If you are a burn nurse, I applaud you. You have one of the hardest jobs on the planet. Your work encompasses so many skills: ICU skills, rehab skills, and above all, those sterile dressing skills, working on dressings that often takes hours to complete. I've heard a few stories from my traveling partner, who spent the first part of her career as a RN and NP in a burn unit at a level one trauma center.
John O'Leary's On Fire centers around his experience as a burn victim and the things that happened after this life-changing event.
There are a lot of tear-jerking and inspirational events in this book, but the one that got me was when he saw his favorite nurse years later.
If they ever make this into a movie, that part will have everyone in the audience bawling.
Hope you enjoy it as much as I did. Stay tuned for more book reviews.
Showing posts with label ICU. Show all posts
Showing posts with label ICU. Show all posts
Wednesday, June 15, 2016
Wednesday, May 27, 2015
Dear Surgeon
When you come on the floor, could you actually talk? Grunting and pointing are things Bubba did when he was three years old. Besides, you're not in the OR with a mask on any more. It scares the patients. They think you never smile. (BTW I win bets when you do.)
And finally, please, please, please, do not poke around on folks who have pressure ulcers near bones.
I do not like finding out a patient is in a pool of blood when I turn him/her for the other provider to see his/her wounds because you were just poking around to see what would happen. (Just ask me--I've seen exsanguination like this before.) Dr. X can't see anything with all the blood and I have to get our people to get your people, and then you can't take off on time to go eat your lunch on the veranda with your wife.
It is not fun to volume deplete someone here at the Hotel when getting blood products here is a major, hours long ordeal. We don't have an ICU, so if you screw up, we call 911 and pray.
Thanking you in advance (and I promise I won't trip you in the hallway),
Sincerely not,
RehabRN
And finally, please, please, please, do not poke around on folks who have pressure ulcers near bones.
I do not like finding out a patient is in a pool of blood when I turn him/her for the other provider to see his/her wounds because you were just poking around to see what would happen. (Just ask me--I've seen exsanguination like this before.) Dr. X can't see anything with all the blood and I have to get our people to get your people, and then you can't take off on time to go eat your lunch on the veranda with your wife.
It is not fun to volume deplete someone here at the Hotel when getting blood products here is a major, hours long ordeal. We don't have an ICU, so if you screw up, we call 911 and pray.
Thanking you in advance (and I promise I won't trip you in the hallway),
Sincerely not,
RehabRN
Thursday, May 14, 2015
Things not to do as a nurse, part LVIII
Here's another installment of the popular section on what not to do as a nurse. Listen up, new grads. This is NOT the way to get your 15 minutes of fame.
If you think it is, just remember, NCLEX is getting harder. Here in RehabLand, the pass rate went down, but luckily, the licensing folks are thrilled we are still above the national average pass rate.
Here are a few things that got nurses in RehabLand in trouble lately. Just remember, don't try these at home (or work, either) if you plan on keeping that bright, shiny license.
1. If you're supposed to monitor someone in the ICU, monitor them.
Don't paint your nails, don't go on Facebook, don't blow off the newer nurse you're working with who points out the fact that your patient now has a heart rate of 160 and maybe you should call the doc for orders. Also, when said heart rate goes to 200, don't tell everyone that "I had no idea."
Doesn't work. End of story.
2. If you plead guilty to felony theft, you may lose your license.
Another pretty simple example.
3. Falling in love with a felon could get you in trouble.
No, it's not related to #2, but it could be. Jailhouse Nurse falls for an inmate she's caring for. She goes out and gets him a handcuff key and a gun. To add to the fun, she smokes some marijuana (a friend brought it in from a legal state) and gets caught doing that while with said inmate/felon. Boundary violations are not a good thing.
4. Oxygen saturation is important for everything.
Remember your ABCs: Airway Breathing Circulation. Yes, those are important. Failing to notice low oxygen sats and to do something about it, can get you into licensure trouble.
5. When you are a private duty nurse, you have to be there (both physically and mentally).
Two examples: one nurse decided to run "personal errands" for almost two hours while caring for her private duty patient, who had hourly vital signs. She also "forgot" to chart that "errand."
Another private duty nurse decided to huff some Dust-Off while her patient's mother fell asleep. The mom found the nurse passed out in the living room on the couch, and when aroused he/she was in no state to work.
