I get a lot of email asking me for stuff.  Ad requests, what my thoughts are on this or that, could I post this link?  Would I like a guest post?  Hey, we’ve linked to you, can you link back to us?  And really a whole lot of “we are positive that your readers will find this link very interesting!  You should post it!”  Sometimes someone does actually send something interesting, and I’ll read it and think, “Oh, this sounds neat” but then I’ll get distracted and forget and then I go back to reading through all the email a week later and it’s too late.  Anyway, my point is that I’m terrible at answering email, even when I find it interesting.

But today I got a different sort of email, and the sender asked me to share his personal fundraiser on my blog.  “Seriously?” I thought.  But something caught my interest (and both kids were napping, so that helped) and I clicked his link.  It’s an interesting back story and that last perk there at the bottom just made me laugh, so I made a deal with the guy – I’d post his link if he gave me some stories to go along with it.  And he did.

So the email said this:  “My name is Paul Sebring and I am currently enrolled at the Ida V. Moffett School of Nursing at Samford University because after having helped in Haiti after the earthquake and leading a cleft lip/palate mission in Ecuador, I realized that becoming a nurse was the most important thing I could do in this life.”

And then he provided a link wherein he asks for money.  So here are some stories he wrote about his experiences in Haiti.  If you like them, throw a few bucks his way.   He gave me a few choices – I found these interesting:

Burr Hole Boy:  06/11/2010

On Monday night we went to the Plaza Hotel  to check emails and such when Gabe from IMC pulled me to the side and asked if there was anything we could do to help a 16 year old boy that needed a Neurosurgeon.  It turns out that 3 days earlier this kid was in a motorcycle accident in Gonaive and his family finally got him to the General (state run hospital).  He had a pretty bad head injury and he seemed to be somewhat stable but he still needed a Burr Hole procedure.  This is a simple procedure where they drill a few holes into your head to relieve pressure on the brain.  Anyway, so Gabe tells me what’s going on and what the kid needs when the attending doc at the General calls me to tell me about the kid too.

It’s apparent now that we need to get this kid to a Neuro team to save his life.  Medishare hospital wasn’t an option since they were right in the middle of being moved to their new facility and Adventist hospital didn’t have a Neuro team at their facility either.  I knew that the hospital in Milot (I was there a few weeks ago doing a supply run) had a Neurologist showing up soon so I called Jo and asked her if they could take the kid.  She was really excited to take him since their Neuro team was showing up the next day, but when she talked to the local hospital administrator he denied our request because he felt they were not well equipped to do brain surgery.  The problem is that this kid didn’t need brain surgery, just a decompression.  Jo tried her hardest but knew there was no way to change this guy’s mind so Jo took it upon herself to call a hospital in the Dominican Republic and she actually got the hospital there to accept the kid, a full Neuro team to receive him, and she lined up an ambulance to pick him up from the heliport.  Jo, you’re amazing.

This is where it got good.

I called up Sam from Grass Roots United because I needed his help with getting a helicopter and he had a connection.  Keep in mind that Grass Roots is about as big an NGO (Non Governmental Organization) as ourselves.  When he heard of what was going on he called up his contacts and got the helicopter.

Now all we have to worry about is how are we going to get this kid through customs and out of Haiti.

Back to Jo, she’s now working with the Dominican Republic to get his papers approved, I’m working with the General to get the kid’s papers ready and Sam is working with Haitian customs to put it all together.  At 10am the next morning we had all the paperwork in order, a green light from Haitian customs, a green light from the DR customs, a helicopter, a doctor to go with the kid, a medical team to receive the kid and an ambulance to take him to the hospital.   Time to put everything in to play.

Christina and Micaela go to the General and scoop up the kid and take him to the airport.  When they get there, guess what, the Haitian official “claims” that she never received the email with paperwork and it would cost $100 USD to get the kid out of the country.  Sam pays the $100 fee (bribe) and gets the kid on the helicopter, which just happens to be the size of a VW bug, and gets him to the DR.  When they arrive in the DR it was a bit of fiasco with the Immigrations department but the receiving hospital got them to accept the kid, they loaded him into their rig and got him to their facility to do the procedure.

