How has nursing changed since 1887?

Nurse Talk recently put up a link to an article in Scrubs magazine called, A list of rules from 1887, in which the nurse administration is offering up rules and advice for the nursing staff.  I couldn’t help but chuckle as times have definitely changed!  I would like to offer that I would most likely not be in good standing in that work facility as I frequent the beauty salon on a regular basis and consume wine!  (Such a hussy J)

On a more serious note I was intrigued by the other rules on the list. After a good laugh I really looked at the list. The rules were practical and straight forward.  Clean your patient’s room…washing the floors and dust.  While I’m glad that I do not have to do that myself I am very happy that housekeeping is around to clean my patient’s floors and dust their room to keep germs at bay and provide the feeling of calm.  The nurse was also responsible for the lighting in the patient’s room so she had to tend to the candle wicks, (how awful to practice with no electricity!!)

Getting to work on time is an important rule wouldn’t you say…as is keeping good notes on your patient’s condition, “for the doctor.” 

I thought it was rather interesting that the administration told the nurses to “put aside a good portion of their pay each week as to not become a burden in their older age.” I suppose they thought that as a nurse you had a duty to take care of yourself financially… I suppose they felt it irrelevant to tell the nurses to eat properly and get exercise and eat well, that was probably just a given back then whereas today …not so much!

Finally, if the nurse served her patients, the docs and the facility well for 5 years she may get a raise…Let’s hope that rule doesn’t come back!! 

I decided to think back on the list of rules I was taught 21 years ago…in 1991…  Present yourself to work on time and leave on time as to not cause the hospital financial grief.  Present yourself in a professional manner, clean white, pressed uniform and clean white shoes. (if not you would be sent home to change.)  No bear legs, wear white hose.  Name badge is to be clean and have all your pins of accomplishment on it to provide the patient with a sense of calm.  No swearing.  Clean fingernails and minimal makeup.  Hair was to be kept in a style that would not intrude on your work or fall into the patient’s field of care. Stay current on nursing research and standards.  Be respectful to the doctor at all times, get up and give him your chair, offer to be of assistance and be sure to surrender the chart to him even if your charting was not finished.  You all get the idea…

What is nursing like today?  There are many improvements in terms of nursing rules, our responsibilities have exploded and allowed us to be responsible for every aspect of our patient’s care…but I am not sure that the nurse has improved…now don’t start yelling and swearing here.  I, like all of you, am happy that the word nurse does not mean maid, doctor’s whipping post, slave or housekeeper …but what does the word nurse mean, how are we expected to act now.  It seems to me that we nurses have become an entitled, grumpy, challenging group of people.  We do not like rules imposed upon us and we sure as hell want a raise every year despite our standing.  I am not trying to be a negative nelly here but let us not forget that we became a nurse to “take care of patient’s” 

This has been a very good reminder to me as I hope it has to you.  A nurse is someone who takes care of patients, their every need… (You know what I mean).  Let us do this in a professional manner, with a smile and a caring heart.  I am not saying for us to move back into the dark ages and let people harm us, swear at us or degrade us…but if we want our profession to continue to be the most trusted and highly respected, WE must also respect it and what it stands for.  Let us take pride in our title…NURSE.

A heavy heart.

I cannot get into specifics but I have a question for all of you fellow nurses.  What do you do when you have a patient that is young, experiencing end stage metastatic cancer and they do not know it.  The oncologist has not given them the realistic and total picture of their disease process NOR have they been given the tools to deal with the fact that the treatment they are undergoing IS NOT WORKING.

I worked in hospice many years ago and I had a bitter taste in my mouth then, as I do now, when the oncologist continues to throw one chemo/radiation therapy after another at a person who is just getting worse… and then they die in the midst of treatment and everyone around them, including often times their children and spouse are left with the thoughts of “but they were getting better….the doctor said the treatment was hopeful.”  

While I was a nurse in the hospice world I had a voice and I could council my patients as they directed me to…I could also have a voice with the team that was treating the patient.  I often feel left out in the wind while working these people in the ER.  My role as the ER nurse is to deal with the situational issues that arise with this patient population, not to have a role in their treatment plan.  I feel like I’m standing in the corner of the room with duct tape on my mouth and my hands tied behind my back…watching from afar as this confused, sick and often times dying patient enters our doors and needs help…and the most sickening part is they and their families are so unaware of what is truly happening. 

As a nurse we have the obligation to provide the total and holistic range of care that each of our patients needs and deserves…I cannot help but wonder where the moral compass points on this issue for both nursing and with the medical professionals who treat these types of patients.  The “never give in and never say die” attitude with which many oncologists practice is all fine and good to encourage hope and strength in the patient population, but when is it okay to tell the patient the truth from the facts of their case… I know that it is a struggle of thought that when you tell the facts…the patient may lose the will to fight or may give up…but what if that patient and their family needs that information to stop the insanity and come together for some last weeks of time with saying goodbye?

Each person that we come in contact with has the right to be told the truth of their situation…and sometimes that truth is, “we have done all we can do and now we need to make you as comfortable as possible so you have some good weeks left to be with your family, free from treatment and free from pain, to have the strength and mind to say goodbye.  Fighting the fight is all well and good until the fight needs to be ended…ended in time to allow for time…

What is your experience?

