Predictive Analytics: Breaking it Down

Hi There! I am BACK. And I wanted to share what my main focus in life right now is. 

But first, a little background on where I've been for the past 4 years....

I am a Registered Nurse, and have been for 8 years. I have been in healthcare for 13 1/2 years. About 4 years ago I took a position that actually removed me from the bedside but instead I got to be a part of helping to design and change our electronic health record in a way that improved patient safety and made more sense for nurses and physicians to use.

I remember within my first month on the job, I was quickly drawn to the fact that we could use this electronic health record to capture data and summarize data on hundreds of patients. Better yet, in this new electronic health record, we had abilities to build our own reports! Someone very influential to me, someone I think was placed temporarily in my life for the sole purpose of steering me in my life's direction, sat with me or initially two hours and gave me my first high level crash course in reporting. I-was-hooked!

From there, I continued to grow and expand the use of reporting and my passion for it became apparent. I became the person on my team that was known for being able to whip up new reports and to also be a whiz in Microsoft Excel. These skills allowed me to not only create and put together data from within the system, but to also summarize and track that data.

About a year or so into the job, I knew I had to advance my degree. I have a Bachelor's of Science in Nursing, but I needed more. I've always loved school and am a total school nerd. I enrolled into my local college for a Masters in Nursing with a clinical nurse leader track. I was doing well, about 2-3 courses in- but......I hated it. Guys, nothing felt more nauseating and not right to me in my entire life. It was all research papers and evidenced based practice and blah. Not for me. I didn't really know what else to do, so I switched to a Masters in Nursing Administration. In this track I started to see how cool the whole business aspect of the degree was, but again felt nauseated in what I was learning with regards to how broken our healthcare system is. I spent years on the floor doing my best and it was never enough to the same people that I was in a degree trying to become. Again, it didn't feel right. I took a break from school when I was pregnant with my daughter and in the post partum period as well. I thought long and hard about returning and what felt right.

Then I saw it: A new program at the same college- It was a sign! A Masters in Science in Predictive Analytics. Technically this isn't a healthcare degree, its a business degree. I always had felt that I had to stay in nursing because that's what my background was, even if I hated the pursuit of anything further in it. But this degree.... it felt right in my bones. Multiple people have told me that when I start talking about data analytics/predictive analytics, they can visibly see the light in my eyes go on fire, the rise in pitch and rate of speed in my voice increase, and I could talk about it forever. That right there everyone, is passion. And I knew I had to pursue it. I always joked in the last 4 years in my job that if I could wake up and spend all day in an Excel spreadsheet, I would love-my-job. Data to me makes sense. Its tangible but also infinite. It's like a math equation. There's an answer at the end but also infinite answers! It makes me jump up and down inside, can you tell?

So I started this program in January of 2019, when my daughter was ~ 5 months, leaving my husband to watch Abby for the 3 hours a week I spent in class. It sure has been a whirlwind ever since, and I still am spending 12-15 hours a week involved in the program with homework, reading and in class time. But, what's difference in this is that those 12-15 hours don't even feel like "homework" or "work". Sure I need to make sure I get it done within the deadlines, but its FUN! When I make a dashboard or create a model I get a sense of immense joy and celebrate in my newfound abilities. It kind of feels like what I imagine it felt like for Spiderman to suddenly wake up and realize he has superpowers. This is my superpower.

But, as I started meeting other moms and introduced myself and what I do or mentioned my degree, or talked with friends and family about it, I started noticing a frustrating pattern: No matter who it was, within a minute of talking about it, people's eyes started glazing over and they'd switch the topic. I told new people that I was getting my degree in Predictive Analytics and they acted as if I said I was getting the degree in astrophysical quantum mechanical engineering (if that's even a thing?).

It was sad for me because this was my passion and I wanted to tell the world about it. To me, at work or in school, it was all common talk and people understood it, but I wanted to be able to share it with more than that.

So, I'm here to break it down as best I can.

I don't want to give any fancy definitions of what it is, because even I don't understand those. Lots of statistics and blahblahblah.

To me, predictive analytics is as simple as using and understanding data from the past to predict future events. That's it!

Ok so let me break it down into a real elementary example, then I will advance a little from there.

This example brings in my love of epidemiology also, so its fun. Let's say there was a big gala held last weekend celebrating something. 100 people were in attendance. There was a lot of food served, but lets focus on 5 foods: They served chicken, salmon, filet mignon, and ham as the meat choices. They had a big salad on the side for vegetarians.  However, unfortunately, a few days later the party hosts found out that 20 of their guests got really sick! They called and blamed the food they ate. So the hosts had to find out, what was it that made everyone sick? So they interviewed each of the sick to find out what they ate. But what is important here, is where predictive analytics comes into play is not just interviewing what the sick ate, but what the non-sick ate too. For example, if the 20 sick people all had the ham, but so did 70 non-sick people, it's probably not the ham that made everyone sick. But how could we really say for sure? Well, nothing is ever really sure in data analytics. Data analytics treats words like "always" and "never" like the black plague.

So what we do here is treat each one of those food items as variables. (I'll explain that more). Each variable would be "Did this person eat the ham, yes or no?" or "Did this person eat the turkey, yes or no?"  By then viewing the list of the 20 people and what they ate, we could likely identify a pattern of the common thing(s) that the people ate that got sick. OK now stay with me- we can use that knowledge of understanding what we THINK got sick and assign them values. So perhaps those that ate the turkey were 80% more likely to have gotten sick and assign it a value of 0.8. We now PREDICT, will the rest of our guests get sick? So we take that list we have of our 80 non-sick people, and essentially run it through a model to determine a prediction of how likely that person is to be sick. If we found out that ham and turkey were the culprits that made everyone sick, if we took one of the non-sick people and found out he too had ham and turkey, we could give him a pretty accurate high prediction that he may end up also getting sick. However, if one of the non-sick people say they only had the salad, and non of the sick people ate the salad, we can give that person a pretty accurate prediction that they won't join their friends in the quarantine.

This sounds like a silly example, but its how these predictions work. In examples I am involved with at work, the "20 sick people" that are used to learn and understand the variables, is actually 500,000+ people (perhaps more likely in the millions). Taking data from only 20 people can lead to a lot of inaccurate predictions. Maybe they were lying or forgot details. But if we are seeing common patterns on half a million people, we can gain better accuracy in applying what we learn to future predictions. Instead of the "variables" being 5 food groups, we instead look at hundreds of variables to better understand everything we can about these instances. In this way, we actually can learn new things that may be correlated to a disease or effect.

