Full Moon

Yep, 

it's a full moon weekend.

Guess who is working this weekend.

Shoot me.

It's Flu Season

  It's the time of the year again where, even in the middle of the desert, the air is getting cooler. If you live in more hospitable parts of the country you are seeing leaves change and sweaters are being broken out. Here it seems we have just finally shaken off the summer's death grip on the city and are looking forward to temperature's that fall below 100 degrees. The weather is finally nice enough that one can go outside without suffering from immediate heat stroke so it was hard for me to accept that it is that time of year again, flu season.

  My wake up call came in the bathroom the other night, pinned up on the wall with the other "must read" stuff was the schedule of Employee Health's distribution of flu shots. I sat there staring at the sheet thinking to myself that we just got over summer, how could it be that time again?  Now every patient coming into our unit must be screened for vaccination and offered a flu shot upon admission, gone are the months where that part of the charting was gleefully finished by checking the "not flu season" box and that was that. 

  Later that evening one of our two new Hosptialist's came down into the unit to look over some patients and write some orders. New Hospitalist #1 suddenly looks up and scans the nurses in the unit and sidles up to an RT and asks which nurse in the unit gives the best shot. Turns out that New Hospitalist #1 needs his flu shot and is a total wuss about taking them. Big mistake, never show weakness in front of a bunch of nurses they will have WAY too much fun with that. So we spent the next 20 minutes suggesting nurses:

  "Oh hey how about the Charge Nurse, she's been doing this for 30 years. I'm sure she gives a good shot, she's blind as a bat, but hey you only need to feel the muscle right?"

Hysterical laughter

  "How about the House Supervisor? He can do it, he hasn't given a shot in years but I bet it's like riding a bike, you never really forget."

More laughter mostly directed at the freaked out expression on New Hospitalist #1's face.

"How about IV Nurse, he drops an IV really well so I bet he gives a great shot. Just don't make him nervous or else his hands will start shaking worse than an alcoholic in DT's."

  At this point New Hospitalist #1 hands the syringe and needle to me and tell's me to give him the injection with a hopeful expression on his face that plainly says "the cute quiet one looks like a safe choice". More hysterical laughter ensues at this point, New Hospitalist #1 looks confused as to why his choice would elicit such a reaction, so I figured I'd clue him in.

  "They think it's hysterical that you asked the nurse with the least amount of experience to give you the shot."

  Confused, concerned expression

 "How many years of experience do you have?"

 More laughter

 "None at this point, I'll be done a year in December. You got a totally newbie"

 Quick poke, the guy must work out, he has great deltoids.

"Ok, so are you going to give me the shot or what?"

 I show New Hospitalist #1 the empty syringe and the engaged safety on the needle, then toss it into the sharps bin, while he tries to figure out how and when I stuck him since he obviously didn't feel it. 

  The rest of the night I walked with a little bit of swagger in my step, just a little.

  

Sunday Morning Funnies

                                                                                        Source: doccartoon.blogspot.com via Chanda on Pinterest

Moonlighting

  
The other day while I was on the phone to an old friend from back home I got the oddest call. It was our staffing office, apparently a nurse had called off and they thought that with the census it would be OK, but now there were a bunch of patients backed up in the ER and would I be able to find it in my heart to come in....during the DAY, to work.

  My initial reaction was "Are you kidding me? No." but my good old friend gave me a kick in the butt and reminded me that I wasn't doing anything other than sitting at home talking to her. So I called staffing back and told them I'd be there just give me some time to shower and get dressed, I was still in my PJ's at the time but they didn't need to know that.

  I got in by noon, I made pretty good time considering they called me just around 11am, and walked into pure chaos. Apparently TWO nurses had called off that day and another night shift nurse had picked up an AM shift on her day off too. Everyone was scrambling, alarms were going off everywhere and doctors were giving orders to what appeared to be thin air in hopes that someone may be listening. I shook my head and went to the other side of the unit where my patient would be headed, set up my room and called the ER to let them know there was a nurse to take the patient they had in the wings and then tried to settle into some sort of rhythm.

  I haven't worked the day shift since I was first hired, at the time I was taking classes through my hospital to help me get up to speed on critical care one day a week and putting in two shifts on the floor under a preceptors supervision. It was a little different for me to come back to the AM as a full fledged nurse. 

  Honestly it wasn't a horrible day, there was plenty to keep me occupied, like a second admission in the wings. It was rather nice to have doctors that were awake when they were paged and who responded in minutes rather than hours, but things were just different. I missed the joviality of the night crew, the little jokes that we have and the way that we always pull together in the worst of situations. To be honest, even though we work in the same unit with the same patients, I felt like I was an outsider visiting for a short while. 

  It was nice to go back to days where I started and prove to myself that I could handle the pace and activity now that I am a "real nurse" and have some experience under my belt. I remember a time in the not to distant past when the load of two patients during the day would make me feel like I was drowning. I often wondered if that was a sign that the day shift was harder and that I was unable to make the grade there. Now I know it is not the case, the only thing I was feeling was a lack of experience and now that I have some I can hold my own just fine. It was also nice to go back to days and experience it all again, remind myself what they go through when we are fast asleep at home, it really helped me put a few things in perspective again. Most of all it cemented my belief that I am happiest on night shift, even with the crazy hours and the messed up days off, I found that I am most content slipping into darkened rooms in the wee hours of the night to care for my patients, much like Flo did all those years ago. 

