PixelRN

Back to the MICU, and back to Liverland

2008-04-29T16:08:30Z

So this MICU shift was very difficult after all, and it wasn’t for the reasons that I suspected. I thought it would be the tasks that got me down, i.e. not enough time to get things done. Surprise, surprise, turns out it was the patients.

Imagine a patient with End Stage Live Disease. She currently has hepatic encephalopathy and suspected GI bleeding. She was recently extubated. They usually put an oral gastric tube in and then yank it out at the same time when the patient is extubated. But then the patient continues to have this hepatic encephalopathy, which is a Catch-22 because then she is unable to swallow her lactulose, (which would help to restore her mental status.)

You attempt placing a nasogastric tube, twice, both times unsuccessfully, both times with the patient screaming at the top of her lungs. So at the end of the day, her baseline mental status hasn’t returned, and you have no way of giving her nutrition or lactulose. But she isn’t sick enough to stay in the ICU so you transfer her to the floor.

Typical situation for this disease, I tell myself, and that’s just the way it is. But I feel so frustrated, and so helpless for two reasons. (1) I CAN’T GIVE THIS PATIENT HER LACTULOSE AND THAT IS THE ONE THING THAT WOULD MAKE HER BETTER and (2) Trying to place this NG tube when she is not mentally stable enough to cooperate is very traumatic to her. And inevitably, the docs will always order a lactulose enema out of desperation. GUESS WHAT? If your patient can’t swallow a cupful of medicine, you can be damn sure she won’t be able to retain a pint of lactulose IN HER BUTT. So that never works.

The weird thing is that even though I hadn’t worked since last August, I had the exact same patient scenario: Liver Failure, recently extubated, mentally, in liver land, and unable to swallow lactulose.

Is it a failure of our healthcare system?
Is it a failure of my nursing skills to place an NG tube?
Is it a failure of our normal routine to yank out the OG tube when extubating?
Is it a failure of medicine in that we have failed to discover a better way of reducing a patient’s ammonia level (which is what lactulose does)?

In the end it doesn’t really matter because it was a failure, and I left that day feeling like I had done nothing for my patient except cause discomfort, and transfer her to lower level of care.

One thing is for sure, I vow never to complain again about working at Chez Recovery. It took a shift back in the MICU to make me realize just how good I had it there.

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Back to the MICU

2008-04-18T21:24:43Z

So I’ve had an ab fab week of being a stay at home mom, and caring for my one year old wonder. I’ve also made some progress on my Orientedx3 redesign, and I hope to be able to launch it in a week or two. I won’t get into too much detail here, but suffice it to say that it’s going to be a very cool way to explore nursing related content, with blogs in the forefront.

I’m also working on building some Wordpress themes from scratch and it’s been a really fun and invigorating project. A project that makes me feel as though I am getting closer to being a successful web designer, and farther away from being an unhappy nurse.

One kind of cool but geeky thing I realized is that PixelRN is on page one of a google search for “nursing websites.” It’s kind of meaningful to me because I’ve always believed that nurse bloggers are putting out the best nursing related content on the web, and most of the other nursing websites are light years behind us. It’s also meaningful because the way I discovered nurse blogging was by doing a google search on “nursing websites.” In a way it makes me feel like this blog has come full circle.

At any rate, I am working a shift in the MICU tomorrow, my first time since last summer. I have a feeling it’s going to be a make or break kind of a shift, in that I am either going to rediscover my passion for working in the ICU, or I will be reminded why I wasn’t so keen on going back there in the first place. More importantly, I hope I remember how to care for really, really sick people. I’ve been fetching ginger ale and crackers for post cardiac cath patients for far too long now, and I’m worried that I might have lost my edge.

On the other hand, I may have gained an edge. I can now start IVs, and the turn ‘n’ burn atmosphere of the recovery room has made me hone my time management skills. Either way it should be interesting, but not too interesting, if you know what I mean.

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Should a Nurse have a Mission Statement?

2008-04-16T14:32:26Z

I’ve been reading a lot of books lately on successful business strategies and the topic of mission statements often comes up.

It got me wondering, can nurses benefit from having a mission statement? Many of you already do, but you don’t even realize it. A mission statement can be derived from your philosophy of nursing. For example, what does being a nurse mean to you? What makes a good nurse? Answer these questions and there is the beginning of your mission statement.

Why Would a Nurse Want a Mission Statement?

Quite simply, because it adds meaning to what you do. This can be a great help, especially to those who are suffering from nurse burnout. If you take a moment to reflect on your mission statement, it could serve as a source of inspiration on those days when you just feel like you are just running around in circles, and not really accomplishing anything.

Here’s an example: As a recovery room nurse I often felt dragged down by all the repetitive, meaningless tasks that I was required to do (charting vitals Q 15 minutes, fetching ginger ale and crackers, removing IVs, etc). What if instead of dwelling on these things, instead I focused on the following mission statement:

For all of my patients, I am going to help them to be in control of their health care process.

