7 Insider Tips for a Problem-Free Flu Shot

September 25, 2014
flu shots, pain free flu shot, problem free flu shot

flu shots columbia 1024x768 7 Insider Tips for a Problem Free Flu Shot

I have given over ten thousand flu shots in my nursing career.  No exaggeration.  And I believe that what I’ve learned along the way could help you.  Here is some insider information for a pain-free flu shot:

  1. The person giving you your shot might not have a lot of experience.

I started giving flu shots at campus mobile clinics while still a nursing student.  I’m a quick learner, but believe me, that’s not the case for everyone.  Feel free to request the most experienced nurse or chose one based on item #2.

  1. If there are a few nurses giving shots, pick the one using the “dart” technique.

While you’re standing in line, watch the nurses and how they give shots.  The faster the needle punctures the skin, the less it hurts.  Some nurses slowly push on the skin until the needle pokes a hole in it and this can cause unnecessary pain.

  1. Decide which arm to get your shot in ahead of time.

If you get the shot in your dominant arm (the one you write with) you are going to notice the soreness more frequently as you use your arm more often.  However, with the extra movement, you will be working the vaccine into the muscle more quickly so the pain (if there is any) will go away faster.  It is good to be prepared and the choice is yours.

  1. Make sure the alcohol is dry before the nurse sticks you with the needle.

There are a couple of reasons for this.  First, it stings!  Have you ever rubbed alcohol in a paper cut?  The same thing happens when the alcohol gets pushed through your skin along with the needle.  Second, alcohol pads work in two ways.  The rubbing action breaks open bacteria’s cell membranes while the evaporation process dries out and kills the bacteria’s insides.  You can prevent irritation and infection at the injection site by supervising the cleaning process and waiting for the alcohol to dry.  If the nurse is rushing, you can always say that you need a minute to collect yourself or catch your breath before she injects you.

  1. Relax the muscles in your arm.

When muscles are tense, fibers bunch up and become a tightly enmeshed matrix.  This creates a situation where the needle must tear through the compact mass.  On the contrary, when muscles are relaxed, a needle will glide between the fibers with ease.  So the trick is to relax your shoulder blade which, in turn, relaxes your upper arm.  The easiest way to do this is by putting your hand on your hip like a model at a photo shoot.  It’s kind of the only glamorous part of getting a flu shot.

  1. Drink extra water.

Make sure you are well hydrated before you get the shot and keep drinking extra water following the vaccination.  This will help for many reasons.  A hydrated muscle will recover from the injection and take up the innoculant more efficiently than a dehydrated muscle.  Also, water is a buffer while your body is in high-gear building antibodies to the vaccine.  The more water you drink, the better you will feel.

  1. Tylenol has benefits.

Tylenol (acetaminophen) is the gold standard for lowering fevers.  It’s used more frequently than Motrin (ibuprofen), Aleve (naproxen), or aspirin and can be taken before you get your flu shot as a preventative measure.  Not everyone, but some people, experience a low-grade fever due to increased metabolism while the body processes the vaccine.  Just be sure to follow the directions on the bottle and obviously don’t take it if you are allergic or your doctor has specifically advised against it.  Tylenol (and water!) will also help with body aches, too.  Personally, I take Tylenol when I get the shot, before I go to bed, and again the next day with a few extra glasses of water.


NurseGail.com Likes Humble Pie

September 20, 2014
humble pie YUM

humble pie YUM 300x199 NurseGail.com Likes Humble Pie

In regard to the Katie Duke post, we added an update.  In addition to embedding it in the original page, we are publishing it here

9/20/2014 UPDATE:

I would like to extend a sincere apology to anyone who was hurt by the words from my post about “Nurses Behaving Badly” on the Nurse Blog Carnival.  I must confess, my background in writing drama and fiction may have gotten the best of me.  I never intended to disparage individuals, though I can see how that intention was masked by my inappropriate choice of words.

This blog post has given me the opportunity to reconsider my approach, and for that, I am grateful.  After the solidarity in defense of Katie Duke, I am once again reassured that nurses are a force to be reckoned with and that, with time, the world will recognize it too.

–Mia Ross


I apologize for not editing words that could easily be misconstrued and ultimately harmful.

I am grateful to everyone who participated in this process, especially to Katie Duke who directed her followers to read the post.  Everyone who commented provided an opportunity for learning which I appreciate very much.

There is no way to adequately thank (or apologize to) the host and coordinator of the Nurse Blog Carnival.  Both were truly wonderful throughout this experience.

–Gail Ingram


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Katie Duke is NOT our Role Model | Nurses Behaving Badly | Nurse Blog Carnival

August 29, 2014
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unhealthy katie duke Katie Duke is NOT our Role Model | Nurses Behaving Badly | Nurse Blog Carnival

Katie Duke is NOT our role model.  Photos courtesy of Katie’s own public Instagram account.

Our new editor-in-chief, Mia Ross BSN-RN, shares her thoughts on the topic of Nurses Behaving Badly for this edition of the Nurse Blog Carnival.  Mia is an accomplished nurse writer and was a contributor to Scrubs Magazine until the online publication glorified Katie Duke, a reality TV nurse with questionable ethics, as a role model for nurses.  Mia embodies the tenants of nursing with a high degree professionalism.  Her ideals parallel mine and I am proud to have her on the new NurseGail.com team.


From the desk of Mia Ross BSN-RN:

I usually prefer not to pass judgment upon others, but this is an important opportunity to discuss an issue that impacts the profession.

Nurses behaving badly is a sensitive subject for me.  In short, I am increasingly frustrated by the way many nurses act and present themselves.  I have seen it in nursing school, in the workforce, and in the media.  Nurses who behave poorly, lack etiquette and poise, and whose speech falls well below par seem to be the ones getting the most attention.  The profession has suffered because of this.

For a short time, I wrote advice columns for Scrubs magazine.  I wanted to impart wisdom and encourage intellect and grace for nursing students.  I wanted to inspire them to think outside the task-based jobs they may one day face.  It was a noble endeavor at heart.  As it turns out, though, wisdom and introspection do not sell.  Scrubs magazine and its readers seem to prefer the ostentatious Katie Duke and other “stars” of NY Med.  This bothered me so much that I was unable to continue to write for the magazine.  How can a nurse who is raucous and imprudent be the role model for our profession?  After all, she was fired for showcasing sensitive hospital material on social media.  And yet this nurse, with her flashy nails, bleach-blonde hair, and excessive waistline is at the forefront of nursing (and subsequently health)?  It’s hypocritical.  If we want nursing to be taken seriously, then we cannot allow nurses behaving badly to feel empowered.

We need authentic, smart, savvy and educated nurses giving advice to the public.  If not, our profession’s future looks bleak and the same age-old “nurse bimbo” stereotypes will perpetuate.  Changing the reputability of nursing is one of my main professional goals; which is why I’m thrilled to be named Editor-in-Chief of NurseGail.com.  The new NurseGail.com is an on-line wellness magazine authored solely by nurses (behaving admirably) that will give our profession a respectable platform from which to showcase the very best.

–Mia Ross BSN-RN


Of note, I wrote a post back in March which applies to this Nurse Blog Carnival’s topic of Nurses Behaving Badly:  Negligent Nurses on Social Media  


This post was written as part of the Nurse Blog Carnival coordinated by the Nerdy Nurse.  This edition is being hosted by RTConnections and more posts on the topic can be read on that site.  If you are interested in participating, find out more details and sign up here.


9/20/2014 UPDATE:

I would like to extend a sincere apology to anyone who was hurt by the words from my post about “Nurses Behaving Badly” on the Nurse Blog Carnival.  I must confess, my background in writing drama and fiction may have gotten the best of me.  I never intended to disparage individuals, though I can see how that intention was masked by my inappropriate choice of words.

This blog post has given me the opportunity to reconsider my approach, and for that, I am grateful.  After the solidarity in defense of Katie Duke, I am once again reassured that nurses are a force to be reckoned with and that, with time, the world will recognize it too.

–Mia Ross


I apologize for not editing words that could easily be misconstrued and ultimately harmful.

I am grateful to everyone who participated in this process, especially to Katie Duke who directed her followers to read the post.  Everyone who commented provided an opportunity for learning which I appreciate very much.

There is no way to adequately thank (or apologize to) the host and coordinator of the Nurse Blog Carnival.  Both were truly wonderful throughout this experience.

–Gail Ingram





NurseGail.com UPDATE | Nurses are wellness experts. Period.

August 9, 2014
Gail Ingram, Filippa Pertruccelli, Mia Ross, Kerry Mossman, nursegail.com, nursegail, new york city nurses

NurseGail.com  300x202 NurseGail.com UPDATE | Nurses are wellness experts. Period.

Nurses are wellness experts.  Period.

Although, somehow, actresses who employ ghost writers and publish books have taken over that title.  Aside from personal experience, their message is nothing more than the basic information nurses provide to patients on a daily basis.  The reality is that actresses have a strong voice outside of the hospital or doctor’s office.  So do nurses, but they haven’t found the right way to share what they know.  Until now.

The new NurseGail.com is giving nurses the opportunity to share what they know with the world.  Nurses, through their writing of health-related topics, will be showcased as the wellness experts that they are.

The new website is under construction and the marketing and public relations platform is under development.  Based in New York City, NurseGail.com has access to amazing consultants and is receiving support from tech, business, and nursing leaders.

Nurse writers have been submitting pieces from across the nation and we couldn’t be more pleased.  Our editor in chief, Mia Ross, will be working with new writers to cultivate their voices and create buzz-worthy contributions.

Interested writers can contact the NurseGail.com team at NurseGailSubmission@gmail.com.  We’ll send you a copy of our writer’s guidelines and schedule a time to discuss our mutual goals.

A very special thank you to NurseJournal.org and Erica MacDonald for their support.  They recently included NurseGail.com in their list of “15 Awesome Nurse Blogs to Follow.”


nursegail crew 1 1024x1024 NurseGail.com UPDATE | Nurses are wellness experts. Period.

The NurseGail team: Filippa Petruccelli RN, Gail Ingram RN, Mia Ross RN, Kerry Mossman RN

nursegail.com crew 2 1024x1024 NurseGail.com UPDATE | Nurses are wellness experts. Period.

Gail Ingram RN, Mia Ross RN, Lynn Wojton RN

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Nursing Needs Online Presence | Let’s Do This! | Call for Submissions

April 13, 2014
wellness expert, nurses are wellness experts, nurse wellness experts, nursegail.com, nurse gail, nursegail, nurse gail ingram, gail ingram, ekg paper, ecg paper

NurseGail.com  300x202 Nursing Needs Online Presence | Lets Do This! | Call for Submissions

“Nurse Gail” is not about Gail Ingram. It is a branding strategy that gives health consumers a way to identify and engage with nursing.

Nursing has a branding  problem.  It can’t decide how it wants to present itself or be perceived by the masses.  Because of the many facets of nursing and the fragmentation within the profession, developing an inclusive media plan has proven to be nearly impossible.

There are many well branded doctors in the U.S. and even more self-proclaimed wellness experts who have fantastic PR campaigns which make them household names.  When people are looking for answers to their health and wellness issues, they turn to the internet, and that is who they find.

Where is nursing in the e-health conversation?  Nowhere.  While I personally believe nurses make the best health experts, they are not represented in the digital wellness mix, and unfortunately, nursing is being left behind.

I want to change this and I believe with your help that I can—or we can, rather.  I want to alter the concept of NurseGail.com to become a collaborative health and wellness resource where information is provided solely by nurses.  I want to give nurses a platform to share their knowledge, intelligence, and passion for good health.  No one understands the positive effects of interventions or the experience of illness like nurses.  Nurses are also the best teachers and translators to help others understand complex medical concepts.  Nursing is thought to be the most honest and ethical of any profession and nurses have the potential to deliver trusted health information in the best way.

The new NurseGail.com will operate like KevinMD.com and look like MindBodyGreen.com or WellAndGoodNYC.com.  But before a website redesign, I must make sure that nurses want to collaborate and use their voices to provide people with health information and put nursing on the e-health map.  (Don’t worry about protecting your license–that’s what editors and legal disclaimers are for.)

Submissions needed:

  • Authored by nurse practitioners, nurses, or nursing students
  • 200-500 words in layman’s terms
  • Topics related to health and wellness  (Examples:  How to survive a hospital stay, why raw vegetables are better than cooked, should I lift weights before running on the treadmill?)
  • Short bio including a couple sentences about yourself, photo is optional (Example:  Jane Doe BSN-RN has been an oncology nurse for 5 years and is a graduate NP student at NYU.)
  • Evidence-based writing is a plus

NurseGail.com has been steadily gaining traction and has been recognized by Excite.com‘s top 20 nursing blogs list, NursingSchool411.com’s top 50 nursing blogs, and is on the American Journal of Nursing’s blog roll.  My bullying post got over 2000 hits per day during the week that it was published and my undergraduate nursing admission essay continues to receive over 200 hits per day a year after it was published.  I have a high-traffic health column at NYULocal.com and my association with that publication has a synergistic effect for NurseGail.com.

NurseGail.com was started with the idea that my private clients and their families could get to know me better.  However, it is taking on a life of its own and has the potential to stand for something bigger than myself.  I see it as an opportunity to include other nurses and present nursing in a positive, smart, and professional way.  Please collaborate with me and get nursing recognized with a strong voice in the online health and wellness world.

Nurse Gail Registered Trademark1 786x1024 Nursing Needs Online Presence | Lets Do This! | Call for Submissions

Nurse Gail is the real deal and we are not fooling around here. Let’s do this!

To contact me with questions and submissions, please use the “Contact” link on the left.


This post was written as part of thenerdynurse.com‘s Nurse Blog Carnival hosted by Keith Carlson at RNFMradio.com


Oil Pulling Facts | Good Health or Good Hype?

April 1, 2014
nurse gail, oil pulling, science behind oil pulling, good health, oil pulling hype

oil pulling reasearch nurse gail Oil Pulling Facts | Good Health or Good Hype?

Where’s the clinical data? What does the literature say?

Oil pulling is getting a lot of buzz as a cure-all health remedy and it seems that every pseudo-wellness blogger has something to say about it.  Granted, there is a well established connection between poor oral health and disease but does oil pulling make a difference?  The information circulating about this trend is only half accurate and I want to set the record straight. 

Oil pulling is an ancient Ayurvedic practice in which one swishes edible oil (traditionally sesame but sunflower, olive, and coconut are also used) in the mouth for 15-20 minutes before spitting it out.  It is still used today in developing countries where access to oral care and products is limited.  Health-fad-loving Americans  are embracing oil pulling as an alternative to commercial mouthwash, toothpaste, and teeth whiteners.

But where is the science behind all the hype?  There are only 3 low-level peer-reviewed research studies  published on the benefits of oil pulling and they are all highly flawed.  Conducted in India by the same researcher, S. A. Asokan, each study included only 20 Indian adolescent boys (30 subjects are required to be statistically significant) with gingivitis (inflamed gums) who had never used mouthwash before.  There was no benign control group in any of the studies to evaluate the results of swishing with water for 20 minutes compared to oil or chlorhexidine mouthwash.  It is possible that swishing anything for 20 minutes could have a positive effect.

On the flip side, there are just as many weak studies to counter the benefits of oil pulling.  One study (using 8 subject samples) shows that oil doesn’t kill cavity causing bacteria in tooth enamel and a professional paper with only one adult female subject reports that oil pulling had failed to alleviate her gingivitis.  A letter published in February in the International Journal of Tuberculosis and Lung Disease reports recurrent lipoid pneumonia associated with the practice of oil pulling.  This is caused by accidentally inhaling the oil while holding it in the mouth–imagine coughing, sneezing or laughing with a mouth full of emulsified oil.

In the most recent published study by Asokan, he himself writes, “The exact mechanism of action of oil pulling therapy is still not clear and we are currently carrying out research in this area.”  So when someone claims to know how oil-pulling works, you can call BS.  We don’t know if bacteria are suffocated by the oil (most bacteria in the mouth require oxygen to live) or if the bacterium’s fat-soluble membranes are being broken or if the bacteria are drawn to the oil and expelled whole.

Other misleading claims on the internet suggest using only coconut oil for its unique anti-bacterial properties.  All oil has anti-bacterial properties–that is why you can leave it in the cabinet and not in the refrigerator.  Another claim states you must spit out the oil and never swallow it because it is “toxic waste.”  Seriously?  Nothing that grows in our mouths is toxic waste or we would all be dead.  Swallowing the oil might have a mild laxative effect but the bacteria will disintegrate in stomach acid.

