Nurse Liz

Adventures of a Family Nurse Practitioner

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Medical Bankruptcy: An American Tradition

Recently, my husband’s company sent us an email letting us know the cost of our health insurance premiums for next year if we keep the same plan. They were kind enough to include a little note that said “Hey, we’ve also raised the prices a little bit,” because, you know, the billionaires running insurance companies want to buy a twelfth jet. They didn’t say that last part. But they did let us know about a price increase. A boy was it a doozy: $26,000.

I don’t know about you, but I can’t afford that. 

And it isn’t just me. There are so many people who can’t afford health insurance and health care or can’t afford to use the insurance they have. And that is so not okay. 

So let’s talk about it! Because this is conversation that needs to happen and it needs to happen everywhere and with everyone, regardless of age, social standing, financial status, or political opinion. Because this isn’t about politics. This is about people and a broken system that can’t continue the way it is. 

Check out my video on the topic here or read on, whichever is your preferred medium. The information is all the same!


So…when did the system start to not work. And why isn’t this a problem in other countries. For this we must travel back in history a wee bit. Let’s go.

In ye olden times when people got sick, doctors came to their house. And then the people paid the doctors. There were a few hospitals, most of them run by churches, but they really were mostly just good at killing you almost faster than if you stayed at home because the scientific process wasn’t sorted out. So best you just stay home and try the remedy your local doctor gave you. This obviously benefitted people with money to pay a doctor, and if you couldn’t afford it, well, you probably should just try not being poor. 

Clearly, it was because poor people were lazy, and lazy people don’t deserve to be given the privilege of accessing care that helps them stay alive. As you can see, some things never change. But more on that later.

In the 1910-1920s, some companies and labor unions started to offer assistance for paying for medical care, but it was not commonplace until after World War II. In 1943, President Roosevelt put in place a sort of freeze on wages, because there wasn’t much money with a war going on. So jobs needed a way to incentivize people to work there, but without money, and they decided to leverage something else: the ability for employees and their families to have access to something they may not otherwise have access to—medical care. 

Insurance companies then needed to be born to become the middle man between the people and the health care, and they became widespread because somebody needed to actually handle the transaction of exchanging moneys for healthcare availability. And it worked. People took jobs they otherwise wouldn’t have due to low pay or just not liking it, because they wanted medical care. And it slowly became more common for more exclusive jobs to start offering health insurance to lure in quality candidates when there weren’t many available.

And you might be sitting there saying, but Liz, that makes sense. We had no money and needed an incentive. The intent seems good. And to this I say, yes, at that time it was a decent solution to a problem. But that wage freeze eventually stopped. And guess what didn’t? This insurance system. 

Did some people have objections, saying that this was largely unfair and could be used to manipulate people into staying in low-wage jobs or jobs that treated them poorly just for health insurance, of course! So, how did private insurance companies, who profited the most from this system, convince the general public that this was okay? 

Great question. 

The lobbyists told voters that this was in THEIR best interest. You see, they didn’t want socialized healthcare like GERMANY had. Those evil Nazis. Slogans like “political medicine is bad medicine” were started. And if I may be so bold, this continues to be a fear-mongering tactic we still see used to this day. We don’t want any kind of socialized medicine. The word “communism” is thrown around a lot. “It’s perfect the way it is.” There is a lot of fear around if we changed it, it would be so much worse. I think you’ve probably heard that before.

Back to history! Noticing that this system was leaving quite a few people still without healthcare, President Truman began talking about the idea of having a government-funded health plan in the late 1940s, like the rest of the developed world was doing at the time, because they realized that humans are inherently valuable and worthy of things like access to healthcare. But he was met with opposition from the unions, doctors, and hospitals, because they very much liked things how they were. As were the insurance companies. The insurance companies were also quite thrilled. There was nothing dictating how much a doctor could charge for visits, same for hospitals. They certainly didn’t want to switch to a medical model that would be reimbursed by a set fee by the government and could be controlled that way. And how would unions get people to work crappy jobs if they didn’t have the perk of “if you get sick you can at least get medical care” to dangle over peoples heads like bait. 

