Tag Archives: nursing

Happy CRNA Week- How to have a happy breastfeeding and pumping CRNA

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Disclosure: I share some affiliate links below of products that I personally use. If you purchase I may earn a commission. I only share products that I really enjoy using and hope that it’ll help you too.

First of all, happy CRNA Week. Today I’d like to talk about how to have a happy pumping CRNA.

Before I became a first time mom, I really had no idea what breastfeeding and pumping entailed. It’s not really talked about anywhere online especially regarding those working in healthcare and how they managed to work and pump. Now that’s been more than 8 months, I’d like to share my experience to encourage new moms to continue their breastfeeding journey once they return to work.

It’s good to share than the American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Personally, I set my breastfeeding goals to the first month, then 3 months, and then every 3 months to one year.

What I’ve discovered that the breast pump represents freedom from the baby and the ability to still provide the best and complete nutrition for your baby. You don’t need to have your baby attached to your hip to be a good breastfeeding mom. The breast pump gives you freedom to express milk whenever you want and it is not dependent on when the baby is ready to eat or if the baby has trouble latching. Also in the beginning, nipples take a beating (boo… I highly recommend Motherlove Nipple Cream and Lansinoh Hot/cold pack and Ameda gel pads especially for the first week or two) from breastfeeding so pumping gives your nipples a break.

Ever since I got back to work, I’ve had the support of my colleagues and family and the opportunity to continue feeding my baby breast milk. I have to be thankful for the positive nursing culture and a built-in system in the surgical department. That really is key!

It is super helpful to have supportive CRNA leadership, especially from someone who’s done it before. It’s also helpful to have an understanding from all the other CRNAs who can give me a little extra time to pump (getting a 20 minutes break instead of the usual 15 minute breaks).

For me, I take 10 minutes to pump. 5 minutes to clean my pump parts and use the bathroom. 5 minutes for walking to and from the pump room and getting my cooler bag. However, some moms may take more time to pump, usually up to 20 minutes.

My cooler bag from RTIC includes:

In addition, I just wear my nursing/pumping bra to reduce the time that I have to put on and take off a specific pumping bra. I love the one from Kindred Bravely.

When I get to work every morning, I write down my pumping times on the assignment board so that someone can get my pump break at those times. Breastfeeding is a matter of supply and demand and requires you to pump at least every 4 hours to maintain your supply throughout the day. It is extremely helpful to try to maintain this. It is ok to seldomly miss it but not on a regular basis. Otherwise your supply will take a hit.

Anyways, I try to pump at 5am, 9am, 1pm, 5pm, 9pm. However I do adjust my schedule and move it one hour earlier to accommodate the OR schedule. For example, at 5am (at home), 8am, 12pm, 4pm, 8pm. Many moms will try to pump around the same time she would feed her baby.

Having a dedicated private pump room that is close by to the OR is extremely helpful. When the pump room is far away, it takes so much more time to walk there and back, which cuts into the pump time (and every minute counts!). Also, when there are more than 2 pumping moms in the same unit, it is extremely helpful to have additional pump rooms available nearby. The reason is that frequently, pumping moms will have a similar pump schedule. Our unit has multiple pumping moms. We started with one room when I returned to work 5 months ago. Now we have 4 private pumping rooms near the OR. This will ensure timely pump times.

Here are “must haves” to a private pump room:

  • A lock to lock the room or curtains to separate the space in a large pump area
  • Private room with no windows or a screen if the room has indoor windows so no one can peek in
  • A table large enough to put all the pump bag and supplies (for example, a bedside table typically found in hospitals)
  • Chair where your feet touches the ground
  • Trash (housekeeping should empty this daily)
  • A whiteboard and a dry erase marker for the outside of the door when there’s more than one pumping mom to indicate the estimated “out” of the door time so the next pumping mom knows when the room will be available. It’ll help her decide to either wait for the room or try to find another room.