Claims that oil pulling speeds up metabolism are also silly.  Oil pulling speeds up metabolism just as much as chewing gum because anything in the mouth triggers the body to begin the digestive process.  Also, if someone claims that oil pulling detoxifies the blood, ask them what they think the liver and kidneys do.

Don’t get me wrong.  I’m not saying that oil pulling is a waste of time or that you shouldn’t do it.  I’m sharing the facts surrounding the hype so you won’t sound like a doofus when you talk about it with your friends.  There is no strong empirical evidence, only anecdotal stories, that oil pulling has marked systemic health benefits.  And unfortunately, no amount of oil pulling is a cure for stupid.



[This article was originally posted in my health column as "The Science Behind Oil Pulling--Good Health Or Good Hype?" on 4/1/13 at NYULocal.com.  To read all of my NYULocal.com articles, please visit their site.]

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Negligent Nurses on Social Media | Medical Internet Ethics

March 30, 2014
nurses on social media, negligent nurses, stupid answers to dumb questions, nurse gail ingram

keyboard stethoscope 300x150 Negligent Nurses on Social Media | Medical Internet Ethics

I follow many nurses on Facebook and am appalled by their lack of ethical social media stewardship.  One nurse in particular with 16,000 followers uses Facebook as a forum to discuss health issues and natural remedies.  She posts biased, unsupported propaganda  and does not moderate comments that are misleading or suggest unsafe treatments.

I would like to believe that all nurses practice within their professional scope, have advanced critical thinking skills, and convey medical information in an ethical manner.  As more nurses become active with social media I am seeing how many of them do not meet these criteria.  I have been nursing’s biggest cheerleader and I’m profoundly disappointed in what I am witnessing on the internet.

Registered nurses must be sensitive to the power they have with regard to influencing health decisions.  We are all potential wellness guides for our friends, families, patients, and now millions of internet users who have access to our public on-line commentary.  I am overwhelmed with the negligence shown by my cohorts and wish I could apologize on their behalf.  But I can only continue to be transparent on social media and continue to provide sound information based on empirical data.

If you are a nurse, I ask you to be cognizant of your responsibility as a medical professional and if you are a health consumer, I encourage you to be prudent with whom you trust on the internet.


BP best PhotoGrid 1396160372090 Negligent Nurses on Social Media | Medical Internet Ethics

The nurse who runs this Facebook page is irresponsible for not moderating these comments.  Do you know how much broccoli you have to eat to lower blood pressure?  And low salt is rarely a problem because salt actually causes hypertension and atherosclerosis.  I could go on and on for days and so could the nurse who hosts this page.  It is probably the very reason she chooses to ignore the comments.


  Read more about Nurse Gail’s social media presence in these posts:



Sextastrophes and the Morning After Pill | Statistics & Tolerance

March 13, 2014
morning after pill, emergency contraception, nurse gail ingram, lovenorgestrel, 24 hour pharmacy

pharmacy morning after pill 294x300 Sextastrophes and the Morning After Pill | Statistics & Tolerance

Take the pill before you leave the store.

My girlfriend had a hot weekend sexcapade that required emergency contraception.  I was getting all the juicy details when she said, “I know I shouldn’t take the morning after pill too many times because it eventually stops working the more times I take it.”  She said she hopes it works this time but asked me when her luck will run out.

First of all, the morning after pill (which is levonorgestrel and marketed as Plan B, Next Choice and Levonorgestrel Tablets) does not randomly stop working and there is no such thing as building up resistance.  It doesn’t help that the Levonorgestrel Tablets package insert says the “failure rate” accumulates over time with repeated use.  This is confusing because it sounds like the drug will accumulate over time but the statement is actually referring to generalized averages.

If the morning after pill is taken within 24 hours of sloppy sex, it is 95% effective in preventing pregnancy.  According to the FDA-approved label for Plan B, it is 89% effective when taken as far out as 72 hours.  However the World Health Organization did its own study and found slightly different results.  They tested levonorgestrel (the generic version of Plan B) and found it is 85% effective when taken between 25 and 48 hours and only 58% effective when taken between 49 and 72 hours.  Both data sets report 95% effectiveness when taken as soon as possible.  Meaning, the more time that passes after unprotected sex, the less effective the morning after pill becomes.

Wording the statistics differently can make them more confusing.  For example, another way to say “85-89% effective” is to use its inverse.  This is translated into “1 out of 8 women will become pregnant.”  This can lead someone to believe that they are guaranteed to get knocked up if they use the pill 8 times.  It just isn’t that simple.  Pregnancy depends on many factors including ovulation, stress levels, co-existing health conditions, genetics, and age among other things.  Some women metabolize the morning after pill differently and on the guy’s end, some sperm aren’t healthy and they don’t survive long enough to get to their destination.

Every situation is different and every couple is different.  You might be a woman who will get pregnant every time she has sex within 5 days of ovulation or you might be a guy with super human swimmers.  We just don’t know.  But if this is the case and the two of you found each other, you are probably testing the odds.  For the ladies, regular birth control like the daily pill or an IUD is more effective and recommended by the makers of emergency contraception.

But on the rare occasion that the morning after pill is needed, here are some other things to know.  Every pharmacy has different rules for dispensing emergency contraception because the regulations for dispensing it are constantly changing.  No prescription is needed to purchase Plan B, therefore no ID is required to show proof of age.  ID is required for Levonorgestrel Tablets and Next Choice.  If your ID says you are under 17, you’ll need a prescription.  However, the regulations for Next Choice are being revised and some pharmacies are already selling it without carding.  Plan B is the most expensive (Rite Aid $49.99, CVS $50, Walgreens $54.99) and Next Choice is less (CVS $39.99, Walgreens $44.99) but both contain the same active ingredient.  Whichever brand you buy, for the best results, take the pill before leaving the drug store.

I also told my friend to expect some spotting and that her cycle will be off.  If she hasn’t had a visit from Mother Nature (AKA Aunt Flo) seven days past the expected start date, then she should get a pregnancy test.  3 weeks after unprotected sex, she should also look into STI (sexually transmitted infection) testing and that is a whole other blog post right there!

Read more about my brush with antibiotic-resistant chlamydia.  It is a true story and one of this blog’s most popular posts.

The edited NYULocal version of this post can be read on their site or read all of my NYULocal posts.


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Nurse Blog Carnival | Bullying in Nursing

February 16, 2014
blog carnival 4

Bullying in Nursing

blog carnival 3 Nurse Blog Carnival | Bullying in NursingNURSE BLOG CARNIVAL


Brittney Wilson RN BSN, TheNerdyNurse.com


Gail Ingram RN BSN, NurseGail.com


Keith Carlson RN BSN, DigitalDoorway.blogspot.com

Joyce Fiodembo RN BA, InternationalNurseSupport.com

Gail Ingram RN BSN, NurseGail.com

Erica MacDonald RN MSN, SelfEmployedNurse.com

Caroline Porter Thomas RN BSN, EmpoweRN.com

Renee Thompson RN DNP, guest post at TheNerdyNurse.com

Sarah Wengert, TravelNursingBlogs.com


The NURSE BLOG CARNIVAL is a joint effort by established bloggers to bring focus on a particular topic in the profession of nursing.  By sharing our unique experiences and perspectives, the collaboration draws attention to an issue and sparks a conversation.

This week’s topic is BULLYING IN NURSING and each participant offers something of value in their posts:


Keith Carlson RN BSN—Nurse Bullies:  A Plague on Our House

In his post, Keith gets on his “Bully Pulpit” and inspires us to stand up for ourselves and others.  He makes it clear that hospital administration must develop a zero-tolerance policy because, “without the support from above, our continued struggle in the trenches will be in vain.”  On top of great content, he incorporates some fantastic nautical imagery and found use for the word “elucidate.”


Joyce Fiodembo RN BA—How Minority Nurses Can Avoid Being Bullied

Joyce points out the irony that bullying exists in a profession with, “the most caring human beings on the planet.”  She defines bullying and describes who and why someone becomes a target.  She offers 6 steps to follow if you are a victim.  She states that witnesses cannot remain silent and quotes the great Edmund Burke, “The only thing necessary for the triumph of evil is that good men do nothing.”


Gail Ingram RN BSN—Bullying in Nursing – It Isn’t Just for Kids – Mean Girls

This is my entry.  I explain certain aspects of bullying that are not often discussed and frequently misunderstood.  For example, why is it taking so long to get the word out?  Why is it still happening and what will make it stop?  I also provide a link to the literature review so that you can further evaluate the evidence.  I love to read peer-reviewed research in my spare time.  Maybe you do, too?


Erica MacDonald RN MSN—I Know Why Nurses Eat Their Young…  Maybe

Erica asks, “Why would educated and professional nurses engage in such poor behavior?”  Hint:  High school never ends!  She also describes how the concept of sacrifice allows nurses to accept bullying as the workplace norm.  She notes that slipping into the role of the bully might be easier than you think and perhaps the solution lies in arming nursing students with skills to “fend off the wolves.”


Caroline Porter Thomas RN BSN—Will I be Disrespected as a Nurse?

Caroline is the only vlog contributor on the roster and I wasn’t expecting what I saw in her video.  Her opening sequence is honest and it made me laugh.  Without spoiling it for you, I’ll add that she gives a quick pep talk about self-esteem and provides 4 keys to success.  She is a little ray of sunshine while talking about a topic that can be utterly depressing.


Renee Thompson RN DNP—Ending Nurse Bullying: “Freire Style”

In an effort to end nurse bullying, Renee parallels the work of Paulo Freire, a sociologist who studied human behavior, particularly oppression.  She finds that self-reflection, enhanced communication skills, believing in oneself, and being nice are all part of the solution.  She reminds us we “deserve to work in a nurturing and supportive environment, free from bullies.  To do that requires that we all take action.”


Sarah Wengert—How to Stop Travel Nurse Bullying

Sarah identifies the frequency of bullying and clarifies the difference between vertical and horizontal violence.  She brings the statistics and makes the connection between bullying, patient safety, and financial consequences.  She offers sound advice for travel nurses (AKA temporary contract nurses) who are often targets of staff bullies.


If you are a nurse blogger and want to participate in a future BLOG CARNIVAL please learn more here.


Bullying in Nursing | It’s Not Just For Kids | Mean Girls

February 15, 2014
nurse gail, gail ingram, nurse bully, bullying in nursing, lateral violence in nursing, beth israel, ging

best ging beth israel phillips cropped 1024x534 Bullying in Nursing | Its Not Just For Kids | Mean Girls

I was a travel nurse (far left) on this unit in NYC where I met the most destructive nurse in all of my career (she’s in there, too).

My colleagues who work far away from the hospital bedside don’t see the severity of bullying in nursing.  My friends outside of healthcare think it’s a joke because the term “bullying” is associated with kids.  But I assure you it is a serious problem in the profession and it compromises patient safety.

Exposure:  What is Taking so Long?

The phenomenon of lateral violence, or bullying, is well known among seasoned nurses but it remains a mystery to outsiders.  Exposing the problem is the first step in fixing it and nurses are beginning to wonder what is taking so long.

One reason is due to the lack of evidence to support its existence.  There is a saying in nursing that, “if you didn’t chart it, you didn’t do it.”  The same applies to bullying.  If there isn’t peer-reviewed research to support it, then it doesn’t exist.  Only recently has empirical data in sufficient quantity been published that identifies and reports the prevalence of bullying.

Also, widespread news of nurse bullying may deter prospective nurses from entering the profession.  Nurse staffing levels in hospitals are at about 80% right now and slowly declining.  A full-blown nursing shortage is expected in 2020 and without new graduate nurses we don’t stand a chance.

Causes:  Low Self-Esteem, Limited Communication Skills & Lack of Control

Thankfully the whispers about nurse bullying have evolved into a conversation and attention is being directed at the issue.  However, nurses at the bedside continue to be victimized by their peers.

Identifying the causes of lateral violence is the next step.  There are many reasons that bulling exists in nursing and it is a complex topic.  But, generally speaking, most bullies in nursing have low self-esteem along with a limited communication skill set.

Unfortunately, there are many risk factors for low self-esteem ranging from a dysfunctional family life to a genetic predisposition for depression.  Some people are truly unaware of their own low self-esteem and haven’t got a clue how to help themselves.

Interpersonal communication is a skill, meaning it is learned.  Children who come from certain backgrounds do not learn effective verbal communication and have to assume that responsibility as adults.  Some choose to learn and others do not.

Additionally, bullies report feeling a lack of control regarding their position on the job.  Examples of this include fear of being fired, limited advancement opportunities, or unsupportive management.  The inability to communicate these factors (because of limited communication skills or low self-esteem) further compounds feelings of frustration.  Instead of constructively expressing the frustration, it is unfortunately, inflicted upon unsuspecting coworkers in the form of bullying.

Solutions:  Education, Leadership & Hospital Policy

Self-esteem and communication skills can be bolstered through education, however the educational requirements for nursing are minimal.  A 4-year degree dramatically improves communication skills and a sense of empowerment but only 1/3 of nurses have one.  Legislation requiring all potential nurses to obtain a bachelor’s degree before taking the NCLEX is a viable solution.

Along with increased education, hospitals need to stop filling management positions with warm bodies and instead, fill those positions with leaders.  Much research has been published regarding effective leadership but hospital HR departments struggle to find nurse applicants with those skills.  This means that nursing programs must go beyond teaching tasks and begin to create leaders.

HR faces another problem when executive staff members do not provide a clear zero-tolerance, anti-bullying policy.  Unfortunately unions complicate matters by making it very difficult to fire bullies.

Bottom Line

Everyone from hospital executives to nursing students need to be made aware of lateral violence in the profession of nursing in an effort to end it.  Hospital decision makers need to put leaders in place who can create safe environments for bedside nurses.  Nursing students need to be prepared as leaders who can manage a challenging work environment.  Staff nurses need to advocate for each other when they witness bullying.

More Information

In 2010, Jennifer Embree and Ann White compiled a literature review and I highly recommend you take a look.


For additional nurse blogger posts on bullying in nursing check out the Nurse Blog Carnival.

To read my advice for a University of Texas student on becoming a nurse click HERE.

Also, you might like my foreign educated nurses post.


NYC Bodega Soup | Healthy Choices | NYULocal.com

February 8, 2014
bodega soup

Soup Nazi 240x300 NYC Bodega Soup | Healthy Choices | NYULocal.com

I’m back from NYU’s graduate Study Away program in Buenos Aires, Argentina where I learned all about issues and trends in nursing that are affected by education, culture, economics, and politics.  I toured hospitals, clinics, slums, and participated in lectures about humanitarian nursing, quality control and international indicators of health.

Moving from mind-blowing global concepts, I posted my first column of the semester for NYULocal.com.  Wedged between an article titled, “Fashion Queen Anna Wintour Expands Her Empire” and “Resurgence of Heroin Use May Be Linked To Painkiller Abuse,” you’ll find my post titled, “It’s Not Life Or Death.  It’s Soup.”  Yes, it’s an article about choosing the healthiest soup at the bodega.  Is it a fluff piece?  Maybe.  But I guarantee it is the best 600 words ever written about bodega soup.  I know because when I Google “bodega soup,” nothing even close to being relevant pops up.

Read the NYULocal Nurse Gail article to see just what kind of a nerd I am and why you should pass on the cream of broccoli.

IMG 20140207 163838 300x161 NYC Bodega Soup | Healthy Choices | NYULocal.com




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Please Stop Donating Crap to Food Banks | Healthy Food Drive Donations

November 22, 2013
worst food drive donation, nurse gail, nurse gail ingram, gail ingram, food bank, food donations, canned chicken, worst canned food, disgusting canned food

canned chicken 300x207 Please Stop Donating Crap to Food Banks | Healthy Food Drive Donations

Worst food drive donation ever.

We all have a dusty can of something awful in our cabinets that we’d like to get rid of but donating it to a food bank is not the solution.  People who rely on food banks and donations need nutritious food, not your old cans of Spam and Sloppy Joe sauce.  So instead of giving two cans of something you wouldn’t put into your own mouth, here are my suggestions for healthy donations:

  • Organic baby food (the only item that many food banks will accept in a glass jar)
  • Raw cashew or almond butter (in plastic jars, not glass)
  • Dried or canned beans
  • Brown rice (not instant)
  • Dehydrated fruit (no sugar added)
  • Canned albacore in water (no salt)
  • Tea, coffee, bottled water
  • Olive oil (first cold pressed extra virgin)
  • Thick rolled or steel cut oats (not instant)

Although they are loaded with macronutrients, try not to get too fancy since the donation recipients might not know what to do with quinoa, chia seeds or hemp hearts.

