10-Minute Interview: Kathy Quan, RN, BSN, PHN

With 30 years of nursing experience and health care expertise, Kathy Quan, RN, BSN, PHN is a welcome resource for nurses. In this article she talks about her experiences as a nurse, her formation of TheNursingSite.com and the Nursing Site Blog, and offers suggestions for those just starting out in the field of nursing. Tell us about your medical background and what led you to become a nurse. Like many nurses, the thought of becoming a nurse began when I was still a child. We had had a very mean, grumpy nurse at our family physician’s office, and one day I remember I was so upset with her that I told her I was going to grow up to be a nurse someday and not be mean .... just to spite her! She thought that was a terrific idea. I think my grandmother later told her I had become a nurse shortly before she retired. The idea of being a nurse always remained in my mind, although there were a few other things I aspired to along the way. In high school my physiology teacher was very impressed with how well I caught on to the subject, and encouraged me to become a nurse. You’ve also written extensively online, and in articles and books. Tell us about your medical writing career. As far back as I can remember, I loved to tell stories and write. At some point I realized I would love to be able to write professionally, and so I began to look more into nursing as a means to support myself while I became a writer. Since I had always wanted to be a nurse too, I realized this would be a good combination for me, since I would be able to do the two things I loved. I started writing and running my own desktop publishing company on the side, which I did for many years. I also wrote and published newsletters for the PTA and all of my kids’ youth sports groups as well as worked as a nurse. Then in 2004, I had an opportunity to leave my nursing job and take some time off. There were professional issues I was having problems with and just needed a break. Shortly before I left the job, I had applied to become the Guide to Nursing at About.com. I heard nothing back and kind of forgot about it. However, the first Monday after I had quit, I received an email from About.com telling me I would begin prep in a couple of weeks. If I passed, I would be considered for the job. It was a grueling two weeks, but I apparently did well and they offered me the position. From that job I received several other offers to write for websites and publications (including SupportForNurses.com, Ultimate Nurse.com, Suite101.com and NurseTogether.com), and I also met my book agent. She emailed me one day and asked if I would consider writing a book about nursing. I think the person who had been hired to write The Everything New Nurse Book was unable to commit to the project, so they needed another author right away. I jumped at the chance, and the book was published in March 2006. Now that book has been re-purposed into 150 Tips and Tricks for New Nurses, which is being released February 17, 2009. Another one of my books is titled The Everything Guide to Careers in Health Care (2007). My latest book, The Everything Guide to Caring for Aging Parents, which will also be released February 17, is based on my 30 years of experience as a home health nurse as well as my personal experience with my own parents and in-laws. What was a typical workday like for you as a nurse? A typical day for me as a home health field nurse was to come into the office at 8 AM and find my assignment for the day. Typically we would see 6-8 patients a day. I would spend a couple of hours tying up loose ends from the previous day such as calling MDs, checking on lab results, making sure equipment was delivered, talking to the other disciplines who needed to see the patient such as the PT or MSW, or perhaps a Home Health Aide. Then I would call my patients and give them about a two-hour window of when I would get there. Each patient visit would take 30-45 minutes on average. In addition to any care they required, I would take vital signs and assess them from head to toe. Depending on their diagnosis and presentation, this could be a very complex assessment or a quick one. I would review their medications, diet, activities and home safety issues. After each visit I would document the assessment, care and teaching, and any follow up with the physician. I would set a plan for the next visit and let the patient know when a nurse would be coming again. What was the most interesting or memorable patient you have ever helped? I have had many memorable patients over the years. Due to HIPAA I cannot divulge a lot of identifying information, so I’ll change some up to protect them. One elderly gentleman was a stunt double for a very famous actor in the early motion pictures. He was suffering from cancer and lived alone in a residence hotel in Hollywood. He had no family and a huge volume of memorabilia. In addition to teaching him about his medications and how to deal with the side effects of his chemotherapy, we had to involve our medical social worker to ensure that he wasn’t taken advantage of with his many valuable belongings. She also helped him to get a will written to donate much of his memorabilia to the motion picture association. Another patient who endeared himself to my heart right away was an elderly man who took a cab home from the hospital after recovering from surgery. His family was estranged and lived back east. He had been in the hospital for over two weeks and his landlady had cleaned out his refrigerator (probably thankfully). He had lived alone for many years and was content with his life, but suddenly here he was all alone. He was exhausted from the trip home from the hospital and he had no food. He was sitting in his big comfortable chair crying. After I assessed him, changed his dressing and helped him set up his medications, I offered to go to the grocery store for him. It wasn’t my job and I probably could have gotten in trouble for doing it, but he was alone and had nothing. He also had no cash. He was very grateful. I will never forget the look on his face. I brought him a rotisserie chicken and some fruit, milk, bread and salad veggies, and you would have thought I had given him a fortune in gold! He passed away a couple of weeks later. All of the nurses came to love him. He was so kind and gentle and gracious. What qualities are important in a good nurse? What is the biggest challenge nurses face today? Nurses have to be