Pen Love

We do have a rather strong attachment to pens, don't we?  Or is it just me?  I don't think so. After all, I've given report to you with your pens lined up like little soldiers next to you, I've seen your work bag overflowing with pens.

Some nurses like to have a lot of different pens with them at work, different colors and different types - ink pen, mechanical pencil, highlighter, Sharpie.  (Don't even get me started on Sharpies - my attachment to Sharpies is so unhealthy that I hoard them in a drawer at home, won't even take them to work).

I'm more of a one-pen-at-a-time nurse at work, but I protect that pen with my life while I have it.  I won't even let patients touch my pen to sign anything, I take them one of those generic pens from the nurses station. 

We even talk about pens, don't we?  "Hey - that's a great pen!  Where did you get it?"  We discuss and debate the merits of fine point over medium point (I'm a medium point nurse myself).  Yep, pens are a part of our nursing culture.

 Nurses and pens, a match made in heaven.

The Miracle of Movement

I continue to be amazed at the power of mobility for patients.  There has been a lot of talk in the journals lately about early mobilization for critically ill patients, it's becoming the standard of care in ICUs.

One of my cousins had emergency major abdominal surgery several months ago and her mom, my aunt, wrote in an email to the family that she was shocked and concerned that the nurses wanted my cousin to get up and walk when she was obviously in horrible pain and just had emergency surgery and could we believe that?  Yes, I could believe it - and wasn't my cousin lucky that she had nurses who know about the power of moving.

I'm a recent convert to the mobility miracle.  But, I'm a believer now because I've seen it work.  Patients have less pain, they sleep better, and they get back to their lives faster when they get up to walk.  Walk early, walk often. 

I asked a co-worker about why getting out of bed right away after heart surgery seems to help these patients so much and she said it's because "they realize they're alive".  I agree with that, but I also think that getting out of bed shakes everything back into position.  We're not meant to be lying down, we're meant to be upright (shoot, I know, lying down is soooo much more fun).  Our innards get all messed up when we stay in bed too long, we have to jostle them back to their rightful place.

Bodies in motion stay in motion, right? 

When It's Someone We Know and Love...

As nurses, when we have a family member in the hospital, it is very comforting to know that the nurse caring for them is someone we know.  I know this because a very good friend had a family member in this hospital this week under the saddest and worst of circumstances and she was so comforted by the fact that the assigned nurses were long time friends and co-workers.

For the nurses caring for the patient, it is another story.  When the outcome is not good, when the circumstances are sad and complicated, it makes a challenging situation so much more so.  I know this because I saw it in the nurses' eyes.  When I commented that I appreciated how hard it was for these nurses, I saw tears and pain.  It was impossible for the nurses to protect themselves, they were involved in the pain and sadness. 

We are supposed to have empathy, to express our caring but also maintain professional distance.  When it's someone we know and love, when we know our friend and co-worker is going to experience a horrible loss, that all goes out the window. 

Everybody Needs A Nurse

I've heard it said that every woman needs a wife and I'm pretty sure that's true (sorry guys, but it's true that being the husband is the easy job...in my next life, I want to be the husband).  But, wouldn't it be great if we all had our own nurse?  

Someone to handle things, coordinate healthcare, review medications, intervene to catch near-misses, and listen? I could get on board with that.

It's 2013 and patients still don't understand that it's not their doctor that gets them better, it's their nurse.  I'm not knocking doctors, mind you, but I think we all know that if health care was left to the docs there would be a lot of orders and not much actual care.  Especially in the hospital.  If all patients needed was a doctor, they could just go to the office.  Patients come to hospitals because they need nurses.

Yet, nursing care is still included in the room and board charge for hospitals.  Why is this?  Here's my theory on that:

Have you ever seen those reports that come out every now and then and try to put a value on the work of a stay-at-home parent?  The numbers are always astronomical and it's clear that nobody could ever actually afford to pay a stay-at-home parent what they are worth.   I think it's the same with nurses.  Our work is included in the room-and-board charge because nobody would ever actually be able to pay us for our true worth.  

That being said, I wish I could afford a nurse.  Everybody needs their own nurse.

The Vein Dance

Today a co-worker asked me to start an IV for her.  She had tried once and another nurse had tried twice.  I got lucky an got the IV. What a great feeling!!

