Career Update: Part 1

So I started out in Cardiac Telemetry as a new grad. I knew right out of school that I wanted to have  Telemetry as a foundation for my practice. If you are starting out as a new grad in the US, Tele is a great start. From Tele it is much easier to navigate into specialty areas than moving from Med-Surg. After about 18 months I was fatigued with my job. I worked on the biggest unit in the hospital which was split into regular Tele, Med-Tele, VIP unit, and observation unit; as well as being floated to MICU, CVSD, Maternity, Med-surg and the new sister hospital which had opened a good 20 min drive from the main campus. I had started working on days as a new grad as I thrive under pressure. I learned so much in the first 6 months and definitely found my groove, understanding my patients, documentation and the docs. I found that I really enjoyed working the observation unit as it was high turn over, fast paced, and a bit of a mystery of what the ER was bringing up. One time I had a pt come up dx: Chest Pain. I gave her morphine, did an EKG, put her on O2, call the doc – she was immediately sent to the cath lab. This pt should have been a cardiac alert, turned out that she had 100% occlusion in the Circumflex – she was dying. I loved that I was on the cusp of something, it was fast, it was more challenging than the other units and I liked it. After about 14 months on days, I switched to night shift. Our night shift staff was thin, a lot had left and they were struggling, and to be honest, I needed the pay increase. So I did nights for the last 5 months of my job and started looking for other opportunities.

I landed a job at another hospital, again it was a non-profit hospital, but in an affluent area. I was working in CV-Step Down, sister floor to CVICU post-CABG/TAVR pts mainly. I was thrilled that I was moving deeper into the cardiac specialty, this is what I wanted. After 3 months in my new job I wasn’t happy. I was working nights, the staff were burned out and it showed. I found that the acuity of my patients weren’t all that different from my prior job. Post-open heart really only meant, possible Afib – start Cardizem or Amiodarone drip, chest tubes – usually 2-4, Dermabond midline chest incision and leg donor site, and lastly a foley. There was nothing really interesting about it. The fun happened in the OR, ICU and then during the day when the chest tubes were pulled, I missed out on all of that and just ended up changing the chest tube dressing and drawing blood from the central line.

I started to feel depressed; I started dreading going to work. I wondered if I was looking for something better that didn’t exist. I thought nursing was this great expanse of possibilities, but here I was feeling crappy after changing jobs from a crappy position to another one. I considered if I just wasn’t made for nursing. I’ll be honest, I never planned on being a nurse, I didn’t grow up dressing up as a nurse and putting a stethoscope to my teddy bear – that wasn’t me. Life brought me to nursing, and my ability to take on a challenge, think critically, enjoy interacting with people, had made this a good choice for me, but now I was here in this place where I was unhappy and couldn’t quite figure out how to fix it. So I did what I thought I should do and start looking for another job. Now I was looking for a higher level: ER, ICU, ICU specialities.

Ironically I reapplied for some of the jobs I had applied for when leaving my first job. I really just felt like I had nothing to lose. I did get a call back for an ER job at a Level II Trauma hospital right on the highway. It is one hospital within a large hospital system, which means there are a lot of jobs available without actually quitting and having to learn a whole new system over again. So, I booked the interview and figured I’d wing it, at the end of the day, I still had a job, even if I didn’t get a new one, the bills would still get paid haha!

Stay Tuned for what happens next…!

 

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Too many hours, too little sleep from @ScrubsMagazine #nightshiftproblems

You can read the article >here<

From the Spring 2014 issue of Scrubs

There’s a lot of talk these days about how detrimental it is for hospital patients to have their sleep interrupted.

Given all we know about the health ramifications of short-changing sleep, it’s a topic that deserves discussion. But there’s another sleep issue with implications for patient welfare that’s not getting nearly enough attention, says sleep expert Ann E. Rogers, PhD, RN, FAAN. That’s nurse fatigue. Rogers, the Edith F. Honeycutt Chair in Nursing at Emory University’s Nell Hodgson Woodruff School of Nursing in Atlanta, says it’s a critically important issue because it affects the health and safety of nurses, their patients and the public.

