Happy Holidays

Well it is drawing near the end of 2010...I haven't written as many posts as would have liked...but have reflected a lot over the past several weeks on how fortunate I am to provide the care to my patients.... I have been at my current place of employment for over 9 years and will celebrate my 10th year in May. I have seen many changes all very good changes that add to the quality care . These changes are ongoing and continue to look at better ways to ensure good health care . Through the years, I have cared for many patients during their inpatient stay on the subacute unit I work...I have had the pleasure of seeing these patient as they come back for their outpatient followup and occassional visits back to my unit. Some of my patients have lost their struggle for life....although it is also sad to see one past...knowing that quality end of life care was provided helps ease the pain of their struggle and lost....I am blessed to work with many fine nurses, nursing assitants, doctors, PA's ,lab ,resp and ancillary personnel...My co workers help make the busiest and craziest days bearable....for this; it makes looking forward to each new day a challenge and pleasure to come to work...I thank my family for allowing me to pursue my dreams and career goal of becoming a nurse practitioner...they were supprotive and patient with me during my schooling and continue to provide positive strokes each day I come home from a good or bad day at work...they enjoy my stories of challenges and joys...for this I thank all who have been there to help me be the best I can be in providing the care required to my patients....
I wish all my patients, their families; my co workers and my family and friends a Blessed Holiday Season and Happy and Healthy New Year...I look forward to next year and hopefully can blog more often...
Happy Holiday to all and Happy blogging!

Signs of the future...

Summer has been busy with family gatherings,picnics and relaxing at the pool. Work has been buzzing though...In the 9 years I have worked my current NP job at a VA, I have never seen administration put us on divert...well it happened for one day this summer...many of you in the private sector say this is no big deal but it is in a VA....we always take vets no matter what...we great them with open arms and try to find dispositions for them...some of our vets are very difficult to find discharge planning for because they either have no family and/or no money or insurance...so one day is priceless when you have no beds for those who are waiting in the wings of private facilities or are in need of health care this is scary...I am not sure if this is a sign of what is yet to come....but I do know our vets are older and require more medical attention..this is not to say the younger vets are coming back with both medical and psychological needs....I am sure we will need to stay on top of this and plan for what is yet to come

Happy Nurse Week

I am a little late with this...but as they say better late then never...this Nurses Week brings a very special insight to why I am a nurse...First of all as of May 10th I have been a nurse for 30 years...I graduated from on May 10th 1980 with a BSN...and started my first day of work on May 17th...I remeber that first day of work...I got up and got dressed in the white dress uniform I wore for my pinning...ate breakfast and got a spot of margerine from my toast on my dress...not a good start...I managed to clean the spot and get to work for my first day of orientation....boy did I feel special and ready....little did I know what my career as a nurse would unfold that day...I only wanted to be a nurse that worked part time and have a family...boy ...I never dreamed that my life would end up the way it did....Well I did get married a year after I started working as a nurse and a year after that I had a baby... and a year after that we bought our first house and a month after that I was separated...now I needed to work full time to support myself and my child..ka boom!!! Well actually I worked as a staff nurse for full time for a couple years then I decided I can do better than this for myself and my daughter...I went on to apply for a Staff Development job and at the same time got accepted to MSN program for Nursing Education.....my salary was increased and I was able to get myself on my feet financially...I finished my MSN in 5 years going to work part time....I got remarried after being a single Mom for 9 years.....I continued to work as a Clinical Nurse Specialist after I got married...during the 13 years as a Clin Spec I decided to go back to school to be a Family Nurse Practitioner...this was the best thing I ever did...being an NP is the mecca of being a nurse...you use your nursing skills, knowledge, prioritization, sensitivity, autonomy, medical knowledge and compassion when caring for patients...I have worked in private sector and I am presently in the VA system...the later has given me more satisfaction in my job then anything that I have experienced in my nursing career, the vets I care for have served our country for everything we believe in...freedom,safety and the pride of what this country gives everyone ...opportunity..now it is my time to give back to them...I pray everynight and count my blessings for what I have because of what the service men have done for this country....if it wasn't for our servicemen ...we wouldn't have what we have now.....I have the opportunity to give back to them ...both men and women...I have helped many of vets who either don't have insurance or have very little insurance ....they come to the VA for medical care for service injuries or medical conditions related to serving in the military..some come because they are ill for other reasons....I have been fulfilled with the greatest gift ..the opportunity to use my Nursing skills to give back to these men....I have cared for many that have recoverd from their illnesses and many that I have diagnosed with terminal illnesses and have helped them through a comforting death....I have helped those who have developed debilitating illnesses and can no longer care for themselves and provide for their families....I have cared for those who no longer remember their loved ones or what even happened yesterday...I have cared for those who are strickened with mental illness and substance abuse...those who through the strif of war can not deal with what they have seen or experienced during war times...It is an insrumontable experience....one that I wish I can share with all Americans...especially during this time of so many people not realizing that health care is truely needed for all..and that it truly is a gift that our current leader has been able to make sure that we all can have this ...I really believe the great leader that said "If you have your health you have everything"...for those of you who think the health care policy in dipping into your pockets and putting this country into debt...you need to see what I see everyday....people who have to decide between buying food or paying for medication ..they usually decide on food and let their health deteriate that by the time I get to them it is beyond repair.. It is very sad and suriel to see this happen...so for all the nurses out there that understand what I am saying...I say thank you for all you do...you are truely the handmaiden that Florence Nightengale has depict.. she has lead the way for all of us...I say kudos to all of you... and continue to stand up for what we are meant to all patients.....we deserve to be recognized for everything we do...God bless and continue to do your best work!