Some examples I am working with in healthcare now are predictive models that can predict how likely a patient is to have a cardiac arrest event, or code blue. We use close to a hundred variables that were studied on thousands of patients that DID have a cardiac arrest (think back to the gala example-the people that DID get sick). By learning what was unique about those patients that did have a cardiac arrest, we can then match that set of variables up to a new patient that walks in the door, to see how closely they align to those variables. Perfect match? Yikes, lets get the code cart ready! Hardly a match at all? Pretty good chance they aren't coding on our watch (Again, nothing is certain).

But think of how useful these models are to us, in healthcare and around the world (I'll get to that). By having a prediction like how likely a patient is to have a code blue, we can better prepare as healthcare workers to make sure that doesn't happen. We can better plan staffing ratios, adjust the treatment plan, get other specialists on board, etc.

I'm working on a few other models in healthcare right now, but there are more than I can even count that are actually out there. We are gathering the ability to predict who will experience a fall, who will contract sepsis, who will come to the emergency department, who will not show up for their appointment, who will come back to the hospital, etc. In each of these cases, these accurate predictions allows us to prepare.

But think of it more globally. These same concepts can and are applied to other "predictable" events. We could essentially predict tidal waves, hurricanes, tornadoes by understanding what variables or conditions were in place before those events happened in the PAST to help us predict the FUTURE. We could predict mass shootings by understanding conditions and variables that were attributed to past mass shootings. We could predict train delays or breakdowns, airport delays, stock markets, retail surges, etc. With the growing amount of data being made available to all of us, even you, we will have more and more ability to predict almost any event that can have attributable data to it.

Anyway, I hope I didn't lose you all! If you can't tell, this stuff is my life's passion and I can't wait to see where it takes me. This is really just the beginning. There is so much more involved to it all than what I wrote about in this blog, hence the need to get an entire degree in it (and even that will barely scratch the surface), but I wanted to at least get the concept out there as easily understood. Maybe I'll even inspire someone to go chase the dream for themselves, too!

Thank you for reading.

Toodles!

_ A Writer in an Informatics Nurse's Body

What's Next

Hey everyone! Welcome back. 

So, the past couple months have been a whirlwind of excitement, turmoil, and an incredible learning experience. Let me recap. 

I spent the entire fall not only learning my hospital networks newly adapted Electronic Health Record system, but then teaching it in segmented classes to all of my networks nurses and nurse managers, supervisors and executives. I loved it so much. I never thought I'd make a good teacher, but once I got up there I had the incredible need to share as much information with everyone that I could. I wanted them to know as much as I did, I wanted them to get as excited as I was. I saw how much better this would make our healthcare for patients and I wanted them to see it too. Being a nurse, I was able to bring the information to the nurses and make it relatable. I was able to give them scenarios on why this was helpful for them, a good change. I got great reviews because I was so relatable. I loved it and I wanted more. More teaching, more IT, more knowledge. But then we went live with our software change and unfortunately I was faced with the challenge of my temporary assignment being over and I was then assigned to go back to my nursing unit to work as a nurse until further notice. At first I was terrified, and disappointed. I was terrified because I had been off of the unit for about 5 months and I wasn't sure how well I'd do being submersed back in at full force. I was disappointed because part of the reason I took the temporary assignment in the first place because I was feeling burnt out and run down from Med Surg Nursing. Don't let anyone tell you differently, whether you love it or not, Med Surg Nursing after a few years will take a toll on anyone. So going back was terrifying for me. During my absence many new people were hired, some thought I was the new person since they hadn't met me yet. Every turn I made I met someone new! (And 2 months later, I still am!)

Luckily, like a lot of my friends & family figured, jumping back into bedside nursing truly was like riding a bike. Besides a few minor hospital policy changes, or minor unit workflow changes, or a change in where something is located, I picked up everything within a shift or two. 

Our new software change, in my opinion, has made wondrous incredible changes on the nursing frontline. This makes the geek in me extremely excited. The system prompts you to complete all your necessary work that you still have left to complete for a patient, and it is patient individualized, which means not every patient has the same "To-Do" list! We also get alerted if our patient is deteriorating by the system actually watching our patient's vital signs and observing trends. Not just that but there are may workflow changes that have been improved that are now much more efficient. No more double-charting. No more losing charting. No more downtime. There are so many analytics and reports viewable for our patients that it is incredible, it really makes looking at the patients "whole picture" much easier and user-friendly. Communicating with doctors is more efficient, nurse friendly and faster. Reading progress notes from clinicians is no longer a chore or a handwriting-analysis exercise. All notes from every health care clinician or provider including Doctors, Nurses, Therapists, Case Management, etc., are all typed into this software, and of course readable! This way nurses can better understand (and read) the patients actual plan of care and case. There is nothing I don't like about it! I can confidently say that it has made me a better nurse 100%. Also, with this new change we also were able to adapt devices that have this software loaded onto a small device very similar to an i-phone where nurses and aides can take this from to room to room and have all of their patients information loaded in, and they can chart intakes & outputs, vital signs, complete blood work AND even document medications right from this little device. This also makes the nursing workflow incredibly easier and more efficient. This device uploads in real time and no docking required, unless to charge! 

But even though I find myself becoming a better nurse, I find myself feeling burnt out still from the politics of healthcare and Med Surg nursing. I am ready to move on and am so happy to accept a new position of a Clinical Informatics Analyst starting in 2 weeks! In this job I will be on a small team that analyzes how clinicians and IT work together to improve healthcare and technology. We will improve documentation, fix issues or build workflows, innovate new ideas, make new processes, etc. We are the bridge between IT (non healthcare personnel and nursing). This is super exciting for me because I have been raised on computers. My father comes from a long career history of working intensely with computers and has taught his daughter well. I also probably inherited some genes of being very interested in technology. I am always interested in the newest gadgets, how they work and more importantly, how they can improve human life. So now I will be looking at and working with healthcare gadgets, how they work and how they can improve patient's lives! 

So, as you can see- many changes coming in my life & career. So I want to take a moment to reflect back on my bedside nursing experiences and what I expect for the future. 

