I submitted my grad school application– yes!

I finally finished my essay after several drafts so I submitted my grad school application online. It really makes you think about why you want to go into a career and forces you to be certain about what you’re going to do in the next few years.

I did share my blog in the personal statement essay. In this 21st century, I hoped that was ok. After looking at Twitter, I found that the school also had a WordPress blog. Perhaps they will see what blogging can do for someone… And help many people!

It’s been somewhat of a relief to finally be done with applying for grad school. I went to two information sessions, studied and took the GRE, took the PALS classes, studied and passed the CCRN, made sure recommendation letters are completed and in (and thanked those who’ve helped me), got my Michigan license… It’s been quite a few things to coordinate. Having a timeline helped but it’s mostly been studying, studying, studying. While I welcome the break, I know that I’m going to be itching to do something again.

NYC Marathon Volunteer

IMG_0232.JPG

The 2014 NYC Marathon
Medical volunteer
For the first time
At mile 15
In Queens

Keep those cramps and aches at bay…
PT to the rescue!
Massage, massage
Ice, ice
In 3, 2, 1
Off you go

Don’t drink too much water otherwise
You’ll get hyponatremia
Eat some salt!
Drink Gatorade to replace electrolytes!

Vaseline for chaffed thighs

Tylenol 650, not Advil
And only once
red dot
drink it down
Off you go again

Too cold
Warm up
Sit in the warm ambulance
Keep going!

Blisters
New bandaid

Ankle hurts
Wrap, wrap

And of course,
Scan in, scan out,
The fastest documenting ever

Inspirations abound
Spirits high

Let’s go!!

IMG_5278.JPG

Talking to intubated patients make a difference

I’ve taken care of my fair share of intubated patients. But over the last 2 nights, I encountered something different. They went from calm to wild in just a few minutes. If the sedation was down, then I increased that. Normally it works pretty fast.

But it wasn’t so in this case. Both patients were ‘bucking the vent.’ One didn’t have a PRN order ready so for one I had my coworker help me get an order and prepare ativan. But in the meantime, I remember reading critical care nursing journals about the experiences of previously intubated patients. They said to always assume that the patient can hear you. They said that when the nurse talked to them about where they were, what’s going on, and what to do, in a strong confident voice, that the patients felt comforted by that. So that’s exactly what I did.

This patient kept biting down on the tube (which is a big no no because we don’t want a punctured tube!!). “You’re in the hospital and you’re very sick. I’m Jessica, your nurse. Right now you’re having trouble breathing so you have a breathing tube. I know it’s uncomfortable but you need this. Try to calm down and take slow breaths. Open your mouth. Your face is very red but calming down will allow you to breathe better.”

Once I said this, the patient did calm down and opened her mouth.

“Good, your face is looking better and you’re oxygenating better. We are going to turn you to the side to clean you because you had a little accident, ok?”

She was able to cooperate much more at this point. And this happened before giving the ativan. My coworker then came in, administered it (“we’re going to give you something to help you relax now”), and she was at peace again.

Even though she couldn’t focus her eyes and couldn’t follow simple commands, it seems as though what I said did make a difference.

 

Where’s my ID?!

So they say that a vacation is most enjoyed prior to the actual trip — mostly because you get to fantasize about all the fun you’re going to have. But once you’re there, some things don’t go according to plan — but you’ll still remember that feeling before the trip.

Currently, I’m stuck at the JFK airport waiting for my flight. I’ll back up.

Last week was my boyfriend’s brother’s high school graduation in San Diego so I went for a few days. On the way back, his mom let me use one of her bags to carry back stuff. I first put my ID in a orange backpack. After going through security, I put my ID in that green duffel bag. And left it there.

I worked 4 days. I packed this morning, thinking my ID was in my wallet. I checked my wallet on the way to the airport… a little too late. And no ID.

I thought I left it in the orange bag. My boyfriend, Dan, goes back to see if he can find it. I waited in line for 1/2 hour only to be told that they don’t need a ID to check in but it’d take 1/2 hour to go through the process. Except my flight by then was in 1/2 hour. I rebooked my flight for $50.

Dan gets home. He doesn’t find the ID. I had to go outside to call him. So then I finally recall that the ID was in the duffel bag. And I was carrying that duffel bag in my carryon. I opened up my carry on and there it was — in the front pocket.

I changed up my routine and didn’t put the ID in my usual spot.

