Posted on August 31, 2021August 31, 2021 by Jessica

This last 8 months of 2021 has been difficult, polarizing, and changing. At the beginning of this year, I got the Pfizer COVID-19 vaccine and thought everyone would eventually get on board with getting the vaccine and ready to cull the pandemic to its end.

People were going across state lines where less people were getting the vaccine. The rush to vaccinate began in the USA.

Then I heard chatter amongst my colleagues. People were scared to get the vaccine. A lot of misinformation was and is still out there. They hear about the cases where people got bad side effects. They weren’t going to chance getting the vaccine. They would rather get the virus and brave the disease process and treatment. While many survive, many also maintain “long covid” symptoms such as the loss or reduced smell or taste.

Finally, the rush to vaccinate had subsided and those hesitant to get vaccinated began to say “how could you want an experimental drug, I’m not a guinea pig.” The institutions were not to be trusted— only their “sources” would reveal the “actual truth”.

At the end of June, my hospital decided to implement a vaccine mandate by September 10th, based on the belief that the vaccine would pass FDA approval (and no longer under emergency use authorization). Of course there are medical and religious exemptions.

Since then, protests occurred in the name of freedom. People quitting, going into a different field away from healthcare. Others quit to become a “traveler” where in healthcare you could make 2-3x your regular wages. Nurses becoming jealous of those with big sign on bonuses and thinking of wanting some of that too.

Many religious exemptions were made. Personally, I’m not sure if it is to keep the staff or if there are truly that many religions that are against vaccines. What religion promotes transfer of diseases? When you know a way to protect yourself, adding a layer of armor against something, wouldn’t you want it to help yourself fight?

About a week ago, the FDA approved the Pfizer vaccine. The excuse to not get the vaccine changed again. Did it really encourage those people who were hesitant to get the vaccine to get the vaccine? I hear many say the government pushed them too fast to get it approved. Basically, why trust the government.

Right now in Michigan we are lucky to not have a big surge, unlike in Florida. We are lucky to be “business as usual” without delaying surgical care to patients. We don’t have a huge influx of covid patients and for that I am thankful. We are starting to get a few more covid positive cases compared to the last few months. I sincerely hope with the start of the new school year that everything stays the same. But I highly doubt that. More people will get sick. Sure there’s treatment for it but isn’t it better to take measures to prevent getting a disease?

Starting in September, we will see what will happen. Until then…

As for my little one, I feel fortunate to have pumped /breastfeed for one year. But I am also happy that he readily accepts whole milk and doesn’t mind (too much anyways) that it’s only bottles now.

I can’t believe he’s already 15 months old. He’s running around, bounces up and down to music, climbs furniture more readily, goes up and down the stairs, understands quite a bit of what I say to him (even in Chinese!), points where he wants to go or do or eat, and says a few words. He loves the water and can’t wait to jump back in the water again. It is such an amazing journey.

The storms are getting bad, with my parents losing power for 5 days. I am seriously considering getting solar with a battery backup.

That’s it for now.

My First Labor and Delivery

Posted on August 14, 2020January 1, 2021 by Jessica

I can’t believe it’s been twelve weeks since I had my baby. My entire life has completely changed in so many ways. I’ve become a first-time Asian American mother during a pandemic as a CRNA. Because it has completely changed my mind and body, I’d like to share my labor and delivery story, and later on, I’d like to share some products that made my life easier as a first-time mom.

As a first-time mom throughout the entire third trimester, the body is getting ready for labor by widening the hips. About 1.5 weeks before I went into labor, I lost my mucous plug. For me, it was a yellowish sticky blob.

First Stage

Early Labor

I was exactly 38 weeks along and wished my baby would come that weekend due to my work situation. On an early Saturday morning, my water broke while I was sleeping 3:20 am. A sudden wet gush woke me up! The water breaks before labor in about 15% of women. I called the midwife to let her know. We agreed that since my water was clear and GBS was negative, I could stay at home during my early labor. FYI, a GBS test checks if you have this common bacteria. If you are positive for GBS, you will get an antibiotic through an IV at the hospital during labor.

My goal was to rest and relax as much as possible. I went for a walk, ate breakfast, lunch, and dinner, watched a movie, and took a nap. Around 6:10 pm, my contractions became more regular, and by 8:15 pm, my contractions were 2-4 minutes apart, 45 sec to 1:15 min long, for at least an hour. They wanted me to go to the hospital when it’s about 4-1-1 (4 minutes apart, 1 min long, for an hour) so that they know you’re in active labor.

