Wednesday, November 9, 2011

Smoking for Nurses

Ok, so being a nurse, let me first say that I know better. I really do. However, for the last 11 years, I've been a pack a day smoker.

It's been pretty easy to keep it up: at first I had nursing school as an excuse. I told myself that I'll quit right after nursing school. However, right after that I was dealing with my divorce. I'll quit right after my divorce. Now it's a paternity/custody battle with my son. I'll quit right after that. Also, my job is really stressful at times; I'll just smoke when I'm stressed out. I once had a COPD patient go into respiratory distress, desat to about 68%, get put on a full-rebreather, and sent to the ER; the entire incident stressed me out so much I had to take a break and go burn one. Oh, the irony of that situation is epic.

I definitely recognize this behavior as self-justification. For God's sake, I learned about it psychiatric nursing. Anyhow, since no time will be a good time to quit I decided to just dive right in.

Having several failed attempts with patches and gum, I decided to go with a medication. First of all, let me state that I personally am very skeptical about medications and their long term effects on the body, so it has to be a pretty extreme circumstance for me to consider medication for anything. Especially if the medication works on the brain.

My reasons for quitting are pretty much "DUH!" at this point, but I think the real kicker that got me moving is that I'm sick of hacking up copious phlegm every morning and I really noticed that I've been getting winded easily when I exercise.

I decided on Chantix because it seems to have a general consensus (among websites like WebMD; I refuse to pay $30 for the actual research) to have a higher success rate than Zyban. I liked the more attractive pricing of the Zyban, as well as the antidepressive properties (after all, it is just rebranded Wellbutrin). However, I decided to go for broke and get the newer, supposedly more effective drug (ignoring the research that links depression and suicide to its use). So far, I'm about a week in, so I can still smoke.

My experiences thus far has been pretty positive. I've had no disturbances in sleep and I don't believe that I'm feeling any more depressed than normal. Sure being in the middle of a court case, apartment hunting, and having bill collectors call 24/7 for debts from my marriage that my ex has no intention of paying makes you feel pretty rundown, but I don't believe anymore so than normal. I'm certainly not thinking of offing myself either, so worries there either. (By the way... not me in the photo!)

One thing I've noticed is that I don't have the urge to smoke as much. At the end of my first week, which would be tonight, I've noticed about a 75% reduction in the amount of cigarettes I'm smoking. Sometimes I just forget to, even though I can. I'm smoking about 5 a day instead of the normal 20. When I smoke, it doesn't have the same appeal that it used to. The way the action of the medication works is that it supposedly inhabits the receptor cells in the brain that nicotine used to. I immediately think to compare it to narcotics and narcan. It seems to be doing a decent job so far.

We'll see tomorrow when I go smoke-free. Fingers crossed!

Tuesday, November 8, 2011

Angry Nurses

Okay, so I got screamed  at by an incoming nurse during report. I decided to write a little post about this, and maybe I can get some feedback.

First of all, you probably want to know what major offense caused this particular nurse to go ape-shit, banshee-screaming wild on me. In a nutshell, I forgot to put multi-podus boots (MPB) on someone. Normally, I agree that this is a big deal, however, as explained to her, due to the fact that this particular patient's skin issues were known to me, I repositioned this patient hourly, making sure heels were floated on the pillow each time. Skin issues were abundant. This patient had at least 5-6 pressure ulcers, poor nutrition, tube feeder, wound vac, foley, spongy heels... just the works.

As a sidebar, I don't feel this patient is appropriate for a rehabilitation hospital such as ours; our focus is being the bridge between hospital admissions and home. A prerequisite of our facility is that the patient must be able to physically endure three hours of physical, occupational, and/or speech therapy daily. A big focus is on recovering lost ability or learning to live with a disability. A newly appointed marketing team has been sending us incredibly inappropriate patients. One of last week's patient had dementia so bad she couldn't even finish a sentence because she couldn't recall what she was saying midway through.

Back to the issue at hand, in my defense, I simply didn't have a chance to run across the paperwork stating that MPB were ordered until late in the shift. I have 10-12 acutely ill patients nightly and reading every physician order since admission (it didn't appear on the kardex) is simply not feasible. I was the first one to even notice the order and reported it to her. So, I believe I acted to the best of my ability, and while MPB are great, repositioning hourly I feel would be more effective anyhow, especially since the heels were elevated.

