Salad Tongs, Anyone?

Hasta Luego

2007-04-12T10:32:00.000-05:00

To all my faithful readers... I can't imagine there are many of you left out there.

Just a quick hello and "see you later" (not exactly goodbye).

Blogging is just not happening in the midst of my busy life right now, and I'm "giving up" on it for now.

I appreciate all the thoughts, feedback, and smiles you've provided. I hope to check in on your blogs when I get a chance... you've always been a source of inspiration and encouragement.

So, for now, hasta luego!

Still Here.

2007-03-27T16:50:00.000-05:00

If there has been a lack of writing as of late, it hasn't been for lack of things to say, just the time in which to put the words to "paper" (or screen, as it were).

Status: MIA

Hope to be back in full force soon.

Watch that First Night. It's a Big One.

2007-03-16T07:57:00.000-05:00

Spring fever. Gone.

Winter. Back.

I feel like hibernating all over again.

************

My mind is a bit fuzzy... sleep deprivation will do that to you.

Working nights is hard on the body, but there's no doubt that the first night back is the hardest. I know some who nap before coming in that first night, but my body just won't do it. I try to sleep in for a couple of hours the morning before because that seems to help a bit, but there's nothing quite like being up all day and then expected to function on a highly-skilled nursing level all night as well. To those patients who are sad to see me go, anxious that the next nurse will be a different personality, I am quick to point out, "I am a waste of space after 7:00am... you really wouldn't want me here!" My brain clocks out before my hands can fumble through the motion of swiping my tag.

A few night-shift survival mechanisms that have helped me to make it through:

1. Sleep when you can on your days off... your body will thank you! Sometimes it's hard to switch back and get to bed at a reasonable hour when you're coming off a string of nights, but it makes a difference in the long run.

2. Get regular exercise on your days off... being in good shape is a huge boost, your energy level will be higher all the time.

3. Bring something to munch on in the car on the way home. That drive can be a killer. Literally. For some reason, having something in my mouth keeps my eyelids open.

4. Don't rely too much on caffeine. I've done it both ways, and my body seems to regulate between sleep and awake much more efficiently without. Can't seem to give up that one last cup of coffee... but I've lived on as many as 8-10 cups a day. Say it with me, "Mod-er-a-tion."

5. It's ok to use a sleep aid once in a while, and for some of us, a little Tylenol PM or Benadryl will do the trick. If you're an Ambien advocate, so be it. Just try not to get hooked! And be aware that you may feel a little groggy when waking. It's never been bad for me, and sometimes what I really need is the good, solid (vs. restless, dream-filled) sleep provided with a little medicinal assistance.

6. I'm all about the old-fashioned ear plugs and room-darkening shades. Some people can't stand the feeling of the plugs in their ears, but with boisterous children in the house, I find they're invaluable. And a dark room is awesome, almost tricks your body into believing it IS night-time (key word, almost).

7. Give it time. Eventually you'll get used to those bags under your eyes, and the dull throbbing at the base of your skull. People will stop asking if you're ok, because now it's just the way you look. It's alright... you're a night-shifter... and night people RULE!

Or at least we like to think so, in our delirious, sleeping-while-sitting-up state.

Zzzzzzzzzzzzzzzzzzzzzzz

Sunshine, Happy

2007-03-13T13:28:00.000-05:00

Does anyone else have spring fever so bad it hurts?

Despite the fact that we have snow predicted for Thursday, today is a beautiful tease, a happy reminder that inevitably the snow WILL melt, the juncos will scatter to the north, and the robins will return.

Thank goodness for sunshine!

*****

It's an odd world that we inhabit as hospital nurses, particularly on night shift.

Surrounded by concrete walls, ensconced in darkness, our shifts are marked by activity and change, nonetheless. We take vitals, listen to lung sounds, page doctors, deliver babies, regardless of the outside world and irrespective of the late hour.

Usually, we have a vague sense of what's happening outside as the few patients and doctors come and go, remarking upon significant events or weather phenomena. But there are also times when we walk through the hospital doors at the end of a shift, only to find a dense fog, a new layer of snow, a howling wind. The quiet corridors and dim rooms don't always belie these changes, as they have no bearing on what happens within.

Just a thought, as I sit here and soak up the luscious new warmth. My friends who are working today have no sense of this bright sky, this gentle breeze. How strange to think that if I were there, or were sleeping between shifts today, I, too, would have missed out on this brief glimpse of spring coming.

Thank goodness for the reprieve of a few days off!

Spring Forward!

2007-03-10T17:44:00.000-05:00

To those of you day-shifters that are grumbling about the shortened night tonight, all I have to say is,

"Hoo Hoo Hahahahahaha!"

(Smug grin.)

We earned it.

See you bright and early tomorrow morning!

Driving to Work in the Dark

2007-03-09T08:58:00.000-05:00

Snow drifts on the ground.

My breath hangs uncertainly in the frigid air.

Winter still. Stubborn.

But as I drove to work in the warm cocoon of my car, I was transformed by a vision of bright rows of lights, shining festively through the transparent walls of a greenhouse at one of the nurseries I pass by.

Instantly invigorated!

I imagine the vibrant lights perched above tiny seedlings, coaxing them to grow despite the lingering reality of winter outside their sheltered walls.

And as the birdsongs further testify this morning, spring is coming.

They know it.

And I am hopeful again.

******

I enjoy working at a teaching hospital. Really.

However.

It can be extremely, astoundingly, incomprehensibly frustrating when the team of residents on call are a bunch of indecisive know-it-alls. Sounds contradictory, right? Maybe that's why the plan of care for my clinic patient (whose care is overseen by the residents) changed every 5 minutes or so last night. They all know it ALL and are ALL making the decision.

Draw labs at 0500.

(talk to senior resident)

Cancel that, let's recheck them stat.

Straight cath her.

(discuss with attending)

Actually, now that you just cath'd her, I think we're gonna need a foley.

Let's hold off on the Mag.

(enter senior resident)

Pressure's up but we'll just keep a close eye on it. And better draw those labs again.

(update chief again)

Now we are starting Mag. And antibiotics.

And some rectal Tylenol.

And I think she's gonna need a section.

(review with attending)

Yeah, let's just do the C-section now.

Hold that thought, the other clinic patient needs a section, too. This one can wait an hour.

*** hour goes by while I furiously try to catch up with meds and charting and explain to family why, despite the fact that the decision has been made, we can't do the C-section right now***

(re-enter senior resident)

Let's go, we're ready NOW!

Intersperse numerous cervical exams by whichever resident is around at the time, and you may have a potential cause for the chorio.

Argh.

Baby did great, and the patient came through it all okay.

The nurse, on the other hand, feels defeated and sad. For the patient, for herself, and for a system that could clearly be better.

2007-03-08T13:22:00.000-05:00

Once again, Change of Shift is up at Emergiblog...

I'm headed over there for some gread reads!

Maybe one of these days I'll come up with something worth submitting.

The 50-Yard Dash

2007-03-08T12:10:00.000-05:00

Gearing up for another weekend.

Thinking, "I must be a sprinter."

Life is cyclical, and everything in my life seems to rotate through short bursts of activity.

This week, working out.

Last week, housecleaning.

Before that, writing.

Dieting.

Keeping in touch with friends.

Knitting.

Photography.

Some weeks (a lot of them during these dark winter months), I can't seem to accomplish or keep up with any of it.

I don't have the stamina to sustain any one of my endeavors consistently in the long run. I am not a long-distance runner. I don't know how some people do it.

They must drink a lot more coffee than I do.

I know what my constant is: procrastination. I'm an expert, and that one never fails me.

We all have our talents, right?

Burning, Burning

2007-03-06T12:05:00.000-05:00

Here I am, after taking some of my fellow bloggers' fabulous advice, straight off the treadmill, riding high on workout endorphins (and not a little lactic acid!)... burn out? Me??? Never!

Well, okay. I'm trying.

This nursing thing is a roller coaster. A lot like life in general. Good days, bad days. I try not to carry too much of it with me, but apparently am not completely successful in this endeavor. The work dreams are not a rarity. They happen almost every weekend, and occasionally during the week. I'm hoping they're just my mind's way of decompressing.

