TagNurse Practitioner

Serving those who have Served

The end of my day was nearing and I was putting the finishing touches on my last chart. As I looked at the clock, proud of myself for actually being done before the 13 hour mark, a lady came from the private room across the hall looking distressed.

“Can I help you with something?”

She gave me that look I hate to get from a family member. You all have seen it. It is the one that sets off those intuition bells that make you instantly forget how freekin’ tired you are and that your feet are killing you.

“I need help with my husband,” she said in mid-stride back to the room.

Fortunately for me he was still breathing, had a pulse and was actually talking. He was confused as hell, but talking. I down shifted about 3 gears.

My immediate assessment was post-operative, acute delirium.

Here was a strong man in his late 70’s-early 80’s by educated guess, attempting to strip off his hospital gown because he had somewhere to be.

A second look at his wife said weariness, frustration, worry and love, all rolled into one.

While calming him down, I began asking those questions only a nurse can work into a situation. “How long have you been married?” That is my usual starting point. It inevitably brings comments that I can feed off of. I am not only able to gain very valuable information about the physical and mental state of my patient without alarming the family member, but I also gain the rapport that is so important in caring for someone.

In very few minutes I was told that he had lived a very interesting life, most of it being in the Army. He retired a lieutenant colonel and had served in WWII, Korea and Vietnam. WWII was spent working under General Patton.

This insight changed my strategy completely.

I was very proud to instantly switch into being LT Emily.

“Colonel?” I said in my strong, confident Army voice.

His eyes lit up and he looked me square in the face.

“Sir, my name is LT Emily. I am in the Nurse Corps. We are gonna do everything we can to get you back on your feet in no time.”

He gave a nod and silently agreed that would be acceptable.

I went on to explain what was going on and how things were being taken care of.

During my constant reminders that pulling out the catheter would hurt like hell, and would cause him to sing soprano, I calmly explained to his wife that this should be a temporary state and that we were doing everything to keep him safe in the mean time.

It wasn’t long before the good Colonel started pulling his gown off again. When asked where he was going he said, “I have to go check on my men.”

I chuckled, grabbed his hand and told him I would take care of that for him.

I quickly asked, “Sir, do you have any other orders for me?”

“No, just make sure they are where they should be.”

“Don’t worry Colonel. You have taught me well.”

That seemed to satisfy him.

His wife made my day by simply thanking me for, “speaking his language.”

What she didn’t know is that it wasn’t all for him. That is, and always will be, my language too.

Happy 231st Birthday, US Army

(h/t Blackfive.net)

Coinbackonwhite

Ass Chewing=Aeromed Interview

Got a chewing out from a great work friend of mine.

She (in her minister ways…yes, she is a minister) jumped up and down telling me that I needed to sort out my priorities and figure out what was going to make me happy professionally.

I applied for a flight nurse job 8 months ago…they didn’t interview me saying they were “interested, but shooting for the moon” and hoping for someone with both a nursing and a paramedic license.

The person they offered the position to didn’t end up having the paramedic license.

She turned the job down.

After my friend’s chewing out and hearing that news (my sister is friends with the person who turned it down), I sent the flight person an email yesterday.

She called me today.

I am not doing Nurse Practitioner stuff in my Nurse Practitioner job.

Everything I have done since leaving the Army was so I could fly again.

I may finally have my chance…keep your fingers crossed.

Trauma Season

Here in the great white north, opening day of deer hunting season is treated with what is incomprehensible reverence to an outsider. Annual vacation time is set aside, big buck stories are dusted off and told, arsenals are cleaned, and deer blinds are improved upon.

It is a highly anticipated day as some businesses and schools close, knowing that they can’t beat ’em, so they join ’em.

Opening day of trauma season isn’t celebrated with such fan fair. The day is insidious in date; we don’t mark it with reverence on the calendar. Instead, it comes on slowly as do the crocus flowers and buds on the trees.

Over the past week I have had three different people utter the words, “Tis’ the Season” in reference to the increase of major trauma admissions. Inevitable as spring blossoming, the warm weather brings out the broken bones and rise in our trauma admissions.

Thursday and Friday were no exception.

Thursday was a transfer in from an outside facility. Someone pulled out in front of him and he sustained a pelvis fracture that even our veteran ortho-trauma team was impressed with.

Friday brought another motorcyclist who was pulled out in front of but this time by a drunk driver at mid-day. I was able to follow him from the trauma bay to post-op. When did it get to the point where I am the one counseling family members?

He was the first OR amputation I actually witnessed.

He is under 30.

Another day, Another 50 Cents

I am tired. I have found more projects than I know what to do with. So many things need to be better. We should be doing so many things better.

We need more nursing protocols (to add to the gazillion we already have), we need more medicine protocols (we don’t have the ones that really matter), we need standardized discharge sheets (we have none), we need to fix….blah…..blah….blah.

These things will all dramatically improve patient care in areas that have been neglected for years. The time is right and so are the people involved.

I am finding myself at the forefront of this driving force. Finally in the right position at the right time with the right amount of education to really FIX SHIT. No one is saying, “PFC Medic Emily, this isn’t your responsibility. You need to stay in your lane.”

Although I am just too damn tired to write more about it now, I am realizing what an impact I have had, and am going to have in Orthopaedic Trauma at my institution.

This also goes with my Army job as well. Things are changing for the dramatic better. Maybe not in large part to me, but I have taken on my fair share. I hope to be a fairly significant part of that solution as well. I need to write more on this too.

(Sup! Fort Sam!!! I see you reading this!)— I read the IP addresses for the site statistics today and there were some from the home of AMEDD.