All attempts, and there were many, to create a single-payer, government-funded healthcare system failed, because over and over again, medical providers, healthcare systems, unions, and, later, insurance companies would lobby in favor of making themselves more money at the cost of human lives. And as the lobbyists became more wealthy, they were better able to push the narrative based on fear, NOT facts. They just kept pushing the same line, to the people that we did NOT want to be like the socialist countries out there. 

Let’s fast forward a little bit to the 60’s. What happened in between then and now? Well, things just kept getting worse because people are greedy. Shocker.

In 1965, tensions in healthcare were reaching a boiling point in the whole country in general. Those without health insurance were dying, because they couldn’t afford health insurance, similar to how it really always has been, and even though they had jobs, they didn’t have “in demand” jobs, so the jobs didn’t need to incentivize people to come work there with things like benefits. 

It was also still a thing in the 60s that if you were Black, or really any minority, you couldn’t go to the White hospital. Hospitals were segregated, which just blows my mind. When my parents were alive, hospitals were still segregated. That still is difficult for me to wrap my head around. And even if it wasn’t an entirely separate hospital, it was a separate wing or a basement where your medical care was immensely sub-par. Shockingly, that’s also something that’s still happening, and we need to address it. If you were not lucky enough to be very wealthy, White, or to have a job that provided health insurance you, you had no other option at this point. Kind of like now.

And thus, in 1965, to try to address this, Medicaid and Medicare were formed. And one of the requirements for creating Medicaid and Medicare was they hospitals would be forced to desegregate in or for them to get federal funding. If they didn’t, they weren’t going to get any money, which was a really big motivator, since healthcare always really likes money. 

This was an immense breakthrough for older patients, who could now get Medicare, individuals living on very little income, who could get Medicaid, and this would hopefully start to desegregate medicine just a tiny bit. At least, it was the first, tiny step in the right direction. Not ideal, but the right direction. Unfortunately, it still left out a massive middle ground of Americans who didn’t qualify for Medicaid, but also couldn’t pay for health insurance or they weren’t at one of those jobs that incentivized people to come there with health insurance. Sound familiar? That was when our first “sort of” state-funded healthcare came onto the scene.

Next, how did we get to the place that insurance companies now not only can charge us insane amounts of money to have access to healthcare, but they also dictate our care? That arrived with the implementation of HMOs, Health Maintenance Organizations, in the 1970s. At that point, it became legal at this time for HMOs to offer insurance and operate in a system where there are set guidelines in place of how to manage every condition and the providers within that system are given parameters of how to practice medicine. 

It won’t shock you to know that these guidelines were put in place to save as much money for the company as possible, even if it wasn’t the best treatment for the patient. It also won’t come as a surprise that humans are not all the same, so they probably shouldn’t receive the exact same medical care and that doing so doesn’t always have the best outcomes. We don’t even have the best of both worlds. You can’t say, oh, well, we don’t have nationalized healthcare, but that means we’re not working within those parameters. No, we DON’T have nationalized healthcare, AND we don’t have the freedom of choice as healthcare providers to make our own decisions.

This is how we not only have the most expensive healthcare system in the world, because it’s driven by profit, but also how we manage to have the poorest health outcomes. Because insurance companies don’t allow for individual provider discretion, leading to mismanagement of patients if they don’t fit the model. Oh, and then there’s all those people who fall into the “no insurance” hole or the “my deductible is too high” hole. Those don’t help us with outcomes either. Should we look at those real quick?

I cannot tell you how many people I have talked to in my decade in healthcare who were hardworking, excellent humans who made too much money to qualify for Medicaid, but who couldn’t afford insurance. How is this possible, you may ask. That’s no MY reality. Well, let’s use me as an example. 

My job does not offer insurance. So we get insurance for our family from my husband’s job. My husband’s job offers two types of insurance. First, a very cheap insurance that covers annual physicals, (Awesome!) but, unfortunately, that is literally all it covers. If you need anything else, if you need to go to urgent care, if you need to go to the hospital, if literally anything but a physical happens, you pay out-of-pocket. As we all have some medical conditions, and I can’t tell the future yet to see if we will be requiring hospitalization, this option was out.

