Yes, I've been thinking about the halycion days of nursing school for me and only one word fits: hazing.
Here's the top 10 reasons why nursing school is a lot of hazing.
10. Everyone gets herded into a big room and then you have to stand in line and get your mug shot taken. This is so all the humiliators, I mean, instructors, know you and you can't hide behind anonymity. Everyone is anxious--what is a care plan, what is a clinical, where do I get comfortable white shoes, anyone got cheap books?
9. You have to learn to wash your hands...again. (Yes, this was one of the first "labs" I participated in during nursing school...no joke!)
8. You have to wear a uniform that rarely looks good on anyone, with or without accessories.
7. You have to sit in large lecture halls for weeks on end with people who are sick and too worried about flunking to stay home. This means any and all germs circulate around the HVAC system, so eventually, everyone gets sick.
6. Instructors wear you down at every turn. You are very, very tired. They make you read hundreds of pages a night for one exam a week. They want you to answer questions in class so they can make you look stupid, even if you have the right answer.
5. Care plans. Enough said. Thank goodness some places have easy to use automated ones!
4. APA paper format. I came from a business background and have long used MLA and Chicago style. APA still sends shivers down my spine just thinking about it.
3. You don't get the true stats on how many nurses survive one year out post school until you're in your last semester. That was when they sprung it on my class in nursing management. (If they told you that in advance, you wouldn't give them the money for nursing school, now would you?)
2. You develop bowel and bladder problems from your clinicals. "This is just like floor nursing," your assigned nurse says. "No one goes to the bathroom on our shift."
and finally...you realize nursing school is like hazing because....
1. You survived nursing school with just a few scars (or sprained ankles, like me, because you tripped in the hall or on the steps) only to get to be the newbie again when you orient to your new job...and surprise! The hazing starts all over again.
Monday, October 6, 2008
Thursday, October 2, 2008
Clinical narratives, nursing and image
I read my latest AJN and there is an article that discusses Benner's concept of clinical narratives and how they work in nursing.
If you read this above-linked PDF in detail, you may already realize that many bloggers, including myself, already describe many of these situations. We may obfuscate, consolidate and agglomerate our people and situations, but the comings and goings of our lives as nurses are on the screen. Take note, that this nursing narrative concept was developed in 1993.
I wonder, if Professor Benner looks out in the blogosphere and sees the narrative she defines in this document. I ask you, the lurkers and the bloggers, to start your story if you haven't written at all and if you have, I ask you, please continue to tell your story.
Besides the narratives, there are things we can do daily. We can project a positive image in how we carry ourselves and how we do our jobs. I got the e-mail below in a mailing list digest which discusses the image of nursing. Note the items in bold below, that I've chosen to highlight.
RE: [ni-wg] Are you proud to be a nurse? (from a faculty member at http://nursing.umaryland.edu/)
"Yes, I am proud to be a nurse, but am I proud of how nursing promotes itself and how others perceive us? Not really. Each semester, I ask my first semester undergraduate NI students to close their eyes, picture a physician and a nurse, and then describe what they see. These students, who have no nursing background, usually describe the physician as middle-aged, well-dressed (frequently wearing a lab coat), and very professional looking man. This description has not changed much over the years – varying little with student age and background, but changing somewhat with race and national origin. The nurse students pictured has changed a great deal over the past several years. At first, many students reported picturing a middle-aged, somewhat matronly looking woman in white, occasionally wearing a cap. However, as the incoming students are getting younger (actually younger, not just in context of my age), the nurses they picture look different. Many students report younger women wearing ill-fitting, multi-colored scrubs with animal prints. They reported them as looking harried and dour. Overall, the reports are of nurses that look overworked, unprofessional, and unhappy. This is not something I am particularly proud of. I asked several students who made such negative reports why they chose nursing if they see it in such a negative light. A common response was that they want to be part of changing nursing from a devalued occupation to a respected profession.
Yes, I am proud to be a nurse. I am even prouder of my students who want to be better nurses than those they pictured in their minds eyes."
Yes, Professor. I am proud, too, and this fuels me to do better.
If you read this above-linked PDF in detail, you may already realize that many bloggers, including myself, already describe many of these situations. We may obfuscate, consolidate and agglomerate our people and situations, but the comings and goings of our lives as nurses are on the screen. Take note, that this nursing narrative concept was developed in 1993.
I wonder, if Professor Benner looks out in the blogosphere and sees the narrative she defines in this document. I ask you, the lurkers and the bloggers, to start your story if you haven't written at all and if you have, I ask you, please continue to tell your story.
Besides the narratives, there are things we can do daily. We can project a positive image in how we carry ourselves and how we do our jobs. I got the e-mail below in a mailing list digest which discusses the image of nursing. Note the items in bold below, that I've chosen to highlight.
RE: [ni-wg] Are you proud to be a nurse? (from a faculty member at http://nursing.umaryland.edu/)
"Yes, I am proud to be a nurse, but am I proud of how nursing promotes itself and how others perceive us? Not really. Each semester, I ask my first semester undergraduate NI students to close their eyes, picture a physician and a nurse, and then describe what they see. These students, who have no nursing background, usually describe the physician as middle-aged, well-dressed (frequently wearing a lab coat), and very professional looking man. This description has not changed much over the years – varying little with student age and background, but changing somewhat with race and national origin. The nurse students pictured has changed a great deal over the past several years. At first, many students reported picturing a middle-aged, somewhat matronly looking woman in white, occasionally wearing a cap. However, as the incoming students are getting younger (actually younger, not just in context of my age), the nurses they picture look different. Many students report younger women wearing ill-fitting, multi-colored scrubs with animal prints. They reported them as looking harried and dour. Overall, the reports are of nurses that look overworked, unprofessional, and unhappy. This is not something I am particularly proud of. I asked several students who made such negative reports why they chose nursing if they see it in such a negative light. A common response was that they want to be part of changing nursing from a devalued occupation to a respected profession.
Yes, I am proud to be a nurse. I am even prouder of my students who want to be better nurses than those they pictured in their minds eyes."
Yes, Professor. I am proud, too, and this fuels me to do better.
Wednesday, October 1, 2008
Nuggets for October 1
Here are a few goodies I've encountered on my meanderings on the internet recently. Enjoy!
From the blogosphere...
Hell on White Clogs had this crazy scenario involving Google and residents on fhe floor of one unit. All I have to say is...I'd have to say no to that cath if I didn't see the "real doc" with experience, thank you very much!
ImpactEDnurse had this post about helminth therapy...ugh! I think I'll have to show my allergist this one. I'd be scratching my eyes out, too.
Code blog has this story of the Bigger Picture. Oh, yes, I go there so many times. What do they not understand?
Out in news land...
The Chicago Tribune had this recent article about ways to combat compassion fatigue (aka burnout) among nurses.
The NY Times is running a special section called Decoding Your Health. In today's installment the author discusses using the internet to get medical information. I particularly like this line, "The goal is to find an M.D., not become one."
TV station KTTC of Rochester, MN ran this article about nurse practitioners recently on their web site. It also points out that Nurse Practioner Week is November 9th through the 15th.
NursingLink has this article about avoiding back injuries, which is a good thing, no matter what type of setting.
A subject near and dear to a rehab nurse's heart...bowel routines. Since it was recently National Rehabilitation Awareness Week, this article discusses how one Delaware hospital works with patients to relieve constipation.
From the blogosphere...
Hell on White Clogs had this crazy scenario involving Google and residents on fhe floor of one unit. All I have to say is...I'd have to say no to that cath if I didn't see the "real doc" with experience, thank you very much!
ImpactEDnurse had this post about helminth therapy...ugh! I think I'll have to show my allergist this one. I'd be scratching my eyes out, too.
Code blog has this story of the Bigger Picture. Oh, yes, I go there so many times. What do they not understand?
Out in news land...
The Chicago Tribune had this recent article about ways to combat compassion fatigue (aka burnout) among nurses.
The NY Times is running a special section called Decoding Your Health. In today's installment the author discusses using the internet to get medical information. I particularly like this line, "The goal is to find an M.D., not become one."
TV station KTTC of Rochester, MN ran this article about nurse practitioners recently on their web site. It also points out that Nurse Practioner Week is November 9th through the 15th.
NursingLink has this article about avoiding back injuries, which is a good thing, no matter what type of setting.
A subject near and dear to a rehab nurse's heart...bowel routines. Since it was recently National Rehabilitation Awareness Week, this article discusses how one Delaware hospital works with patients to relieve constipation.
Tuesday, September 30, 2008
Vacation...all I ever wanted!
Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Sunday, September 28, 2008
Not so late
Thankfully, everyone showed up for the night crew. I was warned in advance because as a rule, the charge nurse must stay over if anyone is missing from this shift. Since our charge had already volunteered to work as the fourth person, if someone called in, I'd have to stay. (We have other people who could, but usually they decline or have already left by the end of shift...which is a whole other story). Alas, this did not come to pass.
I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.
I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.
My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.
Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!
More later.
I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.
I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.
My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.
Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!
More later.
Saturday, September 27, 2008
Shifting gears
RIP Paul Newman...now there was a guy who could really shift gears!
Yes, I'm back to the evening shift and so far, things have not been too bad. I've had two patients and a med cart to lug around, but since our census is lower than it's been in a while, it's not too terrible. Our nurse who's famous for calling in on his/her shift to work on Friday even showed up last night.
Our census may stay low for a while since we don't have too many admissions scheduled for next week and only one or maybe two discharges. I'm sure all of the admissions will wait until I come back from my time off next week (Sometimes I think my middle name should be Murphy...as in Murphy's Law.)
My patients have been pretty good considering everything. Mr. AB #1 was back on my list. For some reason, I don't complain about people and I get to take care of the same people over and over. I hear my co-workers say things like, "If I have Mr. X for another day, I'll kill myself." so the boss reassigns them...to me. I must have "team player" or something stamped on my forehead in invisible ink, since I'm always "taking one for the team." At this point, I'm beginning to think that some of my coworkers have more mental issues than some of our patients, or just a heck of a case of compassion fatigue. I think my own compassion fatigue and stress from being the newbie has resolved itself...for now, anyway.
Mr. R. is also one of my customers. He's a trainwreck, who's heading to Washington this week for surgery. He's been made aware that it's very likely he could die during the surgery or not be weaned off a vent after, but he's going for it anyway. His chances of long-term survival are slim. I watch him very carefully, and thankfully, he's been pretty calm when I'm working. He desats when we reposition him in bed, so it makes things really interesting. The one good thing is that his bed actually goes into Trendelenburg mode, so we can move him more quickly and easily.
Finally, I have been busy planning in my off time along with other things, like buying a new furnace and air conditioner (ours is 20 years old and the furnace is dead) and going to doctors appointments. I'll get to do some fun stuff (manicure and pedicure) before Dahey and I go out and celebrate our anniversary. What joy! I love the pedicure place and by a stroke of luck, I found out about a deal with them, and it starts next week!
Gotta run and do work before I go to work. More later...
Yes, I'm back to the evening shift and so far, things have not been too bad. I've had two patients and a med cart to lug around, but since our census is lower than it's been in a while, it's not too terrible. Our nurse who's famous for calling in on his/her shift to work on Friday even showed up last night.
Our census may stay low for a while since we don't have too many admissions scheduled for next week and only one or maybe two discharges. I'm sure all of the admissions will wait until I come back from my time off next week (Sometimes I think my middle name should be Murphy...as in Murphy's Law.)
My patients have been pretty good considering everything. Mr. AB #1 was back on my list. For some reason, I don't complain about people and I get to take care of the same people over and over. I hear my co-workers say things like, "If I have Mr. X for another day, I'll kill myself." so the boss reassigns them...to me. I must have "team player" or something stamped on my forehead in invisible ink, since I'm always "taking one for the team." At this point, I'm beginning to think that some of my coworkers have more mental issues than some of our patients, or just a heck of a case of compassion fatigue. I think my own compassion fatigue and stress from being the newbie has resolved itself...for now, anyway.
Mr. R. is also one of my customers. He's a trainwreck, who's heading to Washington this week for surgery. He's been made aware that it's very likely he could die during the surgery or not be weaned off a vent after, but he's going for it anyway. His chances of long-term survival are slim. I watch him very carefully, and thankfully, he's been pretty calm when I'm working. He desats when we reposition him in bed, so it makes things really interesting. The one good thing is that his bed actually goes into Trendelenburg mode, so we can move him more quickly and easily.
Finally, I have been busy planning in my off time along with other things, like buying a new furnace and air conditioner (ours is 20 years old and the furnace is dead) and going to doctors appointments. I'll get to do some fun stuff (manicure and pedicure) before Dahey and I go out and celebrate our anniversary. What joy! I love the pedicure place and by a stroke of luck, I found out about a deal with them, and it starts next week!
