Here’s a daunting question:

Is the convenience of taking a verbal order worth your nursing license?

When you practice nursing, you kind of have to look at each patient as a legal liability for yourself. At least that is what you are advised to do from the very beginning. Every order that isn’t written correctly, or doesn’t make sense has the potential for turning into a liability for your license. That is why nurses document the crap out of everything, and that is why our motto is, “CYA.”

So in the ICU, you typically have two patients. In the recovery room you might have 10-15 patients (or more) in one day. So does that mean your legal liability goes up accordingly? Not exactly. The ICU patients are much more sick and you are completing many more orders per patient, so most likely it equals out.

But this is the part that scares me. Part of a nurse’s job is to make sure the doctor’s orders are written correctly. In the ICU this is a lot easier. In the recovery room it’s not. I get really tired having to remind the MDs to write a “discharge to home” order. It’s usually pretty obvious that the patient is going home, yet if the doc doesn’t write for it, and I send them home and something bad happens, I am potentially liable.

It seems like I carry out tons of verbal orders in the recovery room, and the physicians rarely cosign these orders. So from a legal point of view, it’s like the order never happened.

A minor annoyance? Not really. It’s actually one of the reasons I am considering leaving nursing, because if a physician is too busy to write or cosign an order, and I have carried it out, my license is on the line, and I’m not cool with that.

In a perfect world it would be the other way around.

Fortunately, my husband has just landed a sweet new job and will be compensated enough so that I no longer have to work. (Don’t hate me, please.) It’s brought about an interesting question:

Would you continue to be a nurse if financially you didn’t have to?

In my case, I’m not quite ready to figure out what I will be doing with this new financial freedom. My full-time contract will be finished on April 12th. There are so many options. For now, I will definitely be spending a lot more time at home with baby Ben, and I will continue to work 1-2 days a week at the hospital, just to stay in the game.

In the meantime this is what I’m considering:

• Full time mom (and blogging as much as I can)
• Picking up where I left off with web/graphic design (freelancing maybe?)
• Graduate school (In what though? Health care IT? MBA? MFA? I’m all over the place with this one)

Notice the lack of the word “nursing” in any of these options.

Yes, I’m afraid it’s true. I’m kind of losing my passion for nursing. It might simply be that working in the recovery room is less than inspiring. When my contract is up, I’m going to try and pick up some MICU shifts to see if that sparks my interest in nursing once again. In the meantime, I will try and blog about what it is about nursing that’s starting to bother me, and maybe the blogosphere can help me put things in perspective.

photo credit: ronnie44052

I’ve been getting a lot of google traffic lately from this particular phrase:

“hillary clinton nurse overpaid”

On first thought you would think I would welcome this traffic, because it might suggest that people are interested in a nurse blogger’s view of politics.

Unfortunately, this isn’t the case, at all.

The most likely scenario is that someone out there heard that Hillary Clinton had uttered the phrase, “nurses are overpaid and undereducated.” and they are trying to somehow to validate this with a reference. Well, I’m here to tell you that you are not going to find it on this blog, and I don’t think you are going to find an accurate reference anywhere on the Internet, including snopes. If you really are desperate to find a source for this, you’re going to have to do a Lexis Nexis search, because the rumor is that it was said sometime around 1992, before the Internet has bloomed into the enormous melting pot of facts, rants, rumors, and opinions that it is today.

Here’s an idea: Instead of investing your time trying to find a source for this unlikely phrase, why not participate in a discussion about what each candidate has in the works for health care reform?

Hillary Clinton says this.

Barack Obama says he’s going to do this.

and John McCain is planning on doing this.

Which plan do you think could actually work?

Loved this “spirited” thread on Digg about Google’s plans for storing and accessing health records. Granted, some of the Digg users are a wee bit paranoid, (my favorite comment being “Hitler and Stalin were minor league compared to Page and Brin,”) it is a worthwhile discussion. It’s completely understandable for people to have questions about privacy, and how their health records will be used in a database created by Google.

My question is, if not Google, then who?

(Incidentally, Microsoft is also in the running with HealthVault, and now they are offering 3M in funding for health care applications in the form of the Be Well Fund.)

Patients need to have access to their own health record. It irks me to no end that I don’t have access to mine, and if I wanted to access it I would have to jump through countless hoops and wait months to see it. An example: I tell my doctor that I am interested in my hematocrit results. I fill out some forms, requesting this information thinking I will get some actual results, only to to get a piece of paper in the mail 6 weeks later saying, “Your CBC was normal.” Um, thanks for note, but I’m still not sure what my hematocrit actually was.

