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Nursing

Treehugger By Kilgore, RN

By | humor, Nursing, Uncategorized | No Comments

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Every nurse encounters poop. Like, lots of poop. And this, friends, is a poop story.

Pt. was admitted to the Medical ICU for a series of TIA’s; he had already suffered multiple strokes before this admission, and resided in an assisted living home. He was not as well tended as he should have been there, and that trend followed him here. I normally work in the CVU, but because our unit was short on patients (“low census,” for the uninitiated), I “floated” to MICU and took care of Patient. I took him from Odessa, another CVU nurse, who had received him from Jimmy, my partner in crime. In his entire admission, he had not once been cared for by any of the native nurses. My guess is that the charge nurse, Heidi, didn’t think we were up to the usual medical disasters present on the MICU (her words to me: “Well, we don’t want to give you anything too hard.” Wow, you’re right, I’m probably stupid. Fuck you too, lady.) Hence, Patient was being handed to the floats because he wasn’t challenging or sexy enough. Whatever. For once, I knew I would get a lunch.

We had a good day, and yes, it was easy to care for him; I felt badly for the regular staff on the unit because they were working unbelievably hard compared to what I was doing. Toward the end of the shift, I received news that Patient was being returned to his facility. I went in to share the news with him that everyone thought he was stable enough to go home. Before I got a single word out, he stared at me dolefully and moaned, “You know, my stomach is just killing me.” I immediately stopped and gave his belly a listen, then pushed on it a bit…damn. It was kind of firm, more so than when I had assessed him previously. I asked him if he felt like he needed to poop, and if he had been passing gas lately. He was bed-bound, so I wasn’t too surprised that no one knew the last time the poor bastard had gotten the pleasure of unloading.

I took a deep breath. Of course, it was 1800, and I was supposed to be preparing his transfer paperwork. But damn it, a man’s gotta move the mail sometimes. Apparently, 1800 with transport en route was that time.

I explained disimpaction to him. He didn’t care, he just said “please, just help me.”

Gloves. A heavy duty chuck (which is a really absorbent pad…sort of a “pee pee pad” for people). Wipes. Surgilube. A garbage can. It was on.

I asked him to try one more time to push on his own. I may be the Brown Queen, but that doesn’t mean I want to wedge my fingers in anyone’s ass. He was unsuccessful, grunting and sweating and groaning all the way.

GO TIME!

I started working on the dry matter. Some poop made its way. Then…he started pushing again.

We had busted the dam.

I had never seen anything like it, and I haven’t since. It was HUGE. The size of a small baby. I am not exaggerating. I was immediately angry that no one at his home had even noticed that he hadn’t notably crapped recently, but relieved I caught it…so to speak. Technically, it had actually landed on the chuck. At least there was no cord to cut.

Another nurse had noticed at this point that I hadn’t been out of the room for a while and came to check on me. Her head popped around the privacy curtain. “Are you okay in here?”, she asked. “Yeah, I’m fine, but I could use a hand getting my friend here cleaned up.” My voice was calm, but I was jerking my head back to urge her to LOOKIT THIS GIANT DOOKER, OMG. She came around the bed to where I was, frowning…and then she saw. Her eyes got big, but in her best nursing voice: “Sure, I’d love to help you. Are you doing all right, sir?”

Honestly, we sound like airline stewardesses in turbulence.
More coffee? SkyMall magazine? A bit of the Finger?
It’s just a little turbulence. We only dropped a few dozen feet.
You only shit a cinder block. It’s fine now.

God. Patient was so happy. I’d swear his grips even improved on his weaker, affected side. He said “thank you so much” at least four times in the time it took me to clean up and wash my hands.

After we got Patient situated, did I do my paperwork? Did I call report to his home? Nope. I texted Jimmy.

“didn’t you have the guy in room X yest?”
“yep, why? is he ok?”
“i just disimpacted him”, then
“omfg, it was like a sequoia log”

Patient went home a new man.

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Fox News SLAMS Nurse Practitioners. How quaint.

By | Healthcare Policy, Nurse Politics, Nursing, VA Nursing | 10 Comments

How do you know an organization knows NOTHING about a subject? Click the big text and watch this video:

VA takes heat over plan to let nurses treat vets without doc supervision

These people are insane.  Twenty-one states have given the GIFT of primary care to their residents by allowing NP’s to practice independently.  The veteran population has so far been denied the choice of a nurse practitioner as a primary care provider, and the VA is said to have long wait times.  This is the obvious solution, and a choice I applaud the VA for making.  And Fox News makes a skewed report that makes it look like *I* will be practicing primary care at the VA next month? “Nurses will have their roles expanded”.  No.  Highly trained Nurse Practitioners will be allowed to practice at the level twenty-one US states say they are able to practice.  And now Veterans are ‘settling for a nurse’.