Active Labor

Triage

I got to the hospital around 9:15 pm and went to the OB triage with my husband (I could only have one support person, so I trained my husband to be there for me!). My primary midwife happened to be on that night, which was awesome!! They checked fetal heart tones (FHT) and external contraction pressure. Normally, I think they would do a cervical exam in the triage area, but I asked to have it done once I was admitted to a room, and my midwife made that happen.

Hospital Admission

They used a soft belly band to hold the two monitors in place and drew a CBC and type and screen (they draw blood just in case you need a blood transfusion). They asked if I wanted an IV, and I agreed to it since I know it sometimes may be more difficult to place one later.

My midwife did a cervical exam and found that I was already 5 cm dilated, 100% effaced, and -1 station.

Later on, my nurse Emily was able to find wireless monitors, so I didn’t have to be attached to the wall. Since I already had regular contractions, and my baby had accelerations during the contractions throughout the admission time, my midwife was comfortable with just periodic checks every 30 minutes. I was monitor free for a few hours and free to move around the room.

For the next 4-5 hours, I used a birthing ball and bounced on it. I breathed through my contractions, mindfully thinking about the pressure I felt. I tried out different positions: “slow danced” with my husband, had my husband pull up on my belly from behind (or I called it a penguin pull). I even got into the water tub. The water distracted and dulled the immense contraction pressure. But at 3 am, I couldn’t take it anymore and asked for an epidural. As a first-time mother, I wanted to labor as long as possible without an epidural, because once an epidural is in, the laboring process slows down.

A Combined Spinal and Epidural (CSE)

I got out of the tub, and my midwife did another cervical exam and found I had dilated to 8cm. There was only another 2 cm left, but I knew that the transition phase was coming, and through my readings, I learned that the transition phase is the most painful part, and I just couldn’t take it anymore. Also, I had attended the AANA Annual Congress last year. I learned that the latest literature indicated that a combined spinal and epidural was a great anesthetic choice for a laboring mother. I couldn’t wait to get relief.

At 3:30 am, the anesthesia resident got the CSE quickly, and I immediately felt relief through the spinal. In case you don’t know, a spinal numbs you quickly, and an epidural keeps you numb. They used a 0.1% bupivacaine with 3 mcg fentanyl concentration solution, and I loved that it was a bolus every 30 minutes rather than a continuous infusion. I felt little light pins from my chest down and slight itchiness from the fentanyl. But it was much easier to tolerate a little itchiness all over than the pain, especially as it neared the transition phase. Once the epidural was in, I did have to be on continuous monitoring, but I had to be in bed anyway. The nurse placed a foley catheter, which drains the urine. Shortly after pain relief, I fell asleep for a few hours until the morning.

Second Stage

In the morning, the nursing staff helped me move into different positions in the bed. Moving into different positions encourages the baby to move down into the canal on his own. At 11 am, the midwife broke the forebag, which prevented the baby from moving into the canal. My body continued contractions, but with the epidural, I didn’t feel any of them. The nursing staff continued to monitor the baby’s heart rate. The baby had accelerations with every contraction that came every 2-3 minutes. The accelerations indicate that the baby was tolerating the contractions perfectly. Finally, after I felt rectal pressure, the midwife came to assist with the delivery. I pushed for about 1 hour lying on my side, and he was born at 3:46 pm!

Third Stage

My baby immediately went on my chest for an hour of skin to skin time. He looked healthy (a APGAR score of 9 at 1 minute and 9 at 5 minutes. The APGAR score was created in 1952 by Dr. Virginia Apgar MD, an obstetrical anesthesiologist, to determine how well the newborn tolerated birth in the first minute and five minutes of his life). so they were happy to wait to do the height, weight, and give 3 medications. He was calm and quiet, having gone through such a traumatic experience! The midwife delayed the cord clamping until it stopped pulsating so that majority of the blood went back to the baby. My husband then clamped the cord. Shortly after, I delivered the placenta as well.

Placenta and Umbilical Cord Blood Donation

The midwife and nurse then gathered the placenta and umbilical cord tissue to prepare it for donation. I decided to donate the cord blood and placental tissue to research and some went to storage to help others cure diseases. I picked Cellsure because it was free to donate the tissue that would’ve otherwise went in the trash. I also checked my hospital to see if they routinely donated tissue but they did not. Around 28 weeks, I spoke to my midwife about donating my tissue. I found Cellsure online that accepted donations. About a month before my due date, I filled out an online questionnaire to qualify. Once I was done, Cellsure sent me a box for me to bring to the hospital when I was in active labor (4-1-1). I let my midwife and nurse know about the donation and they took care of everything. After delivering the baby, the nurse did draw one more set of blood for the Cellsure. They called Cellsure and someone came around 4 hours after the baby’s birth.

