The Adventures of Nurse Nicole Series


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National Nurse Anesthetists Week: 25-31

2015 Poster - Helping New Mothers

Certified Registered Nurse Anesthetists Fact Sheet

Nurse anesthetists have been providing anesthesia care to patients in the United States for more than 150 years.
The credential CRNA (Certified Registered Nurse Anesthetist) came into existence in 1956. CRNAs are anesthesia professionals who safely administer more than 34 million anesthetics to patients each year in the United States, according to the American Association of Nurse Anesthetists (AANA) 2013 Practice Profile Survey.
CRNAs are the primary providers of anesthesia care in rural America, enabling healthcare facilities in these medically underserved areas to offer obstetrical, surgical, pain management and trauma stabilization services. In some states, CRNAs are the sole providers in nearly 100 percent of the rural hospitals.
According to a 1999 report from the Institute of Medicine, anesthesia care is nearly 50 times safer than it was in the early 1980s. Numerous outcomes studies have demonstrated that there is no difference in the quality of care provided by CRNAs and their physician counterparts.
CRNAs provide anesthesia in collaboration with surgeons, anesthesiologists, dentists, podiatrists, and other qualified healthcare professionals. When anesthesia is administered by a nurse anesthetist, it is recognized as the practice of nursing; when administered by an anesthesiologist, it is recognized as the practice of medicine. Regardless of whether their educational background is in nursing or medicine, all anesthesia professionals give anesthesia the same way.
As advanced practice registered nurses, CRNAs practice with a high degree of autonomy and professional respect. They carry a heavy load of responsibility and are compensated accordingly.
CRNAs practice in every setting in which anesthesia is delivered: traditional hospital surgical suites and obstetrical delivery rooms; critical access hospitals; ambulatory surgical centers; the offices of dentists, podiatrists, ophthalmologists, plastic surgeons, and pain management specialists; and U.S. military, Public Health Services, and Department of Veterans Affairs healthcare facilities.
Nurse anesthetists have been the main providers of anesthesia care to U.S. military personnel on the front lines since WWI. Nurses first provided anesthesia to wounded soldiers during the Civil War.
Managed care plans recognize CRNAs for providing high-quality anesthesia care with reduced expense to patients and insurance companies. The cost-efficiency of CRNAs helps control escalating healthcare costs.
In 2001, the Centers for Medicare & Medicaid Services (CMS) changed the federal physician supervision rule for nurse anesthetists to allow state governors to opt out of this facility reimbursement requirement (which applies to hospitals and ambulatory surgical centers) by meeting three criteria: 1) consult the state boards of medicine and nursing about issues related to access to and the quality of anesthesia services in the state, 2) determine that opting out is consistent with state law, and 3) determine that opting out is in the best interests of the state’s citizens. To date, 17 states have opted out of the federal supervision requirement, most recently Kentucky (April 2012). Additional states do not have supervision requirements in state law and are eligible to opt out should the governors elect to do so.
Nationally, the average 2013 malpractice premium for self-employed CRNAs was 33 percent lower than in 1988 (65 percent lower when adjusted for inflation).
Legislation passed by Congress in 1986 made nurse anesthetists the first nursing specialty to be accorded direct reimbursement rights under the Medicare program.
Nearly 48,000 of the nation’s nurse anesthetists (including CRNAs and student registered nurse anesthetists) are members of the AANA (or, greater than 90 percent of all U.S. nurse anesthetists). More than 40 percent of nurse anesthetists are men, compared with less than 10 percent of nursing as a whole.
Education and experience required to become a CRNA include:

  • A Bachelor of Science in Nursing (BSN) or other appropriate baccalaureate degree.
  • A current license as a registered nurse.
  • At least one year of experience as a registered nurse in a critical care setting.
  • Graduation with a minimum of a master’s degree from an accredited nurse anesthesia educational program. As of Nov. 1, 2014, there were 114 accredited nurse anesthesia programs in the United States utilizing more than 2,500 active clinical sites; 32 nurse anesthesia programs are approved to award doctoral degrees for entry into practice. Nurse anesthesia programs range from 24-36 months, depending upon university requirements. All programs include clinical training in university-based or large community hospitals.
  • Pass the National Certification Examination following graduation.
In order to be recertified, CRNAs must obtain a minimum of 40 hours of approved continuing education every two years, document substantial anesthesia practice, maintain current state licensure, and certify that they have not developed any conditions that could adversely affect their ability to practice anesthesia.

