Posts Tagged nurse bloggers

Observations and Assessments

NOTIONS TO SMALL FOR A BLOG POST, ALL IN ONE PLACE, A.K.A. THE PERIODIC LINK DUMP.

Nursing Related:

New  (to me)Blog Shoutouts  —

This blog hopes to present a different perspective on the Vancouver 2011 Stanley Cup Riot. Here, we’ll try to post letters of those that were working on the front lines: police officers, fire fighters, paramedics, doctors, nurses, hospital staff, transit staff, volunteers, and many more.”

The Boerewors Emergency Medicine Chronicles: “A bad day at work yesterday….it was tripping along quite nicely…we were well staffed…I’d even beaten my own best score at ‘Zombie Gunship’

…and then at about 17h50,just before my evening meal break, ShufflingBob called me to the resus room to look at a baby…
…a 13 month old baby who had a number of serious congenital health problems…
…necessitating a colostomy…
…who had been vomiting more than 15 times a day, every day,since Wednesday…
…who had seen the GP on Wednesday (and got given Amoxil) and on Friday (and got given Erythromycin)…
…and who was pale…grey coloured…with an oxygen saturation of 72%…
…a respiratory rate of 84…
…and a pulse of 180…”
…the baby was in a peri-arrest situation..”

Ordinary Citizen by Day:

“Patient: They’re gonna go an exam on me?!

Me: Well, you did come in with a complaint that usually necessitates one to determine the problem.>

Patient: Well you can tell them that I don’t want ANYONE getting all up in my cupcake! No. Way.”

What to Do When Docs Go Wild. Call them out. “A physician who threatened to use an AK-47, a sexually harassing doctor who looked at porn on work computers and a specialist who used to cause nurses to draw straws with the loser having to interact with her. These were some of the horror stories. . . .”

Sweating the Small Stuff. Important. Do it. Really. “But it is also uber important not to let the small stuff slip past. Often the small things are in actuality, big things a long way off. Sometimes this tyranny of distance hides a mass and velocity that are completely underestimated. Until impact.”

Outcomes of Nurse-Inserted Central Venous Catheters. “It adds to a growing body of evidence that nurses can and must provide services for which they are capable and trained and that allowing nurses to function within the full scope of their licensure and education will only increase the efficiency of the healthcare system and improve patient satisfaction and outcomes.”

Stop Calling Them Dear, Dear. It’s nasty and dehumanizing: “But once you’ve decided that “old dear” is fine, you’ve already depersonalised and infantilised the elderly. Why would you care what the old dears think? They’re just a bunch of old dears.”

Update on the Brian Sinclair Case. According to the Winnipeg Free Press:  “Sinclair, a 45-year-old double amputee, died in 2008 of a treatable bladder infection at the Health Sciences Centre after waiting 34 hours for treatment. The Winnipeg Regional Health Authority recently paid Sinclair’s family $110,000 on a portion of their lawsuit dealing with Brian Sinclair’s wrongful death.Berthaudin said in a written decision that Zbogar and Trachtenberg did not provide any evidence to back up their public nuisance allegation.”How Home Care Workers are Treated Like Dirt. “For millions of aging households, a home care worker is the only person who provides the day-to-day assistance and emotional interaction they need to function. Yet, typically, that worker is neglected herself–by the government.”

Other:

Did My Post Suck Today?  “God, I would love it if the Westboro Baptist Church protested this blog.”

One Reason Why Wealthy People Tend to Self-Perpetuate. “I think that one of the reasons that the children of wealthy parents tend to become wealthy too – aside from the obvious – is that they comprehend more career options.”

Irony Alert. Homophobes may be acting out . . . wait for it . . . on their own same-sex attraction: “Individuals who identify as straight but in psychological tests show a strong attraction to the same sex may be threatened by gays and lesbians because homosexuals remind them of similar tendencies within themselves.”

Antibiotic Resistant Bacteria. On meat. Yum.

[UPDATE (17/04/12): after much moaning and whinging, fixed the formatting.Which I tend to fuss over — don’t want to obscure the message.]

