To Code or Not to Code

Hello readers!

So I have a ton of homework to do, which makes me that much better of a blog writer! Hah. No really though, I write better when I'm avoiding doing something else. And I have a good excuse anyway, because this topic has been on my mind for about a month, clawing to get out.


Actually this may even count towards homework because I'm doing research on this for school, so boo yah!

Let me give you the first scenario I have, to slowly dip ya'll into my mindset here.

One month ago, I was assisting/as needed/general help down in our ICU department. After being there for a few, I quickly learned about a case down there. He was an 84 year old gentleman, who had been a code blue (he stopped breathing and no pulse) while on a Med/Surg Floor. He was a "Full Code" at the time, which means we do everything in our possible power to bring a patient back to the living world. We had brought him back to life, and any patient that goes through this automatically gets transferred to the ICU afterwards, no questions asked. There is never a case where we thump on someones chest and shock them and bring them back to life, and then are like, hey- want some apple juice? You seem fine to me! No.

So on he transferred to the ICU, hence where I met up with his case. I heard the ICU nurses talking, their "nursing spidey sense" that I know all too well was all in effect, as they all had a feeling this man was going to die that night again. However, this time his family had decided that this time he would not be a "Full Code". What happens if you aren't a Full Code? You have other options. But in my opinion (and I'll explain this more later) the best option is to pass away peacefully with lots of morphine and silence, and someone holding my hand so I know I'm not alone.

When the ICU nurses noticed his heart rate start to slow down, we knew impending death was soon. Our patient was trying to cross that line and was getting closer. We all agreed to go be with him, as his family had left for the night thinking he would make it overnight and they would say goodbye in the morning. Obviously that wasn't the case. We all stood by him, holding his hand, as we watched at his bedside his alarms going off, his heart rate slowing down dramatically, his breathing erratic. Me, being non-immune to all the alarms in the ICU, only heard the sound of the ventilator (breathing machine) pumping artificial breaths into this man, trying to keep him alive despite higher powers at play.


As sad as this case may seem (if you think that was sad, get your tissues out now), it actually wasn't as bad as it could have been. The reason this man's family didn't want him to be a "full code" in case he passed away again was because they had already seen him code the first time. The general public (hence his family) don't actually know what we mean when we say "Full Code". Doctors ask when you get admitted, usually regardless of your condition, "In the event of your pulse stops or your lungs stop breathing, do you want us to do everything in our power to bring you back?" Given that sentence, that sounds lovely, why yes! Bring me back! At the snap of your finger, or with your magical powerful wand. Bring my loved one back!  However, what most doctors fail to mention is what a Full code really entails. It's not quick. It's not quiet. It's not painless. And its certainly not magical.

For my non-medical readers, let me give you a quick low-down on what happens during a full code on a typical case. Please don't read this paragraph if you get queasy! But I do intend to paint an accurate picture. We automatically begin CPR. You all have seen CPR on TV at some point I'm sure, and the patient always wakes back up within a minute or two.  But have you ever seen CPR in real life? If so, you know that the recommended depth of compressions is 2-2.4" into your chest. Imagine someone right now pushing your ribs in 2", without you backing up. Pushing in 2" while you are laying down, helpless. Yes, ribs are usually broken. We also are doing this at 100 pumps per minute, no less. And we don't stop until the patient does return to life or a family member calls this effort off, or the doctor deems it medically impossible if the code has gone on too long. And that's not all. When we start doing compressions, someone is operating an external airway with whats called an "Ambu" bag, to deliver you 100% oxygen. This is only until we can complete something called "Intubation" where we insert a tube through your mouth and down your throat and into your lungs so that we can hook you up to a ventilator to do the breathing for you. Oh and that's not all.  If you have had anything to eat or drink within the last couple hours, what do you think is going to happen when we are jumping up and down on your chest? Yeah, it's going to come back up! When you're lying on your back unconscious! And we will suction as much out as possible, but it still will be everywhere.


So, that all being said, do you think if Doctors really painted that picture when we asked patients if they want to be a full code, do you think as many patients or patients family members would still want to be a full code? I don't think so. Now I've witnessed hundreds of doctors have this very conversation, and some paint a pretty picture and some don't. However, very very few actually go into detail about what really happens. Why not? Because it seems harsh! It is harsh! That paragraph above is horrible if you imagine it happening to you or your family member. If you get admitted with a broken arm, we still ask you if you want to be a full code. We ask everybody, because you never know what could happen. Life works in mysterious ways. Just a few months ago I remember a case of a man admitted with a UTI (urinary tract infection) but otherwise completely OK. Then BAM, had a massive heart attack while on our floor and coded. You never know.

So if you get admitted with a broken arm or a UTI, and here comes the doctor asking if you want us to save your life if you die? You're automatically going to be like WTF, I have a broken bone- are you not telling me something? Am I dying? If I'm not, why are you asking me this?

Or if the patient does understand the fact that this question is asked of everyone regardless of diagnosis or age, then many patients think that we are "giving up" or "won't treat" the patients condition if they agree to not be a full code. Their logic may be, "well if they aren't going to save my life then whats the point of even being here, or being treated?" Well that simply is completely logical. It is a reasonable way of thinking, but I assure you it is not true. I can say with complete and utter 100% confidence that I have witnessed on so many cases, where the doctors and nurses do so much to help a patient feel better or improve their condition, even if the case is eventually terminal. I promise you, healthcare will never ignore you or not treat you for your current condition as much as possible just because you agree not to be a Full Code if death occurs.


Now don't get me wrong at all, some people should be a Full Code! Absolutely! Let's say you do come in with that broken arm, or are having a heart attack, or a UTI, or whatever- but you are otherwise healthy- You live a happy, meaningful life- You should be a Full Code! You also have the best chance to also survive a full code as your body is healthy besides what is going on now. If we catch your heart stop beating immediately, chances are we will definitely get it back to beating within a very short time frame, especially if your body is remotely healthy. What irks me however is when doctors are unrealistic with those that aren't healthy. Those that come in with terminal cancer. Or have advanced Alzheimer's disease or dementia, or have any end-stage disease (heart disease, kidney disease, lung disease, etc.) Doctor's hit you with what I call a "Double-Positive Whammy", they make you think that death isn't impending soon from your disease, but just in case it is- If you are a full code, we will do everything in our power to bring you back and it will probably be successful! No.

I have been doing a lot of thinking on this and a lot of reflection within myself, my beliefs, my patients, my nursing practice.... and I still firmly believe in what I'm what about to say. I know a lot of people may disagree with me, and I encourage that- Everyone is entitled to their own opinions, especially with ethically situations such as these. I'm entitled to your opinion as are you.

I don't care if you are 18, or if you are 30, 40, 60 or 100.  If you have a disease that is slowly killing you, I see no reason to hold off the inevitable. Now that is a FINE LINE. For example, let's say a healthy person gets diagnosed with cancer. I completely support the notion of undergoing treatment  (surgery, chemo, radiation, etc.) I mean, you were healthy before! But what about after 10 years of treatment after treatment? How is your quality of life doing? Chances are, the patient themself already has a different opinion about their own end-of-life than their family or loved ones do. What I intend to make a point of here, is that regardless of age, if an individual either has a terminal disease, more than three major comorbidities (any major chronic disease that takes a significant toll on your quality of life), or are experiencing a poor quality of life (not eating, not happy, unable to do favorite activities, hobbies, cognitively impaired, etc) then in my honest opinion, they at least deserve the honest picture of what a full code truly means, and then they can decide. I'm not saying it should be mandated that these cases should automatically be a no-code based on an algorithm, that would be unethical. But they at least deserve the honest truth about the decision. The rest is up to them.

The last scenario I would like to share with you (if you are still reading) is a case that really pushed my feelings over the edge. Recently my unit took care of a very sweet elderly lady of the age of 96. She had multiple medical problems and was admitted with anemia (low blood count) due to gastrointestinal bleeding. She was with us for awhile with no events. Sent home. Family brought her right back due to intense abdominal pain. Again she stayed with us for awhile. Her blood counts kept dropping, there was no way to keep up with it. Her internal bleeding was too severe.  Meanwhile, she was absolutely miserable- She couldn't urinate on her own- leading to us straight-cathing her every couple of hours- she was in immeasurable amounts of abdominal pain, and she had a very poor appetite. And yet her daughter was her POA (Power of Attorney) and watched over everything regarding her moms care. And yep, You guessed it! This patient was made a Full Code. Decided by whom? You guessed it! The daughter.

