Feed it Forward

Happy Thanksgiving everyone!
With the spirit of the season upon us I wanted to share
a wonderful program that I found online.

Restaurant.com
has a program running called
“Feed It Forward”
which allows you to gift up to 40 people 
with a $10.00 credit to Restaurant.com that will
allow them to buy gift certificates to a number of restaurants 
of their choice.

If you don’t have 40 people to give to you can 
donate these gift certificates to
“Random Acts of Kindness”
which will distribute them to those in need.

This program runs until December 25th
go check it out and give some holiday cheer!

In the spirit of giving, 
if you would like a free $10.00 gift certificate,
leave me a comment on this post telling me
what you are grateful for this holiday season
 and I will send you one before Dec 25th!
(don’t forget to include your email address)



Dreaming

  Has anyone else had this happen to them? The last couple of nights I’ll dream that I am at work, the ED is overflowing and someone is trying to give me report on a dozen patients that are coming in while I am lying in a bed dozing somewhere. Then they get really mad and yell, at which point I wake up. It always takes me a couple of minutes to realize that I am at home, in my own bed and it’s my night off! I actually have to take a second to mentally tell myself it was all a dream and try to relax and go back to sleep.


  What the heck? My husband thinks this is weird and so do I. I’ve always been a great sleeper and never had problems working the night shift then flipping back to a normal schedule on my days off. I don’t like to use medications but this is getting silly. Any suggestions nurse sisters and brothers?

Aren’t We All On The Same Side?

  After working four nights in a row I was treated this week to my first episode of “Nurses Eating Their Own”. I won’t bore anyone with details, but I made a small mistake and one of the nurses took the chart, not to the charge or even the head of our department, she took it straight to the house supervisor. She even went so far as to make copies of the chart and show the Doc, who got all steamed too. 

  Now I admit I made a mistake, no harm came to the patient. In fact it was a silly thing and I have learned my lesson to read protocols a little more carefully. But really? Aren’t we all on the same side here? Isn’t our job to provide care to our patients, not hunt out silly mistakes made by another nurse and blow it up into a huge mess? I was so demoralized that morning on my way home, I really do believe that healthcare only works when you have a team. I know this is reality but is it really best for the patients that we care for when Doctors and Nurses are at odds with each other? What ever happened to the Sisterhood of Nurses? Back in the day we hung together, now all we do is try to tear each other down, for what gain?  If anyone can tell me what we actually achieve by backstabbing one another I would love to hear it.


  Oh yes in case you were wondering, the Director called me into the office in the AM and told me not to take anything personally. Things like this happen she said, no one is mad at me and did I learn my lesson? 


  Yup I sure did, TRUST NO ONE. 


  Damn I feel like I working in the spy business may be less stressful!

A Perfect Ending to a Perfect Night

  Last night was pure chaos in the ICU.  I took the first admit from the ED while trying to balance a patient who was busy trying to hop out of bed restraints and all.  So here is the initial report I got,
60 something male c/o SOB, Respiratory failure and now intubated and ventilated.  


  Ok no problem, I actually like working with vented patients, and no it’s not because they are out cold, I’ve actually worked with them before as an LPN. So we get the respiratory room set up complete with a special bed that rocks and shakes them. Next thing I know I get the SBAR faxed over and it says: 60 something male, c/o SOB CHF exacerbation, 16L O2 non rebreather mask.


Hold up, what on earth made them think he was vented earlier? Ok, whatever I take report and tell them to bring him on over. Five minutes later the ED nurse arrives with a patient on a gurney and the following equipment: heart monitor, IV pole with a Nitro drip hanging and the fellow on a nasal cannula. Not to mention one measly 20 gauge in his arm. 


Nurse Twit then gives me a quick bedside as we are transferring him into his new digs. 


“Oh yeah BTW he still has that inch of nitro paste on his chest in addition to the drip because I couldn’t find a doctor to give me an order to take it off”


 Ok Brilliant, now the guy is getting a double dose of nitro, wonder what his blood pressure looks like.


“Um yeah and he was diagnosed with pneumonia in the ED but we didn’t start any core measures. He’s going to need two antibiotics and he’s only got the one IV. So you’ll need to start another one. Lucky for you he’s got veins.”


Great, how many hours has he been here and you couldn’t draw the blood cultures or get a sputum? And that IV looks like a field stick so how the heck would you know what his veins look like since you obviously haven’t examined them?


  Nurse Twit heads back the the ED and I settle our guy in and tell him that I need to poke him again. He’s pleasant as all heck about it and I don’t tell him this is the first time I have ever stuk someone without a person hovering over me giving directions. Oh yeah his veins were crap, huge and easy to see but all gnarled. I found a decently straight one in his hand and dropped a 22 gauge in there like a pro. Thank god because my other guy was trying to crawl out of bed again.


  I somehow manage to survive the night. I nearly kill my relief who takes 30 minutes to get report from the nurse with her other patient and then finally makes it to me. Great now Mr is late for work (yes we still don’t have enough for another car so we carpool) and the director is giving me the evil eye because I’m overtime.


  I bolt from that place screaming TGIF (my Friday at least) and hop in the car. Almost home free! Until we get to the intersection a block form home and wonder why no one is moving. I poke my head out the window and my heart just sinks. 


 From around the big truck blocking my view I see feet, on the concrete, in the middle of the intersection. I holler at the Mr to sit tight and jump out, to take a look. Yep hit and run in the middle of a busy intersection at rush hour, on a Monday with some dear strangers standing around him to keep the jerk drivers who are trying to cut around because they are too busy to care, from hitting him. Thankfully an EMT was on the scene and paramedics were screaming up as I got the the fellow. 


I got back into the car and the Mr just looked at me and asked


“Is it a full moon?”

A Few of My Favorite Things

  It doesn’t take much to make me happy.
These are just a few things that I have found lately that make me happy,
very happy!
Let me tell you about them.

A. Tresemme Fresh Start Dry Shampoo : I never used dry shampoo before because generally the only place you could get the stuff is at salon or prestige counter at the beauty supply store and at an average of $20 a pop I was not going to indulge that much, I could use shampoo, the wet kind, thank you very much.
  But wait! As I was walking through Target, I spied this product in the hair care aisle, priced at under $6.00 I thought I would give it a try. 
  Why does it make me happy? Because I have pretty oily hair that needs to be washed every day. In the past I have been showering when i get home and then when I get ready for work, that’s tough on the hair, especially if you have color in it. Now I just shower when I get home, go to sleep and apply this stuff to my hair when I get dressed. It keeps my hair looking clean and oil free for my 12 hour shift, and it smells clean and pretty.

B. Mio Liquid Water Enhancer : Look in my work bag and you will always find at least two of these rattling around in there. These little bottles take up no room and are perfect for masking that nasty taste of hospital water. Because they are liquid they mix right in to ice cold water unlike those drink crystals which take forever to dissolve and often result in a thick concentration of flavor at the bottom of your cup. Blech!
  These guys make me happy because I can adjust the flavor in my water to how I like it. I like my flavor kinda light, Mr likes his full of flavor. Even better these Mio’s also have an energy formula if you want a quick boost but don’t feel like reaching for a cup of coffee. I mix the flavors through out the night too!

C. Therafirm Compression Socks : You can quit snickering, yes I wear compression hose and yes it makes me happy. These light weight trouser socks apply medically correct pressure to the legs in a gradient that prevents blood from pooling, resulting in less tired, achy legs after 12 hours of being on my feet. Don’t wait until you start having problems like varicose veins, or swollen ankle before you decide to get a pair. Get a pair NOW and prevent these problems, it’s called preventative medicine nurses!

D. Pedi-Scrub Foot Buffer : We beat up our feet, spending 12 hour shifts on them while shoved into hot sweater shoes. These little scrubbers show your feet some love! They come in two scents Citron Eucalyptus and Lavendar Tea Tree. These little flower shaped scrubbies are impregnated with moisturizers and cleansers, the dual sided sponge has a scrub side for exfoliating your feet, the sponge side bathes your feet in all the foamy good stuff. 
  I started using this foot buffer everyday, after a week I noticed my feet were way softer and smoother. This is how I keep my feet looking presentable between pedi’s!

These are a few of my favorite things,
what are a few of yours?

Here Comes the Train!

  I hope everyone will forgive the lack of posts in the last few weeks, but it is that time of the year again! The unit is getting admits and most of them are train wrecks.

  Normally a typical assignment in our units for a single nurse consists of one vent and one “walkie talkie” this way the nurse only has one total care patient. A stable vent requires q2hr turns, a full bed bath etc, so they take up a little more time so you don’t hit a nurse with two vented patients unless they ask for it,

  This past week there was not a single patient in the unit that was not on a ventilator, meaning every nurse had a double vent load and some of us ended up with seriously unstable vents that had us hopping all night. Top it off with a code, a couple of emergency bed side procedures and it made for a very busy week.

  On weeks like this you will find that it is the team you work with that makes or breaks the shift. Lucky for me we had a great team and even though it was a rough three in a row we found time to laugh and although we were beat up and tired at the end of the night we walked out smiling. These are the sorts of nights where I am so thankful for finding the job that I did (or it finding me) and where I really, really love my job.

Braaains!

  As a student I always giggled when a nurse exclaimed “Oh crap I’ve lost my brain again”. It always sounded so strange, calling that ratty, dog eared scrap of paper your brain. I never fully appreciated how such a small piece of paper could assist a nurse with keeping all pertinent information straight.


 That was until now. Now I totally understand how devastating losing my “brains” is. I have also learned that no nurses keeps hers exactly like another nurse. From organization to  pertinent information, every nurse has their own unique way scribbling it down to fit on one sheet of paper, making it very apt that we call these papers “brains”. Not to mention every department requires a slightly different brain sheet, you’ll notice a Tele nurses brain looks nothing like an ICU nurses brain.


  When I was first getting started it was one of the things that required a lot of trial and error for me to get “just right”. In the development process I looked at how the other nurses around me scribbled down their information, paying close attention to how they organized it and what info they kept and what they did not. Now I have a system that works for me pretty well, and I figured I’d share. 

  So let’s start with a brains for Telemetry.



 Obviously this is a HIPPA-ized version of my report sheet, but it IS a real one from my last trip to Telemetry.


