The Dog Ate My Care Plan…

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

Mind Your Bedside Manners

Posted by isntshelovlei on April 9, 2011

Today was the last day of clinical for the semester—hallelujah. No offense, but I was CICU’d out. I felt like I had the same patient everyday—afib, CHF, afib, MI, afib…

My clinical instructor assigned us two patients as usual (the nurses on that floor only have three themselves). I’d been working with the same nurse for the past couple weeks so I came in and let her know which two of her three patients I’d been assigned to. She automatically said, “Oh no, I don’t want you to have 47.” I assumed the patient was a “difficult” one (which usually meant interpersonally challenged) so I didn’t resist or even blink—it was the last day and besides that guy had about three pages of meds anyway. The nurse said he was just really mean and she didn’t want me to have to deal with that all day. Trust and believe, I’ve already been called my share of four- and five-letter words by patients so it really didn’t make any difference to me. But they ended up giving me her other patient—who ALSO had three pages of meds (cringe)! But hey, such is life…

So I’m going about my merry day, and “47” needed a bladder scan so the nurse ask me if I had ever done one (no) and if I wanted to watch (sure). We go in and she starts doing the scan—the guy’s condom cath was bone dry but he had about 650 mL being held hostage in the confines of his bladder. She told/reminded him that he’d had two accidents yesterday and that she needed him to ring the call bell when he needed to go. He rolled his eyes and told her he had been ringing the call bell, but “they” take too long to come (which sadly, I could believe). She kinda laughs and replies “Well, we’re busy.” Love her to death, but I didn’t think that was the most therapeutic response she could have given him but I kept a straight face. “47” asked her for some ginger ale and ice. While she finished up with his urine and left, I went to the pantry. I came back with a cup of ice and a diet ginger ale—he told me it was too much ice. So I said okay and went and dumped some in the sink—”how about now?” He said it was fine. I needed to raise his head of bed but knew that would cause him discomfort so I told him I would go slow and for him to tell me when to stop. “Is that too much?” I asked. I had to keep asking him to repeat himself because he didn’t talk very loud and I didn’t understand what he was saying. Meanwhile, the housekeeping guy was in there cleaning the room and I could feel him watching me—I guess he was waiting for me to lose my patience as I went back and forth with the patient nitpicking over this and that. I cracked open the can and poured the ginger ale over the ice and handed “47” the cup. He sipped. “What’s your origin?” he asked. Again, I wasn’t sure what he’d said and asked him to repeat it for me. “Where are you from?” I assumed he was asking about my nationality so told him I was from “here”—that I was born in Florida. “You speak so soft. But these nurses, they yell at me.” “I do ring the bell,” he continued, “but they don’t come for 15, 20 minutes sometimes. It’s too long.” I nodded, and apologized for his experience. He continued to talk, telling me how he had 2000 people working under him and how he had never been spoken to the way he has been spoken to in the hospital. He told me about how his brother was taking over the family business now that he was sick. I stayed and listened to his story. His nurse came in and asked if I was okay—I’m sure she was wondering why I was still in there. I said that I was. Clearly he wanted someone to listen, and I had the time. Usually I have all of my assessments and morning meds done by 9:30am anyway.

But I didn’t see the “mean” patient everyone else saw (and therefore wanted nothing to do with). The man was sick. And he was in pain. And he had been retaining almost 700 mLs of urine before being straight-cathed—you’d be a little irritable yourself. But all it took was for someone to listen, to give him a few extra minutes of attention, for him to mellow out. I realize that nursing staffing levels (and the insane amount of documentation) oftentimes makes it difficult for nurses to spend more time at the bedside, but this is something we need to work on—it can really make a difference in the quality of patient care. For a little food for thought, head on over to NurseTogether and check out Sue Heacocks’ article, Bedside Manners 101.

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Test Tactics

Posted by isntshelovlei on March 31, 2011

So I think I offended some with my tweet about people who study up until the second the scantron hits their desks.

My bad.

