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?

 

 

Happy Birthday CoS!!!

Change of Shift has completed 3 successful years and will now be starting year 4!!  Hard to believe.  I don't get into it too often because I tend to forget to submit my posts........oops!  Not intentional just too busy to remember.  Anyway I'm in this one so check it out.  You can find it at:   http://www.emergiblog.com/2009/07/change-of-shift-begins-fourth-year-volume-four-number-one.html

 

Thanks Kim for creating and continuing such a great thing!!

Lifesaver

     A few years ago I took care of a patient with pneumonia.  She also had a history of aggressive breast cancer.  She quickly went downhill and ended up intubated.  She was at death's door for well over a week.  Her husband spent everyday there and was so devoted to her.  In making small talk with him many of us nurses commented to him multiple times on her toenail polish color and how unique and pretty of a color it was.  It is hard to describe the color but it is a shade of coralish orange.

    When she finally got better she didn't remember any of her intubated period or realize how sick and near death she was.  Her husband told her several times how sick she had been and how us nurses had saved her life.  She kept saying that she couldn't have been....

    In doing her care we mostly did small talk or talked about how devoted her hubby was or her breast cancer etc.  But at least once a day someone mentioned her toenail polish to her.  She would just laugh and say that it was her favorite color but that she desperately needed a pedicure!

    She finally after several weeks made it out of our unit, went to the respiratory floor and got better enough to go home.  Several weeks later I came in at 7pm for my shift and there was a basket sitting on the counter with a note attached.  It was from her and her husband thanking us for our efforts in saving her and getting her well again.  The card stated that she had gotten her pedicure and that she felt that all of us nurses deserved one too so she had sent us all bottles of her favorite nail polish.  Sure enough it was the color she had had on her toes!  The most touching part of the entire thing was that the card went on to say that she had never really noted what the exact name of the color was until she was preparing the basket.  She had turned over one of the bottles to look and smiled when she saw the name.................................................LIFESAVER!!!!

    

One of those people who had an impact

 

      A few nights ago I was doing rounds and in talking with a nurse about her assignment saw a name on a chart.  I laughed and said "that was the name of the principle of my middle school, what a coincidence!"  She stated "she is a retired principle so maybe that's her".  Being 3 am I didn't think it was a great idea to check and figured I'd go back first thing in the morning.  As usual though I forgot in the excitement of getting off work and my bed calling me!!

 

    I was then off for 3 nights so figured I missed my opportunity to check and see if it was the same person.  But hoping I hadn't I head up to that floor last night to check.  Sure enough, she is no longer in the census.  Still hoping I check and sure enough she had been moved to another floor.  I head down there and poke my head in. 

 

    I politely say her name "hello Mrs. Johnson"  (because you would never think of calling her by her first name) "Were you by chance the principle of Tyler Middle School?  "Why yes I was.  What is your name?" She asks.  I tell her my maiden name.  "Oh yes, I remember you."  She says.  In my head I'm thinking yeah right she remembers me since I was a kid who never got in trouble, but then after talking for a few she asks about how my brother is doing....guess she does remember me since I hadn't mentioned him at that point!!!

 

    Then I tell her what an impact she has had on my life.  Many of the life's lessons that I learned at Tyler I still remember to this day.  Walk on the right side of the hall, don't walk by a piece of trash without picking it up, be respectful & courteous, don't chew gum in school.  These were the major rules there.  I still walk on the right side and you know when I'm at the mall etc it makes it so much easier and when people don't it is so hard to get around and I'm worried my small children will get trampled especially around the holidays.  I still pick up trash around the hospital.  It makes for such a cleaner place to work and therefor more enjoyable.  Plus it's just good for the environment.  Being respectful and courteous..........do I really need to explain that one???  :-) 

 

    As to the gum chewing....I never understood that one.  And actually that was the only detention I ever got in all my days of school.  Darn it I was going to chew gum!!!  So, I asked her about it.  And she explained that it was her little war that helped us learn about bigger wars.  Basically that in life there will always be a war to fight and that we needed to learn that there will always be someone higher up than you telling you what to do so you might as well get used to it early in life.  You can either fight it or learn to give up on the smaller stuff and get along.  Not a bad lesson in my opinion! 

 

    I told her what an impact she still has on me all these years later and she was blown away.  She was so happy to hear it.  We talked about my job and all the teaching etc I do now.  She told me that even though I had never directly taken care of her she could tell by my actions in our conversation what a good nurse and a good person I am.  It was nice to hear.  Maybe I'll stop in an see her again tonite!

Featured Healthblogger on Wellsphere

I'm honored to be chosen to be a featured healthblogger on wellsphere.  I was contacted by them and asked to be a featured blogger on their site.  After checking out their site and liking what they had there for health information I decided to give it a go.  Check out their site: http://www.wellsphere.com/home.s

 

Check out my profile:   http://www.wellsphere.com/tracey-profile/135510

 

And I get this really cool badge to put on my blog which will go up soon.  Come back and check it out.

 

Quite the honor if you ask me!!