Now, let’s put this in perspective.  What we did for this kid saved his life and it was all done by 2 small NGO’s with no funding.  You all know how I feel about this topic, and I’m not going to go on another tirade about how ineffective the big NGO’s can be.  All I have to say is thank you Jo and Sam for helping us get this kid to a medical team that saved his life.

All in a days work:  Haiti update from 8/2/10

Let’s start off by saying that the Haiti diet is the best way to lose weight. Between the flop sweating, mass consumption of water and overall repetitive diet I have lost almost 65 pounds since my first trip here. Jenny Craig ain’t got nothin on Haiti. The bad thing is that I am still out of shape. Granted I’ve had to have people bring me new clothes because all my original pants would fall off me and the 3-4x shirts looked like tents on me. I’m now at a 40 inch waist and a 2x shirt.

Now, back to the out of shape thing.

This morning a few of us had to go to the General (state run hospital) today to transfer a pre-term momma to Adventist hospital. She is TB positive and about 30 weeks along. Contractions were 10 minutes apart so we had to get her to a place that was much more well equipped to handle the mom and baby.

LP (co-founder of MMRC) was dropping Tuwanda, Jeanne and Ellen off at a clinic near the Embassy so we had to walk to the hospital. It’s only about 1.5 miles but the fun part is that you get to dodge traffic and pedestrians while walking at a very brisk pace. I was on the phone with the TB Clinic Doc about this patient and it was apparent that we had to get her out of there and to Adventist ASAP. About 6 blocks from the hospital I told the boys we had to pick it up so we started running. Now please try and picture this: 2 marines and a fat guy running the streets of Port Au Prince. The marines look like they are in great shape. They’re running in unison, have great form and are weaving through cars. They don’t even look tired and they’re barely breathing hard.

And then there’s the fat guy…. ME

I’ve got one hand on my backpack to keep it from flailing everywhere and the other on my belt to keep my pants from falling off. I’m trying to not get hit by cars that I can’t see because the sweat is flowing so profusely down my face it is blinding me. I’m beet red and am huffing and puffing so hard that the locals can’t stop staring at me. And the best part is, you can’t stop this much momentum without a few hundred yards notice.

So after about 3 blocks I holler at Sully (one of the marines) that he can run if he wants but poppa bear is going to have to keep it at a brisk pace. We finally arrive at the General and I am sweating so bad and I’m so hot I can’t even form complete sentences. Oh ya, I almost forgot, my pants are soaking wet and my grey shirt is dripping.

After being there for about 15 minutes we get the ok to use an ambulance, we load up the patient and Michelle (RN), Sully (Marine), Riaan (Corpman) and myself head over to the Adventist hospital with her. The best part is that I still can’t stop sweating but now I have to wear gloves and a mask the whole time we are en route and try to comfort a very scared mother. Brooke (RN) was expecting us when we arrived and she made sure everything went through smoothly.

As we drove back I had a chance to look down at myself and it is apparent that I’m a hot mess. I just wish I had video of this so I could just see what the locals got to witness.

I found out 2 days later that both the mom and her new baby daughter are just fine.  The family brought the mother back to the TB ward 24 hours after the delivery.

Good luck, Paul!

In case you missed it, a new blog debuted on the most recent edition of Change of Shift.

That blog is The Adventures of Bob the Nurse and was started by none other than Keith at Digital Doorway.

Bob the Nurse is an action figure that lives a very, well, adventurous life.  His blog is a photo blog depicting his various antics.

I’m very fond of this concept (you know, stealing your neighbor’s garden gnome and taking pictures of it in front of Niagara Falls or some such place).  When I moved to California, I stole borrowed took the coffee pot from the dialysis office with me.  I bought it a little wig and some googly eyes and took pictures of it at interesting places along the way as I drove here from the midwest.  The dialysis nurses were some serious pranksters, so this was my final prank on them.