One night, her vital signs started significantly dropping. The bleeding too severe for her body to compensate with. It came time that using our own nursing judgement, being that she was a Full Code, with the vital signs the way they were- she was quickly knocking down deaths door. If she was going to remain a Full code, we needed to treat her like a Full Code and get her to the ICU before she codes, that way she gets more intensive treatment to prevent that from happening. So we called what is known is as an RRT (Rapid Response Team) which is sort of like a pre-code. The patient isn't coding yet, but could be on their way soon if we don't fix the problem now. So of course during a RRT, a lot of healthcare personnel show up. Multiple RNs, Med Surg and ICU, 1-2 Respiratory therapists, a doctor or PA/NP, nursing supervisor, etc. We always draw bloodwork, usually put in a new IV. There's people everywhere and the bright lights are on in your face. Its like a code except you are awake and aware for it all. Well, this sweet lady is terrified and is screaming in pain. She's also crying, "Please, no." "Don't do this to me." "Let me die." "I want to die." "Don't do this." "stop this". And yet, because her daughter has the POA (who happened to be in the room watching this whole scenario unfold), the daughter has the decision on the code status. And despite her mom crying in pain and agony, the daughter demanded we do everything possible to save her. Maybe, maybe not- but if the daughter really knew what a code really meant, would she come to her senses and not want that for her mom?

If a loved one of mine were in the situation, don't get me wrong- Its awful. It's incredibly sad & frightening. But If i knew that my loved ones medical condition had made their life quality so horrible and they didn't want to live anymore, or they were in immense amounts of pain, I would never prolong the inevitable. I would of course want to treat them and care for them, but if the higher powers decide its their turn to go, then all I want for them is to not be alone and to not be in pain as they make that journey. I think that's the best gift I can give them as their own loved one.



Thank you for reading. I know its a hard topic, and a never-ending one. A very ethical one, and I know a lot of people will disagree with me. Chances are, not a lot of nurses will disagree with me, however. Because we see this every day. We see cases like these two every day. We are immune to the sadness, the awfulness of it all. We are trained to do what we have to do. If someone wants to be a full code, then so be it, we will  do everything we can to save your life. Just be sure its really what you want for yourself or your family member.


With love and passion for humanity,


A writer in a nurses body <3 nbsp="" p="">




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Not in My World

So this post is about an issue that has come up recently in my little nursing world. Very recently, only over the past week have I noticed it but it's happened 5-6 times in separate instances...


So in case you don't know my nursing history, I was an aide for five years until I graduated nursing school and was hired, at the same hospital as an R.N. For awhile I struggled accepting the differences between being a nurse aide and a registered nurse. I couldn't grasp the fact that now I had to delegate tasks to my coworkers that used to be the same position as me, but now they were beneath me. I knew how busy they were because I had been in their exact shoes. So I became determined to always try and do everything myself and only ask for help from the aides when my patients safety depends on it.

Then this year I came over to a new hospital, where it was a little easier to accept the boundaries between being an RN and the aide. I respect my new aides very much and still always try to help them out, even with patients that are not my own. I try and only ask for help when either I cannot do it or another patient needs me more or I just need an extra hand in the room.

 But recently, my patients (like I said, 5-6 different patients within the past week) have done something peculiar.

I go into the room to do my nursing assessment, or perhaps give them a medication of some kind. This one patient asked me the other day, "Do you have CNAs (nurse aides) or something?" I said "Yes, we do." She said, "Can you please send one in when you have a chance, I need some ice water." I looked perplexed, I  said back- "well I can certainly get you some ice water, I'll be right back." and she quickly said, "No no, you're the RN, you have much more important things to do. Send a CNA in." This was the first time I had ever heard something like this. I assured her I had the time to do it and I wanted to get her ice water and that I did.

A couple of other patients have done the same thing, and its only been recently. A male patient I had last night spilled a drink of water and needed a new set of napkins, and a towel to clean up the water. I said "sure, I'll be right back" and when I got back, he said, "you didn't have to do that, that is dirty work, i know you have more important things to do."

I looked up at him , almost incredulously- as this was the 5th or 6th this same instance had happened with other patients, and I assured him that helping him and making him feel better in any way was just as important to me as anything else. I don't mind doing anything, that is my job-regardless or not if it can also be the aides job. In fact I think I think it's even in my hospitals nursing policy that we do not leave any room without making sure the patient has everything they need and they are happy. If they aren't happy, we need to find a person with different capabilities that can make them happy. I don't know why my patients have gotten it in their head that the RNs are "better" than the aides. We aren't better. We just can do different things for our patients. Just like I don't necessarily consider doctors "better" than RNs, they just do different things. Sure, I respect the doctors I work with and they are obviously a vital part of health care. But so are nurses. And so are aides. Ok I've gone off on a tangent.

Anyway, my boyfriend has puppy eyes and is staring at me over top my computer screen waiting for me to finish, so I'm wrapping this up. Sorry for the short blog, I just wanted to write about it since its happened so many times recently....and it just doesn't fly in my world.


With Love, WNB



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Thank You Dr. Improv....

So the other day I go into see my patient. I'm assessing him, being that it's the beginning of my shift. I noticed the surgeon had just left the room but I was tied up with another patient and didn't get to talk to him.

So I notice on my patients bed sheet above his leg area, it's bright red.

Obviously, being that we're in a hospital, I'm a nurse- this is my patient ...my first thought is somehow my patient is bleeding profusely...from his....thigh area...

Noticing my sudden concern regarding the bright red marks on the sheet, the patient laughs.


I have a raised, expectant eyebrow expression- like this- ^_^ (sort of).

Patient: "oh don't worry. Dr. Improv did that."

Me: (again) ^_^....... "um....can I...see what happened...?"

Patient: "what do you mean?"

Me: "the blood? On your sheet."

Patient: "oh! No. That's marker. Dr. Improv was drawing pictures for me about the surgery hes doing on me tomorrow. See, this is my stomach, those are...the intestines...I think...that's the duodenum there..."


Me: "well, this is a first."



Reason # 37291 why I don't advise using red markers to draw pictures on your patients bed sheets.



*sigh*

-WNB




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Doctors Throw Tantrums Too

So weekends at the hospital have small potential to be a little less insane than the weekdays. There is usually a lot less patients, but also less staff. Regular services aren't offered on the weekends (in small hospitals such as mine)- services such as physical therapy, non-emergency surgeries, short procedures, etc.

Last night I come on to the floor, and its already a slow night. I'm already finished with my charting at 8pm, which means that I can sit at the nurses station at 8pm- And this is almost unheard of. This means that *sometimes* doctors are still lingering at the station, finishing up the days work for them. This was such the case last night.

Said doctor was already frustrated that he was still doing work at 8pm on a Saturday. He is a specialist and was seeing a patient for that specific specialty, obviously. However the patients family was very upset about a lot of other issues going on with the patient, and Mr.NiceDoctor was attempting to consult other specialties for this patient and even get some therapy started that night to speed up the healing process.

In order to do that, he had to page other doctors to speak with them for advice on what to order. So he pages Doctor #1. Waits 15 minutes. No answer. Pages him again. No answer. Pages another doctor. Doctor #2 answers, He's not on call this weekend- Click! Hang up. Mr.NiceDoctor dials operator in a rage to find out WHO is officially on call for the specialty he needs. Operator says....Oh...Its Doctor #3.  Mr. NiceDoctor pages Doctor #3- That doctor says, "No- you must mean the OTHER DoctorWithTheSameLastNameAsMe. I'm not with that specialty."

This is precisely when Mr.NiceDoctor hangs up the phone and says (rather loudly) to anyone thats within earshot- "IS IT ALWAYS THIS DIFFICULT!?" ( I think he even stomped his foot, too.)

My answer, very softly- "Every day."  And then I smiled.

He then proceeded to ramble on, "Is it always this hard to get in touch with people around here?!"

And I held back....because I love my job, so so so...so, much-And I said nothing except a little shrug. But me and my telepathic coworker said in our minds, "Just doctors!"


In case you like happy endings, Mr.NiceDoctor DID eventually get in contact with the specialty he needed and the patient was started on 3 antibiotics. Happy Ending.



:-) WNB



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Doctors Don't Know Everything

So me and fellow co-nurse are discussing one of our patients foot wounds. She asks me the correct anatomical term to describe the area beneath the big toe.

