Tides

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A Phase brings to mind

Other words

like

In and out

Up and down

Beginning and End.

A phase is a moment,

A beautiful start

Of something amazing

New and exciting

That has potential and possibilities

That is life changing

Until

The phase

Dwindles out

And fades away

Into the past,

Becoming

Distant memory-

Or

Suddenly becomes

No longer a phase,

But a way

Of life!

 

Certainty

Dream when the sun is shining

So brightly that your eyes hurt

Dream of a day when

All you will see

Is the Son shining

So brightly that your heart hurts,

Dream when the sky

Is dark and angry

Of a day (or maybe a night)

When the clouds roll back.

Dream when your tears

Are streaming

And you sob so hard

That your chest is shaking

Of a time when your tears

Will be wiped away

By the One who

Gave you the hope,

Not the pieinthesky kind,

Of hope,

But the sure hope

To be able to dream

Of the day when

Dreams become

Reality

And you finally see

Your Savior’s face.

 

Navigating HealthCare

 

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I am going to give you some basic tips for getting through your next hospital visit.

1.    Carry your insurance card as well as some form of identification with you.
2.    Have a list of your medications and maybe even several copies. Have the list up to date.
3.    Write down past medical history on that list.
4.    Write down your allergies and tell them to everyone that you see.
5.    Show up early for your appointments. Registration takes time.
6.    Have a list of your vaccinations. Know what you have had and when.
7.    Ask, ask, ask questions. Don’t be a bystander in your healthcare, be an active participant.
8.    When someone gives you a drug, ask what it is for.
9.     If someone orders a test, ask why.
10.    Ask for your test results.
11.    Ask for explanations. It is your right.
12.    If you feel uncomfortable, tell someone.
13.    Carry a notebook and pen with you during a hospitalization to write down any questions that you have.
14.    If you have a healthcare proxy form or any advanced directive form, bring that with you.

This is just a small list, but by asking questions, having the appropriate documentation and lists with you- you can make your journey through the healthcare system much more manageable.

~SarahLee, RN

So You Want to Be a Nurse?

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Are you thinking of changing careers? Are you thinking of finding a career? Have you thought about being a nurse?

Being a nurse can be great work, but it can be hard. A nurse often works 8-12 hour shifts, sometimes without breaks. A nurse sees people at their worst and at their most vulnerable, when they are sick. Being a nurse can be very rewarding, but to become a nurse should not be taken lightly.

I thought that I would offer a little bit of advice to you about what to consider if you are considering nursing.

First, why are you thinking about being a nurse? Do you care about people? How are you when someone is hurt? Are you sympathetic? These are all good qualities to have if you want to be a nurse. If you don’t have the foundation of caring for others, you may burn out very quickly.

Do you know what a nurse does? A nurse does much more than hand out band-aids and water. A nurse assesses patients, formulates a nursing diagnosis, implements a plan of care and then evaluates that plan of care. Each of those steps involve more than you might think. Have you ever followed around a nurse for a day? If you haven’t I suggest that you find someone to follow to get your feet wet and see if this is something that you want to do.

What kind of nurse do you want to be? There are (in the United States) LPNs, or Licensed Practical Nurses. There are RNs, or Registered Nurses. Each of these nurses have different job descriptions and responsibilities. A person can become a LPN generally by completing a 1-2 year course. A person can become a RN by several different routes. To be a RN you have to have an Associates degree or a Bachelor’s Degree. The interesting thing to keep in mind is that whether you have a 2 or 4 year degree, everyone has to take the same board test for nursing, the NCLEX. Many nurses obtain their 2 year degree, pass the NCLEX and then move towards their 4 year degree while working as a nurse. Other nurses go and get the 4 year degree and then take the NCLEX. Of course, following the ADN or the BSN, a Master’s Degree can be obtained in several areas including nurse education and nurse practitioner.

The great thing about being a nurse is that there are so many different areas to be a nurse! You could work in a hospital, in a home care setting, in a Dr.’s office, on ships, on planes and in other countries. Generally after a nurse graduates he or she works on a general Medical-Surgical floor for at least a year to gain experience. Many nurses then specialize in certain areas such as pediatrics, intensive care, emergency care and operating rooms.

There are many great resources out there for those who are learning about this profession. One great resource is the Johnson and Johnson Discover Nursing Campaign. This site provides information regarding the different areas of the nursing career path. The site also provides information about scholarships and schools for aspiring nurses.

This little article has only scratched the surface of what it involves to become a nurse. I encourage anyone who is seriously considering this amazing and at times stressful career to carefully do research.  Make sure that you would be a good fit for the profession, and that the profession would be a good fit for you.

I wish you well!

