slow progress

The firewall at work has placed this site in the "adult" category, so I couldn't access my list of articles that I'd set aside to look up today. I could call the IT people to try to talk some sense into them, but I'm afraid it would generate more problems than it would fix. ("What do you mean, you're working on a school project online? Are you one of our nursing students? What program are you enrolled in? Have you cleared this with Risk Management? We have paramedics that work here? But I thought all ambulance people were volunteer. . . ") And then I'd be stapling an IT specialist to an office chair.

I try to pick my battles.

I made reasonable use of my downtime at work today, though. I got smart at work on Saturday night and printed up a ton of continuing education articles, which are now sitting in my mailbox. When I have time, but don't have access to the internet to work on my professionalism project, I pull out an article and read. By the time I've finished the article, I can usually get online for at least long enough to take the quiz and earn one or two hours' worth of CE. I feel as if I'm wasting my time at work if I'm not getting something else done. And frankly, I run out of small talk with the other medics long before twelve hours is up.



Poking fun at my somewhat obsessive approach to my education, one of the medics compared me to this little guy, who was Foghorn Leghorn's nephew in the old Looney Tunes cartoons. He could usually be seen walking around the barnyard, reading a book .

literature review: professionalism

Medline, Academic Search Primer, and Health Source: Nursing / Academic Edition were accessed on 6/25/2006 with KW: nursing and KW: professionalism with the ten results below; asterisked entries will be accessed (the rest look like nonsense)



From Tele-ed to Telehealth. By: Simpson, Roy L.. Nursing Administration Quarterly, Oct-Dec2005, Vol. 29 Issue 4, p344-348, 5p; (AN 18845294)
PDF Full Text (388K)

2. Nursing Morbidity and Mortality Reviews in the Emergency Department. By: Nolan, Scot. Topics in Emergency Medicine, Oct-Dec2005, Vol. 27 Issue 4, p322-323, 2p; (AN 19204764)
PDF Full Text (169K)

*3. Confirming mentorship. By: Ronsten, Barbro; Andersson, Ewa; Gustafsson, Barbro. Journal of Nursing Management, Jul2005, Vol. 13 Issue 4, p312-321, 10p; DOI: 10.1111/j.1365-2934.2005.00541.x; (AN 17246845)

4. Diaspora, dispute and diffusion: bringing professional values to the punitive culture of the Poor Law. By: Kirby, Stephanie. Nursing Inquiry, Sep2004, Vol. 11 Issue 3, p185-191, 7p; DOI: 10.1111/j.1440-1800.2004.00221.x; (AN 14230770)
PDF Full Text (102K)

5. Journeying to professionalism: The case of Irish nursing and midwifery research. By: Condell, Sarah L.. International Journal of Nursing Practice, Aug2004, Vol. 10 Issue 4, p145-149, 5p; DOI: 10.1111/j.1440-172X.2004.00475.x; (AN 13839917)
PDF Full Text (58K)

6. Being professional and being human: one nurse's relationship with a psychiatric patient. By: Hem, Marit Helene; Heggen, Kristin. Journal of Advanced Nursing, Jul2003, Vol. 43 Issue 1, p101-108, 8p; DOI: 10.1046/j.1365-2648.2003.02677.x; (AN 10030481)
PDF Full Text (81K)

*7. Professional nurse autonomy: concept analysis and application to nursing education. By: Wade, Gail Holland; Wade, Gail. Journal of Advanced Nursing, Aug99, Vol. 30 Issue 2, p310-318, 9p; DOI: 10.1046/j.1365-2648.1999.01083.x; (AN 5903971)
HTML Full Text PDF Full Text (88K)

*8. The nature of philosophy of science, theory and knowledge relating to nursing and professionalism. By: Rutty, Jane E.. Journal of Advanced Nursing, Aug98, Vol. 28 Issue 2, p243-250, 8p; DOI: 10.1046/j.1365-2648.1998.00795.x; (AN 5277821)
HTML Full Text PDF Full Text (83K)

9. Record-keeping and routine nursing practice: the view from the wards. By: Allen, Davina; Allen. Journal of Advanced Nursing, Jun98, Vol. 27 Issue 6, p1223-1230, 8p; (AN 5277984)
HTML Full Text PDF Full Text (77K)

*10. Changes in practice nursing: professionalism, segmentation and sponsorship. By: Dent, Mike; Burtney, Elizabeth. Journal of Clinical Nursing, Sep97, Vol. 6 Issue 5, p355-363, 9p; DOI: 10.1111/1365-2702.ep11545734; (AN 11545734)

PSPR objectives and strategic plan

B. Objectives:

At the end of the project, I will be able to

• Provide training for advanced airway management in the critical care transport environment

• Utilize professional nursing education theory in developing skills training for registered nurses

• Describe how preparing for and providing the in-service, and working with my mentor, has affected my concepts of professionalism and my behavior as a professional


C. Strategic plan for project completion:

4 hours Review literature on professionalism, teaching strategies for registered nurses, and advanced airway management.

