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!!~~