Monday, March 31, 2008
Sunday, March 30, 2008
Saturday, March 29, 2008
Friday, March 28, 2008
Wednesday, March 26, 2008
Tuesday, March 25, 2008
Monday, March 24, 2008
Sunday, March 23, 2008
I am interested in traveling nursing. My 5 year old daughter has Cystic Fibrosis. We live in Illinois and she is sick all winter. I am considering traveling nursing so I can see how she does in other climates. I would be traveling with my husband and 2 daughters. How is traveling with families? How does the insurance work regarding coverage for your family? Do you have any advice for me? I am overwhelmed with how many agencies to choose from. Do you use the same agency every time? Have you found an agency that works better than others with families? I would appreciate any advice for me.
If you have any advice for this mother/nurse you can leave it as a comment to this post or e-mail me and I will pass it along to her. Please, no agency e-mails. And, YES, I can tell when I am being spammed by an agency.
Saturday, March 22, 2008
Friday, March 21, 2008
Thursday, March 20, 2008
Wednesday, March 19, 2008
Tuesday, March 18, 2008
It's been 4 years since I was "hit" with Transverse Myelitis and paralyzed at T1 (and down). It's been like being on a roller coaster, ups and downs, and sometimes scary.
I went from being completely paralyzed from the mid-chest down to being paralyzed on the left side with the left leg being the most affected. Plenty of other functions don't work well (bowel, bladder, intercostal muscles...) and I have pain 24/7 and am a walking pharmacy, BUT, for the most part I don't let it get me down or stop me from doing what I want to be doing. Sure I have days (more lately) when I am sad and frustrated and wish it had never happened. But I can't change it and figure I have 2 choices... crawl in bed and do NOTHING or continue living the life I choose to live. I've never been one to give up or sit still for long, so I choose to live.
I walk with a long leg brace and a cane, and sometimes use my wheelchair. I get plenty of "poor you" looks from strangers and at times odd, insensitive comments too. Whatever!
I am in my last semester of my RN program and will be graduating this May (fingers and toes crossed). I never thought I would make it, yes I wanted to, but honestly had no idea if my body would let me. So far, so good!
I thank the nurses who inspired me and encouraged me to do this. I will never forget it, it means so much to me. THANK YOU!
Monday, March 17, 2008
Sunday, March 16, 2008
Saturday, March 15, 2008
Friday, March 14, 2008
Thursday, March 13, 2008
Wednesday, March 12, 2008
Good nutrition is vital. People who have inadequate intake of diet and fluid do not get better. They deteriorate. They are at risk of impaired skin integrity. Wounds do not not heal as well when one is malnourished. I have seen renal failure, electrolyte imbalances, dry cracked painful lips, mouths and tongues on elderly people who are not given drinks. They are so confused that they often pull out their IV cannulas making hydration via IV fluids impossible. I have seen frail
elderly people get even skinnier in hospital to the point that they appear to be skin and bones. Pressure sores form. You can see muscles and bone as the sore is so deep. The become more disorientated. Renal failure courtesy of dehydration. They suffer. It sucks. It should never happen yet it frequently does.
We are constantly interrupted every thirty seconds during mealtimes. Everyone from relatives to pharmacy to doctors to physio does this. The registered nurses at my facility all got together and got on management's case. We pushed for protected meal times. We fought hard. Let's take the evening meal for example: At 6PM the domestics bring the food trolley out and it is the job of the nurses along with the help of the care assistants to get dinner served to every single patient. There are 25 patients and because we are a medical ward that has a high number of elderly patients most of our people are either too sick to feed themselves or too confused to just too old. Usually we have anywhere between 8 and 20 people who are identified as feeds. Each patient takes about 20 minutes to feed. Some are faster and some are slower but we will work with the average. Many have no appetite.
If I take 2 patients that is 40 minutes down. The other nurse takes 2 patients and that is 40 minutes down. The first HCA takes 2 patients and that is 40 minutes down. The other HCA tries to feed 2 but also tries and manage all the people asking for the toilet, ringing the bell during this time. There are 2 Registered nurses and 2 care assistants for 25 patients IF WE ARE LUCKY.
