The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Archive for March, 2010

A Gag Order? Shame on You Temple

Posted by isntshelovlei on March 30, 2010

If you live or work in the tri-state area then you’ve probably heard about the drama brewing around Temple University Hospital and their intention to essentially gag their nursing and allied health staff.

Just this past year, two Texas nurses were prosecuted for voicing their concerns via a so-called anonymous complaint about one docs’ practices. The charges were dropped against one of the nurses; the other nurse was later found not guilty.

And now, Temple President Ann Weaver Hart wants to include a provision in their nursing contracts that basically says that if you do your job, you lose your job. Has the familiar saying “snitches get stitches” now crept into the healthcare system?!? Needless to say—the staff aren’t having it (thankfully and rightfully so).

This is not a joke—and it’s really not about money or nurses and other health care professionals on a power-trip either. This is also bigger than freedom of speech—this is about PATIENT SAFETY. Peoples’ lives are hanging in the balance here. Now I may be a wet-behind-the-ears student nurse but what I do know is that one of the very tenets of nursing practice is patient advocacy. And for some patients, their nurses are their only voices. Nurses are at the front line caring for their patients day in and day out, monitoring them closely. Nurses are more likely than other health care professionals to catch a medication error, notice an unsafe practice, or know when something is just not quite right. If there is something amiss, it is their duty to speak up.  

Hart’s proposition is truly ridiculous. Next thing you know they’ll have patients signing statements upon admission that they can only be treated if the patient promises not to sue…

With that said, Temple nurses plan to strike tomorrow, Wednesday, March 31, 2010 at 7am. For updates on this situation, check out Temple Watch.

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I Just Didn’t…

Posted by isntshelovlei on March 29, 2010

Clinical this past Sunday was a little more interesting than last week—but not much. I did a newborn assessment, and charted a little in the paper and computer charts. Oh, and I got to help make a couple of beds—exciting stuff for a student nurse thirsty for hands-on patient care right? I did not get to do a postpartum assessment on mom (her regular nurse completed it when I whisked the baby off to the nursery). I did not get to see a birth (vaginal nor c-section). I did not get to pass meds. I did not pass go and I did not collect $200.

It was a little strange at first handling “normal” newborns. I’m used to my NICU babies who have various catheters and such attached to them; these babies were so….free—bundled up like little burritos. Mom was still kind of out of it and preferred that I fed her daughter so I did. It just felt weird being able to scoop up the little peanut from her bassinet and stroll over to the rocking chair with no IV poles or monitors to navigate around. Sitting there with that 7lb bundle of joy made me think back to when my own children were that small (and before they learned to say words such as “no” and “mine”). My lecture instructor said in class that someone always gets pregnant during this rotation—uh, no thanks, I’m retired from that line of work. I already have three strikes, so I’m out of that game.

Sadly, most of the nurses weren’t any better (read: nicer) than the ones we had last semester. I thought (or hoped) that since these nurses cared for hormonal women and babies their demeanor would be a little more accommodating—guess not. No one was outright hostile like my dear Nurse Nasty from last semester, but they did tend to make you feel like some colossal inconvenience. I still don’t quite get that whole “nurses eat their young” thing…

No clinical next weekend since it falls on Easter. Good thing too since I could really use a solid weekend to catch up on some much-needed reading.

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Med Math

Posted by isntshelovlei on March 24, 2010

So we had a dimensional analysis quiz last night. Ah yes, the dreaded med math—what some nursing students have nightmares about. Every semester we have quizzes on drug calculations. In my program we have to get a 90% or higher on them—at some schools it’s 100%—or you will fail the clinical portion of the course (which means you’ll just fail the course—you can’t fail clinical and pass lecture). Hence why many students get their panties (or boxers/briefs) all up in a bunch. I’m not sure what the old-school method was, but dimensional analysis is really quite simple. The biggest challenge is remembering all of the conversion factors. Some are well-known such as 1000 mg = 1 g, whereas some like 1 gr = 60 mg (what the heck is a grain anyway?) are a little less so. But once you have the conversions factors under your belt, it’s pretty much all downhill from there.

Let’s look at an example. Let’s say the physician has ordered a patient to receive Erythromycin 150 mg PO TID. The pharmacy sends the medication in a bottle labeled 0.75 g per fluid ounce. How many ml should be given at each dose?

I always like to start with the amount ordered (150 mg). Next I look at the dose on hand (as if the pharmacy could ever send it to you the way you actually need it), which is 0.75 g per fluid ounce. The monkeywrench is that I need to administer the medication in milliliters. So I’ll need two conversion factors to make this work—1 gram = 1000 mg and 30 ml = 1 ounce. If you set up the problem correctly the unnecessary measurements will cancel out and you’ll be left with what you need—milliliters. Keep in mind that the conversion factors can always be flipped so that the unwanted measurements cancel out properly—notice how I wrote 1 oz / 0.75 g instead of 0.75 g / 1 oz. Once you have it all lined up, multiply across the top, multiply across the bottom, simplify, and voilà! Piece of cake.

