Tuesday, May 27, 2014

First day of school: Clinical instructors POV

Its that time of year again! The first day of school has arrived. The night before losing sleep due to anticipation. Wondering and thinking about who you are going to meet and the impressions to be left. The first day sets the tone for the whole semester. Your first and last words will be everlasting to your students. Everything you say is imprinted in their brains to be tried and tested time and time again. 

You make sure your scrubs are ironed and coordinated. You have google mapped directions to and from the facility to ensure the best route is taken. You read all of the students materials as well as your own. You think about every question a new nurse could possibly have. 

Once you awaken on that wonderful morning you anticipate getting your first cup of coffee and an energizing breakfast to keep that pep from beginning to end. You show up before the students to set the standards in the beginning. You see your first student walk through the lobby of your facility with a look of desperation and fear as your are ready to comfort her with comforting words to ensure her it seems scarier than it really is. And as you open your mouth that cold you had yesterday had turned to laryngitis. Your voice is gone! Nothing but inaudible squeaks and whispers. As students continue to pour in the first day of school has become an awkard moment for you as if you are the one in school again. Soon the roles have switched and students are encouraging you to persevere through the day!

Thank God for Nursing Students :)

Monday, May 26, 2014

Thick Skin

It is important as a nurse to develop thick skin otherwise we would not have made it through nursing school or our first days on the floor or the verbally and physically abusive patients or the long shifts or the dying patient or the code that goes bad or irregular sleep cycles or the lack of time to eat ... the list can go on on and on but what happens on those days when your skin is not so thick. Those days when emotions get the best of you. Do you take a moment and shed a tear? Do you lash out? What are the outlets for us nurses? 

The reality is that nursing is a difficult profession but not only physically but emotionally. Our role is to be a caregiver, advocate, medicate, counsel, manage, act as a change agent, and research. With all of those roles there are some days it can become overwhelming. Some days we forget about ourselves to the point where our bodies will not allow us to move forward. Our roles and responsibilities have become a norm for us but what about those days during a shift when out when we feel we can no longer move forward?

We just keep going.....

Saturday, May 17, 2014

Graduation day

Graduation is approaching quickly! I am attending my third graduation; once for high school, once for my bachelors and now once again for my Masters of Science in Nursing education.  So a little about me: My background was med/surg tele. As a new nurse with novice expertise I would constantly arrive to work frustrated and overwhelmed with the responsibility of caring for patients and knowing that my decisions would or could affect a person’s wellbeing. I watched the unit I worked on go through many transitions and I therefore I found comfort in knowing and understanding that change is constant. During that time I got married and had a beautiful daughter, suffered with postpartum depression that caused me to struggle daily at work. I began to understand that nurses really do “eat their young.” I learned during that time that I have to take of me (which is a lesson that most nurses struggle with). This sparked an “aha” moment that drew me to return to school. All I knew at this time is that I wanted to share my experiences and perspectives with “our young” and aspiring nurses.

 During the first semesters of my graduate degree I found solace in the campus life. I enjoyed the first days of school as if I were in elementary school again. The anticipation of the unknown was exhilarating. Not knowing who I was going to meet, how hard and/or different graduate classes are and most importantly how I was going to be able to write ALLLL of those papers on the syllabus. Now, two years later graduation is approaching. With yet another transition approaching I some decisions to make that affect not only my career but my family as well. For the past two years I have the luxury of working prn in the float pools of two different hospitals which provided the flexibility I needed to be home with my young daughter and focus on my schooling. Now I have to decide if I want or need to work fulltime. Should I become a faculty member at a college? Should I teach part time? Should I work for a hospital? Or should I return to school and pursue a Family Nurse Practitioner?

