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Feb 27

The Latest in CPR Techniques

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(Foreman performs the life saving “titty twister technique” after House OD’s on methadone)

Renewed my CPR today. In the beginning I was so blase about it. I couldn’t believe that the content could actually take up 4 hours and I complained about it. But once I was there I had a better attitude because I remembered that this is pretty important stuff, and so it’s important to practice and brush up on your skills every once in awhile. By the end of the class I was really starting to thing that I am ready to go back. I’m not afraid. It’s going to be a good thing. Oh sure there will be some tough days (and nights) but I’ve done it before and I’ll do it again.

A couple surprises, though:

1. They didn’t mention the Stayin Alive factor. Something I find incredibly useful in keeping pace.

2. They didn’t mention the “titty twister method.” For those of you unfamilliar with this it was on House last week. House went into respiratory arrest and Foreman brought him back with an heroic titty twister. My initial thought? This would be perfect for those who like to fake seizures.

Dec 16

Passing the NCLEX

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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

Oct 17

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Why I’ll Probably Quit Nursing

There’s been a lot of recent discussion about nursing salaries and the nursing shortage.

I wanted to chime in because (a) I love to over-simplify things, and (b) I am on the verge of becoming one of those nurses they refer to – the kind who works 2-3 years after school and then quits.

The reasons aren’t complicated. Here’s why I’ll probably end up quitting:

  • The money sucks.
  • It takes its toll on you physically.
  • I don’t want to work nights, weekends, or holidays.

Sure there are many peripheral issues – nurses dumping on each other, lack of autonomy, lack of time and resources to get the job done right. But other than that it’s a personally rewarding, and (at times) intellectually challenging job. It feels good to help people when they are sick. I love being the voice of calm in a storm. I love working as a team and saving lives (sometimes.)

I just don’t love it enough to get over the three points that I listed above.

It’s that simple. If I became a nurse when I was 22 I might have gotten a few more good years in, but sadly, I didn’t. So if there’s any constructive advice springing from this negative view of nursing it would be this: Get ‘em in while they’re young. The earlier you start your nursing career, the later your burnout will be.

Oct 12

The Future of Health Care Blogging: Blog World Expo 2008

I recently was fortunate enough to attend Blog Word Expo 2008, the world’s largest blogging and new media conference. Part of my agenda was to meet with other health care bloggers like Kim from Emergiblog, and Dr. Val Jones from GetBetterHealth, to discuss the possibility of putting together a track dedicated to health care bloggers at next year’s conference. We also met with Rob Halper, who oversees the Johnson & Johnson Youtube channel, and Shane Pike, of HealthCareToday. Together we brainstormed ways that we could make this happen. The result? A health care blogger track is a sure thing for next year (September 2009), and it’s going to be the first event of its kind that will bring all types of health care bloggers together. Potential topics include: HIPAA issues, using blogging to affect change in health care policy, and using your blog to leverage your expertise in your field. If you’re interested, Emergiblog has a poll up where you can see the list of topics and vote on the best ones.

One of our goals for the health care blogger’s track is to include all types of bloggers in the health care arena. That includes nurses, doctors, students, EMTs, technicians, medical librarians, social workers, pharmacists, researchers, and patients. One of the great things about health care blogging is that it brings together people from all specialties, and the result is one of the largest (and liveliest) ongoing multidisciplinary discussions on the state of health care. If you are still new to this idea of people blogging about health care, I would urge you to check out Grand Rounds. It’s a weekly roundup of some of the best blog posts with a medical theme.

Blog World Expo is a worthwhile and energizing experience for any type of blogger. If you have a blog, whether it be about nursing, or any thing else, I would urge you to go.  Presentations included topics such as how to make money from your blog, building readership on your blog, and how to analyze your blog statistics. One of the best things about Blog World Expo was getting to meet other bloggers face to face. I had known of Kim and Dr. Val through their blogs for a couple of years now, but this was the first time I had a chance to sit down and have a conversation with them. It was a very energizing experience.

If you’d like to learn more about Blog World Expo and the health care blogger’s track, stop by Emergiblog and leave a comment with your email. Kim, the author of Emergiblog, is putting together an email list and will be updating us through out the year on this event. Hope to see you there!

