Thursday, April 30, 2009


I have been nominated for my first EVER blog award!!! WHOO HOOO!!! Thank you so so much Mops and Pops Place!! She nominated me for the Lemonade Stand Award. This award is given to "people who have a good attitude or a sense of gratitude".

The goal is to pass this award along to others. So if you are nominated you can then nominate up to 10 others. Post a link to their blog and then send them a message that you nominated them.

Here is who I nominate. . .

My Charming Kids

Bring the Rain

Michelles Path

Go visit these three blogs and congratulate them! These are three that I truly love reading! It is hard to pick people for an award. So I just narrowed it down to my favorite three.

Thanks Mops and Pops!!!


Wednesday, April 29, 2009


I have a good friend who has been bugging me to write this post. It is a funny story, however I think it was much funnier when it happened.

On the day in question, there were about five nursing students doing clinicals on our floor. They were in their last semester and one of the students was assigned to one of my confused patients. I have to say that at the beginning of my shift I was already thankful for this. I got report from the previous shift that this sweet 75+ year old lady, was not so sweet. She lived in nursing home and had become increasing confused. They wanted her admitted for "med adjustments". In the hospital world that means that she was "out of hand" and causing trouble and they needed a break for a few days.

The reporting nurse told me how this lady had not slept all night. She was climbing out of bed, yelling, hitting the staff and pulled out her IV. The night shift was unable to get another IV in her and she had medications that she HAD to have. The doctor didn't want to do a central line because she wasn't going to be there long enough and why risk infection, right?

So when I got to her room to do my first assessment, she was in a vest restraint in bed with a bed alarm on her bed. They had already told me that had used wrist restraints to keep her IV in, but she somehow got out of those. They had also already tried mittens and again, she got out of those.

So, I talked to the Student nurse and explained the situation. She was going to have to stay VERY close to this room all day. We needed her out of restraints for 24 hours so she could be discharged and we had to get an IV in her. . .somehow. The student jumped at this. She needed to do an IV and was so excited.

Later that morning, she and another student came in. That is when the student and I went over the "starting and IV" process. She said she had done one before with her instructor, so she and I were going to do this one. Even after this lady had her medications to help calm her down, she was still pretty alert and just not very nice. So I had one of the students hold her hand and just talk to her. Trying to keep her calm. The other student was going to start the IV while I held that hand in hopes of keeping her from moving it. The lady ALL OF THE SUDDEN turned really sweet. I think she liked having her hand held. The Student who was starting the IV was very confident and ready to go. As soon as that needle hit the arm, the patient turned. She started yelling and trying to move her arm away. She had already been told what we were about to do, but like I said earlier, she was confused and demented. I am sure she didn't remember. As the student kept working, I tried talking to the lady, trying to keep her calm.

The student wasn't able to get the IV, however she was OH SO CLOSE! I grabbed a hold of the butterfly she was using and told her to trade me places. As I was leaning over her to get this IV in, this little 90 pound lady pulled her leg up and put it her foot on my shoulder. At this point I am thinking, "Ok, at least she is not kicking me, I can still do this." I told the students to just leave her legs alone. She was not hurting me and holding her legs would just make her more angry.

Now this is all happening very very fast. I am in the vein, I have a good blood return. All I have to do is flush it and dress it. As I reach for the flush, the patients leg is no longer on my shoulder. Nope, it is now wrapped around my neck!!! I was in a headlock!! All I could do was laugh, but I could still reach her IV and it was still compromised as long as I didn't have the dressing. So, the students continued to hold her hands to keep her from hitting me, and I got that silly IV flushed and dressed with a leg wrapped around my neck.

I know it is hard to believe and you have had to be there probably to see how incredibly funny it was. By the time we left that room, we were all sweating and laughing so hard!!!

The IV stayed good at least through my shift, she got her IV meds and because there were students who could sit with her, she didn't have to have the restraints. I am not one that is big on restraints. I truly believe if there is any other way, then that should be tried first! Restraints most often times, just aggrivate the patient more.

That day, I was pretty impressed with my IV skills. It is not every day you have that big of a challenge. But I was up for it that day.

I was thankful the lady was much more sweet in the afternoon than in the morning! The rest of the day went like clockwork!

Thank God for the nursing students, who learned that day how to become a WWF Nurse!!!


Sunday, April 26, 2009

A Mother's Love Never Dies

I have always had a love for seniors. I especially enjoy caring for the ederly who have some form of dementia. Alzheimer's is a terrible diagnosis and so sad to witness. However, I love caring for those patients. I spent many years working in long term care and several of those years were spent on a dementia unit. Since my time working in the hospital, I have become known as the nurse who would trade patients with other nurses. I would gladly take the 80 year old lady who has no clue where they are, and is climbing out of bed, all while she is forgetting that she is no longer able to walk, rather than take the 25 year old male who has just had an appendectomy. Most nurses don't understand why I would do this because the dementia patients are much harder to care for.

There was one day I was working on the dementia unit and we were going through our nightly rounding and one of the every two hour bedchecks. There was a lady who was yelling out most of the night. There was nothing that could be done to help her sleep. We went into her room and all she kept saying was "It's coming, it's coming!" She kept telling us to get the doctor. She thought she was having a baby. When we went into the room she was laying uncovered with both of her knees up, "in position". The other nurse that was working with me had already done all she could do to help her. We couldn't figure out how to get her to settle down and go to sleep. She was starting to wake up the other residents. And if you have ever worked in long term care, several people awake at one time in the night, makes for a very long night.

This lady had a baby doll that she carried around all day. This doll was laying in a chair by her bed, so the nurse told this lady to "PUSH!" She instructed her just like she was in the maternity ward. Within minutes, this sweet 80+ year old lady was handed a sweet baby (doll). She immediately stopped yelling and smiled from ear to ear. She named the baby (doll) John, held him in her arms and went fast to sleep. We didn't hear another peep out of her all night.

Now, I don't know what it was that made her yell like that, or made her think she was having a baby. What I do know is that sometimes, with dementia you just have to go to whatever space they are in and be there with them. Even though there was nothing physically, that we could see, that was even close to that of giving birth, this sweet lady believed it was time. In her mind, she was pregnant and ready to deliver and there was no one there to help her.

After she woke the next morning, I am sure she had no memory of the previous night. It was back to business as usual. The nurse aids helped her get up, get bathed and dress and fed her breakfast. She carried around "baby John" all day, just as she did every day. I don't think it ever occured to her that "John" was only a day old.

The beautiful part of dementia is that most times these patients go back in their mind to happier days. At least at some point of the disease process they do this. This lady raised many children, that is what she was really good at. She was a great mother to her children. She was content and happy knowing that she was still raising "children".

My prayer is that as those precious people in my life grow old, they will remember all that is good about their lives. When their minds play tricks on them and they have trouble remembering, I pray those memories of what was most important to them and those "happier days", will come front and center. I pray that they will live out their lives remembering all the love they shared and those who loved them as well. I pray that whomever will be there to care for them at that stage in life, will not try to make them wrong. That they will not try to bring them back to the reality that haunts them. I pray that those caregivers will have mercy, and compassion, and go to the place where THEY are, and just "be" with them. Wherever that may be.

This reminds me of Jesus. Not all people were allowed to come or well enough to come to the synagogue. That did not hinder Jesus, he went to them. He calmed their fears, healed their bodies and simply showed them love.