 It was made on a single sheet of paper that was folded in four so that it can be folded and fit easily into my pocket for quick reference.


  My belief behind my brain is that is should contain only relevant information but at the same time I should be able to know everything about the patient in just a glance to my brains.
  
So let’s go over a few of my organizational tricks really fast before I go in depth into my brain.


  


  The first thing I do is color code my brains, notice the red and black pen. Basically the black pen is your basic information, major systems information, vascular access, labs etc. The red pen is important information that you want your eyes to fall on like drug allergies, medical history and diagnosis, and things to do like blood glucose checks and meds to give.


  Second thing to do is decide what information is relevant to me and my treatment of the patient. On a Telemetry ward it’s handy to know what telemonitor the patient is assigned. Generally I take down information by exception, meaning I only write down what is abnormal with my patients rather than everything that is going on. I always right down what lines the patient has, where they are and what is running through them this way I know who is going to have IV’s to hang. Also if the patient has any procedures going on like dialysis it’s important to note what days they generally have it done on in case the Doc wants to know.


  Third thing I do is review what is on the To Do List for the the shift and jot it down (in red) so I know what has to be done with each patient. More importantly this gives you a picture of what your night is going to look like as a whole and gives you the ability to prioritize. By doing this I can now look at all the meds that I have to give on this shift and know that Patient #4 doesn’t have any meds due until 2300 so I can leave them to last for med admin and get to the other folks who have earlier meds due.

  To help sum up everything I’ve said 
here is what my brains for just one patient looks like.

  I hope this helps and makes it easier for you to summarize the whack loads of information that we get as nurses down into a small concise picture of what is going on with your patient.

 If you are looking for some more templates for brains 
Scrubs Magazine 
has a great set of brain sheets with a number of different layouts for different specialties 
here

Do you have any tips that you would like to share?


Staycation

  After working four nights in a row sometimes I need is a little holiday from work.
Ask and ye shall receive apparently.
Coming home to made bed and mints on the pillows 
was awesome.
It’s great to have a hubby with a sense of humor.

Cultural Sensitivity Gone Wrong

This week a writer for ESPN was fired for writing this headline

“Chink In the Armor”

  This was in reference to the New York Knicks newest sensation Jeremy Lin and the Knicks loss that evening in the wake of an incredible run that began with Asian American Lin’s amazing off the bench performance that saw the team enjoy a winning streak the team had not seen before in years.  The headline ran on ESPN’s website article that detailed the Knicks loss and Lin’s less than spectacular performance that night until outraged readers complained believing that the word “chink” was being used as a pun and racial slur. One writer lost his job for this oversight and the reporter has been suspended for 30 days.
  I won’t fill this post with links to all the articles that have be written about this headline because I couldn’t fit them all in one post. Much heated debate has taken place about this headline, many people are offended.  Miriam Webster defines “chink” as “a weak spot that may leave one vulnerable”  not immediately as racial slur and might I be so radical as to say that perhaps that is how this headline should have been read. 


  But this brings me to my point. All through nursing school we have had cultural sensitivity crammed down our throats and now in the work world we are being constantly being harried by someone in management about being culturally sensitive. But are we now just fostering a need to be hyper-vigilant to anything that could possibly be translated as a racial injustice? I notice nurses around me being worried about how to take care of a patient who’s culture is foriegn to them lest they make a mistake and get hauled into HR for being insensitive. Being Asian myself I have found that on more than one occasion people were offended on my behalf whereas I didn’t even notice the alleged slight. Case in point is this little interaction I had seen with a nurse and patient while in school.


Patient: Nurse have you seen that nice student nurse who has been helping me today?


Nurse: Well Sir we have about ten student nurses here today, which one were you looking for?


Patient: That nice Oriental girl


Nurse: Sir! That is horrible language!


Patient: What is? I didn’t say anything mean.


Nurse: Sir Oriental is a derogatory term and very offensive, the correct word is Asian.


Patient: Since when was Oriental a bad word? 


Nurse: Sir! Oriental is a RUG not a Person!


  The nurse obviously meant well in trying to be sensitive to my culture, but seriously did she need to berate an 80 year old man? And she never once asked if I was offended by being referred to as “Oriental”, which I was not.  My belief is that the intent behind what is said is much more important than a persons choice of words. I also believe that while a respect for a persons culture is important in our ever globalizing world that this trend to hyper sensitivity is not helping anyone. My belief is that as nurses we should strive to treat everyone as with dignity and respect, and in doing this we can transcend cultural difference because we acknowledge each other as human beings. 

Survived!

  Thank you for all your support! I survived my first day in the ICU with an awesome preceptor. It was a crazy day, we didn’t get our charting started until the day was nearly half done. We spent an hour in CT scan  with a 300 + lb patient. The CT tech looked at us like we were nuts when we brought her in, and wasn’t sure if she would fit in the scanner. After calling in some muscle (we have the best security guys!) to help move her on to the the scanner, we hop into the control room and begin scanning. The patient begins hollering at us from the machine, 


  “Let me out! I’m hungry, I want to eat!”


  “Ma’am that’s what landed you here” mutters the tech.



Pysch Test

This brings back memories of the psych tests we took.
Yes, nurses have to a pysch portion too…
Uploaded with ImageShack.us

Hmmm,
What does it say when every nursing student I showed it to answered “F”?

Why I Became A Nurse


  Want to know a secret? I never wanted to be a nurse, in fact as a child I though it was one of the most horrible jobs in the world. I mean who wanted to do mean things to people like give them shots that made them cry, not me! As I grew older I viewed nurses as nothing more than mean spiteful people who were grumpy all the time in spite of earning a decent paycheck. So I never gave nursing a second thought as a career.
  So now you are wondering how on earth I ended up with the letter RN attached to my name and blogging about it? Well it wasn’t really all that eventful, no major epiphany or light from above, it was necessity.  I was stuck in a sales job that just wouldn’t pay the bills and my husband was getting nowhere with a real career, so we made a huge life changing decision. We moved from Canada to the United States and my husband began his studies at a large University. This means we came down on student visas, which basically only allow you to study, working was not an option. After a couple of months of sitting doing nothing I began to go crazy, I needed to do something. A family member offered to help me pay for school if I wanted to go back and get a degree, she suggested nursing. It was a logical suggestion as the degree could transfer back home and just about anywhere we went, so I’d always have a good career to fall back on.
  Nursing? Me, the one that wants to crawl under a table at the mere sight of a needle, as nurse. It was almost laughable, absurd really. Somehow I got talked into attempting the pre-requisites. It was terrifying going back to school at 30-somthing and facing my demons like math and chemistry. With a ton of help and patience from my husband I made it through the pre-requisites, but there was a waiting list a mile long for all the programs in the area. We decided I would enroll in a CNA course and get my feet wet to see if I really liked healthcare. It was love at first class. The weeks flew by and I found myself looking forward to every clinical day even though it meant dragging my butt out of bed at 5am. 
  The CNA certification allowed me entry into an LPN program which I loved even more. Though I will admit when we started learning to give injections my heart rate must have jumped into the 200’s. After I graduated LPN school and received my license I was able to obtain a temporary work permit and began working in a long term care center for patients on ventilators. I loved my job. Many people find what I did depressing, many people in that place never went home, we often talked about the only way out of that place being “celestial discharge”, but I loved it. I found so much joy in the talking to the residents, becoming a familiar and welcome face and a part of their routine and ultimately their lives. I also found great peace in caring for a someone in their last days, ensuring family and friends as well as the patient were together and comfortable for those last moments. When my work permit expired I returned to school to complete my RN.
  I now work in a local hospital. I didn’t choose a big, shiny teaching facility, there are many here in my city. Oh no, I work, literally in an inner city ghetto. The neighborhood is slowly trying to fight it’s way out of the depths of poverty and gang violence, trying to become a place where children can grow up without the sounds of gunshots and not fear playing outside. I chose this place because I can truly help people here, I can make a difference in their lives. I feel that if perhaps one person treats these people like people, tells a drug addict that someone believes in them or tells a little kid they can become a Doctor and not a gangbanger, that maybe they will believe it and believe in themselves.
  Why did I become a nurse? Because I needed a job. Why do I continue to be a nurse? Because I believe I can make a difference in peoples lives.

What They Didn’t Cover in Nursing School

Me this morning, last night, yesterday…….

  Couldn’t sleep, I think I finally passed out around 3am yesterday…er…this morning(?) Got up at 7am because I couldn’t stay asleep and stumbled around like a zombie waiting for 10am to roll around because I have decided that is an acceptable hour to make that “Hi, remember me?” call. 


  Oh yeah, someone upstairs must be having fun with me today because that silent paper weight I call a phone has been ringing like mad, no one I want to talk to unfortunately. One guy actually called me saying that T-Mobile gave him the same phone number as me and then tried to carry on a conversation asking me where I lived. CREEPY!

  So anyone out there want to give this newbie a hand? This is where nursing school has left me woefully uneducated. I can jump into a code, have been a first responder for a spinal injury but I am lost about the hiring practices. So if anyone, ANYONE wants to chime in on these questions please do!
  1. How long is “normal” for it to take a hospital to get back to you with an offer of employment?
  2. How long should you wait before you decide you don’t have the job?
  3. Do you get a “thanks but no thanks” call, email etc? Or do they never talk to you again?
  4. I’ve called once, is it permissible to contact again and how long do I wait?
  5. Any tips on how to get a job?
  I’d love to hear from anyone, I mean it’s something to do other than climb the walls right?

Days vs Nights

  The eternal question when looking at jobs in nursing, days or nights? That’s the wonderful thing about the healthcare industry, we are 24/7. This can lead to amazing flexibility in when and how often you work. In very few jobs can you say you work full time and only work 3 days in a week.  Yes I know it can be frustrating because we do not always have the option to have major holidays off to be with our families, but in truth nursing offers some of the most flexible scheduling options. 

  Think about this. Some hospitals will hire nurses only for weekends due to a lack of staff interested in working these days. If you work the ER there are a number of different shifts up for grabs, your traditional 7-7, 12-12 even 10-10. If you think you would like a regular 9-5 five days a week kind of job then you may love working in a doctors office or outpatient surgery. The options are really endless. The first real question that you need to ask yourself is days or nights?