I have learned overtime that as your life transitions you must be flexible and optimistic. At this point in my transition I am leaning toward FNP program. Although teaching is my goal I am not sure I have made it to a point in my career where I can see myself as fulltime faculty. I have learned things about the roles and responsibilities of faculty members that I am not sure I am ready to take on with a young growing family but I also know that if continue to hone in on my clinical skills with an advanced practice degree I can make a similar impact on healthcare until the time comes for me to “settle down.”
Suggestions/comments are well appreciated. J

~Mother Nurse

Tuesday, May 13, 2014

OT vs RN

The overall goal of both professions is to improve quality of life for their patients. Both professions overlap in a way that confuses the patients. Both assist with patient interventions. Both provide plans of care but from different perspectives. With so many commonalities why does it seem like each profession does not get along with the other? I have worked on a unit where the therapists have one refrigerator and the nurses have another. They have two microwaves, and separate unit parties where one group is not included and given leftovers after the celebration is complete. I find this to be an odd phenomenon because although the professions have differences we still work side by side with a common goal of ensuring patients are cared for in the most optimal way. I have watch therapists bellies grow and be excluded from the baby shower celebration. I have been to staff meetings where one profession bashes the other. I have walked in a room with a patient and the therapist questioned the care I am administering in front of the patient. What is that saying to the patient? On the flip side I have heard nurses complain about the therapists. I have heard them have a total disregard for the occupational therapy profession. How is this in the patients best interest. My solution is educating both professions on the differences between the two. Maybe if there were an understanding between both parties then maybe an alliance can form between the two thus provide a more collaborative and efficient way of providing care. Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, communities, and populations (American Nurses Association,2014) Occupational therapist complete an individualized evaluation, during which the client/family and occupational therapist determine the person’s goals, customized intervention to improve the person’s ability to perform daily activities and reach the goals, and also completes an outcomes evaluation to ensure that the goals are being met and/or make changes to the intervention plan, (The American Occupational Therapy Association, 2014)

“The very first requirement in a hospital is that it should do the sick no harm.” Florence Nightingale


Monday, May 12, 2014

How do I feel about the legalization of marijuana???

Ok I am totally against the recreational use of marijuana. Like any other substance use without supervision can be deadly but I do not understand why a person cannot use a drug for medical purposes that are proven to be effective for multiple symptoms in certain diseases. Currently marijuana is a schedule I controlled substance in the same category as LSD GHB and heroin. Let’s consider the effects of marijuana vs other prescription drugs or better yet other legal drugs. Neurontin, for example, is an antipsychotic drug which is used in the treatment of seizures and is a schedule V drug.  Schedule V means the drug is widely accepted for medicinal use and has a low potential for abuse but the side effects of Neurontin taken orally include depression, suicidal thoughts/attempts, mood changes, drowsiness, tiredness, and blurred vision. These side effects are similar to the so-called “high” caused by marijuana. Neurontin and marijuana share similar side effects and treat similar symptoms such as seizures. However, Neurontin is legalized as a prescription drug in Maryland but marijuana is not.

Another surprising fact: Neurontin is the primary cause of 968 deaths from January 1997 to June 2005. Seventeen other FDA approved drugs were the primary cause of 10,008 deaths during the same time frame. Marijuana was the primary cause of none.Now healthcare providers think about this: how many times have you seen a person come into your facility with violently ill withdrawal symptoms of marijuana? Now think about how many times you have seen a person come in with violently ill withdrawal symptoms of alcohol? Methadone? Dilaudid?  Oxycodone? All legal and widely used.

Hey, at this point I feel like a hippy encouraging one to throw one in the air but really I am advocating for patients being treated with what I feel is the safest method of treatment. If someone can explain why it should not be used I welcome the feedback.


Thursday, May 8, 2014

Whats wrong with paper??

Today I was mandated to take a course to educate us nurses on the new upgrades to our computer system (meditech). Which btw is an upgrade to the upgrade that was done 3 years ago. This mandatory upgrade was in direct relation medication reconciliation. Some functions changed or moved slightly but in essence this is the same program that we had been using.
So as I am sitting through this course it was mentioned on more than one occasion that this is a requirement to do this correctly 100% of the time because "we" would receive an unknown amount in government funding and this is a mandate of the state.
As I am sitting  through this overly redundant course I think to myself what is wrong with documenting the patient's home medications on paper. Now don't get me wrong I am all for the evolution of processes but I do not understand how this helps the patient. At this point in the technological advancements at this particular hospital we do 50% on paper and 50% on the computer. Many orders are placed on the computer but just as many are written by hand. I also began to think to myself why is the government requiring that patients medications be loaded on a computer. We already depend on a computer so much but what if a computer fails at some point where does the patients information go? It was further explained to me that patients will have access to this information through a portal so I immediately thought of HIPPA and weather the government has access to patient information. I mean really, is the government handing out money to access patient information?
This post is being written on nurses week so I must also mention does this unknown amount of money in some way benefit the nursing staff? I am not sure what your hospital did in celebration of nurses week but this hospital claimed that there was no budget to have a decent celebration. We received lifesavers one day stating we are a "lifesaver" and on another day a sheet cake was split between each of the floors. Now please do not take this as complaining because I do not do what I do for a gift but I would like to point out in the seven years I have been a nurse I have watched nurses week celebrations dwindle. One of the first years of becoming a nurse we had a hospital wide cook with music, hamburgers hotdogs etc. Now it seems that nurse appreciation is not budgeted but there is more being required of nursing staff.