Twas the night before Christmas and the nurse is at Work

Twas the night before Christmas and the nurse is at work

Many a creature is stirring, including a jerk.

All the IV’s are hung by their poles with care

In hopes that 7am would soon be there.

The patients are snuggled all safe in their beds

While drug induced dreams dance in their heads.

My fellow nurses and I who are no longer in caps

Are Just sitting down at the station to rap

When out of room seven arose such a clatter

I sprang from my seat to see what was the matter

Away to the bedside I flew in a flash

Where I grabbed the puke bucket from the cabinet stash

The light I turned on, in order to know

Exactly what the bucket contained and would show

When what to my wondering eyes should appear

But a disgusting recycled bucket of beer

Lifting my leg to hit the call bell with a kick

My fellow nurse came to assist quick as a lick

We changed him and flushed the bucket of shame

And he whistled and shouted “All hale the dames”

“They are the queens of the ER~…maybe one is a Vixen”

“Lets order some pizza! and we can call it a Mix in”

“We’ll sit on floor or lean on the wall”

“or maybe Ill just lie down in the hall”

We guided the poet who was on such a high

Back to his bed so sleep could apply

Within 5 seconds he was snoring anew

His monitor showing vitals not to warrant Code Blue

And then in a twinkling we heard something aloof

It was only the tech Ben, always being a goof.

As I let out a laugh and was turning around

He hit me with a spit ball and it fell to the ground

The patient in room seven was again up and on one foot

And this time his gown was all wet and stained with “soot”

A bundle of sheets flung over his back

He looked like street walker complete with a sack

His eyes how they twinkled, his mood was so merry

His cheeks were like roses, and his nose like a cherry

His droll little mouth was drawn up in a bow

And the beard on his chin was no longer white as snow

The spittle of puke held tight to his teeth

And the bed pan he held on his head like a wreath

He had a thin face but a big round belly

That now shook with a laugh like a bowl full of jelly

He was nothing like a plump jolly old elf

And we laughed when we saw him in spites of ourselves

A wink of eye and twist of his head

He turned around, showed us his butt…and went back to bed

He spoke not a word but flashed us a smirk

Even I had to say he was no longer a jerk

And putting his finger up inside his nose

Then giving a nod he declared, “this blows”

We moved back to our seats and sat down with a whistle

His room looked as if it was hit with a missle.

But all together we laughed and said, while keeping the patient in sight

Merry Christmas to all…and to all a good night.

Marriage, Love and Holistic Nursing.

My husband and I have been married for 27 years, and have been together for 29.  We were high school sweethearts. I love to think back on those days.  I was the cheerleader and he was the jock from a small town high school.  I used to sit in the middle of his truck seat while we were on dates, snuggled up close.  I couldn’t get enough of being near him!  Today it really is still like that for us… I know people will moan and groan at reading that, but by the grace of God it is true. 

I say this because I was witness to the sweetest and saddest thing today, and as a nurse it was my honor to be a part of it. 

I walked into the room of my newest patient, a 94 year old woman with increased confusion.  She was sent to the ER from her nursing home residence.  Her chart tells me that she has dementia and a long history of UTI's and resulting sepsis. 

"Good morning _____, I'm Bobbi and I will be your nurse today,"  I say as I enter the room, put the chart on the counter and move to the stretcher.  

She says nothing, and only watches me.  Her eyes are large and brown.  She seems to go long periods with blinking...but her eyes see me~ they are not vacant.  She has elegant white hair that is styled in a rather severe bun on top of her head, held in place with a gold scrunchy elastic.

"Your care givers are concerned that you may be sick, so they sent you to the ER for a check up...I need to do my assessment now if you don't mind."

Again, nothing but her eyes watching me.  No recognition of my words making sense.

As I undress her to look for any indication of infection (sores, wounds or skin breakdown) I continue to tell her what I'm doing and why.  I change her into a johnny, listen to her heart and lung sounds, give her warm blankets and place her on our vital sign monitor. I collect a fem-cath urine sample, draw blood while starting her IV and do an EKG.  

"I'm finished for now Mrs. _____.  I have to go and give this EKG to the doctor and then I will return in a few minutes.  Here is your call bell, this red button is the one to push if you need me."  

Just as I start to leave the room a very elderly man enters and introduces himself to me as “…….’s husband.” He is dressed in a navy blue sport coat over a black sweater, dark gray pants and a very dapper gray hat.  He walks hunched over with a cane for support.  His eye brows are very full and seem to move on their own as he spoke.  His accent sounds British.  I explained to him what I have done so far with his wife and what we would be looking for.  I pulled up a chair by the bed for him to sit.  He shook my hand and smiled.  His large arthritic hand is very cold. He moved to the bed and leaned over the rail and kissed his wife on the lips.  She smiled, but didn’t speak. He then took the chair I had offered but continued to hold his wife's hand through the stretcher rail.

“We have been married for 75 years.” He said.  

An ER tech stepped inside and took the EKG from me and winked.

“Congratulations, what is the secret to such a long marriage?” I inquire as I sit on the stool next to him. (I knew I had other patients but nothing was immediately pressing and I just felt compelled to sit and talk to this man.)

