Wish me luck!
Saturday, June 30, 2007
Driving?
I've decided to get my learner's licence. Bought the book to study from, taking the online practice tests and so far doing all right. When I do the driving test, I'll need a med form filled out and a CAR! I have a friend who will let me use hers since we do not have one. And by the time I take the test I'll be working (fingers crossed) and will be able to save up to get a crap car to start with!
Wish me luck!
Wish me luck!
Blog to visit
I just paid this blog a visit and found some interesting comments on generational issues AND some suggestions for change! Judy
http://www.onehealthpro.com/
http://www.onehealthpro.com/
Friday, June 29, 2007
Thursday, June 28, 2007
Wednesday, June 27, 2007
Medication reconciliation
Do you think medication reconciliation works in the ER?
Giggles comes in from home. She lives alone with a caregiver that comes three times a week but didn't accompany her to the hospital. She is a very vague historian, has no clue what med's she takes or what pharmacy she gets them from. She gives me her physicians name so I put in a call to his office. Three calls and much time on hold later I finally get in touch with the medical assistant who is finally able to tell me that the patient is not theirs. Close to 45 minutes wasted and still no clue what medications she is on. He last hospital record is from three years ago and she was admitted by the hospitalist then. I could start randomly calling pharmacies but there are 39 of them in the area and that would take hours.
Nice mid sixties gentleman comes in with Chest Pain. He knows he takes a blood pressure pill, a water pill and something for his sugar, not the names or the dosages. He gets his med's through the mail from the VA. I don't know about where you work, but I could part the Red Sea easier than I could get that information from the VA.
A 77 year old lady comes in with all her pills (14 different kinds) helpfully arranged in a pill box. It is midnight and her pharmacy and doctors office is closed. It takes over an hour with the identidex system and help from the pharmacist to identify 13 of them. The last one is an alien pill that denies definition and she has no idea what it is for.
Who has time to spend doing this nonsense. Tracking down the elusive med list, the ambulances keep coming, starting IV's, titrate pain meds, do EKG's, start foleys, gastric lavage, restrain and monitor psychotic patients, talk to familys, take admit orders over the phone, arrange to get my patients upstairs and so on and so on. Spending hours trying to track down a med list that is one or two or three people that are sitting in the lobby waiting for a bed or a sick patient who's not being taken care of isn't going to work.
Nurses need to be at the bedside. Period.
Giggles comes in from home. She lives alone with a caregiver that comes three times a week but didn't accompany her to the hospital. She is a very vague historian, has no clue what med's she takes or what pharmacy she gets them from. She gives me her physicians name so I put in a call to his office. Three calls and much time on hold later I finally get in touch with the medical assistant who is finally able to tell me that the patient is not theirs. Close to 45 minutes wasted and still no clue what medications she is on. He last hospital record is from three years ago and she was admitted by the hospitalist then. I could start randomly calling pharmacies but there are 39 of them in the area and that would take hours.
Nice mid sixties gentleman comes in with Chest Pain. He knows he takes a blood pressure pill, a water pill and something for his sugar, not the names or the dosages. He gets his med's through the mail from the VA. I don't know about where you work, but I could part the Red Sea easier than I could get that information from the VA.
A 77 year old lady comes in with all her pills (14 different kinds) helpfully arranged in a pill box. It is midnight and her pharmacy and doctors office is closed. It takes over an hour with the identidex system and help from the pharmacist to identify 13 of them. The last one is an alien pill that denies definition and she has no idea what it is for.
Who has time to spend doing this nonsense. Tracking down the elusive med list, the ambulances keep coming, starting IV's, titrate pain meds, do EKG's, start foleys, gastric lavage, restrain and monitor psychotic patients, talk to familys, take admit orders over the phone, arrange to get my patients upstairs and so on and so on. Spending hours trying to track down a med list that is one or two or three people that are sitting in the lobby waiting for a bed or a sick patient who's not being taken care of isn't going to work.
Nurses need to be at the bedside. Period.
Tuesday, June 26, 2007
Monday, June 25, 2007
Sunday, June 24, 2007
Rules for non-bedside nurses
We are very concerned about the nursing shortage in
America, if the paperwork nurses actually did some nursing, no shortage would exist.