Happy New Year!!


It is time to look back over the past year and decide what you want to change about your life in the new year. For many people, New Years resolutions are an opportunity to make a fresh start. For others, it is the chance to learn new habits and live a healthier and happy life. No matter what your approach is to New Years resolutions, here are the top 10 New Years resolutions that many people start with at the beginning of the year.

1 – Quit Smoking

Smoking is one of the number one health problems worldwide. Smoking can lead to a multitude of health problems, including lung cancer, emphysema, high blood pressure, esophageal cancer and many others. Quitting smoking as a New Years resolution is difficult and addiction to nicotine is extremely hard to fight. But with enough dedication and assistance, you can stop smoking.

There are several methods that have proven to be effective in stopping smoking. One of the most effective tools to stop smoking is one-on-one counseling. With counseling you’ll have someone with you every step of the way to quit smoking.

2 – Get Out Of Debt

Today, Americans carry an average of over $10,000 in credit card debt and this is a major New Years resolution. In order to get out of debt, review your budget and cut out the things that you really do not need. Even getting one less daily latte or expensive pair of shoes can make a difference in your budget. If you are deeply in debt, bite the bullet and consider talking to a credit counselor. They may be able to help you consolidate your credit card debts into a single payment or eliminate at least part of your debt and give you some breathing room.

3 – Get Organized

Getting organized can be easy if you are dedicated to carrying through once you get going with it. If your New Years resolution is to get organized, break it down into specifics. Decide precisely what you want to be organized about and then take steps to put it into action. For instance, if you want to be organized about paying your bills every month, mark a day on your calendar when you will pay bills and then set aside a specific place for collecting bills. Then write out your payment checks or log online and make your payments. If you make this into a habit, then it becomes second nature to do it automatically every week or monthly.

4 – Spend More Time With Family & Friends

If your New Years resolution is to spend more time with your family and friends, then you need to set aside time to make it happen. One way to accomplish this is to have one night a week that is for social events. Call your friends and make a date for dinner or to go to the movies. Family night is another great way to spend time with your family. Spending time with friends and family is important because it fosters close relationships and trust. For kids, especially, spending time together can be emotionally healthy and help them develop into healthy adults.

5 – Get In Shape

Getting in shape is a big commitment. Most Americans are overweight and losing even a few pounds and keeping them off can be a challenge for a New Years resolution. If you are out of shape, start slowly and talk to your doctor to discuss any health problems you might have to take into consideration when making a workout plan.

You can take small walks every day and get a good amount of moderate exercise. Instead of parking as close to the mall as possible, park a little farther out and walk the extra steps to go shopping. spaced throughout the day, exercise can be easily integrated into your life.

Also make simple changes to your eating habits to get into shape. Instead of eating ice cream for dessert, choose a dish of fresh fruit. Instead of eating that burger for a quick lunch, choose a healthy salad with a vinaigrette dressing. Even doing this just a few days a week can make a big difference to your waistline.

6 – Help Others

One of the most popular New Years resolutions is to help others. Helping others can be accomplished in a number of ways. If you are active in your church, consider participating in charitable activities, like visiting residents in elderly care or nursing homes. You can also volunteer time in programs to teach adults to read or become a supportive adult to a child. Helping others can be as simple as being kind to the people around you and being willing to lend a comforting shoulder to someone in need.