My educated answer? "google it"

So we googled it and unfortunately google didn't offer any insight.

At that time one of the nice(r) doctors strolled up to the unit. I whispered to my co-nurse that we should ask doctor, right?

Nurse: "Dr.YouShouldKnowThis, what would be the correct anatomical term to describe this area of the foot?" * you can't get it wrong, as said nurse even took off her shoe and really made sure to point at the right spot*

Dr.YouShouldKnowThis: ummm.....the ball of the foot?

Nurse: I know, but what's the fancy name?

Dr. YouShouldKnowThis: I don't know.  I'd google it.

Now keep in mind, Dr.YouShouldKnowThis does have a Medical Degree, however she is a hospitalist. They treat patients that come into the hospital, they have no primary practice. They are usually younger doctors. They get paid pretty crappy for doing a lot of work. So I didn't even blame her for not being up to par on her anatomy.

So alas, being that this is important and we have to chart it in legal documentation, we had not finished our quest for enduring everlasting foot wound knowledge. So Dr.YouShouldKnowThis leaves, and a couple minutes later another doctor arrives.

Now this doctor is a lot older and more experienced. He's a family primary practice and he's seen a lot in his day.

Nurse: "Dr.YouShouldDefiniteKnowThis, what is this area known as on the foot?" is it...metatarsal? Plantar? *she takes off shoe again*


Dr.YouShouldDefinitelyKnowThis: ummm...I would definitely just google that.





Lol.


_wnb



Google solves all problems.




PS_ We ended up charting it as the ball of the foot.

Nursing doctor funny of the day

Doctor: is this patient having diarrhea?

Patient: no, not really. She had a small episode where she farted and it came out as poop.

Doctor: oh. I was going to get a stool culture for reports of diarrhea but I guess I can't culture a fart.





Lololol.  A lot of things make me giggle relentlessly at 4:30 am.  This was one of them.

What is a Nurse?

A (Good) nurse is :

• A nurse
• a friend, to hold your hand
• A psychologist, to help you through your strangest quirks and secrets
• A mom, to tell you "no" and put things back in perspective.
• a politician, so the hospital is a better place.
• an advocate, so we make sure the doctors don't kill you.
• a security guard, for when you start freaking out.
• a mechanic, for fixing everything and anything that breaks on the floor.
• a gymnast, for bending in really small spaces to plug in your IV.
• an artist, you are our canvas.
• a scientist, because what else do we use our critical thinking for?
• A diagnostician, because sometimes we diagnose you before the doctors do.

A nurse is not:

• a waiter, we are not employed to go and get you 4 sandwiches in 3 hours.
• a hotel attendant, we are not going to put a mint on your pillows.
• a punching bag, yeah-just try.
• your drug dealer, because actually- we can't just give you unlimited amounts of narcotics.
• a Marriage/family counselor- solve your own damn problems with your family, outside of the hospital.

C'mon fellow nurses out there- leave some comments with some more you can think of!



~WNB



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A Big Win for the MD Community!

So, I know a lot of you readers know that I am extremely anti-dairy. Not just lactose intolerant but I am a big believer in the theory that dairy products are damaging to anyone's health and that I can come up with a number of ways that dairy can be causing any symptom you might be having right now. However, what you may not know about me is that I am extremely PRO for Probiotics!

To explain a little, probiotics are simply the combat for antibiotics. Both, essentially, are needed, and good things. Antibiotics are given to patients who need to fight off a harmful bacteria that is present in their body somewhere. The antibiotics wipe out all bacteria found in the system. However, the body always has a balance of good and bad bacteria. We get both kinds from food breakdown, water, contact, etc. When we are feeling healthy, we have a better balance of good bacteria, they are essentially "Winning". When we start feeling symptoms of an infection, it means the bad bacteria are essentially "winning", so to speak. So when an antibiotic wipes out all your bacteria, its also depleting your good bacteria. Because of this, when you are on antibiotic therapy, you might start to experience unpleasant symptoms (diarrhea, nausea, etc.). To help combat this its really important to replace your good bacteria. How can you do this, might you ask? The answer is probiotics.

Probiotics can be found in many ways. The easiest way for the common population is yogurt. This is easy to tell patients and anyone that doesn't feel comfortable buying a "box/bottle of bacteria". Yogurt just sounds more....easier to stomach?  A lot of people don't understand. They think that by purposefully putting bacteria into their system, even if its good, that is harmful. What they don't GET is that you're doing yourself an extreme favor. You think its gross putting good bacteria into your system? What about putting bad bacteria into your system when you drink bad water, or food poisoning, or accidentally put your fingers in your mouth after touching everything? By taking probiotics, you help the "good guys" win inside your body. You help your body restore its natural balance, so the good guys can win the war and keep you healthy.

Now, yogurt is the simplest form. However its also a very small dosage. Also, for people that also firmly believe in the anti-lactose theory, I cannot get probiotics from yogurt. However there are lots of other ways to attain them. Some of the big brands you may have heard of are, "Align", or "Phillips Colon Health", or, what I take and love, "Culturelle". There are also many many other combinations. Each one has their own unique effect and if you do choose to try one, its important to find one that works well with your body. For example, Align and I didn't get along at all. For some reason that strain of bacteria, even though it was good, didn't sit well with me. However Culturelle, what I take, is what I believe to be the cause of my usual good health nowadays.

So, going back to my title, I get really, really really frustrated when my patients are on antibiotics (strong ones at that) and yet they never, ever get replacement probiotic therapy. And then the patients end up with a new strain of bad-bacteria that happens when your good bacteria is depleted, its called c-difficile. This causes extremely unpleasant diarrhea. When you get this, your doctor will give you yet another antibiotic to treat the new bad bacteria, and yet they NEVER mention probiotics! It drives me nuts. Then I try and educate my patients on everything they need to know about probiotics in a nutshell, and they ask me how come their doctor has never told them to do this, and my face usually says it all without saying anything.

However, recently I had a patient on your typical IV(intravenous) antibiotic. After a couple days in the hospital she started developing the typical diarrhea. Now, her family started freaking out- What is this? What is wrong with her now? Why is she having diarrhea?? Can she have imodium??  Well, the MD (doctor) was called to tell him about this new diarrhea, and the nurse prior to me asked if she could have some imodium. His response, much to my surprise, was: "She can have one dose of Imodium but I'm prescribing some yogurt three times a day. I really want to push some probiotics here." 

I was. ASTOUNDED. That was the first time, in my life, I've ever heard a doctor push the probiotics. Not just in my small RN career, but as a patient for 22 years with many, many many stomach issues. I almost literally jumped for joy for that doctor. I wanted to call him back myself and say, GOOD JOB! Finally!


I can't even tell you why doctors don't do this automatically, prophylactic. Is it because they aren't educated about it in school? Maybe. I don't know. Is it because they don't "believe" in anything thats not an actual drug? Probiotic therapy can be considered holistic therapy, is that out of their range of practice entirely? Drives me nuts.

Its frustrating because as an RN, when I get patients with either stomach issues or headache issues, I know how to help them. I have had both for 22 years and I know a lot of tricks in the book. And yet I can't help them because I can't prescribe anything myself. I can't "refer" them to the type of doctor they really need to be seeing instead. Sometimes I wish I were a doctor just for that reason. But I would be a holistic type of doctor, because I'm a big believer. Because of this, I still might become a Holistic Nurse Practitioner that specializes in gastroenterology....we'll see.

On a sidenote, I had a patient recently that was admitted for severe migraines. The doctors were running every test and scan under the sun and they couldn't find any reason for these severe headaches. When I found out they were chronic migraines, I started thinking. I received her as a patient on her third day already in the hospital. When I went in to go see her, I asked her if she had ever seen any specialist for these migraines. A neurologist? A nutritionist? An Allergist? An Opthamologist? Anything? Her answer was no.

So I sat down with her and did a little tiny nutrition consult with her. I went over the top 5 foods that cause migraines. Turns out, she eats all of them. A lot. I taught her ways to take these foods out of her system and how to replace them. I taught her about the benefits to seeing an allergist, and that they can help you figure out if you're actually allergic or intolerant to a type of food that can actually be causing your migraines. I asked about vision, and she said she used to wear glasses until "she didn't need them anymore". I told her she should see an eye-doctor just in case, because your eyes may be straining to see and you don't even know it. However, nutrition alone, the first thing I went over, is enough to fix 85% of her migraines, I can guarantee it. Her and her family asked why, despite her being in the hospital (which everyone believes to be the big savior to all your problems), no doctor has ever told her anything I just did. Again, my response was...........I wish I knew. I can't bash the doctors in for not educating their patients, that is strictly against my range of job description. And yet how do I tell my patient honestly that the doctors didn't tell you this because they don't know? The doctors are so focused on drugs and tests, before something as simple as talking about nutrition. She eats the top 5 foods that cause migraines! Think about it!