1. Nurses that do not provide direct patient care on a daily basis should not develop policies for nurses that do. (Have you ever noticed how the policies for your nursing practice are written without any input from the people who have to carry out the policies?)
2. Nurses that do not provide direct patient care on a daily basis should not develop forms for nurses that do. (that way a nurse won't have to waste her time putting the VS on the flow sheet and the graphics form and a report sheet etc. etc. etc.)
3. Nurses that do not provide direct patient care on a daily basis should not represent nurses that do in any advertising portraying them as bedside nurses. If you don't do the job, you don't get to claim the glory. ( I don't know about you but I've never seen any of the people who are portrayed as nurses at my hospital or they are all directors and QRM people.)
4. Nurses that do not provide direct patient care on a daily basis should not ever speak for those that do. (It is not OK for QRM to tell admin that the ER nurses should do audits on every patient to see if they meet admission criteria.)
5. Nurses that do not provide direct patient care on a daily basis should not develop staffing guidelines since they have no clue how much work is involved in caring for patients in today's world, including filling out the myriad redundant forms developed by the nurses that do not provide direct patient care on a daily basis. (don't tell us we don't need tech's when you haven't worked at the bedside in 20 years.)
6. Nurses that do not provide direct patient care on a daily basis should not ever have a place on any committee or governmental agency that develop policy or have oversight over nurses that do. (JCAHO etc. needs to have practicing nurses so that someone can tell them how idiotic their policies are and help them actually do some good.)
7. All nursing staff should be required to perform clinical shifts on a regular basis so that they don't lose their skills which may be needed in times of surge capacity and so that they don't forget how hard nurses have to work.
If this sounds a bit bitter, it probably is. Thanks to the non-practicing nurses I now spend more than half my time filling out redundant forms rather than be at the bedside with my patient.
America, if the paperwork nurses actually did some nursing, no shortage would exist.
1. Nurses that do not provide direct patient care on a daily basis should not develop policies for nurses that do. (Have you ever noticed how the policies for your nursing practice are written without any input from the people who have to carry out the policies?)
2. Nurses that do not provide direct patient care on a daily basis should not develop forms for nurses that do. (that way a nurse won't have to waste her time putting the VS on the flow sheet and the graphics form and a report sheet etc. etc. etc.)
3. Nurses that do not provide direct patient care on a daily basis should not represent nurses that do in any advertising portraying them as bedside nurses. If you don't do the job, you don't get to claim the glory. ( I don't know about you but I've never seen any of the people who are portrayed as nurses at my hospital or they are all directors and QRM people.)
4. Nurses that do not provide direct patient care on a daily basis should not ever speak for those that do. (It is not OK for QRM to tell admin that the ER nurses should do audits on every patient to see if they meet admission criteria.)
5. Nurses that do not provide direct patient care on a daily basis should not develop staffing guidelines since they have no clue how much work is involved in caring for patients in today's world, including filling out the myriad redundant forms developed by the nurses that do not provide direct patient care on a daily basis. (don't tell us we don't need tech's when you haven't worked at the bedside in 20 years.)
6. Nurses that do not provide direct patient care on a daily basis should not ever have a place on any committee or governmental agency that develop policy or have oversight over nurses that do. (JCAHO etc. needs to have practicing nurses so that someone can tell them how idiotic their policies are and help them actually do some good.)
7. All nursing staff should be required to perform clinical shifts on a regular basis so that they don't lose their skills which may be needed in times of surge capacity and so that they don't forget how hard nurses have to work.
If this sounds a bit bitter, it probably is. Thanks to the non-practicing nurses I now spend more than half my time filling out redundant forms rather than be at the bedside with my patient.
Saturday, June 23, 2007
Friday, June 22, 2007
Filth
A pet peeve for many is the fact many hospitals are filthy. Housekeepers often come from contracted services that provide the lowest amount they can get away with and pay them minimum wage with no benefits. The turnover is stupendous and they have no incentive at all to do a good job.
Sure, the center hall is buffed to a glossy finish but the patient rooms aren't wiped down every day, curtains aren't changed, walls not wiped and high dusting not done. All those areas are teaming with bacteria.
