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.

onbeinganurse: a fresh start.

It’s been six months since I posted a nurse blog. I don’t know why, but probably because I ran out of what I felt was material to blog. Retired from active practice for 19 months now, there are no patients to inspire me and share a human interest story. They were my material. I had wanted to volunteer at a nursing home or hospice, but mobility issues had by now caught up with me, making my balance somewhat unsteady. Another resource for patient contact lost. So eventually I took a hiatus from blogging and instead formed a writer’s group at our local library. A writer’s group of two; another “want-to-be” writer and me. Instant soul sisters, we provide mutual support, laughing (or crying) at one another’s written words. Who wants a round-robin of criticism when productive comments make for a more pleasant atmosphere? We only have an hour to read and comment on one another’s effort, and no point in going away feeling blue. To guide us we have a writing resource copy from a college journaling course.
So we’ve plundered on, both women totally different in our writing styles. During the Fall, my new BBF bit the bullet and submitted a satirical slant on a popular fairy tale to a national magazine, and darned if they didn’t suggest it be published on their author blog site! I was green. But, truthfully, I enjoyed her surprise and sense of validation that she might just be the writer she thought she was.
Meanwhile, I had given up on my attempt at a fictional novel (about a nurse, wouldn’t you know), having written my protagonist into a corner and left her stuck there. Writer’s block. What appeals to me is “real” life, an active ethical dilemma I could explore and submit to a nursing journal. After the Boston terrorist bombing, I called the Human Resources department of Beth Israel Deaconess Medical Center in Boston and asked how the nursing staff felt about being assigned to care for the terrorist and his injuries, while, at the same time and down the hall, his victims were suffering amputations and other physical and emotional results of the bombing. My questions were put to the ethics committee and answered in a thoughtful and timely manner. After I wrote the article, the same committee reviewed it for any corrections or concerns, meeting their approval. I felt really good about the piece and submitted it to a nursing journal, where it was peer-reviewed by the editors and accepted. Yippee! Inspired, I researched for another article on a subject nurses would be interested in, and a journal accepted it following peer-review. A third article is pending approval. I’m on a roll here!
What I’ve learned is that I can still practice nursing, but in a different way than hands-on. The articles are a form of mentoring my fellow colleagues. And my brain won’t turn to mush.
Reinventing myself, I’m happy to say I’m still a nurse.

onbeinganurse: Where I’m from…

I’m from starched white caps, white uniforms and polished white leather duty shoes…
I’m from giving AM care, PM back rubs and unwrinkled hospital sheets…
I’m from giving up my chair to a doctor at the nurses’ station…
I’m from paper charts and hand-written nurses’ notes to Electronic Medical Records…
I’m from smoking allowed at the nurses’ stations…
I’m from drawing up syringes of chemotherapy in the nurses’ kitchen before ventilated hoods and OSHA guidelines adopted…
I’m from “This is the way we’ve always done it,” to national nursing standard and patient effective Evidence-Based-Practice…
I’m from time-consuming deciphering and clarification of scribbled orders to prevent un-intended consequences…
I’m from initiating physician/nurse meetings to promote recognition of our common goal to bring a patient to their fullest health potential…
I’m from mentoring (with awkward feelings) a Russian-trained M.D. working as a nurses’ aide while learning English and preparing to take U.S. medical boards…
I’m from driving home after 11PM to 7AM shifts and not remembering if I stopped for traffic lights or stop signs…
I’m from calling the nurses’ station as soon as I got home to ask if my patient’s family made it to the hospital to say good-bye for the last time…

onbeinganurse: A nightingale’s and a yellow-bird’s calling to nursing.

I started out this blog to draw attention to May 6-12 being National Nurses Week, and as I wrote a commemoration to my beloved profession it made me think of Florence Nightingale, the Englsh woman who in the mid-1800’s trained in London as a nurse and did so against her wealthy parents’ wishes: Nurses back then were considered to be either drunks, prostitutes, or both. Florence became known as “the Lady with the lamp” for her relentless efforts to obtain better nursing care and improve hygiene conditions for the wounded English soldiers fighting in the 1854-1856 Crimean War; 3,000 men died of their wounds during the war, but 17,000 died of infection. When I see what medical hygiene practice changes she made, I can see the first nursing research of “Evidence Based Practice”, which is today’s nursing standards of care.

At a time when women did not nurse soldiers, Miss Nightingale initiated a nursing program and then took three dozen women with her to Crimea where she saw the terrible conditions of the wounded men and and began to change the filthy state of the make-shift British-run hospitals. Her ethical practice, hygiene changes and diligent pursuasion with the doctors of that time eventually brought professionalism and respect to nursing. Now, 150 years later, national polls note that nurses are among the most respected and trusted professionals in our current time.