That means that the best case scenario is that 40 minutes after the trays have been dropped onto the bedside table only 6 people have been fed and the rest have had trays sat in front of them going cold for 40 minutes while they stared at it. And remember that the phone is ringing off the hook at this time and we have no ward clerk. Remember that pharmacy is showing up with controlled drugs and demanding that a Nurse instantly stop what she is doing to check those narcotics in....god forbid if the precious pharmacist gets delayed or GASP has to do it herself.
The example I wrote above is best case scenario. It really is. But the reality is this: People will become extremely unwell around mealtime unexpectedly causing me to have to haul some serious ass and stay focused on them in order to carry out the doctors orders and not harm them. If that situation occurs the doctor is going to have a shit fit if I leave him and his patient to run off and feed people. That leaves 2-3 to try and cope with all the feeds, and everything else.
The phone rings non stop during mealtimes. Non-fucking stop. We can thank the relatives for that as they get 5 people to ring for the same patient every hour. If you ask them to get one person to ring once day in order to minimize the nurses having to spend all shift running to the phone every 2 minutes they become nasty, abusive and most of all paranoid....accusing us of not wanting to share information. They also like to spend ages giving their dysfunctional family history i.e. "5 different people have to ring because so and so doesn't speak to so and so".
Ringing a ward during mealtimes when your loved one is stable and you have already rung 5 times during the day is very disruptive. The phone is a hell of a long walk away from the patients and the food trolley. I no sooner put the phone down and start the trek back up to my patient before the damn thing rings again. You have no idea how many problems we have with this. No goddamn wonder they have trays out of reach and food gets cold. If the patient is frail and confused we may leave the tray out of reach whilst hoping to get back and feed him in good time. Leave the tray where he can get it and he will choke himself and throw it onto the floor. We have to hand all the trays out before we can go back and feed. Have to. Without interruptions this takes 25 minutes. With all the usual interruptions it takes longer.
I can ignore the phone and try to carry on but the last time I did that management got a complaint from a relative about us not answering the phone for an hour and we got a disciplinary. No they won't fucking pay for a ward clark to be sat there on an evening answering the phone.
The other day the daughter of one of the 30 patients rang and demanded to speak to the Nurse immediately. I was trying to feed 3 patients at the time as well as monitor a patient with a head injury. She demanded that I come to the phone even though the HCA told her it was mealtime. She scared the HCA. I came to the phone. The woman wanted to me to answer 101 stupid questions and tried to keep me on the phone. I told her that I was trying to take care of patients and that it was mealtime it would be best if she rang back later. "How dare you, I have an appointment later and it would be very inconvienant for me to ring later" she said. I often tell my friends and family that you are in more danger from you Nurse's other patients' relatives than you are from a bad nurse or doctor. I managed to get off the phone with this bitch and when I got back down the ward my head injury patient was on the floor again.
One of the ways I try and sort this is I really start moving my ass at 4PM...or as soon as I finish sorting out all the things that should have been done during the day. If I have been lucky I have sorted out all the day shift problems by that time. It is a losing battle but I try.
I try and knock out every med /IV and otherwise that is due between 4:30 PM and 6:30 PM. There are tons of them each with a problem. Half the time the stuff isn't there and I have to leave my patients to leg it to pharmacy.
I also spend that hour and the half giving pain meds to anyway known to have pain. I ask everyone if they need anything. We try and get everyone toileted. We try to turn and reposition and clean everyone who needs it. I try to do a quick assessment of all my patients (usually about 14)to head off any problems that may rear it's ugly head at meal time. I try to ignore all the interruptions in order to do this and I pray that I will be able to focus on meals when that trolley shows up at 6PM. But relatives and non ward staff piss and moan when they walk onto a ward and interrupt a Nurse and she doesn't drop what she is doing immediately to service their non essential problem. What I am trying to accomplish is impossible but it doesn't stop us from trying. I just want to be able to focus on feeding patients. We all do.