ER's are the worst. The gurney and surfaces wiped quickly by the RN in between patients but the rooms are cleaned well only once daily, if that. Pull our the gurney and look at what is under it. No wonder hospital acquired infections are rampant. That should be the first thing looked at when a hospitals infection rates go up, how many housekeepers are there....is one person responsible for covering three units?
I think housekeeping services need to be hospital based, not contracted. Pay them a decent living wage and give them benefits. That way you can attract and retain people that want to work and not the bottom of the barrel. Fire them if they don't want to do the job because there will be people wanting to work for you. Give them proper training on why it is so important to do their jobs well and hold them to a high standard.
It doesn't do the staff any good to wash their hands until they bleed if the hospital itself is filthy.
Sure, the center hall is buffed to a glossy finish but the patient rooms aren't wiped down every day, curtains aren't changed, walls not wiped and high dusting not done. All those areas are teaming with bacteria.
ER's are the worst. The gurney and surfaces wiped quickly by the RN in between patients but the rooms are cleaned well only once daily, if that. Pull our the gurney and look at what is under it. No wonder hospital acquired infections are rampant. That should be the first thing looked at when a hospitals infection rates go up, how many housekeepers are there....is one person responsible for covering three units?
I think housekeeping services need to be hospital based, not contracted. Pay them a decent living wage and give them benefits. That way you can attract and retain people that want to work and not the bottom of the barrel. Fire them if they don't want to do the job because there will be people wanting to work for you. Give them proper training on why it is so important to do their jobs well and hold them to a high standard.
It doesn't do the staff any good to wash their hands until they bleed if the hospital itself is filthy.
Thursday, June 21, 2007
Wednesday, June 20, 2007
Tuesday, June 19, 2007
Monday, June 18, 2007
E-Journal Club #6
Andrews, Tom RN, PhD, Waterman, Heather RN, PhD, “Packaging: a grounded theory of how to report physiological deterioration effectively”, Journal of Advanced Nursing, December 2005, 52(5), pp473-481.
Aim: The aim of this paper is to present a study of how ward-based staff use vital signs and the Early Warning Score to package physiological deterioration effectively to ensure successful referral to doctors.
Background: The literature tends to emphasize the identification of premonitory signs in predicting physiological deterioration. However, these signs lack sensitivity and specificity, and there is evidence that nurses rely on subjective and subtle indicators. The Early Warning Score was developed for the early detection of deterioration and has been widely implemented, with various modifications.
Method: The data reported here form part of a larger study investigating the practical problems faced by general ward staff in detecting physiological deterioration. During 2002, interviews and observations were carried out using a grounded theory approach, and a total of 44 participants were interviewed (30 nurses, 7 doctors and 7 healthcare support workers).
Findings: Participants reported that quantifiable evidence is the most effective means of referring patients to doctors, and the Early Warning Score achieves this by improving communication between professionals. Rather than reporting changes in individual vital signs, the Early Warning Score effectively packages them together, resulting in a much more convincing referral. It gives nurses a precise, concise and unambiguous means of communicating deterioration, and confidence in using medical language. Thus, nurses are empowered and doctors can focus quickly on identified problems.
Conclusion: The Early Warning Score leads to successful referral of patients by providing an agreed framework for assessment, increasing confidence in the use of medical language and empowering nurses. It is essential that nurses and nursing students are supported in its use and in developing confidence in using medical language by continued emphasis on physiology and pathophysiology in the nursing curriculum.
Sunday, June 17, 2007
Saturday, June 16, 2007
Finding travel nursing jobs through the internet
A friend of mine recently decided to try travel nursing and asked me to help her find a job. I thought I'd write about my advice to her after my experiences in travel nursing.
First of all, you can apply for a travel nurse job by phone, fax, email or (my favorite way) over the internet.
Here is a travel nursing site to get you started but you can search for others as there are many agencies offering online registration.
Browse their information and call a recruiter if you have questions or need help. If you are interested all you do is fill out the agency form and they'll have a recruiter call you.
First of all, you can apply for a travel nurse job by phone, fax, email or (my favorite way) over the internet.
Here is a travel nursing site to get you started but you can search for others as there are many agencies offering online registration.
Browse their information and call a recruiter if you have questions or need help. If you are interested all you do is fill out the agency form and they'll have a recruiter call you.
