With my orientation coming to an end, the time has come for me to learn the role of the "scrub nurse" during a cesarean section. From the beginning, this has been the one aspect of my job that I dreaded learning. Why? Mostly because of the high stress environment that cesareans usually are - especially on night shift, where I am. Usually the operation is being performed as an emergent resolution and everyone is under a lot of stress - compile that with any little extra thing and people - yes, specifically doctors - tend to lash out at the closest thing/person to them: THE SCRUB NURSE.
What a silly reason to not want to learn another skill that can only make me more valuable as a L&D nurse... But, it's the truth. And, I've seen more than one instrument being "tossed not so gently" at a scrub nurse and heard more than one "not so nice" word being yelled at them too.
I've gotten some advice from a nurse I've come to admire... She said she actually likes to scrub and I confided in her my fear of being yelled at and having things taken out on me with no room for error... She said she doesn't let it get to her and never takes it personally. She said that if the doctor cannot even hold it together to do an operation - which is his job, then it is the doctor's problem, not hers. The instruments are lying right there within both her and the doctor's reach, so if she accidentally hands him a straight mayo instead of a curved mayo, and he's in such a rush to have the correct one, then he is perfectly capable of reaching over and grabbing the right mayo, for goodness sakes.
So, last week was my learning week.... I scrubbed in on some - yet didn't do the scrub nurse job yet... I start that this week - Tomorrow AM I have two sections to scrub in for....
What are the roles of the scrub nurse? We are responsible for the sterile field. We set up the sterile instrument tables and drape the patient.... If anyone breeches the sterile field, they hear about it from us.... We then proceed to assist the Dr and his assistant by handing them instruments, suctioning or blotting blood with a sponge from the field to improve the surgeon's vision of the field. During repair, we load needle holders with the appropriate sutures (chromic, vicryl, etc.) according to what layer the Dr. is repairing. For example, the uterus takes a different type of suture than does the peritoneum...and the peritoneum takes a different type than the bladder flap, etc. We may help establish homeostasis by assisting with cauterization of bleeders. The scrub nurse also takes part in the instrument count before, during and after surgery to ensure nothing was "left behind."
So, all in all it is not a hard job, but like I said, the scub nurse must hold it together under pressure, know her instruments and not take lashing out behavior personally.... I'll work on it. Thankfully, the vast majority of sections I've attended the doctor's behaved themselves just fine.... It just so happens that the few times I've seen Dr.s lose their cool it was during a section -- Directed at scrub nurses....
Sunday, December 28, 2008
Wednesday, December 17, 2008
Sweet Dream
This is a totally random post... It has nothing at all to do with nursing, childbirth or my family...
Last night I had a dream that was just out of the blue and funny...
I was at the karate studio with the kids... Only Lance wasn't there - Isaac and Madeline were in Karate instead of Isaac and Lance.
Anyway, I was watching Isaac's class do their forms and I saw someone new in the class: Bon Jovi. He was right there beside Isaac doing Karate Forms.. and he was doing them very well, I must add. Funny thing, though, nobody else seemed to recognize him or even realize he was there. So, I got out my video camera and started recording Isaac and Bon Jovi doing karate forms together.
After they were done with forms I pulled the instructor over and showed him the video tape I had taken. Then, everyone was like, "WOW! Bon Jovi is here doing Karate with us!"
So, then everybody was going up to him with their Karate Tickets (why they had tickets to get into karate class I don't know).... They were asking him to sign their tickets. So, I thought that was a good idea.... Only when I reached into my purse to get out the kids' karate tickets I realized to my horror that I was wearing my white, paper surgery hat I have to wear into the Operating room during C-Sections..... And then I couldn't decide which was worse, going up to Bon Jovi for an autograph WITH the puffy white hat on or WITHOUT it on - because once that hat goes on your head there is NO saving your hair afterwards!!
I decided to take the hat off and to my surprise my hair was just lovely... So Madeline and I went up to Bon Jovi and had him sign our karate ticket.
Funny, Huh? :)
Last night I had a dream that was just out of the blue and funny...
I was at the karate studio with the kids... Only Lance wasn't there - Isaac and Madeline were in Karate instead of Isaac and Lance.
Anyway, I was watching Isaac's class do their forms and I saw someone new in the class: Bon Jovi. He was right there beside Isaac doing Karate Forms.. and he was doing them very well, I must add. Funny thing, though, nobody else seemed to recognize him or even realize he was there. So, I got out my video camera and started recording Isaac and Bon Jovi doing karate forms together.
After they were done with forms I pulled the instructor over and showed him the video tape I had taken. Then, everyone was like, "WOW! Bon Jovi is here doing Karate with us!"
So, then everybody was going up to him with their Karate Tickets (why they had tickets to get into karate class I don't know).... They were asking him to sign their tickets. So, I thought that was a good idea.... Only when I reached into my purse to get out the kids' karate tickets I realized to my horror that I was wearing my white, paper surgery hat I have to wear into the Operating room during C-Sections..... And then I couldn't decide which was worse, going up to Bon Jovi for an autograph WITH the puffy white hat on or WITHOUT it on - because once that hat goes on your head there is NO saving your hair afterwards!!
I decided to take the hat off and to my surprise my hair was just lovely... So Madeline and I went up to Bon Jovi and had him sign our karate ticket.
Funny, Huh? :)
Sunday, December 14, 2008
Courses
Procrastination over - and with the help of my tech savvy hubby, I finished my power point presentation and am now done with the Fall 2008 semester and Nursing Informatics, thank goodness.
I'm doing the accelerated RN to BS program that is new to PSU this year. It provides an opportunity for an Associate degree nurse to complete all requirements for her baccalaureate degree in one calendar year. The program makes it possible by making courses run only 7 weeks in length and stacking them all on one day of the week, so an already employed nurse needs only to take one day off a week to attend classes. So, I'm on track to graduate in August with a BSN. We'll see how it goes, but right now I'm scheduled for 11 credits in the Spring, all classes on Tuesdays.
I'm scheduled for:
Nurs 200W: Nursing Research, writing intensive. The study of the methods and philosophy of empirical inquiry as applied to research in nursing (Yes, Caressa, I'll be calling you for help with proof-reading my papers - Get the red pens ready!).
Nurs 417: Family & Community Health Concepts. Study of the concepts of family and community based nursing care emphasizing multicultural influences on health practices. This course includes 40 hours of clinical practice.
Nurs 351: Health Assessment. Goals for the course include: Identify psychosocial, cultural and developmental factors affecting the health assessment process; utilize appropriate communication and interviewing techniques to facilitate the health assessment; gather health history and current health status in a thorough and systematic manner, document the health history and current health status, and the physical exam according to the accepted standards, utilize inspection, palpation, percussion, and auscultation effectively, recognize normal parameters of the health assessment, demonstrate competency in performing the physical examination; and demonstrate critical thinking in the analysis of physical findings.
Kinesiology 013: CPR, First Aid and Personal Safety. This is truly a "Fluff" course. It is only one credit. I took it because I was lacking one "GHA" credit towards graduation... There are very few one credit GHA courses to pick from. I'm already CPR certified.... But, I need one GHA credit... And, it is only 2 days long... So, no biggie... I'll take it. Whatever.
Onward & Upward.
I'm doing the accelerated RN to BS program that is new to PSU this year. It provides an opportunity for an Associate degree nurse to complete all requirements for her baccalaureate degree in one calendar year. The program makes it possible by making courses run only 7 weeks in length and stacking them all on one day of the week, so an already employed nurse needs only to take one day off a week to attend classes. So, I'm on track to graduate in August with a BSN. We'll see how it goes, but right now I'm scheduled for 11 credits in the Spring, all classes on Tuesdays.
I'm scheduled for:
Nurs 200W: Nursing Research, writing intensive. The study of the methods and philosophy of empirical inquiry as applied to research in nursing (Yes, Caressa, I'll be calling you for help with proof-reading my papers - Get the red pens ready!).
Nurs 417: Family & Community Health Concepts. Study of the concepts of family and community based nursing care emphasizing multicultural influences on health practices. This course includes 40 hours of clinical practice.
Nurs 351: Health Assessment. Goals for the course include: Identify psychosocial, cultural and developmental factors affecting the health assessment process; utilize appropriate communication and interviewing techniques to facilitate the health assessment; gather health history and current health status in a thorough and systematic manner, document the health history and current health status, and the physical exam according to the accepted standards, utilize inspection, palpation, percussion, and auscultation effectively, recognize normal parameters of the health assessment, demonstrate competency in performing the physical examination; and demonstrate critical thinking in the analysis of physical findings.
Kinesiology 013: CPR, First Aid and Personal Safety. This is truly a "Fluff" course. It is only one credit. I took it because I was lacking one "GHA" credit towards graduation... There are very few one credit GHA courses to pick from. I'm already CPR certified.... But, I need one GHA credit... And, it is only 2 days long... So, no biggie... I'll take it. Whatever.
Onward & Upward.
MRSA in Nurseries
Tomorrow is the last day of classes for the semester. I only took 2 classes this semester. Nurs 390 during the 1st 7 weeks; Nurs 457 during the last seven. Currently, I'm procrastinating - I have to finish up my last project of the semester: a power point presentation on "Electronic Health Records and Their Impact on Nursing Informatics." BORING. But necessary, I suppose.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
As an nod to Nurs 390 and in an effort to procrastinate even more, I'll share one of the papers I wrote this semester here..... Enjoy.
Prevention of Methicillin-resistant Staphylococcus aureus (MRSA) in Neonatal Nurseries
The presence of Methicillin-resistant Staphylococcus aureus (MRSA) in the hospital setting and medical research has increased dramatically and is steadily growing from less than 5% in 1976 to 40% in 1999 (Chambers, 2001). Additionally, 25% to 50% of the general population is a carrier of MRSA. And, young children, who can become colonized shortly after birth, have a higher rate of colonization than do adults (Chambers, 2001). These facts, along with recent outbreaks of MRSA in well-baby neonatal nurseries across the country, make the strictly enforced use of standard precautions imperative as a mainstay for the successful prevention of new cases in the vulnerable infant population.
Standard precautions are used as a minimal acceptable practice on all patients in the healthcare environment. These are basic precautions used to safeguard healthcare providers and their patients alike from infections and cross-contamination. Along with other protective measures such as wearing gloves and gowns when indicated, standard precautions include the practice of performing hand hygiene before and after patient contact, and disinfecting shared patient equipment between each use (CDC, 2006). These measures have been established by the Center for Disease Control and Prevention and are universally accepted as good and safe practices that are effective at limiting the spread of pathogens (CDC, 2006).
However, healthcare providers, including nurses and physicians, frequently fail to adhere to these guidelines when performing patient care activities. Reasons given by delinquent providers for non-adherence include a heavy workload leading to time limitations, forgetfulness, unavailable equipment and false beliefs such as the belief that the patient did not pose a risk or the belief that their co-workers also were not following standard precautions (Ferguson, Waitzkin, Beekman, & Doebbeling, 2004).
These excuses given by healthcare providers for not following standard precautions represent flawed logic and contribute to cross-contamination and subsequent increasing rates of MRSA and other infectious diseases in our hospital settings. If a healthcare provider is non-adherent and fails to sanitize their hand or their equipment between patients for any reason they are increasing the chance of cross-contamination which could lead to susceptible patients becoming infected with MRSA. Consequently the patients’ hospital stay, costs and mortality are accordingly increased as well (CDC, 2006).
The infant patient population is uniquely susceptible to MRSA infections because of their immature immune systems, close contact with other patients in the night nursery and routine skin integrity breaks from circumcision, as addressed below. Therefore, I believe there needs to be 100% compliance by neonatal nurses with the guidelines set forth by the CDC to prevent the spread of MRSA, regardless of convenience to the healthcare provider or patient. Additionally, I believe there are other unique interventions that are outlined that neonatal nurses need to implement in order to protect their unique patient population.
According to research it is of importance to note that the solution used during newborn baths and hand-washing influences the effectiveness of the disinfection obtained. Bacti-stat (0.3% triclosan) has been proven to eradicate MRSA outbreaks in well-baby nurseries (Zafer, Reese & Mennonna, 1995). Therefore, some hospitals are in the routine, prophylactic practice of giving a baby a bath with bacti-stat on two occasions: at birth and before discharge in order to reduce the likelihood that the infant will contract and take home any infectious disease like MRSA.
Another unique contributing factor to newborn MRSA infections is the circumcision procedure which occurs during this period of hospitalization. Any break in skin integrity along with recent surgical procedures, which circumcision is, increases a patient’s likelihood of contracting MRSA (CDC, 2006). Accordingly, as Van Howe points out, when there is an outbreak of neonatal MRSA, male infants are disproportionately infected (2007). In fact, one study directly linked circumcision and the related lidocaine injections with neonatal MRSA. Additionally, the same study stated that the moist post-circumcision site is particularly susceptible to microorganism growth (Nguyen, Bancroft, Guevara & Yasuda, 2007).
With this knowledge a neonatal nurse can intervene in practical ways to decrease a circumcised male’s incident of contracting MRSA. Initially, good hand hygiene should be preformed prior to, during and after circumcision while providing circumcision care. Next, all surgical circumcision equipment should be kept covered until time for it to be used (Nguyen, et al, 2007). Finally, multiple use lidocaine vials should be eliminated as they have been linked to contamination and subsequent MRSA infections (Nguyen, et al, 2007).
