Tag Archives: nurses

Popcorn Lung?

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Twice this past week, I arrived at work to the noxious odor of burning popcorn wafting throughout the infusion center. What is it with nurses and microwave popcorn? We save lives daily. We keep critically injured patients from circling the drain into certain doom. We safely medicate patients and do complex procedures, but as a group we are notorious for our inability to pop popcorn in microwaves without burning it. I can’t remember ever smelling burning popcorn in a movie theater. Statistically speaking, you’d think burnt popcorn occurs more often in a movie theater than a hospital, based on the sheer volumes of popcorn popped at movie theaters. That isn’t the case. I wonder why.

You think I exaggerate? Using the search words popcorn microwave hospital fires today resulted in 93,200 results in 0.22 seconds on Google. My favorite is this YouTube Video about a pediatric ER nurse named Stephanie:

Stephanie, you are not alone among your nursing peers. I found an unconfirmed reference online that said Seattle, Washington has made it illegal to pop microwave popcorn in its hospitals because of the fire hazard.

When I signed up for nursing, I expected exposure to many unpleasant odors, including “code browns” (poopy messes), emesis (vomit), and blood. I can handle all of them, but burnt popcorn makes me gag.  Also, fumes of microwave popcorn containing diacetyl, burnt or otherwise, may cause Popcorn Lung, according to this article (dated September 2007). I wonder if this is covered by workman’s comp?

I love microwave popcorn, and it makes a quick, tasty snack that is easy to share with coworkers. Let’s preserve this simple pleasure. If we can save lives, surely we can learn to pop popcorn without burning it.

It Ain’t no Sin to be Glad You’re Alive

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Bathing Sparrow (sorry it's hard to see) photo:JParadisi 2010

After weeks of daily rain, the sun was shining in a brilliant blue sky and the weatherman promised the warm weather would last all weekend.  My coworkers were feeling fine too: in the staff lounge, two of them sang “If I can’t have you, I don’t want nobody baby” and I joined in as the third Bee Gee, before traipsing to blood bank to retrieve a couple of units for a transfusion. On the way, I passed a surgery tech wearing cap and scrubs, who started dancing in the hospital hallway to the tune of his ringing cell phone. We both laughed when he caught me watching. I was still smiling when a woman stepped out of the elevator, looking haggard and sad. She was not hospital staff, and her sorrow reminded me that many people in the hospital were not having a good day at all. I quickly doused the smile and flipped on my professional demeanor switch.

It’s part of the job when you are a nurse. It’s not enough to like people and have excellent skills. Nurses need the ability to separate their personal lives from their jobs. Don’t bring your own drama in, and don’t take the drama of others out. This is a valuable survival technique for longevity in health care. I’m pretty good at it, but occasionally worlds collide.

Like this morning. My oncology patient mentioned she sure missed having a glass of wine once in awhile. We joked about it before I went into the room of my next patient. Filling out the admission record, I asked the required question: “Do you drink alcohol?” I was unprepared for the ferocity of my patient’s reaction, as she explained emphatically that she does not drink alcohol, and it ought to be illegal to drink it. I stopped the admission process, sat down on the rolly stool in the room, and listened to her. When she finished, her glaring eyes dared me to contradict her. I quietly asked, “Have you or someone you love been harmed by someone drinking alcohol?” She had. Or rather, her son was in an automobile accident caused by a drunk driver. Now he is ventilator-dependent and confined to a wheel chair for the rest of his life.

Joking with one patient about an anticipated glass of wine as a reward for going through chemo is supportive. Bringing the topic up with another patient is traumatic. Nursing requires the ability to respond thoughtfully to either patient, sometimes within the span of a few footsteps.

While warming myself in the sunlight on a bench in a neighborhood park after work, I thought about all of this, reminded of how good it is to be alive and healthy. At the end of even difficult shifts, nurses leave the hospital behind while the patients stay there and endure.

