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Tough love at pole position May 29, 2007

Posted by 5 Wester in General Announcements.
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“You’re getting 37 and 38. Just be sure you have the charts way apart, they have the same last names, and by the way, 38 is a VIP.”

“VIP?” I asked my charge nurse, “what do you mean?”

“I think he is a relative of one of the hospital board members”, he said.

VIP (I thought to myself), all my patients to me are VIPs, i.e., they all get the same treatment, nothing more than the best they can get from me regardless of what their socio-economic or political status is.

As I took report, the outgoing nurse tells me, “I think they have him mistaken for somebody else… he’s no board member relative, he just have lots of visitors all the time”…. I just kept things to myself then proceeded to make my rounds.

So it turns out, my “VIP” is a young man in his thirties who apparently had too much to drink, attempted to drive home and plowed into a pole. He’s lying there with a c-collar and a fractured c2 odontoid process. No neurological deficits so far, an ORIF planned to fix this, he complains of abdominal pain. Loving wife at bedside attentive to his needs. His family comes in/out with disregard to hospital visiting policies. Yep, the VIP.

How do you take care of someone, a VIP at that, who ended up in the hospital because of doing some stupid thing like driving drunk. My golly, that pole could have been one of my friends, a relative, or a family member. Could you imagine if that was your mom, your dad or even your child. VIP my a**! What do you do?

You smile and say, “My name is (state your name), I’ll be your nurse today. You tell me you have abdominal pain? Let me see what the problem is.” You do your assessment, then you smile and say, “It seems like you have quite a bit of gas. I’ll notify your doctor and hopefully he’ll give you something to ease your pain.” Or you can give him a bit of reality therapy and shake him off his invincibility cloak and say, “Dude, that’s what you get for driving drunk. You could have hurt someone bad, or worse, kill someone because of your irresponsible stupid short sighted narrow minded reckless party attitude. And as for you loving wife at the bedside, why do you even condone this?” Back to reality, you go about your business.

“Nurse, I’m shaking all over” he says, “I feel nervous.” What do you do?

Like any good nurse you do your assessment and offer him Ativan 1mg IV q4 as ordered for “agitation/anxiety”. “Let me get your meds and I’ll be right back!” Or you can give him tough love and say, “Yes you should feel nervous. You’re looking at a DWUI buddy. I hope they revoke your license before you kill someone. I’ll nurse you to health so you won’t miss your court date.” Then you smile and leave the room gracefully.

“Ouch… ouch… ouch… that hurts” he says while you clean up his wound. What do you do?

You say, “Oh, I’m sorry, does that hurt? I guess the Morphine I gave you earlier hasn’t taken effect yet, let’s wait a while and I’ll do this later.” Or you can say, “Oh, c’mon, you weren’t thinking about the possible consequence when you took the wheel after you’ve been drinking. Be glad you didn’t hurt or kill anyone. Just suck it up and take it like a man, you 200 lbs. baby!”

The above scenarios may not be as whimsical as the Wizard of Oz, however, there is reality here. People do stupid things and as a result, they end the hospital. I see this time, and time again. Yep, VIP treatment. Sometimes I feel like a lawyer defending a convicted serial killer who was caught red-handed, yet has the audacity to plead “not guilty”. But then again, everyone deserves a second chance, right? I just hope that for the safety of those around them, they don’t do that again.

I asked my wife, “what would you do if I ended up in the ICU because I hit a pole while driving drunk?” She said, “I’d tell you ‘that’s what you get for being stupid’ stupid!”.

You know… she’s right! 🙂

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Memorial Day Float! May 28, 2007

Posted by 5 Wester in General Announcements.
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Happy Memorial Day everyone!

Today we celebrate the memory of the brave men and women who fought and died for our country. Amid this war that everybody seem to think is so unpopular (when has war been popular anyway?), lets not devalue the sacrifice our enlisted men and women do for us to preserve our freedom.

On that note, I came across the news about Cindy Sheehan, the famous anti-war mother from California, who’s son died in Iraq in 2004. According to the article, she is giving up her protest against the war due to financial and health burdens. She writes it in her diary entry entitled “Good Riddance Attention Whore”. What strikes me about the whole deal is the fact that she devalued her son’s death, and in her own words say that her son “did indeed die for nothing” (Sheehan, 2007). Like she said, “I failed my boy and that hurts the most.” (Sheehan, 2007) and it’s true… sadly she failed her boy.

