22 posts tagged “nursing”
I started blogging again as a means of trying to have a more creative hobby than video gaming. All that carpal tunnel action from playing Rock Band isn't healthy! And thanks to Kyle's fantastic new theme (pictured above! -- I can't believe it!) I've got a new lease on life :)
MRSA is a medical acronym for methicillin resistant staphylococcus aureus. It's one of the known "superbugs" that has emerged as a result of different bacterial mutations (likely in response to multiple antibiotic therapies to treat it). The hospital can send off cultures -- everything from sputum to urine -- to determine which site has been infected with MRSA. Treatment for it may come in the form of antibiotics, isolation rooms, and good old tender loving care.
Working in any setting -- you get patients with MRSA all the time; it's a fact of life that you have to gown up everytime you go into one of these patient's rooms. It may not seem like such a big deal, but after you've done it at least 40 times in a night, you can see how it gets annoying. This however, is the price we as nurses pay for not getting the bacteria all over our scrubs and spreading it to other individuals we come in contact with. With the frequency that we deal with patients who have MRSA and the not-so-full-proof barrier methods we use, most nurses and healthcare workers are likely carriers of MRSA.
Scary isn't it?
I don't doubt that if you swab tested the nostrils of every healthcare provider you knew, they'd likely be positive. For hospital politics though, staff aren't tested for it. Generally speaking though, individuals with healthy immune systems can live in harmony with MRSA and likely will never need to worry about it through their lifetime. Whether this means carriers who are non-symptomatic can't spread MRSA, I don't know.
Even if you attempted to place all the MRSA infected patients into one isolated unit it would still be difficult to stop its spread. Everything from the use of barrier techniques by the doctors/nurses/respiratory therapists to the way the room is cleaned isn't full proof. There are way too many factors to control and it's because of this that hospitals and community settings alike are having difficulty controlling the spread of MRSA.
So just relax, take a deep breath, and live with the idea that you may be living in harmony with a few superbacteria. So long as you are realtively healthy it should never be an issue -- your immune system will naturally protect you.
Interesting tidbit, but did you know that if your loved one dies in a hospital you don't need to sign the release of remains off to a funeral home? You can take the body home with you if you like, instead.
I spend most of my week driving back and forth between Richmond and metro Washington D.C.. For a good portion of most of these trips I am listening to my iPod obnoxiously loud, and wailing out of tune. Every so often though, I'll switch to one of the local stations to listen to the radio.
What I had heard as I tuned in this week was a d.j. saying that according to a recent survey, 1 in every 6 nurses has had sex with a patient. She went on to further note that 1 in 10 of these has known a colleague, or has his/herself, been someone accepting of the idea of having romantic relations with a patient. I still find the entire thing shocking and wonder how legitimate the whole survey really was (and furthermore, where it was done... hopefully in the backwoods of West Virginia -- sorry WVers.).
Maybe it's the type of setting that I work in, but frankly -- I wouldn't want to have sex with another adult whose poop I was once wiping off their butt. The imagery alone is a total turn-off! On the flip side though... Would you want to sleep with someone that was once pushing medications through a tube in your nose?
Nursing just isn't the sexiest occupation.
Just as I'm getting ready to leave to go back to Richmond I read my friend Sarah's post about what you would do if you were offered the opportunity to just get away.
I'd leave.
I think since coming back to America I've had a load of stress -- readjusting to my job hasn't been easy. Being absent a few days puts you at a disadvantage when it comes to practice. I feel like I'm still forgetting little housekeeping things that I would've otherwise taken care of usually and I've been feeling slightly guilty about it lately. I've also been missing life there, mostly the food though -- I'm constantly getting sick from all the grease and lack of movement here, so much that it's driving me mad. But I think what I miss the most is the feeling that I'm having an adventure.
As an adult, I feel like I'd lost that in the months that I became depressed. Finally taking that vacation was a real eye-opener and reminder of the person that I used to be and the person that I can become. In the spirit of it, I decided to continue to forward my plans for applying to graduate school and also maybe accept the challenge of changing occupations to learn Japanese better.
Recently, in spite of all the grad school preparation, I've found that financing a study abroad (particularly in Japan) is very, very difficult. There aren't loan programs that will easily lend to institutions without large populations of Americans attending. Because of this I'm kind of stuck in this rut of filling out the applications but scared of trying to figure out how I'm going to self-finance a $17,000/year tuition and living costs through graduate school. In the end I might have to take up a private loan from a bank just like my friends and just bite the bullet in terms of trying to pay that off after I graduate. Who knows.
I've applied for a job with an English-language teaching program in Japan through an eikawa called Geos. To be honest, I kind of did it on a whim. If I don't make it into graduate school (which, at this point seems like a likely circumstance considering I have little work experience) I'd like to spend the time working in Japan and learning Japanese better in the meantime. It'd mean giving up nursing, but I'd be chasing a dream and living an adventure.
