Built to Serve, Trained to Save

Sh*t Nurses Say

2012-02-08T02:46:00.005-05:00

In the spirit of all the other videos I made one with the help of my friends and nursing buddies.

Enjoy. If you have trouble seeing the video click here.

1LT Promotions - Friends

2012-01-25T11:31:00.002-05:00

I love promotion ceremonies. I love them more when they are of my friends. It's funny how sometimes your friends don't invite you to their promotion ceremony. Usually this a great sign of recognition and a sign that you're moving up in your career. Odd how that happens.

Thanks 1LT Cipperly for inviting me!

BTS still shot - WAMC Patient Care Touch Video

2012-01-24T08:30:00.004-05:00

I've been tasked with producing WAMC's Patient Care Touch video to be shown on the ANC 111th Birthday on 02FEB2012. I've got a couple of LTs on board with me to get video and stills of life around the hospital.

I love OR light. Especially when the house lights are down. I wish I could bring that light to all the shoots I do.

I'll post a link to the final video after it's shown.

3 Tips for success - CPT Board Prep

2012-01-21T09:38:00.006-05:00

My name was brought up recently for the AN CPT board!

I found out that I was 8 days from being in the last year group. So close yet so far...

I've updated my DA photo, submitted my OER, and am waiting to meet my DON to go over my ORB. It's awesome that our DON used to work at HRC.

A couple of tips that I have learned through this process

DA Photo - Be yourself. Smile if it's you. Practice posing in front of the camera/mirror. Have someone take a photo of you. Perception is everything and is important when the board looks at you. The photographer will not coach you on your smile. You have to coach yourself. You spend about 5 mins in the studio. Make it count. You can only update your DA Photo once per year.

OER - Be specific in your job title. Instead of "Clinical Staff Nurse" put "2N Staff Nurse." I've been on 3 separate wards in my career so far but my ORB looks like I've only been on 2 because of my job title being "Clinical Staff Nurse" at the first 2 wards. Put your location and your duty.

ORB - Have someone who knows what they're doing look at your ORB. This is usually one in your senior leadership. They've been through this process several times. Find one that you know and trust to take a look at it.

The board meets in April. I can't wait!

What grinds my gears...

2012-01-04T12:45:00.002-05:00

... is when on-call surgeons don't want to do their job. For instance refusing to come to the hospital from home to admit a patient with uncontrollable nausea issues because the surgeon forgot his hospital issued laptop so he could do it from home (not my problem).

How am I supposed to explain this to the husband who's been at the hospital all day for his wife (the patient), hasn't seen his 3 kids at home in which one of them has down syndrome? Don't put us in a hard place doc.

AAR of 2011

2012-01-01T14:32:00.006-05:00

Happy new year everyone! Every year comes with lots of changes and interesting experiences. There's a small recap of I've been through this year.

In June I transfered from the surgical ward to the PACU. It's a different change from being on the floor. It's a much faster pace and I like it. I found out after the first couple of weeks taking care of PACU patients is like taking care of random drunk people - you don't know how they're going to wake up. During my orientation I've taken care of the criers, the flailers, the sleep talkers, the party animals, and more.

Still no word of a deployment. I've given up obsessing over it. I did turn down a CSH postion at Ft. Lewis. I wasn't interested in being with a CSH that was coming back from deployment. The position was offered to me months after HRC put it online as a priority fill. Now it was not a deployable priority fill. Not interested.

In the meantime before going to my next duty station and if I ever deploy I've been keeping myself busy with projects around the hospital. I am the marketing director of our Junior Officer Council in charge of promoting and distributing information about our organization events. I'm glad to work with a team of LTs and CPTs who believe in developing ourselves to be better leaders, learn new tools of our trade, and to exercise them to help our community.

I am happy to meet so many new people this year. Most of them are friends of my other friends I've made in my travels and in courses. I'm glad we are able to still keep in touch even though they are deployed, at new duty stations, or living their lives outside the Army.

My goals this year? Keeping my expectations low with deployment. PCS? Been trying Korea for 2 years. In the meantime JOC has finally given me an outlet to finally let some of my creative ideas take place. Since there hasn't been a real JOC established at WAMC our team gets to set the bar. I'm able to implement the things I've been reading from the books that I've been reading related to business management, marketing, and social media.

Speaking of books here are a couple of books I've read in the past year that have been helpful to me.

Poke the Box - by Seth Godin - This book is about not waiting for permission to do something you know that needs to be done. Ideas are great, but sometimes you need to poke to get your idea into action

Tribes - by Seth Godin - There is a difference in being charge of a team and leading a team. This book has let me use the interwebs as a way to connect with other JOCs in our AMEDD.

Purple Cow - by Seth Godin - This book is about being remarkable. Being average is boring. Be different. Find a purple cow.

Free Prize Inside - by Seth Godin - A great follow up to Purple Cow that has ideas and tips on how to be remarkable with your new idea.

48 Days to the Work You Love - by Dan Miller - This book is about finding your passions, dreams, and turning them into reality. It's your life so make it happen.

Entreleadership by Dave Ramsey - One of the best books on leadership, management, and team building.

That's 2011 wrapped up in a blog. 2012 is going to bring some interesting changes, especially that our military is officially fighting one war. The CPT board is now a best qualified board, 140,000 troops will be cut, and there is still talk about our 20 year retirement plan.

The quote that I'm carrying throughout 2012 is this:

Regret doesn't remind us that we did badly, it reminds us that we can do better - Kathryn Schulz

Happy new year and God bless!

Medical Demotivational Posters part 1

2011-11-29T10:17:00.004-05:00

We know that as medical professionals we have a... different sense of humor. After finding out that there are medical demotivational posters out there I've decided to start a collection of them. If you find any please send them my way and I'll credit you! Or better yet make your own and send it to me. I wonder what crazy stuff we can come up with.

Stole from Amy Smith's FB wall

Happy Tuesday!

Give Thanks in All Circumstances

2011-11-26T15:22:00.001-05:00

Yes Thanksgiving has come and gone, but it doesn't mean what we should stop being thankful. I especially need to work on that.

You're probably tired of me ranting that I'm not getting what I want from being in the Army. Believe me I am too. It wasn't until the other day that I was smacked in the face with a large humble pie that I had everything that I needed.

It was a busy day in pre-op getting patients ready for surgery. Doctors were wondering where wondering where their patients where, we had no beds to put patients in, and the OR was backed up. It was just a mess.

It was near the end of the day when I was exhausted from the busyness of the day. I didn't get a break and swallowed my food just to taste it later. I had several more patients left to pre-op then I could clean up the unit and finally go home.

I introduced myself to my next patient and told him what the plan was. I was caught off guard when "Alan" asked me if I was ok. I stumbled my words for a second then told him that it was a long day and I wasn't feeling my best. For some reason I felt that I could vent a little bit with this patient.

Alan then told me despite my venting, "Well LT, looks like everything is going well for you." I became puzzled and confused by his statement. I just told Alan about having a really bad day and he says everything is going well? This doesn't make sense.

I learned from our conversation that Alan is in the WTB with a injury to his left lower extremity after his convoy was hit by an IED. He has had multiple surgeries trying to gain full functionality of his leg. He cannot run, walk normally, and has to use a cane to get everywhere.

Alan told me, "Sir, you have all for limbs, you can walk, you can see. You are doing better than a lot of people in this world, including me." However Alan's tone was not of anger or regret, but of hope.

The whole realization of what he said didn't hit me until this Thanksgiving weekend. I hung out with my adopted family for the weekend. One of the verses that was read before we prayed for our meal was 1 Thessalonians 5:18 - "Give thanks in all circumstances for this is God's will for you.".

What happened to Alan is an unfortunate event, however he is not bitter or has hatred against world. I on the other hand sound like a bitter old man who has resentment towards everyone. My attitude sucks. I am complaining about things I want, but Alan still has joy despite his loss.

Lord thank you for bringing Alan as a patient to me. I pray he may be able to walk and run again. I also pray that you will help me to have a heart like Alan not only this Thanksgiving, but in everything I do.

Been too long for good reason

2011-11-06T11:29:00.004-05:00

I've been told that if you have nothing good to say, say nothing at all.

Hence the reasoning for not posting anything the last couple of months. Somethings are better left unsaid, but there are things that need to be pointed out.

Board delayed x2 -

My year group's CPT board is delayed twice. One for the new regulation to go from 36 to 42 months and that the AMEDD board is not meeting in December, but in April of 2012. Pin on will most likely be this time 2012.

How I found out about this was the most interesting part. Neither HRC or my command told any of us about this. A buddy of mine from OBC mentioned it on Facebook and another person from our OBC class has the MILPER message. HRC's website said the board would meet in January 2012, but the MILPER message said they would meet in April. Inconsistencies? Yes. Great communication? Definitely. Surprising? No.

No thank you Ft. Lewis -

I turned down the 47th CSH position in Ft. Lewis this past week. Yes I know you are probably dogging me because I've been ranting and raving about wanting to deploy. However, the 47th CSH is coming back home from Iraq and isn't on the timetable for deploying anytime soon. With Afghanistan being our only other world wide conflict the CSH rotations will not be as frequent as they have been before. If I were to be at the 47th CSH I would be borrowed manpower to the MEDCEN there and would be doing the same thing I'm doing now. Why go to all that trouble for something I won't get?

Do not communicate. Do not collect $200 -

I've been working as the marketing director with our JOC the last several months to help revamp the JOC into something attractive and useful for junior officers at WAMC but also to other JOC'ers out there.

We've been using Facebook and email marketing to get the word out to our members about meetings, events, and community outreaching. We can't get on Facebook at WAMC so I've been using a iContact as our solution. I can send a personalized email update to our members and it will also post onto our Facebook Page. This way we have the same communication on various levels. Recently our email marketing solution has been blocked for some reason. I've talked with various people about the continuing frustration I'm having with the technology and communication at the hospital. The solution is now to talk to IA and JAG about this to get this resolved. With the amounts of social media tools DOD uses they decide to block an email marketing solution that's used to communicate with junior officers.

I'll leave the other frustration for another post. Just thinking about it makes me more frustrated.

On the lighter side I've been reading 48 Days to the Work You Love (it's definitely not what I'm doing now). I highly recommend this book for anyone who doesn't love their job or who loves their job.

ETS status - 693 days left...

"Hulk smash" felt at WAMC

2011-08-23T18:24:00.003-04:00

I've survived the tornados earlier this spring. Now I've survived the 5.9 earthquake. Both survived from the same place: Womack Army Medical Center.

I was in the PACU making a routine call back of a surgery patient when I felt the rumble. We do call packs to make sure everything is ok with the patient while at home by answering any questions, connecting them to the appropriate clinic, or urging them to call 911/go to the emergency room.

Anywho, I was about to end the conversation on the telephone when I feel the rumbling of my desk and see my computer monitor sway back and forth. It stopped momentarily then started up again. My monitor kept swaying and the rumbling became stronger below my feet. I looked at my co-worker next to me and we were in denial. "Was that an earthquake?" Then my patient still on the phone starts saying "OMG the house is shaking!" I thought I was just imagining things, but it did really happen.

The rumbling stopped after what felt like 30 seconds. I asked if my patient was ok and if anyone was hurt. Everyone at the patient's home was fine. I ended our conversation and proceeded to go outside to check the hospital surroundings. Mostly everyone was going about doing their own thing. I asked a couple of people if they felt the quake. Most of them said they didn't feel anything. It was an eerie feeling.

The rest of the day was spent taking care of the last several patients who were going home from the OR and lightly bringing the earthquake up in conversation. No one was hurt, no MASCAL called.

Prayers out to those who got hurt from the quake. Hope everyone is ok.

Also, it's hurricane prep time. Irene is supposed to hit hard this weekend along the Atlantic coast. For more tips on how to prepare for this upcoming storm go here: http://www.ncdhhs.gov/hurricanes/

Stay safe everyone.

Surgery Buddy: Lizzy

2011-08-19T09:24:00.003-04:00

This is how cool kids are treated at WAMC. Matching IV, matching dressing to LLE, matching mask, and even the hair cover. I was never treated like this at the old children's hospital when I had procedures done as a kid. Super jealous.

OPD - Deployment Updates

2011-08-15T23:38:00.003-04:00

Just had a officer profesional development (OPD) session at work this evening about deployment. I am even more frustrated about my limbo status than I was before.

Turns out that since the 115th CSH (who is in Afghanistan) and I'm here on "a list" I cannot switch my PROFIS unit. Both PROFIS iterations have deployed and the 115th CSH's year is almost up. The only way I'll be able to go is if someone gets hurt or someone is KIA (I'm not hoping for this just to let you know). However, I am in limbo and on-call to deploy just in case.

There a lot of opportunities coming up to deploy but our MTF is not being tapped for most of them. The ones that are going to really cool places are not locked down to a PROFIS unit like I am, so they're going.

I know in a previous post I've mentioned that I'm over this whole deployment thing. I am. I have no control over what goes on here. Higher knows how squeeky I've been wanting the oil. I'm loud, squeeky loud. My situation kept being brought up throughout the whole presentation about what it's like to be in deployment limbo. After that presentation I'm now the poster child.

My new options:

Turn in my SF packet (more in a later post)
Reapply for LTHET
PCS (if command will let me, PACU is super short staffed)
Wait until I make CPT next year
Keep looking at my ETS countdown

God, you're in control. Lead me where you want me to go.

Influence and sharing ideas - Tips from a former extremist

2011-07-18T10:10:00.004-04:00

I've recently been fascinated by books and conference videos that talk about connecting, sharing, and networking with other people that promote change. I'll be doing a series of blog spots of my thoughts of sharing ideas in my workplace.

My MTF has been making efforts for civilian and military staff members to head various committees and projects. If you're military like I am the committee is chosen for you due to need and you are there until you are moved to another unit or PCS'd to another location.

I was put on the PI team for the medical floor I worked on two years and attended one meeting. I had no idea what I was doing. I wasn't briefed on what to do or how to do it. I was told to go, show up, and report back. I was disinterested in doing PI. I had no desire to do something that I no desire to do let alone be told to do it. Apparently there were others who felt the same way as me because even the coordinator at the time did not send any other emails promoting future PI meetings.

