Let’s Continue…..

So far we’ve talked about reasons I’ve heard for becoming a nurse. Now let’s start with basic nursing care. Basic nursing care includes recording a patient’s temperature, respirations, heart rate and blood pressure (called taking their “vital signs”). This is important to help us gauge how a patient is doing; are they getting better or worse? Are the treatments they are being given helping or not? Are we missing something about the patient’s condition that we hadn’t seen before? A complete physical assessment, or a “head-to-toe” assessment is where we examine the patient from head to toe. Are they alert and oriented to person, time and place? Do they know who they are as well as recognizing family or friends? Do they know  where they are, what day it is and who is the current President? We look at the color of their skin. What color is it and is it normal for the patient’s race and age? Is their skin moist, dry, scaly, reddened, or do they have a rash? How is their skin turgor? This is a way of telling how hydrated a patient is.When you gently pinch some skin on their body does it go back to normal fairly quickly or does it stay “pinched up” which is a sign of dehydration. How does the skin on the rest of their body look?  Are their mucous membranes (mouth and nose) moist and pink or are they pale or dry etc? Are their eyes clear or cloudy? Are they bloodshot? Are their pupils dilated normally? Are they able to smile at you with both sides of their mouth going up at the same time or is one side lower or drooping? Do they have equal strength on both sides of their body? Can they grip with both hands equally and can they push against your hands with both feet equally? How do their lungs sound? Can you hear sounds in all four lung fields (upper and lower lobes in the chest and the back) and what do you hear? How do their bowels sound? Do you hear noises or not and what kinds of noises? Have they been having regular bowel movements and can they urinate normally? Can they walk, talk, see, hear? Are their “private parts” normal and functioning? Is their sex life normal? Are they eating well? These are things a good nurse checks at least once a day if not more often, especially when the patient is sick. When a patient is first see there are other questions to be asked as well. Do they have food, shelter, clothing and money for all of these things? Do they have any chronic ailments? These are health conditions that need to be treated on a regular basis such as high blood pressure, diabetes, high or low thyroid conditions, high cholesterol etc. Other health conditions are important to consider as well. These can include mental health issues requiring medication and/or follow-up with a psychiatrist, psychologist, counseling or family practice professional. Depression can be the result of or related to the death of family or friends, unemployment, loss of housing, abuse or other reasons. Mental health issues can be genetic (other family members have issues as well), due to substance abuse or because of traumatic injury etc. When you care for a patient you have to know more about them than what brought them to the hospital or doctor’s office. Nursing isn’t simply helping patient’s recover from sickness or injury, it’s helping them get ready to go home and be able to lead a normal life; whatever normal is for them. Nurses follow doctor’s orders for patient treatment but we do so much more than that. We support our patients and their families during times of illness or injury and help them have hope for recovery. If there is no hope of recovery, we help the patient and their loved ones deal with that as well. When you care for the same patient more than once you often develop a relationship with them. The patient and their family become comfortable with you and trust you to do your best for them. If you have taken care of the patient previously you can compare their current health situation to what you know they were like previously. Are they better or worse and what can we do to improve poor health issues?

That’s probably enough for now. Next time we’ll talk about different areas of nursing practice.

Take care and keep looking up

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jokes and cartoons about nursing

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Why do you want to become a nurse part 3

In this post I’ll talk about the last 2 reasons I’ve heard

I want to marry a doctor and I want to make a lot of money

I can respond to both of these quite easily….give me a break!!!!!

In the first place, if you want to become a nurse for either of those reasons you’re watching too many soap operas, situation-comedies or medically based shows.

“I want to marry a doctor” is not only a shallow reason to become a nurse, it can be unrealistic. Yes, as a nurse you meet and work with several physicians and yes, some nurses are married to doctors. Physicians don’t go to school so they can marry a nurse, they may not be looking to find a wife in the first place. I’ve seen what physicians go through as far as being on call for12-24 hours or more with little to no sleep. Do you really want to be married to someone who you may never see due to office hours, hospital rounds and on-call hours? And as I stated above, they may make a lot of money but they have to spend a lot for insurance, office overhead, not to mention what they’ve spent for education and training. Unless they’re already rich, they’ll be paying on their student loans for quite a while.

