eric135

Just so

I tend to get nervous taking care of other nurses. I think that's natural. I usually will tell them at the beginning of the shift that, although I am aware of the fact that they are nurses, I encourage them to "accept the patient role" and to try not to be a nurse while they are sick.

So when I hang the IV, I tell them what it's for. I go over new medications. The whole bit. And I encourage my nurses to do the same when they are assigned a nurse as a patient (the same with physicians as patients).

Sometimes that's enough; often it is not. Then it's the "hey, you are my patient right now, not my colleague" discussion.

The last night I worked, I got a call asking me to start an IV. It was one of our co-workers (not on our floor but works in our hospital). Everyone was giggling when I arrived, because the patient was our IV nurse. He's the one we always call when we just can't get the IV started. He's backed me up on countless occasions.

Two nurses had already tried, and they both suffered a terrible case of "performance anxiety," worsened now that two attempts had ended in failure.

As I was getting ready to Throw the Dart, he was constantly palpating his own veins, and telling me the various techniques he uses on tough sticks (he likes to omit the tourniquet, and he likes to advance the needle within the IV catheter rather than getting a flash and advancing the catheter off the needle). I calmly told him he needed to just lie there and let me Throw the Damn Dart and get the IV (and I pretty much always use the tourniquet, and I will end up going through the vein if I try to advance with the needle).

And I smacked his hand as he reached into my IV tray to help set up.

And yes, I thought I'd have to shave part of his arm.

And yes, I would flush with lots of saline.

And yes, I'd go for an 18 guage instead of my usual 20.

After it was done, my Dart hitting the mark, as I taped his dressing, he thanked me for a fairly painless stab..

... and when he thought my back was turned, repositioned the tape on the dressing... just so...

I admit that it's hard to accept the patient role when you're in the business. A few years ago, when I was admitted to have my gall bladder removed, it took 9 attempts to start my IV. Lab draws often took two attempts, and I was getting drawn a couple of times a day. It was hard to just lie there. Surprisingly, I found out a few nurses were too nervous to take me as an assignment (one later admitted she was mortified at the thought of having to give me a shot in my butt).

And I gotta admit -- I lifted the tape on my dressing too... so it would lay... just so...

how wonderful it would be

I was a big fan of Ally McBeal. One of the improbable ideas was that the legal firm would have its own bar in the basement, where lawyers, legal assistants, secretaries, etc. could sing and dance.

How great would that be if, between cleaning up piles of poop and slipping nitroglycerine tablets under people's tongues, we could go down for a 10-minute disco break?

We even have a place. Our cafeteria recently went though an expansion and upgrade, and now sports a shiney parquet (sp?) floor, just asking to be danced on. We're just missing the disco ball (oh, and the sound system).

Hell, why couldn't the patients join in? (Well, unless they were the ones whose tongues we were shoving those nitro pills under, due to chest pain.) Instead of an Ambulatory Tech, we could put a Dance Tech down there, equiped with a pulse oximeter, a few tanks of oxygen, and a walker (in case someone overdid it a bit).

Think of the physicians' orders:

Dance TID as tolerated.
Village People QID and PRN keeping sats >90% on room air
Dancing Queen at least twice daily, with walker

I've actually used dance therapy before, as a nursing student. Another student and I decided to let the patients on our psych ward, most of whom were elderly suffering more from dementia, dance to disco music. I guess it's possible, but it's really hard to dance angry, or sad. Almost always, it led to laughter, giggles, and bright happy faces, at least for a few minutes.

And those old folks... my god how they just loved ABBA's Dancing Queen... and when we taught them how to do the YMCA dance, it was pure Happy Bedlam... though most of them were doing "HHHH" or "YYYY" due to physical/cognitive limitations.

Not quite Six Sigma, admittedly.

Die a little death

I found this very useful article on Excel shortcuts. It's from BNET.com. I know it requires a registration, but I find the numerous articles and "white papers" applicable in my professional life as a charge nurse. I'm a heavy Excel user, but some of the tricks are really cool.

I sent a link to this pdf article (admittedly a bit dated) about how hospitals will have to react to all of the various economic issues. I sent it to someone that I had always assumed to be pretty good with technology. I got an email reply about how she couldn't read it because the print was so small. She had no idea how to use the "magnifying" function in Adobe Acrobat. I was taken aback, not in ridicule of this person, but by how much I assume is "going on in the background" when I try to have discussions within a virtual environment.

