Doing the right thing

I had a patient come in the other night............drunk with a head injury. As typical of us jaded ED nurses we kinda rolled our eyes and figured he was one of our regulars who had slightly bumped his head while intoxicated. That was not to be......

This man was someone who had only had 1 previous ED visit with us. He came in the ambulance doors with snoring respirations and his face covered in blood. He was immediately intubated and rushed to CT. Unresponsive throughout it all.

His CT scan showed a LARGE intracerebral bleed with a shift. Not a subdural bleed but intracerebral. His pupils were uneven too. We headed back to the ED and by then neurosurg was there to see him. After an exam and look at his CT it was evident that his prognosis was terminal. He was, in fact, brain dead in less than 24 hours. The only good thing that came of this is that his organs were harvested.

So...........you may be asking why the post is titled "Doing the right thing" with such a sad story?? Well, it gets sadder. This man was drinking at a friend's house that night and decided he was too drunk to drive home (he was, as his etoh level was 2x the legal limit) so stayed at the friend's house. He then got up at some point that night and fell causing his fatal head injury.

Just sad, so sad. He was only doing the right thing. I only hope that he is resting in peace at this time.

Resurection?

Perhaps it's time.............

For a resurection!!

Of this blog that is. I'm not gonna make any promises but I'm gonna give it an honest effort. Now that I'm an ED nurse I have TONS of great stories!! I have been an ED nurse for almost a year now. I think. Ha ha. I honestly cannot remember if I transferred to the ED in Nov of last year or January of this one. I could find out I'm sure, but honestly I don't care that much!!

I'm still on the fence as to whether ED nursing is for me too. I said I would give it a year and then reassess but closing in on that year I'm just not sure. Some days I love it and some days I utterly hate it. And then there is the in between ones too :-) Perhaps it is just the 12 years of inpatient nursing I did and how different the ED is. It could be any number of things, many of them which I could name but will just leave alone here. For now though, I'm staying put. Really where else would I go? I've done most of what my hospital has to offer......floor nursing, critical care, MET nurse and now ED. All that is left is NICU as our pediatric floor is a combined adult/pedi floor so holds no interest for me. And I think I'll save NICU for later in my career when my back is gone :p

Next post I won't just mutter along absently but will actually give you a story!! See ya then.

Guest Post by Jennifer Johnson

nuTop 5 Ways to Stay Awake

Might as well call you a Vampire— while the rest of the world sleeps, you’re awake, transporting bodies and dealing with blood. You are 12-hour night shift nurse. And while the rest of the public might not be able to do what you do you, you love your job because of the higher pay, no traffic during your commute and you get to chime in on a family event every now and then. And oh yeah, you save people’s lives. But you’re not really immortal, you’re human— and a lack of chronic sleep can and does take a toll on you. Here are the top 5 ways to stay awake during your shift without caffeine—because even though you’re go-to choice of drink may get you over the occasional slump, it’s bad for you and dehydrates your body. You know this. You’re a nurse.rse.
1. Drink tons of Water.
Dehydration reduces your blood volume, which makes you feel tired. Drinking plenty of water will also, in turn, make you want to go to the restroom more— a feeling that can help you stay awake. Try drinking the standard 8 glasses a day to keep your brain and body functioning properly. It’s not scientifically proven but mints are also supposed to stimulate a sense of alertness. Try mint-flavored water, it’s a two-in-one kind of deal.
2. Exercise. It moves oxygen through the bloodstream and stimulates cells, which is vital in keeping the body alert. While it might look strange to do jumping jacks and squats down the surgical unit, you can excuse yourself for a moment and do a couple of lunges outside. Even doing some basic stretches will help. Take a couple of huge gulps of fresh air while you’re out there too. It’ll also help you stay awake.
3. Eat. Fruit, such as apples, keep energy levels high because they are more easily digestible than many other foods and give the instantaneous fuel you need to keep going. Don’t really feel like carrying a huge apple inside your pocket? Opt out for a fruit smoothie instead of a Starbucks frapp during your break.
4. Turn on the lights. Your body responds to changes in light. Though it is the sun that contains the highest levels of short wavelength blue-light—the energizing light that activates our brains—bright lights around you can also help. Most hospitals are already highly illuminated, but if it is unnaturally dark in an area where you are working, flip on a light switch or go someplace that you know is filled with an excessive amount of light, like a bathroom.
5. Laugh. Not only does laughter reduce stress, but it also stimulates the feel-good chemicals that boost up your energy levels. Ask some of the doctors, other nurses, staff members or even some light-hearted patients to tell you a good joke. It’ll help you feel better mentally and physically and prevent you from falling asleep during your shift.