Happy Anniversary

So next month I will celebrate 30 years as a nurse..wow...did I ever think back when I was in school that I would even reach this....30 years....I look at my self and I'm not an old hag or nurse Ratchet...I am a mature women who looks like she isn't even 50 something ....in good health and still going...I have seen many changes in nursing and health care throughout the years....so I am dedicating this blog to changes that I have seen..
Nursing education ...
Then there were diplomas and BSN programs Now Associate Degree and BSN programs and quick transitional programs BSN to MSN....as well as Advance Nursing Programs

Then there white uniforms nursing pins and nursing caps Now no white uniforms no nursing pins no nursing caps but cute scrubs

Then writing in charts med kardex and nursing kardex..Now computerized charting and Bar Code Medication administration

Then team nursing....Now Primary Care nursing or Fax similie

Then pompous Doctors that you would have to stand up when they entered the nurses station and give up your seat..Now Doctors who sit next to you and have Nurse Practitioners or Physician Assistants help with their caseload

Then the most complicated patient on your unit was someone who had a gallbladder removed...Now someone who just had Open Heart surgery

Then no case management no DRG's no social work...Now case management is on the case to get patient out in a timely fashion

Then blood tests xrays Now blood tests DNA testing xrays CAT scans ultrasounds EMG MRI MRA PET scans

Then RN NA LPN now RN NA Health TECh LPN NP CSN PA

Then admitted to the hospital day prior to surgery for perop work up...today come in the day of surgery...same day surgery units go home same day of surgery ...48 hours for childbirth

Then the most serious surgery was a colostomy...now organ transplan


Then ER...now Trauma hospitals Mediquick clinics Triage

Then free standing Psychiatric Hospitals...now mainstreaming Mental health into the community...communtiy home living for mental health...free standing psychiatric hospitals..outpatient treatment for mental illness...

Then everyone was a full code now you can request DNR and have a living will and ask for palliative care and/or hospice care for terminal disease

Then no environmental laws or adaptation for the handicapped now every building and sidewalk/parking lot is adapted for the physically handicapped

There are probably many more changes that have occurred throughout the years...let me know what I have left out

For myself I have grown from a candystripper, nusring student, novice nurse, experienced staff nurse in med/surge/telemetry/rehab, staff development, clinical nurse specialist to a nurse practitioner..In all my dreams of wanting to be a nurse I would have never thought I would be where I am at now....I love what I do...I have certainly gone beyond what my dreams have taken me...I thank my family, my husband and my collegues for helping to get to where I am now...mostly my patients...they believe in me ...I pary daily that I deliver the best care to my patients and stay concientious and consistent in all that I do for them...