For more information about Alzheimer's or to find support in your area click here.


Friday, April 24, 2009

Don't "stroke" out!

Have you ever known anyone to have a stroke? Have you ever been the caregiver of someone who has experienced a stroke? Many times it is not an easy task for the patient or the nurse. Once stroke symptoms start you are suddenly on a time schedule. You have so much time to get to a certified stroke center and get the appropriate medical treatment for the type of stroke you are having, to be able to minimize the mass long term effects of a stroke.

If you are having an ischemic stroke and are treated within 3 hours of FIRST symptoms you have a much higher percentage of recovering with little residual effects than someone who is not treated within this time frame. Therefore it is important to know the signs and symptoms of a stroke as well as the risk factors of having a stroke.

Some of the warning signs of a stroke include:

* Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
* Sudden confusion, trouble speaking or understanding
* Sudden trouble seeing in one or both eyes
* Sudden trouble walking, dizziness, loss of balance or coordination
* Sudden, severe headache with no known cause

If you or someone you know experience the above symptoms call 9-1-1 immediately. Do not drive them yourself to a hospital or clinic.

There are two types of risk factors for stoke; controllable and uncontrollable

The uncontrollable risk factors include:
* Age
* Gender
* Race
* Family History
* Previous Stroke or TIA

The controllable risk factors include:

High Blood Pressure (Hypertension) - A blood pressure below 120/80 is considered "normal". If you have high blood pressure your heart is working harder to pump blood through your body, which can weaken the blood vessels and damage your brain as well as other major organs. Medication can be used to control high blood pressure.

Atrial Fibrillation (AF) - This is where the atria of the heart beats unpredictably and rapidly, which produces an irregular heartbeat. This causes blood to pool in the the heart and form clots. When the clots are released from the heart and carried to the brain, this causes a stroke.
Atrial Fibrillation increases the risk for stroke up to 6 times. Medication can be used to help control atrial fibrillation.

High Cholesterol - A fatty substance in the blood that our bodies make on their own. However we also get it from fat in the foods we eat.

Arteries can become clogged by too much cholesterol in the bloodstream, and lead to a stroke or heart attack. This also puts you at greater risk for heart disease which in turn puts you at greater risk for a stroke. Your combined HDL and LDL cholesterol should fall below 200mg/dL

Diabetes - In diabetes, the body doesn't produce enough insulin or the cells ignore the insulin.
Most diabetics have other health problems such as high blood pressure, high cholesterol and obesity/excess weight. These problems increase their risk of stroke even more. People who are Diabetic are at a 2-4 times greater risk for stroke.

Tobacco Use/Smoking - Smoking damages blood vessel walls, speeds up the clogging of arteries, raises blood pressure and makes the heart work harder. Smoking doubles the risk of stroke.

Alcohol Use -Drinking more than 2 drinks per day may increase stroke risk by 50%.

Obesity/Excessive Weight - Excess weight makes people more likely to have high cholesterol, high blood pressure and diabetes. It also puts a greater strain on the body in general.

Suprisingly up to 80% of all strokes are preventable! Know the risk factors and if you fall into any of these catagories pay attention to your body.

Below is a list of things you can do to help prevent a stroke:

* Monitor your blood pressure and if it is above normal range speak to your physician about
ways to help keep manage it and keep it at a safe level for you.
* If you have atrial fibrillation, take your medication and follow up with your physician.
* If you smoke, stop.
* If you drink alcohol, keep it in moderation.
* If you are diabetic, work with your physician and a dietician to help keep it closely monitored
and controlled.
* Exercise! Even a 30 minute brisk walk can help reduce your risk and improve your overall
* Lower your sodium and fat intake in your diet.
* Know the symptoms listed above and don't wait to act on them.
If you have ever seen anyone have a stroke or seen someone with mass effects from a stroke you will understand why this is so important. I have personally cared for many stroke patients. Some who made it to the hospital in time and were treated and had little residual effects. Others who were not so lucky and had mass effects.

It is saddening to see a patient young or old who is unable to communicate, unable to swallow, unable to eat, unable to move one side of their body and now has to rely on caregivers to do normal tasks that they once were able to do for themselves. It is saddening to speak to a patient who is unable to speak back to you, but you look at them and can see in their eyes that they have something they so desperately want to say but can't. They can't tell you what hurts, they can't tell you they are afraid, they can't tell their family how much they love them. They can't tell you how humiliated they are feeling because they have urinated on themselves because they couldn't communicate to you, their caregiver, that they even had to urinate.

It breaks my heart to see these patients. I have seen many recover, with the help of good physical therapy, occupational therapy, and speech therapy. However, I have seen all too many who leave the hospital not walking, not able to live at home any more and now will live their days in a facility, where they will have 24 hour care by professionals, not their family.

Please, if you or someone you love is at risk for a stroke, share this information. Educate yourself and your loved ones. Seek medical attention and advice from your physician.

I am a medical professional, however I am not a doctor. All I can do here is increase awareness and pray that each of you understand the importance of knowing the risk factors and symptoms to watch for. All the information on this particular post was found at the above red links.
For more information on strokes please go to the National Stroke Association website at or the Amerian Stroke Association at

Keep yourself educated!!


Tuesday, April 21, 2009

Better Today Because of You

There is one day in particular that I will never forget during my med/surg clinical rotation in nursing school. I had an instructor that I did not like at all. Actually, come to think of it, not many of the students liked her. She was arogant, and pretty much talked down to all of us. We all decided that since we had her first year they must be trying to break us down in the beginning so they could build us up in the end. Kinda like the military, I would think.

On this particular day, she had handed out our assignments. There were 8 of us and she was going to watch all 8 of us administer medications that day, like she did every clinical day. She told me I could go last because I had the most medications to give. The patient I was assigned to had over 16 medications to give that morning.

I promptly went to get his med book and started writing down all the medications I was to give. I looked them all up and wrote as much as I could on my little paper. I knew that she was going to ask me questions about ALL of them, and I tried to anticipate what the questions would be. She was one that would pick the most unusual things to ask. It was like she was trying to pick something to ask that she would know you would not have written on your paper.

All the other students were running behind and she came to me 2 or 3 times asking if I was ready. I just told her no and reminded her she told me I could go last. Then on the 4th try, she finally said, "Let's just do it, no one else seems to have their act together today!" I again reminded her that I was not finished writing everything. She then replied with, "well, I guess we will see how ready you are." So instead of arguing with her, I just gave in. I knew it wouldn't make a difference and she was already mad because of the other students.

We went into the patients room, and she had me set the med book on the window sill. I laid each med out beside it's name in the book, that is like she liked us to do it. Then one by one I did the checks, reading the name and doage of the med from the book then again from the med packaging. She would proceed with questions like:
1. What is this used for? 2. What are the side effects? 3. Will it interact with anything else they are taking? 4. What labs need to be followed while on this medication? There were other quesitons but this was the basics she asked on almost all the meds.

Now, remember that she didn't give me the time she had promised and I had already told her I wasn't done looking everything up. So, for the first few meds I was doing great. I answered 100%. Then all of the sudden she asked me about the med Cozaar. I told her that was one that I didn't get looked up. She then again asked me what was it for. I had not given this med before, and remember we were first year students, so they were not ALL etched in my brain just yet. I proceeded to tell her, "I think it is for high blood pressure." Her reply, "You THINK? You mean you don't know?" Again I reminded her that I didn't have time to get them all looked up and that was one that was not looked up. She then looked at me with horrible anger and said, "I guess you are right, your not any more ready than the rest of them. I will be back to finish with you and you better be ready."