  The majority of society works during the daylight hours, so it is pretty normal to know how things are going to work out. For many people nights is a very alluring possibility, the shift differential, the lack of round physicians, and less need for child care. These are all good reasons to think about trying night shift, but many people wonder can they survive? 

  That is a very hard question to answer. Personally I was born for the night shift, literally. My parents tell stories about me as a baby being up all night and sleeping all day. To this day I am a night owl and would rather be up prowling around at 2am then waking up at 6am to face a new day. A friend of mine asked me the other day how you know if you are just NOT cut out for nights as she was thinking about switching because she could really use the extra money. So I sat down and thought about all the people I have seen try to switch to night and what made them fail or succeed. Here’s what I cam up with.

  Do you have a circadian rhythm? Are you one of those people that starts yawning the minute the sun goes down and jumps out of bed at sunrise? If you are the night shift may not be for you. It’s very hard to break that natural rhythm. One fellow who started working at the same time I did was that type and within 2 months was desperately looking for a spot on days. He just could not break his body of that rhythm. It was so bad that when the sun began coming up earlier, he could not sleep when he got home.  

  How do you sleep? Are you very particular, do you need silence, the room to be dark, for it to be cold? These are things that very few people take into account and begin to notice as they try to adjust. People forget that during the day there is so much more activity taking place that you may find the general everyday noise to hinder your sleeping. Me, I sleep a coma, dead to the world, no word of a lie but I slept through an earthquake once. The noise doesn’t bother me, but if you are used to sleeping at night when most of the world is in bed you may find the amount of noise to be earth shattering.

 Can you sleep with the lights on? Personally I think there is nothing better than curling up in bed with a sunbeam on my face, me and the cat often fight over napping spots. But a lot of people find that little spot light obnoxious. Think it over carefully, blackout curtains only work so well. My suggestion is think about if you nap well during the day, and if you do nap where and for how long you do. Ask yourself do you sleep deeply or just drowse? Remember the quality of sleep you get will be a huge factor in how you feel deep into your 12 hours.

  What kind of a nurse are you? Are you very task oriented, do you prefer to have everyone leave you alone? I hear it over and over, the differences in nurse on days versus nights is well like day and night. This is very true, don’t listen to the lies that one is easier than the other, because they are not, but they are hugely different. Knowing yourself is key to finding a good fit. Having worked both shifts I will say this…

  Day shift tends to be very task oriented. Take your patient to CT scan, then PT, then speak with the rounding physicians and participate with Case Management etc.  If you like a lot of structure to your shift, days is an excellent place for you. On days everyone is around, doctors are constantly in and out along with all the other departments, if you like to influence and take a very active role in your patients care, you will do great on days.

  Nights is a whole different kettle of fish. Doctors rarely round on nights, in fact you rarely see anyone in the evening, meaning it’s just you and your compadres. If anything goes down, it’s up to you to figure out how to deal with it. If you work nights you will need to be comfortable knowing that you call the shots. You need to be able to work independently and have a high level of critical thinking, it’s up to you to decide when to call the Doc for orders, or ask the Hospitalist to come and actually look at the patient because they are heading south. You will need to be ok with getting yelled at when you wake up a Doc in the middle of the night and they do not agree with your assessment of the situation, and you will need be strong enough to stand up to the Doc who doesn’t want to leave the sleeping room to come see your patient, but you know they need to.

  In the end sometimes all you need to do it try it. There have been many people who have though they had no business being on one shift or the other and found their niche. And in the end if you really can’t take it you can always transfer when an opening arises!

Ever Wonder…..

Ever been through a chart and see these funny diagrams 
the Doc writes in his progress note?

It took me awhile to ask what the heck these were,
and I finally have an answer.
Now you know too!

5 Minute Salsa Recipe

  We night nurses love to potluck. What can we say, when the cafeteria isn’t open and your options for dinner is Dennys or organizing a small feast of home made goodies I can tell you what wins every time!  But that does mean that you have to actually cook, if you are just coming on after a couple days off you have plenty of time. If you are not you may be scrambling for something that you can whip up in five minutes so you don’t look like the looser who ran to Costco on the way to work.


  I found this amazing salsa recipe on Pintrest,  I cannot claim any kudos here it is not mine, but I will accept love and adoration for sharing it. The recipe comes from Mountain Mama Cooks, so if you love the recipe please take a moment to pop over and let her know.  This salsa is more of the blended type you get at real Mexican restaurants, and the best part is you can literally whip this up in about 5 minutes in a blender. The only change I made to the original recipe is that I left out the teaspoon of honey and add a touch more cumin.


  This has been field tested and my co-workers demolished the entire batch I made, this recipe makes about 3 cups of salsa.

5 Minute Salsa

Ingredients:

  • 1- 14 oz can diced tomatoes
  • 1- 10 oz can orginal Rotel
  • 1/2 small onion, roughly chopped
  • 1 clove garlic, peeled and squished
  • 1/2-1 jalapeno, seeded or not (depends on how spicy you like it)
  • 1/2 teaspoon salt
  • 1/4 teaspoon ground cumin
  • small to medium size handful of cilantro, washed
  • juice of 1 lime

Directions:

Put all the ingredients in the blender and whiz for 30 seconds or so until all the ingredients are finely chopped and salsa is desired consistency. Taste for seasoning and adjust to taste. Serve with chips or over tacos.
———————————————————————————————————————————
 This really is a dummy proof recipe, you can play with the spicing to your taste. I tried a can of Rotel with Cilantro and Lime and it gave it a more piquante flavor. Also if you are a little more health conscious use tomatoes that have no salt added, I did this with the batch I took to work and no one was the wiser.




Tablet “Sweater” Pattern

Look what I got!
Yep I got myself a tablet! 
This thing is the coolest gadget in the world but there was one problem,
my tablet needed some protection.
So I knitted my tablet it’s very own little “sweater”, pretty cool huh?
Want to make your own? 
This project is relatively easy and a great beginner cable project that whips up in no time.
This pattern is based off the measurements of my Samsung Note Tablet
which is roughly 10″x 7″
It would be relatively easy to size this pattern up or down by adding or subtracting stitches in the knit sections of this pattern.

Tablet Sweater

Materials:
  1 skien of worsted weight yarn (I used Caron’s Simply Soft in Grey)
  1 pair of4 mm (# 8) knitting needles 
  1 4 mm (#8) crochet hook
  1 cable needle
  2 buttons
  small amount of fabric for lining

C4F – Slip 4 Stitches onto Cable needle and hold to the front of work, knit next 4 stitches on left needle, then knit 4 stitches from cable needle

C4B – Slip 4 Stitches onto Cable needle and hold to the back of work, knit next 4 stitches on left needle, then knit 4 stitches from cable needle

Pattern:

Cast on 50 stitches

Rows 1-4: K10, P2, K8, P2, K6, P2, K8, P2, K10
Row 5: K10, P2,C4F, P2, K6, P2, C4F, P2, K10
Rows 6 – 13:  K10, P2, K8, P2, K6, P2, K8, P2, K10
Row 14:  K10, P2,C4B, P2, K6, P2, C4F, P2, K10

Continue in pattern until piece measures approximately 19 inches, then:

K10, P2, K8, P2, K6, P2, K8, P2, K10 for 3 rows
K10, P2, K3 YO K2tog K4, P2, K6, P2, K3 YO K2tog K4 , P2, K10 (this creates the button holes)
K10, P2, K8, P2, K6, P2, K8, P2, K10 for 4 rows

Bind off

To Assemble:

Block knitted piece well to allow design to show
Cut fabric to roughly same size as knitted piece and sew down to the edges.
Fold and sew up sides, leaving a flap.
Using crochet hook single crochet around the edges of the flap for a tidy looking trim.
Sew on buttons and admire!

 If you spot any errors in the pattern please let me know

      

I Want to Crawl Under a Rock….

Oh yes, 
I knew it was going to be a day.

The paperweight that is my phone rang,
I just about jumped out of my skin
and 
grabbed it and answered in my most 
professional voice,

“Hello this is Nurse Kitty”

The voice on the other line said 

“Hello this is HR lady from the group that Local Hospital is 
affiliated with….”

And that’s when 
the phone fell from my hands, hit the floor and promptly
hung up on HR lady.  I desperately check caller ID, it comes up as unknown.

It’s been an hour and no call from HR lady again.

I think I’m going to crawl under a rock now.

The Things Left in the ER

  Worked the other night in the ER, it was a typical night of babies with runny noses, tummy aches and bug bites. So I wasn’t overly surprised to hear from one of our visitors that they were bitten by a spider, nor was I surprised that they had captured the spider and brought it in a bottle for us to see so we could determine whether it was the poisonous kind. Turns out that it was a wolf spider, a pretty harmless spider that would leave you with a bite that would hurt but with no danger to the patient. PA No-Bullshit was on and he had them in and out in less than an hour much to our delight.

 A few minutes after they left I hear a shriek from the room and go running, I see the housekeeper pointing in horror to a water bottle that had been tossed on the floor and had rolled under the bed. The bottle containing the, still live, spider. 

  Now seriously, first off who the heck just leaves their junk lying around for someone else to clean up? And secondly who the heck just leaves a live spider in a bottle on the floor for someone else to clean up?

  Seriously, 
I wonder about people like that…and what their homes must look like.

No spiders were harmed in this ER visit.
The spider was released alive and well into
it’s natural habitat, outside the hospital.


Normal Hemodynamic Values

    Holidays are over and I know all you student nurses are heading back to school.  Cardiac monitoring was always a hard one for me to keep straight with all the values that you need to remember. I used to get a small pocket sized note book, type up my norms in charts and then past the little charts into my notebook.  I know a little OCD but WAY cheaper than those pocket books they try and sell you in the bookstore.
  So as a little back to school present for you all here is a nifty little chart that will give you all the norms for hemodynamic monitoring.