7 – Learn Something New

Learning something new is one of the most popular New Years resolutions. Think about something that you have always wanted to know and take a shot at it. If you have always wanted to learn Italian, enroll in a language course online or at your local community college. Take an art appreciation course or start reading a non-fiction book on a topic of interest. If you take the attitude that you can always learn something new, then you will grow as a person.

8 – Travel to New Places

Travel is always exciting and is one of the very common New Years resolutions. Choose a place to travel where you have never been and begin to plan your trip. If you do not have someone special to go with you, then try investigating companion travel programs. Be adventurous and throw a dart at a map and go where ever the dart lands on the map.

9 – Enjoy Life More

Enjoying life more is among the top New Years resolutions. Enjoying life is about attitude. If you have a positive attitude and make the best of every situation you are presenting with in life, you will find yourself happier and more content, even through the difficult times. Enjoying life is a great goal to have for the new year.

10 – Go to School

In today’s economy, people are often looking for ways to reinvent themselves. Going to school is one of the top New Years resolutions as a way to start a new career or develop new skills. Even if you goal is simply to learn about a new topic, going to school is a great way to develop new friends and engage yourself.

Most people who create New Years resolutions unfortunately fail as a result of a number of factors. These factors include creating too many New Years resolutions, not writing down your New Years resolutions, not having a support group and keeping your New Years resolutions to yourself.

How Do I Stick to My New Years Resolutions?

The secret to sticking to your New Years resolutions is to start immediately so when New Years day comes you’ll be well and truly on your way to accomplishing your goals. Get your pen and paper out and write up a top 10 list of New Years resolutions for 2015.

Top 10 Reasons to Work a Holiday Shift

If you are a nurse or in health care chances are many of you are working this holiday weekend. You might be bummed about missing time at all those family events. However, there could be an upside to that.

Thought I’d lift some spirits by sharing my top 10 reasons that working holidays is a perk of nursing:

• Excuse not to go to a party you did not want to attend.
• Getting paid ‘holiday time’ or getting some extra time off.
• A less hectic shift, as many procedures might be postponed.
• A good excuse for missing those family gatherings.
• Missing that one family member that makes your skin crawl.
• A plus: is meeting patients’ families.
• Time to celebrate with your colleagues, eating the whole shift because it is there.
• Days off during the typical work week.
• The Doctors and social workers won’t be in the office
• What ever you do – Smile and Enjoy the Season

By Angela Brooks –

Happy Holiday’s to all the nurses and healthcare providers who are spending their holidays on the job!
From Nurse Nicole!!

National Hand Washing Awareness Week is December 7th-13th

Wash Your hands cover[1]

The Power is in Your Hands

In the midst of the cold and flu season, you can take control of your own well-being and help protect those who live and work around you. By practicing a few, simple handwashing behaviors, you can decrease the risk of contracting and spreading respiratory and gastrointestinal illnesses – like H1N1 and the seasonal flu.

Keep Germs Out

Germs enter your body through direct contamination of the eyes, nose and mouth… at the hands of your own hands! Frequent handwashing is one sure way to safeguard against illness. Another way to battle germs is through flu vaccinations which help lower your reaction to viruses. Talk to your Healthcare professional about a plan to keep you and your family healthy this winter.

Four Simple Steps to Stop Germs from Spreading:

• Wash your hands frequently: before you eat and when they’re dirty
• Do NOT cough into your hands
• Do NOT sneeze into your hands
• Do NOT touch your nose, eyes, or mouth with your hands – instead, use a clean tissue when touching these areas of your face

Ask today about ways you can lower your risks for getting a cold or the flu. Also, sign up to win a free book with the Nurse Nicole holiday giveaway!!

Do you need information to explain hand washing to your children?
For books and DVDs on how to decrease germs, check out

Happy Hand Washing Week!!

Nurse Nicole Holiday Book Giveaway

Nurse Nicole Holiday Book Giveaway

Nurse Nicole Holiday Book Giveaway

Visit to enter to win a free autographed copy from The Adventures of Nurse Nicole – N is for Nurse!! No purchase required!! Please share with your friends – you get an extra entry into the contest if you do!!