1 hour Identify mentor and confirm credentials. Discuss details of my educational program; determine need for in-service that would fulfill project requirements. Confirm willingness of mentor to work with me on the project and serve in the mentor role.

12 hours Draw up teaching plan, handouts, and visual aids. Create a written test and a skills critical element checklist to evaluate learning. Develop an instructor evaluation for the students to complete. Review these with mentor, allowing time for revision as necessary.

2 hours Procure needed airway supplies and mannequins. Explore the option of using an out of service ambulance so that skills can be demonstrated in as realistic an environment as possible.

1 hour Schedule in-service time and place, coordinating with mentor, medical control physician and nurses.

4 hours Conduct in-service. Plan for meeting with mentor after evaluations have been collected to review evaluations and my performance as an instructor. Solicit feedback from medical control physician.

1 hour Pre-plan with mentor for strategies for staff remediation, if needed.

4 hours Compare my preparation and performance as an instructor with the professional literature on teaching strategies.

4 hours Keep a journal to track my progress. Plan to keep journal online to facilitate frequent entries.

1 hour Plan for termination of the mentor relationship.

Total: 33 hours

dirty button pushers

I worked last night, after being up all day, and now I'm on call again. The good news is that scrubs make really good jammies. I will have to hope that McCabe leaves me alone today.

I spent a good portion of the afternoon yesterday trying to figure out how and when I was going to score enough CEUs to recert my medic card by the end of the year. It's a bit of a ways off, but it's better to get it organized ahead of time, especially if things keep accelerating the way they are. I'm beginning to wonder whether it's not impossible to finish up the program by the time my lease is up; if so, things are going to be a little crazy around here at the beginning of next year.

For my last recert, I was able to rely almost exclusively on my ADN classes. National Registry puts a ten hour cap on "distributive" courses - web, magazine, video, etc., but I had unlimited use of my nursing school credit. While they were "online" courses, the credit is by proctored exam, so I got away with it. I have access to tons of great online CE now, but I don't have the loophole to apply it all to a medic recert. And, unfortunately, the BSN classes are far less useful for a recert; there is virtually no clinical content. I was getting irritated at the thought of having to sign up for a refresher class when I remembered that I had critical care orientation last year -- 66 hours of classroom based, clinical CEUs. And I got PAID to sit through it. Cha scams again.

addendum

I'm watching Patton. I think it's in an attempt to get the taste of that nursing management exam out of my mouth. I've been watching it in installments, but it's great. For the same reason, although I didn't know why at the time, I picked up The Art of War and The Seven Habits of Highly Effective People when I was in Barnes & Noble the other day. A bookstore is a very effective Rorschach test for me.

The cat is still a little worse for wear. He let me dose him with liquid amoxicillin this morning, something he didn't let me get away with when he was a kitten weighing one tenth what he does now. He doesn't appear to have pain, or the plantar stance that he did on Wednesday, but he is still lethargic and weak. Nonetheless, in the middle of the night he managed to climb onto the captain's chair, where I found him sleeping splayed out on his side this morning. He got helped down, and the chair went on its side for the time being. I can't do anything about the kitchen counter, so I'll have to hope that he doesn't find anything up there interesting while I'm out. He tried to jump up on the counter last night and didn't quite make it.

I feel like an ass for being so hung up on this cat, but it is also proof that there is still territory that hasn't been overtaken by my work persona of professional detachment. I'll be stopping by the vet's later with chocolate and a card thanking them for their patience with his hysterics and mine.

in a better place

Things are looking a lot better around here than they were 24 hours ago. I recovered my cat from the vet today. It sounds as if he was more interested in influencing people than making friends. He seems to be doing better, although he's still sort of stumbling around with his eyes at half-mast. They tell me he had escaped earlier and was ranging around the hospital terrorizing everyone, so they snowed him good and proper before attempting to get his IV out. Poor thing -- sounds like he gave them all a run for their money.