  Feel free to cut and paste it!
Parameter Normal Value
Mixed venous oxygen (SvO2)
60% -80%
Cardiac output (CO)
4-8 L/min
Pulmonary artery pressure (PAP)
25/10 mm Hg (20-30 / 8-12)
Pulmonary artery occlusive pressure (wedge) (PAOP)
4-12 mm Hg
Central venous pressure (CVP)
2-8 mm Hg
Stroke volume (SV)
60-70 ml
Stroke index (SI)
25-50 ml/beat/m2
Cardiac index (CI)
2.5-4.0 L/m2
Systemic vascular resistance (SVR)
900-1400 dyne/s/cm-5/m2
Pulmonary vascular resistance (PVR)
100-240 dyne/s/cm-5/m2

Stuck in a Rut

 There hasn’t been a lot of posting because there hasn’t been anything, in my opinion, to talk about. I get up, go to work, come back and sleep a coma. It’s been the same old same old nothing seems new and fascinating and cool any more. Perhaps that is where the problem is, I am stuck in a rut.

  It’s not like things aren’t happening around me, but perhaps the problem is lately the same old issues keeping popping up and they never seem to get fixed. I have been reading a book written by a nurse, her story spans from the mid 1980’s to present day and it was stunning to see that even in another country and another time that the nurses are plagued by the same problems we are to this day. It was both affirming and frustrating to see, it was nice to know that it wasn’t just my unit or this city that these problems keep cropping up. At the same time it is frustrating to know that we, as nurses, have been fighting with the same issues for over twenty years!

  I’m not sure what the right Tx for this little “mood” I am finding myself in lately. I’ve been trying as hard as I can to separate myself from work when I am not there, which is challenging when your phone is ringing everyday with messages from staffing cheerfully asking if you could find some way to work just one more night. 

  A friend at work gave me a little bit of cynical advice, “Take care of yourself because in the end you are all you have to rely on and no one is going to do it for you.” A little mercenary, but when I sat down to think about it she was right. I see it everyday, the bewildered spouse who suddenly finds themselves hovering over a loved ones bed in my unit. How many times have I gently told that person that they should go home and take care of themselves while we take care of their loved. I know what my friend is saying is in the end we all need to know how to rely on ourselves. There is no crime in leaning on a friend or spouse, but to be able to stand on your own when needed.

  So I’m taking her advice and finding better ways to take care of myself. The first step to that is turning off the ringer on my phone, and picking up a good book and a cup of coffee. After I get done with my book, I’ll try and figure out the rest of the plan.

Happy Nurses Week

  The other night was the big kick off to Nurses Week, the pot luck was set out and delicious smells rolled out of the galley and were making my stomach growl. I wanted to run out and grab something hot, but I was stuck. Stuck in my room with a patient who was in a very very bad way and a family who didn’t dare move from the room. I don’t know why but whenever a potluck is set out, my patient crumps. I stayed in that room for most of the night unable to step out for supplies let alone for food, but at the end of the night I couldn’t feel happier.
  That night was a blinding example of nursing at its absolute perfection, the team pulled together, nurses in and out of the room helping me with supplies, an extra set of hands or just whisking away the accumulating mess of tubing and wires and surgical instruments. Cups of coffee were cheerfully delivered to the family, reassuring smiles flashed their way and somehow, somehow they knew everything was going to be OK.
  At the end of the shift I was exhausted, but not as exhausted as the family who sat and watched helpless to do anything and having to put trust and faith in absolute strangers. When I left that morning I saw tears on their cheeks but hope in their eyes, I received hugs that conveyed so much more than any words.
  I walked out the doors that morning exhausted yet somehow renewed and revived. It’s because of these moments I am a nurse.

Happy Nurses Week to all of you who have felt what I felt that morning.

Overtime or Overworked?



  Sorry for the layoff folks but that whole “Real Nurse” thing got in the way of…well everything this week.  This week I worked SIX shifts straight, because I can’t say no when the staffing office calls  looking for someone to come in extra. Don’t get me wrong here, I’m happy I made a load of overtime this week, but I am exhausted, which leads me kinda to the point here. When does overtime just become overworked?


  Let’s be honest, being fresh out of school I still have very vivid memories of what it is like to not know how you are going to make ends meet. So kinda like a stray cat that eats whatever you put in front of it, I will take any chance to pad my bank account. Whether it means floating to any floor in the hospital to avoid being called off due to low census, working holidays without a complaint, or picking up pretty much any overtime shift that is offered to me, regardless of how insane it is. I’m sure plenty of new nurses reading this know exactly what I mean and plenty of you nursing student who are set to hit the workplace soon are planning to do this too, the money is good and it’s there for the taking if you are willing to do it, but should you?


  There are always pros and cons to everything you do, and now that I have done what I really thought was impossible I can sit back and go over in my head how smart or stupid this little exercise of my endurance and love of a fat paycheck really is. 


  Having done it once now I’m not sure I’ll do it again and I am not sure how much I recommend it to any nurse. To be quite honest my whole body hurts and I think I have totally undone the work the massage therapist did on my back last Saturday. My sleep schedule is now seriously messed up having gotten used to sleeping in the AM and being awake in the PM , that it’s going to be tough to revert back to being a “normal” person on my days off. 


  More concerning is the how my ability to handle stress went slowly down hill the further into the week I got. No matter how you slice it, working 12 hours a day is rough. Now when you are into your 48th hour in 4 days you may find that it has some toll on your emotional endurance. Yes, I was a little crabsy this week, and was that really fair to my patients? I’m not sure, I guess one could argue that with the way things were going, having a nurse was better than the outlook had been at the beginning of the night. At the same time I may have been a better nurse if I hadn’t been on day 5 of 6. Also, my concentration was not great by day 5, when I began to notice I got super cautious with everything I did, double and triple checking meds to be certain that I wasn’t making an error. Sure I get a gold start for being careful, but it really slowed down my productivity and was a little nerve wracking at times.


   On the flip side, there ARE upsides to picking up some overtime besides the big paycheck. I have made friends for life with he staffing folks for saving their butts and my co-workers all think I wear a halo for giving up a couple days off to help them out. My boss, our director, thanked me for being such a great team player and probably has a touch more respect for me now. For a new nurse it’s really important for me to establish to the higher ups that I am a team player, I have a connection to my unit and show them that I am willing to work, I think I established all these goals this week.


  So, was it worth losing a week of my life? Yes. Would I recommend you do it? I can’t speak to that in a yes or no way. Instead this is what I suggest, nursing is about total honesty. Be totally honest with yourself. Take some self inventory and ask yourself if you REALLY can handle that extra shift. Don’t think about it in dollar terms, just be honest about your limits and if you have even an inkling of a doubt in your mind don’t do it.  If you are worried about feeling guilty or caving to pressure, don’t answer your phone and talk to your staffing person, let them leave a message, they always do. Then take a moment to take a personal inventory and decide for yourself if you can handle it, only you can figure that one out. Remember, another opportunity will always pop up down the road to pick up a shift, just because you don’t feel like you handle one in the here and now doesn’t mean you won’t be able later, another day, another time.


  In the end I am glad I did it. I learned that I can handle way more than I thought I could, but I also learned a few things about my own personal limitations. I also learned that limitations are not a bad thing, or even written in stone, but just like road signs, they are something that you really need to pay attention to.

Trial By Fire

  Last night was my first night of orientation, meaning my patients all mine. I wound up with a fellow who came in a few days ago a very sick man and ended up vented and a lady who has been with us for a couple weeks now and was really looking more and more like a Hospice candidate if it wasn’t for the family wanting everything but compression’s done.


  The fellow began my night with a sudden high fever that required a call out to the Doc on call who laughed at the charming notion that a nurse was calling him for a Tylenol order. After he rounded and teased the newbie things seemed to settle into a decent flow of the night.


  Until my lady went down hill and fast. One minute I’m on the phone with the lab and the next I’m trying to get the code cart open for Epi.  I would love to say that we heroically saved her, but not so. Part way through the code the family got the idea that the meds we were pushing were not going to save her and requested us to stop. The thanked us for all our efforts and let her go.


  I somehow was left at the end of the night feeling like I had not been on my A game and if I had the night would have ended differently. I’m not sure what I have could have done, even the Doc had spoken to the family and let them know that it was best not to continue with life support. I just guess I have that feeling like that should not have happened on MY shift. 

Time Flies…

  Wow time flies, I just completed my very last day of orientation. Next week I will officially be an ICU Nurse, geeze what a weird feeling. It feels like I just stepped into nursing school and already I am stepping out on my own. 
  
  My patients, my decisions, my license. There are days when I sign the chart I stop a moment and stare at the “RN” behind my name and it feels so surreal. 

Paging Dr. Grumpy

 “Page the Doctor.” 

  The three words that seems to strike fear into the heart of every new nurse. In nursing school I cannot tell you the number of time that when the teacher said;
  
  “You’ll need to call the Doc if this happens.”
  “But what if he yells at you?” someone in the class would pipe up and ask every time.

  Why is this the gut reaction of every new nurse? Are doctors really terrifying creatures that put on a human skin when they come out of the lounge but in reality are snarling beasts when there are no prying eyes to see? Or is it that every doctor has an inner ear condition that is painfully exacerbated by only the exact pitch of the cell phone or pager ringer that sends them into a fit of pain induced rage when ever a nurse calls?

  All kidding aside, as a new nurse I have found it daunting to call a doctor, especially in the middle of the night. I don’t like talking to some disembodied voice, that I have no face to attach to. In the end I did have to get over this irrational fear of talking to doctors, what helped me through this phase was to have a formula when I called the Doc.

  Remember SBAR? Yes it felt like I was pulling that one from the depths of my brain, but I guess they taught it to us for a reason. A charge nurse suggested that every time I contacted the Dr I should write my report down in SBAR fashion so that it was organized and I had all my information in front of me. OK for those of you who have forgotten lets review.

  SBAR stands for SITUATION, BACKGROUND, ASSESSMENT and RECOMMENDATION. This format is often used in giving report to help the nurse give a full picture of the patients status in a short, concise manner to someone who would not be familiar with them. Let’s face it, Dr’s see hundreds of patients everyday, if you just call them about Mrs Smith it might be the eighth Mrs Smith they have seen, you need to give them enough to jog their memory about the patient so they can make the right call. SBAR report may be awkward in the beginning but with enough practice it will become second nature.Here’s a little taste of how it often goes.

