Emergiblog: Interview with Kim McAllister

14/09/11 2:00 AM

Nursing: Beyond the BooksFor our seventh installment of this series, we talked with Kim McAllister of Emergiblog.  An RN, BSN and CEN, her bio states: “My name is Kim McAllister, and I’m a registered nurse in the San Francisco Bay area. I graduated in 1978 with my ADN and have been a nurse for 33 years. My experience is predominately Emergency and Critical Care, but I have also worked in Telemetry, Psychiatry and pediatric telephone triage.” In addition to the work she has done on Emergiblog since 2005, in the summer of 2011 she was invited to become the blogger for Masters in Nursing.com, and she contributes a bi-monthly post to AllHealthcareJobs.com.

The bold statements are taken directly from her posted works, followed by our questions and her responses.


I made the decision to be a nurse in 1966, on my ninth birthday, after receiving “Cherry Ames, Student Nurse” from my great-grandmother. Are there ever lingering moments where you question the path you have chosen, or has nursing provided you a relatively unfailing foundation with lots of room to interpret it personally? How much of your path would be considered “by-the-book” for a nursing student (study, practice, advance, study, specialize, new credentials/training, etc…) and how much of it was you making it up as you went along?

Oh, I have totally questioned it a million times. Every time I feel overwhelmed at work; every time I roll out of bed, exhausted, before a night shift; every time I have to engage with a surgeon who thinks the sun rises and sets on his rear end. LOL! But the operative word in you question was “lingering”. These moments don’t linger at all. And every time I entertain “escape” fantasies and imagine myself doing something else, I realize I am where I am supposed to be.

My path was totally by-the-book. Nursing school virtually out of high school, right into med surg for a brief period followed by critical care followed by ER, all within eight years or so. Maybe it was a bit unusual in that I veered in to psych nursing for about 2 ½ years, which is something not everyone does, and it did take me 32 years to earn a BSN, which may be a little unusual. I can pretty much guarantee that  I will be the oldest MSN graduate on record, so perhaps, now, I AM making it up as I go!

I spent the last three decades working in CCU, ICU, and ER with a side of psychiatry and pediatrics. When you left nursing school, did you have loose plans to try different areas of care or did specific  professional/personal situations tend to be the ones to open doors for you or lead you somewhere?

Well, first of all, I was NEVER going to go into critical care, EVER! And within six months of graduation, that is exactly where I ended up! I was nurtured by a wonderful group of nurses in a small community hospital who took the time to bring along a young nurse who didn’t know her head from a hole in the ground. Seriously, I was twenty years old when I graduated.  It didn’t take me long to realize that in critical care you could give the sort of nursing care that you were educated to give.  You could focus on one or two patients fully. It was intense in a different way than floor nursing. I fell into ER by accident, the census was very low one summer and instead of making us stay home, they offered us the chance to orient to ER so we could help out if we wanted to. It was a very small ER, only 3 beds.  And I was NEVER going to work ER, EVER (are you detecting a pattern here?), but I figured there could be no harm in orienting. I fell in love the FIRST HOUR! LOL! It was fast, the turn over was amazing, never the same thing twice (same complaints, but every patient was different), the time just flew by – this was my next step!  The job in psychiatry came along because of an interest in working with patients with eating disorders. There was actually a unit in a local hospital and I applied. The director kept my application in her desk, and long after the unit had changed to an open general psych unit, she called and asked if I was still interested. I had always been interested in psych, loved it in school, and was rather burned out with critical care and ER. It was the right call at the right time.

But I got bored after 2 ½ years and returned to ER. Twenty years later, the same thing happened. I was burnt beyond belief and got a job 9-5 as a pediatric telephone advice RN. LOVED IT! First, I love talking to parents – it was a wonderful facility with great coworkers.  They placed no quotas, no time limits on us at all, so we could talk as long as we needed to and answer as many questions as the parent needed to ask.  Sounds wonderful – day shift, 9-5, very few weekends, no holidays….and then…I got bored! I was back in ER in 9 months (are you detecting another pattern here? LOL)

So, sorry I’m rambling, after school I expected to work in med surg for my entire career and then retire after my husband settled a ginormous case (he’s a lawyer).  Instead, I would up working in the area that scared the hell out of me in school, entering areas I never would have tried and always trying to escape to what I thought I wanted only to find the grass really isn’t greener and coming back to ER.