I made very little progress on my project today. I discovered that a Journal for Nursing Staff Development exists; it should probably have some resources for me regarding in-servicing RNs. Unfortunately, it doesn't appear to be listed in any of the Excelsior databases. Perhaps that is a red flag?

some good news

The mailman is safe; I got my letter from Excelsior, and my proposal was approved. Thank God. Now all I need to do is provide the in-service and write it up.

It's pretty amazing. After nearly a year of zero progress on this degree, I've gotten unstuck. I currently have twenty credits to go. By the end of the summer, it'll be half that.

I wish I were in a better mood, but I'm distracted, because my cat is in the hospital; he sprained his ass, or something. I thought he'd stroked out when I found him, so I was a bit of a wreck this afternoon. About to crawl into bed and hope that things look less insurmountable in the morning.

alphabet soup

The new review book worked! I passed CCRN this morning, with a bigger margin than I expected. I'm glad I went over ABGs and hemodynamics; at least half of the questions involved those concepts.

Of course, for the time being, the cert is valuable for resume decoration only. But it's something I wanted to do, and now that it's done, I can focus my attention on the rest of the checklist. I'm still stalking the mailman for some response from Excelsior regarding the professionalism project, and statistics class begins in a couple of weeks. . .

Incidentally, my partner and I got called back to the block where we had our dueling resuscitations a couple of weeks ago. It turns out that the lady we brought in intubated did really well, got discharged a week later, and now had an unrelated and far less acute complaint. As much as it pains me to say this, I have to hand it to our ICU -- they must have taken really good care of her when she was on the vent. It's miraculous for an 89 year old patient who was field intubated to be discharged to home with full independence.

It was swampy and disgusting yesterday, but I'm enjoying it. It's been a while since I've really had to work outside in the heat; last year I was in the ER full time, and the summer before that, I was on Lobby North. I'll definitely choose to forego the air conditioning in either of those places and sweat in polyester outside. Better to rule in hell, I suppose.

6/17/06

No word from Excelsior yet. I'm sure have two more full weeks of this to look forward to, but I obsessively drive home from work every afternoon and check the mail as if I'm expecting an admissions letter from Princeton. Stalking the mailman with what must look like hesitation marks on my arms from my sociopathic cat -- I'd fit right in back in high school now!

In the meantime, I've acquired a new CCRN review book that focuses less on nursing intervention and more on disease process. I'm doing the cardiology section right now, and it's so cute - it goes right from how many milliseconds each little box means to all kinds of wonky stuff about determining whether there's an anterior or posterior fascicular hemiblock. Thank God Tonnie Glick beat most of this stuff into my brain back in medic school. I wonder how she's doing. Tonnie was a critical care nurse back in the seventies. She began instructing when the paramedic curriculum was just beginning to be formed out of the primordial ooze. She's probably responsible for the didactic education of fifty percent of the practicing medics in the state. In spite of my lecture hall narcolepsy, I managed to get a good education from her program, and I'm grateful. She'd probably get a good chuckle out of my current academic adventures.

I was talking to one of my co-workers yesterday who is looking to start doing the Excelsior program. I printed her a copy of the course outline for the first nursing exam, in hopes that it would dispel any apprehension she had about its difficulty. She and I have similar frustrations about work right now, and I hope that she finds it as helpful as I have to have the distraction of studying during downtime.

On a side note, I bought a French press coffeemaker this week. It supposedly makes eight cups, but that's eight little catering hall thimble cups, which equals one and a half of the steins that I drink in the morning. Nonetheless, you use eight measuring spoons of grind to make the coffee, so even with my tolerance level, I am duly tweaked. That's good, because my book was putting me under at work yesterday, and I have a ton of studying to do now.


Tonnie gamely doing battle with our ignorance

4 down, 20 to go

I passed the Management and Leadership in Nursing exam. Other than the fact that it was a requirement for the program BSN, it was a complete waste of time, and this blog is the last time I intend to think about it.

I'm looking at the reading list for the Research in Nursing exam right now, to see what books I'll need to pick up. I don't plan to sit for the exam until I'm at least underway with stats, but it can't hurt to get a head start. Research in Nursing is the last computer-based exam for the program; after that and stats at BCC this summer, it's all performance.

survivor guilt

Today I plan to finish up preparation for the Management and Leadership in Nursing exam, which is at noon tomorrow. I admit that I'm less than 100% satisfied with my preparation for the exam, but I think I'm going to do well enough; the concepts that the exam covers are not exactly intuitive to me, and the assigned book is just so-so in its coverage. I just want to get it done and not look back.

