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Nursing Boards

Brian has been laying hardwood in the bedrooms. He has finished Kayla’s and Allyson’s room and is currently working on ours. This requires everything to be moved out and going through everything. I refuse to discuss how much stuff I have either given or thrown away. I still have more than enough junk and I can’t help but wonder where it comes from.

Yesterday I was cleaning out my night stand when I found this gem.

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It has been in the same place well protected for THIRTY years now. I still remember this like it was yesterday. Back in the day, NCLEX was a class you could take to help you study for boards. I am thinking it was a couple of hundred bucks to which Gena and I said nope not taking it. It was optional and the acutal test was just called  boards. Now the test is called NCLEX which is very confusing for me.

Back in 1988 it was a two-day test given in Springfield Missouri, The test was in four parts, two each morning and two in the afternoon. Gena, Katie and I all drove down together. I borrowed my moms car because it had air conditioning and my personalized plates had already arrived RACH-RN. I figured it would be bad karma to drive mine to the test as if I had already passed. We shared a hotel room as well. I can’t remember which night we went to the mall and had this done but we each received a copy.

The test was awful. For starters people walked around the entire time staring at you making sure you didn’t cheat. If you had to use the restroom, you had to raise your hand and be escorted to the bathroom like a three-year old. I remember the room was filled with long cafeteria like tables. It seems like we had two hours for each portion. This led to once everyone was finished, we would all start comparing answers and be convinced we had all failed. I had smoked during nursing school but quit when I graduated. Over those two days I easily smoked over a pack of cigs by myself. I remember throwing what I had left out the window on the way home.

I think it was a good six weeks before our results arrived in the mail. I was so thankful to see a small envelope because that meant I had passed. I swore if I failed, I was working at Hardees for the rest of my life because I wasn’t going through that again in December. Boards were only offered twice a year back then. Gena and Katie also passed as well, although by the time we had arrived home we just knew we had failed. Katie and I worked together at Deaconess until I left for St. Johns burn unit. I must really be getting old because all of these memories just keep flooding back and I am starting to feel like an old person with all my “back in my day” stories!

 

Mole Moral ~ You never know what I am going to find in my house when I actually go through stuff. This was a true gem and put back where it has always been kept!

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Monday Night Golf League

Brian has been in the Monday night golf league for what seems like forever. He has no idea when he joined and neither do I. This past Monday he came home early and totally freaked out. I thought for sure he got his first speeding ticket of his life but his evening was way more traumatic.

Golf was finished for the night and some of the guys were sitting outside drinking beer and doing whatever it is guys do when all of a sudden Dave falls out of his chair. He lands on the ground and is unresponsive. Brian springs to action to see if he’s breathing. His chest is not moving so he tells one guy to check for a pulse and barks at the others to call 911. The other guy can’t find a pulse (I’m really not sure if I could find a carotid pulse either in that situation) so Brian says to him you are going to have to start chest compressions. The guy is like I don’t know how to do that. Just then Dave wakes up and says he is fine except his neck hurts. No one had managed to call 911 so they skip calling them. Brian drives Dave home from golf and stays with him until his wife gets home. The next day after work I make Brian text Dave to make sure he is still alive. A person usually doesn’t go unresponsive, apneic and potentially pulseless for no reason. Dave answers right away that he is fine but his neck still hurts. Sometime later that evening Brian’s text message buzzer goes off and the next words out of his mouth are something to the effect of holy shit. Well I have a nose problem and ask him what is up. The text is from Dave.

Dave decided to go to urgent care because his neck was hurting so bad. They did a CT scan and determined he broke his neck and they were sending him by ambulance to Barnes. So the paranoid nurse in me was like, he was walking around with an unstable neck fracture for 24 hours, he’s lucky it didn’t extend into his spine and paralyze him. How crazy is that a fall out of a chair can lead to a broken neck. I am also secretly thinking they will check out his heart to see what caused the episode leading up to the broken neck.

Brian heard back the next day and after 2 CT scans, 15 x-rays and an MRI they determine surgery wasn’t needed but he will be in a brace for two weeks. I of course ask what about his heart. “I don’t know” was Brian’s response. Trying to get information out of dudes is almost impossible. I do know Dave won’t be finishing out the golf season except for maybe the after golf drinking and doing whatever it is dude’s do.

I was super impressed with Brian’s take charge attitude of the situation. He has taken CPR at least three times that I can remember. It’s probably because he has lived with bossy pants me for 28 years. Also so caring of him to drive Dave home as well. I really do have an awesome husband!