Here are “nice to haves” (but you can have workarounds):

  • Sink to wash parts
  • Paper towel to dry parts, clean off sink and pump area
    • Workaround: Use the wipes from above
  • Mini-fridge to keep the milk/breast pump parts cold
    • Workaround: get a cooler bag and place an ice pack in there. Or put the whole pump bag or just the milk bottles into your work refrigerator (but it may take more space)
  • Nice ambiance conducive to a relaxing environment. Stress decreases milk production so thinking or looking at pictures of videos of the baby helps
  • Extra pumping supplies. If the hospital already has a mother/baby unit that has a hospital grade breast pump, having this extra set is extremely helpful when something breaks (your own breast pump, parts) or is missing (you forgot to pack it!).
    • I always keep a manual breast pump (the hospital gave it to me after giving birth before I left for home) in my locker for those “just in case” times. I’ve used it several times and I could actually empty one breast in 5 minutes but it definitely requires using one hand to pump and the other to manually pressing the breast towards the nipple to empty the milk ducts.
  • Snacks such as lactation cookies- breastfeeding requires an additional 500 calories a day. Moms are feeding for two!

Whenever possible when I’m home, I’ll directly nurse the baby. Once you get the hang of breastfeeding, I find it to be easier than exclusively pumping. However, there are definitely pros and cons to both.

In conclusion, having a happy pumping mom at work is so vital to prevent burnout and help moms do great work and feed her little one. Having a private pump room close to the OR and a respected pump break time helps immensely.

If you’re a potential or current pumping mom, what would or has made your pumping journey easier?

If you’re in management, what can do you to implement a better pumping culture to reduce burnout for new pumping moms?

Love Thy Neighbor: Wear a Mask

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Michiganders are now required by Executive Order from Governor Whitmer to wear a mask indoors and in crowded outdoor settings except in certain situations. All workers in indoor businesses should also wear masks and businesses must turn away customers who don’t wear masks.

The Emergency Alert showed up on my phone today at 4:44pm

Our state leader is setting the right example by wearing a mask and is attempting to change the “American culture” of individual freedoms fast. She has to set this executive order to tell everyone the seriousness of this pandemic and what we all must do to combat COVID-19.

Unfortunately our national leader, the president of the United States, does not want to set a good example and has made masks a political movement. It should not be a political movement! Instead, this is truly a public health crisis.

Wearing a mask is a symbol of caring for thy neighbor, anyone you come in contact with. The mask protects the other person from you, just in case you are amongst the 40% of asymptomatic coronavirus carriers.

Being an asymptomatic carrier means that you have no symptoms whatsoever and you still have the virus and can easily spread the virus to others. Currently, the WHO and scientists worldwide tell us the primary way of getting this severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the name of this coronavirus, is by being close to others in less than 6 feet and breathing in their air.

This coronavirus is not going away until a viable vaccine is ready, which is unlikely to happen until next year. We must remain vigilant and always think what we must do to protect our loved ones and those on the front line. Just when Florida and Texas think they are in the clear and open up the country prematurely, now they are paying for it with American lives and wrecking havoc on thousands of families. If Florida was a country, they would be number 4 in the highest number of cases right now.

Love Thy Neighbor: Wear a Mask

This is especially important as a nurse. You must always protect yourself in order to protect and serve others. Encourage those around you to follow good practices.

I have to admit it’s been difficult. I wished for my sister to drive from New York and visit me and my newborn. Unfortunately I had to decline and tell her to visit me next year when we have a vaccine. My newborn is completely vulnerable and I would feel horrible if something happened to him. She had also visited several groups of people in the week leading up to the planned visit and planned to stay in a hotel for a night. It doesn’t help that videos come up that show hotel rooms still not being adequately cleaned even during the pandemic.

What have you done to encourage others to wear a mask? How have you struggled during this pandemic? Let me know in the comments below.

Words Create Reality

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Words create thoughts.

Thoughts create reality.

Change your words, change your reality.

Good thing words are free.

In a Ted video, Lera Boroditsky described a tribe that didn’t use the words left and right and rather described direction only in terms of north, south, east, and west. The tribal members were better with a sense of direction compared to anyone else.

In Russian, it’s common to use varying descriptions of the color blue. Whereas in English, we say blue. It is much easier for a Russian to differentiate the different shades of blue compared to an American.

In a book called “Bringing up Bebe,” the American mom says in France, there are descriptors for “a behavior of small annoyance,” which help differentiate small bad behaviors from horrific acts. Because such a word does not exist in English, a kid who doesn’t finish his carrots versus a kid who kicks a dog may be all labeled “bad kids”. It doesn’t help distinguish the level of “badness” and the behavior from the child.

