Its a nursing thing

An the Oscar Goes To...

2008-05-25T09:52:00.002-05:00

The ER nurses at UAB (University of Alabama Birmingham) get a gold star and lots of laughs for this hilarious "recruitment video." The video is about 2 years old, so you may have seen it...but its worth it.

I was actually amazed at all the videos about hospitals, nurses, doctors, and patients that are posted on You Tube.

Ode To A Friend

2008-05-01T13:15:00.002-05:00

I had the best day today. Im working on completing my BSN at U of M Flint and today I had to test off on my Physical Assessment class. (much more detailed then what we learned in my ADN program, btw)

A friend of mine, E, politely obliged to be my guinea pig for the exam. It went well, except for the part when I put the tuning fork on the mandibular joint instead of the mastoid process for the Rhine test. My prof was cool, but she didn't correct me until I had made a complete fool of myself...

After the exam, E and I went to lunch and had fun talking about nursing and school and kids and husbands...it was so refreshing. She is a new grad from THE most grueling program around, I respect her for it and know she is an awesome nurse. I can't wait till she's an RN in my ED. Im so excited to have a friend down there that I've known for awhile.

There is nothing like being refreshed by good conversation with a good friend. I feel blessed today.

Terrible, Horrible, No-Good, Very Bad Day and Now - Im In Debt!

2008-03-19T12:13:00.009-05:00

I've been turned loose on my ED. No more orientation, no more preceptor, no more hand holding. This is the real thing. Its been about two weeks and I have to be honest, its gone really well. Little did I know that during these past two weeks I have been lulled into a false sense of confidence. Little did I know that an ED nurse never really feels 100% confident, because he/she never knows what the next rig is going to bring in.

My reality check arrived last week, it was a Friday. The short and the sweet of it is, I "got my butt kicked." I knew it was going to be a "terrible, horrible no good very bad day" when my first encounter with an assigned pt was to find him lying on a stretcher with a 12cm 3inch deep lac on his upper arm that was in the process of being "explored" by a surgeon's gloved hand (NOT a sterile glove, by the way). The kid was young and trying to be tough (fists clenched and white knuckled) and I was ticked he hadn't been pre-medicated. In fact, in all reality he should have been taken to surgery for the repair. From that point it just got worse and worse as each new pt arrived. I was bitten in CT by a pt I had just given an amp of Narcan thanks to an OD of Kadian with a respiratory rate of 4. I was yelled at by a cardiologist, and belittled by a cocky neurologist younger than I. UGH!! By the end of the day I wanted to move to Australia.

All of that background to sing the praises of one of our float nurses. He's an ED vet, and he knew exactly what to say and what to do for me. He didn't take over, just took some of the tasks that were "muddy-ing" my waters. He didn't sugar coat it and caudal me. Instead he re-oriented me to my priorities, told me what I could ignore and what I needed to heed. His best advice thru it all was "take a minute to collect yourself, because that is when we make mistakes."

I recognize what he did for me, but its so frustrating to know that he will always know more, always be 10 steps ahead of me, so how will I ever be able to return the favor?
A debt I can't repay.

"I Can See Clearly Now" A Plug For TNCC

2008-03-09T10:02:00.005-05:00

Have you ever heard of TNCC? Its a certification offered by the ENA for ER nurses (any critical care nurse, actually). I took a two day course last week and it was SO helpful. As a newbie, I highly recommend taking the course. Its challenging, but if you read the book, study, and practice the assessment mnemonic ABCDE/FGHI, you should find success.

Aside from the learning experience it provides, it is also an excellent way to network with other ER nurses. I took my class at a hospital 2 hours from my own ED. I was nervous at first, not knowing anyone, but I was able to get to know how other EDs function and I had the chance to swap stories with other nurses. It offered great perspective on differences among various EDs.

In my class of 10 RNs, 2 were ICU nurses. They said it was hard, but worth it because they now have a much better understanding of what happens in the ED. They also reported feeling more confident in assuming care of an ED transfer under stressful circumstances where report was short and sweet.
(we never do that, do we??)

A Profession vs. A Job

2008-02-28T11:50:00.004-05:00

Whew! Its been so long since I've blogged. I did end up with the ED job. I LOVE it. Since then I have taken my boards, ACLS, TNCC and an advanced ECG course. Busy is an understatement, but oh what a fun trip its been.

I even have secured a day shift!! God is good all the time.

I just read an article from crzegrl, the flight nurse about nursing being a job or a profession. I have endevoured for the latter. I can tell which nurses in the ED are there for the paycheck and which ones define themselves by their role as an ED nurse. I have had the good fortune to be precepted by an awe inspiring nurse. Im so thrilled to have my RN and to be able to care for people in times of crisis.

Tuesday at 3:30pm

2007-11-09T14:30:00.000-05:00

Where will you be? I will be sitting in an interview of a lifetime. I got the call today from the regional level I trauma center for an ER position! If you're a nay-sayer about new grads in critical care, I don't want to hear it. (the times of putting in two years in med/surg before you move up are over and likely will be until they solve the nursing shortage)
If however, you have any interview advice, I'm all ears!!

ok...I'm not that cold hearted, if you truely feel its a mistake, I guess I am open to your opinion....but I'm still interviewing... : )

..............................

Today's nursing collection spotlight is.....

PEZ!!

This is actually an over sized version that has a bobble head. The original nurse pez dispensers go for about $100 (if you have one, take care of it)
Interesting side note, the "nurse" is actually Pez dressed for undercover work...apparently it was a storyline that accompanied the toy.

No Respect

2007-11-08T07:48:00.000-05:00

I am supposed to be putting the finishing touches on my last caremap ever (unless there are caremaps in grad school-God, I hope not) but I just can't get into the groove. Its on asthma...zzz..zzz..zzz...oh sorry...drifted off there...

I just read Drug Pushers latest post and it made me sad. I know the nurse shortage is real, I know...but crazy hours at work, no respect, and mounting frustrations is not what we went to school for, and its not a reflection of our value. In my hospital, if you have RN behind your name and you're not a complete freak-any job is available w/in 6 months. It baffles me why a good nurse (like Drug Pusher) is considering relocating because his/her hospital is not looking out for him.

........

New feature in my rediscovered blog (lol) I have long been a collector of all things nurse, especially WWII era stuff (back when nurses still wore their caps). So I thought Id start showing you my finds!! Some are dinky, some are silly, but whats the point in a collection if you can't share it???

My first find is my coup d'etat...a nurses cape!! I fought long and hard for this on ebay! I just need some ideas on how to display it.

Its history is that it was made in the Altro shop in NY, Its an authentic 1920's navy blue wool nurse's cape with label "Altro Work Shops Inc. New York".
It is a double breasted four button front closure and stand up collar embroidered with "S.N. & M.C.". The nurses name stitched into wool says "Doris M. Shrinn".

Altro Work Shops Inc. is the oldest sheltered workshop in New York and dates back to 1915. Its main function was to rehabilitate men & woman with stabilized tuberculosis (and later cardiac disabilities and mental disease) who could not return to full time employment.
The Altro Work Shops was a garment factory that made uniforms for hospitals, restaurants and hotels and manned by tuberculosis ex-patients working under medical supervision.

LONG Summer-No Fall Whats up with that?

2007-11-05T15:56:00.000-05:00

Im embarrassed to admit I haven't posted anything since April. My final semester of nursing school has been nuts to say the least. But Im in the home stretch! 6 weeks left!

Ive applied to the ER, OB (I interned there all summer) and a general nurse residency program. I REALLY want ER, but its in God's hands.

I have to whisper this next line...hubby's not geeked about this, but I am considering joining the army reserves...

more later

Gary Gnu

2007-04-30T13:30:00.001-05:00

Does anyone remember the cartoon "The Great Space Coaster" ? Remember the little newscaster who would always say, "No Gnews is good Gnews" ? Anyways, Im low on posts lately because Im low on news...nothing new really, just the same old student nursing stuff.

However I can report the following:
I really dont like my Peds instructor, and therefore have not been real crazy about Peds. I will be glad when its over, and thats the first time I have felt this way about nursing school.

In two weeks, my UofM classes start, and Im taking a Chem class at my community college where Im going to nursing school. Most normal nursing students would be lining up jobs and summer vacations, but here I am plugging away at more school. Enough already, says my hubby.

On the job front, I have gotten past the stigma that Im a dosing nurse at a methadone clinic. Its a job. I get paid well, and the people actually add some spice to my life. They have some crazy experiences and some of the most creative reasons I have ever heard for why I should not urine drop them before I give them their dose of methadone...lol.

Im not sure if I mentioned I will be working midnights this summer, full time, at the better of two hospitals in town. Ill be a "Nurse Extern" (i.e. glorified tech) on the labor and delivery unit. Im geeked about getting my foot in the door at this hospital, but not crazy about how midnights will effect my body...hopefully it all will work out.

My youngest son, 18mo, is becoming all boy very quickly. He has learned how to scale just about anything, and Im sure an after hours visit is in my future for a broken arm or sprained ankle. Im getting dangerously close to hauling out the pack and play to contain him sometimes...lol.

Finally, I know Im stressed out when Im having dreams about being on an exam table in the drs office, upon which I slide across. But in real life, my fat a$% is on my nightstand, sliding across it, until I fall off (yes, I really did this) and bruise my arm and thigh, and when my hubby asks if Im ok, I say yes, and in the morning I dont remember a thing but the dream. (I destroyed my bedside lamp, btw).