Earning my BSN in 2010 through the online University of Wisconsin – Green Bay BSN/LINC program was the best decision I ever made for my career. Do you feel you reached this decision because of your rich and varied field experience, or is additional education something you would now, in retrospect, suggest someone already a student simply stay with – taking educational opportunities further while they are already entrenched in the routine of school?

I went back for my BSN because I read blogs by nursing students who were excited by what they were learning, who had a passion for nursing that I wasn’t exactly feeling anymore. I thought “these people are sacrificing soooo much for a profession that I am taking for granted.  I will tell you up front that I would not have appreciated the education without the clinical experience to back it up.  And face it, after nursing school the last thing you want to see is another textbook. My thoughts would be to get out, get a job, work in the real, honest, gritty world of the real day to day nurse for at least a year or two and then get back into it. At that point you are no longer a sponge, but you are actually bringing wisdom and experience to the classroom and the difference is enormous. Plus, with online classes and programs, you can actually go for your BSN part time, my program at UWGB did not even have a time limit. There were semesters I took only one class. Anyone can do one class. Trust me, you can!

From 2008: When I started back for my BSN, my goal was to take my time and enjoy the process. … I am enjoying the process, but sometimes I have to remind myself to keep my eye on the prize. Spending a week immersed in Margaret Newman’s Health as Expanding Consciousness theory has made me glassy eyed and wondering if I should just spend the rest of my days crocheting doilies and baby blankets for the grandkids I don’t have yet. Baby blankets aside, have any of the theory-type of classes that you drudged-through actually surprised you by being more relevant than you had believed possible?

Yes, but that is because I am a geek by nature. I love that stuff. I will take nursing theory and I will see it in daily practice. Some of my colleagues in and around the interwebs disagree with me.  I found EVERY class relevant – but this is what having clinical experience does to you when you go back to school. You will relate EVERY SINGLE THING  you are learning to something you have experienced. Now, you may say, “Well, there is no room for that in MY practice!” but at least you were exposed to it and you had the opportunity to apply it or not apply it! And you are a better, more well rounded nurse for knowing it.

And for the record, I didn’t drudge through a single class! Ms. Newman may have had me wondering what on EARTH she was thinking, but that class on theory was one of the best. School for me is exciting, a constant state of “what’s next?” There is a quote in Doctor Who that sums up my philosophy of education “all of time and space, everything that ever happened or ever will… Where do you want to start?

Like I said, I’m a total geek 😀

Nurse manager. Clinical Coordinator. Head Nurse. Whatever the title, it’s a rough job. They must balance the needs of the nurses and the unit with the orders that come down from Administration. Is there anything you’d suggest to a current student as far as classes to take, internships or other potential ways to get better exposure to this balance to understand if management is a smart trajectory?

Now this is where I am waaaay out of my league.  I wouldn’t be a manager if you paid me a million bucks. First of all, I’d be on the side of my nurses and my attitude would be one of trying to protect my staff from administration. NOT a good attitude for a manager. LOL! Seriously, I don’t know how managers do it, but I could never be one of them. I see the job as one long exercise in conflict management, and definitely not my thing. So I would not be the person to go to for management advice at all. Now given what I’ve said previously, I’ll probably be a manager by the end of the year : )

Let’s just say God help the manager who has to deal with a nurse going through severe, depressive burnout. The life of a nurse is often going to be high-stress, low pay, and demanding physically…so what are the best strategies you have learned to overcome your own professional burnout? What are some early warning signs that suggest a potential problem is on the way?

The best way to deal with burn out is not to let it happen at all. So, do NOT work yourself to the bone with overtime no matter how attractive the money looks or how badly your unit needs you or how badly your manager pleads or lays on the guilt trip.  Learn to say “no” early and often.  You need your days off to process and to refuel.  The occasional extra shift is fine, especially if it is scheduled ahead, but doing double after double or double after double-back (doing a double and then coming in 8 hours later for your regular shift) will kill your spirit no matter how old you are or how much you love your job. Have interests outside of nursing. I have so many outside interests it has become a standing joke in the family, but when you are off your mind needs to be as far away from nursing as possible.