According to the Rich Dad’s Guide to Investing, if you use the words of a rich person, then you will become rich. Gaining a financial education is one of the key factors that will get you there. You gain education through the words you use.

One of the new advances in medicine and nursing that are rocking the world right now is the use of pocket ultrasound. While ultrasound has been available for years, it has remained prohibitively expensive, especially in rural and poor countries. However, the Butterfly IQ has come out, and I believe it will change how people are diagnosed. Some healthcare providers may be reluctant to use it because it was not utilized in their initial training, but as with any advances, it will be imperative to learn new words (and images) and ultrasound education, to fully embrace the new technology and change the way people are diagnosed.

In each field, we use different words to give us more details, and it dictates our thinking. Our thinking turns into action (or inaction), and that becomes our reality. So to become a better anything, you have to learn the words.

That is why if you say you can’t do something, then that is your reality. That is why if you say you do something, then that becomes your reality.

So if you believe you belong in nursing school, then you will do everything you can to get there. If you believe you will become a great nurse anesthetist, then you will find the resources to become one. If you believe that you can make a difference, then you will learn great behaviors from your role models.

Whatever your dreams are, believe in the new words to create a better reality for yourself.

NYU Accelerated Nursing Program FAQ’s Part II

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I recently received an email from a prospective nursing student and thought that it was worth posting my answers.

Hi Jessica,
I came across to your blog while searching for NYU’s accelerated nursing program.  Reading your blog has been very helpful. Congrats on becoming a nurse. Currently I have my undergrad in a business discipline and I am really considering a nursing career instead. I just have some questions regarding nursing, it would be great to get your feedback. Thanks so much if you have the time to answer any of these questions!

1.       Does it matter whether you take your pre-reqs at a community college or 4-yr college when applying to NYU? Do pre-req grades matter? Will there be a higher chance if acceptance if pre-reqs are taken in NYU?

You can take your pre-reqs at a community college or a 4 year college. Pre-req grades matter a lot. Definitely do well on these. I don’t believe there’s a higher chance of acceptance of the pre-reqs are taken at NYU. Majority of students take pre-reqs at a community college or a 4 year college.


2.        What were your credentials when you applied to NYU (eg. GPA, experience)? And did you find NYU to be worth it after working in the field? Is there any other nursing programs you would recommend in NY?

My GPA was 3.84. As for experience, I volunteered at a hospital when I was applying. It’s important to highlight your feelings towards nursing especially after speaking to them and seeing what they do.
NYU is a great school and I’m glad I attended the school. The professors are top-notch and the students are helpful. There’s an interdisciplinary program so med students and nursing students learn about working together and each other’s roles. It is one of the top research institutions as well especially in elder care (NICHE Program http://www.nicheprogram.org). However, it is a really expensive program so I don’t recommend it to everyone.
The other nursing schools in New York / Long Island that I hear good things from include Hunter, Columbia, Stony Brook, Adelphi, Molloy and Pace.

3.       Difficulty finding a job? Did you work part-time while studying in the program?

After I passed the NCLEX, it took about 6 months to find a nursing position. A couple of problems I ran into included not knowing how to interview (because this is a skill you need to practice). I didn’t start my search until after I passed. Some students connected with nurse managers during clinical and were able to secure a position shortly after graduation.

I did work once a week as a swim instructor during school to help supplement the costs. Some students didn’t work at all while others worked 36 hours a week (a full-time job!!). The first and second semester are the toughest so give more time devoted to school before deciding to work.

4.       Do grades matter a lot to employers? Do I need to get straight A’s or can I afford to have a few B’s or even a C?

Some employers require a minimum GPA (3.4, 3.5) before they even look at your application. Some don’t. It’s how you present yourself and your mannerism that matter and whether you retained information from school and can apply it.


5.       What is the starting salary like and is it worth being a nurse practitioner? What kind of nurse do you think is best to become/specialize in if any?

Starting salary differs from location to location, ranging from $40-80k. In NYC, it starts around $70-80k if you’re working at a private hospital.

