MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'Nurse Sean' source. Fri, 19 Sep 2008 15:15:16 +0100 http://nursesean.com/musings/the-wheel-just-keeps-on-turning.htm I just turned off the fans, closed the windows, and turned on the heat. I am absolutely sure that this would be the first time in about four months that any of these activities occurred. I am, after all, a lover of cold weather and gloomy skies. The summer months are spent reaching in desperation for a cool breeze and a drop of rain. I have my limits though, and I am currently curled up in my new hoodie and my favorite blanket. I have been away from my world on a quick vacation for almost a week, just arriving back on Sunday evening. That was following by two twelve hour days shifts Monday and Tuesday. Today, Wednesday, is my first day to put up my feet, drink cup after cup of expensive tea, and reflect upon my life. A few updates! Firstly, I was nominated for post of the day over at The Rising Blogger by Laura at Adventures in Juggling. If you look at the top left of my blog, you will see the award button that I earned. The post that was nominated and chosen was A Dark Place. I am infinitely grateful and honored. Thank you SO much to both of you! It still surprises me how large the response was to that particular post, earning me more hits and more comments than anything I have written before. I cringe every time I read it; it seems so overly melodramatic and whiny. But, truthfully, it was exactly what I was feeling at the time, and why. Things have improved since then, and going on a nice vacation to my favorite city on the entire planet helped immensely. I feel much calmer and relaxed now, with a slight bit of renewed energy. The problem is that my vacation was not even seven days long and was a result of a place in my schedule where I had a few days off, not as a result of me taking vacation time. I have six weeks of vacation saved up that I simply cannot take. Vacation time is a HUGE struggle on our unit as there are too many people to fill all vacation requests. To get a feel for it, people that were asking for a week off during weird times such as November or February were rejected. All but those with the most seniority get the privilege of rest. I am feeling energized, with my biggest source of energy being that I have made a new plan for myself that I hope will work out. I have two more courses until I have completed my critical care certificate (out of five courses), so I want to finish that. I want to finish all possible certifications in the ICU. I want to complete my ACLS and become a proficient member of the code blue team. I want to finally write my test to become a certified critical care nurse (you know, and get all those fancy letters after my name). Once I have completed all these goals, I would like to enter a Masters degree program and truly move on in my career. I’m looking at a few universities, but I certainly have my favorite. I have no interest in being a Nurse Practitioner, but am rather more passionate about the theoretical side of nursing, particularly the qualitative research side. I’d like to enter a thesis based program and work on a big project for a couple years and hopefully end up in a PhD program. Then I can be Dr. NurseSean… I’m simply coming to the realization that bedside nursing is not something I want to do for the rest of my career. I’m already cranky and feeling burnt out after only a two and a half years. I just don’t have the endurance to make it for 35 years. My hat is off to everyone who does! Whenever I’m at work, I look around and I see happy people that love their job. I often fool myself into thinking I love my job (or perhaps I really do at those times), but if I dig deep and answer truthfully, as previous posts have shown, I’m just not happy. But I feel that in order to make it as a nurse researcher, you need to work as a bedside nurse. You need this experience to study the experiences of nursing properly and with credibility. At least I have a sense of humor about it all. Yesterday, I had two patients (not typical in a Canadian ICU…we generally have one). Both patients had been waiting several days for a bed to open up on the floor. One patient was particularly agitated (to put it mildly) and was, as a result, a handful. However, both patients were very low acuity and were nowhere near the sickest patient you see, even as a floor nurse. I was the only person doubled, so when the charge nurse had to find a spot for one of our new employees, still in training, she put her with me so that I would have help. She was particularly awesome as she was reaching the end of her several months of preceptorship. I took one patient and she took the other, with the goal of being as independent as possible. I couldn’t help but notice the snickers of other nurses, clearly rolling their eyes, and talking behind my back, shocked that I would be “training” someone new. I use the word training lightly because frankly, a first year nursing student could have cared for her patient, and she needed no help or guidance at all. All of a sudden I’m hearing choruses of, “but you don’t know what you don’t know!” Yes, yes, I know, it was inappropriate, but I once again reiterate, I’m new to the ICU, not new to nursing. I’ve had many students and new orientees with me. And, I repeat, these patients were really not sick enough for the ICU. I sent one of my patients to the floor: the agitated one, yay! One nurse said, with a definite snicker, “oh good, you can help me for a minute, you have no patient now since you discharged yours.” “Yes I do, I was doubled.” “Please! The new person is taking care of her, I doubt you don’t even know what her lungs sound like.” She quickly responded, challenging me, I had fallen into her trap. Yup, I could definitely tell she thinks I’m an idiot. I wonder to myself: when will people stop treating me like an idiot, maybe I am an idiot…why won’t someone just tell me if I suck at this job so I can move on with my life!!! “Yah, I do know what her lungs sound like, they’re quite clear, just a bit diminished to the left lower quadrant…pneumonia.” I guess I did know. I felt vindicated. She didn’t respond. Where, oh WHERE do people get these holier-than-though attitudes? Oh I could go on and on…I won’t. ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1759855 Wed, 03 Sep 2008 18:06:08 +0100 1759855 http://nursesean.com/musings/8-ways-to-become-a-better-nurse-phil-baumann-rn.htm This post is incredible, and definitely worth echoing and sharing! A great find, if I do say so myself–and I do say so myself by the way… One of the benefits of being away from bedside nursing is that I’ve had time to reflect on my own performance. How could I have been better? What simple precepts would have helped? Being out of the “fog of war” has given me a clearer view of what’s right and what’s wrong in health care. Our culture doesn’t offer much positive encouragement for the nursing profession. That’s a costly shame, as many Baby Boomers soon will discover. To help out, I’ve come up with eight ways to become a better nurse. Pay attention to how you perceive your patients Intend nothing but the best for your patients Speak the truth in a way that echoes your wisdom, not your darkness Act on the facts but respect your intuition Live your life as a connection to something greater than yourself Work through your hardest times, not against them Mind your mind: its power to destroy is its power to heal Focus on the moment, not the past Some of us are cut for bedside nursing, some of us aren’t. I think if you’re in bedside nursing and enjoy what you do then you’re a Jedi Knight who commands more respect than you probably receive. For those of you who don’t quite enjoy what you do, think about your reasons for what you do. Consider the eight precepts (or make up your own) and see if anything changes for the better. You have more options than you realize. Feel free to add your own suggestions for becoming a better nurse. If I get to 101, I’ll post your thoughts here and promote the living shit out of the list. I hope the list I’m offering here helps you to become a better nurse, a better person, a better part of our quickly-changing world. This post has come at an important time in my career in which I am particularly struggling with bedside nursing. It has given my a lot to think about over the next few days as I take a short rest from work (does five days count as rest?) A powerful post! Here’s the original item link: 8 Ways to Become a Better Nurse : phil baumann /*rn*/ ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1726341 Fri, 22 Aug 2008 13:12:16 +0100 1726341 http://nursesean.com/musings/busy-months-ahead.htm In the next couple months, I will be CRAZY busy! In the next couple weeks, I will be oriented to code blue stuff and will be expected to be part of the code blue team. More anxiety…awesome… In September I renew my nursing registration. This involved gathering documents, writing learning plans/goals, proving that I met last years goals, etc. Not to mention the $400 it costs! In September, I also start the next course in my critical care certificate program. This time I will be studying pathophysiology. Crap, another $600. In October, I have both BCLS and ACLS. Apparently, ACLS comes with a text book to read and study. I love to learn, but this is getting ridiculous! Oh yes, and that’s another $375 All on top of a full time job that is constantly threatening to destroy me with anxiety, fear, and frustration. Did I mention I was moving into my new condo in October? Yes, I have to find time for that too…not to mention all the money for furniture and lawyer feets etc. I think I’ll plan my next vacation right now!!! Oh wait, I won’t have any money left for one… Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1723429 Fri, 22 Aug 2008 06:47:01 +0100 1723429 http://nursesean.com/musings/the-itouchiphone-really-is-that-cool.htm My dog ate yet another power cord for my MacBook yesterday. between my iBook and MacBook, he’s chewed three cords over two years. Unfortunately, I didn’t notice it wasn’t working until my laptop gave me the low battery warning, despite being plugged in–meaning I had no computer all of a sudden, without warning! PANIC! I was forced to use my iPod Touch for 24h as my main internet access. I don’t have an iPhone yet as I’m still on a contract with my current phone. Plus, the plans here in Canada are WAY overpriced and not even unlimited. Even further, I really REALLY don’t want to have a three year contract with the one and only company that sells them. For now, the iPod touch is just fine. I really have no good use for the phone part of it at this time. It seems that wherever I go, there is a perfectly fine wireless collection. And I don’t have any plans for cool live-blogging from helicopters or the middle-of-nowhere. But, what I did discover was that it was, besides a couple exceptions, a perfectly good substitute for a full blown computer. Now that apps are downloadable, it is even more simple to use…particularly when it comes to facebook and twitter. Even google has an app now that makes using google reader easier. I just couldn’t watch the Big Brother live feeds, and I couldn’t join my favorite java chat room. Hey CBS/Big Brother! I would pay VERY well for an application that allows me to watch the live feeds on the go with my iPod touch. I swoon at the idea! Two more shifts until I leave for beautiful Victoria, British Columbia for four days.This jewel of a city is my destination of choice–for living. I was intending to move there last year, but it simply didn’t happen. It continues to remain my dream and I am considering applying there for grad school. Ahhhhh…such dreams… Time to start making some road-trip music mixes! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1723430 Fri, 22 Aug 2008 05:03:32 +0100 1723430 http://nursesean.com/musings/and-then-theres-the-tragedy.htm There’s one other thing that has been getting me down in the ICU, more than anything else. That is the shear tragedy of the entire place. Here’s a cross section of patients that I’ve had recently. 