Nursing Comments

          I was born in Iowa (middle of the USA) in 1954.  It’s funny how people think of Iowa as strictly a rural state – farms, corn, cows, pigs, open fields, etc.  But quite the opposite where I grew up – yes, we do have those areas, but I was born and raised in the city, the capital city of Iowa (Des Moines) with a population now of approximately 200,000 and a metro population of almost 500,000.  Des Moines is a hub of government action, business activity, arts and cultural affairs.  It offers some of the nation’s best schools, superb public services and friendly, caring neighborhoods.  We are very fortunate to have affordable housing, short commute times, a diverse population and a wonderful place to live, work and visit.  The following timeline shares my life with you, to the best of my recollection. 

1954 – 1966 

          I had a rather interesting childhood and many fond memories of grade school, including wonderful and special activities like horse-back riding, going to a lake home on weekends to swim, sail, boat, fish, listen to concerts, attend swimming classes, dance lessons, tumbling lessons, going snow skiing in the mountains, flying with my pilot father in his own plane, attending a lot of camps throughout the states, playing with my first cousins, lake friends and lots of neighborhood children.  I also loved my dog, Tumbly, a purebred English setter.  He was beautiful and my best friend of all.  Pretty, silk white color with brown spots.  I named him that when I got him (I was 2) because he tumbled down the hill when he played with me in the snow.  We have all four seasons, so it made it particularly special to enjoy spring, summer, fall and winter interests.  Many of those seasons were spent competing in horse jumping against a very dear friend in the neighborhood – as a matter of fact, we even went to pre-school together.  She usually won the jump-offs, however.  Yes, it was somewhat of a privileged life.  However, part of the reason for all these special endeavors was simply because there was trouble lurking at home.  My parents started to get a divorce when I was just 6 years old and it was not final until I reached the age of 12.  Friends to this day can’t believe it took so long; in fact, it went all the way to the Supreme Court.  In those days, it was very unusual to get a divorce, particularly if there was money involved.  Anyway, Iowa became a no-fault divorce state because of this very case – really!

          I spent an enormous amount of time with my grandparents.  They lived just down the hill from our home, and I remember getting our sleds ready and sliding down the hill in winter to go into their home and grab some hot chocolate and cookies.  This is how the weekends were spent in the winter, along with the other classes mentioned earlier and some ice-skating at numerous skating rinks.  Sometimes, we would even take off for a long weekend and go to the mountains in Colorado to snow ski.  As stated above, our summers were spent mostly at the lake home with my grandparents and parents (sometimes).  During this time, my sister, the only sibling, and I lived with my mother.  She was 2 ½ years older than me.  We were close to the grade school (about 6 blocks) and walked to school everyday.  Mom had gone back to school to get her masters in history so that she could begin teaching.  I remember her getting up at 4:00 a.m. so that she could sell donuts to make some extra money while she continued her studies.  Dad worked at the family lumber company (founded in 1879) and was quite busy.  He had a little cabin on a river close by and we would get to see him every Sunday night.  Because he could not cook, each Sunday was a popcorn and chocolate malt night, which we both loved – and love to this day!  We rode piggy-back on his back for some family fun.  He could really move in those days – I remember falling off his back on several occasions.  Earlier on Sundays, we would head to the lumber company and rip invoices for 25 cents/hour.  That was my first job (age 9).  Anyway, I continued to do many additional things other than remain in the home.  My sister, Jennifer, really did not like to go away from home.  She hated camp and many of the activities that I loved.  For me, I cherished the adventures of everything I did!  It was fun to meet different people, try new sports and visit other states and places.  It’s certainly part of who I am today and I would not change it for anything. 

