August 03, 2005
The important things have stayed the same
I graduated from nursing school in 1967. I did many things, including med-surg, psychiatric, intensive care, and maternal/child nursing. In 1971, I entered the world of invasive cardiology and fell in love!
A cardiac catheterization was never performed until weeks after a heart attack, but the whole "techie" thing of looking at a heart under
fluoroscopy, injecting various dyes, and filming a beating heart fascinated me. To be able to tell parents exactly what was wrong with a child's heart and show them pictures and know what surgical procedure might be needed was a relief for everyone. I participated in all aspects, scrubbing in to assist the doctor, taking x-rays, running the monitor and analyzing rhythms, cleaning the devices, riding a stretcher to the operating room doing CPR, holding the hand of patients whom we couldn't save. What is so amazing is that with the rapid advancement of technology the procedures have gone from being strictly a diagnostic procedure - and pretty crude - to being able to intervene in a myocardial infarction and prevent muscle loss! The various devices and procedures are astounding - with more sophisticated procedures just over the horizon.
And yet one thing remains the same...the people. All are anxious and frightened; everyone needs a kind word and caring touch. Despite all our technologic advances, the human to human part of caring cannot be replaced. Smiles, words of comfort and caring, tears, hand holding, and phone calls are still very much the same as in 1971.
Dee Land, RN
July 13, 2005
How nice to hear from a rural nurse practitioner.
I am a rural clinic advanced registered nurse practitioner (ARNP). As part of an initiative at the state level, designated rural health clinics must employ ARNPs. There are 2 ARNPs operating the walk-in clinic. We work with 4 physicians who rotate as needed as our back up resource. Occasionally, when there is a need, I fill in for the local community college as a clinical instructor. Having spent most of my 25 year nursing career in a medium size city, I greatly admired the nurses working in the rural setting!
At our little local hospital, the census may only be 2-4 acute patients. One RN covers the ER and another covers the floor. The floor nurse may be covering a surgery patient while caring for other patients of any age or diagnosis. She may be admitting an obstetrics patient while waiting for the “on call” nurse to come and take over that duty. If the ER is slow, that nurse will assist as needed. However, the ER may receive a critical patient needing transfer to a larger facility, keeping that nurses hands full! Clearly the rural nurse wears many hats and has a wide base of knowledge and experience.
My duties as an ARNP here are much like those in the city. My patients are usually a bit more relaxed and friendly here. The patients show a genuine interest in getting to know me. I see industrial injuries from the orchards and occasionally from the farms. I have patients living "up lake". If they become ill in the dead of winter, they have to wait for a boat or plane to bring them "down lake" to visit the clinic. The boat only sails every few days in the winter!
Nursing is the most interesting profession I can imagine. I learn something new every day and am thankful to my fellow nurses (and to my patients) I am fortunate for having such a ”rich” career.
J H ARNP
June 25, 2005
We received just a few emails from geriatric nurses. This Canadian nurse shares her experiences and passion for the work she does. We should all be as fortunate as the patients she cares for!
I am a Registered Practical Nurse and I love my job. I have worked in a long term care facility for more than 25 years. Working with seniors has been the most rewarding job. The stories they can tell you about their lives are most inspiring.
A gentleman in the facility told me how he lied about his age to get into the navy at the time of the 1st World War. He shoveled coal in the engine room on a ship. He described an instance in which the crew was all called up on deck. The crew watched as they passed through a mine field in the English Channel. The mines passed by the ship with only inches to spare.
Another senior told me how she walked a mile to work each day, coming home for a lunch and walking back to work and then home again at the end of each day. Her feet were all crooked with huge bunions and corns from improper footwear. But she never complained.
Through the years I have seen hundreds for residents live with us for many years. Sometimes they are only with us for a few short months. You get to know these people sometimes better than their own families. As they pass onto a better place, I try to provide them with the respect and dignity that they deserve. I also provide families with the comfort and reassurance to help them get through an often very difficult time.
My own grandmother passed away at this facility after living there for more than 13 years. It was so sad to come in after her last stroke, unable to talk but did not even recognize her three grandchildren and her own son. They were all cried as they couldn't console her just as she used to do for them many times in the past.
I share this experience with most families and let them know that it is OK to tell their loved one to move on. I also let the families know that my grandmother loved to have us lay with her on the couch when she came to visit when I was a child. That last week of her life, I slept with her every night and I held her head in my lap as she peacefully slipped away. Some families are so grateful because they feel it isn't appropriate as the facility may frown upon this.