Friday, June 15, 2007
Thursday, June 14, 2007
Urodynamic Testing A.K.A. Things I find Embarassing
So, had another test today. One I have once a year every year since I was paralyzed... It is the test I HATE THE MOST! I find it embarassing and intrussive, but it needs to be done...
It is a UrodynamicTest. You ask, "what is this?", I'll tell you!
Basically it is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. In my case it doesn't do either well as I have aneurogenic bladder. Yippee for me! It's common with people who are paraplegic like me, who has an injury in the Thoracic spine and quadraplegics.
My tracings look something like these top two.. all is calm and quiet, then at around 200cc it rises, then calms down again, then at another 50cc it goes up again, eventually it just makes lots of peaks as my bladder is filled and all I want to do is void!
The other pic is of the computer and IV pole with the Sterile water or NS (I'm not sure) they use to fill you up...
It is a UrodynamicTest. You ask, "what is this?", I'll tell you!
Basically it is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. In my case it doesn't do either well as I have aneurogenic bladder. Yippee for me! It's common with people who are paraplegic like me, who has an injury in the Thoracic spine and quadraplegics.
My tracings look something like these top two.. all is calm and quiet, then at around 200cc it rises, then calms down again, then at another 50cc it goes up again, eventually it just makes lots of peaks as my bladder is filled and all I want to do is void!
The other pic is of the computer and IV pole with the Sterile water or NS (I'm not sure) they use to fill you up...
Wednesday, June 13, 2007
Tuesday, June 12, 2007
Monday, June 11, 2007
Julie's picks from the May literature
1. Plach SK. Paulson-Conger M. Demystifying the research process with participatory learning: a taste of research. Journal for Nurses in Staff Development. 2007 Jan-Feb; 23(1): 45-8. (10 ref) Burlew carries this journal AN: 2009574921 NLM Unique Identifier: 17259821.
2. Harris K. Spinweber C. Dohergy M. Milligan L. Addy L. Hydo B. The integration of a nurse model to increase clinical excellence. Journal for Nurses in Staff Development. 2007 Jan-Feb; 23(1): 12-9. (12 ref) Burlew carries this journal AN: 2009511674 NLM Unique Identifier: 17259816
3. Catania K. Huang C. James P. Madison M. Moran M. Ohr M. Wound wise. PUPPI: the Pressure Ulcer Prevention Protocol Interventions. American Journal of Nursing. 2007 Apr; 107(4): 44-53. (24 ref) Burlew carries this journal AN: 2009566362 NLM Unique Identifier: 17413732.
4. Rheingans JI. A systematic review of nonpharmacologic adjunctive therapies for symptom management in children with cancer. Journal of Pediatric Oncology Nursing. 2007 Mar-Apr; 24(2): 81-94. (49 ref) Burlew carries this journal AN: 2009523593 NLM Unique Identifier: 17332422
5. Levin RF. Feldman HR. The EBP controversy: misconception, misunderstanding, or myth. Research and Theory for Nursing Practice. 2006 Fall; 20(3): 183-6. (9 ref) AN: 2009285308 NLM Unique Identifier: 16986352
6. Shirey MR. Stress and coping in nurse managers: two decades of research. Nursing Economics. 2006 Jul-Aug; 24(4): 193-203, 211. (62 ref) Burlew carries this journal AN: 2009270153 NLM Unique Identifier: 16967890.
7. Vratny A. Shriver D. A conceptual model for growing evidence-based practice. Nursing Administration Quarterly. 2007 Apr-Jun; 31(2): 162-70. (57 ref) Burlew carries this journal AN: 2009553588 NLM Unique Identifier: 17413511.
8. Shaha M. Rabenschlag F. Burdensome situations in everyday nursing: an explorative qualitative action research on a medical ward. Nursing Administration Quarterly. 2007 Apr-Jun; 31(2): 134-45. (47 ref) Burlew carries this journal AN: 2009553584 NLM Unique Identifier: 17413507.
9. Schiemann D. Moers M. Expert standards in nursing as an instrument for evidence-based nursing practice. Journal of Nursing Care Quality. 2007 Apr-Jun; 22(2): 172-9. (11 ref) Burlew carries this journal AN: 2009552693 NLM Unique Identifier: 17353755.