As a new graduate, I started on a women's health specialty oncology unit. Having only 11 beds and working nightshift with only 1 other nurse, I had to pick up the skill of autonomy very quickly. With high acuity patients, it was a crash course in nursing. I then transferred to a bigger hospital in my network where they I worked on a Med Surg Telemetry unit where I am now. A lot of things changed when I came here, because not only was I transferring campuses, but my old hospital had just been bought out by the hospital network I transferred to but hadn't quite completely integrated all of their changes into my old hospital by the time I left. So even though I was transferring within my network, It felt like I was transferring to a whole different world. I was also crossing state lines, where there was different healthcare rules. In my new hospital, now nurses and aides were responsible for all blood work.The laboratory   only ran tests, no more on the floor phlebotomists. Nursing and aides were also responsible for EKGs, which actually used to be done by respiratory therapists back in the day at my hospital. I also had to quickly adapt to a sicker patient and higher acuity workload on a telemetry unit. At my old hospital, I had the pleasure of having "telemetry techs" that sat in a room and watched every single heart monitor rhythm in the hospital. They simply called me if there were an issue. I am ashamed to say that within my first few months, the tech called me and told me my patient had a few beat run in Vtach, and I remember replying..."oh. Thats bad, right?" Sigh. Whereas in my new hospital there was no tech and I was responsible for not only caring for 7 patients but also keeping an eye on their telemetry heart monitor rhythms too. 0_0 

Needless to say, I survived but not a day went by where I felt like it was easy. It was always challenging and kept me intrigued. But my home life started to wear away as this increased stress load starting eating away at me. I would lie awake at night and wonder if I did something wrong, if I charted everything okay, did I waste every med? Could I have saved that patient? Did I miss something? I started dreading going in to work and my headaches and nausea incidences picked up immensely. I can't even count the amount of times I have been in a shift and thought, "If I can make it through this shift, It will be a miracle. I will be so thankful to be back home and hide under my covers." 

Yes, Its true. And I'm sure every single nurse that you know or that reads this knows exactly what I'm talking about. 

Over the past 4.5 years of nursing, I picked up a lot of skills and I consider myself a mixture of Proficiency and Expert in Patricia Benner's Novice to Expert Nursing Model. However I always was self conscious and thought it to be a weakness of mine that I never really developed a special skill. I was never the "best IV stick" on the floor. Or the "best charge nurse". Or the "best wound care person" ( i never really grasped wound care), or the best person to know X, Y, Z. I rather considered myself a jack of all trades. Or should I say a Jack of all nurses? I felt like even though I never really mastered one skill to its maximum, my "skill" was that I knew a little bit about everything. I had gotten myself involved in a lot of different committees and PI projects and let me tell you, network is KEY to strengthening your career AND your knowledge base. I was always interested in learning and would read nursing books galore and take CE credit courses on my own time or attend nursing conferences. So i knew a lot but mastered none. I always considered this to be a weakness. I always thought to myself, how can I have been through almost 5 years of nursing and I'm still not absolutely great at putting in IVs? How come I never memorize what ABG results mean?? And more. But then I realized that my skill in having multiple trade skills was my super skill! I had the uncanny ability to remember patients information, to organize their care and to stand up for my patient. I had good judgement. I studied their plan of care by reading doctors note after doctors note until I understood everything about the patient. I was able to look at the patient's whole picture and situation and I would honestly take that learned skill over putting in the world's best IV any day. I think this skill has gotten me to exactly where I am today, as I have always had the passion to improve care for patients. Ever since my first day in nursing, I have always thought, "Why are we doing it this way?" I have always thought of imaginary new devices that could be invented to make nurses jobs easier, or new workflows. I have always been able to think out of the box. I know enough to understand the "textbook rules", but have enough judgement to throw most of that away and do whats actually right for the individual patient. When A, B, and C don't work, lets figure out what else will work for the patient. That was my super skill and thats why I think I will do well in informatics. 

Part of me is also terrified to leave the bedside. This time its not temporary, its permanent. I scare myself that I'm only 27 and I'm stepping away from the bedside, something a lot of nurses don't do until they are a lot older or have more experience. I want to stay current in what is going on in nursing and want to maintain my clinical skills. I don't want to get so involved in the IT world that I don't feel like a nurse anymore. I don't want to forget what it was like, so that I can remember how to make it better. 

I don't predict however that this will be the end of my bedside career. If I ever do return, I don't think I can ever realistically return to bedside Med Surg Nursing. It's simply not an option for my soul & heart anymore. If I do return, I am interested in three pathways that actually have nothing to do with each other. Either the NICU, Hospice Nursing, or Emergency or ICU nursing. So maybe that will be where I end up one day. I am not the type of person to stay in one position for forever, I am adaptable, a hard worker and always intend to move up or change positions to learn more or to try something new. 

Whew! I talked about a lot. Sorry. My brain had a lot to say. I am very excited. If you read that all, you are a true fan and a friend of mine. Like I said when I "came back" recently to blogging, I am mostly writing for me. I want to document my endeavors in nursing so I can look back on this in 20 years and see where I was in my career. If you like it and get something out of it, then that is absolutely fabulous! I want to help as many nurses succeed in their career as I can. 

With love, 

A Writer in a Nurses Body 

<3 

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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Go-Live Success

Well, as promised- I have returned for a second time in under a week! That's already an accomplishment! Also, as promised- I want to tell you all about how our Go-Live went. Now remember I'm not naming my hospital network or the system we went live with, but refer to my last post for a clue... Now anyway, the system is amazing, just like I knew it would be. It is fascinating having had the privilege of learning the system since September and teaching it to others, but so far only having seen it with fake patients. I was so eager just to get to see it work for real! As we drew closer and closer to the Go-Live Flipswitch, my coworkers fear and anxiety levels rose but my excitement drew higher.

Getting to work with it all weekend after that moment has been fantastic and very eye-opening. I remember having had "play time" on one of my last days of my own training where we were allowed to just play around and practice anything so that we felt completely ready to help once we went-live. I practiced and practiced and I thought surely, I know everything know- What other situation could arise that I don't know how to do?

Well, I should have slapped myself right there because the rest of the weekend I was "go-Live support" which entailed me running around the hospital ( I literally ran up and down some stairs a few occasions) in order to help all three of our units and the ICU, and handle any problems that were arising. Needless to say, my "to-do" list was about 20 items long and it kept me busy all 12 hours of my shift. I would cross one thing off and be on my way to handle another and then on that route another problem would occur. So, point of the story is I thought I knew how to handle everything but then when real patients are in with unique individual situations and the patients aren't fake, certain charting queries come up and there needs to be a firm solution on how to handle that. I was put on the spot many times and had to rack my brain at 3 am in order to get a solution.

It is interesting watching people learn. Like I said before, I had the opportunity all fall to teach fellow nurses, PCAs, and Nurse managers on how to use the system. We faced a lot of kickback, frustration, tears, confusion, etc. And although I saw a lot of frustration with the Go-Live as well, overall these nurses knew that frustration was not going to help their patient and that if they just sit back and let us teach them how to handle the problem, they would go a lot further. Therefore a lot more health care personnel were a lot more open to learning this time around since we were working with real patients, real time, real problems. It was also delightful getting a lot more "Ah-ha!" moments from our users.