Becoming a NP is dependent on the person. While I’ve heard that becoming an NP is the greatest thing in the world (I hear a lot of positive feedback), there are still a few who are discontent with the position, as there is more responsibility that comes with the position. Some people don’t want to deal with the higher stress and responsibility but wanted to go back to school and ended up hating being an NP. This requires a lot of self-reflection. What do you think would suit you and are you ready for it?
Personally, I’ve explored many advanced nursing professions. Not only should you look at your duties but also the lifestyle. Where would you want to work, what would you do, when would you want to work, what income would you make, what mobility is there? The best advanced nursing profession depends on the individual and what they want out of life. I picked Certified Registered Nurse Anesthetist. I like the one-on-one direct patient care aspect requiring a high level of critical thinking and autonomy and teamwork.

6.       What’s life as a nurse? What are the difficulties and good parts of being a nurse? Expectations in the work force?

Life as a nurse differs between the environment that you work in. I work at the hospital where there’s 12 hour shifts (7-7:30am and pm), 3 days a week (for full time) and you can choose your schedule (with some limitations such as having to choose at least 3 weekend days, 2 Fridays, etc). Some people choose to do 3 in a row each week and have 4 days off. Other hospitals have it so you work 3 12-hour shifts plus 1 additional day every 4 weeks. Some units, especially in CTICU, PACU and ER, have other shifts from 11am to 11pm or 2pm to 2am.

It’s great having 4 days off because you definitely need it to recuperate and you’ll have time to do something else if you’d like.
Some places have day (7a -3p), evening (3p-11p), and night shift (11p-7a), especially in rehab and nursing homes, and require you work 5 days a week.
At work, you often need to have handoff communication about the patients. Then you assess the patient and pass out medications. You make nursing diagnoses about each patient and use critical thinking. You think to yourself: What’s the goal for the patient today? And then make it happen. You’ll speak to various disciplines to coordinate the care.
—
There’s a couple of tough parts about being a nurse.
1) Families – Some follow the unit policies and others do whatever they want. Communication is sometimes hard but trying to understand where they are coming from helps.
2) Physicians, MLP – your input is often crucial to the patient’s outcome but sometimes the provider will disagree with you.
3) Patients – some are nice and others are crazy, confused and not so nice.
4) Self- being able to let go everyday of the outcome is tough. At the end of the time, you have to set 1 small goal for the patient and as long as they meet that, you have to be satisfied with the care you provided. Nurses tend to be overachievers and want to always give more but with the number of things that must be done, it’s impossible to do everything you had in mind. You have to remember that nursing is a 24/7 job.
—
The good parts about being a nurse is knowing that you’ve made a difference is someone’s life. You get to think about an active problem and you get to take yourself and solve that problem. You get to hold someone’s hand and reassure them. It’s an amazing privilege to have to save a life, to have a better life, or to let someone die with dignity.
As for expectations in the workforce, there are several different angles you can discuss but I’ll discuss about your own expectations. There’s a nursing theorist named Patricia Benner who stated that the nursing career is based on the nursing model-
You really do start not knowing a lot, just the basics. You focus a lot on technical skills because it’s something you have to work on. Then as you progress, you build more confidence. Soon you’ll start to see areas in nursing where care can be streamlined or have protocols to standardize care. You’ll be in charge, take on harder assignments, be a preceptor, etc.

7.       Any general suggestions on what I should focus on or do to become a nurse/get into NYU program?

Do well on your pre-reqs, volunteer or work in healthcare, and get to know a few professors who will write a letter of recommendation for you. And write a killer personal statement answering every question asked.

I hoped that helped! Read my first post for more information on NYU’s Accelerated Nursing Program, find out if NYU Nursing is worth it, how to pick a good nursing school, and find out if you can afford an accelerated program. Or if you have any further questions, email me.

Jessica

Finally off of my critical care probation!

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sim manYesterday marked the last day of my critical care probation. So what did I do to pass? Instead of being at the hospital, I went to the simulation lab with Mr. Sim Man.

While I did sign a confidentiality agreement not to discuss the specifics of the lab, I can briefly state that it was similar to being at work in the hospital. When you receive a patient, you do a Head to Toe assessment, and determine the next step in care. Is he stable or unstable? If the patient doesn’t respond to your care, what is the next step?

