If you have a serious illness, should you get palliative care?


Yes. Palliative care provides an additional level of support while still providing curative treatment. Hospice care, on the other hand, also provides support but focuses on pain management and a good quality end-of-life care. Coming from NYU, I’m aware of the NICHE program (Nurses Improving Care for Healthsystem Elders). One thing it does is provide caregiver resources especially useful while you or your loved one is at the hospital. Here is their guide for helping you determine if you need palliative care.

1. Do you have one or more serious illnesses?

Such as: • Cancer • Congestive heart failure (CHF) • Kidney failure • Liver failure • Neurological diseases (e.g., ALS, Parkinson’s) • Dementia • Chronic obstructive pulmonary disease (COPD), emphysema, lung disease

Yes___ No___

2. Do you have symptoms that make it difficult to be as active as you would like to be, or impact your quality of life?

These symptoms might include: • Pain or discomfort • Shortness of breath • Fatigue • Anxiety • Depression • Lack of appetite • Nausea • Constipation

Yes___ No___

3. Have you, or someone close to you, experienced the following:

• Difficult side effects from treatment • Eating problems due to a serious illness • Frequent emergency room visits • Three or more admissions to the hospital within 12 months, and with the same symptoms

Yes___ No___

4. Do you, or someone close to you, need help with:

• Knowing what to expect • Knowing what programs and resources are available • Making medical decisions about treatment choices/options • Matching your goals and values to your medical care • Understanding the pros and cons (benefits/burdens) of treatments (e.g., dialysis, additional cancer treatments, surgery, etc.)

Yes___ No___

5. Do you, or someone close to you, need help with:

• Coping with the stress of a serious illness • Emotional support • Spiritual or religious support • Talking with your family about your illness and what is important to you

Yes___ No___

If you answered yes to more than one of the questions, palliative care is something you or your loved one may need. If you feel you may benefit from palliative care, please talk to your healthcare provider today.

Update from April 24, 2014
To spread awareness about COPD and raise money for the COPD Foundation, you can write your story and Healthline will donate $10. The top 5 stories will receive a $75 American Express card.

6:1 Patient to Nurse Ratio Begins!


To keep up with the requirements of a “magnet designated” hospital, my hospital has finally decided to change the medical surgical units to a 6:1 patient:nurse ratio. Originally it had been 7-8 patients per nurse. However, on Monday, August 5, 2013, my unit has decreased the ratio. Here are the differences that I have seen so far.

  • More time with each patient — I can have a discussion ranging from medical diagnoses, plan of care to family life and concerns.
  • More time to help the nursing ancillary staff and other nurses
  • More time to think about their nursing diagnoses and next plan of care
  • More time to read notes to get a better understanding of why each patient is on certain treatments
  • More time to catch a change in a patient’s condition

It has been a positive change so far. I feel that patients are happier in that they see the nurse more and sleep earlier at night (since there are less medications to give and less people to see before they have to sleep).

Greater understanding for the plan of care, knowing when things will happen (when will the doctor see them? when will a procedure happen?) and more sleep

= happier patients = an increase in patient satisfaction = higher reimbursement from Obamacare

I hope that more hospitals do this!

Are sleeping pills safe?


A lot of people can’t fall asleep. Especially in hospitals where there are beeping alarms. The first thing they turn to is a sleeping pill. Especially Ambien.

Sometimes it’s wonderful. It helps you sleep throughout the night. It’s great for people who are good on their feet and not connected to anything.

The problem starts when you have to pee. And you are attached to IV fluids. Your first instinct is to roll out of bed and walk to the bathroom.

Except at the hospital, you won’t remember where the bathroom is and that you’re attached to IV fluids. You won’t remember where you are, why you’re there, what year it is. All you want to do is pee.

Next thing you know, you fell on the ground and ripped out the IV. Just great. But by the morning, you won’t remember any of it happening. Only remaining evidence.

Next time someone asks you for Ambien, think about the safety issues. Offer other sleeping solutions such as decreasing pain, closing the door, and providing eye shades and eye plugs.

As from a nursing research POV, maybe it’s a good idea to come up with a Ambien checklist to assess patient safety.

Top 10 Things You Should Know About Nurses

According to a patient in the hospital, these are the top 10 things patients should know about nurses. I thought that this did a good job of summarizing what nurses do at the hospital from the patient’s point of view.

1. You have been placed in the hospital for nursing care.

2. The provider of that care is an educated individual who unselfishly dedicates themselves to your health and well-being. And even though you may not like being told what things are good for you and what are not, the nurse telling you does so to give you a chance to redeem your health and well-being.