Well, this nurse basically turned into a screaming banshee and laid in to me, called me lazy, and embarrassed me in front of a bunch of nurses in the large report room. The one thing I hate about this field is simply working with women sometimes... I feel like I'm cruising on a hormonal highway sometimes; this is something I'm definitely not used to. This particular nurse has had this incredible hulk issue before with others. I don't think it's so much what was said, it was how it was said. I think I had ex-wife post-divorce screaming match flashbacks. Horribly unprofessional, in any case. I did handle the situation well and remained composed... though in the back of my mind I wanted to ask her if perhaps her Paxil prescription ran out.

My point is this: can't we just assume in most cases that our colleagues aren't incompetent or lazy next time someone doesn't have a last bowel movement or other similarly important, yet not immediately crucial, piece of information?

Wednesday, November 2, 2011

Refresher

Okay, so I'm back, my blog has a new name and a new domain!

If you haven't already figured it out, I passed my NCLEX-RN boards! Two clues would have been that number one, I can afford my own domain name now, and two, I haven't really had any time to post.

My divorce with my cheating bitch of an ex-wife is done and over with, now we are just fighting out custody for my son. And get this... three months after the divorce, this dumb ass is married yet again, to the same douchebag who she was with while I busted my ass in nursing school and managed to pay our bills. Oh well, you live and you learn. I'm happier now that I've completed nursing school than I've been in a long time. Get my son out of that weird ass Jerry Springer white trash situation and I'll be doing fantastic.

Nursing school was definitely worth it. Definitely. It was the hardest thing I've ever had to do, but now that's it's done, I've got a really great career. That's a good thing. That's not to say it's not without its downfalls though. It's stressful.

I see a big difference between LPN and RN, even though at first it didn't appear to be a big difference. Speaking about technical skills, it's not very different. However, the big difference comes in with the paperwork. Apparently, there are many... many forms that require an RN signature. There are careplans that need to be done (GAWD I hoped I'd seen the last of those; no such luck). It's just a stressful bitch of a job at times. At least the LPN to RN pay raise was worth the extra schooling.

Hopefully in a month or two I'll have saved up enough into a nice, new apartment. I'm currently rooming with two graduate students who smoke a ton of pot and watch ESPN all day long. It's been a fun ride, but I think I'd rather get a new place with a little more privacy and a little more kid-friendly for my son. Extra privacy for my awesome girlfriend :)

Anyhow there's a little personal update about me. I got a ton of responses regarding my personal issues I made in previous blog posts, so I figured what the hell. I'll be probably posting some stuff that's actually nursing-related in the near future, so keep reading!

New website, same posts, still in the works!

I've been trying to find the time to get this site back up and running! New look, new domain... but I retained all the same posts from the past and will have a bunch more new ones upcoming.

Wednesday, August 10, 2011

Oh, the horror!

Most horrible thing witnessed in my nursing career thus far..

So after my confused patient had a very uneventful night, his bed alarm sounded. By the time I responded, he is in the middle of the room. Normally, this wouldn't be too big of a deal, however, there's a catch. He had a foley in, and apparently while walking, pulled it out.

After this incident, which had me cringing from the thought of pulling a foley out, I of course had to inspect the site. Apparently, on the underside, his penis had split...

This was quite possibly the most gruesome thing I think I'd ever seen. I've seen ripped off arms, dehisced surgical wounds, but I think I was about green for this one.

Anyways, in response, it turns out his penis was partially split anyway and this just finished the job. Either way, there wasn't any blood. You could still see the urethra further back from the split, and since the patient had a urology appointment today anyway, we just decided to have a doc take a peek until the appointment.

Most horrendous thing I've ever seen... and especially if your relieving nurse is a male, if your patient's penis looks like a split hotdog at the ballpark, let him know so he's not walking into it blind!

Wednesday, August 3, 2011

Paper Charting


Making my first graduate nurse post, I'd like to give my thoughts on the EHR, or Electronic Health Record for those nursing students. In comparison to paper charting, I only have one comparison:

BETTER.

In my current job as a nurse, at an acute inpatient rehabilitation center, we use strictly paper charting. I can honestly say I'm pretty happy with getting this experience, however, I just gotta say it totally sucks.

It's not the pre-carpal tunnel pains I'm feeling in my penmanship hand that's my primary reasoning; it's efficiency. I'm paid a pretty penny to take care of my patients. I'm sure that my corporate office would like to see all of their monies they kick my way go for patient care, however, that's just not the case. I spend nearly half of my time each night creating worksheets from scratch, or filling in daily or weekly forms.

