Archive for January, 2008

“So many of the nursing blogs I see are those from very frustrated unhappy nurses.”

(as seen on a thread in nursingvoices.com)

How true do you think this is?

I saw this the other day and I wondered how guilty I am of being one of those frustrated, unhappy nurses. I am one week into my new full time contract. At this point I’m more tired than frustrated. My feet hurt (serves me right for wearing the same pair of Danskos for three years in a row. I think I’m ready for a change - Crocs maybe, or tennis shoes.)

Anyhow, I am sitting here thinking about what to write and the first thing that pops into my head are things that make me unhappy and frustrated. So here is my frustration du jour:

When a patient comes out of a procedure in pain, there are no doctors readily available to write orders and so I feel completely powerless to treat my patient’s pain. By the time the patient comes out, the docs are scrubbed in for the next procedure and so do not answer their pages.

Here are some examples:

Cardiac Catheterizations - These patients must lie flat in bed with their legs held out straight in an uncomfortable stretcher for 4 hours to prevent the risk of bleeding. Many of these patients experience back pain and it would be nice to be able to give them something to treat this. Even just an advil or tylenol might help a little bit.

Chemo Embolizations and Uterine Fibroid Embolizations - Both can be very painful procedures. These patients get a PCA (Patient Controlled Analgesia - “a pain pump” for all you lay readers) with a demand dose of morphine Q 10 minutes. This may sound adequate, but it takes a while to build up in their system. I hate to send them off to the floor without adequate pain relief. I think if each of these patients could start off with a one time 2mg bolus of Morphine, given on an as needed basis, they would be fine but this never seems to happen, and if you page the radiologist to let them know the patient is in pain, they generally don’t seem to answer the page.

I had another patient itching on both of her arms and abdomen and I couldn’t even get her a teeny little dose of benadryl.

AND to top it all off, if a patient does come out of the procedure with some good pain meds ordered, I don’t have access to the pyxis machine (the machine that dispenses the meds) so I have to find another nurse to get the drugs for me. Yesterday I had to stave off a Shirley Maclaine/ Terms of Endearment type situation because a patient had come out of a procedure in pain and most of the other nurses were at lunch.

Being an agency nurse, there’s not much I can do about this. It would be nice if the nursing staff and the doctors did some team building sessions and maybe come up with some solutions to these problems, or at least give us some explanations as to why they don’t write more standing orders. Perhaps the further I get into this contract, things will improve, but for now it’s frustrating. I miss the autonomy of working in the MICU, where there is always a resident around, and there are plenty of protocols and standing orders to keep me covered.

BTW, I totally lifted the RANT idea from problogger.

Welcome to this week’s Change of Shift. I’ve been sitting at my computer all day waiting for an inspiring theme to land on my lap, but guess what? It’s just not happening. So sit back and enjoy these finely crafted blog posts in my themeless edition of Change of Shift!

Patient Encounters

I was pretty blown away by Social Call, over at Traumaqueen; however, I’m still waiting for the scratch ‘n’ sniff version to come out. Haven’t had enough of Kal yet? I also recommend that you go over there and read Natural High. No bad smells in that one, I promise.

DisappearingJohn discusses a patient encounter that was both moving and unexpected in The Long Night, Part One and Part Two. What a great writer, and I suspect, a great nurse.

Kim at Emergiblog tells a fascinating story about communicating with a non-verbal patient in Behind Those Hazel Eyes. Kim, my curiosity is peaked - I might be asking you to borrow a certain book!

In Hard Day’s Night (Workin’ Like a Dog) , Faith Walker talks about several patients. Almost all of them faint at some point during her shift, except for the Yorkie. He just went into shock. Trust me. Just go over there and read it. It gives new meaning to “having a hard day.”

Get Your Gripe On

MJ at Nurse Ratched’s Place writes about how hard it is to get Mr. Grinch to cough up for nurse’s week. I once had a colleague that suggested to our DON to take all the money they would spend on nurses week, and install a 24 hour Starbucks kiosk in the lobby. It never happened. It’s too bad - They would have made their money back pretty darn quickly.

Labor Nurse talks about how difficult it can be to get patient care associates to actually well, do something in Problems With the Help.

Two words that probably sound like fingernails on a chalk board to most nurses these days: Medication Reconciliation. ERNursey gives her take on it.

The Heavy Stuff

The Sisterhood of the Traveling Scrubpants discusses a colleague’s unexpected suicide in Alone. I can’t even begin to imagine how staff members would be able to cope after that.

GNIF Brain Blogger asks a very daunting question: is The Medical Profession on a Downward Spiral?

