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The University of Kansas Hospital serves about 53,000 patients in its emergency room each year, and Mark Puno is one of the people who helps each person through the system.

Puno is a supervising nurse at KU Hospital. More than a third of ER patients are admitted.

“I love people; it’s why I went into nursing,” Puno said. “It’s different every day.”

Emergency medicine has changed a lot over the years, said Dr. Dennis Allin, director of the KU Hospital ER. Allen has been at the hospital 28 years.

“When I started here we had 11 beds,” Allin said. “If you count the psychiatry beds in the trauma room, we’re at 50.”

Puno is also a longtime KU employee, 19 years. When he is not working a 12-hour shift, he works for an air ambulance service as a flight nurse. He also works first aid at the Kansas Speedway, Arrowhead Stadium and Kauffman Stadium.

A busy career as a health professional is something Puno would not change.

“We help people and see the results right there — it’s very, at least for me, very satisfying and gratifying,” Puno said.

Are you a nursing student? Have you been to nursing school? Do you teach nursing students? If so, I give it a 110% chance you’ve met one of these nursing students. Heck, you probably are one – or a mixture of a few!

1. The Question Asker
“Excuse me, I have a question.” Oh yes, you know exactly who I’m talking about. This person asks questions like they are going out of style. Back-to-back-to-back questions, all class long. You can’t help but crack up each time this person raises their hand. Probably roll your eyes just a little, too.

2. The Storyteller
Haha! This person could literally write a book about their life and every person they’ve ever come in contact with. When a story comes to their mind, they just HAVE to share it. To them, there is no other option. Guess what, they will share their story whether anyone likes it or not.

3. The Anxious One
There are so many things to be anxious about in nursing school, exams, clinical, skills check offs. Worry is definitely part of the territory. But, this person totally spins out of control with the tiniest mishap. Like, OMG, I got a 98% on that quiz – my life is going nowhere.

4. The “Self Diagnoser”
Each time the professor reviews a new condition and mentions the signs and symptoms, the person immediately thinks they have the same thing. Cancer? Diabetes? Heart Failure? But, I’m so young. Then spends the next 7 hours Googling their “symptoms.”

5. The Sleepy One
ZZZZZZZZZZZ! This is the person who you have to nudge in the middle of the lecture when the professor stops speaking because this guy (or girl) is yawning so loudly. Ok, I get it, falling asleep in class is easy to do. I might have even done it a few times. Pretty sure my coffee addiction started right around college. Coincidence? I think, not.

Jobs portal CareerCast has published its ranking of the most and least stressful jobs in 2018.

The careers that top the list for 2018 are those that commonly face risk of death or injury, physical demands, and other hazards every single day, CareerCast said.

To rank the most and least stressful careers from the 200 professions on the Jobs Rated report, CareerCast evaluated 11 stress factors: travel required; growth potential; deadlines; working in the public eye; competition in the field; physical demands; environmental conditions; hazards encountered on a regular basis; own life at risk; life of others at risk; and meeting or interacting with the public at large.

These are the 10 most stressful jobs in 2018

#	Job	Stress Factor
1	Enlisted military personnel	72.47
2	Firefighter	72.43
3	Airline pilot	61.07
4	Police officer	51.97
5	Event coordinator	51.15
6	Reporter	49.90
7	Broadcaster	49.83
8	Public relations executive	49.44
9	Surgical Technologist	48.71
10	Taxi driver	48.11

These are the 10 least stressful jobs in 2018

#	Job	Stress Factor
1	Diagnostic medical sonographer	5.11
2	Hair stylist	6.61
3	Audiologist	7.22
4	University professor	8.16
5	Medical records technician	8.54
6	Compliance officer	8.78
7	Jeweler	9.05
8	Pharmacy technician	9.14
9	Operations research analyst	9.17
10	Medical laboratory technician	10.00

Many industries are have been making the shift from in-house personnel to a more remote workforce of employees who work from anywhere. You might be surprised to hear that the field of nursing is no exception.

While most people picture nurses as providing in-person care, there are a surprising number of ways that nurses can practice their skills and still work from home. If you are interested in transitioning out of traditional care facilities, here are just a few career options that will allow you to put your degree to good use and work from home:

Case Management
Nurses are in high demand when it comes to case management positions.

In this role, you will be responsible for handling long and short-term disability claims for patients. You will need to collaborate with physicians, employers and insurance companies to help facilitate communication and ensure compliance among all the parties involved.

Ultimately, your goal is to help coordinate treatment and funding so that a return-to-work goal can be established and met. Since most of your work can be done over the phone or through email, case management is a perfect work from home position for skilled and experienced nurses who are familiar with the healthcare industry.

Insurance Claims
Insurance companies need examiners or investigators who are responsible for reviewing claims and deciding whether or not certain procedures are covered. Making the transition from nursing to working as an insurance claims specialist is a natural one that will allow you more job flexibility along with a salary of about $64,000.

