fabulous nurse - january 2014

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FABULOUS NURSE

Chief Nursing Officers Accounting for a Better Future for Nurses

Weeding out Pain: The Cannabis Dictum

Nurse Profile: Mission to Ecuador & Beyond!

Issue 2.1 January 2014

www.fabulousnurse.com

LIFESTYLES * OPPORTUNITY * EDUCATION

Nurse Profiles

AWARD

WIN NING

Job Opportunities Living WellProfessionalDevelopmentScholastic programs,newsworthy contentand work place toolsfor advancement.

Holistic treatment trends/options for your health & wellness.

FN Mag featuresjob postings inevery nursingspecialty.

Real nurses sharestories to inspire& educate.

Fabulous Nurse Magazine

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Masthead/ContributorWriters Publisher Sony Publishing Corporation

Editorial Sonya Justice

Art & Graphic Design To submit artwork / ad creative Email: [email protected]

Advertising & Marketing For advertising opportunities Email: [email protected]

Contact our Sales Director, Email: [email protected]

WritersTo submit articles for publication Email: [email protected]

Reach Us By PostFabulous Nurse Magazine 12819 SE 38th Street Ste. 173 Bellevue, WA 98006

[email protected]


Elsie EkwaEditor-in-Chief The vision behind Fabulous Nurse Magazine, Ms. Ekwa saw the need for a lifestyle magazine that all at once serves as a celebration of nurses, a guide for better living, a resource for career development, and a guilt-free escape from the sometimes grueling shifts that nurses work. Ms. Ekwa’s distinguished ca-reer as a commercial model, college newspaper editor, and intensive care nurse informs and influences the creative and intellectual direction of Fabulous Nurse Magazine. This is evidenced by the magazine’s fresh approach to home life, dy-namic content, inspiring stories about real nurses, and professionally relevant editorials. Ms. Ekwa is also the managing editor for the Pacific Writer’s Corner online magazine. She writes as Sonya Justice and speaks on health and wellness issues, the business of writing, and entrepreneurship.

Zee NickersonWriterZee Nickerson has a B. S. in Psychology and has owned several successful Businesses. She is currently a writer, fashion consultant, and public speaker. Ms. Nickerson has taught English in Japan, Communist China and state side. As a thrifty world traveler, she can travel for as little as a $1.00 a mile. Along the way, she taught herself spoken and written French, German, and Japanese. She has traveled in all 49 states and would like to add Alaska to her collection. Her watercolor paintings are currently displayed at the Creator’s Gallery in Jacksonville, Oregon. Ms. Nickerson is pleased to announce she is just starting to twitter at HelloZee! A play on the French words for Let’s Go!

Olusegun Iselaiye Editor & Writer Olusegun is seasoned freelance writer, researcher, and entrepreneur. He taught nursing students Human Anatomy in his home country of Nigeria before go-ing into fulltime writing. Olusegun, whose mother happens to be a respiratory nurse, is also a huge fan of the nursing profession. His ambition is to offer a meaningful contribution to Africa and his home country. When some give his country a bad reputation, it is good to see that there are many who live by higher standards. It is thanks to Olusegun that Fabulous Nurse Magazine will be bringing you its rating system.

Angela McCaskill, RN ContributorAngela McCaskill, MA, RN, CHPN is a second career nurse who combines her passion for helping others with her love of travel and intercultural experiences. Having lived in Spain for 10 years and traveling throughout the world, she cur-rently resides in Dallas, TX and works as a Medical Surgical RN. She is bilingual and uses her language skills to reach out to diverse populations. Always seeking to increase her knowledge of nursing, she is working on an advanced degree.

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Margaret SmithWriterMargaret Smith is a native Texan who loves God, family, country, and writing. She has a variety of interests, and has worked in diverse fields from retail to education. Although she is not a nurse, she has done volunteer work in hospitals, where she has always admired the dedication and skill of the nurses she has seen in action. She recently made the decision to become a full-time writer. Margaret enjoys the process of discovery and development in each new project.

Sara Caldwell WriterSara Caldwell is an award-winning writer and the author of three entertainment industry books published by Allworth Press. She has written projects for many healthcare organizations, including the American Hospital Association, the Joint Commis-sion, and the American Optometric Association. Sara is a professor of Media Entertainment Arts at College of the Canyons in Santa Clarita, CA and a frequent workshop leader. She is represented by the ADA Management Group.

Mindy Carney WriterMindy Carney has been a professional copywriter for over fifteen years, working primarily as a freelancer. While not a nurse, she grew up the daughter of a Radiologist and an RN. Mindy’s niece is an RN in a neurology ICU as she pursues her goal of becoming a nurse practitioner. Mindy is the single mom of two daughters, both adopted as infants in China. Mindy and her fam-ily have travelled back to China several times. Much of her writing has focused on adoption, parenting, and cultural balance. She holds both a B.A. and M.A. in Communication, having focused first on journalism and then on education. She believes in a lifelong journey of learning, and her favorite aspect of freelancing is delving into new topics and material.

Carol Sowell WriterCarol Sowell has been a writer and editor for more than four decades. She has edited books for more than a dozen publishers on topics ranging from global economics to mystical sex. In addition, her articles have appeared in Today in PT, National Catholic Reporter, Modern Maturity, and other national publications. As national director of publications for the Muscular Dystrophy Association, she edited MDA’s prize-winning magazine, Quest, and wrote and edited educational materials about medical conditions, caregiving, health care services, and other aspects of living with a chronic disease. She lives in Tucson, Arizona.

Karen KalisWriter

Karen Kalis has ten years of experience as a professional copywriter. She has worked in industries such as education, real estate, healthcare, technology, and with non-profit organizations. With an M.A. in Creative Writing, Karen’s clients include: Fabulous Nurse Magazine, RMS Technologies, Lincoln Electric, Multi-Care Management, and The EPIC Group. An entrepre-neur at heart, Karen focuses on helping businesses communicate what they have to offer with precision.

Matthew FowlerWriter

Matthew Fowler, founder of A Sodality of Wordsmiths, is currently a professional writer for the US government, namely, the US Department of Labor, where he adjudicates claims and writes formal decisions regarding labor issues. He got his start in the career field of language arts as an active duty soldier, civil affairs division, writing press releases and the like. As an active duty soldier he traveled, literally, around the world in various capacities and including combat operations in Bosnia, the Phil-ippines, and Afghanistan to deliver the Army story. His practical experience is bolstered by considerable education, a B.A in Communications and an M.P.A in Public Policy

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Editorial

Yes! Fabulous Nurse Magazine is back! Thank you for your patience, your continued support, and many emails. We are humbled, so many

nurses wrote in requesting that we resume monthly issues of Fabu-lous Nurse. It is always wonderful to know that you believe “Fabu-lous Nurse Magazine is a must-have complement to (your) specialty based nursing magazines.”

Quick housekeeping information:

You will notice some changes in future issues of Fabulous Nurse. To make the magazine more compact and reader friendly, some sections have been edited out. The magazine sections which did not make the final cut now have a new home on the Fabulous Nurse website. These are Beauty Secrets, Breakroom Discussions, Attitude Re-De-fined, and Poetic Voice. We know how much you love these sections and will update the website periodically.

Fabulous Nurse 2.0 features The Nurses Station I, which focuses on professional development – education, finance, management, and communication skills; The Nurses Station II where we rate nurse employers (hospitals and staffing agencies), institutions of learning, and electronic medical records; inspiring nurse profiles are featured in Walk in My Clogs; workplace destinations are highlighted in Travel from a nurse’s perspective for the travel nurses amongst us; find mandatory humor in LOL, and of course Resources for informa-tion on books to read, upcoming conferences, job opportunities, and more…

The prevailing theme is one of renewed advocacy and reverence for the Nursing profession. We love all things nursing and aim to be one of the many beacons that shed a positive light on this noble profes-sion. With that in mind, we have added a television show to our repertoire.

Reel Nurses Television – RNTV

In light of the many negative nurse stereotypes in the media, RNTV was founded with the sole aim to produce television programs and shows which feature a professional and accurate depiction of nurses. Enter The Reel Nurses Talk Show. With television as its primary medium, The Reel Nurses Talk Show features only nurses as guest experts. We are happy to announce that this is a television first. As a renowned physician succinctly stated, “It’s about time!”

When viewers tune in, they will see nurses doing what nurses do best, educating the public on health and wellness issues. Patient edu-cation is something we do readily, frequently, and instinctively at work. Isn’t it time a TV show was created to showcase nurses’ train-ing and the numerous of opportunities for growth available to those who enter the profession of Nursing? In a nutshell, we created The Reel Nurses Talk Show to say loudly and clearly, “Nurses Rock!”

Sonya JusticeEditor/Publisher FNM

Founder RNTV

Updating the Image of Nursing One Project

at a Time!

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Updating the Image of Nursing

Table of ContentsP.22 Weeding out Pain:

The Cannabis Dictum

P.11 ChiefNursingOfficers:Accountingfora Better Future for Nurses

P.36 NurseProfile: Mission to Ecuador & Beyond!

P.43 Diamond Nursing Education Rating

P.32 Joyce E. Johnson: Rx for Change

P.26 2014ClogTrends!

COVER ARTICLES FEATURES

January 2014

EDITORIAL P.8 Updating the Image of Nursing One Project at a Time...

THE NURSE’S STATION I Professional DevelopmentP.14 MaleNurses: WorkinginanEstrogenCloud

P.16 OnlineEducationto StayAheadoftheCurve

P.18 AnExaminationinto AgeisminNursing

FASHION WATCH P.26 2014ClogTrends!