No Gnews is Good Gnews!!

NSNA Annual Convention and finger lights

2007-04-14T16:32:00.000-05:00

Ok, so here I am in California, at the National Student Nurses Association Annual Convention. I'm having fun - Jenna, you better win girl!
I realize that this is what I love about nursing....I love the collaboration of ideas, the power of our collective voice and the motivation it brings me to hear from so many other nursing students who are getting through nursing school with some semblance of their sanity left! ( I even made it over to Disney and picked up some Princess loot for my 3 yr old-shhh, don't tell)

Coolest t-shirt I've seen: front says, "Friends don't let friends..." back says, "...miss clinicals."

Coolest breakout session: Relax, Rejuvenate, Recreate; in short a nurse the nurse primer.

Coolest free stuff from exhibitor hall: finger light for in-the-dark charting.

Coolest New Idea: The findings from the Carnegie Foundation's study of Nursing Education, read the findings here. (I was shocked to hear that a shocking number of schools of nursing are doing more to prepare students for passing the NCLEX than to be nurses, and that most clinical experiences lack quality learning experiences because the staff nurses give the student nurses tasks they find undesirable.)

Anyhoo-great convention, and I have lots to write about in MNSA's Newsletter, NURSETALK.

Medication Math

2007-03-26T13:20:00.000-05:00

Ok, I may possibly be getting this math stuff. I just took a 30 question pre-test and only freaked out about two of them (both reconstitution questions)

See if you can figure this out:

Ticar 3g in 100ml of LR IV to run over 2 hours.

Label on Ticar: 3 grams, to reconstitute, add 12 ml sterile water for injection yield concentration of 200mg/ml.

How much of the reconstituted solution must be added to the IV bag to provide the ordered dose of Ticar 3g?

The answer is 15ml, but I am clueless with how to set these up!

I did, however, find some cool websites for the medication math challenged such as myself!

Check em out!

Dimensional Analysis - http://www.alysion.org/dimensional/analysis.htm#basic

gtts/min - http://www.accd.edu/sac/nursing/math/ivprob.html

My test is tomorrow, and as usual, its do or die. Its a 15 question quiz, I can miss three.

Wish me luck!

Hail To The Victors!

2007-03-14T13:38:00.000-05:00

I am so proud to announce I have been accepted to the University of Michigan to complete the RN to MSN program. I am so geeked! My hubby and brother are graduates from Michigan State University, so I have to be careful how geeked up I get around them. But inside, Im so happy to be headed towards my MSN at U of M.

The next step is to sign up for my first class, Nursing Research. (NUR 308) Its an online class which is a bonus. But sometimes those can be tough, so I will keep you posted.

My long term goal is to be a geriatric nurse practitioner.

Today I passed my mental health final with a 4.0, which means my final grade is a 4.0. I know they tell you to let go of your desire to 4.0 everything once you get into nursing school, but Im having a harder time with that....you see, I love doing what Im told is impossible...its a bit of teenage rebellion that never really went away.

Tomorrow Peds starts with Attila the Hun...stay tuned for the exciting details!

Spanking

2007-03-13T13:22:00.000-05:00

Wow-did our Mental Health class have a heated debate on spanking. Judging by the comments of the professor, I would assume he is against it. He put some of the following ideas on the overhead for our thoughts and comments:

a child assumes that it is "ok" for a bigger person to hit a smaller person

a child learns that it is ok to hit those you love or be hit by those who love you

There were two others that used the word "violence" that I did not include. It was an intriguing debate. Especially when so many of my peers represented polar opposite viewpoints on the topic.

things that make you go hmm....

Nurses March

2007-03-12T14:10:00.000-05:00

Whew! Being politicaly active is hard work! As a member of the Michigan Student Nurses Association, I went to the 1st annual Nurses March on our state's capitol steps. It was freezing that day but it was fun. The govenor greeted us and then we went to the legislators to speak to them about some bills currently circulating. The bills cover things like safe lifting, staff to patient ratios and mandation.
Michigan is the only state in the union right now to have a Chief Nurse too. Her name is Jeanette Wrona Klemczak and she has some great ideas about how to "fast-track" nurses who are willing to become masters prepared nurses and nurse educators.
It was a cold day on the steps of the capitol, but it was fun. By the way, Im in front, in the red coat and glasses holding the sign!!

Magical Thinking

2007-02-25T10:55:00.000-05:00

Mental health is coming to an end. Thank God. I have never experienced such a roller coaster of emotions. Listening to the stay at home parent of a two year old make excuse after excuse for why they beat the snot out of their toddler while they were drunk made me literally sick to my stomach. Giving anti-psychotic meds to a client who was having harmless hallucinations of their recently dead spouse was a values challenege for me. They were depressed that their spouse would be gone forever. And finally, therapeutically communicating with a nurse who had become addicted to prescription drugs in order to cope with the stressors of being a nurse was a very scarey reality check that the profession I am about to enter can be a rocky road.

I did however write a paper on Nursing Presence this term that had profound effects on my developing nursing philosophy. I have always thought about the concept of nursing presence as the art of nursing. But now it has a distinct title and is even a specific NIC listed in the book. It is a topic I will always be interested in reading more about.

So here is where my magical thinking comes in...somewhere along the way I ended up at Michigan's annual nursing students convention, I ran for a board position, and won! Wow! Im the editor for NurseTalk, our state association's newsletter. Um...what the hell was I thinking? lol. I hardly have time to keep up this blog like I should, much less edit a newletter and attend meetings for the association. I have found, however, its very energizing to be around other nursing students who enjoy being a student and enjoy the career they have choosen as much as I do.

Up next, Peds. It starts in three weeks. Any advice???

Therapeutic Communication

2007-01-28T15:28:00.000-05:00

Well, my mental health rotation is underway. I have been assigned to a community mental health hospital that serves several counties. It has an adult psych floor and a gero-psych floor. Both locked units. Oddly enough, I am completely comfortable on gero-psych and terrified to be on the 2nd floor(adult psych). The thought of approaching a client, establishing some level of a relationship, and then delving intro therapeutic communication freaks me right about out.

Kudos to any of you who chose mental health nursing. I would be fascinated to hear your stories and learn more about what attracted you to this profession.

My job is going well. I really enjoy the patients and their families and I enjoy spending time doing little things like brushing someones hair or chatting with a resident about his service in the war. Its a bit frustrating to pass all those meds, but it goes by quickly and I am finding that I do in fact have time to spare and spend with my residents. I am so blessed to have this job.

Mental Health Nursing

2007-01-14T21:38:00.000-05:00

The midnight shift wasn't too bad, much less med passing than 1st and 2nd shift, which was nice. I also got quite a few chapters in my new Michael Crichton book, Next, read! : ) I was surprised at how many night owls there were among the residents.

So mental health, (nursing 260) starts Tuesday. My aunt, oddly enough, co-authored the text. I know I shouldn't be nervous but I'm discovering I really am. Its like a whole new sub-language I need to learn as a psych nurse. To be honest I have some stereotypes I will need to overcome in order to give myself over to really learning this stuff. It should be an interesting 8 weeks.

Ill keep ya posted!

My first midnight shift as an LPN

2007-01-08T21:50:00.000-05:00

OK, I'm back. The holidays, kids, studying, new job...got the best of my time.

So tonight I start my first midnight shift. To be honest I'm not sure how this will work. I can't consume caffeine so I thought I might try and take a nap today to "rest up" for my shift, no such luck. My body complained about all the chores that could be getting done, so I relented and did them.

How do people do this? Especially now that most shifts are 12's which means you are only working three a week. I mean, doesn't your body freak out having to switch back and forth?

The other thing that is weird is staying up in order to go to work. Usually by now I'm heading for bed. Strange, very strange.

My awesome hubby would much rather be watching the BCS game from the comforts of his Serta, but he is staying up until I leave, how sweet is that?

Red Tape

2006-11-29T09:23:00.000-05:00

Tis the season for red ribbons tied into perfect red bows, red chritsmas tree lights of all sorts and fat men with beards dressed in red velvet suits. As a nursing student quickly being catapulted towards my NCLEX-PN exam in early January, I am learning that this is also the season of red-tape as it relates to my NCLEX-PN exam.

In MI, a student must register with two seperate entities, the testing center and the St Board of Nursing in order to be eligible to write the NCLEX. This requires an initial cash outlay of $248 dollars between the two. Then, because I finish my LPN coursework in December (the 15th to be exact) if I write my exam before 1/31/07, I have to renew my license by March of 2007 which requires another $48. Whew...thats a lot of work. I haven't even mentioned all the hoops related to paperwork.

In the midst of all this, as my educational institution has kindly informed me, a successful NCLEX candidate (on average) reads approxiamately 4000 NCLEX style test questions. Hmmm...I guess I'd better quit blogging and start studying.

I've posted a link to the MI State Board of Nursing, The MI Student Nurses Assosiation Website, and I will try and post my favorites of the NCLEX questions I am studying...test your knowledge.

Casino Royale...made this nurse royaly flushed!

2006-11-24T19:21:00.000-05:00

Woo hoo-is the new double "o" double hot!! My amazing husband realized I was deserving of a much needed break from all things nursing and/or turkey related and took me to see Casino Royale. I am a huge Bond fan, loved Pierce, loved Sean the most, but I must say, Daniel Craig is easy on the eyes. (although he does run a bit like a robot)

Speaking of eyes, a girl can get lost in his blue eyes. I actually found myself looking for contact lens edges in the close-ups...I saw none. God must have just re-dipped his paintbrush in Caribbean Blue when he got to Daniel Craig...he certainly has an extra-helping of blue.