1966 – 1972 

          When the divorce was final – my mother remarried a German gentleman that she had met while attending school to get her masters.  He was actually her instructor for one of the world history courses she took and we ended up moving to another side of town.  My father moved back into our childhood home – one he built himself in 1953-1954 just prior to my arrival.  AND – he still lives there today!  By this time I was in 6^th grade and it was not easy leaving my grade school friends.  However, when I look back, I developed yet another set of friends that were just as interesting.  In 6^th grade I attended a very modern school and really got to like this side of town, although I did not get along very well with my step-father at first, but later learned to really appreciate him.  My mother got pregnant and my half-brother, Stephen, was born about a year later.  I remember I had to wear gloves to hold him early on, as I had warts on both hands, and I’m sure my mom was afraid he would catch them.  I’m not sure where the warts came from, but I think it was a virus from horse back riding.  I continued to see my old friends when I could, but it was somewhat of a distance to drive and that soon ceased.

          By the end of 8^th grade, I had my first kiss!  I’ll never forget sitting on a huge log in back of our house and thinking it was so special.  Yet, I missed my dad, and he too had gotten remarried to a woman that he met through a childhood friend.  I moved back in to the family home and started a new school in 9^th grade in my old neighborhood.  It did not seem like it was new though, because I was seeing my old and dearest friends again.  It was so great to see them, but boy how they had aged (or so I thought).  Once more, I had another adjustment period with my new step mother, but I was excited to be ‘home’ and spent endless hours with my grandparents that lived just down the hill.  My sister, Jennifer stayed with my mother and attended a different high school than I eventually did.  My oldest, dearest friend, Laura, attended that middle school too so I was excited to be back amongst the ‘crowd’.

          So now it is time for high school.  I never really studied much, but received excellent grades anyway.  I liked to attend the parties and was more interested in following the boys than working on my studies!  In fact, I even went horse back riding less and less.  I got my first car (an old lumber company car which was a 1963 Comet – fire engine red – and I named it Rouel).  Ever since, I have named my cars with the first letter after the color of the car.  I wrecked a few cars in high school, or someone else did, and I had a total of 4 cars before I even got to college!  There was Baccarat (a blue Chevy after Rouel), Barnie (a black and white convertible VW bug) and Orlena Bernice (an orange and black convertible VW bug).  I did work part-time during my high school years.  Once was for about 2 years selling teenage girl clothing and accessories.  I would do this after school and some weekends.  The other job was telemarketing for a man-made lake about an hour west of where I lived to entice people to buy a lake lot.  I sold quite a few actually, but about 2 years later the lake dried up and it was sure good to be gone off to college!  Just prior to my senior year in high school, my mother got another divorce and I moved back in with her, only this time it was in the same neighborhood.  So, there was no need to switch schools again.  At that time, I knew I was going to graduate a semester early and do something before I headed off to college.  The last job before college was working with my father at the lumber company.  I helped at the counter (learned a lot about hardware), answered telephones and gathered 5-part invoices to put in the appropriate binders.  By this time, my sister had gone up to northeast Iowa and was in her second year of college. 

1972 – 1974 

          My best friend, Laura, had decided to go to college at Iowa State University, about 30 miles north of where we lived.  I followed, and we became roommates for the first two years of college.  The first year was spent in the dorm, and the second year we got our own apartment.  Sororities were not extremely popular then, and neither one of us wanted to go out for ‘rush’ anyway.  The first two years we did not really know what we were interested in doing for a career, so we both ended up taking core courses and a few others – my major was in zoology.  I thought maybe I would be a veterinarian.  Once again, I liked the party life rather than my studies, and my roommate use to laugh at me, because just before a final I would take the book down from the shelf, blow off the dust and study for a few hours.  She couldn’t believe I could pass anything this way, but I hung in there until after two years, when I decided that nursing school might be my best bet.  This idea stemmed from watching my grandparents get older and helping them with household chores in addition to other things as far as personal grooming, shopping, etc.  I loved to help people and I did like math and science, so I thought it might be the perfect match.  Laura, on the other hand, decided she liked traveling more than anything, and she headed off to Lansing, Mi. to pursue a career in international travels.  We did have a blast during our first two years of college – way too many stories to get into – and some that may not be for many people that didn’t experience the ‘crazy’ times! 

