So my best friend - whom I've known for 30+yrs (ever since she was born) - just broke up with her boyfriend (sad I know but not the point) - and so I called to console her (as any good friend would do!) and was asking details and such and then I asked her about whether she would move to be closer to her mom & brothers (all moved from our hometown to the Alberta oil sands), which she said she would (kinda figured she would).
And then we got to talking about how long and such.... she said til she pays off her debt and can afford a good down payment for a house. Ok, that sounds logical right? I asked her if she was going to work in her own field (social worker) and she told me that she probably would but if she couldn't find work then she would take whatever was available, again logical! Then she told me that the ppl there generally earn approx. $30 PER HOUR, without having a specialization or a bacelors+ degree! Hell, her brother who only has a highschool education makes 70,000 per year! ok WOW!
Then I asked her what RPN's make, if her brother knew anyone..... he said they average 100,000 + per year!!!!!!!!!!!!!!
OK, now I'm moving to Alberta!!!! I have LOTS of debt and could totally use a down payment!!!! Now if only I could convince hubby to move to somewhere cold for a couple of years!
Tuesday, December 25, 2012
Saturday, December 1, 2012
"Stop all vital signs"
So last week or so one of the on-call Dr's had to swing by our unit for one reason or another and I commented on an order I had gotten by another doc...
"stop all vital signs".... well I made the comment that it was the first time that I had seen this and I was surprised. Then he told me about a couple of nurses that he had run into that obviously had NO common sense.
When I saw this order I rationalized that it had to do with taking the pt's vital signs and that we no longer had to take them every shift as we have to do with our other pt's. However, when this doc had written a similar order previously, the nurse commented to the doc "ok, how do you propose I stop all this patient's vital signs?"
He also told me about another time when he wrote an order -
doc - give fleet enema standing order daily
stupid nurse THREE days later to ordering doc - ok doc, do I still need to give these enemas standing???? WOW is all I have to say!!!
"stop all vital signs".... well I made the comment that it was the first time that I had seen this and I was surprised. Then he told me about a couple of nurses that he had run into that obviously had NO common sense.
When I saw this order I rationalized that it had to do with taking the pt's vital signs and that we no longer had to take them every shift as we have to do with our other pt's. However, when this doc had written a similar order previously, the nurse commented to the doc "ok, how do you propose I stop all this patient's vital signs?"
He also told me about another time when he wrote an order -
doc - give fleet enema standing order daily
stupid nurse THREE days later to ordering doc - ok doc, do I still need to give these enemas standing???? WOW is all I have to say!!!
Tuesday, November 20, 2012
The one lie nurses will tell
We've had a string of deaths on the unit, majority of them are our DNR's and palliative pt's and surprisingly I'm still a virgin (meaning none of these ppl have died while they're in my care) and tonight when I went to work I found out that one of my pt's I had Saturday night had passed.
I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...
If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.
Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.
Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.
I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...
If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.
Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.
Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.
Tuesday, November 13, 2012
The business of being born
Today I watched the documentary "The business of being born" and it's something that I feel strongly about... I don't necessarily think that every woman should have a home birth - but I certainly think that less intervention during labor and birth should be done.
Birth is a natural process IMO - and though I believe in a woman's choice to pain control - I also believe that birth takes time and as shown in this documentary, many hospitals don't give women the time it takes to have a baby.
I know that in this day and age, we want immediate results and as such this has affected how labor and delivery occurs. What is too often seen is a pt getting pitocin or being brought back for a c-section, which isn't always necessary. That's not to say that c-sections aren't required for some circumstances, but I often think that these are being done too often because establishments (hospital policies, doctors, etc) are saying that it's unsafe for a woman to be in labor without changing on a regular basis.
I postulate this - approx. 20-30 yrs ago - my mother's generation, how likely was it to hear that women had labor that existed for DAYS???!!! And this was alright with physicians!!! I think that a page from yesteryear should be brought back.
It's ALRIGHT to let women labor, and to deliver without interventions like vaccums and pitocin augmentation. There is a time and place for these things but it shouldn't be a majority like it is currently.
I think that doctors and hospitals are too concerned that they're going to be sued by patients if they let women labor for too long and if something should happen for mom or baby, then law suites will occur. Nothing will change unless the patients share responsibility and stop suing doctors for things like this.... become informed, take responsibility for your own labor and take the position that if you want to labor for longer than an institutions' policy, then sign off that you're taking responsibility for this and should anything happen, then you can't sue unless malpractice occurs.
Doubt anything will ever change tho, it's sad, it would reduce c-section rates.
Birth is a natural process IMO - and though I believe in a woman's choice to pain control - I also believe that birth takes time and as shown in this documentary, many hospitals don't give women the time it takes to have a baby.
I know that in this day and age, we want immediate results and as such this has affected how labor and delivery occurs. What is too often seen is a pt getting pitocin or being brought back for a c-section, which isn't always necessary. That's not to say that c-sections aren't required for some circumstances, but I often think that these are being done too often because establishments (hospital policies, doctors, etc) are saying that it's unsafe for a woman to be in labor without changing on a regular basis.