Next we have the second option, the more expensive option, which is, like so many out there, a high-deductible plan. If you aren’t familiar, with a high deductible plan, you pay a monthly premium to the insurance company to have the privilege of having insurance with them. Our monthly premium for this privilege is $1,333 a month. $16,000 a year. One might think, WOW. You are going to have amazing insurance with that cost. I bet they even cover massage therapy, chiropractors, all of that. And, oh friend. Oh, friend. You could not be more wrong.

With a high-deductible plant, after paying $16,000 for the honor of having insurance, if we DARE use the insurance for ANYTHING other than physical exams, we must then pay out-of-pocket until we reach our deductible. This is for things like my daughters getting sick, or my needing to go to the doctor to get a refill on my Zoloft. Appointments are usually $250 a pop for a non-specialist provider. If you have to go to a specialist, like a psychiatrist, or gastroenterology, it’s about $350-plus. But don’t worry, we only have to pay that out of pocket until we hit our deductible. What is our deductible? $13,000. Because we are a family of four. if we were just one person it would only be $7,000. So really, we are getting quite a deal. FOUR deductibles for the price of two? Wow. Thanks, Aetna.

And that, my friends, is how I cannot afford healthcare. Because if we combine the annual cost of health insurance with our deductible, which we almost always hit because we’ve got a family full of people who utilize healthcare, we have a cost of $26,000. Which is more than a quarter of our income. And that doesn’t include taxes or any of that stuff. For one year of medical care for my family of four.

And this is not just me. It’s not just me complaining and saying, “Oh, woe is me.” This is millions of people. This is countless patients being unable to go to the cardiologist for their heart murmur, because they haven’t reached their deductible and they can’t afford it.

This is cancer patients DENYING TREATMENT or denying palliative care, and asking me to not tell their wife, because their credit cards are already maxed out and they can’t get a loan, so they can’t pay their deductible and they’d need to declare bankruptcy to proceed with treatment. And if they don’t live, they don’t want to leave their wife a widow AND in bankruptcy. So they decide to die from treatable cancer so their spouse can live without that burden. I have seen that more than once. I have seen people die in pain because they don’t want to hit their deductible to pay for palliative care. And if you tell me that that is a lie, you are wrong. I have seen it. And you are wrong. It DOES happen, and it happens often.

This looks like sitting in your OBGYN’s office after your first ultrasound, this happened to me, with your new, tiny, poppy-seed-sized baby in your belly, a time that should be joyful, but instead you are in tears in the financial office, because that’s where they direct you after your pregnancy is confirmed, realizing you will need to come up with $13,000 to have this sweet baby. They want $7,000 by next week. But, don’t worry, they offer payment plans. For your BABY. It takes most people years to pay off the birth of their children. Most of my friends, we’re STILL trying to pay off the births of our children. That’s not OK.

This is people paying their t$13,000 deductible for their D&C after a miscarriage. They didn’t even get a baby. They just got a bill.

This is patients not treating small problems because the cost is too high for a visit, only to come into the ER months later with a now incredibly serious and life-threatening complication of a disease that would have been easily treatable, preventing this whole situation, if only they had access to care a few months before and could have dealt with it then.

This is coming off medication for crippling depression because you can’t pay for the office visit that you need in order to get your refill and you haven’t met your deductible. I’ve done that. It was not fun. it did not go well.

This is stretching your insulin, because yep, meds apply to this too. Gotta pay out of pocket until that deductible kicks in. And since you obviously chose to be born with Type 1 Diabetes, you get to pay the $13,000 deductible every single year to cover your medicine before anyone else will pay if you work somewhere that has a high-deductible plan.

This is not working.

This is not working for 90% of the patients I see. I don’t have hard statistics on any of this, because it is just my experience. We have data on how many people have insurance, but we have no data on who is able to utilize their insurance.

