Furniture, Back to School, and GreekFest

Weekend before last, we decided to make the dream a reality and commit to the couch. After scouring Craigslist, Salvation Army, and various furniture stores, I realized: I needed the Costco sectional. Nothing else would do. So we called up our friend, loaded the 7 pieces into our two cars in two trips, and: voila! Comfortable downstairs seating. If you want to see it, however, you will have to come over as we haven’t needed to take a picture of it yet.

Last Thursday, I got up really early and set off to the Big Cities. I gave myself 3 hours because I had no idea what kind of traffic to expect. I had barely reached north Rochester when a torrent began, the rain falling so fast my puny little windshield wipers couldn’t keep up. The next couple hours of driving I heard NPR mention the flooding in Rochester (“standing water in the Mayo clinic!”) Yikes, what a day to head out of town! Thankfully, this is not a blog about sand bags or getting water out of our brand-new carpet… our house survived just fine.

I was heading to the Cities for orientation to my Minnesota State University – Moorhead RN-BSN program. While this is an online program, they do like to have an in-person orientation to get us all on the same (web)page. They fed us and talked to us and let us go early. By the end, I was almost disappointed that I won’t be spending in-person time with these folks for the next two years.

Finally, last weekend was our 4th Annual Greekfest. We joined our friends at a splendid Rochester street festival: Presbyterians and Lutherans mingling by the folding tables, Greek music blasting, cheery Greek American folks yelling “opa!” as they serve you tasty gyros, devouring sticky baklava straight out of the box…

Mmm I’m getting hungry just remembering.

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A beautiful Rochester evening at Greekfest

It’s been a fun and busy end of summer up here. Now it’s time to buckle down for the fall.

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C Shift

I worked C shifts this weekend for the first and possibly last time in my career. A C-shift is 11am-11pm and it has many advantages and disadvantages. Let me say this; it’s an interesting experience!!

There are many different shifts in nursing-land, some of which I’ve talked about before. When we get our schedule (still on paper in 2013), we have our name and then under each day a blank or a letter or symbol. There are about 60 letters and symbols signifying different amounts of time worked, excuses for time not worked, orientation etc etc. 

I have worked D or day shift (7am-3pm), E  or evening (3pm-11pm), A or “all day” (7am-7pm), and M or as I like to think of it “midnight” (7 pm-7am). I’ve never heard of anyone working a B (9am-9pm) but that’s on the list too.

Advantages to a C shift are:

1) Waking up late! None of that 5 in the morning business.

2) Working during “normal awake” hours (for a nurse) and thus being able to return to a normal schedule during the week.

3) Normally on a weekend shift you take 1 45minute -hour long break, but with a C shift most units are very accommodating and will give you 2 30 minute breaks so you can keep up your energy level (mealtimes were something I was worried about but it turns out it’s not an issue!)

4) For me, C shifts apparently meant Cardiac as I went to two different cardiac units this weekend. I can’t read strips but I do enjoy cardiac units. Hearts are cool!

Disadvantages:

1) At 11 am you’re usually taking a patient from someone who has only been there for 4 hours, and then often you’re only there for 4 hours… it can be a little confusing for the patient!

2) You have to wait on that assessment. We normally assess first thing in the morning and sometime in the afternoon/ evening, so with a C shift you’re usually waiting at least 5 hours before doing an official assessment (sometimes more like 10 hours)

3) No one else is working a C shift so at 7 you lose your “crew” and have to make new alliances.

Finally, like all other 12 hour shifts, a C shift is draining and takes up the entire day. But it’s a fun experience and I would do it again! Is it better than an A? Not in my opinion, because after an A shift you can go hang out with your friends until bedtime. With a C shift, you sleep, work, sleep.

So that’s the skinny on C shift! Now back to normal – E’s, A’s, and M’s!

 

Midnight Munchies

I love nursing but it can be a tough job. Multiple patients, multiple halls. All a manner of needs and issues. Calls to be made, forms to be filled out. Before I know which end is up, five hours have passed without a bathroom break, a drink… Or a snack!