“Empathy for one another’s start in life, passion for the teenager you once were with each other and for the man and woman you grew into, pride in the other’s strengths and overlooking most weaknesses and Love ….Love for child of God that you married.” He answered while holding his wife’s wrinkled hand in his. 

I became a little teary as he shared this with me, as he was a little teary.  I told him of my husband and my children and that I felt so blessed.  He told me that God puts 2 people together to make them one, to make them stronger and to make them whole.  He told me that they had raised 4 children and 14 grandchildren and 10 great grandchildren, and that his wife loved him and their children fiercely and that, “it just kills them that she cannot communicate with them anymore.” 

I couldn’t talk, I wanted to cry.  He stood and once again kissed her lips.  She once again smiled but said nothing.  He then said to me, “she may not be able to communicate with words anymore but when I kiss her she still smiles at me the same way she always did….so I still kiss her on the lips as much as I can.”

I thanked him for sharing this with me…for allowing me a glimpse into their world.  He just smiled and tipped his hat.  The doctor came in, oblivious to our conversation and oblivious to the gift that I had just been given.  

New grandbaby and old nursing lesson.

As I sit staring at my new grandson I cannot help but marvel at the art work of God.  This little man came into the world weighing 7.3 lbs. and was 20 inches long.  His fingers are long and strong.  He has big blue eyes and a pouty little mouth.  Black hair covers his crown and perfect little feet top off his long legs.  He is the perfect combination of his mother and father with a spakling of my son and husband.  What I marvel at the most is the instinctive moves he makes~  he turns his head naturally and starts rooting for food when he is hungry, he curls his little fingers around anything that touches his hand.  The wonder of his innate instinct to eat, to stop eating, to urinate and have a bowel movement is another reminder of how wonderful creation is. 

The other thing that I love to watch is the way he cries if hungry and immediately stops when food is provided.  The need for human contact is another area of wonder~  the way that holding him close and talking to him calms him instantly…. We humans need very few things to survive…we are strong and resilient~ but we all need food, clothing, contact and shelter to survive well.

In my first semester of nursing I recall learning this principle…that patients need those basic things as well to heal and to survive and to survive well.  The powerful tool of human contact is one we should all remember. The patient that is fed, given safe shelter and clothing, good medical care and medications will still NOT do well if there is no human caring involved…esp. if they have no caring family in the patient’s world.  The elderly patient that comes in from a nursing home, no family in the area, and in need of medical intervention does much better when the nurse takes the time to sit with them, give them a bath, a soft massage and doing all of this while gently talking to them.  NICU babies will not thrive, and in some cases die, without human contact…behavioral health children do much better while in our care in the ER if the nursing staff has the time to sit with them and talk with them…

I like this phase of my life and my nursing career that has me thinking back and learning lessons.  I like that I am in a place of my career that I have the skills and the job that at times gives me the chance to sit and bond with a patient~ giving them the human contact and caring that they need.  I thank God today for my healthy, beautiful grandson, my family and friends and my nursing career.  I thank God for the continued lessons that he places before me every day. 

Patient's being Violent to nurses

Occupational violence is not a new concern here in the nursing world but it is getting worse.  The dept. of labors 2011 report states that being a nurse in the ER or in the mental health unit or community is ranked top highest job for violence.  A nurse in the ER, nationally, is at a higher risk of being injured than a coal miner and a police officer.  The Emergency nurses association did a report on occupational violence in 2010 that polled over 13,000 ER nurses and the statistics of that study are astounding. 

A middle aged man is brought to the ER by the local PD after they were dispatched to the street that he lives on for “a man walking up and down street aggressively, yelling and screaming at things that aren’t there.”  The man is cuffed and wide eyed, sweating with spittle on his chin.  His cloths are filthy and he has multiple sores on his exposed arms.  He is looking at things and muttering.  He does not know his name or wear he is.  He is fighting the officers and they physically have to drag him to a room.  He has to be strapped to the bed for safety of the staff after he spits in the nurses face and tries to lunge at her while she is assessing him.   This is a man on bath salts. (This is a case I am familiar with.)

A newly 20 something young man is brought to the ED by the police in cuffs after he took a few swings at his mother while intoxicated and angry.  He made some suicidal statements so the holding tank becomes the ER.  The patient is uncooperative and spitting at the officers and the nurse.  He is sneering and making vulgar sexual comments to the nurse.  His raised voice echo’s down the hall as he swears and threatens the nurse.  Another all too often occurrence in the ER. (A case I am familiar with).

A male family member of a young woman gets very angry that they are waiting over an hour for the doctor. (Actual time 25 min) He begins slamming the door repeatedly and yelling threats down the hall. Security is called and the nurse asks him to please calm down, the doctor is with another patient and he will be down in just a few minutes.  He then tells the nurse to go **** herself and slams the door again.  Security asks him to wait in the waiting area to which he refuses.  Police are called for staff safety. (A case I am familiar with).

A 20 something male patient is in the ER requesting narcotics for back pain.  The patient does not receive any narcotics after the doc does his assessment, x-rays and lab work.  The patient throws the discharge paperwork in the nurse’s face after calling her a name that makes my skin crawl and then he proceeds to push the nurse into the wall before leaving.   (A case that I am familiar with).

