Saturday, February 5, 2011

“I am a Nurse, Anyway”

They may stare at you with anger in their eyes, 
look at them with compassion anyway.
They might spit on you while feeding them, 
feed and nourish them anyway.
They shout and ignore you when you talk, 
talk and be with them anyway.

They can bite you when you tuck them in bed,
tuck them in to keep them warm for the night anyway.
They can slap you when you lean closer to listen to them,
hear them out anyway.
They can kick you while trying to jump out of bed,
catch them and keep them from falling anyway.

They may stain your favourite trendy uniform from incontinence,
wash and keep them clean anyway.
They may want to walk in the middle of the night while the rest of the patients are in deep sleep, Walk with them and keep them safe anyway.
They may consume your time by asking same questions repeatedly,
reorient them repeatedly and look in their eyes with a smile anyway.

They may share to you their past stories in the middle of your busy shift,
touch them and spend a fraction of your time anyway.
They may be quiet lying still in bed for hours with tears in their eyes,
wipe their tears and ask them their favourite stories anyway.
Whenever they have a severe cancer pain, give their meds then hold their palms tight and pray for them anyway.

Laugh with them when they are so happy (a good laugh from the heart).
Sing with them even though the lyrics are unfamiliar and old fashion.
Dance with them when they are so excited or just to cheer them up.

Write this in the tablet of your heart
They’ve been a strong, intelligent and beautiful
persons in their prime years and now
they’re approaching their final days…

In the long run, that’s why NURSES are called,
ANGEL of the Sick Room, Anyway.

by Sherrylyn Vergara – Vivero BSN, RN. 


By Roberta B. Abrams, RNC, MA, LCCE

Several years ago, as a member of a Patient Relations committee, I participated in writing a "Patient's Rights and Responsibilities." The purpose of the document was to set forth clearly, both for caregivers and for care recipients, a set of guidelines for our mutual efforts in restoring patients to optimal health.

The document expressed concepts such as the patient's rights to individualized treatment, respect and privacy. It detailed the patient's rights to a clear understanding of the expected outcomes of care - including benefits and anticipated risks. The Patients' Bill of Rights and Responsibilities expressed the patient's responsibilities for following the expected care regimen. It delineated the patient's right to disagree with caregivers, to request a consultation with another caregiver, and to express both satisfaction and dissatisfaction with care provided.

There is a widespread interest in nursing as a profession. Nurses, other care providers, healthcare administrators and consumers are all concerned about the current nursing issues. Among other questions, they want to know what nurses want and need to bolster their professional practice. They want to know how to encourage more people to enter and remain in active nursing practice. They want better understanding about the scope and nature of nursing practice.

One way to answer these questions is to construct a 21st century Nurse's Bill of Rights and Responsibilities:

Nurses' Rights
I. Nurses have the right to be recognized as health professionals with a defined scope of practice that is unique to the profession.

We need to articulate our scope of practice in a manner that is accepted and understood by all. Many of our health consumers still lack a real knowledge of the responsibilities of the contemporary nurse. For too long we have sought refuge in nursing "jargon" that is explained to each other, but neither valued nor understood by those outside the profession. That understanding must occur before nursing can realize its future.

II. Nurses have the right to be recognized as practitioners of quality, cost-effective healthcare. They need to be compensated in a manner equal with their responsibilities and with the quality of care they provide. Those responsibilities and that compensation must be supported by public policy.

Nursing is still listed as a "cost center" in most healthcare organizational budgets. The "costs" for nursing care form a large part of that provider's budget, and thus make a seemingly attractive target for short-sighted "budget fixers." However, patients are admitted to hospitals and other provider venues because they require care which is provided by nurses. Given that,nurses and nursing care should be regarded as a revenue center, and its costs valued as such.

III. Nurses have a right to a seat at the table where healthcare policy is formulated so that they can speak to the issues involved in establishing and maintaining healthcare delivery systems.

For too long, nurses have been the recipients of policy developed and implemented by people who may have no working knowledge of patients' needs or nursing issues. Nurses need to be both visible and articulate in any arena where healthcare policy is formulated, whether that is in a boardroom or a legislative arena. We need to develop a cadre of expert practitioners to collaborate with all other stakeholders in development of policies at the local, state, and national levels. We need nursing leaders who are able and willing to speak for nursing at the table where decisions are made and organizational budgets are formulated.