Anyway, vent over.

There are some things I just want to go over about probiotics, while I'm still talking about them (well, I was). This is just in case I may have caught your attention and you want to try taking them. Here are some pointers.

• Remember that it is important to find the one that works for you. If you experience unpleasant symptoms from one for a long period of time (more than a week), its time to try another one. Don't give up on them entirely.
• If you've never taken a probiotic before, you most likely WILL get symptoms from them, no matter what brand you choose. This is simply because your body is greeting the new good bacteria, the war has officially begun inside your body, and basically, war isn't pleasant. The good guys will start to win and resulting, expel all the bad bacteria from your body. This will result in some diarrhea, and maybe nausea, but the side effects should disappear after a couple of days. It is important to continue taking them regularly despite symptom occurrence. If you stop taking them, the bad bacteria will start to win again and you'll just be back to square one. By taking them regularly, its like sending in troops to fight the war. By continuously sending in good, healthy new fresh troops to fight, your chances of winning are a lot better.
• Probiotics can help cure much more than just combating antibiotic therapy. Basically, if you are at an overall health status (by this I mean, no infection present), probiotic therapy CAN be your antibiotic therapy.  GOing back to my military analogy, if you have a team of 10,000 good-guy troops maintaining an area, (in this case, your body), then if one or two or three bad guys come in  to cause trouble, they are going to die instantly. Your gut (stomach, intestines) is actually one of your biggest immune response fighters. By maintaining a healthy gut, your strengthening your immune response exponentially. This means that probiotics will help fend off colds. They will increase your chances of not getting sick when you drink bad water or bad food. They will increase your chances of not getting sick when travelling abroad. Probiotics in general are known for also regulating the bowels, meaning if you had diarrhea- now you won't, and if you were constipated, now you won't be. Basically, bad bacteria cause irregularity of the bowels. Depending on the strain, it causes diarrhea or constipation. The probiotics help reverse either one. By reversing either symptom, it also will exponentially delete any symptoms of nausea as well. Double win!
• It is important to remember that although probiotic therapy is amazing for the immune response, it cannot fight against a virus. It WILL help keep your OWN immune system STRONG so that if a virus DOES enter your body, YOUR own body might be able to fend it off before you even get symptoms. But if you already have a virus, starting a probiotic regime is not going to solve anything. This is why when a friend of mine has a cold, I don't start them on probiotics immediately. I tell them to ride it out, and then start probiotics to maintain health when you are feeling better.
• It is VERY important to realize that although I'm not a terrific huge fan of antibiotics, they are still life-saving in some cases. They are not to be shunned, and if your doctor does prescribe one to you, it is important to take it. I am in no way saying that you shouldn't. HOWEVER, this is when its especially important to take probiotics. If you don't want to go big on them, all you have to do is try some yogurt. Thats all. However the Biggest most Important thing here, is that you do not take both at the same time. DO NOT take your antibiotic pill and your probiotic at the same time, it will cancel each other out and accomplish nothing. It is important that if you are prescribed an antibiotic twice a day, to maybe take your probiotic in between your antibiotic. Regardless of the timing, be sure to space them both out so they both have a chance for your body to react and do their job.
• Once you start probiotic therapy, it is important to achieve a "maintenance dose". This dose should be fairly small (usually one pill a day). This dose is important to take when nothing is abnormal. No weird symptoms going on, you feel healthy, you're not travelling, you didn't eat anything weird, you haven't been exposed to anything funky recently....BUT, if you HAVE done anything I just said, its important to "boost" your dose a bit. Its important to try and figure out what works for your body and how long you need to do it. If I am exposed to someone else being really sick, I'll take maybe two pills a day for however long I'm going to be exposed. If I'm travelling and eating different foods than what I'm used to, I might take two a day, or even up to 4. If I'm starting to feel sick, I'll boost it up until I feel better. Get it?

I think thats all I have to say. Whew! Long post. I hope some of you have found this helpful. I know when I started probiotics, I went from being nauseous every single day to hardly-ever. And when I accidentally skip a day or two, I can tell, because my symptoms start coming back.

It is really important to remember here that I am not a doctor. All the information provided above is from my own personal knowledge and own personal experience. It has not been taken from any website or book, but instead is a collection of knowledge from many sources in my past. It is important to know that if you do choose to start probiotic therapy, that it is your own choice and I am not your doctor. I am a firm believer in them, but that doesn't necessarily mean they work for everyone. If you have any questions about probiotics, feel free to leave a comment. I hope it works for some of you and this wasn't a really boring post.



Thank you all for reading! With love,

~WNB

Anxiety.

HI! Wow. Okay. So, I know I can't give this disclaimer every friggen time I post, but again, I am so sorry for not updating more often lately. Life has been.....really strange lately? My "me" time has been severely compromised. Its January 13th and I feel like I'm still waiting for the holidays to just simmer down. Is it terribly wrong that I am longing for a day, just one day, to just have to lie in bed and watch tv, read, draw, and eat all day? Not see anyone, not run any errands, not work, not solve any problems......?  And yet I can't ask for that. That, for me, is not healthy, and I've come to realize that. If I let myself do that, I don't come out of it. Once in bed doing nothing for the day, I never want to stop. Suddenly the simplest errand to run becomes a giant, monumental task that I come up with multiple reasons why I shouldn't do it. I make up lots and lots of reasons why I should stay in bed therefore and only get out to eat, sometimes.

So I have to have balance. And that is hard to find, especially on night shift. Because on top of it all, on a work day, on a off-day, on a normal day, on a not normal day, I'm tired. I'm tired when I slept all day to recover from the previous night shift. I'm constantly yawning. So I want to crawl into bed. The bed, all the sudden, becomes the number one priority and I just can't wait to crawl back in, day after day, always looking for the next opportunity that I can sleep and I'm allowed to sleep.

So, I have to figure something out, I guess. Each day, I try to accomplish a mission on my neverending to-do list. Something I've been procrastinating, putting off. Something I've been afraid to do or finish. Each one of these tasks that I accomplish, life gets a little better and I can sleep better, knowing that at least I accomplished something small that day. Anything.


I know that this lifestyle is worth it. That I'll get through it. That despite the above depressing three paragraphs, that I am in here and I am going to be OK. It's winter. I'm on night shift. I see the sun 5% of the time it is out. I am practically a vampire. I like to follow the delusion that I am reacting normally, and I'll be fine. I definitely don't plan to be on night shift for long. 

I know its worth it because I help people at work. I know I do. Its the hardest job I have ever done thus far, and who knows, maybe the hardest division of nursing. Floor nursing.


I am getting better every day. Every shift. I learn something new every day at work. I am slowly developing a bag of skills and tricks to use to make me a better nurse in the future. Other nurses have told me they forget that I'm new, and forget that they need to help me at times, because they think I'm good. And that is good, I guess, but it makes it hard. I like figuring things out, I like solving problems for patients. I like making ethical decisions. I can't wait to be a seasoned experienced nurse so that I can do all those things, except better. I try and solve problems now, and I do, but in 10, 20 years....I can exponentially solve those problems even better. I can't wait to have those extraordinary skills. That "nursing instinct". To know what is wrong with my patient without even them running a test. I want that.


I'm doing fabulously better with communication with doctors. Extraordinary. I never thought I'd say this, but the problem went from being 95% of a problem to nearly 5%. I learned pretty quickly that, 1) Doctors signed on to be called at the randomest of times when they took an oath be a doctor, that 2) if they don't want to be called, they'd have hospitalist/residents cover for them, and 3) in the heat of the moment, you don't have time to be nervous to call the doctor, you just have to call and 4) it is your JOB to at least call the doctor and make them aware.

So thats not a problem for me anymore.

What is my current problem? The simple, mundane task of starting an IV. I am not getting them. The one thing I thought I'd be good at, the one thing I thought I'd enjoy doing....I'm just not getting it. I'm not getting the best veins to go for in the first place. I see everyone as a "hard stick" unless they have bulging veins I could put a 18 G in. Its my number one thing I'm afraid of. I know this fear will go away by practicing. But practicing sucks for your victims. I hate hurting people. I hate having to stick people just so I can get practice, and then not getting the stick and having to send better nurses in.  But, I'm still only 3 months old. I'll get it. In time. Just have to....keep practicing.