As I write about these instances I can feel my heart is racing.  Every day in our ER we nurses and techs are met with at least one patient every few hours that is angry at something or is on something that causes them to be dangerous.  Our ER is just like every other ER across the country.  Patients are getting angrier and their behavior is escalating quicker to violence against us and our staff. This behavior is NOT what we signed up for and it is NOT a part of the job.  Why do you think that many nurses and many nursing administrators feel that “it’s just a part of the job?”  I am lucky to work at a place that puts nurse safety above all else and that does not penalize us for reporting the violence~ and our local PD are very protective of us as well.  That is not so for many nurses across the country.  How has the violence changed in your work area? How do you stay safe?

A few press releases recently on nurses being targets of violence.

http://www.ena.org/media/PressReleases/Pages/workplaceviolence.aspx

http://www.wpix.com/news/wpix-bronx-hospital-emergency-room-shooting,0,5266436.story

http://vitals.msnbc.msn.com/_news/2011/11/08/8705246-swearing-spitting-choking-er-nurses-endure-this-and-more

Being a preceptor to new grads is an honor

When I graduated nursing school wayyyyyy back in 1991, I was hired immediately by the hospital I currently work for.  I began my nursing career on a med-surg floor working the day shift alongside the nurse who was chosen to be my preceptor, Laverne Pellitier. I had never met Laverne prior to this and I was very nervous, not only to meet her but to “be a real nurse.”

Laverne was a seasoned nurse, very professional and very nice.  Her nursing skills were top notch and I learned sooooooooo much from her. She met me with a smile and a detailed packet of what I was to learn and how long I had to learn it.  I received a full 6 months of training alongside Laverne.  When the 6 months were up I truly felt ready to be on my own and to go to the night shift…Laverne had done her job and I was confident in my skills.  Now this isn’t to say there weren’t moments of fear, tears and pain BUT there were more moments of joy, laughter and learning.

I wish I could say that every nurse I worked with during those first few weeks was kind…but that isn’t the case.  There was quite a bit of “nurses eating their young and initiation type attitudes” going on towards myself and the 2 other new grads that had been hired.  We now know that these attitudes are called lateral violence and sadly it occurs far too often!   I hear horror stories about it all the time and in fact this type of unprofessional behavior causes many new grads to leave the nursing profession all together within their first year of nursing! (According to a literature review I performed on this topic recently).

All of this to say how proud I am of a young nurse that I had the honor of precepting as a new grad 3 years ago in the ER.  Her name is Sarah and today she received an award for excellence in patient care in the ER. She is a remarkable young woman and nurse who I have the privilege of working alongside now in the ER as a fellow nurse.  She came to me as a new grad full of intelligence and vigor!  Her passion for nursing was evident and my job was to orient her to ER nursing and to assist her in putting the pieces of all she had learned together in that world of ER NURSING.  I wish I could say she got a full 6 months to learn and stretch her wings but we do not have the luxury of having that much time to give…BUT she was ready to go off on her own despite the less amount of time….

When I decided to become a preceptor I wanted to treat the new grads as I had been treated by Laverne…I view the job of preceptor as an honor and a privilege. I want the new grads to feel safe and cared for and I pray they all have!  It is our job as professional nurses and human beings to treat our new grads with respect and kindness while assisting them in learning. Being in their new position is terrifying and how can they learn compassion for their patients if they are being treated with such hostile attitudes…and how can they feel safe to learn new skills and even make a mistake in that environment? I’m sure many of you have horror stories from your new grad days, but I hope more of you had a preceptor like I did!  Thank you Laverne, where ever you are!!~~

From the eyes of a patient

From the eyes of a patient.

How many of us nurses have been patients a time or two?  What do you recall from your experience in the hospital? 

I have been a patient only a handful of times in my life~ thank you Jesus!  I have had 2 children that were delivered in the hospital…one experience, from my patient perspective, was good and one was very bad.  I had a day surgery experience which was wonderful and I have a childhood memory that was horrific.  What is interesting to me about the memories of these experiences is that my barometer of rating the experience is how I was treated by my nurses.  I cannot for a second recall the doctor in most of these experiences…hmmmmmm.

When I had my first child I was 19 years old, married and scared out of my mind!  The labor was long and painful.  The nurses that tended to me during labor and delivery are somewhat of a blur…  After my daughter was a born, that night I was in terrible pain and alone in my room, (babies were taken to the nurse’s station area back then)  I rang my bell to tell the nurse I was in terrible pain with cramping…a very long time seemed to pass…an older nurse came in, didn’t identify herself and said, “what do you want?”  I told her my problem and she said, “What did you expect when you have a baby at 19…it will pass” and she left the room.  I cried myself to sleep.   I didn’t dare to ring that bell or ask a single question after that.

When I was 7 or 8 I was in the hospital for a few days with an acid problem in my stomach.  My mother came and went but at night I was alone.  I only remember one nurse and she had red hair, was overweight and mean.  She practically growled at me from what I recall…the one thing that really sticks out in my mind and I remember it vividly is night she came into my room and told me to roll over.  I was in bed playing don’t break the ice…I asked her why…she said, “I have to check your back for a rash.”  My mother wasn’t there and the other woman patient was gone too…I remember feeling scared but I wasn’t sure why.  I asked the nurse if she was going to give me a shot.  She said no.  I rolled over and she pulled my bottoms down and quickly shoved a needle into my butt cheek and then left the room……I remember just crying and feeling so scared. 