For instance, as an Excel user, I often will send co-workers Excel workbooks where I compare this and that. Lots of functions, column- or row-ordered calculations, lookup fields, yada yada yada. And I find myself just blabbering on and on about the data, and just making a complete fool of myself -- while my cohorts secretly email each other because they didn't know that the workbook was composed of multiple sheets, and that one had to click on the index tabs to view everything, and basically couldn't understand a word I was typing. Doh!

Or how about the universal concepts of working in Windows? How many times will I have to beam out a step-by-step description of how File>PageSetup>Print works? Or how to print a web document? Or how to use a drop-down menu? Or what a radio button is? F11? Cut and Paste?

CAPS LOCK!!??!!

If you're a techie like I am (and, I feel pretty certain most of you are more techie than I am), to get a feel for it, close your eyes for a minute.

Now don't peek.

Tell me how many shoelace eyelets are on the shoes you are wearing (and don't be a smarty pants and say you only wear loafers).

That's what I go through a lot. I'm just flippin' along, talking about how to tie this kind of knot, that kind of knot, fancy bows, ribbons... and folks are hung up on the eyelets.

... and if you're in IT, you must just die a little death every single day of your lives!

hopefully...

I haven't written anything in more than a week. It's been a stressful week at work, and not at all due to clinical situations.

I had to hand out six verbal and written warnings for attendance. It takes a lot out of me, telling one of my staff I "need to talk to you for a minute in the office." They know it's never for happy news (I try to break happy news in as public a way as possible). It's a challenge to strike a balance between setting firm expectations, but at the same time trying to be as human and understanding as possible.

There's no getting around the fact that my relationship with the physicians is not a positive one. I don't make any apologies about the fact that I like supporting nurses. I get pulled aside by physicians upset about this or that, and I am just amazed at how many times I have to tell them that what they explained to me was simply not the whole picture. This generates lengthy email to my clinical director, which gets a meeting between her and the physician, and I've surprised a lot of physicians at how far I will dig to get at the real issue (which is almost always some version of "the nurse bothered me while I was at home sleeping").

Which hasn't really helped improve my popularity with the medical staff (except the few that really want to get called, because they know we are calling to keep everyone out of trouble). I think the expectation is that they would take me aside, tell me the story, and I'd immediately go out and lash the nurse, which simply doesn't happen that often. Yes, every once in a while, I will have a nurse make a bad decision, and will call at 2am for a couple of tylenol for a headache, or a stool softener. But the vast majority of calls are for problems that have to be handled by a physician. Not by a nurse trying to practice medicine without a license.

So now, I find myself in the odd position of writing emails to THANK physicians for being helpful. To thank them (via my clinical director) for receiving calls and handling clinical situations in the middle of the night. How weird is that?

I guess the good news is that I get to write these "good" emails about as often as I write the "bad" ones. I'm also thankful that the vast majority of physicians still enjoy what they do, and do it well.

I have a feeling one of my nurses is diverting narcotics. I'm going to talk to her about it tomorrow. Fun.

In a couple of days, my director and I will probably have to terminate one of our employees.

I had to deny two requests for summer vacations (because we can only have a couple of folks on vacation at a time).

I have way totally sucked at starting IVs the past three nights.

Hopefully, things will get better.

Freemind

I've been up all night playing with Freemind, a mind-mapping program that was pointed my way by Maria of intueri.org. I Just Love It. I have used a mind mapping program before (I'll link to it if I can remember the name) but this program works on my screen much more neatly.

What I really like about mind mapping software is the idea of "unfolding," where you have branches that you can reveal/hide to keep your audience with you. Nothing can be more mind-numbing than having a 10-screen mind-map explode in your face the first five minutes of a presentation. In an ideal world, I'd run a meeting/class with it, unfolding my planned topics, adding new topics, adding contributions and notes from the group, including online resources. Then I'd keep it on the network for folks to download, and maybe help author additional links and resources. It would be great for keeping virtual notes on staff meetings, with an emphasis on project management (resources, updates from key players, input from front-line grunts, etc.) Staff could log in on any network computer, and get a visually intuitive snapshot of what is going on.

Here's a link to a map built on Freemind that goes over Freemind's features. In just a few seconds, you can get a really good overview of what it's all about, with links that you can explore. Really elegant. Not to mention free.