So 6 PM rolls around, the domestic arrives with the food trolley and I don my lovely pinny and start getting trays out. Never mind that I have critically ill patients who need their meds. I did them an hour ago but they want more. We identify the patients who need help with coloured trays, but we already know anyway. I keep an eye on the health care assistants to ensure that they are bringing pureed diets to people with swallowing problems so that they don't choke to death etc etc. I make sure that the diabetics get a diabetic meal. I try to feed people. We run down to the kitchen getting stuff that patients want that are not on the food trolley.
Now despite that fact that we busted ass from 4PM to 6PM trying to sort everyone out, that wall now is lit up with call lights ringing. Absolutely lit up. We can keep trying to feed or we can answer the bells. I will try and send one care assistant off to get all of the bells while the 3 of us try and feed. Most people are ringing for things like an extra pillow or a blanket. Things they didn't think of before. Many of them are elderly and confused and to be honest they just forgot that someone already walked them to the toilet 20 minutes ago, or they need to go again because the good old bladder just ain't what she used to be. But man will they hit the ceiling and complain if they wait awhile for the nurse to come. Family members who rang at 4:30 ring back again to answer the same dumb questions. For the love of god we have no idea when the doctor is coming, when discharge will happen, when pharmacy will bring those meds or when the ambulance will come. FOR THE LOVE OF CHRIST THERE IS NO WAY FOR THE NURSES TO KNOW THESE THINGS.
The phone is ringing non fucking stop. I am ignoring it even if it means trouble later. I am determined to feed these people.
Five minutes after the domestic brought the trolley out the lady in bed 3 has had a bowel motion in bed and due to her dementia has spread it everywhere. This is a 4 time a day event with this poor lady. She is bedbound and weighs about 19 stone. Would you like the 4 of us (and it will take all 4) to take 20 minutes/probably more to clean her up and then go back to feeding? Or would you like me to leave her like that until I finish feeding the others? Who is feeding the patients whilst the 4 of us are trying to maintain the dignity of the lady who has had the accident? No one. The trays are going cold and the domestic will collect them back in. The bitch.
Oh oh. I do need to answer the phone at 6:10 because the sound of the ring tells me it is an internal call. It is pathology lab. The lady in bed 10 came in this afternoon and had blood taken. She looks like hell. But there is no obvious sign of bleeding. I haven't wanted to leave her side. She has an HB of 5 they say. Look it up. She'll die if I do not get a doc down now to assess her and probably order some blood. She needs obs doing, and tests etc. Then I have to go through a long and complex and time consuming process to get the blood and get it hung. If that was your mum would you want me waiting on that for another hour plus or so while I attempt to feed? Tell me what you think. She needs to be escorted off the ward for a test by a member of the ward staff. The endoscopy department does not care that this leaves 2 or 3 of us to do all these feeds. if we don't send an escort, they won't do the life saving diagnostic test. Now there are 2- 3 of us.
At 6:15 my cancer patient who is dying rings to say that the pain meds she has had isn't helping and you can tell by looking at her that the poor women is in excrutiating pain. It is safe for her to have some oramorph now. I will get it for her simultaneously with sorting the blood for the other woman. But what about the trays going cold?
The oramorph is a controlled drug. Two nurses have to go through a long and time consuming process in order to be able to access that medicine and give it to her. I will not make her wait. Fuck you for asking me too. I had to pull the other RN away from feeding a patient in order to access the oramorph (morphine). There is no way to access it without 2 registered nurses. Now one care assistant is trying to do all the feeds, the food is going cold and the domestic collects them back in.
But what is the most fucked up part about mealtime? Is it the fact that the domestics are on a tight time scale and will run down the ward collecting all the meals back at 6:30 whether they have been eaten or not? Is it the fact that the relatives will show up at 6:30 with venom shooting out of every pore of their being screaming at me wanting to know why grandpa has a cold, untouched tray in front of him?