The long hours (75 percent of nurses work a 12-hour shift), the rotating shifts, the propensity to work through breaks and the stress of the job create the perfect storm for sleep deficiency in nurses, says Rogers.

“Our studies show that nurses devote half their free hours sleeping. In other words, if you have 12 hours free between shifts, you sleep about six hours.” But who has 12 hours free between shifts? On average, nurses put in an extra 50 minutes after their shift officially ends, so the hours on duty are much closer to 13. Tack on the commute time (on average, about 25 minutes each way), do the math and you’ll find there’s not a lot of time left over for shut-eye. In fact, using Rogers’ formula, that leaves about 10½ hours of free time after a 12-hour shift, and that means well under six hours of sleep. Not enough when seven to nine is the recommended amount. On top of that, “Sleep loss is cumulative,” explains Rogers. “So nurses who work 12-hour shifts on consecutive days and are sleep deprived become more and more affected cognitively.”

On the face of it, the sensible solution would seem to be a return to the eight-hour shift, but as Rogers explains, that’s not likely to happen.

“Nurses like the 12-hour shift, and while they don’t like mandatory overtime, they don’t want any restrictions on their ability to work overtime.” One study showed that 80 percent of nurses are happy with current scheduling policies. Results from the same study, however, showed that levels of job dissatisfaction and burnout increase with an increase in the shift hours.

While the evidence clearly points out that the extended hours nurses work pose a threat to patient safety and to their own health, there are ways to mitigate some of those effects.

Most importantly, says Rogers, recognize your own limitations, make sleep a priority and don’t accept an extra shift when you should be catching up on sleep.

Cardiac Conduction System and Understanding ECG, Animation

Nursing Hiring Guide: Resources to Help You During Your Job Hunt | Monster.com

Nursing Hiring Guide: Resources to Help You During Your Job Hunt | Monster.com.

Searching for a job in nursing or looking to make a career change? We’ve pulled together all the articles on Monster Healthcare to help you write your resume, nail the interview, and thrive in nursing. And don’t forget to check out openings on Monster to find nursing jobs in your area.

Knock It Out of the Park: How to Win the Nursing Resume Game

If you’re ready to resume working on your nursing resume, you know it has to shine just the way you will in your new job. Go forward with these expert tips you need to get the job you need. It might even be bigger and better than you expected.

Read the entire article here.

Agency Nursing vs Direct Hospital Nursing – The Pros and Cons

Have you interacted with agency nurses on your unit at work? Are you a new nurse who plans to do travel nursing in the future? Are you a seasoned nurse who needs a new challenge? Are you a home bird who is climbing the ladder within your own healthcare facility? – These are all scenarios where looking at agency nursing and hospital nursing can help you get where you want to go!

Agency Nursing: What is it?
This is similar to being in a “float pool”, you sign up with the agency who then finds suitable jobs for you in your local area or for travel. These are usually short to long term contracts anywhere between 12-24 weeks long. They offer great benefits, often stipends for relocating, travel, living expenses etc. Also they have health and dental coverage, as well as 401k in most instances. It all sounds too good to be true, well yes. They usually require a minimum of 2 years experience in your specialty area, although they have been known in certain circumstances to take RNs after 1 year. Whats the other downside, well as with all things being new is a challenge, the fundamentals don’t change but the environment, people and protocols do. If you are a quick learner this is for you. Other cons to agency nursing is that, as I have seen at my hospital, agency nurses aren’t always treated that well. I have seen agency nurses floated to different areas each shift, having to constantly adjust. One nurse on my unit I hadn’t seen before, I asked if she was new, she told me she was an agency nurse hired for my unit 3 months ago, but this was the first time she’d actually been assigned to my unit! I was shocked, she didn’t seem to happy with the arrangement either, as my hospital opened a sister hospital 2 years ago, and everyone gets quite disgruntled with the call a hour before work to have to float there. Though this isn’t necessarily typical, it is something to keep in mind, staffing know you are not “one of them” so don’t expect the usual employee treatment 100% of the time.