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In Which TorontoEmerg is Famous

OK, not really famous, but published on Kevin Pho’s site, KevinMD.com. Check it out, and Retweet/Like/comment as you will — it’s all in a good cause. I’ll repost it here sometime next week.

I am this morning getting an uptick in visitors from KevinMD.com. Welcome, and free to poke around.

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Nurses are Like Howler Monkeys, Poo and All

When I was a young, inexperienced nurse, I quickly learned one lesson: the cliché that Emergency nurses are fabulously assertive, mouthy, in-your-face pitbulls is absolutely true. I don’t mean ED nurses are bitchy or backstabbing eat-their-own-young types, though this was true also, at least for some of them. I mean this: the Emergency department is a ballet of constrained chaos most days, with many competing claims for attention for the physician, the charge nurse, and your colleagues; if your patient is sick, you need to be assertive, walk right up to the physician and say, “Doctor, this patient is sick. You need to come look at him right now.” This, admittedly, takes a considerable amount of confidence and an ego the size of a battleship, if you are a new graduate, but the alternative, i.e. the patient dies, is not considered good nursing practice.

A little later in my nursing career one of those battle-axe nurses we all dislike decided she had an issue with me — which is to say, she was nearly shouting at me in front of every nurse in the department — over a triage record she thought was incomplete. When she finished, I asked her quietly asked her to step in our to step into our psych quiet room. I said her behaviour was unacceptable. I asked her to speak with me privately if she had a concern about my practice. I informed her if she ever tried taking me out again, I would speak to the manager. For that point on, until she left the department, this nurse avoided me like the plague. This was good. I deserved to work in a toxin-free workplace, right? More importantly, my patients deserved a nurse who wasn’t stressed out by harassment.

Somewhat after that, I began this blog. After writing some funny stories about strange patients and some sarcastic stories about irrational physicians I began to realize there was far more potential — and interest, if truth be told, because stupid patients stories on the Intertubes are as common as erectile dysfunction spam — in writing about how all the things I saw in the Emergency department related to larger issues surrounding the nursing profession and health care in general. To advocate, in other words. I think I have done this, in some small modest way.

This is how I see advocacy then, as a nurse: first for our patients (Jennifer Olin has some good elaboration here), then for ourselves personally, then for our profession. Needless to say, I’m a strong advocate for all of these. I believe most nurses are, if they think about it.

This brings me to my point. Whatever your perspective on the case of Amanda Trujillo, you might think the whole controversy would be a great opportunity for a thorough look at some hard issues related to advocacy.

There has been a lot of off-topic criticism directed at supporters of Amanda Trujillo — myself included —  for pushing the issue too hard. Mostly, this amounts to personal attacks on her advocates, or that her problems are merely a human resources issue, or that “people” are “tired” about hearing about the case, or that Trujillo is crazy or not credible or both, or that we’re all emotional, or that we’re engaging in bizarre conspiracy theories, or that we’re all drinking the Kool-Aid (because supporting Trujillo is like a cult and/or we’re mindless zombies) or that we all should just sit down and shut up, or that “real” advocates for the profession have advanced degrees and repose in legacy institutions like the American Nurses Association, or that we should trust Banner Health’s judgement (because health care corporations never screw up, I suppose), or we should wait for the disciplinary process at the Arizona Board of Nursing (because the Board investigates all cases correctly and without bias) or (my favourite) that we shouldn’t be “blowing up the Internet” because that will make things “worse” for Trujillo (God knows how, at this point) or lastly, that we don’t have all the facts. (I stipulate to the last, but I don’t think it’s all that relevant — an arguable point, I guess.)

What I am not hearing from the contras is any sustained discussion about what patient advocacy means in the context of a complex, conflicted health care environment, or what places nurses have in informing patients about treatment options, or how to effectively (and collectively) support nurses working in hostile environments, or what to do when hospital policy conflicts with basic nursing ethics, or what advocacy means for nurses in the age of social media.

