feel welcome. "Disney Hospital" patients would feel safe, appreciated, respected, and more at ease. They would rest better, eat better, heal faster, perhaps even leave sooner. How much better things would be if we truly treated them as our guests rather than as interruptions, or a room number needing meds. I've seen it too often. Are we too proud to provide this level of service?

Comment from: Lisa [Visitor] · http://www.hospitalimpact.org
People do not need a book or a Disney staff to teach customer care, what they need is to look at how they'd like to be treated, "do onto others as you would yourself."

Comment from: Fred Lee [Visitor]
Maybe the best way of saying it is – a hospital without compassion is like Disney without fun.

Comment from: 20 yr. RN - (Familiar with butts and stressed family) [Visitor] (NOTE: this is a comment in regard to a person, most likely a nurse (but not identified as such) talking about dealing with butts and obnoxious patients)
It's not about you and what you have to deal with. It is about compassion for others and what they are having to deal with, having a heartfelt desire to provide the best, "CARE," possible to meet their, and yes, their family members needs. It's about having patients/clients and their families leave the hospital knowing their needs where met in an exceptionally professional and caring manner whether the client leaves the hospital by car or by hearse. The intent is not to create an amusement park in a hospital. It is about being patient/client centered in ones thinking rather than being task centered.

New Change of Shift today

Check it out here! Also, if you like the cool Change of Shift gizmo on the right sidebar of this blog, go to www.blogcarnival.com and get this very same widget for your blog.

Out sick

Not me, but Bubba. The childcare searches were futile early this morning, so I got the pleasure of calling in today.

Meanwhile, Bubba is lying on the couch watching cartoons on PBS and snoozing in between. At least, he's a cooperative patient so far!

More later...

Pick and choose

That pretty much describes my day, or at least the attitude of most of my patients. Two out of three could get up and go in their wheelchairs and both of them opted out. One didn't get ready until just before lunch appeared on the unit.

The tasks of the day weren't terrible--Foley replacement, WoundVAC dressing and managing ileostomies and colostomies. The Slug did get on my nerves a couple of times, but I managed to hide my irritation, since that would just be something she'd enjoy.

Education showed up and we had an impromptu in-service on flushing and drawing blood from central lines. I learned that our facility actually marks the lumens proximal and distal on our central lines. We don't have too many in rehab, since we mostly have folks with PICC lines.

I helped a couple of other nurses on the unit get their people up and out of bed. I try to do this with at least one person a day because I never know when I'll need help doing the same thing. Since none of my people got up, I just rounded and turned people. One of the other nurses, A., set up two of my patients for lunch, so that worked well for me. I fed Mr. I'm going home next week. He's happy to know he's getting out before Christmas.

Two patients left today and none were admitted, so it was relatively peaceful. One patient got to be bed bingoed to another room since he tested positive for MRSA in the nares. It worked out okay since Mr. W. was being discharged and his room, right across the hall, was a MRSA isolation room. Mr. Hogg (not his real name) in the Clinitron didn't mind at all, since he'll have a new roomie who likes to stay up late at night just like he does. I like Mr. Hogg. He's funny and is another artist on our unit. He draws cartoons that are downright hysterical, particularly of staff and the occasional nursing student. One of the characters he drew recently had a cleft chin that reminded me of Hank from the Family Guy.

I finished my paperwork and got to check out some of our VIP patient's photos from his ceremony last week. They were really good and the organizers even had a book made to commemorate the occasion. I'm sure he'll never forget it!

After that, it was time to get my coat and go home. More tomorrow.

The weather outside is frightful...

No fire here, but at least I got a few things done today on my day off. More to come...stay tuned. It's back to the old grind tomorrow.

Everybody's got one...

My dad, who was prone to colorful language for some reason or another, used to have a saying, "Opinions are like a*&holes, everybody's got one." I'm realizing as a rehab nurse that it's not just opinions that everyone has...it's the nosy patient.

You know him/her if you're in a situation where you care for patients for a longer term than your regular acute hospital stay. He/she's the patient who's always wanting to know the "dirt" on the unit and will ask everybody stuff about everyone else.

This patient, if mobile, likes to hang out where the nurses congregate, especially at the nurses' station. Said patient will listen to your every word and then repeat it all over the place. This same patient will also look at your computer screen and printouts whenever he/she gets the chance. Last night, our guy--let's call him Nosy-- was watching everything. He was watching me write notes (I spent a lot of time minimizing my screen) and on my break, he kept trying to read my e-mail. What joy!

So how do you deal with this kind of patient? Our guy Nosy isn't really mean, but he is extremely bored. First, get him something to do. If he's busy, he's not going to have time to talk to you. Our Nosy likes to visit other patients in their rooms and talk, so we let him do it, if the patients agree and it doesn't interfere with any other regularly scheduled business. Nosy always wants to know why people are with us, so we tell Nosy, "Ask him/her. If they want to tell you, they'll tell you." This is one instance where I like HIPAA...it can be used to keep the nosy patients out of your hair sometimes.

Second, if keeping him busy isn't enough, tell Nosy the truth. Here's what we do a lot: "Nosy, I think you're great, but I have work to do here with Nurse X. We have to talk about our work and we can't share that with you. If you go and come back in about xx minutes, we'll be happy to chat with you later."