Things I have Learned

  When priming a line for albumin it is inevitable that the dang stuff never wants to flow.

It just sits in the bottle refusing to come out

even though you have opened the vent 

and 

pierced the vent with a large bore needle.

I have learned a trick,

it's so simple you won't believe me.

When hanging albumin just let the bottle hang for several minutes.

Gather your tubing and such and just let your albumin sit there and chill.

Then spike your bottle in one quick motion and pop the vent.

If you do this I promise you will never have a problem priming a line with albumin again.

Neurological Review Packet

Neurological Review Packet

 I just inherited my hubby's computer which is a huge upgrade to my old one. In transferring files I found another review packet. This review packet I found in my Nursing Folder is on all things Neurological. Basically they were passed on from "generation" to generation of Block Four (last semester) students. They contain study material that is broken down by system and contain a ton of information about the diseases, medications and interventions that you need to know. Each generation of students have added on to it, making it a great resource. 

  Since I no longer am in need of these I am happy to pass them along to any of you nursing students. Please follow the tradition and pass them along and edit or add any relevant information.  As always this packet comes with the caveat that I make no guarantees that information contained in the packet is up to date or correct, so please do not take it for gospel and do not come back screaming at me if you find any inaccuracies.

DOWNLOAD NEUROLOGICAL REVIEW PACKET HERE

Enjoy!

Sunday Funnies

The new Pain Scale,

tailored for more accuracy.

We decided that this should be implemented immediately in our ER.

Tablet "Sweater" Pattern

Look what I got!

Yep I got myself a tablet! 

This thing is the coolest gadget in the world but there was one problem,

my tablet needed some protection.

So I knitted my tablet it's very own little "sweater", pretty cool huh?

Want to make your own? 

This project is relatively easy and a great beginner cable project that whips up in no time.

This pattern is based off the measurements of my Samsung Note Tablet

which is roughly 10"x 7"

It would be relatively easy to size this pattern up or down by adding or subtracting stitches in the knit sections of this pattern.

Tablet Sweater

Materials:

  1 skien of worsted weight yarn (I used Caron's Simply Soft in Grey)

  1 pair of4 mm (# 8) knitting needles 

  1 4 mm (#8) crochet hook

  1 cable needle

  2 buttons

  small amount of fabric for lining

C4F - Slip 4 Stitches onto Cable needle and hold to the front of work, knit next 4 stitches on left needle, then knit 4 stitches from cable needle

C4B - Slip 4 Stitches onto Cable needle and hold to the back of work, knit next 4 stitches on left needle, then knit 4 stitches from cable needle

Pattern:

Cast on 50 stitches

Rows 1-4: K10, P2, K8, P2, K6, P2, K8, P2, K10

Row 5: K10, P2,C4F, P2, K6, P2, C4F, P2, K10

Rows 6 - 13:  K10, P2, K8, P2, K6, P2, K8, P2, K10

Row 14:  K10, P2,C4B, P2, K6, P2, C4F, P2, K10

Continue in pattern until piece measures approximately 19 inches, then:

K10, P2, K8, P2, K6, P2, K8, P2, K10 for 3 rows

K10, P2, K3 YO K2tog K4, P2, K6, P2, K3 YO K2tog K4 , P2, K10 (this creates the button holes)

K10, P2, K8, P2, K6, P2, K8, P2, K10 for 4 rows

Bind off

To Assemble:

Block knitted piece well to allow design to show

Cut fabric to roughly same size as knitted piece and sew down to the edges.

Fold and sew up sides, leaving a flap.

Using crochet hook single crochet around the edges of the flap for a tidy looking trim.

Sew on buttons and admire!

 If you spot any errors in the pattern please let me know

      

Staycation

  After working four nights in a row sometimes I need is a little holiday from work.

Ask and ye shall receive apparently.

Coming home to made bed and mints on the pillows 

was awesome.

It's great to have a hubby with a sense of humor.

Offended?

  Earlier today I found this article from Scrubs Magazine on Facebook.

Do "New Nurses" Scare You Too?

This article was written by a Nurse Practitioner who obviously feels less than thrilled 

"new nurses" lately.

Personally I was seriously offended by the entire tone of the article

but I would like you, dear readers, to take a look and decide for yourselves.

Should I be offended?

Should you be offended?

Are you?

What would you like to say to this fellow in response to his article?

Pediatrics

  The other night I had the cutest kid in the ED, now you all know I'm not a huge kid person but I swear this child was a better patient than any of my adults that night. He had a painful injury that required us to transfer him out to a pediatric hospital and sat there smiling at me the entire time he was in my care. The little fellow even gulped down a decent dose of oral meds that, from the smell, I'm not sure I would have been able to take in one swallow.