By-line:
This guest post is contributed by Jennifer Johnson, who writes on the topics of Nurse Practitioner School. She welcomes your comments at her email Id: j.johnson19june@gmail.com.

The NICU

I came in last night and the nursing supervisor asked me if I had ever worked in the NICU.  Uhhh.....nope, the regular newborn nursery but not the NICU. But hey, I'm up for anything as long as they understand that I can only do so much.

 

I get over there and they are greatful for the help.  They have only 3 nurses on and have a total of 5 babies with 2 on the way.  A drug withdrawal baby that screams a lot, a set of feeder & grower twins that were born at 33 weeks, a bruiser of a 10lb baby that aspirated meconium at birth and a set of 29 weeker twins that were born yesterday and were quite unstable (1 of who was about to be shipped to a tertiary hospital).  The two on the way are a set of 34 week twins on CPAP. 

 

While they worked I got to do the fun stuff....sit in a rocker and feed!!  I ended up being there 5 hours and fed the drug baby twice and the feeder & grower set of twins once.  What a joy to sit there in a chair and feed a baby for a job!!  It felt like I was at a different place.  I had to remind myself I was even at work!!

 

At the end I got to watch them give surfactant to the other 29 weeker.  A pretty neat experience since I had heard about it lots of times but didn't really know how it was given.  Also my nephew was given it at birth, so now I know what he went thru.  He's quite the sick little boy (the 29 weeker, not my nephew) so hopefully he will do well, though I have my doubts I'm sad to say.

 

All in all it was a pretty neat experience.  One I'll do again if asked! 

Chief complaint

I get to spend quite a bit of time in our ED doing my job as our resource nurse.  The other day I was down there for awhile and happened to notice the chief complaint of one of the patients:

 

 

 

Having a bad day

I was named to....50 Best Blogs for New Nurses

I got an email the other day letting me know that I was named to a list of 50 Best Blogs for New Nurses.  I love being named to these kinds of lists!  Especially lately when my blog has taken a back seat to other things in my life!! 

 

To check out the entire list check out:  http://nursepractitionerschools.org/50-best-blogs-for-new-nurses/  She does a wonderful job describing each blog too.  Thanks Jennifer!!

Please Stop....

The other night I was helping in the ED and we got this patient that was showing signs of an acute stroke.  She arrived talking though she had some expressive aphasia.  Then all of the sudden she went unresponsive.  As the doctor started getting the intubation supplies ready I shook her shoulder and yelled her name.  Not responding to that I did the next step....a sternal rub. 

 

At this she started posturing.  Never a good sign.  But, then she suddenly awoke again!  I rushed her to CT for a head scan and we all expected her to have a head bleed.  Nope!  In CT she had another unresponsive episode though.  Again, shake the shoulder....nothing.  Sternal rub....posturing.  Then a minute or so later she awoke again.  Very strange!

 

Back to the ED and she had 2 more of these episodes.  Always the same.  Then no more.  After that she was more awake but just kept complaining of being "so so tired" and just wanting to go to sleep.  Explaining to her that she really needed to stay awake until we could get more information on what was going on with her she looked at me and said:

 

"Can you please stop doing that thing to my chest because it really hurts" 

 

I was shocked that she even felt it since she postured each time I did it.  She went on to say that she was quite tired and that she heard me and that she was trying her hardest to open her eyes for me but that it was just so hard.  So then I would push on her chest and that hurt so much.  Could I please just stop doing that!!!  I felt so bad!!  The poor thing.  I promised her that I would stop as long as she stayed awake.  It was a deal!!

 

Everytime I went into her room after that and she saw me the first thing she would do was point to her eyes and say "see they are open"!!!!!!!  She was quite the cutie!

 

 

Lions and Tigers and Nurses....A Review

Awhile back I did a post on Amy Glenn Vega's Nursing Novella titled Lions and Tigers and Nurses. You can find that post here. If you remember (or just read) I was a bit skeptical when first asked to be involved with these nursing novellas on my blog but then opened the press release and figured I'd give them a try. I'm glad I did. I received a copy of this first novella and was excited to read it. Unfortunately I haven't had the proper time to sit down and review it properly on here. So here it is:

This story is a classic "nurses eat their young" story. The two main characters are Haylie, the new grad and Miriam, the preceptor. Haylie starts and Miriam immediately treats her like she knows nothing instead of taking her under her wing and teaching her how to be a great nurse.