Gotta run and do work before I go to work. More later...
Wednesday, September 24, 2008
Life's comings and goings
Lots and lots of stuff happening this week...so today on my day off, I'm doing the usual errands including taking our dog to the groomer. He hates getting a bath, but he needs it. He's been shedding like mad and really needs the haircut.
The story of the last few days has involved that famous (or infamous) condom catheter.
They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.
Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)
We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.
More goodies later....gotta take the dog to his groomer.
The story of the last few days has involved that famous (or infamous) condom catheter.
They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.
Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)
We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.
More goodies later....gotta take the dog to his groomer.
Saturday, September 20, 2008
Heard on the unit...
Here are a few of the gems I heard this weekend on our unit.
"I'm getting my own room in front to be closer to you." Mr. J.
Mr. J. said this to me when he got moved up to our private room when Ms. R. left this week.
What did he do to win the suite, you ask? Why he came up positive on his last UAC&S for acinetobacter in addition to the MRSA he already has in his wound. He was just saying that because my boss seems to assign me to the patients on the front end of the unit a lot more than the back.
"Ah. My Pepsi angel!" Mr. K.
I brought in a couple for him to keep him quiet but it didn't work. His behavior may or may not have been related to his suddenly missing Gabapentin order. He's got it back now and is more lucid than he's been in days.
"I hear the boss is alphabetizing everyone." Mr. J. (again)
Mr. J. got booted from his private suite when the other Mr. J. came up positive for acinetobacter, too. Besides that, two of our Mr. HIJ's (not their real names, but they are similar) got put in the same room, too, because the boss needed a three-bed room available for our new admissions next week. So much for avoiding similar names in the same room. It just makes for more excitement with the bed bingo that always seems to happen on our unit.
"I'm getting my own room in front to be closer to you." Mr. J.
Mr. J. said this to me when he got moved up to our private room when Ms. R. left this week.
What did he do to win the suite, you ask? Why he came up positive on his last UAC&S for acinetobacter in addition to the MRSA he already has in his wound. He was just saying that because my boss seems to assign me to the patients on the front end of the unit a lot more than the back.
"Ah. My Pepsi angel!" Mr. K.
I brought in a couple for him to keep him quiet but it didn't work. His behavior may or may not have been related to his suddenly missing Gabapentin order. He's got it back now and is more lucid than he's been in days.
"I hear the boss is alphabetizing everyone." Mr. J. (again)
Mr. J. got booted from his private suite when the other Mr. J. came up positive for acinetobacter, too. Besides that, two of our Mr. HIJ's (not their real names, but they are similar) got put in the same room, too, because the boss needed a three-bed room available for our new admissions next week. So much for avoiding similar names in the same room. It just makes for more excitement with the bed bingo that always seems to happen on our unit.
Fun Friday
This happens when one, the census is down, two, both of your patients have doctor's appointments at the same time and three, you are not working the weekend. Oh, what joy!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
Friday, September 19, 2008
Ahoy! CoS is up and running, mate!
Yes, it's Talk like a Pirate day today, and so the latest installment of Change of Shift has a pirate theme over at crzegrl's place.
This swabby even has a post noted there. Thanks a ton, mate!
This swabby even has a post noted there. Thanks a ton, mate!
Tuesday, September 16, 2008
Nuggets for September 16
Yes, I'm off today, so I'm surfing again before I start the real vice...baking. Fall has come to our neck of the woods, the furnace is dead, so why not heat up the house by baking!
To the blogs we go...
Alas, here are a couple of newer blogs I've found since I was reading my sitemeter stats today. You gotta love the link love! Many, many thanks to all of you who link to this blog. I appreciate it! (Mucho, mucho, mucho...as I tell Bubba).
PerfectRN is also a second career RN like me in the Midwest (yes!) who's chronicling her adventures in her blog.
And via PerfectRN, I found Booty Nurse (what will Google do with that...whoa!) who's giving us her view from Endoscopy in rural New England. BN, I gotta tell you, I thought endoscopy was pretty cool when I saw it on my clinicals. And no, I'm not just saying that to get any brownie points from my brother-in-law, the gastroenterologist. He's the man who loves Katie Couric because of this story.
DisappearingJohn is one of my favorite ER RN bloggers. I loved this quote he found from atyourcervix. John, if you only knew how much poop (literal and figurative) there is on evenings in rehab!
Articles of note from the NY Times
ER patients often left confused after visits
This should be an interesting topic on all the other ER nurse blogs (MonkeyGirl, GuitarGirlRN, DisappearingJohn, etc.) I doubt this author actually talked to one nurse. If she did, she camoflages it well.
The strep that wasn't...a cautionary tale
This was a scary story. If you have kids, you must read this one. It really scared me.
Spit it out...the DNA testing fad
This was actually listed under the Fashion section, but it does have some health implications. Who'd a thought DNA would turn glam? Ah, yes, the CSI effect...
Death and a new nurse
Another second career nurse describes her thoughts on this subject and what happened to her.
A good cause
If you want to help military and veteran families who are in the hospital, support your local Fisher House.
A Fisher House is “a home away from home” for families of patients receiving medical care at major military and VA medical centers. The homes are normally located within walking distance of the treatment facility or have transportation available. There are 38 Fisher Houses located on 18 military installations and nine VA medical centers. Five more houses are under construction.
We're still waiting for ours at Madison. It's on the drawing board, though.
To the blogs we go...
Alas, here are a couple of newer blogs I've found since I was reading my sitemeter stats today. You gotta love the link love! Many, many thanks to all of you who link to this blog. I appreciate it! (Mucho, mucho, mucho...as I tell Bubba).
PerfectRN is also a second career RN like me in the Midwest (yes!) who's chronicling her adventures in her blog.
And via PerfectRN, I found Booty Nurse (what will Google do with that...whoa!) who's giving us her view from Endoscopy in rural New England. BN, I gotta tell you, I thought endoscopy was pretty cool when I saw it on my clinicals. And no, I'm not just saying that to get any brownie points from my brother-in-law, the gastroenterologist. He's the man who loves Katie Couric because of this story.
DisappearingJohn is one of my favorite ER RN bloggers. I loved this quote he found from atyourcervix. John, if you only knew how much poop (literal and figurative) there is on evenings in rehab!
Articles of note from the NY Times
ER patients often left confused after visits
This should be an interesting topic on all the other ER nurse blogs (MonkeyGirl, GuitarGirlRN, DisappearingJohn, etc.) I doubt this author actually talked to one nurse. If she did, she camoflages it well.
The strep that wasn't...a cautionary tale
This was a scary story. If you have kids, you must read this one. It really scared me.
Spit it out...the DNA testing fad
This was actually listed under the Fashion section, but it does have some health implications. Who'd a thought DNA would turn glam? Ah, yes, the CSI effect...
Death and a new nurse
Another second career nurse describes her thoughts on this subject and what happened to her.
A good cause
If you want to help military and veteran families who are in the hospital, support your local Fisher House.
A Fisher House is “a home away from home” for families of patients receiving medical care at major military and VA medical centers. The homes are normally located within walking distance of the treatment facility or have transportation available. There are 38 Fisher Houses located on 18 military installations and nine VA medical centers. Five more houses are under construction.
We're still waiting for ours at Madison. It's on the drawing board, though.
Monday, September 15, 2008
How to know the moon is full
Listen up, all you nursing students, although you may have thought meteorology has nothing to do with nursing outside of being listed before it in the class schedule, the full moon can make a difference on your unit.
In my short time as a student and so far as a nurse, I've heard from psych to labor and delivery to LTC nurses that the change in the phases of the moon brings out the strange and unusual more than you'd think.
Well, since yesterday was the full moon, here's a few of the fun things that happened at Madison.
1. The crazy people get crazier. Yes, lil' ol' Mr. K. keeps forgetting he's a quad, even when he's reoriented, and in between, he even acts lucid. Last night's installment: he kept wanting to put on his pants and get up, so he kept ringing his call light. Not even the two Pepsis (he loves Pepsi so much they could use him in ads) I brought in as a bribe kept him quiet.
I'm starting to like the idea of aerosolized Haldol for not just patients, but some of my coworkers.
2. Your coworkers get edgy. When I asked about Mr. K. and his light buzzing, I remarked, "Wow, has he been quiet all night?" since Mr. K. did not buzz once while I was sitting at the nurses' station (which was not long). The Slug, true to her pain in the backside self replied, "You've been smoking crack."
Nevertheless, I blew her off, since I spent most of my night actually on the floor with patients, while she sat by the phone and played secretary in between her med passes. It's actually better for her to sit by the phone because whenever you work with her, because you'll get about 20-25 calls a night and 99% will be for her. It's just a whole lot easier not being at the desk so you don't have to be her secretary.
3. The normally quiet people decide they need something...now! Mr. H. decided to do this last night before the end of shift. I guess he got tired of me going into his room and always giving his roomies their PRN pain meds. I've delivered meds on his hall for a while and this was the first time I've ever given him a pain med.
One of his roommates is a basket case. He's taking every psych drug, pain pill, and sleeping pill we'll give him. That's what happens when you can't deal with the life you've created on the outside. The roomie is having problems with his wife and infidelity again. The story gets better and better--he was with the other woman when he was injured and she is having his baby. Other Woman decided to let the wife know once he was injured. Said wife was really perturbed when he visited Labor Day weekend.
With real-life stories like this, who needs to watch a soap?
4. Although it's not related to the full moon here in our neck of the woods, the weather's been crazy. Ike's remnants flew through the midwestern US and left us with a whole bunch of water. Lots of low-lying areas around here that don't normally flood filled up really fast. We had fun taking not one but two detours to get to a family reunion yesterday. After the second one, I told Dahey to just go back home and take the route closest to our house, since that doesn't normally flood and it worked out well. I just wish we could have stayed longer at the reunion. It stunk having to leave and go to work.
One more evening, then back to days. Stay tuned for all the excitement.
In my short time as a student and so far as a nurse, I've heard from psych to labor and delivery to LTC nurses that the change in the phases of the moon brings out the strange and unusual more than you'd think.
Well, since yesterday was the full moon, here's a few of the fun things that happened at Madison.
1. The crazy people get crazier. Yes, lil' ol' Mr. K. keeps forgetting he's a quad, even when he's reoriented, and in between, he even acts lucid. Last night's installment: he kept wanting to put on his pants and get up, so he kept ringing his call light. Not even the two Pepsis (he loves Pepsi so much they could use him in ads) I brought in as a bribe kept him quiet.
I'm starting to like the idea of aerosolized Haldol for not just patients, but some of my coworkers.
2. Your coworkers get edgy. When I asked about Mr. K. and his light buzzing, I remarked, "Wow, has he been quiet all night?" since Mr. K. did not buzz once while I was sitting at the nurses' station (which was not long). The Slug, true to her pain in the backside self replied, "You've been smoking crack."
Nevertheless, I blew her off, since I spent most of my night actually on the floor with patients, while she sat by the phone and played secretary in between her med passes. It's actually better for her to sit by the phone because whenever you work with her, because you'll get about 20-25 calls a night and 99% will be for her. It's just a whole lot easier not being at the desk so you don't have to be her secretary.
3. The normally quiet people decide they need something...now! Mr. H. decided to do this last night before the end of shift. I guess he got tired of me going into his room and always giving his roomies their PRN pain meds. I've delivered meds on his hall for a while and this was the first time I've ever given him a pain med.
One of his roommates is a basket case. He's taking every psych drug, pain pill, and sleeping pill we'll give him. That's what happens when you can't deal with the life you've created on the outside. The roomie is having problems with his wife and infidelity again. The story gets better and better--he was with the other woman when he was injured and she is having his baby. Other Woman decided to let the wife know once he was injured. Said wife was really perturbed when he visited Labor Day weekend.
With real-life stories like this, who needs to watch a soap?
4. Although it's not related to the full moon here in our neck of the woods, the weather's been crazy. Ike's remnants flew through the midwestern US and left us with a whole bunch of water. Lots of low-lying areas around here that don't normally flood filled up really fast. We had fun taking not one but two detours to get to a family reunion yesterday. After the second one, I told Dahey to just go back home and take the route closest to our house, since that doesn't normally flood and it worked out well. I just wish we could have stayed longer at the reunion. It stunk having to leave and go to work.
One more evening, then back to days. Stay tuned for all the excitement.
Sunday, September 14, 2008
Remnants of Ike...no Tina
Yes, we're getting that rain here in our neck of the Midwest. The yard now has a big lake in it. Three of my five evening shifts are done and the last few days have been interesting enough.
Friday I went to a prescription drug abuse seminar put on by a local psych hospital. They even had free CEs for the RNs and all sorts of goodies. I registered via e-mail and got a confirmation but I forgot to bring the e-mail along. I show up early figuring my name is on the lists there and my name is no where to be found (for CE people and non-CE people). I was very agitated about this, but a lot of other people were, too, (and they actually paid for the CEs and need them this month for their various licenses) so I decided the best course of action was to find the local Starbucks, get a coffee and read my e-mail.
