Do I need to know?

Last night I was assigned to the CCU for the first 4 hours of my shift as they were short a nurse and getting a post-PCI patient (heart attack that just got angioplasty) along with another ER admission.  So I took the PCI patient and did her admission.  Figured that would help and then I would turn her over to the 11pm nurse. 

 

She came with corrections officers.  Usually they only come with 1 but for some reason she had 2.  She wasn't unusually dangerous, it just had something to do with transportation etc.  Anyway, after I got the admission paperwork that I had to do with her done and was out at the nurse's desk doing the rest one of my coworkers asked why they were in there with her.  I said cuz she is a prisoner.  She gets all excited and asks if she is shackled to the bed etc and lots of other questions.  Then she asked the one that really got me thinking......

 

What is she in prison for?  I told her I had no idea.  She asked if I had asked the CO.  Nope.  Is it in her chart?  Nope.  Did you ask her?  Nope.  Don't you want to know?  NOPE.  Then she asked why.  I took a minute and thought about it.......

 

Isn't our judgment already a bit clouded just in knowing that she is a prisoner?  Do I really want to cloud it any more by knowing what got her there?  Instead why don't I just know that she is a person that needs my care.  Sure, she's done something that a jury of her peers and our society deemed wrong but right now she is a sick person who needs my care.  This is all I want to know.  I also know that she is appreciative of my care and is respectful and cooperative.  Why ruin that? 

 

I'm not saying that I have never wondered the same thing my coworker did.  I have.  I even asked once.  We had another prisoner who came in quite frequently for CHF.  After the 4th or 5th time I took care of her I finally got up the nerve to ask her.  She told me that she committed arson.  She was very ashamed about it too.  She even cried as she told me.  I knew in that moment that I never wanted to know again what someone was in prison for.  Who knows, maybe I needed her to know that I don't need to know.  Maybe without her I would still be like my coworker.  I'm blessed instead to ask myself:  Do I need to know?  and know the answer is NO everytime.

I've been listed as a top 50 blog!!

How exciting for me!!  I've been listed as a top 50 nursing blog!!!  I'm honored.  Thanks for being a reader and thanks to onlinenursingdegreeguide.org for listing me.  The entire top 50 list can be found here: http://onlinenursingdegreeguide.org/2009/top-50-nursing-blogs/  Please check it out and have fun reading the other blogs.  They are broken down into catagories to make it easier to find what type of nursing blog you are looking for even.

 

Thanks again both to my readers and to the list!

Nursing novellas as continuing education

I got an email the other day asking if I would be willing to put a press release on my blog.  Being skeptical of anything but my own stories I was a bit leary at first.  But I opened the press release to read it and it actually sounded like a pretty good idea.  So many states require CEUs and so many out there are certified which also requires CEUs.  I know that's the only reason I haven't yet gotten certified in critical care.  I have a 5 year old and 3 year old twins.  There is no way I'd be able to keep up with the CEUs.  But this sounds like a great way to get some of them.  Here is the press release so judge for yourself:

 

Pritchett & Hull Associates, Inc.

3440 Oakcliff Road NE, Suite 110

Atlanta, GA 30340

Email: kenb@p-h.com

Web: http://www.p-h.com

        

NURSING NOVELLAS

Amy Vega takes a Novel Approach to Nursing Education 
FOR IMMEDIATE RELEASE 
For more information call:

Ken Baumann

(770)451-0602 
 

      ATLANTA, GEORGIA, APRIL 27, 2009 – When you think of continuing education for nursing, you may imagine medical textbooks, complicated graphs and loads of acronyms. Well, Amy Glenn Vega hopes to transform continuing education by taking nursing lessons and crafting them into steamy page-turners nurses can read while cozying up next to the fireplace in their favorite comfy chairs.  