TRAVEL P.36 MedicalMissions: APersonalMessageof Passion in Practice

LIVING WELL P.40 Obesity: In Search of a Root Cause

WALK IN MY CLOGS

P.30 360Nursing:AnInsider View – Zoom Harb

THE NURSE’S STATION II Facility RatingsP.45 HospitalRating: HaywoodMedicalCenter,NC

P.46 StaffingAgencyRating: ContinentalNurses

P.47 NursingSchoolRating: OregonHealth&Science University

LAUGH OUT LOUD P.50 Nursing Humor

P.50 GeneralHumor

RESOURCESP.52 BookReview–InspiredNurse

P.53 JobOpportunities–Perm&Travel

P.54 2014 Nursing Conference

P.56 NursingNews–PressReleases


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Nurse’sStation I

The

Professional Development


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Professional Development

The Chief Nursing Officer position continues to advance with more responsibility, and better remu-

nerations. However, as expected, this de-velopment has its attendant challenges and concerns. Chief Nursing Officers are indis-pensable in health care because their duty is to oversee the delivery of patient care, the only end-product in health care sector. Their extended accountability echoes the signifi-cance of patient care delivery. Consequently, Chief Nursing Officers must have apprecia-ble level of influence in strategic decision-making processes/issues at the executive level. Therefore, this article is an attempt to discuss how CHIEF NURSING OFFICERs account for a better future for nurses.

Nursing ProfessionNursing profession has continued to conquer sociocultural barriers since the days of Flor-ence Nightingale, when she demonstrated her invaluable, selflessness, skills and knowledge to help the wounded soldiers. Ever since then, Nursing has continuously ranked among the top issues in the health sector.

Nursing Challenges The health care sector unarguably currently faces unprecedented challenges. Nurses need to play a commendable role in overcoming these challenges. In spite this critical need, nursing profession has to take care of its own challenges first and foremost.

The World Health Organization (WHO) and the International Council of Nurses (ICN) have elaborated some of these nursing chal-lenges in their Quarterly Journal in Winter 1992 volume. The first challenge concerns the inability of many health care institutions to jointly develop nursing education, practice and management. The second is the “need for nurses to take responsibility for caregiving wherever it may take place,” said Contance Holleran, former Executive Director of ICN. The third is the need to develop and practice nursing and midwifery with continuous dis-course with the individuals and populations for whom the services are intended.

Apart from the three challenges stated above, WHO and ICN identify that nursing manage-ment has a major responsibility in the area of development of knowledge, skills, schemes, as well as structures that will engender quality and cost-effective health care provision.

Nurses will continue to remain less relevant in the health care sector if these challenges are left unattended. And the only way to properly

address these concerns is for health care orga-nizations to have a competent nursing man-agement, which cannot be achieved without strategically involving the Chief Nursing Of-ficers at the management level.

Chief Nursing Officer, Future of Nursing and Health CareToday, the Chief Nursing Officer is expected to strategically lead as the senior executive staff taking responsibility for all nursing and other designated caregiving roles and services within the health care facility. Es-sentially, the role is expected to assume re-sponsibility for a facility-level assessment, planning, coordination, implementation and evaluation of nursing practice. The role takes on a 24/7 responsibility, accounting for the provision of high quality, safe and suitable nursing care, clinical staff capability, and proper management of caregiving related resources. The Chief Nursing Officer’s duty is to represent nursing concerns and interests on the governing board as well as at medical staff management meetings.

Chief Nursing Officers

By Olusegun Iselaiye

Accounting for a Better Future for Nurses


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The future health care is incomplete without the nurses. This is the reason health care re-form is never discussed without mentioning the future of nursing together with the roles of nurses. The Future of Nursing: Leading Change, Advancing Health, a 2010 report by the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF), examines what it will take nurses, hospitals, health administrators, government agencies, and others in the health care team to meet future demands for health care. The report made some recommendations, encouraging the senior leadership of health care organiza-tions to appoint Chief Nursing Officer’s (or nurse executives) to positions that contribute meaningfully to strategic decision-making issues and processes. The IOM/RWJF report underscores the importance of nurse leaders’ active involvement in the acquisition and implementation of ICT and quality improve-ment processes.

Another report by the IOM, The Future of Nursing: Focus on Scope of Practice, ac-knowledges that nurses will play a more heroic role in health care. The report states that “Nurses have a considerable opportu-

nity to act as full partners with other health professionals and to lead in the improvement and redesign of the health care system and its practice environment.” But this depends largely on the Chief Nursing Officers.

Future Challenges PersistBallein Search Partners’ study, Why Senior Nursing Officers Matter: A National Sur-vey of Nursing Executives, reveals that 95 percent of Senior (Chief) Nursing Officers have established collaborative robust rela-tionships with the executive team as they get support from them for the implementation of needed changes. However, these Chief Nurs-ing Officers have ranked the following as the top three challenges they face today accord-ing to the Ballein Search Partners’ survey:

1. Recruitment, retention, and/or staffing;

2. Provision of training/leadership into the future; and

3. Acquisition of technology to make care more efficient.

Conclusion The Chief Nursing Officer, who should have a minimum of master’s degree as the nurs-ing officer who interacts with other depart-ment heads in the hospital organization, is a professional player. This officer is faced with the responsibility of accountability for a better future for the nurses in general. No wonder RWJF’s Gallup poll of health care officials in March 2012 that examined how nurses might galvanize a change reveals that “Opinion leaders feel [that] society, and nurses themselves, should have higher expectations for what nurses can achieve, and that nurses should be held accountable for not only providing quality direct patient care, but also health care leadership.”

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You’d think that public speaking

wouldn’t be a job requirement for

nurses, but that isn’t true. With

more and more nurses involved in research,

teaching, and leadership positions, having

exemplary public speaking and presentation

skills is a virtual must in the nursing field

today.

Public Speaking Is Necessary For Nurses

While most people don’t love public speak-

ing, nurses who avoid it can slow down their

career. According to Vicky, an RN and au-

thor of “Tips for Effective Public Speaking”

AllNurses (July 4, 2009), “Public speaking

is such a powerful form of communication

that almost every profession requires it.

The reluctance to get up in front of an au-

dience can be a major impediment to career

advancement.” Indeed, public speaking –

whether to another group of nurses, a com-

munity group, physicians or business people

– can open doors, as well as, provide new

career opportunities for you.

The good news is that despite the fact that

many people cite public speaking as their

number one fear, it is a skill that can be

mastered, according to Gillianne Meek in

her article “Enhancing Nurses’ Presentation

&

Skills,” (June, 2005). “Nurses frequently

have to give presentations, whether as part of

a job interview, as feedback from a course or

conference or simply as part of a profession-

al development program. It can be daunting.

However, giving effective presentations is a

skill everyone can learn.”

How To Prepare

If you are asked to do a presentation, here

are some key considerations to keep in mind

when preparing. First, ask good questions

of the people that are asking you to speak.

How long do they want you to speak? What

Male Nurses By Karen Kalis

Working in an Estrogen Cloud

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topic would they like you to cover? Where

will you be speaking? Is it a formal speech

or a casual Q & A format? Will anyone else

be speaking? Who will you be addressing?

Having all of this information provides you

with critical information as you prepare.

Secondly, Vicky suggests that you, “Know

your subject material thoroughly, including

the purpose of the presentation. Know it so

well that you generate enthusiasm. Prepara-

tion is one of the most important factors for

oral communication success.”

A good deal of practice is the key to becom-

ing at ease when doing public speaking. Try

to vary your pitch, remember to speak loudly

and look at the people you are speaking to.

Maintaining eye contact keeps your audi-

ence paying attention to you. You may even

pick up subtle body language as you speak.

Another area where nurses may need coach-

ing on public speaking is on what to wear.

While scrubs may be appropriate for on-duty

hours, public speaking may require a change

of dress. What you wear will change how

you feel, so choose carefully, always select-

ing the most professional appearance.

Finding Your Niche

While you may not enjoy public speak-

ing now, you may learn to enjoy it. Public

speaking was a skill that Karon White-Gib-

son, an RN and host of her own television

show, “Outspoken with Karon,” developed

along the way. “I was terrified of public

speaking. Never took it in high school. I

was asked to go to colleges and universities

when [my book was published]. The bigger

the crowd, the better I liked it. I was asked

a lot of questions that weren’t in the book.

What I learned is that you have to say what

you have to say no matter what they ask you.

You have to get a message across,” she said.

That is sage advice. As a nurse you know

that no matter the interruption or distraction,

you must stick to your job. Public speaking

is no different. Completing your message

is critical and will help you develop your

professional image and reputation. Beverly

Malone, Ph.D., R.N., F.A.A.N., the National

League for Nursing Chief Executive Officer

said, “It’s nice that you’re brilliant but, if you

can’t pass it on, it’s for naught.” (“Future

Academic Nurse Leaders Hone Presentation

Skills, April 23, 2009, Robert Wood Johnson

Foundation Speech).

As a nurse, you may never have considered

public speaking a professional requirement,

but as more and more nurses work outside of

the medical community, complete research

that needs to be presented, and become nurse

educators, those public speaking skills be-

come critical. With a little practice, no mat-

ter how daunting speaking in front of a group

may seem, you can master it.


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Cheryl B. was a highly successful advertising executive. She spent her mornings in meetings, drink-

ing coffee and pitching big ideas to bigger clients. She spent her afternoons drinking martinis at three-hour-lunch meetings. And she was making a whole lot of money. Her life was full of energy, vitality, productivity, and meetings. She should have been deliri-ously happy, and she thought she was. Then cancer struck.