I am looking back today at my prior full time medic job. I got a call this morning that one of the night crews ate a telephone pole on the way to a job. The story thus far is that the driver of the unit swerved to avoid a car that cut in front of them. ESU had to cut both of them out of the car. Both of the guys on the truck are hospitalized, one on a floor with a concussion, and one in the unit with a pelvic fx and multiple long bone fx as well.

About a month ago, I was driving to a job when some idiot did her best to make sure that I collided with her. My thought at the time was that I was really grateful I was driving a truck with only 40,000 miles on it that was regularly sent for maintenance, because if I'd been driving something that didn't have decent brakes and handling, the truck's grill would have been in that driver's lap, instead of over the B post. I was also really grateful that in spite of the fact that I got in an accident with the newest truck in the fleet, I didn't catch hell from the boss; he was just happy everybody was okay.

I do my best to be safe at work, and I try to model safe behavior for my partners and the BLS. By local standards, I am a very careful driver. (Suburban medics tend to drive a lot faster than urban medics, for a number of reasons.) And now that I am out of the woods financially, I don't pull 24's or work when I'm too sick or tired to hold my own. I also don't believe that this is the full explanation of why I've been spared what these two guys are experiencing. I've already called to let the usual suspects know that I'm aware of the situation and willing to help however I can. My thoughts and prayers are with them and their families today.

let the obsessing begin

It's submitted. . . time to forget about it and study for my mgmt class and the CCRN.

that wasn't too bad

I just completed my professional project proposal. I'm going to let it sit overnight. Tomorrow I will correct all of the grammatical errors, typos and logical inconsistencies that are invisible to me now in my elated state. And then, I will take a deep breath and send it to Albany.

Duh.

The nurse who runs the SCTU at McCabe is 1) a BSN 2) has three + years experience and 3) in need of an advanced airway skills lab for the other SCTU nurses.

I think I just found my project!

another direction

The more that I think about it, the more it seems to make sense to approach the extern director and ask her to be my mentor for the project. I'm just concerned about the timing, since the summer program just started up, and I'm sure she'll be busy. The possible benefit is that we will be able to finish a project by the summer, and by Labor Day I'll be able to forget about this whole process.

The other option I'm beginning to consider is to call the state director of ENA or AACN and ask if they have any sort of legislative scut work project that's been lying around, waiting for some cheap labor to appear.

getting a mentor lined up

I managed to sneak over to the School of Nursing and leave a note for one of my potential PSPR mentors. About a month ago I approached her about training the nursing students to use triage tags, and she seemed enthusiastic; it was after that conversation that it occurred to me that I might be able to parlay the training into my PSPR requirement. I hope to sit down with her soon, and see if she is agreeable to it.

I also tracked down the nurse who ran the student extern program I completed before I went for my clinical boards. She was orienting a fresh batch of student nurse externs and invited me in to introduce myself and explain my quest for world domination to them. Naturally, I got a job about ninety seconds into it, but I ran into her again later on, when I was humping equipment back from biomed. Anyway, it was great to finally catch up with her again, not only because she's cool as hell, but because she might be even more willing to perform the mentor role for the PSPR -- if I could tie it into this summer's extern program, I might be able to sew the whole thing up by Labor Day. That would rock. Plus, the nurse externs now have a good idea of the basic job description of a paramedic. . . lug heavy crap around and get your errands interrupted by MICCOM. . .

"ways of knowing" vs. "evidence-based practice"

I followed up on some of the references to that last journal article, and will be gleefully skewering them here soon. I didn't get too far with the articles at work today -- too much time running jobs and attempting to fill yet another schedule opening and generally tripping over my co-workers in that veal pen of an office. I did, however, identify a nursing theory catchphrase that is legitimately used maybe one time in a thousand in the literature. The remaining 999 times are, I believe, indicative of academic sloth and should be considered a violation of the civil rights of anyone who's taken the time to seek education past the eighth grade level.

I speak, of course, of "ways of knowing".

"Ways of knowing" is the hearts and flowers print scrub set of nursing theory. It sets nursing back to the Stone Age and puts it on a par with phrenology. It fails at its attempt to honor the importance of intuition and experience; it only discredits the importance of measurable phenomena.

To me, it's incredible hubris for nursing academics to discuss "ways of knowing", as if a "truth" were unassailable because it cannot be independently proved or disproved. I think that the scientific tradition is truly humble when it discusses all but the most fundamental laws of physics as "theory".