PI is important for the hospital. It's also important for HIPAA when they come every year on their rounds. But how do you get staff members fired up to do something like this or any other movements?

Maajid Nawaz talks about the era of behavior: "a period of trans-national ideas and narratives affecting allegiances and behavior." Being a former Islamist extremist Nawaz was forced to think outside the box to spread extremist ideas and propaganda against democratic cultures. The internet was a great tool to connect and bring others to his cause.

See his presentation below.

If Maajid Nawaz can do this, can we do this as well in our hospital settings?

PCS Dream list

2011-06-23T00:48:00.004-04:00

HRC finally contacted me yesterday! My branch manager asked me for my dream list from her list. Here's mine:

1. 212th CSH - 3 Year assignment (Germany baby!)
2. Fort Lewis- 47th CSH (I can get my deployment patch)
3. West Point, New York (it's an hour away from New York. Bu-yah.)
4. Ft. Irwin, CA - (really don't want)
5. Ft. Benning, GA (really really don't want)

If I were to PCS in 2012 my top 5 duty locations would be:
1. 121 Brian Allgood Com Hosp, Korea
2. 212th CSH
3. Landstuhl Regional Medical Center, Germany
4. Fort Carson, Colorado (Would love to snowboard out there)
5. Joint Base Lewis-McChord, Washington (JBLM - Formerly Fort Lewis)

The 47th CSH is asking for immediate fills so I figure I'll be going there rather than Germany. I'm really salty that Korea isn't an option. I had a buddy of mine in Korea tell me that slots for the hospital have been filled up and that they don't need any more personnel. I'm like, wah?! Korea doesn't need any more medical personnel?! Outrageous. Unheard of. Those are the same reactions I've been getting from my command when I tell them about Korea. They are more confused than I am.

I've been praying for God's will for me in my career in the Army. I'm also thinking about things I want to do if I get out. We'll see what happens. Either way I'm starting to become more hopeful about the future.

Surgical ward to PACU - part 2

2011-06-13T18:45:00.003-04:00

I'm still currently on orientation to PACU but I've seen and learned a lot during my first week.

PACU's role in the care of the patient is important after surgery. Patients can have different reactions to anesthesia intraoperatively and post-operatively. The PACU nurse is responsible for maintaining the patient's ABCs, obtaining a tolerable pain level, and control any nausea/vomiting. Also it's important to look out for any post-operative complications such as excessive bleeding and notify the surgeron across the hall.

The flow of the PACU is dependant on the flow of the operating rooms. When OR cases start finishing up they notify our charge nurse of the time the case has finished. The PACU charge nurse can prepare the staff for the arrival of the next patient. When that patient arrives it's important to look at the patient (assess ABCs) then attach the patient to the vital sign monitors. Report is given by the nurse anesthetist or anesthesiologist at the bedside. From here care of the patient is performed by the PACU nurse.

I'm told that if there are any pain or nausea/vomiting issues the nurse anesthetist or anesthesiologist is responsible for giving orders. If patient decides to go south the nurse anesthetist or anesthesiologist is across the hall and comes immediately. When I was on the surgical floor it was difficult during the day to obtain orders pertinent to my patients because the surgeons were in the OR. In the PACU I have almost instant access to them.

Patients have different reactions to anesthesia. I've had a couple of humrous cases. I had a patient that was coming to when he stated that he needed to go to the party, the Kid Rock party. He said that the staff were invited to come as well. Later on the patient said he had the coolest dream being at Kid Rock's party and that the staff was there. I've got a feeling I'll be seeing a lot of these reactions frequently throughout the week.

My experience in the PACU so far has been a great learning experience. I do miss working 12hour shifts. I just can't seem to get my body to wake up Monday to Friday for work. I've been working shift work for the past 2-3 years and that's all I know. My body was dying at day 3 last week.

More anesthesia reaction stories to come...

P.S. Here's a photo from my farewell at Joe's Crab Shack by 2N. Ms. Murray was another nurse that left 2N to be the head nurse of the ortho clinic. I'll miss the crazy times we had.

Surgical ward to PACU

2011-06-13T00:09:00.003-04:00

I transfered to the PACU last week from being on the surgical floor for a year and two months. It's interesting to see what happens to patients prior to them coming to me on the surgical floor. I've always wondered why my patients are always nauseated and in pain prior to them coming to the floor. Now I know.

I've got photos from my farewell and more thoughts about PACU coming to a post later this week.

P.S. I'm glad the Army has gone back to patrol caps. I hate wearing my beret.

Road2Anc on Twitter!

2011-05-25T01:43:00.003-04:00

I have an announcement to make: I'm now on Twitter!

I'll be posting links to this blog, odd medical news articles, and random nursing interactions with staff and physicians on my Twitter. Sometimes you only need 140 characters to state the rage, joy, and hilariousness of being a nurse.

The handle for me is @road2anc. Be sure to follow!

GBP

2011-05-19T09:28:00.002-04:00

Why do female s/p gastric bypass patients come to the inpatient ward with so much drama? Something I've been seeing very frequently.

It's over 10,000!

2011-05-18T09:37:00.001-04:00

Whoa. I just realized on my counter below that I've hit over 10,000 views.

Whoa.

I never expected this blog to be seen by so many people. Thank you all for reading, messaging me, and for sharing your experiences with me.

Thank you for reading.

Nurse's Week at WAMC

2011-05-14T09:08:00.007-04:00

It's been a busy week at work this week! PT Test and Nurse's Weeek at WAMC. Here's a recap of the events I captured.

We started off on Monday with a Nurse's Prayer Breakfast at the dining facility.

Chaplain Matsler pointed out that in all the medical personnel he's encountered the nurses are the most spiritual.

Mother baby + ED + Surgical nurses represent (in that order from left to right)

Tuesday and Thursday were ice cream delivery days. Senior staff members brought ice cream to the day and night shift nurses around to the wards.

Wednesday morning was our fun run. Staff members brought their dogs too.

The last event I covered was an event not at WAMC, but at the VA Medical Center in Durham, NC. COL Gordon, WAMC's Deputy Commander of Patient Services, was asked to speak at the Nurse Excellence Award Ceremony.

Had a great time talking with the vets. They have lots of stories to tell.

All-American Week is next week!

Leadership Quote

2011-05-09T10:24:00.002-04:00

Leadership isn’t difficult, but you’ve been trained for years to avoid it. - Seth Godin (Tribes)

From Nurse to Army Surgeon General

2011-05-06T15:30:00.003-04:00

Congrats to MG Horoho for being confirmed in being the next Army Surgeon General!

And happy nurses' week! A little bummed that my pirate costume theme for the surgical floor next week was a no-go, but oh well. Looking forward to the pot lucks!

[First nurse nominated as Army surgeon general]

Precepting thoughts

2011-05-06T01:28:00.002-04:00

I feel that I am a horrible preceptor. I feel that I don't have any patience with my preceptee. It's mostly just computer stuff, but it's such a drag when my preceptee doesn't have access to our computer charting system and I have to be charge nurse, take patients, precept a new nurse on the floor, and co-sign everything my preceptee does under Essentris.

I must've been a real pain as a preceptee come to think about it. Major props to my preceptor who didn't falter in training me.

Tornado Mascal Prep

2011-04-19T11:54:00.006-04:00

This past weekend 62 tornados hit North Carolina. The areas around Ft. Bragg were hit affecting soldiers and local residents. Several entrance gates are closed off due to debris blocking off that area.

I was charge nurse on the surgical ward during the day shift. We were updated throughout the day through our supervisors about what was happening around post and patient care would be affected.

The storm dropped down in the afternoon around WAMC. Rain and a white wall covered the Reilly road entrance. My staff and patients looked out the window in awe of the chaos outside.

After the storm hit we got reports of injuries and property damage all around North Carolina. We then got word from our supervisor that we were to prepare for a mascal. The local hospital declared a mascal and WAMC was to receive transfers of patients due to the natural disaster.

Once I got word I called for a team huddle with my 4 staff nurses and medic who were with me for the shift. We first determined who were the most stable patients that could be transfered. This would allow more room on the surgical floor for post-op patients if necessary. Then we divided up tasks to make sure rooms were cleaned, prepared to receive patients, and that we had a plan to receive the patients. Lastly I made sure my staff had food (replenish strength for the next possible busy hours) and made contact with their families prior us initiating our plan. We were operating on limited power, but we had internet, computer access to Essentris, and the phones were working.

We ended up not taking patients related to the tornado, but we were prepared for the worse and hoped for the best. Prayers out to the families affected by this disaster.

A thousand times no.

2011-04-14T01:40:00.002-04:00

Yesterday a nursing student came up to me and one of my medics while we were eating lunch and asked if she could put a foley catheter in one of us.

A thousand times no.

Patient Prayer

2011-04-05T22:28:00.006-04:00

Just another Saturday on the surgical floor. Not to many surgeries planned and a lot of patients to be discharged to home. It was going to be a predictable day.

Having no medic or aide during the evening shift, I began collecting dinner trays. I came to a room with Mr. Fall. He didn't have a tray because he was NPO for surgery in the evening. Mr. Fall was on my surgical floor with a fractured right ankle from falling off a ladder. He was in the process of setting up a projector at a local church. We then started having small talk about our faith and our background in the military. I felt lead to pray for this patient. I asked if I could pray for Mr. Fall's surgery with him. He said yes.

Then the unexpected happened. After I finished praying for him, Mr. Fall asked if he could pray for me.

This was the first time a patient has ever prayed for me.

I was pleasantly surprised, humbled, and touched by his words. He prayed for my future in the Army and that I would find a Godly wife.

Mr. Fall did well after surgery and left after 2 days. I hope that projector is working well.

Update - Transfer to PACU?

2011-03-29T05:49:00.003-04:00

Came back from the weekend to talk to my OIC. Just been volun-told to go to the PACU at the end of the month.

I guess that solves the issue if I'm going or not.

Transfer to PACU?

2011-03-25T17:52:00.002-04:00

After finishing up my 3-month rotation of night shift on the surgical ward, my OIC wanted to talk to me about a couple of things. First we discussed floor issues, scheduling (I do the schedule), and then came up the subject about transferring to the PACU.

The biggest reason for transferring to the PACU is due to my rank and time on the ward. I am one of the two senior LTs on the floor. My OIC suggested that going to the PACU would help broaden my nursing knowledge and possible leadership opportunities (not much leadership opportunities in the ANC, more on that in a future post).

My first response was, is there anywhere else I can go? PACU doesn't seem to be in my realm. I'm told it's step towards critical care, but I'm more interested in trauma than critical care. My ultimate goal is to go into nursing informatics, but my informatics mentors tell me to expand my nursing knowledge so when I become an informatist I'll have a good nursing experience to draw from.

The schedule is another concern. I like not working 5 days a week. It gives me time to go out and explore, work out, and enjoy my time off while normal people are at work.

However, a benefit of working 5 days a week is that I'll be able to get all my training holidays and federal holidays. I currently don't get that doing shift work.

I have the weekend to think about it. I'll be talking and emailing my mentors about this.

What are your thoughts, suggestions? Or am I being a total lame-o? I welcome all constructive feedback.

Want. (while deployed)

2011-03-24T15:40:00.004-04:00

These are some of the new ground MEDAVACs that are being used overseas. They are built similar to the MRAPs but are modified for speed and mobility for crossing the rough Afghanistan terrain.

One cool thing is having oxygen in the truck.

The most interesting new feature is an oxygen concentrator that turns ambient air into medical-grade oxygen, thus removing the need to carry heavy tanks of air that might explode and turn into projectiles if hit.

I would like to check these out in person one day.

[This is the U.S. Army’s tough new high-tech ambulance - Jalopnik]

Those two words

2011-03-21T20:27:00.004-04:00

The other night I was dragg'n. Lately I haven't been able to sleep and it's been really affecting my mood. Even my coworkers saw how grumpy my mood was. On top of my lack of sleep I got a couple of emails from HRC that I'm not too happy about. I was grumpy about lack of sleep and my future career. Oh and my allergies.

That night I only had several easy ortho patients with pain management issues and a lap appy who was in the OR when I got on shift. I made sure I took care of my patients without them seeing my mood. Just when I got my ortho patients pain level at a comfortable level my s/p lap appy patient came.

"Jane's" family was in the room asking a kabillion questions when Jane came in. I got all their questions answered with Jane's permission and they took off. Jane had some pain and nausea but her biggest concern was getting her Red Cross message overseas to her husband. I'm thinking, really? For a lap appy? With no other surgical or medical history and having an uncomplicated surgery she wants a Red Cross message sent? There's no way her husband was going home from overseas for this. Yes, I'm a jerk. Moving on.

I got her pain and nausea under control and start making phone calls. It took about 30 mins to gather info from the patient, the chart, and from the surgeon. After everything was done and Jane was able to talk to the Red Cross person on the phone I tucked Jane back into bed. I turned out the light and proceded out the door Jane softly said "thank you."

Those two words caught me off guard. They made me stop in my boots for a couple seconds. I was sleep deprived, exhausted, my eyes watery from allergies, and hungry. I turned back to Jane and said "you're welcome" as I fixed her blanket. I went out and closed the door behind me. I sat in my workstation chair for a couple minutes.

I'm a jerk.

I didn't deserve those kind words. Even though I didn't show my dismay towards her situation she still thanked me. I felt so wrong and wanted to sink into my chair and never get up.

There are days like this that really put you in your place.

Sleep for a week

2011-03-15T12:28:00.000-04:00

Precepting thoughts

2011-03-10T14:57:00.002-05:00

After scheduling people with preceptors for about a year I finally am scheduling myself with a preceptee.

I'll be precepting a nurse new to our unit, but not new to nursing. My role is to orientate the new nurse to how we run things on the surgical foor. I'll be precepting this nurse for about a month.

As of today I have two years of nursing experience: medical, surgical, with bits of pieces of the ED, ICU, SDU, pediatrics, and yes mother/baby. I don't feel that I have a complete grasp of my surgical nursing field, but I am mostly comfortable with working in my current field. Are my experiences and training enough for me to guide someone into my unit?

I guess we'll see.