1. A 49 year old woman who was fine one day. Then nobody heard from her in many many days. She was found several days later, face down in a pool of her own urine (that she had aspirated on as well). She had had a massive hemorrhage that even bone flaps and drains couldn’t fix. 2. A young fit women who was rock climbing without ropes or a helmet. She fell 100 feet. Very very broken. It’s amazing just how many family members will appear out of nowhere for an argument over whether someone should live or die; regardless of how estranged they are. 3. A drunk driver who slammed into a minivan who had a broken leg and a stable C7 fracture and is going through severe DTs (of course). The family of three (used to be six before the accident) that he hit was being taken care of on the other side of the unit. 4. A man that was simply walking down the street on his lunch break. A piece of construction equipment fell on him. He experienced a traumatic brain injury and is not expected to survive. 5. A young women with severe respiratory failure. Nobody knows why. They ran out of tests to run. She died. I wonder if the autopsy gave them answers? 6. Have you ever seen what a body looks like when a femoral line goes interstitial that was running high doses of levophed? Nobody noticed for two days because he was so swollen to begin with. It goes on and on and on. It seems that not a day goes by that I don’t hear wailing coming from some distraught family. There’s also the fighting between family members. I’m finding that with these big big tragedies, the emotional walls that I have built over the years to deal with the sadness of nursing are being torn down. I need to find some better coping skills! I PROMISE the next post will be a happy one. I swear!!! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1709051 Fri, 15 Aug 2008 17:22:32 +0100 1709051 http://nursesean.com/musings/a-dark-place.htm I haven’t been around lately (maybe one or two of my three readers noticed). I went to a dark place in the world of nursing: a long tunnel filled with fears, regrets, and frustration. I really didn’t think I would be able to come out the other side of this darkness, I still haven’t, but at least now I’m 68% positive I will. Let me explain:It happened as quickly as someone flipping a switch. I went from being excited about my career, from engaging and learning, from dreaming of future career paths, to hating every moment of every day that I had to be a registered nurse. Some would call my symptoms depression. I was nauseous all the time, I was exhausted and slept twelve hours a day, I struggled to leave my bed on my days off, and if I did, it was only to lay on the couch and watch television. I was miserable and cranky, moody and angry.I would start to cry at the thought of reading nursing blogs or forums. In disgust, I ran from everything nursing related.To an extent, all these feelings are still there, they are simply improving. I have yet to truly regain my desire to be a nurse anymore, going so far as to look through job search sites, browse college program brochures, and contemplate running away to become a Buddhist priest. These are the examples/things that are getting me down. 1. Learning the ICU is a tough gig. My knowledge base is general surgery, not trauma, neuro, or medical. Every day I’m given a patient that I’m absolutely clueless about. Drains I’ve never seen, equipment that is mysterious, treatments that are frustrating, and procedures that are completely bizarre. And of course, as an ICU nurse, you feel as though you should know everything about everything. What I wouldn’t give for a nice simple bowel resection patient. And, frankly, I have barely even begun to learn ICU nursing. Soon, I will be expected to take my ACLS and start being part of the code blue team, then I learn PA catheters, then CRRT, and on and on. There is never a moment where I get to feel comfortable. There’s never a day I walk in and see my patient and say, with confidence, “I know exactly how to deal with this.” 2. I’m tired of being tested. I’m tired of having other nurses breathing down my neck. I’m tired of being treated as though I came with zero experience and need to be helped with every little skill. Who knows, maybe I’m doing a horrible job, but nobody has said anything, and one would hope they would. I’m very good at knowing my limits–I’m almost too cautious–so trust me, I’ll let you know if I need help. 3. On two occasions, when my patient was in trouble, despite doing a great job at handling the situation and stabilizing my patient, I was told I was too calm. “If it were me, I would have been freaking out. I didn’t even know you needed help. If you needed help, why didn’t you ask?” First of all, I did ask–just not you. I had a doctor and another RN who was familiar with my patient helping out. Second, since when is staying calm in an emergency become a negative? I can’t believe I was accused of being too calm by two separate coworkers on two separate occasions.Let me just say this: Just because I’m new to the ICU, it doesn’t mean I’m a new nurse. I’m used to dealing with very similar emergencies on the floor with less staff, no doctors, and less resources in the form of medications and monitoring equipment. Perhaps I’m not panicking because although things are going bad, it is in a very controlled environment. Next time my patients MAP is 48, I will jump up and down, scream and shout, cry and have a nervous breakdown. THEN I’ll get the fluids and Levo. Makes so much more sense. 4. I’m not a bitch/asshole. Therefore I’m not a good nurse. I’m not bossy, argumentative, crude, crass, rude. Therefore, I’m simply not a good advocate for my patient. I’m willing to wait a minute or two for my doctor to finish with another patient, rather than interrupting him rudely to come immediately (not an emergency by the way). I shouldn’t let doctors dismiss me like that, I was told. Ugh! 5. I don’t spend my entire day complaining about management, the new residents (I can’t believe how mean some of these nurses are to them!!!!), attending physicians, nurses on other floors, my patients, the colour of the curtains, or worst of all, I don’t say rude things about my patient, such as “what a waste of skin!” within hearing distance. Therefore I’m not hardened enough and jaded enough to be a good nurse. I’m too kind and sensitive. 6. Example: My patient had recently been extubated. He was sitting in a chair comfortably, laughing and talking with his family, his lungs sounded clear, he was breathing about twenty resps a minute, he was on 2L of oxygen, and his Sats were 99%. He was all ready for discharge. I did a blood gas. Apparently, I’m a bad nurse because I didn’t run to the doctor in a panic (yes, apparently as an ICU nurse, I’m supposed to be panicked all the time) because his C02 has risen from 44 to 50. Sure it’s high, but we treat the patient, not the numbers, right? It’s an important number, but I didn’t see the need to panic. I’m a bad nurse. 7. I’m tired of working twelve hours on weekends, holidays, and nights. When I started nursing school at age twenty-four, was single, and loved to go out all days of the week partying, working shift work seemed like fun. Fast forward to six years later, I’m in a relationship with a kid (my dog) and it just doesn’t fit my lifestyle anymore. I want a “grown-up” job where I work in an office downtown, get weekends off, get vacations (almost impossible right now with my seniority), get Christmas off, and most of all, I want to come home after work with energy to do stuff in the evening–rather than be so exhausted that even breathing is hard. 8. I’m truly tired of dealing with patients, and especially family, that are completely horrible, ignorant, rude, people. I want to spend my days surrounded by well-balanced individuals for a change.These are the tangible ideas that I am able to write down. There are also many intangible feelings that I just can’t put into words. Honestly, the best way to say it is that I feel as thought there is a dark cloud over me and my career. I’m trying to snap out of it, and I’m slowly succeeding. But really, this is why it has been so tough to write–I simply didn’t want to think about nursing whatsoever. Sorry for the depressing post, but I thought I’d explain a bit about my absence, and give a bit of an update. I regret that I won’t have numerous posts about the many interesting firsts over the past few months, but alas, I just couldn’t do it. Here’s hoping things improve! Edit: Thanks everyone for your wonderful comments! I wish I had written this earlier. Just writing it all down made me feel better, but to do it in such a supportive public forum is that much better! Just to clarify though, I’m not a new grad. I worked on a surgical unit for two years prior to ICU     Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1709052 Thu, 14 Aug 2008 19:21:07 +0100 1709052 http://nursesean.com/musings/change-of-shift-4.htm Change of Shift is up over at Parallel Universes. Go check out this great edition. Don’t forget to spread the word and offer some link love. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1709053 Thu, 15 May 2008 19:12:43 +0100 1709053 http://nursesean.com/http:/nursesean.com/musings/change-of-shift-4.htm Change of Shift is up over at Parallel Universes. Go check out this great edition. Don’t forget to spread the word and offer some link love. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1446022 Thu, 15 May 2008 19:12:43 +0100 1446022 http://nursesean.com/http:/nursesean.com/musings/a-day-in-the-life-of-a-new-icu-nurse.htm 07:00–I’m sitting in the staff lounge with my tea in one hand. The day staff is trickling in. Between smiles, you can tell we are all miserable from being up so early and having to work. Everyone watches the large clock on the wall slowly move toward 07:15 07:15–We are given our bed assignment: just the bed number, the rest we will have to wait until we see our patient and hear report. 07:15–I walk to my assigned bed, curious about the acuity. Because I’m just a month of orientation, my patient assignments alternate between ridiculously easy, and slightly challenging (to me) but relatively easy for any other ICU nurse. At this point, a lot of my patients have been completely non-acute. They are walkie-talkies who have been waiting days for a bed on the floor. I’m used to taking care of 6-8 sicker patients than these ones. So, taking care of only one has had the tendency to lead to many head-banging boring moments. I look at my patient: a moderate number of IV drips, ventilated. This may be one of my more challenging days. A thought crosses my mind: It actually is exactly one month since I finished orientation. That means another batch of newbies will be starting. That means no more easy patients for me. Time to step it up to the next level. I think I’m ready. 07:30–Report is done. My patient is a very tragic case, as most ICU stories are. She broke a hip and had respiratory failure post surgery so was never extubated. She ended up in the ICU paralyzed and sedated. When her respiratory status improved, they weaned the sedation and paralitics. She never woke up. Tests and EEGs showed brain death. A CT scan showed copious fat emboli in the brain stem. She never will wake up. Family is the true issue. Fights over who will make the long distance trip to see her and “pull the plug.” Add lawyers, social workers, feuding siblings, devastated boyfriends, and a frequently shared family history of severe mental health issues, and you have the makings for a very interested scene. What it boiled down to is that we were keeping her alive until the appointed family member could make the trip, see him, get all the information that he and his lawyer want, and then “pull the plug.” 07:31–I start my head-to-toe assessment. Spending time in the ICU will hone anyone’s assessment skills quickly. Not out of necessity alone, but out of pure availability of time. I can stop and listen to the lung or heart sounds for several minutes if I desire. I can really take the time to find those pedal pulsed. Besides my assessment, in no particular order, I do many other things: print of rhythm strips to analyze and add to the chart, check placement of the oral-gastric (OG) tube before testing for residuals and flushing, check blood sugar and adjust insulin drip, suction secretions from her mouth but decide against deep suction as the lungs sound great, change the central line dressing as sweat and phlegm have pulled it away from the neck. 08:00–Crap! It’s already time for my first set of vitals and Ins and outs. No problem, it doesn’t take long. I check my lines, following the lumens of the central line to their stop cocks to their labels to the pump and to the bag. Dates are checked, labels are checked, concentrations of drugs are checked, the art. line and CVP are zeroed and their wave forms and square waves are checked. 