That guy with the Afro who painted on TV? Yeah him. The one, that hippie guy on PBS, that embraced his "happy little accidents"...he knew what he was talking about.
I recently took up a hobby. Making quilts. I have some sewing experience but last time I tried quilting it was a complete failure.
This time I read blogs to learn some basic techniques. And I made a small practice quilt that is a hodgepodge of all the stuff I learned.
It was very satisfying to create something again.
I used to paint. I was artsy. Then I became a control-freak-perfectionist-nurse. That's not a fun job. Satisfying in many ways. But not fun.
While working on my quilt I was about to rip out some mistakes. Then, somehow, I channelled Bob Ross. He told me they were only mistakes If I wanted them to be. That I could choose to let them be "happy little accidents". That I should let it go. Be free and happy. Enjoy and trust the process.
I am so happy I listened. Letting go of that perfectionist attitude allowed me to have fun. Allowed me to experience some real joy. Allowed me to be more creative.
Thanks Bob. But now what do I do about this new obsession?! All I can think about is my next quilt!
I guess there is more to life than just nursing.
Dec 8, 2011
Dec 1, 2011
That did not take long...
Unfortunately, I was only one imperfect RN today with enough work for at least 3 perfect RN's to complete in 12 hours. (I will go read my last post so I can remember a good day.)
I know some poor night shift RN out on the medical floor (where I transferred a patient) is happily writing me up for holding that dose of methadone and doing a blood sugar late because the patient was sleeping. Which may have had something to do with the vitamin A he needed and I gladly gave.
I can only hope the night shift ICU nurse I gave report to, "Hoover", has as busy an assignment as mine was and won't have time to write me up for missing that 1600 H/H.
I did have my perfect moments. Like when I wrestled an Ativan order out of a pulmonologist for my patient I was sure has been in benzodiazepine withdrawal.
I realized last night in my sleep that his tox screen was positive for benzodiazepines on admit, and all we kept giving him was fentanyl for pain. Which maybe, sometimes, lasted an hour. Then he was fidgeting and pulling and moaning and grabbing and yelling "help me!" in his frail little pitiful voice over and over.
One dose of Ativan 0.5 mg IV and he was calm, slept well, wasn't oversedated. No narcs for most of the day. I did try the new order for dilaudid once and it didn't do much to him. Maybe slowed him down a little but he was still miserable.
Ativan. Vitamin A. Thank you big pharma for this. (I take back all the bad things I've said about you)
I also knew the answer to the pulmonologist's pop quiz question. (maybe that's why he agreed to write for the Ativan). He asked me, "Why would I not want to give the patient blood until his Hgb was less than 7? I answered, without hesitation, "Because studies have shown that patients die when we do". He was impressed.
I failed the follow up question: "Why does it kill them?". I couldn't remember. It is because of infection related to the immuno-suppressive effects of the transfusion. Or so he says. I bet it's more than that.
I happen to think we kill people every day with over treatment.
I did one more perfect thing. I made a patient get out of bed, take a shower (the completion of which was an incredible feat in itself), and let his wife go home. That doesn't sound like much. But it is everything.
He wasn't at risk of dying from his knee infection anymore. His biggest risk was now a secondary infection...from being filthy (refusing nursing care and expecting his wife do it all); or pneumonia from not getting out of bed; or from a DVT due to his immobility.
He was IRATE with me. He almost fired me. Right then his doc showed up and I asked him to reinforce what I told the patient. He did. And the patient did what I said. Even though at one point he told me he'd be doing better if I'd stop talking. Ha ha!
Whatever dude! You may not know it. But I saved your life today. And I'm transferring you to the Ortho floor where I know they'll make you get out of bed!
Then I had the 5 hour admit and it all went to $hit. Yes. 5 hours, a PA (useless), and 3 doctors later I finally had the chart. It was now change of shift.
I missed the blood draw in the other room. I let the first guy sleep through his methadone dose and blood sugar until I was transferring him to the floor at which time I did the blood sugar.
I will be written up for something. I was so tired by the end that I could hardly walk to the car. And I called from the car to tell the night nurse one more important thing.
Oh! And I told the doc that the PA had no business seeing our patients. She needs to stay over on the medical floor. That was pretty perfect too.
This is nursing.
PS. To that night shifter writing me up: I hope the computer freezes.
I know some poor night shift RN out on the medical floor (where I transferred a patient) is happily writing me up for holding that dose of methadone and doing a blood sugar late because the patient was sleeping. Which may have had something to do with the vitamin A he needed and I gladly gave.