 “Dr. Grumpy, I’m calling about Mrs Smith. She is a 57 yr old female who came to us with sepsis, since 8pm her BP has been going down and now I notice she has inadequate urine output. (That is your situation) She has a history of CHF and hypertension. (This is the pt’s background, don’t give a life story just what is relevant) Right now her BP is 80/45 and she is tachycardic at 110, with only 50mL urine output in the last 2 hours. (Your assessment) Would you like me to give a bolus of normal saline and start a pressor of some sort?(Your recommendation) 

  If you read that aloud you’ll notice it took under 5 minutes and gives the Doc a nice picture of whats going on in your neck of the woods. Not only have you clearly stated the problem that you are calling about but you have given the Doc enough info to make an informed decision. Here are some other tips:

  • Keep the patients chart open near by, the Doc may want to know the most recent labs. This way you are prepared, not fumbling around, they appreciate that.
  • Take five minutes and write your SBAR down so you have everything you want to say in front of you. I have blanked a couple of times when the Doc got on the phone, it saved my butt!

  • Don’t take is personally if you do get a cranky Doc, they are people too and like us nurses can have bad days. Just be polite, get what you need and hang up, then vent to your fellow nurses, no point getting too upset over it we have more important stuff to attend to!

  When a patient starts to take a turn for the worse it can often be pretty scary especially for a newbie. The best advice I ever got was from my charge who reminded me that a patient rarely goes downhill so fast that you can’t take a minute to organize yourself. Taking a second to clear your mind and focus on all the important things not only improves your patient care but will also make communicating with those Doctors even easier.
  



Please Silence Your Cell

  This weekend I did the unthinkable, I put my cell phone on silence. This crazy move was prompted by a phone call that came in at 7:30 am on my day of. The message went something like this;

 “Hey, we’re really short tonight a bunch of people called off. Would you work a shift tonight? Call us back!”

  What followed was an hour of agonizing over whether or not to pick up a shift, it would mean overtime, but I had just worked three back to back shifts. I took the chicken route out and did not call back. Later that day, my phone chirped again  and another message of very similar content was left for me. I began feeling pretty guilty, I hate working short handed and I can always use the extra and with times being this tight who knows when I will get an offer for overtime again?  

  At that point Mr. looked at me and asked me if I wanted  to work an extra shift. Well want to? Heck no, I don’t want  to but I feel like I should.  Why? He asked, why do you feel like you need to, we have enough money, why do you need to be the one covering when someone calls off?  

  That made me stop and think, why do I feel this guilt when the staffing office calls? I’m not sure but I noticed that it is something that happens most often in “young nurses”. A number of newer nurses on my unit often feel a tremendous pressure to pick up extra shifts, and the staffing office often puts pressure on them by saying things like;

   “You’re young you can handle it” 

  The question is, can you? Many nurses take on extra shifts and don’t ask themselves this question. We all know the dangers of working while tired, so why do we take the chances? Sometimes I think that we as nurses have a touch of the Superman Complex, we keep telling ourselves we can do it, when the question is should we do it?

  After Mr. asked me if I wanted to take the shift I took a quick self inventory. It was 10 am and I was already wanting to hit the bed again for a nap, I was getting grumpy just thinking about another night in the ER and my back was aching. Did I want to take this shift? Hell no, I wanted to sit on the couch like a lump, nap and perhaps con my husband into rubbing my sore back. That’s when it hit me, not only did I not want to take this shift, I couldn’t handle it and no amount of overtime would make up for the misery I would feel during and after that shift. 

  At that point I put my cell phone on silence, put it on the bedside table and pointedly ignored it for the weekend. When I looked at it this morning there was another message from staffing asking me if I wanted to pick up a shift on Sunday night. I am glad I did what I did.

Nursing Dx: Disturbed Body Image is Not Just for Women

  It occurred to me after reading the article Being Ken is as Hard as Being Barbie: Why Body Image is a Male Problem, Too (warning this will take you to a website with adult only content, please lock the kiddies up before viewing) that while the modern media is always talking about all the issues women have with “body image” we very rarely talk about how men feel. For the last decade we have very much ignored the male point of view when it comes to body image issues. 


  Do men not face the same pressures that women to conform to a particular and highly unrealistic image of what is attractive? I find that very hard to believe since every page I turn in a magazine features some well muscled, smooth skinned guy sans his shirt trying to convince you to buy whatever it is he is hocking. 


  As nurses I believe it is very important for us to understand the issues that face those who will walk through our doors in whatever setting that we work, but even more important is to continue to look at all sides of the issues that are presented to us.  I would highly suggest reading the above mentioned article as it is written very honestly from the male point of view, I found it very enlightening.

D.I.Y. Dentistry

Yesterday I was sitting on couch
eating a bowl of gumbo,
suddenly I feel this crunchy,
gritty sensation in my mouth.

Upon further examination,
it appears that the filling in my
back molar has come out.
Of course it would happen now,
when I have no money and no insurance!

So, I do what any prudent nurse does,
hop on the internet and see what one
does to treat this problem.

Here’s what I found:
Rinse twice a day with a chlorxehexidine based mouth wash,
brush gently, avoid chewing on that side
and get this stuff.
OTC temporary filling!
I went out this morning
 and picked it up at my local
Walgreens.

The stuff looks like white putty in a teeny tiny jar.
Scoop some out, roll into a ball 
and cram it into the offending hole in tooth.
Done!
Avoid eating for 1 hour to let it cure,
and I now have a filling that feels as secure as 
the original one.

Best $4.00 I spent all week.

7th Heaven Bar Recipe

  I’m a total disaster when it comes to baking. I can handle coding a patient and I keep my head in the craziest of situations at work but ask me to make a muffin and beware! Because of this I am always on the look out for easy recipes that impress. No one at the potluck needs to be the wiser about my ability to turn chocolate chip cookies into chocolate studded pucks that could kill someone.


  I found this recipe ages ago, they go by a number of names “Better Than Sex Bars” or “7 Layer Cookie Bars”. I call them 7th Heaven Bars, mainly because the recipe is literally layering seven ingredients then baking it.  This is a fool proof recipe and takes less than 30 minutes total to prepare.  If I need to make them to take to work I literally throw it together, shove it in the oven, and then get ready for bed. By that time I can pull them out of the oven and let them cool on the stove while I sleep.  Then when I take them in to work, everyone thinks I’m Betty Crocker!

 So here you go, whip up a batch and see how easy it is!

7th Heaven Bars
  • 1/2 cup butter
  • 1 1/2 cups of graham cracker crumbs
  • 1 can sweetened condensed milk
  • 1 cup chocolate chips
  • 1 cup butterscotch chips
  • 1 cup nuts (I used a mixture of pecans and walnuts)
  • 1 1/2 cup shredded coconut

– Preheat oven to 350 degrees

– Melt butter in the microwave then pour it into a 9″x13″ pan. Tilt the pan and ensure an even coating. 

– Sprinkle graham cracker crumbs evenly over the butter and pat down lightly, like you are making a cheesecake crust.
– Pour the can of condensed milk over the graham cracker crumbs to cover evenly.
– Sprinkle chocolate chips on top
– Sprinkle butterscotch chips on top
– Sprinkle nuts on top
– Sprinkle shredded coconut over top and gently press down.
– Bake for 25 minutes. Remove from oven and let cool then cut into squares.
———————————————————————————————————————————
  Make sure you let these squares cool completely, they are molten hot when they come out of the oven. Do not try to sample them until they are totally cool unless you feel like an ED visit!

Update 4/21/2012
  Took these bars with me while being floated to the ED. Food is always a good way to make friends there. The bars were a huge hit with the other nurses who have now nicknamed these bars “Crack Bars” because of the hugely addictive quality.

  


Hello Again…

 Looking at my last post I feel a little sad, wow it’s been a long, long time since I have had the time (and the drive) to sit down and write. Something that gave me great pleasure not so long ago. 

  With spring having sprung I decided to start on some spring cleaning, closets have been swept clean of 10 year old clothing, the garden has been cleaned and reseeded and I have decided to return to blogging.  I find that now that I am deeper into this world we call nursing that there are times when I need to sit down and really think about what happened and how I feel about it and sometimes seeing my thoughts in the form of words is helpful.

  To all the new nurses and students who may stumble across this post, I suggest that you make time to sit and just think. I know this sounds silly but in reality in school and in the working world it is often so hard to find a moment to sit and just go over things in you head, sort them and file them away. I am the type who is always on the go, moving on moving up, but eventually things caught up to me and I began to feel overwhelmed and I had no idea why. 

  I stopped to “think” because I had to, something inside me broke and I had to stop and ask myself what was really going on, and it was hard.

  Things are better now, and one of the things I decided was to return to blogging if nothing else to “journal”, for a lack of better words. 

  So here we go, a lot of things have stayed the same and a lot of things have changed. There are changes coming, I know that because nothing in this crazy world I have chosen ever stays the same for long, but that is why I love it. 

  So thank you to those of you who read along and welcome to my corner of the nursing world.

Pediatrics

  The other night I had the cutest kid in the ED, now you all know I’m not a huge kid person but I swear this child was a better patient than any of my adults that night. He had a painful injury that required us to transfer him out to a pediatric hospital and sat there smiling at me the entire time he was in my care. The little fellow even gulped down a decent dose of oral meds that, from the smell, I’m not sure I would have been able to take in one swallow.

  When the ambulance crew came in to take my buddy, the little fellow suddenly burst into tears and began sobbing. I was taken aback at the tears since he had been so cheerful all night.

  “He buddy whats wrong? These guys are going to take you for a ride in the ambulance, I thought you were excited about that.”

  The little fellow looked up at me and sniffled, “But I want to stay here with YOU! You’re nice!”

  I think my heart melted a little right then.

  After a couple minutes we had my buddy on the stretcher, giggling and waving good bye, asking the driver if he was going to put on the lights and siren as he was being wheeled out. Every once in a while a patient puts a smile on your face, my little buddy gave me one that lasted most of the night.

IV Insertion Tips

  A couple of days ago a reader asked me for some tips on IV insertion, unfortunately I was in the middle of a three day stretch and I wasn’t able to get a post up in time. It got me thinking though and I began going over all the things that I have learned in the last few months that have made putting in an IV much easier for me. 


  So here is what I could think of, I hope it helps.

Feel, don’t look.  