It is a known fact that users always learn faster when emerged inside of a real situation. We can only teach these users so much and get them to remember when we are working with "John Playdough" instead of a real patient, and when we are teaching 2-3 months away from the Go-Live day. And yet when these users are using it every second of their shift because they have to for their real patients, they pick it up much faster. Just like learning a language- You learn French much better stuck in the middle of France than you do in a classroom.

Overall this whole experience so far has reinforced within my own self that I love informatics, I love teaching people and I still love healthcare. I can't wait to grow inside this field and to accomplish more tasks. I love being in charge of projects around the hospital and reporting to and talking directly to high-up administration (literally had multiple conversations with the vice president of my hospital over the weekend!) not because of a power trip- but because I like being trusted and knowing that people believe I can accomplish difficult tasks.

Well, another weekend of work ahead-stay tuned! In other news, I get to go to my orientation for my masters program tonight! Super awesome! And next Tuesday I start my class! So exciting! Nerdddddddd. :-)

A Story and a Dream

"If theres any body out there listening to me, all I have is a story and a dream. Here I am, and thats all that I can be." -Tori Kelly

Hi. It's me. I'm writing again. I'm here.

I've been thinking about this blog for a very long time. It started in 2009 and around 2013 I lost my drive, my writing mojo. All together. I tried so hard to keep it all together and as my nursing career was starting and going strong I began to lose the writers part of my brain. I began to feel burnt out as a nurse after my 3rd year and it started to consume my entire life, my entire brain. It made me not want to write anymore. I didn't feel like I had anything to say. For awhile I tried making 1-2 posts a year but that just made me feel even worse. Even more guilty.

I guess part of me didn't know what to say and the other part of me didn't want to let my audience down. I worked so hard bringing this blog to where it was, gained so many followers and internet attention as It was being born- and then during my block- sometimes I would think of a post and instead of just going with it like I used to- Who cared what people thought?- I would filter it and ask myself, is this good enough for my blog? And usually I'd talk myself out of it or then find myself too busy to log on and try so the thought wouldn't come to fruition. The evil cycle continued.

However lately, my life has taken many strange and exciting turns. It has been a rollercoaster, to say the least. Like I said, I've been thinking about this blog and have desired to start it back up for quite some time now. But again thought to myself, do I have anything to say? But now I have realized within myself- the same self that started this back in 2009 that who cares what people think? This is my blog, my writing, my self. Lately I've really started paying attention to myself and reacting and standing up for myself and whats right. So from now on I will write what comes to mind and if it bores you then great, find a list to the right hand side of my page with other fantastic blogs you should go read. I need this. I need this blog now to be an open space for me.

So where is my life now? Where is my career? In recent exciting news, I have gotten married! Yeah! Crazy. I married a wonderful gentleman back in October. To say the least, it's been an incredible but very busy fall! I thank fates and heaven every day for my husband and this wonderful man, even though i'm pretty sure he doesn't even know how thankful I am for him every day. I try so hard to be a "good wife" but its not in my genetic code to be very wifely. Once in awhile I pull through for him though. ;) He's so patient with me, takes care of me, encourages me, inspires me, questions me in a good way, watches out for me, protects me, and loves me so much. Just the other day I was explaining to someone else that found them self in a rather new relationship- the friend asked me how I knew this man was the one- I said because we can read each other's minds. Although that sounds telepathic and futuristic- Its true! We can't actually, but we almost always know what the other is thinking.

We haven't been able to take a honeymoon however, much to our dismay. Why? That leads me to my next exciting news. My career took an exciting change for the better in August. The Hospital Network I work for has recently decided to adapt a new electronic health record system. For privacy purposes, I won't outwardly say which one, but if you know anything about health informatics and what system is currently sweeping the entire nation- you can probably guess which one. In August I was selected to come on to a team of trainers to teach all the nurses and care assistants in my entire network on how to use this system before it goes-live. So even though I had spent the last four years on the nursing unit at the patients bedside, I decided it was time for a "break" from the bedside and to follow my heart into healthcare informatics. Although I had never really been a trainer or teacher of any kind before August, I dove right in and for the last few months have been teaching nurses!

My mom is a sixth grade teacher. Growing up watching what she did every day, I didn't think I had it in me-the strength to do what she did. I admired her but didn't think I ever could do it. But, it was what I faced at the time so I jumped right in and started teaching! I soon found out after a few bumps and practice runs that I actually loved to teach! Sure I had a ton of challenges and challenging people (turns out teaching adults is very hard!), but that feeling of sharing your own wealth of knowledge and seeing other people "get it", is very rewarding. I even had a student tell me I was the best teacher he has ever had, including nursing school, and grad school. Go figure!

I knew I was good at it and ran with it. I was good because I was a nurse, teaching nurses. I understood what they go through on a daily basis, because I went through it all too. I understood what I needed to teach them in order for them to be successful. I was able to relate to them, tell stories about my own nursing care, give examples and scenarios on how this new system will make *our* lives easier as nurses. It was the perfect recipe.

So that whole process of going-live with the software? Yeah, that starts tomorrow. I know I am prepared because being a trainer, I know the system inside and out. However I start my journey back on the patients bedside during this whole process, my trainer/teaching time opportunity is thus far all done. So the next couple weeks/months will be stressful at best as we all cope with this very big change in my network. I am personally excited, even though I know it will be stressful. I am excited for the end result because I know the system will eventually better our patient care, give us more time with our patients instead of unnecessary charting. Just, in time. Everything good happens in time, right ? Something like that?

All that time all fall in the classroom has also inspired me to *finally* begin my Masters of Nursing program at a local university, in Clinical Nurse Leadership. I start in a week and a half and I am sooooooooo excited, but also nervous! I LOVE school, and I LOVE to be a student, and I am such a nerd because I honestly seriously do LOVE to learn new things. I want to soak up all the knowledge in the world, the only trick is remembering it all! And paying for all that knowledge. -__-

So upcoming between my return to the unit and starting school, I will have a ton to write about! I will also need this venting space now more than ever. I don't know how I will find the time, but somehow I found the time during my Bachelors program so I can find it now too.

Also in recent months, my beloved 85 year old grandma and best friend, has moved into my state! I tried for it to be the same town, but two towns over isn't too shabby either. She used to live in Long Island, New York, and on a good day it was 3 hours to go see her. On a bad day, up to 6 hours. With her increasing age and frailty, that was too long to travel on a moments notice. So the past couple months has been lots of realty and picking things out and spending time with lawyers, but best of all spending more time with my Grandma. She moved December 10th and I have been able to spend so much more time with her since. I already considered her my best friend prior, I have since I was a child- but even more so now. I am able to get to know so much more about her, and her I. The best part is with all this time spent with her, I felt inspired of all her tales about her life that I wanted to write about it all. So I'm writing a brand new, fresh start, new book. I know I've said that before, but this one feels different... It just does.