Giving feels great.  Please be thoughtful this holiday season and give donations that promote wellness and good health.  You’ll be glad you did.

Learn more about the relationship between hunger, obesity and processed food in my NYULocal.com post.

NYUlocal image small Please Stop Donating Crap to Food Banks | Healthy Food Drive Donations

Read all of my NYULocal posts HERE.


The Straight Poop on Bladder Infections | What causes UTIs?

November 15, 2013
UTI Nurse Gail

UTI Nurse Gail 227x300 The Straight Poop on Bladder Infections | What causes UTIs?


The most common cause of bladder infections is e-coli.

E-coli is predominantly found in the intestinal tract.

How does e-coli get from the gut to the bladder?   Poop.

There.  I said it.  And I say a lot more about it in my health column at NYULocal.com.


NYULocal uti 150x150 The Straight Poop on Bladder Infections | What causes UTIs?

To see all of my weekly articles, click here.

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Thriving as a Nurse | Scrubs Magazine Nurse Blog Carnival

November 11, 2013

[The following is a contribution to the Scrubs Magazine Nurse Blog Carnival.  The topic for this round is "Thriving as a Nurse" and is being moderated by Keith Carlson at DigitalDoorway.blogspot.com.]


I recently received a letter from a first-year nursing student who attends my alma mater.  She asked me how I became successful in nursing and if I had any advice for her.  I think my answer to her question serves the Blog Carnival’s topic well.

UTAustin logo 300x136 Thriving as a Nurse | Scrubs Magazine Nurse Blog CarnivalHey Gail,

I recently stumbled on your blog and I am so glad I did! I am a current freshman at UT Austin and I am really excited to see someone who graduated from the nursing program here at UT achieve so much success. I hope to be like you someday, being a nurse, going to graduate school, and also giving back to the community. I would appreciate if you could provide any tips on how you became so successful at UT and beyond in your career as well.  Thank you very much for being an inspiration to me and I hope to be just as successful as you in the near future.

Best Regards,



Dear Zxxxxx,

THANK YOU for reading NurseGail.com and writing to me personally.  In response to your question, I’ve come up with a quick list and a long explanation using examples from my career that I hope will be helpful.

How to thrive in nursing:

  • Define success by something measurable (but not money).
  • Do as many things in nursing (and nursing school) as you can.
  • Be prepared to become a leader.
  • Land a first job that will open doors for you.
  • Say yes and go beyond what is expected.
  • Get outside your comfort zone.
  • Understand the rules and know which ones to re-write.
  • Be creative.
  • Learn about the business of health care and not just how to give a shot or start an IV.
  • Consider further education.
  • Pat yourself on the back.


When I started out in nursing I didn’t have a clear picture of what success meant to me so I defaulted to money as the measure.  That was just dumb because nurses are paid a standardized hourly wage and are far removed from free-market capitalism.  I was making half the money that my friends were and always felt unsuccessful by comparison.  Thankfully I’ve moved on and now I measure success by how many people I can help and this makes a lot more sense.  It might take you a while to decide what success means to you but please don’t make the mistake that I did by measuring your worth as a nurse by using money as a marker.

Despite the frustration over my paycheck, not all was lost during my early years in nursing.  I was doing something else which turned out to be more valuable than making money.  Because of an unlikely professor, I made it my mission to learn as much about every area of nursing that I could.  I say unlikely because he was a young, new assistant professor and, whether it was nerves or something else, he was flustered during his lectures.  The class picked up on his weakness and grilled him.  It was torturous to watch and I decided that before becoming a leader in nursing, I better have plenty of knowledge and experience.  I wanted to be prepared and set out to build a well-rounded nursing resume.

My first (and only) staff position was in a critical-care step-down unit and it set the tone for my entire career.  I had the opportunity to care for patients who were on the verge of getting better or going downhill fast.  It was a roller coaster ride and I learned to be confident while working outside of my comfort zone.  I highly recommend making contacts and getting your ACLS during nursing school so that you can start working in an ICU or critical care unit right after graduation.  Even if it isn’t what you want to do for the long haul, once you’ve got ICU on your resume, you can do anything.    

After one year and eight months, I moved on to travel nursing which provided countless opportunities to challenge myself and learn more.  I got my TNCC and PALS certifications so I could have more freedom to try new things.  I was floated to the ER, I gave chemo, I took care of pediatric patients, and I got assigned the sickest, most high-acuity patients on the units where I worked.  Because I said yes to new experiences, they continued to open up for me and they will for you, too.

When I settled down in NYC I started taking private duty shifts on the side.  I loved private duty but I wanted a more proactive role in my patient’s wellness.  This was never really appreciated by the agencies that I worked for so I started attending classes at the Baruch SBA Development Center and formed my own LLC.  My business has provided me with wonderful relationships, amazing professional opportunities and I finally have a little bit of money in the bank.  If you know which limitations you set for yourself and which ones are set by others you’ll be better able to move forward.  Don’t let someone else’s rules hold you back from what you know is right.

Now I’m at the stage in my career where I am limited by my BSN–I need to be able to diagnose and prescribe medications for my clients.  I am currently attending NYU and loving every minute of it.  I will transition my business into my private practice after I pass the boards.  You mentioned graduate school and I think that is great.  I would have done it a little sooner if I’d known what I know now.

Finally, I want to congratulate you on your decision to attend the University of Texas for your BSN.  The scholarships and awards you win will remain on your professional CV forever so take the time to apply for them.  Strive for good grades because “cum laude” will set you apart from others when being considered for a job that you really want.  Enjoy everything that Austin has to offer and say hello to Mrs. Patton for me.

I hope this response will help you in some way.  Don’t hesitate to ask me any further questions and keep in touch.  I would love to know how things turn out for you.




CarnivalButton Thriving as a Nurse | Scrubs Magazine Nurse Blog Carnival


NYULocal.com Health Column | Flu Shots | Nurse Gail

October 15, 2013

NYUlocal image small NYULocal.com Health Column | Flu Shots | Nurse Gail

My column for NYULocal.com this week gives tips on how to avoid cold and flu-like symptoms following the flu shot.  I also ask those people who believe they’ve had a bad reaction to stop spreading fear among others who might be interested in a flu shot but are already afraid of needles.  Nobody, especially NYU students, likes to be told to hush up.


Screenshot 2013 10 14 22 43 15 150x150 NYULocal.com Health Column | Flu Shots | Nurse Gail


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Nurse Gail goes beyond NurseGail.com | Social Media Update

October 13, 2013

intagram 300x225 Nurse Gail goes beyond NurseGail.com | Social Media UpdateSome readers follow Twitter but don’t do Instagram.  Some of you love Instagram but aren’t on Facebook.  It’s OK.  I share health information using lots of different sites.  Here are links to optimize your Nurse Gail social media experience:

TWITTER:  You don’t need to have a Twitter account to view my public Tweets.  For those new to Twitter, a tweet is a short message of only 140 characters.  I usually share links to interesting health articles and occasionally funny nurse-related things that happen to me.  I use my own Twitter feed as a library of articles that I share with my patients.  Read more about it on a previous post I wrote called Tweet to Teach.  Take a look at my public Twitter feed on the Twitter site:  @nurseGAILINGRAM

INSTAGRAM:  You don’t need to have an Instagram account to view my public photos.  My photos are all health related and usually include a new health tip for you to consider in the comment section of each photo.  Click on each photo to read my comments on the Instagram site:  nurse_gail

FACEBOOK:  You don’t need to have a Facebook account to check out the public Nurse Gail Facebook page.  Many of my blog posts, tweets and Instagram photos are forwarded to the Nurse Gail Facebook page and I also post light health and nursing articles there, too.  If you do have a Facebook account, “like” the Nurse Gail page and my updates will be included in your new feed.  Here is the link for Nurse Gail on Facebook:  Nurse.Gail.Ingram

NURSEGAIL.COM:  You can subscribe to NurseGail.com and when I publish a new post you will receive an email notification.  Enter your email in the box to the left and hit the subscribe button.  Easy.

QUORA:  You will need to sign up for Quora to read what I’ve written there.  Sometimes I make comments on posts and other times I cut and paste something I’ve already written on NurseGail.com.  It is a fun and interesting site where participants ask thought provoking questions and members who are experts in that area offer an opinion.  I contribute my health care related knowledge and experience.  Here is the link to the site:  Quora.com

Next for Nurse Gail is video!  Stay tuned!

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Cold & Flu Season | Home Remedies that Work

August 31, 2013

tissue box1 246x300 Cold & Flu Season | Home Remedies that WorkDespite all the advances in medicine, my grandma’s home remedies for colds still work the best.

WARM SALT WATER GARGLE:  Yes, it tastes really, really bad but it works.  The salt and warm temperature of the water trigger your body to flush out your throat from the inside.  Externally, the salt kills bacteria which will prevent a possible respiratory infection.  I mix 2 teaspoons of table salt to 1 cup of warm water.

STEAMING:  This is good for congested sinuses, tight chest and, as a bonus, your skin will look fabulous, too.  Boil water and pour it in a large pot (do not use a glass bowl because it will break).  Place the steaming pot of water on a table, pull up a chair, put your face over the pot, and put a towel over your head.  Initially the steam will cause you to cough which is a good thing.  But use common sense–don’t burn your face off and by all means let some air in under the towel if you are uncomfortable.  Try to inhale the steam for 10 minutes or longer.  I keep the kettle on the table for warm ups and a box of tissue nearby so I don’t have to get up.   I also add 3 to 4 drops of essential eucalyptus oil to the hot water because of its natural decongestant and anti-inflammatory properties.

IMG 20130831 1758221 150x150 Cold & Flu Season | Home Remedies that Work

Find essential oils at a health food store.

AVOID OVER-THE-COUNTER COLD MEDICINE:  Taking cold medicine prevents the body from ridding itself of infectious byproducts (cellular waste, dead bacteria and viruses).  Of course I’m the first to reach for Advil Cold & Sinus, Mucinex and Afrin when I have to pull it together for work, but on my days off I let it drain.  Otherwise that stuff gets stuck inside your head and lungs and keeps you sick longer.

DRINK EXTRA WATER:  The body must be well hydrated to thin mucus and flush out infection.  Cold symptoms are compounded by dehydration which only makes things worse.

ZINC SUPPLEMENTS:  When taken at the onset of illness (within the first 48 hours, the sooner the better), zinc fights off cold symptoms by regulating inflammation–your body’s reaction to infection.  I triple or quadruple the dose on the bottle and take it 2 – 3 times a day.  I stop taking it after the symptoms subside.

IBUPROFEN:  Also known as Advil or Motrin, ibuprofen has anti-inflammatory properties that will help ease cold symptoms (swelling in the nose, throat and sinus passages) while reducing body aches.  Tylenol, or acetaminophen, is still the best choice to bring down a fever.

In full disclosure, I added the zinc and ibuprofen but Grandma’s old-school advice still stands.  She will do anything to avoid going to the doctor and now you can, too.  We hope you feel better soon!




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How to Stay Sane in NYC | Mental Health & City Living

August 27, 2013

IMG 20130802 181718 300x225 How to Stay Sane in NYC | Mental Health & City Living

This space was not so pretty when I moved in.

Living in Manhattan is stressful.  To achieve longevity in the City, New Yorkers must be proactive in preventing burnout.  One way to do this is by choosing an apartment with a feature that provides relaxation.

Being open-minded and using creativity is essential when seeking out a relaxation amenity;  it won’t be obvious and you probably won’t know it until you see it.  For example, I have an artist friend who saw potential in a clothes closet.  He cleared it out, changed the light fixture and uses it as his painting studio.  It is cramped but he shuts out all the noise from the City and does what he loves without interruption.  As for me, I transformed an ugly 5′ X 6′ tar paper ledge outside my window into an inviting outdoor space.  I listen to music and write my blog posts there.

Many bright-eyed newcomers believe they’ll hop over to Central Park for some fresh air and relaxation whenever they feel like it.  Unfortunately it’s not possible when feeling sick, working on a deadline, or late at night.  A decompression and relaxation space in the home is key.  Here are some mental health conscious questions to ask yourself when renting an apartment in Manhattan:

  • How many windows are there?  Natural light is important.  Sunlight=life.
  • Southern exposure?  Southern facing apartments get more sun longer throughout the day.
  • Is the view from the window of another building?  Is the sky visible?  Is there a tree in sight?  I didn’t think this mattered until I lived in a ground floor apartment and couldn’t see the sky.  (I have strong feelings against ground floor apartments.  View the Good Day New York video clip.)
  • Is there roof access?  Is it possible to keep a chaise lounge up there?  Can you store one under your bed and haul it up there to stargaze?
  • Is the fire escape on the backside of the building where you might hang out for a while?
  • What about a place inside to stretch/exercise?  A quiet place to pray/reflect?  A space big enough for a yoga mat or meditation cushion?

Remember, everyone moving to Manhattan has to compromise something on their apartment wish list, but it isn’t necessary to compromise mental health.  The time and effort spent finding the right apartment in New York City is an investment in overall wellness.  It is a challenge, but worth the effort if you want to make the City your home.

IMG 20110319 153047 300x224 How to Stay Sane in NYC | Mental Health & City Living

Hard to see the Zen potential unless you’re looking.


IMG 20130805 134300 225x300 How to Stay Sane in NYC | Mental Health & City Living

Wedged between two buildings, I get 20 minutes of direct sun daily–the perfect dose of Vitamin D.

P.S.  I found my apartment on Craigslist and it is $225/month below market value.  It is possible to find something special (if you can imagine it) within a tight budget.  Read my post New York City Nurses Make Less than You Think.

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Prevent Plastic Surgery Bruising | Natural Tricks of the Trade

August 16, 2013

lip bruise 1024x680 Prevent Plastic Surgery Bruising | Natural Tricks of the Trade

These natural remedies prevent bruising from injectables, too.

I recover VIP clients from elective cosmetic procedures done by New York City’s best surgeons. However I’m surprised when some interventions to prevent plastic surgery bruising are not provided by the doctor’s office. The most commonly overlooked include:

PINEAPPLE, MANGO and PAPAYA–all have healing enzymes that minimize bruising.  The general recommendation is to eat 2 cups per day for 5 days before and after surgery. Bromelain supplements can be taken when an allergy or intolerance to these fruits is prohibitive.

ORAL ARNICA SUPPLEMENTS–are being recommended more commonly, but in case they didn’t make your surgeon’s checklist, the usual recommendation is to take for 5 days before and after surgery.

KALE–is rich in vitamin K and thickens the blood.

TOPICAL ARNICA combined with VITAMIN K TOPICAL CREAM–diminishes existing bruises more quickly.

VITAMIN C (CITRUS) and BIOFLAVONOIDS (RICHLY PIGMENTED FRUITS, VEGETABLES, BEANS)–are known to strengthen blood vessels but need to be part of a regular diet beginning 3 months prior to a procedure.  It takes about that long, sometimes less, to achieve the desired results.

It doesn’t matter if the bruising is caused by surgery, roller derby, paint ball or aggressive games of punch buggy.  These natural remedies work for all types of bruises and are available over the counter.  Whatever the reason, I hope you heal quickly!


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Second Career Nurses | Blending Extremes | Blog Carnival

August 15, 2013

[I wrote the following article for the Scrub's Magazine Blog Carnival which was hosted by TheGypsyNurse.com.  The topic was "Career Change" and I chose to write about something personal.]

Vogue Crisp 202x300 Second Career Nurses | Blending Extremes | Blog Carnival

Yup, that’s me.

Career counselors warn clients against making extreme career changes but, contrary to their advice, I have no regrets for making a bold transition.  I believe blending extremes provides an opportunity for immense personal growth and the creation of unique professional niches.

Of all the second career nurses I know, my career change was the most dramatic.  So dramatic, in fact, that my co-workers at the hospital find it difficult to believe that I would give up such a fun and glamorous lifestyle.  Some bedside nurses I work with feel “stuck” in their jobs and when I reveal that I was an international model, I get a lot of, “What?  You went from jet-setting to wiping poop?  What is wrong with you?”

I asked myself that question many times in the first years of my nursing career.  I wasn’t the center of attention at work and time management didn’t revolve around my mood.  It was the biggest ass-kicking of my life and I look back with pride.  I worked harder to become a good nurse than I had ever worked for anything else.

Nursing gives me a profound sense of satisfaction in knowing I’ve helped countless people during years of hands-on work.  I sleep better at night than ever before and I’m one of a few women I know who isn’t taking anti-depressant or anti-anxiety medication.  The holistic benefits of nursing far outweigh the superficial perks of other professions.