1974 – 1977 

          Back to my home town I go and enter into nursing school at the main hospital.  It was a 3-year program, a diploma degree RN, with summers off.  I thought this fit my schedule just fine, as I could now get back to the lakes during the summer, something I really missed during my first two years at Iowa State University.  I believe I only got up to the lakes twice in two years.  Anyway, the studying was more intense than I wanted, and I could not get by with just opening a book or two before finals.  The first year was by far the hardest for me – everything from nutrition to skinning a cat in my basement to learn all of the muscles in the body.  I worked very hard and studied with a friend that I met the first week in school, by the name of Mary.  Many of the courses I simply had to memorize, i.e. chemistry. 

          The body was much more complex than I realized.  By year two, it all started to make sense and we had many hours of ‘hands-on’ in the hospital setting.  Our rotations were extremely interesting – I especially liked surgery for some reason, and ended up taking that for my independent study.  During these first two years, I also worked as a student nurse to gain invaluable experience as a float nurse.  I was on the med/surg floor, oncology floor, orthopaedic floor, surgical intensive care unit, dialysis unit and wherever they needed me to cover vacations, sick leave, etc.  The last year was even more fun – I enjoyed psychiatric nursing immensely; we had to take this rotation at a Veterans Hospital 55 miles south of where I lived, so all of us moved down there to stay in the dorm.  That was a lot of fun as well and all of the students really got to know one another, because we were all together studying, playing and just being college girls.  What I wouldn’t give for that life back again! 

1977 – 1985           

          In 1977, just after my surgery independent study, we took the nursing board exams.  In those days, they lasted two full days.  It was all multiple choice – no essay part on the test whatsoever.  I would have preferred essays, but I certainly didn’t have a say in the matter.  Anyway, I passed my board exams and started on the med-surg and oncology floor at the same hospital where I took nursing school and worked as a student nurse.  I was also taking a few classes toward my BSN degree, since I had only received a 3-year diploma nursing degree.  Med/surg really gave me the nuts and bolts of my nursing experience.  Many of the diseases that I worked with then I write about in my posts today.  The oncology unit was a great learning experience as well.  It was here that I truly learned empathy rather than sympathy.  I recalled from nursing school that all grieving patients (or individuals) go through five specific stages in regards to death, dying and bereavement.  Those stages are denial, anger, bargaining, depression and finally acceptance.  It was my experience that not all patients follow these stages in the exact order.  In fact, many would skip from stage to stage and I learned to know precisely what stage the patient was in.  This was necessary for proper communication and care for the cancer victim and their loved ones.  I also found that the most common ingredients for a successful cancer nurse included education on death and dying, great communication skills, understanding that the patient was extremely ill and that anger was not to be taken personally.  In addition, my colleagues all had a good support system.  On the oncology unit, most patients were receiving blood, platelets, radiation/chemotherapy and/or mind-altering drugs that had a huge effect on their personality.  I noticed that a cancer patient might go from sleeping peacefully to crying, screaming and being confused.  Sometimes it was difficult, but I was proud to be associated with cancer patients and their families – oncology is an extremely specialized field and not everyone can deal with these delicate individuals.