I can only hope the night shift ICU nurse I gave report to, "Hoover", has as busy an assignment as mine was and won't have time to write me up for missing that 1600 H/H.
I did have my perfect moments. Like when I wrestled an Ativan order out of a pulmonologist for my patient I was sure has been in benzodiazepine withdrawal.
I realized last night in my sleep that his tox screen was positive for benzodiazepines on admit, and all we kept giving him was fentanyl for pain. Which maybe, sometimes, lasted an hour. Then he was fidgeting and pulling and moaning and grabbing and yelling "help me!" in his frail little pitiful voice over and over.
One dose of Ativan 0.5 mg IV and he was calm, slept well, wasn't oversedated. No narcs for most of the day. I did try the new order for dilaudid once and it didn't do much to him. Maybe slowed him down a little but he was still miserable.
Ativan. Vitamin A. Thank you big pharma for this. (I take back all the bad things I've said about you)
I also knew the answer to the pulmonologist's pop quiz question. (maybe that's why he agreed to write for the Ativan). He asked me, "Why would I not want to give the patient blood until his Hgb was less than 7? I answered, without hesitation, "Because studies have shown that patients die when we do". He was impressed.
I failed the follow up question: "Why does it kill them?". I couldn't remember. It is because of infection related to the immuno-suppressive effects of the transfusion. Or so he says. I bet it's more than that.
I happen to think we kill people every day with over treatment.
I did one more perfect thing. I made a patient get out of bed, take a shower (the completion of which was an incredible feat in itself), and let his wife go home. That doesn't sound like much. But it is everything.
He wasn't at risk of dying from his knee infection anymore. His biggest risk was now a secondary infection...from being filthy (refusing nursing care and expecting his wife do it all); or pneumonia from not getting out of bed; or from a DVT due to his immobility.
He was IRATE with me. He almost fired me. Right then his doc showed up and I asked him to reinforce what I told the patient. He did. And the patient did what I said. Even though at one point he told me he'd be doing better if I'd stop talking. Ha ha!
Whatever dude! You may not know it. But I saved your life today. And I'm transferring you to the Ortho floor where I know they'll make you get out of bed!
Then I had the 5 hour admit and it all went to $hit. Yes. 5 hours, a PA (useless), and 3 doctors later I finally had the chart. It was now change of shift.
I missed the blood draw in the other room. I let the first guy sleep through his methadone dose and blood sugar until I was transferring him to the floor at which time I did the blood sugar.
I will be written up for something. I was so tired by the end that I could hardly walk to the car. And I called from the car to tell the night nurse one more important thing.
Oh! And I told the doc that the PA had no business seeing our patients. She needs to stay over on the medical floor. That was pretty perfect too.
This is nursing.
PS. To that night shifter writing me up: I hope the computer freezes.
Nov 25, 2011
Today I was perfect.
It's the end of a shift and I'm not running around like a crazy person trying to get everything done. In fact, today, I ate when I was hungry, I peed when I needed to, I provided thorough and excellent patient and family education, and even printed materials for them on their meds and disease process. I answered questions, and charted the care I provided. I crossed all my T's and dotted all my I's.
I feel really good about the care I provided today. Every patient deserves a day like today. Every nurse deserves a day like today. This was how it should be but it never is.
I had two easy PCU patients today, all day. I'm blogging this fact so that you can point it out to me when I complain that I am overworked and had a crazy (usual) day. Perhaps i should have organized my nurse tote (security blanket).
Today was perfect. Today I was perfect. Mark the calendar lest I forget.
I feel really good about the care I provided today. Every patient deserves a day like today. Every nurse deserves a day like today. This was how it should be but it never is.
I had two easy PCU patients today, all day. I'm blogging this fact so that you can point it out to me when I complain that I am overworked and had a crazy (usual) day. Perhaps i should have organized my nurse tote (security blanket).
Today was perfect. Today I was perfect. Mark the calendar lest I forget.
Trying blogger app on my iPhone
Hmm. Not sure I know how to do this. This is JV. One of my nursing buddies. 
Nov 13, 2011
We're all gonna die.
I'm pretty sure that people in the 1800's and early 1900's didn't have living wills. Why would they? Back then, dying was dying and living was living. There was no grey area. If someone survived pneumonia it was a miracle. Survival, that was the surprise, not death. Death was expected. Death was understood to be inevitable.