On the one hand, nursing is a great career. Talk about job stability. They're practically beating down our doors to offer jobs to qualified nurses! I'll always have multiple avenues of practice available if I become unsatisfied with the work that I do now. And I still look forward to most of my shifts, have a sense of camaraderie with my coworkers, enjoy the way my schedule works with my life (most of the time), and am forever in awe of the breathtaking moments my job allows me to witness.

But there are other moments, too. Anyone who has read my blog before can attest to the heavy amount of skepticism I hold for the hospital establishment and the system in general. Paperwork and charting are significantly overvalued in a legalistic atmosphere that reeks of the fear of liability and malpractice. Night shift is great, but my body does not always agree... I've become accustomed to a certain amount of fatigue and fuzziness that never really goes away. And on... and on...

So what, you say?

Nothin' really... these were just a few of my thoughts while burning calories and trying not to burn out.

Working Hard, Even When You're Not There

2007-03-01T10:37:00.000-05:00

Vivid dreams of a terrible shift... working, working. So busy, patients everywhere, bad heart tones in every room. I must have been in charge... I found myself running from one room to the next, putting out fires, starting IV's, calling docs. Remember struggling for a while with IV lines that were hopelessly tangled, and not compatible with our pumps, so I must have dug up an ancient pump from somewhere and figured out how to get the IV running and attached to a pole. Ran to another room to help with an IV, and a newer nurse was poking her with a 20 gauge... thinking, "What are you doing?! We need an 18 gauge!"

In the midst of it all, my kids were there with me, except it was my friend's kids, but they were mine, and the baby was so small, and I had to hold him while he slept. It really pulled at my heartstrings as the chaos swarmed around us.

So strange.

And I haven't even worked my first night this week.

First Name Basis

2007-02-25T09:30:00.000-05:00

It's never a good thing when a patient is called in, and everyone working triage groans. If all the nurses working know you by your first name:

A. You've been here WAY too many times.
B. Clearly, you come in for unnecessary and frivolous admissions... and
C. You always get sent back home. (if there were really something wrong with you, you'd stay)

We had a visit from a patient (let's call her Margo), who we've gotten to know very well over the past several years, now on her fourth baby.

Resident: "I have a patient coming in... it's Margo ___."

Cacophony of disbelief from everyone within earshot: "Oh nooo... not again!"

She's 32 weeks (a mere 8 or so more to go!) and only on her 9th admission to OB triage during this pregnancy, which, in comparison to her first pregnancy, isn't bad. With that child, she was on visit #36 by the time she finally delivered, and practically everyone who worked OB knew her name. Considering we only triage patients who are 20 weeks and up, that's more than a few visits per week. Back then, I remember caring for her two days in a row, both times for a slip and fall on icy pavement. Oh, Margo.

It never ceases to amaze me that she is willing to drag her husband and several small (screaming) children to the hospital in the middle of the night, through nasty weather because she's feeling some vague abdominal pain and general discomfort.

She actually told the person wheeling her up from the ER, "I really think it's something serious this time... I'm not kidding."

She was triaged and discharged back home with a clean bill of health within 45 minutes.

Until next time...

2007-02-22T17:20:00.000-05:00

It's Thursday, and Change of Shift is up!

Check it out over at Protect the Airway.

Nice job, AC!

And the Meme Goes On...

2007-02-22T10:52:00.000-05:00

Fabulous!

/jo and Kim have both posted their *must-have* lists, and tagged a few of my other favorite bloggers...

This meme is proving to be an interesting glimpse inside other nurses' heads.

How do you come up with the four things you really think you can't live without?
Where do you start?
Where do you draw the line?

What do you covet?
What do you really desire that is just beyond your grasp?

These are not things we often sit down and mull over, unless prompted.

I found "What I Covet" to be most challenging and revealing. There are any number of things that I'd really like to have, but when the thought of a real vacation occurred, I could feel my heart beat a little faster, my adrenaline begin to surge. I usually put desires like this far from my conscious mind because I know how unlikely they are to become reality, at least anytime soon. But all the same, we must have something to dream about, something for which to strive. The mental pictures evoked by thoughts of a leisurely stroll through the cobblestone streets of a small Italian village, a vigorous walk up the winding staircase at the Basilique de Sacre-Coeur, an hour or two or four wandering the halls of any museum. For whatever reason, these images motivate me, give me that essential burst of energy, that ray of hope that there may be more to this than day in, day out, week after week. A peek into the future, if I can hold onto it and make it mine.

I'm off to save the world, or at the very least a bunch of moms and babies!

Things I Can't Live Without

2007-02-21T15:15:00.000-05:00

Inspiration strikes! (finally.)

Well, ok. Shane tagged me, so I'm more or less compelled to seek out the inspiration to write... but this was fun, and I look forward to reading others' responses as well. Keep tabs on everyone who's been tagged for this meme at the Nursing Jobs blog.

I had to laugh while browsing through a few of the past "Things I Can't Live Without" articles on Inc.com, looking for that ever-elusive inspiration. The successful business owners who have been interviewed elaborate on the objects of value in their daily professional lives. They *can't live* without a whole lotta really expensive gadgets and gizmos. This is not what I had first planned to blog about when I imagined the most important aspects of my working world. I was thinking more along the lines of: I can't live without sleep, I can't live without the constant intellectual and emotional support of my co-workers, I can't live without hugs from my kids when I walk in the door...

In the interest of sticking to the topic, I'll conform to the heart of the idea. I'm not sure I can narrow it down to just four, but then again, my "things" aren't quite as extravagant as those Inc 500 folks, either. Keeping it simple and honest, here are the "things" that I can't live without:

Dansko Clogs $104.95

I heart my clogs. In all seriousness, I could not live without them, as my feet would likely go on strike. And with the miles I put on every night I work, this is not an option. I flirted with a few months of plantar fasciitis a couple of years ago, and don't care to be debilitated like that ever again. These clogs are awesome, durable, supportive, and best of all... blood and amniotic fluid-proof! They are worth the chunk of change.

At the same time, clogs and sterile blue scrubs are terribly bo-ring! Comfortable, but come ON. It's like wearing unflattering pajamas to work every night. So, I have about a gazillion pairs of fun socks, just to spice it up a bit, even if I'm the only one that can see them. I know they're there.

Johnson's softcream extra care healing hand cream $4.79

The effect of washing your hands approximately 501 times every night? Hands that are raw, chapped, cracking at the knuckles, and peeling between the fingers. Argh! I love this lotion, and it works.

bandage scissors $3.99

I keep a pair of my own bandage scissors in the back pocket of my scrubs, and I use them constantly throughout the night. Who knew that something so rudimentary could be absolutely essential?

clicky pens

Gotta love drug reps. Well, ok, not really. But I do love the pens that they leave lying around, usually transported to L&D in the pockets of the various docs that constitute a steady stream through the unit all day and night. I always like to have at least one "clicky" pen in my pocket... they're more user-friendly and they don't go launching out of my pocket every time I bend over like the regular Bic ones do.

However, I was flabbergasted to find these pens for sale on e-Bay. Hellooooo, people... they're FREE!

Confessions on the Dance Floor by Madonna $12.99

Ok, I admit it. I'm a Madonna fan. I just can't help it. This CD gets me psyched up for working, working out, doing laundry, whatever. When I'm not listening to NPR on the way to work, I'm listening to this for a guaranteed burst of energy.

What I Covet ...

A real vacation. $$$ way-more-than-I-can-afford.99

It's been years. Ideally, I'd love to take a trip to Europe. Doesn't even really matter where... England, France, the Netherlands, Italy, Spain. I'd take any or all of them, preferably with ample time for mindless wandering, lots of picture-taking, exploring castles and cemeteries, visiting museums and lounging at charming cafes. Ohhhhhh...

Who's Next...

I can't resist tagging Kim at Emergiblog. She's one of my favorite bloggers, plus I'm interested to see what "things" she can't live without!

JustCallMeJo over at Sinus Arrhythmia has an insightful and quirky take on the world of ICU nursing. What can't you live without, /jo?

Tag, you're it!

Plus, go check out Beth's "things" at PixelRN. Enjoy!

Tagged?!

2007-02-20T21:22:00.000-05:00

I've been tagged by Shane. Well, go figger. Stay tuned for "Things I Can't Live Without."

And watch out... you may be next!

Tag, you're IT!