“I want to make a lot of money” is a pretty shallow and unrealistic reason as well. Sure, nursing can pay pretty well but not as much as you’d think especially in some areas. Office nurses make a lot less than hospital nurses.  Making “a lot” of money may not offset the long hours you’ll work, the potential for injury you’ll face as well the possibility of abuse you can receive from patients, their families, some physicians and even other nurses. illness. And getting an education as a nurse isn’t cheap either, especially is you get a Bachelors or Masters degree.

I’m not trying to talk you out of becoming a nurse, I’m just trying to get you to look at why you want to do it in the first place.

Next time, we’ll talk about the different nursing specialties.

Keep looking up

Janet

 

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Why do you want to become a nurse?

In my last post, I discussed becoming a nurse because you want to help people/make a difference in someone’s life. Next up is:

“My mother/grandmother/aunt/sister was (or is) a nurse.”

Folks giving this reason usually have at least some idea of what a nurse does, including the long hours, work-related stress, and the “fashionable” clothing required by the job. Family members get used to hearing of work incidents involving bodily fluids, or maltreatment coming from a patient, their family or from other medical personnel. I’ve pretty much seen or heard it all and worn it as well, and been eating a meal while it was discussed. Not real appetizing, but talking about it is an outlet for stress and often humor. If you’re not willing to deal with bodily fluids then you need to be in a managerial, leadership, teaching or administrative position. When I started nursing school, my younger sister, having been a nurse for several years, asked me if it was really what I wanted to do. Then she proceeded to try to talk me out of it. I hadn’t become a nurse because of her. Remember, I thought I wasn’t smart enough? I was in a theology class being taught by a Doctorate level theologian and counselor who had been an RN for 40+ years. While in class one night I heard God tell me he wanted me to “do what she does.” I know without a doubt it was God and that I needed to follow his call. I started school and became an RN 2 years later. That’s my story and I’m “sticking to it.” If one of your family members is a nurse, talk to them if you haven’t already and ask them about work. Where do they work? Do they work in a hospital, doctors office, nursing home or elsewhere? What kinds of patients do they work with? What are their work hours (day shift, evening or night shift)? Usually hospital shifts are 8 or 12 hours long; 7 am to 3 pm or 7 pm, 3 pm to 11 pm or 3 am, 7 pm to 7 am, 10 pm to 6 am or 11 pm to 7 am. Office hours are usually 9 am 5 pm. If you like getting up early ( I do not) then a day shift is for you. If you like to sleep late and work late then afternoon/ evening shift is for you. If you are a total night owl (like me) then you are a night shift person. I have NEVER liked getting up early, if you wake me early, there had better be a darn good reason and you’d better do it with a 10 ft pole from the doorway with a cup of coffee in your hand because I have been known to be vicious. Just ask my husband, poor guy. I have to set a loud alarm and put it across the room so I have to physically get out of bed to turn it off. Which doesn’t stop me from getting back in the bed, but it’s a start. Did I mention I hate getting up?

Ok, that’s enough for now. Next time we’ll talk about wanting to be a nurse so you can marry a doctor…..

Keep looking up

Janet

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Let’s start at the beginning…

Let’s start at the beginning. Why do you want to become a nurse? Here are some typical responses to that question:

I want to help people/make a difference in someone’s life.

My mother/grandmother/sister/aunt was a nurse

I want to marry a doctor

I want to make a lot of money

We’ll discuss these one at a time.