ED Doc's message on Craigslist

2011-02-24T17:33:00.002-05:00

Normally you'd think that Craigslist would be for selling and buying stuff from local people, but you'll find a place where people will rant about just about anything.

I found this posting via Reddit about an ED doc's advice to narc seekers posted a couple years ago. I like the first point he makes:

The first rule is be nice to the nurses. They are underpaid, overworked, and have a lot more influence over your stay in the ER than you think. When you are tempted to treat them like shit because they are not the ones who write the rx, remember: I might write for you to get a shot of 2mg of dilaudid, but your behavior toward the nurses determines what percent of that dilaudid is squirted onto the floor before you get your shot.

We as nurses make the call on what to give to our patients based on our objective analysis of our patient's situation. I do not give pain meds to patients who are loopy, drifting in and out of conversation, or who yell explicits at me when they don't get what they want. Over time I know what to look for in narc seekers, especially when they keep being admitted to the floor (why I don't know).

It's also hard to be compassionate when I see patients walk up to the post-op surgical floor, demand to be admitted for pain management while completely bypassing the ED, and wanting to talk with their surgeon. I see it over and over again. However, it's like the story of the boy who cried wolf: you never know until it too late sometimes.

Anywho the Craigslist posting great piece. I recommend you read and share during shift report.

[Advice from an ER doctor to drug seekers]

Taking charge

2011-02-17T00:09:00.006-05:00

You may have heard of the 61 male who had a heart attack while driving to the ED and had a MVC in the hospital parking lot. Unfortunately he did not make it and some concerns have risen about the hospital's policy about following EMS protocol (waiting for ambulance to arrive) prior to giving care.

Below is the video footage explained with time stamps and identifiers.

One person I want to point out is the charge nurse. Here is the article's account of what that nurse's role:

A Portland Police Officer informed us of a car accident in our garage that we believe occurred at least 20 minutes prior. We advised the officer immediately call 911 because EMS have the mobile equipment to respond to a car accident. Before the officer left our Emergency Department, our charge nurse directed a paramedic to go immediately to the scene. She also dispatched our first responders, who are trained security staff, to go outside to the scene of the accident. When the security staff arrived, the police were already doing CPR. Then the nursing supervisor ran out to the garage. She saw that the ambulance and fire department had arrived and were actively preparing the patient for transport to our emergency room.

That is taking charge, like a boss. The charge nurse could have just continued to follow protocol and wait for EMS to hand off the patient, but knowing the information she immediately took action and prepared the trauma room for this patient.

When in charge, take charge.

[Man Dies at Hospital Waiting for Ambulance Call]

The HRC Verdict is...

2011-02-16T22:47:00.006-05:00

I had my meeting with my HRC branch manager last month. I was told the same thing that everyone has been telling me:

Wait.

I was salty. I can't PCS to the places I want to, very limited 66H slots for deployment, the nurse research deployment slot I was told I had was a farce (higher said they were just looking to see who was interested even thought my OIC gave me the ok to go TDY for training this month in FSH), and I have to stay here for possibly another year.

I'm trying really hard to be positive about all of this. It's already a drag that I'm on night shift along with going with this disappointment. Yes I know that when I signed the dotted line and took the oath to protect and defend the Constitution of the United States that my life would be "managed" by the needs of the Army, but don't like where I am: career wise, education wise, and sense of fulfillment wise.

Since I have no choice but to stay at Bragg for the next year I've changed my goals for the year:

Pass the GRE (they're revamping it in August. I hate doing essays)
Obtain my Med-Surg Certification (yes it's for the monetary incentive)
Start IMD/Surgical Ward software project

That's 2011 for me. I know things are subject to change, but I can't live my life waiting for something that may or may not happen; I still need to live.

And yes I'm thinking about the greener grass on the other side. I've even made a reminder just in case:

Meeting with my HRC Branch Manager today

2011-01-12T01:37:00.001-05:00

I hope I get the assignment I want! *crosses fingers and prays*

ANC Branch Visit to Ft. Bragg

2011-01-10T23:54:00.002-05:00

ANC Branch managers are here from Ft. Knox, KY. They'll be here throughout the week doing interviews and giving briefs.

Today the State of the ANC brief was given. A lot of interesting information about our strength size, career progression, and the proposed 66T course. More info to come out this week.

CAC on a MAC

2010-12-16T12:05:00.004-05:00

~~Please excuse my geeky side.~~ I am a geek. No excuses here.

I was so excited when I found out I can use my CAC on my Apple MacBook Pro. For the past two years I've been using a virtual machine to run Windows XP so that I could access my work email and AKO. It's a pain to memorize all those lengthy passwords that we have. Pin codes, Essentris codes, Omnicell codes, and the list goes on.

Having just upgraded to Snow Leopard (just to play the Left for Dead II via Steam for $6) and have gotten a new CAC this year, this site was able to help me install the software I needed for my MBP to see my CAC, see my certificates, set website permissions for them, and plug them into my keychain access login folder.

Now I can get my work email from anywhere I have internet! Only if I could access the Sharepoint intranet from outside the hospital I could do most of my extra duties in the comfort of my own home...

I do hope some IMD guru comes out with a secure app for my iPhone to check my stuff on the go. Even though having work email with me everywhere I go may seem like a drag, I find out while being on shift work that I miss out on opportunities such as TDY events, assignment opportunities, or even that a free tickets to "that show" are being given away for free in the PAO.

Here's the site for those interested: http://www.militarycac.com/apple.htm

Side note: I'm happy to say that I'm going HOME for Christmas this year and not going to work Christmas like I did last year.

No need for a tourniquet here

2010-12-07T09:30:00.003-05:00

[From A. Michael David via Tumblr. Original post - Street Anatomy]

Active Shooter Training (lighter side)

2010-11-28T21:27:00.004-05:00

The hospital has been doing training lately in regards to what to do if a shooter comes into the hospital. The live training included involving all of the hospital and then a mass casualty simulation. We were instructed to take accountability our patients and personnel then take cover.

Here is my hiding spot.

Hopefully no one will find me.

Deployment Limbo

2010-11-23T13:31:00.003-05:00

Ok I have to come out and say it: I'm frustrated.

I've been PROFIS to the 115th CSH out of Ft. Polk, LA since APR2010. I'm been waiting on news for a deployment ever since I got out of the Nurse Corps Nurse Residency/Clinical Transition Program. Some of my friends have already gone as 2LTs and 1LTs. I was stoked that I would have my chance to serve overseas.

As of now, I still haven't gotten official word of my deployment status. 1st wave of soldiers head out in January. 2nd wave is in the spring. No orders given to me.

I have talked in person with personnel of the 115th CSH, with my command, and even talked with my HRC representative. All they can tell me is: I'm on an inactivated list. Which means: I can be set to deploy anytime.

That's it. That's all the information I've been able to get. When I went to San Antonio a couple weeks ago I saw THE list: THE list of everyone going with the 115th CSH for the year. I'm on A list, but not part of the deployment list. After talking with several people, they said the only way for me to find out if I'm going is to wait until 12DEC2010, the first report date to Ft. Polk, LA. By that date I'll know if MEDCOM will know if they need me overseas or not.

So what am I to do in the meantime? I'm going/may be going, when will I know? The soldiers that I take care of know when their deployment dates are with their units and know approximately when they are coming back. Why can't MEDCOM send out dates like the other divisions do?

I talked with retired CPTs, MAJs, and LTCs and some have expressed my same frustration. One retired MAJ told me he was told 7 times that he was to be deployed, but was recalled 7 times. One time he was so sure that he was going because he got the ok to ship his stuff over.

Another retired CPT who served 6 years told me a similar experience. They pulled her from work to go to the field many times to prep her for deployment while stationed in Germany. She also told me that one of her co-workers had orders, put her stuff in storage, and gave away all her pets only to be told she'd been taken off the list.

My frustration is not something the ANC has not seen before. I feel stuck. I feel that I can't plan my life for what I want to do career wise or even in my personal life. Sure, you can tell me that this is what I signed up for and I need to suck it up. But these CSH deployments are scheduled. It's not like those in a GRF that have to have their bags ready at all times to be on 72hr standby. There is a date, there is a number that needs to be filled: why can't that be finalized to let myself and the other 100+ personnel plan our lives?

All I want to know is: am I going or am I going. If I go or not doesn't really matter. Just being in limbo not being able to take another step is killing me.

It's a small world after all

2010-11-05T10:47:00.006-04:00

The coolest thing about posting blogs about my experiences in the Army Nurse Corps is the opportunity to meet the people who have read my blog in person. I had the opportunity to meet up with LT Henry who is coming to Ft. Bragg after OBLC in San Antonio, TX while I was at JFCTMC.

Just to prove the Army is a small world I'll tell you how LT Henry and I have this connection:

CPT Kikugawa was my preceptor at WAMC.
LT Henry and CPT Kikugawa were in ROTC together.
LT Henry found my blog via my Flickr site.
LT Henry sent me a message on FB and I've been answering her questions to the best of my ability.
I'm in San Antonio for a pre-deployment course and LT Henry is in Ft. Sam Houston for OBLC.
We'll all be in Ft. Bragg in about 2 months.
We'll be sure to take a photo. =D

It's a small small Army Nurse Corps world.

Hello from San Antonio!

2010-11-02T07:21:00.003-04:00

It's day 2 of the Joint Forces Combat Trauma Management Course (JFCTMC) here in San Antonio, TX.

Today is our testing day for Emergency Nursing Pediatric Course (ENPC). Why am I learning about peds? In Afghanistan 1 in 4 patients seen by military medical personnel are children. This is great refresher for my peds skills. Testing is similar to TNCC. We'll find out how it goes this afternoon.

I miss the food here!

[JFCTMC]

Hanging out with the docs

2010-10-26T22:06:00.003-04:00

The other day my running parter Ryan and I went out for a run. We decided to do the track next to the hospital. After a couple of laps we saw one of the family medicine doctors that we knew setting up cones on the field. Then he asked us to join them in their ultimate frisbee game: family medicine staff (browns) vs family medicine residents (greys).

So Ryan and I as nurses got to play with the family medicine team. And was it a lot of fun!

I've worked with the family medicine team on the medicine floor for about a year before I moved to the surgical ward. Seeing everyone again felt like a reunion. We talked about who has left, who's coming in, and who's holding the pager while the team is out playing ultimate frisbee.

I wish we got to do this more often with the staff members that we work with. Sometimes you need a change of environment to get to know someone better.

Thanks to CPT Harris for taking and sending out this photo. I'm the tallest one. =P

P.S. Browns won the game with Ryan and I. Greys said they're going to start recruiting nurses on their team next time.

I'm sorry/Thank you!

2010-10-21T23:26:00.002-04:00

I'm sorry:

I apologize for not updating as much lately. It's been really really busy on the surgical ward the past couple of weeks and I've been venting in other ways than on this blog. I will get back into posting more things from Texas from the Joint Forces Combat Trauma Management Course from 01NOV to 05NOV2010.

Thank you!:

Thank you to all the kind emails, messages, and comments that were given electronically and in person! I'm glad this little blog was intentionally meant to update my family and friends back home, but now has grown into a much larger audience. Thank you for your words of encouragement. The coolest thing is meeting you (the reader of this blog) in person!

Well time to sleep for another weekend at the hospital. Enjoy your weekend!

My name is

2010-10-18T21:04:00.003-04:00

Thanks to the nurse who transfered me a patient today to the surgical ward.

C4 Recap

2010-09-22T16:21:00.005-04:00

Back in NC from the Combat Casualty Care Course (C4)!

I'm actually glad to be back in NC. The weather in Texas was just killer! We had temps in the 90s with humidity peaking over 90%. OVER 90%! NC isn't that bad after all.

Let's not even get into the mosquitos. Those mosquitos that create quarter sized "love bites" on any exposed skin. Yes, let's not go there.

C4 was a great experience for me. What an opportunity to meet medical service personnel from other branches: Navy, Air Force; along with the Army personnel. We shared stories of our experiences with our patients, stories of our duty stations, and where we want to go next. One of the Navy nurses told me about her experience taking take of the Haitians after the earthquake earlier this year. An Army physician told me about his experience being an infantry medical physician. A Chilean physician told me about life in his country. What a wide range of experiences we had at C4! I feel gained the most learning just from talking with people.

Here's a recap of my week:

Day 1 - Flight, Orientation

Day 2-4 - Prehospital Trauma Life Support (PHTLS) certification class (TNCC and ATLS for doctors was also available)

Day 5-7 - Lectures, Field training

Day 8 - Graduation, return flight home

Day 2-4 (PHTLS)

This is a civilian based class with an emphasis in military medicine about medical care from the point of injury (POI) to the ED. All the scenarios were civilian based: car crashes, falls, electrical shocks, burns, etc. The bottom line up front from this class was when arriving at the scene do you: "stay and play" or "pack in go." There are some treatments that can be done on scene, but for more critical pts the best thing would be to package the pt to the nearest trauma center for a more critical immediate intervention: surgery.

Hello Camp Bullis!

My cot

Peaceful night

The recent tropical storm blew all these down. We stayed in the huts above.

At PHTLS class

Day 5-7

Our lectures consisted of to CBRNE, introduction to EFPs (explosively formed penetrator, which have been found to be the cause of wounded soldiers, not IEDs), levels of care, and provider resiliency.

Our first day in the field consisted of round-robin training of various litter carries, familiarization to levels of MOPP, putting on CBRNE gear, and briefings of the next two days.

Manual litter carries

Newest quick clot being used in theatre. Embedded in gauze.

A medic kit

Practicing IO insertion

Our 2nd day in the field included many various lanes. Our platoon started off with a convoy ops hit with an IED, then a rescue mission in getting soldiers out of a down airplane, and a tactical lane in which our squad was in charge of transporting a box to our destination while carrying wounded soldiers. These lanes were made to be as realistic as possible. The mannequins that played as wounded soldiers were about 200lbs. IEDs/mortar rounds sound effects and machine gun fire sound effects were going off during all of the commotion.

Going on a lil trip

Road trip

The last lane for the day was in a controlled building with strobes, dim lights, loud noises, and various mannequins with various battle injuries. Our squad was to clear the building, rescue, and treat our soldiers in the building.