08:15–Respiratory therapy is present to assess and adjust. She putzes around, changing the position of the ETT, fiddles with the ventilator, and does a couple suction passes. She asks if there are any concerns. There are none. 08:30–The dressing to my patient’s incision (remember that hip fracture?) is leaking copiously and has saturated the dressing, the soaker pad, her gown, and much of the bed sheets. I change the dressing, leaving the rest for later. 08:45–The resident-du-jour is present for pre-rounds. He should be assessing the patient, but they never do. He reads the charting since yesterday, asks me for an update, writes down my assessment, mumbles a bit about nothing, and moves on. 09:00–Tip the urine, check the glucose, insulin is running high, adjust insulin rate, enter vital signs, suction mouth, perform mouth care. Tylenol, colace and Antibiotics are due. 09:15–I have to chart everything that has happened so far, including the visits from the RT and residents and every task I performed. Of course, I have to chart my head-to-toe assessment. 10:00–Vitals, urine tipped, glucose checked, insulin adjusted, patient turned, mouth suctioned. It’s also time for a break! 11:00–Vitals, urine tipped, glucose checked, insulin adjusted. It’s time to start fussing over my patient a little bit! I wash her hair and brush it, I then take my time and clean every nook and cranny of her body. I call for some help and we turn her, wash her back, change every last piece of linen, slather her from top to bottom in moisturizer, turn her on her side, and tuck her in with warm blankets. 11:45–The dietician is at the bedside. Great! I wanted to clarify her tube feed orders. 12:00–Vitals, urine tipped, glucose checked, insulin doesn’t have to be adjusted! YAY! But it’s time to do another head-to-to assessment. It’s always faster the second time, but it still must be charted. OG tube is checked for residuals and flushed. It’s break time again. 12:30–My break is interrupted by my charge nurse because the “team” is at my bedside wanting report. My adrenaline peaks, I hate presenting at rounds. I get there and the resident who had done pre-rounds is there and starts giving a brief description of the patient including issues, problems, new stuff that he learned from me in the morning. There’s really not much for him to tell. I give a complete systems assessment, CNS, CVS, GI, GU, etc., then the respiratory therapist reviews their assessment of the respiratory system, dietician gives recommendations, pharmacist reviews medications, physio shares their imput, charge nurse interjects with his opinions. The attending physician asks the resident several obscure questions that he has no chance of answering. The attending proves his intelligence by going into a long lecture explaining the answers to these questions. Goals, plans, new orders are received from all departments. They leave to go the next patient. I go to finish my break. 13:00–Vitals, urine tipped, mouthcare 13:15–I chart that rounds took place and what orders I received. I then complete the orders, which in this case are basic: increase analgesic, decrease fluid intake, change ventilation mode etc. 13:30–The bed across from me is getting a new admission. At the same time, the admitting nurse is trying to help send her other patient to the OR. I help by infusing all the blood products the patient needs before the OR. Then I help with the art. line insertion and lumbar puncture on the other patient. 14:00–Vitals, urine tipped, mouthcare, glucose checked, no adjustment needed in insulin, patient turned. 14:30–I made a mistake with the blood products I helped infuse. I feel horrible despite the very minor nature of the mistake. The doctor is informed but nobody cares. I fill out an incident report despite the fact that the nurse I was helping said there was no need. 15:00–Vitals, urine tipped 15:15–Physiotherapy is at bedside. They don’t to much because there truly isn’t any rehabilitation in this patient’s future. They do a couple deep suction passes after listening to her lungs, and then move on. 15:30–The visitor’s boyfriend arrives with someone pushing him in a wheelchair. He breaks down in sobbing tears and commands his assistant to, “just get me out of here.” That was his version of saying goodbye. It lasted about thirty seconds. 16:00–Vitals, urine tipped, glucose checked, patient turned, mouth care, next head-to-toe assessment completed and charted. OG tube is checked for residuals and flushed. My educator arrives and decides to go over “head” patients, including: traumas and all types of strokes/bleeds. It was fantastic to have some one-to-one time with this stuff. It’s great to be so supported! 17:00–Vitals, urine tipped, more meds given, time for break. 17:45–I have to mix up some more fentanyl and insulin for the next shift, I change a couple lines as well, I also change the tube feed set-up. 18:00–Vitals, urine tipped, mouth care, glucose checked, patient turned 18:15–I make the mistake of going into another room to help a nurse. This patient is VERY sick and has a 2:1 nurse to patient ratio. I almost have a panic attack! The room is FULL of large machines such as the prismaflex for CRRT and many others (who’s existence I wasn’t even aware of.) I decide that I’m happy with my “easy” patient. 18:30–A smaller version of the “team” is around again: just the attending and resident as well as the overnight attending. They are going bed to bed giving report. They actually skip my patient–such a boring patient for everyone but me! 18:45–I start cleaning up. I make sure the patient is clean, positioned nicely in bed with straightened sheets. Her leaky leg dressing is redressed again. Lines are organized nicely. The side table is cleaned and straightened-up, supplies are replenished and organized nicely. The Foley is emptied. I wipe everything down with sanitizers–not because I have to, but because I like to at the beginning and end of my shift–infection control is everybody’s job! 19:00–You guessed it, Vitals, urine tipped. I have fifteen minutes with which to sit and relax, reflect on the day, and praise my luck that no bowel movements occurred. 19:15–The same nurse that gave me report is back, which is nice. I can give a “Cole’s Notes” version of report. Of course, she’s of the interrogation-type when it comes to report, “why didn’t you do this?” and “Why did you do that?” or “You totally missed this and forgot that and did this wrong!” and of course, “The doctor shouldn’t have done that! Why didn’t you tell him to do this and that instead?” My mood can’t be ruined though. I know I did a good job and I am happy with myself. Plus, I have two days off now! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1442808 Wed, 14 May 2008 21:07:04 +0100 1442808 http://nursesean.com/http:/nursesean.com/musings/pleasant.htm I had a pleasant surprise today. Apparently patient census and acuity is extremely low in the ICU tonight. So, because of the large excess of labor recourses (i.e. registered nurses), I was offered the night off. I gladly accepted the offer! That definitely goes under the list of things that would never happen in med/surg nursing! Speaking of that list, another thing that would go there is my experience last night. They did a bedside gastroscopy on the patient next to mine. They hooked up a really neat plasma television-on-wheels to the scope so everyone around can see what they’re doing. I watched the video screen as they carefully pulled six perfectly stacked quarters out of the patients stomach where they had lodged in the pyloric sphincter. It scored an 8/10 on my newly invented and soon to be patented nursing neat-o-meter! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1418967 Sun, 04 May 2008 06:51:33 +0100 1418967 http://nursesean.com/http:/nursesean.com/musings/triple-alarm.htm All ICU nurses are aware of the dreaded “triple alarm.” At least I’m under the impression that this is something common to all ICUs. The triple alarm is part of the cardiac monitor and is just one of many noises, beeps, and cries that it produces. It is three loud high pitched beeps in a row, and it repeats itself over and over. Beep beep beep Beep beep beep Beep beep beep And on and on…. The triple alarm signals to everyone within what seems like a three kilometer radius that it has detected either V.Fib, V.Tach, or Asystole. In other words, the cardiac monitor is shouting, “OH MY GOD, OH MY GOD OH MY GOD!!!!!!” So is the nurse, most likely! However, the overwhelming majority of the times this alarms sounds, it is a false alarm. Moments after you hear it, you generally hear a nurse yelling, “I’m OK.” The general rule is that failing to shout, “I’m OK” is a signal to everyone around that you are, in fact, not OK. So, it was 05:00 in the morning. We were all hanging out, enjoying a lull. It was that dreaded time of the morning in which your body completely rejects wakefulness, and every moment is spent struggling to keep your eyes open. Then I heard it from another patients room. Beep Beep Beep Beep beep beep Beep beep beep I waited for the word that everything was OK Beep beep beep Beep beep beep Beep beep beep One nurse casually says, “Are you OK?” “Uhmmmmm” Was the definitely unsure response. I could visualize the RN checking for a pulse and checking the Art line portion of the screen for a blood pressure. “Do you need a cart?” Still casual. “YES!” A flurry of activity began. I waited a few seconds, probably about fifteen. I wanted to let everyone jump in before I went to watch. As I went around the corner someone yelled, “Starting CPR!” And then the scene appeared before me. Several nurses and the junior resident were working on the patient. Where did the resident magically appear from at 5am? The resident took charge quickly, calmly, and with purpose. “It looks like V.Fib. Everyone agree? I want 200j biphasic” “Charging!” The cart nurse yelled** Seriously? They already had the pads on? And hey look! that RN is doing GREAT CPR! My mind is racing, my eyes are wide. “Everyone clear?” Ka Chunk! The neat-o sound of the defibrillator. “He’s moving!” “We have a blood pressure” The charting nurse and the cart nurse seemed bored–they were talking about something else. I know them though; they’ve done this a billion times. “CBC, electrolytes, chest x-ray….” the resident is still making orders while everyone wanders back to their patients. Crisis averted. No exaggeration here: I’m almost positive that the time from the triple alarm to CPR was less than fifteen seconds, and to defibrillation was about thirty seconds. Exciting stuff! **When a code is called at our hospital, whether it is in the ICU or on the floors, it involves three RNs from the ICU: One RN is the medication nurse who is in charge of getting IV access and pushing meds. The second RN is the cart nurse who prepares meds and passes off supplies. The third RN is there to chart everything going on. The floor nurses (or other nurses if the code happens in the ICU) are there to get supplies, prime IVs, etc. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1416219 Fri, 02 May 2008 11:36:08 +0100 1416219 http://nursesean.com/http:/nursesean.com/musings/change-of-shift-volume-2-number-22.htm Change of Shift is up over at life in the NHS! I must say, the pagan theme certainly appealed to my spiritual senses. The focus is May Day, or as pagans would call it, Beltain. Yes, I actually have danced around the maypole! Go here to read all the wonderful blogs from this fantastic edition! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1414910 Fri, 02 May 2008 06:20:35 +0100 1414910 http://nursesean.com/http:/nursesean.com/musings/kiva.htm I’m not sure if anyone has noticed, but I added a link to Kiva in my sidebar. I wanted to take a quick moment to promote Kiva in my main blog as well. Just so you know, I’m not getting anything in return for promoting Kiva, nor was I approached to promote this program. I’m simply doing this because I think it’s flippin’ cool and deserves some link love. Here’s a description of themselves from their website: We Let You Loan to the Working Poor Kiva’s mission is to connect people through lending for the sake of alleviating poverty. Kiva is the world’s first person-to-person micro-lending website, empowering individuals to lend directly to unique entrepreneurs in the developing world. The people you see on Kiva’s site are real individuals in need of funding - not marketing material. When you browse entrepreneurs’ profiles on the site, choose someone to lend to, and then make a loan, you are helping a real person make great strides towards economic independence and improve life for themselves, their family, and their community. Throughout the course of the loan (usually 6-12 months), you can receive email journal updates and track repayments. Then, when you get your loan money back, you can relend to someone else in need. So, basically, you go to the website and are presented with a list of struggling entrepreneurs from third world countries. Each one is asking for a small business loan to help them create or improve their business. They are looking to drastically improve their quality of life. Once you have chosen who you would like to help, you then decide how much to lend toward their needs. I typically lent around $25. Once each pledge adds up to the total amount needed, the loan is dispersed. Then, over time, the entrepreneur slowly pays back the loan, which goes directly back to you! Did that make sense? If not, just check out the website for a better and more extensive description. The absolute fun part is going through and reading these people’s stories. I love browsing through their businesses to see what they are doing for themselves. I love feeling like I’m truly making a difference in someones life–and I like that I’m doing it with a loan, rather than a pure gift. Anyway, I hope you’ll check out Kiva and give it a go! