Emotional Strengths

During my first shift of this week, I discovered a new appreciation for hospice nurses. I started my shift with 2 patients- the first was a 79-year-old female who was chronically ill with CHF and related respiratory issues; she had been back and forth between the ICU and the telemetry unit over the past month. She had been planning for discharge when she coded on telemetry; she was transferred back to the ICU on a ventilator and multiple drips.

Through that evening, the nurse kept having to increase the amount of vasoactive medications she was on and shortly after the start of my shift that next morning, she was maxed out on multiple medications (vasopressin, epinephrine, levophed, neosynephrine, and dopamine). Her daughter arrived at 0800 and we discussed the fact that her mom probably would not make it through the day no matter what else we tried to do (there’s already so much damage being done to the body on that amount of medication).

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A Battle Plan Against Depression

In one ‘Cathy’ comic, the heroine crossly describes men as ‘all solution, no sympathy.’ For depressed teenagers and their parents, as Dr. Miriam Kaufman has learned over 18 years of work with teens, this attitude can be as misguided as the oft-derided ‘all sympathy, no solution’ approach. She conveys both sympathy and solution in Overcoming Teen Depression: A Guide for Parents, maintaining a scientific, matter-of-fact tone throughout.

Kaufman makes no attempt to gloss over the complexity of depression’s causes and manifestations; she believes that people need to understand their problems in order to deal with them honestly. Thus, she avoids over-simplification and distinguishes between everyday unhappiness and clinical depression as well as between depression and illnesses with similar effects. A diagnosis of major depression requires loss of interest or pleasure in previously enjoyed activities, sometimes experienced as sadness and sometimes as apathy. This feeling must be continuously present for two weeks, accompanied by four of the following: sleep problems; changes in eating patterns; difficulty concentrating; listlessness; feelings of worthlessness, hopelessness or guilt; suicidal thoughts.

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Who owns your DNA?

The answer might not be you. In an era when the map of the human genome can be accessed by any professor with an Internet connection, the question becomes more crucial every day. Courts and lawyers and legislatures wrestle with it; people who joined medical studies wonder just what their participation means. Courts have ruled that people who donate actual tissue — pieces of organs, tumors or blood, for example — have no right to financial compensation if a drug or treatment is developed from research done on that tissue.

But DNA, which contains the genetic blueprint from which you were built, seems more personal, something whose fate you and you alone should have the right to control.

Oregon is the site of the most recent battle over the rights to DNA. The state’s 1995 genetic privacy law, one of the first in the nation, gives a person property rights to his or her own DNA. A proposed change to the law last year would have taken those rights away. An advisory committee is expected to offer recommendations to the governor next month on how to proceed.

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How The Economy is Literally Killing People

At the very beginning of our shift, we received a transfer from the telemetry floor; a 50-something-year-old woman who was admitted 2 days prior with chest pain and elevated cardiac enzymes.

And, at the time, that was all the information we had. She arrived to us having 10/10 (worst pain imaginable, per patient report) chest pain, she was vomiting, diaphoretic (sweating), and so short of breath that she could barely sit back in the bed long enough for us to get a 12-lead EKG. Her EKG showed major ST changes and her blood pressure was quickly dropping to 62/34.

By this time, multiple calls had gone out to the cardiologist and he had scheduled her to go to the cath lab at 10 a.m. (it was 9 a.m. at this time) and he was given all the same assessment information that we had in front of us.
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Nurse Staffing Ratios

Nurses are expert professionals that provide direct patient care. There is no other business or healthcare professional that is taught or tasked with the critical thinking, the science, the legal responsibilities, or the multitasking workload of the clinically performing nurse. Clinically practicing nurse professionals have no less than (and some have more) education and experience than their nurse-colleagues that have chosen not to perform in a clinical environment and instead pursue careers in nursing leadership and nursing education.

Nurses are college-educated, board-tested, and licensed to practice nursing; physicians are also college-educated, board-tested but they are licensed to practice medicine. Nursing professionals are not responsible for medically diagnosing patients or performing surgical procedures, hence the additional four years of graduate medical education is not needed. Both professions enter into residency periods following graduation that provide supervised training for the independent and specialized practice of their careers. Nurses are not doctors, obviously, yet neither are they junior-doctors, wanna-be-doctors, doctor-servants or in any way connected to the practice of medicine …other than they share a patient population and a goal – the safe healing of patients.

