OH, WELL. LET'S GO BACK TO THE BEGINNING AND I'LL GET IT ON THE TAPE.
FLORENCE NIGHTINGALE DEFINED NURSING OVER 100 YEARS AGO
AS THE ACT OF UTILIZING THE ENVIRONMENT OF THE PATIENT
TO ASSIST HIM IN HIS RECOVERY.
ONE OF MY FAVORITE STORIES ABOUT FLORENCE NIGHTINGALE IS THAT SHE WROTE IN HER NOTES
IS THAT SHE FOUND THAT IF SHE OPENED THE WINDOWS IN THE ROOM,
THAT A PATIENT WOULD ACTUALLY TURN TOWARDS THE LIGHT,
JUST LIKE A PLANT TURNS TOWARDS THE LIGHT.
BECAUSE WE ARE DRAWN TO LIGHT. WE NEED THE CLEANLINESS.
AND SO THAT WAS SOME OF HER OBSERVATIONS AND PREMISES AND WE'VE BUILT ON THAT.
BUT WE'VE COME A LONG WAY SINCE THEN AND WE DO A LOT MORE
THAN JUST HAVE CLEAN ROOMS AND WELL-LIT ROOMS.
BUT WE NEED TO BUILD ON THAT PRINCIPLE
BECAUSE PATIENTS STILL NEED CLEANLINESS AND THEY STILL NEED LIGHT.
YOU NEED TO OPEN THE WINDOWS SO THAT THEY CAN SEE.
BUT ONE OF THE DEFINITIONS -- AS WE'RE LOOKING AT ALL THE DEFINITIONS
THAT ONE OF THE MAJOR THEMES IS NURSING IS CARING.
I DON'T KNOW WHY THAT'S FLICKERING OFF. THAT'S WITH THE NEW THING.
NURSING IS CARING. IT'S COMPASSION.
IT'S A RESPECT FOR EACH CLIENT'S DIGNITY AND PERSONHOOD.
EVERYBODY IS DIFFERENT. EVERYBODY COMES WITH A UNIQUE SET OF CIRCUMSTANCES,
CULTURAL EXPERIENCES, EXPECTATIONS AND WE HAVE TO CARE FOR EVERYONE.
AND IT'S REALLY A WONDERFUL PRIVILEGE TO BE ABLE TO DO THAT.
ANOTHER THEME IS THAT NURSE IS AN ART.
AND I HAVE SOME PICTURES THAT I WANT YOU TO SEE.
AND I HOPE THIS JUST DOESN'T FLICKER THE WHOLE TIME
COS THAT WILL JUST BE REALLY A NUISANCE.
BUT I WANT YOU TO LOOK AT WHAT NURSING IS IF YOU TAKE IT FROM AN ARTISTIC POINT OF VIEW.
NOTES AND THEMES.
IF YOU HAVE TO SUMMARIZE WHAT YOU SAW AND WHAT YOU FELT,
WHAT ARE SOME ONE-WORD DESCRIPTIONS THAT COME TO MIND.
HOLLER 'EM OUT. WHAT DID YOU SEE?
- CARING. - CARING. WHAT DID IT LOOK LIKE TO YOU?
- COMPASSION. - COMPASSION.
WHAT ELSE DID YOU SEE? - TOUCHING.
- TOUCHING?
WHAT ELSE?
- LOVE. - PARDON ME?
- LOVE. - LOVE.
- I SEE SMILES. - SMILES. THEY'RE ENJOYING THEMSELVES.
WHAT ELSE?
- NURTURING.
- ART LOOKS DIFFERENT. IF THERE IS A LOOK ABOUT IT.
I CAN TELL YOU WHAT IT DOESN'T LOOK LIKE.
I CAN REMEMBER THE FIRST TIME I WAS TEACHING A NURSE AID CLASS.
OH, GOODNESS, 15 YEARS AGO AND I HAPPEN TO BE --
WHAT DO THEY CALL THOSE "JACK AND JILL" ROOMS.
YOU KNOW, WHERE YOU HAVE A ROOM ON EACH SIDE AND THEN A BATHROOM IN THE MIDDLE.
AND THAT'S KIND OF HOW IT WAS IN THIS NURSING HOME.
AND I WAS CARING FOR A PERSON ON THE RIGHT SIDE,
WAS IN THE BATHROOM OF THE MIDDLE
AND I HAPPENED TO LOOK IN THE DOOR OF THE LEFT SIDE.
AND I SAW A NURSES AID FLIPPING THE LEGS OVER
AND BEING REALLY SHORT AT THE GUY AND I WENT, "WHOA!"
AND I JUST WALKED INTO THE DOOR AND WENT...
YOU KNOW? SHE KNEW SHE WASN'T CARING.
BECAUSE CARING LOOKS DIFFERENT.
THERE'S TOUCHING. THERE'S EYE CONTACT.
DID YOU NOTICE THAT THEY WERE DOWN ON EACH OTHER'S LEVEL?
DID YOU NOTICE THE CLOSENESS OF PEOPLE?
SOMEONE SAID TOUCHING, BUT THERE'S ALSO A SPACE ISSUE.
MOST OF US HAVE A SPACE. HAVE YOU NOTICED THAT?
THAT YOU NEED ABOUT THIS MUCH.
AND YOU DON'T LET EVERYONE INTO THIS SPACE BECAUSE
OH! THAT'S A LITTLE CLOSE.
BUT YOU KNOW WHAT? WHEN YOU'RE A NURSE,
PEOPLE ALLOW YOU INTO THEIR SPACE BECAUSE THEY NEED HELP.
AND YOU GET TO BE IN THAT PERSONAL SPACE.
WHAT A PRIVILEGE THAT YOU HAVE OVER MOST PEOPLE AND PROFESSIONS AS WELL.
WELL, NURSING SEES PEOPLE AS VALUABLE.
THEY SEE PEOPLE AS SOMEONE'S LOVED ONE.
SOMEBODY LOVES THEM. AND IF THEY'RE NOT LOVED BY SOMEONE,
IF THEY'RE AN ALONE PERSON, GOD LOVES THEM.
THEY'RE SEEN AS VALUABLE TO SOMEONE.
WELL, ANOTHER THEME FOR NURSING IS THAT NURSING IS A SCIENCE.
IT'S BASED UPON A BODY OF KNOWLEDGE THAT'S ALWAYS CHANGING
WITH NEW DISCOVERIES AND INNOVATIONS.
AS WE BREATHE SOMETHING IS BEING DISCOVERED,
SOMETHING IS CHANGING, WE CANNOT...
THAT'S THE WONDERFUL THING ABOUT SCIENCE.
WE ARE COMING UP WITH THINGS TO BETTER CARE FOR PEOPLE
AND TO HELP US WITH OUR LONGEVITY OF LIFE,
WITH OUR QUALITY OF LIFE THAT WE HAVE WHILE WE'RE HERE.
AND THIS IS WHAT I THINK SCIENCE LOOKS LIKE.
NOTE SOME OF THE DIFFERENCES.
THAT LAB RIGHT THERE IS 50 YEARS OLD.
50.
WE'VE COME A LONG WAY, BABY, IF YOU KNOW THE PHRASE.
THAT'S A MED CART.
I LOVE THAT PICTURE.
STUDENT NURSE SUCTIONING AN ELDERLY MAN.
MONITORS.
WHAT DO YOU NOTE THAT'S DIFFERENT THAN ART?
WHAT'S DIFFERENT ABOUT SCIENCE?
- IT'S NOT SO WARM.
- IT'S NOT VERY WARM, IS IT?
WHAT ELSE DO YOU NOTICE?
- IT'S JUST THE TECHNOLOGY.
- IT'S JUST TECHNOLOGY.
WHAT ELSE?
- IT JUST LOOKS MORE SYSTEMATIC AND METICULOUS.
- UH-HUH. YEAH. SURE.
WHAT ELSE?
WE'RE NOT JUST SCIENCE.
BUT WE'RE NOT JUST CARING EITHER.
SOME OF US ARE REAL GOOD AT JUST CARING.
GOOD AT IT.
AND SOME PEOPLE ARE JUST GOOD AT SCIENCE. THEY JUST GET IT.
AND THERE ARE A VERY SMALL PORTION THAT COME HERE TODAY THAT HAVE BOTH.
VERY SMALL. BUT THAT MEANS THAT BOTH OF THEM ARE LEARNABLE.
SO IF YOU'RE GOOD AT SCIENCE, WE CAN TEACH YOU TO CARE.
AND IF YOU'RE GOOD AT CARING, WE CAN TEACH YOU SCIENCE.
BUT DON'T THINK YOU'RE JUST GOING TO BE ALL ABOUT ONE
BECAUSE WE'RE GOING TO BE CARING FOR PEOPLE AND THAT'S CRITICAL.