      Amy is a Health Care Educator at the Southern Regional Area Health Education Center in Fayetteville, NC, who has put lots of different theories into practice to reach students over fifteen years. What’s the best way to help teach a nurse who’s in-demand, underappreciated and overworked? Amy Vega has taken the novel approach. “I’d see lots of nurses sipping coffee and taking a brief escape behind the pages of a novel. Then it dawned on me - what if learning something new was as easy as reading a story?”

      

      Nursing Novellas is a new series that helps nurses learn more about dealing with major interpersonal issues in health care using the fictional cast at Dogwood Regional Hospital in North Carolina. Inside a whirlwind of work, family and love-lives in crisis, the nurses of Med-Surg South find ways to come together and overcome their personal and professional challenges. Real nurses learn through reading and sharing these fictional experiences, and then through discussing them with other nurses. 

      Amy’s first novella, Lions and Tigers and Nurses, deals with the lateral violence that is so rampant in healthcare. According to the American Nurses Association, 60% of workplace assaults take place in healthcare related services. “If lateral violence continues to erode the workforce at this rate, our quality of health care will be dramatically compromised,” said Amy Vega. “In my book, I tried to illustrate some of the major learning takeaways about lateral violence in a way that is entertaining and memorable.”  

      Lions and Tigers and Nurses and the second novella, Broken Heart, which is about coping with change and loss, will be available in June from Pritchett & Hull Associates, Inc., Amazon and all major booksellers. Continuing Nursing Education credit is offered and provided by the Southern Regional AHEC. Amy Glenn Vega is an active blogger and her website, nursingnovellas.com, is a place that nurses, nursing students and anyone working in or interested in healthcare can discuss and learn about the major issues and challenges facing healthcare and healthcare professionals. 
 
 

      Amy Glenn Vega is not a nurse, nor does she play one on TV.  However, she has worked closely with nurses over the past fifteen years in her career as a health care educator and a former Emergency Medical Technician-Intermediate.  She obtained her Masters in Business Administration and Masters in Health Administration at Pfeiffer University, and her Bachelor of Science in Health Education at the University of North Carolina in Chapel Hill.  She has served in multiple roles in health care education, to include community health, patient education, and staff development.  She is currently employed as a Director of Interdisciplinary Continuing Education at Southern Regional Area Health Education Center in Fayetteville, NC.  A gifted storyteller, Amy has combined the power of story with teaching in the educational fiction series, "Nursing Novellas."  Amy is also a North Carolina Registered Health Educator and was recently appointed as a Fellow to the Academy of Health Care Education Professionals. 

      Southern Regional AHEC is approved as a provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. 

      Pritchett & Hull Associates, Inc. publishes healthcare materials for nurses & nursing students that encourage exploring and confronting the challenges of current and future healthcare through personal and staff development in fun, creative and challenging ways. The result is better teaching, better prepared healthcare professionals and better quality of care for our future healthcare challenges. P&H brings People & Health together. 

      -END- 

      To learn more about Nursing Novellas, please visit Amy Vega’s website at www.nursingnovellas.com. To learn more about how P&H can help bring People & Health together in fun and innovative ways, please call Ken Baumann, Marketing Director at 770.451.0602 or email Ken at kenb@p-h.com or visit www.p-h.com

 

 

And I thought we had it bad

As a nurse I've seen a lot of gross and awful things.  I thought that my job was pretty near the top of the list of seeing bad things.  However, this night I think someone else got the worst of it.

 

I went down to the ER and heard some serious screaming.  Asking what was going on I heard quite the story.  Apparently in the behavioral hall there was a patient that was an older woman in her 70's that was psychotic.  According to hear daughters this was new for her.  She had always been a bit eccentric but never like this before.  Now, for the last week, she was paranoid and hallucinating.  They had a whole list of things written down that she had been saying and supposedly seeing.

 

The worst of it however, was what she did to the police that were called to pick her up.  When they came and knocked on her door she freaked out and greeted them by throwing a severed kitten head at them.  Yes, a kitten head.  Can you just imagine being that police officer?  And having that happen to you? 

