The Dog Ate My Care Plan…

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

Archive for the ‘Nursing’ Category

The Saga Continues…

Posted by isntshelovlei on September 3, 2012

Be careful what you ask for…IsntSheLovlei is back on the blogging scene!

But now I’m all grown up—or at least I’ve earned a few additional letters behind my name. So instead of bringing TDAMCP back I decided to start an entirely new blog. After a behind the scenes title war with myself (and after not being able to come up with anything else for “The Dog” to eat that wouldn’t get me sued), 3Cs: Coffee, Children, and Cancer was born.

3Cs basically picks up where I left off after graduating from nursing school and passing the boards. Now I’m just a mom/wife/pediatric oncology nurse extraordinaire (in the making anyway) trying to make it in the big bad city. Come check it out, hope to see you there…

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Posted in Nursing | 2 Comments »

She Lives…

Posted by isntshelovlei on January 14, 2012

I know, I know…I’ve been a bad blogger—but not without just cause I assure you.

So I have good news and bad news. The good news is that I’ve finished my Bachelor’s of Science in Nursing!! Now I’m just up to my eyeballs in NCLEX prep as I impatiently await the arrival of my ATT (authorization to test for those who aren’t fluent in nursingstudentese). The bad news is…I will no longer be blogging at TDAMCP.

Somewhere along the way the blog and my identity became intermingled which was never really my intention and I’d really like to regain my anonymity. Not that I plan on violating HIPAA or slandering my organization or my colleagues or anything, I’d just like the real me and the work me to be separate. I also haven’t decided which direction I want to go with my blogging now that I’m no longer a student nurse, whether to continue personal experience blogging or switch to a more professional type of blog. In any event, TDAMCP will remain up for those who may want to reference topics in some of my posts or the resources found herein (I’ll also still be reachable via the Contact Me page as well). And of course I’ll update you all once I pass boards and have officially “crossed over” to the other (dark?) side…

But somewhere, out there, a new grad RN blog has already been born, with yours truly at the helm (I hope they’re ready…). Maybe I’ll see you there… 😉

Posted in Nursing, Nursing school | Tagged: , , | 4 Comments »

GUEST POST: The Warriors Guide to Landing Your First RN Job

Posted by isntshelovlei on October 15, 2011

This is a guest post by Caleb Christenson RN. He is a med-surg nurse living and working in southern California, read more tips from Caleb at RookieNurse.org. A site dedicated to the success of you, the student and new grad nurse. Sign up for his newsletter to get exclusive material and resources.

It has been said that “war is hell.” Well, so is hunting for a job, especially your first nursing job.

Times are tough for new grad RN’s. Older nurses aren’t retiring and schools are pumping out new grads at an ever increasing rate. Google “nursing schools” and see how many career colleges and online programs are preparing nurses, in addition to traditional ADN and BSN programs.

So, as you prepare to graduate nursing school, It is crucial that you adopt a warriors mentality to land your first job. Cannons will be blazing in the form of endless rejection letters and you have to be prepared to win the fight (get hired). You won’t lose a leg, but you will probably get a headache.

Lets look some of a warriors traits and habits and apply the principles to landing a job.

Posted in Guest Post, Nursing | Tagged: , , , , | 9 Comments »

Coming to Work Sick: The CYA Culture

Posted by isntshelovlei on July 31, 2011

I see it everyday in the hospital—staff coming to work with cooties because to not come may be career-suicide.  

There are let’s just say…unwritten policies (and punishments)…when it comes to calling out sick—especially in the hospital environment.

First, now you’re on your managers’/charge nurses’ radar (and not in a good way) because it’s an inconveniece—depending on how much notice you’ve given them they now have to scramble to find someone to fill your slot. Then there’s the fear of being given a write-up for an unexcused or unscheduled absence—which could come back to bite you in the arse during your performance reviews. And now that you’re on management’s proverbial sh*t list you now run of the risk being snubbed, given “harder” assignments or a heavier load than others (and being left to flounder), or other forms of horizontal hostility—even possibly being passed over for promotions and perks.  

So now staff just come to work sick. If you’re sick enough according to managements’ standards (which may mean damn near dying) then they’ll have to send you home. And if management sends you home, you’ll avoid a write-up, be seen as a devoted staff member willing to “take one for the team” coming to work come hell or highwater—plus you’ll still get paid for the day/night. So staff now cover their @sses by putting the ball in managements’ court.