Often I will stagger home at midnight ravenous, even though I ate a perfectly good supper six hours earlier. I will peruse the cupboards, starving for something – I don’t know what – something sweet yet packed with protein and carbs. Something to substitute for dinner with my husband. Something more satisfying than yet lighter than a steak dinner.

Generally although I know it’s not good for me I have craved fat – brownies, cake, cookies. For a long time all I could think about was creme brûlée (not that we ever have that in the house!) Buttercream frosting. Guacamole.

I will eat just about anything. Lean cuisines, leftovers, anything frozen and reheated.

But recently I have discovered the best
midnight snack ever. Reheated frozen fruit, Greek yogurt and honey. Mmmm. Sweet, creamy, delicious – with lots of protein and no fat. (Although I think Greek yogurt may be a scam. That stuff has to be sour cream!)

Discussion with other nurses has revealed that I am not the only nurse with this problem. In fact, floor nursing can be very dangerous to the waistline. The temptation towards high fat and high sugar foods, combined with work that, while exhausting and stressful, isn’t exercise, results in unhealthy eating patterns.

I am still looking for other perfect late night meals so if anyone has tips let me know 🙂

From A(cetaminophen) to Z(ofran): An Alphabet of Nurses

You’re in the hospital. Your nurse is trying to make you better. What is s/he bringing you?

Warning: Blunt nursiness to follow. May be too much for those of a delicate temperament.

Acetaminophen: Come on, y’all, you know this one. Tylenol! Takes the edge off pain (except pill-seekers) AND fever. Double whammy.

Beta-blocker: Okay, okay. It’s not technically one medicine. But if it ends in -ol, it’s probably a beta blocker. Like atenolol, propranolol, etc etc. Great for lowering a high blood pressure.

Calcium: “Come on, I take this at home for my bones!” Not so fast, snarky reader. Not only is calcium great for bones, Tums are great for your tummy.

Digoxin: This was one of the first meds we learned about. It helps to slow the heart and prevent arrhythmias. Cool fact: comes from the foxglove plant!

Enalapril: This is an ACE inhibitor, another blood pressure medication. Can cause a nasty cough.

Flomax (finasteride): Look this one up, y’all. But a lot people get it.

Ginger ale: A lot of people swear by it for nausea…

Haldol: OK, I’ve never given this, but in a nod to psych nurses, this is an important one for chillin’ people out.

Ice: Great for pain and fevers. Sometimes old remedies are the best.

Juice: Great for clear liquid diets, bad for blood sugars. Especially popular – prune, effective for the bowels.

K-phos: On dialysis? Take your K-phos with your food!

Lasix: Gets the fluid off by making you go to the bathroom. A lot. Great for heart failure, bad for potassium.

Milk of mag: A fantastic bowel med, especially when mixed with prune juice or coffee in the delicacy known as a “Brown Cow”

Normal saline: Also .9 NaCl!! Almost everyone gets a bag of this. No nutrients, just straight isotonic fluid replacement.

Oxycodone: The gold standard of pain pills. Some permutation of 5-15 q 2-4 hours should get you through (we’ll titrate up slowly because we don’t want you unconscious!)

Potassium: Nasty big horse pills. Or nasty orange powder. Or nasty “K-rider” that will hurt as it goes in. You take your pick.

Quease-Ease: Great for nausea for some, useless give-away for others. Smells minty. My teacher said you could get the same results with an alcohol wipes, but alcohol wipes don’t look nearly as cool as the submarine-like Quease-Ease tube. And the scent lingers for months!

Respect: I snuck this in here instead of Rifampin, because nurses have (or should have) a lot of respect for their patients. Mutual respect is essential to the healing relationship.

Sulfas: Great for infections. Bad for allergies.

Tiotropium: You got COPD? You’ll get this inhaler (AKA Spiriva) 

Ultram: Tramadol, the non-narcotic narcotic

Vancomycin: You got an infection, we’ll give you a PICC and pump you full of this. But slowly. Cuz it bubbles. And it will turn you red. And if it gets into your tissues… it’s bad.