What I am not hearing from the critics, to be precise, is why Trujillo was wrong to give her patient information on all treatment options, why Banner Health was right to fire Trujillo for what (at worst) could be construed as a minor practice issue, why nurse managers should always bow to angry physicians, why nurses advocating for patients is bad, why Banner Health reporting Trujillo to the state Board of Nursing — a one line complaint! — was necessary to protect the public from harm, why a group of us — including some blogging heavyweights like Emergiblog and Nurse Ratched — have utterly misplaced our passion in supporting Trujillo, and why, finally it is inappropriate to talk about this all over the Internet.

Instead all we get is a lot of fast talk, bloviation and (deliberate?) misinformation. I once hiked in the Guatemalan rainforest near the Mayan ruins at Tikal and a troop of howler monkeys followed us for a long time, flinging poo all the while. I’m having the same sensation now.

Nurses do to each other online exactly as we do to each other in real life. Fling poo. It’s sad, really, that for all our sophistication about social media and tech, things don’t really ever change.

I get that emotions are running high, on both sides. Even so, is it even possible have a serious conversation about Trujillo and what it means to be a nurse and advocate? Even me, secret Pollyanna I am, is beginning to doubt it.

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Note of Clarification: The Arizona Nurses Association issued this statement on their Facebook page, which I am glad to reproduce:  “When AzNA first became aware of this case, Teri Wicker, AzNA President identified a conflict of interest (between AzNA and her employer [Banner Health]) and voluntarily recused herself related to any AzNA discussions or decisions.”

[Cross-posted at NurseUp.com]

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Another One Bites the Dust

Via White Coat’s Call Rooom, I wanted to mention the demise of Weird Nursing Tales:

After nearly 20 years on the internet, Weird Nursing Tales passed away.

Weird Nursing Tales died on February 7, 2012 after it was reported to Administration that the true author was an employee of the Hospital.

Yesterday, February 7, “The Author” sat in a conference room in the Human Resources department with his Administrative Director and the Vice-President of HR to discuss this “discovery.”

After a brief, 15 minute meeting, the plug was pulled and Weird Nursing Tales died, without so much as a gasp.

Family was at the bedside.

Weird Nursing Tales is survived by an only child, “ED Sing-a-Long.”

Weird Nursing Tales may be gone, but Tex is still out there.

And it is gone, gone,  gone. Even cached pages are hard to find — though nothing ever truly dies on the Interwebs. I only hope Tex downloaded all of his work before deleting the blog.

Anonymity has its downside. It’s tricky. The protection you think it affords you may be more apparent than real. No one’s ever truly anomymous, though I think I have been as careful and artfully misdirective as possible. Sometimes when you’re anonymous, it looks like you’re doing something illicit or wrong, and the consequences, as illustrated above, can be disastrous. I’m actively considering of crossing over from the pseudonymous state to the whatever the opposite of pseudonym is — just for this very reason. As Nerdy Nurse says in the comments of White Coat’s post:

This is one of the many reasons that I actually put my blog on my resume. I no longer wanted to blog in fear. I wanted to own it and be proud of and work for an organization that understood and respected me for it.

At any rate, we can all hope Tex will find another outlet for his talents. And that the administrative beating given by the nasty HR types wasn’t too severe.

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Best of 2011

A little late for 2011 retrospectives, but, as I said, I was busy. First list: the most popular by hits. Second: my personal picks.

10 Most Popular Posts (many of which were actually posted in 2010)

1. Can We Stop the I’m-a-Male-Nurse-Who-Isn’t-Gay-Contrary-to-the-Stereotype Routine? (An oldie-but-a-goodie. By far and away the most popular post.)

