Stand Up for Nurses

Today I worked at the hospital again even though it was supposed to be my day off. I got a call from the staffing office at 6 am, but didn't pick up the message until I woke up at 7 am. The hospital was short staffed again, & I didn't have the strength to turn down the overtime pay. I ended up working on the Oncology floor taking care of 5 patients: a 34-year-old woman with a new diagnosis of ovarian cancer; a 41-year-old father of young children with recurrent glioblastoma (brain tumor); a 65-year-old woman with a new diagnosis of lung cancer; a 60-year-old woman with breast cancer (she refused chemotherapy a year ago & now had metastases to her spine, liver & lungs); & a 70-year-old man with severe anemia due to recent chemotherapy & radiation. This assignment was complex & also very typical. It was a busy & tiring, but as usual, rewarding shift. I was in charge of reviewing doctors' orders, performing patient assessments, administering medications, helping with turns & toileting, communicating with families, & constant patient care prioritizing while receiving & processing multiple phone calls from various people & departments.
As often the norm, I didn't go for a break until almost 6 hours into my shift - starving, shaky, dizzy & with a bladder ready to explode by then. Almost every nurse I know does the same. One of my worst memories includes working while 8 months pregnant with Gerritt (By the way, did you know that pregnant nurses get the same patient assignment as everyone else?). I was very hungry & dizzy, but could not leave my patient since he was in the middle of an unexpected transfer to the ICU. Usually calm & collected, I lost it & started sobbing uncontrollably. After a quick snack of milk & crackers, thanks to my coworkers, I was able to finish my assignment. Another memory I have is overdosing a patient by incorrectly programming a patient controlled analgesia (PCA) device so it administered 10x the ordered drug amount. I was a recent nursing school grad & clearly remember suffering from hypoglycemia (low blood sugar), being in a hurry & feeling overwhelmed from my patient load being too heavy. After the error was discovered by another nurse & I was disciplined by the unit manager, I was told that "being tired would not fly well in court," should the hospital be sued. To this day I never know when & whether I'll be able to get my breaks & lunch, so I usually carry some dark chocolate & string cheese in my pocket to keep myself from passing out.
It's an unwritten rule - patients always come first. There is too much to do in a short amount of time. Nursing is an art, & caring is a big part of our job description. Unfortunately, there is no one to care for the nurse. With the hospital's recent change in nurse-to-patient ratio from 1:4 to 1:6, it's more difficult than ever to get the needed rest. It's well documented that nurse's fatigue & resulting decreased alertness jeopardizes patient safety. Even though now I spend most of my work hours helping patients in my role as a Nurse Practitioner, nursing issues are close to my heart. I perform a lot of medical tasks such as ordering diagnostic tests, formulating medical diagnoses & prescribing pharmaceuticals, but I am a nurse first.
That's why I was so happy to get the Washington State Nurses Association's (WSNA) email newsletter about the WSNA & Evergreen hospital settlement over nurse rest breaks this week. A few months ago, the WSNA filed a lawsuit over consistently missed rest breaks for nurses at the Evergreen. "The proposed settlement not only includes payment for rest breaks missed in the past, but also sets forth sweeping changes to the way rest breaks are handled at Evergreen. There will be extensive changes in timekeeping, payroll, & policy designed to ensure that taking rest breaks is the norm, that we are appropriately staffed to allow for breaks & that nurses are properly compensated when rest breaks are missed." I've been a nurse for almost 10 years & this is a truly groundbreaking & landmark settlement! Did you know that when I do take my 30-minute lunch break, I still have my work cell phone with me, so I can never get away from work completely? Thanks to the WSNA, their definition of a break now includes that it must be UNINTERRUPTED & that brief trips to the bathroom & getting a drink of water do not count as breaks. Isn't it sad that we have to be that specific?
Most of the public is largely unaware of the nursing shortage while it's projected to get worse. It only makes sense to take care of the nurses we have now to keep them from suffering "compassion fatigue" & burnout & leaving the profession all together. I will finish the post by advising to have someone by your side at all times if you are ever hospitalized. With the nursing shortage & nurses being as overworked & tired as they are, it is wise to have an advocate who would double check things for you. Take it from me, it just may save your life!