The week of May 6-12 is designated to celebrate the nursing profession: National Student Nurses Day on May 8th, and (world-wide) International Nurses Day on May 12, which purposely coinsides with Florence Nightingale’s birthday. However, as I googled the Florence Nightingale Pledge and her personal history, I came across the name of another strong advocate for the soldiers, and, before the war, nursing victims of cholera and yellow fever- Mrs. Mary Seacole, a Jamaican nurse and “doctoress” who was a contemporary of Miss Nightingale. However, she was refused permission by the London War Office and other military offices to volunteer in service to her own Jamaican-born soldiers fighting alongside the English troups. In her memoir she cited racism and Victorian attitudes. Undaunted, Mrs. Seacole went to Turkey at her own expense, setting up a boarding house for both Jamaican and English wounded soldiers, and even going to the Crimean front lines to nurse the fallen. Eventually she volunteered in evenings with Nightingale’s nurses, although Florence had been among those in London who had first refused her offer. Seacole became as well-known as Nightingale, but in a different capacity; she was a hands-on nurse, while Florence’s focus was as an organizer of nursing services and with the monetary means to do anything within her power. The grateful soldiers called Mary “the black Nightingale” and recognized her cheerful yellow dress and blue bonnet with red ribbons. Mary’s brilliant flame as the first advanced nurse practioner was brief, while the wealthy and well-appointed Florence went on to establish the first Training School for Nurses and was hailed over many years for her accomplishments in raising the standards of nursing practice. It was 100 years later, in the 1970’s, that Mrs. Seacole’s life work became a symbol for Black nurses, civil rights, and the women’s liberation movement.

I confess that during my student nursing days I don’t remember hearing of Mary Seacole; it was Florence Nightingale all the way. I am grateful to learn of her and to have been further enlightened of both these influential women as I began this May tribute to Nurses Week: the two leaders would be proud to have been the forefront of the educational advancements, specialty areas, and opportunities that nursing encompasses today. Congratulations to all the Registered Nurses, Liscensed Practical Nurses, and Certified Nursing Assistants devoting their education, skills, and compassion to those who receive their care.

onbeinganurse:Certified Nurses Day

March 19th is not only the day before Spring; it’s the day nurses are recognized for being certified, or specialists, in their field. Nursing starts out with a general knowledge of many diagnoses. In 1984, when I graduated as a nurse (GN), it was common to work in a medical-surgical area for at least one year while passing licensure as an RN and building on the learned base, gaining more experience. Specialty certification in a particular field was an option and has grown tremendously: pediatrics, cardiology, endocrinology (diabetes, thyroid), renal (kidney disease, to identify only a few. For example, the initials after the example RN, MA, CGRN, CNOR, mean this nurse is a licensed Registered Nurse, has graduate education achieving a Masters Degree, and has earned specialized training as a Certified Gastroenterology Registered Nurse and a Certified Operating-room Nurse. The yardstick to become certified in any medical specialty is high and set to establish a standard of care.

Certification in cancer nursing (OCN, or Oncology Certified Nurse) appealed to me within a few months after graduation and after an unexpected transfer to my hospital’s oncology unit. I found I loved this field of nursing and wanted to give the safest oncology care possible. Over the years I’ve worked with many excellent nurses who are not certified in their particular field: there are many valid and individual reasons why this may not be feasible. One reason is that aside from the time commitment to prepare, for example, the oncology certification’s initial sit-down test, the cost is over $200 and many employers will not reimburse. I was fortunate our hospital did reimburse with a passing grade and also a $0.50/hour raise, and my employers since have also encouraged certification with these incentives. The test is given every four years, and recertification is required each time to continue carrying the initials ONC (Oncology Certified Nurse) and all it implies. In recent years more and more recruitement managers are suggesting certification is preferred, but not required. And you can be sure patients & families notice any initials after a medical caregiver’s name and will ask what they stand for. I do, too.

The oncology nursing test involves multiple areas including comfort, coping with psychosocial, cultural and altered body issues, supportive care, sexuality, rehabilitation, pharmacologic and non-pharmacologic interventions, alterations in nutrition and elimination, immune-compromise, cardiopulmonary function, oncology emergencies, radiation, nursing care of the different types of cancer diagnosis, chemotherapy administration & possible side effects. It includes several other issues including health promotion and early detection, and professional performance. I know there’s a few I’ve forgotten here, either by poor memory or deliberatly wanting to forget, whatever the stressful topic. The Oncology Nursing Society (ONS) is based in Pittsburg, PA, and is a globally recognized ooncology educational organization: nurses from all the free countries of the world can take the test for certification. Every ONS educational magazine issue I receive has peer-reiewed articles written by OCN RN’s and from so many countries including Japan, England, Austrailia, Switzerland, etc.: cancer does not exclude any culture.

Today I’m congratulating nursing colleagues everywhere on their special achievement and celebrate this special day, March 19th. Anyone who isn’t a nurse, but reads this blog, may be surprised to see what’s behind the initials on their caregiver’s uniform.


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