Tuesday, November 20, 2012

Vietnam Nurses

I pretty much failed in my attempt celebrate veteran nurses last week for a Veteran's Day tribute.  Honestly, I just couldn't come up with the right words to talk about the nurses who served in Vietnam, my admiration of them is so big.

Back in the 1980's when I was working at Children's Hospital Los Angeles, I was introduced to some nurses who served in Vietnam during that war.  They had come to the hospital to speak to the nursing staff as a part of a Nurse Week celebration.  These nurses mentioned two books that changed my life and that I highly recommend. 

"Home Before Morning" was written by Lynda Van Devanter.  She tells her story so poignantly, it is phenomenal.  I also suggest "A Piece of My Heart", the story of 26 women who served in Vietnam. 

Nurses were sent to Vietnam unprepared for what they would have to do and then they were asked (told) to do things that nobody had ever considered that nurses should be doing.  These nurses, who basically made life and death decisions completely on their own in Vietnam, returned home to find that nursing here had not moved at the pace they had, they had no autonomy and struggled to fit in to the health care environment they had desired to be a part of when they went to nursing school.  They had no support, were given no credit for what they had done, even treated like criminals for the work they did to save lives and to provide soldiers with a dignified death.  They are heroes.

I have both books, you are welcome to borrow them.  You won't be sorry.

Saturday, November 17, 2012

Chocolate - We Always Knew It

Chocolate prevents strokes and heart attacks.  This is not news to nurses, we have snacked on chocolate for our health all along - right? 

The November 2012 issue of Bold Voices, an American Association of Critical Care Nurses publication, reports two published studies that show a link between high chocolate consumption and reduction of stroke and heart attack risk. 

Great news just in time for the height of the chocolate season!

Thursday, November 15, 2012

Nursing Superstitions

I don't mind when a black cat crosses my path and I've broken many a mirror without a care, but when it comes to nursing, I'm pretty superstitious.  I get nervous when someone uses the Q-word (you're nurses, I don't need to spell it out), I think a slow start to the shift means the end will be nuts, and if we drag out the ECMO machine, we don't put it away just because we hear the patient might not come.  Here are a few more of "rules" I try to follow to avoid to ward off trouble:

- Asking for a specific assignment always ends in disaster
- If someone asks you to trade assignments or float for them, always say yes
- Never ask someone to trade or float for you
- If you say out loud that you're happy you got the "good" patient and someone else got the "less-good" patient, your patient WILL code.

Occasionally, I test my superstitions by forgetting my rules and I'm always sorry.  Do you have nursing superstitions?

Monday, November 12, 2012

Starting IVs - Thank you World War II

It happens often, the rules during war are different than the rules before war.  Before WW 2, IV therapy was the domain of physicians.  Starting an IV meant piercing body tissue and this was considered to be out of the nurse’s scope of practice. 
Nurses who served in WW2 started IVs and administered IV therapy out of necessity.  They returned home to find out that it was actually illegal for them to place IVs in some states.  To be fair, IV therapy in the 1940’s looked much different than it does now.  IV catheters were hard metal tubes that had to be sterilized and sharpened after use.  Veins were often accessed via cutdowns – something us oldie goldies are familiar with.
It took until the 1970’s until IV therapy became the domain of nursing.  From the 1940’s to the 1970’s, the idea of nurses performing venipunctures and administering IV therapy was debated by nurses, doctors, and hospital administrators.
In the end, I’m sure it was a financial decision – cheaper to have the nurse who was already there start the IV than call in a doctor. 
So this week we are grateful for disposable, pre-sharpened IV catheters and thank the nurses of WW 2 for leading the way!

Sunday, November 11, 2012

War and Nursing

On Veteran’s Day, it is only fitting that we consider and thank all of the military nurses who have served and continue to serve.  In addition to the influence they have and had on our country, we thank them for the influence they have had over our daily practice.
Nursing practice is tied to war.  Many of the practices, interventions, and actions we perform as nurses and take for granted as a part of our profession came about because of war. 
In fact, the very foundation of our profession is credited to Florence Nightingale and her work during the Crimean War.  In the first of many post-war changes to the nursing profession, Florence is recognized for creating the first “real” school of nursing, the original program upon which the education we all received is based.
I hope you will indulge me this week while I attempt to celebrate the contribution of veteran nurses to the knowledge and privileges we experience today.
Happy Veteran's Day

Saturday, November 10, 2012

Where Are My People?

A patient’s family member remarked to me that he didn’t realize how much work it is to be a nurse.  I must have looked confused because he went on to explain that he knew nurses had to know “a lot about medications and stuff” but he didn’t know that nursing is so “physical”, as he put it.  He paused and clarified again that he assumed nurses were on their feet all the time but didn’t think there was so much lifting involved. 
Then he said my favorite line of the month, “I just figured you had people to do that for you.”

Thursday, November 8, 2012

Do You Know Cherry Ames?

I have a passion for vintage books about nurses – just ask my PICU friends who were forced to read vintage Harlequin romances about nurses one year for Nurses Week.  One of my favorites is the Cherry Ames series.  The series started in the 1940’s and ran through the late 1960’s.  In that time, Cherry had about 23 jobs.  She was a major job-hopper.  