          One weekend I headed to the lake and the plastic surgeon that I worked very closely with during my independent study (surgery) called me.  He asked if I would like to work for him as his private scrub nurse.  I was SO excited, and I remember my friend Barb was with me.  We had to cut the vacation short so that I could get back and talk to the hospital.  I told them my situation and they were very nice and let me report for duty at my new position (same hospital) the very next day!  I went through a hefty orientation process.  That experience was one to always remember.  Some of the surgeries lasted 45 minutes, others 14 hours.  I’ll never forget when a national television company came to film the first ever successful vocal cord reconstruction surgery.  I reviewed that clip numerous times just to remember how remarkable it was and that I was so lucky to be a part of it.  Other operations we performed were penile implants, breast augmentations, liposuction, rhytidectomy (face lift), skin flaps, scar revisions, blepharoplasty (eyelid surgery), mastopexy (breast lift), acne scar removal, dimple creations, lip augmentation, mole removals, rhinoplasty (nose surgery), cleft chin creation, buttocks lift surgery, abdominoplasty (tummy tuck) and the list goes on and on.  The doctor was an absolute artist!  One day we were performing a lip augmentation and he said, “Stephanie, have them prep the labia”.  I couldn’t figure out why, but all of a sudden a bell went off in his head and he took part of the labia, attached it to the lip area, and it turned out picture perfect.  The same color, the soft, smooth and shiny touches.  It was this incredible moment, and many others, that I remember so well.

          My next career move led me to my father’s lumber business (a family business that was started in 1879).  The year was 1980 and I still worked p.r.n.(as needed) at the hospital as a float nurse.  Floating was a great experience to keep my nursing skills alive – they had me on any floor where a fill-in nurse was needed to cover vacations, sick leave, etc.  After oncology and med/surg, in addition to surgery, I had a pretty good feel caring for any patient that was in the hospital setting.  When I first started at the lumber company, I didn’t have a clue about business and I immediately switched my studies from a BSN focus to a BSBA in management.  All courses were obtained via correspondence, other than the one month I had to go to Maine for the actual computer classes and finals.  My training at the lumber company started with the credit manager, who was getting close to retirement.  She took me to the credit meetings, showed me the importance of accounts receivable and she taught me to file liens on homes and how to file lawsuits in small claims court.  For small claims, we never actually used an attorney – we had the proof of delivery and the appropriate invoices, so it was always an open and shut case.  When she finally retired after numerous years at the lumber company, I took over all of her duties and then some.  I went from credit manager to managing all of the finances for the Company, and eventually (over a three year period of time) became Treasurer.  In the meantime, a rather nasty recession hit in the early 80s and I had to cut bad debt expenses from over $50,000/year to just under $3,000/year in a very short one year period.  In addition, my father had become ill with cancer and was admitted to Rochester, Mn. for treatment and surgery.  At this point I took over as interim CEO, as we had meetings with the bank almost weekly because of borrowing a large amount of money to build a new facility.  Without going into all of the details, I had to close two out of three locations, deal with union issues, computerize the financial functions of the Company, prepare a new pension and profit sharing plan and attend a TON of meetings.  By this time, my head was swimming!  Luckily my father recuperated from his ordeal and the decision was made to merge with another lumber company in town that was also dealing with hard economic times.  Hence, the merger of two of the largest lumber companies in Iowa pulling together, and in 1985 they became one.

1986 – 2000

          The next 15 years of my life involved a lot of jobs, some at home, and some out in the field – all in nursing however.  I also had two children during this period, neither one planned, and had to buckle down not only make an income, but also to be a mom.  I never married the father of either child, and that brought about several challenges which single moms know about all too well.  I mostly experienced great joy, but shed many tears during these years as well.  When I was pregnant with my first son, Ryland, I was employed by the school district and worked as a substitute school nurse until he was born.  In 1987, I started a company, Medical Litigation Review, and assisted attorneys in evaluating the nature, extent and consequences of clients’ injuries.  After an attorney decided to take a case, I reviewed medical and legal documents, picked up medical records, translated them from medical shorthand into useable English and summarized the whole medical picture.  This allowed me to stay home (most of the time) raising my son without the use of daycare.  Occasionally when things slowed down, I would work as a nurse for temporary agencies, doing anything from hospice cases to caring for children with autism.  I also wrote a rather lengthy home study course for nurses that wanted to learn the field of law and work as a legal nurse consultant.  I marketed this course both online and off – selling each course for $299.00 which allowed me further income. 

