What’s in my nursing bag?

There are two main points to drive home in this blog post.

First, I love seeing what’s in people’s bags, purses, pockets, etc. I think it’s interesting to see what they find important to keep with/on themselves, but also I like to see what products people are using. Ages ago I joined a “what’s in your bag” group on Flickr, and lost hours of my life looking at photos of the possessions of complete strangers.

Second, I carry a lot of crap on me. As the family expression goes, I can fit 10-pounds of crap in a 5-pound bag. For years I’ve referred to it as my urban survival kit, which was born from being a car-less student in a college town for almost a decade. Now as a nurse, I’m still leaving home for upwards of 12 hours at a time, so if I’m gonna need it anytime, I gotta lug it around.

If the internet has taught me anything, it’s that people like being voyeurs (in this case, I mean that very innocently). So I’m gonna show you what’s in my nursing bag that I carry to and from work. There are some things not shown because they’re stashed in my locker, but I do a separate post on locker contents.

This might be a snoozer from looking at the photo, but allow me to explain myself.

Ok, let’s try this clockwise starting top left, looking at the photo of all the bag guts I’ve included:

Scrub coat, extra pair of compression socks and a headband.
Tiny black zipper case with earbuds in them: helps me relax on breaks and long walks to the microbiology lab.
Water bottle with my name on it (Secret Santa 2016 – Thanks, Summer!)
Hand lotion and dry shampoo – you know – to keep my hands moist and my scalp dry.
Tiny ziploc bag of stethoscope parts (that needs to go in my locker).
Coin purse for emergent trips to the snack machine.
“a” bag = electronics bag i.e. power cords, remote triggers, phone camera lenses, etc.
orange and tan zipper bag aka period kit – tampons, liners, sani-wipes – you know, just glam shit.
Face wipes, hand wipes (more so for the car but will dry out if I leave them in the Iowa heat).
The headache med collection: Rx, ibuprofen, Excedrin migraine, and tylenol. Also among the ranks, lavendar and peppermint oil. [Not shown: allergy meds]
Umbrella that I lost in the hospital in 2010 (and found again in 2014 on the unit where I currently work).
Hand sanitizer I got for free at the Cystic Fibrosis Foundation National Convention in 2016.
My wooden hand fan that I use to cool off in the break room every chance I get.
3 half-full packs of Orbit gum because I can never remember if I’m out when I’m at the register.
2 packs of nut butter for a quick on-the-go high protein snack. Also a chocolatey “granola” bar.
My blinding light on a badge reel that I use to see into the depths of my giant bag.
Tiny skull and crossbones sentence journal that I wrote about in a previous blog post.
$5 emergency snack money.
Back scratcher that I bought in the hospital gift shop. That thing has come in handy SO MANY times.
An array of pens, sharpies, pencils and highlighters. Also I got my ECG caliper pins that I don’t need because all the measurements are digital.
My portable pulse oximeter that I need to put back on it’s lanyard.
The research articles I’m reading for my Nurse Residency Program project.
My badge which adorned with three pins, my locker key and a squeeze-light.

Not shown:
4500 more unnecessary pens, markers and carpujets.
Loose change, alcohol pads, and gum wrappers.

My stethoscope – my pride and joy – Littman Cardiology IV in bright pink. I can hear things with it that I couldn’t hear with my shitty old nursing school steth. Oh, you say the bases are decreased? Yeah, we’ll ole pinkie hear tells me there are some crackles down there.

What’s in your bag? Do you carry more than you need or do you use all the things you keep in tow? Talk to me, health care professionals!!

 

 

So, Your Nurse Declined Your Friend Request…

Well, guys, it happened.

I got my first Facebook friend request from a patient.

I’ve been sitting on it for weeks, unsure how I wanted to handle this. I mean, this decision carries some weight since it’s setting a precedent for the rest of my career. It’s opening a potential floodgate.  I know I have a pamphlet in my locker warning nurses to use social media carefully since these online relationships can have some serious repercussions. I’ve been thinking about this a lot and I’ve been asking my peers how they handle the patient-friend boundary lines, too. I wanted to spend some time here talking this out – as I’m still exploring my feelings on this –  though I think my decision is made.

…anticlimactic drum-roll please….

I will not be accepting any social media connection from anyone that has been under my care or could potentially be under my care in the future. I’ve got some reasons, I think.

