My BSN program, when all was said in done came out to about four and a half years (with required summer courses). A BSN program typically includes a massive amount of pharmacology and medication training as reflected by all the medication questions on the NCLEX licensing exam. But, I still was left wondering how nurses are supposed to be able to spot a medication error unless we know everything that the prescribing doctor knows about meds.

I soon learned, once on the floor, that the best ways to avoid a problem are to have a current drug reference on hand and to always, always, always ask the doctor if you have any questions or doubts.  As a night shift nurse this took a bit of courage to wake up a physician at three in the morning – but it sure beats being named in a malpractice lawsuit and even more importantly risking a human life.

As reported by the May 5th Oregonian, there is apparently some controversy brewing in Oregon, where the state legislature is debating whether psychologists, who lack the same amount of training as physicians, should be allowed to prescribe “the most dangerous and lethal pharmaceuticals” to patients. The bill does include certain restrictions regarding psychotropic medications (ex. antidepressants, anti-psychotics).

I should note that physicians are not the only one authorized to prescribe medications. This privilege also is extended to doctors of osteopathy, nurse practitioners and physician assistants. Psychologists in America, at this point, do not have universal prescribing privileges – only some are given permission to dole out the meds.

In the meantime, Oregon House Bill 2702, according to recent reporting, is currently stalled in the Oregon house pending review of a medical task force later this year.

For school purposes, we were instructed to look as identical as possible – white dresses or white tops and white pants. This way the staff nurses at our clinical facilities would see us coming down the hall and be properly alarmed – “oh no, here come the student nurses!” As a group of about eight students, we looked rather like a process of church acolytes.

However, after graduation, free from school policies, I went shopping again. Now that I was able to branch out beyond all white, the colorful uniform options were almost overwhelming. It was like trading in a black and white television for a color unit. There were flowers, stripes, cartoons and every other type of print under the sun.

Excited by the possibilities, I bought a little of everything. But I also kept my little white dress from nursing school. And, surprisingly, once I started working as a real RN I ended up wearing the white dress more than any of the multi-colored scrub tops and pants. For some reason, I felt a special sense of pride and professionalism when I donned the white dress, white pantyhose, and white shoes and pinned by school BSN pin on the lapel. I felt more like an RN than ever.

I realize that many other nurses do not feel the same way about uniforms and I respect that. There are two basic sides to the “nursing uniform debate.” The first argues that nurses should wear the white or at least agree on a basic uniform so patients will be able to differentiate their RN caregivers from the hospital workers tasked with bring them their dinner tray, transporting them to surgery or drawing blood. The second side argues that comfort, functionality and individuality for nurses trumps uniformity.

In England, the Royal College of Nursing (RCN) recently voted 76 to 24 percent that every nurse in that country should indeed dress alike for exactly the reasons that I cited. Although according to the Department of Health, the RCN vote does not indicate any plans to introduce a “national uniform.”

What do you think about the uniformity of nursing uniforms here and abroad?  I wonder what Florence would say.

My charting system consisted of a clipboard and a sheet of plain blank paper that I would methodically divide into squares with a ruler before my shift. Each patient got a square wherein I would write clinical data such as diagnosis, vital signs, medication times, procedures, IV information and other “need to know” facts to keep my patients straight.

I would continuously update the squares with the most pertinent information throughout my shift. It was like “Hollywood Squares” meets “ER,” and yet it was effective for providing organized, quality patient care. It also kept all my patient information right at my fingertips for a smooth, streamlined shift report to the nurse taking over my patients.

Thank goodness someone has had the good sense to update my little arts and crafts project shift organization system. Actually two “someones” – a pair of RN, BSN sisters from Florida have accomplished this.  The Elson (not Olsen) sisters have invented a product called “RNReport card” to standardize patient note taking and shift reporting. This will especially benefit nursing students and nursing new grads, finding their way through the often daunting process of thorough and accurate patient documentation.

The product is a 5×7 booklet that fits easily in uniform pockets and standardizes how patient information is recorded and then communicated at shift change. It is also useful for having the most critical patient data available in the same standardized format at a moment’s notice to share with physicians or other members of the patient care team.

Standardized tools for reporting patient information also reduce the likelihood of a medical malpractice action due to inaccurate or missing patient documentation. After all, even as I was dividing my sheet of paper into squares at the beginning of each shift, the adage – “If you didn’t write it, you didn’t do it” – was always on my mind.

In all seriousness, nursing is a course of study that requires a great deal of instructor attention and close supervision, especially in the clinical phase when students deal with their first actual patients. In fact, the recommended instructor to student ratio in school isn’t too far off from the recommended nurse to patient ration in the real world.

Accredited nursing programs across the country are struggling to fill open instructor slots so that qualified applicants with the desire to enter this recession proof field can get started. In 2006-7, an estimated 99,000 qualified RN nursing program applicants (40 percent of all applications submitted) were turned away, due to a lack of instructors. Fortunately, state and federal lawmakers are also jumping in and lending a helping hand to nursing schools.

In California, one of the states with the fewest nurses per capita, Senator Barbara Boxer has introduced legislation to establish mandatory nurse-to-patient ratios. The new law would also award stipends to nursing students who commit to working at clinics and other facilities that serve patient populations most in need.

California has also allocated $60 million in grant money for programs that will fund specialty training at community colleges while training nursing instructors. The “golden state” needs to educate about 206,000 more nurses and health care workers by 2014 to keep up with population demands.

At the federal level, the pieces of President Obama’s 2010 budget proposal that address the nursing shortage and corresponding nursing faculty shortage, are being praised by The National League for Nursing. The specific legislation affected is Title VIII and VII. The proposed federal funding allots $125 million for nursing education loan repayment. It also grants the nurse faculty loan program a 40 percent increase in funding.

*National League for Nursing; www.nln.org

LPN’s have already been out the in field, working side by side with RN’s in hospitals and nursing home settings.  They understand the nurse’s place on the patient care team and have seen for themselves all the challenges and stress that nurses face. This undoubtedly helps to prevent the “RN burnout” that many new grad RN’s face during their first year.

LPN’s making the transition to RN’s also have working knowledge of patient care challenges. LPN’s who have worked in nursing homes have critical experience managing large patient loads and working with patients suffering from memory disorders such as Alzheimer’s. This is a group of patients that can require a period of adjustment and learning for the new RN.

The challenges faced by the transitioning LPN are related to their change of hat. Because of their role assisting RN’s with their duties, LPN’s frequently get the feeling that they know what it takes to become an RN because they have actually done it. Yes, they may have learned important clinical and patient care skills, but what LPN’s are missing that they will gain in their RN training, is the critical thinking and academic knowledge base.

As LPN’s they may be used to turning to the RN or the MD for help with critical patient care decisions. RN’s are expected to utilize their knowledge base and critical thinking skills to be instrumental in key decisions, even recognizing when a doctor has unintentionally made an error on a medication order. This requires a period of adjustment for the LPN nursing student.

However, the fact remains that LPN’s have a proven edge over their “newbie” nursing student counterparts in RN training programs. As the expression goes – they have been there and done that.