Watching her mother go through the diffi-cult processes of realization, then treatment, Cheryl felt impotent. Her attempts to cheer her mother with trivial conversation just bounced off the distraction and fell flat. Her father was already grieving, completely in-consolable in his anxiety. Cheryl hated feel-ing so helpless.

In the hospital, she began to notice scrubs-clad miracles striding briskly from room to room in their whisper-quiet clogs. Their

presence had a calming influence, and she could see that they were making a differ-ence, making her parents more relaxed and hopeful. Of course, the doctors were a vis-ible presence, too, and they did their part to analyze and treat; but it was the nurses who lingered an extra moment, making sure needs were met, questions answered, and fears calmed.

Eventually, thankfully, Cheryl’s mother was cancer-free, but Cheryl continued brooding about the experience. Those wonderful nurs-es had taken a dire situation and channeled the focus to comfort and assurance. Their efficiency, skill, warm smiles and cheer-ful attitudes had brought about the changes that Cheryl had not been able to accomplish. This was what she needed in her own life: the power to make a difference. Cheryl knew that it was time to change careers.

Like others before her, Cheryl decided to get on the fast track to a new career with an As-

sociate’s degree in nursing. She felt it was the best decision she ever made. She loved her new career as an RN but, also like others before her, she wanted to broaden her career possibilities. So she decided to kick it up a notch.

A blueprint for change

In order to maintain a high level of profi-ciency and stay on the cutting edge of the field, nurses can explore opportunities for advancement through professional devel-opment. According to Discover Nursing 6/29/11, when ADNs raise the bar by going for a BSN, they instantly open more doors and find greater flexibility in specialties and locations. Nurses with a BSN can apply for positions as nurse managers or hold titles such as assistant director of nursing.

By obtaining an advanced degree, nurses have even more options as to how they make their contributions. As Find Nursing Schools

Online Nursing Programs

by Margaret Smith

to Stay Ahead of the Curve

Issue 2.1

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7/2/11 reports, nurses with an MSN can be-come nurse practitioners, where they’ll be able to offer primary care, make diagnoses, and prescribe treatment. They may also opt to become a researcher or a nurse entrepre-neur. Moreover, MSN degrees enable nurses to meet the continually increasing demand for nurse leaders, educators, or executive po-sitions, such as policy advisers and innova-tors. The choices are almost limitless.

Who has time?

Unfortunately, nurses are extremely busy. It’s difficult to find time to commute to a site, sit in a class taking notes, and commute back to job or family. Unless, of course, the professional development is part of an online nursing program, the answer to a prayer for many nurses.

Good online programs provide the profes-sional instruction of the traditional class-room, but without the time or geographical constraints. Through online bridge programs, RNs can advance their careers with BSN, MSN, and sometimes even PhD degrees. Working with a laptop computer, they can participate from virtually any location. Ac-cording to Accelerated Nursing Guide, most RNs can complete a bridge course to an MSN degree in under three years, and BSNs can earn their MSN in approximately two years. Considering that a higher-level degree will pay off with higher-level duties, a better pay rate, and more options, two to three years is a minor investment of time.

Sounds tempting, but . . .

Are online nursing programs really a viable option, or is the idea too good to be true? The truth is, they’re not for everyone. According to Find Nursing Schools 7/3/11, online students need to be highly disciplined self-starters, able to regularly dedicate part of their schedule to the courses and study. Additionally, if students are uncomfortable with comput-ers, there may be a problem with online classes. A working knowledge of com-puter technology is necessary to navi-

gate the complexities of discussion boards or chat rooms, as well as upload, download, and email assignments. And some people re-ally do need the face-to-face interaction with faculty and peers.

Other than those considerations, there are many advantages to obtaining advanced degrees through online courses. The major benefits are the convenience and flexibility they provide. Students can locate and enroll in programs that address their personal in-terests without ever having to drive to the campus. Although there are programs that require some online classes to meet at spe-cific times, most lectures can be attended at the student’s convenience. They can log in to classes early in the morning, late in the eve-ning, or at random opportunities. Moreover, lectures can be interrupted, then continued—or revisited, if students feel they’ve missed anything.

The accelerated nature of courses is another advantage to online professional develop-ment. Again, this aspect may not be in some students’ comfort zone. The pace may be too intense and the assignment deadlines too tight for some, but if a student is up to the challenge, the time necessary to graduate will be reduced.

Danger, Will Robinson!

In researching online programs, students will find that some may be more expensive

than brick- and-mortar institutions, and some may be less expensive. This is where a little caution is required. While there are a multitude of reputable programs out there, according to Discover Nursing 6/29/11, there are also some charlatans, sometimes referred to as “diploma mills,” just out to get your money. Many prospective nurses have invested their time and money only to find that the online “degree” they’ve acquired is not recognized by potential employers. What a waste! But if you do your homework, you can avoid swindlers.

The only sure way to a degree is through a recognized accredited program. You can obtain a list of accrediting bodies from the Council for Higher Education, and see if the program you’re considering meets the prop-er standards. Another way to make sure the program is genuine is to verify that it leads to the NCLEX exam, which is required to obtain a nursing license. It’s also a good idea to check out the pass rates for the exam, the failure rate of students in the program, the cost, the demand on your time, and credit transferability. But students should beware of programs that offer credit for life experi-ence; according to an article on Ezine 7/2/11, this is not usually legitimate, and employers won’t accept it. By keeping their eyes open, students can avoid the pitfalls. In many cas-es, employers will even pick up the tab!

Online professional development pro-grams can be the answer for RNs who want to remain employed and continue their education. Many outstanding in-stitutions offer excellent online nursing programs: Drexel University, Keiser University, University of Phoenix, and Jacksonville University are some of the better known names. With such excep-tional online programs, along with the commitment and drive to go the dis-tance, aspiring nurse leaders will be ex-ceptionally well-prepared to help guide America’s health care system to a new

vitality.


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R – E – S – P – E – C – T .

It wasn’t long ago that being an older person

meant you got your due share of it. Younger

generations actually appreciated and re-

spected the wisdom and experience of their

elders. In nursing teams that could include

four generations, older nurses were especial-

ly revered for their longstanding expertise,

and younger nurses would seek out their ad-

vice and use them as role models.

Then the age of technology came along. As

changes in professional and personal meth-

ods occurred almost daily, older nurses were

left out of the loop unless they made con-

scious efforts to battle this new technology

monster. Some of them were a little slow to

pick it up. While there are few specific stud-

ies that address the issue, there is a great

deal of anecdotal evidence that demonstrates

that younger nurses became disrespectful

toward older nurses in both words and atti-

tudes. Recognizing that they suddenly had

an edge over their elders, some members

An Examination into Ageism in Nursing

By Margaret Smith Older Nurses: Aged to Perfection

Issue 2.1

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Older Nurses: Aged to Perfection


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streamline the process of patient care. For

nurses who didn’t cut their teeth on technol-

ogy, the learning curve can be pretty steep.

Keeping up with the technological develop-

ments, not to mention new practice guide-

lines and advances in science and medicine,

can be difficult for older nurses. While there

are courses and workshops available, it be-

comes an additional demand on time and

energy. Although older nurses still have the

drive and the spirit, their physical stamina

isn’t what it used to be.

The information age has added an unexpect-

ed element to the mix: as the nurses from

of the younger generations gradually began

to exhibit signs of loss of respect for their el-

ders. In the workplace, this change in levels

of respect can lead to conflict, resulting in

a negative impact on the efficacy of a team.

Challenges faced by older nurses

For nurses in the Silent Generation (born be-

tween 1925 and 1945) and the Baby Boom-

ers (1946-1964), it’s been a very long time

since nursing school graduation. The profes-

sion has undergone a metamorphosis, and

the changes go far beyond the shedding of

the all-white uniform and nurse’s cap. Now

just about everything depends on technol-

ogy. Where hospital corridors used to rever-

berate with calls for Dr. So and So or Nurse

Whatsis, the overhead PA system has been

replaced with handheld mobile computers

that enable nurses to make and receive calls.

Beyond that, according to Nurse Zone

10/11/11, these same devices also facilitate

identification confirmation with bedside

scans of patient wristbands, retrieval of med-

ical record and lab order information, and

verification of administration of meds. In

some cases, the devices are also used to take

photographs to document patient progress.

Moreover, computerized charting, com-

puters on wheels, smart systems, and even

smart phones are being used in hospitals to

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Generation X and Millennium Generation

are able to access the newest information

through technological research, they are no

longer turning to older nurses for help and

advice. They perceive their older colleagues

as old-fashioned and resistant to technologi-

cal advancements. They become frustrated

with their co-workers who need a little more

time to absorb the intricacies of technology.

It’s a shame that older nurses are facing

this sort of attitude when more experienced

nurses should be considered an asset to the

profession. Patients regard them with trust

because, although they may have issues with

technology, their care for patients is just as

important to them now as it was before tech-

nology “simplified” everything. And older

nurses are happy to team up with doctors

and help them with the smaller tasks that

their young counterparts often dislike doing.

Consequently, they’re perceived by doctors

as more desirable to assist on medical teams.

Reality check

In light of the nursing shortage that is pre-

dicted to continue until 2020, older nurses

who wish to continue in the profession

should be supported in their objective rather

than discouraged by an undesirable work

environment. When the differences be-

tween multiple generations create conflict

and disrespect, professionalism declines and

the quality of care is affected. According

to Nursing Profession News, August 2007,

nurse leaders have begun to recognize the is-

sues and are taking steps to improve levels

of mutual respect and understanding among

colleagues of multiple generations.