An Outstanding Nurse... and Registered-Nurse-to-Be

2007-02-20T11:09:00.000-05:00

Due to a severe case of Major Lack of Inspiration as of late, I've been completely MIA. I'm still here... and hope to be back in full force one of these days. The spring thaw will come.

******

In the meantime, I'm honored to present the first non-blogger entry for the Nursing Jobs educational scholarships, totalling $5,000 and to be awarded March 31. Get your entries posted by March 19!

When Shane sent this essay out, offering to let one of us post it to our blog, I was immediately drawn to Sarah's story of courage and affirmation. It would seem that she has been "called" to the right profession. What an incredible nurse! Check it out:

Why I Chose Nursing

by Sarah, LPN

Approximately 6 years ago, I was living in Raleigh, NC. I had a job in the mortgage industry, a "wonderful" husband, a beautiful home, two great kids, and thought I had it all. However, as it sometimes happens, the rug was pulled out from under my high-heeled shoes. My "wonderful" husband decided he wasn’t through dating other women and so we divorced. It was left up to me to provide for myself and my two children. Though I was making a 6-figure-a-year salary, I was quickly beginning to see that it isn’t always about the money. The stress of trying to take care of my children and make a living was catching up fast.

So, I turned to my high-school dream of becoming a nurse. It was a dream that I had pushed to the back of my mind when I decided to marry and start a family. But I could not pursue my goal, work, and take care of my children alone. So, I reluctantly left the city and returned to my childhood home in Arkansas - and to my family. My parents were such a great help in my pursuit of my RN. However, after 2 years of school, I realized that there was no way my children and I could continue without income. So I decided to take 11 months, get my LPN, and work until my children could graduate from high school. And that’s what I did.

I have always dreamed of being a nurse and now that I am, I realize even more that this is what I was born to do. I chose to work in the geriatric field because I feel a connection with the elderly and a need to protect the weak. I am in constant search of ways to make my residents feel useful and wanted. I can’t begin to describe the wonderful feeling of joy I receive from my job. Though my salary will never be as it once was, there truly is not enough money in the world to replace the feeling of satisfaction I receive in my work. I became a nurse because I want to make a difference. Now that I am an LPN, I want to continue my education and become an RN. I feel that as an RN I will have a greater effect on LPNs and other nurses. There’s a saying "give a man a fish and he’ll eat for a day- teach him to fish and he’ll never be hungry". I feel that this can be applied to my current situation. As an LPN, I can touch the lives of my residents only. As an RN, I can influence the LPNs who will touch so many more.

At times I can’t understand why any caring person would not pursue nursing. Then, at other times I see nurses that make me question why they would consider nursing. I feel that nursing is a profession that each person should be "called" to do. Being a nurse is not what you do – it’s what you ARE. And I can proudly say, I am a Nurse.

******

Good luck to you, Sarah. It's obvious that you'll succeed in whatever path you choose.

N

A Time for Change... of Shift

2007-02-08T09:45:00.000-05:00

Change of Shift is up over at Nurse Ratched's Place...

It's a Valentine's edition. Can't you feel the love?

Enjoy!

******

In other news, my creative juice pipes have frozen and burst.

Here's hoping we get a thaw sometime soon.

This week has been consumed with shoveling, snow days, shivering and shoveling some more.

BRRRRR!

On the Other Hand.

2007-02-06T12:01:00.000-05:00

And in sharp contrast to Labor Girl:

******

She rolled in by ambulance. Well, ok, the roads were a bit treacherous.

EMT: "23 year old female, fourth baby, term, her water broke about 20 minutes ago, she usually delivers an hour after her water breaks."

Ok.

I'm getting her hooked up to the monitors, asking the usual questions...

Any health problems? No.
Any problems during the pregnancy? No.
Clear fluid? Yes.
Any bleeding? No.
Feeling the baby move? Yes.
Who is your doctor? I don't have one.

What?

I don't have one.

You didn't see anyone during the pregnancy? No.
Not even one time? No.

Okie doke.

How do you know how far along you are? I'm about 9 months.

Uh-huh.

Is there anyone on the way to be with you? No, my husband is home with our other children.

Oh my.

I said, "It's ok, honey. We're here with you." And I held her hand.

******

She did deliver a term infant about an hour after her water broke. Doesn't like doctors. Doesn't like hospitals. But my baby will be just fine.

And she's probably right.

Girls Just Wanna Have... Babies.

2007-01-31T11:11:00.000-05:00

You know her. She's the labor-wannabe. Let's call her Labor Girl.

******

Labor Girl arrives in the ER, breathless, cheeks flushed, anxious but elated. This must be it!

Her husband, let's call him Dear Hubby, parks the car and then joins her in ER triage, arms loaded with suitcases, birthing ball, boppy, radio and fan. He is a little panicky... a trickle of persperation slides from his upper lip. What have I gotten myself into?

But Labor Girl is thrilled. The deck of Uno cards is tucked into the front pocket of her suitcase, and a CD of soothing music resides in the portable stereo. This is going to be fun!

She is quickly retrieved from the ER and wheeled to OB triage, breathing obediently when her belly hardens. The babe inside her kicks in protest. She smiles knowingly.

******

Once she is safely ensconced in her tiny (if not somewhat unsatisfactory) triage room, she slowly strips out of the clothing she had carefully planned as her "going to the hospital" outfit. Dons the threadbare and breezy hospital gown, careful not to displace her perfectly coiffed hair and generously applied makeup. Pushes the call light.

Dear Hubby commences hand-wringing in the corner. Perhaps Labor Girl should share her deep-breathing techniques with him.

******

Soon the monitors are applied, blood pressure and temperature checked. Labor Girl dutifully answers the questions of the triage nurse, alternately smiling and breathing with the periodic tightening.

"Well... I'd rate these contractions about 6 or 7 on the pain scale." Straight face. It's that darn pain scale again.

******

Bad news.

"I'm only dilated to 2 cm?"

Labor Girl is clearly disappointed.
Doubt begins to curl around the edges of her optimism.
"Are you going to send me home?"

******

After a short while, the monitors are removed, and Labor Girl begrudgingly goes for a stroll. This isn't as fun as she had anticipated. Who wants to go for a walk at 2:30 in the morning? Another wave of doubt crests. Maybe if I walk a little faster.

******

Round and round she drags Dear Hubby, whose exhaustion has overtaken his fears.

The nurses smile understandingly each time the determined couple rounds the corner. Does Labor Girl think this is a race that she can win? That if she makes it through the hallways quickly enough or does enough laps, then we'll keep her?

******

It's time to be rechecked.

"Yes," Labor Girl nods to the nurse. "The contractions feel much stronger!"

She holds her breath, awaiting the verdict.

"I'm still 2 cm?!"

******

And now, here it is: the Walk of Shame.

Poor Labor Girl.

She trudges out the doors, pouting, vistaril in hand. How can this NOT be it?

Dear Hubby gathers the belongings and follows her solemnly home. Thank goodness this wasn't it.

******

And so, you see, sometimes no matter how badly you want it, labor it is not.

Maybe next time, Labor Girl.

I'm sure we'll see you soon...

Count Me In

2007-01-29T16:15:00.000-05:00

I want to form a committee.

I hereby volunteer to chair the Committee for Outlawing Committees that Accomplish Absolutely Nothing Except Wasting Valuable Time (COCAANEWVT). Anyone care to join me?

Seriously.

As a *lowly* staff nurse, I am subjected daily to the whims and wishes of upper management. Start a new type of charting starting by this deadline, go to this inservice on one of the above days, try to work amicably with nurses from postpartum when they need your help, don't forget your core ideals, have face-to-face conversations when you disagree with coworkers, make sure you pick up your shoes in the locker room... and on and on.

You might hypothesize that a good way to mitigate this problem would be to join one of the numerous committees that are dependent on staff nurse participation in order provide input and encourage change in the workplace.

If only it worked that way.

Despite the best of intentions, committees with which I have been involved rarely accomplish any tangible change. We spend hours brainstorming great ideas that should improve the flow of our work, the effectiveness of our communication, and the professionalism of our practice. But first we must delegate responsibility for each new concept to a subcommittee, survey staff as a whole to guage what kind of reception this change will receive, propose said idea to management for approval, and create posters and inservices so that everyone will know how to alter their practice.

