Interview with a Friend

 

It is my sincere desire to challenge nurses (or anyone for that matter) to pick up the gauntlet, better yourself, and the world around you through life-long learning. Be it through higher education or just a spirit of inquisitiveness. Be willing to explore the world beyond the boundaries of your experience. Now, on with the interview . . . 

 

Trying to realize what a master’s degree in nursing education (MSN Ed) means cannot be realized through reading a book, attending courses, or landing a first position. An MSN Ed is an artful practice. In this design, passion flows from the culmination of experience, challenges, and relationships. Graduating with an associate of science degree in nursing (ASN) in December 2003, my psychiatric professor and first mentor guided me to my first and present position. Finding a niche, growing by leaps and bounds as a nurse, family member, and citizen, returning to college was the next logical step. Fast forward to my first MSN Ed assignment. After driving to my alma mater and seeking a willing interviewee, to my surprise standing in the nursing department’s hallway was my mentor and psychiatric professor. He offered graciously to be interviewed as we caught up on lost time. Below is his perspective of a master’s prepared nurse educator including his career development, purpose of education, current position, and pearls of wisdom.
Overview of Career
The most significant thing that prepared him for his career as an educator was his experience as a registered nurse. He spent more than 12 years in psychiatric nursing (PN), describing succinctly that PN is more than understanding the difference between schizophrenia and bipolar disorder, handing out pills, or control psychotic symptoms. PN is effective communication, patient trust and rapport, guiding leadership, and modeling healthy behaviors that foster recovery and mental health. Wanting to enhance his career, he returned to school.
Graduate Education
Getting his MSN opened doors he never knew were possible. The opportunity to be a college instructor took his career in an important direction. He developed a passion as an educator that continues to this day and still aspires higher levels of education and career opportunities. The original reason he sought graduate education was to be able to move into management and administrative positions in quality improvement. An underlying motivating factor was financial gain. Over time, his motivations and goals started to shift. Personal satisfaction stemming from spontaneous altruistic outcroppings began to take hold. The palatability of earlier motivations subsided in an atmosphere of sharing knowledge and giving to others. Currently, he is pursuing a doctorate in education and continues to give his time, insight, and perspective to others. It is clear that his experience as a graduate nurse has been both enriching and enlightening.
Present Position
Graduate education has provided many opportunities that were not available in his undergraduate years. He is now functioning as Assistant Director of Nursing at my alma mater. He also is an adjunct faculty member at the following institutions: Roseman University (formerly University of Southern Nevada), Southwestern College, University of Phoenix, and other seasonal positions.  He spent three years co-directing the California Nurse Mentorship Project, which lead to other contacts in education, new opportunities, and experiences. Perhaps the most exciting part of his educational journey is the fact that there is another mountain to climb on the horizon. Career-wise, he is confident the future will be even more fulfilling. An interesting point was learning how principles of graduate nursing are applied to his leadership role as Assistant Director of Nursing. Integrating theory into practice and applying it through instruction to nursing students demonstrates the complex and compelling amalgam that is nursing education.
Pearls of Wisdom
First and foremost,  realize the importance of fostering relationships made along your journey as nurse. These relationships are very important and may open doors in the future. Secondly, be willing to go outside your comfort zone and take risks. Venturing into the unknown always provides benefit even in the light of the occasional misstep. One of the greatest mistakes he made was leaving the college he is currently employed for another (seemingly more appealing) teaching position.  He eventually returned to the college he left and remains to this day. In light of this, he learned a valuable personal lesson and developed more professional relationships. Taking risks carries a caveat. Sometimes we fail. Even in failure we gain wisdom and grow as a person. Success and failure are parallel paradigms in our journey and what we learn through both is equally important.
Conclusion
In summary, my psychiatric nursing instructor has not only played a significant role in my early career decisions, now more than ever he continues to guide me in ways not yet realized. There is also the renewed appreciation of a genuine professional and friend. My mentor holds close to his belt competencies that are consistent with the American Association of Colleges of Nursing (AACN). Here is a short list quickly observed through our brief discussion that applies the AACN Essentials of Master’s Education in Nursing (AACN, 2011): flexible leadership as observed by historical roles and current leadership positions; advancing personal excellence through lifelong learning; application of research into practice; and most importantly, sharing through mentoring and guidance continued learning as it applies to nurses at a higher level of practice. This was more than just an assignment. It was an inspirational moment that showed the value and life enriching experience associated with continued excellence in education. It also shows how nurses can positively influence the lives and careers of their colleagues.