1. Slippery Slope. It’s the elementary school birthday party guest list nightmare all over again. Mom said “If you invite some kids, you gotta invite them all. Otherwise, you’re gonna hurt feelings.” That’s why, that one year for my birthday party, fellow kid N.M. popped all my balloons and C.J. just sat in the corner and softly cried to go home. It just wasn’t meant to be an all-inclusive environment.

If I accept one, I gotta accept ’em all. And I don’t really like ’em all. Is that mean to say? No. It’s reality. I take great care of each one. I just don’t necessarily want them to see all my vacation photos. 😉

2. Don’t Clutter the Relationship. I am a very opinionated woman on political and social issues, generally in the direction of helping those who get screwed by the world at large. The current political climate has divided our nation and it’s also soured me towards some people whom I had no idea held opinions I find horrifically wrong and unkind. At times, I’d rather not know so I’m not subconsciously swayed.

I provide the best care I can for every patient I see – whether they be jerks, sweethearts, prisoners, executives, homeless folks, or whatever. Their care should not vary based on how I perceive them.

This is easy in theory and tough in practice. So I’d rather not clutter up this critical relationship with my patient with info about their views on politics, social issues, or personal beliefs unrelated to their care. More importantly, I don’t want them to question whether they can trust me because I posted a meme that opposes a meme they posted. I don’t want them to think I won’t help them because we voted for different people last year. I like keeping work, work and personal, personal. I’ll still get to know my patient in ways that benefit our therapeutic relationship, but I pray they don’t small talk about immigration as I give them their insulin.

3. HIPAA (and liability) HOLLA! Uh, yeah, I’m not an expert on privacy laws, but I really don’t want to lose my job, my license, my money and go to jail over an accidental slip-up online…………..sooooooo I just don’t wanna touch patient communication on social media with a ten-foot pole. I don’t want someone who doesn’t have my obsession for boundaries to be instant messaging me asking me if I can give them advice about their meds or poop or something.

4. I’ve worked with some difficult patients, and a few are quite manipulative. I worry that having access to information I or my family/friends post could be used negatively, even if it’s not information that I consider highly private. I’m not actively worried about myself or family being stalked, but I just like to play a zero-risk game when I can.

OK, so those are the big reasons. As far as some of the opinions expressed by co-workers and friends, the answers have been varied but lean towards the general opinion of “don’t do it”.  A few said they regret accepting patients and now they feel obligated to accept them all. Some didn’t care, citing they’re not very active on facebook. Others said they felt they reserved the right to pick and choose and didn’t see any problems when they cared for those patients again (I work with a population we get to see often and know fairly well).

My verdict and advice to you, if you haven’t already, don’t go down this road.

If you have accepted patients as friends on social media and have had positive experiences, I’d love to hear from you.

If you’re one of my patients and you’ve stumbled upon my blog, understand that regardless of my personal feelings for you, I will be your advocate, protector, educator and TLC-giver when I see you in that hospital room next. I hope to not see you soon. ❤

 

The Best Advice I’ve Got…

On days like today, when I’ve screwed up my sleep schedule heading into three consecutive overnights, the game becomes one of minimizing damage.
I tried to take a nap a few hours before I start my elaborate pre-work routine, and with only an hour left on the nap clock, I’ve given up. I won’t be sleeping before work. I won’t be sleeping til tomorrow morning when I arrive home. This is the reality I created when I didn’t nap yesterday on my day off and stay up late to acclimate myself back to the night. Nothing I can do about that now.

So, the focus now is on whatever I can do to make myself feel good before my shift makes me feel not-so-good. Since I’ve got the bed to myself, I’m stretching–paying attention to tight spots and getting a really good stretch in despite this lazy venue. I do my brow bone massage that scares away tension headaches, self-hand and foot massages, and some square-breathing for calm.
All this before I’ve even gotten out of bed.
It’s my way of apologizing to my body for putting her through another long stretch of wakefulness.

The upside is that I will hopefully be so tired in the morning that I’ll be asleep before my head hits my pillow.
What do you do when you know you’re not going to get enough sleep before shift? Share your damage control tactics in the comments.

Hospitality for Your Floaters & Travelers

When I see a nurse  or CNA I don’t recognize creeping sheepishly into our conversation-filled report room at shift change, I make a point to say hello, ask if they’re joining us and give them a warm welcome. Let’s face it, for new and experienced nurses alike, floating can be stressful. It’s even worse when you walk into a room and your co-workers for the next twelve or so hours don’t acknowledge your presence, or they do and it’s smile-less and brisk. This can set a sour tone for the shift and put the balance of the team off-kilter.