IV. Nurses have the right to lead and direct their own practice.

The magnet health facilities have shown us the value of shared governance in nursing. In places that maintain nurses' autonomy, care outcomes are improved, and staff retention is manifested in a body of nurses whose tenure and skills provide excellence in patient care. Collaborative practice committees have demonstrated the value of nurses working with other practitioners to research and develop practice patterns based on sound outcome-driven data.

V. Nurses have the right to personnel and material resources commensurate with the area and scope of their responsibilities.

A major source of dissatisfaction for today's professional nurse is the lack of adequate and appropriate staff, and the lack of equipment needed to provide quality care. Mandatory overtime, regular use of agency personnel, continuous need to orient new or inexperienced staff, dependence on outmoded equipment, and lack of requisite care supplies all add to the frustration of nurses who are responsible for quality care of patients with increasing acuities. Wise leaders recognize that appropriate staff and supplies obviate patient errors and improve outcomes. Quality is cost-effective.

Nurses' Responsibilities

I. Nurses have the responsibility to advance their professional abilities through ongoing professional education.

Nursing practice is constantly changing. New modes of treatment, research into treatment efficacy and the constant advancement of our knowledge about patients and their problems mandate that the nurse in practice today be involved in continued professional development. Wise leaders encourage staff development by supporting attendance at continuing education conferences and membership in professional nursing organizations. Wise nurses use these opportunities, as well as journal readings, in-house and computerized educational media to support their own growth and development.

II. Nurses have the responsibility to collaborate with one another and with other health care provider colleagues to develop and implement integrated models for healthcare delivery through research, education, and practice. These collaborations must also work at developing public policy to improve the health of the populace for whom they care.

As nurses, we must formulate strategic partnerships to promote the use of research data and evidence based practice in developing and implementing new and improved patterns of care. Too much of our current practice is predicated on "traditions" which no longer have validity or which result in expensive, sub-optimal outcomes. It is our responsibility to work within our own profession, and with other professionals to examine all current practices, promoting those whose efficacy provides the best possible outcomes to each patient and for each episode of care.

III. Nurses have the responsibility to advocate for advances in healthcare policy and legislation.

As the largest single body of healthcare providers, nurses must collaborate with each other and with members of other provider professions to develop and promote evidence-based health policy. We must educate and communicate with healthcare providers, with consumers, and with legislators to promote policies that increase access to healthcare services and competent, cost-effective healthcare.

IV. Nurses have the responsibility to promote nursing's image, and knowledge of nursing's role in the healthcare delivery system to each other, to other professionals and to the general public.

Nursing guru, Leah Curtin, has told us that: "Nursing is the only profession that eats its young."

Too many nursing gatherings become venues where nurses gather to complain about each other, about "higher ups," and about the conditions under which they work. While understandable, these conversations tend to be counterproductive. They don't fix the situation; they merely create a "miasma of misery" which makes nurses wonder why they remain in nursing.

We need to reframe our viewpoints. We need to become advocates for requisite improvements in the practice settings. We have the responsibility to articulate our needs to those who have the ability and authority to provide those improvements. 

We are responsible for supporting and nurturing our younger colleagues so that they may develop the skills and abilities to take their rightful place in the healthcare arena. We have the responsibility to ameliorate conditions within nursing so that it becomes an attractive consideration for today's young men and women.

V. Nurses have the responsibility to be advocates for and promoters of health for all persons. Nurses are responsible to work in collaboration with other healthcare providers, with community groups, and with the legislatures to increase the years of healthy life of the people in the community and to eliminate disparities in healthcare delivery systems.

Most of us are aware of the precepts set forth in Healthy People 2010. We recognize that the majority of healthcare expenditures are spent on restoration of health, and only a small percent on health promotion. We are similarly aware of the large numbers of people who are without appropriate access to the healthcare system because of economic issues.