I spent 75% of my appointments in primary care trying to figure out how the heck to get treatment for people or fighting with insurance companies who didn’t want to provide the treatments people needed when they finally did meet their deductible. 

We’re like, we got here, and then the insurance company was like, “No, try X, Y, and Z first.” And then the year timed-out, and it was time to start over again. Or, I was researching treatments I was never trained to prescribe, didn’t feel comfortable prescribing, because the patient could not afford to go to the specialist who was trained in this. And without it, they may die. So I guess I’m going to be looking into this with my collaborating physician, and we’re going to be figuring this out.

I am not being dramatic. I know some people will say I am. I KNOW people will say that I am.

But I promise you, this was every day. Almost every appointment. And it’s heartbreaking. And I am angry. I tried for a long time to film this without being angry, but I think it’s okay to be angry, because this is not okay.

Are I know some of you are going to point out that this isn’t every type of insurance. And you are right.

Some jobs offer awesome healthcare insurance. My old nursing job had incredible insurance. I paid very little for it. I paid $88 to have my first child in comparison to the $13,000 I paid for my second child. People drive an hour-and-a-half to that hospital to work there just for the insurance. They drove by dozens of other hospitals to get to ours just for the insurance.

And here’s a fun fact. If you are an executive at a company, this is also likely not a problem for you. Because companies usually have “executive insurance policies” where you don’t have to pay for insurance and you don’t really have a deductible either, and if you do, it’s super low and they usually throw a health savings account at you with enough to cover a good chunk of the deductible. I did not know that until my spouse worked in insurance, and he was like, “Did you know this was a thing?” And I was like, “Excuse me?” So these are people that are making a lot of the decisions because the executives have a lot of money. Interesting. Follow the money.

There are also non-high-deductible plans, like PPOs. We don’t have that option available to us, but they exist if your employer pays more on your behalf to have that option provided, as a job incentive, like when this all started. Some companies offer better insurance than others. They’ll offer PPOs, they’ll pay more for it so you pay less out of pocket. So again, just work at a job that has those. Easy, right?

And there are cost-sharing insurance plans that act as a sort of insurance where they decide what they will cover, usually based on religious influences, and the cost is shared amongst people, like MediShare. This is fine if you align with those principles are are OK with their limitations. It can usually kind of get pretty expensive if you need certain other things, but for a lot of people, those do work.

We have the healthcare marketplace now, as well, where people can go on and shop for their own insurance if it’s not provided by their employer. But it’s usually in the same ballpark of price as my plan I described earlier. We looked and searched all over for one, but couldn’t find a plan for cheaper than our $26,000 plan so, bummer, dude. Good try though. They had it, but it was catastrophic, so, great, as if this whole situation isn’t catastrophic. It’s fine.

And then there are the people who just can’t afford it and they just don’t have insurance. And they show up at the ER when they are epically sick. Unable to pay the $300,000 dollar bill they get after emergency surgery and a hospital stay, they declare bankruptcy to not die, and the hospital writes it off as a loss. Don’t think that happens? The number one cause of bankruptcy in the U.S. is medical debt. People are desperately trying to stay alive and are destroying their financial world to do it. What a cute and fun American tradition.

So, what do we do?

Let’s change it. Please, let’s change it. 

Please listen to this and don’t blow it off as a “liberal scheme”, because this is not political. This is people. Remember how this started. Lobbyists trying to make money, using what they KNEW would scare people. “Socialist like Germany”. How many times do we hear single-payer healthcare described like that today? As socialist. As communist. As something that would “never work as well as our American system” that is not working. People were using that fear tactic back in the 1920s. And it’s 100 years later. We can do better. 

We can open our eyes and see that EVERY single other industrialized country has figured out single-payer healthcare. And we can too. We can figure out how to implement a healthcare system that acknowledges everyone’s right to receive healthcare because they are alive and living here and they don’t need to go bankrupt to do it. What if the most stressful thing about getting diagnosed with cancer wasn’t how you are going to pay for it, but how you are going to survive. As if it’s not already stressful enough. Can you just imagine that, and put yourself in the shoes of other people, and say, “Oh, people deserve this.” Even if the current system is okay for you, it is not okay for most people.