THIS PICTURE DIDN'T TURN OUT VERY GOOD WHEN IT CAME ONTO POWERPOINT.
BUT THIS IS ACTUALLY A NURSE TAKING A TEMPERATURE OF A CHILD, IF YOU CAN SEE IT AT ALL.
AND SO WHEN WE PUT NURSING, THE CARING AND THE SCIENCE TOGETHER INTO PRACTICE,
THE QUALITY OF CARE PROVIDED TO CLIENTS IS AT A LEVEL OF EXCELLENCE
THAT BENEFITS THE CLIENTS IN INNUMERABLE WAYS.
YOU KNOW, RECENTLY, A FRIEND OF MINE, HER HUSBAND JUST DIED.
AND I HAD SPOKEN TO HER AND THE FIRST THING SHE SAID --
I'M A NURSE AND SO SHE WANTS TO TALK ABOUT HOW WONDERFUL NURSING IS.
I SAID, "OH, REALLY. WHAT DID THEY DO?"
"OH, THEY WERE SO WONDERFUL. WHEN I CAME IN, THEY PUT A BLANKET AROUND MY SHOULDERS.
AND THEY MADE SURE EVERYONE HAD A PLACE TO SIT WHEN THE FAMILY CAME TO VISIT.
AND AFTER MY HUSBAND DIED, THEY WALKED ME OUT TO MY CAR."
WHAT DO YOU HEAR? - CARING.
CARING. THERE WAS NOT ONE SCIENTIFIC THING THAT HAPPENED.
THERE WAS NOTHING ABOUT THE MEDS. THERE WAS NOTHING ABOUT THE MACHINE.
THERE WAS NOTHING ABOUT HOW THEY KEPT UP WITH HIS PROCESSES OF ELIMINATION. NO.
THEY CARED FOR THEM AND RECOGNIZED THEM.
SO YOU'RE CARING GOES BEYOND EVEN JUST PATIENT, BUT IT GOES TO FAMILY.
BUT IF WE DON'T CARE FOR THEM IN A SCIENTIFIC WAY
AND MEET THEIR PHYSICAL NEEDS, THEN WE'RE OF NO VALUE TO THEM EITHER.
WE HAVE TO BE MORE THAN THAT.
WELL, NURSING IS A SCIENCE.
IT'S CLIENT-CENTERED.
IT'S CONSCIENTIOUS.
IT'S KNOWLEDGEABLE ABOUT THE CARE IT PROVIDES.
IT'S HOLISTIC. IT'S ADAPTIVE.
AND IT'S A HELPING PROFESSION.
NURSING AS A PROFESSION IS CONSCIENTIOUS, KNOWLEDGEABLE
AND RESPONSIBLE TO SELF AND OTHERS.
SEE WE KIND OF TRANSITION.
WE'RE A NURSE, BUT WE'RE A PROFESSION.
WE ARE NOT A TECHNICAL PERSON ANYMORE.
THAT'S A DIFFERENCE BETWEEN A NURSE'S AIDE AND A NURSE.
THEY'RE DOING TECHNICAL. THEY'RE TASK ORIENTED.
THEY HAVE THINGS TO DO AND THEY JUST DO THEM.
AND SOMETIMES WE WISH THAT WAS US. IT WOULD BE EASIER.
BUT WE'RE A PROFESSIONAL. AND WHAT DOES IT MEAN TO BE A PROFESSIONAL?
THAT WE HAVE, ONE, SOME AUTONOMY AS WELL.
BUT WE'RE KNOWLEDGEABLE AND WE HAVE RESPONSIBILITY
NOT ONLY TOWARDS OURSELVES, BUT TO OTHERS.
BUT NOT JUST TO OTHERS, TO OURSELVES AS WELL.
IN ADDITION, PROFESSIONS PROFESS OR POSSESS...
A LOT OF DIFFERENT THINGS.
WE HAVE EXTENDED EDUCATION. THAT'S WHY YOU'RE HERE.
YOU DON'T JUST GO BE A NURSE BECAUSE YOU WANT TO
OR YOU WERE SICK AND SOMEONE HELPED YOU
AND YOU THOUGHT THAT WAS WONDERFUL AND YOU WANT TO HELP PEOPLE TOO.
IT'S GOT AN EDUCATIONAL BASE, SOME THEORETICAL FRAMEWORKS
FROM WHICH WE BUILD OUR PRACTICE.
WE DON'T WORK AS UNTO A VACUUM
AND JUST DO WHAT WE THINK WOULD BE BEST.
WE WORK BASED ON EDUCATION.
THAT'S WHY ON THAT FIRST DAY WHEN I MET YOU, I SAID, "TRUST BUT VERIFY."
THERE IS A BODY OF KNOWLEDGE OUT THERE
THAT YOU'RE GOING TO BE REFERRING TO THE WHOLE OF YOUR CAREER.
ONE OF THE PHRASES YOU'RE GOING TO HEAR FOREVER
IS THAT WE'RE A LIFELONG LEARNERS.
ACCEPT THE FACT RIGHT NOW THAT YOU'LL NEVER KNOW EVERYTHING.
YOU CERTAINLY DON'T NOW, MOST OF US KNOW THAT,
BUT WE ARE LIFELONG LEARNERS. AND IN FACT, ONCE YOU GET YOUR LICENSE,
YOU ARE REQUIRED TO GET 30 HOURS OF CONTINUING ED EVERY TWO YEARS.
BECAUSE THEY KNOW THAT THERE'S MORE FOR YOU TO LEARN
AND THEY DON'T WANT YOU TO GET LAZY ABOUT IT.
THEY WANT YOU TO KEEP UP AND GET YOUR EDUCATION.
SO WE HAVE A BODY OF KNOWLEDGE.
OUR MEMBERS HAVE AUTONOMY IN DECISION MAKING.
I CAN DECIDE WHAT'S BEST FOR MY CLIENT.
I CAN DECIDE WHEN TO INITIATE SOME THINGS.
AND WE'LL TALK ABOUT WHAT YOU CAN AND CAN'T DO.
BUT I HAVE AUTONOMY TO PRACTICE.
I HAVE AUTONOMY TO TEACH THE WAY I WANT TO TEACH,
THE WAY I THINK WILL BEST GIVE YOU THE INFORMATION
SO THAT WHEN YOU JOIN OUR PROFESSION, YOU HAVE BEST KNOWLEDGE
AND YOU'RE BEST ABLE TO WORK AS A COLLEAGUE WITHIN THE PROFESSION.
WE HAVE A CODE OF ETHICS.
WE HAVE STANDARDS OF PRACTICE THAT WE HAVE IN TAKING CARE OF PATIENTS.
WE CAN'T DO CERTAIN THINGS TO THEM.
WE CAN'T TRY CERTAIN PRODUCTS ON THEM.
WE CAN'T TEST CERTAIN MEDS WITHOUT POLICIES AND PROCEDURES BEING FULFILLED,
AND PERMISSIONS BEING GAINED AND TESTS BEING DONE TO PROVE THAT IT'S OKAY.
THERE'S ETHICS WITHIN OUR PROFESSION.
AUTONOMY. I TALKED ABOUT NOT ONLY IN DECISION MAKING,
BUT IN OUR PRACTICE AND HOW WE OPERATE AS A PROFESSIONAL.
I CAN BE WHATEVER I WANT TO BE ONCE I'VE HAD MY EDUCATION.
YOU ARE GOING TO BE TAUGHT A LOT OF DIFFERENT TYPES OF NURSING.
BUT YOU ARE THEN ABLE TO CHOOSE WHAT YOU LOVE THE BEST
AND WORK YOUR OWN PRACTICE AROUND THAT.
WE'RE GOING TO TALK ABOUT SOME THINGS THAT NURSES HAVE DONE ON THEIR OWN,
AND WITHIN OUR PROFESSION OR PROFESSIONAL ORGANIZATIONS.
THEN WE'RE GOING TO TALK ABOUT THESE PROFESSIONAL ORGANIZATIONS.
AGAIN, WE DON'T WORK UNTO OURSELVES,
WE HAVE A GOVERNING BOARD THAT HAS REGULATIONS, LAWS THAT GOVERN US.
AND THE FIRST ONE THAT YOU NEED TO KNOW IS THE BOARD OF REGISTERED NURSING.
THIS BOARD FUNCTIONS PRIMARILY TO PROTECT THE PUBLIC.
AND THE WAY THEY PROTECT THE PUBLIC IS TO MAKE SURE THAT YOU'RE A SAFE PRACTITIONER.
SO THEY'RE THE ONES THAT ADMINISTER THE INCLEX EXAM
THAT YOU'RE GOING TO TAKE.