Miss-elaine-ious talks about her first code in
20 something year olds shouldn’t die. As a nurse, you never forget your first code.

MyOwnWoman discusses the mistake of giving a patient false hope in A Lesson Learned the Hard Way. She also reminds me that I could never, ever, ever work Trauma.

Controversies of the Week

Therapydoc poses the question that all of us in the medical blogosphere have struggled with in Anxiety, Ethics, and Blogging.

ER Murse discusses several controversial topics this week including organ donation in
Who are the real Villains in the Nataline Sarkisyan case? and the rectal exam lawsuit, in Managing Assault Behavior in the Trauma Room.

And just in case you haven’t had enough to read yet, SharpBrains presents 21 books to read on brain health in Brain Plasticity, Health and Fitness Books.

Two more additions… Sorry, no cool icons for you late-comers. In fact I oughta write you both up for it! ( ;
Practice ICU Interview Questions from Nurse Sean.
Stella And the Pain Pills from Mamma Mia.

Happy reading everyone! It looks like the next edition will be hosted at NursingVoices (my favorite place to win an iPhone!) So I am going to put my money where my mouth is and add it to my list so I don’t forget to submit.

1. Make a list - Nurses are masters of list-making. Lists are the secret to time management. At the beginning of every shift a nurse makes a list of every thing she will do throughout the day. If it’s not on the list, it doesn’t get done. There are days when I am lazy and don’t make up my list. Those are usually the days that I fall hopelessly behind. Add blogging to your life list. If you don’t use a list in your regular life, start doing so now. I even go so far as to put blogging on my calendar to ensure that I won’t forget to do it.
2. Write as if you were giving report - Short and sweet. Bullet Points! I swear by em. Give me the facts, just the facts, because I don’t really have time for anything else. Try writing your posts that way - Edit, edit, edit! I am devout consumer of blogs but I have to say, once a blogger starts to ramble I click right on through to the next blog. Like it or not, our attention spans have been steadily shrinking and so now instead of the 4-5 page magazine article, people want the 2-3 paragraph blurb.
3. Know your resources - A great nurse always knows his resources. He knows who to call in radiology get his patient in faster. He knows the quickest way to get missing meds from the pharmacy. He knows where to find the 12 x 12 xeroform. This holds true for blogging. Know where to get stock photography to spice up your posts. Know how to use google reader to search for pertinent news items. Know how to make quick changes to your blog’s template.
4. Leave it behind when you are finished - Nurses are excellent at this. You work a grueling 12 hour shift, surrounded by high acuity patients and what do you do when you get home? Kick back, relax, and leave it all behind. Try this approach with blogging. (Not that blogging should in any way be considered grueling!) Write a post and walk away from it. Don’t keep checking your stats, don’t keep peeking to see if anyone commented. Don’t dwell on whether or not you should have hit that “publish” button. Just walk away from it, and wait to be inspired again.
5. Write a Care Plan for your Blog. Okay, so this one is pure silliness. I just couldn’t resist:

   Assessment - My blog sucks because I don’t get enough hits, visitors and comments.
   Diagnosis - Blog suckiness r/t lack of frequent posts.
   Plan - Increase blog posts by three per week.
   Implementation - Add blogging to your weekly calendar.
   Evaluation - Increased posts = increases visitors, comments and hits! Whoohoo!

Okay, I am now officially having a bad day:

Drinking a couple of cups of coffee a day has long been considered safe during pregnancy, but a new study finds that even this modest amount of caffeine could double a woman’s risk of miscarriage.

NOOOOO! Not my coffee. I don’t just love my coffee in the morning, I LURVE it. Please don’t tell me I have to give it up.

I was just perusing some design blogs and came across this.

Apparently my new blog redesign is “3 columns of idiocy.” You see? This is why I never made it as a web designer. It’s a good thing there are so many free wordpress themes out there, because it might be time to choose another one.

Note to self: Your You’re Fired. (Guess I won’t be quitting my day job any time soon.)

I think I’ve found a new career option: Digital Coach. According to Seth Godin digital coaches are…

“…people who charge $100 an hour to hear what you do and how you do it and then show you how to do it better. People who organize data and put it in the right place. People who overhaul the way small groups use technology so they can use it dramatically better.”

