I was having a normal day at work yesterday...the usual getting all gowned up for a Cdiff patient and bringing 25 out the 26 supplies I needed into the room. Weaned off some pressers only to have to put them back on again. Seeing a dear patient that isn't making progress. It was sort of getting me down for a few hours.
Then my patients wife came in to visit. She shared her husbands story with me and it almost brought me to tears, as a nurse and a normal human :)
Her husband suffered multiple medical problems in the last year putting him in the hospital, where he then suffered from several heart attacks and strokes. Everyone wrote him off. He had a stage 4 pressure ulcer you could stick your fist in. He was sent to hospice to ease him from the pain of what he was going through.
Then...
He didn't get worse. He got better bit by bit. His wife was there, turning him, dressing his wound, applying Dakins solution (which is pretty much just bleach), toileting him for weeks. He was moved out of hospice into a rehab and was transferred to us for heart surgery. When I saw him yesterday, we got him out of bed and he popped right up like he didn't spend the last year almost on his death bed. His pressure ulcer? Healed. Completely. We transferred him out of the ICU yesterday. His wife showed me her catalog of iPhone pictures from the last 11 months showing his acute decline and steady and slow progress back to a strong, independent man. Back to his wife of over 30 years.
Those kind of stories make me come back for more, day after day, week after week. Even though we are understaffed every day and night, even though we trudge through hospital politics sometimes just to care for our patients. Even though sometimes you feel like you aren't making a difference for anyone, anywhere sometimes. It makes me proud to put those scrubs on and introduce myself as the nurse to my patients every morning.
Wednesday, December 10, 2014
Wednesday, December 3, 2014
Something about why I like being a NURSE
Why didn't you go to medical school? You are too smart to be a nurse. Did you need training to become a nurse? When are you done with school?
I know, we've all heard these things. Sometimes you get a patient that you really bond with and they appreciate your hard work and attention to detail and to them. You've finally found the one, you think. Their family brings in Donut Holes. It's true love. And then they ask why you didn't want to become a doctor. Your heart rips open. Another patient who doesn't understand the line between medicine and nursing. But why would they? My favorite part about rounds is when a large group of doctors comes to tell the patient that 'we' extubated you, 'we' titrated your drips, 'we' got you out of bed, 'we' fed you a heart healthy diet... I'm sorry but when I explain your heart surgery to you, I don't say 'we' carefully sawed your sternum open, 'we' stopped your heart, 'we' carefully cut through layers of tissue, 'we' bypassed your arteries, 'we' sewed your sternum back together.... I give credit where credit is due...mostly because I'm not a surgeon.
That is a rant I didn't meant to take us on.
What I meant to say is that, why can't we change the fact that people ask these questions? I'm getting my Master's degree in Nursing and I've been asked more than a few times why I'm not just going to go to medical school. Because I'm a nurse. The Growth and Development of Nurse Leaders by Angela Barron McBride is a book I was forced to read during my leadership class and I've now revisited to help me answer those questions. She literally says "Nurses have long known what they do, and, if anything, have been annoyed that others didn't understand what they did.' Is that not how we all feel? Did this woman read my mind? She goes on to say that if we want others to understand what we do, we have to name it. And we can't just name it nursing because if everything we do is just 'nursing'. Why? Because then Florence Nightingale just continues to be the woman who put cool cloths on fevered heads, not the woman who wrote over 200 books, created the first school to train nurses, and was inducted into the Royal Statistical Society for her work with nursing statistics, showing infection rates and treatment effectiveness.
What might be a surprise to some people is that what we do all day is not ask for permission to perform our nursing duties from a doctor.