THE INCLEX STANDS FOR AND I ALWAYS HAVE TO REVIEW WHAT THAT IS,
THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING LICENSURE EXAM.
NO WONDER THEY CALL IT INCLEX, RIGHT?
SO THE NATIONAL COUNCIL OF STATE BOARDS OF NURSING LICENSURE EXAM.
THE BOARD OF REGISTERED NURSING ALSO HAS NURSE PRACTICE ACTS.
AND EACH STATE HAS ITS OWN BOARD.
THIS IS OUR CALIFORNIA PRACTICE ACT.
AND YOU SEE I PUT A FEW FLAGS IN HERE.
LAST NIGHT I THOUGHT I'D FLIP THROUGH IT AND SEE
SOME INTERESTING THINGS THAT YOU MIGHT FIT IN HERE.
ONE IS THEY DETERMINE WHO USES THE ACRONYM 'RN' AFTER THEIR NAME.
IN FACT, IF SOMEONE PUT THE WORD 'RN', REGISTERED NURSE,
AFTER THEIR NAME AND THEY WEREN'T A REGISTERED NURSE,
THEY WILL TAKE THAT UP WITH THEM IN COURT. THAT'S A PROBLEM.
IN FACT, THERE WAS A PERSON I MET MANY YEARS AGO THAT DID THAT.
SHE WAS FINED. SHE WAS -- I FORGET WHAT HAPPENED,
BUT THE BOARD ADMINISTERED A DISCIPLINE
AND SHE WASN'T ABLE TO GO INTO NURSING EVEN THOUGH
SHE HAD PREPARED AND DONE EVERYTHING RIGHT AND WAS REALLY A VERY BRIGHT LADY.
BUT SHE WAS SIGNING 'RN' FOR A WHILE AND SHE WAS NOT 'RN'.
YOU DON'T GET TO DO THAT OR THEY DISCIPLINE YOU,
BECAUSE IT'S A LAW AND A REGULATION WITHIN OUR PRACTICE.
THEY ALSO DETERMINE WHAT'S GROSS NEGLIGENCE.
THAT WOULD BE IF YOU DON'T DO SOMETHING
THAT MOST NORMAL NURSES WOULD DO
OR YOU SHOULD HAVE BEEN TAUGHT TO DO, YOU WILL BE DISCIPLINED.
AND DISCIPLINE CAN BE AS SEVERE AS YOU WON'T BE ABLE TO PRACTICE ANYMORE AS A NURSE.
IT MAYBE FINING. IT MAYBE SOMETHING SIMILAR TO THAT.
AND WE'LL LEARN MORE ABOUT THAT OVER THE MONTHS AND YEARS TO COME.
THEY DETERMINE WHO QUALIFIES FOR NURSING.
WHO IS ABLE -- WHY YOU HAD TO HAVE THOSE PREREQUISITES
TO GET HERE TODAY AT MINIMUM STANDARD.
OKAY. THEY ALSO DETERMINE WHO TEACHES FOR YOU
AND THEY HAVE REGULATIONS FOR US.
WE HAVE TO BE MASTER'S PREPARED.
AND IT CAN JUST BE A MASTER'S IN ANYTHING.
AND THEY DETERMINE WHAT THOSE RULES AND REGULATIONS ARE.
ONE OF YOUR RESPONSIBILITIES AS A PRACTICING NURSE IS,
WE'LL TEACH YOU THE REGS FOR CALIFORNIA
BECAUSE THAT'S WHERE WE LIVE AND THAT'S WHAT WE KNOW.
BUT IF YOU GO AND YOU MOVE TO ARIZONA,
YOUR FIRST RESPONSIBILITY IS TO CONTACT THAT BOARD OF REGISTERED NURSING
AND FIND OUT WHAT THE PRACTICE ACT IS FOR THAT STATE.
TYPICALLY, THE RULES AND THE REGULATIONS ARE VERY SIMILAR.
WE TRY TO BE VERY... WELL, SIMILAR
SO THAT WE CAN GO FROM STATE TO STATE AND PRACTICE.
YOU'VE GOT THESE TRAVELING NURSES. YOU'VE GOT ALL THIS STUFF GOING ON.
HOW CAN WE PRACTICE IF EVERYONE'S DOING IT DIFFERENT?
BUT DIFFERENT STATES DO HAVE A FEW DIFFERENT REGULATIONS AS TO,
FOR EXAMPLE, AN 'LBN' CAN DRAW BLOOD
OR AN 'LBN' CAN GIVE IV MEDICATI0NS AND SO FORTH.
THAT'S ALL HANDLED WITHIN THE PRACTICE ACT
AND YOU NEED TO KNOW THAT.
SO WHO GIVES US -- THAT'S AS A REGULATORY BODY.
IN ADDITION, WE HAVE THE AMERICAN NURSES ASSOCIATION.
THE AMERICAN NURSES ASSOCIATION
REPRESENTS THE NATION'S ENTIRE 'RN' POPULATION.
IN FACT, THEY ARE THE LARGEST UNION FOR NURSING,
THE AMERICAN NURSES ASSOCIATION.
THEY'RE A COLLECTIVE BARGAINING AGENT FOR NURSES.
THEY'RE DEDICATED TO ENSURING ADEQUATE SUPPLY
OF HIGHLY-SKILLED AND WELL-TRAINED NURSES.
SO IN COLLABORATION WITH THE PEOPLE THAT LEGISLATE HOW WE WILL PRACTICE,
THEY SET STANDARDS OF PRACTICE FOR US.
YOUR BOOK DID A WONDERFUL JOB. YOU HAVEN'T HAD A CHANCE TO READ YET.
BUT THEY GAVE YOU PAGES AND PAGES COPIED OUT OF THE PRACTICE ACT FOR NURSES.
I WOULD ENCOURAGE YOU TO READ THROUGH IT. IT WILL BE A LITTLE TEDIOUS.
BUT YOU WANT TO BE A NURSE, THAT'S WHAT WE ARE
AND THOSE ARE THE STANDARDS THAT WE HAVE TO MEET.
AND I JUST WANTED TO GO THROUGH A FEW OF THOSE STANDARDS FOR US.
ONE IS THAT WE ARE TO HAVE QUALITY PRACTICE.
THEY HAVE MANY, MANY SUB HEADINGS ABOUT WHAT QUALITY PRACTICE IS.
BASICALLY, THAT WE'RE SYSTEMATICALLY EVALUATING THE QUALITY
AND EFFECTIVENESS OF OUR PRACTICE.
WE'RE RESPONSIBLE FOR THAT.
THAT WE'RE EDUCATED
AND THAT WE MAINTAIN CURRENT KNOWLEDGE.
THAT WE EVALUATE THE CARE OF OUR CARE AND OF OUR PROFESSION.
SO, WE ARE TAKING CARE OF OURSELVES, ONCE WE'RE A NURSE.
WE'RE LOOKING TO SEE IS THE CARE ADEQUATE FOR OUR CLIENT.
THAT'S WHY WE HAVE NURSES DOING QUALITY ASSURANCE.
WE HAVE NURSES DOING RESEARCH. WE'RE TRYING TO DETERMINE IS WHAT WE'RE DOING WORKING.
ARE WE HELPING PEOPLE?
THE AMERICAN NURSES ASSOCIATION SAYS WE WANT YOU TO BE COLLEGIAL
WE DON'T WANT YOU TO JUST WORK BY YOURSELVES.
WE WANT YOU TO GET ALONG AND WE WANT YOU TO SHARE YOUR KNOWLEDGE WITH EACH OTHER.
SO THEY SET THAT PRACTICE THAT WE HAVE WAYS
THAT WE CAN GET TOGETHER AND DISSEMINATE INFORMATION.
ONE OF THOSE WAYS IS THE AMERICAN NURSES ASSOCIATION PUBLISHES A JOURNAL.
IT'S CALLED THE AMERICAN JOURNAL OF NURSING.
AND THAT KEEPS US UP TO DATED WITH SOME OF THEIR...
LAWS THAT HAVE BEEN PASSED, SOME OF THE PRACTICES THAT THEY'RE DOING.
BUT IT ALSO IS EDUCATIONAL FOR US.
BUT IT'S THEIR WAY OF HELPING US BE A LITTLE MORE COLLEGIAL.
I'VE SUBSCRIBED TO THE AJN FOR ALL MY LIFE.
BECAUSE IT'S JUST A PIECE OF INFORMATION
THAT'S THAT IMPORTANT TO ME TO KEEP UP WITH.
WHO'S ON STRIKE? WHO'S NOT ON STRIKE?
WHAT'S HAPPENING IN THE LEGISLATION?
THEY'RE THE ONES THAT SET ACUITIES. HAVE YOU HEARD OF THAT?