I wonder what was going on with the 2 nurses that I just spoke of?  From what the first nurse said to me I can presume she was hostile towards me because I was 19 and she felt  I was perhaps “loose…” and from the second nurse I can presume she didn’t like children…  either way their attitude toward their patient was disturbing and extremely unprofessional. Maybe they were burnt out? 

I had not thought of these experiences in many years until yesterday when a scared pregnant teenager entered triage and asked where labor and delivery was.  My experience came rushing back like a flood. As I reflected on both of the mentioned experiences I cringed.  I have always made it a practice to enter the patient’s room with a smile, tell them my name and title and then address their issue.  I hope that I have NEVER treated anyone in such a manner as I was treated.  I am thankful for the experiences now and I’m thankful for the recall of them so that I can keep in mind the patient perspective.  Treating people/patients as we want ourselves and our families to be treated should be our motto as a nurse.  I’m thankful for the reminder today. 

Then and Now...

I grew up in a small town in Maine.  My mother was a stay at home mom…my father worked full time and many times, over time, in the local paper mill.  We were not poor but we were not rich.  My brother and I had all the material things that were necessary and a few fun things for birthdays or Christmas.  We did not eat out in restaurants, my mother cooked all of our meals, and if we were sick we stayed home from school and my mother took care of us.  There wasn’t anything that bag balm, duct tape and Vicks couldn’t fix!! 

Thinking back on several childhood illnesses, what I remember, is laying on the couch in my pj’s, comforter and pillow situated so I could see the TV and the famous orange bowl (puke bowl) on the floor by the couch.  I would sleep, puke, run to the bathroom, sip flat cola and nibble on toast until feeling better.  If we had a fever my mother would give us Tylenol and Vicks hot packs.  Sometimes our illness lasted several days and we would remain on that couch until the symptoms passed. I say all of that because it is very troubling for me to see a culture today that is unable to think through how to care for the typical illnesses that run through our communities.

Our healthcare system is out of control with its spending, as is our government with its spending.  I hear from nurses all over the country (ENA) who are concerned for this very thing as well. The abuse of the healthcare system is a hot button topic (one that every ER nurse in the country to go on for hours about!) The ER’s are overcrowded and in that mix is the person who has had a sore throat for 1 day, a child who has been nauseous for 2 hours, a child with a fever for 4 hours and has not had any Tylenol…People do not either know how to care for these basic illnesses or are unwilling to or don’t have the ability to be the stay at home mom with the time to do so.  Quick fixes are what people want. 

As a nurse I am saddened that my role as educator has been removed!  The patient is the consumer now and they do not want to be taught anything…they want us to fix it…give them a magic pill and send them home.  I am sad that we in healthcare have stopped being the patient advocate and the patient has stopped wanting that …teaching them how to help themselves…teaching them how to use natural cures for simple health issues…teaching them that by losing weight and eating healthy foods to help with inflammation that is causing so many of their health crisis…encouraging them to stop smoking, and on and on it goes. 

The patient of this day gets down right angry if the healthcare team tries to encourage healthy behaviors for better health.  Our healthcare employers are concerned about customer satisfaction and thus discourage making the patient uncomfortable in any way…so NO patient education for healthy living, it tends to offend. 

We are not helping our patients by giving into their every demand (like they know more than the doctor what will help their problems), or by handing out prescription pain medication by the handfuls for every possible ailment.  Sadly, as I listen to nurses in every possible nursing field, we are not helping our communities by dumbing down our health care system…by NOT educating our patients with practical and alternative therapies to promote better health.    

Times they have changed, and not for the better in healthcare.  I wonder…if our economy continues to do a nosedive, will healthcare be forced to go back to times of old? 

A little prayer goes a long way!

Driving into work this morning I was admiring the last of the leaves remaining on the trees, realizing that the storm that was headed our way would most likely end the leaf peeping season. My high beams caught shining orange, yellow and red leafs that lined the road way and dangled loosely from outstretched branches.   I thanked God for the beauty that I was able to see on my way to and from work every day…every season.  Right now my commute begins in the dark and ends in the dark!  The amazing part is right now my commute takes me 30 min and at this time of year I get to see the glorious pink and orange sunrise as it peeks up over the trees and water…it is amazing!!  I thanked God numerous times for the beauty that he allowed me to see this morning~ and I felt such a peace and comfort knowing that he heard me!

I do not want to climb on a religious soap box here but I do want to talk about the power of prayer and the effect it has on our patients.  As a Christian I know first -hand the power of prayer in my own life.  I have prayed for miracles and seen them done.  I have prayed for peace and it was delivered.  I have prayed for wisdom, knowledge and guidance and seen the answers. I could go on and on about how prayer has blessed my life.  God uses prayer as a communication tool to him.  We can use prayer as a tool in our arsenal of patient care.

In my nursing research class last semester I did a paper on the healing aspects of prayer in patient care.  The research was qualitative in nature of course but there was also some very quantitative findings as well.  There were several studies that I looked at 1. The patient being prayed for by another, either out loud or silently and 2. the patient doing the praying.  Patient’s vital signs, visual signs of stress/pain were noted and a pre and post prayer session pain scale was used to monitor the effects.

