The Ativan isn’t working…

Hey doc,

It’s Fred, the MRI nurse calling about your claustrophobic patient detoxing from opioids.

The ativan isn’t working. 😒

I’m not sure why you thought 1 MG of ativan IV would get your patient to hold still for an hour inside of a tube that can sound like a jack hammer but THE ATIVAN ISN’T WORKING. It’s not going to work. He is detoxing… FROM OPIOIDS!

How about you let us do this the way we wanted to and let us complete this HOUR LONG STUDY under anesthesia? It’s propofol, you know, the same stuff you guys were using when you had him intubated? Remember how well that worked? Yeah, we can do that down here as well. We use just enough to get him asleep and only leave it on long enough to complete the study.

But no. Instead you would like for us to “just give it a shot” without sedation. He has pain medication and the ativan so that should keep him still. Oh okay. Well, I hope you get all the information you can from these blurry images we were able to get before we stopped the scan because he almost climbed off the table.

Let us know when you want to schedule him for sedation, I can do that for you…

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Stress

I am about to start school. Another one of my coworkers is about to start clinicals for her NP. Another coworker is about to start her NP program. Needless to say, we are all stressed. At least I’m not alone, right?

I decided, however, I’m not going to let myself break under the stress of school and work. I am going to make sure I have some kind of kind outlet.

The first time I went to nursing school my friends and I would go out as a way to celebrate completing a semester. We would dance and let loose. It helped, it gave us a little something to look forward to. When I went back for my BSN my brother would notice I was stressed and drag me to Starbucks or Barnes and Noble (two of my favorite places) to have a moment of of the house. He would also make me do my studying there where there were no distractions (like the TV 😐) to steal my attention. It worked.

So now I’m trying to figure out what my de-stress plan will be for this go round. I know I’ll be doing the “out of house” studying. I think it may be time to bring back the end of semester party night as well! I just know I can’t let myself break under pressure. I’ve got to figure out what my self care will be for this experience…

April 1st

It’s coming.

April 1st.

No, I am not worried about April Fools Day.

I start graduate school. I make that first step towards my Master’s degree. I take that big leap back into school.

I. Am. Terrified. I don’t know why. I feel like I’m not ready. I feel like I have gotten myself in over my head. I feel like I am not good enough for this. I know this is my anxiety talking. This isn’t my first time dealing with the panic and self doubt that comes with anxiety. Anxiety stopped me from going back to school before now. Anxiety almost stopped me from taking the job I have now. Anxiety has awoken me from my sleep with my heart racing for absolutely no reason. True anxiety is no joke. It’s not easy for me to admit that I deal with depression and anxiety. I am the nurse that has it all together. I am the nurse that other nurses vent to. I am the nurse running a blog giving advise to other nurses. I am the nurse that has mental health issues.

I am not going to let anxiety win though. Yeah, I am scared sh*tless, I won’t lie. I feel like I might have made a mistake. However, I am still going to log into my student portal on April 1st and begin looking over my first assignment. I am the nurse that is going to have her Master’s in two years because I am the nurse that refuses to give up.

A new thing

So I’m trying something new for health reasons.

Actually, I’m closing out my fifth week of it.

I removed meat from my diet.

My blood pressure the last few times has been borderline hypertensive. My weight is higher than it really needs to be. I always felt sluggish after eating a meal with a lot of meat. I also felt like it took so long for me to digest.

I know I wasn’t eating the right proportions of meat to vegetables. My meals were always meat-heavy. So I made a conscious decision to just cut it out all together and leafn how to eat the veggies I so often avoided.

My pressure is down closer to normal the last time it was checked. I lost about 3 pounds. One thing I wasn’t prepared for was how often I’m in the bathroom! Fiber, man, fiber! But I can honestly say I do feel better. I have no idea how long I’m going to keep this up. So far I’m not missing meat. I do wish veggie bacon tasted better though. Either way, let’s see how long this lasts…

Unnecessary

I almost lost my temper.

One of the anesthesiologist does NOT know how to talk to people.

It feels like she is being condescending at all times. I get it, you’re a doctor. I respect that. However, it’s totally unnecessary to speak to people in that manner. I am a nurse. If you talk to me instead of at me you would know I have plenty of nursing experience. I know quite a bit more than you give me credit for. I am fully capable of the tasks that are required of me during this anesthesia case. I can do whatever you need if you just ask. Contrary to popular belief, nurses don’t read minds.