During the first hour, my baby tried to nurse but was just figuring out how to latch on. Latching is probably the most important part about breastfeeding!

The next day, I was super sore all over. I had the first-degree tear, so the midwife didn’t think I needed stitches. For pain relief, I used lidocaine spray and cooled witch hazel pads provided at the hospital. When I ran out, I used benzocaine spray. I took ibuprofen and acetaminophen whenever offered (every 6 hours in the hospital, and I slowly cut back over the following two weeks). I also took Miralax once a day for the first four days after birth to help with bowel movements. My first few poops were all nice and soft so, I was happy about that. 🙂

How Nurses Can Successfully Work in the UK

Posted on August 14, 2020August 14, 2020 by Jessica

Working in the UK as a nurse could be an excellent career choice with the added bonus of an opportunity to travel. Hospitals within both the National Health Service (NHS) and private sector often conduct recruitment in other countries in order to attract qualified nurses.

Employment opportunities in the UK

UK recruiters have acknowledged that there is still a significant demand for full-time nurses. Besides hospitals and clinics, nursing and care homes are also looking for nurses to fill their vacancies.

So where do you start?

If you are from overseas and want to work in the UK, then naturally you will need to make an application. The process will take some time and a little bit of paperwork.

The requirements will also differ depending on whether you trained:

Within the European Economic Area (EEA)
Outside the EEA

The difference is due to the EU’s employment regulations. If you want to speed up the recruitment process, here is some sound advice.

Register with the Nursing and Midwifery Council

Registering is a requirement for all those who wish to work as a nurse in the UK as the NMC is the official organization that regulates the nursing profession.

If you are from overseas, you will also need to secure a UK work permit and find an employer who will sponsor you. Once you have registered with the NMC, you will receive a PIN number which will allow you to practice as a nurse in the UK. You can visit the NMC website to find out more information about registering as a nurse. To secure a placement, you should contact the hospitals directly.

Once you have submitted your application, you will either be accepted, rejected, or asked to fulfill further requirements, perhaps by undergoing a supervised practice period.

If you have been trained as a nurse outside the EEA, you may have to take a nursing course so you can adapt your existing knowledge and skills to a UK setting. You can then register with the NMC once you have completed this course. Non-EEA trained nurses will also need to pass a competence test (CBT) and a practical skills examination (OSCE).

The particular type of work permit or visa required will depend on your country of origin. If you are from the EEA region, you can visit the Home Office website for information on how to secure a UK work permit. If you are from outside the EEA and Switzerland, you need to apply for the General Visa – Tier 2.

UK nursing vacancies during the COVID-19 pandemic

The COVID-19 crisis has meant that some of the usual hiring practices have been modified, especially for nursing home jobs. For instance, candidates can expect to be interviewed by their prospective employers via a video call. In addition, candidates may only be able to visit the employer’s facility when it is necessary or after they have been hired.

Even before the pandemic, there was a high demand for nurses in the care home sector. UK recruiters anticipate that this demand will only increase once the current crisis has abated.

Apply for a nursing position in advance

As mentioned earlier, the UK nursing application process may take some time. It can also be rather complicated. As a result, it is vital that you make your application as early as possible, well before you arrive in the UK.

To expedite the hiring process, make sure you bring all your essential documents, such as:

Diplomas
Training logs
References
Birth certificate

Conclusion

Nurses who are interested in working in the UK can expect a warm welcome from recruiters and employers alike. The demand for qualified and skilled nurses is still very high. Although it may require some effort and time to apply, it will be well worth it in the end. If you want to evaluate your career options, go to the NMC and UK Home Office websites to find out more information.

Guest Post by:

The COVID-19 Crisis: CRNAs to the Rescue

Posted on August 8, 2020August 8, 2020 by Jessica

One of the most memorable photos from the COVID-19 pandemic is an image of two healthcare workers in full PPE embracing, face shield to face shield. It’s an even prouder moment for the nursing community as the two are a certified registered nurse anesthetist (CRNA) couple from Tampa General Hospital.

These two CRNAs, Mindy Brock and Ben Cayer, are on the hospital’s airway team. When a COVID patient is in respiratory distress and requires intubation, they are there to sedate and intubate the patient. This is a high-stress situation where time is of the essence, as a COVID-19 patient’s oxygen saturation is known to drop rapidly.