Well, this has been a long enough first blog back. I work all weekend as we "go-live", but I assure you after this weekend, I will post again to tell you all about how that all went down. Probably with a glass of wine. ;)

For the followers that still follow, thank you from the bottom of my heart for still having interest. For any newcomers, welcome!


With love,


A Writer in a Nurse's Body


P.S. That quote up top and the title of my post. There's a (small) story to that. As I tried to muster up the courage to come on here and write again, as I loaded the webpage, a song by Tori Kelly called "Where I belong" came on and I heard these lyrics and it was exactly what I needed to hear. Because thats exactly what I think, what I am, where I belong. I am just a girl with a story and a dream.

My First Interview

Hey Folks! So I have been contacted by a webmaster for a neat nursing website (www.cnacareeragency.com), and was asked to be interviewed as a "Nurse writer", being that I so frequently demonstrate my creative side and nursing abilities equally. How cool is that!? Someone out there wanted to interview me.

!!!!

So, over the last couple weeks, I completed this interview with this webmaster and this is what came out of it! Enjoy! Thanks for tuning in. :-) The link to the interview is here:
http://www.cnacareeragency.com/interview-with-a-writer-in-a-nurses-body/

Q: Thank you for taking the time to talk with us! Can you tell us a little about your own background, and why you decided to become a nurse?
A: I have a bit of a comical background. I’ve always been an “old soul” type and have been thinking about what I want to be when I grow up ever since I was five. In fact, when I was five, I was sure I wanted to be a writer. I stayed with that notion until high school where the career goal bounced around at least once a week. One week I wanted to be an architect and the next I would want to be a child psychologist. I’m the type of person that is interested in everything and fascinated by what people do. I wanted (and still want) to do everything and it was so hard to narrow it down to one thing to do for the rest of my life. That’s part of what made me choose nursing.
I remember exactly the day I decided to become a nurse. I don’t have a sappy story of a family member being sick for so long and I was the caregiver, and that’s what made see I could be a nurse. No, I’m much different, in probably not a good way. I was a junior in high school and my history teacher (a horrible one at that) was out for the day and the substitute played a video about World War II. In this video was a small clip of healthcare, and nurses taking care of soldiers and newborn babies during the war. For some reason, It was right then that I realized that was definitely what I wanted to do, And I haven’t changed my mind since. I then became a Certified Nurse Aide for 5 years as I worked through college, and now have been nurse for almost three. Crazy!


Q: Can you tell us about the challenges of being a nurse? What are some of the benefits?
A: There are many, many challenges to being a nurse, particularly a hospital staff nurse. So much so that I see new graduates or nursing students and I want to blurt out, “are you sure you want to do this??” But then I stop myself because I know deep in my heart that if I had to do it all over again, I’d still be a nurse.
It’s a very thankless job. Nurses run the hospital and don’t get any of the credit, rarely even a pat on the back. We work the hardest and it’s a blessing if we even get a chance to urinate or chow down on a protein bar on the run. There will be days when you as a nurse will try your absolute hardest and you still can’t save everyone, or someone will think your hardest just wasn’t good enough. You just can’t be everywhere at one time.
Yet we still come back, shift after shift because of the benefits of nursing. Not only are there global benefits (general good pay, you can work anywhere in the world, there’s over 200 types of nursing jobs you can do, flexible schedule with unconventional hours), but just the benefits on shift are amazing. Once you break through that first year as a scared nurse who doubts himself or herself every day, you push into this amazing nurse leader before you even realize it. Suddenly you find an extreme high after a code blue and you helped save someone’s life.  Or even something simple, where you spent the extra twenty minutes helping a patient cope with something completely unrelated to their diagnosis and they thank you for listening to them. It’s the small joys on the job that really make it worth it in the end.


Q: What is your proudest moment as a nurse?
A: Oh, there are so many, and probably some cliché. But that’s OK. I like to think a lot of nurses most proud moments involve a lot of “firsts”, as do mine. My first successful IV, successfully doing CPR for the first time, giving your first ACLS drug and watch as it saves someone’s life, putting your first foley in and seeing that wicked awesome flashback of urine makes you want to squeal for joy (I’m telling you, it’s the small things on the job!).


Q: What is your *strangest* moment as a nurse? Some of our nurses have told us some pretty crazy stories!
A: Oh boy. Where do I start?  Seven years in healthcare now I definitely have a couple!
There was one time I was in charge of the unit and a couple of us heard some shouts for help. Running towards it we found a middle aged man in his patient bed, with a 70 year old Portuguese woman in bed with him. At first we thought it was some sort of weird marital dispute going on, until I saw they were BOTH in patient gowns! We quickly realized that this woman was the patient next door and had crawled into bed with her neighbor! Not only did she have advanced dementia but she didn’t speak a word of English and she was trying to snuggle up with her patient-neighbor! As we tried to wrestle her out of the bed she grabbed one of our stethoscopes and used it as a lasso and whips it up over her head and is screaming. We eventually got that from her and with about 6 people were able to pick her up and slide her into a chair which we slid into her own bed next door. Then security showed up. Helpful.

I’ve definitely seen a lot of weird and strange stuff, especially on full moons. We had a 30-year-old female patient who when we entered the room, found it was covered in baby powder. Walls, the floor, the bed, everything. We found her sitting on the couch sitting in the baby powder. Her excuse? She was trying to “dry up the air” as it was too humid. Another patient also thought it was a good time to cut her hair, in the shower no less and this clogs up the shower plumbing and we find water flooding into the hallway. Good times. Lots of crazy stuff in healthcare!


Q: Many of our readers have expressed concerns about being overwhelmed when beginning a career in the medical field. Do you have any advice for them?
A: Honestly it is overwhelming and I’m not going to sugar coat it. I’m three years in and I’m still overwhelmed. But, it does get better. The only thing I can say is to literally take it day by day. I can’t emphasize enough to not be afraid to ask questions. Especially on orientation. That is your golden time, a time where your new unit has specifically budgeted out a large block of time where an experienced nurse is there for just you and to teach you and answer all your questions. Don’t be afraid to ask the “stupid questions”, because that is your time. Heck I still think I ask stupid questions three years in, but always think- Would you rather ask a “stupid” question or make a fatal mistake because you didn’t? I put stupid in quotation marks because there really is no such thing as a stupid question in healthcare.
The only thing I have to say in addition is that when you start out in nursing, research as you go! Don’t throw away the textbooks as soon as you graduate! When you encounter a diagnosis you’re a bit unfamiliar with, go home and study it and you’ll be that much the wiser the next time and might even be a resource for someone else!
Just remember it will  be overwhelming, so prepare yourself for it. Every shift will be different. Some will be easy, some will be hell. On those hell days, finish your shift, go home, and forget about it. Your next shift will be different. Don’t take it home with you!