No the most fucked up thing at meal time is the goddamn doctors. I look after 14 patients with 8 different doctors and they LOVE to show up at mealtime to do a ward round and demand that the nurse drop what she is doing and follow them around for a half an hour. The bastards do it every fucking mealtime. I hate them. When the nurses asked for protected meal times we begged the docs to try and do their rounds outside of mealtime. The response was that their ward round will get done when it is convienant for them, not the nurses. They also laughed right out loud at us for asking. And you can bet your ass that on every single mealtime we are sure to have 2 or 3 consultant doctors show up to do rounds. Remember that best case scenario I wrote about above? The one where we can at least get 6 people fed in 40 minutes if all hands are on deck. You can fucking forget it thanks to the docs. I can refuse to attend their ward round and keep on feeding. But it means getting screamed at in front of all the patients and a complaint about me going into management.
Whether we have 6 people who need to be fed or 16, the number of staff DOES NOT alter. We get 2 nurses and 2 healthcare assistants no matter what. If I get a contracter into my house to do some work, and it looks like the job is bigger than he anticipated he gets more staff. If a nursery takes more children than the normal numbers on any given day they get more staff. A hair salon has more staff in on their busiest days. This does not happen in nursing.
So I open the newspaper and I see comments galore accusing the nurses of not caring about feeding patients. They suggest coloured trays to identify vulnerable patients....as if we are too stupid to know. They all look the other way when the hospitals get rid of nurses and refuse to hire nurses. The coloured trays don't do shit. They don't help at all. You can take your coloured trays and shove them you your asses. Please help us instead of making things worse.
So we begged management for protected mealtimes. We begged them to help us tell the public not to ring at this time. We begged the docs to not do ward rounds at this time if they can help it. We asked a higher power to not allow anyone to crash or become extremely unwell, especially during meal times. We begged management to allow us to increase our numbers. We begged the domestics to not collect the damn meals in so quickly when we haven't had a chance to feed.
Their collective response has all pretty much been : Fuck you Nurse. Fuck you.
Thanks a lot for your fucking support.
The nurses will keep on trucking but if they only bit of help we get is a goddamn coloured tray...then I just don't see things improving.
Tuesday, March 11, 2008
We went to church two weeks ago and almost 3/4 of the congregation was out sick with the same symptoms. I have spoken to friends and relatives of ours in Phoenix, Dallas, Provo, Utah and Orlando and they all know someone with the same symptoms. We were listening to one of the national radio talk shows and people were calling in talking about the same type of illness.
This has led me to ask: Is the whole country sick with this illness? Leave a comment and let me know if you have seen the same thing.
Monday, March 10, 2008
Sunday, March 9, 2008
To date we have received 347cm of snow this season.. another 40 cm and we break the snowfall record of 1971 with 383cm! I for one, would NOT like to see that record broken frankly. We are supposed to have MORE snow though...
... and a pic of Bear Jr, the former outdoor kitty!
Saturday, March 8, 2008
Friday, March 7, 2008
Thursday, March 6, 2008
Wednesday, March 5, 2008
I am taking over the Nursing research council here at xxxxx and absolutely love your website. I love the idea of your journal club, can you give me some more details on how you got that set up and has it been successful.
Also, how are your meetings set up for the NRC. Do you just have an agenda and give updates on all projects or do you incorporate some work time in those meetings.
I appreciate any advice you can give me because I truly feel like I am floundering. I have been ... here for about 3 years and this new position lacks a team that is motivated and most are floundering like I am and it is important for me to instill motivation and direction. Please help.
xxx- Good luck... I've been at this for ~4 years, and have periods when I feel "success" and those when I wonder what's going on. Patient care is definitely the priority of staff - not nursing research.
My journal clubs have not been wildly successful in terms of #s attending. However, each session (5-6 per year generic sessions, and unit-based sessions upon request) has a heterogeneity of attendees (at this point, I'm still selecting the articles, and the nurses come... usually NOT having read the article). I give an article synopsis, emphasizing Why the authors did the study (I ususally do research articles), what they did (methods... briefly), what they found (briefly), and the so what? Then, the discussion usually takes off on how this might be applicable in our setting. Even though I've been disappointed in turnout, and in the fact that nurses aren't reading, the sessions (around 1 hour at lunchtime - everyone brings lunch) are usually lively, and I think the nurses love the time to really talk about nursing and what the topic is outside of the normal work environment. A couple have led to practice changes - one about using factsheets has led to several projects that use factsheets to disseminate knowledge, one on effects of shiftwork on nurses added to the discussion on whether nightshift nurses should be allowed to sleep on their breaks, etc.
