Chest Tubes or Bacon?

The trauma surgeon was doing an excellent job lecturing to us about chest tube insertion but as soon as the pig rolled in-- all eyes were on the bacon.

He demonstrated to the class how to insert a chest tube and then we went to the lab and tried it ourselves.  Let's just say that inserting a chest tube is not as easy as it looks.  If I ever have to do this on a real human being-- help me.

Technology in medicine

Tomorrow is our panel presentation in 'Advanced Technology & Clinical Decisions in Acute Care.'  Why must the course names be so long, really?  Anyway, this presentation is kind of a big deal-- as in 40% of our grade.

The assignment is to select a controversial therapy that is currently offered to patients- select a pro side and a con side, find the latest research on the topic and creatively present on this topic for 30 minutes.  Our topic is standard radiation therapy vs. proton therapy in cancer patients.  I won't bore you with the details but instead, have posted this TED talk for your viewing pleasure.

Sometimes, we rely too heavily on technology to provide us with assessment information that we can obtain from a good old fashioned physical exam-- let's not forget that.  

The Chest X-ray

Today was our chest x-ray lecture.  It was truly a captivating 3 hour lecture given by Dr. Wallace T. Miller, Jr.  He is an expert in his field and an amazing teacher.  It's pretty awesome when the lecturer is also the same guy who wrote the book about chest x-rays that I have on my shelf. 

We looked at many slides of-- well, you guessed it-- chest x-rays.  His tip for the novice reader is to ask yourself these 4 questions.

1.  Is it normal or abnormal?
2.  Is there a problem with the heart or the lungs?
3.  Is the problem diffuse, focal or multi-focal?
4.  Is the pattern alveolar or interstitial?

I know that I was mesmerized and so was the class.  There is so much to learn and I came away wanting to learn a lot more.  It also didn't hurt that he enjoyed cold-calling students for their 'expert' opinion about the films.  Yikes!

Here's an article about the Miller duo- Father and Son


Today was our SimMan practicum.  Admittedly, I was nervous and did not know what to expect.  The professors were vague at best.  Also, this was my first experience with a SimMan.  We did work with mannequins in nursing school but never an 'intelligent' SimMan.

They divided us into groups of 4 but one of our group members couldn't make it because of car trouble.  The room was large and along the wall was Mr. Hottie himself- Sim.  He was connected to a speaker in the room next to ours.  Another professor was speaking for him, in other words, playing the role of the patient and observing us through a one way piece of glass.  Two adjunct clinical faculty members were grading us in the room and our professor was assisting us with obtaining the lab results, EKG results, etc when we asked for them.

The setting was in an ED and we were his NP's.  We were given info about him ie: age, presenting complaint, past medical/past surgical history.  Then, it was our turn to elicit the history of present illness, conduct a review of systems, a physical exam, order labs, drugs, oxygen, etc.  We interpreted the labs and proceeded accordingly.  In the end, our case scenario was a pt with a NSTEMI (non-ST segment elevation myocardial infarction).

It was pretty straight forward and we received high marks as a group.  Although, I was trying to complicate things by also ruling out a pneumonia.  I thought that our professors would give us 2 issues that we had to address-- but it ended up being simpler than that.  In the end, I was glad that I explored the possible pneumonia/resp infection because SimMan did have a temp, coarse breath sounds and a high WBC count so it did fit the clinical picture but the chest x-ray was normal.

Overall, I did like the SimMan practicum.  I thought that it was helpful in understanding my own strengths/weaknesses.

Have you ever used a SimMan?  Did you find the experience helpful or a waste of time?

Image by John McLellan

Christiana Hospital

It's official-- my first clinical rotation beginning in January will be at Christiana Hospital! I received an email from the Delaware Board of Nursing that my nursing license by endorsement was approved. Yay!  I was worried that it would not be approved in time.  

I'm very excited because I wanted this rotation for several reasons.  I will be working alongside a NP in their Neuro/Trauma ICU.  According to the clinical faculty, this is an excellent rotation.  The clinical coordinator had only glowing things to say about the NP who will be my preceptor.  Also, I'm especially excited about this patient population.