If you need a floater or a traveler to complete your staffing for the shift, you’d better treat them well. After all, the whole point of them being there is to help you. Otherwise those extra patients get spread around an already thin staff.  I believe in the five-star treatment for our guest nurses and CNAs. Introduce yourself, get them connected with the charge nurse for their assignment, and don’t forget to show them around – the bathroom, med rooms, linen closets, lightswitches, etc. Wasted minutes and frustrations add up when you can’t find things during a busy shift.

I had a particularly bad float experience years ago when I went to a unit where I didn’t have access to the bathroom. My badge wasn’t recognized by the door readers on that unit, so each time I had to pee or access my personal items, I had to ask another staff member to let me in. I got rolled eyes and huffy replies. To this day, I hate floating there. It’s all about how I was treated. Not as a helpful staff member, but as an annoyance….how do you think I felt asking permission to pee?

Here are my top tips for Floater Hospitality, in no particular order:

1. Intro to the unit and the staff. Give a general idea of layout, what support staff are usually around, if there are special expectations  or times for care of your patient population, and introduce them to other nurses and CNAs. Let them know who to ask if they have questions or problems.

2. Check in periodically to make sure they’re acclimating ok. Just a throw ’em a quick “Hey, you doing ok? Need anything?” when you have a free minute.  This should be a courtesy extended to every member of your team, but especially to staff members who might be struggling and not know how or who to ask for help….unless you took my advice from step 1, in which case they know how to get the assistance they need. 😉

3. If you have time, be chatty and learn something about them. They might have a particular strength that you can learn from, or they might be an ally to you when you float to their unit. Who knows – maybe they’ll love your unit and apply for a  permanent job and make your team that much better. Networking in nursing is never a bad thing and can lead to relationships and opportunities that become valuable down the road.

4. If they’re going to be with you awhile, or if they’re new to the area, adopt them. Include them in any out-of-work activities your colleagues might participate in on days off or after work. I found a new nurse bff that way….he knows who he is. 😉 I’ve met lots of cool traveling nurses and many have decided to stay with us for many “re-ups” of their contracts. We just said goodbye to a great lady who was with us for 6 months. That’s because we have our nursing hospitality down. We love our floats and travelers and we want them to WANT to come back and work with us.

5. On a more serious note: set aside your resentments that travelers make more money than you to work along side you- you get to go home to your family and own bed at night. Sure, I wish all nurses, travelers or not, made a nice little bankroll. But look at the non-monetary rewards and drawbacks of travel vs stationary nurses. Set aside any bitterness towards these nurses who are taking a huge chance leaving home to work somewhere they may know no one. Treat them like you would want to be treated if you were the new kid on the block.

6. If you see any co-workers being less than hospitable, do what you can to show that a bullying mentality is not gonna fly on your unit. If you don’t feel comfortable telling someone to stop negative behavior, you can at least be a positive example of a hospitable nurse and team player.

If I’ve learned anything working in a hospital for years, it’s that a person you work with once today may someday become a permanent co-worker. Or you may find that you’re on their unit, feeling stressed and out of your element, looking for a friendly face to make the float less stressful. In any case, it’s always best to foster good working relationships, including with those single-serving co-workers helping out for a shift or short-term travelers. Keep your nurse karma good and treat your nursing brothers and sisters to a warm welcome when they come your way.

Therapeutic Journaling with Minimal Committment

I have been a registered nurse on a pretty intense inpatient unit for seven months. It’s fast-paced, emotionally intense and physically demanding. The start of my nursing career was rocky, as my anxiety and emotions were getting the best of me, not to mention, day shift was not being kind to this noctournal brain of mine. I feel I’m coming out of that stage a bit as work straight nights, and gain competency and confidence with more acute patients. This entire time, I’ve been seeking out easy things to add to my day to help me avoid being weighed down by the life-or-death scenarios I encounter on every shift.

There are a few thing on this list of coping devices, but today, I just want to focus on one. My aptly-named Sentence Journal was started in August of 2016, one month after I started my job, around the same time I realized my endlessly supportive partner, Doug, was unable to be the lone and constant audience for all the pretty intense stuff I had to get off my chest after each shift.