I postulate this - approx. 20-30 yrs ago - my mother's generation, how likely was it to hear that women had labor that existed for DAYS???!!! And this was alright with physicians!!! I think that a page from yesteryear should be brought back.
It's ALRIGHT to let women labor, and to deliver without interventions like vaccums and pitocin augmentation. There is a time and place for these things but it shouldn't be a majority like it is currently.
I think that doctors and hospitals are too concerned that they're going to be sued by patients if they let women labor for too long and if something should happen for mom or baby, then law suites will occur. Nothing will change unless the patients share responsibility and stop suing doctors for things like this.... become informed, take responsibility for your own labor and take the position that if you want to labor for longer than an institutions' policy, then sign off that you're taking responsibility for this and should anything happen, then you can't sue unless malpractice occurs.
Doubt anything will ever change tho, it's sad, it would reduce c-section rates.
Withdrawing care & comfort care measures
I've spoken about this before, but we see it ALOT on our unit. Because we have many stroke patients come through our unit, it really gets to me that ppl don't know how to bring up this subject.
Why is it so hard to talk to ppl about death and dying and being realistic. Why hold out hope that your family member/patient will pull through to just be a burden on the system and the family?! IMO, if God wills this person to live, they will but don't put in a NG/G/Peg tube to prolong the life of ppl. I think it's a pointless to prolong these lives.
There's one family I dealt with who their father had a stroke several years back, he lived for 3 yrs with complications before finally dying. Because of this, their mother indicated verbally (of course not in writing!) that should anything like that befall her, to make her a DNR and let her die! Well go figure, same happens to her and this family makes her a full code!!! Then when she stabilizes, the family is FINALLY persuaded to make her a DNR BUT they want to put in a G-tube.... STUPID!!!! UGH But of course I have to keep my opinions to myself and respect the decisions of this family. After a month or so, the only thng she had done was open her eyes. Not much of a life right?! Another pt we've dealt with is semi-comotose and they put a g-tube in her. It's soooo frustrating.
On the other side of this coin, we've had several where the family decided to withdraw care other than comfort care measures and these people have passed peacefully without having to suffer from bed sores, infections,etc. I relish those times.
I have also dealt with a family who had their loved one come in with pneumonia, possible TB and the person is elderly and cognitively intact and doesn't want to eat or drink. What's going to be their decision???? I think that if ppl can make decisions before they lose their minds, let them do what they want! Provide comfort care measures and end of life support and allow them to pass they way they want to!
Why is it so hard to talk to ppl about death and dying and being realistic. Why hold out hope that your family member/patient will pull through to just be a burden on the system and the family?! IMO, if God wills this person to live, they will but don't put in a NG/G/Peg tube to prolong the life of ppl. I think it's a pointless to prolong these lives.
There's one family I dealt with who their father had a stroke several years back, he lived for 3 yrs with complications before finally dying. Because of this, their mother indicated verbally (of course not in writing!) that should anything like that befall her, to make her a DNR and let her die! Well go figure, same happens to her and this family makes her a full code!!! Then when she stabilizes, the family is FINALLY persuaded to make her a DNR BUT they want to put in a G-tube.... STUPID!!!! UGH But of course I have to keep my opinions to myself and respect the decisions of this family. After a month or so, the only thng she had done was open her eyes. Not much of a life right?! Another pt we've dealt with is semi-comotose and they put a g-tube in her. It's soooo frustrating.
On the other side of this coin, we've had several where the family decided to withdraw care other than comfort care measures and these people have passed peacefully without having to suffer from bed sores, infections,etc. I relish those times.
I have also dealt with a family who had their loved one come in with pneumonia, possible TB and the person is elderly and cognitively intact and doesn't want to eat or drink. What's going to be their decision???? I think that if ppl can make decisions before they lose their minds, let them do what they want! Provide comfort care measures and end of life support and allow them to pass they way they want to!
Tuesday, October 30, 2012
I FINALLY finished my exams for a years worth
So I'm officially one step closer to attaining my RN license! I finished all four of my challenge exams.
Next step - NCLEX-PN.... trying to get to write it is half the battle though, frig the obstacles they're making me jump through just to sit and write a friggin exam is rediculous!!!
On a side note - the weather has hit us from Hurricane Sandy - though it's a good storm, I don't see why ppl are freaking out about it. It's a STORM not and I repeat NOT a hurricane here in Ontario Canada!!! Now if I lived on the coast I may be a bit more worried, but I don't so it's all good!!!
Next step - NCLEX-PN.... trying to get to write it is half the battle though, frig the obstacles they're making me jump through just to sit and write a friggin exam is rediculous!!!
On a side note - the weather has hit us from Hurricane Sandy - though it's a good storm, I don't see why ppl are freaking out about it. It's a STORM not and I repeat NOT a hurricane here in Ontario Canada!!! Now if I lived on the coast I may be a bit more worried, but I don't so it's all good!!!
Saturday, October 20, 2012
Tumefactive MS (multiple sclerosis)
In our hospital we deal with a lot of WEIRD/uncommon diseases. One of the weird ones I've encountered is tumefactive MS. I hadn't ever heard of this and I had to do some research on this. I also spoke with one of our neurologists. Especially considering my aunt has MS and when they started treatment for my patient, it was completely different than the normal.