The most important step to institute is open

communication and the recognition that

each generation has something worthwhile

to contribute to a team. If all parties listen to

other viewpoints with respect and openness,

the atmosphere will be more conducive to

professionalism and compatibility.

Other ways to ensure that older nurses will

want to remain in the work force are to im-

prove working conditions. There could be

more opportunities for work that is appro-

priate for their energy level and physical

abilities. Developing schedules with flexible

working hours, providing equipment that is

ergonomic and safe, and providing pools of

nurses for short-term needs are further ways

to make the job more tolerable for older

nurses.

Breaking the age barriers

Once the workplace has become more

practicable, it’s up to the nurses to

fine-tune their skills and underscore

their relevance to the institution they

work for. One obvious way to stay

current with the constantly chang-

ing profession is to take continuing

education courses to learn about

new procedures, techniques, and

medications. Studying profes-

sional journals and taking

advantage of conferences

that offer concentrated

learning opportuni-

ties in a short pe-

riod of time will

help nurses stay on

the cutting edge.

Finally, if older

nurses want to

safeguard their

jobs, it’s a good

idea to join com-

mittees to stay

informed, es-

pecially com-

mittees that

d e t e r m i n e

policies and procedures. It all takes

some extra effort, but it will prove to

be worthwhile to the nurse and to the

profession.

Gray hair and a few wrinkles have never

been a sign of incompetence. In a field as

vital as health care, every nurse is an asset.

By finding ways to overcome the ageism and

disrespect that are driving many older nurses

from the profession before they’re ready, we

can all be assured of a brighter future.


22

Cannabis sativa, also called weed, mari-

juana, pot, cannabis, grass, hemp, marijuana

(marijuana), hash, ganja, and smoke, etc. is

an annual flowering plant that grows wild

in tropical and warm climates and is often

cultivated commercially, though illegally

in many countries. There are two other spe-

cies of cannabis apart from Cannabis sativa:

Cannabis indica and Cannabis ruderalis.

Why Cannabis?

Cannabis has a long history of medical use. The US Federal fo-cal point for research on drug abuse and addiction, National Institute on Drug Abuse (NIDA), states that “The use of cannabis for purposes of healing predates recorded history. The earliest written reference is found in the

By Olusegun Iselaiye

15th century BC Chinese Pharma-copeia, the Rh-Ya.” The U.S. law, since 1970, has classified mari-juana in Schedule I controlled substances. In other words, there was no generally accepted medi-cal use for the substance, particu-larly when smoked.

Today, THC and marijuana are promoted as pain relievers, in addition to the uses already identified above. Experts also report that THC lowers intra-ocular pressure, the reason it is believed to be useful in manag-ing glaucoma. Marijuana, as also argued by some promoters, has anti-bacterial properties, is an inhibitor of tumor growth and a dilator of the airways – believed

to be useful reducing the severity of asthma crises. It has also been argued that marijuana is effective in controlling seizures and mus-cular spasms in individuals with epilepsy and injured spinal cords. Bloggers and medical writers, as of 2012, also reported that mari-juana oil (or hemp oil) can cure a wide range of diseases includ-ing cancer, diabetes, ulcers, mi-graines, arthritis, infections, and insomnia, etc.

Cannabis Misuse Around The World

According to the World Drug Report (WDR) 2013, cannabis is the most widely consumed il-licit substance in the world; about 180.6 million people, aged 15-64, joined the population of illegal users of cannabis in the world be-tween 2009 and 2010 alone. Can-nabis cultivation seems to have gone up in the United States in

Until recently, marijuana was known to a limited medical use because different amounts of various compounds are contained in different strains of the plant. The most commonly isolated substances from the plant are cannabinoids,

which can be administered in specific doses either alone or in combination with other drugs. THC or chemical delta-9-tetrahydrocannabinol is the most potent cannabinoid. While other marijuana extracts are still under test, the US Food and Drug Administration, FDA, has approved some cannabinoid drugs to control vomiting/nausea, boost appetite in cancer and AIDS patients.

Weeding Out Pain:

The Cannabis Dictum

Issue 2.1

23

general. Cannabis herb seizures in South America rose by 46% in 2011. Many African coun-tries reported high level of can-nabis herb seizures, with Nige-ria having the highest figures in the region. WDR 2013 could not provide accurate numbers for Eu-ropean countries because its cul-tivation varies widely across the continent.

The regions with the highest prevalence rate of cannabis use are Central and West Africa (12.4%); Australia and New Zealand (10.9%); North Amer-ica (10.7%); and Central and Western Europe (7.6%). About 10 million people in the UK admit to having tried cannabis. Over a 33 percent of people aged 16-24 have taken cannabis at least once in their lives. In the UK, more than 2 million people smoke the substance.

Legalizing Cannabis

Cannabis use, sale, and/or pos-session is illegal in the United States. However, the Federal Government has declared that states reserve the right to pass laws to legalize cannabis for recreational use. The Federal Government advised further that states should have cannabis laws in place to guide the use of the substance.

But how well have the individual state laws proposals complied with the Federal standard on can-nabis use? It has been a mixed result. While a number of states have successfully permitted the psychoactive substance to some varying degrees, others have

outrightly exempted medical cannabis, and many others have come up with both proposals to decriminalize and pass medical laws. Colorado and Washington states have both legalized the cannabis for recreational use via state referenda approvals in 2012 elections, while Oregon’s attempt to do same failed.

Basically, cannabis legality for recreational or general use varies from country to country, though many countries are beginning to decriminalize its possession in small quantities and accepting its consumption for medical pur-poses.

Does Cannabis Weed Out Pain?

In terms of pain treatment with cannabis, both pill and puff forms work well according to a carefully controlled, small-scale, new research study. The pill has a longer pain relief effect than puff, but may not cause high-feeling effect like puff form.

A non-profit group ProCon.org reports that cannabis, called medical marijuana, has now been made legal in 18 American states

as well as the District of Colum-bia. Surveys have shown that pain is one of the major reasons medical marijuana is prescribed by doctors. But researchers test-ing the pain relieving properties of cannabis have reported dichot-omous results. Some maintain that it works much like mild opi-oid/narcotic pain relievers such

as codeine, while others have revealed that there are possibili-ties of the drug worsening the pain instead of reducing it.

Despite the mixed results, pain relief remains one of most estab-lished benefits of medical mari-juana. Actually, the American Academy of Family Physicians (AAFP), the American Public Health Association (APHA), and the American Nurses As-sociation (ANA) have all en-dorsed medical marijuana’s use

in treating severe chronic pain. In fact, the New England Journal of Medicine also supports its use for severe chronic pain. Canna-bis has also been reported as an effective treatment for nerve in-jury (chronic neuropathic pain). Medical marijuana was tagged the most promising neuropathic pain treatment by a group of pain research experts who convened at a MedPanel summit in 2006.

For more information, scan the QR code below to view pain management video.


24

Issue 2.1

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FASHIO

NWAT

CH



26

Clog

Trends 2014Footwear Trends for 2014 come as varied as the nursing population itself…

Kayla - Good Vibes

By Alegria - Kayla Collection. This slip-on shoe fea-

tures a mild rocker outsole to reduce metatarsal

pressure, stain resistant upper, and a footbed

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ible with custom orthotics. Priced

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Austin

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White Smooth Shayla

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ing at $69.99

Dove

By Nurse Mates - This easy slip-on shoe features a tum-

bled leather upper with stain-resistant finish and ultra-

lightweight flexible construction including rubber

inserts for slip-resistance and longer wear.

Heel height: 1 4/8”. Priced start-

ing at $69.99

Blue Caiman

By Dansko – Professional XP collection. Provides the

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ty EVA footbed with memory foam.

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Revive

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outsole and longer lasting EVA footbed provide

extra support. Moisture wicking Poliyou sock-

liner; extra thick insole provides more shock

absorbing comfort & support. Priced

starting at $44.99

Issue 2.1

27

Professional Lindsey

By Koi (Sanita) - This shoe features a patent

upper, rocker bottom, skid resistant outsole,

reinforced padded instep, absorbent insole,

and roomy toe box for comfort. Priced

starting at $129.99

Lewiston

By Alegria - Mens - Lewiston Collection. This ankle

high slip on shoe features double-sided goring for

comfort, removable footbed with cork & mem-

ory foam; hand sewn leather lining, arch

support and a roomy toe box. Priced

starting at $149.99

Debra

By Algeria. The Debra slip-on features a handcrafted

sole and a 1.5 inches heel, leather for durability,

contrast stitching edges, foam footbed for

comfort, elastic goring for easy slip-on

and slip-off. Priced starting at

$68.99


28

Issue 2.1

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Walk inMy Clogs



30

they don’t violate the rules of society.” Be-cause Harb arrived in Saudi Arabia already married, she was allowed to live outside the hospital compound.

While things in Saudi Arabia may not al-ways make sense to us, they are improving. “There are a lot of European and American women, so they are making concessions. At the large shopping malls in Riyadh we didn’t wear the abaya. It was bad for business if they made us wear it while shopping. Oth-erwise, if I had to go to the marketplace, or the normal places, I had to cover my hair, because the police might be lurking,” said Harb. Other areas were not as progressive.

At WorkHarb said that in terms of technology, work-ing as a nurse in Saudi Arabia was fairly similar to being in America. “In the hospi-tal, I worked in CCU. We worked using the normal bypass. It was pretty similar to an American hospital. What we learn and have here, they implement it there,” she said. Luckily, all the hospitals orders are written in English, so language wasn’t a barrier in the professional setting.