Designed with nurses in mind

When the Children's Hospital of Pittsburg was redesigned recently by Astorino Inc. it was done after much consideration of the aging nursing popluation.  Read below the story about this design project and how it helped with the physical burdens that we face as nurses while laboring to care for our patients.  The photo is of one of their new care team stations and was taken by Alexander Denmarsh.

 

CHILDREN’S HOSPITAL OF PITTSBURGH OF UPMC: DESIGNED TO HEAL

Architecture firm Astorino employs unique research technique to translate needs and experiences of patients, families and staff into a world-class healthcare facility
 
 
PITTSBURGH, PA, May 11, 2009 – Children’s Hospital of Pittsburgh of UPMC has unveiled a new, thoughtful design that distinguishes itself as a model for pediatric healthcare for the 21st century. Astorino, the full-service architectural and engineering firm that designed the hospital, created this revolutionary facility by employing a unique process that gained insights into the hearts and minds of patients, families and staff. The result is a healing space that meets the deepest needs of all who will inhabit this 10-acre campus for generations to come.
 
Astorino leveraged deep design research from its affiliate company fathom to address the innermost needs of patients, families and staff. To best determine what those needs were, fathom used a market research tool originated by Olson Zaltman Associates, a Harvard University-based company. The Zaltman Metaphor Elicitation Technique (ZMET) is a unique one-on-one interview process that invites participants to find images that represent their deepest thoughts and feelings about a given topic. Through this research study, key metaphors for the ideal experience at Children’s emerged; Transformation became the overarching theme and Control, Connection and Energy were identified as supporting metaphors.
 
“Children and their families go through incredibly trying times at hospitals,” said Louis D. Astorino FAIA, CEO and Chairman of Astorino. “Unfortunately, most environments today do little to aid in the healing process because they are not designed with people’s deepest needs in mind. The design of Children’s Hospital of Pittsburgh of UPMC is intended to alleviate stress and enhance the transformative healing process that patients and their families experience when in a hospital.”
 
Transforming the Hospital Experience
Fundamentally, the new design is about transformation – moving from an unbalanced state to a balanced state. The theme of transformation runs throughout the hospital in an effort to guide patients and their families through the arduous process of treatment and healing. It starts before patients even see a doctor during the walk through the Transformation Corridor, a hallway that connects the parking garage to the hospital’s main lobby. Visitors begin to experience the feeling of transformation from the change in seasons represented in the floor patterns to the impressive wall mural of a cocoon turning into a butterfly.
Maximizing Energy Accelerates Healing Process
An atmosphere of positive energy is infused both inside and outside the building, giving patients, family members and staff opportunities to “recharge their batteries”. For example, the spacious waiting room – filled with movable, patterned furniture in bright colors – provides ample room for patients to run freely and offers positive distractions, such as art work, a fish tank, toys and games. The outdoor spaces, chapel, library and various medicine-free sanctuaries are calming areas where families and patients can clear their minds. Playrooms, fitness areas and sibling centers offer energy sources for higher-intensity activities and provide welcome distractions. The Family Town Square, a central gathering location, includes a two-story movie screen that can be used for showing educational and entertainment programs. The cafeteria exudes a whimsical, carnival feel complete with light fixtures that resemble cotton candy. Astorino also addressed the number one way energy is replenished – a good night’s sleep – by eliminating noise distractions, such as the overhead paging system. 
Increasing Control Empowers Hospital Users   
Hospitals today present fearful unknowns and are not designed to empower people to take control over their life and environment. Children’s new design provides increased control over variables that can normally cause stress among patients, families and physicians. For example, patient rooms were turned into kid-friendly spaces that are intimate and private, and allow children to take control over things like lighting and display of personal items. Floor plans were also organized to maximize usable space, increase productivity and reduce medical errors (i.e. care team stations were decentralized so staff is never far away from their patients; they were also designed with private and confidential areas for nurses and doctors to conference).
 
Creating Connections Fosters Sense of Community
Children’s design connects patients with the outside world, themselves and others and alleviates the sense of isolation often felt inside hospitals. For example, the building’s rich and colorful interior and exterior – with lively red, blue, yellow and orange colors – provides an emotional connection for children. Private rooms with separate areas for parents to sleep keep families close and connected, but also comfortable. The 4,000 square-foot Rooftop Healing Garden offers everyone a comfortable space to socially interact and rejuvenate. Windows placed at the end of each hallway also enable patients to see and connect with the outside world.
 
Louis D. Astorino continued, “Healthcare is rapidly changing – from the way people receive care to advances in medicine – and architects need to be more nimble than ever to be able to respond to these changes. At Astorino, we believe design can play an active role in the healing process and we hope that our work at Children’s will not just prove this, but inspire others to create designs that meet the deepest needs of users and pave the way for better care.”
 
About Astorino
Astorino is at the forefront of where people and design intersect. A full-service architectural and engineering firm, Astorino deploys a discovery, design, and build strategy, combining unprecedented human-centered research, design and construction services into one seamless process. Each service inspires the other, creating a final product that meets the deepest needs of people who live, heal, work and play in these environments. For more information, please visit www.astorino.com

 

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.