Insurance claims specialists also work to decide how much money the insurance company is required to pay for each claim. A background in nursing will help you to make informed decisions that are in the best interest of the patients, medical providers and insurance companies.

Telephone Triage
Busy medical facilities and doctors will often use nurses to run triage by telephone. This allows highly qualified nurses to speak with patients, assess their symptoms and recommend the best course of action.

Often times, patients are calling to directly reach the doctor when many of their questions can be answered by a nurse. They may just want to know whether they should make an appointment or continue with at-home treatments.

The telephone triage system helps to handle less urgent problems more efficiently so that resources are appropriately distributed. Tele-nurses can work from home and provide valuable medical advice to patients with a wide variety of problems.

Health Informatics
This exciting new branch of healthcare is using technology to improve patient care and create better healthcare system. Health informatics works to find innovative intersections among technology, communication and healthcare in order to move the entire industry forward.

If you are interested in changing the system by developing and implementing new solutions, then you may be able to put your nursing degree to good use in health informatics.

Because the field is constantly evolving and taking shape, there is plenty of room to grow, explore your interests and help create your position.

Call Center Nurse
While telephone triage and call center nurses are closely related, a call center position doesn’t require as much experience. A home-based call center nurse will be in charge of directing calls to the appropriate parties, but won’t be responsible for handing out medical advice.

Essentially, this is more of an administrative role, but medical and healthcare companies will give candidates with medical background the edge when it comes to hiring. Keep in mind that fewer responsibilities also means lower pay.

There are more opportunities than ever to enjoy a flexible schedule where you can work from home and find a work/life balance that works best for you.

By: Blake Lynch, “Nurse Blake”

I’m that annoying nurse who sometimes forgets essential supplies when entering an isolation room.

Ok, who am I kidding? I forget these items all the time.

Why do I suddenly have Adele’s “Hello” stuck in my head? Oh, because “I must have called (my coworkers) a thousand times.” Pretty sure they’ve started to pretend they don’t hear me!

During my last shift I must have gowned-up over 100 times (or, at least it felt that way!) Seriously, most of my shifts are spent in isolation rooms – a lot of patients are on contact precautions nowadays.

Let’s be real, I dread having to gown-up then undress and gown-up again just to grab a darn alcohol swap. Why do I ALWAYS forget those? Ugh.

In 2018 I have set the resolution to be better prepared for the room of no return. Here’s my checklist of items I commonly forget – don’t be like me, just bring these items in the room with you:

1. Stethoscope
I can’t be the ONLY one who forgets the most essential nursing tool. Or, am I? In my opinion, disposable stethoscopes are the best. I just wonder why I never notice them in the isolation room until after I request one from my awesome coworker. OOPS!

2. Flushes
I mean, always! Do I even have to explain?

3. NS Bag
It never fails that the time I don’t bring in an NS bag, the infusion alarm will start beeping. Of course!

4. Wipes and Bed Sheet
CODE BROWN! CODE BROWN! Whenever this happens, there’s usually only 1 scragly wipe left in the entire room when I need like 10 packs.

5. Alcohol Swabs
This is like leaving disposable grocery bags at your house and realizing it when you’re checking out at Whole Foods. ALWAYS!

Did I mention how much I love my awesome co-workers who come to the rescue every time? Love you, guys. You’re the best!

When patients have surgery, they want to know that everyone on the surgical team knows what they’re doing. One member of the team that many patients don’t know exists is the surgical technologist — a paraprofessional who assists the surgeon during the surgery. Not all states certify or license surgical technologists, or require a verification process.

States That Require Certification
The Association of Surgical Technologists has introduced legislation that would require states to allow only graduates of an accredited program to work as a surgical technologist. In addition, the AST wants to see all surgical technologists certified by a national accrediting agency, the National Board of Surgical Technology and Surgical Assisting. In 2012, six states — Illinois, Indiana, New Jersey, South Carolina, Tennessee and Texas — required certification for surgical technologists. Kentucky also requires certification for surgical assistants, who perform similar tasks as surgical technologists.

States That Require Registration or Licensure
Just two states, Colorado and Washington, require surgical technologists to register before working in their states. Colorado also requires surgical assistants to register. No states require surgical technologists to be licensed, but Texas and the District of Columbia require surgical assistants to be registered. Texas exempts surgical assistants who practice in the hospital under the delegated authority of a physician from needing to be licensed.

Mandatory Certification Issues
Surgical technologists are currently the only members of the surgical team not required to meet certain educational standards or to be certified, the Association of Surgical Technologists reports. Some surgical technologists as well as the AST support mandatory certification, according to the Virginia Joint Commission on Health Care. The Virginia Hospital and Healthcare Association, however, opposes mandatory certification because surgical technologists work under the auspices of physicians and stringent regulations for the surgical suite are in place.