In conclusion, because in most cases well women come to the hospital and deliver well infants, it is especially urgent for the obstetrical staff to do everything possible to limit iatrogenic infections such as MRSA. This can be accomplished with strict adherence to standard precautions, especially in the common well-nursery, initiation of bacti-stat solution for newborn baths, and sanitary circumcision procedures including the elimination of multi-dose lidocaine vials. The implications of these prophylactic procedures would be providing the best evidenced-based practice currently available in order to achieve exceptional quality, safety and service.
References:
Center of Disease Control and Prevention. (2006). Management of multidrug resistant organisms in healthcare settings, 2006. Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/dhqp/pdf/ar/MDROGuideline2006.pdf
Chambers HF. (2001). The Changing Epidemiology of Staphylococcus aureus? Emerging Infectious Disease, Mar-Apr; 7(2). Retrieved September 14, 2008, from
http://www.cdc.gov/ncidod/eid/vol7no2/chambers.htm
Ferguson KJ, Waitzkin H, Beekman SE, Doebbeling BN. (2004). Critical Incidence of non-adherence with standard precautions: Guidelines among community hospital-based healthcare workers. Journal of General Internal Medicine, July; 19(7): 726-731. Retrieved September 14, 2008, from
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1492480
Nguyen DM, Bancroft E, Mascola L, Guevara R, Yasuda L. (2007). Risk factors for neonatal methicillin-resistant Staphylococcus aureus infection in a well-infant nursery. Infection Control and Hospital Epidemeology, 28(4):406-411.
Van Howe, RS. (2007). The possible role of circumcision in newborn outbreaks of community-associated methicillin-resistant Staphylococcus aureus. Clinical Pediatrics, 46(4): 356-358.
Zafer AB, Butler RC, Reese DJ, Gaydos LA, & Mennonna PA. (1995). Use of 0.3% triclosan (Bacti-Stat) to eradicate an outbreak of methicillin-resistant Staphylococcus aureus in a neonatal nursery. American Journal of Infection Control, Jun; 23(3):200-8.
Thursday, December 4, 2008
Night Shift Update
Quick update before I go out again tonight... I've worked 2 weeks on nights now and the grade has been raised from a "D" to about a "B-."
It is a different pace from Days... Mostly more laid back... no supervisors and doctors running around. We nurses handle a lot of the stuff ourselves and only correspond with the doctors as needed on the phone and call them at the very end when birth is imminent.
I have a problem sleeping... I work 3 nights in a row then am off 4, typically. The first day after I work, it is nearly impossible for me to get to sleep and stay asleep... Therefore, making the second night working the worst. Then, I have NO problem sleeping the next day.
Ups and Downs...
But overall it is better than I thought it would be originally
It is a different pace from Days... Mostly more laid back... no supervisors and doctors running around. We nurses handle a lot of the stuff ourselves and only correspond with the doctors as needed on the phone and call them at the very end when birth is imminent.
I have a problem sleeping... I work 3 nights in a row then am off 4, typically. The first day after I work, it is nearly impossible for me to get to sleep and stay asleep... Therefore, making the second night working the worst. Then, I have NO problem sleeping the next day.
Ups and Downs...
But overall it is better than I thought it would be originally
Wednesday, November 26, 2008
Night Shift
I successfully stayed awake all night... That's about the only good thing about my night. It is a very different pace.... I think I much prefer the fast pace of day shift... Maybe because I always have to be doing something... If there's nothing to do, I make something to do....
The other nurses told me it was a slow night for them and it usually isn't that slow... And, I suppose I cannot judge a whole shift on one night.....
But, overall, if I were grading my experience I would give it a "D." I hope it gets better - or I adapt because I'm stuck on night shift for an undetermined amount of time... until a spot comes open on days....and there are many in front of me - seniority wise - who will scoop the daylight shifts up quickly before I have a shot.
So, my goal is to make the best of it....
I had a hard time sleeping when I got home... Even though I was exhausted, I couldn't really fall asleep until about 10am... But, then I slept right through the day until about 3pm.
On an unrelated note, I'm excited about a new purchase we made: A COUCH!! If you've been to our house, you know we were in need of one - badly... The one we had was so uncomfortable...and old... But we didn't want to buy one with little kidd-os around beating it up... Now that they are older, somewhat, we thought it time to get a new one... It is so comfy -- and we bought a matching chair and ottoman. It will look like we have a regular living room suit! It comes next week... I can't wait!
Here is a picture of it. It is a light, sage green color.
The other nurses told me it was a slow night for them and it usually isn't that slow... And, I suppose I cannot judge a whole shift on one night.....
But, overall, if I were grading my experience I would give it a "D." I hope it gets better - or I adapt because I'm stuck on night shift for an undetermined amount of time... until a spot comes open on days....and there are many in front of me - seniority wise - who will scoop the daylight shifts up quickly before I have a shot.
So, my goal is to make the best of it....
I had a hard time sleeping when I got home... Even though I was exhausted, I couldn't really fall asleep until about 10am... But, then I slept right through the day until about 3pm.
On an unrelated note, I'm excited about a new purchase we made: A COUCH!! If you've been to our house, you know we were in need of one - badly... The one we had was so uncomfortable...and old... But we didn't want to buy one with little kidd-os around beating it up... Now that they are older, somewhat, we thought it time to get a new one... It is so comfy -- and we bought a matching chair and ottoman. It will look like we have a regular living room suit! It comes next week... I can't wait!
Here is a picture of it. It is a light, sage green color.
Sunday, November 23, 2008
Random Things
Heard around the House recently:
"Can you believe in Santa and not believe in Rudolf, because I don't think that reindeer can have a red, glowing nose." - Lance, age 8
"Did you know that both 'poop' and 'puke' can be nouns OR verbs!" - Isaac, age 10 (Obviously following his aunt's bent for meticulous grammar usage)
Thinking we were Lucky:
When I originally bought Mark's PSU football tickets I thought I ordered them for yesterday's game against Michigan State... But, I received tickets for the Indiana game. Anyway, I'm glad that mistake happened....and we weren't stuck outside "cheering" in 20 degree, snowy weather yesterday.
Change of Shift:
Tomorrow I start my new shift: 7pm - 7am. I'm not sure if it's a good or a bad thing yet. I can see both sides.... I will be home 4 days a week and only work three. I will be home during the day every day.... I will sleep while the kids are in school.... But, not sure how I'll adapt to switching my sleep schedule back and forth like that.... Historically, my body is sensitive to changes... with migraines being my main affliction when anything goes awry. Here's hoping for the best. Any night shift-ers or previous night shift-ers with advice would be welcome!!
"Can you believe in Santa and not believe in Rudolf, because I don't think that reindeer can have a red, glowing nose." - Lance, age 8
"Did you know that both 'poop' and 'puke' can be nouns OR verbs!" - Isaac, age 10 (Obviously following his aunt's bent for meticulous grammar usage)
Thinking we were Lucky:
When I originally bought Mark's PSU football tickets I thought I ordered them for yesterday's game against Michigan State... But, I received tickets for the Indiana game. Anyway, I'm glad that mistake happened....and we weren't stuck outside "cheering" in 20 degree, snowy weather yesterday.
Change of Shift:
Tomorrow I start my new shift: 7pm - 7am. I'm not sure if it's a good or a bad thing yet. I can see both sides.... I will be home 4 days a week and only work three. I will be home during the day every day.... I will sleep while the kids are in school.... But, not sure how I'll adapt to switching my sleep schedule back and forth like that.... Historically, my body is sensitive to changes... with migraines being my main affliction when anything goes awry. Here's hoping for the best. Any night shift-ers or previous night shift-ers with advice would be welcome!!
Wednesday, November 19, 2008
The Short End of the Stick
Since I'm still on orientation, my name is written on the board at the nursing station with the category I am focusing on. For example, right now I'm finishing up Labor & Circulation for sections. So, it says that on the board in order for the charge nurse to make proper patient assignments.
Yesterday I had an odd shift and didn't start until 11am. So, when I came on at 11am, I took on one of the other nurse's labor patients. The off-going nurse was giving me report on the patient and said, "Boy, I wish I could just stay with this couple... They are so nice." But, she gave the labor patient up willingly to me, so I could learn; and, she took on two post-op hysterectomy patients who were coming back from surgery (Our floor occasionally takes a few gyne patients if our census is low enough).
Not half an hour later I heard a slight commotion in the hallway but not thinking much of it, I simply closed my patient's door so she wouldn't be disturbed during labor. Then, when I went out for a break later on I found out what the commotion was: One of the nurse's post-op patients went into respiratory arrest and the nurse had to call a full code blue!
Luckily, the code ended well.... But, boy did that nurse get the short end of that stick.... I got a lovely vaginal birth during my shift with time left over to do all of my charting .... and ... she got a code blue.
She laughed at the end of the day and said, "You owe me!"
That I do.
Yesterday I had an odd shift and didn't start until 11am. So, when I came on at 11am, I took on one of the other nurse's labor patients. The off-going nurse was giving me report on the patient and said, "Boy, I wish I could just stay with this couple... They are so nice." But, she gave the labor patient up willingly to me, so I could learn; and, she took on two post-op hysterectomy patients who were coming back from surgery (Our floor occasionally takes a few gyne patients if our census is low enough).
Not half an hour later I heard a slight commotion in the hallway but not thinking much of it, I simply closed my patient's door so she wouldn't be disturbed during labor. Then, when I went out for a break later on I found out what the commotion was: One of the nurse's post-op patients went into respiratory arrest and the nurse had to call a full code blue!
Luckily, the code ended well.... But, boy did that nurse get the short end of that stick.... I got a lovely vaginal birth during my shift with time left over to do all of my charting .... and ... she got a code blue.
She laughed at the end of the day and said, "You owe me!"
That I do.
Football Game Update v. II
Ok, since no one took the bait..... Mark and I went to the PSU game last weekend and it was tons of fun.
For the whole month between giving him the tickets and the actual game, every time I walked outside and felt the chill of the November air, I secretly dreaded spending 4 hours outside for a football game - I don't really know a lot about the game... It always gets me when they start running away from the ball... Anyway, I knew I wanted to spend time with Mark, so I was determined to deal with the weather.
The day of the game my mom came to watch the kids and she brought bundles of clothes to put on me... Yes, my mother dressed me for the game... Weird, but it worked. Boy, does she know how to bundle someone... I had on 2 shirts plus a hoody sweatshirt, long-john pants plus jeans, 3 pair of socks, boots, a winter coat, hat, gloves and a poncho. Plus, she gave me a "Lava-Buns" to sit on. Nothing was getting through to ruin the game for me!
It was chilly and it rained the whole game off and on.... But I wasn't cold or wet in the least... I enjoyed a good hot chocolate and time with Mark, and still after 15 years was asking him "Why are they all running away from the ball?" :)
Tuesday, November 18, 2008
Friday, November 14, 2008
The Hat
After I graduated from nursing school, I wanted to do something just for the heck of it... for - what's that forgotten word? - FUN.... So, being the adventurous gal that I am, I decided I would teach myself how to crochet. :)
This has been something I've had the desire to learn for quite some time... I just always pictured the calming presence of a birth attendant rocking in a chair crocheting or knitting .... Comforting by presence not by grand gesture or actions. Plus, my grandmother used to crochet afghans for us all the time; and, she passed away this past year... When looking at the afghans we have from her, I imagine the time she invested in making the blanket as a gift of love to us. So, I was inspired by that as well.
This past week I went to visit my uncle who lives in my grandmother's house. He pulled out three bins of yarn she had been using and gave them to me. So, now, I'm even carrying on the crocheting tradition with my grandmother's own yarn.
Anyway, I've been practicing since June.... I made a baby blanket and some booties.... and I'm working on a doily for our coffee table. But, Lance asked me about a month ago if I could make him a hat. So, knowing that this will likely be one of the last times in his life when he would eagerly ask for something his mother crocheted for him, I gladly began making my first crocheted hat.
He was thrilled all along watching me crochet during his karate classes and while sitting around at home. His little friend came over last weekend and he quickly brought him over to where I was working on the hat and told him, "My Mom Is Making Me a HAT!!!" His excitement was a gift to me.
So, the process is completed. It is not perfect, and I found out making a pom-pom is much more work than it is worth.......I will surely just buy a pom-pom next time.... But, here is the finished product.
This has been something I've had the desire to learn for quite some time... I just always pictured the calming presence of a birth attendant rocking in a chair crocheting or knitting .... Comforting by presence not by grand gesture or actions. Plus, my grandmother used to crochet afghans for us all the time; and, she passed away this past year... When looking at the afghans we have from her, I imagine the time she invested in making the blanket as a gift of love to us. So, I was inspired by that as well.
This past week I went to visit my uncle who lives in my grandmother's house. He pulled out three bins of yarn she had been using and gave them to me. So, now, I'm even carrying on the crocheting tradition with my grandmother's own yarn.
Anyway, I've been practicing since June.... I made a baby blanket and some booties.... and I'm working on a doily for our coffee table. But, Lance asked me about a month ago if I could make him a hat. So, knowing that this will likely be one of the last times in his life when he would eagerly ask for something his mother crocheted for him, I gladly began making my first crocheted hat.
He was thrilled all along watching me crochet during his karate classes and while sitting around at home. His little friend came over last weekend and he quickly brought him over to where I was working on the hat and told him, "My Mom Is Making Me a HAT!!!" His excitement was a gift to me.