  I know every instructor has said this and it makes about zero sense, but trust me, this is one time in nursing that your eyes can lie to you. It makes sense that every new nurse (and even some seasoned ones) will go for an easily visible vein, but often these veins are very close to the surface and will blow easily, deeper veins are often stronger, less fragile veins.  
  Palpate veins with your fingers tips and feel around for a springy feeling vein. It will feel vaguely like  pressing down on an under inflated balloon, it will “bounce” a little under your fingers. Avoid “mushy” or soft feeling veins, these can be more delicate and blow easier. Select the largest vein you can find, they are way harder to miss, you can use a nice large catheter and they are less likely to “go bad”. No point in putting in an IV that only lasts a few hours. 

  Once you have a found a nice big, bouncy vein follow it up about an inch or two and make sure it feels pretty much the same all the way up. A hardened area can indicate a valve or sclerotic area that will not allow the catheter to advance. If you find one of these area’s be patient and follow the vein further up or down until you find a nice stretch of clean vein.

Hold on!
  Now that you found that vein, anchor that sucker!  You went through all the time to find it now make sure it doesn’t run away when you try to poke it. I hear a lot of people say that a patient has veins that roll, all veins do roll to a certain extent so hold em down!

 Everyone does it a little differently
For really roll-y veins try stabilizing
between two fingers.
Spread your fingers wide and hold the skin 
very taut.

OR
Anchor the base of the vein close to your puncture site.
Apply pressure and pull your thumb towards yourself
pulling the skin taut

  The key to anchoring a vein is to apply pressure,  so don’t be shy about pushing down on your patient and to pull their skin nice and tight. Apologize and let them know the discomfort will only be for a few seconds, it’s a way better option than having to poke them a second time. 
Don’t go deep!
  It’s tempting to puncture the vein at a 30 to 45 degree angle, especially if you have drawn blood a lot, then drop your angle and attempt to advance the catheter, don’t do it!  Going in on a steeper angle than 15 or 20 degrees increases your chance of going straight through the vein, and I find that when I drop my angle after a flash I flub the insertion almost 50% of the time.

  An IV nurse I work with gave me these tips, go in at an angle that is only slightly steeper than parallel with the vein and then check for your flash. If you don’t have one advance slightly at a slightly steeper angle.  As she put it veins aren’t that deep and your aren’t drilling for oil.


Don’t be shy
  OK so you got a great flash, but as you advanced the catheter you lose it. Sound familiar? It happened to me over an over again until my friend the IV Nurse commented that I am “bashful” in threading the catheter.

  What she meant is that when I was advancing the catheter I would do so slowly because I was worried about losing my IV. Problem was that my caution was what was causing me to lose my IV sticks. She reminded me that advancing a catheter quickly would not cause any damage.

  What I learned to do it insert the IV and check for a flash, 
then wait and see how well the flash chamber is filling. 
When I see that the chamber is nearly full, 
 I am sure the IV is in the vein.
Now in one smooth quick motion I advance the catheter.

  I know it sounds way too simple but honestly it has worked like a charm every time. Oh yes and don’t worry, if there is a valve or sclerotic area that you did not find prior to inserting the catheter won’t advance, promise.

And remember….
If you don’t get it the first, second or even third time
it’s OK.
Don’t beat yourself up about it, 
stop and think about what you learned from the experience.
Then let it go.

Remember,
 none of us were born with these skills.
We all have had to learn them
and
YOU WILL TOO!






A Nurses Christmas Link Up


Once again I’m linking up with Anna @ The Days When I’m Not a NurseandRenee @ This Won’t Hurt a Bit
Girls want to know what my Christmas plans are.
This year I am lucky enough to have Christmas Eve off!So I will be chilling with family.
But in the meantime,the holiday is in full swing!
Every year I make every nurse I work with a small handmade gift,this is what I came up with this year.

Handmade bath bombs
which I made in a variety of scents.
I got the idea here and here 
on Pintrest.
Then ended up combining the “recipes”
and making my own
which seems to have worked out pretty darn well!

They smell great 
and
 when I tested one in my bath 
it really made my dry skin feel soft.
I think all the stressed nurses need these!

So I made a whole bunch of them!
There should be enough for every nurse,
plus the Respiratory Therapists,
Phelbotomists, X-Ray Techs 
and 
Pharmacy Techs
that works on my unit.

Hopefully it will spread some holiday cheer!




Revelations

  Last night I spent my shift keeping a dying man alive.  I know, this is what I am paid to do, this is my job and as some people say is my “calling”. But when you watch and infection ravage a person in this way and make them nearly unrecognizable to loved ones it becomes hard to see the good that you are doing.


  I spent the night asking myself why. Why were we working so hard to keep a person alive when his body was telling us it wanted to do exactly the opposite? His body was shutting down, system by system.  Why were we pumping medication into him to keep his heart beating when the medications were just as damaging as the illness that had him here? The pressors needed to keep his blood pressure high enough we starting to have damaging effects on his fingers and toes.   Why did we force his lungs to breath with a machine when they had already decided to stop working.  If he was able to tell us would he have told us to stop?


  At about 3am I got my answer when his family arrived to the unit, arms encircling one another they went into his room. I had tried my best to clean him up and hide the damage the medications and the infection had done to his body by covering him up to his chin in blankets.  There were a lot of them, and they surrounded his bed talking softly to one another and touching his face.  When the came out the wife came over to speak to us, asking us to not go through life saving efforts when his heart gives out the next time. 


  She smiled at us and said,  “He’s heard his trumpet, he’s going to see Jesus and I am happy for him. He’ll be there waiting for me when it’s my turn.”


  Then she and the family thanked us, all of us for taking such good care of their loved one, for making sure he was there so they see him one last time and say good bye to him. Everyone one of them hugged us as they filed out of the unit to go home and get some rest. And everyone of them smiled through the tears, everyone of them was at peace as they left, knowing that they had one last moment with him.


  Last night I learned that sometime we don’t always save the lives of our patients, but me make a difference in lives of the people who remain here on Earth.

Dilemma and a Giveaway!

  I have a dilemma, but it is the very best kind of dilemma to have. Mr and I have decided that we need to get away, this will be our very FIRST vacation ever!  So we are now tossing around ideas as to where to head off too. We live smack dab in the middle of two great choices, Las Vegas or California, so where to go? Now you see my dilemma!


  It is two totally different vacations, in two totally different spots. I could head out to the Coast and spend my vacation on the beach, laid back out in the sun and just chill. On the other hand I could head over to Vegas and party it up, shop and let loose with the glam night life. Such a hard decision!!


  OK, so while I consider my trip destination I figured I would offer you ladies a very similar dilemma in the form of a giveaway. (Guys are welcome to join but the prizes are girly stuff, but hey maybe you have a lady in your life who would love them)


  Here’s the deal, there are two prize packs to be given away and a lucky winner for each.

The Pamper Pack





This prize contains all a nurse needs to pamper herself after a long shift!


– Simple Moisturizing Face Wash
– Wen by Chaz Dean Sweet Almond Mint ReMoist Intensive Hair Treatment
– Soothing Peppermint Menthol Foot Balm
– Sally Hansen Nail File

The Glam Girl





You may wear scrubs for a living but a girl has to glam it up once in a while!


– 14 Gorgeous Bangles
– Pair of Aviator Sunglasses
– Multi-Strand Rhinestone Necklace






















The Rules:

  You must be a follower of this blog either through Google Friends Connect or Google+, your choice. Now leave me a comment telling me which prize pack you would love to win and why you should get it. Make it funny, silly or serious but leave me something to make me decide to give it to you, this will not be drawn at random, my favorite commentors will win the prize. That’s it!


  Oh yes, and since I have to choose between vacation spots, you guys have to choose between prize packs, meaning you can only enter for one prize!


  The winners will be announced on June 29th.


(Everyone is invited to enter, this giveaway is not limited to nurses only. US and Canadian Addresses only)

Nurses Week

 This week I lost a colleague, co-worker and friend. 

  This week that is for celebrating nurses and all that they do, the world lost a great nurse. There will be news stories devoted to her, but it rocked the worlds of all those who worked with her, knew her and loved her.

  This week while many of us will be enjoying food, prizes and gifts to say thank you for all the sacrifices we make, one group of us while be mourning the loss of a friend and drawing close one another for comfort.

  What can I tell you about her? She was a nurse. She cared for her patients, not always in the tender, gentle, stereotyped way that TV and books glorify as the hallmark of a “good nurse”. But always with her patients best interests and well being in the very fore front of her mind. She cared for people with great skill and a good heart always. She volunteered for disaster relief even though it pulled her away from her family at times. She always helped those around her with good nature. In the end she was a good person and she was a nurse, in every embodiment of the word and was proud of that title.

  On this week when you are celebrating Nurses Week, remember those around you and celebrate them. Not this trumped up idea of what the “ideal” nurse is, but the people that they are. Who they are and what they do, because you never know if you will not be able to tell them how amazing they are tomorrow.

 This Nurses Week I will celebrate who she was, a colleague, co-worker, friend and a nurse.
  

A question for my fellow vampires:

I have a blood draw coming up in the next week. Normally, I have veins you could hit with a harpoon from a door three blocks down. This, however, will be a fasting blood draw, and my veins disappear when I fast, no matter how much water I drink.

Would it be a breach of manners to show the phlebotomy guy my left radial vein and say, “This one, right here, with an eighteen-gauge butterfly”? It’s at my wrist, which is an odd place, but then, I have odd anatomy (thanks, Mom!). Or is that considered sub-fusc?
Comments welcome. Last time, he had to stick me six times before getting enough blood for two vials.

I just had a realization.

I am a crazy old lady, forty years early.

