Monday, January 29, 2007
Recently we took a little time off for what my husband calls a "mini-vacation." We pulled our boys out of school for a couple of days and took a short 2 1/2 hour trip southeast of Tallahassee to Silver Springs, Florida. My husband and I decided some time ago that when we get a chance to give our kids a little "hands on" experience with life (i.e. nature, history, etc.) that pulling them out of school for a couple days is a small price to pay.
Take a look at what I mean by "hands on" experience. Reading it in a book is fine if that is the best you can do. But holding it in your hands can make a lifelong impression.
Silver Springs has several different glass bottom boat rides you can take the kids on. The water is so clear and the fish so big it is almost unbelievable. You can see the kids in this picture looking through the glass bottom of the boat at a school of fish. I think the tour guide called them Bluegills.
The tour guide said that a number of old Tarzan movies were filmed at the springs, as well as some James Bond and other movies.
Across the parking lot from Silver Springs is a water park. It was closed for the winter. The kids were a little disappointed about not going swimming so we found a hotel with one of those indoor heated pools and swam until we were all prunes.
What a fun "mini-vacation."
Thursday, January 25, 2007
He had been biking without a helmet down one of the roads running through a local college campus when he was T-boned by a car going about 35 mph. His body went over the hood of the car, ricocheted off the windshield, over the roof of the car and onto the pavement. He said he recalled everything up until he hit the pavement. When he finally came to, there was a crowd gathered around him and blood was gushing from a deep cut extending about six inches from the side of his right eye upward to the edge of his hairline. The impact had almost taken his eyesight. His bike was about 40 feet away lying in a mangled clump of titanium.
All night he kept saying that if he had rotated just a few more inches while in the air he could have lost his eyesight or suffered sever brain damage. He said he never rides a bike without a helmet, but thought this one time as he rode on campus he would be alright.
All things considered, he was lucky. Very lucky.
Tuesday, January 23, 2007
I can see that I have a fight on my hands and will have to prove myself EVERY day I have her! Great!
Monday, January 22, 2007
"Publish Not Perish, is a free online tutorial designedto introduce graduate students, junior faculty, and other potentialauthors to the mysterious world of scholarly publishing, from gettingideas and choosing a journal to submitting and revising a manuscript. "Publish or perish" has been the standard marching order since thecreation of the tenure system, and faculty and graduate students oftenmust fall in step with it. The tutorial can help maximize chances ofpublication and minimize frustrations. Learn about the variables ofscholarly publishing, how to control the ones you have influence over,and how to learn and grow from the ones you can't control. Publish NotPerish was created through a collaborative effort of the CU systemlibraries, with funding from the CU President's office. "
Friday, January 19, 2007
It will be weird not seeing her, not that I see her every day, but now I know I won't be... I can pick up the phone and call her I know or email (as we often do now) or use msn messenger, but still, in a weird way feel like I am losing a friend. (I know I am not, it's just what I feel).
Good Luck my friend, have fun and COME BACK WITH the guy!
SO I won't say goodbuy, but see you soon!
This tool provides a checklist of issues that should be considered when writing a protocol, examples of how these issues have been addressed by other researchers and teaching materials. The tool is available in both English and Spanish. A recent article in the Nov 2006 issue of Journal of Clinical Epidemiology has been published on Practihc.
SlideShare.net is a new Web 2.0 tool that allows people to share their slide presentations. You can't download any of the presentations but just being able to view a slide show can be a great resource to give you ideas for content and layout. SlideShare is a new resource so the content is just in its infancy stage. Subjects range the gamut from wedding slide shows to slide shows on medical ethics and HIPAA. There's not much there yet on nursing but hopefully that will change. Be sure to consider this a resource for posting a slide show you've developed or for searching for topics that you need to create.
Check it out!! http://www.SlideShare.net
Thursday, January 18, 2007
My clinical teacher is apparently the one to have, the others are jealous, so I guess it's a good sign. She is strict, and demanding in what she wants, but has a sense of humour and is friendly. We'll see what she's like in clinical. I am on 6 medical at the RVH. Never been to that ward, been told that we get a real mix of diagnoses. Should be interesting...
So, here we go! Oh ya, she also told us that it is impossible to get 80's-90's in Med-Surge II... great! NOT a good sign when the teacher tells you this... oye!
Well, I'll keep you all posted (literally) on what happens, that's it for now, I have to go do some homework for TOMORROW!
Before I start any new travel assignment, I make sure I have a written (not a verbal) contract with my agency. It has been my experience that promises made over the telephone between me and the agency don’t mean much until they are reduced to writing. Agencies experience personnel changes and the person who made the verbal promise may no longer work for the agency when it comes time to enforce the promise. Also, people’s memories become foggy when you try to get them to honor verbal promises they no longer want to honor.
