on being anurse:”Just a nurse.”

In the aftermath of the Miss America contest on September 13 and Miss Colorado’s talent monologue on what it is to be a nurse, there has been a volume of comments on her choice to represent the nursing profession in this venue. Kelley Johnson, RN, shared her experience on television with the judges and national audience about an Alzheimer’s patient, Joe, and their nurse/patient relationship. Her eloquent, thoughtfully presented story of their mutual personal understanding of the other’s roles gave a dignity to Joe that he was able to comprehend. He in turn thanked Kelley for recognizing that in spite of his frustration with Alzheimer’s, he was “still Joe” and there was dignity in maintaining his identity. The monologue brought a largely positive response across the media about nursing. The audience’s and the medical profession’s reaction to the nurses’ empathetic monologue has swelled to a positive proportion and verbal gift to our profession that she could not have foreseen.
Disappointing to me, a retired nurse and daily fan of The View, was the panel of some of the hostesses’ negative and sarcastically joking comments the following day and again on the next Wednesday, about nurses and Miss Johnson’s choice to not do the usual entertainment talent known for the Miss America contests. Have the panelists or their family never been cared for by a nurse? A baby’s birth; an elderly’s parent’s comfort; a guiding light through a maze of tests and medical-speak? Joy Behar and Michelle Collins have since clarified their comments, but only in a thwarted effort to dispel the audiences shocked reaction to damage done.
The trite attitudes displayed on the panel towards nursing only served to demean themselves, and to do so on national TV was shameful.


onbeinganurse: Thanks for laboring on Labor Day!

Being a nurse brings with the profession a responsibility and understood duty to provide care in hospitals and urgent care facilities across the USA during holidays. For several years, nurses have been privileged to be considered the most trusted professional service in the USA. On Labor Day our country recognizes all professional and volunteer services with an established day of “thank you” to the firefighters, the police who keep our roads and streets safer, EMT’s, the pharmacies, grocery clerks, utility techs, and the thousands of military and workers who keep our communities and country running as smoothly and safely as possible. They generously put in a shift or interrupt part of the summer’s holiday picnics, their children’s birthday parties,Thanksgiving dinner, Christmas and Chanukah family celebrations, and New Year’s Eve midnight wishes to their sweethearts.
Our country’s first Labor Day was established by President Grover Cleveland in 1887. Canada, England, and about 80 other countries recognize the value of their workers on May Day, also called International Worker’s Day.
I hope everyone enjoys at least a part of today’s fun and cook-out , or whatever your pleasure is on this day of a special nod to workers and volunteers.

onbeinganurse: Blogging does not come easily to me.

A nursing journal editor once told me he liked my blogs, but they weren’t frequent enough for his magazine to pick up. I know my blogs are sporadic: a topic has to “reach out” to me as a teaching tool for nurses or my FB public. My jealous side rears when I read another writer’s post or clinical article and it flows effortlessly, passing along great information that had never occurred to me to write about.
For several years I was reluctant to say the words, “I’m a writer.” A practicing nurse for thirty years, I had begun to write down some of the human interest experiences that I had had with patients. Our office’s patient newsletter editor was gracious (brave?)
enough to print some.
One of the doctors encouraged me to submit an article I was toying with about my father’s non-compliance to medical recommendations while I and my siblings became helpless lackey’s participating in his quest to do things his way or take the highway. To hear from an editor and then see my words in a peer-reviewed journal ranked up there with the birth of my children.
One day in the treatment room, a patient as we chatted volunteered that his second and “non-paying” occupation was as a writer. A kindred spirit! And I heard myself exclaim, “Oh, I’m a writer, too!” During his infusion treatment we talked about writing. I heard myself exchanging the lofty author-speak words I had only used inside my mind before, like “genre”, “editor”, and, the Holy grail of being an author; publication. Publication was the only validation acceptable to me at the time and so far I had been papering my walls with rejections. In the last ten years the ratio of accepted v.s. rejected clinical and human interest articles has been fairly equal. An experiment in 30 chapters of a murder/mystery fiction has taken a few years and many revisions. Based on my time, if I actually sell it I would guess a return a dollar amount of about five cents a chapter.
Creating my world of words is as necessary to me as breathing. My father wrote funny stories about his hunting and fishing adventures and he helped me choose a catchy title for my first 7th grade English essay. My older brother has written and published three books, and our sister writes research papers in her field of environmental forestry. Is there a gene passed along that pushes a compulsion to fill pages with words? I would feel stymied if I didn’t write even a few sentences every day, at least in my e-mail. Retirement from practicing nursing was daunting, but the void is filled by hopefully mentoring nurses through what I learned in the trenches.
Within my local library’s Writer’s Critique Group the talent of the other six writers is humbling. I am grateful to be a small flicker within the flame of these creative authors.

onbeinganurse:”Text Neck”? What next?