2. Full Code (Have no idea why. Badly written. Needs a do-over.)

3. A Medication Error Leads to Suicide

4. The Lady with the Lamp

5. More on Racism in Health Care (Suspect a Google search term.)

6. Images of Nursing: “I’m just a nurse”

7. The Placenta, The Nursing Student and the Teachable Moment (Widely tweeted and referred)

8. Florence Nightingale: Images and Words

9. A Fix for MRSA? (Ditto on the search term)

10. Maxims for New Graduates

My Favourite Posts from 2011

1. Under Construction

2. Sometimes Things Ain’t What They Seem

3. In Which TorontoEmerg Discourses on Some Aspects of Human Nature

4. So When Does This Become a Crisis?

5. Three Strikes and You’re Out, and By Out, I Mean Dead

6. The Most Useless Form on the Planet

7. Don’t Tell Your Patient This. Or That.

8. On the Dying Art of the Bed Bath

9. When Nurses Write About Physician Bullies, Don’t Shoot the Messenger

10. Clinical Days: A Short History

11. Empathy

12. Accessing CVADs is Like Killing Puppies, Only Worse

13. How Mr. Jones Died

14. I’m New. Please Be Kind.

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So Long, Robert

Not unnoticed by me is Robert Fenton’s likely last post at Nurse XY. This a real loss — Robert is a truly gifted writer, and always has something interesting and insightful to say. If you have a chance, head over and check out his stuff. Here’s hoping he changes his mind.

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I’ve Been Selected for a Not-So-Clever Marketing Scheme

This blog has been named as one of the  “20 Best Blog for Nurses” by that august institution, Jacksonville University School of Nursing. My jaded, cynical, shrivelled heart tells me it’s a trojan horse marketing scheme, since the button they emailed me links to information on their MScN program, and there doesn’t seem to a “20 Best Blogs for Nurses” page on their site.

I’m curious. How many other nurse bloggers got a note saying they were one of the 20 Best?

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More on Meera Bai, Faith and Nursing

I realized after I wrote yesterday about Meera Bai and her work at Insite, the Vancouver safe drug injection site, that she has both a blog called Strong Hands and a Twitter feed — @senoritabai. When I spoke to her on Twitter last night, she pointed me to an article she wrote describing her experiences at Insite, provocatively titled “Why I Help Addicts Shoot Up.” A couple of excerpts:

Something about seeing people at their lowest and most desperate, half-clothed from turning tricks for drugs while hating themselves for it, opens into a profound level of intimacy. I am blessed to enter the darkest place of people whose sins are far more public than those of the rest of us. Constant humiliation makes the people I work with especially vulnerable, and vulnerable in almost every way: to violence, to exploitation, to false hope and finally to despair. When allowed into these dark places, it is my privilege, and that of all InSite staff, to communicate worth and love instead of judgment and scorn.

The day nurse asks me to keep an eye out for a specific participant—a regular who comes in several times a day. She hadn’t been seen yet. Later that night, the woman finally comes in, and she’s beaming. “I went to see my daughter today! And I didn’t use all day! F—, soon I’m gonna get off this s—!” We break out in applause and cheers, celebrating her triumphs with her—as she mixes her drugs to take in a few minutes in our facility. Other participants in the room are excited as well; two of them come over to hug her.

Another regular later chats with me in the treatment room as I dress his abscess, trying not to cringe away from the overwhelming odour he emanates. “It would have been my anniversary with my wife today, if she hadn’t gone missing. We’ve both been down and out, but she took care of me out here. Now, I got nobody to talk to. This is the first human touch I’ve had today.” I look up, startled. I am wearing gloves, holding my breath, cleaning his sores with a 10-inch sterile Q-tip. Even this, my deficient attempt to heal, is taken as love by a man desperate for human connection. I am ashamed.

I finish dressing the wound, clean up, remove my gloves and give him a hug. I hop up on the treatment bench next to him and we sit together and talk for another 15 minutes: about life, love and faith. He says goodbye, and then asks for a referral to an exit program. I give it to him. He knows the referral is merely one point along our journey together, and that I will listen to his story whether he goes to the program or not. As a Christian, I know that his life is part of God’s real story of redemption. InSite is one of the few places where I get to hear it openly spoken, with trust, without judgment.

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Often, participants at InSite are forced to sleep outside at night. Not having a warm, safe bed takes its toll on bodies, and special care is needed for feet. An InSite staff member chats with me behind the desk as he fills up a basin of warm, soapy water. Kneeling on the floor, he gently strips damp socks off the swollen foot of a participant and lowers it into the soothing water.

Washing feet here isn’t an oddity from a discomfiting Bible story, but a regular occurrence. Foot baths are healing—for body and soul. As I fill up another basin, I marvel at the timelessness of this act of community. The humility necessary for all involved in washing feet produces beautiful vulnerability and relationship, which, unsurprisingly, creates change.