The following is a list of items you need to address in your written contract:
1) Is there a provision in the contract guaranteeing my assignment? The concern here is that you move to your new assignment and the position is no longer available at the facility. Your agency should then be responsible for finding you another similar assignment in the same area or paying you until they find an available assignment.
2) Are my hours and pay rate guaranteed? You do not want to get to your new assignment and find out that the pay you think you are going to receive only applies if you work as a charge nurse on the night shift when you were supposed to be working as a regular floor nurse on days. Also, because you will likely be receiving a higher pay rate than the other nurses, facilities would generally rather send you home first when the census is low. Make sure your contract contains guaranteed hours.
3) How often will I be paid? You will likely not have much control over whether you are paid every two weeks or every month as agencies pay you when they are paid from the facility. However, you do not want your agency to hold on to your funds once they have been paid by the facility. I personally have never run into this problem, but you never know.
4) Will I be paid by my agency or the facility? I personally prefer to be paid by my agency. It creates more consistency for me as I travel from one assignment to another. If there is a problem with my check I know who I need to contact.
5) If I am going to a large metropolitan facility, will I have to pay for parking? This may not seem like much, but some facilities seem to try to make a living off charging their employees for parking and other related items.
I think the above addresses the specific e-mails I have received. Other items you may want to address in your contract are: Will I be paid via direct deposit or bank check?; and what items will be deducted from my paycheck? If I think of any others I will try to include them in a future post.
Also, one final bit of advice, read through your travel nurse contract and make sure the above items are in there. Do not assume that because you have discussed an item the item is addressed in the contract. If you have a question as to where the item is located in your contract bring it up with your agency contact. More often than not she can show you where the item is addressed or add it if it has not been added.
Wednesday, January 17, 2007
For my Theory class:
Abdo sx & Peptic ulcer,
Occupational health; Pulmonary embolism, TB,
NSG process/Family, Coping w/ Loss&Grief.,
Adrenal imbalance, Thyroid imbalance,
Neoplasms, Chemo & Radiation,
GU obstruction, GU: renal failure, IBD,
Cancer Lung/Skin, Colon cancer, Breast cancer
Allergies & Anaphylaxis,
Nursing Lab/Practical (ALL this is done in 6 labs!):
Clinical Skills review (aspetic technique, IV therapy, physical assessment, chest assessment, O2/aerosol equipment/tx)
Tracheostomy care and suctioning
Sputum collection (review), oro/nasopharyngeal suctioning (review)
NG tube insertion
Blood Glucose testing/monitoring (review)
TPN/PPN via central & PICC lines
Urinary Catheterization (insertionn/specimen collection/irrigation..)
Communication lab/patient teaching/OSCE Practice!
I start Med-Surge II tomorrow. The hardest semester in nursing school. I have to focus and just do it. Study like crazy without going crazy. I have worked so hard to get this far, from being paralyzed and in hospital for 10 weeks, to rehab hospital for another 8 weeks, out-patient for another year, going back to work, then going to nursing school. I can walk now, albeit with a brace and cane and at times have had to prove myself to others and to myself. This won't stop, I know, but with time others will accept it and not question whether I can or can't.
I jokingly said to a friend (and former nurse of mine) that I should write a book. I was only half joking, she said I should too. Maybe one day, when I have more time. Though I should start now, bit by bit, while I can still recall all that has happened.
To those who read this, continue to support me, leave comments if you like and even though I tend to go into crazy-student- study-mode during the semester, I am still here and do enjoy the distraction of getting an email or phone call!
I look at this picture and remember all I've been through and remember how far I've come.
Monday, January 15, 2007
I walked into the bathroom where the patient, a 350 pound woman, had apparently been sitting on the toilet when she began bleeding out of her femoral artery in her left groin. There were already four or five nurses working on her. I later found out that several days earlier she had had "an uncomplicated" heart catheterization procedure. Uncomplicated, that is, until she passed out on the toilet and nearly died.
I helped start IV fluids for the patient and hooked them up to her heplock. It took six people to lift the patient off the toilet and put her back on her bed. As we did so, one of the nurses kept a ball of gauze pressed against the slit in the patient's groin to keep the blood from coming out. I then backed away from the scene and watched as the cardiovascular surgeon climbed on top of the patient and while straddling her, pried open the slit in her groin with his hands and pressed directly on the artery. The patient and the doctor were then whisked out of the room, down the hall and into the elevator toward the operating room.
As I walked out of the hospital I thought to myself how consistent nursing is no matter where I have worked. In every hospital I have worked in there have been good days and bad days. Days where not much happened, and days, like today, where all heck breaks loose at the end of the shift and you have to react as quickly as you can. But in every hospital I have worked in "Code" always means "this is important, pay attention and react," "Code Brown" means "someone has dropped anchor on themselves" and "Stat" always means "move your butt right now."