All of the above interaction happened IN the patient's room. I was so embarassed. She walked out and I told the patient I was sorry and I would be back in a few minutes with the instructor. I gathered my things and rushed out of the room and looked up the rest of the meds as quickly as I could. I still had 4 left to look up and I hadn't been able to look up the lab results from that morning yet because all of the staff nurses were on the computers.

It wasn't 5 minutes before she was back. I had the med written down but not the labs. I wasn't about to tell her, I just prayed she wouldn't ask. We went through the same steps as before. When we got to Cozaar, I knew for SURE it was for high blood pressure. I was angry because I was right before, and she wouldn't take the answer. She was angry because none of the other students had been ready and when she got to me I wasn't ready either. Then the dreaded question came. I had to give the patient potassium. She wanted to know what his potassium level was that morning. I know I must have had a defeated look on my face because that is certainly how I was feeling. All I could do was look at her and say, "I don't know." I tried to explain that I was not able to get on the computers to check lab results because the staff nurses were on all of them. At that moment she picked up the med cup that had all the unopened meds in it and threw them up in the air. She then proceeded to walk out of the room. When she got to the door she turned around long enough to tell me "Let me know when think you are ready!", and then she was gone.

There I was, standing in a patients room, again, after being yelled at. Except now his medications were all over the floor. I apologized again to that patient, quickly picked up the meds and left the room. I went to the bathroom and cried. I was so angry and my feelings were hurt and I was humiliated!! I wanted to run!!

My instructor did come back, I did give my meds and care for my patient that day and I survived! At the end of that particular day, my patient actually apologized to ME. I told him it was ok, it was not his fault, and I apologized to him for having to be witness to my learning experience. He was very sweet and understanding. I think he realized how terrible my instructor had acted and I think he kind of felt sorry for me. That was the longest semester ever!! And I know that I am a better nurse today because of it.

At then end of my last semester, while we were planning for the pinning ceremony, I had the opportunity to talk to that instructor again. Until that moment I had done everything in my power to stay as far away from her as possible. And when the moment came, and I had all the courage I could muster up, I said these words to her,
"I didn't really like you during our first semester. I thought you were too hard on people. There were moments of humilation during that clinical rotation with you. And what I learned is that I will be a better nurse because of the instructors who treated their students like we didn't know anything. I will be a better nurse in spite of those moments of humilation. I will also have mercy on the students who come after me, that I will someday be a mentor to. So, thank you, for teaching me mercy, and making me stronger in myself." I didn't really give her a chance to say anything in response. I walked away, with my head high and shoulders back, ready to graduate and take on that nursing world that came many times be cruel and nonmerciful.

I hold on to this experience so I will not forget what kind of nurse I strive to be. How I treat my paitents, how I treat the new students who come to do clinicals where I work, and the new grads that we train.

I have compassion, and mercy and tolerance. Nursing school was a hard time, a time that could have easily broken my spirit. I conquered it!!! My spirit soars today, knowing that I am a great nurse and I truly care. This is not my job, this is my ministry!


When the patients are sleeping. . . .

So what is it that nurses do when the patients are sleeping?
Well tonight is the first night in a really long time that I have had a TOTALLY uneventful night. Three patients, all ready to be discharged to home in the morning and all sleeping very soundly ALL night long. No one used their call buttons once. No one had medications between the hours of 9pm and 5am. No one required their vitals taken between the hours of 9pm and 5am. What's a nurse to do. . . ?

Well, in between checking to make sure everyone was breathing. . and they were. . they were ALL SNORING! Very loudly might I add. I would look in on each of them about every hour. Then I watched the clock move slowly, and the more the night went on the slower the clock seemed to tick. It was almost painful!

Then it was internet time. . . I googled strange medical terms, diagnosis that I didn't know, I read through patient charts, I read blogs, I tried to plan a vacation, I helped other nurses (who were just as NOT busy as I was). Then I read more blogs.

I also took some time to pray for a sweet 5 month old baby boy named Stellan who will be having a Heart Ablation this morning. Please take a minute to check out his moms blog. You won't be able to read one post without falling in love with this child. The whole world seems to be following her blog and praying for this child. There is a button to the right on my blog that will get you there. It is amazing how God is working in his little life.

So, I am bored silly and really can't think of any great funny stories to tell. So, leave me a comment telling me what you do at work, when the work seems to be all done and there is nothing to do. I would love some new ideas, because reading the newspaper online is getting a little old.


Wednesday, April 15, 2009

Are These Your Teeth?

I was in my early twenties working in a nursing home. I enjoyed my time in long term care, I worked as a CNA (Certified Nurse Assistant). That was some of the hardest work I have ever done, and I loved it. I loved learning from the residents, they were so wise and just loved to share their knowledge. What I loved even more were the residents who had Alzheimers. I enjoyed going to "their world" with them. Many times the world they would revert back to was much more pleasant than the current place they were in, in their lives. And joining them there, made it all the better for them.

At this time in my life, I was working night shift. This shift in a nursing home is a very regimented shift. First, make sure everyone that didn't get put to bed on evening shift, is now safely tucked in for the night. Second, start bedcheck; turn, change, potty, offer drink, and anything else they wanted. Third, dump linen, and restock the linen cart. Forth, wash wheel chairs, change out supplies, etc. until the next bedcheck. Bedcheck was every 2 hours. If you were lucky enough your assignment didn't take a whole 2 hours to complete a bedcheck.

During a particular night shift, I was working with a LPN (Licensed Practical Nurse) and a new QMA (Qualified Medical Assistant). The QMA was helping me with bedcheck and the CNA duties. She was still on orientation, as I remember it. We were so lucky this night because we had some down time in between bed checks. She was so excited to be able to sit back put her feet up and read a magazine. Just as I was realizing what she was about to do, I informed her, during the down times we were to clean. Clean wheelchairs, resident rooms, bedside tables, resident closets, dresser drawers, or anything that looked like it needed to be cleaned.

I told the new QMA to head down the hall and brush all the dentures that were sitting on each person's bedside table. I knew that many times the evening shift would take a "short cut" and just put each person's dentures in a cup of cold water, without brushing them. They would just soaked all night. So, the QMA headed down the hall to begin brushing teeth. I started on antoher cleaning project. It wasn't 10 minutes before I saw the QMA coming down the hall with a wash basin. "What'cha doin'?", I asked her. She replied with a simple, "Washing dentures". I quickly learned that she had filled a wash basin with water, placed several tablets of efferdent in the water and then proceeded down the hall to gather the dentures. There were probably 15 sets of dentures sitting in that water soaking up the goodness. She sat down at the table where I was, pulled out ONE toothbrush and some toothpaste. She was so proud she was going to get these dentures so clean and save some time by doing them all at the same time.

I was having trouble trying to process this. I couldn't believe what she had just done!! "You can't do that!", I said, "How would you like to brush your teeth with someone elses tooth brush? Besides that, do you know who all those teeth belong to?" She replied that she did not, while her head just hung. She was realizing what she had just done.

At the time this happened, dentists were not putting a name inside dentures. So, without knowing how to fix this any other way, we went and got more tooth brushes, cleaned each set of dentures individually. Afterwards we spent the rest of the night, fitting dentures, cleaning them, and refitting them.