And what better place to start than in the health care environment, where I see countless examples of where technology should be used, but is not. Unfortunately there are barriers. Last year when I was still in the Medical Intensive Care Unit, I proposed the idea of building a website for the unit. I was inspired by the fact that the walls were filled with random notes that someone had taped up because they didn’t know how else to get their info across. Things like, “When the MICU Social worker is on call, this is the number you should use…” And “The lab is no longer accepting form 23c so it must be replaced with form 25c.” The walls were covered, even in the employee bathrooms. It was truly a horror to such an aesthete as myself. My idea was to have an easy to navigate website that would contain every piece of information that was deemed worthy of being taped to the wall. My nurse manager, as well as my fellow co-workers seemed happy with the idea so I moved forward with it.

But then the problems started. Because it’s Hopkins, we had to have countless meetings before the website could even get off the ground, and out of these meetings arose an issue. Out of all the info that I wanted to include, there were things that should only be seen by Hopkins employees, and things that should only be seen by MICU employees, and things that we wanted the general public to be able to read. The idea of having 2 levels of password protection seemed too complicated for my skill level as a web designer. Also, I knew that if my coworkers needed to remember a password to get onto the site, they would never use it.

I struggled with some solutions until the final blow came. Johns Hopkins uses a Content Management System for all of their websites and this system is only compatible with Internet Explorer 7. Therefore, I was unable to use the CMS due to the fact that I use a Mac. (Internet Explorer stopped making Internet Exporer for the Mac after version 5.) I tried unsuccessfully to get my nurse manager to finagle a PC laptop for me, and eventually I had to drop the project.

What’s the take home here? I guess if I truly did want to be a digital coach it would be wise to start on a much smaller level. So on that note… anyone out there need a digital coach? Maybe I could come up with a plan to increase your blog productivity. Any takers? C’mon. Get me now while you can still afford me.. ( ;

Isn’t it fun having a sidebar? I love rearranging mine - It’s like moving the furniture around but without the muscle strain. Today I decided to dispose of all of my Google Adsense ads because quite frankly, my dears, I don’t think I will ever hit the $100 threshold. Instead I’ve installed a new social networking widget that I saw at Nursingbytes.net (The new nursing blog brought to you by my favorite flight nurse, crzegrl.

So it’s a lazy, cold Sunday here on the East coast and I am intermittently watching the NFL playoffs and and binging on Facebook and Twitter friends. Incidentally if you would like befriend me, just use the new widget in my left sidebar to click through to my profile.

Oh yeah, and nursing stories… There is one particular patient encounter that I have been thinking about all weekend. The only problem is that each time I start to strip away all of the patient details, (to comply with HIPPA) there’s not much to the story. Dontcha hate it when that happens?

Thank you, blogosphere for all of your comments re: How to console someone. You know, it’s been a crazy, crazy year - lots of ups and downs. Actually mostly one big “up” (Benjamin) and many smaller “downs” that have been eating away at my resilience. I’ve had some financial problems that have forced me to make some erratic career choices. And some opportunities that have left me questioning what I really want to do for the rest of my life, career-wise. Working for Affinity Labs really gave me a taste for working in the world of Internet media and now I feel like I want to get back into it somehow. But there’s just not enough room in my life for raising a kid, nursing, and a brand new career so I think I have some tough choices coming up. (And by choices I mean between nursing and Internet media. Obviously the kid stays.)

At any rate, a heartfelt thanks, because it really makes me feel better to dump all of my problems onto the Internet and get some great comments in return. You guys never disappoint. I did however, have a great non-internet exchange with one of the nurses I am working with at my new job. I told her how I had left an Internet start-up company that quickly got sold for $61 million.

“Holy crap!” she said. “For that kind of money I’d disimpact someone every day for six months!”

And that my friends, is just the kind of reaction I like to hear. Why? Because it made me laugh, and not just a casual little polite giggle, rather a deep down inside, honest to goodness, laugh. And for one delicious moment I felt really good.

Sorry to get all personal on ya. More nursing stories coming soon.

Take a look at the Urban Legend ER, where they triage for falling pennies, pop rocks, and bathtub kidney transplants.

I’m hosting Change of Shift here at PixelRN.com on Thursday, January 24th. Please send in your submissions by noon on the previous Wednesday. You can email them to BETH at PIXELRN dot COM or you can submit through Blog Carnival using this link.

I am quite excited to be hosting here at PixelRN (but also a little stressed considering I just started working 40 hours a week again!)

No theme - anything goes, but if you need some inspiration, here is a lovely picture that has absolutely nothing to do with nursing:

It’s from a collaboration between Flickr and the Library of Congress, called “The Commons.” The Library of Congress print collection contains over 14 million prints and photographs and they are using Flickr to categorize them. It’s really cool - they’ve uploaded a bunch of photos to a Flickr account and invite you, the viewer, to tag the photos in order to describe the content. I urge you to take a look. It’s your public duty!