But at what cost? Not only are you not at your best (which can be a recipe for disaster in patient care), but it creates the potential for others to get whatever the hell cootie it is that YOU have! And oftentimes, for whatever reason (*hint, hint* staffing), management may not send you home! They may decide (with the plethora of licensed bodies in a hospital qualified to assess you) that you do in fact “look okay” to stay and work. Big. Fat. Fail. Now what?

This call-out taboo is even brainwashed into nursing students. To call out from clinical is to shoot yourself financially in the foot—students are sometimes threatened with having to personally pay the clinical instructor ($50/hr I have heard quoted) to come in on a non-scheduled clinical day to oversee your make up. As if. Or sometimes they’ll give you an ungodly amount of ridiculous busy work to do to make up the hours. And so students just come to clinical sick hoping they can just make it through the eight- (sometimes twelve-) hour shift. We are breeding the next generation of nurses with cover-your-ass-itis.

I was sick a few months ago. And I don’t get sick often, but I really felt like death warmed over. I went to my primary, who gave me a note stating that I needed to stay home (his exact words were “you shouldn’t be in anyone’s ICU like this”). I called the big cheese to let him know (and way before the two hours notice we’re required to give when we call out—I wanted to give him as much notice as possible to find someone else to come in).  I was told that even though I had a doctor’s note it would still be “an incident.” I stayed home anyway.

Would you???

For more insight on the subject, check out Terri Polick’s post, Presenteeism: Why Nurses Don’t Call Out Sick and @TorontoEmerg‘s How Hospitals Punish Nurses for Being Sick.

Posted in Health Care, Nursing, Pet Peeves and Rants | Tagged: , , , , , , | 7 Comments »

Do As I Say Not As I Do?

Posted by isntshelovlei on January 6, 2011

According to the CDC, almost thirty-four percent of adults in the U.S. are obese. Surely that figure includes some of our doctors and nurses. In the shift from “sick care” to “health care,” or a more preventative health care model, we should be seeing a lot more patient education. But as a patient, how do you think I am going to look at you when you sit me down for the weight loss speech: chastising my diet/eating habits, telling me I need to increase my physical activity…if your BMI is just as high if not higher than my own? Isn’t that like the pot calling the kettle black?

Then at higher risk for heart attack and stroke we have our smokers, and more than twenty percent of adults in America smoke. If I’m a cardiac patient and you’re doing my discharge teaching and telling me how much I really need to kick the stick yet anyone standing within three feet of you knows that’s not perfume you’re wearing but more like eau de cigarette…I mean really…no wonder so much patient education just goes in one ear and out the other.

I’m not saying that health care professionals need to be perfect—totally abstaining from all smoking, drinking, and drugs (I mean what would I do without my caffeine?), and only eating tree bark and berries, after all, we’re human too, but shouldn’t we be a little healthier—or at least striving to be? What exactly is our responsibility (if any) to our patients here? Are we obligated to set any kind of example? Most of us are willing to inject foreign substances into ourselves all in the name of our “duty” to our patients. It seems to me that losing a few pounds or quitting smoking is a lot less invasive…

When faced with health care decisions patients will oftentimes turn to the health care provider and ask “if it were you, what would YOU do?” That’s because we’re the “professionals,” we’re more familiar with the most up-to-date research, we’re supposed to know what’s best (or at least be able to make an evidenced-based recommendation). Patients tend to look at their HCP as sort of a health role model. But when we don’t seem to be making healthy lifestyle choices ourselves, do we lose our credibility as patient educators?

Maybe a little practicing what we preach is in order…

Posted in Health Care, Nursing | Tagged: , , , , , | 9 Comments »

Insights in Nursing Podcast, Episode 23

Posted by isntshelovlei on December 17, 2010

This week on Insights in Nursing the panelists delve into the Institute of Medicine’s report, The Future of Nursing: Leading Change, Advancing Health. Topics on the docket include the IOM’s recommendation to have eighty percent of the nursing workforce be BSN-prepared by 2020 as well as extending full provider status to advanced practice nurses—something that has seen much resistance by our physician-friends in the media recently. In addition to the nursing shortage there’s also a shortage of primary health care providers—APN’s are ready and able to fill that void. I’m not sure if the problem that (some) physicians have with this idea is because some still live in the ice age and believe that nurses are some type of subordinate health care professional that needs to work for not with doctors, or if they just don’t want us dipping in their honey pots… You be the judge.