The findings were that if the patients believed in prayer it didn’t matter if they were praying or if another person was praying for them, they felt less anxious, had less pain and vitals decreased….both during and after the prayer. If the person didn’t believe in the power of prayer but accepted the prayers of another there vitals showed a decrease and they also stated less pain but not less anxiety.

Doctors and nurses alike who took part in these studies were profoundly effected as they realized the spiritual nature of each patient and that there are times when prayer works better than the pain meds we so readily push!

I bring this up to just get you thinking…what tools are at your disposal for better patient care. You may not want to pray with someone yourself but you can always ask if they want it and find a clergy or another nurse who would be willing.  I pray for my patients as I care for them all the time, usually in my head as I’m doing my tasks but I have had the amazing privilege of praying for them physically as well.

Prayer is free, it doesn’t take a lot of time, it gets you to focus on the need of your patient in a way that you might not otherwise see, it benefits you just as much as it benefits your patient, the patient feels cared for and cared about as a whole person BODY MIND and SPIRIT… isn’t that what we all want?

Trip down memory lane

I had the awesome privilege of being able to speak to an Associate RN class on my experience with nursing, burn out, self- care and Reiki the other day.  As I stood in front of the class and reflected on my 21 years of experience it struck me how easy it had been to just go along with the motions of every- day life and let the memories fade away. 

As I drove home from that day I thought back to nursing school~  I made a couple of really long lasting friendships from those long study days…shout out to Robin and Kim!!  I also still have close contact with 2 amazing instructors who touched my life in many ways…shout out to Terry and Lynn… I recalled the excitement of imagining being a “real nurse” and the fear of not knowing all I needed to know. In fact I was sooooo green that on my first day of clinical I walked into a male patients room and the side rails of his bed were up, and his urinal was hanging off the side rail….now I was green…very green…. I picked up the urinal and asked him if he would like me to fill his water jug!!  Yup..I thought the urinal was a water jug~~~ for real…  that man laughed so hard and I didn’t know why…after his hysterical laughter he says, “oh my you really are a brand new student nurse aren’t you…honey, I piss in this jug!”  lol.  I have learned a lot since then!!  lol

 I remember the pride of the pinning ceremony and of graduation…wearing my professional nurse uniform (white dress with white hose and white shoes and yes a white cap) to my first day of work J.  I have very fond memories of my nursing preceptor Laverne~ who treated me so kindly and taught me so much about being a professional, caring nurse. 

I have had the privilege of working in many different settings and with many different patient populations,  medsurg, post op ortho, homecare/hospice, emergency room….I can say the ER is my favorite as it gives you the variety of cases that are different every day and the rush of a trauma or an MI…being able to intervene and really save someone’s life is amazing!! 

What I shared with that class the other day again cemented for me that patient care is not just about all the technical things we know how to do and love to do….it’s about touching someone’s life in a positive way…I often times forget that and that is when burnout hits me the hardest…The patient does not give 2 hoots that you can read their EKG and intervene, or that you can start their IV, draw their blood, hang their medications, dress their wounds or collect evidence from every orifice known to man!!!  They only care that you, the nurse, gives 2 hoots that they are there…that your eyes and face convey to them that you are listening to them, caring that they are in pain, offer them a warm blanket and a hand to hold…now I’m not saying our nursing skills are not important, because we all know if we do not perform those skills well the patient will notice!  But we could mess up every skill we have and if we have sat with that patient for 10 min, held their hand or given them a warm blanket and a warm smile…they think we are the best nurse on the planet!!  I don’t know about you but my thank you cards from patients NEVER mention my awesome skills…but they always mention the warm blanket and the caring smile. 

Here’s to remembering your early years as a student…a new nurse…and why you love nursing…take some time to think back to those early days…it’s a fun recall J

Apparently I always wanted to be a nurse

     So I got home from work last night and on my counter was a book "all about me" that my mother had sent in the mail~  it was one of those kindergarden through 12th grade books...including pictures! and comments about friends and aspirations, grades and boyfriends... you know the kind...
      My husband was dying to flip through it with me (he already had looked at it!!) and laugh at my ongoing short bobbed hair cut that had a few layering variations...and comment on the outfits I chose to wear for the first day back to school...I had to laugh as well as we looked at them~~~I always thought I looked so cute! 
I will never make fun of the photo's of him wearing his orange tough skins again!!  (ok so I probably will :) )
       I enjoyed looking at the book and remembering some old times, and some outfits I really thought were awesome!!  but what I noticed most was the running theme of, what do you want to be when you grow up, my career choice~  Since Kindergarden I either wanted to be a nurse or a teacher...one year I said  I wanted to work with children...how, Im not sure...But nurse won out with the most votes of 7. 
       At this stage in my life I want to be an educated nurse!..hahhhahaha..
       Looking back at the school girl book has been a gift in a few ways...one, it brings me back to some very fun times in my life...two, it shows me NEVER to wear my hair that short again...three, it has given me a kick in the pants to get exercising again ...as my weight has dramatically increased since graduation!!  four, it has given me the gift of showing me that I have always wanted to be a nurse...and that being burnt out in the every day grind is different than being burnt out with nursing. 
       The gift of being a nurse is so multi layered ...besides the patient care aspect of touching people's lives physically and emotionally, we get the gift of having a profession that takes us anywhere we want to go...the ER, the OR, ICU, NICU, Med-Surg, School nursing, Clinic nursing, home health, hospice, Nurse Educator, Flight nurse, Interventional Radiology, Psych nursing, travel nursing, Clinical nurse specialist in many fields, NP....and on and on it goes~ 
        Where are you in nursing now??? Where do you want to go????
        