6. Why you don't want to become Walgreens/CVS/insert favorite drug store here.
This was pretty interesting. Two nurses were cited related to "collecting medications to give to poor/uninsured patients" Surprisingly, my license does not say MD or registered pharmacist, either.
Some medications just should not be shared (one RN took unused vials to reuse).
7. Don't bring medical records home.
Ever. No matter how behind you are at work. Can you say HIPAA? This RN took home records that affected a patient's care. Very ugly.
And finally...
8. Don't spank your patients.
Even if they are kids who wriggle around and smack you on the nose while doing their dressing.
That is all. Stay tuned for more in our next installment.
If you think it is, just remember, NCLEX is getting harder. Here in RehabLand, the pass rate went down, but luckily, the licensing folks are thrilled we are still above the national average pass rate.
Here are a few things that got nurses in RehabLand in trouble lately. Just remember, don't try these at home (or work, either) if you plan on keeping that bright, shiny license.
1. If you're supposed to monitor someone in the ICU, monitor them.
Don't paint your nails, don't go on Facebook, don't blow off the newer nurse you're working with who points out the fact that your patient now has a heart rate of 160 and maybe you should call the doc for orders. Also, when said heart rate goes to 200, don't tell everyone that "I had no idea."
Doesn't work. End of story.
2. If you plead guilty to felony theft, you may lose your license.
Another pretty simple example.
3. Falling in love with a felon could get you in trouble.
No, it's not related to #2, but it could be. Jailhouse Nurse falls for an inmate she's caring for. She goes out and gets him a handcuff key and a gun. To add to the fun, she smokes some marijuana (a friend brought it in from a legal state) and gets caught doing that while with said inmate/felon. Boundary violations are not a good thing.
4. Oxygen saturation is important for everything.
Remember your ABCs: Airway Breathing Circulation. Yes, those are important. Failing to notice low oxygen sats and to do something about it, can get you into licensure trouble.
5. When you are a private duty nurse, you have to be there (both physically and mentally).
Two examples: one nurse decided to run "personal errands" for almost two hours while caring for her private duty patient, who had hourly vital signs. She also "forgot" to chart that "errand."
Another private duty nurse decided to huff some Dust-Off while her patient's mother fell asleep. The mom found the nurse passed out in the living room on the couch, and when aroused he/she was in no state to work.
6. Why you don't want to become Walgreens/CVS/insert favorite drug store here.
This was pretty interesting. Two nurses were cited related to "collecting medications to give to poor/uninsured patients" Surprisingly, my license does not say MD or registered pharmacist, either.
Some medications just should not be shared (one RN took unused vials to reuse).
7. Don't bring medical records home.
Ever. No matter how behind you are at work. Can you say HIPAA? This RN took home records that affected a patient's care. Very ugly.
And finally...
8. Don't spank your patients.
Even if they are kids who wriggle around and smack you on the nose while doing their dressing.
That is all. Stay tuned for more in our next installment.
Saturday, September 24, 2011
Rejection
I think that you have to believe in your destiny; that you will succeed, you will meet a lot of rejection and it is not always a straight path, there will be detours - so enjoy the view. --Michael York
It's been a while since you first came back to the Hotel. Yes, I saw you in the clinic while I was in the SU for a regular visit. "I'm going home if they don't decide to keep me, " you said, as I passed you between patients. Once I saw them put you on the stretcher, I knew you were going to stay.
They brought you back to the Hotel Rehab because you got sick.You had a monstrous UTI but the docs said you were stable enough to stay with us for a bit, until it ran it's course. Unfortunately, the course was not typical or easy.
One day you felt bad and the next, we noticed you were sick, and then the week was over and you were really bad. Pretty soon, you were on the fast track to ICU and they airlifted you to the specialty hospital because you were horribly sick. World Renown Hospital took care of your specialty issue and kept your "lemon" as you called the lump they removed from you (damn med students!) but you just wouldn't wean from the vent. It took about a couple of months, but finally you got off it. You still have a trach, which drives you nuts.
And so, you go back and forth, from illness to getting better and just about done, then back again. But now, you can't go home again. Your family can't deal with the trach and they have their own problems. Your parents are sick and old and falling apart, too. Mom and Dad finally relented and told you, "Son, we love you, but we can't physically do it anymore." Your children have families of their own with lots of work, too.