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1402954 Mon, 28 Apr 2008 06:30:23 +0100 1402954 http://nursesean.com/http:/nursesean.com/musings/the-perfect-day.htm One thing I miss about working a rotation with day/night eight hour shifts (as opposed to my current day/night 12 hour rotation) is that no matter what I worked, I always had my evenings off. That meant I never had to miss any of my favorite television shows! Now, I miss A LOT of shows while I’m at work, but fortunately the hard drive on my satellite receiver records everything I could ever conceive of watching. Today, on my first day off after a couple twelve hour shifts, I woke up at 07:30 and watched recorded televisions shows–commercial free–until 18:00 with only a pee breaks for me and my dog, and quick trips to the kitchen for food. I could win awards for my ability to slack off. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1400655 Sat, 26 Apr 2008 03:46:31 +0100 1400655 http://nursesean.com/http:/nursesean.com/musings/sinus-arrhythmia-beer-does-this.htm Sinus arrhythmia: Beer does this. I love this article! I can’t wait until I have the knowledge and experience to properly take care of a patient this sick. It takes year! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1395101 Thu, 24 Apr 2008 02:19:38 +0100 1395101 http://nursesean.com/http:/nursesean.com/musings/grand-rounds-431.htm Grand Rounds 4.31: How … - Blogs - Revolution Health Grand Rounds is up over at Dr. Val’s! Click the link above to check it out! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1391010 Tue, 22 Apr 2008 18:31:55 +0100 1391010 http://nursesean.com/http:/nursesean.com/musings/have-you-seen-the-elevator-guy-yet.htm Embedded Video Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1388969 Tue, 22 Apr 2008 00:27:12 +0100 1388969 http://nursesean.com/http:/nursesean.com/musings/a-bit-better.htm I missed A LOT of work over the weekend. In fact, I didn’t work at all! We’re talking THREE twelve hour shifts missed by your’s truly. Thirty-Six hours of sick time taken all in one massive chunk. My manager must adore me right now…*cringe* But today, I’m finally starting to feel better. I have no sense of smell (except for that strange, sickeningly sweet smell of infection that is stuck in my sinuses), My intercostal and abdominal muscles ache from all the coughing, and I’m a bit dizzy. However, in general, that is a vast improvement. I find it amazing that colds always seem to come when they are needed the most. They are natures way of telling you that life is way to stressful, you’re running on empty, and you just need to stop and lie down for a couple days: preferably with season four of ER fully available for your viewing pleasure. I left the house only once briefly. I decided that since I was missing so much work, it was only fair that I went and got a sick note (they never did ask for one). I got to the local walk in clinic and was greeted by a fresh sign stating, “We are full, please go the the nearest Emergency Room.” I contemplated actually going to the ER. I wanted to see the look on the triage nurse’s face when I told her I had a particularly bad cold and needed a sick note for work. I didn’t have the guts though. Not to mention, the ER shares a wall with the ICU that I work in–I’m sure I would have been seen and put to work. Today, I’m actually going to venture out of the house and visit a friend of mine for coffee. It will seem strange to actually see the light of day in it’s full glory. The fresh air may seem overwhelming, and the noise of being in public may stun me. I will let you know if I survive the onslaught of stimulation. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1388970 Mon, 21 Apr 2008 14:59:22 +0100 1388970 http://nursesean.com/http:/nursesean.com/musings/wachters-world-snooping-at-britney%e2%80%99s-chart-why-should-docs-and-nurses-have-different-rules.htm Wachter’s World : Snooping At Britney’s Chart: Why Should Docs and Nurses Have Different Rules? Should doctors and nurses be subject to different penalties for precisely the same infraction? Of course not. Are they? Sure. Just ask Britney Spears. Britney was hospitalized at UCLA at least twice in the past few years – once when she gave birth to her first son in 2005, and again in early 2008 for psychiatric care. Both times, dozens of UCLA staff members peeked at her medical records, despite having no clinical reason to do so. I’m glad somebody brought this up! I have been pondering this very issue lately: particularly in light of the mentioned Britney Spears incident. Great article! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1388971 Mon, 21 Apr 2008 14:22:58 +0100 1388971 http://nursesean.com/http:/nursesean.com/musings/thank-you.htm I wanted to take a quick moment to thank everyone for their kind comments regarding Change of Shift. I also want to thank many of you for your ever appreciated link love. Hopefully, I will again have the chance to host Change of Shift. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1386808 Mon, 21 Apr 2008 01:00:44 +0100 1386808 http://nursesean.com/http:/nursesean.com/musings/the-icu-gods-have-had-their-sacrifice.htm About a month ago I had a really crappy couple of days. I was in the middle of my classroom  portion of my ICU training. Interspersed throughout these classroom days was a smattering of “buddy” shifts. All in a span of forty-eight hours, during these buddy shifts, I lost three beloved expensive items. These items were, in order: My very expensive Littman stethoscope, my very expensive and very amazing book Fast Facts for Critical Care Nurses, and My brand new iPod Touch. I blamed this absent-mindedness on the stress of being a new orientee. However, the truth is that I had gotten into the habit of accidentally leaving things around at work–and expecting to find them right where I left them the next day–or even sometimes nicely tucked away. This was almost the case in the ICU. My Fast Facts was quickly found in a desk drawer sporting a nice label proclaiming, “This belongs to Sean…one of the new ICU nurses.” My iPod was found as well. After giving up on finding it I heard an announcement that boomed through the entire hospital, “Could Sean, owner of a lost iPod, please call the ICU?” Apparently, the Unit clerk had found it and spent her morning going through the iPod looking for a name. Unfortunately, my stethoscope was never found. I loved that stethoscope for no other reason than it was a present to myself following graduation from nursing school: a nice symbol of completion. I have searched and explored every nook and cranny in that ICU, and it has yet to turn up. So, I declared it to be a sacrifice to the gods of the ICU, begging for good luck in return. Yesterday, I went out and bought a new Littman Master Cardiology. I freakin’ LOVE this new stethoscope. It’s just so gosh darn beautiful! What do you want to bet that the next time I go to work, I will immediately find my old stethoscope? That’s just Murphy’s Law for you… Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1382332 Fri, 18 Apr 2008 19:08:05 +0100 1382332 http://nursesean.com/http:/nursesean.com/musings/the-common-cold.htm On the first day of orientation to the ICU, my manager nonchalantly mentioned that all new employees get sick about six weeks after starting–thanks to all the stress and anxiety thrust upon them. I chuckled, assuming it was a gross generalization; and of course it wouldn’t happen to me. So, here it is, six weeks into my new job in the ICU, and I’m sick as a dog (see cold virus above). After  feeling run down and super duper stressed out all week, my body finally gave in to illlness. I felt bad, but I had to call in sick for tomorrow, and will possibly have to on Saturday. Ugh! I would much rather have been the epitome of the perfect employee who never gets sick. Or perhaps even the do-gooder that toughs it out and goes to work suffering. Nope! Instead, I have a date with my blanket and bed tomorrow… Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1380514 Fri, 18 Apr 2008 01:41:51 +0100 1380514 http://nursesean.com/http:/nursesean.com/musings/change-of-shift-volume-two-number-21.htm Welcome to Change of Shift for April 17th, 2008. I have enthusiastically dubbed it, “The European Dreams Edition.” I know I’m not alone in feeling a slight bit of cabin fever after a long winter. Everyone at work and on the blog-o-sphere seem to be a wee bit cranky these days–myself included. Over the last few days and weeks I have found my mind wandering to my newest dream: a European adventure. I never did get that one opportunity in my youth to backpack across this most exciting continent in order to “find myself.” Perhaps I’m having a bit of an age crisis, considering I’m about to turn thirty, but I can’t stop ruminating on the idea of strapping on a backpack and running shoes, buying a Eurail pass, and living out that famous of youthful rituals–Europe. It’s gotten to the point that as work gets more stressful, the more my mind escapes to my new fantasy. And look! It’s even having an effect on Change of Shift! Now, without further adieu, I would like to present some fantastic blogs that have popped up over the last couple of weeks. Some fell into my lap, and others I went looking for. I hope you enjoy each and every one! I hope you like the pictures too! The Eiffel Tower has certainly become one of the ultimate symbols of European ambiance. I’ve heard stories that when it was first built, all of Paris despised it and wanted it torn down. Everyone thought it was an eyesore! Now, it is the epitome of beauty! First impressions certainly are important. NoFo writes about his experience as a patient in his local emergency department. In a similar post, Blobby writes about his experience as a patient. When I think of progress, I think of London and the rest of England: the home of the industrial revolution! In this way, I suppose we can thank London for all the technology and equipment that we must use on a daily basis in our jobs as nurses. Ian over at ImpactEDnurse reminds us, it’s not always about the technology! Speaking of technology, a Guest Poster over at chaarka’s blog discusses how cell phone technology is helping physicians. It reminds me of when plastic surgeons or enterostomal therapy nurses take pictures of wounds to track their progress. What about my favorite technology: restraints? DisappearingJohn has written about his experience with restraints. Traveling around Europe causes me great trepidation! There’s so many roads, rails, taxis and buses. Learning the routes, prices, pros, and cons is a large undertaking! It causes such anxiety! Speaking of anxiety, how about the painful experience of orienting to new units/jobs as a nurse? OUCH! As a brand new ICU nurse, I’m really noticing just how challenging it is to leap out of one’s own comfort zone to try something new. I wrote a post about things I have learned as a new ICU nurse, and another post about preceptors in the ICU. Brainscramble wrote a post about trying to navigate the world of nursing as a student nurse, and learning that being an advocate for a patient is difficult–and extremely important. Here’s the follow-up post. Stuffed Nurse does a great job at helping us get through our first year as a RN. Maybe if I had followed these steps when starting in the ICU, I wouldn’t be so stressed out now–with my mind always on Europe! Or perhaps having a mission statement would have helped me. I have a personal philosophy of nursing (see tabs above), I have a yearly learning plan I need to complete in order