Archive for December, 2007

It occurred to me that some of you might be reading this blog but haven’t yet subscribed. (that means you, Mom!) I love the convenience of reading all of my blogs with a feed reader. It lends organization to the massive amounts of info that we are exposed to on a daily basis. In short, I am a true believer in RSS. So I wrote this guide to turn all of you into true believers, as well.

What is RSS?
RSS is basically a system that allows the content on a website to be easily syndicated. RSS actually stands for Really Simple Syndication.

The first thing you need to do to take advantage of RSS is to choose a feed reader. What is a feed reader, you might be wondering? In very simple terms, it’s an application that collects a group of feeds of your choosing, and presents them to you in an organized manner. I use Google Reader and Bloglines. Either one is a great choice to start with.

To get started, pick out some blogs that you like. (Can’t think of any at the moment? You can always start with PixelRN.)

Go to bloglines.com and create an account.

Once you are logged in, make sure the tab that says “Feeds,” is active.

Click on “Add.”

Type in the blog URL and hit “Subscribe”

It couldn’t be any easier.

In some cases it might give you multiple feeds to choose from. I usually just choose the one with the most subscribers or the most recent date, but if you’re still not sure which one to pick, click on “Preview Feed” and you can make sure it is the right one.

Also you can find the feed link on any blog by looking for the RSS symbol, or looking for a link that says, subscribe. If you right click on the link, you can then paste it into the “Add” field in bloglines and you will be subscribed.

Bloglines is great because you can just type in the blog address, rather than the feed address (which is different) and it automatically finds the feed for you.

So that’s it! Every time one of your blogs or sites is updated, it pops up in your bloglines sidebar. You can then read the content directly from Bloglines, or click through to the blog to read it.

Still not convinced? Here’s the best reason to use feed readers: When you are at work during a very quiet, very boring night shift, it is so much easier to catch up on your nurse blogs if you are using Bloglines or Google Reader.

I hope you have found this helpful. If any of this was confusing, please let me know in the comments section and I will try to clarify as much as I can for you.

It was doomed before it even began. I asked my agency if the hospital would offer some sort of orientation other than the few online courses they provided. The answer was no. I talked to the shift supervisor at the hospital and she assured me that this was normal. She said, “The charge nurse will know it’s your first day and she will help you out.”

Fast forward to shift change, 7 AM.

I let the charge nurse know that this is my first day on the unit and she asks me:

“Have you had any orientation?”

“No.”

She rolled her eyes and continued trying to figure out the assignments for the day. Welcome to agency nursing.

So I was assigned one really sick patient, on two pressors, probably going to die, with a crazy family that was not dealing well with the situation. The other patient was a paralytic receiving a bowel prep for possible endoscopy. This is my worst nightmare of a two patient assignment - One patient unstable on pressors, the other patient stable and awake enough to know that they are lying in shit and the nurse doesn’t have time to come and clean them up every 30 minutes because her other patient is to unstable.

After getting report on both patients, my head started spinning. I didn’t even know how to get into the computer system and look at my patient’s orders. It’s true that I took an online course a couple weeks ago but I had never actually gone into the system and learned how to use it. Meanwhile, there were worse things. Patient #1 was alarming because her BP was 80’s over 30’s. SHIT. Her vasopressin had run dry, or better yet, the night nurse left me with an empty bag of vasopressin. Okay, so I didn’t know how to work these IV pumps at all but I managed how to figure out how to program a few more cc’s into until I could figure out where the hell the vasopressin was. I asked the charge nurse. She stopped what she was doing and went to mix me some. Okay, so I go back to figuring out what to do next and my spinning head turned into pure unadulterated panic. I didn’t know what I was doing, I didn’t know how to use any of the equipment, and I couldn’t even get into the computer. SHIT.

I started thinking about something I learned in nursing school, which was that you should never accept an assignment that wasn’t safe, and this assignment was starting to look pretty darn unsafe to me. So I told the charge nurse, “Look. I’m feeling completely overwhelmed. I don’t know how to use any of the equipment.”