YOU'VE HEARD OF IT IN THE NEWS. I THINK WE VOTED ON IT.
WE USED TO -- WHEN I FIRST STARTED NURSING,
I TOOK CARE OF ANYWHERE FROM 12 TO 15 PATIENTS ON THE EVENING SHIFT.
MAY I SAY THAT'S MORE THAN ME AND THAT WAS VERY DIFFICULT.
SOMEONE FINALLY GOT IT TOGETHER AND SAID,
"YOU KNOW WHAT, WE JUST CAN'T DO THAT."
AND SO THEY SET MINIMUM STANDARDS
AND IT WAS THROUGH THE ANA THAT WE ONLY TAKE CARE OF FIVE PATIENTS NOW.
THANK THE LORD. YOU CAN ALMOST KEEP UP WITH FIVE,
BUT YOU CANNOT KEEP UP WITH 15. AND SOMEONE SAW THAT.
WE WERE EVALUATING FOR OURSELVES
THE QUALITY OF CARE THAT WE WERE ABLE TO GIVE
TO 15 PATIENTS VERSUS 5.
THANK YOU ANA. WE HAVE ETHICS.
DECISIONS AND ACTIONS ARE DETERMINED IN AN ETHICAL MANNER.
WE APPLY RESEARCH -- IN FACT, NURSING IS A VERY YOUNG RESEARCH BODY.
WE ONLY HAVE A BODY OF KNOWLEDGE THAT'S ABOUT 100 YEARS OLD
THAT IS NURSING RESEARCH SPECIFIC TO OUR PROFESSION.
AND THAT'S EXCITING FOR US BECAUSE NURSING IS LOOKING AT NURSING.
THEY'RE LOOKING AT BEST WAYS TO GIVE SHOTS.
THEY'RE LOOKING AT BEST WAYS TO GIVE BED BATHS. I TALKED ABOUT BED BATH THEORY.
BUT THEY'RE LOOKING AT WHAT'S BEST FOR THE CLIENT.
THEY ALSO ARE LOOKING AT RESOURCE UTILIZATION.
SO THEY'RE ADVANCING HIGH STANDARDS OF THE NURSING PRACTICE
AND THEY'RE IN THE FOREFRONT OF POLICY AND INITIATING INFORMATION.
IN ADDITION -- AND I KIND OF FLIPPED PAST HERE,
BUT THERE'S ALSO STANDARDS OF PRACTICE,
WHICH WE'RE GOING TO TALK ABOUT MORE WHEN WE LOOK AT THE NURSING PROCESS.
BUT THE AMERICAN NURSING ASSOCIATION IS THE ONE THAT SAID,
NURSES ASSESS CLIENTS, NURSES EDUCATE CLIENTS.
AND WE'RE THE ONLY ONES THAT CAN.
BECAUSE THAT'S IN OUR PRACTICE ACT
AND THAT'S THE STANDARD OF CARE THAT WE'RE HELD TO
BY OUR BODY OF NURSES. ALRIGHT.
THE NATIONAL LEAGUE OF NURSES. THIS ONE IS NOT IN YOUR BOOK.
AND I WAS, KIND OF, SURPRISED ABOUT THIS
BECAUSE THIS IS A HUGELY IMPORTANT ORGANIZATION TO NURSING.
AND THE REASON THAT THE NATIONAL LEAGUE OF NURSES IS IMPORTANT
IS BECAUSE THIS IS THE ONLY ORGANIZATION
THAT HAS NURSES AND OTHERS
THAT ARE INTERESTED IN NURSING AS MEMBERS. AND WHAT DO I MEAN BY THAT?
WELL, YOUR HOSPITAL CEO'S COULD BE A MEMBER OF THE NURSING --
THE NATIONAL LEAGUE OF NURSES.
WHEREAS THE AMERICAN NURSES ASSOCIATION,
YOU COULDN'T BE A MEMBER IF YOU JUST WANTED TO BE.
SO PEOPLE THAT ARE ACTIVELY INVOLVED IN NURSING,
HEALTHCARE PROVIDERS CAN BE A PART OF THE NATIONAL LEAGUE OF NURSES.
THE NATIONAL LEAGUE OF NURSES, ITS PRIMARY OBJECTIVE
IS TO DEVELOP AND IMPROVE NURSING SERVICES AND NURSING EDUCATION.
SO, THEY'RE PEOPLE THAT EDUCATE US.
THEY ALSO COME AND THEY LOOK AT OUR SCHOOLS OF NURSING
AND THEY APPROVE US AS MEETING A HIGH ENOUGH -- A HIGH STANDARD OF NURSING.
THIS COLLEGE IS NOT NLN ACCREDITED IF YOU WILL.
BUT YOU CAN PAY MONEY TO HAVE THE NLN COME AND LOOK OVER YOUR PROGRAM
AND SEE IF YOU'RE MEETING THE STANDARDS THAT THEY HAVE PRESET TO MEET.
THEY GIVE YOU A BOOK, YOU GET YOURSELF ALTOGETHER TO MEET THEIR HIGH STANDARD.
BECAUSE THAT'S WHAT THEY HAVE INVESTED IN,
CREATING A HIGH QUALITY OF SERVICE AND EDUCATION FOR NURSES. VERY IMPORTANT.
THEY DO CONTINUING EDUCATION. THEY DO SURVEYS
AND THEY WORK WITH OTHER MEMBERS OF THE COMMUNITY
TO MAKE SURE THAT THEY UNDERSTAND WHAT NURSING IS.
AND YOU'LL CARE A LOT ABOUT THE NATIONAL LEAGUE OF NURSES THROUGHOUT YOU CAREER.
THIS IS ANOTHER INTERESTING ORGANIZATION THAT'S ALSO NOT IN YOU BOOK
AND IT'S CALLED THE INTERNATIONAL COUNCIL OF NURSES.
IT'S A FEDERATION OF NATIONAL NURSES ASSOCIATIONS.
SO, FOR EXAMPLE, WE HAVE THE AMERICAN NURSES ASSOCIATION.
WHICH IS WHAT?
- ANA.
- I KNOW IT'S ANA, BUT WHAT DOES IT DO?
WHAT IS ITS PRIMARY GOAL?
OH, WOULDN'T THAT BE A GOOD TEST QUESTION? I HAVE TO THINK ABOUT IT. I DON'T KNOW.
WHAT IS IT? WHO ARE THEY?
THEY ARE OUR LARGEST UNION.
THEY REPRESENT THE ENTIRE BODY OF NURSES IN THE WHOLE ENTIRE NATION.
CANADA ALSO HAS A SIMILAR ORGANIZATION.
THEY ARE CALLED THE CANADIAN NURSES ASSOCIATION.
WELL, THE CANADIAN NURSES ASSOCIATION MEETS WITH THE AMERICAN NURSES ASSOCIATION,
SO THAT WE HAVE A WORLDWIDE SYSTEM OF COMMUNICATION AND STANDARD.
BECAUSE THE TRUTH OF THE MATTER IS THAT SOME NATIONS
ARE A LITTLE MORE ADVANCED THAN OTHERS IN PROVIDING QUALITY CARE.
SO HOW CAN WE GET EVERYBODY UP TO THE BEST STANDARD?
WHAT'S WORKING? AND SO THAT'S ANOTHER WAY OF COLLABORATING,
AND THAT'S THROUGH THE INTERNATIONAL COUNCIL OF NURSES.
THEY ALSO HAVE THEIR OWN LITERATURE THAT YOU CAN GET TO COMMUNICATE
WHAT'S GOING ON WORLDWIDE.
AND FINALLY, I JUST THINK YOU NEED TO KNOW
THAT THERE IS AN ORGANIZATION FOR YOU THAT'S OUT THERE.
AND THAT'S CALLED THE NATIONAL STUDENT NURSES' ASSOCIATION.
IT'S NOT IN YOUR BOOK AND I AM THINKING WHY ISN'T IT?
BECAUSE THAT'S WHERE YOU NEED TO GET INVOLVED.
IT'S THE OFFICIAL PRE-PROFESSIONAL ORGANIZATION FOR NURSING STUDENTS.
AND I AM TELLING YOU, IT IS ONE EXCITING GROUP OF NURSING STUDENTS TO GO BE APART OF.
THEY MEET TWICE A YEAR IN CONFERENCES ALL OVER THE NATION.
I USED TO BE THE ADVISOR FOR THE STUDENT NURSES' ASSOCIATION AND I TRAVELED EVERYWHERE.
AND I HAVE TO TELL YOU, I LEARNED AS MUCH FROM THEIR CONFERENCES
AS I LEARNED FROM ANY CONFERENCE I WENT TO AS A NURSE.
