PixelRN

Wow. I’ve been so busy getting ready for this guy’s 2nd birthday…

…that I totally missed another birthday. This blog turned 4 years old on March 20th! I enjoyed revisiting my first post. It’s funny to think of myself as a brand spanking new nurse, worrying about how I was going to handle death. I guess that’s pretty much why I turned to blogging in the first place.

Speaking of death, I’ve pretty much pulled the plug on OrientedX3, for a variety of reasons. First of all because it got hacked - not once, but twice (thank you, wordpress). And also because I just don’t have time to keep updating it, improving it, and promoting it.

I’m still very interested in aggregation though, and particularly twitter aggregation. I felt re-energized this week when I came across this site: Exectweets. This is exactly what I had hoped OrientedX3 would evolve into (with nurses instead of executives, of course). So don’t be surprised if OrientedX3 returns - perhaps in the form of a NurseTweets.com.

Another reason I felt energized is that there are so many more nurses on twitter now and there are easier ways to find them. But I am still stifled by this same question: Is this type of aggregation useful? Is it valuable? Can nurses benefit from this personally or professionally?

I don’t know. Sometimes I wonder. I haven’t worked a nursing shift since January, so I’ve been feeling a little out of touch with the profession. I’m sure this will change when I start my MICU contract in April. I’m also very excited to meet some like minded professionals at HealthCamp Philly this weekend! Also very stoked to possibly score a decent cheesesteak while I’m there.

Oh, and if you think the title of this post sounds vaguely familiar, here’s why.

First off, what is HealthCamp Philadelphia? It’s a free mini-conference that gives health care providers and technically minded people the chance to come together and discuss their ideas.

So why am I going?

First of all, I’m looking forward to meeting some of my favorite tweeps like @holaolah, @LizScherer, and @PhilBaumann in person. Secondly, I’m hoping to have a discussion about the way patient information is exchanged between health care providers. In nursing we like to refer to this as “report.” Technology should theoretically allow our reports to be exchanged in away that is timely, accurate, and efficient. We have computerized nearly all the aspects of our health care delivery from ordering, to charting, to health records. Yet our nursing reports still consist of handwritten notes and rushed phone conversations! Why is this?

To explain my frustration, I offer you a typical MICU scenario:

A doctor goes to the computer and places an order for your patient to go to radiology for a procedure. You haven’t seen the order yet because you are in your other patient’s room, doing an assessment. You get a phone call. It’s the procedural nurse.

“Your patient is coming to radiology, right? We haven’t gotten your transport sheet yet.”

“I haven’t even seen the order yet.”

“Well, try to hurry up and send us the transport sheet.”

(The transport sheet is basically a patient report sheet that you fill out by hand and fax to the appropriate people.)

So you finish the assessment while thinking about what meds you will need to give before your patient can leave the floor. You get another phone call. This time it’s the transport team.

“Your patient is going to radiology, right? We haven’t gotten the transport sheet yet. We’ll have a team ready in 15 minutes but you have to fax us the transport sheet.”

“Just got the order. I’ll get it to you as soon as I can.”

As an ICU nurse, you have to grab this piece of paper from the nurses station, open up your electronic chart, and start writing down the information on a piece of paper so it can be faxed to 2 different parts of the hospital.

Do you see the folly in this? (I guess you could say the transport sheets are kind of like my TPS Reports.)

The flow of patient care has just been interrupted not once, but twice, by people telling you to “Hurry up and fax us the transport sheet!”

You’re already working with electronic charting. Why do you have to transcribe something with pen and paper? Isn’t the whole point of making things ELECTRONIC so that you don’t have to do it that way? If another health care provider needs access to this information a patient report should be automatically generated and sent to the appropriate areas of the hospital. Then, if anyone has any questions about the patient, they can call you to get clarification, hopefully without too much interruption.

So what’s the answer?