3. That provider is proud to be a nurse.

4. That nurse does more than you know. She plans your care around your medical condition, emotional state, abilities to do for yourself (sorry, [nurse], I think you said “self care” in your rant), that nurse provides support to you and your family, she/he is the link between you and the doctor, [and] the everything in the facility.

5. That nurse does your bedside care, she knows what medicine you need when, and how to give it. She knows what all the tubes and stuff are and what they are used for and what to look at them for.

6. That nurse can hang an IV or hold your hand and reassure you.

7. That nurse watches over you and reads monitors and knows when [you’re] sleeping and when [you’re] awake and pulls strings to get you that cup of tea at 3 a.m.

8. That nurse is your lifeline, she can call a whole team of professionals together with her calm voice and make them work their [butts] off for your life with the flash of her/his eyes.

9. That nurse will wish you luck and give you all the instructions you need when you leave her competent care even if you were the biggest pain in the ass she ever met.

10. The nurse is why you are in the hospital and why you will go onward, be it home, perpetual care, or the morgue, she will insure that you do so with your dignity and rights intact. Why? Because it is what a nurse does.

What Do Nurses Really Do

What Do Nurses Really Do

One of the most common misperceptions about nursing is that “all we do is clean up bedpans.” While that may be ONE thing that we do, we do a lot more to direct patient care. When there’s a change in conditions (sudden onset of chest pain, trouble breathing, pain, vital sign changes, etc), we are the ones who see it first and decide the next best thing to do. When we see a treatment not working for patients, we are the ones who speak up to change the course of treatment. We make sure there’s no further complications associated with lying in bed for a long period of time (DVT, confusion, constipation, bed sores/pressure ulcers, falls, etc). Clinically, we should be at the top of our game. Below is a list of what nurses really do.

  • Nurses catch and prevent the medication error that would have killed you.
  • Nurses catch and stop the infection that would have killed you.
  • Nurses diagnose an ICU patient’s wide complex tachycardia, call a code, and defibrillate–saving the patient’s life.
  • Nurses triage ED patients based on their own expert evaluation of how sick the patients are–saving patients’ lives.
  • Nurses give powerful medications and vaccinations–saving patients’ lives.
  • Nurses are the care givers most likely to be there when patients are screaming, crying, laughing, or dying.
  • Nurses manage that violent, intoxicated patient alone until security gets there–if security gets there.
  • Nurses are the hospital caregivers most likely to be assaulted.
  • Nurses persuade that psychiatric patient to stick with the program.
  • Nurses persuade a poor young mother to save her baby’s life through prenatal visits and breastfeeding.
  • Nurses provide adequate pain medication for terminal patients and the opportunity to die at home.
  • Nurses provide expert support in your final hour.
  • Nurses teach you how to avoid getting AIDS, and how to live with it if you do.
  • Nurses subtly show the sickest patients that it’s worth trying, perhaps by discussing Harry Potter with the young leukemia patient, or watching a few minutes of the news with that despondent, elderly post-op patient.
  • Nursing students spend years in demanding science programs that test their sanity and cause some to quit or fail.
  • Nursing scholars struggle to get grants, publish groundbreaking research and get tenure.
  • Nurses serve as the chief executive officers of large hospitals.
  • Nurses spearhead efforts to help your teenage son not start smoking.
  • Nurses deliver babies in U.S. teaching hospitals and mountain villages in Bolivia.
  • Nurses provide much, if not most, of the health care given by aid groups with names like Doctors Without Borders.
  • Nurses explain what that physician was trying to communicate–saving countless lives.
  • Nurses, as commissioned officers, manage complex military care operations around the world.
  • Nurses found and run new health systems for underserved urban and rural communities–saving countless lives.
  • Nurses confront disruptive physician behavior, life-threatening nurse short-staffing, and bitter class divisions and horizontal violence within their own profession.
  • Nurses go on strike.
  • Burned-out nurses explode and quit.
  • Nurses train and mentor nursing students and new nurses.
  • Nurses kick intoxicated surgeons out of the OR and fight to have surgeons who are dangerous removed permanently.
  • Nurses refuse to give drugs that will hurt that fetus, or any other patient.
  • Nurses risk their careers to blow the whistle on deadly incompetence.
  • Nurses make mistakes and kill people, especially when they are understaffed or exhausted.
  • Nurses regularly have intense interactions with physicians about patient care. For instance, nurses may identify symptoms physicians have overlooked, and they may struggle to convince physicians that those symptoms exist.
  • What is Nursing?

    I was browsing the net and stumbled upon the website called the Truth About Nursing. The purpose is to teach the difference between the mass portrayal of nursing (especially through TV shows) and what nursing really is. Their definition and their description of what nurses do everyday is pretty good and accurate.