But really, go read the whole thing. It’s worth it.

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Observations and Assessments

Notions too small for a blog post, all in one place.

Stormy weather. Some of you probably noticed a slight lack of presence here the last couple of days. The wind storm which swept over Ontario last Thursday left us without electricity, telephone and internet service, as well as blowing out an upstairs window and knocking over a fence. The power (or hydro as we say in Ontario) came back the same day; the telephone and internet returned only last night — there was some damage to the local wireless tower as well. The really bad news is that not only are Canadians voting in a federal election today, but that it’s also tax deadline day here in Canada. Because of the lack of internet access, filing was impossible* — and I have, as of writing thirteen hours and ten minutes to find my T4 slip and load up TurboTax.

The Good News. You were all spared — and I am pretty sure my American readers are especially grateful — a blog post about the various parties’ positions on health care. Believe it or not, I did wade through all the platforms, and they essentially ranged from generally sucky with bright spots  to really awful and/or nonexistent. (Hello, Conservatives?) Given the demographic wave which is about to wash over and possibly overwhelm the health care system, and the high priority Canadians place health care as an issue, some sort of debate around this issue might have been useful. Yet we heard nothing at all.

Oh, no, not again. Just so you know, for reasons previously stated, I am ignoring Nurses Week.

New meat. Some shout outs to some new (to me, anyway) nurse bloggers: RNnnnrGrl and Frazzled_razzleRN, The Adventures of a Nursing Student, and in particular Dreaming of Call Bells, who blogs from Moose Factory, Ontario.

Death over the airwaves. A new British television show will show will show footage a terminally ill man dying:

The death of a terminally ill 84-year-old man will be broadcast on British television in May, as part of a series documenting the life cycle of the human body.

A man suffering from cancer and identified only as Gerald will be shown taking his final breath — at home, surrounded by his family — on the second episode of the BBC One series Inside the Human Body.

Speaking to BBC listings magazine Radio Times, host Michael Mosley defended the footage, saying producers did not want to “shy away from talking about death, and when it’s warranted, showing it.”

He acknowledged that the decision to include the footage would inevitably draw criticism.

“I know that there are those who feel that showing a human death on television is wrong, whatever the circumstances. Although I respect this point of view, I think there is a case to be made for filming a peaceful, natural death — a view shared by many who work closely with the dying,” Mosley said.

Similarly, a new documentary shows a terminally ill cancer patient in Oregon taking a lethal (and legal) dose of euthanasia:

I’m not squeamish about death, and theoretically, anyway, I would support physician-assisted suicide. But when confronted with an actual person planning her death, I start having a hard time with it. It seems, well, too cold-blooded. Am I wrong?

Hospital food is awful and bad for you. This seems to be as true in Australia as it is in Canada. Inadequate nutrition is a serious issue in the deconditioning of elderly patients (see here, for example).

Doctors have called for a hospital food review, because patients are being discharged malnourished.

Australian Medical Association state president Andrew Lavender said the below-par quality of hospital food, set serving times for three meals a day, and a one-size-fits-all approach could lead to patients checking out malnourished.

“A lot of patients do become malnourished in hospitals,” he said. “They are trying to improve nutrition, but when you’re cooking for 700 or 800 people the quality is often not up to scratch.”

“Generally, the elderly and those who are sick don’t have an appetite and there isn’t much of a follow-up in terms of what someone doesn’t eat. People having major operations are in a state where their body requires extra nutrients to recover and they often they don’t get that. People do depart hospital down in weight.”

And yet, when looking for increased efficiencies in hospital budgets, the kitchen is often the first place to get the axe.

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*I mean, who does paper returns anymore?

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“We Do More In Our First Hour Than Most Do All Day”

[One of the many great submissions to the Those Emergency Blues Prize for Writing. Posted here with permission.]

Author: Sean Dent

Blog: My Strong Medicine

We Do More In Our First Hour Than Most Do All Day

I think we nurses should start advertising our skills like the Army does. You know that commercial or that saying about those in the Army do more before 6am than most do all day.