UV Radiation Protection & Sophia's Roseola

Today I worked my last evening shift as a nurse at the Evergreen Hospital Medical Center. What a relief! These past 3 days I had a really heavy patient assignment (2 total-care demented "screamers," 1 patient who couldn't stop throwing up, & another one who had several MRSA-infected wounds (he was my easiest one)). Today was the type of a day where you don't use a restroom for 8 hours, take a short dinner, & no breaks (there is just not enough time). All 4 of my patients were diabetics, so I had to check their blood sugars before dinner & at bedtime (8 total times!). 3 of them were poorly-controlled diabetics, so I had to call MD for new insulin orders. I also dealt with one patient's anxious family, treated another patient's dangerously high blood pressure with IV antihypertensives (resulting in more frequent vital sign monitoring), changed several wound dressings, put in a new peripheral IV, helped turn patients unable to turn by themselves in bed, & dealt with a multitude of various small tasks. I will certainly not miss the craziness of hospital bedside nursing & the overwhelming feeling of having too much to do in short 8 hours (while not accumulating any overtime & taking your full dinner break).
A couple of weeks ago I had a suspicious mole removed off my left lower leg. I watched the Dr. Oz show on signs of melanoma & made an appointment with dermatologist since my mole fit 2 of the 5 melanoma criteria (irregular borders & various shades of color). Well, the shave biopsy report came back as moderately dysplastic pagetoid conjunctional nevus (in lay language, moderately abnormal cells that have spread below the superficial layer of the skin), so now I need to go back for the 5 mm "margin control," or re-excision (to get all of the abnormal cells that may have been left behind after biopsy). Not fun! I will have a large ugly scar on my leg, not to mention the pain of recovery. I am just glad the abnormal mole wasn't on my face or ear. I tried to talk my way out of surgery after researching the subject on my own, but the dermatologist would not hear of it (she called the act of not re-excising a "malpractice"), so I will have surgery next Tuesday. I will need to be off my feet for several days. I don't have much sick time at my new Nurse Practitioner job, so I am planning on going to my 1st day of work on Wednesday. There is no way I could be on my feet all day while working as a nurse, but since Nurse Practitioners have many opportunities to sit, I will probably be OK. It looks like the year of 2010 is dedicated to taking care of my health!
Immediately after finding out the biopsy result I went online (Sierra Trading Post) & bought the UV-protective long-sleeved clothes for the children & myself. The Ultraviolet Protection Factor (UPF) shows how well a fabric protects one's skin from solar UV. UPF ratings range from 15-50+. The clothes labeled UPF of 25-35 provide very good protection blocking 95.9-97.4% of the UV radiation, & clothes labeled UPF 40-50+ provide excellent protection blocking >97.5% of the UV radiation.
I will be wearing long-sleeved shirts & pants from now on to prevent any more UV damage to my skin. I am already taking vitamin D3 supplements, so vitamin D deficiency will not be a problem. Most of the skin damage occurs in the first 18 years of life so I'll be keeping a close eye on the kids for years to come. The article by the Federal Trade Commission has also suggested staying out of the sun between 10 am - 3 pm (even on cool & cloudy days), dressing the children for maximum protection (long-sleeved clothes & wide-brimmed hats), & wearing sun glasses to prevent eye damage.
This week Sophia went to her new daycare for the 1st time. She handled it better than I hoped. I was dreading our initial separation, but she got so busy playing with other children & toys, she didn't even notice me leaving. I called from work to see how she was doing on Wednesday & Thursday & got positive reports both times. Vladimir, the daycare owner, said Sophia is similar to Gerritt because she likes to eat & sleeps well. :-) I insist on packing her food from home since I want her to have mostly organic meat, dairy, fruits & vegetables.
At home, she is almost sleeping through the night. After the 2nd day of the new daycare attendance, Sophia slept from 7 pm until 6 am (!). I can't believe she'll be 10 months old tomorrow! Her two top teeths are almost out, so soon there will be 4 teeths all together. She really enjoys gnawing on a banana or a piece of toasted & buttered bread. Actually, that's one of my favorite ways to stop her from crying - just give her something edible to hold! :-) My other way of stopping Sophia's crying is singing to her. She especially loves "If you're happy & you know it, clap your hands. If you're happy & you know it, stomp your feet, etc."
In the beginning of March Sophia was ill with Roseola. Of course, I didn't know it was Roseola until the characteristic generalized rash appeared immediately after the fever stopped (the fevers lasted for 3 days). They say girls are hardier than boys, & Sophia handled it better than Gerritt did when he was a baby. While Gerritt refused to eat completely & got dehydrated, Sophia continued to eat, just smaller amounts. While Gerritt was lethargic & would probably sleep all day if I let him, Sophia refused to be put down & fell asleep only in my arms. I even watched a whole movie one evening while she was sleeping on my lap! The fevers were pretty scary (up to 104 degrees F), but we just gave her some Tylenol & Ibuprofen, & hoped for the best. Sure enough, she was back to normal as soon as the fever stopped & the rash appeared right after. She now has immunity to another group of viruses!