It’s just part of my own personal test-taking philosophy I’ve acquired over the years. It consists of three things:

1) I don’t overstudy. I read what I’m supposed to read; I listen to my recorded lectures; and I review my powerpoints and notes. But I gave up some of my more neurotic studying habits. I no longer strategically position my notes on the steering wheel on the way to class so that I can take a glimpse or two at every red light or stop sign. And though I do review the morning/afternoon of the exam I don’t try to cram in the last few minutes while the scantrons are going out. What for? Whatever I don’t know at that point I’m not going to learn in the five minutes before the exam starts. At that point I’ve turned on my “it is what it is” switch. Woo-sah. And to be honest my grades have been better since I stopped driving myself into the ground. I’m more relaxed and I no longer stress-eat on test days. When you overstudy, if you don’t go in there and suffer a total brain fart (which sucks after all that extra effort), you’re overthinking the questions and second guessing yourself—all because you psyched yourself out. And so I don’t (anymore). There’s a lot of information to learn in nursing school and you do need to study. But you don’t need to overdo it.

2) I don’t sit and stare at test questions if I don’t know the answer. What for? The answer is not going to jump off the page waving its arms at you. Pick one and keep it moving. Narrow them down (with multiple choice there’s usually two you can toss out right off the top anyway) and eeny, meeny, miny, moe the rest if you have to. Though on a rare occasion if I’m really torn between two answers I will skip a question and come back to it—you just have to be very careful that you also skip it on the scantron sheet or that can lead to a whole other mess…

3) I never erase. Go with your gut. Usually when you change an answer, you had it right the first time.

I guess it also helps that I happen to be a good test taker. The Kaplan review course for instance that many people like to take before they take their boards (it’s actually required for my program) is actually less about content review and more about how to be a better test taker. It’s all about strategies for breaking down the questions and recognizing traps. I’ve already got that down. To be perfectly honest, I don’t even read the whole question most of the time (which is why it only takes me about 30 seconds per question when we’re allotted a minute and a half for each). Usually, half of the question is superfluous information you don’t need and was thrown in there to confuse you. I choose not be be distracted by the distractors. This is not to say I’m just guessing answers and getting lucky. You do need to have a solid knowledge base to be able to recognize trigger words/phrases and weed out the riff-raff. But hey, this is just what works for me. Different strokes for different folks…

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Are You Ready to Save a Life?

Posted by isntshelovlei on March 15, 2011

As health care professionals and students we have all taken a CPR certification course. Every one to two years we have to take a renewal course.

But is it just something you do because you have to—to meet a job or maybe your clinical requirements? When and if the time came, would you be willing (and able) to use what you’ve learned?

Personally, I keep my pocket mask and even my course book in the glove compartment of my car—do you know where yours are? You never know when you might need them and my mind often flickers to the fact that they are there when I pass accident scenes during my comings and goings. Thankfully, I have never had to use that mask though I do remember once having to perform the Heimlich Maneuver on my own infant because some brilliant fool decided to give her a piece of hard candy. I don’t know if it was the years of CPR training or my mother’s instinct, but I acted automatically. Her color changed and she couldn’t get any air in, and couldn’t cough. I flipped her around almost reflexively on my forearm, head down over my thigh, gave her four blows to the back and out came that offending piece of confection. I then proceeded to annihilate the brilliant fool…

I am glad that has been the extent of my calls to duty and that I have not had to perform actual CPR. But have you ever really thought about what you’d do? When people ask on television shows “Is there a doctor in the house?” I always think that there are more than just those that raise their hand. These days people seem to not want to get involved for various reasons—like getting sued or even not being confident in their own skills…

Will you help that person choking while you’re out at a romantic dinner with your partner? What about your neighbor that collapses from cardiac arrest while shoveling snow? What if you found your own child face down in the swimming pool? Anyone can carry a card in their wallet, but when it really matters will you make it count?

I hope that I never have to use what I learn in those CPR courses, but I know that if need be, I’m ready and I will. But the fact of the matter is someone in the United States suffers from a cardiac arrest every two minutes, so you really never know when YOU may be the one called into action. Are you ready to save a life?

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Cabbage Anyone?

Posted by isntshelovlei on February 27, 2011 if there weren’t enough lingo, medical jargon, and unapproved abbreviations…enters “cabbage.” The first time I heard the expression was in Nursing Research. It really didn’t register at first as I usually tune 3/4 of that three-hour lecture out anyway (don’t even get me started on that class). The second time was probably in post conference (we’re in the CICU this rotation). “Patient had a ‘cabbage’ times two…” This time my antenna went up—patient had a what?!? But there’s a silent rule among nursing students in post conference—short, sweet answers only and don’t ask a lot of questions so we can get the hell out of there. If you really need to talk or ask the clinical instructor something stay afterwards and do it on your own time. So I kept my puzzlement to myself for the time being, “just smile and nod” as they say. It wasn’t until I was catching up on my reading for the week (we just so happened to be doing cardiac) that I had an epiphany.