I’ll say this, she has one more time to speak in her condescending tone. One more. While I am going to be professional and respectful, I’m going to put her in her place. I’ve had to do it with plenty of residents and a few attendings. This isn’t new for me, I know how to get my point across. She needs to be knocked off the pedestal she placed herself on… I’m just the one to do it.

A la carte

I work with different doctors almost every day. What I’m doing depends on the doctor I’m working with or which doctor I’m on the phone with at the time. It can be super frustrating.

Doctor A wants things done this way when they are in the department. Doctor B wants to do it a totally different way. Doctor C doesn’t care how its done as long as it’s done. None of the docs actually communicate their wants with the nurse until the nurse does it the way they don’t like. Oh, and Doctor D on the phone wants the test done with contrast but Doctor E ordered it without. As the nurse, I’m just supposed to make it work. It’s as if I should be able to read minds.

Sometimes it feels like doctors order from a menu when they give orders to nurses. A little of this, some of that, a few of those… I just wish we could all get on the same page. Let’s pick a method and stick with it. Why is this so hard?

Decision made…

So…

If you remember some blogs ago, I posted about applying for NP school.

I didn’t get in.

sad failure

I felt like sh*t. I felt small. I felt insignificant. I felt like a failure. I was super bummed about it.

Was…

You know how you make a plan and then allow the opinions of others to make you veer from your plan? Yeah, that happened. Let’s go back a little, shall we?

If you have been with me for a while then you know I have been wanting to go back for a Master’s degree for quite some time. I have bounced between where in the nursing field I wanted to specialize. I have had people tell me I would make a great teacher. I love teaching people about things I know. Teaching is something I have grown to really, dare I say, love. Months ago I was talking to one of my coworkers that has been a nurse forever. I told him about wanting to get my DNP ultimately. His response? “Great! Get your MSN in education and then come back here (the academic hospital where we work) and get your DNP! You’ll make a good teacher”. Prior to even talking to him, the “education” path had been floating around in my mind. I kept pushing it away because according to everyone else, that’s not the “money making” field. As far as most people are concerned, there’s no reason to go back to school unless it’s to get a degree that is going to make you way more money. Forget doing what I like to do. Forget wanting to make a difference in the medical field. Forget wanting to help others. Will it make me more money?

I got sucked into that mindset.  A DNP will make me more money and I need to get it now. Forget getting an MSN and then a DNP, that’ll take too long. Nope, I’m going BSN-DNP STAT!

I was introduced to a program that had the BSN-DNP option. Great! I expressed interest and quickly found out I did not have the GPA currently to do the DNP program.

denied

I could do one of the NP tracks though. Oh… Okay, I guess. I mean, I wasn’t really looking to be an NP but according to everyone else, it was the way to go. So I applied for the NP option. I filled out the application (3 times because the system kept losing it which was probably my first red flag), updated and sent in my resume, completed the essay, and got glowing references (which I ended up having to scan to my email to send to the advisor because the reference link wouldn’t link back to my application because of a glitch, second red flag), and I waited…

And waited…

And waited…

For four weeks.

And then the rejection email and the pity party.

So after all of that, I had to really sit down and think all of this through.

What do I enjoy doing? Where do see my career going? How do feel I can be the best benefit to others? What do really want to do?

I. Like. Educating.

DAMMIT SHAUNELLE, YOU’RE AN EDUCATOR!!!!

I am planning to start school in April. I got accepted into an MSN in education program at the same university that I obtained my BSN from. I should have my degree in about 1.5-2 years if I can buckle down and do this full time. I am not doing what everyone else wants me to do. I am not going for the big bucks (if I wanted big bucks nursing is probably not where I should have headed anyway). I am going to do what I feel is going to make me happy in the long run. It may take an extra step or two but I am going to do things my way.

 

 

 

CIDP

In nursing, we are always learning something new. Sometimes we learn about a new med. Sometimes we learn about a new use for a med. Sometimes it’s a new side effect. Sometimes it’s a disease you weren’t aware of.

As I’m writing this, I just came across a disease I never knew existed: chronic inflammatory demyelinating polyneuropathy.

Say that five times fast!

I had a patient that had an MRI of the brain and complete spine ordered (that’s at least two hours) and the reason was “CIDP”. I have never come across this abbreviation before so I had to hit up good ol’ Google to find out what it is.

Turned out to be very interesting, at least to me.

What is it?

CIDP is rare. It’s a disorder where there is inflammation in the nerve roots and peripheral nerves. It also destroys the myelin sheath over the nerves. This inflammation and destruction interfere with signal transmission. Patients notice muscle weakness, impaired motor function, and it’s typically noticed on both sides of the body.

How is it diagnosed?