Oh sure, we spend hours on implementation and evaluation of new ideas. We are congratulated by managers for our active participation in these processes. Thank you for all that you do to improve our unit, blah, blah, blah...

Does anything ever really change? No.

The finance committee has been hard at work. There are reams of paper lying around somewhere to prove that the new charging system in triage is more effective than the old one. Or were the papers used to disprove it? Who knows. And I'm sure the new Good Job forms work infinitely better than the outdated ones. Good thing the central values committee spent weeks on that. Now, how can we solve the problem of inadequate staffing during peak scheduled procedure times? Let's send an OB tech to the recovery room to help and make the secretaries do baby baths. But we'd better filter that idea down through the OB tech and secretary committees.

Last item on the agenda: the inconsequential issue of low staff morale and poor RN retention?

Let's pass that one on to the shared leadership committee. I'm sure they'll have that one solved in no time.

Meeting adjourned.

And on a BUSY night...

2007-01-27T09:00:00.000-05:00

Finally, a busy night with the pedometer, and I feel somewhat vindicated.

15,367 steps!

That's 7.03 miles!

My dogs are barkin'... time to put them to bed.

2007-01-26T17:02:00.000-05:00

Change of Shift is up at Kim's blog.

Cheers!

How Will Nurse Blogging Change You?

2007-01-22T10:27:00.000-05:00

Since embarking on this nurse blog journey, I've noticed several changes in myself, both practical and philosophical. Perhaps these are changes that would have occurred in the natural evolution of my nursing career... I'll never know.

I am increasingly aware of issues about which I would never have given a second thought, and I have started to apply what I'm learning at the bedside. I've also found myself becoming more lucid and verbal in work-related situations which I previously would probably have either ignored or gone with the status quo. Lately, I look at nursing issues (and sometimes life as a whole) from a new and wider perspective.

Take some time blog-hopping, described here by the Curmudgeon. Or simply read through a few of the links on my sidebar. You'll see what I mean.

I have to conclude that reading up on the opinions and experiences of the other medical bloggers out there, and responding or at least pondering a response, has changed me. Perhaps not always for the better. I have to admit I've been caught up from time to time, mindlessly lurking from one blog to the next, soaking up useless and sometimes utterly personal information from the multitude of blogs available.

However, if I peruse with a purpose (wink), sometimes I am struck with inspiration. To change my practice, adjust my attitude, or be called to action. All of which, I find, are stretching my limits and my yearning for growth and knowledge anew.

At times, I am also discouraged by what I read. I must confess that I am humbled by the bloggers whom I admire, those who write both prolifically and eloquently on a level to which I aspire. But if I stay silent until I measure up, this blog will lay dormant forever. It is those I seek to emulate who make me both afraid to click the "Publish" button and compelled to do so.

Speaking of my heroes, you can read Kim's ideas for beginning nurse bloggers here. See what I mean? Witty, comprehensive, insightful? Check, check, and check.

I'd love to hear how blogging has changed YOU... for better or worse. After all, this dialogue is what blogging is all about.

Or something.

Day 3

2007-01-21T09:22:00.000-05:00

Best yet: 8,415 steps!

And still not THAT busy.

Huh.

Day 2

2007-01-20T09:40:00.000-05:00

6,647 steps!

3.04 miles.

92 steps/min.

Not even a busy night. (not complaining about that!)

Pedometer

2007-01-19T09:40:00.000-05:00

Day One: 6,805 steps! (at work for 12+ hours last night)

I am such a geek.

Ouch!

2007-01-18T11:08:00.000-05:00

I'm thinking of changing the way in which I describe the pain scale to patients before asking them to rate their pain.

As a small part of the volumes of charting we are required to do for every patient, we must enter a digit into the computer, detailing where on the pain scale the patient is rating their pain. Then, we're able to reassess the pain at various intervals, and determine whether or not interventions used to ease the pain have been effective. Great, in theory.

This is how I usually phrase the question: "So tell me, how would you rate the pain, on a scale from zero to 10, zero being no pain, 10 being the worst pain you can imagine?"

Key word, imagine.

Apparently some of my patients suffer from a grave lack of imagination.

Imagining that "worst pain" seems to be a difficult concept to grasp, despite my assurance that this is not about whether you have experienced severe pain in your lifetime and how your current pain feels in comparison. I understand that if you've never been in labor, never had a serious injury, never had major surgery, it can be hard to imagine that kind of intense pain. But seriously, TRY.

Do patients think that I find it amusing that they rate their pain "11" out of 10, when they're conversing with their friends and answering their cell phone, whilst the poor woman across the hall can barely utter "7-8" out of 10 while she sweats and groans and writhes on the bed? And I'm not talking about some ultra-stoic multip. Often, it's the first-timers who like to think that early labor must be as bad as it can possibly get. As I said, key work, imagine. Otherwise, it just defeats the purpose.

The thing is, I really don't intend to judge others on their perception of pain. I frequently elaborate on the fact that we all experience pain differently, and that the pain scale is intended to help us monitor "where we go from here." But it is useful to have a somwhat accurate picture of the current pain level and perceived intensity of pain for each individual patient. Chances are, if you can chat and laugh through a contraction... it's not that bad. Some patients will even go so far as to keep one eye on the monitor so that they will know when they are contracting and can be sure to act accordingly. Believe me, if you're really in labor, you don't need the monitor to tell you when the pain comes!

Apparently, I need to rethink my assessment technique on this one.

How would this work? "So tell me, how would you rate your pain on a scale from zero to 10, zero being no pain, 10 being the pain you would experience while being run over by a steam roller?"

I wonder what kind of a response that will evoke. Probably wouldn't be making too many friends.

Another tactic...

The New-and-Improved Labor Pain Scale:

1. "I think someone just pricked me with a pin, but I can't remember exactly where because I can't feel it anymore."

2. A twinge of pain that's definitely there, but quickly forgotten.

3. Headache pain that is distracting enough, but treatable with a little ibuprofen and a cup of coffee.

4. "Whew, that pain was pretty bad, and made me stop in my tracks and breathe for a minute."

5. Now, c'mon girls... I know not everyone experiences period cramps, but who has never had really bad diarrhea, when you think the cramps are promptly going to expel most of your bowels, along with their contents?

6. When you stub your toe so hard, you're fairly certain it's broken, and probably won't be able to walk on it for a day or so.

7. I have dislocated my shoulder, so I speak from experience when I say that this worth at least a "7" on the scale... that feeling of almost having torn one of your limbs from your body.

8. I've heard really bad back labor described as, "It feels like the baby is trying to come out through my tailbone, like my body is ripping itself in two!"

9. Being dipped in boiling oil... not sure, but this seems like it would be unbelievably painful.

10. Last but not least, the aforementioned steam roller/crushing experience.

Now, some of these are open to interpretation and finesse, but I think perhaps I'd get a more accurate assessment of the patient's pain if she were obligated to take this scale into consideration. Anyone else have fun ideas or suggestions to work into the scale?

***I know... seriously tongue-in-cheek. C'mon, tell me you've never rolled your eyes when your patient rates their pain an "8" out of 10, only to turn around and ask for a sandwich and "How long is this going to take?"

This is So Cool.

2007-01-16T11:50:00.000-05:00

Pun intended.

(WARNING: highly educational and seriously UNfunny post to follow.)

In this age of technology and gadgets, it's not often that a revolutionary breakthrough utilizes basic physiology to make a miraculous difference.

Brain cooling is an amazing new (relatively speaking) technique being offered by several NICUs across the nation, and unfortunately, we've had a few babes over the last year that have needed it. Fortunately, it can work.

I was thinking about these kiddos the other day, which led me to do a little surfing in search of further information.

Brain cooling is intended for infants that have undergone hypoxic injury related to labor or delivery, with events such as abruption, ruptured uterus or cord prolapse or occlusion. This article, from Georgetown University Hospital, discusses the pathology of hypoxic-ischemic encephalopathy (HIE) and how brain cooling is used to try to avoid what was described to me as the "second wave" of brain damage that occurs following the hypoxic event.

While specific processes differ slightly, most sources agree that the cooling must be initiated within six hours of birth and bring the infant to a hypothermic state (around 91 degrees Fahrenheit!), slowing down the body's metabolic processes to avoid further chemical and inflammatory damage to the brain tissue. After 72 hours, the infant is then slowly rewarmed.

