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.

SBAR: How to Give a Good Handoff Report

Last Updated: July 13, 2020


As a new nurse, one of the most nerve-wracking things to do is giving a handoff report to another healthcare provider, be it the next oncoming nurse, the charge nurse, the nurse who covers you on break, the doctors, and the ancillary staff. It is nerve-wracking because you don’t want to miss important information, but you don’t want to give too much or too little information. Providing the right amount of information pertinent to each healthcare provider is what makes a handoff report great.

While I was in school, I thought it was a little silly to repeat the information that the instructor just gave m,e and I felt that I was doing it all wrong. But honestly, it’s good to repeat the information out loud, so you know what’s going on.

SBAR is comprehensive and is great for the oncoming nurse. Here are the elements.

S : Situation 

  • Name, age, sex, admitting doctor, mental status, allergies, code status (full code vs DNR, DNI), problem

B : Background 

  • Admission diagnosis, pertinent past medical history, current treatments

A : Assessment 

  • Current vital signs (VS), physical assessment from head to toe, test results

R : Request 

  • Needs MD/MLP evaluation, further testing, nursing care, transfer to a higher level of care

For example:

S: This is Jane Doe, 78 year old female under Dr. So-And-So. A/O x 3 but forgetful. She has no allergies, not on isolation, and is a full code.

B: She came in with pneumonia. Her past medical history includes COPD and diabetes. She came in yesterday and started on oxygen and antibiotics.

A: (Vital signs) Her vital signs are stable. Afebrile. No pain.
(Activity) She can get out of bed to chair with 1 assist.
(IVs) She has 2 peripheral IVs, an 18 gauge in the right AC and 20 gauge in the left forearm from two days ago. No drips but gets IV antibiotics.
(Skin) Her skin is intact. Palpable pulses.
(Lungs) She’s on 2 L nasal cannula sating 95%. Lungs diminished bilaterally.
(GI) Active bowel sounds. Regular diet. The last bowel movement was today.
(GU) Voids. Good urine output.
(Glucometer) The last fingerstick was 130 before dinner.
(Labs) She needs a CBC and BMP in the morning.

Current labs Her WBC is elevated.

R: I recommend ID (infectious disease) consult on her.

SBAR

How to give a good handoff report to other healthcare providers

For a doctor or PA/NP who is new to the patient

Do a shortened SBAR with the situation, pertinent past medical history, pertinent physical assessment, trending labs if available, and recommendation.

For a doctor or PA/NP who already knows the patient

Give a shortened SBAR with the situation, any changes in vital signs, mental status, respiratory, GI, GU, lab work), and your recommendation.

For the charge nurse

  • You give a handoff report twice: once at the beginning of the shift and one closer to the end.
  • In the beginning, say the situation, any drips, and the plan for the patient. And if you anticipate that you’ll need help from her, this is the time to speak up.
  • For the second report, state what has changed since you started your shift (any new labs, tests performed, drips, assessment) and the plan for the patient.

For the nurse covering your break

State the situation, code status, mental status, activity, diet, drips, and any abnormal vital signs that have stabilized or anything else to look out for and need to do.

For the ancillary staff

State the situation, code status, mental status, activity, diet, and any other additional nursing care (fingerstick, lab work, turn patients, last wash, incontinence).

For more information, the IHI (Institute for Healthcare Improvement) has the following documents that may be helpful.
SBAR Guidelines Kaiser Permanente
SBAR Worksheet Kaiser Permanente

I hoped that helps!

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

Critical Care Orientation

Hi future critical care nurses,

Here were the topics that we covered in my critical care orientation. While the instructor said that this class is not to provoke anxiety, some of the topics made me a little nervous, but I guess that’s normal for anyone doing something for the first time.

Day 1

  • Compensation Mechanisms
  • Pharmacology

Day 2

  • Arctic Sun (Hypothermia therapy)
  • Hemodynamics I – Arterial lines, CVP
  • Intra-arterial thrombolytics

Day 3

  • Hemodynamics II – PA Catheters (Swan Ganz)
  • Hemodynamic Scenarios

Day 4

  • Glycemic Control
  • DKA/HHS
  • Insulin Infusion with Delta
  • Neuromuscular Blockage
  • IABP
  • TPA for MI
  • Temporary Pacing

Day 5

  • Phillips Monitoring
  • Acute Renal Failure
  • Peritoneal Dialysis
  • DIEP

Day 6

  • Mechanical Ventilation
  • Oxygenation
  • ABG Analysis

Day 7

  • Shock States
  • Sepsis

Day 8

  • ACLS Part 1 (BLS + videos)

Day 9

  • Intra-abdominal Pressure (IAP) Monitoring
  • Pulmonary Vein Isolation (PVI)
  • Crash Cart – Defib, Cardioversion, Pacing
  • EPIC Code narrator/critical care flowsheet

Day 10

  • Neuro RRT/tPA
  • Neuro Assessment
  • Neurosurgery
  • Intracranial (ICP) Monitoring

Day 11

  • Exams (Core and Pharmacology)
  • PACU Day – recovery from anesthesia

Day 12

  • ACLS Part 2 (Respiratory, Tachy, Brady algorithms; Test “Megacode”)

At least now I have some background information!