50 Reasons for Nurses to be Thankful

Thankful Nurses

Thankful Nurses

Thanksgiving is a time for reflection, and nurses can look beyond their own families for things to be grateful for. No matter how you feel about your job or what your career has been like, you can always find something redeeming about nursing. Here are fifty reasons for you to give thanks this holiday season.

Sometimes it is difficult to be thankful in a profession so challenging and all-consuming, but as you can see, you have many reasons to be thankful for your job, despite those challenges. You care for people from birth to death in so many often traumatic circumstances. Yet, you do it with grace. You are very fortunate to be part of a career field with so many options. Many jobs do not have the flexibility or choices that you have and that is probably one of the best perks of your job.

Feel free to add your own to the list. I only went as far as fifty, but I could have come up with fifty more. I’m interested in what other nurses are grateful for! Lets see how many more we can come up with!

1.You get to make a difference in other people’s lives.
2.You get to wear scrubs, or what amounts to pajamas, to work.
3.You know how to talk to doctors and make them listen.
4.You cherish the time you get to spend with your family because you know life is precious.
5.Your holidays off are the best times of the year, even if you know you have to work the next one.
6.Your co-workers have your back during some of the worst times.
7.Bodily fluids wash off with soap and water.
8.You only have to work three days per week if you work 12s.
9.Patients often tell funny stories.
10.You’re part of a community of nurses when you pass boards.
11.You have many options open to you in your nursing career.
12.You can always go back to school to become a more specialized nurse.
13.Certifications in specialties make you a more valuable nurse, usually resulting in higher pay.
14.You can share horror stories with nurse colleagues and laugh about them.
15.You can call that cranky doctor in the middle of the night and ruin his sleep.
16.You can save lives with quick action and critical thinking.
17.Assertiveness training in nursing leads to assertiveness in other parts of your life.
18.No matter how sick your kids get, you can deal with it.
19.You can assess certain patients from the door with experience.
20.If you are unhappy with your workplace, you can always find another job.
21.Nurses who work holidays have potluck parties so everyone can have fun.
22.You get the chance to decorate the unit for the holidays.
23.With your cheerfulness, you can brighten the day of someone in the hospital for the holidays.
24.When census is low, you can get called off.
25.As your seniority grows, you can become more in charge of the unit and its direction.
26.You never have a dull day.
27.Taking off your shoes at the end of a shift feels like heaven.
28.If a patient passes away, you can clean them so the family sees them in peace.
29.You can really develop a connection with patients and their families.
30.DVRs and Netflix exist so that you don’t miss great TV and movies because you’re working.
31.Gloves and protective gear are plentiful to protect from disease.
32.You wash your hands so much that you are less likely to get sick.
33.Hand sanitizer makes your shift flow so much easier.
34.You can type as fast as lightening after so much charting.
35.Despite your lack of muscles, you can lift surprisingly heavy weights.
36.There is no need to wear makeup and do your nails for your shift.
37.You know a hundred ways to save a life.
38.One look at a list of lab results can tell you what’s wrong with a patient.
39.You can wear Crocs without any fashion backlash.
40.If you get your clothes dirty, there are always more scrubs in the OR to change into.
41.You get paid more than minimum wage — though admittedly not nearly enough.
42.You get to choose the needle gauge based on your patient’s behavior.
43.Stabbing people with needles is easy, convenient, and fun.
44.IV pumps mean you don’t have to count drips anymore.
45.Plastic bedpans mean you can just throw away messes instead of trying to clean them.
46.Disposable plastic syringes mean that you can throw away used needles.
47.CPR, ACLS, and 911 exist to save lives that would otherwise be lost.
48.You have your beloved brain sheets and refer to them constantly throughout the shift.
49.You don’t have to chart by hand anymore.
50.Computers have reduced errors and saved many lives in the process.