I want to help people/make a difference in someone’s life.” This is one of the most frequent statements I’ve heard. Nursing is a way of helping people and a good nurse can make a difference in someone’s life. As a nurse, you’re helping your patient through illness, surgery and procedures. All of these things can be very scary to a patient as well as to their loved ones. There are no guarantees in medicine. The patient may or may not recover from an illness or surgical procedure and any diagnostic procedure can have adverse consequences. That’s why patients or their families have to sign what’s called an “informed consent.” It means you are aware of all of the risks and benefits of the test or treatment and you are willing to accept those risks. In many cases, if you refuse treatment you have to sign a document which states your decision is  against medical advice and that by signing it you accept the consequences, which can include death. This is called a “worst case scenario.” There are times I’ve had to explain to patients what the doctor has said to them. I’ve also told patients (or their family) that they can refuse a treatment or procedure. Not all procedures are necessary, even if a medical person has told you that they are. Some doctors aren’t “happy campers” when a nurse tells them that the patient has refused a procedure or treatment. And they aren’t thrilled when I’ve told them that I don’t agree with what they plan to do. To be blunt, that’s too bad. Many years ago it was considered appropriate for the nurse to stand and give the doctor the nearest chair. Nurses are considered part of the health care team now and are on equal footing with other medical personnel. Unfortunately, there are still physicians out there who think nurses are their “handmaidens/slaves” to command. We call this having a “god” complex.  It sounds like I’ve gone off into a tangent but all of this relates to wanting to help people and make a difference in their lives. One of the most important roles a nurse can play is that of patient advocate. By being a patient advocate you ARE making a difference in someone’s life and that’s admirable.

Until next time, keep looking up,

Janet

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Who am I?

Greetings all!

Janet here, ready to talk with you about becoming a nurse. I’ll talk about myself this time so you know what my background is and whether or not I know what I’m talking about. I usually do, but some folks might disagree!

First off, I’m originally from Iowa and moved to the south in 2001. I’m 56 years old and have been an RN for 22 years. Most of my experience has been in a hospital setting. I’ve worked in Labor and Delivery (15 years), with the remainder of my experience working with medical/surgical patients as well as OR, ER, and forensic nursing, some of that concurrently.

I tell people I didn’t get into nursing until I was in my mid 30s because I didn’t know what I wanted to be when I “grew up.” I had actually always wanted to be a nurse but never thought I was “smart enough.” That’s bunk because I have 6 degrees, the last 2 Magna Cum Laude. I graduated in 1978 from Iowa State University with a Bachelors in Sociology with accreditation in Social Work and worked in Social work for about 4 years with juvenile delinquents. Because Social work paid so well (NOT) I also worked in a medical supply warehouse. I’m a farm girl so driving a fork lift was kinda fun but after 8 years of packing  medical supplies I got kinda bored

In 1988 I finally listened to what God was telling me to do and went to school for nursing. I’m a Christian and know for a fact that God told me to become a nurse.In 1990 I graduated with my Associates degree in Nursing from Des Moines Area Community College and got a job at Iowa Lutheran Hospital in Des Moines, Iowa on a Med/Surg/Gyn/Renal Unit. Iowa Lutheran is a 200+ bed hospital). I worked rotating 7 am -3 pm/ 3 pm-11 pm shifts. I took care of patients prior to and after their surgeries (gall bladder removal, appendectomy, new or revised access for renal dialysis, mastectomy, bowel resection etc) renal patients (who were often diabetic as well), elderly patients with pneumonia, pressure ulcers (breakdown in their skin and tissue, usually over bony prominences, or related to diabetes), and multiple sclerosis patients. Occasionally we took care of elderly patients who had been dumped in ER by their family or caretaker because they wanted a break….sad but true.  I always wanted to be a Labor and Delivery Nurse, but again, didn’t think I was “smart enough.”  In some hospitals you must have been a nurse for several years before you can get into specialty units like Labor and Delivery, ICU, ER, OR, Recovery, etc. This isn’t always true, but I wanted to get a good working knowledge as a nurse before I went into Labor and Delivery.

In 1993 my first husband died of a brain tumor after diagnosis in 1991. He had about 6 different surgical procedures and full rounds of chemotherapy and radiation treatments. We also lost a baby during that time when I had a ruptured ectopic pregnancy. I re-married in 1995, moved out of Des Moines and went to Donnellson Iowa and started working in Van Buren County Hospital in Keosauqua. There I worked 3 pm -11 pm. There were a whopping 40 beds in that hospital; 6-8 patients were Long Term Care (nursing home level), the rest of the beds were for skilled and acute care patients. We had a 4 bed “ICU” a 3 bed ER, 1 Labor room and 2 postpartum rooms (women who have delivered and are recuperating). That’s where I started by Labor and Delivery experience. Considering we only delivered 30-50 babies a year and any high-risk women were transferred to University of Iowa Hospital in Iowa City you can imagine how much experience I got…..not much.  Patients having heart attacks, strokes or other emergent condition were taken to University of Iowa by ground or helicopter ambulance.