Orientation is definitely over.
Saturday, January 13, 2007
Fourth level focuses on Mental Health, Nursing Research, and Critical Care. I could care less about the first two, but I've been waiting all of college to get to the CC class. It's what I'm interested in and what I care about, so I'm enthusiastic about the semester.
General impressions after the first week:
Nursing research has the potential to be very interesting or very tedious. We basically have to do a big group project the whole semester. I'm trying to think up topics. In the past people have done stuff like studying and working and develop better practices of TB screenings on prison inmates (a population with relatively high TB). I have though of some interesting ideas, but I honestly don't see how they could be studied. Things like "If a student is employed as a Nurse Tech program while in school, does this affect their pass rates on the NCLEX in a positive way?" or even "How does the layout/structure of the nurses' station affect the quality of patient care?" (Is it better open or closed?)
Those kinds of questions can't have a proper control group on this small scale, so I can't compare anything. I'm looking around at work to see what other ideas jump out at me... but otherwise it's been slow going.
I can already see that the total freedom to chose, research, and pace my own study is going to be the most difficult part of the project. Managing time. I'm going to talk my group into meeting 3 hours a week rain or shine.
Orientation for Critical Care was great. I walked into the room only to be immediately handed a stack of ECG strips and taught how to analyze dysrhythmias. We just jumped right in on the first day. And much to my delight, this one class was taught by Instructor Fantastic! She won't be the usual instructor, but I always enjoy listening to her teach. She's smart and funny and loud enough to make things stick in my brain.
Mental Health was... um... interesting.
It's obvious that Instructor Psych knows a lot about taking care of mental health patients. And her anecdotal advice was very good; she'd illustrate principles of communication with really hilarious stories. But she also has some eccentricities that made me laugh. Right off the bat she told us there were definitely ghosts in the local psychiatric hospital. Also, she told us that she swears because we're going to hear it a lot on the mental health floors anyway. "And the first time I say 'fuck', I always get reported upstairs to the Dean!", she laughed. Oh my gosh! All my past instructors have had their eccentricities, but I can tell these lectures are going to be... colorful.
I did get my first level clinical instructor again as my Psych clinical instructor. She's sweet, so I'm glad.
I'll tell you how it goes. If I can find the time to post.
Thursday, January 11, 2007
Just reading through what I will learn in the next 15 weeks gives me a headache and I feel nauseaus, GREAT! Let the stress begin!
Wednesday, January 10, 2007
Will update as it comes! Stay tuned.
|You Are Kermit|
Hi, ho! Lovable and friendly, you get along well with everyone you know.
You're a big thinker, and sometimes you over think life's problems.
Don't worry - everyone know's it's not easy being green.
Just remember, time's fun when you're having flies!
Tuesday, January 9, 2007
"I have a question, if you'd be so kind. once you sign a contract with a agency, how do you get to the destination? does the agency pay for you to get to your assignment or do you? I live in texas, if I take an assignment in California, who pays for the travel out there?
[Reader], thanks for your e-mail. Some agencies will pay for the move or at least give you an alotment that you can spend towards the move. The amount depends upon the distance of the move. Some will even hire the moving company for you.
It has been my experience that if you do elect to have the agency move you they will lower your sign-on bonus or your monthly pay. I usually choose to move myself and keep the bonus and have a higher hourly pay rate.
I suspect there are quite a few other potential travel nurses who have the same question. I will probably post about it in the near future.
Amy Robbins, RN, BSN"
One of my purposes in writing this blog is to provide information to readers who are thinking about becoming travel nurses. When I first became a travel nurse the fear of the unknown was almost too much for me. I am, however, glad I took the plunge as it has allowed me to visit places and see things that I would not have otherwise been able to.
I have used several nursing agencies during my time as a travel nurse, but have intentionally omitted their names on this blog. Why? Because I have decided not to endorse any specific agency over another. Nor do I allow people to publish comments on my blog endorsing an agency.
This blog absolutely endorses travel nursing, but has refrained from endorsing any specific travel nursing agency.
Monday, January 8, 2007
I was a walking zombie all day long. Fortunately, I was just orienting and didn't have any patients... "Sorry about giving you that Estrogen shot, Mr. Jones"... I am now a little concerned about the doubtless whisperings that will come out of today... "Have you seen the new brain dead travel nurse"...Thank goodness I don't have to go back in until tomorrow.
Friday, January 5, 2007
My husband also said that bloggers have their own community pecking orders complete with Wise Grandparent, Sarcastic Uncle, Alcoholic Best Friend, Court Jester and Wet-Behind-the-Ears Newbie. Two guesses on where this blog falls into those categories (hint: Newbie).
