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  1. The Drama Begins - The Phone Call When I picked up my ringing cellphone, I didn't realize the drama I was going to plunge into! It was one of the attending in the clinic, Dr. Needy. She could not get hold of anyone in the clinic ("The phone just keeps going to voicemail)", and called me on my personal cell. She wanted to get an elderly patient June, to come in and get labs done today. Apparently, June had taken too many medications last week and was still feeling sob and fatigued. "Annie, she took 3 Lisinoprils, 3 Metoprolol, and 3 Aspirins on the same day, a few days ago!" "She didn't bottom out or have a heart block?" "Apparently not! I just finished a televisit today and she seemed fine but I just want to be sure and get some labs done". "No problem! I will schedule her today and call her to come in." By the way, she had Covid one month ago and she is off quarantine!” “O.K. thanks for letting me know.” Appointment Scheduled I looked outside. It was snowing a little more intensely. The roads were slushy with brown snow. I scheduled her for the next available slot at 2 pm and then picked up the phone and called our lab in the clinic. "Sandra, I just scheduled a patient June Smith for labs today and put her on your 2 pm slot. However, she is 79 and it's snowing hard outside. It's 10.30 am now. I am going to call her and inform her about the appointment. I wanted her to come in ASAP, get her in and out. Can you see June before her time?" "Sure, I can Annie!" "I'll tell her about the appointment and to be here before 11.30 am as I know you are closed for lunch from 12- 1 pm!" "Sounds good Annie". I thanked her hung up, called June's home, and informed the niece Jennifer, about the appointment. This was a Friday. “Is this urgent? Can this wait till Monday?” “Yes, it is urgent. The doctor wants to make sure that there is no ongoing issue that needs to be fixed, like low potassium. Otherwise, June may end up in the hospital ER unnecessarily. If you bring her in today, we could check her blood and call you back if any issues by tomorrow or right away if any of the labs come back really abnormal.” Jennifer convinced reluctant June who felt tired and wanted to sleep, to come! Blister Pack Medication Confusion While we waited for her to come, I reviewed her electronic medical record and noticed that she used the pharmacy on the same floor as our clinic. I spoke to Tom the new pharmacist and asked if the patient’s medications could be blister packed to avoid future mistakes. “Annie, she is getting her medications in a blister pack. Matter of fact, I gave the niece a new blister pack last week and she seemed to understand it well. So I am not sure how the mistake was made. She apparently took the am medications for 3 days on the same day!” “Maybe she is getting forgetful, she is 79 after all!” “Maybe!” Tom agreed. “I wonder if she’s taking her own meds or if someone is giving her the medications. Either way, they may need visual cues. What do you suggest?” “How about rubber-banding it?” “What do you mean?" “I mean putting a rubber band on the blister pack under each day so that they know not to go below it.” “That’s a cool idea and how about we draw a line with a red marker under each day where the rubber band would go?” "Sounds like a plan!”, Tom agreed. “I am coming over. Can you give me an empty blister pack and a rubber band? I’ll get a red marker.” “No problem.” I went over with a marker that I got from my Nurse Manager who was horrified when he heard the story. Tom who was new, turned out to be a tall 6.5 ft and hefty guy. “I am putting that I want to be as tall as Tom on my this year Christmas wish list!” I joked. We laughed and he gave me the empty blister pack with the rubber band. I drew red lines under each day, thanked him, and went over to the lab. I briefly told Sandra from the lab what happened. She was horrified. Sandra and I went way back when I was an ED nurse and later on the evening manager of the ED and she was an ACLS medic. We both knew the ramifications of what could have happened when all the meds were taken together. “She is lucky to be alive!” Sandra said amazed. “Yup! Her guardian angel must have been working overtime!” We both laughed. “Anyway, here is the blister pack, marker, and rubber band. Call me when they come please.” “No problem, I will.” Office Visit I got the call half an hour later and went to the lab. I saw June shuffle into the lab, her niece Jennifer holding and guiding her gently. As Sandra did the labs, Jennifer and I discussed what had happened on the day of the medication error. “I normally give her medications but on that day, I had to go in to school as I am a teacher. So my mom who is her sister and June figured out how to take the medication! Instead of taking the morning, afternoon, and night medications that are placed in a row horizontally, she took the morning medications that were vertically placed three times on the same day! I didn’t realize till the next day when I took the blister pack to give her morning medications!” “Ah! I see how that happened now!” “When I asked her, she told me Isn’t it from Top to Bottom?”, Jennifer shook her head ruefully. “I can see them both figuring it out, sisters!” Jennifer and I chuckled. I reviewed the “rubber band and red marker method” with Jennifer. “This is brilliant! I am going to teach my mom and aunt. They will understand it and I have plenty of red markers at home!” “Sounds like a plan!” Now that the safety issue was taken care of, I wondered what her vitals was and if she needed an EKG. The shortness of breath could be from the Covid or the residue from the medication error just because she was older. It would be wise to be careful. I had not seen any follow-up appointment on her schedule. So I talked to Laura, one of the attending doctors, and put her in for a same-day appointment. She saw June and checked her out. Her vitals and EKG were perfect and the family left satisfied that everything was done and that June was safe---for now! Problem Solved I went back to my office realizing that it was always important to not assume that instructions were always understood. There is so much more than prescribing medications and doing a medication reconciliation. It is important to know if there could be potential complications like health illiteracy, cognitive impairment issues, inability to read or write, lack of family support, and a host of other social issues that could affect medication compliance. As we assist our patients to navigate and manage their health needs, nurses as critical thinkers should remember to investigate issues from top to bottom! In this case, June’s labs came out good and she continues to be mildly short of breath and fatigued, a residue from her recent Covid infection. Jennifer, June’s niece reported that the rubber band method is a hit at home and June strums on her medication blister pack while she waits on her water to wash them down! Apparently, June was always a wannabe singer and guitarist who never plucked her courage to act on her dreams. Now she gets to fulfill them with her medication blister pack and her vocals although I am not sure how good she sings! June is a wise woman and knows that it is never too late to follow your dreams! References The Most Common Medication Errors for Seniors, and How to Avoid Them Medication Errors Made By Elderly, Chronically Ill Patients
  2. You may also be interested in Prioritization: Helping New Nurses Transition into Practice. When I've interviewed new graduate nurses about what they find most difficult as they transition from student nurse to professional nurse, the majority admit that they struggle with safe and effective delegation. This is because the artful skill of delegation can take a couple years of experience to master. The mastery of delegation includes transferring responsibility from the nurse to support personnel, while remaining accountable for outcomes of delegated tasks. This role is very different for new grad nurses to get comfortable with, especially since opportunities to practice delegation in nursing school are slim to none. Considering that new grad nurses are hesitant in transferring responsibility of patient care tasks, this brings on additional stress to the transitioning nurse, which often results in poor time management and overwhelming workloads. The truth is that nursing is not a one-person job. It takes an entire team to safely and effectively care for patients. Since it is essential for nursing to remain a team effort, it is vital that the new nurse master strategies for safe and effective delegation. How To Delegate Effectively and Safely STEP 1 This is a test. Ask yourself: "When should I delegate?" When in doubt, you should consider to NEVER delegate what you can E.A.T. Remember that RNs are responsible for Evaluating, Assessing and Teaching. Once the RN has assessed the patient and considers the condition and needs of the patient, delegation can begin. Let's not forget that initial assessment (including vital signs) are to be done by the RN, and therefore should not be delegated to the nursing assistant. Once you have assessed your patients and have considered their needs, now you can begin to think about whom you may delegate to. STEP 2 Carefully consider competence of support personnel It is essential for the nurse to understand the skill set of each team member to match the task assignments appropriately. An easy way to accomplish this is to know your co-workers. You will want to be able to answer these questions before choosing whom to delegate to: Are they licensed or unlicensed? How long have they worked within their role? Have they been validated for competence in performing the task? Will they feel confident that they can safely and effectively perform the task? Do they need any additional training or instruction to complete the task independently? Once you have asked yourself these questions, you will be able to safely move onto providing instructions for the delegated tasks. STEP 3 Clearly communicate when delegating For tasks to be effectively and safely delegated, you must give clear, concise and detailed instruction to the support personnel. This will include purpose, limits and expected outcomes of the task. Additionally, you must ensure that the person to assume the task can complete it within an expected time frame. You should consider that the person you are delegating to will be working with several other patients, so be mindful and set realistic and attainable goals. Finally, you should always ask if there are any questions or concerns which will promote clarification and opportunity for supportive personnel to discuss any questions or concerns related to the task. STEP 4 Be available to supervise and give feedback To be sure that the delegated task has been completed appropriately, you will need to offer direct supervision and feedback. You will also need to be available in case an unexpected outcome occurs. Prudent nurses never assume that the task was completed without validating it by checking that all components of the task have been accurately carried out. One way to help the transitioning nurse build strong relationships with nursing support staff, you will want to identify areas of success and offer suggestions for improvement. When your support personnel do a great job, don't forget to say "thank you"-it goes a long way! STEP 5 Always evaluate the outcomes of delegated tasks To ensure that the patient received the care needed and that the team worked together efficiently, RNs must evaluate that task completed is effective and that it met the needs of the patient. If an unexpected outcome occurs, it's important that RNs develop a new plan to correct the deficiencies if possible. Sometimes the RN needs to go back to the drawing board by reassessing the patient and their needs. If this is the case, don't fret - patients are complex and ever-changing, so keep your focus on patient-centered care and you'll develop the most appropriate care plan for your patient. So as you hit the floor running, remember that learning to delegate effectively and safely takes time and diligent practice. One final tip - be sure to always follow the nursing process and find areas to improve upon your practice every single day. Before you know it, you'll be confidently, effectively, and safely delegating tasks to your nursing supportive personnel. Good luck -you got this! If you have any tips for effective and safe delegation, please feel free to share your thoughts in the comments section below!
  3. The Boss, and it's Urgent My phone buzzed. It was a Friday night, but it was my boss, so I picked up. “Beth, please, please, can you come in tomorrow to orient a group of California Department of Public Health (CDPH) Strike Force Nurses?” “Who? What? Tomorrow...on Saturday?” “Yes, it’s urgent. They need mask-fit testing and skills validation before we can send them to the floor. They’ll be flying in in the morning, and be escorted straight to Human Resources. Charlene in HR is coming in to do their ID badges. They’re only here for 72 hours, they’ll go straight to the floor from you, and then work Sunday, Monday and Tuesday”. “That’s it? Seventy-two hours?” It sounded crazy to me, but we were in surge and desperate for nurses. Many of our own nurses were off sick themselves or working far too much overtime. The CDPH Strike Force CDPH had apparently reached out and contacted active and non-active CA nurses to recruit them to work short contracts during the pandemic. They were assured that they would be of help no matter what their background, and that they would be doing a great service in time of the pandemic. Our hospital was in disaster staffing mode, and nurses were streaming in from all different agencies to be oriented and sent to the floors. My job was to make sure they were competent on our Alaris infusion pumps and glucometer machines, to validate their Restraint competencies, and make sure they could document in our platform, Cerner. It was basically a week's orientation compressed to one day. Saturday morning I turned up early at 0730 to greet the new nurses. At 0800, a group of four nurses walked in. "Oh. My. Goodness.", I thought. This was a non-nurse-looking group if ever there was one. Hippy Harry Leading the pack was Hippy Harry. He walked in wearing a triangular red bandana on his deeply tanned and lined face, like a cowboy on a movie set. He wore a black T-shirt, khaki cargo shorts, leather sandals, and sported a puka shell necklace. Whenever he talked, his makeshift bandana slipped down off of his nose. I pointedly handed him a surgical mask and he reluctantly stuffed his red bandana into one of his pockets, donning the mask. I learned Hippy Harry had been volunteering in Africa and had not worked in a hospital in 15 years. I guessed Harry to be 73, but he volunteered that he was 68. He was warm and charming with twinkly blue eyes, and he struck me as quite the ladies man. Geriatric Barbie Next was Geriatric Barbie, a frail-looking, petite, retired school nurse in a pastel blue matching sweater set complete with a strand of pearls. She had bony hands with age spots and pink painted nails. Her manner was kind and gentle, and she really tried, but after several attempts, Barbie simply could not bar code scan the glucometer strips. Later, while I was teaching basic computer documentation, she needed 1:1 help with commands such as “right-click” and “re-size your window”. Dapper Dan Dapper Dan was a tall man with a chiseled face and artfully trimmed beard, looking as if he’d stepped right off of a GQ magazine cover. I could not mask-fit test him because of the beard and asked if he’d shave it. He stroked his jaw protectively “No way, my partner would kill me”. ‘OK, well, last I heard we were out of PAPRs but let me check again”. “Thanks”, said Dan, “and, I’ll need some scrubs to change into. Size medium but medium/tall if you have them. The agency said you’d provide them”. Right. Let's see if I can get those from Surgery. Tattoo Tonya Next was Tattoo Tonya. In the computer room when I was standing over her is when I first noticed the tattoos on her scalp, in between her dyed-blonde cornrows. The tats were black and swirly, vaguely matching the ones on her arms. She had ear cuffs and a nose piercing. She picked up on everything super fast, and leaned in to help Barbie frequently. It didn’t take long before I saw past her colorful presentation and realized she was the star of the group. She documented easily in Cerner and knew how to use the Alaris pump and NovaStat strip. I had no qualms sending her to ICU. Nurse Beth Pulls it All Together While they were busy on the computer, I started to make preceptor arrangements. I called the ICU Charge Nurse to find a preceptor for Hippy Harry. “Hi Ashley, I know you’re busy but I have a Strike Force nurse here who needs to be precepted from 1400-1930 today.” “Beth, my preceptors are all so burned out <sigh>, I hate to ask them. Let me ask Lindsey...no, she already has someone with her. I’ll call you back”. Later, Ashley called to say she had persuaded Stephanie to precept Harry. “Ashley, thank you so much! I appreciate it”. Right about then, Harry approached me. “Beth, I know I’m hired for ICU- and I can do it, don’t get me wrong, but you know- it’s been a while. I think I’d be more comfortable in ED”. He smiled charmingly and all I could say was, “Let me call ED and see what I can do”. After all, they were volunteers, right? ..Update Monday morning Harry walked into my office, hospital-issued scrubs neatly folded and badge in extended hand. “I’ve realized this just isn’t going to work out. I worked a half shift in ED and things have changed too much. I'm too far behind. I’m sorry to have taken up your time.” I smiled ruefully. It had truly been my pleasure to meet Harry and the whole group. Perhaps Harry was a romantic, responding to the plea for help, and seeking an adventure. I wished him the best. Later, I talked with Karen, the ICU educator. She said Barbie was not assigned patients but kept herself busy by going around patting patient’s hands and smoothing their covers. She was going to work one more shift. Tonya was a superstar as predicted and they were trying to recruit her to stay longer. A PAPR was found for Dan but it was discovered he did not pass his Basic Arrhythmia exam and he had to be pulled from the floor. Then she confided a bit of gossip. Apparently Harry and Barbie had spent quite a bit of time together in the hotel. Actually, the term “hooked-up” was used. Maybe Harry found his romance and adventure, after all.
  4. Patient Presentation "She did what?!" "Yup! She threw the stool and urine straight at Dr. Clean!" "You gotta be kidding! So what's her story?" "Well! Apparently they found her 2 days ago at GreenMart unconscious by the milk refrigerator. One of the employees called 911 and they brought her here. They can't figure out what language she speaks. She has no ID or cell phone." "Great! So what's the plan for her?" "We don't know her history but she might be Diabetic. Her finger-stick glucose at the scene was 46. So the glucose is being monitored. Her labs were OK and her EKG and chest X-ray were negative. Since she was combative, she was restrained. She has been registered as Jane Doe!" "Looks like this is going to be an interesting day! See you tonight?" "I'll be here!" "Well, get some sleep, Tess. Thanks for the report." Tess turned as she reached the door and laughed. "Annie, she spits across the room! Be careful!" I sighed and shook my head. "Just what I wanted to hear to start my day!" Nursing Assessment I made quick rounds on all patients and peered through the door glass into Jane Doe's room. She looked like she was sleeping. Her telemetry rhythm was sinus and the vitals on the telemetry monitor at the nurse's station was within normal range. Her next order was for a finger-stick glucose in 2 hours, so I had some time. I quickly settled my other patients, scanned through her paper chart and then gowned up in full PPE's before I opened the door softly. These were before the days of formal language interpreters, electronic charts and iphones. I walked closer to the bed and silently observed her sleeping. Her hair was uncombed and there were tear stains on her cheeks. Her hands and legs were tied. She wore a long gown and a scarf lay on the floor amidst straws and blood soaked gauge and band aids. One of the hands was in a fist and was clutching on to something. I took a step forward and peered at it. It was a wooden Tasbih, an Islamic prayer bead. The woman was a Muslim! She probably had a dialect that was Beuodian (an ethnic group of nomadic Arabs). How Did I know All of This? Five years before, I was working in Saudi Arabia in a remote village with Beuodians and spoke fluent Arabic. I knew their culture, customs and dressing. This woman was most probably from Saudi Arabia. I went over and took the scarf and shook it. It looked clean. I went and touched her arm gently. Her eyes flew open and she stared at me with frightened eyes. I must have not inspired any confidence in my full PPEs! Praying that she wouldn't spit at me, I took off my face shield and mask so that she could see my face. "Salam Malaekum Ukht " (pronounced uktu) meaning greetings sister! Tears pooled in her eyes as she whispered back, "Malekum Salam" (greeting to you!) I motioned with my hand and spoke to her in Arabic. "May I put your scarf back on your head?" She nodded, the tears flowing freely now. I gently combed her hair with my hands and tied the scarf around her hair. For an orthodox Muslim woman leaving her hair uncovered for others to see is considered "haram"(forbidden) and a scarf or Hijab is an easily identifiable sign of her faith. Just like some people wear a cross as a Christian identity. Gaining Trust Putting her scarf back on showed my respect for her and her faith. This also was a tiny step to gain her trust. I gently patted her hand and pulled up a chair and sat by her bed. Even though I spoke Arabic well, her dialect was hard to understand. The words poured out amidst sobs. She kept saying the words over and over again. "Untie me now! Please. Untie me now!" I raised my hand slightly and spoke to her. "First give me your name." "Saida." "What is your husband's name?" "Ismail Mohamed". "OK. Do you know your address?" "No." "Do you know his phone number?" "Yes." "That's very good. Give me the number." I wrote it down and then touched her. "I am going to untie your hands now. Promise you won't hurt me." "I won't." I gingerly untied her hands (left the legs tied, just in case she lunged at me). Massaging her reddened wrists with some hospital lotion, I smiled at her and asked, "Shall we call your husband?" She sat up eagerly as I dialed out and was connected to her frantic husband. I calmed him down, told him what happened and gave him the phone number to the room and the address of the hospital. Saida tearfully spoke to him. I found out that they had come to visit their son Ali in New York and only been in the country for 2 weeks. The first week, the father had a fall, broke his ankle and was on bed rest. Ali gave his mother money and taught her to buy essentials like milk, eggs and cheese from the local Greenmart. He went out of town for the weekend on work and the father did not have his number. Ali had given his contact numbers to the mother who had kept it safely in the apartment! Anyway, he was supposed to come back that night. The father did not know the emergency systems (call 911, call hospitals, police, etc.) and barely spoke English. So he was home worried and helpless. Now that Saida was calmer, I untied her legs, took her to the bathroom and helped her with a warm shower and a clean gown. I put her back on the phone with her husband and made her a cup of hot