 

Mole Moral ~ Guys never stop thinking they are invincible even when they are all over the age of 50!

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The Bleeing Edge

This Netflix documentary was released the week I was at Big Stuf camp. I had quite a few people ask me if I had watched it yet. I finally sat down and watched it two days ago. I wish I could say I was shocked but I wasn’t, as most of it I already knew.

It’s been almost four years since I was a work and someone said Rachel Dr. Veronikis is calling from the OR and wants to talk to you. First of all Dr. V rarely calls anyone, much less from the OR so I went totally paranoid and figured he was going to yell at me. Instead he said I want you to go in and talk to my patient in 16. We had just moved to our new unit and I had to figure out where that room was. So I walked into Melynda’s room and said something like hi I’m Rachel and Dr. V told me to come talk to you. She had mesh removed by a doctor in California and was here for reconstruction with Dr. V. She shared her story with me.

I must say not only was she super nice but she was super smart. She had one of the Johnson and Johnson mesh put in. It wasn’t the small piece that supports the urethra but an entire thing that lifted the bladder up and had arms. She told me they knew when it was brought on the market their would be some lawsuits so they set aside a slush fund to cover them. There were no trials or studies on living women. The mesh had gotten approval through the 510k process. If a new product is similar to one currently on the market it is approved without trials or research. Physicians were trained over a weekend using cadavers. That’s dead women. Some physicians were also given kickbacks for every sling they placed. I have seen enough of Dr. V patients that had mesh placed that never needed it, to know this is truth. I am sure everyone involved would deny it but actions speak louder than words. Melynda added me to a Facebook group with all kinds of links to mesh articles. I read as much as I could and joined a few of the public groups to stay informed and keep up with what is going on.

So I started the show knowing full well I would be furious, but it was way worse than I imagined. It started with essure, the coils placed in tubes to prevent pregnancy   Again very little training and doctors were told if you missed the tube just put in another one. One lady had five of them floating in her uterus. These are made of metal so it only seems logical people would react to these. The trials they did were rigged. Some of the gals responses were changed right in front of them to make it say they had zero complications and one hundred percent satisfied only because they weren’t pregnant. It was taken off the market in every country except for the United States. However, right before the documentary aired it was announced it would be pulled from the market at the end of this year. I guess the greedy company wants to get a little more money while turning a blind eye to all the people they have harmed.

I have never been a fan of the daVinci (robot) machine. After watching this I would not ever encourage anyone to use it. They state it’s less invasive for hysterectomy. However the least invasive is the vaginal approach. The robot makes a blind stab for the first incision and most of the time that works out fine. However when it was developed an eight month training period was recommended. However again greed knew no one would buy it or invest so it was cut to a much shorter time period. And the show says a doctor practices and then had another physician watch him for two or three times and then he can perform on his own. This is accurate in my world. They had four different women end up with their intestines falling out of their vagina. I say no thanks.

So many people have been injured, maimed and have had their life ruined and yet the greed continues. Profit before people seems to be the motto these days. The FDA 501k process is broken and the loophole needs to be closed. When some of the FDA scientist attempted to be whistleblowers they were either terminated or had their job eliminated.

I don’t have the answers except to do your homework and don’t let anyone implant anything in you without extensive research on your part. The latest greatest doesn’t always mean safest or best.

 

Mole Moral ~ Melynda found her mesh on eBay, purchased it and gave it to Dr. V at her six-week check up. It makes you wonder just how easily any untrained physician can get their hands on it and implant it into unsuspecting people.

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Own it, don’t dismiss it.

A few weeks back my music switched to cycling through everything on iTunes, instead of just my play list. I usually tolerate this until one of the kids nasty worded rap songs comes on and I switch it back to my Christian music. After I saw Rob Bell two years ago I downloaded some of his first pod casts and it so happened number seven popped on. I had heard it before but I had a feeling I should listen again. I believe he called it the tapes in your head. The word tape kind of shows our age since I’m pretty sure they no longer exist.