Unfortunately, she focused on the wrong thing. She should have focused her time and energy keeping the memory of his boy alive and honoring his service and sacrifice to the country he loved. You may have already heard this, “Greater love has no one than this, that he lay down his life for his friends.” (John 15:13). To me, her son, and all the men and women who give their life in service for their county, is a hero, and they don’t deserve anything less than a hero’s honor.

War is war. There’s nothing good about it. You may disagree but we know it is a necessary evil. It’s just the nature of the beast. For ages when people don’t agree with each other, they go to war. Clearly there are no winners or losers because frankly everyone loses. War no doubt changes the course of history, and for the most part, it brought us the liberties and freedoms we know today. The Great Book, the Bible, even talks about war in this context… “a time to kill and a time to heal”… then later “a time for war and a time for peace”. You can find this passage in the book of Ecclesiastes Chapter 3, also known as “A Time for Everything” chapter. Just click on the link to read it in it’s entirety. For as long as man will be on this earth, there will always be war because the fact is, war has been raging since the beginning of time, i.e., the war between Good and Evil also known as The Great Controversy. Don’t believe me? Just look around you. So to Mrs. Cindy Sheehan, we’re sorry for your loss, however, don’t devalue your son’s death. To us, he is a hero. It’s time to take care of yourself, your remaining family, and move on.

On a lighter note, I got floated to my former home floor 5 West. Funny I had that feeling. We only have 14 patient’s in the ICU that night so, I made like a root beer and float! 🙂

It was nice to see my former co-workers. The night crew is practically the same… a few good men, and women who make up the core group. Then you have a few new ones (mostly from the morning shift).

I took report from a greenhorn. It was his first day on the job. Sparing the details, this cocky shortness of breath (SOB) (unfortunately) had to be put in his place. It’s a dirty job (I hate doing it), but it had to be done. Maybe he’ll have more respect for his “elders” next time and think twice before copping out and attitude. Needless to say the evening went on perfectly. It’s rare to have moment’s like this so I baste in it and wait till the morning crew came in.

We had the usual 4-6 patient load. Most of them were “frequent fliers”, you know, those uninsured patient’s who require dialysis. I’m surprised they send these people home without arranging for outpatient dialysis. In my previous experience (back in California), according to the law you cannot dismiss a patient that required life sustaining procedures such as dialysis without first making arrangements for it. At least that’s what I knew from when I used to direct a 99-bed skilled nursing facility. I guess things are different down here. I tell my co-workers that the hospital may save on money if they opened up 6 West (a wing they shut down a year ago due to “low census”), you know, just house them there instead of having them come in/out. Imagine all the paperwork you’d save. But then again, it’s business as usual.

Anyhow… I hope you had a wonderful Memorial Day celebration (and I’m not just talking about the sales!). 🙂

800,000 short… coming soon in 2020! May 27, 2007

Posted by 5 Wester in General Announcements.
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“Did you that by the year 2020, there will be an estimated shortage of 800,000 nurses?” (discovernursing.com)

This is the introduction to job opportunities section of discovernursing.com, a website sponsored by the Johnson & Johnson company to help encourage a new generation of young people to take up a career in nursing. After all, who wouldn’t want to be a nurse anyway? Ask a nurse and you’ll know. 🙂

The one question I always ask a student nurse whenever I encounter one is, “Why do you want to be a nurse?”. In fairness, I ask myself the same question everyday… “why do I want to be a nurse or continue to be one?”

Most of the answers I get reflect the signs of the times. There’s no doubt that financially, a career in nursing is quite promising. You’ll have above average earnings compared to most professions out there, plus there is “job security” since the supply does not meet the demand, you’d think you have leverage. I guess the reality of the problem of the projected nursing shortage hasn’t hit the nation yet. There seems to be a “cold war” between health care providers (hospitals) and health care workers (nurses in particular), i.e., hospitals want to treat more and more patients (mainly for profit) while nurses want to give more quality care through reasonable nurse-patient ratios. How do we strike a balance?