Come to find out, “cabbage” is “short” for CABG, or coronary artery bypass graft. Well color me unimpressed. It’s not even a true acronym. CABG is actually an initialism; those four letters do not in fact form a word just because someone decided to pronounce them like one. 

I’ll get off my English lesson soapbox now…

But next thing you know we’ll be calling amyotrophic lateral sclerosis (ALS) “Alice” or saying patients with chronic myelocytic leukemia (CML) have “Camel”—I wonder with one hump or two?…

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Senior Jitters?

Posted by isntshelovlei on February 8, 2011 it’s a great clinical rotation, the CICU makes me nervous. Just their 10-page daily flow sheet alone was a rude awakening to how much stuff I still don’t know and how little time I have left to learn it all. So as we edge towards another clinical weekend, I can already feel my anxiety starting to build… 

Part of the problem is I feel like we do a lot of stuffing and dumping every semester—we focus on and study what we need to know for that particular class and then that knowledge gets neatly tucked away in some obscure corner (hopefully of the mind and not of a bookshelf). For instance, I took maternity/OB last spring and at this particular moment it totally escapes me what the hell BUBBLEHEP stands for. Breasts, uterus….oh forget it. L&D is the last place I want to work anyway. I also often get frustrated if I don’t remember the brand name/generic/class/action/or indication for one of the gillions of meds I know we’ve already covered. It’s just a lot information. As it has been said before, nursing school is like trying to stuff 10 lbs of information into a 5 lb bag. Ten pounds of constantly changing information at that. Nursing is one of those fields where you truly never stop learning. There are always new meds, new equipment, new best practices… To all of those that have come before me—how the hell do you retain it all?!?

So as you can probably tell I’m becoming a bit unraveled. I know most of it is just the nerves, the stress, and the sleep deprivation weighing me down like the itis after Sunday dinner at Big Momma’s house, but it’s definitely times like this that I wish I wasn’t a nontraditional student. Those fresh-outta-high-school-no-kids-no-mortgage-no-car-note-don’t-gotta-work-cause-mom-and-dad-footing-the-bill students just don’t realize how good they’ve got it. What I wouldn’t give to be able to just focus on studying.

But that’s not my reality. So I gotta buckle down and push through…I’ve come too far to crap out now.

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Life of a Bee

Posted by isntshelovlei on January 30, 2011

Image Credit:

So in case you couldn’t tell from the abrupt cessation of posts—spring classes have commenced. I’m already back on autopilot, buzzing from here to there, doing what I do. This semester is Med-Surg II (Chronic) and Nursing Research. Med-surg is a handful—all of the pathophys makes it very “science-y”…gives me A&P flashbacks. But I do appreciate that we get to use the same mammoth textbook for all three of our med-surg courses—that will definitely save me a few ducats. I also really like our professor. She moves really fast, but she’s thorough and will stop to explain things again or a little more in depth if you ask her to (we’ve come a long way from the default response to every question being “it’s in the book”). Nursing research on the other hand, the professor of which is a self-proclaimed “cynic by nature,” is thus far…you know what, I’m not even going to go there. Let’s just say it’s not my favorite subject and leave it at that. I guess I’m a doer, and there’s just no doing in that class. No interventions to learn, no pathophys to navigate through, just reading, and writing. And about what? It’s PAIN-FUL.

On the bright side I landed a really good clinical placement this semester—top hospital, magnet status, and no Nurse Nastys (knock on wood)!! I’m on a cardiac intermediate care unit (I had been dreading the possibility of another ortho unit) so the learning opportunities are endless. Last week I would have thought a VT Storm was a model of a sports car. We had orientation yesterday and today was our first day on the floor and it went pretty smoothly. 

But two weeks into the semester and I am already beyond tired (some of you may have noticed my sleep deprived tweets). The other day at work instead of answering the phone “Department X, IsntSheLovlei speaking” I almost said “Nursing Research, IsntSheLovlei speaking.” Talk about having school on the brain.