          As Ryland started kindergarten at the age of five, I returned to full-time nursing (mainly to get benefits) as a Director of Nursing for a long-term care facility.  This was also a good experience, learning what aging was all about and the complications of getting older, dealing with Alzheimer’s patients, car accident victims with head injuries, old age in general and a lot of other diagnoses one finds in a long-term care setting.  But my main purpose was to provide quality nursing and behavioral healthcare and treatment to adults in the 107-bed facility.  I managed and supported the nursing department, supervised and monitored the staff, educated the CNAs and nurses regarding proper care of the residents, developed, maintained and modified program policy and procedure parameters, assured that the unit was therapeutic and physically safe and secure and assessed and evaluated all nursing care.  In addition to these duties, I had to keep abreast of social, economic and legal issues, along with preparing for state inspections at any time.  All regulations and guidelines had to be monitored everyday.  I guess the most depressing thing to me in this line of work was the greed involved.  I don’t mind someone making a profit, but I remember we could not use pool nurses or CNAs due to the expense.  One winter season almost all of the nursing staff had the seasonal flu and I’ve never seen such chaos in my life.  I was working the floor (which I didn’t mind), but in addition to my nursing duties, I was also having to perform CNA duties like grooming, dressing, bathing and feeding the residents.  I was working really long hours and I stuck it out for a few years, and then went on to yet another field of nursing. 

          The year was 1995 and I was pregnant with my second son, Kingsley.  Close to my home, there was a clinic through the same hospital I use to work for.  It was an inpatient and outpatient psychiatric clinic.  I jumped in full-time, with little orientation, as a psychiatric nurse.  You talk about an eye opener!  I loved it and worked with every kind of patient you can imagine.  Some of the issues I encountered included depression, anxiety, bipolar disorder, substance abuse, obsessive-compulsive disorder, panic and phobia disorders, post-traumatic stress, schizophrenia, ADD, eating disorders, delirium, suicide attempts, etc.  This area of nursing taught me how to develop skills in comprehensive biopsychosocial assessment, participate in interdisciplinary collaboration, identify and coordinate relevant resources for clients and families, using the psychiatric diagnostic classification systems and being proficient in therapeutic communication and realizing therapeutic use of self.  Further, I provided psychoeducation for clients and families, while administering and monitoring psychopharmacologic agents.  The development of the care plans dealt with the patient and addressed every specific problem.  As with any field of nursing, these plans needed to be updated and the progress had to be reported to the doctor and other nursing staff.  It was especially important for me to be aware of my demeanor.  This provided confidence in me as a caregiver as well as trust.  I learned a different form of communication and listening skills through maintaining eye contact to show that I was approachable.  Additionally, I had to be ready to deal with conflict, yet be assertive without being threatening.  It was particularly rewarding when I had a breakthrough with a patient.  Both the patient and the family are extremely appreciative when the psychiatric nurse helps to achieve a better quality of life.  I found that psychiatric nursing is really a specialized area – one that is based on theories of human behavior as its science and the ‘therapeutic use of self’ as its art.  In this setting, it was truly a nurse-patient relationship that evolved into a nurse-patient partnership.  The elements included clinical competence, patient-family advocacy, fiscal responsibility, interdisciplinary collaboration, social accountability and legal-ethical parameters.  I stayed in this field, full-time at first and then went to part-time, for 5 years.  However, I did take a short 9 month absence while learning dialysis nursing, but that was a field I did not enjoy and went right back to the clinic close to my house.  When I was doing the psychiatric nursing part-time, I also did daycare and medical transcription for three doctors that I knew.  Weekends were tied up with the transcription, and the daycare and psychiatric nursing filled up the remainder of the week.  In 1999, I wrote my second, lengthy home study course, Transcription Services, and once again I sold these courses online to individuals that wanted to start their own transcription business.  My clientele was mostly nurses.