Water: Ice water, and lots of it.  

Xanax: You are getting sleepy… very… sleepy…

Yaz: OK, I don’t give this much either, but the few young women who I treat usually bring their own from home.

Zofran: Great for nausea, oral or IV.

There you have it! A nursing alphabet!!

Music and EAs

I worked an overnight shift on Saturday on a unit I had spent relatively little time on… and it went fine! Overnight shifts are very busy from 7-11 and then quiet down until around 5. I don’t mind them, except for the fact that they are overnight and mess with my sleep schedule. Thankfully I only do them every 6th weekend (for now). 

I slept until 1:30 and then got up to face the day. I had the special opportunity to perform with several other talented musicians and dear friends at the Festival of Music. Our church hosts this series every year and one “episode” is always “Lee Afdahl and Friends,” featuring our talented music director and organist, Lee, and other local musicians. This year, I was one of Lee’s friends!

Our “flute” choir, composed of 4 flautists from our church (one with a piccolo and one with a bass flute!) and a clarinetist, performed a cheerful Celtic ditty. I loved it and in fact it is still stuck in my head. We also had some excellent performances by trumpets, soprano saxophone, clarinet, and voice in a range of styles. Nevertheless throughout the whole concert I had the weight of work hanging over my head. I love my job but on this celebratory Sunday I was dreading having to leave the fold of musicians and go to the hospital.

However by 6:00 I felt ready to head in. I donned my scrubs and headed out to the car. As I started to drive away, I realized I hadn’t eaten anything. I decided I would eat my sandwich while I did my prep work.

Then, as I was about to pull into the parking garage, I got the call. “We had an opening and we can give you an EA. And we’ll give you twelve hours.”

“Awesome!” I cried, turning my car around and heading back to the church to change and then attend a delightful evening with the Festival of Music committee…

***

“Hold on,” you’re saying. “What’s an EA?”

An EA, or Excused Absence, is like Christmas in July. It only occurs when 1) you have signed up to take an excused absence, and 2) they have enough nurses and don’t need you that particular shift.

In this case it occurred at the last minute. And it was PERFECT! I went to the party, drank champagne, and had a lovely evening.

Of course I couldn’t go to sleep until 1:30 because I had slept all day but you know what? It was worth it.

5 “Rights” for a Good Float

In nursing school we learned about the Five Rights of medication administration – right medication, right patient, right route, right dose, right time. (Some people added right indication.) If you follow the five rights, you will have done your duty in administering those medications.

Come to think of it, the 5 rights are suspiciously similar to the  Eightfold Path of Buddhism...

Someday I will post about medications. But today I want to talk about the 5 “Rights” that make a float a good float.

1) Right assignment – we’re float nurses. We’re specialized at being generalists. And obviously, floats from other floors are specialized in something different than the floor they are going to.

So we can handle a lot but maybe not that super-unique patient that only ever comes to your floor because nobody else knows how to take care of him/her. No, we don’t need an EASY assignment. But a FAIR assignment.

And before you give us Y patient that everyone else is sick of, think – is that the right nurse for the right patient?  If I can do everything for that patient, I am happy to take them for a night. It’s only a night! But if I can’t, if I will be constantly running to your nurses and taking them away from their patients…

2) Right resources – As a float, it’s important to have a good resource from the floor to help answer all those picky questions. “Do you chart in this or this?” “How do you do this on your floor?” “Where do I find X tiny little thing in the par stock room?” Also it’s great to have other helpful staff – PCAs, secretaries, pharmacists – who are polite and responsive and really make you feel part of the team.

3) Right attitude – on both sides! As the float nurse, I need to have what my facility calls a questioning, receptive attitude where I am flexible and open to learning, where I am not upset if my assignment seems hard but instead am willing to trust the charge nurse. And a right attitude from the staff is really helpful.

In fact, sneaky tip, it’s good when both sides (the float and the unit) are over the top. In general, I don’t feel like people need to thank me for floating to them. It’s my job! But, come on, who doesn’t like being thanked and maybe getting a piece of candy? And people respond well when I compliment their unit (no insincere compliments of course, but there’s something good about every unit!)

