Archive for April, 2007

A recent comment from a not so recent post…

I’m curently in an MN program and taking a research class. My research question is “Are nursing students influenced by television nursing characters in their career choice?” Anyone care to comment?

Let me be the first to chime in:

NO.

The first “grown-up” TV show I remember watching was Emergency.

I was completely enthralled with Randolph Mantooth. When my best friend, Theresa, told me that she and her mom were moving to LA, we decided to draw pictures for him because naturally, she would be able to walk up to his house and drop them off. Did I mention that I was in the first grade?

Years later I was enjoying Kim’s Emergency post and I came to the part about Nurse Dixie McCall. Unfortunately my reaction was: “There was a nurse on the show?”

Next show I remember was St Elsewhere.

I remember Christina Pickles portraying Nurse Helen Rosenthal. At the time I was aspiring to be either a belly-dancer or a truck driver, so no influence there.

Then there was ER. Didn’t Nurse Carol Hathaway start off the show with a suicide attempt after being lovelorn over a doctor?

I can honestly say that TV nursing characters have not influenced my career choice; rather, it was the real life nurses I came in contact with.

BTW, anyone interested in further reading on this subject should check out The Beautiful Hospital by Sallie Tisdale. This is an entertaining, well written article. I enjoyed the comments, too. It’s funny how people get so heated about this subject. One commenter writes:

“are you worried that makes you any less of a nurse or that nurses play any less of a role because people believe what they see on House. tough then. go to medical school and shoulder the bills…try not to bring everyone down with your pettiness.”

Umm, punctuate much?

Anyhow, lest you think there is a shortage of positive media about nurses, this piece was published in the Wall Street Journal last week and it is ABSOLUTELY a MUST READ. John Blanton was working as an editor at the Wall Street Journal when he decide to pursue a career in nursing. His description of working night shift in a Burn Care Unit is so dead on, it took me right back to when I was orienting in the MICU. It also reminded me of why I chose nursing. I’ll also mention that both my boss AND my mother decided to forward it to me, so those are two pretty heavy-duty thumbs up right there.

…but how fast can they start an IV?

The ever vigilant Center for Nursing Advocacy has brought it to my attention that the honorable firefighters and EMTs of my town have participated in a poll to determine which hospital has the hottest nurses.

How dare they! Thankfully we have Laura Vozzella of the Baltimore Sun to eloquently point out the irony of firefighters asking this question while their own “department is reeling from a fatal, flawed training exercise, and two fire unions are calling for the chief’s resignation.”

Is it just me or did he just steal that look from Derek Zoolander?

I’m just a little peeved because as of this viewing, the Greatest Hospital Of All Time (GHOAT) has only received 3.97% of the vote and Shock Trauma is winning by a large margin. *Sigh.* That’s always been the story here in Charm City. Shock Trauma gets all the glory (and all the wounded policeman, firefighters, and appearances on Discovery Health Channel), while GHOAT just gets a plethora of mystery diseases and wealthy sheiks.

But then again maybe it’s just their cute pink scrubs.

At any rate, pixelRN would like to refrain from opining further but as usual will leave you with a true story:

Not too long ago we received a transfer from another hospital. The patient was critical but stable, and had arrived via helicopter. As I was charting the arrival of this patient I noticed a larger than usual number of staff helping out. Every available nurse was in the room, not to mention respiratory therapists, physical therapists, heck I think there was even an aromatherapist in there. And every last one of these happy helpers were of the female persuation. The cause for all this extreme helpfulness? The flight nurse who had brought the patient in was male, and QUITE easy on the eyes.

So please take a minute to stop and think the next time you go and purchase your sexy firefighter calender.

National nursing board forsakes caring attitude

Nurse graduate, Jenny Powell missed her chance to take the NCLEX because her mother unexpectedly died the morning before she was scheduled to take the test. When asked if she could be given a break the National Council of State Boards of Nursing said, “No.”

And you wonder how we let JCAHO run all over us…

The New Hampshire Telehealth Program’s answer to the nursing shortage…

When they learn to do dressing changes this way I’m going to start looking for a new job.

Medics baffled as ‘dead’ man found breathing

So the patient arrested, was worked on for 30 minutes, but to no avail. He was pronounced dead, but then started breathing again as he was being prepared for the morgue.

Yes, folks this actually happens. I’ve never actually seen it happen with such a good outcome, (usually after someone is “worked on” for 30 minutes one wonders how many of those minutes the patient’s brain received oxygen), but in this case the man was reported to be “in good spirits,” after re-joining us in this earthly life.

Here’s a story that’s closer to my reality: One time we got this patient from the ER. Patient cardiac arrested, staff worked on her for 45 minutes, pronounced her dead. Then, when they were preparing to take the patient to the morgue, someone “thought” they saw her chest rise and fall with a breath. They jump started her heart once again with drugs, started externally pacing her, and transferred her to the MICU. I don’t think that she even had a pulse. (With patients like that, no wonder the MICU gets such a bad rap). The reasoning behind the transfer? The MICU would maintain this patient on life support so the family could come and say goodbye, and THEN take her off life support.

