I am a nurse… But I am black first.

I am watching the protests around this country and realizing just how little people knew about the racism that black people still experience. I have sat in my department and listened to people complain about the protests without understanding what it is we are protesting.

We want justice and equality as a people!

I quickly realized that while I will always be a nurse, which I have always seen as my identity, I am black first.

My mind goes back to all those times I’ve had patients hand me their trash because they thought I was EVS, even though I wear the same ciel blue as all their previous nurses. I go back to the times where my patient assumed I was the tech and my white tech was the nurse, and looked almost dismayed when my tech corrected them. I go back to being called “n*gger” multiple times by patients who saw no issue with using the word and fully meant it as an insult. I go back to being the only black nurse on a shift and not being included in conversations.

I realize that I am a nurse but I have always been black first.

I am proud to be black.

I am proud to be a nurse.

Both of those things are a part of me, they are intertwined.

Instead of being angry at comments based on ignorance of what is really happening, I have started educating my coworkers. I am speaking on the black experience in this country. I now speak up about what police mean to black individuals. I speak on our experiences. I talk to my coworkers about racism at its core.

I don’t want to be the “angry black woman”, I want to be the black woman that educates on the black perspective.

I am a black nurse, I carry black experiences, I will not carry them quietly.

It’s hit home

I have been following COVID-19 since December when I first heard about it, and it was still being called the “Wuhan Flu”. Reading what the CDC is saying, reading WHO recommendations, reading articles about it, and so on.

But it was over there and I am over here. I kept up with the information but it remained at a distance to me. I was curious as we nurses are, but I wasn’t yet concerned. It hadn’t hit home.

And then that started to change. First Washington state. Curiousity turned to slight concern because now it’s on home soil… but still it was over there on the west coast and I am over here safely on the east coast. Then it hit California. Now I’m following it far more closely because it’s spreading. However, somehow in my mind I was still safe. That’s when I started hearing about cases in Florida. Okay, now it’s over here but it’s states away.

I’m still safe.

And then it hit Washington DC.

It hit home.

It was only a 2 hour drive away. That’s when I began closely following everything. I’m watching the news, I’m reading all the WHO and CDC updates. I’m trying to learn all I can. It hadn’t yet hit my city though and there was still that little idea that I was somehow still safe.

That idea dissolved when I heard about the case in one of the hospitals in my area. More cases followed. Now my hospital is dealing with cases and it’s a nightmare. We are now rationing masks. We have to be mindful of how many antimicrobial wipes we use because there is a limit on how many containers of wipes we can get a day. The department I am in cares for inpatients and outpatients so our risk of exposure is high. The ER is at the front line. God bless those providers. Visitation has been suspended. People are being screened before walking into the hospital now. I’m no longer concerned, I’m officially rattled to my core. It feels like things are spiraling out of control and as a nurse that’s a big no-no! States are having to go into quarantine. We haven’t hit that yet but I don’t think it’s far away. It feels unreal, like a movie almost. People are panic buying everything. I can’t find a roll of toilet paper anywhere. I had to go to two stores to find garlic…GARLIC! Who panic buys garlic?

The panic and fear is real.

It’s serious and we need to make sure we are taking it seriously. My colleagues and I have been making sure to teach patients proper hand washing techniques. We are all trying to send each other health care memes to keep our spirits up.

It’s not been great for my anxiety.

I can only hope and pray that we start to get things back under control. I hope humanity can band together and get through this as one. I hope we see that the differences between us are nothing in the grand scheme of things. I hope we as a people come out of this better than we were before.

It’s that time of year again…

It’s flu season!

Yaaaaaayyyyyy!

That means it’s time for myths, inaccuracies, and “internet doctors” to try and convince everyone the flu vaccine is evil.

Let’s address some of the foolishness, shall we?