So, the process is completed. It is not perfect, and I found out making a pom-pom is much more work than it is worth.......I will surely just buy a pom-pom next time.... But, here is the finished product.
Lancey in a Blue Hat.
Sunday, November 9, 2008
Sad Work
This week I was involved in my first fetal demise. It was known that the baby would not live long after birth.
I was assigned to be the "baby catcher."
I really didn't know how I would respond. Would I be paralyzed with emotions? Would I break down and cry? Could I handle it?
I took a 4 hour class just a couple weeks ago on handling fetal demise cases. But, there is really no better way to learn than to do it.
In contrast to medical practice years ago when the baby was whisked away without the parents ever seeing the child; today we make every effort to make and preserve memories for these families. We help them bathe and dress the infant. We take photos and do footprints/handprints. We save locks of hair. We make memory boxes to put all of these keepsakes in.
I was surprised at how controlled I was able to be. I was handed the baby after birth because the parents wanted her cleaned and wrapped before holding her. So, I cleaned and wrapped the precious, breathless baby who was not crying - and was not going to. I delivered the baby to the parents and continued to listen for heart tones intermittently so we could call the time of death.
It was a very somber experience. But, I didn't cry. ---- That is, until I watched to photo montage the next day that the labor nurse put together and set to music (the theme from titanic & "There are angels among us") for the family. All of us nurses gathered around the nursing station to watch the slide show.... Passing the tissues around... It was time to cry... time to be human and to allow myself to feel the sadness....
I think I was focused on doing the nursing tasks and helping to make the experience meaningful and meet all of the needs of the family during the birth, that I didn't allow myself to become emotional...I was all business.... I guess... I'm a little surprised at my reaction, to tell you the truth. Why didn't I allow myself to cry then? I did consciously hold back the tears at one point.. I'm sure the parents would have been touched to see that their child's birth impacted another person.... But, I didn't. I only cried later, when in a safe place, away from patients..... But, as soon as the slide show was over, my other patient rang out and I had to go in to help her feed her squalling, pink baby...with tear stained cheeks from the baby who passed.
Usually this job is full of joy and happiness. It isn't usually sad... But, when it is sad, it is really, really sad.
SIDE NOTE:
As a side note, our department likes to have memory boxes to give to the family after a demise. Usually they are small, about the size of a shoe box, and decorated with crafty things like paint or fabric or ribbons, etc. We are all out. Us, nurses, are making some as we can....But if you are crafty or are part of a group that is looking for a charity project to take on.... We would welcome donations of memory boxes. Just let me know if you are interested and we can talk details.
I was assigned to be the "baby catcher."
I really didn't know how I would respond. Would I be paralyzed with emotions? Would I break down and cry? Could I handle it?
I took a 4 hour class just a couple weeks ago on handling fetal demise cases. But, there is really no better way to learn than to do it.
In contrast to medical practice years ago when the baby was whisked away without the parents ever seeing the child; today we make every effort to make and preserve memories for these families. We help them bathe and dress the infant. We take photos and do footprints/handprints. We save locks of hair. We make memory boxes to put all of these keepsakes in.
I was surprised at how controlled I was able to be. I was handed the baby after birth because the parents wanted her cleaned and wrapped before holding her. So, I cleaned and wrapped the precious, breathless baby who was not crying - and was not going to. I delivered the baby to the parents and continued to listen for heart tones intermittently so we could call the time of death.
It was a very somber experience. But, I didn't cry. ---- That is, until I watched to photo montage the next day that the labor nurse put together and set to music (the theme from titanic & "There are angels among us") for the family. All of us nurses gathered around the nursing station to watch the slide show.... Passing the tissues around... It was time to cry... time to be human and to allow myself to feel the sadness....
I think I was focused on doing the nursing tasks and helping to make the experience meaningful and meet all of the needs of the family during the birth, that I didn't allow myself to become emotional...I was all business.... I guess... I'm a little surprised at my reaction, to tell you the truth. Why didn't I allow myself to cry then? I did consciously hold back the tears at one point.. I'm sure the parents would have been touched to see that their child's birth impacted another person.... But, I didn't. I only cried later, when in a safe place, away from patients..... But, as soon as the slide show was over, my other patient rang out and I had to go in to help her feed her squalling, pink baby...with tear stained cheeks from the baby who passed.
Usually this job is full of joy and happiness. It isn't usually sad... But, when it is sad, it is really, really sad.
SIDE NOTE:
As a side note, our department likes to have memory boxes to give to the family after a demise. Usually they are small, about the size of a shoe box, and decorated with crafty things like paint or fabric or ribbons, etc. We are all out. Us, nurses, are making some as we can....But if you are crafty or are part of a group that is looking for a charity project to take on.... We would welcome donations of memory boxes. Just let me know if you are interested and we can talk details.
Called Off
I got called off work today for the first time. I got up at 5am and took my shower and was getting ready in the bathroom when the phone rang.... There were only 3 postpartum patients there and they all were going home today. So, me and a handfull of others were called off.
Mark commented that he never heard of a job where they could call you and tell you NOT to work. But, the hospital cannot justify paying 7 OB nurses with only 3 patients.... So, unfortunately this is what can happen.
Another possibility (which wouldn't happen while I am still on orientation), is that you could be "pulled" from your floor with a low census to other floors that have a high census. This is a very unpopular option.... OB nurses are sheltered and pretty much separated from the rest of the hospital.... We go into the locked OB unit and don't really emerge until our shift is over. From what I hear, when we go to the other floors to work, it is less than ideal.
We are so specialized that being able to function independently on med/surg floors is unreasonable. We have to be paired up with another RN and get used as LPNs or Aids, mainly. And, when med/surg nurses get pulled to the OB unit, they cannot function independently, either. They have to be paired up with an RN and can only work with postpartum moms and babies.... They aren't trained to be OB nurses and we aren't trained to be med/surg nurses. So, generally, we all would almost rather be called off than be pulled.
But, then you have the fact that when you are called off you are not paid for those hours. I was doing the math today and I lost a pretty penny for having an extra day off this week. But, what can you do.
I did some crocheting this weekend. I finished Lance's hat. Pictures soon. And I started a new project. More on that later.
Mark commented that he never heard of a job where they could call you and tell you NOT to work. But, the hospital cannot justify paying 7 OB nurses with only 3 patients.... So, unfortunately this is what can happen.
Another possibility (which wouldn't happen while I am still on orientation), is that you could be "pulled" from your floor with a low census to other floors that have a high census. This is a very unpopular option.... OB nurses are sheltered and pretty much separated from the rest of the hospital.... We go into the locked OB unit and don't really emerge until our shift is over. From what I hear, when we go to the other floors to work, it is less than ideal.
We are so specialized that being able to function independently on med/surg floors is unreasonable. We have to be paired up with another RN and get used as LPNs or Aids, mainly. And, when med/surg nurses get pulled to the OB unit, they cannot function independently, either. They have to be paired up with an RN and can only work with postpartum moms and babies.... They aren't trained to be OB nurses and we aren't trained to be med/surg nurses. So, generally, we all would almost rather be called off than be pulled.
But, then you have the fact that when you are called off you are not paid for those hours. I was doing the math today and I lost a pretty penny for having an extra day off this week. But, what can you do.
I did some crocheting this weekend. I finished Lance's hat. Pictures soon. And I started a new project. More on that later.
Wednesday, November 5, 2008
The Good, Bad & the Ugly
Yesterday was a great day - milestone wise - for me at work. I was assigned to an AROM induction that I handled the whole way through from admission to IV start and AROM to epidural to birth and recovery - INDEPENDENTLY!!! My preceptor didn't even have to come in the room.... I was thrilled.... Because there has usually been a point sometime during the labor that I get the "deer in the headlights" look and get lost or sidetracked as to what I need to do next... But yesterday I held it together the whole way through!!
I didn't do everything perfectly, and there is room for improvement... But I'm thrilled to be on my way to independence in labor/delivery nursing.
Speaking of imperfection.... Yesterday I did the "set-up" which involves setting up a sterile field with the doctor's instruments for delivery on it - each dr has their own specific preferences, etc. for how they want it set up. So, I was doing the sterile set up and I thought to myself, "Hmmm, this table seems different than usual." But, not being able to put my finger on what was different, I covered the table when I was done and went on. Then, when the doctor came in for delivery, he uncovered the table and said, "Are we trying to save space?" I looked at it and thought for a second about what he said then realized what was different.... I forgot to pull up the side table flap that makes the table about a foot longer when it is pulled up..... He laughed when he saw that I realized my mistake... I said, "Can you tell I'm still on orientation?" :)
That doctor is pretty easy going and easy to work with... But there is one doctor in particular that intimidates me, regretably. I try to not feel flustered when working with him or calling him...but without fail I am flustered and I inevitably do or say something stupid/absent-mindedly because of it. For example, the other day I was calling him with lab values and I read off the one value as being "0.0" as in saying "zero POINT zero." DUH! It's just zero. And then another time he was leaving the floor (by way of the back staircase) when I received a panic WBC value on my patient. So, wanting to catch him quickly, I ran over to the stair case and called his name right before the door closed. He turned around and I (having never gone down that staircase before) pushed on the door to open it... Nothing. Then I pushed again... Nothing!!! He rolled his eyes and said, "Push the green button." Sure enough, there was a big green button on the wall beside the door that said, "DOOR."
Something like not knowing how to push open a door seems silly and almost laughable...But on that particular day it sent me over the edge. We had just had a hard delivery with a baby born with an apgar of 1, then 4 and was transferred to the NICU - at the same time the baby was going bad, the mother had a postpartum hemorrhage and we lost her IV site and I was scrambling to start another so I could infuse pitocicn while giving hemabate and methergine......So, follow that kind of delivery up with an un-open-able door and you get tears. After I was done receiving orders on the patient with the panic value, I went back to the nurses station and lost my composure and cried. The un-open-able door was the straw that broke the camel's back, you could say....
So, I've had bad days and good ones... It just so happens that yesterday was a rather good one... :) So, I'll enjoy my day off today!
I didn't do everything perfectly, and there is room for improvement... But I'm thrilled to be on my way to independence in labor/delivery nursing.
Speaking of imperfection.... Yesterday I did the "set-up" which involves setting up a sterile field with the doctor's instruments for delivery on it - each dr has their own specific preferences, etc. for how they want it set up. So, I was doing the sterile set up and I thought to myself, "Hmmm, this table seems different than usual." But, not being able to put my finger on what was different, I covered the table when I was done and went on. Then, when the doctor came in for delivery, he uncovered the table and said, "Are we trying to save space?" I looked at it and thought for a second about what he said then realized what was different.... I forgot to pull up the side table flap that makes the table about a foot longer when it is pulled up..... He laughed when he saw that I realized my mistake... I said, "Can you tell I'm still on orientation?" :)
That doctor is pretty easy going and easy to work with... But there is one doctor in particular that intimidates me, regretably. I try to not feel flustered when working with him or calling him...but without fail I am flustered and I inevitably do or say something stupid/absent-mindedly because of it. For example, the other day I was calling him with lab values and I read off the one value as being "0.0" as in saying "zero POINT zero." DUH! It's just zero. And then another time he was leaving the floor (by way of the back staircase) when I received a panic WBC value on my patient. So, wanting to catch him quickly, I ran over to the stair case and called his name right before the door closed. He turned around and I (having never gone down that staircase before) pushed on the door to open it... Nothing. Then I pushed again... Nothing!!! He rolled his eyes and said, "Push the green button." Sure enough, there was a big green button on the wall beside the door that said, "DOOR."
Something like not knowing how to push open a door seems silly and almost laughable...But on that particular day it sent me over the edge. We had just had a hard delivery with a baby born with an apgar of 1, then 4 and was transferred to the NICU - at the same time the baby was going bad, the mother had a postpartum hemorrhage and we lost her IV site and I was scrambling to start another so I could infuse pitocicn while giving hemabate and methergine......So, follow that kind of delivery up with an un-open-able door and you get tears. After I was done receiving orders on the patient with the panic value, I went back to the nurses station and lost my composure and cried. The un-open-able door was the straw that broke the camel's back, you could say....
So, I've had bad days and good ones... It just so happens that yesterday was a rather good one... :) So, I'll enjoy my day off today!
Halloween
This post is a little late...but....Here are a couple pics of the boys on halloween.... they were the only ones young enough to really embrace it this year... soon we won't have any pumpkin carvers or dressed up kiddies.... how quickly these things go....
But, here they are: Lance was a scarecrow and Isaac went as "Joe Paterno."
Tuesday, October 28, 2008
The Latest on Labor
I've been doing labor orientation for almost a month and I LOVE it! It was a bit intimidating at first. I felt like I was overwhelmed with the MANY things RNs have to assess and chart during labor that I was totally paralyzed to do any of the things I normally would do as far as comfort measures as a doula. But, slowly I'm finding myself more able to incorporate my doula training and experience to some extent. My hope is that as the nursing tasks become more second nature to me, that I won't have to dedicate so much time focusing on them and can slowly transform and grow into a well rounded, caring and competent labor nurse. Today I was able to help with hands on pain management - doula style - for about 1/2 an hour and not get too far behind in my charting... little steps
There is a ton of charting, as I expected....but even more so. According to what's going on in labor (early vs. active, pitocin or epidural infusions) the protocols vary. So, there are a lot of protocols to learn.