It’s exciting to be off probation now, considering that I’ve been on the unit since December 2013! Now I will have to float to the SICU or CTICU, stepdown, PACU and ER. I’m a little scared to not know everything is (again), but it should be ok!

What mean, demanding patients want – poem

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20140903-091612-33372622.jpg
He so in control, even when he’s ill
Demanding that the TV’s on
as he rolls into the new room
“Sir I need to make sure you’re breathing”
“No, the TV will keep my sanity”
Even when he can hardly breathe

Nothing’s my way
only his way
“But dad when you do it their way
you get better
and you do it your way
and you’re back in the hospital
So just listen to them”

No I don’t want that
then what do you want
I want what’s best for me
what is best for you?
I don’t know you tell me
let’s keep this on
Okay

He wants control, his decisions
because slowly but surely
he’ll lose one thing at a time
So he’s demanding
and mean

I get it
but what do I do?
How do I deal?
Just wait for 12 hours to be over?

It’s time to be a Strong Nurse

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I was about to ‘boost’ a patient up in the bed with a colleague and I noticed how strong she was. I hardly did anything! Later that night, a patient coded and she started CPR. I noticed that she could do it for such a long time with so much force. She’d take a break just for a few minutes before she took over again.

When I took over, I realized how little endurance I had. I was wiped out after a minute.

After the code, another colleague mentioned how she heard pumping noises right before the code was called. She knew that it was that strong nurse doing CPR.

After I went home for the day, I felt my abs hurting.

This made me think about all the strong nurses there are. Especially in the ICU. Especially her. So she’s my strong nurse idol. I want to be a strong nurse.

I bought new running shoes and workout clothes yesterday from Adidas. I haven’t had a sports bra since high school (I’ve been swimming instead). I have to build my endurance. Do free weights. Etc.

It’s time to be a strong nurse.

And I’m bringing my boyfriend along for the ride.

Strong nurse!

At The New Grad Nurse Interview: Be a storyteller

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how to get a new grad nurse job - be a storyteller Your interviewer loves stories. In fact, you love stories. Everyone loves stories. So it only makes sense to become a great storyteller. To secure your first job as a nurse, you have to perfect the art of storytelling. About yourself.

I royally screwed up telling the story about myself. Twice! My first interview, I wasn’t prepared at all and just said whatever came to my head. My second interview, I didn’t focus my story about being a clinical nurse and drifted off into ‘health policy’ –that was a no-no.

I got better after learning the hard way. For my third interview, I started to focus my answers and got the job at a nursing home. By the time my current employment interviewed me — my fourth and fifth interview — I had some real nursing experience and relied on that to come up with some great stories.

So what’s the difference between a tale and a story?

A tale is simply stating something that happened. People don’t usually care about what happened. However, a story has a moral, a meaning, a takeaway point to it. We care about the 3 major things – the ‘bad situation’, the ‘thing you did to make it better’, and the ‘aftermath.’

Here’s an example for a question: Tell me how you dealt with a difficult situation.

A tale: a women wouldn’t take her medications. Later she did after I convinced her.

A story: a women wouldn’t take her medications. After thinking about why she wouldn’t, I realized that she wanted more control over what was happening to her. Instead, I gave her a choice and asked her, “would you like to take your medications in 10 minutes or 20 minutes?” She replied, “in 10 minutes. Thank you.” 10 minutes later, I went back to her to give her medications and she took them like a champ. Giving her the options allowed her to gain some control but not complete free-reign. This compromise allowed me to accomplish my goal (to give her meds) and made the patient happy.

Here’s another example: Tell me about your greatest strength.

A tale: I ask a ton of questions because I always want to learn.

A story: As a new nurse, I know that I have a lot to learn. I understand that sometimes I will be asked to do something that I’ve never done before but I am not afraid to ask questions to make sure that I’m competent the next time it comes up. I wasn’t sure how to put someone on a bedpan so I asked the ancillary staff. The next time I did it with someone. Another time I wasn’t sure if I heard the breath sounds correctly so I asked another nurse to confirm what they heard. Asking questions is my strength and understand that this is key to learning fast.

Here are some common questions. Think of your clinical experiences and come up with a story for each question.