As a VIP private duty nurse and concierge care manager in NYC, I draw upon my experience in fashion to compliment my nursing care.  Who better understands the VIP population than someone who, at one point in time, was a VIP?  I have an immense amount of patience for divas and can empathize with clients who need a little (or lot of) extra TLC.  By blending both careers I have carved a special niche for myself in a very rewarding field.

Private Jet 300x190 Second Career Nurses | Blending Extremes | Blog Carnival

My love of private jets and nursing come together on VIP transport flights.

I’m looking forward to my next bold move which will bring me continued personal growth and the opportunity for professional creativity.  I’m in the NP program at NYU and always looking for the best way to utilize my unique skill set.  Who knows?  Maybe politics are in my future.  New York could use an infusion of ethics and honesty right about now.

Track my career moves on NurseGail.com.

CarnivalButton Second Career Nurses | Blending Extremes | Blog Carnival


My Best Hangover Cure | FRESH Coconut Water | Nurse Gail

August 5, 2013

IMG 20130805 1517531 258x300 My Best Hangover Cure | FRESH Coconut Water | Nurse Gail

One could say that the best hangover cure is prevention but seriously, who can keep track of how much champagne they’ve had when the glass is continuously topped off?

When I know I’m going to an event, I will stock my fridge with FRESH coconut water.  I drink fresh coconut water along with filtered water before going out and again when I return home.  I also make sure I have enough stocked for the next day.

Fresh coconut water isn’t a magic bullet but it will help by maintaining blood sugar levels and fluid balance.  Be sure not to waste your time or money on processed coconut water with additives.  Processing, as with all things, reduces nature’s goodness and the extra sugar along with preservatives found in major store-bought brands will not ease your hangover.

When it is needed, I turn to ibuprofen for its anti-inflammatory action.  Sometimes it is unclear if the dance moves or the alcohol cause more pain in the morning.  Cheers to friends who don’t post pictures!



Purple is Better | Pick the Purple Version of your Favorite Veggies

August 4, 2013

purple basil 671x1024 Purple is Better | Pick the Purple Version of your Favorite Veggies


I try to go to the farmer’s market as often as I can and while I’m there I stick to a general rule:  BUY PURPLE.  First, I walk through the market on a scouting mission and then I go back for a second loop to buy the purple variety of everything on my list.


PICT3798 cropped 284x300 Purple is Better | Pick the Purple Version of your Favorite Veggies

All this purple kale for $3!

Purple vegetables contain ANTHOCYANINS which are the most potent type of phytonutrients.  They have anti-inflammatory and anti-carcinogenic effects that reduce the risk of heart disease, cancer and diabetes.  So why would you eat regular vegetables when there are purple varieties available to help you live longer?

PICT3768 300x225 Purple is Better | Pick the Purple Version of your Favorite Veggies

When I need comfort food I have purple potatoes with salt, garlic and olive oil. It’s not carbs and fat–it’s fighting disease!

I usually shop at the Union Square Farmer’s Market in NYC.  Hope to see you there!

2010 03 24 14.26.00 150x150 Purple is Better | Pick the Purple Version of your Favorite Veggies

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Best Tall Nursing Scrubs | UniformedScrubs.com

August 2, 2013

uniformed scrubs 300x124 Best Tall Nursing Scrubs | UniformedScrubs.comWomen with model-like proportions are the minority in general and even more so in the nursing profession.  I’m 5’9″ and 125 pounds and I can assure you that the scrubs industry doesn’t cater to the minority–it is hard to find fitted tall nursing scrubs.   Wide-legged, high waters are not my style but I had to wear them until Dickies offered tall sizes.  But even then, after I washed and dried them a few times they became bell-bottom high waters which were probably worse.

Finally I have found the holy grail of tall fitted scrub pants and the website to buy them!  The manager at UniformedScrubs.com helped me to order these on their website:  Dickies EDS  Back Elastic Cargo Pant #854206T in size small and the matching size small top #84755.

I have washed and dried the scrubs on high heat and they don’t shrink.  In fact, for taller women it is worth noting that I can wear a 3″ clog with an inch in pant length to spare.  These scrub pants were made for models and I think they look great.

The top is also nice because it is long (there is no size tall top but the regular small falls to my hips).  I can reach above my head without exposing the waist of the scrub pants.  There is no breast pocket which inevitably spills when bending over.  Two lower front pockets are what I like.   There are also two deep pockets in the scrub pants with a cargo pocket on the right leg.

Again, the manager was very nice and helpful to me.  Call or email the company with questions because they might be able to solve a problem for you like they did for me.  Happy shopping!

Keywords:  Nurse Scrubs, Dickies Scrub Set 


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HPV Vaccine Reduces Throat Cancer | 93% Effective

July 22, 2013

nursegail needle HPV Vaccine Reduces Throat Cancer | 93% EffectiveI was so excited when Michael Douglas recently broke the silence about HPV and its connection with throat cancer that I wrote, not just one, but two blog posts about it.  You could say I was pretty fired up.

Last Friday, HealthDay.com published an article about a new study that suggests the HPV vaccine dramatically reduces the incidence of throat cancer.

Highlights from the article:

  • Nearly 42,000 Americans will be diagnosed with oral and throat cancer in 2013, and more than 8,000 people will die from these conditions.
  • Oral cancer is much more prevalent among men than in women.
  • Boys, too, should be vaccinated to protect them from oral cancers.
  • The HPV vaccine was 93 percent effective in preventing throat cancer.

Here is the link.  Enjoy.

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New Money Available for Holocaust Survivor Nursing Care

July 18, 2013

Holocaust Tattoo 21 300x90 New Money Available for Holocaust Survivor Nursing CareLiving and working in New York City I have the privilege to care for some of the world’s most special people–Holocaust survivors.  I am honored to have shared many hours providing bedside care and creating bonds with this unique patient population.

In May of this year, the German Finance Ministry met with the Conference on Jewish Material Claims Against Germany [AKA the Claims Conference] in Israel to discuss further restitution for Holocaust survivors.  As a result, Germany is to provide an additional $800 million in home care to Holocaust victims between now and 2017.

According to the Jewish Philanthropy website:

Currently, the Claims Conference is supporting homecare for 56,000 Holocaust victims around the world. Based on the organization’s assessments, the need has not yet peaked, as all the survivors who remain alive are increasingly elderly, with many growing more frail and vulnerable. The Claims Conference has worked with the German Ministry of Finance to provide comprehensive data regarding the current and projected needs of Nazi victims. In addition to the 56,000 Nazi victims who are receiving Claims Conference-funded homecare, there are an additional 90,000 Holocaust survivors worldwide who receive other welfare services such as food, medicine, socialization programs and transportation from the Claims Conference.

The Claims Conference provides funding to local agencies that provide Holocaust survivor nursing care.  To find an agency in your area that is funded by the Claims Conference, visit their Help Centers Map.  There is also a page on the website to learn if someone you know is eligible for compensation along with a frequently asked questions page.  If you are fortunate enough to know or care for a Holocaust survivor, please pass along this direct contact information:

The Conference on Jewish Material Claims Against Germany
1359 Broadway, Room 2000
New York, NY 10018



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Teamwork Prevails Over Meningitis Outbreak in NYC | No New Cases

July 17, 2013

IMG 20130518 155244 225x300 Teamwork Prevails Over Meningitis Outbreak in NYC | No New Cases

NY Daily News, Saturday, May 18, 2013

The New York City Department of Health and Hygiene issued a press release on March 6 stating, “Four new cases of meningitis among men who have sex with men have been reported in 2013.  Three of the last five cases have been fatal.”  At the time of the release, 22 cases had been diagnosed since the first one in August 2010 resulting in a total of 7 deaths.  The word epidemic has been used frequently in the media to describe the meningitis outbreak in NYC.

However, between you and me, this new strain of bacterial meningitis may have reached “epidemic” proportions because healthcare workers were unable to identify the symptoms, treat it quickly and report data to appropriate agencies.  The Physician Health Alert (issued by Thomas Farley, M.D., M.P.H., the Commissioner of the New York City Department of Health and Hygiene, for health care providers) on March 6, 2013 stated:

In three of the last four cases, providers did not report cases promptly to the Department of Health and Mental Hygiene (DOHMH). In two cases, providers waited until the diagnosis was confirmed by positive culture, which occurred 48 hours or longer after specimen collection. In the third case, providers did not initially report the case, because cultures were negative; the suspected case was eventually reported 10 days after admission, and DOHMH confirmed the diagnosis by PCR testing the following day.

The media has done a great job spreading the word without throwing health care workers under the bus.  At-risk groups have been made aware and provided vaccination information while health care workers were given a meningitis refresher and put on high alert.

On June 30th, New York City celebrated the annual Gay Pride Parade which is one of the nation’s largest gatherings of gay men.  Thanks to the media, health care professionals, and responsible members of the community, there have been no new cases or deaths reported.  GMHC (stands for Gay Men’s Health Crisis) also notes that NYC Council Speaker Christine Quinn’s efforts to increase the number of people vaccinated has been instrumental in reducing infection.

Vaccines are currently being given at the GMHC Center on 224 West 29th Street between 7th/8th Avenues (map).   To receive a free vaccination, registration in advance is required either in person at GMHC’s Main Office on 446 West 33rd Street (7th Floor) between 9th/10th Avenues (map), by calling (212) 367-1420, or by e-mailing kalyanis@gmhc.org .

meningitisdocs 300x225 Teamwork Prevails Over Meningitis Outbreak in NYC | No New Cases

Dr. Daskalakis & Dr. Sinelli coordinate the free vaccine clinics at GMHC. Over 700 vaccines have been given.

But act fast if you want one!  According to a representative at the GMHC clinic, the NYC Department of Health and Hygiene is calling a provider meeting to discuss discontinuing mass vaccinations.  Bravo teamwork!  Epidemic squashed!




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Life with Jess | Fellow Nurse Blogger Shout Out

July 16, 2013

Life with Jess 300x197 Life with Jess | Fellow Nurse Blogger Shout Out

Of course Nurse Gail is the best nurse blogger out there, but just in case you want some variety, check out LIFE WITH JESS.  Jess is a relatively new nurse who graduated from the NYU College of Nursing in May 2012.  She offers a light and fresh perspective and sprinkles in some of her personal observations.  I enjoyed her post on poop donation.    Both Jess and I will be working on our adult nurse practitioner graduate degrees at NYU in the fall.



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What is Travel Nursing? | Nurse Gail via Quora.com

July 15, 2013


Quora 300x145 What is Travel Nursing? | Nurse Gail via Quora.com

I love to share my knowledge of nursing and I’ve been a travel nurse for over 6 years.  I felt compelled to post an answer on Quora when I saw the question, “What is travel nursing?”

Gail Ingram BSN-RN responds:

Hospitals look to fill positions with travel nurses on units with high turn-over.  Retention issues are often caused by poor or no management and working conditions can be tough.  Depending on the unit’s unique nursing culture and circumstances, support can be limited and it is imperative for travel nurses to be highly competent and proficient in their clinical skill set.

After a couple of years of solid acute bedside experience, travel nursing is a great way for newer nurses to increase their income.  It allows them the opportunity to work outside of nursing unions which base pay only on years of experience and not nursing excellence.  But once a nurse has been in the field for about 8 years, the pay rate of unionized nurses tends to match that of a travel nurse.

However there are also tax advantages for travel nurses.  Travel nurses are paid a low hourly wage ($25-$35) which keeps them in a low tax bracket. The bulk of their income is in the form of a furnished corporate apartment near the hospital.  Although when the nurse finds his/her own housing, a housing stipend can be negotiated.  Housing stipends are tax-free reimbursements (AKA undocumented income) and are not declared on income tax.  Housing stipends range from $1800 to $3000/month in addition to $25-$35 per hour depending on the city/state/institution of employment.

Some disadvantages to being in a lower tax bracket and receiving tax-free stipends (undocumented income) occur when applying for credit, buying a car, or attempting to rent an apartment which requires a certain W-2 income.  A letter from the travel nurse agency will usually suffice but some landlords and banks won’t accept anything but official tax documents.

To find work, travel nurses can utilize several agencies at the same time and choose between a multitude of job offers.  There are national agencies (Cross Country, American Mobile, etc.) and local agencies (Seattle—HRN, New York—Access, Prime, etc.).  Local agencies usually offer higher pay rates but may skimp on the health insurance.

An ICU trained nurse has the largest selection of travel assignments available to them.  They can work contracts in an ICU, PACU, IMC, PCU, tele-stepdown, tele/med-surg or other assignments like clinic or occupational health nursing depending on their previous experience and comfort level.  A med/surg nurse can only be assigned med/surg or clinic/occupational health positions.  It is very hard to change specialties while travel nursing.

When signing up with a new agency, travel nurses must pass tests (pharmacology, cardiac arrhythmias, etc.) and fill out endless skills checklists.  Upon arriving at the hospital, the institution will require additional testing and completion of JCAHO compliance paperwork.  A classroom orientation is scheduled which includes the hospital’s philosophy, equipment usage, and computer charting.  Travel nurses receive two days of orientation on their unit (learning the location of fire extinguishers, finding the medication, supply, and dirty utility rooms, practice charting assessments) and are expected to function independently by their third shift.

From personal experience, pay rates went down during the recession but are on the rise again.  In December 2008 to March 2009 I was paid $30/hour (taxed) and a $3000/month housing stipend (un-taxed) to work on a Progressive Care Unit just outside of Seattle.  This was with a national agency and included health insurance.  I worked several summers on a telemetry unit in the Hamptons and made $40 to $44/hour with shared housing provided (no health insurance).  The current rate of pay in Manhattan varies by agency, institution and a nurse’s negotiation power.  With no health insurance, $30/hour and $3000/month stipend is on par for local agencies.  This works out to approximately $50/hour after it is all broken down.  Compared to the cost of living, travel nurses make more working in other markets.

[Here is a post I wrote about the first travel assignment I took in NYC:   New York City Nursing | East Coast vs. West Coast]

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Horoscope vs. Menstrual Phases | Alisa Vitti, FLO Living Center

July 14, 2013

5390988459 538f77bf29 300x132 Horoscope vs. Menstrual Phases | Alisa Vitti, FLO Living Center

I’m a Pisces.

Ladies, we can stop reading horoscopes for guidance and start watching our bodies instead.  According to Alisa Vitti, founder and CEO of FLO Living Center  in NYC, we can predict the best days to have difficult conversations with our partners or when to repaint the office by closely observing the phases of our menstrual cycles.  Here’s the breakdown:


  • Follicular Phase (Day 1-13):   Most creative time of the month.


  • Ovulation Phase (Day 12-16):   Communication skills are heightened.


  • Luteal Phase (Day 15-28):   Detail-oriented tasks are easy.


  • Menstruation (Day 1-5):   Self-evaluation and gut feelings are clear.


Self-evaluation and gut feelings during the menstrual phase trump the follicular phase’s creativity during the overlap on days 1-5.

For more information about the four phases of the menstrual cycle, visit Menstrupedia.   Physiology of each phase is explained in greater detail.

To keep track of your periods, try Period Tracker for Android ($1.99) or Period Tracker Lite (free) or Period Tracker Deluxe ($1.99)  for iPhone.

If you don’t have periods, check out the New York Post Daily Horoscope.

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There Is No Comprehensive Test For HPV Status | HPV Ignorance

June 4, 2013

Michael and Diandra Douglas There Is No Comprehensive Test For HPV Status | HPV Ignorance

Michael Douglas’ ex-wife wants you to know that she does not have HPV.  I want you to know that kind of ignorant statement is why fear and stigma persist regarding sexual health.  Here is why Diandra’s declaration is bunk:

  1. There is no test to identify HPV in the mouth/throat or rectum.  HPV can come and go (and be passed to others) between cervical testing gaps.
  2. There is no test to determine if someone has previously been infected with and cleared the virus.
  3. There are no signs or symptoms in 90% of people with HPV infections.
  4. Diandra (Luker) Douglas was 19 when she married Michael who was 32.  Even if their marriage was free from infidelity, the CDC reports “HPV is so common that nearly all sexually-active men and women get it at some point in their lives. This is true even for people who only have sex with one person in their lifetime.”
  5. Diandra filed for divorce in 1997.  13 years later Michael announced his cancer diagnosis.  It takes approximately 10-15 years for an HPV infection to result in cancer.
  6. There are too many variables for Diandra to declare never having HPV.