The vaginal exams are going GREAT... It only took about a week of fumbling around before I was accurately calling the dilatation/effacement/station.... I can only attribute that to the many years of visualizing the changing cervix and teaching my clients about theirs.....
The first time I was independently doing vag exams on a patient all day was a little stressful for me... I was so used to the safety net of my preceptors checking the cervix either before or after me and giving me feedback.... But, on that first day, I was so nervous.... Especially when I checked the patient and she was 9-10cm. My preceptor said, "Ok, then, I'll call the doctor." Inside I was thinking: "WHAT?? Don't you want to double check???" But, we got the patient ready and started pushing when I decided she was complete. The doctor came and I literally held my breath when he put his glove on and checked her..... All was good... She was complete.
But, my preceptors have told me stories of calling the doctor, having the patient up in stirrups only to have the dr. tell them the patient is 4cm. What a day that must've been... and they survived... and became great labor nurses... so, I've vowed to give myself time and permission to learn from my mistakes.... So far so good with the vaginal exams, though.....
Thursday I go to a fetal monitoring class. I'm looking forward to learning more about appropriately interpreting the fetal monitoring tracings. I learned some in school and am learning "on the job" during actual births, but I like classroom learning, too... having a list of scenarios or examples and knowing the right thing to do in each situation (is my accounting background showing through?). Regardless, I think Thursday will be helpful.
There is a ton of charting, as I expected....but even more so. According to what's going on in labor (early vs. active, pitocin or epidural infusions) the protocols vary. So, there are a lot of protocols to learn.
The vaginal exams are going GREAT... It only took about a week of fumbling around before I was accurately calling the dilatation/effacement/station.... I can only attribute that to the many years of visualizing the changing cervix and teaching my clients about theirs.....
The first time I was independently doing vag exams on a patient all day was a little stressful for me... I was so used to the safety net of my preceptors checking the cervix either before or after me and giving me feedback.... But, on that first day, I was so nervous.... Especially when I checked the patient and she was 9-10cm. My preceptor said, "Ok, then, I'll call the doctor." Inside I was thinking: "WHAT?? Don't you want to double check???" But, we got the patient ready and started pushing when I decided she was complete. The doctor came and I literally held my breath when he put his glove on and checked her..... All was good... She was complete.
But, my preceptors have told me stories of calling the doctor, having the patient up in stirrups only to have the dr. tell them the patient is 4cm. What a day that must've been... and they survived... and became great labor nurses... so, I've vowed to give myself time and permission to learn from my mistakes.... So far so good with the vaginal exams, though.....
Thursday I go to a fetal monitoring class. I'm looking forward to learning more about appropriately interpreting the fetal monitoring tracings. I learned some in school and am learning "on the job" during actual births, but I like classroom learning, too... having a list of scenarios or examples and knowing the right thing to do in each situation (is my accounting background showing through?). Regardless, I think Thursday will be helpful.
Achy Legs
I just finished with two 8 hour days and am gearing up to do two 12 hour days. My biggest question: What can I do to make my feet and legs stop aching?
I've "obtained" a pair of compression stockings aka TEDS and wear them religiously at work. When I first started wearing them, I could really notice a difference, but now my legs are aching again - from my toes up to my thighs. I've been awakened in the middle of the night with muscle cramps in my legs.
I'm trying to be smarter at work by doing things like pulling a chair into the patient's room so I can sit and chart during labors. And, I never wear the same shoes two days in a row....that seems to kill me, so I alternate. Any other tips would be appreciated.
I've "obtained" a pair of compression stockings aka TEDS and wear them religiously at work. When I first started wearing them, I could really notice a difference, but now my legs are aching again - from my toes up to my thighs. I've been awakened in the middle of the night with muscle cramps in my legs.
I'm trying to be smarter at work by doing things like pulling a chair into the patient's room so I can sit and chart during labors. And, I never wear the same shoes two days in a row....that seems to kill me, so I alternate. Any other tips would be appreciated.
Saturday, October 25, 2008
My Man
I met Mark 15 years ago this fall.
We were both attending PSU at different campuses.... and there was a system called "PSU-VM" where all of the students logged on at all campuses could "chat" with each other (before AOL online). All of the student's names would be on a list who were on-line. I knew that I liked Italians... so I looked through the list for an "Italian" last name.... and saw Mark's name.... and it all began like that...
We chatted back and forth for a few weeks... then a friend of mine and a friend of his arranged for us four to all meet up at a PSU football game and meet..... It was cold and raining... but one of the best days of my life.... I looked like a drowned rat, but Mark was able to see past all of that and we instantly connected.
A few weeks later it was his birthday and I skipped accounting class to make him cupcakes and surprise him with them.
We had a romantic courtship. He wrote poems and sent cards. We had "Compu-dates" set up where we would agree to log on our computers at a certain time (2:30 aka "Chinese dentist time") and "chat" with each other over PSU-VM. At one compu-date, we began chatting and then a delivery person showed up at the computer lounge with a vase of flowers Mark had arranged to be brought to me during our "date"....
15 years later he's still doing thoughtful acts like that.. Just 3 months ago, he had a vase of the same flowers I had in our wedding delivered to me at my nurse's station to surprise me.
Once while we were engaged, he drove an hour just to come and hold me because he heard I had a migraine. Still today, he is sensitive to my needs and always tries to meet them...he wakes up with me at 5am just to make sure I have coffee, start my car and give me a kiss goodbye... Little Lance never fails to wake up and say good bye to me, too.... He is his father's son... thoughtful and loving. He will make someone a good husband, too.
It's been the steady support and the little daily things that mean so much to me. We've blended our lives into one... Someone once said that marriage was like two streams coming together and joining as one... It is a little rough and there is some turbulence in the beginning....expectedly so... But, then it blends beautifully....
We've survived in-law problems, and financial issues - I remember one period where I would have $30 budgeted for food for the week to feed all 6 of us..... Not easy... But we never turned on each other and fought about things like that... we just made a plan and forged ahead. We went through many medical problems together.... loved ones dying, children having surgeries and mental health issues.... all of it making us more united.
What will the next 15 years bring? I'm not sure, but as long as Mark and I go through it together, it will be better than going through it alone.
I gave Mark Penn State Football tickets for his birthday. So, in a couple weeks, we will again, go to Beaver Stadium. It will probably be cold and rainy...but I'm pretty sure it will also be one of the best days ever.
I love you, Mark. Happy Birthday!
We were both attending PSU at different campuses.... and there was a system called "PSU-VM" where all of the students logged on at all campuses could "chat" with each other (before AOL online). All of the student's names would be on a list who were on-line. I knew that I liked Italians... so I looked through the list for an "Italian" last name.... and saw Mark's name.... and it all began like that...
We chatted back and forth for a few weeks... then a friend of mine and a friend of his arranged for us four to all meet up at a PSU football game and meet..... It was cold and raining... but one of the best days of my life.... I looked like a drowned rat, but Mark was able to see past all of that and we instantly connected.
A few weeks later it was his birthday and I skipped accounting class to make him cupcakes and surprise him with them.
We had a romantic courtship. He wrote poems and sent cards. We had "Compu-dates" set up where we would agree to log on our computers at a certain time (2:30 aka "Chinese dentist time") and "chat" with each other over PSU-VM. At one compu-date, we began chatting and then a delivery person showed up at the computer lounge with a vase of flowers Mark had arranged to be brought to me during our "date"....
15 years later he's still doing thoughtful acts like that.. Just 3 months ago, he had a vase of the same flowers I had in our wedding delivered to me at my nurse's station to surprise me.
Once while we were engaged, he drove an hour just to come and hold me because he heard I had a migraine. Still today, he is sensitive to my needs and always tries to meet them...he wakes up with me at 5am just to make sure I have coffee, start my car and give me a kiss goodbye... Little Lance never fails to wake up and say good bye to me, too.... He is his father's son... thoughtful and loving. He will make someone a good husband, too.
It's been the steady support and the little daily things that mean so much to me. We've blended our lives into one... Someone once said that marriage was like two streams coming together and joining as one... It is a little rough and there is some turbulence in the beginning....expectedly so... But, then it blends beautifully....
We've survived in-law problems, and financial issues - I remember one period where I would have $30 budgeted for food for the week to feed all 6 of us..... Not easy... But we never turned on each other and fought about things like that... we just made a plan and forged ahead. We went through many medical problems together.... loved ones dying, children having surgeries and mental health issues.... all of it making us more united.
What will the next 15 years bring? I'm not sure, but as long as Mark and I go through it together, it will be better than going through it alone.
I gave Mark Penn State Football tickets for his birthday. So, in a couple weeks, we will again, go to Beaver Stadium. It will probably be cold and rainy...but I'm pretty sure it will also be one of the best days ever.
I love you, Mark. Happy Birthday!
Sunday, October 19, 2008
Fountain of Youth?
It seems I've somehow mistakenly fallen into the fountain of youth - or at least look like I did.
Today I was interacting with my patient and her mother, who was floored to hear that I have four children ranging in age from 8-18. She said she thought I was 21 or 22 at most... WHAT???
This is not a one time occurrence, either.... Just a couple weeks ago, someone had the same reaction and then guessed my age as 10 years younger than I am.
I suppose one day I will be thankful for my "youthful appearance" but right now it is simply annoying.... I mean, I am supposed to be a professional nurse with wisdom and experience to help people with..... I get so frustrated when people continually take me for a green, twenty-something fresh out of college...... I guess it is showing my own insecurities and buying into the pre-conceived ideas that women with wisdom are gray-haired and wrinkled.... But, I honestly would rather have the gray hair and wrinkles.... bring it on....
But, no gray yet....and only a couple little crow's feet...... phoo-ey.
Today I was interacting with my patient and her mother, who was floored to hear that I have four children ranging in age from 8-18. She said she thought I was 21 or 22 at most... WHAT???
This is not a one time occurrence, either.... Just a couple weeks ago, someone had the same reaction and then guessed my age as 10 years younger than I am.
I suppose one day I will be thankful for my "youthful appearance" but right now it is simply annoying.... I mean, I am supposed to be a professional nurse with wisdom and experience to help people with..... I get so frustrated when people continually take me for a green, twenty-something fresh out of college...... I guess it is showing my own insecurities and buying into the pre-conceived ideas that women with wisdom are gray-haired and wrinkled.... But, I honestly would rather have the gray hair and wrinkles.... bring it on....
But, no gray yet....and only a couple little crow's feet...... phoo-ey.
Wednesday, October 15, 2008
Too Funny!!!
My preceptor and I were in a laboring patient's room charting yesterday when the patient fell asleep. The TV was on in the background with the Ellen show on. It caught our attention when Dennis Quaid was talking about the medication error that occurred to his newborn twins. More about that in a second. But, watch this clip of the prank Ellen had Dennis play on unsuspecting people in a starbucks. WE WERE DYING with laughter!!! Trying not to wake up our patient... It was sooo funny:
Now, about the tragic medication error that effected his infant twins and now has his attention focused on eliminating medical errors: Here is a link to a 60 minutes segment that does a good job explaining the near fatal medication error....Watch the video on the webpage - just amazing.
This is a real problem in healthcare... I worry about it DAILY. Knowing that I am human and that I have and will make errors makes me scared to death that I will make a MEDICATION error. I double and triple check my meds, almost to the point of being inefficient... But, honestly, it scares me to think about accidentally giving the wrong drug or wrong dose, etc.
There are technological advances in medication administration available to help control the nearly 100,000 deaths due to medical errors each year. But, they are expensive. Our hospital is implementing a new computer based med system in a few months... I am very pleased as it will be one more check between the patient and a mistake.
Now, about the tragic medication error that effected his infant twins and now has his attention focused on eliminating medical errors: Here is a link to a 60 minutes segment that does a good job explaining the near fatal medication error....Watch the video on the webpage - just amazing.
This is a real problem in healthcare... I worry about it DAILY. Knowing that I am human and that I have and will make errors makes me scared to death that I will make a MEDICATION error. I double and triple check my meds, almost to the point of being inefficient... But, honestly, it scares me to think about accidentally giving the wrong drug or wrong dose, etc.
There are technological advances in medication administration available to help control the nearly 100,000 deaths due to medical errors each year. But, they are expensive. Our hospital is implementing a new computer based med system in a few months... I am very pleased as it will be one more check between the patient and a mistake.
Sunday, October 12, 2008
Photo Album
We had a nice family celebration of Alex's 18th birthday - with a few rare photo-ops of Alex, himself (although he doesn't like the camera, he obliged).Here's one of me and the kids.
And, here are my kids with my sister's kids all together.
Little Berkeley AKA "B" is sweeter than ever.... I got to see her eat her first Cheerio this weekend - so cute!!!
Friday, October 10, 2008
A Childhood Gone
My "Man Child" is 18 today.I've heard parents say before that it felt as though they blinked and their children were grown. I always kinda laughed and thought, "SURE, it does."
BUT, honestly, I feel like Alex was my little buddy hanging out with pappy while he did lawn work just a couple years ago.... My little guy is now a big adult.
How swiftly the sweet years of childhood go by.
On Vag Exams
This past week or so has been filled with learning labor - and a part of that is learning vaginal exams.
Usually how it is taught is the "learning nurse" does a vag exam on the patient right after another experienced nurse, who directs the "learner" where to feel and what the correct interpretation of that particular exam is.
So, my first exam was done with a doctor who had just examined the patient. The doctor was finished and instructed me where to go and what to feel..... Honestly, all I felt was a bunch of mush! I was so nervous I didn't say that, of coarse, I just nodded and got out as fast as I could.