(As a side note: I tried to find that commercial with no luck.)

OK. So maybe it wasn’t the Army? It was some branch of military darn it!

Aanny Hoo..

I thought I’d just highlight the first hour of a nurse working at the bedside in a hospital. I’m going to be a lil biased and use a nurse working in the ICU (sorry).

Most nurses arrive 15 minutes before their shift just to brew their coffee, change their clothes (shoes mostly), gather their needed equipment (clipboard, stethoscope, pens/ pencils/ markers, scissors, etc.), get a lay of the land (in the break room and also out on the unit), prepare their day ahead (priorities), put their initials on and stash their lunch, use the bathroom (since this might be the last time you get there for quite a long time), do their hair / makeup (no – not me), and any other sidebars before they actually clock in!

Clock in

Oh wait I forgot. Most of us will still prepare ahead of time. We either have pre-printed report forms we write on during report, or we go to the computer and print out our report sheets, also print out a current census sheet and also view the staffing for the day to determine that plan of action.

Who’s here, who’s not. What’s the staff :patient ratio today? (yes, it will vary in some organizations) This is always about how understaffed the unit could or could not be.

OK.. Back to clocking in

Assignments and staffing

Staffing is assigned (or a vague attempt). Most of the time we try to be fair and even (when I say ‘we’ I mean the charge nurse with the input of the other staff nurses). If you worked the prior day we try to line you up with the same assignment (although that can change at the drop of a hat). Is there a secretary? What is the skill mix of today’s staff versus the complexity of the patient load? What is the severity of the patient illnesses(ventilated / hemodynamic monitoring /etc.)? Is there newer nurses who need experience? Are there orientees with preceptors (no preceptors)? Which patients have procedures and road trips? Any with multiple procedures? Surgeries today? Incoming and outgoing patients? Also what is the length of every staff members shift for the day? Who’s here for 8hr? 12 hr? Who’s coming in and when? Wait, are there student nurses visiting the unit today?

Pre-report analysis

This is where the ‘big picture’ is put together for each patient that you are assigned. Everything from admitting diagnosis, days on the unit, severity of illness, road of recovery, treatment plan, etc. All of the information needed is more than likely in numerous places. What is allowed, not allowed? Diet – fluid restriction / special diet / diabetic? Patient toileting needs (foley, voiding, assistance). Contact information allotment for change in patient condition as well as consents for procedures. What services are on this patients case (multiple medical services as well as primary care – ortho, surgery, pumonary, etc) What is the patients code status (full code? DNR?) Current therapies – everything from occupational and physical therapy to intravenous fluid status and needs. Any special precautions taken – is the patient in contact / droplet precautions?

Patient history – everything pertinent to their care. Allergies? Past medical illnesses? Past surgeries? Any and all of these findings will change and direct your care. Patients age is also pertinent to the customization of your care.

This is also the time to review all pertinent labs in regards to the patient. What’s normal? Abnormal? Why and why not for each finding. What to do about all your findings? What has been done for the lab values, what hasn’t been done. Who needs notified?

Report

This can be nurse to nurse, or a pre-recorded message. This is where the previous shifts activities are reviewed. This is when you compare what you know, what you expect to hear, what you expect to find with what actually is happening to the patient. What you read on paper and on charts never tells the full and accurate story of their care. EVER. Listen intently and list anything that is pertinent to your days activities. There are so many things to note during a report that they are too numerous to list. The bottom line is to extract every finite detail to try and prevent any mistakes during the application of your care, as well as customize what you do towards your patients needs

If you listened to a pre-recorded report you would then follow up and get any additional updates and have any questions you may have answered with the previous shift nurse.

Med check

This is where…

Oh wait. I think I lapsed past the first hour already? Whew…

I left out so much. I know I did. I tried to envision me at work, but there is so much that happens behind the scenes and ‘automatically’ that I can’t account for it all.

The message here is we have so much to do in such little time. You wonder why we nurses arrive early, cheat and prepare before we clock in??

That whole time management thing – yeah we got it.

LOL

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