He was talking about the way you talk about yourself in your head. So he launches into a scenario where he is playing kickball with you and you catch his ball but you trip and fall and run a spike through your chest. So he cuts the spike loose and halls you to ER. I had a hard time getting past playing kickball with Rob and not calling 911. Anyway you arrive to ER and they stat page a doctor to your room. Do you want your doctor to play this in her head? I’m not really sure about this. I graduated last in my class. There are so many doctors that are better than me. Or would you want her tape to say I’ve got this. I know exactly what needs to be done. I have the skills and the team to accomplish this. Another thing he spoke about is not owning compliments but rather dismissing them or downplaying them.
Three hours after I listened to this I walked into work and my boss was talking with another gal I had never met. The unknown called me high energy and my first thought was no I’m not. And then it was if my head shook and cleared my brain and I was like I think she’s right. So I’ve been thinking about how my life does indeed reflect high energy.
For starters my job reflects this. I am scheduled eleven am until seven-thirty pm to come in and take all the new admits. They include surgeries, direct admits (straight from home or doctors office) ER patients and moms who just had a baby that ends up in NICU. This shift originally started because for a few years the hospital did away with having people on call and we were not allowed to staff for patients who weren’t there at the start of the day. On big surgery days (10 or more) this could be a nightmare with every nurse being at max capacity and yet more surgeries needing to come. I worked three to eleven back then so a lot of times they would call me to work early. So anyway I now come in at whatever time they need me. This may be as early as eight thirty or as late as three. I sometimes have all five patients within three hours. The recovery room loves me because I almost always take report when they call and have taken back to back and say send at same time I’ll make it work. The only time this is a nightmare for me is when the patients were not given adequate pain medicine during surgery and are out of control upon arrival. This keeps me running for the first few hours. Our unit is huge and really spread out so on a crazy day I can easily hit ten thousand steps in eight hours. And to think my husband likes to harass me and say all nurses do is sit around and eat chips and dip.
My activity level screams high energy too. I walk almost three miles every day for my coffee and then around the back neighborhood. It’s also my time to play Pokémon. I’m still running and always training for something. Last years fifty mile runalone says either high energy or belongs in an insane asylum.
At the end of the same day I had a patient and her husband thank me for being the kindest nurse and person they ever met. My first reaction was to dismiss the entire compliment and then Rob popped into my head and the love dare. I remembered one of the three things Brian said he admired about me was my willingness to do whatever I could to help others. And I must admit they were right. They were of a different culture and I respected that and incorporated it into my plan of care. Plus they were Heartprint patients which will always have a special place in my heart.
So over the past three weeks I’ve been trying to own it, instead of dismissing it. I must say this is a lot harder than I thought it would be. My head tape likes to go immediately to the negative and the worst case scenario. I guess I have something to work on.
Mole Moral ~ If the tape is negative, eject it, and replace with a positive one, you deserve it!
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Time Really Does Fly!

On this day thirty years ago I graduated from Deaconess College of Nursing with my diploma in nursing. So much has changed since then that it is almost impossible to believe. For starters there is only one diploma school left in the area and that is Lutheran School of Nursing. Every other program is either associate or bachelors in nursing. The diploma schools had the most clinical hours back in the day and were usually associated with hospitals. In other words free labor.

I recently looked at my scrapbook to figure out which day I graduated on. I was very surprised to discover I graduated on Uncle Larry’s birthday. I would have thought I would have remembered this but I guess this is why I scrapbook. Things you think you will remember forever you quickly forget.

I must say nursing school has not changed at all during this time. It is still the most stressful time in a person’s life. I swear they do everything they think of to get people to quit and weed out the weak. I mean if you even think about applying they start quoting wait lists and GPA’s and drop out rates. It is just ridiculous. I can honestly say I would never go through it again. One and done.

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I thought I would list some of the changes over time. Please feel free to comment any others.

  1. All white with a nursing cap. Scrubs started around 1989 and the caps were gone by the time I started working at Deaconess
  2. No computers at all. All charts were paper and kept at the  nurses station.
  3. Medication carts with narcotics on them. Now my friend Gena who works at a small hospital still has them. I haven’t carted one up and down the hall since 1990 when I went to the burn unit.
  4. Gloves were only for sterile procedures. You carefully cleaned up people and emptied foley catheters.
  5. It cost money to watch TV and there were only seven channels.
  6. Smoking occurred anywhere in the hospital. Patients were placed in rooms based on smoking preference.
  7. No scanning medications or automatic times placed in charts. Also the medication records were hand copied by night shift every four days.
  8. All pain medications were given IM. There was no IV push pain medication.
  9. Darvocet was not a narcotic. It no longer exits as it was taken off the market years ago.
  10. Two nurses had to count narcotics at shift change. No one could leave until the count was right. If you forgot to sign out a narcotic it held up everything.
  11. LPN’s were phased out of mercy at least five or more years ago.
  12. There were no twelve-hour shifts.
  13. There was no straight day shift. You could work straight evenings or straight nights but days were rotated with either evenings or nights.
  14. People were admitted the night before for tests now done outpatient such as cardiac cath, upper and lower gi, stress test, etc.
  15. Nursing boards were a two-day event with a six-week wait for results. Small envelope you passed, big envelope you failed and they were only offered two times a year.

