NotReady4PrimeTime's Nursing Blog

NotReady4PrimeTime's Nursing Blog

NotReady4PrimeTime, RN (36,730 Views) Senior Moderator

Joined Jun 26, '01. Posts: 9,473 (35% Liked) Likes: 7,346

Stop the (Deskilling) Merry-Go-Round, I Want to Get OFF!

Alternative title (courtesy of Brian Booth): How much is that cheap thing you bought going to cost you in the long run? Once upon a time, the Powers-That-Be, residing in the ivory towers of academe, decided that nurses should be considered professional providers of health care. The main flaw in the situation at the time was the definition of professional, which implied university preparation with perhaps some advanced education on top... and too many of the "professionals" in the nursing... Read More →

Short Circuit: Supraventricular Tachycardia for the Novice PICU Nurse

Let's pretend you're working on a pediatric inpatient unit and one of your patients was admitted for the ubiquitous and poorly-defined failure-to-thrive syndrome. This little kiddo is 5 months old and weighs 4 kg, so obviously not a robust and chubby individual. Physical exam of Julie, as we'll call our hypothetical patient, is essentially normal except for her small stature. She seems to have a good appetite but rarely finishes a bottle. While feeding she sometimes becomes pale and tachypneic,... Read More →

Haywire! Some Uncommon Causes of Status Epilepticus in Children

PICU nurses are no strangers to the seizing child. There are many causes of seizure disorder in the pediatric population and some are much more common than others. The usual suspects are the infamous and usually not serious febrile seizure, CNS injuries related to prematurity or birth trauma, hydrocephalus and head injury. The manifestations range from staring to lip-smacking, single limb twitches to full-body twitching and jerking. They can be subtle and easily-overlooked at times and... Read More →

Measles, Mumps, Rubella... Forgotten but NOT Gone

To immunize or not to immunize... that is the question. When I was growing up, there really wasn't any controversy - when we were in certain grades, we were all lined up at school and the public health nurse either gave us a shot in the arm or a little pink drop of sugary liquid on a plastic spoon. I have a nice, circular scar on each of my upper arms just below my shoulders that signify my immunization against smallpox, the only disease to have been declared eradicated from the Earth. When my... Read More →

Grow Brave Through Reflection: Moral Distress in PICU (Part IV)

Each of us brings our own particular personalities, opinions and experiences to the workplace and we all deal with issues in our own ways. Coping mechanisms are as individual as fingerprints. Some nurses have left their units and others have left the profession in an effort to escape the unrelieved stress of facing moral conflict on a day-to-day basis. There is, however, hope for those who don't want to take this path to rise above their own responses. Let's take a look at some suggestions for... Read More →

Grow Brave Part III: A Case Study

The scene: a tertiary care combined adult/pediatric hospital in a large city on the first Sunday night of spring break. The PICU is full although there is one patient who could have gone to the ward but didn't due to staffing problems there. The staffing in PICU isn't any better, in fact, it's tight; the only unassigned nurse is the charge, who is covering breaks and keeping the unit afloat. The hospital is a referral center for a large geographical area and has patients from several smaller... Read More →

Grow Brave Through Reflection: Moral Distress in PICU (Part II)

We all know nurses who exhibit signs of burnout. Everyone will have different reasons for their behaviour, and moral distress is often on the list. What does burnout look like? It has many faces, and no two individuals will have the same signs and symptoms. Often the most obvious is apathy, the loss of that attitude of caring about what goes on around them. They take shortcuts in providing care; they omit some of the basic nursing care activities we take for granted: mouth care, skin care,... Read More →

Grow Brave Through Reflection: Moral Distress in PICU (Part I)

There has been a lot written in recent years about moral distress in health care. With the rapid pace of technological change it has become commonplace for patients to survive injuries and illnesses that less than a decade ago would have ended their lives. With this comes an upswing in moral distress experienced by caregivers across the spectrum. Moral distress by definition arises from the inability to act in ways that we believe to be ethical or honorable. But what sets pediatric critical... Read More →

The Art of the Snappy Comeback or How to Render a Teenager Speechless

I knew even before I walked onto the unit that it was going to one of those nights. The looks on my coworkers' faces when they saw my assignment told me more than I wanted to know. Why me? I wondered, but I already knew why. As the mother of three adults including a daughter who wrote the book on acting out, I have a no-nonsense, take-no-prisoners reputation. That's how I came to meet Desiree. (All names changed to protect the guilty!) Desiree was 16 years old and had been admitted to our... Read More →

The Human Spirit

There have been many patients over the years who have taught me something, about nursing, about critical care, about myself, about the human spirit. Each one has touched me in some way and I will never forget them; hopefully I won't forget the lessons they've taught me either. One little boy gave me insights into all four. "Lincoln" came into my life as a toddler. Not quite two years old, he had taken a header down a short flight of carpeted stairs, picked himself and dusted himself off... Read More →

I could NEVER do PICU!!

I've lost count of the times I've heard that exclamation from another nurse. I've also forgotten how many times I've heard, "I just don't know how you do it," not only from other nurses but from friends, casual acquaintances and family. But I don't know how I could do anything else. My first exposure to the nursing specialty that has become my passion began with the PICU admission of my youngest child following a liver transplant. I'd kicked the idea of going to nursing school around in my... Read More →

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