Our last day in the field consisted of Level II care training. In this setting the patients have been delivered to us and we are able to provide more services than out in the battlefield. We have access to a pharmacy, chest tubes, telemetry, and more.

Packaged and ready to go

KIA

Arrival

Tracking the flow

Treatment

We finalized our last field day with a full out Level II scenario in which one platoon was moulaged and the other platoon were in charge of the Level II facility. Those in the Level II facility were split into various groups: triage, treatment, and evacuation. We were to simulate a real Level II facility taking patients just as if we were in theater.

I enjoyed working with all the medical staff from all the other different services. Everyone was helpful and everyone had something from their experience to share whether it was about their profession or what it was like being deployed.

The biggest lesson I learned was "we'll make do with what we have." All of our scenarios involved lack of supplies and resources: there aren't enough litters, the next pick up is in 1.5 hours, we're out of gauze; these are some of the things that we had to deal with while conducting our lanes. One of the Navy HM-2 instructors told us about the time he was out with the marines for a one-day mission. He packed enough just for one-day as he was instructed. The group's stay outside the wire was for 60+ days. He had to live on just that one-day pack for a long time, including the use of his medic kit.

If our our corpsmen, medics, and our medical facilities overseas can make do with what they have, then our medical centers stateside should have no problem at all with the abundant resources and staff, right?

C4 was a blast! I'm looking forward to my next course: Joint Forces Combat Trauma Management Course in November.

Me and a really hilarous cool German Army PA

Ortho vs Anesthesia

2010-09-01T06:00:00.001-04:00

This was just too funny to not post especially working on the surgical ward.

I am your nurse, not your doc

2010-08-30T21:45:00.003-04:00

It's been a trend lately that I've been mistaken as a the doctor or the kid that his mother knows that he's playing Army (I really get patients that tell me that). I do make sure I introduce myself and my position of the day (nurse or charge nurse), but most of the time I'm referred to as "the doc."

I do make sure to correct my patients for legality reasons, but also for identity reasons. Patients should know who they are coming into contact to and what their title and role they have in managing their health care. I would also like to know who is involved in my patients care. Sometimes I have new residents that come up to the floor at 0500-0600 going through files, folders, my paper work, then asking me about patient-so-and-so. I've also seen random people go through the files on occasion. When this happens I make sure to stop that person, have them introduce themselves, state what role they have in my patient's care, then drive on to the point of the conversation. Very simple, no?

I feel the real reason why I correct my patients is because I feel nurses are under-appreciated. This may seem like a self-esteem boaster to say it, but let me explain.

The past week the surgical floor felt like the psych ward. I don't know if it was because it was full moon phase, but most of the patients had a lot of issues, not just medical. One of my co-workers had a 300 lbs patient that enjoyed sitting in her urine and wouldn't call us to help clean her up unless we checked on her. It takes 3 people to help move due to her fractured left leg.

Another co-worker had a patient who was getting so anxious that ativan wouldn't couldn't calm him down. We felt that he was going to be a danger to himself. We got the on-call doc to let finally let him go smoke outside with an escort so that he'd finally calm down.

I had a young 17-week pregnant G3P1011 20-year old female with abdominal pain tell me everything that was going in her failing marriage. I made sure the consult for chaplain services was put in for her so that she could get seen in the morning.

These are just some of the things that happened just in the past week. Was there a magic pill/medication/treatment that a doctor could do to fix these problems? No. The solutions we had to do were all initiated by nurses. This is not a put down post about doctors. The surgeons that I work with go through many surgeries a day and also work long hours on the weekends. But as the floor nurse, I handle the pain issues, the family issues, and the discharge issues. When the doctors are finished closing up, the nurses take over from the PACU to the ward.

I'm not looking for a gold medal or a plaque. I just want my patient to know what my role is. From their stay, I hope that they realize the person who responded to their pain and their needs was the nursing staff.

I am your nurse.

Froggy Style

2010-08-28T13:51:00.007-04:00

This was an email I sent out to some of my colleagues in response to our CSM not allowing the Vibram Five Finger shoes to be worn with the PT uniform or even for the APFT.

I feel that CSM [*] take on the design of the Vibram Five Finger
shoes not being for running using quotes from the VFF website is taken
out of context.

The original text from the company's website is as follows with
reference:
"Outdoor enthusiasts have found FiveFingers to be the ideal crossover
shoe for multiple sports and activities-from ChiRunning and bouldering
to kayaking and windsurfing. Fitness enthusiasts use FiveFingers for
core strength training, yoga and Pilates. Our customers continually
discover new and creative uses for our alternative performance
footwear." http://www.vibramfivefingers.com/barefooting/index.htm

Note that the following statement from the VFF site indicates the
various uses that consumers use their products, not the sole intent of
what the product is intended for by the company. The uses for VFF from
the company's website are: barefoot running, water sports,
trekking/traveling, yoga, and fitness. The information for using VFF for
barefoot running is located here:
http://www.vibramfivefingers.com/barefooting/barefoot_running.cfm

The Air Force allows their soldiers to wear VFF with their PT uniform,
but with socks (which defeats the purpose of the shoes, but that's for
another conversation). Reference here:
http://militarytimes.com/blogs/afteraction/2010/07/15/barefoot-running-a
llowed-at-air-force-gyms/

The Army Times has an article about the benefits of barefoot running,
the idea in which VFF were created. Reference here:
http://www.armytimes.com/offduty/sports/offduty_barefoot_032210w/

Despite all the research in the world that show that VFFs can be
beneficial to runners, I understand that the commander has the final
say. However, I hope CSM [*] will reconsider. I prefer my VFF because
I do not have shin splints after I run with them. How many other
soldiers also reap of the health benefits of utilizing these shoes?
Research has been shown that these types of shoes help reduce injury
(http://www.wired.com/wiredscience/2009/07/barefoot/) and pain in lower
extremities
(http://www.fitnessspotlight.com/2009/09/10/barefoot-running-injuries/).

What are the benefits at the unit level? Reduced profiles related to
foot injuries (we know several of our peers who constantly have these),
available able soldiers to completed the task/mission at hand (jumps,
training, morning PT, etc.), and a physically stronger fighting force.

My argument is not just for the use of VFF for the APFT, but for the
idea of barefoot running. If this concept can be used to help better
train soldiers to be better fit and able soldiers, why not support it?
It can start with the approval of shoes such as the VFF at the APFT (I
know the Huarache Running Sandals won't be approved:
http://barefootted.com/MakeHuaraches.pdf).

Just some thoughts.

I love my Vibram Five Finger shoes.

Me @ Grandfather Mountain, NC

Update 01SEP2010: Army policy is very difficult to change. Don't question it and drive on. Hooah.

C4 and other things

2010-08-21T18:26:00.001-04:00

Whoa it's been a while! I'm going to do my best to update this blog more often. Lots of stuff going on!

I just got my class confirmation for C4: Combat Casualty Care Course in Camp Bullis, TX for September. I'm excited to be in Texas again. I miss the authentic Mexican food. All the Taco Bell in the world cannot compare to the burritos and chimichangas of Texas. I can't wait!

C4 has students from Army, Navy, and Air Force attending this course. Here's a description from Army Training Requirements And Resources System (ATRRS):

The Combat Casualty Care Course (c4) is a tri-service, continuing medical education course designed to enhance medical readiness of physicians, physician assistants, nurses, dentists and other medical specialties by providing training in field leadership, knowledge and skills that may be necessary for direct medical support in conditions related to any combat situation or contemporary Operational Environment. Training is based on multi-phased scenario-where students must perform the duties of their respective careen fields as well as the duties of 1st responders in a simulated combat environment.

From the welcome packet my packing list seems light. I'll be getting TA-50 from the course and my meals will be MREs. This should be a fun course to go to.

Other things going on:
WSMNi - We go live at the hospital at the end of the month with our new patient acutity system. Scheduling will also be handled by this system. I spent the last week or so learning its interface. For the most part it's mostly user friendly. Just a couple of objects resized to fit the screen so I don't have to scroll within a scrolled object would be really helpful.

Thinking about:
I really need to pick up my med-surg certification study book. There is a review course on October 18 in Fayetteville. If I start studying for it I can take the test before the end of the year.

Also,
I want to deploy. Just say'n.

Mid-Summer Thoughts

2010-07-27T07:04:00.004-04:00

I really miss having a summer vacation. Then again I never really had one going through nursing school subjects throughout the summer, LDAC and ROTC events, and studying for the NCLEX. So am I really missing something I had before? No. Just something that I could never have.

Everyone around me is moving, deploying, or coming back. I'm helping out one of my buddies move into his new place today. I just heard last week a friend of mine is going overseas for 6 months. And several of my friends are coming home. It's a period of time because I feel that I'm caught in the middle of it. I feel that I'm stuck. Not moving. At all.

Am I happy with my new spot on the surgical floor? I'm starting to become more comfortable working the floor. Dealing with surgeons is still difficult, but it's ok to have some constants. I've become more proficient in my wound care skills and my time management. I'm learning a lot about how the floor and the hospital works by doing the scheduler for military staff. But I haven't answered the question have I...

Sometimes I dread coming into work. I really do. Somedays I feel like wanting to just sit behind a desk and not talk with anyone. I have to remind myself that I was put in this position for a reason, a position that I can do. There is a mission that I must accomplish. I remember that I won't be here forever. It sounds cheesy, but the key point is that I have to change my attitude. I choose to be positive. I choose to make a difference in someone's life today. I choose to take care of soldiers and their families.

I choose today to be a nurse.

Blessed

2010-07-03T18:07:00.000-04:00

I talked with an Army wife today at the commissary after work. She was buying supplies for her husband's party because he deploys today. God bless our soldiers and their families.

Happy Independence Day!

The storm is coming...

2010-05-28T17:46:00.002-04:00

Katrina Tour
Originally uploaded by jeku arce

Oh boy. It's that season again, hurricane season that is.

I've been notified that I'm on a list to deploy with the 115th CSH out of Ft. Polk, LA to support FEMA in disaster relief, mainly hurricane disaster relief for the next couple of months.

I found an article today predicting just about how many hurricanes will be produced by the Atlantic Ocean:

The Atlantic storm season could produce as many as 14 hurricanes this year, the U.S. government's top climate agency predicted on Thursday, setting the scene for potentially the most intense season since 2005.

...Three to 7 of those could be major Category 3 or above hurricanes, with winds of more than 110 miles per hour (177 km per hour)

Oh boy. That's a lot of potential for some serious damage.

This will be a good chance for me to have some humanitarian mission time, but I have to be ready to roll in 72 hours after I get the call. In the meantime I'm getting all my papers together, making a readiness plan on who's taking care of my car, my place, and making sure the wills are sign, sealed, and delivered. Stuff can happen anywhere and anytime. As the 2nd Reg Dragoons say, "Always ready!"

I'm not too bummed about having my fall plans suddenly changed, I feel worrisome about making any plans. I talked with my ward OIC about this and she told me to just live as if I didn't get this notice. She also said you can't predict what's going to happen, but you can't put our lives on hold waiting around for this. Go on and live.

So I shall with the words of wisdom given to me from my ward OIC. I have training C4 in Sept and the Joint Forces Trauma Management Course in November. I have some plans to take leave as well. I'll stick with my plans, but remember this important word: flexicute (to be flexible and execute when stuff happens.

[Up to 14 hurricanes predicted for Atlantic storm season - Via Yahoo News]

The scheduler

2010-05-10T20:25:00.003-04:00

I am officially the person to see about one of the most talked about subjects on the surgical floor: the schedule.

The hand off was done a couple of weeks ago as the former scheduler is going to be moving to a different floor after her maternity leave. I thought it was weird that the "new guy" to the floor was given this role, but I like it.

My role on the surgical ward as scheduler is to make sure we have enough staff to take care of patients. On the weekends and holidays we won't need as much staff, but I found out our busiest days seem to be Monday, Thursday, and Friday. The weekends aren't as busy, however we do get some soldiers flown in for surgery.

I also handle pass forms, leave forms, as well as making sure the nurse residents get their day/night off of their conference day once a month, planning training days, and making sure people rotate every 3 months from days to nights with special circumstances noted of course.

I feel a lot of responsibility with this position, but more importantly I see how now my role plays into the hospital's mission in taking care of patients. I knew as charge nurse on 4S medical/telemetry we would have some days where we would have more staff than others, but never really understood how that happened. I also know now that there should be no reason for me to call someone in because the schedule should be a set for the number of nurses for a full patient load. Gets me wondering now why we float our nurses to other units (other than someone calls out or a soldier goes to sick call)...

---

Nurse's week is over and so is the hospital's Spring Formal! What a busy photo week. This weekend I was able to finish sorting and editing all the photos. Today I went in and uploaded the photos onto our intranet website so everyone could see them. COL Fiorey talked with me during the Spring Formal about the pictures I was taking. She said she saw me at all these different events, but never got to see my work. I was puzzled because I've been passing around CDs of different events that I've taken to people who volunteered me to these events. That got me thinking about putting it on the hospital's Sharepoint site. Now everyone in the hospital can see stuff.

In the next couple of weeks before I go on leave, I'll be posting pictures from different events that I've done at the hospital on the Sharepoint site. This should be nice to hear everyone's input and see what I need to improve on as a photographer.

And no, I didn't take over Joe's spot as photographer. He's still working in the PAO. We bump into each other time to time and at different events.

I leave you with a teaser from the Spring Formal last week. I still have Nurse's Week photos to put up too! Stay tuned!

1LT Promotion Ceremony

2010-04-25T21:03:00.007-04:00

No longer a butter bar!

There were 6 of us that were promoted at the same time on 20APR2010. It turns out that all 6 of us all came to Ft. Bragg together after being at OBLC in Ft. Sam Houston. I thought that was cool: to see ourselves grow, hang out, and work together for 18 months as well as see ourselves being promoted together.

It was also neat to see the promotion list come out online. I first saw my name pop up on the Army Times. All the people I went to OBLC with are on that list. Names of people I was with 18 months ago in training were on that list. When I found it I quickly sent out a couple text messages and posted some stuff on my buddies Facebook walls. It's an exciting time for us!