According to discovernursing.com the median income for a nurse is close to $50,000 a year. Not bad if you were single, no kids, and able to save 50% of your income into an IRA or 401K. But with today’s gas prices and the cost of living (even in Texas), 50K may not be enough for a family of 4. There has to be a balance between profits and quality care. I think nurses need to band together and be more united. We’ve heard of doctors owned hospitals… could you imagine if there was a nurses owned hospital.

Introducing “Nurse’s Hospital of the Valley” where nurses rack up the profits and give top quality health care to patients. Patient ratio would be: CU 1-to-1, Telemetry 3-to-1, Med/Surg 5-to-1. Salaries start at $40/hr + benefits with a working clinical ladder and an active educational department. The board is composed of nurses and a few business people. Schedule is flexible and every nurse is a “department head”, i.e., all departments answer to them, from pharmacy to house keeping. After all, a hospital isn’t much without the nursing department. Not trivialize other departments… just like my co-worker put’s it, “nurses can do what other departments can do (given proper training/orientation of course), but they can’t do what nurses can do (unless you get educated as a nurse). What do you think?

If it would hurt their bottom line to lose nurses, do you think hospitals would treat nurses a lot better? If the median income for nurses is about $50,000 annually and there is an estimated 800,000 nurses needed to fill the shortage in 2020, doing the math you’re looking at a savings of $40 million dollars annually for hospitals nationwide. Wow, with all that profit we better start buying health care stocks today! 🙂 If minimum wage is set at an average of $5.15/hr, will there be any “minimum wage” set for nurses? How does $50/hr sound?

Unfortunately with our profit driven health care system this is reality. For all it’s worth, when the time comes that the nursing shortage hits home, I hope we can come up with a solution to the coming crisis. 2020 is not far from here, and unless we start making changes to the health care delivery system, it’s just going to get worse. So to all the nurses out there, (and to those who are contemplating on becoming one), I ask “why did you want to be a nurse?”

Pain medication please… I’m depressed! May 20, 2007

Posted by 5 Wester in General Announcements.
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“How ironic”, I thought to myself as I prepare morphine for my 25-year-old patient who attempted to commit suicide by trying to skewer himself on the neighbor’s unfinished concrete fence.

He apparently jump onto the metal prongs that protruded out of the construction site in hopes of puncturing his heart. Instead, he ends up in the ICU with a chest tube, battered and bruised all over with two puncture wounds to his chest and abdomen…. I’m thinking, OUCH!

Therapeutic communication comes to mind as I entered the room. What do you say in a situation like this one, knowing that this is his 2nd attempt? Do you say something or do you just play it cool? How do you help an individual in this situation? How do you say, “listen up buddy, get your act straight, you got 3 kids and a wife depending on you!”…

As I attended to his need, it became apparent to me that there was something quite odd about my patient. I can’t put my finger on it, but you know there’s something off about him. One thing I did observe… he seems to enjoy the fact that family is pouring over him in this pathetic state. Well, I don’t know what the circumstances are, all I know is that I’m in a position to help, at least with the chest trauma. What’s going on in his head? Who knows? He’s going to a court appointed psychiatric facility after he gets better despite objections from his mother.

I could imagine what the mother is going through. She’s probably thinking to herself… “I did not raise a psycho.” It’s sad when you see family like this… the stigma of having someone in the family that has a mental problem… in this case depression.

I’m sure we’ve all experienced this, however, not to a point we want to end our lives. In 2005 it is estimated that there are 18.8 million American adults affected by depression (Murrey, 2005). You will find other statistical data on the link just mentioned. As you know, depression affects everyone… not just the person that actually has it. So how do we deal with depression?

There are many resources out there for dealing with depression. You’ll find a plethora of resources available on the internet, just Google it! I guess like any psychiatric problem it comes does to an individual’s ability to cope with a given situation or problem. Some are able to cope better than others. Yet, the problem can be attributed to hormonal imbalances in the brain. If that’s the case, certainly drug therapy is indicated, and hopefully the patient sticks to the treatment plan.