10. Cooper CL. Nolt JD. Development of an evidence-based pediatric fall prevention program. Journal of Nursing Care Quality. 2007 Apr-Jun; 22(2): 107-12. (16 ref) Burlew carries this journal AN: 2009555080 NLM Unique Identifier: 17353745.
11. Fontenot HB. Transition and adaptation to adoptive motherhood. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007 Mar-Apr; 36(2): 175-82. (15 ref) Burlew carries this journal AN: 2009549935 NLM Unique Identifier: 17371522.
12. Ridley RT. Diagnosis and intervention for occiput posterior malposition. JOGNN: Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2007 Mar-Apr; 36(2): 135-43. (31 ref) Burlew carries this journal AN: 2009549928 NLM Unique Identifier: 17371514.
13. Muller-Staub M. Lavin MA. Needham I. van Achterberg T. Nursing diagnoses, interventions and outcomes -- application and impact on nursing practice: systematic review. Journal of Advanced Nursing. 2006 Dec; 56(5): 514-31. (92 ref) Burlew has some years. AN: 2009323396 NLM Unique Identifier: 17078827.
14. Freeman T. 'Best practice' in focus group research: making sense of different views. Journal of Advanced Nursing. 2006 Dec; 56(5): 491-7. (24 ref) Burlew has some years. AN: 2009323394 NLM Unique Identifier: 17078825
15. Vaughn F. Wichowski H. Bosworth G. Does preoperative anxiety level predict postoperative pain? AORN Journal. 2007 Mar; 85(3): 589-94, 597-604. (20 ref) Burlew carries this journal AN: 2009540490 NLM Unique Identifier: 17352896.
16. Chi GC. The role of hope in patients with cancer. Oncology Nursing Forum. 2007 Mar; 34(2): 415-24. (45 ref) Burlew carries this journal AN: 2009545021.
17. Vanderboom T. Does music reduce anxiety during invasive procedures with procedural sedation? An integrative research review. Journal of Radiology Nursing. 2007 Mar; 26(1): 15-22. (21 ref) AN: 2009541527.
18. Richards T. Johnson J. Sparks A. Emerson H. The effect of music therapy on patients' perception and manifestation of pain, anxiety, and patient satisfaction. MEDSURG Nursing. 2007 Feb; 16(1): 7-15. (20 ref 2 bib) Burlew carries this journal AN: 2009539240.
Sunday, June 10, 2007
Saturday, June 9, 2007
Friday, June 8, 2007
Thursday, June 7, 2007
Wednesday, June 6, 2007
Tuesday, June 5, 2007
Just because it's neat...
This is from 1996 or 1997. Taken in the Eastern Townships on my friend's dock. Neat.
Monday, June 4, 2007
more old pics...
These 2 pics are for my UBPN/BPI Friends. A while back, my friend Amy asked me if I had any pictures from when I had a tendon transfer (I was 14 going on 15) and now that I have a funtional scanner I managed to find a couple taken at my 15th birthday party (this was 10 days post-op) 1990.
I had this tendon transfer to get external rotation as I have a brachial plexus injury due to a traumatic birth. I had the surgery at the Montreal Shriners.
Memories...
I just bought a new printer-scanner and so have been able to scan some old pics into the cpu, YAY! So I figured I would put in some of my skating pics from before I was paralyzed (Transverse Myelitis in 2004)... so here are some from over the years (1997-2004) from various competitions in Canada and in the USA:
E-Journal Club #5
Todd, Betsy MPH, RN, CIC, “Extensively Drug Resistant Tuberculosis”, AJN, Vol.107 (6), June 2007, pp. 29-31.
Abstract: Recent outbreaks highlight the need for improved prevention,
control, and surveillance programs.
I like the American Journal of Nursing because their articles are short, to the point and usually timely (as well as informative). This week’s article has all of these characteristics as well as some pretty impressive graphics if you visit the journal in person or on-line at the Burlew library’s web site “Burlew On-Line Journals”.
I found this an excellent article to supplement an understanding to the recent news report on a drug resistant tuberculosis patient who was flying a commercial plane internationally.
While the article addresses the history and need for control, how will that control be achieved? How are an individual’s rights and responsibilities balanced? It is enlightening to understand the prevalence of this type of TB.
Sunday, June 3, 2007
Saturday, June 2, 2007
Friday, June 1, 2007
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