It was no suprise to me when I learned that this particular QMA only worked in this facility for another few days, then she was gone. I have no idea where she is now, and honestly don't even remember her name. What I hope is this: where ever she works at, I hope she doesn't use the same toothbrush on every resident. I hope she brushes her teeth. And I hope all dentures have names in them, just in case.

Mistakes are made to be learned from. We all certainly learned that night. She learned about sanitation. We all learned that in healthcare, there are no real or safe shortcuts. We also learned one of the arts of denistry. . . denture fitting!

Suggestion. . . .keep up with your dental visits, keep your teeth healthy, brush three times a day, floss at least twice a day and if you do have to have dentures someday. . . make sure your name gets put in them.


Take This Quiz. . . Read Following Post. . .

Ignorance Is Not Bliss

When I saw this little quiz it reminded me of a patient I cared for probably 20 years ago, back when I was Certified Nurse Aid (CNA).

I worked in a long term care facility and there was a patient admitted who was in his late 30's. He was no longer able to care for himself at home because he had AIDS. It had advanced to the point that he required 24 hour nursing care.

The day he was admitted the whole facility was in an uproar. People were scared to death, to say the least. Little did he know, he was the talk of the facility. The nurses didn't feel comfortable caring for him and many of the CNA simply refused. I was just as uneducated as the rest of them. I will not lie, there was an element of fear. However, I knew that no matter what his diagnosis, he was here for us to take care of. He needed us.

I remember sitting in the breakroom before the start of my shift listening to all the "buzz" that was going on. I was hearing all kinds of stories about how he contracted AIDS. I heard he was gay and very permiscuous. He was an IV drug user and just plain white trash. He has had it for a very long time and was knowingly passing it on to other people he slept with and the stories just went on and on.

I was so angry that people would actually refuse to care for him. I was NOT going to be one of those people. However, I was just as ignorant as the rest of them. I did have him on my assignment. I did double glove when I cared for him. I did listen to all the stories, and wasn't sure which ones to believe. It was something for our small town nursing home to have a patient with this diagnosis, let alone one this young.

He was a smoker, and at that time there was a room designed just for the residents of this nursing home to sit in and smoke. Every day he would wheel himself to the "smoke room" and sit there for as long as he could stand it. There was a TV in that room, to keep him company, as well as other residents who also enjoyed smoking. He was young, he didn't want to play Bingo or do crafts. He just wanted to live out the rest of his days in peace and quiet. He wasn't always nice, as a matter of fact he was rarely nice. He didn't talk to much of anyone. He was angry about his diagnosis. He was angry about where he was in life. Basically he was just angry. He didn't like it when the nurses or CNA's would double glove. He was totally offended by this and had no trouble letting us know it. He would yell, cuss, and kick people out of his room.

It wasn't long before word got around to the other residents that he had AIDS. Then the trouble started. He would go to the smoke room and the other residents would leave. He would be alone. They would complain that they couldn't sit in there with HIM. They were afraid, afraid of what they didn't know. They were ignorant too.

As the rumors continued to spread about this young man, people began to learn the truth. Administration had done their best to keep details of his diagnosis away from us. I think part of this was because they thought it would help him in the long run. All we needed to know was that he had AIDS. They thought we needed to know this so there would be no "short cuts" made in the area of universal precautions. However, the rumors were getting out of hand. We needed to know the truth. The truth was, he got a raw deal. His wife had an affair, he had contracted AIDS from her. He had done nothing wrong, he didn't deserve this (no one does), it just happened. He divorced his wife, however she visited him every day. I think there was some guilt she had to deal with. I am not sure, but she was faithful in her visits.

Once everyone knew the "truth", they seemed to lighten up a bit. People were nicer to him, kind of like they now felt sorry for him. In return, he started being nicer too. However the stress of going to the "smoke room" was becoming too much for his body. It was becoming too cold for him to go outside, where he could isolate himself and he still wanted to smoke. I remember working night shift and caring for him. He always had his bed close to the window, and he always kept his door closed. One night as I was doing my bedchecks, I smelled smoke. I followed the smell into his room. He was laying in bed with a plasic cup of water in the window sill and was smoking. He had the biggest grin on his face. I told him he was only allowed to smoke in the smoking room. He reminded me that was impossible at this point. He couldn't make it down there anymore, he was too weak. I couldn't argue that. So I went and spoke with the nurse. Between the two of us, we decided to let it go. I had a talk with him and we decided he could smoke in his room during our shifts. But he had to promise not to tell anyone, because we could get in so much trouble. He had to promise to be careful and could not fall asleep while smoking. He agreed.

Looking back now, I can't believe we allowed this. It is so dangerous, anything could have happened. Even though it was SO against the rules, it helped create a bond, a trust so to speak, between him and me. He would allow me to care for him, and he was happier when I was on shift.

We spent many nights talking in between bed checks. He shared his fears and his anger with me. I began to learn true compassion from him. I began to understand why he was so mean to us in the beginning. I began to truly care for him.

It wasn't long after the night I caught him smoking that he passed. He couldn't fight anymore. He was too tired and frail to continue on in this life. And I will never forget how I learned to have compassion for those with AIDS. I learned to not have prejudgements about people with a certain diagnosis. I learned to overcome my own fear of caring for someone with AIDS.

Fear in this case and in most cases come from ingorance. If we all educate ourselves on the things we are afraid of, some of those fears will no longer exist. Some of those fears are able to change from fear to caution. Now when I care for someone on my current job that has AIDS, I no longer fear their diagnosis. I still remain cautious, and use the skills I have learned to protect myself and them. But I do not have fear.

Education is the key here. Education and compassion.

Some facts about AIDS you might not know. . .
Information found here

According to the CDC, in 2000, an estimated 850,000-950,000 people in the United States were living with HIV and approximately one fourth of these people did not know they were infected.

HIV can be transmitted through the blood, sexual fluids (semen, preseminal fluid, or vaginal fluid) or breast milk of an HIV-infected person. People can get HIV one of these fluids enters the body by way of the mucous membranes (the soft, moist skin found in any opening of the body) or the blood stream. The disease can be passed during unprotected vaginal, anal or oral sex with a HIV-infected person. An HIV-infected mother can transmit HIV to her infant during pregnancy, delivery or while breastfeeding. People can also become infected with HIV when using injection drugs through sharing needles and other equipment (or works) including cookers and cottons with someone who is infected.

The following information found here. . .

HIV is NOT transmitted through casual contact including: hugging, kissing, using public toilets, sharing eating utensils, pools or coughing.

There is NO cure for AIDS. Scientists have discovered strong medications to slow down the disease so people will live longer, but there is NO cure.

There are other ways to prevent the spread of HIV and AIDS by blood or body fluids:
Never touch another person's sores, cuts, or blood. If someone at school or at sports gets hurt and starts bleeding, ask an adult for help right away.
Never pick up or handle needles that you might find outside.
Health care workers such as doctors, nurses, and dentists should always wear plastic gloves when working on a patient. Hospitals have strict procedures for handling samples of blood and other body fluids to prevent others from coming in contact with HIV.

What I learned in nursing school . . .

This suprised me probably more than anything in nursing school. It is easier to get Hepatitis C from a patient that I am caring for than it is for me to get AIDS from a patient I am caring for. Rule of thumb. . . treat everyone the same, protect yourself and them, and use universal precautions on every patient.