The reasons why I don’t text are mounting, and now reinforced by the latest information that we aren’t physically designed to hold our average-weight 12-pound heads in a continuous lowered position (like staring downward at an iPod or cell phone) for the 5 hours or so that people spend texting or gaming, etc..

A syndrome called Text Neck adds, inch by inch as the neck bends lower toward the pad, as much as 60 pounds of strain to the neck & shoulder muscles. Over time the weight can even change straight posture to become an outward curve at the shoulder area. The 60 pounds of strain is compared to carrying an 8 pound baby around your neck.

Teens and Millennium-aged (college and early adulthood) are particularly prone to frequent and long periods of texting and gaming. We’ve all had to dodge the totally oblivious communicators who are texting and walking along, not watching for anybody or any traffic. The Baby Boomers’ generation is catching up pretty quick, too. Another side effect of this obsession with texting is feeling the need to be accessible or in constant technical/social communication. Certainly when a parent or guardian is on-call there is good reason to have instant communication, but for the most part that is not the case.

Text Neck is recognized by physicians and easy to look up on Google, simply type in Text Neck and several sites come up. The usual first suggestion is to stop texting or computer time every 15 minutes and raise the head to look forward, releasing muscle strain. Yoga upper body stretches or Pilates helps loosen the muscles and also encourages straight posture. Limit the amount of technology time spent every day. If the pain and shoulder soreness continues there is reason to see the doctor and be evaluated.

Meanwhile, when out among the public, try keeping the technology pocketed and pay attention to where you’re going. Please don’t bump into me in the grocery aisle: I don’t dodge and weave too well.


onbeinganurse:Passwords are making me crazy

Today I’ve spent several hours and too many of my few remaining brain cells trying to get into a web site that just yesterday welcomed me with open gigabits, or whatever they’re called. The same user and password, so appreciated yesterday as a new member, is not on their guest list today. It’s like not being invited to the birthday party.
This is not my first go-round with the technical maze. I was a paper chart nurse and very comfortable with that. But my husband and I relocated a few years ago and I innocently accepted a position in a medical office that used electronic charting. To my mind, I could e-mail, so I could certainly learn to chart electronically. But that was a huge misunderstanding–navigating through an EMR system shares no comparison to e-mailing a friend. The hours spent learning and putting the system into safe practice nearly made me quit within three months. So I wrote an article, “Paper Chart Nurse”, about my experience as an older nurse floundering in the technical world and finally managing to get by, albeit with a lot of daily support from my younger colleagues. The article struck a cord among the nursing journal’s readers and I heard from several medical people across the U.S. who were either struggling or had even resigned from their practice, including a physician.
I DO believe in progress and computer technology and EMR’s…I do, I do, I do! But today has brought me to the limit of my patience.
Help! I just want to get into e-Bay.

onbeinganurse:Where have I been?

It’s been months since I’ve blogged. What ‘ha-happened’, as a friend of mine begins a tale, is that, although I am a nurse, I needed a nurse. For the last seven months, as a matter of fact. And  now I know more about osteomyelitis than I ever wanted to know.   Except where I could have contracted the strep infection from in the first place: it made itself a home in the bone of the first metatarsal on the right foot. The big toe, for any non-nurses reading this. This seemed unfair because I never get pedicures and I see a podiatrist regularly, so it was a puzzle. At least the saving grace for me was that for the multiple consultations and treatments involved, I’ve only had to slip off whatever foot covering was protecting it and not have to struggle to reveal a body part more difficult to undress.
To get rid of this nasty, stubborn bug involved surgery, a self-administered IV antibiotic at home through a pic-line in my arm for six weeks and several x/rays to check the effectiveness of the initial debridement and the antibiotic. The hospital nurses, wound care and home care nurses made me proud to be part of the profession and they’ve respected my dinosaur nursing history. The two hospital roommates between two 4-day admissions in two months were pleasant enough, and one was even a nurse, but we each could have gone along the rest of our lives without the hospital’s social experience of knowing one another.
But here it is, nearly March and finally wearing identical shoes, I’m cleared from the strep infection. But in the meantime in late December I developed a temporary problem in the left leg, not related to the strep. In fact, I joke that now my “bad” right leg is my “good” leg, and the left leg is my “bad” leg. Whatever, this additional set-back is almost resolved, just in time for Spring.
Many thanks to my husband, family, and friends for their help and support, and their patience– I walk slower than a turtle. Some writing projects are synapsing in my brain and maybe in a few months you’ll see me on Amazon with a select bunch of fascinating nurse stories, all patients protected by HIPPA, of course.
But if as a nurse the situation reads familiar, you are probably right that it’s you. Or maybe not. In any case, I’ll use writer’s license and deny the coincidence.