Next to the bench, a sparrow bathed itself in a tiny pond. I watched him scatter water droplets that glittered like diamonds in the bright sun, thoroughly enjoying himself on a beautiful day. He wasn’t paying attention to me. He wasn’t thinking about patients, car accidents, cancer, or a glass of wine. He was just enjoying the moment.

“…it ain’t no sin to be glad you’re alive.” (Bruce Springsteen)


And for Memorial Day…

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     *Originally published on Veteran’s Day, November 11, 2009.

    

photo: JParadisi 2009

 This fall, I’m reading the first four books of the Cherry Ames series, by Helen Wells, for the first time. Cherry Ames, if you don’t know, is an 18-year-old student nurse, whose intuitive style of patient care and indomitable spunk lead her through a spree of madcap adventures in the halls of fictional Spencer Hospital, eventually ”winning” her cap and the coveted black stripe of a graduate nurse, during World War II.  

     Unlike Cherry, I did not want to be nurse as a young person, and I was not particularly interested in books about nursing. From junior high on, I felt heroes like Cherry Ames were kid stuff.  In high school, I read Kurt Vonnegut, John Irving, Ray Bradbury, Robert A.  Heinlein and James Thurber.  Characters such as Michael Valentine and Garp held more intrigue for me.

     I felt pretty much the same way as an adult reading Cherry Ames.  In a world of Nurse Jackies, Cherry’s declarations that,

“The patient always comes first. Save the patient at any cost to yourself. That was the nurse’s creed.”

And,

“Nursing had always been Cherry’s dream. She knew it was the finest way a girl could serve people, and Cherry loved people and wanted to help them. Nursing was the way to put her idealism into practice.”

come across as cheesy cliques.  At least, that’s what I thought until last Thursday, November 5, 2009, when the Fort Hood shootings occurred, and the stories of heroism during the crisis became publicly known.

     The first story of heroism I heard was that of civilian officer Sgt. Kimberly Munley, the first responder on the scene, who simultaneously shot the assailant as he fired upon her. She put herself (as the clique goes) in danger’s way to save the lives of others.

     On Tuesday morning, I watched The Today Show. Meredith Vieira’s guests were 19 year-old Pfc. Amber Baher, and her mother.  Amber is a soldier, credited with applying a tourniquet on the bleeding wound of one of her “battle buddies,” then carrying him to safety, while she herself was shot in the back. “I don’t know if it was adrenaline, but my own personal safety wasn’t really what mattered to me,” Bahr told Meredith. “Making sure that my battle buddies were safe was my No.1 priority.”

     Another soldier, US Army Reservist Dorothy “Dorrie” Carskadon (who has family here in Portland) was injured during the shooting, reportedly while assisting one of her comrades.

     I am deeply moved by each of these stories of individuals choosing to save the lives of others, at any cost to themselves.  By their actions, they put their idealism into practice. These women, these soldiers, exemplified, on American soil, the values and commitment of our past and present veterans overseas. This type of courage happens every day, on battlefields far from home. “Their lives’ work is our security, and the freedom we all too often take for granted.”

     In healthcare, we borrow military language. We wage a war on cancer. We battle disease. Severely broken bodies in trauma units are FUBAR. Today, I went to work, hoping I would also borrow a small amount of the courage and idealism displayed by our soldiers.

I need to reconsider my opinion of Cherry Ames.

Portland, Oregon: Nurse Practioner Provides for City’s Children & Needs Your Support

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     Fellow Portlander, Registered Nurse, and blogger Peggy McDaniel posted this on my Facebook Wall yesterday:

Make a difference and help out Dr. Janie. Copy and paste this as your profile status. Help underprivileged kids get critical medical care by voting for Rose City Pediatrics Pepsi Refresh grant. Vote today and every day through the end of the May. http://www.refresheverything.com/healthcareforunderinsuredkids

 

www.refresheverything.com
Pepsi is giving away millions each month to fund refreshing ideas that change the world. The ideas with the most votes will receive grants, so vote for your favorites. Do you have an idea that needs support? Learn how Pepsi can help.
The American Journal of Nursing has posted it nationally on their blog Off the Charts.
So, click on the Pepsi Refresh link above, and vote for Dr. Janie’s (a pediatric Nurse Practitioner) project providing health care to Portland’s uninsured children.
Peggy also sent a link to this article from the Portland Tribune,  providing more information about the project. Please join me in supporting it with your vote.