There is a greater risk of you passing germs to the AIDS patient that will make them very ill, than there is of you catching AIDS from them. Their immune system is so compromised, that is you could easily pass your cold, or respiratory infection to them (if you are at work with a respiratory infection), causing them to become very ill.

So again. . . rule of thumb. . .
Treat each patient as you would like to be treated. Do not judge them by their diagnosis. AND. . show compassion. You don't know what their day/ night was like (in their mind) before your shift started. It could be any one of us in their shoes one day, wishing someone would treat us like a person and not a diagnosis.


Tuesday, April 14, 2009

Where Are The Nurses?

It is no secret there has been and continues to be a nursing shortage in the US. This is ever so evident if you are in fact a nurse. We work many hours, and I would guess that most of those hours are spent with an increase in patient/nurse ratio. This causes the quality of care to decrease. I would say that many people in our country may not realize how important this is. As a nurse, and speaking generally, we try to not let it show that we are many times overworked. We do what has to be done to care for our patients, while not letting the stress show. Not letting the patient know how many other patients you are responsible for, while you are caring for them.
We work extra shifts out of guilt. Guilt of leaving our fellow nurses short staffed, as well as guilt for leaving the patients with an inadequate number of nurses. We leave our shifts feeling as though there was something missed, too many corners cut, and not really feeling like a nurse at all. We drive home in our cars thinking about how we didn't have time to listen, really listen to our patients as they try to tell their stories. We think about how we may have been a little short or standoff'ish with that one patient who pushed their call button one too many times for things that really could have waited. We think about who that particular patient may have just wanted the reassurance that someone would come if they called. We think about that person who was disoriented and climbing out of bed every 5 minutes, and how we didn't do the trial restraint release on our shift, because we didn't have the time to sit with them until they fell asleep and forgot that they were trying to get up and were unable to walk. (Don't even go there, if you are a nurse, you know - you know what I am talking about. And if you are not a nurse, don't judge this until you have walked in the shoes of a nurse.) You think about your charting, did you forget something, what about that shift note that you probably should have written but didn't because really, nothing significant happened, but the notes are important and you let that one go.

Studies are showing that the nursing shortage is predicted to just get worse. The Council on Physician and Nurse Supply released a statement in March 2008 that stated, based on a study done by the University of Pennsylvania, 30,000 additional nurses should graduate annually to meet the US healthcare needs. This was 30% more than the current number of graduates at the time of that study.
The problem with this number is that I found this study by AACN that showed 49,948 qualified applicants were turned away from baccalaureate and graduate nursing programs in 2008. Why were they turned away, if they were qualified, you ask? Because there was not enough faculty, clinical sites, classroom space, or clinical preceptors. This report also listed budget constraints. The report listed that almost 2/3 of the schools surveyed listed faculty shortages.

Another point of focus could also be the average age of the current RN. This study released in July 2006, by the Nursing Management Aging Workforce, showed 55% of the nurses reported intended to retire between 2011 and 2020.
Forty-four years old. That is the projected average age of RN's by 2012. Nurses in their 50's are expected to become almost 1/4 of the RN population. These nurses will be, by this time, seriously looking toward retirement. They will be burned out and/or looking toward management positions, because the patient care load is too much, the pace is too fast, the physical labor may be taking a toll on them.
In essence what I see happening? Put simply. . .
No faculty = less graduates = higher patient/nurse ratio = decrease in quality care
=increase in burnout = increase in nurse turnover rate
= decrease in continuity of care
= decrease in quality of care

Do you see a cycle here? It all goes back to quality care.

From what I saw as a nursing student 4 years ago, facaulty was not paid well. They were expected work an ungodly amount of hours. Not necessarily hours with students but hours in preparation, clinicals, classroom time, grading papers, tutoring, mentoring, encouraging students, meetings, etc. They do this for little pay. In the state that I live in, I just learned the average salary for an Assistant Professor was $51,000. I know RN's who are associate nurse RN's who are working in hospitals making more than that. Those assistant professors are still working full time hours and then taking work home to prepare for classes and clinicals. No wonder we don't have enough faculty!

A report initiated in March 2007 by the Agency for Healcare Research and Quality on Nursing Staffing and Quality of Patient Care found that the RN shortage along with increased workload, did in fact pose a potential threat to the quality of care. Increasing the RN staffing showed reductions in hospital related mortality and failure to rescure and also decreased the average length of stay. Patient care and safety showed compromise in hospitals with less than adequate staffing.

What can we do about this? Well, I found alot of information about how bad it is, but I didn't find alot of information about how we are going to make it better. What I found was information on the Nurse Education, Expansion, and Development Act (NEED Act). This Act if passed would amend Title VIII of the Public Health Service Act, authorizing caitation grants for nursing schools. This will result in the increase of faculty which results in the increase of students. This is called a capitation grant. This is not a new idea. Capitation grants have been helping to stabilize the nursing shortage for years. The Nurse Training Act of 1971, as well as the Nurse Traning Act of 1975 were brought about to increase enrollment thus help the shortages. From 1971 to 1978 the government provided capitation grants to nursing schools in support of education.

There are also many initiatives at a local level to help stabilize the nursing shortage. There are monies available in some states that will give extra financial assistance to nurses who are continuing their education in a master's program. There is also some states that have a loan forgiveness program for nurses who become faculty.
For me, it is nice to see there are initiatives being put into place. It was also disturbing that I found more research and studies done on the problem than I found on the solution.

What I know is that most of the nurses I know and work with are not doing this job because of the money. The money is good, I will not lie about that, and it does help. But most nurses just love the job. They love that they have the chance to make a difference in someone's life, that their life is changed on a daily basis by the patients they encounter. Many of the nurses I know, if given the opportunity and finances to quit their job, would not do it. I myself would not do it. Someone could give me $1million today. I would be estatic. I promise you that, but I would not quit my job. Nursing is a part of me. It makes up who I am. I would feel there was a piece of me missing if I did not have patients to care for. I would feel I have lost my purpose.

So, even though there is a shortage and many of us feel overworked. I keep my chin up, I show up for work when I am scheduled, I do my very best to have a good attitude and never let my patients know or feel that I might not have time to listen to their story. I have learned over the past several years, that some of those stories they feel they need to tell. The stories of their illness, misfortune, fears, and recovery have been meant just for me to hear. Some of those stories are imbedded in my mind and heart and help me daily be the compassionate nurse that my patients deserve.

Shortage or no shortage, I will always be a nurse and will always love what I do.

If you have considered being a nurse, take a minute to do some research. Ask a nurse you know if you can shadow them one day on their job. See what it is all about. Learn how rewarding this job can be and what a difference your patients can make in your life.

Help us end this shortage, and be able to provide the care each person deserves. You may be a patient some day and wish that your nurse had more time to spend with you. That is when you will get to see the other side of this story. That is when you will remember what you have read here. When you do, please remember to thank your nurse. They work hard to care for you. And even when the day is bad, and your nurse is running like a mad person, they really do care. That is just the nature of being a nurse.


