Happy retirement MAJ Cerbas!

After 25 years of service to this great nation of the United States of America, MAJ Cerbas has decided to retire as an officer in the Army Nurse Corps. MAJ Cerbas started in the ANC after being an enlisted soldier via the Green to Gold program. He was first pediatric nurse at Walter Reed Army Medical Center. He later obtained his 66C identifier as a psychiatric nurse. He has been stationed at Walter Reed Army Medical Center for numerous assignments, Korea 121 Medical Evacuation Hospital, and finally Womack Army Medical Center in Ft. Bragg, NC. MAJ Cerbas will be going back home to his family in Maryland.

I first met MAJ Cerbas while going through hospital orientation when I arrived to Ft. Bragg earlier this year. He was looking for people who were interested in playing racquetball. Having learned racquetball in college and enjoyed it I thought this would be a good way to learn new techniques from other people.

My buddy Kearney and I learned a lot from MAJ Cerbas about racquetball, but also about being an Army Nurse Corps Officer. He would share his experiences about different places he has been as well as the positions he held as an officer. We would always stop by his office in HESD to see what creative artistic project he was planning in his limited free time. Whenever we said hello he would always joke with us about something, either a flop in one of our racquetball games or another random event.

Having a mentor as a first year nurse and as a new officer in the Army Nurse Corps helped me understand my role as a health care provider and as a leader. I needed someone who could guide me and counsel me when I needed correction. I needed someone who has been in my shoes and can tell me what lies ahead. Even though he is now retired, I still have his contact information and will be bugging him frequently about things I don't understand and input about certain situations.

Congratulations MAJ Cerbas on your retirement! Enjoy being assigned to Ft. Living Room.

Here are some photos from MAJ Cerbas' retirement ceremony that I took.

MAJ Enteterio L Cerbas

Last minute look at the final speech

The Speech

Final salute

The Cerbas Family

My mentor and me

Take 2.

From Iraq with shots (of flu vaccine)

I was glad to hear from my former preceptor when she called our ward the other morning from Iraq. She was recently featured on the American Forces Network in Iraq. Here's the video from Iraq with 1LT Kikugawa about vaccinating deployed soldiers.

Miss you at the hospital 1LT Kikugawa!

Video by PFC Christian Young [DVIDS Flu Shots for Soldiers]

Floating

As of a couple weeks ago the new trend at the hospital was for floor nurses was to float to other units to "help support the mission" regardless of census level of the unit. Another purpose we were told by higher was to cross-train nurses to working in other areas of the hospital.

I personally love floating to the ED because I like seeing all the trauma patients, but please don't put me in the mother baby unit. I wouldn't know what to do.

There are a couple issues I see with floating nurses to different units:

• Access
  ED nurses have access to its locked doors, Omnicell access, and medications. Nurses who float to the ED do not have such access.
  
  Yesterday I asked my Evening Supervisor who floated me to the ED from my medical/telemetry floor if I could follow her to see a case in the ICU because the ED was slow (it was one of those rare moments). I thought it would be a good way to see what happens in the hospital from a supervisor's point of view. She told me to stay put in the ED in case a mass casualty occurred. One minute ago before she told me this, a doctor came up to me to ask for special tape from the Omnicell. I simply told him I could not help him, but an ED nurse could. If I cannot help a doctor obtain the tape he wants to use on a patient how much more helpful will I be when we have a mass casualty situation?
  
  If floating nurses had the same access as the other nurses of the unit, then the floating nurse would be able to access the tools and supplies needed for patient care.
• Safety
  Floating to different units means abiding to the units SOPs and protocols. The safe thing to do is to follow a nurse for a while until there is an appropriate level of comfortability and confidence from the floating nurse and the unit to decide whether the floating nurse is able to perform nursing care solo in that unit. Where is that level of conformability and confidence? It may depend on who is charge nurse for the day. It may be depend on the needs of the floor. No matter who floats to the unit that nurse needs to be supervised. The nurse may not have any intentions of harming a patient, but when taking care of people's lives in an unfamiliar environment, the risk is increased. How would you feel if your nurse has never dealt with your issue of chest pain unrelieved with three doses of nitro?
• Staffing
  I have seen supervisors take one RN from my unit to answer phones for another unit. I have also seen supervisors take and RN and an aide to another unit while our patient acuities are high. I have also seen supervisors call-in nurses to float them to other units.
  All these issues should be dealt at the unit level. Units should be able to sustain themselves with their own staffing: calling in scheduled on-call staff, scheduling more staff due to acuities, etc. Leaving the responsibility to the unit level would allow staff to use their compensation time that they have earned from working extra hours at their unit.

This week:

• 28CSH deployment ceremony - Monday
• JFEX on Tuesday night

P.S. Our ACU scrubs came in! More next about that next post.

On a cold rainy day

I'm back on day shift! >_<

Yes that was a >_<. It is for 3 reasons:

• I'm a night owl
• I like running in daylight (it's getting darker earlier now)
• PT test is next week (sleep cycle is NOW totally off)

Today was my first day back on days and charge nurse. I was nervous coming onto the floor today. I've been asking my coworkers for tips on what the flow was like during the day. I got one word from everyone: busy.

I found some differences between being charge nurse on days versus nights.

1. Rounding
   This is where I round with family medicine/internal medicine plus the ancillary staff: discharge planning, PT/OT, RT, etc. This should take about 30 mins total because we all have other obligations to handle. I feel this is important in expressing concerns and bringing up issues with patients with everyone handing patient care.
   
2. Discharges
   I didn't charge many patients during the night. I had a lot of discharges today. However, there was a delay in getting the patients home. It was mostly paperwork. If I can keep track of who is going home and follow up on discharge paperwork from the doctors we can get people home sooner.
3. The never ending phone ringing
   I think we need to have a cordless phone on the floor. I feel like staying away from the phone. I was being asked for information about the patients, the staffing, and for new admissions. Everyone wanted a piece of me today. ED was pushing patients on the floor, clinics were direct admitting without calling us, and even one AMS patient wanted a piece of me when she started becoming combative while trying to lead back to the room.

Today I wouldn't have survived with the help from the following people:

• Extra staff
  I had 3 extra people come up to help our floor out. One taking patient load and two as admission/discharge nurses. Yes, two! It was a great help in getting the flow going again when we got these people on our floor.
  
• NAs/Medics
  Oh man were a life saver. They were our eyes and ears today. They did a great job in checking up on my patients throughout the ward when my nurses were dealing with AMS patients, procedures performed in the rooms, and assisting in getting rooms ready for the next "wave" of patients.
  
• Head Nurse
  My head nurse couldn't orientate me as charge nurse today, but she did her best to provide extra help and guidance for me being spanking new on day shift. She had meetings all day and came up when she could. I had a ton of questions on what to do and how to do it. What really helped me out the most was her asking, "are you ok?" Every time she asked me that I had to pause and think about it. Having that moment to reflect saved me from blowing up.

Being charge nurse on day shift is very stressful. I feel that with a couple days of orientation I can ease into it. Today I was blessed by fire. At the end of the shift no one died, coded, or fell. Its hectic days like this that something terribly wrong can happen.

I am glad to have survived my first charge nurse day on day shift. I wonder what tomorrow will bring... o_O