Please don’t make the same mistake Diandra made.  To deny having had HPV shows a profound lack of education and awareness.  Learn more about HPV here:  Michael Douglas HPV | Oral Sex | Oropharyngeal Cancer and Girl Talk with Nurse Gail | HPV and Pap Guidelines | Cervical Cancer.


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Michael Douglas HPV | Oral Sex | Oropharyngeal Cancer

June 4, 2013

 michael douglas HPV 220x300 Michael Douglas HPV | Oral Sex | Oropharyngeal Cancer

I am thrilled that Michael Douglas has brought HPV into the spotlight.  The medical community has known for decades that HPV infections cause throat and mouth cancer and have been quietly collecting data and watching trends.  Finally someone with enough clout and courage has given it some attention and brought it to the mainstream.

What is HPV?  HPV [human papillomavirus] is a virus that is transmitted through sex (oral, genital and anal).  Just like a virus that causes a cold, HPV is generally fought off by a strong immune system and clears the body on its own.  In some cases, HPV hangs on and can cause cellular changes in the tissue that it infects (example: cervix in women, mouth or throat in men or women, or rectum in men or women).  The cellular changes can lead to cancer.

Who gets HPV?  To be honest, most people having unprotected sex are probably passing around at least one strain of HPV with no signs or symptoms.  The CDC backs me up here and goes even further to say, “This is true even for people who only have sex with one person in their lifetime.”  79 million Americans are infected with HPV and there are 14 million new cases each year.  But remember there are many, many strains of HPV and only a couple of them are linked to cancer.  Also, the body generally clears HPV on its own and the risk of contracting a cancer-linked strain is rare—especially if you are healthy, don’t smoke or drink, aren’t overly stressed, or are not immunocompromised (with chronic illness, on corticosteroids, or HIV+).

How do I avoid HPV?  Kids are getting vaccinated at ages 11 and 12 with a series of two shots.  Men and women can get vaccinated up to age 26**.  But what about sexually active men and women over 26?  As a nurse I will tell them to prevent contact with genital fluids during oral, genital or anal sex.  As a nurse I will also tell them to use condoms and dental dams during sexual contact at all times.  But when I’m not acting as a clinician, I understand that for many people this is unrealistic advice.

For those who chose not to use condoms or dental dams, staying healthy is the key.  Exercise, cut out processed foods and take a Complex-B vitamin to enhance the immune system.  Limit stress in your life;  do yoga, meditate, spend time in nature.  Be as physically strong and mentally healthy as possible.  Don’t get run down and sleep regularly.  Stop smoking and limit alcohol intake.

Is there a test for HPV?  HPV tests are only available for women to screen for cervical cancer.  However a woman can have an unknown HPV infection because it can be acquired and clear on its own between tests.  There is no approved test to find HPV in the mouth, throat or rectum.

To learn more about HPV, cervical cancer and Pap guidelines see my previous blog:  GIRL TALK WITH NURSE GAIL 

Below is a snippet of information on Orophryngeal (mouth/throat) cancer caused by HPV.


CBSNews.com reported on 6/3/13:  “The 2013 “Annual Report to the Nation on the Status of Cancer” found about 13,000 new cases of oropharyngeal in both men and women linked to HPV in 2009 (the last year of available data), more than 10,500 of which were in men. More than 60 percent of oropharyngeal cancers are caused by HPV, according to the National Cancer Institute, which was an author in the report.

From 2000 to 2009, incidence rates increased for HPV-associated cancer of the oropharynx among white men and women, the report also found.

Previous research found HPV fueled a 28 percent rise in oropharyngeal cancer cases since 1988, amounting for an additional 10,000 U.S. cases each year.”

Dr. Eric Genden, professor and chair of otolaryngology at Icahn School of Medicine at Mt. Sinai Hospital in New York City, told CBSNews.com, “There’s an epidemic of HPV-related throat cancers.”  Genden said HPV-related throat cancers are now more common in men than cervical cancer — which is caused by the same virus — in women. These cancers are also more commonly found in younger populations, adults between ages 40 and 65, a group typically younger than those affected by smoking-related throat cancers.

People who are developing throat cancer now likely had gotten HPV more than 10 or 15 years earlier, Genden pointed out.”


*We started calling them STIs [Sexually Transmitted Infections] decades ago in an attempt to decrease the stigma associated with sexually transmitted “disease.”

**Vaccination stops at age 26 because testing for the vaccine has not been conducted on older age groups.




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Nursing School Essay | University of Texas School of Nursing

May 1, 2013

love letters best 1024x728 Nursing School Essay | University of Texas School of Nursing


I was rifling through some old love letters when I found my application essay to the University of Texas School of Nursing ( UTSON ).  I think posting it here will give current nursing students an example of an essay that undergraduate admission panels are looking for.  Personally, it is interesting for me to reflect on my relationship with nursing–my initial hopes and dreams, the harsh reality, and my commitment and loyalty to a challenging profession.  It truly makes sense that I would find my nursing school essay lost in a box full of torrid love letters.



Nursing is a Way of Life

When contemplating a career choice, psychologists often suggest revisiting the activities that one took pleasure in as a child.  Unwittingly, children engross themselves wholeheartedly in activities that bring them the greatest delight and contentment.  As adults, those qualities equate to stimulation and satisfaction–two elements necessary to sustain a successful career.  In my youth, I enjoyed playing “schoolteacher,” more importantly however, from the ages of six to fifteen, I tended to the needs of my chronically ill grandmother.  During this period of time, the idea of playing nurse never crossed my mind; rather, care giving was a way of life.

The magnitude of influence that caring for my grandmother had in shaping my career decisions is immense;  although it was unknown to me for quite some time.  A distinct correlation was made early in my employment as a Clinical Assistant at Seton Medical Center.  While holding the hand of a patient, as he passed through the stages of a stroke, I recognized the tone and delivery of my words as that which I used when comforting my grandmother during a similar event.  Amidst the chaos of the medical team, I became overwhelmed with a sense of complete wholeness that I had not felt before.  I become acutely aware that my childhood care giving role had provided me with a unique ability to invest myself fully into the health and wellbeing of others, in the very same way that I had done with my grandmother.

In addition to caring for patients, I also maintain an affinity for teaching.  The delight I found while playing “schoolteacher” as a child derived from the act of sharing new information with imaginary students.  My thirst for knowledge and the desire to share is no less prevalent now as it was then, however my knowledge is based in scientific method, holistic healthcare promotion and nursing theory.

Nursing synthesizes care giving and teaching in a way that utilizes my natural strengths while benefiting others.  The intrinsic value of caring for my grandmother and my desire to share knowledge provide me with undaunted motivation.  My core professional values embody the need for empathy and ethical conduct while holistic treatment is imperative in effective healing.

Unfortunately, the current state of healthcare does not allow maximum nurturing to individual patients in hospital settings.  Attaining a Bachelor’s of Science in Nursing degree allows me to consult, collaborate and coordinate healthcare policy on an administrative level.  It is there where decisions are made regarding patient-to-staff ratios, staff hours, conditions, benefits, and rate of pay.  If one is to change the environment of nursing in a clinical setting, it must be done by a leader in a policy making position.  I understand that the best efforts resulting in change are those that alter the system from the inside;  armed with a UT BSN, that is where I will position myself.

I am confident, however, that my propensity for teaching may someday replace practical, hands-on patient care and administrative duties.  The lack of qualified professors in the area of nursing will perpetuate the absence of university degreed healthcare professionals in the industry.  Without degreed professionals, advancement in many areas of nursing will suffer.  With love of nursing as my greatest tool, I hope to inspire students to engage in its field of study.

Advancing the field of nursing is not only a professional success, but a personal success as well.  Nursing is not a conscious choice that was cultivated by a college advisor or a team of psychologists;  it is who I am–it is my past, present and future.  My natural inclination lead me to the field of nursing where I wholly and unwittingly applied myself and found immeasurable stimulation and satisfaction.  For me, nursing is not merely an opportunity for a sustaining career, it is who I am;  care giving has always been and will continue to be a way of life.



Here are a couple of other posts that you might enjoy:  Letter to a UT Nursing Student on how to ThriveWhere you go to Nursing School Matters and Foreign Educated Nurses (learn why they are getting all the jobs and US nursing grads aren’t).

My most popular posts are Bullying in Nursing and New York City Nurses Don’t Make as Much as You Think.




BE NICE TO THE NURSE | Verbal Aggression is cause of Nursing Errors

April 10, 2013

stressed nurse 300x199 BE NICE TO THE NURSE | Verbal Aggression is cause of Nursing Errors

I was recently at the hospital preparing injections for a patient when a belligerent family member interrupted me in the hallway.  He berated me about an overflowing trash can in one of the rooms and told me that I was a lazy nurse for not having emptied it.  His pushy, condescending and sarcastic demeanor elicited a fight or flight response but in the moment I had to squelch my instinct to react and decide which was most important—calming the visitor’s displaced aggression, dumping the garbage, or preparing my sick patient’s medications on time.  Unfortunately my brain stopped working altogether and my focus was drawn to the shaking in my hands.

Sadly this happens all the time in the hospital.  Nurses are constantly bombarded by aggressive patients, family members, doctors, and coworkers who interrupt the process of their work. Day in and day out, nurses are the recipients of unacceptable behavior and hostility while attempting to complete tasks that require their full attention.

A recent study published in the Journal of Applied Psychology [September 2012, When Customers Exhibit Verbal Aggression, Employees Pay Cognitive Costs by A. Rafaeli, et al*] explores what happens to a customer service employee’s cognitive functioning when they encounter rude behavior from customers.  Since nurses are the ultimate customer service employees, this research is appropriate for both waiters in restaurants and nurses in the hospital.

The study shows even minor verbal aggression can negatively affect an employee’s performance.  Under hostile circumstances, the employee experiences memory and perception problems.  He or she feels upset, contemplates what went wrong, and dwells on the encounter.  These brain functions distract an employee from the task at hand which ultimately leads to errors.

Some errors are more serious than others.  When a waitress makes an error at a restaurant, the result is frustration.  If a nurse makes a mistake at the hospital, a patient might be physically harmed or worse.  In 1999 the Institute of Medicine published “To Err is Human”  which concluded that between 48,000 to 98,000 patients die each year as a result of preventable medical errors.  In 2004 HealthGrades conducted a study  that showed an average of 195,000 patients died between the years of 2000 and 2002 because of potentially preventable in-hospital medical errors.  A report released in 2010 by the Office of the Inspector General at the U.S. Department of Health and Human Services found that in-patient medical errors contributed to the deaths of 180,000 patients every year.  A New England Journal of Medicine study published in 2010 showed approximately 18% of hospital patients are injured during the course of their stay and that many of those incidences are life-threatening, or even fatal.  A study published in 2011 showed that medical errors occur in one-third of hospital admissions which is 10 times more than previously estimated.

Hospitals have implemented countless strategies for reducing errors that are sound in theory but are not significantly reducing the number of mistakes which continue to occur.  Rafaeli et al offer a reason for this.  Protocols simply will not work when a nurse is frazzled by workplace hostility or verbal aggression.  Nurses become distracted and their cognition and perception are altered after an encounter with a rude patient, family member or doctor.

Because nurses make errors when they encounter aggression, there should be protocols that protect nurses from such behaviors.  Patient care liaisons should be on the front lines fielding patient complaints and buffering family member freak outs.  Doctors should be reprimanded when they belittle nurses and managers should be active in creating a healthy milieu for staff.  Patients and family members also need to be educated that their bad behavior can have serious consequences when directed at a nurse.  Aggressive behavior on their part opens the door to medication mistakes and other nursing errors.

So please, BE NICE TO THE NURSE.   In doing so, you might prevent a medical error and save a patient’s life.




*Rafaeli, A., Erez, A., Ravid, S., Derfler-Rozin, R., Treister, D.E., & Scheyer, R. (2012). When customers exhibit verbal aggression, employees pay cognitive costs. Journal of Applied Psychology, 97(5), 931-950.



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Joseph Conte | Travel Nurse Tax . com | BEST accountant for nurses

January 24, 2013

joe conte family santa 300x199 Joseph Conte | Travel Nurse Tax . com | BEST accountant for nurses

Joe Conte & his beautiful family. His wife is an RN!

Joseph Conte is the best CPA that I have ever worked with or known for that matter.  Not only does he prepare my taxes every year but he also set up my retirement portfolio, gives me sound business advice, reviews contracts, recommended both a mentor and a bookkeeper, and is an all around nice guy with a beautiful family.

Joe’s contact information was initially given to me by my recruiter at Cross Country TravCorps.  I had always done my own taxes as a staff nurse but travel nurse income tax preparation is complicated.  I was unsure which special forms to fill out, what to deduct, and if I had to pay New York City tax in addition to Washington State tax (my tax home state at the time).

Joe has over twelve years of accounting experience with six of those years at some of the world’s largest and most respected accounting firms.  When looking to leave the world of Big 4 accounting, he partnered with a travel nurse and started TravelNurseTax.com.  Joe specializes in travel nurse tax preparation as well as tax prep for other medical professionals (doctors, techs, non-traveling staff nurses).  He is licensed in New York, based in Florida and approved by the IRS to serve anyone in the U.S.A.  Geography is not an issue as Joe can assist you via phone and email.

In addition, Joe is also married to a nurse!  Because of this, Joe has genuine empathy and understanding of nurses and health care professionals.  He also likes to get to know his clients personally so that he can best meet their individual needs.

Do not hesitate to call Joe if you are in some kind of tax crisis.  I recommended Joe to a fellow traveler who hadn’t paid his taxes in over three years.  Joe worked wonders for him.  Hopefully that isn’t your situation, but if so, Joe will alleviate your anxiety and talk you through the entire process with ease.

Joes rates are affordable and there are no hidden fees.  I can’t thank him enough for his exceptional customer service and the extra phone time he has spent advising me on business and investing.  He won’t take any extra money from me so I hope that this post will bring him some lovely new clients.

Please call Joe at 800-672-0364 or email joseph@travelnursetax.com to discuss your tax needs. 

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Where You Go to Nursing School Matters | University of Texas in Austin

December 5, 2012

UTSON Badge 1024x795 Where You Go to Nursing School Matters | University of Texas in Austin

I am frequently asked, “Does it matter where I graduate from nursing school?”  My answer is always, “Yes!”  I graduated cum laude from the University of Texas School of Nursing and it has positively affected my nursing career in profound ways.

First, I was educated by happy professors in a sunny environment perfect for learning.  Both transplanted faculty and out-of-state students embrace the local culture while living in beautiful Austin, Texas.  Moving at a southern pace, educators take their time to ensure that students fully understand the material and perform clinical tasks using best practice methods.  Because of their example, I treat my patients with southern hospitality;  I smile, take the time to understand their needs, make them comfortable, and answer any questions they may have.

In addition, the goal of the University of Texas is to create leaders in nursing who will ultimately enhance the profession.  There is a big difference between a nurse who is taught to lead and one who is taught clinical tasks.  UT graduates can do both.

Furthermore, my alma mater looks great on a resume.  It is easily recognized and many people know that its nursing program is always ranked among the top ten in the United States.  It is well known that UT is dedicated to academic research and when I graduated, the National Institutes for Health [NIH] gave the University of Texas at Austin the highest ranking for a nursing school not linked to a health science center or medical school.  Currently, UT is ranked in the top 25 of the world’s elite universities in the Times Higher Education World University Rankings, which is considered to be the most authoritative assessments of universities.

It has been seven years since I graduated and the University is still supportive of me and my career.  For example, the UT School of Nursing featured my Hurricane Sandy story on their website.   A less reputable school with fewer students could not promote NurseGail.com in the same way.

When I graduated from UT, I was saddled with over $45,000 of debt and like anyone who spends that kind of money, I was a critical consumer with high expectations.  Looking back, I am proud to have made the choice to attend the University of Texas and when I make my monthly student loan payments, I do so with satisfaction.  I am hopeful for the day when I can begin to give back.



Additional reading:

Lack of Education Among NYC Nurses





2012 Gallup Poll: Nurses are Most Honest and Ethical AGAIN

December 5, 2012

ethics 2012 Gallup Poll: Nurses are Most Honest and Ethical AGAIN

Since 1976 Gallup has been surveying Americans to rank professionals based on honesty and ethical standards.  The nursing profession was added to the poll in 1999 and has ranked the highest in 13 out of 14 annual surveys.  The only exception came in 2001 when firefighters ranked higher following the events of 9/11.  Pharmacists have generally ranked second and medical doctors third.