Interruptions Increase Errors. Really?

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Nurse's Note artist: JParadisi. pencil and ink on paper

     I am writing this post while my husband pumps air into his bicycle tires in our living room (ka-chunka chunka-chunka), muttering about how much work cycling is. Finding uninterrupted time to write or paint is sometimes challenging. In nursing, where the safety of patients depends on accuracy, it is impossible. It is the biggest absurdity of my two careers.    

      This morning I read a Medscape article about interruptions exponentially increasing nursing medication and procedure errors. Researchers collected data for the study by observing nurses at two hospitals. Although the conclusion seems obvious, I appreciate hard numbers applied to a reality all nurses recognize. Collecting data is the first step towards change. Shockingly, according to the study a single interruption during medication administration increases frequency of errors to 25%.    

     In all my years of nursing, I have never completed a single task from start to finish without an interruption. A coworker asks a question, a patient or family member needs something, a phone call from a physician or another department and I am distracted. Once, on pediatric unit, I entered my first patient’s room to find him vomiting violently in the bathroom. While holding his small head out of the toilet, calming him down, and keeping his IV in place, my pager beeped. I had to ignore it, but as soon as the patient was safely in bed, I went to the nurses’ station to see why I was paged. There, a unit secretary lectured me about her expectation for an immediate call back to a page (although doctors have an unwritten, twenty-minute grace period to answer pages for non-urgent matters). Why was I paged? A doctor had a question. I did not need to explain myself to the secretary; when I did, her expectation remained unchanged. Whatever. I called the doctor back, and there wasn’t a problem. My point is interruptions can wait until a patient is safe. The problem is most nursing units have expectations that everything be done now. STAT is the most over-used word in health care. Is there really such a thing as STAT Colace? There is an unrealistic pressure on nurses to do everything at once. It is impossible, and patient safety suffers. It’s a no brainer. How sad studies are necessary to prove the obvious.    

        Creating a safe zone where nurses can draw up medications without interruption is a reasonable idea; however, it does not address the interruptions occurring in the patient’s room, like the pager going off in my pocket.  I am often interrupted while double-checking blood, accessing a port, or hanging chemo by the patient asking for a blanket “when you get a chance” or answering their cell phone. They do not realize how much concentration it takes to give safe care. More than once, I have explained to patients or family members “I need to focus on what I’m doing to keep you safe, and I will be glad to answer your question as soon as I finish.”  I’ve never had a patient or family member complain about it. They appreciate dedication to their safety.   

     Interruptions are a daily part of everyone’s life. Reducing nonessential ones is crucial to safe nursing practice, and adjusting expectations (including staffing ratios) is critical.     

     You can find the article   

Interruptions Linked to Medication Errors by Nurses    

At  medscape.com

Oncology and Hospice Nurses Should Read this Article

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       Okay, this isn’t the happiest subject to post on a beautiful Friday morning before a weekend, but the topic is important and it’s part of my job to know this stuff. Warning: it’s about end of life treatment for patients with terminal cancer.

      Oncology and Hospice nurses, please read this article in today’s Health section of the New York Times. Whether to turn off pacemakers in the face of terminal illness is a consideration in end of life discussions with patients and their families. Read the article:

Life Saving Devices can Cause Havoc at Life’s End

     Have any reader’s had experiences related to this? 