And what about when you leave one practitioner to start seeing another? I was almost precluded from using a birthing center when I switched from an OB to my midwife. I was told that it would take 6-8 weeks for my records to be transferred (I was due in 4 weeks). These records were sitting in an office and all they had to do was hand them to me so I could walk two floors down and give them to my midwife!

It’s true that if Google ends up being the one to provide this technology, then they will have access to your health records, and the possibility exists that they will use this to somehow turn a profit. I’m not sure why “profit” has become such an objectionable word these days. But the reality is that profit motivates innovation.

Here’s an idea. Let Google do their thing, but hold them fully accountable to the rules and regulations of HIPPA. In fact, it looks like they are already working within this framework with the Clevelend Clinic pilot program, as reported by ZDNet:

This data transfer will not be handled by Google. Instead users will be directed to the Cleveland Clinic site, which acts as a Business Associate of Google in this case. The Clinic is a covered entity under HIPAA, and Google will not store its data, nor distribute it. The consumer will get their data from the Clinic, then control it through Google.

Otherwise, what is the alternative? Should we trust the government with this herculean task? Good luck getting it done in this century. Besides, then the Digg enthusiasts would ranting about how Big Brother is watching your cholesterol.

Did you ever notice a phrase that you start to hear in one or two places, and then it starts to spread like wildfire to the point that every time you hear the phrase, you want to cringe? For me, the phrase That Being Said, is rapidly becoming just such a phrase.

So I am asking you to think before you use it, and I am even offering you some tips on how to avoid it.

This is how it is normally used:

Blogging is hard work. It requires concentration, motivation, and relentless editing. That being said, I love to blog.

*cringe*

Next time you are tempted to use that phrase, think about what else you could put in the sentence. Last time I checked there were 10 gazillion blogs out there and so it pays to differentiate yourself from the crowd. Here are some suggestions:

I love to blog, despite the fact that it requires concentration, motivation, and relentless editing.

Blogging tends to require hard work in the form of concentration, motivation, and relentless editing; however, I love to blog.

Blogging is hard work in that it requires concentration, motivation, and relentless editing. Nonetheless, I love to blog.

Blogging is hard work in that it requires concentration, motivation, and relentless editing. Still, I like blogging.

I’ll admit that there still might be some appropriate places to use this phrase (see? I could have used it in this sentence but I restrained myself.) All I am saying is, think before you use it, (or any overused phrase for that matter) and you will elevate your level of writing.

One of the reasons I like MICU nursing is the same reason I used to like it in the restaurant business when the hostess fills up your section on a busy Saturday night:

It can’t get any worse than this.

Let me explain. Working in the MICU, You will most likely get assigned two very sick patients, often both on the ventilator, sometimes with multiple drips and multiple disease conditions, and with high acuity. You know at the beginning of your shift what you will be dealing with.

When the hostess completely fills up your section on a busy Saturday night, the underlying thought is this: I may be in the weeds right now, but it can’t get any worse than this, because she can’t seat me anymore.

This is not true at all with floor nursing, or in my case, recovery room nursing. You get four patients that you have to recover from a procedure and each one of them is a ticking time bomb. Anything could go wrong at any moment. And when things do go wrong you don’t have the same resources that the ICU has, so you just wing it. You can call the medicine intern and hope they will come up and assess your patient who is A&Ox1 with increasing 02 requirements. You can page the radiology fellow to tell them that your patient has 9/10 pain, and pray that the fellow hasn’t already begun his next procedure (in which case the patient in pain is SOL.) You can page the radiology attending (because none of the fellows are answering their pages) to tell him that your patient has spiked a fever, their BP has shot up to 260/110, with HR in the 120’s, only to be yelled at for paging the attending instead of the fellow.

I miss the MICU, and I miss working with pulmonologists. No doctor in the MICU has ever yelled at me for alerting him or her to a change in my patient’s condition.

Question: What do you do with a recovery room nurse who has laryngitis?

Answer: Teach her how to pull femoral artery sheaths.

So my “flu” of last week petered out into a cold, and then eventually robbed me of my voice. I almost called in sick because of my inability to talk. Think about it. Do you think you could do your job without a voice? I mean, half of what I do is explaining to the patient what the heck is going on. And the other half is giving discharge instructions.