As you can guess from the title, A Sentence Journal is a no muss, no fuss system…I essentially unload all the things on my mind in one or two sentences per topic, resisting the urge to elaborate on these stories. (I’ll try to funnel the raconteuring to this blog.) Not only does this serve as a way for me to get stressful stuff off my chest, but now, I’m amused to go back reminisce at the funny things, smile and remember patients we’ve lost, and also have a record of my growth and maturation in my role as a nurse. There are gaps in my journaling, usually during periods of high stress or illness or whatever, but I’ve resumed my committment to myself to write a little for every shift.

For the sake of not violating my patients’ privacy, and not going to prison or losing my license, I don’t include names or identifying information in my journal. I learned in elementary school that, if you don’t wanna get in trouble, you should never put sensitive things in ink. #bustednotepasser

The journal itself is small, maybe 4″ X 6″, and a quarter inch thick, covered in a repeating skull and crossbones pattern. (It came in a set with another that was adorned with pirate ships, which I mailed to a friend.) It’s not entirely inappropriate for me since I love the macabre, am a supporter of death positivity (which you can read about here), and regularly provide end-of-life (EOL) care as part of my job. I carry it in my workbag, concealed in a pocket so as not to be easily lost of dumped out. While it’s HIPAA-clean, it’s still my journal and personal to me. I like having it at work, so that I can jot things down if I get a break and feel compelled by something – usually something I find funny.

I wanted to share a few that I find most entertaining, and hopefully I won’t let anything scandalous slip. Although, as I read back through, it’s pretty tame in terms of sarcasm or hilarity. I’ll have to work on that. And yes, nursing can be funny without being mean.

Ok, here’s one:

My patient vomited minutes after swallowing a narc; I wondered if any of it remained in their belly. A short while later, I discovered the half-dissolved pill dried and stuck to the hem of my pant leg.                                  *I wasted it with another nurse who laughed at me

Two days later I overheard a transplant surgeon doing patient education with a woman who was about to discharge after her bilateral lung transplant.

Because of the incision (under the breasts) female transplant patients can only have sex standing up or on top until the incision is healed. Keep those edges approximated!!

Honestly, I had forgotten about this moment:

I started an IV in a broken arm at the patient’s request. “That arm already hurts, and I won’t be using it, so just put it there.”  I felt this was a reasonable conclusion and obliged.

or this night:

The combined total weight of my three patients tonight is 1056lbs. Already tired and I just got here.

I had also forgotten about this sad day, which serves as a reminder that the work-life-balance can be tough when both suck. This is why self-care is a required skill in this line of work.

My first patient death occurred last night. Unfortunately, so did the death of Doug’s dad. I am tired. so. so. so. tired. and so sad.”

This little book is quickly becoming a roller coaster ride of emotions, but I don’t feel distress when looking back on these things. I almost feel like I don’t need to carry this baggage with me, because I know it’s contained on these pages. It’s a symbolic setting down of the weight of my job. 

I didn’t journal from September 2016  to January 2017, and I’m kinda sad that I ‘lost’ those insights and milestones. The months I have journaled I was smart enough to mark my progress with little uninteresting tasks like, I took two admissions today, or IV push meds make me really nervous or I feel like I’m getting the hang of giving thorough report, and other inane details about learning the ins-and-outs of fast-paced nursing.

I almost feel challenged , going forward, to fill this little book with the best and worst of my experiences. I’m a romantic in the sense that I want to have something to look back on as a old woman that can make me giggle and cry and remember those first months of my career. I also think this book works to fulfill the intrinsic human desire to document one’s own existence and experiences. I can at least daydream about someday using it as an outline for my outrageously interesting  memoirs which I’ll write in my golden years.

I’d love to hear how others use journaling as a stress-reducer. Does the minimal-committment nature of a Sentence Journal sound appealing to the busy, tired or lazy  wannabe journaler? Comment below, folks.

NursePROTIPS: LEAK-FREE FLEXI SEAL (RECTAL TUBE)

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Don’t you hate it when you go to reposition your total care patient and you discover that the rectal tube has done nothing but leak since the last clean-up? It happens from time to time, and sometimes can’t be helped. You just can’t will someone to have better rectal tone. But you can eliminate most of your leak-related issues with a few common sense steps.