Perhaps a better question is -- if you were given the chance to live another life, would you?
I guess we'll see in a few weeks.
My unit (in comparison to the previous one I worked in at a smaller hospital) receives a massive amount of post-arrest patients. The difference with our service is that our unit is probably the one most familiar with initiating what's called the hypothermia protocol.
The hypothermia protocol is a treatment plan that's initiated after someone has been resuscitated from an 'arrest state' (induced by either ventricular fibrillation, ventricular tachycardia, or pulseless electrical activity). During hypothermia protocol, a patient is chilled (down to 32 degrees celsius) for a period of 24 hours and then slowly rewarmed back to a normothermic body temperature. The reasoning behind hypothermia protocol is that if you can chill a patient (whose body has just sustained a large amount of damage and is in a 'hypermetabolic' state) down, you can slow the rate at which the cells are being destroyed and minimize damage to the body and, in theory, preserve some of it's function. All of this winds down to hypothesizing that patients who have been through hypothermia and rewarming have better outcomes than patients who receive no such treatment at all (if they didn't -- why would we bother going through the therapy at all?).
Of course there are also other factors that need to be taken into account before saying that the survivability is greater after hypothermia... Co-morbidities like shock states (cardiogenic, septic, etc.), disseminated intravascular coagulation (DIC), previous damage from other heart attacks/arrests also play into how good of a chance a person is going to have in surviving the arrest itself in addition to how well they will recover from the hypothermia therapy.
Lately, perhaps because we're in the midst of a hot summer, the ICU acuity at our medical center has been through the roof with patients requiring the hypothermia therapy. I'm interested in knowing how many medical centers actually implement a supportive therapy of this type and whether it improves their mortality rates or not.
I've recently decided to take up juggling a busy schedule.
Things at my new job are still going great and I'm learning quite a lot, so much in fact, that I now have a voracious appetite for more information. I've taken re-certification classes in intraaortic balloon pump counterpulsation therapy and in the continuous renal replacement therapy, but the opportunity hasn't yet come up for me to utilize the skills. Though our patients are acutely ill, I've noticed that CRRT is rarely used (even though we see a higher degree of kidney dysfunction), but that CRRT when used at my current institution is more of a nurse driven therapy than it is by medicine.
Anyway, I won't get into all that complicated crap in this entry.
I'm actually writing after spending the past three hours making phone calls to Japan in hopes of making research contacts for a scholarship that I'm applying for. The Fulbright is a scholarship geared towards promoting international research, sending scholars from the United States around the world to study different topics of interest relating the host countries to home. The process of applying for this scholarship however, is long and painstaking -- it takes about a year just to develop the contacts and write up the paperwork and then another year to go through the selection process. The applicant pool is competitive and you're competing against the best and brightest at not only your university, but in the United States. The reward is great though -- a year-long study in your country of choice, all expenses paid. Everything from tuition, to living costs, and transportation are all covered under the full grant scholarship.
So far, I've been working on writing the narrative curriculum vitae and the project statement as well as making contacts and increasing my work and volunteer experience while I'm still here in the United States. Part of the reason I've been so busy lately and have "fallen off the face of the earth" is because I've been juggling beginning volunteering for two organizations, tutoring two students, working, writing the Fulbright, learning Japanese, calling around and socializing to make research contacts, and studying for some nursing specialty exams (the CCRN and the CMC). While it looks and sounds kind of crazy -- I've really enjoyed it.
The hardest part has really been making the research contacts though. I can't tell you how difficult it is to make a phone call to another country and speak in another language well enough to try to ask about nursing research or even getting an organization to listen to you long enough to help you. I feel kind of smarmy constantly socializing for the sake of my research interests, but I guess this is what it's like to pimp a cause (how educated did I just sound there...?).
Either way, it's 4am EST and I still have three e-mails with project statements and curriculum vitaes to send out. So I'm out for now. More interesting posts later this week.
So lately I've been the queen of the flexi-seal fecal management device -- I've been putting these bad boys in left and right. And I'm wondering how many other nurses out there have used it.
We use it quite frequently in our ICU setting because of the amount of curry-poop-inducing drugs that we give, but I find that sometimes if it isn't done right it induces more work than it needs to. Usually most of the trouble is caused by too little inflation of the balloon that holds the device in place in the rectum.