Good to be back.


onbeinganurse:The other side of the bed.

It’s a strange switch from being the caregiver to being the patient.
A bum knee has sidelined me for several months, necessitating medical equipment at home that I’d only made reference to for my patients use, not for me. Now I have rail guards in our apartment’s bathrooms and baby monitors in all the rooms so that my hearing-impaired husband would hear me call for any reason. Perhaps, settled with my knee elevated in the recliner, I might need something important like another dish of ice cream, or to please get me the TV remote from where I left it sitting on the computer ten feet away.
And I’d like to have a dollar for every time I reminded a patient to “Put your quad cane base squarely on the floor; don’t “carry” it up in the air like that!” The other day a physical therapist told me the same thing. I didn’t even realize I was holding it off the ground as I walked. My bad.
An arthroscopy was on my dance card this past week. NPO after midnight (excuse me- does that mean no coffee?); be at the hospital at an ungodly hour; remember your paperwork; and bring a wheeled walker. Oh, yes…that fancy, hot lavender-colored one I have that’s folded away in the closet?
Years ago I occasionally worked in my hospital’s pre-op area, but, by today’s standards the process back then was brief. Is the consent form signed? Did you have anything to eat or drink? Who’s with you and will they take you home? Let’s do your vital signs and then you can put on this gown that will not cover you completely no matter how you try to hold it together. However, 32 years later and in the 21st century, my assigned nurse asked me dozens of patient identity and medical history questions and asked if anyone had beaten me up lately or verbally abused me. Thirty minutes had gone by and I was still in street clothes.
I passed that test and we proceeded to the reason I was there; to repair my bum knee. My nurse gave me three packages of sterile antibacterial towels and specific instructions as to applying in proper sequence to the arms, legs, the body last, and then asked me to verbally repeat the sequence. And there was the flimsy gown waiting and exactly the same; snaps-at-the-shoulders and open at the back. Those skimpy gowns haven’t gotten any less revealing in thirty years. Once I was properly attired my surgeon came in, ostensibly to say hello, but really to ask me who I was (didn’t he remember me from our meeting together?), why I was there, and, lastly, which body part was he going to operate on? You’re kidding me, yes? When I gave the correct answer- my left knee- he was obviously so happy, and then he printed a YES on top of my left knee with a purple marker and handed it to me. So I printed a NO on my right knee.
An ecg, an interview with the anesthesiologist (he didn’t know who I was either and we went through the HIPPA thing again), an IV start, and we were finally ready: GO, team, GO!
The anesthesia was my most feared, but most favorite part- it seemed like only a moment before I woke up, feeling fresh as a daisy and ready for coffee. These new meds are amazing; no grogginess or hang-over effect: when I had my tonsils out as a kid I was sick as a dog for hours.
While in recovery the nurse brought my husband in to show him I was doing fine, all repaired and good as new. However, he doesn’t do well in medical situations and panics at the confusion of so much equipment and beeping machines. Right away he was overwhelmed by the vital sign monitor, telling me in alarm that my blood pressure was “only 80 over 20!” (my pulse and respirations). Then he complained to the nurse about how cold it was in the room and the next thing I know he’s been seated in a comfortable chair with a cozy heated blanket over him. This scene had become All About Him. Why was I not surprised?
My hero took me home and all evening carefully followed me around the house if I was on my feet for any reason. At one point he said he hated to ask, but did I have a urine catheter and was it supposed to be dragging on the floor? I wasn’t aware that my knee’s drainage tubing had slipped down the inside of my leg trouser and the fluid collection bulb was dragging along behind me. I got a big chuckle out of that.
All in all, my experience of being on The Other Side of the Bed was reassuring to me as the patient, because I am no Spring chicken and doubt this will be my only encounter. Staff accountability was evident, competent and caring nurses provided excellent care. And, as an extra bonus, my nurses had a sense of humor.
It was a good day.

onbeinganurse: Can we talk?

Our society has become so enamored of iPhones and texting that people don’t make eye contact or conversation face to face anymore: too interested in the in-coming “mail” or video game rather than the person in front of them. In a restaurant, for example, I’ve watched families have a whole meal without ever exchanging a word except into their phones to who-knows-who; not to their companions. The whole time looking downward at their technological addiction device and fiddling with that.
Today I witnessed what is becoming a rare human encounter; a young father and his son, about 13 or 14 years old, actually sharing a conversation during a meal. My first impression of the father was not good because as they came in he had put out a cigarette (the nurse in me) and also his upper body was covered with tattoos. He had on a skimpy tee-shirt that showed his skin artwork to its best advantage. What surprised me was that they each had cells, but laid them on the table and left them to the side: they never looked at the phones even once. Chatting away to beat the band, they obviously enjoyed one another’s company.
As my husband and I left, I impulsively stopped at their table and excused myself for interrupting, then explained how pleasant it was to see the two talking together and not with their faces engrossed in a small box instead of one another. The dad graciously thanked me and then beamed at his son, saying, “Well, of course- this is my boy- he’s a great kid!”
They made my whole day golden.