tea. Her finger-stick glucose and vitals were fine. Her husband had given me a brief medical history-HTN, DM and an allergy to Penicillin. No surgeries in the past and 2 hypoglycemic episodes a few months ago in their country, Saudi Arabia. I called Dr. Clean who was very glad to hear the news, discontinued the restraint order and asked me that he be paged as soon as the son arrived. Ismail, her husband, was going to send their son Ali to the hospital as soon as he came back. I called and alerted the security desk and let them know to let him up whatever time he came, given the circumstances. I then called the kitchen and requested a tray with rice, salad, fish and olives. I also got her a stash of teabags and sweet and low instead of sugar! I also gave her a cotton sling wrap to cover her hair as she had washed her scarf and it was hanging in the bathroom to dry! We both laughed when she put it on, as it looked so different from her ornate scarf!! I also called the Nursing office and asked for help to get an Arabic interpreter ASAP. I went back to my other patients and checked in on her periodically. She was a bit anxious but otherwise a model patient for the rest of the shift! When Tess came back that night to get report, I showed her a wet spot on my uniform (water spill) and mournfully told her "Spit" to pull her leg! I then told her what happened and that it was not spit! She promised to look out for the son Ali and page Dr. Clean when he arrived at the hospital. I told Saida that I would be back the next day and went home feeling good inside. Cultural Competence and Knowledge On Other Faiths Looking back to this incident, I realize the importance of cultural competence and knowledge on other faiths and what is important to them. EMS was following protocol when they removed the scarf and put her on a C-Spine collar and board. She grew agitated when she saw where she was, couldn't communicate and had her hair uncovered. It just went downhill from there! As a new graduate, I had gone and worked in a remote village in Saudia as a Public Health Nurse with poor nomadic villagers while my classmates landed hospital jobs from Medical Surgical, Telemetry, ED, ICU, CCU to NICUs and Cath labs. I always wondered what good my experiences there would be in America and worried that I did not have their kind of expertise. I realize now that my experience there helped the right patient at the right time and made a difference in Saida's life at that moment. Even later on in life, the Saudian experience has served me to break the ice and gain the trust of many Muslim patients especially post 911, when many innocent Muslims were targeted. At the end of the day, I find all experiences useful to bring warmth and kindness, when our patients are at their most vulnerable. Patient Discharge Teaching Saida was discharged the next day home and showered me with blessings before she left. When discharging her, I reminded her to always carry some ID, a phone and a medical card with medication names and allergies in her purse. She shook her head and said she was not stepping out of the apartment again! Matter of fact, she just wanted to go back home to Saudia with her husband! I told her that Inshallah (God willing/by the grace of God) things would get better and she would start enjoying her visit! We also reviewed DM, causes, treatment, diet and signs and symptoms and treatment of hypoglycemia and hyperglycemia before they left the hospital. She came back with Ali, a week later, with a gift for me - a Tasbih (prayer beads). I have it next to my rosary! References American Diabetes Association (ADA)
  5. At some point in our lives we all decided to become a Nurse. Maybe some of us decided to be a Nurse after reading the stories on www.acrestn.com. Now, some of us have days when we feel defeated and want to quit and never look back. Other days, we know we've made significant differences in the lives of our patients and are convinced we've made the right career move. Do you remember when and why YOU decided to become a Nurse? allnurses welcomes you to share your stories.
  6. "Go check the waiting room!" I looked up sharply from the ER nursing schedules I was doing. It was 10:30 p.m. I would be done by 11 p.m. Did I hear that or was it my imagination? There was no one in the office but me! I got up and stretched. Slipping on my white coat and stethoscope I walked out to the waiting room. It was packed. I stood by the security desk casually making conversation with Tony, the guard while my eyes swept across the big room. Hopeful eyes looked at me. My eyes stopped at the older African American gentleman sitting quietly between four young white men. He was answering their questions in monosyllables. I saw them exchange worried glances at each other. I walked towards them observing the grey pallor on the man's skin. "Something is wrong" ... "Hi, I am Annie the ED manager. Who is the patient here?" One of the young guy's piped up, "It's Mr. Gary!", and nodded toward the older gentleman. "Hi, Mr. Gary! How are you?" "I've had better days!", he mumbled. "And, you are--?" I asked looking at the four young men. "We are Gary's friends. We work together as caddies at the Green Meadows Golf Course!" "OK! So what's going on? Why did you come to the ER?" "Cause, something is wrong! This is just not him!" "What do you mean?" "Gary is very fun loving and is always joking around! He has changed in the last one month!" "Yeah! Ever since the fall!", one of the other guys chimed in. "What fall?" I asked casually as I watched Gary rubbing his temples. "He fell backward last month. I think he slipped. He was checked out in the ER and was sent home. He's been different since then! He's very lethargic!" "His balance is off and he vomited today!" "Mr. Gary! Do you have a headache?" "Yes! The worst headache in my life!" "Have you been taking something for it?" "Been popping Aspirins and motrins! Nothings working!" History, Assessment and Action "Let's get you in. I am going to triage you inside!" I grabbed a wheelchair and told his friends to wait outside. As Tony, the security guard, swiped me into the ED, I motioned Claire the secretary and asked her to send in for a stat registration to stretcher A1. "Any medical problems?" "I have a funny heart rhythm! Can't remember the name!" "Atrial Fibrillation?" "Yes!" "Are you on coumadin or warfarin, which is a blood thinner?" "Yes, 7.5 mg every night!" I groaned inwardly. He could be a bleed! I had Joan, the ED tech, hook him up to a monitor, get vitals and a stat EKG as I triaged him. Got Vilma, the nurse, to throw in 2 large bore lines in him and send labs including Type and screen. I went over to Rick, one of the Attendings in the ED. "Rick! We may have a bleed. Guy in A1, name's Gary, 72 years old, no allergies, had a fall 1 month ago and has the worst headache of his life. He has been taking Asprin, motrin and coumadin! A Perfect cocktail! His friends noticed a change in his behavior and brought him to the ED!" "Great! Let's get a stat CT Head!" He quickly examined Gary while I called over to CAT scan and informed them. Within 10 minutes we were looking at the films with the neurologist who we paged - a large subdural bleed. It was a short matter of time before his airway got compromised! Gary was getting disoriented. He was electively intubated and arrangements made for his transfer to our main hospital Neuro ICU. Vilma gave report and Claire called for an ACLS transport. It was 11:30 p.m. "He's like a dad to us" I went outside to speak to Gary's friends! "How is he doing?" They were all anxious as they had not seen him for an hour. "Well! He is stable and I want to thank you for being good friends!" "What's going on?" "Your friend Gary was behaving differently because he was having a bleed in his head! It was getting worse as it was causing a headache and Gary was taking medications for the headache like motrin and aspirin that are blood thinners and made him bleed more, a vicious cycle. He is also on a blood thinner coumadin which worsened the problem!" "Is he bleeding in the head?" "Yes, the bleed is putting pressure on his brain and so we had to intubate him as it would affect his breathing at any point." "He's on a ventilator?" "Yes, he is. The good news is that his vitals are good but he needs to be transferred over to our main hospital for further treatment. Does he have family?" "He has a sister in North Carolina but we are his family here!" "OK! That's good! I will have Vilma, his nurse, keep you informed. If you can find out his sister's information, let Vilma know!" "OK ! We will! Thanks, Nurse Annie!" "Thank you! Gary has great friends in you! You saved his life bringing him in today!" "He's like a dad to us! We just want him to be OK!" Reflection I smiled and walked away back to my office thanking God for the humanity those young men, all New Yorkers, showed to their coworker despite their age and racial differences! As I headed out of the ambulance bay, Gary was being loaded up for the transfer by the ACLS team. The young men anxiously watched and planned to follow him to the main hospital. As I drove home, I reflected on the story of the good Samaritan and thought of the right choices those men made to help Gary! I wondered which of their Guardian Angel's spoke to me in my office! I had plenty to choose from! Thank God for good people in the world! References/Resources WebMD: Subdural Hematoma
  7. I remember when I first made the decision to go to nursing school. I was 31-years-old and struggling with the idea that I had spent 9 years working in a career that I didn't really like. In fact, I hated my profession. I had spent nearly a decade selling medical equipment to hospital operating rooms, traveling up and down the west coast, schmoozing with doctors and hospital purchasing managers so they would buy my stuff. But even though my heart wasn't passionate about my profession at the time, I was passionate about working hard and performing well. So, each year I met my professional goals and advanced in the profession. Which, in turn, also made it harder for me to leave. But then one day, it hit me. I didn't want to just work in the medical profession. I wanted to be an actual medical professional. I remember thinking how bored I was sitting on the sidelines as a device rep, watching procedures and literally thinking, "this is SO lame, please shoot me!" So (a few mental breakdowns later) I finally did it. I signed up for the 7 prerequisite science classes that I needed to take before I was even able to apply to nursing school (as a prior journalism major, I hadn't taken very many science classes at that point). I took my classes in the evenings after work. And I started studying to take the TEAS. It all took me about a year to complete, and in 2010 I started my journey to become a nurse. Things You Need To Know... #1 Nursing school is crazy hard (and expensive) Not only will you have daily classes, labs, weekly exams, and intense competition from classmates, but you will also be working clinical shifts as a student nurse. Many nursing programs also advise against outside work during the program because they warm that you won't be able to keep up with the work. And in California (like many other states), hospitals are no longer hire nurses who don't have a BSN. As a result, many nurses are graduating from nursing school with 50-100K or more in student loan debt. #2 You will probably have to work night shifts, at least in the beginning Nurses are needed 24 hours a day, 365 days a year. Since many nurses don't want to work all night, seniority is often the deciding factor when it comes to assigning nurses to the day shifts. Some hospital units even have a rule that new nurses must work night shifts for at least the first few years of being there. You will want to invest in a great set of blackout shades, at least one pair of blue blocker sunglasses, and a box of ear plugs (so the guy mowing his lawn at 1100 doesn't wake you up). #3 Working three days a week as a nurse isn't as easy as it sounds I remember thinking how awesome it would be to only have to work 3 days a week. I mean come on, its only 3 days! But that also means that the days you do work are incredibly long. Nursing shifts are often advertised as being 12 hours, but they are actually more like 14-16 hours once you factor in oncoming nurse reports, overtime due to short-staffing, and your commute to and from work. #4 You will be afraid that you might kill someone This one is a real fear because, for example, if a nurse makes a medication error or forgets to check vitals or a patient's neuro status's per order, then you actually accidentally could kill someone. But as you grow more tenured in your career, you develop a sixth sense for things that might go wrong and you figure out how to triple check in the most time-crunched circumstances. And you learn how to assess your patients quickly enough that if there are any vital or neuro status changes, that you can get the help you need before things go downhill. #5 You will learn to balance more information then you have ever had to before There really is no such thing as multitasking, because our brains can't actually focus on more then one things at the exact same time. But nurses developed the uncanny ability to juggle multiple ongoing tasks for multiple patients for up to 12 hours a day - such as medical orders, patient requests, vital signs, medications, allergies to medications, lab values, care plans, etc ... We forget too eat and pee all day, but we remember the important medical information we need to know for our patients. Being a nurse stretches your brain further then you even thought it could go. #6 Nurse abuse really does happen Sadly, abuse against nurses isn't uncommon. In fact, nurses are expected to put up with levels of abuse that would NEVER be acceptable in just about any other professional setting. I have been cussed at more times than I can count, in just about every colorful way you could imagine, for just doing my job. Even worse, violence against nurses is prevalent (especially emergency room nurses) and it usually isn’t even routinely tracked. I have been lucky not to find myself the victim of direct physical violence as a nurse as of yet. Many nurses have not been so not lucky. #7 Your whole body will start to hurt There is alarming evidence now that even proper lifting techniques expose nurses’s spines to dangerous forces. If that's not bad enough, chronic back pain in the nursing population is a common ailment. An evidenced-based review at the Texas Women’s University reported that estimates of chronic low back pain among nurses range from 50%-80%. You may not be able to escape some of the wear and tear from being a nurse at the bedside. However, you can pick up healthy habits outside of the hospital like yoga, running or weightlifting to help recuperate on your days off. #8 You will find that there are multiple types of job opportunities away from the bedside One thing that I Iove about being a nurse is that there are so many job opportunities away from the bedside for nurses. So even if you decide that beside nursing isn't for you anymore, there are other nurse occupations to look into. Here are a few examples from some of my nurse peers: aesthetics nursing legal nurse consultant nurse blogger/freelance writer medical/pharmaceutical sales professional nurse coach nurse recruiter Despite the Intensity, I Love Being a Nurse I'm proud of what I do to help humankind, all within a 12-hour shift. I get to help people in some of the worst moments of their lives, and I am surrounded by other co-workers who enjoy being helpful as much as I do. And, I am always being inspired to keep learning more. References Violence against nurses in hospitals not routinely tracked, reported Violence Against Nurses Working in US Emergency Departments Even 'Proper' Technique Exposes Nurses' Spines To Dangerous Forces Mind-Body Exercises for Nurses with Chronic Low Back Pain: An Evidence-Based Review
  8. If you think you know the correct diagnosis for this Case Study (CSI)... DO NOT POST ANSWER HERE. Instead, post your answer in the ADMIN HELP DESK.; We don't want to spoil it for others who are late in joining us. In a few days, after I post the diagnosis, the Admins will announce the names of those members who correctly identified the problem. We hope to turn this into a friendly competition with more Case Studies to come. You CAN post questions and post comments below. BUT... Do NOT post your diagnosis guess below. Disclaimer: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills. Presentation A 45-yr-old, white, premenopausal woman presents for her annual exam. About 5 weeks ago, she noticed a small, painless lump in the upper outer quadrant of her left breast. “I didn’t think much about it because I’ve had so many lumps – they always pop up when I get my period.” She states that usually the lumps become palpable and bother her about 10 days before her menses, but then they go away. Right now, she is about 4 days from her expected date of menstruation. She is a nonsmoker, nondrinker and denies recreational drug use. She only takes PRN medications occasionally. She has a supportive partner and two children ages 13 and 17. Chief Complaint “My breasts have always been cystic, but I found a new lump in my left breast that has me worried.” History of Present Illness She has no history of dysmenorrhea, but the lump hasn’t gone away and seems to have grown in size. She denies tenderness, pain, nipple discharge and skin changes in her breasts and no masses in the axillary region of her left arm are found. She states that she practices breast self-exams, “but not as often as I should.” She has never had a mammogram. Several years ago, she had a breast biopsy that was consistent with fibrocystic changes. Her only Pap smear was done two years ago, and the result was normal. Past Medical History Her medical history is unremarkable except for a broken arm in grade school. Menarche was at age 11. Her first pregnancy was at age 27 and her second at age 32 – both pregnancies were full term and deliveries were vaginal with no complications. Family History Paternal grandmother diagnosed with breast cancer before menopause at age 48. Mother died of breast cancer at age 75, though the cancer was diagnosed when she was 45. She had two periods of long-term remission, but it recurred again 16 years ago. Her father is 88 and has HTN, history of stroke, type 2 DM and Alzheimer’s disease. He lives in a nursing home. Social History Drinks 6-8 cups of coffee weekly, exercises 3x weekly, has a degree in communications from a local college, but she now works as a personal life coach. Allergies Latex and adhesive tape cause a rash. Questions What are the possible reasons for this lump? Is it just another cyst? How many reasons for breast lumps can you come up with off the top of your head? How many risk factors for breast cancer can you spot? What labs do you want? What other diagnostic tests should we run? REMEMBER: DON’T post the ANSWER HERE! Ask questions and I’ll give you more information.
  9. ?? When you need the money, your shift is cancelled; when you have a weekend planned, you have to do overtime. ?? Realizing the patient you've just injected has a serious infection causes you to stab yourself with the used needle. ?? A 500 pound patient needs all care, while your 80 pound patient needs a finger dressing ... and your colleague has a "bad back." ?? It's you're first night shift for three years. And it's a full moon. ?? You're doing the "Only 27 more minutes of the shift from hell happy-dance", only to turn around to see your supervisor standing there. ?? In a critical situation, the most highly qualified clinician will offer the most advice and the least support. ?? The absurdity of the suggestion is directly proportional to the distance from the bedside. ?? As soon as you finish a thirty minute dressing the doctor will come in, and take a look at the wound. ?? The disoriented patient always comes from a Nursing Home whose beautiful paperwork has no phone number on it. ?? Your nose will itch the very moment your gloved hands get contaminated with bodily fluids. ?? The patient who has been dying all night finally meets his maker 12.5 minutes before shift change. ?? You walk out of a patient's room after you've asked them if they need anything: they will put the call bell on as you are about three quarters the way down the hall. ?? The patient furthest away from the nurses' station rings the call bell more often than the patient nearest to the nurses' station. ?? The doctor with the worst handwriting and most original use of the English Language will be responsible for your most critical patient. ?? You always remember "just one more thing" you need after you've gowned, gloved, and masked and gone into that isolation room. ?? The correct depth of compression in adult CPR is a bit less than the depth you just reached when you broke those ribs. ?? When you cancel extra staff because it's so quiet, you are guaranteed a rash of admissions. ?? If you wear a new white uniform, expect to be thrown up on. ?? Corollary: Residents always poop on your brand new shoes. ?? When management smiles at you, be very, very afraid ... ?? Staffing will gladly send you three aides--but you have to float two of your RNs. ?? As soon as you discontinue the IV line, more fluids will be ordered. ?? Mandatory meetings are always scheduled after you've had the night from hell and just want to go home to bed. ?? You always forget what it was you wanted after you get to the supply room. You always remember when you get back to the other end ... ?? Doctors only ask your name when the patient isn't doing well. ?? Success occurs when no one is looking, failure occurs when the boss is watching. ?? As soon as you've ordered the pizzas, 25 patients show up at the ER registration desk along with three ambulances all with cardiac arrests! ?? For every action, there is an equal and opposite criticism. ?? Ten seconds after you have finished giving a complete bed bath and changing the bed, the patient has a giant code brown. ?? If a patient needs four pills, the packet will contain three. ?? Your buddies who were reading the paper at the nurses' desk a minute ago always disappear when you need help ... ?? Expect to get your pay raise the same day the hospital raises the parking rates (and other charges) ?? The better job you do, the more work you can expect to be handed ... ?? The amount of clean linen available is inversely proportional to your immediate needs. ?? The more confused and impulsive a patient is, the less chance there is for a family member or friend to sit with the patient. ?? The perfect nurse for the job will apply the day after that post is filled by some semi qualified idiot. ?? If only one solution can be found for a problem, then it is usually a stupid solution. ?? When the nurse on the preceding shift has surrounded the patient with absorbent pads, the code brown will hit every sheet and miss every pad. ?? Rest assured that when you are in a hurry, the nurse's notes have not been written. ?? When you are starting an IV on an uncooperative patient, or dealing with a huge code brown, there is a phone call for you and it's that crabby physician that you have been paging all morning. ?? Fire drills always occur on your day from hell ?? The first person in line when the clinic opens will not require urgent care. The sickest person will arrive 5 minutes before closing: "I thought I'd feel better" The Nursing Catch-22: If you're running around horribly busy, you're unorganized and need to prioritize, but if you're not running around horribly busy, you're lazy and need to find more work to do. Remember folks - Murphy was an optimist! Add your Murphy's Law below! Murphys-Laws-of-Nursing.pdf
  10. vintagegal