Just venting a frustration today

Soooo how long is it humane to keep a human being in a behavioral health room that is 10x10, with no windows and no fresh air????

 Let me set the stage for you… Our Hospital is a small rural, critical care access site and our ER is a 22 bed~ highly functioning machine that can take care of every person and every diagnosis that walks through our doors, (or comes in via ambulance.)  except for the psych patient that has real psych interventions…. Now, I don’t mean that our ER cannot take care of that person…by keeping them safe, giving them shelter, meals, a hot shower, meds and interaction….what I mean is the “system” cannot take care of them.  This person comes to us for help…they are suicidal or psychotic…or manic…whatever the situation, we get them to a place that they are unable to harm themselves or others…they are watched and cared for as we and our “crisis” team search for a hospital bed in a psych facility that can properly house and treat them accordingly.  It sounds like this should be so easy…so cut and dry.  It is not.  This system, our mental health system, is broken!! 

We have had many behavioral / psych patients that have been “housed” in our ER for up to a week at a time as we have worked daily, for many hours, searching for a hospital bed that could meet their needs. There are only 4 hospitals in our state that take these types of patients and it seems they are always full…or they cannot take our patient because “they are too high risk for the rest of our patient population”   What this means is…the patient can stay in the ER where they get their physical needs met (except sunshine and fresh air because we cannot risk elopement) BUT not their mental health needs!!  Most ER's, including ours, does not have a psychiatrist or mental health trained nurses to tend to the needs of this population. We try to follow their med regimes but typically they need med adjustments and therapy...both of which ER docs are not trained to do.  The ER docs, nurses and mental health patient end up being frustrated as we search for the trained professionals in mental health hospitals that have the ability to properly care for these patients AND are willing to accept them.

 Now call me stupid but I cannot understand why the psych hospitals can reject a patient when they have open beds because the patient does not meet their criteria….BUT we take every patient that walks through our doors…NO matter if we are down staff, if our patient population is at full capacity or if this new patient doesn’t fit well with others…. These patients can stay in our ER for days…a week…like a caged animal...or a prisoner…waiting for the care they need!!  It is very frustrating as a provider… and I cannot even imagine what it is like to be that patient.

I wish there was an easy solution to this problem… it is a huge problem…seems so overwhelming…

The one thing for us all to keep in mind is that this patient is a human being.  They need care and concern, a healing touch and an open mind. I admit that this patient population isn’t the one that usually gets my mothering juices flowing but yesterday I had a moment with just such a patient that made me remember just how human they are…. Something that we all could use a reminder in.

I went into the behavioral health area to answer this patient’s call bell and the patient told me her back hurt and that she wanted an ice bag.  I filled an ice bag and went back to her… she was crying and lying on her bed.  I placed the ice bag onto her low back and asked her if I could help her in any other way (I feel so useless in this area when I have no mental health training…and I just don’t want to say the wrong thing!) She asked me to rub her back.  I did.  She began to sob…and said, “that feels so good… no one has touched me or rubbed my back in so long.”   This touched my heart so deeply.  As I rubbed her back and listened to her cry I was so thankful that I could fill this one need for her and maybe help calm her. 

Sadly this patient is still with us…in our small area…with no windows and no fresh air because none of the mental health facilities in our state can “take her level of care.”  

 

Even when the day starts out with 2 nurses out ...it can be fun!

So I come into work this morning and find that I'm in charge, no biggie,  and that we are down 2 nurses...kind of biggie.  The one thing that keeps me from screaming~~  the group of nurses, techs, and providers that is on are all fabulous and hard workers!  We decided to "look at the glass half full instead of half empty."  Lots of patient care, nurse stories, charcoal fun and Thai for lunch is making this day that could have been horrible~~  quite nice! 

Staffing is always an issue in the ER it seems....Both ER's I have worked in have an above average number of call outs... I think that it is the stress of this type of nursing...working 12 hour shifts with constant noise, patients in pain, death, sometimes no breaks and working short staffed~ often....can kind of wear you down a bit.  Lets face it our patient population is very UNIQUE....we go from days old to 102yo...we have drunks that are yelling and vomiting up and down the halls, heart attack and stroke patients next to each other...we may have a rape victim or 2...we do sutures and casting, IV's and NG tubes...and lots of foley's... let us not forget the BEHAVIORAL patients (1-4 a day)...we have the septic patient and the one with pneumonia...we have to know CPR, BLS, ACLS, PALS and TNCC...some of us have SAFE training.. and we all must have superior IV skills, EKG reading and we of course need to know how to read minds!!  and oh yes,  we must not forget that we must acclimate to each provider in order to get the patient's needs met most effectively.
I also think that a reason for the multitude of call outs ...is BURNOUT~the syndrome that afflicts medical professionals, esp those who work in intense environments. 
As we nurses pondered the call out situation today we were discussing some ways to increase moral for those staff members that are left ....we decided that the staff that is working short should get an extra dollar an hour...and if we are down 2 nurses we should get 2 dollars an hour extra.  What do you all think about working short staffed???