Then, a few hours later, my preceptor examined the same woman and it was my turn again. So, I hesitantly went in again..... It was there!! I actually found the cervix and felt it --- Small successes.
Next, I have to not only find them but accurately interpret their dilation, effacement and station.
I did a few vag exams since... accurately pronouncing one cervix as "4" and then inaccurately calling one "7" that was only "6."
The hardest was doing vaginal exams on a person I knew..... Yeah, kinda uncomfortable...but you get past it and move on......
Usually how it is taught is the "learning nurse" does a vag exam on the patient right after another experienced nurse, who directs the "learner" where to feel and what the correct interpretation of that particular exam is.
So, my first exam was done with a doctor who had just examined the patient. The doctor was finished and instructed me where to go and what to feel..... Honestly, all I felt was a bunch of mush! I was so nervous I didn't say that, of coarse, I just nodded and got out as fast as I could.
Then, a few hours later, my preceptor examined the same woman and it was my turn again. So, I hesitantly went in again..... It was there!! I actually found the cervix and felt it --- Small successes.
Next, I have to not only find them but accurately interpret their dilation, effacement and station.
I did a few vag exams since... accurately pronouncing one cervix as "4" and then inaccurately calling one "7" that was only "6."
The hardest was doing vaginal exams on a person I knew..... Yeah, kinda uncomfortable...but you get past it and move on......
Continuity of Care
During my interview for my current position, one of the questions asked of me was what do I see as a drawback of being a nurse. There were a couple of things that came to mind, but the one I gave as my answer was that in providing care to maternity patients as a nurse (compared to being a doula), there is limited continuity of care. After a nurse's shift, she leaves. She doesn't build a relationship with the patient prior to or after delivery and isn't even guaranteed to be present for the entire birth and recovery.
This fact was pronounced to me this week. I'm now working on labor skills and I spent my whole 12 hour shift with this one couple - One on one nursing - Built a relationship with them, helped them through hours of labor. At the end of my shift, I had reported off to the next nurse and was going back in to say good-bye to the couple when she reported a change, so she was checked again... She was ready to push! And, I was leaving.
I've been to many births, so it wasn't that I felt bad over the missed experience for myself, but this couple who began to build a trusting relationship has to start out all over with a new nurse at a pivotal point in their birth process. I could have stayed longer to be a support to her, but honestly my feet were aching and my body tired after two straight days of 12 hour shifts. Plus there was no way to foresee how long she was going to have to push, etc. This job is truly not meant to be worked more than 12 hours, I don't believe.
While our hospital tries to address the continuity of care issues by having most of their staff work 12 hour shifts and assigning nurses to the same patients day after day, if possible, the issue remains.
This fact was pronounced to me this week. I'm now working on labor skills and I spent my whole 12 hour shift with this one couple - One on one nursing - Built a relationship with them, helped them through hours of labor. At the end of my shift, I had reported off to the next nurse and was going back in to say good-bye to the couple when she reported a change, so she was checked again... She was ready to push! And, I was leaving.
I've been to many births, so it wasn't that I felt bad over the missed experience for myself, but this couple who began to build a trusting relationship has to start out all over with a new nurse at a pivotal point in their birth process. I could have stayed longer to be a support to her, but honestly my feet were aching and my body tired after two straight days of 12 hour shifts. Plus there was no way to foresee how long she was going to have to push, etc. This job is truly not meant to be worked more than 12 hours, I don't believe.
While our hospital tries to address the continuity of care issues by having most of their staff work 12 hour shifts and assigning nurses to the same patients day after day, if possible, the issue remains.
Tuesday, October 7, 2008
A Taste of Fall
What am I doing with my day off today?
Trying a new recipe for Pumpkin Pecan Muffins: MMMmmmm
Tastes like fall now, with some warm spiced cider on the side.
Trying a new recipe for Pumpkin Pecan Muffins: MMMmmmm
Tastes like fall now, with some warm spiced cider on the side.
Monday, October 6, 2008
Awareness
October is Breast Cancer Awareness month.
Go to this site to view some touching short films (10 min or less) made by people who have been affected by breast cancer. I thought the one made by little Maxwell titled, "My Mommy has Cancer" was truly touching.
Somehow my kids and I got onto the topic of cancer last night. It was difficult to explain to them why there is not a cure for cancer. Let's hold onto the hope that one day there will be and until then pray for peace for those who are living through cancer right now.
Go to this site to view some touching short films (10 min or less) made by people who have been affected by breast cancer. I thought the one made by little Maxwell titled, "My Mommy has Cancer" was truly touching.
Somehow my kids and I got onto the topic of cancer last night. It was difficult to explain to them why there is not a cure for cancer. Let's hold onto the hope that one day there will be and until then pray for peace for those who are living through cancer right now.
Who's Got Your Back?
I've mentioned here before how great I think my co-workers are. They are a true team. If one person is in a spot with her patient where she needs a hand or has too much building up - everyone is there for them... No complaints, they are just there. They ask each other if they got time for lunch or a break yet, and take over the other person's patients to provide breaks when needed. And, when I had a baby born that needed resuscitated, I pushed the "code white" AKA "HELP!" button and within seconds there were 2 nurses there by my side helping me to resuscitate the baby.
This team of nurses is a blessing to be a part of, for sure. But last week, they proved themselves even more supportive. They not only talked the talk; they walked the walk. I had been on a good streak with inserting IVs successfully - THEN, something happened and I got three in a row that I missed. My confidence was in the toilet. So, what did my team of co-workers do? They literally lined up for me to insert IVs into their own arms so I could re-build my confidence! They talked me through each insertion, giving me tips and cheering me on. Afterwards, it felt so good to have the support from these women - now with bandages on their hands and arms from my needle sticks. It must be the same feeling "blood brothers" get.... We've shared in pain together for the good of another....
Now I've started the labor and delivery rotation - with my first day of vaginal exams yesterday... Hopefully I won't need extra help in perfecting this skill... It would be more than a little uncomfortable asking for their help in that area!
This team of nurses is a blessing to be a part of, for sure. But last week, they proved themselves even more supportive. They not only talked the talk; they walked the walk. I had been on a good streak with inserting IVs successfully - THEN, something happened and I got three in a row that I missed. My confidence was in the toilet. So, what did my team of co-workers do? They literally lined up for me to insert IVs into their own arms so I could re-build my confidence! They talked me through each insertion, giving me tips and cheering me on. Afterwards, it felt so good to have the support from these women - now with bandages on their hands and arms from my needle sticks. It must be the same feeling "blood brothers" get.... We've shared in pain together for the good of another....
Now I've started the labor and delivery rotation - with my first day of vaginal exams yesterday... Hopefully I won't need extra help in perfecting this skill... It would be more than a little uncomfortable asking for their help in that area!
Question
As part of my nursing class, this week's "Question of the Week" and my answer is below. The class is over next week! And, I'll be 3 more credits closer to my next degree. I then start the next nursing class the following week. Keep plugging away....
Question:
List 2 topics that you personally would like to research. This can be a clinical topic, management issue, or any topic in nursing that you feel the need for additional research to be completed. Give the reasons why you feel strongly about the subjects and who you might link with in order to complete the research.
My Answer:
The first topic that would be of interest to me to research more is "Intimate Partner Violence During Pregnancy." I believe obstetric nurses neglect this topic during ante & intra - partum care. We ask the standard "Do you feel safe at home" question but rarely is this answered affirmatively. And, current research shows that intimate partner violence during pregnancy reaches 20% - That is a higher percentage than both pre-ecclampsia & gestational diabetes - Both of which maternity nurses obtain much training and knowledge with which to address these problems. But, we do not receive specific training about how to more effectively screen for and intervene in cases of intimate partner violence. I think we tend to "give our practice away" by simply referring the abused or suspected abused woman to social services, then washing our hands of the situation. While I think social services is an excellent resource and a good place for me (or us as nurses) to start to look into this topic more, it should not be our only resource.
Secondly, I would like to do some more research on the topic of "The Autonomy of Midwives." Currently midwives are frequently denied practicing privileges in many area hospitals - the decision to allow midwives to practice is often put to a vote by THE DOCTORS! The doctors, who are in direct competition for the patients midwives would potential serve, have the final say in whether midwives are allowed to practice in a hospital. I would like to explore this topic more. While I understand midwives must work in collaboration with physicians, I believe there should be a certain degree of autonomy as advanced practice nurses, which is not there currently. A good place for me to start would be to talk to the local midwives and see how they have addressed this issue. And, I could contact ACNM as they have a special division just for such topics about restriction of practice.
Question:
List 2 topics that you personally would like to research. This can be a clinical topic, management issue, or any topic in nursing that you feel the need for additional research to be completed. Give the reasons why you feel strongly about the subjects and who you might link with in order to complete the research.
My Answer:
The first topic that would be of interest to me to research more is "Intimate Partner Violence During Pregnancy." I believe obstetric nurses neglect this topic during ante & intra - partum care. We ask the standard "Do you feel safe at home" question but rarely is this answered affirmatively. And, current research shows that intimate partner violence during pregnancy reaches 20% - That is a higher percentage than both pre-ecclampsia & gestational diabetes - Both of which maternity nurses obtain much training and knowledge with which to address these problems. But, we do not receive specific training about how to more effectively screen for and intervene in cases of intimate partner violence. I think we tend to "give our practice away" by simply referring the abused or suspected abused woman to social services, then washing our hands of the situation. While I think social services is an excellent resource and a good place for me (or us as nurses) to start to look into this topic more, it should not be our only resource.
Secondly, I would like to do some more research on the topic of "The Autonomy of Midwives." Currently midwives are frequently denied practicing privileges in many area hospitals - the decision to allow midwives to practice is often put to a vote by THE DOCTORS! The doctors, who are in direct competition for the patients midwives would potential serve, have the final say in whether midwives are allowed to practice in a hospital. I would like to explore this topic more. While I understand midwives must work in collaboration with physicians, I believe there should be a certain degree of autonomy as advanced practice nurses, which is not there currently. A good place for me to start would be to talk to the local midwives and see how they have addressed this issue. And, I could contact ACNM as they have a special division just for such topics about restriction of practice.
Monday, September 29, 2008
Musings
Just some perceptions with no general direction.... Not about nursing or birth or anything... Just some musings (that's what you get when I have time on my hands).
I watched the presidential debates the other night. Well, I should say I watched the 20/20 episode before them and then I watched the debate until I fell asleep in the middle of it.
The 20/20 episode highlighted both candidate's childhood, education and political and family life up until this point in time. I found it incredibly intriguing.
While the candidate's experiences and upbringing were as different as any two people on the globe could be, they were strangely similar. Similar in that both candidates came from dysfunctional families and parents who were less than ideal but whom they were still striving to impress and gain favor with.
It struck me. If the two men who are running as presidential candidates of the USA survived dysfunction including alcoholic fathers, then our own dysfunctional families cannot serve as an excuse for failure anymore.
And, if these two men can overcome the errors of their upbringing, then won't our children be able to overcome our errors? Sometimes I find myself in tears regretting things I've done as a mother and a wife. If only I could go back in time, then my children wouldn't have to endure my mistakes. Aren't we as mothers prone to feel this kind of guilt?
But, if Barack Obama can overcome being left by two parents; and, John McCain can rise up after feeling he left his father down when he read a confession beaten out of him in a POW camp; then, our kids have to have nearly the same chance of acheiving greatness one day.
I'm believing more and more that everyone has some dysfunction in their family - whether they admit it or not... And, it is those who try to portray perfection who are probably the most inundated with dysfunction.
I watched the presidential debates the other night. Well, I should say I watched the 20/20 episode before them and then I watched the debate until I fell asleep in the middle of it.
The 20/20 episode highlighted both candidate's childhood, education and political and family life up until this point in time. I found it incredibly intriguing.
While the candidate's experiences and upbringing were as different as any two people on the globe could be, they were strangely similar. Similar in that both candidates came from dysfunctional families and parents who were less than ideal but whom they were still striving to impress and gain favor with.
It struck me. If the two men who are running as presidential candidates of the USA survived dysfunction including alcoholic fathers, then our own dysfunctional families cannot serve as an excuse for failure anymore.
And, if these two men can overcome the errors of their upbringing, then won't our children be able to overcome our errors? Sometimes I find myself in tears regretting things I've done as a mother and a wife. If only I could go back in time, then my children wouldn't have to endure my mistakes. Aren't we as mothers prone to feel this kind of guilt?
But, if Barack Obama can overcome being left by two parents; and, John McCain can rise up after feeling he left his father down when he read a confession beaten out of him in a POW camp; then, our kids have to have nearly the same chance of acheiving greatness one day.
I'm believing more and more that everyone has some dysfunction in their family - whether they admit it or not... And, it is those who try to portray perfection who are probably the most inundated with dysfunction.
Nothing But Time
This week I'm starting 12 hour shifts. So, instead of working 5 days each week, I'm only going to be working 3 days a week plus one 8 hour shift every other week.
So, this week, I only work Tuesday, Wednesday and Saturday!!
I'm excited... But a little nervous: What will I do with all of my free time???
Today I did laundry, cleaned curtains and bed linens. I baked some decedent homemade apple cinnamon rolls. And, I finished the trim on the first ever blanket that I crocheted.
What's left for Thursday and Friday?
:)
So, this week, I only work Tuesday, Wednesday and Saturday!!