Thanks, Maria!

An octave lower

Almost a year ago, our dishwasher, in mid-cycle, started making this lound metalic grinding/clicking sound. I figured a utensil had dropped down to some grinder (do they have grinders in dishwashers? I always assumed so) and thought to myself, "Ok, I'm going to have to get that fixed."

It's a year later and I finally called to get it fixed (we've been washing dishes by hand and using the dishwasher as a drying stand). I hate having anyone in the apartment just in general, and having "strangers" over from the complex always put me into a fit of anxiety.

When I called, the very nice lady in the office takes my information and the day and time I would like someone to come over (the idea of having someone come in when we are out is just completely out of the question).

She suddenly says, "Hey, are you the guy that has that ADORABLE miniature Schnauzer?"

I tell her, "No, we have kitties, we don't have a dog..."

"Oh... you just SOUND just like him... he has... a distinctive voice... too... just like yours"

Instinctively deepening my voice, I continue to set the appointment for the guy to come in to fix the dishwasher.

It's just weird.

(an octave lower)... really weird...

PCCN conference

I found a great way to wrap iPod headphone wires so they don't get all tangled up.

I've been searching for a nursing conference to attend. I haven't really done much ongoing education since I got my license in 2000, and I really do need to do it. There is just so much going on in nursing, especially with telemetry and critical care, that your skills really can get old without those conferences and seminars.

I know it goes against what is the usual deal, but I prefer my learning experiences a bit on the dry side. I don't like working in groups, and having to make up a powerpoint presentation as part of the learning experience. And so many nurse educators are entirely too much into class participation. I know that most people do better in an interactive style, and maybe I do as well, but I prefer to get the material through an excellent lecturer. I just hate the whole "split yourselves into groups, come up with a list of stuff, pick a leader to write your stuff up on the board, discuss" style of teaching.

And I hate powerpoint. I'd much rather see an excellent teacher work an old fashioned chalk board, or dry erase board with colored markers. I think that process is an entirely more "organic" one. I remember as a teacher using colored chalk while working chemistry and mathematics problems on the board. Some kids really clued in to what colors you selected, and that might be the only thing that keeps their attention long enough for the learning to happen. Students also do better working problems with the ideas "blossoming" out from the center, with arrows and lines, rather than "top-down" in the typical powerpoint bulletted enumeration.

There's a conference coming up in May. It's in Annaheim, California, and a good part of the draw will the the nearby Disneyland parks. It's geared toward nurses preparing for the Progressive Cardiac Care Nursing certification, which might be something I am interested in.

I'd like to suggest these "concurrent sessions":

• When Patients Attack
• Fists Full of Stool
• Dealing with the Sleep-Deprived Physician
• Differential Diagnosis using the Sense of Smell
• Fifty Ways to Tie a Square Knot (in under 5 seconds)
• The Nursing Shift Report: The Pros and Cons of Interpretive Dance
• What To Do when your Staff Suffers from ICU Psychosis
• Fun Tricks and Pranks for the Hallucinating Psychiatric Patient

Just kidding.

The Fog

I occasionally sleepwalk. It doesn't happen very often, and almost always it happens after I have foolishly watched any kind of zombie horror flick. I've had conversations with roomie that I don't remember. I've moved items from the refrigerator to the cupboard. I've sent weird email. I've had phone sex that I don't remember.

The other day, apparently, I called work and offered to come in on my day off.

I'm at the gym. I have decided to work out at 5pm, rather than my usual time period between 5a-8a. The place is packed. To my left is Ed Asner. To my right is Rory from The Gilmore Girls.

I am enjoying my new iPod, listening to Tracy Ulman's They Don't Know About Us, Pat Benatar's Shadows of the Night, Bach's Organ Cantata No. 29, Germaine Jackson and Whitney Houston's If You Say My Eyes are Beautiful, and a dance version of the Bach-Gounod Ave Maria (the diva is singing in latin -- I am not kidding.)

My charge nurse shift change occurs at 545pm. At 610pm, my phone (which was in my pocket instead of locked up in my locker) rings. It is Vivaldi's Spring, and so I know it's the hospital. I ignore the ring, thinking they are just calling to ask me to come to work extra. About a minute later, it rings again, followed by the melodic tones indicating a voicemail message. Another minute. Another round of Spring. A beep indicating a numeric page. Another ring. Another voicemail. Another ring.