The book then goes on to tackle lateral violence which is rampant in healthcare today. In the book Haylie, Miriam and their nurse manager Donna attend a class on it to help deal with the way they are treating each other. Amy is very thorough in this class in describing lateral violence using the "Lateral Violence Top Ten Among Nurses" list.

By the end of the book everyone has learned quite a bit about each other and how to treat each other. And there is even a bit of romance!! Does Haylie leave Miriam's floor due to the way she was treated? Now, that would be giving things away!! Read it for yourself and get the CNEs. To get them you have to answer 15 questions on what you learned about lateral violence.

Amy's second novella Broken Heart is out now too. It deals with coping with change and loss. It is next on my reading list. Thanks to Ken, Amy and Pritchett & Hull for giving me this opportunity.

Code 8 where?????

 

    Not too long ago we had a person (that wasn't a patient or employee) however was in the hospital building try and hurt themself.  In the process of doing this he set off a smoke alarm.  When a security guard and the nursing supervisor went to check the status of the alarm this person was found.  The injuries were not life threatening but he was badly injured at the same time so to get the right people there for immediate help it was decided to call a Code 8 which is our hospital's Code Blue response.  This is what was heard overhead:

 

Code 8 Morgue, Code 8 Morgue, Code 8 Morgue

 

What?????  No, the person wasn't acutally in the morgue but just outside so security and the nursing super figured it would be the easiest landmark to call the team to.  But can you just imagine????

Travel Nursing

 
    Do you use travel nurses at your hospital?  We used to use them all the time and they were great to fill in the gaps.  We got some great travel nurses in--some that I am still friends with in fact.   With our new senior leadership we hardly get travel nurses anymore which is hard on us and unfortunate for them.  What a great way to start out your career and see where you may want to settle down or way to end your career by touring the country while working those last few years. 

    I have never been a travel nurse and due to being married and having 3 wonderful kiddos it won't be an option for me in the near future. If you are a travel nurse or have thought of being one here is a company  (www.nurse.tv)  you should consider checking out and what has been said about them:

    

Let’s be honest about a fact here. As a travel nurse, you are one of the few professionals who are in demand in America today. Not only are you in demand, you are paid the best salaries and benefits that are on par with the ones offered in similar professions. Now it is also a known fact that you are not in this profession just for the money. You want adventure and exposure too. You know one way of getting the adventure and the exposure you seek is by traveling. As a travel nurse, you can travel the length and breadth of the United States and sometimes overseas too. This is the profession you always wanted and now that you are in it, are you actually happy working in the profession that you dreamed of pursuing?

There are many travel nurses who would say that they made a mistake of taking this up as a profession, and that they don’t earn enough or don’t get to travel that much. The truth is, the problem is not with the profession, it is how you’ve chosen to pursue your career. It all starts with the travel nursing companies. Selecting the right one is paramount to your happiness. Actually, many travel nursing companies give negative signs right at the time of your applying for a job. They can torture you with very cumbersome paperwork when applying, and annoying phone calls or mailers after you sign up. It’s like you are on their watch list for all the wrong reasons. Good professional nursing companies don’t do that. They will hire you without any needless paperwork, provided you are qualified for the job. They will assist you in information regarding licenses and give you a choice of three destinations to choose from. Most travel nursing companies don’t do this.

The better nursing companies work for the benefit of both the hospital and you. Even the interview process is quite simple and they can set up an interview (mostly telephonic) with the hospital that in most cases last only 5 minutes. The hospitals are the final authority on your recruitment, but the job is as good as got because the good travel nursing companies know where to present your profile to your maximum advantage. Their job doesn’t end there. They see to that your accommodation needs are met and can even help you with stuffs like cable, telephone etc. Good travel nursing companies can get you wages between $22 and $50 per hour and they will deposit a direct check into a bank account of your choice at the end of the month. They will send you W-2 at the end of the year and your 401k plan starts the very first day you join the job. Compare this with travel nurse companies that don’t pay their staff even their salaries for months together.

The benefits of joining a professional travel nursing company are endless. Lots of things like travel reimbursement (flight, rail or road), insurance, bonuses and incentives, general housing subsidiaries- the list could go on! Good salaries, minimum work hours guarantee and choice of destinations, what more could a travel nurse want?  And they just don’t stop at that, they offer you support -24/7 support, 365 days a year! That’s what the best travel nursing companies do, they look out for you!

Is your travel nursing company giving you all this? If the answer is no, then don’t you think it’s time you looked at better options now?