Now, you cycle through the latest illness and wait. Nursing home after nursing home says maybe they'll take you, then they "decline due to staffing". You are still you: silly, gossipy, funny, grandpa, dad, son, but now everything has changed because of that darned "lemon".
It sucks to be rejected.
It's been a while since you first came back to the Hotel. Yes, I saw you in the clinic while I was in the SU for a regular visit. "I'm going home if they don't decide to keep me, " you said, as I passed you between patients. Once I saw them put you on the stretcher, I knew you were going to stay.
They brought you back to the Hotel Rehab because you got sick.You had a monstrous UTI but the docs said you were stable enough to stay with us for a bit, until it ran it's course. Unfortunately, the course was not typical or easy.
One day you felt bad and the next, we noticed you were sick, and then the week was over and you were really bad. Pretty soon, you were on the fast track to ICU and they airlifted you to the specialty hospital because you were horribly sick. World Renown Hospital took care of your specialty issue and kept your "lemon" as you called the lump they removed from you (damn med students!) but you just wouldn't wean from the vent. It took about a couple of months, but finally you got off it. You still have a trach, which drives you nuts.
And so, you go back and forth, from illness to getting better and just about done, then back again. But now, you can't go home again. Your family can't deal with the trach and they have their own problems. Your parents are sick and old and falling apart, too. Mom and Dad finally relented and told you, "Son, we love you, but we can't physically do it anymore." Your children have families of their own with lots of work, too.
Now, you cycle through the latest illness and wait. Nursing home after nursing home says maybe they'll take you, then they "decline due to staffing". You are still you: silly, gossipy, funny, grandpa, dad, son, but now everything has changed because of that darned "lemon".
It sucks to be rejected.
Tuesday, January 25, 2011
Good excuses
Here are some really good excuses to miss your appointment with your specialist. (some I had lately).
1. You have horrible diarrhea. I am a nurse, but so happy you're not coming in today.
2. You're currently in the ICU (happened to two people lately) which leads to ...
3. You're on a vent. I really believe ABCs apply here.
3. You're on major antibiotics. We can't perform that procedure you want when that happens.
4. You're still on a (name any) major blood thinner. I'm not talking aspirin, folks. If you're on Plavix, Coumadin, Ticlid or a couple of others, we can't work on you, either.
Yet, even with these good ones, there are the run-of-the-mill ones, not so good ones, too.
1. I'm in too much pain.
2. I'm not in pain, so I don't need to come anymore (which is followed up by a call in one week...)
3. The weather is too bad (like it never snows here) or
4. It's too nice to go sit in a doctor's office.
5. Amnesia is always a good excuse. One recently drove the doc nuts. "Well, I was late (missed) because I was at the (fill in the blank) party getting a free lunch."
I'm stopping the list here, but I'm sure all of you office folks get some really good ones.
Stay tuned....more to come.
1. You have horrible diarrhea. I am a nurse, but so happy you're not coming in today.
2. You're currently in the ICU (happened to two people lately) which leads to ...
3. You're on a vent. I really believe ABCs apply here.
3. You're on major antibiotics. We can't perform that procedure you want when that happens.
4. You're still on a (name any) major blood thinner. I'm not talking aspirin, folks. If you're on Plavix, Coumadin, Ticlid or a couple of others, we can't work on you, either.
Yet, even with these good ones, there are the run-of-the-mill ones, not so good ones, too.
1. I'm in too much pain.
2. I'm not in pain, so I don't need to come anymore (which is followed up by a call in one week...)
3. The weather is too bad (like it never snows here) or
4. It's too nice to go sit in a doctor's office.
5. Amnesia is always a good excuse. One recently drove the doc nuts. "Well, I was late (missed) because I was at the (fill in the blank) party getting a free lunch."
I'm stopping the list here, but I'm sure all of you office folks get some really good ones.
Stay tuned....more to come.
Wednesday, June 16, 2010
Fate
"I see it in your eyes. You have the look of a man who accepts what he sees because he is expecting to wake up. Ironically, that's not far from the truth. Do you believe in fate, Neo?" (Morpheus in The Matrix, 1999)
I wish I could wake up. I wish I could see that another person who needed hospice didn't do it in the ICU, but yes, it happened again to a friend's family member.
He/she's resigned and I just shake my head. It could have been different, it could have been different. We become so blind that we cannot see the forest for the trees. A beautiful human being suffered needlessly.
More later...