    Quick! Blame the Nurse!

    You have all been there before, no matter what decision you make it’s the wrong one. To give you perspective I am currently working geriatrics and lead a non-nursing team. For awhile it has been a struggle to get the team on board with following protocol, procedures, and general patient safety. Everything turns into an argument and there is no work ethic. I am exhausted with trying to teach a group of people who don’t want to learn, nor are passionate about the group they care for. I end up working 16+ days with no day off because people don’t show up for their shifts or can’t function when I am not there. Don’t get me wrong, not painting the whole team with the same brush. It is just bothersome to me that people would enter this profession if they aren’t serious about it. I have tried to be nice, tried to be understanding, tried to be patient. Nothing I do is working so should I pony up and be a jerk for once and require more of the team? I promised myself I would not be *that* nurse. To make matters worse, I have other areas such as dining, housekeeping, etc. always blaming me for issues I am not responsible for. Doesn’t matter what I do or say, it’s not good enough. Situations I have nothing to do with are always passed off to me. They are practically bullying me out the door. It seems as though EVERYTHING gets blamed on the nurse. I find myself integrating into other areas that I don’t belong in because if I don’t do it, it won’t get done. After patient care, answering phones, the door, and juggling administrative work I am at a loss as to why nobody is acting like a team player. Maybe they are used to me going above and beyond but at this point I am killing myself trying to do it all. My team is not interested in helping me, even though I have always been there for them. When they are falling short of expectation they turn it around on me instead of taking responsibility. I don’t know whether I should give up now and enter a new area of nursing or stick with it and pray it gets better. I have tried everything short of being a nurse ratchet. Advice welcome.
  11. Nurse Beth