The movie rocks-go see it. And just between you and me...the gratuitous shots of Virgin Air and its owner were a bit much.

Vote!

2006-11-07T07:18:00.000-05:00

Take the 20 to 30 minutes out of your life today and cast your vote, a freedom many do not have in this world.

Cast your vote and whisper a word of thank you to all the men and women who sacrificed their lives so that you could do so.

Cast your vote with pride that the country you live in fervently protects this privilege. Walk in your freedom, cast a vote today and don your "I voted today" sticker with pride.

By the way...Grand Rounds is up today HERE. Awesome edition too.I'm shocked I'm the only nursing post. Come on people...There are some great nursing blogs out there...submit to Grand Rounds AND Change of Shift!

Weird Interview Questions

2006-10-31T15:31:00.000-05:00

An interesting article in an e-magazine for nurses, Advance for Nurses caught my attention and got me thinking. What would I do if I was asked weird questions like this in an interview?

Weirdest Questions
They asked me to tell them about myself. Then as each took turns asking me questions, things got strange. One guy asked me to name 10 ways to find a needle in a haystack. Another wanted to know how many gallons of water it took to put out an average house fire. What almost put me over the edge was when one of them asked me how many things I could do with a marshmellow. I couldn't tell her what I was actually thinking!

What was the strangest question you were asked in an interview? Send us your responses: mmatta@merion.com

If you send in some weird interview moments to the author of that article, leave a comment here, too...I'm curious how weird it could get...

Photo Credit

Grand Rounds in Prose

2006-10-31T08:46:00.000-05:00

Dr. Hebert never fails to disappoint. Check out this week's Grand Rounds with a nod to Edgar Allen Poe.

Carve A Virtual Pumpkin

2006-10-29T20:34:00.000-05:00

As many of you are now experiencing or can remember, nursing students have no life. This includes me. I have an embarrassing admission to make. I purchased big, perfectly formed pumpkins with the pipe dream of finding the time to carve them in a rare family activity. Since it never happened and I am one of the "uncool" folks in the neighborhood with 5 uncarved pumpkins on my porch, I thought this website was appropriate.

This is the coolest thing I've seen off the internet in quite some time. Simple, no cookies, no download games....just a pumpkin you can carve.

When you're done, be sure to click the done button for a neat surprise.

Happy Halloween!
http://www.cubpack81.com/images/carve_pumpkin.swf

Mission Impossible

2006-10-25T13:49:00.000-05:00

"Your mission, young student nurse, should you choose to accept it, is to perform trach care (a sterile technique) without turning an already critically ill patient hypoxic."

Seem easy? Please enlighten me as to how in the heck this is even possible? My instructor suggested to try and do it while holding your breath. This will give us a sense of what your patient feels in regards to O2 loss.

So here's the deal, I barely had my sterile gloves donned and q-tips wet before I myself was gasping for a breath.

Do tell, oh wise nurses, how is this procedure even possible without breaking sterile technique and still keeping your patient alive....

(by the way, this guy's trach ties are WAY too tight!)

Power Trips and Flowers from the ER

2006-10-19T07:07:00.000-05:00

Acute Med/Surg started yesterday. By the end of the day, my head felt like exploding. My lead faculty for the course has what equates to alphabet soup behind her name...MS, RN, APRN (I thought the RN was unnecessary but I am but a lowly student with a mere BA behind my name.) She, by the way, is a PhD student who, in her free time, writes grants requesting palm pilots for her students. (I recieved mine yesterday and find it most useful in entertaining myself with JawBreaker during boring lecture where the powerpoints are being read to me.)

So, in a genuine effort to be positive about the next 8 weeks, I am trying my best to get past the question that has plagued me since I started nursing school, "What is up with middle aged female nurses deciding to be nurse educators and then becoming drunk in their authority over the students?" Teach me, mentor me, but please spare me from the the "almighty nurse educator" persona. If you deserve my admiration and respect, you will surely receive it. Rub your sickening authority complex in my face for 8 hours and I will withhold my respect on purpose.

In unrelated news, I picked up a Wall Street Journal yesterday. The article, titled Hospitals Open Up Space in The ER, goes into details of "boarding",

One solution gaining adherents is the Full Capacity Protocol, a standard developed by Peter Viccellio, clinical director of the emergency department at Stony Brook University Medical Center. When his hospital emergency room is full and patients are being boarded in hallways, the emergency department can begin transferring patients to halls in other units, spreading the burden of care around the hospital -- and ratcheting up the pressure on those units to free up beds by discharging patients who are fine to go home. Data he presented at the New Orleans meeting showed that one-third of patients being boarded in the Stony Brook emergency department last year were transferred to other units, and 20% waited less than an hour to get into a room once in those units. "If the emergency department has to hold patients, no one has any incentive to open beds," says Dr. Viccellio. "But put patients in other hallways, and rooms magically appear." To appease patients who have been boarded, the hospital adopted a formal policy to send flowers once they are in a room.

Excellent article, quick read. I recommend it.

Halloween and Acute Care Med/Surg

2006-10-11T15:07:00.000-05:00

Our town has a wonderful second hand clothing store and I always seem to find great deals there. Today I blew a wad of cash on fall and winter stuff for the two little kids (if it were only that simple for the two older ones).

Girl will be Eeyore this year ($12). Boy will be a frog. (Girl's costume last year-$0) Shamelssly showing these pictures to their prom dates in 13 years....PRICELESS!

OB is finally coming to an end. Just a cumulative final next week and its on to Acute Care Med/Surg. Chest tubes and suction freak me out just a bit. I told myself if I can handle watching all the reefing of a c-section, and all the "bodily fluids" of a vaginal delivery, suction and chest tubes may not seem so bad.

I think I can, I think I can...

On The Right Path

2006-09-28T13:15:00.000-05:00

I have awesome exciting news! I was offered a job today! It is a shadow LPN position that will have me operating as a treatment nurse, then when I obtain my licenser, I will be allowed to pass meds and be a "real" LPN.

I am so anxious to get started. The position is in long term care, yes thats right...a nursing home. I am actually one of the few nursing students who actually wants to work in this field. I have a long history in LTC and I feel so wonderful when I have made the life of an elderly person more full. No, its not the high-glam world of ICU or labor and delivery, but for me it is exhilarating. My long-term goal is to become an FNP, and work with the elderly. So today, I accepted a job that has me pointed in the right direction.

What an exciting time, to begin working with the population that always seem to give me more in return that I provide to them in terms of healthcare. I have been enriched so deeply by the intriguing stories of times gone by. I sit in awe as I listen to how the world used to operate, long before I was born. This population has so much to offer and Im honored to use my skills to provide care for them.

Maybe someday I will collaborate on a book about "old school" nursing. Something along the lines of Tom Brokaw's The Greatest Generation.

Back to Nursing

2006-09-23T14:28:00.000-05:00

Friday: clinical day, end of the week, lets order pizza because Im too whipped to cook. I stayed an hour past end of clinical to finish birthing with my patient. Well worth it, but I was exhausted.

I helped deliver two baby boys yesterday. One was GA of 35 weeks, weighed 4lbs and was out in one push. The baby was grunting, retracting, getting more and more pale with every passing minute and after 5 or 6 minutes was sent up to NICU for some help with respirations. Great experience, and I also learned I will never work in this hospitals NICU. Man were those women witchy. I couldn't get out of there fast enough.
I did notice, however, they most of those nurses had BSN after their RN on their badges.

Second delivery was a post dates induction. Routine labor and delivery. I had the chance to straight cath (sterile technique is tough enough but when the baby started having variable decels from mom being on her back, the beads of sweat were breaking out on my brow.)I also held her leg back and counted with her as she pushed. It was her 4th baby. It was occipital posterior (doc didn't mention left or right.) I was shocked to watch a big strong doc try and turn the baby to anterior and he was obviously using a ton of arm strength to complete the task. But he was successful and as soon as baby flipped, baby crowned.

When baby was out, it was then I realized I had been putting a lot of energy into holding up and back her leg for about a half an hour..and boy was my back killing me by the time I was home.

I think I cried as much as the mom did when it came out. This family was young, mom and dad still starry eyed-in love and this was her fourth baby. I sent them a plant today as a thank you for allowing me to be a part of their birth experience.

A few observations: I don't want to be an L/D nurse. Its a high glam, high energy job, but there is too much sitting around. I felt the phrase hurry up and wait would have been appropriate for describing how yesterday progressed.

Just because she's Katie Couric...

2006-09-21T09:00:00.000-05:00

Dear Katie,

I have been watching the CBS evening news since I was a small child. "Dan", as Mr. Rather was affectionately called in our home was welcomed in our home each night after dinner.

As an adult, he was welcomed into my home each evening as well. I was saddened to see him go but was thrilled with Bob's appearance in his place. Bob was the quintessential newsman. He was professional, serious, asked questions of his correspondents that were not canned and predictable. He had a wonderful sense of humor and I laughed as hard as he did when he interviewed the professor from England with the monocle.

Having said that, I know the bar has been set high for you and some would even say the deck is stacked against your success. I was hoping the following suggestions would be helpful in making your transition to the evening news a successful one.