We give a detailed head to toe report to each other twice a day (or more sometimes), introduce our patients to the new nurses, comb through electronic medical records for all the details. We decide on our daily tasks early. Dressing changes, neuro checks, clapping on someones back every hour to help them expectorate some sputum, increasing their levophed, standing them up or rolling them over every two hours so they don't get skin breakdown, hanging IV bags of antibiotics, electrolytes, nutrition, vasopressors, vasodilators, vasowhosiwhatsits, decreasing their levophed, suctioning out their stomach contents because they aren't digesting, measuring those stomach contents, deciding to either throw them away or put them back in....taking out central lines, putting IV lines back in, measuring urine in foley bags, taking foleys out, putting foleys back in, increasing their levophed, adding continuous sedation, holding them back when they try to take their endotracheal tubes out, increasing their sedation, increasing their levophed, change ventilator settings, drawing arterial blood gases, change vent settings, increase their levophed, decrease their sedation, draw more ABGs, change more vent settings, turn them and look at their butts, rub cream everywhere, decrease their sedation....aaanndddd chart it all hour by hour, minute by minute, task by task.
My favorite part about what we call nursing? Way deep down, I do really like to hold my patient's hand and coach them through a recovery and watching them as they overcome their pain. But don't tell any doctors that, I don't want anyone saying 'we' comforted you when the dilaudid just wasn't cutting it.
I know, we've all heard these things. Sometimes you get a patient that you really bond with and they appreciate your hard work and attention to detail and to them. You've finally found the one, you think. Their family brings in Donut Holes. It's true love. And then they ask why you didn't want to become a doctor. Your heart rips open. Another patient who doesn't understand the line between medicine and nursing. But why would they? My favorite part about rounds is when a large group of doctors comes to tell the patient that 'we' extubated you, 'we' titrated your drips, 'we' got you out of bed, 'we' fed you a heart healthy diet... I'm sorry but when I explain your heart surgery to you, I don't say 'we' carefully sawed your sternum open, 'we' stopped your heart, 'we' carefully cut through layers of tissue, 'we' bypassed your arteries, 'we' sewed your sternum back together.... I give credit where credit is due...mostly because I'm not a surgeon.
That is a rant I didn't meant to take us on.
What I meant to say is that, why can't we change the fact that people ask these questions? I'm getting my Master's degree in Nursing and I've been asked more than a few times why I'm not just going to go to medical school. Because I'm a nurse. The Growth and Development of Nurse Leaders by Angela Barron McBride is a book I was forced to read during my leadership class and I've now revisited to help me answer those questions. She literally says "Nurses have long known what they do, and, if anything, have been annoyed that others didn't understand what they did.' Is that not how we all feel? Did this woman read my mind? She goes on to say that if we want others to understand what we do, we have to name it. And we can't just name it nursing because if everything we do is just 'nursing'. Why? Because then Florence Nightingale just continues to be the woman who put cool cloths on fevered heads, not the woman who wrote over 200 books, created the first school to train nurses, and was inducted into the Royal Statistical Society for her work with nursing statistics, showing infection rates and treatment effectiveness.
What might be a surprise to some people is that what we do all day is not ask for permission to perform our nursing duties from a doctor.
We give a detailed head to toe report to each other twice a day (or more sometimes), introduce our patients to the new nurses, comb through electronic medical records for all the details. We decide on our daily tasks early. Dressing changes, neuro checks, clapping on someones back every hour to help them expectorate some sputum, increasing their levophed, standing them up or rolling them over every two hours so they don't get skin breakdown, hanging IV bags of antibiotics, electrolytes, nutrition, vasopressors, vasodilators, vasowhosiwhatsits, decreasing their levophed, suctioning out their stomach contents because they aren't digesting, measuring those stomach contents, deciding to either throw them away or put them back in....taking out central lines, putting IV lines back in, measuring urine in foley bags, taking foleys out, putting foleys back in, increasing their levophed, adding continuous sedation, holding them back when they try to take their endotracheal tubes out, increasing their sedation, increasing their levophed, change ventilator settings, drawing arterial blood gases, change vent settings, increase their levophed, decrease their sedation, draw more ABGs, change more vent settings, turn them and look at their butts, rub cream everywhere, decrease their sedation....aaanndddd chart it all hour by hour, minute by minute, task by task.
My favorite part about what we call nursing? Way deep down, I do really like to hold my patient's hand and coach them through a recovery and watching them as they overcome their pain. But don't tell any doctors that, I don't want anyone saying 'we' comforted you when the dilaudid just wasn't cutting it.
Wednesday, November 12, 2014
What's the big deal about heart disease anyways?