Mommy's Attempt at Potty Training. Gerritt's Attempt to Cosleep. Gerritt's Favorite Breakfast.

Gerritt in his toddler class


Gerritt found unexpected fun in an empty diaper box


Making faces at the playground


Gerritt's cars all neatly organized


Sitting on a potty while watching his favorite "Word World"

I finally made it to Friday! After watching Sophia for 6 nights I am ready to have some "me" time. My husband took both of the kids to his Mom's house with an overnight stay since I have to work next couple of days. Not looking forward to my 12-hour+ work day tomorrow, however, I can't complain after having 7 days off in a row. I really love being a nurse! What other job would give me such flexibility? Speaking of my job, I got the H1N1 flu vaccine last Monday. After reading reports on Dr. Mercola's website about potential dangers of this vaccine, I wasn't going to get it. I intended to be one of those nurses at my hospital who would complete the Flu education module on line & sign a paper stating that I was informed of the risks of not getting the flu vaccine including potentially not being able to work for up to 2 weeks, infecting my unsuspecting patients & bringing the flu home to my family. I quickly changed my mind after having to take care of 3 Swine Flu patients last week. In fact, when I came to work last Friday, the Evergreen hospital has moved to Level 3 alert due to more than average patients with flu-like symptoms being admitted to the ER. It was decided that all of the flu patients would be put on 8 West, the hospital wing where I happened to be assigned that evening. The swine flu pandemic wasn't exaggerated news after all. The patients I've admitted were very sick & had high fevers (103-104 degrees F), fatigue, malaise, myalgia (muscle aches), hard-to-control cough, shortness of breath, & decreased blood oxygen saturation level (in low 80s with normal being above 92%). One of my patients was a young 32-year-old mother of 4; another one was an immunocompromised woman in her 60s. It wasn't the H1N1 flu itself that made my patients so ill, but the resulting bacterial pneumonia. Heavy-duty intravenous antibiotics (Vancomycin, Rocephin, Azithromax) were needed to help them get "over the hump." I started to seriously doubt that my diligent handwashing, N-95 mask & extra vitamin D3 alone would be enough to keep me from catching the swine flu. I've decided to receive the H1N1 FluMist vaccine instead of the injectable one to avoid controversial mercury & other preservatives. Luckily I didn't experience any side effects. I will have full immunity against the H1N1 flu in about 2 weeks. I was fortunate to get vaccinated since our hospital has received only 400 doses of the H1N1 FluMist & I was on the high-priority list due to working on the front lines, so to speak.
Moving on to my mothering job... I've been trying to potty-train Gerritt for the past couple of days. Several wet urine spots on the carpet, several pairs of wet pants & many hours of watchful waiting didn't amount to much. Gerritt was without his diaper from 8 am until 12:30 pm & he still pooped in his diaper as soon as I put it back on at 12:40 pm. He always has a BM right after breakfast, so I made sure he was planted firmly on his Baby Bjorn potty chair while eating & for at least 30 minutes afterwords. It looks like he is afraid to poop in the potty. Not sure how we are going to solve that one. He is becoming more aware of where the urine comes from & even takes off his wet pants all on his own. It is not pleasant to have wet spots all over our living room carpet, however, we are getting rid of it anyways (we are transitioning to hard-wood floor everywhere). I'll keep on trying...