Current Criteria for Certification
The National Board of Surgical Technology and Surgical Assisting currently sets certain eligibility criteria to take the certification exam. Graduates of an accredited program in surgical technology or surgical first assisting programs can take the exam with a notarized letter from their program director stating their graduation date, with a copy of their transcript. Current surgical technologists can also take the exam if they have an associate degree or higher in any field, have completed 120 cases within the last four years, and have completed 30 continuing education credits within the last two years. Graduates of military surgical technology programs can also take the exam.

This map shows the real value of $100 in each state. Prices for the same goods are often much cheaper in states like Missouri or Ohio than they are in states like New York or California. As a result, the same amount of cash can buy you comparatively more in a low-price state than in a high-price state.

The Bureau of Economic Analysis has been measuring this phenomenon for two years now; it recently published its data for prices in 2014. Using this data, we have adjusted the value of $100 to show how much it buys you in each state.

For example, Ohio is a low-price state. There, $100 will buy you stuff that would cost $111.98 in a state at the national average price level. You could think of this as meaning that Ohioans are, for the purposes of day-to-day living, 11 percent richer than their incomes suggest.

Nurses are a strange bunch with superstitions – whether we want to admit it or not. For some of the smartest people on the planet (more so than rocket scientists or…doctors…in some cases), we sure get bent out of shape when someone says certain phrases.

As nurses, we have learned the hard way to never say certain statements. Why? Well, that could be because the first time we said it – or heard it said – we got the “evil eye”. Think back to the time you first heard some naive soul say, “Wow, it sure is quiet today!” “Sure is slow”, “Nothing has happened today”, “We haven’t had a code this week”, and comments of the like – just are not acceptable!

If you are an experienced nurse (even with one day of experience), you will be able to testify to what will happen to the unfortunate employee who makes such a claim, right?! Let’s just say that person is not the most popular person on the unit!

It is a fact. Some sayings are just taboo! What does that even mean? Taboo is, by definition, a social or religious custom prohibiting or forbidding discussion of a particular practice, or forbidding association with a particular person, place or thing. It is something that is prohibited or restricted by social custom.

We knock on wood if we say we have been having a good week, or we may reach out to touch the face of a beautiful child who is our patient so they don’t have a turn for the worse. We cross ourselves and say a prayer when someone mentions the drug seeking patient (not currently a patient) who goes on a rampage when the doctor refuses to order the dilaudid. Therefore, speaking of such topics are prohibited!

So, what other topics is it that we as nurses don’t want to hear? What is it that really grates on our nerves? Here are a few sayings…and the rationale behind it!
I interviewed some top notch nurses I know, and here is what they have to say on the subject:

1.~Karen Martinez: “We’re slow today”. Why? It causes the floodgates to open wide and you will probably never get a potty break the rest of your shift!

2.~Sylvia Nelson: “Our anesthesiologists have a thing against saying a child is calm, because then they wake up like a demon. i will never tell my surgeon i hope their night is quiet!”

3.~Jennifer Collins: “It’s been a good day!” That’s when the **** hits the fan. Wait until your shift is over and you have given report!

4.~Ashley Elizabeth: “I have a fantastic assignment!” – There is no such thing if you say it before the end of your shift….; “Calling a patient a ‘stable vented patient’” will cause them to not be stable for long – you will be running a code in no time; “This patient is an easy stick.” Your patient will suddenly become a turnip.

5.~Cherrie Aquino: “Telling parents, “Oh, he/she is the BEST IV starter!” Your patient will be a scientific marvel and have no veins.

6.~Elissa Norris: “Don’t ever mention the chronic kid (or adult patient) that has a crazy mom (or wife/husband/family member) – inevitably they show up!”

7.~Carol Kaplan: “You should never, ever, repeat the name of a ‘repeat offender’ patient. You will admit that patient on your shift!”

8.~Diana Montalvo: “The doctor will be in – just a few minutes.” The doctor will not even be in the building…maybe not even in the country, since you said it!

9.~Sarah Weishuhn: “As a surgical nurse, we never say, ‘Wow, there aren’t any add on cases today?!’ Because five minutes later, the bottom will fall out and we will have an open fracture, an appy, and a C-section…NOW!”

10.~Sandra Cambridge: “Never comment on how well behaved a pediatric patient is until they are walking out the door.” unless you wish to come face to face with the devil with the parent who has no control or expects you to be the nanny.

We learn to never say words like, ‘quiet’, ‘boring’, ‘easy’. We never attribute these qualities to our patient(s), or the shift. We have learned, from having to jump in the trenches after these words are uttered, that these words will open up the gates of Hades and set forth a war that will cause you to have to wage battle against until your shift is “supposed” to be over.