#1 thing I forget about my patients: they didn't go to nursing school. Wait...what? I find myself rolling my eyes sometimes when I get asked a 'stupid' question (When I wake up, my blood sugar is 250, but that's pretty good right?). I scoff at the history that states 'had chest pain for 2 years, came to ER last night'. You groan when the over weight sweating patient asks if he can order out chinese food because the food they gave him in the cardiac unit is too bland. When my patients are allowed to eat solid food, I used to tell them they can eat 'whatever they want'...thinking people understood the gravity of being admitted to a cardiac unit and the lifestyle choices that may have contributed to their current predicament. But they don't understand. They haven't had this kind of education drilled into them every day. They don't see the consequences of bad diet, no exercise, avoiding the doctors office and leading a stressful lifestyle everyday. That's why I love those commercials with the live heart surgery that warn against smoking....that is no joke. Have you ever seen a sternum sawed open and then sewed back up with metal wires? That's enough to make you want to get your cholesterol checked and only eat kale chips and quinoa for the rest of your life.
So...because I'm always on the CDC website for school anyways, I thought I'd outline some facts and stats about heart disease.
There were over 50,000 admissions for cardiac intervention in New York State in 2011(NY Dept of Health). Most of them in NYC. It's stressful living in NYC, having to ride on the subway on a daily basis is enough for me to have some narrowing of my arteries.
Heart disease is the number one cause of death of Americans, female and male. Every year, more than 720,000 Americans will have a heart attack...costing our health system over 100 billion dollars. That. Is. Nuts. I thought I would find that heart disease death rates would be more prevalent in large cities in America, but deaths related to heart disease are actually higher in the Southern states and in the West.
In 2005, a study was done to determine what people knew about the warning signs of a heart attack. 92% knew that chest pain was a major symptom of a heart attack, but only 27% knew the other symptoms and to call 911 when someone was having a heart attack. 27%. More than 88% of heart attacks occur at home. These are the signs and symptoms of a heart attack and reason to either visit the ER or call 911:
So there's a bunch of stuff about how scary it would be to have a heart attack and how often it actually happens....but who is at risk?
Men are more at risk than women, having a little over half of the deaths from heart disease in America. Heart disease is the leading cause of death for African Americans, White and Hispanics. High blood pressure, high LDL cholesterol and smoking are key risk factors for heart disease, almost half of Americans have one of these three risk factors. Other risk factors include obesity, diabetes, poor diet, little exercise and excessive alcohol use. (CDC, 2014)
But, I LOVE saturated fats and lying on my couch and drinking too much......mmm oreos and prosciutto and lard.....WHAT! Could it be so easy to prevent having a heart attack? Could it be so simple?
Stop smoking.
Eat a diet rich in fiber and low in saturated fats.
Take an Omega 3 supplement.
Exercise 3 times a week for at least 30 minutes (please call your doctor before you start running marathons and dancing some Zumba).
Don't drink...so much. Red wine is full of antioxidants!!! (More on antioxidants in another blog post!)
Visit the CDC Website for suggestions on a healthy heart lifestyle!
One last thought. I have had two patients that I can remember that lived to tell the tale of receiving CPR (they may not remember that part) and being admitted to the ER, having heart surgery and being discharged. Two. That means that out of all the people (those 88% that have heart attacks at home) and become unresponsive, I have seen two live. Worth it to look up some quinoa and kale chips recipes right?
So...because I'm always on the CDC website for school anyways, I thought I'd outline some facts and stats about heart disease.
There were over 50,000 admissions for cardiac intervention in New York State in 2011(NY Dept of Health). Most of them in NYC. It's stressful living in NYC, having to ride on the subway on a daily basis is enough for me to have some narrowing of my arteries.
Heart disease is the number one cause of death of Americans, female and male. Every year, more than 720,000 Americans will have a heart attack...costing our health system over 100 billion dollars. That. Is. Nuts. I thought I would find that heart disease death rates would be more prevalent in large cities in America, but deaths related to heart disease are actually higher in the Southern states and in the West.
In 2005, a study was done to determine what people knew about the warning signs of a heart attack. 92% knew that chest pain was a major symptom of a heart attack, but only 27% knew the other symptoms and to call 911 when someone was having a heart attack. 27%. More than 88% of heart attacks occur at home. These are the signs and symptoms of a heart attack and reason to either visit the ER or call 911:
- Chest pain or discomfort.
