Winter Coldness andLoses

Well, we are certainly in the midst of weather in southwest Pennsylvania. Thankfully, Phil predicted an early spring. My winter has been very busy at work. Not because the weather has been bad or the flu season is here. I have been working solo on the worst snow days... My co worker has decided not to come in on snow day because of the distance to work which leaves me holding the fort....Actually it has been ok....thankfully I enjoy my work...despite the busy unit I work on I have found solitude and enjoyment in my patient load. I do have one patient I would like to share of my experience during these months. He was a very challenging patient when he first came to me in September. He literally damaged his mind and body from cocaine. He drained all of his finances and laid in his bed agitated confused and angered. He required 1:1 nursing 24 hours for almost 2 months. Psychiatry saw his patient everyday..The nurses did not fear this man but worked hard to bring him to the point that he would recognize us and cooperate with us. He learned to communicate effectively. Sometimes with choice words and foul language ...but by the time Christmas came around he would wheel himself in his wheelchair and sing Christmas songs with the visiting musicians. He was more social and would even have an attention span long enough to play tic tac toe with one of our nurses....We grew very fond of him but his time was growing short with us and was medically stable to move to a longterm care unit.... that day came he we said our good byes...I knew deep down inside he would soon return....for one thing that I have learned in my years as a nurse and nurse practitioner ...this type of patient can easily become sick and not get better....one month after we transferred him he returned...sick and more demented...I knew as much as I tried to help him he would never be the way I remembered him singing the Christmas songs...I worked closely with his family and many discussion occurred and the family decided to make him hospice...he died within a week of going to hospice unit...Although I was sad to hear this, I knew he lived his last months in a sheltered environment, comforted, in no pain, and around people and family that loved him and cared for him...His family and children are beautiful people and have grown up to love him very much...I did tell him that before he went to hospice..he looked at me and I knew he appreciated me telling him this. The day he died his family came to thank me for all I did.....I was only doing my job and I knew if this was my loved one, I would want the same thing for them that I gave to this patient.

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