to maintain my license, but I don’t have a mission statement. PixelRN looks at this idea in her post about nursing mission statements. Very interesting stuff! What is Europe without art, museums, and architecture? In fact, I’ve heard that travelers to Europe quickly burn out from all the museums and tourist attractions. They are quickly whisked past the hundreds of sites they are “supposed to see” with little time to stop and smell the roses. It costs A LOT of money to see all these attractions. In fact the cost of traveling to Europe is HUGE. One of the reasons I haven’t done my dream European backpacking trip is because I was in nursing school for almost five years–and we all know how much money that takes! In fact, Not Nurse Ratched even wrote a post about it! In the colosseum, gladiators used to fight all sorts of animals that the Roman soldiers had brought back from their conquests. Can you imagine being put into the ring with a lion? Well, what if you were a veterinarian trying to sedate a lion? Isn’t that pretty much the same thing? How much propofol is that? Read about one veterinarian’s experience with this in her clinic at spindyeknit Moscow! The home of Communism for decades, and a land currently undergoing drastic changes. Pondering this great city makes me philosophize about just exactly how a person defines freedom. Certainly, some define freedom as including, almost definitively, capitalism. Braden over at 20outof10 (I love that name…I think only health care professionals would understand) writes about the “free” products one can receive. How does this system affect the market on a larger scale? Very thought provoking! Speaking of change, I have often heard that traveling to Europe will change your life in profound and mysterious ways. And you often hear of people going to Europe to “find themselves.” Kim at As the Pump Turns is a dialysis technician who will soon be a nursing student. She writes about a life-changing event for one of her patients and how it has effected her personally. What a neat perspective! Whenever I think of Greece and Athens, I think about the great philosophical debates between Plato, Aristotle, and Socrates. As we know, there are a lot of debates taking place in the field of medicine. Over at The Nurse Practitioner’s Place, a debate about Nurse Practitioners is described. OK, I know, a little bit of overkill on the Berlin pictures. But, of all the cities in Europe, it is the one that fascinates me the most. What a history! Just imagine: a massive city, completely divided by a heavily guarded wall, each side isolated and allowed to develop independently under completely different governments and lifestyles. Then, in 1989, the wall came down and the two cultures were allowed to clash and mingle. And all the conflict! The Hapsburgs, Hitler, Communism, democracy…wow! Now, in many ways, when I think of Germany, I think of leadership and the effects it can have on people. Here is a great post on The 7 Attributes of Leadership. Do you see these attributes in your manager? How about in your charge nurse? Anyone? I certainly can’t think about leadership and management without thinking of discipline. Ermurse wrote a fascinating article about disparities in healthcare and staff discipline. Of course, Germany has been a major player in A LOT of war. But is there a war on nurses? Mother Jones wrote two very powerful posts over at Nurse Ratched’s Place regarding violence against nurses. There’s a part one, and a part two. When people think of Amsterdam, they can’t help but think of their progressive thinking attitude toward drug use. Perhaps you agree with it, and perhaps you don’t. What I do know is that harm reduction techniques work in the fight against addiction. Here’s a post from Canadian Medicine explaining the story of a safe injection site in Vancouver. When thinking of Amsterdam, I also think of little cafes with laid back atmospheres. I envision travelers from around the world gathering together to share their stories. One of the greatest places for nurses to do this is at the forums of Nurse Connect. There are some bloggers over there too! Here’s some posts from Katy: Sexism in healthcare The Dating Game Healthcare Conspiracy scenario. And here’s some posts from Laura: Bringing up Baby Docs Pink Collar Professionals: Powerful Stuff or Powder Puff? Patient Satisfaction: What really defines it? Well, readers, that’s all for this edition. I had a great time gathering posts! Thank you for indulging in my fantasies and dreams of a European adventure. Next week’s edition will be hosted over at Life in the NHS. So, please send any and all submissions that way. ****** Please click on each picture for original source of pictures (i.e. credit). Also, some posts were added at the very last second and I did not have time to ask permission. Please, if you object to your blog being present, please let me know so I can remove it immediately. Same goes for pictures. ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1377951 Thu, 17 Apr 2008 02:55:12 +0100 1377951 http://nursesean.com/http:/nursesean.com/musings/last-call.htm Hey everyone! This is the last call for Change of Shift Submissions. Send me anything you would like included. You have about three hours! Hurry hurry! Please send all last minute submissions to owner@nursesean.com ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1377952 Wed, 16 Apr 2008 23:29:36 +0100 1377952 http://nursesean.com/http:/nursesean.com/musings/dr-wes-welcome-to-grand-rounds-vol-4-no-29.htm Dr. Wes: Welcome to Grand Rounds - Vol. 4, No. 29 Dr. Wes, who is endlessly fascinating to read, is hosting Grand Rounds this week. Check it out by clicking the link above! During my ICU training, I have gained an absolute fascination for cardiology and cardiac electrophysiology. So, it’s no surprise that I’m absolutely enamored with this edition, who’s theme has a decidedly “cardiovascular bent.” What are you waiting for? Run, don’t walk! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1356083 Tue, 08 Apr 2008 15:55:57 +0100 1356083 http://nursesean.com/http:/nursesean.com/musings/by-the-way.htm I am finally announcing that I will be hosting Change of Shift next week (April 17th).  I am extremely excited as this is my very first time! So! Please submit any and all posts that you would like to see include. I am not looking for a particular topic or theme, so anything goes! I will also be on the prowl for great posts I would like to include. So, don’t be surprised if you get a note from me, begging to include your work. Submission instructions are easy! At the top of the page is a tab entitled “contact.” Click there and you will be directed to my email address. Please send me the link to the post you would like included. The other option is to go to Kim’s site Emergiblog where Change of Shift officially lives. You will find alternate submission options there. I will post another reminder in approximately one week. Post well and post often! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1353962 Mon, 07 Apr 2008 17:09:32 +0100 1353962 http://nursesean.com/http:/nursesean.com/musings/oprahs-big-give-2.htm I’m an almost-thirty-year-old male. And I need to stop watching Oprah’s Big Give. It makes me cry. It’s embarrassing. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1353963 Mon, 07 Apr 2008 16:50:00 +0100 1353963 http://nursesean.com/http:/nursesean.com/musings/lessons-from-the-icu.htm 1. Working in the ICU will expose weaknesses in your practice, and fast! We all have weaknesses, and spending just a few shifts will quickly put them in the spotlight for you, your preceptor, and everyone else to see. At the same time, it gives you the opportunity to work on these weaknesses because you simply can’t hide them or work around them. 2. Residents in the ICU have a tough life. Perhaps it is similar to nursing in that starting in the ICU is a very humbling experience that puts their weaknesses on a platter for everyone to devour. During rounds when everyone has finished their spiel, and the attending turns to the resident and says, “So! What’s your plan?” I cringe. I feel bad as the resident stammers through guesses, wrong answers, and moments of brilliance. 3. Starting in the ICU is challenging in that you have to find a balance between leaving what you know behind–starting with a clean slate, and bringing what you know with you before going forward. It’s hard when you discover just how many bad habits you have–especially when you thought you didn’t have any. But at the same time, you do have a deep pool of knowledge that is very relevant. 4. If there are no crashing patients on the unit, no code blues in the hospital, or no new patients coming in by helicopter, the ICU can be a fairly tedious and slow place. Yesterday, a patient that was in a car accident and was EXTREMELY sick was coming in by helicopter. Everyone’s mouth was watering, craving the excitement. Then, everyone seemed a little sad when word got out that the patient had died in the OR. Back to monitoring waves and tipping urinals on the hour (ha! I make is sound so simple!). ICU nurses are adrenaline junkies. 5. ICU nurses are extremely particular, controlling, and anal-retentive. But, all in different ways. And all in very important ways. So, as a new nurse, it’s extremely difficult to go from one preceptor to another and try to interpret each of their quirks. There’s nothing like finally figuring out someone’s style, only to go to a new preceptor and being told that everything that you are doing is completely wrong–and that you need to conform to her/his style. 6. The following words will echo through my head forever, “In the ICU, you can’t do anything nonchalantly. Everything is done with precision and intent.” 7. My biggest weakness is that I do a lot of tasks nonchalantly without precision and intent. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1353964 Mon, 07 Apr 2008 14:49:01 +0100 1353964 http://nursesean.com/http:/nursesean.com/musings/crappy-horrible-days.htm Me and the ICU are officially fighting! I have never felt so inept in my entire life. I have never made so many basic mistakes in my life. Today, for the first time, I started to wonder about my decision to work in the ICU. *sigh* Perhaps I will purge the story in a blog tomorrow. For now, I plan to eat brownies and pringles… Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1353965 Mon, 07 Apr 2008 02:16:37 +0100 1353965 http://nursesean.com/http:/nursesean.com/musings/nursing-preceptors.htm A good preceptor can make all the difference between a good day and a bad day while training on a new unit. Frankly, I’m long past the days in which a preceptor could have an effect on my sense of self-worth, or make me question my decision to pursue nursing. Instead, I’m finding that I have time to really sit back and notice the strengths and weaknesses of different styles of nursing and precepting. I thought I would highlight some of the different preceptors I have had so far during my ICU orientation, and discuss how their personalities have effected my experience. I think we’ll all recognize these folks in those that we work with in any setting. My very first preceptor was young, beautiful, and hip. She was cold, dry, sarcastic, and witty. She was absolutely fantastic and thorough at her job, but wasn’t shy about explaining her believe that she tries to do as little work as possible. She didn’t cut corners or skip tasks, she simply didn’t make work for herself. She wanted her patients to be stable, sedated, paralyzed, and orphaned. Her personality was fine with me! I laughed hysterically all day–which was a welcome experience considering it was my first shift. I was completely in a state of fear/shock/anxiety/panic, but she was very warm, and welcoming–not afraid to talk to me about the unit, look for interesting things for me to see, and get me involved with hands-on care. “Have you ever drawn an ABG from an art. line?” Was one of the first things she said to me. “No, actually, I’m not certified yet. I haven’t done the classroom theory or the exam.” I meekly responded. “Pfffffft!!” she laughed. “Here’s the syringe. You’re going to do it.” My second preceptor was completely different. He was just finishing up the last few days of his Master’s degree. He had just defended his thesis and was waiting the results. He was also doing some last shifts in his final Nurse Practitioner practicum. He was a nurse that was extremely controlling of his environment. Every last detail of the shift was filled with checking, rechecking, adjusting, and readjusting. I don’t think I will ever again see a CVP/ICP/Art. line