The Dog Ate My Care Plan…

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

Posts Tagged ‘Nursing’

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 »

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 »

Semester Roundup

Posted by isntshelovlei on July 26, 2011

Here I am back at my poor neglected blog with its splattering of unfinished posts. I just haven’t had the time or the energy this semester…

So here’s my summer semester roundup!

This summer I took Public Health Nursing (also known as “Public HELLth” if you follow me on twitter) and the Art of Listening—I know, WTF right? But I needed one last elective that had to be an art (already had credit), language (only offered the same night as Public Health), literature (too much reading/writing), history (same), or music. So Art of Listening it was. And it was offered online which saved me another night of trekking to campus.

I actually thought I might enjoy a slight break from nursing topics. How bad could it be with no meds, no care plans, and no NCLEX practice questions? Bad enough apparently. Besides the fact that the class was all over the place the topic just didn’t hold my interest—I developed some serious ADHD trying to get all my reading and forum posts done by all of the crazy deadlines.

And then there was Public HELLth. O. M. G. To her credit I will say the professor tried to keep it interesting: breaking up the lectures with videos, tossing frisbees with communicable diseases taped on them around the classroom, and other theatrical stunts—it just didn’t work. She did give out candy at the beginning of class which was nice—especially if there were pink Starbursts (my fave). But eventually, I just stopped going if there wasn’t an exam/quiz or if we didn’t have something due that day. I found her lectures distracting and understood things a lot better when I just read and studied on my own. I’m not trying to corrupt anyone else, that’s just what happened to work for me, for this particular semester. On the other hand, the instructor I have this upcoming fall I’ve had before and I wouldn’t dare miss one of her classes—her lectures are like GOLD.

I also managed to squeeze in a second peds clinical rotation this semester (we usually only have one) and worked as an Asthma Educator in a peds clinic. And man was there some educating to do! From parents giving their kids their maintenance inhaler when they should have been using their rescue inhaler (and wondering why it wasn’t working) to the parents who just didn’t see the point of giving the maintenance inhaler every day when their kid wasn’t currently having any difficulty breathing—and so they didn’t (le sigh). No wonder there are so many uncontrolled pediatric asthmatics and asthma is the #1 admitting diagnosis in our local children’s hospital. Sheesh.

But that’s all over. Now I get a month off to rest my fragile mind (and get some sand between my toes) before heading back into the flames for the grand finale. That’s right—final semester coming up! I can hardly contain my excitement. Until then…

Peace, love, and coffee…

~IsntSheLovlei

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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.

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

Life of a Bee

Posted by isntshelovlei on January 30, 2011

Image Credit: http://glitterista.blogspot.com

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…

Posted in Nursing school | Tagged: , , , , , | 1 Comment »

Pretty Please

Posted by isntshelovlei on October 28, 2010

Although peds and psych lectures both started back in August, the clinicals were broken up so that we did one at a time (I had psych clinical first). New rotations are usually preceded by a “clinical immersion” (think one-day clinical crash course); we just had one for peds this past Sunday.  But this weekend is the real deal—we’ll be starting another round of 12-hour shifts at our assigned hospitals, 630am to 630pm. Oy vey.

Most people know that I plan to specialize in pediatric nursing in one way shape or form after it’s all said and done—whether it’s pediatric intensive care, oncology, or maybe even palliative care. So since I began this journey over a year ago (wow, has it really been that long?), I have been looking forward to peds—I absolutely couldn’t wait to get here. This will be my sixth clinical rotation. I have fought my way through fundamentals, health assessment, maternity/OB, med-surg, and mental health to get to this point. After all of the running out the door at the butt crack of dawn with one eye open and mix-matched socks on, the Nurse Nastys and the Cindy Lou Whos, the stress and the hair loss I’ve had to endure to get this far, and even though I’ve been less than pleased with lecture portion of peds (and that exam last night was KIL-LER), I am praying that my peds clinical experience is all that I’ve hoped it would be.

So with that said…

I’m goin in, I’m goin in, I’m goin in, I’m goin in… (in my Lil Wayne voice)…

Posted in Nursing school | Tagged: , , , , | 2 Comments »

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.

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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…

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

Ape to Man

Posted by isntshelovlei on August 28, 2010

My books arrived from Amazon.com yesterday. Now I’m starting to get the pre-semester jitters. I already felt like I was hanging on by a thread this past summer—I was (am?) beyond burnt out. But I know I need to start taking better care of ME and just push through it. 

It’s also a little disturbing to see how much our cohort has dwindled over these past three semesters. We started out with two classes of about 35 students each. We lost a couple here and there for various reasons, but after pharmacology this summer we’re down to about 40 students—TOTAL. The two sections of our cohort have now been combined into one class. With 4 more semesters to go, it kind of makes you wonder if that person sitting next to you now will walk with you at commencment.  Nursing school really is survival of the fittest.

Though class doesn’t officially start until Monday, I was glad to see that our professor (well one of them anyway) posted the syllabus and the powerpoints on Blackboard early. I like to (try to) read the chapters before the actual lecture so I can halfway know what’s going on. It’s hard to sit still for three hours when you have no clue what the instructor is talking about. But when you don’t get the syllabus until the first day of class you’re already behind in the reading.

So back to the books it is. As Erykah Badu says, “They sleep. We grind.”

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

Insights in Nursing Podcast, Episode 11

Posted by isntshelovlei on August 27, 2010

Can you believe that a patient who’d just had a C-section two days prior was actually asked to “tidy up” her hospital room before she was discharged? One of the midwifes (allegedly) described the task as “those bits that we don’t have time for.” Wow. Just wow. Maybe that equal access, government-funded health care isn’t all it’s cracked up to be… And what about nurses with doctorates??—Are they doctors? Are they nurses? What do we call them? Paging Dr. Nurse? Check out these topics and more on the latest episode of Insights in Nursing with Kim from the Emergiblog, Terri over at Nurse Ratched’s Place, host and jack of all trades Jamie Davis, and yours truly.

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