Nurses are advocates for those in their care. It is an appropriate extension of our responsibilities to extend our advocacy to those in the community in which we serve. We need to work with others to reframe health care delivery systems and to end inequities in care. The end result should be improvements in the public health and improvements in the economics and outcomes of care. The representatives from major nursing associations who prepared Nursing's Agenda for the Future (2001) under the auspices of the American Nurses Association said it best: 

"Nursing is the pivotal healthcare profession, highly valued for its specialized knowledge, skill and caring in improving the health status of the public and ensuring safe, effective, quality care. 

The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems.

Individuals choose nursing as a career, and remain in the profession, because of the opportunities for personal and professional growth, supportive work environments and compensation commensurate with roles and responsibilities."

The Rights and Responsibilities for Nurses is a document that requests study and continued revision. As nursing and healthcare change, so will our rights and responsibilities. Nursing asks much of its practitioners. As a profession we strive to improve our abilities to meet the needs of those we serve. We appreciate the intangible rewards, and seek the tangible: A place at the table of decision, and reward commensurate with the skill, knowledge and effort involved. 
Roberta B. Abrams, RNC, MA, LCCE is principal of RBA Consults, in Farmington Hills, Mich., and is on the adjunct nursing faculty at Madonna University. She may be contacted

Inspirational Quotes Every Nurse Should Read

“Constant attention by a good nurse may be just as important as a major operation by a surgeon.”

– Dag Hammarskjold

Friday, February 4, 2011

Surviving Modern Healthcare: A Nurse' Toolkit

Surviving Modern Healthcare: A Nurse' Toolkit
Dr. Val Gokenbach
 The dynamics surrounding the modern healthcare environment is placing incredible pressures on hospitals and other types of healthcare organizations to continue to reduce costs and increase productivity. It appears that many hospitals have focused solely on productivity, forgetting the mission of healthcare organizations to serve those who need our help and to make a difference in the lives of others. The argument of no margin no mission is certainly a reality, but when you look at where cuts are made, it is oftentimes at the point of service where the manpower, especially nurses, is vitally needed.
Several factors contribute to this dilemma. Healthcare reform will definitely reduce payments to hospital and physicians, reducing revenues used to fund organizational operations. Pay for performance, although a positive step to improve quality, will further reduce revenues as hospitals scramble to improve process to meet these targets. Some of these quality targets have no research to substantiate that they will improve quality and ultimately save lives. Technology and the cost of drugs are also facing tough economic times, forcing their costs to rise as well, which will transfer to the increase cost of technology and drugs in the hospitals. All of this will reduce the dollars that hospitals will have to spend on expenses. Being a service industry, the bulk of costs in healthcare reside in salaries, the greatest being within the nursing department.
These economic challenges are acutely felt by the nursing staff at the bedside. Many hospitals and healthcare organizations are laying off staff, freezing hiring and cutting services that increase the workload of the nurse. This increased workload not only causes stress for the nurses, but it can also create an unsafe environment for the patients. The decision to reduce nursing staff and services that affect the bedside are counter-intuitive and actually hurt hospitals more than help. The competition for patients in many demographic areas is fierce, and anything that reduces the level or quality of care at the bedside will increase the patient’s dissatisfaction and encourage them to seek services in other organizations. Less staff increases the chances of adverse events for the patients, increasing the risk of lawsuits and negative public press. All of this goes against the mission of hospitals and healthcare organizations to protect and save lives, but if the administration is looking at the quick fix and forgetting the long-term potential problems, they are setting their organizations up for failure. As an administrator for 35 years, I never understood the hiring freezes in areas where we know we need the staff. This practice results in the use of overtime which increases costs. Another quick fix in many organizations is to lay off ancillary staff such as housekeepers and dietary aides. Guess what? The work still needs to be done, so it ends up the responsibility of the nurse. These tasks that should be done by someone else further pull the nurse away from the vital responsibility of the science of patient care. The answer is radical changes of processes with increased technology to decrease the workload of the staff.
Despite the challenging environment of healthcare, there are things that nurses can do to improve their work and personal life. This series will focus on many topics vital to the needs of nurses, including tips and strategies to put control back into your life, both personally and professionally.

