Everything Conceivable

I just found this on another blog. It is a post about a new book that just came out titled "Everything Conceivable" by Liza Mundy. It is about the reproductively challenged and the implications of their fertility treatments.

Since every state does not require insurance companies to assist with payment (here is a list) I wonder if we are creating a society where only the reproductively challenged who are rich can reproduce, and what might that mean. Being new to the policy behind this, I wonder what made states decide to mandate this among insurers and why every state isn't on board.

This just brings up the further debate about the widening gap in healthcare due to socioeconomic status. It isn't just happening with reproductive abilities. In the hospital I see all too frequently who can afford healthcare and who cannot. Those that cannot often end up in the hospital with certain conditions more than the wealthy. One of the reasons thought to be a cause of this is the lack of access to preventative medicine by those that cannot afford healthcare. This of course leads us right down the slippery slope to discussing the uninsured, which I will refrain from doing in this post. An article I read today from the BBC news has made what I see every day even more depressing. It reveals a study that found the health gap between the lowest and highest paid occupational groups widens even more in retirement.

A quote from Bono (the singer for the band U2) sums it up quite nicely, "The rich stay healthy and the sick stay poor."

Is it becoming the same for the reproductively challenged?

Tough To Get Nursing Jobs

I have been hearing from some of the soon to be new grads that they are having difficulty finding jobs in the large teaching hospitals. They have been told from HR reps that they want people with more experience. Has anyone else found this to be true?

To all the students that have been reading this blog: have you been having trouble finding jobs?

Messy Doctors

There has been a lot of buzz around the hospital lately about nursing uniforms. Should we go to a set uniform or should we just be more uniformed in what we wear? I hear the Chief Nurse will be coming out with the answer shortly. The reason behind this is that patients have complained about how the nursing staff looks unprofessional, and how it is difficult to distinguish nurses from other helpers.

My question is about the doctors. Do they have a dress code? Just tonight there was a resident up on the floor reading a chart with his Ipod on, visibly in both ears, while wearing a running jacket over his scrubs. How unprofessional is that! The three day beard is one thing, but running jackets over scrubs with an Ipod is another. Before going in to see the patient he did take his bag and Ipod off, but he left the running jacket on.

Leaving Student Nurses Alone

Articles like this really frost me. All it is doing is scaring the general public. Working in a large teaching hospital student nurses make up a noticeable proportion of the staff some days. This article makes it seem as if student nurses are being left alone with a patient to perform open heart surgery! I want the data as to WHEN they were left alone.

Was it to ask a patient a questionnaire that they needed for class?

Was it while the student was straightening up a room, or setting up suction as a precaution?

Was it while the patient was sitting in a chair and they were simply making the bed?

Was it when the patient was using the bedpan and they were simply standing on the other side of a curtain waiting for the call to get the nurse to get the patient back off the bedpan?

An Honor To Care For

Every now and then you get a family for which it is a privilege to care for their loved one.

An elderly gentleman had a questionable stroke, and required some emergent surgery. After coming up to the floor from the PACU, I settled the patient and went out to talk to the waiting family. I prepared them for his current neurological deficits, and answered their questions. They were very attentive and patient.

After bringing them into the room to see their loved one I could tell they were unfamiliar with hospitals and how they run. I took the time to explain the doctor heirarchy, when nurses change shift and how we make our assignments. I also talked to them about signing a health care proxy (which they did an hour later), and thoughts about what he may want should decisions need to be made.

Then even more visitors came, but all equally polite, respectful of the environment, and supportive of the patient. At this point I realized how loved the patient was and realized we could be in for a little problem if they all try to call us everyday. So I headed the problem off at the pass and told them that they are welcome to call and speak to the nurse, however we can't field 7 phone calls a day from various people due to the time and HIPPA laws. Can you believe that they immediately appointed two people who would do all the calling, and cleared it with the patient as to who can know information?

It was so refreshing for there to be no drama amongst the visitors. Decisions were made, considerations were made for the patient's roommate, and it was done in an efficient, thoughtful way. I'm still shocked! It is so rare for a family to take a crisis so well. Kudos to you. I hope he will return to the man you love and know.

Training the Next Generation

I'm fortunate enough to be precepting a soon to be new grad this semester. I've never taught one-on-one before, but I have always loved teaching ever since I did it as an undergrad. This semester has been frustrating and very rewarding, all at the same time.

Frustrating because I wish I could give her all the knowledge that I have already acquired, and frustrating because I know I just have to be patient and let her learn these things on her own, as other nurses did with me. Rewarding as I am learning a lot about my own practice, and to see her connect the dots with what is going on with a patient using all those critical thinking skills is a powerful experience. Every time I see the switch flip in her mind I feel a sense of renewal and energy. I guess it is a fraction of what a parent must feel like the first time they watch their child take a step.