Around 1997 I switched to Keokuk Area Hospital in Keokuk, Iowa and worked full-time on the OB/GYN unit. I worked 3 pm -11 pm there. It was a 63 bed hospital and we  had 3-4 labor rooms (depending on how many patients we had). The other 4-5 rooms doubled as postpartum or post-op  hysterectomy rooms. We also had a nursery and usually at most we had 3 babies. I remember seeing a picture of the L & D nursing staff in the nursery with about 6 babies, the nurses looked shell-shocked and VERY tired. I was an OB/Float nurse, meaning if we didn’t have enough patients on the OB unit, I floated throughout the hospital helping in the other units, i.e., Medical Surgical, pediatrics, skilled care, ER, Recovery, and ICU. We delivered a about 300 babies there so I got more experience.

I got divorced in 1998 and re-married in 2001, moving to South Carolina. I worked in Self Regional Hospital (420 beds) in Greenwood, SC, working on the OB/GYN unit there.  Self delivers around 1500 babies a year (or they did when I was there). I worked 7 pm -7 am and loved working nights. I am not a day person. If you wake me before I’m ready to get up you’d better do it with a 10 foot pole from the doorway and have a cup of coffee in your hand…I bite! 😉

In 2003 my husband and I moved to Bat Cave, NC and no Batman does not live there! I got a job in OB at Mission Hospital in Asheville, NC. I worked 7 pm – 7 am there as well. Mission is licensed for 800 patient beds and bassinets. Labor and Delivery delivers between 3800-4100 babies a year and is the high risk pregnancy center for 17+ counties. I got a lot more delivery experience there as well as experience working with pregnant patients admitted for problems with high blood pressure, diabetes, premature rupture of membranes (the bag of waters broke early), pre-eclampsia and other issues. I also worked with patients who had lost or were going to lose their babies due to abnormalities, infections or other reasons. While I enjoyed working with many laboring women, I counted it as a privilege to work with these women who were not going to have babies to take home with them. It is a difficult situation and emotionally draining on the patients and their families as well as medical staff taking care of them. Many of us would cry right along with these families.

In late 2006 I became trained as a Forensic Nurse Examiner or SANE, which means Sexual Assault Nurse Examiner, taking 72 hours of call a month, later cutting down to 36-48 hours of call a month.  Forensic Nurses gather evidence  to be used in  court against the assailants. We later took on Domestic Violence cases as well. I stopped doing forensic nursing around 2008 due to emotional and physical stress. In 2007 I had divorced again and settled in Asheville. In 2010 I got remarried (yes, again) and inherited a step son.

In the fall of 2011 I quit Mission and started working for CarePartners Health Services as a Private Duty RN, which is my current position. At this time I take care of pediatric patients in their homes, with feeding tubes, trachs and on ventilators. That was a definite change in practice, but I love it. I had injured by back so many times over the years that I just couldn’t take the physical or emotional stress of working in a hospital. I still work night but now do 8 -9 hour shifts 5 night a week. Definitely a different dynamic in patient care but, as I said, I love it. I believe one-on-one patient care is what nursing is about . Unfortunately, over the years medicine in general has become so bogged down with paperwork that we don’t have as much time with our patients. If we do give our patients the time and attention they need in the office or hospital setting we’re there for 1 or more hours after our shift is done to catch up on charting.  That’s another reason I left hospital nursing. I felt I wasn’t able to give good nursing care and keep up with paperwork too.

I just finished my Bachelors in Nursing from Western Carolina University (on-line classes) and may finally proved to myself that I am smart enough! I was  procrastinator when it comes to homework so I was in a constant state of panic trying to get it done in time. Statistics was the bane of my existence along with APA papers, both give me hives. I told my family and friends that if I ever said I was  going to go back to school for my Masters in Nursing Education (my original goal) to shoot me. They’d probably want to do that anyway due to my constant state of panic 😉   My best friend gave me a huge coffee cup one Christmas that said “What Deadline?”

That’s enough for this time, I’ve probably put you into “Janet information overload” anyway. If you have questions for me about nursing then please comment on this blog and I’ll address those questions. Until next time, keep looking up

Janet

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