Thursday, February 3, 2011

Go With The Flow

Go With the Flow

Nursing is never easy, especially when you work in an area like the emergency room, or a nursing home where death and dying are always knocking at the door. This is why nurse humor is so important to the job. No matter what that day has in store for you, learn to laugh it off. Building a good nurse/patient relationship with the people that you work with can make it all the more easy.
Accumulate humorous stories. Take in anything that you can laugh at. Did someone tell a funny joke that made you laugh? Perhaps one of the elderly people you work with wandered around all day with toilet paper on their shoe. Whatever happens, take it all with a grain of salt and learn to go with the flow. Nurse jokes are all over the internet, try to find a site that offers many of them and start each shift with a joke to carry you through. Tell it to everyone so they can share in your laughter. Little things like these will make the day go by all the more quicker.

Wednesday, February 2, 2011

Nurse, What Are You In It For? Reflections of a Nurse-Teacher

by Fidelindo Lim, M.A., R.N.

When I went to nursing school, I never imagined there would come a time when I would be so privileged to give a "keynote" address. My expertise is more on narcotic keys and nurse's notes. But it happened. I was honored to address the graduating class at the College of Nursing at New York University during their pinning ceremonies. I asked my co-faculties for some suggestions for my speech. They told me to talk about what I know best, stories from my own life. So I looked inwards and shared with them this personal lived experience.
Fidelindo Lim, R.N., M.A.Fidelindo Lim, R.N., M.A.
In late November of 2009, I took care of a 75-year-old Asian woman. She had a longstanding history of diabetes, CAD, HTN. Her health had started to decline earlier that year. She broke her wrist in a mechanical fall, and a wound failed to heal on the sole of her right foot after a debridement. Another fall led to a sub-dural hematoma, requiring surgical evacuation, after her foot amputation. The nearest hospital was two and half hours from her home, through rugged mountain roads. She did not have health insurance, and her immediate caregivers were only vaguely aware of the basics of infection control. She also had no advance directives, and she admitted to being incompliant with her diabetic meds, as she was trying to economize her meager resources. Later that year, she passed away due to complications of sepsis after a failed CPR. This grandmother of 10, who spoke little English, endured it all calmly and without complaint, even as she watched her life savings vanish in the last three months of her life to pay for health care. This woman was my mother.
I share this story not for sentimental reasons, but to reflect on the challenges that all nurses face today. The headlines constantly remind us of the ever-increasing uninsured population, the health care disparities, the lack of access to health care resources, gaps in practice and research, deficiencies in culturally competent care, the global graying of the population, geriatric syndromes, the astronomical cost of health care, and so much more. These issues make nurses, now more than ever, vital collaborators in health care delivery and reform, because in our jobs we become intimately aware of these things.
Of course, I didn't know I would have to deal with these challenges when I went to nursing school. I was barely 16-years old when I was accepted into the program. All I wanted was a college degree, and it didn't matter which one. Looking back after almost 25 years of nursing, I can say with great confidence and pride that sticking with nursing was the best decision I have ever made.
Men and women join the nursing profession for a variety of reasons. As a faculty member, I have the privilege of hearing students articulate the reasons why they choose to become a nurse. What is the underlying theme in their testimonies? They are committed to healing the sick and bringing compassion to the bedside and beyond. Generally speaking, nurses are not in it for the money.
When President Obama rallied the legislature to reform United States health care, he sought the advice of nurses. In his remarks on July 15, 2009, he said, "I know how important nurses are, and the nation does too. Nurses aren't in health care to get rich. Last I checked, they're in it to care for all of us, from the time they bring a new life into this world to the moment they ease the pain of those who pass from it. If it weren't for nurses, many Americans in underserved and rural areas would have no access to health care at all."1 In many ways, nurses are patients first and last line of defense.
As a nursing faculty member, I have the unique honor and obligation of ushering young and still malleable minds to become professional healers and agents of change in their profession. I explain to them that meeting the challenges of nursing is similar to peeling an onion. As graduates assume whatever life-saving careers they choose, they will assume responsibilities and meet challenges, peeling that onion until they are down where the tears are. But I don't mean tears of despair and helplessness, even if their first job is not exactly how they imagined it to be. I am thinking of tears of satisfaction firmly rooted in compassion. These are the quiet, deeply felt tears that I sometimes shed because I am glad I have nursed someone.
So, nurse, what are you in it for?

