I present to you the latest job opening from my nursing agency:

It is a study at Suchandsuch Hospital, dealing with stool. The study volunteers would collect their own stool and the nurse would then grade the stool and monitor the patients for dehydration. There will be an orientation date the week before, to be announced.

You must be able to start IV’s and be willing to work with Stool.

Pay is $42/hr for all shifts.

Okay, so two things that had me ROTFLMAO about this announcement. One, that stool is capitalized. And two, that nurses can get paid $42 an hour to look at poop and assign a grade to it. The sad thing is that ever since I became a nurse, I am pretty much obsessed with stool. In nursing school, they tell you that this will happen and everyone says, “No way am I going to be obsessed with poo poo!”

But then one day it happens. You find yourself staring down into the toilet bowl thinking, “Hmmm. Think I need to increase my fluid intake.” Then your husband says he doesn’t feel so good after the mexican food he ate. “Have you pooped yet?” You ask. “What did it look like?” That’s when you know you are a real nurse.

The consolation here is that nurses aren’t alone in using stool as a key indicator of health. If you’ve ever seen Dr. Oz on Oprah, you’d know that he often advocates the use of stool as a diagnostic tool. In the segment “Everybody Poops,” he even goes so far as to analyze the sound that it makes as it drops into the toilet:

“You want to hear what the stool, the poop, sounds like when it hits the water. If it sounds like a bombardier, you know, ‘plop, plop, plop,’ that’s not right because it means you’re constipated. It means the food is too hard by the time it comes out. It should hit the water like a diver from Acapulco hits the water [swoosh].”

Dr. Oz, you are my kinda MD.

Kim at Emergiblog has an excellent post on cheesy marketing ideas for nurses week. Please go read, “I have enough water bottles, thank you,” immediately. Because 15 is only the minimum.

Should a state department of health be able to prohibit restaurants from serving food to people who are obese? This is quoted from an actual bill being introduced to the Mississippi legislature:

Any food establishment to which this section applies shall not be allowed to serve food to any person who is obese, based on criteria prescribed by the State Department of Health after consultation with the Mississippi Council on Obesity Prevention and Management established under Section 41-101-1 or its successor. The State Department of Health shall prepare written materials that describe and explain the criteria for determining whether a person is obese, and shall provide those materials to all food establishments to which this section applies.

This is very disturbing to me. New York City has already outlawed trans fats. Has NYC paved the way for states to create similar, more restrictive laws? I hope not. It doesn’t seem probable that this kind of legislation could pass, and even if it did, it would probably be knocked down immediately by a lawsuit. However, it’s pretty frightening that there are politicians out there that are even daring to propose this.

(via the Accidental Hedonist)

More blog reactions:

Junkfood Science
Copious Dissent

Things in the recovery room can be both extremely dull, and overwhelmingly busy. When I came in this morning, I sat around for 2 hours with very little to do. I pushed some stretchers into the prep area. I read some blogs on my iPhone. Then, a couple of patients started to trickle in. Then it was lunch. Then the afternoon became very, very busy. It’s a lot like working at a busy downtown diner at lunch rush. Get ’em in get ’em out. Turn your tables. Everyone pretty much orders the same thing.

I spend an inordinate amount of time pushing stretchers around, transporting patients and wiping down equipment, because there are too many nurses and not enough support associates. I find it amazing that they are paying me premium nursing agency wages to record vital signs and stare at people’s groins to make sure they are not bleeding out of their femoral arteries. It seems like a mismanagement of resources, but what do I know. I’m just the nurse.

What can I say, I am bored.

I’ve been complaining a lot lately, but there it is. It’s a very dull job.

But since I am resigned to spend the next 11 weeks working there, I’ll try to focus on some positives:

When it’s slow in the morning I can read blogs on my iPhone and no one seems to care.

I don’t have to work night shift, or weekends.

The staff is a wonderful bunch of people; very friendly, helpful, and welcoming.

There are lorna doone shortbread cookies in the nutrition cabinet, and they’ve trusted me enough to give me a key to it.

There are a lot of cancer patients out there with awesome senses of humor. I love the way they laugh in the face of their disease.

For the first time in my life, I am caring for patients who are awake and alert enough to partake in some interesting conversations. For instance, I now know what it feels like to be in various arrhythmias, rather than just being able to detect them on the heart monitor. One patient told me that when she is in trigeminy, she wished she could just give her chest one good *thwack* and make it stop. Another patient described to me the heaviness of what a-fib feels like. I enjoy interacting with these patients, and hearing about how they manage their diseases at home. There are so many people out there with so much unsung resilience, and I never realized that before.

Since the birth of my son, I’ve become a pretty big football fan. At first it was just the inevitability of being outnumbered by the boys 2:1, but now I am a genuine fan. And I’ve been looking forward to the Superbowl all year long, even though my thinking on it was that it was going to be the Patriots vs. whoever, in a game with no suspense. I watched the Ravens almost beat the Patriots, the Eagles almost beat the Patriots, and the yes, the Giants almost beat the Patriots (on December 30th.) I kept telling my husband, the Suberbowl is not going to have any suspense this year. He kept trying to tell me that in football, it’s any given team, on any given Sunday.