I had plans for lunch, so I found a Starbucks in the neighborhood, so I didn't have to drive around in rush hour traffic. I couldn't get on to the wifi hotspot on my Palm, so I read my Rehabilitation Nursing magazine from cover to cover (it's on polytrauma), which I had meant to do for a couple of weeks. It was a good read and I highly recommend it. I wanted my e-mail, though, so I headed up the street to a local eatery that had accessible wifi and I found a nice booth and newspaper and I read my e-mail and the paper until lunchtime. It was a diversion, but a pleasant one nevertheless.
After my fun surfing and reading, I met my friend C. for lunch. C. was happy I got bumped so she could escape the office a little earlier. We had a great time.
At work, I've been lucky enough again to be pushing the med cart. Supposedly, we get a less taxing assignment when we're giving pills, but it's not necessarily the case. I had the AB boys (that's what I'm calling them because of their bug--acinetobacter) up in the front and it was hellish. The room was so hot. Something is wrong with the HVAC system and these guys have fans, but to go in their room garbed up in an isolation gown makes me sweat like mad. It's a lot of work. They can be needy. Thankfully, C. the charge on Thursday kept them quiet for me while I adjusted to being back at work and on the pill delivery route, which, incidentally is all the way at the other end of the unit. (Our boss is really good at crazy geographical assignments like that!)
Outside of that, our new schedule came out and yes, I did actually get those vacation days I asked for recently. I got lucky and found a couple of blank spots on the calendar and asked my boss if I could take off three days in October and three days in November. I'll actually be away for six whole days, since those days are right before my normal weekend off. My husband Dahey is going to surprise me this year for our anniversary. He's making all the plans. All I have to do is show up. At least that was a good excuse for buying a new dress and some other new clothes recently. Bubba will be hanging out with my friend's boys while we're out, so he should have fun.
More later. Stay tuned.
Friday I went to a prescription drug abuse seminar put on by a local psych hospital. They even had free CEs for the RNs and all sorts of goodies. I registered via e-mail and got a confirmation but I forgot to bring the e-mail along. I show up early figuring my name is on the lists there and my name is no where to be found (for CE people and non-CE people). I was very agitated about this, but a lot of other people were, too, (and they actually paid for the CEs and need them this month for their various licenses) so I decided the best course of action was to find the local Starbucks, get a coffee and read my e-mail.
I had plans for lunch, so I found a Starbucks in the neighborhood, so I didn't have to drive around in rush hour traffic. I couldn't get on to the wifi hotspot on my Palm, so I read my Rehabilitation Nursing magazine from cover to cover (it's on polytrauma), which I had meant to do for a couple of weeks. It was a good read and I highly recommend it. I wanted my e-mail, though, so I headed up the street to a local eatery that had accessible wifi and I found a nice booth and newspaper and I read my e-mail and the paper until lunchtime. It was a diversion, but a pleasant one nevertheless.
After my fun surfing and reading, I met my friend C. for lunch. C. was happy I got bumped so she could escape the office a little earlier. We had a great time.
At work, I've been lucky enough again to be pushing the med cart. Supposedly, we get a less taxing assignment when we're giving pills, but it's not necessarily the case. I had the AB boys (that's what I'm calling them because of their bug--acinetobacter) up in the front and it was hellish. The room was so hot. Something is wrong with the HVAC system and these guys have fans, but to go in their room garbed up in an isolation gown makes me sweat like mad. It's a lot of work. They can be needy. Thankfully, C. the charge on Thursday kept them quiet for me while I adjusted to being back at work and on the pill delivery route, which, incidentally is all the way at the other end of the unit. (Our boss is really good at crazy geographical assignments like that!)
Outside of that, our new schedule came out and yes, I did actually get those vacation days I asked for recently. I got lucky and found a couple of blank spots on the calendar and asked my boss if I could take off three days in October and three days in November. I'll actually be away for six whole days, since those days are right before my normal weekend off. My husband Dahey is going to surprise me this year for our anniversary. He's making all the plans. All I have to do is show up. At least that was a good excuse for buying a new dress and some other new clothes recently. Bubba will be hanging out with my friend's boys while we're out, so he should have fun.
More later. Stay tuned.
Thursday, September 11, 2008
Nuggets for September 11
First of all, I pause to remember those lost this day seven years ago. It's hard to believe it's been that long ago, and that I was living another life as an IT person. How things have changed!
A few of these items have been hanging out on my list for a while, so I will pass them along, right after I get off my soapbox on this first one.
No, this is not in my area of rehab per se, but due to a connection with an expert in the field, I feel a need to discuss this.
WARNING: Soapbox ahead!
Nurse.com has a great article about radiation safety. How does this affect you, you say? Well, if you work in an area where portable x-rays are done regularly, you are a student hanging out in such areas or if you accompany your patients to x-ray or any other radiological procedure and have to position them while the machine runs as I sometimes do, this article applies to you.
Mainly, follow the guidelines noted in this article. If you are supposed to wear your dosimetry badge, wear it. If you are hanging out in the PACU and they want to do a portable on someone in one of the bays, go hang out across the room behind a wall. If you position patients during a procedure, keep your hands out of the beam and wear your lead apron. If you remotely think you are pregnant, tell someone and stay out. If you have any questions, ask for the radiation safety officer and/or his/her's designate to know what's going on in your facility.
By doing this, hopefully, you'll help guarantee a long career as a nurse. That is all. End of soapbox.
Now for a few other items I've run into lately...
Dementia and Margaret Thatcher. This article discusses the book released in the UK by Thatcher's daughter and the ethics of such a release. (from the Blogs section of http://www.nytimes.com/)
http://newoldage.blogs.nytimes.com/2008/09/02/margaret-thatchers-open-secret/
VA voter drives anytime soon? We shall see. None yet at Madison, anyway. (from http://www.nytimes.com/)
http://www.nytimes.com/2008/09/09/us/politics/09vets.html
This article discusses all of the places you'll find technology in use by nurses. (from http://www.nursinglink.com/)
http://www.nursinglink.com/careers/5322-technology-in-nursing
And for something completely different, check out Tex's post about working with women and why he loves it. I can identify with the flipping part, Tex. Lots and lots of flipping in rehab!
A few of these items have been hanging out on my list for a while, so I will pass them along, right after I get off my soapbox on this first one.
No, this is not in my area of rehab per se, but due to a connection with an expert in the field, I feel a need to discuss this.
WARNING: Soapbox ahead!
Nurse.com has a great article about radiation safety. How does this affect you, you say? Well, if you work in an area where portable x-rays are done regularly, you are a student hanging out in such areas or if you accompany your patients to x-ray or any other radiological procedure and have to position them while the machine runs as I sometimes do, this article applies to you.
Mainly, follow the guidelines noted in this article. If you are supposed to wear your dosimetry badge, wear it. If you are hanging out in the PACU and they want to do a portable on someone in one of the bays, go hang out across the room behind a wall. If you position patients during a procedure, keep your hands out of the beam and wear your lead apron. If you remotely think you are pregnant, tell someone and stay out. If you have any questions, ask for the radiation safety officer and/or his/her's designate to know what's going on in your facility.
By doing this, hopefully, you'll help guarantee a long career as a nurse. That is all. End of soapbox.
Now for a few other items I've run into lately...
Dementia and Margaret Thatcher. This article discusses the book released in the UK by Thatcher's daughter and the ethics of such a release. (from the Blogs section of http://www.nytimes.com/)
http://newoldage.blogs.nytimes.com/2008/09/02/margaret-thatchers-open-secret/
VA voter drives anytime soon? We shall see. None yet at Madison, anyway. (from http://www.nytimes.com/)
http://www.nytimes.com/2008/09/09/us/politics/09vets.html
This article discusses all of the places you'll find technology in use by nurses. (from http://www.nursinglink.com/)
http://www.nursinglink.com/careers/5322-technology-in-nursing
And for something completely different, check out Tex's post about working with women and why he loves it. I can identify with the flipping part, Tex. Lots and lots of flipping in rehab!
Wednesday, September 10, 2008
The colors of rehab
Yes, you'd see a lot of colors on our unit, and it's not just in the scrubs worn by the staff. There are colors in therapy--yellow, pink, blue Theraputty in those tubs. Next, you have the therabands in blue, green and red. The drugs even have pretty colors, too--the clear dark-red of guaifenesin, the fruity-smelling, clear with a gold tinge of liquid Neurontin, the neon yellow-green of Tygacil. Our patients have colorful equipment, too--the red, blue, black, silver, American flag print, green and even purple wheelchairs.
Also, if you didn't know it already, you see a lot of colors in the input and output for patients. The strangest thing I ever saw on a bed pad recently was an aqua-blue serous looking drainage. The patient never had it during the day, because I looked each time I turned him. I told the docs about it on Monday and everyone just said, "Oh well," and that was it.
So yesterday, I saved the pad after I cleaned him up and bluish dressing. The docs didn't figure it out right away, but the NPs took one look and they did. "Pseudomonas!", they chimed in chorus. "We have to get something to put on that dressing." MA ordered Iodaform gel, but we couldn't get it by the end of the day, so she gave me a new order to use Gentamicin cream with the dressing until the gel arrives. I fixed him up, fluffed, buffed and turned him and before I knew it, it was time to go home.
Outside, the sky was a brilliant, sun-filled blue with just a hint of the fall coolness to come and the end of another interesting day. More later!
Also, if you didn't know it already, you see a lot of colors in the input and output for patients. The strangest thing I ever saw on a bed pad recently was an aqua-blue serous looking drainage. The patient never had it during the day, because I looked each time I turned him. I told the docs about it on Monday and everyone just said, "Oh well," and that was it.
So yesterday, I saved the pad after I cleaned him up and bluish dressing. The docs didn't figure it out right away, but the NPs took one look and they did. "Pseudomonas!", they chimed in chorus. "We have to get something to put on that dressing." MA ordered Iodaform gel, but we couldn't get it by the end of the day, so she gave me a new order to use Gentamicin cream with the dressing until the gel arrives. I fixed him up, fluffed, buffed and turned him and before I knew it, it was time to go home.
Outside, the sky was a brilliant, sun-filled blue with just a hint of the fall coolness to come and the end of another interesting day. More later!
Saturday, September 6, 2008
ARN journal now online
If you're a member of the Association of Rehabilitation Nurses, you can now access the journal Rehabilitation Nursing online at http://www.rehabnurse.org/. VA nurses: take note. This new issue is dedicated to polytrauma and has some great articles about OIF/OEF veterans who are suffering from multiple injuries.
Rehabnurse.org is a great site, especially if you're looking for information about being a rehab nurse. It's especially advantageous, since you get access to regular free CEs online.
In addition, you can also find some great general rehab-oreinted documents. Specifically, I found a guide on bowel care, which is a very important part of the rehab process. As my old friend G. used to tell me, "rehab is all about bowel, bladder and skin."
Rehabnurse.org is a great site, especially if you're looking for information about being a rehab nurse. It's especially advantageous, since you get access to regular free CEs online.
In addition, you can also find some great general rehab-oreinted documents. Specifically, I found a guide on bowel care, which is a very important part of the rehab process. As my old friend G. used to tell me, "rehab is all about bowel, bladder and skin."
Friday, September 5, 2008
TGIF, baby!
Oh, I rejoice! The weekend is here...and I'm not working down at Madison. Hooray!
The last three days have been fun, really, with ol' Mr. K. and Mr. J., especially since Mr. K. is getting his Haldol titrated, and having less hallucinations, but today was busy, even though at 1020, I was ahead of the game.
I was still driving the drug wagon as the med nurse on the most populous hall (we have 13 people here instead of the 11 on the other one...), but luckily, people weren't so agitated about how fast I got them their pain meds. Sometimes, the natives get a little restless down there...I really wanted to kill the Slug today, because she was being so onery and lazy about doing the accuchecks to which she was assigned. To relax, I sat in my car and ate lunch and charged my phone. I did not want to sit one minute in the lunch room with her, because I would have put my license at risk. (Going to Federal prison for killing her is not on my list of things to do right now!) It was lovely! It was only 15 minutes (I came in and checked my e-mail at the nurses' station for the other 15) but it was an oasis. I'm not going to detail everything, but I find that escape does have its advantages, especially when you're contemplating killing your co-worker for being such a slack.
The rest of the afternoon went well. Everyone got their pain pills, their Ativan and whatever fixed their ailments, including pillow fluffing, so they were happy. I got to hand over the keys to my med cart to K., instead of B., which was also a relief. He's another story, but I only deal with him on evenings, so I won't worry until next week!
Happy weekend! More later...stay tuned.