Whether I'm writing a report sheet, or filling out multidisciplinary conference forms, I feel that all this paperwork could be easily generated with some decent EHR software. Why should I spend as much time as I do chart-diving when EHR software would easily generate these forms for me?

I think the key to this is training, training, training. I work with a bunch of older nurses and I think there may be a few hold-outs. This is more of a rant that a full blown article, however, I'd love to see an even wider range of use when it comes to EHR software.

For clinicals, I participated in a pretty sweet McKesson software based acute hospital. It was awesome, quite frakly. Well...not really, but in comparison to the documentation methods I use where I work now, it's like comparing tin cans with string to high-speed cable internet.

Here's to hoping rehab and LTC facilities start to see the light. Less paperwork time means better patient care. Better patient care means more of those sweet 100% score satisfaction surveys.

Any readers care to share their thoughts on the EHR?

Blog Change

New career. New blog style, new blog name. Look for a new domain with redirect coming soon! All student blog posts will be retained and archived.

Finally made it...

First post in six months... I know, I know, so sue me.

Well quite a bit has happened. First and foremost, I passed my class. I did it, I graduated nursing school! We had quite the party and the local drunk bus had to come pick me up. It was a fairly epic evening.

However, I still need to complete the NCLEX-RN. Mailing in my papers tomorrow. Then I get to sit. Then, hopefully, I'll be in RN mode :)

Thursday, January 20, 2011

Dying Good

This new class is really something else. Now let me start by saying I don't even think it does it justice to call it one course; it's really four courses.
  1. Community Nursing
  2. Advanced Pediatrics
  3. Advanced Mother-Baby
  4. Leadership
Each section has it's own clinical sites. Each has it's own APA-style research paper and associated online tests I need to complete. There's also a massive group teaching project as well. This course really feels like they are cramming about one year of a Bachelor program into 12-weeks.

I did my clinical yesterday at an inpatient hospice facility. I thought it was really awesome. I mean really awesome. Patients were comfortable, not stressed, and it was very peaceful with the exception of family members not coping with their impending loss well. I mean seriously, if I'm gonna go, this is how I want to go.

I've seen patients, even some at my work, that I truly believe need this kind of nursing. I had a 90-year old patient with a gangrenous leg a few nights ago who was a full code status. The only reason she still had the leg was because she wasn't a surgical candidate... she would have died during the amputation. So instead of placing her on hospice care, the family felt it was best to admit her to a intense in-patient rehabilitation center where she was forced to complete 3 hours of physical therapy a day. She'd cry and say she just wanted to stay home and drink coffee and watch talk shows. I'll be damned if someone 90 years old in that poor of a condition shouldn't be able to do whatever the hell they want to and spend there last weeks or possibly months in comfort. You gotta love idiot MPOAs that can't see anything beyond their own selfish needs to hang onto someone's life with no regard for the quality of it.

I'd never seen hospice before yesterdaty, but I'm telling you, my patient from the other night could have drank all the coffee she wanted and watched all the TV shows she wanted and not had to deal with the ridiculously intense pain of muscle death in her gangrenous leg. If you're going out, that's how you want to go: pain-free, but not sedated, with plenty of time for inner reflection and meaningful goodbyes to your friends and family. Truly an amazing thing hospice is.

As far as the class, it's fairly insane the rate at which it goes. One thing after another, and another, and another... But I'm actually kind of used to it and not really shocked at this point.

Anyhow, until next post!

Wednesday, January 5, 2011

Arrangements for Next Semester

Ok, first and foremost, I got out of my living situation. Left the wife and now am living with my mom, who needs a little extra help due to some health issues. This is great in some respects, kinda crappy in others. Basically, I miss my son...

Continuing on and beginning to think about school again, I had to have a damn background check done (again) to have clinicals in a particular retirement home. Passed with flying colors!!

This semester really will be the last of the RN portion and I'll done! Complete with a degree, an RN license, and all that. I really want to get back into night school for my BSN and eventually MSN in FNP. I can't hardly wait.

This semester is essentially my "miscellaneous" course. There's going to be rotations in school nursing, advanced peds (NICU), and taking over an entire wing of a nursing home. This one is historically much easier than the class I just passed which was the advanced med-surg class.

I really feel like I'm on the home stretch. This is great all my work seems to be paying off; I just hope my living situation doesn't cause too much of a distraction for me; it's a tough situation to be having going on while wrapping up nursing school.

Until next post, and thanks for all the great advice I received last post!