I wish I could wake up. I wish I could see that another person who needed hospice didn't do it in the ICU, but yes, it happened again to a friend's family member.
He/she's resigned and I just shake my head. It could have been different, it could have been different. We become so blind that we cannot see the forest for the trees. A beautiful human being suffered needlessly.
More later...
Wednesday, May 5, 2010
Low tech, high tech
This story below is from Giacomo, my friend, hospital chaplain at World Renown, a fancy-schmancy level one trauma center.
Giacomo was at the nurses' station in a certain ICU unit, talking to a fellow chaplain, when he noticed something move on the floor. Turns out one of the resident varmints (aka good sized cockroach) ambled into the nurses' station in the middle of day shift.
Giacomo says to the charge nurse, "What's your policy on him?" pointing to said cucharacha. Charge nurse just shrugged and took off.
Being the manly character he is, Giacomo strolls over to the stopped varmint, smashes him and with a tissue, picks it up and buries it in the nearest garbage can.
Giacomo goes back to his spot with the other chaplain and says, "It's nice to know in this high-tech ICU, some things are still low tech." which caused an enormous roar of laughter from the intensivist sitting nearby.
I'll have to remember to tell our chaplain this story the next time he's on the unit....
Giacomo was at the nurses' station in a certain ICU unit, talking to a fellow chaplain, when he noticed something move on the floor. Turns out one of the resident varmints (aka good sized cockroach) ambled into the nurses' station in the middle of day shift.
Giacomo says to the charge nurse, "What's your policy on him?" pointing to said cucharacha. Charge nurse just shrugged and took off.
Being the manly character he is, Giacomo strolls over to the stopped varmint, smashes him and with a tissue, picks it up and buries it in the nearest garbage can.
Giacomo goes back to his spot with the other chaplain and says, "It's nice to know in this high-tech ICU, some things are still low tech." which caused an enormous roar of laughter from the intensivist sitting nearby.
I'll have to remember to tell our chaplain this story the next time he's on the unit....
Saturday, August 8, 2009
Ironies
There are just some things that are very ironic in my job.
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
First, no one expects anyone at the Madison to be efficient. As a professional, I expect my coworkers and team members to act that way, but apparently, it's only an illusion. We have people who are really, really professional, and others, who somehow missed the professional boat. Or it's just a hope, by some of the medical staff, that the nurses will screw up so they have something to complain about.
I'm not a transporter but occasionally, I have to transport my patients, when our one lowly transporter decides to do something else and not bother to notify the nurse manager or the charge nurse. This week, I had a person from another department actually stop me and ask me if "transporter" was somehow now on my badge, since she was so incredulous that RNs actually transport patients to and fro. Yes, Tina, RNs really do transport people in rehab! It's annoying, but it's just one of those tasks we get to do...and things that interrupt us (see page 7 in this article).
Second, doctors really need to have a communication class. For grins, we were reading notes on one of our patients. Note one said patient had been in an ICU situation and has a trach. Said patient wanted to talk so patient told attending, "Take this trach out." Said patient was so seriously ill that attending viewed this as the patient wanting to end his/her life. Attending, probably freaked out by patient wanting to end it all in his/her ICU, consulted psych. Note two said psych visited and patient repeatedly denied wanting to end his/her life. Patient stated, "I just want to take this thing out so I can talk." Can you imagine what would have happened if psych didn't get involved? This could have been the ultimate whoops situation.
One other good thing did occur: patient decided to have a family member act as healthcare POA in the event he/she really can't communicate.
Finally, I'm starting to think life is really like a collection of Seinfeld episodes. One of our patients looked just like a recurring character from the show. Many other folks on the floor (including myself) have bitten our tongues laughing as we want to yell his name as we stroll to his room down the hall. Besides humoring ourselves with this patient, we also spent a lot of the week talking about the Seinfeld episode about the English Patient. Yours truly finally got a copy and watched it...so that Seinfeld finally makes sense. We don't have any English patients, but the ironies of that movie and Seinfeld linger in our little world.
Stay tuned. More merriment to come...
Tuesday, January 13, 2009
Walking...in the ICU?
I can only imagine how many nurses and support staff it will take to get some of these folks out of bed.
We deal with lots of tubes and wires in a rehab setting, but I can only imagine that number squared in an ICU.
We deal with lots of tubes and wires in a rehab setting, but I can only imagine that number squared in an ICU.
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