Finally, if that doesn't work, take your chat with Nurse X elsewhere. We have a staff lounge that is off-limits to patients, so when all else fails, we have to go there. Excuse yourself and disappear.

New sheriff

We're getting a new boss...if he passes the screening.

Nuggets for December 6

Happy St. Nicholas Day to all! It's been a busy week at Hotel Madison, but it's been fun.

Evenings is always a blast of a shift to come back to if only for the havoc we sometimes have with staff. (One was a no-call no-show last night.) Patients are generally good, unless of course, they're busy sundowning. Last night was decent enough, so I am happy for little things. Our shift missed the annual holiday party that our manager has, so said manager sent pizza.

In addition to all of the early in the shift hubbub, we had a TV crew show up to talk to one of our patients. Nothing like having hospital PR staff, the nursing staff and TV people on your floor roaming around just before the craziness of dinner time.

Here are a few of the interesting topics I've encountered recently.

One of my patients I noticed was taking Demeclocycline. I thought it was an odd antibiotic to use until I read this article about SIADH.

Last night, our charge nurse and I were talking about one of our patients who has a tenodesis splint and one who needs one. Another option for this problem: one of our docs talked to a patient this week about getting tenodesis surgery to improve his pincer grip.

Finally, I saw a drug I haven't seen in a long time at our place...good old hydralyzine show up for one of our new patients on the floor. This patient was a character. He looked exactly like a famous criminal and when I checked him to give him the hydralyzine and told him what it was, he denied hypertension. (Surprise, surprise.) He's with us only for a short visit, so he'll easily be home by Christmas.

More later...

Out of order

Everything functioned pretty well today, but the order of our day was a little off with all the excitement.

One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)

I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.

At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.

My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.

He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.

One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!

Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.

One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.

I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...

Nuggets for December 2

Here are a few things that have been topics of conversation on our unit and the things I've discovered about them on the internet. Enjoy!

Can you smell cancer?
This was one of the questions recently that folks were talking about since one of our nurses (actually a couple) has worked in oncology.

"So and so (fill in patient name here) is a real pain"
This patient-focused article from the University of Washington talks about the different types of pain in spinal cord injury (SCI) patients.

Stress and the holidays (an oldie but goodie)
It's not just the patients, but the nurses, too, get a little stressed out this time of year.

Ice and snow are back again

In these parts, the folks have to be reoriented to driving in winter weather. Ahh, there's nothing like the first snow fender benders to slow up your morning.

Today was a typical Monday, where somebody, everybody and nobody worked. Somebody was supposed to gather supplies for the patient going on pass out-of-town tomorrow, everybody knew about it, but nobody did it. An astute nurse who always helps out got the ball rolling and two other nurses (including me) got the job done...by quitting time. What a miracle!

I got assigned the only admission for today. Our doc comes down to assess the patient, and then decides to take said patient up to the clinic where it's more private for her assessment. A little later, we get a call that said patient will be discharged. Huh? Patient just arrived...about an hour ago and ate lunch. This patient had some issues that didn't really require being an in-patient so said doc discharged patient. Said patient will be back tomorrow to work with specialist, which was really the only reason why patient visited us. I'm so glad I didn't start the really long, eye-crossing paperwork!

The icy winds were blowing when I left, but I escaped intact, and only a few minutes late. Another day done...hooray! More to come...

The long and winding road

Do you ever wonder how in the world you ended up where you are now? I do all the time.

I know there are a lot of folks out there in this worsening economy who say, "I need a job that lasts like a healthcare one." For them, I'd like to pass along a few things about my experience.

First of all, yes, healthcare is indeed a necessity. Unlike sales or marketing or computers, everyone needs to have access to a doctor and/or hospital. With that access comes access to a variety of other assorted healthcare professionals, namely nurses.

Nurses are in a lot of places from schools to hospitals to local, state and federal health agencies. Nurses do lots and lots of paperwork in addition to doing patient assessment, administering drugs, general patient care and patient education.

Second, before you go jumping into the nursing school pool, be prepared to wait. Some nursing schools have waiting lists of two or more years. Do your homework!

One of the best books I've encountered that discusses many of the nursing specialties out there is Opportunities to Care: The Pfizer Guide to Careers in Nursing. It has a general overview of issues in nursing and a general overview of the role of nurse in the healthcare setting, as well as career planning and words of wisdom. The most valuable part is that it has lots of little vignettes that describe different specialties. (Shameless plug: you can find the rehabilitation nursing story on page 132 in Chapter 27.)

Third, I'd be remiss if I didn't mention something that LaTonia Denise Wright is always talking about in her blog, My 2 cents. Please, please, please consult a lawyer if you have any legal issues in your past. You might go out and get a degree in nursing, but no school on earth will guarantee that your state will license you if you have certain convictions, which is why you need to get an attorney who knows what will and will not work in your state before you start. Your state Board of Nursing is out to protect the public, not your investment in nursing school.

Finally, if visiting hospitals, talking to people and checking out the nursing program of your choice and its statistics and everything else I've mentioned above hasn't scared you away, and you've got all your prereqs in order, dive in. It's an experience you'll never forget.