Your job is neverending

So yesterday started out to be a regular day...but ended in a day of sadness..At work I had to break the news to a patient that he had metastatic ca and he was a poor surgical canidate and would likely only benefit from palliative care chemo....I hate this part of my job....I try to put myself in the patient's position knowing what it would be like to get news like this...the patient took it very well and basically asked me if he was dying...I said yes....this patient has no one ....he is by himself has no one but himself....I tried to stay with the patient as long as I could to help answer any questions he may have about this awful news...he just wanted to be by himself...I offer palliative care and psychology to help him through this...He graciously accepts this offer ....
So it is one thing when this is your job to deliver such news...it is another when such news affects a family member...Ironically I got a call from my sister as I was leaving work yesterday to tell me she was just diagnosed with breast ca...She asks me what she should expect and what does it all mean...my mind and self go back into the role of an NP but has more emotions attached to it now...this is my younger sister..how can this be...I go into my sister-NP mode and try to explain what she has to look forward to in simple but not drastic words that may scare her even more than she already is...then to make things worse...after I get off the phone with my sister and calming her down...I must return a call to my Mother to answer her questions and calm her of her fears of the news regarding my sister....however despite the C word mentioned to my mother it seems all she is worried about is....can she tell my brothers about this news....I kindly tell my Mom....please put things in perspective and think about your daughter right now...this decision is up to her....if my brothers can't understand that then they need a reality check...everyone deals with this news differently...please don't burden my sister with anymore trivial things than what she is dealing with now!!!
So after these two phone calls...I go to my friends restaurant and meet my husband for dinner and glass of wine....I come home hoping to unwind the days damage to now get a phone call from my sister's husband asking me what he can expect with the C diagnosis...surprisingly I go back into the NP role and camly explain to him in simple and kind words that things will be fine...she was diagnosed at stage0 noninvasive microcalcification ca DICS.....despite the C word....she is going to have a good prognosis....I was too exhausted to write this last night....so I am here today...you never know what the day has in store for you.....face each day anew with little expectation...and go through each day knowing minutes turn into hours....know that as an NP you are someones provider, sister, wife, daughter and friend...you are looked upon as one who can answer unanswer questions about health issues and expect to give answers that will satisfy their fears and satisfaction and provide them comfort at the sametime...take time in doing this ..handle with care...but remember who you are and be good to yourself on the downtimes....find comfort in the comfort you give to others...seek solice in the care you provide whether it is a patient or a friend or family member...you are cherished by all and should cherish yourself...You have a special gift that doesn't stop giving....be thankful and blessed ....and thank God everyday for who you are and that you can always give to those who need you ...at any time any minute

Disappointed

Well I am disappointment that no one is reading my blog...I guess I have to spice it up a bit...I must admit I am new at this..so I still have a learing curve...no frets to my one and only follower...I will try to keep you entertain..or not...but feel free to pass it along to others...I am also disappointed I lost 3 posts....all that lead up to this moment....In brief...the 3 posts lost in summary
1. How I decided I wanted to be a nurse...there was no decision...I was concieved,born and decided to be a nurse...I even volunteered during my weekends and summers when I was a teenager
2. Schooling...no brainer there...had to go to college....back in the 70's this was a new way of educating nurses....not so popular....3 year diploma programs were still around...now they aren't... who was the smart one?
3. Nursing in the stone ages...believe me you would have love this one especially if you are a new nurse now...in summary...no compueterized medication record, nurses mixed IV's and hyperalimentation, no gloves, no gowns, no microwavable washclothes, no diapers, (plastic drawsheets instead), and we wore white uniforms, with are caps and nursing pins,called doctors for abormal labs..stood up for the doctors when they entered the nurses station ...say no more
I did go into more detail but in my previous blog...you get my drift...
so my promise is to make my blogs more interesting...then maybe I will get more followers