There are many different ways to solve this problem. I’ll focus on one: I believe that twitter could serve as a model for relaying patient information efficiently, timely, and accurately. (And obviously you would address the issue of patient privacy as well.) Bonus points? The 140 character limit forces you to enter the most relevant and concise facts about your patient, so you’re not flooded with information that you don’t need at that particular point in time.

And that’s just one use for twitter in the health care arena. Check out Phil Baumann’s slideshare presentation of 140 more!

Is twitter an oversimplified way of solving this complicated problem?

Perhaps. But the point is that we have to start discussing this. The technology exists to make hospitals so much more efficient, and yet I can tell you from a nurse’s perspective, we aren’t seeing much in the way of innovation. Hopefully in the near future we will be seeing more of these Healthcamp-like events where people can get together and start the discussion.

I’ll be going back to the MICU for a contract that starts at the end of April. For a variety of reasons.

Still twittering at times but overall have been feeling burned out on the whole social media thing. I made the mistake of following a bunch of Chris Brogan types and all of a sudden my twitter stream turned into this big circus of social media types high fiving each other all day long. After awhile I started to prefer those who tweet about what they are eating.

My blog was hacked (again) while I was on vacation. This time it was because I didn’t update from Wordpress 2.6 to 2.7. Needless to say, I’m not really feeling the love for Wordpress. But what’s the alternative?

My husband got me a Nikon D90 for Christmas! The funny thing was that he had to spoil the surprise because he read this post and was afraid I would impulsively go out and buy a new camera. I’m really excited to get outside and start shooting away (that doesn’t sound good, does it?) but unfortunately it’s been so dang cold around here.

I have been utterly obsessed with economics, politics and the Great Depression 2.0. I’ve gone from confusion to outrage to fear to bewilderment and now I’m think I’m starting to make peace with the whole idea. Hence the MICU contract. Don’t you just love it when a blog post comes full circle?

It’s that NCLEX time of year again. While most of us are stressing out about Christmas, I know there are a select few of you who are stressing out about NCLEX.  I want you to know, it’s not as bad as you think. I actually wasn’t too nervous about taking the NCLEX back in 2004. In fact, I felt pretty confident. Why? Because my nursing school had a good passing rate. Something like 92%. That means that 92% of the students from the previous class had passed the NCLEX on the first try. While I wasn’t at the tippy-top of my class, I knew that my grades were respectable. Perhaps even admirable. So statistically speaking, it would be very unlikely that I wouldn’t pass.

In the end I think passing the NCLEX comes down to three factors:

1. NCLEX Practice questions. Take lots of them and when you do, don’t get bogged down by the details. The point of taking the practice questions is to get you to think like a nurse. As a nurse you will have to prioritize everything you do, and therefore the questions are formatted as such. So many questions boil down to prioritization (i.e. You have 4 tasks. Which one should you do first?) And that’s where your ABCs come into play…
2. ABCs. Airway, Breathing, Circulation. Live it, love it, learn it. So many questions are based on this hierarchy. So even if you come across a question with a drug or a disease that you’ve never heard of (I’m not gonna lie to you - it happens) you can always try to pare the question down to the ABCs.
3. RELAX!!! I can’t stress this enough. I think there are some pretty smart cookies out there that fail just because the get themselves all in a tizzy before they take the test. Don’t be that student. You will have ample time to take the test. Just take a deep breath before every question, and give it your best shot.

And finally, congratulations to Not Nurse Ratched, RN(!!!), who passed the NCLEX early and inspired me to write this post!

Creative Commons photo courtesy of Nicole St. John

The other day I was talking to a veteran CCU nurse. She told me that she worked at the hospital where the first defibrillations were studied and performed. Like many health care studies, the testing was done on animals - dogs in this case.

She then went on to tell me that one of the requirements for working in her CCU (back in the 1970’s) was that you actually had to defibrillate a dog to show that you were competent in that skill! Yes, the dogs were sedated before hand, but still.

Nurses see (and do) the craziest things.