As a travel nurse, Harb’s experience with

Introduction

Travel nursing is becoming more and more popular as an option for nurs-es. Zoom Harb, R.N., spent time as

a travel nurse in Saudi Arabia from 2002-2004. We asked her some pointed questions about her time living and working in the Middle East.

Culture ShockWhen she found out she was going to Ri-yadh, Saudi Arabia as part of her husband’s work, she was concerned about how it would be to work abroad. “At first, I didn’t really want to go there, especially based on the sto-ries I was told,” she said, “When I got there, I had culture shock.” Culture shock for trav-el nurses is usually softened by the hospital-provided orientation. “The first thing they did when I got there was orient us as to what we could not do in Saudi Arabia. I had to carry my marriage certificate with me. Any policeman could have asked us why my hus-band and I were together. It’s really a very different type of society. It’s a bit extreme,” said Harb.

Working as a travel nurse in Saudi Arabia can be a challenge because of the restric-

tions of the culture. As an American woman living in Saudi Arabia, Harb had to wear a covering whenever she went out. “You can-not move around in normal dresses. I had to wear an abaya (head scarf) if I had to go in the street. In the hospital I had to cover my hair with a cap. It is the law in the society. Otherwise the religious police or regular po-lice would send us to jail,” she explained.

In addition to appropriate coverings, single travel nurses in Saudi Arabia are required to live in hospital provided housing within the compound. “If you are single you stay in-side the compound where everything is regu-lated,” Harb said. That includes shopping as a group with a designated drop off and pick up time. “When they go out, if they are late and miss the bus, they can be penalized for that,” said Harb. Being penalized might in-clude being stuck in the compound for a day or two. Single nurses are required to move in a group because, according to Harb, there are cultural concerns, “It’s a safety issue be-cause [Saudi Arabian men] don’t have any access to women and although I’ve heard of prostitution going on, it is underground. Sin-gle women cannot date freely. But, men can go around as much as they want as long as

360 Nursing: An Insider View

ZoomHarb

Issue 2.1

31

patients was pretty similar to here in the US. “The locals are very friendly to nurses and they still have the bad apples. It’s the same as here,” she said. One custom that was completely different in Saudi Arabia is tipping the nurses. Harb ex-plained, “They like to give tips. You have to accept it, otherwise they might be of-fended. They have a practice to give money – they see it as charity.” Nurses can get tips for even the most mundane things. “When they brought the baby from the nursery the nurse would get a tip, but that was a bit ridiculous,” she said. Working in the hospital gave Harb ac-

In Her Spare Time Off duty, Harb spent time with Amer, her husband, and her young family. She has two daughters, Reham, who is currently 17, and Rowan, who is currently 14. While they were in Saudia Arabia, they did a minimal amount of travel. “There are some museums in Riyadh. In the summertime, we drove across Jordan. That’s how we got away. We went to Petra and the Acaba resort. Not a lot in Saudi Arabia,” she said.

For fun, Harb would go shopping or to the park, but per Saudi customs, she was never alone. She said, “My husband has relatives there and we went to the parks for a BBQ. Sometimes I went out with my co-workers. They have a waterpark and entertainment

centers. No movies or theaters. Women are not allowed to watch soccer games. Only men are allowed to go in the stadium.”

Harb said that there are all types of food in Saudi Arabia, but it isn’t particularly healthy. She explained, “Their food is very fattening. They have a lot of bake shops in the city. It’s a mixed thing. In a normal city, you can find anything.”

After spending several years in Saudi Ara-bia, Harb learned a lot about the culture, but said she would not go back, except to visit. “I was amazed to see how people could stay for 20 years!” While offering excellent com-pensation and many financial allowances, there is a trade-off for women interested in travel nursing in Saudi Arabia – excellent compensation, but less freedom. For those considering travel nursing in Saudi Arabia, knowing Harb’s story may be a helpful voice in the decision making process.

cess to some Saudi elites. “Some of the pa-tients are Royal family or family members of the Royal family. They were nice,” said Harb. The only complication in dealing with patients could be with language. While some of the people spoke English, not ev-eryone did. Harb said, “I didn’t have a hard time except for the language. My mind is resistant to the language. Some of the locals only speak Arabic, but most people who are educated speak English.”

Harb’s co-workers were one of the bright spots in her time in Saudi Arabia, she said, “The people I worked with were really nice. We were really a melting pot because people were from everywhere.” Among her co-workers, Harb discovered those holding American passports get the highest pay. The compensation has encouraged many people to make a career in Saudi Arabia. The major-ity of the medical centers in Riyadh are run

by Americans and accord-ing to Harb, some stayed for quite a long time because of the compensation. “I would ask them why they stayed. It was because the compensa-

tion was very good. They would be given tickets to fly home every three months-- and housing, food, and transportation were free,” she explained. Saudi Arabian hospitals do this primarily to attract people from other countries.

“There are resorts on the

Persian Gulf but you have to

go swimming in your jeans

and abaya. ”


32

nurses had a strong framework of support. It

started with gradually adding sixteen educa-

tors to the three who were there when she

arrived. This created a strong educational

and training support system on site. Then, as

further stated in NM, she took educational

support up another notch, by managing to

acquire funding at a time when Georgetown

Hospital and many other hospitals were still

losing millions. These funds, which amount-

ed to approximately $400,000 per year, were

dedicated to the establishment of the hospi-

tal’s tax-free nursing scholarship.

Creating a line of attack

Joyce had a specific series of tactics for

making the heart of Georgetown Hospital

beat strongly again. First step: more nurses!

According to Nursing Management (NM)

1/2011, within two weeks of taking the posi-

tion, she was aggressively recruiting nurses

under a plan called “100 nurses in a hundred

days.”

Once she had acquired the nurse-power,

she began to address the problems of low

employee morale. One obvious cause of

gloomy spirits had to be the fact that salaries

had been stationary for several years before

Joyce arrived on the scene. In her first two

months she remedied that particular problem

by delivering two significant pay raises for

staff nurses, and since then, according to

NM, base salaries have climbed a whopping

160%!

But, as anyone can tell you, money alone

doesn’t buy happiness on the job. So Joyce

set about building a system to ensure that all

Joyce E. Johnson

by Margaret Smith

A Prescription for Change

It was July, 2000, and the patient was critical. Eyes glassy, complexion pasty, pulse thready and weak…The situation looked hopeless. Actually, this is a case with symptoms that are metaphorical—the patient wasn’t flesh and blood, but a body of medical professionals

about to expire because of severely declining morale and trust. What was desperately needed was a metaphorical heart transplant.

Georgetown University Hospital had been languishing for several years. According to gumc.georgetown.edu 6/23/11, the facility had lost approximately $250 million in the years be-tween 1996 and 2000. Almost at the last minute, a partnership was formed with Medstar Health, which provided the necessary infusion of funds for the hospital to continue to func-tion. With the fiscal health of the institution bolstered, at least for the time being, it was time to do what nurses do: address the needs of the whole patient.

Enter Joyce E. Johnson, RN, P hD, FAAN, NEA, BC. Joyce imparted new life into the hospi-tal when she stepped in as Senior Vice President for Nursing. Within two weeks, she had im-plemented a strategy to rebuild a strong Nursing Division, which is the heart of any hospital.

Issue 2.1

33

Inspiring to aspire

The next goal: national certification of all qualified nurses throughout the organization.

Joyce established programs to facilitate certification for anyone who wanted to pursue

this opportunity. Under her direction, the hospital provided financial support for review

courses and exams, opportunities for celebration and recognition, and bonuses. NM re-

ports that she even modeled the process by sitting for the Nurse Executive, Advanced

exam.

The power of open communication

Continuing on her mission to return Georgetown nursing to its former place in national

prominence, Joyce maintained a vigorous campaign to communicate her own under-

standing of the profession’s greater purpose: caring for the whole person. Every decision

she made considered the welfare of the patient. Her philosophy basically encapsulates

an important premise—taking care of nurses is essential to providing the best care of the

patient. Never one to sit on a crystal throne and delegate responsibility, she maintained

a participatory style of management, providing an open-door policy for nurses at every

level to share their ideas and concerns. This practice created a high level of responsive-

ness among nurses. Problems were heard, then addressed. Every nurse was part of the

whole, and every nurse was a participant in each success achieved by the nursing divi-

sion. The validation of Joyce’s policies could be seen in the continually improving nurs-

ing care and in more and more positive outcomes.

Giving nurses a break

One improvement that Joyce made at Georgetown University Hospital is quite likely

the move that most endeared her to the staff, and that is the addition of the famous

Georgetown Nurses Lounge. Realizing that hard-working nurses were just as deserving

as physicians of a place to relax and regenerate on breaks or off duty, she conceived the

idea for the creation of a well-appointed lounge for nurses. As NM reveals, the nurses

of Georgetown now have a roomy, relaxing haven where they are free to check e-mail

or relax, watch the big-screen TV, and enjoy a cappuccino from the complimentary cof-

feemaker. For ultimate relaxation, an adjoining room offers massaging reclining chairs,

low lights, and relaxing music.

Under the guidance of a caring, sensitive, sensible woman, Georgetown University Hos-

pital has made a miraculous recovery, and the prognosis is positive. Because of the wis-

dom and efforts of Joyce E. Johnson, Georgetown nurses can be assured that they are

among the best in the profession, and the patient will continue to thrive.