~SarahLee RN

Doctors and Nurses

Doctors and Nurses

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Linked are two articles, from which all in healthcare can learn and reflect. The original article is On Breaking One’s Neck: by Dr. Arnold Relman, with a complimentary article :A Patient’s-Eye-View of Nurses by Dr. Lawrence Altman.

There are compliments in both articles for nurses, as well as warnings that should be considered.

. As quoted from the original article :On Breaking One’s Neck:

“What personal care hospitalized patients now get is mostly from nurses. In the MGHICU the nursing care was superb; at Spaulding it was inconsistent. I had never before understood how much good nursing care contributes to patients’ safety and comfort, especially when they are very sick or disabled. This is a lesson all physicians and hospital administrators should learn. When nursing is not optimal, patient care is never good.”

The review article in the New York Times, written by Dr. Altman,  brings to light the thought provoking differences between physicians and the nursing staff. Dr. Atman expresses concern at the movement towards technology, citing technology as objects that can “Deflect the doctor’s attention.”

I think that nursing as a profession should also heed this concern-does our bedside report become just a huddle in the hallway? Are we including the patient? Are we prioritizing our time between the computer and the patient?

Hopefully we are not, as nurses, using as our starting point of care the review of notes-or as Dr. Relman so memorably states:

“Lengthy notes in the computerized record, full of repetitious boilerplate language and lab data, but lacking in coherent descriptions of my medical progress, or my complaints and state of mind.”

This is referring to the MD notes-but what about our nurses’ notes? Do they adequately reflect the patient? Do they just present the data, or the whole person? I have a tendency as a nurse to at times subconsciously rely on previous documentation-but our starting point needs to be the patient, not the notes. How are we doing? Do we clarify what we saw in the record with the living person in front of us?

Another nice quote, by Dr. Altman, complimenting nurses is as follows:

“Nurses’ observations and suggestions have saved many doctors from making fatal mistakes in caring for patients. Though most physicians are grateful for such aid, a few dismiss it — out of arrogance and a mistaken belief that a nurse cannot know more than a doctor.”

I think that nurses everywhere should read these two articles and be thankful for the recognition. But we should also realize that what is wise for the doctors is wise for the nurses.

We should never forget, in this healthcare system that is changing faster and becoming more difficult every day, the patient is first-and someday the person in the bed could be me or my family.

I had a nursing instructor once that said:

When you enter a room, and you see lines, and IVs, and ‘stuff’, don’t worry about all of those lines, start at the patient, and work your way out.”

Will our patients, will we, our families, be reduced to hallway huddles and medical note jargon and technical terminology? Or will our care be about the individual, the person, with a cautious inclusion of technology as needed?

These articles provide warning signs about our healthcare and we will do well to heed them, whether doctor or nurse.

Clinical Day 1: Discoveries

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A lesson learned few years ago, but never forgotten.

“No, hon, you’re not going to want that. Those are old. You’re going to want these,” said the nurse, pointing at a rack full of thick binders on the side of the desk.
Bewildered, I put the first binder back on the shelf (it was big and heavy) and turned to face the other rack.
Not really sure what I was looking at but attempting to look professional, I grabbed the binder with my newly acquired client’s room number on the spine, clutched it to my chest, and practically ran from the nurses’ station.
As I fled back to the safety of the visitor’s room that the freshmen nursing students had confiscated for headquarter purposes, I could imagine that poor nurse’s thoughts in the back of my mind. “That freshmen nursing student, thinks that she’ll be an RN someday and she doesn’t even know what a chart looks like!” I could just see her shaking her head and rolling her eyes at the inconvenience of having to deal with a floor full of freshmen. I made it back to the visitor room and sank into a chair with the chart in my lap.

My need to stay in my comfort zone was very quickly overcome by my clinical instructor’s orders to “Find your client’s medications from the chart and write them down.” Then she added with a touch of sadistic delight, “Some of these clients are going to have a lot of meds. One student last year had a client with twenty medications.”
Staring at my instructor with disbelief coupled with shock, I tentatively opened my patient’s chart. Pages and pages of information jumped in front of my eyes. Words that I had never seen before, much less understood, attacked me from the pages. I had no idea where to even begin looking for my client’s medication information.
Suddenly remembering that I would need more care plan information about my client than just medication info, I was struck with the bright idea of taking my client’s chart into her room and sitting with her while I attempted to decipher this terrifying binder. At least I wouldn’t be under the eyes of some of the more experienced freshmen or my clinical instructor. I was still delusional enough to think that my classmates were less confused than I was. If I had actually looked around I think that I would have seen the same deer –in-the-headlights-look on their faces that was so evident on my face.
Quickly sucking in my breath like a diver ready to jump, I rose from my chair, slammed the binder shut, and started walking briskly to my client’s room. As I left the visitor’s room I suddenly felt a surge of confidence. After all, here I was, in my new uniform, young, full of ambition and I had almost four weeks of classrooms lectures and lab time behind me! My self-confidence was returning! I felt knowledgeable, smart, and self-sufficient.