Cherry paid her dues, she spent some time in the Army right out of nurses training (they got trained back then, kind of like monkeys) and then worked nights – even supervised on the night shift. Note her supervisory look of concern for the angry gentleman patient: 

Quite the single girl on the move, Cherry had some great jobs and the occasional fling with a young good-looking doctor, but she never really settled down.  Cherry is my hero.  Two of the best jobs she had, I think, were her stint as a Dude Ranch Nurse…
(I guess all of her flings were not with doctors - she's giving that cowboy the eye)
…and Department Store Nurse.
Seriously, I would be a GREAT Department Store Nurse!

Wednesday, November 7, 2012

The Magic Food Counter

“Don’t throw that out,” I said to my husband, “I’ll take it to work.” 
“Nobody’s going to eat this old candy,” he said, “or want this open box of Wheat Thins.”
Of course they will, they’re nurses!  I’ll just put it on The Counter.
No matter where we work, we all have that one counter that magically turns unwanted food items into culinary delights.  Six-month-old Halloween candy that was deemed inedible even by the kids is suddenly a rare delicacy.  Leftover half-stale cookies transform into tasty treats.  Shriveled up Peeps that the dog turned up his nose at now look like the perfect mid-morning snack. 
To nurses, anything left on The Counter is fair game.  Don’t set a box of Girl Scout cookies you just bought from a mom on another unit there and think it will be intact when you get back.  It won’t.
Food from The Counter even tastes better than other food.  Somebody’s brother’s mother-in-law’s birthday cake from last weekend melts in your mouth when wolfed down between getting call lights while standing and eating it with your hands.  That plain-cheese-caramel popcorn that comes in a tin is the lamest imaginable gift from your neighbors when they drop it off at your house; placed on The Counter, it is a culinary delight. 
Another nursing phenomenon, the power of The Counter.

Tuesday, November 6, 2012

Animal! Animal!

A friend was working in an infant cardiac unit one day when some nurses from South America were present on the unit to observe; they had a limited ability to speak English and were just sort of standing around and watching the nursing staff.  My friend was assigned to care for a baby with a heart defect who was sleeping in an overhead warmer and was covered by a hospital-issue blanket that had little teddy bears.
One of the observing nurses pointed to the baby and said “animal!”  The PICU nurse responded “oh yes, we have cute blankets here with little animals on them” and turned back to the computer she was working on.  The observer pointed again at the baby and said “animal!” and the nurse, who was trying to concentrate on finishing her charting gave a half-hearted smile, a nod, and an “um hmm” to the South American nurse. 
At this point, the observer gave an even more emphatic “Animal!  Animal!” to my colleague who got frustrated enough with this exchange to get up and walk the few paces to the warmer. The PICU nurse looked down at the warmer to see the “animals” the observer was talking about – a line of ants walking across the baby’s blanket!

Monday, November 5, 2012

What Do Nurses Do?

            My first true realization that people have no idea what nurses do came at a bar in Dallas.  I was on a travel assignment in that city and went with a group of travel nurses out for a drink.  One of the nurses in the group had chosen a travel assignment in Dallas because her boyfriend lived there; the boyfriend met us at the bar with some of his friends.  When he introduced us he said something to the effect that we were all nurses and then asked his friends if they knew anything about nursing.  “You can’t believe it,” he said incredulously, “they really work hard.  You’d think they only hand out pills and give people bedpans, but they really have to know a lot.  They even have to tell doctors what to do sometimes!”  He said this with great enthusiasm and awe.  It was obvious that he was proud of himself for having figured this out.
            I don’t remember much else about that evening out.  Oh, except for the fact that my roommate wore a corduroy skirt and a plaid sweater, and when she walked up to the bar, before she could order her white zinfandel, the bartender said “you must be the designated driver.”
            Do people have any idea what nurses really do?  I don’t think so.  Even the patients we are taking care of only see what we physically do for them, they don’t see the “behind-the-scenes” work of constant communication with other members of the health care team, evaluating each medication, coordinating tests and procedures, or the critical thinking behind each step we take.   Patients and families sometimes make comments about how busy we are and how hard we are working, but they most likely have no idea of what this work truly entails.  
            There are many nursing theorists who have described the work of nursing, but I have trouble understanding them so I don’t think it would be wise to share these theories with the public; I doubt it would lead to a better picture of what nurses do.  Nursing is, I believe, an unexplainable phenomenon that is understood only by nurses doing nursing work.

Sunday, November 4, 2012

Don’t Ask Me How I Know…
Country singer Bobby Pinson gives advice based on how to live our lives, suggesting we learn through his mistakes.  Unfortunately, after my many years of nursing, I have my own “Don’t Ask Me How I Know”…
Don’t intubate your patient because of low O2 sats until you check that the oxygen tubing is actually connected to the flow meter…don’t ask me how I know.
When your patient’s arterial blood pressure is sky high, before giving astronomical amounts of pressors or sedation to bring it down, look for the transducer on the floor…don’t ask me how I know.
If you call in sick to go shopping with a friend, you will see your Nurse Manager at the mall…don’t ask me how I know.
If a patient says the pink pill looks a lot bigger than the one they take at home, take it out of the cup…don’t ask me how I know.

What are your don’t ask me how I know moments?