  1. Ensure the proper amount of water is inflating the retention balloon that holds the tube in place. Refer to the manufacturer’s instructions and hospital policy. Seems simple, but is often overlooked.
  2. Give a GENTLE, OH-SO-GENTLE tug to the flexi to ensure the retention balloon is against the inside of the rectum, minimizing stool that is able to leak around it. Always communicate with your patient before tugging things attached to their body, for the record.
  3. Periodically ensure that there are no twists, turns or kinks in the tubing from patient to bag. The more your patient squirms around, the more often you should check the line. You want it to be like a waterslide, with a smooth, unobstructed path, as much as possible.
  4. Don’t position your patient flat on their back. Keep them slightly lateral lying so as not to have gravity and their body weight crush the tubing, kinking off the flow. Left lateral is best, to follow the path of the colon, but as long as they’re on their side, the stool can pass without too much resistance in the tubing.
  5. When you help them lay laterally, place pillows behind your patient, leaving pillowless space near the patient’s sacrum, using it as a channel off the side of the bed, behind the patient. The tubing should take the path of a tail, not crossing over the patient’s legs/feet, pillows, etc. When bag is on the same side of the bed as the patient is facing, there is no clear path except under and over legs, causing an upward climb for the stool. This can also cause back flow – which is bad news. Use gravity to your advantage wherever possible.
  6. Don’t allow the tubing to be pulled taut or piled up. Hang it on the bed frame hooks so that it has slack, but does not fold over on itself or coil up. If the bed frame has no spot to hang the bag, place the bag in a plastic basin or other receptacle, per your institution’s policy. Just keep it from lying directly on the floor.
  7. Strip the tubing periodically. If the stool is thick or pasty, stripping the tubing between gloved fingers keeps thing moving forward and prevents back-up in the tubing.


These all seem like common sense in the nursing community, but I’m always amazed when I walk into a patient’s room and i see that the rectal tubing looks like a corkscrew while the nurse or CNA complains about all the leaks in the bed. Basics, folks. Don’t overlook the basics. Paying attention to the details throughout your shift can save you some big, time-consuming bed changes and impromptu bed baths from leaky fecal collection tubes.

 

My World at Night

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While I’ve bitched and moaned for years about the hardships of working night shift (and believe me, there are plenty of them), I really have come to love my nocturnal world. There are a few particular things about being in the hospital at night that bring me the same lovely, lost emotions that I felt the first time I watched Lost in Translation. There’s both a loneliness and a solitude to walking the halls of this giant campus at night. I noticed it more than a few years ago…I found myself getting possessive of the night, feeling snarley at the staff that came in at 6 or 7am and flipped all the lights on without warning. I felt like the night, in some small way, belonged to me and how dare they trample it with their daytime voices and fresh coffee smells.

I love going outside the hospital, in good weather, and taking a walk around the adjacent football stadium at 4 or 5am. It’s the part of the day where the prime hours of the bats and the birds overlap a little bit. The perfect walking time is right around the same time color starts to appear in the dark sky. Once the first group of day shifters start to make their way in, that perfect walking time is over.

I used to do this regularly back in the misguided days when I was a cigarette smoker. It was an excuse for me to get out of the building, and walking around was a way to avoid having security sneak up on me. I would often run into patients out doing the same covert thing I was.

I no longer smoke, but I still love the idea of walking around a night. I was detered a year or two ago when a local serial groper pervert was caught in one of the hospital’s parking ramps – but really I just have to remain alert and keep my phone and pepper spray with me. I won’t have the night solitude stolen from me.

At night, I rarely have to wait for an elevator, or slow my pace when walking down any corridor to accomodate slower walkers, wheelchairs and beds in transit. Cafeteria lines are short, and from my spot up on the 7th floor, the city lights of this lovely river town sparkle and twinkle in the distance. When I go to the lower level at night, I can faintly hear music playing over the loudspeakers echoing down the empty linoleum hallways, an occurence you’d never come upon in the day time.

I like going into patient rooms at night, especially if they are sleeping well. I’m pretty stealthy after 11 years of night shift, so I can sneak in quietly, work in the soft glow of light from a computer monitor or IV pump. In the event that’s not enough, I have a tiny light clipped to my badge for checking Foleys and chest tubes in the dark. The other morning a patient commented to me about how they never heard  or felt me come in and detach their IV line from their PICC at 0130. Charting my cares while listening to a sweet old lady snore softly from a warm bed can provoke some nice feelings in a nurse.   Nights aren’t always quiet and content, but when they are, it’s really great.

And the best part is that, just as the day begins, the hallways fill up, the phones start ringing, the teams of doctors start rounding, families show up to visit and patients wake up with a list of needs from bathroom to teeth brushing to pain meds to showers…. I give report and stroll out into the blinding light of day, heading straight to my warm, soft bed.