  1. The flu vaccine does not give people the flu. If they get the flu after the vaccine there is a good chance they were already exposed to the flu virus before vaccination or right after receiving the vaccine (it can take up to 2 weeks to develop immunity).
  2. The flu vaccine is not made with a live flu virus. The virus used in the vaccine is dead.
  3. People still need to get the vaccine every year.
  4. Vaccines DO NOT cause autism (let’s let this lie finally die, ok?)
  5. Yes, there are sometimes multiple strains of the flu virus. That does not mean there is no point in getting vaccinated.
  6. While it is recommended for the young and the elderly, even healthy young people can benefit from getting the vaccine for protection.
  7. For those people that think getting the flu will help build your immunity better than getting the vaccine, no. Just… no. The flu can be deadly. Don’t play with your health like that!
  8. It is considered safe to get the vaccine while pregnant.
  9. Yes, the vaccine contains some additives, however, they are in small amounts and considered safe (Here is a list of what’s in the typical flu vaccine and why).
  10. Those “essential oils” are not going to effectively protect against the flu.

Flu season occurs every year and every year the same misconceptions pop up. As health care providers, it is our duty to educate and provide as much accurate information as possible. There is a wealth of information (like this, or this, and this) that can help us provide evidence-based information to our patients whenever possible. Of course we won’t be able to convince every patient we talk to but hey, we can try!

Team

You need a team.

If you’re a nurse, you need a good team. There is no way to survive on any unit without team work.

When you interview for a position, ask about the team work. How well do the nurses work together? How is bullying handled?

You’ll want to know these things. A unit that isn’t a team is a unit headed to hell in a hand basket. It can’t function effectively. Trust me, I’ve worked on units where it was every nurse for themselves. It was horrible. There were nurses that wouldn’t help with the new admission. It took an act of congress to get someone to help clean up a patient. Gossip spread like wild fire. Nurses ate their young for fun. It was two years of nursing that I never want to experience again. From that point on I decided I would not waste time on units like that.

That’s why finding about the team mentality is so important. You want to work somewhere with nurses that work together. You want to work in an environment that is not toxic. Regardless of how the shift is going, you want to know your coworkers have your back.

Nursing isn’t a solo job. We aren’t super heroes that can handle everything on our own. We have to depend on each other to get through the day. When the shift is nuts, you want someone you can vent to. When you aren’t able to save the patient, you want someone that understands the pain. You’ll want someone you can ask questions to that won’t make you feel like you’re stupid. You’ll want a team.

Do yourself a favor, find a good place to work.

July…

It’s July. For some of you that’s no big deal. However, if you work in a teaching hospital July means something deeper… Darker…

The “brand new” residents begin their rotations…

Chaos ensues.

If you have had the pleasure of avoiding the July rush, you’re lucky. For the rest of us, there’s a sense of impending doom.

So many orders. Most make no sense.

-pediatric doses ordered for adults.

-level one head CT for “AMS” on your 98 year old patient with known dementia.

-12.5 mcg of fentanyl q3hrs for your chronic pain patient.

-one unit of blood for an hgb of 5.

-MRI of the ankle to look for osteomyolitis of the toe.

Many, many more orders from an alternate reality…

In this moment, it is your time to shine! You are the only barrier between your patient and a doctor that is still getting their bearings. You’re going to have to speak up, a lot. You’re going to have to advocate. You may even have to knock a new doc off their self-appointed pedestal (when they tell you you’re “just a nurse” please refrain from punching them in the throat).

You can do this. Take a deep breath and remember: you’ve made it through many July’s and you’ll make it through many more…

Set up… To fail

So, the higher ups have decided to implement new changes in our department to make us more “efficient”.

😒🙄

Are the changes going to work?

No.

I say no, not because I am against change. I embrace change and fully believe medicine is an ever changing field.

I say no because the changes are rigid.

Our department is very fluid. We may not have a single patient one minute, and the next minute 6 outpatients are here and there is an vented ICU patient on the way down and a patient waiting to go back to their room. Our patient flow changes throughout the day and unfortunately the decision makers don’t recognize that. They see numbers. They see productivity. Pie charts and bar graphs.

Patient care just doesn’t work like that.

However, we are going to implement the changes. We will go along with what management wants. We will grumble and groan as we see how poorly the changes work. We aren’t afraid to speak up. The speaking has been done. At this point, we are going along so we can watch the changes fail and create more problems. We are doing this so that they can see how inefficient their decisions are.

Sometimes the only way to get through to someone is to stop talking.

Drug dealers

Sometimes I feel like the health care industry are some of the biggest drug dealers around.