1. The evening news is not the time to grab the first thing you find out of your closet and throw it on, as it appears that is what you've been doing. I have one word for you...color. Im certain you're being adequately compensated to hire a stylist if you need one. White just washes you out honey, and its time to admit that and move on.

2. When you do choose to wear a white silk blouse, you simply must wear a camisole over your bra. I learned that in middle school. Besides, something about being able to see the hardware that holds your bra together detracts from the beauty of silk charmeuse.

3. Yet another lesson I learned early in my career....NEVER sit on the desk. It looks terrible, and although you seem to want to unprofessionalize the evening news, it just rubs professional people who have spent all day sitting BEHIND their desks the wrong way.

4. While we are on the subject of the newsdesk, why is your chair up so high? It looks awkward. I want someone to reach down and pull the little lever that brings the chair down. Don't you feel up on a pedestal, especially when you have correspondents who have their chairs properly adjusted? Or is that the point? To look like your higher than they are?

5. Make-up is essential. Consistently wearing it is even more essential. They have amazing creams now for dark circles. Throwing on your favorite cardigan sweater and putting on a head-band just isn't professional. I mean, Walter freakin Cronkite is introducing you each night. Step it up girlfriend!

6. As a healthcare professional, I was deeply offended that you fired the longstanding CBS medical correspondent to replace her with your own personal physician. I was hopeful you would be above the good ol'boys network, but it appears otherwise. I was especially shocked at this move as it does not portray the unbiased nature that any good news anchor should have. Just in case no one filled you in, Dan lost his job for unprofessional behavior...

7. Finally, have you read the statistics that have been published? They state that America is watching you for the everyday news, but when something serious is happening, they are turning the channel. This does not bode well for you.

When I turn on my television to watch the news, I want Steve Hartman to be lighthearted and funny. I want to see my anchor be professional, wearing make-up, a nice suit, and appropriate undergarments. I want to see them on a chair, behind the newsdesk, a chair that is appropriately adjusted to the height of the newsdesk.

Come on Katie, your not getting a free ticket because of your success in daytime. Step up and act like a professional. Your certainly being paid like one.

Regards,
An observant nursing student in the Midwest.

Whats on My iPod? More than 7 songs...

2006-09-20T15:31:00.000-05:00

Tagged, for music preference this time...

I own an iPod nano 2GB. I never in a million years thought I would be able to fill it, as it holds over 500 songs. With head hung low, I must admit I have filled it, and now the iPod video 30GB is on my Christmas list.

Needless to say 7 songs is a harder request than it seems. I like everything, including Opera (although I would enjoy it more could I understand Latin).

Here is my list, organized by the activities that seem to occupy my time the most.
1. Morning routine, i.e showering, primping. (afterall, nothing gets the blood flowing like belting out a tune in the shower)
The Proclaimers, 500 Miles

2. Studying
Aaron Copeland, Rodeo and Billy The Kid

3. At the Gym
50 Cent, In Da Club (I like Hip Hop when its not too offensive-50 would have to be the top of my "offended" threshold.)

4. Road Trips, Driving
I LOVE Jazz and Blues. Anything by Harry Connick jr. or the new old stuff re-mixed by Rod Stewart

5. Kids are with a sitter and the candles are lit
Norah Jones, Turn Me On

6. Playing with the kids on the floor
Raffi

7. Cooking
Dixie Chicks or Bob Dillon (his new CD is really good)

As for passing this on, most of the bloggers I read or who read me have already played. I guess the buck stops here. : )

Go State!

2006-09-16T14:45:00.000-05:00

Michigan State University 38
University of Pittsburg 23

MSU is now 3 and 0, and thank God, because in the next four weeks they will play Ohio State, Michigan and Norte Dame...at least they got off to a strong start...

Clinical #3 Tomorrow

2006-09-14T12:37:00.000-05:00

Im hoping I will feel like less of a voyeur at clinicals this week and more like a student nurse. I am getting the sense that this area of nursing can be a bit territorial. The nurses consider the babies their own, and they guard the new moms like a cat guards her new kittens.

Today is my day off. I spent it getting my daughters ears pierced. I've worked very hard with her on saying please and thank you, so when the nurse finished her second ear, through her tears she managed a thank you. I felt a twinge of guilt. But, hey, she's polite...

(our pediatrician's office offers ear piercing...very good idea!)

Hail in August!

2006-09-13T14:17:00.000-05:00

I must be better if I can sit through a 4 hour lecture and not have hot flashes and cold spells...I wish I could say the same about my nausea, but I am having a hard time talking about postpartum perineal lacs and lochia consistencies without feeling queasy. I guess my stomach will toughen up eventually.

Ok, so I passed my math test, missed a 4.0 on my first lecture test by 0.7% (I guess I should have actually been serious about studying) but I still have no clue what the heck Im doing in clinicals. I feel like a gawker. Standing just far enough behind my nurse so as not to annoy her, but close enough to see what I need to see.

Last week we had a hail storm. It was actually pretty severe. I lost all the petals on my flowers and the amount of hail that fell in 20 min was astonishing. It also decimated my tomato plants. The pictures posted are from my front porch and front yard. The "pile" of white stuff is hail that collected in this weird pile where the buried downspout opens up in the yard. Im bummed I lost all my summer color, but now I can start decorating with colorful mums and Halloween garb. I love fall.

Always a new challenge

2006-09-10T17:02:00.000-05:00

Last semester during the first two weeks of nursing school my 3 month old was hospitalized with RSV and my grandma passed away. This semester Im off to a similar start. Last weekend my entire family had the stomach flu, this weekend its my turn.

I am cold, hot, nauseated, achy in places I didnt know could ache (like the palms of my hands...) and I am so sick of lying in my bed. I should be too sick to feel bored, but alas, its the final insult...Im sick and bored.

Ok, so maybe the final insult is that Im blogging about this. Im not using my energies to shower, or to rest...nay, I blog! God help me...lol

A meme from Moof-Are you next?

2006-09-07T17:32:00.000-05:00

What is a "meme"?
meme n (mÃ«m): A unit of cultural information, such as a cultural practice or idea, that is transmitted verbally or by repeated action from one mind to another. From the Greek mimÃ«ma, something imitated, from mimeisthai, to imitate.

Definition: In the world of blogs and bloggers, a meme is an idea, question, statement or project that is posted in one blog and answered to in many other blogs. Memes are used to propagate ideas in the blogosphere. Some blogs or web sites post memes on a daily, weekly, fortnightly or monthly basis.
description taken from:http://weblogs.about.com/cs/blogsglossary/g/memes.htm

1) Are you happy/satisfied with your blog's content and look?
I like my look, for a newbie-I subscribe to the mantra, Keep It Simple, Baby. I would like to add some more non-blog related links...I have a few but there are so many more out there.
2) Does your family know about your blog?
Yes. I wish they would read it more often though. Occasionaly my hubby posts a comment or two, like when he gets jelous of my admiration of Hugh Laurie...lol
3) Do you feel embarrassed to let your friends know about your blog?
No, in fact I wish more would read it, because they would discover all the good nurses out there who blog.
Do you consider it a private thing? I haven't really had an experience I wanted to blog about that would need to be kept private, so no.
4) Did blogging cause positive changes in your thoughts? Not really, but I am now always thinking how an experience could be a good post or thinking about the catch phrase for a blog story that would interest readers.
5) Do you only open the blogs of those who comment on your blog or do you love to go and discover more by yourself? Im always looking for new ones, medical and non-medical alike. (I will say, however, there are some WEIRD blogs out there...cue Twilight Zone music)
6) What does a visitor counter mean to you? I have yet to decide if that many people have actually looked and read parts of my blog, or if the site counts spammers, etc. Do you like having one on your blog? I will admit, part of the reason I blog is to get interaction with others, so I rely on the counter to reassure me Im not a lone voice in the wilderness.
7) Did you try to imagine your fellow bloggers and give them real pictures?Uh, no. Thats a little weird for me. If a doc leaves a comment I picture a guy in a white lab coat, if a nurse comments, I see someone in scrubs, unless its Kim from Emergiblog, then I see I nurse in all whites with a gleaming white nurses cap on...(shameless aren't I?)
8) Admit it. Do you think there is any real benefit in blogging? I am so excited to answer this...YES YES YES! It has been a huge force in empowering me to see physicians as approachable, witty, and down-to-earth. It has also given me a real-life peek at what real nurses do for a living, and given me a chance to elicit valuable and applicable advice.
9) Do you think that blogger's society is isolated from the real world or interaction with events? No in fact if the model works correctly, it can offer more sides to a topic that one would normallyexposedosed to.
10) Does criticism annoy you or do you feel it's a normal thing? Hasn't happened yet, but I can take it on the chin and assign value as its appropriate. I am my toughest critic anyways.
11) Do you fear some political blogs and avoid them? I avoid them completely. Im not strong enough in my own political belief's to be reading those and then able to sort out quality from junk.
12) Were you shocked by the arrest of some bloggers? America may have the illusion of free speech, but I have never thought it was unfettered. There are always people watching and reading, and there are always lines that can be crossed.
13) What do you think will happen to your blog after you die? not sure. I hope someone will at least sign me off from it officially.
14) What song do you like to hear? I personally was in awe of Grand Rounds when it was hosted by, MexicoMedStudent the background classical music completed my reading experience. Unfortunately, because I have been known to read said carnival during lecture, (hence-incognito) the music is a treat I could only seldom enjoy. What song would you like to link to on your blog? like the pics on my blog, it would have to change for each post.
15) The next victims? Originally, I told Moof that this meme is for the seasoned blogger and I would like to see some of the doc bloggers respond to it, so...