onbeinganurse: “Mirror Images”

There are five of us siblings; three brothers, our sister, and myself. Ranging in age from 74 to 50 years old, two are Senior Citizens and three are Baby Boomers. Spread apart also by location, we represent Hawaii, New York, Pennsylvania, and Florida, making it difficult for all to get together at the same time. Eleven years had passed since we’d all been together. I’m happy to say that it was with eager anticipation we planned to meet two weeks ago in Naples, Florida, on June 3rd.
My biggest concern was that I’d cry when I saw my older brother, Jim. Two years apart, we’ve always had a close bond. One of my first memories is of my big brother holding my 4 year old hand within the safety of his as we walked the block from our home to our waiting Grandmother, who stood watching for us at the top of our same street. Jim has always been healthy and strong; and, at 74, what in medicine we call a “good” 74 year old. But these past ten months have brought a diagnosis of cancer and weeks of radiation plus targeted IV chemotherapy. By the 2nd to 3rd week of treatment the side effect of fatigue necessitated a driver for the 3 hour round-trip. Weight loss gradually melted 35 pounds from a tall frame which couldn’t afford it, and by Christmas Eve his new address was a hospital room for two weeks of hydration and enteral feedings. He was positive through it all. Other patients he met along the way made encouraging comments and bolstered his own courage through theirs.
He is a published writer by profession and as his strength improves he feels another book coming on, based on this experience. The best news has been two clear CT scans since completing therapy in January. However, I knew that he was still weak from the weight loss and had issues walking, complicated by an arthritic leg. Not the picture of him that I carried in my mind and heart from stronger days.
As I said, I was nervous about seeing my brother for the first time after such an ordeal. Meanwhile I had a couple mobility issues of my own and had prepared him for a change in what had been my previously sprightly steps.
My husband and I were to pick Jim up at the Florida airport. I had made a sign that said “Reunion 2014” and held it up at the car’s window as we approached him. I opened the door, we looked at one another, and both of us broke into laughter. As kids we shared many things, and, decades later, I saw that we are still sharing, only now it is our Senior Citizen mirror images: we each have a cane, walk with a hitch, and have wisdom lines on our faces.
“Gosh,” I said with dry-eyed relief, “you sure look familiar.” Immediately he “got it”. He understood my wry comment and we convulsed into giggles again.
It was a great reunion.

onbeinganurse: “Positive deviance”.

During Florence Nightingale’s time and through most the 20th century, doctors and nurses have had an unbalanced colleague relationship: the doctors told nurses what to do and we subserviently took the order. During the 1980’s, collaboration began improving across the medical community as a majority of physicians recognized the extent of nursing skills: they saw that our education and assessment skills adds up to independent clinical thinking. There are times in our patient assessment when we see that a “doctor’s order” might not be in the best interests of the patient, such as giving a particular medication when vital signs or symptoms might indicate withholding the prescription. This concept of ‘positive deviance’ has always been a nursing option. In my day, this was called common sense. Of course as an RN or LPN we inform the physician and/or our facility supervisor of our assessment and that the med has been held pending this change in condition. We are bound by the Nurse Practice Act (NPA) to bring a patient to their fullest health potential: there is nothing in the NPA that encourages a nurse to blindly follow “doctor’s orders”. When, for example, we see an indication that, by administering a scheduled medication, harm could follow, we withhold that order (medication) and notify the physician directly.
In the August 2013 issue of The American Journal of Nursing, Volume 113, No. 8, “Viewpoint”, (C.Reuter, MSN, RN, and V. Fitzsimons, EdD, RN, FAAN) the authors suggest that instead of “order”, the term “prescription”, or “regimen” be used. Collaborative care means working jointly for the benefit of the patient, and since the early 1990’s medical staff committees across the country have encouraged physician and nurse to work together in a collegial, respectful atmosphere. The term ‘regimen’ has a different implication than ‘order’. In the thesaurus, ‘prescription’ is described as making obligatory or mandatory. ‘Regimen’ in Webster’s Dictionary definition states a ‘systematic course of treatment or training’. In my experience the latter more fully encompasses both roles of doctor and nurse, acknowledging the physician’s determination of the most effective treatment at the time of her/his assessment, but also recognizing the nurse’s clinical evaluation of the patient’s condition at the time of following through: symptoms may have changed in the interim and may indicate a change in the regimen. Before following through and in the best interests of our mutual patient, we practice positive deviance; ‘hold’ the regimen as it stands and call the doctor.


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