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Interview – Informatics Nurse

Ever wonder how all those hospital systems are created and maintained? (computer charting, systems to report data to national and state organizations, to name a couple)  Sure, they could hire some IT guy to run them, but everything seems to flow better with a nurse’s touch.  After all, we’re the ones using them all the time, right?  Jen C, RN, BSN almost MSN gives us a look into the world of nursing informatics.

Jen has been doing this job for 2 years.  She says she “stumbled into it” when she was interviewing for a new job and mentioned that she was starting her Master’s in Informatics.  Although she was hired to be a staff nurse, within 4 months she was working in Informatics.

What do you do all day?

Each day is different. I do a lot of troubleshooting. I go to a lot of meetings. I do system development and upkeep.  I listen to the nurses and what their issues are with the various systems. I do education. And I still fill in at the bedside (I’m still a NICU nurse at heart).

What frustrates you about your job?

Little definition and recognition as to what my job is. I often seem to be a catch all. I also don’t have a mentor. I’m the only one in my hospital that has formal education in this area and only 1 or 2 in the whole hospital.

What about your job makes you proud to be a nurse?

I still affect patient care. If I do my job well, the nurses at the bedside can do a better job of taking care of patients.

Do you feel you receive adequate support for your responsibilities?

No. I have no backup. I’m essentially on call 24/7.  And don’t get paid for that.  I can’t accomplish all I need to do within the constraints of my hours – I work at home too.  I am paid hourly for now while I’m in school.  I work 4 days a week 9-10 hours a day.

What do you get called about on your off-hours?

Case in point was this weekend. On Thursday night I got a call from the L&D charge nurse.  She told me that the patients weren’t appearing in the charting system they use. No one was moving out of the beds either, despite admissions doing it in their system. The charge nurse had already called the house supervisor who called IT and got nowhere…. So they called me. I was able to troubleshoot over the phone and call the right person in IT directly. Yesterday another charge nurse called me that there were two charts for a patient, and asked if I could fix that.

What is something a nurse who does not work in your particular field might find surprising about your job?

I know more about evidence based practice than most bedside nurses. You can’t expect staff to chart based on evidence based practice if the charts don’t support it. Recently I had to change the way our lactation nurses charted to support the evidence. I’ve done similar things for our neonatologists and gynecology nurses. Often I find out about the changes and pass it on to staff (who usually have no idea).  I also know far more than I ever wanted to know about rules and regulations and core measures. I have to keep my clinical skills sharp. If I don’t do the above, I can’t build an effective system.

Does what you do involve a lot of teamwork, or is it more of an individual job?

It’s both. The actual building of a system is a one man job, BUT getting to that point requires teamwork. I also need the staff to work with me in order to meet their needs.

Was there any extra training besides on-the-job learning that you were required to complete for this job?

You need to be trained on the system(s) you work on. It does help to have formal education in informatics. I see a big difference between myself and those who have no formal education. You get the “big picture” with the formal education.

One of the biggest complaints given by hospital unit-based nurses is that they rarely have time to eat or go to the bathroom.  Do you find that to be the case with your job as well?

It depends. When the poop hits the fan, then no, but most days yes. Eating is another story.

What is nursing informatics’ definition of “poop hitting the fan?”

This is a very geeky answer, so bear with me. One system I support runs on a primary and backup server.  This past summer one server started to fail. In layman’s terms, the server is supposed to run on 4 wheels, we lost one, but it was ok to run on 3 wheels. In the middle of a very busy Sunday afternoon, the 3rd wheel blew, killing that server.

It was a hairy couple of hours while we configured everything to run on the one server. (Since it was Sunday I flew into the hospital to start dealing with it). Another time, one system wouldn’t talk to any other system and just froze up.  It was our fetal monitoring system, so it was a crisis.  I got very well acquainted with tech support that day.  We were down for roughly an hour (so no central monitoring for fetal monitoring).

Thanks to Jen for her explanations of what a nurse in informatics does.  Good thing we have someone on the IT inside :)

(My post about this project and a list of interviews done so far is linked here.)

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Nurse Turned Patient

Hey everyone.

A friend of mine started a blog and I wanted to send some traffic her way.  Go check out Nurse Turned Patient.  As the title suggests, it’s a first-hand account of medical procedure that she underwent told from the perspective of a nurse.

I’ve had several nurses write to me about the interviews!  A few have completed them and I will be posting about one per week.