2001 – 2009

          When Kingsley was picked by a random drawing for all-day kindergarten in 2000, I felt it was time to go back to a full-time position with benefits.  I lucked out, because there was an opening for an Administrator to run a same-day surgery center quite close to where I lived.  This center was a joint venture with the same hospital I had always worked for (non-profit) and an orthopaedic surgeons’ group (for profit).  The politics were interesting to say the least.  But it was a delightful, small center that desperately needed some administrative attention, as they did not have an Administrator for years.  The purpose of hiring me was to make the center profitable – they were not making much money when I started.  My first day was January 2, 2001 and I walked in with the intention of being trained, or at least oriented.  But, I guess they thought you should be able to figure it out in this type of position.  So, I started from scratch and made great headway for the first two years.  The second two years of my tenure were basically maintaining what policies and procedures I had put in place, building our volume and keeping up our accreditation with Joint Commission (JCAHO) and ensuring excellence of care.  During these first two years, it was also hinted that I get my MBA so that I could grow with the surgery center.  Luckily the hospital helped me a little bit financially, but it was really expensive and I’m still paying on student loans to this day!  Going back to school after 14 years was about the hardest thing I’d ever done – having two children (now 6 & 14) at home, working full time and now trying to keep up on some rather grueling studies!  Anyway, back to the administration position.  Right from the start, I found there were many things that needed to be addressed.  It was like putting together all of the pieces to a puzzle – here is what I worked on and solved for the first two years: revenue, cost of goods, pricing of our procedures, salaries and overtime issues, contract reimbursement, proper coding, billing, accounts receivable, dictation, transcription costs, accreditation and excellence of care.  I found that all of these pieces needed restructuring.  For starters, we were supposed to be part of a group purchasing organization (GPO) and I found the contracts early on – ALL unsigned.  We were being overcharged for our operating room (OR) supplies and our drugs.  In addition, we were not properly charging for our procedures and we did not bill for the extras used in the operating room (including implants).  After procedures, we did not get reimbursed for things like post-op shoes, crutches and ted hose.  There was no marketing in place to increase revenue.  We were running a lot of overtime, due to inappropriate scheduling.  We were not using our operating rooms efficiently (time wise).  Contract reimbursement rates had not been negotiated for years.  The place was in a mess!  Anyway, after a two year period, I brought in $700,000 more revenue annually, increased the profitability 5 ½ times over that two year period and achieved a grid score of 96/100 from the JCAHO inspection.  Other duties that I had to uphold at the same time included being responsible for all yearly budgets, overseeing expenditures, making sure each doctor was properly credentialed, educating the staff on safety issues, HIPPA regulations and other mandatory education, reporting and preparing information to the Board members on a monthly basis, making recommendations and carrying out their directives, supervising the surgery scheduling, registration, billing personnel and nursing staff and hiring and firing all staff of the surgery center, excluding the surgeons and anesthesiologists.  As my fourth year at the center approached, there was talk of the surgeons building a new surgery center – bigger and better – and owning the facility alone, without the hospital being involved.  Politics were brewing and it was time to move along once again.       

          The end of 2004 brought about an entirely new idea.  I had been searching on the Internet for something to do again at home when I ran into a company (out of Atlanta, Georgia at that time) by the name of Business Alliance.  This company required an investment for training and they taught you how to become a franchise consultant.  I had a gentleman come here from Connecticut to train me – it took a full two days.  The reason I liked this company is that you received a full refund AFTER training if you did not think the business was for you.  In this venture, you did not actually do the selling, rather consulted with people on what might be their best option for a business.  Obviously, this included talking with them about their finances, education, hobbies and interest level, their seriousness about pursuing ownership of a business, qualifying the candidate, matching them to the perfect business, referring them to the proper franchise headquarters, following up until a decision had been made, asking for referrals and of course getting paid on the closed deals.  It was a great commission structure, but once again, there were no benefits and you had to pay estimated quarterly income taxes, etc.  I still work on franchises when I am contacted directly through my franchise website, but it is not as though you close a franchise everyday!  Just another thing that I like to do to help people and it’s sure rewarding when they contact you at a later date to inform you that they truly love the business and have become successful.  Initially, I represented over 200 franchises.  That list has now grown to about 250 franchises.  If you are interested in pursuing a franchise, feel free to visit my other website at:  www.aboutfranchises.net