Through rain sleet wind and snow

I am sure many of you heard of the snow the northeast received this past week....it hit a record according to the National Weather service...Snow blizzards are of no feat to nurses. Being a nurse is being like the mailman...you must get to your job no matter what it is like outside. This weeks blizzard was like any other blizzard during my 30 years of nursing.
I can remember the first blizzard I attempted to get to work. I was living 20 miles from work.... the snowfall started throughout the night. I woke up extra early to make my way to work..Oh I forgot to mention...I was 6 months pregnant. This was during the winter of 1982. Probably one of the snow storms that was also record high ...I didn't have a 4 wheeldrive..I am not even sure they made them back then. I had a Chevy Nova....I drove with my face up against the windshield and my wipers going at fast mode...I could hardly see. I was creeping along slow as a snail...Most of my ride was flat rode....but then the dreaded hill came...I couldn't even start up the hill....I slid off to the side of the rode and got stuck...now picture this....615 in the morning ..still snowing fiercely....dark out and I am 6 months pregnant...I get out of my car and hike to the nearest house 1/4 mile down the road...knocked on the door and asked them to use their phone...Oh yes remember 1982...no cell phones...The lady who answered the door of course let me in ..first of all who would let a 6 month pregnant women stay out in a blizzard....My first call was to my husband who was probably was still sleeping(by the way we got divorced shorthly thereafter)...the second call was to work to tell them I would be late.
After I made my calls..I thanked the nice lady for letting me use her phone and trucked back in the knee high snow back to my stranded car. I sat in the car with the engine running for only 5minutes before a nice man with a pickup came along and asked if I needed help....No I just like to sit on the side of the road 630 am in a blizzard...Of course I need help...he hooked a chain to my car and pulled me out of the snow...by that time my husband arrived in his Pinto...( I am sure if this man didn't come along my husband would not have been able to get my car out). My husband followed me to work to make sure I got there ok....all along yelling out of his window to pump my brakes down the dreaded hill that I got stuck on. I was grateful when I got to work....I worked all day..by then the snow had stopped and I stayed at my parents house that evening ( they lived 5 min from the hospital) I was not going to attempt to go home that evening after my morning commute.
The next storm was the 1983 another blizzard....I was working 3-11 on a Friday when the storm hit...It was snowing when I went to work...I did make it to work this time...plus I was working at a different hospital that was only across town from where I was living. During the whole shift we all knew that we weren't going to go home ..not because we couldn't drive home...the nursing supervisor wouldn't let us go home because no one from 11-7 could make it in...so we had to decide amongst us who was going to sleep and who was going to continue to work 11-7...I volunteered to continue to work...only because work promised us that if we work...maintenance crew would drive us home...the was the key...so I worked like a zombie...was up for 24 hours and got a ride home with the maintenance man in his truck..oh and I didn't have to come in the next evening for my scheduled shift...another xtra bonus.
I think there were a couple other snowstorms between now and then....and every snow storm I made it... in even the blizzard of 1996... I wasn't a staff nurse then...I was a nurse educator. ...but because I made it in the Monday after that blizzard...the nursing supervisors put me on the floor to work because they were too short staffed...ugggh.
So I don't even give if it a second thought about snow anymore...I get up put my snow gear on, make sure I have my emergency car kit, shovel, blanket,bring xtra change of clothes and xtra food. and head to work....Oh and I drive a 4 wheel drive and have a cell phone now...

...Through rain sleet wind and snow

Life is Fragile...