THEY ARE REALLY ON THE FOREFRONT OF HOW PEOPLE GET INVOLVED
AND KNOW WHAT'S GOING ON POLITICALLY AS WELL AS PROFESSIONALLY AS A NURSE.
AND IN FACT, NURSING STUDENTS GET TOGETHER AND THEY WRITE UP SUGGESTIONS
AND POLICIES THAT THEY THINK OUGHT TO BE HAPPENING
AND THEY SUBMIT THEM TO THE AMERICAN NURSES ASSOCIATION FOR CONSIDERATION.
AND MANY, IF NOT MOST, ARE ADOPTED AS STANDARDS OF PRACTICE FOR NURSES.
YOU HAVE A VOICE IN MAKING NURSING STUDENTS AFFECTTIVE IN WHAT THEY'RE DOING.
NOW, THIS IS THE NATIONAL STUDENT NURSING ASSOCIATION,
BUT WE HAVE A LOCAL BRANCH OF THAT WITHIN OUR SCHOOL.
YOU CAN ONLY BE A PART OF ONE IF YOU'RE AN APPROVED SCHOOL OF NURSING,
WHICH WE ARE BY THE BRN.
SO, JUST SO YOU KNOW, I SAID WE WEREN'T NLN APPROVED.
WE ARE BRN --
AND WE HAVE WHAT WE CALL THE STUDENT NURSES' ASSOCIATION.
AND ON FRIDAY, THE PRESIDENT OF THE STUDENT NURSES' ASSOCIATION
IS GOING TO COME IN AND MEET YOU AND TELL YOU
HOW YOU CAN GET INVOLVED WITH THE STUDENT GOVERNANCE HERE LOCALLY.
THERE'S A LOT OF ACTIVITIES GOING ON FOR STUDENTS
AND REALLY, YOU WANT TO GET INVOLVED.
IT REALLY HELPS YOU NETWORK WITH THE OTHER SEMESTERS.
AND YOU NEED TO KNOW THEM BECAUSE THEY KNOW A LOT OF STUFF
ABOUT WHAT'S GOING ON AND HOW TO SUCCESSFULLY MOVE ON THROUGH THE PROGRAM.
BUT THEY'RE ALSO INVOLVED IN A LOT OF OTHER THINGS.
AND THEY WENT TO BOTH CONFERENCES. I DO BELIEVE THAT ONE WAS IN --
WELL, NOW I FORGET WHERE THEY WENT.
WAS IT IN PITTSBURGH OR PENNSYLVANIA OR SOMETHING? THEY WENT FOR A WEEK.
THAT'S THE ONLY TIME I'LL GIVE YOU AN EXCUSED ABSENCE.
YOU NEED TO GO THERE. I WANT YOU TO GO.
THE WHOLE CLASS CAN GO. THAT'LL BE GREAT.
AND SEE WHAT THOSE BOTH CONFERENCES ARE ABOUT.
AND YOU'LL JUST BE EXCITED TO KNOW
THAT, REALLY, YOU ARE IN A GREAT PROGRAM
AND IT'S NEAT TO SEE WHAT OTHER STUDENT NURSES ARE DOING OUT THERE.
AND THEY ALL HAVE THE SAME COMPLAINTS.
"THERE'S TOO MUCH WORK, TESTS ARE HARD AND IT'S GOING TO FAST."
YOU'RE NOT ALONE. BUT IT'S GOOD TO FEEL THAT BECAUSE YOU FEEL KIND OF...
"IT'S ALL ABOUT TESTS THERE FOR A WHILE."
ALRIGHT. SO PROFESSIONAL ROLES AND RESPONSIBILITIES.
WE'VE TALKED A LOT ABOUT AUTONOMY AND ACCOUNTABLE.
I'M ACCOUNTABLE FOR THE PRACTICE THAT I GIVE.
THE CARE THAT I GIVE. YOU'RE NOT GOING TO GET SUED FOR IT, I AM.
I'M RESPONSIBLE FOR WHAT I DO WITH AND FOR MY CLIENTS, JUST AS YOU WILL BE.
SO WE HAVE AUTONOMY AND ACCOUNTABILITY.
WE ARE CARE GIVERS. WE GIVE CARE TO PEOPLE.
IT'S ALL ABOUT PEOPLE.
I SUPPOSE THERE ARE A FEW THINGS AT NURSING YOU CAN DO
THAT AREN'T PEOPLE ORIENTED.
I WAS GOING TO SAY, IF YOU DON'T LIKE PEOPLE, THIS MAYBE ISN'T THE PROFESSION FOR YOU.
AND I, KIND OF, STILL THINK THAT
BECAUSE IF YOU'RE EVEN IN THE ROLE OF MAYBE DOING RESEARCH
OR IN THE ROLE OF PUBLIC POLITICS,
YOU'RE DOING THAT IN THE BEST OF PEOPLE.
SO YOU'VE GOT TO LOVE PEOPLE
TO BE ABOUT CARING FOR PEOPLE AND WE ARE CARE GIVERS.
WE'RE ADVOCATES. WE ARE ADVOCATES FOR OUR PATIENTS.
WE ACT TO PROTECT THE CLIENT
AND WE ASSIST THE CLIENT IN EXERCISING THEIR RIGHTS.
WE HELP THEM GET WHAT THEY WANT, NOT WHAT WE WANT.
WE ADVOCATE FOR THEM.
WE HELP 'EM UNDERSTAND THE SYSTEM.
WE HELP THE SYSTEM UNDERSTAND THEM.
WE'RE THE ONES THAT STANDS IN THE GAP FOR OUR PATIENTS.
AND THAT'S A FUN ROLE TO BE IN.
IT'S A STRESSFUL ROLE SOMETIMES
BECAUSE IT'S HARD OUT THERE BETWEEN INSURANCE
AND ALL THE STUFF THAT'S GOING ON.
HOW CAN A PATIENT GET BEST CARE? BUT WE'RE THERE FOR THEM TO HELP THAT HAPPEN.
WE ARE EDUCATORS. NO ONE CAN TAKE THAT ROLE FROM US.
EVEN THOUGH YOU'RE STANDING UP HERE AS I AM TODAY,
YOU'RE GOING TO BE TEACHING YOUR CLIENTS EVERYTHING THAT YOU'VE LEARNT
AND EVERYTHING THAT YOU KNOW
AND WE CANNOT DELEGATE THAT ROLE TO A NURSE'S AIDE OR TO AN LVN.
WE ARE THE ONLY ONES THAT CAN TEACH.
SO WE HAVE TO RECOGNIZE THE NEED AND MAKE SURE THAT THEY KNOW.
CAN I JUST TELL YOU, PEOPLE WON'T DO WHAT YOU DON'T TELL 'EM TO DO.
SO DON'T ASSUME THEY JUST KNOW.
IT'S OUR JOB TO MAKE SURE AND TO EDUCATE.
WE'RE COMMUNICATORS AND THAT FALLS REALLY IN LINE WITH THE EDUCATOR ROLE.
BUT WE HAVE TO EXPLAIN WHAT WE'RE DOING.
AND SO YOU'RE GOING TO SEE, WHEN WE GO TO RN2 AND WE'RE DOING OUR CLINICAL,
ALMOST EVERY TIME ON STEP THREE OF THAT HIGH FIVE,
IT SAYS, "IDENTIFY CLIENT AND EXPLAIN PROCEDURE."
WE WANT YOU TO TALK TO THEM AND EXPLAIN,
"I AM GOING TO --"
I DON'T KNOW WHAT I'M GOING TO DO, BUT YOU GOT TO FIND A WAY
TO GET IT OUT OF YOUR MOUTH AND TELL 'EM WHAT YOU'RE GOING TO DO.
SO, WE'LL PRACTICE WITH THAT.
YOU'RE GOING TO MANAGE. YOU'RE GOING TO HAVE PEOPLE UNDER YOU.
YOU'RE GOING TO WORK WITH WARD CLERKS. YOU'RE GOING TO WORK WITH AIDES,
YOU'RE GOING TO WORK WITH HOUSEKEEPING AND YOU'RE GOING TO WORK WITH DOCTORS.
YOU'RE GOING TO WORK WITH EVERY GAMUT OF THE HEALTHCARE PROFESSION
AND YOU'VE GOT TO MAKE SURE IT ALL COMES TOGETHER.
YOU'RE THE NURSE RIGHT IN THE MIDDLE, YOU'RE MANAGER.
YOU DEVELOP YOUR OWN CAREER. AND THERE ARE A LOT OF PLACES YOU CAN GO.
WE'RE GOING TO LOOK AT THAT.
YOU'RE COULD BE A CLINICIAN, WHICH IS WHAT YOU'RE TRAINING TO DO RIGHT NOW.
AN ADN NURSE, AN ASSOCIATE DEGREE NURSE IS A CLINICIAN.