          In 2005 I started to do in-home care for seniors, handicapped and autistic children.  It was my own business and, as with anything, it had its slow times and its really busy times.  I still have a couple of clients that I help; it is the nature of this business that clients either get well or they die.  I was not Medicare/Medicaid certified and I did not use waiver programs.  In other words, it was strictly private pay and that did weed out a lot of people that could not afford to pay the fee.  However, a lot of insurance companies did allow (and reimbursed) for housekeeping and personal services.  I did not compete against other nursing services per se.  For instance, Nurse Force and Visiting Nursing Service would perform medical services in the home (i.e. wound care, IVs and blood draws) where my company was really non-medical in-home care services.  By that I mean we provided services such as companionship and comfort, light housekeeping, errands and transportation, meal planning and preparation, assistance with bathing and grooming, walks and light exercises, mobility assistance, monitoring of medications, lawn care and snow removal, care for household plants and pets, after-school care, child care and maternity assistance.  I often worked the hospice cases myself, in conjunction with a nurse from hospice.  For the other duties, I hired CNAs as independent contractors.  This got rid of a lot of employment and litigation issues.  I thoroughly checked each CNA as to their background, called and talked to references and performed supervisory visits, which included observation of skin integrity, psychological concerns, reviewing new orders, checking vitals, monitoring urinary output as well as bowel function, arranging for hospital beds, commodes, walkers, electrical chairs, etc. for ease of daily living at home.  Further, each client got to choose who they wanted as a caregiver.  I also went to the initial visit myself so that I could develop a plan of care suitable to both the patient and the family.  Finally, I needed to perform the administrative duties of billing, writing the paychecks, etc.  I was also licensed, insured and bonded.  As I stated earlier, I still have a couple of clients that I help today.

          2007, 2008 and a small part of 2009 were interesting and fun years in regards to another type of nursing.  Although I had previously reviewed medical and legal documents for attorneys here in town, my next job was done completely via the Internet, again reviewing medical and legal documents.  This time the review was for a pharmaceutical company in regards to complaints, allegations and discovery.  It also entailed reviewing medical records for the past ten years on specific plaintiffs.  Records reviewed included hospital documents, operative reports, autopsies, death certificates, skilled nursing facility documentation, cardiovascular and neurology reports, etc.  While you reviewed these various records, you were also looking for pre-existing conditions and risk factors, including family histories.  The job involved many calculations of ingested drugs and how other drugs may have interfered with the drug in which the plaintiff had alleged caused the accident or injury.  Triage types were noted, allegation types were substantiated in the medical records and then these were all organized per a hierarchy list.  We also looked for missing information in the medical records as well as in the provider information reports.  There was a record tree, and the nurses had to list the key/pertinent providers, assign letters to the different groups of medical records, apply software applications to each specific case, note loss of wages claimed and review all records pertaining to death.  Finally, we reviewed all demographic information for accurateness, noted the level of education and the place of occupation (in case there was a specific chemical at work that might have led to the injury or accident), paid particular attention to mind-altering drugs and listed alcohol, nicotine and illicit drug use in a separate area.

2010

          We finally arrive to the present!  I ordered a course from an expert blogger, because I still want to be at home working AND enjoy what I am doing.  Let’s face it, I’m not getting any younger, 55 now, and I’d like to keep my nursing knowledge alive, be with my youngest son for the rest of his high school years (my older one is just about to graduate in accounting from Iowa State University) and make enough money to pay the bills.  My hope is to focus on providing information that is helpful to colleagues, nursing students, patients, moms, caregivers and the general public.  I intend to accomplish this, through words, by reviewing current affairs in nursing and medicine, as well as bringing out some of my past experiences in the different fields of nursing in which I have worked and thoroughly loved. 

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