References
AACN, (2004). AACN Postion Statement on the Practice Doctorate in Nursing, October 2004. American College of Association of Nurses. Retrieved November 21, 2011 from http://www.aacn.nche.edu/publications/position/DNPpositionstatement.pdf
AACN, (2011). The Essentials of Master’s Education in Nursing. American Association of Colleges of Nursing. Retrieved November 28, 2011 from http://www.aacn.nche.edu/education-resources/MastersEssentials11.pdf
Barker, A. (2009). Advanced Practice Nursing: Essential Knowledge for the Profession. Sudburry, Ma: Jones and Bartlett.

 

Low Total Cholesterol and Mortality Rates

This is an exploration of mortality rates associated with low cholesterol. The review was published in Circulation: Journal of the American Heart Association. In this review, the National Heart, Lung, and Blood Institute held a conference seeking to understand why lower total cholesterol (TC) levels are associated with some cancers, respiratory and digestive diseases, trauma, and residual deaths.

Apparently, men are more susceptible to this correlation than women. They examined 19 cohort studies from the U.S., Europe, Israel, and Japan. TC is a calculation of cholesterol measurements of LDL, HDL, and triglycerides.  The review noted high rates of cerebral hemorrhage with lower average TC. The rate of cerebral hemorrhage decreased as average TC went up in prospective populations. This was true in the Multiple Risk Factor Intervention Trial (MRFIT) in addition to increased incidence of colon cancer with lower TC. This may be related to what I wrote in an earlier post.

For women, 6 of the 11 studies showed no variation in cancer death rates across all spectrum of TC levels. There was an increased cancer risk in men when their TC levels fell below 180 mg/dL. In non-cancer and non-cardiovascular death rates, both men and women had similar risk findings. When TC was below 160 mg/dL there was a 40% increase of mortality compared to 160-199 mg/dL levels. Risk was also reduced by 10% when TC levels were between 200-240 mg/dL compared to the reference class (TC between 160-199 mg/dL levels).

This increase in non-cardiovascular deaths raises the issue of the dangers associated with taking cholesterol lowering drugs. These dangers are real and should not be taken likely (as mentioned in the study). Once again, when the data was pooled together, TC below 160 mg/dL was associated with highest risk of mortality.

Unfortunately, some of the data did not differentiate between age or sex but we can assume that having TC this low for anyone is quite risky. The review did take into account people with diabetes, smokers, CVD, alcohol intake, and other possible factors that might skew the data. Some of the research also separated participants further by age and gender.

Findings for all-cause mortality (ACM [death from any cause]) for those with TC between 200-240 mg/dL had the lowest incidence. The rate of death increased the TC went down below 199 mg/dL (are you seeing a trend yet?). Interestingly enough, the American Heart Association, the journal’s parent organization, say that total cholesterol should be below 200 mg/dL. This is the range that has been demonstrated by the AHA to increase risk death from all causes. The standard protocol for primary care providers is to prescribe statin medication when TC is above 200 mg/dL which will place patients well within the range of increased risk of death. 

There are also other health risks associated with direct effect of statin use in addition to health benefits not associated with TC lowering mechanisms. Statins act on many mechanisms in addition to reducing cholesterol synthesis in the liver. A benefit-risk analysis of statin use will be explored in a future post.

It is safe to say that total cholesterol levels appear safest when they remain in the range between 200-240 mg/dL. This is my target. Unless you have a very rare disease, it is completely controllable through diet which will be discussed later. Don’t forget exercise will increase your total cholesterol level (by increasing HDL) as it improves your health.