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Wanted: Nurses to Interview

I seem to have developed an interest in other fields of nursing.  I think the most “typical” nursing field is probably med/surg in a hospital.  But nurses are everywhere!  What about nurses who work on cruise ships?   At stadiums or on movie sets?  Are there nurses who work for NASA?  On Antarctica?  This blog has mainly been about my experiences in CCU, but I’d love to learn more about what other kinds of nursing jobs there are!

I decided to start a new category for codeblog that will hopefully become a recurring feature.  I’d love to interview nurses who work in offbeat areas.  I’m interested in what your day is like, what you do, what your experiences have been.

If you work in an unusual field of nursing, one that isn’t “mainstream,” write to me at codeblogrn@gmail.com.  Even if you do work in a mainstream field (hospital, school, prison, etc) and you are interested in being interviewed for this blog, feel free to write to that same address.  Doesn’t matter if you have a blog or not.

Interviews posted so far:

Nurse who works with the Developmentally Disabled

Nursing Informatics RN

Director of Nursing, Rehab/Long Term Care

Correctional Nursing

Nurse Journalist

Cardiac Cath Lab

Nurse Author – Tilda Shalof, RN

School Nurse

Operating Room – Assistant Clinical Nurse Manager

Humanitarian Nursing

 

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Nurse Vs Policeman, and Other Topics

So who hasn’t heard about The Policeman vs. Nurse?  A nurse was pulled over for speeding, told the policeman that she hoped he would never end up as her patient, and was subsequently fired when the policeman complained to the hospital she worked at.

Really?  I have the utmost respect for the police of course, but put on some big boy undies and get over it.   Should the nurse have made that comment?  No.  Not in front of him, at least.  That was pretty dumb.  But being fired for saying it is ridiculous in my opinion.  Does that cop go complain to the pimp when the hooker he’s arresting makes a sassy comment?

Hey, I just saw that Nurse and Lawyer had a pretty good discussion about the whole situation.

Next up:  Rapid Response Teams Sign of Poor Bed Management.  Really?  I think GruntDoc summed it up best in his tweet about it.  The article states that Rapid Response Teams (RRTs) are utilized due to overcrowding because sometimes patients aren’t placed in a unit that is appropriate for their needs.  Therefore, their condition worsens and they need help.

I suppose all hospitals are run differently, but at the one I work at patients admitted to the ICU are sometimes rock stable.  Seriously – orders like, “Saline at 100cc/hr, Regular diet, Up ad lib.”  No pressors, no oxygen requirements, no aggressive pain management.  Why does the doc then order an ICU admission?  I don’t know.   Maybe they just have a feeling, although that’s not really a good enough reason to admit to ICU.  Regardless, it’s unusual that a very sick patient is admitted to a regular nursing floor.  We actually tend to err on the side of caution.  If a unit that provides a higher level of care has no beds, the patient stays in the ER until a bed opens up or until they stabilize and can safely be assigned to a room on a regular floor.

RRTs are an excellent resource.  Basically, if a nurse on a regular floor is taking care of a patient that seems to be deteriorating, they call for the RRT to come help out.  A nurse and a respiratory therapist (maybe others) respond to the code and help the patient’s nurse out.  How could having MORE people assessing/treating you/notifying your doctor be a bad thing exactly?   I don’t believe RRTs are called because the patient was already in bad shape and assigned to a low level of care.  I think they are called because stable patients just stop being stable sometimes.

RRTs are a way of getting people to come help you before it becomes necessary to call a code blue.   Personally, if I worked on a regular floor, knowing that I could call someone experienced to come assess a patient who was doing poorly would make me feel very secure.  Like someone had my back.  And the patient’s back, actually… there would be someone there helping the patient while I went to go call the doc.

Anyway, I know the article isn’t saying that RRTs are a bad thing.  But I’m not sure the reasoning for their use is on target this time.

Last:  Harvey MD sent me an app that he thought would be of use to nurses.  It’s a “credential reminder” to help keep track of when our various certifications expire/time to do the TB test/keep track of our CV’s.  I can’t say I’ve used it, but it does look fairly useful if your employer isn’t the sort to start hounding you about these sorts of things coming due MONTHS before they actually expire. Ahem.