I think that intuition is just the way that some people process information. The process is strictly cognitive, there is no magic about it, and it is not infallible. Intuition happens when the subconscious picks up on some stimuli from the outside world and deems it important, in spite of the fact that the conscious brain has placed it in the spam folder. This does not, however, impact the reality of the outside stimulus -- and if it can be isolated by the thinker, the thought process ceases to be intuitive.

As an example, let's look at pediatric assessment. Any EMS provider with decent experience can tell you a story about walking into a job and knowing from across the room that the kid "was fine" or "looked like shit". Intuition, right? Perhaps. There are plenty of providers out there who can accurately and consistently perform this basic sick / not-sick assessment without being able to articulate what precisely it was that they saw that led them to that conclusion. And, thank God, they do it without describing it as "EMS ways of knowing".

There is nothing intuitive, however, about an EMS provider going to a PEPP class and learning the pediatric assessment triangle and learning how to tell from across the room based on MEASURABLE phenomena whether the kid is "fine" or "looks like shit". It only looks like intuition, or magic, if you don't know what the person is looking for.

The problem with nursing theory and research relying so heavily on ethereal "ways of knowing" as an explanation or rationale is that they are impossible to teach, document, bill for or research meaningfully. There is plenty in both nursing and medicine we won't be able to explain, or can't explain yet, and that's fine. Read anything in pharmacology and you will see the phrase, "the exact mechanism of action is not well understood". But to stop the discourse at "it's a nurse thing, you wouldn't understand," is a total cop-out, and the ones who wind up suffering the most from the lack of understanding are nurses.

good news from the Park

I just heard that a patient who was a complete disaster in my ER wound up doing really well. We had transferred her out for the emergent cath, where they ballooned and stented two 100% occlusions, and she recovered with no signs of muscle damage.

I remember her case because it was such a nightmare. . . IV in the foot, multiple defibrillations, difficult tube that we finally got anaesthesia to do. . . and meanwhile, the ER is just continuing to go crazy around us. I was going to get her transferred out if I had to set my hair on fire to do it, if only to reduce the census of critical ER patients by one. She was comparatively young, so I'm glad to hear that she did well.

Reflection, the way to professional development? (journal article)

type of article: academic
class that forced me to read it: PSPR
avx online? yes
useful? if you have a birdcage that needs lining, maybe
tolerated? the sheer volume of uselessness made me seasick

Gustafsson, C. & Fagerberg, I. (2004). Reflection, the way to professional development? Journal of clinical nursing, 13, 271-280.

I had high hopes for this article, I truly did. I was hoping to find an academic study that would justify my Piscean penchant for navel-gazing. Instead, I found more evidence that I have no excuse for not having published or conducted research yet. It can't be that difficult to get past peer review if I am seeing articles like this in print.

The "phenomenographic" method was used in this study, which consisted of the interviews of four RNs who were hand-picked for being believed to use "reflective practice". The stunning conclusion of the study was that these nurses affirmed that reflecting on their past practice was useful to shaping their future practice.

Thanks for clearing that up, guys.

The authors committed various academic sins, such as inventing catchphrases ("to meet the unique") with neither explanation nor apology. Grammar was unacceptably uneven; this is explained if not excused by the fact that the study took place in Sweden. Finally, the authors stopped far short of their goal "to recognize the advantages of reflective practice and how and when to use such measures" (Gustafsson & Fagerberg, 2004). The closest they came was a line diagram, borrowed from a study from several years before, which did nothing to flesh out the idea of their model for professional development in nursing.

I would skip this article and go directly to one of the sources it cites: From Novice To Expert: Excellence and Power in Clinical Nursing Practice by P. Benner. I am going to chase down a few of the other references to see if there's anything there worth reading.

Another view on professionalism (journal article)

type of article: editorial
class that forced me to read it: PSPR
avx online? yes
useful? only in that it directed my attention to the Bruhn article, which was already in the reading list for this class
tolerated? The brevity of the editorial was such that I didn't have time to develop significant symptoms.

Feeg, V.D. (2001). Another view on professionalism. Pediatric Nursing, 27(3), 220-221.

The author makes a good plug for the importance of publishing to the development of nursing professionalism. First, though, she touches on one of nursing's favorite indoor sports: complaining about co-workers. "With the nursing shortage. . . impact(ing). . . workers' interpersonal behaviors, we're beginning to hear unpleasant stories. Some might simply call a colleague 'unprofessional' demonstrating a behavior that we know lacks in sensitivity, judgment, or courtesy" (Feeg 2001).