    Nurses are Pushed to the Brink

    Greetings from California ?? The situation is dire here, and nurses are spent. I hope it's better in your area. I have an idea of how to make things a little better that I just can't shake. It's a simple idea. Tell me what you think. Short of Beds Patients are lying on hard gurneys inside tents hastily assembled on concrete hospital parking lots. Meanwhile, inside, hospital beds are pulled up from basement storage in and pushed to the end of MedSurg hallways with a privacy screen, a commode, and a handbell. There’s no TV, no call light and of course no bathroom. GI labs and surgery waiting areas are being converted to ICU overflow beds. Patients are even being held in lobbies and gift shops of hospitals that have run out of beds. Short of Nurses Nurses are calling out in droves. Nurses who aren’t sick drag themselves in to work but are physically and emotionally fatigued. Suffering moral distress, some have seen more deaths in the last few months than in their entire career. Holding an ipad so their dying patient can face-time their loved ones to say goodbye is heartbreaking, but there’s no time to recover, even after their patient dies. Arrangements have to be made and the room turned over. An ED patient is waiting in queue for that bed. Nurses talk quietly among themselves about who is the latest one of them to come down with COVID. Even though coworkers are getting sick, vigilance occasionally wanes because it’s exhausting to be on guard for months and months. On guard through Spring, Summer, Fall and now Winter. Most times in break rooms there’s only 2 people eating lunch at opposite ends of the table. But not always. In illogical denial, on one level some healthcare workers believe they won’t get COVID from their bff at work, but at the same time, worry constantly. “How’s my taste? Can I still smell OK? I have a headache. Is this it?” And in the back of every nurse’s mind is the very real fear of infecting their own family. Inside hospitals, everything except for staffing has fallen by the wayside. Education classes are not attended, staff meetings are canceled. Nurses are called to work every day, sometimes twice a day, and offered varying amounts of crisis pay. But $50.00/hr extra is no longer an incentive for nurses who are exhausted as never before. Short of Travel Nurses Hospitals are desperately trying to hire crisis travelers. Federal, state and county government agencies are trying to get healthcare workers to hospitals. The National Guard sent crisis workers. The state sent crisis nurses to work for 48 hrs but some of these nurses had been retired for years (read about crisis nurses Hippy Harry and Geriatric Barbie in Day in the Life of an Educator). Even with lucrative contracts of $180.00 per hour base pay, there are not enough travelers to meet the need. California Ratios In California, nurse-patient ratios were waived by the California Department of Public Health (CDPH). Here are the changes: ICU ratios went from 1:2 to 1:3 Step Down units went from 1:3 to 1:4 MedSurg went from 1:5 to 1:7 Tele went from 1:4 to 1:6 ED went from 1:4 to 1:6 In reality, it’s a moment by moment staffing. Two nurses may take a team of 13 patients, with 1 nurse giving meds and the other doing assessments. If lucky, they may get a “helper nurse” from the OR because surgeries are canceled, but OR nurses aren’t familiar with the meds, have never barcode scanned medications, and have limited experience with computer documentation. Why Not Hire A LOT of Nursing Assistants? If RNs have to double their patient loads, work 16 hr shifts, come in on their days off, and be exposed to COVID, then they should be given all the help possible. Today, in the midst of a national emergency where nurses are central, RNs need to focus on RN tasks. Not clerical tasks. Not housekeeping tasks. Over the years, hospitals have cut nursing assistants and PCTs to the bare minimum, and RNs have picked up the slack. RNs spend a lot of valuable time chasing down supplies, answering phone calls, answering call lights, wheeling patients out for discharge, helping patients and families, sometimes even cleaning beds and turning rooms over. But what if RNs didn’t have to answer call lights? What if all patients were toileted and bathed, ambulated, turned and proned, with water pitchers full and vitals taken? What if? If the RN could focus on RN tasks, she/he could safely handle a higher workload. This isn’t about RNs being too good to perform non-RN tasks. It’s about patient safety and maximizing RNs when they’re overburdened. Would it be helpful if a surgeon on his way to perform an emergency surgery stopped to answer a call light, make and serve coffee? How about turning the buzzword “working to the top of your license” into a reality? I’m talking about hiring a lot of nursing assistants and PCTs. Flood the units with them. Is there really no money to hire unlicensed personnel? Paying RNs $180.00 per hour while having 1 nursing assistant per 15 patients is stepping over a dollar to pick up a dime. If a massive number of nursing assistants had been recruited and hired just a month or two ago, there would be some relief today for nurses and more help for patients. Hopefully, it can still happen. What other ideas might help? Having clinical pharmacists pass meds? Have lab techs perform all draws, or as many as able? GI techs and OR techs can go to the floors and help patients call their families, or run to Distribution to pick up supplies. Just my thoughts, thanks for reading. What do you think? Be well and stay safe. Best wishes, Nurse Beth
  12. missnursingstudent19

    So Sick Of Rudeness At Work

    1. A patient was about 2 seconds from leaving AMA so I paged the MD because that’s the quickest way to get in touch. “First of all let me just say that I don’t like to be paged.” Like, the patient could have been coding, you don’t know why I paged yet so why start off like that instead of ensuring that the patient is OK? 2. Coworker helping me change ostomy which I don’t have much experience with. I was hesitating to stick on the pouch because I knew it had to go on a certain way but wasn’t sure how. “Just stick it on!” So I stick it on. “OMG be careful, it has to go on a certain way!!” 3. Walking out of the nurses' station to go give med. call light phone is dinging. Coworker sitting at desk charting says “Do you ever answer the call light?!” 4. Taking report. Go to one patient's room who says “?????? she doesn’t have my medicine in her hand!” So I say “I’m sorry, I just got here. I’ll go and get your pain medicine.” Even though I still had one more nurse to get report from. As I’m in this patient’s room giving the pain meds, the nurse who I still need to get report from comes in the room and says “What are you doing? I’m ready to give report” I’m just over it. It’s tough times right now so please let’s just all be kind.
  13. My mouth fell open! I rubbed my eyes and read the message from the patient again that had been sent 20 minutes ago! I had just received an urgent warm handoff by phone from one of the phone bank staff that received this message. The message from the patient stated that she felt that she was going to die. It went on to describe the kind of funeral she wanted, specifics on the coffin-white cherubs on them, and which cemetery she wanted to be buried next to her closest relative! I glanced at the clock at 2.30 pm and quickly scanned her chart-Young noncompliant female with multiple commodities, on three antihypertensives with a history of manic depressive psychosis, depression, substance abuse, and domestic violence. Was this a medical issue or a psychiatric issue? Only Philomena, the patient could tell me! I pulled up a phone note and called the five numbers listed one after the other. I was able to leave a message on one of the numbers but the patient never picked up. I looked at the clock - 2:37 pm. I called 911 and was connected to Emergency Medical Services. I read the note out, gave them a brief history including allergies (none), the patient's address, and my callback number. I then called the patient's emergency contact and Linda her friend, picked up. I asked her if she had a number for Philomena. She gave me a sixth number and told me that she just got off the phone with the patient. My mind racing, I casually asked her how she sounded. "She seems fine. Laughing and talking!" "Did she sound depressed?" "Not at all. We spoke for around 20 minutes!" "Thanks! Let me try that number!" I hung up and called the patient who picked up! "Hi, this is Dr. Annie from the clinic. I work with Dr. Smith, your doctor. May I speak to Philomena?" "This is she!" "Hi! Philomena! We got your message. Are you OK? What's going on and how can I help you?" "Oh! I have a killer headache and feel like something bad is going to happen!" "I see! Did you take your meds and eat anything today?" "Yes! I can't get my pressure under control!" "Anything else going on? Are you depressed? Do you feel like you want to hurt yourself or someone else?" "Not at all!" "OK! I have already called an ambulance. Please unlock your door, get dressed, and have your purse ready. Take your meds in a bag and make sure you have your insurance card. They should be there in the next 15 minutes." "OK. Thanks! I will !" "Philomena, call me if you can't get through to the clinic for any issues. May I give you my number?" She took my number and I hung up. I called 911 and asked them to connect me to EMS dispatch. They did once I gave them the patient's address. I spoke to EMS and told them that it was a medical issue probably a hypertensive crisis and definitely not psych. They thanked me. I called the PCP on his cell (he was working from home doing telephone visits )and informed him. He told me this patient's issues were complicated by her noncompliance and psych issues. I give him her number and he told me he was going to call her in the evening. This was a Friday. The clinic was closed for the weekend. I called back the patient on Monday. She told me that she was in the ICU and her BP in the ED WAS 240/130. Since she was in a different hospital from our system, I did not have access to her information. I spoke to the ICU nurse who cited HIPAA and would not speak to me! I gave her our contact numbers and she promised to have the doctor call back but no one did. I kept in touch with the pt and finally got to talk to her team when she was sent to step down. She was positive for drugs on the urine toxicology screen. She was being treated for hypertension and now Clostridium difficile colitis. Apparently, she was sent home with a prescription which she never filled. She never picked up her phone for 2 weeks. Our calls and messages went unanswered. The next time she called me she was back in the ED with worsening renal function. She refused dialysis as she stated that she had some bad examples. Her mother died after having issues with her shunt and a roommate died too. I discussed her risk factors, family history, and her ongoing issues with her blood pressure. We discussed hemodialysis, peritoneal dialysis and even being on the transplant list. "I don't want to live hooked up on a machine, I would rather die!' "I get it that you are afraid but you may not die as soon as you wish. You could have a long drawn out affair and also end up with a bleed or stroke! It is your choice. You are 38 years old and you have your whole life ahead of you! What do YOU want for yourself!" "I am very independent. I want to live my life MY way!" "Alright! It's your body and I will respect your choices. Call me if I can be of any help!" "Thank you! Merry Christmas and Happy New Year Dr. Annie! Thank you for being concerned about me! I have your number and will call you if I need you!" "OK! Philomena! Stay safe!" I had to back off and watch an impending train wreck. Last week, I called her. She is back in the ED, this time has a head bleed and HTN. She was waiting for a bed upstairs for four days. Dr. Smith and I called and spoke to the ED attending. They thought she was still using drugs in the ED as every time she came out of the bathroom, her pressures spiked up and she looked spacey. I am not sure, why they didn't do a check on her, but then she can be very convincing and talk her way out of anything apparently! Her partner at home is on drugs. We hope she comes out of this, consider emergency dialysis, and get her blood pressure back to a normal range. Otherwise, it is only a matter of time before I see her in her coffin with white cherubs! It is a hard pill to swallow! You can't save them all! You can only try your best! References: Hypertensive Crisis: When You Should Call 911 for High Blood Pressure
  14. I sighed! I was not looking forward to making this call. I had 14 more triages to check online and I knew this call was going to take time. The patient was deaf and mute and was at home. I was calling from the clinic and it was really hard to get the sign language interpreter on the phone. As expected, I got the run around for 15 minutes before I was finally connected. The interpreter connected me to the patient. "Hi, Sam. This is Dr. Annie. I am a registered nurse calling from your doctor's office. We got your message that you are feeling dizzy. How are you feeling now?" Silence. I waited patiently. The interpreter began answering for him. "I am still feeling dizzy. The world is spinning!" "Did you eat today?" "Yes!" "Any headache or blurry vision?" "No." I scanned his chart and saw that he had multiple visits to the ED for the same complaint. His last CAT scan of the head was negative. "Sam, do you notice that your dizziness comes on when you change position from say lying down to sitting?" "Yes!" "What about when you move your head or bend down?" "Yes all the time. I have a problem at work!" "Really? What kind of work do you do?" "I wash dishes in a hospital cafeteria and in the kitchen. Been doing that for the last twenty years!" "That is amazing. You sound like a loyal employee! Do you have to bend to pick up the dishes?" "Yes!" "Sam, do you get frequent colds, runny nose, or allergies? "Yes, allergies all the time!" "Sam, can I tell you what might be happening with you?" "Yes please. I get scared and don't want this to happen." "OK, I think this may be a problem with your balance. This is from a problem in your inner ear, which we can't see!" "My ear? I don't have any pain in it!" "You don't have to have pain. When you have allergies and your nose is stuffy, the inflammation travels to your inner ear and increases fluid production. The inner ear deals with balance and every time there is a sudden change in movement, it triggers the brain and you get signs and symptoms of imbalance like dizziness, nausea, unsteady gait, feeling like you are going to fall or pass out." "What! I thought I was having a stroke and something was wrong like a tumor. How come nobody told me? I went so many times to the ER!" "I see that you have been to the ER many times recently. Let me tell you what will help you at home!" "Go ahead!" "OK. The first thing is to remember to do everything slowly. Give yourself time when you get up. Sit for 2 minutes before you stand up!" "I see! I always jump out of bed and get dizzy!" "So, slowly like Justin Bieber says, "Pasito a pasito, suave suavecito! I say Pokito Pokito!" The interpreter states that Sam is laughing and nodding his head! "Sam, you need to bend with your knees not head when picking up anything. Bending the head triggers the inner ear. It's like keeping each leg on a different boat!" "That makes sense!" "Sam, another thing that helps is to open your mouth when you blow your nose. It helps with too much pressure not going into your ear. It is a bit difficult but will come with practice!" "I will try that!" "Sam, do you have constipation?" "Sometimes!" "OK, increase drinking water, eat salad and fruits, and when you are in the bathroom, don't bear down but pant like this ... huh, huh, huh ... when pooping. Bearing down to poop will trigger the dizziness!" "I wish I knew this before! I always felt dizzy in the bathroom! Now I know why!" "So try it, Sam, and see if it helps you!" "I will!" "In case you tried everything but still feel dizzy, lie down for half-hour and don't move. Pretend you are a dead body, close your eyes but don't forget to breathe! The dizziness will subside!" "I will do that!" "How do you go to work? Do you drive?" "No, I ride my bike! I need to slow down now. I used to weave in and out of traffic!" (Ah! I finally get to meet a weaver! Drives me insane but that's another story ... !) "Sam, when you look at things from the corner of your eye, it can trigger dizziness. You need to look directly and don't whip your hair, sorry, head back and forth!" "That's a Jade Smith song! I whip my hair back and forth!" "True, Sam. I see you know your singers!" The interpreter informs me that patient is laughing! "I think slowing down would be a very smart thing to do, Sam! You could also keep the dishes a little higher and closer to you so that you don't have to constantly bend!" "I am going to try all this. Thank you so much!" "You're welcome, Sam. I am going to give you a telephone visit with your doctor so that you can follow up." I made him a telephone appointment with his Primary Care Provider and gave him the information. "Thank you so much. I think this new year I won't need an ER visit! "I hope so, Sam! Happy New Year!" "Thank you! You, too!" I thanked the interpreter and hung up and went back to triaging! References Labyrinthitis and Vestibular Neuritis Labyrinthitis
  15. Joe V