Direct Hospital Nursing: To contract or not to contract?
To some degree it is always better to skip the contract, but for new grads you really just have to take whatever comes your way (beggars can’t be choosers!). When to contract? Well as a new grad with no other options – yes, if it is for a job that includes a lot of training, such as going up a level of care – from tele to ICU for instance, this may be an option, particularly if you won’t be moving anywhere for approx. 2 years, then why the hell not? Its worth taking the contract to get the training, experience, and then you can move on after to some major $$$. When not to take a contract? When it doesn’t include everything you want. If it isn’t perfect for your needs don’t do it. You’ll only regret it, the regret will make you unhappy, and eventually that will show up with you at work… (don’t be THAT nurse!) Bottom line is you’re going to be stuck for 1-2 yrs, if you’re not 110% sure, then don’t tie yourself down.

No Posts? No Worries? Gimme your thoughts!

So I’ve been MIA for a hot minute, not for any particular reasons except life is all consuming. I’m still working in the same field, unit etc. I’ve now worked days and nights and know the pros and cons of both. Nursing school is far back in my rear view mirror (where I’d like to keep it). I’m currently on the job hunt, looking to advance in more acute care, but remaining in cardiac, ‘cus thats the stuff I like. I’ve considered posting more regularly since its a new year etc. While I’ve been gone the blog has continued to have traffic which I find pretty amazing. I see potential but I’m not sure what direction to take it, more educational stuff? More on-the-job reflections? Memes/funny stories? I’d like some feedback so please check out my poll, depending on response I’ll pick this beast up again (if there are multiple options you like, you can vote more than once!) Many thanks for reading and happy new year! JaeJxRN

Top 10 highest paying nursing specialties – Repost

Top 10 highest paying nursing specialties (via http://scrubsmag.com/)

After you finish nursing school, or if you’re considering going back for more training, choosing the right nursing specialty becomes your chief focus. With so many specialties to choose from, many prospective nurses find it difficult to just pick…

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A New Way To Vent? Twitter Anons…

Everyone who’s anyone know about the new technological issues we are facing with workplace professionalism and social media. The debate over what employers should be able to judge you on when you are “off the clock”, and what is your personal and private life is a hot topic. So is there are growing movement to counter this on twitter? I think so! Many people see social media as a way to communicate their thoughts or feelings with others who they may or may not know. They find commonalities in agreements and disagreements, but somehow, this new outlet of self expression is now being censored because people are afraid of what their employers may see, think or act upon. So in stifling this self expression has caused an emergence of those who call themselves “anons”. They are individuals in the medical and healthcare field who create accounts under a medical theme and feel free to talk about anything they want without threat of their words biting them in the ass later.

There is now a whole community of Anons on twitter: Doctors, RNs, Nursing Students. Much of what is posted is nursing advice, sarcastic jokes, banter, vague but hilarious stories. I follow several Anons and enjoying catching up on my tweets every morning in place of a newspaper – trust me the tweets are much more amusing.

So is this a good thing, or a bad thing? I am pro-anons. I feel that this is a great outlet of self-expression and a perfect answer to the employment bombardment on our private lives. Yes using social media is allowing your private life to be shared, but I don’t believe that your personal life has anything to do with your professional performance. Looking back into history we have had many great leaders who were struggled with demons in their personal lives, and yet, they got the job done.

Are you thinking about becoming an Anon, or following some? Search for names like Nursing Anon, Premed Student or Nightshift MD – there are so many. Follow one and see the similar options provided by Twitter, that is a helpful way to network the anon community. If you are becoming an Anon, think about you name, that is what people will be basing their decision to follow you off of.

So join the community, reclaim your self-expression and live without fear! Social media is a powerful and wonderful thing, lets share the knowledge and love around in the healthcare community!

Nursing Skills: NG Tubes!

NG tubes. Yes, they’re pretty gross. Anything going in or coming out of the nose is gross, have you seen the stuff that comes out when an NGT is put to suction? I’m talking rainbow secretions! All joking aside, if you think they are gross, just imagine how the patient feels. I put a NG tube in the other day and was struggling to get it around the sinuses, it isn’t a straight route y’know.