For lay people, basically the device is placed much like a foley catheter which is a tube inserted in your 'pee-pee' (urethra) that drains liquid in an orifice, by gravity, into a collecting bag positioned below the patient. In the case of the Flexi-seal system however, you're inflating (instead of a small balloon) a small stretchy liquid donut that inflates to expand in the rectal portion of someone's sigmoid colon. The easiest way I've found to get the device in is usually in the sidelying position (or if you're short on help and/or the patient is too grossly heavy -- with one leg bent up at the knee). Also, since I've had to put this device in more frequently than I've wanted to these days, with patients that are greater than 300lbs you can place the bed in Trendelenburg positioning to facilitate movement of their tissue "backwards" down the bed making it a little easier for you to spread their cheeks apart and place the device (this also works with foleys for large women).
With that, you just lube up your donut and maybe an inch of the tubing and with one finger gently slide it in until it's pretty much a finger length in and inflate the balloon with your 45mL of water. Usually the remaining stool sitting in the rectum below where the balloon is placed will ooze out and you won't have anything left to clean up after it's all cleared out.
This is a tube that's not to be used with formed stool (like the kind you can craft a pot out of), but instead with loose formed (which apparently is what the irrigation port is for on the tubing -- but honestly if they can poop something out that's that hard the damn device needs to come out anyway) stools or diarrhea/curry/watery stools. There's a medication we give often that lowers people's potassium called Kayexelate which acts by binding to the potassium from one's intestine and excreting it via powerful diarrhea. I find that the Kayexelate/lactulose/miralax diarrhea is the kind that passes best through the device and down into the collection.
What I've encountered is that during repositioning the tube either gets pulled downward or the donut gets deflated and people aren't reinflating it or repositioning the device when it happens. Sometimes too, you might start to get formed stool (when the diarrhea is tapering off) and you just need to irrigate the tube via the irrigation port near the inflation port for the rectal balloon.
Anyway, this post was just kind of a helpful hint kind of post for all the poop-scooping nurses out there (for better instructions you should see the package insert). Hope your life is a little easier!
Lately, I've been on a serious binge to start saving for graduate school and finding scholarships/funding for schools that I'd like to attend overseas, but so far the search has yielded few results.
I've finally decided after changing my mind time and time again, that when I go to graduate school in a few years I'd like some type of management related degree like an MBA or nursing management. While I enjoy bedside practice, I don't think that it's something I really want to do for the rest of my life, but I'd still like to move up in the nursing world in other ways. Maybe it's my mom's influence in me, but somehow crunching the numbers behind an intensive care unit interests me more than intubating and suspending animation on someone in an operating room as a nurse anesthestist.
Part of the thing that scares me about graduate school is that I'll be going alone. Matt, who is my second nearest and dearest (and whom I've toughed out most of my college years with), is applying for anesthesia school soon and depending on how things go with him, we'll be parting ways to endeavor on our own separate nursing journeys. The scariest part isn't the actual separation itself -- but the fact that I'm losing the support of a good friend that could relate to the nursing experiences I was going through.
Nursing school hadn't seemed so intimidating at the start. To be honest, I didn't really want to be there and felt a certain snobbery against the other nursing students along the lines of, "Ugh, damn I can't believe I dropped mechanical engineering for this crap. I just want to go to med school; I bet these girls are nothing but ditzes." I think after a few years of sobering nursing experiences and realizing that the program itself (one of the top 50 in the United States) was not as easy as once expected, I started to take it more seriously. It was at that point that I also realized I didn't want to lose what I had worked for years to achieve -- when the classes got tougher, I started to see that my intelligence alone wasn't going to get me through university, but that it was going to need harder work as well.
I can't tell you how many times I cried from sheer frustration during my third year of undergrad. In retrospect, there aren't many memories from that period of time that are good ones. It so happened that two of my other roommates during that time were also having trouble with school so I had people I could relate and commiserate with. Matt was always balancing nursing school with his paramedic classes, two jobs, and volunteering -- while he couldn't really 'commiserate' with my particular situation, he always offered a shoulder to lean on about all of it. After several scares (with psychiatric/mental health, and pediatric nursing classes), I made it out of my junior year barely alive and wondering whether I wanted to be a nurse at all. The negative academic experiences I'd had that year really made me question whether I was cut out for medical/graduate school, or even nursing at all. The first positive experience I really had with nursing was getting my first job at the hospital in the intensive care unit that I currently work in now.
It was because of the great guidance of my nurse manager and the nurses on my unit that I even continued nursing school. They showed me an array of experiences from the good to bad and instilled in me an actual love for the practice of nursing and not just the task itself. It's for this reason that I remain so loyal to that unit and part of the reason I cherish it the way I do (as sappy as that sounds).
Someone once said to me that the best care in the hospital isn't given by the nurses and doctors that do their jobs for just "the money", or the satisfaction of helping others -- but the ones who actually do it because they love doing so. I've always thought that this is a good sentiment to have about any occupation regardless of whether it's healthcare related or not.
I'd like to think that in a few years when I leave bedside practice that I'll still love being that kind of nurse and hopefully be starting grad school with the same sort of mindset.