Nursing in geriatrics has been the best job. Yes, the job can get extremely stressful but the rewards outweigh them 10 times. To put a CD on and listen to several residents singing to "Good Night Irene" or "Jesus Loves Me," while others who can no longer talk, move their feet to the beat of the music; just melts my heart.
My goal before I retire is continue to love my job while teaching new nurses how to give these seniors that respect and dignity that they greatly deserve.
June 21, 2005
My nursing career began in pediatrics. After 2 maternity leave of absences, I was assigned to a neuro medical surgical unit. One day the Infection Control Professional (ICP) told me I would be offered a newly created ICP position because I was very detail oriented and always read my patients lab reports. I said "Gee, I don't know anything about infection control" and she whispered "Don't worry, no one else does either!"
That was 26 years ago, and I have been an ICP since that day… but, WOW has my job changed over time: AIDS came, OSHA (Occupational Safety & Health Administration) came, MRSA (Methicillin-Resistant Staphylococcus Aureus) and VRE (Vancomycin Resistant Enterococcus) came, TB (Tuberculosis), SARS (Severe Acute Respiratory Syndrome), Anthrax, bioterrorism came, needlesticks due to re-capping are gone, educated patients ask staff to wash hands, and public reporting of hospital infections has put a new spin on everything. I have almost always worked alone, full time and have never had a dull day. I rally my "nurse's heart and spirit" daily by remembering that if I am not enthusiastic and credible about all aspects of infection control, the staff and patients are not getting what they need and deserve… which is really why I became a Nurse… to care, and I do, through my role as an ICP.
Tina Lamberski, RN, CIC
All kids need
I am the Health Services Director at Indiana Developmental Training Center. We have 86 (soon to be 96) residential beds for mentally retarded and psychiatrically challenged youth from 6 to 21 years of age. We also have 2 group homes and a 64 bed residential facility. These kids have been through so much. Some have had more placements than they are years old. These kids need 24 hour parents and role models.
I do this work because I believe that by giving them some structure we might be able to turn their destructive behavior into constructive lives. We do have success stories, maybe not a large percentage, but enough to believe in what we do! I have worked in 2 places, and some of the kids I see as teens now are ones that were children in treatment in the other place I worked. They always get a kick out of mentioning the fact that I knew them when they were little. I get a warm feeling that they remember. I can't imagine not being involved somehow in the mental health care of our youth.
Nancy M. Ward RN, C
All kids need …a little hope and somebody who believes in them.
Having given birth to 8 children and having served as a doula, I went to nursing school anticipating becoming a labor and delivery nurse. After I completed my clinical rotation, I realized that a nurse cannot really get to know a patient well during the brief stays new moms have in the hospital. Instead, I worked in home health nursing for 6 years, serving in a variety of ways with a wide range of disease problems.
A friend told me that I really should work for the Arc of the Piedmont, which provides long term care for cognitively-impaired patients who have mental retardation or brain injury. A year after I starting working for the Arc, my 15-year old daughter was in a fatal car accident. She and the driver were declared dead at the scene, but she became combative when they were putting her in a body bag.
I was told that there was little hope for her rehabilitation with a 4-way coup-contrecoup such as hers. What I had learned from working at the Arc taught me there was hope. Music therapy animated her brain. My daughter, now 19, is studying to be a psychologist for brain-injured children. Only God knew that the Arc, not the labor and delivery suite, would prepare me for a life's tragedy.
Nina Beaman MS RNC CMA
June 13, 2005
I am a wound care nurse. I started out in a Skilled Nursing Facility/Hospice unit as a new graduate and charge nurse. The only RN with new graduate LVN's was a challenge. We learned from each other, textbooks, and the knowledge of nurses and doctors who would pass through and take the time to teach us.
At the time, wound care was something I knew nothing about. The wound care rate was greater than 40% so I started going to every seminar on wound care I could. With the assistance of a good physical therapist , the infection control nurse and the support of the hospital I started a wound care team. Five years later it revolved into a multidisciplinary team with protocols determined by the Agency for Health Care Policy and Research (AHCPR) guidelines and the Wound, Ostomy, and Continence Nurses (WOCN). This team presented to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) for a performance improvement project. Mandatory education to all nursing was required to teach how to measure treat wounds and the physiological causes of wounds. This was at a major hospital in Houston.
I have worked ICU, surgery, medical surgical; all have enhanced my knowledge in the treatment of wounds. I now work in a 110 bed long term care facility (as a wound care director) and have just taken my National Certification for Wound Care. I love to educate and teach how to prevent pressure ulcers and other significant wounds. It is nice to be able to work side by side with physicians and other disciplines to have a respectful relationship and work as a team to treat the whole patient.
