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Dr. Val Podcast and Grand Rounds

Dr. Val hosted a great Podcast this last week about stereotypes in nursing. It was attended by myself, Terri from Nurse Ratched’s Place and Strong One from My Strong Medicine. We had a really great discussion which Dr. Val so nicely summarized. At the end of her post there is a link to the podcast.

I really enjoyed participating in this and talking with Dr. Val, Strong One and Terri!

DrRich at the Covert Rationing Blog wrote an interesting post related to the podcast that I highly recommend reading.

Another post that I highly recommend is Grand Rounds hosted by Musings of a Distractible Mind this week. I have no idea how he managed the number of submissions… it will take me a week to read them!

As for the new codeblog, the template is finished, the tweaking is done… now I just have to figure out how to move the domain.

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Election Day Grand Rounds

Election day Grand Rounds are up over at Nurse Ratched’s Place. She did a terrific job and all the historical info about the Presidents is fascinating!

Codeblog is part of Blog Networks on facebook. So if you’re on facebook and you feel like joining the Blog Network, come on over!

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The Sound I’ll Never Get Used To

I’ve written before about the myriad of sounds in the ICU environment. That post mostly dealt with IV pumps beeping, ventilators alarming, and constant talking. But there is one sound that will always rise above the cacophony: the soul-deep sob of someone who has just gotten the worst news of their entire lives.

The average office worker, barista, pilot or librarian may never hear that sound their whole life. Even for a nurse who works in a critical care area, I would say it’s fairly infrequent. Most people take devastating news rather well in public. Some people are so shocked that no sound could come out even if they wanted to cry.

You may think you’ve heard it on TV shows or seen it in a movie. But not even the best actor in the world could accurately capture it well enough to shake the dark recesses of your psyche when you hear it just a few feet away.

There is not one other sound that I can think of that would put such a halt to a busy nursing station. Hearing “code blue” overhead would momentarily reset us into action. Hearing the fire alarm barely fazes us anymore. Some crazy person running through the unit screaming would startle us, but we’d immediately get over it and take care of the situation.

But when we hear the muffled cries of someone who is trying to escape the unit, we never know if they’re going to make it to solitude. Sometimes they don’t. People have literally fallen into a heap on the hallway floor mid-step when their bodies just can’t hold the horror in another second.

It sends a chill down every single one of us and we are momentarily paralyzed by it. Humans (in America at least) are usually very guarded with our emotions. We don’t want to be vulnerable in front of a bunch of people we don’t know. So when we hear such a raw and primitive sound coming from another person, a stranger, it resonates very deeply. The sound is like a tangible thread that darts out to everyone within earshot and for an instant ties us all together.

One or two of us will break out of our paralysis to go to the person, but the rest of us are stunned into silence. What do we do? Do we stand there gaping at them, or do we turn back to our charting, our conversations? It’s disrespectful to gawk but then again, it’s disrespectful to go on as though someone isn’t falling apart 3 feet away from us.

If my coworkers are anything like me, it put them into sort of a daze for the rest of the day, too.

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CoS, Grand Rounds and a Blog Update

Kim at Emergiblog hosted Grand Rounds this week. Another great edition as usual! And a spooooky Change of Shift is up at This Crazy Miracle Called Life.

As for codeblog’s status – I’ve moved everything to wordpress and am making changes to the site there. My husband and I (and sister!) are currently tweaking the template. I hope it have it up sometime in the next week or so!

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This Week’s Change of Shift

Change of Shift is up over at Nurse Ratched’s Place… with a Be True To Your School theme!

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Injuries

Kim wrote a recent post about why nurses leave the bedside. She referenced an article that talked about more of the same.

Sinus arrhythmia then wrote a response post about nurses and salary. Both the posts and the article are a very intriguing read.

But of all the reasons a nurse would leave the bedside, one of the biggest reasons must be injuries, and this was not mentioned anywhere at all. There are a few articles about injuries and nurses; feel free to get your facts and figures there.

I personally know of nurses who have had such severe shoulder and back injuries from caring for patients that they required months and months off of work and surgical intervention. I know of one nurse who was kicked in the head by a patient. She was not harmed in any serious way, thank goodness, but the potential was there.

There is also the concept of repetitive stress injury. This is where you perform the same action (pulling patients up in bed, assisting them to the bathroom, etc) again and again over years. Then one day, you’re pulling a patient up in bed, and wham! You pull a muscle in your back or sprain a ligament in your shoulder, even if you’d had no problem with those areas before. Even with practicing good body mechanics, you can still incur these types of injuries over time.

Consider a scenario: You are working in a critical care unit that is crazy busy. You have a 350 pound patient that stooled in the bed and needs to be cleaned up. This patient has horrible skin problems and laying in stool will really exacerbate those problems. Literally every other nurse is busy with issues just as important. The only person you can find to help you is 5 feet tall and might weigh 110 pounds after a large meal.

What do you do? It’s a horrible dilemma. You could try to turn the patient by yourselves, but you wouldn’t be acting in a safe manner at all. In order to practice good body mechanics, the person who would be turning the patient towards them should have the side rail down. 350 pounds is a lot of weight… get a tiny bit of momentum there and the patient could literally fall off the bed if the nurse/aide wasn’t able to keep them on it! Not to mention the fact that you’d be seriously risking your back by doing that.

Some nurses would actually attempt cleaning the patient with only one other person to help them. Some would let the patient lay in stool until enough personnel were available to help turn the patient safely. Both situations have major drawbacks.

What’s a nurse to do??