- Upper body pain or discomfort in the arms, back, neck, jaw, or upper stomach.
- Shortness of breath.
- Nausea, lightheadedness, or cold sweats.
Not only is it important to call 911 or know when to go to the ER, it's also important to know CPR! Did you know that only 32% of heart attack victims receive CPR from a bystander and only 8% of those people who have a cardiac arrest outside the hospital will survive? Here is a link to the Hands Only CPR video from the AHA.
So there's a bunch of stuff about how scary it would be to have a heart attack and how often it actually happens....but who is at risk?
Men are more at risk than women, having a little over half of the deaths from heart disease in America. Heart disease is the leading cause of death for African Americans, White and Hispanics. High blood pressure, high LDL cholesterol and smoking are key risk factors for heart disease, almost half of Americans have one of these three risk factors. Other risk factors include obesity, diabetes, poor diet, little exercise and excessive alcohol use. (CDC, 2014)
But, I LOVE saturated fats and lying on my couch and drinking too much......mmm oreos and prosciutto and lard.....WHAT! Could it be so easy to prevent having a heart attack? Could it be so simple?
Stop smoking.
Eat a diet rich in fiber and low in saturated fats.
Take an Omega 3 supplement.
Exercise 3 times a week for at least 30 minutes (please call your doctor before you start running marathons and dancing some Zumba).
Don't drink...so much. Red wine is full of antioxidants!!! (More on antioxidants in another blog post!)
Visit the CDC Website for suggestions on a healthy heart lifestyle!
One last thought. I have had two patients that I can remember that lived to tell the tale of receiving CPR (they may not remember that part) and being admitted to the ER, having heart surgery and being discharged. Two. That means that out of all the people (those 88% that have heart attacks at home) and become unresponsive, I have seen two live. Worth it to look up some quinoa and kale chips recipes right?
Friday, November 7, 2014
Thursday, November 6, 2014
Fake it til you Make it
Just to be clear...
This post isn't about lying (white lies or big lies) and it's not about skirting away from tough situations. It's about how I've created a 'second personality' at work because of the way I feel families and patients should be treated. It's about how I make sure my patients and their loved ones don't know about the pressure behind the scenes of nursing.
Thank goodness that's out of the way.
So, today. Not all days are the same when you're a nurse. Sure, there are patients that linger, patients that get cycled from ICU to step-down back to ICU and so forth. But for the most part, I am seeing new families, new faces and new questions almost every day I work.
However, today I had one of those experiences where you ride the fine line of using too much 'nursing language' and trying to take a lot of one on one time with a worried family member to ease their worry. So often, we ride this fine line as nurses. Trying to make every patient feel as if they are the center of your universe that day (no sarcasm) and also completing the mountain of incredibly important (sarcasm) documentation. Isn't this the classic nurse complaint/issue?
I have a practiced smile, a level tone of voice. I have an arsenal of finely tuned one liners for families. Today I used this skill to help calm the wife of my patient. Her husband was in my care, barely recognizable under the lines, tubes, wires and machines. She was ragged, having been at the hospital over 24 hours, being shuffled in and out of the waiting room to 'view' her husband and then be told 'we are going to turn/insert a tube/draw labs/etc, could you step out?'.
I make sure they first interaction I have with a family is with a smile. 'Hi, my name is Carissa. I'll be your husbands/wifes/fathers nurse today!' No matter the turmoil behind that curtain. Hit 'em with a smile.
I ask for their story. How long have YOU been at the hospital? Have YOU slept/eaten breakfast/showered? Lots of families forget that they are allowed to
go home and don't think of it until someone reassures them that they are allowed to leave. We will be here all day and all night.
Even if I'm just hanging a bag of potassium, I like to let them in on the little things when I have the time to explain. It makes the big things seem less daunting.
It can be so easy...