The last three days have been fun, really, with ol' Mr. K. and Mr. J., especially since Mr. K. is getting his Haldol titrated, and having less hallucinations, but today was busy, even though at 1020, I was ahead of the game.
I was still driving the drug wagon as the med nurse on the most populous hall (we have 13 people here instead of the 11 on the other one...), but luckily, people weren't so agitated about how fast I got them their pain meds. Sometimes, the natives get a little restless down there...I really wanted to kill the Slug today, because she was being so onery and lazy about doing the accuchecks to which she was assigned. To relax, I sat in my car and ate lunch and charged my phone. I did not want to sit one minute in the lunch room with her, because I would have put my license at risk. (Going to Federal prison for killing her is not on my list of things to do right now!) It was lovely! It was only 15 minutes (I came in and checked my e-mail at the nurses' station for the other 15) but it was an oasis. I'm not going to detail everything, but I find that escape does have its advantages, especially when you're contemplating killing your co-worker for being such a slack.
The rest of the afternoon went well. Everyone got their pain pills, their Ativan and whatever fixed their ailments, including pillow fluffing, so they were happy. I got to hand over the keys to my med cart to K., instead of B., which was also a relief. He's another story, but I only deal with him on evenings, so I won't worry until next week!
Happy weekend! More later...stay tuned.
Thursday, September 4, 2008
Change of shift
Yes, the famous Change of Shift is up at Nurse Ratched's Place, and check out all the cool pulp fiction covers over there.
Tuesday, September 2, 2008
Nuggets for September 2
Yes, it's been a long time since I posted Nuggets, but I really missed them, so...Now that I've returned from my trek to ye old neighborhood pet store to get an electronic fence for the wild ol' herding dog at my house who nearly got hit chasing a scooter yesterday, I discovered a couple of goodies out there of note.
Enjoy!
Long-term ills tied to bad food (from www.washingtonpost.com)
That salmonella or E-coli can cause trouble for years in some folks.
The Well at the New York Times website is a blog that has lots of interesting articles on health-related topics.
Here are a couple of the more interesting ones out there right now:
Voices of Crohn's disease is a multimedia collection including audio files with comments from folks with this disease.
Best online psychology tests Just in case you needed a break!
The Wall Street Journal also has a health blog with a great story this week about a study regarding older fathers and kids with bipolar disorder.
Enjoy!
Long-term ills tied to bad food (from www.washingtonpost.com)
That salmonella or E-coli can cause trouble for years in some folks.
The Well at the New York Times website is a blog that has lots of interesting articles on health-related topics.
Here are a couple of the more interesting ones out there right now:
Voices of Crohn's disease is a multimedia collection including audio files with comments from folks with this disease.
Best online psychology tests Just in case you needed a break!
The Wall Street Journal also has a health blog with a great story this week about a study regarding older fathers and kids with bipolar disorder.
No truer words
"nursing is head on, hands on, heart on. all together. all at once. maybe that is enough explanation why there is a nursing shortage. it is because not a lot of people can be all that, all at once."
--may at www.aboutanurse.com
If you haven't already discovered may's aboutanurse blog, do not pass go, do not collect $200, go straight there. I have been reading it for quite a while (I know I started in nursing school) and there is always something to think about.
My evenings are over for this week. Thankfully, everything went reasonably well. I had the same guys all five days and everyone was doing well. Mr. H. got in the shower, not once, but twice. I also let him know that M., our charge nurse, will get him there, too, if he wants to shower when she works, since M. does not rotate shifts like me. Mr. H. is a para amputee, but M is known on the unit for getting quads up and in the shower. Mr. B. was her longtime customer every Friday night until he left. Consequently, Mr. H.has been in a pleasant mood. I really think the showering is doing him a lot of good.
Mr. O., his roommate, is reasonably new. He's one of our few rehab patients. He's got a balky bladder, due to some previous cancer history, so I've been working on the rationale (aka sales pitch) for intermittent catheterization with him. He's been balky with some of the other nurses, so I go in and tell him very nicely and slowly how important it is that he empty his bladder. So far, he's agreed to cath more than he's refused. I cathed him, not once, but twice last night. Hopefully, they can get him on a schedule and just do it until he can get his urodynamics study.
The man across the hall, Mr. B. is still on C diff precautions and still has that foul, smelling stool. He is eating better (mostly Taco Bell, but he's actually eating other stuff with that), but we really have to sell him on drinking water. He drinks almost no water during the day when he has visitors (sometimes 20+ people), because when I was checking him on first rounds, his urine was always dark. By the end of the night, when I'd encourage the fluids and he'd drink them, it would get lighter. Who said nursing wasn't a sales job? I do a lot of encouragement and followup to get people to do what they need to do to succeed at the program. His halo is intact, but still causing him pain, so until the C diff stooling stops, we can't try getting him up into a chair.
I'm going to stop here...so many things to do in a short time on this day off. More later...
--may at www.aboutanurse.com
If you haven't already discovered may's aboutanurse blog, do not pass go, do not collect $200, go straight there. I have been reading it for quite a while (I know I started in nursing school) and there is always something to think about.
My evenings are over for this week. Thankfully, everything went reasonably well. I had the same guys all five days and everyone was doing well. Mr. H. got in the shower, not once, but twice. I also let him know that M., our charge nurse, will get him there, too, if he wants to shower when she works, since M. does not rotate shifts like me. Mr. H. is a para amputee, but M is known on the unit for getting quads up and in the shower. Mr. B. was her longtime customer every Friday night until he left. Consequently, Mr. H.has been in a pleasant mood. I really think the showering is doing him a lot of good.
Mr. O., his roommate, is reasonably new. He's one of our few rehab patients. He's got a balky bladder, due to some previous cancer history, so I've been working on the rationale (aka sales pitch) for intermittent catheterization with him. He's been balky with some of the other nurses, so I go in and tell him very nicely and slowly how important it is that he empty his bladder. So far, he's agreed to cath more than he's refused. I cathed him, not once, but twice last night. Hopefully, they can get him on a schedule and just do it until he can get his urodynamics study.
The man across the hall, Mr. B. is still on C diff precautions and still has that foul, smelling stool. He is eating better (mostly Taco Bell, but he's actually eating other stuff with that), but we really have to sell him on drinking water. He drinks almost no water during the day when he has visitors (sometimes 20+ people), because when I was checking him on first rounds, his urine was always dark. By the end of the night, when I'd encourage the fluids and he'd drink them, it would get lighter. Who said nursing wasn't a sales job? I do a lot of encouragement and followup to get people to do what they need to do to succeed at the program. His halo is intact, but still causing him pain, so until the C diff stooling stops, we can't try getting him up into a chair.
I'm going to stop here...so many things to do in a short time on this day off. More later...
Monday, September 1, 2008
A good one
Sometimes you need a good laugh...especially when you wake up itching and sneezing...again. Alas, ragweed season seems to be in full bloom in our neck of the woods.
Head Nurse has this simple test for all you nurses out there, so if you don't have to labor today on Labor Day like me, (even if you do) check it out.
Head Nurse has this simple test for all you nurses out there, so if you don't have to labor today on Labor Day like me, (even if you do) check it out.
Sunday, August 31, 2008
The smell of the week...
Sure it's summer and barbecue season. When I think of summer as a kid, I remember the smell of charcoal lighter fluid, Coppertone 4 sun lotion (no one called it sunscreen then), chlorine and the smell of food on the barbecue pit. Those smells still evoke fond memories for me.
This week, the smell is C. diff, as one of my assigned patients has this dreaded spore. It's really a hard to describe smell. To me, it's a flat, acrid smell that just seems to stick in your nose. It got so bad the other night, that I actually left the unit to sit outside in the breeze for a while. I had gowned, gloved and thoroughly washed my hands when I was done, but that smell (or the memory) hung around in my nose for a while. So far, this patient hasn't developed colitis, but we'll have to wait and see.
If you want more information on C. diff, check out these sites:
CDC
C diff project website (Netherlands)
On another smell note, totally unrelated to rehab nursing, check out Luscious Cargo. I got some perfume samples from them this week after I read a NY Times article about perfume. They even sent me a free one for Fracas, which is a very interesting scent.
Their smells sure beat C. diff!
More later...two more shifts on evenings this week.
This week, the smell is C. diff, as one of my assigned patients has this dreaded spore. It's really a hard to describe smell. To me, it's a flat, acrid smell that just seems to stick in your nose. It got so bad the other night, that I actually left the unit to sit outside in the breeze for a while. I had gowned, gloved and thoroughly washed my hands when I was done, but that smell (or the memory) hung around in my nose for a while. So far, this patient hasn't developed colitis, but we'll have to wait and see.
If you want more information on C. diff, check out these sites:
CDC
C diff project website (Netherlands)
On another smell note, totally unrelated to rehab nursing, check out Luscious Cargo. I got some perfume samples from them this week after I read a NY Times article about perfume. They even sent me a free one for Fracas, which is a very interesting scent.
Their smells sure beat C. diff!
More later...two more shifts on evenings this week.
Tuesday, August 26, 2008
Happiness is...
Only having two patients instead of three (one crashing) and a new admit. Why? Lots less paperwork for one thing! I only had two patients today, Mr. S.and Mr. M. and it was like heaven. No rushing, no fussing, everything got done, charted and I was out on time. Hooray!
Sadly, Mr. H. who I took care of a couple of months ago was back at Washington in the ER. Apparently, he was taking too many drugs over the weekend and developed a subarachnoid hemorrhage. He's now on a vent and not expected to make it.
I'm off tomorrow, so more fun starts later this week on evenings...stay tuned.
Sadly, Mr. H. who I took care of a couple of months ago was back at Washington in the ER. Apparently, he was taking too many drugs over the weekend and developed a subarachnoid hemorrhage. He's now on a vent and not expected to make it.
I'm off tomorrow, so more fun starts later this week on evenings...stay tuned.
Sunday, August 24, 2008
CRRN prep, book club
The big Rehabilitation Nursing book by Shirley P. Hoeman arrived this week. I'm using it, along with Rehabilitation Nursing Secrets to start my quest for the CRRN next year. Only eight months to go, so I'll be reading away.
I'm also reading a stack of interesting stuff from my local library. Here are a couple of books on the stack so far...
The Ostomy Book by Barbara Dorr Mullen and Kerry Anne McGinn, RN ARNP
We deal with quite a few patients with ostomies, so I plan on giving this book a thorough read.
The Sexual Paradox: Men, Women and the real Gender Gap by Susan Pinker
Not sure how far I'll get with this one, but it's on the stack right now.
I'm also reading a stack of interesting stuff from my local library. Here are a couple of books on the stack so far...
The Ostomy Book by Barbara Dorr Mullen and Kerry Anne McGinn, RN ARNP
We deal with quite a few patients with ostomies, so I plan on giving this book a thorough read.
The Sexual Paradox: Men, Women and the real Gender Gap by Susan Pinker
Not sure how far I'll get with this one, but it's on the stack right now.
And if you don't have enough to worry about..
Check out this article from the UK on the use of "stripper therapy" for some Huntington's disease patients. Thanks MJ from www.nurseratchedsplace.com for that one.
What a can of worms this would open up here in the US....just a few things to consider...
1. What would our other patients think if they wanted to go along, but didn't have the requisite disease...I see trouble on the unit!
2. Would the rec therapy folks get fired, since all we'd have to do is take the folks to our favorite red light district for "therapy"?
3. Would they start hiring "nurses" from said red light district? And as MJ mentioned, could you imagine the care plans?
And now, since I've finished reading From Silence to Voice, I find it incredibly ironic that the "nurses" arranged this trip. Wouldn't the "nurses" need doctor's orders for the patients to leave the unit for said trip? And do you see the word "doctor" anywhere in this story? No, you don't.
Hmm...and we wonder why people think what they do about nurses.
What a can of worms this would open up here in the US....just a few things to consider...
1. What would our other patients think if they wanted to go along, but didn't have the requisite disease...I see trouble on the unit!
2. Would the rec therapy folks get fired, since all we'd have to do is take the folks to our favorite red light district for "therapy"?
3. Would they start hiring "nurses" from said red light district? And as MJ mentioned, could you imagine the care plans?
And now, since I've finished reading From Silence to Voice, I find it incredibly ironic that the "nurses" arranged this trip. Wouldn't the "nurses" need doctor's orders for the patients to leave the unit for said trip? And do you see the word "doctor" anywhere in this story? No, you don't.
Hmm...and we wonder why people think what they do about nurses.
Friday, August 22, 2008
Every good turn deserves another
I have had a wonderful three days at work, even though I feel like all I've done is run. I was taking care of the meds on one hall and I took care of two guys at the other end of the hall. I hadn't taken care of those guys in a while, and it was really fun.
There's been a few posts I've seen regarding Phil Baumann's Eight Ways to Become a Better Nurse.