She said, “Well, this is how agency nurses are supposed to work.”

“Nonetheless, I don’t feel like I can handle this assignment without any orientation.”

So she asked if I wanted to go home. And the minute it was offered I said, YES. Oh how I desperately wanted to go home. It was easy enough. I called my shift supervisor and the shift supervisor for the hospital and told both of them that I couldn’t handle the assignment. The charge nurse reassigned my patients, I gave report to the other nurses and left.

Walking to my car, I felt about as lowly as a human being could feel and there were two things that made it worse. When I reported off to one of the nurses, he refused to make eye contact with me while I was giving report. It was like I could feel him seething with disrespect for me because I was abandoning my assignment.

Then I called my husband from the car. I was almost in tears and I needed to talk to someone right away. His reaction? Silence. Just plain silence. Which was not what I needed to hear at all.

So then I spent the next week feeling I feel like I was under a blanket of failure, not knowing what to do about it. I only started to feel better a week later when I ran into one of my nurse friends from the MICU. I told her what had happened. She told me that I have to insist on an orientation and if the hospital didn’t want to give it, then I shouldn’t accept the assignment. How right she was. The terrible thing was that I had accepted the assignment out of sheer financial desperation (so you can begin to imagine why there was silence from my husband.)

I am now very carefully starting to plan my next career move, and you can bet it will not be a decision arising out of desperation.

Facebook for old people, found via Seth Godin’s blog.

I took this photo with my lightbox thingamajig. It’s one of my many nurse tchotchke Christmas ornaments.

So here we have a nurse dressed up as snowman, wielding a big fat syringe. I wonder what she’s got in there and who she plans to administer it to. Perhaps a reindeer-sized flu vaccine?

When I read this headline…

Study: Timing of Pills Might Matter

…my first thought was, “Well, isn’t that obvious? Why else do nurses rush to get all their medications given by the correct administration time?” But then I realized it’s not about being “on time,” rather it’s about the “timing” of the meds.

The article is actually quite interesting. It’s all about how people who suffer from hypertension tend to be dippers (their BP naturally dips down at night) or non-dippers (their BP stays high throughout the night.) According to the article, the non-dippers tend to develop more serious heart and kidney disease. As a result of this insight, researchers at Johns Hopkins are now planning a more broad study to find out if the simple act of taking your blood pressure pill at night time will result in a decrease heart and kidney disease.

So simple it just might work.

One thing it lead me to wonder: How can you tell if you are a dipper or a non-dipper? Would this require invasive arterial monitoring while you sleep or could a person simply wake up in the middle of the night and randomly check their blood pressure with a cuff?

Here’s some advice for the new ICU nurse. Here’s an example of some of your orders:

Notify House Officer (NHO) if HR < 60 or > 100
NHO if MAP < 60
NHO if 02 sat < 92%

and so on and so on…

One of the challenges of a new nurse in the ICU is learning when to notify the MD of changing conditions. If you look at the above orders it would seem that you have some pretty clear guidelines, right? Well, not exactly. You might have a patient whose heart rate has been steadily in the 110’s. In that case, when do you NHO (Notify House Officer)? When the heart rate reaches 115? 120? 130? In my experience, when a patient’s condition changes it is rare for the MD to actually change the parameters in the NHO order. In a perfect world the nurse will request an MD to change the parameters, but in my experience this rarely happens. More often than not you end up going by common sense.

Once upon a night shift I received a patient who was hypotensive. In report I was told that the patient had been on and off levophed for the past 48 hours, and currently it was off. I also had an order to restart levophed if his MAP fell below 60. I ended up having to restart it at around 3:30 AM. The intern was asleep and my impression was that the patient had been on and off Levophed so it wasn’t really noteworthy that I was restarting it. The next day I found out that the medical team (or more likely just the intern) was irked that I hadn’t notified them about the change. Okay, fair enough. I supposed that there was an unwritten rule of the ICU that I had been ignorant of: Always NHO if you have to restart a pressor. Even if you have a current order for it, and even if it is 3:30 AM and the House Officer is sleeping.