It is by no means the perfect miracle cure. This article, from the BBC, suggests that it results in significant improvement in outcomes for only one out of every six to eight babies that undergo the treatment and is unlikely to make a difference for those with the most severe brain injuries. However, that is still 12-16% of these deathly ill infants who may now have a chance for recovery.

Here is a short video documenting one such case.

What can I say?

So cool.

When Words Are Not Enough

2007-01-15T11:47:00.000-05:00

Sometimes all it takes is one sentence to trigger a flood of memory. Kim's moving recollection about a very sick AIDS patient sent me flying into the past with this sentence: "A family desperately clinging to denial is a painful thing to witness."

*****

She was 22 weeks along, and absolutely convinced that she was out of the danger zone, that there must be something we could do, either to stop her from delivering or to save her baby. If she prayed hard enough, had enough faith... surely everything would be fine.

"I felt him kick again. He's still alive!" she exclaimed brightly. Smiling at her husband, she said, "See honey? He's right here. I can feel him kicking."

Over and over she murmured to herself, "It's going to be okay, you're going to make it. Just keep praying..."

*****

"Do a C-section. Save my baby!" she demanded, once she realized that delivery was unavoidable and the baby's heart rate was slowing. Now, she was scared and angry.

We gently explained that the baby was too early and did not have any hope of survival, whether or not we delivered him quickly. She refused to accept these facts. The tension and terror were palpable in the room, a wall of silence between us.

"It's going to be fine... he's going to make it."

*****

Her denial persisted as we moved her to a delivery room, where the inevitable birth would take place. She insisted that we call the neonatal team to be present, so that they could resuscitate the baby, make him LIVE, as she knew in her heart he could, if only she prayed hard enough. She asked for a chaplain and "anyone that believes in God" to come and pray with her.

*****

And then it came.

The moment of realization, like an invisible bubble bursting. She saw him.

"Oh," she whispered, as he was whisked into the waiting arms of the neonatologist... "He's too small." And she looked into my eyes, and then, she knew.

*****

He was too small. Only 370 grams, 13 ounces.

There is no ET tube small enough... no prayer big enough. I wanted to take her in my arms, shield her from the pain.

But at last, she was able to let go. Now she could see that it was not meant to be. Now she could hold her son, and grieve for him, and love him, as he was.

*****

Denial can be so cruel. So, too, can the onset of reality... and with it, the loss of hope.

MAGNETism

2007-01-08T07:56:00.000-05:00

I am ambivalent about my hospital's claim that we are seeking Magnet status. You can find more information about this designation here.

At times, I feel inspired to aid in the effort, certain that if we can find enough like-minded colleagues to work towards positive change, we can make it a better workplace. I am often proud to acknowledge that I am part of such an esteemed institution, that we can provide professional, highly-specialized and complex, but heartfelt, individualized care to a high volume of patients. I assume that my fellow nurses choose to stay because they, too, appreciate the high expectations and abundant opportunities inherent to a large teaching facility.

However, there are also times when I am discouraged by the ridiculous processes and mindless functions of the executives and managers who spend so much time talking in circles and sitting on committees that accomplish nothing. How can we effect change if those in leadership roles care more about the statistics than they do about the people "beneath" them who are daily offering their blood, sweat, and tears at the bedside? I wish I could say that we have a cohesive team from top to bottom, but I am constantly reminded that this is simply not true. There are an abundance of petty battles being waged at any given point, with very few satifactory resolutions made.

To my fellow bloggers: Do you work for a Magnet hospital? I would love to know... how is it?

=======

A few other random thoughts:

-------

It was an incredibly busy weekend. Low staffing didn't help: it would not have seemed quite so out of control with a few more warm bodies present, but we made do (as always) with what we had. Now that all the holiday celebrating has ceased, we have settled back into the normal routine... busyness as usual. Today feels like I'm recovering from a marathon: achy head, sore shoulders, heavy eyelids, sore throat. I still didn't manage to get a pedometer for Christmas, so I'm not sure how many miles it was this weekend. It felt like at least a marathon's worth!

-------

As a charge nurse, I often step into the room for the actual delivery, to make sure that there are enough hands available and that the newborn can receive any extra care if necessary. Sometimes I miss having a close bond with one patient and seeing her through the entire experience, but it is thrilling to be present for so many of those most magical of moments. Within an hour and a half the other night, I witnessed a natural (and naked) birth that was documented by a professional photograper and videographer, the birth of an undiagnosed Downs Syndrome infant, the birth of a first child after days of labor and hours of pushing, and the birth of a sweet babe with a previously diagnosed cleft lip and palate.

Sigh... our bodies are so amazing. And sometimes they betray us, but that's a post for another day.

The Nurse is Out

2006-12-27T22:23:00.000-05:00

Oh dear, has it really been that long?

Apologies.

The nurse is out feeding her face and running around participating in other acts of holiday gluttony.

Be back soon.
Happy Holidays!

Get. A. Clue.

2006-12-17T09:39:00.000-05:00

As per usual after my third night in a row, I'm feeling a little punch drunk and slap happy this morning. (Consider this fair warning that the following post should be read with a VERY sarcastic tone of voice... if you're in the habit of reading posts out loud, that is.)

To all potential patients who choose to shoot up, snort, smoke or drink substances that are a) not legal and/or b) not really recommended during pregnancy (or the rest of your life for that matter):

No matter how dumb or tired your OB triage nurse looks, she is not dumb enough to believe the following really convenient lies that you are about to tell.

-- your UDS tested positive for marijuana because your sister-in-law smokes pot in your house

-- your UDS tested positive for cocaine because you were with a bunch of friends that were smoking crack

Girlfriend, get a clue. And get some new friends.

---------------------------------------------------

Well, you get the idea. Enough sarcasm.

It's been a weekend full of weirdness and busyness... both the good and the bad. Absolutely exhausting, but very fulfilling. I don't know about everyone else that I worked with, but I hope that they walked out of the building this morning with a tired smile and a sense of accomplishment, as I did.

Is there any other profession in which the juxtaposition of such wildly different emotions and realities is so striking every time you come to work? To feel so helpless in the face of unknowns and uncertainties, yet so full of hope for a smooth labor, a good outcome. Sometimes I feel the fear creep up on me... there are SO many things that can (and sometimes will) go wrong. How can we possibly make it through?

Yet we always do. We are never alone. There is always another willing set of hands, another discerning eye, another reassuring word.

Sigh.

Sweet and Bitter

2006-12-10T09:50:00.000-05:00

Today it's not so much bone tired as totally wired.

There's nothing quite like the feeling of helping a patient who is completely out of control because her labor is barreling like a runaway train towards delivery. A very anxious first-time mom who delivers a couple of hours after feeling the first contraction is going to be understandably agitated by the fact that her uterus chooses to contract every one minute in order to expel the baby, wham-bam-thank-you-ma'am! However, screaming at the top of your lungs for your mommy does not (contrary to the popular belief of many patients whose labors progress this quickly), NOT help to get your baby out.

While a delivery like that can be completely draining, it is also exquisitely intense... working and coaching with the patient to breathe and to push, allowing her body to do its work, forcing her to look into my eyes so that she can stay focused and not let the fear take over. I certainly cannot take credit for what these patients accomplish... it is awe-inspiring.

Unfortunately, the babe was not at all impressed with the process of slamming through the pelvis and into a cold, bright and, according to this babe, rather tiresome world. After working with babe for a few minutes, we got pinkness and a few squawks, but the dusky color quickly returned as babe decided breathing isn't all it's cracked up to be, and after working with babe for almost an hour... got tranferred to Neo. Disheartening. Hopefully babe will turn around after basking in the O's for a while, but it was sad to separate mom from her sweet child after all that.

That's the Sweet and the Bitter in my world this morning.

Nighty-night.

Bone Tired

2006-12-09T09:48:00.000-05:00

I am not even kidding.

When I finally get myself a friggin' pedometer, I am totally going to get on here and brag. I must have walked/run at least 8 miles last night.

And when we're already crashing a patient who's bleeding out, is it really necessary to clue me in on the fact that the patient who was 8 cm when she got to triage is (oopsy) also BREECH?

So what if I'm in charge? At that point, I just don't wanna know.