This would include:

Making sure they know when and with whom to schedule a follow-up appointment.
Making sure they have the proper educational tools; e.g. if they have a nephrostomy tube placed, do they know how to care for it? If they have a pacemaker placed, are they aware of what the settings are, and what these settings mean?
Do they need copies of their lab values for their personal records?
Have the doctors answered all of their questions related to the procedure?

Sure, most of these things are part of the job anyway, but if I view them in the context of my mission statement, it might make my job more meaningful, and hence, more satisfying.

If you had to choose a mission statement as a nurse, what would it be?

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Cherokee Scrubs: A Test Drive

2008-04-07T11:29:30Z

Today I will be reviewing the Cherokee V-neck tunic scrub top and the Cherokee v-neck scrub pant, both in mandarin orange, from My Nursing Uniforms. It’s taken me awhile to write this review. That’s because there was something slightly unfavorable about these scrubs and I wasn’t sure how to approach it. The color I chose is a little bit “out there,” so to speak. It was described as Mandarin Orange, but I think a more apt description would be Safety Belt Orange. In fact, the first time I wore them, one of my not so tactful colleagues felt the urge to ask me if I had just gotten out of prison. My not so tactful husband asked me if I was going to work out on the roads that day.

Despite these snarky comments, I also got many compliments on the color. Whether these people were just being polite, or they think that neon orange is a good color on me, I will never know. I can safely say, however, that this shade of orange is definitely a conversation starter.

There are also some things that I really like about these scrubs and I would definitely purchase them for myself, but perhaps in a more muted color. What else did I like? Two things: the cut and the pockets. If you’ve read my other reviews, you know how I feel about pockets, I need them to do my job. The Cherokee tunic top actually has two deep pockets and an inner longer pocket that is great for storing pens. I also like the tunic cut. It is a little longer, going down a little past the waistline. The pants were slightly too long for me. They are mediums and I am 5′4″ and the hem drags on the floor.

All of this considered, I would definitely consider these scrubs PixelRN-worthy - just in a different color and a slightly shorter pant.

(In the interest of full disclosure, I will let you know that my friends at My Nursing Uniforms are compensating me for this review, although the compensation was not dependent on a positive or glowing review - what I am telling you here is my honest of opinion of these scrubs.)

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Chez Recovery and Beyond

2008-04-01T11:24:47Z

So two more weeks left of working at Chez Recovery, and I am ready to move on to bigger and better things. The funny thing is, after all the complaining I’ve been doing, the job is really starting to grow on me. I think this has something to do with the law of leaving a job - the closer you get to the end, the more you start to like it. I think it also has to do with the great group of nurses that I met there, and have really enjoyed getting to know.

Anyhow, I think my complaints can all be boiled down to 3 neat little concepts:

40 hours a week is too many hours to work as a nurse. 20-24 would be more like it.
I would like the job a lot more if I had some added responsibilities like say, training as a charge nurse. Since I’m leaving in two weeks, this most likely will not happen.
I am not sure I still have a passion for nursing.

I’ve been toying with the idea of picking up where I left off with web design, and thinking about doing some freelancing. I’d like to start setting up sites for businesses using Wordpress, and help these businesses to get more traffic by adding blogs, as well as other types of Web 2.0 apps to their sites. If you own a business and think you might be interested in this sort of thing drop me a line (Beth-AT-pixelRN-DOT-com) and we can discuss some ideas.

AND on another exciting note I am planning on relaunching OrientedX3, but in a in a much different form. More news to follow in the weeks to come.

And then there’s this guy. I’m looking forward to spending a lot more time with him. He just celebrated his first birthday and has the cake on his face to prove it:

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Listen to your Head Nurse

2008-03-28T10:00:21Z

And then, after all the bitching and complaining I’ve been doing about nursing, and all the bitching and complaining about people who complain about people who are bitching and complaining….

comes the voice of reason.

To anyone who is considering nursing, studying nursing, or just plain a nurse, go and read this post. Thank you, Head Nurse for putting things into perspective.

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Nurses: Let the Bidding Begin

2008-03-27T21:13:45Z

Here’s one approach to ending the nursing shortage. Nurseauction.com is a new site that features an auction style marketplace where nurses can bid for shifts that employers have posted. Also, nurses can post when they will available to work, and set their price.

As you can see, I’ve already gotten in on the action:

All kidding aside, I was irked lately by something an agency nurse told me. She said she was asked not to discuss her wages with her co-workers. My feeling on that was that it’s your business if you want to discuss your wages. If a hospital will pay a nurse $33/hour for a shift and an agency will pay a nurse $46/hour for the exact same shift, who are you benefiting by keeping quiet about it? It’s really no secret that agency nurses make gobs more than staff nurses. It’s a trade-off. You trade job security, upward mobility, benefits, and vacation time for higher wages. It would be interesting to see an open market like this one show what a nurse’s services are truly worth.

So if any hospitals administrators are reading this, and know that they will have a vacant shift on April 21st, I will gladly come and work in your ICU for $1893 an hour. In fact, I’ll be there with bells on.

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The Anger is Coming From Within

2008-03-27T20:20:07Z

I read this post last night and realized it could have been written about me. I certainly have been doing a lot of complaining lately. A nursing student reading my blog might think twice before continuing with their nursing degree. My question is, what’s wrong with thinking twice about something?