I am proud to be a nurse and I am pleased that the nursing profession is perceived by the public to be the most trustworthy.  Recent focus on poor hospital customer service scores, little positive mention of nurses or nursing care, and patients excessively gushing over the doctors who disrespect us behind closed doors have caused me to forget that the general public actually values us.

While I need reminding, it doesn’t surprise me that Americans consistently rank nurses the most honest with the highest ethical standards of any other profession.  We don’t collect kick-backs from pharmaceutical companies or government agencies nor do we set our pay scale for private practice or use billing codes and charge on a fee-for-service basis.  We are paid less than most other professions requiring advanced education.

With managers, doctors, family members, and patients continuously challenging nurses, I am happy for the annual reminder by Gallup that we are highly thought of.  The Gallup poll is like getting a glowing comment card from, not just one appreciative patient, but from all of America.


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Hurricane Sandy Volunteer Nurse | Rockaway Beach | Belle Harbor, NY

November 26, 2012


Hurricane Sandy Volunteer Nurse1 1024x764 Hurricane Sandy Volunteer Nurse | Rockaway Beach | Belle Harbor, NY

Volunteer nurse Gail Ingram and nurse Michelle Archer provide post-Hurricane Sandy care in the Rockaways.


Volunteering in the Rockaways renewed my passion for nursing.  I was able to help others in need who truly appreciated my time and skill.  Of course it wasn’t my contribution alone that made the experience rewarding;  it was hundreds of volunteers working together.

It required a team effort just getting to the ravaged beaches of Belle Harbor.   Bridge closures, subway repairs and gas rations created overwhelming obstacles for volunteers.  Gregory Solometo and Justin Kohn of Alliance Nursing arranged transportation for me and Greg navigated the chaos until we found a medical station where I could be of use.

Saint Francis parish school and parking lot had become command central for the community near Beach 129th Street.  Each neighborhood had designated locations as hubs for residents to access supply donations, hot food and medical attention.  Volunteers unloaded trucks filled with cases of bleach for cleaning water-damaged homes and batches of used clothes were being sorted in the school’s cafeteria.  In the church parking lot a huge warming tent heated by generators held endless chafing trays full of homemade turkey meatballs, lasagna, and lentil soup, as well as perfectly decorated cupcakes and hot coffee for dessert.  There was a smaller tent staffed with therapists for residents to grieve their losses.  A man on the steps of the school directed confused and disoriented people to where they needed to be.  He directed me to follow the hand-made Red Cross signs to the urgent care medical clinic on the second floor of the school.

When I got to the school’s infirmary there was no Red Cross presence and there were no FEMA volunteers.  There were only boxes of medical supplies and a package of promotional airline-style blankets garnished with the Red Cross logo.  The presence of branded goods gave the illusion that the clinic was staffed with official disaster relief Red Cross volunteers but that was not the case.

Behind the scenes was a fly-by-the-seat-of-your-pants clinic run by an amazing doctor who lives and practices near the affected area.  Dr. John Meringolo was a multi-tasking superhero coordinating medication deliveries, seeing patients, and directing volunteers while putting smiles on everyone’s faces.  Dr. George Sandor also volunteered his valuable time and was instrumental in treating patients.  He performed our first “surgery” of the day for a man who had developed an infected toe after slogging around in sewage-filled floodwaters while gutting his basement.

Also volunteering was Michelle Archer who is a travel nurse from upstate New York currently working at Columbia Medical Center in the City.  She noted that many visitors to the clinic needed blood sugar checks after their diabetes equipment and supplies had been damaged or destroyed in the flood.  She quickly became an expert with in-home glucometers and instructed patients in their use.  The clinic was stocked with replacement meters that patients could take with them.

Local pharmacies were without power and, even if they had a generator, computers were down making it impossible to track patient records and insurance information.  Stocks of medication had been destroyed by floodwater and employees were dealing with their own losses and unable to work.  The nearest operational pharmacy to our clinic was 20 blocks away and many of our patients were unable to make the trek.  Dr. John arranged for non-medical volunteers to fill prescriptions at the pharmacy and deliver them to our waiting patients.  It was creative problem solving at its best.

Unfortunately the pharmacy ran out of pre-filled insulin pens and could only provide vials of insulin to customers.  I was happy to teach one of our visitors how to properly draw up and administer insulin with a syringe.  We both laughed when the hardest part of the lesson was getting to an injection site.  After peeling off five layers he said, “My winter clothes were destroyed in the flood.  I’m wearing all of the clothes that I have.”  Looking down at his sweatshirt he smiled and said, “Actually, I don’t even know whose shirt this is!”

Another favorite clinic moment was when a volunteer attempted to help a deaf man whom she could not understand.  She was unsure of his needs and was hoping that someone could facilitate.  I recalled learning the sign language alphabet in third grade (thank you Mrs. Racey at Our Lady of Guadalupe in Seattle, WA), had a deaf neighbor growing up and plenty of experience with medical charades so I gave it my best shot.  I learned that he had no medical issues, had a place to sleep at night and was not interested in staying at a shelter.  His apartment had been destroyed in the flood and he needed help renting a new one right away.  The volunteer then escorted him to the appropriate organization desk for assistance.  I was grateful in my ability to help the two of them communicate with one another.

Later in the day, a high-spirited 87 year old visitor climbed the two flights of stairs to the clinic requesting ibuprofen for her arthritis.  Another senior visitor was undergoing a series of teeth extractions for the process of getting dentures and also requested ibuprofen.  They both asked for only what they needed instead of taking everything they could get and it warmed my heart.  I gave them both bottles of ibuprofen and wish I could have told them what a privilege it was to meet them.

We had a chiropractor and a dentist on-hand who were able to offer their services as well.  The chiropractor treated anyone in need and offered volunteers complimentary alignments. The dentist brought with her dozens of homemade chocolate chip cookies and many non-medical friends who organized the medical supply donations.

Medical donations were essential in the clinic’s success and I am grateful for them.  However, I was curious why there were no official personnel dispatched to diagnose patients and administer the supplies.  By asking around, I learned that the major national disaster relief organizations were focusing on New Jersey.  Because tourism is New Jersey’s second largest source of revenue, it is imperative to restore its beaches as quickly as possible.  If the State of New Jersey goes bankrupt, there could be far-reaching effects on the country’s economic state which will affect all Americans.

Currently, there is no electricity for many residents of Rockaway and Dr. Meringolo warns that cold temperatures and mold will contribute to respiratory infections.  Residents and volunteers will also require tetanus shots as demolition projects continue.  The St. Francis community resource hub has moved to another location on the peninsula and the school is scheduled to be renovated.  The urgent care clinic has closed but a NYC mobile van is parked outside for walk-ups.  Fortunately, private practices and pharmacies are beginning to reopen and provide services.

I feel privileged to have been part of a hands-on, community effort to support fellow New Yorkers in their time of need.  It was a privilege to offer my training and skill to the residents of Rockaway Beach in the aftermath of Hurricane Sandy.   The true spirit of nursing has been renewed within me and I look forward to sharing it with others.


5 Things I Learned as a Hurricane Sandy Volunteer Nurse

November 21, 2012

view from clinic in rockaway 1024x764 5 Things I Learned as a Hurricane Sandy Volunteer Nurse

View from the acute care clinic on Beach 129th Street after Hurricane Sandy in Belle Harbor, NY.


I was a volunteer nurse at a grassroots urgent care clinic in Rockaway Beach during the aftermath of Hurricane Sandy. Here are 5 things that I learned:


1.  The national Hurricane Sandy relief organizations are focused on New Jersey, not New York.

Because tourism is New Jersey’s second largest source of revenue, it is imperative to restore its Atlantic shore as quickly as possible.  If the State of New Jersey goes bankrupt, there could be far reaching effects felt by every American.  If you want to specifically help New Yorkers right now, donate to a local cause.


2.  Pharmacies are closed during disasters.

Rockaway pharmacies were without power and even if they had a generator, their computers were down and unable to track patient records and insurance information.  Stores of medication had been destroyed by flood water and employees were dealing with their own losses while road closures, subway repairs and gas rations made getting to work impossible.  For the rare pharmacies that did remain open, there were no incoming deliveries to replenish bare shelves.


3.  Anesthesiologists are underrated.

Anesthesiologists have long been my favorite specialty of doctors because of their laid back and non-competitive attitudes.  But volunteering at a grass-roots clinic run by an anesthesiologist reminded me how much they know about multiple areas of medicine if not life itself.  They organized volunteers, performed I&Ds, prescribed inhalers, gave vaccinations, delivered coffee, and wiped tears.


4.  Not everyone is a drug seeker.

In my hospital and clinic work, I frequently interact with highly manipulative and belligerent patients who bully me in an attempt to gain access to narcotic pain medication.  In Rockaway, I met several patients who wanted nothing more than a single dose of ibuprofen for pain.  They asked for what they needed and nothing more.  It renewed my faith in humanity.


5.  Hurricane Sandy is far from over.

Electricity is not expected to be restored in the Rockaways until after Christmas.  With cold temperatures and mold from flood damaged homes, respiratory problems are going to plague the community.  Injuries from ambitious DIY homeowners and volunteers taking on construction projects will also continue to rise.


Organic Processed Food is still Processed Food | Marketing Organic Junk

November 20, 2012

organic mac and cheese 149x300 Organic Processed Food is still Processed Food | Marketing Organic Junk

Just because its organic doesn’t mean its good for you.

Slapping “organic” on a box and jacking up the price is a marketing scheme which targets good people who hope to find healthier versions of their favorite processed foods.

Unfortunately, processed foods that are made with organic ingredients are just as devoid of nutrition as processed foods made without organic ingredients.

When our bodies go without adequate nutrition, we experience food cravings or hunger pangs.

Using processed foods to quell hunger doesn’t work because processed foods are high in calories and fat, not nutrition.

Food cravings and hunger pangs continue because our bodies crave nutrition, not calories alone.

Americans are overweight and starving at the same time because we are stuffing ourselves with food that doesn’t nourish or satisfy our bodies.

So put the organic box of reconstitutable whatever back on the shelf and eat something that is the same shape and color as it was when it was picked.

Stop eating pre-packaged processed foods.  Organic or not.  Please.

And do NOT donate this crap to food banks.  People who use food banks need REAL food.  Probably more than you or I do.


Related reading:

Focus on Food Movies

Sodium Lauryl Sulfate – Don’t be a Victim of Marketing



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Nurse Gail is Blogging Strong | WSJ Health Blog not so much

November 17, 2012

blog end 300x158 Nurse Gail is Blogging Strong | WSJ Health Blog not so much

NurseGail.com got more hits today than the Wall Street Journal Health blog, the New York Times Prescriptions blog and the USA Today Healthy Perspective blog combined!

That is, of course, because they no longer exist.  On November 14th, the Wall Street Journal announced that their health blog had flatlined after a five year run and USA Today hasn’t updated their health blog since September.  The New York Times continues to maintain their Well Blog but the Prescriptions blog devoted to the ins and outs of healthcare and healthcare reform has been abandoned.

With the big health blog contenders failing to find longevity, I’d like to reassure my readers that I haven’t put away my pen, or keyboard for that matter.  I have had the extraordinary experience of nursing my grandmother at her time of transition and subsequently dealing with the effects of Hurricane Sandy.  All of which I hope to write about soon so please keep reading.


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New York City Nurses Make Less than You Think | NYC Cost of Living

September 9, 2012

BLOG job offer 300x227 New York City Nurses Make Less than You Think | NYC Cost of Living

Scrubs is a nursing magazine with an on-line blog which recently posted the “Top U.S. States to be a Nurse in 2012” by Linda Lampert.  Linda, using salary data from a 2012 staff survey published by Physician’s Practice, includes New York as one of the top three states to be a nurse.  I agree that the numbers might look good to an outsider, but the reality is that most nurses in New York State work in Manhattan hospitals and compared to the cost of living, nurses don’t make as much money as you think.

I was recently offered a critical care position at a major New York City hospital while I was working as a contract employee.  The hospital is unionized and the salary is non-negotiable.  Here is the breakdown:

.          Base pay:                             $68,812

.          BSN pay:                              $1,600

.          7 years experience:            $2,831.13

.          ———————————————-

.          TOTAL (gross)                       $73,243.13 per year (equivalent to $37.56 per hour)

In order to be approved for an apartment in Manhattan, rental applicants must provide tax returns that indicate their gross income is FORTY times the cost of one month’s rent.  According to a June 2012 Bloomberg report, the median cost for a one bedroom apartment in Manhattan is $3100/month.  In a March 2012 article by the NY Post, $54.46 per square foot (annually) is average.  MNS reports that the current mean rental rate of a one bedroom apartment (no doorman, no elevator) is $2986/month.  NY Habitat reports the range for a midtown one bedroom (no doorman, no elevator) is between $2200-$3000/month.  From personal experience, a one bedroom for $2500 (no doorman, no elevator) is reasonable.

Let’s do the math:

.          $2500/month X 40 = $100,000 minimum annual income.  Application DENIED.

.          $1825/month X 40 = $73,000 minimum annual income.  Application APPROVED.

After a $1825 broker’s fee and a $1825 deposit, $1825 per month will afford a tiny 402 square foot studio (no doorman, no elevator) in Manhattan.  Now let’s consider all annual expenses combined using conservative estimates.

.          Rent                      $21,600

.          Utilities                $960  (electric)

.          Groceries             $7000

.          Transportation     $3648 ($200/month taxi fare, $104/month unlimited MetroCard)

.          Cell Phone            $1200 (Verizon smart phone service)

.          Laundry                 $850

.          ——————————

.          TOTAL                   $35,258

Remember, New York City residents pay some of the highest city, state and federal taxes in the country.  On average, one-third of gross pay will be deducted.

.          $73,243.13 – 1/3 ($24,170.23) = $49,072.90 annual net income

.          $49,072.90 annual net income – $35,258 basic living expenses = $13,814.90 remaining

The remaining $13,814.90 must be used to make student loan or credit card payments, join a gym, budget entertainment or hobbies, purchase household incidentals (extra roach spray and mouse traps), pay for medical costs, buy uniforms, clothes/shoes, gifts, pets, and possibly a vacation.  One word:  Impossible.

According to the Scrubs article, the magazine conducted a poll to rate nurse’s happiness levels.  Only 4% of local respondents indicated that they were happy or extremely happy.  Lynda Lampert writes, “I think we can all guess that this number is a low ball figure, right? I mean, really, what self-respecting New Yorker admits to being ‘extremely happy’?”

I can assure you that 4% is not “a low ball figure.”  The lives of New York City hospital nurses are compromised by the high cost of living.  Living with roommates, moving to an outer borough, and getting a second job can alleviate financial stress but will make for a stressful life.  Seeking employment at a non-union hospital (New York Presbyterian Cornell, Hospital for Special Surgery, Memorial Sloan Kettering) can allow some negotiation in salary.  But in general, nurses choosing to live and work in Manhattan must truly enjoy New Yorkers, the city and nursing because there is nothing to love about the pay.


For additional reading:

New York City Nurses Don’t Get Paid to be Nice

Welcome to New York

Internationally Educated Nurses in New York

Lack of Education Among New York City Nurses





Tweet to Teach | Social Media | Nurses on Twitter

August 19, 2012

Twitter Image1 150x150 Tweet to Teach | Social Media | Nurses on Twitter

Initially I began using Twitter as a professional networking medium and I shared links to my favorite health related articles, news clips, and educational videos.  By posting useful links to current research, I created a personal on-line library of potential teaching tools.

When educating my savvy, free-thinking NYC patients, I no longer say, “I read something somewhere,” or “I think I saw it on the news a while back.”  I am able to instantly access links on my Twitter feed that support my teaching.  My patients are grateful for the information and are more likely to be compliant.

Visit my public Twitter feed:  @nurseGAILINGRAM





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Circumcision–A New Perspective Part II

August 15, 2012

nursinghome 150x150 Circumcision  A New Perspective Part II

In response to a previous post, “Circumcision–A New Perspective” a reader writes:

“Glad you gave your patient tender care.  But I do think that this case points more what is lacking in the system  (time, skilled attendants, knowledge) rather than that this gentleman escaped RIC.   I can imagine infections/conditions of all kinds might thrive in a struggling system.   For men and women.  If these stresses on “the system” look unsolvable, maybe it would be more fair to offer adult circumcision  upon being eligible for medicare.   (If our leaders allow it to still exist)  That way, men don’t miss out on a whole lifetime of benefits of having a foreskin.     Was wondering if you are in communication with any nurses in Europe anywhere.  Do they feel the same way?  Most men in Europe are not circumcised, so I wonder how common problems are for them, as they age.”