Sep 25

Social Networking Strategies for Travel Nurses: Part 2

In this post, we’ll take a look at Facebook, Blogger, and WordPress. Facebook is kind of a grab-bag for all of your social networking activity. You can create a profile, upload photos, write notes, and post links, and find people that you may know from high school, college, or previous places of employment (among other things.) If you are a traveling nurse and still aren’t using facebook, I suggest you sign up. It’s a very convenient and fun way of staying in touch with people. There are also social sites dedicated strictly to nurses and people who are interested in nursing. Nursinglink is one of them. It contains many of the same features that you see on Facebook but centers around nursing. If you are really ambitious about social networking you can start your own blog. What is a blog, exactly? The original word comes from web + log, and the first blogs were kind of like personal journals. They date back to earlier in this decade. These days a blog can be about anything you want it to be. It can be a personal diary, a way to update your friends and family on where you are traveling, or it can even be a collection of articles that you have written on a chosen subject. Travel nursing and blogging go hand in hand, and there is a great community of nurses who blog out there. Setting up a blog is really very easy to do, and free as well. You can start a free blog at wordpress.com or blogger.com. Each of these sites have templates that you can choose from and fairly easy to use interfaces. There’s a large community of nurses who blog. You can find a partial list of them at OrientedX3.com. There’s also a biweekly roundup of some of the best nursing blog posts called Change of Shift. You can see the latest edition of Change of Shift at crzegrl.net. In part three we’ll take a look at Twitter, a micro-blogging tool, and LinkedIn, a social site for professionals.

Sep 25

Travel Nurses and Social Networking

What could a travel nurse possibly want to know about social networking? How about everything? In my view, every travel nurse should acquaint themselves with at least one or two of the social networking tools that are available. I can’t think of a better way to stay in touch with friends and family while you’re on the road. With that in mind I wrote a series of articles for my friends over at travelnursingblogs.com. You can find part one here. I’d also like to thank Medical Solutions for sponsoring my trip to Blog World Expo. It was well worth it! Also, I just finished writing my about page. I’ve had this blog for a long time and it recently occurred to me that I’d really like to tell the story of how I got here to people who arrive by *accident* Enjoy!

Sep 20

Medbloggers at Blog World

Sent from my iPhone

Posted by email from pixelrn’s posterous

Okay, so who’s who in this picture?

Rob Halper, who runs the JNJ Health Channel, yours truly, Shane Pike of Health Care Today fame, the illustrious Kim of emergiblog, and the vivacious Dr. Val.

Sep 17

Social Networking Strategies for Travel Nurses: Part 1

First of all, what is social networking, and why would a travel nurse be interested in it? A social networking service is basically any type of website that provides a way for people to connect and socialize online. More and more nurses these days are using social networking services to connect with friends, family, and other nurses. Travel nurses, especially, can benefit from these new technologies. They travel from job to job, making new friends along the way and trying to keep in touch with old friends, not to mention the people they leave behind at their home base. Online communities, blogs, and photo-sharing sites can help them stay connected to everyone. But there are many different sites out there and figuring out which ones to use can sometimes be overwhelming. I’d like to share with you my top 5 favorite social networking sites, and explain how they can benefit the travel nurse.

Let’s start with one of my favorite social networking sites, Flickr

Flickr is a site that lets you store and share your photos. Two things make flickr especially useful, the ability to “tag” your photos and organize them according to subject, and the ability to search other people’s photos by subject matter. Also, you can create a profile and “friend” other flickr users. Flickr and traveling go hand in hand. Say you are about to accept a travel assignment in Baltimore, MD. You’ve never been there before and you are anxious to get a feel for the city. Perhaps you’d like to figure out what neighborhood to live in, or what sites you’d like to see. Flickr allows you to search all of the photos tagged, Baltimore. From here you might search other neighborhoods in Baltimore, like Canton or Charles Village. I recommend searching by “tags only” and by “most interesting” as opposed to “most recent.” That way, flickr will pick out the most relevant photos for you. You can also search by clicking on “Explore” and choosing “Places.” Then, type in the place you would like to see and flickr will show you photos that have been geo-tagged with that place, and also show you some photo groups that revolve around that location.