Boy, was he right.

Eli Manning, you are my new hero. Thank you for showing us that anything is possible.

Now back to your regularly scheduled nursing blog.

Okay, so I’m about to expose myself as a grumpy old curmudgeon but I will admit it: I didn’t wear red scrubs to work on Friday. The reason was simple. I actually don’t own any articles of clothing that are red, because it makes me look washed out.

I actually got a little tired of answering the question, “Where’s your red?” Finally someone handed me a National Wear Red Day sticker to wear. The sticker came complete with the two corporate logos of Macy’s and Merck. Guess what, folks? The national wear red campaign is a marketing campaign, meant to bring higher awareness to women’s heart health, but also to bring a higher awareness to its corporate sponsors.

Does not wearing red mean that I don’t support heart health for women? Of course not. Like I said, I don’t actually own any red, but the the thing that bothers me is how willing people are to jump on the bandwagon and not really think about why they are doing it. It reminds me of those ubiquitous pink ribbons that symbolize the fact that you hate breast cancer. I mean isn’t it obvious? Don’t we all hate breast cancer by now? But now people use the symbol more often than not to sell products, and so as a symbol it has become kind of meaningless.

Am I too cynical? Maybe. But maybe I just like to expose this world of marketing that lies beneath the surface of your reality. Another example is the Discover Nursing campaign by Johnson & Johnson. Do you think a bunch of marketing execs got together and said “What type of cause would we most like to benefit today?” More likely it was the other way around, as in, “Which cause would most likely benefit Johnson & Johnson?” Again, I’m not knocking the actual campaign. I’ll leave that to the Center for Nursing Advocacy. The campaign has perhaps done some good over the years but they don’t do much to address the real problem, which is that there’s a shortage of nursing educators, more than there’s an actual shortage of nurses.

“So many of the nursing blogs I see are those from very frustrated unhappy nurses.”

(as seen on a thread in nursingvoices.com)

How true do you think this is?

I saw this the other day and I wondered how guilty I am of being one of those frustrated, unhappy nurses. I am one week into my new full time contract. At this point I’m more tired than frustrated. My feet hurt (serves me right for wearing the same pair of Danskos for three years in a row. I think I’m ready for a change – Crocs maybe, or tennis shoes.)

Anyhow, I am sitting here thinking about what to write and the first thing that pops into my head are things that make me unhappy and frustrated. So here is my frustration du jour:

When a patient comes out of a procedure in pain, there are no doctors readily available to write orders and so I feel completely powerless to treat my patient’s pain. By the time the patient comes out, the docs are scrubbed in for the next procedure and so do not answer their pages.

Here are some examples:

Cardiac Catheterizations – These patients must lie flat in bed with their legs held out straight in an uncomfortable stretcher for 4 hours to prevent the risk of bleeding. Many of these patients experience back pain and it would be nice to be able to give them something to treat this. Even just an advil or tylenol might help a little bit.

Chemo Embolizations and Uterine Fibroid Embolizations – Both can be very painful procedures. These patients get a PCA (Patient Controlled Analgesia – “a pain pump” for all you lay readers) with a demand dose of morphine Q 10 minutes. This may sound adequate, but it takes a while to build up in their system. I hate to send them off to the floor without adequate pain relief. I think if each of these patients could start off with a one time 2mg bolus of Morphine, given on an as needed basis, they would be fine but this never seems to happen, and if you page the radiologist to let them know the patient is in pain, they generally don’t seem to answer the page.

I had another patient itching on both of her arms and abdomen and I couldn’t even get her a teeny little dose of benadryl.

AND to top it all off, if a patient does come out of the procedure with some good pain meds ordered, I don’t have access to the pyxis machine (the machine that dispenses the meds) so I have to find another nurse to get the drugs for me. Yesterday I had to stave off a Shirley Maclaine/ Terms of Endearment type situation because a patient had come out of a procedure in pain and most of the other nurses were at lunch.

Being an agency nurse, there’s not much I can do about this. It would be nice if the nursing staff and the doctors did some team building sessions and maybe come up with some solutions to these problems, or at least give us some explanations as to why they don’t write more standing orders. Perhaps the further I get into this contract, things will improve, but for now it’s frustrating. I miss the autonomy of working in the MICU, where there is always a resident around, and there are plenty of protocols and standing orders to keep me covered.

BTW, I totally lifted the RANT idea from problogger.

Welcome to this week’s Change of Shift. I’ve been sitting at my computer all day waiting for an inspiring theme to land on my lap, but guess what? It’s just not happening. So sit back and enjoy these finely crafted blog posts in my themeless edition of Change of Shift!

Patient Encounters

I was pretty blown away by Social Call, over at Traumaqueen; however, I’m still waiting for the scratch ‘n’ sniff version to come out. Haven’t had enough of Kal yet? I also recommend that you go over there and read Natural High. No bad smells in that one, I promise.