I hope I have been patient and kind, but straightforward with expectations. I hope that I am able to fill gaps in my own knowledge, and that I'm not too proud to say "I don't know, why don't we go look it up together." I hope I can show her efficiency, and help her organize her day.

Does anybody have any last tips to a soon to be new grad?

Admissions

It's so difficult at times to work on this unit. People keep coming back, again and again, each time a little worse. Some of these patients just suck the life out of you, you give and give and give, they take and take and take. Just when you've had a couple of months to recover and get some vitality back, they get re-admitted.

I feel terrible that when making the assignment you have the choice between the "psychotic demented patient awaiting psych admission," the "woman who has 10 meaningless requests every time you walk by just because she feels entitled," "the pt. on the call light every 10 minutes," and the one who's family "lives in the room and smothers the patient while draining the life out of you by making you run around for insignificant things."

It is going to be a rough week.

Will You Wash My Back?

Here is one of my favorite stories yet.

We have a retired nurse from another country on our floor right now. She is VERY particular about how her care is given, and she has sent more than one nurse over the edge.

More than once the aid and I offered to help her wash up that day. Mind you, she can take care of herself completely, but she requests our assistance and we are happy to help. So we were trying to help her all morning to wash, but she refused our offers again and again to help her as she "wasn't ready". Finally, she decided it was time around noon. So the aid set her up with a wash basin full of water, etc., all she had to do was wash herself. The aid and I were both in with other patients after that. This patient was so inpatient she had her roommate wash her back as she couldn't wait for us. YES, she had her roommate, another patient, help her wash her back. Upon discovering this I told her it was inappropriate. She responded with "well, if you nurses did your job I wouldn't have to." This was followed by a rant on how terrible we are.

I promptly left the room before the rant entered 3rd gear, and I'm still in shock at how inappropriate this former nurse was.

I Feel Pretty

Today I had a demented patient worth having. She repeatedly told me I was pretty every time I came into the room to work with her, and then would tell me how she wasn't "one of those people who just say that to get people to do something nice for them."

Clearly she had forgotten that she had told me the same thing an hour earlier. It was rather funny, by the end of the shift I wondered if indeed she DID want me to do something extra for her.

That is the kind of dementia one can put up with easily for 12 hours!!

End-of-Life Conversations

Thank you to the medical professionals of the world that have the strength and courage to discuss end of life issues with families of ill patients.

A patient is about to have a biopsy on questionably positive lymph nodes seen on a PET scan. Everything is pointing to a positive cancer diagnosis. He is elderly, he has lived a good life. He had dementia, and has always lived his life full of fear that he would one day "get it." And now, at the point in his life when he has the least amount of control is the time when he's going to find out. But what really is the point? To put him through all of that...for what?

So today, before the biopsy has even been scheduled, the primary care doctor had the talk with his children about what the patient would want. I'm so happy to see this, because I often see health professionals who won't have that talk with the families. Doctors are trained to save lives and will do nothing short of everything to do so. It is difficult to accept that sometimes the patient has had enough.

It is so important to remember that patients have choices. They have the right to have every treatment on the planet, and they have the right to choose not to. Most importantly, they deserve to die with dignity and have as many choices as possible about their end.

What is the best way to have these conversations with people? In my very limited experience I have found that it is helpful to get to the point in the kindest, nicest way. I also like to add a very brief, personal story of a loved one and their end of life choices. I find that families and patients are a little more open to you discussing this with them when they realize that you are a person too.

Oxy-what??

The media has done an excellent job of scaring patients from taking their medications. I was just reading on Fingers and Tubes in Every Orifice a blog post about a patient who was drug seeking, and that is often times the case. However, I find it very interesting the number of patients who refuse to take painkillers, even when needed. Here is an example of an often repeated event:

Me: "Do you have any pain since we turned off the PCA?"
Patient: "Yes."
"We wanted to switch you over to an oral pain medication, something called Oxycodone."
"No! Is that the Oxy-stuff I always hear about on TV? I don't want to be a drug addict and lose my mind."
"The drug you are referring to is OxyconTIN, which is a long acting formula of the drug I wanted to give you--OxycoDONE."

(insert the "Oxy-what??" if they are hard of hearing--here)

"What's the difference?"
Me: "The are the same drug, except one pill has an effect that is supposed to last for 12 hours while the other is only supposed to last for 4. So if you were interested in getting a 'high' you would crush up the long acting pill and take it all at once. The equivalent is to take 5 of the pills of Oxycodone all at once. But you know better than to do either, so it is safe for you to take."

I'm still amazed at how many people are afraid to take this painkiller because of the media hype. The funny part is that if you offer them Percocet they will gobble it right up without any questions! Amazing what media can do.

e care

This is a link to an article that I found on the google site that answers the question: "How do you know you are getting the best care possible?"

This article discusses this by simply answering the most common questions that google has been asked by people who search for health care information on the web.