It won't last. 

Tomorrow I'll be asking someone to start an IV for me after I've missed twice.  That's the way it is with IVs.  Some days you can't hit a vein with flashing arrows and a sign that says "stick here"; some days you you can put a catheter in a rock with your eyes closed.

Don't you wish patients understood this?  Don't you love it when they suggest that you go get the doctor to start their IV?  Don't you love it when they tell you that the phlebotomist had no problem getting a vein yesterday? 

Sigh. 

Oh well, today I was the IV starting equivalent of the windshield.  Tomorrow, I'll be the bug.

Here In The Real World

Reality Shock is what happens when new graduate nurses enter professional practice for the first time and realize that it has absolutely nothing to do with what they learned in school.  I remember it well, even though I've been out of school a long (long, long) time.  I remember my preceptor, Cindy, standing next to me and telling me that I'd better hurry and put the blood I'd just drawn from a heparin lock (that's how long ago it was, we had heparin locks) into the tube before it clotted.  I must have looked like an idiot because I was thinking:  what tube?  how do I get it in there?  what happens if it clots?  you can draw blood from a heparin lock? WHY DIDN'T THEY TEACH US THIS STUFF IN SCHOOL???  I had no idea what I was doing and I was experiencing a serious case of Reality Shock. 

I also remember the first day things came together for me.  The six to eight months in between these two days are mostly a blur with tiny little vivid moments of terror. 

Awhile ago I watched a new nurse trying so hard to do assessments the way he learned in school, the long way, while his preceptor explained that doing them that way won't work if he ever wants to finish.  And he may not have cared at that moment if he ever actually finished, but she's been a nurse for awhile and she definitely wants to get done.

It's not the new nurses fault, it's nobody's fault, it's just the way it is.  The problem is that it's virtually impossible in nursing school to actually explain how it's going to be after nursing school.  Nurse educators have to teach things the way they would be in a perfect world.  Unfortunately, as nurses, we work in the real world. 

The Nursing Freak Show

Once at a carnival, I paid 25 cents to see a headless woman.  Yes, I was an adult at the time. No, I'm not proud of it. I paid my quarter and went up a set of steps to stand on a platform which looked into a space where a "woman" sat in a rocking chair moving her hands while a supposed ventilator breathed for her through a metal cap on her neck where her head, if she'd had one, would have been.  

It was lame.  Like I said, not my proudest moment.  

This got me thinking that as nurses, we could probably put on our own show at a carnival.  You know, charge money to see some of our "oddities".  

Like...

The world's largest bladder.

The world's largest collection of alcohol wipes.

The world's largest pen collection.

The world's sickest humor.

The world’s fastest eater.

Step right up, folks!  It’s our own little nursing freak show!  Can you think of more?

Lunchtime Follies

I'm convinced you can tell how long a nurse has been a nurse by their response to this question:

"Do you want to go to lunch?"

The novice nurse will tell you "No, I can't. I have charting/meds/dressing change/admission/discharge to do before I can go to lunch" the first four times asked.  Then, after being threatened with no lunch on the fifth time asked, this nurse will develop an apprehensive facial expression and finally hand over a clip board that rivals the thickness of that first med-surg textbook we had in nursing school, give a report so detailed it would allow the covering nurse to publish a biography of each patient, and, after a few more threats, walk hesitantly from the unit.

When asked if he/she wants to go to lunch, the experienced nurse will ask someone to take over doing compressions, throw a crumpled report sheet at the person who is covering, and run from the unit like a bat out of hell. 

Now a short quiz:

You return from lunch and the nurse covering for you looks surprised to see you and says "I guess they were okay.  Nobody called for anything."

This nurse is:

A. Novice
B. Experienced

Don't Be a Pill

I love a good pill-taker.  Doesn't it just make you happy when you take a medicine cup full of pills to a patient and they throw them back like a jigger of tequila on $1 shot night?  Don't you just want to hug that patient?  Sometimes I feel like skipping out of their room, it's such a nice treat.