 

I actually felt bad for 3 souls that night:  1) the kitten, 2) the police officer and 3) the woman. 

 

I never did get the chance to find out what made her acutely psychotic either.  I would have liked to have known.  They were questioning a UTI.....but seriously.......a UTI that makes you decapitate your own kitten?  She did have other issues too.  She apparently had many, many cats and didn't take the greatest care of herself, them or the house.  All around a sad, sad story.

 

A disturbing trend.....local or national?

I want everyone in the US who reads this to respond if possible.  In my hospital we are trying to find out if this is a trend in our hospital or something national.  So, please respond!!!

  Our hospitalists are giving out huge amounts of pain meds these days.  I remember when I started nursing (10 years ago) we gave out demerol (wow!) and morphine only.  To give diludid was a rarity and it was reserved for someone with chronic pain or someone in intense pain that demerol or morphine didn't work for.  These days demerol isn't used and morphine is even going by the wayside except for cardiac patients.

  For our chronic pain patients and really everyone we are giving out diludid like it is candy.  For those that come in with acute pain they will get anywhere from 0.5-2 mg IV q 4-6 hours depending on their age & size, etc.  But for those that are our chronic pain patients we are giving anywhere from 2-8 mg IV q 2-4 hours!!!!  Yes that's right we sometimes are giving 8mg of IV diludid q3h!!  That's enough to kill an elephant!  But the patient that was getting it last week was complaining that it wasn't enough!  What???

  This is becoming disturbing to us nurses and we were talking about it the other day.  We are surprised about several things: 1) the doctors are ordering doses this high, 2) the pharmacists are allowing us to administer doses this high and 3) patients are tolerating doses this high without complications.  

  So my question for those out there reading this is........

Is this happening out there or just here?
 

S....t.....u.....c......k

The other morning I head to the ER and they ask me if I had heard about the PCI that is coming in.  Knowing that it is my job to open the cath lab when a PCI arrives, I ask what they are talking about.  Apparently, they got an EMS patch that they were responding to a chest pain call and when they got there and did the initial EKG it was for a man that was actively having an anterior MI. It looked like a pretty big one by the EKG they had faxed over....with tombstones and recriprocal changes.   

We had just gotten slightly over a foot of snow within the last day that had just ended in the last several hours.  When the EMS got the guy into the ambulance and started for the hospital it got stuck in the snow!!

From what I hear it was approximately 30 min that they were stuck in the snow before finally digging themselves out.  We aren't sure why they didn't just dispatch another ambulance since the poor guy was actively infarcting his heart the entire time.  They were finally pulling into the ER bay as I was leaving for the day so unfortunately I'm not sure how he made out.  Maybe a future update.........................

12 seconds

Sometimes you should be careful what you wish for.....

 

For instance, one night our ER was going down 2 nurses at 3am so I was assigned to go there for 3am -7am to cover.  Usually when they are going down 1 nurse I just go as helping hands since I have to cover any METs or Codes that may occur during that period too.  But this night they were particularly short so I was asked to take an assignment and the charge nurse would cover me if any emergencies happened elsewhere. 

 

I was given 3 beds in the observation area but only 2 were filled.  They were both going to be admitted but there were no beds in the hospital so both were holds.  Both elderly and both settled in and asleep.  A set of signs on each, a pair of assessments and a talk with one who had family and I was in the clear. 

 

I then asked the charge nurse several times to give me another patient to fill my other bed but she said no as she already had 3 of her own and didn't want to cover 3 more if I had to leave.  So, I helped others and waited and waited and waited.  And, of course, being me complained a bit as to how useless I was being.

 

Then about 5:50am the triage nurse doesn't consult with the charge nurse and puts a patient in my 3rd bed.  I go in to see what he is and find a young man in his early 30's.  She tells me he had just had a syncopal episode at work with a LOC for approx 10-15 seconds.  Kinda impressive but I'm not really expecting much.  They rarely repeat themselves for us nurses!! 