Here are some pics from the ceremony. Click to enlarge.

Our flyer

All 6 of us who were promoted!

1LT Kearney velcroing me.

With my former head nurse CPT Rauh

With LTC Solet-Lindsay. She was our nurse track advisor in OBLC. Now she followed us to Ft. Bragg.

With LTC Henkel, our new Evening Night Supervisor.

My buddy Ryan and I. 1LTs all the way!

"With great wealth comes great responsibility" - Bill Gates

I can't wait to see what exciting things are going to happen!

Next month - Nurses Week

Promotion day!

2010-04-20T01:45:00.001-04:00

In a couple of hours I will no longer be a 2LT. That noob status is now going away.

I can't wait!

Photos to come soon.

Is the grass greener on the other side?

2010-04-12T15:34:00.005-04:00

This past weekend I got go to up see a buddy of mine from OBLC in Silver Springs, MD. He just got out of the hospital for a minor surgery, but he's ok. Took him out to eat and got to go visit the old hospital that I did my Nurse Summer Training Program (NSTP) for three weeks after LDAC a couple years go: Walter Reed Army Medical Center.

I got to visit my old unit, 45B the MICU/PICU. That unit is now next door and another service has taken over the place I had once interned at. It's been 3 years and I'm amazed how much has changed! Logos, commanders, units changing; it's almost as if it's a totally different place.

It was comforting to see that some things didn't change. I remember the Dunkin Donuts, the dinning facility I used to eat at for breakfast, lunch, and dinner, and the super long hallways this hospital had. Those were some good memories.

My buddy took me on a night shift tour of the place and I got to see some of my old buddies from OBLC! It was a blast catching up with them. Of course they were surprised and wondered why I came all the way from North Carolina to Maryland and showing up their hospital in the middle of the night. We talked about our plans for our nursing career, the courses we wanted to take, and the million-dollar question everyone wants to know: when are you deploying?

Looking around the facility I found a lot of things that I liked. I kept thinking, hey we could do that at Womack! How much better would it be if we did that? It was neat to see how their floor units run, see their staffing schedules, and learn what difficulties they had. After talking with them, we had a lot in common: communication, staffing, scheduling, etc.

So are things really greener on the other side? It's all about perspective.

Surgical Ward

2010-04-04T08:46:00.003-04:00

After a week of being floated after moving from the 4S medical/telemetry floor, I finally had an orientation to my new floor at WAMC: the surgical ward.

I was orientated to days for a week then orientated to nights. I am currently on my night rotation. The patient population that this ward serves is numerous. Here is what services this floor covers:

OB/GYN
ENT
General Surgery
Urology
Plastic Surgery
Family Practice
Radiology
Ortho
Oral surgery
Opthalmology
Podiatry
Internal Medicine
Vascular

That is a lot of different types of patients! There are also numerous doctors this floor works with. Imagine trying to remember all the doctor's names, which services they belong to, and what their pager numbers are. It was overwhelming at first when I briefed about the floor, but there are pager rosters and lists around the nurses station that help communication flowing. Unlike the medicine/telemetry ward, the surgeons and residents are not available on the floor during the day time. They are in the operating room. This can cause a problem if we need orders

Nursing care wise, I find myself dealing with more hardware than the patho-physiology of the patient. Jackon-pratt drains, wound vac machines, patient controlled analgesia machines, chest tubes, suction canisters; these are just some of the things I learned how to use in the last month. Some of these things I have not touched since nursing school.

Overall the care of these patients less acute than on the medicine/telemetry ward. Most of the patients that I've seen are young healthy fit soldiers who do PT five to six days a week. There is no telemetry on this ward so patients who have cardiac issues are not admitted to this ward. The things that I need to look out for each patient are: vital signs every 4 hours for the first 24 hours, make sure they urinate within four to six hours after coming on to the floor, monitor for drainages and reinforce dressings if necessary, ambulate if possible, use of the incentive spirometer, and

application of the SCD machine if possible.

This will be a great learning experience during this rotation. We'll see what's to come! Making sure I have Narcan in reach...

Straight to the point

2010-03-22T23:11:00.004-04:00

Dr. Earl Sunderhaus is an ophthalmologist whose license was brought up to the North Carolina medical board. Cause: a patient was offended when he told her she was fat.

"I poked her thigh to emphasize that diabetes is the leading cause of blindness," he said Thursday. "People have got to accept criticism without getting their bowels in an uproar."

Now some may say that this is not the right way to address this problem, but after practicing for 30 years Dr. Sunderhaus has probably seen a large rate of non-compliance. He is straight to the point and no jokes about it. After all, it's his patient's health. It's his job as a health care professional to give their best opinion in favor of prolonging his patient's life and well being. Sugar coating the truth would set the patient up for failure in having a more healthy life.

After seeing so many cases that could have been preventable (not smoking, moderate alcohol, using clean razors, etc.) I think it's time to be more blunt in educating patients in taking care of themselves so they get the point.

I had Mr. Smoker as patient one day who presented with shortness of breath and decreased SP02. The plan was to administer steroid medication, PRN nebulizers, and wean off oxygen. He told me he wanted to go smoke, but the doctor did not order hospital privileges. The doc did order a nicotine patch so that Mr. Smoker could have his fix. Later in the day I go to check on him and he's not in his room. He's not on the ward. I look outside from the 4th floor and I see Mr. Smoker at the entrance smoking a cigarette. As I go to fetch him he comes through the entrance with his IV pole.

When we got back to his room I gave an intense education briefing to the patient about the safety issues related to his condition. Mr. Smoker said he started feeling short of breath more than before. I wonder why...

Sometimes it necessary to be blunt when educating patients. Not rude, but straight to the point and to be firm about it. What if Mr. Smoker collapsed while he was out having one lit? That would have been a horrible situation that could happen to him.

[Via newsobserver.com]

Mock Codes

2010-03-11T20:48:00.006-05:00

WAMC is bringing back the Mock Code team again! This team is currently assessing the competency level of units on performing a code during day and night shifts. After data is collected, the CNS educators will develop an education plan in order to make sure staff are trained to perform in an emergency situation.

As a BLS instructor, I saw live BLS taking place in a hospital setting during this mock code. This let me know how much more emphasis I need to do in making sure my students really know how to perform BLS adequately.

I had an opportunity to go around with the Mock Code team and snap a couple pics.

The practice crash cart

They remembered to switch out after 5 cycles/2mins. Very good!

Medication nurse in action

Nursing gadgets I want

2010-03-05T14:36:00.007-05:00

What do you get when you cross trauma scissors and an extreme environment? These trauma scissors. The large carabiner is big enough to allow gloves to be used with this tool while being easily accessible on the belt or bag. Made of titanium, 3x stronger than steel, these blades will cut through clothing with ease.

I can see myself using this in the inpatient setting for cutting various items such as tubing and tape. This can also be used I work in the ED during jump nights to cut boots and clothing off of patients with possible fractures. So many uses!

This model will run you $44.95 but a personalized version is only $5 more.

[Via Get Better Health via Medgadget]

Where's my bagel?

2010-02-27T14:51:00.006-05:00

I met Mr. Hungry during bedside report last night. He asks me if he could have anything to eat because he hasn't eaten all day. Mr. Hungry asks me if I've seen his bagel with cream cheese around. I see the cream cheese cup empty at the bedside table. I figured he ate it and wanted another one.

I tell Mr. Hungry that I'll check the orders on what he can have and will come back. I found out he's diabetic with bilateral BKA and hasn't eaten all day. I double check his fasting finger stick. I come back to perform my physical assessment and bring back crackers as we were out of bagels (night shift). Mr. Hungry was still asking for his bagel with cream cheese.

I had one of my medics help me move him up in bed so I could better assess Mr. Hungry. I asked him to turn to his side so we would fix the draw sheet. My medic then says "There's something on his back." She pulls it out and shows me a round brown object with a hole in the middle. She flips it over and there is a white creamy substance on it. It's a bagel with cream cheese. The patient sees it and says, "There it is! I lost my bagel."

How it got back there still remains a mystery...

109th Nurse Corps Ball - WAMC

2010-02-22T13:43:00.005-05:00

This year we celebrate the 109th birthday of the Army Nurse Corps. Do you remember when the actual birthday is? It's February 2, 1901. Don't you forget it!

The celebration was held at the Officer's Club on Fr. Bragg, not too far from the hospital. It was different this year than last year. We held the tradition of the Army's dining-out, its rules, regulations, and punishments. For first timers here's a list of things you should bring:

Lots of quarters
Your "coin"
A camera
All proper badges/pins/ribbons
A bottle of pepto-bismol

As photographer of the WAMC Nightingale Gazette I had a chance to take a couple of photos. Here are some highlights:

The "O" Club

Surgery ward's contribution to the grog bowl

Mother Baby unit's addition

ED's contribution in their newly stocked emesis bags

Here are a couple pics with me 'n my co-workers

Ahhh the new dress mess blues. Don't we look so grand? =D

I had fun this year at the ANC Birthday Ball. Being on shift work doesn't let me get to see everyone that I work with all at the same time. It was good night to relax and talk with friends who I haven't seen in a while.

I'm happy to say my peto-bismol bottle was still full at the end of the night. =)

Coffee = awake

2010-02-10T02:26:00.002-05:00

A lot has happened in the last couple of weeks! Here's a break down summary of what's going on:

Nightshift on 4S Medical/Telemetry
I started back on nights last week and I'm doing better in transitioning than I did last year. The reason why I'm not getting a lot of sleep lately is due to our upcoming deadline for the Nightingale Gazette. I've been floating the last couple of nights to ICU and mother/baby. Yes mother/baby. It was actually a delightful experience, not like my rotation in nursing school. I'm trying to cook more often now so that I don't order out as much. I found myself ordering out more food at night then when I'm on dayshift. Eating, walking around, and coffee help keep me awake.

Nurse Clinical Transition Program Graduate
I am officially a graudate of the Nurse Clinical Transition Program! We had a small ceremony with several classes who were due to graduate. COL Sanmartino gave some words of encouragement to us in the Weaver Auditorium.

Snowed in at WAMC!
We had a change in weather one weekend in Janurary that command called in staff to stay the weekend due to the ice/sleet. Military staff were allowed to go home as the weather cleared up, but I wasn't going to risk it. I stayed the whole weekend at the hospital for my safety. More pictures and descriptions of my stay in a later post.

Moving to 2N - Surgical Ward
In March I'll be orientating to the surgical ward. It'll be a change from medicine, but it'll be a good change. Our section chief is swapping nurses from both sides to become more well rounded in their nursing skills. I will miss the people that I work with, but I am ready to learn new things and keep myself uptodate with my nursing knowledge.

Nightingale Gazette deadline
Our next edition of the WAMC Nightingale Gazette is due. My editor and I are working to get all the articles, photos, and layout ready for review. I've been working on a lot of photos from the past several events. I even worked on them during the superbowl this past weekend on my day off. Lots of crunching near deadline. I'm excited for this issue's release as my editor and I worked on various ideas.

109th Army Nurse Corps Birthday Ball
Last Friday was WAMC's celebration of the ANC birthday. It was a very nice dining out at the Officer's Club at Ft. Bragg. I'm glad my stomach did not have to meet the grog bowl this year.

Yes a lot has happened lately. I will elaborate on some of these topics once I get some shut eye. Yesterday I was up for 24 hours and could only sleep for 4 hours. Falls risk? Yes. Safety issue? Yes. But what can I do? I'm still transitioning into an abnormal human sleep cycle. I'm only human.

Uncle Sam: SEND ME!

2010-01-19T19:45:00.003-05:00

Haiti has been hit by a devastating earthquake in the last 2 weeks. It's been been big news all over the news. People are donating lots of money, supplies are being sent, organizations are sending people, and the US Army has deployed soldiers from Ft. Bragg to help aid in this horrific situation.

I'm left here at Ft. Bragg, NC.

Hello! *waves hand* Uncle Sam! SEND ME! I can help!

I've been hearing from friends that they are going to Haiti. I just heard today that one member from my church is leaving also. And I'm left here at Ft. Bragg, NC.

I want to go to Haiti. I want to help aid those who need help. So far no one I know from the hospital is going. My friends that are going are non-medical personnel.

I do admit I have other motives to wanting to go other than to help people: the thrill of a new assignment other than shift work at the hospital, the opportunity to travel, the chance to work with different organizational groups from around the world; all related to being away from the hospital in which I am currently assigned to.

I've been at WAMC for a year now and I still haven't decided what I want to do in my career. However, I do know I need a change of pace other than working the medical floor. Being in Haiti while tending to the wounded and sick would help distract me from the worries of focusing on me and help focus my thoughts on others who need help.

Of course the patient population I take care of on the floor do need my help and I do learn something everyday, but it feels repetitive. I need something different, even if it's for 2-weeks or a month. I wouldn't mind coming back to the floor, but I feel I need to do something to keep myself focused on myself. Everyone in my group is talking about promotions, assignments, courses, etc. and I have nothing to input. I have yet to decide.

So Uncle Sam: I know you need me at Womack Army Medical Center, but if you need nurses in Haiti, I'm interested. I want to go.

My first year of nursing - photos

2009-12-30T11:36:00.004-05:00

AHH! I didn't add photos in my last entry. Here is a collection of photos from the last year as an Army Nurse Corps Officer at Womack Army Medical Center in Ft. Bragg, NC.

Womack Army Medical Center

Ft. Bragg, NC

Veteran's Day with biker vets

Birthday bash at The Key's Piano Bar with friends

SFC Cook, LT Hamlin and me
28CSH deployment ceremony

At the M9 range

Me, LT Kuyt and LT Kearney
M9 qualification range

My mentor: MAJ Cerbas (R) and me

Deployment ceremony for the 550th Med Com
With LT Messinger and LT Kikugawa

LT Lord's deployment ceremony with the 82nd Airborne

MSTC @ Ft. Bragg

MSTC Day with the Nurse Residency Program

My first year of nursing - review

2009-12-30T10:52:00.004-05:00

2010 is just around the corner! Boy has it been a fast and furious year for me as my first year as a military nurse. I have learned a lot working the medical/telemetry floor at Womack Army Medical Center, but I know I still have a lot to learn about.

