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.