But I’m almost there (so they tell me), and just trying to keep it together. 319 more days of nursing school on the wall, 319 days of nursing school, take one down and pass it around…

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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…

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Selected Shorts: The New Girl

Posted by isntshelovlei on January 4, 2011

One day early in my orientation I was answering all of the fifty phones that were ringing because we were playing the lets-train-the-new-girl-by-making-her-do-all-the-work-while-we-facebook-it-up game. I answer phones the way I would think anyone would, not only at a hospital, but at any place of business—in a pleasant voice, providing my name and the name of the department that the caller has reached. So one particular call happens to be a semi-personal call for another staff member. I asked the caller if he could hold a moment and went to retrieve the staff member. When she picks up the phone the caller asked her who I was, as I sounded “professional.” She responded with a chuckle, “Oh that’s IsntSheLovlei, she’s new…” as if my absurd and apparently unexpected behavior warranted some type of explanation!

My bad. I guess after you get past the interview and are comfortably on the payroll (and in the union), some people feel like they can drop the charade (I mean who’s not on their best behavior during an interview?). Maybe they would have preferred that I’d answered, “Yo yo yo…wassup?!?”

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Carpe Diem!

Posted by isntshelovlei on January 1, 2011

So what’s it gonna be this year? Lose weight…quit smoking…go back to school…fix your credit? Every year many people go through this ritualistic task of making up a list of new year’s resolutions, only to toss them to the wind by the second or third week of January. Then they wait until next year to try again. What ever happened to Aaliyah’s motto: “dust yourself off and try again?” And I mean, right now, not three hundred and some-odd days from now…

I’ve been working on taking better care of myself. That larger goal is made up of many smaller ones (sort of like a care plan) such as getting more sleep, taking my vitamins, and learning to say “no” when I’m overextended. That last one is a lot easier said than done. I am so many things to so many people—mother, wife, sister, friend—that I myself get lost in the sauce sometimes. Add school and work into the mix and you can have a recipe for disaster. But what can I say, I’m a work in progress…

But why do we need to wait for a new year to make these self improvements? Every day, every hour, every minute, every second, is a new opportunity to do or be better. Live in the moment. Carpe diem—seize the day!

“In today already walks tomorrow.” ~Friedrich von Schiller

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The Graveyard

Posted by isntshelovlei on December 22, 2010

Armed with Starbucks and diet Mountain Dew (please no caffeine-after-dark lectures—I was a caffeine junkie when I worked days and this is now my day so I’m just adjusting my addiction accordingly), I’ve now joined the ranks of those that work night shift. The first day I was cool—I was wide awake all night just sipping away on my Mountain Dew (while other people  managed to sleep sitting straight up). I drove home the next morning still on a MD high, and couldn’t get myself to sleep. I called my husband to let him know that I survived the night and by his amused tone I knew I must have been rambling like a raving manic.  I have since tweaked my nightly regimen to cut off caffeine at around 4-5am so that I am able to simmer down when I get home.

The second night (which happened to be a week or so later) didn’t go as well. First, I didn’t get a (good) pre-nap in. The kids just wouldn’t let me be—they were running around like park apes, excited about finding our escape artist cat who came home looking all mangled (and probably pregnant my husband insists). Second, I had a headache that was on the verge of escalating to migraine status. And third, I was bored to tears (knock on wood). Some things take other people hours to do, but I like to knock them out and get them over with. Then I end up sitting there twiddling my thumbs and clock-watching (which really makes the time go even slower). And with the semester being over I had no homework or care plans to do, and no tests to study for.

Cheese. On. Bread.

When I finally went on break at about 4am, to my dismay McDonald’s had already started serving breakfast and I was craving salt (in the form of fries not some processed sausage patty). They’d also run out of fruit and yogurt parfaits which are about the only two things I’ll eat out of that place (sorry Ronald). And of course I had forgotten my “lunch”—if you can even call it that when it’s consumed at 4am. So I bought an orange juice which I figured was safe and settled down to play a few rounds of Angry Birds and Cut The Rope before going back to the unit.

And is it just me or is it extra cold in the hospital at night? Snuggie anyone?…

But things have gotten better; I’m adjusting. Even though I sleep when I get home in the morning it’s important for me to get that pre-work nap in—it really does make a world of difference. Any other night-shifters with suggestions feel free to drop me a line.

Meanwhile, I am loving winter break. I’ll be back to the wonderful world of nursing school on January 19th.

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