So I find The Adventures of Bob the Nurse very amusing.  My favorite picture so far is this one.  I think it’s hilarious.

Keith explains the concept for Bob the Nurse in this post.  If you think you can broaden Bob’s horizons even more and would like to have him as a guest, contact Keith or leave a comment on Bob’s blog.  I have already offered – there are lots of places around here I can take Bob :)

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.

When I ask a new patient what brought them to the hospital that day, I of course get many different answers. I get a lot of “I woke up with chest pain at 3am and came in.” When I ask how they came in, I get a variety of answers, the worst being, “I had my wife/husband drive me.” No, no wait – the worst is “I drove myself.”

Now, as perfectly healthy people driving around, do any of you feel comfortable sharing the road with someone possibly having a heart attack? I think not. You see, to simplify things, a heart attack is when the heart muscle is deprived of oxygen. When deprived of oxygen, the heart muscle begins to die. If a certain area of the heart begins to die, the person not only feels chest pain, diaphoresis (sweating), short of breath, etc. – their heart may go into a fatal rhythm. A rhythm not conducive to safe driving. Or driving at all.

So while the patient started out with a mere heart attack, he may end up with a car accident to boot…. not only taking out himself, but possibly others.

There are many reasons to call for an ambulance. Symptoms of a heart attack or stroke are high on that list. Another equally important reason to call for an ambulance is as Kim at Emergiblog touched upon in a recent post. An ambulance is a mini ER on wheels. People who know what they’re doing come to your house and start taking care of you WHILE transporting you to a place that you need to be. They have nitroglycerin, IV fluids, EKG’s and can start to diagnose and treat your condition en route. And if your heart stops beating, they can try to shock it back to life right there. Last I checked, defibrillators had not been added as options on modern cars.

If you feel as though you are having a heart attack or stroke, definitely don’t drive yourself to the hospital. Don’t have your spouse drive you. Please call 911 to get an ambulance. It could save your life and the lives of others.

Galen’s Log has announced that the website for their company is now operational!

GPI’s product is Medi Binder and I think it’s an extremely helpful product. As Grunt Doc says, “I like this product idea, and personally recommend it, especially for people who have more than 3 medicines / allergies, more than 3 doctors, or more than three surgical scars on the body.”

I have to say that I completely agree. This is a great tool that can guide you in keeping important medical information up-to-date and handy. As a nurse, I can tell you with 100% certainty that if all of my patients handed one of these to me when they rolled into the unit, my job would be SO much easier.

Taking antibiotics while on birth control pills will decrease the effectiveness of the pill.

Not much time around here to blog, but I wanted to put something up really quick… The other day, I heard about yet another baby being conceived because the mother had been taking antibiotics while also using birth control pills. I know of 4 babies that are in the world right now due to those very circumstances.

In all cases, the mother has said that NO ONE informed her when she was prescribed antibiotics that they would decrease the effectiveness of the pill. I find this to be extremely sloppy practice, and that’s putting it nicely. I’m supposing it’s possible that it was mentioned as a “by the way” while the patient was gathering their things getting ready to leave. And I’m sure it’s on the leaflet that the pharmacy hands out, written in small print. Actually I’m not entirely sure of that, and although it is the patient’s responsibility to read about medications that they are prescribed, it is also the responsibility of the prescriber to notify the patient of any drug interactions or possible side effects.

I was thinking of this the other day, and maybe someone can answer it… Would antibiotics also interfere with the effectiveness of the other forms of hormonal birth control? Depo shots, Norplant, or the new patch?

I couldn’t have said it better myself!

California has enacted a law (AB 394) that will change nurse-to-patient ratios. Because I work in Critical Care, Title 22 already mandates that I must only have 1-2 patients in CCU at any time. Even if my patient has transfer orders to a stepdown unit or med/surg floor, I still must only have 1-2 patients, because I am working in a critical care setting.