  • What is your greatest weakness?
  • “Tell me about yourself.”
  • What made you interested in nursing?
  • What do you like about nursing?
  • What was your favorite clinical rotation? Why? (please relate this directly with the position you applied for)
  • Tell me about a time when you had to prioritize.
  • Tell me about a time when you had to delegate.
  • Tell me about a time when you had to problem solve.
  • Where do you see yourself in 5 years?
  • Do you have plans on going back to school?
  • Tell me about ‘x’ experience that you wrote about on your resume.

Work on becoming a great storyteller and you’ll find that you’ll use this skill over and over again during every handoff report. And hopefully you’ll get a job offer! Good luck! Let me know if you have something crafted but would like a little help looking it over.

—-

I wrote this article as a part of the “Most Marketable Skills” Campaign on Webucator. I have to thank Bob Cleary for letting me be a part of the campaign! While I personally haven’t utilized their resources, they look helpful! Currently they are offering a free Microsoft Word 2013 class that involves learning about advanced formatting, using Word 2013 drawing tools, creating and managing tables, and working with column layouts. Each month they offer a new free course, so check it out even after this post is long done.

In case you missed the campaign, here are some of the other blogger’s input:

Achieving Success in the workplace – What is your most marketable skill? by @cjperadilla

What makes you marketable by @amandastrav

Self Brand Marketing : Social Proof To Boost Your Career by @CustomerRivet

Preparing for the workforce: Why learning to write well is worth your while by @moses_says

The Success of Mimicking by @Lbee27

My First ICU patient who passed away

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He officially passed away this morning
while I was on break. DNR status.

Yesterday his son asked for my thoughts.
“I think he’ll make it tonight.”
Even though he was slowly deteriorating,
Maxed out on oxygen and 3 drips to keep up his blood pressure.
On fentanyl to make him comfortable.
He made it.

I returned last night.
It was a different story.

“Jessica, how’s he doing?” His son asked.
The generic “he’s fine” is off limits. It was time for the truth.

“Last night his respiratory rate was 9 or 10. Now it’s 15-18.
Often when people are nearing the end of life,
it goes from slow to faster and back to slow again.”

“But his heart rate looks ok. It’s 85.”

“Yes that’s true.
But his blood pressure is slowing decreasing.
His heart is still trying to compensate.”
He cocked his head. I tried again.
“His heart is trying to get enough blood to his body
but it’s not working. It will eventually give up.”

Optimism in his voice,
“But wouldn’t the heart rate slowly taper off?
I thought he would live a couple more days.”

“No, his heart can suddenly stop because it’s giving up.
I’m not sure if he will make it through the morning.
His drips cause his blood vessels to constrict.
That explains why his hands are cold
and the oxygen probe to not read well.”

After midnight, his HR was suddenly dropped to 42. RR was 9. SpO2 77%.
“Can you give us an update, doc?”

“Well I’m not a doctor.”

“It’s ok. We’ve promoted you. Just give it to us straight.”

I started to tear up a little bit.
It wasn’t easy for me to tell them what I thought:
He’s on his way out.

They told me that they’ve shed their tears already
and were waiting this.
“Thank you for taking great care of him.
You should be proud of you and your coworkers.
Tremendous sense of purpose and goal and comradery.”

His blood pressures stop reading.
Apnea alarm sounds.
That probably should’ve been my cue.
I still felt a carotid pulse.
I checked my drips.
Gave report and went on break.

I came back from break and looked at the monitor.
His was black.
“Your patient expired.”
Icy cold hospital terminology.

I debriefed with the experienced nurse covering for me.
What could I do better next time?
1. Listen for his heartbeat, not only feel for pulse.
2. Consider the BiPAP machine delivering breaths for him.
What’s the rate set at and what is his RR now?

In the final progress note
Include: heart rhythm- PEA,
who pronounced time of death,
which doctors notified of death.
Family at bedside or contacted.

In the end,
This family was ready to accept their father’s fate.
The son shared his friend’s voicemail message:
“How did they prepare the chicken?
They told him he was going to die.”
We chuckled.
Humor can start the healing process.

After I gave report,
I said bye to the family
And they all gave me a hug
And thanked me again.

I drove home
Half crying
Trying to drown the feeling
By turning up the radio.

I showered, ate, and wrote this down
So that I don’t forget.