34

Issue 2.1

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Travelwww.fabulousnurse.com


36

After my first year of being a RN, I packed my bags and headed to Kenya for my first medical mission trip. Nervous, yet excited to explore the world of medical missions, I met

A s nurses we are blessed with the op-portunity every new shift to make a positive difference in someone’s

life. We may touch the life of a patient, their family, or even our own coworkers. Unfor-tunately, with the stressors and time con-straints involved in our challenging profes-sion, it is easy to feel like you are just going through the motions. Frustrations about what you could not do often overshadow what you did accomplish. When I decided at the age of 36 to become a nurse, I was optimistic, yet naïve regarding the reality faced by nurses in our complex healthcare system. Shortly after becoming a nurse I became disenchant-ed and frustrated by what I saw as a lack of respect and appreciation for the critical role played by the nurse. Fortunately, I found an

outlet that renews my excitement about be-ing a nurse, and reminds me of the unique set of education, skills, and talents I have to offer society.

Medical Missions

by Angela McCaskill, MA, RN, CHPN

A Personal Message of Passion in Practice

Issue 2.1

37

who do not have access to medical services.

It is imperative that prospective volunteers do research to find an organization that best fits their goals and objectives, that has a need for their specialty, and that is an established entity that is fiscally sound and legit. Impor-tantly, it is not selfish for a volunteer to want to go to a specific country or serve a certain culture. Therefore, prospects should explore whether the organization has outreaches in their preferred location.

The internet is a good place to start your search for medical mission opportunities. When contacting an organization, I always ask them to describe a typical day of work in the field, the kind of healthcare services provided, the usual makeup of the healthcare team, the living and eating arrangements, and the costs involved in the trip. The suc-cess of any venture is often dependent on

up with a group of healthcare “strangers” who would soon become cherished team members. During the next ten days, our team was able to address the health concerns of over 300 patients located in remote areas. The patients were so appreciative, but I was the one who was truly blessed. I was not only able to give of my skills freely and without the pressures of the hospital setting, but was also inspired by the kindness and expertise of my fellow healthcare workers. It was a truly energizing experience, igniting in me a desire to serve as a nurse through volunteer-ing my time and resources.

This past January, I joined a team of doctors, nurses, pharmacists, and college students headed to the rain forest in Ecuador . These truly were hard to reach communities, as we even had to take a canoe to reach areas inaccessible by road. During this medical outreach, we were able to evaluate and treat

over 600 people. Major health issues includ-ed bacterial and skin infections, malnutrion, respiratory issues, and vision problems. Just like in the Unites States, many had pain is-sues; however, most of their pain was related to hard labor out in the jungle, carrying jugs of water while walking for very long dis-tances, or wearing infants in cloth slings tied around their necks. While it is a joy to greet and treat the patients, the lack of resources and supplies we can offer is disheartening. Being involved in medical missions requires

resourcefulness and creativity.

Frequently, other nurses ask me about how they can get involved with medical mission work. First, let me share that it can be ex-pensive, as the volunteer customarily pays his or her airline ticket, room and board, and fees that are designated to setting up the healthcare delivery facilities. Most medi-cal supplies come from generous donations from hospitals and doctors’ offices in the United States. Some resourceful nurses are able to raise financial support from donors, while others obtain grants or scholarships from their place of employment. Although the trip can be pricey, the cost does not com-pare to the rewards felt when helping those


38

one’s expectations. Therefore, try to ask as many questions as you can think of before you go. Nonetheless, part of the mystery and adventure in medical missions is the unknown. Flexibility is a must, as situations change quickly, providing one with opportu-nities for growth on both personal and pro-fessional levels. A sense of humor is a must on the medical mission field!

There are a variety of trip lengths to accom-modate volunteer availability, ranging from

7 days to 2 months. For those who want a longer commitment, placement is available from 3 months to 2 years.

Many ask the question, “Why do you have to travel around the world to help people when there are needs in your own backyard?” I understand this point of view and I encour-age every nurse to find their own niche for volunteering. Just as there are many differ-ent types of nurses, there are many different opportunities to serve. If your desire is to

help in a community clinic, then go for it. On the other hand, if you want to provide medical care in the mountains of Nepal, you are needed there as well.

Medical missions work is an intercultural experience that continues to renew my pas-sion for nursing. It broadens your mind, challenges your preconceived notions, and requires sacrifice. I would not have it any other way!

Issue 2.1

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40

WellLiving


Issue 2.1

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Obesity remains a complex prob-lem in many parts of the world today, which many people and ex-

perts are still trying to understand. Genetics seem to be the culprit in some cases while in others, a wide range of factors may be re-sponsible, including behavioral, hormonal, and metabolic factors. However, more often than not, determining the exact cause of obe-sity is difficult.

Why Obesity and Overweight?

For a prospective provider, it is often difficult to pinpoint the exact cause of excess body fat accumulation in a patient. But something certainly is responsible for obesity epidemic in the country. How human genetics, levels

of hormones, and/or metabolic activity inter-act to cause rapid and simultaneous changes in millions of people may be difficult to un-derstand. Like in every other industrialized country, obesity has become epidemic in the U.S. Within the last 40 years, obesity preva-lence in the U.S. has risen above 50 percent in adults, and is fast infiltrating the children population, too.

Most times, obese people are at higher risk of diabetes, hypertension, and cardiovascu-lar diseases, than non-obese people. Obesity also predisposes people to other diseases such as arthritis, cancer, depression, liver disease, kidney stones, and erectile dysfunc-tion. Generally speaking, overweight and

obesity are responsible for approximately one in every 10 American deaths, draining Americans of about $223 billion yearly.

Is Work Life Responsible?

Though the concept of obesity has not been fully understood, researchers have applied the U.S. Bureau of Labor Statistics data to conduct decades of studies to assess the con-nection between workplace physical activi-ties and obesity. As at 1960, about 50 percent of private sector jobs demanded at least rea-sonable physical activity, on the other hand in 2010, not up to 20 percent demanded this much physical work. Due to the globaliza-tion and mechanization of manufacturing and agriculture, there has been a decline

By Olusegun Iselaiye In Search of a Root Cause Obesity


42

in human energy needed at work. As excel-lent as the news sounds for a man’s back, it is not good for his girth/belly. In reality, this kind of reduction in expenditure of oc-cupational energy implies that the average man in America now burns fewer calories (about 143 calories) daily than he did about 50 years back. An average sized man in U.S. weighed 169 pounds in the early 1960s, and this has increased to about 202 pounds by 2006. According to another study conducted in Europe in 2011, the effects of inactivity are seen more around the girth, in the ab-dominal region.

Lack Of Exercise Contributes

Counterbalancing a decrease in workplace

physical activities with lei-sure-time exercise would not cause weight gain. But this rarely happens in the U.S. Findings have shown that less than 5 percent of American adults get enough daily exer-cise, which a 30-minute walk a day can provide.

Average American adults rarely work out in their spare time. They prefer to sit idly by; more often than not, they spend more than half of their waking hours sitting down. They do not

only sit down, they watch films. A study involving 123,216 adults (average age 63) was conducted by Ameri-can Cancer Society (ACS). The study revealed that sitting can damage our health. It was reported that men who spent the bulk of their time sitting had 17 percent higher death rate than that of their coun-terparts who spent lesser time sitting. A similar result was reported in a 2011 European study specifically targeted at TV watching.

Eating Habit

For the most part, deskbound work and lazy recreation habits, if any, are the

reasons for obesity epidemic. Still, modern eating habits also play a

fundamental role in predisposing people to overweight and obesi-ty. Researchers at the University of North Carolina have proved this. They based their research on nationally representative data from four large surveys that comprised of 44,754 Americans (from 19 years and above). It

was a longitudinal research conducted over a period of 30 years, 1977 to 2006, a time dur-ing which national girth continued to widen. America’s average daily caloric intake rose increasingly during the period of study, though the causal factors changed over time. Swelling portion sizes was responsible for the caloric splurge during the first half while unchecked excessive snacking and eating habits became the culprit in the second half, from the 1990s precisely.

Implication For Health Care

After tobacco, obesity causes the greatest

damage to America’s collective health. Its

consequences on general health are deep,

wide ranging, and real – leaving a lasting

impact on communities, and most notably,

on individuals. According to the article, The

Preventable Causes Of Death In The United

States: Comparative Risk Assessment Of Di-

etary, Lifestyle, And Metabolic Risk Factors,

obesity, after tobacco, is responsible for the

highest number deaths in adults under age

70 every year. In 2012, Reuters reported that

obesity cost the U.S. an estimated $190 bil-

lion a year.

More on healthcare implications in part 2 of

this article…Your thoughts?

Issue 2.1

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Nurse’sStation II

The

Facility Ratings



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The 5 Star Hospital Rating System

Profile

Established as Haywood County Hospital in December 31, 1927, Haywood Regional Medical Center (HRMC) was the first coun-ty hospital in North Carolina to be built by taxation approved by the people. HRMC is a District Authority owned 161-bed hos-pital located in Clyde, NC. It is accredited by the Joint Commission. In October 2009, HRMC and WestCare Health System, which includes Harris Regional and Swain County hospitals, entered into an affiliation agree-ment. The new joint operating company is known as MedWest Health System. Med-West Health Systems, located in Western North Carolina, provides quality healthcare in Haywood, Jackson, Swain, Macon and Graham Counties. MedWest is affiliated with Carolinas HealthCare, the largest healthcare system in the Carolinas.

Quality of Nursing Care: Indications from patients as well as other details sourced from rating agencies including US News, Find-TheBest, and Medicare reveal that nursing care quality at Haywood Regional Medical

Center is the same as the national average.