 

The tech gets an EKG, I get him on the monitor and we start chatting etc.  I'm actually starting to think like an ER nurse (scary for a critical care nurse at heart!!)  and go get a rainbow of lab tubes to get his blood while I put his IV in.  I start an 18 in his AC.  As I'm getting the last tube of blood I hear the monitor start to beep and look up.  He had this whole time been a nice NSR in the 80's with no ectopy or anything funny.  Now he's in the 40's!!  Yikes! 

 

I ask him how he's feeling and he initially says fine.  Then changes his mind and says he's a bit nauseated.  I look out and there is NO ONE to be found at the nursing desk!!  Oh shit!!!!!  I then look back at the monitor and his heart rate is now 30's and he's telling me that he is really feeling quite nauseated and not good at all.  I look again and see another nurse and barely get her attention but luckily she comes to my aid.  She gets some atropine and goes to flush my IV site and in my haste to tape the site in I had taped it too far down and we cannot get the flush syringe on the catheter.  Oh shit BIG TIME now as he is now in full blown asystole and his limbs are stiffening and he is totally out. 

 

I finally get the tape off, get the site flushed and she gets the atropine in.  Not sure if his heart restarted on it's own or with the atropine but it did restart.  Thank God!!  He then wakes and asks what happened.  The doc explains that he showed us what happened when he had the last syncopal episode and thanked him for helping in the diagnosis!!  I told him that if he really wanted to get my attention he didn't need to make his heart stop, that there were easier ways to do it!!

 

All in all he was in asystole for a total of 12.4 seconds by the monitor strip!  Needless to say he didn't tolerate it well at all.  Much more and he would have gotten some good ol' fashioned CPR.  He was close as it was.  Went to the CCU and got a temp pacer in his jugular and then a PPM the next day.  I don't think they ever found a cause.

 

But I definitely learned a lesson.........................when in the ER be careful what you ask for!!!!!

Super Pube

I get this call from a nurse on one of the floors the other night and she says "Can you come and check this super pube for me?"  I make my way up there and am wondering what I'm going to find.....................a HUGE pubic hair or a superpubic catheter!!!

"Just a nurse"

I came across this blog post on the Happy Hospitalist's blog and wanted to share it with my other nurse readers.  It's a great story.  Thanks again Happy!

http://thehappyhospitalist.blogspot.com/2009/01/just-nurse.html

Raisins on sticks

Wow, it's been awhile since I've been here.  I've been sick on/off for about 8 months now.  Had some 4 month long mystery illness that spontaneously resolved in the late summer to early fall and then recently had Lyme disease and mono at the same time.  Now just found out that I've had iron deficiency anemia for at least 6 months if not more.  Needless to say I haven't been feeling my best and since I can't give up being a mom or nurse the blog is the thing that went!!  But I'm back and am going to try and get back into the swing of blogging my nursing stories at least a few times a week.

This is actually a story that one of the cardiologists I used to work closely with told me.  The background that made it so much more funny is that he is in his early 50's and quite reserved.  He does talk and joke with the nurses but never in a way that the younger male docs would if you get my drift.  

He was in late one evening and we had a confused older lady who was continuously taking her gown off.  We were joking about how this lady just liked to be naked no matter what we tried to do.  So he pipes up with "I've got a story for you gals about older naked ladies".  Coming from him we weren't really sure what to expect.

He tells us about all the times he walks into an exam room to see a patient and it is an older lady in her 70's or 80's and she will be sitting there on the exam table naked from the waist up.  He says "I'm a cardiologist.......not a GYN who would need to do a breast exam."  We figure with him that's the punch line but oh no it gets better!

He goes on to say "yep it just takes me by surprise each time.....there they are sitting there chest bare and it's like two raisins hanging on the ends of the sticks."