Definitions: “Old” means, to me, at least eighty. Although, given the long-livedness of my family, I should probably push that to eight-five or ninety.
“Crazy” means a cackling, cigarette-holder-waving, martini-drinking, be-lipsticked woman with heavy black-rimmed Harry Potter glasses with one of those beaded chains on them. Also many cats, also insane decor. Also big bell-sleeved pieces of clothing that might or might not have been Victorian men’s smoking jackets at some point in the past.
“Lady” means being able to cackle, wave your Sobranies around in your ivory holder, drink your pink gin at four pip emma on the dot, and still have people coming over to eat your potroast and sit on your insanely decorated couch.
Aside from the smoking jackets and ivory cigarette holder (and the martinis; I’ve never liked martinis [Sorry, Granddad and Granny!]) I’m there. Proof?
Following Sal’s lead, I’ve been looking into color in my wardrobe. Also something more than jeans and V-necked T-shirts and cardigans. Gudrun Sjoden is my new obsession.
Also obsessive? Glass beads. In different brilliant colors.
And displaying my Fiestaware and various other midmod ceramics. On shelves. Above the doors of the kitchen and dining room. Where the cats can’t get to them. HA!
Also biscuit tins and salt boxes that date to the turn of the century.
Also really good power tools. I’m thinking I may need to upgrade my two B-level drills for one A-level. But holey kamole are they expensive!
Also another tool belt. Currently, I have a black-and-pink, studded, Hello Kitty belt with the typical hammer loop/nail pouches/level hook on it. The belt has strangely become too large over the last several months, so I’m looking for another. Preferably one that Lady Gaga would wear while putting up picture frames with nothing in them.
And this. I do not know why.

A slow day, or: Online Dating In Four Words:

The horror! The horror!


Kiva and I were in the unit yesterday. Both patients had gone off to have obscure tests of one sort or another done, and things were slow. She asked how my love life was.
“Dismal.”
“Have you thought about finding a man here at work?”
When I recovered sufficiently, I pointed out that, as a nurse, you are not around men most of the time, unless they’re not neurologically intact, and that’s sort of a requirement for me, thanks.
“What about online dating?” she asked.
Now, Kiva’s not from here. Her marriage, as is usual where she’s from, was arranged. Over the last twenty years and two kids, it’s grown into the sort of partnership that gives arranged marriage a good name. But, as you might expect, she’s a little clueless when it comes to the reality of being a forty-year-old woman in the online dating world.
Without a word, I punched up Match dot com.
Kiva watched me enter my pertinent information, then peered over my shoulder excitedly.
“Gracious, there are a lot of pictures of tongues.”
I scrolled down the page.
“Oooo! This one looks good! He’s thirty-seven, and….wait. No, he works at Wal-Mart. And he’s married? And looking for a slave girl?”
I continued scrolling.
“What about….oh, no. You aren’t part of a couple.”
Still scrolling.
“What on earth does that mean?” she asked at one point. I wasn’t brave enough to tell her.
“He looks nice” she said, “Really strange, but nice.”
Except, at fifty, he wanted a woman no older than twenty-three.
Finally, Kiva found somebody she figured was perfect for me. He could punctuate, knew the difference between “they’re” and “their” and “your” and “you’re”, and was single, looking for a single woman, and wasn’t possessed of any of the stranger fetishes.
“Except he’s nineteen,” I said, “and looking for a cougar.”
“Perhaps you can tell him that two of your cats equals one big one” Kiva said.
I didn’t have the heart to tell her what “cougar” really meant.

Enough with the sweet sentimentality. It’s time for some bitching.

1. When a nurse charges, we give them little phones to carry around. That way, we can reach them when something like a code or a respiratory-team response happens. If you are a charge nurse, please carry your phone so we can reach you, and some gooberhead like me doesn’t have to respond to RTRs with a little box and a befuddled expression.

2. If you smoke before rounds, Doctor, please flap your coat around outside so you don’t choke the rest of us with your putrid cigar smoke. Or smoke better cigars. Please.
3. You’re going to get a bath. I don’t care what you say. You’re in the ICU, you get a bath. If not now, later. Seriously. If I can smell you from the door, you might get two. Believe me, it’s not fun for me, either, but it does help cut down on infection rates.
4. Neuro-breath may be the worst thing ever. It’s not due to intubation–non-intubated patients get it too–and it has nothing to do with overall oral hygiene. It’s a weird, awful bad breath that people who’ve had bleeds get. I do not know why, and I’d like to, so that there might be some chance someday of some bright person solving the problem.
5. Delicate-featured, pale redheads should never wear as much makeup as you’re wearing, Doctor. Trust me on this. If you’re leaving smudges on your own labcoat by turning your head, you’ve got too much paint on.
6. While I’m at it, can every owner of every beauty and fashion blog in the world please get over this putting-eyeliner-on-the-inside-rim-of-your-eye kick? It looked like crap in 1983, and it looks like crap now. Not only do you end up with irritated eyes and black eye boogers, you look like a tired old whore. Or at least I do. Because I believe in truth in advertising.
7. The time to schedule every single elective aneurysm clipping in a three-state area is not the week that our main CT develops some weird software problem and has to be taken apart.
8. And while I’m at it, the time to mention that oh, yeah, I forgot, I *do* have some metal implants in this arm from when I broke it as a kid is *not* as I’m sliding you into the MRI. Especially when it’s a stat MRI. Perhaps especially-especially when the resident on call has already dragged his exhausted ass out of bed and come up here to admit you, and he’s already cranky.
9. If your six-hundred-pound mother-in-law has just had an extremely risky gastric bypass surgery, she is not allowed fried chicken to eat. Please don’t try to smuggle it in under your shirt.
10. Likewise, when we’ve just had a huge scare regarding Fifth’s Disease and immunocompromised patients (and pregnant nurses) is not the time to attempt to smuggle your small baby into the ICU in a tote bag.
There. I’m done now. You can expect more sweet sentimentality and wide-eyed wonder next week.

Saturday Sublime

Purple patent pumps from ECCO.

Italian paper from Paper Studio. This is going on the inside back of my secretary if I ever get around to redoing it.

Anna at Door Sixteen just finished stripping paint off the locks from her living room windows.

This is the sort of thing I admire her for: I barely have the patience to consider the job.
Codigo Mio silver-and-gold Braille ring.

Tuesday Meditation: On Prayer

The Man of God (my neighbor, Pastor Paul) and I were talking about prayer. I mentioned to him that my Brother In BFE had said that he was trying to pray more; that he felt like he didn’t pray enough (or maybe at the right times).

I told TMOG that my first thought in response to that was, “What? You don’t pray as you breathe?”
And TMOG pointed out, quite rightly, that I am fortunate in being able to do what Buddhists call walking meditation, and what I call prayer while breathing.
I am not much of a Christian. I’m still not down, Dawg, with the primary tenets of the Christian faith, chief among them being Jesus’ divinity. I studied comparative religion in college and so learned about a donkey-headed half-man, half-god who was nailed to a tree and raised from the dead three days later. I have too much doubt to call myself a Christian, though I might call myself, on a good day, a follower of Christ. (Paul-the-Pastor says that Christian disciples go all the way up on the cross, while followers stop at the bottom of the hill. I’m down here, at the bottom of the hill. Join me! I have cookies!)
And yet I pray. I pray intercessory prayers, for people I work with who are sick or hurting. I pray intercessory prayers for my patients. I pray intercessory prayers for myself, because there are things that I want to change.
Most of the time, though, the prayers are wordless. They come out of me as simply as a breath and as regularly. What began as a conscious effort when I was in school has evolved to a very simple state of being, in which weeding the garden is a prayer. Dusting the bookshelves is a prayer. Dealing with the be-damned cats is sometimes not so much a prayer as a florid curse, but I’m working on that one.
There are times when words simply won’t do. Those times happen most often when I’m confronted with a person so sick, so beyond my help, that I can’t even comprehend what on earth I’m supposed to be doing here. It’s in those times that a still, small voice (there is a little cloud/it is like a man’s hand) tells me to do the simplest thing first. I consider that an answer to a wordless prayer.
I would not be here, talking about this, were it not for the work I do.
In the main, I am a scientist. I look dispassionately on what works and what doesn’t; the idea of a double-blind study is like crack. But there is a part of me that prays with every step as though I were counting the beads on a Buddhist rosary: one hundred and eight, with subsidiary strands: enough to get lost in the process.
We are all dichotomus. The friend who has been seeking Christ finds he doesn’t pray enough. I, who have never sought Christ but instead raged at God and cursed Her less-understandable ideas, am the one who prays as naturally as breathing.
From Brother Cadfael’s Penance, by Ellis Peters:
If it was the sharp, clear cold of frost outside, it was the heavy, solemn cold of stone within the nave, near darkness, and utter silence. The similitude of death, but for the red-gold gleam of the constant lamp on the parish altar. Beyond in the choir, two altar candles burned low. . .Now he had now true right to mount the one shallow step that would take him into the monastic paradise. His lower place was here, among the laity, but he had no quarrel with that; he had known, among the humblest, spirits excelling archbishops, and as absolute in honor as earls. . .

. . .He lay down on his face, close, close, his overlong hair brushing the shallow step up into the choir, his brown against the chill of the tiles, the absurd bristles of his unshaven tonsure prickly as thorns. His arms he spread wide, clasping the uneven edges of the patterned paving as drowning men hold fast to drifting weed. He prayed without coherent words, for all those caught between right and expedient, between duty and conscience, between the affections of earth and the abnegations of heaven. . .

Nix and Hydra, and other things.

It’s the solstice. This is always sort of a sad day for me, as it marks the time when the days begin to get shorter. There are plenty of blackberries still to be had, and apples and Brussels sprouts still to come…but. One begins to feel like Robinson Crusoe, rescuing spars and detritus from a wreck that’s long since gone down.

Nix and Hydra, Pluto’s two moons, were disovered on this day in 2006. Were they demoted, too?
The Battle of Okinawa ended, in 1945.
Bats are particularly active at this time of year.

The downside to being single

I was thinking about this last night, as I was cooking hashbrowns to go with my breakfast-for-dinner entree of Boca Burger and Muenster omelette (don’t knock it; it’s quite tasty). There was nobody around to say to, hey would you mind scooping the cat boxes because I forgot to do it before I started cooking and now I have to make sure the onions don’t burn.