Q: Do you have any favorite websites related to nursing?
A: I’ve always personally been a fan of www.allnurses.com, whenever I have a question I can generally find a good consensus of what I’m looking for.
Some of my *favorite* nursing/medical blogs are:
http://newnurseinthehood.blogspot.com/
www.drgrumpyinthehouse.blogspot.com
http://www.sharayurkiewicz.com/  (really profound pieces)
Also I love to browse http://www.nursingworld.org/  It’s not that expensive to join and it’s a great resource!
www.nurse.com is great too.


Q: Do you have any advice for the www.CNACareerAgency.com readers who are interested in becoming nurses?
A: If you’re not already in healthcare but you’re thinking of becoming a nurse, I suggest you find a way to get yourself immersed in healthcare somehow to see what nurses do on a daily basis. Many states will hire you as a Certified Nurse Aide with no prior background or class training, training is on the job. This job is a GREAT way to see what Nurses really do all day. Every nurse should be an aide of some type first. If you can’t handle being an aide, you can’t handle being a nurse. If you’re interested in becoming an aide but your schedule or life situation can’t support it at the moment, try volunteering at a hospital or becoming a unit secretary. As unit secretary, you get tons of experience learning medical lingo and the behind the scenes know-how of how orders happen, doctors names, doctors handwriting, etc. Plus it gets your foot in the door! If getting a job like this is simply out of the question, just try and find a nurse you know and ask her what a typical day is like, what are the worst and best parts? Ask if you can shadow him/her for the day. You MUST do any of these options BEFORE investing in any type of nursing school!


Q: What’s your favorite novel? What are you reading now? I just read “Shantaram,” and it was AMAZING. It was, like, 1200 pages, but I’m considering reading it again. Here’s a link to the book.
A: Thanks for the recommendation! I love to read! Right now I literally just finished (Like an hour ago) reading “If I stay” by Gayle Forman. I read it mostly for research on my own book I’m writing, because the book seemed like it’s a lot like mine. It was a really good read and very interesting! I have like 14 books on my nook that I keep downloading and plan to read next, and I haven’t decided which ones yet! Some medical books I have that I want to read include, “No Good Deed” by Lewis Cohen, MD.,  “Life Support” by Suzanne Gorden or “Call the Midwife” by Mary MacLeod. But some non medical books I’m dying to read are “Gone Girl” by Gillian Flynn, or “Reconstructing Amelia” by Kimberly McCreight. Lots of good choices!!!


Q: We’re always surprised at how many nurses start blogs—there must be something about the profession that lends itself to reaching out to others. Your blog is a lot of fun—you’ve got your own bucket list, a page where you discuss the things that keep you happy and motivated, and a section where you discuss your latest projects. Do you have any advice for our nurses who are starting their own webpages?
A: Aw, Thank you for such a high compliment! If a nurse wants to start their own blog, obviously they have a lot on their mind they want to get out to the world! That’s awesome! First things first though, do your research! Know what you’re talking about before you go blasting a medical opinion online. Secondly, find your twist. Be original. If you want to become a nurse blogger for the sole purpose of reaching thousands or millions, you must be original. Like anything else in media and fame, something must be different about what you have to say. Maybe you have a unique type of nursing job. Or maybe you want to write about one type of medical condition only that means something to you. However, if you just want to write for your own benefit and for sole documentation purposes (how I started out in 2009), then simply write whatever comes to mind and see what happens with it!! When I started my blog, I had one reader and that was my best friend. Now I have readers from all over the world and over 55K views. Who knew?!
Last but not least, if you want to start a blog, I cannot stress enough that you must be very careful! If you are employed as a nurse, you simply cannot speak as freely as anyone else online. Anywhere. I am careful not to post anywhere on my blog where I work. Even with that precaution, I still won’t give too many details when telling a dramatic or funny story about a patient. If I talk about something happening in the medical community, I stay very general and don’t criticize any hospital or network. Be careful what you say! Hospitals and employers are watching everything online nowadays, don’t let a simple blog be the downfall of your career.


Q: That drawing you have on your site is incredible! Where do you come up with your ideas?
A: Thank you!!! I mostly draw from photographs that inspire me. Usually they are photographs I take, but not always. I am good friends with an amazing photographer that I love to draw from. Unfortunately I haven’t quite perfected the art of drawing from within my own mind. I like to draw people and settings that display a lot of people, or an emotion of some kind. I just use drawing as a portal to get from this world to another- A world of peace and happiness where I can just be myself.


Q: How has nursing helped (or hindered!) your creative instinct?
A: Hmmmmm….This is a great question! My Creative instinct has control of my brain at almost all times. I think if you let it, creativity and nursing go hand in hand and help each other. I use my creative side in nursing all the time. If something isn’t working or malfunctioning, I find a new way to improvise and make a solution. Nursing has further powered my creative instinct also because nursing brings forth so many powerful emotions. Nurses usually aren’t the type to let those emotions out, we don’t want others to know that we’ve been affected by someone else’s pain, sorrow or joy. So having a healthy outlet in art to pull forth and let out those emotions is a wonderful blessing I will always cherish.


Q: Do you have any advice for those future nurses who want to develop their creative abilities?
A: Get out there and do it! Nothing is stopping you. Nurses typically only work 3 days a week, so you have no excuse but to do whatever it is that makes you creative the other 4 days. You already have a brilliant mind if you are a nurse (or becoming one) so go make it happen. Go show the world who you are!

Never Work a Full Moon

You'd think that by now I may have learned my lesson, but alas, that is false. When self scheduling as a nurse, I always forget to check when the next full moon is and almost always find myself working over the full moons. Not just one shift, or two, but three fabulous shifts all in the spree of the full moon. And this past one was extra special, being the lunar eclipse last night. Patients were lining up outside the hospital 5 days ago for this full moon.

Now I'm pretty sure everyone knows that full moons make patients go crazy in hospitals. But it's not just that. Normal patients start acting crazy, and the crazy ones just get even crazier. It's like they all gang up and conspire with each other on how they can plan the most eventful full moon shift ever. And that's not even it. Equipment acts up. You'll hear the strangest noises come out of your machines and equipment, or all of the sudden it stops working, or all the sudden your hospital phone won't work anymore. And things come alive and get lost and walk away. You'll be looking for your bladder scanner and turns out its 4 floors down and they have no idea how it got there. And then there's other just weird stuff, like your patient comes in with one thing and you're dealing with a completely different, extremely time consuming issue. Great fun.