So I am interrupting my life story about being a nurse to add some present day insight...my husband is 10 years older than I and has all the bad genes of his ancestors...Hypertension, Mixed hyperlipidemia, Diabetes and really bad anxiety....His hypertension has been somewhat controlled. His diabetes is a little controlled and his hyperlipidemia is difficult to control...He also developed atrial fibrillation about 3.5 yrs ago...and has been pretty well controlled with a beta blocker up until mid last year when the doctor placed him on an antiarrythmic which didn't work at all...we were referred to EPS specialist who recommended ablation therapy...my husband underwent a new ablation treatment yesterday using laser instead of radiao ablation...it is actually a study that by husband was enrolled in...the procedure actually took a little over 8 hours however my husband was actually off the unit for 12 hours....the procedure went well...we are keeping our fingers crossed that the procedure cures the a fib...my husband today is realizing he needs to be kinder to his body and eat and do what he needs to do to prevent problems down the road...a mantra that I have been saying to him for a long time but he always poo poo's me....I am hoping he really learns this mantra and lives by it...life is very precious...sometimes we do things to our bodies not knowing what the after effects can be....I love my husband...and want to be a wife to him I am also a nurse practitioner and know what needs to be done to prevent the bad things..i e cardiovascular disease...when I try to educate my husband I am not badgering him ..I am loving him and trying to educate him...I think he gets that now...anyone else out there that feels where I am coming from?

Nursing in the stone ages

Yes back in the stone ages ...I am truly dating myself...in looking back to when I was a staff nurse..things were soooo different. First of all the attire...white uniforms, white stockings, white shoes, nursing cap, nursing pin and name tag....As a new grad you had the choice of evening or night shift. (3-11 or 11-7) we didn't have 12 hour shifts...you had to earn in seniority and experience to work on day shift..work schedule was predictable...worked every other weekend. if you worked Christmas or New Years one year you had it off the next year...You had 2 weeks vacation.
Primary care nursing was just coming into vogue..but it was by districts. You were assigned a group of rooms...you had these rooms for 3 months then you rotated to the next set of rooms. On evening shift ( the shift I chose to work) I had a 8 patients. I had these patients from admission to discharge. The shift started by getting report from the day shift nurse who had the same set of patients. We did walking rounds..That means verbal one to one report outside the patients rooms then going in and inspecting the patient with the off going nurse...checking IV's IV site, intake and outputs, dressings, cleanliness of room.....once report was finished...we went through the kardex to check on the nursing and doctor orders...then we would pre pour meds for the whole shift...we did not have computers. we had med cards handwritten with the name of medication, dose and time the meds were to be given. we poured each medications into a med cup for each patient for the whole shift....we had certain times medications were distributed...We signed off the when medications were given in the med kardex.Then we actually went in and did a physical assessment on each patients. head to toe...and then wrote the assessment into the chart....Once dinner was completed and visiting hours were over...we passed out nourishment and gave back rubs...we also sat with the patients and provided patient education on whatever they were in for or whatever surgeries they were going to have the next day....We didn't have infusion pumps for IV's we actually calculated the drip rate and counted the drops of the IV to make sure it was running at the rate it was ordered....We called doctors with abnormal lab values...the doctors didn' get labs from a computer ....We respected physicians and gave them our chairs when they entered the nurses station...We were expected to help the doctors with bedside procedures...i.e chest tube insertion, spinal tap. the unit was quiet...no yelling in the hall from staff to staff...We charted every shift on every patient. Every patient got a bed bath and had their linens changed daily. No one under the age of 18 was allowed to visit.... We didn't have blood glucose machines..we checked urines for sugars instead..we didn't have sliding scales...The sickest patient on a med surg unit was someone who just had gallbladder surgery or a TURP....patent's who had wisdom teeth removed were admitted to the hospital....Patent's were admitted the day before their surgery to have preop blood work....We mixed our own IVPB and TPN...metal bed pans...sippy diet (for GI bleeds milk and maalox alternating every 30min). Someone with a colostomy was a complicated patient. We had vetilator patients on med surg floor for months...no social workers, no case managers, no DRG's, no time limit to when the patient could go home.....

The First Step to Being a Nurse...