Never again… at least I’ll arrive in Vegas at midnight for our biannual vacation with the family.

So moral of the story —

  1. Always return your ID in that special spot ASAP.
  2. Check the ID before leaving for the airport.

In bed by 8:07am

Wow, I’ve never driven home from work, shower and be in bed by 8:07am. Yay!!! And I’m getting report from the same nurse tonight. I love that– back to back report to and from the same nurse.

Caring from the heart is nursing

Yesterday I wrote about a frustrating moment I had. A reader said that nursing is caring from the heart. I agree with that.

Since going to the ICU,
most of my patients can’t talk to me.
But one was A/O x3, could speak, though didn’t seem normal quite yet.

He was what I called “call-bell happy.”
Too hot, too cold, not comfortable–
it can all happen in a matter of 10 minutes.

1st night- “can I have a sleeping pill?” “Ice, ice, ice” “blankets on, blankets off”

2nd night- slept throughout the night but I’d catch him when he woke up and waved at me to come over. “hurts, hurts, hurts” “your bum?” He nods. I turned him to the other side and boom! He was fast asleep again.

3rd night- he looked like a new man!! Ahh the wonders of a good night rest.

He waved me over to fix him up at change of shift. He proceeded, “thank you. I knew that the moment I looked at you that you’re caring from the heart. You have made a big difference for me.”

I was a little bit shocked that he spoke so normally. We continued to talk and he spoke about another hospital. I asked him about his experience there. His eyes lit up and said, “You should be working there! There’s where you belong. You see that everyone collaborates and works so seamlessly as teams.”

I was taken back a little bit because I felt my unit had members who worked well as teams too. Does that mean he implied that here was worse than there?

He continued, “Leave your information. I’m friends with the head doctor there. I’ll get you a job there. I will. Include your specialty.” And he repeated this several times before he went to sleep.

Unfortunately, he was a step down patient and a critical care patient needed to get transferred into his room. So he left. And a new patient went into his place.

I never did leave my information because I felt that it was a little unprofessional but also, would he really remember? He still has to go to rehab to recover and it would be odd to have my information amongst his personal belongings. I’m not sure if I would’ve gone- I kinda like where I am now. Plus I’m just starting here!!

Another patient- I also had her for 2 nights with a couple days off in between. On the 3rd night she just came back from a procedure. She saw me and reached out for me. The PACU nurse said, “aww she really likes you!” I squeezed the patient’s hand and she squeezed back.

I think that says everything.

When the human condition is in conflict with itself

Wow, I just read grrm.livejournal.com blog and it reminded me of how I used to write. Just as myself and not another “list” or really thought out piece. So here’s my start to get back to journaling.

I came across another article about stories– the only stories worth reading are the ones when the human condition is in conflict with itself. You have a set of ideals and yet you’re torn with how you feel.

For example, last night a patient was complaining of pain and her nurse gave her pain medication. 15 minutes later, she’s asking for help. Her nurse is across the room and she saw me sitting at nurse’s station. I knew that her nurse had already attended to her so I ignored her (wow that sounds bad but I was busy catching up!!). After she called 3 more times I walk over and ask her, “what’s the problem?”

“Why didn’t you come over right away?” She probed.
“Your nurse just spoke to you. What’s going on?”
“I’m in pain!”
“Did you tell your nurse?”
“Yes. He gave me pain medications.”
I overheard him say that he gave the pain meds 15 minutes ago. “Ok, then you have to let it kick in.”
“Yes but it hurts!!!”
“Ok but you still have to wait for it to kick in!” I thought to myself, why made her think that complaining to me would make any difference?

I felt sympathetic for her because face it, who likes to be in pain? But I felt the issue was already addressed and that’s nothing left for me to do. Is that wrong? Did I lose my patience?

She ended up falling asleep.

As a nurse, I feel compassion and empathy but there’s only so much to go around. I pour it all on my patients and any patient that has a 3 alarm star going off… Or I’ll help out another nurse “boost” a patient up in the bed. But that’s about it.

I wish I knew that before

2013 was the best year of my life.
Independence rang true – new apartment, new car,
new nursing career from the nursing home, to tele and ortho, to ICU.
(wow, I sound like a typical millenniallook at the table below)

My family and friends started new careers too,
life is getting sweeter.

The stats were an all-time high,
Getting emails and comments all the time,
About NYU Nursing
Advising and inspiring future nurses.
To me, there’s no greater praise.