If YOU have experienced a lack of healthcare due to either lack of insurance or lack of an ability to hit your deductible, I am sorry. I have been there, I AM there, and it sucks. If you’re comfortable, I would appreciate you leaving your experience in the comments. It doesn’t have to be details, just the general gist. I’ve tried so many times to have this conversation with people and every time it ends the same way:

“Well our system is better.”

“People don’t have insurance because they are lazy.”

“Single-payer is socialist or communist.” 

“The wait times would be too long.” 

As if our wait times aren’t too long. I have to wait nine months to get to primary care. And, have we ever thought that our wait times would also be even longer if EVERYONE had access to healthcare versus only those who could afford it? Other countries might have slightly longer wait times because EVERYONE has access. And it seems like everyone having access is an important thing to make things equal. But we’re not always very good at making things equal. I digress.

So what would I love to see? I would love to see if we could stop with the “well I got mine” attitude. And what do I mean by that? I mean, let’s just stop thinking that if this isn’t an issue for you, wonderful, but I have taken care of a lot of people, and I can tell you that this is an issue for A LOT of people. They don’t have access to healthcare. And I would love if you could help me spread that message. If we all talk about this, we can change it. I really think that. Please share this. please share your experiences. Thanks you so much, and thank you for reading this. Remember, this is a PEOPLE issue, and I so hope we can see it as that and come together to fix it.

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Posted on November 2, 2021 by Liz

The U.S. Health Insurance Crisis

From the start of my channel, my goal has been to educate, whether it  be new nurses, student nurses, working parents, or new parents. Occasionally, I’ve dabbled in other topics that interest me or are important to me, but nursing education has always been at the forefront. Now, after all these years, I’m bringing the two together to hopefully bring attention to a topic that’s not only incredibly important to me, but also affects everyone in this country: our broken health insurance system. 

Health insurance in the United States didn’t just stop working recently, or after the recession, or during COVID, or with the population boom. It’s not the millennials’ fault, it’s not the boomers’ fault, or whoever-you-want-to-blame’s fault. 

The system has been rigged and broken from the start. And that’s not okay. 

Millions of people in our country either can’t afford health insurance or can’t afford to use the insurance they have, and this is a multifaceted problem that will take a lot of work and probably a lot of time to fix. But it can’t get fixed if we don’t start trying. 

It’s so important to start this conversation, so I’m going to do just that. This is the first installment in my U.S. Health Insurance Deep Dive, where I’ll take a deep look at the history of our insurance and care system, focusing on its start and important moments in its history.

Going forward, we’re going to look at how the last few administrations have handled the health crisis, starting with the Obama Administration and the introduction of the Affordable Care Act, moving through the Trump Administration, and finally looking at what the Biden Administration plans do. I’ll also be interviewing people who have experienced this crisis from both sides of the Capitol aisle, and I’m excited to really dig into this conversation with all of you! 

Finally, I’m going to look at what legislation is currently on the books in the capital, what activists are doing at the state and federal levels, and looking at how we can help get better treatment for all Americans. Because all humans deserve quality care. It’s just that simple. 

This is obviously a huge project, and it’s going to take a long time. I’m planning on releasing one video a month, so please stick around and subscribe to my YouTube channel and newsletter, so you never miss an update! 

Alright, let’s get into this! Check out my next post for my first video in the series and the history of our broken system. 

See you there! 

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Posted on November 2, 2021 by Liz

Top 5 Tips for Back to Nursing/NP School

Going back to school is daunting, sometimes scary, often overwhelming, and just all around a lot to handle. But it doesn’t have to be! Here are my five top tips for surviving nursing and NP school. This is, however, just my basic list. For more in-depth information and some words of encouragement, check out my Top 5 Tips video too (click here).


1: Stay Motivated (easier said than done, right? Wrong!)