Gerritt's favorite games still involve playing with puzzles & cars. He loves to stuff the cars into the crevices between our couch pillows, line them up on a carpet in a straight line, hide them under a pillow or a blanket, or line them up along a window seal. He went through a period of wanting to sleep with cars too. It wasn't easy to hold his stuffed dog, bear, blanket & 3-4 cars while putting him to sleep in a rocking chair. I had to wait until he was asleep & then quietly sneak into his room to remove all of the cars to prevent Gerritt from rolling over them in his sleep. Thankfully, this stage didn't last long! Unfortunately, there is always something else to take its place. For the past couple of days, Gerritt has been refusing to sleep in his crib. I would rock him for up to 1 hour in a rocking chair & as soon as I attempted to put him into his crib, he would shake his head "no" & cry loudly. I was so tired that I ended up putting him to sleep with me in our bed for the last couple of nights. Actually, it's not such a big deal to me. I am aware Americans in general are strongly opposed to having their kids sleep with them in a family bed, & cosleepers are looked down upon by other parents & doctors. I used to share my parents' bed occasionally up until I went to school (age 7). My parents divorced when I was about 4 years old, so cosleeping with my Mom & Dad (when I visited him) was very comforting to all of us. Since I practice the attachment style of parenting, cosleeping was something I've been wanting to do for a while. I tried to cosleep with newborn Gerritt & couldn't do it since I wasn't getting any rest due to my anxiety of constantly checking on him & being woken up by all of his newborn noises. I've tried sleeping with him again since he became a toddler, however, wasn't able to do it since he kept climbing all over me & laughing (even with the lights out) thinking it was a game. I will welcome Gerritt into our bed gladly if he is truly serious about it this time. I guess we'll find out. That was the whole reason we bought a king-size bed. I was imagining both of the kids sleeping with us eventually, if not during the week, then at least snuggling together on weekend mornings. :-)
Not sure what brought this on... My husband thinks Gerritt really misses me when he goes to daycare 3 days a week. It is not hard to guess. Yesterday after coming home from daycare Gerritt followed me all over the house & even to the bathroom when I took a shower. He undressed himself wanting to get into the bathtub with me. So much for Mommy's relaxation time! We ended up bathing together & playing with foam alphabet letters once again. On Tuesday in our toddler class Gerritt did not let me out of his sight. When I went to a separate room for my bi-weekly parenting lecture, he found me there, grabbed my fingers & tried to pull me off the couch while whispering, "Mommy, come! Mommy, come!" (I guess he was shy of other Moms sitting next to me, so he didn't speak in his full voice. :-))
As much as Gerritt enjoys being in his new Russian daycare, there is no place like home, even if being at home involves doing nothing exciting. He just likes to be close to me. Since I don't leave for work until 2:30 pm, Gerritt & I have plenty of time to bond in the mornings. Sophia is already at her Korean grandmother's house, so Gerritt gets undivided attention. My husband likes to get a rise out of him by saying," Common, Gerritt! I'll take you to daycare. Let's go!" Gerritt makes a sour face & responds in a whiny voice, "Daddy, york ("work"). Mommy, stay!" If I attempt to take him to daycare, he immediately switches his whining to, "Pacaaaaakes ("pancakes"), saaausyyyyy! ("sausage")." I proceed to ask him if he is hungry, to which he replies, "Baby, hungry!" I usually comply dutifully since making pancakes & sausage doesn't involve that much time & happens to be our family's favorite breakfast of all time.


Our favorite pancake mixes are the Arrowhead Mills' Organic Buckwheat Pancake & Waffle Mix & the Arrowhead Mills' Buttermilk Pancake & Waffle Mix. I follow directions on the package, but alter it slightly by adding a few tablespoons of Bob's Red Mill Whole Ground Flaxseed Meal (a good source of omega-3 fatty acids) & Pure Bourbon Vanilla Extract for flavor. We serve pancakes with pure maple syrup & sauteed fruit (like peaches or strawberries). I serve some kind of protein at every meal, so our favorite protein to have with pancakes is ground turkey patties (Gerritt calls them sausage). Waking up on Saturday mornings to a delicious smell of pancakes is one of my happy childhood memories & the one I would like to create for Gerritt & Sophia.

"A life-long blessing for children is to fill them with warm memories of times together. Happy memories become treasures in the heart to pull out on the tough days of adulthood." ~ Charlotte Davis Kasl