Last year’s theme was ‘New Nurse Blog.’
But now I’m no longer a fresh fresh nurse.
I’ve got one year under my belt!

For 2014 I’m changing it to
I wish I knew that before.’
“I” can be me, a friend, or you.
Health, Food, Money and Rights are my passions

So here it goes!

—-

This table is from a Medscape Nurses article about how to manage a 4 generation gap nursing workforce. You can sign up for a free account to read the article.

Generation What They Want Strategies
Traditionalists Less demanding schedules (part-time; shorter shifts)
Reduced stress or workload
A job well done
Use a personal touch
Provide traditional rewards
Use as mentors
Offer less physically demanding positions
Boomers Recognition for experience and excellence
Positive work environment
Good pay and benefits
Continuing education
Give public recognition
Find opportunities to share expertise (precept, mentor)
Promote “gradual retirement”
Xers Career advancement
Shared governance
Autonomy and independence
Work/life balance
Provide opportunities for skill development and leadership
Involve in decision-making
Avoid micromanaging
Millennials Meaningful work;
Stimulation, engagement, involvement; multitasking
Skill development
Socializing and networking
Impatient for promotion
“Move up or out”
Encourage teamwork
Offer a supportive work environment
Begin leadership development early
Provide feedback
Provide access to social networks; build on technology strengths
Develop skill base

First Code – CPR or hospice care for terminal illness?

20130717-231231.jpg

This 90 something year old man was repeating, “I want to die” a couple days before. With stage 4 cancer (meaning, it spread from the source location), he should’ve been DNR (Do Not Resuscitate). But since he started to lose his mind (he couldn’t answer the 3 questions: name, location, and time), his family members began to make decisions for him (as a Heath Care Proxy). His family was in such denial that it was time for him to pass away. They believed he didn’t need morphine to ease his pain and should remain in full code in case his heart rhythm converted to v fib or v tach (at this point, you do CPR).

Throughout the night, he kept moaning. But his family would only allow him to take Tylenol. Which honestly isn’t enough if you have overgrown cells invading essential organs. And these organs allow you to breathe and circulate blood throughout your body.

After I had given out my morning meds and taken out a foley, I saw a nurse run. The next thing I heard was “999 on 1 West”. I saw 2 nurses with the crash cart wheel past me heading to a room in the next district over. When I saw them wheel the cart into that room, I knew it was him. The nurse there was already doing CPR compressions and someone else got the ambu bag ready. Though it felt like 5 minutes, about 30 seconds later, 2 critical care PAs, 3 critical care nurses, 2 MDs, respiratory therapist, nurse educator, patient care assistants, and all the nurses on the unit were there. The PAs took over the compressions. The pads were slapped on.

The EKG monitor was still on, so I watched it go in and out of v fib and v tach. Nurses made the call out to the attending and the family to tell them to come in immediately. My nurse manager told me to go the next unit over to get the Line Cart. I learned fast that’s the cart with the equipment to do a central line. Inserting a central line would allow them to bolus (or “quickly give”) fluid directly to his heart to increase blood pressure. Without a properly beating heart, the body won’t have circulating blood.

When I came back, I saw that he was also bleeding out from his rectum and abdomen. Cracked ribs and his tap sites from before may be the cause. Regardless, I primed the normal saline line to attach it to blood that we would give to him.

More epinephrine was needed. More flushes. The nurse educator asked if I knew any of the nurses in the room so she can document everything that’s happening in the room. I gave some names and then let the nurse who was taking care of him take over.

After the defibrillator delivered the shock, I heard that sound. That sound was an asystole sound. A solid beeeeeeeeeep. I looked at the EKG monitor and saw a solid line. He was gone. He got his wish.

This happened in 17 minutes.

20130717-231534.jpg

If only he had been DNR and was comforted, he would’ve died more peacefully. He wouldn’t have bled, have cracked ribs, have something tied to keep his tongue down in case of intubation. He died suffering from pain and misery. It could’ve been in peace in his sleep.

Family members may feel guilty if they decide to make their loved ones a DNR. They may feel that they aren’t doing the right thing and that they should do everything possible to save them. But in terminal cases, the focus should switch from treatment to comfort. This increases the quality of someone’s end-of-life care.

In my mind, when I die, I would want to die in my sleep. Peacefully. No pain. Just as living is a part of life, death is too. And we should pass with dignity.