My first job as a registered nurse in an ICU was at University Medical Center- Brackenridge in Austin, Texas.  I worked in their neuro/trauma unit and really enjoyed it.  I learned so much in that unit because as you can imagine, the acuity was incredibly high.  The patient population consisted of traumatic brain injuries, brain aneurysms, strokes, multiple fractures, and the list goes on.  I'm ready to dive back into this setting to see what the job is like from the nurse practitioner perspective.

Why The University of Pennsylvania?

I'll give a bit of background info- don't tune out yet.  My husband and I moved from Texas (where I was born and raised) to New Jersey 5 years ago. Never in a million years did I think I'd call New Jersey home-- never.

I decided to take a job in Philadelphia working in a surgical ICU, seeing a lot of post-op cardiac bypass patients, something I knew nothing about.  I still vividly remember crossing the Ben Franklin Bridge for the first time to go to my job interview.  It was my first time driving in Philadelphia and in a less than luxurious 15 yr old Jeep Wrangler with an incredibly difficult clutch.  It was a cold day in February and I was nervous.  The interview went well and I was offered the job.

Fast forward 2 years and I was trying to decide where to go to NP school.  If you know anything about Philadelphia, you know that there are about 35 colleges-- well, not quite but close.  I knew that the University of Pennsylvania had/has a great reputation, but a hefty price tag. I decided to attend Univ. of Penn's open house and I was sold.

There were several former and current students at the open house who had impressive resumes and great job offers.  I got a great vibe from everyone I met.  I was impressed by Carrie, MSN, ACNP the associate program director.  Above all, the biggest selling point was Penn's reputation.  Penn's program has an excellent network of NP and MD preceptors in a variety of clinical settings.  In addition, I did not want to have to find my own clinical rotations-- something I knew I would have to do if I attended other programs in the area.

Sure, I'm probably going to have to sell my firstborn child to pay back my loans, but so far I've been very impressed with the program.  The professors have been incredibly knowledgeable and experts in their field.  Often times, physicians and NP's from Penn Medicine lecture on topics for which they are expert clinicians.

Also, Penn Nursing School expects that each grad student will publish a paper while in the program.  They emphasize nursing and medical research, making it an integral part of almost every lecture and class.

If you're looking for a top nursing school, I would highly recommend The University of Pennsylvania.

Are you currently trying to decide where to go to graduate school?  How did you make your decision?  Are you happy with your choice?

Why a Nurse Practitioner?

Why nurse practitioner vs physician assistant vs certified registered nurse anesthetist?

The decision to become a nurse practitioner was one that did not happen overnight.  I won't bore you with the details but I'll give you the abbreviated version.  

I quickly ruled out PA school because I was already a nurse and a master's in nursing seemed like the more logical route.  I have nothing against the PA profession.  I know that both NP's and PA's make a valuable contribution to healthcare.  

What I did consider for several years was the decision between CRNA vs NP.  After talking with both CRNA's and NP's I was still torn because everyone I spoke with was satisfied with their profession. I shadowed a CRNA for a day at a busy hospital in Philadelphia and even though what she did was interesting, I just wasn't excited at the thought of working in an operating room all day.  I realize that CRNA's also work in outpatient settings but administering anesthesia all day still was not appealing.   I wanted to contribute to healthcare in a different way.  So, the decision to become a nurse practitioner was made partly by the process of elimination.  

I am excited about becoming a nurse practitioner for several reasons:

1.  I can work in a variety of settings: inpatient or outpatient and in a variety of specialties such as neuro, trauma, cardiac, nephrology, and the list goes on and on.....

2.  I can become an educator in my profession and if I'm crazy enough, perhaps I'll pursue a PhD.

3.  I enjoy interacting with patients and their family members.  Hard to believe, I know-- but for the most part I do enjoy helping people, especially during a stressful time such as a hospitalization.  I hope that I can take the time with my patients to help them better understand their diagnosis and the treatments. 

So, there you have it, that is how I decided NP school was the right choice for me-- the shortened version.

How about you?  Are you still deciding?  If you are a NP, how did you know that that the was the best fit for you?

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