Anyway, happy holidays! Can’t wait to start.

Med-Surg to ICU Interview Questions

I’m so excited to announce that I was recently accepted into the MICU (medical intensive care unit) at my hospital! Critical care class starts in 2 days and I just finished my last shift on the telemetry med-surg and orthopedic unit!! I loved my team there– the people are truly incredible. The CCPs, PCAs, management, my fellow night nurses and day nurses made my time there truly amazing. It felt like a great teamwork every night, making sure essential things get done and always going above and beyond. :)

One year ago, I started at a nursing home for a month. 11 months ago, I started at the hospital on the telemetry unit. My hospital is having some of our ICU nurses go to another hospital in the system to build up their units so this great opportunity came up for me to go work in the ICU.

Fortunately, the interview was a “formality” but it’s no excuse not to prepare! With nearly a year of experience under my belt, it was much easier to come up with experiences showing my leadership. And remember, people relate to specific STORIES more than generalities! Here is a list of questions the nurse manager asked me.

  1. May I see your resume? (Asks questions on the resume especially regarding additional schooling aka your future plans and previous experience)
  2. What made you interested in coming to the ICU?
  3. How has your experience prepared you?
  4. What kind of drips have you used?
  5. Have you called a RRT or a neuro RRT or code before? What happened? What was that like?
  6. Describe a busy night for you.
  7. If you have several things going on, how do you deal with that? (Delegation and priority- give specific examples where this came in handy!))
  8. How do you keep your ancillary staff accountable? Do you always or only sometimes have huddles? Do you meet up with them again? How do you make sure they do what you asked them to?
  9. What do you do when you’re unsure of something?
  10. What is a strength you have? A weakness?
  11. What have you heard about this unit?
  12. Do you have any questions for me? (The answer is always yes and you ask questions!! Such as the type of patients, the ratio, the professional nursing organization, scheduling, etc)

I hope this helps! If you have heard of additional questions, I’d be happy to add in more to get a more comprehensive list. And happy thanksgiving to everyone!! I have a lot to be thankful for, including the readers who have given me positive feedback through emails, comments, and likes. :) so thank you!!!

Help by voting please! Affordable senior care depends on you!

help by voting!

Future and current nurses please help!!
And friends and families of nurses!
And those touched by a nurse! Please help!

My parents have helped over 100s of seniors and their families over the last 20 years by providing quality care in Assisted Living homes. However, costs have skyrocketed! Help us provide affordable quality care by voting. Since we need 250 votes by November 15, please vote and have your friends vote too! It’ll take 2 minutes but it will make a big difference. If each Life With Jess reader voted, we can reach the goal in 5 days. Thank you for your help!

More information about the Assisted Living Homes:
In the early 1990s, my mom was working on her Masters thesis on providing affordable quality care to seniors while working as a registered nurse. She put her thesis to the test. Since then, Citizens for Quality Care (CQC) has been home to 100s of seniors in Southeast Michigan and has made a great difference in families’ lives.

More information about the Chase Mission Main Street Grants:
Chase Bank is offering $250,000 for 12 businesses this year. In order to be considered for the grant, we need 250 votes by November 15. The grant will be used to replace an old boiler that would reduce the cost by thousands each month. While we saved a hospital from demolition by converting it into a beautiful Assisted Living home, some expensive parts need financial help to replace for us to continue to provide affordable quality care.

More information about voting:
A Facebook account is needed to vote at the website: https://www.missionmainstreetgrants.com/business/detail/137710! You can also enter https://www.missionmainstreetgrants.com/, type in 49221 and click on CQC Stephenson Home. Thank you for your help and please share!

Feel free to ask questions in the comment section.

Gratitude

I anticipated a rough night. A super needy patient, an anxious patient and one straight up with no manners who didn’t know if it’s a good idea to take pain meds or not. And 3 others.

After running around for 11 hours, I hear a thank you.

I hear, “you’re very nice and thanks for taking care of me the last few days. You treat everyone as an equal.”

I hear, “this morning I woke up, crying with tears of joy. I called my best friend to tell him I had the best morning at the hospital since I’ve been here. And it’s all thanks to you.”

It doesn’t get better than that. The gratitude.

And the night before, a patient stated, “I’m so glad you’re here.” And gave me a big smile. He got up; I took his BPs to make sure there’s no orthostatic hypotension (a key sign that not enough blood volume circulates through the body); he walked a good distance for the first time since he had been here and couldn’t be happier.

Using my knowledge to help people get better has always been my top priority and it’s so great to hear it and see it. I love nursing! :)