mixed results in articles

It appears to be a big month for discussing the nursing career in general nursing journals and magazines. Advance for Nurses highlighted "2010 Nursing Forecast" on their cover, Advance for Nurse Practitioners released their salary results in "Salary Survey Results: good news despite economy," and there's Lippincott's 2010 Nursing Career Directory that came out.

Kind of interesting to read them and come away with mixed reviews. The article Nursing (Job) Shortage discussed the difficulties new nursing grads are having in finding jobs because older nurses aren't retiring in this economy, seasoned nurses aren't venturing out for a position change right now, and the regular workers are picking up extra shifts.

On the flip side, the NP salary results article painted a different impression of the nursing profession. It discussed how healtcare jobs appeared strong, while overall other employment was bleak. It stated that healthcare actually added almost 600,000 positions and the overall NP salary increased yet again (up by >$8000).

Perhaps the difference is in being a new grad vs. already in a position. Perhaps the difference is between finding an RN job vs. an NP job. Maybe there's some bias in the articles. I'm not trying to compare apples and oranges. But I did feel there was a discrepancy among the articles in the overall outlook and impression of where our discipline stands in this economy right now.

From my standpoint, I don't feel largely impacted by the economy. I heard our hospital did a hiring-freeze, which has now been lifted. We did miss our annual pay raise, which I suppose does count for something. But I don't know of anyone who lost a job in our hospital or suffered a pay cut or cut in hours. I suppose even if I took the position that nursing has hit hard times, I have no doubt it will bounce back. The old are getting older, and there will be more and more of them to take care of. Nursing will be needed.

Head Bleeds

Yesterday we had a discussion about a case involving a significant head injury resulting in death. We ended up talking about different types of head bleeds and I thought it would be good to do a refresher.


Subdural hematoma/hemorrhage (SDH): This is when blood collects within the inner meningeal layer of the dura mater, the outer protective covering of the brain. The picture to the right is a CT scan showing a good sized left SDH, which you can see is also exerting midline shift to the right. (Of note when looking at CT scans, blood shows up white, air is black, brain matter grey, and the image is reversed- like a chest x-ray).



Subarachnoid hemorrhage (SAH): This is bleeding into the subarachnoid space, which is the area between the arachnoid membrane and the pia mater surrounding the brain (meaning the area between the brain and the thin tissues that cover the brain). The SAH image to the left shows blood in bilateral sylvian fissures and down the center interhemispheric fissure. The 2 white spots toward the back are not blood but rather normal calcifications.


Intraparenchymal hemorrhage (IPH): This is where there is bleeding into the tissue of the brain. Pretty obvious, that white blotch on the left.


Epidural hematoma (EDH): This is where blood collects between the dura mater and the skull. This is outside the dura, whereas the SDH was below the dura. It's pretty hard to miss that EDH imaged to the right, which is causing midline shift and compression of the left ventricle.


Question: How can someone status post craniectomy (bone flap NOT replaced) still have elevated ICPs?
Answer: Even with a bone flap missing, neurosurgeons almost always still close the dura, which is that tough outer membrane. The dura is tough enough to still limit significant cerebral edema and impose pressure, therefore raising ICP (intracranial pressures).

Haiti Relief

As we all know, unless you're under a rock, there was a large earthquake in Haiti earlier this week that resulted in thousands of deaths and massive destruction. Well, does anyone remember my blog about the new nursing super-union? In response to this tragedy, they have issued an urgent call for nurse volunteers to help in "Earthquake Ravaged Haiti." The National Nurses United activated its nationwide disaster relief program to recruit nurse volunteers to help residents of Haiti following the earthquake devastation. Just to remind everybody, the 150,000-member NNU was formed last month through the unification of California Nurses Association/National Nurses Organizing Committee, United American Nurses, and Massachusetts Nurses Association.

“Nurses will be fundamental to the disaster relief process, to provide immediate healing and therapeutic support to the patients and families facing the devastation from this tragic earthquake,” the Co-Executive Director, Rose Ann DeMoro, said. They are working on sending nurses to provide emergency short and long term medical support, as they have done in previous major disasters, such as Katrina.

What else can I be?

I get asked a lot about my job. What is a nurse practitioner? What do you do? How are you different than a doctor? How are you different than a nurse? And in one of my first blogs I discussed a lot of this. But I also get asked what career alternatives are out there. So I thought I'd mention a few other career options if you think healthcare is for you but not sold on being an NP.

Probably the most similar job is a physician assistant, aka a PA. Like NPs, they diagnose, treat, manage patient's care, prescribe, and order and analyze labs and studies. The main difference is that NPs practice under the nursing model and PAs practice under the medical model, like physicians. Training is also different. NP programs entail earning an MSN (master's in nursing) degree in an area of specialty (acute care, adult, pediatric, etc). PAs spend generally 2 years studying general medical and surgical care.

If you are interested in anesthesia, you should definitely consider becoming a Certified Registered Nurse Anesthetist (CRNA). This is also an advanced practice nurse, requiring a master's degree, and that allows you to deliver anesthesia. Of the practicing CRNAs they are 51% females and 49% males. This is the nursing version of an anesthesiologist.

If you are interesting in delivering babies, you should consider being a nusre midwife. Once again, this is a master's prepared advanced practice nurse, and is similar to an OB/GYN physician. Midwives tend to care for the pregnancies in the no to low-risk category and practice under the nursing model.

There are far more options for a career in healthcare other than these mentioned, but these are options that could be considered largely on par with choosing a career as a nurse practitioner. You could also work as a registered nurse, physician, clinical nurse specialist, nurse researcher, physical or occupational therapist, respiratory therapist, and more. With so many options, you're bound to find a niche that works for you!

Happy New Year

Happy New Year to everyone! And let me tell you, people celebrated! Wednesday before New Year's eve was not too bad in the hospital, but they certainly started rolling in on New Year's eve. In fact, they started coming in around 9am and really just kept coming for the next 24hrs. Fortunately I anticipated this and had a big push for any possible discharges that could be done the day before. That actually cut our list down to half. But on New Year's eve, a new one came in about every 30 minutes during the day and there were 20+ new admissions overnight. That's a whole bunch of new people to round on the next day. But I'm sure it could still be worse.

So let me say, I just do not understand our radiologists. I waited ALL DAY for radiology reads to come back so I could clear c-spines and dc people. I paged them multiple times, and they just couldn't get it to move faster. All I'd get is, "Well, there are a lot of traumas." I'm like, yeah, I know, I'm taking care of all of them and they want to go! It was SO painful waiting until 5PM to get final reads. What's even more rediculous is they read the newer patients first. So I can have a guy that came in a 10am on New Year's day and he gets his CT c-spine read before someone who came in at noon on New Year's eve. Make sense of that, will you? I think for a level 1 trauma center to have radiologists this slow is a crime. The head CT attending radiologist strolls in at 3 pm to do reads. Really? That just doesn't seem right to me.

Anyway, as painful as it was, we have made it through New Years. Of course we still have to make it through Sat night, which is notoriously busy, no matter the month. And sadly it probably gave all the New Year's eve drinkers a day of recovery so they can be back at it tonight.