Other than that, I just have to learn new things yet. I have to just wait for new experiences.

I'm still afraid to have my first Code, or even first CAT/ RRT call. I'm trying to avoid my first Code BY calling the CAT/RRT before the Code. I try to do my best by remembering everything about my patient all the time so that in the unfortunate a code or CAT/RRT call happens, I can tell the team everything they need to know....but I'm still pretty scared.

The worst part of it all is the anxiety. The insomnia. Every time i do try and sleep, my entire shift replays in my head. Did I cross my T's and dot my I's? Did I remember to waste all the drugs in the machine. Did I remember to chart about everything I did? These thoughts race through my head. My entire shift gets repeated, constantly, in my head, just waiting for a mistake for me to realize I did, so that I don't get any sleep. I hope that 1) this is normal for new nurses and 2) this will go away soon....its exhausting and definitely not contributing to restful sleep.


Well, I work tonight. Every shift I have to make myself a better nurse, somehow. I remember always having a back up plan in school, like- "If I don't pass this test, or if I fail out of the program, what am I going to major in next? What will I do?"  Well I passed school, I graduated, I got a job now. Obviously. But the confidence still isn't there. I'm still constantly conjuring up a back up plan. Is that detrimental to my career? I'm constantly thinking, "If I get sued so bad I can't practice anymore, or If I got fired, or If I got laid off, or lost my license, what would I do with my life? Would I be able to move on? To do something else? To maybe follow my real dream, art?" I think these thoughts are detrimental.



But anyway. Time to get some shut-eye before tonights shift. Sorry, depressing post. But it helped, a lot. Got a lot of my current anxious thoughts out of my head. Look forward soon to a happy post. With photography. And artwork. And a movie review! Coming up! :-)


With love,


~WNB


PS- Don't worry about me, I'll be alright. I promise :-)


.

Paralell Universe Begun

This post is way late because I have simply not had a single spare moment to write it since...last thursday! I had friday and saturday off and it was spent either sleeping in (MUCH needed- TRUST me, packing (moving into a new apartment in less than a week!). Craziness!

But its been on my mind, and I definitely wanted to share.

Recently I had a post about working with student nurses, and that I liked it. Well, that day when I made that first blog, they asked when I'd be working again with them and we figured out it would be this past Thursday. I was actually looking forward to teaching them again and all week anticipated their arrival.

However, when Thursday eventually came, we decided THAT morning to switch how we do our entire med pass system, in anticipation of our upcoming major medication renovation system. We are slowly converting to a much more modern and convenient way of doing our med passes. However just because its going to eventually be convenient, doesn't mean its convenient to switch now when I'm in my fifth week and just learned how to do med pass in the first place. Yikes.


So, here I am, on thursday. I have a pretty high acuity patient load. I had a very unique set of patients and no one in my section was particularly easy, one of them being the hardest yet I think I've ever had. Like, Ever. As an aide too.

So, processing my interesting section in my head, trying to organize my thoughts and getting used to these new med carts, all of the sudden, I see the students in the hallway.

I thought to my self, there is no.way. I cannot handle a student right now. I can't! I cannot. I am already behind, and swamped and how can I give a student report on my patient when I can't even gather my thoughts long enough to know what the hell is going on!? Part of me at that moment wanted to hide and wished I didn't have a student that day. I just didn't think I could take it on.

But, sure enough, a student came up to me. All bright eyed and ready for the day, with her new notebook. They already know wayyyy more about my patient, because here's how it goes:

Me: I get a 5-10 minute report on what my patient is in for, what we're doing to help him, how he/she did overnight/what has to be done this coming day and when he/she can go home. Thats it. 5 minutes

Student: Come the night before, write everything down from the chart (like, lab values dating back to two weeks ago), go home, research that ONE patient, and come in the morning, read the chart again to see if they missed a detail or two, and then  they come say hi to me. 

Boy, do I miss those days. One patient for the day. Research all night before you get them.

I used to think, when I was in clinical, that I better know everything on that chart because the nurse is going to quiz me! I thought for sure the nurses knew everything in that chart, and if I didnt know every detail then I was definitely going to fail. But as it turns out, I haven't "looked through" a chart, since I've started. Other than what I've HAD to do, to figure out why an order is the way it is, or to sign off on orders, or to track progress, etc. I have not had time to venture beyond "physician notes, nurses notes, and history and physical (thats if I'm lucky)" No time!

So, the students know more information than me, yes. But they don't know how to use  it. They don't know what it means. They haven't learned yet whats important.

So, back to my story, this student comes up to me. Even though in my head, I'm thinking of how far behind in the morning I am and how much I reallllly don't have time for a student, I put on my happy/nice nurse face persona and gave her report (did my best). She asked if she could not only do anything involving the patient she was assigned, but also follow me around for the day. I told her I was a little frazzled, to be honest,  and that I needed to just make a plan for the day and collect my thoughts but that I would definitely pull her into any out of the ordinary learning experience any of my patients had.

Eventually, I got in to see the patient she was specifically assigned to. She was with him doing therapeutic communication (even though I can't say I've heard that patient talk more than a whole sentence strung together at one time, so i'm not sure how that was going....) and I taught her how to do my kick-ass nursing assessment that I learned from my school. After we left, I taught her my kick-ass way of documenting that assessment on my paper before I had time to put it in the computer. After that, we went to go assess my other patient, who had far more interesting abnormalities, so I got to teach her a lot about why that was the case.  I made sure to answer every single one of her questions, and make myself open to ask more questions if she so chose (I think thats really important). That way, even If I DO get really busy with other patients, she shouldnt

So I got to do a lot of education, about medications, assessments, vitals, nursing in general, and that was just me "getting by", I was really just trying to do my best with her and praying she wasnt thinking I was a complete neurotic nut that was all over the place.


Well, turns out, when she was done for the day, she was supposed to come give me "report" on my patient. I remember those days too, but now that I think about it- that concept is pretty silly. I was with the patient as much as she was and was already familiar with what was going on, but I listened to her report anyway.

She gave me a tiny report (there really wasnt much to say on the guy) and then right before she left, she told me something I'll never forget. She told me that I changed everything for her. That she learned more from me in two hours then she has learned all this time so far in school ( I found that hard to believe!), she told me that driving here on the way to clinical, she thought to herself that she didn't think she could do this anymore- this nursing profession road. She thought she wasn't capable, that it wasn't for her. She told me that after last clinical, she had such a rotten time that she went home crying (I remember those days, too). But today (thursday), everything changed when she was with me. She told me I made things make sense. It just did. She told me I made it possible in her eyes that she could do it too one day, and reassured her that there were nice nurses still out there. She thanked me a million times for being so understanding, kind, patient, caring and thoughtful and overall a fantastic nurse.

I have to say, I pretty much just stood there, looking at her. I did not know what to say- I couldn't believe what I was hearing. Was she talking about me?

She then went on to say that everyone in her nursing class should have a one day session with me as the nurse, and that way everyone could learn as much as she did that day.

I was absolutely flattered. But I couldn't believe it! I even told her, that she was very sweet but that I was honestly just doing my job. I explained to her I was just recently in her shoes less than a year ago and will never ever forget what its like. I won't forget tomorrow and I won't forget in twenty years. Nursing students, despite their lack of critical thinking and overall knowledge base, are the future. If you want future nurses to be terrible, then don't teach them. And then be pissed at them all the time when they are new graduates and never learned the right way. Or, take the time to really teach them. Show them tricks, take them under your wing, be NICE. From that you grow a nurse just like me. Thats how I grew. Not only did I learn from bad and good nurse examples in clinical and remember every moment on how I was treated as a student, but I have spent the past five years watching good and bad nurses on my floor. 