Regarding our Research Council meetings. We meet 10 times per year for 2 hours. Up to this point, meetings have included mostly reports of activities. The first year I did a 20 minute "educational brief" on various research topics to bring folks up to speed on research terminology. Those have not been repeated, but we have new members all the time, so probably should be. We are embarking on a new venture this year .... Did You Know? posters. A task force is working on how to roll this out. Research council meetings (3-4 per year) will be spent actively working on these posters which will involve rotating materials on poster templates and "pushing" these out to units. Optimally, topics will be unit-specific. This is an idea as yet... so will keep you posted.
Tuesday, March 4, 2008
Monday, March 3, 2008
1. Fehder WP. Nursing care & management of pathological oral conditions among women and children. MCN: The American Journal of Maternal/Child Nursing. 2008 Jan-Feb; 33(1): 38-44. (31 ref) Burlew carries this journal AN: 2009759201 NLM Unique Identifier: 18158526.
2. 2009766135. Leung SF. Chong SYC. Arthur DG.
Title Reducing medication errors: development of a new model of drug
administration for enhancing safe nursing practice.
Asian Journal of Nursing. 2007 Sep; 10(3): 191-9. (15 ref)
3. Labeau S. Vereecke A. Vandijck DM. Claes B. Blot SI. Critical care nurses' knowledge of evidence-based guidelines for preventing infections associated with central venous catheters: an evaluation questionnaire. American Journal of Critical Care. 2008 Jan; 17(1): 65-72. (28 ref) Burlew carries this journal AN: 2009753997 NLM Unique Identifier: 18158
4. Pinto BM. Floyd A. Methodologic issues in exercise intervention research in oncology. Seminars in Oncology Nursing. 2007 Nov; 23(4): 297-304. (59 ref) Burlew carries this journal AN: 2009742237 NLM Unique Identifier: 18022057.
5. Knobf MT. Musanti R. Dorward J. Exercise and quality of life outcomes in patients with cancer. Seminars in Oncology Nursing. 2007 Nov; 23(4): 285-96. (67 ref) Burlew carries this journal AN: 2009742236 NLM Unique Identifier: 1802205
6. Rourke DR. The hospital library as a "Magnet Force" for a research and evidence-based nursing culture: a case study of two Magnet hospitals in one health system. Medical Reference Services Quarterly. 2007 Fall; 26(3): 47-54. (15 ref) AN: 2009651473 NLM Unique Identifier: 17915630.
7. Walker L. Lamont S. The use of antiembolic stockings. Part 1: a literature review. British Journal of Nursing. 2007 Dec 13-2008 Jan 9; 16(22): 1408-12. (23 ref) AN: 2009774725.
NLM Serial ID Number
8. Murphy TH. Labonte P. Klock M. Houser L. Falls prevention for elders in acute care: an evidence-based nursing practice initiative. Critical Care Nursing Quarterly. 2008 Jan; 31(1): 33-9. (14 ref) Burlew has some online access, no print issues. AN: 2009774859.
9. Lynch M. Dahlin CM. The National Consensus Project and National Quality Forum preferred practices in care of the imminently dying. Journal of Hospice and Palliative Nursing. 2007 Nov-Dec; 9(6): 316-22. (34 ref) Burlew carries this journal AN: 2009751680.
10. Eilers J. Million R. Prevention and management of oral mucositis in patients with cancer. Seminars in Oncology Nursing. 2007 Aug; 23(3): 201-12. (71 ref) Burlew carries this journal AN: 2009738961 NLM Unique Identifier: 17693347.
11. Rodriguez W. McCarty D. O'Donnell A. Kane J. Nolan S. Carlese C. How much blood is enough? An evidence-based study on the minimum blood volume required for laboratory tests... Oncology Nursing Society 32nd Annual Congress, April 24-27, 2007, Las Vegas, NV. Oncology Nursing Forum. 2007 Mar; 34(2): 527. Burlew carries this journal AN: 2009561732.