I know swallowing pills is hard for some people (read: my husband) and I feel for them, but, seriously, it's  painful to give a patient 20 pills one-at-a-time. And they never just take the pill from you; they pass it from hand to hand, lay it down on the bedside table and pick it up again, think about taking the pill, ask you for more water, and, inevitably drop a couple on the floor so you have to start all over again. 

Taking pills should be a skill that is mastered before being allowed out of elementary school.

Thank you, good pill-takers, and consider yourself hugged.  This is me, skipping away...

Let Me Tell You A Story

You have to kind of feel for the family members of nurses.  We just aren't that interested when they get mildly hurt or a little bit sick.  "Hmmm.  Take some Tylenol" we respond when they tell us they have a headache/throatache/sore back. We have to see a LOT of blood before we get excited. "Don't bother me unless there's an actual arm or leg off" we say when the kids whine about a paper cut.  Little do they know that if there is an actual arm or leg off, we'd probably snap a few pictures of it and share it with our nurse friends before we sought medical help for it.

I won't reveal any names, but I have several nurse friends who blew off their child's complaints of arm pain for days, even weeks, before taking the kid to the doctor and finding out the arm was broken.  I'm not judging, mind you, it's just an observation.

It can be rough growing up as the child of nurse.  We've seen and heard too much, we know too many stories, we know what can happen in the blink of an eye.  Not only are we unimpressed with minor injuries but we won't let our kids do the stuff other kids do.

One of my nurse friends from PICU used to tell his kids stories about injuries he saw at work whenever they'd ask to do something or get caught doing something somewhat dangerous.  "Let me tell you a story..." he'd say, when the kids ran around the pool, got on their bikes without helmets, or wanted to play outside in a thunderstorm. 

I used to feel bad when my husband or kids told me they felt sorry for my patients because I'm obviously a very mean nurse, I won't even ooh and ahh over a scraped up knee or bruised finger.  Now I don't.  "I've seen worse", I say, "let me tell you a story..."

Say What?

Yesterday I took care of a patient who was VERY hard of hearing.  I had significant trouble communicating with him; as in, he had no idea what I was saying.  So this morning I did some research on what I could have done to make things better (yes, I know, a day late...).

It turns out I did virtually everything wrong. I yelled (talking loud actually distorts the sound and makes things worse), I stood too close, my pitch was too high, I talked too fast, and I did not wear bright red lipstick. 

Yep, the source* I looked to suggested that when teaching older adults with hearing loss, women wear bright red lipstick and men wear lip gloss.  Why should the guys wear lip gloss and not wear bright red lipstick?  I have no idea.  Apparently hearing impaired adults can only hear women with bright red lipstick and men with lip gloss.

* Bastable, S. B. (2008). Nurse as educator: principles of teaching and learning for nursing practice. (3^rd ed.). Syracuse, NY:  Jones and Bartlett

Do You Advertise?

When I'm out and about I get asked frequently if I'm a firefighter.  I'd like to think it's because I look so strong and fit, but it's actually because I tend to wear my husband's t-shirts and most of them have something to do with fire rescue.  I can't help myself, they're big and comfy and I'm a girl, we love to wear our guys' clothes.

I do have a couple of t-shirts that have hospital names on them, but nothing that advertises I'm the fact that I'm a nurse.  At my first job, a co-worker told me to be careful about displaying items such as my stethoscope in my car or wearing clothing that tells people I'm a nurse because people would think I had access to drugs and I was likely to get robbed.  Now that sounds kind of silly to me.  More likely, someone would realize I likely have a steady job and rob me.  Either idea is probably nuts, but the former must have stuck with me because I still don't have much that advertises the fact that I'm a nurse.

I don't think many nurses wear t-shirts or have vanity plates telling the world that we are nurses.  We get asked to play nurse by our family and neighbors often enough, we don't need strangers asking us to look at their rash.

For The Psych Nurses

Today I am grateful for psychiatric nurses.  I have no idea why you do what you do, but I appreciate that you take care of psychiatric patients.  Thank you.  God Bless You.

Isn't it great how there's something for everyone in nursing? 

I once worked with a nurse who's previous job was working on a unit called "Infected Ortho".  Can you imagine? I mean, you can see why those nurses who work at Club Med resorts go in, but there are actually nurses who willingly went to work each day and took care of patients on a unit called Infected Ortho!

There is a key to every lock, even in nursing.