DisappearingJohn discusses a patient encounter that was both moving and unexpected in The Long Night, Part One and Part Two. What a great writer, and I suspect, a great nurse.

Kim at Emergiblog tells a fascinating story about communicating with a non-verbal patient in Behind Those Hazel Eyes. Kim, my curiosity is peaked – I might be asking you to borrow a certain book!

In Hard Day’s Night (Workin’ Like a Dog) , Faith Walker talks about several patients. Almost all of them faint at some point during her shift, except for the Yorkie. He just went into shock. Trust me. Just go over there and read it. It gives new meaning to “having a hard day.”

Get Your Gripe On

MJ at Nurse Ratched’s Place writes about how hard it is to get Mr. Grinch to cough up for nurse’s week. I once had a colleague that suggested to our DON to take all the money they would spend on nurses week, and install a 24 hour Starbucks kiosk in the lobby. It never happened. It’s too bad – They would have made their money back pretty darn quickly.

Labor Nurse talks about how difficult it can be to get patient care associates to actually well, do something in Problems With the Help.

Two words that probably sound like fingernails on a chalk board to most nurses these days: Medication Reconciliation. ERNursey gives her take on it.

The Heavy Stuff

The Sisterhood of the Traveling Scrubpants discusses a colleague’s unexpected suicide in Alone. I can’t even begin to imagine how staff members would be able to cope after that.

GNIF Brain Blogger asks a very daunting question: is The Medical Profession on a Downward Spiral?

Miss-elaine-ious talks about her first code in
20 something year olds shouldn’t die. As a nurse, you never forget your first code.

MyOwnWoman discusses the mistake of giving a patient false hope in A Lesson Learned the Hard Way. She also reminds me that I could never, ever, ever work Trauma.

Controversies of the Week

Therapydoc poses the question that all of us in the medical blogosphere have struggled with in Anxiety, Ethics, and Blogging.

ER Murse discusses several controversial topics this week including organ donation in
Who are the real Villains in the Nataline Sarkisyan case? and the rectal exam lawsuit, in Managing Assault Behavior in the Trauma Room.

And just in case you haven’t had enough to read yet, SharpBrains presents 21 books to read on brain health in Brain Plasticity, Health and Fitness Books.

Two more additions… Sorry, no cool icons for you late-comers. In fact I oughta write you both up for it! ( ;
Practice ICU Interview Questions from Nurse Sean.
Stella And the Pain Pills from Mamma Mia.

Happy reading everyone! It looks like the next edition will be hosted at NursingVoices (my favorite place to win an iPhone!) So I am going to put my money where my mouth is and add it to my list so I don’t forget to submit.

1. Make a list – Nurses are masters of list-making. Lists are the secret to time management. At the beginning of every shift a nurse makes a list of every thing she will do throughout the day. If it’s not on the list, it doesn’t get done. There are days when I am lazy and don’t make up my list. Those are usually the days that I fall hopelessly behind. Add blogging to your life list. If you don’t use a list in your regular life, start doing so now. I even go so far as to put blogging on my calendar to ensure that I won’t forget to do it.
2. Write as if you were giving report – Short and sweet. Bullet Points! I swear by em. Give me the facts, just the facts, because I don’t really have time for anything else. Try writing your posts that way – Edit, edit, edit! I am devout consumer of blogs but I have to say, once a blogger starts to ramble I click right on through to the next blog. Like it or not, our attention spans have been steadily shrinking and so now instead of the 4-5 page magazine article, people want the 2-3 paragraph blurb.
3. Know your resources – A great nurse always knows his resources. He knows who to call in radiology get his patient in faster. He knows the quickest way to get missing meds from the pharmacy. He knows where to find the 12 x 12 xeroform. This holds true for blogging. Know where to get stock photography to spice up your posts. Know how to use google reader to search for pertinent news items. Know how to make quick changes to your blog’s template.
4. Leave it behind when you are finished – Nurses are excellent at this. You work a grueling 12 hour shift, surrounded by high acuity patients and what do you do when you get home? Kick back, relax, and leave it all behind. Try this approach with blogging. (Not that blogging should in any way be considered grueling!) Write a post and walk away from it. Don’t keep checking your stats, don’t keep peeking to see if anyone commented. Don’t dwell on whether or not you should have hit that “publish” button. Just walk away from it, and wait to be inspired again.
5. Write a Care Plan for your Blog. Okay, so this one is pure silliness. I just couldn’t resist:

   Assessment – My blog sucks because I don’t get enough hits, visitors and comments.
   Diagnosis – Blog suckiness r/t lack of frequent posts.
   Plan – Increase blog posts by three per week.
   Implementation – Add blogging to your weekly calendar.
   Evaluation – Increased posts = increases visitors, comments and hits! Whoohoo!

Okay, I am now officially having a bad day:

Drinking a couple of cups of coffee a day has long been considered safe during pregnancy, but a new study finds that even this modest amount of caffeine could double a woman’s risk of miscarriage.

NOOOOO! Not my coffee. I don’t just love my coffee in the morning, I LURVE it. Please don’t tell me I have to give it up.