Not All Days are Magically Delicious

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Wound Vac ink & pastel on paper 2010 by JParadisi

        When I was a pediatric critical care nurse working in busy trauma centers, my duties included wound care. I have salved and wrapped burns, and limbs ravaged by meningococcemia. I’ve dressed the fingers of a child whose surgeon successfully used leeches to regain their circulation.  As an adult oncology nurse, I occasionally float to the wound care area and change dressings. 

       A few weeks ago, I changed a wound vac dressing. A wound vac is a small mechanical device in a fanny bag, worn by the patient 24/7.  Black sponge is packed into the wound and covered with an adhesive, transparent film. A suction tube connects the dressing to a canister attached to the wound vac. When the wound vac is turned on, it sucks all the air out, compressing the sponge tightly into the wound. There is barely any sound as the machine ”vacuums” the wound’s drainage into the canister. The suction stimulates healthy tissue, often reducing healing time dramatically. If an air leak is present, there is a loud sucking noise when the machine powers on, and the sponge will not compress. This means it needs more transparent covering to seal it. If that fails, the entire dressing comes off and redone, which is not very comfortable for the patient. 

     The patient I was seeing dreaded the dressing changes. I sat on a rolly stool, listening to him express his feelings about the progress he was making. I used my best communication skills. We connected, and he trusted me with the dressing change. 

     His wound was shaped like one of the marshmallows in a box of Lucky Charms cereal. Its complex shape made cutting the bulky, black sponge to fit difficult. Nope, there wasn’t a template from the previous dressing changes, but that would have been nice. The wound’s location made keeping the sponge in place challenging. Using tricks, I managed to get everything in place. The patient tolerated the procedure well. I turned on the wound vac. 

     The machine made a loud sucking noise and the sponge did not compress. I looked at my patient and the disappointment in his eyes matched my own. I was unable to make an airtight seal by reinforcing suspicious areas with more transparent film. My patient said, “You’re not going to redo the dressing, are you?” It sounded more like a statement than a question. I knew he had reached his limit of tolerance, and I felt terrible.  ”Let me try one more thing first,” I said. I stepped into the hallway and looked for help. Fortuitously, one of my WCON friends was out there, holding her lunch sack.  Also a nurse, she has advanced certification in wound and ostomy care.  ”I need help, I can’t get a seal on a wound vac,” I pleaded. She put away her lunch and in five minutes she found the leak, fixed it, and the wound vac powered on in silence. The black sponge fully compressed. My patient went home. 

     I was not the hero I wanted to be that day. Someone else stepped in for me. That’s why I like being part of a team, because not all days are magically delicious.

What You Focus on Expands

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    Yesterday morning, I attended an awards breakfast at the hospital I work for, honoring 105 nurses with Certificates of Nursing Excellence. My colleagues were recognized for developing patient safety and education programs, precepting, and academic or certification achievements. I received recognition because the American Journal of Nursing published my painting Love You to Death on its October 2009 cover. I was scheduled to work during the breakfast, but two days earlier, our manager arranged patient scheduling so I could attend, without burdening my coworkers with extra work.

     The usual hospital administrators, with the addition of a Chief Nursing Officer, presented the awards. This executive nurse sits on our hospital’s Board. To my knowledge, she is the first nurse to sit on the Board. She makes significant contributions to nursing management.

     Home from work, I checked my email and found that senior art editor Sylvia Foley mentioned both of my blogs, JParadisi RN’s Blog and Die Krankenschwester in a post on the AJN blog Off the Charts.

     Recognition for hard work feels good.

     There are more than 105 excellent nurses working at our hospital. Many simply did not fill out the form required to receive recognition. They choose to work hard without it. We are all wired a little differently, in that respect.  I used to prefer staying under the radar too. But part of taking care of me is taking time to celebrate accomplishments, instead of keeping track of failures. What you focus on expands.

     Happy Nurses Day.

New Image Posted on Die Krankenschwester

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     Little Girls in White Dresses (First Communion) is the latest painting in the From Cradle to Grave: The Color White series on the art blog Die Krankenschwester. The blog chronicles a developing body of visual art exploring the theme of identity.