Actually, that wasn’t last.  I have a bit of a rant.  I took a photography class this weekend.  It was about how to use your digital camera, tips n tricks and all that.  Very interesting class, but something the instructor said kind of offended me, and I don’t think I’m the type to truly get offended easily.  She was talking about the “scene modes” and was telling us that the camera manufacturers decided to use the little icons in the menu (the party hat, the snowman for snow scenes, the lady for portrait pictures, etc) “in case you went to nursing school instead of taking photography classes” so we’d understand what each scene the icon represented.

I’m sorry, what?

I know what she meant, but good grief.  What a crappy thing to say about any profession.  Especially nursing!  I know how to use an unbelievable amount of equipment (IV pumps, balloon pumps, CVVH/dialysis machines, cardiac output machines, monitors, etc etc etc) none of which have any icons except for the little button that has a slash through a bell.   That one is very important :-)

If she’d had an occasion to ask me what I did, I would have replied, “I’m a nurse.  You know, one of those people that they dumb down the cameras for.”  Alas, no opportunity presented itself for that ultra-witty comeback, so it’ll have to remain unsaid.  Or blogged.  Whichever.

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CaringBridge

When Beth found out that her husband had cancer, a friend suggested that she look into creating a page on CaringBridge.org.  As she puts it, “CaringBridge became a tool to help us communicate with others.”

I spoke with Sona Mehring last week, who is the owner of CaringBridge.  The site started as a simple webpage for a friend of Sona’s who was going through a difficult pregnancy.  Sona and her friends used the site to keep friends and family informed of updates, keeping everyone in the loop without having to make several phone calls each day.

Thus, CaringBridge was born.  Anyone with an illness or those who are taking care of someone with an illness can create their own webpage through the site to keep friends and family informed of the patient’s progress.   It’s free, there are no ads, and Beth states, “I appreciate its ease of use. It is an intuitive interface, so it didn’t take much time at all to set up and use. I’ve never been frustrated using it!”

Sona pointed out that using the site is beneficial to 3 different groups of people.  The patient stays connected to family and friends through updates.  Those who get updates can then sign a guestbook with questions or words of encouragement.

The patient’s main caregiver can also benefit from messages of support.  Being a primary caregiver can become very isolating as they become more and more involved with the patient’s day to day care – traveling to appointments, trying to procure test results or helping out in the hospital.  The caregiver might also find comfort in being able to journal their feelings on the site.

And the site can aid the community’s ability to rally around the patient and caregiver.  Sona mentioned a study showing that contact with family and friends can decrease significantly when someone is diagnosed with a major illness.  One of the biggest reasons was that the patient’s community did not want to “bother” the patient or caregiver.  This concept was not lost on Beth, who said, “I sense that some are eager to keep in the know, but do not want to feel like they are bothering me.”

CaringBridge not only connects patients with community; it also connects patients with other patients.  Sona explained that patients and families often meet others going through the same thing in waiting rooms or treatment rooms and swap CaringBridge websites, thereby forming a support group of sorts amongst themselves.

Sona says that people come to use the site mainly through word of mouth from current and previous users.  Hospital employees also refer patients and families, and CaringBridge is active in trade conferences as well.

Personally, as a nurse, I think this site is a fantastic idea.  I certainly have days at work when I’m getting call after call inquiring about the status of a patient from different family members.   We always encourage families to designate one person to call the unit for an update and then disseminate that information to everyone else.  Rather than making numerous phone calls, that designee can update the website.  People visiting the site can enter an email address to be updated automatically every time an entry is made.

Beth did say that it’s sometimes difficult to know how to say things: “One of the challenges has been knowing what to share and how to share it, as the information is broadcasted.”  She went to on explain that when both caregiver and patient are contributing to the site, the needs of both need to be taken into account.  One person may have the desire to share a lot of information when the other person might want to show a little more restraint.

The last feature about the site I want to mention is the ability to easily turn a journal/pictures/guestbook into a real book.  Sona mentioned that some of these books are even used at memorial services.

If you’ve been reading codeblog for awhile, you know that I don’t regularly endorse websites.  I find CaringBridge.org to be exceedingly useful to patients and families and wanted to help spread the word.

You can also find them on Twitter and Facebook.

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A Rambling and Some News and Some Other News

I took care of an elderly man recently.  He’d been dealing with multiple medical problems for almost 30 years.  Despite being in some very significant pain, he still made eye contact, still said “please” and “thank you.”