So advice for NG insertion:

• Explain EVERYTHING to the patient! Tell them it will be uncomfortable. Tell them you will be there for them. Tell them that it is crucial to swallow. Tell them you are going to try to do the procedure as quick as possible. REASSURANCE is key!
• Pre-medicate if necessary. This is controversial. My patient the other day got morphine sulfate IV before the procedure, this totally helped in chilling out her gag-reflex and made the process easier BUT, if your patient is prone to becoming sedated or unable to follow commands then lay off the meds – use your judgement.
• Measure correctly. Remember that it is nose to ear to xyphoid process – mark it with tape.
• Lube, lube and more lube! We need that tube to slide and it has a long way to go, so be liberal with that lube!
• Encourage your patient to sip water. The swallowing effect with assist you in moving the tube down the esophagus.
• Don’t give up in getting it down! There may be issues along the way so troubleshoot fast. If you cannot get it pass the sinuses, twist and manipulate the directing you are inserting the tube. Have the patient open their mouth to check for coiling in the back of the throat.
• Lastly, always check your placement. Use the piston to blow an air bubble in, listen at the xyphoid process with your stethoscope for the air bubble. Placement is also checked with a follow up CXR.

There are many reasons why an NG tube may be placed. There are reasons to suction, give meds, remove acid, or feeding – regardless they are not comfortable for the patient and careful consideration should be made for skin breakdown in the nares or insertion site.

EKG: Hypokalemia vs Hyperkalemia

So you should already know that potassium (K+) is VERY important in our bodies. From the action of K+ in the depolarization and repolarization which takes place in the heart, you can imagine that if there is too little, or too much potassium, then the effects will be present in the heart muscle.

HYPOkalemia

Hypo –  meaning; less, not enough, below normal levels. Therefore, here we are talking about not enough potassium. Below is an EKG, and from my last posting where you became familiar with a normal EKG, you should be able to notice there are things about this EKG that are abnormal (If you noticed that, then well done!)

You can see that the U wave is really big, or in medical terms; prominent U waves are present. The T wave on the other hand is said to be “inverted” or the opposite direction that it should be, it can be flattened also. So just looking at this portion we can see that the REpolarization phase is definitely going to be affected by these changes.

I like to think of hypokalemia as making everything more depressed. A depressed person, moves slower, things take longer for them to do, they are disorganized and one thing runs into another.

Other things that can be seen in Hypokalemia in the EKG: the ST segment can be depressed (below the flat baseline), the PR interval can be prolonged (longer that should be) as well as the QT interval (due to the merging of T and U waves) and the P wave can get taller and longer.

Hypokalemia is serious because it can develop into life threatening arrhythmia such as Torsades de Pointe, Ventricular Tachycardia, Ventricular Fibrillation.

HYPERkalemia

This is the opposite, HYPER: too much, more than baseline, overload. Too much is just as dangerous and not enough, and as you can see from the strip below, the EKG will show you signs of high K+.

P waves here in this strip is missing; you might see small to no P waves, coupled with spiked T waves. Look at the T waves here, they are as tall as the QRS complex! In severe hyperkalemia, the QRS complex can widen also.

So as with hypokalemia, I like to think use little story concepts to remember the differences. So I like to think of hyperkalemia as an ADHD child: the T waves are hyper and the P waves are playing hide-&-go-seek. Repolarization period here is affected by surplus potassium by causing a faster repolarization period, and reducing the response of sodium channels in the myocardium; therefore slowing conduction around the heart and reducing the P wave in the strip.

So how can we tell when someone is hyperkalemic? Think: Blood test (straight forward, check K+ level), ABG (metabolic acidosis), hx renal disease (reduces elimination of K+), Addison’s disease, severe burns (mass K+ being released for cells/cell-lysis?), Digoxin toxicity.

What to know about potassium:

Potassium is mostly found inside the cells.

The normal range for potassium is 3.5-5.0 mEq/L