So, within the past couple shifts I worked over the full moon, these are the top 15 reasons  that I hate working full moons.

1) I asked my patient if she could tell me her full name. She tells me, "I'm Italian! Do you think I know not my name!?"

2) A patient on the floor tried to convince me he was legit abducted from aliens, I wasn't good enough to have been abducted, and he was looking to speak with a scientist. But I was definitely not the scientist.

3) Same guy as said above proceeded to injure staff and scream down the hall, wrestle people in the hallways, despite 5 doses of Ativan, 2 geodon, and 1 haldol.

4) My patient tells me when I get on shift, "I just had diarrhea." Me, "Ok.....thank you....for....letting me know..."   patient,-"yeah...its still in the toilet. I need you to look at it."   Me,-"why?"  patient, "I think I swallowed something. Can you tell me what those colored things are?"

5) one of my IV poles presented with "ERROR" on the screen. Despite me being tech-savvy and familiar with the IVs, I have not only never seen this error message, (or the horrifying beeping eradicating from the machine), but I couldn't get it to turn off, either. The best part is it wasn't even on in the first place.

6) Call light goes on, about 330am.  Me, "Hi, how can I help you?"  Patient-"The music! I turned on the music box and it kept ringing, and ringing, and I couldn't get it to stop, but then it stopped. Do you hear the music now?"

7) my (previously normal) patient tried to pull out her NG tube and foley. At the same time.

8) same patient, turns out her NG tube was draining poop. Because, why not?  For my fellow nurses out there, you know how rare this is, but it definitely happens. lots of fun.

9) The giving nurse tells you, "the patient came from home taking ThisWeirdDrugIveNeverHeardOF but were not giving it to him here because you can only get it from canada. WTF.

10) I take a chest pain admission and the patient speaks ONLY (literally) Italian. So does the wife. And the son is trying to order pizza to the hospital room, and only speaks Italian and is trying to ask me (In Italian) how to order pizza. I only know this because he's shouting PIZZA and the 8 year old grandson is translating into English for me. Turns out the patient has no chest pain, he's severely constipated. So you know, pizza should be good for that.

11) Same patient as above was angry that we could not get his Italian drugs imported from Italy for him to take during his stay with us. Because that is extremely unreasonable.

12) I had to explain to said patient that I had to give him a laxative suppository. Since I don't speak Italian, I tried to do this through gestures. That Involved a lot of gestures I hope to never have to use again.

13) One of my dementia patients told me he wanted his Easter bread. If he didn't get his Easter bread, God would strike me with zebras and the patient was going to leave and go to the hotel next door ( room # 745 specifically) so he could get his Easter bread.

14) Patient asks me for Morphine. I told patient she doesn't have an IV, how am I supposed to give her morphine? She told me I can inject it into her brain.

15)  Patient asks me for food at 3:30 AM. I offer crackers. He asks for an egg sandwich. I tell him kitchen is closed. He says OK how about Cornbread? Ummmm, no. I don't have cornbread. He then asks for fresh fruit. I tell him again kitchen is closed but I can give him crackers. He said he's not hungry enough for crackers but what about a Milkshake?

16) The nurse before you tells you she charted she gave medicine but really didn't and can I please call the doctor to see if he really needs it? Um no. No I cannot do that.

17) My 93 year old patient asks me what a Hookah is.

18) My 36 year old female patient tells me she hasn't urinated in the past 14 hours because she doesn't like to use public bathrooms and asks me what I can do for her.



I can't make this stuff up you guys. Seriously.

Thankity Thanks Thanksgivingsly Thankful

Hey everyone! So although I don't get to post much, it wouldn't be thanksgiving without my annual thanksgiving post. It has after all been....four years?

So my personal tradition annually is to list things I am thankful for each year. Just like my traditional new years resolutions, I don't really do it for others to see, more so for myself to see each year and watch myself grow.

What am I thankful this year? Where do I start?

I am so thankful to have had a very successful first year in my first house! No disasters, no fires, nothing bad so far. Just a couple ghost sightings (friendly!) and lots and lots of house improvements!

 I am thankful for having a big-girl job that pays me well enough to be able to afford all of these amazing improvements to my little humble house. Every day I thank my lucky stars that I am decently comfortable.

On that note I am also extremely thankful for a job that although comes with some drawbacks, I am so blessed to be able to have the schedule I do and go into work every weekend and see what I can truly call some pretty awesome friends. My weekend co-workers and I are a true team, we help each other out and don't let anyone drown and that truly makes the difference in hospital nursing, when someone has your back.

I am thankful for my family, all healthy, all loving! My father is absolutely the most helpful father I could ever ask for when it comes to starting up a first year house with lots of necessary home improvements! And my mom is certainly helpful when it comes to critiquing home improvements and help decide on future renovations!

I'm thankful for my healthy grandma that finally got to see my house just a week ago! Although facing severe macular degeneration and hip pains, she strives every day to enjoy life and enjoy time with family.

I am thankful for what is now my year and 3 month boyfriend, Brian.  He teaches me and motivates me every day on how to be a better person. He also keeps my house looking amazing and helps with a lot of improvements as well! What more could I ask for?

I'm thankful for my sister, we've been getting to know each other on a more adult-personal level and turns out she's a pretty cool cat, a lot cooler than when we were 5 ;) I think I'll keep her around.

Speaking of cats, I am thankful for my two most adorable kittens in the world, Ms. Lilly and Belle. Although they at times torment my house and my sleep schedule, they make me laugh every single day and are always there to greet me when I come in the door and always know when I need a hug and some love. And they are cuddly :-)

I am thankful for my own kind heart. I've been facing a lot of adversity lately. I've been feeling slightly jaded as a nurse and I hate that, and I've been going through a lot of self reflection lately. And although many in the world believe the only way to survive is to only think and fight for yourself only, I strive to believe that is not the only way. Through all this self reflection and taking a step back to look at myself, I've noticed the things I do that I consider to be very kind, and I do it out of pure reflex, or instinct. I don't do them for any monetary or personal enrichment. I just help people because that's what needs to be done. I'm trying to spread this attitude and I want others to see that if we just sprout more and more kind hearts, that maybe we can overcome the evil in the world. SO many kind hearted people out there are masked with evil actions because they feel that the only way to beat evil is to be evil themselves. I'm thankful for my acceptance that for at least the time being, I refuse to screw someone else over in any way just for my own benefit.

I'm thankful for my new side job, with Premier Designs Jewelry! Although I never would have guessed I'd be an independent business owner for jewelry (I used to hate jewelry), it has truly been a wonderful and interesting experience, and certainly worth my time!