I know I am forgetting so many things but there are many others I will always remember.

  1. My first patient that passed away.
  2. My preceptor, Lisa from my first job.
  3. My ten years in the burn unit including my first really critical burn.
  4. How hard nursing school was.
  5. How I learned to never date a patient the scary hard way.
  6. Why I transferred to Women’s Health.
  7. Being pregnant and vomiting in the trash can during a feeding tube insertion.
  8. Taking care of my first Christmas Angel.
  9. Leaving a code to go the bathroom to avoid peeing in my pants.
  10. The class I had to take to learn how to use a computer mouse.

 

Mole Moral ~ As I look at my picture I think dang I had a nice figure and yet if you would have asked me back then I would have told you I was fat. My body image disturbance isn’t just a nursing diagnosis, it’s a reality!

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Mercy Heartprints

I rarely blog about work because with HIPAA I do not want to be in violation and potentially lose my job. However I feel this subject will be safe because it really has nothing to do with a specific patient of circumstance.  A little over seventeen years ago my nephew was born and it was apparent he would not survive so the decision was made to take him off of life support and have his parents hold him until he passed. I was there and it was the most difficult thing I had ever been through. Prior to this I had worked in the burn unit and been with my patients when this was done. I thought it was easier because there was no hope, however I discovered that although your head knows it’s the right thing to do, your heart is broken into a million pieces. After this happened my sister-in-law was transferred from the mother/baby floor to the gynecology floor. I had been thinking about leaving the burn unit for a few months and after visiting her there I knew it was time to transfer.

Mercy Heartprints is a program for families who experience the loss of a baby through miscarriage, ectopic, stillbirth or neonatal death. It is run by a wonderful lady who has been in charge for longer than I have worked on Women’s Health. (At some point the name of our floor was changed from Gynecology to Women’s Health but I cannot remember when.) We have an open visitation policy so if the mom wants to see her baby again before she leaves, we do that for her. I remember when I was in my labor and delivery rotation and our instructor called us in to see a twenty week loss. She was touching the baby and I remember thinking that I would NEVER touch a dead baby. See how that word bites me every single time I use it. Sadly, I have touched more than I ever could have imagined. I used the word sad because every baby is a loss for a family.

Most people wonder why and how I can do this and there are two reasons for this. One, if I could go back in time and hold my nephew even though he had passed I would. I do not want any of my patients to ever have that feeling. Two, I know it is the last time they will see their baby until they themselves die and go to Heaven. For those of you who are wondering we do indeed warm, dress, and wrap the babies in blankets. All of this is then given to the parents to keep.

My mom taught me how to crochet when I was really young. I’m thinking maybe eight or so. I even made clothes for my sisters Barbie dolls. I never played with those stupid things. Shocking I know. I always wanted to learn how to do granny squares but no one I knew could make them. I bought a book with the instructions but I might as well have  been reading Chinese. So when I had Emily, an aunt made her a granny square blanket. It was beautiful and I will always treasure it.

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Brian took this photo all on his own when Emily was three days old. You can see the blanket in the picture. Finally about a year ago, I thought I bet there are You Tube videos on how to do granny squares. Sure enough there was and I finally was able to do make them and then the Chinese directions actually made sense. So I started a pinkish one and then the girl who does my hair was having a baby so I made one for her but she was having a boy so I had to switch yarn colors. Then my other friend was pregnant again with number eleven and I was convinced she was having a boy so I made another blue one. However, about a month before she was to deliver I decided to finish the pink one just in case. When she texted me she had a girl I believe my response was “OMG! It’s a good thing I have a back up plan.” I have since made about three more blankets for other friends that are expecting. I ran out of people to make them for so I decided I would make them for the Heartprint patients. Since most of the time those babies are smaller, I only use one skein of yarn for each blanket. Hobby Lobby has a brand of yarn called I Love This Yarn and all of the colors are amazing. I have currently made twenty blankets (I have been asked if I think I am OCD. That answer is you better believe it) and I see no end in sight. I have a lot of solid colors from past projects so I am doing a solid and then a fun multi-colored one. I feel that if just one blanket brings one mom some comfort and peace knowing her baby was recognized then it is worth making a thousand. My husband did ask how much i was charging for them. I said they are gifts to the Heartprint program. He asked me how I am ever  going to get rich. I said giving them away makes me richer than Bill Gates.