Would you be so kind FatDoctor, SurgeonsBlog, and GruntDoc?
You too Kim!

Im Hooked!

2006-09-01T16:36:00.000-05:00

OB rocks! As the mother of four kids with healthy lungs, I rather enjoyed leaving the nursery of screaming and fussy babies today, knowing I would get a full nights sleep tonight, scream-free.

I was able to do a newborn assessment.
Coolest part: all the intact reflexes. I felt like I was in a lab experimenting with a really cool toy....I must have done the Babinski Reflex 3 times, because the toes looked so cute when they splayed apart...

A gracious new mom, 8 hours post partum allowed me the chance to palpate her fundus. It was firm and one fingers breadth below the umbilicus.
Coolest part: she was a nurse so she helped me find it.

And finally, the icing on my cake today, my own personal obstetrician noticed me, pulled me into the treatment room and had me assist with a circumcision.
Coolest part: it didnt really bleed all that much and baby hardly even fussed.

Healthcare is cool. Im hooked. I feel such a sense of confirmation that I am on the right career path.

Intelinurse's Back To School Top 5

2006-08-29T20:14:00.000-05:00

Today's Top 5...

5. The meter maids are still as vigilant as they were last semester, and a parking ticket is still $15, (cheaper than parking in the ramp for the day).

4. My laptop battery does not last through a lecture when I am reading Grand Rounds and typing notes.

3. The Profs still have not caught on that we all can read and we do not require the course syllabus be read to us word for word, while we "follow-along."

2. The snack shop, aptly if not poorly named, "Recovery Room Cafe" is not my friend. I must stay away from the candy, I must stay away from the candy, I must stay away from the candy...

1. Im scared as hell about Labor and Delivery and hearing about last semester's "surprise delivery in the hall" did not help facilitate excitement in this student nurse.

Man's Best Friend

2006-08-27T19:51:00.000-05:00

I said goodbye to my best friend yesterday. I was going to post about it then, but I knew I couldn't get through the typing without sobbing.

Its silly, really, that dogs can have such a hold on your emotions. Charlie could make a crappy day awesome as I found him dutifully at my feet, or he could be the straw that broke the camels back on the days that life got crazy.

Charlie is a 2 1/2 year old golden retriever. I dragged my husband all over MI to find the perfect breeder and then waited 2 months for a litter. I temperament tested the entire litter and had the first pick...Charlie was it! Not too aggressive, not too docile. Truth be told, I would have paid double the $850 asking price.

In my head and heart, golden retrievers are not referred to as goldens, but "Charlie Dogs."

Charlie was obedient, loving, playful, and witty. His ability to endlessly chase a tennis ball and his desire to always bring it back was amazing. His companionship was faithful. He layed outside the shower door every morning, instinctively moving to the bedroom when he heard the shower turn off. He never begged for table scraps and was grateful to act as the dustbuster when the kids spilled Cherrios. Charlie was always up for a walk, a car ride, or a trip uptown to run some errands. Charlie never barked, and when he had enough of the toddlers tugging on his ears or tail, he would simply get up and walk away. He treated every guest to our home as if they were his master. He greeted every human he met with a wagging tail that could clear a coffee table with one swipe.

He will always be the best. He will always have a place in my heart. I love you Charlie.

My couch potato days are over!

2006-08-25T21:33:00.000-05:00

So I'm spending time with my 11 yr old son today, I needed to buy a Microbiology textbook ($113) and run some other errands. He was reluctant to leave the Playstation idle for more than a few hours, but I baited him with the prospect of buying some school supplies and a new back pack. I always really enjoy those times with him, as he is chatty and "real" with me. A side that sneaks under a rock when his sister or other friends are around.

So we are in the car, talking about college, and he asks me, in all seriousness, "Mom?, Can a girl be a doctor?"
I swear I felt the immediate urge to pull over the car and launch into a lecture...but I restrained my mouth, and simply smiled and said a "girl" can be anything she wants to be, that includes a doctor, a NASCAR driver, an NFL football player or the President of The United States. I ended the short discussion with, "and guys can be nurses too, darn good ones."

What are they teaching my kids in school? Better question, what have I portrayed for him as it relates to careers and gender?
___________

I am really not ready for the slam of classes and clinicals to start. I have fallen off the wagon and slumped back into my TV addiction...but tonight I thoroughly enjoyed watching Hugh Laurie being interviewed on Inside The Actors Studio. I guess this reflects my age, but I had no idea he was a Brit! His British accent makes him even more sexy...a-hem, I digress...I also didn't know he was an accomplished piano player and singer...and did you know his dad was/is a doc and he admits to being the type of person that doesn't enjoy being happy? How fitting. He also read for the role of Wilson during the initial casting for House. Ok, one last thing, and Ill stop worshipping Hugh Laurie...(smirk) he sums up the show by a phrase from Hamlet (Laurie graduated from Eton and Cambridge by the way) "I must be cruel to be kind."

Physician Input Appreciated

2006-08-24T11:06:00.000-05:00

Another edition is up at Change of Shift. Kim always does such a good job with this carnival. Im always so impressed with the great posts. I learn something everytime.

This week, Emergiblog posted a piece on talking to Docs. The Nurse Practioner's Place also posted on this topic recently. Its a topic of particular interest to me because of one of my posts about the very same thing.

Because the topic seems to be heating up in some med blogs, I thought you may be interested in the following studies and some of their findings: (stats from this Medscape.com article: Nurs Econ. 2006;24(3):150-155.)

1. Oermann and Moffitt-Wolf (1997) reported that recent graduates experienced a moderate amount of stress during orientation. Stresses in rank order were lack of experience, interactions with physicians, lack of organizational skills, and new situations. (emphasis added)

2. Duchscher (2001) conducted semi-structured interviews at 2 and 6 months of employment and found three major themes evolved sequentially: doing nursing (included dependency issues on others, fear of physicians, self-absorption, not questioning authority), the meaning of nursing (comfort with fallibility, self-awareness, patient-centered caring), and being a nurse (no longer feeling like a puppet on a string.) (emphasis added)

The list of studies and articles on this issue is a mile long. Obviously, its an issue for new grads. This nursing student will be sure to overcome the trepidation of speaking with docs BEFORE I hit the floor as a new grad. Thanks for all the posts and comments that offer applicable advice for this real-life issue nurses are facing everyday.

Any physicians out there who would like to contribute to this discussion, i.e. advice, retorts, opinions...make your voice heard.

No One Can Spin It Like Spike

2006-08-22T18:16:00.000-05:00

If you haven't seen it, I would highly recommend watching Spike Lee's HBO documentary on Katrina.

He has a gift for in-your-face subtleness. Of note for me was the montage of dead bodies depicted with no voice-overs or narration, only a haunting violin piece that was reminiscent of the holocaust. He also managed to replay press conference footage in black and white which somehow reminded me and my husband of the footage I have seen from the 60's when the South was de-segregating. Chilling. He whispers racism in your ear as he documents the failure of a nation to respond to this disaster.

I was angered by what I saw transpire in New Orleans last summer. This piece re-kindles those emotions. Most especially, it renewed my disgust with the slow Federal response and the political games that were played by the Govenor, the Mayor and the President.

It is my deepest hope that we have learned from this disaster.

Grand Rounds Becomes A Centenarian

2006-08-22T08:51:00.000-05:00

Check out this weeks all inclusive 57 submissions. Great Job Dr. Charles.

Tagged

2006-08-17T19:59:00.000-05:00

Sweet! I will shamelessly admit I have been hoping I was popular enough for someone to tag me. Good things come to those who wait, because not only have I been tagged, but tagged by a Canadian med student! I affectionately refer to her blog as "itis" because its summer, school is out, and there are too many syllables in medstudentitis. I highly recommend a perusal of her site-she makes a wonderful addition to the medical blogosphere. Ok, enough shameless brown-nosing. (hey-you never know, I may be nursing one of her pt's one day.)

1. One book that changed your life: Bible, God

2. One book that you've read more than once: Left Behind, LaHaye, Jenkins

3. One book you'd want on a desert island: 98.6 Degrees, The Art of Keeping Your Ass Alive, Cody Lundin

4. One book that made you laugh: The Indespensable Calvin and Hobbes, Bill Watterson I wish he would come back from retirement for one last hurrah.

5. One book that made you cry: Night, Elie Wiesel

6. One book that you wish had been written: Overcoming Arithmophobia for Dummies

7. One book that you wish had never been written: The DaVinci Code, Dan Brown (link disabled purposefully)

8. One book you're currently reading: The Priest, Francine Rivers

9. One book you've been meaning to read: Manhunt, 12 Day Search For Lincoln's Killers, James Swanson
I tag... Surgeonsblog and N is For Nursing

The Cookie Monster Blues

2006-08-17T08:58:00.000-05:00

Clinicals start in exactly 14 days. I wonder if the hospital nursing staff posts this sign somewhere, upgrading the student nurse terror alert to Blue?

Last semester I noticed that the scrubs of the upperclassmen looked washed out and dull. So it was then I decided to buy a new set of scrubs each semester. I bought them yesterday. I had forgotten just how bright they are, just how much I scream "student nurse" when I wear them. I had forgotten why I have developed a distaste for anything in the hue of Royal Blue. And I had forgotten that the color is affectionately referred to as Cookie Monster Blue.So keep your eyes peeled, and if you think you spot a posse of Cookie Monsters walking down your floor at the hospital, not to fear, for its just your friendly student nurses, back for another semester.