Here are my own ways (I also posted them in his comments)
1. Improve one thing you do every day. There may be a lot of things you need to do, but work on it by choosing one thing every day.
2. Leave work at work. Unload before you leave the door. Your family will appreciate it.
3. Find outlets for creativity in your work.
4. Make patients smile.
5. Be kind, especially to those in need, whether they're your patients, someone else's patients or your coworkers.
6. Take care of yourself.
7. Keep your eyes on the horizon. Look out for trouble that may be coming.
8. Say please and thank you to everyone...and mean it.
I'm off this weekend, so I'll be working on all sorts of stuff, here, there and everywhere. Stay tuned!
There's been a few posts I've seen regarding Phil Baumann's Eight Ways to Become a Better Nurse.
Here are my own ways (I also posted them in his comments)
1. Improve one thing you do every day. There may be a lot of things you need to do, but work on it by choosing one thing every day.
2. Leave work at work. Unload before you leave the door. Your family will appreciate it.
3. Find outlets for creativity in your work.
4. Make patients smile.
5. Be kind, especially to those in need, whether they're your patients, someone else's patients or your coworkers.
6. Take care of yourself.
7. Keep your eyes on the horizon. Look out for trouble that may be coming.
8. Say please and thank you to everyone...and mean it.
I'm off this weekend, so I'll be working on all sorts of stuff, here, there and everywhere. Stay tuned!
Wednesday, August 20, 2008
Work is still...work
Yes, one day off after working an evening and then waking up early with a kindergartener is an exhausting experience. After a very nice day visiting my sister, seeing some of my old friends in that second largest 'burb of the county where I used to work and having lunch with C., then coming home and baking a couple of pies, I was too tired to do much around the house. I put my favorite vaccuuming CD on the stereo, cranked it, and vegged for a half hour.
It was back to work today and I felt really slow. First, we had an in-service today on Fragmin. Most of the people were watching the shiny stuff--the pens that light up and the other goodies. Besides being a big sales pitch, it was reasonably interesting. We even talked about the famous debate of "should you blow the bubble". Second, my boss changed my assignment. I was a little perturbed, but I got two reasonable patients and the med cart on the main hall. I was running a little, but it turned out reasonably well considering everything, including an irascible patient or two and an exploding colostomy bag (happily a controlled explosion!).
In the last few days, I've found some interesting sites and articles on the internet. Hope you enjoy them. More items to come...
Check out the patient safety info at this site: http://www.patientsafety.gov/resources.html
The NY Times recently ran an interesting article on Hepatitis C: http://health.nytimes.com/ref/health/healthguide/esn-hepatitisC-ess.html
Can chewing gum may shorten your hospital stay? The jury's still out on that issue, but there may be more research to come. Could Wrigley's be the next sponsor? Stay tuned.
http://www.medscape.com/viewarticle/579243
It was back to work today and I felt really slow. First, we had an in-service today on Fragmin. Most of the people were watching the shiny stuff--the pens that light up and the other goodies. Besides being a big sales pitch, it was reasonably interesting. We even talked about the famous debate of "should you blow the bubble". Second, my boss changed my assignment. I was a little perturbed, but I got two reasonable patients and the med cart on the main hall. I was running a little, but it turned out reasonably well considering everything, including an irascible patient or two and an exploding colostomy bag (happily a controlled explosion!).
In the last few days, I've found some interesting sites and articles on the internet. Hope you enjoy them. More items to come...
Check out the patient safety info at this site: http://www.patientsafety.gov/resources.html
The NY Times recently ran an interesting article on Hepatitis C: http://health.nytimes.com/ref/health/healthguide/esn-hepatitisC-ess.html
Can chewing gum may shorten your hospital stay? The jury's still out on that issue, but there may be more research to come. Could Wrigley's be the next sponsor? Stay tuned.
http://www.medscape.com/viewarticle/579243
Monday, August 18, 2008
When RNs are left to their own devices...
Some of us start doing homework! Yes, that's right. Since many of our current continuing education items are now in the VA's much-vaunted LMS system (learning management system), we're playing catch-up whenever there is a free moment.
I did my required items recently, so I helped my coworkers to log into the system. It's amazing how people complain about the system not working, especially when they won't read the startup instructions.
Besides the goodies in LMS, we often have educators drop off sheets to read on our lunchroom table. Once you unearth them from the hubris, you can get those learning items done, too. One of our recent ones was about a new feeding pump, which had a very nice DVD, which I just popped in one of the PCs and watched the other night.
Outside of those learning activities, I decided to check out a few other things when I had a spare moment. Stay tuned and I'll have more goodies later this week!
I did my required items recently, so I helped my coworkers to log into the system. It's amazing how people complain about the system not working, especially when they won't read the startup instructions.
Besides the goodies in LMS, we often have educators drop off sheets to read on our lunchroom table. Once you unearth them from the hubris, you can get those learning items done, too. One of our recent ones was about a new feeding pump, which had a very nice DVD, which I just popped in one of the PCs and watched the other night.
Outside of those learning activities, I decided to check out a few other things when I had a spare moment. Stay tuned and I'll have more goodies later this week!
Saturday, August 16, 2008
This week at Madison
Here are a few of the interesting topics I've encountered dealing with my patients this week. Links to appropriate resources are also included for more information.
Before I headed back to the evening shift, I got to admit a fellow from a far western state. Our unit may be the red-headed stepchild of the SCI system, but we have a reputation for healing people with wounds that can't get healed anywhere else. (It also helps that our boss has friends in a major research hospital in town, too.)
The new guy, Mr. C., got a room with a fellow (Mr. W.) who's also had step one of the same type of surgery he's being evaluated for--girdlestone surgery. Said patient is pretty nice, but physically, mentally and emotionally, he's been a trainwreck. Patient was a victim of violence. Patient has several health problems now directly related to the incident: short gut syndrome, and a whole bunch of other things. The dietician has put him on an FAA diet (free amino acid) with a different type of formula--Vivonex. It's really amazing that he's as positive as he is.
Mr. K., our elderly gentleman who's just about to hit one year at our place (on and off, with trips to acute at Washington) came back yesterday from Washington. He had some mental status changes (possibly medication related) and also mastoiditis. Some of the staff were a little upset with him because he told the folks at Washington that there were "drug problems" at Madison. (One of his previous roommates was discharged due to drug issues.) While Mr. K. is a little off sometimes, more often than not, he's very astute to things. As a consequence, he's very upset that he's back in his old room, and he told us if he could get up he'd probably slug his roommate. Nice. It should be interesting to see what the boss decides to do with him, since we're running at full capacity and getting four new people next week. There aren't enough rooms to make another room isolation right now...
Nuggets
Here are a few other goodies to check out this week, if you haven't already.
I found this cancer article in the NY Times this week, along with another article about doctors and condolences.
MonkeyGirl's Rehab post was just a riot. Head on over and read it for a good laugh.
RehabRN book club items
I recently finished reading Best care anywhere by Phillip Longman. Even if you don't work at the VA, this is a fascinating book.
I'm still working on From Silence to Voice by Suzanne Gordon and Bernice Buresh about nurses and communicating to the public.
On a non-nursing note, I finished Elizabeth Berg's The day I ate whatever I wanted. This was a great book. I really loved the apple pie recipe story near the back.
BTW visitor 5000 showed up here on 8/12/08 at 11:42:55PM from beautiful, downtown Chicago, IL via www.nurseratchedsplace.com. Thanks for your visit!
More later...stay tuned.
Before I headed back to the evening shift, I got to admit a fellow from a far western state. Our unit may be the red-headed stepchild of the SCI system, but we have a reputation for healing people with wounds that can't get healed anywhere else. (It also helps that our boss has friends in a major research hospital in town, too.)
The new guy, Mr. C., got a room with a fellow (Mr. W.) who's also had step one of the same type of surgery he's being evaluated for--girdlestone surgery. Said patient is pretty nice, but physically, mentally and emotionally, he's been a trainwreck. Patient was a victim of violence. Patient has several health problems now directly related to the incident: short gut syndrome, and a whole bunch of other things. The dietician has put him on an FAA diet (free amino acid) with a different type of formula--Vivonex. It's really amazing that he's as positive as he is.
Mr. K., our elderly gentleman who's just about to hit one year at our place (on and off, with trips to acute at Washington) came back yesterday from Washington. He had some mental status changes (possibly medication related) and also mastoiditis. Some of the staff were a little upset with him because he told the folks at Washington that there were "drug problems" at Madison. (One of his previous roommates was discharged due to drug issues.) While Mr. K. is a little off sometimes, more often than not, he's very astute to things. As a consequence, he's very upset that he's back in his old room, and he told us if he could get up he'd probably slug his roommate. Nice. It should be interesting to see what the boss decides to do with him, since we're running at full capacity and getting four new people next week. There aren't enough rooms to make another room isolation right now...
Nuggets
Here are a few other goodies to check out this week, if you haven't already.
I found this cancer article in the NY Times this week, along with another article about doctors and condolences.
MonkeyGirl's Rehab post was just a riot. Head on over and read it for a good laugh.
RehabRN book club items
I recently finished reading Best care anywhere by Phillip Longman. Even if you don't work at the VA, this is a fascinating book.
I'm still working on From Silence to Voice by Suzanne Gordon and Bernice Buresh about nurses and communicating to the public.
On a non-nursing note, I finished Elizabeth Berg's The day I ate whatever I wanted. This was a great book. I really loved the apple pie recipe story near the back.
BTW visitor 5000 showed up here on 8/12/08 at 11:42:55PM from beautiful, downtown Chicago, IL via www.nurseratchedsplace.com. Thanks for your visit!
More later...stay tuned.
Sunday, August 10, 2008
Quick study...5000
Yes, I'm popping in for a new feature. I'm calling it quick study, since it will give you a good overview of some of the topics this rehab nurse has encountered lately.
One of our patients has IBS and is using a different drug to treat it--Elavil. Here are a few links to some articles of interest I've found.
http://www.webmd.com/ibs/guide/irritable-bowel-syndrome-ibs-treatment-overview
http://www.emedicinehealth.com/irritable_bowel_syndrome/page8_em.htm
http://www.emedicine.com/ped/topic1210.htm
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/ibs/ibs.htm
Another patient suffered from phimosis, so he won the most common treatment: circumcision.
http://www.emedicine.com/med/topic2873.htm
The 5000 references the number of hits I've nearly met for this blog. To all my visitors, thank you! And please come back again!
One of our patients has IBS and is using a different drug to treat it--Elavil. Here are a few links to some articles of interest I've found.
http://www.webmd.com/ibs/guide/irritable-bowel-syndrome-ibs-treatment-overview
http://www.emedicinehealth.com/irritable_bowel_syndrome/page8_em.htm
http://www.emedicine.com/ped/topic1210.htm
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/gastro/ibs/ibs.htm
Another patient suffered from phimosis, so he won the most common treatment: circumcision.
http://www.emedicine.com/med/topic2873.htm
The 5000 references the number of hits I've nearly met for this blog. To all my visitors, thank you! And please come back again!
Thursday, August 7, 2008
Update
I'm running, running, running. Lots of things going on in my life and I'm still rearranging all the pieces.
I'm working on finding the things that make me happy and I've dropped off the blog for a little while to do that. Things are getting clearer for me, so rest assured, I'll be back later. I'm finding that this blog has a lot of potential. Just think of getting into a well-maintained car with a full tank of gas. There are so many places to go and often, with the freedom of travel, comes restraints (such as how much time and gas money you have.)
So, for now, I'm consulting the road maps, and getting ready to continue on the trips, whether they're long or short.
Stay tuned!
I'm working on finding the things that make me happy and I've dropped off the blog for a little while to do that. Things are getting clearer for me, so rest assured, I'll be back later. I'm finding that this blog has a lot of potential. Just think of getting into a well-maintained car with a full tank of gas. There are so many places to go and often, with the freedom of travel, comes restraints (such as how much time and gas money you have.)
So, for now, I'm consulting the road maps, and getting ready to continue on the trips, whether they're long or short.
Stay tuned!
Friday, August 1, 2008
Some things you just can't forget...
1. Seeing a patient for the first time and how sick they look when they come to you for rehab.
2. Seeing that same patient after discharge and they look so alive they glow.
3. Nurse Practictioner's Place talks about those two dirty words that are unforgettable.
2. Seeing that same patient after discharge and they look so alive they glow.
3. Nurse Practictioner's Place talks about those two dirty words that are unforgettable.
Saturday, June 28, 2008
Nuggets for June 28
Here's today's installment of interesting items from my perusals on the internet. Enjoy!
On epidemiology (a/k/a My favorite bug)
The MRSA Bug (from Medscape Nurses blog)
How private is your curtain?