Tuesday, February 1, 2011

Nurse Leadership: How to Inspire Others

This article addresses effective and inspirational nurse leadership.  I first want to define leadership, as there are many interpretations of the definition out there.  For the purpose of this article, leadership is:
“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.”

                - John Quincy Adams, 6th President of the United States

Let’s address “Dream”, “Learn”, “Do”, and “Become” separately.

Dream:  An inspirational leader first identifies his/her employees’ visions for the future and then sets a plan in motion for helping him/her achieve the goals. Encouragement of dreams, support in attainment of those dreams, and advice along the way are defining moments in leadership.  Also categorized under dreams is creativity.  If you – by your leadership style – not only allow but also encourage your employees to use their personal creative touch and imagination to make daily tasks better and to learn more, you are an exemplary leader.

Learn:  A great leader understands and embraces the fact that learning is a lifelong process.  He/she not only maintains his/her updated education, but also encourages his/her employees to do the same.  An inspirational nurse leader provides ample on-the-job training and education so that his/her employee can excel and provide the best patient care possible.  Employees of an inspirational leader WANT to learn more to further themselves and their careers.

Do:  An inspirational leader leads by example.  He/she is the first one in and the last one to leave.  He/she “walks the talk” as the expression goes.  An inspirational leader knows the tasks in his/her department backward and forward and is able to perform them with ease.  The effective leader encourages his/her employees to do more through motivational techniques and leading the way!  This part of leadership is often overlooked but is key in inspirational leadership.

Become:  When you are able to see the dreams of your employees come to fruition and know that you were instrumental in your employees’ achievements, you are an inspirational leader.  You have assisted him/her to achieve what they dreamed they would.  When that employee leaves your department for the promotion he/she has worked towards and dreamed of, you can celebrate your inspirational your leadership.

Here are some further tips on how to be an inspirational leader:

Effective Leadership Qualities and Skills:

Having the Right Perspective:
Know your job and know your people!  Know what the atmosphere of the area is going in.  Gain the “right perspective” day one by OBSERVING and talking to your employees individually to gain insight.  Don’t make changes or judge until you are sure you have the full picture.

Constructive Feedback:
There is a right way and a wrong way here.  I have had managers (can’t call them leaders) who have yelled, belittled, and been the passive-aggressive type of leader.  Not good.  I have also been blessed to have leaders who took the right approach and provided timely and constructive feedback to me as an individual. An inspirational leader knows his/her employees as individuals and how to best approach each one.

Possess the Right Spirit!:
Don’t come into work with a frown on your face every morning.  Don’t talk to your employees about your personal problems or management issues.  Create an atmosphere of joy and happiness.  I know this sound “utopist”, but it can be done!

Setting Goals:
You should set personal and team short and long-term goals.  These goals should be aimed at improving both departmental and individual achievements.  Discuss these goals with your team members and create benchmarks checks along the way.  Reward your team when each benchmark is attained.

Delegation of Responsibilities:
Knowing the strengths and weaknesses of each of your employees and delegating the right task(s) to the right people is the art of leadership.  You may have team members who love public speaking and can provide team training.  You may have others who are shy but artistically talented and would create masterful PowerPoint presentations.  Don’t only delegate, but tell the individuals why you picked them for this particular task.  Talk up their talents!  They will perform to the max!

Creating an Enjoyable Atmosphere:
Yes, we are all busy and have work to do.  But this does not mean we have to do it in an atmosphere of distrust, intimidation, or dictatorship.  Inspirational leaders create an atmosphere where employees (yes, you can) actually look forward to coming to work. 