My reply:

Elizabeth, thank you for reading and commenting.  Many of my blog entries focus on “what is lacking in the system,” and my post is just as much about the state of U.S. health care as it is about circumcision.

To your point regarding elective adult circumcision, I just finished a contract at an ambulatory surgical center and I recovered many men in their 30s who underwent the procedure.  All of the patients that I cared for were circumcised in an attempt to resolve chronic infections in which all other treatment options had been exhausted.  Through conversation, each of them stated, in one way or another, that they would not have undergone circumcision if it had not been a last resort.

Medicare does not cover an adult circumcision to prevent future infections unless there is a documented history of infection.   A costly, out-of-pocket adult circumcision to prevent an uncertain outcome secondary to aging is not recommended by doctors nor is it appealing to men.  Fear associated with manipulating a man’s healthy penis far outweighs anything he can imagine happening in his twilight years.

You bring up a good point about infection rates in nursing homes in Europe.  However, care for the elderly and the culture of aging is so different that a comparison is difficult.  Families assume care of their elderly in the home and socialized medicine has altogether different priorities than do American health facilities.   Owning a nursing home in America is a profitable business as long as staffing is poor, the pay is low, and education is minimal.

Also, there are no billable tracking codes to follow foreskin related infection rates in U.S. nursing homes and the only evidence is anecdotal; empirical data is needed.  Therefore I offer my perspective on circumcision not as a directive, but as a discussion point.

Elizabeth, I’m glad that you are continuing the conversation in a thoughtful way.  I hope that others continue to do the same.


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NYC Nurses Don’t Get Paid to be Nice | New York | Nursing | HCAHPS

August 5, 2012

happy to serve you 275x300 NYC Nurses Dont Get Paid to be Nice | New York | Nursing | HCAHPSNursing care affects a patient’s experience more than any other factor during a hospital stay and negative patient satisfaction surveys are affecting hospitals financially (see my previous post regarding HCAHPS).  Because government financial incentives are being linked to survey scores, hospitals are asking nurses to bulk up their customer service skills and deliver care with a smile.

However, it is not written in the official job description that nurses have to be friendly toward patients and disciplinary action cannot be taken against nurses who don’t smile.  A nurse’s job is to keep patients safe—not necessarily happy.

Furthermore, starting pay rates in most New York City hospitals are not based on an applicant’s potential for giving smiles and there are no raises awarded for friendly care.  Nursing union (1199SEIU) and association (NYSNA) delegates pre-determine the starting pay for all new-hires based on years in the union/association and/or years as a registered nurse.  Friendly, happy, patient-oriented nurses do not get paid more than burned out, angry, task-oriented nurses.

Yet smiling, friendly nurses are correlated with high patient satisfaction scores which ultimately result in financial gain for hospitals.  Unfortunately, the nurses who are responsible for those high scores don’t reap the rewards.  Nurses do not have any vested interest in the institutions that they work and don’t get shares in the business or financial bonuses when the company does well.

Nurses in New York City don’t have a whole lot to smile about when they are overwhelmed by increasingly high patient loads and dangerous staffing levels.    The hospital environment is often negative and chaotic with sick, confused and angry patients, scared family members, frustrated doctors, and unsupportive administration all counting on nurses to fix their problems.

The hospital’s expectation for staff to smile and be extra helpful will cause a backlash among nurses in the City.  Union and association members will file grievances and demand increased pay for increased responsibilities.  I support the hard working nurses of New York City in this endeavor as I would like very much to be paid for something that I have been doing all along for free.



New York City Nursing | East Coast vs. West Coast

August 2, 2012

blog washington state 300x200 New York City Nursing | East Coast vs. West Coast


I came to New York City as a travel nurse in 2007.  A travel nurse is a temporary employee who is flown from his or her home state, housed in a corporate apartment, provided an hourly wage, and flown back to his or her home state upon completion of the contract which is usually thirteen weeks in length.

At the time, my home state was Washington (no, not Washington D.C.—the REAL Washington—the one that New Yorkers have never been to) and my specialty was cardiac nursing.  I was told before I left Seattle that the difference between nursing in Washington (west coast) and New York (east coast) is the staffing ratio.  The staffing ratio in my home hospital was 4 to 5 monitored cardiac patients per nurse.  It was discussed during the phone interview and written in my contract that I would be caring for 6 monitored cardiac patients in Manhattan and I felt comfortable with that ratio.

On the second day of my contract, the cardiac Nurse Manager threw up her hands, shouted, “I can’t take this any longer!” and never returned.  On the third day of my contract, the hospital’s Director of Nursing brought the cardiac nurses into the conference room and informed us that we no longer had a manager.  Conditions with a manager were chaotic at best and I could only imagine how the unit would function without supervision.

With a manager in place, I was assigned 8 to 10 patients during busy 12-hour day shifts, rather than the 6 patients I was contracted to care for.  Adding to the chaos, nurses were responsible for watching each other’s patients during breaks, burdening us at times with 16 to 20 patients each.  As a result, we did not take breaks out of fear that a patient would crash while we were off the floor.  Supplies were limited and staff would hoard everything from spoons and straws to EKG electrodes while the aides would hide the rolling blood pressure machines and thermometers behind doors, in bathrooms and behind curtains.

Normally I would discuss nursing issues with a unit manager, but since we were operating without one I took the opportunity to inform the Nursing Director of the dangerous conditions on the unit.  I first conveyed my understanding of east coast nursing and expressed my respect for her and the staff nurses.  I continued, “But the nursing ratio on this unit is a serious patient safety issue.  My contract states that I am to care for 6 patients, and I am comfortable with that, but every day I’m assigned between 8 and 10.  What are your thoughts?”  She replied, “I think you have a decision to make.  You might consider going back to California.”   With that she turned on her heel and walked away.  The executive responsible for setting the tone and culture among the nursing staff told me to get out of her house with no concern for improving patient safety.

Regardless, I completed my contract despite witnessing abominable health care.  I saw nursing aides drawing blood while talking on their cell phones.  I saw nurses crying in the bathroom from sheer exhaustion.  I saw patients ignored and neglected.  It was heartbreaking.

Since my contract ended I’ve seen this particular institution associated with Medicare / Medicaid fraud, embezzlement, and bankruptcy.  It is public record that executives and even some doctors continue to put profit ahead of patient safety at this facility.  I see a desperate, vulnerable, low socio-economic patient population in dire need of care with few other options.  Decision-makers understand that many of the hospital’s patients are naïve and lack the resources to sue if their wellness is compromised.  The nurses, mostly internationally trained ESL immigrants, have limited job opportunities which prevent them from finding work elsewhere [see Lack of Education in Nursing and Foreign Trained Nurses blog posts].

As a travel nurse, I had the option of returning to the west coast and never looking back.   However I finished my contract and chose to remain in Manhattan.  For the past five years I have observed a complex health care system and endeavored to find my place within it.  I believe that challenging experiences make me smarter and stronger in the way that I advocate for both patients and nurses. I could not have become the professional that I am today without working in New York City.  But when my patients ask, “You’re not from around here, are you?” I smile and relish the opportunity to tell them all about Washington State.


1 Comment |

Focus on Food Movies | Nutrition Education

July 30, 2012

food inc Focus on Food Movies | Nutrition Education I find that few Americans continue to learn about food and nutrition once they’ve graduated from school.  At some point, learning how to change diapers or buy a house or advance a career takes precedent.

Only after a diagnosis of cancer do most adults begin to educate themselves regarding the relationship between food and disease.  A lot of complex information has emerged regarding the production of food and its direct relationship to health.  The body of knowledge on the topic is complicated, large and growing—it is almost insurmountable for folks who are beginning the process with no formal science or nutrition education.

The easiest and most entertaining way I have found to educate patients about diet and nutrition is by prescribing documentaries.  The food documentaries of today are well written, beautiful to watch, provocative, and engaging.  I have my patients start with King Corn (available on Instant/DVD Netflix & Hulu Plus) which explains why high-fructose corn syrup and genetically modified corn are bad for us.  Food Inc. (available on Instant/DVD Netflix) explores the food industry in America and reveals shocking insider secrets that ultimately affect our health.  If you’ve seen Morgan Spurlock’s Super Size Me (available on DVD Netflix & Hulu), I recommend following it up with Fat Head (available on Instant/DVD Netflix & Hulu Plus).  If you haven’t seen either, don’t watch one without the other.  Forks over Knives (available on Instant/DVD Netflix and Hulu Plus) supports a whole-food plant-based diet and the Gerson Miracle (available on Instant/DVD Netflix and Hulu Plus) promotes juicing and coffee enemas.  Food Matters (available on Instant/DVD Netflix) supports anti-conventional medicine and self-healing through an organic plant-based diet and vitamin therapy.  While not a documentary, Fast Food Nation  (available on DVD Netflix) based on the book by Eric Schlosser, is worth watching.  This compelling drama examines the environmental and social consequences of fast food.

So, the next time you are mindlessly flipping through channels, please consider watching a food movie.  Although it might be difficult to stay focused from time to time (the beginning of Fat Head was rough for me) the truth is that you might actually live longer for watching.

Here is a complete list:

  • Hungry for Change (2012)
  • The Skinny on Obesity—An Epidemic for Every Body, 7 part UCTV series (2012)
  • The Weight of the Nation (2012)
  • Forks over Knives (2011) [See above.]
  • Fat, Sick & Nearly Dead (2010) [Wealthy, overweight Aussie seeks moderation in his lifestyle through juice fasts. A reinforcement film; less education, more feel-good.]
  • Food Stamped (2010)
  • Vegucated (2010)
  • Dirt! The Movie (2009)
  • Earth Voice Food Choice (2009)
  • Fat Head (2009) [See above. Former health writer and comedian refutes Super Size Me in a creative and intelligent way.]
  • Food Beware (French) (2009)
  • Fresh (2009)
  • Fridays at the Farm (2009) [19 minute short. Beautiful to watch. Watch on Vimeo.]
  • Ingredients (2009)
  • Sugar—the Bitter Truth (2009)
  • What’s on your Plate (2009)
  • The Beautiful Truth (2008) [Seems like a Gerson Therapy propaganda film for teens. Touches on mercury in dental fillings, MSG and aspartame.]
  • A Delicate Balance: the Truth (2008)
  • Food Fight (2008) [Shines the light on the government's role in feeding Americans cheap processed foods.]
  • Food, Inc. (2008) [See above.]
  • Food Matters (2008) [See above.]
  • The Garden (2008)
  • Killer at Large (2008)
  • King Corn (2007) [See above.]
  • Fast Food Nation (non-documentary) (2006) [See above.]
  • Frankensteer (2006)
  • Media that Matters:  Good Food (2006)
  • As We Sow (2005) [Well done short film. View on YouTube in 3 parts.  Watch for Jan Weber's new project Farmlandia.]
  • Bad Seed—the Truth about Our Food (2005)
  • Our Daily Bread (European) (2005)
  • The Real Dirt on Farmer John (2005)
  • Super Size Me (2004) [See above.]
  • The Future of Food (2004)
  • The Gershon Miracle (2004) [See above.]
  • Life Running Out of Control (2004)
  • Supercharge Your Immune System (2003)
  • Deconstructing Supper (2002) [Canadian restaurant owner learns about genetically altered foods and goes 100% organic.]
  • Fed Up (2002)


1 Comment |

Patients and Doctors Benefit from a Nurse Patient Advocate

July 27, 2012

speak up1 150x150 Patients and Doctors Benefit from a Nurse Patient AdvocateThis month a study published in the Archives of Internal Medicine reported that only one out of seven patients is willing to voice their opinion and disagree with a doctor’s treatment plan.  The majority of participants in the study stated they felt uncomfortable speaking up out of respect for their doctor and fear of being labeled a bad patient.

Clearly there is a breakdown of communication between patients and doctors.  This, of course, becomes a safety issue when patients return home and don’t fill their prescriptions, get a blood test, or make an appointment with a physical therapist.  The doctor is unaware that the patient is not following through with the treatment plan and the patient may become sicker in the long run.

It is my belief that everyone can benefit from a Nurse Patient Advocate when interacting with a medical practitioner.  Nurses know what immediate and long range questions to ask, they know what tests are ordered by a physician solely to prevent a lawsuit, and they know how to suggest other effective treatments without offending a doctor and don’t take it personally if they do.  Nurses speak the language of the medical community and can break it down in a way that everyone can understand.  They also do it with warmth and a smile.

Where does someone find a Nurse Patient Advocate in Manhattan?  My friends at Nightingale Wellness specialize in this sort of thing.  Contact them if you need a nurse advocate while in the hospital or at a doctor’s appointment.  They also manage the health needs of clients who require medical stewardship or whose families live out of state.

However, if you decide to go it alone, begin by asking your doctor how important the treatment is that he or she is prescribing.  For example, “What is going to happen if I don’t get this prescription filled?” or, “My insurance won’t cover a CT scan.  Are there other alternatives?”  This is a good way to open the conversation without offending the doctor.  In fact, most doctors are happy when their patients take an active interest in their own care.  But if your physician is reluctant to discuss the rationale behind his or her treatment plan, it might be time to get a new doctor.


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Circumcision–A new perspective | Elders at Risk for Infection

July 16, 2012

circumcision glasses2 150x150 Circumcision  A new perspective | Elders at Risk for InfectionI witness many conversations, both professionally and socially, regarding infant circumcision.  In all of the discussions, no one mentions how circumcision, or the lack of, impacts a man when he has aged and can no longer care for himself.

One of the most gut wrenching experiences of my hospital career came when I was a nurse’s aide on a medical/surgical floor.  A stoic elderly man was transferred to my unit from a nursing home and it was my responsibility to remove his street clothes and dress him in a hospital gown.  The stench of gangrene filled the room and overwhelmed me when I removed his pants.  He was too sick to communicate with words but looked at me with soft eyes and an apologetic face.  I discovered a severe infection that fused the meatus inside the foreskin.  I alerted the nurse to what I had found and she delegated the laborious task of cleaning to me.  It took hours of warm compresses followed by excruciating crust removal.  I apologized repeatedly and when tears flowed from beneath his thick horn-rimmed glasses, I cried too.

I will never forget this experience and I offer it to others when they consider circumcision.  The elderly population, specifically 85 years and older, is growing at a rapid rate in the United States.  Men are living longer than ever and the health care system is struggling to keep up.  Hospitals, rehabs and nursing homes are filled with patients who need increasing assistance with activities of daily living.  Dementia, incontinence, decreased sensation, and impaired vision are risk factors which can lead to infection in the uncircumcised elderly male.  Lack of awareness in this area by family and/or overworked, underpaid nursing home staff contributes to the problem.

Parents who are considering circumcision should examine the consequences for a child at different stages of life.  The discomfort of circumcision for an infant may be minor compared to the loss of dignity and pain experienced by the uncircumcised elder.  Parents can honor their child by making a decision that outreaches their lifetime; one that allows their baby to face his twilight years with grace.

[View comments below and click to read Circumcision Part II.]



Leaving Against Medical Advice | Hospital Bill | KevinMD

July 8, 2012

Hospital Bill 300x268 Leaving Against Medical Advice | Hospital Bill | KevinMD

My second favorite blog site for health and medical perspectives is KevinMD.com.  Doctor Kevin Pho features guest bloggers who discuss behind-the-scenes medical information from a physician’s point of view.  I find the topics to be relevant and provocative.

After reading a post on KevinMD.com I became aware that a commonly used ploy to prevent patients from leaving against medical advice [AMA] is simply an urban (or hospital) legend.  It is regarded as truth by both doctors and nurses that a patient who signs him or herself out of the hospital prematurely will not be reimbursed by their insurance carrier for the length of their stay.  I, personally, have been told by coworkers that hospitalizations will not be covered without an official doctor’s discharge order and that the patient will be burdened with the entire bill.

Thanks to Doctor John Schumann, a guest blogger for KevinMD.com, I can set my cohorts straight.  It is not true that insurance companies will deny their policy holders a claim based on an AMA discharge.  Hospital charts are not flagged and insurance companies don’t check discharge status.

While additional tests and treatments may save someone’s life, doctors and nurses can no longer coerce patients from leaving the hospital by the use of this tactic.  My thanks to Doctor Schumann and KevinMD.com for the clarification.


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Internationally Educated Nurses | New York City | Foreign Trained

June 25, 2012

filipino nurses Internationally Educated Nurses | New York City | Foreign TrainedMost people don’t realize that American educated nurses are the minority among Manhattan’s hospital bedside staff.  In the 2008 National Sample Survey of Registered Nurses [NSSRN] half of all internationally educated nurses [IENs] work in only four states:  California, New York, Florida, and Texas.  Of the 12% who live in New York, most of them work in a New York City hospital.  50% of all IENs come from the Philippines.