I'm thankful for my vision, as I've seen what my grandma is going through and it makes me so, so thankful for my own. I do wear glasses and my vision is awful without them, but at least I have no tunnel vision or black spots, I have full range of vision and for that I am thankful. Without my vision I couldn't do three of the things I am most thankful for, art, writing, and reading.

I am thankful for my hearing, for without it I would not have music. Music is my therapy, the only way I know how to calm down and focus. Music Is there for me when I've had a nursing shift from hell, music is there for me when I want to just be calm, be by myself and create art. Music is always there for me and it is my love. Music can do so much more for me than any person.

I am thankful for my studio. Although I haven't had time to be a writer this year, I am thankful for my new space that is just for my studio and I have since created multiple pieces of art that I love. I am thankful for that space.

And most of all, I am thankful for this blog! Woot! I have readers from all over the world and over 50,000 views and you guys are seriously awesome for reading what I just think is my regular thoughts every day.


That's all folks,
love you, all. Miss you, all. I'll write soon. :-)




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Life in the Middle Lane

Hello lovely, lovely readers! You are lovely because you still read this blog, even though I never post as much as I should! I really do always have a lot to say, just never the time, or balls, to actually say it.

I write this blog today because I've just about exactly hit my "Two Years" Nurse Anniversary. This is a definite bittersweet anniversary/year.

Lets discuss.

It is sweet because, hell, I've been a nurse for two years! I've SURVIVED! If I can survive this long, chances are I'll survive the entire career. I've made it past that point where I doubt myself every minute of every shift. I've made it past the point where my coworkers doubt me every minute of every shift. (Now only some coworkers do, lol). No really though, in all seriousness, I've been on two very autonomous, heart-wrenching (literal and figurative), fast-paced hospital nursing units now, and I can proudly say I've seen and done a lot in those two years where I legit feel comfortable with my knowledge base now. So much so in fact that I'm craving more knowledge. 


This is also the problem, knowledge. Now, roll with me guys. Does it make sense at all, if I tell you that despite what I just said above, hitting the two-year mark also means I'm hitting the "I've been a nurse for two years and I still don't know what the hell I'm doing" mark? I know you're confused but let me (try) to explain. Despite having a wide array of skills and a comfortable knowledge base that has grown in these two years, there is still so much I don't know. And I understand that nurses feel like that after fifty years of nursing, too. There's always going to be something new or confusing. I know enough now where my unit seems to think I'm charge-nurse quality and I'm frequently elected charge nurse to this telemetry unit, where I'm in charge of 2-6 nurses and 14-36 patients at a time. And yet when I am in charge, there are still so many times I run into a new situation that I don't have an answer to. And those times, I have nurses that need those answers from me, like I needed from my superiors back when I first started. And that's batshit crazy.

It's just, nurses are required to know the entire body system. Even though I work on a telemetry cardiac-focused care floor, the heart can affect many other organs and I must be prepared to handle anything. And there's so much to know and remember I don't think I'll have it all down by the time I'm retired, but I'll always be trying. I want to be the nurse that knows everything, that can help everyone, my staff and my patients. I want to always have an answer. But as the saying goes, the nurse that knows everything can be the most dangerous. So I have to be patient with myself. I have to accept the fact that it's okay to not know everything. But I'm finally at the point where at least I know a lot of things.

So that's where I am now. But looking towards the future, I'm still at a loss. I don't want to become stagnant In my position, I want to keep growing. I talk to my patients in their 80's that tell me they worked the same job for 50 years and I can't even fathom that. I know that generation workforce is entirely different than the one today. Not only could I not last 50 years in this position, but I feel almost pressured to move on. Like good nurses are supposed to keep growing, keep changing, keep moving to different units so their knowledge base becomes even more diverse and themselves more experienced. Like If I stayed on this unit for 10 years and did nothing else, I would feel like nothing. Like I'm taking my life nowhere, In no direction.

So now that I've hit that two year mark where I feel slightly confident in my skills, I feel that pressure that I need to do something else with those skills. I've recently successfully passed ACLS, which stands for Advanced Cardiovascular Life Support, which is a major step up from only being allowed to do compressions and airway support with just a BLS (Basic Life Support) Certification. Now with ACLS I can direct and lead a code blue in an emergency situation, even without a doctor being present. I can push life-saving medications into a patient during, just before or just after a code. I can participate in advanced airway management techniques now. So this has quenched my thirst for more self-evolution and knowledge, but only temporarily so.

So where does that put me now? Well, I want to go back to school. Not only because I just actually really do like school, but because that's the ticket to advancing my career. The only major problem is, what career?  Applying for a masters in nursing is like a senior in high school that is trying to pick a career out of all the choices in the world again. Yes I am trying to advance my career in nursing, but in what route? There are so many choices and routes that I could potentially see myself being successful in, but how do I know which one I actually will be happy in? I can't get a degree in everything (as much as I'd like to), so I have to be sure.

I've debated starting to a local program near me that is for a "Nurse Executive" degree, basically a dual-degree of MSN/MBA. It would take forever and be super expensive but would put me down the road of maybe eventually being very high up in the hospital administration pool one day. But as high-paying, important and as cool as that is, is that really what I want? To leave the patient bedside? To lose what it really is to be a nurse? To hold someone's hand and tell them they are not alone and will be okay? To instead be in an office making and revising policies, firing and hiring people and enforcing rules? Is that what I want? I don't know yet.

I've also been interested in the future of nursing informatics, but I would also completely lose the bedside nursing aspect there, too. With a degree in there I could help formulate programs and design new computer charting for nurses. I've also fantasized about working in epidemiology, where I could easily travel and investigate new diseases around the world and help stop or control them.  I'm also very interested in the route of emergency nursing, where that would keep me at the patient bedside, but in a totally different manner. I'm slightly interested in ER nursing, but even more interested in field nursing, but even that has many different routes. I could do pre-hospital nursing (riding with ambulances providing pre-hospital care), or I could go completely crazy and apply to be in a disaster relief system to travel to new disaster areas and help triage (that really is crazy I don't think I'd actually do that). I'd miss my kittens too much. ;-)

But can you see how overwhelming this could be? That is the blessing and the curse of nursing. Just because you're in nursing as your one career, does not make you limited. I can still pretty much do anything I want and that scares the shit out of me.

So that's where I am. I know a lot but am craving to know more. I've been a nurse for two years and don't know where I'll spend the next 30 years. So (too) many options.


I just try and like....meditate, and try and picture myself in the future, what am I doing and am I happy? And I just can't see it. I guess that's because I can't tell the future....makes sense I guess.



Anyway, with love.....


~WNB





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