I chose long term care because it allows me to follow wounds from the beginning to resolution. Taking the wound care certification has allowed me to apply the knowledge I have learned to direct patient care. It has also taught me the importance of treating the whole patient not just a wound.
Barbara Springer, RN (soon to be Certified Wound Specialist)
May 26, 2005
College health nurse
I've been a nurse now for twenty years practicing mostly in the hospital setting. Two years ago, I had a yearning to work in a clinic setting of some sort. While taking a Trauma Care Coarse, one of the instructors who I hadn't seen around the hospital in awhile told me she had left the ER to practice at local college health clinic. After a long discussion about college health nursing, I decided to apply for an inpatient position at that includes weekend clinic hours. I still work in the ICU at our regional medical center as well as part time at the college health center.
While the role of nursing is similar, the actual role is dramatically different in many ways. First and most obvious, the patients at the health center are much younger and overall healthier than the typical hospital patient. Therefore, the plan of care for the student is very dynamic and changes in hours versus the plan of care for the hospital patient is longer and often changes over days. The student patient response to treatment is much faster and therefore their return to health is much quicker. For example, many of the students that are admitted to the inpatient unit for dehydration from gastroenteritis turn around within hours and are discharged in a day.
Secondly, my role as a college health nurse involves more primary health care nursing since the clinic is staffed with a physician during the weekday hours but is on-call during the evening and weekend. The nurses assess and diagnosis the students and then treat them accordingly via medical directives. Much of our care (assessment, diagnosing and treating) therefore is done independently. The students present with a wide variety of problems ranging from the simple conjunctivitis to the difficult injury or serious illnesses requiring central lines care. Boy, does this ever demand and strengthen independent assessment and critical thinking skills!
Overall, I thoroughly enjoy the differences in the two areas of nursing. I enjoy working in the student clinic equally as much as in the ICU. I learn something new everyday at each setting that strengthens my practice and care at the other setting. I don't believe that there are many professions that would allow this type of variety and contrast in the same professional role.
May 19, 2005
Trying to make a difference
I started working as a nurses aide right after graduating from high school. In 1976 I graduated as an RN. Following 30 years of hospital nursing, I am now doing long term care (LTC).
In 2000, my father became ill. His physician gave little hope for his recovery. He was then on oxygen 24 hours a day, diabetic in chronic heart failure (CHF), and having gastro-intestinal bleeds which the physician assured me were Coumadin related. The physician said "You know, he is 80 years old. Do you expect him to live forever"? I said "No, but I want him to have the best quality of life he can have while he is here". I took off work, and cared for him. I found a different physician who cared about his quality of life. He was evaluated at the Cleveland Clinic.
Dad required an aortic valve replacement. A few months later he needed a bowel resection for colon cancer – something the previous physician never bothered to look for. I began to rehab him slowly. When he finally improved and off oxygen, I decided to enter long term care to see if I could make a difference for others as well.
As an ER nurse I had often lamented the LTC patients who were not sent for medical care soon enough for there to be a good outcome. I am now the unit manager of a skilled wing in a LTC facility. I have a variety of surgical as well as medical residents and am seeing improved outcomes with rapid interventions.
The elderly should not be shuffled off to LTC just to die. They need to feel they are a part of their surroundings and know they are cared for by people who are concerned about them. Their health and well being should remain a priority. Immediate action and vigilance improves outcomes. When the time for death comes, we are there to insure their dignity and comfort.
Despite the grim prognosis the original physician offered, Dad, now 85, is able to be outside planting Azaleas and raking up debris from winter. We must make efforts to improve long term care now.
Remember…we will soon be the ones being cared for.
An RN from Ohio.
May 18, 2005
Patience, empathy, listening,... and more
I am a psychiatric nurse who practices on a medical psychiatric unit. Patience, empathy, listening, and assessing without all the bells and whistles of medical nursing are my trademark skills.
I have to employ empathy, while they share with me, stories of horrible abuse they've endured. I have to let these stories go through me, around me, never ever letting the horror stay inside of me. If I did, I couldn't continue to do my job.
I listen to sorrow of a mother when she has lost her child, or a child that has lost a parent. They have lost their world as they know it. I try to help them find the skills and the will to pick up the pieces and put it back together.
I help the man from under the bridge, who drank rubbing alcohol, go through our withdrawal protocol to get sober. I also try to explain to the parents of the child who doesn't recognize them, what PCP is. I comfort the wife of the man who sold their children's Christmas presents for crack.