    What is Nursing?

    Nurses save and improve lives as front line members of the health care delivery team. They independently assess and monitor patients, and taking a holistic approach, determine what patients need to attain and preserve their health. Nurses then provide care and, if needed, alert other health care professionals to assist. For instance, emergency department nurses triage all incoming patients, deciding which are the sickest and in what order they require the attention of other health care professionals. Thus, nurses coordinate care delivery by physicians, nurse practitioners, social workers, physical therapists and others. Nurses assess whether care is successful. If not, they create a different plan of action.

    One of the most important roles of the nurse is to be a patient advocate–to protect the interests of patients when the patients themselves cannot because of illness or inadequate health knowledge.

    Nurses are patient educators, responsible for explaining procedures and treatments. For instance, nurses teach patients and their families how to eat in a healthier way, take medicines, change wound dressings, and use health care equipment.

    Nurses empower patients, guiding them toward healthy behaviors and support them in time of need. When patients are able, nurses encourage and teach them how to care for themselves. Nurses provide physical care only when patients cannot do so for themselves.

    As patients near the end of their lives, nurses provide dignity in death by advocating for sufficient pain medication and the opportunity to die at home to allow them to spend meaningful time with family members in their final days.

    Hospital nurses are responsible for discharge planning, deciding together with other health professionals when patients can go home, and helping patients adapt to their conditions and work toward full recovery.

    Nurses, especially those working in community settings, work to prevent illness through education and community programs designed to decrease transmittable illnesses, violence, obesity and tobacco use, and provide maternal-child education–to prevent some of the leading health problems of our time.

    Some nurses are independent scholars whose work is at the forefront of health care research. Many nurses obtain Master’s and Ph.D. degrees in nursing, then work as scholars, educators, health policy makers, managers, advanced practitioners such as Clinical Nurse Specialists or Nurse Practitioners, or sit on Boards of Directors.

    First paid vacation!

    I scheduled my first vacation as a new nurse.

    Granted, it’s a week trip back to my hometown in Michigan (nothing too glamorous, just time with the family), but I’m getting paid for it. Sweet!

    Timeline from starting at the hospital:
    Mid January 2013: Date of Hire
    Beginning of July: Accrued 2 weeks of vacation time (6 days). By end of this year, it’ll be a total of 4 weeks (12 days).
    End of July: Requested for 2 days off
    3 Days later: Approved request (only 2 people can take vacation on a shift at a time)

    It’s like what my critical care professor said. After you start work, you’ll put in 6 months where you’re a little nervous about going to work. Then around 8 months in, you go on vacation. 1 year later, you’ll look back and see how far you’ve come since the beginning. So far, she’s pretty accurate. 🙂

    One of the great things about working here is a work-life balance and the 4 weeks of vacation time that I get after coming off probation. 🙂

    I’ll never look at antibiotics the same way again

    I heard it again. Another code. This time, it was for a patient getting this specific IV antibiotics for the first time. She went into a full on allergic reaction, or anaphylactic shock. I ran over, “Jessica, get the ambu bag!” This will force air into her lungs. Already compressions were started.

    “Get a 1000cc bag of normal saline!” She had low blood pressure because her heart rhythm went into v-tach and her pulse is through the roof.

    Her airway was swollen so respiratory therapists were there to make sure the airway remained open. She was eventually stabilized and sent up to ICU.

    Lesson Learned
    For first dose antibiotics and blood and any medication…
    Always inform your patients of possible allergic reactions and to alert you if they develop these symptoms: difficulty breathing, itchy, redness, chest tightness, swelling.

    If they do, always STOP giving the medication (or blood, especially if IV) immediately and give Benadryl, an antihistamine that stops the allergic reaction.

    Then DOCUMENT it in the allergy section so that it won’t ever happen again.

    Remember, the first time exposure to a medication typically has a mild reaction. But after the first time, your body has built antibodies to react to the allergen. The subsequent exposure will tend to have a more severe reaction.

    Nurse Gail – Travel Nursing

    I love the Internet because it allows you to connect with people that you may not have otherwise. Nurse Gail is a prime example! She went to University of Texas for nursing school and now is a travel nurse in NYC for 6 years. It has given her the opportunity to experience New York in a wide variety of settings and has challenged her everyday. We will both be attending NYU College of Nursing for our Master’s this fall so I’m very excited to meet her in person. 🙂

    Her blog discusses the challenges of NYC nurse working conditions, pros and cons of travel nursing, and nursing related issues. One I particularly liked discussed a journal article on the effects of aggression towards the nurse. Medical errors increase so the bottom line is to be nice to the nurse! I encourage you to check out her blog.

    Until next time,