Nurse-Patient Ratio:

Accessibility: Of all the 12 hospitals avail-able within 50 miles of Zip Code 40207, Haywood Regional Medical Center is the closest i.e., at 10.1 miles.

Staff Quality &Welfare: Retirement benefit at HRMC is based on North Carolina Local Governmental Employee Retirement Sys-tem. Other benefits apart from salary include medical insurance, voluntary insurances (i.e., dental, vision, life, etc.), paid time off accrual, sick leave (12 days/year), tuition reimbursement ($1,500/year), free fitness center, nursing clinical ladder, free parking, direct deposit payroll checks, urgent care center’s employee sick care, Employee caf-eteria discounts, bereavement, education & military leave, check cashing & ATM ser-vices, and health & wellness programs.

Mortality Rate: According to reports, over-all in-patient mortality rate at HRMC is no different than US national average.

Fabulous Nurse Rating SummaryHere is the summary of the Fabulous Nurse ten-point rating system for Haywood Regional Medical

Center, Clyde:

Rating Parameter Points Quality of Nursing Care 8Nurse-Patient Ratio 0Accessibility 8Staff Quality & Welfare 8Mortality Rate 8Financial Base 8Patient Volume 10‘Green’ Factor 0Academic Activity 0Management Style 8

Total 58

Financial Base & Related Information: According to Mac McCrary and Al Byers’s report, “A Tale of Two Hospitals,” in Sep-tember 2010 issue of Trustee magazine, HRMC operated profitably and had a strong balance sheet with about $20 million dollars in unrestricted reserves.

Patient Volume:

Admissions: 5,750

Inpatient surgeries: 1,527

Outpatient visits: 168,944

ER visits: 24,709

Births: 375

‘Green Factor’:

Academic Activity:

Management Style: Testimonies from em-ployees and reports reveal that the manage-ment of Haywood Regional Medical Center involves nurses at the leadership level.

With a total of 58 points, Haywood Regional Medical Center, Clyde is rated 3 Stars.

Haywood Regional Medical Center, Clyde, North Carolina


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The 5Star Staffing Agency Rating

Profile

A winner of Joint Commission’s Gold Seal of ApprovalTM, a symbol of quality that reflects an organization’s commitment to meeting certain performance standards, Continental Nurses is nurse-owned and nurse-operated travel nursing agency with 25 years of operation.

Insurance Coverage: Health, life and dis-ability insurance are available.

Retirement Package: 401(k) plan is avail-able—eligibility is immediate, vesting is im-mediate, there is 100% company matching and one of the nation’s largest service bro-kers is utilized.

Education Opportunity /International Placements: As part of an initiative to sup-port nurses in maintaining and improving clinical performance, a number of nursing continuing education services are presented within Continental Nurses’ website. Conti-

nental Nurses’ online continuing education courses are highlighted on additional pages, as well as courses specifically for Registered Nurses, LPNs, and Nurse Practitioners.

Incentive Programs: In addition to com-petitive salaries, incentives offered at Con-tinental Nurses include assignment bonuses, referral bonuses, licensure, CEU reimburse-ment, paid travel allowance to and from each assignment, Per Diem, free housing and util-ities are also offered at Continental Nurses.

Earnings: Continental Nurses offers top

Fabulous Nurse Rating SummaryHere is the summary of the Fabulous Nurse ten-point rating system for Continental Nurses, Mooresville, North Carolina:

Rating Parameter PointsInsurance Coverage 25Retirement Package 20Education Opportunity 8Incentive Programs 8Earnings 15Logistics Support 10

Total 86

hourly pay rate, assignment bonuses and re-ferral bonuses.

Logistics Support: Staff professionals are available 24 hours a day, to help travel nurs-es with any problems or concerns they may have. Travel nurses are assigned personal re-cruiter to help them prepare for new assign-ment and adventure in the most knowledge-able and efficient manner.

With a total 86 points, which gives 4.3 when divided by 20, Continental Nurses is a 4-Star travel nursing agency.

Continental Nurses, Mooresville, NC

Issue 2.1

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Profile The OHSU School of Nursing is among America’s best, according to the 2010-2011 U.S. News & World Report ranking of grad-uate schools. The OHSU School of Nursing is ranked 7th in the country.

Academic Standards: The OHSU School of Nursing is one of America’s best and the world’s leading schools. Programs offered in the nursing school ranked highly according to 2010-2011 U.S. News & World Report ranking of graduate schools— 1st in Nurs-ing-Midwifery, 6th in Family Nurse Practi-tioner, and 7th in Masters in Nursing.

Student Quality and Turnover: OHSU of-fers undergraduate, graduate, and doctoral programs across five campuses throughout Oregon. With rigorous academic programs, engaged in the learning process with re-nowned faculty, OHSU has more approxi-mately 800 students enrolled in its nursing programs.

Financial Aid: OHSU School of Nursing has different categories of financial aids:

• scholarships- considered gift aid (they do not require employment or repayment)

• grants- considered gift aid (they do not re-quire employment or repayment)

• loans - referred to as self-help

• employment - referred to as self-help

OHSU School of nursing awarded over $200,000 in scholarships to incoming and current students between the 2010 - 2011 academic year. All students are eligible to apply. Get information on how to apply for a scholarship. More detail available at http://www.ohsu.edu/.

Accreditation: The Oregon Health & Sci-ence University is accredited by the North-west Commission on Colleges and Univer-sities (NWCU) and has been re-affirmed accreditation until 2015. The Commission on Collegiate Nursing Education (CCNE) has accredited the Bachelor of Science (BS)

Peer Review: OHSU School of Nursing is rated very high by other schools, indicating OHSU’s high standard.

Quality of Teaching Staff: OHSU School of Nursing not only endeavors to create a com-fortable learning environment for students, but it also strives to create one that allows both faculty and staff to enhance and enrich their own experiences at work as well.

Academic Facilities: OHSU School of Nursing applies latest technology in teach-ing, learning, and research. All facilities to provide world-class standards are available

Fabulous Nurse Rating SummaryHere is the summary of the Fabulous Nurse ten-point rating system for OHSU, Portland:

Rating Parameter PointsAcademic Standards 10Student Quality & Turnover 9Financial Aid 10Accreditation 10Peer Review 10Quality of Teaching Staff 10Academic Facilities 10Students’ Reviews 9Affordability 9Job Prospects for Students 10

Total 97

through the Academic Technology Depart-ment.

Students’ Review and Affordability: High standard with competitive fees.

Job Prospects: OHSU is a key economic and social force in the Northwest. With an annual budget of $1.4 billion and more than 13,600 employees, OHSU is Portland’s larg-est, and the state’s fourth largest employer (excluding government). So, graduating stu-dents from OHSU stand high chances of be-ing absorbed directly.

Therefore, with total of 97 points,OHSU School of Nursing is rated 5 Diamonds.

Oregon Health & Science University (OHSU) Portland

in nursing, Master of Science (MS), Master of Nursing (MN), and Doctor of Nursing Practice (DNP) degree programs. Further in-formation on accredited programs at OHSU School of Nursing is available at http://www.ohsu.edu/xd/education/schools/school-of-nursing/about/accreditation.cfm.


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Issue 2.1

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OutLoud

Laughwww.fabulousnurse.com


50

A traffic cop stopped a young man who was

going 90mph on a 65mph highway. “Do you

know how fast you were going, the police offer

asked.” “Fast,” the young man replied. “Well,

then I have been waiting all day for you,” the

officer said with a sarcastic smile. With aplomb

the young man said, “Great, I was driving as

fast I could to get here!”

1. I resolve to be far less perfect this year. 2. I resolve to take up smoking and quit the gym. 3. I resolve to start wearing aprons over my scrubs. 4. I resolve to freak out during a code.5. I resolve to stop patient care and re-tweet something funny. 6. I resolve to stay off Facebook for good, this time around. 7. I resolve to be slower and less effective with my time. 8. I resolve to tattoo DNR on my face, chest, and biceps. 9. I resolve to never use the spellcheck option in my nursing notes. 10. This New Year I resolve to be meaner and angrier at my patients and co-workers.

Nursing HumorTop 10 New Year’s Resolutions a Nurse will never keep

General Humor

Issue 2.1

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Resources



52

Inspired Nurse

As part of our continuing series of book reviews, we now take a look at Inspired Nurse by Rich Bluni.

Summarily, Nurse is a passionate book, and the passion Rich brings to his discussion of how to remain “inspired” comes from his direct experience. After seeing how nurses changed his father’s life while he was fight-ing cancer, Rich became a nurse in 1993. “I saw the great and small things nurses ac-complished in their day and realized that there was no higher calling, for me, than to become a nurse.” Since then he has worked in Pediatric Oncology, Pediatric Intensive Care, Flight Nursing, and Trauma Intensive Care. He has also served as an emergency department manager for a large community hospital. Finally, to spread his message of inspiration, Rich joined the Studer Goup (a health care consulting firm and publishing house) in 2007, published numerous works about nursing, and has become a motiva-tional keynote speaker for nursing seminars around the country.

Nurse is an inspiration in and of itself. Rich shares his personal experiences in a way that flows naturally within the text and highlights moments which would easily be visceral to anyone (like me), not just nurses; he tells an utterly human tale. Beyond the spiritual journey, however, Rich brings the reader back down to earth by offering practical ex-ercises and other techniques to address the doldrums nurses may experience resulting from performing repetitive daily duties.

The nursing industry agrees.