Mindy and Ben are just one example of the roles that CRNAs have played in helping fight COVID-19 across the country. Keep reading to find out more about how CRNAs are contributing to this health crisis.

How CRNA Qualifications Help

CRNAs are advanced practice nurses who are trained in skills such as intubation, arterial line insertion, central line insertion, and pain management techniques, such as regional blocks. Prior to earning their degree and certification, CRNAs are required to have intensive care unit (ICU) experience so they are well-versed in managing critically ill patients.

This education and training takes a CRNA to the head of the bed in an operating room, surgery center, or doctor’s office, but the COVID-19 pandemic has CRNAs finding new opportunities to pitch in.

Continuing the Fight in Medically Underserved Areas

CRNAs have full practice authority in 29 states. This means they can practice without a physician’s supervision. As a result, CRNAs often provide care and airway expertise in traditionally underserved areas. An example would be in a community access hospital where hiring a CRNA can be a cost-effective practice.

According to the American Association of Nurse Anesthetists, on March 30, 2020, the Centers for Medicare & Medicaid Services issued a temporary suspension of supervision requirements for CRNAs. This suspension meant hospitals and health systems could utilize CRNAs to the fullest extent of their practice. In a press release about the suspension, Kate Jansky, the AANA President, said this decision allows CRNAs to manage and staff intensive care units as well as staff operating rooms without a physician’s supervision.

Traveling to the Front Lines

Lots of facilities canceled their elective surgeries to slow the spread and preserve their PPE, and many furloughed CRNAs took the opportunity to travel to some of the hardest-hit areas to provide their services. One example of this was when 30 CRNAs from the North American Partners in Anesthesia (NAPA) group traveled to New Jersey to join in the fight against COVID-19.

CRNAs traveling to states that were hit hard would work on intubation teams as well as resuscitation teams. When a COVID-19 patient coded in the hospital, the CRNAs would provide assistance in airway management, medication administration, and other potentially life-saving tasks.

Many CRNAs left behind families and risked their personal health to serve those most in need. Some have even come out of retirement to volunteer.

Returning to the Bedside

Because CRNAs have worked in different ICU settings before going to graduate school, some have opted to return to the bedside during the pandemic. For example, many have stepped into roles helping manage ventilators and airways in ICUs as well as taking patient assignments.

With elective surgeries on hold in many parts of the country, working in the ICUs or in emergency triage settings allows CRNAs to utilize their hard-earned skills.

The Takeaway

While 2020 has looked very different for the healthcare community than anyone had anticipated, there are countless stories of nurses, including CRNAs, who have answered the personal call to help. The pandemic has also shined a light on CRNAs’ services and engaged politicians and communities to lobby for expanded practice rights.

Where there is a health need, nurses — including CRNAs — will answer the call.

Guest Post by:

Happy International Nurses’ Day

Posted on May 12, 2020May 12, 2020 by Jessica

2020 is also the year of the nurse and midwife as designated by the World Health Organization (WHO) in honor of Florence Nightingale’s 200 year anniversary of her birth.

Florence Nightingale is the pioneer of modern nursing.

It is almost very fitting that this is the year of the nurse and midwife. They are on the frontlines of taking care of patients with COVID-19 and must advocate for not only the patient but also themselves. The protection and safety for themselves is vital for taking care of others.

Unfortunately there are already too many stories of nurses who were not equipped with the appropriate amount of personal protective equipment (PPE) and died because of it. Every hospital system should do everything to support the nurses and anyone on the frontline to get the right PPE. No system should deny the nurses safety and their own judgement on what is required to keep them safe.

As for the midwives, I am proud to say that I choose a midwife to be my primary care provider. Thankfully midwives and the hospital system have a good working relationship and thus many best evidenced based practices are utilized. I’ll go over it in more detail tomorrow. Goodnight for now.

Day 1 of Stay Home Stay Safe Order in Michigan

Posted on March 24, 2020March 24, 2020 by Jessica

Wow.

So much has happened since I last posted but almost more importantly, this pandemic is just starting to get crazy.

That’s right, just starting.

It’s been 2 weeks since Michigan declared a state of emergency when there were two positive cases of COVID 19. Now there are 1791 confirmed positive cases with 24 people dead.

“Flattening the Curve” by Staying Home

Right now our hospital systems can handle the number of cases. It will still be able to as long as people stay home. This week. YES. This week is the critical week that will help determine if our hospitals will be completely overrun with patients and us having to make decisions on who gets a ventilator and who doesn’t. I hope that we don’t get to that point. But the only way to stop it is by staying home.

Category Archives: COVID19

My First Labor and Delivery

First Stage

Early Labor