YOU'RE A BEDSIDE NURSE AND THAT'S WHAT WE'RE TRAINING YOU TO DO.
BUT YOU CAN GO ON TO BE AN ADVANCED PRACTICE NURSE.
I DON'T KNOW WHY THIS IS TURNING OUT -- MY APOLOGIES.
A CLINICAL NURSE SPECIALIST, A NURSE PRACTITIONER,
CERTIFIED NURSE-MIDWIFE,
CERTIFIED RN ANESTHETIST, NURSE EDUCATOR
NURSE ADMINISTRATOR OR A RESEARCHER.
THESE ARE INCREDIBLE ROLES.
ADVANCED PRACTICE NURSES ACTUALLY WORK ON THEIR OWN.
ALL OF NURSING HAS TO BE UNDER SOME KIND OF SUPERVISION BY A PHYSICIAN.
BUT AN ADVANCED PRACTICE NURSE HAS AN ADVANCED DEGREE
AND STILL PROVIDES DIRECT PATIENT CARE.
SO IN YOUR HOSPITALS SOMETIMES, THEY HAVE DIFFERENT LABELS FOR 'EM.
LIKE, THEY'LL CALL 'EM A CLINICAL NURSE II
AND A CLINICAL NURSE III AND A CLINICAL NURSE THIS AND THAT.
THAT MEANS THAT THEY HAVE MORE EDUCATION AND MORE EXPERIENCE
AND THAT THEY PROVED THEMSELVES TO BE COMPETENT AT A DIFFERENT LEVEL.
AND THEY GET PAID FOR IT TOO, SO THAT'S ALWAYS GOOD TO KNOW.
NURSE PRACTITIONERS ARE PEOPLE THAT ACTUALLY WORK INDEPENDENTLY UNDER A PHYSICIAN.
AND THEY CAN BE A FAMILY NURSE PRACTITIONER,
A SCHOOL NURSE PRACTITIONER, PEDIATRIC NURSE PRACTITIONER
OR A GERONTOLOGY NURSE PRACTITIONER.
AND ALL OF THOSE ARE MASTER'S PREPARED LEVEL NURSES
THAT GO ON TO WORK INDEPENDENTLY.
FOR EXAMPLE, A GERIATRIC NURSE PRACTITIONER.
THAT'S WHAT MRS PAULSON IS.
AND SHE HAS GONE TO SCHOOL AND SPECIALIZED IN THE GERIATRIC CLIENT.
AND SHE ACTUALLY WORKS UNDER A PHYSICIAN.
THAT'S HOW SHE GOT STARTED OUT AT SELMA.
AND SHE CAN WRITE A LIMITED NUMBER OF PRESCRIPTIONS
THAT HE'S -- WHAT'S THE WORD? PRE-APPROVED.
AND SHE CAN DO A LOT OF THINGS AS AN INDEPENDENT AUTONOMOUS PRACTITIONER
BECAUSE SHE'S GONE ONTO HIGHER EDUCATION.
CERTIFIED NURSE-MIDWIFE HAS TAKEN, OF COURSE, MORE EDUCATION.
THEY CAN DELIVER WELL BABIES.
THEY DON'T EVER DELIVER HIGH-RISK BABIES AS A PLAN.
SOMETIMES THEY TURN HIGH-RISK, BUT THAT'S NOT THEIR PLAN.
THEY DO PRE-NATAL VISITS, POST-NATAL VISITS
AND THEY ALSO CAN DO PAP SMEARS AS WELL.
SO THEY CAN DO SOME VAGINAL EXAMS UNDER THEIR CERTIFICATION,
WHICH IS THINGS WE DON'T DO AT THE CLINICAL LEVEL.
RN ANESTHETISTS. THAT'S REALLY INTERESTING.
YOU CAN BE AN RN AND ADMINISTER ANESTHESIA TO A VARIETY OF CLIENTS.
NOT ONLY DO YOU ADMINISTER ANESTHESIA,
BUT YOU DO THEIR PRE-OP AND POST-OP VISITS
AND FOLLOW UP WITH THOSE CLIENTS AS WELL.
BUT AGAIN, YOU'RE GOING ON FOR YOUR MASTER'S IN SPECIAL EDUCATION.
NURSE EDUCATOR, AGAIN, THAT'S MY ROLE.
AND MOST OF THE TIME YOU SEE NURSE EDUCATORS IN THE SCHOOL SETTING,
BUT OUR HOSPITALS AND DIFFERENT FACILITIES HAVE EDUCATORS AS WELL.
NURSING ADMINISTRATORS.
I LOVE IT WHEN NURSES ARE THE ADMINISTRATORS OF HOSPITALS
BECAUSE I FEEL LIKE SOMEONE REALLY UNDERSTANDS THE SCOPE OF WHAT'S GOING
ON THE HOSPITAL FLOOR WHEN WE'RE TAKING CARE OF OUR CLIENTS.
AND NURSE RESEARCHER IS JUST CRITICAL.
LIKE I SAID, WE REALLY HAVE A YOUNG BODY OF KNOWLEDGE SPECIFIC TO NURSING.
AND RESEARCH IS PHENOMENAL AS TO HOW IT HELPS US IMPROVE OUR PRACTICE.
WELL, NURSING.
IT'S ABOUT COMMITMENT TO THE PROFESSION.
IT'S ABOUT COMMITMENT AND RESPONSIBILITY TO THE ART AND SCIENCE
FOR THE GOOD OF PEOPLE.
AND IT'S ABOUT COMMITMENT TO KNOWLEDGE,
EXPERTISE, LIFELONG LEARNING GAINED THROUGH THE PROCESS OF CRITICAL THINKING.
SO IT'S ART AND SCIENCE, IT'S KNOWLEDGE,
IT'S EXPERTISE AND IT'S LEARNING FOREVER.
THIS IS ONLY THE BEGINNING, YOU'RE GOING TO GO TO SCHOOL FOREVER.
OH, BOY, HOPE YOU LIKE IT.
ALRIGHT. SO WHAT'S CRITICAL THINKING
IF THAT'S PART OF WHAT WE HAVE TO DO?
WELL, CRITICAL THINKING WAS DEFINED BY PAUL AS THIS.
IT INVOLVES THINKING ABOUT YOUR THINKING WHILE YOU'RE THINKING,
IN ORDER TO MAKE YOUR THINKING BETTER,
MORE CLEAR, MORE ACCURATE.
YOU JUST NEED TO STOP AND THINK ABOUT THAT A MINUTE.
DO YOU EVER READ YOUR BOOK AND THEN GO THINK ABOUT YOUR BOOK?
AND THEN THINK ABOUT IT SOME MORE AND GO READ IT
TO MAKE SURE IT'S WHAT YOU THINK WERE THINKING.
AND YOU READ IT AND GO, "OH, I MISSED THAT PART.
I NEED TO THINK ABOUT THAT SOME MORE.
AND THEN YOU THINK ABOUT IT AND GO,
"BUT WHEN I SAW MRS SMITH, I DON'T REMEMBER THAT.
I WONDER IF WE HAD DONE THAT, WOULD THAT HAVE WORKED?"
THAT'S CRITICAL THINKING.
IT'S NOT JUST TAKING A BLOOD PRESSURE,
AND "I GOT IT, AND IT'S HIGH AND I'M GOING TO TELL THE DOCTOR."
WE GOT TO DO BETTER THAN THAT.
"WHY IS IT HIGH? IS THERE ANYTHING I CAN DO ABOUT THAT?
IS THAT NORMAL FOR THEM? IS IT BECAUSE OF THEIR MEDICATION?
SHOULD I EXPECT IT TO BE HIGH? OR IS IT LOWER THAN IT WAS
SO IT'S ACTUALLY BETTER EVEN THOUGH IT'S HIGH."
THAT'S CRITICAL THINKING.
IT'S JUST NOT ACCEPTING A PIECE OF INFORMATION GOING, "YEAH."
OH, PLEASE. WE GOT TO BE BETTER THAN THAT.
I WANT YOU BETTER THAN THAT WHEN YOU'RE CARING FOR ME.
WE GOT TO LOOK AT OUR INFORMATION AND THINK ABOUT IT.
I LOVE THAT DEFINITION, MAYBE ONE OF MY FAVORITES.
MCPECK THOUGH, SAYS CRITICAL THINKING IS THINKING WITH SKEPTICISM
ABOUT A SUBJECT OR FIELD.
BUT YOU HAVE TO POSSESS THE SKILLS OF THE FIELD.
SO RIGHT NOW I WOULDN'T EXACTLY PUT YOU IN CHARGE
OF POLICY ON THE MED-SURG FLOOR BECAUSE YOU'RE JUST NOT QUITE READY FOR IT.