I thought of it again today, after hauling myself out of bed at 10:53 ack emma (in my defense, I did get up and stay up in the middle of the night) and trotting out to the grocery store. I have a sore throat–not the kind that comes on suddenly and necessitates antibiotics, but the viral sort that just lingers on and on. And I needed soup and juice. And beer. And guaifenesin. And there was nobody to send for it.
So, yes. While being single rocks overall, there are parts of it which, situationally, suck.
I suppose I could put an ad up, maybe on Craigslist. The thought of actually joining something like Match dot Com is entirely too frightening; besides, have you seen what’s on there? Guys who either work out twice a day, or list the requirement of liking NASCAR. As my personal ad would probably be titled “WOMAN WITH PULSE SEEKS MAN WITH SAME”, I don’t think I’d get too much of a response. Especially as I would be tempted to use a picture of a velociraptor as my profile picture.
So. Let’s assume that I put up an ad. I don’t really *want* a boyfriend, but I don’t want to advertise for somebody to come ’round and get me soup and make me tea when I’m not feeling well, and to scoop the cat box when I’m busy. For one thing, putting the words “cat box” in a personal ad would attract two kinds of attention, both of them the wrong sort: the first from men who think that “cat box” is a coded phrase for Something Else Entirely; the second from men who would be willing to scoop said box (the more I say that, the awfuller it sounds) and take out the trash and make a cup of tea, but who would insist on wearing a leather harness and calling me “Mistress” while doing it. The former is too much trouble to explain away; the latter is too much work.
Therefore, I suppose I would have to advertise for a boyfriend. Unfortunately, I don’t have a lot of personal qualities that translate well to personal-ad-format. For instance, I can make up bad song lyrics at a moment’s notice and have a gift for limericks. I’m a hella good cook, but mentioning “hella good cooking” brings to mind women in aprons with immobile hair and a rictus of joyous fulfillment at the thought of a new vacuum cleaner. Besides, my grooming is inconsistent at best. Somehow,

SQUATTY WOMAN WITH INCONSISTENT PERSONAL GROOMING SEEKS MODERN-DAY ADONIS FOR LIMERICK RECITAL, TRASH REMOVAL, AND CAT-BOX SCOOPING. MUST BE FINANCIALLY SOLVENT AND NOT INTO WEARING BONDAGE GEAR OUTSIDE THE BEDROOM. PLEASE HAVE EQUAL FACILITY IN QUOTING SAYERS AND PEELING GRAPES

doesn’t seem like a formula for success. Especially not when paired with a velociraptor snap.
Oh, I could hire people to do it for me, I suppose, but there’s the problem: it would take multiple people to do what I need done. The drunken man who pounds on my door twice a week offering to mow my lawn is not the person I’d trust to feed my animals. Nor is a cleaning service likely to take kindly to the suggestion that their already-overworked employees trim back the bushes along the fence line. (You’ll note that I did not include bush-trimming in the example above. Combined with a mention of personal grooming, that too raises unpleasant associations.)
Is there such a thing as husband-rental, and does it come by the hour, and without the need to nag? Because that’s truly what I need. I’m not, however, willing to put up with either the expense of getting married or the irritation of picking up 1500 socks every day, none of which the owner of said socks will claim. And divorce is just a flaming pain in the ass.
Any newly-minted nurses need letters of recommendation? Because I’d be happy to write some. If you’ll come scoop the cat box and trim back the bushes and mow the lawn.

OMG WTF AM I DOING HERE? A guide to your first months as a nurse (with special thanks to Pip)

When I was a new-new nurse, like my first six months on the job, I would show up way early for work every morning and pray in the hospital chapel that I wouldn’t kill somebody. I was scared–constantly terrified–of all the mistakes I could make, of how little I knew, of how easy it was to screw up and do damage.

Slowly, those feelings went away. It took about a year and a half before I could say “I’m a nurse” without feeling like a fraud. Watching other new nurses go through orientation after me really helped–it showed me exactly how many people are watching your every move as an RN.
So, and with full thanks to Faithful Minon Pip, who said, “Yo, dude, you need to write a ‘surviving as a nurse’ post”, here are tips for Surviving As A New Nurse, Dude. Yo:
1. Pee.
This is the single most important piece of advice I have for new nurses. Right after report, but before you hit the floor, pee. Emptying your bladder will clear your mind and take one small worry away. With any luck, it’ll be hours before you need to pee again (unless you’re me) and you’ll have a chance to get things done before then.
2. You are not going to kill anybody. No, really, you’re not.
There are three reasons for this, so I will subset them under the main point:
A. Humans can take an unbelievable amount of damage before they keel over.
You’re unlikely to do the sort of damage it would take to kill somebody yourself; it generally takes a fair number of tiny mistakes that add up. At every stage of the way, there’s the chance to ask questions, to catch problems, and to stop bad things from happening. Your job, therefore, is to be The Elephant’s Child and ask questions about anything you don’t completely understand and feel comfortable with.
B. Everybody is looking over your shoulder.
Yeah, you as the RN have ultimate accountability and responsibility for what happens, but remember: you have other nurses, pharmacists, and docs checking you all the time. Lean on them. See “asking questions”, above.
C. Humans can take an unbelievable amount of damage before they keel over.
This is exactly the first point, but I’d like to take a different tack on it: I have had patients with potassium or magnesium or calcium or pH levels that were totally incompatible with life, and those patients weren’t even all that sick. I have had patients with blood pressures that would make your eyes bug out and others with pressures that made me wonder if they were perfusing everything. I have had patients missing legs, arms, and (once) half of a body. All of those folks lived, and they all did mostly fine. It’s all about what that person is used to. For some people, walking around with a calcium of 5.3 is totally legit.
3. The First Rule Of Nursing Is: If You Have To Fuck With It, It’s Wrong*.
There was a story years ago about a new nurse in my orientation class who ran oral contrast through a central line, thus injuring (but not killing) her patient (see, we really can take a lot!). In order to do that, she had to set up a Rube Goldbergian series of tubes and connectors, find a certain type of syringe that would fit the end of it, and then administer the oral contrast bit by bit, because it’s very thick stuff.
Think of how much she had to fuck with that to make it work. If you’re having to force something to make sense or work, STOP. Look around. Ask if you’re doing it right. Medical equipment, med-administration rules, and protocols are so bulletproof these days that it’s work to screw them up.
4. Find somebody whose shoulder you can cry on.
This might be a preceptor, a fellow orientee, a more experienced nurse, or your mom. Whoever it is, find that person and use them as a sounding board for when you do something really stoopid. You *will* do stoopid things now and again–all nurses do, all through their careers–and it’s important that you find someone who understands and can make you feel like less of a donkey.
5. Remember that things will get easier.
It’s hard at first to get your skills and time-management and organization down. You might miss lunch or end up with a bladder infection, but that will change. Eventually, some things will become so second-nature that you’ll have to double-check to make sure you did them. Eventually, changing a bed with a patient in it will be simple. And eventually, you’ll have time for lunch. Don’t despair.
6. Don’t be afraid to ask for help.
Delegation is a beautiful thing. Find the people who are willing to help you and lean on them.
7. Don’t be afraid to ask questions, even stupid ones.
I ask questions all the time, sometimes the same ones over and over in a shift. Nobody thinks I’m an idiot. Obsessive-compulsive, yes, and perhaps with a little short-term memory deficit, but not stupid. They do it too. Questions are good.
8. Be kind to the techs and the unit secretary, for they will save your ass someday.
This one needs no explanation.
9. Likewise, be kind to the doctors, for mostly they love to teach and are fairly nice people.
If you find one who’s a jerk, avoid him or her at all costs until you feel more confident. Nothing will make you fade faster than being yelled at by an asshole with “MD” after his/her name.
10. And do find time to be kind to yourself.
You didn’t spring fully-fledged from some god’s forehead, and neither did any other nurse currently in existence. Even Cherry Ames screwed up now and then, and she learned things every day of her career. You will, too. Be easy on yourself: you’ve taken on a very tough job, in a challenging, rapidly-changing profession, and the whole of it is something that nobody but another nurse could really understand.
*Funny story about Jo’s First Rule Of Nursing: I had a student precepting with me the other week in the CCU, and I told her as we started, “Remember: the first rule of nursing is, ‘if you have to fuck with it, it’s wrong’.” She immediately said, “Oh, my gosh! You read Head Nurse, too! I love that blog!” I concurred solemnly that the writer was a damn genius, the crafter of elegant and spare prose without equal in the world today, and then we went on with our day.

The Crip Files: Well, At Least It’s Not Broken edition, Plus: Musings.

Got a call from the happy doctor people yesterday. Doc Pedro reviewed my X-rays and determined that I have degenerative changes in my spine, specifically in the areas C5, C6, C7 (what a shocker that was), but no obvious subluxation or fractures or aliens.

At least no aliens that are radio-opaque.
That was good to know, especially as my assigned light duty turned into heavy duty quite quickly yesterday afternoon. There’s something about having three stat CT scans and no transporters that makes “light duty” into “take this immensely heavy bed on which the drive has gone out down this stretch of carpet, down seven floors, and oh, by the way, you’ll have to push the damn thing aaaaalllll the way down here, to where we’ve built the new radiology department.”
I hate not having enough bodies around to do the work. I’ve been training heavier so that I could do more on my own, and that, combined with the fact that I have to do more on my own, is what led to this injury. I’m backing off the heavy weight. My new goal is to look like Christina Hendricks, but with definition.
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As a follow-up to my last post, I have to point out: I had a patient have multiple TIAs during my shift the other day. The nurse practitioner came in and immediately dropped the head of his bed and raised his legs.
I’ve worked so long with *hemorrhagic* strokes that that didn’t even occur to me. With hemorrhages, you keep the head of the bed 30 degrees or *more*. With occlusive strokes, it’s 30 degrees or *less*.
This is going to be a really steep learning curve.
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What I want, she thinks, is to be outside on the deck, drinking a dry sparkling wine and eating stinky cheese and fruit. Instead, it’s been raining off and on all day (more like HOLY SHIT THE WORLD IS COMING TO AN END pouring off and on all day; so much for the dusty plains of central Texas) and it’s just humid enough to require gills for breathing. Plus, the flies and mosquitoes are out in force. So I’m sitting indoors, eating Auntie Jo’s Special Refried Leftover Ramen Concoction and drinking the Scotch that Nurse Ames brought me from the duty-free.
Perhaps I will hit the farmers’ market tomorrow and buy blueberries blackberries strawberries buffalo mozzarella cheese tiny ornate vegetables home-made whole-grain crackers and a bottle of something drinkable from Becker. Then I will sit out, rain or shine, and watch the bats and the satellites.