Not very if you work in a double or triple room, like I do at Madison. ERnursey talks about Patient Privacy in the ER. The British Journal of Nursing also has an abstract on the issue of patient privacy here. Another article talks about noise shielding curtains, but I have yet to see any more literature about their use.
Non-formulary (a/k/a Stuff you can't have)
On the alternative medicine front, you may enjoy two unusual posts at Hell on White Clogs for June 25 and 26. The best (or most hilarious): an order for shots (not SQ or IM) and a patient dunning letter.
On epidemiology (a/k/a My favorite bug)
The MRSA Bug (from Medscape Nurses blog)
How private is your curtain?
Not very if you work in a double or triple room, like I do at Madison. ERnursey talks about Patient Privacy in the ER. The British Journal of Nursing also has an abstract on the issue of patient privacy here. Another article talks about noise shielding curtains, but I have yet to see any more literature about their use.
Non-formulary (a/k/a Stuff you can't have)
On the alternative medicine front, you may enjoy two unusual posts at Hell on White Clogs for June 25 and 26. The best (or most hilarious): an order for shots (not SQ or IM) and a patient dunning letter.
Monday, June 23, 2008
Nuggets for June 23
Today's installment features a few important (and sometimes funny) aspects of nursing.
First of all, there's a nursing shortage. Surprise, surprise. I know a few of you are rolling your eyes as you're looking at the latest newbie RN on your floor. Nurse.com has a great article about the Versant RN residency program which is being used in various hospitals throughout the US. According to the article, RN residency programs are keeping new RN turnover levels lower than the national average.
Residency program prepares new Texas RNs (from http://www.nurse.com/)
Next, it's not the newest post she has out there, but PixelRN has a great one about nursing and the Maternal Suckling Thing. The moral of the story: Don't worry, some people just don't get nursing in today's modern hospitals. Hopefully, Flo's not spinning over this one!
After that biology lesson, head on over to Podunk Memorial for an Ode to a Node. I don't read many ECGs, but it makes me want to get the book referenced in this post.
Finally, let's look at an oldie but goodie that bears repeating. I really enjoy reading Taralynn Mackay's blogs, Information for nurses and A Nurse Attorney's Thoughts. Both blogs spotlight legal interest stories that are appropriate for nurses. Just because someone tells you, "Oh, you're a nurse, don't worry." you should. As grown-ups and nurses, our job is to know what is going on in the world and what's going on with our patients.
This post, appropriately called Why you don't want a stupid nurse really made me think. I was flabbergasted in May when I attended a symposium for new grads in an accelerated program when one of my younger, louder classmates, commented that I was stupid because I thought it was important to recognize failure to rescue. "We don't do that every day. You don't need to worry about that." Well, yes, we do Ms. Jen, yes, we do.
And that is all for today, so enjoy your goodies, folks. More later!
First of all, there's a nursing shortage. Surprise, surprise. I know a few of you are rolling your eyes as you're looking at the latest newbie RN on your floor. Nurse.com has a great article about the Versant RN residency program which is being used in various hospitals throughout the US. According to the article, RN residency programs are keeping new RN turnover levels lower than the national average.
Residency program prepares new Texas RNs (from http://www.nurse.com/)
Next, it's not the newest post she has out there, but PixelRN has a great one about nursing and the Maternal Suckling Thing. The moral of the story: Don't worry, some people just don't get nursing in today's modern hospitals. Hopefully, Flo's not spinning over this one!
After that biology lesson, head on over to Podunk Memorial for an Ode to a Node. I don't read many ECGs, but it makes me want to get the book referenced in this post.
Finally, let's look at an oldie but goodie that bears repeating. I really enjoy reading Taralynn Mackay's blogs, Information for nurses and A Nurse Attorney's Thoughts. Both blogs spotlight legal interest stories that are appropriate for nurses. Just because someone tells you, "Oh, you're a nurse, don't worry." you should. As grown-ups and nurses, our job is to know what is going on in the world and what's going on with our patients.
This post, appropriately called Why you don't want a stupid nurse really made me think. I was flabbergasted in May when I attended a symposium for new grads in an accelerated program when one of my younger, louder classmates, commented that I was stupid because I thought it was important to recognize failure to rescue. "We don't do that every day. You don't need to worry about that." Well, yes, we do Ms. Jen, yes, we do.
And that is all for today, so enjoy your goodies, folks. More later!
Monday, June 16, 2008
Nuggets for June 16
Here are a few of the latest finds from various blogs on the internet. Enjoy! Happy Monday!
Get some ed-ju-macation (or educating yourself in the blogosphere)
Spook, RN (aka Drug Pusher) talks about the vocabulary of the medical folks he found out there a while ago, called Gallows Humor.
Lost on the Floor has a link to another slang list you may enjoy, if you're looking for something in the same genre. Someone at Madison just told me about the 3H enema last week.
Although, it's not a nursing blog...
Stories of the Incredibly Stupid blog about life in the pharmacy has some really funny stories lately. My favorites are the Making it Fun series and Karma.
Get some ed-ju-macation (or educating yourself in the blogosphere)
Spook, RN (aka Drug Pusher) talks about the vocabulary of the medical folks he found out there a while ago, called Gallows Humor.
Lost on the Floor has a link to another slang list you may enjoy, if you're looking for something in the same genre. Someone at Madison just told me about the 3H enema last week.
Although, it's not a nursing blog...
Stories of the Incredibly Stupid blog about life in the pharmacy has some really funny stories lately. My favorites are the Making it Fun series and Karma.
Tuesday, June 10, 2008
Nuggets for June 10
Happy Birthday to my brother, AJ. (Now we're all in a row--37, 38, 39)
Here are a few goodies for the rest of you, in honor of today's birthdays and the political season.
In the news
Just in case you missed Hillary Clinton's trip to the hospital, Barack Obama shadowed a nurse in St. Louis today.
I hope no one coded on you, Senator.
After all the stories about bad tomatoes in the news lately, maybe buying local is the best thing after all.
Boosting health with local food (from www.nytimes.com)
The weird section
Monkeygirl always has something interesting, and I just about fell over when I read this one:
Life's little drain plug
It reminded me of Terry's post from earlier this year (from Counting Sheep) called Speechless.
Let them read this over your shoulder at work...
Showing the patient the door...permanently (from www.nytimes.com)
People were actually gasping behind me when they read this one over my shoulder yesterday.
It may have something to do with the fact that our docs might actually enjoy this with a couple of specific patients.
Here are a few goodies for the rest of you, in honor of today's birthdays and the political season.
In the news
Just in case you missed Hillary Clinton's trip to the hospital, Barack Obama shadowed a nurse in St. Louis today.
I hope no one coded on you, Senator.
After all the stories about bad tomatoes in the news lately, maybe buying local is the best thing after all.
Boosting health with local food (from www.nytimes.com)
The weird section
Monkeygirl always has something interesting, and I just about fell over when I read this one:
Life's little drain plug
It reminded me of Terry's post from earlier this year (from Counting Sheep) called Speechless.
Let them read this over your shoulder at work...
Showing the patient the door...permanently (from www.nytimes.com)
People were actually gasping behind me when they read this one over my shoulder yesterday.
It may have something to do with the fact that our docs might actually enjoy this with a couple of specific patients.
Wednesday, June 4, 2008
Nuggets for June 4
Since I've had the day off, besides cleaning gutters and doing some trimming, here are a few items of interest from my perusals on the internet. Enjoy the ride!
Even if you've already heard this...
Some moms go above and beyond. A China earthquake story about a policewoman who nursed babies who needed it.
A great Google book:
Spinal Cord Diseases: Diagnosis and Treatment, edited by Engler, Cole and Merton
On brainy topics again:
The science of sarcasm (like you care) (from http://www.nytimes.com/)
Vaccine may boost survival of brain cancer patients (from http://www.forbes.com/)
Something hubby (an old Navy nuke) will appreciate:
Nuclear cleanup could derail an experimental cancer treatment, study says (from www.nytimes.com)
Other health-related items from the internet:
A calorie counter to get to your goal weight (from http://www.nytimes.com/)
Even if you've already heard this...
Some moms go above and beyond. A China earthquake story about a policewoman who nursed babies who needed it.
A great Google book:
Spinal Cord Diseases: Diagnosis and Treatment, edited by Engler, Cole and Merton
On brainy topics again:
The science of sarcasm (like you care) (from http://www.nytimes.com/)
Vaccine may boost survival of brain cancer patients (from http://www.forbes.com/)
Something hubby (an old Navy nuke) will appreciate:
Nuclear cleanup could derail an experimental cancer treatment, study says (from www.nytimes.com)
Other health-related items from the internet:
A calorie counter to get to your goal weight (from http://www.nytimes.com/)
Monday, May 26, 2008
Memorial Day nuggets - May 26
Many many moons ago, I spent Memorial Day in Le Havre, France, searching for a drawing that turned into a project that lead to a book in my home town by a local historian. I get shivers thinking about how things were there in 1945 on the same day, just before D-day.
In honor of Memorial Day, here are some internet items that you should see:
Ambulance Drivers ode to Memorial Day
History.com has a fascinating site with recorded interviews of veterans from WWII to Vietnam, with lots of information on this holiday.
David Merchant, a Navy veteran, has lots of Memorial Day information on usmemorialday.org
In honor of Memorial Day, here are some internet items that you should see:
Ambulance Drivers ode to Memorial Day
History.com has a fascinating site with recorded interviews of veterans from WWII to Vietnam, with lots of information on this holiday.
David Merchant, a Navy veteran, has lots of Memorial Day information on usmemorialday.org
Thursday, May 22, 2008
Nuggets for May 22
Here are a few goodies I've encountered on the web recently. Enjoy!
From the strange but true category:
And you only thought nurses and medical personnel were worried about brain stem edema...
Check out this post from Photoshop Disasters.
On my mind, or maybe brain this week:
Lots of brain-y stuff in the news this week with the revelation Tuesday that Senator Ted Kennedy has a malignant glioma.
Another great article about the brain from Wednesday's New York Times:
An older brain may be a wiser brain
Second Chance to Live is a blog by Craig J. Phillips that describes how he's living with TBI.
The American Epilepsy Society is also realizing that some veterans with TBI are developing epilepsy. This page shows a bill that was sponsored in Congress last year and also has links to many resources of the Society. Check it out for more information.
Don't forget...this weekend is Memorial Day weekend (May 26 actual holiday). Remember our veterans, who have died and been injured keeping this country free for you and me.
Check out this link to the National Park Service to see various DC memorials on a map.
From the strange but true category:
And you only thought nurses and medical personnel were worried about brain stem edema...
Check out this post from Photoshop Disasters.
On my mind, or maybe brain this week:
Lots of brain-y stuff in the news this week with the revelation Tuesday that Senator Ted Kennedy has a malignant glioma.
Another great article about the brain from Wednesday's New York Times:
An older brain may be a wiser brain
Second Chance to Live is a blog by Craig J. Phillips that describes how he's living with TBI.
The American Epilepsy Society is also realizing that some veterans with TBI are developing epilepsy. This page shows a bill that was sponsored in Congress last year and also has links to many resources of the Society. Check it out for more information.
Don't forget...this weekend is Memorial Day weekend (May 26 actual holiday). Remember our veterans, who have died and been injured keeping this country free for you and me.
Check out this link to the National Park Service to see various DC memorials on a map.
Friday, May 16, 2008
Nuggets for May 16
Here are a few interesting and silly tidbits I've found on the internet and in some of my favorite blogs. Enjoy the ride!
In the rehab and sports category:
Disclaimer: I love reading the New York Times. I've been a reader since the 1980s (yes, I'm dating myself!) when I discovered it in my high school library. I'd read the Sunday Magazine from cover to cover each week.
I particularly enjoyed this story about wheelchair racers called A blur of hands, spokes and determination (from www.nytimes.com)
As a spinal cord rehab nurse, I'm always thinking about what Dr. V. used to say about wheelchair athletes and clothespins...that some athletes use them to increase their blood pressure during events.
Some fun and some sobering facts:
JustCallMeJo of Sinus Arrhythmia, an escaped from rehab to ICU nurse, has had some great posts of late. Here are two of my favorites:
The fun:
...and then there are good days (about the patients you enjoy)
The sobering:
If you haven't seen this you need to discusses medical triage and what might happen in here in a pandemic or other mass casualty situation.
For silly stuff:
In the e-mailed joke category, DisappearingJohn has a good one this week. Let's just call it...
Going to third grade.
In the rehab and sports category:
Disclaimer: I love reading the New York Times. I've been a reader since the 1980s (yes, I'm dating myself!) when I discovered it in my high school library. I'd read the Sunday Magazine from cover to cover each week.
I particularly enjoyed this story about wheelchair racers called A blur of hands, spokes and determination (from www.nytimes.com)
As a spinal cord rehab nurse, I'm always thinking about what Dr. V. used to say about wheelchair athletes and clothespins...that some athletes use them to increase their blood pressure during events.