Then I passed the nurses’ station where I had gotten my chart. My confidence quickly dwindled as I walked, no; I sneaked, past that station. No snappy uniform or college based confidence could stand in the face of plain old experience that was represented by those sitting behind that desk. I quivered.

Still clutching my binder, I made it past the nurses’ station and arrived safely, albeit somewhat un-confidently, at my client’s door.
I then gave myself my one thousandth pep talk of the morning. “You’re doing fine, everyone feels like this on their first day. Just relax.”
We had been taught to always knock before entering a client’s room, however, upon meeting my client earlier in the day I had discovered that in my client’s instance that little textbook jewel could be thrown right out the proverbial window. I would have to hit that door multiple times with a crowbar before my client would even hear it. The dear woman’s hearing was not very good, and so, I concluded that all textbook information could be adapted to meet specific client needs. Looking around me, half expecting, half afraid to see my clinical instructor behind me, I discarded textbook policy, and walked right in. I walked up to my client, being careful to approach her from the front so that she could see me clearly. Leaning towards her, I raised my voice ever so slightly. “Hello, Ms. So and So! My name is—— and I am a student nurse. I am going to take care of you today!”
That was my very first ever clinical experience. I wrote about this experience very shortly after it happened. I have learned so much since that day; it would take me thousands and thousands of words to even begin to scratch the surface of all that I have learned since that first clinical day.

First of all, I learned that I was not alone in my feelings of nervousness.

I learned that I was not the only freshmen nursing student in the world to have felt so illiterate at the clinical setting.

I learned that my instructors were and are not sadistic, but in fact want to push me to my limits and challenge me with new experiences.

I learned that my instructors were approachable when I was unsure of myself.

I learned that my instructors didn’t mind me ‘adapting’ textbook policy (within reason of course!)

I learned that it was possible to understand a client’s chart!

I learned that the clinical staff can be invaluable tools for learning.

I learned that if I didn’t know anything, I should ask questions.
And the most important thing I learned that day was how to apply my textbook and lecture knowledge. I learned that no matter how much I learned in school, or how much I knew, when it came down to the client, it had to be personally applied to that client.
Although in the school lab, I would lose points during a re-demo for forgetting to knock on a client’s door, in the “real world”, if my client couldn’t hear me, I had to find another way of making my presence known respectfully without knocking on the door. I had to adapt my knowledge to meet a specific situation.
That little lesson turned the ‘light bulb’ on for me, and helped me to understand the nursing process.  It helped me to understand how to critically think a situation, even in a very small way.

I think that I learned more in that one tiny experience, with a hard of hearing lady in a nursing home, than in four hours of lecture on critical thinking. And, small as it was, I know that I will remember what I learned on that first clinical day for the rest of my life.
~SarahLee,RN

Please-Just Let Me Go Home Part II

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~Continued~

When I called the Dr.-he again prescribed an even higher dose of the same medication. I gave it, hoping that this time, it would be enough.

My shift was almost over, and as I was giving report to the oncoming nurse, Virginia was again trying to climb out of bed. Together, we both put her in a chair and brought her to the nurses’ station, attempting to calm her down as well as put her in a safe area where they could keep an eye on her throughout the night.

She was getting increasingly more agitated, and kept saying “Why is this happening? Why can’t I go home?”

I left feeling devastated that she had to be in such an emotional state.

The next day I heard what had happened after I left for the night.

Virginia did not get better. She continued to get more and more agitated throughout the night.  Even ANOTHER dose of the medication was given to her without any results whatsoever.

Finally, sometime before morning, one of the nurses was going through Virginia’ chart and realized that a medication she had been on at home had not been prescribed to her. A medication that a person could experience withdrawal from.

Surprised at finding this, the nurse notified the physician, who ordered the medication.

And by around noon the next day, Virginia was completely back to her normal mental state.

And she told me later that the night before had been “The worst night of her life, and she had lived a nightmare.”

I tell this story because I think of how I assumed. I assumed that Virginia, because she was elderly, was demented. How that once the night was over with some medication, she would be fine. That she was ‘sun downing’ and probably just had some ‘memory issues.’

I assumed that how I have treated dementia patients in the past was how I could treat Virginia.

When in fact, she did not have dementia at all, but was suffering from medication withdrawal!

Just because someone is elderly does not mean that they must or will be confused.

Just because one medication works in one situation, does not always mean it will work in another.

When giving care, never assume.

You could change a person’s life for the better.

Or for the worse.

You never know.