-Write down why you wanted to go to nursing school, and keep it in your planner or journal as a reminder.

-Create a visual representation of how excited you were to get into nursing school, and keep it with you. 

-Take a moment to reflect on the first two when you are feeling depleted.


2: Organize Your Thoughts and Attitude

-Reframe how you think about nursing school: hard vs. busy

-Give yourself enough time to complete assignments. Cramming will only lead to overwhelm. 

-Get a planner you will actually use. And stickers. Lots of sticker. They’re fun and bring joy. 

-Before school starts, take one day and write down all the assignments and due dates for the entire semester. Color-code based on assignment type. And just let yourself feel overwhelmed on this planning day. It’s the only day you’re looking at the whole picture. 

-Look at your assignments in manageable chunks. Look at what the next 3 weeks look like, and see what you can do this week. Make DOABLE to-do lists. 

-Once tasks are planned out, only look at your current day and focus on those attainable goals. 


3: Learn How to Really Learn and Study New Information

-Don’t just go into studying willy-nilly. Utilize learning programs online, like Lecturio, that focus on science-based teaching and learning methods that encourage natural and effective learning. 

*You can also use my code NURSELIZ to save 50% at Lecturio


4: Don’t Freak Out After Your First Exams and Papers

-Use the first exam to learn the teacher’s style. It’s not the end of the world if you don’t do well. Most people don’t. Unless they are unicorns. 

-Learn from the first exam and change your studying methods accordingly to better serve you going forward. 

-Do practice questions to get used to nursing-style questions. While you are learning, ask yourself how the information would be applicable in real life. 

-Remember, test scores are not an indication of what type of nurse you will be. Don’t dwell on things you can’t change. Learn from them and move on.


5: Understand and Learn to Handle Imposter Syndrome

-Recognize what imposter syndrome is and feels like, so you can identify it in yourself. 

-Know that you are not alone. We all feel this. It is normal and expected. 

-Remember that you CAN do hard things. How do we know? Because you’ve already done SO MANY hard things just to get here. Make a list of those hard things and look at it often. Add to it as you do more hard things. YOU. CAN. DO. THIS!


And that’s my list! What are your top study tricks? Share them below and help other students!

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Posted on August 23, 2021 by Rachel

HOW TO WRITE A PAPER


Rachel’s Quality Control Writing Tips (in no particular order)

Writing is probably one of the more difficult things you’ll have to do in school, whether you’re a “writing” person or not. Sure, maybe it’s easy to write a moderately okay paper that kinda-sorta get’s your point across. But what if that paper is your thesis? Your keystone project? Your final research paper or presentation? Maybe even your application essay? As difficult as writing may seem, it’s also one of the easiest ways to boost your grade or even give you a leg up in the application process. Most of these tips will focus on academic writing, like term and research papers and theses, but some tips are applicable to less expository writing as well, such as application essays. If you want more tips on personal, narrative driven writing (what you’ll use in an application essay), let me or my sister know! I’m happy to help!

First, I want to preface this: These tips cannot replace an editor or proofreader for something like a master’s thesis or a dissertation (please PLEASE use an editor for such important research papers). But, you’ll find they are useful tools for just about everything else. Below are my top five tips for self-driven quality control in your writing, as well as six editing quick-tips I use not only in my own writing, but it my everyday life as an editor.

1: Read it out loud

The brain is an amazing thing, and often, when we read in our heads, it autocorrects missed words or similar but incorrect words, an vs. a for example, as we read them. This is also partially because we aren’t necessarily paying as much attention when we’re reading in our own heads because it’s simply easier than reading aloud.

Reading aloud forces you to stumble over words that are being used incorrectly, phrases that don’t flow, and other common typos. You can read it aloud to yourself and mark where you stumble or you can read it to someone else. This is usually the option I prefer, and I’m about to tell you why.