Monday, April 13, 2009

Milk and Molasses

I was a "baby nurse", not even out of school 8 months when I was assigned to a VERY difficult patient. Now if you are a nurse or in the medical field, you know where I am about to go with this. It is not that she was medically difficult, it was that behaviorally she was difficult. She was your basic med/surg patient. I can't exactly remember what her diagnosis was. What I do remember is that she was on her call light every 30 minutes for trivial things. She would want more water, then in 30 minutes she would want to go to the bathroom, then in 30 minutes she would want a snack. I would come back with a snack and she would say, "Oh, I'm sorry, could I get something more to drink too?". I had no problem giving her what she asked for but if I was already going to the kitchen to get a snack and had asked her if she needed something to drink, and she said no, then changed her mind when I got back to the room, I felt like I was just running the halls. Not to mention I had other patients that were much worse off and needed more attention.

Besides running me crazy, I also remember this particular patient was scheduled to be moved from my floor to a regular med/surg floor. She was placed with us as an overflow patient. However, they didn't want her to go until she had a BM and she hadn't had one in about 4 days. The doctor told me to give her an enema and once it worked we could move her. When I looked at the order, after the doctor left, he had written for a "milk and molasses enema". WHAT??? Was he serious? I had never heard of such a thing. I asked the more seasoned nurses working with me if this was a joke. They assured me it was for real and explained to me how it works and to get in touch with dietary to bring me the molasses.

I had all my supplies ready in the kitchen. Evidentally, I was supposed to mix this myself. I was instructed to mix half milk and half molasses, warm it in the microwave, then put it in the bucket and wahla! Ready to go.

I did exactly as I was told as far as mixing. I had given enemas before but they had always been in a bag, not a bucket. I was so afraid I was going to make a mess, so I opened the plastic around the bucket and just pulled it down, but didn't take the bucket out of the plastic. I kept ALL the supplies in the plastic to save on room when I had to carry it back to the patients room. I have the milk/molasses mixture all ready and warm and start pooring it into the bucket. They told me to make 800mls of it. All of the sudden the bag is filling up. There is a HOLE in my bucket!!! I immediately stop pouring and put my finger over the hole while I try to figure out what went wrong. I took the bucket out of the bag, only to find the tubing is NOT already attached to the bucket. They didn't tell me that! By now there is milk/molasses mixture running out of the bag onto the counter. I still have a finger over the hole, but I had to figure out how to get the tubing attached. With my free hand I grab the tubing and quickly attach it to the bucket. Now there was milk/molasses running down the front of the cabinet onto the floor. HURRY. . . clamp the tubing! Just when I think all is well, there is yet another fountain of milk/molasses coming from the tubing. WHAT? I looked at it, just to find, I put it on backwards. There is an extra hole in the tubing so all the liquid is coming out that hole. That is the part of the tubing that is supposed to be inserted for the enema. This is where it gets really bad. I put my finger over the hole, and try to figure out how I am going to get the tubing turned around without losing all my mixture to the floor. I don't know how I did it, but I did. And I did it without adding too much to my already large mess.

Now for the clean up. I set the bucket aside, grab all the wet papertowels I can and start cleaning up the countertop and cabinets. Did you know that molasses is REALLY sticky? Then I wiped up what I could off the floor. I peeked out the kitchen door looking for a housekeeping so I could get a mop, just as my boss was walking by. "Do you need something?", she asked. "Oh no, just looking for a housekeeper. I will find her." was my reply. "Here, let me help you", she said as she walked in to see what needed cleaning. She asked me what happened and I reluctanly told her. Then she left. Next thing I know, I have a mop and help from ALL my co-workers, as they are laughing to see what in the world I had done.

Let me tell you, while all of this was going on I felt like I was in the middle of an I Love Lucy show and I was Lucy Ricardo. All anyone could do was laugh. It was embarassing, but even more than that it was so funny.

I bet you think that is it right? Well. . . hang on cause it does get worse.

I was instructed on how to give this enema, and it was very detailed instructions. The patient was to lay on her left side, I was to let a little of the mixture go in, then she was to hold it in, turn on her right, let a little more go in, then she was to get on all fours and let the rest go in. Yep you hear right, all 200 pounds of her on all fours in her bed, while I am letting this mixture go in. As much as she could hold. That was terrible. I had this horrible feeling the mixture was going to go straight across the room to the wall. Fortunately it didn't.

She held it for as long as she could then needed help getting to the bedside commode. Once there, she let go! And I do mean, LET GO!!! The pan on the bedside commode ended up on the floor, and yet again, milk and molasses was all over the floor! I called for the mop again, hung my head as I headed to the nurses station and asked someone to please hurry and get the bed assignment for her room move.

Poor lady, never had good results, but she did have some great entertainment from this nurse. AND she got to move within the hour.

I have never given another milk and molasses enema, however people I don't even know that work in the hospital where I work have heard the story. Some of them don't know it was me, but I have heard them telling other "baby nurses" the story of the milk and molasses enema. I guess I have created quiet a reputation.


Sunday, April 12, 2009

Murphy's Law Morning

The night started out as any other normal nightshift. My night was very uneventful! I had time to do the little extras, to "fluff and puff" as I call it. So when 3:00am came around, I thought I would put off some of my normal duties to allow my patients a little time to sleep in.

At 4am one of the patients put on his call light. I went into his room only to find out his speech was a little slurred and the right side of his mouth was slightly doopy. After completing a full assessment I called the on call number for his doctor and got a returned call from the nurse. We sent him for a STAT CT Scan. Within 15 minutes he was whisked off the floor to the CT. "Whew. . .", I thought, "Now I guess I should quit waisting time and get busy!"

Another patient, was going into what is called Diabetes Insipidus (DI). He was putting out way too much urine. So again, I had to call the same nurse to report this output and see if we were going to start giving him DDAVP. We decided to just keep measuring and monitoring. He needed to be watched closely.

I quickly began to go room to room doing assessments, taking vitals, drawing blood, and meeting the needs of my other patients. I had made it through most of my rooms and sent all the blood drawn down to the lab, when another call light went off. Upon entering this particular room, I found the patient in the bathroom with BM all the way from the bed to the bathroom. I felt so bad for him. He just kept saying he was sorry. I told him to stay in the bathroom and I would go get clean linen for his bed, a clean gown, wash clothes and towels as well as something to clean up the floor. While I was in the linen room gathering my supplies, my phone rang. Another one of my patients had a critically low potassium. I had arms full of linen and the phone between my ear and shoulder. I quickly went to the desk, set down the linen, wrote the information down and repeated it back to the lab tech. I paged the doctor, grabbed the linen and was finally on my way to help this poor man get cleaned up.

With a fresh clean bed and clean gown, and freshly mopped floor, the nice older man was ready to get back to bed. My phone rang, I told the doctor about the critical potassium and got new orders to give that patient a potassium replacement via IV. I took a deep breath and reminded this doctor that the patient that needed the potassium had 4 different IV antibiotics going, and only one line. The potassium would take four hours and we didn't have that kind of time due to the timing of the antibiotics. So, I asked if there was a reason she couldn't take it PO (by mouth). He ok'd the order for the PO potassium, so I wrote that order and sent it to pharmacy.

As I was heading back to her room with the potassium effervescent tablets, my patient that had the CT Scan is coming down the hall. The transporter needed help getting him back to his bed. So I have to stop to get him situated and comfy again. He is doing good, no change from before, thank God. So off I went with the potassium. The patient took it and I was on my way to my next patient. Just in time for another phone call from lab.