altruistic. You have to care about people and do it selflessly. This is probably the hardest job ever, both physically and emotionally, so you have to be able to find your own rewards and to replenish yourself often. You have to be open-minded and non-judgmental. You will meet people from all walks of life, with all varieties of beliefs and values, and your job is to help them recover and to become independent with their health care and wellness, not to judge them or try to change them. Critical thinking skills are also vital, along with the ability to look at the whole person and not just the diagnosis. For nurses today, the challenges are huge: nursing has come a long way and made many advances in the past 15 years. However, the downturn in the economy threatens a lot of what we have gained. Administrators will try to cut back to bare bones and expect nurses to give up the nurse-to-patient ratios that we have fought so hard for. They will expect nurses to work longer hours and do mandatory overtime. All of these have been proven to threaten patient safety, and nurses need to hold strong to their ground and not let this slip backwards with and without union support. What are some tips you can provide to help nurses keep morale high and avoid burnout? Nursing offers so many opportunities. One of the most important things for nurses to learn is that they are never stuck in their own little rut. They have skills that translate from adults to children and from ER to oncology, to home health, to school nursing, to occupational health care to utilization review. It may take some convincing and some additional education, but there is a huge world of nursing to choose from. Even just changing units in the same facility can help....just a new set of faces to see everyday. Nurses also have to learn to reward themselves for a job well done. Patients and their family members are not in a place to be thankful and gracious. None of us are at our best when we don’t feel good! One of the things I have always recommended for nurses is to keep a journal or a little locked box with notes in it. When something good happens, write it down. Or when you’ve had a horrible day or week, sit down and review the good times and remember why you became a nurse! When was the website “https://TheNursingSite.com” created? Why was it important to start this site? What are some of the features available on the website? I created TheNursingSite.com and the accompanying Nursing Site Blog (https://nursingsite.blogspot.com/) in November 2007, when About.com made the decision to combine the nursing site into a whole new health careers site. I really didn’t want to be the Guide to that new site, and consequently wasn’t chosen for it. The content I had written belonged to me and I moved much of it to this new site. I continue to update old material as well as write new stuff and add to these sites every day. Over the years I had amassed a huge following of nurses and those who wanted to become nurses, and felt like I didn’t want to leave them hanging. Many nurse educators link to my material, especially my head to toe assessment instructions and my discussion about the Nursing Process, so I needed to find a new home for these. Writing and helping to develop new nurses is a passion of mine, and I use these sites to continue where my books left off. What is your best piece of advice for others starting out in the field of nursing? One of the most important points for all new nurses to understand is that it’s going to take a whole year after passing the NCLEX to feel comfortable in those nursing shoes. You don’t learn it all in school. Nursing, in fact, is a lifelong learning experience. Studies have shown that new nurses hit a low point somewhere about 6-8 months into the job, where they suddenly feel like they have made a tragic mistake in choosing this career. Those who ride it out have shown that after 12 months, they realize that they are OK and will be good nurses after all. For some this experience is more profound than for others, but all nurses go through it. For those looking for educational and career opportunities, what can you suggest? Also, do you think it is important for nurses to join regional or national societies such as the American Nurses Association? Nursing schools are impacted due to a shortage of nurse educators, so it’s going to take time to get into a program. Be patient. But you also need to understand the competition is fierce. Get the best grades possible, and go above and beyond the other requirements. Nurses are, by nature, most often overachievers anyway, but you have to be patient and put your best efforts into being chosen for the programs. There are schools that don’t have waiting lists. You don’t have to go to school in California to be a nurse there; it just has to be an accredited nursing school, and then you take the NCLEX in California. The economy has put some real dampers on health care jobs, such as freezes on hiring, but hopefully this will improve in the next year or so. The stimulus packages have health care as a primary focus. Nurses are the backbone of the health care industry, and there is a tremendous shortage already. Should nurses join the ANA? I’m a member and I think nursing needs some strong leadership, but even the ANA recognizes it has lost ground in this area because it became too associated with unions and not nursing leadership. I think nurses need to be involved at a grassroots level, whether it be their community or their facility to promote nursing and quality (safe) patient care. Is there anything else you’d like to add? Over half the population is health care illiterate. That doesn’t mean they can’t read and write — it means that they don’t understand the human body, the actions of medications and treatments, and the health care system. Therefore, they often don’t even know the questions to ask to get help, and will often fail. They get labeled as non-compliant and judged by their providers. We all need to look beyond the obvious and peel away the layers to see why patients don’t follow instructions and directions. I believe that more often than not we will find that patients will be more than happy to comply with their care if they have the education they need to do it. Patient education is a huge part of the nurses’ job today, and nurses need to understand health care illiteracy in order to ensure their patient education sticks. For more information, please visit: https://thenursingsite.com