Undercover Boss

        I was watching the show Undercover Boss last night and it made me a little emotional.  The show has a wonderful concept, the CEO of the company goes undercover and becomes a worker in 2 or 3 different areas of the company to find out how the company is really functioning...and to see how the employees function in their positions.  Last night 3 exceptional employees of the company, 7 eleven, were highlighted and awarded for their excellent service. 
       What struck me about these employees was their true love of the job...they brought their A game every day and they didnt bitch and moan while performing their job.  These people did not have cushy positions with a window overlooking the ocean!!  These people had the menial jobs that make companies run smoothly...an elderly woman who works the coffee machines...She knew every customers name and served them with a smile...a night delivery man, who is an immigrant~  smiling and so happy to have a job that supports his family and an ex military man who works on a dessert assembly line...who was smiling and encouraging to the "new" guy.  All of these people were given this "new" guy to train.  Not one of them bemoaned their job or their employer...they were encouraging to him and didnt make him feel like he was bothering them...
      This brings me to the thought....What would the CEO of my company see if he went undercover in the ER???  The nurses, techs, secretaries, docs and lab techs that work in our ER do an amazing job everyday!! We serve anywhere from 60-120 people and their families in a 24 hour period.  We work 12 hour shifts and sometimes do not get a break.  Our environment is noisy, smelly and oddly lite with bright lights.  At times we work short staffed and sick.  We work with patients that are at times hard to please and critically ill...we see things that most people would never know or believe existed!  We see death. We also get sworn at on a daily basis!  BUT we also have patients that are sweet, caring and thank us for a job well done. 
       What I gleaned from last nights show was this...I know that I go to work and give 100% to my patients and their families...BUT do I always have a good attitude about what Im doing (away from the patients of course)??? NO.  Im going to watch myself this weekend when I work and see just how grateful I am for my job and for the service I provide.  Do I hold pride in being a nurse??? I think Ive lost some of that...Do my co-workers like working with me??? I hope so, I think so...But Im sure I could improve with my attitude....

Just a thought.

For the past several months my nurse gals and I have been pondering why we feel that patients and their families seem to disrespect us more now than in the past.  I know that personally when I started nursing....way back in 1991.... that patients and their families seemed to hold the nurses in high regard.  I was never sworn at, spit at or called vulgar names, and unfortunately I cannot say the same now.  As I reflected on this problem I started to wonder if our uniforms had anything to do with it....now hold on, just hear me out.  I know that the times are different, people are angrier, money is tighter, and the expectations are different...we are now in "customer service" not "patient care"...  BUT when I started my career the nurses still wore white~  and dresses with white hose, and white shoes...and yes,  a cap!! 
This leads me to a thought.  Yesterday my husband and I were at my mother in laws for lunch, along with my sister in law and her teenage daughters.  We were discussing soccer and softball at the lunch table and the topic of uniforms came up.  My niece Nathalie was excited because the coach for softball told the girls that they were getting new uniforms and that "they are going to be so sharp looking!"  My mother in law chuckled at this and felt that my niece was holding too much value on the uniform.  I disagreed.  I know that when I see a team come out on the field and they have on really nice uniforms, and they all look the same, I view that team as impressive.  I even may feel they are better equipped to win...for whatever reason I tend to view the team with the nicest uniforms as better.  Now I know this isn't the case...but I do feel that those kids in the sharp uniforms feel good about themselves, they hold their heads higher and they may feel they are superior to the other team with less than impressive uniforms on....does anyone recall the movie "the bad news bears"...wasn't there a uniform story in that movie????
So all of that to say this...When I wore my white uniform I felt pride.  I felt professional and I felt important..When I put on that uniform to go to work, it was like putting my nurse on...getting my nurse groove on... and then off I went. I truly feel that the patients and their families viewed me that way as well.  I think so much of that has been lost since we wear uniforms that every other department in the hospital wears...aka housekeeping, laundry and the kitchen staff.   (not that they are less than us... that is NOT what I'm saying.)   
So what are your thoughts fellow nurses??? and friends.

The extreme satisfaction of catching an Inferior MI as it begins

Our ER went from easy flowing to full scale crazy in a half hours time.  Filling the rooms were patients of varying ages, and varying complaints.  Room 8 was not my patient but I noticed her being wheeled in by the tech from the waiting room.  Approx age looked to be mid 40's, she was not in any obvious acute distress but the board said her complaint was chest pain.  Her skin was pink and dry, she looked scared but otherwise normal.  I went about tending to my own patients which ranged from a child with a URI, an elderly woman with confusion and an elderly man with hip pain, post fall.  After a half hour of direct patient care, I came into the nursing station to chart and noticed room 8's monitor.  I wasnt sure what her initial ekg showed but she looked to be having elevation in lead 11 which was up in the nursing station.  Her nurse was busy, so I went in with the ekg machine and grabbed another one....acute inferior MI in all leads!!  Acting from there, our staff worked quickly to get another IV line, give her TNK as well as all the other drugs necessary (heparin etc.) and get her shipped to the cath lab within 40 min.  When I think about my job as an emergency room those stories are the ones that make me so proud to be a nurse in that setting!