Posted in Current Events, Nursing | Tagged: , , , , , , , , | 1 Comment »

Peds Wrap-Up

Posted by isntshelovlei on December 5, 2010

Although there were no sudden flashes of perception or insight, I was not visited by any wise men (or wise women—maybe in the form of Florence Nightingale?), nor did I experience any other surreal epiphanies causing me to exclaim “Eureka!” in the middle of doing a straight cath, pediatrics was definitely one of my better clinical experiences thus far.

So just a few things I’ve come away from this rotation with…

I now (to my children’s dismay) calculate safe dose ranges before I give my kids any medicine, even Tylenol. I’ve also gotten into the habit of calling drugs by their generic names and forget that I do so until I get a dumbfounded look from my husband after asking him to pass me the acetaminophen.

The fact that I have three children ranging in ages up to eleven has also helped me appreciate some of the more theoristic (is that a word?) stuff that you learn in pediatrics—which to be honest, up to this point has for the most part gone in one ear and out of the other. Take Erikson for instance. My four-year-old is definitely in the midst of the whole initiative vs. guilt stage. She doesn’t need you to tie her shoes, she can and wants to do it herself…and I have to force myself to let her—even if it takes five, or ten, whole minutes—for-one-shoe (oy vey). Same thing with the zippers and the buttons on the sweaters and jackets. Though if she could tear her attention away from NickJr. for a couple of minutes that might speed the process up a bit…

Even Freud wasn’t as out there as I’d originally thought he was. That Oedipus-Electra complex stuff may actually have a ring of truth to it. I don’t know about the penis envy and all that but my daughter is definitely a daddy’s girl and I am her number one competition. She makes sure to let me know that my husband is her daddy; don’t touch her daddy, etc. And she’s always talking all this “Mommy’s in the red, Daddy’s in the green” nonsense—what’s that all about? LOL.

This rotation I also felt more like a nurse and less like a PCA (no offense to my PCAs, but that’s not what I’m paying $500/credit to learn to be). This semester I got to do a lot more “real” nursing stuff and not just vital signs, AM care, and changing sheets (though I can miter like nobody’s business). Since the patient population we were working with consisted of mostly spinal cord injuries and scoliosis (i.e. post-op spinal fusion, veptr, halo, etc.), there were plenty of straight caths to go around (and to think I used to be scared to do those…), plus lots of IV meds, and pin care. Dealing with children and adolescents I got to practice my art of persuasion (or I guess in nursing it’s called “therapeutic communication”) to encourage them to meet their goals, where it was to increase their fluids or work on becoming more independent with their ADLs.

So all in all I think my pediatric rotation went pretty well. I also not only made benchmark on the peds HESI, but it was my highest scoring HESI exam to-date. 🙂

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Insights in Nursing Podcast, Episode 14

Posted by isntshelovlei on September 17, 2010

Yet again we have more doctors voicing their “concerns” about the apparently very intimidating “Doctor Nurses” (*enter scary music*). Le sigh. I plan to eventually pursue my DNP. Do I plan to have my patients address me as “Dr. IsntSheLovlei?”—absolutely not. I am however, likely to display my shiny new credentials on my letterhead, my lab coat that I’ll sling over the back of my chair (as if I would ever really wear one of those things), or perhaps even on a paperweight on my desk.

I honestly think some our doctor-friends are hiding behind this whole “you’re going to confuse the patients” excuse as to why they are so against nurses with doctorates. What is the problem really? Afraid of a little friendly competition? Think an increasing number of patients will be drawn (if they are not already) to the more holistic model of care that nurses provide? But it’s not like we’ll be taking food out of your mouths—there’s actually a shortage of primary care physicians. Advanced practice nurses are willing and more than capable of helping to fill that void. As far as confusing the patients—I think that patients are less concerned with the alphabet soup behind your name and more so with the excellent (or not so excellent) care that you provide. JMHO.

Check out our discussion of this topic and more on the latest episode of Insights in Nursing with Cora Vizcarra from the Infusion Nurse Blog, host Jamie Davis also of the Nursing Show and MedicCast, and of course—yours truly.

Posted in Nursing | Tagged: , , , , , , , | Leave a Comment »

Insights in Nursing Podcast, Episode 13

Posted by isntshelovlei on September 10, 2010

Has the whole autism-vaccine controversy finally been put to rest? With the internet and so much bad information (and bad publicity by pearly-teethed former Playboy playmates) so readily accessible to people nowadays, will fears now begin to subside? 

Colorado, will now not only be known for its rocky mountains, but for their rocky viewpoint as well (though I guess everyone’s entitled to their opinions…). Apparently, a group of anesthesiologists in Colorado have their panties all in a twist at the thought of nurses, not doctors, making “life-and-death medical decisions” for patients (the gall!!).  I’m not even a nurse yet, and I was personally offended. Can’t we all just get along?… Le sigh. 