The to-do list for a nurse (any kind of nurse, ICU, ER, Med/Surg, Dialysis, L&D) is immense. Especially as a new nurse it can be hard to find your way around the to-do list and back to your patient and their loved ones. We are taught in nursing school that any patient isn't a diagnosis, they are a person. "We've got an AVR in this room, a diabetic in this room and this guys got hypertension"....whatttttt? As much as it can leak through sometimes, the rushed 'I don't have time to explain this to you' tone of voice makes patients and families scared. It makes them nervous. Do you have time for me? What if something happens, will you have time to care for my loved one? Even if I'm simultaneously drawing blood, reading vitals, hanging drips, checking pulses and checking for intact skin, my goal is to keep my tone of voice conversational and inviting rather than short, quick, one sentence answers.
I've found myself thinking about this a lot lately and studying family members. The more I can put them at ease, even if the news isn't great, even if we are making infinitesimal changes, learning how to spin it in a way each individual will understand is so important.
Ok nursiness to the side for a minute. My goal for this week was to go to the gym before work. I failed this morning. Set my alarm. Woke up. Rolled over and decided I didn't need to go. I'm training for a marathon in May and I have to be able to keep up with my sister the gazelle. So, tomorrow. Gym. Goals. These words aren't in my vocabulary at 4:30am but we'll see. Another day.
This post isn't about lying (white lies or big lies) and it's not about skirting away from tough situations. It's about how I've created a 'second personality' at work because of the way I feel families and patients should be treated. It's about how I make sure my patients and their loved ones don't know about the pressure behind the scenes of nursing.
Thank goodness that's out of the way.
So, today. Not all days are the same when you're a nurse. Sure, there are patients that linger, patients that get cycled from ICU to step-down back to ICU and so forth. But for the most part, I am seeing new families, new faces and new questions almost every day I work.
However, today I had one of those experiences where you ride the fine line of using too much 'nursing language' and trying to take a lot of one on one time with a worried family member to ease their worry. So often, we ride this fine line as nurses. Trying to make every patient feel as if they are the center of your universe that day (no sarcasm) and also completing the mountain of incredibly important (sarcasm) documentation. Isn't this the classic nurse complaint/issue?
I have a practiced smile, a level tone of voice. I have an arsenal of finely tuned one liners for families. Today I used this skill to help calm the wife of my patient. Her husband was in my care, barely recognizable under the lines, tubes, wires and machines. She was ragged, having been at the hospital over 24 hours, being shuffled in and out of the waiting room to 'view' her husband and then be told 'we are going to turn/insert a tube/draw labs/etc, could you step out?'.
I make sure they first interaction I have with a family is with a smile. 'Hi, my name is Carissa. I'll be your husbands/wifes/fathers nurse today!' No matter the turmoil behind that curtain. Hit 'em with a smile.
I ask for their story. How long have YOU been at the hospital? Have YOU slept/eaten breakfast/showered? Lots of families forget that they are allowed to
go home and don't think of it until someone reassures them that they are allowed to leave. We will be here all day and all night.
Even if I'm just hanging a bag of potassium, I like to let them in on the little things when I have the time to explain. It makes the big things seem less daunting.
It can be so easy...
The to-do list for a nurse (any kind of nurse, ICU, ER, Med/Surg, Dialysis, L&D) is immense. Especially as a new nurse it can be hard to find your way around the to-do list and back to your patient and their loved ones. We are taught in nursing school that any patient isn't a diagnosis, they are a person. "We've got an AVR in this room, a diabetic in this room and this guys got hypertension"....whatttttt? As much as it can leak through sometimes, the rushed 'I don't have time to explain this to you' tone of voice makes patients and families scared. It makes them nervous. Do you have time for me? What if something happens, will you have time to care for my loved one? Even if I'm simultaneously drawing blood, reading vitals, hanging drips, checking pulses and checking for intact skin, my goal is to keep my tone of voice conversational and inviting rather than short, quick, one sentence answers.
I've found myself thinking about this a lot lately and studying family members. The more I can put them at ease, even if the news isn't great, even if we are making infinitesimal changes, learning how to spin it in a way each individual will understand is so important.
Ok nursiness to the side for a minute. My goal for this week was to go to the gym before work. I failed this morning. Set my alarm. Woke up. Rolled over and decided I didn't need to go. I'm training for a marathon in May and I have to be able to keep up with my sister the gazelle. So, tomorrow. Gym. Goals. These words aren't in my vocabulary at 4:30am but we'll see. Another day.