As I administer the morphine my patient lets out a sigh. No… more like the sound someone makes after sipping a tasty cup of coffee. You can hear the ahhhh! Did I just give him his drug fix? Bottom line, he wouldn’t be here if he didn’t think to skewer himself. Unfortunately most of our ICU people end up here because of their own doing, i.e., most of their injuries could have been prevented. But what can you do? You give care the best way you possibly can. You nurse them back to health and hopefully give them tips on how to prevent this sort of thing from happening again. Then you hope they don’t come back because they followed your advice and health education, and maybe they’d appreciate the second chance at life they’ve been given. You allay the family’s anxiety (or maybe ask the doctor to give them some Ativan 🙂 ). Then you go home and hug and kiss your wife and kids and count your blessings… after all, it’s God’s gift to you. Then you remind yourself, God is in control… and knowing that, you shouldn’t be depressed at all.

Happy Mother’s Day! May 13, 2007

Posted by 5 Wester in General Announcements.
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I took my wife to a 5-star restaurant, ordered the best Fillet Mignon, a tall glass of vintage red wine, dined with candle light overlooking the ocean, with a four string quartet playing in the background… then I woke up to the sound of my alarm clock. It’s 5 p.m. gotta get ready for work!

As much as I’d love to do this (my wife smirks at me with that “yeah right” look 🙂 ), things aren’t as ideal as I’d want it to be… at least for now. Just a few flowers to say “Happy Mother’s Day”. I’m sure we all did this for the special women in our lives… our mothers, and our wives.

My son brought home an apron which he painted the designs himself that had “#1 Mom” on it. My two daughters took out the water colors and created Happy Mother’s Day posters. I, on the other hand, was asleep when the flowers came. We had a simple dinner and off to work I went (despite objections from my wife… “do you still have PTO?”)

Whatever you did for mother’s day was just a simple gesture to show how we appreciate the mothers. God sure knew what he was doing when he created Eve. For one, the patience of a mother is something that only mothers know. Have you noticed that whenever kids hurt (or anybody at any age for that matter), they call their mother? Even when the kids come home from school and I greet them at the door, the first thing they say is, “where’s mommy?”. And for those mothers who actually stay home… I salute you! It’s more work staying home than going to work, and I’m sure you will agree… I should know… I spend my off days fixing and cleaning the house (4 kids, what do you expect 🙂 ).

On this special day, let’s thank the mothers in who make a difference in our lives, and most of all, thank the Lord for giving us kind, loving mothers…. After all, it is mothers who make the house a home!

Happy Nurses’ Week May 9, 2007

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May 6-12 is National Nurses’ Week.

This whole week, culminating on Florence Nightingale’s birthday, is dedicated to the appreciation of the men and women who dedicate their lives in caring for the sick.

As I opened my email today I received a greeting together with the Florence Nightingale pledge composed by Lystra Gretter in 1893. As you know, Florence Nightingale is the pioneer of modern nursing.

I remember that day when we, as student nurses years ago, took the same pledge and dedicated our lives to this noble profession. I’d like to share this one with you…

The Nightlingale Pledge

“I solemnly pledge myself before God and in the presence of this assembly, to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession, and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling. With loyalty will I endeavor to aid the physician, in his work, and devote myself to the welfare of those committed to my care.”

I still remember the day when we had our capping and pinning ceremony, which was also the candle lighting and dedication ceremony where we recited the Nightingale pledge. Imagine, 180 nursing students all wearing white holding candles in a dark auditorium. It was a solemn event as we looked forward to our future nursing career. Today’s nursing reality is a far cry from that solemn night we took our pledges. Times have definitely changed. We are no longer wide-eyed and idealistic greenhorns who would be out there to change the world… battle-scarred and broken, we’re in the trenches fighting the war everyday.

As a token of their appreciation to nurses, MMC gave us blue sporty duffle bags with matching water bottles, and Craker Jacks (yum 🙂 ) distributed by the department heads. I guess the best form of appreciation you can get is a “Thank You for everything!” you get from your patient or their family as you carry on your duties as a nurse. I say, there should be a national “Hug and Kiss a Nurse Week”…. At home, everyday is “Hug and Kiss a Nurse Day”. I know…my wife and kids do it all the time!

To all you nurses out there (especially to the fine people at 5 West, my home from where I’ve been exiled 🙂 ), Happy Nurses’ Week! And remember… take care of yourself because, no one else will! 🙂