I'm excited... But a little nervous: What will I do with all of my free time???
Today I did laundry, cleaned curtains and bed linens. I baked some decedent homemade apple cinnamon rolls. And, I finished the trim on the first ever blanket that I crocheted.
What's left for Thursday and Friday?
:)
Friday, September 26, 2008
An Awesome Responsibility
This past week a blue, limp and breathless baby was born.
And, the doctor handed her to me.
The resuscitation was successful. My colleagues were there beside me when I needed their help.
Being a Nurse is more than I envisioned it to be.
Being a Nurse is, by far, more than a job to me. It is a commitment. A commitment to learn and continue to learn. To care and hold no biases; pass no judgements. To relieve pain, but also to cause it sometimes; and, to embrace it when we must. To have days that are thankless and tasks that are messy. To be a part of a team, knowing I am not alone.
Mostly, being a Nurse is the act of pouring myself into my passion and being greatly rewarded for it.
And, the doctor handed her to me.
The resuscitation was successful. My colleagues were there beside me when I needed their help.
Being a Nurse is more than I envisioned it to be.
Being a Nurse is, by far, more than a job to me. It is a commitment. A commitment to learn and continue to learn. To care and hold no biases; pass no judgements. To relieve pain, but also to cause it sometimes; and, to embrace it when we must. To have days that are thankless and tasks that are messy. To be a part of a team, knowing I am not alone.
Mostly, being a Nurse is the act of pouring myself into my passion and being greatly rewarded for it.
Thursday, September 25, 2008
A Free Smile
After an emotionally and physically exhausting shift, I came home, took a shower and curled up in my recliner. I had the good-fortune of accidentally running across this 60 minutes BON JOVI interview from June of this year.
This is a rare interview during which I didn't once want to just beg him to shut up or sing. He made me laugh out loud. It is a good interview.
Jon's Interview
Relax and enjoy!
This is a rare interview during which I didn't once want to just beg him to shut up or sing. He made me laugh out loud. It is a good interview.
Jon's Interview
Relax and enjoy!
Tuesday, September 23, 2008
Seminar
Today I went to a seminar on legal issues in nursing, specifically "defensive charting." I saw a flyer about the seminar and immediately thought it was one I wanted to attend. So, I submitted a request to my nurse manager to have the department send me. The request was approved.
I've gone to many conferences and seminars before, but never on anyone else's dime. I've always had to clear my calendar, take time off of work and foot the bill myself. But, today, I was sent to this seminar AND paid for a full day's work at the same time. Pretty good deal.
The seminar was lead by a lawyer who represents hospitals in malpractice suits. He gave many good tips on how to document fully and responsibly.
Documentation takes up about 1/2 of my day. I would say for about every minute of patient care I do, I could do a minute of charting. Everything we do as nurses and everything we witness the patient doing, is chart-able. When nurses get busy doing patient care activities, their charting time is decreased. It's sort of a hard place to be. Your job is to provided competent care to patients, but you might as well not have given any care if you didn't chart it, because "If you didn't chart it, you didn't do it."
The seminar was useful. There was a "mock deposition" at the end of it. I sure hope I am never deposed, but the chances are I will be someday. The obstetrical healthcare provider can be sued for up to 20 years after any adverse infant event. Can you imagine trying to remember the specifics of a particular patient and their care 18 or 19 years later? All the nurse has to go by is her memory and her charting. My memory is not so swift.... So, I will be focusing more on my charting so I can have a complete picture if I so need.
I've gone to many conferences and seminars before, but never on anyone else's dime. I've always had to clear my calendar, take time off of work and foot the bill myself. But, today, I was sent to this seminar AND paid for a full day's work at the same time. Pretty good deal.
The seminar was lead by a lawyer who represents hospitals in malpractice suits. He gave many good tips on how to document fully and responsibly.Documentation takes up about 1/2 of my day. I would say for about every minute of patient care I do, I could do a minute of charting. Everything we do as nurses and everything we witness the patient doing, is chart-able. When nurses get busy doing patient care activities, their charting time is decreased. It's sort of a hard place to be. Your job is to provided competent care to patients, but you might as well not have given any care if you didn't chart it, because "If you didn't chart it, you didn't do it."
The seminar was useful. There was a "mock deposition" at the end of it. I sure hope I am never deposed, but the chances are I will be someday. The obstetrical healthcare provider can be sued for up to 20 years after any adverse infant event. Can you imagine trying to remember the specifics of a particular patient and their care 18 or 19 years later? All the nurse has to go by is her memory and her charting. My memory is not so swift.... So, I will be focusing more on my charting so I can have a complete picture if I so need.
Monday, September 22, 2008
The Image of Nursing
As part of the nursing class I am currently completing, I have to answer opinion based questions. Here is this week's question and my response.
Question: What is the current image of nursing in society?
While the media may devalue nursing as a profession in shows such as "Gray's Anatomy" by portraying nurses as mere "helpers to doctors," this is not the overall, actual accepted perception of nurses in the public.
Nurses are consistently described as honest and ethical in gallop polls year after year. The public sees nurses as caring - for individuals and the community with hands on help and healing with an ability to make a positive difference (Roxane, 2004). This is in part because, fortunately, an individual's perception of nursing is not singularly shaped by popular prime time television shows. Rather, people are exposed to nursing in a variety of ways including their own personal experience with professional nurses. And, the average person's experience with nursing is that of a positive nature. Additionally, people consistently receive positive images of nurses assisting with disastrous situations in news stories .
In fact, one 2008 Nursing Economics study revealed that "The public sees nursing as combining knowledge, skill, and professionalism with caring (Donelan, Buerhaus, Desroches, Dittus & Dutwin, 2008)."
Therefore, the image of nursing in society is influenced in various ways resulting in an overall positive view of the professional nurse.
Donelan, K., Buerhaus, P., Desroches, C., Dittus, R., Dutwin, D. Public Perceptions of Nursing Careers. (2008). Nursing Economics, 26(3): 143-150.
Roxane, S. Restoring caring back into nursing (2004). Nursing Administration Quarterly, 28(4): 255-257.
Question: What is the current image of nursing in society?
While the media may devalue nursing as a profession in shows such as "Gray's Anatomy" by portraying nurses as mere "helpers to doctors," this is not the overall, actual accepted perception of nurses in the public.
Nurses are consistently described as honest and ethical in gallop polls year after year. The public sees nurses as caring - for individuals and the community with hands on help and healing with an ability to make a positive difference (Roxane, 2004). This is in part because, fortunately, an individual's perception of nursing is not singularly shaped by popular prime time television shows. Rather, people are exposed to nursing in a variety of ways including their own personal experience with professional nurses. And, the average person's experience with nursing is that of a positive nature. Additionally, people consistently receive positive images of nurses assisting with disastrous situations in news stories .
In fact, one 2008 Nursing Economics study revealed that "The public sees nursing as combining knowledge, skill, and professionalism with caring (Donelan, Buerhaus, Desroches, Dittus & Dutwin, 2008)."
Therefore, the image of nursing in society is influenced in various ways resulting in an overall positive view of the professional nurse.
Donelan, K., Buerhaus, P., Desroches, C., Dittus, R., Dutwin, D. Public Perceptions of Nursing Careers. (2008). Nursing Economics, 26(3): 143-150.
Roxane, S. Restoring caring back into nursing (2004). Nursing Administration Quarterly, 28(4): 255-257.
Friday, September 19, 2008
Next Topic
At our weekly meeting today, my supervisor, preceptor and I decided to move onto the next area of Obstetrical Nursing: Cesarean Sections.
There are two roles a nurse fills during a c-section, the scrub nurse and the circulating nurse.
In general, the scrub nurse "scrubs" in for the surgery. She fills the sterile role by being an assistant to the surgeon. Sets up sterile equipment, counts, assists during the surgery with instruments and suctioning, etc.
The circulating nurse is not sterile. She is there to coordinate the whole ER including the surgeon, scrub nurse and the baby catcher. She gets any needed equipment or supplies. She records and documents events; makes any necessary phone calls needed. She does the sterile scrubbing and draping of the abdomen. Before the surgery, she prepares the patient with an IV, foley, shave prep and IV fluids. Then, after the cesarean she recovers the patient and the infant.
Moving on.
From now until my cesarean rotation is over, I can probably wake up 1/2 an hour later because it is absolutely useless to spend any time doing my hair in the morning. After one case in the OR with that white cap on my head, there is NO turning back... It's a bad hair day all the way... I might as well just keep the cap on my head from there on out.
There are two roles a nurse fills during a c-section, the scrub nurse and the circulating nurse.
In general, the scrub nurse "scrubs" in for the surgery. She fills the sterile role by being an assistant to the surgeon. Sets up sterile equipment, counts, assists during the surgery with instruments and suctioning, etc.
The circulating nurse is not sterile. She is there to coordinate the whole ER including the surgeon, scrub nurse and the baby catcher. She gets any needed equipment or supplies. She records and documents events; makes any necessary phone calls needed. She does the sterile scrubbing and draping of the abdomen. Before the surgery, she prepares the patient with an IV, foley, shave prep and IV fluids. Then, after the cesarean she recovers the patient and the infant.
Moving on.
From now until my cesarean rotation is over, I can probably wake up 1/2 an hour later because it is absolutely useless to spend any time doing my hair in the morning. After one case in the OR with that white cap on my head, there is NO turning back... It's a bad hair day all the way... I might as well just keep the cap on my head from there on out.
Thursday, September 18, 2008
Flying Solo
I wrote last week about the fact that I am now doing postpartum patients independently, without my preceptor.
Well, this week, I am off of orientation during baby catching as well. I caught my first baby by myself yesterday! And, it was the biggest newborn I've ever seen.
I was surely scared and nervous as anything... But that fear kept me focused.
Another good thing happened yesterday: I did 2 successful IVs in a row! I have done them in the past as a nursing student.... But working in Postpartum, I didn't have a lot of exposure to it. I did try, but it was unsuccessful. But, yesterday, I did it - twice.
It was quite the scene the first time I did it. My preceptor sent me into the room by myself with an IV pole and a basket full of IV supplies. I tried to appear confident - I didn't let on this would be my first successful IV as a registered nurse, If - in fact - I even succeeded!
Her veins weren't visible, either. SHOOT!! I thought. Then I put the tourniquet on and rubbed, flicked and slapped the back of her hand, hoping something would surface. It did! I could visualize 2 metacarpal veins. ok. So, I prepared my supplies (at least I thought I had) and I went for it. Success. I hit a vein. I got back flow, so I advanced the cath tip. Then I retracted the needle and then..... what? I didn't have the tubing ready. So this poor lady is bleeding out the cath I just put in her vein and I'm fumbling for the IV tubing!! It's just a good thing I put a chux under her arm before I began. In the end it was a bloody mess with an intact IV. Semi-successful.
My preceptor high fived me when I was done, then I was asked to start another one. I didn't want to push my luck, but knew I HAD to master this elusive skill, so I agreed.
This time I wanted to avoid the blood bath of a fiascal I had last time. So, I had EVERYTHING ready before I started. And, I hit a vein agian! There was barely a dribble of blood after this one. Whew. What a stressful event.
But, it certainly boosted my confidence a little.
It was a good day.
Well, this week, I am off of orientation during baby catching as well. I caught my first baby by myself yesterday! And, it was the biggest newborn I've ever seen.
I was surely scared and nervous as anything... But that fear kept me focused.
Another good thing happened yesterday: I did 2 successful IVs in a row! I have done them in the past as a nursing student.... But working in Postpartum, I didn't have a lot of exposure to it. I did try, but it was unsuccessful. But, yesterday, I did it - twice.
It was quite the scene the first time I did it. My preceptor sent me into the room by myself with an IV pole and a basket full of IV supplies. I tried to appear confident - I didn't let on this would be my first successful IV as a registered nurse, If - in fact - I even succeeded!
Her veins weren't visible, either. SHOOT!! I thought. Then I put the tourniquet on and rubbed, flicked and slapped the back of her hand, hoping something would surface. It did! I could visualize 2 metacarpal veins. ok. So, I prepared my supplies (at least I thought I had) and I went for it. Success. I hit a vein. I got back flow, so I advanced the cath tip. Then I retracted the needle and then..... what? I didn't have the tubing ready. So this poor lady is bleeding out the cath I just put in her vein and I'm fumbling for the IV tubing!! It's just a good thing I put a chux under her arm before I began. In the end it was a bloody mess with an intact IV. Semi-successful.
My preceptor high fived me when I was done, then I was asked to start another one. I didn't want to push my luck, but knew I HAD to master this elusive skill, so I agreed.
This time I wanted to avoid the blood bath of a fiascal I had last time. So, I had EVERYTHING ready before I started. And, I hit a vein agian! There was barely a dribble of blood after this one. Whew. What a stressful event.
But, it certainly boosted my confidence a little.
It was a good day.
Sunday, September 14, 2008
Paper #1
With Mark and the kids out of town for the day to a family birthday party, I had plenty of time and quietness to work on the papers I have to write for my nursing class. My goal was to write both, but realistically, getting one paper done will help in getting a head start so the course will not affect our family's sanity - too much.
So, I'm happy to say I wrote one of the papers today and the reference list for the second one. The topic I chose for the first paper ended up being "Preventing MRSA in neonatal nurseries."