    Many Faces of Nursing

    We learned all about various nursing specialties in school, but we were never told there would be days like this. So many faces in one shift! Have you counted how many faces you have each shift?
  16. I work as a charge nurse in an ICU. I am having a problem with a nurse sleeping while on duty. I'm not talking about sleeping while on her 30 minute, unpaid break but rather, sleeping for hours at a time, every single shift. She doesn't let anyone know, she just disappears into the computer room at the back of the unit or into the family conference room and sleeps. Her patient's end up being horribly neglected all night as a result and the other nurses on the unit end up picking up her slack by having to answer her call lights or silencing her pumps. Not too long ago, one of her patient's coded and, while I have no proof of this, I strongly suspect she was sleeping just before it happened. I have spoken directly to her about. I wake her up every time I find her sleeping. I have went to management about it. Nothing works. It seems like management couldn't care less about the situation and, since she keeps getting away with it, the behavior continues. I have no idea what to do about it now. I just feel like eventually a patient is going to be harmed and/or will die as a result of her sleeping. What would you do in this situation?
  17. Hi, my name is AngelfireRN, I'll be your nurse tonight. I am not a waitress, nor am I your slave. Yelling and hurling obscenities at me will not get you your pain meds any sooner than they are ordered. Nor will having your family member or entourage do the same. Threatening lawsuits and having umpteen family members camp out in the halls or hold up the nurse's station will not get you preferential treatment. Physically grabbing me as I go down the hall is NOT a good idea. I do not give the orders, but I do have to follow/enforce them. This is something that you should take up with your doctor. No, I will not call him again to ask him for more pain medicine. He has been called twice and has said no both times. No, I will not give you his number so you can "straighten him out". No, you are not my only patient, and I highly doubt that you are single-handedly paying my salary. On the off chance that you are, let's talk about a raise. NO, NO, NO, I most empahatically will NOT come get you when it is time for your next pain shot while you are having a smoke break. I also will not bring it to you in the smoking room. (Have actually said that, I am allergic to cigarettes. I did it once, had an asthma attack, desatted to 83, and turned blue, according to the patient and my charge nurse, after the patient had to help me back to the floor). No, I don't really care if your family has not eaten all day, they drove here by themselves, they are not sick, and no, I will not call for 6 guest trays. (This of course, is if the patient in question does not need all 6 family members present, and is not at death's door). No, you may not have 3 six-packs of soda from the kitchen, there are other people that would like a snack, too. No, they will not open up the kitchen up just for you, at 1 in the morning, because you don't like the snacks we have on the floor. I could think of hundreds, but those will do for a start. I know it sounds mean, but this is why I got out of bedside nursing. When a hospital becomes the Hilton, I'm gone! Have fun!
  18. PositiveEnergy