And last, an Australian nursing school unveiled an awesome “Women Who Shaped Nursing” display for History Week. Truly a beautiful thing. I’m all about honoring those that paved the way. But what about our male nurses? What about the men who helped pave the way for the military to allow male nurses in the service?  James Derham, who worked as a nurse to buy his freedom? Most people don’t even know that Walt Whitman was a nurse—only that he was a writer and poet. There are many men in the history of nursing—but few people know anything about them because we only talk about the women in nursing. Check out our discussion of these topics and more on the latest episode of Insights in Nursing with Kim from the Emergiblog, host and jack of all trades Jamie Davis, and a scratchy-throat-catching-a-cold yours truly.

Posted in Current Events, Nursing | Tagged: , , , , , , , , | Leave a Comment »

I Don’t Know It All

Posted by isntshelovlei on September 6, 2010

Do you ever feel like you are treated a little differently because you’re a nursing student, nurse, or other health care professional? For example, are you provided with less patient education because people know that you work in health care and “assume” that you already know certain things? Or is patient education just not occuring as much as it should in general and we just notice it more because of our background?

For instance, one of my kids had a physical last week. Towards the end of the visit her doc mentioned that they had the flu vaccine (already?!?—it’s still like 100 degrees outside!) and that she should get it today. It was less of a question—she basically assumed that I would want my child to get the vaccine. And my silence I suppose, was implied consent. Why wouldn’t I you/she might ask? That is a post for another day…

Anyway, the physical is completed and the doc says as she leaves that the medical assistant will be in to give the vaccine. No “do you have any questions?” No “is she allergic to eggs?” Now I know that an egg allergy wasn’t documented in my kids’ EMR, but still it’s just a computer program—there are glitches and cooties and sometimes computers are just blatantly stupid. And there’s really no way that out of the hundreds of patients that she has she remembers my one little daughters’ allergies. I thought you were always supposed to (or maybe it’s just best/better practice) (re)confirm things like allergies at every encounter, especially when administering medications/vaccinations.  And don’t some people develop allergies over the years?—you’re not always born with them. I’m just saying… But I didn’t stop her from leaving since I did happen to be comfortable with my level of education regarding flu vaccines. Besides—sometimes I just like to sit back and watch these things play out. Personally, I know how to ask questions when I want to. I am more than capable of making my needs known—just ask any of the early intervention agencies in my areas (poor things). My point though, is that some parents/patients DON’T.  And that’s why we still have people that believe that vaccines cause autism. Information, good information, is power.

So the MA comes in with the vaccine, squirts it up my kids’ nose (it was LAIV/Flumist), gives me the information sheet (after the fact), gives my kid a sticker and goes on her merry way. Meanwhile, I’m wondering, who does the education around here? Shouldn’t they really give you those information sheets BEFORE they shoot your kid up with something? What if I look over the info sheet and suddenly realize “oh sh!t” my kid is pregnant (don’t act like that couldn’t happen in these days and times)…she shouldn’t get it?!? What if I couldn’t READ the damn thing at all (but then again I’m a nursing student I guess I should be able to read)? What if English wasn’t my first language? Maybe I’m over-reacting, my critical thinking (and often fastidious) student nurse wheels a’grinding… But then again, maybe I’m not.

Now I know that the person that administered my daughter’s flu vaccine was not a nurse but a medical assistant. And I know that patient education cannot be delegated to a UAP (unlicensed assistive personnel for those not fluent in healthcare/medicalese). But shouldn’t someone be doing the education? I just think that regardless of your background things like patient education should be part of every health care encounter even if it’s redundant (unless declined). I had a nursing professor that would say “well i’m not a cardiac nurse so I’m not familiar with xyz…” And she was a CRNP! But it wasn’t her specialty, so her knowledge base wasn’t as wide in that area. People shouldn’t assume that just because you’re a health care professional that you know (or even more importantly, understand) every nook and cranny.

So honestly I really don’t know for sure if my being a nursing student really was the reason why we received so little (if any) patient education. But it wouldn’t have been the first time. During a brief hospital visit of my own, it was frequently implied that they didn’t need to explain things to me because I was a nursing student. Key word in that sentence—”student.” But even when I become a full-fledged RN I will not know everything. Not to sound cliche but, “you never stop learning.”

If the nation is really going to try to shift from “sick care” to “health care” and focus on prevention, patient education will have to be a large part of that. Might as well start practicing now…

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