Does anyone else see something wrong with this scenario?

Would you want your family to see you like this? And would you want your family to have to be the ones to take you off life support?

Do computers make our jobs easier?

It depends on where you are on the learning curve. If you ask a nurse who has just been handed a new technology to use the answer will be a resounding, “NO!!” Ask the same nurse a few months later and the answer may be a less resounding, “Well… maybe.”

When I was recently hospitalized for the birth of my son, the maternity care nurses had just begun using a new computerized system to dispense meds and they were not happy about it.

The system consisted of a laptop computer with a hand held scanner, mounted on a cart so you could wheel it into each patient’s room. I’m not sure what the name for this new system is, but visually it reminded me of a medium sized dinosaur. Awkward looking, to say the least. Awkward to use, as well. When the nurse needed to give me a medication she had to retrieve the medication, wheel the computer into my room, scan my name band, and then page through to the correct screen where there was a list of my medications. Then she could give me the medication, which in my case was a simple tab of motrin.

It got to the point where I felt bad asking for my PRN motrin, watching what they had to go through to dispense it to me. Also, I had some motrin in my bag and I could have just taken some myself. My former self would done just that, but as a nurse you are taught that under no circumstance should any patient be able to dispense their own meds. So if I took it myself I would then have to lie to my nurse about it, and I’m not a very good liar.

So I listened to the nurses complain about the darn thing each time they came in to dispense meds. They had trouble with the user interface, trouble getting the scanner to work, and trouble fitting the darn computer into the room when the room was filled with visitors.

After having gone through my own frustrations when we switched to a computerized physician order entry (cPOE) system on our unit, I assured them that it would get better after time.

HOWEVER. This leads me to another message for the all the nursing students out there… if you are required to take a course called “nursing informatics,” be patient and pay attention. (And believe me, I remember how we used to complain about all the “extra” courses we had to take - If it wasn’t about blood and guts we just didn’t have the time for it.) But think about it this way: We need informatics nurses because they will be the ones designing the technology that we use in the hospital. So I urge you to consider this field. The more nurses that are actually designing the equipment that we use, the happier we will be with that equipment. And the more likely we will be walking around with cute little efficient hand helds rather than dinosaur-like computers on wheels.

Okay, students, now you can get back to your blood and guts.

Peruse this story, if you will, and when you come back I will share my own story:

Student nurses ‘left unsupervised with patients’

Okay, so this story about nursing students’ lack of supervision has surfaced in the UK recently. I was prepared to read about something shocking, like say a nursing student who was left alone with a coding patient. Instead I read that this student was complaining that he had been left alone with a patient from a dementia unit that had soiled himself.

I do remember being a student: the horror, the feeling of ineptitude, the hopes and prayers that you don’t kill someone…but still. This is something you have to get over. If you come across a demented patient who has soiled himself, HELP HIM GET CLEANED UP FOR GOODNESS SAKE!

Students, am I being too tough here?

If you answered, yes, then you will surely enjoy this true story of my own ineptitude as a student nurse:

I was working through my med-surge rotation when one of my fellow students rounded some us up to “help him clean up his patient.” Like a good student nurse comrade I offered my help. Four of us went into the room to clean up his patient who appeared to be sleeping; very deeply sleeping. At one point one of the more enlightened of us stopped what she was doing and said, “Um, is this patient alive?” She checked the patient’s pulse, there was none.

Instead of panicking or calling a code, we all simultaneously came to the realization that this patient was, in fact, deceased. She had died during a procedure and was brought back to her room to be cleaned up so the family could visit her one last time. As far as I know, the nurse hadn’t specifically told the student that the patient had died. I think she had just said something like “Go clean up the patient in room 22 before the family comes!” And then rushed off to do something else.

At any rate, never have I felt so foolish and inept as I did knowing that I had failed to recognize that this patient was, in fact, dead. My only consolation was that 3 of my fellow students had failed to recognize this as well.

We all gotta start out somewhere, you know?

I’ve always loved being a patient. Perhaps that’s why I became a nurse. (Of course, it’s easy for me to like being a patient when the only things I have ever been hospitalized for were a tonsilecomy and the birth of my son.)

And I’ve always loved hospitals, the same way that I love airports. They are both places where big things happen; arrivals, departures, births, deaths.

When I was twenty years old, I had my tonsils removed. I woke up in a haze in the PACU and there in front of me was Janice, a girl I knew from my first job scooping ice cream at the mall. The one thing that I remembered about Janice was that she always knew she wanted to be a nurse. That was her plan. And here she was, 4 years later, a nurse.

“Janice!” I said. Boy did that scare the crap out of her. How many times does your post-op patient sit bolt upright and call you by your name?

I asked if she remembered me from the ice cream store.

She studied my face. “Oh, yeah, I do remember you,” she said. Then I fell back asleep.