    Evolving As A Nurse

    “Hello, my name is Corey I’m your student nurse for the day.” Remember how unnerved you felt the first time uttering those words to a patient? Or, how you once peered longingly at the “floor nurses” who waltzed from room to room with such confidence, administering care that seemed so complex, mentally praying someday to be as poised, calm, and assured? For some, those days might seem a gazillion years ago if you are a seasoned nurse, or like yesterday if you are still a novice, just beginning your career; a nurse (or student) with yet many firsts ahead. First experiences will forever remain embedded in the nadirs of your mind, like how your hands trembled as you filled the syringe with pain medication to administer your FIRST intramuscular injection! Or, the mental image of this same experience with your clinical instructor peering over your shoulder, watching your every move as you drew up the medication and injected your patient. Scary times, but thank goodness the shot was a success, and the competency signed off. Absolutely, this was a career milestone worthy of a high-five and a happy dance! On that first day, despite quivering lips and the knot in your stomach you managed to articulate the introductory “hello”. An acknowledgment meant to break the ice and allow you to assume “patient care”. Surprisingly at the end of the day, despite your initial butterflies and feeling a bit overwhelmed, you felt victorious. Not because providing basic care was any grandiose accomplishment, but now you connected with the profession and knew this was where you belonged. You stood steadfast, keeping your shoes planted where they needed to be – ready to meet the challenges ahead. Recalling such first experiences triggers my own thoughts of the many uphill steps I have taken along my nursing path. Likewise, the reference of steps makes me think of my nursing shoes. For me and I believe for many, our nursing shoes could convey our stories. How as we stride along in our daily routines, we gain experience and new knowledge. Over time, and between good days and bad days we climb the stepladder from rookie to expert. Then, mostly without being consciously aware, we become those seasoned nurses who walk with confidence and possess the intuitive wisdom to immediately size up clinical situations. Mentioning nursing shoes moves me to share a piece I previously journaled, while recollecting the steps of my own journey. My account, Nursing Shoes, is an evolving tribute, reflecting my growth from a neophyte to a mature, veteran nurse. Today, I would not be the nurse and person I am if I had worn only one style of nursing shoes, or if I failed to change into new, more comfortable shoes when the fit no longer felt right. As you track my footsteps, I ask you to read between the lines. You will hear emotions reflecting insecurity and self-doubt typically experienced in the early stages of one’s career. However, with maturity, self-confidence, mindfulness, and real grit one’s career can evolve into a rewarding, profitable, and memorable experience. You too, will wear several different pairs of shoes along the way. Some will start out feeling comfortable and just right, but in time begin to feel flawed and misshaped. There will be times you marvel at the shine and newness of your shoes, and other days when you look down and wonder when your shoes started looking so blemished and gray. But hopefully, there will be loads of days when you celebrate the spry bounce and agile step your shoes allow you to take. I have been a nurse for many years, climbed many steps (and “yes” fallen backwards a time or two), held various roles, and worn a number of different style shoes. Before I tell you my Nursing Shoes story, I will answer the question commonly asked of seasoned nurses like myself. That being, “What wisdoms do you have to share with nurses just starting their careers, and for those nurses feeling overwhelmed with the demands of the profession (probable all nurses at some time or another)?” Here are some approaches I recommend to keep your shoes feeling balanced and to maintain a steady step. Advice Sometimes you will have to sidestep, take a deep cleansing breath, rest for a bit, and then propel forward with a fresh new stride. Avoid walking backwards. Always venture forward, but acknowledge those times when pausing is vital for spiritual refueling. Expect there will be smooth roads and bumpy roads. Mentally parrot the mantra And, This To, Shall Pass when in stressful situations that feel unending. Find a nursing friend at your workplace. This person will be your support, your buddy, your confidante, and “have your back” in difficult situations. Network with new professional colleagues. Meet others outside your own sphere of practice by partaking in nursing conferences. Attending is a great way to realize your concerns are not unique, provide you a forum for a professional voice, and offer spiritual renewal. If attending a conference is out of your budget, do not give up. Check with your employer for potential ways (e.g., presenting a nursing issue, doing a poster presentation) to receive reimbursement. Use your accrued vacation time to take those deserved sidesteps. Do not put off mental escapes until you feel exhausted or burned-out. Even stay-at-home vacations can be mentally rejuvenating. Take your entitled shift breaks (e.g. 15 minutes, lunch/dinner) and actually leave your unit. A short time away can help you recharge. Embrace the humorous moments. Laugh together whenever you can, because some days you will cry together. Learn something new each day, no matter how complex or simple. Always understand the “why” of what you are doing. Be curious about the “whys”. Never forget to ask for help. Beware of the symptoms of the burnout “virus”. Almost everyone eventually catches the bug. The weariness feeling, so typical of burnout will creep up and consume you if not recognized. Identify symptoms early, reach out for help, and individualize treatment to meet your needs. Realize sometimes the best option is to step away, or pronounce, “I’ve had enough”. If the latter is best, feel proud of all you achieved and move on to your life’s next adventures. Sometimes you may feel the field of nursing in which you are currently employed has become too tedious, or has caused you to feel disheartened with the profession. Remember, there is a plethora of nursing venues, which might offer you a healthy, new perspective. Try something different like moving onto a new specialty, a new department, or even an entirely different place of employment. Always treat one another with respect. All nurses learn respect and dignity are basic human rights, which should be part of every nurse-patient encounter. We do a great job of upholding these integrities with patients, but I believe we fall short of doing a stellar job treating our own colleagues with respect. You might think this accusation is a stretch, but I ask you: Why are terms like “bullying” or “lateral violence” still in our nursing vocabulary? Ask yourself, “when was the last time I complimented a peer on a job well done?” Or, have you ever thought to nominate a deserving colleague for a famed nursing award (e.g., The DAISY Award, The New York Times Job Market Nursing Award, Nurse of the Year (Lippincott Solutions), ANA National Awards Program, Nursing Excellence GEM Awards)? There are many occasions to nominate colleagues. However, such windows of opportunities typically are not acted on. Unfortunately, when not actualized, both the worthy recipient as well as the nominator lose out on chances to feel good about something positive. The tip I feel is key to survival is to vent your feelings; tell your stories. Use some art form or creative expression such as drawing, journaling, picture taking, singing, or sculpturing to release those stories you hold inside. If you can, verbally share your stories. There is nothing like a gathering of nurses to hear some wonderful, heartfelt stories. I believe an evening of storytelling is a meaningful and therapeutic gift which employers can give their nursing staff, or nurses to themselves, during Nurses Week each May. Remember this quote: “They may forget your name but they will never forget how you made them feel” (Maya Angelou). This is for those times when you ask your “buddy” friend, “Remind me again, why I signed up for this.” Now that I have offered some of my general survival recommendations, read on because within my Nursing Shoes musings you will find other embedded lessons and professional wisdoms. Nursing Shoes Ah, my dear nursing shoes. They have been with me every step of the way as I have grown from novice to expert. Just as I have changed so has the style and comfort of my shoes. My original shoes were the traditional snug fitting, highly polished white leather nursing shoes that hugged one’s foot. They kept my foot secure and in place. They prevented me from slipping and falling with their soft, almost flat, non-conductive copper-colored rubber soles. Their style truly mirrored me as the nurse I was at the time. I wore this style as a student and a new RN. At the time, I did little thinking outside the box, I adhered to the rules and regulations learned in nursing school, and intentionally conformed to the practices of the other nurses I observed. I backed up my actions by the book and did nothing out of the ordinary. The feel of my shoes mirrored my inner fear of making a mistake, or of being different. All my actions were housed in the novelty of being a new graduate. After going through several of these traditional shoes, I began to wear shoes of softer white leather that gave around the contour of my feet. My new style was more contemporary. Now I preferred loosely fitting, white leather clogs with closed heels (open heels were not permitted for safety reasons). The softer grip allowed my foot freedom, but the fit was not so loose that my step would wobble and cause me to fall. My shoes were me. They were relaxed, accurately reflecting a nurse with newfound confidence. As a maturing nurse, I felt less inhibited in sharing ideas with supervisors and colleagues. I was advancing, leaving the novice behind, and moving towards the more expert-thinking nurse, but I was not quite there yet. I still had a few more changes of shoes. My next and most preferred shoes would be chic ones. They offered me the ultimate support, contoured to my feet, and allowed me to move with grace. These were the white nursing shoes designed with the latest foot technology to provide ultimate comfort and a free-spirited step. For some, and even me, this was in the form of a white canvas or white leather sneaker fabricated specifically for the active nurse in mind. In this style, as I walked in my supremely soft and comfortable shoes (my white leather sneakers) my step was secure. I felt sure-footed and confident in how balanced I felt. As I progressed, I occasionally stopped, cleaned the scuffmarks off, and smiled as I continued down my nursing path. Later, in my career the clog style-nursing shoe became popular once again. Only this new shoe was vibrantly different. Now these clog shoes were a multitude of colors, rather than predominantly white. For me these shoes signified the essence of nursing. No longer did I see nursing solely through white lens, but now I saw whirls of different colors intermingled throughout. These new brushes of colors epitomized the aesthetic, multi-dimensional, and multi-cultural aspects of care. The hodge-podge of colors in the fabric of my shoes signified the diversity, deeper philosophical understanding, and phenomenology of human nature I came to appreciate. I saw my own newfound wisdoms reflected in these colors. In the palette of my shoes I saw: Tints of indigo that splendidly exemplified my now advanced level of nursing intuition and critical thinking. Spats of yellow intermingled with the luster of blue denoted the peace I felt in knowing I possessed a deeper understanding of my profession, and of who I was as a nurse. Splashes of orange symbolized optimism, which I learned was essential to bequeath. Gleams of red denoted my passion that all nurses tell their stories. The glimmer of purple, my most favorite shading, I believed represented imagination, a vital attribute. Collectively for me, these colors signify the hues of our profession as we adjust, redefine, and invent new and creative ways to handle healthcare challenges. Most recently as I contemplated retiring my colorful shoes and storing them amongst the dust bunnies in my closet, our world, and our profession turned upside down with the tsunami, COVID-19. Now some frontline nurses shield their shoes with standard hospital-grade, blue foot covers. Coverings clad by frontline nurses to complete their ensemble of Personal Protective Equipment (PPE). Protective layers worn from head to toe with the hopes of safeguarding others and themselves from corona hitchhikers. Sadly, despite these protective efforts, this horrific COVID wave has taken the lives of nurses. Because of this threat to nurses, and to all of mankind, this virus can be considered one of nursing’s most monumental challenges. With the mounting COVID stress there are times now, especially after a stent of caring for COVID patients when one’s feet ache, a mere extension of a heavy heart. Whether coming or going to work, one’s shoes feel lined with lead. A heaviness that changes the normal Spring in one’s step to a slow and weary pace. Our nurses are tired, but everyday continue to put on their shoes and maintain the pandemic march. I think about how our nurses need something special to come along (vaccine) so they can put aside those heavy, uncomfortable shoes and once again strut full-stride ahead. When I look down and see blue covered shoes, I think of the ocean and its glimmering waters. An intriguing mental image that gives me hope. In this sphere of nature, I see something never stagnant, always changing, and forever creating a new tapestry of life. This is why I have hope that change is ahead, just on the horizon as we ride the waves of this unprecedented pandemic. At times the waves feel like they are mounting, quite over our heads. But countless waves have risen before, and eventually folded into the sparkling waters of the shore. This predictable rhythm of the wading ocean is what gives me hope, that COVID too will recede like the ebbing ocean tide. Though we are experiencing rough waters at this time, a vaccine will be developed and the colossal waves will break. Then once again, nurses, their families, and mankind will advance forward with sure-footed steps. Step, Step…Breathe (SSB) Corey
  19. “Every member of the colony has a job to do and their altruism is what makes them so successful.” - by Robin QueenDuty CallsIn the wee hours of a pitch-black Pacific northwest morning, I’m jolted out of a dream by the grating sound of my alarm. The air is still and crisp and this bed, full of toasty dog and human bodies, isn’t exactly an incentive to move my tired bones. I’m exhausted to my core, a not-too-unfamiliar feeling held by bedside nurses, compounded by an epidemic that overnight has transformed our hospitals, our profession, and our world. But duty calls, night nurses are weary, and people are dying. Download allnurses Magazine Breathing Clean Air - A Precious CommodityWith my precious family safe and sound, the fear of bringing home this silent visitor not only weighs heavily on me, but especially for parents and those with their own aging parents to protect. Coffee in hand, I slip out the door and slide on my clogs waiting dutifully on the back porch, a common practice when the enemy clings to your feet. Just a few months ago no one had heard of it, this deadly invader - Coronavirus, Covid-19, SARS Cov-2 to name a few of her aliases. Now Corona is on everyone’s hearts and minds (and hands and metal surfaces for that matter). She’s finally gotten the wake-up call essential to thwart a pandemic this vicious in spite of feet-dragging leadership from the current administration. Rather than repelling from crisis, we nurses and other medically trained citizens, head directly towards it like firefighters to a burning building. Things previously taken for granted like thoughtlessly breathing the air around us, or our job security; are now both precious commodities. Nurses Swarm the Hospital Like a buzzing hive, nurses swarm the hospital decked out in full personal protective equipment, or PPE as we say: blue-gloved and wrestling with negative pressure helmets like awkward astronauts navigating life without gravity. In the first and last hours of the workday, a hospital hosts double the staff as night and day shift nurses hand off stories and requisite details of the past twelve hours, information that can’t be gleaned from perusing charts alone. One of the beauties of nursing is leaving your grueling shift behind you and passing it on to the next highly-capable nurse. It’s her turn now, and with a rested mind she eagerly gets a breakdown of what’s in store. Today I’m charged with three step-down patients on telemetry- in other words, they aren’t sick enough to require one-to-one observation, but they do require being placed on a heart monitor and haven’t be cleared to leave ICU. Lives at StakeNew policies seem to surface by the hour, the newest one being mandatory use of OR scrubs which add to the look of an insect colony. The endless stream of indiscernible teal-green nurses stride up and down ICU hallways 24/7. In his renowned book, The Superorganism: The Beauty, Elegance and Strangeness of Insect Societies, Harvard biologist Edward O. Wilson described the extraordinary lives of social insects and how they cease to be individuals but rather function as a single organism. These superorganisms are formed by “altruistic cooperation, complex communication, and division of labor” much like these teams of front-line healthcare workers at the heart of this epidemic. Every member of the colony has a job to do and their altruism is what makes them so successful. The beauty and grace with which they execute critical health care so adeptly is quite moving, knowing that both patients' and nurses' lives are at stake. The newly coined ‘COVID row’ in ICU is an impossibly long hall of glass doors and shiny equipment carts, bays occupied with unconscious prone bodies, like sunbathers leisurely napping on a noisy crowded beach. Nurses peek through their isolation suits secluded further behind glass. They write their requests with dry erase markers, while non-isolation nurses act as runners for supplies, medications, and delivery of crucial labs for testing. By mid-morning I’m lending a set of hands to the rounding team flipping patients every eight hours in a last-ditch attempt to increase lung expansion and in turn, oxygen levels. That being said, once they have reached this point, the general consensus is that they will almost never pull through. Daily UpdatesWe learn more and more about this nasty intruder on a daily basis, like how there seems to be no rhyme or reason to who and why it hits hardest. The virus now appears to affect not just the frail and elderly but young people too, with very few medical problems. Unusual new tidbits of information creep in daily, like COVID’s connection to hyper-coagulation which can lead to devastating, widespread blood clots and even more anomalous, a loss of taste and smell. No Time to PeeIt’s noon and I haven’t had a single break, eaten, or peed since I walked on to the unit this morning. Nurses will admit, it’s easy for us to neglect our own basic human necessities when a patient’s unmet needs mean someone is suffering. I ask another nurse across the hall from me to keep an eye on my call lights while I take a much-needed lunch and bathroom break- just enough time to recharge and get back on the floor. VentilatorsI’ve been recruited to pull and sign off on sedation medications designed to optimize comfort for these patients who are intentionally paralyzed in an effort to minimize every ounce of oxygen use while on ventilators. Once patients are dependent on these vents, more often than not it becomes the point of no return, critical-care trained nurses strait-forwardly identifying who will make it and who won’t based on impressive levels of experience and intuition. A maze of tubing and wires surround monitors working around the clock to tell us what we need to know to keep patients alive. Lack of TestingThe elephant in the room is that few of us nurses are being tested proactively regardless of our being at the highest risk of exposure and in turn exposing others. Without overt symptoms, the protocol doesn’t call for testing, and a positive test means loss of income for us too. The reality is that COVID-positive nurses means no one to take care of patients who just keep coming. Emotions run high among staff with an influx of daily emails informing us of test results from now COVID-positive patients we’ve had contact with. Caring for so many patients on a daily basis, it’s often difficult to put a name with a face trying to remember precisely how careful you were in protecting yourself. Rationing face masks, reusing equipment, running out of disinfectant wipes is the new normal and we are all acutely aware of how we are putting ourselves, and in turn our families at risk. Up Close and Personal with COVIDBeing up close and personal to this virus is both humbling and frightening. Our nurturing personalities allow us to lean in to the discomfort, but the fear remains. We want to save lives and use our knowledge to ease suffering but at what cost? Results continue popping up positive faster than the hospital’s lab can process results, and the sickest patients are being put on comfort care, essentially ending any further treatment designed to cure them. The pressure cooker finally began leaking steam, taking its toll with the onslaught of media reports, worried friends and family, and a hospital understandably not equipped for what COVID brought through its doors. Two shifts prior, I was in a patient's room every hour on the hour for an unrelated medical problem that got him admitted to our unit and had since tested positive for Corona. The most obvious problem is that all of us, nurses, techs, doctors, respiratory therapists, speech pathologists, physical and occupational therapists, the environmental and food service workers — we’ve all been exposed to some degree. Isolation carts are under-stocked or offer only simple surgical masks, ineffective for airborne viruses which is what Corona becomes once aerosolized by breathing treatment nebulizers and CPAP machines for patients with sleep apnea. Previously non-isolated patients are getting orders to be ruled out for the virus after endless staff have been in and out of these rooms for days. We handle bodily fluids in all its forms on an hourly basis while the CDC and hospital administration are scrambling to keep us up-to-date with guidelines that change faster than they can be typed and distributed. COVID-positive patients are moved to the outskirts of each unit in an attempt at isolation but the hospital initially had no choice but to mix them in with the general population. The environment in the hospital is nerve-racking aside from dealing with improper PPE equipment, reusing of old, contaminated masks, a lack of transparency with staff testing positive, and the higher-ups pushing back on offering critical pay. All we can do is dig deeper and scrub our hands a little harder, until the skin is raw, and faces are left grooved from N95 masks. We guard the cleanest PPE with our lives so no one helps themselves to this now-precious commodity. Fifteen minutes is all I have to empty my bladder, top off the tank, and get back on the floor. Not Enough Critical Care PersonnelIn truth, we simply don’t have enough critical care nurses or intensivists (critical care doctors) to manage these patients and because of it, ICU nurses delegate vital tasks right up to the limit of their scope of practice. A glut of extra nurses are out of work and on the unit-due to near-empty ORs and recovery rooms. Outpatient clinic nurses pace the halls as “helpers” and to ensure PPE is worn and removed properly, the only task they are permitted to do out of their home units. Other wings are eerily quiet without the usual influx of anxious family members and elective surgeries. No Treatment or Cure - Supportive Measures OnlyWith no reliable treatment or cure while we wait for research to catch up, nurses cling to what we know-supplemental oxygen, IV fluids, adequate rest-the basics of supportive care. This isn’t the last pandemic we will see, but it is my first as a nurse. Deadly diseases are part of the human experience and mankind has coexisted with them since the beginning of time. But the effects of Corona will forever change the way we deliver nursing care and relate to other human beings as a society. We are social creatures and need human connection as much as we need oxygen to breathe. Intimacy is at the core of what we do. Scared of Becoming a StatisticThroughout the pandemic I’ve been depleted, enduring dog-tired days-on-end where I wasn’t sure how I’d muster the strength to come back for another twelve hours. I’ve felt both fortunate and guilty for the job security because people are dying, including hundreds of front-line workers-nurses just like me. I’ve felt humbled and honored to be the person at the bedside of dying patients unable to make contact with family due to restrictions on visitation. I’ve been scared to become just another statistic myself and felt the urge to hide in equipment closets so no one sees the nurse breakdown and cry too. Nation's Failed ResponseIt's impossible not to recognize how our nation’s response has failed its citizens, how unprepared we were with a broken healthcare system so fixated on profit, and how blatant misinformation and ignorance allowed the virus to spread like wildfire, how Jeff Bazos and insurance company’s bottom lines are likened to war-time profiteering of yesteryear. Like landing on the moon and electing our first black president, we will forever split our memories into pre and post-Corona virus eras and nurses will forever remember the days when we didn't always wear masks. Running the COVID MarathonEvery shift is like running a marathon and by four or five o’clock, you can just about see the finish line. That coffee you slammed down while your patient was off the floor for an MRI gives you enough kick to admit a new ED patient and catch up on charting before shift change. Experienced nurses know the importance of self-care habits like adequate sleep, turning off your brain at the end of the day, eating right, and all those things that allow our immune system to choreograph its exquisite dance of knowing what to kill and what to keep. But today I settle for simple moment of silence to reflect on what we just accomplished. By a quarter ‘till seven, night shift begins trickling in and the mere sight of them inspires joy in us all. The handoffs commence like clockwork, as night nurses anxiously take control. Day shifters convene at cohort borders, stripping off contaminated scrubs and masks under the strict supervision of trained observers. Tokens of AppreciationI sit down for the first time in hours. Boxes of donated food, and thank you cards from the community have taken over break-room tables. There are hand-written notes from girl-scouts, homemade cookies, doughnuts, and gourmet meals from local restaurants-it’s overwhelming but always devoured. I wish I could find a way to tell them all that these meals are saving our lives too. Their words of encouragement and appreciation for taking care of precious loved ones make it all worthwhile. “Thank you for your service!” a gal says to me in the Whole Foods parking lot. The comment catches me off guard having spent a grueling twelve hours on my feet, my brain running on fumes. I failed to notice the way scrubs cause a nurse to stand out more than ever. I’m just doing my job, I say to myself, just business as usual when you're a nurse. Not exactly a hero here. My father, a Vietnam era veteran, also always took the praise with ambivalence, feeling he was simply a cog in the corporate-American wheel. I’m not exactly used to having the entire world shining a spotlight on what I do every day, but admittedly, it’s incredibly comforting to have this sudden connection to complete strangers. I too have always been uncomfortable with being the center of attention but like I coach my father into doing, I smile gratefully and say, you’re so welcome. A Nurse at Ground Zero WORD 8:12.docx
  20. allnurses