So, she told me that because of how great her day went that day, that I changed her mind about her career, and now she wanted to stick with nursing. I was honest and told her there was a long road ahead, but its so worth it in the end. Its worth it. And, it gets better, it really does. I also gave her my number if she ever had another crises where she didn't think she could do it anymore and needed encouraging words. Was that too far over the top? Probably. Who knows. But to know that I changed someones life? Thats huge! Hopefully she'll make a good nurse and I changed her life for the better. Its just amazing and hard to believe that because of me, because I was at work that day taking care of that patient, that I changed how she thought of the entire career. Pretty cool :)



As for myself, I'm definitely putting some thought into becoming a student again sometime soon within the next two years. Its crazy how much I'm already learning. I can't wait to take my experience back to the classroom and learn even more to build on top of the experience I'm already getting. In this lifetime, I will never go to med school to be a doctor. I'm already 23 and that is never going to happen. However I'm starting to realize that I probably could have been a doctor, but I'd make a better nurse. I'm starting to get to that point now that I can anticipate what the doctor will want when I call him on the phone. I suggest things for him. I come up with diagnoses in my head (I dont share them...yet- in fear of being wrong). I know being a doctor has got to be one of the most stressful jobs ever. Especially when they don't know whats wrong and they have to figure out the mystery. But besides that, they just follow protocols, follow standard type treatments, treat abnormal lab values, infections, surgeries, maintain health, etc. They have guidelines (for 70% of their patients).  But who knows....I'm sure it really is a lot harder than I think it looks. I didn't think nursing looked (that) hard when I was just an aide. I was way wrong.



So, its been a fantastic couple of weeks. So much learning, so much fun.....I have a good set of patients this week and can't wait to go back tomorrow.



Goodnight, with love--

~WNB




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Why Thank You, Doctor!

So I am getting to be a LOT better with doctors. I never thought I'd hear myself saying that, but I guess its human nature to eventually get better at things you suck at. And in the nursing world, either you get better at it, or you fall drastically behind. You have *no time* to be bad, you have no time to be nervous about talking to doctors, you just have to do it, and quickly. Know what you're talking about, try and have as much information available as possible, and ask the right questions. And be really, really nice. That always helps. :)

I'm getting to be pretty comfortable with the doctors, too. The other day I called one out on 2 mistakes he made med-wise that could have been pretty unfortunate if I hadn't questioned it. So, yay!

So far all the doctors I have worked with have been very cordial. Which is awesome. And for the scarier ones, I can get by with doing the above and being super nice. However, being new has its extreme disadvantages. For example, we don't have "pictures" of the doctors. Eventually the nurses just meet each doctor one by one and memorize what they look like. But when I'm new, there are a bajillion things on your mind, and memorizing doctors isn't high on that priority list (yet). There have been days when my preceptor is like, "when you see Dr. Blahblah, make sure to tell your patient is blahblahblahing" and I'm all like, "okay." And then five minutes later I realize I haven't the slightest idea what Dr. Blahblah looks like.

So eventually I'm meeting them one by one. I embarrass myself frequently by staring them down in the hallways, trying to get a good view of their nametags and memorize their face. They aren't a huge fan of that (me staring at them funny). I try and do it like as I'm walking by or tying my shoe or something, but...well, you know. Also, whenever *any* type of doctor,( primary, secondary, consult, hospitalist, etc) is in to see my patient, I introduce myself and try to make myself memorable so they know later who they're talking to on the phone. I'd so much rather walk right up to a doctor in person and introduce myself rather than talk to a doctor I don't know on the phone.


And thats why I came up with a brilliant idea. Granted, nurses must face hardships when starting their first job.  Its unavoidable, and necessary. Older nurses training younger nurses play it off as, "eventually you'll learn the doctors". But the way I see it as, patient safety is nursing number one concern, right? Right. Not learning doctors. Why make an extra stressor for ourselves (for new nurses) if we don't have to, and could instead be stressing on how to advocate best for our patients? Doctor and nurse communication has improved, but is still lacking. And thats in general. New nurse and doctor communication is suffering even more. Which circles back to patient safety. If new nurses are afraid to speak up to doctors, then they might not speak up at all. Advocacy suffers, less phone calls are made and the nurse is definitely not going to make the extra effort to give you (the doc) as much information as possible.


So this is my cure. A luncheon! Yeah!

No really, I'm serious. What if hospitals adapted a monthly luncheon for doctors to meet all new staff (and anyone else that wanted to come?). At first, you may laugh. Especially if you happen to be a doctor reading this blog. But seriously, hear me out.

This benefits the doctors too. Believe it or not, (especially big hospitals), new doctors come on staff all the time. If I were a doctor I'd like to attend and graze over a couple friendly nurse faces that I'll be working with on the floors. Also, c'mon...free food. From the hospital (probably?).

Who would attend? Residents (new and old), doctors, Interns, surgeons, etc. As many different types of doctors that wanted to come as possible. And new nurses would be required to go, and old nurses highly encouraged to go.

Granted, no one wants to go to "these types of things" ever. So there would have to be a cool incentive to go, like cake. Everyone likes cake. And money. But cake is cool too.

What would people do there, besides eat and stare at each others name tags? Well, hopefully talk. Strike up some conversations. If it was totally awkward like a middle school dance and no one talked, I would have to bring out the icebreakers. Like actually getting a podium and introducing new staff for all to see. And maybe make them say a five second blurb about themselves. But thats the last resort.



So, granted, the hospital wouldn't want to pay for this, doctors wouldn't want to go to such a "lame" thing, and it would probably never work. But its a nice thought, in theory.....in a nice cooperative world, it would totally work. And be awesome. Then again in a nice cooperative world, you wouldn't need this, because doctors and nurses would have awesome communication techniques all the time.

Its just that some doctors just don't.....get it. They don't get nurses, don't see nurses as a vital part of their patients care. If you call them, you're bothering them. It makes all the difference. However, a couple shifts ago last week one of my patients doctors came in. After he was done speaking to my patient, I caught him on his way out. I introduced myself, and he introduced himself and what kind of doctor he was (that was helpful). After blahblahblah talking, he made sure to finish the conversation with, "Call anytime for anything you need for him."  I felt like going to give him a super duper handshake or pat on the back or something for being so awesome. Thats how doctors should be! Yes!


The hospitalist I've been working with for four weeks now, has been.....truly amazing. Granted he is quite new himself and is probably trying to just be nice to everyone he meets, but I genuinely think he's just a nice, great, smart doctor. He has been *so* patient with me and me being new. Anything my patients need, I can feel comfortable calling him for anything and it is no problem. Thats the line of communication that is ultimately desired with all (or at least most) of your coworker doctors. Right? Right. Today he went home two hours late, and he looked tired. And all I wanted to do was go give him a huge hug or high five or any of the above, for not only being such a terrific doctor thus far but for treating me as an equal and for being so patient with me. A + for him. But I didn't. Because any of the above actions would be very strange.


What do my fellow nurse readers think? (if I have any?) Do you guys have a luncheon or something similar to get docs and nurses acquainted? How do docs and nurses communicate differently in your hospital? Does it affect patient safety or patient advocacy? Is there something you want to do about that?


:-)


With love, ~ WNB


Do something! Communicate!


.

.

Day 3 as an RN: Under Fire

Whew! So, lets go over this week.

Day one summary- Easy. "This job is awesome! I love being an RN! Woo! This is going to be GREAT!"

Day two summary- First patient. "This is great! I'm doing great! Running into a couple problems but easily solved. Helping out lots of others on the floor. Eager to learn more, do more!! Bring it!"

Day three summary- "WHAT THE HECK AM I DOING!!!"



And thats pretty much all I need to say. But I'll say more- have no fear, thats why I'm here.


The biggest lesson I learned throughout reflecting on the day (I actually learned it during my lunch break when I literally just sat there staring at the wall, breathing) was that although the day thus far had been CRAZY and there were MULTIPLE times I literally thought in my head, "I'm not cut out for this. I am in over my head, like way in over my head, and I cannot do this", I do realize that I DID learn a lot yesterday because of that insanity. Not only did I learn true prioritization and time management, but I will remember the skills I learned forever. It was all very fast and in the heat of the moment (s) and it was either do it or you don't do it and the patient suffers.

I guess what I'm confusingly trying to say is, I learn better that way. Under fire. When you really don't have time to over-analyze it, (but still enough time to do it the right way!).  If my preceptor is going to just calmly be like, "Okay, step one, you do this....and step two, do this..." and I only watch, and its all hypothetical, then I might learn that in the back of my mind but its not truly ingrained. Whereas in the heat of the moment, you remember everything that you did. Did it work? Okay, do it again that way. Did you run into a problem? Did you learn the right way to do it after that? That, you will remember forever. I guess I learn best via trial and error.