zeroed so many times in one shift! Lines were checked (all twelve of them) several times during the day–carefully followed from the patient to the label to the machine to the bag. IV labels were torn off and replaced with his nicer looking writing. Dressings were changed if he didn’t like the way the tape was positioned. Every time he did anything at all, he would turn to me, explain exactly what he was doing, why he was doing it, and (not joking) list several research papers and their list of authors that backed up exactly why it was the best practice. I remember how he listed all the things he would tell the team on rounds, and how they would respond. He explained what he expected the new goals for the day to be. He was spot on! Rounds went almost word-for-word how he predicted. I loved the shift I spent with him. It proved to me how research and intellectualism play an integral part in the ICU. Every little move we make is because somebody spent years researching the practice. Often this research had been done by nurses and doctors within our very own ICU. I also learned just how NOT controlling and detail-oriented my nursing practice is. In my mind, the jury is still out on whether I am OK with that. My third preceptor was a delight! She was very warm, friendly, and encouraging. She wanted me to dive in and do absolutely everything I could. She helped me work toward being a bit more independent. “So, Sean. This is your third shift. Are you ready to present a patient at rounds?” She said with a sickeningly sweet smile. I had been dreading the day someone suggested this very thing. “ACK! NO! But the way I see it, I will never feel ready unless I just do it a few times and get a feel for it.” I responded. I’m sure, by the way she looked at me, that I had turned white as a ghost. There were many “first times” that day, and each and every time, she told me how great a job I was doing. At the end of the day, she said I was doing great and let me go early. I left that day on cloud nine! I was loving myself, my job, and the ICU. My fourth preceptor was again completely different. She had twenty years of experience in the ICU. She was a very quiet and silent person. She rarely said anything unless it was to tell me I had done something wrong. She didn’t let me dive in and try anything unless I specifically asked, “Would it be OK if I did that while you watch me?” She always seemed surprised, and responded with an, “oh…OK…I guess.” And if I didn’t ask her in time, (which happened a few times)and I found her mid procedure, I would have to ask her what she was doing, and what her rationale was. I tend to be a very shy person and struggle with starting conversation. Generally I find that I am on the receiving end of someone trying to make conversation (note to self: work on that!). However, by the end of the day I found myself desperately asking her questions, trying anything possible to break her out of her silence. Now, she was a very nice person. She was never mean to me. It was just that she didn’t make a great teacher. However, she was a HUGE source of knowledge, and whenever I did prompt her for information or explanations, she was able to provide it with depth and little effort. At the end of the day, she said, “Wow, I feel so useless today! You’ve been doing everything!” I took that as progress for myself. I don’t necessarily think there is a perfect preceptor when learning a new job. In fact, I think every single nurse has something very important to give to new staff–whether they’ve been there six months or thirty years. This is why I don’t personally believe in having one single preceptor during orientation or a practicum. Every single nurse I have had has shown me the ICU from a slightly different angle. Just like in nursing school, I am poaching my favorite practices of each nurse that teaches me. Picking and choosing my own style. Seven more preceptor shifts to go. Then the REAL test begins! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1352021 Fri, 04 Apr 2008 22:30:25 +0100 1352021 http://nursesean.com/http:/nursesean.com/musings/militant-medical-nurse-stupid-bitch-matrons.htm I found this blog post fascinating (link and exert below)! I have heard many people at work express opinions and thoughts similar to these. By the way, I’m assuming that a Matron=Nurse Manager. It often seems to me that a nurse manager’s role is SO far removed from bedside nursing that it seems like a complete waste of resources. Would it be better to get them back to the bedside and replace them with actual managers (as in people that have a degree in management)? Sometimes I wonder if a properly trained manager would do the job more efficiently and with more verve. Then I  argue that nurse managers are surely much more in tune with the needs of nursing staff since they have experience as nurses. But as we all know, this certainly isn’t always the case. Give the article a read. Tell me what you think. Militant Medical Nurse: Stupid Bitch Matrons At my hospital we always had a saying…”Matrons are like ghosts…we know they exist but we never see them.” Who are the modern matrons? They are highly trained and highly educated nurses who take on clinical specialist/ management roles. Highly trained and highly educated nurses are great at the bedside. Research has shown that patients have a higher survival rate when they are receiving total care by a degree educated RN. Even better if she has a manageable number of patients. Many of our modern Matrons, however, are as useless as tits on a bull. They have no soul. They have no interest in patients. I would rather eat c-diff positive shit than bestow the honourable title of “Nurse” onto one of these people*. ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1346139 Wed, 02 Apr 2008 21:05:44 +0100 1346139 http://nursesean.com/http:/nursesean.com/musings/nurseauctioncom-aims-to-alleviate-nurse-shortage-with-online-nurse-bidding.htm NurseAuction.com Aims To Alleviate Nurse Shortage With Online Nurse Bidding A new website, NurseAuction.com, has launched in hopes of filling the current and projected void. “The site is based on the law of supply and demand,” said Dr. Olusanya, company founder. “There’s obviously an enormous need for nurses. However, many nurses are leaving the field because they are overworked and underpaid.” I love the idea of nurses becoming contractors and making a LOT more money! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1334467 Fri, 28 Mar 2008 22:00:41 +0100 1334467 http://nursesean.com/http:/nursesean.com/musings/three-weeks-can-go-by-so-fast.htm I have officially finished the classroom portion of my ICU training! It was three long weeks of sitting in a classroom listening to lengthy, yet fascinating, lectures. I learned absolutely TONNES, but I’m glad it’s over. I can’t wait to actually get some hands on practice. Not that I’m complaining! Getting paid to sit on my butt–not to mention having weekends off–was a nice change. I have even finished the requisite theory exams that we are required to write. They were as follows: ECG interpretation, Hemodynamics, pharmacology, Pacemakers, defribrillation, and two or three others that I’m having trouble bringing to mind. Now, I just need to work my butt off to get all my return demonstrations done (three times for each skill) so I can start working more independently. Over the next year, I will take certifications in PA catheters, ACLS, CRRT, as well as code blue team training. I’m extremely eager to gulp down these further skills, but I have to relax and let myself become comfortable. But darnit! I just want to know everything, and now! I have seven “buddy” shifts left. Now that I have my tests (mentioned above) done, and have completed computer training, I can take a much more hands on role during these shifts than my two previous buddy shifts. I’m a bit tired of just sitting back and observing, desperately trying to figure out what’s going on. I picked up my uniforms the other day. I love the light greyish-blue colour. I can’t wait to not look like an outsider thanks to my “wrong” coloured scurbs! Anyway, as you may have noticed, there’s really not a heck of a lot going on. What can I say about sitting in a classroom eight hours a day? Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1334468 Fri, 28 Mar 2008 21:50:18 +0100 1334468 http://nursesean.com/http:/nursesean.com/musings/just-a-quick-note.htm Can I just say… The ICU is full of the nicest, warmest, most welcoming people I have met in the nursing field so far. The images I’ve both had and heard of the cold, mean, snobby ICU nurse are such a myth! I just felt the sudden need to mention that. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1317772 Fri, 21 Mar 2008 02:32:14 +0100 1317772 http://nursesean.com/http:/nursesean.com/musings/another-day-in-the-icu.htm What a DAY! Today I helped care for a traumatic brain injury patient, which was a definite first for me! She was sixteen years old and had flipped her car while skipping school see to her forbidden boyfriend. I think, in my naiivity, I didn’t realize just how sick she was until another nurse came by and shook her head, looked at the ICP, and stated, “You guys have been fighting one heck of a war with this one” I was absolutely engrossed in the dips, waves, dives, swoops, climbs, peaks and creeps of her ICP, CPP, MAP, and brain tissue. All day it was: Mannitol, propofol, ativan, Hypertonic saline, levophed, open the EVD, close the EVD. We weren’t titrating medications, we were titrating hope. Speaking of EVDs, I actually had the opportunity to see the neurosurgeon drill a hole in her head and guide the EVD into a ventricle. Oddly, the insertion actually seemed a lot less complicated than setting up the lines for the transducer and monitor! And she was the first person I ever “bagged.” I was standing there as we prepared her for a head CT. “here” said the respiratory therapist. “Bag her for me while I figure out the oxygen tank.” And so I discovered what it feels like to literally keep someone alive just by squeezing a bag. As I left the unit she was being whisked to the OR to have a bone flap removed. The EVD just wasn’t relieving the pressure. She will either die soon or have a VERY long recovery. I thing the former is more likely. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1315357 Thu, 20 Mar 2008 02:33:13 +0100 1315357 http://nursesean.com/http:/nursesean.com/musings/sherri-shepherd-takes-an-ambulance-for-the-stomach-flu.htm I have never been a fan of Sherri Shepherd from The View. It started with her fundamentalist Christian leanings, progressed with her belief that the world may be flat, and climaxed when she seemed confused that some people believe the earth and society existed before Jesus. She’s just plain dumb! I was hoping to find an actual news story to describe what I heard her say on The View today so I could link it to my blog. However, It would appear as though it will be me breaking the story. Granted, her comments today were not as shocking previous behavior, but it certainly made me roll my eyes. She was talking about her experience with having the stomach flu last week when she causally mentioned her ambulance ride. Seriously Sherri? You took an ambulance because you had the stomach flu? Then the story progressed into a commentary about the fact that no cars would move over and let her ambulance by. She related this to the fact that she was in New York, and, well, that’s what New York is like, right? Actually, Sherri, I’m thinking, nobody moved over because you had the stomach flu and the ambulance was probably going at a normal speed with it’s lights off. I’m sure the drivers were rolling their eyes too. Of course, I don’t know any further details of the story, so it could have been much more serious, but it just seemed outright silly to me! And the rest of the hosts didn’t even flinch or take the chance to question her on her choice of transportation. Perhaps they too think this is an appropriate use of resources. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1309036 Tue, 18 Mar 2008 00:14:06 +0100 1309036 http://nursesean.com/http:/nursesean.com/musings/hospital-workers-fired-for-snooping-in-spears-files.htm Hospital workers fired for snooping in Spears’ files Updated Fri. Mar. 14 2008 8:49 PM ET The Associated Press LOS ANGELES — UCLA Medical Center will fire some employees and discipline others for snooping at the confidential medical records of Britney Spears while she was hospitalized in its psychiatric ward, a hospital official told The Associated Press. CTV.ca | Hospital workers fired for snooping in Spears’ files Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1307689 Mon, 17 Mar 2008 13:12:32 +0100 1307689 http://nursesean.com/http:/nursesean.com/musings/overheard.htm I was browsing at a local bookstore, flipping through Love in the Time of Cholera (a book I keep meaning to buy but never do). Two young women walked behind me, one with a newborn strapped to her. They were mid-conversation. “And do you know what I heard!?” The lady with the baby said in an urgent, warning voice. “What?” Her friend responded. I thought I caught a slight tone in her voice that indicated she wished her friend would shut up and stop babbling. “Now they are saying that epidurals cause autism too!!!! Epidurals are SO evil!” With my head still buried in the book, I gave a GIANT eye roll. It wasn’t so much about what she was saying (OK, it was. I am so tired of hearing about the increased autism/increased vaccination correlation, and I really don’t want to have to start hearing about it in regards to epidurals) but rather that I’m tired of hearing women shame other women into feeling guilty about using epidurals. I GET IT! some women think other women are failures if they use them, and that they’re terrible terrible mothers who are obviously directly harming their babies–it’s getting old. And it’s mean to even imply that. Fortunately, I looked over and saw this woman’s friend rolling her eyes even more than I was. I think she was thinking the exact same thing I was. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1306521 Sun, 16 Mar 2008 22:32:01 +0100 1306521 http://nursesean.com/http:/nursesean.com/musings/a-response-to-a-comment.htm I wanted to respond to a comment left by Lee-Anne on my last post. I was very interested by what she had to say and I have been ruminating on it all day as a result. I would like to caution you about not getting caught up in all of the technology and remind yourself that beyond everything else there is a person in the bed connected to the technology who has a family who loves him/her. I don’t find it fascinating to watch a dying heart on a monitor. It represents the end of someone’s life and the sorrow that will follow. Always remember, it is a privledge to nurse a patient and care for the family when someone is dying. The reason I wanted to respond was because I completely disagree with part of the sentiment of this comment. I want to emphasize that I respectfully disagree. I don’t disrespect Lee-Anne’s opinion, I only want to share how mine differs. I simply do not see being fascinated by technology and science as mutually exclusive to nursing practice–even in the case of a dying patient. In fact, my fascination with human biology and medicine is what began my interest in nursing, and it’s what keeps me interested in nursing as I dive into my career. I understand the ideology that nurses can be swept up in the machinery, monitors, and equipment, completely forgetting that a living being is laying on the bed suffering. It is important to care for the patient rather than the machines–but I fully disagree that it is wrong to be fascinated by these machines at the same time. I must add that I just can’t imagine not being fascinated by dysrhythmias, disease processes, and complex procedures! Nursing is NOT just hand-holding and kleenex dispensing. It’s also a large set of hands-on skills; it is the implementation and collection of scientific knowledge; it is advocacy; it is ethics; It is SO many things! So, I feel that to diminish the entire facet that includes scientific knowledge as less important than the traditional ideals of “care” is in error. Perhaps it is only because I am male, or perhaps it is because of my personality, but I’m not a huggy-touch-feely nurse. Being emotionally supportive of families is not my strength. In fact, I think most would consider it awkward if I tried to be emotionally supportive of families in the same ways as females–holding hands, long hugs. I am emotionally supportive, but not likely in the same way many nurses are. The science and skill of nursing is my strength. Many nurses may find satisfaction in their job from the emotional care of patients/families, but I find my job satisfaction by seeking out knowledge and perfecting procedures. I don’t see anything wrong with this. After all, don’t all nurses differ in terms of strengths and weaknesses? Put simply and succinctly (I know–too late) I do not feel that it was wrong for me to pursue more knowledge about the electrophysiology of the dying heart. Furthermore, I do not feel it is unethical to be fascinated by this knowledge. Lastly, I understand that it is a privilege to care for a dying patient, that was never forgotten at the moment. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1301809 Thu, 13 Mar 2008 21:48:28 +0100 1301809 http://nursesean.com/http:/nursesean.com/musings/icu-pharmacology.htm Learning ICU pharmacology is like someone handing you the “S” section of the dictionary and telling you, “Someday, sometime, somewhere, I’m going to randomly pick a word from the ‘S’ section of the dictionary. If you can’t recite the definition exactly, word-for-word, your patient will die.” Perhaps that’s an exaggeration, but at least that’s what it feels like as I study drug after drug after drug and desperately try to commit the details to memory. If all the medications came in cool blue florescent bottles, it would make it MUCH more interesting. I love this simplistic picture of an ICU patient. Does anyone else have an interpretation for that ECG? Clearly a junctional rhythm, or perhaps supraventricular tachycardia, or is it some kind of bundle branch block? It’s definitely not good though. Don’t ask me why, but I think that this picture, stamped on a t-shirt, would be very funky and trendy. All the rage in the staffroom–around the water cooler. Today I’m in the classroom again. It’s respiratory/ventilator day! Hopefully I will feel a little better when the mystique of the big machine in corner is revealed. Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1300303 Thu, 13 Mar 2008 12:48:33 +0100 1300303 http://nursesean.com/http:/nursesean.com/musings/a-sciatic-wrap-up.htm Well, I survived my first shift in the ICU. It was far more overwhelming than I expected and I am totally freaked out. It wasn’t so much the clinical, theoretical, or hands-on stuff that scared me. Instead, it was the panicked realization that I don’t know what to do in any situation–big or small. I have completely left my comfort zone for. If my comfort zone is Mars, I have now found myself in Venus. My patient today was very interesting. He had acquired gangrene to the back of his thigh. It was so extensive that his hamstring muscle and large masses of his thigh and groin had been removed. When all the packing was out, the femur was clearly visible–as well as the large sciatic nerve. Has anyone else here had to wrap soaked gauze around the sciatic nerve? I’m not positive, but I’m fairly certain it was a rare experience. On another note, I noticed that strange things are done in the ICU that will take me forever to get used to. For example, my patient’s blood sugar was 7.4 when we checked just after starting a tube feed. “What are you doing?” I said as I saw my preceptor playing around with some tubing and meds. “I’ve decided to start an insulin drip.” She said matter-of-factly. “Really? We can do that?” I said. I could see the smirk on her face as she enjoyed the amateur question. “Yup, I’ll let the resident know next time he’s around. You’re forgetting just how much autonomy we get here in the ICU.” Autonomy is one of those things we all want, but it’s fairly daunting when you get it! New experiences today: I drew my first blood gasses, learned to zero and Arterial line, suctioned through an endotrachial tube, inserted an oral-gastric tube. My favorite experience of the day: A patient next door was taken off life support. We brought the ECG up on our monitor so I could watch the dying heart. I didn’t even blink once as I watched the rhythm change from normal sinus rhythm to a clearly junctional rhythm, and then the QRS widened more until a text-book agonal rhythm could be seen. Finally, the monitor started flashing “asystole.” Fascinating! My head honestly hurts from being so incredibly overstimulated. Now, back to studying ICU pharmacology! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1298690 Thu, 13 Mar 2008 00:59:12 +0100 1298690 http://nursesean.com/http:/nursesean.com/musings/anxiety-scared-panic.htm Holy Crap! What a gruesome picture!!! This is what you get when you search flickr for “anxiety,” “scared,” and “panic.” It really does represent how I feel right now, even if only on the inside… All that blood is is from my head exploding after filling it too full with information about critical care pharmacology. Unfortunately, when it exploded, all the info flew out–putting me back at square one. The rest of the panic, anxiety, and fear is coming from my looming first day in the ICU tomorrow. Even though it’s just a buddy/shadow day, I still can’t help but have horribly embarrassing scenarios run through my head–Like the one where I trip on a chord, fly through the air, take out a ventilator, and pull out a central line while grasping for balance…of course killing the patient in a dramatic, yet tragic fashion. Yes, I know, I’m very melodramatic about the whole thing. Isn’t that allowed? What the picture doesn’t show is my absolute and incredible excitement. I’m nearly vibrating with joy! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1296045 Wed, 12 Mar 2008 03:34:32 +0100 1296045 http://nursesean.com/http:/nursesean.com/musings/first-day-of-icu-orientation.htm Today was day one of my ICU orientation. It felt good to finally be there, sitting in an ICU, learning new concepts. Today we learned ECG interpretation! I’ve taken ECG interpretation recently through my Critical Care nursing course; However it was quite amazing to finally get some hands-on experience. Firstly, it was nice to actually put the leads on someone (mannequin actually) and learn the location of the leads. When there’s a 3-D representation directly in front of you, it’s much easier to visualize exactly why ECGs are negative and positive. It was fun playing around with the monitor! Our instructor had a fake patient–a box about the size of a tape-recorder–that you plug into any monitor. She was able to change the setting on the box to show us a live example of what each dysrhythmia would look like. She even plugged the box into a crash cart and showed us what cardioversion looks like. I definitely feel like I have a huge advantage in this class having taken ECG interpretations prior. The rest of the class seems absolutely lost right now–and I’m right on top of everything! It feels good! I’m also glad that I’m not the only newbie in the class. I was afraid it would be full of nurses with TONNES of experience, or perhaps transferring from other ICUs. However, we’re generally all in the same boat: out of school for a year or two and looking for a new challenge. The highlight of the day was when I was in the bathroom on the ICU unit. While I was peeing, directly across the hallway a patient started coding. All I heard through the locked door was, “Someone get the crash cart!” followed by many footsteps. Yes, even the bathroom is exciting in the ICU! Blogged with the Flock Browser ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1292229 Mon, 10 Mar 2008 21:40:51 +0100 1292229 http://nursesean.com/http:/nursesean.com/musings/last-week-new-beginnings.htm I don’t have much time for a truly significant update to my blog. However, I didn’t want to neglect it too much at this time. I just worked my last week at my first nursing job. I “grew up” on that unit, so it’s truly bitter-sweet to be leaving. I started there as a Nursing Attendant, then made my way through the Undergrad Nurse, Graduate Nurse, and Registered Nurse stages. Each one of these steps were complex and challenging. Even more challenging was trying to make it on a unit that required you to prove yourself “worthy” to be there. Many difficult personalities dotted the staff roster. But, I survived, and eventually thrived. I was never fully “comfortable” on that unit. After all, I’d only been there two years. We dealt with such complex surgeries, and such sick patients that it would have taken closer to five years to reach a true level of comfort. Nursing involves so many little details that take time to even start noticing, let along mastering. For my last week there I had the honor of being charge nurse. I was thrilled at this! One of my regrets of leaving med/surg nursing so soon in my career to learn ICU nursing was that I would miss out on the opportunity to train for charge nurse duties. So, for fourty-eight hours last week I was the boss man. My first night as charge nurse, we had two codes and and an aggressively confused man. It made for one hell of a scary first night as charge nurse! The second night as charge was the most intimidating. There were three very tough personalities working that night. Each had over twenty years experience on the unit and were the usual nurses that do night charge duty on the unit. They are definitely the type to roll their eyes and laugh at the thought of someone like me being charge nurse. But, I think I held my own and earned a little respect–I think. And now I have to spend my weekend diving into ICU pharmacology! Holy frack is there a lot to learn!!! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1288389 Sat, 08 Mar 2008 21:00:37 +0100 1288389 http://nursesean.com/http:/nursesean.com/musings/flock.htm Has anyone tried out the new Flock web browser? It still feels a bit awkward, being that it’s my first day, and it’s an entirely different web-browsing experience; however, I can help but be fascinated by it’s features! Flock takes a whole step forward from past browsers (almost in the same way Firefox did) and shows us what we have to look forward to in the coming years. Rather than simply being a starting point from which to surf the web, it’s more of a console for the Web 2.0 experience. It handles social networking sites and media streams in a fascinating and refreshing style. I’m even blogging this from it’s built-in console. Give it a try! I’m going to go back to exploring! Blogged with the Flock Browser Tags: flock, browser, web ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1271280 Sun, 02 Mar 2008 03:43:42 +0100 1271280 http://nursesean.com/http:/nursesean.com/musings/busy.htm It has taken me all morning to catch up on what I wanted to write on my blog,  including making some changes to the visual style etc. I just can’t believe how busy I have been with work and career stuff! I have been going to bed thinking about nursing, and waking up with nursing on my brain. Frequently, I dream of taking care of patients. This career really can be all-consuming! Last week, I wrote my cardiology assessment exam. This was a doozy! It’s tough to have ECG interpretation and hemodynamic monitoring (amongst a million other details) thrown at you all at once, to learn in two weeks. Now, I have about a week and a half to learn the renal unit and write the test. On top of that, I need to learn the approximately two-hundred paged pharmacology unit for my actual ICU orientation that starts two weeks from today. I guess the good news is that I will have a huge head-start when we do the hemodynamic monitoring, renal, ECG, respiratory units when I do my orientation. I will be feeling lucky that I have a fairly good grasp of the theoretical components. The tough part will be getting a strong, confident grasp on the hands-on skills. My other fear is meeting new people. I’m not looking forward to being the new person that knows nobody and isn’t known by anyone. I hate the idea of being the “student” after finally getting used to being the “go-to person.” But, what the heck, challenges and change is what makes life interesting! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1255036 Mon, 25 Feb 2008 17:38:35 +0100 1255036 http://nursesean.com/http:/nursesean.com/musings/book-review-flashback.htm In celebration of my blog’s new focus, I would like to repost a review of the book that instantly convinced me to become an ICU nurse. When I had my interview for the ICU, I wasn’t ashamed to say that I wanted to work there because of Tilda Shalof’s book. Have a read, the book review says it all! When I first read Tilda Shalof’s book, “A Nurse’s Story: Life, Death, and In-Between in an Intensive Care Unit” three years ago, it changed the course of my entire nursing career. When I began work on my Bachelor’s degree in Nursing, I was dead set on becoming an Emergency Room nurse. My vision was completely tunneled, and no other alternative was acceptable. When I wrote a paper in my first of four years entitled “Why I Became a Nurse,” I wrote that I became a nurse because I loved the television show ER and I wanted to be just like the nurses I saw on TV. This reason was partially in defiance of what I felt was an essay topic suitable for a grade three class, and partly because I wanted to be unique. I was quite aware that what they were looking for were stories of being “called” to the profession. However, in Tilda Shalof’s book, I found a new hero (sorry Carol Hathoway)! The author takes our hand and pulls us, with eye’s wide open, into the world of the ICU. When I first read the book, I had minimal real-life hospital experience. I had only spent about eighty hours on a medical unit giving bed baths and helping patients to the bathroom. At the time, the ICU was a completely mysterious and inaccessible place (and to a large extent, still is). There were no television shows that focused around the lives of the doctors and nurses that inhabited their halls, and I knew that my education would not include any critical care experience. Thanks to Shalof’s accounts, I discovered that the ICU was a completely unique experience in nursing. Instead of many patients, the nurse has one patient that they focus on completely throughout the day. Shalof describes in much detail the many focused tasks that ICU nurses are continually performing: all the tubes that must be checked, the monitors that must be monitored, and the constant assessing and adjusting of treatments. But as nurses know, the direct patient care is only the tip of the iceberg. Shalof shows us the true behind the scenes workings of the ICU: constant debates with doctors, the nursing of families, the education of new nurses, the chaos of being charge nurse. She also reaches into the depths of a nurse’s soul to expose the emotional vulnerabilities in caring for extremely sick patients, as well as the fear that comes with the possibility of making a mistake at any time. Fortunately (and this is my favorite part of the book), Shalof completes her portrait of the ICU with descriptions and dialogs of the nurses and doctors that surround her. Each of them with a unique personality that shows differing opinions and complementary strengths. These characters are her support group and remind me (and will remind any nurse) of those that surround them in their own jobs. Shalof does not shy away from any topic. From discussion of adoring some patients while disliking others, and certain “shitty” nursing tasks, to a mother’s possible indiscretions with her mentally handicapped Son. These stories serve as the backbone for her larger discussion of nursing as a profession. When I first read this book I was focused on the fascinating stories and tasks performed in the ICU. But on more recent readings, I realized that the true story is the angst that the author is feeling throughout her career. She discusses foremost the fine balancing act nurses must walk between emotional connection and disconnection with each patient. This constant struggle causes turmoil and (I would say) neurosis within nurses. Another reoccurring theme is that of how much treatment is too much. Shalof vividly describes stories in which families and doctors go too far to keep patients alive, instead of allowing them to die peacefully. The characters in the book all add their opinions to this ongoing debate that does not have a concrete solution. From this debate comes one of my favorite mottos that I have taken to heart, “We can withdraw treatment, but we never withdraw care.” The moments that connect with me the most are her brief, yet poignant descriptions of floor nurses. Shalof describes the absolute chaos she and her patients feel when they are transferred out of the ICU with 1:1 nursing care to the floor where nurses may have up to eight patients. As a floor nurse, I can see the shock this causes a patient, and the difficulty they and their families have when being transferred. I have often witnessed their anxiety when a nurse is not present at all times. In fact, we jokingly refer to it as ICUitis, and is usually diagnosed during a night shift when the patient starts hitting the call bell every two minutes for the smallest of reasons. Now, I said that this book changed the course of my entire career, and that is true. The moment I finished this book in my first year of nursing school, I abandoned all plans to become an ER nurse, firmly aware that I wanted to work in the ICU. I have read this book again and again and I continue to come to the same conclusion. In fact, I have just recently been accepted the Critical Care certificate program and will begin the theoretical portions this fall. So, I tip my hat to Tilda Shalof (and all of “Laura’s Line”) who has inspired me in my career and my nursing care. Shalof has since written a book entitled “The Making of a Nurse” that describes her life outside of the ICU and how it affected her career. I recommend both books with all my heart, which is why they have a permanent home on my blog (look to your left). There is not one single nurse that would not benefit from a read of this extraordinary realistic account of ICU nursing. I only hope somebody, someday writes a similar account of nursing from the perspective of a medical-surgical nurse. The biggest reward of writing this review was hearing from Tilda Shalof herself! I was absolutely awed when the following comment appeared on my blog: Dear Sean, I love your blog. Reading it, I hear the voice of a strong nurse, speaking out, sharing his stories, telling it like it is, taking a stand, and representing to the world some of the best qualities of our profession - in short, I love it!! I am thrilled also to know that you enjoyed my book and that it had such a positive effect on you. I love critical care nursing too, as you know, and I am sure you will enjoy it and find it endlessly challenging and stimulating. I also have a sense that the kind of nurse you are will find yourself at home in in any/every specialty. All I can say is we are lucky to have you and oh yes, keep on writing. I am completley in agreement with your views on our Canadian health care system that you wrote about most recently. Best, Tilda Shalof I love the the feeling that my career is blossoming and my life is going somewhere… ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1255037 Mon, 25 Feb 2008 17:18:36 +0100 1255037 http://nursesean.com/http:/nursesean.com/musings/the-ups-and-downs-of-my-first-year-in-the-icu.htm I have decided to slightly refocus my blog toward the big changes that are happening in my career. In two weeks from today, I will be sitting in a classroom on my first day of orientation for the ICU. I am excited, scared, anxious, happy, panicked, and maniacally happy! I know that the next year will be one of the most important and memorable in my life. In order to reflect these emotions, I’m dedicating my blog to the experiences of a new ICU nurse. My goal is to highlight my stories–the ups and downs that I go through. I have even renamed my blog: Nurse Sean (dot) com: The Ups and Downs of My First Year in the ICU. I hope everyone enjoys my new theme! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1255038 Mon, 25 Feb 2008 16:56:54 +0100 1255038 http://nursesean.com/http:/nursesean.com/musings/you-want-me-to-learn-what.htm My pants are wet! I received my ICU orientation manuals today. I decided to be proactive and get them a couple weeks before my training started. The unit educator plopped into my hands two eight inch binders (but you know how guys are…they were probably only six inches) full of information I will need to cram into my head. Then, after realizing I only had three weeks to learn all the information contained in these binders, I immediately peed my pants–and that’s how they got wet… Then I learned I only have ten buddy shifts before being on my own! CODE BROWN!!!! ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1243438 Tue, 19 Feb 2008 21:35:51 +0100 1243438 http://nursesean.com/http:/nursesean.com/musings/abu-hamza-finds-out-his-nurse-is-gay-is-not-happy.htm One handed islamic firebrand, Abu Hamza has a male nurse to assist him getting dressed and washed in prison - and has just found out that the guy is gay. I have to wonder if the placement of the nurse was deliberate read more | digg story ShareThis (Source: Nurse Sean) Nurse Sean blogs http://www.medworm.com/rss/comments.php?id=1240175 Tue, 19 Feb 2008 00:29:41 +0100 1240175