By Lynda Lampert, RN

November is National Alzheimer’s Awareness Month

Alzheimer's Awareness Month

Alzheimer’s Awareness Month

10 Early Signs and Symptoms of Alzheimer’s

1. Memory loss that disrupts daily life
One of the most common signs of Alzheimer’s is memory loss, especially forgetting recently learned information. Others include forgetting important dates or events; asking for the same information over and over; increasingly needing to rely on memory aids (e.g., reminder notes or electronic devices) or family members for things they used to handle on their own.
What’s a typical age-related change?
Sometimes forgetting names or appointments, but remembering them later.

2. Challenges in planning or solving problems
Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before.
What’s a typical age-related change?
Making occasional errors when balancing a checkbook.

3. Difficulty completing familiar tasks at home, at work or at leisure

People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work or remembering the rules of a favorite game.

What’s a typical age-related change?
Occasionally needing help to use the settings on a microwave or to record a television show.

4. Confusion with time or place
People with Alzheimer’s can lose track of dates, seasons and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there.
What’s a typical age-related change?
Getting confused about the day of the week but figuring it out later.

5. Trouble understanding visual images and spatial relationships
For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance and determining color or contrast, which may cause problems with driving.

What’s a typical age-related change?
Vision changes related to cataracts.

6. New problems with words in speaking or writing
People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with vocabulary, have problems finding the right word or call things by the wrong name (e.g., calling a “watch” a “hand-clock”).

What’s a typical age-related change?
Sometimes having trouble finding the right word.

7. Misplacing things and losing the ability to retrace steps
A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again. Sometimes, they may accuse others of stealing. This may occur more frequently over time.

What’s a typical age-related change?
Misplacing things from time to time and retracing steps to find them.

8. Decreased or poor judgment
People with Alzheimer’s may experience changes in judgment or decision-making. For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean.

What’s a typical age-related change?
Making a bad decision once in a while.

9. Withdrawal from work or social activities
A person with Alzheimer’s may start to remove themselves from hobbies, social activities, work projects or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What’s a typical age-related change?
Sometimes feeling weary of work, family and social obligations.

10. Changes in mood and personality
The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful or anxious. They may be easily upset at home, at work, with friends or in places where they are out of their comfort zone.

What’s a typical age-related change?
Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Typical age-related memory loss and other changes compared to Alzheimer’s in a chart

Signs of Alzheimer’s Typical age-related changes
Poor judgment and decision making Making a bad decision once in a while
Inability to manage a budget Missing a monthly payment
Losing track of the date or the season Forgetting which day it is
Difficulty having a conversation Sometimes forgetting which word to use
Misplacing things and being unable to retrace steps to find them Losing things from time to time

With early detection, you can:

Get the maximum benefit from available treatments – You can explore treatments that may provide some relief of symptoms and help you maintain a level of independence longer. You may also increase your chances of participating in clinical drug trials that help advance research.

Have more time to plan for the future – A diagnosis of Alzheimer’s allows you to take part in decisions about care, transportation, living options, financial and legal matters. You can also participate in building the right care team and social support network.

Help for you and your loved ones – Care and support services are available, making it easier for you and your family to live the best life possible with Alzheimer’s or dementia.

Check out this site:

November is Diabetes Awareness Month


Diabetes is one of the leading causes of disability and death in the United States. If it’s not controlled, diabetes can cause blindness, nerve damage, kidney disease, and other health problems.

One in 12 Americans has diabetes – that’s more than 25 million people. And another 79 million adults in the United States are at high risk of developing type 2 diabetes.

The good news? People who are at high risk for type 2 diabetes can lower their risk by more than half if they make healthy changes. These changes include: eating healthy, increasing physical activity, and losing weight.

How can American Diabetes Month make a difference?

We can use this month to raise awareness about diabetes risk factors and encourage people to make healthy changes.