Grand Rounds 3.14
One of the blogs that definitely falls in the medical blog heirarchy under Wise Grandparent is Blogborygmi written by Nick Genes. Nick has recently posted his self described "collection of the best posts in medical blogging" known as Grand Rounds 3.14. Nick's latest edition of Grand Rounds reminds me a little of Einstein's publication of the Theory of Relativity. No, the post doesn't provide any monumental breakthrough in science...but hear me out.
It is my understanding that when Einstein published his Theory of Relativity, he did so first as a footnote to a larger thesis he had been working on. When the scientific community pored over his thesis they found the obscure footnote and began to question him on it. From an obscure little footnote came one of the most important incites of our time.
On a smaller scale, Nick provides an incite into the medical blog community that may get lost in the pomp and circumstance of his Grand Rounds awards. He says that "Bloggers talk to each other enough, reading and commenting on posts so frequently, that when one of them disappears, it feels like we're losing a friend." This may be the most important statement in his entire post. For those of you who only read blogs, it is up to you to find the incite in his statement. I hate to end this post so abruptly, but it is late and I start my new travel nurse assignment tomorrow.
A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a patient throws up
A Graduate Nurse wears so many pins on their name badge you can´t read it.
An experienced nurse doesn´t wear a name badge for liability reasons
A Graduate Nurse charts too much.
An experienced nurse doesn´t chart enough.
A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes.
A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn´t want anyone to know they are a nurse.
A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their hand, paper scraps, napkins, etc.
A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them.
A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse can´t hear any alarms at any distance.
A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse doesn´t want to know about them unless the patient is symptomatic.
A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath.
A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse.
A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody.
A Graduate Nurse looks for a chance "to work with the family."
An experienced nurse avoids the family.
A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all.
A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter.
A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.
A Graduate Nurse thinks psych patients are interesting.
An experienced nurse thinks psych patients are crazy.
A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some "cough syrup" in their bag.
A Graduate Nurse doesn´t find this funny.
An experienced nurse does.
Thursday, January 4, 2007
So why the 80's music flashback? My travel nurse agency called yesterday to tell me that I needed to get updated tetanus, influenza and PPD (tuberculosis) shots before I can start my new assignment. What a bummer. Although I can administer shots with the best of them, I do not do quite as well when it is my time to be stuck.
My visit to the employee health clinic at the hospital this afternoon was no picnic. The nurse was rude and seemed to take pleasure in sticking me three times in the arm. On the bright side, after my hospital visit our family went to a local petting zoo in Tallahassee. The zoo is located beside a large marshy lake that reminds me of pictures of the Everglades I have seen. There were alligators, bears, panthers and a number of other animals the kids were allowed to pet.
My first shift in Tallahassee is scheduled for this weekend and I actually look forward to it.
Wednesday, January 3, 2007
Patient with Multiple Contusions, Lacerations and Fractures
One evening while working on an orthopedic (bone related) floor a young man was brought into the unit with multiple contusions (bruises), lacerations (cuts) and fractures (broken bones). He had been stabilized in the Emergency Room after many hours of work by doctors and nurses before being transferred to my floor.
The young man had broken four ribs, one arm, one leg in two places and had a head injury. He was also clearly experiencing psychological pain from what had happened to him. My first thought was “why would anybody ride a motorcycle without a helmet?” But this was no motorcycle accident. In fact, it probably would have been better had the man actually been in a motorcycle accident.
No, this man had experienced what it is like first hand to be sucked into a tornado.
“It Was Just Like Being Flushed Down The Toilet”
Two nights before I had him as a patient, the young man, his sister, his niece and nephew were sitting in their mobile home watching TV when they heard a noise outside. He said the noise sounded “like a train engine barreling down” on them. The family jumped off the couch where they were sitting and began running toward the bathtub. He, his niece and his nephew made it to the tub before the tornado began ripping their mobile home to pieces.
The young man said that he watched from the tub as the ceiling of the mobile home was ripped off and his sister was sucked out and disappeared into the dark. He then tried to cling to his niece as she was pulled out of the tub. He was unable to hold onto her and she too was sucked out. The last thing he recalled was feeling extreme pressure pushing and pulling on his body and then he was pulled out of the tub into a swirling funnel.
When the rescue team finally found him many hours later he was laying in a ditch several hundred yards away from where the mobile home had been and a portion of the mobile home was on top of him. His sister and niece had been killed. I am not sure of the status of his nephew. The last I heard the nephew was still in intensive care.
In all of my years as a travel nurse, I don’t think I have ever taken care of a patient who has gone through anything as surreal sounding as what this patient experienced.