Burn out starts insidiously. You start worrying about work outside of working hours. You start dreading your shift hours before you go in and then days before you go in. You sleep too much or you have insomnia. You overeat or don’t feel like eating at all. You feel very sad or you feel nothing at all and all you want to do on your days off is sit on the couch. You either start being unable to detach from patients and situations or you are totally detached. It is very similar to what depression feels like, and you need to be careful about decisions you make during this time.  You feel trapped and like you suffocating. You are just going through the motions. You may blame it on the job and make a job change on impulse. Conversely, don’t be afraid to make a change if that is what you need.  This is where you need to talk to someone, because you need someone with a fresh perspective. Being in the throes of full on burnout is unbelievably painful, so better to not get there at all. The word “no” and the ability to realize when you need a change and act on it are to major ways of heading it off.

Been there, done that, wiped up body fluids with the T-shirt. How long does it take a nurse to say this with confidence? After the decades you have spent as a caregiver, are there surprises still waiting for you in many shifts – or does there come a time when professionally, you really have seen it all (in a relative sense, of course)? What shocks you now, if anything – and is it ever difficult to put on your game face?

I think each nurse is unique in terms of when they feel like they “have it”.  The first year, no way! LOL! That was a year of just getting used to the role and functioning as a nurse. I would say by year 3 I was hitting a stride, but it was when I moved on from my initial hospital and realized that I could make it “out there”  that I knew I was a seasoned pro.

There are always surprises because you never know what is going to walk in the door or more importantly WHO is going to walk in the door. Each patient is different. So while the diseases and symptoms may similar, the way they manifest in the individual patient can always present you with something new. It’s never routine.  The only thing that still shocks me is the rudeness of  the public, the lack of manners and general civility, particularly concerning new technology – just when I think I HAVE seen it all, someone reaches a new plateau of  audacity with a cell phone. I can put on my game face for ANYTHING  but that!

It’s a catch-22. You are supposed to move faster because there are more people to see, but every year more information is required from each patient at the point of intake. Is there any way for an aspiring nurse to better prepare for this inequity, or do you see it as part and parcel with the changing times? How does one improve at triage if experience is not an option (say for a new nurse)?

I wrote that specifically with the emergency department in mind – and the only way to prepare for it is to adapt emerging technologies to make it (triage) a more efficient process. I’m sure that would translate to other nursing disciplines, too, but that particular quote was in reference to ER.

We’re nurses. And we should be proud of our accomplishments. Every department. Every day. Every shift. How have you found it easier to maintain this necessary sense of pride in your work? How has that changed for you as your professional experiences grow?

I’ve always had pride in my work and in nursing, but it does get easier as I gain experience because I am am able to put my experiences, and nursing in general, into a greater perspective, to see areas of growth and to marvel at the changes in both myself and the profession. Nurses, as a whole, don’t value themselves or their contribution, in my opinion. We tend to say, “Well, it’s just what we do.” Yes, it’s just what we do and thank goodness we are here to do it!

I’m saying that all entry level programs whether ADN or BSN have one thing in common: they all must teach with an eye on passing the NCLEX. That makes the programs very inflexible as to what can be taught, and neither program can provide what you really need to appreciate nursing education at the baccalaureate level: Experience. When do you think are the logical transitional periods for a nurse – when they should move from academic pursuits into practice and then back again?

I really do feel that there needs to be a period of real world experience either before or concurrent with  obtaining a BSN if you have your ADN, as I explained in a question above.  I believe that even moreso from a BSN to MSN if only that the MSN requires even more specialization – you have to know what you want to do with the degree at that point. At least this has been my personal experience. Everybody’s mileage may vary.

You refer to having an “inner-hippie” so how has the hippie within you found its expression through nursing?

LOL – freedom is NOT just another word for nothing left to lose, freedom is having the ability to be open and share and accept and appreciate the world around you and I think nursing has opened me up to be able to do that. Or maybe I chose nursing because I wanted the space to be able to do that. Oh sure, there are rules and regulations,  but they have yet to legislate how you connect with people and that is the best part of nursing. I can actually be me and more to the point, I can appreciate people for who they are and what they bring to the table of life. Life and death and illness tend to strip away facades and you see the real side of humanity on a daily basis. It isn’t always pretty, but we are privileged to be with people at the most intimate moments of their lives, often the most frightening moments.  What other profession can you think of that just being there, just being, is therapeutic?


Kim McAlister RN, BSN, CENThanks for sharing your insights and depth of experiences, Kim! Be sure to check out Kim’s work on Emergiblog and Masters in Nursing.com.

Return tomorrow, and enjoy our eighth part of this series where we talk to Terri Polick about the way she has successfully blended nursing into life, and back again.

Nursing: Beyond the Books

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