My gentleman who had the BM mishap, had a critically low Magnesium. So I called the doctor. As I was on the phone with the doctor another call light was going off. It was the patient with the low potassium. I was on the phone with the doctor as I walk into her room. She had vomitted! "Ok", I am thinking to myself, "deep breath". Anyone that knows me, knows I don't do vomit well. I handed her a washcloth, while I was listening to the verbal orders coming from the doctor talking to me on the phone. Then I noticed that the patient only vomitted the liquid potassium I had just given her. So, I needed to find another route to give this. I decided I would just use her tube, since she has one. She asked that I wait about 30 minutes to give her stomach a break. Now I was feeling time is getting away from.

I took the order for the magnesium replacement and send it to pharmacy. I had to wait for them to get it to me so I took a minute to try to chart. HOLY COW! Is that dayshift people I see? It was now 6:30am, day shift is coming in!!! I had not charted anything since 4:00am, I still had magnesium to give, potassium to give, and try to watch for the results of the CT Scan so I could call that nurse back. WAIT! What about the guy who was urinating every hour. . . .?

Yep sure enough there goes his call light, another 400mls of urine that require urine being sent to lab, as well as another call to the nurse. Now I was feeling a little overwhelmed.

I got the urine taken care of, and checked for the CT results. Oh great. . . the CT showed nothing new, but it did show an old stroke. Nowhere did his chart say ANYTHING about an old stroke!!! Later the patient told me he had a stroke about four years ago. Boy, I wish I had known that earlier!

Now day shift to be ready for report. Still the potassium had not been given, the magnesium was not up from pharmacy yet, and I had still not charted. I went ahead and gave them report, and the potassium and magnesium had to be done by day shift. I sat down to chart my morning, trying to concentrate on deep breaths, so I could stop feeling overwhelmed.

I left that morning feeling like a horrible nurse. I put things off for an hour thinking I was doing a good thing by letting my patients have one extra hour of sleep, and it threw my whole morning off. I hate leaving things for the next shift and now they had to give meds that I should have given. Was there something I missed, the morning went so quickly it all seemed like a blur.

That is when I remembered that nursing is a 24 hour operation. We all do our best to not leave things for the next shift. Sometimes that is out of our control. We just work for it to not be a habit. I did what was needed to be done. I made the calls. I tended to the needs, and prioritized as best I could. I was so thankful it was my last day of the week because at that point I was exhausted!

I prayed on the way home that all my patients for that night would ok during day shift and that they knew I did my best. Then I resolved that this particular morning was nothing more than a "Murphy's Law Morning".

Moral of the story? Don't put off for an hour, what can be done now, to save your behind later! And, if you decide to put it off anyway, make sure you have a pair of rollerskate to get keep up the pace.


Saturday, April 11, 2009

Dinner and A Movie

How far you go in life depends on you being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and the strong. Because someday in life you will have been all of these. - George Washington Carver

I was working on a neurological floor and had only been an RN for about a year and a half when I had a patient, I won't soon forget. He had come to the ER 2 days earlier, with a severe headache that would just not go away. The pain was so bad it was causing him to vomit and pain medication was doing little more than taking the edge off. His wife had come to the ER with him, leaving his 3 small children at home with a babysitter.

He was sure they would give him some medication, the headache would go away and he would be home in time to wake his babies up the next morning. Instead he found himself lying in a hospital bed facing his life in a totally new aspect.

When I was assigned as his nurse, he had already had two surgeries. The first to remove a large brain tumor that was found during a scan while in the ER. The second surgery was to place a feeding tube directly in his stomach, now that he had lost his ability to swallow safely.

See, after the scan, this 30 'something year old man and his wife were informed he had what was called a Glioblastoma. Now, I remember alot of things about this man, but I do not remember what grade this tumor was. I do remember how devistated, scared and hopeless he and his wife felt. He had already faced a long major brain surgery to remove this tumor. The surgery had affected his emotions. He was what I call emotionally incontinent. He was unable to control them. He would laugh when it really wasn't appropriate to be laughing, and cry when just at anything, right in the middle of saying a word he would begin crying. He was confused by these runs of emotions. He was afraid. . . . He was frustrated. . . . He was hungry! He was having difficulty swallowing after the surgery and they had placed a feeding tube. So his belly was getting full, but he was not able to eat or drink anything, no tasting of his food, no food for pleasure.

The doctors told him his swallow would probably return but it would take speech therapy and several months. He had also been told, he would be expected to live 6 months to a year. This tumor had been removed, well most of it anyway. They were unable to get everything. He would undergo radiation therapy and if he wanted possibly another surgery, but that would not change the outcome. For him, it would only prolong the inevidible.

His wife had gone home to be with their 3 small children for the morning. She was due back later that afternoon. He spent his morning contemplating life. What was he going to do? The realization that he would never see his children grow up was beginning to hit him hard. His mind was racing of the things he had done or not done, to plan for his families future. Would his wife be ok? Would she be able to make it financially with 3 small children? Would she find someone else to fall in love with and be a father to his children, and if she did, was he ok with that?

I had spent some time in his room that morning, refilling his feeding bag, taking his vitals, assessing his incision, listening to his lungs, walking with him to the bathroom, and just talking. He was disappointed this particular day, because he had planned a nice date for him and his wife for the following evening. They had a babysitter arranged, he had reservations at a nice resturant and she was going to take her to a movie. The first date they had been able to have since the youngest child was born just less than a year a ago. Now. . . he was here, not able to eat, they were both faced with an uncertain future, and the babysitter was no longer available tomorrow night. His wife, instead had told him she would spend the night at home that night and be with the children, who were beginning to feel the effects of daddy being in the hospital. In his heart he knew it was the right thing for her to do.
I asked him quetions about their date, where he planned to take her, what movie they were going to see. Making small talk and giving him the chance to talk it out. I told him that I was scheduled to work the next day and since he would not be having company, I would share a "dinner date" with him. We talked about what movies he liked and I promised to bring him one.

The next day when I came to work, he was bluer than blue! His wife had not been there most of the day, as she was trying to keep things as normal as possible for their children and she felt she needed to be home with them. No one else had come to visit him that previous evening or morning and he was feeling quiet alone. It was giving him way too much quiet time to sit and think about what was to come. So, during my lunch break, I went into his room with the VCR and TV cart we had on this particular floor. I gave him 3-4 movies and told him to pick one. I asked what his favorite meal was. He told he was really craving a T-bone steak with a baked potato and a nice green salad. That is what he had planned on having on his date with his wife that evening, that was now not going to happen. So, I reached into my pocket, pulled out several Sharpie markers and on his feeding bag, drew a picture of a T-bone steak and baked potato. I put the movie in that he chose and we watched a movie for my entire lunch break.

That day, is one I will never forget. That day my heart was full. That particular day, I learned that as a nurse, giving and receiving are in fact the same. As I was able to give this young man a moment of my time to show that I did care about what he was going through, he was able to give me something as well. He showed me courage through a storm. He made me feel happy that I had become a nurse. He gave me confimation that I was doing exactly what I was called to do. This is what nursing is all about. Not just caring for the body, but also caring for the spirit. His spirt had been broken. That day, both of us were able to end our days with a lifted spirit. No matter what was to come next. . . . it had been a good day.
It was about 8 months later that I saw his obituary in the paper. He didn't make it to the one year mark, he did though make it past 6 months. He lived each of those days loving his wife and children the best he knew how.