Realized at 5:00am that I never ate lunch.

Too late now. I'm sure I'll make up for it at a later date. You know how we nurses like to enable each others' eating habits at the holidays!

Off to bed... I feel a coma coming.

I am a Nurse in Real Life... And You?

2006-12-04T19:27:00.000-05:00

As I gorged myself on primetime TV tonight, a novel idea occurred.

What is the big deal with the way that nurses are portrayed on television? Get over it.

Granted, most of us are probably already over it (or were never under it), but seriously. The Center for Nursing Advocacy has an interesting and aggressive take on the issue. My question is, why does there need to be an issue? The Center's website riles against popular medical dramas, like Grey's Anatomy and ER, for grossly misrepresenting the role that real nurses play in real life.

Therein lies the thing. TV is not real life.

I enjoyed the shows I watched tonight... for their entertainment value. For the laughs and the tears. TV is a form of entertainment. Real life, it is not.

I watched a pair of TV "cops" conducting an investigation; their laughable interrogation of a suspect, highly contrived police conversations are completely stereotypical, but that's okay because... it's TV.

I watched a newly pregnant TV character, whose doctor told her at 12 weeks that he may be able to determine the sex of the baby on ultrasound. Uh-huh... NOT. Except on TV. She then proceeded to stuff her face with every morsel of food in sight for the rest of the episode. Kind of annoying portrayal of a fairly inaccurate pregnancy stereotype. Oh, well... it's TV.

And so.... hmmm. While I admire the Center's noble attempts to "increase public understanding of nursing", I'm over it. I'm comfortable with what and who I am, no matter how it may perceived by the public or portrayed in the media. And you?

You Don't Say.

2006-11-28T18:39:00.000-05:00

We all have work lingo... in the health care field, the jargon can be particularly mind-boggling. On L&D alone, we drop acronyms all day, from PPROM, SROM, AROM... PTL, PUPPS... to IUGR, PIH, GDM and HELLP... from EFM, FHTs, LTV, IUPC, and FSE..... to SOL, PDI, ROP, LOA, and RC/S... along with Michelle Murray's brilliant and oft' repeated TFTF (too fat to fit!).

But it's the other phrases that fascinate me... the ones you won't find in any medical terminology text book, but which need no explanation among L&D staff.

A few examples that come to mind:

"They're wheeling her up from ER 'cause she's one-cheekin' it down there."
(Patient can't sit straight on the wheelchair. She's probably already pushing, so lets get a room ready for delivery.)

"She's got a positive wet wheelchair test so we're bypassing triage."
(We can be sure that her water broke because she's wet all the way through her pants and onto the wheelchair.)

"I think she's gonna need a little vitamin P."
(Her labor sucks, and it's time for some pitocin augmentation.)

"She's gonna need a zipper."
(She'll need a C-section.)

"She ended up delivering the vaginal bypass route."
(She had a C-section.)

"Can someone bring a glass of orange juice in for ______?"
(_____ is about to pass out... probably mid-epidural placement... and needs a little sugar boost.)

"Call the clinic doc to stand by."
(The patient's physician probably isn't going to make it in time for delivery, so get an attending nearby, just in case.)

Last, but certainly not least, the always-adrenalin-inducing:

"I need another set of hands in here!"
(Something's going down the tubes fast so somebody get your ass in here!... without completely freaking out the patient or FOB.)

Occasionally, this one is followed by:

"Tell them to open the OR!"
(self-explanatory.)

Truth is Stranger Than Fiction. Period.

2006-11-26T09:18:00.000-05:00

HowManyOfMe.com

There are:
8
people with my name
in the U.S.A.

How many have your name?

So what are the chances that I would care for a patient with the same first and last name as me?

Because I DID. About 4 years ago, I was pulled to the antepartum unit for a four-hour stint, and one of the patients in my assignment was... me! Well, same name anyway. Slightly different age, way different skin color. Huh. I wonder what the statistical probability of that happening would be.

Give Thanks

2006-11-23T09:13:00.000-05:00

It's a day to reflect on all that we are thankful for.

I am thankful for the calling to a noble profession dedicated to helping people.
I am thankful for the opportunity to make a difference in the lives of families every time I go to work.
I am thankful for the tremendous moment of birth when the ultimate outcome is truly out of our hands, that blink of an eye in which a tiny life begins... and is both completely dependent yet must breath and suck and pump blood all on its own.
I am thankful for the technology and advances in medicine that allow us to help sick moms and babes.
I am thankful that most deliveries require no such technology.
I am thankful for the team of dedicated nurses and other staff members with whom I work, the people who make work more than bearable, the ones who fill it with laughter, smiles and enjoyment.
I am thankful for the instances when there is no laughter or joy, when life is at its rawest and most real.
I am thankful that I can return to the loving, understanding arms of my family and a warm, inviting home.

Happy Thanksgiving.

the Sandman Cometh

2006-11-21T15:23:00.000-05:00

I love to sleep.

As I snuggled between the covers and closed my eyes the other night, this thought superceded all others in my mind.

I love to sleep.

And night-time sleep is somehow so different than sleeping after working all night. I thrill at the chance to climb into bed along with the rest of the "normal" (i.e. daytime workers) world.

I'm not sure that people who exist primarily in the daytime can actually appreciate the extent to which a night-shift worker can long for sleep, the way we ache to stretch out and feel that release. Granted, I have a few kooky co-workers that only require a few odd hours of sleep after working a 12 hour night shift. I am NOT one of those people.

What can I say? I love to sleep.

Due to some scheduling changes, I have an extra stretch of nights off over the course of this week. While I would normally start to readjust to a daytime schedule at home on the same day that I have to go back to work, this week I have a few extra days of "normalcy". I feel like my perpetually foggy brain has cleared and that I have a ounce or so of energy and motivation when I usually would not. It's amazing how our circadian rhythms rule us. And how we throw them out the window for necessity's sake.

Night shift definitely has its perks. Lack of sleep is NOT one of them.

Food for Thought

2006-11-18T08:45:00.000-05:00

How not to make friends with the Neo charge nurse: give her a 28 weeker, 30 week twins and then 30 week triplets over the course of about 4 hours.

Huh.

I'll try to remember that one next time.

Probably best not to mention the 26 weeker with a bulging bag at this point, huh?

Family Nurse Extraordinaire... otherwise known as a Comedy of Errors

2006-11-16T10:27:00.001-05:00

As a nurse, you can and probably will find yourself appointed the Family Health Expert on any and all health-related topics.

I should know. I have spent the last day and a half proving the point.

It seemed simple enough at the start. Grandmother (GM) calls me and says she thinks she has a bladder infection and has been trying to reach her physician to call in an antibiotic prescription (I know, eyebrows raised) but just can't seem to get the phone call to go through. Little did we know, making the connection would be the least of our problems.

GM: "I listen and then I press 1 and then I don't know what happens."

I can just imagine... did I mention that GM is 99% deaf? She gives me the name of Her Doctor (a phrase we can use loosely here considering that she has seen him face-to-face ONCE... did I mention that GM also has a serious doctor phobia?). This physician has changed practices since she saw him... but, no biggie, right? (HA!)

me: What phone number have you been calling?
GM: "Um, I don't know... I can't seem to find it here, but that doesn't matter. It wasn't working anyway."

Uh-huh. Family Health Expert to the rescue.

I get through to the office without difficulty. However, it is now 12:32 pm and their lunch break started at 12:30. Perfect.

I call back at 1:30, and, after a brief explanation to the phone nurse, I'm given the phone number to Her Doctor's New Office. Okay.

Call to New Office.
Repeat brief explanation of situation.

Phone nurse: "We'll need to get GM's records transferred here and have her sign a release. Would she like to do that today?"
me: Ummm, considering that GM lives more than half an hour from your office and has a doctor phobia... no. (in so many words)

Call to Old Office.

me: Could you please fax pertinent records to New Office and GM will sign a release when able?

Thank goodness the answer was yes.
Call to New Office.

Phone nurse: "Oh look, we found GM's records. They were here all along because she signed a release when we switched practices. However, GM has never been here and Her Doctor is out of the office this week. We'll need to see GM."
me: Ummm, no. (insert brief repeat explanation of GM's doctor phobia and fact that she lives more than half an hour from New Office.) Can we please have her leave a urine sample at the hospital lab here in town?
Phone nurse: (and really, she was very accomodating, all things considered) "Let me check with Her Doctor's New Partner."