For more information on the above “Effective Leadership Qualities”, refer to:

Sue Heacock, RN, MBA, COHN-S

Handling Difficult Patients and Co-workers

As if the actual JOB is not hard enough, add difficult patients or co-workers to the mix and you may have a recipe for disaster.  Dealing with difficult behavior can often times take its toll on us emotionally, leaving us feeling beat up and spent.  Does that sound familiar?
Research has shown that 1 in 3 nurses have likely experienced some sort of physical or emotional abuse this month.  Have you?  With all the training on policies and procedures, where is the training to help us deal with some of the most trying issues that people, who intentionally or not, maltreat and drain the life and the hope right out of us.
Next time someone is trying to tie your "catheter in a knot", consider these tips for handling difficult patients and co-workers:
  • Don’t try to change them.  Chances are good that this is their habitual behavior.  That will not change unless they decide to take accountability for it.  Some people are in love with their misery - sad but true.
  • Don’t take it personally!  Their actions are a reflection of where they are at in life.  They may be sick (your patients),  tired (your co-workers), have issues at home and have many other things that are affecting their behavior.
  • Set firm boundaries.  “I will not tolerate being spoken to that way.”  “I treat you respectfully, and I expect the same in return.”  Statements such as these teach others how to treat you and set precedence for future behavior.
  • Everyone wants to be heard.  Restate what the patient or coworker is saying and what you are hearing between the lines. 
  • Acknowledge their feelings.  That doesn’t mean you have agree, just acknowledge their feelings. 
  • Try empathy.  I often feel sorry for people who are stuck in a state of negativity or anger.  It must be awful to be angry all the time, and sometimes compassion lessons the blow.
  • Hold your ground.  If you give in, you may be opening up the door for even more challenges.  Difficult people are often in love with their misery and will keep after you the more you give in.
  • Use fewer words.  Don’t blather on and on, they are not listening anyway. Short, concise messages are more likely to drive your point home.
  • Look at them IN BETWEEN their eyes.  This will allow you to remain focused on what you need to do and not get distracted by what is probably their penetrating stare.
  • Research for solutions.  Ask others, read behavioral books, search the internet.  There is ALWAYS one more thing to try, so don’t give up!
While nothing will work every time, some things will work sometimes!  Continue to collect an arsenal of tools that may also include:  humor, taking the higher ground, ambivalence and/or a positive attitude.  If you have a selection to draw upon, when the incident arrives, you will be well prepared to deal with the difficult people in your life. 
They may not go away, but make a decision that says they will not take you down with them and you will not be converted over to the "dark side."
Good Luck, nurses!

---Stephanie Staples

Monday, January 31, 2011

Good Nurses Humor

Good Nurses Humor

A nursing assistant, floor nurse, and charge nurse from a small nursing home were taking a lunch break in the break room. In walks a lady dressed in silk scarfs and wearing large polished stoned jewlery.
"I am 'Gina the Great'," stated the lady. "I am so pleased with the way you have taken care of my aunt that I will now grant the next three wishes!" With a wave of her hand and a puff of smoke, the room was filled with flowers, fruit and bottles of drink, proving that she did have the power to grant wishes before any of the nurses refute her.
The nurses quickly aurgued amongst themselves as to which one would ask for the first wish. Speaking up, the nursing assistant wished first.
"I wish I were on a tropical island beach, with single, well-built men feeding me fruit and tending to my every need." With a puff of smoke, the nursing assistant was gone.
The floor nurse went next."I wish I were rich and retired and spending my days in my own warm cabin at a ski resort with well groomed men feeding me cocoa and doughnuts." With a puff of smoke, she too was gone.
"Now, what is the last wish?" asked the lady.
The charge nurse said," I want those two back on the floor at the end of the lunch break!"

Sunday, January 30, 2011

Differences Between Graduate Nurse and Experienced Nurses

A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a patient throws up
A Graduate Nurse wears so many pins on their name badge you can't read it.
An experienced nurse doesn't wear a name badge for liability reasons
A Graduate Nurse charts too much.
An experienced nurse doesn't chart enough.
A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes.
A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn't want anyone to know they are a nurse.
A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their hand, paper scraps, napkins, etc.
A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them.
A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse can't hear any alarms at any distance.
A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse doesn't want to know about them unless the patient is symptomatic.
A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath.
A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse.
A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody.
A Graduate Nurse looks for a chance "to work with the family."
An experienced nurse avoids the family.
A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all.
A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter.
A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.
A Graduate Nurse thinks psych patients are interesting.
An experienced nurse thinks psych patients are crazy.
A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some "cough syrup" in their bag.
A Graduate Nurse doesn't find this funny.
An experienced nurse does.

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