Really, Fox News? Really?VA-health-care-scandal-590x442

Be clear, the VA is taking no heat from me on the subject.  I am a VA employee and I do not agree with some of their policies, but this one is spot on. I am a veteran and a nurse, and I would be totally OK with a nurse practitioner taking care of my primary care needs at the VA.  As a matter of fact, I am now going to make it a point to register for VA health care. They take my insurance, and it would be extremely convenient to see someone in my building for primary care. Less sick time, less travel time, less wait time.  Everyone wins, especially me.

Even if you are opposed to Nurse Practitioners privately practicing in standalone clinics, the VA is a wonderful environment for NP’s.  There are all kinds of resources, and a physician is a phone call away.  All specialties are represented, and the VA Nurse Practitioner can get patients in to see specialists when necessary, with seamless continuity of care. Patients get their medications from an in-house pharmacy, and the VA Pharmacist has access to the patient’s medical record if there is a question about the dosage or choice of a particular drug.  This is the perfect situation for Nurse Practitioners; they are able to practice to their greatest ability, and they have backup.  Everyone wins – Especially the patient.STLHealthcareSystemLogov2

What people do not seem to understand is that the VA is actually held to way HIGHER standards than the private sector. We are taking care of our veterans, to whom we owe our very lives, so this is appropriate. It may take you 3-4 months to get in to see a new Primary Care Physician in the private sector.  The VA is required to get the new patient seen within thirty days.  Not only that, but if we are unable to get patients seen within thirty days, we run the risk of being dragged through the mud on Fox News.  In the private sector, nobody would be looking and the media would never be told about it. That is the difference between wait times in the private sector and the VA.  Public knowledge.

3e487c3Yellow Journalism at its finest.

I have seen ‘surveys’ of veterans who say they want care outside of the VA on the news.  I want to meet these people and see how random the surveys were.  As stated, I work for the VA.  I have so far had one patient say they wanted to go outside the VA for their healthcare.  The rest of them generally say something along these lines: “I know that I hear a lot of bad stuff about care at the VA, but i’ll tell you, they have always treated me great!” I have scheduled veterans who have insisted on driving four hours to our VA Hospital for a procedure, rather than having the procedure done close to their home because they TRUST the VA. 

Odd how that happens.

Thank you, Secretary McDonald for allowing us to further improve VA healthcare by providing even greater access to primary care.  Our veterans deserve it.  Thank you for utilizing Nurse Practitioners to help veterans get the best care anywhere.

 

Love,

 

Janie

 

 

 

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Spreading the Gospel of Ratios

By | Advocacy, Events, Healthcare Policy, Nursing, professional, Unity, Workplace Safety | 4 Comments
zdogg

ZDoggMD, representin’.

Huh. Who knew staffing ratios were a big deal?
Oh, right. WE DID.

Nurses everywhere have taken up the call—staffing ratios impact the care and safety of our patients, and keep the profession from burning out and getting hurt on the job. Even a certain Dogg knows it. (See Z-DoggMD’s AMA here.)

(ZdoggMD is on fleek in our Staffing Ratios Matter shirt. Get one here.)

We’re waking up and ready to destroy the current paradigm: doing more with less. SHENANIGANS, Y’ALL. All chronic understaffing has done is increase the rates of morbidity and mortality, and decreased professional satisfaction—which means fewer nurses stay at their jobs…which means fewer nurses are at work…which leads to more injury and infection. Instead of the Circle of Life, it’s the Spiral of Disaster.

Let’s tell our administrators, CEOs and legislators what we know to be true. Are we cool with staffing ratios that endanger patients, decimate the health care worker population and and ultimately increase cost of care? NOPE.

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Kelsey R. of yourheartismine.net. She knows what’s up!

Here’s what you can do:

  • Tell your health care friends, teachers and students about how unsafe staffing levels increase the number of adverse patient events, up to and including death
  • Also mention that it can increase the number of workplace injuries
  • Invite them to join us in Washington on May 12, 2016
  • Or, attend a state capitol event on the same day
  • Share this press release with your colleagues, coworkers and friends: http://smysofficial.com/advocacy/safe-staffing/
  • Get the Staffing Ratios Matter Shirt & rock that thang! It’s the Little Shirt that Could. It’s everywhere, and it’s back on sale. Order here.
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Let’s talk about stereotypes, and double standards. The ‘sexy nurse’

By | Nursing, professional, Unity | 6 Comments
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Sexy Nurse Basketball Cheerleaders.