BUT IT'S LOOKING AT SOMETHING AND GOING, "YOU KNOW WHAT? THIS ISN'T WORKING."
"THIS LIFTING TOOL THEY BOUGHT, I HAVEN'T SEEN IT MOVE FROM THIS PLACE.
IN FACT, THE DUST BUNNIES ARE SO THICK AROUND IT.
I KNOW PEOPLE AREN'T USING IT AND WE'RE HURTING OUR BACKS.
WHAT ARE WE GOING TO DO ABOUT IT?"
SOMEONE'S PUTTING THE PICTURES TOGETHER AND THEY'RE THINKING.
BUT BECAUSE THEY KNOW ABOUT THE PROFESSION AND THEY KNOW WHAT'S BEST.
ENNIS SAYS...
THAT CRITICAL THINKING IS...
USING REASONABLE REFLECTIVE THINKING
TO DECIDE WHAT TO BELIEVE OR DO.
IT REQUIRES DISCIPLINE, SELF-DIRECTED THINKING.
IT'S BASED ON MASTERY OF INTELLECTUAL SKILLS AND ABILITIES
AND IT USES THE THREE P'S.
PRACTICE, PRACTICE, PRACTICE.
WE GOT TO KEEP WORKING AT IT, DOING IT OVER,
SAYING IT AGAIN, LOOKING AT OUR INFORMATION.
WE'RE GOING TO BE CRITICAL THINKING ON FRIDAY.
WE'RE GOING TO PUT SOME OF THAT INFORMATION TOGETHER
AND THINK ABOUT IT AND DECIDE WHAT WE'RE GOING TO DO AS NURSES
AND APPLY THAT INFORMATION TO SOME REAL-LIFE CIRCUMSTANCES.
HATCHER SAYS, CRITICAL THINKING.
THINKERS MUST EVALUATE AN ARGUMENT -
WELL, THIS IS JUST REALLY ANNOYING.
EVALUATE AN ARGUMENT WHICH INVOLVES ASKING QUESTIONS.
IN OTHER WORDS, YOU DON'T JUST READ IT
OR YOU DON'T JUST HEAR WHAT I SAY.
YOU GO, "DID SHE MEAN THIS?
IS THIS WHAT THIS REALLY MEANS IF I WERE TO DEFINE IT?"
AND THAT'S CRITICAL THINKING.
YOU APPLY LOGIC TO EVALUATE THINKING AND DECISIONS.
SO YOU'RE LOOKING AT YOUR LIFE EXPERIENCE AND WHAT YOU'RE READING
AND YOU'RE TRYING TO PUT THE TWO TOGETHER. "DOES THIS MAKE SENSE?"
CRITICAL THINKING.
AND FINALLY, SHE WAS THE WRITER OF CRITICAL THINKING.
DO YOU KNOW THERE'S FULL COURSES? YOU COULD BE HERE FOR HOURS ON CRITICAL THINKING.
THEY SPEND A WHOLE 18 WEEKS ON HOW TO THINK.
BECAUSE WE HAVE LOST THE ART OF THINKING.
AND YOU KNOW WHY WE HAVE? MEDIA.
WE DON'T HAVE SILENCE IN OUR HOUSES ANYMORE,
SO WE DON'T THINK. WE HAVE MUSIC ON ALL THE TIME.
SO WE DON'T THINK.
WE HAVE NOISE GOING. WE'RE NOT THINKING.
I WOULD ENCOURAGE YOU THIS SEMESTER
TO TAKE SOME TIME TO JUST TURN EVERYTHING OFF
READ A PARAGRAPH AND THEN THINK ABOUT IT
AS SOON AS YOU GET IT.
CAPOTE SAYS CRITICAL THINKING IS A COMPLEX THINKING PROCESS.
IT IS. IT'S --
IT'S NOT JUST READING IT, IT'S THINKING ABOUT IT, DWELLING ON IT,
MAKING SENSE OF IT, TRYING TO TEACH IT, GETTING IT OUT OF YOU.
IT'S DISCIPLINED AND SELF-DIRECTED
WHICH MEANS WHEN YOU STUDY -- HOW DO YOU STUDY?
ARE YOU DISCIPLINED ABOUT IT?
OR DO YOU JUST GRAB IT WHEN YOU CAN GRAB IT?
I WOULD SUGGEST THAT YOU FIND YOUR BEST TIME TO STUDY EVERYDAY.
AND THAT YOU STUDY A LITTLE BIT EVERYDAY AS OPPOSED TO CRAMMING.
IF CRAMMING HAS WORKED FOR YOU IN THE PAST, IT MAY NOT WORK FOR YOU HERE
BECAUSE THERE'S TOO MUCH TO KNOW.
YOU'RE GOING TO HAVE TO FIND SOME DISCIPLINE IN YOUR STUDYING AND THINKING.
AND YOU'RE GOING TO HAVE TO DO IT YOURSELF. NO ONE'S GOING TO BE ABLE TO MAKE YOU.
IT'S MASTERY OF THINKING SKILLS AND ABILITY.
YOU'RE GOING TO HAVE TO WORK AT IT TO GET THAT DONE.
ONE THING I KNOW IF I READ IT REAL QUICK AND TURN,
IT'LL BE READY FOR ME WHEN I GET BACK. ABLE TO TIE ME DOWN.
CRITICAL THINKING IS BEST DEVELOPED WHEN APPLIED TO ACTUAL
OR SIMULATED REAL-WORLD SITUATIONS.
SO YOU DON'T CRITICAL THINK ABOUT SOMETHING THAT DOESN'T EXIST.
THAT'S IMAGINATION AND FANTASY.
YOU CRITICAL THINK ABOUT THE REAL WORLD,
ABOUT WHAT YOU'VE READ TANGIBLY
AND WHAT YOU'VE SEEN OR WHAT YOU HOPE TO EXPERIENCE, BUT REAL WORLD.
IT INVOLVES THINKING ABOUT THE THINKING PROCESS AS IT'S OCCURRING.
WHAT'S YOUR OPINION? I'M GOING TO START ASKING
AND ONCE I KNOW YOUR NAME, I'M GOING TO SCARE YOU TO DEATH, BUT I'M CALLING YOU.
I NEED TO KNOW WHAT YOU'RE THINKING. I'M WATCHING YOUR FACES.
WHAT ARE YOU -- WHAT'S GOING ON?
IT EVALUATES THE DECISIONS OR SOLUTION
AGAINST A STANDARDIZED SET OF CRITERIA.
SO SOMEONE MAKES A DECISION, YOU MAKE A DECISION,
DO YOU HAVE SUPPORT FOR THAT OR IS IT JUST YOUR OPINION?
BECAUSE YOUR OPINION'S NOT WORTH MUCH
IN THE FIELD OF NURSING AND IN MEDICAL HEALTHCARE AREAS.
YOU HAVE TO SUPPORT IT WITH SOME KIND OF RESEARCH AND SOME KIND OF KNOWLEDGE.
ALRIGHT. WELL, LET'S SKIP THAT ONE. OH, THAT WAS FUN.
CRITICAL THINKING. LET'S SEE IF I NEEDED TO TALK ABOUT THAT.
OH, FROM YOUR BOOK ON PAGE 262, IF YOU WANT TO DRIVE DOWN.
IT'S A CRITICAL THINKING DEFINITION AND I THINK IT'S REALLY EXCELLENT.
AND IT SAYS, 'CRITICAL THINKING PRE-SUPPOSES
A CERTAIN BASIC LEVEL OF INTELLECTUAL HUMILITY.'
I LOVE THAT.
YOU KNOW WHO THE SCARIEST NURSING STUDENT IS?
THE NURSING STUDENT THAT'S GOT ATTITUDE AND THINKS
THEY KNOW IT ALL AND YOU DON'T, AND LET'S JUST GET ME THROUGH.
THEY'RE FRIGHTENING, ABSOLUTELY FRIGHTENING.
BECAUSE IF YOU AREN'T HUMBLE ENOUGH TO KNOW THERE'S SO MUCH FOR ME TO LEARN,
AND YOU HAVE SOMETHING TO OFFER, THEN THAT IS SCARY.
CRITICAL THINKING PRE-SUPPOSES A BASIC LEVEL OF INTELLECTUAL HUMILITY.
THAT DOESN'T MEAN YOU DON'T KNOW ANYTHING,
BUT YOU ACKNOWLEDGE YOUR OWN IGNORANCE
AND YOU HAVE A COMMITMENT TO THINKING AND REASONING.
THAT IS TO CLEAR, PRECISE, ACCURATE ASSESSMENT OF A SITUATION.
ACTING ON A BASIC -- A BASIS OF GENUINE KNOWLEDGE
THAT COMES FROM A SITUATION AND FROM NURSING SCIENCE.