Later on I thought about Janice, and how much I respected her ability to follow through with her career plans. Here I was, a floundering college student, majoring in fine art but clueless as to how I was going to leverage my education into a career. And here was Janice, already ensconced in a career, working as a nurse. It occurred to me that nurses really know how to get stuff done.

I think that’s where my reverence for nursing started.

A few days later, one of my tonsilectomy stitches popped open. Blood was oozing from my throat into my stomach, and I eventually fainted in the doctor’s office. I ended up with an ambulance ride back to the hospital so they could repair the stitches. The next day I woke up and discovered that once again, my nurse was yet another person that I knew from high school. Again, I was so impressed. The idea of her already having a career made me feel a little more lost than I needed to feel at the time.

Fast forward 10 years. I was fed up with all of the careers I had tried and gotten no satisfaction from. My husband convinced me I should try my hand at sales. Why not? Can’t rule it out until I’ve tried it. After some job fairs and interviews, I found myself shadowing a copy machine salesperson in preparation for my new sales job. Yes, I was about to embark on a career of selling copy machines.

Our first sales call was a doctor’s office. We asked who was in charge of ordering office supplies, and we were introduced to a couple of very busy looking nurses. My first and immediate thought was this:

These nurses have real jobs. As a salesperson, I am interrupting the real work that needs to be done.

(If there are any salespeople out there, please take no offense. This was just my personal reaction to the situation. And now that I am a health care professional, I appreciate those of you who are in medical sales. Without you the purchasing department of our hospitals might have us using thermometers with mercury in them. Come to think of it, without copy machine salespeople we might still be using the mimeograph.)

This was April. By September I was enrolled in an Anatomy and Physiology class, in preparation for nursing school.

So what did I mean by “real job” and “real work”? I wasn’t quite sure at the time; it just kind of popped into my head and it seemed to ring true. Now that I am a nurse I know exactly what it meant, which is this: I might go home from work feeling exhausted, frustrated, or even sad. But I never go home from work thinking that I wasn’t doing something important, something meaningful. Something that needed to be done on that particular day, for that particular patient. It’s a very satisfying feeling. Once you have the “meaningful job” nailed down, it frees you to go on with the rest of your life.

Someone recently asked me why I chose to specialize in critical care. I gave him my stock answer which is this:

As a student, I got the impression that if you can be successful in critical care, then you can pretty much be successful at any kind of nursing.

Later on I was pondering this and realized that my stock answer is not entirely honest. Here’s what really happened…

As a student, each time I started a new clinical rotation, I was filled with enthusiasm. “This is for me!” I thought, when I did my psychiatric nursing rotation. I love working with the mentally ill! Maybe I’ll eventually become an art therapist! Then, onto maternity care nursing… “I would love working in Labor and Delivery! How exciting, to be able to participate in the mircle of birth every single day you are at work!” My fellow students were becoming exasperated with me: “She’s changing her mind again?”

It was down to the last few days… I had to choose a specialty for my senior semester. Someone mentioned to me that Certified Registered Nurse Anesthetists (CRNAs) start out with six figure salaries, and in order to get into CRNA school, you must do two years of critical care.

Six figures? I was intrigued. I didn’t even think about what a nurse anesthetist actually did - I just thought, “Sign me up!”

So I did a little research and looked for nurse anesthetist jobs on monster.com. Sure enough, there were many postings for CRNAs and they all started out at six figures. So I made up my mind - critical care. I’d like to point out that while I certainly didn’t know for certain that I wanted to become a nurse anesthetist; I just knew that I didn’t want to rule it out.

A month later I found myself in the MICU, entering my final student rotation.

As it turns out, many of my colleagues in the MICU chose critical care for the same reason, and quite a few have put in their two years and are now in CRNA school. As for myself? I have decided that I decided that I have absolutely no interest in becoming a nurse anesthetist. It’s just not how I want to spent my days. I’m more interested in some of the psychosocial aspects of nursing…the family dynamics, palliative care, the team approach. Besides, my personality and style of working is much better suited to medicine than to surgery, and as a CRNA I would find myself working side by side with surgeons.

It’s true that critical care nursing is challenging and will prepare you for a variety of situations, but I am no longer am of the opinion that if you can hack critical care, you can pretty much hack any kind of nursing. For example, as interesting as I might find psychiatric nursing, I don’t think I have that special kind of patience that it requires. Same goes for labor and delivery. As I was going through my own labor, the nurse who took care of me was outstanding - calm, patient, and managing to do her job despite my screaming and howling.

So I guess my point is this: If you are a nursing student and are wondering what to specialize in, don’t sweat it too much. Sometimes it’s not important how you arrive somewhere, it’s just important that you actually get there.

Here’s my excuse:

Born March 26th. 8 pounds even…

Yes, we are so in love with him and his name is Benjamin.

Remember Switching Teams?

Well, I started out in the birthing center but after 24 hours of intense labor I was rushed to the hospital (in an underground tunnel nonetheless!) where I received “the works.” Not to worry though, Ben and I are both doing fine now. Hopefully once we get our routine down I will share the whole story with you. It was quite an interesting experience being the patient instead of the nurse.