Just a rant :)

Saturday, May 3, 2014

Super Nurse or naw


Do you consider yourself a super nurse? What qualifies as a superpower? Do all nurses share the same purpose?
I think the profession of nursing is special. We do something that no other healthcare profession is capable of. We are patient advocates, we facilitate communication between healthcare teams, our role is ensure our patients are safe and their best interests are taken care of. Overall, I think those are the superpowers that we possess. Healthcare is foreign to most. The language, the environment, the procedures, and protocols. Think about going to Germany. The language/s, the environment and laws are all something that you know nothing about. Think about how difficult it would be for you to drive to the store and go grocery shopping for a few items. Would the items you are looking for look the same will the staff be friendly and patient with you. How about something as simple as driving... will the road signs be readable? That is a lot to think about and you will be overwhelmed. Think about how much of a difference it would make if you knew the language or better yet have someone guide you through the process with compassion that you know you can trust.

Now lets think about the patient who has to get a simple procedure done... for example insertion of a foley catheter and the dr uses words like urethra, insertion, bladder, infection, in less than ten seconds then walks out. Of course that patient would be overwhelmed.... But here comes SUPER nurse to save the day! So the next time you go to work think about the simple yet major impact you are having on each and everyone of your patients that day. Also give yourself a pat on your back for withstanding the trials and tribulations that come along with being a nurse that day and ENJOY your nurses week!!...Each and everyone of you no matter  your specialty.

Friday, May 2, 2014

Alcohol Abuse

Servodidio, C. A. (2011). Alcohol Abuse in the Workplace and Patient Safety. Clinical Journal Of Oncology Nursing, 15(2), 143-145. doi:10.1188/11.CJON.143-145

Have you ever been in the situation where you suspected substance abuse in a co worker. What signs did you notice? As a nurse it is our responsibility to to assess for substance abuse in individuals all of the time. We have acronyms such as CAGE to help us remember how to assess. When it comes to our co-workers we tend to turn a blind eye. In a situation that I was in I saw the signs and symptoms but did not relate it to substance abuse. In this case this person displayed professional signs that included inappropriate behavior, moving to off shifts, complaining about personal problems, and volunteerng for extra shifts. This person was vounteered for extra shifts on multiple units so it was not known how many hours she was working. A policy in the institution was created because she was able to accumualte 80 and 90 hrs a week. She became unkempt in her appearance and if you cared for a patient after her you would spend most of the shift playing catch up. She did not document, many tasks were not completed, meds were missing. As a new nurse at the time, I did relate that to abuse behaviors but after her dismissal it was found she was suffering alcohol abuse with multiple dui's and mandated to go to treatment. This was a sad situation to watch for she was the perosn who helped train me. :(

Thursday, May 1, 2014

Quote of the day "If you are not serving then you're on the menu"

What does that mean to you???? How does this relate to nursing???

I believe that many of us nurses are typically found on the menu. How many times have administration changed a policy that you did not agree with? How many times have you complained that nothing gets done? Or worried that your patient was going to suffer at your expense. The reality is many nurses do not have a voice because we do not serve on the committees or professional associations. We do not take action as a unified front. Many time we find ourselves combating against each other and  bullying one another.

There are 2.8 million nurses in the united states... and how many of you are apart of the ANA, or any other professional organization. Nursing is a unique profession that requires a voice and forward thinkers. 
Now let me ask how many are apart of their homeowners association. On a smaller scale if there was no HOA in your community think about how many of the landscaping needs and equipment failures would be prevalent. Or if you are not on your HOA how many times do you wish your community had something that does not exist but if you did serve  or at least attend meetings you could vocalize your opinions to those who make decisions for your community.  Or if you do not have a HOA how well kept is your community?

Just my thoughts