Case in point, the largest drug bust involving medical providers happened just this month. I first heard about it on the news while at work. Of course I had to look into it because I didn’t want to believe professionals in the very field I work in would stoop this low.

I was wrong.

This NPR article gave some numbers that were astonishing. There were almost 60 individuals caught in this bust. The Appalachia region of the US has been hard hit by the opioid epidemic. It was discovered that over 32 MILLION opioid pills had been prescribed in this region. If you don’t know, that’s more pills than there are people in most of the states in the Appalachian area! Doctors, NP’s, pharmacists, even a damn dentist was part of the drug problem. The Washington Post article tells a little bit more about how absolutely unbelievable these “professionals” were. Some traded opiates for sex. One doctor operated a pharmacy in his waiting room. The dentist apparently unnecessarily pulled teeth to justify writing prescriptions! However, the article goes even further with all kinds of things these people were doing in exchange for writing prescriptions. It’s shameful. So many people are dying of overdoses. So many are in our emergency rooms getting narcan to try and save their lives. So many people are on our units going through horrible withdrawal symptoms. Why would anyone in the medical field want to contribute to opioid epidemic?

It seems like the DEA (Drug Enforcement Administration) is starting to crack down on medical field when it comes to opioids. The New York branch of the DEA just charged a pharmaceutical distributor with unlawful distribution. This case is one of the first of its kind in the country. If this works out as planned, I feel like we may start to see more companies held responsible as well as individuals.

It needs to happen. There needs to be some sort of accountability for the medical field. Some of us are a part of the problem, they need to be removed. We are here to save lives, not destroy them!

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.

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!

GFR

Now that I am in the radiology department I spend a lot of time focusing on GFR and kidney function. Why? Good question!

In MRI and CT we give contrast to a lot of patients. In CT the contrast is iodine based. In MRI the contrast is gadolinium (metal) based. Both types of contrasts are filtered out through the kidneys and thus the reason kidney function is so important in this department. The way we assess kidney function is by checking a patient’s creatinine level in their blood. Luckily for us we have machine called the i-Stat that can test the blood and give a result in two minutes. The result transfers into Cerner (our EMR) and the computer then uses that result to calculate the GFR. Great… except I didn’t really have an understanding of why we were checking the creatinine, what GFR really was, or why there is a GFR result for African Americans and non-African Americans. I decided to do a little reasearch and I figured, since this is a nursing blog and all, why don’t I share what I have learned?

What is “GFR”?

GFR stands for glomerular filtration rate. Basically, the GFR tells you the flow rate of fluids through the kidney. Your glomeruli are the capillaries in your nephrons inside the kidney. Blood is filtered across the capillary membranes helping to remove waste that can ultimately be excreted through the urine. Taking you back to anatomy and physiology in nursing school aren’t I? *shudders*

A simple google search will bring up lots of GFR calculators. Typically the GFR calculator takes into account serum creatinine, age, gender, and race (African American versus not) and then it will give you the estimated GFR. A GFR >60 indicates a generally healthy kidney. Less than 60 can indicate potential kidney disease. Less than 15 can indicate full on failure. Here is a little infographic that is patient centered.

Why creatinine?

Why does the GFR equation use creatinine? In the most basic terms, creatinine is a waste product of creatine. Creatine is used by the muscle cells for energy. Your kidneys help filter the creatinine out of the blood to be excreted in the urine. Low creatinine typically indicates good kidney function (which makes sense, healthy kidneys will filter out creatinine effectively). High creatinine indicates the opposite, kidney function is probably on the lower end because the kidneys are unable to filter out the waste product. Creatinine is primarily filtered out through the kidneys which is why it is a pretty good indicator of kidney function.

Why is the result different based on race?

Many, many times I have looked at my labs and wondered why the GFR had a result for African Americans and then essentially everyone else. It wasn’t until I started working here and paying attention to the GFR that I decided to look it up. Turns out studies show we have “higher than average” muscle mass so we generate higher levels of creatinine. Higher creatinine levels lead to higher filtration rates. The difference in results account for this.

Now I can actually explain to my patients why I am taking blood after I start an IV. I like to be able to asnwer my patient’s questions so of course I had to do a little learning on my end. Hopefully some of you will also find this information useful! (Also here is a great reference for frequently asked questions from the National Kidney Foundation because, why not!)