Here are a couple thoughts about my growth as a nurse this year:

Confidence

Only going with I learned from nursing school and the knowledge from NCLEX review so long ago, I started my nursing career in the US Army this last January. There were a lot of new things that I needed to know: new charting procedures, new SOPs for the floor, new treatments for patients, and new population of patients just to name a few. The time I had with my preceptor helped boost my confidence in my skills, assessment, and day to day interactions with my patients and staff. Practice makes permanence of course. It took a while for me to find my "groove" or how I manage my flow for the day, but I feel that I'm getting the gist of a daily routine of what I need to do to get the tasks done for the shift.

Orientating to charge nurse on days dropped my confidence completely. It is a totally different scene than being charge nurse on nights where I was first trained. I am being thrown at every direction: charge nurse huddles, multidisciplinary team meetings, admissions, random requests from doctors, helping with patient care, etc. In the three months of being charge nurse on day shift, I am frightened every time I walk from my truck to the floor. I am afraid of what chaos will await me: which staff member is going to call out, again... how is the patient flow, which staff member is being floated while our acuities are high, has "that patient" come back again, etc.

As charge nurse, I can't be showing my fears by freaking out by every little thing (although a lot of little things will cause me to freak out due to annoyance). I have to maintain command presence by remaining calm, collected, and being assertive in making sure patient flow is smooth and patient safety is maintained at all times. In this position, it's assumed that I will know everything. I do admit I don't know everything, but I know who to ask for further information or will do my best to find the answer.

Research/Further learning

Nursing school was over a year ago and I am glad. However, learning does not stop at nursing school. New advances in technology in medicine have been changing everyday. Research is finding new ways to help treat and cure diseases. If you follow me on Facebook, you'll see my random log of posts related to health care issues around the world, odd medical phenomena, and new nursing tools that would be awesome to have in the work place.

One of my nursing instructors told our class, "There are 14 new medical articles posted every day. How far behind are you?"

Articles are not the only place where I've learned a lot this year. I've been able to talk with informatists, infection control reps, wound care nurses, x-ray techs, medics, pharmacists, and friends who work at different hospitals. There is valuable information that can be obtained by just talking to the people you see everyday at the hospital or speak on the phone with. My favorite is talking to the medics who have been deployed overseas. They have a lot of stories to share about the care they gave during their missions. I also like to ask my friends what happens in their hospital and see what they have going on at their facility compared to where I work. Maybe what works for them may work for us at Womack.

Planning my career

Coming to Womack I thought I knew what I wanted to do for the rest of my career. As of now, I am totally lost in what I want to do. There are so many positions and jobs in the Army Nurse Corps that I don't know where to begin. I've been looking at the list of positions on the HRC website and looking at the latest available assignments. I feel like a kid at Christmas looking at the newspaper ads and circling which toys I want.

For now I have decided not to specialize. A fellow colleague decided to go to the OR course, but decided not to go because she felt it wasn't right for her. We both feel that we'd like to remain flexible as a 66H and look for opportunities that arise.

Plans for 2010

Deployment

Our commander-in-chief has ordered 30,000 troops to Afghanistan. As I've learned in OBLC: maneuver drives support, and support drives resources. I fit into support. I am hoping to be deployed next year God willing.

Med-Surg certification

I miss school. Not nursing school mind you, but having to study for something and having a reward at the end. I've been looking at this certification as well as several of my co-workers. One of the LTs on my floor obtained hers recently. I'll keep looking into this.

Conference

I would like to go to a conference of some sort next year. Being charge nurse opened my eyes to management of care from an administrative standpoint. I am also interested in informatics as well. I better start researching!

That's 2009 in the wraps! I pray next year will be a great year for me as I advance in my journey on this road through the Army Nurse Corps. Happy Holidays, Happy New Year, and may God bless and protect our soldiers overseas.

See you in 2010!

Working Christmas Day

2009-12-25T08:52:00.006-05:00

25DEC2009 Uniform @ WAMC
Originally uploaded by jeku arce

Today is Christmas day! I'll be at work but it's ok. We got our Med-Surg potluck going, music will be bump'n, and I got my ACU santa hat with my ACU scrub top. I am ready to spread Christmas cheer this year!

I am sad that I'm not able to go home this year to spend Christmas with my family. This is the first Christmas in which I'm not able to spend Thanksgiving, Christmas, or New Years.

The depression of not going home hit hard last week, but I've been keeping myself busy with friends on my off days. I've been checking out the sights of North Carolina outfitted for the Christmas season.

Merry Christmas to all, including our soldiers who are deployed and very far from home. Thank you for your sacrifice. May God bless you and keep you safe until you arrive back.

Time to go hit up the potluck! I can't wait to see what we have for Christmas lunch. mMm!

Merry Christmas from WAMC!

2009-12-08T22:40:00.002-05:00

WAMC Christmas 2009
Originally uploaded by jeku arce

The hospital finally got its Christmas tree up just in time for the holiday season.

Fear of snow has been spreading around. The locals tell me Ft. Bragg is due for another snow storm. I better have my scrapers and water at the low ready...

Merry Christmas!

BLS Instructor

2009-12-05T21:13:00.002-05:00

I am now a BLS instructor! Teaching is a lot of fun. It's especially fun meeting new people that work at the hospital and the surrounding clinics.

BLS for healthcare providers is a required certification for working in a hospital/clinic setting. It's important to know what to do in an emergency situation. Studies have shown that taking the appropriate actions can save a person's life.

I've had to retest some people and most took the criticism well and passed the second time. Some took offense that I didn't pass them and had to be retested. They claimed that they have been working in a health care setting for years and never had to be retested at any BLS recertification course.

Here's why they should have not taken offense:

They've seen the video demonstration during class
They've had time to practice during class with an instructor present
Time to ask for questions was given
They have the check off sheet - which shows how and what they will be tested on *HINT*

Certain people wanted a new tester after I didn't pass them. They complained about me to the other instructor. Their skills were reviewed and corrected as I had pointed them out to them earlier, but this time by another instructor. They passed after the 2nd time after.

Lessons learned:

Study the material given to you. BLS is something everyone as a health care provider should pass. The tools are there. Use them.
If you're wrong, you're wrong. It doesn't matter if you've been doing it a certain way for many years. If it's not right, it's wrong. We're dealing with peoples' lives in his profession. We don't have time to make mistakes in an emergency. Also, shame on those who didn't correct you earlier.
Ask for help. I asked my senior instructor for guidance and was helpful in my situation with those who didn't pass the skills portion.

If I'm your instructor, I hope you studied and looked at the check off guide *HINT*!

Relationship Based Care

2009-11-20T11:15:00.005-05:00

This week on my floor at WAMC the implementation of Relationship Based Care has been initiated. Our DON sees this model in providing safe, satisfying, effective care for our patients. This model has been used across the United States and has been found to be a success.

What is Relationship Based Care?

The RBC model provides a conceptual framework with a vision for care and underlying values and principles, a practical infrastructure for putting it into action, the education and leadership necessary to make it happen and ways to measure evidence of success.

Care takes place in a Caring and Healing Environment with the Patient and Family at the center. Six dimensions are critical for successful transformation:
Leadership
Teamwork
Professional Nursing Practice
Patient Care Delivery System
Resource Driven Practice
Outcomes Measurement

Some examples of implementing RBC on my medical/telemetry floor include involving the patient's family with the patient's care, hourly checks, and teamwork with the staff.

Early this week we kicked off the even with a small ceremony introducing RBC and cake!

[via Relationship Based Care - Creative Health Care Management]

Veteran's Day 2009

2009-11-11T23:33:00.001-05:00

Veteran's Day 2009
Originally uploaded by jeku arce

Happy Veteran's Day!

I worked today as charge nurse. Most ancillary services were closed for the day, so it wasn't as chaotic as usual.

In the early afternoon we had a surprise! We had representatives of the Fisher House come by with books, magazines, and desserts. What a treat by these veterans to give to soldiers and fellow retirees. We had chance to talk them and their experiences in the military. We were honored that they would come in to the hospital to share their these gifts and their time on a day such as this. God bless them for their sacrifice and service to the greatest nation on this earth.

It was a good day to be at work. It was a good day to be an American soldier.

Happy retirement MAJ Cerbas!

2009-10-30T10:52:00.006-04:00

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)

2009-10-27T15:47:00.007-04:00

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

2009-10-24T19:56:00.003-04:00

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

2009-10-14T22:16:00.006-04:00

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.

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.
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.
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

My Locker

2009-09-28T08:43:00.003-04:00

I have a small locker to keep my stuff secure while I'm at work. Here's a peek into my locker:

Originally uploaded by jeku arce

Coffee + mug
This goes without saying. A must for pulling night shifts and long days. Also good for keeping morale up by making a fresh brew during the shift.

Crystal light
Because the taste of water is without flavor.

Various medications
Omnicell access is for patient meds only. I bring my own just in case.

Gum
For building rapport with patients and staff.

Various snacks
Keeping the hunger down when not able to get lunch or just out of energy.

Toothbrush + toothpaste
For those long overtime shifts or those times I don't have Orbit to keep my teeth minty fresh.

Things I want to add:
Photos of friends and family

*Note: I have no vested interest in any of these products.

Eat with me please?

2009-09-28T04:48:00.005-04:00

One night one of my patients had come back from a procedure and was NPO for a long time. I offered her a box lunch (sandwich) because our dining facility was closed. She refused and wanted something else. My patient asked for a phone book to order food. I checked her diet orders and she was clear for a regular diet. She was given a phone book and she had money with her and made her order. My patient asked me if I wanted any thing to order, but I politely refused.

When her pizza came the CNA working with me told me that my patient who ordered pizza wanted me to have some pizza. My CNA told me that my patient insisted that I go in.

At this point I'm at an ethical dilemma: politely refuse again a free gift harming rapport or accept this free gift to increase rapport with my patient. I know I'm to maintain a professional nurse-patient relationship, but my patient keeps insisting I take this gift.

I made sure all my other patients were fine and went to see my patient. She had plates, soda, and the pizza she ordered on her bedside table. Seeing her face I knew I would do more harm by refusing again. I pulled up a chair next to the bed and took a slice she offered to me. We began to converse about her life as a military wife prior to when her husband retired. She had quite the travel record. She told me about her favorite places and the amazing things she saw. After about 15 mins I thanked her for the food and told her I needed to go back to work.

I realized that my patient just wanted someone to talk to. She did not have any visitors that day and her husband has passed away. I feel that ordering food was a way to entice me to spend some time with her making me feel guilty for trying to refuse her offer. It worked.

Was my decision the right thing to do? This was not a monetary gift, however it was not shared with the rest of the staff who was working that night. However, my patient kept insisting I eat with her. At the time I didn't really know the answer, but spending time with my patient made her feel better.

Emergency Department Rotation

2009-09-07T14:42:00.008-04:00

WAMC ED
Originally uploaded by jeku arce

Chaos. Mayhem. Fury.

Those are some of the words some people call the ED. Being that my home unit is a medical/telemetry floor where most things are scheduled out for my shift, I agree with some of those descriptive words. During my rotation I found 3 characteristics one must have when working in the ED: good communication skills, critical thinking skills, and endurance.

Communication -
Asking the right questions related to the patient's chief complaint is important in determining the plan of care. Obtaining information can be difficult when a patient is unable to answer questions due to development level, with decreased level of consciousness, or refuses to respond. Getting information from parents, friends, or EMS becomes crucial in obtaining patients medical history: surgeries, medications, allergies, etc.

Communicating with staff and ancillary staff is important in implementing care. The doctors are in close proximity looking at x-rays, labs, and writ ting orders. This makes bringing up concerns easier to bring to attention. I've had several pediatric patients with problems I had no solutions to. Calling up to pediatrics and getting consults over the phone from other nurses helped me implement care for my patient. Knowing who to contact for help made giving care easier.

Critical thinking -
This skill is needed when acting as triage nurse. My experience with the triage nurse showed me how low my expectations were. I feel acting as triage nurse is the 2nd hardest job next to being charge nurse in the ED. The triage nurse asks the chief complaint of the patient and follows and the algorithm related to the chief complaint. The thinking process is "at this moment, what will kill my patient?" With each patient response the triage nurse can rule out possible causes. This may seem like diagnosing the patient, but it the goal is to get as much information needed for the nurse and doctor that will see the patient next.

Situational awareness is necessary when acting as triage nurse. The ability to gauge the waiting room wait time and to see what patients need to be re-prioritized will provide a smoother shift. The waiting room is full of people with many different chief complaints. Some may be non-emergent like a cold or some may be emergent like chest pain. Being able to re-prioritize who needs to be seen next can save a life. My preceptor told me that people can die in the waiting room.

It's vital to keep assessing your patient from the time you see your patient walk through the door until when the patient leaves the building. The patient's condition can change at any moment and being quick to catch the change to respond to it can safe your patient's life. With every vital sign check to just talking freely keep assessing your patient for changes.

Endurance -
This can be defined as the "ability to sustain a specific activity for a long period of time." Nursing care can take a toll on the body. Being in the ED the only time I had time to sit in a chair was when I was typing up discharge orders. It can get very busy during the day it is important to keep your energy and attitude in high gear. Having snacks in my pockets and drinks readily available kept my energy up. I learned that having a weird sense of humor is necessary to get through the day. Laughing at a silly joke or talking about the time where a staff member expeled their emesis on a patient after not being able to tolerate the smell of feces when cleaning up the same patient lightens up the mood from a rough day.

I enjoyed my week rotation in the ED. I the skills I learned can be applied to my medcial/telemetry ward. Now I know what's going on before my patient gets admitted to my floor. Boy do they have it rough down there.

Are we clear?

2009-08-28T10:41:00.004-04:00

Clarifying orders is usually no big deal, but one night I had the hardest time doing so from one of the doctors.

Patient presented with chest pain that resolved in the ED with no medications. Has no history of cardiac issues being under 40 years old nor significant family history. The admitting doctor ordered an chest CT to rule out PE but the patient has an allergy to fish. Orders were given for CT prep with Prednisone and Benadyl. The comments indicated specific instructions in terms of timing of the medications. However, they were unclear to me and to my charge nurse. Neither of us have ever this a patient going through this before.