4) Right break – If I get a lunch at a reasonable time, and if I am eating in the break room and other people include me, I am a happy nurse.

If not, I’m not as happy.

Our place is great about prioritizing lunches and promoting inclusiveness.

5) Right handoff – a timely, smooth hand-off is a wonderful thing. Come find me and ask me for report before I only have five minutes to discuss 3 patients. Because then you know I’ll leave late, and I’ll be sad, because I’ve already been at work at least 8.5 hours.

By these criteria, most of my floats are good floats. And for all you nurses out there, getting ready to go to another unit…

Have a good float!

 

Phlebotomy

Etymology: from Greek phlebotomos “opening veins,” from phleps (genitive phlebos) “vein” + -tomia “cutting of,” from tome “a cutting.” 

I work at the hospital, and I love being a float nurse there. Part of the reason I enjoy it is the teamwork aspect. Need a room cleaned? The housekeeper is already there. Don’t have time fora  bath? Ask the PCA to help. Need a new IV start? IV team. Anything to do with a catheter? Cath team.  Instead, I focus on what I learned a lot about in nursing school: the big picture in acute care nursing. Assessments, critical changes, meds, education, and coordination.

However, I volunteer at a clinic, and I love volunteering there because it’s so completely different. Different pace, different responsibilities. I had previously volunteered in a different capacity, but yesterday I walked in for the first time as a volunteer nurse. I thought, “I work in a hospital. This will be easy.” But I got a patient’s information, walked into the room, and stammered through my interview.  I’m not used to gathering a history, except informally…I didn’t know what to ask about!

Another new skill at the clinic is, as you might have guessed, phlebotomy. K., the supervisor, mentioned that he wanted me to try a venipuncture sometime that morning and I felt… nervous. In many hospitals, nurses do their own labs and their own IVs but, as mentioned, not at ours, so sticking a needle in someone’s veins is a foreign procedure that feels personal and invasive. He had me practice a few times on a cushion and then asked me if I wanted to practice on his arm.

I wasn’t sure. Maybe I should think it over. Maybe I should study up on it.

Maybe I SHOULD practice on my husband. Maybe when he was asleep. (OK, probably a bad idea). Or could I practice on myself?

I studied K., the clinic supervisor as well as a former classmate of mine. It seemed like a bad idea to stick my boss, even at a volunteer gig, with a big steel needle. Maybe I should wait until A., a less intimidating coworker who boasted of good veins, offered her arm…

But at the same time, I wanted to be brave. “Have I not commanded you? Be strong and courageous. Do not be frightened, and do not be dismayed, for the LORD your God is with you wherever you go.” (Joshua 1:9).

Not to mention, “fortune favors the brave” and I wanted some luck to avoid sticking K. twice.

“I’ll try it,” I announced as confidently as possible.

Looking nervous, K. slipped into the chair. I prepared my supplies, tourniqueted his arm with the blue band, palpated, gloved, steadied, prepared my needle…

and got it on the first time!!

As I watched the dark blood spurt into the orange and black tubed vial theycall the “tiger tube,” I felt the rush of success. (Then I tried again on someone else and lost the vein after the first tube, but everyone has a few stories like that…)

***

As I walked out of the clinic after a half day, I felt like my brain was about to explode, but in a good way.  I love learning new skills and information.

Venipuncture seems to be more than another skill. The medical setting allows us to violate that most basic personal boundary – skin.  Causing them pain, tapping into the source of a person’s very life, their flowing blood. Phlebos. Cutting  (tomia) like surgeons once did to “bleed” people to health.

Now we bleed people to read the secrets of their cells. Anemia, diabetes, leukemia. So many stories are written in the blood. Answers in antigens.  We have to hurt to heal.

Tome: From Greek tomos “volume, section of a book,” originally “section, piece cut off,” from temnein “to cut,” from PIE [Primitive Indo-European] *tom-/*tem- “to cut”

Phlebotomy. A tome of blood. It all comes back to the books.