Henceforth, I’m not sure what the current working ratios for med/surg are. I floated once to telemetry and had 5 patients. I thought that was okay, but one in particular took up a LOT of my time, thus leaving less time to deal with the other 4. AB 394 puts forth minimum staffing ratios. Critical Care will remain 1:1-2, but most other floors (excluding nursery, ante- and post-partum) will eventually phase to 1 licensed nurse to 4 patients. I believe this to be fair.

However… did you notice I said licensed nurses, not registered? There are two classifications of nurses – RN’s and LVN’s. LVN’s (or LPN’s – they’re the same thing) are Licensed Vocational (Practical) Nurses. I have searched for quite awhile tonight to find out just exactly what the difference is between RN’s and LVN’s and haven’t really come up with anything concrete.

From what I’ve heard over the years, LPN’s can’t do as much clinically as an RN. I’ve read sources saying that LPN’s cannot assess patients, and sources saying that they can. Most LPN’s cannot give IV medications, but some can if they are specifically trained to do so. As a rule, an RN is to thoroughly assess their patients and formulate a nursing diagnosis for each, devise a plan, implement the plan, then evaluate the outcome and change the plan as needed. Nursing care plans are the bane of a nurse’s life. But more on that another time :-) It is my understanding that LPN’s may assess patients in more of a “fact gathering” capacity than an “assessment” capacity and are not able to formulate a nursing diagnosis. Big deal, I say. Nursing care plans are overrated!

Unfortunately, I’m also getting the idea that LPN’s can only work under the supervision of an RN. THAT is distressing to me. Say that AB 394 is implemented in January 2004, and hospitals must then staff their floors at 1 RN for 4 patients (1:4). Theoretically, this means that hospitals can hire LPN’s – after all, an RN’s scope of practice is wider than that of an LPN, so RN’s cost more. Hiring LPN’s to pick up the staffing slack would make a lot of sense. However, this also means that because an LVN works under an RN, it is possible to assign one RN to 10 patients, if the LVN takes 5 of them. This would meet staffing ratios, but would then require the RN to care for her own 5 patients and supervise the care of the LVN’s patients as well.

Most RN’s I know hate supervising anything. After all, if you want it done and done correctly, you do it yourself! Certified Nursing Assistants are invaluable to nurses in helping them turn and clean up patients, empty foley bags, and check fingerstick blood sugars. Other than that, it’s Me RN who will be control freaking on every other aspect of my patient’s care. If I had to o.k. an assessment that an LPN under me does, or determine that one of their patients can have some IV pain medication and then have to go give it, what is the point? It still takes up my time.

I know that there are many areas that are perfect for an LPN/LVN. CCU will never be one of these, but I doubt that that would happen anyway – I’m more concerned about the above happening on med/surg and telemetry floors. There is also a raging debate going on regarding how RN’s treat LPN’s (as though they aren’t “real nurses.”) Regarding LPN’s, I say go for it – use them if that’s the best fit. Just don’t ask me to supervise.

I’m off to NTI in San Antonio for a week. Bye!

This has nothing at all to do with medicine, but I have to ask.

We were in traffic yesterday, and decided to use the carpool lane. It
got me to thinking: What makes people NOT use the carpool lane? I see
all kinds of one-person cars out there – what makes them not just kind of
scoot over a little for a few miles or so?

I rarely see police cars around. When carpool lanes “came out,” were
there stiff penalties for using the lane alone? Does riding solo in the carpool lane elicit ridicule from other drivers? Being newish to the area awhile back, I
was driving in the carpool lane one night by myself during the posted times,
and no one seemed to notice or care.

Anyway – not a pressing topic for sure, but one I’m curious about nonetheless. In a society where the road becomes a parking lot for hours every day – why aren’t more people tempted to break free and use an
almost completely empty lane?