My name is Beth. I couldn't cut it as a web designer so instead I decided to do something completely random and become a nurse. I'm 
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Back to the MICU, and back to Liverland
By Beth | April 29, 2008
So this MICU shift was very difficult after all, and it wasn’t for the reasons that I suspected. I thought it would be the tasks that got me down, i.e. not enough time to get things done. Surprise, surprise, turns out it was the patients.
Imagine a patient with End Stage Live Disease. She currently has hepatic encephalopathy and suspected GI bleeding. She was recently extubated. They usually put an oral gastric tube in and then yank it out at the same time when the patient is extubated. But then the patient continues to have this hepatic encephalopathy, which is a Catch-22 because then she is unable to swallow her lactulose, (which would help to restore her mental status.)
You attempt placing a nasogastric tube, twice, both times unsuccessfully, both times with the patient screaming at the top of her lungs. So at the end of the day, her baseline mental status hasn’t returned, and you have no way of giving her nutrition or lactulose. But she isn’t sick enough to stay in the ICU so you transfer her to the floor.
Typical situation for this disease, I tell myself, and that’s just the way it is. But I feel so frustrated, and so helpless for two reasons. (1) I CAN’T GIVE THIS PATIENT HER LACTULOSE AND THAT IS THE ONE THING THAT WOULD MAKE HER BETTER and (2) Trying to place this NG tube when she is not mentally stable enough to cooperate is very traumatic to her. And inevitably, the docs will always order a lactulose enema out of desperation. GUESS WHAT? If your patient can’t swallow a cupful of medicine, you can be damn sure she won’t be able to retain a pint of lactulose IN HER BUTT. So that never works.
The weird thing is that even though I hadn’t worked since last August, I had the exact same patient scenario: Liver Failure, recently extubated, mentally, in liver land, and unable to swallow lactulose.
Is it a failure of our healthcare system?
Is it a failure of my nursing skills to place an NG tube?
Is it a failure of our normal routine to yank out the OG tube when extubating?
Is it a failure of medicine in that we have failed to discover a better way of reducing a patient’s ammonia level (which is what lactulose does)?
In the end it doesn’t really matter because it was a failure, and I left that day feeling like I had done nothing for my patient except cause discomfort, and transfer her to lower level of care.
One thing is for sure, I vow never to complain again about working at Chez Recovery. It took a shift back in the MICU to make me realize just how good I had it there.
Topics: Blog | 4 Comments »
Back to the MICU
By Beth | April 18, 2008
So I’ve had an ab fab week of being a stay at home mom, and caring for my one year old wonder. I’ve also made some progress on my Orientedx3 redesign, and I hope to be able to launch it in a week or two. I won’t get into too much detail here, but suffice it to say that it’s going to be a very cool way to explore nursing related content, with blogs in the forefront.
I’m also working on building some Wordpress themes from scratch and it’s been a really fun and invigorating project. A project that makes me feel as though I am getting closer to being a successful web designer, and farther away from being an unhappy nurse.
One kind of cool but geeky thing I realized is that PixelRN is on page one of a google search for “nursing websites.” It’s kind of meaningful to me because I’ve always believed that nurse bloggers are putting out the best nursing related content on the web, and most of the other nursing websites are light years behind us. It’s also meaningful because the way I discovered nurse blogging was by doing a google search on “nursing websites.” In a way it makes me feel like this blog has come full circle.
At any rate, I am working a shift in the MICU tomorrow, my first time since last summer. I have a feeling it’s going to be a make or break kind of a shift, in that I am either going to rediscover my passion for working in the ICU, or I will be reminded why I wasn’t so keen on going back there in the first place. More importantly, I hope I remember how to care for really, really sick people. I’ve been fetching ginger ale and crackers for post cardiac cath patients for far too long now, and I’m worried that I might have lost my edge.
On the other hand, I may have gained an edge. I can now start IVs, and the turn ‘n’ burn atmosphere of the recovery room has made me hone my time management skills. Either way it should be interesting, but not too interesting, if you know what I mean.
Topics: ICU, nursing | 4 Comments »
Should a Nurse have a Mission Statement?
By Beth | April 16, 2008
I’ve been reading a lot of books lately on successful business strategies and the topic of mission statements often comes up.
It got me wondering, can nurses benefit from having a mission statement? Many of you already do, but you don’t even realize it. A mission statement can be derived from your philosophy of nursing. For example, what does being a nurse mean to you? What makes a good nurse? Answer these questions and there is the beginning of your mission statement.
Why Would a Nurse Want a Mission Statement?
Quite simply, because it adds meaning to what you do. This can be a great help, especially to those who are suffering from nurse burnout. If you take a moment to reflect on your mission statement, it could serve as a source of inspiration on those days when you just feel like you are just running around in circles, and not really accomplishing anything.
Here’s an example: As a recovery room nurse I often felt dragged down by all the repetitive, meaningless tasks that I was required to do (charting vitals Q 15 minutes, fetching ginger ale and crackers, removing IVs, etc). What if instead of dwelling on these things, instead I focused on the following mission statement:
For all of my patients, I am going to help them to be in control of their health care process.
This would include:
- Making sure they know when and with whom to schedule a follow-up appointment.
- Making sure they have the proper educational tools; e.g. if they have a nephrostomy tube placed, do they know how to care for it? If they have a pacemaker placed, are they aware of what the settings are, and what these settings mean?
- Do they need copies of their lab values for their personal records?
- Have the doctors answered all of their questions related to the procedure?
Sure, most of these things are part of the job anyway, but if I view them in the context of my mission statement, it might make my job more meaningful, and hence, more satisfying.
If you had to choose a mission statement as a nurse, what would it be?
Topics: Blog | 2 Comments »
Cherokee Scrubs: A Test Drive
By Beth | April 7, 2008
Today I will be reviewing the Cherokee V-neck tunic scrub top and the Cherokee v-neck scrub pant, both in mandarin orange, from My Nursing Uniforms. It’s taken me awhile to write this review. That’s because there was something slightly unfavorable about these scrubs and I wasn’t sure how to approach it. The color I chose is a little bit “out there,” so to speak. It was described as Mandarin Orange, but I think a more apt description would be Safety Belt Orange. In fact, the first time I wore them, one of my not so tactful colleagues felt the urge to ask me if I had just gotten out of prison. My not so tactful husband asked me if I was going to work out on the roads that day.
Despite these snarky comments, I also got many compliments on the color. Whether these people were just being polite, or they think that neon orange is a good color on me, I will never know. I can safely say, however, that this shade of orange is definitely a conversation starter.
There are also some things that I really like about these scrubs and I would definitely purchase them for myself, but perhaps in a more muted color. What else did I like? Two things: the cut and the pockets. If you’ve read my other reviews, you know how I feel about pockets, I need them to do my job. The Cherokee tunic top actually has two deep pockets and an inner longer pocket that is great for storing pens. I also like the tunic cut. It is a little longer, going down a little past the waistline. The pants were slightly too long for me. They are mediums and I am 5′4″ and the hem drags on the floor.
All of this considered, I would definitely consider these scrubs PixelRN-worthy - just in a different color and a slightly shorter pant.
(In the interest of full disclosure, I will let you know that my friends at My Nursing Uniforms are compensating me for this review, although the compensation was not dependent on a positive or glowing review - what I am telling you here is my honest of opinion of these scrubs.)
Topics: Scrubs | 2 Comments »