    Fall 2020

    Version Fall 2020

    The previous issue, Spring 2020, focused on the Coronavirus as it was first evolving. Who knew at that time we would still be in the thick of the virus now with so many increasing uncertainties for the future. In the Fall 2020 issue, several allnurses members share their thoughts about the continuing Pandemic and interesting ideas on what the future holds. In this issue, you can read about what it was/is like in the day of the life of one nurse at ground zero. Another nurse shares her Pandemic Memories 20 years from now, while another nurse discusses College Life Yesterday, Today, and Tomorrow, and how these changes are affecting her college-age twin daughters and other students. Don’t miss this issue filled with COVID discussion from nurses. What are your ideas regarding the New Normal? College Life Yesterday, Today and Tomorrow COVID-19 has affected almost every facet of our lives. For college students, the campus and classes look different today than yesterday, and some of these temporary changes may end up being permanent.… The New Normal It's hard to know what the future holds for us after COVID-19. My Covid Crystal Ball I discuss some social issues stemming from the Covid, problems with distance learning courses in higher education, and implications for state laws and restrictions on our lives My Memories of the Pandemic 20 Years Down the Memory Lane As a nurse, dealing with increased pressure was nothing new. As a nurse, I have been trained to maintain focus, take instant decisions, and perform complicated procedures while responding to heart at… Nurses Wanted A framed article in the form of a job posting that reveals what the state of nursing may be like in the future post-Covid world after nurses have left the profession in droves. A satirical piece. A Day in the Life of a Nurse at Ground Zero A bedside travel nurse reflects on her latest assignment at a Seattle-area hospital during the height of the Covid-19 pandemic. Memorialization of Nurses Who Died From COVID-19: They Had Grit Nurses spent 60% of the time with patients when COVID-19 came. Nurses were sent to war without ammunition and were dodging invisible bullets. Lack of PPE early in the pandemic caused many nurses and o… Five Months Later, Where is the PPE? Billions of dollars have been spent by way of the Defense Production Act in the past few months. Let's take a look at how well (or poorly) the money has been spent. School nurses facing a pandemic head-on allnurses recently spoke with a school nurses as she prepared for the 2020-21 school year. Along with concerns are messages of hope and encouragement from a sometimes overlooked healthcare professiona…

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  21. Wyckoff Hospital is in Brooklyn, New York, and Amy has had a busy week after being named as one of the 100 Influential People in 2020 by Time Magazine. Her image graces the cover, representing the heroism of nurses and other frontline workers. Time chose her as an individual who seized the moment to save lives. The list reflects the pulse of society and life in these extraordinary times. Amy was interviewed by Dr. Esther Joseph Pottoore, DNP, RN, a New York nurse working in the South Bronx in a Primary Care clinic. An Interview with Amy Esther: Thank you Amy for calling me on your break and consenting to this interview! Let me know when you have to go back to work! Amy: You are welcome! I will let you know when my break is over. Esther: How long have you been a nurse? Amy: Since 1992 (28 years) and 19 years in the Emergency Room at Wyckoff Heights Medical Center. Esther: Where did you study Nursing? Amy: In New York at BMCC - Borough of Manhattan Community College in the downtown area of Manhattan. Esther: What degree did you get? Amy: I have an Associates Degree in Nursing! Esther: Where were you before you came to New York? Amy: I was born in San Jose, California. My family moved all of us to Baton Rouge, Louisiana where we grew up after my dad retired from the Navy. I came to New York after high school. Why did you become a nurse? Esther: Did you always want to be a nurse? What sparked your interest? Amy: I remember vividly when my dad was in the hospital he was very sick and dying and how the nurses took care of him. I was in awe of them, watching them - which now I realize are IV drips, ventilators and how they maneuvered to manage them was amazing. That's when I knew In my heart, that's what I wanted to do in life. Esther: Tell me something the world doesn’t know about you! Amy: Well pretty much everyone I know knows the family's passion; my passion is the water. We have to be close to water at all times. We have a pool in the back yard; we love to swim. I am an avid surfer. I love to surf! I have been surfing since my twenties and am self-taught. At least twice a year we would drive to the Gulf of Mexico to the Florida Panhandle to surf - one of my favorite beaches. And when we're in New York, we try to get to Long Beach Island (LBI) which is in New Jersey at least once a week to surf with the whole family, my partner Tiffany and the three kids, Summer who is five, Kali who is 11, and Ocean who is 13. Esther: That’s impressive! I am afraid of swimming! Amy: Really? I love the water! Even in the cold months, I want to be in the water and the kids do too - just sitting on the beach during the cold weather makes us happy. First Encounter with COVID-19 Esther: Let's talk about the pre-COVID days in New York. Did your hospital or ED make any special preparations or educational sessions to get ready? Amy: I think like most everyone we were unsure of what was coming our way or what to expect. We talked about it, but on the day of a very large group huddle in the emergency room, we were talking about the Coronavirus and the precautions that we needed to take. At that point, we weren't sure that the first COVID patient in Brooklyn was in our ER in an isolation room. That was the day that I took care of the first suspected COVID case. Esther: Tell me more about that case. What do you remember? Amy: What I remember most is she was super sweet, and I sat in her room and talked to her for the longest time. She told me she had traveled to the Philippines in late January and returned in late February. She wasn't feeling great during the last two weeks of February. It was the beginning of March when she arrived in our ER, feeling tired and weak, with no fever. She was in the main ED for over 8 hours. Esther: At what point did you suspect COVID? Amy: Actually one of the ER attendings suspected it as the chest x-ray confirmed an abnormal pneumonia - a pattern of pneumonia that is rarely seen up until now, which we now know is COVID pneumonia. She died 10 days later. She was the first COVID death reported in New York State. Amy's Personal Battle with COVID Esther: I heard that you then got sick. What happened? Amy: I remember the day our first COVID patient entered the ER there were talks of possible quarantines for any staff members who came in contact, even though we were all asymptomatic at that point. The following day myself along with a doctor and six or seven other nurses were asked to quarantine themselves, which we did. There was a lot of anxiety with all of us with the unknown and fears that went along with this. I remember each one of us talking every day about how we were feeling and about any symptoms that we may have had. That was a great support system that we all shared with each other. As far as myself, I think I was just feeling tired and fatigued. About three days later, I noticed I was feeling winded. I was searching for a place close to home to just be tested. It was very difficult to find that test, but at that point, I started to feel short of breath, so I called the administrator on duty at Wyckoff, and she told me, "We will have a room ready for you. Please come! We will take care of you." So, I hopped in my jeep drove to the hospital, and found myself in an isolation room, where on a daily basis I saw and took care of patients before. It was very odd to be on the other side. Thereafter, it was becoming more difficult for me to breathe. I remember one of the ER residents coming into the room, gowned up with his PPE's. He placed me on a BiPAP as my fellow coworkers sat outside the room watching and crying with worry. I was taken up to ICU pretty quickly where the ER attending told me that I had Pneumonia, which shocked me to hear that news. I was intubated soon thereafter. I was then transferred to another hospital in Long Island where I was in ICU for a few more days until I was extubated 4 days later, and soon I was discharged home to recover. Esther: Were you out a long time? Amy: I remember the first week was the worst week of my life. I felt horrible; there's no comparison to anything I've ever felt before. The second week was a little better. The third week was even better and then soon after that, I return to work. Esther: The pandemic was kicking in at that time. That must have been tough! Amy: I don't know if tough is a good word it was just something in all of us that made us want to go to work and help. I remember my partner, Tiffany, calling me before I returned to work telling me that they were COVID patients and that it was busy. Each day more and more patients would arrive at the emergency room with COVID-related symptoms. At that point, when I returned to work, 98% of the patients who entered the emergency room were COVID patients. As I and the staff members watched, the emergency room started to overextend itself. We actually made the pediatric emergency room a makeshift ICU unit where there were intubated patients. Every floor was an ICU with COVID patients. At that point, they built a makeshift patient treatment area in the lobby of the hospital where we could take care of at least 20 other patients who were stable when they entered the hospital but had COVID-related symptoms. Esther: How did you cope in the ED? Amy: What I found is that we've all become closer and more trusting of each other. We worked as a group helping each other out as much as we could. We just did what we had to. Everyone helped! Security guards were gowned-up in their PPE's, helping us in every way they could, even making beds. The clerks and technicians were out on the floor helping us do whatever they could do. Administrators who normally wear suits and skirts and the CEO put their scrubs on, geared up, and helped us in the emergency room every single day during this crisis. Esther: Did other staff get sick with COVID? Amy: I don't know the exact number, but there were many nurses, doctors, technicians, and clerks who became sick but also returned to work soon after their recovery. Esther: Did you lose any of your coworkers? Amy: There were five staff members in the hospital who did not work in the emergency room who unfortunately passed from COVID-related issues. Coping with the After-Effects of COVID Esther: So sorry to hear that. I know this has stressed us all out. What has been the effect on you post COVID? Amy: You know, at first I found myself with insomnia, feeling restless; I wasn't able to focus and feeling very antsy. I thought it was because I wasn't able to go to the gym because the gyms had been closed during the pandemic. Before the pandemic, I would go to the gym during my lunch break for one hour and return to work. While I wasn't sure what I was experiencing, I thought I was just tired. But I soon realized one day I was having a panic attack while I was working which I've never had in my life. After I came back out on the floor, I was talking to the pharmacist about how I felt and he told me he also has had panic attacks and feels very anxious post-COVID. Then I started asking questions to the other nurses about how they were feeling, and they all agreed that they have anxiety now which they all say they've never had before up until now. Then I reached out to a therapist who specializes in PTSD. Now I am going to therapy, which has been my savior. My partner, Tiffany, also started going to therapy. During all this, we have had each other to talk to about what we went through each day. This has been a wonderful support for each one of us because no one on the outside understood what we were feeling or seeing outside of the hospital setting. Esther: I see that in some of my coworkers who tested positive too! How are you normally? Amy: Yeah, testing during the crisis was frustrating for most of us. We were unsure of the results and it was hard for us to find somewhere to be tested. I am normally funny, outgoing, silly. I love to joke around with the patients to try to make their visit to the emergency room not so serious and fearful for them. Esther: What are you doing to cope? Amy: It was a slow recovery. I didn't feel really like doing much just laying around, which is something I never do. I slowly started meditating and doing some yoga at home. The gyms have reopened so going to the gym during my lunch break. A big part of this recovery is therapy Esther: I would say having no traffic while going to and fro work was great! I have to confess I was way over the speed limit and I reached work in 15 minutes! No traffic in New York was really good! The one positive of COVID times! (Both laugh). Amy: Yes, traffic in New York was horrible. One of the good things about this pandemic was there was no one on the road but frontline workers which was great. Travel was less stressful, less tiring, and less time-consuming. However, what I've noticed now is that people are returning to work, and I see a lot of aggression on the roads and people in a hurry to get somewhere. Esther: During the height of the pandemic what did you see that was concerning to you? Amy: What concerned me most was being safe. We're in our PPE's, but how are we going to keep our family at home safe? So we changed our entire homecoming to taking our clothes off in the garage, putting them in a separate bin. Shoes are outside in a separate area. We would walk up through the garage, which we've never done before. No one was allowed to talk to us, no one was allowed to touch us, not even the dogs, and we can go right to the shower. We were sure to wipe down the insides of our jeeps, our phones, and our IDs from work. Dealing with Lack of PPEs Esther: How about PPEs? Amy: PPE's were given to us, however, the hospital could not keep up with the demand in the outpouring of patients that entered our emergency room on a daily basis. And then our savior, Melanie. We were lucky because Melanie from an organization called International Medical Response started an ongoing Emergency Supply Cabinet Project, initially funded by a GoFundMe page. They were angels and got us supplies throughout the pandemic! They hand-delivered them to us outside the emergency room throughout the Pandemic. The surge was from March 2020 to June 2020. Home and Family Esther: How did your family take all this? Amy: Well, thankfully, Tiffany is a nurse in the same emergency room where I work, so we were able to figure this out as a couple. However, our entire routine changed with the 3 kids, 3 dogs and 3 cats. They were used to us coming home and sitting at the table and talking about our day with then and how their day was. We would play with the dogs and the cats, but now it's come to going right to the shower and going right to bed. That's now the new normal for us. Esther: I think you are missing fish and birds! Amy: Well we did have a fish tank, but it was a lot of work along with three kids, three dogs, and three cats. We thought about birds, but we were afraid the kitties would bother the birds. One of Time Magazine's 100 Most Influential People 2020 Esther: This has been a rough year for both of you! Despite all this, you were chosen by Time Magazine! How did that happen? Amy: That was by chance! I happened to go on my day off to protest alongside my colleagues in front of the hospital about the scarcity of PPEs. There was a lot of media and I was talking to them. The CEO of the hospital who is a very nice man came with a reporter from Time and recommended that he talk to me. Since I was still at work, we talked later when he called me and I was off work. The hospital later allowed cameras in the ED and they saw the team in action in and out of work. They even followed us home! That’s going to be a documentary that will come out at some point. Later on, I found out that I was nominated and then later named as one of the 100! They came for a photoshoot! Esther: What was your first reaction? Amy: I said, “You gotta be ****ing kidding me!” I curse a lot! Esther: How did it make you feel? Amy: Happy. This is for the entire team and not just me! There are staff that have been to hell and back. Their stories have not been told, mine was. Ever since this was announced on ABC Network, the phones have not stopped ringing! I got interviewed by major networks and I heard that Ellen DeGeneres might be calling! Esther: That’s definitely exciting! What’s happening in the ED now? Amy: We are beginning to see patients with pneumonia, cough, positive D-Dimers, and a negative chest x-ray. We are isolating them and getting them COVID tested. The numbers are increasing. We are also seeing a lot of stress-related issues like PTSD, aggression, overdose, suicides, and stabbings. Advice for Nurses Esther: What is your advice for healthcare workers especially nurses? Amy: Wear your PPEs. Do not take off your N95 mask. Do not rub your eyes or bite your nails. Maintain social distancing at work and at home. I am homeschooling my kids till this is over. Esther: Did you think about family, death, spirituality, or faith during these times? Amy: I do not have a particular faith. I believe in Karma. Good Karma begets good actions and auras. I did and still worry about the kids. What if anything happens to us? We have no family here in NY. I try not to think too much about it. I also was worried about getting targeted for wearing scrubs. I always wore and still wear my mask when I am out in public. Life is so fragile. You have to live every moment because soon it may be gone! Esther: Do you have any final words for new nurses? Amy: Just be honest and be yourself! Congratulations and Thank You Esther: Thank you for being the Face of Nursing 2020. Congratulations on making it in the list of the 100 most influential people in the world. It’s an honor for all nurses in the International Year of the Nurse! Have a wonderful and safe day and thank you for all you do! Amy: Thank you and be safe! As we wrapped up part 2 of her interview, she was driving home in her baby blue jeep with the top down! I could hear shouted congratulations from regular people who recognized her on the street! Amy’s response was a typical New Yorker’s response. “Yo! Thanks, man!” Let the Diamond Within Shine To all my nursing colleagues! Let's take a page from the Harley motorcycle riding, avid surfer RN Amy O’Sullivan, and ride the next wave of life with confidence! Like her, let's treat each other and our patients with kindness. Let us be the light that shines brightly in the dark and the source of comfort in a time of need for others. Like Amy, let the diamond within shine! Dr. Esther Joseph Pottoore, DNP, RN
  22. BButterfly1993