 

Mole Moral ~ Often in this world, we never know how one-act of kindness can make a difference to just one person.

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CPR can KMA

This May I will have been a nurse for thirty years. I can still remember taking CPR for my first job. That year they had these fancy mannequins that recorded rate and depth on a strip. You had to get so many right to pass. I managed to pass it just fine, but many others did not. They didn’t have to retake it or anything either. Two years later when it was time to recertify they had changed it and no longer required a passing strip. So it was much easier and way less stressful. Two years ago I took one of the last old style classes in which there were instructors and real live people who checked you off. This year it was online with learning modules and then you go into a room and perform on a mannequin that is hooked to a computer that will only pass you if you do it perfectly.

Please keep in mind that I am old school. When I went to nursing school, computers did not exist. I mean there were some a frame type computers but personal computers were not around and everything was typed on a typewriter. I went to class every day and listened to lectures and took notes. So this online stuff is not really my way of learning. I have had numerous people ask me why I don’t go back to school and become a nurse practitioner. One, I have no interest in leaving bedside nursing and two, I do not want to write papers and do group projects to earn a degree. So back to CPR. I did the online stuff without any issues. It only took about two hours to get through all the modules and the simulation stuff. I managed to forget to turn the AED on every single time before applying the pads. Yesterday I went to the lab for the manequin portion.

I did just fine on ventilating the adult and the baby. I also had no issues with the check off for the chest compressions on both. CPR on the baby was ridiculous. I had to push so hard I swore I was going to break both of my fingers. Then the adult came and no matter what I did, I could not pass the three cycles. In the middle of my attempts I posted on Facebook and someone asked if I was having trouble with the ventilation. My response was “I can blow like a porn star!”, it’s the chest compressions I cannot manage to do effectively. Someone else said you have to do it hard, fast, and deep. My first thought was do I look like a dude? Maybe my husband could give me some pointers! I finally asked for help and the gal came over and gave me pointers but by this time I was so exhausted I was told I had to come back the next day or day after depending on how sore I am. She also gave me the you need to work on upper body strength to which I replied I am a runner and that’s what I enjoyed. When she continued to annoy me about upper body strength until I threw out there that I just ran fifty miles. That pretty much shut her up. Yes lady I am in the best physical shape of my life, this computerized mannequin is stupid.

On the way home I started thinking about one of my many bus rides to Big Stuf camp. Jack Riley was on my bus for my very first camp and he was a freshman that year. Fast forward to the year he was an Obtern and an EMT. We were talking about CPR across the aisle from each other. I said to him “the person is dead so if you screw it up, it’s not like you killed the person.” He started cracking up and knew what I said was true. However the other kids sitting around us about lost it. But I speak the truth, if your heart isn’t beating, you are dead and your chances of CPR working is not the greatest. Now if you heart is in an arrhythmia and you have an AED available then your odds have greatly increased. So here I am all worked up over ineffective CPR on a plastic mannequin. I went up to the floor afterwards and burst into tears. My good friend Amy said what is really going on, there is no way you are crying over CPR. I was like seriously my life is cool for a change. It was only this morning I realized what the issue is. I had forgotten to take my crazy pills for over a week, so I took two right away.

I cannot even think about attempting it today. I forgot to take my Fitbit watch off and it put a nice red mark and bruise on the top of my wrist. My arms are killing me and the palms of my hands are bruised as well. Hopefully I can perform tomorrow or I won’t be working until I can pass. Once you expire, Mercy will not let you work. Now had I been taking my medication properly I would look at it like this “I can’t pass, cool I get a day off work.” But since I am unmedicated I look at like this “Oh look Rachel is such a loser and horrible nurse she can’t even pass CPR.” The second statement is beyond false but the voices in my head like to shout at me and without Zoloft they are louder than my God voice that tells me I am a treasured child and a really cool person. Work has just called me to come in so I will sign off.

 

Mole Moral ~ If you are CR, never attempt CPR unmedicated!