I would bet my next paycheck that in at best a minority of these "unpleasant stories" involving a co-worker's "unprofessional" behavior did the nurse affected simply confront the offending individual in anything approaching an adult, assertive manner. I would also wager that the story of the offending individual was offered for consideration to anyone else who would listen. This is the sort of communication style that typifies the interaction of fifth-grade girls in the schoolyard, and it has no place in the repertoire of anyone who's made it past the first lurches of adolescence. The article would have sat with me a little better if Feeg had come down on this bullshit; instead there seems to be tacit approval.

Being good and doing good (journal article)

type of article: academic
class that forced me to read it: PSPR
avx online? yes
useful? probably. I plan to use the bullet points listed below somewhere in my PSPR write-up.
tolerated? This article caused me only a slight headache. What's interesting is that this article was written from a medical perspective, not nursing. The author is an adjunct professor of health sciences, and if he is a nurse, he's coyly hiding those initials behind his PhD. The 50+ references that follow the article alll draw from medical and healthcare managment journals.


Bruhn, J. (2001). Being good and doing good: The culture of professionalism in the health professions. Health Care Manager, 2001, 19(4) 47-59

The author discusses the erosion of trust and integrity in American culture, and how it and the profit-driven managed care revolution has affected healthcare. By providing this context, he is able to hold all players in the "system" -- payers, providers, and the public -- accountable. He avoids both sounding preachy and succumbing to relativist I-blame-society pandering. One would think it's not too fine a line to walk, but even a brief review of the nursing literature out there will prove otherwise.

I've listed below the breakout points from his article:

General characteristics of being good:
* Being good is a choice.
* Being good is an ideal.
* Being good is a process involving choices throughout life.
* Being good is a judgment others make of us.
* Being good has risks.
* Being good and doing good are virtues that change in degree.

What is professionalism?
* Ethical codes of a profession
* Character of the person
* Social contract that ties technical competence to moral discretion
* A set of attitudes and behaviors that reflects personal beliefs and ideals

Twelve pointers on professionalism:
1. Be civil. Treat people with respect. You do not have to like or agree with a person to treat him or her as you would want to be treated.
2. Be ethical. Stand up for personal and professional standards. Do what is right, not what is expected.
3. Be honest. Be forthright. Do not participate in gossip and rumor.
4. Be the best. Strive to be better than good.
5. Be consistent. Behavior should coincide with values and beliefs.
6. Be a communicator. Invite ideas, opinions, and feedback from patients and colleagues.
7. Be accountable. Do what you say you will do. Follow up.
8. Be collaborative. Work in partnership with health professionals in related disciplines for the benefit of patients.
9. Be forgiving. Everyone makes mistakes. Give people a fair chance.
10. Be current. Keep knowledge and skills up to date.
11. Be involved in your profession. Be active at the local, state, and national levels of your profession.
12. Be a model. Your words and actions reflect on your profession. (Bruhn, 2001)

Why I'm doing this

Part of the problem is that I'm stubborn and impatient. By the time I make up my mind that I want to accomplish something, I want it done, and I want it done yesterday. The goal at hand now is a BSN through an online program. I want a BSN for three main reasons: first, it's required for me to enter the USAF as an officer. Second, when it's time to go back to school for whatever comes next, it will be very helpful to have a nice shiny GPA (unlike my one from UD). Third, and perhaps most compellingly, I've told everybody I would, so now it's my pride on the line.

That reason applies for the rationale to stay with the online program. The didactic exams are not difficult to prepare for, but the last performance exam I did with them was a nightmare. However, I know in my heart that I would have been the most miserable nursing student alive in a brick-and-mortar program, so it was worth it. My work schedule is still non-conducive to class, and I'm pretty sure I'd continue my tradition of falling asleep in lecture hall -- not to mention that the tuition for local BSN programs is astronomical. So here I am.

For my Professional Socialization exam, I am expected to keep a journal describing my "professional development". Here's the problem -- a year and a half into my license, I am barely socialized as a nurse. I've been a paramedic for five years. I still work full time as a paramedic. I do critical care transport, and I work in an emergency room one shift a pay period. I don't act, sound or think like a nurse, and I've gotten a good laugh at some of the more mealy-mouthed journal articles on nursing professionalism I've read thus far. Don't get me wrong -- I think professionalism is very important. It's just that a lot of nursing theorists make me throw up in my mouth a little.

Wish me luck.