Oddly, though, our professor is having us submit our papers online at Turn In In dot-com. I've never used it before, so I'm curious about how it works. Apparently, it is a site that helps professors judge the originality of the paper. My question is, What if you are just a good writer? Will the site judge you "non-original" if you have blatantly copied script from a published source or will having a significantly scholarly paper sound off the alarms?
I'm not saying my writing will be "significantly scholarly" --- But.. what if?
I submitted the paper and we will see, I suppose...because I know that I wrote that darn thing here today....sitting on the couch while taking some breaks to zoom through a recorded Y&R or two.... you know.
So, I'm happy to say I wrote one of the papers today and the reference list for the second one. The topic I chose for the first paper ended up being "Preventing MRSA in neonatal nurseries."
Oddly, though, our professor is having us submit our papers online at Turn In In dot-com. I've never used it before, so I'm curious about how it works. Apparently, it is a site that helps professors judge the originality of the paper. My question is, What if you are just a good writer? Will the site judge you "non-original" if you have blatantly copied script from a published source or will having a significantly scholarly paper sound off the alarms?
I'm not saying my writing will be "significantly scholarly" --- But.. what if?
I submitted the paper and we will see, I suppose...because I know that I wrote that darn thing here today....sitting on the couch while taking some breaks to zoom through a recorded Y&R or two.... you know.
Saturday, September 13, 2008
Choices
I have to write two papers for my current nursing class. I'm having some trouble deciding on the topic. I have a few topics I've been researching lately and would be happy to write about. Which two will fit the assignment best? I don't know.
Here is my short list:
- Nursing screening and interventions for intimate partner violence during pregnancy
- Risk factors for and prevention of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal nurseries.
- Professional autonomy for midwives
- Watson's theory of human caring
- Strategies to prevent medication errors.
Here is my short list:
- Nursing screening and interventions for intimate partner violence during pregnancy
- Risk factors for and prevention of methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in neonatal nurseries.
- Professional autonomy for midwives
- Watson's theory of human caring
- Strategies to prevent medication errors.
Thursday, September 11, 2008
A Real Catch & A Real Nurse
Today for the second time since I started working on OB (only 3 months ago) a nurse had to deliver a baby. The Dr was in surgery and couldn't very well leave an opened abdomen to go catch a baby. I guess it happens more than one would think. Especially at a fast growing hospital like this one is.
All went well. The nurse who caught was very experienced and did a great job. In fact, when I walked into the room at delivery to help "catch" the baby, I didn't even realize it was the nurse delivering. I was focused on grabbing a blanket, putting gloves on and watching how close birth was. The nurse was doing all of the maneuvers the doctor usually does; she was calm. It wasn't until afterwards that I noticed who it was.
Today neither of my preceptors were working. This has happened before and I've just been assigned to work with another nurse for the day. But, starting this week, I am working independently - off of orientation - with postpartum moms and babies; so, I worked independently all day. I felt like a "real" nurse. Yeah! Onward and Upward.
All went well. The nurse who caught was very experienced and did a great job. In fact, when I walked into the room at delivery to help "catch" the baby, I didn't even realize it was the nurse delivering. I was focused on grabbing a blanket, putting gloves on and watching how close birth was. The nurse was doing all of the maneuvers the doctor usually does; she was calm. It wasn't until afterwards that I noticed who it was.
Today neither of my preceptors were working. This has happened before and I've just been assigned to work with another nurse for the day. But, starting this week, I am working independently - off of orientation - with postpartum moms and babies; so, I worked independently all day. I felt like a "real" nurse. Yeah! Onward and Upward.
Monday, September 8, 2008
Fun New Site
I just found a new site (hooray, for days off). It is called Wordle. You go and type in text and it makes a neat creation using the words you type in.
I used a poem I wrote years ago about breastfeeding and the results are kinda neat.
Here it is in "Wordle Mode" (click on it to see it bigger)
And, Here it is in the original format:
"My Best"
As the moons pass month after month
My belly and breasts swell …
Fuller and Rounder - radiating the glow of life within.
I admire the wonders of my womanly body as
My sensuous curves turn motherly
My motherly curves remain sensuous.
Finally, My day arrives.
The day woman becomes mother.
I'm frightened by the surge of energy that comes from a place deep within me I have never known before.
I need comforting,
I need support,
I need a wise woman - a mother to guide me.
As she stands motionless, I sense her presence.
She whispers for me to be strong,
To fully embrace my rite of passage.
To unite with other birthing women around the world who are also laboring with me.
Then, as the wind blows softly through my window it surrounds my body and holds me.
I feel the strength from the women of the world embrace me.
I now welcome the tremendous waves of energy my body produces.
Wave after wave after wave
My body works perfectly to birth my child.
And then, my hand reaches out and touches the unreal, the dreamed of, the perfect head of my precious child.
My baby is entering the world.
This world
So Kind and Cruel
So Joyful and Sorrowful
So Beautiful and Ugly
This is the world I have to offer my child
I vow to provide the best for my precious babe.
I will shelter, protect and nurture this gift from God.
I now offer my breast.
Full and round from months of anticipation.
Naked and ready for my babe's strong suck
I offer my breast.
I offer my best.
I used a poem I wrote years ago about breastfeeding and the results are kinda neat.
Here it is in "Wordle Mode" (click on it to see it bigger)
And, Here it is in the original format:
"My Best"
As the moons pass month after month
My belly and breasts swell …
Fuller and Rounder - radiating the glow of life within.
I admire the wonders of my womanly body as
My sensuous curves turn motherly
My motherly curves remain sensuous.
Finally, My day arrives.
The day woman becomes mother.
I'm frightened by the surge of energy that comes from a place deep within me I have never known before.
I need comforting,
I need support,
I need a wise woman - a mother to guide me.
As she stands motionless, I sense her presence.
She whispers for me to be strong,
To fully embrace my rite of passage.
To unite with other birthing women around the world who are also laboring with me.
Then, as the wind blows softly through my window it surrounds my body and holds me.
I feel the strength from the women of the world embrace me.
I now welcome the tremendous waves of energy my body produces.
Wave after wave after wave
My body works perfectly to birth my child.
And then, my hand reaches out and touches the unreal, the dreamed of, the perfect head of my precious child.
My baby is entering the world.
This world
So Kind and Cruel
So Joyful and Sorrowful
So Beautiful and Ugly
This is the world I have to offer my child
I vow to provide the best for my precious babe.
I will shelter, protect and nurture this gift from God.
I now offer my breast.
Full and round from months of anticipation.
Naked and ready for my babe's strong suck
I offer my breast.
I offer my best.
Saturday, September 6, 2008
Being a "Team Player"
"There's no 'I' in 'Team!"
Right?
I know it, but I'm still feeling frustrated, somewhat. The past week has been crazy busy on OB. In the past 24 hours there were 8 babies born.....8!
And with the babies coming fast and furiously, the staff is stretched to the limit. And, I am finding myself being used as a postpartum nurse, so my preceptor can then take on other patients as well. I know it is best for the "team." But, having it so busy that there isn't time for my preceptor to precept me is.... kinda ... counter-productive. Wouldn't it be more profitable if I could function in all aspects of care independently, rather than just being able to be a postpartum nurse independently? Then, I could help lessen the strain on the staff even more.
I feel like my orientation has been stalled and I am spinning my wheels in postpartum. I can now care for four patients and their newborns proficiently.
But, I am feeling ready to move on. We only did Outpatients two days this week.
I'll wait and see what the next week brings.. Hopefully it will bring some progress and new learning experiences.
Right?
I know it, but I'm still feeling frustrated, somewhat. The past week has been crazy busy on OB. In the past 24 hours there were 8 babies born.....8!
And with the babies coming fast and furiously, the staff is stretched to the limit. And, I am finding myself being used as a postpartum nurse, so my preceptor can then take on other patients as well. I know it is best for the "team." But, having it so busy that there isn't time for my preceptor to precept me is.... kinda ... counter-productive. Wouldn't it be more profitable if I could function in all aspects of care independently, rather than just being able to be a postpartum nurse independently? Then, I could help lessen the strain on the staff even more.
I feel like my orientation has been stalled and I am spinning my wheels in postpartum. I can now care for four patients and their newborns proficiently.
But, I am feeling ready to move on. We only did Outpatients two days this week.
I'll wait and see what the next week brings.. Hopefully it will bring some progress and new learning experiences.
Tuesday, September 2, 2008
Credentials
As part of my class towards my BSN, I am asked to answer an opinion based question with adequate support of that opinion. I will share with you here question #2 and my response.
Question:
What do you think should be the entry level of education into professional nursing practice?
My response:
The topic of academic credentialing is one that has fascinated me, personally, for some years now. When I first became interested in childbirth, I slowly realized that I felt lead to become a midwife. One who would calmly guide birthing women during their pregnancies and births, facilitating gently childbirth and peaceful postpartum experiences.
Historically, women received this type of care generally from the women in their families, who would all surround the birthing woman and lend her their strength and enhance her endurance and specifically from the community midwife. However, throughout the years, matriarchal childbirth has faded behind the medicalization that is now commonplace.
In researching my available choices regarding my educational path into midwifery I had to consider many factors. Many of which focused on the "Professionalism" of Midwifery and the formal education required in order to be considered a "Professional."
There are two types of midwives, basically. Direct-entry midwives (those who learn through apprenticeship or direct practice) and Certified Nurse Midwives (those who learned the skill of nursing first, then continued into specialized training to become CNMs).
In my heart, I embraced the direct-entry (home birth) midwives. I value their innate trust in the birthing process and the respect and empowerment they infuse into the women they touch. However, I had serious reservations about the social standing of these midwives in today's society, leaving them open to legal problems and uncertainty.
Home birth midwives are not viewed as "professionals." They do not acquire their knowledge through well-defined academic pathways. Nor do they necessarily have to belong to or adhere to any professional organization or standard of practice. Furthermore, they are not protected by the profession's standards and codes, as outlined in Nunnery (1997).
So, in making my own personal choice about my journey into midwifery, I had to weigh all of the information. Finally, I was led to the decision to submit to the social authority placed on Registered Nurses and Certified Nurse Midwives. In doing so, I am also embracing the umbrella of protection provided by adhering to their established scope of practice, standards and code of ethics.
However, this is not to say that I do not respect direct-entry midwives or their mode of education. In fact, their mode of education make sense to me. The new apprentices learn at the knee of experienced midwife. They learn the process of childbirth inside and out with an experienced provider, hands on.
This process looked more and more appealing to me as I got deeper and deeper into nursing school. I would stay up late into the night making a 6 page nursing care plan for an elderly man with COPD. I would think to myself, "HOW is this going to help me become a good midwife?" I would wonder if my time couldn't be spent more wisely going on prenatals with the community midwife, observing the way she palpated the uterus and identified the presenting part.
But, I would remind myself, society has recognized this pathway, and I was committed to making the best choice for not only me but my family as well.
So, I can see the value in many various modes of education. Formal, academic education in a university surpasses other modes of learning merely by allowing one to become academically credentialed, something that is of high value in our society, perhaps to the point of hindering free trade and inflating the growing job monopoly created by the education-based hierarchy (Collins, 1979). It does not, in my opinion, automatically, make one more knowledgeable, more prepared or more able to provide care for someone.
In today's society it is a necessity to complete a formal academic education in order to provide healthcare. It protects the healthcare provider and the patient alike. Apprenticeships into nursing are not available. Nor, would they be socially acceptable.
Considering the available options of entry into nursing, it is my opinion that it would be acceptable to enter into nursing at the diploma level just as much as the baccallareate level as long as the combination of academic knowlege and skill competency is present.
A single piece of paper does not say all there is to say about ones skill level or ability to provide safe, competent care.
Collins, R. (1979)The credential society. New York. Academic Press, 1979. Retrieved September 2, 2008, from http://home.earthlink.net/~fheapblog/id14.html
Nunnery, R. K. (1997). Advancing Your career: Concepts of Professional Nursing. F. A. Davis Company. Philadelphia, PA.
Question:
What do you think should be the entry level of education into professional nursing practice?
My response:
The topic of academic credentialing is one that has fascinated me, personally, for some years now. When I first became interested in childbirth, I slowly realized that I felt lead to become a midwife. One who would calmly guide birthing women during their pregnancies and births, facilitating gently childbirth and peaceful postpartum experiences.
Historically, women received this type of care generally from the women in their families, who would all surround the birthing woman and lend her their strength and enhance her endurance and specifically from the community midwife. However, throughout the years, matriarchal childbirth has faded behind the medicalization that is now commonplace.
In researching my available choices regarding my educational path into midwifery I had to consider many factors. Many of which focused on the "Professionalism" of Midwifery and the formal education required in order to be considered a "Professional."
There are two types of midwives, basically. Direct-entry midwives (those who learn through apprenticeship or direct practice) and Certified Nurse Midwives (those who learned the skill of nursing first, then continued into specialized training to become CNMs).
In my heart, I embraced the direct-entry (home birth) midwives. I value their innate trust in the birthing process and the respect and empowerment they infuse into the women they touch. However, I had serious reservations about the social standing of these midwives in today's society, leaving them open to legal problems and uncertainty.
Home birth midwives are not viewed as "professionals." They do not acquire their knowledge through well-defined academic pathways. Nor do they necessarily have to belong to or adhere to any professional organization or standard of practice. Furthermore, they are not protected by the profession's standards and codes, as outlined in Nunnery (1997).