According to the rare disease database put together by NORD (National Organization for Rare Diseases), the symptoms of CIDP progress slowly. Patients notice “symmetric weakness of both muscles around the hip and shoulder as well as of the hands and feet”. These symptoms must continue for at least eight weeks without improvement to be considered CIDP. Patients may also undergo EMG’S, nerve conduction studies, lumbar punctures, and MRI’S to help lead physicians to the diagnosis.

Why do symptoms have to persist for so long, you ask? Great question.

Turns out, Guillain-Barré syndrome is kind of an acute form of inflammatory demyelinating polyneuropathy. With GBS there’s typically a preceding virus or illness. GBS progresses over three or four weeks. The symptoms plateau, get better, and don’t re-occur.

The extended period of time is to differentiate CIDP from the acute forms. With CIDP, the symptoms don’t get better without treatment. GBS is usually related to an illness while CIDP doesn’t really have a known cause yet.

How is it treated?

Corticosteroids and immunosuppresants are the standard treatments. According to the NORD article I linked to, IVIG has also been proven effective. It seems that plasma exchange has also been an effective form of treatment. However, both forms of therapy only last a few weeks and the patient may need intermittent treatments.

I spent about an hour reading about this disease because it was so new to me. That’s something I’m trying to make sure I do, read up and learn about the new things I come in contact with here in the hospital. I know I can’t learn everything. That isn’t going to stop me from trying though!

Pause and plan

All hell is breaking loose.

It looks like it’s not going to get better any time soon.

You are really close to the point of tears.

Pause. Breathe. Let’s plan this out.

It’s time to break out those critical thinking skills and use that time management you have been developing.

Look at the situation as a whole, is it as complicated as it seems? Can things be broken down into multiple manageable tasks instead of one giant ball of “what the actual hell”?

Start thinking. Which patient is the most critical? Can someone check on your other patient while you attend to the patient circling the drain? (You know what, the cup of ice is going to have to wait.) Which tasks are the most important? What tasks can be delegated? Do we really need to go to CT right now or can we see if we can push it to a later time when things are a bit more calm? So there are 5 patients in the waiting room, they all came at the same time. All of them are here for their scan. That’s great but you only have two scanners so let’s take each patient one by one.

The point is this: you are one nurse. One. Singular. Nurse. You CANNOT do everything at the same time and that does not make you a failure. Don’t panic. Take a moment. Pause and plan. Use your resources. Who can help you? Align your tasks from most important to least important. Tackle what is most important first.

More importantly understand this: there are only so many hours in your shift. There is only so much you can do. If you have to pass on a task or two, don’t feel like you failed for the day. Nursing is a 24-hour job. You are not super-human. Sometimes you can’t do it all. Understand that’s okay.

Appreciated

A while ago my nurse manager came down to the department I was in to check on me.

My nurse manager came to check on me.

The day was turning into a hot mess and I had to get help from our sister nursing department to help get things back on track and help me put out the flames. After things started to calm down, my nurse manager came down to where I was to check on me and do you know what she said? “Fred, I am so glad I hired you.”

Say. What?

Did… Did she just show appreciation for how hard I was working?

HOLY HELL MANAGERS DO THAT?!?

Turns out, good management does. I cannot even count how many times either my nurse clinician or nurse manager has popped up in the department giving us updates or just checking in.

I have never really had that happen before. In fact, I was so unused to it that the first time my nurse clinician came down to the department checking in I thought I was in trouble! I really thought I had gotten reported for something and was about to be written up! That is how little I was used to seeing management (unless they were asking if we updated our whiteboards).

I was talking to another floor nurse, in fact, the one from the last blog, and telling her about management coming and checking in and she was also flabbergasted. She, too, was only used to seeing management whenever there was an issue.

That’s sad.

I don’t place 100% of the blame on management, though. I know they are encountering the same problem. Their higher-ups only want to discuss what they are doing wrong, give them unrealistic expectations, and unrealistic time-frames to complete the unrealistic expectations. Meeting after meeting they get bombarded with complaints. It’s a miserable existence and I can totally understand why so many nurse managers leave the job.

This is a bigger problem with how hospitals are a business focused more on numbers than patients. It trickles down. Miserable management creates miserable staff, and that leads to the high turnover rates in the nursing field.

No one feels appreciated and that needs to change.

I am lucky enough to work in a department where I actually feel appreciated. Yes, we have our foolishness just like every other area in the hospital. However, I find myself far less stressed in this position. I want more nurses to be able to feel this way. I want it to get to a point where seeing management becomes a positive thing. I wonder how we, as a group, can change this?