Now-a-days, we are surprised when someone dies, for any reason. But if you ask most people they will tell you they don't want to be kept alive artificially, they don't want to be Terri Shiavo, they don't want to be a vegetable, or a paraplegic, or on a ventilator, or... you name it. No one wants a chronic, painful, debilitating disease that makes their quality of life unbearable. My husband says "If I can't swing a golf club honey, pull the plug." Not being able to swing a club would make his quality of life unbearable. (duly noted honey)
I am there when the time has come to face these life or death decisions. No, let me change that. I am there when you should decide to stop torturing a dying person with invasive procedures and treatments that will only serve to prolong the inevitable. Time and time again I see how what we would choose for ourselves is not what we choose for our loved ones.
Where the heck did this grey area between life and death come from? Technology. Medical "advances". Changes in societal expectations. There are worse things than death. Ask any ICU nurse.
Now-a-days, we are surprised when someone dies, for any reason. But if you ask most people they will tell you they don't want to be kept alive artificially, they don't want to be Terri Shiavo, they don't want to be a vegetable, or a paraplegic, or on a ventilator, or... you name it. No one wants a chronic, painful, debilitating disease that makes their quality of life unbearable. My husband says "If I can't swing a golf club honey, pull the plug." Not being able to swing a club would make his quality of life unbearable. (duly noted honey)
I am there when the time has come to face these life or death decisions. No, let me change that. I am there when you should decide to stop torturing a dying person with invasive procedures and treatments that will only serve to prolong the inevitable. Time and time again I see how what we would choose for ourselves is not what we choose for our loved ones.
Where the heck did this grey area between life and death come from? Technology. Medical "advances". Changes in societal expectations. There are worse things than death. Ask any ICU nurse.
Jul 26, 2011
Lonely Nurse
dear miss nightingale,
I am working on a hospital committee that is tasked with decreasing our 30 day readmission rate for heart failure patients. The group has developed a "clinical pathway" for the heart failure patient. It is a multidisciplinary document that includes all the care that we (MD, RN, nutrition, PT/OT, etc.) provide for a patient with the diagnosis of heart failure.
I am a critical care nurse with 15 years of nursing experience. This last year I was part of an interdisciplinary team that developed the care plan content that will be used in our future EMR. Currently, I am working as a subject matter expert for the EMR implementation team.
This is my problem: I have experienced a paradigm shift in my thinking about care planning and documentation in an EMR environment and I don't know how to share this epiphany with others. I don't have all the words I need and I don't have the positional authority to be heard if I did.
NOTE: When words are found to describe this epiphany I will insert them here.
I feel as though I have trekked through a long dark maze of unexpected twists and turns and murky waters, with weeds tangling my feet and cobwebs sticking in my hair and I've left my peers at the other side. The injuries I sustained on this journey have healed so no one can tell what I went through.
Now I can see the path as clear as day inside my head. I want to tell them how to get through the maze but why would they listen to me? Who am I to tell them? And if they would listen, I don't know that I would have the right words. What if I lose most of them along the way? It is very lonely on this side.
Sincerely,
One a-Maze-ing Nurse
I am working on a hospital committee that is tasked with decreasing our 30 day readmission rate for heart failure patients. The group has developed a "clinical pathway" for the heart failure patient. It is a multidisciplinary document that includes all the care that we (MD, RN, nutrition, PT/OT, etc.) provide for a patient with the diagnosis of heart failure.
I am a critical care nurse with 15 years of nursing experience. This last year I was part of an interdisciplinary team that developed the care plan content that will be used in our future EMR. Currently, I am working as a subject matter expert for the EMR implementation team.
This is my problem: I have experienced a paradigm shift in my thinking about care planning and documentation in an EMR environment and I don't know how to share this epiphany with others. I don't have all the words I need and I don't have the positional authority to be heard if I did.
NOTE: When words are found to describe this epiphany I will insert them here.
I feel as though I have trekked through a long dark maze of unexpected twists and turns and murky waters, with weeds tangling my feet and cobwebs sticking in my hair and I've left my peers at the other side. The injuries I sustained on this journey have healed so no one can tell what I went through.
Now I can see the path as clear as day inside my head. I want to tell them how to get through the maze but why would they listen to me? Who am I to tell them? And if they would listen, I don't know that I would have the right words. What if I lose most of them along the way? It is very lonely on this side.
Sincerely,
One a-Maze-ing Nurse
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