There are some solutions – lift teams, no-lift policies, and lifting equipment that can make moving patients easier. We have several pieces of equipment that help us move patients…. from bed to gurney, from bed to chair, from laying down to dangling. But I don’t know of any equipment that would help in the above scenario other than having at least 3 other human beings in the room with you to help move that patient. Yes, there are some beds that inflate/deflate in weird ways to make it easier to move the patient over, but sometimes you have to move them way over. And that takes manpower.

On a crazy busy unit, it can take a long time to find 3 other nurses/aides who are all free and can help you with something that could easily take 15-20 minutes.

So I know that nurses are leaving the bedside due to salary, lack of opportunities to advance, and even hostile work environments. But one should never forget what a physically demanding job it is to be a nurse. Some nurses leave the bedside and never come back because they have been injured just doing their jobs.

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Update

Thanks to those of you that answered my poll. To the 3 people that told me I should stop – I’m sorry to disappoint you, but I think codeblog will go on. :)

Codeblog will go on, slightly repurposed. Only slightly!

Until that’s all taken care of, I’ve pruned my sidebar, a la GruntDoc. I was really sad to delete some of those buttons. I know many more medblogs have started up and are thriving, though, so new buttons will be added as I come across them! If I have deleted your button by accident, or you want me to add a button for you, email me at codeblogrn ~at~ gmail . com.

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Live Blogging a Liver Transplant

Moreena at Falling Down is Also a Gift live-blogged her daughter’s third liver transplant. If you want to read from the beginning, here is where she gets the call.

Annika is out of surgery now and is in PICU but not yet out of the woods. Please keep this family in your thoughts and prayers. I’m sure a comment or two of support would not be unappreciated!

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Where I’ve Been

Where to start?

As I’ve said in the past, I’ve never been a very prolific blogger. I don’t subscribe to the idea that one can’t have a successful blog if they don’t post several times a week. Unfortunately, I’m now blogging even less than my own personal threshold.

Part of it is motherhood. My son is a very busy little guy and I’m enjoying spending lots of time with him.

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Another thing is that I’ve been working from home this summer. Thus, many spare moments have gone into finishing that job. Lastly, I only work one day a week in the ICU. I simply don’t see anything interesting to write about because of working so infrequently.

PixelRN wrote a post about how one could be a better blogger by just writing posts after imbibing some wine. The idea is to let down your guard a little and post sans insecurity. I’ve always been a little distant in terms of my personal life on this blog, but now I’m finding that I have little else to blog about. My personal life is taking up all my time! :)

**(We interrupt this post to take a trip to the park.)**

See, that was fun, but now I’ve lost all my concentration and momentum!

I’ve considered putting Gabe in daycare and going back to work more often. Honestly I think he would LOVE daycare, but I don’t think I would love being back at that particular job. (I wonder if my boss still reads my blog…. I have a feeling I’m about to find out). What I’d really love to do is work in fertility (Sorry, erm, “reproductive health”) clinic. Anyone have any leads on that??? :)

So I’m not sure in which direction I should take this blog. I know for absolute certainty that I will leave it up. I have a lot of links out there and I hate dead links. But as for what to post… I don’t know. I still get story submissions. Maybe I could focus more on those and use this blog as a forum to give nurses out in the trenches a voice. Or I could focus more on my personal life, but to be honest I’m not sure anyone would want to read about it. That’s not self-disparaging; it is merely truth.

I also know for certainty that this place needs a facelift badly. It’s had the same look for over 5 years. My husband put SO much work into it that I feel bad changing it around.

Anyway… thanks to the 5 of you who have kept codeblog on your blogrolls. Perhaps I’ll leave the fate of this blog up to a vote:

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Looking at the Bigger Picture

Here’s a story submission by Michelle G, RN. My thoughts are in italics at the end.

I called first thing this morning to see if they needed me to work extra. Sure enough, a scheduled nurse was not coming in. I show up on my unit which is the medical floor to see that I have been assigned 4 patients. Wonderful! Great not to have 5 right off the bat.

Today I take care of a gentleman who I had taken care of just 4 months ago. He was diagnosed back then with liver failure and was not a candidate for liver transplant. This admission brings him in with End Stage Liver Failure which means he could have a few weeks to under 6 months to live. He is in denial and refuses some of the treatments/medicines/blood draws. Patient’s wife is excited to see that I will be his nurse again with this admission. Patient has been noncompliant and has not been following medical advice. He is on a 1500ml fluid restriction but doesn’t seem to want to adhere to those restricitons nor acknowledge them. I gently remind him about his fluid restrictions during the day which seemed to agitate him. I explained to the patient why the fluid restrictions…there was a reason for this.

Well, now he wants a wheelchair to go outside. I know exactly what he wants to do….smoke. We are a smoke free hospital but I am not security. I explained I am not going to babysit him nor police him. I explained to he and his wife that we can not cure him nor are we going to give him anything that will make him better. If the patient wants the extra juice or cup of ice than who am I to restrict a dying man?! Who are we to deny a dying man’s last pleasures…ice, a smoke, a visit outside on a sunny day?

Much of nursing is not only carrying out doctor’s orders and educating the patient why those orders are there…but looking at the BIGGER PICTURE.

At the end of my shift; patient and family were greatful to have had a nurse that took the time to explain the disease process and plan of care but also most importantly to treat him as a human being with respect and care.

What do you think?

I think Michelle is absolutely right. If the patient is able to get all the information he needs, then it’s up to the patient to make the decision. If there is no cure what what ails – heck, sometimes even when there is – a life lived with restriction after restriction with no pleasure at all is probably not worth it to many people.

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Author

  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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