I have to know what a fundus is and how to check it. I have to know what normal fetal heart tones sound like. How could I take care of a pregnant or postpartum patient if I didn't? Post-partum depression is deadly, and I can prepare and carryout a care plan for this patient.
I can recognize seizures, abnormal levels of consciousness, changes in mental status, and start the detective work to figure out if it is a alcohol/drug withdrawal, overdose, stroke, or other organic problem.
I can assist with a pelvic exam and do penal swabs. I know the facts to teach how to treat and prevent sexually transmitted diseases.
I can prepare a patient for surgery, dress wounds, and take out sutures/staples. I can assist with the application of a cast, apply an ace bandages, or reapply a splint.
I can take care of a diabetic bulimic and/or anorexic adolescent runaway, drug addict, schizophrenic, or 83 year old Alzheimer's patient.
I can take care of a kidney dialysis patient, and know how to prepare and carry out their treatment plan.
I can give nebulizer treatments, monitor O2 Sats (% of Oxygen Saturation in the Blood), and hook up Consentrators. My patients have COPD, lung cancer, and emphysema.
HIV, syphilis, gonorrhea, hepatitis, MRSA, lice, scabies, ringworm, and positive TB skin tests (PPDs), are all part of my daily routine. I'm with the Doctor when he gives the diagnosis. After he leaves, I have to answer all the questions of the patient and their families. Then, I have to know the routine treatment/protocols for all of these diseases.
I take care of the homeless, the middle class, and the rich and the famous. Psychiatry is not just for the faceless anymore.
Psychiatry is about having broad nursing skills, being autonomous, and a patient advocate. Most of all, you have to be willing to use your hands, eyes, ears, nursing instinct, and your heart to do your job.
May 11, 2005
An angel in hospice
We received several very moving emails from hospice nurses. While every type of nursing demands some form of unique skills, nursing in a hospice setting has its own demands and unique rewards.
I am the Associate Director of a small hospice. In my heart, in my role and in my practice… I am a hospice nurse. Why am I a hospice nurse? Hospice nursing is holistic… encompassing every nursing assessment skill and life experience that we all accumulate throughout the years working with a true multidisciplinary team whose focused goal is providing excellence in end of life care… quality of life… helping people live each day as fully as possible… providing physical, emotional and spiritual care to those who have reached the end of their life while supporting the families and friends as their loved one declines. This all encompassing, holistic care is exciting, rewarding and is actually energizing. However, as I compose these words, to me, they sound so empty and canned. These words do not express the satisfaction that providing this specialized care in fact brings.
As I think about the last 2 weeks… a moving experience comes to mind that best expresses how being a hospice nurse provides joy and satisfaction. A young lady, who I will call Angel, recently died in our program. She was a young lady in her 20's with Downs Syndrome who was dying from a genetic heart defect. She was cared for by her mother and father. Two adult sisters also provided care and support. We were blessed to have Angel on program for a couple of years. What a gift! Angel’s Mom was a wonderful caregiver… fiercely protective. Her Dad and her sisters were very devoted.
I had heard about Angel from all our team members and had the privilege to meet Angel one Friday afternoon. I further had the pleasure of making multiple visits with her and her family. She was a young lady who totally lived in the moment. She was a child. She took life at face value. She took joy in the small things… the things that most of us don't have time to enjoy or appreciate. She loved any ordinary moment. She loved each person she met without reservation and expressed this love and affection with enthusiasm. She was generous with her emotions.
I think in many ways our team envied her ability to see each day through the eyes of a child. She live with honesty, wondrously, innocently, trustingly, openly, acceptingly. She saw the world in a way that was sacred and a world of love and peace. Even in her pain and her last days, Angel continued to love and to give of herself to everyone she met… her family and our hospice team. Her family also entered our lives and our heart.
Yes, my role as nurse is affirming. I was able to help with the medical aspects of Angel's care, and I was able to support the family during her decline. Most importantly, Angel left me we a gift that will forever be with me and other members of our team… the gift of love. She was unique as all of our patients are. Each patient teaches us a lesson, each impacts our life and how we live. Each impacts our nursing practice and approach in little ways. Angel impacted each of us in such a big way. She taught us about innocence and generosity and about the child that lives in each of us. I a hospice nurse… because of people like Angel. We continue to search for our next "Angel". Hospice is a gift to the professionals that open themselves up to the gifts of end of life care… to living each day as if it were a lifetime.