We learn to bask in the warmth of silence or calmness that may befall our units without having to think about – much less comment about – the fact!

We never mention that we will be discharging all of our patients and request to leave when we have no more patients to care for….for good reasons! We know what will happen if we do. Not only will you be discharging all of your patients, but you will be the admitting nurse for all of the ones that ED will be sending up – because inevitably, some brickhead in the ED said, “Sure is quiet today!”

What sayings are taboo in your field?

We all know that there are some taboos in the nursing profession. Leaving a code, losing your temper, and not following up on a patient are some of the most damning actions a nurse can take.

Unfortunately, nursing is full of things that you should not do, and this can be depressing at times. You can still learn a good deal from what you shouldn’t do, though, rather than what you should be doing.

1. Lose Patience with a Patient
You should never lose patience with a patient. They are suffering, hurting, and need you, and if you lose your patience with them, you wind up hurting the nurse-patient relationship.

This isn’t to say that you will never lose your patience. On the contrary, you will often, but you cannot let it show to the patient.

You need to take your feelings and express them to a coworker or even your family at home. If you vent on a patient, you may feel better momentarily, but you will often wind up regretting your indiscretion.

2. Complain about Staffing to a Patient
No one likes to be understaffed, and it can be very frustrating for a nurse to have to deal with the consequences of call offs or just the lack of staff. Patients, on the other hands, can be demanding and may not understand the stresses you are up against.

However, telling a patient that you are overworked is only going to decrease their faith and trust in you. The problems of your facility are not their fault, and they shouldn’t even be aware of the problem at all.

If you want to talk about staffing, save it for coworkers and management. The patient should not curtail their needs because you have too much to do.

3. Fail to Find Relaxing, Non Nursing Activities
All nurses need to find a way to relax after working a shift. If you don’t find something to take your mind off nursing, you will lose your sanity quickly.

Engage in a hobby, enjoy your family, or exercise to clear your mind from the rigors of your job. Don’t take your work home with you, and try to find a way to unwind that is going to recharge your batteries for the next shift.

4. Confront a Manager or Coworker in Public
Tempers can run high on a nursing unit, and you may have a volatile personality to begin with. If a manager or a coworker rubs you the wrong way, you may be tempted to let them have it right where you are.

Unfortunately, this is the very definition of poor professionalism. You should not lose your temper in public, at the nurse’s station, in front of other employees, or in a patient’s room because you are expected to keep yourself under control.

Instead, take the person who angered you aside, to an office, an empty break room, or an empty patient room. Calmly explain why you are angry and work with your adversary to come to an agreement about the issue that set you off.

5. Skip Lunches and Breaks
You should never skip a break, no matter how busy you are. Breaks are part of recharging, and you can’t be expected to be at your best if you are running from punch in to punch out.

Sometimes it feels like you can’t take a break, but you need to find the time. Your patient’s health may depend on how relaxed and rested you are, so take a break, go to the bathroom, get something to eat, and then come back out onto the floor and do the best job you can.

(Memphis) When it comes to our health, nurses are on the front lines of providing the care we need.

In a hospital, they are often the first faces we see and the first to deal with frustrated even volatile patients.

The On Your Side Investigators shows us why some nurses now need protection from the people they are trying to help.

The ER is where you go when your health is in crisis.

Most patients and their families are thankful for the care but it’s the few who aren’t that are forcing hospitals to look for ways to protect employees.

“Our clinical assessment person had someone identify, watch their car and did find out where they lived based on their car,” said Carri Ann, St. Francis ER Nurse.

Next came a direct threat

The nurse said it was an issue of the person telling the staff member what street they lived on and threatening to find her later on.

Situations like that are why St. Francis Hospital in Memphis is focusing more on employee safety.

“You look at the news unfortunately and you take a look at what’s going on in society these days. I think all of us have an escalated sense of what we need to do to make sure that our employees are safe,” said Marilynn Robinson, VP St. Francis Hospital.

In an age where violence is becoming the norm in public places like airports, shopping malls and movie theaters, hospital administrators are making changes.

Some changes you can’t see. Others are more obvious.

Employees in the so-called sensitive hospital areas no longer have their last names listed on their badges.

“It gives them some anonymity in case people get upset about something related to the care or if those individuals may have some issues,” said Robinson.

We checked other major hospital systems in the Memphis area.

Baptist and The MED say employees have their full names on their badges.

Methodist said it also has an amended badge policy for areas where there might be a unique safety concern.

St. Francis employees are well aware of these concerns.

Carri Ann said, “A lot of patients assume because we’re in medical care that we have easy access to medications and supplies and it reduces the risk of them coming to my home and causing any life threatening complications.”

Hospital administrators say she isn’t aware of any St. Francis employees being hounded by patients for narcotics but they’re not willing to take any chances.