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!
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?
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