I called the doctor for clarification. The doctor gave me different instructions than what was written on the order. I asked for a new order, but the doctor said that the order was clear and should be followed. I told the doctor that if I had to call and ask about the order the order was not clear. No new order with clarification placed. I wrote what was told to me over the phone as a note and started preparation for CT scan.

As morning and shift change approached, the admitting doctor came to my floor to tell me that it was inappropriate for me to call and ask for clarification for an order that was clear. I reminded the doctor that if the order was clear there would be no need for me to call. I still asked for a new order with clarified instructions. Doctor refused to do so.

When the team of doctors came in the morning I told them my situation. They suggested consulting the radiologist for correct preparation of a patient for a CT scan with an allergy to fish. The radiologist made it even simpler for me to understand what needed to be done. The team of doctors were notified and orders were placed.

Notes:
-Communication: I communicated with the admitting doctor about what was going on and made contact with other disciplinary teams.
-Documentation: I made sure I wrote down what happened with a timeline to cover myself.
-Rank: The admitting doctor tried to pull rank on me saying that there is no need to call a MAJ for an order such as this. I reminded the doctor that my concern was communication and patient safety. The order was not clear. It needed to be clarified and rewritten. If it wasn't the next shift may not follow the instructions correctly and harm could have come to the patient.

Lessons learned:
-Patient safety comes first
-If you can't find your answer, seek elsewhere
-Stand your ground with respect

Jump Night @ WAMC ED

2009-08-27T15:29:00.004-04:00

Night jump
Originally uploaded by Army.mil

Jump night at WAMC is a huge deal. Lots of preparation goes into making sure that soldiers who have jump injuries are taken care of. Here's some of the things that are needed to make jump night in the ED happen:

- Extra staff: doctors, PAs, nurses, clerks, etc
- Extra equipment: beds, chairs, supplies
- Rooms: in case of need to admit for surgery
- Energy replenishment: food, energy drinks, water

ED has their own flow of taking soldiers in when the injured arrive. First ED gets report on number and types of injuries. Nurses get the heads up and on standby at triage that is set in the back where soldiers come in. Soldiers come in and triaged based on acuity. Walkers are assisted to the chairs and higher acuity patients are assisted to gurneys. Focused assessment, vitals, and history of injury is done at this time.

After the nurses assess the pt the PA or doctor comes by to assess the soldier with the jump injury. If a fracture is suspected x-rays will be taken. Head injuries will be given a c-collar if not already placed and will have a CT scan. Any serious injuries will be treated accordingly based on acuity.

Being my first jump night I was nervous. I've only been to the ED several times and haven't worked triage before. I was paired with an experienced nurse and was guided through the night as far as assessment, documentation, and assisting with ortho for applying splints.

I liked how everyone was helpful in getting things moving. I didn't hear anyone complain about having to take an extra load or needed to take extra time out to help out someone else who had a higher acuity patient. There also wasn't any yelling and screaming from the staff. The night was stressful enough and all that extra noise wouldn't help anyway.

Communication was essential to a smooth and successful night. The flow of communication must be constant and consistent. Situational awareness was also a must amongst the organized chaos.

Last night was fast, furious, and intense. And I liked it. Working in the ED has got me really thinking about the M-5 course in my career.

Report sheets

2009-08-21T03:46:00.005-04:00

Reporting off to the next nurse is important in maintaining communication regarding the patient's care. Reporting off can be done any time and in different formats; there is no set way.

I've been looking for an effective method in reporting off to the next nurse for the end-of-shift report. I've tried different methods having followed various people including my preceptor for several weeks.

Having previous experience in the ICU I learned to report a full detailed physical assessment of each body system. Currently in a med-surg setting with up to 6 patients at a time, I learned that I cannot apply that method of reporting here.

Looking around online, I found this one via Allnurses.com, a great resource for nursing knowledge and for networking.

I'm still trying it out, but so far I'm liking it. Here's my pros and cons:
Pros:
-Labs + legend: Easy place to put important labs for the next shift to know
-Diagram: Good place for putting important assessment findings
-White space: place for extra notes

Cons:
- Pain control times
- Allergies

Just minor cons that I found with this sheet. It's been useful for me. If I find another one I'll review it here. Also, if you have any report sheets you find send a link underneath the comments section.

Nursing Superstitions

2009-08-04T18:16:00.003-04:00

While I was charge nurse last night I had an enjoyable conversation with my staff. I was happy how everything was going well, after all, I'm still fairly new to the position of being CN. Then I said something that was forbidden, taboo: the "B" word.

I was puzzled when my fellow colleagues gasped and looked at me with their eyes wide open. They shook their fingers at me, put my name on the white board, and put a tick mark by my name. My colleagues began telling the other nurses about what I had said. I was still confused and puzzled about what was going on.

My coworker called some of the other nurses over to the nurses station. She told me to sit down. I thought they were going to tar and feather me! She began explaining the horrible deed that I had done. I was shocked to know that one simple word could mean so much to the rest of the staff.

My coworker brought up nursing superstitions that she learned in nursing school and throughout her experience. The other nurses added on as each person began sharing their experiences on certain nights.

Here are some of the things that were dicussed:

Women go into labor more often when it's raining because their water breaks with the storm.
If a patient is perspiring profusely (and is already on antibiotics and antipyretics) place a pan of water under the bed to stop the fever.
A penny above the door of a patient in ICU ensures good luck.
There seems to be a "full moon effect" whereby one experiences increased workload, stress and general chaos.
Codes, deaths and births happen in threes.
Certain rooms are unlucky.
Never say the "Q" word. If it's been a quiet shift, don't say so or, it is told, the dam will break. (This is, hands down, the most popular nursing superstition I have come across.)
Never say the name of a frequent visiting patient aloud or s/he will miraculously appear.
If one has turned down the bedding for an expected admission and the admission is canceled, pulling the linen back up will ensure an immediate unexpected admission.
If a patient may code, place the crash cart outside the door of the patient's room to prevent the code.
Have a lucky pen? You're not alone. Apparently it ensures patients' well-being and a good shift.
Place a penny above the door of a patient in ICU for good luck.
If a knot is tied in the sheet of a dying patient during the night shift, that patient will not die until morning.

I find it humorous that a profession that is based on evidence based research and scientific findings would have some beliefs related to superstition. I still don't believe in the "admission gods" or keeping lucky talismans with me at all times. However there may be some truth in some of these matters.

Hey, what do you know, the next full moon cycle is this Thursday. I guess we'll see what happens then yeah? [Circus Nurse]

Orienting to Charge Nurse

2009-07-25T13:14:00.004-04:00

This past week I've been orienting to the position of charge nurse on my medical floor. I've only been working as a nurse since March and now I'm going to be charge! It seem so fast, but I know I won't be alone. I'll always have help near by.

I took the charge nurse course earlier this month and learned a lot of things about how the floor is supposed to run. I see the bigger picture in how the hospital operates and works with other floors in a collaborative effort.

I'm excited for my orientation. I do hear that some other nurses don't like being charge nurse. They say they don't like the responsibility. They would rather take their load of patients and ignore everyone else for the day. The practice of nursing should be a team effort with everyone working together to make sure patients get the best care the providers can give.

I'll update more once I get more experience underneath my belt.

Womack Army Medical Center, Ft. Bragg

2009-07-15T23:32:00.002-04:00

WAMC
Originally uploaded by j3ku

Womack Army Medical Center, located at Fort Bragg in Fayetteville, N.C., is dedicated to Medal of Honor recipient, and medic, Pfc. Bryant Homer Womack.

The hospital started as a 500-bed facility in 1918 when the post was known as Camp Bragg. Prior to the construction of WAMC in 1955, the hospital was part of two cantonment-type hospitals with a bed-capacity of 2,682 and one-story wood frame wards connected by covered walkways.

Today, the hospital serves more than 160,000 eligible beneficiaries in the region—active duty, retirees, and family members—with services such as obstetrics, orthopedics, optometry, cardiology, hematology-oncology, pulmonology, and chiropractics.

Womack personnel use the latest technology to better serve its patients. From interventional radiology techniques to laser eye surgery, its physicians strive keep their fingers on the pulse of modern medicine

Information from GoArmy.com

Communicating with doctors

2009-07-15T22:41:00.003-04:00

I remember in nursing school the doctors were referred to as this all-powerful being that we must serve and who knows best for the patient. I remember some old-school nurses in clinical giving up their chairs for the doctors. Apparently that was the way back then: nurses would rise and give up their seats for the doctors.

However, my clinical instructors taught me about collaboration with the doctors; we work together as a TEAM: nurses, doctors, respiratory therapists, physical therapists, social workers, etc. We work together for the health and well being of our patients.

Why do we need to contact doctors?

There are several conditions that are necessary to call the doctor: status change, unstable vital signs, order discrepancy/clarification, and the most common, pain medication. Also if your nursing gut feeling says you need to call the doctor, do it after you've assessed the patient. There is nothing wrong with informing the doctor about the patient's clinical outlook with the right reason. As nurses, we are the eyes and ears of the patient because we are with them throughout the day in constant contact.

Occasionally we have surgical and obstetric patients that come to our medical floor. The doctors handling their care are not usually around our floor. On night shift prior to report I make sure I page the doctors to give them an update on how their patients did through the night. It lets me express any concerns that happened and gives the doctors a heads up before making rounds in the morning.

What information do I give the docs?

SBAR has been an effective tool for me to use in giving doctors information:

Situation - what is going on with the patient
Background - what is the patient here for, any important medical history/procedures
Assessment - report any significant findings
Recommendations - give suggestions or ask "what can we do for my patient?"

A sample telephone conversation can go like this:

"Dr. Smith, this is LT Awesome. I have Mrs. White who has admitted here today for pyelonephritis. Her heart rate is 103, her blood pressure is 150/90, and is complaining of 10/10 constant sharp pain to her right flank. No pain medications are ordered. She is allergic to morphine. What can I give her for pain?"

Or,

"Dr. Cosby, this is LT Cool. Mr. Bradley is here for fever unknown origin. His vitals last night were stable, but has spiked a temperature of 101.5 in the last hour with a pulse of 110. He is sweating and has chills. No blood cultures were done since his admission. Do you want any blood cultures before I give him Tylenol?"

After communicating with the doctor I make the effort to make a nurses note about when I paged the doctor, the time the doctor called back, and a brief description of the plan of action. I found it a good practice to keep a running note throughout the night. It helps me and it helps the next nurse coming on shift to have an idea of what happened the shift before.

Contacting the doctor

Working at WAMC I have found three methods of obtaining access to a doctor:

Face to face
Telephone paging system
Online-paging system

Face to face

Doctors are easiest to get physical contact with in the morning and throughout the majority of day. The residents and attending are making rounds on the floor. This makes for easy access to give information to them.

Telephone paging system

Each team of doctors have their own dedicated pager as well as their own personal ones. When a doctor of a particular team is unavailable on the floor, the telephone paging system is available. Just be sure to be nearby the phone and ask your co-workers if they need to speak to the doctor about their patients too.

Online paging system

This was new to me at WAMC. The pagers here can be sent text messages of 150 characters via the WAMC home page. Type in the pager number/pick provider name on drop down menu, type in message, and press send. If I have something non-urgent I tend to use this method.

The recommended format is as follows:

RE: Patient last, first intial - DX: ~~~. Message to be sent. Person making page. Contact extention
Example: "RE: Smith, J - DX: GI bleed. Request diet order post-endoscopy. LT Bold 1345"

All these things are tools to help disseminate information to the health care providers. Be sure to utilize them.

Tips:

Get as much background/assessment information needed
Get to the point, don't ramble or point blame
Document attempts and call backs
Respect each other

09-903 WAMC

2009-07-11T20:00:00.001-04:00

09-903 WAMC
Originally uploaded by j3ku

These are new 66H 2LTs from the class of 09-903 who are part of the ANC Med-Surg program.

Welcome!

09-902 WAMC

2009-07-11T19:57:00.001-04:00

09-902 WAMC
Originally uploaded by j3ku

These are new 66H 2LTs from the class of 09-902 who are part of the ANC Med-Surg program.

Welcome!

Multi-lingual

2009-07-11T18:55:00.004-04:00

In the past month we've our census has given us some non-English speakers on the floor. It gave me a chance to practice some of the languages I've learned: Japanese and Spanish.

I'm not very fluent in these languages, but I know enough medical terminology and phrases to get by: pain scale, assessment, greetings, and some teaching. Of course if there is something that I am unable to translate to the patient a hospital staff translator will be requested.

I've also had many patients who were bilingual that I've had the opportunity to practice some other greeting phrases. I've realized that being able to converse with the patient's native language helped breakdown some of the awkwardness of having a new patient. Anything to help build on the patient-nurse relationship for the shift or stay will make things easier. I'm down for making anything thing easier.

The experiences I had last month and the exposure of how out of practice I am with the languages I once learned has turned me to Rosetta Stone. Through AKO Rosetta Stone classes can be taken. Go to http://usarmy.rosettastone.com/ for more information.

So this is sayonara, adios, or ciao for now!

Thanks for reading!

2009-07-10T01:00:00.003-04:00

I've been busy the last couple of weeks and haven't been able to update lately. I should be posting more stuff this weekend, not that I have free time, but that I'll be "scheduling" time to update this blog more often.

I've been getting a lot of personal-in-person feedback about how helpful this blog has been! I'm surprised to hear that other LTs tell me that the things they have learned from reading my experiences have been helpful. I'm grateful to those who have thanked me in person and via comments on this blog. I'm glad sharing my experience with others has been helpful. I hope everyone else who reads this blog shares their experience too!

Nightingale Gazette

2009-06-21T23:35:00.002-04:00

WAMC has decided to put up it's nursing newsletter the Nightingale Gazette back into commission. I am assigned as the lead photographer for the paper. I can't wait to see what articles we going to put out in the world of nursing here at WAMC and within the ANC at Ft. Bragg.