I step off the eliptical and call the staffing office, wondering if something terrible has happened.

"Eric... do you know what time it is? Are you All Right?," the supervisor, Mary, says.

"Of course I'm all right. Is something wrong, you've called four times," I say.

"... Eric... you are supposed to be at work..."

"... ... Mary, I've been on vacation and I don't come back until tomorrow night!"

"... ... ... honey... you called me this morning at 8am? Don't you remember? You wanted me to put you down to work..."

"... No way, it must be another Eric... could you have talked to someone else?"

"... Eric you have a... ummm.. distinctive voice... honey I know it was you..."

"... Oh hell, I totally don't remember talking to you (and, silently,  what do you mean, 'distinctive voice?!?; "

"... honey... sweetie... remember, you said you wanted to get in some extra time? you talked about making up the time from the flu because you were sick?"

"... But I haven't been sick, I've been on vacation... "

Anyway, I decided to come on in. I nodded good bye to Ed and Rory, grabbed my stuff, rushed home, showered, put on some scrubs, and came to work, 90 minutes late.

The night before, we had watched the new version of The Fog.

Music

I've been spending the past week going through all of my music CDs and converting them to digital files to play on my iPod.

I know, I'm a tad late to the party. I hadn't even given iPods a second thought (except for the few weeks I owned Apple stock many months ago), but for three recent factors. I borrowed my room mate's iPod for my recent vacation, and really fell in love with the "form factor". Our recent purchase of a laptop and then hooking it up to the cable modem makes for fast downloading. Lastly, I got one as a gift (and so could no longer bemoan the 200-bucks pricetag).

I've been a ripping whore ever since.

Things I didn't know an iPod could do that I have since fallen in love with:

• I thought the only music it could play were downloaded mp3's. I didn't realize how easy it was to convert old CDs into files that can be played on the iPod (a process that is easy and legal).
• I didn't know you could play music stored on an iPod on another computer. it's been nice downloading and ripping files on the laptop, uploading to the iPod, walking over to my office computer, hooking up the iPod, and playing music there as well. When I click on music I've purchased on the iTunes website, I enter my ID/password and can play that file on up to 5 computers.
• Arranging music into playlists is easy, and updating my iPod with new songs added to playlists happens automatically.
• Arranging songs according to "genre" is easy, and the iPod can play songs according to genre, and you can use as many genres as you want.
• There are third-party vendors for pretty neat gadgets, including charging adapters for regular outlets, cassette adapters for car stereos, and also a little gizmo that will transmit to your car's FM receiver so you can play wirelessly.
• There's a BPM (beats per minute) field. Unfortunately, it isn't populated automatically during download or ripping, you have to enter it manually. But it's good for setting up playlists for workouts on the eliptical. I found this online BPM calculator that calculates the BPM as you tap a key on your keyboard. There are programs that do this automatically from the digital file, but some songs I can use at "double time" so while a 70 BPM is too slow, I can manually enter 140 (my preferred strides/minute). After entering the BPM, I can order my library by this fiend and drag/drop workout songs into a "workout" playlist.
• I really like the Smart Playlist feature. This function (on the PC interface) makes playlists using music in your library based on the values of certain fields. So you can make a play list of all "dance" music, or all "classical" music. Or all music with BPM of 130-150. Or All music with BPM of 130-150 that are not classical and from the 80's. It can also select according to how often (or infrequent) the song has been played. And this list can be updated with each download/rip. Once the playlist is generated, it can be uploaded to the iPod. It's a pretty entertaining tool.

Interesting, this article from Yahoo! news, discussing the woes of the music industry. I now know that downloading music files is becoming more and more mainstream, now that I am doing it (and have been a late adopter of the technology). The article says folks think the price of a CD is too high, considering you usually only like one or two tracks.  I like one guy's idea that, for every CD puchase, you get a few free downloads.

I also somewhat agree that the music being produced is "bad." A lot of music doesn't sound all that melodic to me -- basically anger, hatred, bigotry, homophobia and exploitation of women set to a drum beat. The last truly beautiful song that I can remember is Christina Aguilera's Beautiful, with a video as positive and affirming as the song.

So it doesn't surprise me that most of my music is pretty old. And that the last CD I bought was a Christmas album in 2004.

Ok, back to ripping...