Hmph!

2006-08-12T09:39:00.000-05:00

I have tried watching Grey's Anatomy this summer. I just can't seem to get into it. Now I know why.

Catching up on good shows I didn't have time for during school is a mindless activity I enjoy during the summer. Having said that, I have heard all the hype on Grey's Anatomy, but have never seen an episode. A few nights ago, I watched my first episode. It was titled, "Tell Me Sweet Little Lies." For those of you who watch it regularly, it was the episode where the nurses went on strike.

In the episode, there was a small scene between one of the "stars" and a nursing student. The nursing student was portrayed by a pencil thin blonde woman, all of 21. A character that is not representative of the students sitting next to me in class. But I take issue with how this student was portrayed. She was being bossed around by the resident, nay, she was being barked at. And of course, the student replied with skittish uncertainty. Now I can certainly relate to skittish uncertainty...see Um, Excuse me. However, must the American public be subjected to unfair stereotyping of student nurses? Hmph! I was actually a little embarrassed as my hubby was watching the episode too. He said in jest, "Is that how it is in clinicals, honey?"

I read an editorial in an AJN publication once about how nurses are being portrayed in the "new generation" of medical thrillers on TV. The days of being respected as we were in the show ER are over. Now we have to deal with the false portrayals of our profession as depicted in House, and Grey's Anatomy.

Rise up proud nurses! Fight to defend your hard earned reputation, take to the streets in protest. Turn off your televisions, boycott these shows!

Ok, so that's a bit extreme. For I too will be placed squarely in front of my television for the season opener of House this fall, but isn't there something we can do?

Mental Filing Cabinet

2006-08-11T17:42:00.000-05:00

I took my 11 yo dtr in to the doc today to have some pesky warts treated. Her previous pediatrician refused to treat them and told her to keep duct tape over it for 6 weeks, and they would go away. Seriously, thats what they told her. (darn HMO docs, so freaked out to spend a little money) : )

Anyways, my daughter asked the nurse if she could tell her if she was the right weight for her age and height. Peer pressure starts so young these days. The nurse would not tell her. Is there some secret I don't know about here? Is she afraid she will create an anorexic/bulemic by giving her this info? Dtr is too polite (especially in front of mom) to push for an answer, but mom isn't!

I asked her why she was avoiding answering the question. The nurse said I should really have that issue addressed at her next physical ( a year from now). What? Isn't it a nurses job to educate?
So I smiled, relenting my lack of knowledge in this area to a nurse who could have simply plotted the info on a chart she has in front of her. I decided I would bug the doc instead.

Doc said an 11yo female who weighs 128lbs and is 62 inches tall is in the 90th percentile. It took him less than one minute to plot it and I was satisfied. What was that nurses problem?

Mental Filing Cabinet Under "Never Do as a Nurse"
Avoid an opportunity to educate a patient.

2006-08-09T15:12:00.000-05:00

Welcome to Change of Shift. As usual the posts are wonderful and the submissions will not disappoint. I enjoyed the recent Grand Rounds' format of a stroll through a Garden, so I am adopting the style. However, I thought it appropriate to walk readers through a college campus, after all, I am a nursing student!

Welcome to campus! Our first stop on the college campus tour is the lectern, a place where ideas are brought to fruition, and theory examined in an atmosphere of teaching.

Nursing Studio kicks this portion of the tour off with an informative piece on ACLS. Setting the bar for all of us, she has mastered the audioblog feature for your listening pleasure and offers her post as a podcast! Much better than chalkdust and erasers. Unbounded Medicine follows with a helpful primer regarding Gallstone Ileus.

The next stop on our tour is the faculty lounge, where the experienced teachers go to share their war stories, and their personal feelings. A place of retreat. A place every student, could they be a fly on the wall, would learn so much regarding the "real world" they are preparing for.

Mediblogopathy sits down for a break first, as a new "faculty member" to her blog is introduced. Welcome Paeds RN, and thanks for the advice to fellow faculty in Compromise. The next faculty member to stop in for a break is Dr. Schwab at Surgeonsblog. He shares his gut-wrenching experience with a young Memorable Patient no. 4. Maybe Donorcycle would like to offer him a drink after that story as she relates a story about teen-suicide that is a good reminder not to get to cynical in Good For Her. Warrior Mom follows with her experience in going the extra mile for a patient in Empathy. Digital Doorway lightens the faculty discussion in re-telling his own experience as a vet and ailurophile in The Nurse as Vet. Finally, OncRN admits, with a level of honesty that only comes out when the faculty lounge door is closed, that somedays she is just going for the Oscar in I'd Like to Thank The Academy.

What would a university be without the local cafe? A place where students can find an escape, chatting with old friends and meeting new ones. How relaxing it is to grab a latte, open up the laptop and enjoy a favorite blog, or download iTunes to the iPod?

A newcomer to the healthcare blogging scene, Drug Induced Hallucinations, is welcomed into the cafe with a creative approach to writing in EMS Concerto. Blissful Entropy joins our Paramedic student at the cafe table and expresses much deserved gratitude in Thanks To The Frontlines. The conversation switches gears when Its a Nursing Thing vents about her arithmophobia and shares a song from her iPod with Math Sucks, Jimmy Buffet says so. Improbable Optimisms shares her feelings about how the people that she ministers to in an ED embody Christ with God in The ER. Finally, KT Living takes a seat and shares a shift experience that almost broke her as a nurse. Sounds like it was friends and fellow nurses who helped her through a tough experience. Thankfully the cafe offers complimentary Kleenex!

Finally, a spot on campus near and dear to everyone's heart, the library. Students and faculty alike explore the printed word for a look into history, or possibly for work on a research paper. Whatever the purpose the book serves, it is a powerful tool in eliciting a wide range of emotions, points of view, and in furthering that which was spoken of from behind the lectern. What do the stacks hold this week?

Our first selection from the shelves appears to be a well written biography. Fat Doctor authors Supermom, RN, MN, CDE. Emergiblog writes a persuasive essay exploring a personal experience with Hospice care several years ago and how it has evolved since then in Valley of The Shadow. Has it been a good or not-so-good evolution? Wrapping up our tour through the library is a historical look back from Nurse Ratched in Do You Remember When. This is the type of writing I enjoy the most, history. We can never seem to imagine life as they experienced it, but a few generations from now, the same will be said of us..."How did they put up with that?"

This concludes your campus tour. Hopefully you have enjoyed your stroll. Fall is coming and soon the leaves will be changing, the drum corps will be audible practicing for the first home football game of the season, and us students will be back to class, learning, experiencing and blogging all about it!

Where did summer go?

2006-08-06T20:49:00.000-05:00

Yesterday the mail contained three children's catalogs, all of which prominently promoting their vast selections of Halloween costumes. I wanted to protest the advancement of summer towards fall by not looking at the catalogues, but the kids have surrendered on my behalf and have already decided on their Halloween identities and with whom they will trick or treat.

Today, as I came in from the deck, enjoying a wonderful warm summer breeze and plentiful sunshine, I heard "the voices." The voices that will forever remind me of fall, the immanent end of summer and back to school. The voices of John Madden and Al Michaels, the voices of NFL football. Tonight was the first televised pre-season pro-football game, and the first sign it is nearing the end of my summer.

Math Sucks, Jimmy Buffet says so!

2006-08-05T09:25:00.000-05:00

Jimmy Buffet said it best in his song, "Math Sucks." I am convinced it is the sole reason I am not in medical school and am also certain it is the reason I have a near nervous breakdown during the first two weeks of every semester in nursing school. Maybe its because my 10th grade geometry teacher was more interested in running football plays with his players than teaching math, but ever since then, I have struggled with math. It killed my ACT scores...goodbye pre-med at the local Big Ten university. and it wreaks havoc on my ego everytime my husband does the math in his head quicker than I can peck the numbers into the calculator.

I have a BA in business, and only obtained it by taking stats twice. When I decided to go into nursing school, I had to take Algebra II before I would be considered as a candidate for the nursing program. I took it online and only passed it because my accountant hubby helped me with my quizzes and homework. So I was hopeful that having passed those hurdles, I would be mostly math free in nursing school...I said hopeful.

How is it that I have been accepted into a nursing school that feels the need to proove its "dedication" to producing math competent nurses. Their policy? To have a mandatory math test in each nursing course. If a student doesn't pass the test? You're Auf'd. Seriously. Auf Weidersehen. And no kisses on the cheek from a gorgeous blonde lingerie model either. You're just done-irregardless of how far into the program you have advanced.

I am not devaluing math's place in the life of a nurse. I understand that certain orders require the nurse to calculate rates and dosages. But if its so important, why not just create a Nursing Math class as a part of the program? Why must the powers that be rob me of my back to class excitement by throwing in a do or die math test. To make it all the worse, it occurs in the first week back to class after a long math free summer.

Im sure my attitude does nothing but perpetuate my anxiety towards these impending tests. Im also sure that I will be a good nurse even if I have to ask a colleague to check my calculations before I give a med. But as all nursing students know, we are but puppets, who dance willingly when our strings are pulled. For the puppetmasters know how desperate we are to be successful nurses who will graduate.

But math still sucks.