But anyway, I got through. And by the end of the day, I did everything I was required to do. I swam through the deep end and made it to shore. I got everything squared away with my complicated patient, and even had time to volunteer to do another nurses admission assessment, despite it being my first time doing it, I thought, "How hard can that be? The computer guides you through the whole thing." So I got to do that, that was cool.


Update on the doctors...I got to deal with a new group of doctors yesterday, well, residents really. Which was excellent. The residents are so....eager to help it seems. They are still learning so they are still so genuinely interested in their patients and actually like when you call them. And I even got to meet the resident bunch when they came to do rounds on the floor and I met the actual one I was doing most of the talking with on the phone, and I redeemed myself and made sure to not come across as a total newbie/idiot. So, cool. Getting practice....eventually calling them will be no big deal. Eventually!


I also encountered my first family gathering/update/education session....twice! My patient was 94 and with severe dementia so not much education was happening with her. However, midday someone came up to me and asked if I was the nurse for that patient. I said yes, and she introduced herself as the daughter-in-law and had a couple questions and wanted an update. So I gave her an update and suprisingly answered all her questions! Somehow. So, that turned out alright without any prior "prep time". If I had known she was coming I would have read through the chart furiously and gave her the best possible update. But I told her what I knew. And then a couple hours later, I was informed that the son was in the room and wanted to speak with me. So he had some more questions, which I was also able to answer all of them! I love love love finally being able to answer questions from families! Its been so annoying these past five years reciting, "I don't know, let me get your nurse."  Woot!

I went to a meeting at work, after my shift, that was all about how to handle angry patients and how to make them happy again so they pretty much don't leave our hospital saying they would never come back again. But point is, the speaker made a really good point that shed some light on my work and probably a lot of others, too. Despite how bad my day is, on my worst shift on the worst day, I am doing good. I am helping people. And, I get to go back home at night. I'm not stuck in a hospital bed, waiting for biopsy results, or listening to my IV beep, away from my family. No matter how bad the shift is, your patients day is probably worse. So an interesting perspective to think about when I feel like I am having the worst day.






Well, I have the weekend off! So, lots of drawing, some photography work, and maybe some writing I hope!! Yay!



Thanks for reading everyone,

~WNB

Day 2 as an RN: Overcoming Fears

AH!

So.....day 2. I survived. I'm still sort of gathering my thoughts....


I got my own patient! But he was not complicated at all, and all I got to do with him was some education, an initial assessment, lots (and lots) ((and LOTS)) of meds, IV meds, piggys, primarys, subqs, and other fun stuff like that. Felt *just* like I was back in clinical. Which is OK.....because at least I don't have my intimidating teacher looking to fail me anymore. Now I have a preceptor trying to teach me and make me a good nurse, and she trusts me (probably a little too much) to do a lot on my own. So, thats good.


The biggest hurdle I have yet to cross is getting over whatever I fear I have of doctors. Okay, It's not that I'm afraid of doctors. It's just in my personality code that I:

1) hate to bother people
2) hate to talk on the phone
3) have trouble understanding diction...especially heavier accents =\

So,  ^^ all that is pretty much all doctorness. I don't mind at all talking to doctors in person. I am a very personable person and I understand nonverbal communication so much better than over the phone. I don't care if you are furious with me, I'd still rather talk to you in person than on the phone. I hate the phone. Hopefully that will change. That has to change. Nurses are on the phone just as much as they aren't.

Today I was only working with one doctor since I only had one patient. Luckily I got to see him on the floor so I took advantage and snuck in there and got to introduce myself while asking him to change a patient order (that sounds so awesome and nursy official but it really wasnt lol). And so then a couple hours later I had to call him again and get an order verified to continue it. Well, I did not want to call him. But my preceptor felt it was time I get over it and get on the phone and start calling the doctors. She reminded me that if I don't call, then I'm not looking out for my patient.

Luckily during our quick 40 second phone conversation, I didn't say anything too entirely stupid, I understood him (most of the time) and I got what I needed.... But it was still not preferable.

I guess at this point its just a matter of learning what each doctor is like, their personality, when you can call them, when you can't, what you can call them for, or should you call their intern? Funny thing is night shift won't be so bad because unless your patient is dying, chances are the residents will take care of what ever you need. And the residents/interns are usually closer to my age, just as clueless as me, and in the same boat (ok different boat, but similar), and we work together. Together is key. If were both equally as clueless, lets work together with our different knowledge bases and solve this together!


Anyway, my other hurdle is putting in an IV. Tomorrow is day 3 and its about time I at least attempt my first....so, I'll update on that tomorrow. =\

It's funny how in nursing school my biggest fear was anything to do with the IV system. Piggy's, primarys, tubing, or whatever. My teacher always made it seem to frightening. But now I love working with them. It all makes perfect sense now and I don't understand why I ever thought it was scary. So, thats good! I knew I would get my technical skills down fast, its just a matter of learning reasoning behind actions, remembering everything, doctors, knowing what to do in emerging situations, etc....it will all come with time, I hope! It's only day 2 and I think I'm expecting my personal performance to be at day 124,111,293. I'm a perfectionist I guess and I can't sleep at night if I know I did something wrong with, on or too my patient. So I also have to learn that mistakes do happen and thats how we learn and become great nurses. And, no one is perfect on day 2. Right?


So, tomorrow, pretty much just a repeat of today except hopefully can do better, be more on top of things, and hopefully get my first IV stick.



Thanks for reading! To my non-nursing affiliated readers, I am sorry! I hopefully will come out with a non-nursy post soon, this weekend perhaps. What would you like to hear about? A funny story? Some photography? Writing? Just an update on my life? :-)



~ WNB < 3

Where I want to Be

I'm having an off night. Can't really explain it....I don't think I could if I even tried. I guess thats the scary part? But its midnight now and I am drawing and listening to some music and this is helping. If "this" is still happening Monday I will *have* to go to the Doctor even though I hate most doctors and how all of my health issues are subjective. For once It'd be nice if a doctor could see what is inside of me, what I am feeling, rather than what they can see. I get it, for them. I know. I know how frustrated doctors are. Its like stabbing in the dark with patients like me. If they can't see the problem, how is it best to treat? Drugs, drugs, drugs? Ugh. Hardly. I want to go back to my holistic NP but can't exactly afford $180/hr right now.


Drawing helps, it gets my mind away from me. It takes me somewhere else.....when you are able to focus on something like that, whether it be drawing, or playing some sort of video game, or....running, or walking, or painting or whatever, when you can be awake and yet let your mind "take a break" from yourself, from your thoughts, its sort of free to do what it wants. Its like accessing the dream state while awake. Although I am in my present self focusing on my drawing, my mind is a thousand miles away. And then I re-focus and my drawing is 75% done! Nice :) So thats what drawing does for me. Thats what reading does. Thats what writing does. Thats what music does.


Right now, in this present moment, I would really just love to be here:

Bryant Park, New York City


This place, right here.....this place is magical. Everyone who has been there, knows it. Definitely makes my "top five" favorite places...and I've been to Europe.

Speaking of Europe, I'd also rather be back here right now:

This probably marks my favorite place. Luxembourg Gardens, Paris. Which is funny, because I didn't even know this existed in the world, let alone Paris, until I got off the bus and it was right in front of me. But isn't that sort of what makes it surreal? Those special moments when you think you are lost, and you make a turn and you walk into this magical place where all these people are, and you think, how does everyone else know the address to heaven?? And there you are, in the middle of it all. It's perfect, and you are happy. I want to go back.

So, thats that. Tonight is a blast Blue October kind of night. As Justin Furstenfeld puts it, "Just believe in all who shine the light to help you see...'cause if I believe in you, will you believe in me?" from Kangaroo Cry

Goodnight, World. Here's to hopefully a better weekend ahead :)

~WNB

PS- This is my 365th post!!! Ah! Funny since that marks a year, sort of, even though I've had this for two years now. Odd. :-) 

So I'm Not a Basket Case

Appointment with the Holistic Practitioner went very well!

- She's testing an 88 food sensitivity panel to see what my body is reacting too- YAY!

- She is testing my thyroid for suspected hypothyroidism

- She is doing a complete metabolic panel to test my nutrients & hormones and all that cool stuff.

- She is testing (the right way) for Celiac disease because she highly suspects that to be the culprit of the majority of my problems....

..which means I would return to a Gluten-Free diet, pretty soon. Which is hard, but worth it- If it makes me feel better....And this time around it will be easier to do because in just the two years that I have done it last, the Gluten-free nation is rapidly gaining popularity. This means more products, more attention, more restaurants hopping on the bandwagon, Yay!