Some fun and some sobering facts:
JustCallMeJo of Sinus Arrhythmia, an escaped from rehab to ICU nurse, has had some great posts of late. Here are two of my favorites:
The fun:
...and then there are good days (about the patients you enjoy)
The sobering:
If you haven't seen this you need to discusses medical triage and what might happen in here in a pandemic or other mass casualty situation.
For silly stuff:
In the e-mailed joke category, DisappearingJohn has a good one this week. Let's just call it...
Going to third grade.
Monday, May 5, 2008
Nuggets for May 5
Yes, it's Cinco de Mayo, folks. Sorry, no tacos, but I did find a few things of interest in the realm of the dismal science, economics, recently in my adventures in the blogosphere.
BTW I'm still waiting for my economic stimulus check. Hope you've got yours. Enjoy it, spend it, or save it, because it's yours!
Enjoy!
M.D.O.D. had this post about universal healthcare called Bar Stool Economics.
FatDoctor talks about how much fun it is to be on call in this post called Highly Paid Intern.
Yes, folks, there is even a publication called Nursing Economic$ (Yes, the dollar sign is supposed to be there).
This link to their Continuing Nursing Education articles gives you a look at some of the issues discussed in this magazine.
If this list of goodies has whetted your appetite for more economic-related material, check out this site for more links to all sorts of economic topics: http://economics.about.com/
BTW I'm still waiting for my economic stimulus check. Hope you've got yours. Enjoy it, spend it, or save it, because it's yours!
Enjoy!
M.D.O.D. had this post about universal healthcare called Bar Stool Economics.
FatDoctor talks about how much fun it is to be on call in this post called Highly Paid Intern.
Yes, folks, there is even a publication called Nursing Economic$ (Yes, the dollar sign is supposed to be there).
This link to their Continuing Nursing Education articles gives you a look at some of the issues discussed in this magazine.
If this list of goodies has whetted your appetite for more economic-related material, check out this site for more links to all sorts of economic topics: http://economics.about.com/
Sunday, April 27, 2008
Nuggets for April 27
A few finds from the blogosphere and beyond...enjoy!
I found this photo link courtesy of Snotjockeys Revisited (a RT blog). You have to see it to believe it. It is one man's last message to the world, and it is very powerful.
Angrier Nurse weighs in on the cons of being sick after her own viral illness.
Dear Nurses is by Margaret Agard is back in business (following a vacation) and the latest installment is geared to all you new grads out there, so check it out: Clinical Settings Step By Step
One of my favorite med blogs is Radiology Picture of the Day. It may not be immediately useful as a nurse on the floor, but it's very interesting and includes a detailed explanation (thank you!) of what you're seeing.
Nurse Ratched's had a lot going on over on her blog lately, and most of it, I would not want, especially that homocidal patient. Thankfully, Mom stepped in and sent this item in a post called Email from Mother: The Banister of Life. NR, may you encounter few or no splinters!
I found this photo link courtesy of Snotjockeys Revisited (a RT blog). You have to see it to believe it. It is one man's last message to the world, and it is very powerful.
Angrier Nurse weighs in on the cons of being sick after her own viral illness.
Dear Nurses is by Margaret Agard is back in business (following a vacation) and the latest installment is geared to all you new grads out there, so check it out: Clinical Settings Step By Step
One of my favorite med blogs is Radiology Picture of the Day. It may not be immediately useful as a nurse on the floor, but it's very interesting and includes a detailed explanation (thank you!) of what you're seeing.
Nurse Ratched's had a lot going on over on her blog lately, and most of it, I would not want, especially that homocidal patient. Thankfully, Mom stepped in and sent this item in a post called Email from Mother: The Banister of Life. NR, may you encounter few or no splinters!
Tuesday, April 22, 2008
Nuggets for April 22
Since I'm a SCI rehab nurse, I always find some of the techniques the therapists use to be pretty interesting. Many people think the PTs and OTs are using "space age" stuff with all the different equipment and materials that are available now. My favorite techniques are the ones that are incredibly simple.
At 66, he learned to sing so he could learn to talk (from www.nytimes.com)
Pet therapy is a component of many rehabilitation facilities. At Saintarama, the dogs came out on Wednesday nights, so it was always interesting to see how patients would react when they saw 4-6 dogs, big and small on the unit.
While it's not about pet therapy per se, I enjoyed this article about the Pope and cats from this past week. It just goes to prove that pets can make a difference in people's lives, even for the big guy at the Vatican.
Cat lovers appreciate soul mate in Vatican (also from www.nytimes.com)
TBI (Traumatic Brain Injury) is in the news a lot lately, particularly since many members of the military are returning home with this type of injury. For the VA, it is a major research topic.
Here are a couple of links, one linked to a VA research article, and one lay article, from a family's perspective.
Feature Article: Special Journal Issue on Traumatic Brain Injury (info from www.research.va.gov)
The TBI Recovery Network is a 501(c)(3) non-profit in Carlisle, OH, started by the parents of Ashleigh, a TBI patient, and contains information they discovered on the road to her recovery.
At 66, he learned to sing so he could learn to talk (from www.nytimes.com)
Pet therapy is a component of many rehabilitation facilities. At Saintarama, the dogs came out on Wednesday nights, so it was always interesting to see how patients would react when they saw 4-6 dogs, big and small on the unit.
While it's not about pet therapy per se, I enjoyed this article about the Pope and cats from this past week. It just goes to prove that pets can make a difference in people's lives, even for the big guy at the Vatican.
Cat lovers appreciate soul mate in Vatican (also from www.nytimes.com)
TBI (Traumatic Brain Injury) is in the news a lot lately, particularly since many members of the military are returning home with this type of injury. For the VA, it is a major research topic.
Here are a couple of links, one linked to a VA research article, and one lay article, from a family's perspective.
Feature Article: Special Journal Issue on Traumatic Brain Injury (info from www.research.va.gov)
The TBI Recovery Network is a 501(c)(3) non-profit in Carlisle, OH, started by the parents of Ashleigh, a TBI patient, and contains information they discovered on the road to her recovery.
Saturday, April 12, 2008
Nuggets for April 12
Here are a few items of note from the internet.
WSJ Health Blog
It's billed as the "WSJ's blog on health and the business of health". As a former subscriber (and business major in another life), I really enjoy the Journal's take on this subject. There are several posts on current healthcare business topics, so go on over and check it out.
Salt 'n Pepper Nursing (from EDNurseasaurus)
An interesting take on experienced nurses sharing information for the rest of us from someone who knows.
Before Code Blue: Who's minding the patient? (from Hell on White Clogs)
This post references a http://www.msnbc.com/ article of the same name (see the article for the link) addresses one of the most common causes of death in the hospital these days--failure to rescue.
I posted a reply to this conversation that followed because I felt a little uneasy about people dissing one year or accelerated program nurses and got an interesting reply.
Phones vs. Physicians-The Showdown (from fatdoctor)
Doc, it's not just you...those rascally patients drive us nurses nuts chatting all day on the phone, too. Somedays, you just wish they'd hang up!
WSJ Health Blog
It's billed as the "WSJ's blog on health and the business of health". As a former subscriber (and business major in another life), I really enjoy the Journal's take on this subject. There are several posts on current healthcare business topics, so go on over and check it out.
Salt 'n Pepper Nursing (from EDNurseasaurus)
An interesting take on experienced nurses sharing information for the rest of us from someone who knows.
Before Code Blue: Who's minding the patient? (from Hell on White Clogs)
This post references a http://www.msnbc.com/ article of the same name (see the article for the link) addresses one of the most common causes of death in the hospital these days--failure to rescue.
I posted a reply to this conversation that followed because I felt a little uneasy about people dissing one year or accelerated program nurses and got an interesting reply.
Phones vs. Physicians-The Showdown (from fatdoctor)
Doc, it's not just you...those rascally patients drive us nurses nuts chatting all day on the phone, too. Somedays, you just wish they'd hang up!
Tuesday, April 8, 2008
Nuggets for April 8
Here are a few of my favorites from my recent ventures out on the 'net.
Nursing 101 (from ERNursey)
ERNursey, thank you for this post.
Don't buy liability insurance (from My 2 cents)
This is one of my favorite blogs, discussing a very important issue that, for some reason, people tend to gloss over.
Give it time (from tex at weirdnursingtales)
A good, short piece on ED nurses. I'm not there yet, either, Tex, but boy, my BS radar is gettin' pretty sharp!
Chez Recovery and Beyond (from pixelrn)
Boy, Beth, I sure feel for you...been to the IT promised land, escaped to nursing school, and now I'm wondering if I should ever go back. It's just TOO tempting!
Keeping priorities straight, even at the end (from nytimes.com)
The NY Times article about Carnegie-Mellon prof, Randy Pausch and his last lecture.
Nursing 101 (from ERNursey)
ERNursey, thank you for this post.
Don't buy liability insurance (from My 2 cents)
This is one of my favorite blogs, discussing a very important issue that, for some reason, people tend to gloss over.
Give it time (from tex at weirdnursingtales)
A good, short piece on ED nurses. I'm not there yet, either, Tex, but boy, my BS radar is gettin' pretty sharp!
Chez Recovery and Beyond (from pixelrn)
Boy, Beth, I sure feel for you...been to the IT promised land, escaped to nursing school, and now I'm wondering if I should ever go back. It's just TOO tempting!
Keeping priorities straight, even at the end (from nytimes.com)
The NY Times article about Carnegie-Mellon prof, Randy Pausch and his last lecture.
Thursday, April 3, 2008
Nuggets for April 3
Here are a few goodies I've read lately from the internet and various blogs.
Doctor, did you wash your hands (from http://www.nytimes.com/)
This article discusses a study about patient questions to doctors and nurse. No, I don't mind if you ask at all.
60-plus, ripped and natural (from http://www.nytimes.com/)
This isn't your average bodybuilding article, and it brings up some really interesting points. Now, if they could just convince women to do it, not just for looks, but for the health aspects (like stronger bones, for one)
I don't like gas stations in the alternate universe very much (from drugnazi)
I really enjoyed this post, since I've had a few weird dreams like this myself.
I just couldn't pass this one up, in light of my recent dealings with car insurance companies.
see more crazy cat pics
Enjoy these goodies!
Doctor, did you wash your hands (from http://www.nytimes.com/)
This article discusses a study about patient questions to doctors and nurse. No, I don't mind if you ask at all.
60-plus, ripped and natural (from http://www.nytimes.com/)
This isn't your average bodybuilding article, and it brings up some really interesting points. Now, if they could just convince women to do it, not just for looks, but for the health aspects (like stronger bones, for one)
I don't like gas stations in the alternate universe very much (from drugnazi)
I really enjoyed this post, since I've had a few weird dreams like this myself.
I just couldn't pass this one up, in light of my recent dealings with car insurance companies.
see more crazy cat pics
Enjoy these goodies!
Sunday, March 30, 2008
Nuggets for March 30
Patients driving you crazy? Some days, it seems like a really short trip. Here are a couple of goodies I've run into on the internet recently on this very subject and other interesting items. Enjoy them!
Driving your nurse crazy (from headnurse)
Things NOT to do when you go to the hospital. Sadly, I think I've encountered about 90% of these during my first year in nursing.
Failure to build rapport is not failure (from http://www.aboutanurse.com/)
May writes another one about dealing with a difficult patient.
The BON may just be the beginning (from Information for Nurses)
Taralynn Mackay provides some information on this very important item for nurses. And you thought your state BON was scary....read these!
A neighbor, a death and thoughts thereof (from digitaldoorway)
I really liked this first-person piece about a neighbor who suddenly passes away.
Driving your nurse crazy (from headnurse)
Things NOT to do when you go to the hospital. Sadly, I think I've encountered about 90% of these during my first year in nursing.
Failure to build rapport is not failure (from http://www.aboutanurse.com/)
May writes another one about dealing with a difficult patient.
The BON may just be the beginning (from Information for Nurses)
Taralynn Mackay provides some information on this very important item for nurses. And you thought your state BON was scary....read these!
A neighbor, a death and thoughts thereof (from digitaldoorway)
I really liked this first-person piece about a neighbor who suddenly passes away.
Friday, March 28, 2008
A few handy things for a new rehab nurse
Since I just realized that I'm closing in on one year as a nurse, I thought I'd share a few things for the students about to graduate who may be heading into rehab as their specialty. Your mileage may vary, but never fear...there's always room for innovation out there. Keep your eyes open!
1. Good shoes and socks.
You may have discovered this in nursing school, but if you have not, seek and find until you discover your favorite pair, and once you do, buy two pairs. Your back and your legs and the rest of your body will thank you.