So, in making my own personal choice about my journey into midwifery, I had to weigh all of the information. Finally, I was led to the decision to submit to the social authority placed on Registered Nurses and Certified Nurse Midwives. In doing so, I am also embracing the umbrella of protection provided by adhering to their established scope of practice, standards and code of ethics.
However, this is not to say that I do not respect direct-entry midwives or their mode of education. In fact, their mode of education make sense to me. The new apprentices learn at the knee of experienced midwife. They learn the process of childbirth inside and out with an experienced provider, hands on.
This process looked more and more appealing to me as I got deeper and deeper into nursing school. I would stay up late into the night making a 6 page nursing care plan for an elderly man with COPD. I would think to myself, "HOW is this going to help me become a good midwife?" I would wonder if my time couldn't be spent more wisely going on prenatals with the community midwife, observing the way she palpated the uterus and identified the presenting part.
But, I would remind myself, society has recognized this pathway, and I was committed to making the best choice for not only me but my family as well.
So, I can see the value in many various modes of education. Formal, academic education in a university surpasses other modes of learning merely by allowing one to become academically credentialed, something that is of high value in our society, perhaps to the point of hindering free trade and inflating the growing job monopoly created by the education-based hierarchy (Collins, 1979). It does not, in my opinion, automatically, make one more knowledgeable, more prepared or more able to provide care for someone.
In today's society it is a necessity to complete a formal academic education in order to provide healthcare. It protects the healthcare provider and the patient alike. Apprenticeships into nursing are not available. Nor, would they be socially acceptable.
Considering the available options of entry into nursing, it is my opinion that it would be acceptable to enter into nursing at the diploma level just as much as the baccallareate level as long as the combination of academic knowlege and skill competency is present.
A single piece of paper does not say all there is to say about ones skill level or ability to provide safe, competent care.
Collins, R. (1979)The credential society. New York. Academic Press, 1979. Retrieved September 2, 2008, from http://home.earthlink.net/~fheapblog/id14.html
Nunnery, R. K. (1997). Advancing Your career: Concepts of Professional Nursing. F. A. Davis Company. Philadelphia, PA.
A "Profession"
As part of the class I am taking towards my BSN degree, I have to answer opinion based questions with adequate support for those opinions.
I will share with you here question #1 and my response.
Question:
What are the characteristics of a profession? Does nursing currently fulfill the characteristics of a profession?
My Response:
As explained in Nunnery, a profession is a skilled occupation that has received socially granted authority. Knowledge within that profession is achieved and passed on through an established, academic route. The profession is governed by laws and socially established standards and codes. The resulting professionals are included into and guided by the established professional culture manifested by collaboration and support as needed through groups, formally and informally.
I believe nursing does fulfill these characteristics. Socially, nurses are viewed as ethical and honest; and, they are esteemed with respect (Jacobs, 2005). In fact, nurses are consistently ranked among the top professionals who are deemed most trusted by the general public, according to gallup polls. Additionally, the path to becoming a professional nurse is soley through clearly defined academic programs. Then, when one does become a nurse, they are bound by a Code of Ethics and must practice within the nursing scope and standards of practice.
Finally, there are many formal professional nursing organizations that nurses may join for support and collaboration throughout their career.
Nunnery, R. K. (1997). Advancing Your Career: Concepts of Professional Nursing. F. A. Davis Company. Philadelphia, PA.
Jacobs, A.K., MD. (2005). Rebuilding an enduring trust in medicine. Circulation 2005; 111:3494-3498. Retrieved September, 2 2008, from http://www.circ.ahajournals.org/cgi/content/full/111/25/3494
I will share with you here question #1 and my response.
Question:
What are the characteristics of a profession? Does nursing currently fulfill the characteristics of a profession?
My Response:
As explained in Nunnery, a profession is a skilled occupation that has received socially granted authority. Knowledge within that profession is achieved and passed on through an established, academic route. The profession is governed by laws and socially established standards and codes. The resulting professionals are included into and guided by the established professional culture manifested by collaboration and support as needed through groups, formally and informally.
I believe nursing does fulfill these characteristics. Socially, nurses are viewed as ethical and honest; and, they are esteemed with respect (Jacobs, 2005). In fact, nurses are consistently ranked among the top professionals who are deemed most trusted by the general public, according to gallup polls. Additionally, the path to becoming a professional nurse is soley through clearly defined academic programs. Then, when one does become a nurse, they are bound by a Code of Ethics and must practice within the nursing scope and standards of practice.
Finally, there are many formal professional nursing organizations that nurses may join for support and collaboration throughout their career.
Nunnery, R. K. (1997). Advancing Your Career: Concepts of Professional Nursing. F. A. Davis Company. Philadelphia, PA.
Jacobs, A.K., MD. (2005). Rebuilding an enduring trust in medicine. Circulation 2005; 111:3494-3498. Retrieved September, 2 2008, from http://www.circ.ahajournals.org/cgi/content/full/111/25/3494
Friday, August 29, 2008
Movin' Along
If you remember, my OB nursing orientation is broken into 5 rotations:
- Postpartum & Catching Babies
- Out Patients
- Labor & Delivery
- Cesarean Sections (Scrub & Circulating nurse)
- High Risk OB & Antepartum
Well, after 10 full weeks on the floor, I am "graduating" from postpartum & baby catching and moving into out patients. *applause* :)
I feel proficient with postpartum patients now. This week, I've worked independently, for the most part, with my preceptors being able to take on other tasks/patients on their own. I'm still a little tenuous when catching babies. I've never had to give an apgar score less than 7; so that tells you I haven't had a "bad baby" yet. I sincerely hope I have a bad baby while on orientation, with my preceptor right beside me.
I'm excited to move on. This out patient rotation will not be as long as postpartum was, I don't believe.
Today was the first day I had to work over-time: I caught a baby at 3:06pm. I got out of the hospital at 10 till 5pm...that is how long it takes to do all of the charting involved in catching. It was a good birth, though, and I didn't mind having to stay later.
Monday will be the first I have to work on a holiday. It's not a major holiday or anything... But, still. We are having our family picnic on Sunday instead of Monday, so that worked out ok; and, I get paid time and a half! Can't beat that.
- Postpartum & Catching Babies
- Out Patients
- Labor & Delivery
- Cesarean Sections (Scrub & Circulating nurse)
- High Risk OB & Antepartum
Well, after 10 full weeks on the floor, I am "graduating" from postpartum & baby catching and moving into out patients. *applause* :)
I feel proficient with postpartum patients now. This week, I've worked independently, for the most part, with my preceptors being able to take on other tasks/patients on their own. I'm still a little tenuous when catching babies. I've never had to give an apgar score less than 7; so that tells you I haven't had a "bad baby" yet. I sincerely hope I have a bad baby while on orientation, with my preceptor right beside me.
I'm excited to move on. This out patient rotation will not be as long as postpartum was, I don't believe.
Today was the first day I had to work over-time: I caught a baby at 3:06pm. I got out of the hospital at 10 till 5pm...that is how long it takes to do all of the charting involved in catching. It was a good birth, though, and I didn't mind having to stay later.
Monday will be the first I have to work on a holiday. It's not a major holiday or anything... But, still. We are having our family picnic on Sunday instead of Monday, so that worked out ok; and, I get paid time and a half! Can't beat that.
Monday, August 25, 2008
Hitting the book (singular)
Tonight I start another leg of the Journey.... Working towards my baccalaureate nursing degree.
The school I graduated from has just started an accelerated tract where an associate degree RN can complete all further requirements for the Bachelor's of Science in Nursing degree in one calendar year.
I'm not sure if I'm actually going to do the accelerated tract... I don't have a lot of classes left that I need to complete... So, I'm just taking one class at a time, chipping away at what's left. If it gets done in a year, great, if not, I'm not in a hurry.
My main focus is on gaining experience right now and completing the next degree is secondary. While I do not want to stop working towards it (because the temptation not to "go back" will be greater the longer I wait), I am not in a rush to get it all done, either.
When Madeline heard that I was going to class tonight, her eyes got wide and she said, "What? I thought you were done with your degree." I told her yes, but there are two more degrees I want to get. But I reassured her that doing one class at a time is going to be a world away from the craziness we all lived during nursing school. This class is one night a week for seven weeks, then it's over. Nothing like the 20 hours of clinicals followed by the classes and exams, etc. that was endured the last two years.
It will all be good. As long as I live, I hope I am learning new things.
The school I graduated from has just started an accelerated tract where an associate degree RN can complete all further requirements for the Bachelor's of Science in Nursing degree in one calendar year.
I'm not sure if I'm actually going to do the accelerated tract... I don't have a lot of classes left that I need to complete... So, I'm just taking one class at a time, chipping away at what's left. If it gets done in a year, great, if not, I'm not in a hurry.
My main focus is on gaining experience right now and completing the next degree is secondary. While I do not want to stop working towards it (because the temptation not to "go back" will be greater the longer I wait), I am not in a rush to get it all done, either.
When Madeline heard that I was going to class tonight, her eyes got wide and she said, "What? I thought you were done with your degree." I told her yes, but there are two more degrees I want to get. But I reassured her that doing one class at a time is going to be a world away from the craziness we all lived during nursing school. This class is one night a week for seven weeks, then it's over. Nothing like the 20 hours of clinicals followed by the classes and exams, etc. that was endured the last two years.
It will all be good. As long as I live, I hope I am learning new things.
Saturday, August 23, 2008
Something to Cry About
The family cat, Ariel, is missing the children along with me.
Normally she is a quiet animal that you hardly know is around except for the nightly request to Mark for a kitty treat before bed. She busies herself sunning by the sliding door or sleeping on Madeline's bed.
Not this past week.
She follows Mark and I from room to room, crying and crying. She is on our laps the minute we sit down. Currently she is sitting between me and the keyboard as I type.
She misses the children.
But, there is good news for little Ariel. The world will soon be as it should be as our children are on their way home from the beach tonight!
Wednesday, August 20, 2008
Monday, August 18, 2008
Summer Fun
We just got home from a mini-vacation at the shore. Mark's brother rented a beach house only a block off of the beach. Because of my new job, I didn't have vacation time earned to be able to take a whole week, so Mark and I went for the weekend and the children are staying the rest of the week with his family there.
I will miss them, but didn't want to deprive them of the opportunity to visit with their cousins and have one last vacation before school starts next week. The kids discovered the fun of a "boogie board." We woke up early and found shells on the shore, rode bikes on the board walk and ate breakfast out. It was a great weekend.
While there, I discovered my newest favorite dessert: Waffles and Ice Cream. It was just divine! I got a warm, freshly made Belgium waffle with 2 scoops of butter pecan ice cream on top. Awesome! I'm just lucky I would have to drive 6 hours in order to get it or I would have some serious problems fitting into my clothes!!
I will miss them, but didn't want to deprive them of the opportunity to visit with their cousins and have one last vacation before school starts next week. The kids discovered the fun of a "boogie board." We woke up early and found shells on the shore, rode bikes on the board walk and ate breakfast out. It was a great weekend.
While there, I discovered my newest favorite dessert: Waffles and Ice Cream. It was just divine! I got a warm, freshly made Belgium waffle with 2 scoops of butter pecan ice cream on top. Awesome! I'm just lucky I would have to drive 6 hours in order to get it or I would have some serious problems fitting into my clothes!!
Wednesday, August 13, 2008
2 Months Into It
I'm still focusing mainly on postpartum along with "catching" babies. The clinical tasks are well under my belt, and I'm becoming more and more comfortable with the policies and procedures that are routine in this hospital.
What I am working on now is prioritizing and critical thinking while allowing my self-confidence to grow more.
An example of a common situation that may arise is: When coming out of report I am faced with a physician who wants assistance with circumcising an infant, a post cesarean mother who is 20 minutes past due for a toradol dose and another mother asking for help breastfeeding her infant. What do I do first? That is what I'm working on. Being able to make decisions quickly.
Another aspect of prioritizing that I need to focus on is my ability to take care of my own needs and put other's needs on hold. Saturday was a perfect example of this: I did not take a breakfast break OR a lunch break. I continued working the entire shift until 3pm when it was time to report off to the next nurse. This was not an ideal day... BUT I need to slow down and let some things wait - even if only for 15 minutes while I empty my bladder and eat a snack. It is good for me and good for the patients in the end. This is no easy task for a mother to do as we, as mothers, are always in the giving/serving mode, it seems.
So, being able to discern what things need to be done, what things need to be done NOW and what things can wait until I take a break is an area I need to work on.
Still plugging away.....
What I am working on now is prioritizing and critical thinking while allowing my self-confidence to grow more.
An example of a common situation that may arise is: When coming out of report I am faced with a physician who wants assistance with circumcising an infant, a post cesarean mother who is 20 minutes past due for a toradol dose and another mother asking for help breastfeeding her infant. What do I do first? That is what I'm working on. Being able to make decisions quickly.
Another aspect of prioritizing that I need to focus on is my ability to take care of my own needs and put other's needs on hold. Saturday was a perfect example of this: I did not take a breakfast break OR a lunch break. I continued working the entire shift until 3pm when it was time to report off to the next nurse. This was not an ideal day... BUT I need to slow down and let some things wait - even if only for 15 minutes while I empty my bladder and eat a snack. It is good for me and good for the patients in the end. This is no easy task for a mother to do as we, as mothers, are always in the giving/serving mode, it seems.
So, being able to discern what things need to be done, what things need to be done NOW and what things can wait until I take a break is an area I need to work on.
Still plugging away.....
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