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Dear Stepford RNs

I have watched with reserved opinion and bridled interest as the first of you graduated your Masters of Nursing programs and entered our ranks at the bedside of patients throughout the hospital.  We’ve all been watching you.

When you were in “clinicals”, we were fascinated that you knew almost nothing about patient care.  Some of you knew less than nothing.  You had no clinical group class, per se, with an instructor to assist you.  Each of you was individually assigned throughout the hospital and regular clinical staff were assigned to babysit teach precept you.  Most all that you learned clinically, was taught to you, one-on-one by good ol’ regularly educated, trained and experienced nurses.  Nurses that were confused yet happy to share with you.

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Thinking of the Big Picture

download-47I often get frustrated at work with the difference in the way doctors think to the way that nurses think. (Well, the good nurses anyways). Doctors don’t often see the “big picture” or what’s in the patient’s best interest. An example from my work week: Patient has been in the hospital for 3 weeks. He had open heart surgery, followed by a long recovery plagued by respiratory, musculoskeletal, and mental/cognitive issues.

For 3 days or so, we (the medical team…nurses, all 6 doctors on his case, social services) had been talking about sending this man to a rehab facility to improve his strength and coordination until he is able to return home… very common occurrence for our long-term patients. By the time we started talking about the patient being transferred to this rehab facility, he was fully ready to leave the hospital.

He’s sick of his ICU bed, sick of the same ol’ hospital food, sick of the daily routine, etc, etc; long story short, he needs a change of scenery. So, we have everything set into place, all the doctors have signed off on the case so the patient can transfer except the hospitalist.

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All throughout my childhood, I dreamed of becoming a doctor. I remember playing with my plastic stethoscope and mapping out the dream estate that my millions of dollars would buy for me and my family.

Through high school, I ended up working as a pharmacy technician for a retail pharmacy, which made me decide that pharmacy school was the path I should follow; realizing all the legality and time-limitations (in patient care) that doctors faced turned me off to medicine.

So, I applied to my dream college, which was a liberal arts schools as pre-pharmacy, but very shortly after starting my first semester of chemistry, I decided that I couldn’t do another 11 semesters of those classes (sick).

So, I talked to my college friends, most of whom were nursing majors, and decided that I could see myself as a nurse. I switched my major, did a semester of summer school to get caught up with pre-requisites, and then my nursing major was officially underway.

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Nursing Image & Ability to Influence Politics

images-14…your job is easy to but I don’t want to be a garbage man. Nurses are a mix of maid and babysitter anyone with an 8th-grade diploma could do it, it’s not hard to do. I guess good nurses are around because who else would get coffee for the doctors.

This is an inflammatory comment left by a fool in the midst of a jumble of comments following this article from Michigan. The comment is asinine and I usually would pay it no attention, but I am hearing and reading this genre of spittle more and more often.

This mindset definitely makes me wonder if this is a sad backlash of our economy, our union activities and the employment situations in which nurses are finding themselves – more “labor” (believed by the masses to be unskilled, at that) than “professionals.”

Are we not worthy of respect and a seat at the Big Boy Table? Do they understand how much work we have and that our education is demanding?!

Here are some of my observations:

Neither medical nor legal professionals are standing on State Legislative lawns with signs.

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We’re All Adults Here

images-40I was taking care of a younger (read: in his 50’s) patient last week. He developed flash pulmonary edema following severe mitral valve regurgitation requiring him to be intubated, treated, extubated, transferred to our hospital for mitral valve repair. He was intubated for surgery and then post-operatively we had a hard time getting him off of the ventilator (he was on 100% FiO2 and 10 of PEEP just to keep his SpO2 in the mid-80s).

I was his nurse on the day of surgery as well as post-op day #1, so the first day he was still under anesthesia, but when I walked into this room on my 2nd day with him, he was wide awake and able to communicate with me more than I had been able to communicate with any other patient prior to him in my career.

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