Wack!
The past couple of weeks have been a fun whirlwind, and frankly it's the happiest I've been since my graduation from college.
My new job is a lot harder than the last, but I feel a sense of fulfillment from it that I didn't get while I was still at that other hospital. Right now, I'm caught in a ridiculous schedule involving lots of day shifts, classes, and competencies -- but regardless of how busy I feel, I'm loving all of it. This is a strangely fuzzy and warm comment -- but I love working with everyone on the unit; it's not perfect, but you can definitely tell that everyone works well together despite it.
Being back at this hospital now makes me realize that while it has it's downsides (but really the only thing I can think of is that I pay for parking), the unit itself really works to make its staff happy. One of the attending physicians (there's a new one every two weeks from a set pool of 4/5), even pays for nurses that wish to take the CCRN to take the exam (a ridiculous $325 if you're not an AACN member) out of her personal pocket. Furthermore, the attendings (with their own personal money) even set up a fund so that someone will teach the nurses the material to pass the exam. Unit culture is nice as well -- most of the doctors are addressed by first names (with the exception of the attending physicians -- but that's understandable) and visa versa. I've got a lot of respect for everyone that I work with -- doctors, nurses, unit secretaries, and care partners alike. I count myself blessed to be a part of their team -- and most of all, I don't doubt the care that any of them would provide a patient. If I have heart disease when I get older -- I would have no qualms about them taking care of me. When you can say that about the people you work with, it means a lot.
I feel like I'm struggling a little bit to remember how to do things. It was hard remembering what the codes were to the doors, which forms to fill out, what resources I had... Then there's the constant bustle of taking patients to scans/tests, doctors constantly asking questions, and learning new techniques on nursing procedures. On my first day taking care of patients, I felt a little overwhelmed with trying to do the things I needed to do (I was a little frustrated with myself for forgetting where some things were in the unit), but I still felt good at the end of the day and I'm excited about going back again. It'll take some time to get acclimated, but I'm looking forward to the challenge.
I'm finally really happy again with my career choice. In the few days I've spent at my new old job (oxymoron, isn't it?) I've gotten to remember why I became a nurse in the first place. I feel like a huge burden's sort of been lifted off of my shoulders since re-realizing those things. And, in doing that I realized this:
There are many different kinds of nurses in many, many different areas of practice -- each has their own value, none more important than the other. But personality wise -- there seem to be only two kinds (well three). There are the nurses that see nursing as a job, and the kind that see nursing as a practice. Everyone has to decide for themselves whether they're going to be a nurse that works just for the money -- or whether you're a nurse that works to change the practice of nursing. The third kind of nurse is a combination of the two, and those are the ones that you typically find (thank God) at academic medical centers where the pay isn't always fabulous, but the nurses are. I think part of the dissonance between me and my former job was that I wasn't the kind of nurse that was in it for the money -- had that really been the kind of nurse I wanted to be; I would've moved back to northern Virginia and taken a job in an academic medical center in DC and get paid almost double what I get paid now. What I wanted was a rewarding experience of having made a difference in someone else's life and in the lives of the people that I work with. There is a big unit culture difference between the two, so my advice to a new graduate nurse that's picking their first job is that when you're making your decision, determine first which of the two you are and then pick your job accordingly -- it'll save you a lot of grief.
Had I been given the opportunity to shadow nurses at my first nursing job, I don't think I would've taken it and I probably would've just waited for an opening at my current job to creep up. Of course, hindsight is always 20/20...
Also, I know that a lot of first jobs in nursing are very discouraging to new graduates. I can't tell you how many times I've reconnected with my old classmates and heard their countless sob stories about their first jobs and how horrible their situations are... and all I can say to that is that if you want to keep your wits, and your love of your job -- just move on. Quit the job you're unhappy with (but at least make sure you're doing it for a legitimate reason) and find a new one that suits you more. Job satisfaction in nursing is what keeps nurses nursing. And always remember, though you may be new -- you never deserve to be shit on. Ever. And if some nurse starts complaining to you about how it's not fair that as a new grad you get treated differently, take the wise advice of Erin T. (one of my favorite former co-workers) and say this: "Just because it was crappy for you back then, doesn't mean it needs to the same way for us. This is a new day, suck it up."
In one month, I'll have been a nurse for one year and I can say that the lessons I've learned in this short amount of time have proven to be priceless information for the path that lies before me. And to this year's new grads -- best of luck on the road ahead; may it be full of good learning experiences and satisfaction.
I love my job.
[Edited] PS: I love the fact that a lot of people at my hospital are young, single, and unmarried. And even more so, I like that Sam Reich's young, single, and unmarried doppleganger sits with me during orientation -- he's perhaps funnier than the original gangster himself, but not an interwebnet guru, instead an internal medicine intern.