Also, most people are confused about the recent nursing shortage in the U.S.  When the real estate bubble popped and the market crashed in 2008, many nurses lost their retirement savings forcing them to remain at the bedside.  This quelled the shortage and the need for nurses isn’t expected to rise again until 2020.

Across the nation, new nursing graduates are struggling to find jobs within the profession and many have had to seek employment in other fields.  75,857 students were turned away from U.S. nursing programs in 2011.

So why are hospitals still hiring IENs from overseas when we have new nurses scrambling for jobs here at home?

  1. Not every American trained nurse has a bachelor’s degree.  In fact, only half of all nurses in the United States do.  Less than 1/3 of nurses in New York State have a Bachelor’s of Science in Nursing [BSN].  U.S. hospitals are now beginning to hire only BSN degreed nurses (in part to achieve Magnet status) and that puts many American educated nurses at a disadvantage.  Nurses from the Philippines and India graduate with a bachelor’s degree as part of their nursing curriculum.
  2. An IEN with many years of experience will theoretically make fewer mistakes than a new grad.  This is good for patient safety while saving the hospital money in lawsuit prevention.
  3. An IEN with ten years experience and a bachelor’s degree is paid the same entry-level salary as a new grad with no experience.
  4. The IEN also commits to work full-time for several years in exchange for a work visa.  New grads do not sign contracts and most bachelor degreed new grads are estimated to remain at the beside for only 18 months before advancing their education or leaving the profession altogether.
  5. The costs associated with recruiting and relocating an IEN are less than the training of a new grad.  On-boarding a new nurse is extensive and costs a hospital approximately $96,000.  Or in some estimates, 0.75 to 2.0 times a nurse’s salary.

Hospitals are businesses and the bottom line rules many decisions that affect hiring nurses.  That’s not to say hospital boards don’t have a great deal to consider when hiring IENs.  For example, the international brain drain or the impact on the future of nursing in America.  Those are discussions for future blog entries.  For now, I enjoy my daily dose of pancit and tagalog lessons.  Salamat.


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Girl Talk with Nurse Gail | HPV and Pap Guidelines | Cervical Cancer

June 9, 2012

HPV 221x300 Girl Talk with Nurse Gail | HPV and Pap Guidelines | Cervical CancerNo longer does an annual gynecological appointment require a Pap test or an HPV screening.  At my recent appointment, in lieu of a physical exam, I spent my time asking about the new guidelines and clearing up confusion.

In 2009, there were 4,000 U.S. deaths* related to cervical cancer and of those cases many of the women had never been screened or, if they had been screened, it was over a decade before their diagnosis was made.   An HPV infection takes ten years to develop into cervical dysplasia or cervical cancer.  With that in consideration, the maximum time between Pap exams should be under ten years.

The new guidelines indicate that routine yearly testing is too frequent.  95% of HPV related cervical abnormalities detected on a Pap are of no consequence to a woman’s health and HPV resolves on its own within a year or two.  Currently, when HPV is discovered during an annual Pap, patients become unnecessarily anxious and clinicians tend to treat the diagnosis prematurely.

The additional testing and treatments for HPV infections and abnormal Paps involve scraping the cervix or removing a part of the cervix resulting in scar tissue.  These procedures have shown to be extraneous and result in compromising the cervix.  The cervix is weakened and cannot support the weight of a fetus during pregnancy which can result in miscarriages.  A negative colposcopy will give an HPV+ woman piece of mind, but it might prevent her from carrying a baby to term when she’s ready to bear children.

There is also the issue of practitioners performing unnecessary procedures for profit.  Many patients, regardless of gender, respect the recommendation of their medical provider and consent to unnecessary interventions.  The new guidelines help to reduce fraud.

The United States Preventive Services Task Force, the American Cancer Society, the American Society for Colposcopy and Cervical Pathology, and the American Society for Clinical Pathology have all published data to support the new screening guidelines for women.

Here are the new guidelines:

  • Women should start screenings no earlier than age 21.
  • Women age 21 to 65 should get a Pap test every three years.
  • Women over 30 should combine the Pap test with HPV testing every three to five years.
  • Screening is not recommended for women 65 or older who have had three normal Pap tests in a row and no abnormal Pap test results in the past 10 years, or who have had two or more negative HPV tests in the past 10 years.
  • Women who have a normal Pap result and a positive HPV test result should repeat both tests in one year.  There is no immediate need for a colposcopy.
  • Women who have been vaccinated against HPV should begin cervical cancer screening at the same age as unvaccinated women (age 21).
  • Women in their 50s or 60s who were exposed to DES in utero and women who are HIV+ are considered high risk and should have more frequent Pap and HPV testing.


Please remember that the new guidelines are effective in preventing cervical cancer but they do not prevent the spread of HPV.  Men transfer the virus from woman to woman without symptoms and there are currently no approved or recommended tests to screen men for HPV.  If you become infected, maintain optimal physical and mental health to aid the virus in clearing your system.  Taking complex-B vitamins will boost immunity.


*Additional statistical information from the National Cancer Institute regarding cervical cancer:

On January 1, 2009, in the United States there were approximately 247,711 women alive who had a history of cancer of the cervix uteri. This includes any person alive on January 1, 2009 who had been diagnosed with cancer of the cervix uteri at any point prior to January 1, 2009 and includes persons with active disease and those who are cured of their disease.

Based on rates from 2007-2009, 0.68% of women born today will be diagnosed with cancer of the cervix uteri at some time during their lifetime. This number can also be expressed as 1 in 147 women will be diagnosed with cancer of the cervix uteri during their lifetime.


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Lack of Education among NYC Nurses | BSN in 10 | Magnet Nursing

June 2, 2012

diploma 300x294 Lack of Education among NYC Nurses | BSN in 10 | Magnet NursingMost people are shocked to learn that there are minimal educational requirements for registered nurses.  While most staff nurses have an associate’s degree from a community college, less than one third of New York nurses have a Bachelor’s degree in Nursing [BSN].  Many have graduated from diploma programs and are practicing with less than an associate’s degree.

With minimal education, nurses feel trapped at the bedside.  Feeling trapped results in low job satisfaction and an attitude of resentment which manifests in treating patients and co-workers with disdain.  Many nurses suffer through their work day with no hope, no pride in what they do, and cling to a tiny paycheck that barely pays the bills.

Many hospitals in NYC have recognized that hiring BSN-RNs is the best way to increase job satisfaction and patient safety.  Research shows that a mere 10% increase in staffing by bachelor degreed nurses results in a 5% decrease in surgical deaths.  NYU, Mount Sinai, New York Presbyterian, and Hospital for Special Surgery will only hire nurses with bachelor degrees.

The new guidelines for achieving Magnet status (effective June 1, 2013) state that, “a hospital must provide an action plan and set a target which demonstrates evidence of progress toward having 80% of direct care registered nurses obtain a baccalaureate degree in nursing or higher by 2020.”  This criteria is strongly influencing the hiring practices of hospitals that wish to receive Magnet designation.

Organizers in New York are also attempting to pass legislation called “BSN in 10” that will require all nurses who apply for licensure in the state to have a bachelor’s degree within ten years of successfully passing the NCLEX exam.  To learn more, hereis a link to an article I like about BSN in 10.

None of these solutions are immediate but I find comfort in knowing that the problem has been identified and attempts are being made to change the culture of bedside nursing and improve patient safety.  Godspeed.


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Sex in the City Meets Nurse Gail | Antibiotic Resistant Chlamydia

April 22, 2012

pocket square1 300x264 Sex in the City Meets Nurse Gail | Antibiotic Resistant ChlamydiaNot only am I a nurse in New York City, I am also a single woman.  I recently met a handsome, elegant, and charming man whom any woman would be drawn to.  We went on several dates and something was amiss.  While at dinner, I asked him to explain a month’s worth of mixed signals.  With surprising confidence he said, “I’m actually glad you asked because this is something we should talk about.  I’ve been dealing with chlamydia since I met you.  I’m on my third round of antibiotics and it won’t go away.”  I heard the woman at the table next to us choke on her wine as I was busy putting on my clinical nurse face.

I provided support and encouragement, “It’s a bacterial infection and it WILL eventually go away.”  I also asked if I could share his story with others.  He shrugged and cavalierly replied, “I don’t care.  Like you said, it’s just a bacterial infection and it will go away.”   The conversation continued.

Nurse Gail:  “Can you tell me a little bit about the woman who gave this to you?”

My Date:  I don’t know.  It could be one of three women given the time period.

Nurse Gail:  You mean you had unprotected sex with three different women in one week?

My Date:  Yeah.

Nurse Gail:  After you went to the doctor, did you tell the ladies about your diagnosis?

My Date:  I told two of the three.  One was Asian and I don’t think it was her.   Actually, I had sex a second time with the one that I think I got it from.  I’m pretty sure it was her because I didn’t feel right afterward.

Nurse Gail:  You mean you think she gave it back to you?

My Date:  She denies having it.  She says she goes to the doctor and has all that stuff checked out every three weeks or so.  I believe her.

Nurse Gail:  Who has STI testing every three weeks?  And what makes you believe her?

My Date:  She’s beautiful.  She’s a blonde from Texas, has her own charity, and a really nice apartment.

My Date’s ability to rise above the stigma of sexually transmitted infections is impressive however his sexual risk taking is not.  Regardless, I am sincerely thankful for his honesty.  I would not have guessed, given his pocket square and high IQ, that he could be infected with and ignorantly spreading chlamydia.  Furthermore, he had no idea that a socially conscious southern belle could have given it to him.  While we all do it to some degree, please remember that using stereotypes and sexual profiling is a bad idea.

There is also the issue of antibiotic resistant chlamydia.  Yes, it exists.  It is uncommon but it’s out there.  It began popping up in the late-nineties and studied more extensively in the 2000s.  The strain(s) are known to be resistant to doxycycline, azithromycin, and ofloxacin.

However, antibiotic resistant gonorrhea is more commonly diagnosed and has been on the medical community’s radar since the mid-eighties.   The Center for Disease Control reports that in 2009, 23.5% of gonorrhea samples evaluated by the Gonococcal Isolate Surveillance Project (29 sites across the United States) were resistant to penicillin, tetracycline, ciprofloxacin, or some combination of these antibiotics.

Please, as a nurse and a single woman, I am urging you to protect yourself–use a condom with every partner.  There is no way to know if My Date has had unprotected sex with your date or your date’s ex.

[Note:  In the early 2000s, the term Sexually Transmitted Disease or STD was updated to Sexually Transmitted Infection or STI in an attempt to minimize stigma.  The D in “Disease” has been changed to I for “Infection”].


In Response to HOSPITALS AREN’T HOTELS | HCAHPS | Medicare

March 20, 2012

hospitals are not hotels 300x225 In Response to HOSPITALS ARENT HOTELS | HCAHPS | MedicareIn October 2012, Medicare / Medicaid will begin withholding a portion of it’s financial reimbursement to hospitals.  The withheld reimbursement will be returned based on the results of a standardized customer service survey completed by patients who receive care.   Hospitals that score high will receive the entire reimbursement.  Hospitals that score low will receive a percentage of the reimbursement.

On March 14th the New York Times published an Op-Ed written by Nurse Theresa Brown in which she suggests that patients won’t give hospitals high ratings when treatments are painful or when patients cannot be cured.  She says that the survey “needs to incorporate questions that address the complete and expected hospital experience.”  Her concern is that “in order to heal, we must first hurt.”

Rather than enhancing the patient experience, Nurse Brown would like to change the survey.  She states, “Judging care in terms of desirable customer experiences could be expensive and may even be dangerous… [and] could easily put pressure on the system to do things it can’t at the expense of what it should.”   I get the sense that she believes patients have unreasonable expectations and should be grateful for, “the specialized, often painful help that only we can provide.”

For me, the delivery of quality health care is holistic and a patient’s perception of their care is important–patients heal faster when they feel safe and comfortable.  Hospital staff must understand and anticipate the expectations of patients and manage those expectations through validation and education.  At the University of Texas, I was taught that 50% of a nurse’s job is to teach and UT’s curriculum includes a great deal of communication content.  I was trained that it is my responsibility to provide psychosocial care and comfort to my patients and I am happy to do so.

I am also happy that Medicare / Medicaid is taking patient’s satisfaction seriously and withholding money from hospitals with low satisfaction ratings.  America was built on consumerism and hospitals can’t continue to ignore the growing dissatisfaction of the public.  Our healthcare system is in a woeful state and I believe that linking reimbursement with patient input may contribute to positive change.



Don’t be a Victim of Marketing | Sodium Lauryl Sulfate | Fragrance

March 15, 2012

soap 300x300 Dont be a Victim of Marketing | Sodium Lauryl Sulfate | Fragrance

Sodium lauryl sulfate [SLS] and sodium laureth sulfate [SLES] are the lathering agents in soap and shampoo—they make the bubbles.  Every few years “natural” soap and shampoo marketers target SLS and SLES as caustic agents to convince potential buyers to switch brands.  Their efforts are working as I have recently witnessed my friends with no science background discussing the topic.  Because of this, I have watched the videos and read the propaganda written by unqualified authors using bits and pieces of outdated studies that have been taken out of context.  It makes me chuckle.

I was first introduced to SLS and SLES bashing in the late 90s when I was taking chemistry courses at UT. One of my professors worked in the soap industry and we had lengthy conversations about chemicals found in soaps, shampoos, and detergents.  SLS and SLES are benign lathering agents with no documented general risks or adverse effects.  Both have been studied rigorously by independent agencies.  Because of the “electric” pull and the size of the molecule, it does not enter the skin and end up “in your system.”  This is true for most other ingredients in shampoo as well.

SLS and SLES don’t grow on trees but they are derived from nature.  Because the process of doing so occurs in a lab, they are known as chemicals.  However, there is a difference between chemicals derived from nature and those constructed by man.  Any ingredient with a number in the name is synthetic (manmade) and in large quantities can become a health hazard.  1,4 Dioxane (synthetic chemical carcinogen) and quaternium-15 (a formaldehyde releasing preservative) are ones to watch for.

In addition to synthetic chemicals (again, usually has a number in the name), watch out for “fragrance” on a product’s ingredient list.  Under FDA law, a manufacturer does not have to disclose ingredients labeled as “fragrance” to protect against knockoff perfume formulations.  Ingredients used to scent shampoos, soaps or detergents are not disclosed to any governing agency and that is where known cancer causing agents may be purposefully hidden.

There are movements in the US to change the “fragrance” protection law but the US Cosmetics, Toiletry and Fragrance Association (CTFA) has strong lobbyists who are paid well by a 60 billion dollar industry.  The EU has banned over 1100 chemicals from personal care products because they may cause cancer, birth defects or reproductive problems.  The US has banned only 9.

In the meantime, you can protect yourself by avoiding synthetic chemicals and products that contain “fragrance” on the ingredient list.  Switching brands frequently might also help to reduce continued exposure to the unlisted ingredients.  Alone, the “natural chemicals” in shampoo, such as SLS and SLES, are not going to harm you but the fragrance might.


I like these sites:  www.safecosmetics.org  www.ewg/skindeep.com 



NURSING PROFESSION–the Most Trusted | Honesty and Ethical Standards

March 5, 2012

trophy 236x300 NURSING PROFESSION  the Most Trusted | Honesty and Ethical StandardsSince 1976 Gallup has been surveying Americans to rank professionals based on honesty and ethical standards.  The nursing profession was added to the poll in 1999 and has ranked the highest in 12 out of 13 annual surveys.  The only exception came in 2001 when firefighters ranked higher following the events of 9/11.  Pharmacists have generally ranked second and medical doctors third.

I am proud to be a nurse and I am pleased that the nursing profession is perceived by the public to be the most trustworthy.  Recent focus on poor hospital customer service scores, little positive mention of nurses or nursing care, and patients excessively gushing over the doctors who disrespect us behind closed doors have caused me to forget that the general public actually values us.

While I need reminding, it doesn’t surprise me that Americans consistently rank nurses the most honest with the highest ethical standards of any other profession.  We don’t collect kick-backs from pharmaceutical companies or government agencies nor do we set our pay scale for private practice or use billing codes and charge on a fee-for-service basis.  We are paid less than most other professions requiring advanced education.

With managers, doctors, family members, and patients continuously challenging nurses, I am happy for the annual reminder by Gallup that we are highly thought of.  The Gallup poll is like getting a glowing comment card from, not just one appreciative patient, but from all of America.


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