Grand Rounds from a surgical suite

2006-07-31T19:54:00.000-05:00

Another excellent edition of Grand Rounds. I've been waiting all weekend for this. With this oppressive heat at its height in MI today, it will be the perfect way to spend down time inside the A/C. Grab an iced tea and enjoy!

Nursing in Israel

2006-07-30T19:59:00.000-05:00

To say the proverbial deck is stacked against this male, Arab nurse in Israel would be a grievous understatement. Given the current events in the Middle East, specifically between Lebanon and its neighbor, Israel, I found this recent AJN article most interesting.

In the article, written by an Arab nurse who was assigned to the direct care of Ariel Sharon during his first CVA in 2005, he writes about how he came to be a nurse. Believe it or not, it was racism that funneled him towards this profession. Nursing, he says, is a profession that is not considered a "security risk" to the Nation of Israel. Arabs in a Jewish state, he claims, are not allowed to enter into high-tech or military vocations for the very reason they are Arabs and could pose a security risk to the nation.

The irony is inescapable. As an Arab nurse, he ended up caring for the Jewish Prime Minister of the very country that has deemed his ethnicity a "security-risk."

The well written article ends with this quote:

I don't see Sharon as my enemy, although Israel does not always see Arabs as friends. Fighting stereotypes is what I do almost every day, whether it is prejudice aimed at me as a man in a traditionally woman's profession or as an Arab living and working in Israel. I am helped in this by the principles of nursing, which emphasize patience and tolerance toward others, without regard to race, religion, sex, or nationality.

Whatever your feelings about the current situation between Israel and Lebanon and who may be at fault, this article reminds me that I have chosen a profession that proudly alienates itself from racism and prejudices of any sort.

I am reminded of my colleagues in Iraq who daily provide superb nursing care to both Americans and Iraqis (friendly and the enemy alike.) But when they put their stethoscope on a patients chest to auscultate lung sounds, they do not hear ethnicity or even political affiliation. They hear a universal sound, the movement of air through human lungs.

Another great edition of Change of Shift

2006-07-28T20:42:00.000-05:00

I am honored to be included this week. If you have ever considered submitting a post-Just Do It! Its the broad spectrum of opinions and viewpoints, stories, and experiences that make it such a great medical web log carnival.

Grand Rounds is Up

2006-07-25T10:10:00.000-05:00

This weeks Grand Rounds is up and a Medical Humanities blog is hosting. Very interesting to look at healthcare as an art aiken to gardening vs. always looking at it through the lens of warfare. Enjoy!

Warm and Fuzzy aka Bedside Manner

2006-07-19T16:36:00.000-05:00

During my weekly perusal of some of my favorite blogs, I came across an interesting post from GruntDoc. He discusses a particular experience as a patient himself that gave him pause to consider bedside manner, including his own. Its worth the full read, but I wanted to quote him on one item in particular, "However, Derm's lack of any appreciable bedside manner has me reevaluating one of my longest-held beliefs, that people don't really care if their doctor has a great bedside manner, but only really want a doctor who is very competent and does the job right." excerpt from gruntdoc.com July 19, 2006 post.

It struck me as interesting that in my recent meetings with docs, my warm fuzzy side does need a bit of hand holding. When it doesn't happen and I begin to introspectively wonder if its me, my intellect steps in. I remind myself I am, in fact, only there looking for this particular physicians wisdom, skill and knowledge. I am not looking for interpersonal relationship pointers or positive affirmations.

It is interesting to me that patients will let it slide when a doc doesn't demonstrate the warm and fuzzy, but when a nurse won't give it up...look out! It has been my observation that patients demand both from a nurse. They look for, if not require, skill and good bedside manner. Patients are much more apt to complain about their nurses when they don't get a balanced mix of both. Most nurses I know sense this need from their patients and oblige this unspoken request. On a final note, think of the "bad nursing" stories you've read or heard. How many of those situations could have been made better or eliminated altogether with a change in the nurses disposition?

Its just an MRI

2006-07-17T19:40:00.000-05:00

I've determined I am not a good patient and that is probably what seasons my compassion as a nurse. I can honestly empathize with patients who have anxiety about the medical setting and procedures, because I do too.

I am scheduled for an MRI tomorrow morning, at 0720 (way too early). My options were 0730 or 1930. I chose the morning because I didn't want the whole day to think about the impending test.

This is silliness. Its an MRI not a spinal tap! Its painless, a little noisy, and only 60min. in length. As I was lying in the tanning bed this morning (I know I shouldn't fake bake but Im scary pale if I don't) I tried pretending I was on an MRI table, I think I made it less than a minute w/o moving...this is gonna be tough for me. Amazingly, its not the small space, its not being able to move....

They called to pre-register me yesterday. The receptionist informed me I can't bring a CD because their CD player is broken...nice. She also told me there is a "button" I can push to stop the test if I get claustrophobic. "Claustrophobic?", I question, "Is that a common reaction?" Her hesitation at how to frame her response was all I needed to realize if I don't have claustrophobia I may feel like I do for this test. Oh man...I can do this, its pain free. I just have to keep telling myself its an hour of kid-free. No phones, no housework calling to me. Its just an MRI.

Im planning to go shopping afterwards as a reward. This is crazy, really, its just an MRI.

UPDATE: MRI went fine. I took 1mg of xanex (Gods gift to the nervous) and it seemed to fly by. The techs and nurse were super nice. It made all the difference! I may have to wait a few hours before I head of to the mall though, Im still feelin pretty "chilled out" : )

A World Without Nurses

2006-07-16T11:09:00.000-05:00

"Imagine a world without nurses. Think of a world without persons who know what nurses know; who believe as nurses believe; who do what nurses do: who have the effect that nurses have on the health of individuals, families, and the nation; who enjoy the trust that nurses enjoy from the American people. Imagine a world like that, a world without nurses".
Margretta Madden Styles, past president of ANA and ICN

My favorite professional publication to date is The American Journal of Nursing. It is well worth every penny of its subscription price. I enjoy almost everything about it, from the wide range of editorial views of nurses with all types of experience to the articles that always expand my knowledge. I am working on a post about the publication, but in my research, I came across this quote and had to share it. My favorite thought within the quote is ..."imagine a world without nurses...who believe as nurses believe."

The eyes have it

2006-07-11T09:36:00.000-05:00

I thought to myself, "Have her eyebrows always been that short?" Then my God-given gift of mothers intuition kicked in and I remembered asking 11 yr old to give 2yr old a bath yesterday.

The fact I have misjudged 11yr old's capabilities in giving 2 yr old a bath is now a foregone conclusion, as her explanation leaves much in question...

In a desperate attempt to explain her actions, 11yr old said, "Mom, don't get mad. I was actually helping. 2yr old took the razor and shaved off a chunk of her L eyebrow, so I had to fix it...Don't get mad." Again, mothers intuition would translate that defense as, "I saw the razor and was curious what she would look like with only half of her eyebrows."

She must have felt the need to repeat the direction not to get mad because smoke, Im quite certain, began to pour from my ears and my voice dropped several octaves.

So tell me, how do you discipline the 11 yr old? I've already reluctantly ruled out shaving half of 11yr olds eyebrows off. (the heck of it is that I rely on her for relatively cheap, dependable childcare for my quick errands) Not Anymore. :(

Um, excuse me

2006-07-10T13:04:00.000-05:00

I finally had the courage to comment on one of my favorite med blogs by a doctor. Check her out. And it occurred to me that this confidence thing is an emerging issue I need to get a handle on if Im going to be a successful nurse.

In clinicals, the few times I needed to talk to a doctor one would have thought I was facing George W. himself. I have never been "quick on my toes" and I've always known I would never be an ED nurse for that very reason. However, I really must learn to muster some confidence to speak with physicians. My patients and their physicians rely on me to effectively communicate information. I, however, am frozen in fear about not having the info they need or not having the info fast enough for them. (Afterall, it still takes me 15 minutes to do a simple assessment that takes experienced nurses all of 5 minutes to perform.)

My Fundamentals nursing instructor went so far as to suggest that if we are going to refer to physicians as "Dr. so and so" then we as nurses should insist on being referred to as "Nurse so and so." Im not sure I would go that far with my confidence (Imagine how House would react to that request...lol) but at the very least, I do need to muster some confidence.

Mistakes

2006-07-08T17:31:00.000-05:00

I just read an awesome post from a nurse. Read it. In it, she mentions making a mistake and it made me remember my first "big mistake" as a nursing student...the memory still makes me squirm.

I thought I was educating a daughter about the "farting noises" (dtr's words) coming from her moms stomach. I was explaining that her mom's stoma from her colostomy will allow gas to pass through it and it will sound louder that normal passing of gas. Originally, her mom went in for a suprapubic catheter placed because she had lost bladder control because of a neurogenic bladder. (nerve damage to nerves inneravting the bladder). Needless to say, the bowels sort of got in the way and the surgeon punctured a hole right through them while he was piercing the bladder for the catheter. Normally, a surgeon would simply explain to the pt/family what happened and what had to be done as a result. This guy neglected to tell the pt or her dtr what happened, so no one but the nurses and surgeon even knew about the colostomy.

Enter student nurse...and all the sudden Ive opened a can of worms. When I told my clinical instructor about it, she treated me like I was a moron. I think she even said something like, "why are you teaching?" I felt so degraded. I thought that was part of our job, to teach. This dtr needed to know what the noise was (at the very least.)
I hated that feeling.

Clinical Instructors/Nurse Mentors: please do not portray a nurses duties as ones that should and will always be performed w/o error. Please be honest and real with your nursing students and new nurses; mistakes are real, they happen and it does not necessarily mean you are a bad nurse.