Apparently, Her Doctor's New Partner does not have priveleges at the hospital here in town, so one way or another GM would have to drive to the next town up in order to get any help from New Office. ARGH. (That last part was unspoken, but definitely heartfelt.)

Next step, half hour conversation with GM regarding whether or not to stay with Her Doctor and drive to New Office out of town, or switch to someone else at Old Office here in town. After much hemming and hawing (I'm talking MUCH here... due to GM's hearing difficulties, I must repeat virtually every sentence at least once), GM decides to switch to someone else at Old Office. Okay, now we're getting somewhere.

Call to Old Office.

me: Hi, it's me again. GM would like to switch back to your practice (I can almost see Phone nurse rolling her eyes at this point)... would it be possible for her to leave a urine sample at the hospital here in town so that she can have an antibiotic called in if necessary?
Phone nurse: "Yes, but you see, we no longer have GM's records, so she'll need to sign a release and have them transferred back from New Office."
me: (muttering under my breath for a moment...) Okay.

Call to New Office. (by this time I'm not even sure who's who... I'm just glad they're still willing to take my calls.)

me: Hi, it's me again. GM decided to seek advice at Old Office. Could you please fax pertinent records there?

Again, the answer was yes. Sigh of relief.

Next step, explain to GM that we still need a urine sample. If she drives to my house, I will take her to the hospital lab where she can give one. No problem.

I proceed to wait for another half an hour or so, expecting GM to show up at my house. At this point, she calls me.

GM: "Well, I got about halfway to your house and it got really foggy. I started thinking about how long I'm going to have to sit in that doctor's office, and I really can't be driving home in the dark. So, I turned around and came home. I think I'll just wait it out. After all, it's not really that bad."
me: (pause for silent scream) GM, I really think you should do this. I'll come and get you. And you won't have to sit in the office. We're just going to go in so you can pee in a cup (at this point, I really did use the words "pee in a cup" with my Grandmother... yikes.).
GM: No.

Call to Old Office.

me: Yeah, it's me AGAIN. I'm very sorry. You're not going to believe this, but GM does not want to come in today. She agreed to call or come if anything gets worse. You see, she's got this doctor phobia...
Phone nurse: You know, I think I remember GM.
me: I bet you do.

End of story, right? Wrong.

Over the course of that evening and the next morning, there were a few intervening phone calls from GM, reassuring me that she's feeling just fine and thinks that her discomfort will probably go away if she keeps up with the water and cranberry juice, also informing me that "if it gets really bad in the middle of the night, I'll just call 911." She said it so matter-of-factly that I really thought she was kidding. Not so. And I'm fairly certain that I did not dissuade her from that plan, despite my attempts to make her promise to call me if anything were to happen during the night. ("Oh, I wouldn't want to wake you up!" Little does she know, I'll probably lie awake anyway, wondering if the fire department is being summoned to the home of a little 88-year old woman with a UTI.)

So, next morning... not half an hour after calling to inform me again that she's feeling just fine and she'll call me if anything changes, she calls back and says that she was talking to a friend who informed her that the weather is supposed to be nasty for the next few days, and perhaps she should just give the sample and get it over with before she can't get through on the roads.

me: (gasp of disbelief and slap to forehead...) Well, sure. (thinking, Why didn't I think of something like that?!)

After all that fuss, GM came to my house and we went to the hospital lab and she gave the sample.

End of story.

For now.

Thanks to Dr. Dinosaur and the link to him at Grand Rounds for a little inspiration this week. :)

Not Enough and/or Too Much to Say

2006-11-13T12:13:00.000-05:00

Am I the only one who's gotten so intimidated by the excellent medical bloggers out there that I've developed a severe case of writer's block?

Ugh.

Please refer to the links I've posted on the sidebar for bloggers who have many worthwhile and insightful things to say...

And, yes, I realize that I haven't even been at this for very long. I'm just trying to find the right rhythm and groove, struggling not to make a fool of myself.

Forgive the blatant whining. Hopefully I'll be back with something worthwhile.

And, yes, it's also a case of life-long, eldest-child perfectionism. Sometimes you just have to laugh at yourself.

I've been busy.

2006-11-10T08:56:00.000-05:00

From the Merriam-Webster Dictionary:

Main Entry: hi·a·tus
Pronunciation: hI-'A-t&s
Function: noun
Etymology: Latin, from hiare to yawn -- more at YAWN
1 a : a break in or as if in a material object : GAP b : a gap or passage in an anatomical part or organ
2 a : an interruption in time or continuity : BREAK; especially : a period when something (as a program or activity) is suspended or interrupted b : the occurrence of two vowel sounds without pause or intervening consonantal sound

Can the word "yawn" be contagious when read?

As the day charge nurse aptly put last night upon my arrival, "Everything was going okay until 4:00pm, when the skies opened up and started raining pregnant women!" Well, the day nurses this morning came on to a very nice board, due in large part to the fact that we delivered the whole flood of patients that were left to us, along with another wave that followed.

Note to self: do not EVER make comment to departing shift based upon the current census on the floor along the lines of "Well, it must have been a good night (or day, as applies to situation)... you're all just sitting around." The fact is, we got our butts kicked and then did it all over again a couple of times and right now we're sitting here staring at each other because every ounce of energy we may have had is completely gone.

On that note, nighty-night!

Now, That's What I'm Talkin' About!

2006-11-04T10:09:00.000-05:00

One of our anesthesiologists had a relative in labor last night. The guy must have learned a thing or two in all his years of practice... he magnanimously slipped a wad of cash to one of the nurses at the desk and had her order pizza for everyone on (have I mentioned that we have at least 20-25 nurses working L&D at any given time?).

Good man.

Ewwwwww!

2006-11-02T20:57:00.000-05:00

This RN's definition of "gross".

We each have our own niche, our own interests... our own comfort zone. For registered nurses, the sight of blood and body fluids, parts and procedures is typically less gruesome than it may be for the lay population (I hope). However, even within the nursing universe, that which turns our stomachs and leaves us feeling green can vary widely.

For instance, I'm comfortable with vaginas. (I'll spare you the visual aid here... I said I was comfortable with them. Doesn't mean I think they're worth looking at.) I have no qualms about saying that. And it's a good thing, for obvious reasons. In obstetric nursing, and particularly in labor & delivery, the vagina is simply a means to an end. A few of my friends from nursing school have said, "How can you handle that, down there?" Even patients are occasionally embarassed about nursing care they receive, such as the intimate care that we may have to assist with in the bathroom after delivery. I've had more than one patient comment, "You must really hate this part of your job." It's difficult for me to explain and probably even harder for them to understand, but those things just don't bother me.

However, there are some things that do.

I think eyes are YUCK. Not to look at from across the room. Not to gaze into on the countenance of your loved one. To examine, to touch and to fix. I'm fortunate enough to have good vision and have therefore never needed glasses or contacts. Thank goodness, because I'm pretty sure regular eye exams would kill me. As luck would have it, one night at work, we were discussing the benefits of laser eye surgery and I mentioned my eye phobia (it went something like, "Argh! Stop talking about that! Eyes are so gross!"). No joke, a few hours later I somehow managed to flick a piece of plastic into my eye. After trying desperately for half an hour to stop blinking and tearing like a faucet, my coworkers convinced me to go downstairs and have it checked out. An hour later, you would think I'd been purposely sent to the ED for a course of torture... first the numbing drops, shine a bright light in my eye, wait for the numbing drops to work, put orange liquid in my eye, shine an ultraviolet light in my eye while my head is being held still with a big metal contraption, wait for the attending, shine the ultraviolet thingy again and both come up with the brilliant conclusion that "That's a BIG corneal abrasion. It must hurt!" Thanks. And YUCK. Just gimme my Vicodin and erythromycin, and I'll blink my way back up to OB.

Not much further to the south is the mouth. I give dental hygeniests all the credit here... just as I'm often the one who gets to push for three hours with a patient so that the physician can come in with a catcher's mitt and look like the hero, the hygeniest is the one who gets to do all the picking and plucking, rinsing and buffing so that the dentist can take a peek in there at the end of the appointment and declare the state of tooth health or decay. Blech! I can't imagine what it's like when they get a really nasty mouth. And I've seen them... fortunately from a safe distance!