I respect this practitioner so much because of how she looks at the patient.  She sees the whole picture, which is what every doctor should be trained to do, and what a good nurse does anyway, regardless of education. So, putting those two points together, a Holistic Nurse Practitioner makes absolute perfect sense and should take over as the Surgeon General or President of the United States, or something like that....

Doctors these days are losing primary care. Doctors don't want to go into primary care anymore, because its losing money. They aren't being trained anymore to "know everything" because once out of school, they go for the big bucks and they specialize. They specialize in one body system and they are "experts" in this system (most of the time). Well that's GREAT, except for when my Gastroenterologist is only looking at my GI system and not concerned about how whats going on in my gut can be affecting my anemia, headaches, heart, and so forth. It all Connects and this nurse practitioner is the first medical professional that I have seen that realizes this and is testing everything. I am so happy to finally be on the same page as a medical professional.

Its a shame that insurance companies aren't working with holistic practitioners (at least in this area) because if you think about everything I just said, they are stupid not too. Holistic Practitioners (whether they be a doctor or nurse) see the whole picture and are therefore more likely to make the patient well again. Also, holistic practitioners promote overall wellness and are more able to maintain it, which insurance companies should be interested in. Its got to be cheaper to keep a patient healthy with a little work than to treat big problems with a lot of work, right? 

I agree that sometimes, specialists are needed. Sometimes a primary doctor or a holistic practitioner gets in over their head and don't feel comfortable treating the case because they don't have enough knowledge about it. They get referred to a specialist for their safety. And those are the patients that should be seen by a specialist. But why should someone with chronic GI (and other) issues be seen by a GI doc when a holistic practitioner can see the whole picture and treat with natural supplements and diet? (Rather than a prescription for the rest of your life?) I hate prescription drugs. My GI doc wants to put me on one for the rest of my life....and well, I am doing everything in my power to avoid that.

So, I'll keep you updated! I won't know more until a couple of weeks, so look forward to it. :-) Thanks for Reading!



I feel like health is on the way =]


~A Writer in a Nurse's Body

The Frustrating Cycle of Doctorness

So here's how it goes...

I have "phases" or "bad days" of feeling really sick....It all hits at once. Sometimes I know what caused it (milk got into diet) and I'm OK with surviving through the consequences. But when something hits me and I have no idea whats causing it.....I feel hopeless. I say to myself, I need to see a doctor NOW, but its not serious enough to go to the ER, I just want to see one in an appt. I need to see him and show him the symptoms I am having NOW. But doctors don't see you NOW, they see you when they have an appointment open. By then, I feel better. I usually feel better the next day.

Despite feeling like I am going to die one day, and having myself so convinced that I promise to call the doctor the next day , the next day comes and I feel totally better and I think, "Well....I feel better now. I survived.  I helped myself all on my own. I don't need a silly doctor to help me." Despite feeling desperate for one the day before.

I am just so fed up with how our healthcare system.  I cant even beGIN to explain how frustrated I am with it all. I know something is really, really wrong me and its getting worse....but usually, you wouldn't know just by looking at me. And therefore, doctor's don't know. They have a hard time believing what they can't see. So they put you through endless testing, (sometimes more than once) to try and "see" whats wrong. If they can't figure it out- You are pegged with having Irritable Bowel Syndrome.

I spoke with an NP at the Nurse's convention that specialized in Celiac Disease. She had me convinced that a majority of all my symptoms somehow relate to Celiac Disease. I told her my GI doctor tested via endoscopy and denied it. However, sometimes it doesnt show up that way, especially since I had been on a gluten-free diet previously at the time. So she says I need to have a genetic test. Thats a sure-fire way of knowing if you have the gene or not.

*sigh*. Today is a bad day. But the doctors I want to see aren't open today, and I have so much work to do for the next week MONTH that I can't even envision having an hour to spend with a doctor anyway.

I just want a doctor to look at me, and understand. To believe me. To know what the flying duck they are doing.

*Frustrated*

~ A Writer in a (Frustrated) Nurse's Body

Hurricane

I think my town had a hurricane rip through last night. And maybe the whole Northeastern coast, probably. It probably wasn't just my town.

But it was seriously intense. I don't think it was an actual hurricane (It wasn't). But it was a serious thunderstorm. In NOVEMBER. I even saw this lightning that was pretty incredible. Did I mention its november?? I felt like Dorothy because I sleep right next to my window (like literally-my window is right along side my body), and I was sittting there watching the storm and I'm like- Oh god. I'm going to die. Wait, how can lightning kill me through this window? I don't know. I guess I should have paid attention in science. I just always remembered my parents telling me not to stand by the windows when it thunderstormed. It didn't work out so well for Dorothy, did it now?...


Anyway- Health update: this is day two of Prednisone. THis is probably the most serious drug I have ever taken and it makes me scared. Corticosteroids come with a lot of risks...and a lot of risks I am not so happy about and am worried about getting. Prednisone in particular has side effects of (weight gain, moon face, insomnia, severe nausea, irritability and mood swings, jittery feeling, increased heart rate, suppression of the immune system)....so...um, yeah. Usually when I get a prescription from my GP I personally decide if I want to take it, which patients should, I guess, if they are properly educated. I do a lot of research on my prescribed meds, and I know a little from picking it up in clinical and at school lectures. So, normally I would take this high dose (30mg) of prednisone and shove it- (don't know where)- because i Am afraid of the side effects....and i like to make decisions for myself. However, I have a serious problem here (bowel inflammation) and it is not going to be fixed on its own. I can feel it getting better with the prednisone, so i am going to combat the side effects on my own and continue taking it. Luckily it will only be a short term therapy and next week she should hopefully be tapering the dose. Also, this is a GI specialist, not just a GP, and she probably is very educated about outweighing prednisone's benefits and risks. Doctors are prescription happy and I hate that but maybe this one will solve my problem. As for combating(sp?) the side effects, I *think* the weight gain is caused by increased appetite that is caused by the prednisone. So I plan to not give in to my increased appetite and continue to eat healthy and not too much. As for the nausea, I am combatting (sp?-again-I think this one is better. I should google it.) that by taking the prednisone with foods. So far, so good. As for the insomnia combat (thats better), I am just taking the prednisone with breakfast. It has kept me wide awake both yesterday and today with no naps (which is GOOD, because I am on paper writing, presentation writing and med/surg reading duties!). The insomnia last night was not terrible...I had a hard time falling asleep, but I do remember sleeping. I think having a hard time falling asleep had something to do with the following stream of consciousness:

Boy...I hope that prednisone dosen't cause insomnia for me...because I really need sleep....am i sleeping yet?...sleep is important...if it causes insomnia for me that is very bad....I'm going to have to bring that up with my doctor...speaking (thinking) of doctors...I should spend all morning tomorrow reading med/surg....ah, so stressful, I haven't even started reading med/surg....meanwhile everyone else has been through 2 lectures....I definitely need to do that....thinking of school, boy, I am really stressed about my group presentation...crap, what am i going to do? ...How is my group still going to let me be in their group if i'm not there to work on it with them....am i sleeping yet?..how about thinking of something else a little less stressful....butterflies are nice....am i sleeping yet?....I can't believe I missed my interview today...I can't believe I did that.... I hope she lets me reschedule and still considers me for the job....so stressful...am i sleeping yet? No.


So thats how it goes down.
I need to stop thinking about stressful things at night. What is that going to accomplish? Nothing. What am I realistically going to do about reading med/surg, and working things out with my group, and writing my paper, at 12 am ? Nothing. I can't do anything right then except sleep. I need to let everything else go.

Hopefully tonight goes better.

SORRY FOR THE LONG NOVELISH POST!! HOPE YOU FINISHED READING!! Oh, prednisone makes you HYPER too. HAVE YOU NOTICED??????


for now, with love,

~A Writer in a Nurse's Body <3

Doctors office

Doctor: "hello, how are you?"

Me: .....what am I supposed to say? Is this a trick question? The standard American response is "good" but I'm not good- and you-my doctor- obviously knows that or else I wouldn't be in your office. Believe it or not I don't come down to your office because I'm good. I always want to blurt out "good" even if I am in some horrible state because that's whats normal but i feel If I said good- they would look at me funny and be like- ok why are you here? But if I say how I truly feel- "um...miserable" then they also just look at me funny.


I think I think too much into things. Yeah.