Monday, November 3, 2014
My Life as an RN: 5 Years In
Who am I and why am I starting a blog?
1) I am one year away from graduating with my Masters in Nursing and earning my Advanced Practice RN certification and I feel like I am in a cloud of nurse emotions.
2) I feel as though I am forgetting my first love and why I fell in love in the first place: nursing.
3) My mind is a muddle of things as I'm beginning a new chapter in my life and I feel the need to get some concrete words on the screen to make myself feel more real.
I have been a cardiothoracic surgery nurse since I graduated from Quinnipiac University in 2009. I worked in New Haven for 2 and half years and now I've been working on the Upper East Side of NYC for the same amount of time.
I made the decision to go back to school to get my Family Nurse Practitioner after working in New York for about 6 months. At time I've felt useless as a nurse and at times I've felt as if I'm the only one that matters to a patient. There have been times when I've struggled to push down my own feelings and times when I've felt like I don't have any left. Isn't that the hallmark of a nurse? Wondering where the feelings have gone and then not being surprised when they rush back all at once while talking to a family member of a beloved dying patient? Is it this emotion sickness that pushed me away from the bedside and to study to be a white coat wearing prescription writing family history inquiring practitioner? Was it something more simple, such as the realization that in 5 years when I (hopefully) have a household full of kids and dogs, that I will want to work hours that normal human beings work and not have to work holidays and weekends? Or was it the fact that at the point that my patients reach me, they are already suffering from so many different diseases that I wonder how they've made it this far? Eh, it's probably a combination of all of those, it's hard to pinpoint which one is more important from one day to the next.
I'm married to a wonderful man that I met at nursing school who then became a cop for the NYPD in 2012. We recently moved out of the city to the suburbs which couldn't have made me happier. Besides not knowing anyone up here besides our neighbors who are all over the age of 65, it's the perfect place for me to plant myself.
What else interests me?
Running, baking, cooking, reading. I know I'm so interesting. But perhaps while I don't write about nursey things, I will write about sugar and flour and the joys of training for marathons with my little sister.
1) I am one year away from graduating with my Masters in Nursing and earning my Advanced Practice RN certification and I feel like I am in a cloud of nurse emotions.
2) I feel as though I am forgetting my first love and why I fell in love in the first place: nursing.
3) My mind is a muddle of things as I'm beginning a new chapter in my life and I feel the need to get some concrete words on the screen to make myself feel more real.
I have been a cardiothoracic surgery nurse since I graduated from Quinnipiac University in 2009. I worked in New Haven for 2 and half years and now I've been working on the Upper East Side of NYC for the same amount of time.
I made the decision to go back to school to get my Family Nurse Practitioner after working in New York for about 6 months. At time I've felt useless as a nurse and at times I've felt as if I'm the only one that matters to a patient. There have been times when I've struggled to push down my own feelings and times when I've felt like I don't have any left. Isn't that the hallmark of a nurse? Wondering where the feelings have gone and then not being surprised when they rush back all at once while talking to a family member of a beloved dying patient? Is it this emotion sickness that pushed me away from the bedside and to study to be a white coat wearing prescription writing family history inquiring practitioner? Was it something more simple, such as the realization that in 5 years when I (hopefully) have a household full of kids and dogs, that I will want to work hours that normal human beings work and not have to work holidays and weekends? Or was it the fact that at the point that my patients reach me, they are already suffering from so many different diseases that I wonder how they've made it this far? Eh, it's probably a combination of all of those, it's hard to pinpoint which one is more important from one day to the next.
I'm married to a wonderful man that I met at nursing school who then became a cop for the NYPD in 2012. We recently moved out of the city to the suburbs which couldn't have made me happier. Besides not knowing anyone up here besides our neighbors who are all over the age of 65, it's the perfect place for me to plant myself.
What else interests me?
Running, baking, cooking, reading. I know I'm so interesting. But perhaps while I don't write about nursey things, I will write about sugar and flour and the joys of training for marathons with my little sister.
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