We ran into a little double standard today on SMYS, and I would love to talk about it. A guy complained about a picture of barechested guys, identifying as nurses.

Ok, everyone knows I hate the sexy nurse thing.  I. Hate. It.  I try to swallow my feelings because others (non-nurses mostly) think I am very sensitive about it, and I do not like to force my beliefs on anyone.  I had to go on autopilot last Halloween.  The sexy nurse costumes actually cost this group hundreds and maybe thousands of good members, but I didn’t want to add another restriction to the list.

We were all in agreement about the sexy nurse toddler shirt, as it was pretty disgusting. Because making CHILDREN sex objects is just not ok on any level.

At the very beginning of the “Show Me Your Stethoscope” phenomenon, we lost perhaps MORE members than that because of the guy nurse ‘beefcake’ pictures.  There was a nurse who got so many likes on a barechested picture of himself that he imploded when I deleted it (because I felt it was marginalizing male nurses as sex objects, and him in particular).  He was horrified that I deleted his picture, because it got so much attention.  Quite honestly, I am sure he got a lot of attention in his real life, based on that picture. I had a hard time relating.  It is possible that I was insensitive.

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Washington DC Party with SMYS. Flo Approves.

But here is the thing…. There IS a ‘sexy nurse’ stereotype.  I have had patients and physicians mention it.  It is kind of icky.  I feel like it robs our profession of the respect we deserve.  The short vinyl skirt and nurse’s cap are insulting.  It is someone pretending to be a nurse and sexualizing the profession.  We go INSANE when someone impersonates a nurse, but we are not bothered at all when it is accompanied by sexualization? Weird.

A member who we will call R.B. recently posted a ‘shower’ picture showing his safe staffing bracelet.  I found it hysterical, but was that because he was a guy, or because only the back of his shoulder and his hair were visible?

So, is it ok to post barechested pictures of yourself in a healthcare group, identifying as a nurse? I don’t mean ‘is it morally ok?’ or ‘is it ok according to my religion?’ or ‘is it ok with me aesthetically?’.  I mean, is it ok for the profession? Does it perpetuate a stereotype? Does it marginalize nurses? Does your action actually impact the way nurses are seen by the general public?

I know, right? A lot to think about.  You thought you were just showing us the awesome muscles you got at the gym, folks! 🙂 Why is it ok to sexualize MEN in nursing, and not women?

Discuss. Halloween is coming around again.

 

Love,

Janie

 

 

waldenu_minitypeakesso_ad

 

 

 

 

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But are you satisfied with your care?

By | Nursing | One Comment

Having worked in ER and ICU for the majority of my nursing career, I am used to being around some pretty sick people. It’s my happy place. My security blanket, if you will.  When I mentioned taking a desk job not too long ago, my husband’s mouth dropped open in shock.  His statement? “Janie, you will DIE OF BOREDOM if you are not around someone who could drop dead any second” .

care2I hope I don’t give off that vibe. 🙂

Quite some time ago, in a hospital far, far away a nurse took care of a patient in septic shock.  The patient arrested in the department right in front of her, and she can recall the snapping of ribs on her first chest compression.  Naturally, she winced a little, however, it is one of those necessary evils when saving a life sometimes.  Studies show that up to 97% of patients sustain rib fractures with CPR. They rarely cause any internal damage, and are usually completely uncomplicated.

There was a complication this time.  

The complication was that the patient was absolutely livid that her ribs were broken during CPR.  She completely recovered, by the way.  It wasn’t even a terribly long hospital admission.  She did REALLY well.  However, according to Nurses in the unit she transferred to, she had frequent complaints about how ‘That person doing CPR’ manhandled her and broke her ribs. She complained about not being treated ‘gently’.  She actually wanted to “Write a letter about how that person needs better training”. Luckily, a couple of the nurses and docs made sure she understood she was lucky to be alive.

So…..

As we all know, slow, gentle chest compressions are useless. The nurse’s chest compressions (and those of her coworkers) were properly fast and effective.  The patient lived. So why was she fixated on her broken ribs?

Because it HURT..  She was scared about what happened and fixated on the broken ribs. I get it.

And she did eventually (a few days)  stop complaining, laugh at herself, and realize that she had not been gently handled because it was not possible.

My question is….. what do you think she said on her patient satisfaction survey?

I guess it doesn’t matter, because she lived, so the goal was achieved. But it could financially matter to the hospital.  Satisfied patients are not necessarily the ones who got the best care.  This patient had no idea that broken ribs were a normal side effect of CPR.  She had to be educated repeatedly about it.  And she also expected to have a hospital experience with absolutely no pain.  NONE.

I think we might need to get better about educating the public that medical procedures are rarely completely painless. care

 

Love,

 

Janie

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