Friday, April 10, 2009

What's My Name. . .?

There were no balloons, no cameras, no proud papa's standing on the other side of a double pane window pointing at the "one". No one making goofy faces as they ooohed and ahhed at all the tine wrinkled faces with tightly bundled up bodies in white hospital blankets. No, this little boy had no one. . . .

I was in my 3rd semester of clinicals and was so excited about it being my OB rotation. I just knew I was going to do so good this semester. Really, how hard can it be to just love up on all those sweet little babies? Boy was I ever wrong about that!!!! I had clinicals twice a week at a local hospital. One day I would be assigned to a "mother" and the next day I would be assigned to a "baby". I didn't really care for being assigned to the mother's. They all just wanted to be left alone. Understandably, they wanted to spend the next 24-48 hours (all the time they had in the hospital), with their husbands, boyfriends, baby and other family. They did not want some nursing student coming in asking them about pain, pushing on their belly's and looking for more drainage. They did not want a nursing student reminding them to wash and stay clean. And they certainly didn't want a nursing student trying to help them learn how to breastfeed their child.
I just knew after that first day with a mother, that I would love being in the newborn nursery even more. I would bathe, and hold and just love on all those babies. That is exactly what I did.

Day #1 - He's a boy!!! A sweet little bald headed boy. That is who I was assigned to. I went in the nursery, found my babies chart, wrote all the information I would need to write my paper. He was healthy, nothing unusual, normal weight, not eating really well, but that was to be expected. He was less than 24 hours old. While I am writing, I realize the nursery is much noiser than I expected. There is this one baby crying non stop. All the nurses were busy with other babies. In my mind, I kept thinking, "Why won't someone make that baby stop, why won't someone just pick him up, take him to his mother. . . something!". I put down my paper and pen and go to the crib of the now SCREAMING baby. I learned this was MY baby for the day. I also had heard from the other students that Nursery Nurses are VERY possesive. . . ask BEFORE you pick up ANY baby. So I asked the nurses if it was ok for me to hold him. They just looked at me with this weird face and said, "Sure, if you want. . ". I picked him up and he immediately stopped crying. I was hooked right there! I looked at the little blue "tag" in his crib but there was no name. It just said "Baby Boy". I took him to a rocking chair and rocked him with is pacifier in his mouth. Once he was quiet I asked another nurse about the name on the crib card. Maybe the mom hadn't decided yet . . .?

This is where it all went south!! I learned that his mother in fact had not named him. This little one didn't know his mother, his father, his grandparents, aunts, or uncles. Did he have siblings? See, his mom had given birth to him late the night before. When the nurses went to check on her that morning, shortly before I got there, she was nowhere to be found. She was all of 19 years old. She had come into the hospital alone and now alone is exactly how she left this sweet little baby boy she brought into this world. She had abandoned her baby!!!

Before I could stop myself, I had tears streaming down my face. How could someone do such a thing?? I just didn't understand, couldn't understand, and really didn't want to understand. It was totally unacceptable!!! Social services had been contacted. They had tried to contact the mom of this baby, without success. She was gone. . . long gone! This "Baby Boy" would now become a ward of the state, he would be in foster care until a judge decided he could be adopted. He was now crying again. . . I was crying. I couldn't contain myself. I just held him and prayed. There was nothing else to do. I wanted to take him and run as far away as I could. I could give him a good home, I would love him, I would take care of him. But I knew that I couldn't do that. I knew that would just be worse. It was my moment of irrational thinking. You know the one. . . when someone is in crisis and you will do just about anything to make it all better, even if it means breaking the law. Then all of the sudden reality hits you so hard in the back of the head you feel like you have whiplash. . . that is what happened. So, instead of running, I prayed. I prayed that a good family would be found, QUICKLY! I prayed for his mom, that she would be ok, that she was healthy and would somehow, someday find resolution in what she had done. I prayed that he would grow up knowing he was loved and have a big full life of all that is wonderful! Together we cried and rocked for what seemed like my entire day.

It was that day in paticular that I remember most about my OB rotation. The day I decided I wanted NOTHING to do with being an OB nurse. The day I realized my heart would break every day if I had to deal with new life being taken for granite like this. The day I realized I really didn't like this part of nursing school. The first day of a semester full of tears.

That was in 2004. "Baby Boy" would be 5 years old now. I still think of him often and it still brings a tear to my eyes. Did he find a good home? Is someone loving him enough? Is he healthy and happy? Maybe I have seen him somewhere and didn't even know it. But there is a connection. That day we were both grieving his lose. Today, I pray that he is living an abundant life, full of hopes and dreams. Running through the grass barefoot, playing in the dirt and learning to ride a bike. He would be a "Big Boy" now!


Thursday, April 9, 2009

The Nightengale Pledge

When a person graduates from Nursing School, he/she not only has a graduation, but they have a pinning ceremony as well. For me the graduation was a big deal, but the pinning ceremony is what really counted. That is what really made me feel like I had accomplished being a nurse.
We listened to our Professors give us words of wisdom, encouragement for the jobs we were about to do, the world we were about to face. And we heard numerous funny stories of happenings during out time in school.

Then the serious part came. . .
We walked across the stage one at a time when our names were called. Each of us wore white robes, under which we were dressed in our Sunday best. We were given a pin. This pin stated we had made it, we had graduated from this school. We were ready to take our state boards, go out into the "real" world and be RN's!!
THEN . . . It happened. . . .

We all stood together and said the following words in unison. . .

I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.

Those words are "The Nightengale Pledge". This pledge was composed by Lystra Gretter, an instructor of nursing at the old Harper Hospital in Detroit, Michigan, and was first used by its graduating class in the spring of 1893. It is an adaptation of the Hippocratic Oath taken by physicians.

It has become tradition for Nursing Schools across the country, maybe even the world (I am not sure). I believe I read somewhere that there are variations to this pledge. That some words are been replaced (such as using "God"), however that is totally another post!!!

I remember crying as I said those words. I remember praying as I read those words. Praying that God would give me the wisdom to do this job; that I would not forget all that I had learned in those 4 years. I prayed I would have all the compassion needed, the stomach it took, and the patience to care for all who crossed my path. I remember walking out of that auditorium that day with my head in the clouds, my heart full, and . . . scared to death. I had just become a nurse. I had just fulfilled a dream. I had just become someone who would at some point in my career be in a position where I had to advocate for a patient or family, someone who might have to challenge a doctor, someone who had potential to make a fatal mistake. I would be given the opportunity to hold the hand of a dying person, young and old. I might have the opportunity to be witness to a first breath of new life. OH MY. . . I was an RN!!

Today, I still remember that pledge. It has been 4 years since I first spoke those words. I still pray everyday on my way to work.

Lord, please give me the wisdom to care for the patients whom I will be assigned to today. Give me patience for those who are difficult. Give me patience for the doctors who are difficult. Lord, allow my compassion to show, even during times of frustration. Remind me to look at the whole picture, and that the person I am caring for is so much more than a diagnosis. Lord, let my arms be your arms, and my hands be your hands. Let he words of my mouth speak nothing but kindess. Let my co-workers see You through me today.

I still LOVE being a nurse. I love that I work a different unit every day. I love that I am continuing to learn new things with each shift. I love and crave the times that my team is small enough that I have time to give to each individual patient. Listening to their fears, their joys, or anything else they want to share.