I'll give you some background cuz how this pt came to us is unusual.... the pt is a new mom, still a teenager (therefore should have gone to paediatrics, but didn't) and when she was brought to the hospital it was because her family thought she had post partum depression (PPD).... she was sleeping like 20 hrs a day and had stopped taking care of herself and her baby. The crazy thing is that she had been like this for 2+ WEEKS before they brought her to the hospital!!! Her BF admitted that he had been oblivious to what was going on with her and the only reason they brought her to the hospital was because she had gone crazy on her BF's head when he tried to push her into having a shower.
Now, I will at least give the physician's at our hospital a kudos because when they received her, they gave her a head CT - but after they put her on a form 1 (involuntary psych hold for 72 hrs for assessment) and gave her the diagnosis of "psychosis" - which even after a definitive diagnosis still follows her throughout her stay at the hospital, and IMO is ridiculous!
When they did the CT scan they found FIVE lesions on her brain - HOLY CRAZY BAT MAN!!! Because of this all he brain was swollen and put all together caused a massive decrease in her LOC and mental capabilities.
When she came to our unit, I asked her our person, place, and time questions but made it more personal, this is how it went...
me: "can you tell me what month we're in..."
her: "it's June"
my thoughts - ok we're only off by 4 months LOL
me: "ok, what day is it..."
her: "the 27th"
my thoughts - yep we sure are off like 3 weeks!
me: "well then, what year are we in..."
her: "1994"
me.... trying VERY hard not to giggle at her.... we're only off like 18 yrs....
I looked at her mom and said, "isn't that her birthday?" Ya sure is....
When I asked her about what gender her baby was, she told me that she had had a boy
that's when I knew she was in deep trouble because there isn't ANY mother that would screw up the gender of their child unless there's something major going on!
When they started treatment for her, they started her on solu medrol (aka prednisone - aka steroid)but no meds that decrease the demyelinization that occurs with MS... that's when I asked the neurologist why they did this....
I guess the difference between regular MS and this kind is that it's a fast acting MS and causes lesions to occur in the brain and therefore the solumedrol will decrease this.... the freakiness of this condition is that it attacks fast and mimics a lot of other neuro conditions and is often mis diagnosed as a brain tumor which is dealt with differently and could lead to the patient's demise.
Even 4 days on a high level of this steroid there wasn't much change in her neurological status until they doubled the dose... now she's a spit fire and soon will need to have rehab to try to gain what this condition has robbed her of. Patient's like these make me wish that I could follow them along because it's soooo interesting.
I'll give you some background cuz how this pt came to us is unusual.... the pt is a new mom, still a teenager (therefore should have gone to paediatrics, but didn't) and when she was brought to the hospital it was because her family thought she had post partum depression (PPD).... she was sleeping like 20 hrs a day and had stopped taking care of herself and her baby. The crazy thing is that she had been like this for 2+ WEEKS before they brought her to the hospital!!! Her BF admitted that he had been oblivious to what was going on with her and the only reason they brought her to the hospital was because she had gone crazy on her BF's head when he tried to push her into having a shower.
Now, I will at least give the physician's at our hospital a kudos because when they received her, they gave her a head CT - but after they put her on a form 1 (involuntary psych hold for 72 hrs for assessment) and gave her the diagnosis of "psychosis" - which even after a definitive diagnosis still follows her throughout her stay at the hospital, and IMO is ridiculous!
When they did the CT scan they found FIVE lesions on her brain - HOLY CRAZY BAT MAN!!! Because of this all he brain was swollen and put all together caused a massive decrease in her LOC and mental capabilities.
When she came to our unit, I asked her our person, place, and time questions but made it more personal, this is how it went...
me: "can you tell me what month we're in..."
her: "it's June"
my thoughts - ok we're only off by 4 months LOL
me: "ok, what day is it..."
her: "the 27th"
my thoughts - yep we sure are off like 3 weeks!
me: "well then, what year are we in..."
her: "1994"
me.... trying VERY hard not to giggle at her.... we're only off like 18 yrs....
I looked at her mom and said, "isn't that her birthday?" Ya sure is....
When I asked her about what gender her baby was, she told me that she had had a boy
that's when I knew she was in deep trouble because there isn't ANY mother that would screw up the gender of their child unless there's something major going on!
When they started treatment for her, they started her on solu medrol (aka prednisone - aka steroid)but no meds that decrease the demyelinization that occurs with MS... that's when I asked the neurologist why they did this....
I guess the difference between regular MS and this kind is that it's a fast acting MS and causes lesions to occur in the brain and therefore the solumedrol will decrease this.... the freakiness of this condition is that it attacks fast and mimics a lot of other neuro conditions and is often mis diagnosed as a brain tumor which is dealt with differently and could lead to the patient's demise.
Even 4 days on a high level of this steroid there wasn't much change in her neurological status until they doubled the dose... now she's a spit fire and soon will need to have rehab to try to gain what this condition has robbed her of. Patient's like these make me wish that I could follow them along because it's soooo interesting.
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