But here’s the conundrum: There are some residents that I know if I woke them to apprise them of that situation, they would say, “Why are you waking me for this? You know what to do and you you have the order.” So as a nurse, you have to first figure out the unwritten rule, then you have to figure out who it applies to. New interns? Yes. Senior residents? Perhaps not.

Unfortunately, the only way to get to know what to do in these situations is through experience, and trial and error. It’s kind of scary in a way, but after awhile a wisdom based on common sense takes over and you gain more confidence in your decisions. Until then it’s going to be a challenge and you should recognize it as such. Bottom line: Think about the safety of your patient and always err on the side of giving the MD too much information rather than too little.

I’d like to welcome a new sponsor of PixelRN.com - MyNursingUniforms.com. According to their website, they began as a family business over 50 years ago as a seamstress shop across from a hospital in the small town of Wilmington, Delaware. Over the years they have evolved into a web-based business, and have been selling nursing uniforms ever since. and in this post I am going to review their website, MyNursingUniforms.com.

One thing I really like about the site is its clean design and easy navigation. There was another site that I used to go to (that I won’t mention here) for scrubs that is very cluttered and loud. Think about it - you wouldn’t want to shop at a regular store that is cluttered with so many things that you don’t even know where to look. Why would that be acceptable for an online shopping experience?

MyNursingUniforms.com is well organized and very easy to navigate through. You can easily find where to search for your scrubs via brand (My personal favorite is Urbane Scrubs) and there is even a button for the clearance rack.

There’s also a link to a size chart. This is really helpful when it comes to shopping online. I love the convenience of shopping online but it’s tough when you can’t try things on. I am one of those people that is perpetually in between sizes. My shoe size is 8 1/2 which means that sometimes I am an 8 and sometimes I am a 9. Scrubs are usually fitted in Small-Medium-Large so it really helps to have a measurement chart to help you select your size.

Another thing I like about this site is that they’ve taken the time to link to some interesting nursing resources. If you look on the side bar there is a link called, “Resources for Nurses.” One link leads you to a “History of Nursing Uniforms.” Here you will find some great sites that chronicle the history of nursing through photos of nursing uniforms. Even if you don’t need scrubs right now, I recommend clicking on through to this section to see some really interesting photographs.

Overall, I would definitely recommend shopping at Mynursinguniforms.com for scrubs. And here’s an idea: Instead of buying your favorite nurse another silly nurse tchotchke this year, why not get him or her a pair of scrubs?

Warning: This post has absolutely nothing to do with nursing. Thanks to BillyBob, my favorite liver blogger, for tagging me.

1. I was born in Japan (on a naval base) and hope to one day return there for a visit.
2. I once put all of my belongings in storage and went on a three month road trip across America. My favorite places were Taos, NM; Archer City, TX; Big Sur, CA; Key West, FL; and Amarillo, TX.
3. I will forever be a frustrated artist who wished she could paint and draw well, or at least have an Etsy store. In the meantime, I will settle for my photography.
4. I am addicted to sharpie permanent markers. I have them in every possible size, shape, and color.
5. I once found a golden ladybug on the floor of a bakery in which I worked. The weird thing is that it would turn back into normal ladybug colors and then go back to gold. I kept it in a little plastic box with some blades of grass. One of my co-workers set it free. I hated him for that, even thought at the time I had a crush on him.
6. Because I love blogs so much, I recently made a vow never to purchase another print magazine again. We will see how long this lasts.
7. I can’t stop collecting baby food jars. No, I am not a hoarder, but for some reason I can’t seem to throw them away. They are just like these perfect little glass vessels. If anyone has any ideas for what I can do with them, please let me know.

I tag:

Bobby (We’ve heard 7 randoms things from Bobby’s liver. Now let’s here 7 random things from Bobby, himself!)

Brainscramble

Nursing Zen

Nurse Ali

Geena@codeblog

MJ@Nurse Ratched’s Place

Need some Christmas gift ideas? This company will produce artwork based on your DNA sample.

So you think you picked up a bug the last time you flew on a plane? Think again. It just might have been from the hotel you stayed at.