So, Army and Ortho/Trauma NP job are going well.

I am going to bed. Yes, it is indeed only 2030 (that’s 8:30 p.m. for some of you.)

Good night.

p.s. Wish me luck. I’m going to ask for a raise next week. (no, not from the Army…duh!)

Another example of the “Sexed Up Nurse” Part III

Jennifer (see last post) actually sent me a great example of yet another sexed up nurse.

Skechers

How did I miss this one? Apparently this drew so much negative mail that Sketchers withdrew the ad. My biggest complaint is that they used Christina Aguilera. Yeesh.

The blog Peeling Wallpaper posted quite a humorous bit from a quote taken from the web site of the Center for Nursing Advocacy which was strongly against the ad.

The image of Christina Aguilera (who is, to say the least, closely associated with public sexuality) holding a gleaming silver syringe/vibrator, wearing a sultry look, a nurse’s cap with red cross, a white “nurse’s” mini-dress that fails to conceal much of her breasts, her red heart-patterned white bra, her near-fully visible garter belt which runs down to her white stockings and white dominatrix boots…

What Peeling Wallpaper didn’t discuss was the strange links off of the Center for Nursing Advocacy’s website. These links included, not only a HUGE blown up, high resolution version of the ad, but also a link to CherryFlava’s blog discussing how ‘super HOT’ the ads are.

Strange things to include in a professional rant which was attempting to get the ad pulled.

Fortunately, the Center for Nursing Advocacy is also fighting things like the piece from the ‘Today Show’ which implied that walk in clinics staffed by Nurse Practitioners were putting patients’ health at risk.

Portray me and my profession any sexual way you would like, just DO NOT imply that my work is shoddy or that I put patients at risk. Let me just tell you about how many patient scenarios I have kept from becoming misses or near misses. NPs and MDs both have a place in healthcare.

(thanks to Jen at Unraveling.nu and Peeling Wallpaper)

What I really wanted to say…

Do not, I repeat, do NOT threaten me with an attorney within the first 3 minutes of my very first conversation with you.

When your almost 90 year old mother-in-law has suffered an injury that has great odds of killing her I know you are concerned (hip fracture).

I am too.

That is why we held off on surgery until we could figure out why she fell at the nursing home after suffering from a syncopal event (passed-out). We want to know why she was found in a puddle of her own stool, possibly seizing before we place her under general anesthesia.

Why do you think we have given her morphine to control her pain, placed her in traction and done everything possible to prevent bed sores from the minute she was admitted?

Oh, and telling me that _I_ should have arranged to send her to our other hospital when I knew she wasn’t going to be immediately taken to the OR really makes me wonder about your true motivations.

Let me break the largest bone in your body, get you all tucked in and comfortable IN TRACTION, only to transfer you to a gurney, into the back of a bouncing ambulance, back into a bed with the entire trip through cold northern winter weather.

Let me try to get an accepting physician at that hospital to clear their schedule to do a procedure on you as a high risk patient.

Sure, don’t listen to my explaination of what our Ortho/Trauma room flow works like (life/limb first, triage). I WILL NOT tell you because of HIPAA that it took us 2 hours to intubate a patient today, or that the 95 year old woman down the hall needed her hip fixed more urgently AND had been here longer.

I really start to wonder when, after I offer to call patient relations, you state, “Don’t bother! I know where the office is. I will go there myself!”

It really motivates us to give extrodinary care when you BERATE the Orthopaedic Trauma Surgeon who is doing your mother’s surgery because the wait was “unacceptable.” We won’t mention that the surgeon had been operating for over 12 hours and this would keep him at the hospital until after his kids’ bedtime. Bumping your mother-in-law’s case to the next day would have been perfectly acceptable. He refused to do that.

“I want you to know that if she suffers any adverse effects from this wait, there WILL be an Attorney involved!”

The above statement, although proving that you are somewhat educated, says nothing more to me than you will call a lawyer that does NOT advertise during afternoon soap operas.

Attorney, Lawyer…they are all empty threats when I KNOW we are giving appropriate Evidence Based Care.

The nurse manager summed it up best. She said that the people who are the most belligerent are the ones who are inconvenienced. THEY don’t want to wait in the hospital all day. It has absolutely nothing to do with the patient we are doing our best to treat.

So, what did I say to this well dressed lady who was inconvenienced by her mother-in-law’s hip fracture?

“Is there anything else I can do for you?”

The patient was taken to the OR and fixed that night…a mere 26 hours after admission…suffering no complications from her “unacceptable wait.”

False Alarm

No JCAHO today. What a shocker …blech…

I am, however doing 8 (ok, closer to 9) hour days and I kinda like it.

45 minute drive to work

normal work day

45 minute drive home

I have the energy to go to the gym. Go out to dinner. Get in the hot tub for a soak. AND BLOG! There is a concept.

Oh, and I had a patient’s parents come back to visit me today. They came back to say thank you. (and to have a form filled out…but that is ok).

How many of you have actually had someone come back to say thank you? It makes my day when it happens. It really makes my day.

Dum, Dum de Dum. Dum de Dum. Dum de Dum. (’Emperor’s March’ ala Star Wars)

AKA: JCAHO Cometh

Yes, the speculation for the next “unannounced” JCAHO visit has swirled madly for the past few months. This has picked up intensity with the floor manager and charge nurses raising anxiety levels over coffee cups balanced on hallway chart racks, and laptop carts in hallways.

I have been in healthcare for 12 years.

This will be the first time I have not wiggled out of JCAHO.

My peer (aka: “the other nurse practitioner”) is on vacation. Scuba diving in Mexico no less.

Damn I am losing my skills.