It always happens in 3's

How is it in the medical profession everything happens in threes....someone dies...it is in 3s...someone codes...it is in 3's..someone falls ...it is in 3's....well this week we had 3 codes in a matter of 48 hours on our floor.....is it the change of season..the lunar force...time change...don't know if anyone out there has an answer let me know....another thing is Full moons..if you are working in a hospital, you don't want to work during a full moon...crazy things happen...for us ...people fall, leave ama or do crazy things...like being admitted for alcohol detox and leave the unit to go to the downtown bar...again..lunar forces????
The codes on our floor were from a man being unresponsive, a staff nurse suffering a panic attack (aka chest pain) and a patient who decided to not breathe very well because of his moprhine for pain medication.....of course they all happened when I was there..and 2 out of the 3 happened right before I was ready to leave work....so much for getting out of work on time..and the last one happened on a Friday afternoon..not very good timing...but codes never are...but I do have to commend the nursing staff, respiratory, ems, and my attending for always doing a great job and acting smartly and quickly in providing great emergency care....until next time...watch out for the full moons...and remember it always happens in 3's

DNR

The worst part of my job is discussing DNR status with a patient or their family. I find people are not well educated as to what really happens when a patient is found without a pulse or breathing...people only know what they see on TV which really doesn't protray the reality and success rate of CPR....the drama of doctors and nurses beating on someone's chest and putting pattles on someone and then showing the EKG monitor going from aystole to NSR is not what really happens. I had the opportunity to really explain the success rate of CPR to a family member the other day...I have to say this is probably the 100th time a provider has explain this him during his brothers longterm stay and he always says "I want to do to my brother the same thing I want for me"....well the reality is that the healthiest person will only have a 20% survival if CPR is preformed on them....if the person, like this patient, has any other health problems(emphysema, ascvd and heart disease) that 20% significantly drops...then I get the question...what would you do if it is one of your family members...I don't even want to go there...why does hearing what I would do help you decide what you are going to do...just know the fact plus look at the quality of life...this particular patient has already has a poor quality of life...has dementia,fed by tube feed is dependent in his care, is immobile, needs a lift to get him in and out of bed...I just don't understand how his family sees that doing CPR will make this man's life any better.....I am all for doing the best for our patients and do no harm but really what is truly the best for this patient...I just hope after my lengthy conversation with this patient's brother, that he really makes a sound and educated decision....I know thats what I would want for my family members...

Work Doldrums

Well, I am trying to keep my promise to write more this year and here I am again...I am sure many of you feel when does the work day end and when can I go home and soak my self in calgon to get me away from it all... typicallly I don't feel this way. I have learned to handle the stress of my job creatively and productively...I come home kiss my husband and sit down and relax to a good home cook meal..maybe accompanied by a glass of wine,...then prop my feet up and do some mindless reading or knitting in the winter or gardening in the summer...for the most part I look forward to work..but this week was not so...first of all I am really hating winter...Southeast PA has had its share of weekly snow or ice storms; secondly (as I mentioned before) running solo at work without help on these snow days hasn't helped my morale...then I was sick last weekend into the beginning of the week...I hate being sick... no kidding...my job is taking care of sick people all day...why do I want to feel the way they do...not...so I was really feeling low and under...to the point I told my husband ...not sure how much longer I can do this....so, I thought, what are my options...Well I can retire in 3 more years...but I still have to work...and if I still have to work what would I do...I know nothing but health care. If I retire and have to work...I want nothing to do with health care...and if I work I want to work part time like 2-3 days a week from 10am to 2pm....I did toss around going for my certification in laser hair removal...but do I really want to go back to school again and learn something else...not...do I sound like I am winning because I am....What other options do I have....well when I came to this point ..the weather finally turned around and we had a 60 degree day and a 70 degree day...all of a sudden I wasn't thinking of options anymore but back to lovin my work...there is one thing I have learned when I do get down and out at work not to take it out on my patients or their families...this does take a lot of patience and indurance...I want the best for my patients and I don't want them into my mind where they feel they are making me this way....after 12 + years of being an NP this has taking sometime and self training to do...so come on warm weather...I nee a healthty dose of Vit d to help my happy thoughts to keep me in the work mode for a longtime...at least another 6 years!!!

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!