Here are just a few ideas:
Encourage people to make small changes, like taking the stairs instead of the elevator.
Talk to people in your community about getting regular checkups. They can get their blood pressure and cholesterol checked, and ask the doctor about their diabetes risk.
Ask doctors and nurses to be leaders in their communities by speaking about the importance of healthy eating and physical activity.

How can I help spread the word?
-Share this post!!

How to Teach Young Children About Nursing

Nurse products for kids

Nurse Nicole visits Stuffy Bear Factory at Chesterfield Town Center, VA.

Explore fun and creative methods to teach young children about the profession of nursing.

1. Develop products to introduce nursing as a future career choice to young children.
2. Display products to introduce nursing as a future career option for young children.

Nurse product line:

The nursing shortage has drawn attention to the need to encourage young children to choose nursing as a future career goal. The Adventures of Nurse Nicole is designed to help young children become aware of nursing. Helps children develop skills that are needed to become a nurse. The products will focus on the current realities related to what nurses do in the nursing profession. The tools developed are age-specific such as books titled, “N is for Nurse & Wash Your Hands.” In addition, another tool is an age-specific animated DVD titled, “Battle of the Germs.” Other items available are bears and t-shirts for children. The information reviewed in the books and DVD was used by a nurse to create teaching materials for children.

Free nursing gifts are available on site when Nurse Nicole visits Stuffy Bear factory at Chesterfield Town Center, VA or visit the website

Happy Holiday Season,

Nicole M. Brown, RN aka Nurse Nicole

Creating Cancer Awareness With Breast Cancer Jewelry

If you look at the statistics, you may shudder at the number of women who suffer from breast cancer. What is even more pitiable is the fact that a lot of women fail to get the right treatment because they do not get the problem diagnosed. If the medical ailment is diagnosed in the later stages, it can be very hard to get it treated.

There is a pressing need to create the right kind of awareness because both men and women need to be educated about it. There is nothing to be embarrassed as this too is a medical ailment like most other diseases. However, so many efforts have gone down the drain for so long. Thus, the need was felt for something radical and dynamic and this is where breast cancer jewelry comes into place.

Pink is the color that speaks

The official color for breast cancer awareness is pink. You can find innumerable breast cancer jewelries that are all drenched in pink. When you are looking to buy one of those, you will be amazed at the variety which you will get.

Regardless of what your choices are, you are sure to find some of the most amazing jewelry which you will love to wear. However, the purpose of this jewelry is not just the style factor. There is greater cause for which you need to participate.

When you sport pink breast cancer jewelry; be it bracelets, rings or pins; it is sure to bring attention. Pink is not the conventional color for jewelry and this is the reason; people are likely to notice it. The main purpose of such a piece of jewelry is to let others know that you are concerned about breast cancer and you want to be the change that you wish to see.

No waves of great change can be brought unless you do your bit. You need to start of the change and sometimes it is these little things that can make the biggest difference which you need.

When you are sporting such jewelry, try and tell people about the same. It can spark a chain reaction and that will set out the right awareness campaign which is the need of the hour. Do not flinch from telling others about how painful this cancer may be and why the patients deserve love and respect rather than being looked down. It is one such disease that can occur to anyone and the amount of pain that women go through is incomprehensible.

It is the love, care and support that will give them the strength to face the turmoil and tiring times. It might look like a piece of jewelry to some, but the message which these pink bracelets or even rings and clips convey is immaculate.

Breast cancer is not a disease to be ashamed of. If you can get it diagnosed in the earlier stages, the chances of it being treated increases manifold. Do your bit today. By buying and wearing this jewelry, you can educate people about the need to create awareness and contribute to it. Do not shy away from your duties.
For ideas, please check out these websites!!

Books by Nicole M. Brown

The Adventures of Nurse Nicole: N is for Nurse

The Adventures of Nurse Nicole: N is for Nurse

The Adventures of Nurse Nicole: Wash Hands

The Adventures of Nurse Nicole: Wash Hands

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