Nursing Students: Mistakes will happen. Do not allow them to rob you of a very important skill, your confidence.

I Might Be A Redneck...

2006-07-05T18:41:00.000-05:00

I think I might be a redneck. My uncle brought a $600 bottle of red wine to a dinner party at my home. He needed a decanter, all I had to offer was a tupperware pitcher. He asked for cheesecloth to strain the sediment from the wine, all I had was coffee filters. So there we all are, seated around a semi-formally set dinner table drinking very expensive grape juice from a plastic tupperware pitcher...I wonder if he felt like he should have brought the $7 bottle instead?

It was good wine. I would have never paid more than $50 for it though. My hubby and I actually love wine. We are not wine snobs. We just enjoy Napa Valley in the fall, know what wines we like, and enjoy watching The Wine Guy, Mark Phillips,whenever he is on PBS.

Cheers~

Yadda Yadda Yadda

2006-07-03T18:32:00.000-05:00

Maybe this is the place to get this off my chest. I happen to strongly dislike the people in nursing school who turn a routine _____ (insert topic here) lecture into a therapy session as they rehash the stories of their childbirths, family deaths, ED visits with kamikaze kids..yadda yadda yadda.

But, I have one of those stories (actually two, ok three). So in an attempt not to tick off fellow classmates this fall, and in an attempt for penance for recounting one story during first sem, here are my stories.

He Has What?
my mom was diagnosed w/ multiple myeloma. she was sent to karmanos for a stem cell transplant, 2 days after the transplant, my dad is sitting at her bedside and complains of chest pain. the nurse sends him down to the ED, they draw his blood and "what the fu$%" was almost audible when the doc read the labs...leukemia...serious leukemia...gonna die in a few days leukemia. that was a thursday night. On monday night at 11, he died. My brother and I were frequent flyers on the hospital elevators as we spent an hour at one bedside and another hour at the other bedside. At one point, they wheeled in my dad in his hospital bed, parked it next to my moms bed and all they had the strength for was to hold each others hand. God, what a pitiful picture seared in my head for eternity. Cancer sucks, I want to defeat it, I want to kill it and stomp on it and mash it into the ground like you do with a nasty looking bug on the sidewalk. I want to be an oncology nurse...I think. I want the nurses who cared for my dad to know they were awesome, they made a difference, they cared for him technically and with a human love that exceeds technology.

Don't Push!
I have four kids, how can I not share a birthing experience...
I weaseld my way into getting induced 2 weeks early. I was geeked, a planned birth w/ an epidural in place even before the first contraction...BONUS! The doc says, well, why dont you walk over to l/d, we'll get the epidural placed, Ill break your water and you'll be nursing by Jeopardy. BONUS! I walk over to l/d...pain free so far BONUS! oh, wait, I think this is a contrac....oh shit this hurts....the nurse (goddess) says sit on the edge of the bed, curl your back like a cat and we'll get the epidural placed. I sit...GUSH...water all over the floor (its so warm...did I just pee my pants?) The nurse (not so goddess like anymore) says..."that was your water, you're not getting an epidural, lets check you, swing your legs up on the bed...(this is where I wish I could insert the noise a pinball machine makes when you loose your last ball)
I open my legs and out comes a head...Im now screaming (sorry, I cant help it) the nurse closes my knees and says DO NOT PUSH. (where is the doc? the instrument table isn't even set up...)
Dont Push? Are you freaking kidding me?? You may be a seasoned l/d nurse, but have you ever had a kid? I have to push, its a little beyond my control at this point. So the baby's out, the doc makes it in to "catch" and the nurse hands the baby to me and says "here, hold her until I can get the warmer turned on" Needless to say, I was nursing my baby during Guiding Light, not Jeopardy.
I think I want to be an l/d nurse.

Good Grip
last one and I will be done...(remember I have four kids)
Same scenario, I conned my way into an early delivery, although they were a bit more cautious this time given the speediness of baby #3.
Epidural is in this time, but it only took on one side (this should feel interesting). This nurse checks often, Im progressing quickly-big surprise, they broke my water, doc checks and Im at 7, and "oh" she says, "he has a good little grip." WHAT THE F%^$? what do you mean he has a good little grip? He was presenting with his hand, I was at a seven, ready to deliver in short order. I've never seen nurses and a doctor move so fast in my life (no, I haven't rotated in ED yet) I was on my way to OR for a c-section. BUT WAIT I say...DO NOT CUT...I can feel half of my body (and not the half from waist up) After it was all said and done, I could barely feel my chest...and my b/p was 40 over something...uh, Im feeling a tich liquidated over here....
I learned I could never be a nurse anesthetist, but again I think I would enjoy labor and delivery

Ok, so my stories have been broadcast, I promise not to be the one in class who monopolizes the lecture with my war stories. We all have them, and we will all collect them as we ride this crazy coaster called nursing.

If I can do this, so can you.

2006-06-30T14:23:00.000-05:00

I am 32. I am married. I have four children. I am a nursing student in a community college with my first semester under my belt. A hard earned 4.0 and a few experiences that have shaped my character...and I honestly am so glad I decided to pursue my dream.

I want my first blog to be one of encouragement for students in the thick of it (nursing school, that is) and for anyone who is still considering it.

I was working a desk job, earning about 30k a year and was bored stiff. Maybe you know the feeling, I would get to work at 8, grab some caffeine and sit at my desk wondering what I was going to do to keep myself busy today. It usually took me all of 15 or 20 minutes until I started thinking about my first break. I loathed my meetings. I would sit around the conference table and look at the people I worked with. Mostly women who seemed all too content in their vocation. I wondered where they mustered their enthusiasm to deal with the same things day in and day out, month after month, year after year. When I thought of being there for years and years, I would shudder. The corporate ladder at this place was laden with politics beyond the norm. If I knew enough true gossip, or had silently endured a sexual advance from the owner, my climb up the ladder would be brief. If I planned to maintain my values and ethics, I would be forever at the bottom rungs looking at the stiletos of the women who had "paid their dues." No thank you.

I wanted more. More varied opportunities, more flexibility, more power to decide what direction my career took. And I will admit, I wanted more money and some more recognition for efforts made and accomplishments met.

The short and sweet of it is this, one day at a time, one test at a time, one clinical day at a time, and before I knew it I was finished with first semester. Holy crap...I am really becoming a nurse.

Theory Schmeary

2006-06-07T13:04:00.000-05:00

“How empty is theory in the presence of fact” Mark Twain

To get the gears spinning again, in preparation for classes which resume in a week or so, I read the following article; "Why a Well-Paid Nurse is a Better Nurse" by Julie Nelson and Nancy Folbre. It came to my attention through my online Medscape Nurses subscription. (If you don't have one, I highly recommend it. Its free and worth the 2 minutes it takes to sign up.) I have found most articles to be timely, intellectual, and interesting. This article proved no different.

I did have to leave my AOL Dictionary window open while I read the article, as it was written as a "review" of sorts and involved several economic terms with which I was unfamiliar.

The article examines the theory (by economist Anthony Heyes) that a willingness to accept a lower wage, all else equal, distinguishes a good nurse, from the "wrongsort." In retort the authors pick apart this theory and expand upon their own theory which supports higher wages for nurses. Heyes argues raising nurses' pay would reduce the proportion of nurses who have a natural vocation for the field and result in a decrease in the quality of care provided by those nurses.

Within the article, the concept of Crowding In or Out is really what peaked my interest. Crowding Out or Intrinsic Motivations is a concept that is best illustrated by the blood supply study conducted by Richard Titmuss (1971). In it he proved that in some cases, paying people to do something they might otherwise do voluntarily can drive out their impulses to do the activity for their own pleasure, other's benefit, or other internally supplied reasons. The economist this article argues against (Heyes)asserted that paying nurses a higher wage would actually produce lower quality nurses uses the crowding out theory to support his position.

An economist who did further research on Titmuss's work, (Frey), found that the theory must be taken further in order to be fully realized. To truly understand the concept and how it would directly effect the subject of nursing wages, you need also to understand the importance of Crowding In. Frey actually found that external motivations like pay "crowd out intrinsic motivation if they are perceived to be controlling, and they crowd in intrinsic motivation if they are perceived to be acknowledging." So vocation can actually be dampened or extinguished or strengthened by an employers choice in how to compensate their nurses. If high pay is given in such a way that nurses feel respected and rewarded for their care and professionalism, feelings of vocation can be reinforced and expanded. In turn, creating a better nurse.

Heyes's "theory" is junk on so many levels I don't know where to start. Here is a quick list compiled after reading the article.
1. Even the strongest of vocation does not guarantee skill. Attracting nurses w/ only high vocation is risky in that it may be a trade for skill levels. Nurses need both to be good ones.
2. Nurses who have both vocation and skill have a higher reservation wage (will not work for less than "x"). So not offering at least that wage, will drive them to other professions that are willing to exceed their reservation wage, even though nursing may have been their first choice.

It is extremely important that Heyes and his theory does not influence the opinions of the HR Directors working in healthcare. Nurses are people who bring a strong sense of vocation AND a huge skill set to the healthcare environment. If our hospitals need these people, we have to be willing to pay for them. There is a need to recognize the value of a worker who is skillfully trained AND has a strong vocation for the nursing profession. We may never see an end to the nursing shortage unless attitudes like those discussed above are changed.