    Feeling lost in my nursing career

    Hello, I have been a nurse for 3 years with previous experience in ICU, cath lab, and Interventional radiology. I started in ICU straight out of nursing school and I have been doing critical care since then. I currently work 4 days /10hr shifts each week. Our cath lab is extremely short staffed and I have been forced to take 15-20 days of call each month. This obviously increases your chance of being called in for emergencies. Our patients have been extremely sick, requiring more nursing care on a skeleton crew. We have also been having really late cases, so I typically work 10-14hr shifts. Needless to say, I am completely burned out. I have a newborn at home which requires all my attention as soon as I walk through the door. I am exhausted, tired, and frustrated. Now that I have my son, a lot of my nursing career priorities have changed. I want to go back to 3 days /12hr shifts. I would like to cut back on call or eliminate it completely. Back in July I accepted a day surgery position but my current director will not release me to this unit until September due to how short our cath lab unit is. I am having a hard time managing my current nursing career since I am being pulled into many directions. My team members are giving me a hard time for changing units, my director is also acting different now, and my home life is also requesting so much of my energy. I am feeling lost within my nursing career because I feel like I want to step back from emergency medicine and having to react quickly...solo. Recently, I have become so bitter and angry at work. I have never EVER been like this before. It makes me wonder if it is my environment within my unit (It has a lot of issues) or just burnout. I have applied for a few other jobs including surgery and an oncology unit. I really miss 1 on 1 nursing and educating patients. I love talking to patients and feeling like I make a difference. I also want to be home with my growing boy. I love my son so much and I’ve wasted a lot of time at work. I am stressed all the time -wondering if I am making the right decision. I feel guilty to step away from critical care since I’ve done it my whole career. Is anyone else experiencing this or have experienced a clash between home life and nursing career?
  23. allnurses

    Spring 2018

    Version Spring 2018

    The Spring 2018 issue of the allnurses magazine is the first issue of our magazine, featuring articles from some of our most-talented writers including Beth Hawkes (@Nurse Beth), @ElizabethScala1, and @Lorie Brown RN, MN, JD. In this inaugural issue, we are very pleased to cover the #NursesTakeDC rally which took place which took place in April, 2018. Beth Hawkes shares an amazing in-depth article centered around #NursesTakeDC and the related efforts for improved Nurse-Patient ratios. It truly is a must-read for anyone in the nursing profession. Nurses Advocate for Safer Staffing, Patient Safety, and Quality Care CALLING ALL NURSES! Our voices will be heard in Washington, DC at the #NursesTakeDC on April 25th and 26th, 2018 as we address and show our support for the Nurse Staffing Standards for Hospital Patien… Patients Over Profits We walk and run up and down the halls trying to care for our patients every day. And we will continue to walk, talk, and do whatever it takes to get a break for ourselves and safer quality care for our patients. Join in advocating putting patients over profits. Nurses Week: An Opportunity to Reflect and Celebrate Nurses Week is fast-approaching and will be here before we know it! I see this very special time as one of reflection and celebration. Forced to Clock Out for Two Meal Breaks - Is This Legal? An LPN night shift charge nurse is mandated by new management to clock out for two meal breaks. Who is in charge when she is off the clock? Should I Carry My Own Malpractice Insurance? Probably the number one question I get asked as a nurse attorney is "should I carry my own malpractice insurance?" You would think I would have an easy answer, like "yes" or "no," but that is not the … What You Don't Know About Nursing Boards When one takes a test for a driver’s license, that person must know the rules of the road. However, when nurses take the NCLEX examination, they are tested on how to be a nurse and not necessarily on …

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  24. allnurses

    Spooky & Sweet Toons

    Version August 2020

    Whether Spooky or Sweet, Halloween is a time of fun ..... and a time for strange things to happen. In the nursing profession, this is especially true. In the life of the nurse, any day on the job can be stressful and using humor can help overcome the anxiety of most situations. Crazy things happen every day at work when you are a nurse, but imagine being in one of these situations. Enjoy and smile while you read over this collection of nursing cartoons and stories. Bet you could add a few of your own funnies...feel free to share. Share your favorite toon below! Enjoy 'A Career In Nursing' video ... a montage of some of the toons found in this ebook... About Cartoonist Jerry King: Award-winning cartoonist Jerry King is one of the most published and prolific cartoonists in the world, selling more than 300 cartoons per month. His work appears in magazines, newspapers, greeting cards, books, calendars, websites, blogs, and social media. In addition to allnurses, his client list includes Disney, American Greetings, and many others around the world. Aside from greeting cards and magazines, Jerry is the author and illustrator of seven nationally published cartoon books. He has also illustrated ten children's books, and has provided illustrations for numerous children's publications. After serving three years in the army as a medic, Jerry, 42, went on to graduate from The Ohio State University with a BA in English. He now resides in NE. Ohio with his wife, daughters, and 2 dogs. When he's not at the drawing board, Jerry is probably on a golf course losing.

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  25. allnurses

    Fall 2019

    Version Fall 2019

    Thoughts of back to school always come to mind in the Fall. That doesn’t end upon graduation from high school, college, or grad school. We all should think of ourselves as lifelong learners. Nurses are no exception. We need to constantly seek more knowledge. In the 2019 issue of the allnurses Magazine, two married couples, all nurses, share the inspiring stories of their commitment to one another and to lifelong learning. Another nurse shares how achieving an advanced degree was the key to her career. Even those who are thinking about their “Third Act” have much to learn about how to use their nursing talents to create their own “Third Act Care Plan”. Don’t miss Beth Hawkes’ entertaining article about the Elephant in Her Room about retirement. Security Won’t Stop The Violence Workplace violence in hospitals is unfortunately increasing in frequency. What can be done to stop this? Security is vital to the day-to-day operations of hospitals. There is no doubt they do keep u… When Should I Retire? My Struggle Usually when I write an article, I hope for a lot of views. But this time I’m not so sure. It’s because this article is way more personal than what I usually write. You may think me shallow or worse a… Got 3rd Act Issues On Your Mind? Are you stressing over entering your Third Act? In denial that it is actually happening? Starting to have thoughts you never had before about “the end might be near?” As a nurse you are well aware t… Background Check Reveals Arrest. Application to Sit Boards Denied How to submit a Letter of Explanation to the Board of Nursing for prior arrests. An Advanced Degree was the Key to My Career Nursing is a wonderful career. It has afforded me a comfortable standard of living, and a job where I feel I can make a difference. However, it’s been a journey.

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