He wasn’t faking the pain.  He was very stoic, but I could tell he was hurting.  That tight-lipped grimace, the tachycardia, not moving a muscle unless it was absolutely necessary.  Still, manners prevailed.

My colleagues and I went above and beyond for him and his family.  There’s just something about being polite to others that makes those others want to help you and help you and help you some more.

I’m not saying that we don’t want to help those that aren’t overly polite.  It was just nice to be treated, well, so nicely.  I wouldn’t expect everyone in severe pain to maintain such decorum.  Every once in awhile you just click with a patient and it makes being a nurse so enjoyable.

So!  News #1.  Another of my posts has made it into a book.  It’s called “Lives in the Balance” and was edited by Tilda Shalof, who has written quite a number of books about ICU nursing.  I have read some of those books, so when she personally asked for one of my posts to be included I was quite flattered!

I’ve read the whole book, which is full of very compelling stories written by nurses who work in ICU.  I highly recommend giving it a read, and not just because one of my little posts made it in!

News #2 will only be news if you don’t follow me on Twitter or Facebook.  I am just over 10 weeks pregnant!  We are over the moon about this and can’t wait to meet him or her in late July.

And I guess the bonus news is that this blog is 7 years old this month :-)

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Change of Shift & The Doctor Anonymous Show

First of all, hightail it over to Reality Rounds for the latest edition of Change of Shift!  She did a splendid job of making it very spooky by renaming our blogs.  (I am Corpseblog!)

And tune in tonight at 6pm PST to the Dr. Anonymous show, where he will be interviewing me.  Talk about scary :-)  I am excited to finally be asked (I’ve waited years!) but also nervous because I am not exactly well-practiced in live interviews!

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Blog World Expo 2009

Last week I attended the Blog World Expo conference in Las Vegas.  This is the first year that medbloggers had a track all to ourselves!  The sessions I attended were interesting, and as part of the audience I was delighted to watch my fellow medbloggers on the panels.  There were lots of thoughtful questions & answers, and many silly antics (how many times DID Doctor Rob get onto the big live Twitter feed anyway?? blogworld blogworld blogworld!)

Unfortunately, due to a splitting headache, I was not able to attend the last session, but I had plenty of chances to meet and spend some time with medical bloggers that I have been reading for years.  It was truly great meeting each and every one of you and I’m looking forward to seeing everyone again!

Meeting Terri from Nurse Ratched’s Place was a real treat, as was meeting Kim at Emergiblog.  Kim posted quite a bit about the conference – you can read her post here, which contains LOTS of pictures!  Kim and I shared a lovely (albeit sugary!) lunch together AND managed also to do a joint interview, which can be seen here. (The MJ Propofol anecdote?  True story.)

Here are some other thoughts from the bloggers that attended, namely Doctor Rob (one of these days I will earn a golden llama for my blog.  It is a blog goal of mine), Dr. Wes, Dr. V, Kerri (congratulations!), Kevin MD, Doctor AnonymousNick MD, and Dr. Ramona Bates.  Ramona made a beautiful quilt that we all signed.  It was given away as a door prize to one very lucky person, who did not happen to be me.  I was really thrilled to meet one of my favorite bloggers who is also the medical blogger I’ve known for the longest time (7 years in December!) GruntDoc.

A big thanks goes to Dr. Val (also fantastic meeting her finally!) who helped arrange the whole darn thing, and Johnson & Johnson and Medpage Today, who sponsored us.

2010, anyone??  :)

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Some Tips for a Safe Hospital Stay

I meant to link to this awhile ago but didn’t think about it again until today.  Get Better Health posted an article outlining some tips for patients describing ways to stay safe while in the hospital.

They are very good ideas, and I’d take the very last tip one step further.  When you are being discharged and your nurse is going over your discharge instructions, ask for a printout giving information about new medications you’ll be taking.   This should be available at most hospitals… and if it isn’t, it should be.  That way you’ll have a detailed reference you can look at later when you’re at home.

Here is the post. Enjoy!

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Kim turns 4 today!

4 years ago today, Kim at Emergiblog wrote her first post.  Since that time she has become one of the most well-known nurse bloggers ever to have blogged.  She has remained quite dedicated to her blog, even during the writer’s block times – which is very hard to do.

Kim has done much to further the image of Actual Real Life Nursing through her blog, and for that I thank her.  Happy Birthday, Emergiblog!

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  • 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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