There are a few miscellaneous rules to remember with med math. For instance, always use leading zeros and never use trailing zeros. This helps to reduce possible medication errors. People’s handwriting often sucks and so if a nurse transcribes an order into the MAR for 1.0 grams of a medication but the next nurse doesn’t see the barely-there decimal sign and misinterprets it as 10 grams—she just gave your patient ten times the medication they were supposed to get. Same thing with leading zeros—.1 g can be misinterpreted as 1g. Watch those zeros! Rounding answers can also be tricky. In general, you’ll want to round to a whole number when your measurement is a capsule, gelcap, unscored tablet, etc. Nothing like trying to administer 0.92 of a tablet to a patient…

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Posted by isntshelovlei on March 22, 2010

Our first day in Maternity/OB clinical was pretty uneventful–almost downright boring. Part of the problem is that we have clinicals on the weekend. C-sections and inductions are not typically scheduled for weekends. So we are basically just sitting around waiting for someone to spontaneously go into labor (and with all the planned C-sections these days I’m not sure if people still do that…). There was a single postpartum mom on the entire unit. The clinical instructors had to go “find” a baby so that they could show us how to do a newborn assessment. I will admit technically it was just our hospital orientation day (which translates into boring computer training on yet another EHR system), but I was all ready to palpate some funduses (fundi?) or something. I also heard that we’re not even going to be giving meds which leaves not much else to do than a lot of patient teaching–if there’s anyone there to teach…

So although many of my fellow students are still excited about this rotation since some would like to work in maternity, I can already see it’s not my cup of tea. I need more “action”–like in an intensive care or ED environment (but real emergencies–not “my baby has hiccups”). Not that I thrive off of dire emergencies or people being critically ill/injured but when you’ll be working 12-hour shifts I’d like to be doing a little more than reading the tabloids at the nurse’s station (don’t act like you haven’t seen it). Who really cares how Kendra Wilkinson lost 10 lbs in 10 days?–she probably ran 5 miles a day on a strict diet of romaine lettuce…

Of course now I’ve totally jinxed myself and this weekend it will be on and popping (hopefully)…

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Posted by isntshelovlei on March 16, 2010

Let me tell you a little secret–nursing students LOVE mnemonics. There would be absolutely no way to store all of the information we need to know without them. You’ve got the basics like “ADPIE” (which is the nursing process: assessment, diagnosis, planning, intervention, and evaluation) and “OLDCARTS”  (the attributes of a symptom: onset, location, duration, characteristics, aggravating factors, relieving factors, timing, and severity). Some others I’ve picked up so far are “Nancy Reagan, RN” (how to draw up a mixed insulin dose–air into NPH, air into Regular, draw up Regular, then draw up NPH); “LAB RAT” (left atrium: biscuspid; right atrium: tricuspid–which I always used to mix up!); and there are about gillion different ones for cranial nerves. I like “Olympic Opium Occupies Troubled Triathletes After Finishing Vegas Gambling Vacations Still High”–olfactory, optic, oculomotor, trochlear, trigeminal, abducens, facial, vestibulocochlear/acoustic, glossopharyngeal, vagus, spinal accessory, and hypoglossal. Tonight, I learned a new one to add to the list–VEAL CHOP–which relates to fetal heart rate.

Variable decels => Cord compression (usually a change in mother’s position helps)

Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems)

Accelerations => O2 (baby is well oxygenated–this is good)

Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby). You’ll also hear/see this called “uteroplacental insufficiency,” but VEAL CHOU just doesn’t have the same ring to it does it?

And that’s our lesson for today folks. It’s only the first lecture but so far I think I’m really going to like this class. My professor is really on the ball and I actually didn’t mind that she kept us until the last minute of class because the material was interesting and I felt like I was actually learning something–like the stages of labor (not to be confused with the phases which all occur during the 1st stage) and the 5 P’s (powers, passage, passenger, psyche, and position). I think I’m almost ready to catch a baby–clinical starts on Saturday! 🙂

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Coming Soon to a Delivery Room Near You

Posted by isntshelovlei on March 12, 2010

Like most of my classmates, I cannot wait to start Maternity/OB–or is it more that we’re eager to escape the clutches of Health Assessment? 😉 Now I’ve had three children of my own–one I was so completely epiduralized (I’m sure that’s not really a word) that I could not feel my legs; one natural, but not by choice; and one using Hypnobabies (that’s a story for another day but check it out, it really works!). So although I’m sure my husband would disagree, I personally think it’ll be quite interesting to be on the “other end” for a change.  Guess I’ll need to drag my clinical uniform and lab coat out of retirement…

In other news, I purchased my own individual malpractice insurance policy from Nurses Service Organization (NSO). It’s only $29/year for nursing students and I think it’s a pretty worthwhile investment. Sure we have malpractice coverage through the school (maybe that’s where all my tuition goes…), but I am positive that their policy covers their asses more than mine. It’s also shared between a lot of nursing students so I’m sure there’s some sort of cap per individual. And contrary to popular belief–shit happens–and yes, you can be sued as a nursing student. So don’t be sorry, be prepared.