I know your were dying for me to come back and finish telling you about my college experience....Well college was fun...It took me a year to really fit in to the college scene...I had no problems making friends...but I wasn't going to give up my study habits....I was a die-hard for sticking to my class objectives and reading list and studying every night ......But I did make time on the weekends for some fun...I didn't get real crazy....but don't get me wrong...I did enjoy a party or many.... but all and all I finished college with a 3.5gpa...back to how college prepared me to be a nurse....The first 2 years of college were all the liberal art courses and general requirements...I was dying...all I wanted to do was be a NURSE My sophomore year was pretty interesting this is where we took the hard core science classes to prepare us to enter nursing. In anatomy class we dissected a cat. In microbiology we cultured everything under the sun and looked at it under the microscope. In pathology we learned all about diseases and Psychology we learned about mental illness ...finally my junior year I got to take my first nursing course...but the biggest event was the capping...yes the capping...this is an elaborate ceremony where you wear your student nurse uniform (blue dress with a white pinafore) and get inducted as a student nurse...this ceremony acknowledges that I have survived the boring first two years of my liberal arts and required course and am now taking the plunge to finally learn to be a Nurse...the ceremomy ended with each of us receiving our caps...each nursing school has their own personalized cap...ours were square shape and had a purple and gold stripe ..our school colors.....now the real hard work starts....we were now required to attend 3 1/2 day classes devoted to learning nursing skills/nursing theory/nursing process and on our own time we had to go to the nursing simulation lab...this is where we practiced on mannequins how to give bed baths; make a bed with a patient in it;do dressing changes; use bed pans...take vital signs...once we passed this lab we were set to go on our first clinical rotation....Each clinic rotation was 2 days a week and lasted a whole semester. My first rotation was in a day care center...I really wasn't getting this...but I guess it fit into the curriculum somehow...The really cool rotations were Obstetrics...ahhh and if you were the lucky one you could even watch a baby born...I never was lucky ...the really scary rotation was at a Psychiatric Hospital....we were each assigned a psych patient...my patient was schizophrenic and was obsessed with talking about trucks .....and sex....this was a scary place especially on the locked units...when that locked door closed behind you and you turned around to see all the psychiatric patients walking aimlessly and talking to themselves...you wanted to get out of there but fast....the most challenging rotation was Cardiac Care and Med Surgical Units...it wasn't because the patients were complicated...it was the instructors ..the Cardiac Care instructor would expect you to memorize all of your patients medications. Not only did you have to memorize the medications you had to write each of the medications on a 3x5 card and copy word for word what was in the PDR about this medication....that was what you were to memorize....plus on top of that...the instructor would lock you and her in the med room the next day staring you down and quizzing you about all the medications and what was on that 3x5 card....thank God I got through that one...Oh and the med surg instructor....would stand behind you when you were with your patient making sure you were doing everything right ...for example how would you like your instructor looking over your shoulder when you were catheterizing a patient for the first time....and this was a sterile procedure..you couldn't do anything wrong....
When I look back on my clinical rotations I remember one patient that stands out and I really feel bad for this person now and what I put him through...He was going through DT's was hallucinating and confused...he had multiple IV lines and I was trying to bathe him and change his hospital gown...being a novice and trying to thread all the IV tubes through his old gown and threading the tubes back into the new gown...well needless to say...it was one big knot when I was done.. the patient survived but it took me about 30minutes to get everything straightened out....
Despite all of this I made it ....the pomp and circumstance was the pinning...this was another ceremony marking the completion of our nursing requirements to label has a Graduate Nurse...during the ceremony we proudly wore white nursing uniforms, our caps and were pinned with the nursing school pin....we were on our way to pick up where Florence Nightingale left off....this was an exciting time...I had a job waiting for me at that same Community Hospital where I candy stripped at working on a Medical Surgical Floor...I was going to work 3-11 shift...BUT it doesn't stop here...I still had one more big step to take before I could be a full fledged RN...that was taking the BOARDS....