Nurse Connect, a website about nursing of-fers “While many educational materials exist to foster nurses’ growth as clinicians, Rich Bluni, RN, found little to help him reaffirm the reasons he became a nurse. So he sought to discover some techniques and compiled them in Inspired Nurse, a book filled with thought-provoking exercises—called “spiri-tual stretches”—that are designed to sustain nurses’ energy and passion.”

Gina Mangini-Snyder, BSN, RN, CSN, of Advance Editorial Review opines “Inspired Nurse, a soul-probing, self-help workbook can help the caregiver recapture the essence of nursing as well as coping with life’s chal-lenges and changes. The author offers an abundance of spiritual/emotional exercises that enable the reader to incorporate the re-wards and disappointments of nursing into everyday experiences. Though he tends to focus on the most heart-wrenching and negative events that he encountered, he does draw the reader in with these compelling ac-counts while allowing them to recall their own enlightening moments as a nurse.”

Inspired Nurse is genuine and comes across as such through the simplicity of the story telling. Rich’s personal stories directly and powerfully remind nurses their chosen pro-fession is fraught not only with challenging work, complicated by dire circumstances and the bludgeoning emotions that accompany those circumstances, but with the pitfalls of complacency and desensitization that can sap motivation. Additionally, because Inspired Nurse is not for the faint of heart, non-health care professionals who have read some of the stories could easily be daunted by what it means to be a healer. Ultimately, Inspired Nurse escapes the bonds of the cheesy self-help genre by being powerful and true, and in that regard, truly inspiring.

Book reviewed by Matthew Fowler

Issue 2.1

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Emerald currently provides travel nurses to hun-dreds of hospitals and currently is offering as-signments in every major specialty (ICU, L&D, ER OR, TELE PACU, PICU, NICU, and PEDS).

Contact Emerald at any time at 1-800-917-5055, or respond to this message via E-mail or you can also visit us on the web at www.emeraldhs.com

Nightingale, a nationally recognized leader in travel healthcare professionals, has Immediate and Exclusive needs for all Nursing Specialties with excellent pay.

If you are available for consideration, please reply to this email and a recruiting specialist will contact you as soon as possible.

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Fabulous Nurse Job Board has over 2,000 job opportunities in all nursing specialties. Scan the QR Code and

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Job Opportunities Perm & Travel


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Issue 2.1

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FOR IMMEDIATE RELEASE Contact: Eric B. Gordon Executive Director of Marketing and Communications 207.992.4925 [email protected]

Husson University to Hold the Second Annual Interprofessional Evening of Conversation

for Aspiring Healthcare and Education Professionals BANGOR, MAINE – January 17, 2014 – On January 30, more than 250 students from the Husson University Schools of Physical Therapy, Occupational Therapy, Nursing, Pharmacy, Education, and Mental Health Counseling will participate in the Second Annual Interprofessional Evening of Conversation from 5:30 p.m. – 8:00 p.m. at the Gracie Theatre. This event, structured in a manner similar to “grand rounds” includes a simulated case presentation with a student actor representing a patient with a chronic health condition. Husson University is one of only a few institutions of higher education in Maine, and the only one in central and northern Maine, that is using this cutting-edge method of education for their healthcare and education programs. During the event, a student actor will portray a client being interviewed about his chronic health condition. Students will observe the interview and then engage in small group discussions from an interprofessional perspective. Twenty-five faculty members will help engage the more than 250 Husson students participating in this event. Once completed, students from the various healthcare and education disciplines at Husson University will have gained insight into drawing out information from patients, identifying treatment options and the potential for various healthcare disciplines to contribute to a plan of action that improves patient outcomes. “Participating in this event will help students gain the skills they’ll need to be effective in today’s team-oriented healthcare delivery system,” said Peg Olson, PT, MEd., NCS, a faculty member within the School of Physical Therapy at Husson Uni-versity. “This includes the medical home models of healthcare delivery that demand interprofessional evaluation and consul-tation.” Why is Interprofessional Communication Important? Communication is an important key to eliminating medical errors. According to the National Center for Health Statistics, medical errors caused by inadequate communication are one of the leading causes of death in the United States, ahead of accidents, diabetes, and Alzheimer’s disease, as well as AIDS, breast cancer, and gunshot wounds.[1] Educating aspiring healthcare and education professionals in the importance of good communication is an important step toward improving patients’ clinical outcomes and safety. More About Husson University For more than 100 years, Husson University has prepared future leaders to handle the challenges of tomorrow through inno-vative undergraduate and graduate degrees. With a commitment to delivering affordable classroom, online and experiential learning opportunities, Husson University has come to represent superior value in higher education. Our Bangor campus and off-campus satellite education centers in Southern Maine, Wells and Northern Maine provide advanced knowledge in busi-ness; health and education; pharmacy studies; science and humanities; as well as communication. In addition, Husson Uni-versity has a robust adult learning program. For more information about educational opportunities that can lead to personal and professional success, visit Husson.edu.

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ORLANDO, January 22, 2014 – The University of Cen-

tral Florida College of Nursing has received a $1 mil-

lion grant to establish an endowed chair for healthcare

simulation. Research professor Gregory Welch, Ph.D., a

computer scientist and engineer, has been appointed to

the chair.

The Florida Hospital Endowed Chair in Healthcare

Simulation will support the research and development of

enhanced simulation technology to improve health care

education.

“We are grateful to our partner, Florida Hospital, for its

great generosity,” said Mary Lou Sole, Ph.D., interim

dean of the College of Nursing. “This new endowed chair

underscores the College of Nursing’s commitment to be-

coming a national leader in developing and testing inno-

vative technologies to enhance nursing and health care

education as well as patient care delivery. Ultimately,

patient outcomes will be improved.”

This is the sixth endowed chair established in the College

of Nursing, and the second chair that Florida Hospital has

endowed at UCF. The first is in the College of Medicine.

“Dr. Welch brings significant education and experience

in simulation from a culture outside of health care, and

we believe he will challenge our thinking about medical

simulation in all the right ways,” said Sheryl Dodds, chief

clinical officer at Florida Hospital. “We feel his work will

have a positive effect on both health care education and

our clinical operations. We are excited to be working with

Dr. Welch, UCF and other professionals as we explore

new opportunities and expand the Florida Hospital ap-

proach to simulation in health care.”

Sole also welcomed Welch to his new appointment, say-

ing that he brings both a record of technological innova-

tion – he is the co-inventor on multiple patents – and a

longstanding interest in health care.

“With the endowed chair for healthcare simulation,

Florida Hospital has demonstrated once again the impact

that giving to UCF can have on real world problems,”

UNIVERSITY OF CENTRAL

FLORIDAUCF College of Nursing Receives $1M

from Florida Hospital for Endowed Chair


58

said Robert J. Holmes Jr., CEO, UCF Foundation. “In its

generosity and partnership with our university, Florida

Hospital is ensuring that health care education meets the

needs of our communities in Central Florida well into the

future.”

While a professor at the University of North Carolina

at Chapel Hill, where he earned his Ph.D. and is still an

adjunct professor, Welch led research efforts to develop

three-dimensional remote health care consulting tech-

nology, which would allow physicians to “look over

the shoulder” and coach emergency medical personnel

through necessary emergent procedures while responding

to motor vehicle crashes and other emergencies.

Prior to academia, he worked on the Voyager Spacecraft

Project at NASA’s Jet Propulsion Laboratory, and on

airborne electronic countermeasures at Northrop-Grum-

man’s Defense Systems Division.

His primary focus now is improving the simulated pa-

tients that are used in the education of nurses and other

health care professionals, as well as other uses of technol-

ogy for patient care. His research interests include virtual

and augmented reality, human tracking systems, human

surrogates for training and telepresence, computer vision,

and the capture of human movement for simulation and

training, particularly related to health care.

“Computer scientists don’t exist to develop technology

and conduct experiments in a vacuum,” he said. “As one

of my mentors, Fred Brooks, says, we are tool smiths who

support the work of others. Health care professionals help

other people and so supporting them appeals to me per-

sonally.”

The tenured chair includes appointments to the UCF

nursing faculty, the Institute for Simulation and Training,

and the Department of Electrical Engineering and Com-

puter Science.

Welch expects the multi-disciplinary nature of his ap-

pointment to allow him to generate collaboration between

computer scientists and health care educators, practitio-

ners and organizations so that UCF can develop the next

generation of health care technology.

—UCF—

Contact: Carolyn Petagno, College of Nursing, 407-823-

1665, [email protected]

Educating Nurses Since 1979: UCF College of Nursing

offers several high-quality academic programs (BSN,

MSN, DNP, PhD, Specialty Certificates), growing re-

search and scholarship opportunities, and a long-standing

commitment to clinical excellence and community ser-

vice. U.S. News & World Report recently ranked the col-

lege’s online graduate tracks among the nation’s 25 best

nursing programs. UCF’s nursing students are highly

sought after by employers for their demonstrated aca-

demic excellence—scoring well above the national and

state averages on nursing board certification and licensure

exams. For more information, visit http://nursing.ucf.edu.

America’s Partnership University: The University of

Central Florida, the nation’s second-largest university

with nearly 60,000 students, has grown in size, quality,

diversity and reputation in its first 50 years. Today, the

university offers more than 200 degree programs at its

main campus in Orlando and more than a dozen other

locations. UCF is an economic engine attracting and

supporting industries vital to the region’s future while

providing students with real-world experiences that help

them succeed after graduation. For more information,

visit http://today.ucf.edu.

Issue 2.1

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fabulous nurse - january 2014

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