12. Wiener B. Chacko S. Cron SG. Cohen MZ. Guideline development and education to insure accurate and consistent pulmonary artery wedge pressure measurement by nurses in intensive care units. DCCN: Dimensions of Critical Care Nursing. 2007 Nov-Dec; 26(6): 263-8. (4 ref) Burlew carries this journal AN: 2009741185 NLM Unique Identifier: 18090148.
13. McAndrew L. Schneider SH. Burns E. Leventhal H. Does patient blood glucose monitoring improve diabetes control? A systematic review of the literature. Diabetes Educator. 2007 Nov-Dec; 33(6): 991-1010. (62 ref) Burlew carries this journal
14. Povey RC. Clark-Carter D. Diabetes and healthy eating: a systematic review of the literature. Diabetes Educator. 2007 Nov-Dec; 33(6): 931-59. (37 ref) Burlew carries this journal AN: 2009749033 NLM Unique Identifier: 18057263.
15. Horton K. Tschudin V. Forget A. The value of nursing: a literature review. Nursing Ethics. 2007 Nov; 14(6): 716-40. (83 ref) AN: 2009707487 NLM Unique Identifier: 17901183.
16. Gardetto NJ. Carroll KC. Management strategies to meet the core heart failure measures for acute decompensated heart failure: a nursing perspective. Critical Care Nursing Quarterly. 2007 Oct-Dec; 30(4): 307-20. (24 ref) Burlew has some online access, no print issues. AN: 2009683482 NLM Unique Identifier: 17873567.
Sunday, March 2, 2008
Saturday, March 1, 2008
A Crowd Gathers
I brought my nursing bag to our neighbors' house, knocked on the door and my husband and I were invited in. Unexpectedly, a small crowd had gathered in the living room (call it morbid curiosity) to watch me give the shot; my first real shot to a non-human. When I walked into the room Bear came up to me wagging her tail. She seemed to enjoy being the center of attention. I sat and pet her for 10 minutes or so to let her get used to me.
***Note to animals: Don't trust a strange human with a black medical bag showing you an unusual amount of attention.***
When Bear finally seemed to be calm enough for me to administer the shot, her owners took her in their laps and held her as I got everything ready. She was extremely calm. I quickly ran through the following in my mind:
Subcutaneous Injection 101: Pull out syringe. Stick pointy end into vial. Suck medicine into syringe. Remove from vial, and (my favorite part) stick pointy end into the dog.
My next thought was that I could use this as a teaching opportunity for those in the crowd who might be considering a job in the medical field. I started explaining the different types of medical equipment in my bag and began to walk them through each step in the injection process. My head swelled as one of the girls in the crowd started asking medical questions. As I answered the questions I could feel myself becoming the neighborhood expert on veterinary medicine.
A Teaching Opportunity
I continued answering questions as I prepped the patient for her shot. Reaching forward, I grabbed the lose skin and hair around the scruff of Bear's neck, raised it away from her body with my left thumb and index finger and inserted the needle with my right hand. Still explaining the process to my new student, I began to press the plunger into the syringe. When all of the medicine was adiminstered, I pulled the needle out and said "See, its that simple."
Back Down To Earth
Just then, one of the owners said "What is all of that wet stuff on Bear's neck? Is it blood?" I looked down at the dog and immediately turned bright red. I had stuck the needle into one side of the dog's scruff and out the other and squirted the medicine all over the dog's back. Not a drop reached the patient. So much for my veterinary expertise. In my defense, the dog was extremely hairy and had a lot of excess skin.
Two Things I Learned from the Experience
(1) I just love teaching opportunities; especially when they completely blow up in my face; and
(2) My husband can be a real jerk. He was the first person in the crowd to make fun of me saying "Oh yeah, you can give me a shot anytime." Now when he tells the story the dog ends up blinded by the medicine which somehow shot from the scruff of the dogs neck into its eye.
I hope my readers realize that I use a lot of sarcasm in my writing and that, in fact, my husband and I have a great relationship. We do LOVE giving each other a hard time though.