~ Peace, love, pickles and ice cream

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Spring Break!!

Posted by isntshelovlei on March 5, 2010

Health Assessment is over. Finished. Finito. We took our final exam last night and now have to wait 48 long hours for our grades (probably even longer for our final course grades). I actually didn’t think the test was that bad. And since I made benchmark on the HESI I already have an extra 10-point cushion. There were a lot of questions that looked let’s just say “familiar” and I found myself thinking “ooh! I know that!” throughout most of the exam. There were 70 questions total and I was done in about 35 minutes. My professor hesitantly took my scantron—“Are you sure???” I just smiled and shrugged. You know my motto—“Either you know it or you don’t.” I have never been one to sit and stare at test questions as if the answers are going to magically pop out all of a sudden. I have also made it my policy to never change my answers on exams. Most of the time when people change their answers they had it right the first time.

My interview for the nurse extern program was today—I think it went pretty well. It was initially a group info session and then we broke out to tour and interview with the managers of our preferred units. They received almost 600 applications for the program and can only take 32-34 externs so my fingers are crossed—matter of fact while we’re at it, cross yours too! My only concern is the scheduling of it all. They would like for you to work as an extern fulltime—which of course I can’t do or I’ll lose my benefits. So I would have to work my extern schedule around dropping down to a 0.5 FTE at my “real job” (*smirk*), plus my lectures and clinicals since my nursing program runs all year round. Not an easy task, but it can be done!

And so spring break it is—sadly there will not be any sandy beaches in my forecast. I will say it is starting to warm up a little since that record-breaking snow we got but it’s still probably only about 45 degrees on a good day. But at least I’ll get to go to sleep at a normal hour for a few days…

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Buh-bye Health Assessment

Posted by isntshelovlei on March 1, 2010

Health Assessment is just about coming to a close—thank goodness. For a minute there I thought I wasn’t going to make it–my hair even started falling out again. But I’m still here, balding and all lol. We had our clinical final exam/check-offs this past Saturday. You have to do an assessment of one major system (Neurological, Thorax & Lungs, or Abdominal) and two minor systems (CN 1-6, CN 7-12, Cardiac & Peripheral Vascular, or Head/Neck/Face/Ears)—which you basically pick out of a hat. Since you don’t know which ones you’re going to get until that morning you have to know ALL of them perfectly—or at least sufficiently well as clinical is pass/fail. With so many minor details within each system I must have studied for it for a week straight—I even slept with my notes the night before. Instead of visions of sugar-plums dancing in my head I was having nightmares about cranial nerves, diaphragmatic expansion, and liver spans. But it actually turned out ok. My major system was abdominal—which of course was one of my least favorites. I’m just not comfortable with the percussion aspect of it. Liver spans, splenic dullness, tympany over the gastric bubble—most of the time it all sounds like the same ol’ shit to me. And how many nurses really percuss in their daily practice? I am almost 29-years-old and I don’t remember ever being percussed. For my minor systems I had Head/Face/Neck/Ears (and I remembered to hold the otoscope upside down!) and Cranial Nerves 7-12—piece of cake.

We still have to take the HESI tomorrow night and our final exam on Thursday. If we make benchmark on the HESI (we’ll see how that goes), we get 10 points added to our final exam grade. Now I wouldn’t mind that at all…

Up next, Maternity/OB. But first, spring break here I come! Of course it won’t be a full week of pure unproductive bliss since we’re expected to have read the first five chapters in our maternity textbook for the first day of class—oy!

In other exciting news, I have an interview scheduled for the 2010 Nurse Extern Program at the #1 pediatric hospital in the nation! Go me! And from what I’ve heard, due to the economy they’ve had to cut the number of spots in the program in half, so I would just about pee myself if I actually get a spot. It is such a great opportunity—clinicals are such a tease to me at this point! If I’m selected I’ll get to do more hands-on direct care, and in peds at that! For those of you looking for a similar opportunity check out the 2010 U.S. Summer Externship and Opportunity Resource Guide. UPenn puts this out every year; it was recently updated so it should be pretty accurate. Good luck!

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