  When the ambulance crew came in to take my buddy, the little fellow suddenly burst into tears and began sobbing. I was taken aback at the tears since he had been so cheerful all night.

  "He buddy whats wrong? These guys are going to take you for a ride in the ambulance, I thought you were excited about that."

  The little fellow looked up at me and sniffled, "But I want to stay here with YOU! You're nice!"

  I think my heart melted a little right then.

  After a couple minutes we had my buddy on the stretcher, giggling and waving good bye, asking the driver if he was going to put on the lights and siren as he was being wheeled out. Every once in a while a patient puts a smile on your face, my little buddy gave me one that lasted most of the night.

Q&A Link Up

Time to join in the fun! My friends at The Days When I'm Not a Nurse and This Won't Hurt a Bit asked us a few questions in this months link up head on over to the linky and see what other nurses and nursing students said.
1. Where do you see yourself and your nursing practice in 10 years?
  My hope is that in 10 years I will have my Nurse Practitioner license and be practicing as a certified Wound Care nurse. I'm not sure why but I have always loved working with wounds and my dream is to contract out as a mobile wound care service to nursing homes and clinics that don't have an in house wound care staff.

2. What was your first doctor confrontation like? (or most memorable, if you can't remember the first)
  Will never forget this encounter, not my first but pretty close. I was working in LTC as an LPN and discovered that the pharmacy had sent the wrong dose of Klonopin for one of my patients and worse that I had given it. I also figured this out around 1am and then had to call the on call physician. 
  I got a very sleepy Doc on the phone who listened patiently then asked if the patient was displaying any odd behavior, which they were not, then chuckled at me and thanked me for my honesty in reporting the med error.  
  Apparently the dose she was on was half the normal dose for an adult patient and the dose the pharmacy sent was only what a normal dose for an adult would have been. I was just relieved that the Doc didn't scream at me for waking him up at 1am.

3. Which would you rather: heavy GI bleed patient, trach patient with copious secretions, a projectile vomitter, or a patient with a colostomy bag that will NOT stay on? 
  Having had everyone of these patients at one time or another, I can say with all certainty that I would MUCH rather have the trach patient secretions and all. That being said I will say that trachs and vents are my comfort zone since I worked around them my entire LPN and RN career. Like the RT's say, "Your sputum is my bread and butter!"
  I cannot stand the smell of a GI Bleeder when they have a bowel movement, not sure what it is about that smell but it really makes my stomach do a flip flop.
  Projectile vomiting? I like going home in the scrubs I came in, thank you very much. Been puked on once and I swear I could smell it on me for days, even after multiple showers.
  As for the colostomy bag sliding around, I have rigged belts out of kerlix and tape to keep one of these suckers on. It's not the grossness factor on this one that makes me want to avoid it, but the time suck it can be when that damn bag won't stay on!

4. If you could warn your patients to avoid one thing from the hospital menu, what would it be?
  The french fries, which breaks my heart because french fries are my favorite food. I'm not sure how you can screw up deep fried potato's, but our kitchen can in a big way.

5. Do you have a nurse idol? If so, who and why?
  I idolize one of the nurses I work with. She's been in nursing for over 30 years and still has a deep love and compassion for her patients. If you walking into the ICU you can always pick out her patients because they are immaculately clean, the room is neat and nothing beeps in that room. On top of great patient care she seems to know everything, she's an amazing resource to me and is always happy to pass it on. When she tells me I did good, it's the best compliment ever.

6. If you could push one piece of medical equipment out the window, which one would it be?
  The IV pumps! Sure they make our jobs a little easier but I swear that the only thing they do well is beep and drive nurses insane. I'd be much happier adjusting drips by hand some night with the way those things go off for the tiniest occlusion!

7. What do look forward to MOST when you go to work? 
  The people I work with. We have a very close unit, probably because it is very small, it means you get to develop some special relationships with the people you work with and I love all mine!

8. What body system intimidates you most?
  Cardio is my least comfortable system, mainly because I don't have a ton of experience with patients that have major cardiac issues. I can work with an arterial line and understand basic hemodynamic monitoring but get me into Swan Guazes and Balloon pumps and I'm done! 

9. What advice would you give to someone who is considering the nursing profession?
  Take the time to be sure this is what you want to do. The school may only be two years for an Associates, but the amount of time and effort that is put into getting your RN is a lot more. If you really want to be sure if this is right for you take the time to do a CNA class, if you like what they do you will be OK. If you find yourself saying "I can't wait until I'm a nurse so I don't have to do this." than nursing is not for you. 

10. If you hadn't become a nurse, what would you have done?
  Before I was a nurse I worked in an optical both as a store front person who sold the glasses and in the back as a lab technician who ground the lenses. I guess if no one had kicked me in the butt to do more with myself I would still be there. Thank heavens I'm not!

Sunday Morning Funnies

These are about the cutest cookies ever!

Found on Friend a Nurse

I think I'm going to make some then next time a group of us need to re-cert for ACLS.

The person who can identify the rhythm correctly gets to eat the cookie!