I’ve seen a lot of angry nurse blogs and it concerns me too, but I don’t think the answer is to discourage angry nurses from blogging. To me, angry nurse bloggers = angry nurses, and so there are a lot of unresolved issues within the profession.

John says: “By presenting such a negative picture of our lives, aren’t we, as nurses, beating up those who read our blogs who may be just starting in the profession, or worse, considering joining the profession?”

To me, this couldn’t be further from the truth. When I voice my complaints about the profession, I feel I am doing a service to my readers who are thinking about entering it. I am telling the real story of what it’s like to be a nurse in the hospital. My BSN program did their best to fill my mind with nursing theory, nursing politics, and nursing lingo, but they did very little in explaining what it is actually like to be a nurse, and for that I feel a little cheated at times.

Another thought. The majority of these “angry nurse bloggers” work in hospitals, and hospitals are where the nursing shortage exists. To suggest that all nurses who are unhappy should simply find another specialty, is not really going to do much in the way solving the nursing shortage. There are some very real problems with hospital nursing, and within our health care system in general, and these things issues need to be addressed, not hushed up.

Yes, working as a nurse is frustrating, even infuriating at times. But it’s also exciting, meaningful, and extremely rewarding. And you can find all of these points of view by reading nurse blogs.

Nursing students and novice nurses, take these angry nurse blogs with a grain of salt. People will always complain about their jobs, no matter what profession they are in. On the same token, I would encourage you to take these complaints very seriously because they are real and legitimate. Perhaps a new generation of nurses is needed to actually change things, and to create an environment where nurses aren’t so angry all the time.

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Makeover Madness

2008-03-19T15:57:31Z

Let’s face it. I’ve been blogging about some pretty frustrating topics lately. I think it’s high time we start having some fun around here. With that in mind I will offer you the following warning about this post:

a. It’s not at all about nursing,
b. It may entice you to waste huge amounts of time,
c. It’s unabashedly girly so if you’re not into that sort of thing, feel free to check back later.

So some of you may have noticed that I created a new profile picture. In the process of doing so, I came across this incredibly addictive site, Taaz.com. It’s basically a site that allows you to upload a picture of yourself, and then try out different make-up and hairstyles.

So my first instinct was to try it out and see if it really worked, and I was pleased to see that it did! You can add lipstick, eye make-up, and foundation, and it actually looks somewhat real:

But then I got all crazy and tried to make myself look like a goth girl. Instead I think I ended up somewhere between Loretta Lynne and Kate from the B-52’s:

Then I got even crazier and started photoshopping my new goth girl look:

And now I’ll probably spend the rest of the day playing with this totally addictive site, because that’s just the kind of self-absorbed girl that I am. Hey, at least you will be spared another rant as to why I want to leave nursing, right?

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Follow the Money

2008-03-16T20:42:02Z

At the end of my rant about sloppy physician’s orders, I asked the question, “How do you get beyond that kind of apathy?”

May, whom I have a great deal of admiration for, said,

“i know that clearly looks like apathy, but it could also mean something else. i maybe apathetic about the issue, but i know i still want to take care of sick people most of the time, despite the challenges…”

May, I want to thank you for reminding me that the nurses I work with are very caring and compassionate people, and so apathy may not be the right word to use at all.

Perhaps it’s simply a matter of economics.

So the nurses have voiced their complaints. They have staff meetings, they have a nurse manager who supposedly advocates for them. So why does nothing change? Perhaps it’s just the balance of economic power that exists within the hospital.

Doctors who do expensive procedures bring big gobs of money to the hospital, therefore they have power. Nurses, on the other hand, don’t really bring any money into the hospital and so they have very little power.

It’s a very simple concept: money equals power. You can complain all day long about doctors who are sloppy about writing orders, but what incentive to they have to listen to you? I suppose one incentive is that they might miss out on having a top-notch nursing staff, because they will only attract nurses who will put up with sloppy orders, but does that really matter to a radiologist or an interventional cardiologist?

Maybe not. It doesn’t take much to do my current job. I monitor vital signs, and I tell people to lie flat until their groin site heals. I hand out generic discharge instructions. I occasionally transport a patient to the floor. It’s pretty simple stuff.

That’s not to say that I don’t work with some top-notch nurses in the recovery room. Quite a few of them are excellent. But I think the reason that most of them work there is because it’s a wonderful thing to have a nursing job with no night or weekend requirements.

So what’s my point anyway? Why am I complaining? Why am I so frustrated?

Mark Graban made an interesting point: “It requires Leadership! This isn’t something that Lean can solve if there’s not leadership and a drive to fix problems like this.”

Unfortunately, I have no desire to be some sort of visionary leader who will solve all of the problems in the recovery room. Rather, my instincts are telling me to get as far away from the recovery room as possible. Maybe the answer lies in the fact that my job would be vastly improved if we used a CPOE system. And yes, I have thought about working for a company that sells CPOE programs, because I am truly an evangelist when it comes to using them.

Hmmm. Now there’s something to think about.

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