SO THAT'S ALL FROM YOUR BOOK, LOOK IT UP.
THAT'S CRITICAL THINKING IN A NUTSHELL.
ALRIGHT.
NURSES THEN, TO BE CRITICAL THINKERS ARE A SURVEILLANCE SYSTEM.
WE'RE WATCHING ALL THE TIME.
I WISH I COULD TELL YOU EVERYTHING I'VE ASSESSED OF YOU TODAY.
I CAN'T HELP IT. I'M A VISUAL LEARNER.
I'VE WATCHED YOU. I'VE MADE EYE CONTACT.
I'VE SEEN WHO TAKES NOTES, WHO DOESN'T, WHO'S A LISTENER.
I'VE ALREADY DECIDED I DON'T EVEN NEED TO READ YOUR PAPERS.
BECAUSE I'M A SURVEILLANCE SYSTEM.
I LOOK AT MY PATIENTS AND I THINK,
"DIRTY ROOM, WHERE'S HOUSEKEEPING? NO VISITORS, OH."
DO YOU SEE WHAT I MEAN? THAT'S WHAT WE'RE ABOUT.
AND SO NURSES ARE CRITICAL THINKERS
IN THEIR ROLE OF SURVEILLANCE.
AND WE ARE -
SEE, WE ARE TO FIND EARLY PROBLEMS
BEFORE THEY BECOME PROBLEMS. THAT'S OUR JOB.
DID YOU NOTICE THERE'S A WET SPOT OVER THERE?
WE GOT TO GET IT CLEANED UP RIGHT NOW BEFORE SOMEONE'S ON THEIR BUTT.
THAT'S US. WE'RE EARLY DETECTION.
INTERVENTIONS TO PREVENT ADVERSE OCCURRENCES.
THAT'S WHAT WE ARE AS A SURVEILLANCE SYSTEM.
WE'RE GOING TO DO SOMETHING SO THAT SOMETHING DOESN'T GO WRONG.
WE'RE GOING TO INTERVENE TO DECREASE THE MORTALITY RATE
AND FAILURE TO RESCUE RATE.
WHAT'S MORTALITY?
DEATH. WHAT'S MORBIDITY?
SICKNESS. DISEASE. GET THOSE STRAIGHT.
THAT WAS ONE OF THOSE WORDS I HAD TROUBLE WITH AS A STUDENT.
WHICH ONE IS THAT? ARE THEY DYING ON THAT ONE OR NOT?
MORTALITY RATE. WE WANT TO DO THINGS TO KEEP PEOPLE FROM DYING, TO SAVE THEM.
THAT'S PART OF SURVEILLANCE.
THAT'S WHY THEY TAUGHT YOU CPR BEFORE YOU EVEN ENTERED THE STUDENT HOOD
SO THAT IF SOMETHING HAPPENS, WE'RE THERE TO HELP PEOPLE.
WE'RE SURVEILLANCE. THAT'S CRITICAL THINKING.
TO BE ABLE TO RECOGNIZE THAT SOMETHING'S AMISS HERE.
IMPROVING PATIENT OUTCOMES.
WE WANT PEOPLE TO DO BETTER THAN THEY'RE DOING.
IF WE'RE SEEING THAT AN ANTIBIOTIC'S NOT WORKING
OR THAT BACTERIA'S BEING SPREAD,
WE WANT TO -- WE WANT TO FIX THAT. WE'RE FIXERS.
MOST NURSES BY NATURE WANT TO MAKE THINGS RIGHT.
MOST OF US ARE PERFECTIONISTS.
WE CAN'T HELP IT. THAT'S WHY WE'RE HERE.
THAT'S WHY I LOVE YOU ALREADY,
BECAUSE WE HAVE THAT IN COMMON.
WE LIKE -- AND WE WANT TO HELP PEOPLE.
WE WANT TO IMPROVE HOW PEOPLE RECOVER.
WE WANT TO IMPROVE HOW THEY DO.
ALRIGHT, DON'T YOU LOVE THIS TITLE?
I'VE SHOWN IT TO MY MOTHER AND SHE SAID, "YOU CAN'T DO THREE OR FOUR."
I SAID, "I CAN TOO. IT'S MY SLIDE."
I'M THE TEACHER. I CAN DO WHATEVER I WANT.
AND IN YOUR BOOK IT LISTS THREE STAGES OF CRITICAL THINKING,
BUT I THINK THERE ARE FOUR.
SO IT'S MY PAPER SO THAT'S WHY I DID IT.
I DIDN'T WANT TO CONFUSE YOU, I ADDED ONE. SEE WHICH ONE I ADDED.
ALRIGHT, IN CRITICAL THINKING,
THIS IS, KIND OF, WHAT HAPPENS IN THE BEGINNING OF YOUR CRITICAL THINKING.
SOME OF YOU ARE PROBABLY ALREADY REALLY GOOD CRITICAL THINKERS AND SOME ARE NOT.
AND SOME ARE AT THIS BASIC --
IT'S A BASIC RIGHT OR WRONG.
YOU WANT A RIGHT ANSWER OR A WRONG ANSWER TO THAT QUESTION.
YOU WANT THIS OR THAT AND THAT'S WHAT YOU WANT.
AND THAT'S BASIC CRITICAL THINKING.
AT LEAST SETTING UP THE RULES.
AND WE'RE GOING TO GIVE YOU SOME RULES.
OH, MAN THERE'S GOING TO BE DEVIATION FROM THOSE RULES, IF YOU WILL.
SO CRITICAL THINKERS NEED TO KNOW SOME THINGS THAT ARE RIGHT OR WRONG,
BUT THE TRUTH IS THERE ARE ALTERNATIVES.
THERE IS MORE THAN ONE WAY TO DO SOMETHING.
YOU KNOW, THERE'S MORE THAN ONE WAY TO DO AN OCCUPIED BED.
THERE'S MORE THAN ONE WAY TO GIVE A BED BATH.
SHE PROBABLY TAUGHT YOU TO STAND ON ONE SIDE OF THE BED,
BUT WHAT HAPPENS IF THEY'RE REALLY HARD TO REACH
BECAUSE THEY'VE GOT TUBES AND STUFF,
AND YOU'RE GOING TO HAVE TO DO SOMETHING DIFFERENT.
WHAT IF THEY DON'T WANT YOU TO DO A PARTICULAR BODY PART?
ARE YOU UNDONE? NO, THERE ARE ALTERNATIVES.
YOU START THINKING WHAT'S BEST FOR THIS CLIENT?
HOW CAN WE BEST MEET THEIR NEEDS?
AND NOW THERE'S ALTERNATIVES TO WHAT YOU DO.
THERE'S DIFFERENT KINDS OF SOAPS FOR HEAVEN'S SAKES.
THERE'S SO MUCH THAT'S DIFFERENT.
THIS ONE I ADDED. NURSING IS COMPLEX.
AND WHEN YOU START THINKING ABOUT CRITICAL THINKING,
IT'S REALLY VERY COMPLEX.
CRITICAL THINKERS KNOW THAT THERE ARE MANY VARIABLES
AFFECTING PROBLEMS, ISSUES AND DILEMMAS.
THERE'S SO MUCH OUT THERE TO KNOW, I WISH I KNEW EVERYTHING.
PROBABLY MY HEART'S DESIRE IS JUST TO KNOW EVERYTHING.
AND I SO DON'T. I KNOW WHAT I KNOW.
I HAVE MY EXPERIENCE AND I HAVE A LOT TO OFFER.
BUT THERE'S SO MUCH.
AND I'M GOING TO LEARN SO MUCH EVEN HERE TODAY FROM YOU,
THAT WE HAVE JUST HAVE TO PUT EVEN ALL OF THAT INTO PLAY
AS WE'RE TAKING CARE OF PEOPLE AND MAKING DECISIONS THAT AFFECT THEIR LIVES.
THE WELFARE OF PEOPLE, FAMILIES AND EVEN COMMUNITIES.
IT'S VERY, VERY COMPLEX.
AND THEN FINALLY, YOUR BOOK SAYS COMMITMENT TO CRITICAL THINKING.
AND THAT'S ANTICIPATING THE NEED TO MAKE CHOICES
WITHOUT ASSISTANCE FROM OTHERS
AND THEN YOU ASSUME ACCOUNTABILITY FOR THEM.
THERE'S A COMMITMENT TO CRITICAL THINKING.
I AM JUST NOT GOING TO SETTLE FOR ROTE LEARNING,
I'M NOT JUST GOING TO SETTLE FOR RIGHTS AND WRONGS.
BUT I AM COMMITTED TO LOOKING AT ALTERNATIVES,
I AM COMMITTED TO FINDING OUT WHAT'S BEST FOR THE FAMILY.