I am also a disciple of Compression Socks. Some of you may think they're crazy, but I love them, since my feet feel great when I'm done with my shift. Besides, it's another way to educate your patients on wearing their TED hose. My favorite quote, "See, Bob (insert your patient name here), I've got mine on. Let's get yours ready to go."
2. Be prepared.
Just like they say in the Boy Scouts and Girl Scouts, it's good to be prepared. Especially when you have the patient in isolation who wants to be suctioned multiple times on your shift. I always try to keep a mental list of what my patients have in the room, so I can keep it stocked. It can get crazy, but you can do it. If your patients go to therapy, restock them while they're gone. If not, try to restock whenever you can. That extra minute of stocking can save you five when you're in a hurry.
3. Pillow cases work wonders in many situations.
This is a corollary of #2. I have used pillow cases as bibs, quick towels and as the occasional non-plastic Depend backup for a quad who had dig stim every morning but wanted a little more security when he went to therapy. They are also wonderful for use on the sliding boards (keeps the butt sliding to the commode, if you get my drift.)
4. Look, listen and learn from your peers.
Sure, you just got out of school (nursing program name here) and know lots of facts and figures, but on the floor is where the rubber hits the road. Hang back and watch first, then do. Pay attention and you will see who is doing things the RIGHT way (i.e. correctly following policy and procedure), and who is not. The older nurses on the floor may not do everything the way you think (or policy says) they should, but you can learn something from everyone. I would have never learned a better way to put a Foley in females had I not watched K. the pseudocharge at Saintarama. She was 99% on the first try with her Foleys on the floor and after watching a few times I noted some of her techniques--less lube and shorter grip.
5. The patient is the star of the show.
Yes, you'll have lots of competition in this category, especially doctors and other people demanding your time, but keep in mind that the patients on your assignment are your top priority.
When you get your assignment, they are yours until you hand them off at the end of the shift. Take care of them and give them your undivided attention while you are with them. Let them know if deviations may cause you to leave the room while you are working with them if this is feasible. Make each one feel like a million bucks whenever you can...even if you don't want to or feel horrible. That person in the room is someone's special someone, so make them feel that way when you are around, too.
6. Stay positive.
Yes, you may get into work and the sky may seem to be falling. Keep reminding yourself that you will have a good day, and you will get through whatever trouble may be cropping up here and there. You survived nursing school and have the license and skills to prove it. Use them, especially those coping skills. Just as animals sense fear, patients can pick up on crabby nurses pretty darned quickly. You'll make your patients feel better (and yourself) if you can model calm and collected behavior on the outside, even if you don't really feel too calm and collected inside!
1. Good shoes and socks.
You may have discovered this in nursing school, but if you have not, seek and find until you discover your favorite pair, and once you do, buy two pairs. Your back and your legs and the rest of your body will thank you.
I am also a disciple of Compression Socks. Some of you may think they're crazy, but I love them, since my feet feel great when I'm done with my shift. Besides, it's another way to educate your patients on wearing their TED hose. My favorite quote, "See, Bob (insert your patient name here), I've got mine on. Let's get yours ready to go."
2. Be prepared.
Just like they say in the Boy Scouts and Girl Scouts, it's good to be prepared. Especially when you have the patient in isolation who wants to be suctioned multiple times on your shift. I always try to keep a mental list of what my patients have in the room, so I can keep it stocked. It can get crazy, but you can do it. If your patients go to therapy, restock them while they're gone. If not, try to restock whenever you can. That extra minute of stocking can save you five when you're in a hurry.
3. Pillow cases work wonders in many situations.
This is a corollary of #2. I have used pillow cases as bibs, quick towels and as the occasional non-plastic Depend backup for a quad who had dig stim every morning but wanted a little more security when he went to therapy. They are also wonderful for use on the sliding boards (keeps the butt sliding to the commode, if you get my drift.)
4. Look, listen and learn from your peers.
Sure, you just got out of school (nursing program name here) and know lots of facts and figures, but on the floor is where the rubber hits the road. Hang back and watch first, then do. Pay attention and you will see who is doing things the RIGHT way (i.e. correctly following policy and procedure), and who is not. The older nurses on the floor may not do everything the way you think (or policy says) they should, but you can learn something from everyone. I would have never learned a better way to put a Foley in females had I not watched K. the pseudocharge at Saintarama. She was 99% on the first try with her Foleys on the floor and after watching a few times I noted some of her techniques--less lube and shorter grip.
5. The patient is the star of the show.
Yes, you'll have lots of competition in this category, especially doctors and other people demanding your time, but keep in mind that the patients on your assignment are your top priority.
When you get your assignment, they are yours until you hand them off at the end of the shift. Take care of them and give them your undivided attention while you are with them. Let them know if deviations may cause you to leave the room while you are working with them if this is feasible. Make each one feel like a million bucks whenever you can...even if you don't want to or feel horrible. That person in the room is someone's special someone, so make them feel that way when you are around, too.
6. Stay positive.
Yes, you may get into work and the sky may seem to be falling. Keep reminding yourself that you will have a good day, and you will get through whatever trouble may be cropping up here and there. You survived nursing school and have the license and skills to prove it. Use them, especially those coping skills. Just as animals sense fear, patients can pick up on crabby nurses pretty darned quickly. You'll make your patients feel better (and yourself) if you can model calm and collected behavior on the outside, even if you don't really feel too calm and collected inside!
Wednesday, March 26, 2008
Nuggets for March 26
Here are the latest articles of note I've read recently.
Night shift, sleep deprivation may be hazardous to health (from the LA Times)
More and more articles are discussing research into this very important issue.
High blood pressure runs in families (from Yahoo!News)
Another interesting study about hypertension.
Hospitals go automated (from kansas.com)
One hospital group's take on automation
Night shift, sleep deprivation may be hazardous to health (from the LA Times)
More and more articles are discussing research into this very important issue.
High blood pressure runs in families (from Yahoo!News)
Another interesting study about hypertension.
Hospitals go automated (from kansas.com)
One hospital group's take on automation
Thursday, March 20, 2008
Nuggets for March 20
Here are a few items of note for today:
Heparin Discovery May Point to Chinese Counterfeiting (from http://www.nytimes.com/)
I suspect I may get a few refusals to take this if people have been watching TV.
For amputees, an unlikely painkiller: Mirrors
An interesting therapy being studied to relieve phantom pain.
We take care of our own
Another installment on gratitude (and what happens when patients leave) from Podunk Memorial. Short...but sweet.
Heparin Discovery May Point to Chinese Counterfeiting (from http://www.nytimes.com/)
I suspect I may get a few refusals to take this if people have been watching TV.
For amputees, an unlikely painkiller: Mirrors
An interesting therapy being studied to relieve phantom pain.
We take care of our own
Another installment on gratitude (and what happens when patients leave) from Podunk Memorial. Short...but sweet.
Saturday, March 8, 2008
A nugget of a poem
Warning: if you have a weak stomach or are in the middle of your lunch break, come back later. Otherwise, continue, as you have been warned...
The Underside of Nursing always has an interesting ditty or two, but since some of the nursing bloggers I've been reading have been talking about bowels in one form or another lately, here's an ode to that potassium-ridding drug, Kayexalate.
Reminds me of Mr. G. Wonder how long he spent on the throne after leaving Saintarama with a going on 7 K a little over a month ago.
I'm always going to be wondering about the end of some of the stories I end up being part of as a nurse.
More later. Happy weekend all!
The Underside of Nursing always has an interesting ditty or two, but since some of the nursing bloggers I've been reading have been talking about bowels in one form or another lately, here's an ode to that potassium-ridding drug, Kayexalate.
Reminds me of Mr. G. Wonder how long he spent on the throne after leaving Saintarama with a going on 7 K a little over a month ago.
I'm always going to be wondering about the end of some of the stories I end up being part of as a nurse.
More later. Happy weekend all!
Wednesday, March 5, 2008
Nuggets for March 5
Here a few goodies I've encountered lately that I just have to share, because I'm that kind of gal.
If you think your day was bad category:
The Laws of Nature have been temporarily suspended... (from head-nurse.blogspot.com)
There's always something interesting going on with head-nurse, so check this out.
A minor tragedy in two acts (from gentlemansc.blogspot.com)
It's not nursing related, but some of you nursing students can appreciate this.
In the same vein, if you'd like to know what those instructors are really thinking, check out Rate Your Students, which is a snappier retort to http://www.rateyourprofessors.com/.
The trolls are on the loose at GuitarGirlRN when she discusses methadone users who try to score in the ED.
Finally, I found this article about seductive nurses from the Times online in the UK when I read this post at Nurse Ratcheds. They're both worth a read, but I really was ROFL when I saw this comment in the online story from the Times:
Oh good! I'm going in for a hip operation on my 86th birthday. I might get laid at last.
David, London, UK
If you think your day was bad category:
The Laws of Nature have been temporarily suspended... (from head-nurse.blogspot.com)
There's always something interesting going on with head-nurse, so check this out.
A minor tragedy in two acts (from gentlemansc.blogspot.com)
It's not nursing related, but some of you nursing students can appreciate this.
In the same vein, if you'd like to know what those instructors are really thinking, check out Rate Your Students, which is a snappier retort to http://www.rateyourprofessors.com/.
The trolls are on the loose at GuitarGirlRN when she discusses methadone users who try to score in the ED.
Finally, I found this article about seductive nurses from the Times online in the UK when I read this post at Nurse Ratcheds. They're both worth a read, but I really was ROFL when I saw this comment in the online story from the Times:
Oh good! I'm going in for a hip operation on my 86th birthday. I might get laid at last.
David, London, UK
Saturday, March 1, 2008
A real code and nuggets for March 1
I went back to work yesterday, just to get into the computer and get access to my timecard. Saintarama, in their infinite wisdom, doesn't make this accessible to employees from home (since that would be too logical, maybe...) After fun and excitement talking to the Kronos admin, he let me in and I downloaded my report and left down the hall. One patient, Mr. R., was in the room on the left. I talked to my manager for a little bit and told her what I had done, since I had discussed it with her on Thursday.
J and K were working and so I talked to them on the way out. Things had just quieted down from the AM therapy rush. I wished them well for the rest of the day. I even chatted with S., the secretary.
All of a sudden, the code lights flashed. This has been a regular thing on our unit, since we were blessed with all sorts of mechanical difficulties. However, this was not a drill. Apparently, Mr. R. went down and Y. the tech called for backup. Uh-oh. J and K ran down the hall. S. answered the calls and told everyone who called the code was real. She got Mr. R's chart and I saw the contingent of docs, residents and the rest of the code team go down the hall. Dr. D. was going that way, so I gave him the chart, just outside the room. He passed it on, since this patient coding, was not his. Hubby and I walked off the unit with him and I told him that I was finished at Saintarama. He was surprised, but wished me well. It turns out, he lives two blocks away from Saintarama. He knows how I feel.
After that, I came home and just surfed away. Here are a few of the interesting things I encountered yesterday, and some today. Enjoy!
Not sick, but TIRED (from aboutanurse.com)
A post that makes me tired just reading it!
An old poster with a timeless theme (at weirdnursingtales)
Thankfully, we don't see much of this bug in rehab, at least not in the ones I've worked in lately.
The Great White Hunter and the ER Nurse (from Nurse Ratched's Place)
I just love this story of bait and switch and revenge. The security part is the best.
The problem with "you" nurses (from first do no harm)
A great story from Podunk Memorial. Oh, CYA, the story of my life...
J and K were working and so I talked to them on the way out. Things had just quieted down from the AM therapy rush. I wished them well for the rest of the day. I even chatted with S., the secretary.
All of a sudden, the code lights flashed. This has been a regular thing on our unit, since we were blessed with all sorts of mechanical difficulties. However, this was not a drill. Apparently, Mr. R. went down and Y. the tech called for backup. Uh-oh. J and K ran down the hall. S. answered the calls and told everyone who called the code was real. She got Mr. R's chart and I saw the contingent of docs, residents and the rest of the code team go down the hall. Dr. D. was going that way, so I gave him the chart, just outside the room. He passed it on, since this patient coding, was not his. Hubby and I walked off the unit with him and I told him that I was finished at Saintarama. He was surprised, but wished me well. It turns out, he lives two blocks away from Saintarama. He knows how I feel.
After that, I came home and just surfed away. Here are a few of the interesting things I encountered yesterday, and some today. Enjoy!
Not sick, but TIRED (from aboutanurse.com)
A post that makes me tired just reading it!
An old poster with a timeless theme (at weirdnursingtales)
Thankfully, we don't see much of this bug in rehab, at least not in the ones I've worked in lately.
The Great White Hunter and the ER Nurse (from Nurse Ratched's Place)
I just love this story of bait and switch and revenge. The security part is the best.
The problem with "you" nurses (from first do no harm)
A great story from Podunk Memorial. Oh, CYA, the story of my life...
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