Some article ideas have popped such as nurse profiles, hail and farewells, and social events, but I'm really excited about getting pictures out by the CSH. The hospital has its exciting moments, but not a lot of opportunities to take pictures of nurses at the hospital due to HIPPA regulations. I would love to get some action pictures of nurses out in the training enviornments where they get down and dirty in the field.

I'll be sure to post a link on here to WAMC's annual Nightingale Gazatte when it's published. I hope it'll be posted on WAMC's new external website.

Tips for Night Shift

2009-06-12T14:27:00.003-04:00

It's been about 3 weeks that I've been on nights and I still haven't adjusted to the new shift. I average about 4-5 hours of sleep after work, my eating habits are out of wack, and I feel like a walking zombie all the time. I've asked for some tips from various people and here's the top 3 that I will be trying out.

1. Blackout

Blackout refers to the room where I sleep in. The goal is to blackout ALL the light so my body thinks, "Oh! It's night time. Time for bed." Blockout all sunlight, alarm clock lights, and cell phone lights.

Below is the window of my bedroom.

Here is my blackout curtain with 500 mile per hour tape used to tape out the sides of light. How well does this work?

Hmm... Still some light to be shown. Need to find a way to cover the light from the top of the curtain. Otherwise it's about 90% dark in my bedroom.

2. Non-hangover sleep aids

Benadryl is what I have been using lately to help me sleep. With Benadryl, I've been waking up groggy without feeling refreshed. It has been recommended that I see my health care provider to prescribe some non-habitual forming sleep aids.

3. Have a routine

Switching from a normal lifestyle to an uncommon lifestyle is not an easy task. I haven't been able to do so lately. This is my new planned routine while I'm on night shift:

0800 - arrive at home, eat, shower, NO INTERNET, straight to bed in my blackout room
1500 - wake up, eat, workout, internet, prep for work
1820 - Leave for work
Repeat as necessary

I emphasized no internet prior to bed. Another tip I got about sleeping well from here. I've noticed that I'm more alert after checking my emails, blogs, rss feeds, and yes Facebook. Best to avoid it in order to get some restful sleep.

I hope these tips help me out while I'm on my night shift rotation. Still open to new suggestions. How do you sleep during your night shift rotation?

Night Shift

2009-06-01T04:55:00.003-04:00

I am officially off of preceptorship! I am ready to go into the world of nursing on my own. NOT!

I don't feel ready. Right now time management is the biggest thing I need to work on. I've been getting tips from my preceptors and the other nurses on the floor. Here's what I have now as a routine for the shift:

- Assessment
- Meds
- Treatments
- Charting

I learned that these should be done within the first 3-4 hours of the shift. The only problem I'm having is when I have to set up a pt for a procedure in the morning. Sometimes right after change of shift one pt needs to immediately go for a procedure. This changes my routine for the morning. My groove is messed up...

-----

I started nights last week. Boy is it different! My first night was very intense for me. It was a non-typical night shift as I was told by the other nurses. This week it's starting out to be more laid back. Somethings I like about night shift is the quietness of the floor. Not many people talking, not many procedures happening at this time, and most of the patients are sleeping. Even though it may seem more laid back, I've been told that most codes occur at night while patients are sleeping. It's important for me to check up on my patients throughout the night to make sure they are breathing.

Adjusting to nights has been difficult. I do feel that I get more day time than when I was on day shift. It's does feel go to go home in sunlight than in darkness. However, it makes it harder to sleep with sunlight peering through my bedroom window. Working getting blackout curtains to make my bedroom pitch black. Lately I've been only getting 4-5 hours of sleep a night (day). I sleep around 8-9 am and wake up on my own around 1pm. I take care of some business and have been taking a 30 min nap prior to going to work. During my shift I load up on snacks and coffee to keep me alert and awake.

One thing about nights that makes it difficult for me is that all the events I want to do are during the day. Going to church on Sundays will be difficult because after a shift I usually am too tired to do anything but sleep. Falling asleep in church is bad...

Side note:
The ROTC cadets have arrived. Brings me back to my days at Walter Reed back 2 summers ago. What an experience! I learned the most from that summer than I did at my clinicals during nursing school. I hope these "dots" have the same experience that I had.

Variables

2009-05-11T22:50:00.003-04:00

Preceptorship update:

I am going through the last phase of my preceptorship. The plan is to switch over to nights for a week or two. Nights for 2 weeks won't be stressful. DAYS are typically stressful. I don't know schedule I will be on after my preceptorship. I won't complain too much about nights...

--

Variables.

Variables are what most of my ROTC cadets hated when we ran lanes for STX. Variables are unpredictable, can come anytime, and require a mix of creativity and critical thinking. They range from a change in mission from an attack a bunker to a rescue the pilot, being ambushed by a small 3-5 man team, or being slowed down by 2 civilians who are asking for help with moving their cattle across the road you are convoying on. Variables can happen in training, but they can also happen in the real world.

Variables also happen in the world of nursing. During my med-surg preceptorship, I experienced a lot of unpredictable events.

The other day I worked the 0700-1900 shift. The plan was to attend the staff meeting, get fitted for N95 masks (N1H1 protocol), and be prepared for "casualties" during the annual mass casualty exercise. This is not a typical day at the hospital.

After the inservice and mask fitting, it was about 0830. Got report and formulated a plan of action despite losing 1.5 hours of my normal hospital work day. I decided to block my medications and assessments together. This way I can see a patient and give medications/treatments at the same time. I went to each patient after prioritizing them.

I completed seeing my first patient. I felt that this plan was working. The plan was working until I started getting new orders from the doctors about sending 2 patients down for their respective procedures. I hadn't planned on this! In report there was no plan to send my patients off this early in the day. Made a couple phone calls to find out what's going on. I had reroute my priorities: get the patients ready for procedures. My preceptor helped me get my patients ready to go.

Afternoon comes by not fast enough and now discharges are being ordered. Patients are coming back from procedures and now I'm faced with issues: discharge patients or reassess patients from procedures. Discharging is a low priority at this time as they are more stable than the patients that are coming back from procedures.

At the end of the day I eventually got all my charting done, discharged assigned patients, and didn't kill anyone. It was hectic, sporadic, and disorganized, but I got the job done.

My preceptor and I usually have a conference at the end of the week, but we took time out to debrief each other about the day's events. We both knew that lots of other things were going on. It didn't help that resources were taken away from us due to an exercise, but we made due with what we had. Thank God for CNAs! If it wasn't for our awesome CNA staff I wouldn't be able to get through the day.

I told my preceptor about my initial plan for the day. My preceptor then told me about how variables could easily throw me off. It did. It really did today. We came up with new ways to handle the plan of the day, but allow for variables to occur yet be managed.

Variables WILL happen. It's just a matter of REACTING to them. My plan wasn't effective enough, but with some guidance I was able to execute.

Just another day at the hospital...

Preceptorship update - Week 2 midweek

2009-03-24T16:44:00.005-04:00

The 2nd week of preceptorship is in progress with two more work days this week. My schedule is 12-hours on day shift. A lot has happened and I have learned a lot so far. I'm starting learn who the residents, attendings, clerk staff, and my fellow nursing co-workers are. There is a lot to remember! I know over time I'll get it down.

One thing I noticed while working on the floor is the uniform of military personnel on the ward: ACUs. Here's what an ACU uniform looks like:

From Rangeroutfitters.com

Imagine nursing care in this! Here are some issues I see with this unifrom:

Sleeves
It is difficult for infection control to have sleeves as part of nursing care. Hand washing will be the most common annoyance as good hand washing includes washing up to the wrist. It is important to wash the wrists as they can be contaminated with germs while performing care. Sleeves can be contaminated and can be spread from patient to patient when performing care: changing diapers (on adults and infants), foley care, IV insertion, etc.
Also, these sleeves are just annoying and get in the way of performing care. There are many times where I am trying to establish an IV site, but my sleeves get in the way. They also touch every thing.
Patches and Badges
While talking about infection, how often to soldiers change their patches? They cost about $20 to change all the patches, and a lil more with badges. How many nurses/medics clean their patches and badges with a cavi-wipe after their shift? Germs, germs, germs.
Blouse
Moving around on a medical floor and produce a lot of heat especially on a busy floor. Sweat is produced and odors are present. Nasty, just nasty... I find that taking my blouse off during lengthy procedures such as a bed/bath change, IV access, etc. helps reduce my sweat production and reduces infection control.
Boots
These are pretty heavy and wearing these for a 12 hour shift can make some sore feet. It would be comfortable to have sneakers (I hate Crocs), but that's not part of the uniform. With a lil bit of money, some more comfortable boots can be purchased, but who wants to spend more money on work?

There are some good things I like about the uniform. There are some of them:

Pockets, pockets, and more pockets!
There are pockets everywhere on this uniform! They are good for storing IV flushes, alcohol pads, gauzes, and medications. Scrubs don't have a lot of pockets and I'm not a big fan of the fanny-pack.
Pen holder pocket
Nurses goes through pens like crazy. Someone takes them or they get misplaced when a code occurs. Having a place specifically for pens makes it easier to keep them in line.
Belt
I use my belt to use my holster for my stethoscope. I don't like keeping it around my neck or in my pocket.

The solution:

ACU scrubs Nursejoe.com

Reasons for:

Sleeveless
Pockets
Increased range of motion
Benificial for infection control

Reasons against:

$20 extra out of pocket to pay unless issued by CIF or unit
Cost to standardize throughout MTFs and clinics around world

Note: ACUs are not used in units such as the OR and ICU, but are used generally throughout the hospital.

We will have to see what the future of Army nursing will be like concerning uniforms for military personnel in a healthcare setting.

Preceptorship - Medical floor

2009-03-14T04:02:00.005-04:00

I finally start my preceptorship this Monday! For the next six weeks I'll be assigned to the medical floor where I will be paired with a preceptor to help me learn the ropes. After those six weeks I'll be on my own without the help and guidance of nurses nearby.

The clinical rotations that finished this week gave me a good idea about how WAMC runs. My favorite place was the pre-op/holding area for surgery. I was able to practice my vital signs and even start IVs! When was the last time I stuck someone with a needle... Both times I went to this unit I started 10-15 in several hours. Of course not all of my sticks were done in the first try. There were some I had to stick twice and there were some that I or the anesthetist could not stick so we had a very experienced nurse work their magic. I also enjoyed the PACU in which patients are coming out anesthesia and need pain management as well as monitoring for any adverse events.

I'm glad that I will have a regular schedule starting Monday. I miss having 12-hour shifts and getting 2-3 days off from work. It'll be another adjustment, but working days won't throw me off that much.

Tips for success:
- Sign up for classes early: BLS, PALS, ACLS - they fill up fast!
- GRE for Dummies - I recommend it (as I am currently reading it) if you plan on advancing in the field of nursing

Side note:
These ACUs aren't very good for infection control... more thoughts next entry.

Clinical Rotations

2009-02-25T21:28:00.004-05:00

I'm finally getting a chance to touch patients! I started last week with my rotations around WAMC. For several weeks I'll have the opportunity to shadow different nurses in different units in the hospital. Here's my list:

Medical ward
Surgical ward
Mother/Baby unit
Psych
PACU
OR
Hematology/Oncology clinic
and many more!

It may seem that this sounds like nursing school all over again. That was my first thought. However, being in a new hospital and not using my nursing skills for patient care in about a year made me think twice about the importance of these rotations. This time I'm able to actually do assessments, chart on the computer with MY codes, and stick IVs without a preceptor. It's different now that I have a RN license.

What's really been helping me prepare for working the medical is asking the various units this question: what is the one thing I need to know about the patient that you transfer to my floor? I've been getting different answers from different units. Every patient from these units have special needs that as a medical nurse I need to be attentive too. For instance, the nurses at the hematology/oncology unit told me that taking care of the implanted ports on the patients' chest is the most important thing to remember when taking care of their patients. I was taught how they worked, performed blood draws from that port, and was checked off by a nurse so prove on paper that I am capable of taking care of that port. Mismanagement of the port could lead to infection, injury, and/or harm to the patient.

I have several more weeks of these rotations. End of March I should be hitting the medical floor and running. I hope it goes well!

Happy Birthday 108th b-day Army Nurse Corps!

2009-02-07T19:50:00.004-05:00

Wow! 108 years the Army Nurse Corps has been alive and well! The last week we celebrated the birthday of the ANC at Womack Army Medical Center with many events:

Cake cutting ceremony
Rolling history tours of WAMC
Fun Run/Dog walk
Pizza Party
Ice Cream Social
and an ANC ball!

I wish I could have gotten a shirt, they looked really cool this year. Oh well, there's always next year...

"Embrace the past, engage the present, envision the future"

Back to work: hospital orientation

2009-01-26T22:20:00.002-05:00

Today was the first day going back to work! After being on PTDY for the last 10 days started getting, boring. I got a lot done setting up my place, handling paperwork, and even visited a couple places away from Fayetteville, but I felt glad coming back to work at the hospital even if it was just orientation.

Backtrack: Nursing Residence Get-together
I'm glad I got to meet with my other fellow nurses in the residency program. I also got to meet with the other officers who graduated from OBLC before me and started on their preceptorship. Talking with them put me at ease knowing that they have gone through what I will be doing in the next couple of months. Seeing all my other co-workers let me know that I'm not alone here.

I will be working on the medical floor! Other options were mother/baby (bleh) and surgical. I'm glad I got my pick. Sure, med-surg is a drag, but I'm starting out in my career in nursing. I need to get my skills down starting out before I decide to continue on.

Next on the agenda

Hospital orientation (pt 2)
Nursing orientation (through February)

Tips for success:
When inprocessing, bring EVERYTHING: orders, leave form, but also your health records, certificates, and diplomas. One way to organize your copies of EVERYTHING is to get a 3-inch D-ring binder (you'll get more copies of stuff in the future) and put them in categories inside sheet protectors. Make sure you have PLENTY of copies of your orders and leave form. Don't worry about everything else because each station on the inprocessing sheet has a copy machine. In my case, they took my copy and made a copy for themselves giving me back my copy.

Also, get after each station try to get a copy of what you did at each station. Copy your hearing exam results, your immunizations, PT card, etc. The Army tends to lose things so make sure you have a copy as a back up.