Oh but there’s another thing that cardiac recovery room nurses do and it doesn’t involve much talking. They remove femoral artery sheaths. This is something that the staff nurses usually do but because of my silent state, they decided it would be useful to train me on this skill.

Now, I used to think, what’s the big deal? It’s just pulling a line and then holding pressure. I used to pull lines from the radial artery all the time. The femoral artery just requires a little more pressure right?

Wrong.

It doesn’t require a little more pressure. It requires SO MUCH MORE PRESSURE that your hands eventually become cramped and numb from holding them in the same spot for twenty minutes. “You might want to fill out some of the charting before you pull the sheath, because afterwards you might not be able to hold a pen.” Ha, I thought, she’s got to be exaggerating. Turns out she wasn’t.

Sheath pulling also requires the ability to respond calmly under pressure. Last week the doc was pulling the sheath on one of my patients and after he was finished holding pressure, the artery blew. Let me tell you, it wasn’t pretty. All I saw was an arc of blood pulsing into the room, covering everything, including the doc. And at that point the only thing he could do was to start holding manual pressure again. The patient turned out fine, BTW.

At any rate, after learning the skill myself I have a new respect for those who pull sheaths. It takes patience, a steady hand, and lots of muscle.

I’ve always liked the Dickies brand for uniforms. They have a reputation for being very durable, and yet they also fit well and tend to be comfortable. So I was happy to take these scrubs out for a test drive. Today I’ll be reviewing the Dickies Hip Flip Boot Cut Pant along with the Dickies Hip Flip Mini V-neck Top, both in cocoa.

I’ll start with what I like about this scrub set. The fabric is very durable and yet soft at the same time. I liked the color, a nice warm brown, (although wearing head to toe brown did make me feel a little like a UPS worker!) The cut of the pants is very flattering to a medium build figure like mine; slightly fitted at the top, and slightly flared at the bottom. Big bonus points for the elastic waistband! This is especially great when you are crazy-busy and have about 2.3 seconds to go and void. Nurses, you know what I’m talking about.

And now on to what I didn’t like about this scrub set: The pockets. In the entire set there are 6 pockets. Four of them are kind of pouch-like, which means they are good for sticking your hands into, but they tend to bunch out when you try to stuff pens and paper into them. Two of the pockets are roughly the size of 4 postage stamps, which means that the only thing that fits in them is maybe a quarter or two. Also, the cut of the scrub top was a little too cropped. I felt like I could use a little more coverage from the top because the bottoms were ever so slightly snug.

Overall, I still love Dickies scrubs and I would buy them again, but next time I might go for Dickies Sandwashed Mock Wrap Top. It looks a little longer in cut, and the pockets look perfect. I also would go for the sky blue or the powder blue.

(In the interest of full disclosure, I will let you know that my friends at My Nursing Uniforms are compensating me for this review, although the compensation was not dependent on a positive or glowing review – what I am telling you here is my honest of opinion of these scrubs after wearing them for several 10 hour shifts.)

Spotted a red shouldered hawk in our backyard this morning. Actually, Bill spotted it first. When I heard him yell, “You gotta see this – Come here IMMEDIATELY!!!” I thought that Ben must have taken his first steps. Instead I ran in to find Bill staring out the window at this red-shouldered hawk. It’s a miracle that the bird stood still long enough for me to drag out the tripod.

Sometimes I miss living in the city, but not when I have beautiful backyard visitors like this one. When we lived in the city our backyard visitors consisted of small rats, medium rats, and large rats. Now our list of visitors includes a turkey vulture, a fox, an opossum, loads of chipmunks, squirrels, and rabbits; hummingbirds, cardinals, blue jays; and now this majestic hawk.

Here’s a cardinal I spotted while visiting our friends, Matt and Karla. Matt and Karla have what I think is the cutest idea: His and Her blogs. Her blog is called MentalMother, and his is called MentalFather, and they both blog about their beautiful daughter, Ella. Hey, I just thought of something. They should register MentalDaughter so that when Ella is old enough to blog it is ready and waiting for her.

At least that’s what it feels like. Body aches all over, slightly febrile (t = 100), throat is both soar and scratchy. Head is swimming.

I’ve been so tired of hearing the phrase, “There’s a lot of it going around this year.” (Because, really, isn’t there a lot of it going around every year?) But now that I, in fact, have “it”, I am willing to concur. The main thing now is making sure little Ben doesn’t get “it” but for now he sure gets a lot of amusement out of watching me cough and sneeze.