2: Read it to someone else

A common problem seen by all writers is slowly becoming blind to what you have written. You’ve been dealing with this paper for so long that no matter what you write, it’s going to seem like it makes sense. However, the clarity of your paper is incredibly important. It makes it easier to read and allows you to deliver your information directly and without fuss. It might work for English Lit. majors (no offense to lit majors), but writing papers so confusingly that you have spent five hours writing 15 pages of nothing isn’t gong to get you anywhere in a technical field where your knowledge and ability to present and use that knowledge is more impressive and important than your ability to write a flouncy, verbose paper.

So, how do you make sure your information is being portrayed as clearly and concisely as possible? You find someone who doesn’t have the faintest clue what you’re talking about, or at least, has very minimal knowledge of the field, and you read your paper to them. And look at that; you just ticked off item one, too! When you’re done, ask them if they can tell you what it was about and if they understood it. If they can, excellent! If not, ask them what was unclear and where you could clarify or simplify. Also, encourage them to speak up while you’re reading to them. If something sounds weird or unclear in the moment, fix it and rework it until it is clear.

3: Check your structure

Your paper should be organized in a manner that best showcases the information you’re trying to convey. There are several ways to order your paper, your paragraphs, even sentences, but the two main are ascending importance or time and something I call bookending. Again, please note that these are the main structures for ACADEMIC writing. There are so many different options for narrative or creative writing. But for now, let’s just focus on these two.

Ascending order is exactly what it sounds like; you’re building to a larger conclusion. This works very well if you are defending your research and your individual arguments augment and build upon each other. You want to build the hype.

Bookending works on another writing fundamental: the beginning and end of a paper, section, paragraph, or sentence are the most important. This works well for straight, cut and dry exposition where you aren’t necessarily trying to prove a point but are simply presenting information. Your first and last paragraphs (or sections because, let’s face it, the idea that each paragraph fully comprises your argument is completely ludicrous) should pack a punch and engage your reader (first) and remind them why this is important (last).

Of course, no one said you have to pick just one. Each part of your paper is unique, so really give thought to what you are trying to do with your paper? Are you defending the efficacy of evidence-based practice? Then you’re going to use a mix of structures. You’re going to use ascending order for your main points, but within each section, you’re going to bookend, especially if you’re argument is based on a compare-and-contrast scenario. Give them the opposing argument to start and blow that argument out of the water with your supporting evidence at the end. Fill the middle with some data and evidence and voila! Cake! Or, you know, a compelling argument. Both are nice.

How you present your information is just as important as what your information is, so think carefully on how you’re going to do just that. Other options: are you describing a body system, the nervous system perhaps? Great! Mimic the nervous system in your paper. Start with data input, nerve endings, and end with where all that data ends up, the brain! (ascending) Are you defending the argument that certain preventive measures need to be taken in a specific patient population to enhance quality of life? Bookend that paper! Start with anecdotes of what has gone wrong and how things need to change in that population, give your supporting evidence (usually in ascending order. See, we’re already mixing things up!) and finish with a rousing success story to get your audience motivated. Get creative!

The good news is, structure is pretty easy to fix even when the paper is completely written by simply cutting and pasting. At that point, it just requires some tweaking of transitions.

4: Be mindful of your transitions

Speaking of, nothing will ruin the clarity and flow of your paper faster than a bad transition. And transitions don’t have to be just an introductory sentence; you can use small two-sentence paragraphs between your sections as transitions. Or you can use a specific set of data, or an anecdote. Seriously, just do the opposite of whatever five-sentence/paragraph structure your high school teacher taught you. However, always remember the purpose of your transitions. They should address what you discussed immediately before and how it relates to what you will discuss immediately following. It sounds simple, but you’d be amazed how often transitions are neglected despite their importance. Get creative with your transitions! Have fun!

5: Forget everything you know about conclusions

Oh, conclusions. High school English teachers everywhere ruin their students’ paper-writing skills before they have even had a chance to develop. They tell you your conclusion should review what you’ve spent your entire paper explaining. Why?! This is boring and incredibly unhelpful. Should your conclusion remind your reader what you were arguing and what your topic was? Absolutely! But don’t overdo it. Reiterate what your main argument was or the main topic you were explaining, yes, but then look to the future. Always leave your reader with somewhere to go next. You can either direct them to more information on what you’ve just discussed or point them forward to future developments or processes that could come about because of what you’ve just presented. A conclusion is never meant to be an end; it’s meant to be a guide to further information that builds off yours.