Somewhere around the middle is the belly button. Now, I realize that this one is totally irrational. Be that as it may, I have a total phobia about belly buttons... my own in particular, and those of others as well. I have good reason for appreciating it's functionality for babies in utero and once born. However, the fact that there's still a hole there... ugh. Anyone who's had to prep an abdomen for surgery and used the big ol' Q-tips specifically made for "cleaning out" that particular little breeding ground can perhaps appreciate that it really makes me want to gag just thinking about it! What else have you got hiding in there?

And finally, at the bottom, feet. Double-YUCK! One of the residents felt the need to elaborate on his athlete's foot problem the other night, and I just about started gagging right there at the desk. Thanks for sharing! Check out the Foot Blog for more gory details. I give foot docs a lot of credit for "going there". Ew! I prefer to ensconce my feet safely in their Dansko clogs and not think about what might be going on in that warm, little night club between my toes.

There you have it. My definition of gross. Totally irrelevant to nursing practice or theory. I guess we can file this one under "amusement." (See my first post.)

It's important to know yourself and what you can (and can't) handle. Anyone care to add to or elaborate on the topic? What is your definition of gross?

Falling Back... aka the Night from Forever

2006-10-29T09:24:00.000-05:00

Anyone else find that the longest night of the year is always one of the slowest?

Just makes that extra hour draaaaaaaaaaaaaaag

A little more.

We did get a good chuckle (ok, that's a blatant lie... we laughed our butts off!) at the three day nurses who all showed up promptly an hour early for their shift. Not feeling a whole lot of sympathy at that point.

Shouldn't we institute a policy of fairness? If the day shift would agree to show up half an hour early, we could split the difference.

Yeah, I know. It'll never happen.

Ugh. My bed calls.

Welcome to OB Triage

2006-10-23T06:44:00.000-05:00

Sometimes I'm convinced that the management and physicians have conspired to place a glowing sign at the ER entrance that states (in large flashing pastel pink and blue letters), "All pregnant freaks and their families, WELCOME! C'mon in to OB Triage" To top it off, the sign is only lit during the most inopportune (i.e., already busier than crap) times.

Case(s) and point:

You are 26 weeks pregnant and have been vomiting for four days. You are starting (Starting?) to wonder if something is wrong. When do you come in to triage? 2:00am on a Saturday night.

You are 39 weeks pregnant and twisted your ankle while tripping over your toddler. Yesterday. Oh, and you don't have a car or money for a cab, so you've missed your last four prenatal visits, despite being high risk due to a history of high blood pressure, diabetes and a pulmonary embolus. When do you roll into triage by ambulance (thanks, glad I just paid my taxes so that you could spend about $1000 of my tax money for a ride... oh look, here comes the rest of your family, who got here in their CAR.)? 2:00am on a Saturday night.

You were sitting on the couch naked ('cause that's something I'd admit to my health care provider), 36 weeks pregnant, eating ham (I repeat, while sitting on the couch. Naked.), and your boyfriend took it upon himself to "check" your cervix, only he noticed some green funk down there instead. In addition (as if that were not bad enough), there was something pinkish on your boyfriends fingers when he pulled them back out. But it might be ham. (Gag. True story.) When do you come in to triage? 2:00am on a Saturday night.

You are 21 weeks pregnant and have not had a bowel movement in three (seriously, I'm not kidding) weeks. When do you come in to triage? 2:00am on a Saturday night. (because NOW it's bothering you?)

You are 24 weeks pregnant and have not felt the baby move for "a couple" of days, which concerns you, despite the fact that you weigh almost 400 lbs and probably have a foot and a half of adipose tissue between the baby and the nerves of your abdominal skin. Oh, by the way, you also have asthma and are having a coughing fit but forgot to bring your albuterol inhaler. What else do you take for your asthma? Nothing, just the albuterol, and since you usually feel worse at night, you use it an average of 6 times every night. (Pause, while nurse picks up lower jaw from floor.) And the icing on the cake, you are latex allergic and have a history of MRSA, so you must be kept in contact isolation. When do you come to triage? 2:00am on a Saturday night.

You have not received prenatal care during this pregnancy due to the slight inconvenience of being incarcerated for the last few months, in another state ("It was my boyfriend's dope in the car, I swear!"), and your mother only recently bailing you out. Now you're just curious how far along you are, and "Can we do an ultrasound to find out the sex of the baby?". When do you stroll up to triage? (Are you sensing a pattern yet?) With perfect timing, you, too, arrive in the middle of our "lunch time". (Looks like it'll be a couple of peices of the Halloween candy someone brought in, swallowed whole, on the run, again.)

Yes, there are quite a few legitimate patients who visit the triage unit amidst the chaos. I wouldn't be surprised if most of them get lost in the shuffle.

Hey, at least I still got my health.

Catharsis

2006-10-22T08:41:00.000-05:00

It's been a long weekend on L&D (busy, stressful, all-out-cuckoo?)... you would think that I might be smart enough to come home and crawl right into bed.

But no: I went looking around the internet, and accidentally (or serendipitously) came across an infant bereavement photography website. Couldn't help myself... I started paging through.

And I came across this stunning eulogy that I felt compelled to share. Please be aware, the website also contains photographs of ill and dead infants. However, this father's words were amazing and uplifting in the face of such sadness. I think that it speaks to much of the grief that those of us who work on L&D and particularly in NICU carry with us.

If anyone is in need of a good emotional release, I know it worked for me.

Why do we do what we do?

2006-10-18T22:52:00.000-05:00

Do you ever feel like a glorified waitress?
I sometimes ponder why we put up with all the baloney. (I'm being diplomatic and politically correct here, in an attempt not to offend those who don't yet know me well enough. Please substitute the actual term I'd like to use in place of "baloney"... use your imagination.)

And does the baloney outweigh the reward?

Would it make a difference if it did?

Men and women enter nursing careers with astoundingly different perspectives and motivations. Certainly, there are enough different nursing fields and forms of practice to satisfy our diverse expectations, but why do we so often "stick it out" in challenging and mediocre work environments?

Honestly, I don't have a global answer for that one and would not presume to venture a guess.

More about the baloney later, I'm sure, but here are a few of the reasons I continue to show up for my shifts (occasionally with bells on):

1. I have to admit, it feeds my family.

2. Most of my co-workers are admirable (if often inexperienced... yes, I do work nights), and we've worked together through those nights from hell, laughed at each others' nutty 5am slap-happy stories, smiled and cried with each other over the joys and tragedies in our personal lives, and managed to keep the unit from completely falling apart at any point to date.

3. The sense of pride and accomplishment when new nurses look to me for help and mentorship... then over time transform into "experienced" nurses themselves.

4. There's nothing quite like the adrenaline rush of a scary or fast delivery. There are those of you who know, it is indescribable.

5. The absolutely unforgettable moments I've spent with close friends who've asked me to be present at the birth of their children, which brings me to perhaps the overwhelming reason I stay:

6. (pause while I sit here and struggle to begin...) I'm having difficulty putting this one into words, but I want to convey my understanding and acceptance of the fact that what I do (help bring babies into the world) is utterly miraculous. I am present at those moments in a family's life that bring both the most anticipated and the most unexpected joy. I also stand by as families experience the most heartbreaking and unspeakable grief. To witness these pivotal moments is both a privelege and a burden, but is definitely one of the most influential factors in my faithful return to the unit, week after week, year after year.

I'll close on that note. There are perhaps innumerable other reasons to "stick it out". Sometimes, it feels as though they are not enough.

A Start

2006-10-17T19:43:00.000-05:00

I'll never claim to be an expert with my finger on the pulse of nursing issues. With the time I might find to devote to this blog, I can't possibly hope to be as well-informed and widely read as many of those whose blogs I have witnessed. This blog will be primarily for self-expression, exploration and amusement. A place for the rational and not-so-rational sides of me to meet. Congregate. Who knows what might happen? I enjoy perusing the other nursing and medical blogs and would like to think that I might have a unique perspective to offer. Any comments are welcome. I look forward to the communication and fear only that my little corner of the blogosphere will be undeserving of the readers who may venture here. Oops, little too much honesty and melodrama there for a minute. (deep breath) Salad tongs, anyone?