Flickr is also a social site, and so you can create a list of contacts. Flickr, like many other social networking sites, allows you to find people you already know by searching your email contacts on gmail, hotmail, and yahoo mail. When you become friends with someone, it will be easier to view one another’s photos.

Finally, when you start uploading your own photos, you can also “tag” them. Tagging simply refers to designating a keyword to your photo, making it easier to search for at a later date. You can basically choose any tags you want, and organize your photos according to subject matter, location, or when you took them.

In part two I’ll take a look at Facebook, and also talk about starting your own blog.

Sep 6

More Thoughts on Dying

Sorry folks, it’s turning out to be a bit of a morbid week but what can I say? Death, dying, and palliative care in the ICU have always been of great interest to me.

The Medscape Nurse blog asks, “Who tells a patient’s family that their loved one is dying?” Specifically, should a nurse initiate this conversation, or should it be left up to the medical team? My answer would be that it’s fine for the nurse to initiate this conversation, in fact many situations it’s preferred. Sometimes the medical team is so wrapped up in finding the answer, and finding sucess, that they forget that there is patient there lying in the bed, suffering, day after day.

As a new nurse, I was very reluctant to ever bring up the DNR conversation without first getting the blessing of the medical team. The more experience I gained, the more I realized that initiating this conversation was not only okay, at times it was necessary.

Sometimes health care providers don’t want to initate the DNR conversation out of fear of offending the patient’s family. My take on this? Death is death. Why should someone get offended by it? As health care providers, we shouldn’t espouse the view that stopping treatment on the dying patient is “giving up,” because really, have we ever actually found a way to beat death altogether? Not that I know of.

But neither is it a black and white issue. I remember an oft-quoted statistic that palliative care RNs love to quote. It’s something along the lines of, when you poll people on the question, “Where would you like to die?” The answer overwhelmingly is “In my home.” But there is a disconnect from what people think they want and what actually happens. And this isn’t necessarily the fault of the health care team for not initiating the DNR conversation in a timely matter. Rather, I think this has more to do with the fact that people are deathly afraid of death. They don’t want to think about it and they don’t want to deal with it.

As a a nurse that has spent some time in the ICU, I urge you to think about your death. Think about what it might be like to die. I’m even giving you permission to think about what it might be like for a close member of your family to die. This does not make you morbid, it merely helps you to prepare for something that it ultimately inevitable. It’s not an easy thing to think about. But thinking about it now might ultimately save you (or your family member) from suffering in the long run.

Sep 3

On Death and Dying and Throwing a Good Party

Thought I could make it out of the MICU without a brush with death. I thought wrong.

Why is it that every time I have a patient that we are withdrawing life support on, I always feel strangely like a hostess? It’s like planning a party; a pre-wake, if you will. There may be friends and relatives there. You want to make sure everyone has a good seat, tissues, maybe some ice water to sip on. It’s a very sad, intense, confusing time and you want to do everything you can to make sure it goes smoothly.

I know it sounds kind of crazy, but the more I think about it, the more true it seems. You want to have everything in place ready to go. You want to have the bereavement packet (“What to do when a loved one dies…”) at arms length, but not in plain view. You have to be ready to give it to the family member who seems least likely to fall apart, and you can’t give it prematurely.

The family will leave the patient’s room for the actual extubation. Make sure they have a place to go. An empty conference room perhaps.

Make sure your co-workers are aware of what is happening and will adjust their voices accordingly. The ICU has a strange tendency to be a jocular place at times, despite (or perhaps because of) all the intensity.

Make sure you adjust the monitor settings so they don’t alarm when the patient starts going into PEA.

Make sure you take off the blood pressure cuff and the SCDs.

Make sure the chaplain is ready and waiting.

Make sure the scopolamine patch is ordered before the patient starts to die.

You see? It’s quite a lot of details. And you want to make sure it all goes off without a hitch. Why? Because the family has just made one of the most difficult decisions they might ever make, and you don’t want them regret it. The best thing you can do is make them feel like they did the right thing.

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