Editing Quick-Tips

Now, you’ve passed quality control, but your paper still needs some polishing. Don’t underestimate the power of good editing and a good editor. Ensuring your paper is as clean and tight as it can be on a technical level is one of the easiest ways to make sure your paper is a step above the rest. Of course, for your major papers, such as theses or dissertations, please hire a professional editor, but for regular research papers, here are some quick tips for pulling it all together.

1: Write yourself a checklist

Okay, so technically, you should do this first, not only to help you write, but to help you make sure you’ve ticked all the boxes. Look at your rubric (and the above quality controls) and create a checklist of everything you need to accomplish with your paper and all the technical criteria you need to meet, such as style. Then, as you read it back, check with that list to make sure you’ve fulfilled all criteria.

2: Create a style cheat-sheet

Figure out what style guide your program uses and create a checklist of the most important conventions and fixes for the most common errors. For most nursing programs, this will be APA style. You can find several of the common rules online, but these things can get complicated. If you’d like, I can create cheat sheets for the most common style guides and provide them to you through Liz. You will be amazing how much you can elevate your paper (and your grade) simply by making sure you adhere neatly to style guide conventions.

3: Be clear, be simple, be concise

Although this was mentioned above, it cannot be overstated. You aren’t aiming to impress your professor with flouncy prose. You are aiming to educate and defend a position. So put down the thesaurus! When you’re editing your paper, be mindful of language that is too complicated. Is it easily understood at first glance? No? Rewrite it. It’s always better to say it once and say it well, then to say it ten different mediocre ways. Another way to check for this is to actually track how many times you’ve used a certain phrase or made a specific point. If you find yourself making the same point over and over again, highlight it or underline it, then go back and figure out what is necessary and what isn’t.

4: MAKE AN OUTLINE

This kind of goes hand-in-hand with number one up there, and, again, do this before you start writing. I can’t tell you how many people think they don’t need to make an outline. Yes, yes you do. This makes the writing process less stressful and gives you a lovely road map for writing and editing your paper. When you’re reading your paper back, if you find it starts to wander away from your strict outline, that’s a sign you need some revision.

5: Take a break

One of the first things I learned when taking my editing courses was that sometimes you just have to step away. You start to become blind to what you’ve written when you’ve worked on the same paper for so long. Take a break between writing and editing your paper so you can look at it with fresh eyes. I actually suggest taking a break between different stages of editing, too. Write, then take a break. Do your quality controls, then take a break. Apply your editing quick-tips, then take a break before your final proof. You’ll be able to catch any mistakes much more easily after some time away. Of course, this only works if you don’t procrastinate, which Liz and I both do. So, yeah.

6: Be mindful of misplaced modifiers

One of the most common mistakes I see is misplaced modifiers. A major linguistic theory finds that like things tend to stay close together in a sentence. Take for example: “Art representing the four seasons by acclaimed artists” is preferred over “Art by acclaimed artists representing the four seasons.” This is because misplaced modifiers cause ambiguity. In the second example “representing the four seasons” could technically be modifying “art” and “artists.” Read your papers carefully and reword to avoid any and all cases of ambiguity. Then voila! You’re done! (Well, really, you can do these in any order, but at least you’re done reading my long ramblings!)


Thank you Rachel for guest writing the above article! Rachel has a BA in English linguistics from Eastern Michigan University and a professional certificate in editing from the University of Chicago Graham School. She’s edited content in academia, marketing, journalism, and creative literature, and she is currently an assistant editor for a graphic novel publisher in the greater Philadelphia area. She also freelances on the side and is a member of the Editorial Freelancers Association. If you would like to work with her for some more personalized editing help with your academic papers, you can contact her at im.rachel.editor@gmail.com.

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Posted on August 20, 2019August 19, 2019 by Liz
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